bluuebunny/crossref_metadata_2025 huggingface dataset:
MRI appearances of the axilla in treated breast cancer.
Authors: Potterton A J , Yuille F , Tinkler S , Chippindale A J , Wilsdon J B , Lucraft H H , Dawes P J , Coulthard A
Published: June 2014

Differentiation between recurrent axillary disease and changes due to radiotherapy or surgery has major implications for management in patients following breast cancer treatment, but clinical examination of the axilla may be difficult. This study was undertaken to correlate the MRI appearances of the axilla following breast cancer treatment with clinical outcome. 74 women with treated breast cancer were evaluated by MRI (0.5 T) and the appearances defined by consensus. Outcome was assessed by long-term clinical follow-up. 62 women had symptoms related to the axilla while 12 were scanned to stage the axilla. None of the axillary staging group had abnormal MRI appearances and none of these subsequently developed recurrence. The 62 symptomatic women were subdivided according to MRI appearances. 22 had normal axillary appearances, 18 had an axillary mass and 22 women had abnormal axillary appearances (rated mild, moderate and severe) in the absence of a mass. Normal axillary appearances on MRI excluded recurrent disease as the cause of symptoms with a specificity of 94.7% and a positive predictive value (PPV) of 95.5%. The presence of an axillary mass was commonly but not exclusively due to recurrent disease (sensitivity 68.4%, specificity 88.4%, PPV 72.2%). Sensitivity for diagnosis of axillary recurrence was increased to 89.5% with a specificity of 76.7% if the criteria for recurrent disease were taken as either the presence of an axillary mass or severe axillary changes in the absence of a mass lesion.
CT findings in involvement of the paranasal sinuses by lepromatous leprosy.
Authors: Srinivasan S , Nehru V I , Bapuraj J R , Sharma V K , Mann S B
Published: June 2014

The role of nasal infection in the transmission of leprosy has been extensively studied. Leprosy can affect the paranasal sinuses due to mucosal continuity and bacillaemia. This prospective study was performed on 25 untreated patients with lepromatous leprosy. 5 mm contiguous axial and coronal CT sections of paranasal sinuses, on soft tissue and bone windows, were obtained in all patients. Each sinus was examined for mucosal thickening, soft tissue densities and bony outlines. Representative biopsies were taken from ethmoid sinus to confirm the radiological diagnosis in 12 patients with multiple paranasal sinus involvement. Ethmoid aircells were involved in 20 patients (80%). Maxillary, frontal and sphenoid sinuses showed abnormalities in 12, four and three patients, respectively. The ethmoid biopsy showed involvement by lepromatous leprosy in seven of 12 patients (58.3%). Involvement of paranasal sinuses is common in lepromatous leprosy and is of considerable epidemiological significance.
Brain radiotherapy during pregnancy: an analysis of conceptus dose using anthropomorphic phantoms.
Authors: Mazonakis M , Damilakis J , Theoharopoulos N , Varveris H , Gourtsoyiannis N
Published: June 2014

The aims of this study were: (a) to determine conceptus dose resulting from brain radiotherapy; (b) to investigate the necessity of using shielding devices over patient's abdomen during treatment; and (c) to estimate the components of conceptus dose. Radiation doses received by conceptus were measured using anthropomorphic phantoms simulating pregnancy at 4, 12 and 24 weeks gestation and thermoluminescent dosemeters. All irradiations were performed with two lateral and opposed fields approximating the minimum, medium and maximum field size used during treatment of brain malignancies. For a treatment course delivering 65 Gy to tumour without using shielding equipment, conceptus dose never exceeded 100 mGy. Appropriate positioning of 5.1 cm of lead over the phantom's abdomen provided reduction of conceptus dose from 26% to 71%, depending upon gestational age, field size and distance from the field isocentre. The contribution of scatter arising from within the phantom to the conceptus dose was small compared with that from head leakage and collimator scatter. Our dosimetric results indicate that the construction of special shielding equipment is not a prerequisite for treating brain malignancies during pregnancy. However, based on the concept that exposures in women of childbearing age should be kept as low as reasonably achievable, we suggest that shielding devices should be used whenever possible.
Use of dose-volume histograms and biophysical models to compare 2D and 3D irradiation techniques for non-small cell lung cancer.
Authors: Ragazzi G , Cattaneo G M , Fiorino C , Ceresoli G , Verusio C , Villa E , Calandrino R
Published: June 2014

For non-small cell lung cancer (NSCLC), unsatisfactory local control (LC) still remains an important cause of failure. It has been suggested that improved LC can be achieved with both higher radiation dosage and adequate target coverage. Modern three-dimensional treatment planning systems (3D-TPSs) offer many tools for planning optimization. Biophysical models, which estimate the normal tissue complication probability (NTCP), are gaining in importance in comparing plans. This study compares conventional two-dimensional (2D) with 3D irradiation techniques using parameters related to volumetric dose distribution and two different biophysical models predicting normal tissue tolerance to radiotherapy (RT). Nine patients with inoperable locally advanced NSCLC were treated with a beam's eye view-based 3D technique. For the same patients, a conventional treatment was simulated; the irradiation geometry and beam contour were fully defined at the simulator and then transferred to the 3D-TPS to calculate the dose distribution. Both techniques gave the same prescribed dose at the reference point. Dose-volume histograms (DVHs) and dose statistics of organs at risk (OARs) (heart, lung(s), parenchyma lung, spinal cord and oesophagus) were analysed. The probability of side effects was estimated using two different biophysical models: the integrated normal ("empirical") model and the relative seriality model. Apart from contralateral lung, the 3D irradiation technique significantly reduced the average mean doses to all OARs. The current analysis suggests that in the treatment of locally advanced NSCLC, the use of 3D irradiation techniques allows a large sparing of OARs; this advantage is confirmed by both dose statistics analysis and NTCP values.
Volumetric assessment of carotid artery bifurcation using freehand-acquired, compound 3D ultrasound.
Authors: Allott C P , Barry C D , Pickford R , Waterton J C
Published: June 2014

The aim of this study was to establish the reproducibility of sequential three-dimensional (3D) ultrasound reconstructions of an identified segment of the carotid artery bifurcation in asymptomatic subjects. A freehand acquisition, compound reconstruction, 3D ultrasound system was used on three occasions, over a period of 1 year. The lumen of the vessel was reconstructed to provide a volume measurement and a rotatable 3D structure representation that could be examined for geometrical correspondence. The four subjects differed significantly in the visualized 3D geometry of the vessel bifurcation. There was good correspondence in the sequential reconstructions for each individual in both the 3D geometry and in the measured lumen volume, with an overall coefficient of variation of 5% and no evidence of deterioration in correlation with time.
MR findings in ovarian granulocytic sarcoma.
Authors: Jung S E , Chun K A , Park S H , Lee E J
Published: June 2014

Granulocytic sarcoma (chloroma) is a mass of malignant myeloid precursor cells in an extramedullary location. The female genital tract, including the ovary, may be the first site for clinical manifestation of granulocytic sarcoma. The MR findings are reported in a case of ovarian granulocytic sarcoma which preceded acute myelogenous leukaemia. Granulocytic sarcoma shows a mixed cystic and solid adnexal mass with intermediate signal intensity on T1 weighted images and hypointensity on T2 weighted images.
Spontaneous regression of pulmonary metastases demonstrated by CT.
Authors: Wadsworth S J , Davies C W , Gray W , Gleeson F V
Published: June 2014

Two cases of disappearing or spontaneous regression of pulmonary metastases on CT are presented. In both cases, cytological proof was obtained by radiologically guided fine needle aspiration. The lesions subsequently regressed on follow-up CT studies without recognized systemic treatment.
CT of unusual nasal masses.
Authors: Grainger A J , Zammit-Maempel I
Published: June 2014

This pictorial review illustrates the CT appearances of unusual nasal masses and the possibility of offering a correct diagnosis in some cases but a reliance on histology in others where radiology can only offer a differential diagnosis.
Estimating the effective dose to children undergoing heart investigations--a phantom study.
Authors: Axelsson B , Khalil C , Lidegran M , Schuwert P , Mortensson W
Published: June 2014

The aim of the investigation was to assess the conversion factor (F) for derivation of effective dose from measured dose-area product (DAP) during radiological examination of congenital heart diseases. Two anthropomorphic phantoms corresponding to a 1-year-old and a 5-year-old child were irradiated at several projections to imitate irradiation conditions at heart examinations. Organ doses were measured using thermoluminescent dosimeters for calculation of mean organ doses and effective dose according to ICRP. DAP values were measured simultaneously. The conversion factor (F) was calculated from the ratio of effective dose (mSv) to DAP value (Gy cm2). The conversion factor (F) correlated strongly to the size of the phantom but less to the irradiation projection. However, at major beam angulation and at lateral projection F deviated note-worthily from that obtained at true or slightly angulated frontal views. Effective dose can therefore be estimated from the DAP values at heart investigation using two different F values. The following values are recommended for PA and lateral view respectively: for children weighing 7-11 kg, 1.8 and 1.4; for children weighing 15-26 kg 0.9 and 0.7.
Value of a multileaf prescription preparation system for palliative external beam irradiation.
Authors: Thilmann C , Adamietz I A , Ramm U , Mose S , Saran F , Boettcher H D
Published: June 2014

In palliative treatment, irregularly shaped fields are used to reduce side-effects and can improve, or avoid, field matching. We investigated the effectiveness of a multileaf collimator (MLC) supported by a digitizing data entry system in the palliative radiotherapy treatment of 66 patients and compared it with conventional shielding with geometrically shaped blocks. After conventional simulation of rectangular fields, irregular field shapes were marked on the simulator film in 17 patients (27%) to reduce radiotherapy related side-effects. Individual leading was performed with an MLC. Digitizing and fitting of the optimum leaf position were carried out using a multileaf preparation system (MLP, Elekta, Crawley, UK). Target volumes included bone metastases in the pelvis, spine and extremities, mediastinal soft tissues, lymph nodes and central nervous system. In 10 patients, treated with a parallel pair for pelvic metastases, MLC and conventional shielding were prospectively compared with regard to time requirements and area shielded. Compared with conventional blocking, the mean simulation, preparation and treatment time required for MLP fields was shorter (9.55 +/- 1.44 min vs 16.90 +/- 2.64 min, and 5.50 +/- 1.14 min vs 8.97 +/- 1.75 min). The mean shielded area was 31 cm2 larger for MLC fields compared with geometrically shaped blocks (p < 0.05). Compared with cerrobend blocking, the use of an MLC, supported by preparation data entry software, is more flexible and reduces radiotherapy resources. Therefore, a preparation data entry system as a separate device, or integrated into the treatment planning system, is a useful tool in palliative treatment.
The use of independent collimation in the treatment of Graves' ophthalmopathy.
Authors: Snow A
Published: June 2014

Graves' ophthalmopathy is an infiltrative disease of the orbit and randomized trials show that radiotherapy should be the first treatment of choice. This article describes how linear accelerators with independent collimation can be used for setting up purposes, in place of lead blocks, to shield the lens. This benefits the patient and radiographer by being quicker, more accurate and easier to set up.
Right atrial metastatic melanoma detected by dynamic contrast enhanced spiral CT.
Authors: Burn P R , Chinn R , King D M
Published: June 2014

The use of and transoesophageal echocardiography has been well described in the diagnosis of intracardiac metastases. We present a case of a right atrial mass in a patient with metastatic melanoma which was unexpectedly detected by dynamic enhanced spiral CT. The diagnosis was subsequently confirmed by MRI. It is likely that the increasingly widespread use of spiral CT will result in a greater detection rate of intracardiac tumours.
Multiple pyogenic granuloma demonstrated by SPECT using 99Tcm-labelled red blood cells.
Authors: Lin K J , Yen T C , Tzen K Y
Published: June 2014

Pyogenic granuloma is a polypoid form of capillary haemangioma that occurs on the skin and mucosal surface. The eruption of multiple pyogenic granuloma is a rare phenomenon. We report the case of a 73-year-old male with a 2 year history of intermittent lower gastrointestinal bleeding. 99Tcm-labelled red blood cell scintigraphy was performed to rule out the possibility of capillary haemangioma on the mucosal surface of the gastrointestinal tract. The images showed disseminated haemangiomas involving the skull, abdominal wall, intestine, scrotum and right leg. The final diagnosis of multiple pyogenic granuloma was made by skin biopsy. To the best of our knowledge, this is the first case using 99Tcm-labelled red blood cell scintigraphy to demonstrate multiple pyogenic granuloma.
The repositioning of migrated Tenckhoff continuous ambulatory peritoneal dialysis catheters under fluoroscopic control.
Authors: Dobrashian R D , Conway B , Hutchison A , Gokal R , Taylor P M
Published: June 2014

We describe a non-invasive, simple technique which, under fluoroscopic control, repositions migrated Tenckhoff CAPD catheters back into the pelvis. 18 patients, who had a total of 23 manipulations, were studied retrospectively over 2 1/2 years. Technical success (successful repositioning of the catheter at screening) and clinical success (continued effective CAPD for at least 6 months thereafter) were obtained in 84% and 45% of patients respectively. The results showed this technique to be effective in restoring the correct catheter position in CAPD patients whose catheters have migrated. Clinical success was more likely to be achieved in patients who had fewer risk factors for the development of peritoneal adhesions. The use of custom-made stainless steel wires eased manipulations and significantly reduced the radiation dose to patient and operator from the procedure.
Increased first trimester nuchal translucency: pregnancy and infant outcomes after routine screening for Down's syndrome in an unselected antenatal population.
Authors: Adekunle O , Gopee A , el-Sayed M , Thilaganathan B
Published: June 2014

Although increased nuchal translucency (NT) has been linked to a wide range of fetal chromosomal abnormalities and genetic syndromes, very few studies have looked at the outcomes of chromosomally normal pregnancies in unselected obstetric populations. This study aims to evaluate the outcomes of pregnancies with nuchal translucency measurements greater than or equal to 4 mm in a low risk obstetric population attending for routine first trimester screening. Women attending for booking scans were routinely offered nuchal translucency measurement as a screening test for Down's syndrome between 10 and 14 weeks gestation. The prevalence of increased nuchal translucency was 0.8% (n = 53). There were 15 (28.3%) chromosomal abnormalities, the commonest of which was Down's syndrome. Of the 38 chromosomally normal pregnancies, seven resulted in intrauterine death, early neonatal death or termination of pregnancy. The remaining 31 cases resulted in livebirths, of which two infants now exhibit developmental delay of unknown aetiology and one has been diagnosed as having Noonan's syndrome. 10 (19%) pregnancies were diagnosed as having major anatomical malformations resulting in fetal or neonatal demise or requiring postnatal surgery. In a routine obstetric population, the finding of an NT measurement greater than or equal to 4 mm is associated with a poor pregnancy outcome in the majority of cases, mainly owing to chromosomal abnormality. This study establishes the need for focused fetal assessment in cases with such first trimester findings.
Characterization of new portal film systems for radiotherapy verification.
Authors: Langmack K A , Goss V
Published: June 2014

Portal images are an important verification tool in radiotherapy. Their use has been limited by their poor image quality, which is due to the inherent lack of contrast at megavoltage energies. Recently CEA and Kodak have introduced new portal film-cassette systems with much improved contrast. We have determined the H-D curves for these systems and found the gamma (gamma) for the CEA system (8.5) to be larger than that for the Kodak EC-L system (6.3). The optimal doses were CEA TLF 1.2 cGy, CEA TVS 15.9 cGy and Kodak EC-L 1.5 cGy. We also obtained phantom images that were evaluated by 11 radiotherapists. They ranked the CEA B High Plus cassette with CEA TVS film the highest, followed by the Kodak EC-L system. Some clinical films of a lateral pelvis are also presented, to demonstrate the improvement in image quality with these new film systems as compared with conventional portal films.
Stage IV endometrial carcinoma: a 10 year review of patients.
Authors: Cook A M , Lodge N , Blake P
Published: June 2014

Stage IV endometrial cancer is uncommon, often occurs in elderly patients and has a poor prognosis, which makes the choice of treatment difficult. 18 patients with stage IV endometrial cancer presenting over a 10 year period, between 1987 and 1997, were reviewed with regard to mode of treatment and response. The mean age was 65 years. Five had disease confined to the pelvis and 13 had extra pelvic disease. 15 of 18 patients had a total abdominal hysterectomy (TAH). One patient received radiotherapy alone and five received post-operative radiotherapy. Overall freedom from pelvic symptoms was achieved in seven of 18 patients. All seven had undergone TAH and two had received post-operative radiotherapy. Progestogens were given to 13 patients. Six received progestogens alone, without radiotherapy or chemotherapy. Of these, two responded, one for 9 months and one with verified lung metastases, who had a complete response, is still alive at 6.5 years. Eight patients received chemotherapy, with single agent cisplatin or carboplatin AUC 6. Three patients responded, one for 4.5 years. The overall median survival was 12 months from diagnosis. Actuarial 5 year survival was 15% (CI 3-36). There was no significant survival difference for, hormone therapy or chemotherapy. Stage IV endometrial cancer has a poor prognosis but durable response can be achieved in some patients.
Paradoxical pulmonary embolism secondary to aortocaval fistula: diagnosis by helical CT.
Authors: Lay J P , Swainson C J , Sukumar S A
Published: June 2014

Spontaneous aortocaval fistula is an unusual but well recognized complication of abdominal aortic aneurysm. Reports of aortocaval fistula as the source of pulmonary embolism are rare. We report a case of paradoxical pulmonary embolism secondary to an aortocaval fistula. The abdominal aortic aneurysm and the associated aortocaval fistula were well demonstrated on helical CT, leading to early diagnosis and prompt surgical treatment with good clinical outcome.
Ultrasound diagnosis and guided biopsy in renal actinomycosis.
Authors: Hyldgaard-Jensen J , Sandstrøm H R , Pedersen J F
Published: June 2014

We report the case of a 45-year-old man with 3 months malaise, in whom ultrasound showed an atypical tumour of the right kidney. Ultrasound-guided fine needle biopsy led to a diagnosis of renal actinomycosis.
Extracranial metastatic meningioma.
Authors: Figueroa B E , Quint D J , McKeever P E , Chandler W F
Published: June 2014

Meningiomas rarely metastasize outside the intracranial compartment. We report a case of disseminated metastases from a recurrent intracranial meningioma and review the imaging and pathological literature on metastatic meningioma.
Assessment of accuracy of daily set-ups in prostate radiotherapy using electronic imaging.
Authors: Stryker J A , Shafer J , Beatty R E
Published: June 2014

The purpose of the study was to assess the accuracy, using electronic portal imaging, of daily set-ups, in patients undergoing radiotherapy for prostate carcinoma. We used a scanning liquid ion chamber to assess the accuracy of set-ups in 25 consecutive patients undergoing a 6 1/2 week course of radiotherapy to the prostate. Electronic images (EPIs) were collected during 33 treatments to each of four ports. The positions of anatomical structures on the EPIs were compared with the same structures seen on digitally reconstructed radiographs (DRRs) made after CT simulation before beginning radiotherapy. Displacements of the EPIs compared with the DRRs were computer-calculated in millimetres in lateral, longitudinal and rotational directions for each port. 11 patients had ports moved because of discrepancies between the EPIs and the DRRs; eight required moves in the first five treatments to correct systematic (simulator) errors. In the right-left and anterior-posterior directions, nearly 95% of the EPIs were within 5 mm of the simulated port position. In the superior-inferior direction, 98% of the ports were within 5 mm of the simulated port position. Two patients had in-plane rotational errors on the lateral ports (8 degrees and 10 degrees respectively). It was concluded that daily electronic imaging is an effective technique for assessing the accuracy of set-ups in prostate radiotherapy.
Perianal Paget's disease.
Authors: Amin R
Published: June 2014

Perianal Paget's disease is rare. Unlike Paget's disease of the nipple, which is always associated with a subjacent breast adenocarcinoma, perianal Paget's disease is not always associated with a subjacent or visceral malignancy. The treatment recommendation in nearly all reported cases has been surgical excision. Radiation therapy is seldom used as a curative treatment. A case of perianal Paget's disease is described in whom radiation therapy was used with a curative intent after four unsuccessful surgical resections.
Evaluation of head examinations produced with a mobile CT unit.
Authors: Matson M B , Jarosz J M , Gallacher D , Malcolm P N , Holemans J A , Leong C , Seed P T , Ayers A B , Rankin S C
Published: June 2014

Recent years have seen the development of mobile CT units, designed for use in operating theatres, intensive care units and accident and emergency departments. One such unit is the Tomoscan M (Philips, Utrecht, The Netherlands). It operates with a maximum tube voltage of 130 kV, and a maximum tube current of only 50 mA. This study tested whether acceptable quality CT images of the brain could be produced on the mobile unit with these parameters. 44 consecutive normal head examinations performed on the mobile scanner were compared with 35 examinations from two conventional CT units. Two independent readers scored the examinations for noise and artefact. CT dose index (CTDI) values for the three CT units were obtained in free air as an estimate of patient dose. Differences in artefact score between CT units were generally small, but noise scores were worse when using the Tomoscan M with a 2 s slice time. The lowest CTDI values were obtained with the Somatom DRH (Siemens, Erlangen, Germany) unit and the highest with the SR 7000 (Philips, Utrecht, The Netherlands), with values from Tomoscan M, in all except one case, falling between these values for the protocols used in the study. The measured scattered radiation doses from the Tomoscan M are presented.
Cricoid cartilage masquerading as a tumour on thyroid ultrasound.
Authors: Strauss S
Published: June 2014

On ultrasound scanning of the thyroid gland in a sagittal plane, the cricoid cartilage can falsely create the impression of a mass in the gland if the transducer is angled slightly medially. The illusion of a mass is fortified on transverse view if the cricothyroid and inferior pharyngeal constrictor muscles, which lie between the upper pole of the thyroid gland and the cricoid cartilage, are misinterpreted as a solid lesion. The purpose of this study was to describe the ultrasound features of the cricoid cartilage and to determine the frequency in which a pseudolesion is created. In 15 of 26 volunteers the cartilage was seen as a hypoechoic structure surrounded by an anechoic halo and containing foci of calcification, closely resembling a thyroid nodule. In 11 of the subjects, with a mean age of 55 years, the cartilage was heavily calcified, poorly visualized and did not simulate a thyroid lesion. Awareness of the cause and appearance of this pseudolesion should help radiologists avoid a potential pitfall and prevent unnecessary invasive procedures.
Analysis of optical density and contrast in mammograms.
Authors: Meeson S , Young K C , Ramsdale M L , Wallis M G , Cooke J
Published: June 2014

The objective of this project is the development of tools for the UK NHSBSP to assess image quality quantitatively in clinical films, for the purposes of optimizing imaging procedures and audit. As an initial step, 120 mammograms of 46 women on a single day of screening were digitized and analysed to produce indices of optical density (OD) and contrast. Analysis was performed on three regions of interest (ROI): pectoral muscle, main breast and skin edge. Two radiologists independently graded the quality of information in the different parts of each mammogram, and categorized breast type as either "dense", "mixed density" or "fatty". Measurements of contrast and OD generally correlated well with the opinions of the radiologists. For the oblique mammograms, the mean OD in the main breast ranged between films from 1.25 to 2.24 with a mean of 1.69 +/- 0.02. In the craniocaudal mammograms, the mean OD in the main breast ROI ranged from 1.14 to 1.94 with a mean of 1.61 +/- 0.05. The OD for a quality control film of a 40 mm block of PMMA exposed on the same day with this system was 1.53. A contrast index (CI) was calculated for each mammogram as the difference between the points of maximum and minimum OD in the main breast. Mean CI was 1.02 +/- 0.09 for fatty breasts, 1.50 +/- 0.10 for mixed density breasts and 2.05 +/- 0.23 for dense breasts. A review of the radiologist assessments indicated that the main breast was satisfactorily displayed when glandular and fatty tissues were displayed within the OD range 0.8-2.9. An analysis of the dynamic range requirements showed that 17% of films had a dynamic range that lay above that calculated using the suggested OD limits.
An evaluation of a new gel-coupled ultrasound device for the quantitative assessment of bone.
Authors: Tsuda-Futami E , Hans D , Njeh C F , Fuerst T , Fan B , Li J , He Y Q , Genant H K
Published: June 2014

Quantitative ultrasound (QUS) is now being accepted as a tool in the assessment of bone status. Most QUS devices measure broadband ultrasound attenuation (BUA) and speed of sound (SOS). A newly introduced device, the Acoustic Osteo-Screener (AOS-100), measures both SOS and an attenuation related parameter called the transmission index (TI) and provides a derived parameter called osteo sono-assessment index (OSI). The purpose of this study was to examine the reproducibility of this new device, compare the results with the UBA 575+ and evaluate the effect of using two platforms to compensate for different foot sizes on the measured values. 83 subjects aged 21-89 years, who gave informed consent, were recruited. Subjects were assigned to three different groups determined by age and health status. The short-term measurement precision (expressed as root mean square coefficient of variation) of SOS (0.13-0.16%) and TI (1.18-1.96%) was similar to and better than that obtained for the UBA 575+. Significant negative correlations were found between the differences in SOS measured with the two platforms (adaptors to adjust the position of the foot relative to the foot plate) and foot length (p < 0.0001). This implies that small feet are more influenced by the differences of measured location. All QUS parameters measured with the small platform were found to be significantly smaller than those with the large platform (p < 0.0001). The mean percentage differences were 0.6% in SOS, 2.8% in TI and 4.3% in OSI with the large foot platform giving larger value results. Proper use of the platforms resulted in more reproducible SOS and TI. This study demonstrated that the newly developed AOS-100 parameters TI and OSI were highly reproducible. This study also demonstrated that the use of an inappropriate platform can cause discrepancies in QUS readings and poor reproducibility.
Fatal complication of an expandable metallic bronchial stent.
Authors: Wadsworth S J , Juniper M C , Benson M K , Gleeson F V
Published: June 2014

A case of massive fatal haemoptysis secondary to erosion of a Gianturco expandable wire bronchial stent is described. The stent had been inserted for a benign bronchial stenosis. CT demonstrated erosion of the stent through the oesophagus and a false aneurysm of the descending thoracic aorta. The CT and plain radiographic appearances are presented. The potential for progressive migration and local damage should limit the use of this type of stent in benign bronchial stenoses.
MRI of local disease in nasopharyngeal carcinoma: tumour extent vs tumour stage.
Authors: King A D , Lam W W , Leung S F , Chan Y L , Teo P , Metreweli C
Published: June 2014

The purpose was to use MRI to study in detail local tumour extension in patients presenting with nasopharyngeal carcinoma (NPC) and to compare the extent of local disease with the current T-stage classification. MR images of 150 patients with newly diagnosed nasopharyngeal carcinoma were obtained on a 1.5 T unit. 10 extranasopharyngeal sites were analysed for tumour involvement. The number of concurrently involved sites was determined. The extent of tumour invasion was compared with staging as defined by the fifth edition of the AJCC classification. The T-stage distribution was T1 21%, T2 16%, T3 41% and T4 22%. The frequencies of tumour invasion into an individual site, and the mean number of other concurrently involved sites were as follows: skull base 63%, 3.9 sites; parapharyngeal 56%, 3.9 sites; nasal cavity 53%, 4.0 sites; oropharyngeal 17%, 5.2 sites; sphenoid sinus 27%, 5.6 sites; cranium 21%, 5.7 sites; infratemporal fossa 2%, 6.3 sites; ethmoid sinus 14%, 6.5 sites; orbit 5%, 7.0 sites; maxillary sinus 5%, 7.1 sites; and hypopharynx 0%, 0 sites. Extranasopharyngeal extension commonly occurred superiorly into the skull base rather than inferiorly to the oropharynx (p < 0.0001). Anatomical sites defined within the same T-stage category had different frequencies of involvement and different frequencies of concurrently involved sites. Oropharyngeal involvement (T2 stage) was associated with a number of concurrently involved sites comparable to structures in the T3 category. Maxillary and ethmoid sinus involvement (T3 stage) were associated with a number of involved sites comparable to the T4 stage. Invasion of the maxillary antrum and orbit are markers of the most bulky form of NPC.
Magnetic resonance imaging and proton MR spectroscopy in Wilson's disease.
Authors: Alanen A , Komu M , Penttinen M , Leino R
Published: June 2014

MRI of the brain and liver using T2 relaxation time measurements and proton spectroscopy (1H-MRS) of the brain was performed in four siblings with Wilson's disease (one with clinical disease and three asymptomatic) as well as age- and sex-matched control subjects. The T2 values of the liver were correlated with liver biopsy results. 1H-MRS of the left and right globus pallidus was obtained. The patient with clinical disease was examined three times, and two of three asymptomatic siblings twice. MR images of the brain were abnormal in all four patients. High signal intensity areas in the posterior thalamus, general atrophy and pontine myelinolysis were present in the patient with clinical manifestations. The T2 measurements of these areas confirmed the results of image analysis. Apart from general brain atrophy, the changes in the patient with clinical disease were largely reversible. The T2 values were significantly different from those of the control subjects only in the globus pallidus. The NAA/Cho, NAA/Cr and Cho/Cr ratios from the 1H-MR spectra of globus pallidus showed no significant difference between patients and control subjects. The mean values of NAA/Cho and NAA/Cr were lower in patients with Wilson's disease than in the control subjects. One of the patients had hepatic steatosis, but the liver T2 values were no different to those of the control subjects. In conclusion, the MRI findings reflect the success of the specific therapy in patients. MRI thus seems to be useful in the follow-up of Wilson's disease.
Novel solutions to the problems encountered in electron irradiation to the surface of the head.
Authors: Walker C , Wadd N J , Lucraft H H
Published: June 2014

A novel treatment for two patients with mycosis fungoides involving all or most of the skin surface of the head is described using large overlapping low energy electron beams. Shielding of previously treated and uninvolved areas was achieved by encapsulating cerrobend within a thermoplastic shell in one patient. In the other patient, GE Saturnes unique asymmetric electron field definition facility was used. Satisfactory dose uniformity was demonstrated by the computation of dose distributions on the full summed electron pencil beam model on the Target Series 2 treatment planning system. Verification of the calculated dose homogeneity was confirmed with lithium fluoride (TLD-100) thermoluminescent dosimetry. The relatively simple treatment set-up was accomplished easily on a routine basis and was well tolerated by the patients, both of whom have been in complete remission since their treatment.
CT guided interstitial high dose rate brachytherapy for recurrent malignant gliomas.
Authors: Kolotas C , Birn G , Baltas D , Rogge B , Ulrich P , Zamboglou N
Published: June 2014

This paper describes the technique and preliminary results of high dose rate (HDR) interstitial brachytherapy for recurrent grade III and grade IV gliomas. Although in the initial treatment of malignant gliomas brachytherapy has been shown to give better results than external beam therapy, this has previously always been with low dose rate (LDR) brachytherapy. Stereotactic frames are used for interstitial LDR brachytherapy but a CT image-guided technique does not require such a frame. The survival rates for our initial 53 patients do not significantly differ from LDR results. However, using HDR there are several advantages, including a much shorter treatment time with HDR than LDR and better patient comfort. HDR also allows better individualized optimization of the treatment than LDR.
Inflammatory pseudotumour of the bladder: CT and MRI findings.
Authors: Sugita R , Saito M , Miura M , Yuda F
Published: June 2014

The MRI findings are described in a case of inflammatory pseudotumour of the bladder. The signal characteristics are correlated with the histological findings.
Intrahepatic portosystemic venous shunt associated with a large abdominal tumour.
Authors: Yamagami T , Arai Y , Takeuchi Y , Sueyoshi S , Inaba Y , Maeda T
Published: June 2014

Intrahepatic portosystemic venous shunt (IPSVS) is relatively uncommon, and is usually associated with chronic hepatitis or cirrhosis. We present a case of IPSVS that was considered to be caused by increased blood flow from a large abdominal tumour. The characteristic intrahepatic haemodynamics were demonstrated by CT angiography.
In vivo anatomical analysis of arterial contact with trigeminal nerve: detection with three-dimensional spoiled grass imaging.
Authors: Ueda F , Suzuki M , Fujinaga Y , Kadoya M , Takashima T
Published: June 2014

The purpose of this study was to review the normal in vivo neurovascular relationship between the trigeminal nerve and surrounding arteries without the use of volunteers. 290 nerves in 145 cases were reviewed during a 1-year period. Axial source images and multiplanar reconstructed (MPR) images were used to determine the neurovascular contact and direction of contact. Multiplanar volume reformation (MPVR) was used to identify the contact vessels and to demonstrate the relationship between the nerve and arteries. Vascular contact was found in 29% of the 290 nerves (83 nerves). The arteries involved were the superior cerebellar artery (SCA) or the anterior inferior cerebellar artery (AICA). Vascular contact with two arteries was found in 3%. Of the 286 asymptomatic nerves, the nerve was located between the two vessels in 3% and compression was seen in 1%. Three points of vascular contact by the two arteries were identified in one asymptomatic nerve. The direction of contact between the SCA and the nerve was superior (38%), superomedial (32%) or medial (15%) in most cases. The direction of contact between the AICA and the nerve was inferior, inferolateral or lateral in all cases. Vascular contact at the root entry zone (REZ) was noted in 90%. Four nerves were affected by trigeminal neuralgia, one of which touched an artery and two were compressed. It was concluded that arterial contact can be assessed without difficulty but evaluation of vascular compression is not easy.
Comparison of film, hard copy computed radiography (CR) and soft copy picture archiving and communication (PACS) systems using a contrast detail test object.
Authors: Weatherburn G C , Davies J G
Published: June 2014

This paper describes two experiments where a widely available test object (FAXIL TO20) was used to compare film, hard copy computed radiography (CR) and soft copy picture archiving and communication systems (PACS) images. Baseline images were produced with a fixed mAs. All images were scored by four experienced medical physicists. Contrast detail curves for the three types of images were almost identical. A second series of images was produced with the mAs varying from 1 mAs to 250 mAs. The contrast detail curves were plotted for each mAs value and the wider exposure latitude of CR compared with film was demonstrated. Use of PACS provided no further increase in exposure latitude. The density of the film images increased with mAs but the density of the CR hard copy images remained constant. It is of concern that the wider latitude of the CR images extends to exposures that are much higher than those used for film with no noticeable change in CR image density but with better images at higher exposures, because the potential exists for patient doses to increase. Hard copy CR images provide information about the exposure index which relates to the input dose to the plate and hence approximately to the dose to the patient. However, since such information is currently not available on default soft copy images, the authors suggest that all manufacturers of PACS should provide an indication of dose as a mandatory default setting.
Endorectal magnetic resonance imaging of a rectal duplication cyst.
Authors: Beattie C H , Garvey C J , Hershman M J
Published: June 2014

A case of a duplication cyst of the rectum is presented. This case highlights the potential role of endoluminal magnetic resonance imaging in the diagnosis of this uncommon condition. Alternative imaging modalities and differential diagnoses are discussed.
Ultrasound evidence of gas in the fissure for ligamentum teres: a sign of perforated duodenal ulcer.
Authors: Patel S V , Gopichandran T D
Published: June 2014

We present a case of confined duodenal ulcer perforation diagnosed on ultrasound. Locules of gas were visible in the fissure for ligamentum teres along with a small amount of free fluid in Morrison's pouch and thickening of the gall bladder wall. To our knowledge, "free" intraperitoneal gas confined to the fissure for ligamentum teres has not previously been reported as an ultrasound finding in perforated duodenal ulcer.
Aberrant gastric venous inflow to the left lobe of the liver parenchyma adjacent to the falciform ligament.
Authors: Yamagami T , Nakamura T , Maeda T
Published: June 2014

Direct inflow of the aberrant right gastric vein independent of the portal venous system to the liver parenchyma is a well known cause of non-tumorous abnormalities on CT angiography. However, there have been no previous reports of aberrant gastric venous drainage as the cause of non-tumorous abnormalities in the left lobe of the liver parenchyma adjacent to the falciform ligament on CT angiography. We present a case of direct inflow of an aberrant gastric vein to this region of the liver, which influenced the non-tumorous enhancement shown by CT hepatic arteriography.
Echoplanar MRI in patients with an acute stroke syndrome.
Authors: Wilcock D J , Jones D K , Horsfield M A , Cherryman G R
Published: June 2014

An increasing number of patients with an acute stroke syndrome are being admitted to hospitals with on-site echoplanar MRI scanners. In this pictorial review, we describe our experience of an MRI protocol in the first 150 such patients scanned in our hospital. We illustrate some of the advantages of using echoplanar MRI. Diffusion and susceptibility weighted acquisitions may supplement conventional MR sequences by providing useful additional information about the age and location of the lesion, together with a high sensitivity to the presence of blood breakdown products.
Ultrasound of testicular epidermoid cysts.
Authors: Moghe P K , Brady A P
Published: June 2014

The ultrasound findings of focal intratesticular lesions may sometimes be characteristic of benign pathology, which accounts for approximately 5% of all testicular tumours. Three cases of epidermoid cysts of the testis are presented along with a review of the literature. Recognition of the typical ultrasound appearances of this entity in a clinical situation of painless testicular swelling in the absence of a history of trauma and signs of inflammation can make testis-sparing surgery feasible.
First trimester nuchal translucency: effective routine screening for Down's syndrome.
Authors: Thilaganathan B , Sairam S , Michailidis G , Wathen N C
Published: June 2014

The objective was to evaluate the effectiveness of 10-14 week nuchal translucency measurement in routine ultrasound screening for Down's syndrome. 11,398 women were scanned at 10-14 weeks of pregnancy for nuchal translucency measurements. The mean maternal age of the screened population was not significantly different from that of the booking population. A 5% screen positive rate was achieved by using a nuchal translucency-derived risk of > or = 1:200. Screening using this nuchal translucency risk would enable the first trimester detection of 16 out of 21 (76%) fetuses with Down's syndrome and 40 out of 49 (81%) aneuploid fetuses. In conclusion, this study demonstrates that first trimester nuchal translucency measurement is an effective method of screening for fetal chromosomal abnormality.
Abdominal ultrasound in acute schistosomiasis mansoni.
Authors: Barata C H , Pinto-Silva R A , Lambertucci J R
Published: June 2014

Reports on abdominal ultrasound studies in patients with acute schistosomiasis are still scarce and limited data are available on structural changes of the liver parenchyma in this stage of the disease. 26 patients with acute schistosomiasis mansoni were submitted to clinical and ultrasound examination. For ultrasound comparison, each acute patient was paired by age, gender, weight and height to a non-infected individual. Ultrasound showed a non-specific homogeneous size increase of the liver, and spleen in all acute patients, and easily identified intraabdominal lymph nodes in the periportal region in most cases. Three out of the five patients with periportal thickening underwent percutaneous liver biopsy. Periportal thickening disappeared 6 months after treatment for schistosomiasis. 24 months after successful treatment there was involution of the liver and spleen; lymph nodes, although reduced in size, were still easily recognized. Liver biopsy showed dense inflammatory infiltration of neutrophils, macrophages and eosinophils in the portal tracts associated with discrete fibrous tissue formation.
Small bowel MRI using water as a contrast medium.
Authors: Lomas D J , Graves M J
Published: June 2014

Magnetic resonance imaging (MRI) of the small bowel has been limited by lack of an adequate luminal contrast medium and problems with image artefacts. In this study we investigate the feasibility of imaging the luminal small bowel using rapid heavily T2w techniques, similar to those used for MR cholangiopancreatography, combined with oral water loading. Eight volunteers were examined after drinking 1-21 of water using serial, multisection, half-Fourier single shot rapid acquisition with relaxation enhancement (RARE) acquisitions. The examinations were continued until the terminal ileum was reached or the water reabsorbed. The results were subjectively assessed for visibility of the small bowel. In all subjects the duodenum, jejunum and ileum were well demonstrated with valvulae conniventes clearly visible. The water column reached the terminal ileum and the caecum in six of the eight subjects but in the remaining two water remained in the small bowel and was ultimately reabsorbed. These preliminary results suggest that with further refinement such an approach may be practical for clinical magnetic resonance imaging of the small bowel.
The performance of a fluoroscopic electronic portal imaging device modified for portability.
Authors: Kirby M C , Atherton S , Carson P , McDonagh C , Sykes J R , Williams P C
Published: June 2014

Advances in external beam therapy technology have made routine, efficient conformal therapy a reality. With it comes the increasing need for online treatment verification, which is only achievable at present through the use of electronic portal imaging devices (EPIDs). For a large radiotherapy centre, the provision of one EPID per treatment machine proves extremely expensive. This paper details modifications to the design of a commercial fluoroscopic EPID (the SRI-100) to produce a portable system, capable of providing quick, high quality imaging on more than one treatment machine. We describe the necessary hardware and software changes made to the system, as well as the variety of mechanical and quality control checks performed for testing the stability and quality of the imaging. The modified system has been found to be both electronically and mechanically robust, with associated image quality, scaling, distortion and movement similar to other EPIDs in the department. Although the modification was designed specifically to allow for the acquisition of images from multiple treatment machines, it may also enable the operation of the EPID for other uses such as total body irradiation (TBI) treatment verification and a further range of quality control procedures on the linear accelerator itself.
Magnetic resonance imaging of actinomycosis presenting as pelvic malignancy.
Authors: Hawnaur J M , Reynolds K , McGettigan C
Published: June 2014

Pelvic actinomycosis is associated with long-standing use of an intrauterine contraceptive device and may present with clinical signs and symptoms of pelvic malignancy. Diagnostic imaging can confirm the presence of a pelvic mass and tissue infiltration but findings are often non-specific. We present a case of pelvic actinomycosis with tubo-ovarian abscess in which magnetic resonance imaging demonstrated lower signal intensity tissue on T2 weighted sequences than would be typical for pelvic malignancy or infection and was useful in confirming regression of pelvic disease in response to antibiotic therapy.