bluuebunny/crossref_metadata_2025 huggingface dataset:
A new phantom for mammography
Authors: Moores B. M.
Published: July 2009

I wish to comment on the paper entitled “A new phantom for mammography” by J. Law (1991). In this paper the author compares the performance of a mammographic test phantom from Du Pont with the Bart's phantom (White & Tucker, 1980) by measuring the numbers of image details visible in images of each phantom for different radiographic factors; kV, focal-spot size, screen/film combination and processing. Unfortunately the comparison as presented is quite inconsistent and highlights the need for great care when attempting to compare the performance of test phantoms.

In the case of the Bart's phantom six images were produced for each set of radiographic conditions. A “global” image-detail score was then measured for each image and the average of the six images formed. Thus, for this phantom the average global score per single image was the measure of performance for a particular set of radiographic conditions.
Body aprons in radiation protection
Authors: Ramsey L. J.
Published: July 2009

The Guidance Notes associated with the Ionising Radiation Regulations (1985) state that protective aprons for the body shall comply with British Standard 3783 and that they should be examined visually at frequent intervals.

This latter clause further states that thorough examination should be carried out at least once a year to ensure that no cracks have developed, and that radiographic examinations are only likely to be justified when the protective material is covered. Uncovered body aprons would seem rarely to be used and it is therefore required of those involved to carry out radiographic, or possibly fluorographic examinations of body aprons at least once a year. It is the carrying out and assessment of such tests which is the subject of this communication.
Ultrasonic detection of parathyroid adenomas
Authors: Murchison J. , McIntosh C. , Aitken A. G. F. , Logie J. , Munro A.
Published: July 2009

High-resolution real time sonography was used to evaluate patients with suspected primary hyperparathyroidism. A total of 12 consecutive patients was scanned pre-operatively. The sensitivity of the procedure was 92% and the specificity 97%. In our hospital sonography is the procedure of choice for localizing enlarged parathyroid glands prior to surgical exploration.
Evaluation of 99Tcm Technegas ventilation scintigraphy in the diagnosis of pulmonary embolism
Authors: James J. M. , Herman K. J. , Lloyd J. J. , Shields R. A. , Testa H. J. , Church S. , Stretton T. B.
Published: July 2009

In the diagnosis of pulmonary embolism, perfusion lung scintigraphy offers high sensitivity but low specificity. The specificity can be significantly increased by the use of combined ventilation and perfusion studies. Most aspects of perfusion lung scintigraphy are uniformly accepted but the technique of ventilation imaging varies from centre to centre. This study describes a new technique for the performance of ventilation scintigraphy using a suspension of ultrafine carbon particles labelled with 99Tcm (“Technegas”). The technique combines the ready availability of 99Tcm and its optimal imaging properties with an easily administered radiopharmaceutical of particle size sufficiently small to deposit in the alveoli. Of 63 patients studied by conventional perfusion scintigraphy plus Technegas ventilation scintigraphy, images of diagnostic quality were obtained in all. 31 of these patients also had a ventilation study using 81Krm gas and in only one instance did the two methods of ventilation imaging lead to differing interpretations. We conclude that high quality diagnostic images may be obtained using this new technique, which can be made available on both a routine and an emergency basis, thus improving the service provided for patients suspected of having pulmonary embolism.
Development of video frame store and distortion correction facilities for an external-beam radiotherapy treatment simulator
Authors: Morton E. J. , Evans P. M. , Ferraro M. , Young E. F. , Swindell W.
Published: July 2009

During the simulation of an external-beam X-ray radiotherapy treatment, a low-energy X-ray source (tube voltage ≈ 50–100 kVp) is used to irradiate the patient and the transmitted intensities are recorded either by X-ray film or an X-ray image intensifier (XRII). The XRII enables the clinician to observe immediately the result of moving the patient within the X-ray beam in order to select an appropriate treatment field. Since the image is produced by the XRII in real time, the image is lost from the screen whenever the X-ray screening button is released. Therefore, the screening button is normally kept depressed during the time in which the clinician reaches a decision about the size and position of the correct treatment field. Since the displayed image is not altered during the decision period, a higher than necessary dose is delivered to the patient, and also to the clinical staff present, during the simulation session.

To reduce this dose and simplify the simulation procedure, a device has been constructed which maintains the image on the television monitors in the simulator area whenever the screening button is released. This enables the clinician to view the most recent XRII simulation image during any decision period without delivering any further X-radiation to the patient. The true XRII image is displayed as soon as the screening button is next depressed. This mode of operation is termed the “active hold” mode.
An unusual cause of a pain in the calf
Authors: Banerjee Arpan K.
Published: July 2009

Calf pain is a common cause for a request for a venogram to exclude the possibility of a deep venous thrombosis. An unusual cause of calf pain due to a venous haemangioma is presented and the radiological features are reviewed.

A 42-year-old Caucasian woman attended the Accident and Emergency Department with a 2-day history of increasing right-sided calf pain. As a child, she had been told she had an abnormality in her right calf that was inoperable. The venogram and computed tomographic (CT) scan of the calf are shown in Figs 1 and 2.
Unusual magnetic resonance findings in Wilson's disease
Authors: Singcharoen T. , Chakkaphak K. , Udompanich O.
Published: July 2009

Wilson's disease or hepatolenticular degeneration is an uncommon genetic disorder of copper metabolism, characterized by abnormal deposition of copper especially in the liver and brain. Computed tomography (CT) and magnetic resonance (MR) findings in Wilson's disease have been described (Kendall et al, 1981; Lawler et al, 1983; Aisen et al, 1985). We report unusual MR findings in two cases of Wilson's disease.
Demonstration on computed tomography of two pseudoaneurysms complicating chronic pancreatitis
Authors: Pantongrag-Brown Linda , Suwanwela Nitaya , Arjhansiri Kiat , Chetpukdeechit Verachai , Kitisin Praphan
Published: July 2009

Arterial pseudoaneurysm as a complication of chronic pancreatitis is relatively uncommon. Most radiologists are well aware of pseudocyst and abscess formation, but not of this vascular complication (Burke et al, 1986). In the English language literature, we found reports of only seven cases documented by computed tomography (CT) of pseudoaneurysm occurring secondary to pancreatitis (Borlaza et al, 1979; Foley et al, 1980; Nino-Murcia et al, 1983; Burke et al, 1986; Falkoff et al, 1986). These cases, however, involved only one artery in each patient, namely the splenic, hepatic or gastroduodenal artery. We report here the case of a man with chronic pancreatitis who developed pseudoaneurysms of both the splenic and pancreaticoduodenal arteries. In this first CT-documented report of such a case, we emphasize the role of CT as an accurate, non-invasive diagnostic method for this easily misdiagnosed lesion.
The effects of sodium nitroprusside on Doppler signals from a soft tissue tumour
Authors: Taylor P. M. , Isherwood I.
Published: July 2009

In a previous study, we described the effects of systemic vasoconstriction on the Doppler signals from a soft tissue tumour (Taylor et al, 1989). Our conclusions were that vasoconstriction produced significant changes in the signals from normal vessels and enhanced the differences between normal and neoplastic vessel signals. The aim of this study was to determine whether converse changes were produced by vasodilatation.
Air aspiration after double–contrast knee arthrography: a worthwhile exercise?
Authors: Bradley S. A. , Chandy J.
Published: July 2009

A prospective study following double-contrast knee arthrography was undertaken to compare pain and discomfort experienced at the conclusion of the procedure and for 7 days afterwards. The patients were divided into two groups. Half had the air aspirated at the end of the examination and the other half did not. Twice as many patients in the aspirated group were totally asymptomatic (48% compared with 22%); however, by 7 days after the procedure the numbers of asymptomatic patients were similar in the two groups (64% and 63%, respectively). Thus our conclusion is that air aspiration after double-contrast knee arthrography does reduce short-term morbidity.
Design of a database with graphical analysis for X-ray quality assurance and dose information to assist in a programme for patient dose reduction
Authors: Lam C. , Martin C. J.
Published: July 2009

A database system has been set up on an IBM PC to store X-ray quality assurance (QA) data and patient doses for all X-ray equipment operated by Grampian Health Board. Graphical analysis facilities have been developed to display data in a readily understandable form. Data on equipment specifications, QA test results, exposure factors for standard examinations, and thermoluminescent dosemeter (TLD) measurements of patient skin doses are stored in separate forms. X-ray machine outputs are fitted to a simple polynomial equation, and the data combined with information on exposure factors to calculate entrance doses for selected examinations. Data such as filtration and backscatter factors are derived from look-up tables for use in dose calculations. Histogram comparisons can be made between calculated doses, means of TLD measurements and National Radiological Protection Board reference levels to allow units giving high skin doses to be identified so that corrective action can be taken.
Malignant melanoma of the vulva: response to radiation
Authors: Singhal R. M. , Narayana A.
Published: July 2009

Although malignant melanoma of the vulva is a relatively rare malignancy with only about 350 cases reported in the literature, in some series it has accounted for a surprising 8–11% of all invasive cancers of the vulva (Morrow, 1981; Jones, 1988). While surgery has remained the treatment of choice, radiation therapy has received very little attention in the management of vulval melanoma. This is despite the fact that clinical responses have been achieved at other sites using high dose fractionation regimens (Habermalz & Fischer, 1976; Strauss et al, 1981). We report a case of melanoma of the vulva where complete clinical regression of both the primary and nodal disease was observed following intermediate dose fractionation, only to be followed by fatal disseminated metastasis 3 months later.
What is it? Intraosseous lipoma in a 13-year-old boy
Authors: Kozlowski K. , Welshman R.
Published: July 2009

A case of intraosseous lipoma in a 13-year-old boy is presented.
Radiosensitization by 17 atmospheres pressure of air
Authors: Conere T. J. , Brock A. , Nias A. H. W.
Published: July 2009

As part of a study of the radiobiological effects of gas mixtures under ambient and hyperbaric conditions (Conere, 1989) we investigated the radiosensitivity of Chinese Hamster ovary (CHO) cells at 17 atmospheres pressure (1.7 × 106Pa) of air. We found that such hyperbaric air caused a significant increase in radiosensitivity.
Proceedings of the British Institute of Radiology
Authors: Camplejohn R. S.
Published: July 2009

The “indirect effect” of ionizing radiation is believed to result from the production of oxidative species following the interaction of radiation with water.

Dichlorofluorescin diacetate (DCFH-DA) is a heterocyclic compound which reacts with hydrogen peroxide in solution. It has been used to measure the production of metabolic oxidative products in polymorphonuclear blood cells. DCFH-DA freely diffuses into cells, whereupon hydrolysis to DCFH occurs thereby trapping the molecule within the cell. Reaction with hydrogen peroxide produced in water by ionizing radiation leads to the quantitative production of the highly fluorescent dichlorofluorescin. Fluorescence can then be measured by flow cytometry. We describe the use of DCFH-DA to measure intracellular oxidative products in human tumour cells following ionizing radiation treatment.
Sclerosing haemangiomatosis: a case report and review of the literature
Authors: Abdelwahab Ibrahim Fikry
Published: July 2009

A case of sclerotic haemangiomatosis of bone without accompanying lytic lesions is presented.
A technique for the local measurement of air kerma rate from small Caesium-137 sources
Authors: Aukett R. J.
Published: July 2009

A method is described in which a Farmer ionization chamber is used for the direct measurement of the air kerma rate in air from small spherical Caesium-137 sources at distances of 35 to 70 mm. The calibration factor and corrections for source and ion chamber geometry are examined. For quality assurance purposes, the results obtained are in sufficient agreement with other methods of calibration.
Measurement of radiation doses in the most frequent simple examinations in paediatric radiology and its dependence on patient age
Authors: Ruiz M. J. , González L. , Vañó E. , Martínez A.
Published: July 2009

Radiation doses to patients were measured in four X-ray rooms specifically devoted to paediatric radiology, from two hospitals. The study was performed for the most frequent simple examinations, namely abdomen, hip and pelvis, skull, spine and chest. Patients were classed into four different age groups: 0.1–1 year, > 1–5 years, >5–10 years and > 10–14 years. Operating X-ray generator parameters and entrance surface doses were recorded for all groups. Representative values were obtained for standard working conditions prior to any correcting action being taken. Dose values are reported, and some of the differences between the results found in the rooms for each examination are discussed. Without attempting to relate adult and paediatric radiology, the entrance surface doses measured and the provisionally recommended CEC values for similar examinations in adult patients are compared.
Radiosensitization of Chinese hamster cells by pimonidazole (Ro 03–8799) at low X-ray doses
Authors: Watts M. E. , Woodcock M.
Published: July 2009

For many years, measurements of survival on mammalian cells in vitro have been made after exposure to large single doses of radiation. However, in radiotherapy regimes, radiation doses are delivered in many small fractions. There has been much debate regarding the validity of extrapolating from survival curve parameters derived from high dose regions of survival curves to low dose regions (Alper, 1975). For example, there have been reports of enhancement ratios for oxygen, misonidazole and etanidazole (SR 2508) being reduced at low X-ray doses (Alper, 1975; Chapman et al, 1975a,b; Palcic et al, 1982; Palcic & Skarsgard, 1984; Palcic et al, 1984; Skarsgard et al, 1986; Watts et al, 1986). Such observations have serious implications for the use of hypoxic cell radiosensitizers in radiotherapy. In the present paper, we report on the radiosensitization of hypoxic Chinese hamster cells by pimonidazole (Ro 03–8799) which has undergone evaluation in clinical trials. The study also includes data obtained concurrently with misonidazole for comparative purposes. The survival data were fitted to the linear quadratic model: In S = − (αD + βD  2) and estimates of αand βderived.

Asynchronous logarithmic phase Chinese hamster V79–379A cells and a conventional survival assay system were used to generate X-ray data at low doses as described by Watts et al (1986). High dose data was generated as described by Adams et al (1976).
A sense of déeja vu
Authors: Hartnell G. G.
Published: July 2009

Whilst reading the May issue of the BJR, I too, like Peter Dawson on a previous occasion (Dawson, 1991), had a distinct sense of déja vu. This feeling occurred when I read the report of renal obstruction by percutaneous nephrostomy in pregnancy (Trewhella et al, 1991).
Percutaneous nephrostomy to relieve renal tract obstruction in pregnancy
Authors: Renny F. H.
Published: July 2009

With reference to the case report “Percutaneous nephrostomy to relieve renal tract obstruction in pregnancy”in the May issue by Trewhella et al (1991) the claim is made that percutaneous nephrostomy in pregnancy has not been reported previously. I performed bilateral percutaneous nephrostomy on a primigravid patient 27 weeks pregnant in 1984. This was subsequently reported by my clinical colleagues, Lewis et al,(1985).
Mistaken hilar mass
Authors: Thomas R.
Published: July 2009

A situation arose recently which helps to remind us that, despite the tempting logistical advantages, simulator radiographs should not be used for diagnostic evaluation (1). A 56-year-old man attended hospital for palliative radiotherapy to an uncomfortable chest wall secondary deposit from a prostatic primary malignancy.
Book reviews
Authors: Gillies N. E.
Published: July 2009

It is only natural that we who teach are tempted to feel that our listeners or readers must be made aware of all the details of the knowledge that we have, otherwise they will be deprived and we will have failed in our duties. On the other hand, we are happy to brush over those areas with which we are much less familiar and are blithely unaware of the deprivation that we may be causing because that does not exist for us. That is one of the problems that faces the single author, particularly if attempting to describe a very wide field. In the book under review, however, the writer has made valiant and largely successful efforts to avoid the latter problem and he has, to my mind, been rather too much at pains to explain and overemphasize the mathematical basis of the subject.
Book reviews
Authors: Dische Stanley
Published: July 2009

Sir David Smithers has, after a distinguished career as Professor in Radiotherapy and Oncology at the Royal Marsden Hospital, pursued a further one in literature—a calling which, quoting Alexander Pope, is referred to as “this idle trade”. Although his pursuits in literature are remarkably wide he has concentrated on medico-literary associations.
Book reviews
Authors: Macvicar David
Published: July 2009

This book has its origin in an introductory course on magnetic resonance (MR) imaging and spectroscopy which the authors have been running for 10 years.
Book reviews
Authors: Valentine Alan
Published: July 2009

This is the fifth volume in a series entitled Clinical Medicine and the Nervous System, edited by John P. Conomy and Michael Swash. The contents are arranged in 12 chapters, the authorship is British and, apart from a contribution from one neurologist, radiological.
Initial investigation of childhood urinary tract infection: does the plain abdominal X ray still have a role?
Authors: Kenney Ian J. , Arthur R. J. , Sweeney L. E. , Hendry G. M. A.
Published: July 2009

To reassess the plain abdominal X ray (AXR) in the initial investigation of childhood urinary tract infection, radiologists from four paediatric units prospectively collected data on the yield from the AXR in 683 children. Five children had renal calculi. All were detected on ultrasound, but one was not visible on the initial AXR. Four spinal abnormalities were identified, none of which prompted any action by the clinician involved. While the costs, in both financial and radiation risk terms, may be small, the benefit of the AXR appears equally small. Where expert paediatric ultrasonography is available we would recommend that the AXR be reserved for patients with haematuria, loin pain, family history of calculus disease, or where further urinary tract infection occurs despite a normal ultrasound scan.
Floating thrombi: diagnosis and follow-up by duplex ultrasound
Authors: Voet D. , Afschrift M.
Published: July 2009

The clinical features and evolution of floating thrombi (FT) diagnosed by duplex ultrasound were examined. In 76 consecutively diagnosed above-knee deep venous thromboses the prevalence of FT was 18%. Of 44 FT diagnosed in 39 patients, 18 (39%) were located in the common femoral, 12 (26%) in the popliteal and seven (15%) in the external iliac veins. Serial duplex examinations revealed that 31% of FT in the iliofemoral segment disappeared, 33% remained unchanged and 36% adhered to the vein wall within 2 weeks following diagnosis. After 3 months, 87% of the floating segments had disappeared, irrespective of the localization or therapeutic regimen. Thirteen patients experienced pulmonary embolism before (12/13) or following (4/13) diagnosis of floating thrombosis; three of four superficial femoral vein FT embolized. Fifteen per cent of the patients with FT died during the study period and 28% of the thrombi were associated with a malignant neoplasm; the incidence of malignancy was 60% in superficial and 39% in common femoral vein FT.
Long term results of Cathetron high dose rate intracavitary radiotherapy in the treatment of carcinoma of the cervix
Authors: Khoury G. G. , Bulman A. S. , Joslin C. A. F.
Published: July 2009

Between 1967 and 1974, 371 patients with carcinoma of the cervix have been treated by a combination of external beam radiotherapy and fractionated high dose rate brachytherapy using the Cathetron. A retrospective review was undertaken in 1986 and median follow-up time was 6 years. Life table analysis of survival and complications to 16 years was undertaken. International Federation of Gynaecology and Obstetrics (FIGO) stage distribution was 26%, 46% and 28% for Stages I, II and III, respectively, and 5 year survival was likewise 94% 63% and 37%. Age and histological type or grade were not found to influence survival. Recurrent disease was recorded in 142 patients; the first site was within the pelvis in 25% and as distant metastases in 17%. Following development of pelvic recurrence median survival was 28 weeks. Salvage surgery was performed in 32 patients, of whom five probably obtained survival benefit. Significant late morbidity was seen in a total of 71 patients (19%); in seven patients this was at more than one site. Late morbidity to the small bowel was recorded as Grade 2 in 10 patients and Grade 3 in 13; to the rectum, Grade 2 in 10 patients and Grade 3 in two patients; to the bladder, Grade 2 in 15 patients and to the vagina Grade 2 in 29 patients. Median time to onset for small bowel morbidity was 14 months, for rectum 18 months, for vagina 20 months and for bladder 52 months. 82% of all late morbidity had been seen by 5 years of follow-up, no case of late morbidity or recurrence was seen between 11 and 18 years of follow-up. These results are comparable to those reported for other methods in use at the time the patients were treated.
Treating the vaginal vault in carcinoma of the endometrium using the Buchler afterloading system
Authors: Thomas H. , Pickering D. G. L. , Dunn P. , Kam K. C. , Stewart J. S. W. , Lambert H. E.
Published: July 2009

The advent of high-dose-rate afterloading intracavitary radiotherapy has implications for both staff safety and the possibility of convenient, outpatient-based treatment for the patient. We have carried out a retrospective analysis of its use with high-activity iridium 192 and the Buchler machine to treat the vaginal vault in patients with adenocarcinoma of the endometrium, most of whom also received external-beam radiotherapy to the pelvis. We have compared the survival, complication and local control rates with a comparable group of historical controls treated with low-dose-rate intracavitary caesium ovoids. Complication rates, which included vaginal stenosis not volunteered by the patient, were 16% (95% confidence intervals 6–26%) in the study group and 28% (95% confidence intervals 17–41%) in the control group, with no serious complications requiring surgery. The actuarial survival was 92% at 5 years in the study group, and 94% at 5 years in the control group. Local control was 94% at 5 years in the control group and 98% at 5 years in the study group. The authors suggest that the use of high-dose-rate intracavitary radiotherapy, with the Buchler afterloading system, for vaginal vault irradiation in carcinoma of the endometrium is a convenient, safe and quick method, which does not necessitate admission or sedation of the patient. In addition it provides complete radiation protection for staff.
A phantom for the measurement of contrast detail performance in film-screen mammography
Authors: Thompson S. R. , Faulkner K.
Published: July 2009

A National Breast Cancer Screening Programme, based on X-ray mammography, has been introduced in the UK. The success of this screening programme is dependent on the production of high quality radiographs. There are various methods of assessing imaging performance in mammography, but contrast detail detectability measurements have an advantage in that the observation of radiographs is taken into consideration. The design and construction of a contrast detail phantom for the assessment of image quality in mammography is described. This phantom can be used to assess the imaging performance of mammographic film-screen combinations. The results of some measurements to verify the accuracy of the contrast predictions are presented together with some initial results of an investigation into the contrast detail performance of film-screen combinations used in mammography.
Paget's disease of the male breast treated by radiotherapy
Authors: Verniers D. , Van den Bogaert W. , van der Schueren E. , Dubelloy R. , Degreef H. , Wolf-Peeters C. De
Published: July 2009

Breast cancer is a rare disease in men; the female: male ratio is around 100:1 (Treves, 1954; Haagensen, 1986). Aetiological factors in male breast cancer are obscure. A marked increase in its incidence has been reported in Klinefelter's syndrome, a condition associated with diminished testosterone levels and an increased incidence of gynecomastia (Rosen et al, 1976; Erlichman et al, 1984).

Paget's disease of the nipple is an early presentation of breast cancer (Nance et al, 1970). In this report, we describe a case in a 74-year-old patient. Since carcinoma of the male breast is a relatively rare malignancy, it is reasonable that the management of this disease should be based on the knowledge available for carcinoma of the female breast. Breast conserving treatment in females has been demonstrated to be equivalent to radical surgery. Therefore, we suggest that radiation therapy is the treatment of choice also in male patients with Paget's disease, as was done in the case reported.

A 74-year-old man noticed, for 1.5 years, an itching painless lesion under the left nipple. There was no family history of breast cancer. On physical examination an erythematous, slightly desquamating area measuring 5 × 2.5 cm was found. There was no palpable mass or lump in the breast. There was no discharge or bleeding. The right breast was normal. There were no palpable lymph nodes in the axillae. The general observation showed no metastases. On 31/10/1988 a biopsy was performed for diagnosis.
A leaking laparoscopy wound
Authors: Regan F. , Crofton M. E.
Published: July 2009

A 34-year-old Bahrainian woman presented to the Accident and Emergency Department complaining of fluid leaking from a recent laparoscopy scar. She spoke very little English so no further history was available. Examination of the abdomen was unremarkable. She was referred for an ultrasound examination of the abdomen to exclude an intra-abdominal collection or urinoma.

A midline sagittal scan of the pelvis and a parasagittal scan to the left are shown (Figs 1 & 2). What is the diagnosis? What were the likely indications for the laparoscopy?

The ultrasound examination revealed a moderate amount of ascites, later confirmed to be the source of the leaking fluid. The uterus was normal in size but had a very thickened endometrial echo (16–18 mm anteroposterior diameter).
Nitrous oxide—radiosensitizer or radioprotector?
Authors: Conere T. J. , Brock A. , Nias A. H. W.
Published: July 2009

As part of a wider study of the radiobiological effects of narcotic gas mixtures (Conere, 1989) the possible radiation protection of Chinese hamster ovary cells (CHO) using a 99% nitrous oxide: 1 ± 0.05% oxygen gas mixture has been investigated. This gas mixture was used in the expectation that the narcotic component in the mixture might displace oxygen from sites within the cells where oxygen is required in order to confer oxygen dependent radiosensitivity.
Percutaneous femoral artery puncture: practice and anatomy
Authors: Towers M. J.
Published: July 2009

I read with interest Dr Hartnell's opinion that fluoroscopy is hardly ever warranted in puncturing the femoral artery (Grier & Hartnell, 1991). Perhaps our patient populations are different, but not infrequently I have to puncture a barely palpable, or indeed a non-palpable artery shown to have flow on non-invasive imaging. My experience is also of thousands of punctures, the majority in severly atherosclerotic vessels. While translumbar, axillary or brachial punctures are then usually indicated, my practice is to attempt a retrograde examination as I have developed faith in the non-invasive assessment that the vessel is open.
How and why are ultrasonic scanners chosen?
Authors: Halliwell M. , Wells P. N. T.
Published: July 2009

What is it that influences the purchase of ultrasound scanners? We recently conducted a postal survey concerned with this. Our objective was to find out how prospective purchasers obtain the information that enables them to select the equipment that they would like to buy. We did not try to discover what features of equipment design, performance and cost are relevant to equipment selection. It is after all reasonable to suppose that purchasers desire ergonimicably designed equipment that produces good images and is competitively priced.
Book reviews
Authors: Heron C.
Published: July 2009

This book is written by Javier Beltran but includes contributions from several of his radiological colleagues and is largely based at the Ohio State University Hospitals.

The first chapter briefly describes the physical principles of magnetic resonance imaging (MRI) and it is followed by eight chapters devoted to individual regions: the temporo-mandibular joints; shoulder; elbow; hand and wrist; pelvis and hips; knees; ankle and foot and the spine.
Book reviews
Authors: Heron C.
Published: July 2009

This book grew out of a perceived need by the editors for “a comprehensive test on musculoskeletal MR” and the observation that “large major references on MR devote surprisingly little space to the interpretation of musculoskeletal MR images”. The editors' aims are well met and the book indeed fills an important need.
Book reviews
Authors: Whitehouse G. H.
Published: July 2009

This book evolved from a training course run by the Department of Radiology at Duke University Medical Center for residents and qualified radiologists. The text is in note form. There are chapters on each body system and on radionuclide imaging and ultrasound.
Book reviews
Authors: Freeman A.
Published: July 2009

This elegant work from France joins a veritable plethora of books on small bowel radiography which have been published in recent years. Amongst these are new books by authors such as Sellink, Antes and Eggeman, Herlinger and Maglinte; so this text joins an already crowded field.
Book reviews
Authors: Renton Peter
Published: July 2009

This is the latest, and greatest, edition of a major work which broke new ground when first published as a single volume in 1971. Overall, these three volumes contain only slightly more pages than did the second edition but the work has been considerably rewritten and updated. In addition, there are new chapters on the use in musculoskeletal disease of computerized tomography (CT), magnetic resonance imaging (MRI) and ultrasonography, as well as radionuclide scanning.
Book reviews
Authors: Williams C. E.
Published: July 2009

This book deals with a plain film assessment of the cervical spine and as the name implies, it concentrates on traps and useful hints in interpretation. The reader's knowledge of the anatomy, pathology and basic radiology of this region is assumed and indeed necessary to fully appreciate its content. The book consists of 60 example cases. In most questions are asked of the reader, the answers to which are then carefully explained, often with the aid of line drawings.
Cholangiography in liver transplantation: a comparison of two types of biliary reconstruction
Authors: Holland P. , Morris E. , Buckels J.
Published: July 2009

Orthotopic liver transplantation has been performed in Birmingham since 1982. Two types of biliary reconstruction have been used, the choledocho-choledochostomy and the choledocho-cholecysto-choledochostomy (gallbladder (GB) conduit). A retrospective study was undertaken to compare the biliary tract complications encountered at cholangiography in these two groups to assess which reconstruction is safest. In the gallbladder (GB) conduit reconstruction, the incidence of biliary leakage (20.4%) and stricture formation (14.4%), the two most serious complications, was higher than in end-to-end duct anastomosis (11% and 10%, respectively), though these differences did not reach statistical significance. This supports evidence from other centres that the choledocho-choledochostomy is the procedure of choice to minimize biliary complications. Biliary debris (14.2%) presented additional problems and was strongly associated with biliary strictures. T-tube related problems were least troublesome. The close relationship between hepatic artery occlusion and biliary complications, particularly leakage, noted in other studies is also emphasized.
Is a short femur length a useful ultrasound marker for Down's syndrome?
Authors: Twining P. , Whalley D. R. , Lewin E. , Foulkes K.
Published: July 2009

To assess the significance of a short femur in the antenatal diagnosis of Down's syndrome a retrospective analysis was made of all Down's syndrome fetuses diagnosed over a 3 year period. 11 fetuses were found to have had a biparietal diameter and femur length measurement taken between 15 and 24 weeks gestation. Normal graphs were plotted for femur length against gestational age, femur length against biparietal diameter and biparietal diameter/femur length against gestational age. When the Down's syndrome measurements were plotted on the normal graphs there were four abnormal measurements. These four measurements, however, represented two fetuses both of which demonstrated other abnormalities, one cystic hygroma and one duodenal atresia with choroid plexus cysts. We do not feel that the femur length measurement is useful in the antenatal diagnosis of Down's syndrome.
Sonographic evaluation of the parotid ducts: its use in tumour localization
Authors: Bradley M. J. , Ahuja A. , Metreweli C.
Published: July 2009

The previously unreported sonographic anatomy of the intraglandular parotid ducts is described, and how this aids tumour localization is illustrated. Forty patients underwent ultrasonography and computed tomography (CT) sialography for the evaluation of parotid tumours. Ultrasound identified two extra unsuspected 5 mm tumours in the superficial lobe, which could not be seen at CT. Both techniques produced similar results for deep and mixed lobe lesions. Ultrasound had one false positive mixed lesion, which surgery subsequently found to be confined to the deep lobe. The full extent of invasion in three deep lobe tumours was revealed only by CT to be parotid invasion by nasopharyngeal carcinomas. We conclude that parotid sonography with reference to the intraglandular ducts is highly accurate in localizing parotid tumours and should probably be the first-line imaging technique. Computed tomography should only be necessary for visualization of deep lobe tumour extent and in those cases where the complete tumour boundary cannot be seen by ultrasound alone.
Normal tissue reactions in the British Institute of Radiology Study of 3 fractions per week versus 5 fractions per week in the treatment of carcinoma of the laryngo-pharynx by radiotherapy
Authors: Rezvani M. , Alcock C. J. , Fowler J. F. , Haybittle J. L. , Hopewell J. W. , Wiernik G.
Published: July 2009

The radiobiological data obtained from a multicentre clinical trial of the British Institute of Radiology, which compared the treatment of carcinoma of the laryngo-pharynx by 3 fractions per week (3F/wk) with 5 fractions per week (5F/wk) radiotherapy, have been studied. The trial involved an intake of 734 patients between 1966 and 1975. The number of fractions, overall treatment time and total doses used by different treatment centres ranges from 9 to 40 fractions, 18 to 70 days and 3880 to 7800 cGy, respectively. An 11–13% reduction in the total radiation dose was applied for treatments with 3F/wk as compared with 5F/wk in centres treating over 6 weeks and 3 weeks, respectively. All patients were followed for 10 years from the start of treatment. Different types of early and late normal-tissue reactions were investigated, ranging from a low percentage incidence of perichondritis to 95% for slight early reactions. Greater than 80% of the late normal-tissue reactions seen were observed within the first year after the start of treatment, and 96% were observed within the first 5 years. There was no statistically significant difference in the normal-tissue event-free rates between the 3F/wk and 5F/wk treatment groups. This finding did not differ when different major treatment centres were studied separately. For a number of end-points, α/β ratios and N- and T-exponents of a modified nominal standard dose (NSD) formula have been calculated.
Book reviews
Authors: Michell M. J.
Published: July 2009

The author's aim in this textbook of breast radiology is to give not only a comprehensive account of radiological diagnosis of breast disorders, but also to discuss other aspects of the management of breast disease which are of importance and interest to radiologists. The first chapter, by Professor R. Blamey, is a summary of current practice in the diagnosis and treatment of breast cancer. In subsequent chapters, there is a detailed description of the normal development and anatomy of the breast with mammographic and histological correlation.
Book reviews
Authors: Pilling D. W.
Published: July 2009

This two volume multi-author text gives a very comprehensive view of the uses of ultrasound in obstetrics and gynaecology. Basic principles of ultrasound scanning are dealt with and the topic of safety of diagnostic ultrasound well discussed. It is somewhat disappointing, however, that there is no mention of the possible increased hazard from the use of transvaginal Doppler ultrasound.
Book reviews
Authors: Horwich A.
Published: July 2009

This multi-author text reviews the current experience of intraoperative radiotherapy (IORT) at a number of American and Japanese centres and also at two European centres (Innsbruck and Pamplona) who are exploring this approach to improve localization. The technical logistic and biological problems associated with this technique are well described in a number of chapters from different centres. However, the general tone of the presentations represents points of view committed to further exploration of IORT and, thus, the book serves as an excellent guide to those planning to incorporate it in their own departments rather than a basis for objectively judging the potential of this approach for improving the practice of radiotherapy.
99Tcm-mercapto acetyl triglycine in paediatric renal tract disease
Authors: Pickworth F. E. , Vivian G. C. , Franklin K. , Brown E. F.
Published: July 2009

The use of 99Tcm-mercapto acetyl triglycine (99Tcm-MAG3), a new hippuran substitute, has been reported widely in adults but not in children. Our experience of its use in 100 infants and children for renography and indirect micturating cystography (IMC) is reported. The average age was 5.6 years. 65 patients completed IMC studies and nine patients had 99Tcm-dimercaptosuccinic acid (99Tcm-DMSA) scans performed on the same day. The majority of patients were referred for the investigation of urinary tract infection. 32 kidneys were found to be scarred on 99Tcm-MAG3 scans, 17 kidneys and ureters refluxed on IMC and 14 kidneys were obstructed. The results of 99Tcm-MAG3 scans were compared with those of other urinary tract investigations including ultrasound, micturating cystography (MCUG), intravenous urography (IVU) and 99Tcm-DMSA scintigraphy. No kidney which was scarred had a normal 99Tcm-MAG3 scan. All significant degrees of dilatation or obstruction on IVU or ultrasound were also detected by 99Tcm-MAG3. 99Tcm-MAG3 gave more information than any other single imaging modality and we believe it represents an ideal initial screening test in the investigation of urinary tract infection in older toilet-trained children.
Choledochal cyst and congenital anomalies of the pancreatico-biliary junction: the clinical findings, radiology and outcome in nine cases
Authors: Young W. T. , Thomas G. V. , Blethyn A. J. , Lawrie B. W.
Published: July 2009

Nine patients with choledochal cyst have been reviewed. There was a 6:3 preponderance of females. Four patients presented in adulthood. Cholangiocarcinoma developed in three patients with an interval ranging from 2 to 35 years following surgery. The predominant complaint was of abdominal pain and symptoms had been present from weeks up to 28 years. Imaging by sonography may be all that is required in the paediatric age group, but in adults further confirmation of the choledochal cyst and the associated anomalous junction of the pancreatico-biliary duct (AJPB) by direct cholangiography is recommended.
Magnetization transfer contrast (MTC) imaging of skeletal muscle at 0.26 Tesla — changes in signal intensity following exercise
Authors: Zhu X. P. , Zhao S. , Isherwood I.
Published: July 2009

Magnetization transfer contrast (MTC) imaging of skeletal muscle before and after exercise has been studied in normal volunteers at 0.26 Tesla. A saturation pulse was applied over a range of offset frequencies immediately before a gradient recall echo sequence. Substantial signal loss was observed in all muscles. After exercise, selective saturation resulted in a significant increase of contrast between active and less active muscle, a phenomenon attributable to an increase in extracellular water content. MTC imaging provides a more sensitive method to detect changes in water distribution in human skeletal muscle.
A standardized multifield irradiation technique for breast tumours using asymmetrical collimators and beam angulation
Authors: Lagendijk J. J. W. , Hofman P.
Published: July 2009

Combined angulation and asymmetrical collimator matching techniques are used for field alignment in breast irradiation. A local regional irradiation technique has been developed that allows a uniform dose distribution to the entire target volume. The localization is characterized by simple measurement of a few patient co-ordinates. The equipment settings to produce a theoretical exact field alignment are calculated by a special computer program. These settings guide the simulation. We have designed the method such that the technique is standardized for all patients receiving breast and lymph node irradiation. This allows an easy, accurate and fast patient throughput at the simulator and accelerators.
What to do with the biopsy specimen — practice in an oncology setting
Authors: Tung K. T. , Fisher C. , Parsons C. A.
Published: July 2009

The technique of image-guided biopsy using either fluoroscopy, ultrasound or computerized tomography (CT) has become well established in recent years. It is. now routine practice in most radiology departments having been shown to have an accuracy of greater than 90–95% (Gazelle & Haaga, 1989; Jennings et al, 1989; Charboneau et al, 1990) and using biopsy needles of 18 gauge or smaller, has a complication rate of less than 1% in many series (Welch et al, 1989; Nolsoe et al, 1990). It makes an important impact on clinical management (Jaeger et al, 1990), allowing diagnosis and treatment planning without recourse to more invasive methods. The automated spring-loaded biopsy gun has simplified the procedure (Parker et al, 1989; Bernardino, 1990) producing adequate specimens without crush artefact and with minimal trauma to the patient.

While most series have concentrated on the technique of image-guided biopsy, little emphasis has been placed on the importance of optimal preparation of tissue specimens once obtained.
Dosimetric accuracy at low monitor unit settings
Authors: Das Indra J. , Kase Kenneth R.
Published: July 2009

In his letter, Bomford has pointed out some concerns about our recent paper, Das et al (1991). Let us state that in the paper we do not suggest that typical patient's treatments are likely to be jeopardized because of low monitor unit settings. In fact, we state in the conclusions that “…in terms of total target dose, the error may be insignificant. Only when the treatment is made up of small MU exposures…” is the error possibly of significance. This situation should arise only rarely, but the user should be aware of the potential for error. Increasing the exposure time may be one of the ways to reduce the error, but this requires reducing pulse repetition frequency (PRF) which may not be readily achievable with all medical accelerators.
The reduction in radiation dose for intra-oral radiographs by the use of thin K-edge filters
Authors: Wilks R.
Published: July 2009

The paper by MacDonald-Jankowski and Lawinski (1991) seems to infer that K-edge filters have some special property which reduces radiation dose. I would contend that the evidence they present can only justify the conclusion that the addition of filtration to the X-ray beam causes its average energy to increase and the proportion of the filtered spectrum absorbed by tissues overlying the image receptor to decrease.
An innovative method for neuraxis radiotherapy using partial transmission block technique
Authors: Magee B.
Published: July 2009

I wish to comment on the paper by Plowman & Doughty (1991). The authors describe an interesting method for cranio-spinal radiation using a PTB technique. They “believe such techniques will become standard practice”.
Is the coned lateral lumbosacral junction radiograph necessary for radiological diagnosis?
Authors: Lamb G. , Davies S.
Published: July 2009

We read with interest the article by Lipton et al (1991). A number of points are worthy of mention.

The authors do not state the centring point for the lateral lumbar view. Eisenberg et al (1979) make the comment that this can vary by up to 10 cm in relation to the iliac crest. Lipton et al (1991) indicate that the lumbosacral junction was visualized adequately in 79% of patients and if the coned view is performed in everyone, then 79% of patients will be unnecessarily exposed to additional radiation.
Ultrasonic detection of parathyroid adenomas
Authors: Aitken A. G. F.
Published: July 2009

In our study all patients presenting with biochemical evidence of primary hyperparathyroidism and raised parathormone levels did in fact undergo pre-operative localization with ultrasound.