bluuebunny/crossref_metadata_2025 huggingface dataset:
Pneumocephalus secondary to colonic perforation by ventriculoperitoneal shunt catheter.
Authors: Shetty P G , Fatterpekar G M , Sahani D V , Shroff M M
Published: June 2014

We present a case of colonic perforation as a complication arising from ventriculoperitoneal shunt catheter. A 58-year-old woman with a ventriculoperitoneal shunt catheter inserted for obstructive hydrocephalus was admitted to hospital with signs and symptoms of meningitis. CT showed an air-fluid level within both lateral ventricles, raising the possibility of colonic perforation since no other aetiology for the pneumocephalus could be found. The CT demonstration of the colonic perforation played a crucial role in patient management.
Quantitative analysis of MRI signal intensity in new variant Creutzfeldt-Jakob disease.
Authors: Coulthard A , Hall K , English P T , Ince P G , Burn D J , Bates D
Published: June 2014

High signal intensity within the posterior thalamus (pulvinar nucleus) has been noted on MRI in patients with new variant Creutzfeldt-Jakob disease (nvCJD). In this study MRI examinations from three patients with proven nvCJD were compared with MRI examinations from a control group of 14 age-matched subjects with no neurological abnormalities. Mean signal intensity from seven target areas (periaqueductal tissue, posterior thalamus, dorsomedial thalamus, anterior thalamus, putamen, caudate head and frontal white matter) was calculated in each case. Absolute signal intensity measurements were not significantly different between the groups. Patients with nvCJD showed significantly higher signal intensity within dorsomedial thalamus, posterior thalamus and periaqueductal region than control patients when these measurements were normalized to the signal intensity of normal appearing white matter. Highly significant differences in posterior thalamus/putamen signal intensity ratio (PPR) and posterior thalamus/caudate ratio (PCR) were observed between the groups. For proton density images, PPR and PCR were greater than 1 for all nvCJD patients and less than 1 for all control patients. Both PPR and PCR are simple to calculate and offer a simple, non-invasive indicator of nvCJD.
Quantitative CT of the orbit in Graves' disease.
Authors: Ozgen A , Alp M N , Ariyürek M , Tütüncü N B , Can I , Günalp I
Published: June 2014

In order to determine the value of quantitative CT of the orbit in patients with Graves' disease, we clinically examined 174 orbits of 87 patients with Graves' disease and evaluated them by CT in respect to the density and size of the extraocular muscles, the globe position and the width of the optic nerve-sheath complex. We also determined the normal ranges for density of extraocular muscles in 200 normal orbits of 100 patients for comparison. Normal ranges for the density of extraocular muscles were (mean +/- 2 SD) medial rectus, 28-63 HU; lateral rectus, 24-78 HU; inferior rectus, 20-64 HU; superior muscle group, 28-62 HU. 51 of 77 (66%) patients with Graves' disease had extraocular muscle density changes. Some extraocular muscles showed fatty infiltration on CT. 50 of 87 (57%) patients had at least one enlarged extraocular muscle, 47 (54%) patients had exophthalmos and 59 (68%) patients had either exophthalmos and/or extraocular muscle enlargement. A diagnosis of Graves' ophthalmopathy was made in 69 of 87 (79%) patients using CT and in 50 (57%) patients by clinical examination. We conclude that quantitative CT imaging of the orbit with evaluation of the size and density values of extraocular muscles and the globe position may be very helpful in detecting ophthalmopathy in patients with Graves' disease.
Radiation burden to paediatric patients due to micturating cystourethrography examinations in a Dutch children's hospital.
Authors: Schultz F W , Geleijns J , Holscher H C , Weststrate J , Zonderland H M , Zoetelief J
Published: June 2014

Micturating cystourethrography (MCU) examinations of paediatric patients in a major Dutch children's hospital (JKZ) were evaluated to generate quantitative information on effective dose (E). A standard examination involves three radiographs plus fluoroscopy. Observed total dose-area product (DAP) for 84 children increased, on average, with increasing age class from 0.2 to 2.2 Gy cm2. In 11 cases, separate DAP per view was measured; enabling determination, per view, of organ (CF) and effective (CE) dose conversion factors, i.e. dose per unit of DAP. Monte Carlo simulation of photon transport in male and female mathematical phantoms was applied for newborn, 1 year, 5 year, 10 year and 15-year-old patients, and interpolated for other ages. CE per view decreases with increasing age class, yielding about a factor of 10 difference between the extremes of the range. Female values are usually some 20-30% above male ones. CE for one of the views appeared to be representative for the complete examination and was used to estimate total E for each patient. Averaged per age class, E remains approximately constant at 0.3-0.4 mSv, although a tendency to increase with increasing age exists, for females in particular. Within an age class, individual patients may differ in E by a factor of two up to six. Stomach, lower large intestine, bladder wall, liver and ovaries receive relatively high doses. Compared with published data and DAP measured in a few other Dutch hospitals, the radiation burden of MCU is low at the JKZ. This indicates a good degree of optimization with respect to radiation protection (e.g. modern equipment, increased tube voltage, fast film-screen combination).
Image quality parameters for the production standard Eliav PORTpro portal imaging device.
Authors: Poynter A J
Published: June 2014

Measurements of the high contrast spatial resolution and contrast-to-noise ratio of the production standard Eliav "PORTpro" portal imaging system have been made using a commercially available quality assurance phantom. The spatial resolution of the images is comparable with published data for other commercial systems, but somewhat lower than that published previously for the prototype of this system. These data may be of use to those involved in the selection, commissioning or quality assurance testing of electronic portal imaging systems.
Successful interstitial treatment for bilateral tongue cancer.
Authors: Yoshimura R , Shibuya H , Hoshina M , Akaike H , Takeda M , Fukuda H , Hoshi A , Miura M
Published: June 2014

We report three cases of bilateral tongue cancer who received interstitial brachytherapy successively for each tumour. Tumour control following treatment are as good as that for unilateral tongue cancer and there have been no severe complications in, or around, the tumour area after using a mandibular protective spacer and dose reduction for the second treatment.
Dual phase helical CT of a primary malignant fibrous histiocytoma of the right renal vein.
Authors: Sy M , Zalcman M , Simon J , Noel J C , Struyven J , Van Gansbeke D
Published: June 2014

A case is reported of primary malignant fibrous histiocytoma of the right renal vein involving the ipsilateral kidney which showed early enhancement on dual phase helical CT. The correct diagnosis of a primary tumour of the renal vein involving the kidney was not made but in retrospect could have been achieved pre-operatively by considering several CT features.
A phantom-based evaluation of an exposure equalization technique in mammography.
Authors: Skiadopoulos S , Pierrakeas C , Costaridou L , Kalogeropoulou C P , Panayiotakis G
Published: June 2014

An anatomical filter based exposure equalization technique in mammography is evaluated quantitatively using a phantom. The evaluation is carried out by a comparative observer performance study, comparing the equalization technique with a conventional one based on visualization of low contrast, 6 mm circular details and high contrast, 0.5 mm and 0.25 mm small size details. These details are situated at the phantom edge, simulating the breast periphery. Visualization of these details is studied with respect to the parameters of tube voltage, optical density, detail location and phantom thickness. Phantom images are interpreted independently by three observers using a four-point grading scale. Use of the Wilcoxon signed ranks test for paired data shows statistically highly significant improvement (p < 0.0001) in the visualization of details for the equalization technique for all values of the parameters studied. The improvement is independent of tube voltage but dependent on optical density, detail location and phantom thickness. Optimal performance is obtained for detail location closer to the outer border of the simulated breast periphery and/or further away from the film, as well as for a greater phantom thickness simulating both thick and dense breast.
Reducing cardiac dose in post-operative irradiation of breast cancer patients: the relative importance of patient positioning and CT scan planning.
Authors: Canney P A , Deehan C , Glegg M , Dickson J
Published: June 2014

Left-sided post-operative radiotherapy fields for the treatment of breast cancer inevitably encompass the heart within the treatment volume, resulting in late mortality which may negate the cause-specific survival advantage of the therapy. The effect of positioning was studied in 11 patients with left-sided tumours and five with right-sided tumours receiving routine post-operative radiotherapy to the breast or chest wall as part of primary therapy for breast cancer. Using the same arrangement of glancing fields for each patient treatment position, the optimum patient positioning resulted in a reduction in cardiac dose compared to our standard patient treatment position. On the left side the reduction in mean cardiac dose was 60% (p < 0.001) and the reduction in maximum dose was 32% (p < 0.001); on the right it was 17% and 31%, respectively. The volume of cardiac tissue irradiated was also reduced for all patients. Using this optimum treatment position, cardiac dose was investigated in a further 10 patients with left-sided tumours and our standard glancing field set-up was compared with 3-dimensional planning. A further reduction of 12% in the mean cardiac dose was achieved. 5 of 10 patients had a further small reduction of 4.6% in the maximum dose and one patient had a further reduction in maximum dose of 58%. In conclusion, sophisticated radiotherapy planning can reduce cardiac doses, but optimum patient positioning is of greater importance. The general application of such relatively simple measures could have a significant positive effect on overall survival from breast cancer.
Hepatic artery aneurysm.
Authors: O'Driscoll D , Olliff S P , Olliff J F
Published: June 2014

Hepatic artery aneurysms (HAAs) are rare. A review of the English language literature from 1985 to 1995 for reports of visceral artery aneurysms showed HAA to be the most frequently reported visceral aneurysm during that decade. This increase in incidence relates to the increasing use of percutaneous diagnostic and therapeutic procedures. A second factor is the increased use of diagnostic CT scanning after blunt liver trauma. The purpose of this pictorial review is to illustrate the imaging presentation and radiological management of HAAs.
Renal duplication artefacts in ultrasound imaging.
Authors: Pedersen J F , Larsen V A , Rosenkilde M
Published: June 2014

A duplication artefact is sometimes encountered on ultrasound examination of the left kidney. It is caused by sound beam refraction between the spleen and adjacent fat. The purpose of this study was to analyse the frequency and types of such artefacts, and examine their physical background. The examiner searched for a left renal duplication artefact in 150 unselected abdominal ultrasound studies. A disturbed contour of the left kidney could be formed in 34 of 123 patients in whom the spleen was in the image without covering the kidney completely. An artefact was seen significantly more often when the lower pole of the spleen was rounded (30/87) than when it was wedge shaped (4/36) (p < 0.02). The artefacts could be categorized into complete upper pole duplication (n = 4), incomplete upper pole duplication (n = 14) and bayonet artefact (n = 16). The thickness of the renal cortex appeared reduced with upper pole duplication artefacts owing to a geometric image compression, which could also be seen in an in vitro experiment. Left renal duplication artefacts are not rare when the upper part of the kidney is examined by ultrasound through the spleen.
MRI of arachnoid granulations within the dural sinuses using a FLAIR pulse sequence.
Authors: Ikushima I , Korogi Y , Makita O , Yamura M , Kawano H , Kohama M , Arikawa K , Takahashi M
Published: June 2014

The purpose of the study was to assess the signal intensities of arachnoid granulations within the dural sinuses using the FLAIR sequence for differentiation of space-occupying lesions in and adjacent to the dural sinuses. We retrospectively reviewed MR images of the brain of 1118 consecutive subjects, ranging in age from 0 to 93 years (mean 57.2 years). Nodules within the dural sinuses with signal intensities similar to that of cerebrospinal fluid (CSF) on both T1 and T2 weighted images were defined as arachnoid granulations. The location, signal intensity on T1 weighted spin echo (SE), T2 weighted fast SE and FLAIR images, the impression on the inner table of the skull, and the size of the lesion were assessed. 112 subjects (10.0%), age range 4-89 years old (mean 58.9 years), were found to have 134 arachnoid granulations. The commonest location was the transverse sinus, with 115 granulations (85.8%). The prevalence of the granulations showed a peak in the sixth decade of age. All granulations were isointense relative to CSF on T2 weighted images and almost all lesions were isointense relative to CSF on T1 weighted images. On FLAIR images, 90.3% of the granulations were isointense relative to CSF and the other 9.7% granulations were slightly hyperintense compared with the CSF. 21 (15.7%) subjects showed impressions on the inner table; one case involved the outer table. In conclusion, arachnoid granulations were isointense or slightly hyperintense relative to CSF on FLAIR. FLAIR images are helpful in differentiating arachnoid granulations from other dural sinus lesions or skull lesions which have an intensity similar to that of CSF on T1 weighted and T2 weighted images.
The effect of antihistamine, endothelin antagonist and corticosteroid prophylaxis on contrast media induced bronchospasm.
Authors: Laude E A , Emery C J , Suvarna S K , Morcos S K
Published: June 2014

Bronchospasm is a well recognized adverse reaction to radiographic contrast media (RCM) and may occur more frequently in asthmatics and atopics. This study was designed to identify RCM which are most likely to cause bronchospasm and to investigate underlying mechanisms mediating this response. Guinea pigs (mean body weight 550 g, n = 46) were anaesthetized with Hypnorm (5 ml kg-1) and Hypnovel (2 ml kg-1) and tracheal, jugular and pleural cannulae introduced. Total airways resistance (Raw) was calculated from the slope of the pressure/flow relationship. The effects of RCM (diatrizoate 370 mgI ml-1, ioxaglate 320 mgI ml-1, iotrolan 300 mgI ml-1 and iopromide 300 mgI ml-1) at a dose of 4 ml kg-1 body weight or control solutions matched for volume, pH and osmolarity administered via the jugular vein on Raw were studied. The effects of pre-treatment (30 min before the administration of RCM) with antihistamine (Mepyramine (30 mg kg-1 i.p.)) or non-selective endothelin receptor antagonist (SB209670 (1 mg kg-1 i.v.)) were investigated. The effectiveness of corticosteroids prophylaxis (prednisolone (20 mg kg-1 i.p.)) administered 18-24 h and 1 h pre-RCM was also assessed. Control animals received normal saline pre-treatment before RCM administration. Lungs were taken for histological examination 30-40 min post-administration of RCM. Only ioxaglate caused a significant (p < 0.05) increase in Raw (5.19 +/- 0.58 to 13.95 +/- 3.53 mmHg ml-1 min-1). Neither mannitol nor saline control solutions had any effect on Raw. Pre-treatment with Mepyramine, SB209670 or prednisolone caused no significant change in the ioxaglate induced increase in Raw. Histological examination of lung tissue from ioxaglate treated animals showed no important abnormalities. In summary, only the ionic dimer ioxaglate caused an increase in Raw. This effect was independent of osmolarity and could be the result of the chemical composition of the contrast agent. It was not an inflammatory response and could not be prevented by prophylactic treatment with antihistamine, endothelin antagonist or corticosteroids. The mechanisms responsible for the increase in Raw remain uncertain.
Repeated 131I treatment of a residual ovarian teratoma containing malignant thyroid tissue.
Authors: Suga K , Hirabayashi A , Motoyama K , Kume N , Matsunaga N , Tamura H , Kato H
Published: June 2014

A 49-year-old woman with ovarian teratoma received 131I treatment three times for an unresectable mass containing malignant thyroid tissue after surgery. Repeated 131I treatment effectively reduced serum thyroglobulin (Tg) level and tumour uptake of 131I, despite absence of any change in size of the treated tumour. Treatment did not inhibit the increase of serum CA-125 and tumour 201Tl uptake, associated with progression of a radioresistant intratumoral hyper-perfused tissue component, detected by colour Doppler ultrasound. Serum CA-125 level and tumour 201Tl uptake were not significantly changed despite temporary increases in serum Tg level after each 131I treatment. These observations indicate the importance of diagnostic measures using combined functional imaging and tumour markers in managing this rare tumour.
Renal metastases from a squamous cell carcinoma of the larynx.
Authors: Paul N S , Harden P , Fowler R C , Chalmers A G
Published: June 2014

Laryngeal squamous cell carcinoma (SCC) tends to exhibit local spread with a low incidence of distal metastases. The majority of distal metastases are to the lungs and renal involvement is extremely rare. We present a case of laryngeal SCC with metastatic spread to the left kidney presenting as a large, mainly cystic mass. The radiological differentiation of renal metastases from primary renal tumours is discussed.
Patient specific doses used to analyse the optimum dose delivery in barium enema examinations.
Authors: Lampinen J S , Rannikko S
Published: June 2014

The exposure and geometrical data for 89 barium enema examination patients were recorded manually in five hospitals in Finland. From the recorded data, organ and primary exit doses as well as effective individual doses were calculated for each patient using the ODS-60 program, which is capable of adjusting the calculation phantom according to a patient's size and sex. The mean (and standard deviation, SD) and median effective individual doses for the patients were 9.3 (5.7) and 6.8 mSv, respectively. Conversion functions from dose-area product to relevant organ doses and to effective individual dose were presented as a function of patient sex and weight. Mean primary exit dose values were calculated for each exposure. These were used to compare a theoretically justified exposure control (EC) function with the function of the automatic exposure (rate) control, AEC (AERC), at different hospitals. According to the analysis of primary exit doses, the implementation of the EC was far from optimum. With EC function proposed in this study the SD of effective individual doses to patients could be lowered considerably.
An experimental study of radiation-induced cognitive dysfunction in an adult rat model.
Authors: Yoneoka Y , Satoh M , Akiyama K , Sano K , Fujii Y , Tanaka R
Published: June 2014

The objectives of this study were to establish an adult rat model for the late onset of radiation-induced cognitive dysfunction and to compare behavioural dysfunction with histopathological changes. While under anaesthesia, 30 rats (experimental group) were irradiated with a total dose of 40 Gy, given as eight fractions in 24 days. Another 30 rats (control group) underwent sham irradiation. The cognitive functions of all rats were evaluated at 6, 9 and 12 months after irradiation using the Morris water maze and passive avoidance tasks. Histopathological examination of these rats was carried out after the evaluation of cognitive functions was complete. At 6 and 9 months after irradiation there were no significant differences between the control and irradiated groups in passive avoidance and water maze tests. At 12 months after irradiation, the passive avoidance task revealed a deterioration of cognitive function in the experimental group. Histopathological observations revealed no abnormal findings in the irradiated brains at the light microscope level. Late onset cognitive dysfunction following cranial irradiation was observed in an adult rat model. Pathological investigations showed no abnormalities in the irradiated brains. These findings indicate that radiation-induced cognitive dysfunction can precede morphological changes in the brain or that they arise without them. The present model seems useful for elucidating the pathogenesis of radiation-induced cognitive dysfunction and for developing methods for therapy and prophylaxis.
Disappearance of stress-induced hyperthermia following a low dose of X-irradiation: involvement of the vomeronasal system in the modulation of the radiation-induced effects.
Authors: Miyachi Y
Published: June 2014

When the rectal temperatures of group-housed mice are measured sequentially, the temperature of the last mouse to be measured is higher than that of the first mouse. The hyperthermia effect observed in the last animal to be measured forms the basis of an experimental paradigm for studying the neurobiology of anticipatory anxiety. Stress-induced hyperthermia (SIH) was calculated as the difference (delta T) between the basal temperature (the averages of the first three mice) and the final temperature (the averages of the last three mice) when the temperatures of the 15 mice were measured sequentially, with a 2 min interval between each temperature measurement. The hyperthermia observed in the last animals measured was abolished by prior treatment with X-irradiation at the relatively low dose of 5-15 cGy. Prevention of the SIH response could be found when the irradiation was confined to the head region only, suggesting the importance of the brain in the radiation-induced effect. Relatively higher doses of 25 or 35 cGy failed to reduce the hyperthermia stress effect. Furthermore, the effect of X-irradiation was not observed following olfactory bulbectomy or resection of the vomeronasal tract. These results indicate that the disappearance of SIH response may only be found following irradiation at low dose levels. Furthermore, the results implicate the olfactory system in the radiation-induced anti-stress effect.
Computer assisted analysis of the chest radiograph lung area and prediction of failure of extubation from mechanical ventilation in preterm neonates.
Authors: Dimitriou G , Greenough A
Published: June 2014

Post-extubation chest radiographs (CXRs) are frequently requested on the neonatal intensive care unit, but it is controversial whether they generate useful information. A low lung volume assessed by measurement of functional residual capacity (FRC) post extubation has been demonstrated to predict extubation failure, which is a subsequent requirement for increased respiratory support. We have previously shown that the CXR lung area obtained by computer assisted analysis significantly correlated with FRC and, therefore, speculated that a low CXR lung area post extubation would reliably predict extubation failure. The aim of this study was to test the hypothesis by analysing CXRs from 20 infants, with median gestational age of 28 weeks (range 25-33 weeks) and postnatal age 4 days (range 1-11 days). CXRs were obtained within 4 h of extubation and were scanned and analysed using a Power Macintosh computer with a Wacom A5 Ultra pad and NIH image software. The cardiac, mediastinal and thymic shadows, and areas of perihilar and lobar consolidation were subtracted from the thoracic area to give the lung area. Seven infants failed extubation and differed significantly from the rest of the cohort only with regard to their CXR lung area, median gestational age, birth weight and postnatal age. Receiver operator characteristic (ROC) curves were constructed and the areas under each ROC curve were compared. Analysis demonstrated that a low CXR lung area and an older postnatal age were the best predictors of extubation failure. A post-extubation CXR lung area of < 8.5 cm2 had the highest specificity (100%) in predicting extubation failure. We conclude that routine post-extubation CXRs can have a useful role.
False positive thallium-201 SPECT imaging in brain abscess.
Authors: Martínez del Valle M D , Gómez-Río M , Horcajadas A , Rodríguez-Fernández A , Muros de Fuentes M A , Acosta-Gómez M J , Castañeda M , Llamas-Elvira J M , Arjona V
Published: June 2014

Three cases of intracranial 201Tl uptake, reported as positive tumour activity in patients with a final diagnosis of abscess, are described. 201Tl has been proposed as a useful oncotropic radiotracer in the diagnosis of brain tumour activity. These cases suggest a note of caution in the interpretation of 201Tl brain images in the differential diagnosis of an intracranial expanding mass.
Intravenous extension of lung carcinoma to the left atrium: demonstration by positron emission tomography with CT correlation.
Authors: Pitman A G , Solomon B , Padmanabhan R , McKenzie A F , Hicks R J
Published: June 2014

Intravenous extension of lung carcinoma is rare. A right upper lobe bronchogenic carcinoma with unusually elongated intravenous extension to the left atrium was first visualized with positron emission tomography (PET) and then confirmed with dynamic CT. The PET appearance of intravascular tumour spread is striking, and presents only a short differential diagnosis.
Asymmetrical hemithorax volume loss due to Wegener's granulomatosis.
Authors: Connor S E , Olliff J F
Published: June 2014

Three patients with Wegener's granulomatosis (WG) established by clinical, serological and histological criteria were noted to have marked asymmetrical hemithorax volume loss on thoracic CT. Lung dimensions were analysed from the CT in each case. Evidence of airways disease, parenchymal abnormalities and pleural changes was evaluated on CT, in order to establish the aetiology of the volume loss. Previous pulmonary infection and thoracic intervention were excluded by the clinical data. The three patients had chronic treated thoracic WG for 1-9 years. There was severe asymmetrical pleural disease in one case and parenchymal disease with evidence of fibrotic healing but no evidence of bronchial disease in two cases. Marked asymmetrical volume loss of a hemithorax is a previously unreported finding and should be added to the features of primary chronic thoracic WG. This finding does not require investigation for additional pathology.
Ultrasound diagnosis of oesophagostomiasis.
Authors: Storey P A , Anemana S , van Oostayen J A , Polderman A M , Magnussen P
Published: June 2014

Human infection with Oesophagostomum bifurcum, a parasitic intestinal helminth, is endemic in parts of West Africa. Oesophagostomum bifurcum juveniles develop in the colonic wall, causing pus-filled granulomas. The pathology has two distinct forms. Multinodular oesophagostomiasis comprises hundreds of small nodules within a thickened, oedematous wall of the large intestine. Uninodular oesophagostomiasis, called the Dapaong tumour, presents as a painful 30-60 mm granulomatous mass in the abdominal wall or within the abdominal cavity. Diagnosis of oesophagostomiasis on clinical grounds alone is difficult. We describe cases illustrating the ultrasound appearance of these two presentations. Multinodular disease shows nodular "target" and "pseudokidney" colonic lesions. The Dapaong tumour is an echo-free ovoid lumen enveloped within a well defined poorly reflective wall.
Cutting needle biopsy in the diagnosis of clinically suspected non-carcinomatous disease of the lung.
Authors: Bungay H K , Adams R F , Morris C M , Haggett P J , Traill Z C , Gleeson F V
Published: June 2014

Most patients referred for lung biopsy have a focal lesion that is likely to be a carcinoma, and fine needle aspiration is usually sufficient to confirm the diagnosis. When non-carcinomatous disease is suspected, tissue architecture is important and potential diagnostic techniques include percutaneous cutting needle biopsy (CNB). We retrospectively reviewed 37 CNBs performed for clinically suspected non-carcinomatous disease; recording the biopsy result, final diagnosis, radiological nature of the pulmonary abnormality, distance from the pleura of the lesion biopsied and biopsy complications. 9 patients had a single pulmonary nodule/mass; 13 had multiple nodules/masses; 8 had a lobar consolidation/mass; and 7 had multifocal consolidation. The lesion abutted the pleura in 31 cases, lying within 1 cm in the other 6 cases. The minor complication rate was 14%, with no major complications. Specific malignant diagnoses were made in 9 patients, and specific benign in 23, in all of whom clinicoradiological follow-up was concordant. CNB did not yield a specific diagnosis in five patients, including two lymphomas and one case of unsuspected tuberculosis in which the sample was not cultured. The overall accuracy of CNB was 32/37 (86%). CNB is a safe and accurate means of achieving a tissue diagnosis for patients with peripheral pulmonary parenchymal disease thought not to represent carcinoma.
Quality assurance for MRI: practical experience.
Authors: Firbank M J , Harrison R M , Williams E D , Coulthard A
Published: June 2014

The aim of this study is to propose guidelines for quality assurance (QA) in MRI, based on a comprehensive assessment of QA parameters undertaken on a busy clinical MRI scanner over the course of 1 year. QA phantoms supplied by the scanner manufacturer were used together with the Eurospin MRI phantom set. Signal-to-noise ratio (SNR) and image uniformity were measured daily from spin echo images acquired using a quadrature send-receive head coil and from a gradient echo sequence using the Helmholtz body coil. The voltage of the transmit radiofrequency (RF) amplifier was noted. Monthly measurements of slice thickness, geometric distortion, slice position, image resolution and image ghosting were acquired using the head coil. In addition, SNR was measured monthly on a selection of commonly used coils. Apart from some drift of the RF amplifier voltage, all measurements were within acceptable limits and were stable over the course of 1 year. Satisfactory measurements of SNR were possible using the simple phantom supplied with the scanner. The SNR, geometric distortion and RF amplifier voltage are simple to determine and can be measured in less than 15 min by the scanner operator, using the scanner software. Weekly recording of these parameters is recommended for busy clinical MRI scanners, as this should allow deviations from acceptable limits to be identified early. Such in-house checks can usefully be compared with the less frequent estimations performed by the service engineer. Comprehensive QA routines are discussed for systems used for quantitative measurements.
Dose calculations for asymmetric fields defined by independent collimators using symmetric field data.
Authors: Tsalafoutas I A , Xenofos S , Papalexopoulos A , Nikoletopoulos S
Published: June 2014

Several methods have been developed for the dosimetry of asymmetric radiation fields formed by independently moving collimator jaws. Three of these methods, based on different principles and modified to comply with our set of available data, are utilized for the calculation of asymmetric field dose profiles. All three methods use output factors and per cent depth doses or tissue maximum ratios of symmetric fields. In the first method, calculation of the off-centre ratio (OCR) of the asymmetric field is based on the symmetric field from which the asymmetric is originated, by setting the one jaw in an asymmetrical position. In the second method the OCR of the symmetric field is used for the OCR calculation of the asymmetric field of the same size; whereas the third method does not allow for the asymmetric OCR calculation. The results obtained using data for the 6 MV photon beam of a Philips SL-20 linear accelerator indicate that both the first and second method can accurately reproduce asymmetric field profiles from symmetric field data; the third method does not allow for penumbra reproduction, but it is accurate at the central part of the asymmetric field. The problems encountered in the application of the three methods are reported and their accuracy is compared.
Benign metastasizing leiomyoma with intracaval leiomyomatosis.
Authors: Koh D M , Burn P R , King D M
Published: June 2014

We present an unusual case of benign metastasizing leiomyoma in association with intracaval leiomyomatosis. To our knowledge, this is the first reported case of metastasizing leiomyoma with coexistent intravenous leiomyomatosis (IVL). Magnetic resonance imaging is useful for the diagnosis of pelvic and caval IVL.
The impact of FDG positron emission tomography imaging on the management of lymphomas.
Authors: Shah N , Hoskin P , McMillan A , Gibson P , Lowe J , wong W L
Published: June 2014

The role of 2-(F-18)-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) imaging in the management of patients with lymphoma has been evaluated. 29 patients (12 Hodgkin's disease, 17 non-Hodgkin's lymphoma (NHL)) who underwent FDG-PET imaging during their lymphoma treatment programme were reviewed retrospectively. Correlation between FDG-PET and CT was evaluated, together with the impact upon clinical management of the findings on FDG-PET imaging. FDG-PET added extra information to the findings on clinical examination and CT in 12 patients (41%). This was seen both in patients with negative and positive CT scan. Two false positive FDG-PET scans were seen, reflecting FDG uptake in extranodal sites. Information from FDG-PET imaging resulted in a change in clinical management in 10 patients (34%); in two, initial management was altered, and in eight consolidation therapy after completion of initial chemotherapy was influenced. These changes in clinical management occurred in six patients with high grade NHL, two with low grade NHL and two with Hodgkin's disease. No specific subgroup was identified in whom FDG-PET was particularly discriminant.
A pilot study to assess the feasibility of prior scalp cooling with palliative whole brain radiotherapy.
Authors: Shah N , Groom N , Jackson S , Sibtain A , Hoskin P
Published: June 2014

The objective of this work was to perform a feasibility study on the use of scalp cooling during palliative whole brain radiotherapy. Seven patients (1 male, 6 female) with good performance status underwent scalp cooling prior to and during radiotherapy for cerebral metastases. Five patients were prescribed 12 Gy in two fractions and two patients were prescribed 20 Gy in five fractions. Phantom thermoluminescent dosemeter (TLD) studies to assess the build-up effect from the scalp cap were performed. Seven out of eight patients that were offered scalp cooling completed treatment uneventfully. One patient reported discomfort on application of the scalp cap and continued treatment without scalp cooling. No patients reported other adverse effects from use of the cap during treatment or at follow-up. TLD studies demonstrated a 55-80% increase in dose to the scalp after application of the scalp cap. All patients experienced hair loss. Scalp cooling caps are well tolerated through a course of palliative whole brain radiotherapy. The scalp dose is significantly increased owing to a bolus effect from the scalp cap.
Conformal radiation therapy for hepatoma with portal vein thrombosis.
Authors: Leung S W , Huang E Y , Cheng Y F , Lu S N
Published: June 2014

A 43-year-old male patient was diagnosed as having hepatocellular carcinoma with portal vein thrombosis and arterioportal shunts. Three-dimensional conformal radiation therapy (3DCRT) with high focal dose was given to the left portal venous area. Shrinkage of the tumour and thrombus, disappearance of the arterioportal shunts and restoration of the hepatopedal flow of the portal vein was noted 3 months after treatment. The patient received further transarterial embolisation and achieved successful tumour control. No serious complications were encountered. 3DCRT is technically feasible and effective to treat a small volume of liver tissue with a high dose of radiation in this advanced disease.
The characteristics and significance of thoracic lymphadenopathy in parapneumonic effusion and empyema.
Authors: Kearney S E , Davies C W , Tattersall D J , Gleeson F V
Published: June 2014

The occurrence of significant mediastinal lymphadenopathy together with pleural effusion or empyema inevitably raises concern about the presence of intrathoracic malignancy or granulomatous disease. Lymph node enlargement may also occur when pneumonia is accompanied by a parapneumonic effusion or empyema. Features that allow "benign" lymph node enlargement to be distinguished from malignant causes have not previously been determined. The present study aims to establish the CT characteristics of enlarged nodes in parapneumonic effusion. The appearances of mediastinal lymph nodes were recorded in 50 consecutive patients with parapneumonic effusion/empyema. 18 (36%) had mediastinal lymphadenopathy (node size greater than 1 cm). The mean number of enlarged nodes was 1.9 (range 1-3) and the mean size was 1.4 cm (2 cm maximum). Seven patients had a single involved site, nine patients two sites and two patients three sites. The right paratracheal area was most commonly involved and the subcarinal area contained the largest nodes. The presence of enlarged nodes did not correlate with biochemical and microbiological stage of pleural infection, length of history, or extent of consolidation. This study shows that mediastinal lymphadenopathy is commonly associated with parapneumonic effusion and that multiple sites may be involved. The degree of enlargement is moderate although lymphadenopathy of greater than 2 cm size should raise the possibility of other pathology.
The long-term performance of DXA bone densitometers.
Authors: Wells J , Ryan P J
Published: June 2014

Long-term performance of a bone mass measuring device is an important criterion when considering the purchase of such equipment and has been regarded as an important feature of dual X-ray absorptiometry (DXA). The performance of a 6-year-old bone densitometer, the Lunar DPX alpha, which has undertaken 1500 scans annually over this period, was assessed. The short-term coefficient of variation calculated from 15 measurements with repositioning on a single day, using the Lunar aluminium phantom, was 0.242%. Long-term precision, also calculated by the coefficient of variation, was 0.548%. The manufacturer's quality control (QC) procedure was performed daily and allowed the machine to be used except on 15 occasions when bone density measurements could be acquired after rebooting. However, a 2.2% shift in phantom values occurred in July 1996 owing to a photomultiplier tube failure, but this did not produce a failure in the Lunar QC. The optical disc drive was replaced in July 1997. The machine failed to back up on six occasions over the last 2 years owing to software corruption and the acquired femur data were not saved on seven occasions owing to overloading of the memory buffer. In conclusion, expected hardware failure and minor software problems have occurred. We were concerned that the manufacturer's QC failed to detect a 2% shift in the phantom bone mineral density values and recommend regular measurements of the Lunar aluminum phantom in addition to the daily QC measurement of the tissue-equivalent block. We were nevertheless impressed by the long-term stability and reproducibility of the Lunar DPX alpha.
An isocentrically mounted stand for total body irradiation.
Authors: Jones D , Rieke J W , Madsen B L , Hafermann M D
Published: June 2014

The purpose of this study was to construct a stand to support a patient for total body photon irradiation and to expedite the set-up and treatment by rotating the stand. As in other isocentric treatments, the midline dose is impacted less by source-to-skin distance variations. The method of immobilizing the patient is described. A 10 mm lucite plate is supported in front of the patient to increase skin dose. A matrix of holes in this plate serves to index the location of blocks used to shield the lungs. The dosimetry of the set-up is described, as is the production of tissue deficit compensators. The results of phantom studies and in vivo thermoluminescent dosimetry measurements are presented.
Comparison of cardiac stroke volume measurement determined using stereological analysis of breath-hold cine MRI and phase contrast velocity mapping.
Authors: Graves M J , Dommett D M
Published: June 2014

Cine MRI of the heart using segmented k-space pulse sequences permits multiphase images to be acquired in a single breath-hold. Whilst image quality is improved compared with conventional (non-segmented) cine imaging, subsequent analysis can be relatively time consuming. In this study, multiple slice breath-hold cine imaging of the heart was performed in 11 normal volunteers. Left and right ventricular stroke volume (SV) was estimated from the images by application of the Cavalieri method of modern design stereology in combination with point counting. The measured SVs were compared with those obtained by cine phase contrast velocity mapping in the ascending aorta and main pulmonary artery. Excellent agreement was found between the SVs determined by the two techniques, with mean differences (+/- one SD) of 0.41 +/- 3.00 ml and 0.41 +/- 4.78 ml for left and right ventricles, respectively. Comparison of left and right ventricular SV using stereology yielded a mean difference of 0.84 +/- 5.70 ml. Breath-hold data acquisition together with stereological analysis is demonstrated to be an accurate and unbiased technique for the rapid assessment of cardiac function.
Some limitations in the practical delivery of intensity modulated radiation therapy.
Authors: Meyer J , Mills J A , Haas O C , Parvin E M , Burnham K J
Published: June 2014

The resolution characteristics of intensity modulated beam (IMB) profiles produced by milled compensators and by multileaf collimators (MLCs) are independently investigated with respect to the primary fluence. It is shown that both methods have different characteristics in the longitudinal and lateral direction and, as a consequence, the resolutions of the longitudinal and lateral delivered IMB profiles differ. For both methods, the restrictions are identified. For compensators, the maximum slopes in the machining process, which should not be exceeded, are quantified. For MLCs, emphasis is given to the direction perpendicular to leaf movement. A number of test modulations were created and the effect of different size MLCs on the intensity profile revealed that unacceptable errors can be introduced if the profiles are heavily modulated. The production of intensity modulated radiation therapy (IMRT) beams by both machined compensators or by MLCs is limited by physical constraints. Having identified these constraints, some steps should now be taken to accommodate them either in the objective function for the calculation of the beam profiles or in the delivery system.
Intrafracture fluid: a new diagnostic sign of insufficiency fractures of the sacrum and ilium.
Authors: Peh W C
Published: June 2014

MRI is generally regarded as being sensitive but non-specific for the detection of insufficiency fractures affecting the sacrum and pelvic ring. The finding of intrafracture fluid is described in two elderly patients with insufficiency fractures. This MR feature is believed to be a new diagnostic sign of these fractures affecting the sacrum and ilium.
Osteoma of the thyroid cartilage--an unusual cause of difficult intubation.
Authors: Redman A G , Hide I G , Zammit-Maempel I
Published: June 2014

We describe a case of histologically proven osteoma of the thyroid cartilage that presented because of difficulty in intubation prior to coronary bypass surgery. To our knowledge, this is the first documented case in the English literature.
Metastatic paraganglioma causing spinal cord compression.
Authors: Hamilton M A , Tait D
Published: June 2014

We describe two cases of metastatic retroperitoneal paraganglioma associated with extradural spinal cord compression. Both occurred in young men; one being metastatic at presentation, the other becoming metastatic 19 years after attempted surgical resection. Despite a long, relatively stable natural history after diagnosis (10 and 19 years, respectively) both had an acceleration of their disease once extradural disease was detected. These cases illustrate the potentially aggressive nature of this disease, the need for long-term follow-up and the effectiveness of a variety of therapies for palliation, and also raise the possibility of "prophylactic" treatment to prevent spinal cord compression.
The value of plain radiographs in the prediction of outcome in pelvic fractures treated with embolisation therapy.
Authors: Niwa T , Takebayashi S , Igari H , Morimura N , Uchida K , Sugiyama M , Matsubara S
Published: June 2014

40 haemodynamically unstable patients with pelvic injuries were studied to assess the ability of plain radiographs to detect haemorrhagic sites. Pelvic radiographs and bilateral angiograms were reviewed separately for detection of haemorrhagic sites in both anterior and posterior segments. Sensitivity and specificity of pelvic radiographs for the detection of haemorrhagic sites were obtained by analysis of angiographic findings. Angiography demonstrated arterial injury in 106 divisions: 26 right anterior, 22 right posterior, 33 left anterior and 25 left posterior. Sensitivities of the radiographs for predicting haemorrhagic sites were higher in the anterior segment (right, 96%; left, 100%) than in the posterior segment (right, 73%; left, 83%). However, specificities were lower in the anterior segment (right, 79%; left, 78%) than in the posterior segment (right, 100%; left, 100%). In 15 (58%) of 26 patients with in-dwelling Foley catheters, including those with catheter deviation, the severity of anterior injury indicated on plain radiographs was correlated with angiographic findings. Plain radiographs of the pelvis proved useful for predicting haemorrhagic sites in haemodynamically unstable patients with pelvic fractures, especially in those with anterior fractures.
Directionality of extruded lithium fluoride thermoluminescent dosemeters in a cobalt-60 beam.
Authors: Wagner G S , Batey S E , Mosleh-Shirazi M A
Published: June 2014

An experimental investigation of the directionality of commercially available extruded lithium fluoride (LiF:Mg,Ti) thermoluminescent dosemeters was carried out in a cobalt-60 beam at a water depth of 5 cm. One-half of a batch of 60 chips (3.1 x 3.1 x 0.9 mm3) was exposed face-on (faces perpendicular to the beam central axis), and the other half was exposed in an edge-on orientation (two edges perpendicular and faces parallel to the beam axis). Measurements show that an edge-on exposure results in a thermoluminescence reading approximately 0.9% lower than a face-on exposure. Although this is of minor importance in every day patient dosimetry, it is relevant in evaluating errors in in-phantom dosimetric measurements where greater accuracy is required.
Recurrent superior vena caval obstruction due to invasion by malignant thymoma: treatment using a stent-graft.
Authors: Gill K , Ettles D F , Nicholson A A
Published: June 2014

A stent-graft was used to palliate superior vena caval obstruction in a 50-year-old patient with histologically proven ingrowth of malignant thymoma through three previously inserted non-covered stents. The stent-graft is still patent 12 months later. This is the first report of such a procedure where histological evidence of tumour ingrowth is available and long-term patency is verified.