bluuebunny/crossref_metadata_2025 huggingface dataset:
Renal arterial fibromuscular dysplasia: acute renal infarction in three patients with angiographic evidence of medial fibroplasia
Authors: Stinchcombe S. J. , Manhire A. R. , Bishop M. C. , Gregson R. H. S.
Published: July 2009

Fibromuscular dysplasia of the renal arteries usually presents with hypertension but, rarely, it can present with acute renal infarction. Of the four types of fibromuscular dysplasia, medial fibroplasia has been said not to progress to renal arterial occlusion (Schreiber et al, 1984) and not to predispose to arterial thrombosis or dissection (Stewart et al, 1970).

We report on three patients who presented with acute renal infarction, whose renal angiographic features were more suggestive of the medial fibroplasia type of fibromuscular dysplasia.

A 33-year-old man was admitted with severe right loin pain. The right kidney was non-functioning on intravenous urography, but an ultrasound examination of both kidneys was normal. A right retrograde pyelogram was normal, but dynamic renography (99Tcm-DTPA) revealed that the right kidney was not perfused.

At angiography the right renal artery was completely occluded by thrombus 3 cm from its origin (Fig. 1). The left main renal artery was irregular and two stenoses were seen in one of the segmental vessels (Fig. 2). The thrombus in the right main renal artery was treated with intra-arterial streptokinase to reveal a 75% stenosis. This was treated with balloon angioplasty but peripheral perfusion could not be restored and the kidney remained non-functioning. The angiographic appearances were thought to represent the medial fibroplasia form of fibromuscular dysplasia. Subsequent investigations failed to reveal any other cause of arterial thrombosis or embolism.
Carbogen breathing: a system for use in man
Authors: Dische S. , Rojas A. , Rugg T. , Hong A. , Michael B. D.
Published: July 2009

In the long history of the clinical application of laboratory knowledge concerned with the radioresistance of hypoxic tumour cells, carbogen (95%O2 + 5%CO2) was employed at an early time. In a randomized controlled trial of carbogen breathing in 254 patients with carcinoma of the upper aero-digestive system, initiated in 1972 and performed under the auspices of the radiation therapy oncology group (RTOG), a small margin of advantage to carbogen breathing in carcinoma of the larynx (total of 42 cases) and hypopharynx (total of 39 cases), which did not reach statistical significance, was reported by Rubin et al (1979). The method fell into disuse and in the 1960s and 1970s the clinical effort was concentrated on hyperbaric oxygen (HBO). Finally there was a move to chemical sensitizing agents.

Recently, using clinically relevant dose-fractionation regimes, it has been shown that both carbogen and 100% oxygen-breathing in mouse tumour models give a remarkable increase in radiosensitivity. The enhancement of radiation effect is greater than that achieved by any other system for sensitization of hypoxic cells in the laboratory, including the use of chemical sensitizers and hyperbaric oxygen (Rojas et al, 1990; Rojas, 1991).
The effect on pulmonary function of tangential field technique in radiotherapy for carcinoma of the breast
Authors: Johnson Ann E.
Published: July 2009

I am concerned that the paper by Lund et al (1991) ends with a bald conclusion that “this technique (lumpectomy followed by tangential field radiotherapy) is a safe procedure in breast-preserving treatment”. This should have been qualified by “in patients with normal lung function”, since this was the group which they investigated. The damage due to radiation is not reversible. The initial functional abnormalities after radiation are caused by the effect of the continuing perfusion of the damaged areas.
An innovative method for neuraxis radiotherapy using partial transmission block technique
Authors: Plowman P. N. , Doughty D.
Published: July 2009

B. Magee raises an interesting and important issue. The radiobiological data available (Plowman, 1989; Plowman & Doughty, 1991; Steel & Wheldon, 1992) support the concept that paediatric tumours will respond to low fraction sizes. The historical data from 40 to 50 years ago where, particularly French workers, treated gliomas with low fraction sizes and our own more recent anecdotal experience of initiating similar treatment for gliomas with incipient pressure (Plowman et al, 1987), both support the concept that even gliomas will respond to low fraction size radiotherapy.
The use of a chelating derivative of alpha melanocyte stimulating hormone for the clinical imaging of malignant melanoma
Authors: Wraight E. P. , Bard D. R. , Maughan T. S. , Knight C. G. , Page-Thomas D. P.
Published: July 2009

A novel chelating derivative of alpha melanocyte stimulating hormone, bisMSH-DTPA, has been used for the diagnostic targeting of malignant melanoma. 15 patients were investigated of whom nine were shown by other means to have active disease at the time of the scan. Tumours were imaged in all of these nine patients. Of a total of 46 lesions over 10 mm encountered, 41 (89%) were imaged. There were no false positives and in two cases bisMSH-DTPA was instrumental in reversing diagnoses made using ultrasound. Derivatives of melanocyte stimulating hormone may be of considerable value in targeting melanomas.
Fat suppression in magnetic resonance imaging at low field strength using binomial pulse sequences
Authors: Baudouin Christine J. , Bryant David J. , Young Ian R.
Published: July 2009

The use of binomial pulse sequences for fat suppression in MRI at low field strength (0.15 T) was investigated. Both spin-echo and inversion-recovery sequences were used and images obtained of the limbs, head and neck, and pelvis of volunteers and patients. Good fat suppression was seen particularly in small fields of view. Despite technical problems, chemical shift selective techniques can be applied at low field strength.
The influence of methotrexate on radiation-induced damage to different lengths of the rat spinal cord
Authors: Morris G. M. , Hopewell J. W. , Morris A. D.
Published: July 2009

An experimental model in the rat has been used to assess the possible enhancement of damage to the spinal cord when radiation is given in the presence of methotrexate (MTX). The dose of MTX used, 4 mg/kg, was the maximum dose that could be given to the rat, when administered into the cerebral spinal fluid circulation, without risk of serious neurological effects. Lengths of 4, 8 and 16 mm of the cervical spine were irradiated with single doses of X rays. For animals that developed paralysis within 30 weeks, caused predominantly by the presence of white matter necrosis, there was no evidence to indicate that MTX enhanced the radiation response of the rat spinal cord, at least at a more clinically relevant level of effect i.e. a low incidence of paralysis. However, for the doses associated with the 50% level of effect (ED50) to an 8 mm long field a significant (p < 0.005) enhancement of the response was seen, suggesting a dose modification factor of 1.19 ± 0.07. This was interpreted in terms of an hypothesis to explain the well documented volume effect for very small fields in the rat spinal cord which is based on the migration of viable cells in the periphery of the irradiated site. The apparent smaller effect seen when only 4 mm of the spine was irradiated might be related to the nature of the lesion induced at doses required to produce paralysis in these small fields; the lesions were not restricted to white matter but were more severe and also involved the grey matter and nerve roots after a slightly shorter latent period.
Minimizing radiation dose to patient and staff during fluoroscopic, nasoenteral tube insertions
Authors: Rudin Stephen , Bednarek Daniel R.
Published: July 2009

It is possible to reduce greatly fluoroscopic radiation dose if some image degradation is acceptable. Since the fluoroscopic image during nasoenteral tube placements is used for guidance and not for diagnosis, a lower contrast image with increased quantum mottle can be easily tolerated. The three methods to reduce the radiation dose rate that were investigated consisted of removing the antiscatter grid, increasing the diameter of the optical aperture controlling the percentage of light reaching the television camera from the image intensifier output phosphor, and setting the fluoroscopic mA to the minimum value so that the kVp could be maximized. Fluoroscopic frozen video frames of a clinical tube insertion comparing the images with and without the dose-saving techniques are presented. Measurements of the radiation dose rates using a Plexiglas phantom show that the dose for patient and staff during fluoroscopic-guided nasoenteral tube placements can be reduced by over a factor of 10 without significantly adversely affecting the actual placement procedure.
Magnetic resonance imaging of Fricke-doped agarose gels for the visualization of radiotherapy dose distributions in a lung phantom
Authors: Thomas S. J. , Wilkinson I. D. , Dixon A. K. , Dendy P. P.
Published: July 2009

When calculating a treatment plan for a radiation beam that passes through an inhomogeneity such as lung, the dose at each point needs to be modified to correct for the effect of the inhomogeneities. Many algorithms exist for making such corrections. Algorithms must be verified by measurements in phantoms. Measurements with an ionization chamber in a solid phantom can only be performed at a limited number of points, giving poor spatial resolution. Film dosimetry gives better spatial resolution, but the introduction of non-tissue equivalent photographic film represents a considerable perturbation of a tissue equivalent phantom.

Shultz et al (1990) and Olsson et al (1990) have recently described techniques for the measurement of absorbed dose using magnetic resonance imaging (MRI) of agarose gels doped with Fricke (iron (II) sulphate) solution. After Fe2+ has been oxidized by irradiation to Fe3+, the gel fixes the position of the ions, so that the distribution of Fe3+ in the gel corresponds to the dose distribution. The gel is then imaged to produce a map of the longitudinal proton relaxation time (T1). As a result of the paramagnetic properties of Fe3+, T1 is inversely proportional to Fe3+ concentration and hence to absorbed dose of radiation.

Thus, the technique provides a method of determining a continuous distribution of radiation dose within a phantom. This paper describes preliminary work using the technique on a phantom containing a volume of low density material designed to simulate lung.
An association between leakage of contrast seen on T-tube cholangiogram and subsequent biliary peritonitis
Authors: Mosley John G. , Barron Jenny A. , Holbrook Malcolm C. , Desai Anil
Published: July 2009

Intraperitoneal leakage of bile can occur after routine cholecystectomy, following removal of the T-tube and following invasive diagnostic procedures, such as percutaneous transhepatic cholangiography and liver biopsy (Corbett et al, 1986; Lygidakis, 1986; Anderson et al, 1988). Spontaneous rupture of the common bile duct causing biliary peritonitis has been described (Kyzer et al, 1986). Bile is a cause of chemical peritonitis. Bacterial contamination of bile leads quite frequently to virulent septic peritonitis (McLaughlin, 1942; Schwartz, 1979). In a recent prospective study of the complications of T-tube drainage after choledochotomy and common bile duct drainage, three cases of biliary peritonitis occurred after removal of latex-rubber tubes in 36 patients (Gillett et al, 1985). PVC tubes, introduced in the 1960s, were known to cause an increased incidence of bile peritonitis (Anderson et al, 1988) after their removal, but it is now standard practice to use latex-rubber tubes.
The dose-rate effect in interstitial brachytherapy: a controversy resolved
Authors: Hall Eric J. , Brenner David J.
Published: July 2009

Low-dose-rate interstitial implants generally involve a range of dose rates varying from about 0.3 to 1.5 Gy/h. It has been a matter of some debate as to whether such a variation in dose rate has any impact on clinical results, i.e. whether implant treatment time needs to be taken into account when prescribing the treatment dose. In particular, Paterson and Ellis both published data based on clinical experience suggesting that the prescribed dose should vary with overall treatment time, whereas the Paris school suggested that isoeffect dose should not be varied for treatment times between 3 and 8 days. Experimental radiobiological data obtained in vitro and in vivo imply a significant change in biological effectiveness over this range of dose rates with a greater variation for normal-tissue late effects than for tumour control. We show, based on radiobiological considerations and model calculations, that the disagreement between the two schools in their recommendations for generating isoeffect doses for different treatment times was a result of two factors. First, the Paterson recommendation was unequivocally based on matching limiting late effects, whereas the Paris system recommendations were based on an analysis of a combination of late and early effects. Second, the Paterson recommendations were based on a dosimetry system in which the dose rate does not change greatly with tumour volume, whereas the Paris recommendations were based on a dosimetric system in which dose rate is correlated with tumour volume, which in turn is correlated with changes in both tumour control and, especially, necrosis.
Sonographic detection of neonatal hydrometrocolpos
Authors: Banerjee Arpan K. , Clarke O. , MacDonald L. M.
Published: July 2009

Hydrometrocolpos is the result of an obstruction of the genital tract by an intact hymen, a midplane transverse septum, cloacal anomalies or vaginal atresia. This obstruction allows an accumulation of secretions from the infant cervical mucous glands in the vagina and uterus stimulated by maternal oestrogen (Wilson et al, 1978; Nyberg, 1990).

The incidence is reported to be between one in 16 000 births (Westerhout et al, 1964) and one in 30 000 births (Hill & Hirsch, 1985). Although several cases of hydrometrocolpos have been reported in the world literature (Mahoney & Chamberlain, 1940; Spencer & Levy, 1962; Reed & Griscom, 1973), there are very few reports of the ultrasonographic appearances of this condition (Sailer, 1979; Sawhney et al, 1990).

We present two cases of hydrometrocolpos which showed classical ultrasound features and review the literature on the subject.

A 1-day-old white girl, the product of a normal pregnancy and delivery, presented with a fluctuating mass protruding from the vagina. Clinical examination revealed a palpable abdominal mass and a swollen labia. An ultrasound of the abdomen and pelvis was performed using a 5 MHz probe. A 6 cm × 4 cm cystic left adnexal mass was demonstrated with no posterior acoustic enhancement. The mass contained several internal echoes (Fig. 1). The bladder was not distended and therefore not seen, but both kidneys were normal. The vaginal membrane was incised and 150 ml of milky white fluid was expelled.
An unusual osteochondral body in association with calcium pyrophosphate dihydrate crystal deposition disease
Authors: Jones A. C. , Preston B. J. , Doherty M.
Published: July 2009

Chronic pyrophosphate arthropathy is a recognized subset of osteoarthritis (OA) characterized by deposition of calcium pyrophosphate dihydrate (CPPD) crystals (McCarty, 1976). Typically a disease of the elderly, there is symptomatic and radiographic involvement of characteristic sites, including the patellofemoral, radiocarpal and glenohumeral joints (McCarty & Haskin, 1963; Resnick & Resnick, 1983). CPPD deposition in cartilage (chondrocalcinosis) occurs particularly in the articular and the meniscal cartilages of the knee, the symphysis pubis and the triangular ligament of the wrist (McCarty & Haskin, 1963; Resnick & Resnick, 1983). It has been postulated that sporadic pyrophosphate arthropathy may represent a hypertrophic response to joint insult (Doherty et al, 1984), with CPPD crystal formation being a marker of high extra-cellular pyrophosphate production reflecting increased cellular biosynthetic activity (Caswell et al, 1983).

Osteochondral bodies, arising in synovium by enchondral ossification of islands of chondroid metaplasia, are a common accompaniment to OA and may be particularly florid in the subset of pyrophosphate arthropathy (McCarty & Haskin, 1963; Resnick & Resnick, 1983). Such bodies form by a process of layered growth (Milgram, 1977b), and possibly reflect a generalized hyperplastic response (i.e. attempted repair) by joint tissues. We present a patient with CPPD arthropathy who developed an osteochondral body that showed features both of ossification and chondrocalcinosis.
Three-dimensional imaging of dual isotope data-sets in a case of acute myocardial infarction
Authors: Dilhuydy Hugo P. , McNamara Daniel , Lemieux Raymond J. , Martel Yves , de Guise Jacques A.
Published: July 2009

A patient with acute myocardial infarction was injected with indium 111 (111In)-antimyosin Fab. He then under-went planar imaging before receiving an additional dose of thallium 201 (2O1T1) so as to perform a dual isotope single photon emission computed tomography (SPECT) acquisition. Planar images showed vague myocardial uptake of antimyosin antibody. With tomographic slices, a more defined area of antimyosin uptake was seen but still with a low 111In signal-to-noise ratio. This area corresponded to a 2O1T1 defect. Two three-dimensional (3D) rendering methods showed a well matched 2O1T1 3D defect and 111In 3D hot spot and seemed to facilitate the localization of the infarct as well as the evaluation of its importance relative to the remaining viable tissue. This case study illustrates a situation where 3D imaging of dual isotope data-sets could be useful for direct visualization and localization of myocardial infarction.

A 61-year-old white male with a past history of occasional chest pain was admitted to the ICU for prolonged chest pain. He had multiple risk factors for coronary disease such as smoking (up to 40 cigarettes per day), essential hypertension, diabetes and a family history of coronary artery disease. Laboratory analysis showed elevated plasma enzyme levels of total creatine kinase (CK) (1289 U/l) and the electro-cardiogram showed an infarct in the anterior wall and a possible old inferior wall infarction (see Fig. 1). Five days after his admission coronary angiography revealed severe three-vessel disease.
Anatomy of percutaneous femoral artery puncture
Authors: Stubbs F. , Cumberland D. C.
Published: July 2009

The paper by Grier and Hartnell (1990) discusses the use of the inguinal skin crease and the site of maximal pulsation in femoral artery puncture, but omits mention of the mid-inguinal point. Defined as being “midway between the anterior superior iliac spine and the symphysis pubis”, this point is traditionally held by anatomists to be the most accurate landmark in locating the common femoral artery (Williams & Warwick, 1980).

The anatomical accuracy of the mid-inguinal point was tested by studying 10 adult cadavers, using one side only on each. A tape measure was placed accurately between the two points and the exact mid-point marked on skin. (As the symphysis pubis was impossible to palpate through embalmed skin it was located by a limited dissection.)
Anatomy of percutaneous femoral artery puncture
Authors: Hartnell G. G. , Grier D.
Published: July 2009

Thank you for giving us the opportunity to reply to the letter by Stubbs and Cumberland. We were certainly aware of the mid-inguinal point as a landmark for puncturing the femoral artery. In fact, this was the method which one of us was taught at the start of cardiology training over a decade ago. However, personal experience suggests that there are frequently practical problems when using this method for localizing femoral puncture sites.
Book reviews
Authors: Faulkner K.
Published: July 2009

The purpose of this book is to provide a basic introduction to both the clinical and technical aspects of digital imaging. It is intended to be read by anyone interested in the subject. The various chapters in the book have been written by a number of authors, all prominent in the field of digital imaging. The chapters are grouped together in two main sections, one dealing with clinical aspects and the other with the technical aspects of the subject.
Small bowel fistula secondary to endarteritis obliterans, complicating chemotherapy for small bowel lymphoma
Authors: Knowles S. , Smart H. E. , Al-Dawoud A. , Kerr D. J.
Published: July 2009

Endarteritis obliterans, pathological thickening of the intima associated with luminal stenosis of small and medium sized arteries, is a relatively common late tissue effect following radiotherapy, but it is not associated with cytotoxic drug administration. We report a patient treated with chemotherapy for recurrent lymphoma of the sigmoid colon, who developed a fistula between the large and small bowel which was associated with severe endarteritis obliterans.

A 66-year-old man presented to the surgeons with intermittent abdominal pain and diarrhoea. A barium enema demonstrated an annular narrowing in the sigmoid colon and the patient had a laparotomy which revealed a large tumour of the sigmoid colon invading the bladder and retroperitoneal structures.
Chest radiograph scoring system for use in preterm infants
Authors: Greenough A. , Yuksel B. , Karani J. , Page A.
Published: July 2009

We thank I. Hyde for this interest in our paper (Yuksel et al. 1991).

Two of our patients had undergone lobectomy for gross cystic degeneration following localized severe pulmonary interstitial emphysema. Both infants were ventilator-dependent at the time of lobectomy with deteriorating blood gases. As a consequence of this deterioration in respiratory status it was decided that they should undergo lobectomy following which their respiratory status improved and it was possible to extubate the infants.
Book reviews
Authors: Blngham J. B.
Published: July 2009

Reviewing this textbook was a relatively simple task as it only comprises of images of the joints.

The book is divided into seven sections, covering the shoulder, elbow, wrist and hand, fingers, hip, knee, ankle and foot. Multiple sections are displayed through each joint in coronal, axial and sagittal planes using a T  1-weighted sequence and displayed on the same page as an anatomical section in precisely the same plane in colour.
Calibration of a 0.08 Tesla magnetic resonance imager for in vivo T
1 and T
2 measurement
Authors: Keevil S. F. , Dolke G. , Armstrong P. , Smith M. A.
Published: July 2009

The magnetic resonance unit at St Bartholomew's Hospital is equipped with an upgraded MD800 resistive magnetic resonance imager (Imatec International Limited) operating at a field strength of 0.08 Tesia. In vivo spin-lattice relaxation times (T  1) can be measured using a saturation recovery/inversion recovery sequence (SRIR, T  R = 1000 ms, T  1 = 200 ms) and spin–spin relaxation times (T  2) using a four echo Carr- Purcell-Meiboom-Gill sequence (CPMG, T  R = 1000 ms, T  E = 32, 64, 96, 128 ms). The SRIR sequence consists of selective 90° pulses every 1000 ms, alternate 90° pulses being preceded by 200 ms adiabatic fast passage (AFP) inversion pulses. It can be considered to be an interleaved saturation recovery and inversion recovery sequence with gradient echoes. In each case a relaxation time map is produced on a pixel-by-pixel basis without the need for elaborate off-line image processing.

The aim of the work described was to investigate the accuracy and reproducibility of T  1 and T  2 values measured using the imager, and to determine suitable calibration factors before commencing a programme of clinical research.

The calibration was carried out using a relaxation time test object developed by the EEC Concerted Research Project Identification and Characterisation of Biological Tissues by NMR (EEC Concerted Research Project, 1988; Podo et al, 1988). This object consists of a Perspex disc with a series of holes into which glass tubes are inserted. Each tube contains a quantity of agarose gel doped with gadolinium (III) chloride to produce predictable relaxation properties (Walker et al, 1988, 1989). Calibration data and temperature correction factors for 0.08 T were available for the gels in the test object.
An alternative approach to contrast-detail testing of X-ray image intensifier systems
Authors: Kotre C. J. , Marshall N. W. , Faulkner K.
Published: July 2009

The difficulties of making the results of threshold contrast-detail diameter tests on X-ray image intensifier systems consistent with published performance standards are discussed. The current approach to contrast-detail testing is described and an alternative method intended to give greater consistency for all image intensifier input field diameters proposed. The current and alternative test conditions are compared on two image intensifier systems. The results obtained show that the contrast-detail curves for image intensifier systems with a wide range of input field diameters can be effectively normalized to be directly comparable to a common reference standard by applying the proposed alternative test conditions. The implications of this result on the interpretation of the contrast-detail test are discussed.
Book reviews
Authors: Davies A. M.
Published: July 2009

This 400 page text book is essentially an atlas of trauma radiology with the content almost entirely confined to the plain film. The seven chapters cover the various anatomical sites in a conventional manner; the skull and face, the spine etc. The exception is the first chapter, written by an American lawyer, entitled Radiology Malpractice in the Emergency Room. Some of the advice given is peculiar to American practices but may, in due course, become the norm in Europe.
Primary choroid plexus papilloma of the cerebellopontine angle: magnetic resonance imaging, computed tomographic and angiographic appearances
Authors: Jackson A. , Panizza B. J. , Hughes D. , Reid H.
Published: July 2009

The computed tomographic, angiographic and magnetic resonance imaging (MRI) appearances of a benign primary choroid plexus papilloma of the cerebellopontine angle are reported. Although benign, this tumour showed local invasion of the petrous temporal bone and mastoid air cells. The differential diagnosis of cerebellopontine angle lesions is discussed. Papilloma is suggested by the presence of a vascular, calcined, enhancing extra-axial mass in or around the cerebellopontine angle. MRI may show evidence of high vascularity and internal haemorrhage. Differentiation from other cerebellopontine tumours, most particularly meningioma, may not be possible on radiological features.
The optimum pressure of oxygen for radiotherapy of a mouse tumour
Authors: Perry P. M. , Nias A. H. W.
Published: July 2009

Our previous studies have shown that there is more regrowth delay in mammary tumours irradiated in C3H mice after 25 Gy when breathing normobaric oxygen than in those breathing air, as might be expected. However, in both cases this radiation response was reduced in anaesthetized animals in comparison with unanaesthetized control mice, when a time interval of only 10 min was allowed after anaesthesia. After 25 min, however, the response in air returned to the control level and the oxygen group now showed significantly more radiosensitization. We have now found that when tumour-bearing mice were exposed to different pressures of oxygen for that 25-min period after the induction of anaesthesia, before the tumours were treated with 25 Gy, there was even more regrowth delay with 2 atm pressure than 1, but that there was no further advantage from using 3 atm pressure of oxygen. Our data suggest that 2 atm may be the optimal pressure to use in anaesthetized mice and there is even a small benefit from using this pressure in unanaesthetized animals for a transplanted C3H mammary tumour.
A pilot study of accelerated fractionation in the radiotherapy of invasive carcinoma of the bladder
Authors: Cole D. J. , Durrant K. R. , Roberts J. T. , Dawes P. J. T. K. , Yosef H. , Hopewell J. W.
Published: July 2009

24 patients with muscle invasive carcinoma of the bladder were treated in a pilot study of twice daily fractionation at radiation doses of 1.8–2.0 Gy per fraction to total doses of 54–64 Gy to the bladder and 39.6–44 Gy to the whole pelvis. The treatment aim was to give 32 fractions in 22 days. The interfraction interval was a minimum of 6 h. The principle objective was to record acute and late tolerance, but local control and survival data is also presented. Acute radiation morbidity was scored according to the RTOG system. Grade 2 large bowel effects were seen in 52% of patients, Grade 3 effects in 26% and there was one Grade 4 and one Grade 5 effect. The mean duration of effect was 4.5 weeks although the more severe reactions were also more protracted. Grade 2 urinary effects occurred in 30% and Grade 3 in 17% of patients. The mean duration of effect was 7.2 weeks. There were no Grade 4 or 5 acute urinary effects. Late radiation morbidity was scored according to the EORTC/RTOG system and was assessable in 16 cases who survived more than 6 months. There were two cases (12%) of Grade 1 bowel toxicity, two cases of Grade 1 and three of Grade 2 urinary toxicity. There were no cases of late skin effects. Actuarial analysis at 2 years shows a local control probability of 56% and survival probability of 35%.
A flexion and extension device for dynamic MR imaging of the neck
Authors: Hadley D. M. , Condon B. R. , Richardson W.
Published: July 2009

Magnetic resonance (MR) imaging of flexion and extension manoeuvres in the cervical spine has proved useful in the clinical evaluation of bone and joint instability (Hadley & Condon, 1988; Jordan & Enzmann, 1991) as well as providing a research tool into the biomechanics of the living spinal cord (Condon & Hadley, 1988). Unfortunately the image acquisition procedure is time consuming. Difficulties in repositioning are coupled with problems of patient acceptibility caused by discomfort. Images have to be acquired with the patient's neck in flexion, extension and in a neutral position. Images taken at intermediate neck positions may also be necessary for a cine loop to be constructed so that the dynamics of the interactions between the cord and lesions (e.g. osteophytes, bone movement etc) can be adequately appreciated. In order to produce an image of sufficient resolution and contrast, each position must be maintained for several minutes. Even in normal volunteers this is rarely practicable if the neck is unsupported, so each position is maintained using various shapes of foam padding with the patient being removed from the imager between scans to alter their position. Repeated lifting and relocation of the patient's neck is required until a good angulation is achieved. Each time the patient also has to be carefully repositioned by the operator to ensure that the patient's midline is in the same plane as the long axis of the magnet. Ensuring correct angulation and positioning simultaneously is difficult and prone to error and scans have often to be repeated.
Portable chest radiography in intensive care: a comparison of computed and conventional radiography
Authors: Jennings Paul , Padley Simon P. G. , Hansell David M.
Published: July 2009

A prospective study was performed comparing computed and conventional radiography for the detection and visibility of cardiovascular devices in intensive care unit patients. Computed images were obtained using a commercially available 2K × 2K, 12-bit storage phosphor plate system. Image sets from 50 patients were assessed independently by three observers. A significant difference between the types of image was found for the detection of mediastinal drainage tubes and prosthetic valves. Computed images allowed greater confidence in the identification of courses and tips of lines. This advantage was most marked with edgeenhanced computed images.
Intrathoracic lymphadenopathy and HIV infection
Authors: Cowan N. C. , Salisbury J. R. , Moxham J.
Published: July 2009

A 32-year-old homosexual man, known to be HIV-seropositive for 7 years, presented with a 2-month history of a productive cough, night sweats, lethargy, right-sided upper chest discomfort and exertional dyspnoea. He smoked 10–20 cigarettes per day. There was no other relevant past medical history.

The patient looked thin and unwell but was afebrile. Small lymph nodes were palpable in the neck, axillae and groin. A chest radiograph showed right paratracheal lymphadenopathy with adjacent ill-defined air-space consolidation in the right upper lobe (Fig. 1). At fibreoptic bronchoscopy the only abnormality was tracheal indentation from the right. Other investigations at presentation included a blood CD4 lymphocyte count of 386/mm3 (normal value > 1000/mm3,) a CD8 lymphocyte count of 1819/mm3, Hb 13.6 g/dl, WBC 10.6 × 109, granulocytes 7.7 × 109/l, lymphocytes 2.7 × 109/1; urea, electrolytes and liver function tests were normal except for an elevated alkaline phosphatase (105 IU/1).
Radiation protection associated with well women breast cancer screening
Authors: Moores B. M. , Henshaw E. T.
Published: July 2009

We would like to thank all those who responded to our letter (Moores & Henshaw, 1992). We are fully conversant with the views expressed in all of the replies but unfortunately we feel that none address the fundamental operational radiation protection issues raised in our letter. Therefore, we would like to make the following comments to these replies.

1. Law et al quite rightly point out that: “Screening programmes… should be undertaken only if the expected medical benefits to the individuals examined and to the population as a whole exceed the economic and social costs, including the risks associated with the radiation involved. Since benefits are not always the same for all members of the population screening should be limited normally to particular groups”. The main elements of this statement are:

(a) A screening programme has responsibilities to the individual as well as to the population.

(b) Since well women participating in a breast screening programme are volunteers all those participating should be provided with information appropriate to their own circumstances if they are expected to give informed consent.

(c) Particular groups may need to be considered separately, particularly if items (a) and (b) are to be effectively implemented.
Book reviews
Authors: Shorvon P. J.
Published: July 2009

This is a delightful book, one to be savoured rather than studied. Japan is the mother of endoscopy where virtually all technical advances and experimentation are born. Endoscopists will enjoy the clear descriptions of the remarkable developments that are occurring and I think many radiologists will be amazed at what endoscopy can now achieve.
Book reviews
Authors: Jackson P. C.
Published: July 2009

This book has been written as an introduction for non-experts to the expanding world of magnetic resonance imaging (MRI). This book will appeal to the non-mathematically inclined since the use of equations is avoided completely. There are 11 chapters, taking the reader through a brief description of the requirements for various clinical imaging procedures and the basic concepts of nuclear magnetic resonance (NMR).
Sclerotic bone lesions in Gorlin's syndrome
Authors: Yee K C , Tan C Y , Bhatt K B , Davies A M
Published: July 2009

The naevoid basal cell carcinoma syndrome (NBCCS; Gorlin's Syndrome) was first fully described by Gorlin and Goltz in 1960 and consists of the classic triad of multiple basal cell carcinomas, odontogenic keratocysts and skeletal anomalies (Gorlin & Goltz, 1960; Gorlin, 1987). Osteosclerotic foci are a rare feature of this condition (Hermann & Som, 1981; Blinder et al, 1984) and we present a case in which bone scintigraphy proved helpful in excluding presumed metastatic disease as a cause of these sclerotic lesions.

A 46-year-old woman on follow-up for NBCCS complained of 2 months low back pain and sciatica in February 1990. Lumbosacral and pelvic radiographs, obtained at the time, showed multiple sclerotic foci within the pelvis (Figure 1) and lumbar vertebral bodies (Figure 2). A presumptive diagnosis of multiple metastases was made and the patient referred for further assessment.
Output factors for blocked fields
Authors: Mills J A , Tran Q-A
Published: July 2009

The recent paper by Dean (1992) demonstrated well the effect which blocking has on output factors of megavoltage therapy machines and confirms the results presented by Hans et al (1987). We have also confirmed these results on a Philips SL75 accelerator at 6 MV in the process of examining the dosimetry of mantle and irregular fields.
Book reviews
Authors: Meaney F M
Published: July 2009

This short hardcover book contains approximately 210 images in 120 pages. There are nine chapters divided according to body compartment or organ system, but gynaecological ultrasound is not included. There is only scanty coverage of paediatric conditions. Each chapter starts with a concise and accurate description of normal anatomy, reinforced by well labelled, representative images accompanied by line drawings where appropriate.
Book reviews
Authors: Goddard P
Published: July 2009

Well, another atlas of sectional anatomy. But does it have any particularly distinctive advantages or disadvantages for use as a radiological reference book?

The initial impression is that the images are clear and the legends are easy to read. There are, however, some conundrums if this atlas is really to be used for magnetic resonance imaging (MRI) work as well as computed tomography (CT).
Book reviews
Authors: Kabala J E
Published: July 2009

This book is intended to be “a companion to and an extension of volume 3 (of contemporary issues in computed tomography (CT); of the kidneys and adrenals) and has been expanded to encompass the entire urinary tract” and to include magnetic resonance imaging (MRI).

The book is in two sections.
Book reviews
Authors: Dawson P
Published: July 2009

This is a slightly bulky paperback of 411 pages dedicated, according to the frontal piece, to Ron—“My brain may belong to neuroradiology but my heart definitely belongs to you”!

The book claims to be designed as “a handy reference guide to neuroradiology … intended for neuroradiology and neuroscience students, fellows, clinicians and practising radiologists who perform neuroimaging procedures”. I think it is exactly what it claims to be, namely a reference guide.
Book review
Authors: Saunders A J S
Published: July 2009

There can be few ultrasound departments unacquainted with the first edition of this superb bench book for sonographers produced by Roger Sanders and his team of sonographers at the Johns Hopkins in Baltimore. It contains a wealth of straight factual information, but more importantly a host of practical tips and guides for separating the important diagnostic details from the background of “noise” of anatomical variation and artefact which form an inevitable part of an ultrasound scan.
Low-dose computed tomographic imaging in orbital trauma
Authors: Jackson A , Whitehouse R W
Published: July 2009

We review the findings in 75 computed tomographic (CT) examinations of 66 patients with orbital trauma who were imaged using a low-radiation-dose CT technique. Imaging was performed using a dynamic scan mode and exposure factors of 120 kVp and 80 mAs resulting in a skin dose of 11 mGy with an effective doseequivalent of 0.22 mSv. Image quality was diagnostic in all cases and excellent in 73 examinations. Soft-tissue abnormalities within the orbit including muscle adhesions were well demonstrated both on primary axial and reconstructed multiplanar images. The benefits of multiplanar reconstructions are stressed and the contribution of soft-tissue injuries to symptomatic diplopia is examined.
Assessment of the biliary tract by antegrade cholecystography after percutaneous cholecystostomy in patients with acute cholecystitis
Authors: Creasy T S , GRønvall S , Stage J G
Published: July 2009

The diagnostic value of formal antegrade cholecystography in a consecutive series of 44 patients with scintigraphically confirmed acute cholecystitis, treated by percutaneous transperitoneal cholecystostomy, has been evaluated. A total of six patients did not have antegrade cholecystography (catheter migration in five patients and gangrenous gallbladder perforation in one). Antegrade cholecystography was performed in the remaining 38: 10 patients with persisting cystic duct obstruction and 28 patients with patent cystic ducts. In the persisting cystic duct obstruction group, antegrade cholecystography confirmed the cause of gallbladder outflow obstruction as impacted calculi in either the gallbladder neck or cystic duct in all patients. In the patent cystic duct group, antegrade cholecystography demonstrated the common ducts well in all but two patients, and common duct calculi in eight of nine patients. Three patients had common duct calculi in nondilated ducts. Antegrade cholecystography is an easy and safe method of clarifying gallbladder pathology in all patients, and can be used to evaluate the common duct for associated common duct calculi in most patients.
Sedation and patient monitoring in vascular and interventional radiology
Authors: McDermott V G M , Chapman M E , Gillespie I
Published: July 2009

A postal survey of British and Irish interventional radiologists was carried out in 1991 in order to assess current practice with respect to sedation and monitoring of patients during angiography and interventional procedures. The response rate was 65%. 49% of patients are fasted prior to angiography and 68% prior to interventional procedures. Radiologists participate in obtaining consent in 60% of cases. Patients are often (50%) sedated for angiography and usually (62–94% depending on the procedure) sedated for interventional procedures. Nurses are present for most procedures, but are given the task of monitoring the patient's vital signs in only 49% of cases. Anaesthetists are present for less than 10% of interventional procedures. Pulse oximetry is used routinely in 20% of departments, and automatic blood pressure monitors in 16%. 28% of radiologists never administer oxygen to patients under sedation, whereas 4% always do. 43% of departments have a staffed recovery area. Most vascular/interventional suites are stocked with emergency drugs and 80% with a defibrillator. 28% of departments report at least one death during or shortly after a procedure during the last 10 years. 18% of interventional radiologists have taken a refresher course in cardiopulmonary resuscitation in the past year. These findings indicate a wide variation in practice and a need to standardize practice at a uniform high level.
Evaluation of “Gastromiro” for bowel opacification during computed tomography: comparison with diatrizoate and barium sulphate
Authors: Doyle G J , O'Donnell S C , McDonald J R , Murthy L N S , Keir M J , Wright A R
Published: July 2009

A new oral formulation of iopamidol, “Gastromiro”, was evaluated as a bowel contrast agent during abdominal computed tomography (CT). Comparison was made with the well established agents sodium/ meglumine diatrizoate (“Urografin 370”) and dilute barium sulphate (“E-Z CAT”) in a randomized, blind study of 150 consecutive patients undergoing abdominal and/or pelvic CT. Parameters assessed included quality of bowel opacification, artefact generation, contrast-medium palatibility, side effects and cost. No significant difference was found between the three contrast media in stomach- or small-bowel opacification. E-Z CAT was superior at opacifying the caecum/ascending colon. No compelling reason to choose a particular agent was found in the other assessed parameters, but cost is a significant factor.
Variations in individual radiation dose in a breast screening programme and consequences for the balance between associated risk and benefit
Authors: Law J
Published: July 2009

In a breast screening programme there is a small but inevitable risk of inducing some breast cancers that may appear many years later. This risk has to be compared with the benefits of detecting existing cancers at an early stage. In the current UK screening programme, for women aged 50–64 years and with a 3-year screening interval, the numbers detected greatly exceed the numbers predicted to be induced. For the individual, only those with very large and thick breasts who also have many views taken during the screening process appear to be at any appreciable risk, and the number for whom the risk of induction exceeds the probability of cancer detection is of the order of less than 1 per million, a risk level normally considered negligible. Results are also presented for younger age groups, and for a range of dose levels. Down to age 35 years, induction exceeds detection in less than about 1% of those screened, if a 3-yearly interval is maintained. The effect of shorter screening intervals is briefly considered. All results are based on repeat screening rounds (incidence rounds) using a single view and not on the initial (prevalence) round, and use UK data for breast cancer incidence. The calculation requires a number of assumptions and is intended as a preliminary one, pending more data on doses and numbers of women requiring specific numbers of films in screening programmes, but sufficient to promote discussion of the appropriate age range for breast screening.
Quantitative macroradiography with biochemical correlation of children with renal osteodystrophy
Authors: Wou P C S , Lima E , Turner C , Rigden S , Buckland-Wright J C
Published: July 2009

Renal osteodystrophy is a common complication of chronic renal failure in children. Its radiological appearances include those of hyperparathyroidism, namely subperiosteal bone resorption and ungual tuft erosion and rickets (Meema et al, 1978; Genant & Resnick, 1988).

Subperiosteal resorption has been considered the most sensitive radiographic sign of renal osteodystrophy (Sundaram, 1989) and as such, its extent has been assessed as an indicator for disease activity (Meema et al, 1978). Accurate measurements of its extent have been made using high definition magnification radiographs (Buckland-Wright et al, 1989; 1990). They showed that the extent of percentage subperiosteal resorption (i.e. subperiosteal resorption expressed as a percentage of the total subperiosteal bone length) and its change over time correlated with the level of serum parathyroid hormone (PTH). Thus a high PTH level was associated with extensive subperiosteal resorption. These findings were confirmed by a semiquantitative study employing conventional radiographic techniques, again showing a good correlation betwen PTH levels and the intensity of radiological change (Tratting et al, 1990). Both these studies involved patients who had severe renal osteodystrophy; children in the first study and an adult population in the second. Using the quantitative method devleloped for microfocal radiography, this study examined the extent of subperiosteal resorption in a group of children with controlled renal osteodystrophy, as reflected by their lower PTH levels. Two further questions were addressed.
Book reviews
Authors: Whitehouse G H
Published: July 2009

This book is intended not only for radiologists but also for other clinical specialists who are involved in the management of infertility. The authors' multidisciplinary approach to the subject is reflected by chapters on the clinical aspects of infertility, hysteroscopy and male infertility.
Book review
Authors: Tait D
Published: July 2009

Multidisciplinary activities and efforts are always welcome and refreshing and this book combines the experience of a radiologist, a pathologist and a clinician in the field of detection and management of screened breast abnormalities. However, as with many of its kind, it is difficult to know who the book is aimed at with considerable technical detail being included which might be too much for the non-specialist but better covered in other publications for the specialist in that particular area.
Physical evaluation of recent Kodak films for mammography
Authors: Fernández J M , Guibelalde E
Published: July 2009

Four Kodak films for mammography were evaluated for image quality and dose. Processing times and storage effects have also been evaluated.