bluuebunny/crossref_metadata_2025 huggingface dataset:
Book review
Authors: Ritchie D A
Published: July 2009

This book gives a basic introduction to imaging the acutely injured patient. It is a pictorial atlas divided into two sections dealing with skeletal and non-skeletal trauma. Skeletal trauma is covered in six chapters, the first of which gives a brief introduction to the aims, indicators and terminology of trauma radiology.
Simultaneous supra- and infradiaphragmatic irradiation in Hodgkin's disease
Authors: Krueck W , Hess C F , Kortmann R D , Bamberg M
Published: July 2009

From 1982 to 1989, 68 patients with Stages IA to IIIB Hodgkin's disease were treated by simultaneous supraand infradiaphragmatic irradiation (SSI-RT). 46 patients received exclusive radiotherapy for Stages IA and IIA (extended mantle field irradiation (EMF) 31, and total lymphatic irradiation (TLI) 15). Combined modality treatment including pre-irradiation chemotherapy, was given to 22 patients (CH-EMF 12 and CH-TLI 10). The median follow-up was 64 months. 5-year overall survival was 94% in combined Stages IA and IIA, and 100% in Stage IIIA. 5-year freedom from relapse was 87% in combined Stages IA and IIA, and 80% in Stage IIIA. Toxicity was evaluated in 64 patients. Acute and long term toxicity was similar to previously reported data on sequential supra- and infradiaphragmatic irradiation. In SSI-RT prior chemotherapy affected pre-irradiation blood counts and was associated with delayed post-irradiation haematological recovery. The relative mean white blood cell (WBC) decrease ranged from 47% (EMF) to 61% (TLI). The mean platelet decrease ranged from 43% (EMF) to 80% (CH-TLI). Both prior chemotherapy and total lymphoid irradiation increased haematotoxicity. The mean duration of breaks ranged from 3.9 days in EMF to 14.9 days in CH-TLI. The mean treatment time, ranging from 43 days in EMF to 54 days in TLI, was significantly shorter than in sequential schedules (up to 112 days). Our results indicate that SSI-RT is an effective and safe treatment. Its use seems to be limited mainly by prior chemotherapy. As compared to sequential schedules, the risk of match line overlap is avoided, overall treatment time is decreased, and treatment costs are minimized.
Book review
Authors: Shorvon P J
Published: July 2009

The concept of a comprehensive textbook on endocrine imaging is an interesting one. As James Thrall states in the foreward, most components of endocrine imaging have been “adopted by specialists with interests in different anatomic regions or techniques but not with a broad or comprehensive interest or expertise in the endocrine system”. As a unifying text this book in general works well. However, the authors already having adopted this very broad remit seem to have made their task even more difficult; more than 100 pages at the beginning to the book are devoted to the physics and techniques (including quality assurance) of the imaging methods used in endocrine imaging.
Radiation doses to paediatric patients undergoing less common radiological procedures involving fluoroscopy
Authors: Chapple C-L , Faulkner K , Lee R E J , Hunter E W
Published: July 2009

A semi-automated dosimetry survey has been undertaken to monitor the radiation doses to patients in a paediatric fluoroscopy room. The doses were assessed using large area Diamentor ionization chambers to measure dose × area product, and by means of thermoluminescent dosemeters attached to the patient's skin in various places. Details of patients and examinations were entered into a computer, all information being stored on a data base. Many radiological examinations have been monitored, including renal and jejunal biopsies, nephrostograms, loopograms, tracheograms and fistulograms. Patients included in the study have been divided into three age bands for dose assessment. Radiation doses for different types of examination have been compared, including more common examinations for which data have been previously presented.
Does the Whitaker test add to antegrade pyelography in the investigation of collecting system dilatation in renal allografts?
Authors: Kashi S H , Irving H C , Sadek S A
Published: July 2009

Significant pelvicalyceal dilatation in renal allografts is currently investigated by antegrade pyelography. However, the clinical significance of a radiologically demonstrated narrowing of the ureter is unclear. Over a 21-month period 26 of 155 renal allografts with pelvicalyceal dilatation were investigated by antegrade pyelography. In eight allografts no ureteric stenosis could be identified. Two grafts were shown to have ureteric necrosis and required surgical intervention and 16 of the other grafts appeared to have a ureteric stenosis. 15 of the 16 allografts with radiological ureteric stenosis underwent a concurrent pressure flow study to assess the functional relevance of the ureteric narrowing. As shown by a pressure rise of > 7 mmHg at a perfusion rate of 10 ml min−1, 11 of the 15 grafts were functionally obstructed and were treated by a nephrostomy catheter followed by antegrade insertion of a ureteric stent. The four grafts with a negative pressure flow study were subsequently shown on biopsy to have rejection. The diagnosis of allograft rejection was also confirmed by biopsy in seven of the eight allografts without a radiological ureteric stenosis. The last of the eight allografts was found to be cyclosporin toxic. Pelvicalyceal dilatation of renal allografts is appropriately investigated by antegrade pyelography in combination with a pressure flow study which identifies those grafts with mechanical obstruction.
BJR's policy on colour illustrations
Authors: Hogan T R
Published: July 2009

The British Institute of Radiology, 36 Portland Place, London W1N 4AT

The British Journal of Radiology charges authors £185 for the first colour illustration and £30 for each subsequent illustration. Our aim is to help cover the extra costs associated with the additional colour printing: scanning to produce colour separated film, provision of cromalin proofs and the printing of an extra colour section.
Long source–skin distance rectal irradiation technique: a review of results
Authors: Shenouda G , Gordon P H , Podgorsak E B , Evans M D C , Freeman C R
Published: July 2009

Endocavitary rectal irradiation is a well established curative treatment for patients with selected early cases of adenocarcinoma of the rectum. At McGill we use a long source–skin distance (SSD) rectal irradiation technique as an alternative to the standard short SSD rectal irradiation technique originally described by Papillon. Eight patients, seven women and one man, were treated between April 1986 and November 1988. Median age was 72.5 years (range 46–86 years). Seven patients were treated with curative intent, and one for palliation. The mean follow-up period for all patients was 43 months, with a median of 54 months (range 3–65 months). Actuarial survival and disease-free survival were 86% and 72% at 65 months for the seven patients treated with curative intent. Treatments were well tolerated by all patients and only one patient developed localized proctitis that required steroid enemas, which resulted in complete resolution of symptoms. Our results are comparable with those in other reports in the literature. The complications were similar in type and frequency to other published series.
Appearances on ultrasound of impalpable injection port in a double chamber breast prosthesis
Authors: Skene A I , Collins C D , Barr L , Cosgrove D O
Published: July 2009

Breast reconstruction utilizing tissue expansion is being increasingly practised by both plastic and general surgeons. Our current experience for both immediate and delayed reconstruction is with the double chamber Becker prosthesis. The prosthesis with the resulting breast mound has on occasions rendered the injection port difficult to localize by palpation. We have found ultrasound useful in identifying impalpable ports and in facilitating needle insertion into the injection dome.
Book review
Authors: McMillan T J
Published: July 2009

Following many years of interest in damage-inducible processes in prokaryotes the number of studies of post treatment increase in gene expression in mammalian cells rising rapidly. Advances in the techniques of molecular biology have resulted in the identification of a large number of genes that increase in expression following treatment with DNA-damaging agents. Unfortunately, the biological significance of many of these changes is not yet known.
CT — an increasingly important slice of the medical exposure of patients
Authors: Shrimpton P C , Wall B F
Published: July 2009

It is now 21 years since the revolutionary imaging technique of computed tomography (CT) was introduced into clinical practice. In coming of age, CT has found increasing use in the diagnosis and assessment of cancer and other pathological conditions and has undoubtedly led to significant advances in patient care. As a measure of this success, perhaps, CT now represents a major source of exposure from diagnostic X-rays for the UK population. This importance was firmly established by a national survey relating to the 200 scanners in clinical use in 1989 (Shrimpton, 1992). Information on CT practice was provided by questionnaires completed by over 80% of National Health Service scanners (Shrimpton et al, 1991).
Effect of nuclear medicine on paediatric imaging
Authors: Gordon I
Published: July 2009

Detailed understanding of anatomy and pathology is central to radiology. If functional imaging can be incorporated into the overall picture of the patient then the “radiologist” stands in a unique position to assist the clinician, not only with establishing the diagnosis but also with assessing the effectiveness of therapy.

The role of nuclear medicine varies with different organ systems; almost every nuclear medicine examination must be based on a firm anatomical foundation and therefore radiology (including ultrasound, CT and MRI) must be available close to the time of the nuclear medicine study. There are certain nuclear medicine examinations which are truly complementary to well-established anatomical studies, e.g. ventilation/perfusion (V/Q) lung scans with the chest radiograph or 99Tcm HMPAO brain scans with CT or MRI. Other nuclear medicine examinations have however replaced radiological investigations, e.g.  99Tcm DMSA for the IVU in renal scarring, or the bone scan for the skeletal survey when staging children with malignant disease.

An integrated approach means that the term “radiologist” implies someone who is conversant with the advantages and disadvantages of ultrasound, radiology, CT, MRI and nuclear medicine techniques. This does not imply full training in all modalities. The choice of a particular technique should be based on the least invasive procedure, which usually carries the lowest radiation burden. Important factors which the radiologist must take into account when dealing with children include the invasiveness of a procedure and the radiation burden of an investigation.
Book review
Authors: Rankin S
Published: July 2009

This compact textbook on body CT is a welcome addition to the literature. It begins with a short synopsis on the physics of CT followed by a more detailed chapter on anatomy with line drawings corresponding to the CT images. There is also a section on image analysis and contrast administration.
A frameless method for stereotactic radiotherapy
Authors: Jones D , Christopherson D A , Washington J T , Hafermann M D , Rieke J W , Travaglini J J , Vermeulen S S
Published: July 2009

A frameless method for stereotactic multiple arc radiotherapy (SMART) is described. Three short gold wires are implanted in the scalp approximately 100 mm apart. These are localized in a computed tomographic or angiographic study along with the target. Subsequently the gold markers are localized on beam films and the target position calculated using a computer program ISOLOC. This program provides the couch movements required to move the target to the isocentre and a micropositioner attached to the couch is used to make the adjustment. Beam films are repeated until the movements required are less than 1 mm in any direction. It is shown that the simple procedures of implanting the markers subcutaneously do not provide a stable reference system in about 25% of patients and the markers are now screwed into the cranium. The precision of the method is evaluated by phantom studies and measurements taken during several hundred treatments.
Selection of anti-scatter grids for different imaging tasks: the advantage of low atomic number cover and interspace materials
Authors: Sandborg M , Dance D R , Carlsson G Alm , Persliden J
Published: July 2009

A Monte Carlo computer program has been developed for the study of anti-scatter grids used in diagnostic radiology. The program estimates the scatter from soft tissue phantoms representative of either adult or paediatric examinations and uses dose increase, signal-to-noise ratio improvement and contrast improvement factors to study grid performance. It has been used to quantify the advantage of replacing grids with aluminium covers and interspaces by grids using materials of low atomic number for these components. Two approaches are used. First, the aluminium and low atomic number alternatives are compared for five grid ratios at fixed strip density and width and for tube potentials of 50, 70, 100 and 150 kV. Second, 44 commercially available grids are compared for three different imaging situations (lumbar spine, chest and paediatric). The results demonstrate that grids made with carbon fibre cover and cotton fibre interspace result in greater improvements in contrast and signal-to-noise ratio, and lower dose increase factors, than do grids made with aluminium. The dose reduction varies with irradiation conditions and is generally larger at lower tube potentials, higher grid ratios and lower strip densities. A typical reduction in mean absorbed dose in the patient is 30% in an adult lumbar spine (AP view) at 70 kV with a grid with 36 strips per centimetre and ratio 12.
Book review
Authors: Gleeson J A
Published: July 2009

This text book of approximately 550 pages covers all aspects of gastrointestinal imaging. The initial discussion of the anatomy and physiology is a useful guide to the type and site of pathological changes which may occur; the methods of examination and the use of drugs in imaging are also described.
Computed tomography of generalized lymphangiomatosis and chylothorax
Authors: Higgins J N P , Shah A R , Dicks-Mireaux C F M , Conry B G
Published: July 2009

The diagnosis of lymphangiomatosis can often be made on clinical grounds with the aid of plain radiography. In children with intractable chylothorax computed tomography (CT) of the thorax may reveal the presence of a mediastinal mass but frequently in lymphangiomatosis will not demonstrate any specific features. Abdominal CT, on the other hand, may suggest the diagnosis by the association with intraabdominal lymphangioma.
Hypokalaemic hypertension: a real con!
Authors: Huntley L S , Moore N R
Published: July 2009

A 40-year-old baker was referred for investigation of increasingly frequent episodic fast irregular palpitations with slight chest discomfort and dizziness. There was no dyspnoea. He was hypertensive at 150/105 mmHg. His general practitioner had commenced atenolol 50 mg daily for the hypertension and potassium supplements as a low serum potassium concentration had been discovered during initial investigation. Further assessment showed mild asymmetric left ventricular hypertrophy and confirmed a low serum potassium concentration of 3.2 mmol 1−1 with normal renal function. 24 h urinary catecholamine assessment and supine/standing serum assays of renin and aldosterone were normal. After control of his hypertension he was discharged to the care of his general practitioner.
Clinical diagnosis from digital displays: results and conclusions from the St Mary's evaluation project
Authors: Dawood R M , Craig J O M C , Todd-Pokrapek A , Porter A W , Highman J H , Cunningham D A , Stevens J M , Al-Kutoubi A , Crofton M E
Published: July 2009

Preliminary results with the first commercially available digital display system to be installed in a British radiology department were published in 1989: these consisted of data from observer performance studies of digitized images displayed using a 1024-line monitor, showing a single pathological feature—subperiosteal resorption in renal osteodystrophy. Further experiments have now been conducted with the successor to this equipment, a 1280-line digital display system. Formal observer performance studies were undertaken for four pathological conditions, and the results show statistically significant differences in performance between the digitized displayed images and those on film. The display system was not considered to be good enough for the task of primary radiological diagnosis of subtle lesions; findings support the conclusion that careful, objective clinical evaluation of digital display systems is important before they are introduced into clinical use.
The case of the knotty string
Authors: Kapur V , Kulshreshtha R , Baijal V
Published: July 2009

An 8-year-old boy presented at a peripheral hospital with a 10-day history of upper abdominal pain, vomiting and loose motions. He vomited out worms 5 days later. There was a vague lump in the abdomen. Abdomen and chest skiagrams and ultrasound were reported normal.

In the absence of improvement in clinical status, the patient was admitted to our institution with episodes of recurrent abdominal pain and an evening rise in temperature occurring for a month. Examination revealed anaemia, a rash all over the body and an intraabdominal lump in the epigastrium and left hypochondrium.
Absorbed dose in the skin from beta emitters in medical and laboratory containers
Authors: Beddoe A H , Kelly M T
Published: July 2009

The International Commission on Radiation Protection have recently recommended an annual dose limit for the skin of radiation workers of 500 mSv at a depth of 20–100 μm averaged over any 1 cm2 regardless of the area exposed. It has previously been shown by the authors that beta dose rates on the outer surfaces of typical laboratory containers (vials, test tubes) or on medical syringes can exceed lOOmSv h−1 for radionuclide concentrations of the order of 1 MBq g−1, depending on container diameter, wall thickness and material and the beta particle energy spectrum. Since the fingers are frequently in contact with such containers it is of some importance to extend these dose calculations to depths below the skin surface, taking into consideration the anatomy of skin on the fingers. Using an extension of a Monte Carlo method previously described, dose rates have been calculated for the clinically useful radionuclides 90Y, 32P, 198Au, 153Sm and 131I. For polypropylene syringes the beta dose rates at a depth of 270 μm (a typical basal cell depth in the fingers) range from 77 to 135 mGy h−1 per MBq g−1 for 90Y (maximum energy 2.27 MeV) and approximately zero to 0.62 mGy h− per MBq g−1 for 131I (maximum energy 0.61 MeV). These results emphasize the importance of adequate finger protection when using high energy β emitters and especially for clinicians who typically inject specific activities of the order of 100 MBq g−1 of 32P; in such cases annual permissible dose rates are exceeded in a matter of minutes. It is recommended that a minimum of 5 mm perspex finger protection be used for 90Y and 32P.
Colour Doppler demonstration of pseudoaneurysms complicating pancreatic pseudocysts
Authors: Golzarian J , Braude P , Bank W O , Zalcman M , Gansbeke D Van
Published: July 2009

The great morbidity and mortality associated with pseudoaneurysms complicating pancreatic pseudocysts stress the need for their early detection. The authors report the use of colour Doppler sonography in the detection of pseudoaneurysms within pancreatic pseudocysts, emphasizing not only the value of this modality in the initial diagnosis, but also its value in monitoring the success of transcatheter embolization. Colour Doppler should be used systematically in the evaluation of pancreatic pseudocysts.
Calibration of low activity caesium tubes and needles traceable to the therapy level standard
Authors: Deshpande N A , Wilkinson J M
Published: July 2009

A technique for deriving the reference air kerma rate for low activity brachytherapy sources that is traceable to the therapy level standard at the National Physical Laboratory is presented. Correction factors have been generated to account for the finite source and detector size. The air kerma rate calibration of the secondary standard for caesium quality has been derived by polynomial curve fitting. The reference air kerma rates for several caesium tubes and needles have been determined and the results compared with the manufacturers' source test reports. For all the source types used the agreement between methods was within 2%.
Measurement of computed tomography scanner slice widths
Authors: Czajka J , Shaw A J , Mott D J
Published: July 2009

The slice width of a computed tomography scanner can be considered as the full width at half maximum (FWHM) of the slice dose profile. A method is described which uses dental film to image the slice and allows the FWHM of the dose profile to be determined directly from the digitization and analysis of the film image.
Book review
Authors: Snowdon S L
Published: July 2009

This book attempts to address an important developmental area of interventional radiology covering divergent aspects of clinical and therapeutic management of patients. The views put forward are essentially European in outlook and are based on a series of papers given at an international symposium. There are nearly 50 contributors. Not surprisingly, the presentation is disjointed with some repetition and the style terse.
Room shielding requirements in diagnostic radiology
Authors: Casey M
Published: July 2009

New regulations propose a more stringent limit to the radiation exposure of workers and members of the public. The shielding in X-ray areas will have to be reassessed to take account of these new limits. This technical note identifies a computerized technique for evaluating shielding requirements which yields results that are significantly more cost effective than those determined by traditional methods.
The accuracy of conventional and three-dimensional thallium-technetium scans in patients with hyperpara-thyroidism resulting from multiglandular hyperplasia
Authors: Dudek M K , Jenkins B J , Goode A W , Newell M S , Boucher B J
Published: July 2009

25 patients with hyperparathyroidism resulting from multiglandular hyperplasia were studied prior to cervical exploration. 43% of abnormal glands were correctly localized by preoperative thallium-technetium scintigraphy. In the 11 patients who underwent three-dimensional scanning, all glands already identified by scintigraphy were also localized in a third plane. In one patient an additional gland, not detected by the conventional scan, was visible.
Quality control in mammography: an initiative in France
Authors: Maccia C , Renaud R , Castellano S , Schaffer P , Wahl R , Haehnel P , Dale G , Gairard B
Published: July 2009

The ultimate effectiveness of any mass screening campaign is directly related to strict compliance with certain rules and technical protocols designed for radiological installations. Concerning radiological screening, the primary technical objective is to ensure reproducibly high quality images at low radiation dose to the patient. This paper describes the methodology followed for the implementation of a quality control (QC) programme of 48 mammography installations used within the context of the breast cancer screening campaign in the Bas-Rhin region of eastern France. In order to demonstrate the efficacy of such a programme, results of QC tests and procedures relating to each element of the radiological imaging chain are presented and compared for four control visits carried out at 6 month intervals over a period of 2 years. A reduction of 50% (from 16 mGy to 7.5 mGy) of breast entrance doses (normalized to a breast thickness of 4.5 cm) and a significant improvement of detectability of high contrast details are discussed. The importance of encouraging an extension of a similar process to the other screening experiments currently underway in France is emphasized.
Book reviews
Authors: Duncan A W
Published: July 2009

The format of the book is a division of subjects into anatomical regions of the body, i.e. head, thorax, heart, etc. with transverse sagittal and coronal sections in each region, with oblique or axis views where appropriate.

The main illustration of the section is accompanied by a smaller orientation picture showing the imaged plane of each section for clarity.
The safety of outpatient arteriography using 3F catheters
Authors: Buckenham T M , Belli A-M
Published: July 2009

We were interested to read the article by Reidy and Ludman [1] on arteriography using 3F catheters. We routinely use 3F catheters for intraarterial diagnostic studies and find it surprising that the authors did not mention the major limitations of this technique.

The single most important problem is catheter rupture. Despite using flow rates as low as 6 ml s−1 and pressures of 900 psi, 25% of our Cook 3F catheters rupture at the junction between the hub and the tubing. Once ruptured it is very difficult to reinsert the 0.025 inch amplatz wire to effect a catheter change.
Book reviews
Authors: Perry J N , Williams M P
Published: July 2009

This book contains 400 multiple choice questions, each with five parts. It differs significantly from other collections of MCQs that are on the market in several ways. The number of questions is heavily biased against plain and contrast radiography and towards CT, MRI, angiography, scintigraphy and ultrasound. Each answer is explained and fully referenced.The answers are therefore more voluminous than the questions,and are set out at the end of each chapter rather than on the page facing their respective question. The book is also better bound than some of its competitors.
Serial investigation of balloon angioplasty induced changes in the superficial femoral artery using colour duplex ultrasonography
Authors: Henderson J , Chambers J , Jeddy T A , Chamberlain J , Whittingham T A
Published: July 2009

Percutaneous transluminal balloon angioplasty (PTA) of superficial femoral artery lesions is associated with similar initial success rates in coronary and iliac artery angioplasty but its application is limited by a much higher incidence of restenosis. To improve understanding of the trauma caused to the vessel by balloon angioplasty and the mechanisms contributing to the subsequent processes of healing and restenosis requires serial investigations of the treated arteries in vivo. This paper describes a prospective study using colour duplex ultrasonic imaging to assess arterial changes in 51 patients with atherosclerotic disease undergoing PTA of superficial femoral artery stenoses and occlusions. Each patient was scanned prior to angioplasty and at intervals up to 6 months post-angioplasty. On each scan, measurements were made of the overall vessel and lumen diameters at each site of angioplasty. These measurements indicate that angioplasty improves vessel patency mainly by stretching of the vessel wall, with compression and/or redistribution of the atherosclerotic plaque contributing less than 25% to the improvement of lumen diameter. Serial measurements after angioplasty show complex patterns of change at the angioplasty sites indicating that several mechanisms may be contributing to the processes of vessel healing and subsequent restenosis. Possible mechanisms which could explain the measured changes in overall vessel and lumen diameters are discussed.
Book review
Authors: Dewbury K C
Published: July 2009

This small book of some 280 pages provides a concise and well illustrated text that covers most of the normal and abnormal findings encountered undertaking abdominal ultrasound.
The computed tomographic features of mediastinal bronchogenic cyst rupture into the bronchial tree
Authors: De Nunzio M C , Evans A J
Published: July 2009

Bronchogenic cysts are congenital anomalies which occur most commonly within the mediastinum. They may become complicated by fistula formation with the bronchial tree. We report a case of an adult male where such a complication occurred between the time of the patient's chest radiograph and his examination by computed tomography (CT). We believe that this is the first reported CT demonstration of an air–fluid level within a mediastinal bronchogenic cyst, in a typical site, presumed to be caused by rupture into the bronchial tree.
Variation between os calces as measured by broadband ultrasound attenuation
Authors: Dretakis E , Damilakis J , Kontakis G , Gourtsoyiannis N
Published: July 2009

We compared broadband ultrasonic attenuation (BUA) values of right with left os calcis in 65 women. All subjects were right handed, and they were divided into two groups: Group 1 consisted of 32 normal volunteers and Group 2 of 33 osteoporotic subjects. Both groups had mean absolute differences in BUA between the two os calces greater than the coefficient of variation (p < 0.001). This difference is not related to stated handedness of the individuals. Osteoporosis affects both os calces similarly. BUA measurements should always be performed in the same site in longitudinal studies, otherwise false comparisons will result.
Renal morbidity and compensatory renal responses associated with flank radiotherapy in two children
Authors: Jenkins P J , Plowman P N
Published: July 2009

Unilateral kidney irradiation, above renal tolerance, is occasionally necessary in the treatment of flank tumours in childhood. Renal atrophy follows. There is often a gradual increase in the function of the contralateral kidney to compensate for the radiation injury. The development of this compensatory response appears to be influenced by both age and any dose of radiation received. We report the cases of two children who received high dose unilateral kidney radiotherapy as part of the multimodality treatment of a flank tumour and consider the influences on compensatory hypertrophy of the contralateral kidney.
Presentation of colour flow maps of the peripheral circulation
Authors: Green I R , Dudley N J , Gravill N
Published: July 2009

The use of continuous wave Doppler ultrasound for lower limb arterial assessment is a well established technique in most district hospitals. Patients found to have disturbances in blood flow attributable to arterial plaques are often referred for arteriographic visualization of the disease with its inherent risks and complications. The availability of colour flow mapping on modern ultrasound scanners provides a noninvasive way of detecting the size and extent of these plaques and, in some institutions, is replacing arteriography. One possible disadvantage of the use of colour flow mapping is that it does not provide a permanent record showing the relationship of the plaques to the patient's gross anatomy in the same way as arteriography. This may limit the acceptability of this technique. At Lincoln work was undertaken to develop a system for presenting images of a whole segment of a limb simultaneously along with the associated blood velocity spectrum. This was performed first by hand and then a suite of computer software was developed to automate the process. Comparisons were made between the ultrasound based images and arteriography, showing the techniques to be of similar diagnostic value. The technique provides composite images showing anatomical detail, blood flow and velocity spectra for ease of interpretation. Further studies will be undertaken in order to define patient groups where diagnostic arteriography can be avoided.
Necklace calcification in an infant: a sign of hypoxia; not of strangulation
Authors: Carty H
Published: July 2009

Necklace calcification in an infant: a sign of hypoxia; not of strangulation

Thank you for giving me the opportunity to reply to the above correspondence. I am familiar with the paper by Higgins and Shaw and I accept that they have seen fat necrosis in their child and, indeed, that this has been described on several occasions.
Organ absorbed doses in intraoral dental radiography
Authors: Lecomber A R , Faulkner K
Published: July 2009

We thank Dr Ramsey for the interest shown in our article and welcome the opportunity to reply.

There are two principal types of distortion in projection radiography: image size distortion and image shape distortion. Image size distortion results from a gross magnification of the image, such that the proportions of the image are approximately the same as their counter parts in the object. The image closely matches the object in shape, but the overall size is different.
Book reviews
Authors: Irvine A T
Published: July 2009

This small monograph is an extremely detailed account of the author'sexperience with angioscopy.

Following a brief review of the history of angiography the author discusses the various techniques for performing angioscopy in the radiological suite. There follows a detailed discussion of various angioscopic findings in peripheral vascular disease including the angioscopic appearance following percutaneous transluminal angioplasty. There is a further section on interventional procedures in angioscopy with sections on the assessment of thrombolysis and of stent implantation.
Detection of inflammation/infection with human polyclonal immunoglobulin G labelled with 99Tcm
Authors: Jiménez-Heffernan A , Villanueva J L , Moral A , Rebollo A , González F M , Ureña M , López-Ruiz J M , Llamas-Elvira J M , Mateo A
Published: July 2009

Radiolabelled human polyclonal immunoglobulin G (IgG) has been successful in identifying inflammatory/ infectious processes in human and animal models. We studied 71 patients with suspicion of inflammation of varied origin and location (44 of musculoskeletal location and 27 other) using 99Tcm. IgG images correctly identified 21/22 inflammatory sites of musculoskeletal origin and only 4/14 sites of soft-tissue location. Five false negative studies corresponded to granulomatous processes, three of them tuberculosis. Four false positive studies were obtained in the musculoskeletal group corresponding to three synovial tumours and a Charcot joint. No false positive results were seen in the soft tissue group. 99Tcm-IgG performs well in the identification of bone–joint lesions and rules out non-inflammatory conditions (with the important exception of tumours). The role of 99Tcm-IgG in soft-tissue inflammatory sites, especially in highly vascular organs is inferior, with a high yield of false negative studies. Granulomatous lesions probably represent situations of low or absent IgG uptake.
Comparison of hand injection with mechanical injection for digital subtraction selective cerebral angiography
Authors: Hughes D G , Patel U , Forbes W ST C , Jones A P
Published: July 2009

100 patients undergoing digital subtraction cerebral angiography were randomized to have contrast delivered by either hand or mechanical injection. We compared the two modes of injection for image quality, the presence of vertebral reflux, possible complications and radiation exposure to the radiologist. There was no statistical difference between the two modes of contrast delivery for image quality and vertebral reflux. Only one definite temporary neurological complication was recorded. However, radiation exposure to the radiologist's hand and body were reduced by up to 70% by using a mechanical injector for contrast delivery during selective cerebral angiography with digital subtraction. We advocate use of the mechanical injector by radiologists who perform regular angiography to reduce their exposure to radiation.
A mathematical model of intraluminal and intracavitary brachytherapy
Authors: Jones B , Dale R G , Bleasdale C , Tan L T , Davies M
Published: July 2009

The adaptation of the linear-quadratic model to allow for the effect of tumour regression and clonogen repopulation between initial teletherapy and subsequent brachytherapy has been extended to include the geometrical conditions encountered in intraluminal and intracavitary brachytherapy. For a radiation line source placed at the centre of a lumen or cavity, regression of any endoluminal tumour towards its mural origin will not result in any change in the minimum brachytherapy–tumour dose with time. In contrast, regression of transmural tumour will cause a potentially advantageous increase in the minimum brachytherapy–tumour dose with time. The latter effect will be opposed by tumour clonogen repopulation. The loge cell kill due to brachytherapy has been calculated for tumours of diameters 2, 4 and 6 cm at completion of teletherapy. The centres of the tumours were assumed to be at distances of 0, 1 and 2 cm from the radiation source. Tumour linear regression rates (λ) ranging from 0.025 to 0.25 per week and tumour clonogen doubling times (T  p) of 2.5, 5 and 15 days were used in the calculations. The results demonstrate the critical importance of the distance of the tumour centre from the line source as well as the influence of tumour diameter, λ and T  p. In some instances, both maximum and minimum values of loge, cell kill occur. Calculations of tumour cure probabilities reveal that these variations in loge cell kill predicted by the model can produce highly significant differences in tumour control rates. Where the relevant parameters can be assessed directly or estimated from previous experience, the model provides a basis for the design of future intraluminal or intracavitary brachytherapy protocols.
Complete photopenia of the femoral head on radionuclide bone scanning in septic arthritis of the hip
Authors: Gash A , Walker C R , Carty H
Published: July 2009

Three cases of septic arthritis of the hip are presented. In each case, radionuclide bone scanning, using 99Tcm diphosphonate (MDP), demonstrated complete photopenia of the femoral head. All three cases resulted in avascular necrosis and subsequently had a poor clinical outcome with a reduced range of movement and radiographic epiphyseal deformity. Complete photopenia in the presence of suspected sepsis requires urgent referral with a view to exploration and decompression.
Bone SPECT of the wrist
Authors: Dubowitz D J , Miles K A
Published: July 2009

A technique for single photon emission computed tomography (SPECT) during bone scintigraphy of the wrist is described. The technique has been developed as a means to improve localization of abnormalities observed on 99Tcm-MDP planar bone scintigraphy. A wrist phantom and 15 wrists in 13 symptomatic patients were examined. Good spatial detail was achieved, with the pisiform readily identifiable as a separate bone in six wrists. In seven cases the tomograms permitted better localization of planar image abnormalities and in four cases additional lesions were visible which were missed on planar scintigraphy. This technique can be applied to all patients with suspected carpal injury and allows better anatomical localization and greater sensitivity than planar scintigraphy alone.
Book review
Authors: Joslin C A F
Published: July 2009

This book first appeared in 1950 as a Short Textbook of Radiotherapy for Technicians and Students, edited by H Miller and the late J Walter. Dr Miller has written a foreword to the book and draws attention to this being the fifth edition, having served the needs of radiotherapy radiographers, clinicians and physicists working in radiotherapy worldwide.
Renal artery calcification in an allograft
Authors: Sada P N , Elias J M
Published: July 2009

An unusual case of idiopathic, macroscopic, radiologically visible calcification in the transplant kidney of an allograft recipient is discussed.
Iceberg in the pleural space
Authors: Seetharaman M L , Saluja S
Published: July 2009

A 50-year-old non-diabetic male subject was admitted for right sided hydropneumothorax. 4 days prior to this admission the patient had developed a high grade fever with shaking chills, a cough with scanty expectoration that later turned purulent and a discomfort in the right side of the chest. He denied any history of seizures, trauma to chest and contact with domestic animals. He was a smoker and had consumed alcohol socially. He had no past history of significant respiratory illness.
Book reviews
Authors: Faulkner K
Published: July 2009

This book has been written as an introductory text on the use of dual energy X-ray absorptiometry in medicine. It covers all aspects of the subject, ranging from an introduction to the clinical problem of osteoporosis and a description of measurement techniques to the measurement of bone mineral and body composition in practice.

The first two chapters briefly review metabolic bone disease and bone structure. These chapters are then followed by a group of chapters which describe bone mineral absorptiometry equipment and techniques. This group of chapters represents a wide ranging review of all methods of assessing bone mineralization but with particular emphasis on dual photon absorptiometry and dual energy X-ray absorptiometry.
Magnetic resonance image synthesis using a flexible model
Authors: Zhu X P , Hutchinson C E , Hawnaur J M , Cootes T F , Taylor C J , Isherwood I
Published: July 2009

Image synthesis methods are based on the hypothesis that a magnetic resonance (MR) image with optimized contrast can be reproduced by synthesis from three calculated basic images of T  1, T  2 and spin density. This method, however, is limited by noise due to uncertainties in the initial measurements. The principal component analysis (PCA) method is based on an information theory approach that decomposes MR images into a small set of characteristic feature images. PCA images, or eigenimages, show morphology by condensing the structural information from the source images. Eigenimages have also been shown to improve contrast-to-noise ratio (CNR) compared with source images. In this study we have developed a method of synthesizing MR images using a flexible model, comprising a set of eigenimages derived from PCA. A matching process has been carried out to find the best fit between the model and a synthetic image calculated from the Bloch equations. The method has been applied to MR images obtained from a group of patients with intracranial lesions. The images derived from the flexible model show increased lesion conspicuity, reduced artefact and comparable CNR to the directly acquired images while maintaining the MR characteristic information for diagnosis.
Saccular aneurysm of the intraorbital ophthalmic artery
Authors: Kikuchi K , Kowada M
Published: July 2009

A saccular aneurysm of the intraorbital portion of the ophthalmic artery is extremely rare. We report this entity in a 54-year-old man who also had a dural arteriovenous malformation (AVM) at the base of the anterior cranial fossa. The aneurysmal formation at this unusual site may be explained by a haemodynamic stress that derived from the presence of the dural AVM.
Results of a questionnaire regarding the practice of radiotherapy for carcinoma of the cervix in the UK
Authors: Jones B , Tan L T , Blake P R , Dale R G
Published: July 2009

A questionnaire was sent to 50 departments of clinical oncology in the UK in September 1991. The aim was to determine the range of external beam and brachytherapy techniques employed at that time in the radical treatment of carcinoma of the cervix. Replies were received from 35 centres. This paper summarizes the preliminary findings of the study. Low dose rate (LDR) brachytherapy techniques predominated (34/35 = 97%) but 41% of departments (13/32) had future plans for the use of high dose rate (HDR) equipment. For low bulk (Stage I–II) carcinoma of the cervix, there was no detectable association between the total brachytherapy dose prescribed and the brachytherapy dose rate. In bulky (Stage I–III) carcinoma of the cervix treated by initial open teletherapy (without shielding), there was a statistically significant reduction in the prescribed brachytherapy dose with increasing dose rate. There was considerable variation between centres in the measurement or estimation of normal tissue doses during brachytherapy. The range of techniques used and the variation in expected complication rates should be closely monitored via medical audit and a further follow-up questionnaire may reveal important changes.
A moderately sized resonator/surface coil for radiofrequency electron paramagnetic resonance spectroscopy and imaging in vivo
Authors: Stevens A D
Published: July 2009

A resonator for the radiofrequency (250 MHz) electron paramagnetic resonance spectroscopy (EPRS) and imaging (EPRI) of biological samples is described. It has been designed for use with a 0.5 m bore EPR spectrometer. It is of the double split-ring type, 65 mm in diameter and 100 mm in length, and is equipped with a tuning-lock mechanism for fixed frequency operation. It can be used in the whole-body mode for small animals and as a surface coil for larger samples. The extent of sensitivity in the latter mode is ca. 20 mm. Larger resonators are being developed for whole-body human studies. A phase-locked crystal oscillator frequency source with high spectral purity is used to minimize noise demodulation and automatic tuning; coupling and phase controls have been included to compensate for motional artefacts. For purely aqueous nitroxides, the minimum detectable concentration is ca. 4 × 10−7 M using an internal sample 100 ml in volume. Sensitivity in the surface coil mode is discussed and spectra from phantoms using both physiological saline and a human volunteer to induce realistic conduction losses are shown.
Reducing motion artifacts in in vivo magnetic resonance imaging measurements of relaxation times
Authors: Gowland P A , Leach M O , Tanner S F
Published: July 2009

Robust and accurate methods of measuring relaxation times on commercial scanners have recently been developed. Such methods overcome many machine and sequence dependent errors, but are still subject to errors arising from motion artifacts. This paper considers methods of decreasing the effect of motion artifacts in in vivo  T  1 and T  2 measurements. Three conventional techniques for reducing such artifacts are assessed for their use with relaxation time measurement sequences. It is shown that these techniques do not adversely affect the accuracy of phantom T  1 measurements made with the spin echo/inversion recovery sequence, and of T  2 measurements made using the PHAPS sequence. For in vivo measurements of T  1 it is also shown that these techniques reduce the standard deviation of T  1 measurements in regions of interest and improve the reproducibility of such measurements overall. Two other techniques for reducing motion artifacts were found not to be compatible with the accurate measurement of relaxation times.
A lump in the throat
Authors: Guest P , Husband J
Published: July 2009

A 46-year-old man previously treated for spinal cord compression complained of a painless swelling in his neck. He had no difficulty in breathing swallowing.

A plain radiograph of his neck and a chest radiographor are shown (Figures 1 and 2).

What is the abnormal structure in the neck and what diagnosis can you reach from the films? in the hyoid bone (not shown) consistent with metastasis. The dominant lesion appeared to be in the right humeral head. The diagnosis of osteosarcoma was confirmed on surgical decompression of the spinal cord from thoracic spine disease.