bluuebunny/crossref_metadata_2025 huggingface dataset:
Can serum prostate-specific antigen replace bone scintigraphy in the follow-up of metastatic prostatic cancer?
Authors: Sissons G. R. J. , Clements R. , Peeling W. B. , Penney M. D.
Published: July 2009

Bone scintigraphy is the most sensitive imaging technique for the initial detection of bone metastases and is widely used in the staging of prostatic cancer. This study was performed to assess whether the development of further bone metastases can be detected by serial measurements of the serum glycoprotein prostate-specific antigen (PSA) as an alternative to follow-up scintigraphy. The bone scintigrams and PSA levels of 101 patients with metastatic prostate cancer entered into two therapeutic trials have been reviewed. Serial results of both investigations were available in 59 cases. In three cases new bone deposits were observed without a corresponding rise in PSA. In two other cases the scintigrams were considered to be suspicious of progression with no change in PSA levels; however, further follow-up indicated that these changes were not due to metastases. In 13 cases PSA levels were rising in advance of new deposits on the scintigrams. In the remaining 41 cases the PSA levels and scintigraphic findings paralleled each other. We conclude that serial estimation of PSA levels is a simpler marker for disease progression than bone scintigraphy in metastatic prostatic cancer, but that neither technique in isolation gives complete accuracy.
Radial diffusion coefficient mapping
Authors: Madden Anthoula , Leach Martin O.
Published: July 2009

The two-dimensional mapping of the effective diffusion coefficient of water in tissues may provide a useful method of tissue characterization to complement T  1 and T  2 relaxation time studies for diagnostic purposes. Current diffusion techniques rely on the application of large gradient strengths and long echo times to achieve the required sensitivity. This, in turn, limits the applicability of the technique to tissues having long T  2s with rapid water diffusion. In addition, the inherent directionality of these methods results in only the partial encoding of diffusion information. A modified diffusion sequence is presented, radial diffusion mapping (RAD), which provides enhanced sensitivity diffusion maps by employing gradient sensitization in three orthogonal directions. Results in both phantoms and volunteers are presented, together with an investigation of the effects of T  2 on the measurement accuracy. Using RAD, a two- to five-fold improvement in sensitivity was achieved, thus significantly enhancing the dynamic range of the method and allowing more accurate in vivo diffusion measurements to be carried out.
Functional changes in the pig kidney following irradiation with fractionated doses of fast neutrons (42 MeVd→Be)
Authors: Robbins M. E. C. , Barnes D. W. H. , Hopewell J. W. , Knowles J. F. , Rezvani M. , Sansom J. M.
Published: July 2009

The right kidney of female Large White pigs, approximately 14 weeks old, was irradiated with fractionated doses of fast neutrons (42MeVd→Be). The total doses used were 6.6–9.2 Gy. Changes in kidney function, assessed as the functional index (FI, where FI = irradiated kidney function/unirradiated kidney function) or as individual kidney glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), were serially determined up to 104 weeks after irradiation using 99Tcm-DTPA and 13lI-hippuran renography. The animals were then euthanized, the kidneys removed and weighed. A dose-dependent reduction in FI was seen within 13 weeks of irradiation. Measuring individual kidney function revealed a hyperaemic response in both irradiated and unirradiated kidneys 4 weeks after irradiation. This was followed by a dose-dependent reduction in irradiated kidney GFR and particularly ERPF. The ED50 value for the impairment in ERPF, assessed as the percentage of irradiated kidneys exhibiting a ≥ 50% reduction in ERPF, was significantly lower than that for GFR, i.e. 7.20 ± 0.10 Gy compared with 8.44 ± 0.07 Gy (p < 0.001). A dose-related reduction in irradiated kidney weight was also observed. These fast neutron-induced changes in renal function and weight are qualitatively similar to those observed following photon irradiation of the pig kidney.
Localization of impalpable breast lesions using the Hawkins needle
Authors: Walker T. M. , Ross H. B.
Published: July 2009

Pre-operative localization of impalpable breast lesions detected by mammography has become a routine procedure, especially in those units involved with breast screening. Various techniques are available to facilitate localization, either with the injection of dyes, or using one of a variety of flexible wires or rigid needles.

A new needle, the Hawkins needle*, has recently become available (Urratia et al, 1988), and we wish to describe its use in 99 patients.

The Hawkins needle (Fig. 1) is a co-axial system which consists of a rigid 20-gauge outer sheath with a blunt tip and a small window 1.5 cm from the tip; an inner core has a sharp tip and a spring-hook. When the inner core is advanced the needle point protrudes from the outer sheath; if the core is withdrawn the point is hidden in the sheath and the spring-hook protrudes from the window in the outer sheath. Clear markings at 1 cm intervals are etched on the needle shaft. The proximal end of the inner core has an 18-gauge hub welded to it. There is also a two-part removable plastic hub which fits over the proximal end of the needle. It is available in 10 cm or 12.5 cm lengths.
Second malignant neoplasm following treatment of Hodgkin's disease: a case report
Authors: Rao V. S. N. , Dinshaw K. A. , Shrivastava S. K. , Muckaden M. A. , Susnerwala S. , Advani S. H. , Vyas J. J. , Kavarana N. M.
Published: July 2009

Improvement in the treatment of Hodgkin's Disease (HD) over the past decade has led to increased survival rates, particularly in the early stages. Recognition of long-term complications of the treatment have also increased. Prolonged survival following aggressive treatment of HD is accompanied by an increased risk of the oncogenic effects of radiotherapy and chemotherapy (Halperin etal, 1984). Second malignant neoplasms (SMN) may also develop after the primary has been successfully treated and cured (Kim et al, 1978; Valagussa et al, 1986; Boivin & O'Brien, 1988). We report a case of HD, successfully treated by combined modality treatment developing a chondrosarcoma arising in the chest wall 9 years later.

A 5-year-old female child presented to the Tata Memorial Hospital, in February 1980 with bilateral cervical and left axillary lymphadenopathy of 15 months duration. There was no history suggestive of “B” symptoms. The liver and spleen were not palpable. The chest radiography, bone marrow aspiration and biopsy and lymphogram were all normal. A biopsy of a cervical lymphnode revealed Hodgkin's disease of lymphocyte-predominance type. Thus she was staged clinically as Hodgkin's disease IIA as per the Ann-Arbor classification (Carbone, 1971). The child was treated by radical irradiation with 60Co gamma rays to a total dose of 4000 cGy in 20 fractions over 36 days to the mantle field with a further boost of 1000 cGy in 1 week to the left supraclavicular fossa between March and April 1980.
Basal cell carcinomas do metastasize
Authors: Junor Elizabeth J. , Campbell Ian , Symonds R. Paul
Published: July 2009

The incidence of metastasis in basal cell carcinomas is calculated to be approximately 0.1%. We would like to report a case with some interesting features. This 55- year-old male presented with a large ulcerated lesion on his anterior chest wall. It had been present for 6 years but had enlarged more rapidly over the past 2 years. He had noticed a red itchy patch 32 years previously when he was performing military service in the Middle East. It was slow to heal and he was sure that it had originated as an insect bite. There was no other medical history of note and in particular he had not been exposed to arsenic, mineral oil or radiation. When seen at the clinic his anterior chest wall had a 20 × 20 cm ulcerated lesionwith a rolled edge through which the tendons of sternomastoid could clearly be seen. Biopsy was reported asmetatypical basal cell carcinoma (Fig. 2).
Book review
Authors: Wambersie Andre
Published: July 2009

Ten years after the publication of Fast Neutrons in the Treatment of Cancers by Mary Catterall and David K. Bewley in 1979, David Bewley has published an update on fast neutron therapy which concentrates on physical and radiobiological aspects. Since the first applications of fast neutrons at Hammersmith Hospital in the 1970s significant improvments have been achieved. Improvements have also been seen in the neutron generators and collimation systems as well as in dosimetry and radiobiology. Therefore, it was a good time to present an updated overview and synthesis of the situation of fast neutron therapy, or at least, the developments in its physical and radiobiological aspects.
Segmental reversal of intrahepatic portal flow due to a liver metastasis
Authors: Kishimoto Riwa , Choji Kiyoshi , Massoud Tarik F. , Matsuoka Shin-ichi , Chen Minhua , Fujita Nobuyuki , Irie Goro
Published: July 2009

A 60-year-old woman who had a Dukes C colonic adenocarcinoma resected four years previously presented with malaise, hepatomegaly and elevated serum tumour markers. Her radiological investigations included liver ultrasonography, computed tomography (CT) (Fig. 1), and magnetic resonance imaging. These revealed a 6 cm solitary metastasis mainly in the right lobe (segments S8 and S4) not extending to the porta hepatis. The tumour compressed the inferior vena cava (IVC) and the right hepatic vein. No portal vein thrombosis was demonstrated. Angiography was performed prior to surgical removal of the tumour. The portal phase of a selective superior mesenteric arteriogram unexpectedly revealed abrupt “cut-oft” the main right portal branch at the porta hepatis, and no portal branches were demonstrated within the right lobe of the liver (Fig. 2). A selective common hepatic arteriogram demonstrated the tumour blush in the upper part of the right lobe of the liver as well as a faint blush-like impression of the main branch of the right portal vein in the late phase.

In view of these portal venographic appearances, a duplex ultrasonographic examination was performed for further assessment (Fig. 3a). Due to the patient's abdominal discomfort, she was most at ease whilst lying supine with her knees flexed. In this position, normal flow in all the hepatic veins as well as the intrahepatic portal branches was observed (Fig. 3b). However, when the patient extended her knees fully the haemodynamics altered.
Intrarenal varices mimicking hydronephrosis
Authors: Kincaid W. , Edwards R.
Published: July 2009

A case of intrarenal varices mimicking hydronephrosis on ultrasound examination is described. This is an important differential diagnosis if intervention is being considered.

A 20-year-old male with portal hypertension secondary to idiopathic portal vein thrombosis presented with left loin pain. 3 years previously he had a successful end-to-side distal sple-norenal shunt. Ultrasound examination was reported as showing a mild left hydronephrosis and multiple splenic varices. Doppler examination was not performed. On intravenous urography the left kidney excreted promptly. There was widespread deformity of the calyces but no dilatation. His pain settled and he was discharged.
The Swiss cheese brain
Authors: Jackson A. , Dobson M. J. , Cooper P. N.
Published: July 2009

A 37-year-old Indian man presented with a 6-month history of focal and grand mal convulsions. He had emigrated from India 2 years previously and was working as a chef in a local restaurant. There was no significant past medical history. Initial investigations included a computed tomogram (CT) of his brain (Fig. 1), which demonstrated a number of small enhancing parenchymal lesions with surrounding low-attenuation changes which were attributed to oedema. A magnetic resonance (MR) scan was performed and is illustrated (Figs 2–4).

What are the radiological findings' What is the diagnosis and what other information would you seek to confirm this'

The MR images demonstrate multiple, well-defined lesions throughout the brain, which show a predilection for grey matter.
Correlations between α/β and T
½: implications for clinical biological modelling
Authors: Brenner D. J.
Published: July 2009

There seems little question that future directions in radiotherapy will involve altered or customized fractionation schedules (Cooper, 1990). Recent interest in accelerated fractionation and hyperfractionation, high dose-rate brachytherapy, and the search for predictive assays for tumour proliferation all exemplify this trend.
The role of 99Tcm-HMPAO white cell imaging in suspected orthopaedic infection
Authors: Wilson D.
Published: July 2009

I wonder why we need a new nuclear medicine technique for the clinical problem of suspected infection of total joint prosthesis. It seems to me that if this diagnosis is strongly suspected the appropriate investigation is aspiration of the joint. If the tap is dry, contrast should be injected to confirm that the nededle was correctly placed.
The role of 99Tcm-HMPAO white cell imaging in suspected orthopaedic infection
Authors: Copping C. , Dalgliesh S. M. , Dudley N. J. , Griffiths P. A. , Harrington M. , POtter R. , Smith B. D.
Published: July 2009

We thank you for the opportunity to respond to the interesting letter from Dr Wilson concerning our recent article (Copping et al, 1992).

The group of patients included in the study were those with suspected latent infection. They presented with pain, no elevation of temperature and subsequent negative blood tests. In our opinion, aspiration is not the primary investigation of choice for such patients.
Coil embolization using a saline flush technique
Authors: Tarazov P. G. , Gapchenko E. M. , Dmitrieva I. A. , Ryzhkov V. K.
Published: July 2009

We read with great interest the article by Makita et al (1991). We would like to report our experience with the saline flush technique for coil embolization.

We have been using a similar technique since 1982. The saline flush manoeuvre was carried out in about 200 patients (approximately 400 coils). The splenic, hepatic, renal and hypogastric arteries were successfully embolized.
Imaging of organ function
Authors: Miles K. A.
Published: July 2009

Although the main emphasis of radiology has been the demonstration of disease through observation of changes in structure, imaging of organ function is becoming an increasingly important part of diagnostic radiology.
Book reviews
Authors: Glaholm J.
Published: July 2009

This book is based upon the proceedings of an EORTC Genitourinary Group Sponsored Meeting held in Italy on October 12–15, 1989.
Book reviews
Authors: Hine A. L.
Published: July 2009

Dr Puylaert was one of the first ultrasonologists to employ ultrasound routinely for the diagnosis of appendicitis. In the introduction he states that this book reflects a 4 year experience with ultrasound examination in patients with clinical signs of appendicitis. The comprehensive text and the 169 figures in the book demonstrate the considerable expertise he has gained in this field during this time.
Book reviews
Authors: Hirst D.
Published: July 2009

The publication of conference proceedings in the form of articles which are neither extended abstracts nor full length peer reviewed papers is becoming increasingly prevalent. It is almost as though no meeting can be considered as scientifically worthy unless a compilation of manuscripts appears in print within a couple of years. Whether you like this trend or not it seems to be here to stay.
Hodgkin's disease—a very late recurrence
Authors: Johnson I. J. M. , Pillai R.
Published: July 2009

Hodgkin's disease represents 0.7% of all malignancies excluding skin cancer in England and Wales (Mead & Whitehouse, 1988) and, although the therapeutic regimes produce good results, achievement of cure remains ill defined. There is an increasing awareness of problems with treatment, appearance of a second malignancy and possible relapse. We present an extremely rare case of very late relapse (23 years) and discuss its relevance to the much debated question of the length of time required to follow patients after remission.
Lethal micromelic facial bones sclerosis dysplasia
Authors: Müller D. , Kozlowski K. , Sillence D.
Published: July 2009

This stillborn female, the third born of unrelated parents, was delivered by spontaneous vaginal delivery at 31 weeks gestation after a pregnancy complicated by polyhydramnios. The birth weight was 2750 g and the length 42 cm. Severe hydrops foetalis was present (Fig. 1).

The mother had been treated for insulin dependent diabetes mellitus for the past 10 years. The first child, delivered at 31 weeks of gestation, died aged 7 days with a diagnosis of diabetic fetopathy. There was neither clinical, radiographic nor anatomo-pathological evidence of bone dysplasia. The second child was normal. The father had no history of bone dysplasia.
Non-endoscopic per oral biliary stent insertion
Authors: Singanayagam J. , Chow H. K. , West D. J.
Published: July 2009

We describe a new technique of biliary stent insertion which is particularly suitable for patients with previous gastric surgery where endoscopic or combined endoscopic and percutaneous biliary stent insertion would be technically difficult.

A 64-year-old lady with previous history of palliative polya gastrectomy for antral carcinoma presented with obstructive jaundice due to recurrent tumour. Under local anaesthesia and light sedation a percutaneous transhepatic approach was made into the dilated right intrahepatic biliary tree using a van Sonnenberg two part needle. A percutaneous transhepatic cholangiogram confirmed a dilated biliary tree, occlusion of the common bile duct and multiple stones in the gallbladder (Fig. 1). A hydrophilic guide wire (150 cm long, 0.035″ diameter, Radifocus angled type from Terumo Corporation, Tokyo) was manipulated through the occluded segment of the common bile duct into the proximal duodenal loop. A 110 cm long 5 F cobra catheter was inserted over the guide wire and was used to steer the guide wire through the gastro jejunal anastomosis into the stomach and thereafter through the gastro oesophageal junction into the oesophagus and mouth (Fig. 2).
Fit and … well
Authors: Thomas R. D. , Gould A. J.
Published: July 2009

Previously fit and well, a 65-year-old gentleman awoke at 3 am with searing interscapular pain. The general practitioner administered morphine and referred him urgently to hospital. On arrival he was found to be pale and sweaty with a mild tachycardia and he refused to move his arms. Physical examination was otherwise unremarkable and, of note, his blood pressure was normal. He was considered likely to have suffered a myocardial infarction though an electrocardiogram (ECG) showed only the tachycardia. A chest radiograph was considered normal by the admitting clinicians.

The “arrest team” was called 2 h after admission and found the patient cyanosed and having a grand mal epileptic attack. He recovered spontaneously.
Fluid levels in a spinal aneurysmal bone cyst following biopsy
Authors: Davies A. M.
Published: July 2009

Dr Kessel reports that he has seen a fluid–fluid level in an ABC following which is contrary to the experience expressed in our recent paper (Davies et al, 1992). It is interesting to note that, since the publication of this paper I too have seen a persistent fluid–fluid level in an ABC following biopsy.
Acronyms in bone densitometry
Authors: Genant H. K. , Gluer C. C. , Faulkner K. G. , Majumdar S. , Harris S. T. , Engelke K. , Kuijk C. van
Published: July 2009

In response to our publication (Gluer et al, 1990a), Wilson and colleagues (1990) proposed the adoption of a uniform terminology and corresponding abbreviation for Dual X-ray Absorptiometry (DXA).

We supported this suggestion (Gluer et al, 1990b). Since then, the number of papers on DXA has increased considerably. Still, different abbreviations (DEXA, DER, DRA, QDR and DPX) for this technique for bone densitometry are used, several of which are proprietary in origin. DXA is the upgraded version of DPA (Dual Photon Absorptiometry). The nuclear source has been replaced by an X-ray source and this improved technology has gained wide-spread acceptance and distribution.
Latent image fading and mean glandular dose in mobile mammographic screening
Authors: Robson K. J. , Kotre C. J. , Faulkner K.
Published: July 2009

The phenomenon of latent image fading, although well known (e.g. Kofler & Gray, 1991) is not often considered as a cause of film optical density variations in conventional radiography because of the short times between exposure and processing normally encountered. In mammography used for breast screening, however, the range of times between film exposure and processing can be much greater than in conventional radiology. When a mammogram is taken at a screening or assessment centre where processing is undertaken on site, the delay will be only a few minutes or less, but when films from mobile breast screening trailers are being returned to the centre for processing on the same working day, the delay could be in the region of 7 h.
Book reviews
Authors: Jackson P. C.
Published: July 2009

This book is excellent: it is the “Kaye & Laby” and “Geigy Scientific Tables” for those who work or are connected with the medical sciences.

The book consists of nine chapters covering the thermal, optical (including ultraviolet and infrared), acoustic (i.e., ultrasonic), mechanical and electrical properties of tissue; together with the effects of ionizing radiation and nuclear magnetism within tissues. An additional chapter and appendices provide information on tissue composition and perfusion rates.
Book reviews
Authors: Jackson P. C.
Published: July 2009

This book is a compilation of papers that were presented at a meeting entitled “Computers in Diagnostic Radiology” organized by the Institute of Physical Sciences in Medicine, which was held at Newcastle upon Tyne during 1989. The book consists of 24 chapters from authors who originate mainly from UK centres.
Book reviews
Authors: Cole D. J.
Published: July 2009

This book is a useful basic introduction to radiotherapy practice for trainees, particularly at the Manchester school. It describes a didactic approach to radiation technique and treatment policy which will be most helpful in the early stages of training. There are, however, serious disadvantages for those who want to appreciate widely differing treatment philosophies in radiation oncology. The reader is left with the overriding impression that management policies described in this book are recommended because they have been in use for a long period of time, rather than because they have been subject to critical statistical analysis.
Subtraction gadolinium enhanced magnetic resonance for head and neck imaging
Authors: Lloyd G A S , Barker P G , Phelps P D
Published: July 2009

The subtraction method of Des Plantes has been applied to gadolinium enhanced magnetic resonance imaging (GdMR). Using short acquisition times, T  1 weighted spin echo pulse sequences are made immediately before and after the intravenous administration of gadolinium DTPA. To avoid moving the patient from the scanning tunnel the venipuncture is made into the dorsum of the foot. The needle is placed in the vein prior to putting the patient into the scanner and is irrigated with saline while the control series is obtained. 42 patients with naso-sinus or skull base tumours have been successfully investigated by this technique and satisfactory subtraction studies are now obtained on all patients other than the claustrophobic. Subtraction GdMR provides the best demonstration of the effects of gadolinium DTPA on the magnetic resonance signal for both normal and abnormal tissues. The signal recorded on the subtraction image is dependent on tissue blood supply and provides a more accurate record of tumour extent than that shown by unsubtracted GdMR scans.
Use of peritoneal insufflation to displace the small bowel during pelvic and abdominal radiotherapy in carcinoma of the cervix
Authors: Hindley A , Cole H
Published: July 2009

Peritoneal insufflation is a technique which reliably displaces small bowel from pelvic and abdominal radiotherapy fields with the aim of reducing bowel reactions which limit the dose of radiation applied to these sites. Use of this technique in five patients undergoing radiotherapy for advanced carcinoma of the cervix, and the degree of bowel displacement resulting, dosimetry, acute reactions and tolerability of the technique are presented, with discussion of the possibility of future escalation in radiotherapy dose.
The case of the missing calcified disc
Authors: Wardlaw J , Beggs I
Published: July 2009

A 39-year-old male, with chronic renal failure following a failed renal transplant, presented with acute back pain. His previous history included crystal arthropathy, tertiary hyperparathyroidism and parathyroidectomy.

He had initially presented with tuberculosis of the L5 region and associated psoas and gluteal abcesses 1 year previously. The abcesses had been drained and he had been on apparently adequate chemotherapy ever since. Radiographs of the lower lumbar spine at the time of the original presentation (Figure 1) showed well-defined calcification of the nucleus of the D12/L1 disc.
Output factors for blocked fields
Authors: Dean E M
Published: July 2009

I am grateful to J Mills for pointing out several aspects where caution is required in calculating doses for blocked fields. I agree completely with the points raised, which are vital for improving the accuracy of the dose calculations.
Partial transmission block radiotherapy technique for childhood medulloblastoma
Authors: Plowman P N
Published: July 2009

Our recently published method of craniospinal radiotherapy, designed to reduce late neuropsychometric retardation (Plowman & Doughty, 1991) has been criticized. Both Magee (1992) and Bates & Williams (1992) theorize that the lower prohylactic daily fraction size dose to the neuraxis (circa 100–130 cGy/fraction) could allow the tumour to “grow through”.
Book reviews
Authors: Dawson P
Published: July 2009

On the widely accepted principle that books are best judged for their educational value in a field by non-specialists in that field, I should be an ideal reviewer for this book. I've always felt that, generally speaking, the plain chest X ray is the most challenging image a radiologist can be presented with and should be approached with suitable humility. This classic book, now in its third edition is wholly helpful in leading the reader through the minefield. There are 427 pages of fairly dense text but it is all very readable. The illustrations are good and convincing even when they convey relative subtleties.
Book reviews
Authors: White N
Published: July 2009

This book, now in its second edition, is aimed at undergraduate dental students. The first part effectively covers radiation physics, the production of X Rays and film processing. Chapters on the dental X-Ray set and processing have been successfully updated, the latter now includes sections on diagnosis of film faults and on quality control.
Book reviews
Authors: Saunders A J
Published: July 2009

This multi-author text attempts to cover the full range of nephrourological disorders. Imaging is almost entirely sonographic except in the chapters on the adrenal gland and renal trauma where, not surprisingly, there is a fair amount of computed tomography (CT). The text is full of information and mostly well illustrated with scans selected appropriately. There are three particularly good chapters: one very comprehensive one on scrotal pathology, one well balanced and realistic view of sonography in diffuse renal disease and one good review of renal masses.
Book reviews
Authors: Venables H K
Published: July 2009

This American book is essentially a set of lecture notes on ultrasound physics and instrumentation for complete beginners.

The first few chapters on the fundamentals assume very little prior learning. In particular the section on mathematics is aimed well below GCSE standards. This continues throughout the book with many examples of simple calculations worked out in full. A little insulting to the average intelligence, but very useful for those with an inherent aversion to anything remotely resembling an equation! (Will definitely appeal to my DMU students!)

The following chapters cover the interaction of sound with matter, transducers, resolution etc. through to image processing and display.
Book reviews
Authors: Dawson P
Published: July 2009

This is the 2nd edition of a well known and highly regarded book. It is, as radiology texts go, quite a short book of only 250 or so pages. It is very well illustrated with even the pictures of subperiosteal bone resorption being quite convincing.
The efficacy of a single posteroanterior radiograph in the assessment of metastatic pulmonary melanoma
Authors: Collins C D , Padley S P , Greenwell F , Phelan M
Published: July 2009

Posteroanterior (PA) and lateral chest radiographs are performed as part of the routine staging and follow-up investigation of patients with malignant melanoma. We have assessed the contribution of the lateral chest radiograph in the follow-up of 227 consecutive patients with proven malignant melanoma. In only once case was an abnormality evident on the lateral radiograph which was not previously detected on the PA films. Our department, as a result of this study, has discontinued the routine use of lateral chest radiography in the follow-up of patients with malignant melanoma.
Impaired rectal emptying caused by perineal herniation of the rectum: defaecographic demonstration using oblique projections
Authors: Kaasbøl Mari-Anne , Hauge Christina , Nielsen Michael Bachmann
Published: July 2009

Defaecography is usually performed in the lateral projection alone. We present a case of perineal herniation of the rectum, previously unreported, demonstrated by defaecography in oblique projections.
A new afterloading applicator for primary brachytherapy of endometrial cancer
Authors: Bauer M , Schulz-Wendtland R
Published: July 2009

Surgery is the treatment of choice for carcinoma of the endometrium. If the patient is not eligible for surgery because of advanced age or internal problems, primary irradiation—in most cases a combination of external beam radiation with brachytherapy—is indicated. In the following we present a new applicator used for intrauterine brachytherapy.

In 1936 Heyman showed that the packing technique—which was later modified by Ries (1944), who introduced the so-called radium tamponade method, and by Becker and Scheer (1952)—was superior to the radium tandem method. This was documented by the 20–25% improvement in survival rates (Heyman et al, 1941). Radiation protection regulations have forced us to abandon the radium method in favour of the afterloading technique (Henschke, 1960; Waltstam, 1962). With the afterloading technique the results for cervical cancer are just as good as those of the radium method.

Several afterloading methods have been described to treat cancer of the endometrium. However, to date there has been no satisfactory simulation (Simon et al, 1971; Rotte et al, 1973; Busch et al, 1977; Pernot, 1977; Bauer et al, 1981; Nori et al, 1982). Irradiation using a single applicator is only suitable for brachytherapy of small uteri. Radiation treatment using curved tubes to reach into the corners of the uterus results in a very inhomogenous dose distribution in the uterine mucosa, the tumour, and the target volume of the entire uterus.
Multiple myeloma presenting as bilateral orbital masses: CT and MR appearances
Authors: Jackson A , Kwartz J , Noble J L , Reagan M J
Published: July 2009

Orbital involvement in multiple myeloma is rare with less than 50 cases in the world literature (Mewis-Levin et al, 1981). The commonest form of orbital myeloma is a solitary soft tissue mass often arising from bone and associated with bone destruction. The finding of multiple bilateral orbital plasmacytomas is extremely rare and has been described in only two previous cases (Dufier et al, 1977; Hayes et al, 1980).

We present the findings on computed tomography (CT) and magnetic resonance imaging (MRI) in a patient with multiple myeloma who presented with visual impairment due to bilateral orbital plasmacytoma. The imaging appearances of this pattern of orbital involvement have not been described before and differ from cases presenting with a solitary orbital plasmacytoma.

A 65-year-old man was referred to Manchester Royal Eye Hospital with a 2 week history of blurred vision in both eyes. Visual acuity was reduced bilaterally (right eye 6/36, left eye 6/24) and examination demonstrated mild bilateral proptosis and conjunctival chemosis. Slit lamp biomicroscopy demonstrated full thickness corneal crystals and bilateral choroidal folds. Initial investigations revealed anaemia (Hb 10.9 g dl−1) and an elevated ESR (30 mm hr−1).

CT scan demonstrated bilateral soft tissue orbital masses. In the right orbit a large intraconal mass lesion was seen surrounding and distorting the posterior aspect of the globe and extending posteriorly in contact with the optic nerve.
Book reviews
Authors: Saunders A J S
Published: July 2009

This is a comprehensive multi-author text concerned predominantly with biopsy, aspiration and drainage procedures under ultrasound guidance. The chapters commence with the principles of instrumentation and guidance systems followed by some discussion on fine needle aspiration/ cytology. Subsequent chapters follow a logical sequence starting with the brain then the neck, breast, thorax and heart. Then 10 chapters concentrate on the abdomen and pelvis, including interventional obstetrics. The final chapter is on the extremeties.
Exploring the niches
Authors: Lillicrap S C
Published: July 2009

In his 1990 Presidential Address Professor C R Hill posed the question of whether, given the ethos of the late 20th century, there was a future for radiological science. To answer his question he reviewed the scientific basis of current major branches of radiology, demonstrating progress resulting from initial physical discovery, combined with engineering and medical inventiveness. In the process of the development of radiological science, small-scale speculative research, outside mainstream areas, has proved to be an important element. This address complements Professor Hill's by examining the role of a small-scale speculative research (the niches of the field). Examples are taken from the early pioneers of radiological science and the first British Institute of Radiology Congress. Finally some lesser known research activity in this category, being presented at the Golden Jubilee Congress, is reviewed.
Accuracy of lateral dual energy X-ray absorptiometry for the determination of bone mineral content in the thoracic and lumbar spine: an in vitro study
Authors: Edmondston Stephen J , Singer Kevin P , Price Roger I , Breidahl Peter D
Published: July 2009

Lateral scanning with dual energy X-ray absorptiometry (DXA) was undertaken on 153 thoracic and lumbar vertebral bodies from nine individuals (mean age 67; range 34–92 years) to establish their bone mineral content (BMC). All specimens were subsequently de-fatted and ashed to compare ash weight with BMC of the Tl to L5 segments. Linear regression analysis indicated a higher correlation between BMC and measured ash weights for each vertebral column (range: r = 0.97 0.99), with error analysis for all vertebrae tested showing a standard error of 0.40 g, or 10.8%. For the L2 4 segments the accuracy error was 0.50 g or 7.9%. In both cases there was a mean trend towards underestimation of ash weight. Mean BMC values of the T1 to T5 segments were similar before a progressive increase caudally. These data affirm the utility of DXA for determining bone mineral content in the vertebral column across wide ranges of age, and segmental and bone density.
Factors affecting the radiation dose to the lens of the eye during cardiac catheterization procedures
Authors: Pratt T A , Shaw A J
Published: July 2009

Concern has been expressed about the relatively high radiation doses to the lens of the eye received by the operator during cardiac catheterization studies. A study was undertaken to assess the occupational doses received by cardiologists and to examine the factors that affect the individual's eye dose. Eighteen cardiologists working in five catheterization laboratories at three centres were included in the study. Their eye doses, workload and individual study details were monitored at each centre. Operating dose rates and scattered radiation were also measured for each unit to compare equipment performance. The study demonstrated that the relationships between the cardiologist's eye dose and factors such as the dose efficiency of the X-ray equipment, scattered dose rates, examination protocols and workload are complex and vary from centre to centre. Because of these variations general workload limits may be inaccurate and should only be used for general guidance when no direct measurements are available. Such limits should be verified by local measurements as soon as is practical.
A simple solution to the problems of testing automatic exposure control in diagnostic radiology
Authors: Hunt A J , Plain S G
Published: July 2009

The complete testing of the automatic exposure control (AEC) in radiographic systems usually involves measurement of the optical density of films exposed under well controlled conditions. This can mean typically 30 exposures per unit tested. Until recently the technique adopted locally followed that recommended in TGR 32 Part IV (Hospital Physicists' Association, 1980). A slab of tissue-equivalent material 30 × 30 × 20 cm thick is placed in the position normally occupied by the patient. The X-ray beam is centred on the phantom with an incident field size of 25 × 25 cm. The focus–film distance should be set such that the tube and grid foci coincide (Figure 1).

The consistency of optical density produced while varying the equipment parameters and chambers is then assessed by exposing a film with an L-shaped 2.5 mm mask placed over the cassette (behind the AEC chambers). The use of the current mask means that approximately eight films may be exposed per Bucky assembly, and since two Buckies are commonly included in a typical X-ray room this can mean 16 films must be exposed. The preferred technique is to use the same cassette for each exposure during the testing of each AEC, to use the same film dispenser and the same processor throughout. This avoids screen speed, processing and film batch variations respectively. However the use of this technique can be tedious and expensive in terms of both time and film.
Dynamic forces influencing vertebral fracture risk
Authors: Ammann M E , Winkelbauer F W , Hittmair K , Thurnher S
Published: July 2009

The risk of fracture of human vertebrae in vivo in relation to densitometric data has been reported (Buchanan et al, 1987; Cullum et al, 1989). Densitometric measurements alone do not, however, correlate well with actual structural failure (McBroom et al, 1985). Compressive strength characteristics and modes of fracture of human vertebrae have been determined with single load cycles in vitro (Kazarian & Graves, 1977).

Bone, however, is subjected to mechanical fatigue. Its apparent strength is reduced by multiple load cycles as opposed to a single load cycle. Static methods do not take into account the cyclic dynamic axial loading of the lumbar spine that occurs during everyday life (Brinckmann et al, 1987). We simulated the effect of these changing forces on isolated lumbar vertebrae and on lumbar motion segments consisting of two adjacent vertebrae with the connective tissue joining them left in place (Schmorl & Junghanns, 1968). Elasticity and deformation behaviour were analysed.
Sialography using an intravenous paediatric cannula
Authors: Worthy S , England S J P
Published: July 2009

Dr Walker reports the use of a paediatric 24 G intravenous cannula to cannulate the salivary duct for sialography, (Walker, 1992). We use a modification of the technique that Dr Walker describes in cases of difficult cannulation, and have found this invaluable.
Intubaation dacryocystography in patients with a clinical diagnosis of chronic canaliculitis (“streptothrix”)
Authors: Sathananthan N , Sullivan T J , Rose G E , Moseley I F
Published: July 2009

Magnification dacryocystography in 18 patients with chronic infective canaliculitis showed dilatation and irregularity of the affected lacrimal canaliculi, with prominent filling defects in almost all cases. Filling defects are uncommon in other diseases of the canaliculi and serve to confirm the diagnosis.
Book reviews
Authors: Hudson F R
Published: July 2009

Fundamentals of Magnetic Resonance Imaging sets out to provide an introduction to the subject which bridges the gap between physical concepts and imaging applications. There are nine chapters devoted to the basic principles involved and these are followed by three chapters covering general imaging concepts. Specialized techniques such as flow measurement and fast scanning and spectroscopy are discussed in the next three chapters.
The radiological features of calcifying odontogenic cyst
Authors: Devlin H , Horner K
Published: July 2009

Calcifying odontogenic cyst is a rare benign lesion of the jaws, with no particular specificity for age, sex or site. Three new cases are presented together with a review of the radiological literature. There appear to be no pathognomonic radiological features, although a superficial location on the affected bone and the presence of internal calcification may be useful signs. The role of radiology appears to be limited to determining lesion extent prior to surgery.
Superparamagnetic particles as oral contrast medium in magnetic resonance imaging of patients with treated ovarian cancer—comparison with plain MRI
Authors: Prayer L , Stiglbauer R , Kramer J , Wimberger D , Poelzleitner D , Schima W , Kainz C , Koelbl H , Haugen I , Imhof H
Published: July 2009

In 23 patients with treated ovarian cancer, 24 magnetic resonance (MR) examinations of the abdomen and pelvis were performed before and after administration of an oral superparamagnetic contrast medium. Depiction of bowel loops was judged sufficient in 47% with plain scans and in 85% with enhanced scans. Minor artefacts attributed to the agent were noted in 32% of examinations and were classified as disturbing in 8%. The diagnostic information obtained after contrast enhancement was estimated to be superior to that from plain MRI in 20% of patients. The use of oral contrast medium did not alter the MR diagnosis of “tumour recurrence” or “disease-free” in any patient. Our results suggest that superparamagnetic iron oxide is an effective and reliable approach to negative bowel contrast enhancement, increasing the confidence level when distinguishing intestines from solid structures.
Accurate measurement of surface areas of anatomical structures by computer-assisted triangulation of computed tomography images
Authors: Allardice J T , Jacomb-Hood J , Cookson J , Dykes E , Holman J , Abulafi A M , Williams N S
Published: July 2009

There is a need for accurate surface area measurement of internal irregular anatomical structures in order to define light dosimetry in adjunctive intraoperative photodynamic therapy (AIOPDT). No satisfactory preoperative method exists of measuring this parameter. We have investigated whether computer-assisted triangulation of serial sections generated by computed tomography (CT) scanning can give an accurate assessment of the surface area of the walls of the true pelvis after anterior resection and before colorectal anastomosis. We have shown that the technique of paper density tessellation is an acceptable method of measuring the surface areas of phantom objects, with a maximum error of 0.5%, and is used as the gold standard. Computer-assisted triangulation of CT images of standard geometric objects and accurately-constructed pelvic phantoms gives a surface area assessment with a maximum error of 2.5% compared with the gold standard. The CT images of 20 patients' pelves have been analysed by computer-assisted triangulation and this shows that the surface area of the walls varies from 143 cm2 to 392 cm2. Simple step-like analysis of images and approximation to geometric shapes with subsequent calculation give unacceptably high errors. The surface area of an internal, rigid, irregular surface area for illumination in AIOPDT can be accurately measured preoperatively by computer-assisted triangulation of CT images.
The influence of focal spot size on image resolution and test phantom scores in mammography
Authors: Law J
Published: July 2009

This paper reports an experimental investigation of the extent to which focal spot size influences image resolution in mammography. Films of two different phantoms, both containing high contrast bar patterns, were obtained using three different foci from 0.9 to 0.1 mm, and three degrees of magnification with the smallest of those foci. Some influence of focal spot size was detectable in all films except for the 0.1 mm focus at low magnification, where it was negligible in comparison with film-screen unsharpness, but effects attributed to the film-screen system were more important than focus size except with the 0.9 mm focus or at high magnification. However, a nominal 0.4 mm focus may have an effective size of 0.9 mm close to the chest wall side of the film. These two phantoms, and two others, were used to investigate the changes of perceptibility of “realistic” details, all of which depend on a combination of contrast, resolution and noise, with changes of focal spot size and magnification. As expected, when judged in this way image quality improved as focal spot size decreased. With the fine focus it also improved as magnification increased, unlike changes in high contrast resolution which decreased for high magnification. Thus conventional bar patterns are not always a good guide to detail perceptibility in mammograms, where the effects of noise may be as important as those of focal spot size.
Use of the linear quadratic model in order to accommodate a small reduction in the number of fractions of a standard radiotherapy treatment regime
Authors: Mills J A , Wayte S C
Published: July 2009

Use of the linear quadratic model is considered for reduction, by one or two fractions, of the number of fractions in a daily fractionated reference schedule while maintaining a continuous regime. The cases of maintaining late or early tumour reacting tissue are considered with the inclusion of time effects. The reduction of biologically effective dose (BED) to early-tumour type tissue is shown to be overestimated for both cases if time effects are not taken into account. A third option is outlined, which equates the magnitude of the fractional reduction of BED for early-tumour-reacting tissue to the fractional increase in BED for latereacting tissue without accounting for time effects. Using this option, the resulting variations in BED for lateand early-tumour tissue are compared with the accepted tolerances in physical dose delivery and some examples presented. The overestimated prediction of the variation in BED for early-tumour tissue still applies in this option, suggesting that this is the way the linear quadratic model should be applied to such a schedule change.
Interruption of the inferior vena cava with anomalous intrahepatic continuation
Authors: Balkanci F , Özmen M N
Published: July 2009

Infrahepatic interruption of the inferior vena cava (IVC) with azygos and hemiazygos substitution is a rare IVC anomaly which has been documented in the literature (Anderson et al, 1961; Chuang et al, 1974; Floyd & Nelson, 1976; Mayo et al, 1983). Recently Bercoffet al and Ghossain et al reported two cases with portal continuation of the interrupted IVC (Bercoffet al, 1985; Ghossain et al, 1988). In our case, we describe a left sided IVC with infrahepatic interruption which continues by both the azygos system and the hepatic veins via anomalous intrahepatic vessels. To our knowledge such a continuation with intrahepatic anomalous vessels has not been described before.