bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of significant abnormalities on lumbar spine radiographs
Authors: Davies A M , Fowler J , Tyrrell P N M , Millar J S , Leahy J F , Patel K , Hill J S
Published: July 2009

The purpose of this study was to determine the proportion of significant abnormalities detected on anteroposterior (AP) and lateral radiographs of the lumbar spine when viewed separately, in a series of cases where the prevalence of abnormalities had been artificially increased. Five radiologists of varying experience were required to report separately on the AP and lateral films of 300 cases in which randomly included were 30 cases with metastatic disease, a disc infection or an inflammatory spondylitis. At a later date, unaware of their initial observations, the radiologists repeated the exercise reviewing all the films together. As might be expected the false positive rate was relatively high, particularly in the least experienced radiologists' responses. Nevertheless the overall results indicate that the majority of early inflammatory spondylitis cases will be missed on a solitary lateral film as will many of the metastases. Conversely, fractionally more of the disc infections were observed on the lateral film than on the AP. Further analyses in terms of sensitivity, specificity, positive and negative predictive values are presented. The authors conclude that it is preferable to reduce the overall number of lumbar spine examinations performed, by adherence to accepted guidelines, than to prejudice the detection of significant, albeit rare, abnormalities by restricting the routine series of radiographs.
Measurement of focal spot size in mammography X-ray tubes
Authors: Law J
Published: July 2009

Three different measurement techniques for estimating the size of focal spots in X-ray tubes are described. These are the pin-hole, the slit and the star pattern or resolution pattern, and all are well known. Results are reported for a number of modern mammography X-ray tubes employed in a screening programme, using all three techniques. The results are compared with each other and with makers' specifications, IEC tolerances and UK Department of Health guidelines. Agreement between slit and star pattern results is generally within a few per cent, while pin-hole results are usually appreciably smaller. Although the slit technique is the most reliable for estimating focal spot size, both the others have a useful role, especially in revealing focal spot condition. Compliance with makers' specifications is usually demonstrated, but compliance with Department of Health guidelines is only found on the width of broad foci.
Calibration of ion chambers for use in mammography
Authors: Law J
Published: July 2009

There is at present no UK calibration service for ion chambers for mammography, where X-ray beams are produced from tubes having molybdenum targets and filters. This paper reports calibrations against a radiotherapy secondary standard (calibrated for beams from tungsten targets with aluminium filters) using beams from both types of target and filter. Two examples of the Radcal mammography dosemeter were found to have calibration factors which varied by less than 1% in molybdenum target beams from 30 to 40 kV. Differences between calibrations using the two types of X-ray beam did not exceed about 2%. All calibration factors were within about ±2% of 1.0. Errors are thought to be within ±3%. The results of an independent calibration of one of these dosemeters against a similar chamber calibrated by CEC are also reported. Calibrations of this kind can only be temporary expedients until adequate calibration facilities for mammography beams become available, but are nevertheless useful.
Agenesis of the corpus callosum
Authors: Warren M E , Cook J V
Published: July 2009

Agenesis of the corpus callosum is an uncommon congenital anomaly which causes dilatation of the posterior horns of the lateral ventricles and a falsely high ventricular/hemispheric ratio on antenatal ultrasound scans with an incidence on studies of air encephalograms of 0.7% (Grogono, 1968). It may be confused with hydrocephalus and lead to unnecessary intervention.

The characteristic features on both ante- and postnatal ultrasound are:

(1) Absence of the corpus callosum.

(2) Marked separation of the slit-like anterior horns of the lateral ventricles and dilatation of the posterior and inferior horns creating the typical “rabbit's ear” or “devil's horn” appearance.

(3) Visualization of both medial and lateral walls of the anterior horns of the lateral ventricles which are displaced from the midline.

(4) Variable dorsal and superior displacement of the third ventricle.

(5) Loss of the normal parallel sulcal pattern above the third ventricle.

A case of congenital absence of the corpus callosum is described and the ante-natal ultrasound, post-natal ultrasound and computed tomography (CT) appearances are demonstrated.
Ultrasound diagnosis of duodenal atresia combined with isolated oesophageal atresia
Authors: Kessel D , De Bruyn R , Drake D
Published: July 2009

Duodenal atresia associated with isolated oesophageal atresia is very rare. The combination has distinctive ultrasound appearances. We report a case in which ultrasound was able to establish the diagnosis and thus influence the surgical management.

A 28 year primigravida was investigated for polyhydramnios at 30 weeks of gestation. Ultrasound snowed the typical “double bubble” appearances of duodenal atresia. Chromosomal analysis was normal. The baby was born prematurely at 32 weeks gestation after the spontaneous onset of labour. The umbilical cord had only 2 vessels. Examination revealed a morphologically normal baby. The baby's abdomen was distended with palpable masses in each flank. It was not possible to pass a nasogastric tube.

The chest radiograph (Figure 1) and plain abdominal film revealed oesophageal atresia and a gasless abdomen. A soft tissue mass was seen behind the cardiac silhouette. Six lumbar vertebrae and 12 pairs of ribs were present.
Book reviews
Authors: Vernon C C
Published: July 2009

Hyperthermic technology is now catching up with the radiobiology thus enabling clinical work to emerge, and a review book such as this has been overdue. It consists of 18 chapters covering such subjects as: fundamental biology, physiological effects, technical and physical aspects of heating, thermometry and measurement of thermal dose, clinical practice and trial design, quality assurance and safety considerations. All these chapters are contributed by well-known experts in their fields.
Book reviews
Authors: Bingham J B
Published: July 2009

This book follows the example of previous similar texts on the neural axis providing typical examples of pathology in a test format. Magnetic resonance (MR) images of musculo skeletal pathology are presented on one page with a brief history and a discussion and the final diagnosis on the facing page. Some plain films are presented as part of the diagnostic work up. The book comprises five parts.
Book reviews
Authors: Pinkerton C R
Published: July 2009

With few new effective chemotherapeutic agents on the horizon it is timely that a definitive text reviewing the background and potential role of biological therapy in cancer appears. It is also ppropriate that it is edited by an individual who has been one of the driving forces in the resurrection of interest in this subject. As a treatment strategy immunotherapy has been around for many decades but until recently was generally met with cynicism.
Patients' perception of the hysterosalpingogram: the initial stages of the audit cycle
Authors: Tyrrell P N M , McHugo J M , Hale M
Published: July 2009

A prospective study of 98 consecutive hysterosalpingogram examinations was undertaken to evaluate patients' understanding of the examination, to assess their anxiety levels and to identify any factors where improvements might alleviate this anxiety. This was achieved by employing three simple questionnaires, two being completed by the patient (before and after the examination), the third being completed by the radiologist who recorded clinical and technical details. In this study the majority of patients knew why the examination was being performed, although only 50% had received an explanation of the technique prior to their arrival in the department. Anxiety levels associated with the examination were high. The importance of a sympathetic approach by the radiologist prior to the examination was highlighted, and it was found that time delays contributed to the anxiety level.
Pyogenic sacroiliitis, the missed diagnosis?
Authors: Abbott G T , Carty H
Published: July 2009

Pyogenic sacroiliitis is considered to be an uncommon infection, which is often diagnosed late because of poor localization of symptoms and normal plain radiographs at presentation. Nine cases aged between 20 months and 14 years who presented with sacroiliitis over a 7 year period are reviewed retrospectively. Isotope bone scanning is a useful technique in establishing early diagnosis and its relationship to other diagnostic imaging modalities is discussed. By routinely obtaining views of the entire pelvis in children presenting with hip pain and a limp, pyogenic sacroiliitis may be detected more frequently.
An audit of comparative views in elbow trauma in children
Authors: Rickett A B , Finlay D B L
Published: July 2009

A comparative radiograph of the contralateral elbow was obtained in only 30 (2.5%) of children examined after elbow trauma. Interpretation by junior clinical staff was changed in only three children (0.25%). Radiological review of the ipsilateral elbow alone altered diagnosis in six (20%) of the 30 children referred for comparative views and agreed with the final clinical diagnosis in 29 (97%). Comparative views were requested by inexperienced clinical staff in 28 (95%) of cases and were unnecessary in all patients. A senior radiological or clinical opinion would have resolved problems at interpretation.
The efficacy of lead shielding in megavoltage radiotherapy
Authors: Marrs J E , Hounsell A R , Wilkinson J M
Published: July 2009

The dose received by anatomical structures which are apparently shielded by lead blocks during a course of megavoltage radiotherapy may not be negligible. The dose has three main components; there is that due to radiation transmitted through the shielding block, that due to radiation scattered within the patient and that due to radiation scattered prior to reaching the patient and so circumventing the shield. A calculation method which separates the three components has been investigated and the results have been compared with measurements in a wide range of test situations for both cobalt-60 and 6 MV photon beams. The method of calculation predicts the dose behind the shielding block with acceptable accuracy in all the conditions investigated.
Modification of late dermal necrosis in the pig by treatment with multi-wavelength light
Authors: Rezvani M , Robbins M E C , Hopewell J W , Whitehouse E M
Published: July 2009

Low-level light from a multi-wavelength light source has been used to prevent late X-ray-induced dermal necrosis in the pig. Skin fields, measuring 4 cm × 4 cm on the flank, were irradiated with graded doses of X rays and the incidence of late dermal necrosis at 10–16 weeks after irradiation was scored. The control skin sites were irradiated only with 250 kV X rays but the test skin sites were subsequently exposed to low-level light. Local light exposure was from an array of gallium aluminium arsenide diodes, which produced wavelengths of 660, 820, 880 and 950 nm, pulsating at 5 kHz. Light treatment was given three times a week, from 6–16 weeks after X irradiation. Each treatment session was 1 min, which was equivalent to energy density of 1.08 Jem−2. Light treatment increased the ED50, the dose which causes dermal necrosis in 50% of the irradiated skin fields, from 20.10 ± 0.12 Gy to 21.94 ± 0.30 Gy. This difference, although small, was highly significant (p < 0.001) and was equivalent to a dose modification factor (DMF) of 1.09. The effect of light treatment was minimal at incidence levels of less than the 50% but greater at higher levels of effect. These findings suggest that low-level light, when applied appropriately, may be useful in the prevention of late X-ray-induced damage to the dermis.
Assessment of X-ray field alignment in mammography
Authors: Kotre C J , Robson K J , Faulkner K
Published: July 2009

In mammography it is important that the chest wall edge of the X-ray field is accurately aligned with the edge of the film in the film cassette. Too small an X-ray field (which may result in the loss of clinical information) is easily seen on the resulting image, but too large a field is less easy to detect and is potentially a source of unnecessary patient dose. This is of particular concern when mammography is being used for the screening of asymptomatic women. If the X-ray field is oversized, the scattered radiation dose to the thymus, lungs and to the fraction of the red bone marrow in the chest region will be higher. It is also possible for these organs to be partially irradiated by the primary beam if the field size is excessively large. These organs are recognized as being particularly radiosensitive and are included in the list of tissues considered when calculating effective dose (ICRP, 1990).

Tests of beam alignment have been suggested (IPSM, 1989) which involve the use of films or fluorescent screens overlapping the front edge of the support table together with markers for the field edge and a steel rule. In practice, this approach has been found to be difficult to reproduce on different designs of mammographic unit and, more importantly, found not to give a measurement easily referenced to the actual film position.
Squamous cell carcinoma of the nail bed
Authors: Conill C , Verger E , Vilalta A , Palou J
Published: July 2009

Squamous cell carcinoma of the nail bed is an unusual malignancy often misdiagnosed as a benign condition. It has been suggested in previous papers that trauma, chronic paronychia, X radiation, arsenic exposure, actinic damage, dyskeratosis congenital and human papillomavirus infection (HPV) are risk factors for the development of this carcinoma (Silverman, 1959; Campbell & Klokarn, 1966; Albom, 1975; Attiyeh et al, 1979; Guitart et al, 1990).

A 62-year-old male presented with a history of subungual infection on the middle finger of the left hand, which had been drained 2 years earlier but an exophytic lesion persisted. It had been treated with various topical treatments by different dermatologists without success. When first seen in our institute no past history of exposure to irradiation, chemical carcinogens or obvious evidence of impaired immunity was given.
Clear cell adenocarcinoma of the vagina: MR features
Authors: Gilles R , Michel G , Chancelier M-D , Vanel D , Masselot J
Published: July 2009

Clear cell adenocarcinoma (CCA) of the vagina and the cervix is a rare tumour. Since 1971 its increased incidence has been ascribed to intrauterine exposure to diethylstilboestrol (DES) and as a consequence the US Food and Drug Administration has banned the use of all DES-type medications during pregnancy. We report a case of CCA demonstrated by magnetic resonance imaging.
A multisystem malabsorption
Authors: Mitchison H C , Loose H W C , Lendrum R
Published: July 2009

A 57-year-old Caucasian man presented with a 5 month history of nausea and anorexia, diarrhoea, 19 kg weight loss, itching and loss of hair and nails. On examination he was cadaverous and pigmented with onycholysis (Figure 1), patchy alopecia and a red tongue. There was no relevant past medical, drug or family history. Investigations revealed hypoproteinaemia with abnormal absorption tests and, on gastroscopy, giant nodular folds were seen in the stomach. The duodenum was reddened and coarse with a mosaic pattern under the dissecting microscope. Representative illustrations from the barium meal (Figure 2) and barium enema (Figure 3) examinations are shown. What are the abnormalities and what is the differential diagnosis?

The barium meal shows extensive, largely sessile polyposis in both stomach and duodenum and similar changes are seen on the enema. Histology revealed hamartomatous changes compatible with a diagnosis of Cronkhite–Canada syndrome. A lesser number of polyps was seen in the small bowel (Figure 4).
Ultrasonographic placental grade and thickness: associations with early delivery and low birthweight
Authors: Dudley N J , Fagan D G , Lamb M P
Published: July 2009

Ultrasonic imaging is widely used in antenatal care, both as a screening tool and as an aid to diagnosis. In the investigation of fetal well-being factors other than measurements of fetal size may be of value. For example, it is well known that placental morphology changes as pregnancy progresses. These changes were investigated by Grannum et al (1979) who assigned grades 0, 1, 2 and 3 to the different appearances and associated grade 3 placentae with fetal pulmonary maturity. The clinical value of placental grading has been assessed by several authors. Proud & Grant (1987) found that patients with a grade 3 placenta were at increased risk of problems during labour and that their babies had an increased risk of being of low birthweight, in poor condition at birth or of perinatal death. They suggested that their results should form a basis for the reporting of placental grade when ultrasound examination is performed in the third trimester. Kazzi et al (1983) found the fetus with a small biparietal diameter and a grade 3 placenta to be more likely to be small for gestational age at delivery in a high risk group of 224 patients.

Recent local perinatal deaths have raised the question of whether a grade 3 placenta is an indicator of potential early parturition, where at 40 weeks gestation the pregnancy is in fact postmature.
Use of ultrasound in osteomyelitis
Authors: Roebuck D J
Published: July 2009

I was pleased to read the paper by Dr Nath and Mr Sethu (1992) which draws further attention to the potential value of ultrasound in the diagnosis of osteomyelitis. The authors, however, fail to mention what is possibly the most important reason for adopting this technique.
Book reviews
Authors: Irving H C
Published: July 2009

The authors are a physicist and a vascular surgeon who have produced a text which is intended to explain the underlying physical principles of the Doppler effect, blood flow, signal processing and instrumentation, and they have attempted to link the basic science to the clinical applications.
The use of carbon dioxide as an insufflation agent in barium enema—does it have a role?
Authors: Robson N K , Lloyd M , Regan F
Published: July 2009

A double blind prospective study was undertaken to evaluate the benefit of using carbon dioxide in double contrast barium enema (DCBE). 142 consecutive patients referred for DCBE were randomly allocated to receive either air or carbon dioxide (CO2) as the insufflation agent. The use of CO2 reduced the incidence of immediate and delayed severe pain from 31% to 12.5% and from 12.9% to 4.2% respectively. There was a statistically significant higher incidence of delayed severe pain in the younger age group as found in previous studies. Post-evacuation films showed that there was less residual gas after CO2. The quality of the DCBE was unchanged. We urge the more widespread use of CO2 as insufflation agent in DCBE.
Rapid dynamic contrast-enhanced magnetic resonance imaging of the liver and portal vein
Authors: Ward J , Martinéz D , Chalmers A G , Ridgway J , Robinson P J , Smith M A
Published: July 2009

The purpose of this study was firstly to show the diagnostic value of a rapid acquisition multislice sequence (TurboFLASH) during bolus injection of gadolinium-DTPA by comparing it with the pulse sequences currently used for abdominal studies and secondly to develop improved scanning protocols for the liver. Patients were referred for upper abdominal studies including portal vein assessment. 40 patients were imaged in the coronal plane using a multislice TurboFLASH (TF) sequence (TR = 100; TE = 4) acquired during a breath-hold period of 19 s. The short echo time allows up to 11 slices of 5 mm thickness to be acquired simultaneously. Images were obtained before, during and after bolus administration of Gd-DTPA. The slices from each acquisition were combined using a maximum intensity projection algorithm to include all the vessels on a single image. Initially each patient was scanned using a conventional axial T2 weighted spin-echo sequence (T2W-SE) (TR2000; TE = 45/90) and a coronal T  1 weighted spin-echo sequence (TR450; TE = 15). The clarity of the demonstration of vascular anatomy was compared and scored for all sequences by two radiologists. Vessel patency, the conspicuity of mass lesions and the spread of tumour to adjacent structures were also scored. The anatomy of the main portal vein was significantly better shown by coronal TF images after bolus injection than on T2W-SE images or TF before Gd-DTPA. The right and left portal veins were equally well shown by coronal TF with Gd-DTPA and T2W-SE images. There was no significant difference between contrast enhanced TF and T2W-SE imaging in visualization of the hepatic veins. More lesions were demonstrated by post-contrast TF than by T2W-SE imaging. Portal venous occlusion was better appreciated by post-contrast TF. Our results demonstrate that Gd-DTPA TF imaging improves visualization of the main portal vein compared with SE sequences and provides a more accurate assessment of vessel patency. The segmental anatomy of the liver is better appreciated and the demonstration of focal liver lesions compared with T2W-SE images is improved during the non-equilibrium phase of enhancement. TF acquisitions before and after Gd-DTPA are obtained in approximately 5 min; thus a marked reduction in examination time can be achieved.
Implementation of a programme for reduction of radiographic doses and results achieved through increases in tube potential
Authors: Martin C J , Darragh C L , McKenzie G A , Bayliss A P
Published: July 2009

Experiences in implementation of a programme to reduce doses to patients from radiographic examinations are described. A preliminary survey of entrance doses for selected examinations, calculated from mean exposure factors, identified equipment and examinations requiring attention. Subsequently more detailed studies were carried out with thermoluminescent dosemeters (TLDs). Results were coordinated with the aid of a database, which was used to monitor the agreement between dose calculations and TLD measurements. Surveys highlighted that doses from lumbar and thoracic spine examinations were high throughout the region. Reductions of 26–36% in entrance dose and 20–25% in effective dose were achieved by raising tube potentials for these examinations. This gave a reduction in annual collective dose of 4 man-Sv with no cost implication. In some departments dose charts were used to support the purchase of new screens. Surveys revealed a wide range in other factors such as transmission of X-ray table tops and results are being used in planning replacement of equipment.
Sensitivity of human squamous cell carcinoma of the larynx to fractionated radiotherapy
Authors: Rezvani M , Fowler J F , Hopewell J W , Alcock C J
Published: July 2009

Data obtained for the response of tumours from two multicentre clinical trials of the British Institute of Radiology have been combined and studied. Both trials involved patients with laryngopharyngeal carcinoma. There were 734 patients in the first trial, recruited between 1965 and 1975, and 611 patients in the second trial, recruited between 1975 and 1985. Observed survival and tumour-free rates for all patients are calculated. T-class and the nodal status of the patient at the start of the treatment were important factors in the determination of both observed survival and tumour-free rates. Overall treatment time was an important factor in determining the recurrence of tumour. The longer the overall treatment time the greater was the chance of tumour recurrence. The linear-quadratic (LQ) model was used in the analysis of the tumour recurrence data for a large group of patients with laryngeal tumours without nodal involvement. A small α/β ratio of 0.94 Gy was obtained for T3 tumours while that of T2 tumours was negative, –10.5 Gy. The value for Tl tumours was higher at 23 Gy. However, use of the LQ model with a time component increased the α/β ratios to 26.0 ± 27.20 Gy, 18.0 ± 12.33 Gy and 13.38 ±5.40 Gy for Tl, T2 and T3 tumours, respectively. The time component, the γ/α ratios, for these tumours were 0.15 ± 0.27 Gy/day, 0.81 ± 0.18 Gy/day and 0.76 ± 0.15 Gy/day, respectively.
An unexpected twist
Authors: Briley M
Published: July 2009

A 43-year-old man was admitted for investigation of chest pain. This had occurred, on exertion, for about 1 year but prior to this he had been completely well. There was also a recent history of blackouts.

Examination revealed normal pulses and blood pressure was 120/80. An ejection systolic murmur was heard in the aortic area radiating to the neck and an early diastolic murmur was heard along the left sternal edge.

An electrocardiogram (ECG) showed left ventricular hypertrophy and strain pattern. His chest X ray is shown. (Figure 1.)
Basal cell carcinoma do metastasize
Authors: Mantell B S
Published: July 2009

Junor, Campbell and Symonds (1992) report a case of metastasizing basal cell carcinoma in a 55-year-old male.
The role of hysterosalpingography in modern gynaecological practice
Authors: Hugh A E
Published: July 2009

In the article on “The role of hysterosalpingography in modern gynaecological practice”, Messrs Rajah, McHugo and Obhrai repeat a time honoured suggestion that a relaxant such as hyoscine butylbromide or glucagon can relax supposed tubal spasm. I have considerable doubt whether these agents have such a specific action. I understand that hyoscine is an anti-cholinergic agent which may induce relaxation of various smooth muscles including that of the Fallopian tubes and also the intestine, whereas the action of glucagon is largely that of producing relaxation of the intestine itself, and it is not considered to be an anti-cholinergic agent.
The role of hyterosalpingography in modern gynaecological practice
Authors: Kerslake R W
Published: July 2009

In their article “The role of hysterosalpingography in modern gynaecological practice” (Rajah et al, 1992), the authors state that “HSG remains the examination of choice for the investigation of congenital uterine anomalies”.

This statement is apparently made on the basis of their demonstration by hysterosalpingography (HSG) of various congenital and acquired uterine abnormalities which were not recognized at laparoscopy. No independent confirmation or these diagnoses appears to hve been obtained and the HSG results are thus not corroborated. Furthermore, they state that “ultrasound failed to detect major congenital abnormalitites in our series” yet no discussion of the technique used or results obtained is presented to support such a statement.
The role of hysterosalpingography in modern gynaecological practice
Authors: McHugo J
Published: July 2009

We thank Dr Hugh and Dr Kerslake for their interest in our article and welcome the opportunity to reply.

Dr Hugh doubts the value of relaxants during HSG for non-filling of the Fallopian tubes and suggests that alteration in tubal anatomy secondary to relaxation of the smooth muscle of the bowel may result in the tubal filling. One advantage of a technique using a tenaculum is that gentle movement on the cervix will move the Fallopian tubes if they are not fixed by adhesions. It is our practice to manipulate the tubes in this way.
Book reviews
Authors: Jones B M
Published: July 2009

This little book is written by acknowledged experts in the field of craniofacial surgery who have been involved in 3-dimensional computed tomography (CT) since its inception. They have made a great contribution in following through its application to craniofacial deformities. The book is a difficult one to write in that most surgeons have a very limited knowledge of the technicalities of CT, much less 3-dimensional CT, and most radiologists will have a limited knowledge of craniofacial deformities.
Book reviews
Authors: Dawson P
Published: July 2009

Many regard book reviewing as a chore, levened only by the (occasionally dubious) reward of getting to keep the book. Even this perk is under threat with understandable pressure from impoverished libraries to hand the book over to them. This reviewer subscribes to the view that as regards radiological publications the pain should be reduced for reviewer, reader and editor by brevity.
MRI of the knee
Authors: Heron C W
Published: July 2009

The inherent vulnerability of the knee to injury and degenerative change means that there is a major requirement for an imaging technique capable of assessing such damage accurately, rapidly and noninvasively. Over a relatively short time magnetic resonance imaging (MRI) has emerged as the technique of choice in the assessment of internal derangement of the knee. The present review describes the wide application of MRI to the knee and considers the position of MRI in relation to other diagnostic methods.
In search of optimum chest radiography techniques
Authors: Leitz W K , Månsson L G , Hedberg-Vikström B R K , Kheddache S
Published: July 2009

A nation-wide study of chest radiography in Sweden had previously revealed a large variation in the physical and technical factors involved, in particular the radiation dose. In this study the image quality could not be assessed unambiguously. The aim of the present study was to try to establish a correlation between visual grading of radiographs and physical and technical factors in order to find the optimum chest X-ray system. The physical and technical performance of 24 chest units was evaluated. Radiographs were taken of an anthropomorphic chest phantom supplied with test structures simulating various pathologies. Image quality was assessed by visual grading analysis of the radiographs. The physical and technical parameters of the units rated best were used to exemplify good radiographic practice. The results were in agreement with the recommendations issued by the Commission of the European Communities (CEC). It was also shown that low radiation dose is compatible with high-quality radiographic imaging of the chest.
An integrated phantom for HDR quality control
Authors: Aldrich J E , Samant S S
Published: July 2009

There are several manufacturers of the newer type of high dose rate (HDR) remote afterloading equipment where a small iridium-192 source can be programmed to stop for a given time at any point in the treatment catheters. The quality assurance phantom described in this paper was developed for a Nucletron microSelectron-HDR (Nucletron International BV, Veenendaal, Netherlands), but as the systems are so similar the device can be modified for any of the HDR systems. Because the complete treatments may be given in just few minutes with HDR remote afterloading equipment it is extremely important to perform adequate quality control (QC) checks on the equipment before use. Several papers have been written on the extent of such procedures to be carried out at calibration (Ezzell, 1989a, b, 1991; Ingham et al, 1989; Jones & Bidmead, 1989; Flynn & Workman, 1991) and before each use (Ingham et al, 1989; Jones, 1989; Ezzell, 1990; Flynn, 1990). As full calibration is carried out only when the iridium-192 source is changed every 3 months a comprehensive set of QC checks should be made at that time (Flynn, 1990). Because of time constraints it is not usually possible to perform all these same tests on daily basis and a small subset of important parameters has to be selected. Daily QC should at least cover four specific areas:
A pain in the neck
Authors: Saifuddin A , Renwick I G H
Published: July 2009

A previously healthy 24-year-old man injured his neck in a rugby match and complained of neck pain. There was no history of previous neck trauma. On examination his neck was diffusely tender and there was generalized reduction in neck movements. Plain radiographs of the cervical spine were obtained (Figures la, b). What do they show and what is the diagnosis? How would you confirm this?

The antero-posterior (AP) radiograph of the upper cervical spine (Figure la) shows bilateral atlantoaxial offset of 4 mm. The initial diagnosis was of a burst fracture of the atlas (Jefferson fracture) and a computed tomography (CT) scan was performed to confirm this (Figure 2). CT demonstrated a well-defined, smooth, corticated anterior cleft and a midline posterior defect. No fracture was seen. A diagnosis of bipartite atlas was made. Following CT the plain radiographs were reviewed and several abnormalities observed which had not been previously appreciated. On the lateral radiograph (Figure lb) there was absence of the cortical outline to the anterior tubercle of the atlas and similarly there was no arch–canal line posteriorly.
Sialography using an intravenous paediatric cannula
Authors: Walker D
Published: July 2009

I agree that both fine dilators and guide wires may be useful in cases of difficult duct cannulation but I would like to emphasize that I have found such difficulties less frequently using this cannula than the other devices that are commercially available.
Book reviews
Authors: Pilling D W
Published: July 2009

“If ‘the child is not merely a small adult’, that statement is especially true for the newborn child.” This quotation from the preface to the book probably sums up the genuine need for such an atlas of anatomy. The authors are to be congratulated on producing a comprehensive review of normal anatomy in the newborn from a radiologist's viewpoint.
Book review
Authors: Pennell D
Published: July 2009

This is a handy sized book which summarizes the author's experience in the related fields of cardiac imaging by isotopic and magnetic resonance techniques. The 16 chapters are divided into three broad sections. The first section deals with physiology, and incorporates detailed discussion of the evaluation of myocardial blood flow and metabolism by single and dual photon emitters. The third chapter on radionuclide ventriculography would seem more at home in the second section which discusses the imaging techniques themselves from thallium planar and SPECT imaging to PET and MRI.
Book reviews
Authors: Pilling D
Published: July 2009

Neonatology has developed into a speciality in its own right in the last decade and has not until now been followed by text books of imaging as it applies to this very special group of patients. This omission has been comprehensively rectified by this new book. Many of the chapters are monographs in their own right but blend well together to give a comprehensive review of imaging.
Book reviews
Authors: Faulkner K
Published: July 2009

The early detection of breast cancer using mammography requires excellent image quality. Rigorous quality assurance and control are necessary to ensure that the detection rate approaches a maximum value. This book is, in reality, a textbook on quality control in mammography, but its style is entirely different to the usual publications on the subject which are, in the main, based on measurement protocols.
Subtraction gadolinium enhanced magnetic resonance for head and neck imaging
Authors: Lloyd Gas , Barker P G , Phelps P D
Published: July 2009

Subtraction studies can be performed adequately by either route of injection (dorsum of foot or antecubital fossa).
Book reviews
Authors: Gawne-Cain M
Published: July 2009

This small, multi-author, US book aims to provide a handbook of practical information for radiologists involved in contrast enhanced investigations and as such would be a competitor for the popular A Guide to Radiological Procedures (Chapman &Nakielny, Bailliere Tindall). It should be of particular interest to radiologists in training.
Book reviews
Authors: Dawson P
Published: July 2009

This is a slim paperback volume of only 115 pages but none the worse for that. It is a very readable little survey of the basic physics of the Doppler effect and its application to imaging. Of the two authors, one is a physicist and the other head of magnetic resonance (MR) imaging in the National Hospital, Oslo. Interestingly, more than half the book, some 81 pages, covers the basic physics and is written by the latter. The former confines himself to the shorter, final section on colour flow imaging.
Magnetic resonance imaging of the knee: does foot restraint improve the examination?
Authors: Lomas D J , Mackenzie R , Dixon A
Published: July 2009

Involuntary movement by the patient can cause severe artefacts in magnetic resonance imaging of the knee. We have designed and constructed a device that immobilizes the foot, and thereby the knee. In this way the knee still remains accessible for the application of a variety of surface coils. A retrospective subjective analysis was performed of the magnetic resonance images from a control group of 23 patients who were examined without the restraint device and a study group of 26 patients in whom the device was used. The differences in the central tendency of subjective scores between the control and study groups were not significant for either motion artefact or anatomical conspicuity. However, in terms of dispersion the observed reduction in the study group was significant for anatomical conspicuity (p < 0.05) and almost significant for motion artefact (p < 0.10). These findings suggest that the restraint device may improve image quality by eliminating some of the worst motion artefacts. The device also significantly improves positioning of the knee in relation to the magnet isocentre (p < 0.01).
Book review
Authors: Hately W
Published: July 2009

Chambers' dictionary defines gamuts as the full extent of anything; this text certainly extends widely in its listings of possible causes of ultrasound appearances. It is after the style of similar works in general radiology and nuclear medicine. The authors hope that their gamuts will be useful to both physicians and ultrasonographers when an unusual or rare ultrasound finding occurs.

Where appropriate the gamuts are divided into common and uncommon. Additional information in the form of brief comments is provided for some of the entries in order to help in distinguishing different entities and reduce the number of possible diagnoses. The various lists are well referenced and are up to date. The list of contents is clearly set out at the beginning. No illustrations are included.
Book reviews
Authors: Irving H C
Published: July 2009

Endosonography—the use of specially designed ultrasound probes for insertion into various body orifices—is a significant advance in the practice of ultrasonography. High frequency transducers can be placed close to the organ of interest in order to generate high resolution images which can dramatically increase the yield of clinically useful information.
Muscular fibrosis induced after pig skin irradiation with single doses of 192lr γ-rays
Authors: Lefaix J-L , Martin M , Tricaud Y , Daburon F
Published: July 2009

Localized irradiation of the skin and subcutaneous tissues with large single doses of γ-rays can induce delayed effects characterized by fibrosis which invades the irradiated tissues. In this study the depth of penetration of muscle fibrosis was measured in the pig 30 weeks after irradiation of the skin surface with single doses of 192Ir γ-rays of 16–256 Gy. Irradiation was directed either to the outer side of the thigh or to the back, close to the mid-dorsal line. Fibrosis only developed in irradiated muscle after doses that induced moist desquamation of the skin in the acute phase of the reaction, i.e. after skin surface doses of 48–64 Gy. In skeletal muscles, the limit of fibrotic expansion was reached at a depth dose of 14 ± 4 Gy (±SD) for skin surface doses exceeding 48 Gy.
Book review
Authors: Trivedi M A
Published: July 2009

This is an excellent book on radioiodination with direct application in a progressive nuclear medicine department. This is a practical book true to its title providing hints, guidance and procedures on every topic with up-to-date references. A wide variety of subjects is covered with ease and expertise. The book consists of 19 chapters in five parts.
Not another case of aortic dissection!
Authors: Spencer J A , Golding S J
Published: July 2009

A 70-year-old woman wth a long history of ischaemic heart disease was admitted to hospital after a sudden onset of crushing central chest pain. 3 years previously a permanent transvenous pacemaker had been inserted following a bradycardic episode.

On examination there were signs of left heart failure. Peripheral pulses were normal and equal and she was normotensive. An electrocardiogram showed no features of acute myocardial infarction. A chest radiograph demonstrated cardiomegaly and widening of the superior mediastinum. The patient was referred for contrast computed tomography (CT) examination of the chest (Figures 1 and 2) to exclude dissection of the thoracic aorta.
Vasoconstriction by angiographic contrast media in isolated canine arteries
Authors: Morcos S K , Haylor J , Oldroyd S
Published: July 2009

The article by Gomi (1992) reports a vasoconstrictor response to high osmolar contest media (HOCM) in canine arterial strips in vitro. In vivo, HOCM are generally understood to be net vasodilators (Steiner et al, 1980). The evidence presented by Gomi therefore supported an indirect (neural or humoral) mechanism for the dilator event. However, the authors state in their discussion that “we were unable to find any reports studying vasodilation caused by CM based on in vitro vascular preparations”. We have recently demonstrated vasodilation resulting from an infusion of iothalamate in the isolated rat kidney, constriction only being observed when the CM infusion was stopped (Hayloretal, 1991).
An alternative approach to the semi-quantitative assessment of the transplanted renal artery velocity sonogram
Authors: Ward S P , Taylor M G , Gosling R G
Published: July 2009

There are theoretical problems with the use of resistance based indices, i.e. pulsatility index (PI) or resistive index (RI) as stand alone measures in the renal allograft. PI and RI are heart rate dependent and input pressure dependent for autoregulating organs. A new non-invasive index, termed Pz, has been proposed. Pz may be thought of as the arterial back pressure generated by the kidney representing the pressure which needs to be overcome in perfusing the glomeruli. On a theoretical basis Pz can be shown to be independent of heart rate and resistance and to allow for variations in mean systemic blood pressure. In an initial study, a group of 53 well functioning renal allografts demonstrated a significant reduction in the coefficient of variance for Pz (12.8%) when compared to PI (25.4%). A second study on recently transplanted allografts indicated that acute tubular necrosis could not be separated from rejection on the basis of Pz. Pz did however consistently perform better than PI in terms of reduced variability within pathological groups. We conclude that Pz is more useful than PI in this application.
Resistance and pulsatility Doppler indices: how accurately do they reflect changes in renal vascular resistance
Authors: Mastorakou I , Robbins M E C , Bywaters T
Published: July 2009

Doppler indices such as the resistance (RI) and pulsatility indices (PI) are generally thought to indicate the resistance of the vascular bed supplied by the artery under investigation. However, this association remains uncertain; some studies have demonstrated an excellent correlation between alterations in vascular resistance and changes in Doppler indices, while others have shown no consistent change. In order to assess the validity of these two indices in estimating alterations in renal vascular resistance, 12 female Large White pigs, 45 weeks old, were entered into a double blind study. In nine of the pigs both kidneys received a single dose of 9.8 Gy 60Co γ-rays; the remaining three served as sham-irradiated controls. Renal haemodynamics were measured using 131I-hippuran renography and Duplex Doppler prior to and at 8, and 12 weeks after kidney (sham-)irradiation. The sham-irradiated animals exhibited no significant changes in any of the parameters. In contrast, the animals in which both kidneys were irradiated exhibited a significant decrease (p < 0.001) inrenal blood flow (RBF) 8 and 12 weeks after irradiation. In addition, both PI and RI were increased following kidney irradiation; however, this increase was not significant until 12 weeks after irradiation (p < 0.01). This suggests that the reduction in RBF was not simply a reflection of an increased vascular resistance and/or that PI and RI do not truly represent alterations in vascular resistance. Further studies are required to confirm the applicability of PI and RI in the assessment of renal haemodynamics.
Book review
Authors: Cole D J
Published: July 2009

This multiauthor book seeks to provide a “useful resource for students, professionals and the allied health care members of the musculoskeletal oncologic team”.
Gallbladder function after endoscopic sphincterotomy—a dynamic ultrasound assessment
Authors: Lang I M , Martin D F
Published: July 2009

There is controversy regarding the function of the gallbladder following endoscopic sphincterotomy (ES) for the treatment of gallstones. Using ultrasound to assess gallbladder volume, we evaluated gallbladder contractility in 34 patients (18 male, 16 female), mean age 73 years, who had ES and common bile duct (CBD) clearance a mean of 18 months earlier. In 16 patients gallbladder function could not be measured, either because the fasting gallbladder was small and contracted or because it contained gas. The remaining 18 patients (53%) had “normal” gallbladder contraction with a mean initial fasting volume of 30.3 ml and mean post fatty meal volume of 13.8 ml. 14 of these 18 patients had a repeat fasting volume which showed refilling in all except one. Those with a functioning gallbladder had had significantly smaller stones extracted from the CBD at the time of ES. A smaller or incomplete sphincterotomy may have been performed in these patients, therefore allowing some residual sphincter of Oddi function.
Book reviews
Authors: Plaut S
Published: July 2009

The book is not well presented and edited, and the style is irritating to the reader.

The subject areas covered are an extremely basic look at radiation hazards, pitched at a level well below that appropriate for a radiologist or radiographer.
Book reviews
Authors: Adam A
Published: July 2009

This is a monograph on cancer research, part of a series promoted by the Japanese Cancer Association. The editors and authors are acknowledged experts in the field of liver cancer.
Optimization of ultrasound scanner characteristics: a preliminary study
Authors: Metcalfe S C , Evans J A
Published: July 2009

It is generally accepted that different transducer characteristics are optimal for different examinations, but it is not always obvious which other scanner/transducer parameters, e.g. signal processing should be selected for a given examination. We have examined noise and grey-level parameters for two specific anatomical sections (one showing the liver and right kidney and one showing the uterus) using a combination of subjective and objective assessment. The results confirm that the images chosen for this study have different requirements in terms of noise and grey-scale processing. The uterus image requires a large range of greys assigned to the lower level echoes and requires low noise levels. The liver/kidney image was not affected by noise levels in the systems used and required the lower amplitude grey-levels to be compressed, liberating a greater range of greys for the higher amplitude echoes.
Book reviews
Authors: Watt I
Published: July 2009

Magnetic resonance imaging (MRI) in the evaluation of musculoskeletal disease is unequivocally of great benefit. This short collation under joint authorship focuses on the MRI investigation of sports injuries. A chapter reviews the basic principles of MRI, spectroscopy and imaging, the remainder of the book being divided on a regional basis including the knee, ankle, wrist and other joints.