bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison between the platelet activating properties of different contrast media used in radiology and MRI.
Authors: Laffan M , Dawson P , Gooding R P
Published: June 2014

Previous studies have demonstrated that some intravascular radiographic contrast media (CM) used in angiography, especially non-ionic monomers, may cause platelet activation. This study was designed to elucidate which properties of the CM were responsible for this activity. Platelet activation engendered by CM was studied using flow cytometry to detect platelet degranulation (as CD62 expression) and fibrinogen binding. In order to elucidate the relevant characteristics of the CM responsible, contrast agents of differing structures, properties, formulations and osmolalities were studied; ionic and non-ionic, monomeric and dimeric. Gadolinium chelate MR enhancing agents and saline solutions of differing osmolalities were also investigated. Ionic dimeric sodium meglumine ioxaglate, non-ionic dimeric iodixanol and non-ionic dimeric iotrolan did not produce increased degranulation compared with saline controls. However, all agents produced a mild increase in bound fibrinogen. Experiments using saline solutions demonstrated that these effects are not attributable to the high osmolality of some CM. The broad comparison facilitated by this study shows that previous generalizations regarding platelet activation by CM, based on an ionic-non-ionic division, are not valid. We presume that some chemical structural property of the compounds is responsible and it is of note that the chemically distinct gadolinium chelates, gadolinium DTPA and gadolinium DTPA-BMA, also caused platelet activation to a similar degree. CD62 expression correlated with fibrinogen binding suggesting that at least one common pathway of platelet activation is involved.
Röntgen's other experiment.
Authors: Dawson P
Published: June 2014

Röntgen's fame today rests solely on his discovery of X-rays and takes no account of the fact that he was perhaps the leading experimental physicist of his time. One experiment he devised and brilliantly executed was, arguably, one of the most important of the 19th century. It was greatly celebrated at the time, yet today has been all but completely forgotten. With the aim of developing a more complete picture of Röntgen and his place in the history of physics, this paper describes the nature of the problem he tackled and gives an outline of his experimental approach to it. The significance of his achievement for the construction of the edifice of 19th century physics is explained.
Aneurysm of the left brachiocephalic vein: an unusual cause of mediastinal widening.
Authors: Burkill G J , Burn P R , Padley S P
Published: June 2014

A case of left brachiocephalic venous aneurysm is presented. Thoracic venous aneurysms are rare with only 27 previous cases in the medical literature, the majority involving the superior vena cava. There are only two previous reports of isolated brachiocephalic venous aneurysm. Venous aneurysms are usually first detected as mediastinal widening on a chest radiograph and can be further defined using CT, MRI or angiography. The aetiology is uncertain. Management is usually conservative, but surgical correction has been performed.
Primary choriocarcinoma of the pulmonary artery mimicking pulmonary embolism.
Authors: Trübenbach J , Pereira P L , Huppert P E , Farnsworth C , Mayer R , Feine U , Claussen C D
Published: June 2014

Due to their rarity, primary tumours of the pulmonary arteries are often incorrectly diagnosed as more common diseases such as pulmonary thromboembolism and are seldom diagnosed during a patient's lifetime. Surgery or potentially curative chemotherapy may therefore be withheld. We report a patient with a primary choriocarcinoma of the left pulmonary artery, which was first suspected on a CT scan. The neoplastic nature of the obstruction of the pulmonary arteries was confirmed by positron emission tomography.
Renal cortical retention on delayed CT after angiography and contrast associated nephropathy.
Authors: Yamazaki H , Oi H , Matsushita M , Inoue T , Teshima T , Koizumi M , Nose T , Tanaka E , Nakamura H , Inoue T , Kim T , Elbaradie M M
Published: June 2014

The aim of this study was to examine the relationship between renal cortical retention (RCR) of contrast media observed on delayed CT (median delay: 20 h) and contrast associated nephropathy (CAN). We investigated the incidence of both phenomena in 270 patients. CAN was defined as an increase in the creatinine level > 0.5 mg dl-1 (44 mumol l-1) and > 25% on day 1, 3 or 7, while RCR was recognized when CT values for the renal cortex showed either mild RCR (CT value > 50) or severe RCR (CT value > 100). RCR was demonstrated in 127 patients (47%), mild in 78 (29%) and severe in 49 (18%), on delayed CT after angiography. CAN was found in eight patients (3%). Patients with severe RCR showed a higher CAN rate (8%) than other patients (mild RCR: 4%, RCR (-): 1%) (p = 0.02). The type of contrast medium was independently associated with the incidence of RCR (p = 0.0001). Although severe RCR was associated with a higher frequency of CAN than the milder forms of RCR, RCR as such was not always associated with CAN.
The value of indium-111-labelled leucocyte imaging and ultrasonography in the investigation of pyrexia of unknown origin.
Authors: Tudor G R , Finlay D B , Belton I
Published: June 2014

The aim of this study was to assess indium-111 leucocyte imaging and ultrasound in the investigation of pyrexia of unknown origin (PUO), as well as the predictive value of available clinical information on the radiological outcome. 256 111In leucocyte scans performed over a 5 year period were reviewed. There were 59 scans in 58 patients who fulfilled recognized criteria for true PUO; 47 of these patients had ultrasound. In 15 patients the fever settled and no diagnosis was made; the source of PUO was infective in 20 and non-infective in 24. In the group as a whole, the sensitivities of leucocyte scan and ultrasound were 25% and 23% with specificities of 100% and 83%, respectively. In infective cases of PUO, the sensitivities were 20% for both modalities. There was no correlation between leucocyte count or differential, C reactive protein or the presence or absence of antibiotics. In the cases where the leucocyte scan led to the diagnosis of infection, the scan was performed within 4 weeks of the onset of symptoms. The results show that an infective cause for PUO is established in less than 50% of cases. The leucocyte scan is specific and although not very sensitive can often be a guide to subsequent cross-sectional imaging. If an infective cause for the PUO is strongly suspected, 111In leucocyte scanning may be more sensitive if performed in the first few weeks of fever.
Comparison of an asymmetric screen-film combination with a conventional screen-film combination for chest radiography in 51 patients.
Authors: Greaney T , McCoy C , Masterson J
Published: June 2014

Comparison is made between a new asymmetric screen-film combination and a conventional screen-film combination for use in chest radiography. Seven anatomical features were assessed by three consultant radiologists in each of 51 film pairs. A preference was indicated if one system better demonstrated a particular feature. Alternatively, no preference was indicated if the feature was equally demonstrated by both systems or not demonstrated at all. Any pathology incidentally noted which remained unchanged between the two films was localized to lung, mediastinum or bone and marked in the same way. The asymmetric high contrast system scored higher than the conventional system for demonstration of anatomy in both mediastinum and lungs, but no difference emerged between the two systems in the demonstration of pathology. The asymmetric screen-film system showed improved mediastinal and, to a lesser degree, improved lung detail. Further assessment in necessary to define any associated improvement in diagnostic yield.
Thyroid cancer among "liquidators" of the Chernobyl accident.
Authors: Ivanov V K , Tsyb A F , Gorsky A I , Maksyutov M A , Rastopchin E M , Konogorov A P , Biryukov A P , Matyash V A , Mould R F
Published: June 2014

In 1986, immediately after the Chernobyl accident, the USSR Ministry of Health adopted a large scale programme of establishing an All-Union Distributed Registry of persons affected by radiation due to the accident. The registry was based at the Medical Radiological Research Centre of the Russian Academy of Medical Sciences (MRRC RAMS). In 1992, when the USSR was dissolved, this registry database contained information on 659,000 persons, including 284,000 Chernobyl accident emergency workers ("liquidators"). Currently, the Russian National Medical Dosimetric Registry (RNMDR) contains data on 435,276 persons, including 167,862 liquidators. This paper reviews the data for 47 verified thyroid cancers in the liquidator subgroup of the RNMDR. Analyses show that there is an excess relative risk of thyroid cancer per Gy of 5.31 (95% confidence intervals 0.04 and 10.58) and an excess absolute risk of thyroid cancer per 10(4) person-years per Gy of 1.15 (95% confidence intervals 0.08 and 2.22).
Systemic idiopathic fibrosis with inflammatory pulmonary lesions.
Authors: Nakamura Y , Kohzaki S , Suyama N , Yamaguchi T , Kohno S , Hayashi K
Published: June 2014

Systemic idiopathic fibrosis is characterized by non-suppurative inflammatory diseases of connective tissue, mainly adipose tissue. Although, in this condition, fibrosis may develop in several organs, there have been few reports of fibrosis involving the lung or pleura. We present a case of systemic idiopathic fibrosis associated with inflammatory pulmonary lesions, mimicking lung cancer with multiple pulmonary metastases. Chest CT and MRI showed a spiculated mass around the aortic arch with localized aortic wall thickening and nodules in the lungs. Abdominal CT showed a homogeneous mass around the abdominal aorta, consistent with retroperitoneal fibrosis. Transbronchial lung biopsy of the lesion in the right mid-lung field showed only a few scattered histiocytes accompanying inflammatory and fibrotic change. There was no evidence of malignancy, necrosis, angitis or mycobacterial infection. The lesions almost completely disappeared following prednisone treatment.
Low energy X-ray depth dose data for use in radiotherapy--comments on the review of BJR Supplement 17.
Authors: Harrison R M
Published: June 2014

Percentage depth dose data acquired during the revision of BJR Supplement 17: Central Axis Depth Dose Data for Use in Radiotherapy have been reviewed. Coverage of the half value layer (HVL) and field diameter rang was broad, although gaps were apparent at HVLs of 3-5 and 6-7 mm A1 and field diameters > 14 cm. Comparisons of submitted data with that in Supplement 17 indicate a generally even spread of data about the existing PDD values. Most data agreed to within +/- 5% at 2 cm and +/- 15% at 10 cm depth. Systematic discrepancies may be due to the use of different phantom materials. There is evidence that the spread of data is at least partially due to the problems of beam quality specification. The inadequacy of the first HVL as a specifier of beam quality is a well known and a more realistic specifier might be defined in terms of a broad beam dose ratio at defined depths, for a given beam geometry.
Ultrasound assessment of swallowing in malnourished disabled children.
Authors: Yang W T , Loveday E J , Metreweli C , Sullivan P B
Published: June 2014

Oral motor dysfunction is common in children with neurological impairment. Nutritional advice depends upon an accurate assessment of feeding potential in these cases. Videofluoroscopic assessment of oral motor function has been the accepted "gold standard" investigation for several years but has significant drawbacks, including the time constraints set by the use of ionizing radiation and the problems posed by the cumbersome equipment needed in mimicking the child's normal feeding situation. Ultrasonography (US) has been suggested as an alternative or additional investigation of oral motor function in children with neurological impairment. We prospectively evaluated a scoring system derived from US assessment of oral motor function in 32 malnourished disabled children with feeding problems by comparing them with a group of matched control children without neurological impairment. US imaging provided useful information with regard to the oral cavity and the soft tissue structures, capturing the salient features of tongue/hyoid/palate activity and bolus transport across the tongue and through the hypopharyngeal area. The mean percentage score obtained by US assessment of oral motor function in children with neurological impairment was 54.3 +/- 23.2 and from children without neurological impairment 91.9 +/- 12.7 (p < 0.0001). Scores for the oral and pharyngeal phases of swallowing were also very significantly lower than that in the control group, both phases being equally impaired in the disabled children. This study has demonstrated that a scoring system based on US assessment of different components of oral motor activity detects statistically significant differences in the feeding capabilities of children with neurological impairment.
The relationship between breast asymmetry, breast size and the occurrence of breast cancer.
Authors: Scutt D , Manning J T , Whitehouse G H , Leinster S J , Massey C P
Published: June 2014

Breast cancer is the second most common cancer among women in the world and in developed countries it is the most common. The early identification of women at risk is therefore of great importance and any additional measures which may aid diagnosis, particularly in high risk groups, would be of benefit. Breast volume and breast asymmetry were calculated from mammograms of 250 women with breast cancer and compared with those of 250 age-matched controls. There was evidence that breast cancer patients had more breast asymmetry and larger breasts than age-matched healthy women. The former observation is the first evidence that high breast asymmetry may be a risk factor for breast cancer. Breast asymmetry is likely to be a predictor of, rather than the effect of breast cancer.
The identification of bias in studies of the diagnostic performance of imaging modalities.
Authors: Kelly S , Berry E , Roderick P , Harris K M , Cullingworth J , Gathercole L , Hutton J , Smith M A
Published: June 2014

The demand for evidence-based healthcare is increasing nationally and internationally and it is equally necessary in both diagnostic and therapeutic practice. Evidence may be collected and combined by means of a systematic literature review of published and unpublished data on a well-defined topic. The output of such reviews is then available to guide health policy, influence good practice or direct research. Published guidelines are available on the performance of systematic reviews, especially those of randomized controlled trials. Although there is an extensive literature base of research data in diagnostic imaging there are few such trials, but it is still possible to perform systematic reviews. With the alternative study designs encountered it is important to be aware of the main threats to study validity. In this paper the biases likely to be encountered in studies of diagnostic performance are reviewed, with particular reference to diagnostic imaging tests. The biases are sub-divided into three categories. The first category is patient selection and covers the validity of generalizing results beyond the study population. The other two, concerning study design and execution and the interpretation of results, affect the likely validity of the results of a study. An understanding of these factors is an essential prerequisite for those undertaking or using a systematic literature review in the field of diagnostic imaging. The definitions form the foundations of a defensible review protocol.
Three phase 99Tcm (V)DMSA scintigraphy in Paget's disease: an indicator of pamidronate effect.
Authors: Kobayashi H , Shigeno C , Sakahara H , Yamamoto T , Hosono M , Fujimoto R , Konishi J
Published: June 2014

The use of three phase 99Tcm (V)DMSA scintigraphy is reported in a patient with Paget's disease of bone before and after intravenous pamidronate therapy. It was a useful modality for estimating the activity of Pagetoid lesions and the therapeutic effect of pamidronate, from a different aspect to bone scintigraphy. Three phase 99Tcm (V)DMSA scintigraphy evaluates both the blood flow and the metabolic activity of Pagetoid bone.
Fistula formation from neovascularity developing in malignant fibrous histiocytoma of the heart.
Authors: Nawa S , Tamesue K , Yamamoto H
Published: June 2014

Neovascularity in cardiac tumours is uncommon and fistula formation from such neovascularity is extremely rare. Fistula formation from neovascularity developing in a malignant fibrous histiocytoma of the heart is described in a 48-year-old man. The the case illustrates that cardiac tumour is not only a cause of cardiac output obstruction but also of coronary artery fistula.
Uterine lipoleiomyoma: MRI, CT and ultrasonographic findings.
Authors: Tsushima Y , Kita T , Yamamoto K
Published: June 2014

MRI, CT and ultrasonographic findings in lipoleiomyoma of the uterus are reported. A 73-year-old woman presented with a palpable mass in the lower abdomen. T2 weighted MR images showed an 8 x 5 cm exophytic well defined hyperintense mass of the uterine body. Fat content within the tumour was confirmed because of evident chemical shift artefact. Microscopically, the tumour proved to be lipoleiomyoma consisting of smooth muscle cells and mature adipose tissue. Five cases have been reported in the imaging literature, and the presence of fat within a uterine mass on CT or MRI is diagnostic of lipoleiomyoma.
CT scanning of the paranasal sinuses--the effect of reducing mAs.
Authors: Kearney S E , Jones P , Meakin K , Garvey C J
Published: June 2014

High quality CT scans are required prior to fibreoptic endoscopic sinus surgery (FESS) surgery and in many institutions such scans are performed using a high mAs technique. Consequently, the investigation imparts a radiation dose to the patient and in particular to the eye. Such a radiation dose is a possible source of morbidity. We believe that the mAs, and consequently the radiation dose, can be considerably reduced without affecting scan quality. The present study compares the quality of sinus CT scans performed at two mAs values, 40 and 60. Scan quality was assessed in terms of the ability to visualize clearly important anatomical structures and in terms of overall perceived quality. We show that mAs values as low as 40 can be used without adversely affecting the diagnostic quality of the examination.
Intravenous contrast media: are they being administered safely in radiology departments?
Authors: Connor S E , Banerjee A K , Dawkins D M
Published: June 2014

A recent Royal College of Radiologists (RCR) publication is entitled Advice on The Management of Reactions to Intravenous Contrast Media. This study aims to determine whether radiology departments are adhering to the essential points, covered in the guidelines, regarding prevention, early recognition and prompt treatment of adverse reactions, and whether they are adequately equipped for the proposed contrast media reaction management protocols. A questionnaire was formulated and sent to the superintendent radiographers of 295 radiology departments in the United Kingdom of whom 233 (79%) replied. This was specifically directed at the use of intravenous contrast media in intravenous urography. In almost all departments there was provision for basic life support training, regular checking of equipment and drugs, and prompt access to emergency medical help. Certain "first line" drugs and monitoring equipment were not instantly accessible in the majority of institutions. Most departments did not adequately supervise post-injection patients and did not conform to the guidelines referring to the administration of intravenous contrast to children. Certain areas of the guidelines are being neglected by many radiology departments and there is still much to be done to improve the safety of intravenous contrast medium injection.
A comparison of image quality on 28 mammography X-ray sets in the UK.
Authors: Law J
Published: June 2014

Image quality has been assessed using three different phantoms on 28 mammographic X-ray units in the National Health Service Breast Screening Programme within the UK. The results show only relatively minor differences between different models of X-ray unit and between the 14 associated film processors, but more marked differences between different film-screen combinations. Medium screens give significantly lower image quality scores than fine screens from the same manufacturer. It is suggested that, to improve mammographic image quality, a change of screen type may bring greater benefit than a change of X-ray set model, as well as being much more cost effective.
Patient doses from standard and spiral CT of the head using a fast twin-beam system.
Authors: Seifert H , Hagen T , Bartylla K , Blass G , Piepgras U
Published: June 2014

Investigations were carried out on a novel type of CT scanner, the Elscint CT-Twin, for comparison and optimization of the patient dose caused by standard and spiral CT of the head. For selected CT parameters, organ doses of the Alderson head phantom were measured with thermoluminescent dosemeters. Organ doses were also calculated using the normalized computed tomography dose index (CTDIn) combined with organ dose conversion factors. Then effective doses were deduced. For standard and spiral head CT examinations brain, red bone marrow and bone surface receive the main contributions to effective dose. This amounts to 0.9 and 0.8 mSv for routine standard and spiral CT, respectively, if the combination "dual-slice" mode, 250 mAs per rotation, 5 mm nominal slice width and a packing factor of 1.0, is applied. In clinical practice, for spiral CT head examinations the effective dose has been reduced to 0.7 mSv while guaranteeing adequate image quality, as assessed by determination of low and high contrast resolution. The effective dose values obtained are in the lower part of the range of values published in the literature. The dose determinations showed that, from the aspect of radiation protection of the patient, CT examinations with nominal slice widths between 0.5 and 1 mm as well as packing factors greater than 1.0 should be restricted to really necessary cases.
CT standard protocols are of limited value in assessing actual patient dose.
Authors: Wade J P , Weyman J C , Goldstone K E
Published: June 2014

In the last 10 years the use of computed tomography in radiodiagnosis has increased markedly and CT scanners are now present in most district general hospitals. Modern CT scanners are versatile in their operation and offer the operator a wide choice in exposure parameters which affect the doses received by the patients. As CT is a major contributor to medical radiation doses, the National Radiological Protection Board (NRPB) recommends that an estimate of typical patient dose should be made for commonly used local scanning protocols. A survey has been undertaken in the Anglia and Oxford region covering 12 CT scanners. Common procedures were chosen, concentrating on those most frequently carried out and giving higher effective doses. These included routine heads, routine chests, high resolution chests and abdomen/pelvis examinations. Questionnaires were sent out to each CT centre to collect data on standard protocols and to record the procedure used for five actual patients for each examination type thus enabling a comparison of the two methodologies. This study has shown that many examinations are tailored to the individual patient size and clinical indications, particularly in the chest/abdomen/pelvis. Thus, assessing doses based on collecting standard protocols may not give a true indication of the effective doses being received by particular patients.
Outcome of 259 patients with primary proliferative polycythaemia (PPP) and idiopathic thrombocythaemia (IT) treated in a regional nuclear medicine department with phosphorus-32--a 15 year review.
Authors: Balan K K , Critchley M
Published: June 2014

259 patients with primary proliferative polycythaemia (PPP) and idiopathic thrombocythaemia (IT) have been treated with 32P over the last 15 years. Complete follow-up data were obtained in 238 patients. PPP was the diagnosis in 183 patients and 76 patients had IT. The sex ratio in PPP was male/female 1.1:1 and in IT 1:1.4. Patients' ages ranged from 28 to 95 years (median 72 years). The number of 32P administrations per patient ranged from 1 to 13 (median 2) and the total administered activity per patient ranged from 81.4 to 4162 MBq (median 496 MBq). The outcome showed a normalization of the full blood count in 50% of patients after a single administration of 32P and in 73% after two treatments. 13 patients (5.5%) developed myelofibrosis; 18 (7.6%) developed leukaemia while other cancers arose in 19 patients (8%). 32P therapy proved to be of particular value in the elderly. 32P is easy to administer and is cost effective, compared with the alternative of chemotherapy where good compliance and frequent hospital visits are required.
Effect of routine mammography practice on tumour size of a registry-based series of breast cancer cases compared with those observed in a screening cohort.
Authors: Bucchi L , Piatesi A , Falcini F , Nanni O , Amadori D
Published: June 2014

Routine mammography (MX) practice based on self-referral is considered not to be susceptible to monitoring at the population level. Invasive breast cancer cases notified to the Romagna Cancer Registry between 1989 and 1991 (total 654) were stratified by MX experience and were compared for the proportion of lesions greater than 2 cm in size (T2+) with cases observed in the study group of the Swedish Two Counties Screening Trial (TCST). Any MX more than 6 months prior to diagnosis was considered a previous routine examination. The proportion of cases registered in Romagna within 6-11 months of the most recent MX was quite similar to that shown by the interval cases of the TCST (50% vs 53%). T2+ cases registered in Romagna 12-23 months (27%) and 24-35 months (19%) after previous MX were similar in frequency to those detected at second and later screens in the TCST (22%). For longer intervals, the percentage of large tumours in the Romagna series increased, up to 45% among the cases registered more than 48 months since last MX (p < 0.0001). The whole group of cases with previous MX in Romagna and its counterpart in the TCST (i.e. interval cases + cases detected at second and later screens) had the same size distribution (35% vs 34%). The frequency of large tumours in the total series from Romagna was greater than in the total study group of the TCST (45% vs 36%, p < 0.0001). The difference was entirely accounted for by the cases with no previous MX.
Spontaneous renal pseudoaneurysm rupture presenting as acute intraabdominal haemorrhage.
Authors: Peh W C , Yip K H , Tam P C
Published: June 2014

A 39-year-old man with a known history of end-stage renal disease presented with hypovolaemic shock and acute abdominal pain. Blood-stained peritoneal fluid was present. Right perirenal and extensive mesenteric haematomas were seen at laparotomy and CT. Right renal arteriography demonstrated a small renal artery pseudoaneurysm, and embolization was performed. The patient later developed intractable sepsis and died despite nephrectomy and drainage of the infected haematomas. Although there is an increasing trend towards conservative management of spontaneously ruptured kidneys from benign causes, embolization followed by early surgery should be considered in cases of extensive intraabdominal haemorrhage.
The ultrasound appearances of neonatal renal vein thrombosis.
Authors: Hibbert J , Howlett D C , Greenwood K L , MacDonald L M , Saunders A J
Published: June 2014

Renal vein thrombosis (RVT) is the most frequently occurring vascular condition in the new-born kidney. The predisposing factors include dehydration, sepsis, birth asphyxia, maternal diabetes, polycythaemia and the presence of an indwelling umbilical venous catheter. (RVT) may present clinically with a flank mass, haematuria, hypertension or renal failure. Many imaging modalities have been employed, but ultrasound is the technique most commonly used in the evaluation of neonates with suspected RVT. Thrombosis commences in the small renal veins and subsequently propagates via larger interlobar veins to the main renal vein and inferior vena cava (IVC). The ultrasound appearances depend upon the stage at which the examination is performed and extent of the thrombus. Initially, the interlobular and interlobar thrombus appears as highly echogenic streaks. These streaks commence in a peripheral, focal segment of the involved kidney and only persist for a few days. In the first week the affected kidney swells and becomes echogenic with prominent echopoor medullary pyramids. Later, the swelling increases and the kidney becomes heterogenous with loss of corticomedullary differentiation. Grey scale ultrasound readily demonstrates thrombus within the renal vein and IVC. Adrenal haemorrhage is a recognized association and may be identified ultrasonically. Colour Doppler scanning provides additional information. In the early stages of RVT, colour Doppler may demonstrate absent intrarenal and renal venous flow. Ultimately, the kidney may recover, show focal scarring or become atrophic. Thus, ultrasound provides an accessible and reliable tool in the assessment of suspected neonatal RVT.
Demonstration of the distal end of the oesophagus by transabdominal ultrasound.
Authors: Chen M H , Kikuchi Y , Chu B C , Kishimoto R , Choji K , Miyasaka K
Published: June 2014

This study aimed to demonstrate the distal end of the oesophagus using a transabdominal ultrasound technique (TUS) and to measure the normal oesophageal wall thickness in adults. 65 patients without oesophageal disease and 38 normal volunteers were examined by TUS. A left subcostal approach was used to demonstrate the oesophagus. The wall thickness and length were measured in both the supine and 45 degrees right side up oblique (RUO) positions. The abdominal oesophagus was visualized in 80% of patients in the supine position and 92% in the RUO position. Satisfactory demonstration was obtained in 67% of patients in the supine and 85% in the RUO position. The oesophageal wall thickness averaged 2.8 mm (range 2.0-4.0 mm, SD 0.7 mm). The visualized length in these subjects averaged 2.3 cm in the supine position and 3.0 cm in the RUO position, which included approximately 1.5 cm of the lowest portion of the thoracic oesophagus in addition to the abdominal oesophagus. TUS can demonstrate the abdominal oesophagus in the majority of patients and has the potential to provide information on disorders of structure and motility.
A suggested methodology for the construction of national bone densitometry reference ranges: 1372 Caucasian women from four UK sites.
Authors: Truscott J G , Simpson D S , Fordham J N
Published: June 2014

This paper presents a simple methodology for combining bone densitometry data from different sites in the UK, having instruments from the same manufacturer (LUNAR Radiation). Additive normalization factors were used on all data prior to inclusion in a reference database which ultimately included data on 1372 Caucasian women, aged 20-70 years, of whom 749 were post-menopausal. Reference data for spine (L2-L4) and femoral neck bone mineral density are given in tabular form as 3 year moving averages for: (1) all women; (2) perimenopausal women grouped by menopausal status; and (3) post-menopausal women with respect to years since menopause. These data may be used to construct Z-score. T-score or percentile reporting ranges and may be adopted as the core for a UK reference range.
Measurements of exit dose profiles in 60Co beams with a conventional portal film system.
Authors: Stasi M , Casanova Borca V , Fiorino C
Published: June 2014

An important step in the verification of the reliability of portal films as in vivo dosemeters is the evaluation of the agreement between exit dose profiles and optical density profiles measured on the portal film. To test the possibilities of a conventional portal film system in 60Co beams suitable for head and neck irradiation, we verified the agreement between relative exit doses (measured by ionization chamber) and relative optical densities, on cubic homogeneous phantoms, on an homogeneous "step" phantom and on a cubic phantom including air and aluminium inhomogeneities. The optical density profiles were corrected with the appropriate sensitometric curves. For an homogeneous phantom 10.8 cm thick and with the film in contact with the phantom, the agreement was found to be excellent with a mean deviation of 0.8% and a maximum deviation of 1.5%. The agreement was worse when the air gap between the exit surface of the phantom and the portal film was increased (with an air gap equal to 15 cm the maximum deviation was 4%), and when the thickness of the phantom was increased (for a thickness of 14.4 cm the maximum deviation was 3.1%). The agreement was found to be acceptable for the "step" phantom too, with a mean deviation around 1% and a maximum deviation within 2% (air gap equal to zero). When air and aluminium inhomogeneities were incorporated into the phantom a maximum deviation of 6% and a mean deviation less than 3% were found. Furthermore, the relative optical density profiles show an underestimate of measured off-axis exit dose values under a high density inhomogeneity and a small overestimate under a low density inhomogeneity. Results suggest the possibility of using conventional portal films for exit relative dosimetry in head and neck irradiation with 60Co beams if the air gap is kept as small as possible.
Serial MRI in the management of intramural haemorrhage of the thoracic aorta.
Authors: Oliver T B , Murchison J T , Reid J H
Published: June 2014

Acute intramural haematoma of the ascending and descending aorta was diagnosed by CT in a patient with chest pain and suspected thoracic aortic dissection. Surgical mortality from aortic replacement in this condition is high. Intramural haematoma has an unpredictable course but studies suggest that resolution of haematoma carries a favourable prognosis against further complications. Serial MR examinations over the next 6 weeks demonstrated resolution of the haematoma. This information influenced the decision not to undertake surgery and the patient was continued on antihypertensive medication. Serial MR examination is a safe and reliable method of monitoring the progress of intramural haematoma and thus guiding difficult treatment decisions.
Dimercaptosuccinic acid distribution in renal tubular acidosis.
Authors: Green D A , Davies S G
Published: June 2014

A 99Tcm dimercaptosuccinic acid (DMSA) scan performed after a urinary tract infection demonstrated an unusual pattern of isotope uptake, promoting further investigations leading to a diagnosis of renal tubular acidosis secondary to nephropathic cystinosis. This is known to affect isotope imaging but a unique feature in this undiagnosed case was the uncorrected metabolic acidosis, which had further altered the distribution of the DMSA. It is noteworthy because other patients referred for imaging with renal disease may also have abnormalities of acid base balance.
Early antenatal ultrasound diagnosis of fetal intracranial teratoma.
Authors: Horton D , Pilling D W
Published: June 2014

The commonest fetal intracranial tumour is a teratoma. The prognosis is poor with death usually occurring shortly after birth. Modern high resolution ultrasound scanners facilitate examination of the cranial contents, allowing earlier diagnosis. We report a case where an intracranial teratoma was identified at 21 weeks gestation, the earliest gestational age that this has been reported. The ultrasound appearances are discussed.
Radiotherapy in patients with cardiac pacemakers.
Authors: Last A
Published: June 2014

Patients with permanent cardiac pacemakers occasionally require radiotherapy. Therapeutic irradiation may cause pacemakers to malfunction due to the effects of ionizing radiation or electromagnetic interference. Modern pacemakers, using complementary metal oxide semiconductor (CMOS) circuitry, differ from older bipolar semiconductor devices both in their sensitivity to damage and the types of malfunction observed. The mechanisms and types of radiotherapy-induced pacemaker malfunction are described and in vitro and in vivo studies of pacemaker irradiation are reviewed. Some simple precautions are recommended during the planning and administration of radiotherapy to minimize the risk of harm to patients with pacemakers.
Effect of radiographic contrast media on histamine release from human mast cells and basophils.
Authors: Peachell P T , Morcos S K
Published: June 2014

Radiographic contrast media (RCM) cause histamine-dependent allergic-like reactions. The direct effects of diatrizoate (high osmolar ionic monomer), ioxaglate (low osmolar ionic dimer), iopromide (low osmolar non ionic monomer) and iotrolan (iso-osmolar non ionic dimer) at the concentration of 200 mgI ml-1 (60 min exposure) on the release of histamine from human basophils, human lung mast cells (HLMC), and human skin mast cells (HSMC) were investigated. Diatrizoate induced 48 +/- 4% histamine release in basophils, 15 +/- 3% in HLMC and 25 +/- 6% in HSMC. The remaining RCM were relatively ineffective activators of histamine release in both HLMC and HSMC (ioxaglate 4 +/- 1% and 4 +/- 1%, iopromide 5 +/- 1% and 7 +/- 2%, iotrolan 7 +/- 2% and 10 +/- 3%, respectively). Both iotrolan and ioxaglate were effective in basophils inducing 21 +/- 3% and 24 +/- 6% histamine release, respectively, whereas iopromide was relatively ineffective (7 +/- 4%). Diatrizoate induced histamine release from all three cell types with optimal levels of histamine release after a 2-4 h incubation although significant levels occurred within 15 min. Dose-dependent histamine release from HLMC occurred in all four types of RCM, the largest response (37 +/- 3%) being produced by diatrizoate. The effect of osmolality on histamine release was investigated using different concentrations of mannitol solutions (0.25, 0.5 and 1 M). Histamine release from HLMC, HSMC and basophils after 90 min exposure to mannitol (1 M) was 24 +/- 2% (p < 0.05), 9 +/- 3% (p = 0.06) and 49 +/- 1% (p < 0.05), respectively, suggesting that hyperosmolality per se can induce histamine release from basophils and mast cells. Diatrizoate-induced histamine release in all three cell types was significantly reduced by lowering the temperature to 0 degree C and partially attenuated by the metabolic inhibitors antimycin A (1 microM) and 2-deoxyglucose (5 mM), and by the omission of glucose from the buffer solution. Diatrizoate-induced histamine release was not dependent on extracellular calcium. These data suggest that diatrizoate induces histamine release at least in part by non-cytotoxic mechanisms.
Objective assessment of phantom image quality in mammography: a feasibility study.
Authors: Castellano Smith A D , Castellano Smith I A , Dance D R
Published: June 2014

The need for test objects in mammography quality control programmes to provide an objective measure of image quality pertinent to clinical problems is well documented. However, interobserver variations may be greater than the fluctuations in image quality that the quality control programme is seeking to detect. We have developed a computer algorithm to score a number of features in the Leeds TOR(MAX) mammography phantom. Threshold scoring techniques have been applied in the first instance; scoring schemes which utilize measures such as signal-to-noise ratio and modulation have also been formulated. This fully automatic algorithm has been applied to a set of 10 films which have been digitized at 25 microns resolution using a Joyce-Loebl scanning microdensitometer. The films were chosen retrospectively from quality control test films to demonstrate: (a) a range of optimized imaging systems, and (b) variation from the optimum. The performance of the algorithm has been compared with that of five experienced observers, and has been shown to be as consistent as individual observers, but more consistent than a pool of observers. Problems have been encountered with the detection of small details, indicating that a more sophisticated localization technique is desirable. The computer performs more successfully with the scoring scheme which utilizes the full imaging information available, rather than with the threshold-determined one. However, both the observers and the computer algorithm failed to identify the non-optimum films, suggesting that the sensitivity of the TOR(MAX) test object may not be adequate for modern mammography imaging systems.
Broad beam attenuation of kilovoltage photon beams: effect of ion chambers.
Authors: Das I J
Published: June 2014

In kilovoltage X-ray treatment, beam shaping and shielding normal tissue are accomplished by thin sheets of lead cutout, the thickness of which is selected based upon either published data or measurements. Available broad beam attenuation (BBA) data are found to be unsatisfactory and are the subject of this investigation. BBA is defined as the ratio of intensity with (I) and without (I0) attenuating medium for a large field in a phantom. BBA = I(x,t,E)/I0(x,0,E), where x is the depth of measurement, t is the thickness of attenuator, and E is the beam energy. The depth x should be zero for kilovoltage beams and dmax for megavoltage beams. Unfortunately, x is limited by the window thickness which is the core of this study. A Farmer-type cylindrical ion chamber and three parallel plate ion chambers (Capintec, PS-033; Markus; and Holt) were used to measure BBA for kilovoltage beams from a Siemens Stabilipan unit. Results indicate that attenuation is strongly dependent on the window thickness. For the 240 kVp beam, the thickness of lead for 5% and 1% transmissions are 3.1 mm, and 5.2 mm, respectively, with the Capintec chamber. The corresponding values of lead thickness for the Markus chamber are 2.3 mm and 4.0 mm; for the Holt chamber the values are 1.1 mm and 2.2 mm; and for the cylindrical chambers the values are 1.1 mm and 2.3 mm, respectively. Similar variabilities in lead thickness with ion chambers were also noted for the other kilovoltage beams. The large differences in lead thicknesses produce enormous clinical errors, especially for shielding eye and other critical structures. For small thickness of lead (< 0.1 mm), a 20-fold increase in surface dose could be observed instead of usual beam attenuation. This is due to intense low energy photoelectrons liberated from lead sheets in the contact with tissue. It is concluded that the lead thickness required to shield normal tissue varies with ion chamber. Until national or international guidelines for broad beam transmission measurements are established, the shielding materials in contact with skin should be coated with a thin (> or = 0.3 mm) low atomic number medium. In such a situation, transmission measurements will be independent of the choice of an ion chamber.
Modified radial head--capitellum projection in elbow trauma.
Authors: Tomás F J , Proubasta I R
Published: June 2014

A new technique is described for evaluating trauma to the elbow. The modified radial head--capitellum view is an alternative radiological projection to that described by Greenspan and Norman (the radial head--capitellum view). This new projection is useful in demonstrating minimally displaced or non-displaced fractures of the radial head, capitellum and coronoid process.
A flow model of cerebral aneurysms for use with power Doppler studies.
Authors: Hoskins P R , Prattis J , Wardlaw J
Published: June 2014

It has recently been observed using power Doppler that cerebral aneurysms appear to change size through the cardiac cycle. The purpose of this study was to develop a pulsatile flow model of cerebral aneurysm expansion and to investigate whether the observations of pulsation could be confirmed using the model. The model consisted of a latex bubble glued onto the side of a latex tube. A computer controlled pump was used to generate pulsatile flow. The degree of bubble expansion was adjusted by the use of flow restrictor placed in the downstream section of the flow rig. Ultrasound images were acquired using an Acuson 128 XP/10V colour flow scanner. True expansion (maximum area/minimum area) was measured from the B-scan image using a 7 MHz probe. Three observers measured expansion of the simulated aneurysm from the power Doppler images using a 2 MHz probe. Expansion measured with the power Doppler decreased as the colour gain setting increased, and decreased as the persistence increased. The true expansion of 1.43 was comparable with the colour gain set optimally for a persistence value of 3. The model allows simple investigations of the relationship between true aneurysm expansion and that measured from the power Doppler images. Colour gain and persistence settings must be standardized in clinical studies.
Total skin electron beam irradiation in scleromyxoedema.
Authors: Leung S W , Hsu H C , Huang P H
Published: June 2014

We report a 44-year-old male with generalized progressive scleromyxoedema treated by total skin electron beam therapy (TSEBT) which produced a marked improvement in the skin lesion. TSEBT can provide effective treatment for patients with widespread skin involvement in scleromyxoedema.
CT and MRI appearances of sarcomatous change in chronic pelvic endometriosis.
Authors: Stringfellow J M , Hawnaur J M
Published: June 2014

Endometriosis is a relatively common condition in pre-menopausal women. Rarely, endometrial malignancy may arise in and co-exist with endometriosis. In this case report, the findings on CT and MRI which indicated this development are described. Multiple image-guided biopsies showed features consistent with endometriosis and the diagnosis was not confirmed histopathologically until formal laparotomy and open biopsy.
Venous thromboembolic disease.
Authors: Traill Z C , Gleeson F V
Published: June 2014

The advent of spiral CT has encouraged investigation into the diagnosis of venous thromboembolic disease. It has also exposed the limitations of prior methods of investigation and raised questions as to the significance of small pulmonary emboli. This article discusses this new technique, the clinical detection of venous thromboembolic disease and possible current and future strategies in diagnosis.
Spontaneous rupture of renal tumours: the role of imaging in diagnosis and management.
Authors: Yip K H , Peh W C , Tam P C
Published: June 2014

This study aimed to evaluate whether patients presenting with spontaneous haemorrhage from renal tumours could be accurately diagnosed and initially managed conservatively, and evaluate the role of imaging in guiding the timing and type of subsequent operation. The clinical features, imaging findings and management of seven patients presenting with spontaneous rupture of renal tumour over a 5-year period were reviewed. The information from various imaging studies was evaluated in relation to the subsequent course of intervention. The tumours consisted of six angiomyolipomas and one renal cell carcinoma. In all cases, imaging studies were diagnostic, with computed tomography being the most useful single modality. Emergency surgery was required in one patient for evacuation of suspected infected haematoma and wedge excision of angiomyolipoma. Three elective nephrectomies were performed, while three other patients with ruptured angiomyolipoma were treated conservatively and remained well, without any intervention. In conclusion, patients presenting with spontaneous rupture of renal tumour can be managed conservatively initially. Imaging facilitates accurate pre-operative diagnosis, which was angiomyolipoma in all but one patient in this series. The subsequent intervention can be tailored according to the lesion type and the anticipated risk of re-haemorrhage.