bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous varicocele embolization in the treatment of infertility
Authors: Ferguson J M , Gillespie I N
Published: July 2009

We are grateful to Dr Marsman for his comments about our recent paper [1]. We did not analyse the results for clinical and subclinical vancoceles separately. Patients were referred for embolization with the diagnosis of a left sided varicocele, based on a clinical examination and utilizing Doppler ultrasound where necessary, associated with abnormal semen analysis and infertility. Venography is undertaken as part of the embolization procedure and not for diagnostic purposes. Indeed, a proximal competent valve can still be associated with a Varicocele related to more distal Venous incompetence and collateral venous pathways [2], which can only be abolished by distal embolization.
Time-course changes of contrast enhancement in iron colloid enhanced MRI in patients with hepatocellular carcinoma
Authors: Suto Y , Ametani M , Kamba M , Sugihara S
Published: July 2009

Time-course changes in contrast enhancement of chondroitin sulphate iron colloid (CSIC), an MR contrast agent, were determined in 12 patients with 20 lesions of classical hepatocellular carcinoma (HCC). Spin echo T  1 weighted (T  1  WI) and T  2 weighted images (T  2WI) were obtained before administration of CSIC and 1, 6 and 24 h after injection. The signal-to-noise ratio (SNR) in the tumour region and the liver and the tumour-to-liver contrast-to-noise ratio (CNR) were calculated, and time-course changes of these ratios were determined. SNRs for tumour before the administration of contrast medium did not differ significantly from SNRs after administration on T  1WI or T  2WI SNRs for the liver on both T  2WI and T  2WI were significantly lower at each time point after administration than before administration. The tumour-to-liver CNRs for both T  1WI and T  2WI were significantly higher after administration than before administration The maximum CNR was observed 6 h after administration on both T  1WI and T  2WI. The contrast enhancement was maintained for at least 24 h, with a peak at 6 h after administration. The prolonged enhancement obtained with CSIC has extended the time during which effective contrast is maintained.
Measurement of spin-lattice relaxation times with FLASH for dynamic MRI of the breast
Authors: Brookes J A , Redpath T W , Gilbert F J , Needham G , Murray A D
Published: July 2009

Using a variable flip angle gradient refocused imaging technique, dynamic quantitative T  1 relaxation maps acquired before and after the administration of a gadolinium contrast bolus enable the concentration–time curve of the paramagnetic agent in breast tissue to be calculated. This imaging technique has the aim of improving the diagnostic accuracy of MR mammography. Measurements with phantoms of calibrated T  1 values have been carried out to investigate the accuracy of the method, with particular reference to errors caused by incomplete spoiling of residual transverse magnetization and inaccurate radio frequency (RF) flipangle settings. A clinical example is presented. The method has potential use for any patient study which necessitates rapid quantitation of changing in vivo  T  1 values as a result of contrast agent injection.
The imaging performance of a storage phosphor system for dental radiography
Authors: Brettle D S , Workman A , Ellwood R P , Launders J H , Horner K , Davies R M
Published: July 2009

Direct digital imaging systems are becoming increasingly common in dental radiography. The majority of these systems are based on charge coupled device (CCD) technology. A relatively new system, based on photo-stimulable phosphor luminescence (PSPL), is now commercially available. This system appears to overcome some of the restrictions of CCD systems including those associated with the bulky detector, connecting wire, limited image size and limited exposure latitude. A physical evaluation of the PSPL system was conducted including measurements of sensitometric response, modulation transfer function (MTF), noise power spectrum (NPS), noise equivalent quanta (NEQ) and detective quantum efficiency (DQE). These measurements were compared with results obtained previously for Kodak Ektaspeed (E-speed) film. The results of the evaluation indicate that the PSPL system may be capable of operating at exposures up to 80% lower than for film with comparable image quality.
Bleeding and cholangiographic filling defects — an unavoidable link
Authors: Peh W C G , Lai E C S , Ngan H
Published: July 2009

A 61-year-old woman presented with repeated episodes of intermittent gastrointestinal bleeding. Haemoglobin level was 7.7 g dl−1. On examination, she had telangiectasia of the tongue, lips and nasal cavities. Gastroscopy showed two small vascular malformations in the stomach, but no bleeding source was identified. Except for some altered blood, no lesion was detected on colonoscopy.
Book reviews
Authors: Jones G S
Published: July 2009

The Nuclear Medicine Annual 1995 continues the tried and tested formula of a series of state of the art reviews. The format consists of eight sections, each written from internationally recognized nuclear medicine departments.
Book reviews
Authors: Kerslake R
Published: July 2009

Postgraduate examinations in radiology are a daunting prospect for even the best prepared of applicants. The vast quantities of factual material, the sheer diversity of the subject and the apparent propensity of examiners to pick on the most esoteric of subjects often induce a frenzied search for information as the critical dates approach.
MRA — How I do it and why?
Authors: Goddard P
Published: July 2009

Despite suggestions that the title should be changed by dropping the MRA and concentrating on the “How I do it and why?” the meeting at the Royal Society of Medicine on 22 January was a considerable success. The meeting concentrated on the clinical role of magnetic resonance angiography and how the various centres throughout the UK were utilizing this recent addition to our diagnostic armamentarium. The presentations highlighted the value of MRA in the different body systems from the head to the toe. Various themes recurred throughout the day.
Computerized planimetry in the objective assessment of the antispasmodic effect of Zamifenacin in double contrast barium enemas
Authors: Hughes T , Wright A R , Owen J P , Keir M J
Published: July 2009

A prospective, randomized, double-blind study was undertaken to evaluate Zamifenacin 30 mg (Pfizer Ltd), a novel, orally-administered, gut-specific muscarinic receptor antagonist, as an adjuvant to the double contrast barium enema examination (DCBE). Zamifenacin was compared with placebo in terms of side-effects and colonic tone. Analysis of colonic tone was carried out by two independent observers, using a subjective grading system and also by an objective method using computerized planimetry. Interobserver variability was also assessed. Zamifenacin is safe and well tolerated but at the prescribed dose is an ineffective antispasmodic for DCBE. Subjective assessment of colonic tone was shown to be of limited value whilst the objective analysis using computerized planimetry was reliable and highly reproducible.
Consistency of film optical density in mammographic screening programmes
Authors: Law J
Published: July 2009

Maintaining a constant and appropriate mean film optical density in mammography is an essential part of quality assurance in a breast screening programme. It depends on stability in X-ray exposure controls, film supplies, intensifying screens and film processing. A programme of weekly monitoring is described which helps to trace the source of any irregular or step-wise changes in any of the relevant parameters. Its results are also used to investigate by statistical methods the degree of film optical density variation achieved in periods of several weeks of apparent general stability. Results are presented for 20 X-ray sets and a total of 32 record periods of 8–10 weeks each. The mean standard deviation for density of a single film of a Perspex block was found to be 3.5%. For processor speed index it was the same while for X-ray set variations it was less than 2%. Neither of these last two variables showed any strong correlation with block film optical density.
Oesophageal tumour volume measurement using spiral CT
Authors: Liang E Y , Chan A , Chung S C S , Metreweli C
Published: July 2009

A CT technique for measuring oesophageal cancer tumour volume in the monitoring of local disease response following radiotherapy or chemotherapy is described. Patients with newly diagnosed oesophageal carcinoma were referred for pre- and post-chemotherapy CT scans. IV Buscopan was given to abolish peristalsis. Patients were scanned in prone position. Effervescent gas granules and Calogen (a negative contrast of fat density) were given. Spiral scanning was performed. The area of tumour on each 1 cm slice was measured. The sum of these areas gave tumour volume in cubic centimetres. The accuracy of the method was tested on patients who had had surgery. The volume of the segment of oesophagus containing tumour was measured by its weight and water displacement. Lumenal distention proximal and distal to the tumour was achieved in all patients. 10 gross surgical specimens were available for comparison with pre-operative CT. The correlation coefficient was 0.95. In conclusion, accurate tumour volume assessment was achieved with our technique.
Phrenic artery injury—a rare complication of percutaneous needle lung biopsy
Authors: Padhani A R , Scott W W
Published: July 2009

The phrenic artery is a small vessel that is not often visualized on CT and is at risk of injury during biopsy of low lung lesions. This may result in haemoperitoneum that will not be evident on post-biopsy chest X-rays. We present a patient with a bleeding tendency who had this unusual complication following a needle aspiration lung biopsy.
Acute haemorrhagic presentation of trigeminal neuroma
Authors: Ooi G C , Peh W C G , Fung C F
Published: July 2009

The acute presentation of trigeminal neuroma, due to sudden haemorrhage, in a 26-year-old Chinese man, is described. The clinical, CT and MRI features are reviewed together with the other four cases reported in the literature.
Modulation of normal tissue responses to radiation
Authors: El-Agamawi A Y , Hopewell J W , Plowman P N , Rezvani M , Wilding D
Published: July 2009

There is currently considerable interest in the possible modulation of normal tissue responses to radiation, to improve the therapeutic ratio in radiotherapy. Recent studies in pig skin have suggested that essential fatty acids, administered after radiation, can modulate the expression of both acute and late responses in this tissue [1,2]. There is also evidence that non-steroidal anti-inflammatory drugs will also modify the response of normal skin to irradiation [3].
Pneumocystis carinii pneumonia presenting as a solitary cavitating lung lesion in non-HIV immunosuppressed patients
Authors: Uwyyed K , Bar-Ziv J , Kramer M R
Published: July 2009

Pneumocystis carinii is one of the most common pulmonary opportunistic infections in immunodeficient patients. It has a classical chest radiographic appearance of bilateral interstitial infiltrates. Recently, cystic or cavitating lesions have been reported in HIV patients with Pneumocystis carinii pneumonia. We report two cases of non-AIDS immunosuppressed patients with the unusual presentation of a solitary cavity in the lung.
Paravesical suture granuloma resembling bladder carcinoma on CT scanning
Authors: Carroll K M , Sairam K , Olliff S P , Wallace D M A
Published: July 2009

Paravesical granuloma formation is a rare complication of inguinal herniorrhaphy. Infected non-absorbable suture material is the usual cause. We present a case of paravesical granuloma that was initially thought to be bladder carcinoma both clinically and on CT scanning. The patient presented with urinary symptoms. Repeated biopsies revealed only reactive changes with no evidence of malignancy. CT showed a mass which appeared to arise from the anterior aspect of the bladder with a central area of low attenuation. The diagnosis was established at cystoscopy with deep resection of the mass, when two retained silk stitches with surrounding pus and granulation tissue was found. The diagnosis of paravesical suture granuloma (PSG) should be considered in patients with suprapubic symptoms, no haematuria, an atypical mass and a history of herniorrhaphy, which may have been many years prior to the time of presentation.
Late aggressive meningioma following prophylactic cranial irradiation for acute lymphoblastic leukaemia
Authors: Laitt R D , Foreman N K
Published: July 2009

We read with interest the recent case report by Stein et al [1] describing the late development of an aggressive meningioma 20 years following cranial irradiation for acute lymphoblastic leukaemia (ALL). There are only a handful of case reports in the literature of meningioma developing between 5 and 23 years following cranial irradiation for ALL.
Book reviews
Authors: Whitehouse G H
Published: July 2009

This book describes topics of interest and recent advances in magnetic resonance imaging. There are 29 chapters broadly covering the central nervous system, locomotor system, abdomen, cardiovascular system and breast.
Book reviews
Authors: Healey T
Published: July 2009

This atlas deals with ultrasound, CT, MRI and nucleide imaging of the renal tract to complement the traditional methods of ascending and descending pyelography and cystography. It includes the examination of the penis, but not of the testes. The intended readership is the beginner, but that beginner needs a fair amount of basic information to get the maximum value from the atlas.
Renal Nuclear Medicine
Authors: Critchley M
Published: July 2009

A joint one day meeting, organized by the IPEMB Radionuclide Special Interest Group and the BIR Nuclear Medicine Sub-Committee, examined the state of the art with regard to measurement and intervention in renal nuclear medicine. The pressures from clinical audit, accreditation and medico-legal issues demand greater standardization of guidelines and protocols. There are many tests available and departments differ in personnel, access to radio-pharmaceuticals, age of equipment and physics support. Despite the variation in techniques employed, radionuclide methodology is well suited to the study of kidney function using plasma clearance measurements and/or imaging with renography or renal cortical scanning.
Radiation properties of a miniature X-ray device for radiosurgery
Authors: Biggs D S , Thomson E S
Published: July 2009

An alternative technology for performing interstitial intracranial radiosurgery is presented. Treatments are performed intraoperatively using a stereotactically mounted, miniature X-ray device. A concentrated, spherical pattern of X-rays is generated about the tip of a needle-like probe, which is inserted into the site of the lesion allowing the absorbed dose to healthy tissue to be minimized. A description of the device is given and results of investigations into the operating characteristics discussed.
Dose and image quality in mammography with an automatic beam quality system
Authors: Young K C , Ramsdale M L , Rust A
Published: July 2009

Radiation dose, contrast and image quality for automatic beam quality selection (OPDOSE) with the Siemens Mammomat 3000 has been investigated for different breast thicknesses and compared with those found using manually set tube potentials and a molybdenum target and filter. Automatic beam quality selection was found to have a negligible effect for breasts with a compressed breast thickness of less than 45 mm. However, for larger breasts substantial dose savings were achieved for a loss in contrast. For mammograms of compressed breasts with a thickness in excess of 60 mm the mean glandular dose (MGD) per film was 2.90 mGy for manually selected tube potentials with a molybdenum/molybdenum target filter combination as compared with 1.87 mGy using 26 kVp and a tungsten target with rhodium filtration. The contrast loss in using OPDOSE was measured with a test object to be about 10% for breast thicknesses in excess of 45 mm. The standard breast model, which assumes a 50% glandular content, did not provide a good fit to the MGD for women attending for breast screening in the age range 50 to 64 years.
Renal function and the excretion of contrast agents
Authors: Dawson P , Peters A M
Published: July 2009

The renal excretion of intravascular iodinated X-ray and gadolinium chelate MR contrast is examined theoretically. An expression is derived for the proportion of an administered dose of such an agent excreted in any given time in the face of varying levels of renal function. It is shown that a family of curves may be generated from which an estimate of this proportion for any time may be made. Some circumstances in which such knowledge may be useful are briefly discussed.
Kaposi's sarcoma of the rectum—treatment with radiation therapy
Authors: Kaufmann T , Nisce L Z , Coleman M
Published: July 2009

The number of patients afflicted with the acquired immune deficiency syndrome (AIDS) is on the rise. About 30% of AIDS patients develop Kaposi's sarcoma. Although the skin is the most common site of involvement, lesions may encompass the gastrointestinal tract. The purpose of this report is to describe a patient with AIDS related Kaposi's sarcoma of the rectum, successfully treated with radiation therapy. We believe this to be a useful technique in the treatment of this condition.
A pulmonary embolus, or what?
Authors: Uberoi R , Jenkins L , Marshall A J , Wells I P
Published: July 2009

A 36-year-old man who had previously been well, presented with a 7 day history of shortness of breath and sudden onset of left sided pleuritic chest pain. On admission he was apyrexial and not distressed. His pulse and blood pressure (120/85) were normal. There was a soft systolic murmur in the pulmonary area. The chest was clear on auscultation and there was no evidence of lymphadenopathy or abdominal abnormality. He had a normal white count (4.9 109 l−1), haemoglobin (14.8 g 1−1), urea and electrolytes. An electrocardiogram (ECG) demonstrated inversion of T waves in lead 3 only. A portable chest radiograph was performed (Figure 1), followed immediately by a ventilation and perfusion scan (Figure 2).
Quantitative perfusion parameters of focal nodular hyperplasia and normal liver parenchyma as determined by electron beam tomography
Authors: Dubowitz D J , Miles K A
Published: July 2009

Dr Groell and colleagues are to be commended on their thorough study of quantitative perfusion in focal nodular hyperplasia (FNH) of the liver [1]. As they have described, the sonographic, CT and angiographic findings in FNH are not specific. Perfusion values may not be specific for FNH, and it is not always the case that perfusionin FNH is higher than in hypervascular metastases.
Nasolacrimal duct opacity on CT
Authors: Loftus W K , Kew J , Metreweli C
Published: July 2009

A retrospective analysis of 100 coronal sinus CT scans was performed to investigate the frequency of opacity of the nasolacrimal duct and determine if there was any correlation between the pattern of duct opacity and the presence of inflammatory sinus disease. The study showed that the nasolacrimal ducts are opaque in the majority of normal people and that there is no relationship to inflammatory sinus disease.
Detection of early scirrhous carcinoma of the stomach by endoscopic ultrasonography
Authors: Fujishima H , Chijiiwa Y , Nawata H
Published: July 2009

The endoscopic ultrasonography (US) characteristics of early scirrhous carcinoma of the stomach (ESS) were evaluated in four patients. ESS was defined as the presence of poorly differentiated carcinoma cells spreading through the submucosa and muscularis propria in association with a marked desmoplastic reaction without serosal invasion. ESS was characterized by localized irregular hypoechoic enlargement of the third (sub-mucosal) and the fourth (muscularis propria) layers. The fifth (serosal) layer was normal. The third and fourth layers showed a threefold increase in thickness compared with the thickness of these layers in healthy subjects. Our results suggest that endoscopic US is useful for diagnosis of ESS.
Endoanal ultrasound during contraction of the anal sphincter—improved definition and diagnostic accuracy
Authors: Rieger N A , Downey P R , Wattchow D A
Published: July 2009

Endoanal ultrasound was used in the investigation of 26 patients with faecal incontinence. In each case images of the anal sphincter were taken at rest and during contraction or squeezing (dynamic). Better definition of the normal anal sphincter or anal sphincter defects was obtained in 16 (62%) of the patients with imaging during contraction. In eight of the 13 patients with a sphincter defect there was better definition of the defect and increased separation of the ends of the sphincter during contraction. Imaging during contraction improves diagnostic accuracy and is a useful adjunct with endoanal ultrasound.
Book reviews
Authors: Kemp G J
Published: July 2009

The diagnostic use of magnetic resonance (MR) imaging has put MR machines all over the world. Yet the use of MR spectroscopy to obtain chemical information is the older application.
Book reviews
Authors: Whitehouse G H
Published: July 2009

In this atlas, all parts of the body in normal living subjects are displayed by CT and MRI. The images have been obtained by fourth generation CT scanners, using intravascular and gastrointestinal contrast medium where appropriate, and by a 1.5 tesla MR system.
Book reviews
Authors: White D W
Published: July 2009

This CD ROM and CDi is another addition to the interactive world of anatomy on the computer. The package consists of a standard CD ROM for use with a conventional PC system and a CDi or compact disc interactive allows the package to be played via a CDi system onto a TV screen.
Brachytherapy — clinical dosimetry and the integration of therapies of gynaecological cancer
Authors: Joslin C A
Published: July 2009

The success of irradiation in providing total tumour control in gynaecological cancer is dependent upon appropriate clinical dosimetry. This in turn, will often depend upon the successful integration of external and intracavitary irradiation. Like a successful marriage, both partners must be suited, if not the end result can be failure of both physical and temporal integration. If things don't work out accountability will be necessary to determine causation and this fact was, in principle, identified by the Chairman of the meeting, Dr Peter Blake, by drawing attention to the importance of keeping appropriate records of all brachytherapy treatment. This was further expanded by Mary Wilkins who identified the need for specifying standard treatment with appropriate check procedures and records.
Patterns of chronic adhesive arachnoiditis following Myodil myelography: the significance of spinal canal stenosis and previous surgery
Authors: Laitt R , Jackson A , Isherwood I
Published: July 2009

109 patients who had undergone Myodil myelography on at least one occasion were identified. The patterns of lumbar nerve root distribution in this group were examined using magnetic resonance imaging. The relationship between these patterns and the presence of spinal stenosis or previous surgery was investigated. Chronic adhesive arachnoiditic nerve root patterns were seen in 68 patients and were classified into three groups according to Delemarter et al. Central clumping of nerve roots (type 1) and complete opacification of the thecal sac (type 3), extending over at least one vertebral level, were significantly related to spinal stenosis at an adjacent level (p<0.0001). Peripheral adhesion of nerve roots to the theca (type 2) was significantly related to previous surgery at the level of abnormality (p<0.00005). Only a single case of arachnoiditic nerve root patterns was seen in the absence of stenosis or previous surgery. We conclude that chronic adhesive arachnoiditis is significantly related to previous Myodil myelography in the presence of spinal stenosis or previous surgery but that Myodil alone rarely produces these changes.
MRI as an aid to the fitting of tracheo-oesophageal Blom–Singer valves post-laryngectomy
Authors: Brunton J N , Needham G , Mickleburgh J E
Published: July 2009

The Blom–Singer valve is a device for facilitating speech in patients who have undergone total laryngectomy. The valve is inserted into a surgically created tracheo-oesophageal fistula. Fitting the valve and determining the correct length and direction of the fistula, although usually straightforward, can be difficult. We describe two patients in whom MR imaging of the fistula tract has aided valve fitting.
The influence of air cavities on the optic chiasm dose during pituitary radiotherapy for acromegaly
Authors: Jones B , Samarasekara S , Tan L T , Mayles W P M
Published: July 2009

The treatment planning of acromegalic patients can be complicated by the presence of abnormally large frontal air sinuses which allow increased anterior beam transmission causing increased dose to the optic nerve and chiasm which, if excessive, can result in blindness. This potential problem has been investigated by computer treatment planning exercises which have allowed for a variable thickness (1–3 cm) of air cavity beneath the frontal field and for different weightings of the lateral opposed fields relative to the anterior field. The resultant overdosage can be greater than 5% of the intended dose. The increased biological effect from errors of this magnitude is sufficient to increase the risk of optic nerve damage since neural tissue is very sensitive to small increments in fraction size. Even when the reduced attenuation is allowed for in the computer plan, the thickness of the air sinuses varies across the field so that irradiation through the frontal enlarged frontal air sinuses causes inhomogeneous dose distributions in the target volume. Acromegalic patients should therefore be treated with a more superior beam which would avoid the air sinuses altogether.
Specification and initial evaluation of a multiple application teleradiology system
Authors: O'Hare N J , Wallis F , Kennedy J M T , Hickey E , McDermott G J , Dowling A , Murphy J , Malone J F
Published: July 2009

The digitization and transmission of medical images is becoming increasingly more important and available. The selection of appropriate clinical applications for teleradiology systems is an important factor in determining the success of such ventures. In this paper, the selection of such applications and the evaluation of the teleradiology system is described. The system (LIAISON™, CAPTEC Ltd, Malahide, Ireland) is PC based and is capable of digitization and transmission of three categories of medical images: (1) plain film radiographs; (2) CT film data and (3) video sequences such as ultrasound scans. A comprehensive technical evaluation was carried out on the acquisition and display station in which various parameters such as spatial resolution, signal-to-noise ratio (SNR), and distortion were investigated. Results showed that the system performed well within specifications. An exploratory clinical evaluation was performed using a case mix of subtle fractures, chests and dislocations, and CT scans. Here the system performed well with a diagnostic accuracy of 95% for the digital image compared with the analogue image.
Spatial distribution of femoral bone mineral in dual energy X-ray absorptiometry images: a possible technique to improve discrimination between normal and osteoporotic patients
Authors: Berry E , Truscott J G , Stewart S P , Smith M A
Published: July 2009

The measurement of bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA) provides an indicator of subsequent risk of hip fracture, but because of the significant overlap of measurements obtained from osteoporotic and control groups its predictive power is limited. The radiographic technique of Singh grading for the assessment of femoral osteoporosis utilizes information about the distribution of trabecular bundles, but the morphological information available in the DXA image has not previously been analysed. In this study of DXA images from 64 individuals (32 controls and 32 classified as osteoporotic) a subjective grading technique analogous to Singh grading is proposed, and quantitative measurements are made of image features corresponding to two of the categories. Discrimination was assessed using receiver operating characteristic (ROC) curves: the best discrimination was by spinal BMD (AZ = 0.85±0.05) a performance equalled by one of the new parameters; the subjective grading method (Az = 0.79±0.07) performed as well as measurements of BMD in the femur. These results suggest that although the alternative measures do not improve on the discrimination possible using spinal BMD, morphological information from the hip itself may in the future have a place in the assessment of bone quality.
Survey on image quality and dose levels used in Europe for mammography
Authors: Verdun F R , Moeckli R , Valley J-F , Bochud F , Hessler C
Published: July 2009

Quality assurance programmes are becoming a common practice in the field of mammography. At the present time several recommendations exist and different test objects are used to optimize this radiological procedure. The goal of this study was to check if geographically distant centres using different quality control procedures were comparable when using a common objective way of assessing image quality. The results show that consensus still needs to be found among radiologists to reach a satisfactory level of harmony between patient doses and image quality in Europe.
Kilovoltage measurement with rhodium target and filters on mammography X-ray machines
Authors: Underwood A C , Law J , Goodman D A , Robinson A , Rust A
Published: July 2009

X-ray machines used for mammography have, until recently, almost exclusively employed molybdenum (Mo) as anode material and filtration. In the UK, the RMI model 232 kVp meter is used extensively for the measurement of kilovoltage on such equipment. This unit is provided with switchable internal calibration only for molybdenum and molybdenum, or tungsten and aluminium, as anode and filtration, respectively. However, rhodium (Rh) has recently been introduced for filtration with either a molybdenum or rhodium anode in mammography equipment but, as yet, calibration facilities are not available for rhodium spectra. In this work, appropriate corrections for readings obtained with the RMI 232 kVp meter are derived for use with rhodium as filtration material with either molybdenum or rhodium anode material. An intercomparison between measurements made with four RMI model 232 kVp meters and nine IGE DMR X-ray sets was undertaken. The reproducibility of the instruments was confirmed and measurements of tube potential made on each of the X-ray sets pooled. Measurements were made from a nominal 25–35 kVp using Mo/Mo, Mo/Rh and Rh/Rh target/filter combinations. Corrections for readings obtained with Mo/Rh and Rh/Rh were produced by comparison with readings obtained with Mo/Mo, assuming stability of tube potential between anodes. The results are compared with data recently produced by the manufacturer of the meter.
A patient with chest pain
Authors: Walker J
Published: July 2009

This is a routine chest radiograph from a patient admitted to a general medical ward with chest pain (Figure 1). How would you report it?
Evaluation of palpable breast masses with 201TI scintigraphy
Authors: Roebuck D J
Published: July 2009

Rebollo et al [1] report an experiment in which they irradiated 39 women with thallium-201 in an attempt to assess their palpable breast masses for malignancy.
Book reviews
Authors: Manning D
Published: July 2009

This is the first in a series of annual publications focused on radiography in both its therapeutic and diagnostic guises, aiming to present snapshot views on newsworthy subjects. Intended as a digest of topical issues both technical and political, the book sees its audience as the community of radiographic undergraduates as well as those working in clinical practice.
Book reviews
Authors: Weston M J
Published: July 2009

This small book is unashamedly American. It is written by three obstetricians and contains chapters such as, “The Office Practice” describing how to set up an ultrasound service within private rooms, as well as a chapter on how to control legal liability. There are, of course, a few truths that also apply to British radiologists.
Book reviews
Authors: Banerjee A K
Published: July 2009

Lung cancer is one of the commonest cancers affecting people in the Western world. Successful treatment of this condition depends on diagnosing the cancer as early as possible. All general radiologists are expected to be proficient in the analysis of the plain chest radiograph and the radiologist is often the first person to diagnose malignancy. Lung cancers, of course, are frequently missed.
Effects of radiation on the cell proliferation kinetics of epithelial tissues—therapeutic implications
Authors: Morris G M
Published: July 2009

The cell kinetic responses of the epithelia of the skin, oral mucosa and intestine to photon irradiation are reviewed. One of the fundamental assumptions made in the development of mathematical models, used to predict the acute response of normal tissues to changes in fractionation protocols, is “equal effect per fraction”. There is now accumulating cell kinetic data to indicate that this assumption is unlikely to be valid. The implications of these findings are discussed.
The reduction of tumour control with increasing overall time: mathematical considerations
Authors: Jones B , Dale R G
Published: July 2009

The rate of loss of tumour control (dp/dt) with extension of treatment time is analysed to assess the relative contributions of radiobiological parameters (radiosensitivity, clonogen doubling time, clonogen numbers and fractionation schedule) on such loss. Linear quadratic modelling and Poisson statistics are used to study individual tumour responses. A heterogeneous tumour population is constructed by the use of random sampling techniques to allow for variations in intrinsic radiosensitivity and clonogen doubling times. Average tumour control probability is calculated for this population for two different fractionation schedules (60 Gy in 30 fractions and 50 Gy in 15 fractions), each given over 15–60 days. The magnitude of dp/dt will depend upon the tumour cure probability (P): the loss of control will be most significant for tumours which have a cure of 37% when the Poisson survival model is used. The analysis suggests that compensation for short unscheduled treatment gaps (e.g. by increasing the total dose or rescheduling with use of weekend treatment sessions) may only be required for difficult tumours (i.e. radioresistant and/or with short clonogen doubling times). Where pre-treatment clonogen numbers are relatively low as in small volume tumours or after surgical debulking, the model predicts that correction for short treatment gaps is probably not required if the average effective clonogen doubling times are longer than 5 days. Different dose–time–fractionation schedules, even though producing similar overall cure rates in clinical practice, may actually be achieving cures in different subpopulations within a population of tumours, since the value of dp/dt in each individual tumour will depend upon the set of radiobiological parameters given above. For a hypothetical randomly selected heterogeneous tumour population the predicted rates of loss of tumour control produced by an extension in treatment time are 0.9 and 1.1% per day, respectively, for the above fractionation schedules. These values are close to those reported in the clinical literature for the first 2 weeks of treatment prolongation (1–2% per day for squamous cell carcinomas). The Poisson method, when combined with random sampling techniques, consequently provides realistic data. Modelling of this clinical problem provides an insight into how tumour sub-populations, each characterized by its own set of radiobiological parameters, can influence the overall rate of loss of tumour control in a heterogeneous population. Random sampling techniques should be considered as necessary precursors for the assessment of the choices of dose/fractionation in future clinical trials particularly when more precise data regarding the radiobiological parameters and their statistical variations become available.
Abscess of the adductor muscles of the thigh—an unusual complication of Crohn's disease
Authors: Denton E R E , Jamieson C P , Rankin S C
Published: July 2009

The occurrence of a Crohn's abscess involving the hamstring muscle group has not been reported previously. We report this diagnosis in a patient with ileocolonic Crohn's disease who had presented earlier with a presacral abscess.
Multiple highly reflective foci in the renal parenchyma are not specific for pseudoxanthoma elasticum
Authors: Domjan J M , Dewbury K C
Published: July 2009

A characteristic appearance of highly reflective foci in the renal parenchyma has been reported in patients with pseudoxanthoma elasticum. We describe a similar patient but in addition have found two patients with a similar appearance on ultrasound who have no other evidence of the condition. The appearance of highly reflective foci in the renal parenchyma is not therefore specific for pseudoxanthoma elasticum.
Malignant teratoma in the thyroid gland
Authors: Ramadas K , Augustin J , Parameswaran S , Joseph F
Published: July 2009

Malignant teratomas of the thyroid gland are rare. These are highly malignant tumours with a high frequency of local recurrence and metastases following surgery. We report a case of malignant teratoma of the thyroid gland in a 35-year-old female, who developed local recurrence immediately following total thyroidectomy. Despite achieving local control following chemotherapy and local radiotherapy, the patient developed distant relapse illustrating the aggressive nature of the disease.
Anaphylactic IgE and IgG1 production for hapten can be enhanced by contrast media
Authors: Miyauchi T , Hirano T , Ushiyama C , Ovary Z , Okumura K , Katayama H
Published: July 2009

Various side effects have been associated with the clinical use of contrast media. Immunological mechanisms have been proposed but there have been very few experimental studies with animal models. We have attempted to develop murine models to determine whether or not anaphylactic antibodies such as IgE and IgG1 against hapten (DNP) were enhanced with contrast medium (iopamidol) as an adjuvant or if the contrast medium itself produced antibodies of the IgE class. The results showed that anti-hapten IgE and IgG1 production was greatly enhanced with immunogen plus contrast medium. Anti-contrast medium antibodies of the IgE class could not be detected by PCA reactions. The enhancement of IgE and IgG1 production for hapten was associated with IL-4 release by the neutralization test used by monoclonal anti-IL-4 antibodies. This is the first observation to show that contrast media may have a strong adjuvant effect for the production of IgE and IgG1. This murine model demonstrates a possible immunological function of contrast media in vivo.
Development of an experimental model for high dose rate endocavitary irradiation of the rat rectum
Authors: Johannessen H O , Olsen D R , Giercksky K E
Published: July 2009

Experimental data indicate a greater tolerance for endocavitary than for external beam irradiation of the normal rectal tissue in the rat. Increased tolerance has been attributed to temperature induced rectal hypoxia and a reduction of the dose to the mesentery. The general scarcity of experimental work in the field and the problems concerning hypoxia and dosimetry motivated the development of the current model. An 8 mm diameter endocavitary applicator was used for symmetrical dilatation and central introduction of the 192Ir source into the rectum of male Fischer F344 rats. Pulse oximetry and pO2-electrode readings from the intubated rectum gave no indication of radiobiological hypoxia. In vitro and in vivo thermoluminescence dosimetry (TLD) was supported by MRI based ferrous sulphate gel dosimetry. Using a 25 mm length source configuration the 90% isodose incorporated a 13 mm length segment of the rectum, and a 5–6% maximum deviation from the calculated dose was observed by the TLD and MRI based gel dosimetry. The ureters, the bladder and the skin were the only organs other than the target organ which received doses greater than 10% of the rectal dose. The model seems to be suitable for dose effect studies since endocavitary irradiation of the rat rectum can be performed without induction of local tissue hypoxia.
Sclerotic skeletal haemangiomatosis presenting with spinal cord compression — CT and MRI findings
Authors: Chrysikopoulos H , Roussakis A , Tsakraklides V , Vassilouthis J
Published: July 2009

We report the case of a 59-year-old man with skeletal haemangiomatosis who presented with progressive bilateral lower extremity weakness. Computed tomography (CT) and magnetic resonance imaging (MRI) located the causative lesion in the neural arch of the T4 vertebra. CT demonstrated osseous expansion with a mixed lytic and sclerotic pattern. MRI of the lesion showed hypointensity on T  1 weighted images, mixed signal intensity on T  2 weighted images and moderate contrast enhancement. Similar but less extensive lesions were present in other vertebrae as well as ribs.
Book reviews
Authors: Davies A M
Published: July 2009

Diagnosis of Bone and Joint Disorders by Resnick, now in its 3rd edition, is without doubt the finest musculoskeletal imaging textbook available. Any radiologist wishing to specialize in this field should either have a copy or have access to a copy. It is, therefore, of considerable interest to find that this definitive book is now available on CD-ROM.
External radiation protection audit in National Health Service hospitals
Authors: Rogers A T , Crawley M T , Dixon-Brown A , Dudley N J , Nicholas D , Pearson D , Przeslak A , Weatherburn H
Published: July 2009

Radiation protection advisers are accustomed to carrying out internal audit in organizations for which they provide services but, traditionally, external audit has not been a part of the radiation protection adviser function. To provide an external audit function, two teams of radiation protection advisers undertook external radiation protection audits of their respective organizations, including the radiation protection adviser function itself. These audits were more representative of audits or inspections carried out by government agencies, for example the Health and Safety Executive and the former Inspectorate of Pollution, now the Environment Agency. Subsequently, reports, including recommendations for remedial action, were prepared for each management by the external auditors. The process of setting up and carrying out the external audits is described. Guidelines are suggested for those seeking to carry out an external audit.
The absolute signal-to-noise ratio in MRI acceptance testing
Authors: McRobbie D W
Published: July 2009

The absolute signal-to-noise ratio (SNR) measurable from images is defined and related to the theoretical fundamental SNR for MRI. Absolute SNR for quadrature head coils was obtained by both measurement and analysis of published data for MRI systems in the range 0.5–1.5 T. Mean absolute SNR for 22 MRI systems was 1.59±0.25 × 104 Hz½ ml−1 T−1 and did not vary significantly with the static field strength or gradient strength and signal bandwidth. This can be related to the fundamental SNR calculated as 2.36 × 104 Hz½ ml−1 T−1 through an effective noise figure with an average value of 3.4 dB for the 22 systems. Use of this methodology is discussed in relation to acceptance testing and performance assessment.
Endovascular repair of abdominal aortic aneurysms
Authors: Dyet J F
Published: July 2009

Endovascular repair of abdominal aortic aneurysms is an exciting new procedure. Depending on aneurysm morphology, tube grafts, bifurcated grafts or aorto–uni–iliac systems may be used. Early results are encouraging but many problems will require solving before the technique comes into general use.
A curious cause of a paediatric abdominal mass
Authors: Howlett D C , Malcolm P N , Macdonald L M
Published: July 2009

A 4-year-old West Indian girl presented with a 4 day history of fever and upper abdominal pain. On examination she was unwell with a temperature of 39.5°C. She had “beetroot red” palms and the mucous membranes of her mouth and eyes were infected.
Imaging of anorectal function
Authors: Halligan S
Published: July 2009

Over the last decade the development of sophisticated physiological tests to investigate anorectal function has increased understanding of pelvic floor pathology and stimulated advances in imaging. This commentary will specifically deal with imaging of anorectal dysfunction, namely anal incontinence and constipation. However, it could be argued that the pelvic floor forms a functional unit and should be treated as such. Our inclination to divide this organ into urological, gynaecological and coloproctological territory, each attracting its own expert interest whilst ignoring the contributions of others, should be resisted. The global pelvic floor specialist has arrived, and his closest ally is the radiologist.
Metallic endoprostheses in oesophageal carcinoma
Authors: Watkinson A F
Published: July 2009

Oesophageal carcinoma is a relatively common disease with approximately 3500 new cases presenting in the United Kingdom every year. In more than 50% of patients curative resection is inappropriate and only palliative therapy is possible [1]. The aim of palliative treatment is to improve the patient's quality of life, making oral feeding possible with speed and safety, and without the need for long or repeated hospital admissions [2, 3]. Traditional methods have had limited success in achieving this aim and have included surgery [4], radiotherapy [5–7] and plastic endoprostheses [8–10].
The use of metoclopramide for the small bowel meal examination: pre-procedural versus peri-procedural oral administration
Authors: Paul N , Rawlinson J , Keir M
Published: July 2009

Administration of oral metoclopramide reduces the transit time for barium to reach the caecum during a small bowel meal (SBM). Current practice is to administer the metoclopramide 5–10 min prior to the barium. We devised a prospective randomized, controlled trial to assess whether administration of metoclopramide 90 min prior to the barium would further reduce the transit time without adversely affecting the quality of the study. Although administration of oral metoclopramide significantly reduced the transit time when compared with a control population, there was no significant difference in transit time between the groups which received metoclopramide.