bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of tumour regression rates during radiotherapy for cervical carcinoma by serial MRI: comparison of two measurement techniques and examination of intraobserver and interobserver variability.
Authors: Gong Q Y , Tan L T , Romaniuk C S , Jones B , Brunt J N , Roberts N
Published: June 2014

Tumour regression rates of 11 patients with cervical carcinoma were estimated during external beam radiotherapy (EBRT) using serial MRI (average time interval 7 days; range 3-15 days). An average of five investigations (range 4-8) was performed per subject. Tumour volume was measured by two observers using the Cavalieri method of modern design stereology in combination with (a) planimetry and (b) point counting. The mean precision of all the volume estimates obtained by manually tracing the outline of the tumour was 6.6%. The mean precision obtained by counting an average of 176 points per investigation on the same transects was 6.7%. The intraobserver repeatability of planimetry, interobserver reproducibility of planimetry and point counting were excellent with no significant difference between the volume estimates obtained using either technique. Based on the planimetry measurements, initial tumour volumes ranged from 6.5 to 222 cm3 (mean 63 cm3, median 44 cm3). Based on the point counting measurements, initial tumour volumes ranged from 7.2 to 235 cm3 (mean 68 cm3, median 46 cm3). Tumour regression began within a few days of commencing EBRT and showed an exponential relationship with time (p < 0.01). There was good agreement between the regression rates obtained by planimetry and those obtained by point counting. No significant correlation was found between initial tumour volume and tumour regression rate for either planimetry or point counting. Planimetry measurements were, on average, obtained in about half the time taken for point counting (i.e. 30 min and 50 min, respectively). Although point counting is generally likely to be the more efficient approach, planimetry may be the preferred approach for estimating tumour volume when a purpose built track ball is available and the tumour morphology is relatively simple. Volume measurement should be obtained using the Cavalieri method to ensure that the estimates are unbiased and that their precision can be predicted. The measured tumour regression rates may have important implications for improving local tumour control, optimum timing of brachytherapy and minimizing the risk of radiation damage.
A comparison of two mammography film-screen combinations designed for standard-cycle processing.
Authors: McParland B J
Published: June 2014

This paper presents comparisons of the Kodak Min-R 2000 mammography film-screen combination designed for standard-cycle processing with that of the older Min-RM/Min-R combination. Comparisons were performed in terms of characteristic curves and relative image quality. The Min-R 2000 combination had a speed of 1.7 relative to the Min-RM/Min-R combination to yield an optical density of 1.25; the maximum gradients of the characteristic curves for the two combinations were 4.6 and 2.7, respectively. Image quality was evaluated in a breast detail phantom study. It was demonstrated that image qualities of the film-screen combinations were comparable.
Metanephric adenoma in a solitary kidney.
Authors: Patankar T , Punekar S , Madiwale C , Prasad S , Hanchate V
Published: June 2014

A case of metanephric adenoma occurring in a solitary kidney of a 31-year-old man is presented. Metanephric adenoma is extremely rare and its diagnosis should be considered in a patient with a well circumscribed renal tumour and concomitant paraneoplastic syndromes. Radiological features of the tumour are non-specific and histopathological examination is essential to establish a definitive diagnosis. Recognition of the tumour is of potential importance as conservative treatment with complete surgical enucleation will suffice in all cases.
Computed tomography in abdominal tuberculosis.
Authors: Suri S , Gupta S , Suri R
Published: June 2014

The diagnosis of abdominal tuberculosis is often difficult because of its protean clinical manifestations and non-specific laboratory investigations. In the abdomen, tuberculosis may affect the intestinal tract, lymph nodes, peritoneum and solid viscera in varying combinations. CT, with its ability to provide a comprehensive overview of abdominal structures, is the imaging modality of choice for evaluation of such patients. This pictorial review illustrates the spectrum of CT appearances of abdominal tuberculosis which includes intestinal, lymph nodal, peritoneal, mesenteric, hepatic, splenic and pancreatic disease.
60 Gy isodose volumes in carcinoma of the cervix and their relation to the geometry of uterine tube and ovoids.
Authors: Jacob R , Bidmead A M , Blake P R
Published: June 2014

The International Commission on Radiation Units and Measurements recommends the use of 60 Gy isodose volumes for reporting doses in the intracavity treatment of carcinoma of the uterine cervix. This study was aimed at determining the variation in isodose volumes while using different sizes of intrauterine tubes and ovoids, with different applicator geometries. It was based on the treatment plans of 175 patients with cervical cancer, treated with low dose rate intracavitary brachytherapy with or without additional external beam radiotherapy. The volumes encompassed by the 60 Gy isodose curves were calculated using the Nucletron planning system. Applicator positions in 15 patients who were treated to the same point A dose, using 6 cm intrauterine tube and medium ovoids, were recorded. This was to discover how variations in applicator geometry influences isodose volumes. The 60 Gy isodose volumes increased with increasing point A dose. For a constant point A dose prescription, reference isodose volume increased with ovoid applicator size used, but showed no consistent variation with the length of intrauterine tube. There were individual variations in the isodose volumes within a standard set-up (same sized intrauterine tube and ovoids and same point A dose), due to variations in applicator geometry. Displacement of the ovoids changed the volumes encompassed by the reference isodose. There are significant variations in the volumes encompassed by the 60 Gy isodose during intracavitary treatment using a standard set-up, while treatment using applicators of different sizes can give equivalent values of 60 Gy isodose volume. 60 Gy isodose volumes may hence be useful in dosimetric comparisons but have a limited role in predicting clinical response.
Calculating shielding requirements in diagnostic X-ray departments.
Authors: Petrantonaki M , Kappas C , Efstathopoulos E P , Theodorakos Y , Panayiotakis G
Published: June 2014

Structural radiation protection for diagnostic X-ray facilities is most commonly performed following the recommendations of the National Council on Radiation Protection and Measurements Report No. 49. A number of analytical methods have already been developed to improve the design of these facilities. Specifically, these methods reassess shielding calculations in X-ray areas with respect to the methodology of the calculation of the barrier thickness and the number of sources considered in the area. Thus, they generate an overall solution for the cases met at the medical radiation structural design. This paper presents an extension of an existing method for calculating shielding requirements, for multiple X-ray tubes in a room operated at various beam qualities. The methodology computes the required shielding thickness such that the exposure behind it stays below a desired value. The presented method eliminates the overestimation of added shielding thickness which may occur using the other methods already mentioned. A user-friendly windows-based program has also been developed to assist shielding computations.
Report of an image quality and dose audit according to directive 97/43/Euratom at Spanish private radiodiagnostics facilities.
Authors: González L , Vañó E , Oliete S , Manrique J , Hernáez J M , Lahuerta J , Ruiz J
Published: June 2014

An audit of Spanish private medicine radiodiagnostics facilities has been carried out, based partly on Spanish legislation relating to European Directives on health protection against ionizing radiation risks in medical exposure. The study included an appraisal of infrastructure and equipment, and aspects of quality assurance and radiation protection, by means of data collected through surveys. Of the 51 centres audited, a sample of 24 X-ray rooms was chosen, then an external evaluation with regard to image quality and patient dose was performed, by an advisory board of radiologists and medical physicists. The methodology used was similar to that of the group of European Union experts in European dose evaluation and image quality trials. Chest, abdomen, lumbar spine and breast examinations were monitored. Doses were measured with thermoluminescent dosimeters. A third of the X-ray rooms evaluated reached or exceeded dose reference values, and in a third of the cases the image quality left considerable room for improvement. Breast and chest examinations showed themselves to be the hardest to perform, not only as a result of exceeding the reference doses, but also due to failure to meet good image quality standards.
Imaging findings in primary carcinoid tumour of the liver with gastrin production.
Authors: Kehagias D , Moulopoulos L , Smirniotis V , Pafiti A , Ispanopoulos S , Vlahos L
Published: June 2014

We present a 57-year-old man with Zollinger-Ellison syndrome who had undergone total gastrectomy 12 years previously. At that time, a cystic mass in the left lobe of the liver was palpated but was not removed. The patient currently had high serum gastrin levels. Abdominal ultrasound, CT and MR images showed a well defined liver mass with solid and cystic components. The lesion was resected and a primary hepatic carcinoid tumour was diagnosed. Post-operatively, serum gastrin levels were normal. A primary liver carcinoid may appear as multicystic liver mass with solid components. Careful exclusion of a primary tumour elsewhere is required to establish the diagnosis of this rare entity.
Thallium-201 scintigraphy in malignant mesothelioma.
Authors: Watanabe N , Shimizu M , Kameda K , Kanazawa T , Seto H
Published: June 2014

A patient with malignant pleural mesothelioma was investigated using 201Tl scintigraphy. There was diffuse pleural tumour accumulation on planar scintigraphy. Single photon emission computed tomography (SPECT) demonstrated exact tumour location. It is concluded that planar scintigraphy using 201Tl may be useful in detecting mesothelioma. Clearer tumour localization is possible with SPECT.
Reliability of radiological measurements in the assessment of hip dysplasia in adults.
Authors: Nelitz M , Guenther K P , Gunkel S , Puhl W
Published: June 2014

Radiographic measurements are commonly used to quantify the treatment results of hip dysplasia and assess further need of operative treatment. We investigated the interobserver and intraobserver reliability of the commonest radiographic techniques in the assessment of hip dysplasia in skeletally mature adults. Three observers independently analysed 100 hip radiographs of patients with hip dysplasia aged between 16 and 32 years. We measured centre-edge angle of Wiberg, acetabular angle of Sharp, acetabular index of the weightbearing zone, acetabular index of depth to width, ACM-angle, MZ-distance, acetabular head index, lateral subluxation and neck-shaft angle. In addition, the radiographs were reviewed a second time 3 months apart by two of the observers to assess intraobserver reliability. We found a high correlation (intraclass correlation coefficient) for interobserver reliability (0.76-0.87) and intraobserver reliability (0.70-0.92) for all radiographic measurements except acetabular index of depth to width, ACM-angle and MZ-distance. Depending on the clinical question we therefore recommend the use of one of the reliable measurements to assess the radiograph of a dysplastic hip.
MR features of the denervated tongue in radiation induced neuropathy.
Authors: King A D , Ahuja A , Leung S F , Chan Y L , Lam W W , Metreweli C
Published: June 2014

The MR features of the denervated tongue have been described following nerve injury from radical neck dissection and tumour invasion. The purpose of the study was to determine whether similar features are present in the tongue following radiation induced neuropathy (RIN). The clinical records and MR images of 12 patients with RIN of the hypoglossal nerve were reviewed retrospectively. T1 weighted SE images were performed in 12, T2 weighted TSE images in 11, fat suppressed images in 10 and contrast enhanced T1 weighted images in nine patients. The denervated tongue revealed "oedemalike" changes in five, fatty infiltration in six, atrophy in 11 and pseudohypertrophy in one patient. Abnormal enhancement was not identified, and in five patients the signal intensity was normal on all sequences. The oedemalike changes, fatty infiltration and normal signal intensity were seen 2-48, 2-48, and 6-63 months, respectively, after the onset of RIN. In conclusion, there was no discernible relationship between the duration of RIN and the MR appearance of the denervated tongue. Oedemalike changes, previously described in the acute/subacute phase of denervation, were also seen in long-standing disease and there was no associated abnormal enhancement in any case. Furthermore, the signal intensity may be normal, the MR diagnosis relying on asymmetry of the size of the tongue. It is postulated that radiation causes incomplete and ongoing damage of the nerve, the course of which is unpredictable.
High dose rate brachytherapy practice for the treatment of gynaecological cancers in the UK.
Authors: Jones B , Pryce P L , Blake P R , Dale R G
Published: June 2014

A summary of UK high dose rate brachytherapy practice in gynaecological cancer is presented. There appears to be relatively good uniformity in dose prescription and biological effective doses, which represents a considerable improvement from the findings of a previous report of UK low dose rate brachytherapy practice in 1991. Individual details of the dose schedules used at each treatment centre are presented.
Polypoid endobronchial Hodgkin's disease with pneumomediastinum.
Authors: Kim K I , Lee J W , Lee M K , Lee C H , Park S K
Published: June 2014

We report a 23-year-old man with polypoid endobronchial Hodgkin's disease which presented with intermittent multilobar atelectasis and spontaneous pneumomediastinum. Chest radiograph and CT findings are demonstrated.
Pachymeningitis and optic neuritis in rheumatoid arthritis: MRI findings.
Authors: Ağildere A M , Tutar N U , Yücel E , Coşkun M , Benli S , Aydin P
Published: June 2014

Rheumatoid arthritis is a systemic disease in which cerebral and eye involvement is neither common nor fully understood. Although it is rarely the cause of pachymeningitis and optic neuritis, rheumatoid arthritis should always be kept in mind in these two conditions. We present a 52-year-old male with an 8 month history of rheumatoid arthritis who was referred to the neurology department with headache and decreasing vision and was diagnosed as having rheumatoid pachymeningitis and optic neuritis on the basis of MRI findings.
The meaning and significance of the equilibrium phase in enhanced computed tomography of the liver.
Authors: Dawson P , Morgan J
Published: June 2014

The "equilibrium phase" (EP) in liver contrast enhancement in CT is generally held to be a potential pitfall by way of loss of intrinsic lesion conspicuity. Unfortunately, the definitions extant in the literature are not firmly rooted in a pharmacokinetic basis. Such a basis is developed in this article and a method is described for estimating the time of onset of the EP. It is shown that this may be, effectively, as early as 120 s or so after the beginning of a typical infusion of contrast agent. This means that incremental scanning protocols are likely to result in later slices being acquired in the EP. It is further shown that the pharmacokinetic model does predict a danger of loss of lesion conspicuity in EP scanning. Fortunately, rapid helical/spiral scanning makes it a danger that is easily avoided.
Pre-operative staging of ampullary tumours by endoscopic ultrasound.
Authors: Kubo H , Chijiiwa Y , Akahoshi K , Hamada S , Matsui N , Nawata H
Published: June 2014

Ampullary carcinomas have a significantly higher resectability rate and better prognosis than other periampullary carcinomas, although the prognosis is poor with advanced disease. Accurate tumour staging is therefore important in surgical planning. Our objective was to evaluate the usefulness of, and problems associated with, endoscopic ultrasound (EUS) in the pre-operative staging of ampullary tumours. 35 patients with ampullary tumours were pre-operatively examined with EUS. The imaging results were compared with histopathological findings of the resected specimen according to the TNM staging classification. The overall accuracy of tumour (T) staging was 74% (26/35) for all tumours, and 67% (6/9), 71% (10/14) and 83% (10/12) respectively for T1, T2 and T3 tumours. The overall accuracy of nodal (N) staging was 63%. In diagnosing pancreatic invasion, EUS had an accuracy of 86% (30/35), a sensitivity of 83% (10/12), and a specificity of 87% (20/23). In conclusion, EUS provides an accurate method of evaluating the stage of ampullary tumours, especially infiltration into the pancreas. This modality is useful to surgeons in deciding on an appropriate therapeutic approach and in giving a prognosis.
Malignant mesothelioma of the tunica vaginalis: a case with an unusually indolent course following radical orchidectomy and radiotherapy.
Authors: Harmse J L , Evans A T , Windsor P M
Published: June 2014

Malignant mesothelioma (malignant adenomatoid tumour) of the tunica vaginalis testis is a very rare neoplasm with highly aggressive biological behaviour. Treatment is difficult, and widespread local invasion and/or metastatic disease at presentation are associated with a poor prognosis. In this case report we describe for the first time a patient who, despite presenting with locally advanced disease, remains well 10 years after diagnosis and treatment with radical orchidectomy and high dose radiotherapy.
The hypertrophied antral-pyloric fold: CT appearance.
Authors: Harvey R T , Levine M S , Birnbaum B A
Published: June 2014

We report a patient found to have a hypertrophied antral-pyloric fold on barium study, in whom CT demonstrated a smooth soft tissue mass on the anterior wall of the pre-pyloric antrum. When this finding is encountered on CT, a double-contrast upper GI study should be performed as the next diagnostic test. Endoscopy can probably be avoided if the barium study shows the typical findings of a hypertrophied antral-pyloric fold.
Evaluation of 18F-FDG positron emission tomography in gastric and oesophageal carcinoma.
Authors: McAteer D , Wallis F , Couper G , Norton M , Welch A , Bruce D , Park K , Nicolson M , Gilbert F J , Sharp P
Published: June 2014

The aim of this study was to evaluate 18F-fluoro-deoxyglucose (FDG) positron emission tomography (PET) in gastric and oesophageal carcinoma. 16 patients with biopsy proven oesophageal or gastric carcinoma had PET scans. Four patients had advanced disease and received palliative treatment. The remaining 12 patients were randomized to immediate surgery or neoadjuvant chemotherapy. Three patients had repeat PET scans following chemotherapy. PET detected the primary tumour in all cases including stage T1 lesions. Involved locoregional nodes (N1, N2) were not identified separately from the primary tumour. Semiquantitative analysis was performed in the form of tumour to liver activity ratios (TLR). In general, the TLR values were higher in the higher T stages, although there was only one case each of T1 and T2 lesions. PET scanning using 18F-FDG is a sensitive method for detecting primary oesophageal and gastric cancers but is limited in locoregional staging.
A simple chest radiograph score to predict chronic lung disease in prematurely born infants.
Authors: Greenough A , Kavvadia V , Johnson A H , Calvert S , Peacock J , Karani J
Published: June 2014

A simple scoring system has been evaluated with regard to its ability to characterize the pre-term infant's chest radiograph appearance at 28 days and predict oxygen dependency beyond 36 weeks post-conceptional age (PCA). Chest radiographs taken at approximately 1 month of age in 42 infants (median gestational age 28 weeks) were assessed by the scoring system for the presence of fibrosis/interstitial shadows, cystic elements and degree of hyperinflation (maximum score 8). The system's results were then compared with those obtained using two previously published scoring systems. Using all three systems, there were significant differences in the scores of infants who were and were not oxygen dependent at 28 days (p < 0.001) and 36 weeks PCA (p < 0.001). For the three systems, the positive predictive values of a score of 3 or more to predict oxygen dependency at 36 weeks (PCA) were between 67% and 80% and similar receiver operating characteristic curves were obtained. We conclude that scoring only three abnormalities of the 28 day chest radiograph appearance of pre-term infants gives useful predictive information.
Correlation of a defect of portal perfusion in the dorsal part of segment IV of the liver on CT arterial portography with inflow of the aberrant pancreaticoduodenal vein.
Authors: Yamagami T , Takeuchi Y , Inaba Y , Matsueda K , Arai Y , Maeda T
Published: June 2014

The correlation between an aberrant pancreaticoduodenal vein and a portal perfusion defect in the dorsal part of segment IV as demonstrated on CT arterial portography (CTAP) was investigated. 14 patients with non-tumorous defects of portal perfusion in the dorsal part of segment IV of the liver parenchyma, shown on CTAP underwent CT during pancreaticoduodenal arteriography. The defect on CTAP was shown as an enhanced area resulting from non-portal venous inflow in eight (57%) of 14 patients on CT during pancreaticoduodenal arteriography. In conclusion, the non-portal venous supply via an aberrant pancreaticoduodenal vein occasionally causes a defect of portal perfusion in the dorsal part of segment IV on CT arterial portography.
The cost of radiotherapy as a function of facility size and hours of operation.
Authors: Dunscombe P , Roberts G , Walker J
Published: June 2014

Against a background of constant or decreasing budgets, this study was undertaken to investigate the economic effects of changes in selected operational parameters within a radiation treatment programme. Using financial data from the Northeastern Ontario Regional Cancer Centre and a recognized staffing model, a commercial spreadsheet has been used to calculate the cost of an 18 fraction course of radiotherapy, including all the major preparatory processes such as simulation and treatment planning. Using the spreadsheet, and on the basis of explicit and reasonable assumptions, the cost of radiotherapy has been calculated as the facility size (i.e. equipment complement) and hours of operation are varied. Based on the assumptions used, the cost of radiotherapy in a facility treating less than about 1600 patients per year starts to rise. At 400 patients per year, a course costs approximately 50% more than at 1600 patients per annum. Extended hours of operation do not appear to generate significant, if any, savings when realistic assumptions about machine lifetime and overtime payments are made. Using a spreadsheet to simulate changes in a radiation treatment programme can be an important decision-making tool, as the effects of changes in operating parameters can be demonstrated.
Superior mesenteric artery stenting for mesenteric ischaemia in Sneddon's syndrome.
Authors: Khoo L A , Belli A M
Published: June 2014

Mesenteric ischaemia is a rare but serious cause of abdominal pain. We present the case of a man with Sneddon's syndrome, who had symptomatic mesenteric ischaemia secondary to a superior mesenteric artery stenosis in conjunction with a hepatic artery stenosis. As far as the authors are aware, this has not previously been described in Sneddon's syndrome, which is a vascular systemic disease characterized by an association between cerebrovascular accidents and a livedo reticularis skin rash. He was treated with balloon angioplasty and stent insertion, with good symptomatic improvement. This has implications for other stenoses in this condition should they become symptomatic.
Adverse reactions to radiocontrast media in an Indian population.
Authors: Thomas M , Peedicayil J , Koshi T , Korah I
Published: June 2014

This study was conducted to determine the epidemiological characteristics and clinical presentation of adverse reactions to intravenous radiocontrast media (CM) in patients of Indian origin. 379 of 1798 patients who received either sodium iothalamate or sodium meglumine diatrizoate developed adverse reactions (i.e. 21.08% of patients). The incidence of mild, moderate and severe adverse reactions were 19.47%, 1.33% and 0.28%, respectively. One patient who developed a severe reaction expired. There were no differences in the incidence of adverse reactions according to gender (males 21.2%; females 20.8%; p = 0.907) or age (p = 0.876). The incidence of adverse reactions was significantly higher in patients with a history of previous reactions (45.5%) than in those with no history (20.9%; p = 0.046). The incidence of reactions was also significantly higher in patients with a history of predisposing factors such as bronchial asthma (69.2%) and diabetes mellitus (60.0%) than in those without such a history (20.6%; p = 0). The incidence of adverse reactions in patients who received premedication prior to CM administration because of a history of predisposing factors (21.4%) was not significantly different from that in patients who were not premedicated (21.2%; p = 0.974), a result probably due to inadequate premedication used in the study. The skin was the most commonly affected site of reaction.
A comparison of image reject rates when using film, hard copy computed radiography and soft copy images on picture archiving and communication systems (PACS) workstations.
Authors: Weatherburn G C , Bryan S , West M
Published: June 2014

A comparison has been made of the reject rates of plain images for three separate periods when film, computed radiography (CR) and PACS systems were in operation throughout the Hammersmith Hospital, London. There was a statistically significant reduction in the overall percentage reject rate across all examinations from 9.9% to 8.1% when the hospital changed from using a conventional film based system to a CR system. There was a further reduction in the reject rate to 7.3% when the hospital moved to a hospital-wide PACS system, but this change was not statistically significant. Using estimations of the total number of images used, the percentage reject rates were 6.6% for film, 5.5% for CR and 5.5% for PACS. Thus, if the radiation dose for each image is unchanged, and the same types of images are used for the examination of each body area, a move from conventional film imaging to phosphor plate imaging provides the potential to reduce the patient population dose.
Assessing chemotherapy response of squamous cell oesophageal carcinoma with spiral CT.
Authors: Griffith J F , Chan A C , Chow L T , Leung S F , Lam Y H , Liang E Y , Chung S C , Metreweli C
Published: June 2014

45 patients with squamous cell carcinoma of the oesophagus were examined prior to, and following, pre-operative chemotherapy by spiral CT. Oesophageal CT was performed following gaseous distention of the oesophagus. TNM stage and perceived resectability on CT before and after chemotherapy were compared and related to surgical resectability and pathological staging. T-stage changed in 26% and N-stage changed in 9% of tumours after chemotherapy. Post-chemotherapy CT predicted pathological T-stage with an accuracy of 88% and N-stage with an accuracy of 84%. Six of 14 tumours considered irresectable on CT pre-chemotherapy were considered resectable on post-chemotherapy CT. Five of these six tumours were resectable at surgery. Post-chemotherapy CT predicted surgical resectability with an accuracy of 88%, the main pitfall being underestimation and overestimation of tracheobronchial invasion. CT prediction of chemotherapy response as judged by change in tumour volume was compared with a quantitative pathological assessment of chemotherapy response. 93% of oesophageal tumours changed volume after chemotherapy with 51% having a volume reduction of > or = 50%. However, no correlation was found between tumour volume reduction on serial CT examinations and either a quantitative pathological assessment of tumour response or patient survival.
Comparison of iodixanol and iohexol in renal impairment.
Authors: Chalmers N , Jackson R W
Published: June 2014

Iodixanol (Visipaque, Nycomed, Oslo, Norway) is an iodinated contrast medium in the form of a non-ionic dimer which is iso-osmolar with plasma at all iodine concentrations. There is little evidence regarding its renal tolerance in renal impairment. We therefore undertook a prospective randomized comparison of iodixanol and the non-ionic monomer iohexol (Omnipaque, Nycomed, Oslo, Norway). The serum creatinine was measured pre- and post-angiography in a series of in-patients to establish whether there was any clinically detectable evidence of superiority of iodixanol over iohexol in this high risk group. 8/54 (15%) patients in the iodixanol group had a rise in creatinine of > 10% in the week following angiography compared with 15/48 (31%) in the iohexol group (p < 0.05). The creatinine rise was positively correlated with the dose of both contrast media. These results suggest that iodixanol may be slightly less nephrotoxic than iohexol.
Fetal doses from radiological examinations.
Authors: Osei E K , Faulkner K
Published: June 2014

There has been growing concern about radiation exposures in the case of pregnant women who undergo radiological examinations of the lower abdomen and pelvis, when the embryo/fetus is near or included in the X-ray field. This paper describes a retrospective study of 50 pregnant women accrued over a period of 10 years. Most of these women were not aware of pregnancy at the time of their radiological examinations. They subsequently discovered that they were pregnant and sought advice from their physicians on fetal dose and risk. They were then referred to a Radiation Protection Advisor for an estimation of the fetal dose. Radiation absorbed dose to the embryo/fetus was estimated from a knowledge of technique factors and examination details using normalized uterine doses published by the National Radiological Protection Board (NRPB). Doses to the embryo/fetus varied between less than 0.01 microGy and 117 mGy, depending on the examination. Gestational ages ranged between 2 and 24 weeks.
Relative electron density calibration of CT scanners for radiotherapy treatment planning.
Authors: Thomas S J
Published: June 2014

Several authors have reported data on the variation of Hounsfield numbers with electron density in CT scanners. The data can be fitted with a double straight line approach. For non-bone tissues (or phantom materials with similar atomic numbers) the data from all authors can be fitted to a single straight line. For bone-like materials the line varies between authors. The method used to measure electron density has a greater effect than the differences between scanners, or the kilovoltage used on a given scanner. The effect of variation of these slopes on the accuracy of radiotherapy treatment planning is analysed. For typical radiotherapy beams, to produce a 1% error in dosimetry would require errors of over 8% in bone electron density. Using a single pair of calibration lines for all the scanners reported would give dosimetric errors of under 0.8%. A formula is recommended as a default for use in planning systems in circumstances where no data are available for a particular scanner.
Improving the visibility of radio-opaque markers in mammography.
Authors: Kotre C J , Robson K J , Simpson W
Published: June 2014

Owing to the high mean film optical densities used in breast screening mammography, and the very high maximum optical densities that can be obtained using modern mammographic film, it is often found that for larger exposures the nominally radio-opaque markers used to identify views, left and right etc., cannot be seen using a normal illuminator. A simple solution to this problem is to back the radio-opaque markers with a thin metal filter chosen to keep the marker information visible over a wide range of exposures. A convenient material for this is copper foil in the form of self-adhesive tape. The improvement in marker contrast produced by this modification is illustrated using point optical density measurements on marked test films produced at the extremes of the mammographic exposure range.
MRI assessment of the pre-vertebral soft tissues in acute cervical spine trauma.
Authors: White P , Seymour R , Powell N
Published: June 2014

This pictorial review illustrates the MRI appearances of pre-vertebral haematoma in acute cervical spine trauma. The review is based on 31 patients who underwent MRI within 5 days of injury. MRI showed pre-vertebral haematoma in 24 cases; soft tissue thickening was detected on conventional radiographs in 14 cases. MRI is more sensitive than radiography for the detection of pre-vertebral haematoma.
The indications for scrotal ultrasound.
Authors: Lau M W , Taylor P M , Payne S R
Published: June 2014

Scrotal ultrasound scanning is now a routine and mandatory investigation of the patient presenting with scrotal symptoms. The need for scrotal ultrasound scanning when the physical examination reveals no significant abnormality has not been previously assessed. We conducted a retrospective study of 160 patients attending for scrotal ultrasound over a period of 1 year. The accuracy of clinical examination was compared with the gold standard of ultrasound for identifying clinically significant lesions. The sensitivity, specificity and positive and negative predictive values were calculated. Four clinically relevant groups were used for analysis purposes: Group I, acutely painful scrotum with or without swelling; Group II, chronic testicular pain without swelling; Group III, chronic scrotal swelling with or without pain; and Group IV, the asymptomatic testis. In Group I, sensitivity was 100%, specificity was 81.3%, the positive predictive value was 92.1% and the negative predictive value was 100%. In Group II, sensitivity was 71.4%, specificity was 90.9%, the positive predictive value was 76.9% and the negative predictive value was 88.2%. In Group III, sensitivity was 88.9%, specificity was 66.7%, the positive predictive value was 92.3% and the negative predictive value was 57.1%. In Group IV, sensitivity was 33.3%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 93.9%. All clinically significant abnormalities were identified on clinical examination. Clinically insignificant lesions identified by ultrasound alone did not affect the clinical management. It is recommended that scrotal ultrasound is used in the acutely painful scrotum where a confident diagnosis cannot be made or there is failure to respond to treatment, and in the chronic swelling where a confident clinical diagnosis cannot be made.
A transformation cross-talk technique for simultaneous dual radionuclide imaging: a myocardial perfusion 201Tl/99Tcm sestamibi dog SPECT study.
Authors: Knesaurek K , Machac J
Published: June 2014

We have developed a novel transformation method for the correction of cross-talk in simultaneous dual radionuclide single photon emission CT (SPECT) imaging. It is based on the assumption that the transformations, which transform the primary energy window images into the scatter images as viewed in the other energy windows, are known. The method was tested on a dog model. These transformations were found by measuring the point response functions (prf) in different energy windows for both radionuclides in water. The dual radionuclide correction method described takes into account the different spatial distributions of the primary and scatter cross-talk photons in different energy windows. This method also includes the sequential application of restoration filters to the resulting cross-talk corrected images. We used a dog model in three separate studies: two single radionuclide studies used as references and one dual radionuclide study. Contrast between the left ventricular cavity (LVC) and the myocardium was used in horizontal long axis (HLA) slices as a parameter to evaluate the results of the dual radionuclide correction method with restoration. The increase of the contrast in the dual radionuclide corrected images in both energy windows, i.e. 201Tl primary window (70 keV) and 99Tcm primary window (140 keV), was significant. The cross-talk corrected 70 keV dual radionuclide HLA slice had a contrast of 0.62 compared with 0.35, which was the value in the non-corrected dual radionuclide HLA slice. Restoration improved the contrast to 0.68. In the single radionuclide 201Tl image, the same contrast was 0.59, improving to 0.70 after restoration. For the dual radionuclide 140 keV HLA slice, the contrast increased from 0.69 to 0.76 after cross-talk correction. Additional increase of the contrast to 0.83 resulted from restoration filtering. In the single radionuclide 99Tcm sestamibi 140 keV HLA slice the improvement of contrast was from 0.63 to 0.86 as a result of the restoration. The transformation three-window, dual radionuclide correction method with restoration improves the quality of the simultaneous rest 201Tl/stress 99Tcm sestamibi SPECT imaging.
The bead bag immobilization device.
Authors: Francis I S , Dodge G S , Platts A D
Published: June 2014

Our aim was to reduce motion artefact during radiographic angiography and MRI of the lower limbs. The legs were immobilized using a bead bag with a filtered closeable valve. Air was removed by suction and the bag moulded into a rigid restraint. The bead bag is an effective, well tolerated and easily used immobilization device that is suitable for use in radiological imaging.
In vivo dosimetry using diodes as a quality control tool--experience of 2 years and 2000 patients.
Authors: Shakeshaft J T , Morgan H M , Simpson P D
Published: June 2014

This paper reports the use of diodes as a quality control tool on more than 95% of patients undergoing megavoltage radiotherapy during the past 2 years. The paper describes a simple method for using the diodes, a number of possible pitfalls and a quality issue raised by the measurements. In general, the results have been reassuring with very few patients falling outside a +/- 5% action level.
Measurement imprecision in vertebral morphometry of spinal radiographs obtained in the European Prospective Osteoporosis Study: consequences for the identification of prevalent and incident deformities.
Authors: Weber K , Lunt M , Gowin W , Lauermann T , Armbrecht G , Wieland E , Leb G , O'Neill T , Felsenberg D , Reeve J
Published: June 2014

Several algorithms are currently in use for evaluating vertebral deformities from plain lateral radiographs of the lumbar and thoracic spine. However, the effects of measurement imprecision as well as uncertainties over image magnification on the correct identification of prevalent and incident vertebral deformities with these algorithms has been little studied. In a pilot study for the European Prospective Osteoporosis Study (EPOS), plain radiographs were submitted to a single central evaluating centre for measurement of vertebral height from T4 to L4. The thoracic and lumbar spines were imaged on separate films, and we have assessed the precision of measurement of vertebral heights and height ratios. The standard deviation of the differences between films of each of three height measurements ranged from 1.1 to 1.2 mm. A two-stage strategy for identifying incident deformities was devised. This required that the vertebra be a prevalent deformity at the time of the second radiograph and also that at least one of the vertebral ratios should have changed significantly since the first radiograph. The second stage removed all but two of the 18 vertebrae flagged positive in the first stage but not considered to be certain incident fractures by clinical reading of the radiographs.
High speed injection of radiographic contrast media induces severe particulate contamination.
Authors: Hirakawa M , Sendo T , Kataoka Y , Oishi R
Published: June 2014

In a study of exogenous particulate contamination during angiography, the effect of injection speed of four kinds of radiographic contrast media (RCM) was investigated. The particle count (> or = 10 microns) in all RCM increased in a speed-dependent manner and the increase was especially dramatic at 3 ml s-1. The extent of increase in particulate matter was higher for ioxaglate than for the other three RCM. As particulate matter is unwanted and unnecessary, to prevent the harmful effects in patients much attention should be paid to various factors generating particulate matters, such as characteristics of RCM and plastic syringe.
A case of rectoprostatic fistula due to prostatic abscess visualized by barium enema.
Authors: Sadamoto Y , Araki Y , Harada N , Hamada S , Chijiiwa Y , Nawata H
Published: June 2014

We report a rare case of rectoprostatic fistula due to spontaneous rupture of a prostatic abscess in a patient with diabetes mellitus. Barium enema clearly showed rectoprostatic fistula. Barium enema and colonoscopy were very useful in demonstrating the rectoprostatic fistula.
Imaging of recurrent esthesioneuroblastoma.
Authors: Pickuth D , Heywang-Köbrunner S H
Published: June 2014

Esthesioneuroblastoma is an uncommon neoplasm arising from the olfactory epithelium and characterized by frequent local recurrences. The purpose of this study was to determine the role of CT and MRI in the diagnosis of recurrent esthesioneuroblastoma. A total of 14 histologically confirmed recurrent esthesioneuroblastomas referred to our institution between 1986 and 1998 was retrospectively reviewed. All patients underwent both CT and MRI. The tumour recurrences displayed a variety of imaging characteristics and aggressiveness. They were typically expansile and destructive in their growth patterns. Erosion of the cribriform plate and involvement of the anterior cranial fossa were common findings. The CT and MRI appearances of recurrent esthesioneuroblastoma do not differ significantly from tumours imaged at initial presentation. Patients should receive close follow-ups and CT/MRI examinations for several years beyond diagnosis, as early diagnosis of recurrent disease predicts survival.
Dynamic contrast enhanced magnetic resonance scanning as a predictor of response to accelerated radiotherapy for advanced head and neck cancer.
Authors: Hoskin P J , Saunders M I , Goodchild K , Powell M E , Taylor N J , Baddeley H
Published: June 2014

Tumour perfusion has been assessed in patients with advanced head and neck cancer using dynamic contrast enhanced MRI prior to and at completion of accelerated radiotherapy, and related to local tumour control. Sequential MRI scans, at 3 s intervals after intravenous injection of gadolinium using a dynamic scan sequence through a tumour region of interest (ROI), were performed in 13 patients with advanced head and neck cancer before and on completion of radiotherapy. The scans have been analysed in terms of maximum tumour enhancement (E), slope of the enhancement versus time curve and the time taken to reach maximum tumour enhancement (Tmax), and these parameters related to tumour outcome after radiotherapy. Local tumour control was related to the value of E on a post-radiotherapy scan and the difference in Tmax between a pre- and post-radiotherapy scan. Durable local control was seen in those tumours with a post-radiotherapy value for E of less than 8 and a mean fall in Tmax of 27.3 s. These results imply that tumours with diminished tumour perfusion at the end of radiotherapy are those most sensitive to treatment and that those tumours which show greater tumour enhancement after accelerated radiotherapy are likely to fail locally. This may reflect the persistence of viable perfused tumour at completion of radiotherapy.
Clinical implementation of a computer controlled milling machine for compensating filter production.
Authors: Partridge M , Donovan E , Fenton N , Reise S , Blane S
Published: June 2014

The procedures required for the clinical implementation of a computer controlled milling machine for producing compensators for breast radiotherapy are described. Moulds are cut in a rigid polymer foam block and filled with stainless-steel granulate. Quality assurance procedures are described for ensuring that the compensators produced are consistent and accurate. Relative and absolute dosimetric measurements are presented showing that the compensators are accurate to better than 1% and demonstrate the technique to be clinically acceptable.
Osteoid osteoma of a cervical vertebral body.
Authors: Hermann G , Abdelwahab I F , Casden A , Mosesson R , Klein M J
Published: June 2014

An osteoid osteoma in the anterior part of the body of the fourth cervical vertebra occurred in a 22-year-old female. The patient's main complaint was neck pain and occasional numbness of the extremities. The pain was relieved by analgesics. Plain radiography and a 99Tcm MDP bone scan showed a non-specific abnormality. CT suggested the pathological diagnosis with reasonable certainty. The unusual location of the lesion and the role of various diagnostic modalities are discussed and the literature reviewed.
Subclavian artery aneurysm with oesophagoarterial fistula.
Authors: Dicle O , Secil M , Goktay A Y , Akbaylar H
Published: June 2014

Aneurysms of the subclavian artery are rare. Fistula formation between the subclavian artery and the oesophagus has been described in aberrant subclavian artery and oesophageal foreign body. However, a fistula between a non-aberrant subclavian artery aneurysm and the oesophagus has not been previously reported. In this report, an unusual case of subclavian artery aneurysm with a fistula to the oesophagus causing intractable haematemesis is presented with the angiographic findings.
The risks of treating keloids with radiotherapy.
Authors: Botwood N , Lewanski C , Lowdell C
Published: June 2014

The risk of carcinogenesis from radiation exposure is well known. It has been questioned for some time therefore, whether it is wise to treat benign disease with radiotherapy. We report a case of a patient who developed bilateral breast carcinomas almost 30 years after treatment of chest wall keloids with radiotherapy. There are only anecdotal reports in the literature of malignancies following treatment of keloids with radiotherapy. We review these reports and discuss the safety of this approach to the management of keloid scars.