bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction of patient doses from barium meal and barium enema examinations through changes in equipment factors
Authors: Martin C J , Hunter S
Published: July 2009

A study of patient doses for barium meal and barium enema examinations has been made for X-ray departments throughout Grampian Region. Dose-area products are substantially less than UK reference levels. Contributions from fluoroscopy and radiography varied significantly between different units, with fluoroscopy making up 35–92% of the mean doses for barium meals and 24–57% for barium enemas. Equipment related factors had a greater influence on patient doses than radiologists' techniques. The gain of the image intensifier and the exposure factors selected by the automatic exposure control (AEC) were the most important factors determining doses for fluoroscopy. Changes in kV/mA factors selected by the AEC have allowed reductions of 20–50% to be made in effective dose from fluoroscopy with some units. The method used for recording images was the major influence on radiographic doses. Digital spot images or fluorographic films taken from the intensifier gave only 10–20% of the dose with a film/screen system and are recommended where the image quality is satisfactory for the application. Changes in film/screen systems have given worthwhile reductions in radiographic doses. If all factors are optimized, mean doses for barium examinations could be reduced to 20% of current reference levels.
Precision and accuracy of measurements of whole-body bone mineral: comparisons between Hologic, Lunar and Norland dual-energy X-ray absorptiometers
Authors: Tothill P , Avenell A , Reid D M
Published: July 2009

Measurements of whole-body bone mineral made by Hologic, Lunar and Norland dual-energy X-ray absorptiometers have been compared. It was found that in each case the results were changed by new software protocols introduced by the manufacturers during the course of the study. With a moderately anthropomorphic model, the later software corrected some anomalies of regional bone mineral content (BMC) observed earlier. There was some slight dependence of total BMC on thickness and fat proportion and up to 15% difference between instruments. Measurements on volunteers showed good precision, but there were differences between instruments made by different manufacturers. There were high correlations, but the slopes of regression lines suggested differences of calibration of up to 8%; the standard errors of the estimates were 110 to 190 g, with maximum deviations from regression of 17%. There were regional disparities in BMC, particularly in the trunk, which arise (in part at least) from the imposition of a higher bone threshold by Hologic. From the pattern of results it was concluded that different assumptions were made by the manufacturers, particularly concerning the fat distribution model, which preclude the interchangeability of results from different instruments.
Book reviews
Authors: Faulkner K
Published: July 2009

This book is intended as an introductory text book on medical imaging, however the emphasis is very much on reconstruction techniques and imaging devices employing them. Readers expecting to read about films/screens, image intensifier television systems and computed radiography, as implied by the general nature of the title, will be disappointed. The treatment of the subjects is rigorous though it is not a textbook for the mathematically compromised. The section on the photoelectric effect is shorter than that on the marked transform. The description of each modality included in the book is of a very high standard. It clearly indicates that the authors have a comprehensive knowledge and insight into the subject matter.
Book reviews
Authors: Cherryman G R
Published: July 2009

Today cardiologists use ultrasound on the majority of their patients. The stethoscope has been superseded by this versatile and costeffective technology which delivers both anatomic and functional information. Cardiac Ultrasound is written by cardiologists for cardiologists. Practising radiologists will also find much of interest and importance. Ultrasound is only one of the present generation of rapidly developing cardiac imaging modalities. Those of us working in cardiac MRI or spectroscopy, SPECT and PET need to understand the present role and future of cardiac ultrasound as much as any radiologist already involved in providing an “echo” service.
The siting of consistency checks on mobile image intensifier automatic brightness controls
Authors: Nicholson R A
Published: July 2009

In recent years, it has become widespread practice for radiographers to perform basic QA tests at regular intervals on X-ray equipment. One of the more important tests is assessment of the consistency of the automatic brightness control (ABC) of image intensifiers (Us). Should this drift, raised dose rates may go undetected for several months, until the next service or routine physics inspection. A common consistency check involves recording the operating tube voltage and tube current when different thicknesses of absorbing material are placed in the beam (normally 1 mm and 2 mm copper).
Book reviews
Authors: Banerjee A K
Published: July 2009

There can be very few radiologists who are unaware that 1995 is the centenary of Röntgen's discovery of X-rays. This anniversary has led to a sudden resurgence of interest in the history of radiology.

Dr Mould's scholarly monograph is a timely contribution to the radiological history literature. The book is a fascinating read. The introductory chapters are on the discovery of X-rays by Röntgen and radioactivity by Becquerel.
Book reviews
Authors: Hughes P M
Published: July 2009

This Radiologic Atlas of Bone Tumors is a completely revised second edition of an atlas published in 1973 by the Netherlands Committee on Bone Tumours (NCBT). More than 7000 pathologically proven cases of malignant and benign bone tumours and lesions simulating a bone tumour have been evaluated by the NCBT since its inception, forming the basis for a comprehensive demographic and pictorial review.
Angiographic contrast media relax isolated rabbit aorta through an endothelium-independent mechanism that may not depend on the presence of the iodine atom
Authors: Pugh N D , Hutcheson I R , Edwards D H , Nossen J Ø , Karlsson J O G , Griffith T M
Published: July 2009

Systemically administered iodinated angiographic contrast media evoke vasodilatation through mechanisms that are at present poorly understood. In the current investigation we have evaluated the role of the vascular endothelium in responses to an iso-osmolar formation of the non-ionic dimer iodixanol and a hyperosmolar formulation of the non-ionic monomer iopromide. Isolated rabbit aortic ring preparations with endothelium intact or removed by gentle abrasion were mounted in organ baths containing oxygenated Holman's solution, and cumulative concentration–response curves for relaxation to the contrast media were constructed after pre-constriction by phenylephrine (300 nM) in the presence of indomethacin to inhibit prostaglandin synthesis. Endothelial denudation did not influence the ability of either iodixanol or iopromide to relax the aortic ring preparations. Iopromide was significantly more potent than iodixanol when expressed in terms of iodine concentration (mg I ml−1), but both agents were equipotent when expressed in terms of molarity (mM). We conclude that relaxation of isolated rabbit aortic rings to iodixanol and iopromide under conditions where there is no fluid flow is endothelium-independent, and therefore not mediated by release of the potent endogeneous nitrovasodilator endothelium-derived relaxing factor (EDRF). Furthermore, their relaxant activity under the in vitro experimental conditions employed is attributable to a direct action on vascular smooth muscle by factors in addition to osmolality, and may depend on features that are not specifically associated with the presence of the iodine atom.
Organized chaos? Computed tomographic evaluation of the neuropathic diabetic foot
Authors: Griffith J , Davies A M , Close C F , Nattrass M
Published: July 2009

Accurate radiographic evaluation of diabetic neuroarthropathy is increasingly difficult as the disease becomes more florid. 22 patients with a known diabetic neuroarthropathy of one or both feet were prospectively examined by computed tomography (CT) in the axial and coronal planes. Bilateral changes of a neuroarthropathy were present in 75% of cases. Distinct patterns of disease were seen and categorized into five types in order of increasing severity. Changes at the medial tarsometatarsal joints and adjacent intercuneiform joints were seen in all affected feet. More extensive disease involved the medial arch more commonly than the lateral. Fractures of the tarsal bones were found in 32% of cases and were associated with neuroarthropathic changes in adjacent joints. Calcaneal fractures were seen in four feet. A Lisfranc fracture–dislocation was present in 41% of cases and a bilateral in only 21%. A single CT examination of the foot, while an accurate method of demonstrating the extent of the disease, is an insensitive indicator of disease activity.
Idiopathic isosexual central precocious puberty: magnetic resonance findings in 30 patients
Authors: Robben S G F , Oostdijk W , Drop S L S , Tanghe H L J , Vielvoye G J , Meradji M
Published: July 2009

The purpose of this prospective study was to define the incidence of magnetic resonance imaging (MRI) abnormalities in the brain in patients with idiopathic central precocious puberty without any additional neurological signs and symptoms, and to evaluate the routine use of gadolinium contrast in these patients. 30 patients (29 girls, one boy; age range 1.9–11.9 years) with idiopathic central precocious puberty were studied. MRI of the brain in axial, coronal and sagittal planes was performed before and after administration of gadopentetate dimeglumine, with special attention to the region of the third ventricle. There are three major findings: (1) the height of the pituitary gland is increased up to adult size compared with normal individuals; (2) in four patients (13%) major structural abnormalities were found; three hamartomas of the tuber cinereum and one gliomatous process extending from the chiasm to the optic tract; and (3) the routine use of gadopentetate dimeglumine did not reveal new abnormalities although the lack of enhancement made a positive contribution to diagnostic certainty. We conclude that contrast enhanced MR examination is a safe and reliable method for the exclusion of abnormalities in children with precocious puberty and for the follow-up of those patients in whom abnormalities are present.
A hamartoma presenting as a giant oesophageal polyp
Authors: Halfhide B C , Ginai A Z , Spoelstra H A A , Dees J , Vuzevski V D
Published: July 2009

Giant oesophageal polyp (GOP) is a very rare intraluminal tumour. It is usually a benign, fibrovascular polyp arising from the proximal third of the oesophagus. We describe a patient with such a polyp but with a histological diagnosis of hamartoma. Regurgitation of the polyp into the mouth, which can lead to asphyxia, is a feared complication. A barium swallow and oesophagoscopy are the common diagnostic procedures. The site of the polyp and its volume often define the method of resection.
Archives of Clinical Skiagraphy (1896)
Authors: Rowland S
Published: July 2009

The object of this publication is to put on record in permanent form some of the most striking applications of the New Photography to the needs of Medicine and Surgery.

The progress of this new Art has been so rapid that, although Prof. Rontgen's discovery is only a thing of yesterday, it has already taken its place among the approved and accepted aids to diagnosis. At the first moment, the statement that it had been found possible to penetrate the fleshy coverings of the bones, and to photograph their substance and contour, seemed the realization of almost an impossible scientific dream. The first essays were of a rough and imperfect character; week after week, however, improvements have been made in the practical application of the Art, which I venture to call Skiagraphy; and, at the present time, we are in a position to obtain a visible image of every bone and joint in the body.
MBS: a model for risk benefit analysis of breast cancer screening
Authors: Jansen J Th M , Zoetelief J
Published: July 2009

Breast cancer screening programmes employing mammography are being implemented in various European countries. Different screening protocols are used in demonstration projects and nationwide programmes. To evaluate and improve protocols, a computer model for the evaluation of breast cancer screening has been developed. The availability of such a model can be of great importance in obtaining a better insight into the influence of various parameters. The Monte Carlo computer model is based on random selection from distributions of relevant parameters including tumour onset, tumour growth rate, lifetime expectancy, tumour detection size for screening and spontaneous observation. The radiation risk is calculated for various screening protocols employing multiplicative and additive risk models combined with lifetime expectancy, number of females screened and absorbed dose per screening session. The benefit is calculated on the basis of the reduction in tumour size at detection due to screening compared with spontaneous observation and the survival as a function of tumour diameter. Data from the Swedish two-county study are used to validate the model in terms of prevalence, interval tumour rates and interval tumour diameter distributions. Except for the spontaneous tumour diameter distribution, the model can describe the Swedish two-county study. Specific information is presented on the distributions of relevant parameters.
Computer planning of stereotactic iodine-125 seed brachytherapy for recurrent malignant gliomas
Authors: Hughes S W , Sofat A , Kitchen N D , Brown A , Beaney R P , Timothy A R , Saunders J E , Thomas D G T
Published: July 2009

At St Thomas' Hospital, we have developed a computer program on a Titan graphics supercomputer to plan the stereotactic implantation of iodine-125 seeds for the palliative treatment of recurrent malignant gliomas. Use of the Gill–Thomas–Cosman relocatable frame allows planning and surgery to be carried out at different hospitals on different days. Stereotactic computed tomography (CT) and positron emission tomography (PET) scans are performed and the images transferred to the planning computer. The head, tumour and frame fiducials are outlined on the relevant images, and a three-dimensional model generated. Structures which could interfere with the surgery or radiotherapy, such as major vessels, shunt tubing etc., can also be outlined and included in the display. Catheter target and entry points are set using a three-dimensional cursor controlled by a set of dials attached to the computer. The program calculates and displays the radiation dose distribution within the target volume for various catheter and seed arrangements. The CT co-ordinates of the fiducial rods are used to convert catheter co-ordinates from CT space to frame space and to calculate the catheter insertion angles and depths. The surgically implanted catheters are after-loaded the next day and the seeds left in place for between 4 and 6 days, giving a nominal dose of 50 Gy to the edge of the target volume. 25 patients have been treated so far.
Book reviews
Authors: Faulkner K
Published: July 2009

This is the eighth edition of a long established American textbook, the first edition being published in 1954. The book is intended for radiography students and the latest edition reflects recent changes to the curriculum guide of the American Society of Radiologic Technologists.
Chest radiograph appearance at 24 h of age—prediction of chronic oxygen dependency
Authors: Giffin F , Greenough A , Karani J
Published: July 2009

Chronic oxygen dependence is associated with immaturity, male sex and low birthweight, but amongst that high risk group further criteria are necessary to predict those most at risk. We previously developed a chest radiograph scoring system which, when used at 1 month of age, proved useful in predicting chronic oxygen dependency at 36 weeks post-conceptional age (PCA). We have now assessed whether the scoring system, if applied at 24 h of age, added predictive value to readily available demographic and ventilatory data. 50 infants, birthweight less than 1200 g and ventilated from birth, were examined. They had a median gestational age of 27 weeks (range 23–34), birthweight of 886 g (range 470–1172) and chest radiograph score of 7 (range 2–13). Univariate analysis revealed that oxygen dependency at 28 days and 36 weeks PCA was significantly associated with low gestational age, male sex and high ventilatory requirements, in addition to a high chest radiograph score. Stepwise regression analysis, however, demonstrated that a high chest radiograph score predicted oxygen dependence at 28 days, independent of immaturity, low birthweight, male sex and high ventilatory requirements. A chest radiograph score of more than 5 rendered an infant four times more likely to be oxygen dependent at 28 days than those with lower scores. We conclude the chest radiograph appearance at 24 h of age could be used as a criterion to institute interventional strategies aimed at reducing chronic oxygen dependence.
Cervical lymphadenopathy: ratio of long- to short-axis diameter as a predictor of malignancy
Authors: Steinkamp H J , Cornehl M , Hosten N , Pegios W , Vogl T , Felix R
Published: July 2009

The purpose of this study was to evaluate short- and long-axis diameters of enlarged cervical lymph nodes with ultrasonography and to determine whether the long-to-short axis (1/s) ratio is a valid diagnostic parameter in the differentiation between benign and malignant nodal disease. 730 enlarged cervical lymph nodes in 285 patients were examined with ultrasound. The short- and the long-axis diameters of each enlarged node were measured and the 1/s ratio calculated. Definite diagnoses of the nodes were obtained by histological examination following neck dissection. 95% of enlarged cervical nodes shown on ultrasound to have a 1/s ratio of more than 2 were correctly diagnosed as benign. Nodes presenting with a more circular shape and a 1/s ratio of less than 2 were diagnosed correctly as metastases with 95% accuracy. The 1/s ratio of lymph nodes thus provides an excellent criterion for differentiation between benign and malignant enlargement in cervical lymphadenopathy.
The role of flow cytometry in non-resected cervical carcinoma
Authors: Tang G-J S , Sun C-F , Lin F-J , Tsao K-C
Published: July 2009

Flow cytometry (FCM) has a prognostic value for many malignant neoplasms in terms of treatment response rate and survival. However, its role in non-resected cervical carcinoma remains uncertain. We have collected 96 paraffin-embedded specimens taken from non-resected cervical cancer patients treated by radiotherapy (RT) alone between 1984 and 1986. Our data revealed that FCM has little correlation with patients' age, pathological grade and clinical stage. Ploidy pattern and clinical stage correlate significantly with complete remission (CR) rate (p = 0.001 and 0.03). Most diploid or low-stage tumours (IB to IIA) obtained CR after RT alone. The application of an intravaginal extension electron cone (IVEC) (p = 0.019) and CR status (p = 0.0001) yield significant better overall survival (OS) rates than their alternative groups. The Cox regression model has confirmed these two variables as having an independent influence on OS. We thus conclude that both ploidy pattern and S-phase fraction (SPF) predict neither pre-treatment biological behaviour of the tumours nor overall survival. However, ploidy pattern has an independent influence on CR rate.
Radiation doses to paediatric patients undergoing micturating cystourethrography examinations and potential reduction by radiation protection optimization
Authors: González L , Vañó E , Ruiz M J
Published: July 2009

Dose–area product values were measured in paediatric micturating cystourethrography examinations in two dedicated facilities. The results are compared, taking into account features of the X-ray rooms and differences in examination protocol. Several optimization procedures were simulated or implemented, in order to estimate the dose savings which could be attained. Potential savings identified in the dose–area values reach about 85% for both centres.
Normal tissue injury after cancer therapy is a local response exacerbated by an endocrine effect of TGFβ
Authors: Anscher M S , Kong F-M , Murase T , Jirtle R L
Published: July 2009

The sensitivity of normal tissues rather than of the tumour usually limits the effectiveness of cancer treatment. The normal tissue side effects from chemotherapy and/or radiotherapy result from both direct cellular loss and the extensive fibrosis that develops at the site of injury. Recent evidence suggests that the cytokine, transforming growth factor β (TGFβ), mediates this fibrogenic process. Herein, we provide evidence in support of the hypothesis that the fibrosis formation following therapy results not only from TGFβ produced locally in the injured normal tissue, but also from circulating TGFβ released by the tumour. Thus, therapy-induced normal tissue damage appears in part to be a local manifestation of a systemic condition.
Mediastinal lymph node size in an Asian population
Authors: Murray J G , O'Driscoll M , Curtin J J
Published: July 2009

There is a high incidence of respiratory tuberculosis in the British population of Indian subcontinent (Asian) ethnic origin. Granulomatous diseases can cause long term lymph node enlargement. Separate computed tomography (CT) criteria for normal nodal size could therefore be necessary when staging thoracic malignancy in Asian patients. The objective of this study was to measure mediastinal lymph node size in an Asian population, and to correlate nodal size with previous tuberculosis. Chest CT scans on all Asian patients over a 5 year period were reviewed and those with pulmonary disease, malignancy or grossly distorted anatomy were excluded. The study group consisted of 48 patients (26 male, 22 female) aged 10–75 years (mean 47 years). All nodes were measured and the site of those greater than 7 mm was recorded using the American Thoracic Society (ATS) lymph node map. 81.3% of patients had nodes less than or equal to 7 mm at all ATS stations, 10.4% had nodes of 8–10 mm and 8.3% had nodes greater than 10 mm. All nodes measuring more than 7 mm were in regions 4R, 10R and 7. Fourteen patients had signs of previous tuberculosis, and in this group 50% had nodes greater than 7 mm as compared with 6% in the group with no signs of previous tuberculosis (p < 0.001, χ2 test). Despite these differences only four of the 48 patients (8.3%) had nodes greater than 10 mm, which is in keeping with other general population studies. Thus the generally accepted size criteria for mediastinal lymph node enlargement (greater than 10 mm) can reasonably be applied to all Asian patients when staging lymphoma or bronchogenic carcinoma.
Functional magnetic resonance imaging at 1 T: motor cortex, supplementary motor area and visual cortex activation
Authors: Santosh C G , Rimmington J E , Best J J K
Published: July 2009

Functional activation of the brain has been visualized using magnetic resonance imaging (MRI). Early studies used echo planar imaging and magnetic fields of 2 T and above. However, recent studies have successfully shown the activation of visual and motor areas of the brain using conventional clinical 1.5 T MRI systems. The purpose of the present study was to replicate these studies at a lower field strength. Eight motor and two visual activation studies were performed using a 1 T clinical scanner. Activation was seen in the contralateral motor cortex during motor stimulation in six of the eight volunteers. Activation was also documented within the contralateral supplementary motor area in four of the six volunteers with motor cortex activation. The supplementary motor area was located in the posteromedial aspect of the superior frontal gyrus. Both volunteers subjected to photic stimulation showed activation within the visual cortex. Results show that functional imaging can be successfully carried out with a 1 T clinical scanner. The size of the image intensity on activation change suggests that contrast may not be due solely to susceptibility changes.
A comparison of the effects of methotrexate and misonidazole on the germinal cells of the subependymal plate of the rat
Authors: Morris G M , Hopewell J W , Morris A D
Published: July 2009

The cytotoxic effects of the drugs methotrexate (MTX) and misonidazole have been assessed in the rat brain by quantifying changes in the constituent cell populations of a glial cell progenitor layer, the subependymal plate (SEP). Three distinct cell types can be identified in the SEP on the basis of their nuclear morphology: cells with small dark (SD), small light (SL) or large light (LL) nuclei. The cells with SD nuclei may represent pluripotential glial cell precursors. A reduction in the total nuclear density of the SEP, after the local ventricular administration of MTX, could be accounted for largely by a loss of cells with SD nuclei; to ∼45% of control values 2 days after MTX followed by a full recovery in numbers by day 5. A further decline in the number of cells with SD nuclei occurred at 12 weeks after MTX administration. The pattern of changes in the cellularity of the SEP, after misonidazole administration, were similar to those observed after MTX treatment, although the magnitude of the response was reduced. It was concluded that both drugs, but MTX in particular, could have a potential additive effect on glial progenitor cells when used in combination with other forms of cancer therapy including radiation.
Multimedia clinical records: results of a pilot project at the Radiation Therapy Department of Florence
Authors: Santoni R , Cellai E
Published: July 2009

A system based on Macintosh™, Hypercard™ and a local network was developed at the University and Hospital Department of Radiation Therapy, Florence, Italy, to manage the clinical records as a complex data structure (data, texts, drawings and image storage and retrieval). After 4 years, the system produces over 2000 new charts a year and manages more than 15000 clinical records. Electronic records are produced, printed and updated in their traditional form to be put on file in our archive. On-line consultation of the clinical records is possible from every workstation of the structure even as it is producing, updating, or printing a chart. Physicians and clinical clerks, with different access privileges, currently use the system for all these purposes. The clinical records are typed by secretaries who receive dictation on microcassettes. No extra staff were necessary to set up and manage the system and training was simple. The new system changed neither the organization and structure of the traditional records, nor the flux of information; new tools (computers, printers and a network) were introduced to manage the information and the charts. The author describes the aims of the original project and the result.
Book reviews
Authors: Allan R
Published: July 2009

In his preface to the first edition of this book the author stated that “this book is a review of approaches to the evaluation of vascular disease and the way in which duplex scanning plays a role in that evaluation”.
Book reviews
Authors: Sanson H
Published: July 2009

This pocket atlas, in two soft covered volumes, is solely devoted to CT and MRI cross-sectional anatomy. It contains 250 images from the head, neck, spine, thorax, abdomen, pelvis and joints.
Book review
Authors: Padley S
Published: July 2009

This relatively affordable 1300 plus page book is primarily aimed at radiologists in training. Indeed the authors state in their preface that “we wrote this text to provide a complete yet concise beginning in radiology”, and go on to say that they visualize this book being used in two major fashions both as “the beginning resident's first reader and the graduating resident's last reader”.
Predicting local recurrence by correlating pre-operative mammographic findings with pathological risk factors in patients with breast cancer
Authors: Macmillan R D , Purushotham A D , Cordiner C , Dobson H , Mallon E , George W D
Published: July 2009

The pre-operative mammograms for 231 patients undergoing conservation surgery for breast cancer between March 1988 and September 1992 were analysed for features that may predict the presence of pathological risk factors of local recurrence (residual microscopic disease, extensive intraduct carcinoma (EIC) and lymphatic/vascular invasion). Residual microscopic disease was detected in 40% of patients and was associated with a DY mammographic pattern (p=0.03), casting calcification (p=0.0002) and absence of mammographic nidus (p=0.0006). Residual microscopic disease was found in 75–88.9% of patients when two of these preoperative mammographic features were present in combination. The mean lumpectomy diameter was significantly smaller for patients with DY compared to N.1 mammographic pattern on Wolfe grade (p=0.039). Both residual disease and Wolfe grade were related to age (p=0.0032 and p<0.0001). EIC was found in 22% of patients and was associated with casting (p<0.0001) and non-casting (p=0.04) calcification, absence of mammographic nidus (p<0.0001) and stellate mammographic nidus (p=0.02). No significant association was found between mammographic features and lymphatic/vascular invasion. Pre-operative mammographic features can predict patients likely to have residual microscopic disease or EIC following conservation surgery for breast cancer. These patients should be selected for wider primary excision.
Measurement of human pancreatic perfusion using dynamic computed tomography with perfusion imaging
Authors: Miles K A , Hayball M P , Dixon A K
Published: July 2009

Absolute quantification of pancreatic perfusion in man has been extremely difficult to date. This paper describes a relatively simple application of dynamic computed tomography to provide perfusion imaging of the human pancreas. Values for perfusion in eight normal pancreases ranged between 1.25 and 1.66 ml min−1 ml−1 (mean: 1.52 ml min−1 ml−1). Increased perfusion values were present in a patient with an islet cell tumour (overall perfusion 2.11 ml min−1 ml−1) and a patient with Wilson's disease (3.43 ml min −1 ml−1). Pancreatic perfusion was reduced in a patient with diabetes (0.60 ml min−1 ml−1) and in a failing pancreatic transplant (0.97 ml min−1 ml−1). The combination of functional information and good spatial detail afforded by computed tomography (CT) perfusion imaging means the technique is well suited for the evaluation of the human pancreas. It is currently the only technique which allows non-invasive absolute quantification of pancreatic perfusion.
Volvulus of the splenic flexure in a patient with systemic sclerosis
Authors: Sanderson A J , Elford J , Hayward S J
Published: July 2009

Volvulus of the splenic flexure is described in a patient with systemic sclerosis together with a new radiographic sign which may be helpful in diagnosis.
Book reviews
Authors: Kerslake R W
Published: July 2009

To radiologists, the name of the late Professor Robert Judet is inextricably linked with the eponymous 45° oblique angled views of the acetabulum. The reasons for this are abundantly clear from reading this masterly text which descibes in great detail the pioneering work of Judet and Letournel.
Book reviews
Authors: Britton P D
Published: July 2009

Considering the ever increasing role that ultrasound is playing in breast diagnosis there has been a surprising paucity of books on this subject. The only other substantive volume to be published in the last few years to my knowledge is Ultrasound Mammography by Hackeloer et al. This book is a far superior work and fills the gap in the radiological literature admirably.
The radiation dose to children from X-ray examinations of the pelvis and the urinary tract
Authors: Almén A , Mattsson S
Published: July 2009

X-ray examinations of the pelvis and the urinary tract are frequent examinations of children, in which a large part of the trunk is irradiated. The irradiated volume contains many of the most radiation sensitive organs and tissues. The absorbed dose to children during the examination was estimated from measurements with a dose–area product meter and thermoluminescent dosemeters (TLDs). Entrance surface dose and the dose-area product results are presented. Conversion factors between the entrance surface dose and the organ dose were derived. The energy imparted, organ dose and effective dose were determined. The entrance surface dose for one single exposure varied between 0.32 mGy and 8.6 mGy for the urinary tract examination and between 0.26 mGy and 2.89 mGy per exposure for the pelvis examination. These variations are mainly influenced by the body size of the patient. The number of images taken during one examination varied. For the urinary tract investigation, the average number of exposures was six, while the corresponding number for the pelvis examination was two. The average effective dose for a typical urinary tract investigation ranged from 0.9 mSv to 8.5 mSv and from 0.3 mSv to 1.4 mSv for the pelvis examination. The radiation dose depends greatly on the body size. The recommendations to present the results in relation to age have been followed; however, the variation of body size even within each specified age range is significant. It is suggested that doses should be quoted in relation to a more critical parameter than age.
Vertebral fractures in men and women: how discriminative are bone mass measurements?
Authors: Stewart A , Felsenberg D , Kalidis L , Reid D M
Published: July 2009

Vertebral fractures are associated with osteoporosis. This study examined men and women with vertebral deformation/fractures, as defined by vertebral morphometry. These were compared with a population derived group measured contemporaneously who were defined as having no vertebral deformation/fracture by the radiographs. All patients underwent a dual energy X-ray absorptiometry (DXA) scan of the spine and hip, and a broadband ultrasound attenuation (BUA) scan of their os calcis. The abilities of these two techniques were compared for their discriminatory powers in this type of fracture. The results showed that DXA hip and spine had a better discriminatory power in the female vertebral group compared with BUA. In males none of the bone measurements could discriminate between the fracture and non-fracture groups.
Computed tomography imaging with a radiotherapy simulator
Authors: Engelbrecht J S , Duvenage J , Willemse C A , Lötter M G , Goedhals L.
Published: July 2009

An inexpensive system for obtaining cross-sectional information and accurate body outlines of patients destined for radiotherapy, using a radiotherapy simulator without any major modifications, has been investigated. The image intensifier of the simulator was moved laterally and a narrow fan beam of X-rays passed through the phantom onto the intensifier. Several television (TV) lines of the video signal from the TV camera were digitized by a frame grabber and stored for reconstruction. Multiple projections were acquired by rotating the gantry of the simulator. The field of view was enlarged by increasing the offset distance of the image intensifier and taking two sets of projections. Reconstruction was carried out by using the convolution and back-projection method. The gradient between pixel values in the reconstructed images was used to detect the outlines of structures in the images. The accuracy of outline detection was evaluated with images of a Rando phantom. The outlines of the images were compared with the actual outlines of the phantom. The spatial resolution of the simulator computed tomography (CT) was measured to be 4.05 mm. Large inhomogeneities could be clearly seen. The average difference between the measured and the actual outlines was 3.0 mm with a maximum difference of 10.0 mm at sharp curves in the outline. The simulator CT provides an inexpensive, alternative method of obtaining body outlines and does not require any modifications to the simulator. Data acquisition, processing and display can be performed on a personal computer with image processing facilities.
A lateral will do?
Authors: Tyrrell P N M , Cassar-Pullicino V N , McCall I W
Published: July 2009

Efforts to reduce the dose of diagnostic medical irradiation by applying selective criteria for radiographic examinations have been addressed by the Royal College of Radiologists in their Guidelines. Reduction of the number of views of an area has also been suggested by some authors. Deviating from one of the fundamentals of skeletal radiology which requires at least two views of any part of the skeleton may lead to misdiagnosis. This concept is considered in relation to the lumbar spine. Continued routine acquisition of at least two views for the radiographic examination of the lumbar spine is stressed.
Field matching in craniospinal irradiation
Authors: Tatcher M , Glicksman A S
Published: July 2009

We read with interest the technical note of Cheng et al [1] on the dose in the junction between adjacent orthogonal fields in craniospinal irradiation. For the most part, their results support those reported previously by us [2], and we are pleased to see this independent validation. The modest differences between their dose profiles and ours may be explained by the fact that the composite distributions are sensitive to the behaviour of the dose in and near the penumbra, which may vary for different treatment machines.
Book reviews
Authors: Faulkner K
Published: July 2009

This is the latest in a series of commentaries on various issues associated with radiation protection. These commentaries are intended as briefing statements to stimulate a public debate on specific topics. This commentary describes the issues arising from the need to inform the public about nuclear emergencies. It is interesting to note in passing that in America commerical nuclear power plants are required to notify the authorities within 15 minutes of declaring an emergency.
Book reviews
Authors: Cherryman G R
Published: July 2009

This is the second edition of a well known and highly regarded text. The author is a pathologist with a special interest and international reputation in bone tumours. The book is the careful product of a lifetime's study and thought. Important contributions to the text are made from a radiologist, an orthopaedic surgeon and an orthopaedic oncologist.
Book reviews
Authors: Finch A V
Published: July 2009

Understanding Radiography is a solid book of 17 chapters which sets out to lay a thorough basis for the understanding by technological staff of the photographic and equipment aspects of radiography. The chapter headings include; characteristics of the image, films and screens, automatic processing, exposure factors, the human body as a beam modifier, tomography, film critique, radiation protection, Xray tubes and circuit, TV systems and digital subtraction and finally, computer tomography.
Book reviews
Authors: Cherryman G R
Published: July 2009

Nuclear Cardiology is one of a series of books on practical cardiac diagnosis published by Blackwell Scientific Publications. It has been written to provide practical, almost hands on advice in applying nuclear medicine to cardiac diagnosis and risk stratification. It is aimed at the trainee, the practitioner and the technician.
Percutaneous varicocele embolization in the treatment of infertility
Authors: Ferguson J M , Gillespie I N , Chalmers N , Elton R A , Hargreave T B
Published: July 2009

Clinical and sub-clinical varicoceles are associated with infertility and abnormal sperm parameters. Percutaneous embolization is a minimally invasive, safe, outpatient method of treatment which is cost effective in comparison to surgery. This study is a retrospective review of embolization of the spermatic vein using stainless steel occluding spring coils, performed in 116 males from two infertility clinics. Follow-up results were complete in 87 patients of which 79 (91%) were successful both technically and clinically and all had sperm analysis performed both before and within 2 years after embolization. There was a highly significant increase in motility (mean 35% before, mean 46% after, p<0.001). Sperm density showed a trend towards improvement, but only p<0.10, and there was no significant change in semen volume or morphology. The partners of 29 men (33%) became pregnant in a total of 241 years of follow-up.
Multispiral three-dimensional computed tomography in the investigation of craniosynostosis: technique optimization
Authors: Craven C M , Naik K S , Blanshard K S , Batchelor A G G , Spencer J A
Published: July 2009

21 infants with craniosynostosis were studied with a new three-dimensional (3D) computed tomography (CT) methodology. We describe technique optimization using multiple spiral data acquisitions with low dose (85 mAs) technique. One caudal volume of 3 mm slice thickness was obtained with a further two volumes of 1 mm slice thickness at the vertex. Image reconstruction of spiral raw data allowed overlapping 3 mm sections to be generated without the dose increase that would result from conventional axial CT scanning. We illustrate common technical artefacts of 3D CT and explain their cause and solution. A dramatic dose reduction to the lens was achieved with no loss in 3D image quality. Lens dose was 8.91 mSv compared with 24.6 mSv using the standard paediatric head technique.
Implementation of multiple isocentre treatment for dynamic radiosurgery
Authors: Ramani R , O'Brien P F , Davey P , Schwartz M L , Young C S , Lightstone A W , Mason D L D
Published: July 2009

Radiosurgery using the dynamic rotation technique with a single isocentre was introduced at the Toronto-Bayview Regional Cancer Centre (T-BRCC) in 1988. Since then, over 100 patients have been treated. It was soon recognized that 25–30% of patients were referred with either non-spherical lesions or multiple lesions located sufficiently close together that consideration had to be given to the overlapping dose distributions throughout the treated volume. To treat these more complex targets a multiple isocentre technique was developed which also took account of these effects and the resulting normalization problem. This technique was implemented in September 1992. Comparisons between calculated doses and actual doses delivered have been undertaken using a spherical phantom containing radiochromic film. Measured dose distributions agreed with the planned distributions to within ±1 mm. The effect of multiple isocentres on the penumbra of dose distributions has been examined. The methods adopted for the normalization of treatment plans and clinical examples illustrating the application of the multiple isocentre technique are presented.
The optimization and inherent limitations of 3D conformal radiotherapy treatment plans of the prostate
Authors: Oldham M , Webb S
Published: July 2009

This paper describes the applications of an inverse planning optimization algorithm to the real clinical problem of prostate cancer. The algorithm has been designed to compute optimized beam-weights taking full account of three-dimensional spatial information of dose inside the patient. The algorithm is based on fast simulated annealing, utilizing a cost-function containing both linear and quadratic terms. The linear part of the cost function allows for the implementation of “short-cuts” in the cost-function computation, which reduces the calculation time by a factor of about 30. It has been applied to compute optimized beam-weights for a three-field and a seven-field prostate treatment plan. It is shown for the three-field plan that the optimization algorithm can reproduce, and even slightly improve on, the results of an experienced human planner. For the seven-field plan, the human planner experienced difficulty finding beam-weights that gave an acceptable dose distribution. It is shown that the optimization algorithm can achieve good results in this case. The outcome of the optimization of the seven-field plan prompted an investigation into the best results that could be achieved by an “ideal” conformal radiotherapy technique. The results of this investigation are presented and it is shown that the limiting factor for conformal therapy of the prostate is the size of the overlap volume between the planning target volume (PTV) and the rectum. Finally, the efficiency and accuracy of fast simulated annealing is compared with that of classical simulated annealing. The former was found to be at least 10 times faster for the problem studied.
Pulmonary calcification after liver transplantation in children
Authors: Winter E M , Pollard A J , Chapman S , Kelly D , Spencer D
Published: July 2009

Pulmonary calcification following liver transplantation is a recognized phenomenon in adults but has not been previously described in children. We describe two children who developed pulmonary calcification after liver transplantation. Pulmonary calcification should be considered after liver transplantation when radiographic changes fail to resolve with appropriate treatment.
Bleeding gastric varices secondary to splenic vein thrombosis successfully treated by splenic artery embolization
Authors: McDermott V G , England R E , Newman G E
Published: July 2009

Splenic vein thrombosis is a complication of pancreatic carcinoma or pancreatitis. It may lead to gastric varices which are difficult to treat and splenectomy may be required to stop variceal bleeding. A case of bleeding gastric varices secondary to splenic vein thrombosis and successfully treated by splenic artery embolization is reported. Embolization was performed by transcatheter deposition of four Gianturco coils into the splenic artery. This resulted in reduced blood flow through the spleen with partial splenic infarction and cessation of variceal bleeding. There has been no recurrence of bleeding in the 6 months since the procedure. Literature review confirms that experience of using this treatment is very limited and it should therefore be restricted to patients at high risk from surgery.
Haemangiopericytoma of the oesophagus
Authors: Smith R T , Small W C , Mansour K
Published: July 2009

Haemangiopericytomas are rare, vascular soft tissue sarcomas typically located in the retroperitoneum, pelvis or lower extremities. To our knowledge this neoplasm within the oesophagus has not been reported previously. We present a patient with a haemangiopericytoma of the oesophagus and discuss the radiographic and pathological findings.
Sixth nerve palsy following radiculography
Authors: Lloyd M N H
Published: July 2009

The authors are to be congratulated for an interesting and thought-provoking article [1].

It is clear that myelography does not display the intervertebral discs and the state thereof as the article implies but by inference it does display the effects of a prolapsed/extruded disc upon the subarachnoid space with thecal indentation and nerve root sleeve “amputation”.
Computer aids for decision-making in diagnostic radiology—a literature review
Authors: Taylor P
Published: July 2009

This review looks at a variety of different ways in which computers can be used to assist in the interpretation of radiological images and in radiological decision-making. The issues involved in the design of computerized decision aids are introduced and four criteria proposed for evaluating such aids: need, practicality, veracity and relevance. These criteria are used to assess research into decision aids based on: image databases, numerical methods, expert systems, image processing and image understanding systems. Possible directions for research leading to aids of practical value are discussed in the conclusion.