bluuebunny/crossref_metadata_2025 huggingface dataset:
Computed tomography features of complete splenic infarction, cavitation and spontaneous decompression complicating pancreatitis
Authors: Collie D A , Ferguson J M , Allan P L , Redhead D N
Published: July 2009

Splenic infarction is a rare complication of pancreatitis. We present the case of a 34-year-old woman, who had undergone previous drainage of a pancreatic pseudocyst, and who represented with left upper quadrant pain. Absence of enhancement of the splenic parenchyma during contrast enhanced computed tomography (CT) allowed confident diagnosis of complete splenic infarction. A later CT scan revealed splenic cavitation with spontaneous decompression into the stomach. The aetiology of these unusual complications of pancreatitis is discussed.
A single diagnosis: that is the question
Authors: Avery G R , Chippindale A J
Published: July 2009

A 3-month-old boy presented with a 6 week history of persistent cough, general malaise and increasing pallor. On examination he was noted to have hepatosplenomegaly and his chest radiograph demonstrated miliary shadowing. The diagnosis was confirmed on liver biopsy and urine culture. However, despite appropriate therapy the patient's condition slowly deteriorated.
Book reviews
Authors: Gillard J H
Published: July 2009

This book aims to review the present position of MRI and of MR spectroscopy (MRS) in the diagnosis and management of epilepsy, to summarize current research and also to indicate possible avenues for future research. It is aimed at a broad range of disciplines including radiologists, neurosurgeons, neurologists, neurophysiologists and psychiatrists who work in the field of epilepsy. Shorvon et al are aided in this task by a broad range of coauthors from Europe, North America and Australia who together contributed to the 53 chapters.
Book reviews
Authors: Cole D J
Published: July 2009

This book comprises invited reviews of selected topics in radiation oncology from experts in their fields from both sides of the Atlantic. The topics were chosen to represent some of the growth areas both in clinical practice and in technical innovation (particularly treatment planning). Further volumes are planned at 2–3 yearly intervals.Many of the subjects contained in this volume will be of interest to clinicians and those in training and I would recommend it for each departmental library.

Several chapters consider some areas of technical progress including conformal radiotherapy, multileaf collimation and on-line portal imaging. The experience from the University of Michigan using three dimensional treatment planning is exciting and well complemented by a more cautious assessment from the Royal Marsden Hospital. The latter group emphasizes the importance of evaluating the clinical impact of improved dose distributions in Phase III trials, rather than assuming that physical improvements must be associated with clinical advantage.
Book reviews
Authors: Phelan M
Published: July 2009

This is quite a large paediatric ultrasound textbook consisting of 14 chapters and extending to almost 600 pages, providing a comprehensive review of the applications of ultrasound in the head and extra cranial regions of the body.
Book reviews
Authors: West M B
Published: July 2009

Neither the title, nor the subtitle “A technical quality control protocol for the NHS Breast Screening Programme”, are entirely adequate to describe the scope of this book.
Book reviews
Authors: Cole D J
Published: July 2009

I was impressed with this stimulating collection of reviews by senior figures in the USA from the 27th Annual San Francisco Cancer Symposium in March 1992. The topic addresses the principle objective of the radiation oncologist, that is, to achieve equal or better local tumour control than the surgical oncologist without the debilitating loss of function associated with radical surgery, for example, to cancers of the breast, larynx, prostate, bladder and penis. There is an important emphasis on quality of survival in patients with malignant disease.
Dual compression mammography using computed radiography
Authors: Brettle D S , Thompson J , Parkin G J S , Cowen A R
Published: July 2009

On mammography most malignant growths may be seen as a tethered mass or architectural distortion. Benign lesions such as cysts and fibroadenomas have no focal tethering and are usually well circumscribed. Computed radiography (CR) is a direct digital system which may be used for mammography. One of the main advantages of CR is its wide exposure latitude allowing images to be acquired at lower exposures than required for film–screen systems. A technique was developed, utilizing the exposure latitude of CR, to acquire two mammograms of the same breast at two slightly different compressions, but using approximately the same exposure as a single film-screen mammogram. These images were then “animated” on a computer allowing the fibrous septa movement to be visualized. The movement of the fibrous septa in the presence of an abnormality was used to help confirm whether a lesion was benign or malignant. This technique may have clinical application in classifying architectural distortions and masses which are ultrasonically benign but later found to be malignant. Microcalcifications cannot be used as a diagnostic indicator with this technique because of the increased noise associated with the lower exposures. The increased noise did not affect the visualization of masses.
The role of arteriography in patients with isolated neurological deficit following a penetrating upper limb injury
Authors: Howlett D C , Holemans J A , Downes M O
Published: July 2009

Two cases are described of patients who presented with isolated neurological deficit following penetrating injury to the upper limb. Arteriography demonstrated brachial artery false aneurysm formation in each case. There are accepted indications for emergency angiography following stab wounds including pulse deficit, vascular bruit, expanding haematoma and hypotension with no obvious cause. Indirect indicators of vascular damage include proximity of the injury to an artery with no physical signs or isolated neurological deficit. These indications do have a significant association with concurrent arterial injury and should be investigated by elective angiography if the patient is haemodynamically stable.
An unusual cause of baldness
Authors: Collie D A , Stevenson A J M , Lessells A M
Published: July 2009

A previously well 85-year-old man initially presented with a 6 month history of anorexia and weight loss, together with a 1 month history of vomiting. A barium meal was performed (Figure 1). An abdominal ultrasound revealed a normal liver and biliary tree but diffuse thickening of the stomach wall consistent with infiltration. Endoscopic biopsies of the gastric antrum and duodenum revealed non-specific inflammatory changes and mucosal oedema only.
Systematic errors in displacement measurements performed using CT scannograms
Authors: Davies M L , McCallum H M
Published: July 2009

Computed tomography (CT) scan projection radiographs, or scannograms, are used increasingly to make distance measurements for pelvimetry purposes. A request was received from a local X-ray Department to investigate the efficacy of this method prior to clinical use. One of the factors investigated was the accuracy of cursor measurements in the direction of movement of the couch and transversely across the fan beam. Cursor accuracy was assessed using the method described by Wade [1].
Proceedings of the British Institute of Radiology
Authors: Klevenhagen S C , Thwaites D I , Planskoy B
Published: July 2009

Experimental methods for determining ion recombination corrections are well established. However, recent measurements at NPL and elsewhere using parallel-plate chambers show effects at moderately high polarizing voltages which are not explained by present theory and which compromise the measurement of recombination corrections. Commonly used two-voltage methods, for example the half-voltage method recommended in the UK, are not able to detect these problems and can give erroneous correction factors. Results were presented for the NACP chamber type which show that, so long as certain precautions are taken, consistent results can be achieved over a wide range of dose rates. Values for the coefficient of general recombination in pulsed beams are presented for a series of nominally identical chambers. The values are shown to vary significantly from chamber-to-chamber of the same chamber type. These variations may be interpreted as differences in the chamber volumes, which allow effective electrode spacings and collector diameters to be evaluated.
Does peppermint oil relieve spasm during barium enema?
Authors: Sparks M J W , O'Sullivan P , Herrington A A , Morcos S K
Published: July 2009

The effectiveness of topical peppermint oil added to barium sulphate suspension in relieving colonic muscle spasm during double contrast barium enema examination was assessed in a double blind study. 141 patients were randomized either to a control group (71 patients) examined with standard barium suspension or to the treatment group which received peppermint oil mixed with the barium preparation. No residual spasm was evident in a significant proportion of patients in the treated group (60%) compared with the control group (35%) (p<0.001). The patients' acceptability of the procedure was good and there were no adverse effects on the overall quality of the examination. In conclusion, the addition of peppermint oil to the barium suspension seems to reduce the incidence of colonic spasm during the examination. The technique is simple, safe, cheap and it may lessen the need for intravenous administration of spasmolytic agents.
Assessment of mean glandular dose in mammography
Authors: Faulkner K , Law J , Robson K J
Published: July 2009

The routine assessment of patient dose in the National Health Service Breast Screening Programme is performed as part of the quality assurance protocol recommended by the Institute of Physical Sciences in Medicine. The mean glandular dose to a standard breast is deduced from measurement of the air kerma at the entrance surface of a 4 cm Perspex phantom by applying a series of conversion factors. The exposure factors for this measurement are those used clinically. The measured mean glandular dose is then compared with nationally accepted action levels. In some centres the assessment of mean glandular dose using Perspex is supplemented by patient dose surveys. The mean glandular dose to a series of patients attending a breast screening unit may be estimated from a knowledge of the exposure factors and compressed breast thickness, using a knowledge of the X-ray tube output. Measurements made on units in the Northern Region of England and in Scotland using both methods are presented. The implication of these measurements with regard to patient dose surveys in mammography and quality assurance programmes are discussed. An analysis of the uncertainties associated with the measurement techniques is presented.
An assessment of X-ray protective gloves
Authors: Clasper J C , Pinks T
Published: July 2009

An assessment of X-ray protective gloves is reported which demonstrates that a significant degree of protection from X-ray exposure can be offered by these gloves. The need for such protection, together with the method of assessment is discussed. It is recommended that X-ray protective gloves are considered when undertaking image intensifier work.
Avascular necrosis of the femoral head as a complication of complex embolization for severe pelvic haemorrhage
Authors: Obaro R O , Sniderman K W
Published: July 2009

We present a case of avascular necrosis of the femoral head following embolization of the right medial femoral circumflex artery with alcohol after a failed prior internal iliac artery ligation to control benign pelvic haemorrhage in a 41-year-old woman. No case of late necrosis of the head of the femur as a complication of iliac artery vessel embolization to control haemorrhage has been documented previously. The problems associated with therapeutic pelvic embolization following ligation of the internal iliac artery and the disruption of the femoral head arterial supply are discussed.
Book reviews
Authors: Ryan S
Published: July 2009

Cranial haemorrhage in full-term neonates is much less common than in pre-term neonates, but frequently much more challenging. A detailed review of a large number of cases is therefore a useful guide for clinical practice since individual neonatologists and radiologists may have been involved with few cases. This review is based on 190 retrospective cases of intracranial haemorrhage; 159 neonates detected at the Neonatal Intensive Care Unit at Gent University Hospital, and 31 neonates who had died and underwent post-mortem at the Hammersmith Hospital.
Book reviews
Authors: Weston M J
Published: July 2009

This book forms part of the Medical Radiology—Diagnostic Imaging and Radiation Oncology series and is a companion volume to the earlier Radiology of the Upper Urinary Tract which was also edited by E Lang. The book comprises 19 chapters contributed by 29 authors predominantly from North America. It is a relatively slim volume which of course makes it enticing and easy to read, but renders it a little too succinct for a reference book. There are however extensive lists of references to each chapter to aid deeper study.
Book reviews
Authors: Banerjee A K
Published: July 2009

The last 5 years or so have witnessed the gradual expansion of magnetic resonance imaging facilities in hospitals throughout the country. More and more radiologists therefore are becoming involved with this new imaging modality which is likely to continue to prove a very valuable addition to the radiologist's diagnostic armamentorium. A knowledge of MRI anatomy is crucial for the radiologist interpreting these scans.
John Read, BSc, PhD Hon. Member BIR 1908–1993
Authors: Boag J W
Published: July 2009

John Read, who was elected an Honorary member of the Institute in 1971 for his contributions to research in radiobiology, was well known to older members of the Institute but his decision to emigrate to New Zealand in 1950 meant that he was rarely seen in this country after that time and few of the present members will have known him personally. In many respects he was a representative of the pre-computer age, who believed in simple experiments which he planned and carried out himself.
The relationship between TV position and the effectiveness and comfort of protective spectacles in fluoroscopic procedures
Authors: Nicholson R A
Published: July 2009

Although interventional radiological procedures can result in significant eye doses to an operator, protective measures are often rejected because screens are found to impede manipulations, and 0.5 mm lead equivalent spectacles are heavy and uncomfortable. With many units the TV monitors are positioned so that the operator needs to turn his head through 80° or more to view the image while screening. The aim of this study was to determine the distribution of the shielding in protective spectacles which will combine maximum dose reduction for different TV positions with minimum weight. Thermoluminescent dosimeters were used to assess the effectiveness of various spectacles in shielding the lens of the eye when a skull phantom was orientated at different angles in a large area beam of X-rays generated at a tube potential typical of diagnostic energies. The beam was tilted upwards at an angle of 20° as though originating from the irradiated volume of a patient. The results showed that if weight was a consideration, and the head was turned away from the image intensifier through an angle greater than 80°, the shielding was most effective when concentrated in the side-panels of the spectacles. The shape of the side-panels, however, was critical to the adequate shielding of this radiation.
Malignant mesothelioma of the tunica vaginalis testis—an indolent course
Authors: Amin R
Published: July 2009

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumour. So far less than 50 cases have been reported in the literature. Radical inguinal orchiectomy appears to be the optimal treatment. Upon recurrence, treatment remains unsatisfactory. A further case is reported here, where the disease ran an indolent course despite several recurrences after initial treatment.
Non-malignant cause of brachiocephalic vein compression following treatment for lung cancer
Authors: Bryant G P
Published: July 2009

Obstruction of venous return in the mediastinum or thoracic inlet is well recognized, particularly in oncological practice. In most cases the obstruction is of the superior vena cava. For such venous obstruction to occur following treatment for lung cancer usually implies malignant lymph node involvement and therefore a grave prognosis. This report describes a patient who developed unilateral signs of impaired venous return from the head, upper trunk and upper limb following treatment for lung cancer. The cause was found to be compression of the left brachiocephalic vein by normal anatomical structures as a result of mediastinal shift following pulmonary lobectomy and radiotherapy. This case, together with others reported in the medical literature, suggests that the development of isolated brachiocephalic vein obstruction does not necessarily have the same ominous implications as the development of superior vena caval obstruction.
Factors in dependent lobar superenhancement during CT arterial portography
Authors: Breen D
Published: July 2009

I was interested to read Drs Tarver and Plant's report of apparent density-dependent layering of contrast during superior mesenteric artery (SMA) injected computed tomographic arterial portography (CTAP) [1]. We too have occasionally experienced problems with left lobe/anterior hypoperfusion defects and relative super-enhancement of the dependent posterior segments (Figure 1).
Metastatic breast carcinoma involving the gastric antrum and duodenum: computed tomography appearances
Authors: Elliott L A , Hall G D , Perren T J , Spencer J A
Published: July 2009

We describe the computed tomography (CT) appearances of three cases of antroduodenal linitis plastica metastases from breast carcinoma. Two of the three cases had biliary obstruction as a consequence and required endoscopic stenting. Antroduodenal linitis plastica should be considered as a possible cause for jaundice in patients with breast carcinoma.
High resolution ultrasound anatomy of normal Achilles tendon
Authors: Bertolotto M , Perrone R , Martinoli C , Rollandi G A , Patetta R , Derchi L E
Published: July 2009

To evaluate the ultrasound (US) appearance of the normal Achilles tendon at increasing frequency and establish an anatomical correlation for US findings, 30 normal tendons were examined in vivo and three in vitro with 10 MHz and 15 MHz mechanical sector probes. Side-by-side comparison was performed in vitro between the sonograms and the corresponding anatomical sections. Two tendinous portions were detected by presence of an internal acoustic interface which had different appearances: one (type I) or two (type II) continuous lines of increased thickness and greater reflectivity than adjacent fibrils; or displacement (type III) of the distal portion of the well insonated sector of the tendon body. When, on coronal scans of the tendon, no intratendinous linear echoes of increased reflectivity were visible, the two portions of the tendon were identified through the converging course of their bundles (type 0 pattern). Different echogenicity allowed the detection of two tendinous portions, also on axial images. Scanning of isolated tendons allowed precise location of these interfaces at the boundary between anatomically distinct tendinous portions arising from the soleus and gastrocnemius muscles. Although the normal Achilles tendon is commonly regarded as a uniform structure by US, the use of high resolution probes allows identification of its constituent portions. Their identification may be useful to avoid misdiagnoses of pathological findings.
Magnetic resonance imaging-guided preoperative breast localization using “freehand technique”
Authors: Brenner R J , Shellock F G , Rothman B J , Giuliano A
Published: July 2009

A 1.5 cm focus in the breast with intense gadolinium uptake was incidentally detected during magnetic resonance (MR) imaging evaluation of a cluster of microcalcifications. Because the apparent mass was both mammographically and sonographically occult, MR imaging was used to guide a needle by “freehand technique” to the lesion, permitting successful pre-operative localization and subsequent surgical excision of the area.
An evaluation of a Diamentor based system for estimation of spot film dose–area product values
Authors: Hoskins P R , Adam R D
Published: July 2009

In the audit of barium studies it is not common to assess the contribution of spot films to the total dose. This study investigates the accuracy with which the number of spot films and associated dose–area product (DAP) may be estimated. The study was undertaken for barium enemas, the swallow part of barium swallow studies, and the abdominal part of barium meal studies on X-ray sets with film–screen radiography, digital fluorography and 100 mm camera fluorography. DAP readings from a Diamentor were input to a computer at a rate of three per second and the difference in successive DAP values calculated. These data were used to assess the number and total DAP from spot films. For Diamentor based systems which sample the DAP values at three times per second the threshold algorithm works well for film–screen radiography of barium meals and enemas. However, the estimated number of spot films is generally in error. For the Diamentor M2 it is unlikely that the sample rate can be increased to a high enough value to provide sufficient accuracy for all barium studies obtained using all spot film modalities, although use of the modified threshold algorithm has the potential to provide some increase in accuracy.
Non-surgical treatment of epiphora by balloon dacryocystoplasty — the technique
Authors: Kumar E Nanda
Published: July 2009

Dacryocystoplasty (DCP) was offered as an alternative to patients waiting for dacryocystorhinostomy (DCR) for epiphora. 31 procedures were undertaken with a technical success rate of 93% and a clinical improvement in 89% of these patients. It is concluded that DCP should be the technique of choice in the initial management of epiphora due to stenosis or occlusions of the nasolacrimal ducts before contemplating a DCR.
A painful red eye
Authors: Downie A C , Howlett D C , Banerjee A K
Published: July 2009

A 31-year-old Gurkha living in Nepal was referred with a 4 month history of worsening redness, swelling and pain affecting both eyes, mainly the right. On examination he was pyrexial and had gross right-sided proptosis and periorbital oedema. Visual acuity was normal.
Radiation dose to the lens from CT of petrous bones
Authors: Maclennan A C
Published: July 2009

Further to the studies on radiation dose to the lens from computed tomography (CT) in a neuroradiology department [1], and from brain scans in general radiology departments [2], I report the lens dose from CT of the petrous bones. 14 patients with Paget's disease underwent a coronal scan plus a supraorbitomeatal baseline scan (SOM) or scan parallel to the hard palate [3], or both SOM and hard palate baseline scans if unable to assume the coronal position.
The Application of Automatic Computing Machines to Radiation Treatment Planning
Authors: Tsien K. C.
Published: July 2009

A new method of determining the dose distribution required in treatment planning has been developed by using punched cards, and sorting and tabulating machines instead of isodose charts. The percentage depth doses produced by an X-ray field are first recorded on several sets of punched cards. The number of sets required for one field depends upon the distances used from the cross point of the multifield axes to the point of entry. Each set consists of 36 cards, with each card recording the percentage depth doses of 15 points in one radial line, taking the cross points of central axes of the fields as the origin. In all cases the points are taken at the distances 0, 1, 2, 3, 4, 5, 6, 8, 10, 12, 14, 16, 18, 20, 24 cm from the origin and along radial lines 10 deg. apart.

A special polar co-ordinate dose distribution sheet has been designed, and the contour of the patient's body and the position of the fields designated for treatment are drawn on this sheet. Instead of putting the isodose charts at the proper positions of the fields, the sets of punched cards for the fields to be applied are automatically arranged in the right order. Instead of the time-consuming process of reading off the percentage depth doses from the overlapping isodose charts and adding them up for selected points, the cards are fed into the automatic tabulating machine, which makes the summation of data for all the points mentioned above and tabulates the results. The whole operation is done in 10 to 15 minutes. The tabulated results are then plotted on the special dose distribution sheet.

A generalised mathematical treatment of the dose at any point in the irradiated region is discussed, and an equation of “point-tumour dose ratio” is derived. Further application of this equation is made to special cases for treatment using equal maximum doses, equal tumour doses and rotation therapy. The geometrical principles involved are also indicated.
Quantitative perfusion parameters of focal nodular hyperplasia and normal liver parenchyma as determined by electron beam tomography
Authors: Groell R , Kugler C , Aschauer M , Rienmueller R , Stauber R , Trauner M , Mischinger H J
Published: July 2009

Eight patients with known focal nodular hyperplasia (FNH) were studied by electron beam tomography (EBT) in a multisection flow mode at defined time intervals after intravenous contrast agent injection. Various regions of interest (ROIs) were defined in the areas of FNH, normal liver parenchyma, aorta and portal vein. In each ROI density changes were measured and plotted against time. In those time-density curves (TDCs) the slope, the time of maximal enhancement and the absolute density value of peak enhancement were determined. Arterial tissue perfusion was calculated for normal liver parenchyma and FNH. In all eight patients significant differences in peak density (123.88 ± 18.92 HU vs 102.5 ± 15.49 HU, p = 0.0l2), in the rate of arterial contrast enhancement (252.63 ± 28.05 HU min−1  vs 38.88 ± 4.19 HU min−1, p = 0.012) and in the arterial tissue perfusion (1.36±0.19ml min−1cm−3  vs 0.21±0.03ml min−1cm−3, p = 0.012) between FNH and normal liver parenchyma were found. Perfusion values of normal liver parenchyma correspond to those determined by inert gas clearance. Further studies will determine the practicability of this quantitative method in the evaluation of global and other focal liver diseases.
Calculation of the biological effect of fractionated radiotherapy: the importance of radiation-induced apoptosis
Authors: Olsen D R
Published: July 2009

The total effect (TE) has been calculated for two different fractionation formalisms: the consecutive and repetitive fractionation mechanism, using a modified linear quadratic (LQ) model which includes the effect of apoptosis. For a given total dose, an increase in TE is seen when increasing the dose per fraction as well as the apoptotic fraction (F  a). Also, the TE increases with increasing α/β ratio (of the modified LQ model). The ratio of TE for tumour tissue and TE for late reacting tissue is calculated assuming the absence of apoptosis in late reacting tissue and a common value of α/β (of the modified LQ model). The biological effect ratio (BR) is higher for a large F  a and low doses per fraction, than for large doses per fraction and a small F  a. Assuming a consecutive fractionation mechanism, the TE formalism is unable to predict a log cell kill of more than 3 for β values of 0.010–0.028. It is less dependent on dose per fraction and F  a than the repetitive fractionation mechanism. The biological effect ratio is only slightly higher than 1, and is less influenced by F  a, dose per fraction and α/β ratio. A repetitive fractionation mechanism is also consistent with the preliminary results of published fractionation experiments. The calculations indicate that designing fractionation regimes for optimization of biological effect is a process where the role of apoptotic cell inactivation must be maximized, and where the influence of mitotic cell inactivation may be of less importance.
Dose rates and energy spectra in the maze of a linear accelerator treatment room
Authors: Morgan S , Morgan H M , Lillicrap S C
Published: July 2009

When designing an entrance maze for a linear accelerator facility, it is useful to be able to estimate both the dose rate at the entrance and, in case further shielding is necessary, the energy spectrum of the scattered photons reaching the maze entrance. This study examines the applicability of the commonly used empirical formula contained in the National Council on Radiation Protection and Measurements (NCRP) Report No. 51 for estimating the dose rates at the maze entrance in a typical treatment room, and proposes an improvement allowing for the fact that the initial scattering event occurs most often in the patient at the isocentre. The X-ray energy spectrum at the maze entrance is also measured and shown to have a lower average energy than is assumed in NCRP Report No. 51.
Atypical chest pain!
Authors: Eustace S , Murray J G , Breatnach E
Published: July 2009

A 42-year-old woman presented with sudden onset of severe central chest pain. The patient had been previously well and there was no history of trauma. She had a long history of smoking 20 cigarettes a day, and reported early onset of menarche at 8 years. On physical examination she was mildly distressed. Several “cafe au lait” areas of skin pigmentation were noted over her trunk and abdomen. There was no other clinical abnormality.
Röntgen mystery
Authors: Aves B
Published: July 2009

I sat through the historical lectures at the Centenary Congress, and I have read my copy of Invisible Light, and still have yet to find the answer to the question “Why would a nineteenth century German physicist have on his laboratory bench a screen of either cardboard or paper which had been coated with barium platinocy anide?”. What was it doing there, what had he been using it for, and if it was the sort of thing physicists had around, why didn't Crookes have one?
Book reviews
Authors: Berry R J
Published: July 2009

Initially published in 1992 in Japanese as Genbaku Hoshasen no Jintia Eikyou, this very readable English translation encapsulates between one set of covers the careful follow-up over more than forty years of the survivors of the atomic bombs dropped on Hiroshima and Nagasaki in August 1945. The material comprises much that has been published in the various papers emanating from the Radiation Effects Research Foundation, but benefits by being placed in juxtaposition where the comprehensiveness and painstaking thoroughness of the follow-up programme is clearly apparent. Although the text represents contributions from some 39 authors, the advantage of having had a single (and literate) translator, B Harrison, is a cohesiveness of style rare in most multiauthor tomes.
Preliminary clinical evaluation of a combined optical Doppler ultrasound instrument for the detection of breast cancer
Authors: Brittenden J , Watmough D , Heys S D , Eremin O
Published: July 2009

Mammography is widely used for imaging the breast, but is known to be less effective in evaluating the younger dense breast. In this study the ability of telediaphanography in conjunction with Doppler ultrasound (TDDU) to detect breast carcinomas was assessed. Light absorption, determined by the number of blood cells per unit volume of breast, results in the detection of an opaque lesion. Subsequent Doppler ultrasound detects the neovascularization at the periphery of tumours.

In total, 178 patients were investigated without prior knowledge of the mammographic findings. This consisted of 69 patients presenting to the symptomatic breast clinic with normal mammograms and 109 patients with mammographic detected abnormalities (mean age 54 years). There were 95 neoplastic lesions. The sensitivity and specificity were: telediaphanography alone 73% and 82%; TDDU 61% and 92%, respectively. TDDU was less sensitive for small and impalpable tumours, and did not detect ductal carcinoma in situ (26 false negatives, mean diameter of 1.1 cm (SD of 0.3 cm)). Subsequent Doppler ultrasound did not further increase the sensitivity of the examination, but did increase the specificity. Patients with locally advanced breast cancers showed dramatic changes on repeated optical/Doppler examinations, in concordance with response to chemotherapy. The combined optical/Doppler instrument, with its low sensitivity, is not suitable for screening, even in the young dense breast, but may have a role in assessing the response of large tumours to chemotherapy.
An evaluation of the routine use of rectal air in computed tomography of the pelvis
Authors: Walkden B , Ward S C , Metreweli C
Published: July 2009

We have performed computed tomographic examinations of the pelvis in 50 patients, using rectally administered air to outline the rectosigmoid colon. Bowel cleansing was not performed and smooth muscle relaxants were not used. The procedure was well tolerated by all patients, and diagnostic images were obtained in all cases. There were no complications. This is a safe, low cost and easily administered form of bowel contrast. We recommend it as the technique of choice in routine pelvic computed tomography.
Hidden trouble
Authors: Obaro R O I
Published: July 2009

A 64-year-old man presented with an 8 week history of dysuria, frequency, haemoptysis, haematuria, weight loss and pyrexia. Urine cytology and bronchoscopy were negative. An intravenous urogram (IVU) is shown (Figure 1). Sections from a computed tomography (CT) scan of the lower abdomen are shown in Figures 2 and 3. Finally, Figure 4 is a CT section through the chest at the level of the lower lobe bronchus.
Ultrasound velocity and attenuation at different skeletal sites compared with bone mineral density measured using dual energy X-ray absorptiometry
Authors: Cunningham J L , Fordham J N , Hewitt T A , Speed C A
Published: July 2009

Measurements of ultrasound velocity were performed in the tibia in a group of 89 female subjects (mean age 50 6 years). Velocity and broadband ultrasound attenuation (BUA) measurements were performed in the os-calcis in a group of 100 male and female subjects (mean age 55.8 years). Dual energy X-ray absorptiometry (DEXA) scans were also performed on all of these subjects enabling measurements of lumbar spine and femoral neck bone mineral density (BMD) to be obtained. In two small subgroups of the above groups, each comprising 20 subjects, measurements of tibial BMD and os-calcis BMD were also performed. Tibial BMD and ultrasound velocity were found to be well correlated (r = 0 71), although both spine and femoral neck BMD were poorly correlated with ultrasound velocity in the tibia (r = 0.299 and 0.072, respectively). BUA of the os-calcis was moderately correlated with BMD at the same site (r = 0 44) and showed similar or slightly better correlations with BMD measurements of the lumbar spine and femoral neck (r = 0 410 and 0 537, respectively). Ultrasound velocity in the os-calcis was well correlated with os-calcis BMD (r = 0.729) but only moderately correlated with spine and femoral neck BMD (r = 0.470 and 0.498, respectively). This study suggests that BUA and ultrasound velocity measurements of the os-calcis are better predictors of BMD at the critical skeletal sites of the lumbar spine and femoral neck than ultrasound velocity in the tibia. Ultrasound velocity in the tibia and the os-calcis was found to be a good predictor of the BMD in the measured bone.
Sensitometric and image quality performance of “rapid” intraoral film processing techniques
Authors: Czajka J , Rushton V E , Shearer A C , Horner K
Published: July 2009

A number of products are available to dentists for the rapid production of intraoral radiographic films but there is little information on their relative merits. This study evaluated the performance of five “rapid” film processing products commonly used by British dentists in comparison with standard Kodak manual processing. Two Perspex contrast-detail test objects were made in order to investigate threshold contrast Film speed, film gradient, limiting resolution and threshold contrast results are presented. Rapid processing systems possessed lower film speed when compared with Kodak Ektaspeed film and standard Kodak processing. The speed of E-speed film was found to be lower than that of D-speed film when used with Westone “Rapid X-ray” processing. Overall image quality was generally similar for all film/processing combinations evaluated, with the exception of Nix QP which gave markedly poorer image quality.
Charge-coupled device camera optical density range enhancement and the effect on radiographic image segmentation
Authors: Chester E G , Sharif B S , Owen J P
Published: July 2009

A method is presented for the pre-processing of radiographs in the automated determination of skeletal maturity. By linearly combining several source images, a density range enhancement is obtained without the creation of edge artefacts. An increase of bit depth of 1 bit was obtained, and density range was improved by 1 OD.
Bladder opacification following enteral iopamidol as a sign of occult intestinal infarction
Authors: Coakley F V , Owen R J , Rees Y , Dennison A R
Published: July 2009

A case of intestinal infarction due to superior mesenteric artery embolism is described in a 30-year-old female with Crohn's disease. This was accompanied by bladder opacification following enteral iopamidol administered at endoscopic retrograde cholangiopancreatography. The likely mechanism of this finding is transmural and transperitoneal absorption of enteral contrast medium and its significance as a sign of mesenteric ischaemia is discussed.
The need for caution when using the spleen to assess renal blood flow in renography
Authors: Field C M , Glass D M , Peters A M
Published: July 2009

Visual assessment of renal blood flow from renography is usually achieved by comparing the count rate from the kidney with that of the spleen during the first pass of the radiopharmaceutical agent. This is not justifiable if splenic blood flow is abnormal. In nine subjects without evidence of renal or other significant disease, the mean ratio of the slopes of the first pass curves over the left kidney and the spleen was 1.7 (SD 0.32). However, an additional patient, a 67-year-old female with type-II cryoglobulinaemia, illustrated the need for caution when using this approach. Her splenic blood flow was significantly elevated, resulting in a kidney/spleen slope ratio of only 0.66, even though her renal function was thought to be normal.
Size is not important
Authors: Millar J S , Choksey M S
Published: July 2009

A 14-year-old boy presented with a 4 day history of headache and vomiting. On the morning of admission he had developed left sided weakness and had become drowsy. 2 weeks previously he had suffered a ‘flu’ like illness and had received a course of amoxycillin. He had recovered sufficiently to return to school prior to the presenting illness.
Non-Hodgkin's lymphoma presenting as an encasing pleural mass
Authors: Parnell A P , Frew I
Published: July 2009

We are grateful for the interest shown by Dr Wittram in our case report of non-Hodgkin's lymphoma presenting as an encasing pleural mass.
Book reviews
Authors: Mountford P J
Published: July 2009

The development of111 In oxine as an in vitro cell label towards the end of the 1970s was responsible for a very significant advance in the application and use of radiolabelled blood components in diagnostic nuclear medicine.
Early focal abnormalities on chest radiographs and respiratory prognosis in children with cystic fibrosis
Authors: Mukhopadhyay S , Kirby M L , Duncan A W , Carswell F
Published: July 2009

The variable rate of progression of respiratory disease in cystic fibrosis demands reliable prognostic markers for rational treatment. This study aims to determine whether or not focal abnormalities on chest radiographs during the early clinical course of cystic fibrosis could be used as such a marker. A retrospective review of patient records was carried out. Demographic details, genotype, presentation, and course of respiratory disease over the first 6 years were recorded for all patients, together with spirometry and chest radiograph scores at 7 and 13 years for surviving patients. Comparison was made between those with and those without documented focal opacification on chest radiography during the first 6 years of life. 30 patients satisfied the study entry criteria and had complete records available. Of these, 17 had focal consolidation documented during the first 6 years, and 13 did not. Survival was significantly worse in those with previous consolidation (p <0.01), as was peak expiratory flow at 7 years (p = 0.02). There were no other statistically significant differences between the groups, although those with previous consolidation apparently had worse lung function and more advanced disease on chest radiography at both 7 and 13 years. This study suggests that early focal chest radiographic abnormalities may predict a poorer outcome in cystic fibrosis.
Quantitative computed tomography for spinal bone mineral measurements in chronic renal failure
Authors: Karantanas A H , Kalef-Ezra J A , Sferopoulos G , Siamopoulos K C
Published: July 2009

The aim of this study was to assess non-invasively the status of spinal trabecular bone in patients with chronic renal failure and the influence of the disease stage. Single energy quantitative computed tomography (CT) was used in 89 patients with chronic renal failure to measure spinal trabecular bone equivalent density. 23 patients were independent of dialysis and 66 were receiving long-term haemodialysis. Spinal trabecular bone density of the patients was compared with locally determined normal ranges. Although trabecular bone mineral density (BMD) was lower (9% on average) in the patients who were not dependent on dialysis compared with the predicted mean normal values (BMDp) for age- and sex-matched normal subjects, the difference was not statistically significant. A statistically significant reduction was found in patients on dialysis (BMD/BMDp 0.75±0.16, Z-score – 1.3). Osteosclerosis was found in 11 patients and they were excluded from the study. Longitudinal measurements in 42 patients on dialysis without osteosclerosis showed a 2.9% mean reduction in BMD/BMDp over a period of 8 months. All but one of the 16 haemodialysis patients with osteopenic spinal fractures had trabecular BMD values lower than the fracture threshold determined by our technique. In conclusion, end-stage chronic renal failure was associated with reduction in the spinal trabecular bone density.
Vertebral deformity in the thoracic spine in post-menopausal women: value of lumbar spine bone density
Authors: Grey C , Young R , Bearcroft P W P , Compston J E
Published: July 2009

Differential bone loss in the thoracic and lumbar spine is known to occur in some patients with osteoporosis. However, the discriminant value of lumbar spine bone densitometry in the detection of thoracic spine fractures in healthy, population-based women has not been established. The relationship between lumbar spine bone mineral density and thoracic spine vertebral deformities in a prospective study of 79 post-menopausal population-based women aged 45–65 years has been investigated. Lumbar spme bone mineral density was measured using dual energy X-ray absorptiometry, and vertebral morphometry was assessed from lateral thoracic spine radiographs. Seven women (9%) were found to have one or more vertebral deformities in the thoracic spine (reduction in anterior or posterior height > 25%). Only one of these had a lumbar spme bone mineral density T score below − 2.5, whilst the T score was between − 1 and − 2.5 in three and greater than − 1 in three. Two of these women also had lumbar spine vertebral deformity but lumbar spine radiographs were normal in the remaining five. There were no significant differences in age, height, weight, hormone replacement therapy use or bone mineral density between women with and without thoracic spine fractures. These results demonstrate that vertebral deformities in the thoracic spine occur in a proportion of healthy post-menopausal women in the absence of densitometric or radiographic evidence of osteoporosis in the lumbar spine. Although often asymptomatic, the significance of these fractures lies in the increased risk of further fractures. In the future, morphometric X-ray absorptiometric techniques may prove valuable in the detection of these fractures and avoid the need for conventional radiography.
An experimental investigation of the effect of light-box luminance on the detection of low contrast objects in mammography
Authors: Robson K J , Kotre C J , Faulkner K
Published: July 2009

It has been hypothesized that light-box luminance is an important factor in the detection of objects on radiographs. In this work, existing psychophysical data relating to the measurement of visual thresholds at various scene luminance levels are applied to the problem of the observation of radiographs on a light-box. These data suggest that for a given stimulus size, the threshold contrast varies little over several orders of magnitude of scene lummance. In a series of contrast detail experiments performed over a wide range of lightbox lummances it has been demonstrated that the detection of low contrast objects on mammographic film is dominated by external noise, that is noise on the film, rather than the internal visual noise of the observer. It is therefore suggested that in mammography it is inappropriate to base recommendations for optimal values of light-box luminance on psychophysical studies of visual noise. It has been shown that commonly used light-box luminances are suitable for viewing mammograms at the higher average optical densities now being recommended, provided that precautions are taken to avoid glare and reflection.
Dose–area product values in frequently performed complex paediatric radiology examinations
Authors: Ruiz M J , Vañó E , González L , Fernández J M
Published: July 2009

Mean values of the dose–area product for barium meal, micturating cystourethrography and intravenous urography examinations from three health centres and for four age groups are presented in this study. Values measured are between 13% and 86% higher than results previously reported, which justifies the importance of applying procedures which reduce risks to patients.
Imaging of central nervous system sarcoidosis with gallium-67 single photon emission computed tomography
Authors: Jarman P R , Whyte M K B , Glass D M , Peters A M
Published: July 2009

Involvement of the nervous system is an uncommon and underdiagnosed complication of sarcoidosis. We used gallium single photon emission computed tomography (SPECT) to define areas of meningeal involvement in a patient with neurosarcoidosis. This technique may be of value in the assessment of patients with sarcoidosis and suspected central nervous system involvement.
A child at heart?
Authors: Errington M L , Reid J H
Published: July 2009

An 80-year-old woman presented with a 2 month history of progressive fatigue and ankle swelling. She had a past history of polymyalgia rheumatica but had never smoked and denied chest pain.