bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of a conventional non-ionic contrast medium (iohexol) alone and with adrenaline and an iso-osmolar non-ionic contrast medium (iotrolan) in computed tomographic arthrography of the shoulder
Authors: Wellings R M , Davies A M , Pynsent P B , Cassar-Pullicino V N
Published: July 2009

The physico-chemical properties of the iso-osmolar dimeric contrast medium iotrolan offers potential advantages in computed tomographic arthrography (CTA). A trial was undertaken comparing iotrolan with iohexol to assess if these theoretical benefits produced an increase in the measured densities in a series of shoulder CTAs. The results showed that iotrolan did produce clinically useful increases in density when compared to a monomeric non-ionic contrast medium. The addition of adrenaline to the monomeric contrast medium produced a significant improvement in the computed tomography density which surpassed that offered by the dimeric contrast medium alone.
Physical evaluation of computed radiography as a mammographic X-ray imaging system
Authors: Workman A , Cowen A R , Brettle D S
Published: July 2009

The physical imaging properties of a computed radiography (CR) system operating under mammographic exposure conditions have been measured. These measurements include modulation transfer function (MTF), sensitometric response and noise power spectrum (NPS). These figures were used to derive signal-to-noise ratio (SNR) descriptors of the system performance. The same measures were derived for a mammographic film–screen system. The SNR properties of the CR system indicate superior low frequency performance over a wider dynamic range than the film–screen system. The spatial frequency dependent SNR properties of the CR system are, however, limited. The results of a psychophysical test support the results obtained from physical measurements. These results indicate that despite its limited sharpness, details of dimensions relevant to diagnosis in mammography (circular details 0.25 mm diameter to represent microcalcifications and 3 mm diameter to represent small masses) are reproduced using CR with SNRs which are at least comparable with those of a mammographic film–screen system.
Local control versus dose or overall time: from coefficients to percentages
Authors: Fowler J F , Chappell R
Published: July 2009

When clinical results are analysed to find the treatment variables which affect the outcome, two types of multivariate analysis are done. Firstly, a determination of which variables are important is made: from age, gender, stage, histology, total dose, overall time, etc. Secondly, a quasi-biological model may be set up which includes those variables, e.g.

Function (p) = Variable 1 + Variable 2 + … + α × dose + β × dose × (dose per fraction) − γ × (overall time)

where p is the probability of local control and “Function” is a logit or double-log function. The coefficients thus determined are often presented simply in raw form, or as ratios such as α/β or γ/α where any conversion factors from “Function (p)” to percentages are assumed conveniently to cancel out. However, it is mathematically possible to convert each coefficient directly into “percent change in local control per unit dose” (for α), or “percent per unit time” (for γ), without recourse to the obvious convenience of the ratios. These converted values are more understandable than the coefficients themselves. They mean the rate of change of local control with (for example) total dose if overall time and dose per fraction were held constant; or rate of loss of local control with prolongation if total dose and dose per fraction were held constant. Even though heterogeneity may alter these slopes considerably from the theoretically maximum Poisson slopes, they still tell us what is happening averaged over the group of patients being studied, with often interesting insights.
High dose rate versus low dose rate brachytherapy for squamous cell carcinoma of the cervix: an economic analysis
Authors: Jones G , Lukka H , O'Brien B
Published: July 2009

Brachytherapy is an established and important part of the management of invasive carcinoma of the cervix. Available evidence suggests that low dose rate (LDR) and high dose rate (HDR) are equivalent in terms of tumour control, adverse effects and survival. Proponents of outpatient HDR argue that it is less costly than LDR, but no economic evaluation has been published. We compared the costs of HDR and LDR (capital, operating, maintenance, source and operating costs) for Nucletron intracavitary equipment under alternative assumptions about the number of patients treated per year, the number of insertions per patient and discount rate. For example, for 3 HDR fractionations compared with 1 LDR fractionation, the LDR-3 (Nucletron) is the most cost-effective, practical machine for up to 40 patients per year. Although LDR-3 is more cost effective for a greater number of patients, HDR would be recommended for more than 40 patients a year for practical reasons. Similarly, for 5 HDR compared with 2 LDR fractionations, LDR-3 would be recommended for up to 20 patients per year and HDR for a greater number of patients. Recommendations for other HDR/LDR fractionations and annual number of patients seen can be derived from the model. This recommendation is based on no cost sharing with other sites. Cost sharing was beyond the scope of this analysis, though the principles are similar to the ones used. The model may be adapted to help equipment decision-making for a brachytherapy programme for an individual centre.
Pedicular cleft associated with bilateral pars interarticularis defects and transverse process hypoplasia of a fifth lumbar vertebra
Authors: Kalideen J M , Satyapal K S , Bayat F
Published: July 2009

The rare anomaly of cleft pedicle co-existing with bilateral pars interarticularis defects and ipsilateral transverse process hypoplasia of a lumbar vertebra is described in a 39-year-old male presenting with chronic low backache. The importance of recognizing pedicular clefts as congenital anomalies and distinguishing them from fractures or destructive processes is emphasized, and the relationship of pedicular clefts to hypoplastic or absent pedicles is discussed.
Mesenteric lymph node cavitation an unusual complication of coeliac disease
Authors: Burrell H C , Trescoli C , Chow K , Ward M J
Published: July 2009

We present a case of mesenteric lymph node cavitation diagnosed by computed tomography. This is an unusual but recognized complication of coeliac disease associated with splenic atrophy.
A nasty shock on awakening
Authors: Peh W C G , Chu F S K , Ho T K
Published: July 2009

A 52-year-old man awoke one morning to find, to his distress, that he had become paraplegic. There was no known history of trauma. The motor and sensory deficits were subsequently confirmed on physical examination. He had no significant past medical history other thanhaving a chronically stiff and aching back for several years.
Mesenteric arterial rupture following blunt abdominal trauma: demonstration by computed tomography
Authors: O'Sullivan G , Williams M , Hughes P M
Published: July 2009

We read with interest the article by Campbell and Zammit-Maempel [1] on the demonstration of mesenteric arterial rupture following blunt abdominal trauma and wish to make the following points.

The management and investigation of major trauma victims is likely to receive increasing prominence in the United Kingdom literature with the institution of major trauma facilities. We should remember, however, that such facilities are well established in the United States, providing excellent data on techniques and findings in major trauma victims [2].
Calulation of radiation induced complication probabilities for brain, liver and kidney, and the use of a reliability model to estimate critical volume fractions
Authors: Olsen D R , Kambestad B K , Kristoffersen D T
Published: July 2009

Radiation induced normal tissue complication probability is calculated for three different organs: brain, liver and kidney. The model applied is a reliability model where the volume effect of the tissue is described by the structural parameter, k, which reflects the architecture of the functional subunits of the organ. The complication probability depends on k, the inactivation probability of the functional subunits (p) and the irradiated volume fraction (n). For partial, homogeneous irradiation of the brain, a k-value close to unity was found, and the respective values for liver and kidney were 0.92 and 0.77. An extension of the reliability model to account for individual inactivation probability of the subunits allows calculation of complication probability for inhomogeneous dose distributions. For the brain, intercomparison of a three-field and a two-field technique demonstrated a small reduction in complication probability for the former at low total doses. At high total doses a minimum complication probability was achieved applying a three-field technique, being three times less than that associated with the two-field technique.
Non-uniform dwell times in line source high dose rate brachytherapy: physical and radiobiological considerations
Authors: Jones B , Tan L T , Freestone G , Bleasdale C , Myint S , Littler J
Published: July 2009

The ability to vary source dwell times in high dose rate (HDR) brachytherapy allows for the use of non-uniform dwell times along a line source. This may have advantages in the radical treatment of tumours depending on individual tumour geometry. This study investigates the potential improvements in local tumour control relative to adjacent normal tissue isoeffects when intratumour source dwell times are increased along the central portion of a line source (technique A) in radiotherapy schedules which include a relatively small component of HDR brachytherapy. Such a technique is predicted to increase the local control for tumours of diameters ranging between 2 cm and 4 cm by up to 11% compared with a technique in which there are uniform dwell times along the line source (technique B). There is no difference in the local control rates for the two techniques when used to treat smaller tumours. Normal tissue doses are also modified by the technique used. Technique A produces higher normal tissue doses at points perpendicular to the centre of the line source and lower doses at points nearer the ends of the line source if the prescription point is not in the central plane of the line source. Alternatively, if the dose is prescribed at a point in the central plane of the line source, the dose at all the normal tissue points are lower when technique A is used.
Quantitative magnetic resonance for assessment of radiation fibrosis after post-mastectomy radiotherapy
Authors: Johansen J , Taagehøj F , Christensen T , Overgaard J , Overgaard M
Published: July 2009

Subcutaneous fibrosis is a serious complication of post-mastectomy radiotherapy with a pronounced influence on skin conditions, shoulder movement and arm oedema. To establish safer radiotherapy schedules, precise evaluation of the tissue damage is required. A feasibility study was performed to asses the value of calculated relaxation times from magnetic resonance (MR) images for quantitative characterization of different degrees of subcutaneous fibrosis after post-mastectomy radiotherapy. A surface coil was applied to the irradiated area, as well as to unirradiated skin, to obtain appropriate MR coronal slices for acquisition of calculated values using a mixed imaging sequence technique. 14 patients with clinically diagnosed subcutaneous fibrosis were examined, 10 of whom had severe fibrosis. The mean T  2 values of the treated and untreated side were 53.0 and 56.7, respectively. A statistically significant decrease of the calculated T  2 values on the treated side was observed. No correlation was found between the clinically assessed fibrosis and the calculated relaxation times. The findings indicate that despite a general decrease of T  2 calculated values, the large variation in the relaxation times restricts the value of MR, as applied in this study, in differentiating between different degrees of fibrosis in normal tissues after radiotherapy.
Traumatic aortic rupture: demonstration by magnetic resonance imaging
Authors: Hughes J P , Ruttley M S T , Musumeci F
Published: July 2009

Traumatic rupture of the aorta is a major cause of morbidity and mortality in rapid deceleration road traffic accidents, with an immediate mortality of 85%. Of the 15% that survive the initial injury, approximately 50% will die within 24 h if left untreated. Prompt diagnosis and early surgical treatment are necessary if such patients are to survive. Aortography is the standard investigation of choice and provides a rapid, sensitive test of aortic rupture. Other modalities, such as plain chest radiography, computed tomography (CT) and ultrasound may also play a role in diagnosis. Magnetic resonance imaging (MRI), with its multi-planar imaging capability, is now widely used for imaging non-traumatic disorders of the aorta. However, its use in traumatic rupture has been limited by difficulties in monitoring and in access to the patient during the scan. We present a patient who survived the initial injury, when the diagnosis of aortic rupture was not suspected, and presented 3 weeks later with chest pain. An MRI scan was feasible as the patient was haemodynamically stable, and it provided an elegant non-invasive means of diagnosis, so that aortography was not necessary in this case. Although aortography is likely to remain the investigation of choice in the acute situation, MRI is a useful alternative in selected cases.
Book reviews
Authors: Hirst D G
Published: July 2009

The teaching courses organized by the European Society for Therapeutic Radiology and Oncology (ESTRO) have always been very popular. This book summarizes the content of the ESTRO teaching course in Basic Radiobiology and is a really excellent introduction to the subject. The individual chapters are written by the teachers of that course in a concise format that has deliberately been chosen to be very visual, with a high proportion of figures to text. This allows an enormous amount of information to be included in the 233 pages.The chapters are all well written and easy to read. Complex mathematics has been avoided and those equations which have been included are carefully explained and represent the minimum necessary for a basic understanding of the subject. The individual chapters are laid out very much with teaching in mind and while they incorporate most of the latest concepts they should not be considered as exhaustive reviews on a given subject.
Book reviews
Authors: Cherryman G R
Published: July 2009

Well, what did you do with your FRCR notes? Gary Stimac kept his for use as a study guide for future radiology residents. He has now written, with the help of colleagues, a core text book in radiology based on his own notes. His book is readable, informative and adequately illustrated with well-chosen clinical images.
Book reviews
Authors: Faulkner K
Published: July 2009

This book is a collection of invited individual review papers originating from renown centres in the world who were asked to provide their own clinical experience of Picture Archiving and Communication Systems (PACS) in medicine. The book represents a distillation of a series of PACS case histories. The stated aim of the book is to provide a state of the art overview of the subject. This overview includes both the history and future of digital PACS in medicine,together with an appreciation of the current status.
Variations in the radiological management of intussusception: results of a postal survey
Authors: Jewell F M , Roobottom C , Duncan A
Published: July 2009

A survey of the radiological reduction of intussusception in a selection of British hospitals was performed using a questionnaire. Replies were received from radiologists working in 51 district general hospitals and 25 teaching hospitals or specialist paediatric institutions. Most district general hospitals still use barium as the sole method of reduction of intussusception. Most teaching hospitals and specialist paediatric units have changed to a pneumatic method. The contra-indications, details of patient preparation and technical details of each method varied considerably.
Models for estimating the risk of ulcers in the small intestine after localized single or fractionated irradiation
Authors: Scott B R , Langberg C W , Hauer-Jensen M
Published: July 2009

Subacute and chronic ulcerations of the intestinal mucosa are important causes of serious complications following radiation therapy for abdominal or pelvic tumours. We describe dose–response models for estimating the risk of mucosal ulcers in the small intestine after uniform, localized single or fractionated (once-daily) X-ray exposure. The models were fitted to data for ulceration incidence, based on a 26 week post-irradiation follow-up of male Sprague–Dawley rats which received a wide range of single and fractionated once-daily 250 kV X-ray doses to a short loop (partial volume) of transposed, but functionally intact, small intestine. The models presented for single (Weibull (W)) and fractionated (modified Weibull (MW)) exposures of a partial volume of tissue allow estimation of the risk of radiation-induced injury. While the W model is not new, its adaptation to partial volume irradiation and the MW model are. Isoeffect relationships are presented for the uniform fractional dose Ds{i%} associated with an i% (e.g. 0%, 5%, 10%, 50%) risk of intestinal mucosal ulcers as a function of the number of once-daily dose fractions, where Ds{0%} represents the threshold fractional dose. Although the Ds{5%} and Ds{0%} estimates provided for intestinal mucosal ulcers are based on animal data, the ratio Ds{0%}/Ds{5%} and more generally ratios Ds{j%}/Ds{i%} (where i ≠ j), are presumed to apply to humans. The indicated ratios are predicted to be independent of the partial volume irradiated and the number of once-daily dose fractions, and may be independent of radiation quality. Isoeffect equations are also presented that apply to circumstances where different partial volumes within the same reference volume (i.e. the total volume of tissue considered) receive different doses, but the dose within a given partial volume is uniformly distributed. These isoeffect equations provide a means of converting nonuniform dose within a reference volume to uniform isoeffect dose to the total reference volume and may have applications outside the field of radiation therapy (e.g. evaluating effects of non-uniform exposure of the small intestine or skin by a hot particle).
Update on the recommended viewing protocol for FAXIL threshold contrast detail detectability test objects used in television fluoroscopy
Authors: Launders J H , McArdle S , Workman A , Cowen A R
Published: July 2009

The significance of varying the viewing conditions that may affect the perceived threshold contrast of X-ray television fluoroscopy systems has been investigated. Factors investigated include the ambient room lighting and the viewing distance. The purpose of this study is to find the optimum viewing protocol with which to measure the threshold detection index. This is a particular problem when trying to compare the image quality of television fluoroscopy systems in different input field sizes. The results show that the viewing distance makes a significant difference to the perceived threshold contrast, whereas the ambient light conditions make no significant difference. Experienced observers were found to be capable of finding the optimum viewing distance for detecting details of each size, in effect using a flexible viewing distance. This allows the results from different field sizes to be normalized to account for both the magnification and the entrance air kerma rate differences, which in turn allow for a direct comparison of performance in different field sizes.
Low density contrast in upper abdominal computed tomography
Authors: Walker D , Blaquiere R M
Published: July 2009

We describe the use of a fat-based low density oral contrast agent in computed tomography (CT) of the upper abdomen. It has a CT number of –71 Hounsfield units (HU) and allows excellent visualization of the bowel wall and adjacent structures as well as reducing the artefacts seen with iodinated high density contrast.
Book reviews
Authors: MacSweeney J E
Published: July 2009

As stated in the introduction the speciality of otorhinolaryngology defines a range of anatomical divisions in pathologies that overlap to a considerable extent with other specialities, one of the most prominent of which is radiology.

This clearly laid out and well presented volume provides a concise and practical account of imaging as applied to the clinical practice of ENT surgery.
Book reviews
Authors: Whitehouse G H
Published: July 2009

This book is intended to be an aid to preparation for the American Board of Radiology written examinations. It follows the format of this examination by offering a range of different types of question. Some are multiple choice questions, in the same general style as the Final FRCR examination. Other questions ask for observations and interpretation of signs on radiographs.
Current indications for high resolution computed tomography scanning of the lungs
Authors: Padley S , Gleeson F , Flower C D R
Published: July 2009

High resolution computed tomography (HRCT) is an effective technique for demonstrating the lung parenchyma in detail and overcomes many of the inadequacies of chest radiography in the diagnosis of diffuse lung disease. This article reviews the role of HRCT in the management of patients with chronic infiltrative lung disease, occupational lung disease, airways disease and acute and sub-acute lung disease.
Dual contrast magnetic resonance imaging with combined use of positive and negative contrast agent in human hepatocellular carcinoma
Authors: SUTO Y , Shimatani Y
Published: July 2009

Dual contrast magnetic resonance imaging (DCMR) with combined use of a negative contrast medium, chondroitin sulfate iron colloid (CSIC), and a positive contrast medium, Gd-DTPA, was attempted in 20 cases of hepatocellular carcinoma. Spin echo T  1 weighted and T  2 weighted images (T  1WI, T  2WI), and T  1 weighted images 15 min after intravenous injection of Gd-DTPA (0.1 mmol kg−1) were obtained. Within 1 week, these MR studies were repeated within 1 h of intravenous injection of CSIC (23.6 μmol Fe kg−1) under similar conditions. DCMR and the other five imaging techniques were visually evaluated and compared in terms of tumour detectability, tumour spread and qualification of tumours (depiction of inner structure). DCMR was significantly better than Gd-DTPA enhanced T1WI in tumour detectability, and better than Gd-DTPA enhanced T  1WI or CSIC enhanced T  1WI in depicting tumour spread. In the qualification of tumours, DCMR was significantly better than all the other five imaging techniques. None of the patients in this study showed adverse reactions or significant changes in biochemistry. DCMR is an imaging technique which is able to utilize the characteristics of these contrast agents collectively, and exhibits advantages in grasping the inner structure of tumours, especially in hepatocellular carcinoma.
Subjective evaluation of image quality based on images obtained with a breast tissue phantom: comparison with a conventional image quality phantom
Authors: Olsen J B , Sager E M
Published: July 2009

A breast tissue phantom was used for assessment of mammographic image quality. Three images, exposed to give a reference area film density of 1.25 ± 0.03, were obtained for each of five different film/kV combinations. Each of three radiologists carried out a series of three blind readings, in which the 15 films were ranked according to sharpness and contrast. In a similar experiment with a conventional image quality phantom, scores for the visualization of simulated calcifications and contrast–detail performance, and measures for resolution and contrast were obtained. In both experiments, the judgements of the readers were highly consistent, and both the intraobserver and interobserver variabilities were non-significant. No significant differences between the film/kV combinations were found with respect to high-contrast resolution and visualization of the simulated calcifications. The contrast measures obtained with the conventional phantom correlated well with the contrast scores obtained with the breast tissue phantom. The contrast–detail scores obtained with the conventional phantom showed no correlation with the scores obtained with the breast tissue phantom, nor with the contrast measures obtained with the conventional phantom.
The effect of contrast density on computed tomographic arterial portography
Authors: Tarver D S , Plant G R
Published: July 2009

Artifacts associated with computed tomographic arterial tomography (CTAP) are well documented. We report a patient undergoing CTAP in whom laminar flow artifact occurred using Iopamidol 370mg ml−1 but not when using Iopamidol 300mg ml−1 under identical conditions. The denser Iopamidol 37Omg ml−1 mixed inadequately with unopacified blood in the portal vein. This was not a problem with the less dense Iopamidol 300 mg ml−1 which is likely to be a more reliable contrast agent for CTAP.
Book reviews
Authors: Golding S J
Published: July 2009

I suspect most of us, if we are honest with ourselves, do not feel completely secure in imaging the face and neck. The anatomy is complex and differential diagnosis include some of the rarest conditions the radiologist encounters. Yet to the enthusiast the interplay between normal and morbid anatomy in this area is fascinating. For this reason the present highly detailed atlas is an interesting newcomer to the literature.
A simple technique to reduce breast irradiation
Authors: Kaplan G R , Ridley N F
Published: July 2009

Female breast tissue is sensitive to the induction of cancer by ionizing radiation [1]. This risk is highest in adolescent females and decreases with age. Having noticed that the breasts were often visible on the flexure views of barium enemas, and that many of these women were under 40 years of age, we decided to assess retrospectively 100 barium enema examinations in female patients under the age of 65 years, to determine how frequently the breasts were visible on the flexure views.
Book reviews
Authors: Shorvon P J
Published: July 2009

This small text is a “must” for those with an interest in evacuation proctography (defaecography). It is essentially the proceedings of an international workshop held in Switzerland in 1991. The participants were all invited on the basis of their known interest in anorectal function and included physiologists, surgeons and radiologists. It is both the multidisciplinary nature of the text and the fact that it contradicts the rather negative view of proctography held in conventional thought by the establishment in the UK, that gives the book its strength.
Book reviews
Authors: Dale R G
Published: July 2009

This book is one of a series covering various specialized aspects of diagnostic and therapeutic radiology. Through 11 independent chapters, each prepared by invited contributors, it sets out the progress and, more especially, the controversies arising from the application of radiobiology to cancer management. Although written in the main by experimental radiobiologists, the subject matter is aimed very much at practising and trainee radiation oncologists.
Book reviews
Authors: Blomley M
Published: July 2009

Primarily aimed at the Part 1 FRCR candidate, for whom it can be recommended, this book manages to condense into an inexpensive pocket sized format a vast amount of information on almost all procedures in common use. The new edition has been expanded substantially to include large sections on the newer modalities and contrast media.
High resolution T1 weighted magnetic resonance imaging of the deep brain structures using a reduced bandwidth
Authors: Sigal R , Bittoun J , Jolivet O , Behnam N , Suminski M , Zannoli G , Francke J-P
Published: July 2009

High spatial resolution T  1 weighted images of the brain were acquired in 5–13 min on a whole-body magnetic resonance imager operating at 1.5 T. In order to obtain 5–8 cm field of view images, the receiver bandwidth (Bw) was lowered to 2 kHz. The use of a 2 kHz Bw, instead of the standard 16 kHz Bw, partially compensated the signal loss due to the small pixel size by increasing the signal-to-noise ratio, without scan time penalty. The chemical shift artifact associated with reduced Bw was not observed because fat signal is negligible in the brain.
A survey of the illumination from diagnostic X-ray light-beam diaphragm systems
Authors: Bridge L R , Ison J E
Published: July 2009

UK radiation protection legislation requires, where applicable, the fitting of light-beam diaphragm systems to diagnostic radiographic X-ray equipment. Measurements performed as part of a quality assurance programme showed that the level of illumination from equipment varied considerably. We decided to include a measurement of the illumination of light-beam systems as a routine part of our programme. The standard method used involved measuring the average illumination at 100 cm focus to field distance for a 25 × 25 cm light field. The results of initial measurements for 73 individual systems (44 fixed, 29 mobile) demonstrate a considerable range in levels with the ratio of maximum to minimum values being approximately 16. Mean values are 130 lux (all systems), 123 lux (fixed systems) and 141 lux (mobile systems). Comparisons are made with the limiting values specified by the Department of Health for mammographic X-ray equipment for breast screening and for new General Electric equipment. A local limiting value of 100 lux is proposed for routine testing purposes.
Inferior vena caval thrombosis following severe liver trauma and perihepatic packing—early detection by intraoperative ultrasonography enabling treatment by percutaneous mechanical thrombectomy
Authors: John T G , Chalmers N , Redhead D N , Kumar S , Garden O J
Published: July 2009

Patients with severe liver trauma present a major challenge in management. We report the successful treatment of a patient presenting with a severe liver injury. The detection of major inferior vena caval thrombosis by intraoperative ultrasonography enabled the use of a percutaneous thrombectomy device to facilitate dissolution of the thrombus.
Diffuse fatty infiltration of the renal parenchyma secondary to bilateral angiomyolipomas— features on ultrasound and computed tomography
Authors: Jackson D M A , Collins C D , Cosgrove D O
Published: July 2009

A case is described where ultrasound demonstrated diffusely increased echogenicity in massively enlarged kidneys. Computed tomography confirmed fatty replacement of the renal parenchyma, allowing a confident diagnosis of multiple bilateral angiomyolipomas in a clinical setting of tuberous sclerosis. This is the first ultrasound demonstration of such diffusely echogenic kidneys in angiomyolipoma.
Prolonged contrast enhancement of the inner ear on MRI in Ramsay Hunt syndrome
Authors: Zammit-Maempel I , Campbell R S D
Published: July 2009

We were interested to read the case report by Downie et al [1] on prolonged contrast enhancement of the inner ear on magnetic resonance imaging in Ramsay Hunt syndrome.

We recently encountered a fairly similar case. A 69-year-old man presented with a 3 day history of a discharging right ear, deafness, vertigo and tinnitus together with a 1 day history of a right facial nerve palsy.
Prolonged contrast enhancement of the inner ear on MRI in Ramsay Hunt syndrome
Authors: Downie A C , Tonge K A , Banerjee A K
Published: July 2009

We thank Drs Zammit-Maempel and Campbell for their interest in our paper and we were interested to note their similar experience. With regard to their final comment, however, we would emphasize when contrast enhancement does persist a follow-up scan may leave one no nearer to excluding an acoustic neuroma, and interpretation in the clinical context is all important.
Book reviews
Authors: Corbett R H
Published: July 2009

When I first agreed to review this book, I little realized how long it would take. This is a book that has been used extensively over the last year, so much so that I have had little opportunity to honour my commitment.

The author states in the Preface that there is no single reference book available to answer the frequent and exacting questions from the public on the safety of X-ray examinations, and that it is her intention to provide the information most often requested by staff in a manner easily accessible.
Book reviews
Authors: Preece A W
Published: July 2009

This Penguin sized volume has some 200 pages of text, 50 pages of references and summaries in English and French. The aim is to collect together experimental data in relation to the existing guidelines for human exposure to radiofrequencey radiation.
Book reviews
Authors: Finch A V
Published: July 2009

This is the fouth edition of a well known standard text devoted specifically to radiographic equipment originally designed for diploma students of radiography. Much of the text has been re-ordered and truncated.
Neoplasms of the lungs and bronchi
Authors: Kerley Peter
Published: July 2009

Malignant disease of the lungs is considered to be such a rarity, that it is usually given no more than a paragraph in our text books and is consequently seldom brought up in discussion of differential diagnosis. As long ago as 1889, Hare estimated that of all the deaths from pulmonary disease in London, 2·3 per cent, were due to primary neoplasms. If this be true, and if malignant disease of the lungs has increased since then in the same proportion as it appears to have increased in other organs, this figure should now be much larger. Unfortunately, as the diagnosis is so difficult, and our tacilities for postmortem examinations are so unsatisfactory, it has not yet been possible to verify this.
A method for estimating compressed breast thickness during mammography
Authors: Burch A , Law J
Published: July 2009

Measurement of compressed breast thickness during mammography is necessary for the calculation of breast dose. In theory, it should be possible to calculate breast thickness from the separation of images of radioopaque markers attached to the compression paddle. Such a technique has been evaluated on two models of X-ray set using simulated and real breasts. The results show that breast thickness at a given position can be determined with an average error of about 2 mm by this method, which is likely to be adequate for dosimetry.
Technetium-99m HMPAO labelled leucocyte scanning in the inital diagnosis of Crohn's disease
Authors: Bury B
Published: July 2009

I read the paper by Malcolm et al on leucocyte scanning with interest [1]. I agree that this is an underutilized technique, but the suggestion that it should be used in a screening role makes me rather nervous. Certainly in our department we would be unable to cope with the number of scans likely to be generated by our gastroenterologists, who have a large inflammatory bowel disease practice.
Technetium-99m HMPAO labelled leucocyte scanning in the inital diagnosis of Crohn's disease
Authors: Malcolm P N , Garvie N W
Published: July 2009

We appreciated Dr Bury' s concern that the adoption of the leucocyte scan as a screening technique for inflammatory bowel disease could generate a substantial additional workload for many nuclear medicine departments.
Book reviews
Authors: Carty H
Published: July 2009

This book provides images of a series of scintigrams of the developing skeleton from birth through to late adolescence and sets out to show the apppearances of the skeleton as seen on scintigraphy at the different ages. The illustrations are of high quality and are easy to read.
Book review
Authors: Freeman A H
Published: July 2009

When the original edition of Dynamic Radiology of the Abdomen first apppeared in 1976 it immediately became a best seller because of its highly original approach to abdominal anatomy and the way this influenced pathological change.
Prediction of gall stone composition by ultrasound: implications for non-surgical therapy
Authors: Kapoor B S , Agarwal A K , Khanna N N
Published: July 2009

Oral cholecystography is the basic radiodiagnostic procedure required to assess chemical composition of gallstones as well as functional status of gall bladder prior to non-surgical management of gallstones. However, the value of ultrasound in non-surgical management of gallstones is yet to be proved. In this study we attempt to establish sonographic criteria which will predict the composition of gallstones prior to their non-surgical treatment. For this purpose the ultrasonographic characteristics of 233 patients with gallstone disease and functioning gall bladders were studied and an effort was made to correlate cholesterol and calcium content of different types of stones (as estimated by X-Ray powder diffraction study and atomic absorption spectrophotometry) with their ultrasonographic characteristics. Sonographic criteria for the presence of cholesterol stones were those which were floating and gallstones producing acoustic shadowing without internal echoes from within the stone. In detecting findings which would predict the presence of cholesterol stones on ultrasound, ultrasound had a sensitivity of 72.90% and a specificity of 100%. The predictive values of positive findings and negative findings were 100% and 93.4%, respectively. The demonstration of typical features of cholesterol stones on ultrasound obviates the need for oral cholecystography.
Assessment of organ radiation doses and associated risk for digital bifemoral arteriography
Authors: Castellano A , McNeill J G , Thorp N C , Dance D R , Raphael M J
Published: July 2009

An assessment has been made of the absorbed dose associated with femoral arteriography using a digital imaging system. A bilateral femoral arteriogram was performed on 17 patients, using a filmless 1024 matrix digital image acquisition system with a discrete stepping tube-stand and 40 cm image intensifies A standardized protocol of manual patient/tube-stand positioning under fluoroscopic control and automatic stepping digital acquisition was followed. Skin entry doses were measured with a dose–area product meter for each stage of the procedure, and the total gonad dose was assessed with thermoluminescent dosimeters (TLDs). Published Monte Carlo simulations were supplemented with further calculations to evaluate organ doses from the dose–area products measured. Comparison with the TLD measurements indicated that this technique overestimated organ doses by about 30%. A mean effective dose of 3.1 ± 1.8 mSv was calculated for the procedure, with the greatest dose burden being imposed by fluoroscopy during catheter manipulation. The related radiation detriment is 0.018%, which is insignificant when compared with the overall mortality from peripheral vascular disease.
A radiological education system—organization of an image library
Authors: Strickland N H , Allison D J , Gishen P
Published: July 2009

A successful radiological library and teaching system should be easy to compile, user-friendly, dynamic and flexible. Nowadays it must be amenable to incorporation into digitally-based communication systems such as personal computers (pc) and picture archiving and communication systems (PACS). This article describes the structural organization and capabilities of such a digital radiological education system, and demonstrates how it fulfils these aims.
Septic arthritis of the hip following ureteric stent insertion
Authors: Williams P H , Odurny A
Published: July 2009

Urinary infection is a recognized complication of ureteric stent insertion. We present a case of pelvic abscess and avascular necrosis of the hip following insertion of a stent for ureteric obstruction.
Book reviews
Authors: Yeowell M
Published: July 2009

This book is designed to provide an aid to radiological technologists in the USA preparing for the certifying examination in mammography, with practice in the answering of examination type questions.
Book reviews
Authors: Bingham J B
Published: July 2009

The authors of this paperback book are well known for many publications on the subject of safety of magnetic resonance and have gathered their very extensive experience into a comprehensive book of nearly 300 pages. The first chapter covers the bio-effects of static magnetic fields which are generally insignificant at the field strengths of up to 2.0 Tesla that are usually employed for imaging at present. The effects of gradient magnetic fields are dealt with in chapter 2 and of radiofrequency electro-magnetic fields in chapter 3 and again the hazards at the normally used imaging levels are of little significance.
Book reviews
Authors: Finch A
Published: July 2009

The tape addresses the issue of the title with specific reference to dentistry, although it would be of interest to any health professional dealing with both radiation and the general public.

Professor David Smith addresses and outlines with great clarity the dichotomy between the professional, in this case the dentist, who wishes to use a “minute amount of radiation” in order to clarify a diagnosis, and the concerned mother who, for the purpose of illustration had had two bitewing exposures while pregnant and whose child had subsequently, at the age of fourteen, developed a cancer.
Book reviews
Authors: Shaw D G
Published: July 2009

This is an excellent book written by a histopathologist and a paediatric radiologist, both of whom are renowned in their specialities. specialities. The book is essentially in three parts. The first part deals extensively with details of various forms of bone tumours, categorized as being of cartilagenous, osteoblastic, fibrous tissue, marrow, vascular and neurogenous origins.
Book reviews
Authors: Bingham J B
Published: July 2009

This is a single author text book of over a thousand pages written by a well respected expert in the field. The chapters are arranged in conventional and logical order starting with the basic procedures in neuroradiology followed by the embryology and normal anatomy. Angiography is comprehensively covered with some comparison with MR techniques. The next chapter on congenital disorders is well illustrated by CT and MR.
The role of duplex and colour Doppler ultrasound in the follow-up evaluation of transjugular intrahepatic portosystemic stent shunt (TIPSS)
Authors: Ferguson J M , Jalan R , Redhead D N , Hayes P C , Lallan P
Published: July 2009

Transjugular intrahepatic portosystemic stent shunt (TIPSS) is an effective means of controlling acute variceal haemorrhage. Shunt occlusion or stenosis occurs in up to 30% of patients within 6 months. It is important to detect these patients and intervene to prevent rebleeding. We have compared non-invasive Doppler ultrasound with the portal pressure gradient (PPG) at portography at 3 month follow-up in 23 patients. All patients with a shunt peak velocity greater than 90 cm s−1 (7 of 17 analysable results) had normal shunt function at portography (PPG < 12 mmHg). Portography may therefore be avoided in this group, although the majority of patients will still require portography for TIPSS follow-up assessment.
Long-term venous access service based in the barium room
Authors: McGann G M
Published: July 2009

27 totally implantable venous access devices (ports), 12 long term dual-lumen venous access catheters and one tunnelled long line were placed over 13 months in a standard district general hospital (DGH) screening room. No significant early complications occurred. Two patients referred from outside hospitals were lost to follow-up. Of the 38 lines with comprehensive follow-up, three required removal because of suspected infection and one because of thrombosis giving a major complication rate of 4 per 6800 access days, i.e. 0.59 per 1000 access days. The minor complications comprised five treatable infections and one resolving subclavian thrombosis in 6800 access days. These rates compare favourably with previous radiological series in which procedures were performed in “clean” vascular suites, and with previous surgical series. Radiological insertion of these devices with rapid scheduling and local anaesthesia methods is feasible in a DGH without the use of a specialized vascular suite.
The prevalence of cervical and thoracic congenital skeletal abnormalities in basal cell naevus syndrome; a review of cervical and chest radiographs in 80 patients with BCNS
Authors: Ratcliffe J F , Shanley S , Chenevix-Trench G
Published: July 2009

The major clinical stigmata of basal cell naevus syndrome (BCNS) appear in adolescence and adult life but some occult skeletal abnormalities are congenital. BCNS is dominantly inherited and it would be useful to identify, as early in life as possible, which of the offspring of patients with BCNS are at risk of developing the syndrome. Radiographs of the neck and chest of 80 patients with BCNS diagnosed confidently on clinical criteria have been examined for abnormalities which were considered to be congenital skeletal anomalies. Congenital abnormalities of the cervical and thoracic spine, mainly spina bifida occulta, were found in 45%. Congenital abnormalities of ribs were found in 49% and of the shoulder(s) in 36%. Overall congenital abnormalities were shown on the neck or chest radiograph in 55 (69%) patients. The presence of one or more of these congenital abnormalities on the chest or neck radiograph of a child who is the offspring of a person with BCNS makes it extremely likely that the child also has BCNS. The absence of these features, and of any clinical features of BCNS, would suggest that the risk of the child developing BCNS has been reduced from the prior expectation of 50% to approximately half that (24%).
External and interstitial radiotherapy in the treatment of oropharyngeal squamous cell carcinoma
Authors: Yasumoto M , Shibuya H , Hoshina M , Takeda M , Matsumoto S , Suzuki S
Published: July 2009

The records of 165 patients with squamous cell carcinoma of the oropharynx treated at our hospital with external and/or interstitial radiotherapy between 1971 and 1990 were reviewed to evaluate the treatment results, focusing on primary control and complications. All cancers were restaged according to the UICC 1987 TNM staging system. Of these 165 patients, 11% were in Stage I, 55% in Stage II, 24% in Stage III and 8.5% in Stage IV. Local control and complications were analysed in 140 patients. The remaining 25 patients died of intercurrent or metastatic disease during the first 2 years following treatment and were excluded from the analysis. 70 patients were treated by interstitial implant using permanent implant seeds (Rn-222 in eight patients, Au-198 in 62 patients) with or without external radiation. 56 other patients received external irradiation alone and another 14 patients received pre-operative external irradiation plus surgery. 2-year recurrence-free rates were 73% (100% for Tl, 76% for T2, 36% for T3 tumours) in the patients who received interstitial implant with or without external radiation and 36% (67% for Tl, 48% for T2, 13% for T3 tumours) in the patients treated by external irradiation alone. The incidence of soft-tissue or bone complications requiring long-term treatment was 14%. Based on these findings, it is believed that an interstitial implant using Au-198 grains combined with external beam irradiation is a useful treatment modality for small lesions of the oropharynx.
The efficacy of megavoltage imaging in the radical radiotherapy of non-small cell lung cancer
Authors: Levine E L , Burt P A , Stout R , Kane B
Published: July 2009

Megavoltage imaging (MVI) has been used to obtain digital images of treatment fields during therapy for non-small cell lung cancer. Tumours were seen in all 33 cases studied and in three cases MVI was used to improve the set-up. It is concluded that in the setting of radical radiotherapy for non-small cell lung cancer this is an appropriate technique for the verification and correction of field position and is an aid to quality assurance.