bluuebunny/crossref_metadata_2025 huggingface dataset:
Calibration of a Microselectron HDR iridium 192 source
Authors: Flynn A. , Workman G.
Published: July 2009

A method for the calibration of the output, in terms of an air kerma rate, of the high activity miniature iridium 192 sources used in the Microselectron HDR afterloading unit is described. An air kerma rate is measured using a calibrated thimble chamber in an “in-air” calibration jig. The results are compared with an air kerma rate derived from the manufacturer's test certificate. In some cases, the ionization chamber measurements have been followed by a further calibration check using thermoluminescent dosimetry. Other checks carried out when a new source is received are also briefly described.
Extensive calcification in the breast in chronic renal failure
Authors: Evans S. E. , Whitehouse G. H.
Published: July 2009

Although soft tissue calcification is a frequent finding in chronic renal failure, extensive calcification in the breast is a very rare feature in this condition. It may present as a non-tender mass or be found incidentally on a chest radiograph or mammogram. We report a case of extensive bilateral breast calcification occurring in a woman with chronic renal failure.

A 43-year-old female with a long history of chronic renal failure was referred for mammography, having discovered a lump in her breast on self examination. Renal insufficiency was diagnosed 12 years previously when bilateral staghorn calculi had been removed. Renal transplantation, performed 6 years later, was complicated by multiple post-operative problems including uretero-vesical stenosis and acute rejection. On examination, she had a firm, non-tender mass, 4×5 cm in size, in the upper outer quadrant of the left breast.
Effect of radiological iodinated contrast media on acetylcholinesterase activity
Authors: Tamura Akira , Suzuki Teruyasu , Yamasaki Toshie , Morita Rikushi , Sato Takashi , Fujii Tatsuzo
Published: July 2009

The inhibitory effects of several contrast media on acetylcholinesterase (AchE) activity were studied in vitro. Their inhibiting power was in the order: iothalamate > ioxaglate > iopamidol > iohexol. Because both the Km and maximal velocity (V  max) values of the enzyme were altered on adding ioxaglate, the inhibition mode seemed to be of a mixed type. Complete recovery from such inhibition was observed by removing the contrast media from the enzyme. Adding albumin (1%) to the reaction mixture led to a decrease in the inhibitory effect of ioxaglate. These results suggest that the contrast media, which have an inhibitory effect on AchE activity in vitro, may have no influence on its activity in blood which contains 4–5% of albumin under physiological conditions.

Radiological iodinated contrast media are relatively non-toxic, but they are employed in such large doses that mild toxic effects are common in clinical practice, and severe reactions sometimes occur (Labbe & Peyroux, 1984; Dawson, 1983, 1985). Since some symptoms of their toxicity such as peripheral vasodilation, bronchospasm and disturbances of cardiac rhythm are similar to those produced by acetylcholine, their inhibitory effects on AchE (acetylcholine acetylhydrolase, EC 3117) have been studied (Lasser & Lang, 1966; Dawson & Edgerton, 1983; Howell & Dawson, 1985; Guidollet et al, 1988). The published studies, however, have yielded conflicting results. In this short communication, we report more precisely the nature of the inhibition of AchE by some representative ionic and non-ionic contrast media.
The significance of patient weight when comparing X-ray room performance against guideline levels of dose
Authors: Hart D. , Shrimpton P. C.
Published: July 2009

On the basis of a national survey (Shrimpton et al, 1986) of doses to adult patients from routine X-ray examinations, the National Radiological Protection Board (NRPB) has formulated a set of guideline entrance surface doses for some common radiographic projections. These guideline doses are shown in Table I. They have been recommended by a joint working party of NRPB and the Royal College of Radiologists (RCR) as a useful step in reducing unnecessary medical exposures (RCR & NRPB, 1990). The doses were set at the third quartiles of the exposures found in the national survey, i.e. 75% of radiography rooms achieved a mean dose lower than each guideline.
Occupational exposure and the central index of dose information
Authors: Coulston D. J. , Strong R.
Published: July 2009

The paper by Kendall and Hughes (1990) provided interesting background information on the Health and Safety Executive (HSE) Central Index of Dose Information and occupational exposure levels. However, such has been the pace of events in the field of dose reduction in recent years, that dosimetry data rapidly become superseded.
Book reviews
Authors: Adam E. J.
Published: July 2009

This is a relatively short text book (290 pages) the purpose of which is to provide “a ‘bridge’ … to help cover the ground between the very basic material presented in student text books and the lengthy material currently available in books on computed tomography”.
Book reviews
Authors: Wilson A. G.
Published: July 2009

This is the second volume in the excellent Churchill Livingstone series Contemporary Issues in Computed Tomography and it is edited by an acknowledged leader in the field of lung computed tomography (CT). With certain notable exceptions all contributors, like the editor, are from Johns Hopkins School of Medicine.
Book reviews
Authors: de Sousa N.
Published: July 2009

This useful pocket guide is aimed mainly at trainee radiologists. Part 1 provides lists of differential diagnoses of radiological signs while Part 2 summarizes the radiological findings in some important conditions. Compared with the first edition, there are new sections on obstetrics and gynaecology, mammography, computed tomography (CT) and nuclear medicine, all of which feature increasingly in the final FRCR. Blank pages at the end of chapters are an additional useful feature.
The relative biological effectiveness of fractionated doses of fast neutrons (42 MeVd→Be) for normal tissues in the pig
Authors: Robbins M. E. C. , Barnes D. W. H. , Campling D. , Hopewell J. W. , Knowles J. F. , Sansom J. M. , Simmonds R. H.
Published: July 2009

The effects of fractionated doses of fast neutrons (42 MeVd→Be) on the radiation response of the pig kidney have been assessed and compared with those observed after X irradiation. Following X irradiation there was a marked increase in the total dose at which renal function was preserved with decreasing fraction size. The rate of this increase was dependent on the overall treatment time; for fractionated irradiation given over 18 or 39 days the exponents related to fraction number, N, were 0.36 ± 0.03 and 0.48 ± 0.003, respectively. In contrast, there was no significant change in the iso-effect dose for renal injury following fractionated irradiation with fast neutrons where there was also little effect of varying the overall treatment time. Analysing these data by means of the linear-quadratic (LQ) model, using both an Fe-plot and the Tucker test, gave α/β ratios of 2.42 ± 0.16 Gy and 2.99 ± 0.16 Gy, respectively, for X-ray doses given in 18 days. For fractionated doses of X rays given in 39 days the αβ ratios were 0.40 ± 0.01 Gy and 0.47 ± 0.02 Gy, respectively. The αβ ratios for renal tissue following fast neutron irradiation obtained bythe two methods were also similar, i.e. 15.00 ± 0.60 Gy and 15.72 ± 3.76 Gy, respectively. The pronounced fractionation effect seen with X irradiation, particularly for doses administered over 39 days as opposed to 18 days, coupled with the absence of any such effect with fast neutrons, resulted in a marked increase in relative biological effectiveness (RBE) with decreasing X-ray dose/fraction. The slopes of the resulting regression lines were −0.73 ± 0.05 and −0.33 ± 0.02, respectively. The lack of dose sparing associated with fractionation, or variation of the overall treatment time for fast neutron irradiation, suggests that doses administered to tumours adjacent to the kidney can be given as a few relatively large dose/fractions in a short overall treatment time without an increased risk of complications related to renal tissue. This may be of therapeutic advantage in the treatment of rapidly proliferating tumours where dose may be wasted using more conventional protracted fractionated irradiation schedules.
Malignant fibrous histiocytoma: an unusual presentation
Authors: Hughes P. M. , Zammit-Maempel I. , Hughes M. , Johnson R. J.
Published: July 2009

Malignant fibrous histiocytoma (MFH) is the commonest type of adult soft tissue sarcoma (Weiss & Enzinger, 1978). Intracranial MFHs, however, are rare and unreported in children. We report a case of MFH presenting as a posterior fossa mass in a 9-year-old boy with homocystinuria (HCU). This is an unusual presentation and the computed tomography (CT) finding of localized skull vault destruction proved an important differentiating feature from primary posterior fossa tumours. Early diagnosis of MFH is important as primary wide excision of involved bone margins improves prognosis, irrespective of subsequent radiotherapy or adjuvant chemotherapy (Tracy et al, 1984).
Ultrasonic diagnosis of dislocation of the radius in an infant with Down's syndrome
Authors: Lamont A. C. , Dias J. J.
Published: July 2009

The alignment of the capitellum and the radial head is difficult to ascertain from standard radiography because they do not ossify before the age of 9 months. It may therefore not be possible to distinguish between radiohumeral dislocation and a supracondylar epiphyseal fracture in an infant (Dias et al, 1988). We report a case in which dynamic ultrasonic examination provided good definition of dislocation of the radius.
Melnick–Needles syndrome (osteodysplasty) in an older male–report of a case and a review of the literature
Authors: van der Lely H. , Robben S. G. F. , Meradji M. , Derksen-Lubsen G.
Published: July 2009

In 1966 Melnick and Needles reported on a previously undiagnosed bone dysplasia. The diagnosis was based on characteristic radiographic findings: a delay in closure of the anterior fontanel, i.e. sclerosis of the skull base and mastoids. The long tubular bones are bowed with cortical irregularities and metaphyseal flaring. The ribs also show cortical irregularities and have a ribbonlike or wavy appearance. The vertebral bodies show an increase in height with a decrease in antero-posterior measurement and anterior scalloping. A decrease in disk space is also present. The pelvis has a typical constricted appearance with flaring of the iliac crest and tapering of the ischial and pubic bones. The clinical signs include exophthalmos, full prominent cheeks, mild hypertelorism, micrognatia, large ears and misaligned teeth. Females are affected almost exclusively and inheritance is in an X-linked dominant pattern. The condition is lethal in males born from Melnick–Needles syndrome (MNS) mothers (Donnenfeld, 1987). Three male patients (born from normal parents) are reported to have reached the age of 3 years.

We present the case of an 11-year-old boy, the oldest living male patient documented so far.
A retrospective comparison between different stage classifications for nasopharyngeal carcinoma
Authors: Teo P. , Leung S. F. , Yu P. , Lee W. Y. , Shiu W.
Published: July 2009

From 1984 to 1987, 659 patients with untreated nasopharyngeal carcinoma (NPC) were investigated by computed tomography of the nasopharynx and skull base, and fibreoptic nasopharyngoscopy. Thirty-one patients presenting with distant metastasis were treated palliatively; 628 were treated with intent to cure. Prospective staging was performed for the Ho's classification but since all T- and N-stage data required for staging according to the Huang's, the Changsha and the UICC classifications were recorded and stored in a computer database, retrospective staging according to these classifications could be accurately performed. Ho's classification was concluded to be the best in view of highly significant differences between the overall stages in survival and between N-stages in distant metastasis. The number of prognostically distinct overall stages and N-stages was greatest for Ho's classification. Huang's T-stage classification was superior, however, because it emphasized the significant adverse effect on local tumour control of cranial nerve(s) palsy (Tn) and intracranial tumour extension (Tc). Changsha and UICC classifications were demonstrably less powerful in predicting NPC prognosis. Multiple sites of involvement within the nasopharynx by NPC had no adverse influence on local tumour control. The grouping together of both soft-tissue and skull-base lesions into Changsha's T3 has been shown to be unjustified because of significant differences in local failure.
Small bowel vasculitis
Authors: Gleeson F. V. , Tidbury P. J.
Published: July 2009

Systemic vasculitis affecting the gastrointestinal tract is uncommon. We report a case affecting only the small bowel. The gastrointestinal manifestations and diagnosis of vasculitis are discussed.

A 55-year-old normotensive man with a past history of a leftnephrectomy in 1970 for nephrolithiasis, presented with a 3-month history of upper abdominal pain after food, whichoccasionally radiated through to his back. The pain lasted upto 2 hours, and was sometimes relieved by vomiting. There wasno history of haematemesis or melaena. Initial haematologicalinvestigation was normal and endoscopy demonstrated onlymild oesophagitis. Treatment with cimetidine failed to relievehis symptoms.
Calcified hydronephrosis in pregnancy
Authors: Armstrong S. J. , Witcombe J. B.
Published: July 2009

A 31-year-old woman, who had suffered from urinary calculi for 9 years, presented with left-sided renal colic when 36 weeks pregnant in her third pregnancy. Renal function had always been normal and renal ultrasonography on presentation showed dilated calyces with echogenic margins in both kidneys (Figs 1a&b). Several areas of focal echogenicity with associated acoustic shadowing suggested calculi within the calyces, and the left upper ureter was dilated. Treatment was conserva- tive and following successful delivery an abdominal film showed bilateral nephrocalcinosis together with multiple calculi in the left kidney and a large calculus in the line of the left ureter (Fig. 2).
Inflammatory back pain
Authors: Renowden S. A. , Hayward M. W. J.
Published: July 2009

A 57-year-old male was admitted as an emergency with a 3 day history of thirst, frequency and severe low back pain radiating to his right flank for 24 h. He was apyrexial and examination was normal. An elevated plasma glucose confirmed late onset diabetes. Urinalysis did not show any evidence of infection.

He developed a temperature of 39°C 24 h later and his erythrocyte sedimentation rate (ESR) was raised at 133. Blood cultures demonstrated Gram negative (G-ve) bacilli, later confirmed as Salmonella enteritidis. Appropriate intravenous antibiotics were commenced, stool cultures, ultrasound of his renal tract, gallbladder and plain films of the lumbar spine were normal.
Radiotherapy to the mediastinum in chronic myeloid leukaemia
Authors: Davis S. R. , Wolf M. M. , Ball D. L.
Published: July 2009

We would like to report on the effect on the white cell and platelet counts of a patient with chronic myeloid leukaemia (CML) who received radiotherapy to her mediastinum for a carcinoma of the bronchus.

A 64-year-old female presented with a 6 week history of hoarseness, pain in the left arm, tiredness and dyspnoea on mild exertion. The patient had an ECOG performance status of 2 and had lost approximately 5% of her body weight. Examination confirmed a left upper zone lung lesion and no demonstrable neurological deficit in the left arm. Chest radiograph and computed tomography (CT) scan of the thorax showed a 10 cm mass in the left upper lobe, an enlarged para-aortic lymph node and sputum cytological examination revealed squamous carcinoma. The patient was thus diagnosed as having a T2N2 squamous carcinoma of the lung.
Percutaneous nephrostomy to relieve renal tract obstruction in pregnancy
Authors: Hinwood D. , Manhire A. R.
Published: July 2009

We were surprised to read that percutaneous nephrostomy in pregnancy had not been reported previously (Trewhella et al, 1991). We have records of three nephrostomies being performed in pregnancy in our department in the last 5 years.
Book reviews
Authors: Moskovic Eleanor
Published: July 2009

This eminently readable book offers a fairly detailed guided tour of almost all aspects of modern cancer imaging. In their introduction, the Editors stress that it is not intended to be an atlas of oncologic radiology, but that the emphasis is more on educated tailoring of investigation protocols so that only tests appropriate to individual diseases are performed. This requires a sound knowledge amongst radiologists of the behaviour of tumours, their appearances and patterns of spread, and demands rigorous and continuing liaison between all disciplines involved in patient management. It also necessitates a pragmatic approach to the plethora of new imaging techniques available, with sensible consideration being given to factors such as their invasiveness and cost; responsibility for which rests on all diagnosticians whether clinicians or radiologists.
Book reviews
Authors: Saunders M. I.
Published: July 2009

The Treatment of Cancer edited by K. E. Hainan was first published in 1982. Now 8 years later the second edition is edited by K. Sikora and K. E. Hainan and has been extensively revised and updated. The basic layout of the book remains the same as previously, being divided into three parts: “The Principles”, “Clinical Practice”, and “Common Problems”. The 74 authors, 65 of whom work within the UK, eight in the United States and one in the Far East, have contributed to the 47 chapters.
Book reviews
Authors: Duck F. A.
Published: July 2009

The need for an educational text covering all aspects of the physics and technology of diagnostic ultrasound has never been greater. Radiologists and radiographers in increasing numbers are using the steadily expanding range of ultrasonic tools and techniques available.
Book reviews
Authors: Savage J. R. K.
Published: July 2009

This booklet forms an addendum to the IAEA Safety Series No. 77 (1986) Principles for Limiting Releases of Radioactive Effluents into the Environment and discusses, in more detail, the concept of “upper bounds” used in that document.
Book reviews
Authors: Mould R. F.
Published: July 2009

The book The Legacy of Chernobyl, by Zhores Medvedev, who is well known for his publications on the radiation accident in 1957 near Kyshtym in the Urals, has written a very useful addition to the literature on Chernobyl. His sources are well documented with the large majority from Soviet publications. Nine chapters deal with the accident itself, the environment and health, and then proceed to a discussion on the global impact of the disaster, the Soviet nuclear energy programme and a history of nuclear accidents in the USSR.
Book reviews
Authors: Guy R. L.
Published: July 2009

This book offers a complete practical approach to magnetic resonance (MR) imaging of the bladder. The information it contains is based on a review of the literature and on a detailed comparative study of the role of MRI, computed tomography (CT) and lymphography in the staging of carcinoma of the bladder carried out at the University of Nijmegen.
Book reviews
Authors: Kenny J. B.
Published: July 2009

This book aims to provide both a comprehensive and detailed review of the magnetic resonance imaging (MRI) appearances of a wide variety of spinal disorders and a guide to the advantages and limitations of the modality compared withm existing techniques. The optimal imaging parameters for the various conditions are discussed. It is aimed chiefly at radiologists and would be of value to clinicians with a particular interest in spinal disorders.
Quantitative computed tomography: comparative study using different scanners with two calibration phantoms
Authors: Suzuki Satoshi , Yamamuro Takao , Okumura Hideo , Yamamoto Itsuo
Published: July 2009

To assess computed tomography (CT) scanners in vertebral quantitative computed tomography (QCT) measurement, five cadaveric vertebrae fixed in a water phantom were measured using 16 CT scanners of 10 different models using two types (CaCO3 and K2HPO4) of reference phantom. Although the same reference phantoms were used, the QCT values varied markedly depending on the CT scanner employed. The differences in QCT values were greater in the equivalent amount of CaCO3 than in that of K2HPO4. The largest difference between CT scanners was 40 mg/cm3 in the equivalent amount of CaCO3 and 28 mg/cm3 in that of K2HPO4. These differences were reflected among CT scanners by different slopes and intercepts of the reference lines of CaCO3, K2HPO4 and ash density depending on the CT scanner used. However, good correlations (r > 0.97) were observed for the QCT values obtained by various CT scanners. These results show that QCT values on one machine can be compared more closely with those of another machine if conversion formulae, determined by using materials equivalent to human vertebral bone, are employed.
Oesophageal ruptures complicating balloon dilatation of strictures: a report of two cases
Authors: Mucci B.
Published: July 2009

Balloon dilatation of upper gastro-intestinal tract strictures is accepted as a safe and effective method of dealing with lesions of varying aetiology. Perforation of the oesophagus is a recognized, but rare complication. Two such cases are described and their management is discussed.

A 67-year-old man with a 10 year history of hiatus hernia associated with an oesophageal stricture presented with dysphagia and coughing after swallowing. Endoscopy revealed a benign oesophageal stricture at 35 cm.

Dilatation was performed using a 22 mm Lunderquist-Owman oesophageal dilatation kit (William Cook Europe) balloon under intravenous sedation (6 mg Midazolam Hydrochloride). The balloon was distended three times with ease under fluoroscopic control and no waisting of the balloon was visible on the final dilatation.

The patient complained of pain 4 h after the procedure and a chest radiograph was taken revealing no abnormality. The following morning a further chest radiograph revealed extensive consolidation in the left lower lobe.

A water soluble contrast swallow demonstrated a leak from the lower oesophagus. The patient was treated by bed rest and intravenous fluids for 1 week and no surgical intervention was required. The patient was discharged well on the seventh day following the procedure.

A 59-year-old lady presented with lower oesophageal dysphagia. At endoscopy there was an impassable area of narrowing in the lower oesophagus. Biopsies revealed no evidence of malignancy.
Relapsing polychondritis: report of an unusual case and a review of the literature
Authors: Goddard P. , Cook P. , Laszlo G. , Glover S. C.
Published: July 2009

Relapsing polychondritis is an uncommon multisystem disorder, characterized by recurrent inflammation of cartilage at multiple sites, which can go unrecognized until classical signs of cartilage destruction occur. Destruction of the cartilage of the external ears and nose is easy to recognize. Central airway involvement is more difficult to recognize, but more important in terms of prognosis. Neurological symptoms and signs are uncommon, have been infrequently reported and may lead to incorrect diagnosis and delay in treatment.

A case of relapsing polychondritis presenting as an acute encephalitis is described. The use of computed tomography (CT) in determining the presence and severity of central airway involvement is discussed.

A 58-year-old man was admitted in June 1988 with a 6-week history of ear infection not responding to three courses of antibiotics. During this time he had been unwell with earache, headache, fatigue and lethargy and was sleeping for long periods. He also had fleeting arthralgia and intermittent fever with rigors. Two days before admission he deteriorated and became confused, uncooperative and drowsy.

He was known to have been under the care of an ophthalmologist with left episcleritis, for the previous 8 months. In 1972, mild asthma was treated with inhaled bronchodilators and in 1983 he experienced costochondral chest pain.

On admission he was found to be drowsy, confused and agitated. Bilateral conjunctivitis, swollen eyelids and tender pinnae were noted but the tympanic membranes were normal.
Thorium dioxide, forgotten but not gone
Authors: Kessel D. , Robbins K. F. , Wilkinson M. L. , Smith P. M.
Published: July 2009

The recent report edited by Taylor et al (1989) reminds us of the continuing risk of morbidity in patients exposed to thorium. We present three cases, with hepatic sequelae, in which the radiological diagnosis was missed on initial presentation. They illustrate the need to be alert to the possibility of Thorotrast toxicity.

Thorotrast, a 25% colloidal solution of thorium dioxide, was a widely used contrast medium from 1928 (Blühbaum et al, 1928) until 1955, when its use was abandoned following a report (MacMahon et al, 1947) of hepatic angiosarcoma associated with exposure to Thorotrast and concern about the long term effects of internal irradiation.

A 69-year-old female was admitted in 1989 for investigation of malaise, right hypochondrial pain and anorexia. She had had a cholecystectomy 10 years previously at which abnormal liver texture was noted. A liver biopsy revealed cirrhosis. Examination was normal apart from tender, non-pulsatile hepatomegaly. Liver function revealed a markedly elevated alkaline phosphatase and gamma glutamyl transferase. The alpha-fetoprotein (AFP) was not raised. An abdominal X ray (Fig. 1) revealed metallic opacities in the spleen, periphery of the liver and coeliac axis lymph nodes. Abdominal ultrasound showed the liver to be enlarged with increased echogenicity. The spleen was noted to be very small. Further history revealed that the patient had received Thorotrast in 1938 during investigation of a “kidney problem”. A repeat liver biopsy showed multiple deposits of refractile brown material consistent with Thorotrast. There was macronodular cirrhosis with marked periductal fibrosis.
Book reviews
Authors: Hopewell J. W.
Published: July 2009

This is an extremely detailed book, primarily aimed at providing the practising radiotherapist with the radiobiological principles relating to the development of better cancer treatment. However, in addition it would be a valuable text for trainees in radiotherapy and for radiobiologists.
Advances in basic science: have they benefited patients with cancer?
Authors: Dische Stanley
Published: July 2009

Sir James McKenzie Davidson was a practising ophthalmic surgeon at the time of the report of Rontgen's discovery of X rays in December 1895. He was quick to perceive the potential application in medicine; within weeks he had built his own apparatus and by February 1896 was producing X-ray pictures, including one of the foot with six digits, which was published in a new journal The Archives of Skiagraphy. By the summer of 1897 he had visited Röntgen in Germany and moved to London in order to devote himself to radiology and was engaged in demonstrating its value widely in medicine. He did, for example, in that year, draw attention to the importance of X rays to the diagnosis of urinary calculi, publishing a radiograph of a bladder stone (Burrows, 1986).

McKenzie Davidson, a true pioneer in the application of radiology to medicine, through the two decades in which he worked prior to his untimely death in 1919, stressed the fundamental importance of a knowledge of physics and he himself was actively engaged applying it to radiology right up to the time of his death.

In the past 70 years radiology has expanded beyond the imagination of anyone, even the like of McKenzie Davidson. Diagnostic imaging has been divided into a number of separate disciplines and the therapeutic application has long since separated to become clinical oncology.
Attempting to increase the sensitivity of the plain film for ureteric calculi; use of the full bladder
Authors: Kabala J.
Published: July 2009

Although up to 90% of ureteric calculi are radio-opaque, the accuracy of plain films for their detection is surprisingly poor (Bloom et al, 1988). A case is presented where a vesico-ureteric calculus was visible only when the patient was radiographed with a full bladder. A radiograph taken with an empty bladder allowed bowel loops to fall down into the pelvis and obscure the calculus. Performing the abdominal radiograph with a full bladder rather than post-micturition potentially avoids this problem and may be useful when following up patients with ureteric calculi.
Mistaken identity of a neck mass
Authors: Warren M. J. , Walton J.
Published: July 2009

A 64-year-old woman presented at another hospital with a 4 year history of an asymptomatic left sided neck mass. On examination it was firm, non-tender and non-pulsatile. In addition she had an enlarged left tonsil. Computed tomography (CT) was performed (Fig. 1).

Following a left tonsillectomy surgical exploration of the neck was commenced. This was abandoned because of haemorrhage and the patient was referred for further investigation.
Fractionated high dose rate versus low dose rate cervix cancer regimens
Authors: Orton Colin G.
Published: July 2009

I found the article on fractionated high dose rate (HDR) versus low dose rate (LDR) regimens for intracavitary brachytherapy for cervix cancer by Brenner and Hall (1991) to be most interesting, especially their use of 38 different sets of linear-quadratic (L-Q) model parameters in their computations. Their ability to fit the L-Q model to the observed late complications data from the Christie Hospital LDR clinical trial (their Fig. 8) was especially impressive.
Fractionated high dose rate versus low dose rate cervix cancer regimens
Authors: Brenner D. J. , Hall E. J.
Published: July 2009

Dr Orton's comments are both interesting and pertinent. As the linear-quadratic (L-Q) model increases in complexity from its early two parameter version (α/β early, α/β late), it becomes correspondingly harder to tie down all the relevant parameters. In our model of GYN HDR late effects, which Dr Orton has refitted using further data from his survey (Orton, 1990; Orton et al, 1991), there are no less than eight (sic) parameters ([α, β, T  ½]early, [α, β, T  ½, K, r]late).
Book reviews
Authors: Lambert H.
Published: July 2009

This book is aimed at gynaecologists, oncologists and other cancer specialists using cytotoxic drugs to treat the whole range of gynaecological cancers. It also includes the management of breast cancer.

The book is divided into 20 chapters, many of which deal with an individual site—vulva, vagina, cervix, endometrium, ovary, fallopian tube and breast. There is also a chapter on the chemotherapeutic management of gestational trophoblastic tumours.

The first three chapters are devoted to the principles of cancer chemotherapy including basic cell biology, such as the cell cycle, and pharmacological aspects. The latter includes the development of new drugs, the classification of cytotoxic drugs and their individual therapeutic efficacy in gynaecological cancer. A separate chapter concentrates on the management of adverse effects of chemotherapy.
Book reviews
Authors: Conway J.
Published: July 2009

This expensive, slim volume is divided into three distinct chapters. Part I “Thermometry in therapeutic hyperthermia” reviews the current methods of invasive thermometry used in the clinic. This chapter adequately describes methods of probe implantation for both superficial and deep hyperthermia together with a review of available technologies for invasive thermometry with their respective measurement errors and artefacts.
Chest radiography in the management of breast cancer
Authors: Moskovic E. , Parsons C. , Baum M.
Published: July 2009

This study was undertaken to assess the utility of chest radiography (CXR) in the management of patients with breast cancer and to devise a suitable imaging policy for such patients. A retrospective analysis was performed of the case notes and the CXRs of a series of 141 patients presenting to this hospital in 1980 with a diagnosis of early breast cancer. Data retrieved covered the entire clinical course to date and included the number of CXRs performed for a clinical reason and the number performed as “routine”. Correlation of the result of every CXR requested to subsequent therapeutic decision-making throughout the complete clinical course of each patient was undertaken and the proportion of CXRs initiating a management change, or performed for a clinical reason, out of the total requested was assessed. A total of 1161 CXRs were performed on the 141 patients studied. Of these, only 174 (15%) were undertaken for a direct clinical reason and 987 (85%) were undertaken as part of “routine” follow-up procedures and had no impact on patient management. Four “routine” CXRs (< 0.4%) demonstrated previously undiagnosed pulmonary metastases, in patients with no other history of metastatic disease. Thus, routine chest radiography is not a costeffective method of monitoring asymptomatic patients with breast cancer for metastasis. It is recommended that outside staging procedures for clinical trials, the CXR is used only to address a clinical problem relating specifically to the thorax. It is anticipated that the cessation of all other chest radiography in patients being followed up for breast cancer at this institution will have significant budgetary implications.
The labelling index in carcinoma of the uterine cervix: its correlation with tumour sterilization
Authors: Lagrange J. L. , Courdi A. , Chauvel P. , Gioanni J. , Ettore F. , Bongain A. , Duforestel Th. , Gillet J. Y.
Published: July 2009

The pre-treatment labelling index (LI) was measured in 72 patients with carcinoma of the cervix. It was not correlated with patient age, stage of the disease or histological grade. 46 patients underwent hysterectomy after intracavitary irradiation with or without external radiotherapy. The mean LI in patients with tumour sterilization or microscopic residue was significantly higher than in patients with gross disease. These results suggest that tumours with low LI may be difficult to sterilize with conventional therapeutic measures, or that doomed cells may require several weeks to be eliminated in tumours with low LI.
Is the coned lateral lumbosacral junction radiograph necessary for radiological diagnosis?
Authors: Lipton M. E. , Pellegrini V. , Harris I.
Published: July 2009

May we thank Lamb and Davies for their comments. We apologise for omitting the centring point for the lateral lumbar spine view. We used the lower costal margin as the departmental standard.
Reduction in the diameter of human hairs following irradiation
Authors: Sieber V. K. , Sugden E. M. , Alcock C. J. , Belton R. R.
Published: July 2009

A measurable reduction in hair diameter was observed in human hairs following single exposures to γ-rays, 250 KeV X-rays, 8 MV photons and 10 MV electrons in the range 2.9–14.0 Gy. The data from the different types of radiation were pooled and fitted by linear regression with a slope of 2.34 ± 0.42% Gy−1. There was approximately 2.4% reduction in hair diameter per Gy exposure. It would appear that the measurement of damage to the matrix cells of growing human hairs exhibits potential for use in biological dosemetry, especially in cases of non-uniform overexposure.
Magnetic resonance imaging of penile rhabdomyosarcoma
Authors: Ganesan George S. , Cory David , Mitchell Michael E. , Jones Jeffrey A.
Published: July 2009

In recent years the management of sarcomas of the penis has undergone a radical change. The trend of treatment has shifted away from mutilating surgery (Ashley & Edwards, 1957; Pratt & Ross, 1969), which often left the phallus functionally inadequate and the patient a psychological cripple, to one of conservation of the penis, in selected patients. Adjuvant chemotherapy and excision of the tumour with preservation of the penis has been shown to hold promising results in two patients (Pak etal, 1986; Dalkin & Zaontz, 1989). This has been made possible, largely because of improved chemotherapy of sarcomas in general (Hays etal, 1982a & b).

Magnetic resonance (MR) imaging has been reported previously to be of value in the evaluation of penile pathology, such as Peyronie's disease, carcinoma of the urethra and metastases to the penis (Hricak et al, 1980; Hricak et al, 1988). This report illustrates the use of MR imaging in the staging and follow-up of a soft tissue sarcoma of the penis. This is the first reported case of the successful treatment of an infiltrating sarcoma of the penis, by chemotherapy alone. Evaluation of the response to chemotherapy is dependent on accurate and sensitive imaging modalities. MR imaging seems to fill this role admirably.

A 3-year-old white male presented with a mass, of 4 months duration, on the dorsum of his penis. The child was otherwise asymptomatic. Physical examination revealed a hard mass extending from the corona to the base and circumscribing the penis.
Carcinoma of the ovary: a diagnostic hitch
Authors: Zammit-Maempel I. , Hughes P. M. , Patel U. , Johnson R. J.
Published: July 2009

Ovarian transposition during hysterectomy for carcinoma of the cervix is occasionally practised. Transposed ovaries can be variable in position and cause diagnostic difficulty on computed tomography (CT) when operative detail is incomplete (Reed et al, 1989). We report a case of a cystic adenocarcinoma that arose in a transposed ovary and presented as an epigastric mass. We review the literature concerning ovarian conservation with relevance to diagnostic imaging.
Now you see it… now you don't
Authors: Millar John S.
Published: July 2009

A 52-year-old female presented with a 6 month history of left iliac fossa pain and alteration of bowel habit. She was rather overweight but examination was otherwise unremarkable. A blood count revealed that she was anaemic with a haemoglobin level of 10.1 g d1−1. A barium enema was requested.

Two strictures in the mid-transverse colon were demonstrated (Figs 1 & 2). These appearances were unchanged by intravenous administration of Buscopan 20 mg (hyoscine butylbromide). What is your differential diagnosis?

These are long strictures affecting adjacent segments of an area of distorted bowel with an abrupt cut-off between normal and abnormal bowel. In some views there appears to be shouldering (Fig. 2). The lumen is circumferentially narrowed and there is a normally distended segment of bowel between the strictures.
The significance of patient weight when comparing X-ray room performance against guideline levels of dose
Authors: Williams J. R. , Catling M. K.
Published: July 2009

In their letter on this topic, Hart and Shrimpton (1991) have highlighted a problem in the assessment of radiographic dose and comparison with the recently published guideline doses (NRPB, 1990). The problem is the variation in patient build and its affect on skin dose. They note that in the NRPB survey (Shrimpton et al, 1986) the range of mean patient weight for each room varied by about ± 10 kg around an average of 70 kg.
Book reviews
Authors: Savage J. R. K.
Published: July 2009

To attempt an introduction to “radiobiology”, bearing in mind the diversity of topics covered by this word and the vast literature now available, is no mean task. I think Professor Nias has succeeded admirably. Inevitably, one expects, and indeed finds, some bias towards those topics in which the author has principal interest.
Book reviews
Authors: Butler P.
Published: July 2009

This monograph by authors from Germany, Italy and the United Kingdom, is a very complete treatise on the subject of cranial meningiomas, but as the title indicates, spinal tumours are not covered. The inclusion of Dr Brian Kendall as co-editor and Dr John Stevens from the National Hospital for Nervous Diseases, is a tribute to their important joint contributions to the literature on meningiomas.
The incidence and significance of fluid–fluid levels on computed tomography of osseous lesions
Authors: Davies A. M. , Cassar-Pullicino V. N. , Grimer R. J.
Published: July 2009

The demonstration of a fluid-fluid level (FFL) within an osseous lesion on computed tomography (CT) has been reported as suggestive of an aneurysmal bone cyst (ABC) although FFLS have also been rarely found in association with other lesions. This study was conducted to determine the frequency of FFLS on CT in a group of ABCs and a series of patients presenting to a major tertiary referral centre for the treatment of bone tumours. An FFL was present on CT in 21 (84%) of the 25 ABCs and in 17 was multiple. FFLs are typical of the mid (“blow-out”) or late phase of development of an ABC and not the incipient (“permeative”) stage or where the internal architecture of the tumour has been disrupted by biopsy or previous surgery. In a 3-year period, 16 ABCs were found in 491 bone lesions referred to a bone tumour treatment centre. CT of the ABCs revealed FFLs in 14 (87.5%) cases. Within the same period, 728 CTs of these and other bone lesions were performed and FFLs were identified in two further cases: a massive telangiectatic osteosarcoma and a conventional osteosarcoma following chemotherapy. The diagnostic significance of an FFL on CT for ABC is: sensitivity = 87.5%, specificity = 99.7%, positive predictive value = 87.5%, negative predictive value = 99.7%, accuracy = 99.4%. An FFL within a bone lesion on CT remains strongly suggestive of an ABC although the radiologist should be wary of a rare telangiectatic osteosarcoma.
Bone mineral density in healthy normal women and reproducibility of measurements in spine and hip using dual-energy X-ray absorptiometry
Authors: Haddaway M. J. , Davie M. W. J. , McCall I. W.
Published: July 2009

Bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA) has been measured in 394 healthy normal women. BMD is highest at the end of the 3rd decade and declines from 45 to 75 years by 0.0095 g/cm2/year in the lumbar spine and by 0.0052–0.0078 g/cm2/year in the upper femur depending on the site. BMD appears to increase in the 8th decade. Reproducibility (coefficient of variation (CV) of repeated measurements) was lowest in the lumbar spine (1.45%) and highest in Ward's triangle (4.29%). CV was not influenced by age at any site and by osteoporosis only in the femoral neck. BMD increased from L2 to L4 but the increase could not wholly be accounted for by the size of the vertebra, suggesting that the posterior elements were contributing to the observed increase of bone density.
Dysphagia paediatrica
Authors: Stephenson B. M.
Published: July 2009

A 3½-year-old girl presented with a 6 month history of recurrent chest infections and weight loss. Clinical examination was unremarkable. A barium swallow was performed as she suffered from intermittent vomiting and regurgitation of food (Fig. 1). What does this show and what is the differential diagnosis? What further investigations would be appropriate?

The radiological report suggested food debris above a stricture or vascular ring. A flexible endoscopy was performed which revealed food debris overlying an inflamed and oedematous mucosa which was also pulsatile. She then underwent selective aortic arteriography which showed no evidence of a vascular abnormality.
Book reviews
Authors: Hopewell J. W.
Published: July 2009

This book reports on the proceedings of a meeting held in Washington DC in May 1989 that was seen as the first attempt to obtain a concensus in the treatment of radiation injuries. The conference was designed to address the important area of the potential treatment of haematopoietic injury, infectious complications and combined injuries, specifically those involving trauma.
Computed tomographic assessment of intraperitoneal fluid distribution prior to intraperitoneal chemotherapy for ovarian cancer
Authors: Hughes P. M. , Zammit-Maempel I. , Murphy D.
Published: July 2009

Intraperitoneal chemotherapy (IPCT) is under evaluation in patients with ovarian cancer. Computed tomographic peritoneography (CTP) prior to IPCT establishes the distribution of the infusate, which if complete, demonstrates the patient's suitability for this method of treatment. We report our method of CTP and describe the intraperitoneal fluid distribution and complications encountered in 28 patients with advanced ovarian carcinoma being considered for IPCT.
Cranial stereotactic multiple arc radiotherapy; treatment planning using angiographic images
Authors: Thomson E. S. , Clegg P.
Published: July 2009

Stereotactic multiple arc radiotherapy (SMART) is an irradiation technique developed to treat small intracranial lesions. Calculation of absorbed-dose patterns for this treatment has traditionally involved complex computer programs incorporating algorithms designed to reconstruct the shape of the patient's head from computerized tomography (CT) images. A large proportion of the patients treated with SMART, however, have arteriovenous malformations for which angiography provides a better idea of lesion size and position than CT. This paper describes a computer program developed at St Bartholomew's Hospital which enables calculation of absorbed dose for a SMART treatment directly from angiographic radiographs, avoiding the need for CT. The program is compared with the existing CT-based treatment planning program.
Computer-assisted generation of multi-leaf collimator settings for conformation therapy
Authors: Hounsell A. R. , Sharrock P. J. , Moore C. J. , Shaw A. J. , Wilkinson J. M. , Williams P. C.
Published: July 2009

Techniques for the automatic set up of the individual leaf positions of a Philips multi-leaf collimator system to cover a defined target volume are described. Tumour outline data for multi-field treatments may be obtained from one of two techniques, either from simulator images or from cross-sectional computed tomography (CT) slices. In the first technique, simulator images are digitized directly from image intensifier video signals or from conventional film radiographs using a CCD camera. Corrections for image distortion are carried out before reformatting the digitized images to a common data structure. Target outlines are subsequently traced interactively on the digital image to create an outline file. In the second technique, target volumes are defined on several individual CT slices and these are then used to obtain projected graphical views from any desired angle. In both techniques, a scaled graphical representation of leaf positions is then displayed and set relative to the outer edge of the target outline. Both techniques allow interactive repositioning of single leaves when required, or the operator can specify a margin around the projected target volume. Leaf prescription data files are created and are transferred via a Decnet-OSI-Opennet network link to an Intel microcomputer, which is used to drive the device itself. Examples of both techniques are given.
Dystrophic umbilical artery calcifications in an infant
Authors: Beluffi G. , Fiori P. , Pandiscia A. T.
Published: July 2009

The radiological observation of calcification within an obliterated umbilical artery is a rare occurrence in children. Only a few papers in the literature deal with this subject (Currarino & Weinberg, 1985; Sirinelli et al, 1989); a total of 10 cases have been reported. The case described here is the only one observed in the last ten years in our Section of Paediatric Radiology. During this time 4200 infants underwent pelvic X-ray examination for suspected congenital dislocation of the hip (CDH) and 13 500 children of different ages underwent abdominal radiography for various reasons.

A 6-month-old girl was referred to the Section the Paediatric Radiology of the IRCCS Policlinico S. Matteo, for a pelvic radiograph to exclude CDH. There was no history of perinatal disease, infections or oedema of the lower limbs.