bluuebunny/crossref_metadata_2025 huggingface dataset:
Afterloading radiotherapy for local persistence of nasopharyngeal carcinoma
Authors: Teo P , Leung S F , Choi P , Lee W Y , Johnson P J
Published: July 2009

71 patients suffering from local persistence of nasopharyngeal carcinoma after primary external radiotherapy were treated by afterloading intracavitary 192Ir. 66 (93.0%) had a complete response as evidenced by fibreoptic nasopharyngoscope examination and biopsy 4 weeks after the treatment. Significant prognosticators were studied by both monovariate and multivariate analysis. The early overall clinical stage at first presentation predicted a favourable survival. Local tumour control was adversely affected by advanced T-stage at first presentation, and by using a single 192Ir source, unilaterally applied to treat only one side of the nasopharynx. The intracavitary treatment was tolerated well and treatment complications were confined to the nasopharynx: chronic radiation ulceration (five patients) and diffuse telangiectasia (three patients).
Mesenteric arterial rupture following blunt abdominal trauma: demonstration by computed tomography
Authors: Campbell R S D , Zammit-Maempel I
Published: July 2009

A haemoperitoneum following blunt abdominal trauma, in the absence of injury to any of the solid abdominal viscera, usually implies rupture of one of the mesenteric vessels. Computed tomography (CT) is an accurate method of detecting the presence of a haemoperitoneum, and of excluding visceral damage. We report a case of mesenteric rupture, in which the haemorrhaging artery was identified on the CT examination.
A case of forgetful ness?
Authors: Tong P C , McLean L , Baillie S P
Published: July 2009

An obese 24-year-old man was admitted following a road traffic accident, during which he crashed into several cars and a shop. He had not been drinking alcohol, yet did not recall the incident. The family had noticed recent odd behaviour, episodic aggression and a glazed look at times. Apart from a minor whiplash injury, he was uninjured and clinically normal. A computed tomography (CT) head scan and encephaloelectrography were both normal. Routine investigations were unremarkable apart from a fasting glucose 0.9 mmol 1−1.

In view of the presenting symptoms and fasting hypoglycaemia, a CT scan of the abdomen was performed (Figure 1). What does this show?
Malpositioned Hickman line: what to do when all else fails
Authors: Mitchell A W , Higgins J N , Dick R
Published: July 2009

Having attended the presentation by Taylor et al, given at the British Institute of Radiology' s annual meeting of May 1993, which discussed the use of the Amplatz gooseneck snare [1], we would like to describe a method for repositioning Hickman lines which may be useful when the usual techniques are unsuccessful.

In many centres Hickman lines are still placed by physicians and surgeons without the use of screening facilities. From time to time the tip of the line does not take the expected route and instead of lying in the distal superior vena cava or right atrium comes to lie in the brachiocephalic or the internal jugular vein.
The reproducibility of bronchial circumference measurements using computed tomography
Authors: Desai S R , Wells A U , Cheah F K , Cole P J , Hansell D M
Published: July 2009

Objective measurement of bronchial damage in patients with bronchiectasis is needed to identify progressive disease. This study evaluates the inter- and intraobserver variation in computed tomography (CT) measurements of bronchial wall circumference and examines the precision with which CT measurements of the bronchi can be repeated in patients with bronchiectasis. Twelve patients were scanned and the circumferences of 61 subsegmental bronchi were measured independently on two occasions, by three observers, using a tracing facility on the CT console. To determine the accuracy with which previously acquired sections could be repeated, five patients were scanned on two separate occasions. The mean bronchial circumference measured by the three observers was 16.1 ± 8.3 mm. The standard deviations of differences between first and second measurements of bronchial circumference for the three observers (intraobserver variability) were: 0.60 mm, 0.67 mm and 0.40 mm. The standard deviation of readings for interobserver variability was 0.71 mm. The standard deviations of differences (and coefficients of variation) for measurements of bronchial circumference following rescanning were: 1.82 mm, 1.40 mm and 1.74 mm (9.9%, 7.6% and 9.3%, respectively). The reproducibility of measurements of wall circumference, between and within observers and between examinations, indicates that such measurements may be clinically useful in demonstrating the progression of bronchiectasis.
Outcome of 249 patients attending a nuclear medicine department with well differentiated thyroid cancer; a 23 year review
Authors: Balan K K , Raouf A H , Critchley M
Published: July 2009

249 patients with well differentiated thyroid cancer attended the Nuclear Medicine Department of the Royal Liverpool Hospital (formerly housed at the Liverpool Clinic) from 1967 to 1990. Papillary carcinoma was histologically evident in 68% of patients and follicular carcinoma in 32%. Fifteen percent of all patients died of their cancer. The extent of initial surgery did not appear to influence the recurrence of disease, nor the patient survival. Univariate analysis showed that males had a worse survival rate than females during the 5 years after diagnosis but thereafter survival rates were similar. Multivariate analysis indicated that unfavourable survival factors were “age over 45 years at diagnosis” and “presence of distal metastases”. Survival was not significantly different with or without 131I ablation where there were no distal metastases. Outcome of pregnancy after 131I ablation gave no cause for concern. No serious complications were observed following 131I therapy. Serum thyroglobulin tests were introduced only half way through the review period and were helpful in predicting the presence of tumour recurrence but these data are to be discussed in another communication.
The influence of using an atraumatic needle on the incidence of post-myelography headache
Authors: Jones M J , Selby I R , Gwinnutt C L , Hughes D G
Published: July 2009

The aim of this study was to investigate whether the incidence of headaches following myelography could be reduced by using a needle with an atraumatic tip. 107 patients were studied in a trial of 22 gauge atraumatic versus 22 gauge bevel tipped needles. In the first 3 days after myelography, there was a significant reduction in the incidence of headaches in patients in whom an atraumatic needle had been used.
Osteosclerotic sarcoidosis of spine and pelvis: plain film and magnetic resonance imaging findings
Authors: Golzarian J , Matos C , Golstein M , Stallenberg B , Depierreux M , Struyven J
Published: July 2009

The purpose of this report is to present the plain film and magnetic resonance imaging features in an unusual case of histologically-confirmed sarcoidosis involving the pelvis and spine.
The effect of X-rays on cardiac pacemakers and quartz watches
Authors: Stedeford B
Published: July 2009

Cardiac pacemakers and quartz watches both contain CMOS circuits, and it is known that any solid state circuit can be damaged both by radiation and by strong electro-magnetic fields, but are they likely to be affected by diagnostic or therapeutic X-rays? This is a question not infrequently asked by the radiotherapist of the physicist or the patient of the radiographer.
Clinical evaluation of fast spin echo sequences for cranial magnetic resonance imaging at 0.5 Tesla
Authors: Hawnaur J M , Hutchinson C E , Isherwood I
Published: July 2009

Fast spin echo (FSE) sequences enable T  2-weighted MR scans to be obtained in a fraction of the time necessary for conventional SE sequences with long TR and long TE. Comparison has been made of a FSE sequence (TR = 4000 ms, effective TE = 100 ms, 2 NEX) with the T  2-weighted SE sequence (TR = 2000 ms, TE = 90 ms, 1–2 NEX) normally used in 35 patients referred for cranial MRI. Contrast-to-noise ratios (CNR) for grey:white matter and brain:CSF on the FSE sequence compared favourably with variable echo (VE) sequences which take up to three times as long to acquire. Although the conspicuity of some pathological lesions such as multiple sclerosis plaques was inferior to that of conventional T  2-weighted SE scans, no lesions were missed on FSE scans. The FSE sequence was more prone to movement artefacts. The benefit of the markedly increased patient throughput made possible by using the FSE sequence outweighs the slight reduction in sensitivity for small lesions.
Three-dimensional computed tomography cholangiography: a new technique for biliary tract imaging
Authors: Gillams A , Gardener J , Richards R , Tan A C , Linney A , Lees W R
Published: July 2009

Knowledge of the segmental anatomy and intersegmental biliary connections is an essential prerequisite to the effective management of patients with complex biliary strictures. Three dimensional (3D) imaging has the ability to demonstrate complex anatomical relationships that are difficult to appreciate on simple noninvasive two dimensional (2D) imaging. Our aim was to develop a technique for accurate, non-invasive 3D computed tomography (CT) cholangiography. Contiguous 4 mm CT sections were obtained through the liver during a dynamic bolus of 200 ml IV contrast. 3D surface reconstructions were then performed, the biliary system was isolated from surrounding hepatic parenchyma using segmentation and contrast threshold algorithms. 14 patients (six females, eight males, median age 68 years (range 48–82)) were studied. 13/14 had malignant biliary obstruction and one had obstruction secondary to a pancreatic pseudocyst. Obstruction was at the liver hilum in eight, the common bile duct in five and the common hepatic duct in one. Four patients had biliary endoprostheses but were symptomatic from inadequate drainage. There was good demonstration of the biliary anatomy, obstructed segments and intersegmental biliary connections in 13/14; irregular biliary dilatation secondary to primary sclerosing cholangitis rendered interpretation difficult in one. 3D cholangiography provided a useful adjunct to other imaging techniques. In particular, in patients with complex hilar strictures it aided implementation of appropriate interventional drainage procedures.
A clinical comparison between conventional and digital mammography utilizing computed radiography
Authors: Brettle D S , Ward S C , Parkin G J S , Cowen A R , Sumsion H J
Published: July 2009

Previous work utilizing a specially designed mammographic test object has indicated that the image quality of computed radiography (CR) approaches that of a conventional film–screen technique of equivalent radiographic speed. In an attempt to correlate these results with the clinical situation a subjective rating study of the primary physical parameters of noise, sharpness, and contrast has been conducted. Using a randomized viewing sequence two radiologists experienced in mammography were asked to score these parameters utilizing a 5 point scale. A total of 138 images was used, 62% containing no abnormalities and 38% containing either microcalcifications, masses or both. Additionally, the observers scored their confidence of correct classification, and these results were then used to construct receiver operating characteristic (ROC)curves. The subjective rating of the physical parameters results produced similar results to those obtained using the test object, with CR images providing greater contrast than film. The resolution of CR, however,was lower than for film. Overall the noise levels were similar for both modalities, but the digital images occasionally contained high levels of dust artefacts. In one case these artefacts were mistaken for a cluster ofmicrocalcifications. The test object results and the parameter rating results indicate that CR approaches the performance of film–screen images. Statistically the ROC curves produced indicate CR images to be comparable to the film–screen combination. This may be because the increased contrast compensates for resolution limitations and these findings correlate with our clinical experience.
Correlation of serum prostate specific antigen levels and bone scintigraphy in carcinoma prostate
Authors: Oommen R , Geethanjali F S , Gopalakrishnan G , Chacko N , John S , Kanagasabapathy A S , Roul R K
Published: July 2009

Serum prostate specific antigen (PSA) has been suggested as an accurate means of monitoring prostate cancer. An analysis of PSA levels and bone scan findings was carried out in a heterogeneous group of patients with a view to determine whether PSA can accurately predict bone metastases in carcinoma prostate. Of the 48 patients studied, all 10 untreated cases had elevated PSA levels, eight having bone metastases. In 29 cases on follow-up after treatment of the primary, 10 out of 11 cases with normal PSA had a negative bone scan. In the nine who received hormonal therapy, the PSA levels were generally lower than others in the study group.Two out of four with normal PSA had bone metastases. In 26 cases with positive bone scans, 23 had elevated PSA levels (mean 109.9 ng ml−1). Among 22 patients who had normal bone scans, all 10 with high PSA were found to have soft tissue disease which could explain the elevated PSA. In those with normal PSA, 12 out of 15 patients had negative scans. PSA has fairly high sensitivity (86.5%) and negative predictive value (80%).But it suffers from low specificity (54.5%) and low positive predictive value (69.7%) for bone metastases. In an untreated patient with elevated PSA, a bone scan may be required to exclude bone metastases, whereas during follow-up after treatment, a normal PSA level may obviate a “routine” bone scan.
Can 99Tcm HMPAO leucocyte scintigraphy distinguish between Crohn's disease and ulcerative colitis?
Authors: Li D J , Freeman A , Miles K A , Wraight E P
Published: July 2009

This paper has retrospectively analysed the ability of 99Tcm HMPAO leucocyte scintigraphy to distinguish Crohn's disease from ulcerative colitis. The diagnostic criteria were established by reviewing 99Tcm HMPAO leucocyte scintigrams in 123 patients with histologically proven Crohn's disease (83) or ulcerative colitis (40). Uptake in the right iliac fossa with or without other segments of colon, irregular bowel uptake, small bowel uptake or colonic activity with rectal sparing were all strongly suggestive of Crohn's disease. Left sided colitis was found to indicate ulcerative colitis. Total colitis occurred in both ulcerative colitis and Crohn's disease.The criteria were later tested in an additional 62 patients with excellent results (accuracy 98%). In 63 patients in whom the results of barium radiology were also available, the accuracy of scintigraphy was higher (93%and 83%, respectively). We conclude that 99Tcm HMPAO leucocyte scintigraphy can accurately distinguish between Crohn's disease and ulcerative colitis in a large proportion of cases and appears to be more reliable than conventional radiology.
Estimation of effective dose from dose–area product measurements for barium meals and barium enemas
Authors: Hart D , Wall B F
Published: July 2009

The International Commission on Radiological Protection has recommended the use of a new dose quantity “effective dose”. The doses to 22 organs of the human body are required for a formal calculation of this quantity. This paper shows that a quick estimate of the effective dose received by a patient from a barium meal or a barium enema can be made by multiplying the measured dose–area product for the complete examination by an appropriate conversion coefficient. Despite the varied techniques used for barium examinations, such an estimate is unlikely to be in error by more than 25%.
Transcatheter arterial embolization of obstetric and gynaecological bleeding: efficacy and clinical outcome
Authors: Yamashita Y , Harada M , Yamamoto H , Miyazaki T , Takahashi M , Miyazaki K , Okamura H
Published: July 2009

32 patients with uncontrollable genital bleeding resulting from postpartum haemorrhage (n = 15) or malignant neoplasms (n = 17) were treated by arterial embolization therapy on an emergency basis. The 15 patients with postpartum haemorrhage responded dramatically to treatment by embolization. Follow-up computed tomography or magnetic resonance studies in 12 cases showed haematomas in the pelvic extraperitoneal space, but most then reduced in size or disappeared spontaneously. In two patients with large haematomas, laparotomy was required. No serious complications developed and normal menstruation resumed in the women who did not undergo hysterectomy. In the 17 patients with malignant neoplasms, bleeding was temporally controlled in all, but recurred in seven and required re-embolization in three. One patient experienced slight numbness of the leg and another had a skin ulcer. All patients underwent subsequent treatment including radiation therapy (n = 10), operation (n = 5) or chemotherapy (n = 2). We conclude that arterial embolization has significant merits in the management of patients with uncontrollable genital bleeding.
Mediastinal computed tomography in a British Asian population
Authors: Leahy J F , Millar J , Fitzgerald R
Published: July 2009

We describe a retrospective review of all the thoracic computed tomography (CT) scans performed on British Asian patients at New Cross Hospital, Wolverhampton between January 1989 and April 1992. 39 patients were studied. Of 15 patients with active tuberculosis (TB), 14 showed mediastinal lymphadenopathy. In nine of these 15 patients this adenopathy was the only positive imaging finding, as neither lung parenchymal nor pleural abnormalities were detected on CT or plain chest radiograph (CXR). The patterns of node distribution and enhancement following intravenous contrast are described. We conclude that thoracic CT is useful in Asian or other high risk patients in whom active TB is suspected, but who lack definitive microbiological or CXR proof of diagnosis.
An audit of paediatric technetium-99m methylene diphosphonate bone scans
Authors: Fishwick N G , Krarup K C , Belton I P , Finlay D B L
Published: July 2009

Eighty-nine Technetium-99m-MDP scans performed between January 1987 and June 1990 at the Leicester Royal Infirmary were reviewed with regard to the indication, patient outcome and value of the scans in the patients' management. The significant finding was the value of a normal scan in the management of children with chronic pain.
Hepatocellular carcinoma diagnosed radiologically, treated by transcatheter arterial embolization and limited-field radiotherapy
Authors: Le Pechoux C , Akine Y , Tokita N , Sumi M , Churei H , Takayasu K , Muramatsu Y , Wakao F , Hasegawa H
Published: July 2009

Even though the resection rate for hepatocellular carcinoma (HCC) has risen recently, many patients cannot be treated surgically because of the advanced stage of the tumour and/or coexisting cirrhosis. An alternative therapeutic approach for some of these patients is transcatheter arterial embolization (TAE) which has become very common in Japan. However, it is not a curative measure, and an additional therapy is required to eradicate the residual disease. In this communication, we report a case in which a patient with HCC has been successfully treated by TAE followed by limited-field radiotherapy. The results suggest that this is a very promising therapeutic approach for HCC and that the potential of limited-field radiotherapy for HCC with or without TAE also needs to be explored.
Pulmonary calcification in smallpox handler's lung
Authors: Foster D R
Published: July 2009

Smallpox handler's lung was first described by Morris Evans and Foreman in 1963. During the South Wales smallpox outbreak of 1962 several nurses were noted to develop a “flu-like” illness following an exposure to smallpox patients. The late development of pulmonary calcification in one of these nurses, who is now 74 years old, is described.
Lymphangiomyomatosis with spontaneous peritoneal rupture
Authors: Peh W C G , Law S , Fok M , Ngan H
Published: July 2009

Radiological appearances of pulmonary and retroperitoneal lymphangiomyomatosis in a 47-year-old Chinese woman are described. Onset of abdominal symptoms and development of ascites heralded spontaneous rupture of retroperitoneal lymphangiomyomatosis, which is illustrated on computed tomography.
Factors affecting eye dose during cardiac catheterizations
Authors: Shaw A , Pratt T A
Published: July 2009

Our study was prompted by specific concern from some operators who suspected they received significantly greater eye doses when using one unit compared with another unit at a differenct centre while perfoming similar types of studies. Consequently, our aim was to make a comparison between a number of operators, X-ray units and cardiology centres and attempt to link this to causative factors, rather than present a simple survey of recorded eye doses.
Infantile myofibromatosis—a review
Authors: Davies R S , Carty H , Pierro A
Published: July 2009

Infantile myofibromatosis is a rare condition which usually presents in childhood. It has a wide spectrum of disease activity, ranging from a solitary cutaneous nodule, through to a multicentric form with widespread visceral involvement. We present four cases which demonstrate the diversity of this condition and its radiological findings, together with a review of the literature.
The ultrasonic assessment of osteopenia as defined by dual X-ray absorptiometry
Authors: Herd R J M , Blake G M , Miller C G , Parker J C , Fogelman I
Published: July 2009

Dual X-ray absorptiometry (DXA) studies of bone mineral density (BMD) of the lumbar spine and femoral neck were compared with measurements of broadband ultrasonic attenuation (BUA) and velocity of ultrasound (VOS) in the calcaneus in 300 pre- and postmenopausal women (mean age 53 years). The women were referred for evaluation of possible osteopenia as defined by DXA. The ability of ultrasound measurements to predict osteopenia in women was compared with the ability of lumbar spine and femoral neck DXA scans to predict osteopenia in the hip and spine. A new ultrasound parameter obtained by combining BUA and VOS (combined attenuation and velocity (CAV)) was also evaluated. Linear regression analysis of the three ultrasound parameters and lumbar spine and femoral neck BMD gave weak but statistically significant correlations (r = 0.45–0.54). The correlation between spine and femoral neck BMD was statistically significantly better (r = 0.72). Receiver-operating characteristic (ROC) analysis was used to investigate the sensitivity and specificity of ultrasound measurements in predicting patients with osteopenia. The areas under the ROC curves ranged from 0.64 to 0.75 and ultrasound parameters were shown to be poor at predicting osteopenia as defined by DXA. The ability of lumbar spine and femoral neck DXA measurements to predict osteopenia in the hip and spine, respectively, was statistically significantly better than any of the ultrasound parameters. Ultrasound measurements in the calcaneus did not appear to identify accurately patients with osteopenia defined by DXA measurements of bone density in the axial and appendicular skeleton.
An aid to radiation therapy simulation
Authors: Dunscombe P , Leszczynski K , Cosby S , Krispel F
Published: July 2009

We have mounted a transmission liquid crystal display unit on the head of a radiotherapy simulator and projected, using the field light, a digitized fluoroscopic image with treatment prescription overlay. It is suggested that this approach (i) can aid visualization on the patient of complex field borders including those defined by multileaf collimators; (ii) could play a role in computed tomography or magnetic resonance based treatment planning and (iii) contributes to configuring non-coplanar beams.
Myocardial velocity gradients detected by Doppler imaging
Authors: Fleming A D , Xia X , McDicken W N , Sutherland G R , Fenn L
Published: July 2009

Using a scanner whose colour Doppler mode has been adapted to display tissue motion (instead of blood flow), velocity gradients have been detected across the myocardium. A velocity gradient is a gradual spatial change in the value of velocity estimates. Velocity gradients have potential for assessing regional myocardial contractility. 28 M-mode scans were performed on nine normal volunteers at different locations in the leftventricle posterior wall. In each case simultaneous Doppler M-mode and pulse-echo M-mode images were obtained. Doppler velocity gradient (DVG) was calculated from Doppler M-mode images and rate of change of wall thickness (RCWT) was calculated from pulse-echo M-mode images. In all Doppler M-mode images statistically significant velocity gradients were observed. In all but one scan, cyclically consistent peaks in DVG occur relative to the electrocardiogram waveform. 99% of systolic and 89% of early diastolic peaks in RCWT have a corresponding peak in DVG. Velocity gradients are consistent with wall thickness changes, suggesting that they have potential for assessment of myocardial contractility.
Aortic distensibility in post-menopausal women receiving Tibolone
Authors: Lehmann E D , Hopkins K D , Parker J R , Turay R C , Rymer J , Fogelman I , Gosling R G
Published: July 2009

Both oestrogen and androgens have been shown to affect the structural composition and biophysical properties of the arterial wall in vitro. A non-invasive Doppler ultrasound technique, based on the measurement of pulse wave velocity along the thoraco-abdominal aortic pathway, was used to assess aortic compliance C in vivo in 49 normotensive, normal, healthy post-menopausal female subjects. 23 of the women had been receiving Tibolone, a synthetic steroid structurally related to norethisterone, for at least 3 years. Since C varies with non-chronic changes in blood pressure, an index of intrinsic aortic distensibility, Cp, normally independent of blood pressure, was also calculated. No significant difference was found between the control group and those subjects receiving Tibolone for age, body mass index, systolic blood pressure, diastolic blood pressure, C or Cp. As one would expect the control group Cp values did not show a significant relationship with blood pressure (r = −0.1, not significant). However, in the Tibolone group some dependence of Cp values on pressure still remained (r = −0.58, p < 0.004), suggesting that oral administration of Tibolone had altered the dynamic relationship between structural and functional biophysical properties of the aortic wall in vivo.
The admission chest radiograph after acute inhalation injury and burns
Authors: Wittram C , Kenny J B
Published: July 2009

The admission chest radiographs of 29 patients admitted with acute inhalation injury and burns, who required ventilatory support, were analysed for signs of inhalation injury. Four were excluded because of a history of chronic bronchitis or cardiac failure. 13 had radiological signs of inhalation injury, which included oedema of a nodular, consolidatory and interstitial pattern, and linear opacities due to atelectasis. 12 chest radiographs were normal. Inhalation injury in burns cases often requires clinical, bronchoscopic and blood gas assessment. Although changes were noted on 13/25 chest radiographs, the admission chest radiograph is an insensitive indicator of airway and parenchymal lung damage following acute inhalation injury and burns. We draw attention to the fact that significant lung damage may be present even with a normal initial chest radiograph.
Calculation of dose conversion factors for posterior–anterior chest radiography of adults with a relatively high-energy X-ray spectrum
Authors: Schultz F W , Geleijns J , Zoetelief J
Published: July 2009

In a survey of X-ray units as applied for thorax examinations considerable variations were observed in entrance dose among different hospitals in the Leyden region. For the median exposure conditions, i.e. 125 kVp, heavy filtering and large focus-to-skin distance (177.5 cm), absorbed dose distributions have been derived using mathematical phantoms of a standard male or female adult. For relatively high-energy X-rays, back scatter factors were calculated by Monte Carlo simulation. In addition, conversion factors were obtained, relating organ doses to air kerma, free in air. Effective dose equivalent and effective dose were calculated according to ICRP-26 and ICRP-60 recommendations, respectively. The computational procedures were compared with results reported in the literature for a similar exposure configuration but using lower-energy X-rays. Causes of relative differences ranging from – 56% to + 34% were analysed. In addition to the photon energy spectrum and filtering, the exposure geometry appears to be a very important parameter which can be optimized for the purpose of dose reduction.
The depth-dependent radiation response of human melanoma cells exposed to 65 MeV protons
Authors: Courdi A , Brassart N , Hérault J , Chauvel P
Published: July 2009

Radiation therapy with positively charged particles implies that the Bragg peak be spread out to deliver a homogeneous dose to the tumour. The spread-out Bragg peak (SOBP) has a higher linear energy transfer (LET) than the entrance beam. In addition, there is an LET gradient from proximal to distal SOBP. The aim of this study is to find out whether these small LET variations lead to differences in radiation response. Human melanoma cells (CAL4) were exposed to 65 MeV proton beams produced by the cyclotron Medicyc at five different positions: 2 mm depth corresponding to the entrance, 15, 20, 25 and 26.8 mm depth corresponding to four different positions in the half-modulated SOBP. Survival curves were generated using the in vitro colony method and fitted with the linear-quadratic model. Survival differences were observed at high doses; they were statistically significant at a dose of 8 Gy. With respect to the entrance position (2 mm), the relative biological effectiveness (RBE) at 1% survival was 1.09, 1.12, 1.19 and 1.27 at 15, 20, 25 and 26.8 mm in the SOBP, respectively. Whereas RBE values in the SOBP greater than 1.0 relative to the entrance beam represent a small biological advantage to be added to the well-known physical advantage of high energy proton beams; the RBE gradient along the SOBP would imply that the distal end of the tumour would receive a higher biologically equivalent dose than the proximal end, despite a homogeneous physical dose, especially at the high doses per fraction given in ocular melanomas. Although the increase in effectiveness with depth is mild, it should be kept in mind during eye treatment planning, in case a critical target is present at the extreme end of the SOBP.
Book reviews
Authors: Banerjee A K
Published: July 2009

This new textbook is an enlarged and up-to-date version of Dr Mittelstaedt's previous book Abdominal Ultrasound.

All aspects of ultrasound are comprehensively covered by a team of American contributors with the exception of obstetrics and gynaecology which has been purposely omitted.
Reproducibility of bone ages when performed by radiology registrars: an audit of Tanner and Whitehouse II versus Greulich and Pyle methods
Authors: King D G , Steventon D M , O'Sullivan M P , Cook A M , Hornsby V P L , Jefferson I G , King P R
Published: July 2009

This audit analysed the Tanner and Whitehouse II twenty bone (TW2) method of bone age assessment which was used in our department, and compared it with the Greulich and Pyle (GP) method. 50 previous bone ages were independently re-calculated by each of three registrars using both techniques, with the time taken to perform each assessment being recorded. For each method the interobserver variation was analysed in terms of the spread of results. The intraobserver variation in TW2 was determined by comparing the bone age originally reported with that subsequently calculated on the same film by the same registrar. The average spread of results was 0.74 years for TW2 method, and 0.96 years for the GP method and this difference is not statistically significant at the 5% level. The average intraobserver variation to TW2 was 0.33 years, but with 95% confidence limits of −0.87 to +1.53 years. The average time taken was 7.9 min for TW2 and 1.4 min for GP assessments. It was concluded that the GP method gave similar reproducibility and was faster than the TW2 method. Following clinical discussion the routine departmental bone age assessment method was changed from the TW2 to the GP method.
A comparative study of peri-prosthetic bone mineral density measurement using two different dual-energy X-ray absorptiometry systems
Authors: Cohen B , Rushton N
Published: July 2009

24 patients aged 38–72 years with an uncemented total hip arthroplasty had dual-energy X-ray absorptiometry of the upper femur performed at a mean of 27 months after surgery. Each patient was scanned on both Lunar DPX and Hologic QDR-1000 densitometers. Peri-prosthetic bone mineral density (BMD) around the femoral component was measured in seven Gruen zones using software analysis techniques to allow quantification of bone mineral adjacent to a metal implant. There was a high correlation between the results obtained with the two systems (r = 0.94). BMD measurements using the Lunar DPX were 11% higher than with the Hologic QDR; however, there was a lack of agreement between the two instruments indicating that the two methods may not be used interchangeably.
Perinephric-splenic fistula—a complication of percutaneous perinephric abscess drainage
Authors: Stewart I E T , Borland C
Published: July 2009

A case of acute perinephric abscess due to chronic parenchymal disease and calculi is presented. During percutaneous drainage a reno–splenic vein communication developed acutely. The aetiology and treatment complications of perinephric abscesses are reviewed.
Colonic stricture and fibrosis associated with high-strength pancreatic enzymes in a child with cystic fibrosis
Authors: McHugh K , Thomson A , TAM P
Published: July 2009

High-strength pancreatic enzymes have recently been implicated as a cause of colonic strictures in children with cystic fibrosis (CF). We report a 5-year-old boy with CF who had a stricture of the hepati flexure region with associated narrowing due to submucosal fibrosis of the transverse colon, secondary to high-lipase pancreatin therapy.
Obituary fo Professor Frederick William Spiers, CBE, DSc, FInstP
Authors: Boag J W
Published: July 2009

The sudden death of Professor Spiers on 8 April 1993 has deprived the Institute and the profession of Medical Physics of one of its most distinguished and respected members. Bill Spiers, as he was always known, was educated at Prince Henry's Grammar School, Evesham and at Birmingham University where he took his BSc with First Class Honours in Physics in 1929. It is of interest that Val Mayneord had preceded him by some seven years in each of these institutions and Val's example may have influenced Bill when he came to choose a field of work. At least this bond between them flourished into lifelong friendship.
Perinephric angiomyolipomas in tuberous sclerosis
Authors: Peh W C G , Lim B H , Tam P C
Published: July 2009

Bilateral large perinephric angiomyolipomas in a young Chinese woman with tuberous sclerosis are reported. Computed tomography (CT) demonstrated large fatty masses, containing abnormally dilated blood vessels and muscle strands, within the Gerota's fascia bilaterally. There were multiple foci of involvement in both kidneys. The diagnosis was confirmed on histological examination of the excised left perinephric angiomyolipoma and nephrectomy specimens. The patient subsequently developed bilateral pneumothoraces which were surgically treated. High resolution CT showed extensive thin-walled cysts in both lungs.
European Society of Mastology Consensus Conference on Breast Cancer Screening: Report of the Evaluation Committee
Authors: Wald N J , Chamberlain J , Hackshaw A
Published: July 2009

On 4 February 1993, the European Society of Mastology (EUSOMA) convened a meeting of experts in Paris to evaluate the current evidence on the value and hazards of breast cancer screening. The Committee consisted of individuals from different countries throughout Europe and from different disciplines. We summarise here the deliberations and conclusions of the Committee.
The persistent computed tomography nephrogram: its significance in the diagnosis of contrast-associated nephrotoxicity
Authors: Love L , Johnson M S , Bresler M E , Nelson J E , Olson M C , Flisak M E
Published: July 2009

A study was undertaken to find out if there is a quantitative relationship between the development of contrast-associated nephrotoxicity (CAN) and the mean renal cortical attenuation (RCA) as seen on computed tomography (CT) examination of the kidneys 24 hours after injection of contrast medium. 96 patients undergoing aortography were selected, who were considered “high risk” either because of the presence of a baseline serum creatinine (Cr) of 123.76 μmol I-1 (1.4 mg dl-1) or higher, or who were 73 or older with or without elevated creatinine levels. A CT study of the kidneys at approximately 24 h was correlated with baseline serum creatinine as well as 24 h Cr (48–72 h Cr when available). Medical history and medications were recorded. Eight of 96 patients had RCA of 108–236 HU at 24 h CT and all developed significant CAN of varying degree; 3/96 had RCA ranging from 48 to 67 HU and had transient CAN; two other patients with RCA of 67–90 HU developed CAN; and there was increased incidence of CAN in patients: (a) with pre-existing renal insufficiency; (b) with diabetes with renal insufficiency; (c) on diuretics; (d) who were older; and (e) had a unilateral atrophic kidney. It was concluded that a 24 h CT study evaluating the RCA had better predictive value for the development of CAN than a 24 h creatinine level.
Iomeprol versus iopromide for intravenous urography
Authors: de Geeter P , Melchior H
Published: July 2009

Iomeprol (B16880) is a new non-ionic tri-iodinated radiographic contrast medium. It was the aim of this double blind randomized phase III clinical trial to compare the local and systemic tolerance of iomeprol-300 (300 mg I ml-1) with the commercially available iopromide-300 (300 mg I ml-1) in a group of 198 patients needing intravenous urography. The contrast medium was injected rapidly into an antecubital vein within 2–3 min in most cases, using a standard dosage of 1 ml kg-1 body weight. The proportion of patients with an allergic diathesis was 25% in the iomeprol group and 17.3% in the iopromide group. There were no life-threatening adverse reactions. Eight patients (8%) receiving iomeprol and 6 (6.1%) receiving iopromide had a sensation of heat related to the injection of contrast medium. Only one patient (1%) in the iomeprol group and two patients (2%) in the iopromide group noted pain on injection. Although the incidence of all other side-effects was relatively high (7% after iomeprol and 11.2% after iopromide) these reactions were generally harmless. The most common symptom was nausea and/or vomiting, which occurred with the same incidence (5%) in both groups. Only one patient in each group developed urticaria or erythema. Vital parameters remained essentially unchanged in all patients. The results suggest that iomeprol is a safe contrast medium, with a tendency to produce fewer side effects than iopromide, which is known to be particularly well tolerated.
The relationship between bone mineral density, vertebral body shape and spinal curvature in the elderly thoracolumbar spine: an in vitro study
Authors: Edmondston S J , Singer K P , Price R I , Day R E , Breidahl P D
Published: July 2009

Vertebral body geometry, defined by the anterior/posterior (A/P) and mid/posterior (M/P) vertebral body height ratios, was measured in 18 vertebral columns (T1–L5) from sagittal computed tomography scans. For each vertebra, the trabecular density (VTD) and bone mineral density (BMD) were measured using quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA), respectively. Lateral view radiographs were digitized to measure the thoracic curvature. The segmental correlations between vertebral shape and bone density were poor (r = 0.01–0.31). The mean thoracic BMD and VTD and the mean lumbar VTD were significantly correlated with the mean thoracic A/P ratio (r = 0.55–0.69). The thoracic curvature was significantly correlated with both the mean thoracic and the mean lumbar VTD and BMD (r = 0.55–0.73). In summary, the extent of vertebral wedging and thoracic curvature was moderately indicative of the mean BMD of the thoracic vertebrae, and lumbar spine densitometry is useful to assess the relative severity of osteopenia in individuals with thoracic vertebral deformities.
The effects of static 3.0 T and 0.5 T magnetic fields and the echo-planar imaging experiment at 0.5 T on E. coli
Authors: Mahdi A , Gowland P A , Mansfield P , Coupland R E , Lloyd R G
Published: July 2009

Various mutant strains of Escherichia coli have been exposed to a homogeneous static magnetic field of either 0.5 T or 3.0 T and to the time varying magnetic fields found in echo-planar imaging experiments. No evidence of increased DNA damage was detected, even with bacterial strains disabled for DNA repair.
Hepatic ultrasound findings in the glycogen storage diseases
Authors: Lee P , Mather S , Owens C , Leonard J , Dicks-Mireaux C
Published: July 2009

Hepatic ultrasonography was performed on 70 patients with the hepatic glycogen storage diseases (GSDs) to assess parenchymal echogenicity. 27 patients had GSD-I, 24 had GSD-III and 19 had GSDs-VI/IX; ages varied from 0.6 to 35.7 years (median 11.7). 31 (44%) had normal or mild parenchymal changes, and 41% (11/27) of those with GSD-I, 25% (6/24) with GSD-III and 11% (2/19) with GSDs-VI/IX had marked changes. No relationships were found between the ultrasonographic appearances and other indices of metabolic control, including plasma triglycerides, total cholesterol or height standard deviation score. Seven adult patients (21–29 years) were found to have hepatic tumours: six with GSD-I and one with GSD-III. Those with GSD-I and tumours tended to have the more severe hepatic parenchymal changes. We conclude that ultrasonography may be useful in identifying patients with GSD-I at risk of hepatic tumour formation.
Cine magnetic resonance imaging of pulsatile cerebrospinal fluid flow using CSPAMM
Authors: Wayte S C , Redpath T W
Published: July 2009

Spatial modulation of magnetization (SPAMM) is a well established imaging technique which superimposes a tagging pattern on conventional magnetic resonance (MR) images, allowing movement to be visualized. A modification to the SPAMM technique, called complementary spatial modulation of magnetization (CSPAMM), which improves the contrast of the tagging pattern is explained. The application of CSPAMM to the visualization of pulsatile cerebrospinal fluid flow (CSF) using an 8 frame cardiac-gated cine sequence is described. Various combinations of binomial pulses, up to the fifth order, were investigated to see which produces the optimum tagging pattern in the CSPAMM images. The flip angles of the imaging RF pulses were studied to see which would give equal maximum CSF signal intensity in all the cine images. The optimized cine CSPAMM technique was compared in vivo with SPAMM and CSF motion was found to be more easily visualized in the CSPAMM images.
Radioiodine ablation of residual tissue in thyroid cancer: relationship between administered activity, neck uptake and outcome
Authors: Logue J P , Tsang R W , Brierley J D , Simpson W J
Published: July 2009

A retrospective review was performed to evaluate the effectiveness of radioiodine in the ablation of residual thyroid tissue after surgery for differentiated thyroid cancer. 121 patients were treated at the Princess Margaret Hospital, Toronto, Canada between 1977 and 1989, with the activity of radioiodine determined empirically. Ablation of residual thyroid was determined by 131I nuclear scans, using absent visible uptake (compared with background) as the criterion for successful ablation. 97 patients (80%) had successful ablation of residual thyroid tissue after the first administration of radioiodine. Patients with higher iodine uptake in the neck had a tendency to receive higher activities of 131I. There were no statistically significant differences in age, sex, type of surgery, initial iodine uptake in the neck and administered radioiodine activity between those successfully ablated and those that were not. Patients receiving less than 3.7 GBq (100 mCi) tended to have lower iodine uptake (<5% at 24 or 48 h), but their rate of thyroid ablation was just as high as those given 3.7 GBq or more. In order to take advantage of this, we have formalized our approach by deriving guidelines to the empiric determination of radioiodine activity based on the iodine uptake in the neck. Among the 11 patients treated with lobectomy only, the ablation rate was 64%. Although this was not significantly lower than for other forms of surgery, we continue to recommend completion thyroidectomy for this group of patients, if the goal of treatment is to ablate all thyroid tissue.
Tangential breast irradiation—rationale and methods for improving dosimetry
Authors: Neal A J , Mayles W P M , Yarnold J R
Published: July 2009

In recent years there have been great advances and innovations in all technical aspects of radiotherapy, including three dimensional (3D) computer planning, patient immobilization, radiation delivery and treatment verification. Despite this progress, the technique of tangential breast irradiation has changed little over this period and has not exploited these advances. There is increasing evidence that dose inhomogeneity within the breast is greater than at other anatomical sites, especially in women with large breasts. This paper is a review of the factors contributing to poor dosimetry in the breast, the clinical consequences of an inhomogeneous dose distribution, and how breast dosimetry could be improved by considering each of the stages from planning to accurate treatment delivery. It also highlights the particular problem of women with large breasts who may be more likely to have a poorer cosmetic outcome after a fractionated course of radiotherapy than women with small/medium-sized breasts, and supports the clinical impression that such women are also more likely to have greater dose inhomogeneity when 3D treatment plans are examined. Preliminary data from our current computed tomography (CT) planning study are presented to support these observations.
Dynamic contrast-enhanced and fat suppressed magnetic resonance imaging in suspected recurrent carcinoma of the breast: preliminary experience
Authors: Kerslake R W , Fox J N , Carleton P J , Imrie M J , Cook A M , Bowsley S J , Horsman A
Published: July 2009

20 women with suspected recurrent breast cancer who had undergone previous breast-conserving operations were investigated using dynamic contrast-enhanced gradient echo (GRE) and fat suppressed spin echo (SE) magnetic resonance (MR) imaging. Histologically confirmed recurrent tumour was readily recognized on dynamic GRE scans by virtue of rapid, early and avid enhancement. Benign scars enhanced more slowly and reached lower magnitudes of enhancement. Fat suppressed SE images, which were typically acquired lO min after contrast administration, were sensitive for the detection of tumour recurrence but lacked specificity. Early scanning after contrast administration offers the best prospects for distinguishing tumour recurrence from benign scarring. The criteria used to distinguish these two entities are highly dependent on the scan technique and the time at which images are obtained post-contrast.