bluuebunny/crossref_metadata_2025 huggingface dataset:
Book reviews
Authors: O'Sullivan G J , Williams M P
Published: July 2009

Within the past 3 years the syllabus for the FRCR part 1 examination has been altered, with relatively greater emphasis placed on anatomy, and less on physics, than before. This excellent book is the first to originate after these changes.
Estimating the volume of lung irradiated during tangential breast irradiation using the central lung distance
Authors: Neal A J , Yarnold J R
Published: July 2009

The aim of this study was to evaluate the central lung distance (CLD) as a surrogate for the volume of lung irradiated during tangential breast radiotherapy. 20 women underwent a planning computed tomography (CT) scan and three-dimensional (3D) treatment planning for both breasts. The field size was perturbed in a systematic manner to give a number of plans with the CLD increasing from 0 to 30 mm. The volume of lung irradiated was determined directly using dose–volume histograms of the lung and correlated with the known CLD. The results indicate that absolute and percentage lung volumes increase with increasing CLD according to a quadratic relationship which is different for both left and right lungs. It is concluded that while there is no substitute for a 3D plan and a lung dose–volume histogram calculation, CLD may be used as a guide to the volume of lung included within the tangential fields used for breast radiotherapy.
Quality control of low dose craniospinal irradiation for low risk medulloblastoma
Authors: Benk V , Bouhnik H , Raquin M A , Kalifa C , Habrand J L
Published: July 2009

Between July 1984 and May 1990, 25 children (median age 9 years) classified as low risk medulloblastoma were treated post-operatively with low dose craniospinal irradiation (25 Gy) followed by a boost to the posterior fossa (total dose 55 Gy), with or without chemotherapy. Simulator and portal films were reviewed for all patients. Doses delivered at the mid cerebral and spinal axis, anterior vertebral body, field junctions and posterior fossa were recalculated and correlated with outcome. Three children were excluded because of inadequate data leaving 22 cases for study. The 5-year actuarial survival is 55%. Nine recurrences and one second tumour (astrocytoma) were observed. Sites of recurrence were either in the posterior fossa (5), in the brain (3), in the spinal axis (1), or combined (2). The dose delivered was within ±5% of that prescribed to the brain in 21/22 cases, and to the posterior fossa and the anterior surface of the vertebral body in 17/22 cases. The only patient who received less than 95% of the prescribed dose to the brain (23 Gy) failed in the subfrontal area and olfactory plate. One of the five patients who received less than 95% of the prescribed dose to the posterior fossa (50.3 Gy) failed at the primary site. None of the five patients who received less than 95% of the dose to the spinal axis failed. Quality control of radiation treatment showed that failures could not be correlated with incorrect technique.
Coincident granular cell tumour of the breast with invasive ductal carcinoma
Authors: Tai G , D'Costa H , Lee D , Watkins R M , Jones P
Published: July 2009

Granular cell tumours of the breast are rare lesions which are almost always benign. They are of interest because their clinical, radiological and pathological appearances often closely resemble those of malignancy. A case is described in which screening mammography in an asymptomatic woman led to the diagnosis of simultaneous invasive intraductal carcinoma in one breast and benign granular cell tumour in the other. Granular cell tumour of the breast coincident with other breast tumours is very rarely described and an association with breast carcinoma is unknown.
Sixth nerve palsy following radiculography
Authors: Dinakaran S , Desai S P , Corney C E
Published: July 2009

Dr Lloyd correctly points out demyelination as a possible cause of sixth nerve palsy. It does figure in the differential diagnosis in such cases although not on the top of the list.
Comparison of single reading with double reading of mammograms, and change in effectiveness with experience
Authors: Warren R M L , Duffy W
Published: July 2009

In the prevalence round of screening for breast cancer at a single centre, the benefit of the second radiological report has been assessed using data from 33734 women, their screening results and knowledge of the interval cancers. The service was set up under the UK National Breast Screening Programme, and the data show evidence of learning by both individuals and the team as a whole. Of the 269 cancers detected by screening, 33 would not have been diagnosed if the only report available had been the first. The recall recommendation rate associated with the first report was 6.9% and 236 cancers were detected. The recall recommendation rate associated with all queries of all the reports was 10% (3354 queries). Had these 3354 queries all been investigated (instead of the 1423 actually recalled) only a further three cancers would have been detected. Sensitivity of the programme as a whole was substantially better than that of individual radiologists, while the specificity was maintained. The decision pathway by which recalls were agreed between the two radiologists resulted in a low recall rate (4.2%) for the programme as a whole, and is a critical factor in gaining the benefit of the improved sensitivity without a concomitant deterioration in the specificity. With the passage through the prevalent round, recall rates steadily fell, the malignant to benign biopsy ratio improved and sensitivity increased. The second radiological report yielded 14% additional cancers diagnosed and contributed very significantly to good sensitivity and so to the effectiveness of screening. Economic analysis of the results will be reported in a further paper.
Computed tomography manifestations of tricuspid regurgitation
Authors: Collins M A , Pidgeon J W , Fitzgerald R
Published: July 2009

Six patients undergoing dynamic contrast enhanced abdominal computed tomography (CT) for upper abdominal symptoms and signs are described. Each patient demonstrated early, intense opacification of the inferior vena cava (IVC) and hepatic veins, exceeding that in the aorta on scans through the upper abdomen. Opacification of the IVC returned to normal on more caudal slices. All six patients were found to have echocardiographically proven tricuspid regurgitation (TR). It is suggested that this sign occurs in patients with TR due to direct reflux of contrast from the right atrium into the IVC during protracted bolus injection. Additional CT findings included patchy parenchymal liver enhancement in four patients and ascites in five. Recognition of this simple sign may direct the clinician to a cardiac aetiology for upper abdominal symptoms and signs.
An investigation into techniques for reducing doses from neo-natal radiographic examinations
Authors: Wraith C M , Martin C J , Stockdale E J N , McDonald S , Farquhar B
Published: July 2009

A survey of radiation doses received by infants having radiography in a neo-natal unit was undertaken at Aberdeen Maternity Hospital. Options for dose reduction recommended by the CEC Lake Starnberg Group were investigated. Techniques were implemented for clinical evaluation after assessments of image quality with test objects and phantoms. Clinical image quality of radiographs was evaluated by paediatric radiologists using CEC criteria. Results revealed a clear relationship between entrance dose and patient weight, indicating that reference doses for infants could be linked to weight. At the start of the study the mean entrance dose for chest anteroposterior (AP) radiographs was 65 μGy and the dose-area product 12.3 mGy cm2 for a system with 2.5 mm aluminium filtration using 50 kVp X-rays with a 200 speed class film/screen system. A 400 speed class film/screen combination was investigated but not evaluated clinically, because the image quality was not considered acceptable. Addition of 0.1 mm copper to the filtration of the X-ray tube reduced entrance doses by 50%, but the technique was not adopted, because of a poorer image quality with only 72% of features in clinical images being reproduced to an acceptable standard, compared with 87% with the original system. Use of faster processing chemicals, an increase in filtration to 3.5 mm aluminium and a tube potential of 60 kVp resulted in a 40% reduction in mean entrance dose to 37 μGy with satisfactory clinical image quality.
Röntgen and the discovery of X-rays
Authors: Mould R F
Published: July 2009

This review celebrates the events of 100 years ago to the month of publication of this November 1995 issue of the British Journal of Radiology, when X-rays were discovered by Röntgen (8 November 1895) and he was working in his laboratory leading up to his 28 December 1895 communication “On a new kind of ray”. Biographical details of Röntgen are given, together with his work in Wörzburg before the discovery and popular and scientific opinion in the immediate months after the world first learned of the existence of X-rays. Some of Röntgen's apparatus is illustrated, accompanied by typical advertisements of 1896–1897. Where appropriate I have included information related to the UK, concerning, for example, Sir Arthur Schuster and Lord Kelvin; there is also a mention of the Röntgen Society, the forerunner of today's British Institute of Radiology.
A comparison of the methods of distraction for stress examination of the acromioclavicular joint
Authors: Sluming V A
Published: July 2009

Acromioclavicular joint disruption is frequently evaluated with a radiographic examination of the joint under stress (weight bearing). Certain authors recommend suspending the weights from the arm, rather than being hand-held, to allow for total muscle relaxation. This study examines the relationship between the coracoclavicular distance measured and the method of distraction. 30 normal subjects participated in the study which used ultrasound (5 MHz linear array) to measure the coracoclavicular distance under four conditions (levels of traction): non-stressed, muscles relaxed; non-stressed, muscles tensed; stressed with 7.5 kg weight hand held; stressed with 7.5 kg weight suspended from the wrist.

The data were subjected to a multifactor ANOVA. The level of traction was statistically significant (p>0.001). The data were then subjected to a Bonferroni multiple comparisons procedure. This showed a difference between the non-stressed and stressed conditions, but there was no difference between the two methods of applying stress to the joint. It was concluded that, in normal subjects, the method of performing the weight bearing examination does not have a significant effect on the magnitude of the coracoclavicular distance.
Broadband ultrasonic attenuation: are current measurement techniques inherently inaccurate?
Authors: Petley G W , Robins P A , Aindow J D
Published: July 2009

Measurements of broadband ultrasonic attenuation (BUA) are currently made using large aperture, piezoelectric transducers. The use of such a receiver is known to lead to the possibility of an overestimate of ultrasonic attenuation due to phase cancellation and it is shown theoretically that this same effect can also lead to an overestimate of BUA. Using a new scanning approach, BUA was measured using two methods, one sensitive to the phase of the acoustic wave, the other not. The phase sensitive BUA measurements were found to be of significantly higher value (p < 0.0001) than the phase insensitive measurements with a mean difference of 31.2 dB MHz−1. These findings are compatible with the hypothesis that BUA measurement systems with large aperture, piezo-electric receivers are inherently inaccurate.
Non-destructive elemental analysis of vertebral body trabecular bone using muonic X-rays
Authors: Hosoi Y , Watanabe Y , Sugita R , Tanaka Y , Nagamine K , Ono T , Sakamoto K
Published: July 2009

Non-destructive elemental analysis with muonic X-rays was performed on human vertebral bone and lumbar torso phantoms. It can provide quantitative information on all elements in small deep-seated localized volumes. The experiment was carried out using the superconducting muon channel at TRIUMF in Vancouver, Canada and a lithium drifted germanium detector with an active area of 18.5 cm2. The muon channel produced backward-decayed negative muons with wide kinetic energy range from 0.5 to 54.2 MeV. The muon beam was collimated to a diameter of 18 mm. The number of incoming muons was about 4×l06∼5×l07 per data point. In the measurements with human vertebral bones fixed with neutralized formaldehyde, the correlation coefficient between calcium content measured by muons and by atomic absorption analysis was 0.99 and the level of significance was 0.0003. In the measurements with lumbar torso phantoms, the correlation coefficient between calcium content measured by muons and by atomic absorption analysis was 0.99 and the level of significance was 0.02. The results suggest that elemental analysis in vertebral body trabecular bone using muonic X-rays closely correlates with measurements by atomic absorption analysis.
Radiographers as film readers in screening mammography: an assessment of competence under test and screening conditions
Authors: Pauli R , Hammond S , Cooke J , Ansell J
Published: July 2009

The aim of this study was to investigate the potential of radiographers as film readers in screening mammography. Seven radiographers received training in mammogram interpretation at a National Health Service (NHS) Breast Screening Training Centre. Film reading performance was assessed over a period of 1 year after training with test sets of selected screening mammograms. Actual screening performance on contemporary screening mammograms was monitored after training in relation to radiologist decisions and screening outcome. It was found that trained radiographers read mammograms to a standard comparable with that of radiologists. Film reading skills were maintained consistently over the period of this study and transferred to actual screening performance. It was concluded that radiographers could play a useful role as second readers in screening mammography. Training needs have to be assessed in relation to the role the film reading radiographer is to adopt.
Evaluation of 1H magnetic resonance spectroscopic imaging as a diagnostic tool for the lateralization of epileptogenic seizure foci
Authors: Constantinidis I , Malko J A , Peterman S B , Long R C , Epstein C M , Boor D , Hoffman J C , Shutter L , Weissman J D
Published: July 2009

The purpose of this study was to assess whether a visual examination of 1H spectroscopic images could correctly lateralize patients with intractable temporal lobe epilepsy. 20 patients with intractable temporal lobe epilepsy and 10 volunteers were included in this study. Spectroscopic images were analysed using a protocol based on visual inspection. Images of the metabolites N-acetyl aspartate (NAA), choline (Cho), creatine (Cr) and lactate were obtained from a transverse plane oriented along the sylvian fissure. Images from each individual were evaluated independently by six reviewers. Results of the lateralization procedure obtained from the visual examinations were compared with those obtained from quantitative analysis of the spectra and with those obtained by magnetic resonance imaging (MRI), positron emission tomography (PET), neuropsychological examinations, and electroencephalographic (EEG) recordings. NAA images were found to be the most effective, amongst metabolite images, in lateralizing the epileptogenic lobe. Using the site selected for resection as the definition of the correct lateralization, 70% of the patients who underwent temporal lobectomy were correctly lateralized by the majority of the examiners using the visual inspection protocol. Based on the results of this study it is concluded that visual examination of 1H spectroscopic images is potentially valid in lateralizing patients with intractable temporal lobe seizures. Confidence in the visual interpretation increased as the difference in NAA signal intensity between the temporal lobes increased. The threshold above which the majority of the examiners correctly lateralized the patients was ≈15% in NAA signal loss in the ipsilateral lobe.
Ultrasound diagnosis of polyorchidism
Authors: Ghiacy S
Published: July 2009

A case of polyorchidism is presented where the ultrasound findings fulfilled all the criteria for the diagnosis of polyorchidism, with no evidence of an associated abnormality on clinical and ultrasound examinations. On the basis of these findings surgical exploration was not carried out.
Clinically suspected scaphoid fracture: a comparison of magnetic resonance imaging and bone scintigraphy
Authors: Thorpe A P , Murray A D , Smith F W , Ferguson J
Published: July 2009

59 patients with clinical suspicion of scaphoid fracture, but negative radiographs at presentation and review, were examined by magnetic resonance imaging (MRI) and bone scintigraphy (BS). The diagnoses were compared with subsequent follow-up. There were four scaphoid fractures, 10 other fractures and three significant ligamentous injuries. All scaphoid fractures were identified by MRI and BS. MRI showed better interobserver agreement for scaphoid injury than BS and fewer false positive reports. Significant ligamentous injury and carpal instability diagnosed by MRI were not evident on scintigraphy. Using fast scanning protocols the cost of MRI is comparable with that of BS. MRI should be considered as the appropriate second line investigation in these clinical circumstances.
Ganglioneuroma: computed tomography and magnetic resonance features
Authors: Ichikawa T , Ohtomo K , Araki T , Fujimoto H , Nemoto K , Nanbu A , Onoue M , Aoki K
Published: July 2009

12 patients who had histological proven ganglioneuromas were investigated by computed tomography (CT) and magnetic resonance (MR) imaging. CT scans (n = 11), conventional spin-echo MR images (n = 10) and dynamic MR images (n = 5) were acquired. All lesions showed a well defined, oval shape. Five lesions (42%) showed calcification which was punctate in four and coarse in one on CT. CT attenuation was predominantly low in three of 10 (30%) and intermediate in the remaining seven (70%). In all lesions MR signals were mainly of low intensity on T1 weighted images (T  1WI) and of high intensity on T2 weighted images (T  2WI). Dynamic MR studies in five cases showed a lack of early enhancement but gradual increasing enhancement One case had a ganglioneuroblastoma component which showed soft-tissue density and coarse calcifications on CT scans, MR images with intermediate intensity on T  1WI and T  2WI and early enhancement and little washout on dynamic MR images. In conclusion, ganglioneuroma typically shows punctate calcification and low attenuation on CT and marked hypenntensity on T  2WI with gradual increasing enhancement on dynamic MR images If a ganglioneuroma has atypical CT and MR features, coexistence of a malignant component should be considered.
Computer assisted determination of the dose-area product in retrograde urethrography
Authors: Merkle E , Aschoff A J , Muller M , Merk J , Brambs H-J
Published: July 2009

Retrograde urethrography (RUG) is a dynamic radiological procedure in which the cumulative dose–area product (DAP) comprises radiation doses derived from both fluoroscopy and radiography. In the present prospective study, digital retrograde urethrographs (Prestilix 1600X/DRS, General Electric) were obtained in 40 consecutive male patients (mean age 60.6 years, range 23–88 years) presenting for evaluation of urinary pathology. The radiation dose was recorded as the dose–area product. From these data, a computer program (Diasoft 2 0, PTW, Freiburg, Germany) then determined the respective proportions of the total radiation dose deriving from fluoroscopy and radiography, as well as the number of radiographic exposures. The average total radiation dose was 316 cGy cm2. In five of the 40 patients examined (12 5%), the number of radiographic exposures registered by the program and, hence, the calculated DAPs were erroneous. In the remaining 35 patients, the average proportion of the cumulative DAP resulting from fluoroscopy was 81%, while that deriving from radiography was 19%. The computer program utilized in this study makes possible an intelligent evaluation of the DAP in dynamic procedures such as RUG. Since fluoroscopy is responsible for 81% of the cumulative DAP at RUG, a significant decrease in applied radiation dose may be achieved by reducing fluoroscopy time or by using pulsed fluoroscopy.
MRI appearances of left sided Morgagni hernia containing liver
Authors: Collie D A , Turnbull C M , Shaw T R D , Price W H
Published: July 2009

Morgagni hernias most commonly present in infancy or childhood with gastrointestinal or respiratory symptoms, resulting from visceral herniation into the thorax. They are much rarer in the adult, and may be misdiagnosed as pericardial masses. We report a case of a Morgagni hernia containing liver, which hindered cardiac imaging with echocardiography and angiography, and was best demonstrated with MRI.
Oncology and the BJR
Authors: Tait D
Published: July 2009

The value of the BJR, and indeed membership of the BIR, to clinical oncologists is something that is often discussed within the Committees and Council of the BIR. Some, in fact most, of the issues raised in these discussions equally apply to the other non-diagnostic groups. It is a constant juggling act to satisfy the demands of the majority, the diagnostic radiologists, without allowing these demands to reduce the value of the Institute and the Journal for other groups.
Dual compression mammography using computed radiography
Authors: Highnam R P , Brady J M , Shepstone B J
Published: July 2009

We read with interest the technical note of Brettle et al [1] on the technique which we had developed and called “differential compression mammography” [2–5] but they have chosen to name “dual compression mammography”.
Ultrasound diagnosis of portocaval anastomosis in infants—a report of eight cases
Authors: Farrant P , Meire H B , Karani J
Published: July 2009

We report eight cases of portocaval anastomosis in infants diagnosed by ultrasound. Anatomically we believe this represents continuing patency of the ductus venosus, either as a primary developmental abnormality or secondary to established liver cell failure.
The influence of the number of fractions and bi-exponential repair kinetics on biological equivalence in pulsed brachytherapy
Authors: Millar W T , Hendry J H , Canney P A
Published: July 2009

A linear-quadratic radiobiological model incorporating single or bi-exponential repair kinetics has been used to show the following and other features when a continuous low dose rate (CLDR) 70 Gy/140 h brachytherapy protocol is replaced by a radiobiologically equivalent pulsed dose rate (PDR) system using 140 fractions for reasons of dosage homogeneity. (1) For equivalent effects in late-reacting tissues, the PDR dose (at 5 or 0.05 Gy min−1) × 1 h intervals needs to be reduced by up to only 3%. Progressively further reductions in dose are required when fewer larger fractions are used. (2) When equivalence using pulsed doses is achieved for one normal tissue type, and extrapolated response doses (ERD) are calculated for other tissue types in the irradiated volume, values of the ERD remain within 5% of each other using the above PDR protocol and associated parameters. (3) For tumours with α/β=10 Gy and a single repair halftime of 0.1–1.0 h, there is no significant loss of therapeutic benefit using the PDR protocol equivalenced for late normal tissue reactions. The strategy of replacing an LDR boost protocol of about 24 Gy by a PDR protocol gives similar levels to the 70 Gy PDR protocol for the expected percentage increase in the biological dose to normal tissues (due to the PDR protocol alone). These calculations also highlight the importance of the values assumed for the conventional α/β ratio and the repair kinetics when estimating equivalent PDR protocols. The use of an inappropriate radiobiological parameterization will lead to erroneous conclusions with the potential to advocate PDR protocols which will, in practice, lead to an increase in late complications.
Transrectal ultrasound in the evaluation of cervical carcinoma and comparison with spiral computed tomography and magnetic resonance imaging
Authors: Yang W T , Walkden S B , Ho S , Cheung T H , Lam S K , Teo J , Metreweli C
Published: July 2009

38 women with biopsy proven untreated cervical carcinoma were prospectively studied with transrectal ultrasound (TRUS), spiral computed tomography (SCT) and magnetic resonance imaging (MRI). 20 women had radical hysterectomy and pelvic lymphadenectomy with detailed histological evaluation of the parametra. The echographic features of cervical carcinoma on TRUS are a hypoechoic (60%) or isoechoic (40%) (relative to normal uterine muscle/cervical stroma), poorly defined mass lesion with indistinct margins in an enlarged cervix. This relatively high percentage of isoechoic tumours and relative lack of contrast resolution may pose a problem in the identification of some tumours, and to our knowledge has not been previously reported. Further limitations of TRUS are in the evaluation of advanced cervical cancer, due to bulky tumours rendering poor access to the parametrium and pelvic sidewall. The overall accuracy in staging of early cervical cancer (less than stage 2b) was 85% for examination under anaesthesia (EUA), 75% for TRUS, 65% for MRI and 50% for SCT. The positive predictive value in evaluating the parametra in this group of patients was also lower for SCT (14%) and MRI (33%) compared with TRUS (100%). In the evaluation of advanced cervical cancer (stage 2b or higher), there was poor correlation between TRUS and EUA, with MRI showing the best correlation with EUA. We conclude that SCT is inferior to both TRUS and MRI in the staging of early stage cervical cancer.
Flat and curved crystal spectrography for mammographic X-ray sources
Authors: Chantler C T , Deslattes R D , Henins A , Hudson L T
Published: July 2009

The demand for improved spectral understanding of mammographic X-ray sources and non-invasive voltage calibration of such sources has led to research into applications using curved crystal spectroscopy. Recent developments and the promise of improved precision and control are described. Analytical equations are presented to indicate effects of errors and alignment problems in the flat and curved crystal systems. These are appropriate for all detection systems. Application to and testing of spectrographic detection (using standard X-ray film) is presented. Suitable arrangements exist which can be used to measure X-ray tube voltages well below 1 kV precision in the operating range of 20–35 kV.
Colour Doppler ultrasound in renal artery stenosis: intrarenal waveform analysis
Authors: Baxter G M , Aitchison F , Sheppard D , Moss J G , McLeod M J , Harden P N , Love J G , Robertson M , Taylor G
Published: July 2009

Renal artery stenosis (RAS) is the commonest secondary cause of hypertension and may result in renal ischaemia with resultant renal failure. Recent studies have suggested that colour Doppler ultrasound, with spectral analysis of the intrarenal waveforms, can identify those patients with a significant RAS. A prospective study was performed in which colour Doppler ultrasound was compared with angiography in 73 patients (143 kidneys) presenting for renal angiography. Colour Doppler ultrasound was unsuccessful in 16% of kidneys due to a combination of technical failures and small kidney size. Accessory renal vessels were present in 14% of kidneys on angiography but none was detected by ultrasound. Of the 120 kidneys that had both examinations, no significant difference in intrarenal pulsatility or resistive index was noted between the angiographically stenosed and normal arteries. There were significant differences for intrarenal peak and end diastolic velocities, and acceleration time and index. Of these measurements, acceleration time was the best indicator of RAS. The probability of detecting a high grade RAS in an individual patient did not reach 90% until the acceleration time was prolonged to more than 0.12 s. Intrarenal colour Doppler ultrasound is not a general screening test for RAS and it should be reserved for selected patient groups where the incidence of disease is high Patients with prolonged acceleration times of more than 0.12 s have a high likelihood of at least 70% RAS and should proceed directly to angiography.
Skill mix for radiologists and radiographers
Authors: Williams M P
Published: July 2009

Skill mix is a complex area. It has no agreed definition and means different things to different people. This commentary seeks to explore some of the issues associated with skill mix, which will be considered from four stand-points: of the individual, the professions, the service and of the patient.
Endovascular treatments for intracranial aneurysms
Authors: Byrne J
Published: July 2009

During the last 10 years, the development of flexible microcatheters which can navigate cerebral vessels to lesions deep within the brain, has allowed the treatment of an increasing range of intracranial pathologies, including aneurysms. Techniques to embolize aneurysms, either by occlusion of their parent artery or endosaccular packing with its preservation, have evolved largely in order to treat inoperable aneurysms. Endosaccular packing with thrombogenic coils has recently allowed embolization of smaller aneurysms to be performed in patients acutely ill after subarachnoid haemorrhage. The procedural morbidity associated with these endovascular treatments are less dependent on aneurysm site than conventional neurosurgical clipping and initial results are comparable. These developments are challenging current thinking on the surgical management of patients with intracranial aneurysms. This review describes the evolution and practice of current endovascular treatments and their possible implications for the future of neuroradiology.
Hysterosalpingo-contrast sonography (HyCoSy) using Echovist®-200 in the outpatient investigation of infertility patients
Authors: Ayida G , Harris P , Kennedy S , Seif M , Barlow D , Chamberlain P
Published: July 2009

This study describes the introduction of hysterosalpingo-contrast sonography (HyCoSy) as a first line outpatient investigation of uterine and tubal factors in two fertility units. 136 infertile women had transvaginal scanning before and during the intrauterine injection of contrast medium (Echovist®-200). HyCoSy was successfully completed in 132 cases (97%) within a mean time of 12.6 ± 8.4 (4–50) min. The uterus and its cavity appeared normal in 108 (82%) women. Uterine abnormalities in the remaining 24 women (18%) included structural abnormality (n = 7), fibroids (n = 12) and endometrial polyps (n = 5). A total of 261 fallopian tubes in 132 women were assessed: 186 (71%) appeared patent and 55 (21%) blocked. The remaining 20 (8%) could not be assessed for technical reasons. Polycystic ovaries and ovarian cysts were diagnosed in eight women. The most common adverse effect was mild/moderate pain, similar to period pain, with 24 (18%) women requiring simple analgesia. HyCoSy is a simple and well tolerated outpatient procedure. The technique provides clinically valuable information about tubal patency, ovarian and uterine abnormalities.
Foot axes and angles
Authors: Gentili A , Masih S , Yao L , Seeger L L
Published: July 2009

Using radiographs and diagrams, this article reviews the most commonly used axes and angles of the foot, including: longitudinal axis of the rearfoot, collum tali axis, talocalcaneal angle, cuboid abduction angle, longitudinal axis of the lesser tarsus, lesser tarsus angle, talonavicular angle, longitudinal axis of the metatarsus, forefoot adductus angle, metatarsus adductus angle, first intermetatarsal angle, hallux valgus angle, proximal and distal articular set angles, and hallux interphalangeal angle, plane of support, collum tali axis, talar declination angle, calcaneal inclination axis, lateral talocalcaneal angle, first metatarsal declination axis and calcaneal inclination angle.
Observer variability in the interpretation of contrast enhanced MRI of the breast
Authors: Mussurakis S , Buckley D L , Coady A M , Turnbull L W , Horsman A
Published: July 2009

The purpose of this study was to determine observer variability in the interpretation of contrast enhanced breast MRI and to evaluate its effect on the detection and differentiation of breast cancer. 57 women underwent breast MRI using spin echo and dynamic spoiled gradient-recalled sequences. Images were independently reviewed by three radiologists, two experienced and one newly trained in breast MRI interpretation. One of the experienced readers reviewed all examinations twice. Interpretation was based on lesion conspicuity, signal intensity, contour and enhancement pattern. Contrast uptake was assessed using region of interest (ROI) analysis of the dynamic images and calculation of a maximum enhancement index. Sensitivity and specificity in the diagnosis of malignancy irrespective of disease extent, and in the diagnosis of multifocal malignancy were estimated. 113 lesions were reported. Kappa coefficient estimations showed only a moderate agreement between the two experienced readers in rating morphological characteristics; the agreement between the newly trained reader and the experienced readers was even worse. Moreover, there was significant interobserver and intraobserver variation in the enhancement index measurements. Weighted kappa values indicated good agreement between the experienced readers in lesion and overall interpretation, excellent intraobserver agreement, but substantial disagreement between the newly trained reader and both experienced readers. All readers showed good sensitivity in cancer detection, but specificity was substantially lower. There is significant observer variability and a substantial learning curve in the interpretation of breast MRI, and variability in the ROI analysis of dynamic data. Further efforts to improve the reliability of ROI analysis and image interpretation are needed to help MRI realise its full potential in the clinical management of breast cancer.
Scatter dose estimation based on dose–area product and the specification of radiation barriers
Authors: Williams J R
Published: July 2009

Scatter dose as a function of dose–area product (DAP) has been studied over a range of tube potentials and scattering angles. Data are presented to permit the calculation of scatter dose from DAP at distances of 1 m or more from the patient. This method has been used to calculate absorbed dose to the walls of six existing X-ray rooms which are used for interventional radiology, angiography or barium contrast studies. These calculations have been compared with measurements using thermoluminescent dosemeters. The median ratio of measured to calculated dose was 0.50 and the maximum value was 1.26. It was concluded that the calculation of scatter dose from DAP using the factors derived in this report can be used as the basis for the specification of radiation protection barriers. The busiest room in this study in terms of DAP had a DAP rate of 224 Gy cm2 per day. From the scatter factors presented here, it was shown that the room walls did not need to have more than 1.2 mm of lead equivalence.
Vaginal endosonography to diagnose enterocoele
Authors: Halligan S , Northover J , Bartram C I
Published: July 2009

Radiological diagnosis of enterocoele is possible using evacuation proctography, but the standard technique must be modified to reveal the small bowel. Since prolapsed bowel is interposed between the vagina and rectum, diagnosis may be possible using vaginal endosonography. We describe a simple ultrasound technique to diagnose enterocoele, which has been validated by comparison with proctography. 17 women were examined with vaginal endosonography, and a diagnosis of enterocoele made if bowel was visualized in the rectovaginal space when bearing down. The findings were compared with subsequent proctography. In eight cases (47%) bowel prolapsed into the rectogenital space during straining, obscuring the rectum, while this did not occur in the remaining nine subjects (53%). Proctography confirmed an enterocoele in six of the eight cases in whom it had been diagnosed on endosonography, and confirmed the absence of enterocoele in all of the nine cases negative on endosonography. These values gave vaginal endosonography a sensitivity of 100% and specificity of 82%, with a positive predictive value of 75%, and negative predictive value of 100% for a prevalence of abnormality of 0.35. Vaginal endosonography is a quick, easy and convenient alternative to evacuation proctography for the radiological diagnosis of enterocoele.
Spectral pulsed Doppler sonography of renal vascular resistance in sickle cell disease: clinical implications
Authors: Aikimbaev K S , Oǧuz M , Güvenç B , Başlamişli F , Koçak R
Published: July 2009

The major complications in sickle cell disease (SCD) are microcirculation lesions and impairment of renal function. The aim of this study was the evaluation of renal vascular resistance by means of spectral pulsed Doppler sonography and its relationships with haematological and clinical features in patients with SCD. 40 patients with SCD (mean age 22.4±7.0) and 14 age and sex matched healthy subjects (mean age 25.7±9.5) were included into the study. Spectral Doppler sonography of main renal, segmental and interlobar arteries were performed on both kidneys in all patients and controls. Peak systolic, end diastolic and mean velocities through the entire cardiac cycle were obtained, with calculation of the resistive (RI) and pulsatility (PI) indices. All the patients were investigated in stable state conditions and had not been transfused within a month before investigation. Patients were followed for up to 6 months. Patients with SCD had higher values of RIs and PIs than control subjects (p<0.0001, p<0.0001, respectively). Patients with high value of RIs (RI>0.70) had more pronounced disturbances of blood parameters (all p<0.05), than patients with normal RIs (RI<0.70). Significant positive correlation existed between RIs and ISC number, MCHC level (r=0.52, p<0.001 and r=0.42, p<0.01), while RBC count and Hb level correlated inversely with RIs (r=−0.39, p<0.01 and r=−0.42, p<0.01). During follow-up, nine patients (33.3%) with high RIs and only one patient (5.5%) with normal RI developed painful crises. In conclusion, renal vascular resistance, assessed by Doppler sonography was raised in SCD patients as compared with age matched apparently healthy persons. These changes were more pronounced in those with more severe manifestations of disease and correlated with haematological and clinical features of sickle cell disease.
Tuberculosis of the parotid gland—diagnosis by CT
Authors: Bhargava S , Watmough D J , Chisti F A , Sathar S A
Published: July 2009

A case of parenchymal and intraparotid lymph node tuberculosis is reported in a young Asian male. The diagnosis was suggested pre-operatively by the contrast enhanced CT (CECT) appearance. There were no systemic symptoms of tuberculosis and this is a characteristic feature of the 100 cases reported in the literature. The presence of thick walled rim enhancing lesions with a central lucency on CECT should suggest the diagnosis. Filling defects with or without thin walls are non-specific findings and are seen in tumours and other inflammatory processes. In an appropriate clinical setting, thick walled round rim enhancing lesions with a central lucency are characteristic of tuberculosis.
Prognostic Significance of CXCL12 Expression in Patients With Colorectal Carcinoma
Authors: Akishima-Fukasawa Yuri , Nakanishi Yukihiro , Ino Yoshinori , Moriya Yoshihiro , Kanai Yae , Hirohashi Setsuo
Published: July 2009

The present study investigated the protein expression level of CXCL12 in colorectal cancer and aimed to elucidate its association with prognosis. CXCL12 positivity in 50% or more of tumor cells was defined as high expression and that in less than 50% of the tumor cells as low expression. CXCL12+ tumor budding at the invasive front was divided into 2 grades: high with 10 or more budding foci per ×200 field of view and low grade with fewer than 10 budding foci. Patients with high expression (72.7%) and high grade CXCL12+ tumor budding (43.0%) had significantly shorter survival than patients with low expression (P = .014) and low grade (P = .003), respectively. Patients with a combination of high expression and high grade had the worst outcome (P < .001). Our study demonstrated that CXCL12 expression in colorectal cancer cells and at sites of budding were significant prognostic factors. Furthermore, together with lymph node metastasis, a combination of both expression patterns was a more powerful independent prognostic factor.
Aberrant Expression of CD8 in B-Cell Non-Hodgkin Lymphoma
Authors: Carulli Giovanni , Stacchini Alessandra , Marini Alessandra , Ciriello Maria Matilde , Zucca Alessandra , Cannizzo Elisa , Aliberti Sabrina , Demurtas Anna , Novero Domenico , Calcagno Lara , Callegari Tiziana , Petrini Mario
Published: July 2009

T-cell antigen expression can be observed in B-cell non-Hodgkin lymphoma (B-NHL). Although CD5 is expressed in B-cell chronic lymphocytic leukemia (B-CLL) and mantle cell lymphoma, the presence of other T-cell antigens is less common. This article reports a retrospective multicenter analysis in which flow cytometry was used to evaluate aberrant CD8 expression on the pathologic B cells of 951 bone marrow samples from patients with various types of B-NHL.

In a total of 18 patients, CD8 was coexpressed: 10 had B-CLL; 1, small lymphocytic lymphoma (SLL); 1, marginal zone lymphoma; 1, lymphoplasmacytic lymphoma; 2, diffuse large B-cell lymphoma; and 3, follicular lymphoma. There was a 1.89% overall frequency of CD8 coexpression in which B-CLL/SLL had a higher frequency (3.03%) than did the other B-cell neoplasms (1.18%). Most cases were characterized by a favorable outcome.
Trends in the Postmortem Diagnosis of Opportunistic Invasive Fungal Infections in Patients With AIDS
Authors: Antinori Spinello , Nebuloni Manuela , Magni Carlo , Fasan Marco , Adorni Fulvio , Viola Anita , Corbellino Mario , Galli Massimo , Vago Gianluca , Parravicini Carlo , Ridolfo Anna Lisa
Published: July 2009

We retrospectively evaluated autopsy-proven invasive fungal infections (IFIs) in patients with AIDS who died between 1984 and 2002. IFIs were identified in 297 (18.2%) of 1,630 autopsies. Their prevalence significantly decreased over time (from 25.0% in 1984–1988 to 15% in 1998–2002; P = .004), mainly owing to a significant decrease in pneumocystosis (P = .017) and cryptococcosis (P = .003), whereas the prevalence of aspergillosis and histoplasmosis remained relatively stable and of candidiasis and zygomycosis tended to increase in the last years (P = .028 and P = .042, respectively). IFIs were suspected or confirmed during life in only 46.8% of the cases; this proportion did not vary significantly over time (P = .320). The infections contributed to the deaths of 103 patients (34.7%), and their global impact on mortality was 6.3%. Of fatal cases, 38 (36.9%) were characterized by missed antemortem diagnoses, 17 (45%) of which met Goldman criteria for class I errors.

The epidemiology of IFIs in patients with AIDS is evolving and not completely mirrored by clinical diagnoses or current diagnostic methods. Our results confirm the valuable role of autopsy data, even with highly effective therapies and advanced technologies.
Acute Lymphoblastic Leukemia With Burkitt-like Morphologic Features and High Myeloperoxidase Activity
Authors: Rytting Michael E. , Kantarjian Hagop , Albitar Maher
Published: July 2009

Expression of a high level of myeloperoxidase (MPO) as a sole myeloid marker in acute leukemias that express typical lymphoblastic markers is unusual. Herein we report 5 cases of MPO+, otherwise typical acute lymphoblastic leukemia (ALL) without the expression of other myeloid markers. In most cases, MPO positivity was detected in more than 20% of blasts by immunologic (flow cytometric) and enzymatic testing. The striking feature of most of these cases is a morphologic picture reminiscent of that seen in Burkitt-like B-cell ALL with basophilic cytoplasm and vacuoles but no expression of surface immunoglobulin. All cases responded to ALL therapy and should be distinguished from myeloid leukemia and from Burkitt leukemia/lymphoma.
CARICOM and its Court of Justice
Authors: O'Brien Derek , Foadi S.
Published: July 2009

The Caribbean Court of Justice, which was inaugurated in April 2005, is possessed of both an appellate and an original jurisdiction. In its original jurisdiction the Court is vested with a compulsory and exclusive power to interpret and apply the Revised Treaty of Chaguaramas which establishes the Caribbean Community (CARICOM) Single Market and Economy. This paper explores the Court's original jurisdiction and the role that it could play in promoting regional integration, taking account of the region's history and the institutional structure within which it will be expected to function.
New Zealand's Succession Law: Subverting Reasonable Expectations
Authors: Peart Nicola
Published: July 2009

Succession law in New Zealand has been widely criticized for many years as being incoherent and unprincipled both in regard to its approach to property entitlements for spouses and unmarried partners and in its liberal approach to support claims under the Family Protection Act 1955. Although testamentary freedom was said to apply in New Zealand, the reality was rather different. The Wills Act 1837 was also seen as unnecessarily defeating testamentary intentions. Based on research indicating strong support for testamentary freedom and widespread objections to testators' lack of autonomy, the New Zealand Law Commission recommended radically reforming the law to give better effect to testamentary wishes subject to limitations that were coherent, principled and in line with rights and duties during a testator's lifetime. Parliament largely ignored those recommendations. Between 2001 and 2007, it reformed several statutes affecting succession law, but it did so in piecemeal fashion. Succession law was not viewed holistically and fundamental concerns about ill-defined and unprincipled limits on testamentary freedom were not addressed. The reforms were driven by conflicting policies. While the new Wills Act 2007 is intended to give better effect to testamentary wishes, that aim is frustrated by the enhanced property entitlements of surviving spouses and unmarried partners provided by the Property (Relationships) Amendment Act 2001 and Parliament's failure to curb the liberal approach to support claims under the Family Protection Act. As a result, there is now a greater likelihood than before that testamentary wishes will be undermined and reasonable expectations of testators and their beneficiaries subverted.
Comparative Aspects of Expert Evidence in Civil Litigation
Authors: Verkerk Remme
Published: July 2009

To resolve factual questions that require specialist knowledge in civil cases, European Continental jurisdictions have traditionally used only court-appointed experts. Common law jurisdictions have almost exclusively resorted to experts retained by the parties. This article discusses the legal rules on court-appointed experts in different Continental jurisdictions and contrasts US and Continental rules on experts retained by the parties. These comparisons aim to provide insight into the different methods to regulate the use of experts in civil cases. In recent times, legislators in common law jurisdictions have encouraged the use of court-appointed experts while Continental jurisdictions gradually recognise the merits of hearing party-appointed experts. It is argued that legal rules that have been used and tested in one jurisdiction may serve as a source of inspiration for amending and improving rules in other legal systems.