W ith th e pre val e nce of H e patitis B and C infe ctions in Pak is tan be ing w h at it is , ch ronic l ive r dis e as e (CLD) is an incre as ing burde n on th e h e al th s ys te m s in Pak is tan. Th e de gre e of l ive r fibros is is an im portant de te rm inant of l ong-te rm m orbidity and m ortal ity from th e dis e as e . Traditional l y th is w as done h is to-path ol ogical l y w ith a core l ive r biops y. Th e incide nce of com pl ication fol l ow ing l ive r biops y is l ow but s

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... ignificant. Th is incide nce ris e s w ith th e pre s e nce of CLD w ith th e cons e q ue nt al te ration in l ive r arch ite cture , de range m e nt of coagul ation param e te rs and paucity of pl ate l e ts and th e ir dys function. Th e re h as th e re fore be e n and incre as ing e m ph as is of th e us e on non-invas ive te ch niq ue s f or th e de te ction and e s tim at ion of fibros is . Th e firs t w ide l y us e d de vice e m pl oye d trans ie nt e l as trograph y to do th is . M ore re ce ntl y Sh e arW ave e l as trograph y s ys te m s h ave be e n introduce d. Al l of th e s e are proprie tary te ch nol ogie s and th e re fore h uge l y e xpe ns ive . Davoudi e t al re m ind us th at th e h um bl e ordinary ul tras ound m ach ine f ound in m os t (if not al l ) Radiol ogy de partm e nt s can al s o do th is w it h a f air de gre e of accuracy. Pos tgraduate training in Radiol ogy in Pak is tan is gradual l y m oving from an appre nt ice s h ip m ode l to an e ducat ional m ode l . W h il e th e radiol ogical findings and e xam inte rpre tation is ofte n taugh t both form al l y and inform al l y, th e bas ic s cie nce be h ind th e im age e s pe cial l y patie nt s afe ty, oth e r th an radiation prote ction, is rare l y touch e d upon. Th e re s ide nts are e xpe cte d to im bibe th is inf orm at ion th rough e xpe rie nce . Addit ional l y th e re s ide nts are incre as ingl y turning to w e b bas e d re s ource s for augm e nting th e ir e ducation in al l as pe cts . Sw e ns s on e t al l ook at both th e s e as pe cts of Radiol ogy te ach ing. Th e y find th at (uns urpris ingl y) w h e n patie nt s af e ty is taugh t th e re s ide nt's k now l e dge on th e s ubje ct im prove d. Th e y al s o find th at w e b bas e d ins tructional m odul e s are as good as form al face to face te ach ing for th is purpos e . (Th is w il l of cours e de pe nd on th e q ual ity of th e w e b m odul e ). So re s ide nts tak e h e art and te ach e rs tak e note . If you are s addl e d w ith a te ach e r w h o w on't (or can't) te ach th e re is a w e b m odul e out th e re th at w il l . Th e s im pl e s ol utions are th e m os t e l e gant one s . Pne um ot h orax is not an uncom m on com pl ication of im age guide d ne e dl e biops ie s of th e l ung. M os t of th e tim e it is an inconve nie nce for th e patie nt as it prol ongs h os pital s tay and incre as e s th e cos t of th e proce dure . O ccas ional l y it m ay be l ife th re ate ning re q uiring e m e rge ncy tube th oracos tom y. Li e t al de s cribe th e ir te ch niq ue of s e al ing th e track of th e biops y ne e dl e w ith s im pl e s al ine . Th e y de m ons trate th at th is ine xpe ns ive inte rve ntion s ignificantl y re duce s th e incide nce and th e s e ve rity of th e pne um oth orax. Re ade rs s h oul d note th at it is onl y pos s ibl e to e m pl oy th is w h e n us ing a coaxial s ys te m . Th e avail abl e coaxial s ys te m s are again e xpe ns ive . A l ow cos t al te rnative is to us e a s tandard 16G s pinal ne e dl e as your guiding ne e dl e . M os t 18G core biops y ne e dl e s w il l e as il y trave rs e th is al l ow ing th e coaxial te ch niq ue to be e m pl oye d. Tube rcul os is is e nde m ic in our country. Al th ough th e CT fe ature s of th e l ung dis e as e are w e l l k now n, Koa e t al de s cribe th e ir corre l ation w ith biol ogical l y inf e ctive dis e as e . Th is is an im portant diffe re ntiation from an inf e ction control /publ ic h e al th pe rs pe ctive . Th e ir findings th at ce ntril obul ar nodul e s , "tre e in Bud" and cons ol idation be s t corre l ate w ith a pos itive AFB s m e ar s h oul d re inforce th e practice th at patie nt m anife s ting th e s e appe arance s s h oul d be is ol ate d from oth e r s us ce ptibl e individual s . Las tl y a re vie w articl e th at I am h igh l igh ting for e ve rybody re ading pos t tre atm e nt cas e s of gl iom a. Quite ofte n patie nts are l abe l l e d as progre s s ive dis e as e w h e n th e y actual l y h ave ps e udoprogre s s ion. Th e re vie w by Abdul l a e t al not onl y l ook s at al l th e m odal itie s avail abl e to inve s tigate th e s e patie nts and al s o th e ir re l ative val ue in th e de cis ion m ak ing al gorith m . Prof. Zafar Sajjad Prof e s s or of Radiol ogy Aga K h an Unive rs ity H os pital , Karach i, Pak is tan. Journal of Medical Ultrasound 2015; 23(3): 115-60 Yas m in Davoudi, Parvane h Laye gh , H am idre z a Sim a, Sh iva Tatari, Roya Fagh ani BACKGROUND: Th e m ain outcom e of virus -re l ate d h e patit is is progre s s ion to l ive r f ibros is . Th e re f ore , e arl y diagnos is is ve ry im portant in th e tre atm e nt and m anage m e nt of patie nts . Al th ough l ive r biops y is th e gol d s tandard te s t f or as s e s s m e nt of l ive r fibros is , it is e xpe ns ive and h as s om e dis advantage s s uch as s am pl ing e rrors , inte robs e rve r variabil ity, and a s ignificant m ortal ity and m orbidit y rate . M ore ove r, th is m e th od is invas ive and h as s ide e ff e cts , e s pe cial l y if it ne e ds re pe ate d s am pl ing. In orde r to com e up w ith a re l iabl e noninvas ive m odal it y in pl ace of biops y, w e s tudie d th e val ue of grays cal e ul tras onograph y (US) and Doppl e r ul tras onograph y (DS) for th e diagnos is of l ive r fibros is in patie nt s w ith ch ronic viral h e patitis .