bluuebunny/crossref_metadata_2025 huggingface dataset:
Deterioration following delay in performing femoral angioplasty
Authors: Spencer J. A. , Fletcher E. W. L.
Published: July 2009

It is not uncommon for a delay to occur between assessment arteriography and angioplasty attempt. We reviewed retrospectively the arteriograms of 61 patients where such a delay occurred to assess progression of superficial femoral artery (SFA) disease in this interval. A mean delay of 14.6 days (range 2–60 days) occurred between arteriogram and angioplasty attempt. Arteriographic deterioration was found in six of 61 patients (9.8%) and in three this precluded angioplasty. Of the six patients four had initial arteriography via the same side as the SFA disease whilst two had arteriography via the contralateral femoral approach. We discuss the aetiology of this phenomenon and suggestions are made to reduce its incidence.
Occupational exposure and the Central Index of Dose Information
Authors: Kendall G. M. , Hughes J. S.
Published: July 2009

Occupational exposure to ionizing radiation in the UK is presently controlled by the Ionizing Radiation Regulations, 1985 (Parliament, 1985) which were based on the recommendations of ICRP Publication 26 (ICRP, 1977). These recommendations and, in particular, the dose limits were formulated in the light of contemporary information about the risks of ionizing radiation (UNSCEAR, 1977). Recently, new epidemiological analyses of the survivors of the atomic bombs at Hiroshima and Nagasaki have been published (UNSCEAR, 1988; National Academy of Sciences, 1990). These studies suggest that the risk estimates for low doses and low dose rates may be higher by a factor of about 3 than previous analyses had indicated (Stather et al, 1988). In the light of preliminary announcements of the re-analyses of the atomic bomb survivors (e.g. Preston & Pierce, 1987) and of the ICRP Como Statement (ICRP, 1987), the NRPB recommended that occupational exposure to ionizing radiation should be controlled so as not to exceed an average dose equivalent of 15 mSv per year (NRPB, 1987). This has prompted renewed interest in the levels and distribution of occupational exposure to ionizing radiation.

This paper is based on a talk to the meeting organized by the British Institute of Radiology in December 1989 to discuss the implications of the new risk estimates. It presents statistics on occupational exposures in the UK in recent years and discusses the role of the Central Index of Dose Information (CIDI).
Recent films and screens for mammography
Authors: Law John
Published: July 2009

Comparisons of various film–screen combinations for mammography have been reported in a series of communications, the most recent being one by Law and Kirkpatrick (1990). A further short series is reported here. The technique is unchanged from before. A phantom of “Barts” type (White & Tucker, 1980) with realistic details is used, and films are exposed in evacuated plastic envelopes to avoid any complicating influence from cassette design. The X-ray set used was a CGR 600T with molybdenum target and filter, but in this series all films were exposed at 28 kV with grid (rather than 25 kV, no grid, as before) in line with current clinical practice. All films were contact films at 60 cm focus–film distance (FFD) and were processed by a Dupont-T5A processor at 3.5 minutes, 35°C, and using Kodak chemistry.
The scintigraphic detection of ossific mediastinal and pulmonary metastases in osteosarcoma
Authors: Brady Adrian P. , Ennis Joseph T.
Published: July 2009

Osteosarcoma primarily occurs in the metaphyses of long bones, and metastatic spread is generally hematogenous (Price & Jefree, 1973). While localized lymph node dissemination is frequent, spread to distant nodes is unusual. Detection of occult metastases can influence patient prognosis. This case demonstrates the sensitivity of scintigraphy in detecting ossific metastases not recognized on conventional radiography and not detected by computerized tomography (CT).

A 24-year-old man presented with pain and swelling in the region of the left knee. Plain radiographs demonstrated intense osteoblastic changes in the distal left femur; a radiological diagnosis of osteosarcoma was made (Fig. 1), which was confirmed histologically. Thoracic CT demonstrated no evidence of metastatic spread. Scintigraphy with 99Tcm-MDP demonstrated focal intense uptake in the region of the tumour, but no evidence of satellite lesions.
Book reviews
Authors: Forman Dawn
Published: July 2009

Producing a book which does justice to the reputation of the Chesney's sufficiently to be called a revision, yet has a style which gives credit to the new authors is, as the preface to the book indicates “no easy task”. However, this original aim has been achieved as the book provides the reader with a foundation in radiographic photography in a manner which student radiographers will find easy to relate to.
Misinterpretation of the upper parathyroid adenoma on thallium-201/technetium-99m subtraction scintigraphy
Authors: Chan T. Y. K. , Serpell J. W. , Chan O. , Gaunt J. I. , Young A. E. , Nunan T. O.
Published: July 2009

Pre-operative thallium–technetium subtraction scintigraphy of 50 patients with primary hyperparathyroidism, which was subsequently proven on histology to be due to an adenoma, was compared with operative findings. Six scans were negative and seven uninterpretable. Of the remaining 37 patients, 34 had correct scan prediction of the anatomical locations of the adenomas. On examination of the origins of the adenomas, all six scintigraphic predictions of upper adenomas corresponded to tumours arising from the upper gland found at operation. Of the 25 lower predictions, there was one false positive and 16 were correct, i.e. of lower gland origin, but eight were found to originate from the upper gland. This misinterpretation is thought to be due to the prolapse of an adenoma arising from the upper gland towards the lower pole of the thyroid, thereby mimicking a lower lesion on the scan.
Splenic calcification following treatment of Hodgkin's disease
Authors: Moody A. R. , King D. M.
Published: July 2009

Calcification within the spleen has many different manifestations and aetiologies. We report a single case of a patient with Stage IV Hodgkin disease who developed splenic calcification following chemotherapy. A search of the literature has failed to reveal a previous report of this phenomenon.

A 43-year-old man presented with a 6-month history of increasing painless swelling in the left side of his neck. Latterly this had been accompanied by the development of further smaller cervical nodules. He was otherwise asymptomatic.

On examination, mobile rubbery lymph nodes were confirmed in the left cervical and supra-clavicular regions, the largest being up to 1 cm in diameter. Smaller nodes were also found in the left axilla and both inguinal regions. One of the nodes in the left posterior cervical triangle was removed and histological examination revealed mixed cellularity Hodgkin disease.

A plain radiograph of the chest demonstrated no abnormality and computed tomography (CT) of the thorax and abdomen was performed to delineate the extent of the disease. There was no evidence of mediastinal or other lymph node enlargement; the liver and spleen were normal in size and shape and contained no focal abnormality (Fig. 1). A bipedal lymphogram was performed which demonstrated an unusual and suspicious appearance in the proximal inguinal regions. Lymph node biopsy revealed no evidence of disease. The patient was therefore staged as IA mixed cellularity Hodgkin disease.
Bilateral pneumothorax as a presenting feature of metastatic angiosarcoma of the scalp
Authors: Sizer Bruce
Published: July 2009

Lawton et al (1990) observe that metastatic angiosarcoma is a rare condition and is associated with extremely poor survival following the development of lung complications. They also state that, although radical doses of radiotherapy (44–60 Gy over 4–6 weeks, respectively, 4 fractions per week) have been followed by long term control of local disease, this may not necessarily correlate with improved survival. A further case, identified by retrospective review of patients' records of the Skin Unit of the Peter MacCallum Cancer Institute (PMCI) in Melbourne, is described here to report the response to hypofractionated treatment.
Retroperitoneal haematoma and pelvic haematoma following orchidectomy
Authors: Kennedy C. , Harland S. , Watson G. , Parker C.
Published: July 2009

We read with interest the papers by Page et al (1990) and Russell et al (1990) on the importance of differentiating retroperitoneal haematoma following transinguinal orchidectomy from metastatic lymph node involvement. We have recently seen a 24-year-old man who underwent a right inguinal orchidectomy for testicular swelling of 3 months duration. Histological examination of the resected testis showed malignant teratoma undifferentiated (MTU), with no evidence of vascular invasion and absence of yolk sac elements. Tumour markers were negative pre-operatively and have remained so.
Book reviews
Authors: Baddeley H.
Published: July 2009

The aim of the book is to describe the basic principles of magnetic resonance imaging (MRI) and to survey its current status in clinical applications throughout the body. In common with many MRI texts, the early chapters on the physical basis of MR are adequate, the glossary is fairly comprehensive and the chapter on artefacts useful.
Book reviews
Authors: Grundy Alan
Published: July 2009

In the preface, the editors state that they believe this entry will make a positive contribution to gastroenterologic literature, since it incorporates features not shown by others of its genre. It welcomes inclusion of material by authors who normally publish in foreign languages, and reviews the historical background and clinical relevance of the subject matter. It is intended as a yearly publication.
Book reviews
Authors: Garrett J. A.
Published: July 2009

This is a comprehensive booklet of mammographic equipment tests. Its main commendation lies in practical advice which accompanies the tests; as such it is excellent. The attempt to wrap the tests up in the language of quality systems is not entirely convincing (Ch. 2). “Commissioning” and routine tests are said to comprise the operating techniques of quality control. They are essentially inspection methods.
Book reviews
Authors: Edwards R. H. T.
Published: July 2009

This concise book summarizes an extensive range of presentations on developments in magnetic resonance spectroscopy and relevant magnetic resonance imaging as of 1987. At the time of review (1990) it is evident that there has been an unfortunately long delay between the verbal presentations and the appearance of the public proceedings. This clearly limits the value of the book as an up-todate account of recent developments in the field. It does, however, represent a valuable compendium of physical principles underlying the clinical applications of MR spectroscopy.
Carcinoma of the breast: measurement and the management of treatment. II. The regression of tumours
Authors: Cheung C. W. D. , Johnson A. E.
Published: July 2009

Regression slopes fitted in 238 new cases of primary breast cancer submitted to a variety of managements are analysed. Contrary to the original hypothesis that slopes would primarily reflect the composition of the tumours, the steepness of resorption slopes is found also to be treatment dependent. Investigation of other factors influencing slopes is confined to radiotherapy where the expectation that the prescribed dose will be delivered is high. A large cumulative radiation effect before the start of shrinkage is associated with steeper slopes. A small correlation between slope and both menopausal status and starting diameter has been found, with premenopausal patients and small tumours producing the steepest slopes. The full range of slopes has been seen in postmenopausal patients. The data has been fitted to a linear model to evaluate the relative importance of these associations. Illustrative cases support the hypothesis that resorption slopes are a product of tumour architecture and histology but we conclude that the maximum possible steepness of slope is not always achieved in the clinic, even when radiation is used. A combination of histological and regression data is therefore required to characterize a tumour for predictive purposes.
Defaecography commode with ruler mounted on the side: reference point for measurements of perineal descent
Authors: Nielsen Michael Bachmann
Published: July 2009

Videodefaecography is performed in our department according to the technique previously described by Skomorowska et al (1987, 1988). The procedure (Mahieu et al, 1984) can be simplified further by placing a ruler with lead markings on the side of the commode (Bernier et al, 1988). All measurements can then be made from videotape, and static images are not needed.
Gallium scintigraphy in the diagnosis and management of multi-focal Castleman's disease
Authors: Stansby G. , Hilson A. , Hamilton G.
Published: July 2009

Castleman's disease is a rare condition which can mimic the presentation of more common disorders. We describe the first reported case of the use of gallium scintigraphy in the multifocal form of this disease and suggest that gallium scintigraphy may have an important role to play in both its diagnosis and management.

The patient was a 37-year-old roofer who had previously always been fit and well. He was transferred to our hospital with a 10-day history of dry cough, myalgia and rigours. Except for symmetrical lower limb weakness, examination was normal and the erythrocyte sedimentation rate (ESR) was raised at 58 mm/h. The initial diagnosis was one of a post-viral myositis and he was discharged home on a reducing dose of steroids.
Intermittent inferior vena caval obstruction: an unusual cause demonstrated by ultrasound
Authors: Walter David F. , Ramaiya Lakshmi I.
Published: July 2009

The syndrome of inferior vena caval obstruction may result from a number of diverse causes (Missal et al, 1965; Siqueira-Filho et al, 1976), and the clinical presentation and course depend, with some exceptions, upon the aetiology and level of obstruction. Thrombosis within the inferior vena cava (IVC) is one of the more common causes and may be primary or secondary to abdominal infection, abdominal trauma or surgery, hypercoagulable states or extension from femoral or iliac thrombophlebitis.
An unusual case of pneumonia
Authors: Chaudhuri R.
Published: July 2009

A 41-year-old European man presented with a 4-week history of increasing dyspnoea, left pleuritic chest pain, productive cough and 7 kg weight loss. He had smoked 60–70 cigarettes per day for many years, and he drank 3 pints of beer daily. He had had a myocardial infarction 5 years before, and had paranoid schizophrenia, well controlled on monthly flupenthixol injections.

On examination, he was pyrexial with signs of consolidation at the left lung base. There was no adenopathy. His fingers were heavily nicotine stained and his dental hygiene very poor. Investigations revealed a mild anaemia, elevated white blood cell count and ESR 100 mm/h.
Pulmonary embolus as a complication of therapeutic peripheral arteriovenous malformation embolization
Authors: McCarthy P. , Kennedy A. , Dawson P. , Allison D.
Published: July 2009

Therapeutic embolization is an established technique in interventional radiology. In our unit we have considerable experience in the use of this technique in the management of systemic arteriovenous malformations. During the embolization of systemic vascular lesions containing arteriovenous communications, there is a danger of embolic material being swept into the venous side of the circulation and causing pulmonary embolism. In a previous study of 137 patients treated in this way, overt pulmonary embolism was observed to occur in two patients (1.5%); we did not, however, determine the incidence of subclinical embolism in that series and are unaware of any other available data concerning this (Hemingway & Allison, 1988).
Percutaneous femoral artery puncture: practice and anatomy
Authors: Davies E. Rhys
Published: July 2009

I write to support very strongly the advice given by Drs Grier and Hartnell (1990) about the use of maximal femoral pulse for arterial puncture.
Percutaneous femoral artery puncture: practice and anatomy
Authors: Towers M. J.
Published: July 2009

The paper on percutaneous femoral artery puncture (Grier & Hartnell, 1990) discusses the various means used by angiographers to ensure a common femoral artery puncture. I was surprised to read that 39% of the angiographers questioned use the skin crease as a guide. Anyone doing femoral punctures regularly must soon discover how inaccurate this method is. The inguinal skin crease had been shown to Bear no constant relationship to the inguinal ligament, the common femoral artery or the underlying bones (Lechner etal, 1988) Examination of old or obese patients shows how readily the skin moves in this area. I find it hard to believe that experienced angiographers anywhere today use such an inaccurate method to decide where to puncture, and I would like to ask Drs Grier and Hartnell exactly how they phrased their questionnaire, and in which order were the choices offered.
Percutaneous femoral artery puncture: practice and anatomy
Authors: Grier D. , Hartnell G.
Published: July 2009

We thank Dr Tower for his comments but is is no surprise to discover that 39% of the angiographers questioned used the skin crease as a guide. It is because so many people use the skin crease (remember that angiography is performed by cardiologists as well as properly trained radiologists) that this survey and the subsequent radiographic study was performed. The continued use of the skin crease persists in spite of the well documented inaccuracy of this as a reliable guide to femoral artery puncture. It should be noted that our report is the first to appear in the British literature and it is for this reason we carried out the study.
Related articles?
Authors: Tokita N.
Published: July 2009

We sincerely regret that we inadvertently missed a paper by Dawson et al (1987) on iodine photoactivation before we sent our paper to BJR for publication. Our experimental approach as well as conclusions are similar to those stated in that paper and we apologize for unintentionally omitting it as a reference in our paper.
Book reviews
Authors: Dawson P.
Published: July 2009

This is the second edition of a now well established book. It comes 6 years or so after the first edition with a change of name, substituting “Imaging” for “Radiology”. It has increased in size from 361 to 504 pages but does not, for all that, seem very much bulkier. Much of the original excellent content remains unchanged, but new sections are included on important topics such as digital subtraction angiography, ultrasound and computed tomography (CT).
Book reviews
Authors: Dawson P.
Published: July 2009

This large multi-author volume edited by Dondelinger, Rossi, Kurdziel and Wallace is a large volume of some 800 pages and more than 1000 illustrations. It is a comprehensive and up-to-date survey of the “state of the art” in a rapidly expanding field. The editorship and authorship are multinational with more than 100 contributors. The names of a large proportion of the contributors are very well known, though, interestingly, not always best known for the subjects on which they are writing in this book.
Book reviews
Authors: Hinton J.
Published: July 2009

This is one of four volumes dealing with chest disease, and in this third volume, the following diseases are discussed: embolic disease, pulmonary hypertension, airway disease and pneumoconioses.

The book aims to emphasize the value of the chest radiograph in the initial assessment of chest disease.
Book reviews
Authors: Renton Peter
Published: July 2009

It might be thought unusual for a radiologist to be reviewing a two-volume multi-author text on bone tumours for a radiological journal; indeed, in the past there would have been little reason for a publisher to send such a book to this journal. It is now, however, evident that, at least in the field of bone tumour diagnosis and treatment, neither the clinician, pathologist nor radiologist dare work in isolation. The surgeon is often not the practitioner who carries out the initial biopsy, or who decides what to biopsy.
Book reviews
Authors: Hansell David M.
Published: July 2009

This book is the latest in a long line of self-assessment books primarily aimed at MRCP candidates. The preface indicates that it is the authors', and obviously the publisher's, hope that this book will find favour with others including trainee radiologists. The requirements and standards of MRCP and FRCR are quite different, and the level of difficulty of the cases included are more appropriate to the membership candidate.
Book reviews
Authors: Kohner Eva M.
Published: July 2009

This book is a nicely prepared one, most of the illustrations coming from the University of Mainz in Germany. It is not clear whom the book is aimed at, but it is most likely for junior ophthalmologists during their residency training.

There are introductory pages about fluorescein, its use, the evaluation of angiograms and the appearance of normal retina and choroid. There is a short section at the end about complications of fluorescein injection and their management. The text was originally written in German and then translated, which results in a text difficult to read, with sentence structures left in their heavy Germanistic style.
Fracturing and stretching of angioplasty balloon catheters under bending with tension
Authors: Jeans W. D. , Blakeborough A. , Loose H. W. C.
Published: July 2009

Eight catheters from five manufacturers have been subjected to tests which combined bending and tension. Three failure mechanisms have been identified. These included separation of the balloon from its proximal attachment to the shaft, fracture of the shaft at its junction with the balloon, and undue ductility of the shaft. It is concluded that good catheter design should ensure that there is no sudden change in stiffness along the length of the catheter, and that the optimum relationship of ductility to stiffness has not yet been defined for catheters. Recommendations relating to these characteristics could be included in the British Standards relating to angioplasty balloon catheters.
An irldium-192 applicator for the treatment of stomal recurrence following tracheostomy for subglottic carcinoma
Authors: Jones R. D. , Clarkson D. G. , Symonds R. P. , McNee S. G.
Published: July 2009

A 45-year-old man presented with a left-sided posterior triangle neck node and a history of sore throats for a year. At the time of presentation he had no other symptoms. An examination under anaesthetic was undertaken and revealed no abnormality of the larynx or pharynx but a suspicious area was seen in the nasopharynx. Biopsy of this region, however, was normal. Histology of the nodes dissected from the left side of the neck revealed anaplastic carcinoma and the appearances were in keeping with a primary from the nasopharynx or bronchus. Tonsillar biopsy was normal.

On clinical judgment the nasopharynx was thought to be the most likely primary site and so the patient was treated with radical radiotherapy to the neck and nasopharynx. The neck was treated with an anterior beam of MV photons from a linear accelerator with midline shielding (2 cm wide, 6 cm thick) to redbce the dose to the spinal cord (Ho, 1978).
Metastatic carcinoma to the male breast
Authors: Ramamurthy Lalitha , Cooper Richard A.
Published: July 2009

A case of metastasis to the male breast from prostate carcinoma is reported. For proper treatment, it is important to differentiate primary from metastatic tumours.

Prostate-specific antigen screening should be strongly considered in all breast masses seen in patients with known prostatic carcinoma. One cannot assume that breast enlargement in these patients is solely due to oestrogen-induced gynecomastia.
There's more to it than meets the eye
Authors: Evans Sharon
Published: July 2009

A 39-year-old Indian man presented to the Casualty Department with a 3-week history of headaches and nasal congestion, and a 3-day history of a painful swollen right eye. On examination, he was unwell and pyrexial with a sinus tachycardia. He had a tender right eye with a swollen upper eyelid and an obvious sixth nerve palsy with almost complete failure of abduction.

Computed tomographic (CT) head scan was performed which demonstrated the cause of his symptoms (Fig. 1). What is the diagnosis? How many abnormalities can you detect? What is the appropriate management?

High resolution slices 3 mm thick before and after administration of contrast medium were obtained using an axial plane of section parallel to the orbitomeatal line. No reformatting was considered necessary.
Book reviews
Authors: Duck F. A.
Published: July 2009

When clinical judgements depend on measurement, the accuracy of those measurements are of paramount importance. When alterations in image appearance are to be evaluated, then the highest possible image quality should be generated. This booklet explains how to ensure that ultrasonic diagnostic equipment performs so that measurements are accurate, and so that image quality is as high as possible.
British Institute of Radiology Presidential Address, 1990
Authors: Hill C. R.
Published: July 2009

The historical origin and continuing central raison d'être of the British Institute of Radiology is as an interdisciplinary forum for promoting the advance of radiological science. This preculiar, broad, generalist but scientifically inclined concept of an institution is one that many of us who are part of it cherish very warmly.

I certainly share this feeling, but I also believe that it behoves us from time to time to stand back and examine, from a wider perspective, what we are aiming to achieve, how we fit in to the contemporary cultural environment, and which way the scientific frontiers of our subject are likely to move in the foreseeable future.

An objective outsider even from no further away than somewhere like Calais might well wonder whether the BIR was not in the same class as driving on the left side of the road: one of those quaint, if endearing, British institutions in which, in our insularity, we persist because we have not noticed that the rest of the world has passed us by. Surely, like it or not, we now live in an age of specialists, where the frontiers of physics have receded beyond the comprehension of many radiologists, while physicists, correspondingly, are equally out of their depth in many aspects of modern medicine.

Specialization is affecting us not only at the scientific level but also in the form of professional differentiation.
Quantitative computed tomography for bone mineral measurement: technical aspects, dosimetry, normal data and clinical applications
Authors: Karantanas A. H. , Kalef-Ezra J. A. , Glaros D. C.
Published: July 2009

A single KVp quantitative CT (QCT) technique was used for measuring the spinal trabecular bone density. The trabecular bone equivalent density (TBED) was expressed as the density of a K2HPO4 solution that exhibits a linear attenuation coefficient identical to that of trabecular bone. A field non-uniformity correcting factor was obtained from experiments on phantoms. The effective equivalent dose of the whole examination (four sections and a scout view) is 370 μSv. The in vivo short-term precision (reproducibility coefficient of variation) ranges from 1.4% to 4.1% depending on the TBED values of the normal subjects. The TBED was measured in 206 normal Greeks aged 30–69 years. Average TBED decreased with increasing age for both sexes. Analysis considering separately each vertebra showed a tendency to a caudal spinal TBED reduction. No correlation was found between the TBED values and the body habitus, milk consumption, smoking habits in men, and number of full-term pregnancies. A significant difference (p < 0.01) was found between the TBED values of the normals and those of 50 women suffering from post-menopausal osteoporosis, 37 alcoholic men, and 12 gastrectomized men (Billroth II). Quantitative CT has been established as a method of measuring TBED in health and disease, and the results from this study confirm these applications.
Combined tissue oxygen tension measurement and positron emission tomography studies on glucose utilization in oncogene-transformed cell line tumour xenografts in nude mice
Authors: Kallinowski F. , Brownell A.-L. , Vaupel P. , Brownell G. L.
Published: July 2009

Glucose utilization studies using high resolution positron emission tomography and tissue oxygenation measurements using microelectrode techniques were carried out in nude mice bearing oncogene-transformed (RatlpEJ6.6 and REFpneoMYCrasEpool) cell line tumours and a non-transformed (Ratl) cell line tumour to determine the correlation between glucose utilization, tissue oxygenation and tumour growth rate. Control measurements were performed in the subcutis of tumourfree animals. Accelerated growth rates were observed in both ras-transformed cell lines with tumour doubling times of 2.5–4 days while Ratl tumours had a doubling time of 28 days. Since rapid growth rates necessitate elevated consumption of oxygen and nutrients, severe tumour hypoxia was observed in tumours from both ras-transformed cell lines; median pO2 being 1–5 mmHg (tumour sizes ca. 400 mm3). Size-matched Ratl tumours exhibited a median pO2 value of 12 mmHg corresponding to the slow growth rate. Comparing both ras-transformed cell lines, RatlpEJ6.6 tumours had a more adequate vascularization than REFpneoMYCrasEpool tumours indicated by a better tissue oxygenation (5 mmHg versus 1 mmHg) and higher glucose metabolic rates (13.4 ± 2.2 μmol/min/100 cm3 versus 9.7 ± 1.3 μmol/min/100 cm3). At advanced growth stages, a reduction of tissue oxygen levels is obtained which is accompanied by a 30% elevation of glucose metabolic rate. The data presented here demonstrate for the first time an impact of well defined oncogenic alterations on the therapeutically relevant parameters of the micromilieu of malignant tumours.
Papillary cystic tumour of the pancreas: findings at computed tomography and ultrasound
Authors: Phillips G. W. L. , Chou S. T. , Mulhauser J.
Published: July 2009

Papillary cystic tumour is a rare pancreatic neoplasm which occurs typically in young females and is of importance because of its good prognosis. We describe the computed tomography (CT) and ultrasound features correlated with pathological findings in a case where the tumour was discovered as an incidental finding.

A previously well 17-year-old female presented with right upper quadrant pain. A clinical diagnosis of cholecystitis was made and an ultrasound examination requested.
Interventional ultrasound
Authors: Holm H. H.
Published: July 2009

During recent years interventional ultrasound has become widely used and has had a great impact on patient management with regard to diagnosis as well as therapy. Many surgical procedures have been replaced by more gentle and less time-consuming “needle therapy” to the benefit of the patient. Since material (in its broadest sense) can be removed from or deposited into the body under ultrasound guidance (for diagnostic and therapeutic purposes), “interventional ultrasound” includes a large number of different procedures. The first puncture transducer, which was based on the simple A-presentation principle, was described by Kratochwill in 1969 (personal communication). A few months later we performed abdominal needle biopsies guided by ultrasonic B-scanning using a “home-made” static scanner. The first punctures guided by dynamic scanning were performed sing a linear array scanner with a puncture attachment (Pedersen, 1977). Today a large number of dedicated puncture transducers exist, as well as puncture attachments for abdominal scanners and transluminal transducers.

The scanner is moved until the target is seen on the monitor, then angled until the target is transected by the electronic puncture-line. A needle inserted through the needle-guiding device will now hit the target. A relatively strong needle tip echo indicates the position of the needle tip on its way to the target. An alternative to this puncture method may be applied: a so-called “free hand” technique without the use of a needle guide.
Lymphography—current role in oncology
Authors: Moskovic E. , Fernando I. , Blake P. , Parsons C.
Published: July 2009

A review of the use of lymphography at this hospital, a major oncology centre, is presented. The advent of computed tomography has brought a dramatic reduction in the number of lymphograms currently performed for diseases such as lymphoma, testicular tumours and gynaecological malignancies. This study analyses the reasons for this decline, and concludes that valuable information can still be obtained from lymphography in certain selected groups of patients.
Intraperitoneal pseudocyst formation as a complication of continuous ambulatory peritoneal dialysis
Authors: Namasivayam J.
Published: July 2009

A patient with an intraperitoneal pseudocyst occurring as a complication of continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure is presented. The diagnosis was made pre-operatively by ultrasound. This has not been previously reported.

A 59-year-old man, with chronic renal failure maintained on CAPD for 1 year, presented with a painful tender mass in the left hypochondrium, which had increased rapidly in size over the previous 2 months. There was an associated history of weight loss, poor appetite and some impairment of ultrafiltration. At no stage did he complain of any bowel symptoms.
Quickscan: Doppler ultrasound emulation of angiography—its value prior to arteriography in peripheral vascular disease
Authors: deSouza N. M. , King D. H. , Pilgrim P. , Bates P. , Reidy J. F. , Gosling R. G.
Published: July 2009

The prevalence of peripheral vascular disease demands a quick, reliable, non-invasive technique for initial assessment. We have devised a new method which combines the two physical principles that (1) Doppler shift is proportional to blood velocity and (2) blood velocity is inversely proportional to arterial cross-section with the ability to track probe position using a noncontacting method. An image of the probe track and any arterial narrowing is shown superimposed on an outline of the patient. Pressure measurement, scan and graphics with final report take about 20 minutes. The accuracy of this system in peripheral vascular disease was evaluated. Thirty-one patients underwent quickscan (QS) and arteriography within an average time of 7 days. Abdominal aorta, common iliac-common femoral, superficial femoral and popliteal artery segments were graded independently as normal, significant stenosis (> 50% of diameter) or occluded by both techniques. Of 197 segments, QS correctly assessed 106 normal, 22 stenosed and 28 occluded segments. Four equivocal angiographic stenoses were normal on QS and three severe stenoses were graded occlusion. Fifteen segments on angiography and five on QS were not assessed. For the iliac and superficial femoral artery segments, sensitivity and specificity averaged 77% and 86%, respectively, for all grades. Aortic statistics were invalid (only one significant lesion). Six out of eight popliteal occlusions were correctly diagnosed by QS, but no popliteal stenoses were detected out of six shown on arteriography. Low numbers may contribute to this discrepancy but an improved popliteal scanning method may be necessary. We find initial QS an invaluable aid to direct percutaneous angiography and to indicate potential sites for angioplasty.
Duplex sonography in splenomegaly
Authors: Jarvis L. , Cook P. G. , James C. M. , Rose M. , Prentice A. G. , Dubbins P. A.
Published: July 2009

The aetiology of splenomegaly is seldom clear from either clinical or imaging assessment of the spleen. In the majority of cases sonographic assessment of the spleen produces a homogeneous enlargement of variable echodensity, but with very poor correlation with pathology. A study has been undertaken to assess the Doppler characteristics of the splenic artery in splenomegaly, excluding cases of portal hypertension in an attempt to provide further diagnostic information. Duplex assessment of 18 normal subjects and 10 patients with splenomegaly due to five different causes was undertaken. Analysis of waveform, peak frequency and pulsatility index were compared and failed to demonstrate any significant change. In the normal subject there is a broad systolic spectrum related to the tortuosity of the splenic artery, with persistence of forward flow throughout diastole, a reflection of the low peripheral resistance of the spleen. In splenomegaly the broad systolic spectrum is unchanged, since vessel tortuosity persists. Pathological and physiological assessment of the spleen in splenomegaly shows that a low resistance circulation persists, explaining maintenance of the diastolic flow pattern in splenomegaly. Increased blood flow to the spleen in splenomegaly occurs either as a result of an increase in vessel diameter or an increase in flow velocity, or a variable combination of the two which does not seem to be governed by specific pathology. An increase in peak frequency in some cases reflected some increase in flow velocity but provided no useful correlation. Analysis of the pulsatility index supported the above findings without adding further information.
The reduction in radiation dose for intra-oral radiographs by the use of thin K-edge filters
Authors: MacDonald-Jankowski D. S. , Lawinski C. P.
Published: July 2009

The aim of this investigation was to reduce the radiation dose to patients undergoing intra-oral dental radiography by using thin K-edge filters in addition to the existing aluminium filter. The subject was a head phantom (a human skull embedded in tissue-equivalent material), which was exposed to X rays over a range of tube voltages (50–90 kVp) for each of the four filter systems. These were 2.7 mm aluminium alone (the existing total filtration) or with added 0.1 mm erbium, 0.1 mm yttrium or 0.05 mm niobium. The radiation dose was measured at four selected sites along the primary beam. These were the entrance skin dose, the exit skin dose and intra-orally both in front and behind the dental film packet. The exposure times and radiation doses required to produce an equivalent density (degree of blackening) on a radiograph of an upper molar tooth were determined. Within the usual diagnostic range of 60–80 kV the use of the thin K-edge filter resulted in a doubling of the exposure time (owing to the additional attenuation of the added filters). However, the skin dose and the total dose imparted to the patient were significantly reduced.
Quantitative assessment of a new dental imaging system
Authors: Walker A. , Homer K. , Czajka J. , Shearer A. C. , Wilson N. H. F.
Published: July 2009

The “Radiovisiography” dental imaging unit (Trophy UK Ltd) is a digital system using an intensifying screen and charge-coupled device in an intra-oral sensor. This paper presents a description of the system and an assessment of the original model in terms of patient dose (relative to film systems), resolution (limiting resolution and modulation transfer function), distortion and image noise (amplitude). The system does offer the possibility of reduced patient exposure and minimal distortion, although resolution and latitude are inferior to standard dental film.
Atypical skeletal tuberculosis mimicking neoplasm
Authors: Abdelwahab Ibrahim Fikry , Kenan Samuel , Hermann George , Lewis Michael , Klein Michael , Rabinowitz Jack G.
Published: July 2009

Although the radiographic features of skeletal tuberculosis are well described, little has been written regarding tuberculous involvement of the shaft of tubular bones. In general, para-articular regions are mainly affected. Only 10% of cases spare the joint, and the majority of these are metaphyseal. Diaphyseal disease is rare and the radiographic features are variable and at times confusing. Pulmonary tuberculosis with subsequent skeletal tuberculosis is being encountered with increasing frequency (DHHS, 1988). Our recent experience with two unusual presentations prompted this report.

Two patients, both women, were diagnosed with focal bone tuberculosis. The lesion involved the left tibia in a 40-year-old woman of Chinese extraction and the pubic ramus in a 46-year-old black woman. Conventional radiography, bone scanning and computed tomography (CT) were performed on both patients. In addition, angiography and magnetic resonance imaging (MRI) were also performed on the second patient. The diagnosis was established in both patients by open biopsy. Paraffin sections were stained with haematoxylin and eosin as well as with acid-fast and fungal stains. Smears were made of the fresh material in each case for both Gram's and acid-fast staining. Some of the fresh material from each case was cultured for organisms, including acid-fast bacilli and fungi. Although the sections did not reveal acid-fast organisms, culture for acid-fast bacilli was positive in the two patients.

Physical examination revealed a woman in severe distress, limping and having difficulty walking. There was swelling with skin erythema over the anteromedial aspect of the middle part of the left leg.
A dense problem
Authors: O'Keeffe D. , Adams J. E.
Published: July 2009

A 30-year-old woman with infertility and endometriosis, who was about to commence ovarian suppression therapy with a gonadotrophin releasing (GnRH) agonist, Nafarelin, was referred for measurement of bone mass by quantitative computed tomography (QCT) as a participant in a research study assessing the effects of GnRH agonists on bone.

The patient was asymptomatic; the only past history of note was an isolated episode of unexplained left loin pain 3 years previously. Investigations performed at that time, including an intravenous urogram, had been reported as normal. Her father was hypertensive.
Authors' reply—Perfomance of a commercially available field flatness device
Authors: Plane J. H.
Published: July 2009

Hermes, a commercially available field flatness device (manufactured by Precitron AB, UK agents Graytech Ltd), has been used to measure the value of field flatness of radiotherpay treatment fields including γ-rays (cobalt 60), X rays (55 kV to 8 MV) and electrons (5 MeV to 14 MeV). A secular variation has been observed over a period of 12 months use. It is postulated that this may be partly attributable to radiation damage.

The device contains 10 P type semiconductor diode detectors, nine of which are strategically placed for the measurement of field flatness and one for measurement of depth dose.
Authors' reply—Choroid plexus cysts and chromosomal defects
Authors: Thorpe-Beeston J. G. , Nicolaides K. H. N.
Published: July 2009

McHugo et al (1991) raise a number of important points. Our study (Thorpe-Beeston et al, 1990) did not attempt to investigate the incidence of choroid plexus cysts, and whilst we too eagerly await the results of prospective trials, the detection of choroid plexus cysts at ultrasonography presents a management dilemma now.
Energy imparted to the patient during fluoroscopy using magnified fields of view
Authors: Kotre C. J. , Marshall N. W. , Faulkner K.
Published: July 2009

Most textbooks on radiological equipment contain the information that the gain of an X-ray image intensifier is proportional to the ratio of the areas of its input and output phosphors, but the practical implications of this in terms of dose to the patient appear to be less well known.

For the normal practice of performing fluoroscopy under automatic dose rate control, when switching to a magnified field of view the dose rate would be expected to increase in inverse proportion to the change in gain of the intensifier if a constant signal-to-noise ratio in the image is to be maintained. At the same time an automatic change in collimation should take place so that the radiation beam size is restricted to cover only the active portion of the intensifier input phosphor (NRPB, 1988).
Book reviews
Authors: Shaw D.
Published: July 2009

Another year, another Year Book. Cynical senescent apathy? No, just the reappearance of a faithful friend. This is the last yearbook of which Dr David Bragg will be Editor in Chief after 8 years of maintaining an excellent, readable and informative review of diagnostic radiology literature.
Book review
Authors: McGann B. M. , Valentine A. R.
Published: July 2009

Intraoperative ultrasound (US) has been available since the early eighties, but increasingly sophisticated equipment and more adventurous interventional techniques have allowed a recent expansion of its applications. This compact, well presented volume is aimed mainly at neurosurgeons and radiologists with little experience of US in theatre, although radiographers performing US will also find it of interest.

The first chapter, written by a radiologist, deals mainly with the physics of US. Whilst not making ideal bedtime reading, a difficult topic is dealt with lucidly and in appropriate detail.
The ocular effects of hyoscine-n-butylbromide (“Buscopan”) in radiological practice
Authors: Sissons G. R. J. , McQueenie A. , Mantle M.
Published: July 2009

“Buscopan” (hyoscine-n-butylbromide, HBB) is a smooth muscle relaxant regularly used in radiological and endoscopic procedures. One unwanted effect is temporary impairment of visual accommodation. Near and distance vision were assessed in 100 patients undergoing barium meal and barium enema studies. Visual testing was performed prior to the examination and repeated immediately before leaving the radiology department. Completed data was obtained in 90 patients. Of these, 37 were given a conventional 20 mg intravenous dose of HBB, 37 were given glucagon and 16 received no drug. No patient showed any impairment of distance vision. Minor abnormalities of near vision were observed in five patients. All had been given HBB. They were aged 50 years or less and had been retested 12–21 min after administration of the drug. It is suggested that the degree of visual impairment observed is not sufficient to impair driving ability. Routine questioning concerning history of glaucoma is unlikely to be of value; more appropriate would be a warning to seek urgent medical advice if eye pain or visual loss is experienced.
Anaphylactoid reaction associated with the use of 99Tcm hexamethyl propylene amine oxime as a leukocyte labelling agent
Authors: Giaffer M. H. , Tindale W. B. , Senior S. , Holdsworth C. D.
Published: July 2009

99Tcm-HMPAO-labelled leukocyte bowel scanning is being increasingly used in the assessment of disease extent and activity in patients with inflammatory bowel disease, particularly Crohn's disease, when clinical and laboratory indices of activity can be unreliable. Initial experience with this compound has shown that it is safe. No reported adverse reactions have been associated with its use in white cell studies. This case report describes an anaphylactoid reaction related to the use of this new granulocyte labelling tracer.
Laurence–Moon–Biedl syndrome: renal ultrasound appearances in the neonate
Authors: Garber S. J. , de Bruyn R.
Published: July 2009

Renal disease is now considered one of the cardinal features of the Laurence–Moon–Biedl syndrome (LMBS). The most commonly described radiographic changes are calyceal distortion with cortical and medullary cysts on intravenous urography (IVU). We present two cases of LMBS who, on ultrasound (US) imaging in the neonatal period, had enlarged hyperechoic kidneys indistinguishable from autosomal recessive polycystic kidneys (ARPK). To our knowledge only one such case has previously been reported in the literature (Ritchie et al, 1988).
A clinical red herring
Authors: Murch C. R. , Taylor A. J. Newman
Published: July 2009

A previously healthy 16-year-old school boy was admitted to hospital with a 4-month history of increasing shortness of breath, which had followed a sore throat. Two months later, he was short of breath after climbing stairs and hills, and was unable to participate in sports. He had no previous medical history other than migrainous headaches. Both of his parents had had sarcoidosis, although neither had received treatment.