bluuebunny/crossref_metadata_2025 huggingface dataset:
An investigation into the radiation dose associated with different imaging systems for chest radiology
Authors: Marshall N W , Faulkner K , Busch H P , Marsh D M , Pfenning H
Published: July 2009

With the advent of digital imaging there now exists a range of imaging techniques which may be used to acquire chest images. The purpose of this investigation was to determine typical radiation doses associated with the use of a conventional film–screen system, 100 mm film technique, large-field digital image intensifier radiography, computed radiography and a scanning slit system (AMBER, Oldeft, Netherlands). Radiation doses to relevant organs were assessed using direct measurements made with lithium fluoride thermoluminescent dosemeters, together with calculations made using normalized dose data. Typical doses were assessed using anthropomorphic phantoms for both postero-anterior and lateral projections. The risk-related quantities, i.e. effective dose and effective dose equivalent, were then calculated from these organ doses. When compared on the basis of effective dose equivalent, certain imaging techniques were seen to offer the potential for significant dose reduction, possibly at the expense of image quality.
Energy imparted to neonates during X-ray examinations in a special care baby unit
Authors: Chapple C-L , Faulkner K , Hunter E W
Published: July 2009

Neonates in a special care baby unit may receive a large number of X-rays and their dosimetry is of particular importance. A method of calculating energy imparted to neonates has been developed and a survey carried out in one unit, over a period of 18 months. Entrance dose was calculated from the technique factors used and measurement of tube output. Technique factors were recorded by the radiographer for each exposure taken, and output was measured both with and without an incubator present. Field size was determined by measurements made retrospectively from the radiograph, and a Monte Carlo simulation was used to determine factors for conversion to imparted energy. 119 neonates were included in the survey, and the mean total energy imparted was found to be 0.09 mJ. The maximum value was a factor of nine greater than this. The study also highlighted the potential for dose reduction with regard to better collimation and shielding.
Solitary ischaemic small bowel stenosis
Authors: Ginai A Z , Hussain S M , Hordijk M L , den Hollander J C
Published: July 2009

A case of a solitary short ischaemic stenosis of the small bowel is presented and the literature reviewed. An ischaemic segmental stenosis of the small bowel is a rare lesion, but can lead to acute or subacute obstructive symptoms. A well conducted small bowel enteroclysis is the diagnostic modality of choice in such a case, which may require surgical resection after the diagnosis is made.
Giant cell tumour of metacarpals: report of three cases
Authors: Singhal R M , Mukhopadhyay S , Tanwar R K , Pant G S , Julka P K
Published: July 2009

Giant cell tumour of the metacarpal bone is rare. We have encountered three cases during the last 30 years. Surgical treatment is difficult in such a critical site and is always associated with functional deformities and poor cosmesis. We have successfully treated two males and one female with lesions of the 1st, 2nd and 4th metacarpal bones using a Theratron-60 telecobalt machine. The radiation dose delivered was 50–55 Gy over

4.5–5 weeks. The three patients all tolerated radiotherapy treatment well, though moderate radiation dermatitis (Grade II–III) was seen. The regression of tumour mass started after about 2 months of radiation therapy and complete regression occurred after several months. The pain subsided immediately. Long follow up of 7–11 years revealed no signs of local recurrence, distant metastasis or radiation induced malignancy.

The results of radiation therapy are excellent in terms of functional integrity and cosmesis.
Ultrasound findings following laparoscopic cholecystectomy
Authors: Wright N B , Williamson V C
Published: July 2009

This study was set up to find the incidence of fluid collections in asymptomatic patients following laparoscopic cholecystectomy. Patients had an ultrasound scan on the first postoperative day and approximately 1 week later. Seven of 25 patients (28%) had a total of nine collections on the first postoperative day.Five had resolved by the follow-up scan and two patients developed new collections by the 1 week scan. None of the patients had significant postoperative symptoms. We emphasize the high incidence of ultrasonically detectable fluid collections in asymptomatic patients following laparoscopic cholecystectomy, encourage caution in attributing postoperative morbidity to such findings, and suggest that repeat scanning may behelpful in patient management.
Magnetic resonance assessment of age-related development of the sphenoid sinus
Authors: Szolar D , Preidler K , Ranner G , Braun H , Kern R , Wolf G , Stammberger H , Ebner F
Published: July 2009

Magnetic resonance images of the sphenoid sinus in 401 patients under 15 years old were reviewed to establish normal age-related standards. T  1-weighted sagittal and T  2-weighted axial scans were evaluated for bone marrow conversion, development of pneumatization, spatial enlargement and septation of the sphenoid sinus. The sphenoid sinus had a uniformly low signal intensity (red bone marrow) on T  1weighted images in all children less than 4 months old. Signal intensity changes from hypointense to hyperintense (bone marrow conversion) started at the age of 4 months. Onset of pneumatization was observed in 12% of the patients at age 13–15 months. By age 43–48 months, 85% of the patients showed pneumatization of the anterior part of the sphenoid bone. Pneumatization was complete in all patients older than 10 years. Enlargement of the sinus showed a characteristic profile in each dimension. Median septation was observed irregularly with age, with a maximum of 77%. Septum variants were noticed between 4.5% and 20%. Because paediatric sinus disease is a challenging problem in children, these results may be useful as baseline standards of normal age-related development of the sphenoid sinus during childhood.
Colonic complication of acute lymphoblastic leukaemia
Authors: Gavan D R , Hendry G M A
Published: July 2009

We present four unusual colonic complications of acute lymphoblastic leukaemia which occurred during the early induction period of chemotherapy. These included a transverse colitis, a haemorrhagic proctitis, acaeco-colic intussusception and an ileo-colic intussusception complicating typhlitis. Although complications are rare, they should be considered in the differential diagnosis of abdominal pain in children undergoing chemotherapy.
Measuring image texture to separate “difficult” from “easy” mammograms
Authors: Taylor P , Hajnal S , Dilhuydy M-H , Barreau B
Published: July 2009

We are investigating computerized techniques for sorting mammograms according to whether the breast tissue is fatty or dense. The hypothesis is that areas of dense tissue are a major factor in making certain mammograms harder for both radiologists and computers to interpret. Being able to identify dense mammograms automatically could permit better use of the time and skills of expert radiologists by allowing the difficult mammograms to be examined by the most experienced readers. In addition, the scope for computer-aided detection of abnormalities might be increased by concentrating on the easier, fatty mammograms.The mammograms used in the experiment were classified independently by two radiologists, who agreed in almost all cases. A number of local statistical and texture measures were then computed for patches from digitizations of these mammograms. One of the measures (local skewness in tiles) gives a good separation between fatty and dense patches. This measure has been incorporated into an automated procedure that separates off approximately two thirds of the fatty mammograms. This finding has been replicated on mammograms taken from a UK screening programme. The relationship between the fatty/dense distinction and the classification proposed by Wolfe is discussed.
Squamous cell carcinoma of the skin in both palms, axillary node, donor skin graft site and both soles—associated hyperkeratosis and porokeratosis
Authors: Abadir R , Zurowski S
Published: July 2009

A 74-year-old woman presented with skin squamous cell carcinomas on both palms, ankles and soles. The patient also had biopsy-proven porokeratosis. There was hyperkeratosis of the palms and soles. The left palm cancer was excised and skin grafted, but recurred. A nodule in the scar of the donor site of the skin graft in the left upper arm was biopsy-proven squamous cell carcinoma. A metastatic left axillary lymph node was excised. There were no palpable metastatic lymph nodes in either the groin or right axilla. All cancers were irradiated and disappeared, as did the incidentally irradiated hyperkeratosis. Porokeratosis may be associated with skin squamous cell carcinoma, yet in this case porokeratosis could not be identified in the heavily hyperkeratotic palms and soles. Despite poor prognostic signs, i.e. the location in the palm, and metastasis,the patient has done well so far.
Book reviews
Authors: Hine A L
Published: July 2009

This is the second edition of this book. The English translation of the first edition (Neuroanatomy and Cranial Computed Tomography) has been available since 1986. The translation of this new edition is again excellent. The book is divided into three sections. The initial section of 145 pages is an atlas of line drawings representing coronal, sagittal and axial planes with additional detailed axial sections of the brainstem.
Patient effective dose resulting from radiographic examinations
Authors: Okkalides D , Fotakis M
Published: July 2009

To assess the risk involved, an attempt was made to calculate the effective dose delivered to patients undergoing radiographic examinations. The examination parameters of 704 radiographs were used to calculate the average effective dose for each one of 40 different types of radiographic examinations and the results were tabulated. A sample of 2571 radiographs representing 1586 patients, obtained over a period of 2 weeks, was used to calculate the dose administered to this group. It was found that the average effective dose/ radiograph was 549 μSv and the average effective dose/patient was 890 μSv, taking into account the fact that, on average, there were 1.62 exposures per patient. These figures were extrapolated to the total number of patients going through the radiology department giving a total dose of 59.4 Sv each year, causing an average annual risk of about three malignancies.
Pharmacokinetics and efficacy of 131I-meta-iodobenzylguanidine in two neuroblastoma xenografts
Authors: Gaze M N , Hamilton T G , Mairs R J
Published: July 2009

The pharmacokinetics, biodistribution and efficacy of the radiopharmaceutical 131I-meta-iodobenzylguanidine (131I-mIBG) were determined in murine xenografts of two human neuroblastoma cell lines, SK-N-SH and SK-N-BE(2c). These lines have similar capacities in vitro for active uptake of 131I-mIBG, but different radiobiological characteristics. Groups of four mice were killed after injection of 131I-mIBG, and retained radioactivity in the tumour and normal tissues was measured at 8, 16, 24 and 48 h. Within each type there was heterogeneity of tumour uptake, although average values were similar for both. The per cent injected dose per gram of tumour retained at 24 h was (mean and 95%confidence interval) 0.95 (0.67–1.23) for SK-N-SH and 0.76 (0.47–1.05) for SK-N-BE(2c). The growth of tumours in groups of seven animals following injection of 35, 70 or 105 MBq 131I-mIBG was compared with that of controls. The specific regrowth delay (median and 95% confidence intervals) caused by 105 MBq 131I-mIBG was 4.2 (0.9–5.9) in SK-N-SH and 5.6 (0–11.3) in SK-N-BE(2c) bearing mice. SK-N-BE(2c) xenografts were significantly more sensitive to external beam irradiation than SK-N-SH xenografts.
Splenic vein aneurysm—report of a lesion that progressively expanded
Authors: Ohhira Mo , Ono M , Ohhira Ma , Matsumoto A , Ohta H , Namiki M
Published: July 2009

A case of splenic vein aneurysm is reported. The patient was diagnosed as having a cirrhotic liver with portal hypertension. Computed tomography and angiography demonstrated a splenic vein aneurysm with saccular dilatation. The splenic vein aneurysm increased in size as the hepatic cirrhosis deteriorated; however, there were no complications such as rupture or thrombosis. To our knowledge this is the first report describing the development of a portal system aneurysm.
The pulmonary lesions of chickenpox pneumonia—revisited
Authors: Picken G , Booth A J , Williams M V
Published: July 2009

Infection with the varicella zoster virus can include pulmonary complications. These may cause such minor symptomatology as to go unrecognized and unimaged. We describe a case of active chickenpox pneumonia that mimicked pulmonary metastases and was detected incidentally by means of computed tomography in a man with a past history of testicular teratoma.
A tightening of the belt
Authors: Chaudhuri R , Malik I , Bingham J B
Published: July 2009

A 65-year-old man presented with a 2 week history of an aching pain in the right loin, radiating to the back of both thighs. This pain occurred within walking 25 yards and was relieved by rest. His symptoms had started after changing a car tyre and, consequently, he attributed them to this. He had, however, also been dyspnoeic. On further questioning he had noted feeling bloated and had loosened his trouser belt by two notches. A provisional diagnosis of spinal stenosis or intermittent claudication was made and he was referred for magnetic resonance imaging (MRI) of the lumbar spine.
Quantification of atherosclerotic plaques in carotid arteries by three-dimensional ultrasound
Authors: Delcker A , Diener H C
Published: July 2009

The aim of this study was to develop three-dimensional (3D) ultrasound imaging of the carotid arteries in order to reduce intraexaminer and interexaminer variabilities of volume measurements in follow-up scans of atherosclerotic plaques. The non-invasive quantification of human atherosclerosis by 3D ultrasound was performed using a three-dimensional computer based image reconstruction. The linear movements of the transducer were driven by a motor triggered by electrocardiography. The method included an option to change angle of insonation and a correction of skin contact adaptation. Repeated measurements were performed at weekly intervals in 70 patients. Variabilities and ranges of three newly developed evaluation procedures of plaque volumes (manual tracing, threshold procedure, watershed algorithm) were used. Intraexaminer variability varied between 2.8% (watershed algorithm) and 4.1% (threshold procedure). Interexaminer variability ranged from 4.2% (manual tracing) to 7.6% (threshold procedure), follow-up measurements from 5.2% (watershed algorithm) to 9.4% (threshold procedure). Pearson correlation coefficients of interexaminer agreement and also those between all three measurement procedures were highly significant (p < 0.01). We conclude that the newly developed 3D computer based image reconstruction allows repeated quantification of moderate atherosclerosis with a high reliability.
The radiosensitizer nicotinamide inhibits arterial vasoconstriction
Authors: Hirst D G , Kennovin G D , Flitney F W
Published: July 2009

Nicotinamide (NA) is currently entering clinical trials as a radiosensitizer. A major component of its activity is the improvement of tumour oxygenation resulting from a reduction in microregional ischaemia. NA is known to reduce arterial blood pressure in rodents, suggesting a vascular component in its mechanism of action. We have used an ex vivo system to study the direct action of NA on the contractile properties of vascular smooth muscle. Isolated pieces of rat tail artery were internally perfused with Krebs' solution at a constant flow rate so that constriction of the arterial smooth muscle could be measured as an increase in perfusion pressure. Transient vasoconstrictor responses lasting up to 1O min were induced with bolus injections (10 μl) of phenylephrine, at concentrations ranging from 10−5 to 10−2 M, into the internal perfusate whereas a constant increase in vasoconstrictor tone, giving perfusion pressures of 43–84 mmHg, was induced by constantly perfusing with PE (5 × 10−6M) or raising the K+ concentration of the Krebs' solution to 122 mM. The addition of NA to the perfusate significantly reduced the size of the transient vasoconstrictor responses in a dose-dependent manner and induced the precontracted vessels to relax. This action of NA could not be blocked either by Nω-nitro-L-arginine methyl ester (L-NAME), indomethacin or propranolol. We conclude that direct effects on supplying blood vessels probably contribute to the oxygenating action of NA in tumours, though the precise mechanism remains obscure.
Does degenerative disease of the lumbar spine cause arachnoiditis? A magnetic resonance study and review of the literature
Authors: Jackson A , Isherwood I
Published: July 2009

The magnetic resonance appearances in 165 patients with symptoms suggestive of degenerative lumbar spine disease were reviewed. The aim of the study was to evaluate the relationship between abnormalities of nerve root distribution and degenerative disease of the lumbar spine in the absence of other known risk factors for arachnoiditis. Central clumping of nerve roots was present in 16 patients (9.7%) and was associated with spinal stenosis at one of the affected levels in all (p < 0.001). Spinal stenosis was present in 44 patients giving an incidence of abnormal nerve root distribution of 36% in this group. Nerve root clumping occurred in association with pure spinal stenosis (10 cases), stenosis secondary to disc prolapse (four cases) and degenerative spondylolisthesis (two cases). Nerve root clumping was confined to one vertebral level in nine cases and extended over two to four levels in seven. In five of the latter spinal stenosis was present at multiple levels. The appearance of nerve root clumping described here may result entirely from mechanical apposition of nerve roots but is indistinguishable from the central pattern of nerve root adhesions which occurs in adhesive lumbar arachnoiditis. No abnormalities of nerve root distribution were seen in association with any indicator of degenerative disk disease in the absence of stenosis. We have been unable to demonstrate the previously reported relationship between lumbar disk degeneration and arachnoiditis and discuss this with a critical review of the literature. Abnormal central clumping of nerve roots as described in arachnoiditis may occur in association with spinal stenosis in the absence of other risk factors although the cause for this appearance remains unexplained. Arachnoiditis-like changes extending over more than one vertebral level are rare (7%) except in the presence of spinal stenosis at multiple levels (29%). Awareness of this appearance may avoid a possibly incorrect diagnosis of arachnoiditis in the presence of a treatable stenosis.
Entrance surface and ovarian doses in hysterosalpingography
Authors: Fife I A J , Wilson D J , Lewis C A
Published: July 2009

A survey of entrance surface doses on 40 patients undergoing hysterosalpingography (HSG) has been undertaken. HSG is performed on women primarily of child-bearing age, with the dose to the gonads of these patients being of significant interest. Four lithium fluoride thermoluminescent dosimeters (TLDs) were attached to anatomical landmarks on the patient's skin to measure entrance surface doses. The results ranged from 0.5 mGy to 38.6 mGy with an average entrance surface dose of 13.3 mGy measured at the symphysis pubis. A correlation was observed between the entrance surface dose and imaging technique. Higher doses were measured when 24 × 30 cm film–screen radiography was used as opposed to fluoroscopy using 100 mm cut film for hard copy. Estimates of the organ does to the ovaries were derived for both techniques yielding 2.8 mGy for 24 × 30 cm film–screen radiography and 1.7 mGy for 100 mm cut film.
Sicca syndrome due to primary amyloidosis
Authors: Schima W , Amann G , Steiner E , Steurer M , Vormittag W , Steurer L
Published: July 2009

Sicca syndrome consists of two major clinical findings: keratoconjunctivitis sicca and xerostomia due to destruction of the lacrimal and salivary gland parenchyma. Although it is most often due to Sjögren's syndrome, a variety of other diseases causes sicca syndrome. We report the rare case of a patient with gland infiltration in primary amyloidosis. Sonographic, computed tomographic and magnetic resonance findings are presented.
Outcome of 249 patients attending a nuclear medicine department with well differentiated thyroid cancer; a 23 year review
Authors: Ryan P
Published: July 2009

While it is probably worthwhile publishing data about clinical experience, one surely has to be extremely careful before drawing any conclusions as clinical experience does not constitute a properly conducted study aimed at evaluating a hypothesis. This problem applies to some of the conclusions of the paper by Balan et al [1].
Reporting of fracture radiographs by radiographers: the impact of a training programme
Authors: Loughran C F
Published: July 2009

In order to determine what influence training would have on their ability to interpret skeletal radiographs from the accident and emergency department, a 6 months training programme was established for three radiographers in various aspects of the radiology of orthopaedics and skeletal trauma. During the study the radiographers reported on radiographs from the accident and emergency department and each month an evaluation of their accuracy was undertaken. The overall radiographer error rate for fracture detection (false positive and false negative) declined during the training period. This was highly significant (p < 0.001). The sensitivity for fracture detection improved from 81.1% at the commencement of the trial to 95.9% at the end. This was also highly significant (p < 0.001). Radiographer specificity for the exclusion of fractures also improved from 94.4% during the first 2 months to 96.6% in the final 2 months, and this was also significant (p < 0.05). The overall error rate of two of the three radiographers improved significantly (p < 0.001) but for one radiographer the improvement did not reach a level of statistical significance. The difference in sensitivity for fracture detection at the commencement of the trial period between radiologist and radiographer was highly significant (p < 0.001), but there was no statistically significant difference during the last two months of the trial. The difference in specificity between radiologist and radiographer remained highly significant both at the beginning and the end of the trial (p < 0.001). Experienced radiographers who receive supplementary training in the radiology of skeletal trauma can significantly improve their diagnostic skills and can report such radiographs with a high degree of accuracy. A programme of training and certification of radiographers in fracture reporting could help alleviate the diagnostic radiologists' workload of plain film reporting.
Patient radiation doses from enteroclysis examinations
Authors: Hart D , Haggett P J , Boardman P , Nolan D J , Wall B F
Published: July 2009

Data relating to patient dose have been acquired for enteroclysis examinations (small bowel enemas) performed at the John Radcliffe Hospital, Oxford, on 23 adult patients. Dose–area products, fluoroscopy times and the number of radiographs taken are used to compare the examination procedure at the John Radcliffe Hospital with enteroclysis and barium follow-throughs performed elsewhere. The mean dose–area product for the 23 examinations was 6.8 Gy cm2 and the mean effective dose was estimated to be 1.5 mSv. These doses are intermediate between those arising from barium meals and barium enemas performed in the same room.
Radiation protection in dental radiology
Authors: Horner K
Published: July 2009

Dental radiology represents the most frequent diagnostic radiological investigation in the industrialized world, with over 16 million examinations performed annually in England and Wales alone. Although individual doses and risks are low in dental radiography, the collective dose is not inconsiderable and many examinations are performed in younger age groups. Radiation protection of patients in dental radiology is achieved in three ways: by appropriate selection criteria for patients and equipment, methods of dose limitation and quality assurance procedures. There is a lack of agreed radiographic selection criteria to guide British dentists and this may lead to overuse of certain techniques, principally panoramic radiography. In intraoral radiography the use of fast (E-speed) film and rectangular collimation offer dose reductions of approximately 50% and 60%, respectively. Constant potential X-ray units and rare-earth filtration permit further reductions. In panoramic and cephalometric radiography, improved collimation offers a simple means of dose limitation, while doses can be reduced by up to one-eighth by combining the use of constant potential X-ray units, rare-earth intensifying screens and rare-earth filtration. Lead protection of the abdomen has little relevance to radiation protection; however, thyroid shielding has some value. Concern has been expressed about the poor diagnostic quality of radiographs taken in the general dental services. Consequently a quality assurance programme plays an essential part in dental radiation protection by improving diagnostic yield and limiting repeat examinations.
Estimation of fetal volume by magnetic resonance imaging and stereology
Authors: Roberts N , Garden A S , Cruz-Orive L M , Whitehouse G H , Edwards R H T
Published: July 2009

The current methods to monitor fetal growth in utero are based on ultrasound image measurements which, lacking a proper sampling methodology, may be biased to unknown degrees. The Cavalieri method of stereology guarantees the accurate estimation of the volume of an arbitrary object from a few systematic sections. Non-invasive scanning methods, and magnetic resonance imaging (MRI) in particular, are valuable tools to provide the necessary sections, and therefore offer interesting possibilities for unbiased quantification. This paper describes how to estimate fetal volume in utero with a coefficient of error of less than 5% in less than 5 min, from three or four properly sampled MRI scans. MRI was chosen because it does not use ionizing radiations on the one hand, and it offers a good image quality on the other. The impact of potential sources of bias such as fetal motion, chemical shift and partial voluming artefacts is discussed. The methods are illustrated on four subjects monitored between weeks 28 and 40 of gestation.
Single breath-holding three-dimensional magnetic resonance portography with bolus injection of Gd-DTPA in subjects with normal liver: a comparison with two-dimensional time-of-flight technique
Authors: Suto Y , Ohuchi Y , Kimura T , Takizawa O , Ohta Y
Published: July 2009

Two-dimensional time-of-flight (2D-TOF) magnetic resonance (MR) portography tends to produce general image degradation owing to the phase discrepancy caused by multiple breath-holding. To solve this problem, three-dimensional (3D)-MR portographies were reconstructed from image data acquired with a bolus injection of Gd-DTPA with single breath-holding in 20 subjects with normal liver function. 2D-TOF MR portographies were obtained beforehand for the comparison. All the images were displayed in a cine mode for the two MR angiographic techniques. Visualization was assessed as positive when the vessel was visualized without disruption. 3D-MR portography produced a positive rate of over 80% for all but the left first-order branch. With the 2D-TOF techniques, however, only the portal trunk and left second-order branches were visualized at this rate. The positive rate for most portal branches was significantly higher with 3D-MR portography than with the 2D-TOF technique. In conclusion, 3D-MR portography makes it possible to depict the portal venous system without disruption using a short measurement time with single breath-holding and has the potential to become a powerful method for abdominal MR angiography.
Absorbed dose distribution measurements in brachytherapy using ferrous sulphate gel and magnetic resonance imaging
Authors: Olsen D R , Hellesnes J
Published: July 2009

Measurements of spatial dose distribution by means of Fricke gel dosimetry and magnetic resonance imaging (MRI) are reported for two different brachytherapy applications: a configuration of three parallel linear high dose-rate (HDR) microSelectron 192Ir source trains and a low dose-rate (LDR) 106Ru eye applicator. The presented results verify that sufficient radiation induced change in spin-lattice relaxation time (T  1) is obtained within the gel dosimeter to achieve satisfactory resolution for both the HDR 192Ir source train and the LDR 106Ru applicator. Satisfactory spatial resolution is also obtained, so that the large dose gradients of the brachytherapy sources can be visualized by MRI of irradiated dosimetry gels. A reliable representation of the relative dose level is achieved by calculated T  1 images. The presented study supports the use of dose distribution measurements by means of gel dosimetry and MRI in complex brachytherapy applications.
Benign urachal neoplasm
Authors: Dawson J S , Crisp A J , Boyd S M , Broderick N J
Published: July 2009

Benign urachal neoplasms have been rarely reported. We describe a case of a large benign mesenchymal neoplasm (21 × 19 × 14 cm) arising from the urachus, with imaging by computed tomography and ultrasound.
Pulled elbow in childhood
Authors: Bretland P M
Published: July 2009

In this injury, a sudden pull on the pronated, extended arm of a child up to 5 years of age is followed by refusal to use the arm. After a simple flexion, supination and extension manoeuvre the child starts using the arm in minutes. Radiographs are said to be normal. At least 13 theories of the mechanism have been advanced. Anterior subluxation of the radial head has never been proved radiographically or experimentally. Available evidence favours momentary distraction of the radiocapitellar joint in pronation which allows upward slip of the annular ligament upon the radial head at its shortest diameter and interposition of part of the anterior capsule between the two bones. Radiography is difficult, usually producing oblique views in pronation which are not easy to interpret. The main differential diagnosis is from epiphyseal rotation. In any doubtful case early repeat radiography is essential taking matched views of both elbows, even if non-standard. A collection of 28 radiographs has been analysed, two recent typical contrasting cases are presented, two signs to identify an oblique view of a normal elbow are described and the literature is reviewed. If the best radiograph available in an injured elbow in a child is a normal oblique view in pronation, pulled elbow is a likely diagnosis.
The “aurora sign”—a new sonographic sign of pneumatosis cystoides intestinalis
Authors: Kohzaki S , Hayashi K , Fukuda T , Uetani M , Kawano Y , Iriarte W L Z
Published: July 2009

Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts of varying size within the intestinal wall. Although the characteristic findings on plain abdominal radiograph, computed tomography (CT), and barium enema have been well described, the sonographic findings have not. We recently encountered a case of PCI in which abdominal sonography disclosed a unique finding. We were able to reproduce the finding experimentally and have coined it the “aurora sign”.
Mackenzie Davidson Memorial Lecture 1994: Imaging of treated cancer
Authors: Husband J E S
Published: July 2009

Sir James Mackenzie Davidson was a radiologist of international repute and indeed, the leading radiologist in the United Kingdom in the early 1900s. Sir James was knighted for his contribution to radiology in 1912, his career being highlighted by his work in the localization of foreign bodies using X-rays and in this connection he gave of himself unsparingly during the first World War. Throughout his career, Sir James emphasized the fundamental value of physics to radiology, being particularly interested in the designing of new equipment and methods of measurement. In this review, I would like to discuss the various methods of measurement available to us today in the assessment of treated cancer.

Imaging of treated cancer is a topic which has, until recently, received only limited attention, but is now becoming both increasingly important and relevant to everyday practice for three major reasons. First, the overall incidence of cancer is increasing and secondly, there have been important advances in treatment. Thirdly, and equally important, the advances in imaging over the last two decades now enable us to obtain information not only on changes in tumour morphology, but also on changes in tumour composition and physiology. These issues will be discussed in more detail under the broad categories of: incidence of cancer and the future cancer burden; imaging strategies for service and research; information derived from imaging and its clinical significance in cancer management.
Atlanto–axial rotatory fixation
Authors: Logan P M , O'Rourke K , Gibney R G
Published: July 2009

A 16-year-old male presented to the Accident and Emergency Department with an injury sustained by diving into a shallow swimming pool. He complained of pain in his neck and limitation of neck movements. Examination revealed a marked torticollis and tenderness in the neck. Movement of the neck was limited to 15° on both flexion and extension and lateral rotation was limited to 30° bilaterally. The rest of the examination was unremarkable, in particular there was no neurological deficit.
Intravascular ultrasound imaging of peripheral arteries as an adjunct to atherectomy: preliminary experience
Authors: Korogi Y , Hirai T , Sakamoto Y , Harada M , Yamamoto H , Hamatake S , Takahashi M
Published: July 2009

12 atherosclerotic lesions in nine patients, including four restenoses after balloon angioplasty, were treated by atherectomy under the guidance of intravascular ultrasound (US). Echogenicities of the plaques and morphological alterations in the arterial walls produced by atherectomy were evaluated. The two-layered appearance of post-angioplasty restenoses was found to be inner fibrous intimal thickening with proliferation of smooth muscle cells and outer residual collagen-rich plaque. The deep cut surfaces were shown as concave U-shaped defects. Medial tissues were present in all cases where intravascular US demonstrated the disruption of a thin hyperechoic layer of the internal elastic lamina. Intravascular US imaging may provide valuable information on the degree, eccentricity and histological type of stenosis, the presence of calcification before atherectomy, and on the extent of excision and the morphological changes in the arterial wall after atherectomy.
Measuring the coracoclavicular distance with ultrasound—a new technique
Authors: Sluming V A
Published: July 2009

The distance between the clavicle and the coracoid process of the scapula is frequently assessed during the radiographic investigation of the acromioclavicular joint. This study defines an ultrasound technique (5 MHz real time linear array) for measuring the coracoclavicular distance, and determines its reliability and validity. A new ultrasonic technique was performed on 49 healthy subjects who had volunteered to participate in the study, having given signed, informed consent. The measuring endpoints for the coracoclavicular distance were the superior border of the clavicle and the superior border of the coracoid process. Three replicate scans were performed on each shoulder. The ultrasound measurements for 19 of the subjects were compared with the measurement obtained from a normal shoulder radiograph (which had previously been requested on clinical grounds). The data were subjected to analysis of variance (ANOVA) and the limits of agreement method of analysis. The mean difference between the radiograph and ultrasound measurements was 0.38 mm. The limits of agreement (95% confidence intervals) were −0.57 (−0.97, −0.17) and 1.33 (0.93, 1.73). Intraoperator and interoperator reliability were evaluated with a multifactor ANOVA and gave p = 0.7 for intraoperator reliability and p = 0.5 for interoperator reliability. The mean of the coefficients of variation for the two operators was 1.84%. The average range for repeated trials (same operator, same subject) was 1.35 mm. The maximum differences in the averages for each operator was 1.2 mm. The ultrasound technique described is a reliable, accurate and valid technique for evaluating the coracoclavicular distance and may usefully supplement the routine radiographic examination of the shoulder in patients presenting for radiographic examination of the acromioclavicular joint.
Epidermoid cyst of the floor of the mouth: diagnostic imaging by sonography, computed tomography and magnetic resonance imaging
Authors: Turetschek K , Hospodka H , Steiner E
Published: July 2009

Epidermoid and dermoid cysts are rare benign tumours which may occur anywhere in the body. About 7% of them are found in the head and neck region and only 1.6% are located within the oral cavity. Pre-operative imaging of these lesions provides important diagnostic and anatomical information with regard to the patient's therapeutic management. This case report describes imaging findings in a patient with an extensive epidermoid cyst located within the sublingual space.
Default display arrangements of images on PACS monitors
Authors: Strickland N H , Allison D J
Published: July 2009

Our hospital is currently installing one of the largest non-military hospital-wide picture archiving and communications systems (PACS) in the world [1, 2]. We are designing default modes for the display of images on PACS workstation monitors so that these can be implemented in future software releases. In this article we present the considerations and reasoning influencing our decisions upon how best to arrange and present the images from the various radiological modalities for ease of soft copy reporting.
The radiation exposure of the patient from stablexenon computed tomography
Authors: Seifert H , Blaß G , Leetz H-K , Voges M
Published: July 2009

For stable-xenon computed tomography (CT), an X-ray examination for measurement of cerebral blood circulation in the brain, the radiation exposure of the patient was determined in order to estimate the risk of inducing cancer. Organ doses of brain, eyelenses, thyroid and gonads have been calculated using the measured air kerma free-in-air on the axis of rotation and organ-specific conversion factors calculated with the Monte Carlo method. Dose measurements with TLD-100 rods using a humanoid Alderson phantom were carried out for verification of the calculated organ doses. In the case of brain partially located in the region of primary radiation a mean organ dose of 39 mSv was calculated. The dose measurements showed dose equivalents between 6 and 68 mSv in different regions of the brain and consequently an inhomogeneous dose distribution. From an estimation of the radiation-induced risk using the effective dose of 1.6 mSv it follows that one additional fatal cancer per 12 500 stable-xenon CT examinations has to be expected. The organ doses of eyelenses and thyroid located in the region of scattered radiation are so low that biological effects are hardly to be expected. The calculated dose equivalents of 6.5 mSv and 0.5 mSv, respectively, are in good agreement with measurements. The organ dose of gonads amounted to less than 0.07 mSv.
Annular pancreas divisum—a report of two cases and review of the literature
Authors: England R E , Newcomer M K , Leung J W C , Cotton P B
Published: July 2009

Annular pancreas divisum is a rare congenital variant of pancreatic anatomy which may cause symptoms of gastric outlet obstruction and recurrent pancreatitis. It is diagnosed by endoscopic retrograde pancreatography. We present two cases of this condition and review the literature.
Magnetic resonance imaging of endocrine tumours of the pancreas
Authors: Moore N R , Rogers C E , Britton B J
Published: July 2009

Seven patients who had functioning or non-functioning endocrine pancreatic tumours were investigated by magnetic resonance imaging. Combinations of fat suppressed T  1 weighted spin echo and gradient recalled echo (n = 7), T  2 weighted spin echo (n = 3) and gadolinium diethylamine triamine pentaacetic acid (Gd-DTPA) enhanced fat suppressed T  1 images were acquired. Magnetic resonance imaging detected five of seven tumours prospectively (three of which were smaller than 10 mm) and a further 10 mm tumour retrospectively. Tumours were low signal on T  1 weighted images and showed enhancement after Gd–DTPA. On T  2 weighted images one tumour was hyperintense, and two were isointense with normal pancreas. Computed tomography, transabdominal ultrasound and angiography were performed in six patients but detected only one tumour each. Intraoperative palpation and ultrasound detected all tumours. If pre-operative imaging is required magnetic resonance imaging is the technique of choice to detect small endocrine pancreatic tumours.
Two-dimensional time-of-flight magnetic resonance angiography in the coronal plane for abdominal disease: its usefulness and comparison with conventional angiography
Authors: Miyazaki T , Yamashita Y , Shinzato J , Kojima A , Takahashi M
Published: July 2009

Using two-dimensional time-of-flight magnetic resonance angiography (2D-TOF MRA) in the coronal plane, 54 cases of arterial disease and 46 cases of venous disease were evaluated. The results were compared with those of conventional angiography to establish their relative usefulness for diagnosing abdominal diseases. Using 2D-TOF MRA, relatively large vessels such as the splenic artery, the trunks of the superior mesenteric artery (SMA) and the renal artery were clearly visualized. However, smaller vessels such as the gastroduodenal artery, main hepatic artery, branches of the SMA and the renal artery were not clearly imaged. The diameters of stenotic arteries correlated well with their images on conventional angiography (r = 0.953). In the venous system, the splenic, renal and portal veins and the first branches of the portal vein bilaterally were clearly imaged. Veins, normal or abnormal, less than 5 mm in diameter were not clearly imaged using 2D-TOF MRA. 2D-TOF MRA in the coronal plane provided useful diagnostic information, especially regarding venous diseases, tumour thrombi in the portal vein, renal vein or inferior vena cava (IVC), collateral vessels or shunts, vascular malformations, and the relationships between the portal and hepatic veins. Limitations encountered in arterial disease did not interfere with evaluations of venous disease.
Selection of appropriate ultrasound methods for the estimation of fetal weight
Authors: Dudley N J
Published: July 2009

Many methods for fetal weight estimation have been proposed. Earlier formulae were derived solely by regression analysis but more recently formulae based on physical models have been developed. Some of these formulae are lengthy and difficult to use. The main purpose of this study was to evaluate a concise area based formula developed several years ago against popular and recently published formulae. Data from 388 patients over a 5 year period were collected from clinically required ultrasound scans performed within 10 days of delivery. Four of the seven formulae evaluated proved to be equally accurate over a broad range of birthweights (mean absolute deviations 245–249 g), including the area based formula and a circumference based formula derived from it. On the grounds of the number of terms, the precision of coefficients, the physical meaning and the greater accuracy of individual area measurements compared with those derived from circumference, the area based formula should be the method of choice.
A population study of the screening potential of assessment of trabecular pattern of the femoral neck (Singh index): the Chingford Study
Authors: Masud T , Jawed S , Doyle D V , Spector T D
Published: July 2009

The trabecular pattern of the femoral neck (Singh index) has been used as a measure of osteopenia and fracture risk but the value of this method is controversial. This study assessed the usefulness of the Singh index (SI) by using dual energy X-ray absorptiometry (DXA) as the “gold standard”. 659 Caucasian women (45–70 years) from an age–sex register of a general practice had their femoral neck and lumbar spine bone densities measured by DXA and had antero–posterior hip X-rays performed which were then categorized into six osteopenia grades using the SI method. The intraobserver and interobserver reproducibility of this method was good (kappa = 0.64 and 0.61, respectively). The SI grades correlated significantly with body mass index (r = 0.35) and age (r = 0.17) (p < 0.001). The mean femoral neck and lumbar spine bone densities were significantly higher with increasing SI grade even after adjustment for age and body mass index (p < 0.001). The proportion of subjects below the fracture threshold (2 SD below mean peak bone mass) decreased with increasing SI grade, ranging from 100% in SI grade 2 to 16.8% in SI grade 6. There was, however, wide overlap of bone densities between the grades. Using the criteria “osteoporosis ≤ SI grade 4”, the sensitivity and specificity of the SI method diagnosing low bone mass was 35.1% and 90.0%, respectively. These data suggest that the SI is a reproducible tool which may detect differences in bone mass between populations or subgroups within populations, although caution should be used in classifying individual patients because of the wide variation in bone density. The method has a low sensitivity but a relatively high specificity in diagnosing low bone mass.
Sixth nerve palsy following radiculography
Authors: Dinakaran S , Desai S P , Corney C E
Published: July 2009

Complications following myelography do not usually cause serious disability. However, we report a case of sixth nerve palsy where the disability lasted a few months. We also discuss the possible pathogeneses.
Ultrasound in the evaluation of osteoporosis: a comparison with bone mineral density at distal radius
Authors: Gnudi S , Malavolta N , Ripamonti C , Caudarella R
Published: July 2009

It is proven that, from a technical point of view, ultrasound transmission velocity (UTV) measurement can easily be taken at the distal end of the radius. The reproducibility of UTV is good (coefficient of variation 0.3% intraoperator and 0.5% interoperator). 248 normal and 65 osteoporotic women were then studied to establish the range of UTV values and to compare the ability of UTV and bone mineral density (BMD) measurement, taken at the same skeletal sites, to detect osteoporotic fragility. Osteoporosis was defined by the presence of atraumatic vertebral fractures on an X-ray of the spine. Ultrasound velocity averaged 1570.5±43.3 m s−1 in normal and 1519.2±15.2 m s−1 in osteoporotic women; the difference is also statistically significant (p<0.01) for BMD. Both BMD and UTV decline after menopause and are significantly correlated with age. A weak correlation (r=0.68) was found between UTV and BMD; this supports the thesis that ultrasound velocity measures bone mass as well as other fragility components of bone distinct from the decrease of mass. Receiver operating characteristic (ROC) curve analysis showed that UTV discriminates between normal and osteoporotic patients at least as well as radial BMD, indicating that UTV is a new available diagnostic modality which can be used to screen osteoporotic subjects.