bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical amplitude/velocity reconstructive imaging (CARD) — a new sonographic method for detecting breast lesions
Authors: Richter K 
Published: July 2009

Abstract
X-ray mammography and breast ultrasound are methods for the detection of breast lesions, especially cancers. They work in a complementary manner, but only X-ray mammography can be used for screening purposes because the recent sonographic techniques are not as cost-effective, not as fast as mammography, observerdependent and, in some instances, not reliable enough. A new ultrasound method is described which uses an X-ray-identical examination set-up and the following two properties of breast lesions: change of echo patterns behind the lesion and increased sound velocity, especially within malignant lesions. These features can be imaged on a reference structure, a reflecting plate positioned on the side of the breast which is opposite to the transducer. Results of pre-operative examinations of 80 patients with 39 benign and 52 malignant lesions are reported. Clinical, histopathological, and especially X-ray mammography findings are compared. Five cancers were not detectable by ultrasound but had clear suspicious signs on X-ray mammography. Nine cancers were not detected by X-ray mammography but were clearly visible with the new sonographic examination. By the combination of X-ray mammographic findings and their behaviour with the new sonographic method some lesions could correctly be identified as benign. The new sonographic method works in a complementary way to X-ray mammography. By further technical development it could be automated and probably performed as easily, as fast and as reproducibly as X-ray mammography. Using this method systematically in combination with X-ray mammography the detection rate of breast cancer could possibly be increased and unnecessary biopsies of benign lesions could be prevented.
Ultrasound of the Achilles tendon after surgical repair: morphology and function
Authors: Rupp S , Tempelhof S , Fritsch E 
Published: July 2009

Abstract
Ultrasound is a well established method for the examination of the Achilles tendon. The objective of the study was to provide answers to the following questions: What ultrasonographic structural changes are long lasting after surgical repair? How important is ultrasound with regards to the functional evaluation of late results? 60 patients were examined at an average 11 years (2–19) after surgical repair of Achilles tendon rupture. In only four patients sonographic morphology of the tendon was according to the non-injured side. A variety of distinct basic alterations in ultrasound morphology was found: a hypoechogenic ribbon ventrally to the dorsal paratenon (n=40), spots of hypoechogenic areas in the tendon (n=18), dishomogeneous hyperechogenicity with preservation (n=12) or dissolving (n=22) of its fibrillar components along the longitudinal axis. In most of the cases the paratenon was thickened or could not be differentiated. In the dynamic ultrasound examination gliding mechanism of the achilles tendon was limited in 41 patients. Extensive functional subjective and objective parameters of all patients were evaluated in an Achilles tendon score. The results were rated as excellent (n=18), good (n=29), satisfactory (n=12) and poor (n=l). There was no statistical correlation between ultrasound morphology and clinical outcome. Therefore, it was concluded that ultrasound examination is able to reveal long-lasting alterations in echogenicity of the tendon but is only of limited value with regards to evaluation of the functional results after surgical repair.
Fractures of the lateral process of the talus—the value of lateral tomography
Authors: Whitby E H , Barrington N A 
Published: July 2009

AbstractWe present three cases of fractures of the lateral process of the talus, where routine anteroposterior and lateral radiographs showed an abnormality but were insufficient to assess the degree of bony injury, which is important for clinical management. Lateral tomography provided good diagnostic and anatomical detail. The diagnosis and treatment of this unusual and often missed fracture is discussed.
The demonstration of aortocaval fistulae by helical computed tomography
Authors: McWilliams R G , Lindsay K A , Chalmers A G 
Published: July 2009

Abstract
We report the helical computed tomography findings in two patients with spontaneous aortocaval fistula (ACF) complicating abdominal aortic aneurysm. The use of overlapping slices produced high quality multiplanar reformats which provided anatomical information about the likely site of the ACF and also the relationship of the renal arteries to the neck of the aneurysm.
The measurement of nuchal translucency with transabdominal and transvaginal sonography—success rates, repeatability and levels of agreement
Authors: Braithwaite J M , Economides D L 
Published: July 2009

Abstract
The objective of this prospective observational study was to assess the abilities of transabdominal sonography (TAS) and transvaginal sonography (TVS) to measure nuchal translucency (NT) and to establish the levels of agreement between the two scan mode measures. The study was carried out in the Fetal Medicine Unit and 242 pregnant women were recruited from a routine dating scan clinic. All patients underwent TAS and TVS, and two separately obtained measurements of the NT were recorded. The ability to measure NT and the repeatability and levels of agreement between the scan mode measures was assessed. A measurement of NT was obtained in 92% and 90% of fetuses using TAS and TVS, respectively, and in 100% of fetuses by combination of the scan modes. Failure to measure NT with TAS was due to inability to obtain mid-sagittal views because of unfavourable fetal lie or poor resolution, especially in patients with high body mass indexes. Although there was generally good correlation between the two scan mode measurements, a significant overmeasuring of NT was observed with TAS (mean difference ± SD: 0.10 ± 0.29 mm, p&lt;0.01). The repeatability coefficients were 0.40 mm and 0.22 mm for TAS and TVS, respectively. An examiner needs to have the ability and equipment to perform TAS and TVS to consistently measure NT. Considering the overmeasurement of NT with TAS and the improved repeatability with TVS, measurements of NT in a screening programme for chromosomal abnormalities should be by TVS, at least when a prior TAS reveals a value close to a threshold level.
Risk and benefit associated with radiation dose in breast screening programmes—an update
Authors: Law J 
Published: July 2009

Abstract
This paper discusses and attempts to estimate the very small numbers of women attending the UK Breast Screening Programme for whom the risk of cancer induction may exceed the probability of cancer detection. It updates a previous paper on the same topic. Variations in breast dose between individuals, due to differences in breast size and in numbers of views and films taken, are considered and revised. New data on cancer induction and its variation with age at exposure have been employed. The overall effect of these changes is generally to improve the balance of benefit against risk compared with the previous paper referred to, the very few exceptions being categories where the numbers of women in question remain of the order of one in a million. The implications for certain alternative screening schedules and for some current trials are also discussed, the conclusions being again reasonably reassuring.
Body magnetic resonance angiography and its effect on the use of alternative imaging—experience in 1026 patients
Authors: Hartnell G G , Hughes L A , Longmaid H E , Finn J P 
Published: July 2009

Abstract
Time-of-flight magnetic resonance (MR) angiography has been described for numerous applications but the number of patients described in published reports is usually relatively small. There is little information concerning the general utility of MR angiography in the body, outside the cranial circulation, or its effect on use of other imaging studies. Utilization of two-dimensional (2D) time-of-flight MR angiography over a 3 year period was reviewed to determine its accuracy and impact on other imaging modalities. Cranial and cardiac studies were excluded. Correlation was made with alternative imaging and surgical findings. Between January 1990 and December 1992 2D time-of-flight MR angiography was used to examine 1026 patients. MR angiography was used most frequently to examine the venous system. There was a slight reduction in the use of alternative imaging with two exceptions. When chest MR venography was performed, alternative imaging was completely abolished. Also, contrast portal venography was virtually eliminated. Five errors(0.2% of total MR angiography examinations) were recorded. Time-of-flight MR angiography, especially MR venography, is accurate and can replace contrast venography for abdominal and thoracic applications. Cost and limited availability means that other imaging, usually ultrasound, often precedes MR angiography.
The impact of digital imaging on patient doses during barium studies
Authors: Broadhead D A , Chapple C-L , Faulkner K 
Published: July 2009

Abstract
Barium studies performed on 10 digital and four non-digital fluoroscopic systems were monitored with dose–area product meters as part of a Regional Patient Dosimetry Audit programme. The data have been collected using a computer to read and reset the dose–area product meter and also to collect patient and examination details. A comparison of dose–area product measurements from digital and non-digital fluoroscopy units on over 10000 barium studies is presented. The data have been corrected according to patient size. The mean size corrected dose–area product for a barium meal examination was found to be 7.62 Gy cm2 for a digital set compared with 15.45 Gy cm2 for a non-digital set with 2462 and 1308 patients included in each measurement series, respectively. Dose–area products were also a factor of approximately two lower for barium enema, barium swallow and barium follow-through examinations performed on digital systems.
Historical note
Authors: Dawson Peter 
Published: July 2009

This month we move back to the first half of the century to examine some of the earliest work on contrast media.
It was demonstrated in the 1920s that iodine was an excellent X-ray absorber at diagnostic energies but that inorganic iodide solutions were both painful and toxic. Chemists in Berlin, searching for a “magic bullet” against syphilis, synthesized a large number of compounds just a handful of which were monoiodinated pyridones. They were found to be partially selectively excreted in the urine and were consequently dubbed “uroselectans”. Some of these compounds were used by Moses Swick to perform the first IVU. These early molecules were patented as intravascular contrast agents.
Chronic mesenteric ischaemia as a cause of abnormal bowel uptake of labelled leucocytes
Authors: Ingram G , Reeder A , Tait N P , Tanner A R 
Published: July 2009

Abstract
Chronic mesenteric ischaemia is often difficult to diagnose. A high level of clinical suspicion is needed and further investigation requires invasive procedures. We present a case where weight loss and abdominal pain were dominant features and initial interpretation of a labelled leucocyte scan suggested inflammatory bowel disease. Subsequent investigations excluded this possibility and chronic ischaemia was confirmed at autopsy. Positive small bowel images using 99Tcm-HMPAO labelled leucocytes may indicate chronic ischaemia.
The appearance of “early” chest radiographs and the response to surfactant replacement therapy
Authors: Dimitriou G , Greenough A , Giffin F J , Karani J 
Published: July 2009

Abstract
We have assessed whether the appearance of the chest radiograph performed within the first 2 h of birth was predictive of the response to exogenous surfactant replacement therapy (SRT), as indicated by changes in sensitive indices of disease severity, that is lung volume (functional residual capacity (FRC)) and oxygenation (a/A ratio). 18 premature infants who received two doses of a synthetic surfactant (Exosurf) were studied. The appearances of chest radiographs taken prior to the first and immediately after the second dose of SRT were scored for lung volume, degree of inflation, presence of opacification, interstitial shadows and air bronchograms. At similar times, FRC was measured and the a/A ratio calculated. Although following SRT, the chest radiograph score decreased (p&gt;0.01) and the FRC (p&lt;0.01) and a/A ratio (ns) improved, there was no significant relationship between the change in chest radiograph score and either the change in FRC or a/A ratio. In addition, only the post-SRT chest radiograph appearance correlated significantly with the respective FRC, a/A ratio and outcome (death or oxygen dependency beyond 28 days). Although the appearance of an early chest radiograph is frequently used as an indicator of the need for SRT, these results demonstrate that, unlike the post-SRT radiograph, it is a poor predictor of the response to SRT and outcome.
Optimization of radiographic technique for chest radiography
Authors: Warren-Forward H M , Millar J S 
Published: July 2009

Abstract
Over 1500 patients undergoing chest radiography in the West Midlands have been monitored for entrance surface doses using lithium borate thermoluminescent dosemeters. In total 63 X-ray tubes were monitored from 30 hospital departments. The mean patient entrance surface dose is 0.15 mGy, and the 75th percentile entrance surface dose is 0.18 mGy. A reference level of 0.18 mGy has been recommended for PA chest radiography in the West Midlands. Image quality has been assessed on patient radiographs. Departmental radiologists were responsible for assessing radiographs taken within their hospital. Independent analysis was performed by a control radiologist. Film–screen processor sensitivity has been assessed on 48 film-screen processor combinations. Significant differences were observed between the nominally quoted sensitivities and the measured sensitivities. Only 26% of systems produced measured sensitivities within 10% of the nominal values. A four variable regression model, explaining 78% of the variance, provided the best description for the variation in patient dose. These variables were actual sensitivity, applied potential, generator waveform and radiographic quality. Four recommendations have been made to lower patient doses; these are: (1) an increase in applied potential to a minimum of 90kVp; (2) a film–screen sensitivity of 400; (3) optimization of processor performance and (4) regular radiological audits to reduce repeat rates to a level of 5%. If all of these recommendations are followed, an estimated overall entrance surface dose saving of 53% would result. Changing the applied potential alone will see the variation in the mean entrance surface dose from non-gridded systems reduce from a factor of 4 to a factor of 2.
Thyratron performance—dependence on mounting in a medical linear accelerator
Authors: Balakrishnan I S , Jayaraman R , Bhaskar B K , Lakshmanan A V 
Published: July 2009

Abstract
A thyratron is an important component of a medical linear accelerator. The working life of a thyratron has been found to be dependent on its physical orientation in the accelerator. This observation is a result of maintaining accelerators for over 15 years.
Renal scintigraphy in the diagnosis of urinary extravasation
Authors: Al-Janabi M A , Ahmad R , Kumar K A S , Critchley M 
Published: July 2009

Abstract
Renal scintigraphy is a sensitive method for disclosing urinary extravasation. Its role following a road traffic accident is clearly presented in this case report. It is concluded that such a study can fill an important gap between the clinical and intravenous urography assessment and the more invasive studies in trauma victims.
Long-term survival after embolization of potentially lethal bleeding malignant pelvic tumours
Authors: Hendrickx Ph , Orth G , Grunert J-H 
Published: July 2009

Abstract
Transcatheter embolization was performed in 45 patients suffering from potentially lethal bleeding originating from malignant tumours in the pelvic region. In 21 cases, the basic disease was rectosigmoidal and in 20, gynaecological in origin. Uncommon bleeding sites were embolized in four other cases. The median survival time (Kaplan-Meier) was 6 months. Most patients died from tumour cachexia. In 10 cases (22%), recurrent bleeding occurred, in three of these with lethal consequences. Successful reembolization was performed on seven patients. The different embolization materials used showed a minor impact on the therapeutic result. Embolization therapy proved to be an effective measure in potentially lethal malignant pelvic bleeding. Gianturco, Anderson and Wallace (GAW) coils should be given preference where there is urgency, as they are accurate, easily and quickly insertable, and cause few complications.
Spinal metastasis from carcinoma of the penis
Authors: Jacob R , Jyothirmayi R , Kumar A , Nair M K , Rajan B 
Published: July 2009

Abstract
Carcinoma of the penis has a well documented metastatic pattern, regional lymph nodes being the predominant site of involvement. Distant metastasis is extremely rare, with a reported incidence of 1–10%. Osseous metastasis is even rarer and no case of metastasis to the spine has been reported previously. We present a case of carcinoma of the penis metastasizing to the spine.
Calculation of computed tomography dose index to effective dose conversion factors based on measurement of the dose profile along the fan shaped beam
Authors: Jansen J Th M , Geleijns J , Zweers D , Schultz F W , Zoetelief J 
Published: July 2009

Abstract
The variation in computed tomography dose index (CTDI) to effective dose conversion factors between different types of CT scanner is large (i.e. a factor of about 2 due to differences in beam shaping filters). Consequently, scanner specific conversion factors have to be applied. For some types of scanner, however, detailed information on the construction of beam shaping filters is not provided by the manufacturers. It is of interest to investigate the use of measured dose profiles for the calculation of conversion factors. Based upon measured dose profiles, two appropriate photon spectra selected on the basis of measured half value layers, gender specific adult phantoms Adam and Eva, and the Monte Carlo neutron and photon radiation transport code (MCNP), organ and effective dose conversion factors are calculated. To validate the method, a comparison is made between results for measured and calculated beam profiles for a Philips Tomoscan 350. The results in terms of effective dose per slice per unit of CTDI are compared with published data. Relative difference in conversion factors per slice averaged over all slices used for the calculations is 13 ± 4% between the two spectra, 10 2 ± 0 2% between measured and calculated beam profiles and 50±191% between the phantoms of different gender. The relative difference between the averaged results for the Adam and Eva phantoms and published results for a hermaphrodite phantom is on average equal to or less than 15 ± 13%, depending on the spectrum and beam profile used, although larger differences can occur for specific slices. It is concluded that CTDI to effective dose conversion factors can be derived on the basis of measured beam profiles.
Comparative study of dose values and image quality in mammography in the Madrid area
Authors: Chevalier M , Morán P , Vaño E 
Published: July 2009

Abstract
During 1990–1992 a study of dose and image quality in mammography was carried out in the Madrid area. Values of air kerma and mean glandular dose per film estimated at 14 public and private centres (17 X-ray units) by means of the Leeds TOR(MAX) mammographic phantom and from a sample of patients were reported in a previous paper. This second paper describes image quality results obtained by the same Leeds TOR(MAX) phantom. Inferior image quality was found for units without a grid (most of them older systems) and/or using aluminium filtration. In units with a grid, inferior image quality was due to the low optical density of the images, the use of inadequate image receptors and the use of an aluminium filter. Image quality results were compared with the standards of the UK Breast Screening Programme and proposed European Guidelines. It is concluded that mammography image quality might be considered as acceptable when TOR(MAX) phantom films achieved at least 10 lp mm−1 and 1.2% for high contrast resolution and threshold contrast visibility (6 mm details) respectively.
External anal sphincter defects: correlation between pre-operative anal endosonography and intraoperative findings
Authors: Romano G , Rotondano G , Esposito P , Pellecchia L , Novi A 
Published: July 2009

Abstract
In order to correlate operative findings with external anal sphincter (EAS) defects identified on anal endosonography (AES), 30 faecally incontinent patients undergoing overlapping sphincteroplasty or total pelvic floor repair were investigated by AES before and after surgery. Endosonic findings were correlated with the appearance of EAS at operation. 21 out of 22 defects seen at surgery had been pre-operatively detected by AES (one false negative). Post-operatively the sphincteroplasty was clearly evident on AES. In three cases of failure it showed an extensive hypoechoic area and these patients underwent dynamic graciloplasty. Endosonography is the method of choice for pre-operative imaging of EAS, having an established role in identifying sphincter defects and correlating well with intraoperative findings. Post-operatively, it has the potential to identify breakdown of the previous repair, allowing prompt surgical intervention. Endosonography is helpful in planning the best type of operation following sphincter injury and is useful in auditing the results of surgery.
Is computed tomography of the body overused? An audit of 2068 attendances in a large acute hospital
Authors: Naik K S , Ness L M , Bowker A M B , Robinson P J A 
Published: July 2009

Abstract
Computed tomography (CT) delivers a substantial proportion of the medical radiation dose to the population. The National Radiological Protection Board (NRPB) recommends that “CT examinations should only be carried out after there has been proper clinical justification for the examination of each individual by an experienced radiologist”. The aim of this study was to review the indications for body CT in a large acute hospital in order to identify groups of patients in whom CT might not be “clinically justified”. We reviewed the age, sex and diagnosis of all patients undergoing CT of the abdomen and pelvis (including lumbar spine) in our department in 1992. All requests had been checked by a senior radiologist before booking. CT was performed in 1078 male patients and in 990 females. Patients examined for benign disease were younger (mean age 52 years) than patients with malignant disease (mean age 57 years). Of 915 examinations performed for benign disease, 293 (32%) were orthopaedic in nature and included 255 (87%) for back pain. CT was carried out for benign non-orthopaedic disease in 97 women under 50 years old, usually following other tests with inconclusive or normal results. 49 of these examinations were reported as normal. Of 191 patients who had more than one CT examination, 158 (83%) were undergoing follow-up for malignant disease. All 39 patients who underwent CT on three or more occasions had life-threatening conditions, either malignancy or complicated acute pancreatitis. We have been unable to find substantial numbers of patients in whom CT was performed inappropriately. Substitution of magnetic resonance imaging (MRI) for CT of the spine will help population dose reduction. The benign condition responsible for the largest radiation dose from CT is complicated acute pancreatitis, and it may be possible to substitute MRI for CT in these patients Women under 50 years old with normal CT form an important group for clinical audit.