bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of malignant hypertension
Authors: Williams P. H. , Hemingway A. P.
Published: July 2009

A 44-year-old woman presented with a 3 day history of central visual field impairment in the left eye, which had not changed since onset. The only past medical history of note was that during both pregnancies she had been hypertensive, for which she had required hospital admission. She had not been investigated post-partum and was on no anti-hypertensive medication.

On examination, she had a tachycardia of 112 per min with no radio-femoral delay, a blood pressure of 240/130 in both arms and a bruit audible over the left renal area. No abdominal mass was palpable. Fundoscopy showed a blot haemorrhage in the left retina, bilateral papilloedema with blurred disc margins and arteriovenous nipping. Urinalysis revealed proteinuria.
Relapsing polychondritis
Authors: Mantell B. S.
Published: July 2009

Goddard et al (1991) have reported an unusual case of relapsing polychondritis which presented as acute encephalitis. I have treated a case of this condition with many of the other features described using radiotherapy with long term control. There was, however, no encephalitis.
Book reviews
Authors: Davies J. V.
Published: July 2009

I can remember purchasing Part 1 in this series which covered the fore limb. I was a university veterinary radiologist with, as is often the case, more experience in small animal radiology. In most veterinary faculties, except in the USA and Utrecht, this would be a common occurrence as radiology departments in this country are not big enough to support specialists in both large or small animal radiology. To this end I hoped that such a collection of atlases would expose me to the collective experience of two well known large animal experts. I suppose I have not been disappointed.
The basal turn of the cochlea
Authors: Phelps Peter D.
Published: July 2009

The coils of the cochlea are now readily demonstrated by thin-section high-resolution computed tomography (CT) in the axial plane. This assessment has become important in severely deaf patients who are candidates for cochlear implant surgery. The commonest abnormality shown in these cases is post-meningitic or tympanogenic labyrinthitis ossificans, which can obstruct the passage of the electrode. Severe otosclerosis can cause a similar problem. Congenital deformities of the labyrinth are rarely suitable for implantation, but the procedure may be indicated for the true Mondini deformity. Implantation is contraindicated for severe dysplasia of the cochlea and for the recently described variety of x-linked deafness with deficient bone at the fundus of the internal auditory meatus.
Magnetic resonance imaging of extracranial head and neck tumours
Authors: Kabala J. , Goddard P. , Cook P.
Published: July 2009

The role of magnetic resonance imaging (MRI) in the investigation of head and neck tumours (excluding those primarily arising from the central nervous system or orbits) has been investigated. Follow-up data were obtained on 45 scans on 42 patients. MRI provided significant additional information compared with computed tomography (CT) in nine out of 17 (53%) scans performed for staging purposes. In the assessment of 19 patients with suspected tumour recurrence, MRI demonstrated a sensitivity of 100%, a specificity of 80% and an accuracy of 89%.
Quality assurance of computer controlled radiotherapy treatments
Authors: Morgan Helen M.
Published: July 2009

There is a need in conformal therapy, as in any radiation therapy, for adequate quality assurance of the treatment plan and the delivery of the treatment. This paper examines quality assurance of two methods of conformal treatment, on a cobalt treatment unit using computer control. Each of the two methods demonstrates a different aspect of computer controlled treatments. Following completion of each treatment plan, an additional “quality assurance plan” is prepared. This is used to assess the integrity of the treatment plan, and the precision with which the computer controls the treatment unit. A simple method, using solid state detectors in a Perspex phantom, is used to validate the dosimetry of the “quality assurance plan”. Quality assurance of the computer control is performed daily prior to treatments. At each treatment, parameters identifying the start position and final position of the computer controlled couch movements and the exposure time are noted by the radiographers. Comparison of the recorded movement of the treatment couch and the exposure time with that intended during each course of treatment has demonstrated, inter alia, limitations on couch speed control at speeds of less than 10 mm per min.
New evidence that tamoxifen does not induce osteoporosis: a nuclear activation analysis and absorptiometry study
Authors: Kalef-Ezra J. , Glaros D. , Klouvas G. , Hatzikonstantinou J. , Karantanas A. , Siamopoulos K. C. , Pavlidis N.
Published: July 2009

The possibility of increased risk for osteoporosis in breast cancer patients treated with tamoxifen was investigated. 26 patients aged 41–65 years without skeletal metastases were studied. All patients were treated with 20 mg/d tamoxifen for a mean time of 22 months. The data obtained by in vivo neutron activation analysis of the phosphorus content in hands, were supplemented with data obtained by single photon absorptiometry in the forearm and radiographic morphometry. Comparison of the data with that of age and sex matched normal controls showed that breast cancer patients treated with tamoxifen are not prone to osteoporosis.
Radical treatment of angiosarcoma of the scalp using megavoltage electron beam therapy
Authors: Sagar Stephen M. , Pujara Chandrakant M.
Published: July 2009

Angiosarcoma of the scalp is a multifocal neoplasm that is often initially managed by wide excision and surgical reconstruction. Invariably, adjuvant radiotherapy is required to improve local control. Primary radical radiotherapy to the scalp is not well documented. The major limitation is the technical problem of treating homogeneously an extensive superficial curved volume. We describe a practical technique that can be administered with a standard linear accelerator capable of high-energy electron production. The technique uses a multiple abutted fixed field set-up at constant source to surface distance and the patient is immobilized in a custom wax helmet which also serves to optimize the electron absorbed dose in the treatment volume. Surgical excision and reconstruction is reserved for the salvage of local relapse.
The disappearing bladder—modifying imaging techniques after rectal excision
Authors: Peh W. C. G. , Chokshi N. C. , Young C. H.
Published: July 2009

Urological complications after abdomino-perineal excision of the rectum are well recognized. One complication is chronic urinary retention, which occurs in 14–50% of patients (Watson & Williams, 1952; Buckwalter et al, 1955; Eickenberg et al, 1976; Neal et al, 1982; Watters et al, 1983). The three main theories explaining causes of bladder dysfunction are direct nerve injury, loss of bladder support and pericystitis (Buckwalter et al, 1955; Eickenberg et al, 1976). Vesical neuropathy is now generally accepted as the main cause of urinary retention and this has been reflected in the emphasis on urodynamic studies, conducted mostly by urologists (Rankin, 1969; Fowler, 1973; Fowler et al, 1978; Neal et al, 1982; Chang & Fan, 1983; Lupton, 1986).

We present two male patients who developed posterior–inferior bladder prolapse subsequent to rectal excision and illustrate the modifications of standard imaging technique required to demonstrate the altered anatomy.
Increased attenuation value of a colloid cyst of the third ventricle following ventricular decompression
Authors: Warnock N. G. , Powell T.
Published: July 2009

A 35-year-old woman presented with a 3 month history of postural unsteadiness. She complained of worsening headaches, with blurred vision for 1 week, accompanied by nausea and vomiting. On examination she was found to have bilateral papilloedema, with slight slowness of mentation but no other feature.

Axial computed tomography (CT) (Fig. 1) showed gross dilatation of the lateral ventricles, with a collapsed third ventricle, consistent with the presence of obstruction to cerebrospinal fluid (CSF) flow at the foramina of Munro. No mass was seen.

A ventriculo-peritoneal shunt was inserted into the right lateral ventricle, with relief of symptoms. A repeat CT at 4 days after shunting showed collapse of the right lateral ventricle, with a considerable reduction in the size of the left (Fig. 2). Cerebral angiography was performed and was normal.
An underdiagnosed abdominal mass?
Authors: Edwards R. D. , Kincaid W.
Published: July 2009

A 49-year-old woman presented with a 6 h history of severe abdominal pain and a superficial, palpable mass in the right lower abdomen. She was obese and had noted a variable swelling in this area for 4 months. A right inguinal herniorrhaphy had been performed 3 months previously. Views from the initial ultrasound (US) of the anterior abdominal wall and subsequent barium follow-through (FT) are shown (Figs 1 & 2).
The value of transvaginal scanning in the assessment of second trimester oligohydramnios
Authors: Twining P.
Published: July 2009

Second trimester oligohydramnios is associated with a poor perinatal outcome (Barss et al, 1984), however, this is not a universal finding (Mercer & Brown, 1986). Therefore, it is important to establish an accurate diagnosis before a major management decision is made. The common causes of oligohydramnios are premature rupture of membranes, intrauterine growth retardation and Potter's syndrome. The most difficult problem is to differentiate severe intrauterine growth retardation from Potter's syndrome and transabdominal scanning often provides limited information due to the lack of liquor. The use of the transvaginal transducer, however, demonstrates fetal renal anatomy accurately even in the presence of oligohydramnios (Benacerraf, 1990). The present study describes four patients with severe oligohydramnios in whom transabdominal scanning provided equivocal findings. Subsequent transvaginal scanning demonstrated renal pathology in two patients, normal kidneys in the third and renal agenesis in the last.
Altered radiotherapy fractionation in medulloblastoma
Authors: Bates N. P. , Williams M. V.
Published: July 2009

Plowman and Doughty have recently described a partial transmission block technique for the treatment of children with medulloblastoma or similar tumours, who require total neuraxis radiotherapy (Plowman & Doughty, 1991). In this technique, the neuraxis radiotherapy is given in a larger number of smaller fractions, and it is proposed that this will reduce the neurological morbidity associated with the treatment without reducing tumour control rates. While we agree that late side effects are likely to be less severe, we do not accept that tumour control will be unchanged; indeed we expect that it will be significantly impaired.
Editorial
Authors: Duck Francis , Shaw Don
Published: July 2009

From its emergence as a diagnostic tool about three decades ago ultrasound has expanded and continues to grow in importance and influence as a unique diagnostic device whose potential has yet to be fully explored and exploited. Next month, July 1992, the British Journal of Radiology is devoting its complete issue to diagnostic ultrasound. Whilst it remains the editorial policy of the Journal to maintain its multidisciplinary scientific and clinical spectrum, we believe that highlighting this one area of interest in a special issue will be appreciated by all users of the BJR.
Radiotherapy to the surviving kidney after unilateral nephrectomy in bilateral Wilms' tumour
Authors: Kirkbride P. , Plowman P. N.
Published: July 2009

Despite an improving overall survival rate for children with Wilms' tumour, four out of seven patients with bilateral tumours died in the period from 1952 to 1960 and five out of eight died in the period from 1971 to 1989, at St Bartholomew's Hospital and the Hospital for Sick Children. More aggressive chemotherapy with both adriamycin and actinomycin D and concern over young age being predisposed to late radiation morbidity prompted us to keep radiotherapy dose prescriptions to the surviving kidney below the quoted renal radiation tolerance dose equivalent. In three long-term survivors treated with daily fractions up to 167 cGy and total doses of 1000–1200 cGy, we have found renal function and growth to be within the “normal” range at follow-up and the patients to be normotensive 6–8 years later. As four of the eight patients reported here died from local disease progression within the kidney (albeit despite slightly larger dose prescriptions), we discuss the potential for larger total doses to be delivered in this situation.
A manual afterloading technique for the treatment of patients with bronchial carcinoma using iridium-192 wire
Authors: Vinall A. J. , Mulvey P. J.
Published: July 2009

The difficulties of effective palliative treatment of patients with bronchial and oesophageal tumours have long been under consideration. For a brachytherapy technique the generally accepted way to treat such patients is using a remote afterloading machine such as the Mico-Selectron and some early results have already been reported (Burt et al, 1989). In the absence of funding for such a machine we have developed a technique for manually inserting a single iridium wire, mounted in a dual-catheter system, through a mini-tracheotomy tube. This treatment has been facilitated by the recent availability of high-specific-activity iridium wire (up to 370 MBq/cm).
Juxtaglomerular cell tumour of the kidney as cause of hypertension: a case report
Authors: van den Berg Jos C. , Hermus Ad R. M. M. , Rosenbusch Gerd R.
Published: July 2009

Benign renin-secreting juxtaglomerular cell tumours of the kidney (reninomas) are recognized but rare causes of hypertension.

Although 46 well documented cases have been described since the first report by Robertson et al (1967) there has been little emphasis on the radiological aspects of this clinical entity (Conn et al, 1973; Davidson & Clark 1974; Dunnick et al, 1983). The radiodiagnostic criteria and diagnostic investigations will be dealt with in this case report.

A 33-year-old woman was referred to our hospital because of hypertension (230/130 mmHg) uncontrollable by β-blocking agents. There were no complaints of increased thirst, polyuria or muscular weakness. On physical examination, no abnormalities except for the hypertension were found. The chest radiograph together with an intravenous urogram were normal.
Contrast extravasation from a Pulse-Tec graft: a complication of high-dose recombinant tissue-type plasminogen activator therapy
Authors: Buckenham T. M. , Taylor R. S. , Reiff D. , Page J. E.
Published: July 2009

Transmural contrast extravasation through both knitted Dacron and Gore-Tex grafts is well documented. Reports have appeared associating this complication with the use of both streptokinase and urokinase (Rabe et al, 1982; Becker et al, 1984; Rosner & Doris, 1984; Perler et al, 1986). We report a case of extravasation through a Pulse-Tec (Newtec Vascular Products Ltd, UK) graft in association with the use of high-dose recombinant tissue plasminogen activator (rt-PA) therapy. This complication has not previously been reported in this type of graft or with this particular thrombolytic agent.
Measurement of extrafocal radiation by computed radiography
Authors: Miettunen R. H.
Published: July 2009

Please note that there was an error in the formula contained in the paper entitled Measurement of extrafocal radiation by computed radiography, published in the March 1992 issue of the British Journal of Radiology. The error occurred in the formula on p. 240, the correct formula is shown below.

The Publisher apologizes to both the author and the readers for this error.
Measurement of tissue perfusion by dynamic computed tomography
Authors: Rees S.
Published: July 2009

While finding the paper by Miles (1991) extremely interesting, I was surprised by the comment in the discussion where it is claimed that “absolute values for tissue perfusion from CT have not been previously reported”.
Now you see it … now you don't
Authors: Kessel D. , Bearn P.E.
Published: July 2009

We were interested to read the case report by J. S. Millar (1992) showing the unusual appearance of a para-umbilical hernia. In the discussion the author states that the diagnosis of a diaphragmatic hernia is usually obvious. McHugh et al (1991) makes the point that plain radiographic findings of diaphragmatic hernia are often non-specific and that when suspected a contrast study should be performed. We present a case in which the diaphragm could not be seen but in which the presence of a stricture suggested the correct diagnosis.
A comparison of ultrasound exposure in therapy and pulsed Doppler fields
Authors: Starritt H. C. , Duck F. A.
Published: July 2009

A detailed comparison of the ultrasound exposure in water from a therapeutic beam and a pulsed Doppler beam was carried out. A significant overlap in acoustic power was found between therapy intensity levels used clinically and the upper end of the diagnostic range, between approximately 100 mW and 200 mW. In addition, pulse pressure amplitudes in the range 0.5–1.0 MPa were measured close to the transducer on both units. It is common to use physiotherapy equipment at pulse average intensities of 0.5 W/cm2 or less, and at these levels exposures of similar magnitude may be obtained with beams currently denned as therapeutic and those available from pulsed Doppler equipment
An audit of ultrasound diagnosis of gallbladder calculi
Authors: Walker J. , Chalmers R. T. A. , Allan P. L.
Published: July 2009

Many series suggest that ultrasound is an accurate method for demonstrating cholelithiasis. However, these series were often prospective and the examinations performed by experienced sonographers. This audit addresses whether the accuracy is maintained in daily practice. We reviewed the ultrasound scans of 128 patients who underwent cholecystectomy for cholelithiasis and compared the findings. The operative and ultrasound findings were at variance in eight of the 128 patients (6.2%). Five were reported as having gallstones on ultrasound but none were found at cholecystectomy, a false positive rate for ultrasound of 3.9%. Three had abnormal gallbladders with no gallstones on ultrasound but gallstones were found at operation, a false negative rate of 2.3%. To avoid false positive diagnoses, suboptimal examinations should be repeated and the scan should be repeated immediately pre-operatively if only small calculi are seen. Alternative imaging should be performed if necessary, either cholescintigraphy in the acute situation or elective oral cholecystography. Some false negative examinations may be avoided by performing repeat examinations if the gallbladder is thick-walled and tender. With these provisos we conclude that ultrasound correctly diagnoses cholelithiasis in daily practice.
Conventional 15 G needle technique for renal biopsy compared with ultrasound-guided spring-loaded 18 G needle biopsy
Authors: Cozens N. J. A. , Murchison J. T. , Allan P. L. , Winney R. J.
Published: July 2009

Two techniques for percutaneous renal biopsy were retrospectively reviewed to assess their relative safety and efficacy. Ultrasound localization of the kidney by a radiologists, with subsequent biopsy performed by a renal physician using a hand-held 15 G cutting needle (Tru-Cut), was compared with biopsy performed by a radiologist using an 18 G cutting needle with a springloaded biopsy device (Biopty) and real-time ultrasound guidance. The smaller needle with real-time ultrasound is more reliable at retrieving an adequate specimen for histological examination (93%) than the “conventional” technique (79%). Fewer complications occurred in the Biopty group although the difference did not reach statistical significance. The average length of stay in hospital was significantly shorter for elective biopsies with the Biopty device (1.80 compared with 2.93 nights, p < 0.01). We recommend the use of the Biopty device with an 18 G needle and real-time ultrasound guidance as the method of choice for percutaneous renal biopsy.
The radiological imaging of bronchial atresia
Authors: Kinsella D. , Sissons G. , Williams M. P.
Published: July 2009

The clinical and radiological findings in three cases of bronchial atresia are presented. Bronchial atresia has a characteristic plain radiographic appearance in the majority of cases. Computed tomography may be required to confirm the diagnosis. The condition often presents to the radiologist as an incidental finding on the chest radiograph in a patient undergoing investigation for an unrelated problem.
Image comparison techniques for use with megavoltage imaging systems
Authors: Evans P. M. , Gildersleve J. Q. , Morton E. J. , Swindell W. , Coles R. , Ferraro M. , Rawlings C. , Xiao Z. R. , Dyer J.
Published: July 2009

In this paper we describe software facilities for enabling patient positioning studies using the megavoltage imaging system developed at the Royal Marsden Hospital and Institute of Cancer Research. The study focuses on the use of the system for three purposes: patient position verification (by comparing images taken at treatment simulation with megavoltage images taken at treatment time); reproducibility studies (by analysing a set of megavoltage images); and set-up correction (by adjusting the setup until the megavoltage image obtained at treatment registers with the simulation image). The need is discussed for suitably presented simulator images, a method of determining field boundaries and the possibility of delineating soft-tissue interfaces. Several algorithms of different types, developed specifically for the purpose of intercomparison of planar projection images, are presented. The techniques employed and their usefulness, in both the qualitative and the quantitative sense, are discussed. The results are presented of a phantom and clinical study, to evaluate the rigour and reproducibility of the algorithms. These results indicate that measurements can be made to an accuracy of about 1–2 mm, with a similar value for interobserver reproducibility for the best image comparison techniques available.
Spontaneous disappearance of staghorn calculus
Authors: Sheppard L.
Published: July 2009

I read with interest the report by McGann et al (1991).

There are earlier reports than theirs of spontaneous disappearance of staghorn calculi. Elliot (1954) reviewed the literature to that date and collected 13 cases of spontaneous dissolution of renal calculi to which he added a further four cases. Not all of these fulfilled McGann's criteria, but all involved large stones which disappeared without treatment.
Spontaneous disappearance of staghorn calculus
Authors: Grant D. S.
Published: July 2009

We are grateful to Dr Sheppard for drawing our attention to Dr Elliot's (1954) review of the literature. As acknowledged in Dr Sheppard's letter, not all of these cases fulfilled the criteria specified in our report. In particular, the rapidity of dissolution (7 months) was particularly striking in our case.
Book reviews
Authors: Lewis-Jones D. I.
Published: July 2009

This atlas of sectional anatomy is a beautifully presented book depicting the body in sagittal, coronal and transverse sections. It follows many others that have appeared in recent years but the preparation of specimens is, in this case, different.
Tuberculosis of the ribs: computed tomographic findings
Authors: FitzGerald R. , Hutchinson C. E.
Published: July 2009

Tuberculosis (TB) is still endemic in Britain, 5474 cases being notified in England and Wales during 1989 (9:100000). Eighty-one new cases of TB were notified in Wolverhampton during that year (31:100000). Despite the introduction of preventative and curative treatment, this is little less than half the 195 new cases of TB in Wolverhampton notified during 1947 (Report of the Director of Public Health, Wolverhampton, 1990). The ethnic minorities in Britain are overrepresented amongst the patients with tuberculosis (Davies et al, 1984). Wolverhampton has a rate three times the national average, and this is considered to be due to the social and ethnic structure of its population.

In the USA the incidence of tuberculosis, which had been previously declining over decades, has since 1985 shown an increase (Buckner etal, 1991). This is considered to be due to the HIV epidemic. Clinical manifestations of tuberculosis in patients with AIDS are often atypical. In approximately 15% of patients without HIV infection TB occurs at extrapulmonary sites, whereas this is seen in 40% of patients who are HIV positive (Goldsmith, 1990).

Bony tuberculosis is classically described in about 1% of patients with tuberculosis (Davidson & Horowitz, 1970). The rib is an uncommon site of osteoarticular tuberculosis.

We present two cases of rib tuberculosis which demonstrate the computed tomographic (CT) appearances and the role of CT in its diagnosis.

An 80-year-old male Indian farmer presented with lower left chest pain for 6 months. He had smoked until 3 years prior to his admission.
The third dimension
Authors: King A. D. , Hine A. L.
Published: July 2009

A 31-year-old woman presented with a 6 month history of pain in the neck and 2 months of swelling below the right ear. She had an 8 year history of rheumatoid arthritis for which treatment included prednisolone 5 mg twice a day and monthly gold injections. There was no history of trauma. Physical examination revealed a marked torticollis, pyrexia and a fluctuant mass below the right ear, but no neurological signs. Plain films were difficult to assess because of the torticollis and, therefore, computed tomography (CT) of the neck with bone windows and 3-dimensional (3D) reconstruction was performed.
Localized loss of the infrabronchial descending aortic interface as a normal variant
Authors: van Gelderen W. F. C.
Published: July 2009

Localized loss of the aortic interface may occur as a normal variant or may be due to an adjacent mass or opacification. The former category is divided into four types depending on position and length of loss of interface. The findings on conventional chest radiographs are correlated with computed tomographic findings.
A figure of merit for the assessment of image intensifier systems
Authors: McRobbie D. W. , Hancock A. P. , Castellano I. A.
Published: July 2009

A dimensionless figure of merit (F), which combines key aspects of the performance of image intensifier systems, is derived. This figure is ideally independent of input air kerma rate and field size and relates to the fundamental characteristics of the image reception chain. In practice it is calculated from measurements of the threshold contrast (noise) and limiting resolution using the Leeds test objects and the input air kerma rate. Several practical examples illustrate its usefulness in simple performance assessment and quality assurance procedures. A comparison is made with the use of detection index diagrams.
Extradural paraganglioma with multiple skeletal metastases
Authors: Jindel Rajesh , Gupta A. K. , Mahapatra A. K. , Bal C. S. , Singhal R. M.
Published: July 2009

Tumours arising from the paraganglia (paragangliomas) are characteristically of low malignant potential, with only 10% developing distant metastases (North et al, 1990). Malignancy in paragangliomas is defined either by local invasion or spread to distant sites normally devoid of paraganglia (Irons et al, 1977; Jackson et al, 1982). We present a case with several unusual features: (1) the primary site of the tumour is in the extradural space at D7 and L3 levels (lesion at L3 not biopsied), (2) multiple skeletal metastases at a short interval after primary diagnosis, and (3) absence of mitoses both in the original specimen and the metastatic deposit.

A 29-year-old man presented in December 1989 with girdle pain in the upper abdomen for 3 months, descending numbness and paraparesis for 3 weeks and incontinence for 1 week.
A curious case of pelvic calcification
Authors: Grier D. J. , Sibley G. N. A.
Published: July 2009

A 48-year-old woman complained of chronic dysuria, urinary frequency and incontinence. 20 years ago invasive carcinoma of the cervix had been treated by Wertheim's hysterectomy and radiotherapy (cobalt 60). Between 5200—6000 rads tumour dose were administered over 36 days with no immediate complication.

A colostomy was performed 2 years later for colonic obstruction due to a stricture of the recto-sigmoid. She subsequently developed bilateral ureteric strictures and required an ileal interposition for this, the distal end of the ileal segment being anastomosed to the bladder dome. Both of these episodes were ascribed to fibrosis secondary to radiotherapy.
Radiation protection associated with well woman breast cancer screening
Authors: Patnick J.
Published: July 2009

Moores and Henshaw's letter (1992) suggests that the NHS Breast Screening Programme (NHS BSP), is a research project. The NHS BSP is, in fact, an accepted health programme based on established policies and its specific purpose is to diagnose breast cancer early, thus reducing mortality in the target population by 25%. While it is not in itself research, as it is the first national breast screening programme in the world, it naturally generates various research projects and questions arise which are best answered by research. Such issues, and other matters of policy are considered in the first instance by the Department of Health Breast Screening Advisory Committee, chaired by Professor Martin Vessey.
Radiation protection associated with well women breast cancer screening
Authors: Law J. , Dance D. R. , Faulkner K. , Fitzgerald M. C. , Ramsdale M. L. , Robinson A.
Published: July 2009

The letter from Moores and Henshaw (1992) raises several points which must be answered. However, we believe the answers are relatively simple provided certain points are kept clearly in mind. We wish to make the following comments:

1. To answer the first question in their second paragraph, “Irradiation of well women for screening purposes” does constitute medical exposure, for which there is no dose limit. Paragraph 2.16 of the Guidance Notes to the Ionising Radiations Regulations 1985 (NRPB, 1988) applies, which states: “Screening programmes… should be undertaken only if the expected medical benefits to the individuals examined and to the population as a whole exceed the economic and social costs, including the risks associated with the radiation dose involved. Since benefits are not always the same for all members of the population, screening should be limited normally to particular groups”.
Measuring radiation exposure during percutaneous drainages: can shoulder dosemeters be used to estimate finger doses?
Authors: Vehmas Tapio , Tikkanen Heikki
Published: July 2009

Some previous studies have shown remarkably high finger doses to radiologists performing percutaneous drainage under fluoroscopy. To assess the possible need for extra finger dosemeters in addition to the general dosemeter, radiologists' and assistants' radiation exposure at both shoulders and at the third fingers of both hands were recorded using thermoluminescent dosemeters during 27 interventional drainage procedures. Under couch screening was used. Mean dose rates were calculated by dividing the doses by the screening time. The dose rates for the sites measured were correlated with each other. The radiologists' bilateral finger dose rates did not correlate with each other; nor did dose rates between the left shoulder and the right hand. The radiologists' dose rates at both shoulders, however, correlated with each other, as did the shoulder dose rates with the dose rates athe ispilateral hand. The right shoulder dose rates correlated with the left hand dose rates. The assistants' dose rates at the places of measurement all showed significant correlations with each other. It is therefore concluded that radiologists involved in percutaneous drainages should use finger dosemeters on both hands; for assistants this may not be necessary.
Stage IB cervical carcinoma: a clinical audit
Authors: Gaze M. N. , Kelly C. G. , Dunlop P. R. C. , Redpath A. T. , Kerr G. R. , Cowie V. J.
Published: July 2009

All patients with FIGO Stage IB cervical cancer registered with the Department of Clinical Oncology at the Western General Hospital, Edinburgh, during the 6 years from 1979 to 1984 have been reviewed, as part of a continuing programme of clinical audit. Of the 140 patients with Stage IB disease, 68 (49%) were treated by primary surgery of whom 44 (31%) also received adjuvant radiotherapy. Radical radiotherapy was the definitive treatment for 69 patients (49%). Three patients (2%) were not treated with curative intent. The crude 5-year survival rate for all cases was 72% and the cause-specific 5-year survival rate was 78%. Local tumour control at 5 years was 72%. There was no significant difference in outcome between the surgically treated and irradiated groups of patients. Age, histology and nodal status did not influence outcome. Irradiated patients with bulky tumours fared significantly worse than the other patients who received radical radiotherapy. Multivariate analysis of all patients revealed no significant independent prognostic variables. Primary surgery appears to confer no benefit over radical radiotherapy in terms of either survival or local control. Treatment-related late bladder and bowel morbidity was, however, significantly worse in irradiated patients.
Book reviews
Authors: Heron C.
Published: July 2009

Following the early appreciation of the value of Magnetic Resonance Imaging (MRI) in large joints such as the knee and hip, MRI has been increasingly employed to evaluate smaller joints including the wrist and hand.
Book reviews
Authors: Jones A.
Published: July 2009

This paperback is aimed at the cardiovascular technicans and cardiologists learning adult cardiac ultrasonography. It includes a brief discussion of the presentation of congenital heart disease in adults.
Book reviews
Authors: Buchanan R.
Published: July 2009

This multi-author text is comprised of 12 chapters, the initial four of which are concerned with basic biology, photochemistry, laser systems and light delivery. Chapters 5–11 review clinical applications and the book concludes with a discussion of the future directions for Photodynamic Therapy (PDT)/Phototherapy. With few exceptions, all the discussion relates to PDT and, in this sense, the book's title may appear misleading to those unfamiliar with the subject. For those seeking information about all aspects of the use of light in the diagnosis and management of cancer, this text will appear wanting.
Percutaneous drainage of splenic abscesses: an effective and safe procedure
Authors: Hadas-Halpren I. , Hiller N. , Dolberg M.
Published: July 2009

Percutaneous drainage of splenic abscesses has not yet become a common procedure due to the potential risk of bleeding and the danger of damage to neighbouring organs. We present our experience of percutaneous drainage in eight patients with splenic abscesses. Four patients were treated by therapeutic percutaneous needle aspiration of the fluid collection, and four by percutaneous trocar catheter insertion. All procedures were guided by ultrasound or computed tomography. The procedure was successful in all eight patients with no complications.
The assessment of carotid and vertebral arteries: a comparison of CFM duplex ultrasound with intravenous digital subtraction angiography
Authors: Colquhoun I. , Oates C. P. , Martin K. , Hall K. , Whittingham T. A.
Published: July 2009

The use of duplex ultrasound with colour flow mapping is compared with that of intravenous digital subtraction angiography (IVDSA) in the investigation of carotid and vertebral artery disease. Ninety-nine carotid and vertebral arteries were examined independently by IVDSA and ultrasound for location and degree of disease in 30 men (mean age 58) and 20 women (mean age 53). For purposes of comparison the carotid tree was divided into six segments. In 46% of cases no disease was detected by either modality. In 36% of cases where disease was found, ultrasound found mild disease in arteries reported as normal by IVDSA. Both modalities detected the six cases of total occlusion found in the study. IVDSA underestimated five cases of major disease found by ultrasound at the bifurcation or in the bulb. Overall agreement in grading vessel segments was good, with 74.5% in complete agreement and 90.3% grading stenoses to within ±25% of the other modality. There was good qualitative agreement in the findings for vertebral arteries. In four patients conventional arteriography was also available for comparison.
Myocardial damage following coronary bypass surgery: assessment with antimyosin antibody uptake
Authors: Jiménez-Heffernan A. , Latre J. M. , Concha M. , Torres M. , Martínez-Paredes M. , Llamas-Elvira J. M. , González F. M. , Valverde A. , Mateo A.
Published: July 2009

To assess the role of 111In antimyosin antibody (AbAm) in the delineation of myocardial damage following coronary bypass surgery, we studied 51 consecutive patients who underwent coronary surgery, 27 of whom had a history of prior myocardial infarction. All patients underwent a diagnostic protocol comprising: (1) 99Tcm pyrophosphate (PYP) and AbAm injection 48 h after surgery (AbAm imaging 24 and 48 h post-injection) (myocardial/background and myocardial/lung ratios were obtained respectively from the computer image); (2) Radioimmunoassay (RIA) serum CK-B levels from samples obtained immediately before surgery, and 24 and 48 h later; (3) clinical and ECG follow-up. Twenty-five patients showed positive AbAm studies, 10 had positive PYP images, and 21 had CK-B levels above normal limits at 24 h. One patient with abnormal AbAm, PYP and CK-B studies had new Q waves on the ECG after surgery. This patient was considered to have sustained a peri-operative myocardial infarction. The large number of positive AbAm studies probably reflects myocardial damage frequently associated with coronary bypass surgery.
Assessment of mammographic film processor performance in a hospital and mobile screening unit
Authors: Murray J. G. , Dowsett D. J. , Laird O. , Ennis J. T.
Published: July 2009

In contrast to the majority of mammographic breast screening programmes, film processing at this centre occurs on site in both hospital and mobile trailer units. Initial (1989) quality control (QC) sensitometric tests revealed a large variation in film processor performance in the mobile unit. The clinical significance of these variations was assessed and acceptance limits for processor performance determined. Abnormal mammograms were used as reference material and copied using high definition 35 mm film over a range of exposure settings. The copies were than matched with QC film density variation from the mobile unit. All films were subsequently ranked for spatial and contrast resolution. Optimal values for processing time of 2 min (equivalent to film transit time 3 min and developer time 46 s) and temperature of 36°C were obtained. The widespread anomaly of reporting film transit time as processing time is highlighted. Use of mammogram copies as a means of measuring the influence of film processor variation is advocated. Careful monitoring of the mobile unit film processor performance has produced stable quality comparable with the hospital based unit. The advantages of on site film processing are outlined. The addition of a sensitometric step wedge to all mammography film stock as a means of assessing image quality is recommended.
The influence of needle size on post-myelography headache: a controlled trial
Authors: McGann Garrett M. , Gleeson Fergus V. , Kelly Ian , Valentine Alan R. , Platts Andrew , Butler Paul , Crump Bernard J.
Published: July 2009

This study aimed to test the hypothesis that the use of fine rather than larger calibre needles for myelography reduces the incidence of post-procedural headache. 160 patients were randomized in a prospective controlled trial of 22 gauge versus 26 gauge needles. The incidence and overall severity of headache as measured at 1, 4 and 21 days after myelography was not significantly different in the two groups.
Does Myodil introduced for ventriculography lead to symptomatic lumbar arachnoiditis?
Authors: Hill C. A. Rowland , Hunter J. V. , Moseley I. F. , Kendall B. E.
Published: July 2009

Although there is a substantial body of evidence implicating Myodil or Pantopaque as a cause of lumbar arachnoiditis, assessment of the clinically based evidence is complicated by the additional potentially causative factors present in a high proportion of cases. These include pre-existing spinal pathology, traumatic lumbar puncture and surgery. The aim of this retrospective study was to attempt to ascertain whether Myodil introduced via ventricular catheter was associated with subsequent development of symptomatic lumbar arachnoiditis. In 222 patients in whom clinical records were reviewed there was no excess of back pain following ventriculography compared to the general population. Myodil ventriculography does not appear to be a major cause of symptomatic lumbar arachnoiditis. Several unavoidable problems with the methodology of this study are discussed.
Influence of radiologist grade on fluoroscopic patient dose
Authors: Hoskins P. R. , Williams J. R.
Published: July 2009

The effect of radiologist grade on patient dose during fluoroscopic barium studies was assessed over a one-year period in a large teaching hospital using area–kerma measurements made with a Diamentor M2 system. The number of studies investigated was 164 for barium swallows, 274 for barium meals and 1288 for barium enemas. The patient's AP thickness was assessed at the abdominal level from a formula combining the patient's estimated height and weight. For each study there was significant change in AP thickness as a function of radiologist grade. For all barium studies there was a trend for both the screening time and the patient dose to fall to a minimum for the grades third-year registrar/first-year senior registrar. From this group to consultant level the dose and screening time rose.
Primary leiomyosarcoma of the superior vena cava with massive thrombosis treated by local fibrinolysis
Authors: Marini M. , Tovar E. , López-Fernández M. F. , Pombo F. , Rodriguez E.
Published: July 2009

Occlusion of the superior vena cava (SVC) is usually related to malignant or benign disease involving the mediastinum (Putnam et al, 1988) or secondary to central venous catheters and pacemakers (Capek & Cope, 1989). Acute superior vena cava syndrome (SVCS) caused by massive thrombosis secondary to leiomyosarcoma is a very rare event. Primary leiomyosarcoma of the SVC has been reported in only a few cases and special attention to radiological findings has been described in only two cases (Vogel et al, 1981; Lupetin et al, 1986).

We report a case of massive thrombosis of the SVC and its branches treated by local thrombolytic therapy that achieved complete lysis. Subsequently an intraluminal tumour mass was demonstrated on an enhanced computed tomographic (CT) study. Local fibrinolytic treatment should be given in SVCS due to thrombosis. The CT studies are of value in the search for the aetiology of SVCS. To our knowledge, this case is the first one in which the CT findings of leiomyosarcoma of the SVC are reported.
Cranial stereotactic multiple arc radiotherapy
Authors: Jones D.
Published: July 2009

The paper by Thomson & Clegg (1992) does not discuss the verification of the dose calculation on a case by case basis. We presented our method of SMART at the ICR meeting in which we described a procedure for verification of the “full-blown” 3-D dose calculation using a separate, fast program (MUSET), which takes as input the dimensions of the major axes of an ellipsoid.
Cranial stereotactic multiple arc radiotherapy
Authors: Thomson E. S. , Doughty D.
Published: July 2009

We thank Douglas Jones for his interest in our work. We are glad that their computer program based on a similar principle has been shown to produce good results. With regard to their question about case by case verificaiton, we would refer them to the third paragraph in the Results section of Thomson & Clegg (1992) in which our case by case analysis is discussed.
Book reviews
Authors: Tyrrell P. N. M.
Published: July 2009

In his preface, Dr Helms describes his book as “a small compendium of pearls, differential diagnoses and lessons learned in the reality of skeletal radiology”. This is indeed true. This is a slim volume of 200 pages, dealing almost entirely with plain film diagnosis of bone lesions.
Book reviews
Authors: Franks N. A. , Maynard J. E.
Published: July 2009

On a cursory first reading of this edition, the book seemed to have little more to offer than a collection of short notes concerning patient care in a radiographic department. However, deeper reading revealed a systematic and concise quick reference work, not only useful to student radiographers for whom the book is intended but to anyone having recourse to work within the fields of radiography/radiotherapy.
Book reviews
Authors: Guy J.
Published: July 2009

This paperback pocket book is one of a monthly series devoted to the museums of the German-speaking world. Each issue is self-contained and devoted to a single museum.

The book includes a map of the locality, a plan of the museum and details of its opening hours.
Bowel preparation before intravenous urography: is it necessary?
Authors: George C D , Vinnicombe S J , Balkissoon A R A , Heron C W
Published: July 2009

Whether or not bowel preparation should be used before intravenous urography (IVU) remains a controversial issue. Despite strongly held views on both sides there is little scientific evidence to support either viewpoint. We have conducted a prospective randomized study designed to test the hypothesis that adequate bowel preparation before IVU facilitates better quality studies requiring fewer films and consequently less time and a lower radiation exposure. Data on 188 patients were analysed; 90 patients received bowel preparation and 98 received no bowel preparation. There was no difference between the groups in terms of the number of films taken, the duration of the procedure, the visibility of the renal tracts or the overall quality of the studies. The prepared group did have significantly less faecal residue than the unprepared group. However, the renal tract visibility was no greater, as the combination of gas and haustral folds seen after bowel preparation obscured fine detail of the urinary tract as effectively as faecal residue. The hypothesis that adequate bowel preparation before IVU facilitates better quality studies must therefore be rejected.