bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of iodixanol with iopamidol in aorto-femoral angiography
Authors: Verow P , Nossen J ØYstein , Sheppick A , Kjærsgaard P
Published: July 2009

This double-blind, randomized, parallel group clinical investigation in 140 consecutive patients undergoing aorto-femoral arteriography was carried out to compare iodixanol (Visipaque®) 270 mgI ml−1 with iopamidol (Iopamiro®) 300 mgI ml−1. The aims of the study were to compare adverse events and discomfort, clinical chemistry parameters in blood, haemodynamics and diagnostic information of the angiograms in the two groups. The main parameter for statistical analysis was the visual analogue scale (VAS) score for overall discomfort experienced by the patients during the examination. 134 patients, 69 and 65 receiving iodixanol and iopamidol, respectively, were examined according to the protocol and included in the evaluation. The two groups of patients were judged to be comparative. Statistically significant milder discomfort was felt with iodixanol than with iopamidol (p=0.0001); mean VAS values 16 mm and 51mm, respectively. Pain was reported far less frequently after iodixanol than after iopamidol (7.4% versus 50.8%) whereas sensation of warmth was less intense after iodixanol than after iopamidol. Four patients in the iodixanol group and two in the iopamidol group reported transient, non-serious adverse events. The difference was not statistically significant (p=0.68). Systolic blood pressure was affected to a slightly greater degree after injection of iopamidol than after injection of iodixanol. Measurements of diastolic blood pressure, as well as clinical chemistry parameters in blood, revealed no changes of clinical importance, and all arteriograms performed were of diagnostic value. The conclusion is that iodixanol 270 mgI ml−1 is as efficacious as iopamidol 300 mgI ml−1, but produces less discomfort during arteriography. As such, iodixanol is a good alternative to iopamidol in aorto-femoral angiography.
Errors at knee magnetic resonance imaging: true or false?
Authors: Mackenzie R , Keene G S , Lomas D J , Dixon A K
Published: July 2009

Amongst a series of 332 patients undergoing a prospective evaluation of the influence of magnetic resonance imaging (MRI) on diagnosis and outcome, arthroscopic correlation became available in 92 knees (91 patients). The MRI report, the arthroscopic findings and the patient's case notes were reviewed by a consensus panel. With respect to the menisci and cruciate ligaments, the formal radiological report was at variance with the arthroscopic findings in 22/349 sites where there had been no previous surgery (10 medial meniscus, six lateral meniscus and six anterior cruciate ligament). 12 of these 22 errors were considered, on review, to be genuine MRI errors. However, considerable controversy remains as to whether the other 10 “errors” were true or false. There are several factors which contribute to such controversy. These include technically difficult arthroscopies, delays between MRI and arthroscopy, and ambiguities in the wording of both the referral letter and the radiological report. These factors should be considered when evaluating the diagnostic performance of both MRI and arthroscopy.
Comparison of colour Doppler energy sonography with conventional colour Doppler sonography in detection of flow signal in peripheral renal transplant vessels
Authors: Preidler K W , Szolar D M , Uggowitzer M , Stiskal M , Horina J
Published: July 2009

The technical advantage of colour Doppler energy sonography (CDE) results in a higher sensitivity for blood flow detection than in conventional colour Doppler sonography (CDI). We compared the efficiency of CDE versus CDI in the detection of blood flow signals in asymptomatic patients after renal transplantation. 10 asymptomatic voluntary patients after renal transplantation were evaluated with CDI and subsequently with CDE by two examiners. Filter, scale and gate setting were kept constant, the Doppler gain was increased individually in every patient until background noise just did not derange the image. The assessment of blood flow signal was done using a self defined score system. CDI showed Doppler signal in the interlobar vessels in all 10 patients and blood flow signal in arcuate arteries and adjacent portions of interlobular vessels in nine of 10 patients. We were not able to detect blood flow related signal in the more peripheral medullary and cortical vessels. CDE obtained blood flow signal in interlobar and interlobular vessels in all patients. In addition, Doppler signal was observed in all patients in small medullary and cortical vessels. CDE increases detection of blood flow related signal in peripherally located small medullary and cortical vessels. There was no improvement in the evaluation of blood flow in interlobar vessels but marked improvement in blood flow detection in small peripherally located vessels. CDE cannot completely replace CDI in the sonographic evaluation of vascular complications in renal transplants, but should be used as an additional measure to rule out pathology in small peripheral renal vessels.
Potentially higher patient radiation doses using digital equipment for barium studies
Authors: Hart D , Wall B F
Published: July 2009

Digital fluorography offers several advantages over conventional radiographic systems. The general expectation of digital equipment has been of a lower radiation dose to the patient. A series of dose–area product measurements on two digital sets during barium meal and barium enema examinations has shown that this expectation is not necessarily correct, particularly when the dose from the fluoroscopic part of the examination is considered. Users of digital fluorography sets are advised to check the performance of their equipment by suitable dose measurements.
Book reviews
Authors: Walsh G E , Williams M P
Published: July 2009

This is the second and according to the author the final edition of this text. It completes work which spans almost two decades and which began with the publication of Radiologic Diagnosis of Renal Parenchymal Disease by A J Davidson in 1977.
Comparison of light reflection rheography with ascending venography in the diagnosis of lower limb venous thrombosis
Authors: Cave E M , Weston M J
Published: July 2009

Our attention was drawn to the paper comparing light reflection rheography with ascending venography in the diagnosis of lower limb deep venous thrombosis by Abbott et al [1]. The discussion concerning Doppler ultrasound fails to mention the significant improvements that have occurred during the last 10 years with technological advances and the use of colour Doppler.
Isotope bone scans in patients with painful knee replacements: do they alter management?
Authors: Owen R J T , Harper W M , Finlay D B , Belton I P
Published: July 2009

A retrospective review of the scintigraphic appearances, clinical findings and outcome in 12 patients presenting with painful knee replacements was made. Three patients required revision surgery; symptoms in the remaining nine patients settled without operative management. Three examinations failed to identify prostheses proven to be infected by aspiration and four were falsely positive for infection without supportive clinical evidence. Four examinations demonstrated loosening and in one patient the bone scan was normal but the prostheses was loose at revision surgery. There were no specific features to predict which prostheses required surgical revision and the ability to diagnose or exclude infection was limited. It is concluded that the results of three phase 99Tcm bone scans in symptomatic knee prostheses are of little assistance in guiding clinical management and that a period of conservative management should be considered prior to operative intervention.
Measurement of collapse cavitation in ultrasound fields
Authors: Digby M , Duck F A , Lenz E J , Price G J
Published: July 2009

This note describes a method for the measurement of hydroxyl free radical concentration due to collapse acoustic cavitation in medical ultrasound fields using aqueous terephthalic acid (TA) solution. An enclosed cylindrical chamber with acoustically transparent membranes at either end was used. Control of cavitation activity was achieved by seeding the solution with polystyrene microspheres to provide cavitation centres. Insonation experiments using unseeded TA previously exposed to air gave very variable results, sometimes detecting cavitation activity and at other times detecting nothing, under the same exposure conditions. Introduction of polystyrene microsphere seeds into the TA enabled it to detect reproducibly levels of cavitation activity at least one order of magnitude higher that in unseeded solutions. An experiment using the seeded TA in a standing wave ultrasound field, set up using a brass reflecting plate, demonstrated that the presence of a standing wave inhibited the measured cavitation yield.
Neonatal platyspondylic dwarfism—a new form
Authors: Kozlowski K , John E , Masel J , Muralinath S , Vijayalakshmi G
Published: July 2009

A new type of neonatal bone dysplasia is reported. Unusual radiographic abnormalities (platyspondyly with unique shape of the vertebral bodies, shortening of the long tubular bones without signs of rickets or metaphyseal dysplasia, marked shortening of well-ossified short tubular bones, schneckenbecken-like pelvis with tri-radiate acetabulum, pseudoepiphysis of the right ulna, unusual shape of calcaneus and periarticular calcifications) allow designation of this disorder as a new form of neonatal dwarfism.
Proceedings of the British Institute of Radiology
Authors: Wall B F , Dance D R , Shields R A , Harding K
Published: July 2009

An extensive study is being undertaken in the West Midlands Regional Health Authority to assess the radiation risk to prodpatients undergoing a wide range of diagnostic radiology procedures (simple and complex). The increasing availability of dose-area product (DAP) meters makes routine assessment of patient dose during fluoroscopic procedures easier. The study aims to provide regional reference values of dose-area product readings (Gy cm2) for all types of examinations. Examinations investigated include amongst others chest, abdomen, cervical spine, pelvis, lumbar spine, venograms, barium meals, barium enemas, small bowel enemas and cardiac catheterization. Data for 30 adult patients per X-ray room are collected for the simple examinations, with approximately 30 patients per radiologist/cardiologist per X-ray room for the fluoroscopic examinations. As expected there is a wide range of dose-area product values observed for examinations of the same type. Table I below summarises the of DAP values collected for a sample of examinations. Early results have given mean dose-area products approximately 50% lower than the NRPB reference levels for barium meals (25 Gy cm2) and barium enemas (60 Gy cm2), and 25% lower for the lumbar spine examination (15 Gy cm2). The large size and geographical distribution of this study, is expected to provide a realistic estimate of the radiation risk to the average patient undergoing a wide range of X-ray examinations in Great Britain today.
Book reviews
Authors: Stamp T
Published: July 2009

On first scanning through the pages of this book I was left with the impression that it contained too little detail and covered too many categories of equipment. It is not a maintenance manual and it does not offer the service engineer sufficient detail to carry out comprehensive repairs.
Book reviews
Authors: Ramsey N W
Published: July 2009

This book, brief though it is, contains a considerable amount of information on both naturally occuring and radiation-induced cancer. Much experimental work using animals is described, and in particular some remarkable similarities between mice and humans are referred to. The content of this lecture is wide ranging, dealing amongst other matters with theories of cancer, and giving much attention to the induction of cancer by radiation. It is a concise discussion on a very topical and important subject.
Book reviews
Authors: Sluming V
Published: July 2009

The second edition of this textbook is approximately 100 pages less than the first edition, and is organized into 12 chapters and two appendices. There are 157 figures (12 fewer than the first edition) of which four are new. The main result of this revision has been the reorganization of the text into four sections. The first section, “The Advance of Technology”, consists of three chapters on “Monitor Photography”, “The Laser” and “The Computer”. Sections 2 and 3 provide the base photographic theory of image production and image quality. Section 4, “Safe Working”, contains two chapters “Enviromental Considerations” and “British Regulations”. This lists 27 sources of reference, 15 fewer than the first edition.
The Mackenzie Davidson Memorial Lecture: Detection of small changes to the brain with serial magnetic resonance imaging
Authors: Bydder G M
Published: July 2009

The use of subvoxel registration of serial magnetic resonance images to detect small changes to the brain and its surrounding tissues and fluids is described and the application of this technique to physiological and clinical problems is illustrated. Isotropic T  1 weighted volume images were obtained in normal subjects and patients on two or more occasions (including pre- and post-contrast enhancement). The images were segmented and three-dimensional rigid body translation and rotation were used with sine interpolation to match precisely the images using a X2 test and a minimization routine. Accurately registered images produced in this way, as well as subtraction images derived from them, were used to detect change to the brain. A system of image interpretation based on recognition of changes in tissue or fluid signal intensity as well as site, shape and size is described. Changes in position are analysed using a simple model based on the concept of two plateaux of higher and lower signal intensities and a border zone between them. Small changes due to differences in orientation of the head, as well as inhalation of oxygen, carbon dioxide and carbogen were observed in normal subjects. Changes were also observed in patients with head trauma, an astrocytoma and multiple sclerosis. Differences due to contrast enhancement and treatment were seen. In addition, children showed changes due to growth and development.
High intensity focused ultrasound—potential for cancer treatment
Authors: Hill C R , ter Haar G R
Published: July 2009

The prospect of being able to use “minimally invasive” surgical techniques is of great interest today, particularly for reasons of health economics, patient acceptability and reduced morbidity. High intensity focused ultrasound (HIFU) has long been known to offer the potential of very precise “trackless lesioning” but has only recently, with the advent of high quality methods of medical imaging, become a practicable possibility. High intensity beams can readily be achieved using either bowl or lens focusing procedures and, by choice of a suitable acoustic frequency, regions of tissue destruction—“lesions”—can be induced at depths of up to at least 10 cm with exposure times of the order of 1 s. Theoretical and experimental evidence indicates that the primary mechanism of damage is thermal, i.e. “cooking” of the tissues. Both conventional cavitation and boiling of tissue water may complicate the situation. Furthermore, substantial non-linear behaviour is involved. On histological appearance the lesions have a spatially sharp demarcation between regions of normal and dead cells. When attempts are made to ablate a block of tissue, by creating an array of adjacent elementary lesions, a phenomenon is observed of inhibition of formation of a lesion whose placing is too close to that of a neighbour. Provided that this problem is dealt with, complete ablation of an extended block of tissue can be achieved. For animal tumours in particular, this observation is reinforced by evidence both of in vitro cell survival and of tumour growth delay experiments. Clinically, the sites accessible for HIFU treatment will be limited by the need for a suitably wide acoustic window that either is available naturally or can be provided by a relatively minor surgical procedure. Tumour sites which thus offer a realistic prospect for local control (and some of which are already the subject of phase 1 trials) include liver, bladder, kidney, prostate, breast and brain. There is also considerable interest in non-cancer applications in these and other sites.
Three-dimensional MP-RAGE—an alternative to conventional three-dimensional FLASH sequences for the diagnosis of viscerocranial tumours?
Authors: Held P , Fellner C , Fellner F , Geissler A , Gmeinwieser J
Published: July 2009

Imaging with three-dimensional (3D) sequences is a frequently used magnetic resonance (MR) technique in the assessment of ear, nose and throat (ENT) tumours near the skull base. Few reports on the contrast behaviour of 3D magnetization prepared rapid gradient echo (MP-RAGE) sequences and their application in ENT tumours exist in the published literature. This paper discusses whether 3D MP-RAGE is an alternative to conventional 3D gradient echo (3D GE) sequences for the diagnostic evaluation of the visceral cranium. Measurements were performed with a Magnetom SP 63 MR system (Siemens) at 1.5 T. 10 healthy volunteers were examined using 3D FLASH sequences with varied flip angles (90°, 70°, 40°, 20°, 10°) and using 3D MP-RAGE to optimize the signal-to-noise ratio (SNR) of muscle, fat and gland tissue. After this optimization 25 patients with ENT tumours near the skull base were examined with 3D FLASH 40°, 3D MP-RAGE 10° (both before and after application of contrast medium) and with 3D FISP 70° (without contrast medium). SNR and contrast-to-noise ratio (CNR) of tumour, inflammatory disease, brain (white and grey matter), compact bone, fat and muscle were calculated. The advantages of 3D MP-RAGE over 3D FLASH 40° include decreased imaging time with decreased motion artifacts and a relatively high contrast between tumour and surrounding tissues. The tissue contrast yielded by the T1/T2  * weighted 3D gradient echo sequence FISP with a flip angle of 70° was not as good as that yielded by 3D MP-RAGE with and without contrast together. In conclusion a combination of contrast enhanced and unenhanced 3D MP-RAGE sequences is the technique of choice for the examination of ENT tumours near the base of the skull.
A lateral will do? (2)
Authors: Pullicino V , McCall I W , Tyrrell P N M
Published: July 2009

The intention of our short communication was to provoke thought and stimulate discussion. We are, therefore, grateful for the comments of two of our colleagues in the British Society of Skeletal Radiologists and pleased to see that they share our misgivings about a single lateral view of the lumbar spine.
Proceedings of the British Institute of Radiology
Authors: Harrison R M , Kelly D C
Published: July 2009

Radiotherapy treatment incident reporting has been a feature of this department for several years. Following an earlier paper published in the journalRadiography Today additional data have been gathered which have been combined with the original data. These data cover a period from January 1991 to December 1994 inclusive. Treatment incidents have been analysed with reference to the type, timing, possible reasons for the incidents and types of treatment unit. All new staff are briefed as to the incident reporting procedure and are requested to report any technical incident that results in incorrect treatment delivery.
Computed tomography and magnetic resonance imaging findings in primitive neuroectodermal tumours in adults
Authors: Pickuth D , Leutloff U
Published: July 2009

Primitive neuroectodermal tumours (PNET) are highly malignant, undifferentiated supratentorial neoplasms arising from germinal matrix cells of the primitive neural tube. PNET occur primarily in young children; they are extremely rare in adults. PNET frequently seed within the central nervous system and may be multicentric at the time of diagnosis. Previous reports of the neuroradiological findings refer solely to PNET in children. We describe the computed tomography (CT) and magnetic resonance imaging (MRI) appearances in five adult patients with pathologically proven PNET. In our series, PNET were mostly seen as rather large, heterogeneous masses with cystic and necrotic areas, intratumoral haemorrhage and focal calcification. The prominent contrast enhancement on both CT and MRI scans reflects the increased vascularity of PNET.
Portal imaging with film-cassette combinations: what film should we use?
Authors: Roberts R
Published: July 2009

A large number of commercially available X-ray films were obtained to assess their suitability for megavoltage radiotherapy portal imaging. The speed (represented by optimum film dose), gamma (γ) and latitude of all these films were determined. Films with high γ values are recommended for clinical use to maximize the low levels of radiation contrast produced by a megavoltage beam.
Estimates of radiation dose to National Health Service workers in Northamptonshire from raised radon levels
Authors: Denman A R , Parkinson S
Published: July 2009

Extensive surveys of the radon levels in hospital premises in Northamptonshire have shown that raised radon levels are present, but are localized to areas as small as a single office. Around 9% of sites are above the workplace action limit, and 1% of sites are over 1000 Bq m−3. In addition, radon levels vary throughout the day, and are usually higher at night. Staff in these areas could receive significant doses, and staff working shifts or at night could be at greater risk. Attempts to estimate staff dose using two methods are reported. It is concluded that, even though only a sample of the radon hot-spots was chosen, the radiation dose received by these staff is greater than the occupational exposure of radiographers, radiologists and other health workers.
Low dose rate and high dose rate intracavitary brachytherapy in a patient with carcinoma of the cervix
Authors: Tan L T , Jones B , Freestone G , Dale R G
Published: July 2009

The role of low dose rate (LDR) intracavitary radiotherapy in the management of carcinoma of the uterine cervix is well established. However, there are selected groups of patients in whom high dose rate (HDR) intracavitary radiotherapy may have particular advantages. A case report of a patient with carcinoma of the cervix who received both LDR and HDR intracavitary radiotherapy is presented. A comparison of the normal tissue doses produced by the two forms of brachytherapy is made. The choice of dose for the HDR treatment was calculated using standard linear quadratic isoeffect equations. The relative clinical merits of LDR and HDR treatments in gynaecological cancer are discussed.
Book reviews
Authors: Faulkner K
Published: July 2009

This is the sixth edition of a well established textbook on radiographic imaging. Whilst the book's intended readership is radiography students on the new degree courses, it will be of interest to a wider group.
Checking the consistency of sensitometers and film processors in a mammographic screening programme
Authors: Law J
Published: July 2009

Quality control procedures in relation to speed and contrast in X-ray film processors, both in X-ray departments and breast screening centres, are based on the use of film sensitometers. Calibrations of these instruments, or simple checks of their constancy with time, are not readily available. A procedure is described in which a reference sensitometer is compared on a 3-monthly basis with the local sensitometer in seven breast screening centres (13 processors) in a region. This demonstrated long-term stability of speed and contrast in both sensitometers and processors. The results may also be used to compare speed and contrast between processors in centres using film of a single type. Standard deviations for single measurements are estimated to be approximately 1% for step density on a single sensitometer, less than 3% for comparison of two sensitometers, about 6% for comparison of processor speed, and between 4 and 5% for processor contrast.
Merkel cell carcinoma of the skin: imaging and clinical features in 93 cases
Authors: Eftekhari F , Wallace S , Silva E G , Lenzi R
Published: July 2009

Clinical, pathological and imaging data for 93 patients with Merkel cell carcinoma were reviewed. Median survival duration from the date of diagnosis was estimated using the Kaplan-Meier product-limit method. Survival durations of patients with no metastastic disease, with regional lymph node metastasis only and with distant metastases were compared using the Cox-Mantel log-rank test. The median age for patients with Merkel cell carcinoma was 70 years (range 35–91 years). The tumour occurred in 71 men and 22 women. The most common primary site was the head and neck region (64 patients), followed by the extremities (21 patients) and the trunk (10 patients). Median survival duration for the whole group was 33 months (range 2 140 months). Imaging studies of the primary sites were available for 10 patients and of metastatic sites for seven patients. Sonograms of the primary skin lesions showed single or multicentric hypoechoic nodules arising from the dermis and growing into the subcutaneous tissues. CT scans showed single or multiple minimally enhancing soft tissue nodules, in two instances associated with lytic bone erosion. The metastatic lesions were moderately hypoechoic on sonography and target-shaped with or without ring-enhancement on CT. Imaging studies have a limited role in diagnosis of the clinically evident primary skin lesions, but may be helpful in the assessment of the depth of the invasion and are crucial in the evaluation of regional and distant metastatic disease. If regional adenopathy is found then CT of the chest, abdomen and pelvis may be in order.
Appendicular measurements in screening women for low axial bone mineral density
Authors: Martin J C , Reid D M
Published: July 2009

Assessment of bone density at hip, spine, radius and calcaneus can predict fracture risk. This paper examines whether women with low bone mineral density (BMD) at the hip and spine can be identified by radial or calcaneal BMD assessment, thus enabling pre-selection of such women for further investigation. BMD in the lumbar spine (LS), femoral neck (FN), trochanter (FT) and Ward's area (FW) was measured by dual energy X-ray absorptiometry (DEXA). These measurements were compared with total (Qtot), trabecular (Qtrab), subcortical (Qscort) and cortical (Qcort) BMD of the ultradistal radius measured by peripheral quantitative computed tomography (pQCT), and ultrasound attenuation (BUA) and velocity (VOS) at the os calcis. Measurements were performed on 216 penmenopausal women aged between 45 and 55 years who attended a randomized osteoporosis screening programme. Correlations for pQCT and ultrasound with DEXA measurements were, at best, moderate (r = 005–053), being poorest for Qcort and VOS. Similar correlations were found between ultrasound and pQCT measurements (r = OO5–O31). None of the pQCT or ultrasound measurements predicted low DEXA measurements. 50–56% of women in the lowest quartile (QU4) of Qtot, Qtrab, Qscort and BUA were also in QU4 of LS, 45–57% were in QU4 of FT and FW, but only 22–33% were in QU4 of FN. To detect all women with osteopenia at FN or LS using pQCT or ultrasound, almost the entire population would have to be screened. In conclusion, pQCT and os calcis ultrasound measurements cannot successfully predict hip and spine osteopenia and could not be used to pre-select women for DEXA hip and spine assessment.
Early tumour response and treatment toxicity after hyperfractionated radiotherapy in nasopharyngeal carcinoma
Authors: Teo P M L , Kwan W H , Leung S F , Leung W T , Chan A , Choi P , Yu P , Lee W Y , Johnson P
Published: July 2009

The aim of the present study was to undertake a planned interim analysis of a prospective randomized trial comparing the tumour response and the acute and subacute complications of hyperfractionated radiotherapy and conventional radiotherapy in non-metastatic nasopharyngeal carcinoma (NPC). 100 patients with newly diagnosed non-metastatic NPC were randomized to receive either conventional radiotherapy (Arm I) or hyperfractionated radiotherapy (Arm II). Stratification was done according to the T-Stage (modified Ho's T-Stage classification). The biological effective dose (10 Gy) to the primary and the upper cervical lymphatics were 75.0 and 73.1 for Arm I and 84.4 and 77.2 for Arm II, respectively. Hyperfractionated radiotherapy was associated with significant mucositis which is of higher grade than conventional radiotherapy (p = 0 0001), but the duration of mucositis was similar between the two Arms and all study patients completed radiotherapy on schedule without interruption of radiotherapy. Early survival and tumour recurrence rates were comparable between the Arms. The preliminary results indicate that the hyperfractionated radiotherapy has excellent patient compliance in Chinese patients, with acceptable acute and subacute toxicities and the local and regional complete tumour response rates being comparable with conventional radiotherapy. The significance of the time required after start of radiotherapy to achieve a complete tumour response is discussed.
CT and MRI demonstration of hypothalamic and infundibular relapse in childhood acute lymphoblastic leukaemia
Authors: Tsetis D , Bhattacharya J , Cavenagh J , Thakkar C H
Published: July 2009

The central nervous system is affected in up to 10% of patients with acute lymphoblastic leukaemia, usually in the form of leptomeningeal infiltration. Parenchymal spread is rare. We report a case in which CT and MRI demonstrated hypothalamic and infundibular relapse.
Pseudotumoral brain lesion as the presenting feature of sarcoidosis
Authors: Grand S , Hoffmann D , Bost F , Francois-Joubert A , Pasquier B , Le Bas J F
Published: July 2009

Sarcoidosis rarely presents as an intracranial mass lesion. We report the case of a patient presenting a disturbance of cognitive functions in whom CT and MRI demonstrated a large right fronto-temporal mass lesion with contrast enhancement and surrounding marked oedema, highly suggestive of a brain tumour. The diagnosis of neurosarcoidosis was made after stereotactic biopsy of the lesion.
Transmission titles for X-ray mattresses
Authors: Maughan J , Burniston M , Robertson M
Published: July 2009

Considerable attention has been given to the introduction of carbon fibre components such as table tops in the implementation of a patient dose reduction programme. There appears to have been much less interest in the attenuating properties of the mattresses used.

With the assistance of Medical Technical Officers we have surveyed a range of tables and mattresses used in our hospital. The results were disturbing Figure 1 shows the distribution of table and mattress transmission values.
Embolization for ruptured superior mesenteric artery aneurysms
Authors: Ishii A , Namimoto T , Morishita S , Saitoh R , Oguni T , Makita O , Takahashi M , Tanaka M , Okamoto M , Kaneko Y , Okamura K
Published: July 2009

Superior mesenteric artery (SMA) aneurysms are very uncommon. They are difficult to detect until they rupture and cause hypovolaemic shock. We performed embolization in four cases of aneurysm of branches of the superior mesenteric artery, succeeding in three cases without the need for surgical treatment. In the first case, the aneurysm was excised because of migration of a microcoil into the left hepatic artery. It was not retrieved because sufficient blood flow to the liver was shown on angiography after migration and no ischaemic change of liver was detected on laparotomy. In the second case, the aneurysm arose from the anterior pancreaticoduodenal artery. In the third case, the patient had two SMA aneurysms, one had been resected at surgery, another was revealed on follow-up angiography and embolized with microcoils. The fourth patient had a jejunal artery aneurysm with extravasation; haemostasis was achieved by packing it In all four cases, no major complications were observed in the clinical course after embolization. Microcoils were considered to be the desirable embolic material, in order to prevent post-therapeutic ischaemic change. Embolization should be the treatment of choice for SMA aneurysms, because it is less invasive and takes less time than surgical treatment.
A study of dose reduction using digital luminescence radiography for lateral skull radiography
Authors: Seifert H , Kubale R , Hagen Th , Kramann B , Leetz H-K
Published: July 2009

For lateral skull radiography the minimum required radiation patient exposure to ensure adequate image quality was determined for digital luminescence radiography (DLR) in comparison with a screen film system (speed class 200). Radiographs were produced with a grid technique on conventional X-ray equipment. A real prepared female head including a true fracture above the pars petrosa ossis temporalis was imaged. The tube current–time product (mAs), and thus the surface entrance dose, was varied systematically. Surface entrance dose was measured with TLD-100 rods. Image quality was judged by experienced radiologists according to the criteria: visual resolution, mean optical density, contrast and perceptibility of specific bone structures. Surface entrance dose was reduced from 0.46 to 0.20 mGy by application of DLR instead of speed class 200 screen–film system without loss of diagnostic information in clinical routine. This corresponds to a dose reduction potential of 57% showing a good agreement with the dose reduction potential of 52% obtained in a previous study using the Alderson head phantom.
Dose–area product measurements in paediatric radiography
Authors: McDonald S , Martin C J , Darragh C L , Graham D T
Published: July 2009

The dose–area product (DAP) could provide a useful quantity for monitoring doses for paediatric radiography, because it is a sensitive parameter, which is simple to record. A study of DAP measurements has been carried out for single radiographic projections for paediatric patients and comparisons made with measurements of entrance dose. The technique has been used to investigate doses for examinations performed with and without a grid. There is a linear relationship between DAP and entrance dose, with a variation of ±20% for pelvis, abdomen, spine and skull radiographs, but data for chests are more scattered. Logarithm of the DAP is linearly related to an equivalent patient diameter and reference levels could be set in terms of DAP either by patient age range or size. Effective doses determined from DAPs were 0.1 0.3 mSv for abdomen, pelvis and spine anteroposterior radiographs for 5–15 year olds, and less than 0.03 mSv for 0 and 1 year olds. Doses for examinations performed without a grid were only 20% of those for which a grid was used in the X-ray room studied. Significant reductions in doses for paediatric radiology can be achieved, where the use of grids can be avoided.
Prospective assessment of a new graduated hookwire for the localization of impalpable breast lesions
Authors: Flanagan J J , Conry B G , Rubin G , Mills P , Bentley P G
Published: July 2009

The benefits of the addition of site specific variable graduations to a conventional mammographic localizing wire were assessed in a prospective multidistrict study. Six surgeons and five radiologists localized lesions in 31 patients in three District General Hospitals. The advantages of the graduated wire were shown to be greater ease and accuracy of radiological localization with easier surgical excision and a smaller resected breast specimen.
A method of brachytherapeutic treatment of tracheal stoma recurrence in head and neck cancer
Authors: Schäfer U , Schmilowski G M , Micke O , Mohring R , Willich N
Published: July 2009

Tracheal stoma recurrence after external beam irradiation in patients with laryngeal carcinoma is a serious complication. Treatment can often only be of a symptomatic nature. A simple method of brachytherapeutic treatment is described, consisting of a special flab applicator combined with a tracheostomal tube. The presented applicator system is suitable for treatment of the tracheostomal recurrence as well as the surrounding skin. It can be applied easily and is well tolerated by the patient, while at the same time achieving a good palliative effect.
A rapidly expanding testicular mass due to a ruptured ovarian follicle
Authors: Ablett M J , Masters J , Elliott S T
Published: July 2009

An ovotestis is the commonest gonad in the small number of patients who are true hermaphrodites. In the majority of ovotestes, testicular and ovarian tissue is arranged end-to-end. There has been only one previous report of the sonographic appearances of an ovotestis. We present the sonographic findings in a patient who developed a rapidly enlarging upper pole testicular mass, which was found on histology to be a ruptured ovarian follicle with spermatogenesis occurring within the adjacent testicular tissue.
Book reviews
Authors: Ritchie D A
Published: July 2009

This book is an excellent addition to a series of practical manuals covering interventional radiology of different subspecialities. The main aim of the book is to give a comprehenisive account of the various interventional procedures stressing the importance of careful technique and the clinical value of the procedures.
Posterior pituitary ectopia and hypopituitarism—magnetic resonance appearances of four cases and a review of the literature
Authors: Denton E R E , Powrie J K , Ayers A B , Sonksen P H
Published: July 2009

In four patients presenting in childhood with varying degrees of hypopituitarism, magnetic resonance imaging (MRI) showed a reduction in size of the normal pituitary fossa contents and an absent or very narrow stalk. A high signal intensity, enhancing area at the base of the stalk, having the appearances and signal characteristics of the posterior pituitary, was seen in each case. We discuss the case histories and MR findings in our patients and review the relevant literature.
Patient doses in bone mineral densitometry
Authors: Huda W , Morin R L
Published: July 2009

Procedures were developed to compute effective dose equivalent (HE) values for patients undergoing bone mineral densitometry (BMD) measurements such as dual energy X-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). Representative values of HE were determined for patients undergoing each type of BMD procedure. Typical DEXA measurements are associated with an HE of about 2.5 μSv. For QCT, the values of HE are 300 μSv for single energy techniques and 1 mSv for dual energy techniques, respectively. By comparison, a single well collimated abdominal X-ray examination often taken in conjunction with DEXA studies results in an HE of about 100 μSv. BMD patient doses are at the lower end of the exposure range encountered in diagnostic radiology. As a result, radiation dose is not a primary factor in choosing the method for BMD determination.
Effective doses for coronary angiography
Authors: Leung K C , Martin C J
Published: July 2009

A detailed study of dose data has been made for 100 coronary angiography examinations performed on a digital X-ray unit. Dose–area product (DAP) data have been analysed in terms of fluoroscopy and radiography for different projections. Projections patterns were similar for all cardiologists studied and the contribution to DAP from fluoroscopy was 32%. Data for 10 patients, selected because the percentage contributions to DAP from fluoroscopy and radiography were similar to the mean for the group, were used to derive conversion factors from DAP to effective dose. The mean DAP was 14 Gy cm2 and the effective dose 3.1 mSv. Conversion factors, based on the same protocol, were derived for a range of tube potentials and filtrations for use in estimation of effective doses with other units.
Patient doses from CT in New Zealand and a simple method for estimating effective dose
Authors: Poletti J L
Published: July 2009

A 1992 survey of doses to patients from CT scanning in New Zealand found that CT contributes 81 μSv per capita per annum, representing about 17% of the collective dose from medical irradiation. Because of the significance of CT, estimates of patient dose are now included in the National Radiation Laboratory (NRL) routine surveys of CT scanners. For some models of CT scanner, normalized organ dose data from Monte Carlo studies are available, enabling the calculation of the effective dose. For scanners for which there are no normalized organ dose data, it is shown that the computed tomography dose index (CTDI), determined at 1 cm depth in Perspex phantoms and normalized for mAs, may be used to estimate the effective dose. Estimates of effective dose derived from the CTDI may then be used to formulate reference dose levels, against which individual scanner doses may be compared.
A comparison of doses and techniques between specialist and non-specialist centres in the diagnostic X-ray imaging of children
Authors: Kyriou J C , Fitzgerald M , Pettett A , Cook J V , Pablot S M
Published: July 2009

A dosimetric survey of 14 routine X-ray examinations in children was carried out between 1993 and 1995. Two children's hospitals and four general hospitals took part in the survey which involved the calculation and measurement of nearly 3000 doses. Entrance surface doses (ESD) were calculated from exposure factors for radiographic procedures, and dose–area products (DAP) were recorded for both radiographic and fluoroscopic procedures. Doses were in good agreement with earlier studies, but for some procedures were significantly lower than those reported from other European countries. The main dose influencing factors for radiographic procedures were found to be the speed of the film–screen system and the use of an antiscatter grid. For the main head/trunk examinations, specialist centres often delivered higher doses to the younger children as a result of widespread use of a grid. In fluoroscopy, where the main dose influencing factors were the use of a grid and the dose rate dependence of the image intensifier, the children's hospitals consistently delivered significantly lower doses. Both ESDs and DAPs were found to increase with patient age for the main head/trunk examinations, although in some cases (AP/PA chest) this relationship was weak. The dependence of dose on age necessitates the subdivision of the paediatric sample into a number of age categories. It is suggested that all authors use the same age groupings.
Assessment of osteopenia from spine radiographs using two different methods: the Chingford study
Authors: Masud T , Mootoosamy I , McCloskey E V , O'Sullivan M P , Whitby E P , King D , Matson M B , Doyle D V , Spector T D
Published: July 2009

Two methods for diagnosing radiological osteopenia in thoracic (TS) and lumbar (LS) spine radiographs were assessed: a subjective conventional method (A) and a semiquantitative method (B), by comparing them with bone mineral density (BMD) measured by dual energy X-ray absorptiometry (DEXA), in a population of “normal” women aged 45–70 years (n = 818). For both methods there was good intraobserver and interobserver reproducibility. BMDs were significantly lower with increasing radiological osteopenia grades (p<0.001), and remained lower after adjustment for age and body mass index (p<0.01). The proportion of subjects with DEXA-defined osteoporosis rose with increasing radiological osteopenia grades for both methods. The worst osteopenia categories identified 29.7–55.3% of women with DEXA-defined osteoporosis, compared with 6.1–11.7% in the “normal” categories. Both methods, however, showed a large degree of overlap of BMDs between the various radiological osteopenia grades. The sensitivity and specificity of method A in diagnosing osteoporosis were 45.3% and 78.4%, respectively, for the TS and 19.0% and 94.3%, respectively, for the LS. For method B the sensitivities and specificities were 8.8% and 96.1%, respectively (TS), and 10.2% and 95.6%, respectively (LS). Although both methods have poor sensitivities, “definite” or “high” grade osteopenia should be an indication for bone densitometry The high specificities suggest that a “normal” (no osteopenia) X-ray is unlikely to have a significantly low BMD.
A burning question
Authors: Corbett R H , Hart G
Published: July 2009

The current increase in interventional procedures with fluoroscopic guidance has led to a situation whereby long screening times are being experienced. As a result, some patients are developing acute radiation-induced erythema [1–4]. Skin doses of 2 Gy can be achieved by some fluoroscopy machines within 40 min. The presence of this deterministic effect, i.e. erythema, implies that there is also a significant degree of stochastic detriment. All physicians should note that deterministic radiation injuries are often delayed in onset and may not be observed immediately after the procedure, the exact time depending on the dose delivered [5–7].
Book reviews
Authors: Critchley M , Vinjamuri S
Published: July 2009

This volume provides an excellent synopsis of current nuclear cardiology practice. It is surprisingly enjoyable to read, as well as being informative — surprising because it is not only a multiauthor text but is also a translation from the original Spanish. The text is freeflowing and lucid and much credit is due to the translator Dr Permanyer-Miralda and to Professor P J Ell who revised and refined the translation.
Magnetic resonance imaging in macromelia and macrodactyly
Authors: D'Costa H , Hunter J D , O'Sullivan G , O'Keefe D , Jenkins J P R , Hughes P M
Published: July 2009

We report five cases presenting with soft tissue and bone overgrowth that demonstrate the ability of MRI to establish a diagnosis in the absence of specific clinical features. Disorders included macrodystrophia lipomatosa, angiolipomatosis, Klippel–Trenaunay–Weber syndrome, blue rubber bleb naevus syndrome and one case of segmental limited hypertrophy. The MRI appearances, and other radiological features of these conditions are discussed. MRI is recommended in all cases of macrodystrophy when the clinical features and plain film findings are indeterminate.
Technetium-99m-HMPAO labelled leucocytes in the detection and monitoring of inflammatory bowel disease in children
Authors: Jewell F M , Davies A , Sandhu B , Duncan A , Grier D
Published: July 2009

This study was a retrospective evaluation of the use of technetium-99m hexamethylpropyleneamineoxime (HMPAO) labelled leucocytes in the investigation of suspected inflammatory bowel disease in children. The images were analysed in 35 children and the findings were compared with the results of endoscopy/biopsy, barium studies and antinuclear cytoplasm antibody (ANCA) serology. The sensitivity of the white cell scan was 83% and the specificity 81%. This compares well with other studies in adults and is superior to barium investigations. The technique is recommended as a first line investigation to detect inflammatory bowel disease with a resultant reduction in the use of endoscopy and barium imaging.