bluuebunny/crossref_metadata_2025 huggingface dataset:
The application of microdosimetry to the metrology of low-energy X rays used in mammography
Authors: Waker A. J. , Marco M.
Published: July 2009

In a relatively recent contribution to this journal, Brenner and Amols (1989) published an article concerning the application of microdosimetry to the assessment of the radiological risk of mammography. The ultimate value of their work depends on whether the basic response function referred to in the paper and given in ICRU Report 40 (ICRU, 1986) truly reflects the relative efficiency of low-LET radiation for cancer induction. However, provided the particular response function employed can be expressed in terms of microdosimetric quantities the method itself is independent of the actual function and the paper of Brenner and Amols is a good illustration of the power of this type of analysis.

Microdosimetry is, however, more than just an interesting but somewhat esoteric branch of radiation physics. The objective of this communication is to show, using some preliminary mammographic data, how experimental microdosimetry as a measuring technique can be used to provide, in a direct manner, information concerning the quality of a radiation field and values of basic quantities such as absorbed dose and dose-rate.

The mammographic set used for the measurements was a Soredex Mamex dc, which is fitted with a molybdenum tube operated at a fixed current of 40 mA and applied potentials from 25 kV to a maximum of 31 kV. Total filtration is listed as 0.5 mm A1.
Linear scleroderma and melorheostosis
Authors: Siegel Alan , Williams Hadyn
Published: July 2009

Melorheostosis is an uncommon sclerosing bone dysplasia, which has been associated with other mesenchymal abnormalities. We present a patient with linear scleroderma who has radiographic and scintigraphic confirmation of melorheostosis. Bone scintigraphy in a patient with linear scleroderma and melorheostosis has not, to the best of our knowledge, been previously described.

A 65-year-old woman was admitted for treatment of bilateral plantar fasciitis.

Diagnosis of melorheostosis and linear scleroderma of the left leg was made in 1945 when the patient was 23 years of age. The disease process had reportedly been present since child-hood. Owing to pain and limitation of movement in the left leg, she underwent a fasciotomy in the 1950s. Associated abnormalities include oesophageal dysmotility and Raynaud's phenomenon, for which she underwent a lumbar sympathectomy in 1953.

Examination of the left leg revealed skin thickening on the medial aspect from the knee to the lower leg. Multiple scars were present, secondary to previous surgery.

Radiographs revealed cortical hyperostosis of the medial femoral condyle, which apparently crossed the joint space, extended into the medial aspects of the proximal tibial plateau and continued down the entire length of the medial tibial diaphysis. There was narrowing of the medial compartment of the left knee (Fig. 1).

Bone scintigraphy, performed 4 h following intravenous administration of 925 MBq (25 mCi) of technetium-99m methylene diphosphonate, demonstrated increased activity in the medial left femoral condyle, crossing the joint space into the medial aspect of the tibial plateau.
Impedance plethysmography and thrombo-embolic disease
Authors: Glew D. , Cooper T. , Mitchelmore A. E. , Parsons D. , Goddard P. R. , Hartog M.
Published: July 2009

This study compares the results of impedance plethysmography with lower limb venography in 68 patients referred for investigation of clinical deep vein thrombosis, and with the results of ventilation/perfusion isotope scans in 125 patients with suspected pulmonary embolism. Impedance plethysmography had a sensitivity of 100% and a specificity of 61% for the detection of thromboses involving popliteal or more proximal veins (30 patients), but a sensitivity of 90% and a specificity of 68% in the detection of thrombosis at any level, because of a low sensitivity in the detection of isolated calf vein thrombosis (60% in 10 patients). It is a non-invasive, portable and low-cost technique and, in centres where anticoagulation is only given to patients with popliteal or more proximal thrombosis, venography may only be necessary if impedance plethysmography is positive. It may also be of value in the assessment of patients with suspected pulmonary embolic disease and an indeterminate ventilation/perfusion lung scan.
The role of 99Tcm-HMPAO white cell imaging in suspected orthopaedic infection
Authors: Copping C. , Dalgliesh S. M. , Dudley N. J. , Griffiths P. A. , Harrington M. , Potter R. , Smith B. D.
Published: July 2009

Accurate diagnosis is essential for the effective management of suspected bone infection. Current imaging techniques have had limited success and further work is required. Although white cell labelling techniques have been available for many years the radiopharmaceuticals employed have disadvantages, particularly in their availability and suitability for imaging. These problems have been overcome by the use of 99Tcm-HMPAO as an in vitro leukocyte labelling agent. The aims of this study were to assess retrospectively its role and accuracy in imaging orthopaedic infection and to compare the results with three-phase bone imaging. 30 patients with suspected bone infection underwent three-phase methylene diphosphonate (MDP) bone imaging and labelled leukocyte imaging on separate occasions. 16 bone scans were positive for infection, of which 14 were subsequently confirmed, and there were no false negatives. There were no false positive white cell studies and only one infection was not identified. 99Tcm-HMPAO white cell imaging has been shown to be an accurate technique for the diagnosis of bone infection but should be performed only following a positive finding on three-phase bone scanning, since the latter is highly sensitive but significantly less expensive, making it a more appropriate screening procedure.
An investigation of the dose equivalent to radiographers from a high-energy neutron therapy facility
Authors: Finch J. , Bonnett D. E.
Published: July 2009

The external radiation hazard to radiographers from the use of high-energy neutrons in radiotherapy has been investigated. The contributions from neutron-induced activity in the therapy gantry, the treatment room, the patient and ancillary equipment have been analysed as has the whole-body dose equivalent to radiographers. It was found that there are significant levels of gamma radiation throughout the treatment room, which increase both in the vicinity of the walls in line with the beam axis and in close proximity to the neutron therapy gantry. The mean dose equivalent to radiographers per field treated was found to be 5.1 ± 1.8 μSv. The dose per field also varied considerably with the particular site being treated but it was found that the dose equivalent per field per minute of set-up time was approximately constant. It was also found that the dose per field increased with the number of patients treated per day commensurate with a build-up of induced activity. The studies also showed that the dose equivalent to radiography staff was comparable to that at other high-energy neutron facilities but significantly greater than that recorded at facilities with low-energy beams.
Sonographic features in a case of Fitz-Hugh-Curtis syndrome masquerading as malignancy
Authors: Banerjee B. , Rennison A. , Boyes B. E.
Published: July 2009

Pelvic inflammatory disease, associated with symptoms of pleuritic and upper abdominal pain, is characteristic of Fitz-Hugh-Curtis syndrome. The upper abdominal pain is due to perihepatitis. Gonococcal infection has previously been implicated almost exclusively as the cause of Fitz-Hugh-Curtis syndrome (Curtis, 1930; Fitz-Hugh, 1934). However, recent publications strongly indicate Chlamydia trachomatis as the causative organism in this syndrome. A case of Fitz-Hugh-Curtis syndrome is presented in which the sonographic demonstration of focal lesions in the liver, together with the presence of a pelvic mass led to an erroneous diagnosis of malignancy. Although Fitz-Hugh-Curtis syndrome was described over 50 years ago, it has not been widely publicized and to our knowledge the sonographic demonstration of focal hepatic lesions in Fitz-Hugh-Curtis syndrome has not previously been documented.

A 42-year-old divorced barmaid presented with anorexia, weight loss, upper abdominal pain, menorrhagia and pelvic discomfort. On examination the liver was palpated two fingers below the costal margin. There was tenderness over the right hypochondrium and epigastrium. Haematological investigations revealed a moderate hypochromic microcytic anaemia (haemoglobulin = 9 g/dl), elevated erythrocyte sedimentation rate (ESR) (36 mm/h) and abnormal liver function tests (alkaline phosphate = 184 i.u./l, gamma GT = 80 i.u./l).

Ultrasound examination of the abdomen and pelvis revealed multiple small abnormal foci within both lobes of a moderately enlarged liver. The focal lesions were both hypo- and hyperechoic in nature, but several target or “bull's eye” lesions were present (Fig. 1). There was irregular thickening of the liver capsule, particularly anteriorly (Fig. 2).
Peripheral neuropathy simulating lymphoma
Authors: Swingler R. J. , Cull R. E. , Kean D. , Turnbull L.
Published: July 2009

Nerve hypertrophy occurs in some types of Charcot-Marie-Tooth syndrome (hereditary motor and sensory neuropathy (HMSN) type I), Dejerine-Sottas disease (HMSN type III), Refsum's disease (HMSN type IV), neurofibromatosis, amyloidosis, sarcoidosis, leprosy, diabetes mellitus, chronic relapsing neuropathies, acromegaly, hypothyroidism, isolated peripheral nerve lesions and, very rarely, multiple sclerosis (Dyck, 1984; Walton, 1985). We report a case of HMSN type I with marked intercostal, splanchnic and peripheral nerve hypertrophy producing radiological appearances of pleural lesions and mediastinal widening, which, together with systemic symptoms, simulated lymphoma.

An 18-year-old man (A.P., RIE 110264–1100) had ingrowing toe nails removed in 1982 and subsequently noticed numbness of the big toes, extending onto the dorsum of both feet, and a tendency to lift the feet high when walking.

On general examination he had mild pectus excavatum, bilateral pes cavus and paronychiae affecting both great toes. The peripheral nerves in the upper limbs and intercostal nerves over the chest wall were thickened with diameters of up to 2–3 cm. On neurological examination, tone was reduced in the hands and feet and there was distal wasting and weakness in all limbs with reduced sensation for all modalities in a stocking distribution to mid calf. Tendon reflexes were preserved in the upper limbs and knees but ankle reflexes and plantar responses were absent. Examination of the family revealed no neurological deficits.

On investigation the level of protein in the cerebrospinal fluid was elevated at 2.72 g/1 but other indices were normal. Neurophysiological studies were performed using an MS91 Medelec system and, although normal responses were recorded from the upper limbs, no compound muscle action potential could be recorded from the left common peroneal nerve when the recording electrode was placed on the extensor digitorum brevis; a velocity of 31 m/s (normal > 44 m/s) was observed in tibialis anterior. Sensory nerve action potentials could not be detected in the sural nerves bilaterally.
The spine deformity index in osteoporosis is not related to bone mineral and ultrasound measurements
Authors: Bernecker Peter , Pietschmann Peter , Winkelbauer Friedrich , Krexner Elisabeth , Resch Heinrich , Willvonseder Robert
Published: July 2009

In 34 female patients suffering from osteroporotic vertebral compression fractures, the spine deformity index (SDIM) was determined, according to the method of Minne et al (1988), to reflect the radiological severity of established osteoporosis. Peripheral (single-photon absorptiometry (SPA) of the non-dominant distal forearm) and axial (quantitative computed tomography (QCT) of the lumbar spine) bone mineral measurements, as well as the broadband ultrasound attenuation of the os calcis, were performed in the osteoporotic patients and in a control group of 20 age-matched women. No correlation could be found between bone mineral measurements and radiological severity of osteoporosis, expressed as SDIM. All three densitometry methods showed clearly reduced values in patients with vertebral crush fractures. Correlations established in the control group between peripheral and axial bone mass (SPA versus QCT) could no longer be found in the osteoporotic group, thus indicating changes in bone mineral density of the spine after the occurrence of osteoporotic fractures. Our data show that SDIM is an additional parameter of osteoporotic change in the spine, independent from bone mass measurements. In the management of osteoporotic patients, quantitative radiological methods (i.e. SDIM) in addition to densitometry might be of value for grading and monitoring the progress of disease.
The incidence and severity of hypoxia associated with 99Tcm Technegas ventilation scintigraphy and 99Tcm MAA perfusion scintigraphy
Authors: James J. M. , Lloyd J. J. , Leahy B. C. , Shields R. A. , Prescott M. C. , Testa H. J.
Published: July 2009

Inhalation of the ventilatory radiopharmaceutical 99Tcm Technegas leads, in some patients, to symptoms that may be attributed to temporary lowering of oxygen saturation. In order to evaluate this, oxygen saturation was measured by pulse oximetry in a series of patients undergoing Technegas ventilation scintigraphy. A decrease in oxygen saturation was recorded in 87% of the patient group. The mean change, as a percentage of the initial value, was 8.3% (range 1–24%). Hypoxia arising in association with Technegas administration may be reduced by pre-oxygenation. In patients who were pre-oxygenated, oxygen saturation did not fall below 85% (PaO2: 50 mmHg) but in 39% of those not pre-oxygenated the value fell below this level. Oxygen saturation was also monitored in a series of patients undergoing perfusion scintigraphy. In 17% of patients a decrease was recorded (range 2–11%). In view of the large number of perfusion scans performed annually in this department and elsewhere without untoward effect, such temporary decreases in oxygen saturation presumably present no hazard to the patient.
The Reference Man in diagnostic radiology dosimetry
Authors: Lindskoug Bengt A.
Published: July 2009

Following the legislation for radiation protection in Europe, increasing interest has been given to patient dosimetry indiagnostic radiology. Dose comparisons between groups of patients have demonstrated considerable discrepancies. Theequipment, as well as the procedures used, have been scrutinized in order to find the reasons for the variation and to reduce it. Inthis work, patient size and shape are considered in patient dose evaluations in diagnostic radiology. The size, shape and constitution of the patients are shown to relate exponentially to the energy imparted during examination of the trunk. Theequivalent cylindrical diameter of the patient body is used as the independent variable. Exponential functions are created by linearregression. The ICRP Reference Man with an equivalent diameter of 22.9 cm is used as a body-size standard. A method issuggested by which coordinate transformations reduce data to a base line defined by the Reference Man. It is shown that themethod reduces the range of energy imparted by between 30% and 60% for six common X-ray examinations of the trunk. Resulting data constitute a finer instrument for intercomparisons between hospitals for the same examination. Further, it issuggested that adipose tissues should not be included when detrimental effects of radiologic exposure are determined. TheReference Man, stripped of 10 kg subcutaneous adipose tissue, is used as the non-fat standard dimension corresponding to theequivalent cylindrical diameter 21.2 cm. The suggested method is used to estimate the fraction of energy imparted to vital organsonly. The results show that the energy imparted is reduced by between 30% and 60% according to this model. Consequently,predicted deaths are reduced by the same amount.
Diagnosis and treatment of an oesophageal stricture due to lichen planus
Authors: Holder P. D. , Wong W. L. , Pemberton J. , Thompson R. P. H. , Parker S. C.
Published: July 2009

Involvement of the oral mucous membranes occurs commonly in lichen planus. Oesophageal involvement is less common and may result in pain, dysphagia and strictures. We present a case of an oesophageal stricture in a patient with lichen planus.

A 44-year-old woman with a 24 year history of oral lichen planus and a 9 year history of anogenital involvement gave a 2 year history of dysphagia. An endoscopy performed when she first noticed dysphagia showed oropharyngeal ulceration and the pharynx was narrowed with a friable mucosa. A further endoscopy in December 1990 showed an ulcerated nasopharynx but no abnormality in the oesophagus.
Increasing patient throughput in magnetic resonance imaging: a practical approach
Authors: Moore N. R. , Golding S. J.
Published: July 2009

A major factor governing the throughput of patients in a magnetic resonance imaging (MRI) service is the number length of sequences employed. This study investigated the feasibility of prospectively selecting patients for whom a pre-planned examination of the brain, spine or knee could be applied with a high chance of success. The implications on throughput of using these pre-planned examinations were determined. 173 patients were studied. A successful outcome was defined as an examination in which a diagnosis could be made with 100% confidence and without the need for further sequences. Examinations of the brain (n = 113), knee (n = 23) and lumbar spine (for disc degeneration, n = 14) were performed with success rates of 96%, 87% 64%, respectively. Examinations of the lumbar spine (for radicular symptoms, n = 20) and cervical spine (n = 3) were performed with success rates of 85% and 66%, respectively. The examinations of the brain, knee and lumbar spine (for disc degeneration) were completed within the target time of 20 min in 92%, 95% and 69% of cases, respectively. Examinations of the lumbar spine (for radicular symptoms) and cervical spine were completed within 30 min in 75% and 33% of cases, respectively. Analysis of our results suggests that success rates could be improved by minor changes in sequence design. Carefully selected patients can be successfully examined in short examination times. Instituting these practices would increase the efficiency of MR machine time and improve patient throughput by 80–125%. This would have a marked effect on the length of waiting lists, and would increase the general availability of MRI.
Radiological features during and following treatment of spinal tuberculosis
Authors: Boxer D. I. , Pratt C. , Hine A. L. , McNicol M.
Published: July 2009

A retrospective study was performed in order to document the sequence and time scale of radiological changes occurring during the healing of spinal tuberculosis. 28 episodes occurred in 26 patients, of whom only two were Caucasian. All demonstrated good response to conventional chemotherapy. Soft-tissue masses increased in size for up to 1.5 months and took about 12 months to resolve. Bone destruction was seen in all cases and progressed in 70% of patients, whilst on treatment. There was loss of vertebral body height in 79%, which progressed for up to 14 months; any recovery of height was a very late feature. Sclerosis was seen at presentation in 52% and developed in most of the remaining patients within 5 months of instigating treatment. It progressed for up to 14 months and took, on average, 31 months to return to normal. Reduction in disc height was commonly seen and the vertebrae fused in three-quarters of those affected, the time of onset of fusion being very variable. To manage patients with spinal tuberculosis, an appreciation of the variability of radiological changes that can occur during treatment is necessary.
Use of ultrasound in osteomyelitis
Authors: Nath Ashok Kumar , Sethu Arunchala U.
Published: July 2009

The use of ultrasound in osteomyelitis has been studied in 25 patients clinically suspected of osteomyelitis. A sonographic diagnosis of osteomyelitis was made if fluid was present in direct contact with the bone, without intervening soft tissues. This was thought to represent an inflammatory exudate dissecting in a subperiosteal and/or extraperiosteal location. Ultrasonographically 15 patients were found to have osteomyelitis, proved either by surgical drainage or needle aspiration. Seven patients had soft-tissue abscesses, one had cellulitis and two patients had no abnormality.
Intracardiac metastases from germ cell tumours—an unusual but important site of metastasis
Authors: Pickuth Dirk , Eeles Rosalind , Mason Malcolm , Pumphrey Charles , Goldstraw Peter , Horwich Alan
Published: July 2009

Two cases of intracardiac deposits from testicular teratomas diagnosed by echocardiography and angiocardiography, respectively, are described. The importance of recognizing this as an uncommon site of metastasis from germ cell tumours is discussed.
Low oxygen extraction fraction in tumours measured with the oxygen-15 steady state technique: effect of tissue heterogeneity
Authors: Lammertsma Adriaan A. , Jones Terry
Published: July 2009

Several reports have described decreased oxygen extraction fractions in tumours relative to those in normal tissues as measured with the oxygen-15 steady state technique and positron emission tomography. The present simulation study was carried out to assess the influence of tissue heterogeneity on these measured values. It was found that, within the range analyzed, tissue heterogeneity always resulted in underestimations of mean values of oxygen extraction fraction. It must, therefore, be concluded that the oxygen-15 steady state technique is not an accurate method for the assessment of the oxygen status of tumours. This finding should also apply to other pathological conditions, where a significant degree of tissue heterogeneity can not be excluded. More generally, this study demonstrates the need for detailed analyses of sensitivities of tracer kinetic procedures to tissue heterogeneity.
Asymptomatic temporal lobe injury after radiotherapy for nasopharyngeal carcinoma: incidence and determinants
Authors: Leung S. F. , Kreel Louis , Tsao S. Y.
Published: July 2009

Computed tomography (CT) scans were performed on a cohort of 60 patients for detection of temporal lobe injury (TLI) at 1–3.5 years after radiation therapy for nasopharyngeal carcinoma. Nine cases of TLI were identified, five of which were asymptomatic. The earliest case of asymptomatic TLI was found at 2.2 years after radiation therapy and the earliest symptomatic case at 2.3 years. A significantly higher incidence of TLI was found in patients with decreased temporal lobe shielding consequent to omitted eyeshield to the anterior photon beam and in patients treated with a hyperfractionation schedule giving 67.2 Gy in 42 fractions in 6 weeks. The incidence in these subgroups at 2–3.5 years after radiation therapy was 56% (5/9 patients) and 35% (8/23 patients), respectively. No patient in this study had TLI in the absence of these two factors. The implications of the results are discussed.
Anal endosonography: which endoprobe?
Authors: Papachrysostomou Maria , Pye S. D. , Wild S. R. , Smith A. N.
Published: July 2009

Anal endosonography is a simple, minimally invasive technique that can be used to visualize the anal sphincters and can be advantageous in evaluating the anorectum. The first ultrasonographic studies of the human intestinal wall thickness were made many years ago (Wild, 1950). Until recently, technical shortcomings of the equipment have prevented the clinical use of ultrasound as a means of imaging the anal sphincters; so disruption of a sphincter was determined from clinical examination, pressure studies and by concentric electromyogram mapping. Modern endoprobes give highresolution ultrasound images of the separate sphincter muscles (Law & Bartram, 1989).
Treatment planning for 131I-mIBG radiotherapy of neural crest tumours using 124I-mIBG positron emission tomography
Authors: Ott R. J. , Tait D. , Flower M. A. , Babich J. W. , Lambrecht R. M.
Published: July 2009

Patients designated to receive 131I-meta-iodobenzylguanadine (mIBG) for the treatment of neural crest tumours have been scanned with 124I-mIBG using the MUP-PET positron camera. Uptake was detected in tumour sites in lung, liver and abdomen. The tomographic images produced have allowed estimates to be made of the concentration of mlBG in both tumour and normal tissue. From these data it is possible to predict the radiation doses that would be achieved using therapy levels (up to 11 GBq) of 131I-mIBG. The levels of tumour uptake are between 0.5 and 2.0 kBq/g indicating that the radiation doses to tumour would be in the range 3 Gy to 7.5 Gy.
Errors due to non-uniform distribution of fat in dual X-ray absorptiometry of the lumbar spine
Authors: Tothill Peter , Pye David W.
Published: July 2009

Errors in spinal dual X-ray absorptiometry (DXA) were studied by analysing X-ray CT scans taken for diagnostic purposes on 20 patients representing a wide range of fat content. The mean difference between the fat thickness over the vertebral bodies and that over a background area in antero-posterior (AP) scanning was 6.7 ± 8.1 mm for men and 13.4 ± 4.7 mm for women. For lateral scanning the mean fat thickness difference was only 4 mm for both sexes, but the dispersion was greater, with a standard deviation of 15 mm. To relate these differences to errors in bone mineral, measurements were made of the bone mineral equivalence of fat-equivalent materials on DXA machines from three manufacturers. 10 mm of adipose tissue was equivalent to –0.043 g/cm2 of hydroxyapatite. For AP scanning a non-uniform fat distribution leads to a mean overestimate of 0.029 g/cm2 for men and 0.057 g/cm2 for women. The error exceeded 0.1 g/cm2 in 10% of slices. For lateral scanning the error exceeded 0.1 g/cm2 (about 15% of normal) in a quarter of slices.
Pelvic phleboliths: is there an association with diverticulitis?
Authors: de Vries E. H. , Ginai A. Z. , Robben S. G. F. , Hop W. C. J.
Published: July 2009

Pelvic phleboliths are familiar structures to radiologists although their pathogenesis is not fully understood. The literature suggests a relationship between the prevalence of phleboliths and diverticular disease, and with a low-fibre diet. Phleboliths are said to be seen more frequently in women and on the left side in the pelvis. Their number seems to increase with advancing age. We have attempted to establish relations of phleboliths with diverticulitis, diverticulosis, sex, age and pelvic location. In this study the only statistically significant relation was an increase of the number of phleboliths with advancing age.
Staging of hilar cholangiocarcinoma by ultrasound and duplex sonography: a comparison with angiography and operative findings
Authors: Looser Christian , Stain Steven C. , Baer Hans U. , Triller Jürgen , Blumgart Leslie H.
Published: July 2009

The pre-operative radiological assessment of proximal bile duct tumours is clinically important as resection may be limited by tumour extension along the bile ducts, into hepatic parenchyma or the adjacent vascular structures. Demonstration of the extent of biliary and vascular involvement can direct additional investigations and definitive treatment. 22 patients with hilar cholangiocarcinoma were studied pre-operatively by conventional ultrasound (US) and duplex sonography (DS). The extent of tumour infiltration and vascular involvement was compared with arteriography and operative findings. Bile duct dilatation and the level of obstruction was documented by US in 22 (100%), and the tumour was shown by US in 19 (86%). In these 19 patients, the extent of extraductal extension compared with operative findings was correct in 13, underestimated in two, and in four infiltration was massed. Vascular patency or involvement was correctly determined by DS in 19 (86%), and by arteriography in 18 (82%). In two of the three incorrect DS interpretations, lobar atrophy and contralateral hypertrophy distorted the hilar anatomy. US with DS is valuable in the pre-operative staging of proximal bile duct tumours in predicting ductal and vascular involvement.
Fluid levels in a spinal aneurysmal bone cyst following biopsy
Authors: Kessel D.
Published: July 2009

In their recent article on computed tomography (CT) of osseous lesions (Davies et al, 1992) the authors emphasize the high sensitivity and specificity of the presence of fluid–fluid levels within a lesion for the diagnosis of aneurysmal bone cyst (ABC). In their experience fluid–fluid levels were not seen on CT of ABC following disruption of the tumour by biopsy or previous surgery even when they had been present before the intervention. We have recently seen a spinal ABC with multiple fluid levels following open biopsy.
Direct coronal computed tomography of the temporomandibular joint in patients with rheumatoid arthritis
Authors: Goupille P. , Fouquet B. , Cotty P. , Goga D. , Valat J.-P.
Published: July 2009

Direct coronal computed tomography (CT) of the temporomandibular joint (TMJ) was performed in 26 patients with rheumatoid arthritis (RA) and 26 control subjects. Erosions and cysts of the mandibular condyle had a significantly higher frequency in the RA group than in the control group (p < 0.05) but there was no significant difference in the incidence of other abnormalities. Bone changes were bilateral in RA. A wide range of CT abnormalities was present in patients with RA and in the control group. There are no CT abnormalities specific for RA, but the incidence of erosions and cysts of the mandibular condyle was significantly higher in the RA group and should suggest the diagnosis.
Sonography in thyroid carcinoma in children
Authors: Garcia Cristiant J. , Daneman Alan , McHugh Kieran , Chan Helen , Daneman Denis
Published: July 2009

This paper reviews the clinical, sonographic and pathological findings of 20 children with thyroid carcinoma in an attempt to determine the value and limitations of sonography in thyroid neoplasms in this age group. Although sonography is an excellent technique for the evaluation of thyroid disorders and masses, certain limitations must be kept in mind. Microscopic foci of tumour might be missed and sonography cannot predictably differentiate benign from malignant disease. Previous radiation exposure should increase the level of suspicion for malignancy.
99TcmTechnegas and krypton-81m ventilation scintigraphy: a comparison in known respiratory disease
Authors: James J. M. , Lloyd J. J. , Leahy B. C. , Church S. , Hardy C. C. , Shields R. A. , Prescott M. C. , Testa H. J.
Published: July 2009

Krypton-81m gas, by virtue of its imaging characteristics, is often considered the “gold standard” for ventilation scintigraphy but its use is restricted by its high cost and limited availability. The new radiopharmaceutical 99Tcm-Technegas, a suspension of ultrafine technetium-99m labelled carbon particles, produces high-quality images of ventilation and has the advantage of continuous availability. As part of our evaluation of Technegas the two were compared in 40 patients with a variety of established respiratory diseases. Disparities were seen in five patients in five diagnostic groups and may be a consequence of the differing physical properties of the two agents and the different inhalation techniques used. In addition two interesting features were noted on the Technegas images. (1) Hot spots were seen in 50% of patients, particularly in those with a degree of airways obstruction; (2) preferential basal deposition of activity was seen in 30%, particularly in patients with idiopathic pulmonary fibrosis. Both features were significantly associated with parameters of pulmonary function indicating obstructive lung disease in the former case and restrictive lung disease in the latter.
Computed tomographic appearances of the pelvis following hindquarter amputation
Authors: Fowler J. , Davies A. M. , Carter S. R. , Grimer R. J. , Sneath R. S.
Published: July 2009

Bilateral and midline symmetry of the normal pelvic anatomy is an aid to the interpretation of computed tomographic (CT) examinations. Following hindquarter amputation (HQA) or partial hemipelvectomy (PHP) the normal anatomical relationships are disturbed. The CT examinations of 15 patients who had undergone either an HQA or a PHP for an advanced musculoskeletal malignancy are reviewed. The new “normal” anatomy revealed displacement of the bladder and small bowel to the side of surgery in one third of patients, more commonly in the PHP cases. There were varying degrees of wasting of the ipsilateral musculature, gluteus maximus muscle flap, erector spinae and psoas muscles, etc., because of partial denervation and disruption of their origin or insertion. Recurrent tumour was identified in eight of 10 cases in which it was clinically suspected prior to the CT examination. Invariably the recurrence arose within the muscle flap at the resection margin. Bone involvement by direct tumour spread was present in three cases. Pitfalls in differentiating recurrent tumour from scar tissue are discussed.
Comparison of the effect of different reference data on Lunar DPX and Hologic QDR-1000 dual-energy X-ray absorptiometers
Authors: Laskey M. A. , Crisp A. J. , Cole T. J. , Compston J. E.
Published: July 2009

We have investigated whether the Lunar DPX (software 3.4) and Hologic QDR-1000 dual-energy X-ray absorptiometers have comparable normal reference databases for the spine and femur of white UK and USA subjects. After conversion for systematic differences in absolute bone density values between the two systems, the reference databases were very similar for the spine in young subjects, but there were clear differences in the femur databases of young females and males of all ages. These differences were confirmed by comparing the percent age-matched and young values determined by the two systems for subjects scanned on both systems. Thus the diagnosis and management of a patient could differ, depending on the system used for the bone density measurements.
Book reviews
Authors: Davies A. M.
Published: July 2009

This is a multi-author American text with the editor contributing to six of the 12 chapters. The first chapter comprising in excess of one quarter of the whole book, is basically a magnetic resonance imaging (MRI) atlas of the joints. The quality of the images is acceptable but these could be found in many of the numerous MRI atlases recently published.
The gene as theme in the paradigm of cancer
Authors: Hall Eric J
Published: July 2009

I was indeed honoured to give the Silvanus Thompson Memorial Lecture, grateful to those who thought me worthy of it, and somewhat in awe when I view the list of previous lecturers, beginning with Lord Rutherford in 1918.

The Röntgen Society was founded in 1897, with Silvanus Thompson as its first President, and this society became the forerunner of the British Institute of Radiology.

A physicist and historian of science, Silvanus Thompson was a prolific lecturer and writer on a wide range of scientific and technical subjects. He made important contributions in electrical machinery, optics and X rays, but he is best known as an interpreter of science to the non-scientific public and for his popular works “Elementary Lessons in Electricity and Magnetism” (1881) and “Calculus made Easy” (1910). Like so many later physicists who turned their attention to medicine in general, and radiology in particular, he was a devout practising Quaker. This was of critical importance to his career, for at that period, it excluded him from the older universities and for a time deterred him from the “godless college” of London (Lynch, 1989).

At Radiology and Oncology '92, we also remembered and honoured Nic McNally, who was to have been President of the BIR, but died before taking office. 25 years ago, Nic McNally signed up to come to Oxford as my graduate student but at the last moment received a better offer to stay at Hammersmith with Tikvah Alper and never came to join us in the City of Spires.
Computed tomography of the chest in T1NoMo non-small cell bronchial carcinoma
Authors: Duncan K A , Gomersall L N , Weir J
Published: July 2009

There has been controversy within the recent literature as to the value of computed tomography (CT) of the chest in patients with TINoMo non-small cell bronchial carcinoma, as staged by plain radiography and bronchoscopy. This paper reports on 63 such patients, nine (14.2%) of whom were shown correctly by CT of the chest to have metastatic spread which rendered them inoperable. Of these nine, four had stage N3 mediastinal disease; the other five had metastatic disease, either pulmonary or bony. Patients with lesions less than 2 cm in diameter were also looked at separately: 4/20 had inoperable disease on CT of the chest. In both groups the detection rate of inoperability by CT of the chest justifies its use pre-operatively in all TINoMo non-small cell bronchial carcinomas, in terms of clinical morbidity, mortality and cost.
Lymphography—still useful in the diagnosis of lymphangiomatosis
Authors: Peh W C G , Ngan H
Published: July 2009

Lymphangiomatosis is diagnosed by lymphography in two patients. One case presented with life threatening pleural effusion and was found to have skin haemangiomata, underlying lymphangiomatosis and massive osteolysis of the pelvic bones in the same topographic distribution. The aetiology of this condition is discussed and the role of lymphography emphasized.
Measurement of the bone mineral density of the os calcis as an indication of vertebral fracture in women with lumbar osteoarthritis
Authors: Kotzki P-O , Buyck D , Leroux J-L , Thomas E , Rossi M , Blotman F
Published: July 2009

In women with lumbar osteoarthritis, measurement of the os calcis bone mineral density (BMD) using dualenergy X-ray absorptiometry (DEXA) as an indication of vertebral fracture was evaluated. The in vivo precision of the method was 1.28%. Age- and sex-matched control curves were evaluated using a control of 193 females. The correlation between spine BMD and os calcis BMD was significant (r = 0.65, p ≪ 0.001). For the osteoporotic women without osteoarthritis (n = 34), there was no significant difference in the spine and the os calcis Z-scores (–1.99SD and – 1.83SD respectively). Whereas for osteoporotic women with osteoarthritis (n = 30) the spine Z-score was – 0.49SD the os calcis Z-score was – 1.92SD. The difference was significant (p < 0.001). Receiver operating characteristic (ROC) curves demonstrate the superiority of the os calcis as a measurement site over the lumbar spine, in correlation with existing crush fractures in the presence of osteoarthritis. It is concluded that when lumbar osteoarthritis occurs measurement of the os calcis BMD using DEXA is clinically useful for the estimation of bone mass.
The development of equipment for the technical assessment of respiratory motion induced artefacts in MRI
Authors: Jackson P C , Davies S C , Zananiri F V , Bean J P , Follett D H , Halliwell M , Wells P N T
Published: July 2009

A device and technique to study the effects of respiratory motion on the quality of magnetic resonance images is proposed. The construction of the device enables a variety of test objects to be mounted and used in the evaluation of imaging parameters that may be affected by motion. The equipment is constructed of cast acrylic and the movement is actuated and controlled pneumatically thus ensuring that there are no interactions with the magnetic field and radiofrequency detection system to cause further image artefacts. Separate studies have been performed, using ultrasound, to assess the degree and rate of movement of organs owing to respiration in order to derive the motion parameters for the apparatus. Preliminary results indicate that the technique produces motion induced artefacts simulating those which are the result of the effects of respiration.
Pseudoaneurysm of transplant hepatic artery: a late presentation
Authors: Hutchinson C E , Mackinlay J Y , Buckels J A
Published: July 2009

Vascular problems of the hepatic artery account for about 10% of graft loss after liver transplantation (Todo et al, 1987). Of these the majority are secondary to hepatic artery thrombosis (Tobben et al, 1988). In a large survey of transplants, only a small percentage were found to fail as a result of pseudoaneurysm, often at the anastomotic site, and 25% of these were related to infection (Tobben et al, 1988). The potential for early rupture and fatal haemorrhage makes early diagnosis important. In a review of the literature pseudoaneurysms are seen as an early complication and have not been described later than six months (Wozney et al, 1986; Houssin et al, 1988; Tobben et al, 1988; Zayko et al, 1988). We report a late presenting pseudoaneurysm in which no evidence of infection was demonstrated. The importance of early diagnosis and the value of ultrasound are stressed.

A 36-year-old female who had required an orthotopic liver transplantation for primary biliary cirrhosis 24 months previously presented with deteriorating liver function and an epigastric mass on routine follow-up. She was otherwise asymptomatic. She had required a laparotomy for a small bowel obstruction due to adhesions seven months after transplantation. She had otherwise been well and had had no major rejection episodes.

On examination she was noted to be slightly jaundiced. There was a non-tender palpable liver 4 cm below the costal margin.
Cervical intervertebral foramen widening caused by vertebral artery tortuosity—diagnosis with MR and colour-coded Doppler sonography
Authors: Schima W , Stiglbauer R , Trattnig S , Heimberger K , Kramer J , Imhof H
Published: July 2009

Widening of cervical intervertebral foramen owing to tortuosity of the vertebral artery is a rare condition, mimicking the presence of a tumour in the intervertebral foramen or an aneurysm of the vertebral artery (Schimmel et al, 1976). We present a patient with cervico-brachialgia, who had a right-sided loop of the vertebral artery in the intervertebral foramen at C4/5 level. Various authors have described the clinical and radiological manifestations of this anomaly by using vertebral angiography (Zimmerman & Farrell, 1970; Burnett & Staple, 1981; Royo Salvador et al, 1981). In this case, the diagnosis of this benign condition was made non-invasively with magnetic resonance tomography (MR) and confirmed by colour-coded duplex- Doppler sonography, and the patient thus escaped vertebral angiography.

A 68-year-old male presented with cervicobrachialgia, which radiated into the right hand for several weeks. Physical examination showed numbness of the right palm, thumb and forefinger. Anteroposterior radiographs of the cervical spine, which had been obtained in an outpatient clinic, were unremarkable. A right anterior oblique radiograph showed a slight enlargement of the right C4/5 intervertebral foramen (Figure 1). A computed tomographic (CT) scan (Somatom 2N, Siemens) revealed a soft tissue mass and enlargement of the intervertebral foramen C4/5 on the same side, and a tumour in the intervertebral foramen was suggested (Figure 2). The patient was then referred to the department of neurosurgery of our hospital for further diagnostic work-up.
Improved assessment of supraclavicular and abdominal metastases in oesophageal and gastro-oesophageal junction carcinoma with the combination of ultrasound and computed tomography
Authors: van Overhagen H , Laméris J S , Berger M Y , Tilanus H W , van Pel R , Klooswijk A I J , Schütte H E
Published: July 2009

The purpose of the study was to evaluate ultrasound and computed tomography in the assessment of distant metastases, supraclavicular and abdominal, in 113 patients with carcinoma of the oesophagus and gastrooesophageal junction. Ultrasound and computed tomographic findings were compared with the cytological data in 29 patients and with the surgical data in 84 patients. In assessing distant metastases, ultrasound and computed tomography had a sensitivity of 61% and 70%, and a specificity of 93% and 85%, respectively (p = 1.0). When ultrasound and computed tomography were combined the sensitivity increased to 83% and the specificity decreased to 81%. There was no significant difference in the assessment of supraclavicular metastases (p = 0.8), coeliac metastases (p = 1.0) or liver and other non-lymphatic abdominal metastases (p = 1.0) on ultrasound or computed tomography. The results show that both ultrasound and computed tomography should be used for assessment of distant metastases and abnormalities confirmed by imageguided biopsy.
CT-Dacryocystography for nasolacrimal duct obstruction following paranasal sinus surgery
Authors: Massoud T F , Whittet H B , Anslow P
Published: July 2009

Nasolacrimal duct obstruction and consequent epiphora is a complication that may develop in some patients following paranasal sinus surgery. We describe the technique of CT-dacryocystography which entails contrast injection of the lacrimal system and simultaneous computed tomography (CT) scanning of the facial structures. This technique provides concurrent information regarding obstruction of the nasolacrimal duct and the presence of disease recurrence or persistence in the adjacent paranasal sinuses. The role of CT-dacryocystography prior to endoscopic dacryocystorhinostomy is discussed briefly.
Allergic Aspergillosis of the sphenoid sinus: pitfall on MRI
Authors: Demaerel P , Brown P , Kendall B E , Revesz T , Plant G
Published: July 2009

Recent reports indicate that fungal sinusitis is more common than previously thought. Four different histological subtypes of Aspergillus sinusitis are now recognized. Fulminant Aspergillosis is usually seen in immunosuppressed patients, and chronic invasive Aspergillus sinusitis, allergic Aspergillus sinusitis and Aspergilloma are seen in the non-immunocompromised individual. We present a case of progressive unilateral visual loss in a 30-year-old woman. The unusual magnetic resonance findings and the value of computed tomography are discussed.
Book reviews
Authors: Kabala J E
Published: July 2009

The main body of this book is divided into three sections. The first deals with the techniques of renal imaging with a chapter on each modality (plain film, IVU, ultrasound, nuclear medicine etc.). The second section briefly discusses the investigation of the major presenting symptoms of renal disease (haematuria, loin pain, hypertension etc.). They are both likely to be of use to anyone relatively new to the field. The third section is organized along pathological lines with chapters devoted to developmental anomalies, urinary tract infection, stone disease and so on.
Coronary angiography: an analysis of radiographic practice in the UK
Authors: Coulden R A , Readman L P
Published: July 2009

There is growing public and professional concern over the risks of medical ionizing radiation. It is therefore important to examine our procedures for ways in which we can reduce radiation dose to patients and staff. We surveyed 48 catheter laboratories nationwide to establish the range of practice in performing “routine” coronary angiography and left ventriculography. There were wide variations in the numbers of views obtained, mean ciné film lengths and mean fluoroscopy times. Despite the recommendation of the National Radiological Protection Board, only five of the 36 centres responding were able to provide estimates of patient radiation dose per procedure. Calculations of maximum and minimum patient doses, based on ciné film length and fluoroscopy time, show a fourfold variation between hospitals. Using the concept of estimated dose equivalent, the predicted lifetime fatal cancer risk for a routine examination ranges from 1/16 600 to 1/4300. As a preliminary step in radiation dose reduction we have used this survey data to suggest how a typical coronary angiogram and left ventriculogram might be performed.