bluuebunny/crossref_metadata_2025 huggingface dataset:
High resolution, high field magnetic resonance imaging of joints: unexpected features in proton images of cartilage
Authors: Cole P. R. , Jasani M. K. , Wood B. , Freemont A. J. , Morris G. A.
Published: July 2009

Clinical magnetic resonance (MR) imaging at normal resolution is of proven value in the diagnosis of joint disease (Reicher et al, 1985; Ehman et al, 1988). However, prospective studies of conditions such as osteoarthritis are technically more demanding, requiring reliable quantitative assessment of such parameters as cartilage thinning and matrix over-hydration. This report concerns the observation and explanation of some unexpected features in the high field, high resolution imaging of proximal interphalangeal joints in vivo (Cole et al, 1989) and of sections of knee joints in vitro. The results suggest that high resolution MR images of joints obtained by conventional methods should be interpreted with some caution, but that there may be scope for using some unusual MR properties of cartilage reported below as a probe of joint disease.
Major contamination from an iodine-131 therapy patient
Authors: Madden F. J. F. , Aukett R. J. , Early M. Y. , Dunn M. J. , Rampton J.
Published: July 2009

The events surrounding the iodine therapy of a patient with carcinoma of the thyroid have indicated that the normal pattern of uptake and excretion cannot be taken for granted.

The patient was given 7.4 GBq of I-131 by mouth at approximately 2.00 p.m. on Monday. The level of activity in the patient was assessed by measuring the dose rate at 1 m from the thyroid shortly after the administration and at 24-hour intervals until the following Friday. In normal circumstances, subject to the activity measured on the Friday having fallen to a satisfactory level, the patient would have been discharged at the weekend. Apart from this, the change in activity levels was not followed closely.
Temporary enlargement of penumbra on linear accelerators
Authors: Tuohy J. B. , Morgan A. M.
Published: July 2009

We have recently observed that check radiographs produced on some of our linear accelerators have exhibited a greatly enlarged penumbra in the radial (G–T) direction. The effect was however observed only on fast diagnostic film and not on the much slower radiotherapy verification film.
Book reviews
Authors: Reidy John
Published: July 2009

This slim volume will just slip into a man's inside coat pocket (or be lost in a woman's handbag) yet it contains a wealth of practical information that is well presented in concise note-form style. Dr Kandarpa is a radiologist at Harvard Medical School and together with 11 colleagues, predominantly radiologists, they have produced this comprehensive handbook which covers most aspects of vascular and interventional radiology, except for a few specialized areas.
Book reviews
Authors: Whitehouse G. H.
Published: July 2009

This book encapsulates the vast experience of one of the leading pioneers in the field of mammography. Dr Egan is rather more than an innovator: he is an exceptional communicator, having not only personally taught mammographic techniques and interpretation to many hundreds of radiologists, but also producing over a dozen monographs on the subject. His seminal work at the M. D. Anderson Hospital and Emory University was based on scrupulous radiographic technique, detailed radiological and pathological correlation and extensive statistical analysis.
Real-time digital contrast enhancement and magnification in the assessment of scaphoid and other wrist injuries
Authors: Davies A. M. , Morris E. , Manns R. A. , Fowler J. , Wellings R. M.
Published: July 2009

A study on the value of a commercially available desk-top digital magnifier–contrast enhancer (DETECT System) was made in a series of 550 patients presenting with an acute wrist injury. Four radiologists, of varying experience, independently reviewed the radiographs on a conventional lightbox and later with the digitizer. In the scaphoid series (350 cases), the performance of the two more experienced radiologists was marginally better with the digitizer, whereas the less experienced radiologists performed slightly worse. Overall the digitizer improved the confidence of the radiologists in diagnosing correctly the presence of a scaphoid fracture but, for the less experienced radiologists, this was at the expense of identifying normality. In the wrist series (200 cases), the use of the digitizer resulted in a minor increase in the true positive and decrease in the false negative observations, but this was offset by a concomitant minor increase in the false positive and decrease in the true negative categories. Evaluation of the soft-tissue planes around the wrist joint showed a limited value in the identification of a scaphoid fracture with an overall positive predictive value of 0.26. Correlation of soft-tissue changes and the presence or absence of a scaphoid fracture was slightly worse with the digitizer. Possible causes for the apparently poorer performance of the digitizer are discussed, as well as the relative merits and potential value of the unit.
An unusual cause of abdominal pain
Authors: Wong-You-Cheong J.
Published: July 2009

A 57-year-old Asian woman presented with general malaise and intermittent pyrexia 3 months after a renal transplant. She was immunosuppressed with Cyclosporin A. Examination revealed low grade fever and tenderness in the upper abdomen; chest and abdominal radiographs were unremarkable. An ultrasound scan was performed, which showed a heterogeneous mass in the region of the head of the pancreas, displacing the superior mesenteric vein and compressing the inferior vena cava. There was no biliary dilatation.
Book reviews
Authors: Heron Christine W.
Published: July 2009

Skeletal Radiology is one of a series of nine pocket-size text books in radiology. The book is divided into six major chapters covering tumours, arthritidies, trauma, metabolic bone diseases, congenital anomalies and miscellaneous diseases including haematological disorders and infection. All of the information is presented in outline form as a series of numbered facts, and in several chapters the same format is repeated in the description of different diseases. This layout is intended to allow easy reference with repeated use. “Keyconcepts” are summarized at the beginning of each section to enable review of the most pertinent information.
Book reviews
Authors: Hall Christine M.
Published: July 2009

This small book, Catalog of Prenatally Diagnosed Conditions, by an eminent American clinical geneticist David D. Weaver, aims to encompass our current knowledge as gleaned from the literature of the methods of diagnosis of 448 disorders which have been detected during pregnancy; in this it succeeds.

The information is divided into three sections: the text, the references and the index. Each chapter in the text represents a disease category and the larger chapters, such as congenital malformations, are sub-divided. As might be expected, this particular chapter includes almost half of the total number of prenatally diagnosed conditions. Other chapters cover dermatologic and haematologic disorders, fetal infections and inborn errors of metabolism. A chapter on chromosomal abnormalities has been included but aims only to describe those in which non-cytogenetic findings have been described, for example the cystic hygromas so characteristic of Turner's syndrome. Each condition may be readily found within the relevant chapter by its alphabetical listing, usually using the most accepted nomenclature, although there are one or two exceptions, such as the Martin–Bell syndrome rather than the more commonly used fragile X syndrome.
Book reviews
Authors: Pilling D. W.
Published: July 2009

This book approaches the difficult problem of putting into perspective the different modalities which can be used to image the skeletal system in children. This is a multi-author text bringing together the expertise of 11 distinguished authors from the United States.
Well ventilated bullae: a potential confusion on ventilation/perfusion scanning
Authors: Cunningham Deborah A. , Mitchell David M.
Published: July 2009

Isotope lung scanning is the only non-invasive test capable of making the diagnosis of pulmonary embolism reliably. While defects of perfusion have many causes (Wagner & Strauss, 1975) combining a perfusion lung scan with images of regional ventilation increases specificity, such that segmental or larger defects of perfusion unmatched in ventilation are taken as strong evidence in favour of the diagnosis of pulmonary embolus (“high probability”) (Biello et al, 1979).

In the present paper we report three cases in which bullous areas showed normal ventilation with Krypton 81m and absent perfusion, resulting in large areas of ventilation/perfusion mis-match.

A 65-year-old female Irish betting clerk was admitted with a Staphylococcal septicaemia following a boil on her elbow. She had no respiratory symptoms but she was known to have basal lung fibrosis and a chest radiograph showed apical bullae with bilateral basal fibrosis. During her admission she developed acute left sided pleuritic chest pain and a chest radiograph showed a small left pleural effusion. The diagnosis of pulmonary embolism (PE) seemed likely and a ventilation/ perfusion lung scan was performed using Technetium-99m macro aggregates and Krypton 81m gas.

As expected the bullae in the left apex showed matched defects of ventilation and perfusion. In the right mid-zone, however, there was a large area of ventilation/perfusion mismatch, corresponding to a region of bullous formation on radiography (Fig. 1). A moderate sized mis-matched defect in the left mid-zone probably corresponded to a bullous area also, but PE could not be excluded.
Detection of focal nodular hyperplasia with liver colloid single photon emission computed tomography: a case report and review of the literature
Authors: Aktolun Cumali , Bayhan Hikmet
Published: July 2009

Focal nodular hyperplasia (FNH) is a benign hamartomatous liver mass (Robbins et al, 1984). It is usually identified incidentally during ultrasonographic examination, other diagnostic procedures or autopsy. The patients are often asymptomatic (Drum, 1982). Physical examination is found to be normal in most of the cases. Jaundice, hepatomegaly, palpable mass, and chronic intermittent vague abdominal pain, especially in the right upper quadrant, may be present in some patients. Eighty-eight per cent of the cases are female, of whom 80% give a history of oral contraceptive or supplemental oestrogen use (Kerlin et al, 1983). The lesion may be solitary (55%) or multiple, and it is usually located in the right lobe of the liver (Rogers et al, 1981), varying in size between 1 and 20 cm, and containing hepatocytes, bile ducts and Kuppfer cells (Rogers et al, 1981; Robbins et al, 1984). Colloid scintigraphic appearance may be hyperactive (40%), hypoactive (30–60%) or normoactive (30–55%) (Diament et al, 1982; Kerlin et al, 1983; Rogers et al, 1981; Welch et al, 1985). A central, stellate-shaped collageneous scar with peripherally radiating septa is the typical histopathologic feature of FNH (Kerlin et al, 1983; Rogers et al, 1981).

We present a case of FNH with planar colloid scintigraphy demonstrating slightly increased uptake in the ultrasonographically detected lesion. Single photon emission computed tomography (SPECT) showed a hyperactive region at the lesion site.
Executive distress
Authors: Novell Richard , Stansby Gerard , Dick Robert
Published: July 2009

A 35-year-old sales executive presented with a history of abdominal discomfort and distention of 2 months duration. Systematic enquiry revealed an increased frequency of bowel action and vague dyspepsia over the same period. Examination revealed a poorly denned mass extending from the periumbilical region to the right iliac fossa. An ultrasound scan of the abdomen demonstrated ascites but was unhelpful in further characterizing the mass. A computed tomographic (CT) scan of the abdomen was then performed (Figs 1 and 2). What does this show and what diagnosis would account for these appearances?

The upper cut of the CT scan, at the level of the lower border of T12, shows a soft tissue mass of low attenuation adjacent to the left lobe of the liver. Indenting or “scalloping” of the liver margin by the mass is seen. On the lower cut, at the level of L4, a rim of soft tissue of similar density to the extrahepatic mass is seen anterior to the small bowel which contains oral contrast material. Posterior to the mass, and continuous with it, is a calcified cystic structure 5 cm in diameter. A large volume of ascites is present.

The patient underwent laparotomy 5 days later. At operation the peritoneal cavity was filled with mucoid ascites. Multiple nodules of tumour extended over the entire visceral and parietal peritoneum. The anterior mass shown on CT proved to be a multiloculated semicystic tumour involving the omentum and ascending and transverse colon.
Broad-beam transmission data in lead for scattered radiation produced at diagnostic energies
Authors: Rawlings D. J. , Faulkner K. , Harrison R. M.
Published: July 2009

The growth of interventional techniques in radiology and the consequent close proximity of staff to patients during screening emphasizes the need for provision of proper protective clothing and for appropriate personnel monitoring for radiological staff. In order to comply fully with the Ionising Radiation Regulations (HMSO, 1985a) and the associated Approved Code of Practice and Guidance Notes (HMSO, 1985b; HMSO, 1988), an employer must demonstrate not only that staff doses are below any relevant limits but also that they are as low as is reasonably practicable. Since heavy protective aprons may be unduly inconvenient to wear and since routine personnel monitoring makes use of just one or two dosemeters, it is important for both the optimization of protective clothing and the estimation of whole body effective dose equivalent (IPSM, 1977) that the broad beam shielding properties of lead under relevant working conditions are known (Faulkner & Harrison, 1988).

Although there are several sources which tabulate the broad beam shielding characteristics of lead and other materials at diagnostic X-ray energies (BSI, 1971; HMSO, 1971; O'Riordan & Brotherton, 1968; Binks, 1943; NCRP, 1976), a number of limitations exist when these data are applied in practice to lead apron shielding:

(1) the data represent primary beam attenuation whereas personnel need to be protected against scatter;

(2) data for only a limited number of tube voltages are represented possibly leading to difficult interpolation;

(3) a very large range of thicknesses is covered by the data and accuracy may be compromised at the low lead equivalent thicknesses of aprons.
Book reviews
Authors: Stoker Dennis
Published: July 2009

This small book serves to remind us that tuberculosis has not been eradicated in the Third World, and indeed is increasing even in nations with better than average health care, particularly as a consequence of AIDS. The material illustrated is based on a study of 370 patients seen in The Netherlands over the period 1955–1987.

The text is brief but adequate, and in many respects this could be regarded as an atlas.
Book reviews
Authors: Risdon R. A.
Published: July 2009

As its title suggests, this multi-author text, written by 28 pathologists, radiologists and urologists from the Emory University School of Medicine in Atlanta, Georgia, seeks a multidisciplinary approach to urological pathology.

The book is divided into seven chapters, with varying numbers of contributors to each, covering urological kidney disease, the urinary passages, renal transplantation, the prostate and seminal vesicles, the testis and paratesticular structures, the penis and scrotum, and the adrenals.
Book reviews
Authors: Bewley D. K.
Published: July 2009

This ICRU report maintains the standards of previous ones and will be an essential guide for every department concerned with neutron therapy. It is intended to do for neutrons what Report 29 did for photons and electrons. It is also a successor to Report 26 but does not supersede it as little in Report 26 is repeated.
The chest radiograph appearances seen following high dose chemotherapy and autologous bone marrow transplantation for resistant malignant lymphoma
Authors: Millard F. C. , Nakielny R. A. , Makris M. , Winfield D. A.
Published: July 2009

The objective of this study was to review and analyse the chest radiograph (CXR) appearances seen following high dose chemotherapy and autologous bone marrow transplantation (ABMT), and to identify any characteristic patterns. Thirty-one patients underwent ABMT between 1984 and 1989 for high grade lymphoma resistant to conventional chemotherapy. Their case notes and CXRs were reviewed in conjunction with the clinicians. In this small sample of patients, an acute interstitial pattern was seen with pulmonary oedema following bone marrow reinfusion in two cases of the 13 patients showing CXR changes (15%). Otherwise, the CXR changes following ABMT were not specific, although they did alert the clinician to the possibilities of recurrent lymphoma or opportunistic infection, enabling appropriate investigations and treatment to be instituted at an early stage. The complications and CXR changes did not differ greatly from those seen following allogeneic bone marrow transplantation.
Barium meals in the elderly—a quality reassurance
Authors: Hawkins S. P. , Rowlands P. C. , Shorvon P. J.
Published: July 2009

The consecutive double contrast barium meal examinations of 100 elderly patients (aged over 65 years) and a group of 33 younger adult patients were analysed by two observers for technical quality and pathological abnormalities. Technical quality declined with patient age, especially in those over 75 years, but was sufficient to enable diagnosis of abnormalities in 60% of the elderly group. It is concluded that, in the majority of elderly patients, the technical quality of double contrast barium meal examinations is sufficiently high to offer considerable diagnostic utility.
A new phantom for mammography
Authors: Law J.
Published: July 2009

A new mammography phantom from Du Pont is described. It has a wider range of types of detail than in previous phantoms, including some which closely simulate breast tissues. Experience of its use, and comparisons with an earlier (“Barts”) phantom, are reported. The Du Pont phantom appears to have greater sensitivity to changes in tube kV and focal spot size, and better discrimination between different film–screen combinations and between films from different breast screening centres.
Prenatal diagnosis of unilateral renal disease in tuberous sclerosis
Authors: Blethyn J. , Jones A. , Sullivan B.
Published: July 2009

Sonographic demonstration of an abnormal kidney as the presenting feature of tuberous sclerosis has not been described previously. A large echogenic kidney was first shown on routine prenatal 28 week ultrasound and confirmed as cystic on biopsy after birth. Generalized convulsions and depigmentation developed in infancy and CT showed cerebral cortical tubers.

An enlarged echogenic left kidney was discovered on routine antenatal sonography of a 28 week fetus in a 27-year-old gravida 1 mother (see Figs 1 and 2). The previous 16 week ultrasound scan was normal. A provisional diagnosis of multicystic dysplastic kidney was made in view of the normal right kidney and bladder. A detailed fetal ultrasound at 32 weeks confirmed the unusual appearance of the left kidney, but did not detect any abnormality in the contralateral kidney, the head or the heart.
Ultrasonography in patients with suspected acute appendicitis
Authors: Sherwood Thomas
Published: July 2009

It seems a pity that a paper with this title published in 1990 forgets the discussions of 2 years ago. Rosenquist (1988) showed that ultrasound reports with similar sensitivities, specificities and accuracies might in fact double the death rate from acute appendicitis if adopted.
Dosimetry of electron backscatter at mandibular reconstruction in megavoltage photon beam
Authors: Das Indra J.
Published: July 2009

The dosimetry article by Delacroix et al (1990) in the August issue of BJR demonstrates the ignorance evident when proper literature search is not thoroughly conducted before starting a project. They reported a very superficial aspect of the dose perturbation caused by metallic mandibuilar reconstruction plates (MRP). Their data is redundant and incomplete.

A dose perturbation exists at and near interfaces between two dissimilar atomic number media exposed in a radiation beam. Hence any metallic object in an irradiation field will produce a dose perturbation. The metal–soft-tissue interface problem has been discussed by various research groups in the past. Some of the references can be seen in the articles by Das and Khan (1989) and Werner et al (1987).
Related articles?
Authors: Dawson Peter
Published: July 2009

Reading the paper of Tokita et al (1990) gave me a powerful sense of déjà vu. In concept, justification, basic experimental methods, central results and discussion of implications and applications, it bears an uncanny resemblance to another “Short communication” published in BJR in 1987.
William Hampson (1854–1926)
Authors: Davies Mansel
Published: July 2009

Hampson was the originator of modern air-liquefaction methods, pioneered the prospect of heart pace-makers, made improvements in X-ray radiography and published, inter alia, a 70 000 word critique of the credit system, with his own proposals for reforming society.
Book reviews
Authors: Hansell David M.
Published: July 2009

This is a single-author book of moderate size covering all aspects of imaging the chest. Acknowledgment is given to Professor Paul Stark of California for his collaboration and assistance in translating (along with Dr Norman MacLean) from the original German. The virtually faultless anglicization of the text is impressive. The book is divided into three parts: examination technique and normal findings, pulmonary diseases and finally radiological signs and differential diagnosis. The first section deals concisely with normal chest anatomy, and is particularly good in the way it describes the mediastinal stripes and normal segmental anatomy.
Book reviews
Authors: McNally N. J.
Published: July 2009

Dr Mould has done it again. Repeat prescriptions are usually given because the first dose failed; here it is just the opposite, the first was such a success that the patient is crying out for more of the same! Ambrose Bierce defined a prescription as a physician's guess at what will best prolong the situation with least harm to the patient; in this case, any harm will be due to sore ribs from laughter.
Book reviews
Authors: Dean Mike
Published: July 2009

This book is an introduction to the clinical use of lasers in cardiovascular disease. It is, however, devoted almost entirely to one type of laser device, the metal-tipped laser probe, although a brief last chapter describes alternative devices for delivering laser energy to atherosclerotic plaques. The use of lasers for ablation of atheroma is still experimental, but it is a rapidly developing field.
Fetal choroid plexus cysts: a prospective study and review of the literature
Authors: Twining P. , Zuccollo J. , Clewes J. , Swallow J.
Published: July 2009

To determine the incidence and significance of fetal choroid plexus cysts, a prospective study was carried out at Queen's Medical Centre, Nottingham. The incidence of cysts was found to be 0.42% and the size of cysts varied from 3 to 13 mm with a mean diameter of 6.2 mm. Choroid plexus cysts were associated with other fetal abnormalities in three cases, two of which were subsequently found to have a chromosomal abnormality, one Trisomy 18 and one Trisomy 21. A review of the reported cases of choroid plexus cysts reveals an overall incidence of 5.8% for Trisomy 18. We therefore recommend that in patients with choroid plexus cysts a detailed scan should be carried out to look for the ultrasound markers of Trisomy 18. If there is an associated abnormality or cysts are large (13 mm or greater in diameter) and bilateral then a karyotyping should be carried out.
“State of the art” transrectal ultrasound imaging in the assessment of prostatic disease
Authors: Clements R. , Griffiths G. J. , Peeling W. B.
Published: July 2009

Three major developments have occurred in recent years which have increased our understanding of prostatic disease: a major reassessment of the anatomy of the prostate, the development of the serum assay for prostate-specific antigen, and developments in prostatic imaging. The prostate gland has traditionally been regarded as an organ with a relatively simple anatomical structure, based on a system of lobes, as proposed by Lowsley (1912). Lowsleyapos;s concept was, however, based on observations of fetal prostate glands and this system cannot now be accepted. A zonal system of anatomy of the prostate was initially proposed by McNeil in 1969 and was fully described in 1981. This concept has been supported by work by Blacklock and Boushill (1977). In McNeil's system the prostate is considered as three glandular zones, transition, central and peripheral, and one non-glandular region, the anterior fibromuscular stroma. The urethra and ejaculatory ducts pass through these zones (Fig. 1). It is important to appreciate this concept of prostatic anatomy as these zones can be identified by transrectal ultrasound with state of the art ultrasound transducers and magnetic resonance (MR) imaging. In the young adult prostate, the transition zone constitutes about 5% of prostatic glandular tissue and is located on both sides of the prostatic urethra; it is in this zone that benign hyperplasia develops. The transition zone is separated from the central and peripheral zones of the prostate by the surgical capsule.
Renal transitional cell carcinoma mimicking medullary sponge kidney
Authors: Choong M. , Phillips G. W. L.
Published: July 2009

Transitional cell carcinoma (TCC) is the commonest neoplasm of the renal pelvis, usually appearing on intravenous urography (IVU) and retrograde pyelography as a filling defect in the pelvicalyceal system. We report a case of renal TCC which mimicked medullary sponge kidney (MSK) on IVU, an appearance not previously reported in the literature.

A 68-year-old man with no significant past history presented with macroscopic haematuria and right loin discomfort. Physical examination and plain abdominal X-ray were unremarkable.
Choroid plexus cysts and chromosomal defects
Authors: McHugo J. , Constantine G. , Rajah R.
Published: July 2009

We read with interest the recent paper by Thorpe-Beeston et al describing their findings of a close association between choroid plexus cysts and trisomies. As they point out, theirs is one in a long series of such papers. Most however, including this paper, are flawed in being based on highly selected referred populations and not a general obstetric population. In this case patients were referred with both choroid plexus cysts and other gross anomalies from a variety of sources.
Book reviews
Authors: Ell P. J.
Published: July 2009

This is a small but very handy and useful 130 page book on the clinical utility of single photon emission computed tomography (CT) using I-123-labelled N-isopropyl-iodoamphetamine. The book contains sections on technique, normal and correlative anatomy, pitfalls, clinical disease states and an appendix covering radiopharmaceuticals and equipment, quality control and manufacturers' equipment protocols.
Book reviews
Authors: Dixon Adrian K.
Published: July 2009

Professors Silverman and Zeman have succeeded in maintaining the very high standard of the “Contemporary Issues” series. They should be congratulated, along with the series editor Elliot Fishman. This latest offering tackles a difficult subject. The only pity is that ultrasound is not considered more, but at the outset it is acknowledged that computed tomography (CT) and magnetic resonance imaging (MRI) are principally used when ultrasound leaves unanswered questions.
Iliac insufficiency fractures
Authors: Davies A. M. , Bradley S. A.
Published: July 2009

Twenty-five post-menopausal women with one or more insufficiency fractures of the pelvic ring are reported. In 80% of cases the fractures were multiple and a total of 79 insufficiency fractures was identified. Twelve iliac insufficiency fractures were present in 11 patients located at one of three sites: above and parallel to the acetabular roof (“supra-acetabular”), extending diagonally across the iliac ala from the greater sciatic notch (“oblique iliac”), and adjacent to the sacro-iliac joint (“superomedial iliac”). The plain radiographic appearances of these iliac fractures were typically subtle with ill defined medullary sclerosis, due to trabecular compression, the cardinal sign. Scintigraphy revealed the fractures as foci of increased activity which, in the presence of multiple pelvic insufficiency fractures, may be mistaken for metastatic disease. Computed tomography can be helpful in confirming the presence of suspected fractures, revealing further occult fractures and also excluding the likelihod of malignancy.
Ultrasonic evaluation of gallbladder function prior to non-surgical treatment of gallstones
Authors: Beswick J. S. , Hughes P. M. , Martin D. F.
Published: July 2009

A comparative analysis of ultrasonic and oral cholecystographic assessment of gallbladder function in symptomatic patients with cholelithiasis is presented. Ultrasonic evaluation demonstrated non-contractile gallbladders in all but one patient with non-opacification during oral cholecystography, whereas all those opacifying on oral cholecystography contracted on ultrasonography. Both techniques showed similar abilities to quantify the size and number of biliary calculi within the limits necessary to determine suitability for treatment. Although computed tomography remains necessary to quantify gallstone density prior to non-surgical treatment, ultrasonography is a safe, acceptable, cheap and preferable alternative to oral cholecystography in assessing gallbladder function.
Ultrasound in the diagnosis of the juxta-pleural lesion
Authors: Bradley M. J. , Metreweli C.
Published: July 2009

Any opacity on a chest radiograph has a wide differential diagnosis. Plain radiography and computed tomography may help to differentiate whether bone, intercostal soft tissue or mediastinum are involved. Bronchoscopy is often negative with peripheral lesions. This leaves the physician with a diagnostic problem. We examined ultrasonically 30 patients with juxta-pleural lesions and performed cutting biopsy in 27. Twenty-four of these produced positive histology (90%). The three that were not biopsied were anechoic and had pulsatile lesions due to vascular abnormalities. There were four benign lesions all with hypoechoic appearances and the 20 malignant cases showed a wide spectrum of echogenicity. Of the malignant lesions, 90% showed pleural line disruption with reduced respiratory movement suggesting chest wall invasion. There were no complications, despite using cutting biopsy.
Advances in treatment planning dosimetry for a high energy neutron beam
Authors: Blake S. W.
Published: July 2009

Before starting the clinical programme, a series of physical measurements were made using the Clatterbridge high energy neutron facility. These consisted of measurements made under standard conditions, e.g. with square fields, full scatter conditions and perpendicular beam incidence. Further measurements have now been performed to include various clinically relevant non-standard conditions. These included the effects of field shape, backscatter, oblique incidence, bolus and beam blocking on dose distributions.
Calcified splenic and portal vein thrombosis: an unusual cause of multiple high amplitude echoes in the spleen
Authors: Logan Hugh , Meire Hylton
Published: July 2009

Calcification in the walls of the portal vein and in portal and splenic vein thrombosis is well described (Mobeg, 1943; Magovern & Mensham, 1954; Sherrick et al, 1964; Adler, 1979; Mata et al, 1987). Multiple calcine foci in the splenic parenchyma is an unusual but well recognized appearance that is usually attributed to calcified granulomata due to previous tuberculosis or parasitic infestation (Meire, 1988). We report a case of multiple calcific foci in an enlarged spleen that were unequivocally localized to the lumina of tributaries of the splenic vein on ultrasound in a cirrhotic patient with cavernous transformation of the portal vein and documented portal vein thrombosis.

A 57-year-old English railway worker has been under the care of the Liver Unit in King's College Hospital for the past 20 years for cryptogenic hepatic cirrhosis with protaj hypertension.
Book reviews
Authors: Gadian D.
Published: July 2009

This book is essentially a reprinted collection of papers that contribute towards the physical basis of nuclear magnetic resonance (NMR) as used in biomedicine. The editor has selected 17 papers which he divides into three categories. The first is entitled “General, Historical” and includes classic pa-pers published between 1946 (Bloch on nuclear induction) and 1966 (Ernst and Anderson on Fourier transform NMR). This is followed by “Instrumentation and Technique” which includes, for example, the paper by Hoult and Richards on the signal to noise ratio of the NMR experiment. The final category is “RF Field Effects on Biological Samples”, starting with the 1978 paper by Bottomley and Andrew and continuing with a number of papers on inductive and dielectric losses in biological systems, and on coil design.
A pearl of wisdom
Authors: Rawlinson J. , Coblentz C. L. , Franic S.
Published: July 2009

An 8-year-old girl presented with progressive unsteadiness on her feet over a 2-year period. She was otherwise fit and well. No neurological deficit was found on examination, but movements of the lumbar spine were reduced. Conventional radiographs of the lumbar spine, myelogram and computed tomography (CT) myelographic findings are demonstrated in Figs 1–3, respectively.

What is your differential diagnosis? What further information would you seek to clarify the diagnosis? The plain radiographs of the lumbar spine show a scoliosis concave to the right and subtle scalloping of the posterior aspects of the lumbar vertebral bodies 3–5. On the anteroposterior view there is some flattening of the medial side of both L4 pedicles. There is no evidence of bone destruction, disc space narrowing or expansion of the exit foramina.
Focal myositis, a benign inflammatory pseudotumour: CT appearances
Authors: Moskovic E. , Fisher C. , Westbury G. , Parsons C.
Published: July 2009

Focal myositis is a rare benign pseudotumour of skeletal muscle, of unknown cause. Clinically it presents as an enlarging mass within muscle, usually of an extremity, and is often mistaken for a soft tissue neoplasm. The diagnosis is made by biopsy which reveals characteristic histological changes of inflammation, focal degeneration and regeneration, and some evidence of denervation. The CT findings include irregularity and enlargement of the muscles involved, with diffuse, poorly defined fatty infiltration of the muscle planes, but no evidence of an associated mass. We present two cases of focal myositis of the calf, both of which mimicked a soft tissue neoplasm, and in which CT was helpful in determining the nature and extent of the abnormality, for needle biopsy, and follow-up.
Automated measurement of tumour extent in patients with colorectal liver metastases from X-ray computed tomography
Authors: Perring S. , Hunt T. M. , Fleming J. S. , Blaquiere R. M. , Taylor I.
Published: July 2009

Tumour burden is a significant prognostic factor in patients with colorectal liver metastases, and can be staged according to percentage hepatic replacement (PHR), but accurate measurements of PHR are difficult to obtain. We have used an automated computerized technique to isolate tumour and measure PHR from computed tomography images of 22 patients. Tumour identification was achieved by establishing local histogram-based thresholds at liver-tumour boundaries displaying clear bimodal histogram distributions. There was a significant association between measured PHR and independent visual estimates of PHR stage defined in quartiles (p < 0.001). When the measured value of PHR differed from the PHR stage, the visual estimate was always higher. The accuracy of PHR measurement was assessed on simulated liver computed tomography images. It seems likely that visual estimates of PHR from computed tomography images tend to overestimate tumour extent. The automated technique is probably more accurate and will be useful for assessing and monitoring patients.
Oesophageal atresia and other disorders with a similar antenatal presentation
Authors: Havard A. C. , MacDonald L. M.
Published: July 2009

Oesophageal atresia without distal tracheo-oesophageal fistula is a recognized cause of the absence of fluid in the fetal stomach seen on serial ultrasound examinations. It is rare not to demonstrate fluid in the fetal stomach after 15 weeks gestation. There have been several reports of the antenatal diagnosis of oesophageal atresia by ultrasound, the earliest by Farrant (1980).

Oesophageal atresia occurs once in every 1500 live births and 90% of these are associated with a tracheooesophageal fistula. The fistula is usually to the distal oesophageal segment but rarely are a distal and proximal fistula found. In 1%, an H-type tracheooesophageal fistula is present without an associated oesophageal atresia. In cases of oesophageal atresia with tracheo-oesophageal fistula to the distal segment, fluid in the lungs and major airways may reach the fetal stomach by way of the fistula in spite of oesophageal interruption. Polyhydramnios may still be present. When oesophageal atresia occurs in isolation (10%) or when a single fistula is present to the proximal oesophagus (1%), no fluid can enter the stomach and none will be seen on serial ultrasound examinations.

The purpose of this report is to review other abnormalities that may produce a similar appearance and to document two cases presenting in this manner, which, to our knowledge, have not been previously reported.

A 31-year-old gravida 5 para 3 in her 32nd week of gestation was examined to assess the placental position. A live fetus was present in the vertex position. Mild polyhydramnios was present.
Irregular-shaped fields in electron radiotherapy
Authors: Smith P. B.
Published: July 2009

We read with interest the technical note describing an irregular field technique for electrons, (Plane & Usher, 1990). On our SL 25, at Coventry, we have used a similar technique for over a year with satisfactory results.

On our SL 25, no modification to the applicator is required which makes this technique readily applicable. Perhaps more importantly the shielding alloy we use is MCP 69, and the accessories are cast in an aluminium moulding tray of a size specific to the applicator used. No pre-heating or forced cooling is required making the casting process simpler and possible without special equipment in addition to the moulding trays.
cGy vs Gy
Authors: Abadir Rushdy
Published: July 2009

The radiation oncology practice has a prolonged history of using the rad as a unit. With the introduction of the SI system, the Gy came into being. It is fortunate that the Gy has a metric relation to the rad, such that 1 rad = 0.01 Gy or 1 cGy. The literature is having a mixture of use of Gy as well as cGy. It makes sense to be consistent. To use the cGy rather than the Gy may be preferable for the following reasons.
Book reviews
Authors: Berry R. J.
Published: July 2009

This relatively slim volume is in Springer's “Medical Radiology” series, and is therefore presumably aimed at practising medical imagers and radiation oncologists—a group who should know about radiation risks, but who, at least in the UK, are remarkably un-informed if not positively ill-informed! Sadly, however, although this volume is an updated version of an excellent 1985 German edition and has tremendous value as a source book, it is not sufficiently “user friendly” for radiologists to want to read it. The absence of “executive summary” of the major points made in each of the five otherwise excellent chapters, is a crucial structural omission.
Lymphoproliterative disorders of the thyroid gland: radiological appearances
Authors: Kasagi K. , Hatabu H. , Tokuda Y. , Yamabe H. , Hidaka A. , Yamamoto K. , lida Y. , Misaki T. , Mori T. , Endo K. , Konishi J.
Published: July 2009

Images of lymphoproliferative disorders of the thyroid by ultrasonography (US), computed tomography (CT), 99Tcm and 67Ga scintigraphy were analysed in eight patients (two men and six women, aged 42–83 years). Seven patients were diagnosed as having primary lymphoma and one plasmacytoma. Ultrasound revealed a solid mass with homogeneous and very low echogenicity clearly distinguishable from residual thyroid tissue in five patients, diffuse hypoechoic goitre in one and multiple irregular hypoechoic nodules in both lobes in the patient with plasmacytoma (Case 8). Computed tomography demonstrated a focal low-density area in six cases of lymphoma and decreased density throughout the gland in the other two patients. 99Tcm scintigraphy showed hemilobar enlargement with decreased and uneven trapping, cold area or complete lobar defect in six patients with lymphoma and no trapping in the case of plasmacytoma. 67Ga scintigraphy demonstrated high accumulation in lymphoma and faint accumulation in the case of plasmacytoma. Radiological manifestations with a focal lesion were considered typical and diagnostic of primary thyroid lymphoma, while in one case with diffuse infiltration through the whole gland, the differential diagnosis from Hashimoto's thyroiditis could not be made. In the final case, cells infiltrated diffusely to form islands with patchy distribution among well preserved follicles, correlating with the multiple hypoechoic areas observed by US.
Clinical application of an electronic imaging device for assisting patient set-up in radiotherapy
Authors: Wade J. Penelope , Nicholas David
Published: July 2009

As radiotherapy treatment set-ups are becoming more complicated and a greater emphasis is placed on accuracy, there is an increasing need to verify and record the actual treatments being given. A direct electronic imaging device is currently marketed by Varian (the DYNARAY ID), which uses the latest technology in detection and image processing to obtain digital images of the patient's anatomy using the actual treatment beam. At Norwich we have been using a prototype machine in a busy district radiotherapy centre and have examined over 50 patients. We have found the images easy to obtain and the technique superior to the standard practice of using verification radiographs. The role of this device lies in aiding quality assurance of treatments whilst generating a permanent record of the actual treatment given.
Radiology of secondary amyloidosis of the stomach in a patient with rheumatoid arthritis
Authors: Kawamura S. , Imai A. , Kawamura M. , Kataoka M. , Itoh H. , Komatsu A. , Hamamoto K.
Published: July 2009

Ultrasonography (US) of the fasting stomach in a patient suffering from secondary amyloidosis with a confirmed diagnosis of rheumatoid arthritis revealed thickening of the wall, as well as retention of secretions and delayed emptying of contents despite no administration of an anticholinergic agent such as butylscopolamine (Buscopan, Schering Pharmaceutical Co.). The US findings in the stomach of a patient with secondary amyloidosis are as non-specific as those of barium meal radiography.
The role of the single photon emission computed tomography (SPECT) in detection of ossific mediastinal and pulmonary metastases
Authors: Goddard P. R. , Davies E. Rhys
Published: July 2009

We have read with considerable interest the case report on the scintigraphic detection of ossific mediastinal and pulmonary metastases in osteosarcoma (Brady & Ennis, 1990).

Our recently reported experience of two cases of osteosarcoma (Goddard et al, 1990) has been similar. In one case the pulmonary uptake of 99Tcm MDP demonstrated a metastatic deposit from osteosarcoma that had previously been missed by computed tomography (CT). In the other case, however. CT demonstrated more metastases tha scintigraphy.
Book reviews
Authors: Pilling D. W.
Published: July 2009

There has been a need for some time for a comprehensive atlas of fetal anomalies and the authors of this text are to be congratulated for producing such an excellent review of the subject. The early chapters review methods of obstetric ultrasound, in particular the criteria adopted in America for the different levels of scanning.
Book reviews
Authors: Weir Jamie
Published: July 2009

Peter Wilde's book fills a useful gap in the radiological literature concerning heart disease. It is comforting to see that not all echocardiography has been delegated (intentionally or otherwise) to our cardiological colleagues. As more and more ultrasound machines have Doppler (often including colour) as standard, many more requests concerning “blood flow imaging” are being initiated by clinicians.
Book reviews
Authors: Wialde P.
Published: July 2009

This is a technically well presented atlas of 50 cases in which two-dimensional colour flow Doppler echocardiography is displayed in conjunction with an atlas containing still frames from the cases. The atlas contains discussion which complements the commentary on the video tape. Additionally there are some short notes about the clinical application of colour flow Doppler, physics and instrumentation and various cardiac abnormalities.
Non-specific aorto-arteritis (Takayasu's disease) in children
Authors: Sharma Sandiv , Rajani Mira , Shrivastava Savitri , Kaul Upendra , Kamalakar Takkellapati , Talwar K. K. , Saxena Anita
Published: July 2009

Digital subtraction panaorto-arteriography was performed in 32 consecutive children (21 females, mean age 10.8 years) with non-specific aorto-arteritis to assess digital subtraction angiography (DSA) in imaging these children and to study the patterns of involvement in the Indian sub-continent. Diagnostic quality DSA images were obtained in 21 out of 27 intravenous and nine out of 11 intra-arterial studies. Obstructive lesions were present in all the patients and commonly involved the abdominal aorta (24 patients) and renal arteries (20 patients). Aneurysms were seen in five patients and predominantly involved the descending thoracic aorta. Pulmonary artery involvement was uncommon (five out of 20 patients) and clinically silent. Based on clinical and angiographic features, percutaneous transluminal angioplasty was performed for the management of uncontrolled hypertension in eight patients (10 lesions). Initial success was obtained in eight procedures (80%). Re-stenosis occurred after 5.5 months in one patient, but was successfully re-dilated. The follow-up period ranged between 5 and 16 months (mean 9 months). Long-term efficacy of transluminal angioplasty in the management of these children is awaited.
A new coaxial needle for pre-operative localization of breast abnormalities
Authors: Schoenberger S. G. , Bamber J. C. , Rank W. , Sutherland C. M. , Nichols R. L.
Published: July 2009

A new coaxial needle, containing a retractable anchoring wire with a helical tip, has been developed for purposes of mammographic and sonographic localization of non-palpable suspicious breast abnormalities before surgical excision. The helically shaped tip provides the needle with a number of potential advantages over other currently available localization needles. During in vitro comparisons with other needles quantitative and qualitative evidence was obtained to suggest that the new needle can be expected to have improved anchoring capability, be deflected less by tough fibrous tissue interfaces and be more visible sonographically. The anchoring wire can also be retracted and repositioned. Preliminary clinical experience with the needle was consistent with these expectations.