bluuebunny/crossref_metadata_2025 huggingface dataset:
Duplex Doppler ultrasound in the investigation of occult nephropathy following haemolytic uraemic syndrome
Authors: Gleeson F. V. , Fitzpatrick M. M. , Somers J. , Kennedy C. , De Bruyn R. , Barratt T. M.
Published: July 2009

Duplex doppler ultrasound has been reported to be of value in the detection of raised vascular resistance, particularly in the renal tract. A prospective single blind study investigating the use of duplex Doppler ultrasound to measure resistive index (RI) in patients with impaired renal function and a history of diarrhoea-associated haemolytic uraemic syndrome (D+ HUS) was performed. There was considerable overlap in the range of RIs, with RIs greater than 70% in children with normal renal function and in those with renal impairment following D+ HUS. There was no significant difference in the mean RI between the groups studied. We feel that the RI is not of value in predicting the presence of occult nephropathy following haemolytic uraemic syndrome.
Mitomycin C, 5-fluorouracil and radiation in advanced, locally recurrent rectal cancer
Authors: Dobrowsky W.
Published: July 2009

15 patients with inoperable presacral recurrent rectal cancer following surgery were treated with combined radiation and chemotherapy. Treatment consisted of split-course radiotherapy with 50 Gy in 25 fractions over 5 weeks and, after 4 weeks, an additional 20 Gy in 10 fractions over 2 weeks. At the start of treatment and following the split course, chemotherapy was administered. Mitomycin C was given on Day 1 (dose: 15 mg/m2 i.v. bolus) and 5-fluorouracil from Day 1 to Day 5 (dose: 750 mg/m2/24 h, continuous i.v. infusion). Owing to considerable, predominantly haematological and gastrointestinal toxicity, only six out of 15 patients received treatment according to the protocol. The symptomatic relief of symptoms was good. Pain was controlled in seven of eight symptomatic patients. Seven of the patients showed response according to computed tomography, but in none of these cases was a complete remission seen. After a follow-up of at least 30 months, only three patients are alive. The 1-, 2- and 3-year survival rates are 9/15, 6/15 and 3/12, respectively. The median survival is 14 months (range 4–60+ months). In comparison with historical data from the same institution, combined radio-chemotherapy did not show any prolongation of survival or increased response rate, but increased toxicity excessively, when compared with radiation alone.
The use of 123I-Hippuran renography in the management of synchronous bilateral upper urinary tract transitional cell carcinomata
Authors: Sandhu D. P. S. , Sambrook P. , George N. J. R.
Published: July 2009

Bilateral simuitaneously occurring malignant tumours of the upper tracts are very rare, and present the difficult problem of preservation of renal function and adequate tumour clearance. We report such a case and discuss the difficulties and value of the modern methods of management, including ureteroscopy and 123I-Hippuran gamma camera renography with creatinine clearance to assess total and split renal function and recovery.

A 62-year-old housewife was referred with right loin and back ache associated with haematuria. Two years earlier she had been investigated for right loin pain without haematuria and had normal excretion urography at that time. A repeat urogram revealed a radiolucent filling defect in the upper pole calyx of the right kidney (Fig. la), with hydronephrosis and hydroureter on the left side resulting from probable tumour in the distal ureter (Fig. 1b). Serum creatinine was normal. A 123I-Hippuran renogram demonstrated the obstructed left kidney to contribute 36% of global function.

At initial cystoscopic assessment the urethra, bladder and ureteric orifices were normal. Ureteroscopy was not attempted on the left as the developing urographic appearances were considered to be pathognomonic of ureteric tumour (Fig. lb). Right ureteroscopy (9.5 FG) was successful in reaching the pelvis and tumour-like fronds were seen in the upper pole, but adequate biopsy material could not be obtained. Right retrograde ureteropyelogram appeared to confirm a right pole tumour, although pelvic urine draining from the catheter surprisingly did not subsequently provide positive cytological proof of malignancy.
The significance of patient weight when comparing X-ray room performance against guideline levels of dose
Authors: Hart D. , Shrimpton P. C.
Published: July 2009

It is gratifying to have so quick and detailed a response as given by Williams and Catling in their comments on our letter (Hart & Shrimpton, 1991). We agree that it is essential for patient dose measurements to be conducted efficiently whilst also yielding meaningful data. Indeed, the need for such local surveys has lead to the formulation of appropriate dosimetry protocols by NRPB in collaboration with the Institute of Physical Sciences in Medicine and the College of Radiographers which will be published shortly.
Scattered X-ray intensities from fluoroscopy units
Authors: Bradley D. A. , Arunasalam M. , Ng K. H.
Published: July 2009

We refer to the protection afforded by multileaf Pb aprons on fluoroscopy units and would like to offer our own illustrative example of the importance of such measures in shielding against scattered radiation. Our concern lies with an incident that occurred in a hospital and which involves a fluoroscopy unit (a Siemens Gigantos with a 100 kW multipulse generator capable of delivering 1000 mA and 150 kVp) that was operated in the absence of its protective Pb aprons. Figure 1 shows the image of a gastrointestinal tract (using Curix Agfa Gevaert X-ray film and a CaWO4 normal-speed screen combination) and a superimposed forearm (not that of the patient).
Duplex pulsed Doppler sonography in the differential diagnosis of hepatocellular carcinoma and other common hepatic tumours
Authors: Lin Zu-Yau , Chang Wen-Yu , Wang Liang-Yen , Chen Shinn-Cherng , Chuang Wan-Long , Hsieh Ming-Yuh , Tsai Jung-Fa
Published: July 2009

180 previously untreated consecutive patients with liver tumours (308 lesions), including 104 hepatocellular carcinomas (148 lesions), 43 metastases (116 lesions) and 33 haemangiomas (44 lesions), were studied to determine the value of duplex sonography in the differentiation of hepatocellular carcinoma from other tumours. For lesions measuring ≤ 5 cm in diameter, hepatocellular carcinoma demonstrated the highest rate and haemangioma demonstrated the lowest rate of Doppler signals from within the lesions. To differentiate malignancy from haemangioma, the presence or absence of Doppler signals from these lesions were used as criteria. The specificity and positive predictive value were very high (100%, 100%), but the sensitivity, negative predictive value and accuracy were low (61.5%, 48.3%, 71.7%, respectively). With one exception, all lesions measuring < 3 cm in diameter with detectable Doppler signals were hepatocellular carcinoma. Using these results it is possible to differentiate hepatocellular carcinoma from metastases and haemangioma with high sensitivity, specificity, positive and negative predictive value, and accuracy (80.8%, 96.4%, 95.5%, 84.4%, 88.9%, respectively, for metastases; 80.8%, 100%, 100%, 81.5%, 89.6%, respectively, for haemangioma). We conclude that Doppler signals from within a lesion in combination with its size can aid differentiation of hepatocellular carcinoma from two other kinds of common hepatic tumour.
Results of a survey of doses to paediatric patients undergoing common radiological examinations
Authors: Chapple C.-L. , Faulkner K. , Lee R. E. J. , Hunter E. W.
Published: July 2009

A survey has been performed to investigate typical radiation dose levels for children undergoing a number of common radiological examinations. Doses have been assessed using a Diamentor ionization chamber to measure dose–area product, and by attaching thermoluminescent dosemeters to the patient's skin to determine entrance and organ doses. The survey has been automated by using a personal computer for data collection and storage. Doses have been monitored for a large number of children, primarily in a dedicated paediatric X-ray room, and the results presented can be used as a baseline for making comparative measurements elsewhere. Entrance skin doses were found to range from 0.3 mGy to 5.7 mGy for radiographic examinations, and values of dose–area product from 3 to 225 cGy cm2. The corresponding dose ranges for fluoroscopic examinations are 7.4–26.2 mGy and 130–1241 cGy cm2.
Measurement of extrafocal radiation by computed radiography
Authors: Miettunen Risto H.
Published: July 2009

Measurement of radiation differences from image data is made possible by computed radiography (CR) based on storage phosphor imaging plates. The photostimulable luminescence (PSL) response is linear in a range greater than four orders of magnitude. Pinhole radiographs of focal and extrafocal radiation obtained by CR were quantitatively analysed using the technique originally introduced in recent scatter studies. No films or hard copies were used in the analysis. The material consisted of 54 images for measurement of the focal peak intensity, and a corresponding set of 54 images obtained at a 250 times greater operating sensitivity for the imaging of the extrafocal emission. The extrafocal-to-focal emission ratio was in the range of 0.001–0.006 depending on the off-focus distance. Because of the relatively large area of origin, exposure resulting from extrafocal radiation is estimated to reach up to 20% of the total radiation dosage. The results are in agreement with previous reports using other techniques and show that CR can also be used in a quantitative manner in this kind of comparative measurement.
Accuracy of pelvimetry measurements on CT scanners
Authors: Wade J. P.
Published: July 2009

There is an increasing awareness of radiation dose received by the patient and the use of low dose techniques is encouraged whenever possible. A low dose technique which is available is the use of the overview or scanogram facility on a computed tomography (CT) scanner to produce a digital radiograph for pelvimetry measurements instead of the conventional radiograph. Unfortunately ultrasound, which is the low dose technique, cannot be used for pelvimetry measurements because of the bone geometry. Several published papers discuss the dose reduction (of the order of 90%) which is received by the mother and the fetus by changing to CT pelvimetry examinations (Federle et al, 1982; Suramo et al, 1984; Dobson & Nelson, 1988), and the recent NRPB Report (1990) emphasized this dose reduction. As many district hospitals now have CT scanners, this technique is becoming more widely practised.

Whilst dose reduction is a major consideration when choosing a new technique, it is also important that the results obtained are as good or better than conventional techniques, since any inaccuracies may have serious repercussions and lead to complications during labour. For pelvimetries carried out on CT scanners, a lateral view or an antero-posterior (AP) scanogram, or both, is obtained of the pelvis and the required distances are measured on the viewing console using the distance measurement facilites provided in the software.
A fine needle aspiration technique using high negative pressure
Authors: Rhymer J. C. , McRobbie D. W. , Boultbee J. E.
Published: July 2009

Ultrasound-guided aspiration for diagnostic or therapeutic purposes plays an important role in the management of thoracic, abdominal or pelvic fluid collections. The use of a fine needle is safe (Dewbury, 1990) having the advantages of minimal tissue trauma and minimal patient discomfort. The disadvantage of a small needle of 22 gauge is that its bore limits the rate of aspiration, which is significant in dealing with large or viscous collections. The use of a hand held syringe can be tiring for the operator and needle movement or displacement can occur during prolonged aspirations.

We describe a simple method of overcoming some of these disadvantages.
How good is ultrasound in the detection and evaluation of anterior abdominal wall defects?
Authors: Walkinshaw S. A. , Renwick M. , Hebisch G. , Hey E. N.
Published: July 2009

The ability of routine obstetric ultrasound to detect and accurately describe fetuses with anterior abdominal wall defects has been examined in an unselected population using data from a regional abnormality survey. Examination between 16 and 22 weeks gestation detected 60% of defects with a false positive rate of 5.3%. Fetuses with gastroschisis were incorrectly assigned as exomphalos in 14.7% of cases recognized before 22 weeks gestation. The diagnosis, including description of associated detectable anomalies, was completely accurate in 71.6% of cases. Some of the problems of diagnostic accuracy need to be considered when counselling couples with a fetal anomaly. Cross-referral between obstetric ultrasound units should be encouraged to improve diagnostic accuracy. These results form the basis for audit of obstetric ultrasound in the diagnosis of fetal abnormality within a geographically denned population.
Detection and evaluation of fetal goitre by ultrasound
Authors: Avni E. Fred , Rodesch Frederic , Vandemerckt Carine , Vermeylen Daniéle
Published: July 2009

Antenatal diagnosis of fetal goitre has been reported rarely. Once detected, however, it is important to evaluate fetal thyroid function so early treatment can be initiated if necessary. In reporting three new cases, the authors analyse the various methods of evaluation. The normal sequence of appearance of the various epiphyseal ossification centres is an indirect illustration of thyroid function and can be followed by ultrasound. Direct evaluation of hormone levels through cord blood sampling under sonographic guidance is a complementary method in doubtful cases. The mechanisms predisposing to the development of fetal goitres and the possible implications of these findings are also discussed.
Benign non-infected urachal cyst in an adult: review of the literature and a case report
Authors: Al-Hindawi M. K. , Aman S.
Published: July 2009

Urachal cyst is rather a rare lesion with interesting and different ways of presentation. More urachal cysts are being shown by ultrasound and computed tomography, and their criteria for diagnosis are discussed.
The determination of total filtration on mammographic X-ray sets
Authors: Robson K. J. , Kotre C. J. , Faulkner K.
Published: July 2009

Data produced by a computer model are presented which allow the amount of molybdenum filtration on a molybdenum target mammographic X-ray set to be estimated from the measurement of the half value layer (HVL) in aluminium. Existing data refer either to tungsten target tubes or to molybdenum target tubes for a single anode angle and a constant potential waveform with the compression plate present. In addition to the tube voltage, the present data take account of the waveform of the tube potential and target angle. The results of an experimental verification of the model are presented and the effect of the geometry used in the experimental set-up discussed. Theoretical predictions of the molybdenum filter thickness made using the data from the model are in good agreement with the measured filter thickness, provided that attention is paid to the experimental geometry.
A comparison of four mammographic image quality test objects
Authors: Payne M. , Lawinski C. P.
Published: July 2009

The need for rigorous image quality assurance in mammography is well documented (Pritchard Report, 1989). However, there is still debate over the suitability of those image quality test objects commercially available. We have been able to compare three contemporary test objects with the “Barts” test object which has been in use since 1980 and has been used as a standard by many workers (Kirkpatrick & Law, 1987). The four mammographic test objects have been compared using six mammographic film-screen combinations. The following test objects were used.

The “Barts” mammographic image quality test object (White & Tucker, 1980). This object contains several series of opacities designed to mimic mammographic diagnostic features, some being fat equivalent, some water equivalent, some skin equivalent and some equivalent to calcifications, which are immersed in an epoxyresin scattering medium. The object is designed to assess contrast and resolution combined in various ways.

The Dupont mammographic image quality test object (Ackermann, personal communication, 1988). This simulates microcalcifications, fibrous structures and small spherical objects. It also allows an assessment of minimal detail contrast, line resolution in two dimensions and point resolution. A selection of organic materials is included to simulate benign and malignant tumours, lymph nodes and tissues characteristic of a dense breast. It is designed to be used with a stack of attenuator plates to provide the appropriate absorption, scatter and geometrical unsharpness in test exposures.
Improved image quality for dense breasts in mammography
Authors: Law J.
Published: July 2009

Please note that the films reproduced in parts (a) and (b) of Fig. 2 (p. 51) should be interchanged to correspond with the caption and the text.

Thus the lighter film was obtained with the normal exposure (28 kV, 63 mAs), and the darker film was obtained with the increased exposure (28 keV, 120 mAs).

The Publisher apologises to both the author and the readers for this error.

Reference

LAW, J., 1992. Improved image quality for dense breasts in mammography. British Journal of Radiology, 65, 50–55.
The role of 3D CT in the assessment of acetabular fractures
Authors: Guy R. L. , Butler-Manuel P. A. , Holder P. , Brueton R. N.
Published: July 2009

A total of 16 patients with acetabular fractures were evaluated by plain radiography, axial computed tomography (CT) and three dimensional (3D) CT. It was possible to classify the fracture type in each case from the plain radiographs alone. Axial CT gave additional detail in certain areas, notably the region of the teardrop, the obturator foramen and the acetabular roof. Intra-articular and impacted roof fragments and associated soft tissue injuries were also shown. 3D CT provided the best and most easily interpreted overall assessment of the fractures. In addition to projections equivalent to the plain radiographs, two other views were of particular clinical value in demonstrating surgically inaccessible areas, namely the view of the pelvis from above and the view of the inner aspect of the fractured hemipelvis. However, fracture lines demonstrated on plain radiographs and axial CT were not always apparent on the 3D CT scans. Although 3D CT is a valuable addition to the imaging of acetabular fractures, it is not a substitute for good quality plain radiography and analysis of the axial CT images.
Computed tomography in abdominal trauma: an audit of usage and image quality
Authors: Padhani Anwar R. , Watson Christopher J. E. , Clements Leigh , Calne Roy Y. , Dixon Adrian K.
Published: July 2009

The use and quality of computed tomography (CT) in the evaluation of blunt abdominal trauma has been assessed by a retrospective review of 122 patients referred in the first 8 years following the installation of CT of the body. The referral patterns were analysed, and the quality of the images was assessed, with particular reference to unsatisfactory (unacceptable or poor) images. Referrals increased over the 8 years following installation. A large proportion of these examinations were performed outside normal working hours (58/122, 48%). In 64 out of 122 (52%) of examinations the images were considered of unsatisfactory quality with inadequate use of intravenous contrast medium cited as the most common cause for unsatisfactory exminations. Image quality did not improve with time. Image quality was unsatisfactory in a larger proportion of those examinations performed outside normal working hours (35/58, 60%) than those during the routine working day (29/64, 45%), although this difference did not reach statistical significance (0.1 > p > 0.05). Fewer unsatisfactory examinations were produced by a system dedicated to body CT (31/74, 42%) than by a neuroradiological system (33/48, 69%) (p < 0.01). The proportion of unsatisfactory abdominal examinations was lower when the CT study concentrated on the abdomen (26/65, 40%) than when multiple regions (head, chest, abdomen, etc.) were examined (38/57, 67%) (p < 0.01). This audit revealed many unsatisfactory examinations. In order to complete the audit loop we have addressed many of the contributory factors. A new CT system now provides images of high quality and is used for all abdominal work. Guidelines, which describe an optimized technique, have been issued to radiographers and radiologists. In particular, we have emphasized that there is no place for a poorly supervised “quick look” at the abdomen following a cranial or thoracic study.
Quantitative analysis of CT brain images: a statistical model incorporating partial volume and beam hardening effects
Authors: McLoughlin Raymond F. , Ryan M. Veronica , Heuston Paula M. , McCoy Catherine T. , Masterson James B.
Published: July 2009

The purpose of this study was to construct and evaluate a statistical model for the quantitative analysis of computed tomographic brain images. Data were derived from standard sections in 34 normal studies. A model representing the intracranial pure tissue and partial volume areas, with allowance for beam hardening, was developed. The average percentage error in estimation of areas, derived from phantom tests using the model, was 28.47%. We conclude that our model is not sufficiently accurate to be of clinical use, even though allowance was made for partial volume and beam hardening effects.
Biliary dilatation and pseudo-tumour of the liver
Authors: Grech P.
Published: July 2009

The detection of intrahepatic biliary dilatation is central to the investigation of jaundice and the biochemical abnormalities associated with liver disease. While there may be difficulty distinguishing minimal biliary dilatation from the normal appearance, and biliary obstruction may occur with little biliary dilatation, it is generally agreed that ultrasonography is highly sensitive in the detection of moderately or markedly dilated intrahepatic ducts. A patient was recently encountered with markedly dilated ducts in which the ultrasonic appearances were atypical leading to an erroneous interpretation of the findings.
A sense of déjà vu
Authors: Ratcliffe J.
Published: July 2009

I have been stimulated to add to the correspondence on A sense of déja vu in your October issue (Hartnell, 1991; Hinwood & Manhire, 1991; Renny, 1991) following a similar feeling on reading a paper in your September issue on the use of the Vygon tube for small bowel enemas (Ashleigh et al, 1991) from North Manchester, UK.
Altered radiotherapy fractionation in medulloblastoma
Authors: Plowman P. N. , Doughty D. , Sebag-Montefiore D.
Published: July 2009

The major morbidity of neuraxis radiotherapy in young children is late neuropsychological retardation, which may be severe (reviewed by Gamis et al, 1991). Two recent studies suggest that the total radiation dose to the neuraxis may not be lowered safely in (? any) group of these children (Deutsch et al, 1991, SIOP medulloblastoma second trial unpublished results), and this prevents the most certain method of reducing this morbidity. An alternative method of reducing this morbidity must be desirable, but carefully weighed against a possible loss of tumour control.
Book reviews
Authors: Collins M. C.
Published: July 2009

This is a single volume, comprehensive, manageable textbook written for radiologists by radiologists. There are 22 chapters of easily readable, well illustrated text, complemented by a sympathetic index and generous bibliography section at the end of each chapter. The authors, an American/Canadian team of practising uroradiologists, have more than adequately achieved their aim of providing a standard textbook on the speciality.
The musculoskeletal manifestations of epidermolysis bullosa: an analysis of 19 cases with a review of the literature
Authors: Wong Wai Lup , Pemberton James
Published: July 2009

Epidermolysis bullosa encompasses a group of rare disorders characterized by marked skin fragility and blister formation. In patients with dystrophic epidermolysis bullosa, skeletal and soft-tissue abnormalities are an important feature. An analysis of the musculoskeletal manifestations in 19 patients is presented. In the hands and feet, features included generalized osteoporosis, wedge-shaped thinning and hooking of distal phalanges, overconstricted bones, acro-osteolysis, flexion contractures, metatarsal and metacarpal subluxation, distal trophic changes, webbing of digits, encasement of the whole extremity in a pouch of skin, soft-tissue calcification and retarded skeletal maturity. Previously undescribed findings in the hands and feet are bony ankylosis of the proximal interphalangeal joints, resorption of the metatarsal and metacarpal heads, shortened metatarsal bones, carpal and tarsal fusion and destruction, and cystic changes of the distal radius and ulna. In the remainder of the skeleton, hip dysplasia with premature osteoarthritis, knee joint bony ankylosis and thoracic and thoraco-lumbar scoliosis are other undescribed findings.
Magnetic resonance imaging of pulsatile cerebrospinal fluid flow by spatial modulation of magnetization
Authors: Wayte S. C. , Redpath T. W. , Beale D. J.
Published: July 2009

Various orders of binomial spatial modulation of magnetization sequences up to (1 4 6 4 1) have been tested to find the optimum sequence for clinical application. Stripe width, stripe sharpness and the tolerance of the sequences to radiofrequency non-linearity have been investigated. The (1 3 3 1) sequence was found to be a good compromise between competing design criteria, and its application to viewing pulsatile cerebrospinal fluid motion is described.
The value of magnetic resonance relaxation time in staging ovarian endometrial cysts
Authors: Sugimura Kazuro , Takemori Masayuki , Sugiura Makiko , Okizuka Hiromi , Kono Michio , Ishida Tetsuya
Published: July 2009

We evaluated the use of magnetic resonance imaging (MRI) in the pre-operative staging of 15 endometrial cysts. The effect of the iron content on the T  1 and T  2 relaxation times was assessed in confirmed endometrial cysts employing a 0.15 T MR system and a 200 MHz spectrometer. There was a positive linear correlation (r = 0.93) between the T  1 values of the lesions obtained using the MR system (T  1) and those of the resected cyst contents obtained using the spectrometer (sp-T  1). A similar relationship was found between T  2 and sp-T  2(r = 0.87). There was a negative linear relationship between the T  1, value and the cyst iron content (r = –0.81), but there was no relationship between the T  2 value and the iron content. T  1 was 412±91 ms for Stage II cysts (n = 3), 356±126 ms for Stage III cysts (n = 3) and 208±30 ms for Stage IV cysts (n = 9). The T  1 value for Stage IV cysts was significantly shorter than that for Stages II and III cysts (p<0.05). Thus, the T  1 value was useful in distinguishing fresh from old endometrial cysts, suggesting that the MRI T  1, relaxation time might be useful for staging ovarian endometrial cysts before surgery.
Audit in action: significant reduction of double-contrast barium enema screening time with no loss of examination quality
Authors: Horton D. , Cook A. M. , Taylor A. D.
Published: July 2009

The double-contrast barium enema is an examination of high radiation exposure to the patient. As part of a departmental audit, our own fluoroscopic screening times were being recorded. A study was undertaken to see if a determined effort could reduce the screening time without having a detrimental effect on the quality of the examinations. Methods of screening time reduction were identified and then implemented by two radiologists. In the period before the study the average screening time for radiologists A and B was 2.6 min and 3.2 min, respectively (over 56 examinations). After implementation of the changes, the average screening time for both was 0.9 min (over 50 examinations). This is a statistically significant reduction (p < 0.01). The examinations were assessed independently by a gastroradiologist. No difference in the quality of the examinations was identified. We conclude that a significant reduction of screening time for the double-contrast barium enema can be achieved without loss of examination quality.
Output factors for blocked fields
Authors: Dean E. M. , Davis J. B.
Published: July 2009

This study investigates the output from blocked treatment fields with 6 MV and 18 MV photons. Square fields, defined collimators, were blocked down to smaller symmetrical square, rectangular and asymmetrical rectangular fields using blocks on tray beneath the collimators. Up to 7.5% difference was found between the output measured for the blocked field and the output calculated using a collimator output factor for the surface field size. A method is described by which output factors for the blocked fields can be measured and used in practice. Three methods of approximating these output factors are also presented.
The application of microdosimetry in clinical bone densitometry using a dual-photon absorptiometer
Authors: Waker A. J. , Oldroyd B. , Marco M.
Published: July 2009

Experimental microdosimetric methods have been used to determine absorbed dose values for a scanning dual-photon absorptiometer. Absorbed doses within the scanned field have been obtained for three different scanning speeds. For the normal speed setting used clinically, measurements have also been carried out in a water-filled phantom in order to estimate typical patient entrance, exit and midline doses. The results agree well with values obtained using thermoluminescence dosimetry and support the claims of the manufacturers with regard to upper limits placed on patient dose levels. The microdosimetric method enables changes in radiation quality to be followed and comparisons to be made with other low-energy photon fields used in medical diagnosis.
A preliminary investigation of the imaging performance of photostimulable phosphor computed radiography using a new design of mammographic quality control test object
Authors: Cowen A. R. , Brettle D. S. , Coleman N. J. , Parkin G. J. S.
Published: July 2009

Leeds Test Object TOR[MAM] has been designed to supplement the current FAXIL mammography test object TOR[MAX]. It contains a range of details that have a more natural radiographic appearance and has been designed as a test that more closely approximates the image quality achieved in clinical mammography. Physical aspects of the design and implementation of TOR[MAM] are presented. The TOR[MAM] has been used in a preliminary physical evaluation of the comparative image qualities produced by conventional (screen–film) and photostimulable phosphor computed mammography and the results are discussed. TOR[MAX] results are also presented. The influence of digital image processing (enhancement) on the image quality of computed mammograms is also considered. The results presented indicate the sensitivity of TOR[MAM].
Technique for steel coil embolization of biopsy track for use with the “Biopty” needle
Authors: Dawson Peter , Adam Andreas , Edwards Richard
Published: July 2009

Percutaneous biopsy is quick, usually relatively easy to perform with a minimum of special equipment and, with its high diagnostic yield and low associated morbidity and mortality, is a key tool in the radiologist's armamentarium. Indeed, it is the single most frequently performed interventional procedure. A number of risks have been enumerated (Perrault et al, 1978; Westaby, 1980; Reichert et al, 1983; Whitmire et al, 1985; Lees, 1987), the most serious being severe bleeding, particularly, but not exclusively, in patients with a bleeding diathesis. The bleeding is thought to be related to needle size, and fine-needle aspiration cytology (FNAC), which, with improvements in cytology, is a reliable procedure (Lees et al, 1985), is thought to be safer than histological biopsy. However, there are frequently circumstances, such as diffuse organ disease, suspected unusual or benign neoplasms and lymphoma, where a core biopsy using a larger cutting needle is desirable in spite of some increased risk.

For liver biopsy, in particular, a number of alternative techniques to the percutaneous approach have been developed, the transjugular approach being the most favoured (Hanafee & Winer, 1967; Korshin et al, 1978; Bull et al, 1983; Colapinto, 1985).
Splenic cyst: demonstration of the relationship between subcapsular haematoma and false cyst by imaging
Authors: Dourthe Olivier , Maquin Pierre , Pradere Bernard , Railhac Jean-Jacques
Published: July 2009

Splenic cysts form a heterogeneous group, classified in 1953 by Fowler. Excluding cystic neoplasms and parasitic cysts, splenic cysts can be classified as “true” cysts lined by an epithelium, and “false” cysts without epithelial lining. It has been postulated that the latter are post-traumatic (Dachmann et al, 1986). In the described case, we record the evolution on ultrasound (US) and computed tomography (CT) of a post-traumatic subcapsular haematoma of the spleen that resulted in cyst formation.
Radiation protection associated with well women breast cancer screening
Authors: Moores B. M. , Henshaw E. T.
Published: July 2009

We wish to raise a number of issues concerning radiation protection aspects associated with well women breast cancer screening programmes now established throughout the UK.

Does irradiation of well women for screening purposes constitute a medical exposure and, therefore, fall within the terms of the 1988 Ionizing Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations? If so, then according to section 4 part 3, persons physically directing a medical exposure shall select procedures such as to ensure a dose of ionizing radiation to the “patient” as low as reasonably parcticable in order to achieve the required diagnostic or therapeutic purpose.
Mistaken hilar mass
Authors: Thomas R. J.
Published: July 2009

F. Wright's comments further consolidate my point that simulator radiographs should not be used for diagnostic purposes and the expertise of radiologists is essential to give a broader differential diagnosis.
Results from the HAD psychometric questionnaire in 54 breast cancer patients treated with breast conservation
Authors: Bulman A. S.
Published: July 2009

Following the report in this journal by Bull and Campbell (1991) on the use of the HAD psychometric scale to detect anxiety and depression in women attending for breast screening which turned out to be negative, it may be of interest to compare the results with those obtained in patients with established breast cancer.
Mesenteric lymphadenopathy in idiopathic retroperitoneal fibrosis
Authors: Pombo F. , Perez-Fontan J. , Rodriguez E.
Published: July 2009

Bilateral ureteral obstruction in a 54-year-old man was diagnosed as idiopathic retroperitoneal fibrosis (IRF) on the basis of surgical biopsy and treated with bilateral ureterolysis 8 years ago. 5 years later, the patient presented with symptoms of colonic partial obstruction and mild renal failure. Relapse involving the perivascular retroperitoneum and the pelvis extending to the mesosigmoid colon was evident on an abdominal computed tomography (CT) study.
Two cases of isolated deficiency of all four limbs diagnosed antenatally with a review of the literature
Authors: Wong W. L. , Clarke O. , Bhattacharya J. , MacDonald L. M.
Published: July 2009

Congenital absence of a limb (amelia) is extremely rare with an incidence ranging from between 0.05 to 0.15 per 10000 live births with total absence of an upper limb having an incidence of between 0.02 to 0.07 per 10000 live births (Birch-Jensen, 1949; Bod et al, 1983; Froster-Iskenius & Baird, 1990; Kallen et al, 1984). The different rates quoted probably reflect the different periods over which the cases were collected in the various studies, ranging from 3 to 32 years, rather than a true variation.

Complete absence of all four limbs is particularly unusual. Froster-Iskenius and Baird identified two cases amongst 1213913 consecutive live births in British Columbia between 1952 and 1984, one of which was associated with thalidomide exposure (Froster-Iskenius & Baird, 1990). In their search of the world literature, Dresher and MacDonell identified only 11 cases, including one described in 1886. To these they added a further two cases (Dresher & MacDonell, 1965).

We present two cases of severe limb reduction diagnosed by ultrasound scanning during the second trimester. In one case all four limbs were absent and in the other one limb was absent and there was severe reduction of the other three.

A 37 year old Indian (G7, P6) presented for a routine ultrasound examination at 19 weeks. She had no family history of congenital abnormalities. There were no complications to the pregnancy at this time.

A single live fetus of 19½ weeks gestation was demonstrated. All intracranial and intra-abdominal structures were normal and correctly sited.
Prenatal ultrasonographic diagnosis of an aneurysm of the vein of Galen
Authors: Worswick L. , Lamont R. F. , Thomas R. , Gordon H.
Published: July 2009

A 31-year-old white woman, gravida 2, para 1 was admitted to hospital because of pre-term labour at 29 weeks gestation. An ultrasound scan at 18 weeks gestation at the referring hospital had shown normal fetal anatomy.

On admission, an ultrasound scan revealed a midline, fusiform, echo-free area measuring 35 mm × 20 mm × 20 mm in the fetal brain, superior to the thalamus and extending posteriorly (Fig. 1). The remainder of the fetal anatomy was normal, except for mild left-sided renal pelvic dilatation. There were no signs of fetal hydrops or ascites. An aneurysm of the vein of Galen (AVG) was suspected and Doppler studies were performed which revealed arterial type flow within the cystic structure (Fig. 2).
Foreword
Authors: Meire Hylton B
Published: July 2009

Every year the BJR has published the abstracts of all the papers accepted for presentation at the Annual Scientific Meeting of the British Medical Ultrasound Society.
Subluxation of the patella: evaluation of patellar articular cartilage with MR imaging
Authors: Nakanishi Katsuyuki , Inoue Masahiro , Harada Koushi , Ikezoe Junpei , Murakami Takamichi , Nakamura Hironobu , Kozuka Takahiro
Published: July 2009

In patients with subluxation of the patella, injury of the patellar articular cartilage is frequently observed, and correct evaluation of this cartilage injury is extremely important for the management of these patients. Magnetic Resonance (MR) studies were performed on 102 patellofemoral (PF) joints of 51 patients with subluxation of the patella and 20 PF joints of 10 healthy volunteers. In 77 of the 102 PF joints with subluxation, arthroscopy and/or operation were performed. MR images were obtained with spin-echo and FLASH sequences, and para-axial images were obtained. We retrospectively analysed the MR findings of the 77 joints with special attention to the surface and thickness of the cartilage, and classified them into four grades. These MR grades were compared with the grades on arthroscopy, and the following results were obtained: MR grade 0, normal cartilage (n = 27, sensitivity 90.9%, specificity 74.2%); MR grade 1, thickening of the cartilage (n = 24, sensitivity 50%, specificity 89.1%); MR grade 2, surface irregularity of the cartilage (n = 20, sensitivity 85%, specificity 94.7%); MR grade 3, loss of the cartilage (n = 6, sensitivity 100%, specificity 100%). Although the early changes observed by arthroscopy were underestimated from the MR images, MR imaging proved to be extremely useful for evaluating moderately or advanced patellar cartilage injury.
Accelerated fast neutron therapy: a pilot study
Authors: Husband D. J. , Errington R. D. , Myint Sun , Littler J. A. H. , Warenius H. M.
Published: July 2009

The clinical role of fast neutron therapy has been limited by excessive late normal tissue damage. A pilot study of accelerated fractionation of fast neutron therapy was performed, based on the rationale that this should result in an increase in the response in acute reacting tissues (normal and malignant), with no change in late damage and a consequent increase in the therapeutic ratio. Further accelerated fractionation should improve the local control of rapidly proliferating tumour, without the potential problem of inadequate reoxygenation inherent in accelerated photon schedules. 6 or 12 fractions of 62 MeV (p-Be) neutrons were given over 12 days to 27 sites in 23 patients with locally advanced tumours. With a dose reduction of 12% (18 Gy), acceptable skin and oral mucosa early reactions were obtained. A larger dose reduction (15%) was required at pelvic sites. The incidence of late EORTC/RTOG grade 4 toxicity was 46%. The overall response rate was 76% with a complete response rate of 16%. For locally advanced breast cancer, the complete response rate was 9%, which compares unfavourably with previous results with conventional neutron fractionation schedules. The combination of a low overall complete response rate and excessive late normal tissue toxicity suggests that accelerated fractionation of fast neutrons does not lead to an improvement in the therapeutic ratio, and that late normal tissue damage will continue to be dose limiting.
A rare cause of a common symptom
Authors: Close P. J. , Monks P. L.
Published: July 2009

A 34-year-old woman presented with a short history of painless vaginal bleeding. Her last menstrual period was approximately 8 weeks previously and a recent pregnancy test had been positive. She had a history of two previous lower segment Caesarean sections. On general examination she was mildly shocked. Vaginal examination revealed an enlarged dumb-bell shaped 8–10 week uterus. The cervix was enlarged, invaginating the bladder. The external os was closed.
Radiation damage to mouse skin and oesophagus
Authors: Michalowski A.
Published: July 2009

I read with great interest the article by Marino et al (1990) and would like to dispute some of the statements and conclusions of it,especially those related to radiation damage to the oesophagus.
Accuracy of ultrasound and oral cholecystography in assessing the number and size of gallstones: implications for non-surgical therapy
Authors: Brakel Koen , Laméris Johan S. , Nijs Huub G. T. , Ginai Abida Z. , Terpstra Onno T.
Published: July 2009

Prior to non-surgical therapy of gallstones it is important to assess their number and size. In order to evaluate the accuracy of ultrasound (US) and oral cholecystography (OCG) in counting and measuring gallstones, a prospective blind study was conducted to compare the results of US (n = 99) and OCG (n = 36), either alone or in combination (n = 34), with the number and size of gallstones retrieved after cholecystectomy. The number of gallstones was accurately estimated by US and OCG in 74% and 69% of the cases, respectively. In assessing the presence of up to three, five or 10 gallstones both US and OCG proved reliable. In measuring the size of gallstones, there was 19% accuracy with US compared with only 3% with OCG. With an accepted measurement error of 3 mm these values increased to 80% for US and 44% for OCG. US proved more reliable than OCG in discriminating gallstones smaller or larger than 10 mm and smaller or larger than 20 mm, but with US, detection of gallstones larger than 30 mm was problematic. Both US and OCG underestimated gallstone size. The combination of both techniques did not significantly improve the assessment of either number or size of gallstones compared with the results obtained with US or OCG alone. It is concluded that (1) both US and OCG have some limitations in assessing the number and size of gallstones, (2) the combination of both examinations does not improve acccuracy, and (3) patient selection for non-surgical treatment of gallstones can be started by US alone.
An investigation into the effect of protective devices on the dose to radiosensitive organs in the head and neck
Authors: Marshall N. W. , Faulkner K. , Clarke P.
Published: July 2009

A series of experiments were performed to determine the dose reduction afforded to radiosensitive organs in the head and neck by various protective devices. These included spectacles with plastic, standard glass, photochromic and lead-glass lenses, a thyroid collar and a lead-acrylic face mask. The measurements were performed using an anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters, in conditions realistic of clinical practice. Irradiations were performed using scattered radiation produced by a pelvic phantom, for X-ray beams generated at 80 kVp and 110 KVp. It was found that the reduction in dose to the lens of the eye ranged between 0% and 97%, whilst the dose to the thyroid and oesophagus was reduced by between 76% and 97%, and was dependent on the protective device and tube potential employed. A reduction in brain dose of up to 81% was also measured, for the lead-acrylic face mask. Also presented is the ratio of organ dose to dose to the bridge of the nose for thyroid, oesophagus, brain and sinuses, as measured for the case of no head or neck protection.
Evaluation and skeletal metastases
Authors: Merrick M. V. , Beales J. S. M. , Garvie N. , Leonard R. C. O.
Published: July 2009

Bone scintigraphy remains one of the commonest isotope imaging investigations employed for the detection of occult skeletal metastases when staging a number of common cancers. The objectives of staging are firstly, to identify patients in whom the disease may be locally curable and secondly, to identify those who may have dissemination, in whom radical local treatment is inappropriate. Increasingly, formal restaging is also repeated at first recurrence. The information considered necessary for clinical management is changing continuously, with developments both in treatment and imaging techniques. The costs must be balanced against those of inappropriate administration or withholding of treatment; in the case of bone scintigraphy, a relatively low-cost procedure, it is not difficult to identify net benefits which offset the costs. The objectives of the panel and its associated floor discussion were to review current practice and to determine, clarify and possibly extend areas in which there is agreement.

Cancer of the lung is the commonest single malignancy in the UK, comprising approximately 25% of all cancers. It is responsible for approximately 40000 deaths per annum in the UK (Capewell et al, 1987). The case mortality is one of the highest of all tumours, being second only to carcinoma of the pancreas. Untreated, the mean survival from diagnosis is less than 3 months (Capewell et al, 1990). There is a 30% 5 year survival for patients with “locally curable” disease, mostly squamous carcinoma, but these patients constitute only a small percentage of the overall population with lung cancer.
An afterloading technique utilizing The Royal London Hospital caesium-137 brain needle in an oral obturator
Authors: Tierney A. M. , Mantell B. S.
Published: July 2009

The intended use of the brain needle (Fig. 1) is the irradiation of brain tumours using a stereotactic technique (Mantell et al, 1986). We have adapted the needle to suit another purpose.

A patient with a mixed tumour of the right paranasal sinuses was treated by initial chemotherapy followed by maxillectomy, leaving a large cavity extending to the roof of the sphenoid sinus, where histology of the resected specimen showed residual squamous cell carcinoma. Post-operative external irradiation using 8 MV X rays was given to the entire operated volume as a dose of 5000 cGy in 24 fractions over 36 days. It was intended to boost the dose to the region of the sphenoid sinus to minimize the risk of recurrence at this site, while keeping the dose to the brain stem within tolerance.