bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of small field of view in lumbar spine computed tomography for assumed lumbar disc herniation: Beware contained ruptured aortic aneurysm
Authors: Marsman JWP
Published: March 2008

Among several other atypical clinical presentations, back and leg pain may ensue from a contained ruptured abdominal aortic aneurysm. The present case concerns a patient whose back and leg pain were primarily thought to be orthopaedic or neurologic in origin. Computed tomography with small field of view, performed for the detection of a possible lumbar disc herniation, only partially showed a paraspinal soft tissue mass. Subsequently, recognition of this mass as a contained ruptured aortic aneurysm was delayed. The literature is reviewed concerning comparable cases and it is concluded that computed tomograms performed for possible lumbar disc herniation should also be screened for paraspinal disease and consequently, the applied field of view should be large enough to include at least the paraspinal psoas regions.
The Hutson loop and prosthesis: Clinical uses in hepato‐biliary intervention
Authors: Cameron DC , Frazer CK
Published: March 2008

A number of method of making a Roux‐en‐Y hepaticojejunostomy have been advocated to help the radiologist gain access to the biliary system. We have found markers and rings unsatisfactory and therefore designed and tested our own prosthesis. Reliable rapid access is easily achieved using this device with a much reduced radiation dose to both patient and radiologist. The prosthesis has been used for the past 3 years, and the last 23 patients are reviewed. Seven patients have required repeated interventions via the loop and we present the findings and our results.
Lower limb deep venous thrombosis: A critical view of ultrasound
Authors: Gibson RN
Published: March 2008

The replacement of venography with ultrasound in investigation of lower limb deep venous thrombosis (DVT) is a trend that generally has been appropriate. However, there is substantial variation in reported accuracies related to different clinical contexts, operator experience and sophistication of equipment. The best and most consistent results are for suspected acute femoropopliteal thrombosis, while there is variation in accuracy and diagnostic approach for below knee thrombosis. Potential exists for substantial diagnostic inaccuracy for suspected recurrent DVT, in surveillance of high‐risk patients and in patients with possible pulmonary embolism. The choice of ultrasound over contrast venography should take account of local expertise and accuracy, availability of resources, clinical indication for investigation and cost‐effectiveness.
How do we bring an acceptable level of radiotherapy services to a dispersed population?
Authors: Denham JW
Published: March 2008

Radiotherapy referral data from four Australian States confirm that access difficulties contribute to low radiotherapy utilization rates. Access could be improved by the provision of further small treatment centres in moderately large rural or semi‐rural population centres. Such a policy, however, could endanger existing standards of radiotherapeutic care unless the potential pitfalls of such an approach are addressed prospectively.
The history of neuroradiology: An Australian perspective
Authors: Sage Michael R
Published: March 2008

This paper highlights the contributions of certain individuals working in Australia to the development of neuroradiology.
The changing face of radiation oncology in Australia 1950–1995: A personal view
Authors: Bourne Robert G
Published: March 2008

In 1950, orthovoltage X‐rays were used to treat a wide spectrum of malignant disease but results were impaired by poor depth dose and significant reactions; radium and radon were used commonly and superficial X‐ray therapy was used for a large number of skin cancers as well as many benign skin conditions. Since megavoltage X‐ray therapy was introduced to Australia and with earlier diagnosis, high standards for qualification as a radiation oncologist set by the Royal Australasian College of Radiologists (RACR), improved imaging and tumour localization, improved beam characteristics, computerization and dosimetry, patients are now better treated with improved local control and less morbidity. Public facilities have been chronically underfunded by governments resulting in waiting lists for treatment, and free standing private practices are important in sharing the ever increasing workload consequent to the increasing and ageing population. The use of brachytherapy has fallen but is enjoying a resurgence of interest. Chemotherapy has emerged. Radiobiology has had some influence on radiation treatment. Health education has improved and the needs and expectations of patients better appreciated and helped. Cancer societies have made an important contribution. Statistical evaluation of treatment is better understood. Undergraduate training and academic positions remain insufficient. The formation of the Faculty of Radiation Oncology of the RACR has given fresh impetus to the specialty.
MRI of intraspinal nerve sheath tumours presenting with sciatica
Authors: Loke TKL , Ma HTG , Ward SC , Chan CS , Metreweli C
Published: March 2008

The magnetic resonance imaging (MRI) characteristics of 14 intraspinal nerve sheath tumours (NST) presenting with sciatica were reviewed. The group comprised seven schwannomas, six neurofibromas and one perineuroma. The tumours were either iso‐ or hypointense with respect to spinal cord on T1‐weighted (T1W) images; almost all tumours were hyperintense compared with spinal cord on T2‐weighted (T2W) images. The tumours were all detectable on unenhanced T1W images. Nine NST were scanned following Gadolinium‐Diethylenetriamine penta acetic acid (DTPA) injection and all showed intense enhancement. This aids differentiation from sequestrated disc fragments. Tumours were more likely to show homogeneous enhancement unless they were recurrent tumours. Rim enhancement occurs more commonly in schwannomas and this can be used to differentiate these from neurofibromas. However, on unenhanced images, schwannomas cannot be distinguished from neurofibromas. Four tumours occurred at T11‐T12. There was poor correlation of the site of the lesion with the clinical findings. MRI studies in patients with sciatica should include the lower thoracic region especially if no protruded disc was found in the lumbar region.
Radiological abnormalities in children born as a result of assisted conception
Authors: Leighton DM
Published: March 2008

Over 15 000 children are born each year as a result of the various techniques of assisted conception. In 1991, there were 2083 live births in Australia and New Zealand as a result of these techniques. Radiological abnormalities relating to the increased rate of prematurity, a probable increase in the risk of congenital malformations and a number of cases of neural crest tumours seen in these infants will be presented.
Orbital hydatid cysts: Sonographic and CT appearance
Authors: Sharma Raju , Vashisht Sushma , Berry Manorama
Published: March 2008

Two cases of unilateral proptosis due to orbital hydatid cysts were evaluated by ultrasound and computed tomography. Image morphology of this rare disease is presented.
Hypofractionated irradiation for inoperable non‐small cell lung cancer
Authors: Stevens MJ , Begbie SD
Published: March 2008

A policy of palliative intent thoracic irradiation was prospectively evaluated in 38 consecutive patients referred for treatment of inoperable non‐small cell lung cancer at a single institution. A target dose of 1700cGy in two fractions 1 week apart was delivered. Characteristics of the treatment group revealed most (87%; 33/38) to be of good‐excellent performance status with minimal weight loss before irradiation. Although three patients (8%) had initial metastatic disease, ail had symptoms referable to the thorax with cough (71%), dyspnoea (55%), haemoptysis (39%), and chest wall pain (34%) being dominant. Following treatment, the relative risk of maintaining complete response with regard to each of these symptoms was 0.91, 0.40, 0.92 and 0.78, respectively. Overall 70% of patients maintained complete symptomatic response to time of death or last review. Uncorrected median survival was 35 weeks and was comparable to best international end‐results for either palliative intent or curative intent radiation schedules. We conclude that the radiation regimen employed is safe, efficacious and eminently resource conscious. Recognition of patient groups who overwhelmingly derive no benefit from conventional fractionation schedules will streamline access to radiotherapy services of patients suitable for radical treatment.
Ultrasound and computed tomography appearances of primary hepatic leiomyosarcoma
Authors: Gandhi MR , Wong DC , Wood DJ
Published: March 2008

Primary hepatic leiomyosarcoma is a rare condition. The ultrasound and computed tomography findings in a 73 year old female patient are described. Previous reports have concentrated on the histopathological features and clinical presentation of the condition.
Formation and resolution of bilateral traumatic pulmonary pseudocysts
Authors: Robin J , White R
Published: March 2008

A case of bilateral traumatic pulmonary pseudocysts, an uncommon complication of blunt chest trauma, is presented. The radiologic changes were followed over 6 months until spontaneous resolution had occurred. The mechanism of formation of traumatic pseudocysts and the diagnostic implications are discussed.
Systemic lupus erythematosus serositis
Authors: Low VHS , Robins PD , Sweeney DJ
Published: March 2008

The imaging appearances of a case of systemic lupus erythematosus, which manifested initially as a serositis, is described. Barium small bowel study showed segments of spiculation with tethering, angulation, and obstruction. On computed tomography there was ascites and segments of asymmetrical thickening of small bowel wall were observed. Laparotomy revealed extensive patchy serosai and peritoneal plaques but biopsy of these lesions did not lead to a definitive diagnosis. The diagnosis was made on the basis of marked elevation of antinuclear and anti‐double stranded DNA antibodies.
Obturator hernia: Diagnosis through medical imaging
Authors: O'Connell G , Cole A
Published: March 2008

A rare case of obturator hernia is presented in a patient with persistent small bowel obstruction. There was a paucity of specific signs and poor general health which caused a delay in diagnosis. Ultimately delayed films from a barium follow through showed barium‐filled bowel in the region of the right obturator foramen: A computed tomography scan then confirmed the diagnosis by demonstrating the barium‐filled small bowel herniating through the right obturator foramen. Other imaging modalities such as herniography, barium enemas and ultrasound have also been successfully employed to diagnose obturator hernias.
The 1994 Australian Radiology Workforce Committee Report
Authors: O'Donnell C , Stuckey J
Published: March 2008

The task assigned to the College Workforce Subcommittee by the RACR Federal Council is to define current radiologist and trainee numbers, analyse professional demographics, and attempt to forecast radiologist numbers and the medical demand for radiological services. The period of this forecast is for 7 years leading up to 2001. This time course has been chosen on the basis of a 2 year period before any recommendation by Council could be instituted by the Educational Board and 5 years before any change in trainee numbers would be reflected in radiologist numbers. By necessity, assumptions have been made in formulating the final calculations and recommendations; the most difficult being the designation of an ‘optimum’ number of radiologists for our population. This assignment is an ongoing review and prediction process. The results and conclusions should be compared and contrasted to previous reports, in particular the 1992 Manpower Study.
Radiology in Rwanda
Authors: Miller Philip , Pearn John , Marcollo Shane
Published: March 2008

This account documents some aspects of military radiology in the aftermath of the Rwandan Civil War of 1994. Following the genocidal conflict of April‐July 1994, all radiographic services ceased in Rwanda, a nation of some 7 500 000 people. As part of the United Nations Peacekeeping Force, UNAMIR II, the Australian Medical Support Force established and provided, on an ongoing basis, sophisticated medical, surgical and intensivist care for the sick and wounded United Nations personnel, of whom there were up to 7000 deployed in Rwanda; and, as part of its humanitarian outreach, emergency medical and surgical care for Rwandese civilians. The Australian contingent of 308 service personnel established the Australian Military Hospital (the ‘United Nations Hospital’) in the former Clinic Wing of the Kigali Central Hospital. From August 1994 the Radiology Department of the Australian Medical Support Force provided the first specialist X‐ray services as part of the re‐building of the stricken nation and, over the ensuing year, provided a diagnostic service for soldiers and civilians with both chronic and recent war wounds, trauma victims in the aftermath of the Civil War, sick and injured soldiers and Rwandese suffering from any of the full range of medical conditions encountered in tropical Africa.
The role of colour and duplex Doppler ultrasound in the assessment of thyroid nodules
Authors: Holden Andrew
Published: March 2008

The role of colour and duplex Doppler ultrasound in investigating nodular thyroid disease was evaluated. Fifty patients with solitary or dominant nodules were studied. All nodules were examined with colour Doppler with spectral analysis performed on vascular lesions. Pathological correlation was available for all nodules. The majority of thyroid nodules could be accurately categorized by their colour Doppler appearances. This was true for both solitary and dominant nodules. All neoplastic nodules (adenomas, carcinomas) contained intra‐nodular flow signals. The majority of the colloid nodules were either avascular or had halo flow signals only. A minority of colloid nodules were vascular. These nodules were large (> 2cm), had dominant halo vessels and cytological evidence of follicular cell hyperplasia. Although colour Doppler lacks absolute specificity in discriminating neoplastic and non‐neoplastic thyroid nodules, the data suggests the modality has considerable use in clinical practice. The spectral analysis data was time‐consuming to obtain and had less obvious clinical application.
Magnetic resonance angiography findings in the early post‐carotid endarterectomy period
Authors: Stuckey SL , Gilford EJ , Smith PJ , Kean M
Published: March 2008

This preliminary study was designed to investigate the ability of multiple axial volume three‐dimensional fourier transform (3DFT) time‐of‐flight (TOF) magnetic resonance angiography (MRA) to depict the carotid bifurcation in the early post‐carotid endarterectomy period. Five patients underwent intra‐operative digital subtraction angiography (DSA) and carotid MRA within 5 days of carotid endarterectomy.

An axial volume fast imaging in steady‐state precession (FISP) gradient‐echo 3DFT TOF carotid MRA technique in this limited series appeared to display accurately the surgically significant abnormalities at the carotid bifurcation after endarterectomy. However, in normal or near‐normal intra‐operative DSA studies, overestimation of internal carotid artery stenoses was encountered. Postoperative MRA demonstrates potential as a useful non‐invasive investigation after carotid endarterectomy but should be interpreted with caution until larger studies become available.
Chaotic phasic pattern as sole ultrasound evidence of extensive post‐thrombotic change
Authors: Phillips GWL , Esler S
Published: March 2008

We report three cases of extensive post‐thrombotic change confirmed at ascending venography but which did not demonstrate the currently accepted duplex ultrasound criteria for post‐thrombotic change. We also document a new ultrasound finding which we describe as a chaotic phasic pattern of deep venous flow which was the only duplex evidence of post‐thrombotic change in two of the cases. We suggest that its routine inclusion in duplex ultrasound assessment of the deep veins should be considered.
Calibration of entrance dose measurement for an in vivo dosimetry programme
Authors: Ding W , Patterson W , Tremethick L , Joseph D
Published: March 2008

An increasing number of cancer treatment centres are using in vivo dosimetry as a quality assurance tool for verifying dosimetry as either the entrance or exit surface of the patient undergoing external beam radiotherapy. Equipment is usually limited to either thermoluminescent dosimeters (TLD) or semiconductor detectors such as p‐type diodes. The semiconductor detector is more popular than the TLD due to the major advantage of real time analysis of the actual dose delivered. If a discrepancy is observed between the calculated and the measured entrance dose, it is possible to eliminate several likely sources of errors by immediately verifying all treatment parameters. Five Scanditronix EDP‐10 p‐type diodes were investigated to determine their calibration and relevant correction factors for entrance dose measurements using a Victoreen White Water‐RW3 tissue equivalent phantom and a 6MV photon beam from a Varian Clinac 2100C linear accelerator. Correction factors were determined for individual diodes for the following parameters: source to surface distance (SSD), collimator size, wedge, plate (tray) and temperature. The directional dependence of diode response was also investigated. The SSD correction factor (CSSD) was found to increase by approximately 3% over the range of SSD from 80 to 130cm. The correction factor for collimator size (Cfield) also varied by approximately 3% between 5 × 5 and 40 × 40 cm2. The wedge correction factor (Cwedge) and plate correction factor (Cplate) were found to be a function of collimator size. Over the range of measurement, these factors varied by a maximum of 1 and 1.5%, respectively. The Cplate variation between the solid and the drilled plates under the same irradiation conditions was a maximum of 2.4%. The diode sensitivity demonstrated an increase with temperature. A maximum of 2.5% variation for the directional dependence of diode response was observed for angle of ± 60°. In conclusion, in vivo dosimetry is an important and reliable method for checking the dose delivered to the patient. Preclinical calibration and determination of the relevant correction factors for each diode are essential in order to achieve a high accuracy of dose delivered to the patient.
Heterotopic bone formation affecting the hip joint is preventable in high risk patients by post‐operative radiation
Authors: Spry NA , Dally MJ , Benjamin B , Chapman P , Morum P , Christie DRH
Published: March 2008

Between 1984 and 1993, 40 high risk patients (45 hips) received postoperative irradiation as prophylaxis against heterotopic ossification (HO). Radiotherapy was commenced within 5 days of the surgery in 43 of 45 hips. The development of HO was assessed by comparison of radiographic films prior to irradiation and at least 2 months after treatment (median interval 12 months). Progression of HO was observed in only two of 45 hips (4.3%) and of clinical significance in one (2.2%). Treatment was well tolerated with no acute complications or loosening of prosthetic components attributable to irradiation.

During the study period, the treatment programme changed from 20 Gy in 10 fractions to 6–8 Gy in a single fraction, without loss of treatment efficacy. As well as improving resource utilization, single fraction techniques allow fewer patient transfers thereby reducing patient discomfort and risk of hip dislocation. This procedure is uncomplicated and should be considered more widely in the management of this disabling non‐malignant condition.
The estimation of lung dose from mid‐perineum ionization chamber measurements in total body irradiations: A quality control check on dose delivery
Authors: Cross Peter
Published: March 2008

A series of patients (eleven males and eight females) receiving total body irradiation prior to bone marrow transplantation was monitored during treatment by recording the dose from an ionization chamber placed between the thighs in the mid‐perineal region. The treatment was delivered by opposed lateral 6MV photon beams. The patient was encompassed by the radiation field with the maximum collimator opening at a distance of 3.49 m from the X‐ray focus to the patient mid‐line.

An analysis was made of the measured dose and the calculated percentage average lung dose for each patient in the series to seek a correlation between measured doses and patients' anatomical data so that estimates of delivered lung doses could be made.

Whilst a global factor can be applied to measured dose to predict lung dose, it is concluded that perineal dose measurements distal to the region where dose is prescribed (mean lung dose) are sub‐optimal for checks on target dose delivery. Entrance and exit dose measurements at the level of dose prescription (in the thorax) are preferable for more accurate predictions and quality control checks.
Bizarre parosteal osteochondromatous proliferation of the hands and feet
Authors: Breidahl WH , Wylie EJ
Published: March 2008

Two adults with bizarre parosteal osteochondromatous proliferation of the hands and feet are presented. The pre‐operative diagnosis may be difficult to make and the correct diagnosis was not made in either case until pathological examination of recurrent tumour masses occurred.

The radiological and pathological features of this lesion are discussed. The diagnostic features which differentiate this condition from other causes of new bone formation in the peripheries are described.
Metastatic carcinoma infiltrating lung mimicking BOOP
Authors: Nirenberg Alexander , Meikle Grant R , Goldstein David , Meikle Ronald G
Published: March 2008

A 38 year old female with treated carcinoma of the breast presented with a clinical and radiological diagnosis of bronchiolitis obliterans organising pneumonia. Based on these findings a biopsy was not performed and she was treated with steroids. Following lack of response to steroid therapy a lung biopsy was performed showing peribronchiolar, lymphatic, venular and arteriolar metastatic carcinoma. Her symptoms responded to chemotherapy. Interstitial and intracellular spread of carcinoma should be considered in the differential diagnosis of the radiological appearance of BOOP, and therefore a histological diagnosis should be obtained to determine appropriate management.
Radiological imaging of a massive dermoid in the male pelvis
Authors: Van Gelderen WFC , Al‐Hindawi M , Archibald CG , Merrie AEH , Cheng KS
Published: March 2008

A dermold cyst, arising from the posterior aspects of the prostate and seminal vesicles, and extending into the pelvis to masquerade as a full bladder, must be exceedingly rare. Ultrasound, computed tomography and especially magnetic resonance imaging (MRI) proved to be invaluable in making the diagnosis, and MRI in particular was very useful in providing an anatomical road map for surgery.
The ultrasonic diagnosis of urachal anomalies
Authors: Holten I , Lomas F , Mouratidis B , Malecky G , Simpson E
Published: March 2008

Seven cases of urachal anomalies are presented. The spectrum of the disorder and the criteria for ultrasound diagnosis are described. Six of seven cases were correctly diagnosed pre‐operatively with diagnostic ultrasound, but one case with no cystic component was missed. The appearance of a fixed, midline, cystic, extraperitoneal swelling between the umbilicus and the bladder should suggest the diagnosis.
Radiation treatment of superior sulcus lung carcinoma
Authors: Millar Jeremy , Ball David , Worotniuk Valentina , Smith Jennifer , FRACR Elizabeth Crennan , Bishop Michelle
Published: March 2008

The survival of patients with superior sulcus lung carcinoma and the effects of treatment were reviewed. From a prospective database of 4123 consecutive new patients with lung carcinoma, 131 (3.2%) cases of superior sulcus lung carcinoma were identified. Seventy‐four patients were planned to receive radiation with palliative intent, 53 radical radiotherapy and one was observed only. The remaining three patients, with small‐cell carcinoma, were treated with chemotherapy with or without radiotherapy. Of the 53 radically treated patients, nine were treated with pre‐operative radiation prior to intended radical resection. Analysis was carried out on the effect on survival of performance status, nodal involvement, weight loss, vertebral body or rib involvement, treatment intent and radical combined modality treatment compared with radical radiation alone. The estimated median survival for the whole group was 7.6 months; for those treated radically it was 18.3 months, while for the palliatively treated patients it was 3.7 months. Radically treated patients with no initial nodal involvement had an estimated median survival of 22 months, while radically treated patients with nodal involvement had an estimated median survival of 8.4 months (P= 0.003). There were no statistically significant differences in survival between radically treated patients grouped according to initial weight loss, performance status, or vertebral body and rib involvement. Patients treated with pre‐operative radiation did not survive significantly longer than patients treated with radiation alone, although the numbers are small.
Abdominal wall haematoma in anti‐coagulated patients: The role of imaging in diagnosis
Authors: Davies RS , Goh GJM , Curtis JM , Meaney JFM , Lewis‐Jones HG
Published: March 2008

Abdominal wall haematomas are uncommon, difficult to diagnose clinically and often associated with systemic anticoagulation. Seven cases together with the imaging results are presented and the characteristic features and potential pitfalls are discussed. Ultrasound is the first line investigation but the results can be misleading and computed tomography (CT) is often required to confirm the diagnosis.
Computed tomography in miliary tuberculosis: Comparison with plain films, bronchoalveolar lavage, pulmonary functions and gas exchange
Authors: Sharma SK , Mukhopadhyay S , Arora R , Varma K , Pande JN , Khilnani GC
Published: March 2008

Computed tomography (CT) of the chest, pulmonary function tests, bronchoalveolar lavage (BAL) and arterial blood gas analysis were performed in 26 patients with non‐HIV miliary tuberculosis (MTB). CT was repeated after treatment in 11 patients. Nodular lesions were characteristically seen on CT. CT showed discrete and fine nodules in five patients in whom the lesions appeared to be larger than miliary on chest X‐rays. Coalescing nodular lesions were noted on chest X‐rays (n= 7) and CT (n= 18). Consolidation (n= 6), cavitation (n= 4), fibrosis (n= 9) and air trapping (n= 14) were detected on CT only. During follow up, air trapping increased h = 14) and in some patients it appeared for the first time (n= 2). Lymph node enlargement and calcification were seen on both chest X‐rays (n= 9 and (n= 3, respectively) and CT (n= 12 and n= 7, respectively). Pleural involvement was also seen in chest X‐rays (n= 4) and CT (n= 5). Total lung capacity was higher in patients with a chest X‐ray score > 10. Similarly a higher total cell count in BAL fluid was observed in patients with a CT score > 10. It is concluded from this study that CT is superior to chest X‐rays in detecting nodular lesions, lymphadenopathy and air trapping in patients with MTB.
1895 and the Cavendish connection
Authors: AO Eadie
Published: March 2008

The period 1895 to 1897 was a vintage time for physical science, perhaps its greatest vintage ever, and one of the chief vineyards proved to be the Cavendish Laboratory for Experimental Physics down Free School Lane in the ancient English university town of Cambridge. At Cambridge, some 5 months before Röntgen's discovery of X‐rays on 8 November 1895, the academic politicians, after agonizing long over the matter, decided to admit graduates of other universities to the University as research students, without requiring them to first under‐take a preliminary 3 year Cambridge Bachelor of Arts degree. Some 5 weeks before Röntgen's discovery, within 24 h of each other, the first two students to avail themselves of this new possibility appeared in Cambridge. Both made their way to the Cavendish Laboratory for Experimental Physics.1 One, an Irishman, John Townsend, went on to become Waynflete Professor of Physics in the University of Oxford. The other was a youth from the far antipodes; a young man with a somewhat bucolic manner and a booming voice. The Director of the Cavendish Laboratory, JJ Thomson,2 and his wife seemed to take an immediate liking to the New Zealand flax farmer's son and went out of their way to introduce him to the Cambridge society of the time, which is so evocatively described in Gwen Raverat's little book Period Piece,3 just recently reissued.
Pre‐operative staging of gastro‐oesophageal junction carcinoma: Comparison of endoscopic ultrasound and computed tomography
Authors: Holden Andrew , Mendelson Richard , Edmunds Simon
Published: March 2008

Fifteen patients with carcinoma of the gastro‐oesophageal junction were pre‐operatively staged with endoscopic ultrasound (EUS) and computed tomography (CT). The accuracy of tumour and nodal staging using both modalities was compared to the final histological staging of the resected specimens. In staging depth of tumour growth, EUS was significantly more accurate (87% of lesions correctly staged) than CT (40% correctly staged). In staging nodal involvement, EUS was again significantly more accurate (73% correctly staged) than CT (33%). Two‐thirds of the lesions were traversable with the endoscopic probe, but most of the nontraversed lesions were correctly staged on EUS. In this study, CT has performed poorly as a staging modality for carcinoma at the gastro‐oesophageal junction. Other studies have shown CT to be less accurate at this location than at other oesophageal sites. The orientation of the gastro‐oesophageal junction, lack of surrounding fat planes, proximity of adjacent organs and patient motion contribute to the poor staging performance of CT at this location. In contrast, EUS has been an accurate staging modality at the gastro‐oesophageal junction in this study and compares well with other studies evaluating EUS in the more proximal oesophagus. Endoscopic ultrasound is therefore a necessary modality if accurate pre‐operative staging of gastro‐oesophageal junction carcinoma is to be achieved.
Abscess in the non‐lactating breast: Radiodiagnostic aspects
Authors: MD. Malai Muttarak
Published: March 2008

The value of mammography and ultrasound in evaluating abscesses in the non‐lactating breast was assessed in 20 patients. Inflammatory breast masses in the non‐lactating period are uncommon and the clinical diagnosis can be very difficult when signs of inflammation are absent. There were 20 patients ranging in age from 25 to 60 years in the present study; the mean age was 39.35 years. Patients presented with a lump and/or pain without other clinical signs of inflammation. Mammography was performed to exclude malignancy. Mammograms showed an ill‐defined mass in 11 patients and an area of focal increased density in seven patients. Ultrasonograms showed echoic masses with central echopenia in 17 cases and central septation in three cases. Half the lesions were subareolar and half were peripheral. Two of 20 patients were treated by excision, three by incision and drainage, eight by aspiration and seven by antibiotics. The combination of mammographic and sonographic features may enable the radiologist to recognize this entity, thus preventing unnecessary surgery.
Barium enema preparation: A study of low‐residue diet,‘Picolax'and ‘Kleen‐Prep'
Authors: Hawkins Stewart , Bezuidenhout Peter , FRCR Phillip Shorvon , Hine Andrew
Published: March 2008

A prospective, randomized three‐arm trial is presented of 150 consecutive patients attending for double‐contrast barium enema (BE). This compares ‘Picolax’(a combined stimulant and osmotic agent),‘Picolaxfollowing ‘ a 3 day low‐residue diet and ‘Kleen‐Prep’(a polyethylene‐glycol osmotic agent). Faecal clearance, mucosal coating and colon fluid were scored in four colonic segments by two radiologists working independently and blinded to the preparation used. Analyses of an elderly subgroup and of side effects was performed. Low‐residue diet conferred no benefit to Picolax preparation, which was satisfactory (ability to exclude 5 mm polyps) in 80% of patients. Kleen‐Prep failed to achieve adequate preparation in 46%, due to excess fluid and poor mucosal coating. Kleen‐Prep caused more patient nausea, abdominal bloating and pain than Picolax. Patients 70 years and older had similar results. Low‐residue diet need not be used in addition to Picolax. Kleen‐Prep as a single agent is not recommended for BE preparation.
Transrectal ultrasound‐guided biopsy of the prostate: What you see is not what you get
Authors: Bruce Leibowitz C , Staub Peter G
Published: March 2008

A prospective trial involving 282 patients, beginning in December 1993, was undertaken to assess the correlation between our sonographic impression of prostatic malignancy and the histological findings of a random six quadrant biopsy in addition to histology of any sonographically evident focal peripheral zone (PZ) abnormality. The sonographic criteria used to suggest malignancy were: (i) presence of hypo‐echoic PZ nodule; (ii) inhomogeneity of PZ; and (iii) loss of zonal architecture (ZA). The sonographic appearance was graded as either definitely benign, indeterminate, or definitely malignant. These impressions were then compared with the histology results. Eighty‐two patients had histologically proven malignancy. Ultrasound showed the correct extent and site of malignancy in 42 patients. A further 26 patients had the extent of their malignancy either over‐ or under‐estimated or had the malignancy placed in an incorrect site. Fourteen patients with histologically proven carcinoma had sonographically normal PZs. These findings highlight the shortcomings of ultrasound as a diagnostic tool in prostate cancer and show that six quadrant random biopsy of the prostate is far superior to unifocal biopsy of sonographically evident masses in the detection of prostate cancer.
Epithelioid sarcoma of the forearm
Authors: Hanley SD , Alexander N , Henderson DW , Whyte A
Published: March 2008

A case of epithelioid sarcoma of the forearm is described. The radiological and pathological features, natural history of the tumour and its treatment are reviewed.
Imaging of orbital floor fractures
Authors: Ng Perry , Chu Christopher , Young Noel , Soo Mark
Published: March 2008

The aim of this study was to compare the efficacy of plain films and computed tomography (CT) in defining inferior orbital fractures and any muscle involvement. Forty‐four patients with final diagnosis of orbital floor fractures in the period 1990–94 were retrospectively studied. Computed tomography was performed in 28 patients, 20 being direct coronal acquisitions and eight being fine axial acquisitions with coronal reconstructions. Water's view radiographs were performed in 34 patients. Fourteen fractures on plain films were associated with soft tissue opacities to suggest inferior rectus (IR) muscle involvement, but only two required surgical elevation of the orbital floor. The remaining patients were successfully treated conservatively. Three patients had IR entrapment on direct coronal CT, all requiring surgical elevation of the orbital floor. Seven patients had IR muscle displacement on direct coronal CT and all had conservative management. In four patients with axial acquisition and coronal reconstructions, the CT images were of inadequate quality to determine the presence or absence of a fracture. One patient who had no IR muscle involvement identified on reconstructed coronal CT required surgical elevation of the orbital floor on clinical grounds. We conclude that: (i) soft tissue opacities on plain films are not an accurate indicator of clinically significant IR involvement; (ii) axial CT is not efficacious in detection of fractures or IR involvement; and (iii) direct coronal CT is the most efficacious imaging modality.
Spontaneous intramural haematoma of the oesophagus: Radiologic recognition
Authors: DRACR; W Clark , Cook IJ
Published: March 2008

Spontaneous intramural haematoma of the oesophagus (SIHO) is an uncommon disorder. It presents usually with acute chest pain followed by dysphagia. This condition may mimic spontaneous rupture of the oesophagus (Boerhaave Syndrome), dissection of the thoracic aorta or acute myocardial infarction. Hence early accurate confirmation of the diagnosis by radiology is vital for the appropriate acute management. The condition is frequently mistaken for acute myocardial infarction which may prompt inappropriate thrombolytic therapy. The appearances on contrast studies of oesophagus and on CT scanning are characteristic. Despite this, the diagnosis may easily be missed, if appropriate careful radiological technique is not used. This paper reports three consecutive cases of SIHO managed in one institution. These cases illustrate that early gastrografin contrast radiology followed by barium contrast radiology and if necessary by thoracic CT is diagnostic in all cases of this condition.
Ultrasound‐guided parathyroid aspiration to diagnose parathyroid adenomas
Authors: Campbell Joanne , Diamond Terrence , North Leslie
Published: March 2008

Aim To ascertain the accuracy of ultrasound‐guided fine needle aspiration and parathyroid hormone assay in the identification of parathyroid adenomas.

Design Case study.

Setting Tertiary referral clinic.

Patients 12 subjects, consisting of 10 female and two male patients, with documented primary hyperaparathyroidism.

Intervention Ultrasonography of the parathyroid glands was performed using an Acuson XP 128 machine with a linear array 7.5 MHz multihertz probe. Following accurate localization of the parathyroid lesion, fine needle aspiration was performed using a 23 gauge needle, and parathyroid hormone assay was performed on the aspirate. Preoperative localization was compared with intra‐operative findings.

Results Ultrasound examination detected 10 out of a possible 12 parathyroid adenomas (83% sensitivity), while ultrasound‐guided fine needle aspiration only confirmed nine out of the 12 adenomas (75% sensitivity).

Conclusions While ultrasound‐guided fine needle aspiration may be simple and with minimal morbidity, it does not appear to provide any advantage over ultrasound examination alone for the localization of parathyroid adenomas. It has a potential role in defining the nature of ultrasonically localized nodules.
Results of definitive radiotherapy in T1 and T2 glottic carcinoma: Institute of Rotary Cancer Hospital experience
Authors: Mohanti BK , Tandon DA , Bahadur S , Rath GK , Tanwar RK , Lal P , Biswal BM
Published: March 2008

Early glottic carcinomas (T1 and T2) constitute only 2% of all laryngeal cancers in our data. Seventy patients were seen between 1985 and 1992. All patients were treated by cobalt‐60 small field radiotherapy using a beam directed shell. The total dose delivered was 60–65 Gy in 31 patients and 66–70 Gy in 39 patients. The follow‐up period ranged from 5 to 126 months, with a mean follow up of 37 months overall and 55 months in the surgical salvage group. Radiation therapy controlled disease in 71% (50 of 70) of patients overall; 75% with T1 and 67% with T2 lesions. Total laryngectomy as salvage surgery was performed in 70% (14 of 20) of patients whose disease recurred. Ultimate control including surgical salvage occurred in 64 (91%) of 70 patients in the present study. The actuarial 5 year survival was 83 and 80% in T1 and T2 tumours, respectively (statistically insignificant). This report supports the policy of definitive irradiation, reserving surgical salvage for radiation failures in early laryngeal cancers.
Initial qualitative evaluation of computed radiography in an intensive care unit
Authors: Hillis DJ , Crowe BL , McDonald IG , Kelly WJ , Truran RD , Hailey DM
Published: March 2008

The first computed radiography (CR) unit in Australia was installed at St Vincent's Hospital, Melbourne, in February 1994. An initial qualitative evaluation of the attitude of the intensive care unit (ICU) physicians to the CR unit was conducted in June 1994 by use of a survey. The results of the survey of ICU physicians indicated that images were available faster than under the previous system and that the use of the CR system was preferred to evaluate chest tubes and line placements.

While it is recognized that a further detailed radiological evaluation of the CR system is required to establish the diagnostic performance of CR compared with conventional film, some comments on the implementation of the system and ICU physician attitudes to the CR system are put forward for consideration by other hospitals examining the possible use of CR systems.
Adjuvant VHF therapy in locally recurrent and primary unresectable rectal cancer
Authors: Trotter James M , Edis Anthony J , Blackwell John B , Lamb Margaret H , Bayliss Evan J , Shepherd John M , Cassidy Barry
Published: March 2008

In a prospective randomized study, 434 mHz microwave therapy combined with external beam radiotherapy (VHF+RT) was compared with standard external beam radiotherapy (RT) in controlling locally recurrent or unresectable primary adenocarcinoma of the rectum. Independent assessors documented quality of life scores, performance status, toxicities, local response to treatment, and systemic disease progression before treatment and after treatment and every 8 weeks thereafter. Of 75 patients randomized, 73 were eligible for inclusion in the study. Forty‐three of these patients had local pelvic tumour recurrence only and 21 also had distant metastases. In addition, nine patients had primary inoperable carcinomas, two of whom also had metastases. Thirty‐seven patients were randomized to RT and 36 to VHF+RT. The median dose of radiation in the VHF+RT arm was 4275 cGy with a median fraction size of 150 cGy and median duration of therapy of 48.5 days versus 4500 cGy in the RT‐only arm with a median fraction size of 180 cGy and median duration of therapy of 38 days. These doses are unlikely to be significantly different in biological effect. No significant difference between the two groups was observed in extent and duration of local control, measures of toxicity or quality of life scores. Additionally, survival and cumulative incidence of pelvic site of first progression did not differ significantly between the groups. We conclude that VHF microwave therapy in conjunction with radiotherapy produces no therapeutic advantage over conventional radiation therapy alone in the treatment of locally recurrent rectal carcinoma.
The development of a provincial radiation oncology service: The first year report and its implications for future developments
Authors: Byram David , Joseph David , Bulmer Margaret
Published: March 2008

This study compares the actual first year's workload of a new radiation oncology department with that predicted, and assesses the impact of the differences, and their implications for future similar developments. The treatment records and diaries for the Geelong Hospital Radiation Oncology Department were reviewed after the first 12 months of operation (opened in June 1992). Statistics relating to the number of patients seen, number treated, diagnosis, etc., were evaluated and compared to the original estimates based upon population statistics and likely referral rates. Nine hundred and seven new patients were seen in this period, and from them 718 courses of treatment were initiated. One hundred and eighty‐nine cases (20% of referrals) were seen but not treated. A further 102 treatment courses (14% of total) were initiated upon patients who had previously been irradiated. Forty‐six per cent of patients were managed by 10 fractions or fewer, and a further 23% by 25 or more fractions. Eighty per cent of patients were managed by one or two fields. Electrons were used in only 14% of cases. Further calculations suggested a further possible 441 cases of referral could be expected, based upon current population statistics. Referral rates for radiation oncology are highly dependent on a number of factors. As a result, estimates of referrals and hence the size of a department required for a given population vary widely. Our data support these concepts, and the concept that referral is also strongly dependent upon the distance patients need to travel. In considering the development of units outside of major cities it is suggested that referrals are likely to be on the high side of estimates and a minimum two‐machine unit is essential to cover the given workload.
The role of imaging in renal and extra‐renal rhabdoid tumours
Authors: Roebuck Derek J
Published: March 2008

Rhabdoid tumour of the kidney is an uncommon malignancy with a poor prognosis that usually occurs in childhood. Certain imaging features may help distinguish this lesion from the much more common Wilmstumour ‘. Extra‐renal rhabdoid tumours appear to have no specific imaging characteristics.
Splenic irradiation in HIV‐related thrombocytopenia
Authors: Leung John T , Kuan Richard
Published: March 2008

Splenic irradiation has been used in patients with HIV‐related thrombocytopenia. This retrospective review deals with four patients treated with low dose splenic irradiation. All patients had an increase in platelet count and tolerated the treatment without side effects. However, the treatment response lasted for several months only.
Radiotherapy for melanotic freckles
Authors: Christie David RH , Tiver Kenneth W
Published: March 2008

Five patients who received radiotherapy (RT) for 7 melanotic freckles (MF, also known as Hutchinson's freckles, lentigo maligna) were reviewed 8 to 37 months after their treatment by RT. Local control and a favourable cosmetic result occurred in all patients. Treatment toxicity was minimal. Few reports about the use of RT for MF exist. Many other treatments including observation alone have been associated with high rates of recurrence, and in some cases conversion to invasive melanoma has occurred. RT appears to be a safe and effective treatment for this condition, providing that doses equivalent to 44 Gy in 11 fractions or more are given.
Imaging findings in rabies
Authors: Sing Tom MYS , Soo Mark YS
Published: March 2008

A 10 year old Vietnamese girl presented with clinical features of an acute encephalitic process. A cerebral angiogram performed to rule out vasculitis showed narrowing at the supraclinoid internal carotid and terminal basilar arteries. A diagnosis of rabies was established at autopsy. Although the major blood vessels and basal meninges were normal it was possible that transient arterial spasm induced by the viral infection was responsible for the angiographic appearance. Other imaging findings in our patient are described with a brief review of the literature. This is only the second case of rabies reported in Australia.1,2

Rabies is a rare disease in the Australian community. Recently one patient with atypical clinical presentation was confirmed to have the disease only at autopsy. In the clinical work‐up, various radiological examinations were performed and a range of interesting features were encountered including an abnormal cerebral angiogram. The purpose of this paper is to report on these unusual features and to review those documented in the literature.
Magnetic resonance imaging features of an epidural spinal haemangioma
Authors: Gupta Sanjay , Kumar Sunil , Banerji Deepu , Pandey Rakesh , Gujral Ratni
Published: March 2008

Isolated spinal epidural haemangioma without vertebral involvement is rare. We report a case of an epidural capillary haemangioma in the thoracic region and present the magnetic resonance findings, including contrast‐enhanced features.