bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal hepatic calcification in subcapsular haematoma with hydrops fetalis
Authors: Buxton P. J. , Maheswaran P. , Dewbury K. C. , Moore I. E.
Published: July 2009

There are many causes of fetal and infant hepatic calcification. We present two cases of hepatic calcification in a subcapsular haematoma in neonates with hydrops fetalis and chromosomal abnormalities. We do not believe that such an association has been described previously.

A 22-year-old woman presented at 30 weeks gestation with polyhydramnios. An ultrasound scan at 14 weeks had shown no abnormality. A scan at 30 weeks showed gross fetal ascites and a diagnosis of non-Rhesus hydrops was made. The pregnancy was allowed to continue and a normal vaginal delivery occurred at 33 weeks. A female infant with external features of Down's syndrome was delivered. Chest and abdominal radiographs taken on the first day showed areas of reticular calcification in the right upper quadrant (Fig. 1). An ultrasound examination on the fourth day showed this calcification to lie on the liver surface and to be concentrated mainly around the porta hepatis. There was gross ascites but no other areas of calcification could be seen (Fig. 2). An ultrasound scan of the brain was normal. There was no growth of organisms from blood or ascitic fluid and antibody titres for varicella and toxoplasmosis, rubella, cytomegalovirus and herpes simplex (TORCH) complex viruses were negative. On the fifth day of life she became cyanotic and died. Trisomy 21 was confirmed cytogenetically.

A 27-year-old woman presented at 18 weeks gestation for a routine antenatal ultrasound scan.
The chest X ray in Q-fever: a report on 69 cases from the 1989 West Midlands outbreak
Authors: Smith D. L. , Wellings R. , Walker C. , Ayres J. G. , Burge P. S.
Published: July 2009

Acute and serial chest radiographic appearances of Q-fever in a large UK outbreak in the West Midlands are described. In 69 acute films (taken within 20 days of onset of illness), 10% of films were normal. Appearances in 62 abnormal films were varied and, in contrast to some previous reports, showed no features that might distinguish Q-fever pneumonia from pneumonias of other origins. Analysis of serial films in 47 cases showed that complete radiographic resolution frequently took up to 6 months, longer than has been described previously. Initial appearances deteriorated over the first 2 weeks of radiographic surveillance in 20% of cases. No relationship was found between the extent of radiographic change and the age of the patient or the presence or absence of respiratory symptoms. Age did not affect time to resolution.
Chronic stress injuries of the elbow in young gymnasts
Authors: Chan D. , Aldridge M. J. , Maffulli N. , Davies A. M.
Published: July 2009

The radiological changes of chronic stress injuries of the elbow in 19 adolescent elite gymnasts are reported. The principal abnormalities were avascular necrosis of the capitellar epiphysis (Panner's disease) (one patient), post-traumatic subarticular necrosis (osteochondritis dissecans) of the capitellum (six patients) and the medial articular eminence of the distal humerus (one patient). Flattening and anterior depression of the radial head epiphysis with an underlying metaphyseal notch associated with an epiphyseal cleft (three patients), which, in one patient who continued training, developed into a chronic Salter Type IV stress fracture. A further patient, post-epiphyseal fusion, showed osteochondritis dissecans of the anterior aspect of the radial head. Seven patients exhibited a spectrum of olecranon changes from fragmentation of the epiphysis to chronic Salter Type I stress fractures of the growth plate. A follow-up survey found that, of those who responded to a questionnaire, nearly all the patients with articular surface damage failed to continue with competitive gymnastics whereas those with olecranon abnormalities were able to continue gymnastics at the same level. The mechanism of injury and the pathological changes are discussed.
Quantitative lymphoscintigraphy using 99Tcm human serum albumin in patients with previously treated uterine cancer
Authors: Kataoka M. , Kawamura M. , Hamada K. , Itoh H. , Nishiyama Y. , Hamamoto K.
Published: July 2009

To evaluate the clinical usefulness of lymphoscintigraphy using 99Tcm human serum albumin (99Tcm-HSA) in assessing lymphoedema in the lower extremities, lymphoscintigraphy was performed by subcutaneous injection of 7.4 MBq of 99Tcm-HSA in 26 patients with uterine cancer, previously treated by operation (OP) and/or radiation therapy (RT), and in five controls. Radioactivity at the injection site in the lower extremities was counted for 3 min at 10 min (A) and at 3 h (B) after injection, and clearance of 99Tcm-HSA was defined as (1—(B)/(A)) × 100(%). Clearance in controls was 46.8 ± 3.9%, which was significantly more than those in the other treatment groups. Clearances in patients treated with both OP and RT were less than those in patients treated with either OP or RT alone (30.1 ± 11.4 vs. 41.9 ± 8.9, 43.7 ± 9.6%, respectively; p < 0.01). The clearance in legs with lymphoedema was less than those without lymphoedema in patients treated with both OP and RT (16.6 ± 7.7 vs. 34.9 ± 9.3%; p < 0.01) and in patients treated with RT (33.1 ± 7.4 vs. 48.0 ± 5.6%; p < 0.01). There was a significant difference between clearance in controls and clearance in non-oedematous patients' legs treated with OP and RT (p < 0.01). In patients treated with RT alone, radiation dose was closely correlated with 99Tcm-HSA clearance and with the development of lymphoedema. These data suggest that lymphoscintigraphy using 99Tcm-HSA is useful in evaluating lymphoedema and that radiation dose is one of the factors in the development of lymphoedema.
Radical radiotherapy for 28 cases of mucosal melanoma in the nasal cavity and sinuses
Authors: Gilligan D. , Slevin N. J.
Published: July 2009

Mucosal melanoma is rare and is traditionally treated by radical surgery. A retrospective survey was made of 28 cases of malignant mucosal melanoma of the nasal cavity and paranasal sinuses treated by definitive radiotherapy. Initial complete regression was observed in 22 out of 28 cases (79%). Absolute local control by radiotherapy alone was achieved in 17 out of 28 cases (61%) but follow-up was limited in many cases by early death due to metastatic disease; actuarial local disease-free survival was 49% at 3 years. The approach of radical radiotherapy for melanoma of this site can be justified on the basis of the local control achieved, low treatment morbidity in patients who are typically elderly and the propensity to disseminated disease. Doses of radiotherapy required to achieve local control need to be radical; the influence of dose per fraction is uncertain.
Biological intercomparisons of neutron beams used for radiotherapy generated by p+ → Be in hospital-based cyclotrons
Authors: Hall Eric J. , Brenner David J.
Published: July 2009

The new generation of hospital-based neutron therapy facilities involve cyclotrons using protons on beryllium. The spectrum of neutrons produced includes a large and variable proportion of low-energy neutrons that are poorly penetrating but biologically effective. Cells cultured in vitro were used to compare the three US facilities at Seattle, M.D. Anderson and UCLA, together with the UK facility at Clatterbridge. Cyclotrons were compared within a given experiment on the same day using cells from a common suspension. Among the three US facilities, the relative potency factor at a depth of 25 mm differs by about 11%, with Seattle the least and UCLA the most biologically effective. Clatterbridge was compared directly with M.D. Anderson and found to be less effective by about 5%; it has a slightly lower biological effectiveness than any of the US facilities. There is evidence for an increased biological effectiveness in the build-up region, which reduces the effective skin sparing potential. There is not much difference in build-up between the three US facilities. Using the proton-on-beryllium neutron production process results in a wide spectrum of neutrons with a large but variable low-energy component. The biological effectiveness of the beam depends on target design and thickness as well as the design of the collimating system. Consequently the biological effectiveness of neutron beams generated by this process must be assessed on an individual basis. It cannot be assumed that because cyclotrons have similar accelerating energies that the relative biological effectiveness will be the same.
Erratum
Authors: Huda W. , Sandison G. A. , Lee T. Y.
Published: July 2009

In a paper entitled “Patient doses from computed tomography in Manitoba from 1977 to 1987” by W. Huda et al (1989), there is an error in equation 2 on page 140. The revised equation 2 should read

This change (i.e. replacing the slice thickness T by the slice thickness squared T2) requires modification of the resultant Tables V, VI and VII.

The modified Table V should now read

The corrections for Table VI are only for the years 1984 to 1987. In these years, the collective effective dose equivalent has been overestimated by factors which range from 10% to 30%. The (approximate) corrections for these years are given below.

1984 10% reduction in the collective dose (person-Sv)

1985 15% reduction in the collective dose (person-Sv)

1986 15% reduction in the collective dose (person-Sv)

1987 30% reduction in the collective dose (person-Sv)

In Table VII, the computed average HE values for patients undergoing CT scans in Manitoba are obtained using the collective dose values given in Table VI. Thus the values of average patient HE for the years 1984 through 1987 should be reduced by the same amount as the collective doses in Table VI. In addition, in Table VII the correct scanner specific patient HE values should now read:

Average patient HE for the GE scanner (1987) 3.1 mSv

Average patient HE for the Siemens DRH 3.4 mSv
An unusual presentation of pulmonary alveolar microlithiasis and diaphyseal aclasia
Authors: Ritchie D. A. , O'Connor S. A. , McGivern D.
Published: July 2009

Pulmonary alveolar microlithiasis is a rare disease characterized by deposition of calcified bodies in the alveoli, which produce dense sand-like micronodules throughout the lungs. The radiological, pathological and clinical features have been previously well described (Sosman et al, 1957; Thurairajasingam et al, 1975; Prakash et al, 1983; Fraser et al, 1991).

Diaphyseal aclasia (Solomon, 1963; Murray et al, 1990) is one of the more common anomalies of skeletal development with an estimated prevalence of nine per million (Voutsinas & Wynne-Davis, 1983). Inherited as an autosomal dominant trait, most cases present during childhood development owing to deformity and compli cations; however, milder cases may only be detected later in life by chance.

Both pulmonary alveolar microlithiasis and diaphyseal aclasia demonstrate a familial tendency and have specific radiological features, but they are not known to be related. We present a case of pulmonary alveolar microlithiasis found incidentally while under investigation of skeletal deformity.

In 1967, a 5-year-old boy was referred to an orthopaedic clinic with right upper limb deformity. His developmental milestones were slightly retarded, but he was otherwise well.

A radiograph of his right humerus revealed an osteochondroma in the upper shaft and an abnormal adjacent lung field. A chest radiograph (Fig. 1) showed a diffuse dense interstitial process with a predominantly nodular pattern. There was blurring of the mediastinal borders and a faint negative pleural shadow. Further osteochondromas were demonstrated in other parts of the skeleton in keeping with diaphyseal aclasia.
Book reviews
Authors: Pinkerton C. R.
Published: July 2009

As with other forms of organ transplantation the subject of bone marrow transplantation has aroused considerable public interest and remains an emotive topic. The expense, both in terms of supportive care and patient morbidity must be justified by clear evidence of a therapeutic advantage. This timely overview by several leading practitioners from North America considers, in detail, the main aspects of both bone marrow transplantation techniques and their application to a variety of malignant and non-malignant conditions in children.
Diagnosis of brain death: superiority of perfusion studies with 99Tcm-HMPAO over conventional radionuclide cerebral angiography
Authors: de la Riva A. , González F. M. , Llamas-Elvira J. M. , Latre J. M. , Jimenez-Heffernan A. , Vidal E. , Martinez M. , Torres M. , Guerrero R. , Alvarez F. , Mateo A.
Published: July 2009

The use of technetium-99m hexamethyl-propyleneamine oxime (99Tcm-HMPAO) in the diagnosis of brain death has been evaluated in 41 studies of 37 patients with severe brain injury, who were under the effect of drugs or when other diagnostic methods were equivocal. HMPAO studies were compared with conventional radionuclide angiography performed simultaneously by intravenous administration of HMPAO as a bolus. The ages of patients ranged from 4 months to 75 years. Dynamic flow images and 5-min static uptake images were acquired following bolus injection of 555 Mbq of 99Tcm-HMPAO. All patients showing no brain uptake were confirmed as brain-dead by standard clinical criteria, with no contradictory cases in the static study. In addition, all patients who were not brain-dead showed HMPAO uptake at least in the brainstem. Dynamic flow images were equivocal in five patients, four of whom had no uptake on static images and clinically confirmed brain death. In addition, two other cases showed “mismatched” dynamic and static images: in one case no perfusion was observed on flow images but uptake restricted to the posterior fossa was seen on static images; the other case showed perfusion on the dynamic study and static imaging revealed hemispheric uptake with no posterior fossa uptake. Static perfusion 99Tcm-HMPAO studies offer advantages over conventional brain scintigraphy, better results being due to adequate assessment of posterior fossa activity and avoiding equivocal studies.
Ultrasonic findings in visceral Pneumocystis carinii infection in AIDS
Authors: Grech P.
Published: July 2009

Pneumocystis carinii (P. carinii) pneumonia (PCP) is reported in approximately 75% of AIDS cases (Hughes, 1987). Extrapulmonary infection is considered rare but recently has been increasingly reported. Clinical features of extrapulmonary infection are nonspecific but there are radiographic features which may be helpful in diagnosis. A case is described of biopsy-proven disseminated P. carinii infection with widespread visceral lesions demonstrated by ultrasonography.
Chest radiograph scoring system for use in preterm infants
Authors: Hyde I.
Published: July 2009

Papers dealing with the chest radiograph in pre-term infants are sufficiently rare in the British radiological literature to merit enhanced attention. Yuksel et al (1991) are to be congratulated in helping to refine those features which have a bearing on the outcome of chronic lung disease in these infants.

Although not germane to the theme of the paper, I was struck by the fact that two patients had lobectomies because of expanding air cysts.
High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging
Authors: Aprill C. , Bogduk N.
Published: July 2009

The prevalence, validity and reliability of high-intensity zones in the annulus fibrosus seen on T  2-weighted magnetic resonance images of patients with intractable low-back pain were determined. This sign was readily recognized by two independent observers. It occurred in 28% of 500 patients undergoing magnetic resonance imaging for back pain. The presence of a highintensity zone correlated significantly with the presence of Grade 4 annular disruption and with reproduction of the patient's pain. Its sensitivity as a sign of either annular disruption or pain was modest but its specificity was high, and its positive predictive value for a severely disrupted, symptomatic disc was 86%. This sign is diagnostic of painful internal disc disruption.
Hydatid disease of the liver: evaluation of ultrasound and computed tomography
Authors: El-Tahir M. I. , Omojola M. F. , Malatani T. , Al-Saigh A. H. , Ogunbiyi O. A.
Published: July 2009

We have evaluated computed tomography (CT) and ultrasonography (US) in 41 patients with hepatic hydatid disease. CT was diagnostic in all patients, while US performed on 36 patients was diagnostic in 34. In the remaining two cases, heavy calcification in one and a large amount of intracavitary air in the other prevented accurate diagnosis. The US findings in the liver regarding cyst form (multilocular or unilocular), size and location were comparable to those of CT. CT detected associated extrahepatic cysts in the abdomen and pelvis in 11 patients while US performed on the same group of patients detected such cysts in seven patients. It is suggested that the entire abdomen and pelvis should be scanned in patients suspected of hydatid disease and when a hepatic lesion is suggestive of the disease.
Scintigraphic abnormalities in patients with painful hip replacements treated conservatively
Authors: Miles K. A. , Harper W. M. , Finlay D. B. L. , Belton I.
Published: July 2009

A retrospective review of the scintigraphic appearances of 98 painful hip replacements was made. 16 patients (16%) underwent revision surgery whereas in the remaining 82 hips (84%), symptoms settled with conservative management. 73 of these (89%) had at least one area of increased activity on delayed diphosphonate scintigraphy with 27% having increased activity in three or more areas around the femoral component. Hips with increased activity at the lesser trochanter and tip were less likely to undergo spontaneous resolution of symptoms. Uncemented prostheses were more likely to have multiple areas of increased activity. Abnormalities in dynamic bone scintigraphy and gallium studies were also seen in patients whose symptoms resolved without surgery. Whereas a normal bone scintigram indicates that loosening or infection is most unlikely, the presence of increased activity does not necessarily indicate a need for revision surgery, even when multiple areas are present. A period of conservative management should be considered before operative intervention is undertaken.
A study of the relationship between routine ultrasound quality assurance parameters and subjective operator image assessment
Authors: Metcalfe S. C. , Evans J. A.
Published: July 2009

Comparisons have been made between a number of routine quality assurance (QA) measurements and a number of related subjective aspects of image quality. These comparisons between lateral resolution and perceived definition, dynamic range and subjective grey-level assessment, and slice thickness and overall image quality appraisal showed very poor correlation. We deduce from this that other QA parameters are needed to quantify good image quality as denned by the operators.
Ultrasound demonstration of a leaking hydatid cyst of the liver causing “cyst within a cyst” appearance
Authors: Banerjee B. , Rennison A. , Haque Q. M.
Published: July 2009

Echinococcal disease may affect any part of the body; the liver is the most frequently affected organ (75%) (Saidi, 1976). Although a cyst with internal septation or loculation is the classical ultrasound description of hydatid cyst of the liver, in reality unilocular cysts are more frequently encountered (Sciarrino et al, 1991). On ultrasound unilocular hydatid cysts are usually indistinguishable from innocent simple hepatic cysts, which are common incidental findings during ultrasound examination of the liver. Moreover, in a non-endemic area the index of suspicion is low and the possible diagnosis of hydatid disease may not be entertained when unilocular cysts are detected in the liver.
Epitheloid haemangioendothelioma of liver: a vascular tumour easily mistaken for metastatic carcinoma on ultrasound imaging
Authors: Banerjee B. , Rennison A.
Published: July 2009

Epitheloid haemangioendothelioma is a rare neoplasm of vascular origin that may occur in the liver. Although there have been sporadic reports of this tumour in the past, the term “epitheloid haemangioendothelioma” was first suggested by Weiss and Enzinger only recently (Weiss & Enzinger, 1982). The tumour usually affects adults and pursues a relatively benign course intermediate between haemangioma and angiosarcoma; long-term survival with chemotherapy, hepatic resection and hepatic transplant has been documented. Scant reference can be found to its radiographic appearances. We present a case to illustrate the ultrasound appearances of this tumour and emphasize its potential confusion with metastatic disease.

A 29-year-old woman presented with persistent right upper quadrant abdominal pain and anorexia over a period of 2 months. She had undergone laparotomy and repair of a liver laceration 16 years earlier, following a riding accident, but had been in good health in the intervening period.
Direct and CT measurements of canals and foramina of the skull base
Authors: Berlis A. , Putz R. , Schumacher M.
Published: July 2009

This investigation is based on measurements of 60 macerated adult European skulls from the Alexander-Ecker Collection at the Anatomy Department of the University of Freiburg. Computer tomographical (CT) and anatomical measurements were compared to assess the accuracy of the CT representation of osseous structures. Nine structures were examined: the optic canal; the superior orbital fissure; the foramen rotundum; the foramen ovale; the foramen spinosum; the foramen Vesalii (venosum); the carotid canal; the internal auditory canal, and the hypoglossal canal. The results show a good and even excellent correlation if the cranial opening is approximately at a right angle to the scanline. For this reason, the results of the coronal examination of the internal auditory canal are less satisfactory, and the coronal and axial measurements of the hypoglossal canal show only a moderately good correlation.
Book reviews
Authors: Hopewell J. W.
Published: July 2009

This volume represents a translation, with some updating, of a successful book Radiobiologie that was first published in French in 1986. The book would be of particular value to trainees in radiotherapy and would also provide a useful introduction to the subject for biologists/radiobiologists entering this field of cancer research.
Permanent radiation myelopathy
Authors: Schultheiss Timothy E. , Stephens L. Clifton
Published: July 2009

Because of the morbidity and mortality associated with radiation myelopathy, radiation injury to the spinal cord has been the subject of more clinical reports than any other normal-tissue injury. The spinal cord is perhaps second only to skin as the organ most frequently studied by radiobiologists. Its response has been investigated in mice, rats, cats, guinea pigs, rabbits, pigs, dogs, and rhesus monkeys—virtually every laboratory animal species. Given this level of attention, it is surprising what is not known about the radiation response of the spinal cord. Relatively few animal studies have been performed on the effect of cytotoxic drugs on the radiation response of the spinal cord, the age effects, the effects of blood pressure or other physiological conditions that are controllable in the laboratory, or the relative response of various anatomical levels of the spinal cord. In addition to these unresolved factors, the dose response in the human is still poorly defined. However, as a result of the attention this injury has received, substantial information is available on the diagnosis, pathogenesis and dose fractionation dependence. This review seeks to establish the facts, expose the myths and define the issues still in dispute regarding radiation-induced myelopathy.
Osteosarcoma metastatic to the kidney with invasion of the inferior vena cava
Authors: King C. M. P. , Reznek R. H. , Norton A. J. , Kingston J. E.
Published: July 2009

Although renal metastases are found at autopsy in 12% of patients with osteosarcoma (McKenna et al, 1966), antemortem diagnosis is extremely rare. Deposits occur as part of widespread dissemination of the disease and the patients usually die of other effects before their renal disease becomes symptomatic.

We report a patient who presented 5 years after treatment for a femoral osteosarcoma with a renal metastasis involving the renal vein and inferior vena cava which was demonstrated on computed tomography (CT) and ultrasound. This entity has not been previously described and the initial suspicion was that the patient had developed a further primary tumour.

A 15-year-old male presented in January 1985 with a swelling above the left knee. Radiographs suggested an osteosarcoma and biopsy confirmed the diagnosis. Staging investigations, including CT of the chest and radionuclide bone scan, showed no evidence of metastases. Initial treatment was by limb sparing resection of the primary tumour with pre- and post-operative chemotherapy. Local recurrence a year later necessitated disarticulation of the hip. In March 1989 a left upper lobectomy and wedge resection of the left lower lobe were performed for pulmonary metastases.

Thereafter, he remained well until June 1990 when he presented with a 6 week history of painless haematuria. He failed to attend for investigation of this problem and the haematuria apparently resolved spontaneously. In August 1990 he returned having noticed a lump in the right hypochondrium.
Historical experiments predating commercially available computed tomography
Authors: Webb S.
Published: July 2009

Computed tomography (CT) was a revolution in radiology. Commercially available CT scanners appeared in 1972, a joint effort between the EMI Company, Atkinson Morley's Hospital, London and the Department of Health and Social Security (DHSS). The name of Sir Godfrey Hounsfield will always be associated with these developments.

Like most developments in science the breakthrough came by standing on the shoulders of giants and many experiments can, with the curious wisdom of hindsight, be considered precursors to CT. Gabriel Frank's patent in 1940 showed apparatus for back-projection CT and Takahashi developed equipment in the 1940s for reconstructing from a sinogram; in both cases using an optical “computer”. A medical CT scanner was reportedly constructed in 1957 in Kiev. Transmission CT was performed by Kuhl in 1965. Cormack built an experimental scanner in 1963. Oldendorf identified what was needed for successful CT as early as 1960. Throughout the 1960s a host of independent workers were busy on the mathematical problems of reconstructing from projections with both medical scanning and non-medical applications in mind.

Experiments in early emission tomography influenced the development of CT. With imagination one can even see how close “classical” tomography, as started even before 1920, came to the realization of CT. The pioneering British radiographer Watson stands out from a galaxy of inventors.

The lecture at Radiology and Oncology '91 in Brighton was a thumbnail sketch of the origins of radiological CT. A fuller story is told elsewhere (Webb, 1990).
Erratum — letter to the Editor
Authors: Gandhi M. R. , Brown P. , Romanowski C. A. J. , Morcos S. K. , Campbell S. , El nahas A. M. , Gray T. A.
Published: July 2009

The Publisher apologizes to both the authors and the readers for an error which appeared in this letter which was published in the May 1992 issue of the British Journal of Radiology. The error occurred in the paragraph which covered the creatinine clearance values preand post-administration of contrast media. In the interests of clarity the letter has been reprinted.

The use of theophylline, an adenosine antagonist in the prevention of contrast media induced nephrotoxicity

Impaired renal perfusion has been implicated in the pathogenesis of contrast media (CM) induced nephrotoxicity (El-Sayed et al, 1991). Animal and, more recently, clinical studies have suggested that endogenous adenosine may mediate the renal haemodynamic response to intra vascular CM (Arend et al, 1987;Katholietal, 1991). We have recently attempted to evaluate the protective effect of an adenosine antagonist, theophylline against CM-induced nephrotoxicity.
Appearances of choroidal osteomas with diagnostic imaging
Authors: Bloom Philip A. , Ferris John D. , Laidlaw Alistair , Goddard Paul R.
Published: July 2009

The diagnostic imaging appearances of three choroidal osteomas (osseous choristomas) are presented. This rare, benign choroidal tumour is being recognized with increasing frequency, and is important to remember in the differential diagnosis of any unusual mass in the ocular fundus lest it be mistaken for a more sinister lesion. All three osteomas were demonstrated by ocular ultrasound (US), fluorescein angiography (FA) and computed tomography (CT) but none by plain radiography. None of the lesions was visible on magnetic resonance imaging (MRI); the reason for this is probably the bony nature of the tumours. The appearances of choroidal osteomas on US, FA, plain radiography and CT are discussed. To our knowledge this is the first report of a series of choroidal osteomas investigated by MR.
Doppler ultrasound scanning in the detection of renal artery stenosis in hypertensive patients
Authors: Postma Cornelis T. , van Aalen Joost , de Boo Theo , Rosenbusch Gerd , Thien Theo
Published: July 2009

The diagnostic accuracy of Doppler ultrasound in the detection of renal arterial disease has been assessed in a prospective study of 61 hypertensive patients. The findings of Doppler ultrasound were compared with the results of renal angiography. In 15 patients (24.5%) no accurate Doppler signs could be obtained and the Doppler ultrasound examination was considered a technical failure. Of the remaining 46 patients, 24 had renal artery stenosis. Nine of the stenoses were not detected by Doppler ultrasound and in three patients a false positive diagnosis of renal artery stenosis was made. The sensitivity of Doppler ultrasound was 62.5%, the specificity 86.4% and the overall diagnostic acccuracy was 73.9%. By comparing the 15 patients in whom Doppler ultrasound failed with the 46 in whom it was successful, age appeared to be higher and creatinine clearance lower in the failure group. By comparing the 34 patients with true positive and true negative results with the 12 patients with false results, no significant differences were found. In a multivariate analysis, higher age showed a significant relation to failure of Doppler ultrasound. Doppler ultrasound has limited value in the screening of hypertensive patients for renal artery stenosis.
Impact of hydration status on body composition as measured by dual energy X-ray absorptiometry in normal volunteers and patients on haemodialysis
Authors: Horber F. F. , Thomi F. , Casez J. P. , Fonteille J. , Jaeger Ph.
Published: July 2009

To evaluate the influence of hydration status on the estimation of body composition using dual-energy X-ray absorptiometry (DXA), six normal volunteers and seven patients on maintenance haemodialysis were investigated using two different DXA machines (Lunar DPX, Hologic QDR 1000/W). Normal volunteers were studied (Hologic QDR 1000/W) before and 1 h after ingestion of breakfast, lunch and dinner (drinking various amounts of liquids at each meal, 0.5–2.4 kg). Whereas bone mineral content and body fat mass did not change, lean body mass of the trunk increased as a consequence of the meals. Conversely in patients on haemodialysis (Lunar DPX), lean body mass decreased in all segments of the body as a consequence of removal of 0.9–4.4 kg of salt-containing fluid by haemodialysis (trunk 61%, legs 30%, arms 5.5% and rest of the body 3.5%), whereas bone mineral content and body fat mass remained unchanged. However, this finding(s) did not hold true in one particular patient with bilateral hip prostheses. Measurement of body composition in eight normal volunteers on the same day with both machines showed similar results for lean and fat mass, whereas bone mineral content was found to be 17% higher using the Lunar DPX. In summary, in centres where both machines are available, follow-up of one individual patient should always be performed using the same equipment. In addition, hydration status and food intake must be taken into account when repetitive measurements of lean body mass are performed in the same patient.
Retrospective analysis of nasopharyngeal carcinoma treated during 1976–1985: late complications following megavoltage irradiation
Authors: Lee Anne W. M. , Law Stephen C. K. , Ng S. H. , Chan David K. K. , Poon Y. F. , Foo William , S. K. O  , Tung Stewart Y. , Cheung Fred K. , Ho John H. C.
Published: July 2009

A retrospective analysis was undertaken of the late complications observed in 4527 patients with nasopharyngeal carcinoma treated by megavoltage radiotherapy during the years 1976–1985. Unconventional fractionation schedules were used because of serious resource limitations. The median equivalent doses were 65 Gy to the nasopharyngeal region and 53 Gy to the cervical region. 707 patients had reirradiation for local recurrences and 250 for regional relapses. The 10-year actuarial cancerspecific survival was 47%, and the corresponding all-complication-free and neurological-complication-free rates were 40% and 72%, respectively. Altogether, 1395 (31%) patients developed one or more late irradiation sequelae. The majority were mild softtissue damages, but 322 (7%) had significant functional disturbances, from which 62 (1%) died. Neurological damage that occurred in 450 (10%) patients constituted the major morbidity and accounted for all but three of the treatment mortalities. The cumulative incidence of the various complications is summarized, and the data recorded in the literature reviewed in order to give a proper perspective of the problem. Patients treated during 1981–1985 had a significantly higher actuarial encephalomyelopathyfree rate than those treated during 1976–1980, but the incidence-free rates for the other neurological complications remained unimproved, suggesting that the improvement could be mainly attributed to additional shielding for the brainstem rather than the reduction of dose from 3.8–4.2 Gy to 2.5 Gy per fraction.
Demonstration by computed tomography of a case of internal small bowel herniation
Authors: Hoeffel J. C. , Zimberger J. , Pocard B. , Hoeffel C.
Published: July 2009

Internal hernia is a rare condition. We report a case where computed tomography (CT) demonstrated a saclike encapsulation of small bowel loops which suggested a diagnosis of internal hernia.

A 76-year-old woman presented with abdominal pain and vomiting. Ultrasound examination revealed a 10 cm heterogenous mass posterior to the bladder, close to the ovaries, associated with bilateral hydronephrosis affecting mainly the left side. Contrast-enhanced CT showed a large pelvic mass Fig. 1), behind the bladder, of fluid density and containing septations. The appearance suggested dilated loops of small bowel. Both ureters were dilated, and a plain film of the abdomen 24 h after injection of contrast medium (Fig. 2) showed marked left hydronephrosis and less severe dilatation the right renal tract. Forty-eight hours after injection Fig. 3) the left ureter was still opacified.

At laparotomy a cluster of dilated and congested loops of small bowel were found posterior to the bladder and these were strangulated in the pouch of Douglas. Resection of 50 cm of ileum was necessary, following which the patient made a full recovery.
Caecal herniation through the foramen of Winslow: diagnosis by computed tomography
Authors: Schuster M. R. , Tu R. K. , Scanlan K. A.
Published: July 2009

Herniation of viscera through the foramen of Winslow comprises 0.08% of all hernias, with caecal involvement in nearly a third (Valenziano et al, 1987). Due to the difficulty in diagnosis, only 10% are diagnosed on plain films prior to surgery (Okhuma & Miyazake, 1977); therefore, other imaging methods are being utilized to assist in the diagnosis. This example of caecal herniation through the foramen of Winslow was diagnosed by dynamic abdominal computed tomography (CT) and its important diagnostic points are reviewed.

A 64-year-old woman presented with 12-hour history of shortness of breath and chest pain. Vital signs and laboratory studies were normal.
Dense bones
Authors: Vinnicombe Sarah , Heron Christine , Wansbrough-Jones Mark
Published: July 2009

A 39-year-old Asian woman was investigated for a 4 year history of generalized aches and pains and more recent malaise, fevers and cervical adenopathy. On admission, her erythrocyte sedimentation rate (ESR) was 62 and there was a mild polyclonal gammopathy. Mantoux and Kveim tests were negative and screening cultures of urine and sputum (including for acid and alcohol fast bacilli) were also negative. The chest radiograph is shown in Fig. 1. At this time, radiographs of the skull, pelvis and hands were normal.

The patient received a 6 month trial of antituberculous chemotherapy, but this resulted in minimal symptomatic improvement and her lymphadenopathy persisted.
Enlarged mediastinal lymph nodes in the fibrosing alveolitis of systemic sclerosis
Authors: Garber S. J. , Wells A. U. , duBois R. M. , Hansell D. M.
Published: July 2009

The aim of this study was to determine the prevalence of enlarged mediastinal lymph nodes in systemic sclerosis (SSc) and relate this to the extent of pulmonary disease and disease activity as judged by high resolution computed tomography HRCT). The HRCT scans of 78 patients with SSc were reviewed. The extent of lung disease and HRCT pattern were analysed and CT scans examined on soft tissue window settings for evidence of mediastinal lymph node enlargement. Sixty six (85%) patients had evidence of lung involvement on CT. Enlarged mediastinal lymph nodes were present in 21 (32%) patients with lung involvement but in only 1 (8%) patient without. The prevalence of enlarged mediastinal nodes increased with more extensive lung involvement on CT (p < 0.025), but correlated poorly with the type of CT appearance and concurrent erythrocyte sedimentation rate. Mediastinal lymph node enlargement occurs frequently in patients with SSc, particularly if lung involvement is extensive.
The effect of thin K-edge filters on radiation dose in dental radiography
Authors: MacDonald-Jankowski D. S. , Lawinski C. P.
Published: July 2009

The use of thin K-edge filters has been found to reduce considerably the radiation dose in intra-oral radiography. The aim of this study was to investigate the effect of nitration on the skin entrance dose and several sites (representing organs or areas of interest within the head) along the central beam axis, at other points within the primary beam and at two points just outside the primary beam. The subject was a sliced head phantom (a human skull embedded in tissue-equivalent material) which was exposed to X rays from a conventional dental X-ray unit in the range of tube voltage 55–85 kVp for each of four filter systems. These were 2.7 mm of aluminium alone (the existing total filtration) or with an added 0.1 mm erbium, 0.1 mm yttrium or 0.05 mm niobium metal foils. Measurements of radiation dose were made using thermoluminescent dosemeters (TLD rods) and were adjusted to simulate the exposure resulting from a typical dental radiograph of a maxillary molar. The results suggest that the use of thin K-edge filters significantly reduces the entrance skin dose and to a certain extent reduces the total dose imparted to the head. However, the dose to the ipsilateral orbit at higher tube voltages may be increased.
The distribution of medical X-ray doses amongst individuals in the British population
Authors: Hart D. , Le Heron J. C.
Published: July 2009

This study has estimated the distribution of diagnostic X-ray doses amongst individuals in the British population by sampling the records kept by general practitioners (GPs) on their patients and the records held by the radiology department of a district general hospital. Deceased patients were chosen in the former case in order to evaluate the dose acquired over a complete lifetime. In each case, several hundred records were sampled. The GP data obtained have enabled an estimate to be made of the likelihood of reaching various dose levels in a lifetime. It is estimated that about 1% of the population has received a lifetime effective dose-equivalent of more than 100 mSv. The largest cumulative dose revealed by the samples of GP and radiology department records was about 200 mSv. The GP data have also shown that the last year of life sees a four-fold increase in the number of X-ray examinations experienced compared with the previous 9 years. The hospital data have allowed an estimate to be made of current rates of dose acquisition amongst the population of a District Health Authority.
Comparison of a subjective and a quantitative assessment of the neonatal chest radiograph
Authors: Yuksel B. , Greenough A. , Karani J.
Published: July 2009

The aim of this study was to assess if quantitative classification of the chest radiograph appearance at 7 days predicted chronic oxygen dependency (oxygen dependency beyond 8 weeks of age) more accurately than did subjective classification at 28 days of age. Thirty preterm infants, median gestational age 27 weeks, who had chest radiographs taken for clinical purposes at 7 and 28 days of age, were recruited into the study. The 7-day chest radiograph was scored according to the lung volume, presence of opacification, interstitial changes, pulmonary interstitial emphysema and cystic elements. The range of chest radiograph scores was from 0–18, a score of 18 indicating the most abnormal appearance. The 28-day chest radiograph was classified as Type I or Type II chronic lung disease (CLD), according to the presence or absence, respectively, of coarse reticulation. The median chest radiograph score at 7 days of the 30 infants was 5 (range 2–14). In predicting chronic oxygen dependency, a chest radiograph score of 5 at 7 days had 83% sensitivity and 75% specificity, but a diagnosis of Type II CLD at 28 days of age had only 67% sensitivity and 67% specificity. We conclude that a quantitative assessment of the chest radiograph appearance at 7 days is more useful than a subjective assessment at 28 days of age.
Book reviews
Authors: DeSouza N.
Published: July 2009

This basic text is aimed at the trainee radiologist. Its anglo-american co-editors and several well-known authors from both sides of the Atlantic have produced a comprehensive and readable book that covers general radiology with sections on neuroradiology, obstetric ultrasound and nuclear medicine.
Kinetic considerations in the choice of treatment schedules for neuraxis radiotherapy
Authors: Wheldon T E , O'Donoghue J A , Barrett A
Published: July 2009

Neuraxis radiotherapy of radiosensitive tumours such as medulloblastoma is usually carried out using conventionally sized fractions and a shrinking field technique. Plowman and Doughty (Br. J. Radiol., 64 (1991) 603–607) have proposed a partial transmission block (PTB) technique which entails the use of small daily doses over a conventional time period. Radiobiological analysis suggests that, although the PTB technique may be adequate for slowly growing tumours, therapeutic efficacy is likely to be compromised where the tumour doubling time is short. Accelerated hyperfractionation (twice daily fractions) provides a possible alternative to both conventional scheduling and the PTB technique. Direct measurement of the kinetics of tumour cells in CSF, where possible, may provide useful guidance in the choice of regimes.
The role of radiography and computed tomography in the diagnosis of acute dislocation of the proximal tibiof ibular joint
Authors: Keogh P , Masterson E , Murphy B , McCoy C T , Gibney R G , Kelly E
Published: July 2009

A cadaveric study was undertaken to determine the best radiographic method of diagnosing dislocation of the proximal tibio-fibular (PTFJ) joint. Three pairs of cadaver knees were used, the right side serving as a control in each case. Plain radiographs, antero-posterior (AP) lateral and 45° oblique films, and axial computed tomography (CT) scans were obtained with the joints in each of three positions: (1) anatomical, (2) dislocated anteriorly and (3) dislocated posteriorly. Similar views were obtained in the control joints with the PTFJ undisturbed. The radiographs were assessed by eight independent observers and the results were analysed. The diagnostic accuracy with plain AP and lateral radiographs was 72.5%. This was unchanged with the addition of oblique views, but improved to 82% with the control films and 86% with the axial CT scans. The authors conclude that in the diagnosis of suspected dislocation of the PTFJ, axial CT scanning is the investigation of choice. Plain AP, lateral and comparison views are useful but less accurate, while oblique views are unhelpful and unnecessary.
A blood pressure independent index of aortic distensibility
Authors: Lehmann E D , Gosling R G , Parker J R , deSilva T , Taylor M G
Published: July 2009

A non-invasive Doppler ultrasound technique for the assessment of aortic compliance based on the in vivo measurement of pulse wave velocity along the thoraco-abdominal aortic pathway is described. An approach for correcting for the effect of blood pressure on aortic compliance is considered. The derivation of an index of distensibility, Cp, which is independent of blood pressure is provided and applied to data collected from 58 normal, healthy volunteers. Medical disorders such as atherosclerosis, diabetes mellitus and familial hypercholesterolaemia have all been shown to affect arterial distensibility. We suggest that the clinical measurement of Cp may be a useful, non-invasive tool for assessing such patients' susceptibility to atheromatous arterial disease as well as for monitoring their response to therapy.
Small cell carcinoma induced acute pancreatitis
Authors: Maclennan Alexander C , Macleod Iain A
Published: July 2009

A 56-year-old lady presented with a 6 week history of increasing upper abdominal pain, vomiting and backache. She was jaundiced with reduced air entry over the right lung base and guarding of the upper abdomen. A chest radiograph showed elevation of the right hemidiaphragm; an abdominal radiograph was normal. The serum amylase was 1560 U I−1 (NR < 100). A diagnosis of acute pancreatitis was made and intensive medical treatment started. The following day an ultrasound examination showed several hypoechoic areas within an enlarged pancreas (Figure 1). The biliary tree appeared normal.

The patient's condition deteriorated over the next 10 days with the development of hypoproteinaemia, pleural effusions and oedema despite parenteral nutrition.
Asymptomatic deep venous thrombosis in the calf: accuracy and limitations of ultrasonography as a screening test after total knee arthroplasty
Authors: Vanninen R , Manninen H , Soimakallio S , Katila T , Suomalainen O
Published: July 2009

Patients who have recently undergone total knee arthroplasty are at high risk of developing deep venous thrombosis (DVT) in the calf. The clinical diagnosis of DVT is difficult in these patients owing to recent operation. A combination of compression ultrasonography (US) and colour flow imaging was used as a screening method of asymptomatic DVT in 51 patients who had undergone total knee replacement surgery. Both limbs were examined by US from the common femoral vein to the ankle approximately 7 days after operation and the results were compared with bilateral venography. 12 patients (24%) developed infrapopliteal DVT on the operated side, in two cases the thrombosis extended to the lower part of popliteal vein. One patient had bilateral thrombosis. US showed sensitivity of 77%, specificity of 96% and overall accuracy of 93%. US seems to be a useful screening method for DVT after knee replacement operation.