 Thank you so much for sharing your lecture. At this time, we'll open the floor for any questions from the audience. You can submit a question through the Q&A feature. I see seven questions in the Q&A. Awesome. Some we find it difficult to decide whether there is intersception or is it a transient twisting, whether we should follow because ideal is transient mostly. Yes, that is correct. So, yeah, of course you would like to redo it. You have to redo it, right? 30 minutes as I shared in my talk, right? Thank you so much. So, coming to the next question. When do you do MRI in a patient suspicious for appendicitis? We haven't really, we usually do a CT. So, at our institute, we do CT only. So, I think ultrasound pretty much is very helpful. CT is also less often done in the pitaearrogate group, but yes, we do a CT. Thank you. So, and that's done. So, next is what's the outer cut off diameter for appendicitis? More than 6 millimeters is what we, what the literature says. Okay. Thank you. So, are the surgeons comfortable taking patients to surgery based on ultrasound alone? Like there are clinical findings, there are clinical parameters and then of course there's a lot of thing with the confidence of the radiologist and the confidence of the surgeon that he has. So, depending upon your confidence and diagnosis, demonstration of the pathology, I'm sure the surgeons will definitely get the patient after surgery. So, if you have those nice lips to demonstrate that that's what's happening and you have those nice images to demonstrate and they come and they see the pathology, they are very convinced they'll definitely trust you and take you. I mean, like, I know I do a lot of neck thyroid, parathyroid, ultrasound first, the people take my, I'm very glad to have come up to that level of confidence that when I communicate, it's very effective and it's taken with a lot of trust. So, again, it's a lot ultrasound is such an operator dependent mentality. So, a lot depends upon the confidence. So, the range 44 to 95%. So, the sensitivity and specificity range for the diagnosis of acute appendicitis. So, there is a lot of difference because that difference actually is coming from the learning curve, the operator experience settings and everything. So, to my answer to your question, are the surgeons comfortable? I would say yes, depending on your confidence level. Okay, thank you. So, that's all done. That's also done. As it pertains to the bowel obstruction seen in interception or in general pediatric cases, is there a standard objective measurement to classify obstruction based on age? So, the subjective assessment. We already discussed the numbers, right? More than three millimeters or more than four millimeters thickness of the, oh, that's, you're talking about interception. No, yeah, you can actually see it's the target sign and the sandwich sign, basically, the subjective assessment. Okay, thank you. Next, is there any ultrasound criteria for mesentic adenitis? Oh, you see the lymph nodes, right? And you see the size and you see the character and then you report them and you report the location. Because these can, of course, they need to be treated and followed up. They can, as you see, they can become lead points for the pathologies to happen, right? Okay. Can you show a slice of preparation of hydrostatic reduction? Do you do X-ray abdomen without perforation before the procedure? It's perforation is clinically suspected. We haven't normally done our pediatric department, pediatric doctor joins the ultrasound department, and that's where we do the hydrostatic reduction as a team. So normally X-rays are not done unless they are really suspecting it. I mean, then they would probably just attempt it in the Odeon-ray and then make a call there. Okay, thank you. Madam, no size criteria for mesentic lymph adenitis. I mean, lymph nodes can be as small. The SEDs are often 3mm, 4mm, 5mm, 6mm. We just measure the SED, short its diameter and we report them. There is no size criteria as per the literature that I've seen. So whatever I see, I report because even those tiniest of those lymph nodes, hypertrophic bias patches, those can also become lead points. So we just have to document them if you see. So how many you see? Are there clusters or punches or what do you see? Just gives you an idea of what's going on inside yet for the physician. Okay, thank you. The next, explain pylorospas, pylorospas, pardon me, pylorospas, right? So that's like a spas, like an uterine contraction, like it's transient. So you just have to wait and you just have to evaluate it again and you'll see a different reading of the length of the pyloric canal. So when you go, oh, it was now, it's this, oh, now the reading is changing, now the reading is changing. So that's what you go. It's probably just a temporary spas, which is coming and going away. So that is something you must always exclude before you give a diagnosis of HBS, hypertrophic pyloric stenosis or something. Okay, so that's done. And it's how easy it is to find an inflamed appendix and exclude it with a scan along. Like I said, it's easy. First of all, you need to know the normal anatomy. Where is it? And then what are the possible locations of the appendix? And of course, as you all know by anatomy, you can have subepatic pelvic or characteristic location. So you will look at there. So basically, the idea is to go to the terminal ileumeliocecal junction. That's where you'll find it and it can be pointing in any direction, right? So once you start with that area and you do the graded compression technique, it is possible to do. So to answer how easy it is to find, it is easy and we can exclude it with a scan alone. However, it is challenging. It's easier said than done. And of course, whenever you are in a dilemma, state support from your colleagues, there is a learning curve. Your confidence level will increase as you do more and more cases and you get more and more follow ups and you'll be able to give a confident diagnosis. So use the transducers, use the linear, the curvy and the other transducers, whatever gives you the tip and follow it gently, you'll be able to do it. It requires patience and perseverance, yes or no. And is there any clinical significance of minimal balearic thickness? No. So it just says over a certain point. So that's why they said the smaller the borderline ones, they may just resolve over a period of time. You just do a follow up and you just measure because the child, they may be like between 3mm and 9mm, there may be something in the middle, right? So which may recover or which may go to congenital hepatocarpital x-tinosus, so you just need to follow them up. So yeah, that's it. Thank you. How long does interception take to become an instruction? It depends on the symptoms and I haven't known of this. It depends upon the clinical condition to do a duration. How long does it usually take? I would say, but waiting from case to say, not that I've ever observed this finding. So how much time can you wait? I think that's probably the clinician's opinion of the matter. And can you confidently differentiate between heliosecule and helioline interception? I mean, it's basically what we're talking is small ball inside small ball and small ball inside large ball. So one is, of course, the anatomy, the wall thickness, the outer wall thickness, the intrusive thumb who's taken the receiving segment. How much is the thickness? Of course, in cases of heliosecule that would be more and helioline that would not be that much thick. This can vary though. And of course, location in the abdomen. So if you see in target sign in dialyphosa, you're more likely dealing with heliosecule and helioline. Usually you'll see that maybe it's higher up, usually often in sub hepatic or other areas. Please explain about perpendicular lump. So when you see, when you see just an inclined appendix with or without a lid and just hyperemia, that's just appendicitis. However, you've had any perforation or any leak or any abscess or any collection or anything. All these we put in the umbrella of perpendicular lumps. Then it has to be managed accordingly. When suspect retrusicule, is it, is there any sign on ultrasound and also a net step? I mean, net step is definitely to go for a CT when you really suspect, but there's a lot of bowel gas in front and you think it's there, but it's right behind there. But whatever maneuvers you do to the patient, turn left and right, so you can avoid the bowel gas and then you can try and scan behind. But if you can't do it, you just can't do it. You have to go for a CT. If it's clinically, there is a very high index of suspicion and that's what your suspect in that step is a scan. And Paloro spas and Paloaric stenosis could be said to be the same thing. See, spas will come and go. Paloaric stenosis is a hypertrophy of the muscles. So if you rescan after certain time, or over a period of time, what disappears, maybe that was just a spas or that was just the early borderline scenario. But what you label as Paloaric stenosis is something which may probably need a surgical intervention or another measurement. So they are different. They are not the same. That's the answer. Okay. Thank you so much. All open questions have been answered. And I really, really thank you for all your questions. And I thank you to all the 250 plus people, all who logged in and listening live to this, to this talk. Thank you so much to each and everyone. Thank you, Amara and line for the wonderful platform and opportunity to share. Thank you.