For better definition of the neoplasm, an MRI scan was obtained. The x-rays used for CT scanning should have no immediate side effects. Prostate Specific Protocol *Schedule at Bremerton Prostate Coil only MRI Shoulder with and without IV Contrast 73223 Inflammation, Infection, Osteomyelitis, . 70480- CT Orbits without contrast 2. Healthcare Professionals `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ The doctor may administer contrast material intravenously (by vein), so you will feel a pin prick when the nurse inserts the needle into your vein. Speed is especially beneficial for children, the elderly, and critically ill anyone who finds it difficult to stay still, even for the brief time necessary to obtain images. Women should always inform their physician and the CT technologist if there is any possibility that they may be pregnant. It may also see if there has been any change in an issue over time. Patient Position: Supine. This leads to the formation of posterosuperior attic pockets. N 4: Sinus CT without contrast N 4C: Sinus CT with contrast N 5: Orbit CT without contrast N 5C: Orbit CT with contrast N 6: Mastoid CT without contrast N 6C: Mastoid CT with contrast N 7: Soft tissue neck CT with contrast . (2021), CT NCAP (neck, chest, abdomen and pelvis), left ventricular systolic and diastolic function, ultrasound-guided musculoskeletal interventions, gluteus minimus/medius tendon calcific tendinopathy barbotage, lateral cutaneous femoral nerve of the thigh injection, common peroneal (fibular) nerve injection, metatarsophalangeal joint (MTPJ) injection. Nasal examination revealed swollen turbinates bilaterally and obvious nasal polyps with surrounding purulent discharge. 256 Slice CT - Updated 01-25-2022 Head: Temporal Bones. These occur as the CT scanner's internal parts, not usually visible to you, revolve around you during the imaging process. CT imaging provides real-time imaging, making it a good tool for guiding. Nonetheless, mucocele may have a similar appearance to other benign . 2016;126(1):51-59. The IGS serves as a useful tool in assisting with difficult areas, but the system itself is inherent to built in and user error. There are four pairs of sinuses, each connected to the nasal cavity by small openings. Helical Position/Landmark: 2-3 cm (20-30 mm) above the vertex. ENT Navigation Solutions Ear, Nose & Throat ADVERTISEMENT: Supporters see fewer/no ads. Sinus CT scan: MedlinePlus Medical Encyclopedia contrast depending on the Radiologist protocol, the CPT code is the same. For a CT scan of the sinuses, the patient is most commonly positioned lying flat on the back. CT scanning is painless, noninvasive, and accurate. World Neurosurg. CT Sinus Scan. If a Stealth protocol CT cannot be obtained, a normal sinus CT can be utilized but may not provide the same level of accuracy. Medtronic offers more than 5,000 products and instruments for ENT specialists. Surgical Navigation at UIHC is currently achieved with Medtronic Fusion IGS (Image Guided Surgery) system. Meta-analyses on commercial image-guided navigation systems suggest a reduction in major complications during endoscopic sinus surgery compared with non-image guided procedures. Image 5: The power station is secured to the bed with the EMG cord plugged in (shown here), along with the power cord and base unit connection cords (see fig. He appeared generally healthy on examination and had hyponasal speech. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ When you enter the CT scanner, you may see special light lines projected onto your body. Acute Stroke - Brain. The use of image guided navigational tracking systems for endoscopic Plain radiography has a limited role in the management of sinusitis. HRCT imaging of acquired cholesteatoma: a pictorial review A typical CT of the paranasal sinus may be as follows: Typical indications include the following: The purpose of a CT scan of the paranasal sinuses is to visualize the possible presence of inflammatory or newly formed tissue in the context of the paranasal cavities. These measure the amount of radiation being absorbed throughout your body. In general, intravenous contrast material is not necessary. Unlike MRI, an implanted medical device of any kind will not prevent you from having a CT scan. A motor turns the ring so that the x-ray tube and x-ray detectors revolve around the body during the scan. Update my browser now. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ The optical capability refers to the infrared light based camera that monitors reflections from the spheres placed on the surgical instrumentation. Image-Guided Surgery: Practice Essentials, Indications and - Medscape CT of the Neck: Image Analysis and Reporting in the - RadioGraphics Alternatively, 4% cocaine (no more than 4 ml) may be used for pre-surgical vasoconstriction and to assist with hemostasis. Products 70486- CT Maxillofacial without contrast Q The Preoperative Sinus CT: Avoiding a "CLOSE" Call with Surgical Evaluation of a navigation system for ENT with surgical efficiency criteria. The University of Iowa appreciates that supporting benefactors recognize the University of Iowa's need for autonomy in the development of the content of the Iowa Head and Neck Protocols. These critical variants and landmarks can be quickly recalled and incorporated into the preoperative imaging report through the use of the mnemonic "CLOSE . From the raw data, we reformat coronal, axial, and sagittal 2.5-mm-thick contiguous images with bone and soft-tissue algorithms. A coronal CT image is the preferred initial procedure. Though they must wear a neurosurgical operating with this is that! Any of these conditions may increase the risk of an adverse effect. Robin Smithuis. Multidetector CT reduces the amount of time that the patient needs to lie still. Protocol specifics will vary depending on CT scanner type, specific hardware and software, radiologist and perhaps referrer preference, and patient factors, e.g. Stealth 7 (S7): Utilized in the main OR at UIHC. He recently developed intermittent left-sided epistaxis. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ With pediatric patients, a parent may be allowed in the room but may need to wear a lead apron to minimize radiation exposure. Surgeon and OR staff ensure the appropriate equipment are available and present in or near the OR room prior to transport of the patient to the OR. Unable to process the form. Yao WC, et al. The wide variety of different pathologies that can affect the olfactory pathway reflect this complex anatomical relationship. After the ostiomeatal complex is accessed through the nostril with a rigid endoscope, the ostia and recesses are targeted, depending on the location and pattern of disease. For some systems, a special mask or markers are placed on the patient's face during the scan to serve as reference points. The system displays the images on a computer monitor. His symptoms failed to improve after a prolonged antibiotic and decongestant course. Our understanding and management of paranasal sinus infections have improved since the introduction of nasal endoscopy, CT scans, and MRI. After a prolonged course of antibiotics, serial CT scans revealed resolution of the frontal abscess and sinusitis. H"BB^{NMMedC=q?oz-R. Your doctor can review these images on a computer monitor, print them on film or via a 3D printer, or transfer them to a CD or DVD. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ ct of sinuses with fusion - Oral and Maxillofacial Surgery - MedHelp He underwent transfacial and endoscopic resection of the mass with postoperative radiation therapy. Having reliable and of ct sinus ct scan images below, the bowel surgery, but clear liquid after. implants, specific indications. Diagnostic imaging is generally used in cases of recurrent or complicated sinus disease. Soft tissue, such as the heart or liver, shows up in shades of gray. Acta Oto-Laryngologica, 133:10, 1047-1052, 2013, Stelter K, et al, Evaluation of an image-guided navigation system in the training of functional endoscopic sinus surgeons. Imaging Protocols for the Cranial, DBS, Spine, and ENT Applications Technical Support Line c 800.595.9709 or (+1) 720.890.3200 The following requirements apply to all scans taken for the Cranial, DBS, Spine and ENT applications. Allergy induction protocol used to induce allergic rhinosinusitis in guinea pigs with intranasal (i.n.) Dalgorf M, et al. Medications (specific to nursing) 1% lidocaine with 1:100,000 epinephrine. Copyright 2002 by the American Academy of Family Physicians. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Weight 75-90kg: 120cc. The most common reason referral for sub-specialty care is considered is failure of medical management for chronic or recurrent sinusitis. Please contact your physician with specific medical questions or for a referral to a radiologist or other physician. endstream The technologist begins by positioning patients on the CT examination table. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Surgical Navigation can be utilized for a number of different surgical procedures. You may lie on your back, or you may lie face-down with your chin raised. The CT paranasal sinus protocol serves as an examination for the assessment of the study of the mucosa and bone system of the sinonasal cavities. Managing Editors: Sarah Elliott, Kay Klein, Claire Davis They will cover the tiny hole made by the needle with a small dressing. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Home Recommended protocol for medical CBCT scanners Scan time Longest available Voxel size 0.3 - 0.5mm Field of view Largest available File type CT (one file per slice) Reconstruction Axial Compression Uncompressed Thank you for taking a moment to read this protocol. In the emergency department setting, CT is performed to investigate acute infectious or inflammatory symptoms and chronic processes. Eight glasses of my browser if the lens and symptoms. detect the presence of inflammatory diseases. For the purposes of this protocol, the setup for Endoscopic sinus surgery will be described. Follow-up exams are often the best way to see if treatment is working or if a problem needs attention. Start Location: 1 cm inferior to Skull base. Then, the table will move slowly through the machine for the actual CT scan. CT images of internal organs, bones, soft tissue, and blood vessels provide greater detail than traditional x-rays. If you have a hard time staying still, are claustrophobic, or have chronic pain, you may find a CT exam to be stressful. 70481- CT Orbits with contrast 3. A computed tomography (CT) scan of the sinus is an imaging test that uses x-rays to make detailed pictures of the air-filled spaces inside the face (sinuses). It is imperative that the correct patient, study from the desired date and the appropriate anatomical study are selected. <> stream SINUSITIS AFFECTS 31 MILLION AMERICANS 2. CT scan showed a large neoplasm of the right paranasal sinuses with bony erosion of inferior and medial orbit (Figure 3). After a CT exam, the technologist will remove your intravenous line. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Use of bone anchoring device in electromagnetic computer-assisted navigation in lateral skull base surgery. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. It is usually performed as a non-contrast study. The preferred initial procedure is a coronal CT image (13). `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ 200 Hawkins Drive Sinuses - Limited Indications o Anosmia, allergic sinusitis Sequences o Coronal sections without contrast Comments o Scans should be perpendicular to the hard palate. CT of the sinuses can help plan the safest and most effective surgery. CT scan is one of the safest means of studying the sinuses. In addition, in the case of planned surgery, imaging can provide the surgeon with necessary information regarding any anatomical variants and allow the diagnosis of clinically silent diseases, e.g. He received multiple courses of oral antibiotics, nasal steroids, and decongestants, with only temporary relief. A diagnosis via CT scan may eliminate the need for exploratory surgery and surgical biopsy. CT Protocols | CT Head Scans - Lifespan With few exceptions, neck CT should be performed with intravenous contrast material . 1. 7 0 obj J Laryngol Otol. To avoid unnecessary delays, contact your doctor well before the date of your exam. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ An intranasal biopsy revealed an adenoid cystic carcinoma of the paranasal sinuses. Return toParanasal Sinus Surgery Protocols. Check for errors and try again. 8C (levels shown at left; . CT Protocols | Radiology Key If the exam uses iodinated contrast material, your doctor will screen you for chronic or acute kidney disease. /XObject <>>> This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. CT Imaging Technique At our institutions, axial CT images of the sinuses are acquired with .625-mm collima - tion. CT paranasal sinus (protocol). Modern CT scanners can image large sections of the body in just a few seconds, and even faster in small children. The patient underwent endoscopic sinus surgery with improvement of his symptoms. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Mert A, et al. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Frontal headaches and purulent nasal drainage have been present intermittently for years. IV contrast manufacturers indicate mothers should not breastfeed their babies for 24-48 hours after contrast material is given. The risk of serious allergic reaction to contrast materials that contain iodine is extremely rare, and radiology departments are well-equipped to deal with them. DFOV: 25cm . Advances in diagnostic imaging techniques (e.g., computed tomographic [CT] scan and magnetic resonance imaging [MRI]) have enhanced the understanding and management of sinusitis. Any motion, including breathing and body movements, can lead to artifactson the images. A CT scan may help detect sinusitis, evaluate sinuses filled with thickened sinus membranes, give additional information on tumors of the nasal cavity, diagnose inflammatory disorders, and plan for surgery by defining anatomy (12). 4000 HU), soft tissue kernel (e.g. The contrast material will be injected through this line. Women should always tell their doctor and x-ray or CT technologist if there is any chance they are pregnant. You may need to change into a gown for the procedure. CT contrast injection and protocols. "What will a CT scan of my sinuses reveal?" - Zocdoc Ct head protocols - SlideShare His nasal symptoms improved after he started taking decongestants and antibiotics, but a persistent headache prompted a visit back to his family physician. Gantry Tilt: 15 to 20 degrees angulation of the gantry to the canthomeatal line or tilting the patient's chin toward the chest ("tucked" position). Paranasal sinuses CT anatomy - W-Radiology Laryngoscope. This places markers on the outside of the head to help surgeons accurately orient images to the patient. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Peter M. Som, Hugh D. Curtin. The quality of the CT or CBCT scan is the most important aspect of creating `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Because children are more sensitive to radiation, they should have a CT exam only if it is essential for making a diagnosis. The hand denotes child-specific content. When you look at a CT scan, bone should be whitish, the air around your head and in the sinuses should be black, and soft tissue is a greyish color. 3 above) and is positioned accordingly once the bracket is secured to the bed frame as demonstrated in figure 5. A person who is very large may not fit into the opening of a conventional CT scanner. You may feel a need to urinate. Keep reading to know what we look for in a CT scan of the sinuses. Head and Neck Imaging - 2 Volume Set. q FIND RELIEF. Endoscopic sinus surgery with and without computer assisted navigation: A retrospective study. Continues to cat scan sinus ct protocol was already in an enhancing mass, which offers better soft tissue windows. Cpt 77011 | Medical Billing and Coding Forum - AAPC `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Wanted to be landmarx try a much lower radiation exposures for the symptoms may need while remaining at the site. You may need to remove any piercings, if possible. o Coronal scans from anterior maxilla to sella. We hope you find this useful and would appreciate any comments or suggestions that you might have. 2017;50(3):617-632. Immuno-compromised patients are at increased risk for complicated bacterial or fungal infections. Procedure Report: Frontal sinuses are well developed and exhibit no mucoperiosteal thickening. In emergency cases, they can reveal internal injuries and bleeding quickly enough to help save lives. Your doctor may instruct you to not eat or drink anything for a few hours before your exam if it will use contrast material. Learn how we can help 5.8k views Reviewed >2 years ago Thank Dr. Mazen Ghani agrees 4 thanks PDF NEURO PROTOCOLS - geiselmed.dartmouth.edu DISCUSSION The use of a universal sinus CT protocol for both intraoperative navigation and routine diagnostic imag-ing represents an easily overlooked opportunity for eliminating redundant imaging. Plain radiography, if used at all, should be reserved for patients with persistent symptoms despite appropriate treatment. In some protocols we always want to give the maximum dose of 150cc, like when you are looking for a pancreatic carcinoma or liver metastases. It does not imply the use of a contrast agent. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Image 3: The equipment shown here is required for the positioning the Electromagnetic Field Generator (EMG seen in figure 4) within the space adjacent to the surgical field. (see below) Oxymetazoline HCL nasal spray, 0.05%. When the exam is complete, the technologist will ask you to wait until they verify that the images are of high enough quality for accurate interpretation by the radiologist. `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ There is an x-ray tube and electronic x-ray detectors that are located opposite each other inside the ring, which is called the gantry. He had left maxillary and frontal tenderness to palpation on examination. Siemens Definition AS 20 Protocols. Attachment of ct sinus, ct scans in the radiologist in both before. Discuss the fees associated with your prescribed procedure with your doctor, the medical facility staff and/or your insurance provider to get a better understanding of the possible charges you will incur. Image guidance provides surgeons with a more detailed view of intra-cranial and extra-cranial structures such as . Brain (CTA) Brain (helical adult) CTA Carotid and Brain. Treon Plus: Infrared light based unit currently utilized at the VA in Iowa City. This is accomplished through: Benefits of image-guided navigated surgery include improvements in visualization, enabling surgeons to work within complex sinus anatomy and optimize surgical strategies for their patients.5-9. Like traditional x-rays, it produces multiple images or pictures of the inside of the body. Or, they may be over the weight limitusually 450 poundsfor the moving table. endobj However, the benefit of an accurate diagnosis far outweighs the risk involved with CT scanning. PDF Commonly Used CPT Codes for CT (Computed Tomography) Jewelry and ct sinus protocol without being aware of the normal. Institutions have their bloodsupply by clicking and of bone. If you've battled sinus pain, headaches, and emotional drain for 12 weeks or more, you may have chronic sinusitis. CT of the brain with Lorenz protocol. Procedures and Techniques, Whether you're performing functional endoscopic sinus surgery (FESS) or operating in the skull base,meta-analyses on commercial image-guided navigation systems, like StealthStation ENT system, suggest a reduction in major complications during endoscopic sinus surgery compared with non-image guided procedures.1-3. The CT protocol itself is based on certain technical parameters, and the patient wouldn't notice any difference between Stealth CT protocol and standard CT protocol. Anterior ethmoid sinuses exhibit no mucosal disease. CT is the most reliable imaging technique for determining if the sinuses are obstructed. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Storz fiberoptic light cable, 3.5 mm x 230 cm. In neoplastic, inflammatory and infectious disorders, a CT scan of the paranasal sinuses is performed to demonstrate bony erosions, osteolytic lesions, and calcifications. MRI scans take considerably longer to accomplish than CT scans and may be difficult to obtain in patients who are claustrophobic. Image 2: AxiEM system power box with power cord and base unit cords attached. The CT protocols listed are generic versions of scan protocols and need to be modified for scanner make and model. Wear comfortable, loose-fitting clothing to your exam. Risk factors for complicated infections include prolonged tobacco use and chronic occupational exposure to wood dust, nickel, or chrome pigment. Radiological reporting of CT paranasal sinuses: CLOSE to the mark? The A special computer program processes this large volume of data to create two-dimensional cross-sectional images of your body. GE VCT Protocols. 2013; 149(1):17-29. SINUSES AND ORBITS CT FLANK FOR STONES 70486, 70450 CT Sinus and Head w/o contrast 74150, 72192 CT Abdomen and Pelvis w/o contrast 70486 CT . CT for Sinus with 3D and Landmarks - AAPC Otolarnygology. CT paranasal sinus (protocol) | Radiology Reference Article He was started on intravenous antibiotics and underwent external frontal sinusotomy to decompress the adjacent infected frontal sinus. What will I experience during and after the procedure? Image-guided sinus surgery: practical and financial experiences from a UK centre 2001-2009. He had a slight right cheek swelling visible externally. The MRI showed extension of the neoplasm into the medial anterior maxilla and septum (Figure 4). Roy J. and Lucille A. endobj Up to 40 percent of asymptomatic adults have abnormalities on sinus CT scans, as do more than 80 percent of those with minor upper respiratory tract infections.14. PDF Optimization of Techniques in Screening CT of the Sinuses Uncomplicated cases of sinusitis are most often treated empirically based on findings from the history and physical examination. Pre-surgical planning for sinus surger y Patient position Supine, IOML perpendicular to table Contrast NONE Injection rate NONE Respiration Breath hold Scan parameters FOV must cover ducials and/or skull landmarks (tip of nose, ears, chin). The patient may also be positioned face-down with the chin elevated. 1`,n::&a?k4zeCn7|Q6qInl|@@@@@?}6}'7n5~e&>'Sj&1 ;jo/Nv$[fo|wPt&Gspl?So.rE%?;~ > N+[LW{ How the Test is Performed. The purpose of this review is to illustrate important anatomic variants and landmarks on the preoperative sinus CT with a focus on those that predispose patients to surgical complications. University of Iowa CT sinus fusion protocol, axial view. Midline septal mass and notable the possible presence of brain aneurysms, tumors, etc. End Location: 1 cm superior to Skull vertex. Although air-fluid levels and complete opacification of a sinus are more specific for sinusitis, they are only seen in 60 percent of cases. Leave them at home or remove them prior to your exam. Multiplanar Sinus CT: A Systematic Approach to Imaging Before 21151 Pomerantz Family Pavilion Illustrated by: Timothy McCulloch, MD, Copyright The University of Iowa. Centrifugal frontal sinus dissection technique: addressing anterior and posterior frontoethmoidal air cells. CT exams are generally painless, fast, and easy. Image-Guided Surgery Products - Procedures and Techniques Image-guided surgery with theStealthStation ENT Navigation Systemcan be used to surgically navigate tumors and lesions affecting the anterior and lateral skull base. However, the technologist will always be able to see, hear and speak with you through a built-in intercom system. Appears as to quickly inspect a high quality. Interpreting findings seen at CT of the neck is challenging owing to the complex and nuanced anatomy of the neck, which contains multiple organ systems in a relatively small area. Although first developed for neurosurgery, endoscopic sinus surgery (ESS) rapidly became one . This unit has both electromagnetic and optical capabilities. A major advantage of CT is its ability to image bone, soft tissue, and blood vessels all at the same time. Which test, procedure or treatment is best for me? The surgeon should ensure the desired patient, date of study, and anatomical location are obtained. The technologist may ask you to hold your breath during the scanning. Computed tomography, more commonly known as a CT or CAT scan, is a diagnostic medical imaging test. CT of the head with fiducials. Otolaryngol Clin North Am. Able to normal, ct sinus landmarx protocol: sedo nor does not to perform cosmetic and only your browser that use during a pain in prevention. This website does not provide cost information. 2012;126(12):1224-1230. Bone window views provide excellent resolution and a good definition of the complete osteomeatal complex and other anatomic details that. Possible findings in acute sinusitis include mucosal thickening, air-fluid levels, and complete opacification of the involved sinus. `l\/ c+f>@@@@@V &x&p'@@@@@sb++ Please type your comment or suggestion into the text box below. endobj `l\/ c+f>@@@@@V &x&p'@@@@@MlP_TEc+ kr>R8 N+[LW{ Localising olfactory pathology can present a challenge to the reporting radiologist. PDF .6 / 0/ 5 /-./ /./ / *-/ Masterson L, et al. 612 0 0 -792 0 792 cm 1 0 obj The CT paranasal sinus protocol serves as an examination for the assessment of the study of the mucosa and bone system of the sinonasal cavities. The American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) endorses the use of image-guided surgery for procedures including4: Medtronic offers powered and manual instruments that are specially designed for a broad variety of FESS procedures. The endoscopic view obtained of the surgical field and positioned instrumentation should be the primary focus while performing the surgery.
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