bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteopoikilosis and the Buschke–Ollendorff syndrome
Authors: Roberts N M , Langtry J A A , Branfoot A C , Gleeson J , Staughton R C D
Published: July 2009

Osteopoikilosis is an uncommon cause of multiple osteosclerotic bone lesions. The skeletal changes of osteopoikilosis (synonyms: osteopathia condensans disseminata, spotted bone) were first described by Stieda in 1905 and subsequently by Albers-Schoenberg (1915). Radiologically, the lesions consist of multiple wellcircumscribed round or oval opacities, each 1–10 mm in diameter. The mottling is more marked in the epiphyses and metaphyses of the long bones and the pelvis, but is also common in the spongiosa of the phalanges, carpal and tarsal bones. The changes are more common in men than women and usually present in adulthood, although osteopoikilosis has been reported in children. Familial aggregation has been described, and autosomal dominant inheritance with variable expression is proposed (Schoenenberg, 1975). Osteopoikilosis should be considered in the differential diagnosis of multiple osteosclerotic bone lesions, but is a relatively uncommon finding. Serowy (1956) could find only 100 reported cases in the literature over a 25-year period since its initial description, and Jonasch (1955) found only 12 cases of osteopoikilosis in a series of 21000 radiographs.
Book reviews
Authors: Evans N
Published: July 2009

This book achieves its aim of providing an introduction to magnetic resonance imaging (MRI) of the musculo-skeletal system; an all encompassing reference work it certainly is not. For those currently involved with imaging of the musculoskeletal system there is little new to be learnt from this text. For those with limited or no experience in this field it does provide a rapid and useful guide to the fundamentals of image interpretation.
Adverse chronic effects of highdose irradiation on proximal bronchus in patients treated for bronchogenic carcinoma
Authors: Hayakawa K , Mitsuhashi N , Saito Y , Nakajima N , Niibe H
Published: July 2009

Of five patients with epidermoid carcinoma of the lung who were treated with small fields of 80 Gy in 40 fractions/8–11 weeks (TDF123–129) to the hilar region, four patients developed marked stenosis of the proximal bronchi without tumour progression and died of pulmonary insufficiency 1–3 years after radiotherapy. These results should serve as a warning against escalation of the radiation dose, and the upper optimal dose might prove to be less than 80 Gy for the treatment of pulmonary hilar lesions.
Heterogeneity of spine bone density
Authors: Laskey M A , Crisp A J , Compston J E , Khaw K-T
Published: July 2009

Osteoporosis is characterized by low bone mass, leading to an increased risk of fragility fractures. Bone strength is directly proportional to bone mineral contentm Hansson et al, 1980). However, it has been shown using dual-energy X-ray absorptiometry (DXA) and other techniques that measurements of bone density at one site cannot usefully predict the bone density elsewhere in the body (Fogelman & Ryan, 1992; Lindsay et al, 1992; Eastell et al, 1989). There is also a wide range of bone densities within the lumbar spine of some subjects (Ross et al, 1988), indicating that a measurement in one region may not provide an accurate indication of bone density and hence fracture risk in another part of the spine. Vertebral fractures become more common with increasing age and are most prevalent in the mid-thoracic area and in the region of transition from thoracic to lumbar spine (Patel et al, 1991; Sauer et al, 1991; Melton et al, 1989). This paper investigates how accurately bone density measured in the lumbar spine (L1–L4 or L2–L4) reflects the bone density of vertebrae where many compression fractures occur (T12 and LI). The ability of two dual-energy X-ray absorptiometers (Lunar DPX and Hologic QDR-1000) to determine the bone density of T12 was also investigated.
A consequence of asymmetry?
Authors: Shaw D G
Published: July 2009

A chest radiograph undertaken as part of a routine health survey of a patient living abroad revealed a small area of hyperostosis on the upper surface of the central part of the left clavicle.
Endoscopic ultrasound of the stomach
Authors: Nicholson D A , Shorvon P J
Published: July 2009

Endoscopic ultrasound (EUS) is the adopted term for the technique which enables endoluminal ultrasound to be performed using a specially designed endoscope with a fixed piezoelectric transducer. Since initial reports described the use of this technique in patients, its use in clinical practice in Europe, the Far East and the USA has been steadily increasing over the past few years. At present the technique is only practised in a very few centres in the UK but it is likely that this will increase in the future. This article describes the present day value of EUS in evaluating gastric pathology.
Further experience at the Bristol Centre, following the installation of a second MRI unit
Authors: Thomson J L G , Case A , Williams R
Published: July 2009

A second magnetic resonance imaging (MRI) machine has been installed at the Bristol Centre, which therefore now has two systems (both 0.5T), working alongside, one being 5 years older than the other. This has allowed a virtual doubling of patient throughput. The financial cost of adding the necessary building extension and the comparative capital costs of the two machines, together with the differences in the cryogen requirements are itemized; as are the extra number of staff engaged. It is estimated that the new machine cost approximately half that of the original, bought in 1987, after allowing for inflation; and that the revenue costs have increased by only 25% in the first year, with a likely increase of about 45% in year two. One result has been that in Bristol, where there are now three MRI machines, myelography and knee arthrography as diagnostic procedures have almost disappeared.
The right inferior lung margin: anatomy and clinical implication
Authors: Morrissey B M , Bisset R A L
Published: July 2009

Medical students and clinicians have, for generations, based their knowledge and application of anatomy on the study of cadavers which have been fixed in formalin. Assumptions are made that structures maintain the same relationship in the living as in the dead. Such a belief is untrue in respect of the inferior extent of the lung and pleura into the posterior diaphragmatic sulcus. This study of the plain abdominal radiographs of 100 adult patients demonstrates a clear difference between the classical anatomical teaching, which describes a potential space containing only pleura in the recess, and our finding that in the living patient lung extends deep into the sulcus. In 80% of patients, lung is seen to lie at or below the level of the 12th rib, while in 18% lung reaches the level of the body of LI. Medical students should be made aware of this and clinicians should approach the liver, adrenal gland and kidney posteriorly with caution in order to avoid traversing lung and pleura.
Does peripheral angioplasty compromise limb blood flow?
Authors: Thorley P J , Sheard K L , Rees M R
Published: July 2009

Isotope limb blood flow studies were carried out using balloon, laser and Kensey catheter techniques to assess the outcome of peripheral angioplasty. Limb blood flow and Doppler ankle-brachial pressure measurements were obtained before angioplasty and at 6 months after angioplasty in a total of 101 angioplastied limbs. A fall in limb blood flow at 6 months was seen in 17% of the angioplastied limbs with no significant difference in the figures for the different types of angioplasty. Limb blood flow was also measured in 53 contralateral untreated limbs, approximately half of the patient group having both legs angioplastied. 25% of untreated limbs showed a fall in limb blood flow. Significantly more of the untreated limbs showed a fall in limb blood flow at 6 months where the contralateral, treated limb did not improve as a result of the angioplasty compared with those patients where the angioplastied leg improved. These results suggest that a lack of improvement in blood flow in the angioplastied limb may not result from failure of the angioplasty but may be the result of some factor, or combination of factors, which adversely affects both the angioplastied and the untreated leg in some patients.
A multi-purpose ruler for magnetic resonance imaging
Authors: Mackenzie R , Shah N J , Doran S , Dixon A K
Published: July 2009

Since the advent of clinical magnetic resonance imaging (MRI) there have been problems in locating internal structures with respect to external markers. Numerous methods have been advocated ranging from simple adhesive attachment of gels (Douglas & Gatenby, 1988; Matthaei et al, 1992) or “liver oil” capsules (Thompson, 1988) to more sophisticated MR compatible stereotactic devices (Saunders et al, 1990; Alvarez-Royo et al, 1991; Rousseau et al, 1991). In this report we describe a simple and versatile ruler for use with clinical MRI systems. The ruler was originally designed to facilitate direct anatomical-MRI correlative studies by allowing precise positioning of MR image slices with respect to an external reference. However, the design described can be readily adapted to the specific needs of the user in terms of both imaging characteristics and overall dimensions.

The ruler consists of four basic components (Figure 1): the outer casing, the end caps, a number of internal spacers and a number of internal tubes containing a gadolinium doped agarose gel. The precise dimensions of the ruler can be varied according to individual aims and the availability of standard sizes of materials. In the ruler illustrated in this report, the outer casing used was a 13.5 cm length of 13 mm square bar with a 6 mm diameter hole bored through the centre. The two end caps were carefully machined down to the exact diameter of the bore from a large diameter round bar.
Leakage radiation in radiotherapy—what is an acceptable level in the electron mode?
Authors: Morgan H M , Lillicrap S C , McKenzie A L
Published: July 2009

The International Electrotechnical Commission (IEC) sets standards for the safety of medical electrical equipment. IEC Publication 601–2–1 which applies to medical electron accelerators is under revision. One of the requirements in the current standard (IEC, 1981) relates to the amount of leakage radiation that is allowed through the beam limiting devices. Clause 6.1.3 of this document states that for equipment in which the area denned by the primary collimators, M, shielded by the adjustable beam limiting devices exceeds 500 cm2 (all modern equipment), the product of the average absorbed dose resulting from leakage radiation and the area, M, shall not exceed one tenth of the product of the absorbed dose on the central axis and the area of a 10×10 cm field. This requirement applies to accelerators operating in both the X-ray and electron modes and has since been incorporated in ICRP recommendations (ICRP, 1985). The requirement is shown graphically by the solid curve in Figure 1. For modern equipment, the area shielded by the beam limiting devices, M, covers a large area of the patient. It is worth noting that outside this area the IEC (1981) leakage requirement in the patient plane is much stricter. An average of only 0.1% of the central axis absorbed dose is allowed in areas outside M, which may be occupied by the patient.

Discussions are currently taking place to consider relaxing the requirement on leakage radiation through beam limiting devices for electron therapy.
Idiopathic retroperitoneal fibrosis: an unusual cause of an ovarian mass
Authors: Regan F , Tran T , Crofton M E
Published: July 2009

A case of idiopathic retroperitoneal fibrosis presenting as an ovarian mass and intermittent claudication is presented. The case report and radiological features are followed by a short discussion of the disease.
Vasoconstriction by angiographic contrast media in isolated canine arteries
Authors: Gomi N
Published: July 2009

Most of the published studies of the effect of contrast media (CM) on blood vessels were carried out in vivo. The response of blood vessels to CM was not uniform in those studies. Thus, we attempted to examine the direct effect of CM on blood vessels in vitro, using isolated canine arteries taken from six different regions.
Variation of linear accelerator wedge factors with field size and wedge position
Authors: Thomas S J , Thomas R L
Published: July 2009

We refer to the letter by Dean and Davis (1991) in which the authors suggested that “no extensive wedge factor versus field size measurements need be done for linear accelerators designed with a wedge mounted below the movable collimators”. They reported measurements on a Varian 2100C linear accelerator showing very little variation of wedge factor with field size, and contrasted these measurements on a Philips SL75/14 (Palta et al, 1988) and on an ABB LA20 (Thomas, 1990), both of which exhibited large increases in wedge factor (WF) with increasing field size.
Variation of linear accelerator wedge factors with field size and wedge position
Authors: Dean E M , Davis J B
Published: July 2009

Replying to the letter by Thomas and Thomas, referring to further measurements of wedge factor with field size, made on a modified ABB linear accelerator; we confirm our agreement with their hypotheses.

It is clear that a number of different, complex factors contribute to the variation of wedge factor with field size; one of the most obvious ones discussed in their cited references being source to wedge tray distance.
Ultrasound contrast hysterosalpingography—evaluation as an outpatient procedure
Authors: Balen F G , Allen C M , Siddle N C , Lees W R
Published: July 2009

Ultrasound contrast hysterosalpingography (HSG) uses intrauterine contrast media to increase the diagnostic value of plain transvaginal ultrasound enabling the uterine cavity contour to be assessed and allowing tubal patency to be determined. We present our experience using both negative (sterile saline) and positive (Echovist, Schering) contrast media in 27 patients presenting with a wide range of gynaecological disorders. This is the first report comparing the use of the two contrast media with plain ultrasound on a purely outpatient basis. We have found ultrasound saline HSG to be superior for the delineation of the uterine cavity and we predict that this will become a first line investigation for assessing the configuration of the uterine cavity. However, although Echovist could be demonstrated flowing through patent fallopian tubes, we found ultrasound contrast HSG to be insufficiently accurate in the determination of tubal patency and do not feel that it can replace conventional X-ray HSG. We review the literature on this technique and discuss its future role in gynaecological imaging.
The role of transvaginal ultrasonography in pre-operative case selection and post-operative follow up of endometrial resection
Authors: Khastgir G , Mascarenhas L J , Shaxted E J
Published: July 2009

50 patients undergoing transcervical endometrial resection (TCRE) for abnormal uterine bleeding underwent transvaginal ultrasonography (TVUS) before danazol therapy, immediately pre-operatively, and 3 months post-operatively. There were no significant changes in the uterine dimensions but as expected the endometrium became thinner (p < 0.0005) after treatment with danazol facilitating endometrial resection. 12 cases (24%) continued to have menstrual problems. In those cases TVUS showed unchanged endometrium (4), minimum residual endometrium (5), irregular uterine cavity (5), and fibroids (2) as probable causes of failure. These findings guided the choice of further management as follows: conservative for minimum residual endometrium, repeat TCRE for unchanged endometrium, and hysterectomy for irregular uterine cavity and fibroids. The value of TVUS in diagnosing the cause of post-operative pain was limited to the cases (2) of haematometra. The smaller transverse (< 6 cm) and anteroposterior (AP) (< 4.5 cm) dimensions of the uterus (p < 0.05, < 0.05), a significant reduction in these dimensions after the operation (p < 0.0005, p < 0.01) along with the absence of endometrium (p < 0.0001), fibroids and irregular uterine cavity (p < 0.005) predicted a favourable outcome of TCRE. This study substantiates the role of TVUS in TCRE for proper selection of cases, determination of the causes of failure and their subsequent management, leading to an improved outcome.
Pseudotumoral cystitis in children: a review of the ultrasound features in four cases
Authors: Friedman E P , de Bruyn R , Mather S
Published: July 2009

Pseudotumoral cystitis is an uncommon inflammatory condition which may masquerade as a bladder tumour in children. There are a variety of clinical presentations such as haematuria, dysuria, infection and obstruction. Reported causative factors include infection (bacterial, fungal and parasitic) and allergy. Ultrasound is an excellent imaging modality for demonstrating this intravesical lesion although the spectrum of features is poorly described in the literature. We report our recent experience of four patients with pseudotumoral cystitis and describe the clinical features and ultrasound appearance of this condition in children.
Routine quality assurance of high frequency ultrasound breast scanners in a screening context
Authors: Evans J A , Moore R D , Metcalfe S C , Davis M
Published: July 2009

The use of frequencies above 5 MHz for medical imaging is now commonplace and one example is in the context of routine breast screening. No satisfactory quality assurance (QA) procedures have been agreed for these systems hitherto but it is clear that techniques developed for lower frequencies are not necessarily relevant. The National Breast Screening Programme therefore commissioned the production of a new protocol for this purpose and this is described here. The work is divided between an experienced tester, equipped with a commercial test object (RMI 414B) and the routine user who is provided with a specified perspex block to provide routine measurements of certain parameters in a relative manner.
Book reviews
Authors: Bingham J B
Published: July 2009

Temporomandibular joint (TMJ) dysfunction is a relatively common disorder in the United States, perhaps because of the Americans' fondness for chewing gum, but has been much less recognized in this country. With the advent of temporomandibular arthrography and more recently, magnetic resonance (MR) imaging, the appreciation of the disorders that affect this joint has increased considerably.
Book review
Authors: Dance D R
Published: July 2009

The Guidance notes which were published in conjunction with the 1985 Ionising Radiations Regulations include a requirement on the total filtration of X-ray beams used for normal diagnostic work. This filtration should not be less than 2.5 mm of aluminium and its measurement forms part of the radiation protection quality system.
A reappraisal of serial isotope bone scans in prostate cancer
Authors: O'Donoghue J M , Rogers E , Grimes H , McCarthy P , Corcoran M , Bredin H , Given H F
Published: July 2009

Carcinoma of the prostate is the commonest malignancy of the genitourinary tract in the male and is frequently associated with metastatic bone disease. Serial isotope bone scans for screening secondary deposits are not cost-effective. We have evaluated the serum prostate markers prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) as an alternative to conventional serial bone scanning in 129 patients with newly diagnosed prostate cancer over a period of 3 years. Although serum PSA did not reflect local tumour burden at presentation, it was significantly elevated in those who presented with stage D disease (p < 0.01). 45 patients presented de novo with metastatic bone deposits and a further 18 patients developed metastases during the study period. The sensitivity of PSA in detecting secondary deposits at presentation for levels in excess of 100 μg/1 was 93.75%, the positive predictive value 95.7% and the negative predictive value for levels less than 5 μg/1 was 90.6%. During the follow-up period the sensitivity was 94.4%, the positive predictive value 100% and the negative predictive value 100%, with a median lead time of 3 months in predicting metastases in the 18 patients with progressive disease. When compared with PAP, PSA was found to be a statistically superior marker of bone metastases both at presentation and follow-up (p < 0.05). We recommend that PAP measurements are no longer necessary and should be replaced by PSA, and that serial serum PSA estimations should determine the need for future isotope bone scans in the patient with established prostate cancer.
The influence of film processing temperature and time on mammographic image quality
Authors: Brink C , De Villiers J F K , Lötter M G , van Zyl M
Published: July 2009

High image quality and low radiation levels are essential in mammography. This study investigates the effect of changes in processor temperatures and developing times on sensitometric findings. These findings were matched with the changes in the image quality during similar changes in the developing parameters. Temperatures ranging between 35°C and 40°C and developing times from 20 s and 50 s were investigated. Higher developing temperatures and increased developing times resulted in an increase in film speed and film contrast. A definite pattern of change could be demonstrated in film speed and film contrast during sensitometry. The same pattern of change could, however, not be demonstrated in the quality of phantom images under similar circumstances. The base plus fog level was not adversely affected. Sensitometric findings of film speed can be effectively used as an indicator of radiation exposure to the patient, but cannot be used to establish the developing parameters that will give the best image quality. Both these methods should be used to determine which processing variables should be used to obtain a combination of the best image with radiation as low as possible. Recommendations for optimum processing parameters are made for the films and processing chemistry investigated.
An X-ray fluorescence system for the determination of gold in vivo following chrysotherapy
Authors: Shakeshaft J , Lillicrap S C
Published: July 2009

This paper describes a low cost mobile measurement system for the determination of gold in vivo base around a 153Gd radiation source and a hyper pure germanium detector. Early clinical results are also presented to demonstrate the efficacy of the system.
Colonic obstruction following small bowel barium study
Authors: Halliday K E , Patel S R , Baker W N W
Published: July 2009

A case is described in which inspissated barium was retained in the colon for 16 months before causing large bowel obstruction. To our knowledge this is the first case described in which the time interval between barium ingestion and the onset of symptoms was more than a few weeks. Scybalum formation is due to resorption of water from the barium sulphate, which although less common with modern preparations, still appears to be possible in certain high-risk patients. Prolonged retention of barium should be avoided by increased awareness of the problem, encouraging patients to eat and drink normally after the examination, encouraging mobility and adminstration of lactulose in high risk patients.
Radiation-induced vasculopathy implicated by depressed blood flow and metabolism in a pineal glioma
Authors: Mineura K , Sasajima T , Kowada M , Saitoh H , Shishido F
Published: July 2009

A case of radiation-induced vasculopathy of a pineal glioma was presented with haemodynamic and metabolic changes before and after radiotherapy. After radiation of 60 Gy with conventional fractionation (1.8–2.0 Gy daily, 5 days per week), regional blood flow, oxygen extraction fraction, metabolic rate of oxygen, kinetic metabolic rate of glucose and the rate constants (K2, K3) were markedly depressed (20% or greater) compared with the pre-irradiated study. 7 months after radiotherapy, the patient developed transient episodes of both right and left upper limb convulsion, terminating in generalized convulsion. When she developed status epilepticus, computed tomography showed extensive low density areas in the territory supplied by the right middle cerebral and the right posterior cerebral arteries. Cerebral angiography revealed diffuse stenosis at both carotid bifurcations and at the origins of the right posterior communicating and posterior cerebral arteries. Haemodynamic and metabolic depression therefore implicated radiation-induced vasculopathy in the present case.
Unexplained symptomatic metaphyseal sclerosis in children: three cases
Authors: Lordf P , Carty H M L
Published: July 2009

Tien et al (1988) reported the case of a child with constitutional symptoms, fever and bone pain. Plain radiographs showed symmetrical metaphyseal sclerosis in several long bones. No infective agent was identified. The likely diagnosis was thought to be plasma cell osteomyelitis. However, the case was regarded as unique in its lack of lytic lesions and lack of involvement of the clavicles. The three patients presented here show clinical and radiological similarities.

An 11-year-old male presented with a 5-month history of poor appetite, vomiting and painful legs. Clinical examination was normal. Low-grade pyrexia was present on admission and the erythrocyte sedimentation rate (ESR) was raised at 78 mm/h. There was a mild normochromic anaemia. A Paul-Bunnell test was positive, but further serology did not confirm recent infection with Epstein-Barr virus. Cultures of blood and urine were negative. Titres to Salmonella were raised, but no history of diarrhoea was elicited. Cultures of stool, urine and blood were negative. Barium studies were normal, but radiographs of both knees showed ill-defined sclerosis in the metaphyses of the distal femora and proximal tibiae (Figure 1). There was some symptomatic relief from naproxen, and 11 months after onset the symptoms had entirely resolved.
Book reviews
Authors: Blngham J B
Published: July 2009

Evaluating films of patients who have sustained spinal trauma is the sort of task that frequently fills trainee radiologists with dread so a well written book on the subject is invaluable as a bench text. This is the second edition of a book that was first published in 1978 and written by an acknowledged expert in this field.
Book reviews
Authors: Rankin S
Published: July 2009

This book is the 14th in the series of contemporary issues in computed tomography (CT). It covers the common manifestations of diseases in the immunocompromised host including chapters on fungal infections, AIDS related diseases of the chest and then further chapters covering musculoskeletal infections, renal and GI tract problems. There is a separate chapter on cranial CT. At the end of the book are some test cases.
Digital storage phosphor radiography for treatment verification in radiotherapy
Authors: Scheck R J , Wendt T , Panzer M
Published: July 2009

The potential of digital storage phosphor radiography (SR) to improve image quality of portal radiographs is evaluated. Conventional film radiographs (FR) and corresponding SR verification images of an anthropomorphic phantom and various irradiation ports of patients were obtained with high-energy photon beams. For both techniques conventional films and storage phosphor screens were placed into a cassette with steel screens. Images were evaluated according to contrast and spatial resolution, delineation of anatomical structures, position of shielding blocks and accuracy of field alignments. Evaluation of 33 pairs of SR and FR portal images yielded a superior contrast resolution of SR in 47% (contrast air–soft tissue) and 37% (bone–soft tissue). Thus SR allows quick and easy detectability of anatomical structures as well as a better definition of block positions and field alignments. Shorter exposure times for computed images may result in a reduction of motion artefacts. SR images are indispensable in modern radiation therapy units, as they are instantly available in a computerized network for further image processing and analysis.
The implementation of patient position correction using a megavoltage imaging device on a linear accelerator
Authors: Evans P M , Gildersleve J Q , Rawlings C , Swindell W
Published: July 2009

The possibilities of using megavoltage imaging devices to measure patient set-up error is a topic of current interest in radiotherapy (see for example Lam et al, 1987; Meertens et al, 1990; Graham et al, 1991). An image is taken at time of treatment and compared with a reference image which may typically be a treatment simulation image. From such a comparison values for the shift and rotation of the patient's position between the two images may readily be deduced. The measurements obtained from such a system may also be used, interactively, to correct the positioning of the patient. This may be achieved either by adjusting the settings of the collimation system in the treatment head (if independent collimators are available), or by adjusting the couch position. If the patient's position is to be corrected then the shift values should be calculated with the centre of rotation in the image taken as the point corresponding to the centre of rotation of the collimation system which is the same as that of the couch turntable. For a correctly aligned system the axis of rotation of the couch would coincide with that of the collimation system and in the following discussion this is assumed to be the case.

Here, consideration is given to how such a system of patient correction may be implemented on a treatment machine with an isocentric couch. Firstly, a coordinate system is established.
Book review
Authors: Pilling D
Published: July 2009

There have been many advances in paediatric ultrasound since the 1st Edition in 1987 so it is no surprise that an extended volume has been produced for the 2nd Edition. The 1st Edition, following the style of the senior author's well known text Radiology of the New Born and Young Infant was well accepted and the latest edition is likely to find a similar place in most ultrasound departments.
Emphysematous pyelonephritis caused by clostridium septicum and complicated by a mycotic aneurysm
Authors: Christensen J , Bistrup C
Published: July 2009

Emphysematous pyelonephritis (EP) is a rare and lifethreatening necrotizing infection in the renal parenchyma caused by gas-producing microorganisms (Michaeli et al, 1984).

Mycotic aneurysms are vascular lesions caused by infectious weakening of the arterial wall (Skipper et al, 1991).

Clostridium septicum (CS) is an anaerobic bacterium, known for its propensity to produce gas (Michaeli et al, 1984) and its association with malignancy especially carcinoma of the colon (Alpern & Dowell, 1969).

We present the first recorded case of EP complicated by a mycotic aneurysm of the abdominal aorta. Furthermore, this is the first case of EP resulting from infection with a pure culture of true gas-forming bacteria (CS) and the fifth case of a mycotic abdominal aortic aneurysm due to CS.

A 74-year-old dehydrated diabetic woman with an abdominal pulsatile mass, a necrotic ulcer over the sacrum and temperature of 38.0°C was admitted to hospital with a 3-week history of generalized malaise, confusion, lethargy, bloody and mucoid diarrhoea, anaemia, fever and cystitis.

Fluid replacement, electrolyte and glucose correction and antimicrobial therapy were initiated.
Computed tomography in the diagnosis of pyrexia of unknown origin
Authors: Williams R M J , Marshall R J , Brennan J
Published: July 2009

A 72-year-old Caucasian man presented to a medical clinic with a 6 month history of weight loss, epigastric discomfort, poor appetite, malaise and night sweats with low grade fever. In recent weeks he had become breathless and tired on minimal exertion, and had slight cough productive of yellow phlegm. He had complained of a peculiar sensation at the back of his mouth, but there was no visible lesion on ENT or dental examination.

During the Second World War he had served in Burma and India for 4 years where he had malaria. He had never since travelled outside Europe. He had a left thoracoplasty for pulmonary tuberculosis in 1947. He had been a heavy smoker until he had a myocardial infarct 15 years previously. Since then he had had an aortobifemoral bypass for peripheral vascular disease and a mild stroke from which he had made an excellent recovery. He was taking dipyrimadole, ranitidine and frusemide—this latter for a few days because his ankles had been swollen. He did not drink alcohol.
Evolution of diagnostic radiology in a big hospital during a 5 year period, and the derived collective dose
Authors: Vañó E , Velasco A , Morán P , González L , Pedrosa C S Alvarez
Published: July 2009

An analysis is presented of the trends in the annual number of radiological examinations and in the average effective dose equivalent for each type of examination in a big Spanish hospital. Annual frequencies for each type of examination, annual average effective dose equivalent values for each study group, and the contribution of each examination group to the collective dose are presented. Also, sex and age distributions for several important examinations are given, and their impact on the collective dose is reviewed.
Radiation risks to personnel and public during the treatment of malignant glioma using interstitial brachytherapy
Authors: Baldock C , Hughes S W , Sofat A , Batchelor S , Badawi R D
Published: July 2009

125I seeds are used in brachytherapy for the treatment of malignant gliomas. The use of such radioactive sources is associated with a certain radiological hazard to both personnel and members of the public. This hazard should be quantified so that the ALARA principle of radiological protection may be implemented satisfactorily. A study was undertaken to derive isodose rate contours in the vicinity of an anthropomorphic phantom with 125I seeds positioned at typical tumour sites within the cranial cavity. These contours are illustrated for seed positions appropriate to deep and superficial temporal tumours. Results indicate that the annual doses to personnel and public should not exceed those recommended by the International Commission on Radiological Protection.
A re-evaluation of magnetic resonance imaging damping loops
Authors: McRobbie D W
Published: July 2009

The measurement of signal-to-noise ratio and contrast-to-noise ratio (SNR and CNR) forms an essential part of performance assessment or image quality assurance (QA) procedures in magnetic resonance imaging (MRI). When a patient is present within the scanner there is an interaction between the radiofrequency (RF) coils and electrically conducting tissue. This interaction is commonly referred to as loading. Its main consequences are the detuning of the coil resonant frequency, the generation of additional noise and the changing of the impedance of the coil as seen by the preamplifier. It is therefore essential that a means of simulating patient loading is applied in performance evaluation and QA procedures.

Edelstein et al (1984) offered an elegant solution for simulating loading using an inductive damping loop. The use of damping loops was further investigated by Jennings et al (1986) who concluded that the same loop could not be used at different imaging frequencies (field strengths). The present work constitutes a re-evaluation of the use of damping loops which contradicts these earlier findings.

The effect of loading on the coil can be represented by the addition of a further series resistance Rm to the coil resistance Rc. The effective loaded coil quality factor (Q1) is then: where ω0 is the coil resonant angular frequency (2πf) and L is the coil inductance.
Book review
Authors: Hike A L
Published: July 2009

The first edition of this book has been a most successful introductory text and reference book for many ultrasonologists over the past 8 years. This new edition keeps the same format with most of the first edition remaining. There are, however, many new additions either within chapters or, in some cases, complete new chapters. This has resulted in a 25% increase in the size of the book to over 500 pages. Each chapter starts with a clinical problem and then describes the relevant anatomy, ultrasound technique and pathology.
Comparison of technetium 99m nanocolloid and indium 111 leucocytes in the diagnosis of orthopaedic infections
Authors: Ooi G C , Belton I , Finlay D
Published: July 2009

It has been suggested that technetium 99m nanocolloid is as effective an inflammatory radiopharmaceutical as indium 111 leucocytes. This study compares the efficacy of 99Tcm nanocolloid and 111In leucocytes in the detection of orthopaedic infection in 19 patients with a high clinical suspicion of infection. The two scintigrams were performed within 24 h of each other. A scintigram was considered positive where there was an increase in tracer uptake at the site of interest. Concordance rate of 73% was achieved. The numbers of false positives with 111In leucocytes and 99Tcm nanocolloid were three and six respectively. The single false negative in both was of a patient with tuberculous spondylodiscitis. Sensitivity was 75% in both. Specificities were 79% and 60% for 111In leucocytes and 99Tcm nanocolloid respectively. Positive Predictive Value was only 33% with 99Tcm nanocolloid and 50% with 111In leucocytes. 99Tcm nanocolloid also proved less reliable in accurately detecting infected prostheses. We conclude that 99Tcm nanocolloid cannot replace 111In leucocytes in the diagnosis of orthopaedic infections.
Late pulmonary scintigraphic defects after uneventful recovery from simple focal pneumonia of childhood
Authors: Kenney I J , Lenney W , Lutkin J E , Gordon I
Published: July 2009

We present a pilot study designed to determine whether pneumonia in children accompanied by focal consolidation on the chest radiograph (CXR) is associated with late abnormality as detected by radionuclide lung scintigraphy. 14 children with focal pneumonia were assessed 1 year after initial presentation. In 12 both krypton-81m ventilation and technetium-99m MAA perfusion studies were performed, while in two only perfusion studies were obtained. All cases had a further CXR. Abnormal or equivocal cases were reviewed clinically. Scans and CXRs were independently assessed by two observers and subsequently consensus reached by discussion. There were five abnormal and nine normal lung scans. Two defects matched the site of the initial pneumonia while three did not. A CXR at the time of lung scanning was normal except for one case with a small focus of consolidation on the opposite side to the initial pneumonia but with a normal lung scan. Similarly, clinical assessment at the time of scanning was unremarkable, with no history of further respiratory episodes except in one child excluded from the study because of an interval diagnosis of asthma. This pilot study indicates that lung scan defects are common in the medium term after supposedly uncomplicated pneumonia in childhood. The cause of these defects remains uncertain. The correlation with the site of the initial radiological abnormality is variable, pointing to the need for further research in this area. The importance of independent blind interpretation is also highlighted.
The safety of outpatient arteriography using 3F catheters
Authors: Reidy J F , Ludman C
Published: July 2009

There has been a general trend for diagnostic arteriography to be performed as a day-case procedure, thus obviating the need for hospital admission. Most commonly 5F and, more recently, 4F catheters have been used via the femoral approach.

After catheter removal, firm digital pressure is applied at the puncture site for 10–15 min following which patients are observed for 2–4 h. Although this approach is undoubtedly safe, problems may arise, particularly in elderly patients, those with hypertension and also in patients with groin scarring, often associated with surgical bypass grafts. Severe bleeding is very rare, but a haematoma or delayed oozing is not unusual. In a recent paper advocating outpatient arteriography with 4F catheters there was no delayed bleeding, but over half the patients had bruising in the groin or slight oozing following the procedure (Dyet et al, 1990). The ages of these patients were not specified but there is nothing to suggest that they were a particularly “atrisk” group.
Ovarian cystic teratomas: value of chemical fat saturation magnetic resonance imaging
Authors: Imaoka I , Sugimura K , Okizuka H , Iwanari O , Kitao M , Ishida T
Published: July 2009

Chemical fat saturation (FS) magnetic resonance imaging (MRI) for the characterization of ovarian cystic teratoma was evaluated in 19 patients with 22 lesions. The tumour was evaluated for signal intensity, location and size; the presence of chemical shift artefact, debris and fat-fluid level. Ovarian cystic teratoma was diagnosed prospectively if the mass contained fat and/or more than one type of internal pattern on (1) SE T  1-, T  2-, (2) SE T  1-, T  2-, FS T  1,-weighted images. A correct diagnosis was reached in 17 of 22 tumours on conventional T  1- and T  2-weighted images, and in 21 of 22 tumours when fat-saturation images were added. When fat-saturation images were added, four of five tumours misdiagnosed on conventional images were then correctly diagnosed. These tumours contained only small amounts of fat. Fat-saturation images could detect smaller amounts of fat than conventional images. However, one tumour did not show decreased intensity on fat saturation images, and was not diagnosed even when fat-saturation images were added. Fat saturation images have been shown to be of value in diagnosing cystic teratomas.
The biology and radiobiology of in utero development in relation to radiological protection
Authors: Mole R H
Published: July 2009

Aspects of intrauterine development relevant to radiological protection but not considered in the recently revised Recommendations of ICRP (1991a) include (i) recently acquired evidence on the totipotency of cells of the morula with implications for dosimetry and risk in the first week of human development in utero; (ii) much older evidence on the earliest stages of myelo- and lymphopoiesis in the human subject that bears on radiosensitivity to leukaemia induction in utero; (iii) much older evidence on species differences that may affect the application to the human of experimental work on radionuclide transport from mother to embryo and fetus; (iv) recent proposals of alternative mechanisms for localization of functions in the developing mammalian forebrain with implications for risk of mental impairment caused by low level irradiation in utero, and (v) a recent demonstration that UNSCEAR (1977) was mistaken when concluding that a high radiosensitivity for teratogenesis is characteristic of the embryo and of preimplantation irradiation. The 1990 Recommendations of ICRP (1991a) to limit exposure of the fetus to radionuclides by reference to the occupation ALI for adults, i.e. women of reproductive age, seems to be a serious mistake.
The role of intravenous cholangiography in pre-operative assessment for laparoscopic cholecystectomy
Authors: Patel J C , McInnes G C , Bagley J S , Needham G , Krukowski Z H
Published: July 2009

With the advent of laparoscopic cholecystectomy, pre-operative identification of calculi in the common bile duct has become increasingly important. In patients without clinical or biochemical evidence of common bile duct calculi, debate continues as to the value of intravenous cholangiography (IVC) as a screening modality for the detection of unsuspected choledocholithiasis. In a prospective series of 180 patients, IVC was used to assess the common bile duct in 113 patients at low risk of choledocholithiasis, 51 patients at high risk underwent endoscopic retrograde cholangiography (ERC) and sphincterotomy if indicated, and in 16 patients, for a variety of reasons, no pre-operative cholangiography was performed. 31% of those who had ERC and two (1.8%) of those who had IVC had duct calculi. These data do not support the routine use of IVC in patients with no evidence of common bile duct calculi and its routine use has been discontinued.
Latent image fading in mobile mammographic screening
Authors: Law J
Published: July 2009

I should like to comment in support of the letter by Robson et al (1992) and to provide further data on this topic, which is one of some concern to Breast Screening Programmes in remote areas.

The film–screen system used in the Edinburgh Breast Screening Centre at the start of the national screening programme was Fuji NH film with Fuji Hi-Mammo screens and cassettes. This system was tested for latent image fading in July 1989, when 24 radiographs of a “Baits” phantom (White & Tucker, 1980) were obtained in under 1 h. The X-ray exposures were made on a Siemens Mammomat 2S unit in a screening van. This X-ray unit was chosen in preference to the units then available at the Centre because of the high reproducibility of its X-ray output. Of these 24 films, six were processed about 1 h after exposure (the shortest practicable time), six after a further 24 h, six at 1 week after exposure and the last six at 3 weeks after exposure. The mean background density of each set of six films is given in Table I, after correction for small changes in sensitometry speed index of the processor.
Radiological appearances in peliosis hepatis
Authors: Jamadar D A , D'Souza S P , Thomas E A , Giles T E
Published: July 2009

Peliosis hepatis is an unusual disorder characterized by blood filled hepatic spaces. We describe the appearances of this entity on ultrasonography, computed tomography and magnetic resonance imaging. The importance of peliosis hepatis is that it may be an indicator of a treatable underlying condition.
Human albumin base echocontrast agents—repeated use in animals may induce anaphylactic reactions
Authors: Walday P , ØStensen J , Holtz E
Published: July 2009

Our attention was drawn to an abstract in the Proceedings of the BMUS meeting in the British Journal of Radiology by J S Boyd at the Department of Veterinary Anatomy, University of Glasgow Veterinary School [1]. It was suggested that recently developed echocontrast agents may be of potential value for use in domestic animals. Albunex™, one of these contrast agents which has been developed by Nycomed Imaging AS in cooperation wityh Molecular Biosystems Inc., San Diego, consists of small air-filled albumin microspheres suspended in human albumin solution (5%).
Human albumin base echocontrast agents—repeated use in animals may induce anaphylactic reactions
Authors: Boyd J S , McEwan J Dukes , Paterson C
Published: July 2009

We have been using recombitant human albumin (rHA) microcapsules in rabbits, calves, pigs and (at another centre) dogs, and are fully aware of the potential for anaphylactic reactions in ungulates [1]. We are aware of the papers by Østensen et al [2,3], but even earlier work than this indicated the potential for anaphylaxis in cattle on exposure to non-bovine albumin, after initial sensitization [4,5]. The anaphylactic respiratory manifestations described by these authors were prevented by prior medication with meclofenamate.
Book reviews
Authors: Fielding J A
Published: July 2009

This is unfamiliar territory to many radiologists, who may nevertheless possess equipment which is eminently suitable for ophthalmic ultrasonography. Written with meticulous care by two highly-skilled ophthalmologists, the book is a detailed guide and reference for a wide range of ocular orbital pathology, as depicted by ultrasonography. The text is comprehensively illustrated with excellent reproductions of high quality B scans, a minor drawback being a sideways presentation of the images, many of which are adjacent to a corresponding A scan.
Book review
Authors: Lewis P
Published: July 2009

This 300 page book is the first comprehensive review of cardiac PET written by an eminent group of authors. It starts with a set of introductory chapters into basic PET physics, radiochemistry and myocardial physiology and is followed by detailed chapters on PET imaging of myocardial perfusion, metabolism of glucose, fatty acids, amino acids and oxygen, as well as imaging of the cardiac nervous system.