bluuebunny/crossref_metadata_2025 huggingface dataset:
111In labelling of post-operative thrombus
Authors: Davies E. Rhys
Published: July 2009

I am sure that I am not alone in being excited by the article from Stuttle et al (1989) on platelet specific monoclonal antibody that appeared in the November issue of the Journal. The first publication that I read on this topic, at the beginning of this year, led me to seek a source of MAB P256 for two important research projects in this department, using labelled platelets. I was told that the antibody was not available for general use and I am still unable to obtain a supply.
111In labelling of post-operative thrombus
Authors: Stuttle A. , Klosok J. , Peters A. M. , Lavender J. P.
Published: July 2009

In response to comments by Professor Rhys Davies relating to a publication outlining the use of P256 we should first like to explain the background of this tracer.

The antibody was originally raised at The Imperial Cancer Research Fund (Lincoln's Inn Fields). As a result of a request by Professor Peter Lavender, this antibody was made available for evaluation as a thrombus imaging agent at the Hammersmith Hospital. Studies conducted during 1986 demonstrated the potential value in thrombus detection. Following initial presentations of this work Amersham International plc expressed a commercial interest in the antibody and negotiated with the ICRF to take over production of the antibody. In addition, Amersham agreed to fund the continued evaluation of this tracer at the Hammersmith Hospital.
Book reviews
Authors: Mortimer P. S.
Published: July 2009

This volume is a compilation of the proceedings of the conference “Dermal carcinogenesis: research directions for human relevance” held in Texas, December 1987. It covers basic mechanisms of carcinogenesis, animal and human model systems and addresses the role of papillomaviruses. Biological, cellular and biochemical aspects of tumour initiation, promotion and conversion provide the main thrust of the book.
Book reviews
Authors: Tilley A. J. , Lock N. A.
Published: July 2009

This American book, like the curates egg, has some good parts. The particular strength of the work is in the clear layout of each projection, comprehensively and lucidly described with an accompanying photograph of the position, radiograph and an annotated line drawing of the radiograph, all of the highest quality. Of particular importance are the imaging criteria and helpful hints on how to achieve the desired projection. It is clear to me that the book has been written from a practical viewpoint, and this is further reinforced by references to patient care.

The book is divided into 13 sections starting with a summary of the principles of radiography, dose limits and a section on the care of the patient. Within this section are the bill of rights for American patients and the code of ethics: the bill of rights makes particularly interesting reading. The second section then discusses both radiographic and positioning terminologies, particularly those used in America.
Imaging for cochlear implants
Authors: Phelps Peter D. , Annis Jonathan A. D. , Robinson Philip J.
Published: July 2009

Insertion of a sound amplification device into the round window niche (extracochlear implant) or into the coils of the cochlea (intracochlear implant) can give significant benefits to some carefully selected, severely deaf patients. Imaging has an essential role in selective and pre-operative assessment. Severe otosclerosis and post-meningitic labyrinthitis ossificans are common causes of deafness in these patients and can be demonstrated by computed tomography (CT). The most suitable side for operation can be assessed. We describe our experiences with 165 patients, 69 of whom were found suitable for implants. Thin (1 mm) section CT in axial and coronal planes is the best imaging investigation of the petrous temporal bones but the place of magnetic resonance scanning to confirm that the inner ear is fluid-filled and polytomography to show a multichannel implant in the cochlea is discussed. No implants were used for congenital deformities, but some observations are made of this type of structural deformity of the inner ear.
Quality assurance of viewing boxes: proposal for establishing minimum requirements and results from a Spanish quality control programme
Authors: Guibelalde E. , Vañó E. , Llorca A. L.
Published: July 2009

The Medical Physics Group at the Complutense University of Madrid has undertaken a project, during the last 3 years, under a CEC contract on “Optimization of Radiation Protection in Diagnostic Radiology” (Vañó, 1989) in which a pilot programme of Quality Control (QC) was included (Gonzalez, 1989). Exhaustive patient and occupational dose measurements showed differences between the test results from similar equipment. This fact moved us to set up a Quality Control Programme (Guibelalde & Llorca, 1989), and then several Quality Assurance (QA) programmes.

The necessity to establish minimum performance requirements for image quality, and the convenience of denning objective parameters to make possible further advances in the reduction of patient doses and optimization of image quality, has been pointed out at several Workshops of the Commission of European Communities (CEC) on Image Quality in Diagnostic Radiology. A Working Document of the CEC (1989) has recently been issued emphasizing the need to develop appropriate quality criteria. The aim of these activities is to produce standards and quality criteria that will provide a framework, throughout the European Community, for producing images with minimum patient dose and maximum quality. Efforts to ensure the best quality and consistency of viewing boxes must aid these objectives.

The brightness and uniformity of viewing boxes are two factors that can be measured in absolute units. These factors are not influenced by other elements of image quality control and, therefore, can be used for comparisons between different centres.
Book reviews
Authors: Renton P.
Published: July 2009

It is with the greatest pleasure that I turn to another volume written by Professor Resnick. His previous papers and textbooks are models of clarity, expertise and erudition. In this superbly illustrated and produced book, there is less emphasis on pathology than in his multi-volume work, but all aspects of imaging techniques are considered in the introductory chapters while the chapters on the various disease entities are full and comprehensive.
Book reviews
Authors: Renton P.
Published: July 2009

Conventional and skeletal radiologists are usually blissfully ignorant about dental disease. The jaws, however, often reflect more widespread change and, because they bear teeth, also have distinctive local pathology.
Radiological definition of a new model of portal diversion in the rat
Authors: Jaffe V. , Sandin B. , Wilkins R. A.
Published: July 2009

Diversion of portal blood away from the liver can be accomplished in the rat by two straightforward surgical procedures: subcutaneous transposition of the spleen followed later by portal vein ligation. This experimental model has great potential value in the study of liver cell transplants, porto-systemic shunts and hepatic porto-privation. Contrast medium radiology has been used to clarify and define the model further. Splenography, achieved by direct percutaneous puncture, demonstrated the developing spleno-subcutaneous vessels. Collaterals are seen as early as 3 days and appear extensive by 21 days after transposition. Almost all emanate from the convex outer surface of the spleen and course cranially and caudally in the subcutaneous tissues to drain into the subclavian and iliac veins. The appearance of these collaterals correlates well with survival after portal vein occlusion subsequent to splenic transposition. Direct portography demonstrates that, following portal vein ligation, contrast medium is diverted away from the liver into the splenic veins, through and around the spleen, before draining into the systemic circulation through spleno-subcutaneous collaterals. These radiological studies have demonstrated the changed circulatory pathways of this model of portal diversion and have confirmed that it is the splenic veins and the spleno-subcutaneous collaterals which are fundamental to its successful outcome.
An investigation into the performance of an automated quality assurance and dosimetry system in diagnostic radiology
Authors: Chappie C.-L. , Faulkner K. , Harrison R. M.
Published: July 2009

A system has been developed to undertake automatic quality assurance and dosimetry for diagnostic radiology examinations. The accuracy and reproducibility of the measurements and calculations made by the system have been investigated in a laboratory study and compared with concurrent measurements of exposure parameters made using standard techniques. In a later set of experiments, doses measured using a RANDO phantom and thermoluminescent dosimeters were compared with those calculated by the automated system. Assessment was carried out over a wide range of exposure factors and for a number of different radiological examinations. It is deduced from the results that exposure parameters can be measured with comparable accuracy to standard techniques, and that the automated system is suitable for performing on-line dosimetry.
Radiation therapy in the management of giant lymph node hyperplasia
Authors: Sethi T. , Joshi K. , Sharma S. C. , Gupta B. D.
Published: July 2009

The response of giant lymph node hyperplasia (Castleman's disease) to surgery is well known and surgery is the main technique in the management of these patients. We describe a young man who presented with clinical features suggestive of a lymphoma, but who was diagnosed to have Castleman's disease after histopathology. Complete response to radiation and a disease-free follow- up of 22 months prompts us to advocate radiation as an effective alternative mode of therapy in inoperable cases.

Giant lymph node hyperplasia or Castleman's disease is a benign condition with enlargement of the lymph nodes, particularly common in the mediastinum. The patients are otherwise usually asymptomatic but may sometimes present with fever, anaemia, hyper-gammaglobulinaemia (Bartoli et al, 1980; Frrizera et al, 1983) and multi-centric lymph node enlargement (Gaba et al, 1978) mimicking a lymphoma.
Thin ribs, thin tubular bones, abnormal facies and intrauterine growth retardation: a lethal syndrome
Authors: Sharma Bal Krishana , Kapoor Ravi , Ramji Sidharth , Thirupuram S. , Suri Mohnish
Published: July 2009

Two neonates with peculiar facies, thin ribs and thin long bones are presented. Both these cases had an otherwise uneventful antenatal period but died soon after birth. The two cases had no familial relation to each other.

A male baby was born at term by caesarean section to a booked second gravida mother with borderline contracted pelvis because of breech presentation. The Apgar score was 5, 6 and 6 at 1, 5 and lO min, respectively. The neonate showed increasingly poor respiratory effort and died after 2h. There was no history of maternal exposure to drugs or radiation. Ultrasound examination 10 days prior to delivery showed mild hydramnios.

The newborn weighed 2.2 kg, with head circumference 35 cm, crown–heel length 49.5 cm and an upper segment to lower segment ratio of 1.4. There was frontal bossing with all three fontanelle widely open, low set ears, high arched palate and bilaterally undescended testes.
A localized hypersensitivity reaction to co-trimoxazole in a previously irradiated field simulating a recall phenomenon
Authors: Leslie M. D. , Williams D. S.
Published: July 2009

We read with interest the report of Atahan et al (1989) on an enhanced skin reaction in a previously irradiated site following administration of co-trimoxazole.
A localized hypersensitivity reaction to co-trimoxazole in a previously irradiated field simulating a recall phenomenon
Authors: Atahan I. Lale , Akyol Fadíl H.
Published: July 2009

In our article (Atahan et al, 1989) we described a case of local hypersensitivity reaction to co-trimoxazole* (Trimethoprim 160 mg—sulphamethoxazole 800 mg) developing 3 years after post-operative irradiation of an infiltrative ductal breast carcinoma.
Book reviews
Authors: McKenzie Alan L.
Published: July 2009

The guidelines currently used by the National Aeronautics and Space Administration (NASA) for radiation exposure to astronauts are based on 1970 recommendations. The philosophy was that radiation risks should be kept in perspective in the context of other risks of spaceflight. Since that time, the population of astronauts has increased and now includes women, the age distribution has changed towards younger groups, radiation risks themselves have changed, and the ALAR A principle has been established. These changes prompted this revision of the guidance for space activities which has been produced by the NCRP.
Book reviews
Authors: Russell J. G. B.
Published: July 2009

This is a compilation of the abstracts of 112 papers given at the 4th International Symposium organized in Malvern by the Society for Radiological Protection in June 1989, so publication is commendably rapid. Each abstract is given at least four pages, so there is room for much information; they are published as submitted, so the typefaces and style are very variable.
Age and sex specific radiographic examination frequency in the Netherlands
Authors: Beentjes L. B. , Timmermans C. W. M.
Published: July 2009

Age and sex specific data were obtained concerning diagnostic radiographic procedures performed in the Netherlands over the years 1984–1985. The average annual procedure frequency per caput excluding dental examinations in dentists' practices and mass survey examinations amounted to 0.537. Male and female examination frequencies were determined as 0.543 and 0.531, respectively. Trends in X-ray examination frequency were followed from 1967 to 1988. Until 1982, the X-ray examination frequency was increasing by an average of 4% per year. Mainly because of a decrease in high dose examinations, the annual examination frequency per caput has been decreasing since then. As a consequence, the somatic effective dose equivalent to the population from diagnostic X-ray examinations is expected to decrease to a value of about 0.4 mSv for the year 1989.
Pelvic congestion in women: evaluation with transvaginal ultrasound and observation of venous pharmacology
Authors: Stones R. W. , Rae Toni , Rogers Vera , Fry R. , Beard R. W.
Published: July 2009

Fourteen women with chronic pelvic pain due to congestion underwent transvaginal ultrasound scanning to observe changes in the diameters of dilated pelvic veins. Spontaneous fluctuations were observed, and intravenous dihydroergotamine resulted in a consistent venoconstrictor response (p = 0.0021) during 20min observation. Transvaginal ultrasound is useful for imaging dilated pelvic veins and for the study of venous pharmacology.
A new positioning technique for barium enemas
Authors: Hughes T.
Published: July 2009

Despite the decreasing trend in the percentage of colorectal tumours found in the rectosigmoid region (Maglinte et al, 1983), still over 34% of colorectal polyps are located in the rectosigmoid region (Johannsen et al, 1989) and 36.1% of colorectal carcinomas are located in the rectum with an additional 26.1% in the sigmoid colon (Maglinte et al, 1983). Although the majority of these will be diagnosed by clinical examination and rigid outpatient sigmoidoscopy, inevitably a reasonable percentage will only come to light during a double contrast barium enema examination. If GP referral barium enemas are available, then often sigmoid-oscopy will not have predated the barium study, and a higher proportion of diagnoses will be made by radiography.
Cholesterol granuloma of the petrous apex
Authors: Clifton A. G. , Phelps P. D. , Brookes G. B.
Published: July 2009

A case of cholesterol granuloma (giant chocolate cyst) of the petrous apex of the temporal bone is reported. The importance of correct pre-operative diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is discussed. This may allow, as in this case, less major surgical management by transmastoid drainage.

A 44-year-old woman presented with a 4-year history of left-sided facial spasms, which had become progressively more frequent and severe. They occurred daily and were triggered by noise, cold air or abduction of the arm. Over a few seconds the left eye would close and the angle of the mouth would be drawn up, the facial muscles remaining in spasm for over half an hour. There was no associated pain or parasthesia, but she was aware of facial numbness. There had been associated left-sided hearing loss for the previous 2 years. General and neurological examination between attacks was unremarkable apart from reduction in light touch and pin-prick sensation over the left cheek. A mild conductive hearing loss was present on the affected side. Brain stem evoked potentials were bizarre and poorly seen, features suggesting a retrocochlear lesion involving the auditory pathways. Facial electromyogram during an episode was not consistent with hemifacial spasm or facial myokymia. Facial nerve conduction, blink reflex latency and cerebrospinal fluid analyses were normal.

Computed tomography of the brain (WW75 WL45) was normal.
A cranio-cerebral erosion (growing skull fracture) causing anisometropia
Authors: Whitehouse R. W. , Leatherbarrow B.
Published: July 2009

The progressive enlargement of a skull fracture is a rare complication of head injury in children. The true incidence is unknown but it probably occurs in less than 5% of skull fractures in infancy. It is seen most often in children under the age of 3 years who have sustained a diastatic fracture (greater than 3–4 mm of edge separation) following a fall of at least 10 feet (Tandon et al, 1987). Experimentally, a laceration of both the dura and arachnoid is also necessary for the lesion to develop (Goldstein et al, 1967). Until the series of 60 cases published by Tandon et al, the high incidence of associated brain injury and progressive neurological abnormality in patients with growing fractures had been underemphasized in the literature. In Tandon's series, only two patients had growing fractures of the orbit and these were neither illustrated nor specifically described. No other published series in the radiological or neuro-surgical literature refers to an orbital location. We therefore describe the clinical and radiological findings of an orbital growing fracture.

At the age of 22 months, the patient fell from a first floor window onto a concrete pavement. There was no documented period of unconsciousness but plain radiographs demonstrated a fracture of the left frontal region (Fig. 1). A computed tomographic (CT) examination was performed, demonstrating in intracerebral contusion in the left frontal lobe and blood in the interhemispheric fissure.
“The Dormouse is asleep again” said the Hatter, and he poured a little hot tea upon its nose (Lewis Carroll)
Authors: Ward S. C. , Hornsby V. P. L.
Published: July 2009

A woman of 31 years presented acutely to her general practitioner with left sided pleuritic chest pain of short duration. She had no significant past medical history and was otherwise asymptomatic. On examination, her doctor found no abnormality in the chest, but discovered a large ill defined mass in the left upper abdomen.

He requested a plain radiograph of the abdomen (Fig. 1) and an upper abdominal ultrasound (Fig. 2) before referring the patient to hospital where a computed tomographic (CT) scan of the abdomen was performed (Fig. 3).

What is the diagnosis and how should the patient be managed?

The plain abdominal radiograph confirms the presence of a large rounded mass of soft-tissue density in the left upper quadrant.
Biological dosimetry for iodine contrast medium and X-ray interactions by cell survival
Authors: Tokita N. , Akine Y. , Egawa S. , Raju M. R.
Published: July 2009

In the presence of an iodinated contrast medium, X-ray absorption is enhanced owing to photoelectric interactions. This has been shown both experimentally and in patients undergoing radiographic procedures using contrast media (Adams et al, 1977; Norman et al, 1978; Callisen et al, 1979; Cockran et al, 1980; Matsudaira et al, 1980; Matsubara et al, 1982). Chromosome aberration assays of circulating lymphocytes in these patients revealed a significant increase in absorbed dose compared with those who underwent a similar radiological procedure without the use of contrast media. This effect is most significant at X-ray energy levels just above the binding energy of iodine K electrons. Ejected photoelectrons are estimated to deposit their energy within a few micrometers in tissue (Cole, 1969). In angiography, an iodine contrast medium is irradiated in small blood vessels so that attenuation and “hardening” of X rays are unlikely to be significant. However, when a larger volume of tissue is irradiated in the presence of a contrast medium, the X rays become not only attenuated but also “hardened” as they travel through the iodine-containing tissue. In contrast to the incident X rays, the exit X rays are predicted to be less effective in eliciting photoelectric interactions because of the reduction in the “soft” component of the X-ray spectrum.

In this communication we report measurements of the dose enhancement as a function of iodine concentration and the effect of X-ray hardening on the photoactivation using biological dosimetry based on cell survival.
Book reviews
Authors: Glaholm J.
Published: July 2009

The text endeavours to describe the basic physical principles of radiation oncology and subsequently practical radiotherapy planning. The authors consider that the book will provide a practical guide to treatment planning for radiation oncologists, and my criticism is based upon this premise.
Book reviews
Authors: Freeman A. H.
Published: July 2009

It has to be stated at the outset that this is an extremely practical book, and therefore its appeal will be mainly to individuals who are actively engaged in the performance of ERCP, both diagnostic and therapeutic. It is a book on “how and why” one should do the procedure, and the illustrations reflect this, rather than being a collection of radiographs of pathological changes.
Book reviews
Authors: Keithley A.
Published: July 2009

This book is adapted from the proceedings of the 1st International Symposium on Biliary Lithotripsy which was held in Boston, Massachusetts in July 1988. In addition to sections on the physics of shock waves generated by extracorporal lithotripters, in their in vivo and in vitro effects and early clinical results of extracorporal shock wave lithotripsy (ESWL), other non-surgical treatments are reviewed and there is a useful section on the epidemiology and pathophysiology of cholelithiasis. The treatment of common duct stones is touched upon and the final part of the book is taken up with practical considerations in setting up an ESWL centre, some of which is irrelevant to the British reader since it covers licensing regulations and insurance reimbursement. A series of presentations from different lithotripter manufacturers concludes the book.
Book reviews
Authors: Hilson A. J. W.
Published: July 2009

The first edition of this book appeared in 1972, and it is a measure of the dramatic progress in the field that every chapter has been completely rewritten, and it has been necessary to split it into two parts. It is fascinating to read the first chapter, by Blaufox, on historical aspects and see how much has changed.
Book reviews
Authors: Carr Denis H.
Published: July 2009

This interesting book covers a broad spectrum of magnetic resonance imaging of both cardiac and pulmonary pathology. Initial chapters cover technical considerations including scanning techniques and flow effects, followed by a lucid chapter on normal thoracic anatomy. The first third of the book is devoted to the cardiovascular system.
Book reviews
Authors: Underwood S. R.
Published: July 2009

Magnetic resonance imaging of the cardiovascular system is developing very rapidly, and this makes it difficult to publish a textbook that reflects the current state of play. For instance, in the last 18 months, cine imaging has become commonplace and cine velocity mapping will soon follow. Against this background, the book concentrates on one of the strengths of magnetic resonance, which is its ability to show high resolution anatomy, ventricular function and blood flow in the same investigation. Although the bulk of the contents concerns the cardiovascular system, there is a final chapter describing the assessment of renal function, and it aimed at physicians and radiologists with an interest in either magnetic resonance imaging or the cardiovascular and renal systems.
Book reviews
Authors: Wright F.
Published: July 2009

Dr Norman Blank is Active Emeritus Professor of Diagnostic Radiology and Nuclear Medicine at Stanford University School of Medicine, California. His name is well known to radiologists interested in chest medicine for his papers with Dr Castellino and others on pleural reflections adjacent to the mediastinum, mediastinal lymphadenopathy, intra-thoracic manifestations of lymphomas and leukaemias, etc., some inflammatory lung conditions, particularly in patients with altered immunity.

The preface states that the book is intended for medical students and residents in radiology or chest medicine “to master the principles of chest film interpretation and to develop their ability to extract information from imaging studies”. He tries to show how to analyse radiographic data, whether findings are normal or abnormal, to integrate radiological with clinical findings, and with one's knowledge of disease processes to formulate a differential diagnosis.
Chronic anaemia, hyperbaric oxygen and tumour radiosensitivity
Authors: McCormack Mary , Nias A. H. W. , Smith Eileen
Published: July 2009

Anaemia is an important factor in the response of some human tumours to radiotherapy. The outcome is also influenced by whether the treatment is given in air or high pressure oxygen (HPO). The present study examined the relationship between anaemia and tumour response to radiation given in air or HPO in C3H mice transplanted with a mammary adenocarcinoma using a growth delay assay to assess the radiation response. Chronic anaemia was induced by the use of a low iron diet and was characterized by a significant reduction in host haematocrit and whole blood viscosity. In addition, anaemia was associated with a right shift in the oxyhaemoglobin dissociation curve and an increase in the volume doubling time of the tumour; but there was no change in the concentration of 2,3-diphosphoglycerate in the red cells. Radiation studies with these anaemic mice demonstrated that the tumour radiosensitivity was decreased when treatment was given in air. HPO was successful in overcoming the increased radioresistance associated with anaemia. This result suggested that tumours grown in anaemic mice have a higher hypoxic fraction than those grown in control mice.
Lipiodol computerized tomography: how sensitive and specific is the technique in the diagnosis of hepatocellular carcinoma?
Authors: Ngan Henry
Published: July 2009

Computerized tomography (CT) following the intra-arterial injection of Lipiodol (Lipiodol-CT) was performed on 60 patients suspected of having a hepatocellular carcinoma (HCC). Four main patterns of uptake of the Lipiodol within the liver were seen on CT. Of the 14 well circumscribed lesions with dense homogeneous uptake of Lipiodol, 13 were confirmed to be HCCs. Of the 25 lesions with dense patchy uptake of Lipiodol at the periphery and/or in the centre, 19 were confirmed to be HCCs. In 18 patients, in whom only ill defined faint patchy uptake of Lipiodol was present in the liver, or in whom no hepatic uptake was present at all, only one patient was found later to have an HCC. Of the three hypodense lesions in the liver with no Lipiodol uptake, one was found to be necrotic HCC, one a cholangiocarcinoma and one a regenerative nodule. In the diagnosis of HCC, Lipiodol-CT had an overall sensitivity of 97.1%, an accuracy of 88.3% and a specificity of 76.9%. Of the 34 patients with HCC, only 23 were solitary at diagnosis. The size of the HCCs ranged from 0.8 cm to 11 cm in diameter with the median size at 2.2 cm. Eleven of 34 HCCs (32.3%) were resectable. We conclude that, as part of a screening programme for high risk patients, Lipiodol-CT is useful in the early detection of HCCs. The technique also plays an important role in determining whether the tumour should be resected or managed with chemotherapy. By detecting HCCs while still small, the resectability rate can also be improved.
Choroid plexus cysts and chromosomal defects
Authors: Thorpe-Beeston J. G. , Gosden C. M. , Nicolaides K. H.
Published: July 2009

During a 4-year period, 83 pregnant women with fetal choroid plexus cysts were investigated in our unit. Abnormal karyotypes were found in 20 fetuses, including trisomy 18 (n = 16), trisomy 13 (n = 1), triploidy (n = 1) and translocation Down's syndrome (n = 2). All fetuses with chromosomal defects had structural malformations in addition to the choroid plexus cysts.
A man with three knees? False “hot spot” with dual isotope imaging
Authors: Miles K. A. , Barber R. W.
Published: July 2009

Radionuclide imaging is subject to a wide range of potential artefacts. We have recently come across an unusual example which we have not seen previously described (Wells & Bernier, 1988; Ryo et al, 1985). A 66-year-old man presented with a pyrexia, 3 months after undergoing bilateral upper tibial osteotomies. The patient was referred for a 99Tcm methylene diphosphonate (MDP) bone scan followed by 111 In labelled white blood cell (WBC) scanning to determine whether one of the osteotomy sites was infected. Three hours before imaging, 400 MBq of 99Tcm> MDP was administered. Blood was taken for white cell labelling 90 min prior to MDP imaging. The MDP images showed intense uptake at the osteotomy sites, but were otherwise normal (Fig. la).

Immediately after the MDP bone scan images had been obtained, 15.4 MBq of 111 In WBC were injected. Three hours later, the knees were imaged with the same gamma camera (IGE400A) fitted with a high energy collimator. Energy windows were reset to include the two 111 In peaks at 170 and 245 keV. An area of activity was seen at the site of each osteotomy with an additional area located between the knees (Fig. lb). This additional area of activity proved not to be contamination as it could be eliminated by moving one or other knee out of the field of view.
Computerized calculation of radiation dose to patients from radiography
Authors: Chappie C.-L. , Faulkner K.
Published: July 2009

Further details concerning the computer programs are available from the authors.

There are a number of occasions on which it may be necessary to make a retrospective calculation of the radiation dose to a patient. For instance, a fetal dose may need to be determined. Irradiation during pregnancy is avoided whenever possible, but sometimes the patient's condition may be considered to necessitate a radiological examination, or a pregnancy may be unsuspected at the time of the examination. When this occurs the radiation dose, and the associated risk of harm, to the fetus from the X-ray examination should be estimated. Dose estimates may also be requested for a patient who has received an unusually large number of radiographs over a period of time, to assess the cumulative dose to that patient.

Current procedures for making retrospective dose calculations, which are usually performed manually, can be quite lengthy, and require thorough error checking. A computerized method for estimating fetal doses using tissue-air-ratio data has been described (Clarkson & Brennen, 1987), but this requires considerable data preparation and knowledge of the exact area of irradiation.

This article describes a method of automatically estimating patient doses with a microcomputer, using exposure information typed in by the operator and normalized organ dose data (Jones & Wall, 1985) already stored in the computer memory. The software has been derived from that written for an on-line automated quality assurance and dosimetry system which has been described previously (Faulkner et al, 1990).
Ultrasonic appearances of the early changes in fibrodysplasia ossificans progressiva
Authors: McAteer E. J. , Hallam L. A. , Hendry G. M. A.
Published: July 2009

Progressive heterotopic ossification and congenital skeletal anomalies characterize the very rare and relentless condition of fibrodysplasia ossificans progressiva (FOP) or myositis ossificans progressiva (MOP)(McKusick, 1972). These patients frequently present with subcutaneous masses which are often painful (Lindhout & Golding, 1985) and therefore ultrasound may be used in the initial investigation. We report a case of FOP presenting with recurrent soft-tissue swellings and demonstrate the ultrasonic appearances not previously documented in this condition.

A 5-year-old boy first presented with a history of pain in his right knee following a minor injury. Radiographs showed an apparent simple exostosis arising from the medial side of the proximal tibial metaphysis (Fig. 1); no further investigations were performed at this time. He presented again several months later with a swelling in the subcutaneous tissues of the left anterior thigh and with pain on walking. No soft-tissue abnormality was identified on the radiographs. Ultrasonic examination using a Diasonics 5 MHz rotating transducer demonstrated an increase in the thickness of the soft tissues and a well defined hypoechoic lesion with an echogenic central region in the deep compartment of the anterior thigh (Fig. 2). When radiographs were repeated 3 months later ossification had taken place in this area (Fig. 3.).

Further similar swellings developed in the para-vertebral tissues of the lumbar region and around the right scapula. Ultrasound now demonstrated separation of the normal muscular fasicular planes by echogenic material together with increase in the muscle size (Fig. 4).
Cystic lymphangioma of the pelvis in childhood
Authors: Hoeffel J. C. , Marchal A. L. , Pierre E. , Derelle J.
Published: July 2009

We report a case of a multicystic retroperitoneal lymphangioma appearing in an infant as an inguinal mass.

A 1-year-old boy presented with a right inguinal mass which had the appearance of a lymph node. After biopsy, the pathologist reported “non-specific adenitis”. Six weeks later the boy was admitted because of a recurrent swelling. The inguinal mass was large and irreducible. On urography, the bladder was displaced to the left and there was a right hydronephrosis.

A barium enema demonstrated upward displacement of the ascending colon.

Ultrasound examination showed a large inguinal mass of 8 cm, with solid and liquid areas (Fig. 1). The right ureter was dilated and displaced by the tumour.

On computed tomography (CT), a large tumour was demonstrated (Fig. 2) extending from the aortic bifurcation down to the right inguinal area. It contained fluid levels and areas of mixed density from 25 to 100 Hounsfield Units. Posteriorly, the tumour extended to the right ileo-psoas and anteriorly to the abdominal wall. There was no enhancement after an intravenous injection of contrast medium but the vessels were clearly visible (Fig. 3) within the mass. A diagnosis of cystic lymphangioma was made because of the association of fluid levels with solid areas.
A case of post-operative paresis
Authors: Olliff J. F. C. , Gwyther S. J. , Hart G.
Published: July 2009

An 82-year-old man was admitted for biopsy of an anal mass lesion. Histology revealed a moderately well differentiated squamous cell carcinoma originating at the anal margin. Post-operative pyrexia resolved with intravenous antibiotics. Five days after this he developed neck stiffness, urinary retention and left-sided weakness with a sensory level at C4. Radiographs of the cervical spine were obtained and a cervical myelogram performed (Figs 1 and 2).

What features are seen on the two examinations and what are the likely causes?

The cervical spine radiograph (Fig. 1) shows degenerative changes with reduced height of the disc joint and osteophyte formation at C5/6 and C6/7. The height of the disc joint is also reduced at C3/4 with grade 1 backward slip of C3 on C4. The marginal hypertrophic changes are relatively slight. Subtle prevertebral softtissue swelling can be recognized anteriorly at this level. The myelogram shows almost complete obstruction to flow of contrast medium at the level of the C4/5 disc joint. The theca is displaced posteriorly at this level and the appearances would be in keeping with an extradural obstruction: only a small amount of contrast medium being visible superiorly at C2.

Magnetic resonance imaging (MRI) of the neck was undertaken. The sagittal T  1, weighted (time to repeat (TR) 500 ms, time to echo (TE) 17 ms) image demonstrates abnormal low signal in the vertebral bodies of C3 and C4 with thickening of the pre-vertebral, retropharyngeal soft tissues anteriorly (Fig. 3a).
Mathematical models of repopulation and reoxygenation in radiotherapy
Authors: Scott O. C. A.
Published: July 2009

Mathematical models of the effect of ionizing radiation on tumours have not, so far, received general acceptance, and Wheldon (1989) warns of the dangers of over-generalization. Nevertheless, the construction of models may have a certain value, in that we are forced to define our assumptions with clarity.

It is interesting to compare two models which have been described in the columns of the BJR: “Misonidazole in fractionated radiotherapy: are many small fractions best?” (Denekamp et al, 1980) and “The linear-quadratic formula and progress in fractionated radiotherapy” (Fowler, 1989). The former gives a detailed description of the possible effect of reoxygenation on tumour response, but excludes repopulation. The latter is much concerned with repopulation, but excludes reoxygenation. Evidence that hypoxic cells may be important in the clinical response of tumours has been published recently (Gatenby et al, 1988; Whittle et al, 1990), and it would appear to be logical to combine the two models.

Denekamp et al give a full description of their model, and any computer-literate reader could reconstruct the programs from which they worked. The addition of repopulation is a simple matter, but the marriage of the two programs forces us to face an interesting question: which class of cells repopulates, the oxic or the hypoxic? The work of Tannock (1968), also quoted by Suit et al (1977), suggests that cells deprived of both oxygen and nutrients in a tumour cord are less likely to divide.
Urinary tract dilatation in constipated children
Authors: Herbetko J. , Hyde I.
Published: July 2009

Abnormalities of the upper urinary tract were sought retrospectively in 180 children with constipation who had been investigated surgically over a 5-year period. Of those in whom an intravenous urogram had been performed, the incidence of dilatation of the upper renal tract was high, but only 12% of the patients with non-organic constipation had been so investigated.
A clinical application of iodine quantitation using digital fluorography
Authors: Thompson W. D. , Kotre C. J. , Owen J. P. , Laker M. F.
Published: July 2009

A preliminary clinical study of 20 patients is described in which a method of iodine quantitation in vitro using digital fluoroscopy was applied to the intravenous urogram. It was possible to quantitate iodine levels, in terms of mass thickness, in both the renal parenchyma and collecting system in 38 of 40 kidneys studied (20 patients). In the two kidneys on which measurements could not be made, the cause of failure was subtraction artefact due to movement of bowel gas, compounded in one case by poor renal opacification. The variations of iodine mass thickness against time were plotted and their forms were similar to dynamic computed tomography and magnetic resonance imaging studies of transplanted kidneys. Potential clinical applications of this method, in particular the functional assessment of the dilated upper urinary tract, are suggested based on its ability to offer quantitative information in addition to anatomical images.
A model for hematopoietic death in man from irradiation of bone marrow during radioimmunotherapy
Authors: Scott Bobby R. , Dillehay Larry E.
Published: July 2009

There are numerous institutions worldwide performing clinical trials of radioimmunotherapy (RIT) for cancer. For RIT, an exponentially decaying radionuclide is attached by using a chelating agent to a specific monoclonal or polyclonal tumour antibody (e.g. antiferritin IgG). The major limitation to RIT is toxicity to normal tissue in organs other than the one containing the tumour (e.g. bone marrow). The focus of this manuscript is on modelling the risk (or probability) of hematopoietic death in man for exponentially decaying patterns of high-energy β irradiation (e.g.  90Y) of bone marrow by radioimmunoglobulin injected into the blood. The analytical solutions presented are only applicable to protocols for which significant uptake of radioactivity by the bone marrow does not occur, and only for high energy β emitters. However, the generic equation used to obtain the analytical solutions is applicable to any continuous pattern of high energy β irradiation. A model called the “normalized dose model” was used to generate calculated values for the LD50 as a function of the effective half-time for the radioimmunoglobulin in the blood. A less complicated empirical model was used to describe the calculated values. This model is presumed to be valid for effective halftimes in blood of up to about 20 days. For longer effective half-times, the LD50 can be estimated using the normalized-dose model presented. In this manuscript, we also provide a modified Weibull model that allows estimation of the risk of hematopoietic death for single or multiple injections (in one cycle) of radioimmunoglobulin, for patients with normal susceptibility to irradiation and for patients with heightened susceptibility. With the modified Weibull model, the risk of hematopoietic death depends on the level of medical treatment provided to mitigate radiation injuries.
Lack of late skin necrosis in man after high-dose irradiation using small field sizes: experiences of grid therapy
Authors: Shirato H. , Gupta N. K. , Jordan T. J. , Hendry J. H.
Published: July 2009

Out of a total of 437 patients with superior vena caval syndrome or advanced malignancy, given single-dose grid radiotherapy, four survived to 7 years. The dose to the skin under each of the 77 holes in the grid was approximately 58 Gy. The lack of skin necrosis in the total of 308 skin circles of 1 cm diameter among these survivors, compared with known necrosis rates in larger irradiated areas, implies that there is a marked field-size effect for late necrosis in small areas of irradiated skin.
A rapid method of production of irregular-shaped fields for use with patients receiving electron radiotherapy
Authors: Plane J. H. , Usher C.
Published: July 2009

This technical note describes a method to produce irregularly-shaped electron fields using a polystyrene shape to form the irregular outline, low melting point alloy and modified electron applicators. The method supports a procedure for irregular-field electron therapy which rapid, cheap, accurate and provides a permanent record of the field treated.
Calibration of radiotherapy beams using a PC-based dosimetry recording system
Authors: Kenny M. B. , Millar R. M.
Published: July 2009

Routine calibration of radiotherapy treatment units involves the following steps:

1. radiation measurement under standardized conditions;

2. recording of the resultant data;

3. applying correction factors to the data which take into account the response of the calibrating instrument, the effects of the measurement geometry and the beam type, etc.;

4. scrutinizing the results for significant changes in output from previous calibrations and, if necessary, making appropriate adjustments to the machine's dosimetry system;

5. recording all calculations and sundry other relevant information including date, time, operator, temperature, and barometric pressure etc.;

6. issuing a calibration certificate which either states the machine output or attests that the dosimetry system is set within acceptable tolerances.
Ultrasound cystography: a valuable technique
Authors: Coulden R. A. , Hanbury D. C. , Farman P.
Published: July 2009

Ultrasound is a reliable method for demonstrating dilated upper renal tracts and obstruction (Scheible & Talner, 1979). However, not all dilated pelvicalyceal systems and ureters are obstructed (Flower, 1977). Similar appearances can be seen in vesico-ureteric reflux (VUR), megaureter and pregnancy (Cietak & Newton, 1985). Where there is doubt concerning the cause of dilatation, other techniques are required.

Ultrasound cystography, performed as a part of micturating cystography, has been shown to be useful in demonstrating VUR in children (Kessler & Altman, 1982). In this case report, we demonstrate its wider application in the distinction between obstruction and VUR in a complex urological problem.
The value of computed tomography in the diagnosis of atlanto-axial rotatory fixation
Authors: Murray J. B. , Ziervogel M.
Published: July 2009

A 10-year-old girl was examined in Casualty complaining of a torticollis with her head looking downwards and to the right, which had developed suddenly that morning as she was drying herself after a bath. She had no neurological signs or symptoms. Interpretation of her cervical spine radiographs was difficult owing to her inability to move her neck for proper radiographic positioning (Fig. 1). She was given a soft collar and sent home.
The nidus of an osteoid osteoma mimicking an os supratrochleare dorsale
Authors: Roberts P. , Davies A. M. , Starkie C. M. , Grimer R. J.
Published: July 2009

Osteoid osteomas arising in an intra-articular or paraarticular site can present a diagnostic problem, particularly when occurring around the elbow. The adjacent joint can show evidence of synovitis and proliferative arthritis, and on radiographic examination new bone formation may be slight or absent and the nidus invisible (Marcove & Freiberger, 1966; Moreton & Bartlett, 1966; Corbett et al, 1974; Cronemeyer et al, 1981; Clarke et al, 1981). These atypical features can lead to misdiagnosis of this condition. We present a further cause of misinterpretation of osteoid osteomas around the elbow, that of the nidus mimicking an os supratrochleare dorsale.
Book reviews
Authors: Gordon I.
Published: July 2009

The aim of this monograph is to provide information on the techniques available and the indications for digital subtraction angiography (DSA) in infants and children. The monograph covers the basic physics and general techniques as well as specific chapters on different body systems. The final chapter looks at the future applications of digital imaging.
Book reviews
Authors: Whitehouse G. H.
Published: July 2009

The title of this book is a misnomer in that, while the bulk of it is devoted to mammography, ultrasound is compressed into one brief chapter and there is no mention of the adjunctive, albeit minor, roles of computed tomography and magnetic resonance imaging. There are introductory chapters on the anatomy and pathology of the breast, and on the clinical diagnosis of breast masses. The latter, by a surgeon, surprisingly still describes the use of frozen sections. A chapter on the physics of mammography deals with the subject in a practical and comprehensive manner. However, the description of grids could have been expanded, particularly in regard to the trade off between contrast improvement and patient dose.