bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatocellular carcinoma diagnosed radiologically, treated by transcatheter arterial embolization and limited-field radiotherapy
Authors: Akine Y , Hasegawa H , Takayasu K , Muramatsu Y
Published: July 2009

Issues raised by Dr J E Jackson concerning the case reported by Le Pechoux et al [1] in the BJR are: (1) the reliability of diagnosis based on imaging only; and (2) that of percutaneous biopsy in the diagnosis of a hepatocellular carcinoma (HCC) with its maximum diameter of 8 cm.

The hepatic tumour presented had a fibrous capsule (Figure 1) along with characteristic imaging features as described in the text and thus we feel confident with the diagnosis given. Fibrolamellar hepatoma is extremely rare in Japan as indicated by the fact that we have seen no patient with this disease at the National Cancer Center Hospital where about 100 patients with hepatic tumours are annually operated upon. Hepatic adenoma is also very rarely seen in Japan. As for the possibility of the described lesion being a metastasis, the patient has shown no evidence of other malignant tumour in any other organ for the past 4 years and, in addition, the diagnosis of metastatic tumour is unlikely because of the fibrous capsule.
Book reviews
Authors: Cherryman G R
Published: July 2009

Clinical nuclear medicine has advanced considerably in the five years since the publication of the first edition of the Atlas of Clinical Nuclear Medicine. This much anticipated second edition has been fully revised and restructured.
Book reviews
Authors: Padley S P G
Published: July 2009

This book is one of a series of texts concentrating on the practical aspects of interventional radiology. The stated aim of these books is “to produce highly practical manuals…” and to “highlight such aspects as choice of equipment, pitfalls, complications and trouble-shooting”.
Computed tomography evaluation of renal parenchymal volume in patients with chronic pyelonephritis and its relationship to glomerular filtration rate
Authors: D'Souza R C M , Kotre C J , Owen J P , Keir M J , Ward M K , Wilkinson R
Published: July 2009

The measurement of renal parenchymal volume using a calibrated computed tomography image processing method has been evaluated clinically on a cohort of patients with chronic pyelonephritis. Comparison of renal volume with function as assessed by 99Tcm DTPA renography demonstrated a simple linear relationship in patients who were normotensive and aproteinuric. The implications of this result on the interpretation of prognostic factors determining declining renal function in chronic pyelonephritis are discussed.
Classification of ductal cacinoma in situ by image analysis of calcifications from digital mammograms
Authors: Parker J , Dance D R , Davies D H , Yeoman L J , Michell M J , Humphreys S
Published: July 2009

There is evidence to suggest that non-comedo cases of ductal carcinoma in situ (DCIS) may have a lower risk of progressing to invasive disease than comedo DCIS and may be managed with less radical treatment. Most cases of DCIS present as calcifications on the mammogram and, due to differences in the tumour architecture, comedo calcifications often have a characteristic linear or branching appearance. In this study, computer methods were developed to identify the comedo cases using the imaging features of individual calcifications and of calcification clusters. Classifier performance was measured using the area under the receiver operating characteristic (ROC) curve and was optimized by systematic testing of many different combinations of these features. On a test-set of 42 cases the computer achieved a ROC curve area of 0.91 using six combined cluster features. These results are encouraging given the observed overlap in appearance between the comedo and non-comedo cases.
Inside a thin man—an engrossing problem
Authors: Hughes J P , Jones E Wyn
Published: July 2009

A 21-year-old male presented with a 12 month history of progressive symptoms in his right leg, consisting of weakness and numbness, with a limp which was initially fluctuant, but becoming more persistent. He also complained of lower dorsal back pain which seemed to be posture-related, and over the past 2–3 months he had developed some frequency of micturition. He had been seen 10 years previously on account of clumsiness, but no clear diagnosis had been reached. His general health was normally good and he was on no medication.
Caesium-137 spherical sources for the LDR\WIDR Selectron
Authors: Medley C M T
Published: July 2009

The letter from Dr Jones in the British Journal of Radiology [1] makes a number of points about caesium-137 spherical sources manufactured for Nucletron by Amersham International plc.

I am pleased that Dr Jones found Amersham helpful when discussing the issues; however, I would like to clarify our position and in particular comment on his statement “10 years of technical progress at Amersham … has resulted in a lower quality standard”.
Biophysical properties and clinical applications of magnetic resonance imaging contrast agents
Authors: Vré R Mathur-De , Lemort M
Published: July 2009

Contrast enhanced magnetic resonance imaging (MRI) is a very versatile and effective technique for detecting and characterizing lesions, for identifying a variety of patho-physiological abnormalities, and for providing perfusion and functional information. The application of contrast enhanced MRI to many clinical and research indications has emerged because of the rapid evolution in imaging techniques, improved methodology, and the development of efficient and specific contrast agents. Problems related to optimizing parameters and dosage have been due to complex interplay of relaxation times, biophysical mechanisms and acquisition parameters. A knowledge of basic biophysical aspects is therefore essential for a full understanding of the results obtained for different organs under different conditions, and for optimizing the image parameters and dosage of contrast agents. This article underlines the biophysical basis of the effects of contrast agents in MRI, identifies the problems involved in optimizing the parameters for maximum efficiency, and presents a general overview of the clinical studies and research applications in the central nervous system, perfusion abnormalities, hepatobiliary system, musculoskeletal system and the gastrointestinal tract. The section on perfusion studies includes a discussion of quantitative analysis and kinetic models describing the effects of contrast agents. Finally, a critical evaluation of the scope and limitations of contrast enhanced MRI is presented.
The use of a contrast–detail test object in the optimization of optical density in mammography
Authors: Robson K J , Kotre C J , Faulkner K
Published: July 2009

In mammography, it is important that the maximum amount of diagnostic information is obtained from each radiograph. One of the factors influencing image quality is the optical density of the film. In this study, a contrast–detail test object was used to establish the optimum optical density value on the basis of signal-to-noise ratio (SNR) for two mammographic film–screen combinations under particular processing conditions. The optimum optical density, taken as being the point at which the threshold contrast is a minimum varied little with detail size. The optimum optical density for the Fuji film–screen combination with Photosol chemistry was found to be higher than that for the Kodak film–screen combination and Kodak processing conditions studied. Although the actual values of optical density are specific to the fixed processing conditions encountered, the technique has more general applicability.
Radiation dose reduction in paediatric fluoroscopy using added filtration
Authors: Nicholson R A , Thornton A , Akpan M
Published: July 2009

Studies on a water phantom indicate that the insertion of extra tube filtration combined with the removal of the antiscatter grid can reduce the total energy imparted from paediatric fluoroscopy by a factor of more than four when automatic exposure control is used. The omission of the grid is responsible for up to 40% of the reduction while the addition of 0.7 mm steel filtration is found to account for a further reduction in energy imparted of between 57% and 70%, for depths of water simulating small patients of 6–16 cm thickness. For all contrast paediatric examinations the reduction in image quality was considered to be small and the diagnostic information unimpaired with the filter in place.
Inflammatory abdominal aortic aneurysm—dynamic Gd-DTPA enhanced magnetic resonance imaging features
Authors: Hayashi H , Kumazaki T
Published: July 2009

Inflammatory abdominal aortic aneurysm is an uncommon disorder characterized by marked thickening and extensive inflammatory changes of the aneurysmal wall. The appearances of an inflammatory abdominal aortic aneurysm on dynamic Gd-DTPA enhanced magnetic resonance imaging are described and the value of this modality in achieving a pre-operative diagnosis is emphasized.
Book reviews
Authors: Robinson A
Published: July 2009

This booklet in the IPSM Report Series describes techniques for the physical assessment of dental radiology equipment — both simple intraoral and panoramic X-ray equipment. The first chapter describes methods and gives expected results for measurement of tube output, exposure time, kilovoltage, filtration and focal spot size.
Pseudotumoral pelvic retroperitoneal fibrosis associated with orbital fibrosis
Authors: Van Hoe L , Oyen R , Gryspeerdt S , Baert A L , Bobbaers H , Baert L
Published: July 2009

We report the case of a man with bilateral orbital fibrous pseudotumours and a large pelvic mass which was initially thought to be malignant. Sonographically guided transrectal core biopsies showed it to be a fibrotic retroperitoneal pseudotumour. The mass decreased after steroid therapy. The computed tomography and magnetic resonance imaging features of this unusual form of pelvic fibrosis as well as the association with heterotopic fibrosis are discussed.
Simulated thoracic aortic dissection on magnetic resonance in a patient with interruption of the inferior vena cava
Authors: Savit R M , Panico R A
Published: July 2009

We present a case of simulated thoracic aortic dissection in a patient with interruption of the inferior vena cava and azygous and hemiazygous continuation.
Book review
Authors: Plant G
Published: July 2009

This multiauthored book has been edited by a surgeon, Jonathan Earnshaw and a radiologist, Roger Gregson, and the contributors are radiologists and surgeons from the United Kingdom with extensive expertise and experience in thrombolysis. Nearly all the authors are members of the Thrombolysis Study Group, a multidisciplinary conglomeration who have joined forces to increase the pool of experience with thrombolysis and generate multiinstitutional studies.
Book reviews
Authors: Bates J
Published: July 2009

This is a comprehensive work with contributions from many notable experts in the field. The book starts with three introductory chapters on the physics of Doppler, signal processing and haemodynamics, which are a little more advanced than usual, and are directed at readers who already have a basic, working knowledge of Doppler ultrasound.
Book reviews
Authors: Faulkner K
Published: July 2009

This handbook is intended to be an introductory manual on radiation protection for workers and radiation protection supervisors who are involved with the use of ionizing radiations in laboratories. As befits book prepared on behalf of the Association of University Radiation Protection Officers, it is primarily concerned with radioactive materials and closed sources found in a university environment.
Book review
Authors: Kerslake R W
Published: July 2009

Aimed primarily at radiologists preparing for the Part 1 examination for the Fellowship of the Royal College of Radiologists, the cover of this relatively inexpensive paperback volume proclaims that “no longer will a trainee radiologist/radiographer need to distil a knowledge of diagnostic imaging from a large number of anatomy and radiology books”.
Magnetic resonance imaging in the detection of focal liver lesions: comparison of dynamic contrast-enhanced TurboFLASH and T
2 weighted spin echo images
Authors: Ward J , Baudouin C J , Ridgway J P , RObinson P J
Published: July 2009

In a previous study using dynamic contrast-enhanced TurboFLASH (DCETF) for demonstration of the portal venous system we found that this technique showed more liver lesions than T  2 weighted spin echo (T  2WSE) imaging in the same patients. In this study we have formally compared axial T  2WSE images (TR2000, TE 45/90) with TurboFlash images (TR 135, TE4, FA 80°) acquired immediately after bolus injection of Gd-DTPA (0.1 mmol kg−1) in 41 patients referred for hepatic magnetic resonance imaging (MRI) prior to surgery for liver lesions. The images of each sequence were independently reviewed by two observers. The lesions were counted and each sequence was scored for conspicuity, level of artefact and subjective image quality. Contrast-to-noise ratios using user denned regions of interest were calculated. Significantly more lesions were seen on DCETF (n=186) images than on T  2WSE (n=123) images (p<0.001). Lesion conspicuity was equal in 53% of cases, better on DCETF in 36% and better on T  2WSE in 11%. Contrast-to-noise ratios were significantly higher on DCETF images (p<0.05). DCETF imaging provided a substantial improvement in lesion detection compared with T  2WSE imaging.
Entrance doses during lateral lumbar spine and antero–posterior abdomen examinations: generator waveform dependence
Authors: Morrison G D , Underwood A C
Published: July 2009

In North Trent, UK, an entrance dose survey of lateral lumbar spine and antero-posterior (AP) abdomen examinations has been carried out in 17 radiology departments. The survey comprised 294 lateral lumbar spine and 322 AP abdomen entrance dose measurements. The mean entrance doses were found to be approximately half of the relevant national reference entrance dose levels of 30 mGy and 10 mGy, respectively. The effect of generator waveform on entrance dose was studied by separating the generators into two types: “pulsating potential” (PP) generators and “constant potential” (CP) generators for each examination. PP generators comprised 23% of the total number of examinations. The mean entrance dose and radiographic exposure factors from CP generators were found to be significantly lower than those from PP generators. The use of CP type generators, together with low attenuation components can significantly reduce patient

entrance doses for these examinations.
Analysis of patient doses for myelogram and discogram examinations and their reduction through changes in equipment set-up
Authors: Martin C J , Hunter S
Published: July 2009

Patient doses for myelogram and discogram examinations performed on two C-arm X-ray units have been measured using dose–area product meters. Contributions to the dose from fluoroscopy and radiography have been obtained from analysis of results for a selection of examinations. Information was recorded about the individual beam projections used, in order to allow estimates of effective dose. Effective doses for lumbar myelograms were 3–4 mSv and for cervical myelograms and discograms were 1 mSv. The doses on the two units were similar, but contributions from the various parts of the examinations were different. Quality assurance (QA) measurements of dose variables were used to determine reasons for these differences in performance. Fluoroscopic doses are influenced by image intensifier dose rate and by the way in which exposure factor selection has been set up for the automatic exposure control (AEC) system. Doses from digital fluorography on units for specialized applications may be greater than those with standard film/screen systems. Recommendations have been made concerning ways in which doses on each unit might be reduced. Detailed assessments of doses resulting from AEC set-up options, made during QA tests, can help to ensure that the optimum balance between patient dose and image quality is achieved.
Computed tomography in the investigation of bilateral mandibular coronoid hyperplasia
Authors: Gibbons A J
Published: July 2009

Bilateral mandibular coronoid hyperplasia is characterized by restricted mouth opening due to impingement of the coronoid processes on the zygomatic arches. The condition is unfamiliar to many clinicians and may be significantly under-reported. The presented case highlights the benefits of computed tomography (CT) in the diagnosis and surgical evaluation of this disorder.
Book reviews
Authors: Hately W
Published: July 2009

One might ask, as do the authors in the preface, why a new book on this subject is needed. The question is answered on reading this text atlas itself. There has been a continuing steady increase in the use of ultrasound as the primary and often only technique in imaging the urogenital tract so that much fuller descriptions are required than can be accommodated within a general ultrasound textbook.
Computerized axial tomographic scan measurements as prognostic indicators in patients with cervical carcinoma
Authors: Shepherd S F , Collins C D , Fryatt I J C , Parsons C A , Blake P R
Published: July 2009

This retrospective study of 56 patients with carcinoma of the uterine cervix treated with radical radiotherapy at the Royal Marsden Hospital, London, examined whether simple measurements of maximum tumour dimension from computerized axial tomographic (CT) scans have any prognostic significance. Our results indicate that tumour depth (i.e. maximum antero-posterior dimension) of 4 cm or more is associated with a statistically significant increased relative risk of death of 2.4 (95% CI 1.1–5.5; p = 0.045), as compared with tumours with a depth of less than 4 cm. In addition, there was a clear correlation between tumour depth and lymph node involvement (r = 0.36; p > 0.01), and tumour depth and width (r = 0.70; p > 0.005). We suggest that a measurement of maximum tumour depth from the staging CT scan in these patients provides valuable additional information about likely occult lymph node metastases and prognosis, over and above that suggested by the FIGO staging system alone.
Field matching in craniospinal irradiation
Authors: Cheng C-W , Das I J , Chen D-J
Published: July 2009

We would like to thank Drs Tatcher and Glicksman for their interest in our article [1].

The objective of our investigation [1] was not simply to validate their earlier results [2].
Ultrasonic assessment of hemidiaphragmatic movement: an indirect method of evaluating mediastinal invasion in non-small cell lung cancer
Authors: Houston J G , Fleet M , McMillan N , Cowan M D
Published: July 2009

This preliminary study aimed to assess the potential value of diaphragmatic ultrasound (DUS) in evaluating phrenic nerve involvement indirectly, in the non-invasive pre-operative staging of mediastinal invasion in non-small cell lung cancer (NSCLC). A prospective study of 30 patients with NSCLC comparing the findings of diaphragmatic ultrasound, chest radiograph, computed tomography (CT) thorax and mediastinoscopy was performed. In all cases adequate quantitiative assessment of hemidiaphragmatic excursion was obtained. There was discordance in four of 30 patients between DUS and chest radiograph. Three of nine patients with extensive mediastinal disease on CT had abnormal DUS, and two of eight patients with indeterminate mediastinal disease on CT had abnormal DUS and were later found to be non-resectable. No abnormal cases of DUS were found in those cases with normal mediastinal CT. There was no clear relationship between the site, size and side of the primary tumour on CT, or its pleural or diaphragmatic contiguity, and hemidiaphragmatic excursion. There was concordance between DUS and mediastinoscopy in 17 of 21 patients. Two patients had normal mediastinoscopy and abnormal DUS but were not resectable at thoracotomy. No patient with abnormal DUS was resectable. DUS may be of potential value in the pre-operative staging of NSCLC and is therefore worthy of further evaluation.
A comparison of bone densitometry measurements of the central skeleton in post-menopausal women with and without vertebral fracture
Authors: Duboeuf F , Jergas M , Schott A M , Wu C Y , Glüer C C , Genant H K
Published: July 2009

The purpose of this investigation was to compare the ability of two different bone densitometry techniques (quantitative computed tomography and dual X-ray absorptiometry) to discriminate subjects without any vertebral fracture from those with definite vertebral fractures. Bone mineral density (BMD) was determined in 112 post-menopausal women. 83 women were classified free of vertebral fracture and 29 were considered to have definite vertebral fractures. Quantitative computed tomography (QCT) was performed using three different spinal regions of interest. Dual X-ray absorptiometry (DXA) was measured at the spine (both in posteroanterior (PA) and lateral (L-DXA) projection, and at hip (total, neck and Ward regions). An additional estimated volumetric BMD was derived from the PA and L-DXA spine scans. Individuals with definite vertebral fractures had lower bone mineral density for each of the methods and regions of interest (ROI). Spinal QCT results, total and Ward hip DXA results showed the greatest percentage decrement. Odds ratio estimates revealed a significant relationship between BMD and fracture with spinal QCT, hip, and volumetric spinal DXA. The greatest areas under the receiver operating characteristic (ROC) curves were found with results of spinal QCT, total and Ward hip DXA, and volumetric spinal DXA measurements. It is concluded that spinal QCT and femoral total DXA measurement may be preferred to PA and lateral L3 DXA measurements.
Mammography in the follow-up after breast-conserving treatment in cancer of the breast: suitability for mammographic interpretation, validity and interobserver variation
Authors: Jager J J , Langendijk J A , Dohmen J P , Schreutelkamp I L , Volovics L , van Engelshoven J M , de Jong J M , Schouten L J , Hupperets P S , Blijham G H
Published: July 2009

The aims of this study were to determine the suitability for radiographic interpretation, interobserver variability and validity of mammography after breast-conserving treatment. Initial and post-treatment mammograms of 100 consecutive patients treated between 1982 and 1987, with a minimal follow-up of 5 years, were independently selected for review by two radiologists. Mammograms were classified according to suitability for interpretation and radiological diagnosis based on the presence of characteristics of malignancy. The interobserver variability was expressed in kappa values, the validity in a receiver operating characteristic (ROC) plot. 534 post-treatment and 86 initial mammograms of 92 patients were obtained. Suitability for interpretation was not different from pre-treatment mammograms and was significantly associated with age, being better in the age group over 50 years. No association was observed between suitability for interpretation and treatmentrelated factors, even if irradiation was combined with concurrent chemotherapy. Reliability of conclusions regarding sensitivity and specificity in this study are limited due to the small number of events. Interobserver agreement concerning classification was moderate (weighted kappa = 0.49). ROC analysis showed an optimal decision threshold between the “uncertain” and “suspect” categories of malignancy, resulting in a sensitivity of 86% and a specificity of 98%. The appearance of new pathological microcalcifications with or without tumour mass seemed to be the most important characteristics of malignancy predicting local relapse. No clear alteration in suitability for interpretation was observed in the mammograms after breast-conserving treatment, even if irradiation was combined with concurrent chemotherapy. Mammography after breast conserving-treatment may be slightly less sensitive but is equally specific compared with mammography in the screening situation.
Multiple thoracic haemangiomas—a rare cause of spinal cord compression
Authors: Worthy S A , Gholkar A , Walls T J , TODD N V
Published: July 2009

Benign haemangiomas are a rare cause of mediastinal masses. We present a patient with multiple thoracic wall and mediastinal haemangiomas who developed spinal cord compression as a result of extradural extension of the haemangiomas. This is a rare cause of spinal cord compression.
A simple method for skin/lesion localization using magnetic resonance imaging
Authors: Walkden S B
Published: July 2009

I read with interest the article by English et al in the August 1994 issue of the British Journal of Radiology [1]. We use a similar system for marking the vertebral level in cases of thoracic spinal cord compression. A series of sealed plastic tubes containing Lipiodol are taped to the back enabling skin marking of the abnormal level. In cases of spinal cord compression going to immediate surgery after the magnetic resonance (MR) examination it is unlikely the skin mark will be erased. However, if a patient needs to be transferred to another centre for surgery, or is awaiting irradiation, the time lapse increases the possibility of erasure of the skin mark and a fall back method is useful.
Book reviews
Authors: Shaw D G
Published: July 2009

What are the differences and what is new in this latest edition of what has proved to be an enduring standard texjbook of paediatic radiology?
Book reviews
Authors: Phelan M
Published: July 2009

This is the second edition of this text book which has two aims. The first is to discuss common paediatric imaging in great detail and the second is to provide a text that is designed for clinical problems that need to be solved.
The use of xenon-133 for measurement of blood flow through systemic arteriovenous malformations before and after therapeutic embolization
Authors: Kennedy A M , Banks L M , MacSweeney J E , Myers M J , Peters A M , Allison D J
Published: July 2009

Embolization is increasingly used to treat systemic arteriovenous (AV) shunts although its success, as judged by either angiographic or clinical means, is difficult to quantify. The aim of the study was to quantify blood flow through AV shunts with 133Xe, which, because of its relatively long transit time through peripheral tissues, behaves like microspheres. Following arterial injection, 133Xe entering an AV shunt rapidly arrives in the lung and can be quantified with a scintillation probe. In 17 patients with systemic AV shunts, the reduction in shunt flow following therapeutic embolization was quantified in the angiography theatre by comparing the initial count rates in the lung, recorded by probe, following injection of identical quantities of 133Xe into a supplying artery before and after embolization. By comparing the lung counts with those given by an intravenous injection of 133Xe, the fraction of flow at the catheter tip entering the shunt was also quantified. Tissue perfusion in the vascular territory distal to the shunt was measured at the same time by recording the clearance of non-shunted 133Xe with a second probe over the extremity. Control injections of 133Xe were given in the contralateral limb in order to assess 133Xe transit in the absence of shunting and to compare tissue perfusion between the two sides. Shunt flow ranged from 40% to 100% (of that at the tip of the catheter) (n = 14), while the reduction in shunt flow following embolization ranged from 15% to 96% (n = 19). Tissue perfusion distal to the shunt and in the contralateral limb was about 5 ml 100ml−1 min−1. Contrast medium had no consistent effect on tissue perfusion in either limb, or on shunt flow. There was no difference in peripheral perfusion between the abnormal and control sides, nor any significant difference in perfusion in the distal tissue on the abnormal side before and after embolization. There was, however, a consistent increase in the fraction of the injected 133Xe delivered to the distal tissue after embolization (median increase 93%, p<0.001). The technique is relatively simple and merits further development as a means of continuous quantification of systemic AV shunt flow in the angiography theatre at the time of embolization.
Relationship between the diuretic effect of radiocontrast media and their ability to increase renal vascular resistance
Authors: Morcos S K , Brown P W G , Oldroyd S , EL Nahas A M , Haylor J
Published: July 2009

The relationship between diuresis and natriuresis induced by radiocontrast media (RCM) and their renal haemodynamic effects were investigated. The effects of the iso-osmolar iotrolan and the hyperosmolar diatrizoate on the renal vascular resistance (RVR) were studied in the filtering and non-filtering variants of the isolated perfused rat kidney (IPRK) preparation. In the non-filtering model, no tubular regulatory process can be activated. The effect of diatrizoate on the RVR of the filtering IPRK in the presence of frusemide (0.3 mmol l−1) an inhibitor of the tubuloglomerular feedback (TGF) was also investigated. There was no significant difference (p>0.05) in the response of the filtering (n = 6) and non-filtering (n = 6) IPRK to iotrolan. The induced reduction in the renal perfusate flow (RPF) by iotrolan was 20.5 ± 3.05% and 22.9 ± 3.03%, respectively. The reduction in the RPF which was observed with diatrizoate in the non-filtering IPRK (n = 5,17.5 ± 3.04%) was significantly less (p<0.05) in comparison to that of the filtering IPRK (n = 6,26.9 ± 4.28%). In the frusemide experiments, a reduction in the RPF comparable to that of the non-filtering kidney was observed (n = 5, 13.7 ± 4.34%). This study demonstrates that the renal vascular effect of diatrizoate is partially dependent on the TGF response. No tubular regulatory mechanism was accountable for the haemodynamic effect of iotrolan. The activation of the tubular response is osmolarity dependent.
Explaining variation in radiologists' reporting times
Authors: Bryan S , Weatherburn G , Roddie M , Keen J , Muris N , Buxton M J
Published: July 2009

This paper describes an investigation into the reasons for variation in the time taken by senior radiologists to complete radiological reports. An observational study of the reporting process at one UK hospital was undertaken for a 25 day period. An independent health service researcher observed the radiology reporting process and collected data on a variety of factors including the time taken to produce the report, the number and nature of all images viewed, the experience of the radiologist, and the number of disturbances that occurred. The nature of the variation in reporting time was explored using both simple comparative statistics and more sophisticated multiple regression techniques. Data were collected on 2345 report observations and the median report time was 117 s. This research provides the first empirical evidence for systematic variation in reporting time. The results confirm the importance of certain factors that were expected to explain report time variation. For example, the results indicate that report time tended to be significantly shorter in reporting sessions that were busy, and significantly longer when the radiologist was disturbed during the reporting process or was training juniors during a reporting session. More surprising were the results indicating that there was no significant difference in report time for reports categorized as urgent or “hot” and those categorized as less urgent or “cold”, and that report time appeared to vary systematically depending on the day of the week and on the time of day.
A new device for performing sinograms—the Frank catheter
Authors: Frank J W
Published: July 2009

Usually sinography is a difficult and messy investigation, in that most of the contrast medium seeps past the Foley catheter balloon and out of the orifice. A new sinogram catheter has been devised to overcome this problem.
Tangential breast irradiation
Authors: Yarnold J R , Neal A J
Published: July 2009

We agree with Professor Rodger that the success of breast conserving surgery and radiotherapy depends on surgical technique and radiotherapy dose/fractionation as well as dosimetry. We question his prediction that a randomized controlled trial to explore the importance of dosimetry is not feasible. Our expectation is that in large-breasted women, patient self-assessment questionnaires will clearly discriminate between patients treated with conventional wedge techniques and those treated with 3D tissue compensators. Breast shrinkage, induration and breast pain/tenderness are all expected to be significantly affected. Our prediction is that the improvements will be clinically worthwhile for a significant sub-group of patients.
Book reviews
Authors: Padley S
Published: July 2009

This CD-ROM package (also available in CD-I format) is designed as an electronic reference to the normal anatomy of the temporal bone and posterior cranial fossa, presented in an easy to use visual format. Anatomical sections are provided with equivalent CT and MR images and all three modalities are displayed in axial sagittal and coronal planes. Anatomy, CT and MR sections in the same plane may be viewed simultaneously or individually. The anatomical sections may also be zoomed up by a factor of four, and in the anatomy mode there is an excellent point and click facility that will name over 25000 structures using either an English or Latin convention.
Book reviews
Authors: Qsborn S
Published: July 2009

Bremsstrahlung is not often a major hazard in most uses of radiation, but can make a significant contribution where high energy β=particles are involved. Information about such hazards is not easy to find, and this booklet collects together a mass of information from many sources.
Femoral angiography using the reverse shuffle technique
Authors: Oxtoby J W , Yeong C C , Singanayagam J , West D J , Rees M R
Published: July 2009

We report our findings using the “reverse shuffle” technique of stepping table femoral angiography. This technique represents a simple modification of the conventional stepping table sequence entailing a reverse table movement allowing acquisition of early and late films in the distal positions. It was developed in order to minimize the number of runs required in each examination. In a retrospective study 52/53 (98%) of angiograms using the reverse shuffle technique required only a single run compared with 30/51 (58%) using the conventional technique. We believe that the reverse shuffle should be used where possible when stepping table angiography is performed. Furthermore, the incorporation of a reverse table movement may also be advantageous in angiography using automated digital subtraction angiography (DSA) stepping systems.
Differential calculus
Authors: Roebuck D J , MacDonald L M
Published: July 2009

A previously well 8-year-old girl presented to a casualty department with a 3-week history of urinary frequency, dysuria and nocturia associated with intermittent abdominal pain. She had also had 10 days of watery diarrhoea following antibiotic treatment given by her general practitioner.
Book reviews
Authors: Roberts N
Published: July 2009

Digital Mammography concerns the role of the computer in the diagnosis of breast disease. Although the subject has been extensively studied for over a decade, a definitive textbook is lacking. Fortunately, however, every 2 years almost all those working on the subject meet to pass on and discuss the fruits of their reasearch. The Second International Workshop on Digital Mammography was held in York on 10–12 July 1994. The proceedings of the York meeting, published under the title Digital Mammography, provides an excellent and authoritative review of this wonderfully diverse and enthralling subject.
Evaluation of palpable breast masses with 201TI scintigraphy
Authors: Rebollo A C , Torres-Avisbal M , Espinosa J E , Diaz C , Vallejo J A , Pacheco C , Pera C , Mateo A
Published: July 2009

39 female patients (age range: 31–84 years) with palpable breast masses detected by physical examination, underwent 201Tl scintigraphy in order to assess its value in the detection of breast carcinomas and to differentiate them from benign breast masses. Planar images were carried out at 20–30 min and 2–3 h after intravenous administration of 111–185 MBq (3–5 mCi) of201Tl chloride. In 12 patients single photon emission tomography (SPET) studies were also performed. In 18 patients the scintigraphic studies were positive and in 17 of these cases, breast carcinomas were confirmed. Tumour sizes ranged from 1.3 to 6 cm in diameter. In the remaining patient a false positive result was obtained where there was benign breast change. In three of seven cases, malignant axillary nodes were also detected. All 21 patients with negative scintigraphy had benign breast lesions. There were no differences between images obtained at 20–30 min and 2–3 h or between planar images and SPET studies. In 10 patients there was disagreement between mammography and 201Tl scans. 201Tl scans confirmed the presence of carcinoma in three cases and discarded malignancy in the other six cases. In the remaining case, 201Tl scan was false positive. 201Tl scintigraphy is useful in distinguishing malignant from benign breast masses, even when compared with mammography.
Validation of 99Tcm-HMPAO leucocyte scintigraphy in ulcerative colitis by comparison with histology
Authors: Middleton S J , Li D , Wharton S , Reynolds P D , Wraight E P , Hunter J O
Published: July 2009

Leucocyte scintigraphy offers an alternative to more invasive techniques in the investigation of inflammatory bowel disease. The accuracy of 99Tcm-HMPAO leucocyte scintigraphy has not been assessed by comparison with colonic histology, which was the aim of this study. 15 patients with ulcerative colitis underwent 99Tcm-HMPAO leucocyte scintigraphy (TLS) less than 5 days before colonoscopy. Histological features of mucosal biopsies were compared with total and segmental colonic TLS scores. Segmental and total scintigraphy scores correlated most strongly with histological grades for acute inflammation (r = 0.75, p < 0.001 and r = 0.9, p < 0.001, respectively) and chronic inflammatory cell infiltration in the lamina propria (r = 0.76, p < 0.001 and r = 0.86, p < 0.001, respectively). 99Tcm-HMPAO leucocyte scintigraphy detected acute inflammation in the colon of patients with ulcerative colitis with a sensitivity of 91% and negative predictive value of 80% and localized acute inflammation to a particular colonic segment with a sensitivity of 82%, specificity of 94%, accuracy of 88%, positive predictive value of 94% and negative predictive value of 91%. 99Tcm-HMPAO leucocyte scintigraphy positivity predicts and localizes colonic acute inflammation with a high degree of confidence, but negative scintigraphy does not exclude acute inflammation.
Malignant fibrous histiocytoma following radiation therapy of fibrous dysplasia
Authors: Amin R , Ling R
Published: July 2009

Malignant fibrous histiocytoma commonly occurs spontaneously. In some cases it follows previous therapeutic or incidental irradiation, or miscellaneous pre-existing osseous conditions. Recently, it has been associated with total hip arthroplasty. We report a case of malignant fibrous histiocytoma following radiation therapy of fibrous dysplasia and review the relevant literature.
Late aggressive meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia
Authors: Stein M E , Drumea K , Guilbord J N , Ben-Itzhak O , Kuten A
Published: July 2009

The clinical, radiological and pathological findings in a 28-year-old female patient who developed aggressive meningioma 20 years after prophylatic cranial irradiation (PCI) for acute lymphoblastic leukaemia (ALL) are described here. Only four cases of late atypical/aggressive meningioma following PCI were detected in a thorough search of the literature. The high cure rate in childhood ALL, attributable to aggressive chemotherapy and PCI, is capable of inducing secondary brain tumour, including aggressive meningioma.
Book reviews
Authors: A'Hern R P
Published: July 2009

Good diagnostic tests identify a high proportion of subjects with the condition of interest without suggesting that a significant number of unaffected subjects have the condition i.e. they have both a high sensitivity and specificity. Sensitivity and specificity are both uniquely defined by the cut-off value used to define positive cases.
Book reviews
Authors: Walsh G E , Williams M P
Published: July 2009

This short text of accident and emergency radiology is aimed primarily at junior medical staff working in accident and emergency departments.
A beam model for three-dimensional radiotherapy planning
Authors: Redpath A T
Published: July 2009

A comprehensive beam model for three-dimensional radiotherapy planning is described. Input of patient data is either from an arbitrary spaced set of computed tomography (CT) scans throughout the treatment volume or from outlines traced on a digitizer. Any gantry, head or table rotation is allowed as well as any beam portal shape including internal blocking. Account is taken of beam modification due to the presence of the beam flattening filter, wedges and compensators. Both portal image and beam's eye view displays are readily available. A dose calculation algorithm is presented which uses a differential scatter-air ratio method to calculate the scatter dose in the presence of inhomogeneities. The beam model and algorithm form the basis of an interactive three-dimensional planning system running on a UNIX workstation, and performance times for dose calculation are given.
Ultrasound of the Achilles tendon after surgical repair: morphology and function
Authors: Maffulli N
Published: July 2009

I read with interest the paper by Rupp et al [1]. I have, however, some concerns about their findings and conclusions.

End-to-end suturing was performed in only four of the operations, while the rest of the patients were treated by a variety of methods. The use of plantaris tendon grafts and of gastrocnemius flaps, alone or in combination, suggests to me that these patients were treated significantly later than the immediate post-injury phase. I have personally repaired 106 Achilles tendon ruptures, and was always able to suture the tendon stumps in an end-to-end fashion in all patients who were operated on within 72 h of the injury.
Book reviews
Authors: Walton J M
Published: July 2009

Hylton Meire and Pat Farrant are well known to those involved in the field of diagnostic ultrasound. The authors have identified the need for a text which is aimed at newcomers to ultrasound who have no imaging background.
Display of cross sectional anatomy by nuclear magnetic resonance imaging
Authors: Hinshaw W. S. , Andrew E. R. , Bottomley P. A. , Holland G. N. , Moore W. S. , Worthington B. S.
Published: July 2009

High definition cross-sectional images produced by a new nuclear magnetic resonance (NMR) technique are shown. The images are a series of thin section scans in the coronal plane of the head of a rabbit. The NMR images are derived from the distribution of the density of mobile hydrogen atoms. Various tissue types can be distinguished and a clear registration of gross anatomy is demonstrated. No known hazards are associated with the technique.
Field strength dependence of MRI contrast enhancement: phantom measurements and application to dynamic breast imaging
Authors: Hittmair K , Turetschek K , Gomiscek G , Stiglbauer R , Schurawitzki H
Published: July 2009

Differences in MRI-measured contrast enhancement have been used for tissue characterization, particularly for the characterization of mammary tumours. T  1 weighted spoiled gradient echo sequences have usually been acquired for this purpose and relative signal intensity increase (S  rel) has been determined to quantify contrast uptake. The field strength dependence of this technique is evaluated in this paper by phantom measurements. S  rel is compared with the recently introduced “enhancement factor” (EF) and “contrast uptake equivalent” (CE) as a quantitative assessment parameter for contrast uptake. Enhancing tissues were simulated with water phantoms doped with increasing concentrations of Gd-DTPA. Spoiled gradients echo images (FLASH-2D) were obtained on a 0.2 T and 1.5 T MR system. S  rel, EF and CE were determined and the results of the phantom measurements were applied to typical types of breast tissues.S  rel showed a strong dependence on the magnetic field strength and was greater at higher field strengths. This is because S  rel correlates positively with the native T  1 which is longer at higher field strengths. Conversely, the EF and CE almost eliminated the distorting influences of the magnetic field strength. CE provided a good approximation of the actual contrast uptake. In practice, the dependence of S  rel on the magnetic field strength might cause malignant lesions to be misclassified as benign at low field strengths. Either S  rel criteria should be adjusted to magnetic field strength or EF and CE should be used instead of S  rel for tissue characterization with dynamic contrast-enhanced MRI.
The potential for dose reduction in diagnostic radiology using low attenuation materials in table tops
Authors: Sutton D , Cranley K
Published: July 2009

It is important to be able to assign priorities to the purchase of radiological equipment. The ability to incorporate potential dose savings into a ranking procedure involving costs is therefore of interest. In this paper we have considered the question of the dose saving made available by the selection of low attenuation table tops and have described how to generate a factor which can be used in a ranking procedure such as cost effectiveness analysis. We describe how data on the expected dose saving can be obtained from measurements of the aluminium equivalent thickness in air used in conjunction with theoretical spectral data. The magnitude of the overestimate when in air measurements alone are used is presented, as is a ready reckoner for determining the true dose saving when changes in table top are considered. Unless the table to be replaced is of some age, the expected dose saving will vary between 6% and 1%.
The use of sodium ironedetate (Sytron) as an MRI rectal contrast agent
Authors: Buxton P J
Published: July 2009

The use of bowel contrast medium in abdominal and pelvic MRI examinations is increasingly being recognized as a useful adjunct. A contrast agent which produces a negative contrast effect with T  2 weighted (T  2W) sequences might help distinguish bowel pathology, which has increased signal intensity, from bowel content. A solution of 7.6 mg ml−1 of sodium ironedetate (Sytron, Link Pharmaceuticals) produces positive contrast on the first (proton density) echo and negative contrast (signal void) on the second (T  2W) echo of a dual echo sequence at 0.5 T. When administered rectally it provides a negative contrast bowel marker for pelvic examinations.
Pleural encasement secondary to acinar adenocarcinoma of the submandibular gland
Authors: Hynes J , Howell A , Johnson R J
Published: July 2009

We present a case of a 42-year-old male with metastatic pleural encasement of the lung with extension into the mediastinum, resulting from an acinar adenocarcinoma of the submandibular gland diagnosed 30 years previously. The radiographic and CT appearances are presented, with a literature review.
Femoral angiography using the reverse shuffle technique
Authors: Oxtoby J
Published: July 2009

Our study was a retrospective comparison of the reverse shuffle technique with standard stepping table angiographic technique. It demonstrated that a simple modification of table movement incorporating a reverse step resulted in a significant reduction in the number of angiographic runs required. This is a significant finding because, despite the advent of digital techniques, the stepping table technique remains in widespread use both in the UK and abroad.
Book reviews
Authors: Williams M P
Published: July 2009

The book starts with a foreword by Bruce Reitz where he says “a variety of new technologies has provided clinicians with strikingly beautiful images of patient anatomy”. This book fully bears this out with striking 3D images of all the major vessels, views of their endothelial surfaces and reconstructions viewed from multiple angles.