bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of inappropriate radiological referrals with suspected gallstones: a prospective audit
Authors: Farrell T , Mahon T , Daly L , Masterson J
Published: July 2009

The objective of this study was to derive and test a clinical scoring system in order to predict the presence of gallstones and to identify inappropriate referrals. The design of this scoring system comprised a prospective audit of all referrals with suspected gallstones and a prospective validation of the system on new patients. The subjects used in the study consisted of 300 inpatient, outpatient and general practitioner referrals to a radiology department with suspected gallstones during the period 1984–1986 (1st cohort) and 200 similar referrals from 1987 to 1988 (2nd cohort). The main outcome measures were gallstones as determined by oral cholecystogram and/or ultrasound of the gallbladder. 32.7% and 24.0% of referrals in the first and second cohorts, respectively, had gallstones. A scoring system to predict gallstones was derived on the first cohort based on age, Murphy's sign, duration and type of pain, presence or absence of flatulence, and source of referral. This scoring system discriminated well between those with and without stones in both cohorts. Low risk groups, comprising about 15% of the referrals in each cohort, were identified with a prevalence of gallstones of 4.5% (1st cohort) and 3.0% (2nd cohort). If these patients had not been referred the radiological workload would have dropped by 15%, with a very small reduction in diagnostic yield. We conclude that prior to radiological assessment it is possible, on the basis of source of referral and symptoms, to identify a group of patients with a low prevalence of gallstones. These cases, with a low diagnostic yield, contribute substantially to the workload of a radiological department.
Effect of overall time when radiotherapy includes teletherapy and brachytherapy: a mathematical model
Authors: Jones B , Bleasdale C
Published: July 2009

By expanding the linear quadratic equations to allow for the interval of time between teletherapy and brachytherapy in a model which assumes continual exponential tumour regression following teletherapy, the loge cell kill resulting from brachytherapy is found to depend on radiosensitivity, tumour regression rate (λ) and tumour clonogen doubling time (T  p). When λ is relatively small the precise timing of brachytherapy following teletherapy is shown to influence the tumour cure probabilities. The model predicts a reduction in tumour control if brachytherapy is delayed when λ values are small and T  p values are short, but when T  p values are long, deferral of brachytherapy may be advantageous. By differential calculus the occurrence of a minimum value of log cell kill can be found. Application of these concepts may improve the results of clinical radiotherapy.
A newborn case of chondrodysplasia punctata, tibia-metacarpal type
Authors: Matsui M. , Honma Y , Oguro N , Shiraishi H , Kobayashi S , Yanagisawa M , Nakamura K
Published: July 2009

Chondrodysplasia punctata, tibia-metacarpal type, was diagnosed in a Japanese neonate with short limbs, based on the characteristic radiological findings of widespread calcific stippling in the epiphysis, tarsal area and the sacrum, and dysplasias with predominant involvement of the tibiae and metacarpals.
Diagnostic pharmaco-scintigraphy with hepatic intraarterial technetium-99m macroaggregated albumin in the determination of tumour to non-tumour uptake ratio in hepatocellular carcinoma
Authors: Lau W Y , Leung T W T , Ho S , Chan M , Leung N W Y , Lin J , Metreweli C , LI A K C
Published: July 2009

Between October 1990 and March 1993, 124 patients who had hepatocellular carcinoma (HCC) underwent diagnostic pharmaco-scintigraphy with hepatic intraarterial technetium-99m macroaggregated albumin (TcMAA) to determine the tumorous to non-tumorous liver tissue uptake ratio (T/N ratio). There were 110 males and 14 females. Ages ranged from 16 to 73 with a median of 55 years. The range of T/N ratio was 0.7 to 19.3 with a median of 3.8. 12 patients with inoperable HCC were subsequently selected by predetermined criteria to undergo treatment with hepatic intraarterial yttrium-90 microspheres and the T/N ratios in these patients were validated by beta probe dosimetry and liquid scintillation count of multiple liver biopsies. The T/N ratio determined by preoperative diagnostic TcMAA scan correlated well with intraoperative beta probe dosimetry, with coefficient of correlation r = 0.82. Preoperative TcMAA scan also correlated well with liquid scintillation count of biopsy specimens, with r = 0.96. We conclude that TcMAA scan can be used to determine the T/N ratio in patients with HCC, thus allowing better selection of patients with inoperable tumours for loco-regional therapy.
Book review
Authors: Gleeson J A
Published: July 2009

It is rare to be able to recommend a text book without reservation, happily in this case one can do so.

Radiology of the Small Bowel is an excellent well written book with superb illustrations and up-to-date references from a wide range of sources. For the most part it confines itself to the changes found on “luminal contrast studies” but this is not to the complete exclusion of other methods of investigations when considered of value in reaching a diagnosis.
Comparison of a new dual characteristic film–screen system (Insight) with a standard film–screen system for chest radiology
Authors: Logan P M , Tunney T , McCoy C T , Masterson J
Published: July 2009

A new dual image receptor screen–film combination has been developed by Kodak with the objective of improving mediastinal and retro-cardiac detail whilst retaining good contrast and detail in the lung fields. This system was compared with our standard chest system. The study population was 36 patients with sarcoidosis. A postero-anterior (PA) chest film using our standard system was followed by a PA chest film using the new system—both using high kVp technique. The pairs of radiographs were assessed for (1) presence or absence of lymphadenopathy; (2) visibility of anterior and posterior mediastinal and azygooesophageal lines; (3) visibility of vessels in the outer and inner thirds of the lungs and (4) visibility of infiltrates, if present. The new film–screen combination was judged to show the mediastinal structures better in almost all instances. However, our standard combination was preferred for lung detail visualization in most cases. No significant difference was found between the two systems in their ability to demonstrate lymphadenopathy. The results were almost unchanged when the observers were given the option to score the criteria as equally well demonstrated on both films as opposed to not having this option available. We feel the advantages of the Insight system do not compensate for the significant loss of parenchymal detail resulting from the use of this system.
Image quality and patient dose for different screen–film combinations
Authors: Guibelalde E , Fernández J M , Vañó E , Llorca A , Ruiz M J
Published: July 2009

Comparisons of image quality and estimations of dose reductions were made for several new screen–film combinations including conventional and rare-earth systems under conditions similar to abdomen radiography. The evaluation was carried out using an ANSI type phantom and the TOR(CDR) image quality object developed by the University of Leeds. The parameters employed for the comparison were: entrance dose, high and low contrast threshold sensitivity and resolution. The advantages and limitations of the method are also discussed. Results show that images with high quality can be obtained with comparatively low patient doses, and that there are still wide differences in image quality for similar speed systems, depending on the manufacturer and on the chosen combination.
Metastatic malignant testicular teratoma of the thymus
Authors: Phillips C J
Published: July 2009

Metastasis of malignant testicular teratoma to numerous sites is recognized and thymic hypertrophy following chemotherapy is frequently seen. The finding of metastatic malignant testicular teratoma in the thymus described here illustrates a further cause of thymic enlargement in this group of patients, which has not been previously reported.
Book review
Authors: Dewbury K C
Published: July 2009

This book provides an excellent comprehensive practical text encompassing all major aspects of vaginal ultrasound that are in clinical use today. It is beautifully illustrated using clear diagrams, photographs and high quality ultrasound images. The boxed lists found in many chapters which itemize the main points are a particularly attractive feature and very useful for teaching.
Radiology of stromal sarcoma of the breast with ossifying pleural metastases
Authors: Roditi G , Prasad S
Published: July 2009

Stromal sarcoma of the breast is a rare tumour, the radiology of which has not been to our knowledge properly documented: the case presented returned to medical attention with a large, apparently calcifying pulmonary mass. This proved to be an ossifying pleural metastasis at thoracotomy, when a second smaller, unsuspected similar lesion was found. The radiological findings (including mammography and CT) are reviewed. The role of the radionuclide bone scan (the full significance of which was not appreciated preoperatively) is discussed.
Further experience at the Bristol Centre, following the installation of a second MRI unit
Authors: Goddard P
Published: July 2009

I was pleased to read the excellent report by Thomson et al [1] regarding the installation of the second MRI unit in Bristol. I fear, however, that the report is incomplete without the figures from the MRI machine at the Bristol Royal Infirmary mentioned in the paper. In early 1992 a Siemens 1 T Magnetom Impact MRI unit was installed in the Department of Clinical Radiology at the Bristol Royal Infirmary. In the year April 1992 to March 1993 inclusive, 2728 areas were scanned with the breakdown as shown in Table I.
Plain chest radiographic changes of the absent pulmonary valve syndrome
Authors: Owens C M , Rees P , Elliot M , Shaw D
Published: July 2009

The plain chest radiographs of 40 patients with the absent pulmonary valve syndrome in association with tetralogy of Fallot have been reviewed. The conventional frontal projection showed characteristic changes of massively dilated central pulmonary arteries with normal peripheral markings in all patients (100%). Lobar hyperinflation was present in a significant proportion of the infant group (38%) which in a smaller group can be a complication requiring surgery in addition to that for the cardiac malformation.
Ultrasound diagnosis of obstructed Roux loop after cancer of the pancreas or bile duct
Authors: Holland C L , Olliff S P , Olliff J F
Published: July 2009

We describe three cases with known pancreatic or bile duct neoplasia treated by surgery who subsequently presented with obstructive jaundice. In all cases ultrasound demonstrated a fluid-filled obstructed Roux loop and a patent biliary–enteric anastomosis. The cause of the obstruction was seen in two cases. Ultrasound is a safe, fast, reliable and non-invasive method in the assessment of these patients.
Communication makes all the difference
Authors: Gill K P , Hine A L
Published: July 2009

A 64-year-old man was admitted for excision of a mass in the right groin. The mass had been present for 6 months and had recently enlarged. The patient had noticed aching at the end of the day. His past history was non-contributory.

On clinical examination a fixed hard mass was palpated in the right groin. A similar mass was present in the left groin. A computed tomography (CT) scan of the pelvis was arranged (Figure 1).
Book reviews
Authors: Moskovic E
Published: July 2009

Although we have all been told on numerous occasions that MRI really excels in the skull base and neck, the concept of using “difficult” technology to display “difficult” anatomy can be psychologically off-putting even to an interested party. The intelligence of this atlas is to display MRI at its best and simplest without complicated physics or technical sequencing descriptions, whilst demonstrating just how beautifully head and neck pathology can be imaged.
Book reviews
Authors: Ormerod I E C
Published: July 2009

This excellent little book is one from a series of the Clinicians Guide to Nuclear Medicine edited by P J Ell. This series has therefore been targeted specifically at clinicians rather than at nuclear medicine specialists or radiologists. As a member of the identified audience for the book, I suppose I am in a reasonable position to assess how well it achieves its aims.
A method and contrast–detail phantom for the quantitative assessment of radiotherapy portal imaging systems
Authors: Harrison R M , Lambert G D
Published: July 2009

Several designs of electronic portal imaging systems for radiotherapy have been reported or are now commercially available, as well as the familiar radiographic screen-film combinations. In order to evaluate imaging performance of these, and future, systems a prototype contrast-detail test object has been developed in conjunction with a method for determining contrast from a model of the X-ray spectra produced by linear accelerators. Several existing test objects rely on qualitative or semi-quantitative estimates of contrast. In this technique, quantitative estimates of contrast may be determined for each detail size from realistic estimates of the X-ray spectrum by using a spectral model either in conjunction with narrow-beam attenuation measurements on the linear accelerator used, or by using the nominal value of maximum photon energy. This technique should facilitate the comparison of imaging systems used with linear accelerators of different energies as well as providing a quantitative quality control tool for regular measurements of imaging performance. Examples of the use of the test object in the evaluation of several commercial screen-film combinations are given.
Ultrasound guided transvaginal drainage utilizing a 7 French pig tail balloon catheter
Authors: Bangsbøll S , Karstrup S
Published: July 2009

Ultrasound guided transvaginal drainage of abscesses in the small pelvis is usually performed using needles or stiff pig tail catheters without internal fixation. To prevent dislodgement during the subsequent drainage and irrigation procedure, we have developed a new soft 7 F balloon catheter for continuous transvaginal drainage. The catheter is made of soft C-flex and contains two channels, one for drainage and one for inflating a small distal balloon (outer diameter, 10 mm).
Unfit to sit
Authors: Sidhu P S , Jonker N D , Peters A M
Published: July 2009

A 50-year-old male patient on haemodialysis for endstage renal failure was admitted with severe retrosternal pain and breathlessness. There was a history of septic arthritis of hip and knee, a sigmoid colectomy for a perforated diverticulum, and three failed renal transplants. Haemoglobin was 6gm dl−1, faecal occult bloods were positive and endoscopy showed severe lower oesophageal ulceration. This was treated appropriately, following which there was an improvement improvement in the retrosternal pain. The breathlessness continued and was accompanied by right sided discomfort. A ventilation (V)/perfusion (Q) lung scan was performed using 81Krm and 99Tcm labelled macroaggregated albumin (MAA). Because of his general condition, the patient was imaged supine (Figures la, b).
Acoustic noise levels during magnetic resonance imaging scanning at 1.5 T
Authors: McJury M , Blug A , Joerger C , Condon B , Wyper D
Published: July 2009

Although much has been published concerning the various safety risks associated with magnetic resonance (MR) imaging, little mention is made of the acoustic noise generated during scanning. The existing data are now out of date with regard to currently used imaging protocols and technology. Out of concern for patient safety, measurements were made of the acoustic noise generated during various scan protocols on a high field (1.5 T) Siemens MR imager. These data were compared with published data. The data show that for certain protocols, the exposure to acoustic noise falls outside safety guidelines unless ear protection is used.
Uptake of 99Tcm methyl diphosphonate in goserelin implant
Authors: Buscombe J R , Oliver D J , Jenkins D G
Published: July 2009

We would like to report a new cause of soft tissue uptake on a bone scintigraph which has not been previously reported [1].

Standard 99m1 methyl diphosphonate (MDP) bone scintigraphy was performed in a 50-year-old female patient with carcinoma of the breast and known spinal metastases.
Bowel preparation before intravenous urography: is it necessary?
Authors: Jackson S , Buxton P , Hacking C N
Published: July 2009

We read with interest the paper by George et al [1], and agree with their findings that bowel preparation prior to intravenous urography is unnecessary.
Bowel preparation before intravenous urography: is it necessary?
Authors: George C D , Vinnicombe S J , Balkisoon A R A , Heron C W
Published: July 2009

We read the letter from Jackson et al with interest and thank them for their comments. Although their study is superficially similar to ours it does differ in one very important respect.
Book reviews
Authors: Gleeson J A
Published: July 2009

One is either a “Gamuts” believer and follower or not.

This edition is larger and more comprehensive than the earlier editions, to the believers this is an excellent book; the fingers of Gamuts have extended into CT, ultrasound and MR.
Book reviews
Authors: Corbett R H
Published: July 2009

This is the 16th in a series of lectures on Radiation Protection and Measurement held annually to honour Lauriston S Taylor, who was the first President of the NCRP.

The publication consists of 65 pages, beginning with the welcome address to the lecturer, and ending with five pages of references and an 11 page list of NCRP publications.
Radiological insertion of an implantable drug delivery system
Authors: Lopez A J , Sidhu P S , Dutka D , Cousins C
Published: July 2009

A fully implantable drug delivery system has been shown to overcome many of the problems of long-term venous access. Traditionally these have required surgical implantation but we describe a simple, cost-effective and successful technique for the percutaneous insertion of an implantable vascular device (Vascuport,Ohmeda) in the angiography suite under local anaesthesia. It was successful in all 19 patients in whom it was attempted, with only one minor complication. We recommend that the procedure should be performed inX-ray departments using screening and conventional guidewire techniques.
The measurement of mammographic room protection
Authors: Johnson C H , Walker A
Published: July 2009

Owing to the inherent design of mammographic X-ray tubes, transmission measurements through the surrounding protective barriers are difficult to obtain using the primary beam. An alternative method has been developed which employs an iodine-125 source. Transmission measurements were obtained through common building materials using both the iodine-125 source and a mammographic X-ray beam generated at 35 kVp. Measurements were converted into an aluminium equivalence, from which correction factors were calculated to convert the aluminium equivalence determined using iodine-125 to the true aluminium equivalence. Average correction factors for samples of glass, chipboard and plasterboard were 1.10, 0.75, and 0.85, respectively.
The selection of age groupings for the results of radiation dose surveys in paediatric radiology
Authors: Chapple C-L , Faulkner K , Lee R E J , Hunter E W
Published: July 2009

We are pleased to note that our recent papers in this journal [1,2] have stimulated a discussion on the subject of paediatric radiation dosimetry. We wish to make a number of comments and observations in response to Gallacher and Baldock's letter.

We initiated a survey of patient doses in paediatric radiology during 1989 because of our interest in this subject and also as at that time there were few published surveys to refer to for information. As Gallacher and Baldock have pointed out in their letter, patient size is one of the main influences on radiation doses received by paediatric patients.
Book reviews
Authors: Banerjee A , Banerjee A K
Published: July 2009

In this latest publication in the “Dental Series” from Churchill Livingstone, Mr Eric Whaites, a Consultant in Dental Radiology at Guy's Hospital has produced a textbookoutlining both the theoretical and practical aspects of radiology as applied to students of dentistry. Although it is primarily aimed at dental undergraduates, the contents are detailed enough for postgraduate examinees in dental surgery. Medical graduates preparing for the Fellowship examination in Clinical Radiology [FRCR] are also likely to find this book a useful source of knowledge and reference, and it will help them covera topic which is often neglected in teaching courses.
Comparative study of dose values and image quality in mammography in the area of Madrid
Authors: Morán P , Chevalier M , Vañó E
Published: July 2009

Dose values and image quality in mammography resulting from a study carried out in the area of Madrid during 1990–1991 are presented in a two-part sequence. In this paper are reported the values of air kerma and mean glandular dose per film estimated at 14 centres by means of the Leeds TOR(MAX) mammographic phantom and from patient samples. The results obtained from patient measurements allow us to deduce that the TOR(MAX) phantom assembly used (4.5 cm thick) is equivalent to an average 5 cm thick compressed breast from the population in the area of Madrid. Approximately 75% of the air kerma values resulting from phantom estimations are below 6.6 and 12.2 mGy for X-ray units with and without grid, respectively. The mean glandular doses per film for 75% of the units with and without grid are below 1.5 and 1.7 mGy, respectively. The results showed that the higher values of both air kerma and mean glandular dose obtained for the units without grid result from the use of slow speed recording systems. On the other hand, the quality control programme carried out shows important faults in the performance of the X-ray units which have an important impact on both dose and image quality. Finally, the third quartile values of the air kerma and mean glandular dose per film (10.4 and 1.7 mGy, respectively), deduced by considering all the units (with and without grid), are proposed to be the reference values of the mammographic examinations during the aforementioned period. In a second paper, the image quality is analysed by using the same Leeds TOR(MAX) phantom. Results for each test object included in the phantom are discussed as a function of the X-ray unit characteristics. Subsequently, the phantom images obtained with each X-ray system are scored and the resulting values are compared with the corresponding dose values, so that the dose–image quality relationship for each unit is obtained.
A technique for measuring the surface area of articular cartilage in acetabular fractures
Authors: Hughes S W , Brueton R N
Published: July 2009

The aim of this study was to develop a reliable technique for measuring the area of a curved surface from an axial computed tomography (CT) scan and to apply this clinically in the measurement of articular cartilage surface area in acetabular fractures. The method used was a triangulation algorithm. In order to determine the accuracy of the technique, areas of hemispheres of known size were measured to give the percentage error in area measurement. Seven such hemispheres were machined into a Perspex block and their area measured geometrically, and also from CT scans by means of the triangulation algorithm. Scans of 1, 2 and 4 mm slice thickness and separation were used. The error varied with slice thickness and hemisphere diameter. It was shown that the 2 mm slice thickness provides the most accurate area measurement, while 1 mm cuts overestimate and 4 mm cuts underestimate the area. For a hemisphere diameter of 5 cm, which is of similar size to the acetabulum, the error was –11.2% for 4 mm cuts, +4.2% for 2 mm cuts and + 5.1% for 1 mm cuts. As expected, area measurement was more accurate for larger hemispheres. This method can be applied clinically to quantify acetabular fractures by measuring the percentage area of intact articular cartilage. In the case of both column fractures, the percentage area of secondary congruence can be determined. This technique of quantifying acetabular fractures has a potential clinical application as a prognostic factor and an indication for surgery in the long term.
Book review
Authors: Gleeson J A
Published: July 2009

This is a well written, excellently illustrated book, the images being supplemented where necessary by clear line drawings; it will almost certainly prove to be the chosen book for undergraduate medical students wishing to learn of radiological imaging.
Diffuse idiopathic skeletal hyperostosis in a young patient
Authors: Hammoudeh M , Siam A R
Published: July 2009

A 27-year-old male patient was referred to a rheumatology clinic because of mild pain in the neck of 3 years duration. The pain was mainly present in the morning and after a rest, associated with 10–20 min stiffness, subsiding with activity. He also noticed that he had had some limitation of neck motion. More recently, he complained of shoulder pain bilaterally upon raising his arms.
Factors affecting eye dose during cardiac catheterizations
Authors: Goldstone K E , Dendy P P
Published: July 2009

It is never appropriate to advise against the legitimate pursuit of safety but it is occasionally necessary to point out possible pitfalls.

Pratt and Shaw [1] give a thought provoking analysis of factors affecting the dose to the lens of the eye during cardiac catheterization. However, before readers jump to too many conclusions over the risks of eye doses during such procedures and the apparently large variation between operators and centres, they should note an important feature of the way in which the “doses” in Table I in that paper are presented.
Comparison of technetium-99m nanocolloid and indium-111 leucocytes in the diagnosis of orthopaedic infections
Authors: Stewart I E T , Chan K W , Metreweli C
Published: July 2009

The study by Ooi and Finlay [1] contains a number of errors that raise serious doubts as to the conclusion they reached.

99Tcm nanocolloid is taken up in the marrow as well as the liver and spleen. Diagnostic images should have a good marrow to soft tissue ratio with little soft tissue activity.
Book reviews
Authors: Ormerod I E C
Published: July 2009

With some success the contributors to this book have tried to summarize what is known of the pathogenesis, clinical features, imaging characteristics and pathology of small vessel arterial disease in the brain. They have highlighted the historical background to this and have gone on to discuss the extent to which there is an overlap between the classification and description of small vessel arterial disease. The concepts and terminology have changed since the initial descriptions of arterial disease due to the advent of scanners to image the brain in life.
Book reviews
Authors: Irving H
Published: July 2009

The last volume of the “Clinics in Diagnostic Ultrasound” series that was entirely devoted to the technology of the subject was published in 1980 and it is thus timely that Peter Wells has gathered together an illustrious band of co-contributors “to present a multifaceted view of the most exciting contemporary developments”.
Book reviews
Authors: Plant G
Published: July 2009

The title of this book describes precisely its contents. After reading it one would have a very good idea of all the options available to revascularize obstructed vessels. The editors are well known interventional radiologists and the contributors, an additional 112 names, encompass many of the big names in vascular interventional radiology worldwide with a particular emphasis on the United States and continental Europe.
Pulmonary oedema secondary to laryngospasm following general anaesthesia
Authors: Padley S P G , Downes M O
Published: July 2009

The development of pulmonary oedema following the relief of upper airway obstruction has been reported in a wide range of conditions including post-anaesthetic laryngospasm. Radiologists should be aware of this condition as a complication of general anaesthesia.
Retroperitoneal varices mimicking a mass: diagnosis on colour Doppler
Authors: Kedar R P , Cosgrove D O
Published: July 2009

Retroperitoneal varices may occasionally resemble retroperitoneal masses on computed tomography and B-mode ultrasound. Biopsy could be disastrous in this situation and angiography has previously been required to establish the diagnosis in suspected cases. This unusual problem can nowadays be readily diagnosed by colour Doppler. We report a case in which retroperitoneal varices were initially misinterpreted on B-mode ultrasound as retroperitoneal masses, but colour Doppler established the diagnosis without the need for further investigations.
Book reviews
Authors: Tait D M
Published: July 2009

This is an excellent reference book for anyone involved in the practice of radiotherapy. The layout is extremely clear with good indexing and excellent referencing. In addition, good use is made of easily interpreted figures and photographs which ease the technical writing.
Book reviews
Authors: Wells P N T
Published: July 2009

When a book goes into its fourth edition, it is reasonable to conclude that the author has a winning formula. This is certainly true for Fred Kremkau's Diagnostic Ultrasound.

The text is exceptionally well matched not only to its title but also to the needs of its intended readers. The subject of diagnostic ultrasound is taken to mean cross-sectional anatomical and flow imaging using pusle-echo techniques. The intended readers are sonographers (typically radiographers), vascular technologists and sonologists (including radiologists) who need a basic knowledge of the physical principles and instrumentation of diagnostic sonography.
Book reviews
Authors: Banerjee A K
Published: July 2009

This is the third edition of the well known text on emergency medicine radiology originally published in 1975.

The text is divided into 16 chapters; one each devoted to the skull, the face and the spine; nine devoted to the extremities; one to the chest; one to the abdomen and, finally, chapters on emergencies routinely seen in thecasualty department.
The radiographic appearances of the larynx on the chest radiograph
Authors: Wittram C , Kenny J B
Published: July 2009

100 chest radiographs were reviewed for the normal variable appearances of the larynx. Five radiographs were underexposed and on the remaining 95, contrast between air and soft tissue was identifiable. On 55 radiographs the glottis could be identified, of which 46 had both, eight had none and one had one pyriform recess filled with air. 40 chest radiographs were below the level of the glottis, 34 of which had a convergent appearance of the subglottic region and six had a parallel appearance of the tracheal walls. Appreciation of the variable appearances of the larynx on chest radiography is important before attempting to diagnose laryngeal disease, where practicable standard laryngeal views are recommended.
Limb blood flow measurement in technically successful balloon angioplasty
Authors: Thorley P J , Sheard K L , Sivananthan U M , REES M R
Published: July 2009

An isotope limb blood flow technique was used to assess the outcome of technically successful balloon angioplasty. Measurements were made on a total of 120 limbs, before angioplasty and at least once after angioplasty at 3 weeks, 3 months, 6 months, 12 months and 2–5 years. 67% of treated limbs showed a significant improvement in limb blood flow at 3 weeks. At 12 months following angioplasty 43% of limbs still showed an improvement in blood flow compared with the measurement made before angioplasty. However, a number of these limbs showed a significant fall in limb blood flow between 3 weeks and 12 months even though the 3 week and the 12 month flow figures were still greater than those before angioplasty. The degree of initial improvement in blood flow seen at 3 weeks persisted at 12 months after angioplasty without significant fall in only 30% of limbs. In 33% of limbs where the balloon angioplasty was technically successful there was no improvement in blood flow at 3 weeks. 80% of these limbs had further significant untreated disease angiographically, compared with 43% of limbs where there was an increase in limb blood flow.
The influence of radiotherapy treatment time on the control of laryngeal cancer: a direct analysis of data from two British Institute of Radiology trials to calculate the lag period and the time factor
Authors: Roberts S A , Hendry J H , Brewster A E , Slevin N J
Published: July 2009

This study analyses node-negative laryngeal tumour control data from two clinical trials conducted by the British Institute of Radiology in order to determine the time factors and the presence or absence of a lag period before the time factor takes effect. A direct maximum likelihood approach is used to fit a doublelogarithmic model inlcuding a repopulation term which commences after an initial lag period, T  k. The analysis yields a time factor of 0.8 Gy per day (95% confidence interval 0.5–1.1 Gy per day) as the extra dose required to counteract the reduction in tumour control probability (TCP) with extension of the treatment time. The latter reduction amounted to between 5 and 12% TCP per week, depending on the stage and time period. With this dataset, where few patients were treated for short times, no statistically significant lag phase can be demonstrated. However, the best estimate of T  k is 21 days (95% confidence interval 0–27 days), which is consistent with estimates from other studies on other datasets. If a lag phase exists, this study would indicate that the duration is less than 27 days. Other studies have used retrospective data and are subject to a number of potential biases. The present study, using data from multicentre prospective randomized clinical trials, is free from some of these sources of bias. The fact that very similar estimates of the radiobiological parameters are obtained lends credence to these other studies and suggests that the potential biases may be small in practice.
Prolonged contrast enhancement of the inner ear on magnetic resonance imaging in Ramsay Hunt syndrome
Authors: Downie A C , Howlett D C , Koefman R J , Banerjee A K , Tonge K A
Published: July 2009

There have been recent reports of enhancement of the inner ear in acute labyrinthitis on gadolinium enhanced magnetic resonance imaging (MRI). However, none has described persistence of enhancement beyond 6 weeks. We report a case of Ramsay Hunt syndrome with labyrinthitis, sensorineural hearing loss and facial nerve palsy in which marked enhancement of the inner ear structures was observed on MRI 6 months after the onset of symptoms. Enhancement on delayed or repeated imaging after a period of months does not exclude labyrinthitis from the differential diagnosis of the small intracanalicular acoustic neuroma, and care should be taken not to confuse them.
Venous uptake of 99Tcm-MIBI during resting cardiac imaging: incidence and the effect of using a flush
Authors: Bearcroft P , Wraight E P
Published: July 2009

99Tcm-methoxy-isobutyl-isonitrile (99Tcm-MIBI) is taken up by the vein through which it is injected in some individuals. We prospectively analysed technical and clinical factors that may be associated with this uptake. Imaging was performed over 1 h after injection so excluding a blood pool effect. The frequency of uptake could be reduced from 25.9% to 4.2% by using a 20 ml saline flush (p < 0.05). Other factors appeared irrelevant. The presence of venous uptake did not affect myocardial counting statistics but, if unrecognized, it could cause confusion in studies of the neck or chest that use 99Tcm-MIBI.
Caesium-137 spherical sources for the LDR\MDR Selectron
Authors: Jones C H
Published: July 2009

Recently, we purchased replacement sources for a Nucletron LDR\MDR Selectron remote afterloading machine. The sources were purchased through Nucletron and were supplied by Amersham International pic. The original sources were installed in 1983: there were 48 sources and the ratio of the lowest source strength to the highest source strength was 1.061.
Book reviews
Authors: Thorogood S , Williams M P
Published: July 2009

This monograph is aimed at Accident and Emergency practitioners and their radiologists. It consists of 11 chapters covering the effects of trauma on each part of the anatomy of the chest. The text is concise and it is generously supplemented with chest radiographs and computed tomography (CT) scans.
Book reviews
Authors: Maddison I
Published: July 2009

Do not be misled by the title. This book is about trauma, not Emergency Room radiology. It comprises a multiplicity of contributions from experienced radiologists in the Dallas area. The preface makes their intention quite clear. The book intends to discuss soft tissue injuries. If your patient also has cholecystitis or smoke inhalation, then look elsewhere.
Measurements of the frequency distribution of optical density in screening mammography
Authors: Kotre C J , Robson K J , Faulkner K
Published: July 2009

A method for obtaining histograms of the frequency of occurrence of optical densities in mammograms has been implemented. Averaged optical density distributions were produced for approximately 50 screening mammograms at each of two centres using different film–screen and processing chemistry combinations. Additional measurements were made on films of two commercially available anthropomorphic breast phantoms. The results show that screening mammograms, on average, exhibit a strongly peaked optical density distribution which corresponds closely to the target optical density measured using the current recommended test protocol for automatic exposure control devices.
A study of the relationship between patient dose and size in paediatric radiology
Authors: Martin C J , Farquhar B , Stockdale E , Macdonald S
Published: July 2009

Entrance doses and dose–area products have been measured for paediatric X-ray examinations in a dedicated paediatric department. Dose–area products for barium meal and micturating cystourethrogram examinations involving fluoroscopy were substantially less than results from other studies. A number of factors contribute to this, including a high gain image intensifier used without a grid, shorter screening times, smaller numbers of films, exclusive use of a 100 mm camera and careful collimation of the X-ray field. Entrance air kerma has been measured for pelvis, abdomen, chest and skull radiographs. The relationship between dosimetric quantities and an equivalent patient diameter derived from data on patient height and weight has been studied. The results show a linear relationship between the logarithm of entrance air kerma and equivalent patient diameter for radiographic examinations performed on a single X-ray unit. Application of exponential correction factors could allow entrance doses for radiographs of children of different ages to be compared with appropriate reference doses.
A comparison of computed tomography practice in 1989 and 1991
Authors: Crawley M T , Rogers A T
Published: July 2009

In December 1991, the National Radiological Protection Board (NRPB) published the results of national surveys of the frequency, quality assurance and dosimetric aspects of computed tomography (CT) examinations carried out in hospitals in the UK in 1989. A study of the patient records at two of the original participating hospitals was undertaken to establish whether there had been any change in CT practice between the years 1989 and 1991. Aspects of examination frequency, age distribution and dose were analysed. The results showed significant variations in the patient age distributions between the sub-population studied and the larger sample used by the NRPB, and between the patient age distribution for CT examinations in the years 1989 and 1991 at the two hospitals in this study. The results also showed that in one hospital, where magnetic resonance imaging (MRI) was available and where dose reduction measures had been implemented, there was a net decrease in the collective effective dose from 1989 to 1991, whilst at the other hospital, where MRI was not available and where the introduction of dose saving strategies had been delayed, there was a substantial increase in the collective effective dose from 1989 to 1991. The possibility of continuing increases in the annual collective effective dose attributable to CT underlines the importance of local CT audit to ensure that CT doses are as low as reasonably achievable.
Definitive therapy for prostate carcinoma: Mayo Clinic results at 15 years after treatment
Authors: Swanson G P , Cupps R E , Utz D C , Ilstrup D M , Zincke H , Myers R P
Published: July 2009

Data on long-term follow-up for definitive therapy of prostate cancer are limited, especially for radiation therapy. Either surgery or radiation was used in 322 patients for treatment with curative intent, and follow-up was for a minimum of 15 years. Overall survival was nearly identical to that in an age-matched cohort. 5-, 10-, and 15-year recurrence-free survival rates were 77%, 63% and 53%, respectively. Grade and stage were significant prognostic factors for both recurrence and survival. More than 60% of the initial failures were local, and more than 25% of the failures occurred after 10 years. Radiation therapy was used in 137 patients with clinically staged disease. Radical retropubic prostatectomy and perineal prostatectomy were performed in 133 and 44 patients, respectively. In this group, pathological staging was used. Survival rates for surgically treated patients were better than those in the cohort population. In conclusion, overall long-term follow-up demonstrates that definitive treatment does not have an adverse effect on survival from prostate cancer. Local recurrence is a frequent cause of failure. Caution must be used in interpreting any prostate study with less than 10 years of follow-up, because 25% to 50% of the failures occur after that time.
A case of solitary Peutz-Jegher's hamartoma in the small bowel with angiographic evaluation
Authors: Hanna R M , Dahniya M H , Seddiq M A , Kamel H
Published: July 2009

A case of a solitary small bowel Peutz–Jegher's hamartoma in which angiography revealed the lesion to be vascular is presented. The findings suggest that not all Peutz–Jegher's hamartomas are hypovascular as previously reported and that this type of polyp may mimic other vascular lesions such as haemangiomas and leiomyomas.
Magnetic resonance imaging in Lhermitte-Duclos disease
Authors: Grand S , Pasquier B , LE Bas J F , Chirossel J P
Published: July 2009

A case of Lhermitte–Duclos disease is reported. Characterized by architectural disruption of the cerebellar folia with disorganization of the normal three layers, the lesion is easily identified using magnetic resonance imaging.
A proposed figure of merit for the assessment of unscheduled treatment interruptions
Authors: Dale R G , Sinclair J A
Published: July 2009

There are, as yet, no standard radiobiological methods for devising compensation for unscheduled interruptions to fractionated radiotherapy. For the foreseeable future it is likely that the concept of biologically effective dose (BED) will play an important role in the intercomparison of treatment regimes, and in the examination of the options available for dealing with unscheduled treatment interruptions. However, comparison of the BEDs associated with different treatment options does not provide an intuitively obvious indication of the magnitude of any associated differences in biological effect—an important consideration in the case of those treatments which are designed to deliver near-tolerance doses. This article reviews the implications which derive from this complication, and discusses the desirable properties of possible “one-number” treatment scoring systems which could utilize the BEDs of both the tumour and the critical normal tissue. One possible form of such a scoring parameter is suggested, and applied to some clinical examples. No special “robustness” is claimed for the proposed scoring system, but the method nevertheless allows the ranking of treatment options such that the least satisfactory may be identified and rejected.
Dosimetry in the moving gap region in craniospinal irradiation
Authors: Cheng C-W , Das I J , Chen D-J
Published: July 2009

To minimize the risk of overlap of adjoining orthogonal fields in craniospinal irradiation, a skin gap is usually maintained between the caudal margin of the brain fields and the cephalic margin of the spine field. The moving gap technique (feathering) is commonly used to improve the dose in the gap region. Using Kodak XV ready-pack films and a polystyrene phantom, the dosimetry in the moving gap region at the depth of spinal cord for different gap sizes and feathering step sizes was studied. The dose profiles in the moving gap region with half-beam block set-up were also measured. Our results show that the combination of a small skin gap and a larger feathering step size results in a higher dose in the moving gap compared with that with identical gap and feathering step sizes. For example, with a 0.5 cm gap and 1 cm feathering step size, the dose in the moving gap region at depth of 5 cm ranges from 82 to 88% of the dose to the brain field. The corresponding dose range with 1 cm gap and 1 cm feathering step size is about 68–73%. With no gap and 1 cm feathering step, a dose range of 92–98% is achieved in the moving gap. The slightly steeper penumbra of a half-beam block used in the brain fields does not result in any dosimetric advantage in the moving gap compared with the conventional set-up when feathering is employed.
“But fell like autumn fruit that mellowed long” (John Dryden)
Authors: Yang W T , Evans R M , Chung S C
Published: July 2009

An 89-year-old lady presented in the month of October with vomiting, colicky abdominal pain and abdominal distention. Three years prior to presentation she underwent a Bilroth I partial gastrectomy for a gastric carcinoid tumour. Physical examination revealed that she was dehydrated and there was a positive succussion splash.

A clinical diagnosis of high intestinal or gastric outlet obstruction was made and a contrast study of the upper gastrointestinal tract was performed (Figure 1). What abnormalities are shown and what is your diagnosis?

A large intraluminal filling defect is seen in the proximal jejunum causing obstruction. Mild thickening of the valvulae conniventes is seen proximally. The mass has a stippled appearance (Figure 2).
Book reviews
Authors: Faulkner K
Published: July 2009

The National Council on Radiation Protection and Measurements (NCRP) has issued a series of informative reports over the years. This latest report replaces Report 91. It is a statement by NCRP on radiation protection issues following the recent assessment and publication of data on the biological effects of radiation by various international bodies.
Knee effusions, radiology and acute knee trauma
Authors: Fishwick N G , Learmonth D J A , Finlay D B L
Published: July 2009

Sixty patients wth acute knee trauma were examined radiographically at presentation and subsequently examined under anaesthetic, when arthroscopy was performed. The aim was to assess whether a normal radiograph at presentation excluded significant knee pathology. Nine patients with significant pathology (25%) had normal radiographs at presentation.