bluuebunny/crossref_metadata_2025 huggingface dataset:
Maxillofacial biomodelling—preliminary result
Authors: Yau Y Y , Arvier J F , Barker T M
Published: July 2009

A new technique of manufacturing three-dimensional (3D) hard tissue biomodels is described. The models, derived from computed tomography data, were constructed by a computer-controlled manufacturing device known as stereolithography apparatus (SLA). Selected cases of patients with facial deformities were presented to illustrate clinical applications of the SLA biomodelling. Physical demonstration of the bony internal anatomy in these patients promoted better conceptualization of the disease process, allowing optimal input into the management decision, pre-operative planning and choice of surgical technique with a consequent reduction in operating time and potential reduction in peri-operative morbidity. Limitations of the solid modelling technique include cost, a lengthy production time which renders it unsuitable for emergency cases, and radiation exposure of the patient. With wider use and further technological development, these drawbacks will be minimized. The 3D SLA biomodels may in future become an adjunct, not only to maxillofacial surgery, but also to other medical specialities.
Comparison of light reflection rheography with ascending venography in the diagnosis of lower limb deep venous thrombosis
Authors: Abbott G T , Diggory R T , Harris I
Published: July 2009

A prospective evaluation of light reflective rheography (LRR) in the diagnosis of acute lower limb deep venous thrombosis (DVT) has been conducted by the comparison of rheographic changes with ascending venography. LRR reliably predicts the absence of DVT, but cannot accurately detect its presence. It is suggested that the technique may be used for surveillance but should not replace venography as a method for establishing the diagnosis of DVT.
Comparisons between three dual-energy X-ray absorptiometers used for measuring spine and femur
Authors: Tothill P , Fenner J A K , Reid D M
Published: July 2009

Lunar, Hologic and Norland dual-energy X-ray absorptiometry scanners have been compared for measurements of spine and femur bone density. Precision was not greatly different in realistic phantoms and volunteer subjects. Most clinical therapeutic trials are concerned with measuring changes of bone mineral, and interchangeability in this context was examined using phantoms of spine and femur in which changes of bone mineral density (BMD) were simulated. With each instrument the measured changes were closely linear. For the spine the biggest difference of slope between instruments was 15%. For the femur, in all areas of interest, the differences of slope were less than 10%. It is concluded that the three instruments can be satisfactorily used in multicentre clinical trials to investigate changes in bone mineral. 12 volunteers were measured with each scanner. There were significant mean differences between each pair of instruments, suggesting different calibration criteria. More importantly, those mean differences had appreciable standard deviations (SDs), in proportional terms from 3% to 10%. When the measurements were related to reference ranges and expressed in terms of age-matched normal values the mean biases disappeared, but the SDs did not improve. Results from different manufacturers' apparatus are not interchangeable for studying individual patients. Measurements from the phantoms were used to cross-calibrate the scanners. Those from the variable spine phantom predicted the in vivo ratio within 4%, but this was no better than measurements of the unmodified phantom alone. Results using the European Spine Phantom were less satisfactory. No phantom provided an adequate cross-calibration for femur measurements.
Magnetic resonance imaging in patients with penile carcinoma
Authors: de Kerviler E , Ollier P , Desgrandchamps F , Zagdanski A M , Attal P , Teillac P , Frija J , Le Duc A , Laval-Jeantet M
Published: July 2009

The aim of the study was to determine the role of pre-operative magnetic resonance imaging (MRI), with and without contrast enhancement, in patients with penile carcinoma. Nine patients with a penile cancer were studied. The staging of the tumours was performed by clinical examination, MRI and surgery, according to the TNM classification. Six patients had primary tumours, of clinical stage Tl (n= 1) and T2 (n= 5). Three other patients had been previously treated and presented with a local recurrence of clinical stage T2. Surfacecoil MRI was performed at 0.5 T with T  1 weighted sequences before and after gadolinium-DOTA, and T  2 weighted sequences. MRI results were compared with the clinical and surgical findings. T  1 weighted sequences did not clearly demonstrate the margins of the tumours. T  2 weighted sequences were the more useful in five patients, whereas contrast enhanced T  1 weighted sequences allowed better delineation of the lesions in only three patients. Therefore, an imaging protocol should include spin echo T  2 weighted sequences. Clinical examination correctly staged six of nine tumours; MRI, seven of nine tumours and the combination of both examinations, eight of nine tumours. MRI provided good evaluation of tumoral invasion into the penile shaft.
A randomized, double-blind, parallel group trial of iomeprol, iohexol and iopamidol in intravenous urography
Authors: Harding J R , Bertazzoli M , Spinazzi A
Published: July 2009

The aim of this study was to compare the safety, tolerance, and diagnostic efficacy of iomeprol 350 mg I ml−1, iohexol 350 mg I ml−1, and iopamidol 370 mg I ml−1 in 90 adult patients undergoing intravenous urography. Radiographs obtained 5, 10 and 15 min after contrast injection were blindly graded for quality on a four point scale as: 0, non-diagnostic; 1, diagnostic but of limited quality; 2, diagnostic and of good quality; 3, fully diagnostic and of very good quality. The sum of these scores indicated the overall diagnostic quality (0–4, non-diagnostic; 4–8, diagnostic; 9–12, good or excellent). Contrast tolerability was evaluated by discomfort (heat or pain) associated with injection of the test compounds, and patients were monitored and questioned for adverse experiences. The quality of the individual radiographs was assessed as diagnostic and good or fully diagnostic and very good in most cases, with no significant differences between the three study groups, and overall scores were predominantly good or excellent (p = 0.55). All adverse reactions were transient and non-serious, and most of them were reported as mild in intensity. There were no significant differences between the three groups for heat sensation (p = 0.29). Pain at the injection site was reported only in the iohexol group (p = 0.104). It is concluded that iomeprol 350 mg I ml−1 is at least as safe and effective as iohexol 350 mg I ml−1 or iopamidol 370 mg I ml−1 when used for intravenous urography.
Ultrasound guided aspiration of symptomatic supraspinatus calcific deposits
Authors: Bradley M , Bhamra M S , Robson M J
Published: July 2009

11 consecutive patients with shoulder pain were referred from the shoulder clinic for plain radiography. Supraspinatus calcific deposits were suspected after other causes of shoulder pain had been eliminated by clinical examination and local anaesthetic tests. Radiographs confirmed calcific deposits in all 11 shoulders and all deposits were shown by ultrasound to be lying in the supraspinatus tendon. Using a free-hand ultrasound guidance technique, a 19 G needle was passed percutaneously into all 11 shoulders in an attempt to aspirate the deposit. Six patients experienced immediate pain relief or relief on the same day, whilst four others were pain free at the 2 weeks follow-up clinic. One patient who was thought to have a co-existing supraspinatus tear diagnosed by the scan was symptomatically unchanged.
Brain metastases from papillary carcinoma thyroid
Authors: Jyothirmayi R , Edison J , Nayar P P , Nair M K , Rajan B
Published: July 2009

Papillary carcinoma, the commonest thyroid malignancy, has a good prognosis and low incidence of distant metastases. Brain metastasis is extremely rare with a frequency of 0.1–5% in reported series. The clinical details of two cases of histologically proven brain metastases from papillary thyroid cancer treated in our centre are presented. In one patient, the lesion was in the cerebellar hemisphere, and in the other, the frontal lobe. Also presented is a review of the literature of this unusual clinical presentation.
Intrinsic radiosensitivity as a predictor of patient response to radiotherapy
Authors: West C M L
Published: July 2009

This article reviews the available literature on intrinsic radiosensitivity as a predictor of patient response to radiotherapy. Results have been summarised for tumour, fibroblast and lymphocyte radiosensitivity where results have been correlated with clinical data. Suggestions are made for the possible way forward in this area of radiobiology.
Interval cancers in the National Health Service Breast Screening Programme
Authors: Johnson A E , Shekhdar J
Published: July 2009

The National Health Service (NHS) Breast Screening Programme defines objectives with acceptable and, where possible, achievable standards. This paper examines the problem of interval cancers. Slopes due to shrinkage of primary breast cancers in response to primary systemic therapy are used as surrogates for growth slopes. From the distribution of these slopes the proportion of tumours which might reach particular sizes in any time interval may be estimated. For specific differences in size between screen and clinical detection levels the number of interval cancers which could appear in 1, 2 and 3 years after screening is estimated. The justification for these predictions is evaluated. The literature in relation to growth is reviewed; we add three growth slopes from our own measurements. The range of volume doubling times and volume halving times is the same whereas the mean value derived from the literature is about 90 days in contrast to only 26 days for inferred growth rates. Because of the difficulties inherent in the measurement of growth, it is concluded that the literature defines the left half of a distribution; the right hand side is completed by shrinkage data. The observed rates for interval cancers from different sources vary widely; there is an underlying assumption that interval cancers are an index of failure. These calculations suggest that there is an irreducible minimum of interval cancers, which will depend upon the screening interval and the size at which tumours are detected. The interval cancers will contain more poorly differentiated tumours. The anticipated achievable standards appear to be over optimistic.
Ultrasonographic assessment of bone in normal Italian males and females
Authors: Cepollaro C , Agnusdei D , Gonnelli S , Martini G , Pondrelli C , Borracelli D , Palmieri R , Parisi G , Gennari C
Published: July 2009

Recently ultrasound techniques have been proposed to evaluate skeletal status. Speed of sound and attenuation through the bone are the ultrasound properties currently used to assess bone strength and fragility. The speed of sound in ms−1 (SOS), broadband ultrasound attenuation in dB MHz−1 (BUA) and stiffness (S) in 134 healthy females (age range 10–90 years) and in 100 healthy males (age range 10–93 years) was measured using the Achilles scanner (Lunar Corp., Madison, WI, USA). A polynomial function was applied to the observed data to evaluate a pattern of age-related BUA, SOS and S changes. Peak values of SOS, BUA and S were reached in both sexes at the age of 30 years. Average decreases of 12.9% in BUA, 4.9% in SOS and 28.9% in S were found in men aged between 30 and 90 years. In women average decreases of 17.2% in BUA, 4.2% in SOS and 31.9% in S were discovered in those aged between 30 and 90 years. The analysis of SOS, BUA and S changes between pre- and post-menopausal women revealed a significant decrease of these parameters with years since menopause. These data indicate an age-related decrease of ultrasound signals in both sexes. Furthermore, this technique is able to detect, in females, menopause related changes due to oestrogen failure. In contrast, in males, the age-related loss of ultrasound signals appears to be more linear.
Proximal tibial stress lines—appearances on magnetic resonance imaging of the knee
Authors: Hacking J C , Mackenzie R , Dixon A K
Published: July 2009

Trabecular lines through the proximal tibia in line with the direction of the anterior cruciate ligament are visible in around two-thirds of standard knee magnetic resonance imaging (MRI) examinations. We describe their appearances and postulate that these lines may develop in response to stresses transmitted via the anterior cruciate ligament (ACL).
Magnetic resonance characteristics of intrapelvic haematomas
Authors: Yamashita Y , Hatanaka Y , Torashima M , Takahashi M
Published: July 2009

Although haematomas in the female pelvis are not rare, their magnetic resonance (MR) appearance has not been well characterized. Accordingly, we analysed the MR appearances of various stages of haematomas in the female pelvis. A retrospective analysis of 35 haematomas in 28 patients sequentially imaged with a 1.5 TMR unit was performed. The time interval between the insult and MR imaging was determined and the appearances of the haematoma were evaluated. The results were compared with those in the central nervous system. The evolution of haematomas in the pelvis appeared similar to that of haematomas in the brain, and four stages (acute, early subacute, late subacute and chronic) were identified according to the signal intensity pattern on T  1 and T  2 weighted images. Pelvic haematomas differed from intracranial haematomas in the following features: (1) The speed of evolving pelvic haematomas was gradual. (2) In the centre of acute haematomas, slightly hyperintense areas were seen on both sequences, suggesting residual oxyhaemoglobin.(3) Haematomas evaluated in the early subacute stage had complex appearances. (4) In older haematomas, central intermediate signal intensity areas, presumably due to diamagnetic hemichromes, became predominanton T  1 weighted images. In conclusion, although the evolution of a pelvic haematoma is similar to that of a brain haematoma, its speed is gradual and MR appearances are somewhat different due to environmental differences.
In vivo induction of apoptosis in human lymphocytes by therapeutic fractionated total body irradiation
Authors: Delic J , Magdelénat H , Barbaroux C , Chaillet M-P , Dubray B , Gluckman E , Fourquet A , Girinsky T , Cosset J-M
Published: July 2009

Ionizing radiations have been reported as an in vitro apoptosis initiating stimulus in human lymphocytes. As the cytotoxicity of ionizing radiations and chemotherapeutic agents appears to be dependent on the efficacy of cell death induction, the manipulation of apoptosis initiation might be used as a means to supress some pathological process. In the present study the in vivo induction of γ-ray mediated programmed cell death in humans is reported. The in vivo induction of apoptosis in peripheral blood lymphocytes (PBL) by ionizing radiations was investigated in 33 patients after each of two sessions (2 Gy and 4 Gy) of fractionated total body irradiation (FTBI) as part of their conditioning regimen before bone marrow transplantation. PBL committed to apoptosis were scored before irradiation (SI), 4 h (S2) and 24 h after 2 Gy (S3, 14–17 h after the second 2 Gy fraction). Nuclear morphology and chromatin-DNA were analysed by fluorescence microscopy immediately after blood sample withdrawal (I) and after 24 h in cell culture medium (II). When scored immediately after withdrawal, no circulating PBL with the apoptotic nuclear morphology were observed in S1 and S2 blood samples whereas S3 disclosed 21.9±11.7% of circulating lymphocytes with an apoptotic nuclear morphology. After 24 h in culture, S1 samples (before irradiation) generally contained less than 20% of apoptotic lymphocytes. A higher percentage of apoptotic cells was noted in some cases in relation with recent chemotherapy and possibly with pathology. After 24 h in culture, S2 and S3 samples contained 51.7±17.9% and 60.4±16.4% of apoptotic lymphocytes, respectively. These results confirm that ionizing radiations induce apoptosis in vivo in human lymphocytes and that the commitment to apoptosis can be determined after low doses (2 Gy) of therapeutic whole body irradiation. The results suggest that susceptibility to apoptosis induction by ionizing radiations could be related to previous therapy by cytotoxic drugs and possibly to the type of haematological malignancy.
A linear modelling approach to automatic interpretation of quality control measurements in mammography
Authors: Kotre C J
Published: July 2009

An approach to the automated interpretation of quality control data is described in which the relationship between small changes in system performance and the resulting small changes in the measured quality control test results are approximated as a set of linear equations in matrix form. The inverse of this forward matrix is then used to identify causal changes from the set of measured changes. This approach has been investigated for the case of mammographic screening quality assurance and shown to provide a potentially useful tool to assist in the interpretation task.
How reliable are ultrasound measurements of renal length in adults?
Authors: Ablett M J , Coulthard A , Lee R E J , Richardson D L , Bellas T , Owen J P , Keir M J , Butler T J
Published: July 2009

Ultrasound assessment of patients with renal impairment commonly includes measurement of bipolar renal length. Reduction in length is considered to indicate chronic renal disease and is a factor in deciding whether to proceed to renal biopsy. To date, no published data are available on interobserver and intraobserver variation in sonographic renal length measurement in adults. Bilateral renal lengths were measured in 20 adult subjects, with no history of renal disease, by three experienced operators, on two separate occasions. Limits of agreement for replicate measurements by each ultrasonographer and for replicate measurements by each pair of ultrasonographers were determined. Values of repeatability (a measure of intraobserver variation) and reproducibility (a measure of interobserver variation) were calculated for all renal length measurements, and for right and left renal lengths separately. Results indicate that replicate renal length measurements differ by less than 1.85 cm in 95% of cases, and the magnitude of variations is similar when measurements are made by either single or different ultrasonographers, and are similar for right and left renal length measurements. This suggests that sonographic bipolar renal length measurements in normal adult kidneys are reasonably reliable. In diseased kidneys, however, in which identification of renal poles is difficult, interobserver and intraobserver variation may be much greater.
An assessment of the intrauterine sound intensity level during obstetric echo-planar magnetic resonance imaging
Authors: Glover P , Hykin J , Gowland P , Wright J , Johnson I , Mansfield P
Published: July 2009

In order to assess the sound level experienced by the fetal ear during obstetric magnetic resonance imaging, a fluid filled stomach was used as an experimental model of the gravid uterus. A better than 30 dB attenuation in intensity was recorded across the frequency band of interest for all patient orientations. This was enough to reduce acoustic sound pressure from a level close to the instantaneous damage threshold (120dB), to an acceptable level (<90dB). Direct mechanical coupling through the patient table was also shown to increase uterine sound pressure levels by as much as 10 dB. Much higher peak pressures could be obtained by tapping of abdomen with the fingers.
Dynamic analysis of the pharynx during swallowing using Turbo-FLASH magnetic resonance imaging combined with an oral positive contrast agent—a preliminary study
Authors: Suto Y , Kamba M , Kato T
Published: July 2009

Serial images of the swallowing motions of 10 healthy volunteers were taken using the Turbo-fast low angle shot (FLASH) magnetic resonance (MR) imaging sequence, while the subject swallowed an oral contrast agent containing ferric ammonium citrate. In all cases, the flow of the contrast agent and the motion of the organs in the oral cavity and the pharynx during swallowing could be observed. High-speed MR imaging combined with an oral positive contrast agent has the potential to evaluate accurately swallowing motion.
Fibromatosis of the breast in a male patient
Authors: Burrell H C , Sibbering D M , Wilson A R M
Published: July 2009

Fibromatosis of the breast is an uncommon disease, although several series of this condition in females have been reported in the literature. We present the first case to be described in a male patient.
Breast parenchymal patterns and their changes with age
Authors: van Gils C H , Otten J D M , Verbeek A L M , Hendriks J
Published: July 2009

In studies on mass screening, it has often been reported that tumours in breasts with dense parenchyma are difficult to detect and may have a more advanced stage at diagnosis. Shorter rescreening intervals have been suggested for these women but, before recommending such a strategy, it is important to investigate how often dense breast parenchyma (P2 and DY patterns according to Wolfe) is actually present in a screening population and to what extent these patterns change with age. The prevalence of dense breast parenchyma (P2 and DY) in our study population was 33% at first examination (n = 2581), which is fairly low compared with other screening populations. Its presence was strongly, inversely age-dependent. Breast patterns of 1177 women, aged 35–85 years, were followed for 12 years. In 39% (182/461) of the women with a P2 or DY pattern at their first examination, regression to a lucent pattern (N1 and P1) occurred over the years. The majority of these women were assumed to have reached menopause in the follow-up period. These findings support the hypothesis that the presence of dense breast parenchyma is related to the reproductive period and indicate that shortening the rescreening intervals would be most effective in pre-menopausal age groups.
Follow-up of spongiosa plugs with contrast enhanced magnetic resonance imaging
Authors: Kramer J , Schiller C , Lang S , Frodl J , Hornberger C , Andrea K , Steiner E , Imhof H
Published: July 2009

The aim of this study was to evaluate the extent and duration of the revascularization process in spongiosa plugs when a fibrin sealant was used. 20 patients with tumour-like lesions, benign tumours and tumours with a potential for malignant transformation were studied. After intralesional tumour removal, the defect was filled with homologous spongiosa either combined with or without a fibrin sealant, according to a prospective randomization. Magnetic resonance imaging (MRI) follow-up examinations were performed within 1 week, and 1.5, 3, 4.5, 6, 8, 12, 24 and 36 months after surgery. Those patients without a fibrin sealant showed an increased revascularization zone up to the sixth week. Patients treated with fibrin, however, showed increased revascularization up to 3 months. In the 25% percentile the extent as well as the rate of revascularization is higher in those with a fibrin sealant. It is of clinical relevance that no revascularization should be expected at 3 months after surgery, which is easily demonstrated by MR follow-up.
Identification of a hypoperfused segment in bull's-eye myocardial perfusion images using a feed forward neural network
Authors: Hamilton D , Riley P J , Miola U J , Amro A A
Published: July 2009

Artificial neural networks are computer systems which can be trained to recognize similarities in patterns and which learn by example; one of the more straightforward types being the feed forward neural network (FFNN). We previously reported the use of FFNNs for classification of hypoperfusion patterns in bull's-eye representation of 201T1 single photon emission tomography myocardial perfusion studies and showed that, when such an image was divided into 24 segments, FFNNs could detect perfusion defects without direct comparison to a normal data base. This has been extended in this investigation to assess the ability of an FFNN, trained on data in which only a single segment was hypoperfused, to detect this abnormal segment when the hypoperfusion pattern of the other segments in the image varied. The results indicated that the network could reliably determine whether a segment was normally or under perfused, with accuracies of 99% and 100%, respectively, if all other segments were normally perfused. It could also reliably detect a normally perfused segment, even if other segments were hypoperfused, with accuracies of 95% and 98%. The network was less reliable, however, in detecting a hypoperfused segment when other segments were also hypoperfused, showing accuracies of only 74% and 88%.
Patient dose values in interventional radiology
Authors: Vañó E , González L , Fernández J M , Guibelalde E
Published: July 2009

Large exposures incurred in interventional radiology procedures make it advisable to establish reference dose values. These dose values should be quoted in quantities representative of the radiological risk to the patient. In Spain, measurement methods were developed to comply with the European Directive on Patient Protection. Dose-area product and, when feasible, surface dose using thermoluminescent dosimetry chips were measured. Both approaches are discussed, as well as their potential use in patient protection programmes. Initial results are presented for a sample of 680 patients in 10 hospital centres in Spain. Mean, median and range are reported for some specific procedures. Mean values of 8750, 6651, 6663, 9292 and 6816 cGy cm2 are reported for percutaneous transluminal coronary angioplasty, coronary angiography, low extremity, renal and cerebral arteriographies, respectively.
Oroantral fistula: improved imaging with a dental computed tomography software program
Authors: Bodner L , Gatot A , Bar-Ziv J
Published: July 2009

Oroantral fistula (OAF) is an uncommon complication in oral surgery. About 5% of all extractions of maxillary premolars or molars may result in communication to the antrum. Small fistulae, 1–5 mm in diameter may close spontaneously, but larger fistulae usually require surgical closure. Pre-operative determination of the size of the fistula is often unreliable leading to difficulties in planning subsequent clinical management. We report a method for the precise determination of the size of the OAF using a dental computed tomography (CT) software program.
Book reviews
Authors: Shrimpton P C
Published: July 2009

This substantial yet interim publication represents the near culmination of unprecedented international efforts towards the harmonization of standards in radiation protection and safety, based primarily on the 1990 recommendations of the International Commission on Radiological Protection. The purpose of such Standards is to establish the basic requirements to be fulfilled in all activities involving radiation exposure and the essential elements necessary for an effective radiation protection programme.
An audit of film reject and repeat rates in a department of dental radiology
Authors: Nixon P P , Thorogood J , Holloway J , Smith N J D
Published: July 2009

A study of film reject and repeat rates was undertaken in the Department of Dental Radiology of King's College School of Medicine and Dentistry over a 6 month period. The aim of the study was to assess the effects of changes implemented after a previous audit, and to carry out a more detailed analysis of the factors influencing the reject and repeat rates using a larger volume of data. The information recorded included the equipment and projection used, and the age of the patient if under 16 years. The overall reject rate was 3.06%, 1.84% less than recorded in the earlier study, and the repeat rate was 0.93%. Positioning errors were the most frequent cause for rejection. Significant differences in reject rates were noted between different projections, and also between qualified staff and those in training. The rejection rate for patients under 16 years was not significantly higher than for patients over 16 years, the most frequent cause of rejection was still positioning faults, but patient movement accounted for a larger proportion of the rejects than was the case in adult patients. The results demonstrate the role of audit in isolating factors leading to additional exposures. The effectiveness of changes implemented following a reject film analysis is also shown.
Management of congenital angiodysplasia of the lower limb: magnetic resonance imaging and angiography versus conventional angiography
Authors: Huch R A , Brunner U , Bollinger A , Debatin J F , Hauser M , Krestin G P
Published: July 2009

The purpose of the study was to compare magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) with conventional angiography in distinguishing congenital angiodysplasia amenable to radical cure from that in which only palliation is feasible and to design a rational pre-operative work-up in those patients undergoing an interventional procedure. Axial 71,T2 weighted spin-echo and contrast-enhanced 3D SPGR sequences were performed in 13 patients with angiodysplasia, followed by time-of-flight MRA. The results were compared with conventional arteriography and venography. Dysplasia was arteriovenous with microshunts in nine cases and purely venous in the remaining four. MRI was the best method for assessing the extent of malformation and involvement of anatomical structures. MR arteriography and MR venography were inferior to conventional techniques. It is concluded that MRI is valuable in distinguishing patients amenable to radical cure from those in whom only palliation is feasible. Pre-operatively, conventional arteriography and venography remain mandatory.
Image quality and dose in lumbar spine examinations: results of a 5 year quality control programme following the European quality criteria trial
Authors: Vañó E , Oliete S , González L , Guibelalde E , Velasco A , Fernández J M
Published: July 2009

The large dose values found for lumbar spine examinations in a centre participating in the European quality criteria trial have been investigated within a 5 year quality control programme. Actions focused mainly on optimizing the focus-to-film distance, tube potential (kV), film optical density and X-ray beam filtration. These actions lead to overall dose reductions of up to 75% in lumbo-sacral joint examinations and prove the need for a regular survey of patient skin doses.
Evaluation of the European image quality criteria for chest examinations
Authors: Vañó E , Guibelalde E , Morillo A , Alvarez-Pedrosa C S , Fernández J M
Published: July 2009

The European Commission has published guidelines for image quality, radiographic technique and patient dose. These could be easily checked by staff either during the examination or when reporting the resulting radiographs. The objective was to achieve comparable image quality throughout Europe using optimum techniques. This paper presents an application of the image criteria for chest examinations. The application of criteria to a large number of films helps to correlate scoring films using this method with other alternatives such as the evaluation of physical parameters using phantoms or test objects. The advantages and limitations of the image quality list of criteria are discussed. As a result of its application, some modifications of image quality criteria, based upon simple essential indicators (minimizing the number of criteria) are formulated and presented.
The value of the second view in screening mammography
Authors: Warren R M L , Duffy S W , Bashir S
Published: July 2009

A prospective study of 33 734 women was undertaken during the prevalent round of the UK National Breast Screening Programme. The cancer detection rates and recall rates were compared between a one view and a two view technique. In one fifth of the women, only the single oblique view examination was read. To lose the bias that would have been introduced by the prior knowledge that a second view would be available, the radiologists reading the oblique view did not know whether or not a craniocaudal view would subsequently be available. Readings were available from two radiologists in each case. The cancer detection rate increased from 7.6 per thousand to 8.2 per thousand women screened, with 14 more cancers detected with the two view technique. This represents 6.5% of all screen detected cancers (95% CI 3.2–9.8). The recall rate was reduced from 8.8% to 6.6% by the second view (p<0.001). There was a significantly higher biopsy rate in the two view group (10.6/1000 versus 8.6/1000) (p=0.004). This higher biopsy rate is part of the price paid for the higher detection rate. The additional tumours included small invasive cancers. The National Health Service (NHS) cost of each additional cancer diagnosed was £4129 and the NHS plus private cost was £2742. These findings have practical applications for the National Breast Screening Programme. There would be resource implications on routinely applying two view screening to the prevalent round, but even greater costs if applied to the incident screening round.
Accuracy of maximum velocity estimates made using Doppler ultrasound systems
Authors: Hoskins P R
Published: July 2009

This study was performed in order to provide quantitative data on the estimation of maximum velocity made using modern Doppler ultrasound systems. This is important since the degree of stenosis within arteries is commonly assessed from the maximum velocity. A string phantom was used as the source of Doppler signals. This enables direct comparison between the Doppler estimated maximum velocity and the true filament velocity. Six modern commercial Doppler systems were used. Measurements were made under standard conditions for each probe. In addition a number of factors were varied in turn (beam–filament angle, filament depth, filament velocity and Doppler aperture position). Under standard conditions the maximum velocity was overestimated in all cases (0–29% error). For all measurements maximum velocity errors ranged from –4% to 47% There was a large intraprobe variation in maximum velocity estimation (mean variation of 25%), and a large interprobe variation (mean variation of 18%). These results indicate that, at present, errors in maximum velocity estimation may be directly translated into significant errors in the estimate of the degree of arterial stenosis made from velocity measurements. As a consequence, some patients may be incorrectly categorized. Consideration should be given to applying angle dependent correction factors to maximum velocity measurements, and to the use of conversion from Doppler frequency shift to velocity using the angle derived from the edge of the Doppler aperture.
Tunnelled central venous catheter insertion via the internal jugular vein using a dedicated portable ultrasound device
Authors: Downie A C , Reidy J F , Adam A N
Published: July 2009

We describe the use of a purpose-built portable ultrasound device to assist puncture of the internal jugular vein during percutaneous insertion of tunnelled central venous catheters such as Hickman lines. In many situations the internal jugular route is safer, faster and less costly in comparison with the subclavian approach. The use of ultrasound allows an accurate initial venous puncture with fewer complications, in the hands of both experienced operators and those less familiar with the internal jugular vein approach.
Radiological assessment of a new bone densitometer—the Lunar EXPERT
Authors: Njeh C F , Apple K , Temperton D H , Boivin C M
Published: July 2009

Dual energy X-ray absorptiometry (DXA) is one of the most widely used techniques in the management of osteoporosis and other skeletal diseases. Although patient doses from DXA are generally low, it is still necessary to measure them to assess the risk of radiation injury. We report on a study to estimate the effective dose (ED) to patients and staff from a new DXA scanner—the Lunar EXPERT, and make a comparison with a similar study carried out on a Lunar DPX-L. The entrance surface doses were measured to be 895 μGy and 10.25 μGy for the EXPERT and DPX-L, respectively. The EXPERT maximum EDs were calculated to be 74.7 μSv and 44.9 μSv for the anteropostenor (AP) lumbar spine and the proximal femur, respectively. More than 50% reduction in ED could be achieved by using a smaller scanning width. The maximum EDs for the DPX-L were calculated to be 0.21 μSv and 0.15 μSv for the AP lumbar spine and the proximal femur, respectively. The scattered dose rates (ambient dose equivalent) were measured to be less than 2 and less than 1 μSv h–1 at 50 cm and 100 cm, respectively, for the DPX-L, and the equivalent values for the EXPERT were 240 and 64 μSv h–1. Although both the patient dose and scattered dose rates are quite low relative to other radiological examinations, good practice aimed at dose reduction should still be implemented. Whilst protection for the operator is not needed for the DPX-L system, it may be (depending on the size of the room) for the EXPERT system.
Calcified leg
Authors: Flinn J , Beggs I
Published: July 2009

A 74-year-old man presented with a feeling of heaviness in his right leg on walking. He had fractured his right tibia 50 years previously, sustaining severe neurovascular damage. Subsequently, he had required sympathectomy for trophic ulcer, tenotomies and toe fusion. He needed an orthopaedic boot to compensate for his shortened leg. There was no other relevant history and the patient was otherwise well.
Intracranial arterial calcification and ectasia in visual failure
Authors: Savy L E , Moseley I F
Published: July 2009

Calcification of the major intracranial arteries is frequently observed on computed tomography (CT), particularly in the carotid siphon, and has been implicated as a causative factor in low tension glaucoma. Ectasia of the carotid siphon has also been postulated as a possible cause of compressive optic neuropathy. 153 patients, in whom high resolution CT of the orbits and parasellar region had been performed for suspected anterior visual pathway pathology, were retrospectively reviewed The presence and severity of calcification and ectasia of the major intracranial arteries was recorded. There was a high occurence of carotid siphon calcification, increasing with age, and independent of sex or race. Calcification was very rare in anterior cerebral, middle cerebral and basilar arteries in all age groups The amount and degree of ectasia also increased with advancing age, and was more frequently observed in carotid and basilar than anterior and middle cerebral arteries. There was no correlation between the degree of calcification or ectasia and ophthalmological or neurological deficit.
Application of the principle of optical phase-contrast microscopy to velocity phase-encoded MRI of blood flow in the aorta
Authors: Dymond R C , Redpath T W , McKiddie F I
Published: July 2009

A new method of presenting magnetic resonance phase information is described and an example of its application given in the context of velocity phase-encoded MRI of blood flow in the aorta. The method takes as its starting point Zernike's technique of phase contrast microscopy. It exploits the parallel between the transform plane in Fourier optics and k-space in MRI. In the example described two datasets are acquired, one with and the other without velocity encoding, as in conventional phase-encoded velocity imaging. A dataset is formed which is corrected for unwanted phase variations caused by static field inhomogeneity. The method then effectively combines phase and magnitude information into a single image. The technique is complementary to existing methods of displaying phase information.
The changing world of radiography education
Authors: Sluming V
Published: July 2009

Over recent years, radiography education has undergone enormous change — newly qualified radiographers now emerge as graduates awarded Bachelor's degrees by a university. The impetus for this change was a recognition by the College of Radiographers that “the DCR model imposes a didactic, authoritarian and inflexible model on Schools, and an assessment and evaluation procedure which is theoretical and knowledge based and remote from clinical practice. The model is out of step with informed educational and vocational training practice” [3]. The responsibility for curriculum design was handed over to the radiography education establishments, now free to determine both delivery methods and content. Consequently, the “university” experience that current students participate in should be quite different from the “school” (of radiography) experience of the past, and will continue to evolve. The variation between experience afforded by different degree-awarding courses has yet to be identified. This article discusses some of the differences associated with the “university” experience, and possible future developments.
Occupational dose to the radiographer in dual X-ray absorptiometry: a comparison of pencil-beam and fan-beam systems
Authors: Patel R , Blake G M , Batchelor S , Fogelman I
Published: July 2009

The introduction of advanced dual X-ray absorptiometry (DXA) scanners with fan-beam geometry, improved image definition and faster scan times raises the question as to whether there is a significant radiation dose to the radiographer. We have measured the radiation dose to the operator from studies performed on four DXA systems; the Lunar DPX. Hologic QDR-1000, QDR-2000plus and QDR-4500. The results were compared with the radiographer dose from 99Tcm-MDP radionuclide bone scanning, where it is not usual to use a radiation barrier between the patient and the operator, and 18F-FDG positron emission tomography (PET) scanning where it is usual to protect staff. Ambient dose equivalent rate averaged over 1 h at 1 m from the patient with the DXA systems working at maximum patient throughput were 0.012, 0.12, 2.1 and 2.4 μSv h−1, respectively, for the DPX, QDR-1000, QDR-2000plus and QDR-4500. Annual operator dose for the DPX and QDR-1000 was well below the 1 mSv limit for members of the public recommended by the International Commission on Radiological Protection (ICRP) (1990). Results for the QDR-2000plus and QDR-4500 were similar to a radionuclide bone scan (2.2 μSv h−1), but smaller than for a PET scan (8.9 μSv h−1), and were close to the 5 mSv year−1 limit for a supervised area defined in the 1985 Ionising Radiation Regulations. Precautions to reduce radiographer dose with fan beam DXA include placing the operator at least 2 m from the patient, scanning the right hip instead of the left and using scan modes with short scanning times.
Incidence and possible aetiological factors in the development of pelvic insufficiency fractures following radical radiotherapy
Authors: Bliss P , Parsons C A , Blake P R
Published: July 2009

Five patients out of a total of 183 treated with radical radiotherapy for carcinoma of cervix at The Royal Marsden Hospital from 1991 to 1994 inclusive have developed severe pelvic fractures. Two patients had rheumatoid arthritis, one of whom died as a result of the radiation induced damage. This patient developed radiological evidence of radionecrosis within 1 month of completing radiotherapy. There are very few reports in the literature of such a rapid onset. We suggest that the presence of a connective tissue disorder in a patient with other risk factors such as steroid use, old age and osteopenia should alert the clinician to the risk of radionecrosis following radical irradiation.
Sonographic abnormalities of the thyroid gland following radiotherapy in survivors of childhood Hodgkin's disease
Authors: Healy J C , Shafford E A , Reznek R H , Webb J A W , Thomas J M , Bomanji J B , Kingston J E
Published: July 2009

The aims of this study were as follows. (1) To demonstrate the spectrum, frequency and changes on follow-up of sonographic abnormalities in the thyroid gland of survivors of Hodgkin's disease who had received radiotherapy to the neck in childhood. (2) To compare the sonographic findings with clinical examination and radionuclide imaging. (3) To investigate the association between the presence or absence of focal sonographic abnormalities with age at radiotherapy, the interval from radiotherapy, the presence of a raised thyroid stimulating hormone (TSH) and the length of time the TSH had been raised. 46 patients were scanned prospectively and rescanned at 6–18 months. The mean age at first sonography was 22.7 years, the median age at radiotherapy was 12.5 years, and the median interval post-radiation was 10.3 years. Sonographic abnormalities were seen in all 46 patients. 45 had diffuse atrophy and 30 had focal sonographic abnormalities. 18 patients developed new focal sonographic abnormalities on follow-up. Focal sonographic abnormalities were more commonly associated with longer duration of a raised TSH. Two patients had thyroid carcinoma. Sonographic abnormalities of the thyroid are common in patients following neck radiotherapy in childhood. Focal abnormalities are usually associated with a longer duration of raised TSH.
Bipedal lymphography in the management of carcinoma of the anal canal
Authors: Davey P , Saibil E A , Wong R
Published: July 2009

The purpose of this study was to determine the extent of metastatic pelvic lymph nodes evident on bipedal lymphography in a group of patients under consideration for combined radiation therapy and chemotherapy as definitive treatment for carcinoma of the anal canal. Lymphography was attempted in 32 patients and successful bilateral cannulation and opacification of nodes was achieved in 28 (88%). Seven patients had lymphographic evidence of external iliac node metastases (25%). When patients were categorized according to the extent of clinically evident disease at presentation, 0/15 patients with T1/T2 tumours had positive lymphograms whereas 7/13 patients with T3/T4 tumours and/or positive inguinal or peri-rectal nodes had positive lymphograms (Fisher's exact test p = 0.0015). All patients with a positive lymphogram had undergone CT scanning of the pelvis and in only one patient was external iliac node involvement detected. In none of these patients was visceral or more extensive nodal metastases discovered. Subsequently, the external iliac nodes with radiological evidence of metastases on lymphography were included in the treatment volume taken to radical dosage. The projected cause specific actuarial 5 year survival for this cohort of patients is 86% (median follow-up 4 years). Since the prognosis for patients who relapse in pelvic nodes is poor, bipedal lymphography is advocated as a staging procedure in patients with advanced primary tumours and in all patients with clinically positive inguinal or peri-rectal lymph nodes who are being considered for curative therapy.
Patient doses in hysterosalpingography
Authors: Fernández J M , Vaño E , Guibelalde E
Published: July 2009

The results of a survey of doses imparted on 41 patients undergoing hysterosalpingography is presented. Dosimetric evaluations were carried out by measuring both the dose–area product using a transmission ionization type chamber, and the entrance surface dose using thermoluminiscent dosimeters. As a result, a local reference dose value was obtained for this examination. Correlations between the dose–area product and the entrance surface dose data were analysed and compared in order to find the most appropriate dosimetric procedure. The median dose–area product obtained was 713 cGy cm2 (range 247 cGy cm2–1623 cGy cm2). Ovarian doses were also calculated, and a median value of 4.6 mGy was obtained for the whole examination. Effective doses were estimated with a median value of 3.1 mSv, and a range of 1.0 mSv–8.1 mSv.