bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is there a danger in delaying radiotherapy in childhood medulloblastoma?
Authors: Attard-Montalto S , Plowman N , Breatnach F , Saha V , Eden O B 
Published: July 2009

Abstract
Approximately 45–50% of children with medulloblastoma are cured by conventional surgery and radiotherapy, but survivors may face severe late neuropsychological toxicity. Studies showing good partial responses to platinum-based chemotherapy in relapsed patients and the theoretical possibility of a therapeutic window immediately after surgery have prompted neoadjuvant treatment studies which are ongoing. However, the absolute benefit of chemotherapy for the treatment of medulloblastoma in childhood is, as yet, not proven. There is a danger that chemotherapy may simply delay radiotherapy, and in so doing reduce the radiological impact of this known effective treatment. We report four children with medulloblastoma presenting consecutively to this unit over a 6-month period, whose management was problematic because of either failure to respond to neoadjuvant chemotherapy or their very young age. These cases are discussed in the light of the current literature and future treatment strategies that must seek to improve the therapeutic ratio of multimodality therapy.
Reduced bone mineral density in long-term survivors of medulloblastoma
Authors: Mithal N P , Almond M K , Evans K , Hoskin P J 
Published: July 2009

Abstract
Bone mineral density (BMD) reaches a peak at approximately 30 years of age, and may be influenced by radiotherapy before completion of skeletal maturation. Regional BMD has been measured using dual energy X-Ray absorptiometry (DEXA) in adults following craniospinal irradiation for medulloblastoma between ages 4 and 19 years, receiving doses of 3500–4000 cGy to the brain and spinal cord. Lumbar spine (LS) and femoral neck (FN) BMD measurements were compared with normal age-sex matched control values. There was failure to achieve normal adult BMD at both LS and FN, with a mean reduction at LS of 12.1% ± 2.4% (p &lt; 0.01) and a mean reduction at FN of 14.3% ± 3.4% (p &lt; 0.01). The mean body mass index (BMI) was also less than that of a standard population (21.8 ± 1.5), as were mean standing and sitting heights. No relationship was found between reduction in BMD at either site and age at irradiation, time elapsed since irradiation or BMI at time of scanning. Biochemical and endocrine markers including corrected calcium, alkaline phosphatase, sex hormones and IGF-1 were normal in all seven patients. The reduction in BMD outside the irradiated area suggests that indirect factors may be important in this effect.
Clinical high resolution skeletal single photon emission tomography using a triple-headed gamma camera
Authors: Buscombe J R , Townsend C E , Kouris K , Clarke G , Mahmood S , Jarritt P H , ELL P J 
Published: July 2009

Abstract
Planar skeletal scintigraphy has become established as a standard diagnostic test performed within the nuclear medicine department. Since the 1970s good quality images have been produced using an Anger gamma camera and 99Tcm-labelled diphosphonates. Single photon emission tomography (SPET) has improved the sensitivity of detection and the ability to localize bony pathology, particularly benign bone disease in the spine. Recently multi-detector gamma cameras dedicated to SPET have become available. One such system, the Toshiba GCA-9300A, has been used to perform routine clinical skeletal SPET in 81 patients. Good quality images have been obtained using an 8 min acquisition in the axial skeleton and a 16min acquisition protocol in the peripheral skeleton. Multiple sites can be tomographed in the same patient during the same examination using two or more 8 min acquisitions. Such a multi-detector gamma camera offers advantages over the standard single-headed rotating camera for skeletal SPET in terms of both imaging time and image quality. A cost analysis was performed which demonstrated that the additional cost of purchasing such a multidetector gamma camera was less than £30.00 per SPET study.
Accessory lobe of the liver mimicking lesser omental lymphadenopathy
Authors: Fitzgerald R , Hale M , Williams C R 
Published: July 2009

Abstract
An accessory lobe of the liver is an uncommon occurrence and often an incidental finding. We present the case of a middle-aged man whose upper abdominal pain was relieved following removal of an accessory lobe. His preoperative imaging had led us to believe that he had lesser omental lymphadenopathy. We draw attention to the fact that this congenital abnormality can cause diagnostic confusion.
Radiation exposure to the hands of orthopaedic surgeons during procedures under fluoroscopic X-ray control
Authors: Goldstone K E , Wright I H , Cohen B 
Published: July 2009

Abstract
The hands of the surgeon are most likely to be directly exposed to ionizing radiation during fluoroscopic screening in the orthopaedic theatre. There is however little information available on the level of exposure to radiation during the normal working pattern of individual surgeons. The purpose of this study was to directly measure the radiation exposure to the hands during fluoroscopic screening in a series of consecutive cases over a month in order to establish whether these staff need to be designated classified persons, and if not, whether they need to be routinely monitored. Extremity monitoring was carried out using thermoluminescent dosemeters. The dosemeter was secured to the operating surgeon's dominant index finger. 44 procedures were carried out by nine different surgeons. The total radiation dose received per surgeon ranged from 48–2329 μSv. In 80% of procedures the dose of radiation to the surgeon's hand was less than 100 μSv. The extrapolated annual dose, even for the surgeon with the highest radiation exposure, was well below the annual dose limit for extremities of 500 mSv per year recommended by the International Commission on Radiological Protection, and embodied in the Ionizing Radiations Regulations 1985. Despite the relatively low doses of radiation received by surgeons in this study, occupational exposure to all personnel should be kept to the lowest practicable levels, and a review of procedures, including dose measurements, from time to time is advised.
Dual X-ray absorptiometry: a comparison between fan beam and pencil beam scans
Authors: Blake G M , Parker J C , Buxton F M A , Fogelman I 
Published: July 2009

Abstract
The recent introduction of dual X-ray absorptiometry (DXA) systems with fan beam instead of conventional pencil beam scanning geometry represents a significant technical advance in bone densitometry. This report describes phantom and in-vivo studies of the effect of the change in beam configuration on DXA measurements. Fan beam and pencil beam measurements acquired on one of the new generation scanners, the Hologic QDR-2000, were compared with scans performed on an earlier pencil beam model, the Hologic QDR-1000. The variation with height above the scanning table of fan beam measurements of an anthropomorphic spine phantom were: bone mineral content (BMC): −3.1% cm−1; projected area (AREA): −2.8% cm−1; bone mineral density (BMD): −0.2% cm−1. For pencil beam scans the magnitude of height variation was less than 0.1% cm−1. QDR-2000 fan and pencil beam scan results for 20 volunteers correlated closely with QDR-1000 pencil beam data (r = 0.966–0.998). For BMD measurements on the spine and hip, differences between fan and pencil beam data were consistent with the errors expected from measurement precison. For AREA and BMC data, however, larger differences were observed with individual deviations which correlated with body habitus of the subjects. Although the change from pencil to fan beam goemetry significantly affected AREA and BMC data, the effect on the clinically more important BMD measurements was negligibly small.
The detection and modification of the hypoxic fraction in quiescent cell populations in murine solid tumours
Authors: Masunaga S , Ono K , Abe M 
Published: July 2009

Abstract
Mice bearing SCC VII or EMT6/KU tumours were irradiated after receiving 10 injections of 5-bromo-2′- deoxyuridine (BUdR) to label all proliferating tumour cells, and the tumours were then excised and trypsinized. The tumour cell suspensions thus obtained were incubated with cytochalasin-B (a cytokinesis blocker), and the micronucleus (MN) frequency in cells without BUdR labelling was determined using immunofluorescence staining to BUdR. This MN frequency was then used to calculate the surviving fraction of unlabelled cells from the regression line for the relation between MN frequency and the surviving fraction of all tumour cells. Thus a cell survival curve could be determined for cells not labelled by BUdR, which can be regarded as quiescent tumour cells for all practical purposes. Assays performed immediately after irradiation of both normally aerated and hypoxic tumours showed that quiescent cells contained higher hypoxic fractions than the tumour cells as a whole. Furthermore, administration of nicotinamide before irradiation or the placement of mice in a circulating carbogen (95% O2, 5% CO2) chamber for 30 min before and during irradiation altered the acutely and chronically hypoxic fractions of the proliferating and quiescent tumour cell populations in a way which depended on the tumour system. Combined nicotinamide and carbogen therapy was shown to have a large potential to sensitize cells to low-dose radiation in vivo. In addition, this assay method appears to be useful for determining the size of the hypoxic fraction of quiescent tumour cells in murine solid tumours.
A calcified brain
Authors: Graham J D , Owens C , Godlee J N 
Published: July 2009

A 13-year-old boy complained of increasing head-aches over a 3 month period. At the age of 7 years he had undergone craniotomy and complete resection of a medulloblastoma of the cerebellum. No metastases were detected and post-operative radiotherapy was given to the whole brain and spinal cord to a dose of 30 Gy in 20 fractions over 4 weeks, followed by a boost to the posterior fossa, which received a total dose of 50 Gy in 40 fractions over 8 weeks. A computed tomography (CT) scan 1 year after treatment showed no evidence of disease. Following treatment he required growth hormone replacement and there were behavioural problems that required medication. Incoordination of the right side had been present since cranial surgery but there had been no recent neurological deterioration. A CT scan was performed (Figures 1,2). What does it show? What is the diagnosis and aetiology?
The CT scan shows extensive serrated calcification at the corticomedullary junction and within the basal ganglia.
The challenge of change
Authors: Hately W 
Published: July 2009

In considering a suitable title for a presidential address I was conscious of the need to choose a reasonably general topic for a multidisciplinary audience. One such topic is change, which may be denned as a process of transition from an old state to a new. It seems that our working environment is changing perhaps more rapidly and extensively than at any time in years. In another presidential address, Bill Clinton mentioned change no less than nine times, commenting that the urgent question of our time is whether we can make change our friend, not our enemy. Such change affects the hospitals and organizational structures within which we work, as well as the subject of radiology and its allied sciences, the role of the radiologist and scientist and the British Institute of-Radiology (BIR) and associated bodies. We have all been through something of a revolution. One is reminded of Dickens' quote about another revolutionary era “it was the best of times—it was the worst of times”; perhaps now best in terms of progress in medical imaging and intervention, worst in terms of underfunding.
The environment in which radiology is now practised has been changed to a greater degree, as a result of the present government's reform package, than at any time since the inception of the National Health Service. Now the radiologist works in a provider hospital unit dependent on the securing of contracts with a variety of purchasers, including district health authorities and fund holding GPs.
The development of quality assurance for Sheffield's radiotherapy treatment planning systems
Authors: Whilde N J , Conway J , Bomford C K 
Published: July 2009

Abstract
Quality assurance procedures have been defined and implemented for the treatment planning systems at Weston Park Hospital. The programme of tests and checks covers both hardware and software: hardware checks are concerned with the input and output performance of the system's peripheral devices; the software checks involve testing system data integrity, and testing the algorithms used for planning external photon and electron beams. Beam measurements from an ionization chamber scanned in water and air were compared with calculations from two independent treatment planning systems. Following the implementation of these quality assurance procedures, some improvements have been made to the system data used and changes have been introduced to planning practice.
Is some of our radiation dosimetry wrong?
Authors: Dawson P , Lopez A 
Published: July 2009

Medical X-rays represent only some 10% of the average individual's ionizing radiation exposure but this is, nevertheless, a significant contribution and the only one to any great extent within our power to limit or reduce. The average, as always, conceals the case of the individual undergoing frequent or more complex radiological procedures in whom this medical X-ray exposure dwarfs other contributions. Furthermore, there is a marked variation of exposure associated with any given examination when performed by different radiologists and in different departments (Shrimpton et al, 1986). This variation is a function of radiological technique, age, quality and maintenance of equipment, and of types of film/screen combination. A considerable burden of responsibility, therefore, devolves on the radiology department, a burden not in any way diminished by recent reassessment of the risks of “low level” radiation exposure (ICRP, 1990).
Exposures of organs and tissues in various examinations cannot currently be directly measured and so are calculated. Such calculations inevitably rest on a number of assumptions and simplifications and one factor which seems not to have been taken into account is the presence in many examinations of a contrast agent in, or adjacent to, the exposed tissues. Iodine and barium containing radiological contrast agents were designed to increase diagnostic X-ray absorption. They do so predominantly by means of photoelectric interactions which liberate photoelectrons, with a range in soft tissues of a few tens of microns, and characteristic X-rays.
Ureteric obstruction secondary to contralateral hydronephrosis
Authors: Morris S B , Dick J A 
Published: July 2009

Abstract
Giant hydronephrosis is a rare condition, defined in the adult as a kidney containing more than 1 l of fluid. It is usually secondary to pelvi-ureteric junction obstruction. We describe a case where giant hydronephrosis caused contralateral ureteric obstruction. The radiological findings are described and the literature is reviewed.
The indeterminate breast mass: assessment using contrast enhanced magnetic resonance imaging
Authors: Hickman P F , Moore N R , Shepstone B J 
Published: July 2009

Abstract
Magnetic resonance imaging of the breast was performed on 25 lesions in 24 patients. These lesions were indeterminate on clinical and mammographic examination. The imaging findings were compared with pathological results in all cases. Conventional T 1, and T 2 spin echo images provided a certain diagnosis in only one case. The pattern of signal enhancement following gadolinium diethylamine triamine pentaacetic acid injection as demonstrated by a T 1-weighted gradient recalled echo sequence permitted accurate diagnosis of four recurrent carcinomas and 19 cases of non-malignant disease (17 postoperative scars and two cases of benign breast disease). One false positive diagnosis of cancer was made in a case of fibroadenoma. Dynamic contrast enhanced magnetic resonance imaging may have a role in the assessment of the indeterminate breast mass.
What is the nephrogram?
Authors: Dawson P , Peters A M 
Published: July 2009

Abstract
One of the oldest questions in radiology, “what is the nephrogram?”, has been approached in a novel manner using dynamic bolus contrast enhanced computed tomography to monitor the arrival and distribution of contrast agent in the normal kidney. A modification of a mathematical technique first developed for applications in positron emission tomography has been used to analyse the data. It is concluded that the blood pool contribution to the nephrogram is greater in the first minutes after rapid bolus contrast injection than generally supposed and that the “immediate” nephrogram is a predominantly blood pool contrast phenomenon.
The outcome of fetal ventriculomegaly
Authors: Twining P , Jaspan T , Zuccollo J 
Published: July 2009

Abstract
Over a 5 year period 38 cases of fetal ventriculomegaly were diagnosed at Queen's Medical Centre, Nottingham. There were 12 cases of spina bifida and all patients opted for a termination of pregnancy. There were 15 cases of isolated ventriculomegaly comprising seven cases of aqueduct stenosis, four abnormalities of the corpus callosum, one cavum septum pellucidum cyst, one case of porencephaly and two cases of mild lateral ventricular dilatation. The fetuses in this group had a relatively good outcome with five babies showing normal development, three with mild developmental delay and one with moderate developmental delay. There was one stillbirth and five patients opted for a termination of pregnancy. Associated abnormalities were seen in seven cases and these carried a poor prognosis with one fetus stillborn, one neonatal death, and three patients opted for a termination of pregnancy. Two babies were liveborn, one has severe developmental delay and the other one is normal. The four remaining cases included two Dandy Walker syndrome, one brain tumour and one case of subdural haemorrhage. There were three terminations of pregnancy and one stillbirth in this group. The outcome of fetal ventriculomegaly depends on the presence of associated abnormalities which carry a poor prognosis. It also depends on the timing of the diagnosis as most patients will opt for a termination of pregnancy if the diagnosis is made before 24 weeks gestation. A review of the literature reveals that, excluding terminations, fetuses with isolated ventriculomegaly have an 80% chance of survival and a 50% chance of normal development.
Re-evaluation of a radiation protection cost benefit analysis study in brachytherapy
Authors: Van Den Broek J G , Weatherburn H 
Published: July 2009

Abstract
Cost benefit analysis has been in use for many years as a method for making a comparison between the costs of radiation protection and the benefits of reduced radiation exposure. It is advocated by the International Commission on Radiological Protection (ICRP) and the National Radiological Protection Board (NRPB) has given more specific advice relating to the value of the man Sv to be used in the calculation of cost benefit. The purpose of this study is to investigate the changes in the NRPB advice over the last 10 years by correcting all figures for inflation and applying them to a particular radiation protection example. The example employed is a previously published case of the introduction of afterloading brachytherapy equipment at the Christie Hospital, Manchester. It has been shown that for this specific example the NRPB advice at one time led to a large cost benefit, at another time it led to a large cost deficit and later still it again gives a large cost benefit. Application of cost benefit analysis to decision making in radiation protection is therefore shown to be in need of further investigation and clarification before it can be used with confidence.
Rapid measurement of left ventricular mass by spin echo magnetic resonance imaging
Authors: Forbat S M , Karwatowski S P , Gatehouse P D , Firmin D N , Longmore D B , Underwood S R 
Published: July 2009

Abstract
Magnetic resonance (MR) imaging provides an accurate measurement of left ventricular mass but imaging time can be up to 45 min. We tested a more rapid multislice spin echo technique on 16 volunteers without evidence of heart disease. Multislice short axis spin echo images were acquired in up to three sets of five, clustered around end systole. Total imaging time was 15 min. Myocardial areas were summed and specific gravity was assumed. Comparison was made with multiple single acquisitions timed to end systole. There was good agreement between the two measurements of left ventricular mass. Mean (±standard deviation (sd), range) values were 212 g (±41.71, 152 to 311) by the multislice method and 213 g (±44.26, 155 to 317) by the single slice method. The mean difference (±sd of difference) between measurements was −1.72±14.89 g (95% confidence interval for limits of agreement was ±14%). We have therefore established a more rapid and accurate method of measuring left ventricular mass.
Extrathoracic herniation of the lung with a review of the literature
Authors: Scullion D A , Negus R , Al-Kutoubi A 
Published: July 2009

Abstract
A case of extrathoracic herniation of the lung is described together with the radiological findings in this condition including the role of computed tomography (CT) in its management. In addition a review of the literature is presented which outlines the incidence, classification and clinical features of lung herniae. Some reference is made to possible methods of treatment.
Lung metastasectomy in patients with soft tissue sarcoma
Authors: Robinson M H , Sheppard M , Moskovic E , Fisher C 
Published: July 2009

AbstractMetastases develop in 50–60% of patients with high grade soft tissue sarcomas despite primary treatment. Between 1970 and 1990, 189 patients with soft tissue sarcoma referred to the Royal Marsden Hospital Sarcoma Unit developed lung metastases as the sole first site of disseminated disease. 44 of these 189 cases have been treated by pulmonary metastasectomy. In an attempt to determine which patients benefit from this surgery the medical records, radiology and pathology of these cases have been reviewed. Both the overall 5 year survival (70% vs 19%) and the subsequent survival from the time lung metastases developed (52% vs 7.5%) of those selected for thoracotomy were better than in the 145 patients not undergoing surgery. On multivariate analysis, survival and control of lung disease following resection were not related to the number of metastases resected, completeness of excision, use of adjuvant chemotherapy or presence of bilateral disease. The most important factor was the use of lung resection itself as treatment, for which the risk of death was 0.2 compared with those not having metastasectomy. Age less than 40 years and primary tumour in a lower limb site were also factors associated with a reduced risk of death. Pulmonary metastasectomy should be considered in selected patients with soft tissue sarcoma after primary local cure. However, without collection of prospective data on all patients developing lung metastases or a randomized trial the true role of lung metastasectomy will never be clarified.