 Hello everyone, the senior radiologists who are conducting this sonobus conference. First of all, I would like to thank everyone for giving me this opportunity to present my research paper. So I am Dr. Saurab Singh, third year junior resident, who is the presenting author. I'm presenting the research paper titled as sonographic measurements of Scrotel wall thickness. My corresponding author is Dr. Sahil Gandhi, who is a senior resident. I'm from the department of radio diagnosis. So the basic aim was to reduce the norms established norms of Scrotel wall thickness, which is a wide range of 2 to 8 mm. We wanted to reduce this wide range. And second was that we were suspecting that the Scrotel wall thickness has a major role in thermoregulation of spermatogenesis, which in turn can be a major cause for infertility. So this study estimated the Scrotel wall thickness in males above 21 years of age. So we took the sample size of 50 in males above 21 years of age. Our reference showed that normal Scrotel wall thickness ranges between 2 to 8 mm. We were trying to narrow this wide range because no such study has been conducted before in this region. It was a pilot study. Aim to study the Scrotel wall thickness and to establish norms among male population above 21 years of age with help of ultrasonography. The study will help to suspect cause in patients of infertility as thick Scrotel wall, since it plays a major role in thermoregulation dependence per metogenesis. Materials and method. We conducted it in BVDU sangly. We selected 50 cases above 21 years of age. We took the informed consent before starting the study. Scrotel ultrasonography was performed using the linear probe basically and curvilinear probes were also used with standoff pad after allowing some time for the diatose muscle to relax. We allowed some time for the diatose muscle to relax and then we used a standoff pad. Standoff pad was not available. So what we did is we put a jelly, we filled a pair of gloves with jelly and we used it as standoff pad. So what is the role of standoff pad is it helps to better evaluate the superficial structures. It increases the distance between the transducer and the area of interest that is the Scrotel wall and it places the area of interest at the level of the focal zone. And also it reduces the reverberation artifact and gives a good resolution picture. We can see in the further slide, I have shown one case. High frequency. We also excluded the patients with varicoseal Scrotel skin conditions, inguinal Scrotel hernia, hydrosilin and subjects who were not willing for this study. So we basically excluded the patients who were having Scrotel or testicular diseases and who were not willing. So we used a linear probe. We measured the wall thickness in both Scrotel sacs on three surfaces, anterior, posterior and lateral. We measured on three surfaces, anterior surface, lateral surface and the posterior surface. We wanted to see if this also plays a role in determining the Scrotel wall thickness. So here we can see this is the standoff pad. This is the right anterior, right lateral, right posterior. This is left anterior, left lateral, left posterior. We placed the outer calibre in the innermost portion of the outer echogenic layer. Then we put the innermost calibre in the innermost region of the Scrotel wall. We put the inner calibre in the innermost portion and the outer calibre in the inner surface aspect of the outer most echogenic layer to avoid the discrepancy of the results. So this is the result. We can see the table. The anterior mean thickness on right was 2.87mm, anterior mean thickness on left was 3.01mm, lateral mean thickness on right is 3.04mm, lateral mean thickness on left is 3.11mm, posterior mean thickness on right is 2.89mm, posterior mean thickness on left is 2.81mm. So we convert these table into more understandable tables. So we can see that average mean thickness on right is 2.90 millimeter with minimum and maximum ranging 1.6 to 6.6 millimeter. Average mean thickness on left is 2.93 millimeter with minimum maximum ranging from 1.8 to 6.6 millimeter. And here mean thickness on right is 2.87 millimeter and posterior mean thickness on right is 2.89 millimeter, anterior mean thickness on left 3.01 millimeter and posterior mean thickness on left is 2.81 millimeter. We can see the minimum and maximum ranges are somewhat similar 1.5 to 6.3, 1.5 to 6.8. These are not varying much in all the three tables. So what we concluded is in our study, we found that the average crottal wall thickness ranges between 0.94 to 4.86 millimeter on right and 1.03 to 4.83 millimeter on left. These are also not varying much. So there was no statistical difference between anterior posterior lateral wall thickness on epsilon lateral side as well as on contral lateral sides in healthy males above 21 years of age in our region, Western Maharashtra population. Therefore, we conclude that there is no need to take three different wall thicknesses. It is unnecessary. We had five males who had scrotal wall thickness greater than 5 mm and were taking infertility treatment. But since the sample size was low, it needs further studies. However, this has to be interpreted with caution as the sample size is small. This was a pilot study which has not been done before in our region. Our conclusions have to be supported with further studies. So this is a pilot study. It can act as a pioneer for further studies. So discussion, the scrotal wall composes of the skin that is wrinkled appearance. Since there is no subcutaneous fat, there is just inside the skin is Datto's muscle. That is a tunica Datto's that is major responsibility has the major responsibility for thermoregulation. Inside that is external spheromatic fascia. Just inside that is cremastic muscle and fascia. And the innermost layer is internal spheromatic fascia. So Datto's muscle is a smooth muscle, cremastic muscle is a striated muscle. The tunica Datto's acts to regulate the temperature of the testicles. So that testicles are required in an environment that is two to six degrees cooler than the body core. What things are responsible for it is, we will see in the further slide. The temperature is regulated by the scrotal wall. It is not simply a house that, it is not simply a house that houses the testis. It has an active role for thermoregulation. How? There are four layers, this one is for it. The tunica Datto's smooth muscle, the striated cremastic muscle, the absence of a subcutaneous fat layer, I told you earlier, fat is responsible for heat loss and abundance of sweat glands that helps in removing the heat from the testis. The tunica Datto's is a smooth muscle that lines the scrotal skin, giving the skin its characteristic wrinkled appearance. So it is reported to play an important role in thermoregulation. It changes the surface area by contracting and relaxing, depending on the temperature is low or high, respectively. When it is low, contraction of the Datto's muscle occurs and it reduces the surface area of the scrotum and blood flow to the scrotal skin and it prevents the heat loss. When it is high, the Datto's relaxation causes removal of excessive heat. We postulate that if the thickness or tone of this muscle is more, it contributes to scrotal wall thickness and it can lead to reduce thermoregulation and spermatogenesis causing oligospermia or esthenospermia. This could be a cause, decide the varicoseal that has been established because of male infertility already. Ethnicity and topical hot climatic adaptation must be playing a role in it. Also, it has been established that subcutaneous fat layer is absent in scrotal wall, which can help thermoregulation and lifestyle disease like obesity can cause lipo deposition scrotal wall. So these things were not considered in our study and it requires further studies in this region. Thank you. These are the references. Again, I would like to thank you, Sonobas Community for giving me this opportunity. Thank you so much.