bluuebunny/crossref_metadata_2025 huggingface dataset:
Oesophageal varices: how reliable is a barium swallow?
Authors: Ginai A Z , Van Buuren H R , Hop W C J , Schalm S W
Published: July 2009

Although barium swallow is a quick and easy method for diagnosing oesophageal varices, there is considerable variation between observers because objective quantitative radiological criteria have so far not been defined. In order to define these criteria, a blind radiological/endoscopic comparative study using endoscopy as the gold standard was retrospectively carried out in 72 patients. A prospective study was then carried out in 47 patients to define the validity of the radiological criteria found by the first study. The results of both studies showed that the length and the width of the mucosal folds representing varices as measured on barium swallow radiographs have a significant relationship with the grade of the varices as determined by endoscopy. We conclude that barium swallow is a quick and reliable method for quantitative assessment of oesophageal varices.
Paediatric radiotherapy—the avoidance of late radiation damage to the growing hip
Authors: Irwin C J R , Thomson E , Plowman P N
Published: July 2009

Epiphyseal plates of growing bones are sensitive to ionizing radiation and this poses problems for the paediatric radiotherapist.

The late abnormalities of spinal growth following radiotherapy are well documented in the literature (Rubin & Casarett, 1968; Probert et al, 1973; Probert & Parker, 1975). However, the proximal femoral and acetabular epiphyses are so close to many pelvic and inguinal/thigh portals and the consequences of abnormal hip development are so important, that this particular joint justifies closer scrutiny. Slipped capital femoral epiphysis following radiotherapy and chemotherapy (Dickerman et al 1979; Libshitz & Edeiken, 1981) and avascular necrosis of the femoral head (Timothy et al, 1978) have been described following high doses of radiotherapy to this region.

In this manuscript we describe a child in whom electron beam therapy to the groin delivered only low dose radiation to the proximal hip epiphyses—130 cGy fractionated over 5 weeks—but who suffered late maldevelopment.

We explore the success of various radiotherapy techniques in minimizing the dose to the hip epiphyses in four other children treated subsequently in this department. The appropriate positioning of the limb, the choice of treatment modality and, where possible, individual shielding blocks are considered and their effect on the dose to the hip estimated. Absorbed doses of radiation delivered to the midpoint of the proximal femoral epiphyses have been retrospectively determined.

In August 1983, an 8-month-old boy presented with short history of a lump in the left testis.
Book reviews
Authors: Bingham J B
Published: July 2009

This is a conveniently sized paperback book covering the physics of magnetic resonance (MR) imaging by well known writers in the field. Six chapters cover the basic principles of magnetism and the effects of tissue magnetization with a chapter on image contrast, relaxation processes and pulse sequences and a further chapter on image generation.
Book reviews
Authors: Spittle M F
Published: July 2009

In the foreword to the first edition, Simon Kramer directs it to resident house officers and medical students. The editors themselves feel that it might be a useful book for Fellows in medical oncology, gynaecological oncology and head and neck surgery.
Book reviewsy
Authors: Dawson P
Published: July 2009

This is a remarkable book. It is written by a nuclear medicine specialist American radiologist with background qualifications in physics and biomechanical engineering. According to the Preface the book is intended to be used as a text for a course for radiology residents on image processing and image reconstruction methods. It is made clear that the book is not primarily intended for physicists or engineers. One thing I am absolutely certain about is that this book will not be of interest to British radiology registrars.
The ultrasound markers of chromosomal disease: a retrospective study
Authors: Twining P , Zuccollo J
Published: July 2009

Over a 3 year period 37 pregnancies were complicated by a chromosomal abnormality. In the two cases of trisomy 13, holoprosencephaly, facial clefting, polydactyly and growth retardation were seen. In the seven cases of trisomy 18, abnormalities of the extremities, face and heart were common. Growth retardation and diaphragmatic hernia were also demonstrated. In the 21 cases of Down's syndrome the main abnormalities were cardiac, duodenal atresia and subtle digital anomalies. The two fetuses with triploidy showed a large hydropic placenta and holoprosencephaly respectively, and all five cases of Turner's syndrome demonstrated a cystic hygroma two of which were associated with hydrops. From the antenatal scans major anomalies were detected in 18 fetuses, however, chromosomal disease was suspected in only 15 cases. This was in part owing to a high false negative rate for cardiac anomalies (14 cases) in both routine and detailed scans. Owing to the diversity of anomalies present in chromosomal disease full assessment of the fetus is recommended with particular attention to the fetal heart, face, hands and feet. Specific anomalies are suggested for karyotype.
Abdominal MRI using a negative contrast agent
Authors: Bach-Gansmo T , Dupas B , Gayet-Delacroix M , Lambrechts M
Published: July 2009

A dose of 0.5 g of a negative oral contrast agent for labelling the bowel, was given to 40 patients in a clinical trial. Oral magnetic particles (OMP) consist of crystals of iron oxide with superparamagnetic properties, and are administered in 800 ml of a viscous suspension in order to obtain a uniform distribution. The aim of the study was to identify any adverse effects up to 1 week following ingestion, as well as the contrast distribution and effect, together with the induction of artifacts. A comparison of diagnostic value of the pre and postcontrast ingestion series was also performed. Vomiting followed ingestion in a single patient already nauseated and was the only adverse effect. Good contrast distribution and effect with no artifacts were present. The diagnostic information was greatly improved after OMP ingestion, and the diagnosis would not have been possible without the use of the contrast agent in 41% of the examinations.
Patient doses received during digital subtraction angiography
Authors: Steele H R , Temperton D H
Published: July 2009

Digital subtraction angiography (DSA) is based on digital image processing with logarithmic subtraction and edge enhancement. It is used increasingly for the visualization of blood vessels throughout the body. The bulk of the workload in the angiography suite at the Queen Elizabeth Hospital, Birmingham involves carotid and femoral angiograms with other examinations, including hepatic and renal angiograms, being carried out less frequently.

A typical DSA examination involves both fluoroscopy and DSA images taken at different projections and at different regions of the body. The exposure factors are selected automatically and the ease of image acquisition facilitates the acquisition of large numbers of images—exceeding 100 for some studies. Some examinations, but predominantly femoral angiograms, also involve the use of Puck serial films with the exposure factors being selected manually.

The screening time, number of DSA or Puck images and the exact projection and exposure factors used varies between patients. The dose to different patients varies enormously and, as with all medical radiation exposure, should be clinically justified. Taylor et al (1989) measured the entrance absorbed dose for a posteroanterior (PA) projection using a Rando anthropomorphic phantom and concluded that radiation doses to patients undergoing DSA examinations are amongst the highest for any X-ray procedure. The patient dose is increased because DSA images are taken using low voltages (e.g. 60–70 kVp) if technically possible in order to maximize image contrast.
An alternative approach to stenting the obstructed ureter
Authors: D'Souza R , Tait P , Thomson R W , Trewhella M
Published: July 2009

Ureteric stenting allows palliative treatment of strictures resulting from trauma, surgery, neoplasm or from scarring following treatment of malignancy. Retrograde and antegrade approaches can be used (Mitty et al, 1986; Shore et al, 1987) but, in a small proportion of patients, neither approach is successful, and patients with ureters which are completely occluded present a problem. We describe a combined antegrade and retrograde technique analogous to that used in biliary stenting (Robertson et al, 1987; Freeman et al, 1991) as a useful method in such cases. Three cases are described which illustrate the salient features.

A 56-year-old man was admitted for insertion of a stent across an obstructed right distal ureteric orifice. His well-differentiated bladder tumour had been treated by several endoscopic resections over the previous 5 years and one course of intravesical chemotherapy had been given 16 months earlier.
The transabdominal ultrasound appearances of a colovesical fistula
Authors: Long M A , Boultbee J E
Published: July 2009

When the clinical manifestations of colovesical fistulae lack diagnostic features, significant diagnostic delay may result. The literature contains conflicting recommendations regarding the optimal method of imaging such fistulae. We describe the transabdominal ultrasound appearances of a colovesical fistula and review the relevant literature. The identification of the ureteric orifices with their associated urinary jets and the use of abdominal compression are essential components of the technique.
Subtraction gadolinium enhanced magnetic resonance for head and neck imaging
Authors: Murray J G , Stack J P , Behan M
Published: July 2009

We read with interest the article by Lloyd et al (1993). The authors state that “injection into an arm vein is impractical without the use of multiple lengths of extension tubing”, thus necessitating venipuncture to the “dorsum of the foot”.
Variation in lumbar spine and femoral neck bone mineral measured by dual energy X-ray absorption: a study of 329 normal women
Authors: Truscott J G , Oldroyd B , Simpson M , Stewart S P , Westmacott C F , Milner R , Horsman A , Smith M A
Published: July 2009

Reference ranges used in dual energy X-ray absorptiometry (DXA) have previously used piecewise linear fits to the whole data set for spine or femur bone mineral density (BMD) as a function of age. In a study of 329 Caucasian normal women we present a refinement to the normal range by fitting straight lines between quinquennial mean values of BMD for each site measured (lumbar spine, femoral neck and Ward's triangle). From the age of 40 years onwards the premenopausal women demonstrated minimal loss of BMD whereas postmenopausal women showed a rapid loss amounting to 27% in the lumbar spine, 27% in the femoral neck and 38% in the Ward's triangle region in the age range under examination. Comparison of quinquennial means for pre and postmenopausal women in age bands 45–49 years and 50–54 years shows that at these ages postmenopausal BMD is significantly lower than premenopausal BMD (P < 0.05). This finding suggests that separate normal ranges should be used for pre and postmenopausal women. As reduction in the production of oestrogen is a major factor in postmenopausal bone loss and oestrogen function is related to years since menopause (YSM), a more logical way of displaying postmenopausal normal BMD ranges would be in terms of YSM rather than chronological age. Such data are given in this paper.
A halo-ring technique for fractionated stereotactic radiotherapy
Authors: Clark B G , Podgorsak E B , Souhami L , Olivier A , Sixel K E , Caron J-L
Published: July 2009

Stereotactic radiosurgery has become established as an effective treatment modality for certain non-malignant brain diseases such as arteriovenous malformations. This paper describes an extension of our linear accelerator-based radiosurgical technique to fractionated treatment of intracranial disease. The fractionated stereotactic radiotherapy technique expands the use of the modality by sparing normal cells within the treatment volume thus improving the therapeutic ratio. The first treatment is given using a stereotactic frame both for target localization and patient immobilization. The frame is then removed and subsequent treatments use a standard neurosurgical halo-ring for patient immobilization. The halo-ring is left in place on the skull for the duration of the course of treatment. Thus the physical requirements for fractionation pertain firstly to the patient immobilization and target localization using the halo-ring and secondly to the stringent quality assurance procedures required to maintain spatial accuracy under these new conditions. We describe a sensitive and effective technique for checking the rotational beam parameters and collimator alignment which we use immediately prior to treatment to ensure adequate accuracy of dose delivery to the target volume.
Nasopharyngeal carcinoma: local control by megavoltage irradiation
Authors: Lee A W M , Law S C K , Foo W , Poon Y F , Chan D K K , S K O  , Tung S Y , Cheung F K , Thaw M , Ho J H C
Published: July 2009

This is a retrospective analysis of the long-term local control in 4128 patients with non-disseminated nasopharyngeal carcinoma treated solely by megavoltage irradiation during the years 1976–1985. The T-stage distribution according to Ho's classification was Tl 37%, T2 14% and T3 49%. Different fractionation schedules had been employed at different periods, and the median dose to the primary target was equivalent to 65 Gy by time dose fractionation calculation. In 8% (344) of patients the tumour failed to regress completely after the basic course, but 89% (148/167) of those suitable for salvage with additional irradiation eventually attained complete local remission. The cumulative incidence of local failure was 24% (5% persistence, 19% recurrence). The 10-year actuarial local failure-free survival was 67%. While patients with T2 and T3a tumours achieved local control comparable to Tl, those with T3c-d had the poorest control (with highest incidence of persistence and advanced recurrence). T-stage adjusted analyses suggested a significant trend of dose-response: the odds ratios for local failure were 1.16 and 1.86, respectively, when patients given 60–63 Gy and 55–59 Gy were compared with those given 64 Gy or above (p value = 0.0018). Patients treated during 1981–1985 achieved higher local failure-free survival than those treated during 1976–1980 (75% versus 70% at 5 years, p value = 0.0013). The possible attributes are studied, and ways for future optimization of treatment discussed.
The ultrasound appearances of pelvic venous collaterals in deep vein thrombosis
Authors: Millar J
Published: July 2009

The ultrasound and Doppler appearances of pelvic venous collaterals in a patient with bilateral ilio-femoral deep vein thromboses are presented. Possible mechanisms for their occurrence are discussed. The importance of these appearances are emphasized in view of their similarity to pelvic varices.
Book review
Authors: Abernethy L J
Published: July 2009

Donald Kirks and his colleagues at the Children's Hospital Medical Center, Cincinnati, have produced an outstanding textbook which is a model of clarity and erudition.
Fat necrosis of the breast appearing as oil cysts with fat-fluid levels
Authors: Bargum K , Møller Nielsen S
Published: July 2009

Fat necrosis of the breast is a common, benign condition, which is usually seen following blunt trauma or surgery. It produces different mammographic findings; most frequently, fat necrosis presents as a poorly defined mass, often with spiculated scarring and fixation to the overlying skin. It may therefore be difficult to differentiate from a malignant tumour. Frequently, calcifications are seen within the lesion (Minagi & Youker, 1968; Evers & Troupin, 1991; Stiger et al, 1991). These can be either microcalcifications or calcifications in the periphery of cyst-like structures. Oil cysts may sometimes be seen and are thought to be late stages of fat necrosis (Andersson et al, 1977). These cysts are lipid filled and are characterized by being radiolucent.
Bilateral carpal and tarsal synostoses
Authors: Wahab K H A , Woolf V J , Mulnier J J H
Published: July 2009

Carpal and tarsal synostoses are uncommon. We report a rare combination of bilateral carpal and tarsal synostoses, including fusion across the carpal and tarsal rows, and review the literature.
Imaging of a bilobed gallbladder
Authors: Martinoli C , Derchi L E , Pastorino C , Cittadini G
Published: July 2009

Imaging of the gallbladder demonstrates a wide range of anatomical variants, including anomalies in location, number and shape. Duplication anomalies are quite rare and are characterized by a large variety of configurations depending on the size and degree of fusion of the two lobes, and on the number and disposition of the cystic ducts. We present a case of a deeply cleft, bilobed gallbladder imaged by computed tomography (CT), ultrasonography (US) and oral cholecystography (OCG). The anomaly consisted of complete duplication of the body and fundus into two distinct and separated lobes both of which entered a single infundibulum. Awareness of congenital gallbladder variants may help in recognizing and correctly classifying gallbladder abnormalities, thus preventing misdiagnoses.
Radiology of renal failure — a question answered
Authors: Hartnell G G
Published: July 2009

In his review of Radiology of Renal Failure, in the January 1993 edition of the British Journal of Radiology, Dr Dawson wonders what a “rugger jersey” is called in the United States.
The effects of radiographic contrast media on leucocyte orientation
Authors: Roobottom C A , Farrow R , Wells I P , Hurlock N
Published: July 2009

The effects of radiographic contrast media (RCM) on leucocyte orientation in vitro were studied using a Zigmond chamber. Leucocyte orientation was assessed following exposure of the leucocytes to iotrolan, iohexol, ioxaglate and diatrizoate. The RCM used were diluted to a concentration similar to that obtained in vivo during routine angiography. At this concentration there was a significant reduction in leucocyte orientation for all RCM investigated but the effect was more pronounced in the monomeric than the dimeric RCM. The results may have significance when deciding which radiographic contrast medium to use in selected patients, particularly those who are immunosuppressed or septicaemic.
Gastrointestinal manifestations in the Hallopeau-Siemens variant of recessive dystrophic epidermolysis bullosa
Authors: Wong W L , Entwisle K , Pemberton J
Published: July 2009

Epidermolysis bullosa encompasses a group of rare disorders typified by blister formation following minor trauma to the skin. Gastrointestinal tract involvement may occur in the extremely rare recessive dystrophic variants. The gastrointestinal manifestations present in 25 patients with the Hallopeau-Siemens variant of recessive dystrophic epidermolysis bullosa are reviewed. In the oesophagus both anatomical and motility abnormalities were observed. Features seen included a generally shortened oesophagus, strictures including those resembling webs, hiatus herniae, decreased peristalsis, oesophageal atony and pseudodiverticulum formation. These patients also had faecal impaction.
Changes in the radiation treatment of cancer of the anus in Glasgow
Authors: Jones R D , Symonds R P , Robertson A G , Thomas R
Published: July 2009

The survival and complication rate of two groups of patients with carcinoma of anus were compared. The first group of 20 patients were treated between 1974 and 1983 by double plane implantation using radium or equivalent caesium needles and supplementary external beam radiotherapy to groin nodes if present. The second group of 26 patients were treated between 1984 and 1990 by external beam radiotherapy followed by a jig implant using afterloading iridium needles. 5-year survival was superior in the second group (73% vs. 40%) with a lower incidence of radiation-induced complications.
Is there a danger in delaying radiotherapy in childhood medulloblastoma?
Authors: Attard-Montalto S , Plowman N , Breatnach F , Saha V , Eden O B
Published: July 2009

Approximately 45–50% of children with medulloblastoma are cured by conventional surgery and radiotherapy, but survivors may face severe late neuropsychological toxicity. Studies showing good partial responses to platinum-based chemotherapy in relapsed patients and the theoretical possibility of a therapeutic window immediately after surgery have prompted neoadjuvant treatment studies which are ongoing. However, the absolute benefit of chemotherapy for the treatment of medulloblastoma in childhood is, as yet, not proven. There is a danger that chemotherapy may simply delay radiotherapy, and in so doing reduce the radiological impact of this known effective treatment. We report four children with medulloblastoma presenting consecutively to this unit over a 6-month period, whose management was problematic because of either failure to respond to neoadjuvant chemotherapy or their very young age. These cases are discussed in the light of the current literature and future treatment strategies that must seek to improve the therapeutic ratio of multimodality therapy.
Reduced bone mineral density in long-term survivors of medulloblastoma
Authors: Mithal N P , Almond M K , Evans K , Hoskin P J
Published: July 2009

Bone mineral density (BMD) reaches a peak at approximately 30 years of age, and may be influenced by radiotherapy before completion of skeletal maturation. Regional BMD has been measured using dual energy X-Ray absorptiometry (DEXA) in adults following craniospinal irradiation for medulloblastoma between ages 4 and 19 years, receiving doses of 3500–4000 cGy to the brain and spinal cord. Lumbar spine (LS) and femoral neck (FN) BMD measurements were compared with normal age-sex matched control values. There was failure to achieve normal adult BMD at both LS and FN, with a mean reduction at LS of 12.1% ± 2.4% (p < 0.01) and a mean reduction at FN of 14.3% ± 3.4% (p < 0.01). The mean body mass index (BMI) was also less than that of a standard population (21.8 ± 1.5), as were mean standing and sitting heights. No relationship was found between reduction in BMD at either site and age at irradiation, time elapsed since irradiation or BMI at time of scanning. Biochemical and endocrine markers including corrected calcium, alkaline phosphatase, sex hormones and IGF-1 were normal in all seven patients. The reduction in BMD outside the irradiated area suggests that indirect factors may be important in this effect.
Clinical high resolution skeletal single photon emission tomography using a triple-headed gamma camera
Authors: Buscombe J R , Townsend C E , Kouris K , Clarke G , Mahmood S , Jarritt P H , ELL P J
Published: July 2009

Planar skeletal scintigraphy has become established as a standard diagnostic test performed within the nuclear medicine department. Since the 1970s good quality images have been produced using an Anger gamma camera and 99Tcm-labelled diphosphonates. Single photon emission tomography (SPET) has improved the sensitivity of detection and the ability to localize bony pathology, particularly benign bone disease in the spine. Recently multi-detector gamma cameras dedicated to SPET have become available. One such system, the Toshiba GCA-9300A, has been used to perform routine clinical skeletal SPET in 81 patients. Good quality images have been obtained using an 8 min acquisition in the axial skeleton and a 16min acquisition protocol in the peripheral skeleton. Multiple sites can be tomographed in the same patient during the same examination using two or more 8 min acquisitions. Such a multi-detector gamma camera offers advantages over the standard single-headed rotating camera for skeletal SPET in terms of both imaging time and image quality. A cost analysis was performed which demonstrated that the additional cost of purchasing such a multidetector gamma camera was less than £30.00 per SPET study.
Accessory lobe of the liver mimicking lesser omental lymphadenopathy
Authors: Fitzgerald R , Hale M , Williams C R
Published: July 2009

An accessory lobe of the liver is an uncommon occurrence and often an incidental finding. We present the case of a middle-aged man whose upper abdominal pain was relieved following removal of an accessory lobe. His preoperative imaging had led us to believe that he had lesser omental lymphadenopathy. We draw attention to the fact that this congenital abnormality can cause diagnostic confusion.
Staghorn calculus complicated by psoas abscess presenting as flank mass in a teenager
Authors: Curtin J J , Ridley N T F , Colbeck R
Published: July 2009

An 18-year-old male presented with a marked lack of symptoms despite the presence of a staghorn calculus complicated by a psoas abscess, which had herniated posteriorly through Petit's lumbar triangle.
Radiation exposure to the hands of orthopaedic surgeons during procedures under fluoroscopic X-ray control
Authors: Goldstone K E , Wright I H , Cohen B
Published: July 2009

The hands of the surgeon are most likely to be directly exposed to ionizing radiation during fluoroscopic screening in the orthopaedic theatre. There is however little information available on the level of exposure to radiation during the normal working pattern of individual surgeons. The purpose of this study was to directly measure the radiation exposure to the hands during fluoroscopic screening in a series of consecutive cases over a month in order to establish whether these staff need to be designated classified persons, and if not, whether they need to be routinely monitored. Extremity monitoring was carried out using thermoluminescent dosemeters. The dosemeter was secured to the operating surgeon's dominant index finger. 44 procedures were carried out by nine different surgeons. The total radiation dose received per surgeon ranged from 48–2329 μSv. In 80% of procedures the dose of radiation to the surgeon's hand was less than 100 μSv. The extrapolated annual dose, even for the surgeon with the highest radiation exposure, was well below the annual dose limit for extremities of 500 mSv per year recommended by the International Commission on Radiological Protection, and embodied in the Ionizing Radiations Regulations 1985. Despite the relatively low doses of radiation received by surgeons in this study, occupational exposure to all personnel should be kept to the lowest practicable levels, and a review of procedures, including dose measurements, from time to time is advised.
Dual X-ray absorptiometry: a comparison between fan beam and pencil beam scans
Authors: Blake G M , Parker J C , Buxton F M A , Fogelman I
Published: July 2009

The recent introduction of dual X-ray absorptiometry (DXA) systems with fan beam instead of conventional pencil beam scanning geometry represents a significant technical advance in bone densitometry. This report describes phantom and in-vivo studies of the effect of the change in beam configuration on DXA measurements. Fan beam and pencil beam measurements acquired on one of the new generation scanners, the Hologic QDR-2000, were compared with scans performed on an earlier pencil beam model, the Hologic QDR-1000. The variation with height above the scanning table of fan beam measurements of an anthropomorphic spine phantom were: bone mineral content (BMC): −3.1% cm−1; projected area (AREA): −2.8% cm−1; bone mineral density (BMD): −0.2% cm−1. For pencil beam scans the magnitude of height variation was less than 0.1% cm−1. QDR-2000 fan and pencil beam scan results for 20 volunteers correlated closely with QDR-1000 pencil beam data (r = 0.966–0.998). For BMD measurements on the spine and hip, differences between fan and pencil beam data were consistent with the errors expected from measurement precison. For AREA and BMC data, however, larger differences were observed with individual deviations which correlated with body habitus of the subjects. Although the change from pencil to fan beam goemetry significantly affected AREA and BMC data, the effect on the clinically more important BMD measurements was negligibly small.
The detection and modification of the hypoxic fraction in quiescent cell populations in murine solid tumours
Authors: Masunaga S , Ono K , Abe M
Published: July 2009

Mice bearing SCC VII or EMT6/KU tumours were irradiated after receiving 10 injections of 5-bromo-2′- deoxyuridine (BUdR) to label all proliferating tumour cells, and the tumours were then excised and trypsinized. The tumour cell suspensions thus obtained were incubated with cytochalasin-B (a cytokinesis blocker), and the micronucleus (MN) frequency in cells without BUdR labelling was determined using immunofluorescence staining to BUdR. This MN frequency was then used to calculate the surviving fraction of unlabelled cells from the regression line for the relation between MN frequency and the surviving fraction of all tumour cells. Thus a cell survival curve could be determined for cells not labelled by BUdR, which can be regarded as quiescent tumour cells for all practical purposes. Assays performed immediately after irradiation of both normally aerated and hypoxic tumours showed that quiescent cells contained higher hypoxic fractions than the tumour cells as a whole. Furthermore, administration of nicotinamide before irradiation or the placement of mice in a circulating carbogen (95% O2, 5% CO2) chamber for 30 min before and during irradiation altered the acutely and chronically hypoxic fractions of the proliferating and quiescent tumour cell populations in a way which depended on the tumour system. Combined nicotinamide and carbogen therapy was shown to have a large potential to sensitize cells to low-dose radiation in vivo. In addition, this assay method appears to be useful for determining the size of the hypoxic fraction of quiescent tumour cells in murine solid tumours.
Digital mammography—the comparative evaluation of film digitizers
Authors: Davies D H
Published: July 2009

To study the potential of the computer interpretation of digital mammograms it is necessary to use digitized conventional films because at the present time insufficient resolution may be achieved using computed radiography. For example, the automatic detection of very small subtle calcifications requires digitization at 50 μm or smaller with at least 8 bits of grey level (Chan et al, 1987; Dance, 1993). In this paper we present a simple and practical method to evaluate and compare the technical performance of three film digitizers. These all cost about £20 000 and are being assessed as possible methods for obtaining digital mammograms for a national database (Astley, 1993). The digitizers investigated are a drum scanning microdensitometer, a laser scanning densitometer and a CCD camera. According to manufacturers' specifications, each has a high resolution sampling pixel size (50 μm or less) and is capable of digitizing to a grey level of at least 8 bits over the complete range of diffuse optical densities (0–3 or higher) typically found in a mammogram. The digitizers have been compared by measuring the modulation transfer function (MTF), noise and linearity of each system at a pixel resolution of 50 μm with an 8 bit grey scale. Measurement of these properties provides a means of comparison of important parameters such as resolution and dynamic range. Yin et al (1992) have recently presented an evaluation of the imaging properties of a laser film digitizer using a different approach from that described in this paper.
Discrimination on grounds of colour
Authors: McBride K D , Cooper S M
Published: July 2009

We are concerned at the apparent discrimination being practised by radiological journals. The charging of authors in part or full for the inclusion of colour illustrations is widely practised. Until recently, the use of colour plates in specialist radiology journals was, for the most part, “decorative”. Now that colour Doppler imaging (CDI) is an established part of our practice, colour illustrations are often essential (McBride & Masterson, 1992). There has been a rapid rise in the number of CDI articles in the world literature according to Index Medicus, with 14 appearing in 1989 and 54 in 1992.
A calcified brain
Authors: Graham J D , Owens C , Godlee J N
Published: July 2009

A 13-year-old boy complained of increasing head-aches over a 3 month period. At the age of 7 years he had undergone craniotomy and complete resection of a medulloblastoma of the cerebellum. No metastases were detected and post-operative radiotherapy was given to the whole brain and spinal cord to a dose of 30 Gy in 20 fractions over 4 weeks, followed by a boost to the posterior fossa, which received a total dose of 50 Gy in 40 fractions over 8 weeks. A computed tomography (CT) scan 1 year after treatment showed no evidence of disease. Following treatment he required growth hormone replacement and there were behavioural problems that required medication. Incoordination of the right side had been present since cranial surgery but there had been no recent neurological deterioration. A CT scan was performed (Figures 1,2). What does it show? What is the diagnosis and aetiology?

The CT scan shows extensive serrated calcification at the corticomedullary junction and within the basal ganglia.
The challenge of change
Authors: Hately W
Published: July 2009

In considering a suitable title for a presidential address I was conscious of the need to choose a reasonably general topic for a multidisciplinary audience. One such topic is change, which may be denned as a process of transition from an old state to a new. It seems that our working environment is changing perhaps more rapidly and extensively than at any time in years. In another presidential address, Bill Clinton mentioned change no less than nine times, commenting that the urgent question of our time is whether we can make change our friend, not our enemy. Such change affects the hospitals and organizational structures within which we work, as well as the subject of radiology and its allied sciences, the role of the radiologist and scientist and the British Institute of-Radiology (BIR) and associated bodies. We have all been through something of a revolution. One is reminded of Dickens' quote about another revolutionary era “it was the best of times—it was the worst of times”; perhaps now best in terms of progress in medical imaging and intervention, worst in terms of underfunding.

The environment in which radiology is now practised has been changed to a greater degree, as a result of the present government's reform package, than at any time since the inception of the National Health Service. Now the radiologist works in a provider hospital unit dependent on the securing of contracts with a variety of purchasers, including district health authorities and fund holding GPs.
The development of quality assurance for Sheffield's radiotherapy treatment planning systems
Authors: Whilde N J , Conway J , Bomford C K
Published: July 2009

Quality assurance procedures have been defined and implemented for the treatment planning systems at Weston Park Hospital. The programme of tests and checks covers both hardware and software: hardware checks are concerned with the input and output performance of the system's peripheral devices; the software checks involve testing system data integrity, and testing the algorithms used for planning external photon and electron beams. Beam measurements from an ionization chamber scanned in water and air were compared with calculations from two independent treatment planning systems. Following the implementation of these quality assurance procedures, some improvements have been made to the system data used and changes have been introduced to planning practice.
Book review
Authors: Flower M A
Published: July 2009

This report will be of interest to all nuclear medicine and physics staff who use gamma cameras and associated computer systems. It has been written by a group of experts in the field of nuclear medicine quality control, namely the Radionuclide Topic Group of the Institute of Physical Sciences in Medicine, and replaces the Hospital Physicists Association's earlier report (TGR27) on the theory, specification and testing of Anger type gamma cameras, published in 1978.
Is some of our radiation dosimetry wrong?
Authors: Dawson P , Lopez A
Published: July 2009

Medical X-rays represent only some 10% of the average individual's ionizing radiation exposure but this is, nevertheless, a significant contribution and the only one to any great extent within our power to limit or reduce. The average, as always, conceals the case of the individual undergoing frequent or more complex radiological procedures in whom this medical X-ray exposure dwarfs other contributions. Furthermore, there is a marked variation of exposure associated with any given examination when performed by different radiologists and in different departments (Shrimpton et al, 1986). This variation is a function of radiological technique, age, quality and maintenance of equipment, and of types of film/screen combination. A considerable burden of responsibility, therefore, devolves on the radiology department, a burden not in any way diminished by recent reassessment of the risks of “low level” radiation exposure (ICRP, 1990).

Exposures of organs and tissues in various examinations cannot currently be directly measured and so are calculated. Such calculations inevitably rest on a number of assumptions and simplifications and one factor which seems not to have been taken into account is the presence in many examinations of a contrast agent in, or adjacent to, the exposed tissues. Iodine and barium containing radiological contrast agents were designed to increase diagnostic X-ray absorption. They do so predominantly by means of photoelectric interactions which liberate photoelectrons, with a range in soft tissues of a few tens of microns, and characteristic X-rays.
Ureteric obstruction secondary to contralateral hydronephrosis
Authors: Morris S B , Dick J A
Published: July 2009

Giant hydronephrosis is a rare condition, defined in the adult as a kidney containing more than 1 l of fluid. It is usually secondary to pelvi-ureteric junction obstruction. We describe a case where giant hydronephrosis caused contralateral ureteric obstruction. The radiological findings are described and the literature is reviewed.
The indeterminate breast mass: assessment using contrast enhanced magnetic resonance imaging
Authors: Hickman P F , Moore N R , Shepstone B J
Published: July 2009

Magnetic resonance imaging of the breast was performed on 25 lesions in 24 patients. These lesions were indeterminate on clinical and mammographic examination. The imaging findings were compared with pathological results in all cases. Conventional T  1, and T  2 spin echo images provided a certain diagnosis in only one case. The pattern of signal enhancement following gadolinium diethylamine triamine pentaacetic acid injection as demonstrated by a T  1-weighted gradient recalled echo sequence permitted accurate diagnosis of four recurrent carcinomas and 19 cases of non-malignant disease (17 postoperative scars and two cases of benign breast disease). One false positive diagnosis of cancer was made in a case of fibroadenoma. Dynamic contrast enhanced magnetic resonance imaging may have a role in the assessment of the indeterminate breast mass.
What is the nephrogram?
Authors: Dawson P , Peters A M
Published: July 2009

One of the oldest questions in radiology, “what is the nephrogram?”, has been approached in a novel manner using dynamic bolus contrast enhanced computed tomography to monitor the arrival and distribution of contrast agent in the normal kidney. A modification of a mathematical technique first developed for applications in positron emission tomography has been used to analyse the data. It is concluded that the blood pool contribution to the nephrogram is greater in the first minutes after rapid bolus contrast injection than generally supposed and that the “immediate” nephrogram is a predominantly blood pool contrast phenomenon.
The outcome of fetal ventriculomegaly
Authors: Twining P , Jaspan T , Zuccollo J
Published: July 2009

Over a 5 year period 38 cases of fetal ventriculomegaly were diagnosed at Queen's Medical Centre, Nottingham. There were 12 cases of spina bifida and all patients opted for a termination of pregnancy. There were 15 cases of isolated ventriculomegaly comprising seven cases of aqueduct stenosis, four abnormalities of the corpus callosum, one cavum septum pellucidum cyst, one case of porencephaly and two cases of mild lateral ventricular dilatation. The fetuses in this group had a relatively good outcome with five babies showing normal development, three with mild developmental delay and one with moderate developmental delay. There was one stillbirth and five patients opted for a termination of pregnancy. Associated abnormalities were seen in seven cases and these carried a poor prognosis with one fetus stillborn, one neonatal death, and three patients opted for a termination of pregnancy. Two babies were liveborn, one has severe developmental delay and the other one is normal. The four remaining cases included two Dandy Walker syndrome, one brain tumour and one case of subdural haemorrhage. There were three terminations of pregnancy and one stillbirth in this group. The outcome of fetal ventriculomegaly depends on the presence of associated abnormalities which carry a poor prognosis. It also depends on the timing of the diagnosis as most patients will opt for a termination of pregnancy if the diagnosis is made before 24 weeks gestation. A review of the literature reveals that, excluding terminations, fetuses with isolated ventriculomegaly have an 80% chance of survival and a 50% chance of normal development.
Re-evaluation of a radiation protection cost benefit analysis study in brachytherapy
Authors: Van Den Broek J G , Weatherburn H
Published: July 2009

Cost benefit analysis has been in use for many years as a method for making a comparison between the costs of radiation protection and the benefits of reduced radiation exposure. It is advocated by the International Commission on Radiological Protection (ICRP) and the National Radiological Protection Board (NRPB) has given more specific advice relating to the value of the man Sv to be used in the calculation of cost benefit. The purpose of this study is to investigate the changes in the NRPB advice over the last 10 years by correcting all figures for inflation and applying them to a particular radiation protection example. The example employed is a previously published case of the introduction of afterloading brachytherapy equipment at the Christie Hospital, Manchester. It has been shown that for this specific example the NRPB advice at one time led to a large cost benefit, at another time it led to a large cost deficit and later still it again gives a large cost benefit. Application of cost benefit analysis to decision making in radiation protection is therefore shown to be in need of further investigation and clarification before it can be used with confidence.
Rapid measurement of left ventricular mass by spin echo magnetic resonance imaging
Authors: Forbat S M , Karwatowski S P , Gatehouse P D , Firmin D N , Longmore D B , Underwood S R
Published: July 2009

Magnetic resonance (MR) imaging provides an accurate measurement of left ventricular mass but imaging time can be up to 45 min. We tested a more rapid multislice spin echo technique on 16 volunteers without evidence of heart disease. Multislice short axis spin echo images were acquired in up to three sets of five, clustered around end systole. Total imaging time was 15 min. Myocardial areas were summed and specific gravity was assumed. Comparison was made with multiple single acquisitions timed to end systole. There was good agreement between the two measurements of left ventricular mass. Mean (±standard deviation (sd), range) values were 212 g (±41.71, 152 to 311) by the multislice method and 213 g (±44.26, 155 to 317) by the single slice method. The mean difference (±sd of difference) between measurements was −1.72±14.89 g (95% confidence interval for limits of agreement was ±14%). We have therefore established a more rapid and accurate method of measuring left ventricular mass.
Extrathoracic herniation of the lung with a review of the literature
Authors: Scullion D A , Negus R , Al-Kutoubi A
Published: July 2009

A case of extrathoracic herniation of the lung is described together with the radiological findings in this condition including the role of computed tomography (CT) in its management. In addition a review of the literature is presented which outlines the incidence, classification and clinical features of lung herniae. Some reference is made to possible methods of treatment.
Lung metastasectomy in patients with soft tissue sarcoma
Authors: Robinson M H , Sheppard M , Moskovic E , Fisher C
Published: July 2009

Metastases develop in 50–60% of patients with high grade soft tissue sarcomas despite primary treatment. Between 1970 and 1990, 189 patients with soft tissue sarcoma referred to the Royal Marsden Hospital Sarcoma Unit developed lung metastases as the sole first site of disseminated disease. 44 of these 189 cases have been treated by pulmonary metastasectomy. In an attempt to determine which patients benefit from this surgery the medical records, radiology and pathology of these cases have been reviewed. Both the overall 5 year survival (70% vs 19%) and the subsequent survival from the time lung metastases developed (52% vs 7.5%) of those selected for thoracotomy were better than in the 145 patients not undergoing surgery. On multivariate analysis, survival and control of lung disease following resection were not related to the number of metastases resected, completeness of excision, use of adjuvant chemotherapy or presence of bilateral disease. The most important factor was the use of lung resection itself as treatment, for which the risk of death was 0.2 compared with those not having metastasectomy. Age less than 40 years and primary tumour in a lower limb site were also factors associated with a reduced risk of death. Pulmonary metastasectomy should be considered in selected patients with soft tissue sarcoma after primary local cure. However, without collection of prospective data on all patients developing lung metastases or a randomized trial the true role of lung metastasectomy will never be clarified.
Intrapelvic two-dimensional time-of-flight magnetic resonance angiography in healthy and diseased subjects
Authors: Yoshikawa K , Sugimura K , Kawamitsu H , Ishida T
Published: July 2009

We evaluated the use of magnetic resonance angiography (MRA) based on two-dimensional (2D) time-of-flight (TOF) technique in the pelvic vasculature. In the initial phase of this study, MRA was performed in 10 normal subjects for determination of the optimum imaging parameters. Systemically varied scan parameters included flip angle ranging from 20° to 90° by 10° increments and repetition time (TR) of 30, 40, and 50 ms. The optimum imaging parameters for intrapelvic MR angiography were found to be flip angle of 90°, pulse sequence of 30/4.9 (TR ms/TE ms). Using these imaging parameters, 70–100% of the second division branches of the internal iliac artery could be visualized in each subject. In the second phase of this study, we evaluated the use of MR angiography in patients with intrapelvic vascular disease by comparing its accuracy in evaluating the iliac arteries with that of conventional angiography. In patients with atheromatous disease, the MR angiographic determination was consistent with that of conventional angiography in 23 of 28 visualized arterial segments (82%). In eight lesions in patients with non-stenotic vascular disease or hypervascular pelvic tumours, all lesions were demonstrated clearly with MR angiography. 2D TOF technique with high flip angle excitation is suitable for the evaluation of main iliac branches and diseased vessels.