bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of an infrared touch-screen to control the sensitivity of ultrasound scanners in clinical practice
Authors: Pye S. D. , Elliott V. , Marshall I. , Millar D. , Robertson S. , McDicken W. N. , Wild S. R.
Published: July 2009

Real-time ultrasound involves rapid scanning through the body and easy control manipulation is essential. The sensitivity settings of a scanner (also referred to as the time gain compensation (TGC) settings) are crucial in obtaining good image quality. However, many ultrasound scanners only allow the operator a limited scope for adjusting the sensitivity, and often it is only possible to change the slope or overall level of the TGC or to alter the TGC at a few depth ranges. No commercially available scanners allow the operator to alter the sensitivity in small regions of the image despite the common experience that a diagnosis is often made by examining in detail a particular area of an image.

One approach to this problem is to automate fully the sensitivity controls (McDicken et al, 1974; DeClercq & Maginness, 1975; Pye et al, 1988). Another approach is to make the sensitivity controls more flexible and easier to use. In order to explore the potential of more flexible methods of sensitivity control, an infrared touch-screen has been used in conjunction with a microcomputer to control the sensitivity of a real-time scanner. This system has been evaluated clinically in routine obstetric scanning.

The touch-screen is manufactured by Microvitec Ltd, and comprises an array of infrared emitters and detectors plus control logic mounted in a frame that fits around a 14-inch monitor screen. The maximum resolution of the array is 120 divisions horizontally by 90 vertically.
An illustrative case: enough to raise one's blood pressure
Authors: Herbetko J. , Batty V. , Millar J. G. B.
Published: July 2009

A 64-year-old man was noted, during investigation of labile hypertension, to have marked central obesity and a plethoric facies. Tests revealed diabetes mellitus and consistently elevated urinary excretion of vanillylmandelic acid (VMA) at 1066, 661 and 500μmol/24 h (normal range 7–85).

Imaging with meta-iodobenzylguanidine (MIBG) showed increased uptake in the region of the left adrenal gland (Fig. 1), and subsequent computed tomographic (CT) scans are illustrated in Fig. 2. A repeat CT scan 7 months following surgery is illustrated in Fig. 3.

On the basis of the first CT scan, further investigations were undertaken.

The biochemical findings together with the MIBG image are diagnostic of a phaeochromocytoma.

The CT scan shows the presence of an 8 cm mass containing flecks of calcium, replacing the left adrenal gland, which confirms this diagnosis. In addition, there is marked hypertrophy of the right adrenal gland with preservation of its normal configuration, together with abundant retroperitoneal fat deposition.

These findings of adrenal hyperplasia and an abundant amount of fat can occur in Cushing's syndrome and this was confirmed on biochemical testing. Serum cortisol at 9.00 a.m. was > 1932 nmol/litre (normal 200–700) and at 12.00 p.m. was 1874 nmol/litre (normal <200). On both low (0.5 mg 6-hourly) and high (2 mg 6-hourly) doses of dexamethasone, serum cortisol at 9.00 a.m. was > 1932 nmol/litre. Plasma adrenocorticotrophin hormone (ACTH) at 9.00 a.m. was 399 ng/litre (normal < 80). Plasma corticotrophin releasing factor (CRF) was 270 ng/litre (normal <100).
Common symptom: uncommon cause
Authors: Tung Kean T. , Wilson Graham F.
Published: July 2009

A 48-year-old Bangladeshi man presented with a 2-month history of low lumbar back pain radiating down the right leg. Otherwise he felt well and in particularsuffered no cough, fever or weight loss.

Examination revealed local tenderness over the lower lumbar spine with decreased range of movements but no neurological deficit. The remainder of the physicalexamination was normal.

The chest radiograph (Fig. 1), lateral radiograph of the lumbar spine (Fig. 2) and ultrasound scan of the porta hepatis (Fig. 3) are shown below.
Control of patient positioning for fast neutron therapy using positron emission tomography
Authors: Vynckier S. , Vanneste F. , Richard F. , Bol A. , Michel C. , Wambersie A.
Published: July 2009

With conventional photon therapy, radiographs are widely used for the verification of patient positioning. This method cannot be used with neutrons because of the poor sensitivity of standard films to neutrons compared with γ rays. In addition, there is little difference in energy absorption between bone and soft tissue for these neutron beams (Bewley et al, 1973; Catterall & Bewley, 1979).

The problem can be solved by introducing into the collimator, at the target position, a diagnostic X-ray tube (Risler & Wootton, 1988). Another approach entails visualizing the neutron-induced activity within the patient using positron emission tomography (PET). At high neutron energies, shortlived positron emitters are produced (Kleck et al, 1988; Vynckier et al, 1988) with activities sufficiently high to be visualized; the dose-equivalent rate close to the patient as a result of this activation is ∼ 30 μSv h−1 immediately after irradiation (Tatcher et al, 1987). The same approach was reported recently for pion radiotherapy (Goodman et al, 1986).
Radiological appearances of colonic ring staple anastomoses
Authors: Chan T. Y. K. , Davidson T.
Published: July 2009

We read with interest the article in BJR by Dr Daley and Mr Crowley (1989) relating the plain radiographic appearances of colonic staple ring to possible anastomotic dehiscence. They suggest that urgent water-soluble contrast medium enema should be performed to confirm the diagnosis.
Book reviews
Authors: Burrows E. H.
Published: July 2009

Sir Hugh Cairns, in introducing Almeida Lima's book Cerebral Angiography (Oxford University Press, 1949)—the first English textbook on the subject—wrote: “The reader cannot but be impressed at how much was discovered in the early stages in Lisbon, and how little has since been added.” Lima is said to have performed the first (cut-down) carotid angiogram in England in the 1930s during the 3 years that he spent in London acquiring neurosurgical skills from Cairns. However, Lima himself credited Norman Dott, the Edinburgh neurosurgeon, as being the British pioneer.
The value of transoesophageal ultrasonography in the management of a mediastinal foregut cyst
Authors: Page J. E. , Wilson A. G. , de Belder M. A.
Published: July 2009

Mediastinal foregut cysts account for approximately 10% of primary mediastinal masses. The differentiation of these cysts from other mediastinal masses is important, especially if a policy of aspiration and observation of cysts is adopted. Computed tomography (CT) is generally regarded as the definitive imaging modality in these cases, but it may occasionally fail to identify the cystic nature of the mass. We report a case in which transoesophageal ultrasound contributed to the diagnosis and demonstrated features of the cyst contents that were not visible on CT.
Low-field cine magnetic resonance imaging in aortic valve disease
Authors: Metcalfe Malcolm J. , Jones Richard A. , Redpath Thomas W. , Smith Francis W. , Jennings Kevin , Walton Stephen
Published: July 2009

Cine magnetic resonance imaging (MRI) holds considerable promise as a means of detecting abnormal blood flow patterns within the heart and great vessels. To date, the majority of techniques employed have required moderate to high field strengths. We describe a novel, low-field-strength approach that is technically undemanding and faster than conventional methods, which we have applied to the detection of aortic valve disease. A series of 26 patients with aortic stenosis or aortic regurgitation was compared with 21 normal subjects. All 20 patients with aortic stenosis and 15 of 16 patients with aortic regurgitation were identified. There were four false positives in the aortic stenosis group; all these patients had significant aortic regurgitation. There were no false positives in the aortic regurgitation group. Low-field cine MRI is a practical and useful technique for the detection of aortic valve disease.
Periventricular enhancement: a non-pathognomonic sign of intracerebral tumours
Authors: Murray P. A. , Harriett A. N. , Thompson P. I. , Charlesworth M. , Plowman P. N.
Published: July 2009

Four cases of periventricular contrast enhancement on computed tomography due to different tumours are reported, emphasizing that periventricular contrast enhancement is a non-specific radiological sign.
Kinetics of recovery from sublethal radiation damage
Authors: Guttenberger R. , Thames H. D.
Published: July 2009

In an article published recently, Drs Hopewell and van den Aardweg (1988) re-analyse data on the kinetics of recovery from sublethal radiation damage (SLD). They question whether SLD repair follows mono-exponential kinetics and present a number of graphs that show fast repair in the beginning followed by slower repair. We have also noted that repair kinetics in human skin could be interpreted on the basis of two components (Turesson & Thames, 1989). In the latter study, however, direct analysis (Thames et al, 1986) was used and this differs from the method employed by Hopewell and van den Aardweg, which involved studying changes in the “percentage dose unrepaired.” We wish to point out certain aspects of this analysis that must be considered when applying it.
Lung cancer: tissue characterization by magnetic resonance imaging T
1, and T
2 values in vitro and role of histopathology
Authors: Ranade S. S. , Trivedi P. N. , Bamane V. S.
Published: July 2009

A wide variety of pulmonary disorders including neoplasms are amenable to characterization by magnetic resonance imaging (MRI) (Cohen et al, 1987). Shioya et al (1988) present a careful study favouring discrimination of normal and pathological lung tissues on the basis of T  1 and T  2 values in vitro, MRI intensity and histological correlation.

This paper brings out a facet of nuclear magnetic resonance (NMR) studies and histological correlations that has received limited attention. The need for generating information on relative MR intensity of tissues as an aid to clinical interpretation of MR images has recently been recognized (Ehman et al, 1986). Sundaram et al (1987) have reported association of increased MR signal intensity with cellularity in subclassification of histiocytomas.
The potential value of hyperthermia in the management of human immunodeficiency virus infection
Authors: Cochran K. D. , Weatherburn H.
Published: July 2009

A substantial record of clinical experience exists on the efficacy of zidovudine in symptomatic human immunodeficiency virus (HIV) infection. There is now a trend towards its expression at progressively earlier stages, embracing symptom-free subjects as reported by de Wolf et al (1988) and as proposed in the European Concorde trial (Lancet, 1989).

From the data available, zidovudine emerges as a potent retroviricide, but in vivo the action is incomplete and appears to be largely peripheral. Marrow depression is a prominent risk, and although there may be temporary subjective improvement in established illness, fatality is not avoided. Other agents, and their combinations, provide similar transient benefit.
Book reviews
Authors: Whitehouse Richard W.
Published: July 2009

This little book contains 84 computed tomography (CT) exercises, each with one or more adequately reproduced halftone images. The first eight illustrations demonstrate normal abdominal CT anatomy, the remainder cover a varied but by no means comprehensive collection of abdominal pathologies. The second half of the book contains line diagrams, descriptions and discussion for each of the studies, necessitating repetitive flipping from front to back to connect text with image.
Book reviews
Authors: Watt Iain
Published: July 2009

Orthopaedic radiology has moved irrevocably from “position as shown” plain film reports to a level of considerable sophistication, routinely using all the imaging techniques of any modern department. This book, edited by two well-known academics, brings together chapters on these techniques, with contributions from 33 authors from around the world. The book is in three sections: Radiological Techniques, Bone Mineral Studies and Clinical Indications. It is aimed at a broad audience, from both sides of the surgical/radiological divide.
Assessment and comparison of chest radiography techniques in the United States and Sweden
Authors: Leitz W. K. , Hedberg-Vikström B. R. K. , Conway B. J. , Showalter C. K. , Rueter F. G.
Published: July 2009

The United States Center for Devices and Radiological Health and the Swedish National Institute of Radiation Protection started a collaborative project in 1983. The purpose of the project was to test the adequacy and practicability of the United States (US) Nationwide Evaluation of X-ray Trends (NEXT) programme in Sweden. The NEXT protocol for the postero-anterior chest projection was modified and expanded to make it both “statistical” and “investigational” (in the US, NEXT gives mainly “statistical” information). All chest X-ray units in Sweden were surveyed in 1986–87. The project showed that the NEXT programme is applicable to countries other than the United States and provides a standardized protocol that enables intercomparison of the radiological techniques. This paper presents the comparison of the radiological techniques used in Sweden and the United States. The results of the investigational modifications made to the protocol used in Sweden are discussed. Recommendations concerning expansion of the NEXT protocol to include these valuable tools for investigational surveys are presented.
A method for the assessment of the output of irregularly shaped electron fields
Authors: Jones Douglas , Andre Peter , Washington John T. , Hafermann Mark D.
Published: July 2009

A simple approach to the calculation of dose in cone-collimated electron fields is presented. The method accounts for variations in lateral scatter with field size using a Clarkson Integration. The reduction in output by an irregularly shaped aperture is evaluated based on measurements of the output at various distances from the aperture in a field 2.5 cm in diameter. The first 14 months of clinical use were analysed and it is shown that in 42 out of 600 calculations, the cutout factor was less than 0.95 and that in 77% of these, the calculation method was accurate to ±3%.
Embolization hazard of laser hot-tip catheters and coated guidewires
Authors: Delcour C. , Gusella P. , Richoz B. , Grijalvo C. Aguilera , Struyven J.
Published: July 2009

Laser thermal angioplasty is now widely used for the treatment of arterial occlusions or stenoses (Ginsberg et al, 1985; Cumberland et al, 1986; MacCowan et al, 1988). The first commercially available intravascular laser system uses a metal-capped laser fibre to convert the laser energy into thermal energy. New laser catheters for vascular recanalization have been developed, some of which can be used over a guidewire.

A 56-year-old man presented with left intermittent claudication. An arteriogram revealed a very tight stenosis of the left popliteal artery and diffuse atherosclerotic lesions of the run-off vessels associated with a high-grade stenosis of the origin of the anterior tibial artery and of the tibioperoneal trunk.
A pain in the rear
Authors: Suarez Richard , Morrison Douglas , Suarez Valerie
Published: July 2009

A 79-year-old, non-insulin-dependent diabetic woman presented with severe pain in the rectum and urgency. A year previously she had been seen because of alternating constipation and diarrhoea. Rectal examination and sigmoidoscopy were normal, but she had a distended bladder and was subsequently catheterized. and this had become permanent. She had had a hysterectomy and bilateral salpingo-oöphorectomy after intracavity radium for carcinoma of the body of the uterus 13 years before.

Examination revealed a lax anus, soft stool, and a soft mass behind the rectum. Sigmoidoscopy was again normal.

Pelvic ultrasound was performed after filling the bladder with saline (Fig. 1). This was followed by a barium enema (Fig. 2). A plain radiograph of the pelvis after barium had cleared is also shown (Fig. 3).
Fractionation sensitivity and the oxygen effect
Authors: Hendry J. H. , Thames H. D.
Published: July 2009

Many normal tissues in natural conditions exhibit slight radiobiological hypoxia (Hendry, 1979). Examples of this in man, which necessitated reductions in dose when the oxygenation status of the tissue was increased, are the skin (van den Brenk et al, 1965), the spinal cord (Coy & Dolman, 1971) and laryngeal cartilage (Churchill-Davidson, 1968; Henk et al, 1977). The expected effect of oxygenation status on fractionation sensitivity has not yet been considered in detail.

Fractionation sensitivity can be quantified by the ratio of the parameters α and β in the following equation, which describes the probability (P) of a given level of radiation injury in a tissue following a schedule of doses (x) delivered to a total dose (D).

where K is the number of tissue-rescuing units (TRU) (Hendry & Thames, 1986).
Isoeffective doses
Authors: Scott O. C. A.
Published: July 2009

The interesting letter of Bentzen and Thames (1989) contains a small, but not entirely trivial, error: 51 Gy in 12 fractions should be isoeffective with 37.96 Gy in six fractions, not 37.4 Gy as stated. The use of the corrected figure strengthens the argument in Dr Bates' reply.
Isoeffective doses
Authors: Bentzen S. M. , Thames H. D.
Published: July 2009

We thank Dr Scott for correcting our calculation (Bentzen & Thames, 1989) of the dose in six fractions being isoeffective with 51 Gy in 12 fractions. It was not our intention to question Dr Bates' result obtained by using an α/β at 2 Gy but rather make the point that the uncertainty in our current knowledge of α/β for subcutaneous fibrosis further complicates the interpretation of the results of the St Thomas' trial. Our best current estimate of α/β for subcutaneous fibrosis is 1.9 Gy with 95% confidence limits of 0.8 and 3.0 Gy (Bentzen et al, 1989). This produces an isoeffect dose in six fractions at 38.05 Gy with 95% confidence limits of 36.98 and 38.95 Gy.
Book reviews
Authors: Lewis-Jones H. G. , Lewis-Jones D. I.
Published: July 2009

This is a particularly large and impressive tome, which deals with normal sectional anatomy in both CT and MRI. The authors have attempted to create a reference atlas that correlates axial, sagittal and coronal anatomical sections of the head and body with computerized and MR tomographic sections. In this respect they have succeeded admirably. The book is sensibly divided into anatomical regions — the head, neck and thorax, abdomen and pelvis with an initial chapter covering whole body coronal and sagittal sections.
Book reviews
Authors: Weir J. , Reynolds J.
Published: July 2009

This small textbook is aimed primarily at trainees in radiology preparing for the Part I FRCR examination, the author being an examiner in the therapy section. The best person to assess this type of manuscript is a registrar who has just been through this experience and so the following is a combined review. The book begins with a chapter on basic physics and electronics. This constitutes a useful revision since it will have been several years since most of the readers will have studied these subjects and they are topics that many other textbooks do not include.
An assessment of the sensitivity of in vivo 31P nuclear magnetic resonance spectroscopy as a means of detecting pH heterogeneity in tumours: a simulation study
Authors: Madden A. , Glaholm J. , Leach M. O.
Published: July 2009

The presence of hypoxia and low pH in tumours is known to influence several treatment modalities including radiotherapy, chemotherapy and hyperthermia. Hypoxic and acidic regions have been demonstrated in tumours using pH and pO2 microelectrodes. The technique has shown marked heterogeneity within individual tumours. A non-invasive measure of intracellular pH is provided by 31P nuclear magnetic resonance (NMR) spectroscopy from determination of the chemical shift of inorganic phosphate, and is being increasingly applied to the study of human tumours in vivo. Based upon the assumption that hypoxic cells are also acidic, we have assessed the ability of a whole-body NMR spectrometer to detect acidic subpopulations within a tumour using simulated tumour spectra. In these simulations the size of the acidic subpopulation, assigned pH values from 5.0 to 7.0, was varied between 5% and 50% of the neutral “control” population. Gaussian noise was added to the simulated spectra giving signal-to-noise ratios for the neutral control inorganic phosphate peak of 3, 5 and 7, which are typical of values encountered in human tumour measurements. From the results of the simulations it seems unlikely that human hypoxic, and presumably acidic, cell fractions, typically 1–15%, will be detected by this method in the presence of signal-to-noise levels characteristic of current equipment. Therefore, whole-body in vivo  31P NMR spectroscopy may fail to identify significant pH heterogeneity within human tumours. Improvements in signal-to-noise and line separation owing to improvements in technique and higher field strength instruments may improve sensitivity to heterogeneous populations.
Further comparisons of films, screens and cassettes for mammography
Authors: Law J. , Kirkpatrick A. E.
Published: July 2009

In two previous papers (Kirkpatrick & Law, 1987, Law & Kirkpatrick, 1989), films and screens for mammography have been compared, primarily for image quality and secondarily for dose. The rate at which new products become commercially available makes identification of the better films and screens a never-ending task, although the combination found to be still the best in 1987 had been available since before 1980. At the time of the work for the 1989 paper (late 1987) certain newer products did offer some improvement over previous ones, but further products were known to be imminent. That series of comparisons could not be continued because the processor was changed making it impossible to maintain complete comparability of test conditions.

This paper reports on new films and screens, using essentially the same experimental technique as before, but on a new processor and a new X-ray set. Certain of the better films and screens from the previous paper were included to form a base line against which to compare newer products. Only a direct comparison under a single set of experimental conditions can be considered valid.

All films were obtained on a single X-ray set and a single processor. These were a CGR 600t maramographic X-ray set installed as the assessment unit in the Edinburgh Breast Screening Centre, and a Dupont T5A processor using Kodak chemistry. The X-ray set has Molybdenum target and filtration and broad and fine foci.
Unusual appearances of an adrenal mass on computed tomography
Authors: Hughes David , Golding Stephen
Published: July 2009

When patients undergo imaging investigations to stage malignant disease the finding of a mass in the adrenal gland may not necessarily represent metastasis. Incidental non-functioning adrenal masses have been reported in 0.6% of examinations of the abdomen by computed tomography (CT) (Glazer et al, 1982). We report a patient with such a finding, whose CT scans showed unusual appearances.

A 64-year-old Caucasian man with histologically proven adenocarcinoma of the prostate was referred for CT for staging purposes. There were no clinical signs to suggest spread of the disease and no symptoms referable to the abdomen. Prior to this he had been well.
Magnetic resonance imaging of the chest in infectious mononucleosis
Authors: Goddard P. , Kinsella D. , Duncan A. W. , Hamilton A. , Carswell F.
Published: July 2009

Infectious mononucleosis is a disease of young adults, typically presenting with malaise, fever, sore throat and cervical adenopathy (Juel-Jensen, 1983). Non-specific respiratory symptoms may also be present. The diagnosis is confirmed by serological tests for the virus.

A case is reported in which the presence of lymphadenopathy as demonstrated by a magnetic resonance imaging (MRI) scan led to the diagnosis of infectious mononucleosis.
A critical appraisal of coagulation studies prior to transfemoral angiography
Authors: Wilson N. V. , Corne J. M. , Given-Wilson R. M.
Published: July 2009

The value of requests for coagulation studies prior to angiography is unclear. The rationale that coagulation studies might be helpful in identifying patients likely to suffer from haemorrhagic complications is ill-founded. The primary mechanism of haemostasis following an arterial puncture is the formation of a haemostatic plug, the cellular components of which are the platelets. Aggregation formation on the exposed collagen fibres at the site of puncture results in the formation of a rapid occlusive haemostatic plug (Sixma, 1987). Performing coagulation studies to assess this process is valueless. This can be seen in patients who have haemophilia, where there is a normal bleeding time (a function of the haemostatic plug) but an abnormality of coagulation because of the defects in factor VIII clotting activity.
Screening for breast cancer
Authors: Forrest P.
Published: July 2009

Dr MacDonald's concern is well known, but it was not one which was shared by his colleagues at the time of the working group's report. Our recommendations for single-view mammography for the basic screen and an interval for screening of 3 years were based on the facts then available.
Book reviews
Authors: Plant Graham
Published: July 2009

There are very few books on operative (otherwise known as intraoperative) ultrasound. This book covers most of the subject well, but it is not really orientated towards radiologists.

The stated aim of the book is “to inform surgeons and their radiologic (sic) colleagues in the use of ultrasound imaging in the operating room”. The Editor is Professor of Surgery at the Medical College of Pennsylvania and the contributors are mainly surgeons.

The contents include chapters on instrumentation and techniques as well as one on the basics of ultrasound, an inclusion that seems reasonable in a book aimed at non-radiologists. There are chapters devoted to the use of operative ultrasound in the surgery of various areas of the body and, not surprisingly, these are mainly concerned with the uppergastrointestinal tract (liver, bilary system and pancreas). The use of ultrasound in procedures on the brain and spinal cord and in renal and vascular surgery are also covered.
Book reviews
Authors: Jeans W. D.
Published: July 2009

Have you seen that film about voyaging around the inside of arteries? Angioscopy is like that — but much more difficult, and all that red stuff keeps getting in the way. The movie makers and science fiction writers are usually well ahead of the game, but the scientists are in there battling to catch up, and this book recounts some actions in the battle.
Book reviews
Authors: Gowland M.
Published: July 2009

This is a teaching atlas containing 120 ultrasound case studies. There are between 20 and 30 cases under each of the following headings: Liver and Biliary System; General Abdomen; Urinary System; Obstetrics and Gynaecology and a miscellaneous section. The selection of cases is not designed for beginners but for those who already have some experience in diagnostic ultrasound.
Computers in radiology departments
Authors: Sutherland G. R.
Published: July 2009

It is only a few years since computers were essentially regarded by the public as complicated machines used only by banks, major industrial concerns and research establishments. But the situation is changing rapidly to one where in every household the computer will sit alongside the video tape recorder and the television set. Every schoolchild is now taught how to use computers and elementary keyboard operation skills. They are pervasive throughout our society. A tremendous development of their use by small businesses has occurred where this would not have been considered cost effective only a few years ago. However, it is only with the publication of the “White Paper” on the most recent reorganization of the Health Service that the importance of introducing computers for information management has ultimately been recognized as central to the effective management of the Health Service. It appears that the financial implications of such developments have also been accepted.

Radiologists in this country have been trying to acquire computing systems for their departments for many years now, and many have been effective, but there is still a large core of individuals who remain to be convinced of the effectiveness of such systems in the running of their departments, and it is with the objective of convincing them of the applications and usefulness of computer systems that this article has been written (Sutherland, 1983).

Unfortunately, like many specialties, the computer world is full of jargon that the uninitiated find difficult to understand.
An analysis of personnel dose records which justifies the application of cost-benefit analysis techniques in the design of an afterloading facility and the use of controlled areas and systems of work within suite to control occupational exposure
Authors: Gifford D. , Godden T. J. , Kear D.
Published: July 2009

The sealed source operational policies employed at the Bristol Radiotherapy and Oncology Centre were originally designed to meet the requirements of the 1972 Code of Practice by ensuring that individual personnel doses were kept below the relevant quarterly and annual dose limits. In 1982–1983, measures were taken to improve personnel radiation safety within the brachytherapy treatment facility by (a) making preparations for the introduction of Selectron medium-dose-rate (MDR) afterloading systems at the centre for intracavitary brachytherapy and (b) reviewing the operational policies to ensure that they meet the more stringent requirements of the ALARA (as low as reasonably achievable) principle, a principle subsequently embodied in the 1985 UK Ionising Radiations Regulations (IRR 85). When considering the implications of making existing singlebedded side wards, originally designed for low-dose-rate brachytherapy and suitable for the new systems, the cost of the extra protection required to reduce the instantaneous dose rate in the ward corridors adjacent to the treatment room to less than 7.5 μSv h1 had to be determined. On the basis of the cost-benefit analysis, it was decided not to provide additional shielding but rather to introduce administrative controls based on local rules which contained systems of work and the operational policies for the afterloading systems. After using the MDR afterloading systems for 2 years, a period in which there has also been a marked increase in interstitial brachytherapy, an analysis was made of the doses received by nursing staff over the past 8 years. This has shown that, in spite of higher dose rates in the corridor areas because of the use of an MDR system and the increase in interstitial techniques, the doses to ward nurses have been significantly reduced by encouraging staff to comply with the ALARA principle and the introduction of afterloading systems.
Giant mid-oesophageal diverticulum: a rare cause of dysphagia
Authors: Etherington R. J. , Clements D.
Published: July 2009

Mid-oesophageal diverticula are usually small, asymptomatic and rarely result in complications (Meshkinpour, 1985). We report a case of a giant mid-oesophageal diverticulum which caused dysphagia. The aetiology of these diverticula is discussed.

A 91-year-old man presented with a long history of dysphagia and weight loss of over 20 kg. More recently he had developed vomiting and symptoms of nocturnal aspiration. The dysphagia had become severe and he required intravenous fluids to maintain his hydration.

The chest radiograph demonstrated an irregular gas lucency inferior to the carina (Fig. 1). There was no evidence of previous tuberculous infection. Barium swallow examination revealed a huge sac arising from the mid-part of the oesophagus and extending to the left and anterior to it. Initially, the sac appeared thick walled (Fig. 2), but on delayed radiographs barium penetrated the food residue within it revealing a thin walled diverticulum.
Iliopsoas abscess: an unusual complication of femoral artery catheterization
Authors: Loveday E. J. , Tonge K. A. , du Peloux Menage H. G.
Published: July 2009

We report a case of iliopsoas abscess following percutaneous transfemoral carotid angiography. To our knowledge there are no previous reports of this complication.

The patient, a woman aged 49, was admitted for investigation of occlusive cerebrovascular disease. She was a smoker and had a history of exopthalmic Graves' disease and thyrotoxicosis, previously treated with Iodine 131. Current medications were thyroxine, Voltarol Retard and Nifedipine Retard. Prior to the procedure, haemoglobin level was 14.2 g/dl, white cell count was 8400 × 103/ml and platelet count was 283 000 × 103/ml. Full clotting studies were normal.

Carotid arteriography was performed using a modified Seldinger technique. Full aseptic precautions were taken including groin shave, cleansing with chlorhexidine, povidone iodine skin preparation and sterile drapes and gowns. A 5 F Mani catheter (William Cook Europe ApS) and a 0.035 inch straight guidewire were used during the procedure which was protracted owing to inability to catheterize the left common carotid artery. A subsequent arteriogram using a 5 F pigtail catheter revealed complete occlusion of this vessel at its origin. Compression was applied to the puncture site for 20 min. The patient was well following the procedure and was discharged home shortly thereafter. Minor bruising only was seen at the puncture site.

She presented again 22 days post-investigation complaining of increasing pain in the right groin and difficulty with walking. On examination she was pyrexial; and greenish, offensivesmelling fluid was oozing from the puncture site in the right groin.
Reactions to intravenous contrast media
Authors: Tuck J. S. , Martin D. F.
Published: July 2009

Idiosyncratic reactions are a recognized and documented complication of intravenous contrast media. Angioneurotic oedema is a relatively common feature of both intermediate (9%) and severe (16%) contrast media reactions. (Ansell, 1987). Typically, it involves the eyelids, lips, tongue and, in more severe cases, the larynx. We recently encountered a case of angioneurotic oedema following intravenous contrast medium resulting in an unusual distribution of swelling.
Book reviews
Authors: Griffiths G. J.
Published: July 2009

In recent years transrectal ultrasonography (TRUS) of the prostate has come to be recognized as a valuable technique in the differential diagnosis of prostatic disease. The book reflects the author's experience over the past 10 years and traces TRUS from the original bistable equipment to the present-day handheld multiplanar transrectal probes. It also covers the transabdominal and transperineal routes of prostatic ultrasound.
Book reviews
Authors: Bull C.
Published: July 2009

The adage that a picture is worth a thousand words was never more appropriate than in the description of congenital heartdefects. The authors offer 167 line diagrams illustrating the common congenital cardiac defects including all the more difficult-to-draw variations in atrio-ventricular and ventriculoarterial connections, cardiac positions, atrial situs and aortic arch lateralization. The common operations are also illustrated. The diagrams are simple, two dimensional and not “arty”. The book is spiral bound to make photocopying easy.
The effect of secondary electron spread on the penumbra in high energy photon beam therapy
Authors: Day M. J. , Lambert G. D. , Locks S. M.
Published: July 2009

In photon beam therapy, the geometric penumbra width is determined by the source-size and the collimator design. The width of the physical (i.e. dosimetric) penumbra involves an additional contribution from secondary electron spread. Using a suitably defined measure of penumbra width, the separate widths due to photons and secondary electrons are additive in quadrature. Secondary electron spread functions were measured using photographic dosimetry for 60Co γ rays and for 4, 8 and 16 MV X rays. The results suggest that, under typical treatment conditions, secondary electron spread may be the predominant contributor to the penumbra at effective generating voltages exceeding 10 MV. The implications for selection of beam energy in precision small-field radiotherapy are discussed briefly.
Neutron and gamma ray measurements carried out around a Varian Clinac 2500 linear accelerator
Authors: Beckham W. A.
Published: July 2009

Auckland Hospital, New Zealand, has recently installed a Varian Clinac2500 linear accelerator. This unit is capable of producing 24 MV peak photon energies. It is well known (Fox et al, 1977; Ing et al, 1982; Palta et al, 1984) that such photons are capable of producing neutrons via a photonuclear reaction. The sources of such neutrons from this accelerator have been described (LaRiviere, 1985). In this study a survey was carried out around this new installation to observe some of the characteristics of the neutrons produced, and to assess likely radiological hazards to radiotherapy staff.

Equipment and methods Equivalent neutron dose was measured using an Alnor neutron dose rate meter (rem-meter) model 2202D. Remote pulse counting was carried out using an Elscint model INS-30 nuclear spectrometer.

The manufacturer of this unit claims that the detector exhibits 200 R/h gamma ray discrimination. Initially this would appear satisfactory for carrying out a survey, but owing to the fact that linear accelerators are operatedin pulsed mode, peak leakage and scatter photon dose rates within the treatment room could well exceed 200 R/h. This was confirmed by operating the accelerator in 6 MV photon mode (i.e. producing no expected neutrons) and showing that the neutron meter did in fact respond. However, in the entrance maze to the treatment room the scattered X-ray dose rate was attenuated sufficiently so that it was not contributing to detector response.
Final Report of the BIR fractionation study
Authors: Fletcher Gilbert H.
Published: July 2009

Wiernik et al (1990) have reported on the BIR multicentre trial of 3 versus 5 days per week treatment of tumours of the larynx and pyriform sinus. No statistically significant differences were found between the two arms with respect to survival and complication rates.

The purpose of choosing irradiation over surgery in the tumours of the laryngopharynx is to preserve the larynx. Salvage surgery is highly successful, primarily for failures in patients with mobile cord tumours, but it also has been successful in other sites where, in addition to laryngectomy, radical neck dissection can be curative. Therefore, survival rates do not reflect the effectiveness of the radiation treatment, yet survival analysis makes up the bulk of their report. The brief analysis of the incidence of laryngectomies is lost in an extensive text on statistical methods and a large number of tables and graphs relating to survival rates.
Book reviews
Authors: Kingsley D.
Published: July 2009

Craniospinal Magnetic Resonance Imaging is a multiauthor book under the general editorship of Stephen Pomeranz. It is aimed at a wide readership of both trainees and practising radiologists and consists of 22 chapters including those on the orbit, nasopharynx and temporomandibular joint. Rather surprisingly for such a comprehensive text book there is no chapter on the paranasal air sinuses.

The first four chapters are concerned with the principles of MRI including a very complete overview of the fast scanning techniques currently used.
Thyroid imaging using positron emission tomography—a comparison with ultrasound imaging and conventional scintigraphy in thyrotoxicosis
Authors: Flower M. A. , Irvine A. T. , Ott R. J. , Kabir F. , McCready V. R. , Harmer C. L. , Sharma H. L. , Smith A. G.
Published: July 2009

Forty-six comparative studies were performed on 41 patients with hyperthyroidism. Clinically these comprised two groups: those with Graves' disease, and those with multinodular goitre. All patients underwent an ultrasound examination and positron emission tomography (PET) using 124I, then gamma camera pinhole imaging following their 131I therapy administration. Although the 131I pinhole imaging was not performed for diagnostic purposes, there was good correlation (78% agreement) between it and 124I PET in determining relative lobe size. Hence either imaging modality could be used as an indicator of the relative radiation dose delivered to each thyroid lobe at a macroscopic level. In terms of gland morphology the PET images corresponded well to the high resolution ultrasound images (78% agreement), unlike the pinhole images which correlated poorly (only 28% agreement). The results showed that PET imaging gives better anatomical and physiological detail than 131I pinhole imaging. In 77% of cases where the pinhole image showed a uniform distribution of radioisotope, the improved spatial resolution of the PET images revealed non-homogeneous distribution indicating a non-uniform distribution of radiation dose. Since all dosimetry calculations are based on the assumption of uniform distribution of radioiodine, this non-uniformity could possibly have important consequences in the outcome of radioiodine therapy in thyrotoxicosis.
Oropharynx carcinoma: irradiation alone versus induction chemotherapy plus irradiation—5 year results
Authors: Calais Gilles , Reynaud-Bougnoux Agnés , Garand Gérard , Beutter Patrice , Le Floch Olivier
Published: July 2009

Induction chemotherapy (CT) has demonstrated overall response rates of 80% for oropharynx carcinomas, but no overall survival benefit has been reported. In order to determine the value of induction CT for such patients, we conducted a retrospective study: 121 patients were treated with CT and radiotherapy (RT) (Group 1). This group was compared with a historical group of 84 patients treated by RT alone (Group 2). The CT used was Cisplatinum associated with Bleomycin and Vincristin or Vindesin and with 5 Fluoro-uracil. An objective response to CT was observed for 41% of patients. The 5 year actuarial survival rate was 19% for Group 1 and 24% for Group 2. Patterns of failure were identical in the two groups. The only difference observed was for patients with N3 nodes (26% of 5 year survival rate in Group 1 versus 9% in Group 2) (p = 0.05). The results did not depend on the histological differentiation, the tumour site or the type of CT. We conclude that this retrospective study failed to demonstrate an advantage for induction CT in oropharynx carcinoma except for patients with N3 nodes.
A Chinese puzzle
Authors: Williams J. W. , Collins M. C.
Published: July 2009

A 39-year-old Chinese waiter presented with a 5 week history of intermittent epigastric pain, exacerbated after eating and increasing over the 3 days preceding admission with associated retching.

Previous medical history included a vagotomy and gastro-enterostomy for duodenal ulcer many years earlier, and similar symptoms had settled with conservative management in the past.

Examination revealed abdominal distension and highpitched bowel sounds. A plain abdominal radiograph was obtained (Fig. 1).
Book reviews
Authors: Williams P. C.
Published: July 2009

Tissue substitutes are needed for the construction of phantoms, radiation detectors and as bolus materials in many areas of radiation science. In order to choose appropriate materials for each application it is necessary to have detailed information about the characteristics of tissue substitutes that affect radiation interactions. Report 44 provides this information and discusses the criteria governing its use.
Book reviews
Authors: Keeling D. H.
Published: July 2009

This small booklet of less than 50 pages packs in a great deal of useful information and advice about modern hospital radiopharmacy work. It is an update of the Hospital Physicists' Association Report No. 16, The Hospital Preparation of Radiopharmaceuticals.

The introduction usefully summarizes the legislative framework, regulations and various guidance notes which are relevant in the radiopharmacy, both from the pharmaceutical point of view and from that of radiation protection.
Bronchopulmonary dysplasia: a radiographic and clinical review of 20 patients
Authors: Fitzgerald Patricia , Donoghue Veronica , Gorman W.
Published: July 2009

This paper reviews the radiological features of 20 infants with bronchopulmonary dysplasia, with particular emphasis on the early radiological findings in these infants, the clinical findings and radiological progression. Of 20 infants, eight had idiopathic respiratory distress in the first week of life, two infants had early radiological abnormalities other than idiopathic respiratory distress and 10 infants had normal initial chest radiographs. The complicating features included lower respiratory infections (88%), patent ductus arteriosus (40%) and areas of atelectasis (40%). Areas of atelectasis were more common in infants with an intially normal chest radiograph than in those with idiopathic respiratory distress syndrome (p = 0.015). Mortality from severe bronchopulmonary dysplasia was 70% in this series.
A modified synchronous shielding technique in rotation therapy
Authors: Casebow M. P.
Published: July 2009

Synchronous shielding in rotation radiotherapy involves the movement of an absorber across the X-ray beam profile during a rotation treatment. This procedure can shape the cross-section of a cylindrical treatment volume to avoid nearby radiosensitive structures but often produces unacceptable dose variations within the treatment volume. These effects may be reduced by modifying the dose rate profile of the beam using wedge-shaped niters attached to the absorbers. A mechanism is then required to orientate the absorbers and filters during the rotation. A prototype device was constructed and assessed experimentally using a 6 MV X-ray beam.
The type III dens fracture and its associated soft-tissue injuries: a different form of Hangman's fracture
Authors: Renwick I. G. H.
Published: July 2009

The Hangman's fracture has been defined as a traumatic spondylolysis of the second cervical vertebra occurring after road traffic accidents and judicial hanging. A case is described following an attempted self-hanging which demonstrates a different type of fracture with associated soft-tissue injuries.

A 17-year-old man was brought to the Casualty Department following an attempted self-hanging. After a domestic dispute he had tied a rope around his neck, attached the other end to some scaffolding and jumped. The rope snapped as he dropped and he fell 20 feet to the ground.

A cervical collar was applied by ambulance staff at the scene. On arrival at hospital he was fully conscious with no neurological deficit and clinically he was found to have fractured his pelvis.
Topical infusion of metronidazole in the radiotherapy of tumours of the uterine cervix: interim report on the 2 year survival
Authors: Balmukhanov S. B. , Beisebaev A. A. , Mustaphin D. S. , Aitkolova Z. K. , Kobikova D. H. , Abdrahmanov D. N. , Scott O. C. A. , Révész L.
Published: July 2009

The negative outcome of many clinical radiotherapy trials seen after oral administration of hypoxic cell sensitizers in subtoxic doses can be attributed to an insufficient concentration of the drug in the neoplastic tissue (Brown, 1984). In a trial started in 1986 we sought to answer the question of whether the increased concentration in tumours expected after a direct, intratumoural administration of the sensitizer may improve the therapeutic effect of radiation treatment. Tumours of the uterine cervix were chosen for the trial, using metronidazole as the radiosensitizing substance. In a paper published recently (Balmukhanov et al, 1989), we reported some striking shortterm effects of radiotherapy combined with topical application of metronidazole. Thus, the local clearance rate, the decrease in tumour volume and the cytologic damage to tumours was greatly enhanced in the cases which received the combined treatment. Here we report the observations made during a 2 year follow-up period.