 Changes of disc desiccation with posterior disc bulge seen indenting thecal sac from L1 TO S1 level with maximum

changes and annular fissure noted at L4-L5 level.

L.N.C.T. UNIVERSITY, BHOPAL

MADHYA PRADESH

SYNOPSIS

TO STUDY “Role of computed tomography in non traumatic

acute abdomen in adults. ”

GUIDE
DR. MEGHA JAIN
HEAD OF DEPARTMENT
DEPARTMENT OF RADIODIAGNOSIS

Submitted by:
Dr. AKARSH TANEJA
DEPARTMENT OF RADIODIAGNOSIS
SYNOPSIS

“Role of computed tomography in non traumatic acute

abdomen in adults.”

PRINCIPLE INVESTIGATOR
DR AKARSH TANEJA
POST GRADUATE STUDENT
Department of Radiodiagnosis
L.N. Medical College and Research Centre

GUIDE
DR MEGHA JAIN
HEAD OF DEPARTMENT
DEPARTMENT OF RADIODIAGNOSIS

NAME OF THE INSTITUTION

L.N. Medical College and Research Centre
Bhopal-462042,Madhyapradesh
 To,

The Chairman

Institute Ethics Committee (IEC)

L. N. MEDICAL COLLEGE AND J.K. HOSPITAL,

KOLAR ROAD, BHOPAL, M.P., INDIA.

Sub: Request for approval from the INSTITUTIONAL ETHICAL COMMITTEE to

conduct a study for degree of M.D.

Respected Madam/ Sir,

As I have proposed to conduct a Study on “Role of computed tomography in non traumatic acute
abdomen in adults.”An observational Study ”.

I request for an approval from Institutional ethics committee (IEC).

I am here with enclosing the detail of project work. I submit the following undertaking: -

•I will start the study after obtaining approval of the Institutional ethics committee (IEC)

•I will get informed consent from the patients and maintained confidentiality of the
details and essentially obtain an informed consent from the family in case of post
mortems studies.

•I will carry out the work without detrimental to regular activities as well as without
extra expenditure to the Institution or the Government.

•I will inform the committee in the occurrence of any change in the study procedure,
site, investigation or guide.

•I will not deviate from the area of work for which I have applied for ethical clearance.

•I will inform the Institution ethics committee immediately in the occurrence of any
adverse events or serious adverse reactions.

•I will abide by the rules and regulations of the institution.

 •I will complete the work within the specified period I have applied for and if any
extension of time is required, I shall apply for permission again and continue the work.

•I will submit the summary / report of the study / project to the institution ethics
committee (IEC) on completion.

•I will not claim funds from the institution while doing the work or on completion.

•I understand that the members of the institutional ethics committee (IEC) have the right
to monitor the study / project without prior intimation.

Thanking You

Date:
Yours obediently

Place:

Dr. AKARSH TANEJA

POST GRADUATE STUDENT
Department of Radiodiagnosis
 RECOMMENDATION OF THE HOD

The dissertation titled As I have proposed to conduct “ Role of computed tomography in non
traumatic acute abdomen in adults.” An observational Study”.
-

”By Dr. AKARSH TANEJA at L.N. Medical College & J. K. Hospital, Kolar Road,
Bhopal
will be done according to the regulations of the institutional ethics committee and I
recommend it for acceptance.

Date:

HOD
DEPARTMENT OF RADIODIAGNOSIS
L.N. MEDICALCOLLEGE,
BHOPAL
 NO OBJECTION CERTIFICATE FROM THE HOD

The dissertation/study titled To Study “Role of computed tomography in non traumatic acute
abdomen in adults.” -

By Dr. Akarsh Taneja at L.N. Medical College & J. K. Hospital, Kolar Road, Bhopal will be done
according to the regulations of the Institutional Ethics Comittee. I have no objection on study and
recommend it for acceptance.

Date…………………….

HOD
Department of Radio diagnosis
L. N. Medical College,
Bhopal
 REMARKS OF THE GUIDE

This work undertaken / to be done by DR AKARSH TANEJATitled “Role of computed

tomography in non traumatic acute abdomen in adults.” - An observational Study” at L. N.
-

Medical College & J. K. Hospital, Kolar Road Bhopal (MP) will be under my
supervision and I ensure that the candidate will abide by the rules of the
institutional ethics committee.

Date:

DR MEGHA JAIN
HEAD OF DEPARTMENT
DEPARTMENT OF RADIODIAGNOSIS
L.N.MEDICAL COLLEGE , BHOPAL
 RECOMMENDATION OF THE DEAN

The dissertation / study titled “Role of computed tomography in non traumatic acute abdomen in
adults.” - An observational Study” by Dr. Akarsh Taneja at L.N. MEDICAL COLLEGE
-

BHOPAL Will be done according to the regulations of The Institutional Ethics

Committee and I recommend it for acceptance.

Date:

Dr. NALINI MISHRA

Dean
L. N. Medical College , Bhopal
 STATISTICIAN CERTIFICATE

The statistical analysis of work undertaken by Dr. AKARSH TANEJAtopic “Role of computed
tomography in non traumatic acute abdomen in adults.” at L.N. medical college, Bhopal will be done
-

under my supervisonrequirements of the research protocol.

Name:
Designation:

Department: Community

Medicine , L.N. Medical college,

Bhopal
 UNDERTAKING BY THE INVESTIGATOR

1 Investigator name: DR. AKARSH TANEJA , Room no : S10 PG1, J. K. Hospital campus, Kolar
road, Bhopal Title : PG 1ST YEAR GENERAL RADIODIAGNOSIS

2 Study center: L. N. Medical college and J. K.Hospital , Kolar road, Bhopal

3 Investigator qualification: MBBS, Subharti Medical College, Meerut Registration

no: DMC/R/27700

4 Ethical committee : L. N. Medical college and J. K.Hospital , Kolar road , Bhopal

Protocol title: “Role of computed tomography in non traumatic acute abdomen in adults.” -

5.Commitments

I have reviewed the clinical protocol and agree that it contains all the
necessary information to conduct the study. I will not begin the study until all
necessary ethics committee and regulatory approvals have been obtained.
i. I agree to conduct the study in accordance with the current protocol. I will not
implement any deviation from or changes of the protocol without agreement by
the sponsors and prior review and documented approval or favorable opinion
eliminate and immediate hazard to the trial subjects or when the changes
involved are only logistical or administrative in nature.
ii. Agree to personally conduct and /or supervise the clinical trial at my site
iii. I agree to inform all subjects on, that the drugs used for investigational purpose
and I will ensure that the requirement related to obtaining the informed
consent and ethics committee review and approval specified in GCP guidelines
are met.
iv. I agree to report the sponsor on adverse experience that occurs in the course
of investigation in accordance with the regulatory and GCP guidelines.
 v. I have read and understood the information in the investigator’s brochure,
including the potential risk and side effect of drug.
vi. I agree to ensure that all associates, collogues and employees assisting the
conduct of the study are suitably qualified and experienced and they have been
informed about their obligations in meeting their commitments in the trial.
vii. I agree to maintain adequate and accurate records and to make those records
available for audit/ inspection by the sponsor, ethics committee, licensing
authority or their authorized representatives, in accordance with the regulatory
and GCP provisions. I will fully cooperate with any study related audit
conducted by regulatory officials or authorized representative of the sponsor.
viii. I agree to promptly report to the ethics committee for changes in clinical trials
activities and all anticipated problems involving risk to human subjects or others.
ix. I agree to inform all unexpected serious adverse events to the sponsors as well as
ethics committee within 7 days of their occurrence.
x. I will maintain confidentiality of the identification of all participating study
patients and assure security and confidentiality of study data.
xi. I agree to comply with all requirements, guidelines and statutory obligations as
applicable to clinical investigator participating in clinical trials.

Signature of investigator
Date:………………
1.
TITLE OF THESIS Role of computed tomography in non traumatic acute abdomen in adults .
2.
AIM:- To determine the contributions of CT in non-traumatic acute abdomen for
AIMS AND confirmation of diagnosed or equivocal USG cases, its management and
OBJECTIVES postoperative follow-up .
OR
To study, assess, and diagnose causes of acute abdomen accurately so as to
minimize the chances of exploratory laparotomy and unnecessary operations and
consequently improved patient care .

OBJECTIVES :- To study the radiological CT pattern of non traumatic cases of acute

abdomen in patients in sample studied.
To determine the CT value in predicting activity in cases of acute abdomen .

3. STUDY CENTRE L.N. MEDICAL COLLEGE AND RESEARCH

CENTRE & J.K.HOSPITAL, BHOPAL
4. DURATION
OF STUDY 1.5 YEARS
5. INTRODUCTIO The term acute abdomen is referred to as a condition characterized by severe pain in
abdomen which develops in duration of hours and commonly explains acute
N & NEED FOR abdominal pain in a group of patients who are extremely unwell and complains of
rigidity and tenderness in abdomen.1
STUDY
This can be due to number of reasons ranging from insignificant disease to life-
threatening disease. Therefore, the clinical diagnosis of acute abdomen can be
challenging, because results of physical examination, clinical presentation, and
laboratory examination are often non-specific and non-diagnostic.

The use of conventional radiography (X-rays) has been nowadays of little value with
significance being in the setting of bowel obstruction showing dilated bowel loops
with air fluid levels.

However, computed tomography (CT) is more accurate and more informative

in this setting as well. For this reason, plain radiography is avoided in these
situations unless there is the suspicion of perforation or bowel dilatation.

Ultrasonography (USG) has developed a satisfactory role in evaluating the

gallbladder in all patients and the appendix in children and pregnant women.

Multidetector CT (MDCT), however, has become the Premier modality for

evaluation of the gut, mesenteries, omentum, peritoneum, and retro peritoneum
unaffected by the presence of bowel gas and fat.
6. STUDY DESIGN OBSERVATIONAL STUDY

7. METHODOLOGY The study will be conducted at L.N. Medical College &

Research centre and associated J.K Hospital Bhopal. It
[MATERIALS & will be a observational study to be done on subjects
METHOD] which are coming with
The clinical profile of patients will be evaluated as per
the proforma.

8. INCLUSION All patients with non traumatic acute abdominal pain

CRITERIA referred for CT Abdomen [C+P] and [P] to department
of Radio Diagnosis L.N. Medical College and JK
Hospital , Bhopal during the period of 2023-2025

9. EXCLUSION Contraindication to CT Imaging like Patient with history

CRITERIA of severe or anaphylactic reaction to iodinated contrast ,
inability to cooperate with scan protocols , hemodynamic
instability , decompensated heart failure , acute
myocardial infarction and renal impairment
Pregnant patient..
Patient refusing to give consent and unwilling for
imaging.
Non cooperative sick and claustrophobic patient .

10. SAMPLE SIZE A sample size of approximately 200 - 220 cases.

On an average 10-14 cases of Acute abdomen are

reported every month. [12 cases average ] 12 X 18
months = 216 cases
11. PROCEDURE Patients fulfilling the inclusion criteria will be selected
PLANNED for study. Relevant clinical data will be recorded in a
structured Proforma.
&INVESTIGATION
DETAILS

12. DOES THE STUDY The study is mainly based on Radiology imaging being a
REQUIRE ANY tool of Investigation. The study involves
INVESTIGATIONS OR
only humans. Informed consent would be taken from the
INTERVENTIONS TO BE
CONDUCTED ON patient after explaining about and before
PATIENTS OR OTHER CT Imaging .
ANIMALS? IF SO
PLEASE DESCRIBE
BRIEFLY.

13. STATISTICAL Data will be analyzed statistically. Analysis will be done

ANALYSIS PLAN in the form of percentages, proportions and
represented as tables, charts, graphs wherever
necessary. Appropriate tests of significance will be
applied.
REFERENCES

1. Tsushima Y, Yamada S, Aoki J, Motojima T and Endo K. Effect of contrast-enhanced computed

tomography on diagnosis and management of acute abdomen in adults. Clin Radiol. 2002;57(6):507-
513. https://doi.org/10.1053/crad.2001.0925
2. Ihezue CH, Nwabunike T, Mbonu O and Ojukwu JO. Acute abdomen in the accident and emergency
department. A study of 405 consecutive admissions. ASEAN J Clin Sci. 1988;8:63-68.
3. Al-Mulhim AA. Emergency general surgical admissions. Prospective institutional experience in non-
traumatic acute abdomen: Implications for education, training and service. Saudi Med J.
2006;27(11):1674-1679.
4. Asefa Z. Pattern of acute abdomen in Yirgalem Hospital, southern Ethiopia. Ethiop Med J.
2000;38(4):227-235.
5. Singh R, Harsimar, Narula H and Mittal A. Role of ultrasound and MDCT in evaluation of patients with
acute abdomen. J Med Sci Clin Res. 2019;7(1):163-169. https://doi.org/10.18535/jmscr/v7i1.29
6. Balamurugan PP, Nanjundan M, Kanagadurga S and Thaiyalnayagi S. MDCT evaluation of non-
traumatic acute Abdomen. OSR J Dent Med Sci. 2020;19(6):1-7. https://doi.org/10.9790/0853-
1906160107
7. Moschetta M, Telegrafo M, Rella L, Ianora AA and Angelelli G. Multi-detector CT features of acute
intestinal ischemia and their prognostic correlations. World J Radiol. 2014;6(5):130-138.
https://doi.org/10.4329/wjr.v6.i5.130
8. Rao PM, Rhea JT, Novelline RA, McCabe CJ, Lawrason JN, Berger DL, et al. Helical CT technique for
the diagnosis of appendicitis: Prospective evaluation of a focused appendix CT examination. Radiology.
1997;202(1):139-144. https://doi.org/10.1148/radiology.202.1.8988203
9. Beger HG and Rau BM. Severe acute pancreatitis: Clinical course and management. World J
Gastroenterol. 2007;13(38):5043-5051 https://doi.org/10.3748/wjg.v13.i38.5043
10. Balthazar EJ. Staging of acute pancreatitis. Radiol Clin North Am. 2002;40(6):1199-1209.
https://doi.org/10.1016/s0033-8389(02)00047-7
11. Boulay I, Holtz P, Foley WD, White B and Begun FP. Ureteral calculi: Diagnostic efficacy of helical CT
and implications for treatment of patients. AJR Am J Roentgenol. 1999;172(6):1485-1490.
https://doi.org/10.2214/ajr.172.6.10350277
12. Reddy RK and Reddy S. The efficacy of unenhanced MDCT in the evaluation of
nephroureterolithiasis Int Surg J. 2016;3(1):341-344.
https://doi.org/10.18203/2349-2902.isj20160256
13. Chaudhry TA, Jamil M and Ali A. Acute cholecystitis; early versus interval cholecystectomy for a
comparative study. Prof Med J. 2010;17:185-192.
14. Mallo RD, Salem L, Lalani T and Flum DR. Computed tomography diagnosis of ischemia and
complete obstruction in small bowel obstruction: A systematic review. J Gastrointest Surg. 2005;9(5):690-
694. https://doi.org/10.1016/j.gassur.2004.10.006
15. Kim SH, Shin SS, Jeong YY, Heo SH, Kim JW and Kang HK. Gastrointestinal tract perforation: MDCT
findings according to the perforation sites. Korean J Radiol. 2009;10(1):63-70.
https://doi.org/10.3348/kjr.2009.10.1.63
16. Chin JY, Goldstraw E, Lunniss P and Patel K. Evaluation of the utility of abdominal CT scans in the
diagnosis, management, outcome and information given at discharge of patients with non-traumatic acute
abdominal pain. Br J Radiol. 2012;85(1017):e596-E602. https://doi.org/101259/bjr/95400367
17. MacKersie AB, Lane MJ, Gerhardt RT, Claypool HA, Keenan S, Katz DS, et al. Nontraumatic acute
abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology.
2005;237(1):114-122. https://doi.org/10.1148/radiol.2371040066
18. Weir-McCall J, Shaw A, Arya A, Knight A and Howlett DC. The use of pre-operative computed
tomography in the assessment of the acute abdomen. Ann R Coll Surg Engl. 2012;94(2):102-107.
https://doi.org/10.1308/003588412X13171221501663
 PATIENT INFORMATION SHEET

Name of patient :

Age/ Sex :

Father/ Husband’s Name :

Residential address:

Contact no:

Date of Admission :

OPD/IPD no:

Ward / Bed No:

Consultant Incharge

CHIEF COMPLAINTS

HISTORY OF PRESENT
ILLNESS

PAST HISTORY

PERSONAL HISTORY

OBSTETRIC
HISTORY/MENSTRUAL
HISTORY
CLINICAL PROFORMA :-

 CBC Hemoglobin-
TLC-
DLC-
PLATELET-
 LFT Total bilirubin- SGOT-
SGPT-
Direct bilirubin- ALP-
Indirect bilirubin- Albumin-

 RFT Urea Creatinine-

 S.ELECTROLYTE Na+ -

K+ -
 HbA1C

 LIPID PROFILE Total cholesterol-

HDL-
LDL-
VLDL-
Triglyceride-
CT FINDINGS :  Acute Appendicitis : Appendiceal diameter is increased in
acute appendicitis i.e ≥8-9 mm outer-to-outer diameter has been suggested
as a cut-off value but note this overlaps with the upper limit of normal
appendiceal diameter (~9.5 mm)
 wall thickening (>3 mm) and enhancement
 thickening of the cecal apex: cecal bar sign , arrowhead sign
 intraluminal fluid depth >2.6 mm in a dilated (>6 mm) appendix without
periappendiceal inflammation
 periappendiceal inflammation
o fat stranding
o thickening of the lateroconal fascia or mesoappendix
o extraluminal fluid
o phlegmon (inflammatory mass)
o abscess
 focal wall non-enhancement representing necrosis (gangrenous
appendicitis) and a precursor to perforation

Less specific signs may be associated with appendicitis:

 appendicolith
 periappendiceal reactive nodal enlargement

 Acute cholecystits :
 cholelithiasis: gallstones isodense to bile will be missed on CT
 gallbladder distension
 gallbladder wall thickening
 mural or mucosal hyperenhancement
 pericholecystic fluid and inflammatory fat stranding
 high-density bile
 enhancement of the adjacent liver parenchyma due to reactive
hyperemia
 tensile gallbladder fundus sign
o fundus bulging the anterior abdominal wall
o ~75% sensitivity and ~95% specificity for acute cholecystitis in the
absence of any other CT features
o useful sign in making an early diagnosis

 Small bowel obstruction : Features on CT may include:

 dilated small bowel loops >2.5 cm up from outer wall to outer wall
 normal caliber or collapsed loops distally
 small bowel feces sign

Closed-loop obstructions are diagnosed when a bowel loop of variable length

is occluded at two adjacent points along its course. May be partial or complete
with characteristic features:

 radial distribution of several dilated, fluid-filled bowel loops

 stretching of prominent mesenteric vessels converging towards the
point of torsion
 U-shaped or C-shaped configuration
  beak sign at the site of fusiform tapering
 whirl sign reflecting rotation of bowel loops around a fixed point

Strangulation is defined as closed-loop obstruction associated with intestinal

ischemia. Mainly seen when the diagnosis is delayed (up to 10% of small
bowel obstructions) and associated with high mortality. Features are non-
specific and include:

 thickened and increased attenuation of the bowel wall

 halo or target sign
 pneumatosis intestinalis
 portal venous gas
 localized fluid or hemorrhage in the mesentery

 Acute pancreatitis :
o Focal or diffuse parenchymal enlargement
o changes in density because of edema
o indistinct pancreatic margins owing to inflammation
o surrounding retroperitoneal fat stranding
 liquefactive necrosis of pancreatic parenchyma
o lack of parenchymal enhancement (should ideally be 1 week after
symptom onset to differentiate from pancreatic hypoenhancement
secondary only to edema)
o often multifocal
 infected necrosis
o difficult to distinguish from aseptic liquefactive necrosis
o the presence of gas is helpful (emphysematous pancreatitis)
o FNA helpful
 abscess formation
o circumscribed fluid collection
o little or no necrotic tissues (thus distinguishing it from infected
necrosis)
 hemorrhage
o high-attenuation fluid in the retroperitoneum or peripancreatic
tissues
 calcification
o evidence of background chronic pancreatitis
 retroperitoneal fat necrosis 33
o low density collection showing minimal heterogeneity
o mimicking carcinomatosis

 Acute renal colic :- On CT almost all stones are opaque but vary
considerably in density.

 Perforated peptic ulcer :-

There is a small amount of scattered pneumoperitoneum, with gas locules

clustered around the gastroduodenal transition, where mild fat straining is
present and there are signs of pyloric wall discontinuity suggesting a
perforated ulcer. The bowel is not dilated and demonstrates normal
enhancement of its wall. The multiple colonic diverticula do not have signs
of an acute inflammatory process. There is a small amount of free fluid in
the pelvis. The liver demonstrates a well-defined 1 cm hypodense nodule
 in the segment VII that has a benign appearance. Calcified gallstones
noted. The spleen, adrenal glands, pancreas, and kidneys are all normal.
Minimal atheromatous disease through the abdominal aorta. The lung
bases are clear, the heart is enlarged. No suspicious bone lesions.

 Diverticulitis : pericolic stranding, often disproportionately prominent

compared to amount of bowel wall thickening
 segmental thickening of bowel wall
 enhancement of colonic wall
o usually has inner and outer high-attenuation layers, with a thick
middle layer of low attenuation
 diverticular perforation
o extravasation of gas and fluid into pelvis and peritoneal cavity
 abscess formation (seen in up to 30% of cases)
o may contain fluid, gas or both
 fistula formation (usually a chronic complication)
o gas in the bladder
o direct visualization of a fistulous tract
 INFORMED CONSENT

Study Number:

Title: :- “Role of computed tomography in non traumatic acute abdomen in adults .

Subject’s Initials:

Subject’s Name:

Date of Birth/Age:

1. I confirm that I have read and understood the information sheet dated for the above
study and have had the opportunity to ask questions. ( )
2. I understand that my participation in the study is voluntary and that I am free to
withdraw at any time, without giving any reason without my medical care or legal rights
being affected.( )
3. I understand that the sponsor of the clinical trial, others working on the sponsor’s
behalf, the Ethics Committee and the regulatory authorities of the current study and any
further research that may be conducted in relation to it, even if I withdraw from the
trial. I agree to this access. However, I understand that my identity will not be revealed
in any information related to third parties or published. ( )
4. I agree not to restrict the use of any data or results that arise from this studyprovided
such a use is only for scientific purposes.
( )
5. I agree to take part in above study. ( )

Signature/Thumb impression of the subject / Legally accepted

representative Date:
Signatory’s Name:
Signature of the Investigator:
Date:
Study Investigator’s Name:
 Guide’s curriculum vitae

Name DR MEGHA JAIN

Father’s name MR

Contact number +91

Address LNMC Campus Kolar Road, Bhopal

M.P. 462042

Qualification MBBS, MD(RADIODIAGNOSIS)

Designation Head of Department of

RADIODIAGNOSIS

Date of joining

Permanent registration number MP

State of registration Madhya Pradesh

Date of registration/
//
 Investigator’s curriculum vitae

Name Dr. Akarsh Taneja

Father’s name Shri Pawan Taneja

Contact number 9917402654

Address S-10, PG-I, PG hostel, JK hospital, JK

town, Sarvadham, kolar road,
Bhopal,
Madhya Pradesh.

Qualification MBBS

Designation Postgraduation

Date of joining 19/12/2022

Permanent registration number DMC/R/27700

State of registration Delhi

Date of registration 15/10/2020

 सूचितसहमचत

अध्ययन शीर्षक:
अध्ययन संख्या:
चिर्य केप्रारंचिकअक्षर:
चिर्यकानाम:
पता:-

न्मकीचतचि / आयु:

(1) मैंपुचिकरता हंचक मैंनेसूिनापत्र पढ़ और सम चिया हैो उपयुषक्तअध्ययन केचिए चिनांचकतहैऔर मुप्रनेपूपूश्ने
कानेअिसर चमिा है।( )
(2) मैंसम ता हंचक अध्ययन मेंमेरीिागीिारी स्वैच्छिकहैऔर मैंचकसी िी समय अपनी िागीिारी िापस
िेनेकचिए स्वतंत्रहं।( )
(3)मैंसम ता हंचक नैिाचनकपरीक्षण केप्रायो क, प्रायो क की तरफ सेकाम करनेिािेअन्य, नैचतकता सचमचत और
ितषमानअध्ययन केचनयामक प्राचिकरण और इसकेसंबंिमेंचकए ा सकनेिािेचकसी सम्बंचित चिशी , ििे ही मैं प र र क्ष ण
सेचनकि ाऊं,परीक्षण को ारी रखा ा सकता है|मैंइसिक्तव्य सेसहमत हं। हािांचक, मैंसम ता हंचक मेरीपहिान
तीसरेपक्ष सेसंबंचितचकसी िी ानकारी मेंप्रकाचशत नहींहोगी। ()

(4)मैंइसअध्ययन सेउत्पन्न होनेिािेचकसी िी डेटाया पररणामोंकेउपयोग को प्रचतबंचितनहींकरनेकेचिए सहमत

हंबशतेऐसा उपयोग के ििैज्ञाचनकउद्दे केचिए
है। श्ों ( )
(5) मैंउपरोक्त अध्ययन मेंिाग िेनेकचिए सहमत हं।( ) चिर्य / कानूनीरूप

सेस्वीकृप्रचतचनचि केहस्ताक्षर / अंगूठेकीाप चिनांक:

हस्ताक्षर कताषका नाम:

ांिकताषका हस्ताक्षर:

अध्ययन ांिकताषका नाम: