bluuebunny/crossref_metadata_2025 huggingface dataset:
The physical dimensions of the compressed breast
Authors: Fife I.
Published: July 2009

The success of the National Breast Screening Program relies on accurate dose measurements, essential for any risk–benefit analysis and radiation protection considerations (Forrest, 1986). This need to measure absorbed doses within and around the irradiated breast necessitates the use of carefully selected materials from which phantoms and radiation detectors can be constructed.
Book reviews
Authors: Ellis F.
Published: July 2009

The duty of a doctor is to his patients. This duty aims to preserve the patients' peace of mind either by curing the disease complained of or by ameliorating the symptoms and, in all cases, by preserving or restoring self confidence and maintaining confidence in his doctor. In malignant disease this is difficult for the patient who thinks his condition is likely to be fatal. For treatment of benign conditions, the association of radiation exposure with leukaemia and other types of cancer causes difficulties for the patient and for the radiotherapist, over whom hovers the shadow of litigation if anything untoward should appear to result from treatment.
Book reviews
Authors: Whitehouse G. H.
Published: July 2009

This atlas contains a comprehensive set of magnetic resonance images of the limbs, thorax, abdomen and pelvis in coronal, sagittal and axial planes. In addition, contrast enhanced computed tomography (CT) is used to demonstrate the heart and great vessels as well as the abdomen.
Acute response of mouse kidney clonogens to fractionated irradiation in situ and then assayed in primary culture
Authors: Jen Yee-Min , Hendry Jolyon H.
Published: July 2009

Although the difference in sensitivity to the changes in dose fraction size between early-responding and late-responding tissues is well established, the underlying mechanisms in terms of target-cell responses are not yet clearly identified for any tissue. The radiosensitivity of mouse kidney cells after in situ single-dose, 2, 8, and 16 fraction X-irradiations was measured in primary culture using a clonogenic assay. The assay was made 12 h after single doses or 12 h after the last dose of the multifraction regimens. When analysed using the linear-quadratic model, as predicted the individual α components for all the different fractionation schedules were not significantly different, and the changes in the β values were consistent with those expected on the basis of the reciprocal fraction numbers. When all four data sets were integrated to derive a common α/β ratio, the result was 4.4 ± 1.3 (1SE) Gy, or 2.8 ± 0.9 Gy (a better fit) if the single-dose data set was excluded. These values fall into the range reported for kidney using assays of tissue function at long times after irradiation. Hence, it has been shown for the first time that the fractionation sensitivity of a late-responding organ is mimicked by that of a clonogenic cell population in that organ. The evidence also suggests that the time available prior to fixation of potentially lethal damage does not influence the low α/β ratio observed for the kidney.
The composition of body tissues. (II) Fetus to young adult
Authors: White D. R. , Widdowson E. M. , Woodard H. Q. , Dickerson J. W. T.
Published: July 2009

The composition of body tissues is a function of the age, nutrition, state of health and physical activity of the individual. In this paper, the effects of age on the composition of healthy tissues are reviewed. Eleven soft tissues (adipose tissue, blood—whole, brain—whole, heart, kidney, liver, lung, muscle—skeletal, placenta, skin and spleen) and cortical bone are considered. Elemental compositions, mass and electron densities are tabulated for the tissues, as a function of age, from fetus to young adult. Although the compositions given here are predominantly for healthy tissues, reported changes because of dietary influences are briefly discussed.
Superior mesenteric artery branch aneurysm diagnosed by ultrasound
Authors: Verma Bhim Singh , Bose Ajit Kumar , Bhatia Harish Chandra , Katoch Ravindra
Published: July 2009

Superior mesenteric artery (SMA) branch aneurysms are extremely rare (Jorgensen, 1985). Only 40 cases have been reported in the literature up to 1980 (Mourad et al, 1987). Most are diagnosed after rupture into the mesentery, the intestinal lumen or the peritoneal cavity (Reuter et al, 1968; Jorgensen, 1985). Occasionally they are found by arteriographic studies.

Only one case diagnosed by ultrasound has been reported in the literature (Grech et al, 1989).
Book reviews
Authors: Stevens J. M.
Published: July 2009

This is the second edition of a volume first published in 1982. It has been extensively revised and the dimension of magnetic resonance imaging (MRI) added. The textbook represents a distillation of experience gained in three German University Hospitals, based on a clinical population of 8516 gathered between 1975 and 1986. The book is actually concerned with mass lesions of all kinds, including those of inflammatory, vascular and ischaemic origin, and also includes a brief chapter on intra-orbital pathology.
Observation of cerebrospinal fluid flow with echo-planar magnetic resonance imaging
Authors: Stehling M. K. , Firth J. L. , Worthington B. S. , Guilfoyle D. N. , Ordidge R. J. , Coxon R. , Blamire A. M. , Gibbs P. , Bullock P. , Mansfield P.
Published: July 2009

Using echo-planar (EP) magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) flow patterns have been demonstrated in the normal subject and patients with pathological conditions including communicating hydrocephalus, aqueduct stenosis and syringohydromyelia. Snap-shot imaging times of 128 ms allow detailed demonstration of transient intraventricular CSF flow patterns, which is not possible with conventional MRI. The potential of EPI as a method for qualitative and quantitative assessment of CSF dynamics is illustrated.
The interchangeability of radioisotope and X-ray based measurements of bone mineral density
Authors: Adachi J. D. , Webber C. E.
Published: July 2009

Lumbar spine and femoral neck bone mineral density (BMD) were measured with a Novo radioisotope based dual photon densitometer and with a Lunar X-ray densitometer in 94 subjects attending a Metabolic Bone Disease Clinic. There was a strong correlation between results obtained from each machine for the same skeletal site. The correlation coefficients for the spine and femoral neck were 0.97 and 0.88, respectively. The differences between results from each machine were normally distributed with a mean bias of 37.5% for the spine and 27.8% for the femur, which arise principally from differences in machine calibration. In each case the BMD was greater when measured by X-ray absorptiometry. The range for the bias was approximately 25–50% for the spine and 10–45% for the femoral neck. The results from these two machines are not interchangeable. When subjects who are participating in long term studies using a radioisotope densitometer are transferred to an X-ray densitometer, an individual conversion factor must be measured at each site for each subject.
Final report on the second British Institute of Radiology fractionation study: short versus long overall treatment times for radiotherapy of carcinoma of the laryngo-pharynx
Authors: Wiernik G. , Alcock C. J. , Bates T. D. , Brindle J. M. , Fowler J. F. , Gajek W. R. , Goodman S. , Haybittle J. L. , Henk J. M. , Hopewell J. W. , Hunter R. D. , Lindup R. , Phillips D. L. , Rezvani M.
Published: July 2009

The second British Institute of Radiology trial of dose fractionation in radiotherapy compared two groups of prospectively randomized patients with squamous carcinoma of the laryngo-pharynx; one group was treated in a short (≥4 weeks) and the other in a long (>4 weeks) overall time. Treatment in any one centre could be given, with no planned gap in the course of treatment, either as a conventional, daily (5 fractions per week regime) or as 3 fractions per week. A total of 611 patients were allocated to treatment, of whom nine have had to be excluded from the analysis for a lack of information. Patients were admitted to the trial from January 1976 to December 1985 and were followed up for a maximum of 10 years and a minimum of 3 years. A reduction in total dose was made for use in the short compared with the long treatment regime. This reduction in total dose varied between 18% and 22% depending on whether 5 fractions or 3 fractions per week regimes were used. Overall, no statistically significant differences have been found between the two arms of the trial. The patients treated with 5 fractions per week in a short overall treatment time showed fewer late normal tissue effects. An analysis based on stratification by age, stage and anatomical site gave a relative risk (short/long overall treatment time) for deaths of 1.23 with a 95% confidence interval from 0.96 to 1.59. Analyses stratified for stage and site gave relative risks with 95% confidence intervals of 1.10 (0.84–1.44) for local recurrences/tumour persistence, and 1.01 (0.70–1.45) for laryngectomies.
Hepatocellular carcinoma associated with polyarteritis nodosa with symptoms appearing after intra-arterial chemotherapy
Authors: Minakuchi Kazuo , Fujimoto Keiji , Takada Keiji , Takashima Sumio , Nakamura Kenji , Mitsuhashi Takehiro
Published: July 2009

A 57-year-old man presented with pain in his right hypochondrium. There was no history of blood transfusions, prolonged fever, or pain of the muscles or joints. The patient reported that he had never taken methamphetamine and had not taken sulphonamides or penicillins for a long time. The physical examination revealed a hard elastic mass in the right hypochondrium. Laboratory tests (Table I) showed the presence of a chronic liver disorder, but hepatitis B surface antigen and antibody were not detected. Serum α-fetoprotein (AFP) was 14100 ng/ml. An ultrasound examination of the liver showed a large mass hypoechoic in parts and hyperechoic in other parts in the right lobe. Enhanced computed tomography (CT) revealed a large mass with a diameter of about 6 cm and a low density region in the anterior segment of the right lobe. There were multiple low density nodules throughout the right lobe and the medial segment of the left lobe, and a tumour thrombus in the portal vein and superior mesenteric vein. There was dilatation of intrahepatic bile ducts in other slices of the enhanced CT, and ascites elsewhere (Fig. 1). A first angiogram showed several aneurysms in the intrahepatic arteries, an encapsulated tumour stain with a diameter of about 6 cm in the right lobe, and multiple small tumour stains (Fig. 2). We diagnosed this patient as having advanced hepatocellular carcinoma (HCC) from the results of the imaging studies and because of the high AFP.
Computed tomography of cranial metastatic malignant melanoma: features, early detection and unusual cases
Authors: McGann G. M. , Platts A.
Published: July 2009

The cranial computed tomographic (CT) scans reported as showing metastatic disease in patients with malignant melanoma (MM) seen at the Westminster Hospital over a 5 year period were reviewed. Ninety-eight patients with intracranial metastatic MM were identified. Twelve had an initial scan which was reported as normal and particular attention was given to these to see if, in retrospect, any early features of metastatic disease were discernible. Fifty-eight cases showed the “typical” features of intracranial MM; the remainder were unusual in appearance, behaviour, or site. Radiological regression was shown in only seven cases on follow-up scans; all but one of these patients had one or two large metastases. No significant lesion was thought to have been missed on a scan after the administration of intravenous contrast medium, but the lesions of three patients were difficult to discern on plain scans. Thus when MM metastasis is suspected, the use of the contrast-only scan is advocated.
Late presentation of bone metastases in phaeochromocytoma
Authors: Zammit-Maempel I. , Johnson R. J. , Gattamaneni H. Rao
Published: July 2009

Phaeochromocytoma is a relatively rare tumour of neuroectodermal origin that is said to occur in up to 0.1% of patients with diastolic hypertension (Magner & Gifford, 1977). Around 10% of phaeochromocytomas are malignant and bone is the most common site of metastases. We present two cases of malignant phaeochromocytoma presenting 4 years and 14 years after diagnosis with bone metastases.

A 16-year-old girl presented in 1967 with anxiety, headaches, sweating, palpitations and an elevated blood pressure at 180/130. Twenty-four-hour urine collection confirmed the diagnosis of a phaeochromocytoma with elevated urinary metadrenalines.
Computed tomography of lesser sac hernia through the gastrohepatic omentum
Authors: Tran T. L. , Regan F. , Al-Kutoubi M. A. O.
Published: July 2009

Internal hernia is an unusual cause of intestinal obstruction and pre-operative diagnosis on plain films has seldom been made. Before the introduction of computed tomography (CT), the literature on the subject was composed principally of case reports, often based on observations made at surgery or autopsy. However, with the increasing use of CT, pre-operative diagnosis of paraduodenal hernias has been made (Passas et al, 1986; Day et al, 1988). We report a case of lesser sac hernia through a rare congenital defect in the gastrohepatic omentum. The diagnosis, based on the findings of CT, was made pre-operatively. The CT appearance of the condition has not been described in the literature previously.
Not so pseudo
Authors: Wakeley Charles J. , Cassar-Pullicino Victor N. , McCall lain W.
Published: July 2009

A 9-year-old boy presented in the Casualty Department complaining of a painful neck. The previous night his brother had jumped on his head causing forced flexion of his cervical spine. The patient had restricted active and passive neck movements without neurological symptoms or signs. Figure 1 shows lateral views in flexion and extension of his cervical spine on admission to hospital.
Measurement of tissue perfusion by dynamic computed tomography
Authors: Miles K. A.
Published: July 2009

A method for quantifying tissue perfusion by dynamic computed tomography (CT) is described. By applying a nuclear medicine data processing technique to time-density data from a single-location dynamic CT sequence, tissue perfusion can be determined from the maximum gradient of the tissue time-density curve divided by the peak enhancement of the aorta. Using this method, splenic perfusion was measured at 1.2 ml min−1 ml−1, normal renal cortical perfusion at 2.5 ml min−1 ml−1 and normal renal medullary perfusion at 1.1 ml min−1 ml−1. Changes in cortical and medullary perfusion in renal failure and hypertension were demonstrated. The ability of dynamic CT to provide quantitative functional information is not well recognized and is potentially of value when studying structures, such as the renal cortex and medulla, that cannot be anatomically resolved by standard functional imaging techniques.
Patient dose and associated risk due to radiological investigation of the internal auditory meatus
Authors: Tweed J. J. , Davies M. L. , Faulkner K. , Rawlings D. J. , Forster E.
Published: July 2009

The radiation doses and associated somatic risks due to four radiological examinations for acoustic neuromata (AN) have 6een investigated. These examinations were (I) plain film radiography of the internal auditory meatus (IAM), (2) computed tomography (CT) of the I AM, (3) CT of the posterior fossa and (4) CT of the I AM with air contrast. Organ dose measurements were performed using lithium fluoride thermoluminescent dosemeters loaded in a patient equivalent phantom. Dose equivalents to various organs are presented, together with the effective dose equivalent and collective effective dose equivalent for each examination. Hypothetical fatal somatic risks for each examination studied here have been estimated from the effective dose equivalents. The estimated number of hypothetical fatal cancers induced by radiological examinations for AN is between approximately 110 and 820 times lower than the number of detected AN, depending on the method of assessing the radiation dose to the remainder organs. It is concluded that in this particular study the radiological examinations are of net benefit to this group of patients.
Cancer risk among staff at two radiotherapy departments in Denmark
Authors: Andersson Michael , Engholm Gerda , Ennow Klaus , Jessen Karl A. , Storm Hans H.
Published: July 2009

In comparison with the general Danish population, the relative risk (RR) for cancer among staff members employed in two radiotherapy departments in Denmark during 1954–1982 and alive on 1 April 1968 was assessed by linkage to the Danish Cancer Registry. All staff had been monitored with film dosimeters for exposure to radiation. The study cohort consisted of 4151 persons, accruing 49553 person-years at risk. The collective radiation dose was 76.54 manSv and the mean dose 18.4 mSv. A total of 163 cancer cases were observed with 152.3 expected. The risks for cancers usually considered to be radiogenic were not elevated. A significant excess of prostatic cancer was observed (five cases, relative risk, 6.02; 95% confidence interval, 1.94–14.06); this is likely to be a chance finding. No relation was observed between radiation dose or years of exposure and cancer risk, but a weak non-significant increase in risk with time since first exposure was seen.
Spinal intradural hydatid cyst in a child
Authors: Akhan Okan , Dinçer Alp , Saatçi Işil , Gülekon Nadir , Besim Aytekin
Published: July 2009

Hydatid disease is an infestation by the larval stages of Echinococcus granulosus. In man, the liver and lungs are the organs most frequently involved. In the spinal column, hydatid disease usually begins in the vertebral body. Extension into the spinal canal results in spinal cord compression. Intradural hydatid cyst is extremely rare compared with the other types of spinal hydatid lesions (Rayport et al, 1964; Ley & Marti, 1970; Pamir et al, 1984).

A 6-year-old boy was admitted to hospital because of progressive paraplegia, which had started 2 months previously. He was said to have lost bladder and bowel control in the last few weeks. Physical examination revealed marked reduction in the motor power of the lower limbs. There was bilateral clonus, a positive Babinski's sign and hyperactivity of the deep tendon reflexes at the lower extremities.
Positioning for plain spinal radiography producing paraplegia in a patient with ankylosing spondylitis
Authors: Upadhyay S. S. , Ho E. K. W. , Hsu L. C. S.
Published: July 2009

In the later stages of ankylosing spondylitis the spine is prone to fracture even with minor trauma (Resnick & Niwayama, 1988), because it is rigid, deformed and osteoporotic. Following a trivial injury the patient usually complains of mild back pain. The radiographic findings may not be helpful as the quality of radiographs is often poor owing to severe osteoporosis. A misdiagnosis is not uncommon, nor is the development of neurological symptoms due to displacement of previous fractures. As far as we know, no case has been reported where the patient becomes paraplegic while being positioned for plain radiographs of the spine. We report such a case.

A female aged 75 years with a history of ankylosing spondylitis for over 40 years consulted a local “bonesetter” for back pain a few days after a minor incident when she twisted her back at home. While positioning her for plain radiographs of the spine a crack was heard and she developed weakness in both lower limbs, and was unable to walk. She also became incontinent of urine.

Three months later the patient was referred to the Duchess of Kent Children's Hospital at Sandy Bay, Hong Kong. Clinical examination revealed a localized tenderness over the midlumbar area of her kypho-scoliotic spine. She had impaired sensation in both lower limbs. The motor power was MRC grade 0 for hip and knee muscles, and grade 1 for ankle and foot muscles. Knee and ankle tendon reflexes were absent.
The extrapleural fat in empyema: CT appearance
Authors: Takasugi Julie E. , Godwin J. David , Teefey Sharlene A.
Published: July 2009

Pleural empyema can be accompanied by changes in the adjacent chest wall. We examined the chest wall on computed tomographic scans in 24 patients with pleural effusions. Eighteen patients had pleural empyema and six had transudative effusions. Of the 18 empyema patients, 13 had abnormally high attenuation in the extrapleural tissues. In 12 of these 13, the high attenuation was probably caused by reaction to the pleural infection. In two, it was probably caused by haematoma (one patient had haematoma and empyema). In five patients there was either no clear abnormality in the extrapleural space or an insufficient amount of fat to permit detection of an abnormality, or the parietal pleura could not be distinguished from the pleural fluid because intravenous contrast medium was not given. Of the six patients with proven transudative pleural effusions, all had extrapleural fat which appeared normal. Abnormally high attenuation in the extrapleural tissues can be expected to accompany exudative pleural effusion, particularly empyema, but not transudative effusion.
Organ doses received by atomic bomb survivors during radiological examinations at the Radiation Effects Research Foundation
Authors: Kato Kazuo , Antoku Shigetoshi , Sawada Shozo , Russell Walter J.
Published: July 2009

When evaluating the risks of oncogenesis and cancer mortality following exposure to the radiations of the atomic bombs (A-bombs), the medical X-ray doses received by the A-bomb survivors must also be estimated and considered. Using a human phantom, dosimetry was performed to estimate the X-ray doses received by A-bomb survivors during medical examinations at the Radiation Effects Research Foundation (RERF) as part of the long-term follow-up on the Adult Health Study (AHS). These examinations have been estimated to represent nearly 45% of the survivors' cumulative medical irradiation dose. Doses to the salivary glands, thyroid gland, lung, breast, stomach and colon were measured using thermoluminescent dosemeters. The results, which are reported here, will aid in estimating organ doses received by individual AHS participants.
Organ doses to atomic bomb survivors during photofluorography, fluoroscopy and computed tomography
Authors: Kato Kazuo , Antoku Shigetoshi , Sawada Shozo , Wada Takuro , Russell Walter J.
Published: July 2009

Doses to the salivary glands, thyroid gland, breast, lung, stomach and colon during mass radiological gastric screening, mass radiographic chest screening, upper gastrointestinal series and computed tomography were determined by exposing a female human phantom to simulated radiological X-ray examinations as performed in community hospitals. The doses were measured using thermoluminescent dosemeters, and the results will be used to document organ doses received by participants in the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation Adult Health Study.
Book reviews
Authors: Maskell G. F.
Published: July 2009

After a brief description of the basic principles of computed tomography (CT), the first half of this book by a surgeon and a radiologist from Paris is primarily an atlas of cross-sectional anatomy, from the level of the thoracic inlet to the perineum. Carefully prepared and meticulously labelled anatomical sections from four different subjects are presented together with a CT scout view demonstrating the level of the section and a number of CT images illustrating abnormalities at the same level.
Book reviews
Authors: McIvor James
Published: July 2009

The maxillofacial region is a radiological no-man's land in which few general radiologists have any special interest or knowledge and even ENT radiologists with considerable expertise in assessing the nose, sinuses and pharynx can have problems with lesions of dental origin.
Strontium-89 chloride for pain palliation in prostatic skeletal malignancy
Authors: Laing A. H. , Ackery D. M. , Bayly R. J. , Buchanan R. B. , Lewington V. J. , McEwan A. J. B. , Macleod P. M. , Zivanovic M. A.
Published: July 2009

In a multi-centre study strontium-89 was shown to be effective in relieving bone pain from prostatic carcinoma in patients who had failed conventional therapies. Of 83 patients assessed at 3 months, following the administration of a dose of at least 1.5 MBq/kg, 75% derived benefit and 22% became pain free. Symptomatic improvement usually occurred within 6 weeks and continued for between 4 and 15 months (mean 6 months). Based on the dose estimation part of this study the recommended dose of strontium-89 is 150 MBq. Toxicity was low, provided platelet levels were above 100 × 1091−1 at the time of treatment. Repeat treatments with strontium-89 may be given at intervals of not less than 3 months. Strontium-89 is administered intravenously on an out-patient basis with no special radiological protection precautions.
Measuring the filtration of mammographic X-ray tubes with molybdenum targets
Authors: Cranley Kieran
Published: July 2009

The method employed in this work, to estimate the filtration of mammographic X-ray sets, makes use of the measurement of the half-value layer (HVL) of the X-ray beam, which is filtered by the air path, the X-ray tube window, an added molybdenum filter and a known thickness of Perspex. Sets of data have been calculated that relate the measured HVL to the added molybdenum filter thickness. The mammographic X-ray sets included in this study were all Siemens Mammomat 2 type, which have molybdenum targets and molybdenum filters and the compression plates employed have a Perspex equivalence of about 1 mm or 2 mm. The kilovoltage is produced by a high-frequency generator and has a nominally constant potential waveform.

It is often necessary to determine the HVL of mammographic X-ray sets, for two different reasons: (a) measurement of mean glandular breast dose (Institute of Physical Sciences in Medicine (IPSM), 1989), and (b) determination of total filtration by the HVL method. The estimation of total filtration of X-ray tubes with tungsten targets has previously been given some attention by the author (Cranley & Fogarty, 1988). In addition, errors in the HVL method have been analysed (Gilmore & Cranley, 1990).

The IPSM method of estimating breast dose has become widely adopted by physicists involved in the NHS Breast Screening Programme. The method involves the determination of both incident air kerma (for correct exposure of a phantom representing the standard breast) and HVL of the incident X-ray beam. The compression device should be in position for these measurements, to satisfy the standard breast conditions.

It is necessary, therefore, to have the compression device in position during the measurement of the HVL. The requirement to estimate the filtration of the mammographic X-ray beam comes from the International Commission on Radiation Protection (ICRP) (1982), which recommends that the total permanent filtration should be equivalent to at least 0.5 mm aluminium or 0.03 mm molybdenum. This implies that the total filtration should be estimated with removable filters, such as the compression plate, excluded.

The current method allows the HVL to be measured
Post-mastectomy lymphangiosarcoma (Stewart-Treves syndrome): report of two long-term survivals
Authors: Kaufmann Thomas , Chu Florence , Kaufman Richard
Published: July 2009

Lymphangiosarcoma is one of the rarest forms of soft tissue neoplasms. Lowenstein (1906) was the first to report this entity in a patient with chronic post-traumatic upper extremity lymphoedema. However, it was not until Stewart and Treves (1948) described the development of this malignancy in a post-mastectomy oedematous extremity that this syndrome, which carries their name, became widely recognized.

The tumour is highly malignant and usually arises in a lymphoedematous upper extremity of a patient treated for carcinoma of the breast. It has been well established that lymphangiosarcomas are not directly related to breast cancer (Aegerter & Peale, 1942). The common denominator is the lymphoedema and, therefore, other causes of chronic lymphoedema may lead to the development of this vascular sarcoma (Taswell et al, 1962). Indeed, this disease has occurred in congenital (Dubin et al, 1974), idiopathic, traumatic and filarial lymphoedema (Devi & Bahuleyan, 1977). The pathogenesis of these unusual tumours remain uncertain. Stewart and Treves (1948) believed that a systemic carcinogen was involved in the etiology. Martorell (1951) suggested that the lymphoedema may be tumour inducing while Schreiber etal (1979) postulated that local immunodeficiency was the causative factor.

Histologically these tumours consist of large vascular cavities lined with plump, spindle-shaped endothelial cells containing large nuclei and prominent nucleoli. Some areas may exhibit solid sheets of spindle cells (Silverberg et al, 1971). Immunohistochemistry may prove to be quite useful; factor VIII-AG is the most utilized marker for vascular differentitation (Mukai et al, 1980).
Acute epidural haematoma complicating myelography in a normotensive patient with normal blood coagulability
Authors: Stevens J. M. , Kendall B. E. , Gedroyc W.
Published: July 2009

Acute epidural haematomas are usually idiopathic, but they may occur following spinal trauma (Coin et al, 1979), epidural anaesthesia (Helperin et al, 1971) or in association with spinal tumours (Harris et al, 1978) or vascular malformations (Muller et al, 1982). We report the computed myelographic, computed tomographic (CT) and magnetic resonance imaging (MRI) findings in an unusual case complicating lumbar myelography, requiring surgical decompression, which was not evident on the myelogram.
Clinical and radiological features of atypical giant cell tumours of bone
Authors: Schajowicz Fritz , Granato David B. , McDonald Douglas J. , Sundaram Murali
Published: July 2009

Giant cell tumour (GCT) of bone is an uncommon neoplasm, representing approximately 5% of all bone neoplasms and approximately 21% of benign bone tumours (Dahlin & Unni, 1986). The vast majority of GCTs arise after closure of the growth plate and occur at the end of long bones. GCTs are frequently diagnosed by radiologists because of their preferred location (80% in long bones of the extremities), age distribution (peak incidence in the third decade) and morphologic appearance. Typically, they are expanding radiolucent lesions eccentrically located, most commonly at the articular surface of a long bone. Pathologic and histologic findings are characteristic, although these tumours need to be differentiated from other lesions containing giant cells, such as non-ossifying fibroma, aneurysmal bone cyst, osteoblastoma, chondroblastoma, giant cell reparative granuloma, benign fibrous histiocytoma and brown tumours. The biologic behaviour of GCT frequently is not predictable. In our experience, shared by most authors, histologic grading as a guide to prognosis is of no practical value (Schajowicz, 1981). On the contrary, radiologic features (“quiescent”, “active”, “aggressive”) are a more reliable indication of local clinical behaviour (Campanacci et al, 1987). GCTs are often aggressive in behaviour with a distinct tendency toward local recurrence, most often within the first post-operative years (McDonald et al, 1986). We present a collection of unusual GCTs (excluding those of the facial bones) from 465 histologically proven cases from the Latin American Tumor Registry and St Louis University.
A comparison of semiconductor and thermoluminescent dosemeters for in vivo dosimetry
Authors: Aukett R. J.
Published: July 2009

When making in vivo measurements, particularly of doses to patients undergoing total body irradiation, considerable differences are often found between the results obtained using semiconductors and thermoluminescent dosemeters (TLD) (Naudy, 1981; Aukett, 1985; Welsh & Stedeford, 1986, personal communication).

The variation in sensitivity of lithium fluoride with dose and with photon energy was established when the use of the material was first suggested (Cameron et al, 1961) and is now well known (Fowler & Attix, 1966; McKinlay, 1981).

Variations with dose-rate have been observed for semiconductor detectors (Lavin, 1968; Grüssel & Rikner, 1984). The response of semiconductor detectors also varies with photon energy (Wright & Gager, 1977; Dixon & Ekstrand, 1982; Johansson, 1982; Rikner, 1985). Corresponding variations in sensitivity with depth might be observed for both thermoluminescent and semiconductor dosemeters. Such effects have already been observed for different types of semiconductor detectors (Gager et al, 1977; Rikner & Grüssel, 1983).

In order to investigate this possibility the two types of detector were compared with an ionization chamber at a series of depths including both build-up and build-down regions. Measurements of the variation in sensitivity with dose and dose-rate were also made so that these could be eliminated from the results. The 6 MV linear accelerator used at this centre for total body irradiation was used throughout.

The semiconductors used were Therados type EDP 10 used in conjunction with a DPD 5 dose monitor.
Radiological manifestation of elastofibroma: a case report and review of the literature
Authors: Nakano Takashi , Tsutsumi Zenta , Hada Toshikazu , Higashino Kazuya
Published: July 2009

Elastofibroma is a very rare benign tumour of connective tissue, whose features are distinguished by the presence of abundant elastinophilic polymorphic structures and characteristic location. The lesion usually appears in elderly women (50–80 years) characteristically arising from connective tissue in the subscapular region. There are few reports of elastofibroma in the radiological literature (Berthoty et al, 1986; Marin et al, 1987).

We report a case of elastofibroma dorsi presenting with chest radiographic abnormalities and its radiological manifestation is reviewed.

An 84-year-old Japanese female with no significant medical history was referred to hospital for evaluation of an abnormal chest X ray and a feeling of fullness in the upper abdomen. 6 months earlier she began to experience an occasional feeling of fullness in the upper abdomen. Initial evaluation revealed a gastric polyp, 1.5 × 1.5 cm in diameter, and a mass on the chest radiograph. The polyp was biopsied and histologic examination showed no malignancy. On physical examination, the right scapula was displaced slightly, both laterally and upwardly, and a non-tender hard mass was apparent beneath it. The mass was obvious when the patient raised her arms and rotated them anteriorly but was not adherent to the overlying skin. She had no perisubscapular pain, discomfort, or restriction of movement. She had noticed a swelling at that site 5 years earlier and although the mass had increased in size, it was otherwise unremarkable. There was no lymph node enlargement and otherwise the physical examination was normal.
The radiological (CT) and clinical sequelae of primary intracerebral haemorrhage
Authors: Kreel Louis , Kay Richard , Woo Jean , Wong H. Y. , Nicholls M. Gary
Published: July 2009

To determine the radiological and clinical outcome of primary intracerebral haemorrhage, a prospective study was carried out involving computed tomography (CT) of 388 consecutive Chinese patients admitted with acute stroke to a large public hospital in Hong Kong. Further CT and functional assessment were performed 3 months later in 71% of survivors. The patients were admitted over a 6 month period. 120 (31%) were found to have had presumed primary intracerebral haemorrhage. Of these, 64 patients (53%) died within 3 months. From 40 of the 56 survivors who returned for a follow-up study at 3 months, 30 were functionally independent and five mildly disabled; only five were significantly disabled. Follow-up CT showed no residual lesion in 27%, low attenuation areas in 37%, slit-like lesions in 25% and calcification in 10% of patients. The size of residual lesions correlated statistically with the degree of residual disability, although the association was not close. It is concluded that primary intracerebral haemorrhage accounts for a high percentage of strokes among Hong Kong Chinese with more than half of the patients dying within 3 months. Many survivors, in whom follow-up CT appearances are variable, show good functional recovery.
Time-related changes in lymphatic clearance in pig skin after a single dose of 18 Gy of X rays
Authors: Mortimer P. S. , Simmonds R. H. , Rezvani M. , Robbins M. E. C. , Ryan T. J. , Hopewell J. W.
Published: July 2009

The early and late effects of X rays on lymphatic microcirculatory function have been investigated in pig skin. Paired estimates of lymph clearance were performed in irradiated and unirradiated sites on the flank skin of anaesthetized Large White pigs at 3, 6, 9, 12, 26, 39, 52, 64 and 78 weeks after a single dose of 18 Gy of X rays. The dermal clearance of 99Tcm-colloid was used to assess lymph flow. The results demonstrated two waves of impaired lymphatic clearance which correlated well with the gross morphological changes observed. The first wave occurred between 6 and 12 weeks after irradiation and corresponded to a period of ischaemia and oedema. The second wave, at 52 weeks, corresponded with dermal thinning and subcutaneous atrophy. X irradiation resulted in an impairment of lymph drainage both within and outside the field of irradiation. Impaired lymphatic drainage probably contributes to the gross and histological changes observed in the skin after X irradiation.
Striking a balance: benefit and risk in man's exposure to man-made radiations
Authors: Berry R. J.
Published: July 2009

It is indeed an honour to be invited to give the Silvanus Thompson Memorial Lecture, and awesome when one considers the Hall of Fame represented by one's predecessors, starting with Lord Rutherford in 1918. Silvanus Thompson was the first President of the Roentgen Society, the forerunner of the BIR. Well ahead of his time, he would have today been labelled a “communicator”. Born in York in 1851 he took his first degree in London in 1869 and returned to York as a Science Master. In 1876 he was appointed Professor of Experimental Physics in Bristol and in 1885 moved to the post of Principal Professor of Physics at the City and Guilds Technical College, Finsbury, which he held until his death in 1916. Elected a Fellow of the Royal Society in 1891, he followed his Presidency of the Roentgen Society in 1897, for the first year of its life, by the Presidency of the Institute of Electrical Engineers in 1899, the Physical Society in 1901 and the Optical Society in 1905. His was a key role in founding the multidisciplinary and broadly based organization that the British Institute of Radiology remains to this day.

Despite the euphoria that surrounded Roentgen's description of X rays, some of the risks of exposure to these novel radiations became apparent very early. The first publication of Roentgen's discovery in the English language in January 1896 was followed by the first description of “deterministic” effects only 3 months later.
Book reviews
Authors: Arnott S. J.
Published: July 2009

This book aims to provide an update on the subject of the management of patients with gastrointestinal malignancies, particularly by radiotherapy but details of chemotherapy are also given where appropriate. The volume is a multi-author book, each chapter being devoted to the treatment of one specific tumour type. All the authors are North American; indeed all are from the United States with one notable exception. As a result, the book has a quite distinct North American flavour.
The dependence of the scattered radiation dose to personnel on technique factors in diagnostic radiology
Authors: Marshall N. W. , Faulkner K.
Published: July 2009

The measurement and prediction of scattered radiation dose to staff in diagnostic radiology is particularly important, owing to the increased use and complexity of interventional radiology. The air kerma-area product and scattered radiation dose in the vicinity of the patient couch, for both overcouch and undercouch X-ray tube geometries, were simultaneously monitored. The scattered radiation distribution at the couchside was deduced at a range of tube potentials for both overcouch and undercouch X-ray tube geometries. The variation of scattered radiation with field size on both geometries was investigated, as well as the variation with focus–table distance on an overcouch tube geometry. It was discovered that the scattered radiation dose at a point correlated with the air kerma–area product and the result may be used for radiation protection purposes. A method of predicting the scattered radiation dose at a given position is described.
Improved image quality for dense breasts in mammography
Authors: Law J.
Published: July 2009

Within the UK breast scanning age range of 50–65 years, about 15% of breasts show a dense structure that is underexposed in conventional mammography. This gives rise to a severe reduction in contrast. Methods of improving this contrast by variation of exposure factors are explored, using a Dupont phantom that has a simulated dense breast structure. Results are assessed by considering measured contrast from a Perspex stepwedge, and by obtaining relative scores, on a scale of 1–10, from 15 radiologists involved in mammography. It is concluded from both these methods that approximately doubling the mAs at the normal kV is preferable to increasing the kV by more than a small amount. A modified mammographic technique on these lines could be valuable in selected cases where a previous conventional mammogram was available, i.e. assessment stage or repeat screening in a screening programme, or symptomatic patients. Practical problems in choosing exposure factors and the magnitude and implications of the increased dose are discussed.
99Tcm-HMPAO SPECT and magnetic resonance studies in L-asparaginase induced cerebrovascular accident
Authors: Foreman Nicholas K. , Mahmoud Hazem H. , Lanqston James W.
Published: July 2009

Symptoms including malaise and fever over an 8 week period prompted the parents of their 14-year-old daughter to seek medical attention. She was found to be pancytopenic and, after a bone marrow aspirate suggested a diagnosis of acute leukaemia, she was referred to St Jude Children's Research Hospital. Her initial white cell count was 1.4 × 109/1. Examination of the cerebral spinal fluid (CSF) showed no white cells or blasts in a cytospin preparation. She was entered on the current front-line protocol for the treatment of children with acute lymphoblastic leukaemia (St Jude total therapy study XII). Induction therapy comprised of daunorubicin, prednisone, vincristine and L-asparaginase, followed by tenoposide (VM-26) and cytosine arabinoside (Ara-C) on Day 22. Triple intrathecal chemotherapy with methotrexate, hydrocortisone and cytosine arabinoside was given on Day 2. The patient received six doses of Escherichia coli L-asparaginase (Days 3, 4, 6, 8, 10 and 12). After a gynaecology consultation on Day 10, she was started on medroxyprogesterone acetate (Provera) 2.5 mg/day to suppress menstruation during chemotherapy.

On Day 14 of induction therapy the patient had two brief focal seizures, characterized by jerking of the left arm with deviation of the eyes and the head to the left. There was no loss of consciousness. Physical examination revealed a left facial (VII) nerve palsy and weakness of the left arm, but no other abnormalities.
A persistent offender
Authors: Kinsella D. , Norman P.
Published: July 2009

A 28-year-old lady presented with a 12 hour history of severe occipital headache. The onset of the headache was sudden. On examination there was mild neck stiffness with no focal neurological signs. The initial radiological examination was a head computed tomography (CT) scan which demonstrated a recent subarachnoid haemorrhage. The following day cerebral angiography was performed (Fig. 1).

What abnormalities are shown and what is the diagnosis?

The right common carotid arteriogram demonstrates a communication between the right internal carotid and the basilar arteries. This is caused by a persistent hypoglossal artery. The hypoglossal artery has a large aneurysmal sac close to its termination in the basilar artery. The sac is projected behind the terminal portion of the right internal carotid artery in Fig. lb. It can be identified clearly following a selective hypoglossal artery injection (Fig. 2). There is no retrograde filling of the distal portions of the vertebral arteries following this injection. The origins of the vertebral arteries could not be determined following selective injections into the innominate and left subclavian vessels.
Percutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter: review of 96 patients
Authors: Han Joon Koo , Choi Byung Ihn , Park Jae Hyung , Han Man Chung
Published: July 2009

Intrahepatic biliary stone disease is prevalent in East Asia and there is a high frequency of retained intrahepatic stones after surgical treatment. Percutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter and a Dormier basket was attempted in a group of 96 patients who had a T-tube. Seventy-six had multiple intrahepatic stones, confined to one hepatic lobe in 52 patients. Stones were exclusively intrahepatic in 68 cases. Biliary strictures were present in 92 cases (95.8%). A combination of techniques was used including pre-shaped angulated catheters, irrigation suction, balloon dilatation of strictures, crushing of large stones and extracorporeal Shockwave lithotripsy. Retained stones were completely removed in 48 cases, and incompletely removed in 22 cases. The overall success rate was 72.9%. There were only minor complications. No mortality or significant morbidity requiring hospitalization occurred. Angular deformity, stricture of bile ducts and impacted stones were the most frequent factors responsible for failure or incomplete removal of retained stones. Fluoroscopically guided percutaneous interventional procedures with a pre-shaped angulated catheter are useful complementary procedures to surgery for patients with intrahepatic stones. The major benefits of an individually angulated catheter are safety and easy access to small peripheral bile ducts.
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

In reply to the letter by R. Wilks regarding our paper (MacDonald-Jankowski & Lawinski, 1991) we would like to make the following comments.

We do not infer that K-edge filters have some special property that reduces radiation dose.
Measurement of forearm bone mineral density in normal women by dual-energy X-ray absorptiometry
Authors: Ryan P. J. , Blake G. M. , Fogelman I.
Published: July 2009

We report the results of forearm measurements, without the use of a water bath, using dual-energy X-ray absorptiometry (DEXA) in 100 normal women aged 29–69 years (average age, 52 years). Studies were performed using the Hologic QDR-1000, with bone mineral density (BMD) measured at three sites in the non-dominant forearm: ultradistal, distal one-third and a region between these two. The precision of the technique was 0.74%, 0.55% and 0.58%, respectively. The normal range for forearm BMD and variation with age was established. BMD was also measured in the lumbar spine (L1-L4) and femoral neck. Linear regression analysis gave a range of correlation coefficients between forearm and axial sites of r = 0.49–0.67. Standard errors of the estimate (SEE) in predicting axial from peripheral measurements gave average values from the three forearm sites of 0.085 g/cm2 for the femoral neck and 0.118 g/cm2 for the spine. Forearm measurements using DEXA can now be reliably performed in air. DEXA produces a high-resolution image, is fast and simple to perform, and enables both cortical and trabecular sites to be examined in one measurement. Forearm and axial measurements can be performed using the same equipment, where centres possess a suitable DEXA system.