bluuebunny/crossref_metadata_2025_split huggingface dataset:
Well ventilated bullae: a potential confusion on ventilation/perfusion scanning
Authors: Cunningham Deborah A. , Mitchell David M. 
Published: July 2009

Isotope lung scanning is the only non-invasive test capable of making the diagnosis of pulmonary embolism reliably. While defects of perfusion have many causes (Wagner & Strauss, 1975) combining a perfusion lung scan with images of regional ventilation increases specificity, such that segmental or larger defects of perfusion unmatched in ventilation are taken as strong evidence in favour of the diagnosis of pulmonary embolus (“high probability”) (Biello et al, 1979).
In the present paper we report three cases in which bullous areas showed normal ventilation with Krypton 81m and absent perfusion, resulting in large areas of ventilation/perfusion mis-match.
A 65-year-old female Irish betting clerk was admitted with a Staphylococcal septicaemia following a boil on her elbow. She had no respiratory symptoms but she was known to have basal lung fibrosis and a chest radiograph showed apical bullae with bilateral basal fibrosis. During her admission she developed acute left sided pleuritic chest pain and a chest radiograph showed a small left pleural effusion. The diagnosis of pulmonary embolism (PE) seemed likely and a ventilation/ perfusion lung scan was performed using Technetium-99m macro aggregates and Krypton 81m gas.
As expected the bullae in the left apex showed matched defects of ventilation and perfusion. In the right mid-zone, however, there was a large area of ventilation/perfusion mismatch, corresponding to a region of bullous formation on radiography (Fig. 1). A moderate sized mis-matched defect in the left mid-zone probably corresponded to a bullous area also, but PE could not be excluded.
Detection of focal nodular hyperplasia with liver colloid single photon emission computed tomography: a case report and review of the literature
Authors: Aktolun Cumali , Bayhan Hikmet 
Published: July 2009

Focal nodular hyperplasia (FNH) is a benign hamartomatous liver mass (Robbins et al, 1984). It is usually identified incidentally during ultrasonographic examination, other diagnostic procedures or autopsy. The patients are often asymptomatic (Drum, 1982). Physical examination is found to be normal in most of the cases. Jaundice, hepatomegaly, palpable mass, and chronic intermittent vague abdominal pain, especially in the right upper quadrant, may be present in some patients. Eighty-eight per cent of the cases are female, of whom 80% give a history of oral contraceptive or supplemental oestrogen use (Kerlin et al, 1983). The lesion may be solitary (55%) or multiple, and it is usually located in the right lobe of the liver (Rogers et al, 1981), varying in size between 1 and 20 cm, and containing hepatocytes, bile ducts and Kuppfer cells (Rogers et al, 1981; Robbins et al, 1984). Colloid scintigraphic appearance may be hyperactive (40%), hypoactive (30–60%) or normoactive (30–55%) (Diament et al, 1982; Kerlin et al, 1983; Rogers et al, 1981; Welch et al, 1985). A central, stellate-shaped collageneous scar with peripherally radiating septa is the typical histopathologic feature of FNH (Kerlin et al, 1983; Rogers et al, 1981).
We present a case of FNH with planar colloid scintigraphy demonstrating slightly increased uptake in the ultrasonographically detected lesion. Single photon emission computed tomography (SPECT) showed a hyperactive region at the lesion site.
Executive distress
Authors: Novell Richard , Stansby Gerard , Dick Robert 
Published: July 2009

A 35-year-old sales executive presented with a history of abdominal discomfort and distention of 2 months duration. Systematic enquiry revealed an increased frequency of bowel action and vague dyspepsia over the same period. Examination revealed a poorly denned mass extending from the periumbilical region to the right iliac fossa. An ultrasound scan of the abdomen demonstrated ascites but was unhelpful in further characterizing the mass. A computed tomographic (CT) scan of the abdomen was then performed (Figs 1 and 2). What does this show and what diagnosis would account for these appearances?
The upper cut of the CT scan, at the level of the lower border of T12, shows a soft tissue mass of low attenuation adjacent to the left lobe of the liver. Indenting or “scalloping” of the liver margin by the mass is seen. On the lower cut, at the level of L4, a rim of soft tissue of similar density to the extrahepatic mass is seen anterior to the small bowel which contains oral contrast material. Posterior to the mass, and continuous with it, is a calcified cystic structure 5 cm in diameter. A large volume of ascites is present.
The patient underwent laparotomy 5 days later. At operation the peritoneal cavity was filled with mucoid ascites. Multiple nodules of tumour extended over the entire visceral and parietal peritoneum. The anterior mass shown on CT proved to be a multiloculated semicystic tumour involving the omentum and ascending and transverse colon.
Broad-beam transmission data in lead for scattered radiation produced at diagnostic energies
Authors: Rawlings D. J. , Faulkner K. , Harrison R. M. 
Published: July 2009

The growth of interventional techniques in radiology and the consequent close proximity of staff to patients during screening emphasizes the need for provision of proper protective clothing and for appropriate personnel monitoring for radiological staff. In order to comply fully with the Ionising Radiation Regulations (HMSO, 1985a) and the associated Approved Code of Practice and Guidance Notes (HMSO, 1985b; HMSO, 1988), an employer must demonstrate not only that staff doses are below any relevant limits but also that they are as low as is reasonably practicable. Since heavy protective aprons may be unduly inconvenient to wear and since routine personnel monitoring makes use of just one or two dosemeters, it is important for both the optimization of protective clothing and the estimation of whole body effective dose equivalent (IPSM, 1977) that the broad beam shielding properties of lead under relevant working conditions are known (Faulkner & Harrison, 1988).
Although there are several sources which tabulate the broad beam shielding characteristics of lead and other materials at diagnostic X-ray energies (BSI, 1971; HMSO, 1971; O'Riordan & Brotherton, 1968; Binks, 1943; NCRP, 1976), a number of limitations exist when these data are applied in practice to lead apron shielding:
(1) the data represent primary beam attenuation whereas personnel need to be protected against scatter;
(2) data for only a limited number of tube voltages are represented possibly leading to difficult interpolation;
(3) a very large range of thicknesses is covered by the data and accuracy may be compromised at the low lead equivalent thicknesses of aprons.
Book reviews
Authors: Stoker Dennis 
Published: July 2009

This small book serves to remind us that tuberculosis has not been eradicated in the Third World, and indeed is increasing even in nations with better than average health care, particularly as a consequence of AIDS. The material illustrated is based on a study of 370 patients seen in The Netherlands over the period 1955–1987.
The text is brief but adequate, and in many respects this could be regarded as an atlas.
Book reviews
Authors: Risdon R. A. 
Published: July 2009

As its title suggests, this multi-author text, written by 28 pathologists, radiologists and urologists from the Emory University School of Medicine in Atlanta, Georgia, seeks a multidisciplinary approach to urological pathology.
The book is divided into seven chapters, with varying numbers of contributors to each, covering urological kidney disease, the urinary passages, renal transplantation, the prostate and seminal vesicles, the testis and paratesticular structures, the penis and scrotum, and the adrenals.
The chest radiograph appearances seen following high dose chemotherapy and autologous bone marrow transplantation for resistant malignant lymphoma
Authors: Millard F. C. , Nakielny R. A. , Makris M. , Winfield D. A. 
Published: July 2009

Abstract
The objective of this study was to review and analyse the chest radiograph (CXR) appearances seen following high dose chemotherapy and autologous bone marrow transplantation (ABMT), and to identify any characteristic patterns. Thirty-one patients underwent ABMT between 1984 and 1989 for high grade lymphoma resistant to conventional chemotherapy. Their case notes and CXRs were reviewed in conjunction with the clinicians. In this small sample of patients, an acute interstitial pattern was seen with pulmonary oedema following bone marrow reinfusion in two cases of the 13 patients showing CXR changes (15%). Otherwise, the CXR changes following ABMT were not specific, although they did alert the clinician to the possibilities of recurrent lymphoma or opportunistic infection, enabling appropriate investigations and treatment to be instituted at an early stage. The complications and CXR changes did not differ greatly from those seen following allogeneic bone marrow transplantation.
Barium meals in the elderly—a quality reassurance
Authors: Hawkins S. P. , Rowlands P. C. , Shorvon P. J. 
Published: July 2009

Abstract
The consecutive double contrast barium meal examinations of 100 elderly patients (aged over 65 years) and a group of 33 younger adult patients were analysed by two observers for technical quality and pathological abnormalities. Technical quality declined with patient age, especially in those over 75 years, but was sufficient to enable diagnosis of abnormalities in 60% of the elderly group. It is concluded that, in the majority of elderly patients, the technical quality of double contrast barium meal examinations is sufficiently high to offer considerable diagnostic utility.
A new phantom for mammography
Authors: Law J. 
Published: July 2009

Abstract
A new mammography phantom from Du Pont is described. It has a wider range of types of detail than in previous phantoms, including some which closely simulate breast tissues. Experience of its use, and comparisons with an earlier (“Barts”) phantom, are reported. The Du Pont phantom appears to have greater sensitivity to changes in tube kV and focal spot size, and better discrimination between different film–screen combinations and between films from different breast screening centres.
Prenatal diagnosis of unilateral renal disease in tuberous sclerosis
Authors: Blethyn J. , Jones A. , Sullivan B. 
Published: July 2009

Sonographic demonstration of an abnormal kidney as the presenting feature of tuberous sclerosis has not been described previously. A large echogenic kidney was first shown on routine prenatal 28 week ultrasound and confirmed as cystic on biopsy after birth. Generalized convulsions and depigmentation developed in infancy and CT showed cerebral cortical tubers.
An enlarged echogenic left kidney was discovered on routine antenatal sonography of a 28 week fetus in a 27-year-old gravida 1 mother (see Figs 1 and 2). The previous 16 week ultrasound scan was normal. A provisional diagnosis of multicystic dysplastic kidney was made in view of the normal right kidney and bladder. A detailed fetal ultrasound at 32 weeks confirmed the unusual appearance of the left kidney, but did not detect any abnormality in the contralateral kidney, the head or the heart.
Dosimetry of electron backscatter at mandibular reconstruction in megavoltage photon beam
Authors: Das Indra J. 
Published: July 2009

The dosimetry article by Delacroix et al (1990) in the August issue of BJR demonstrates the ignorance evident when proper literature search is not thoroughly conducted before starting a project. They reported a very superficial aspect of the dose perturbation caused by metallic mandibuilar reconstruction plates (MRP). Their data is redundant and incomplete.
A dose perturbation exists at and near interfaces between two dissimilar atomic number media exposed in a radiation beam. Hence any metallic object in an irradiation field will produce a dose perturbation. The metal–soft-tissue interface problem has been discussed by various research groups in the past. Some of the references can be seen in the articles by Das and Khan (1989) and Werner et al (1987).
Fetal choroid plexus cysts: a prospective study and review of the literature
Authors: Twining P. , Zuccollo J. , Clewes J. , Swallow J. 
Published: July 2009

Abstract
To determine the incidence and significance of fetal choroid plexus cysts, a prospective study was carried out at Queen's Medical Centre, Nottingham. The incidence of cysts was found to be 0.42% and the size of cysts varied from 3 to 13 mm with a mean diameter of 6.2 mm. Choroid plexus cysts were associated with other fetal abnormalities in three cases, two of which were subsequently found to have a chromosomal abnormality, one Trisomy 18 and one Trisomy 21. A review of the reported cases of choroid plexus cysts reveals an overall incidence of 5.8% for Trisomy 18. We therefore recommend that in patients with choroid plexus cysts a detailed scan should be carried out to look for the ultrasound markers of Trisomy 18. If there is an associated abnormality or cysts are large (13 mm or greater in diameter) and bilateral then a karyotyping should be carried out.
Renal transitional cell carcinoma mimicking medullary sponge kidney
Authors: Choong M. , Phillips G. W. L. 
Published: July 2009

Transitional cell carcinoma (TCC) is the commonest neoplasm of the renal pelvis, usually appearing on intravenous urography (IVU) and retrograde pyelography as a filling defect in the pelvicalyceal system. We report a case of renal TCC which mimicked medullary sponge kidney (MSK) on IVU, an appearance not previously reported in the literature.
A 68-year-old man with no significant past history presented with macroscopic haematuria and right loin discomfort. Physical examination and plain abdominal X-ray were unremarkable.
Iliac insufficiency fractures
Authors: Davies A. M. , Bradley S. A. 
Published: July 2009

Abstract
Twenty-five post-menopausal women with one or more insufficiency fractures of the pelvic ring are reported. In 80% of cases the fractures were multiple and a total of 79 insufficiency fractures was identified. Twelve iliac insufficiency fractures were present in 11 patients located at one of three sites: above and parallel to the acetabular roof (“supra-acetabular”), extending diagonally across the iliac ala from the greater sciatic notch (“oblique iliac”), and adjacent to the sacro-iliac joint (“superomedial iliac”). The plain radiographic appearances of these iliac fractures were typically subtle with ill defined medullary sclerosis, due to trabecular compression, the cardinal sign. Scintigraphy revealed the fractures as foci of increased activity which, in the presence of multiple pelvic insufficiency fractures, may be mistaken for metastatic disease. Computed tomography can be helpful in confirming the presence of suspected fractures, revealing further occult fractures and also excluding the likelihod of malignancy.
Ultrasonic evaluation of gallbladder function prior to non-surgical treatment of gallstones
Authors: Beswick J. S. , Hughes P. M. , Martin D. F. 
Published: July 2009

Abstract
A comparative analysis of ultrasonic and oral cholecystographic assessment of gallbladder function in symptomatic patients with cholelithiasis is presented. Ultrasonic evaluation demonstrated non-contractile gallbladders in all but one patient with non-opacification during oral cholecystography, whereas all those opacifying on oral cholecystography contracted on ultrasonography. Both techniques showed similar abilities to quantify the size and number of biliary calculi within the limits necessary to determine suitability for treatment. Although computed tomography remains necessary to quantify gallstone density prior to non-surgical treatment, ultrasonography is a safe, acceptable, cheap and preferable alternative to oral cholecystography in assessing gallbladder function.
Ultrasound in the diagnosis of the juxta-pleural lesion
Authors: Bradley M. J. , Metreweli C. 
Published: July 2009

Abstract
Any opacity on a chest radiograph has a wide differential diagnosis. Plain radiography and computed tomography may help to differentiate whether bone, intercostal soft tissue or mediastinum are involved. Bronchoscopy is often negative with peripheral lesions. This leaves the physician with a diagnostic problem. We examined ultrasonically 30 patients with juxta-pleural lesions and performed cutting biopsy in 27. Twenty-four of these produced positive histology (90%). The three that were not biopsied were anechoic and had pulsatile lesions due to vascular abnormalities. There were four benign lesions all with hypoechoic appearances and the 20 malignant cases showed a wide spectrum of echogenicity. Of the malignant lesions, 90% showed pleural line disruption with reduced respiratory movement suggesting chest wall invasion. There were no complications, despite using cutting biopsy.
Advances in treatment planning dosimetry for a high energy neutron beam
Authors: Blake S. W. 
Published: July 2009

Abstract
Before starting the clinical programme, a series of physical measurements were made using the Clatterbridge high energy neutron facility. These consisted of measurements made under standard conditions, e.g. with square fields, full scatter conditions and perpendicular beam incidence. Further measurements have now been performed to include various clinically relevant non-standard conditions. These included the effects of field shape, backscatter, oblique incidence, bolus and beam blocking on dose distributions.
Calcified splenic and portal vein thrombosis: an unusual cause of multiple high amplitude echoes in the spleen
Authors: Logan Hugh , Meire Hylton 
Published: July 2009

Calcification in the walls of the portal vein and in portal and splenic vein thrombosis is well described (Mobeg, 1943; Magovern & Mensham, 1954; Sherrick et al, 1964; Adler, 1979; Mata et al, 1987). Multiple calcine foci in the splenic parenchyma is an unusual but well recognized appearance that is usually attributed to calcified granulomata due to previous tuberculosis or parasitic infestation (Meire, 1988). We report a case of multiple calcific foci in an enlarged spleen that were unequivocally localized to the lumina of tributaries of the splenic vein on ultrasound in a cirrhotic patient with cavernous transformation of the portal vein and documented portal vein thrombosis.
A 57-year-old English railway worker has been under the care of the Liver Unit in King's College Hospital for the past 20 years for cryptogenic hepatic cirrhosis with protaj hypertension.
A pearl of wisdom
Authors: Rawlinson J. , Coblentz C. L. , Franic S. 
Published: July 2009

An 8-year-old girl presented with progressive unsteadiness on her feet over a 2-year period. She was otherwise fit and well. No neurological deficit was found on examination, but movements of the lumbar spine were reduced. Conventional radiographs of the lumbar spine, myelogram and computed tomography (CT) myelographic findings are demonstrated in Figs 1–3, respectively.
What is your differential diagnosis? What further information would you seek to clarify the diagnosis? The plain radiographs of the lumbar spine show a scoliosis concave to the right and subtle scalloping of the posterior aspects of the lumbar vertebral bodies 3–5. On the anteroposterior view there is some flattening of the medial side of both L4 pedicles. There is no evidence of bone destruction, disc space narrowing or expansion of the exit foramina.
Focal myositis, a benign inflammatory pseudotumour: CT appearances
Authors: Moskovic E. , Fisher C. , Westbury G. , Parsons C. 
Published: July 2009

Abstract
Focal myositis is a rare benign pseudotumour of skeletal muscle, of unknown cause. Clinically it presents as an enlarging mass within muscle, usually of an extremity, and is often mistaken for a soft tissue neoplasm. The diagnosis is made by biopsy which reveals characteristic histological changes of inflammation, focal degeneration and regeneration, and some evidence of denervation. The CT findings include irregularity and enlargement of the muscles involved, with diffuse, poorly defined fatty infiltration of the muscle planes, but no evidence of an associated mass. We present two cases of focal myositis of the calf, both of which mimicked a soft tissue neoplasm, and in which CT was helpful in determining the nature and extent of the abnormality, for needle biopsy, and follow-up.
Automated measurement of tumour extent in patients with colorectal liver metastases from X-ray computed tomography
Authors: Perring S. , Hunt T. M. , Fleming J. S. , Blaquiere R. M. , Taylor I. 
Published: July 2009

Abstract
Tumour burden is a significant prognostic factor in patients with colorectal liver metastases, and can be staged according to percentage hepatic replacement (PHR), but accurate measurements of PHR are difficult to obtain. We have used an automated computerized technique to isolate tumour and measure PHR from computed tomography images of 22 patients. Tumour identification was achieved by establishing local histogram-based thresholds at liver-tumour boundaries displaying clear bimodal histogram distributions. There was a significant association between measured PHR and independent visual estimates of PHR stage defined in quartiles (p &lt; 0.001). When the measured value of PHR differed from the PHR stage, the visual estimate was always higher. The accuracy of PHR measurement was assessed on simulated liver computed tomography images. It seems likely that visual estimates of PHR from computed tomography images tend to overestimate tumour extent. The automated technique is probably more accurate and will be useful for assessing and monitoring patients.
Oesophageal atresia and other disorders with a similar antenatal presentation
Authors: Havard A. C. , MacDonald L. M. 
Published: July 2009

Oesophageal atresia without distal tracheo-oesophageal fistula is a recognized cause of the absence of fluid in the fetal stomach seen on serial ultrasound examinations. It is rare not to demonstrate fluid in the fetal stomach after 15 weeks gestation. There have been several reports of the antenatal diagnosis of oesophageal atresia by ultrasound, the earliest by Farrant (1980).
Oesophageal atresia occurs once in every 1500 live births and 90% of these are associated with a tracheooesophageal fistula. The fistula is usually to the distal oesophageal segment but rarely are a distal and proximal fistula found. In 1%, an H-type tracheooesophageal fistula is present without an associated oesophageal atresia. In cases of oesophageal atresia with tracheo-oesophageal fistula to the distal segment, fluid in the lungs and major airways may reach the fetal stomach by way of the fistula in spite of oesophageal interruption. Polyhydramnios may still be present. When oesophageal atresia occurs in isolation (10%) or when a single fistula is present to the proximal oesophagus (1%), no fluid can enter the stomach and none will be seen on serial ultrasound examinations.
The purpose of this report is to review other abnormalities that may produce a similar appearance and to document two cases presenting in this manner, which, to our knowledge, have not been previously reported.
A 31-year-old gravida 5 para 3 in her 32nd week of gestation was examined to assess the placental position. A live fetus was present in the vertex position. Mild polyhydramnios was present.
Irregular-shaped fields in electron radiotherapy
Authors: Smith P. B. 
Published: July 2009

We read with interest the technical note describing an irregular field technique for electrons, (Plane & Usher, 1990). On our SL 25, at Coventry, we have used a similar technique for over a year with satisfactory results.
On our SL 25, no modification to the applicator is required which makes this technique readily applicable. Perhaps more importantly the shielding alloy we use is MCP 69, and the accessories are cast in an aluminium moulding tray of a size specific to the applicator used. No pre-heating or forced cooling is required making the casting process simpler and possible without special equipment in addition to the moulding trays.