bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does peripheral angioplasty compromise limb blood flow?
Authors: Thorley P J , Sheard K L , Rees M R 
Published: July 2009

Abstract
Isotope limb blood flow studies were carried out using balloon, laser and Kensey catheter techniques to assess the outcome of peripheral angioplasty. Limb blood flow and Doppler ankle-brachial pressure measurements were obtained before angioplasty and at 6 months after angioplasty in a total of 101 angioplastied limbs. A fall in limb blood flow at 6 months was seen in 17% of the angioplastied limbs with no significant difference in the figures for the different types of angioplasty. Limb blood flow was also measured in 53 contralateral untreated limbs, approximately half of the patient group having both legs angioplastied. 25% of untreated limbs showed a fall in limb blood flow. Significantly more of the untreated limbs showed a fall in limb blood flow at 6 months where the contralateral, treated limb did not improve as a result of the angioplasty compared with those patients where the angioplastied leg improved. These results suggest that a lack of improvement in blood flow in the angioplastied limb may not result from failure of the angioplasty but may be the result of some factor, or combination of factors, which adversely affects both the angioplastied and the untreated leg in some patients.
A multi-purpose ruler for magnetic resonance imaging
Authors: Mackenzie R , Shah N J , Doran S , Dixon A K 
Published: July 2009

Since the advent of clinical magnetic resonance imaging (MRI) there have been problems in locating internal structures with respect to external markers. Numerous methods have been advocated ranging from simple adhesive attachment of gels (Douglas & Gatenby, 1988; Matthaei et al, 1992) or “liver oil” capsules (Thompson, 1988) to more sophisticated MR compatible stereotactic devices (Saunders et al, 1990; Alvarez-Royo et al, 1991; Rousseau et al, 1991). In this report we describe a simple and versatile ruler for use with clinical MRI systems. The ruler was originally designed to facilitate direct anatomical-MRI correlative studies by allowing precise positioning of MR image slices with respect to an external reference. However, the design described can be readily adapted to the specific needs of the user in terms of both imaging characteristics and overall dimensions.
The ruler consists of four basic components (Figure 1): the outer casing, the end caps, a number of internal spacers and a number of internal tubes containing a gadolinium doped agarose gel. The precise dimensions of the ruler can be varied according to individual aims and the availability of standard sizes of materials. In the ruler illustrated in this report, the outer casing used was a 13.5 cm length of 13 mm square bar with a 6 mm diameter hole bored through the centre. The two end caps were carefully machined down to the exact diameter of the bore from a large diameter round bar.
Leakage radiation in radiotherapy—what is an acceptable level in the electron mode?
Authors: Morgan H M , Lillicrap S C , McKenzie A L 
Published: July 2009

The International Electrotechnical Commission (IEC) sets standards for the safety of medical electrical equipment. IEC Publication 601–2–1 which applies to medical electron accelerators is under revision. One of the requirements in the current standard (IEC, 1981) relates to the amount of leakage radiation that is allowed through the beam limiting devices. Clause 6.1.3 of this document states that for equipment in which the area denned by the primary collimators, M, shielded by the adjustable beam limiting devices exceeds 500 cm2 (all modern equipment), the product of the average absorbed dose resulting from leakage radiation and the area, M, shall not exceed one tenth of the product of the absorbed dose on the central axis and the area of a 10×10 cm field. This requirement applies to accelerators operating in both the X-ray and electron modes and has since been incorporated in ICRP recommendations (ICRP, 1985). The requirement is shown graphically by the solid curve in Figure 1. For modern equipment, the area shielded by the beam limiting devices, M, covers a large area of the patient. It is worth noting that outside this area the IEC (1981) leakage requirement in the patient plane is much stricter. An average of only 0.1% of the central axis absorbed dose is allowed in areas outside M, which may be occupied by the patient.
Discussions are currently taking place to consider relaxing the requirement on leakage radiation through beam limiting devices for electron therapy.
Variation of linear accelerator wedge factors with field size and wedge position
Authors: Dean E M , Davis J B 
Published: July 2009

Replying to the letter by Thomas and Thomas, referring to further measurements of wedge factor with field size, made on a modified ABB linear accelerator; we confirm our agreement with their hypotheses.
It is clear that a number of different, complex factors contribute to the variation of wedge factor with field size; one of the most obvious ones discussed in their cited references being source to wedge tray distance.
Ultrasound contrast hysterosalpingography—evaluation as an outpatient procedure
Authors: Balen F G , Allen C M , Siddle N C , Lees W R 
Published: July 2009

Abstract
Ultrasound contrast hysterosalpingography (HSG) uses intrauterine contrast media to increase the diagnostic value of plain transvaginal ultrasound enabling the uterine cavity contour to be assessed and allowing tubal patency to be determined. We present our experience using both negative (sterile saline) and positive (Echovist, Schering) contrast media in 27 patients presenting with a wide range of gynaecological disorders. This is the first report comparing the use of the two contrast media with plain ultrasound on a purely outpatient basis. We have found ultrasound saline HSG to be superior for the delineation of the uterine cavity and we predict that this will become a first line investigation for assessing the configuration of the uterine cavity. However, although Echovist could be demonstrated flowing through patent fallopian tubes, we found ultrasound contrast HSG to be insufficiently accurate in the determination of tubal patency and do not feel that it can replace conventional X-ray HSG. We review the literature on this technique and discuss its future role in gynaecological imaging.
The role of transvaginal ultrasonography in pre-operative case selection and post-operative follow up of endometrial resection
Authors: Khastgir G , Mascarenhas L J , Shaxted E J 
Published: July 2009

Abstract
50 patients undergoing transcervical endometrial resection (TCRE) for abnormal uterine bleeding underwent transvaginal ultrasonography (TVUS) before danazol therapy, immediately pre-operatively, and 3 months post-operatively. There were no significant changes in the uterine dimensions but as expected the endometrium became thinner (p &lt; 0.0005) after treatment with danazol facilitating endometrial resection. 12 cases (24%) continued to have menstrual problems. In those cases TVUS showed unchanged endometrium (4), minimum residual endometrium (5), irregular uterine cavity (5), and fibroids (2) as probable causes of failure. These findings guided the choice of further management as follows: conservative for minimum residual endometrium, repeat TCRE for unchanged endometrium, and hysterectomy for irregular uterine cavity and fibroids. The value of TVUS in diagnosing the cause of post-operative pain was limited to the cases (2) of haematometra. The smaller transverse (&lt; 6 cm) and anteroposterior (AP) (&lt; 4.5 cm) dimensions of the uterus (p &lt; 0.05, &lt; 0.05), a significant reduction in these dimensions after the operation (p &lt; 0.0005, p &lt; 0.01) along with the absence of endometrium (p &lt; 0.0001), fibroids and irregular uterine cavity (p &lt; 0.005) predicted a favourable outcome of TCRE. This study substantiates the role of TVUS in TCRE for proper selection of cases, determination of the causes of failure and their subsequent management, leading to an improved outcome.
Pseudotumoral cystitis in children: a review of the ultrasound features in four cases
Authors: Friedman E P , de Bruyn R , Mather S 
Published: July 2009

Abstract
Pseudotumoral cystitis is an uncommon inflammatory condition which may masquerade as a bladder tumour in children. There are a variety of clinical presentations such as haematuria, dysuria, infection and obstruction. Reported causative factors include infection (bacterial, fungal and parasitic) and allergy. Ultrasound is an excellent imaging modality for demonstrating this intravesical lesion although the spectrum of features is poorly described in the literature. We report our recent experience of four patients with pseudotumoral cystitis and describe the clinical features and ultrasound appearance of this condition in children.
Routine quality assurance of high frequency ultrasound breast scanners in a screening context
Authors: Evans J A , Moore R D , Metcalfe S C , Davis M 
Published: July 2009

Abstract
The use of frequencies above 5 MHz for medical imaging is now commonplace and one example is in the context of routine breast screening. No satisfactory quality assurance (QA) procedures have been agreed for these systems hitherto but it is clear that techniques developed for lower frequencies are not necessarily relevant. The National Breast Screening Programme therefore commissioned the production of a new protocol for this purpose and this is described here. The work is divided between an experienced tester, equipped with a commercial test object (RMI 414B) and the routine user who is provided with a specified perspex block to provide routine measurements of certain parameters in a relative manner.
A reappraisal of serial isotope bone scans in prostate cancer
Authors: O'Donoghue J M , Rogers E , Grimes H , McCarthy P , Corcoran M , Bredin H , Given H F 
Published: July 2009

Abstract
Carcinoma of the prostate is the commonest malignancy of the genitourinary tract in the male and is frequently associated with metastatic bone disease. Serial isotope bone scans for screening secondary deposits are not cost-effective. We have evaluated the serum prostate markers prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) as an alternative to conventional serial bone scanning in 129 patients with newly diagnosed prostate cancer over a period of 3 years. Although serum PSA did not reflect local tumour burden at presentation, it was significantly elevated in those who presented with stage D disease (p &lt; 0.01). 45 patients presented de novo with metastatic bone deposits and a further 18 patients developed metastases during the study period. The sensitivity of PSA in detecting secondary deposits at presentation for levels in excess of 100 μg/1 was 93.75%, the positive predictive value 95.7% and the negative predictive value for levels less than 5 μg/1 was 90.6%. During the follow-up period the sensitivity was 94.4%, the positive predictive value 100% and the negative predictive value 100%, with a median lead time of 3 months in predicting metastases in the 18 patients with progressive disease. When compared with PAP, PSA was found to be a statistically superior marker of bone metastases both at presentation and follow-up (p &lt; 0.05). We recommend that PAP measurements are no longer necessary and should be replaced by PSA, and that serial serum PSA estimations should determine the need for future isotope bone scans in the patient with established prostate cancer.
The influence of film processing temperature and time on mammographic image quality
Authors: Brink C , De Villiers J F K , Lötter M G , van Zyl M 
Published: July 2009

Abstract
High image quality and low radiation levels are essential in mammography. This study investigates the effect of changes in processor temperatures and developing times on sensitometric findings. These findings were matched with the changes in the image quality during similar changes in the developing parameters. Temperatures ranging between 35°C and 40°C and developing times from 20 s and 50 s were investigated. Higher developing temperatures and increased developing times resulted in an increase in film speed and film contrast. A definite pattern of change could be demonstrated in film speed and film contrast during sensitometry. The same pattern of change could, however, not be demonstrated in the quality of phantom images under similar circumstances. The base plus fog level was not adversely affected. Sensitometric findings of film speed can be effectively used as an indicator of radiation exposure to the patient, but cannot be used to establish the developing parameters that will give the best image quality. Both these methods should be used to determine which processing variables should be used to obtain a combination of the best image with radiation as low as possible. Recommendations for optimum processing parameters are made for the films and processing chemistry investigated.
Colonic obstruction following small bowel barium study
Authors: Halliday K E , Patel S R , Baker W N W 
Published: July 2009

Abstract
A case is described in which inspissated barium was retained in the colon for 16 months before causing large bowel obstruction. To our knowledge this is the first case described in which the time interval between barium ingestion and the onset of symptoms was more than a few weeks. Scybalum formation is due to resorption of water from the barium sulphate, which although less common with modern preparations, still appears to be possible in certain high-risk patients. Prolonged retention of barium should be avoided by increased awareness of the problem, encouraging patients to eat and drink normally after the examination, encouraging mobility and adminstration of lactulose in high risk patients.
Radiation-induced vasculopathy implicated by depressed blood flow and metabolism in a pineal glioma
Authors: Mineura K , Sasajima T , Kowada M , Saitoh H , Shishido F 
Published: July 2009

Abstract
A case of radiation-induced vasculopathy of a pineal glioma was presented with haemodynamic and metabolic changes before and after radiotherapy. After radiation of 60 Gy with conventional fractionation (1.8–2.0 Gy daily, 5 days per week), regional blood flow, oxygen extraction fraction, metabolic rate of oxygen, kinetic metabolic rate of glucose and the rate constants (K2, K3) were markedly depressed (20% or greater) compared with the pre-irradiated study. 7 months after radiotherapy, the patient developed transient episodes of both right and left upper limb convulsion, terminating in generalized convulsion. When she developed status epilepticus, computed tomography showed extensive low density areas in the territory supplied by the right middle cerebral and the right posterior cerebral arteries. Cerebral angiography revealed diffuse stenosis at both carotid bifurcations and at the origins of the right posterior communicating and posterior cerebral arteries. Haemodynamic and metabolic depression therefore implicated radiation-induced vasculopathy in the present case.
Unexplained symptomatic metaphyseal sclerosis in children: three cases
Authors: Lordf P , Carty H M L 
Published: July 2009

Tien et al (1988) reported the case of a child with constitutional symptoms, fever and bone pain. Plain radiographs showed symmetrical metaphyseal sclerosis in several long bones. No infective agent was identified. The likely diagnosis was thought to be plasma cell osteomyelitis. However, the case was regarded as unique in its lack of lytic lesions and lack of involvement of the clavicles. The three patients presented here show clinical and radiological similarities.
An 11-year-old male presented with a 5-month history of poor appetite, vomiting and painful legs. Clinical examination was normal. Low-grade pyrexia was present on admission and the erythrocyte sedimentation rate (ESR) was raised at 78 mm/h. There was a mild normochromic anaemia. A Paul-Bunnell test was positive, but further serology did not confirm recent infection with Epstein-Barr virus. Cultures of blood and urine were negative. Titres to Salmonella were raised, but no history of diarrhoea was elicited. Cultures of stool, urine and blood were negative. Barium studies were normal, but radiographs of both knees showed ill-defined sclerosis in the metaphyses of the distal femora and proximal tibiae (Figure 1). There was some symptomatic relief from naproxen, and 11 months after onset the symptoms had entirely resolved.
Digital storage phosphor radiography for treatment verification in radiotherapy
Authors: Scheck R J , Wendt T , Panzer M 
Published: July 2009

Abstract
The potential of digital storage phosphor radiography (SR) to improve image quality of portal radiographs is evaluated. Conventional film radiographs (FR) and corresponding SR verification images of an anthropomorphic phantom and various irradiation ports of patients were obtained with high-energy photon beams. For both techniques conventional films and storage phosphor screens were placed into a cassette with steel screens. Images were evaluated according to contrast and spatial resolution, delineation of anatomical structures, position of shielding blocks and accuracy of field alignments. Evaluation of 33 pairs of SR and FR portal images yielded a superior contrast resolution of SR in 47% (contrast air–soft tissue) and 37% (bone–soft tissue). Thus SR allows quick and easy detectability of anatomical structures as well as a better definition of block positions and field alignments. Shorter exposure times for computed images may result in a reduction of motion artefacts. SR images are indispensable in modern radiation therapy units, as they are instantly available in a computerized network for further image processing and analysis.
The implementation of patient position correction using a megavoltage imaging device on a linear accelerator
Authors: Evans P M , Gildersleve J Q , Rawlings C , Swindell W 
Published: July 2009

The possibilities of using megavoltage imaging devices to measure patient set-up error is a topic of current interest in radiotherapy (see for example Lam et al, 1987; Meertens et al, 1990; Graham et al, 1991). An image is taken at time of treatment and compared with a reference image which may typically be a treatment simulation image. From such a comparison values for the shift and rotation of the patient's position between the two images may readily be deduced. The measurements obtained from such a system may also be used, interactively, to correct the positioning of the patient. This may be achieved either by adjusting the settings of the collimation system in the treatment head (if independent collimators are available), or by adjusting the couch position. If the patient's position is to be corrected then the shift values should be calculated with the centre of rotation in the image taken as the point corresponding to the centre of rotation of the collimation system which is the same as that of the couch turntable. For a correctly aligned system the axis of rotation of the couch would coincide with that of the collimation system and in the following discussion this is assumed to be the case.
Here, consideration is given to how such a system of patient correction may be implemented on a treatment machine with an isocentric couch. Firstly, a coordinate system is established.
Emphysematous pyelonephritis caused by clostridium septicum and complicated by a mycotic aneurysm
Authors: Christensen J , Bistrup C 
Published: July 2009

Emphysematous pyelonephritis (EP) is a rare and lifethreatening necrotizing infection in the renal parenchyma caused by gas-producing microorganisms (Michaeli et al, 1984).
Mycotic aneurysms are vascular lesions caused by infectious weakening of the arterial wall (Skipper et al, 1991).
Clostridium septicum (CS) is an anaerobic bacterium, known for its propensity to produce gas (Michaeli et al, 1984) and its association with malignancy especially carcinoma of the colon (Alpern & Dowell, 1969).
We present the first recorded case of EP complicated by a mycotic aneurysm of the abdominal aorta. Furthermore, this is the first case of EP resulting from infection with a pure culture of true gas-forming bacteria (CS) and the fifth case of a mycotic abdominal aortic aneurysm due to CS.
A 74-year-old dehydrated diabetic woman with an abdominal pulsatile mass, a necrotic ulcer over the sacrum and temperature of 38.0°C was admitted to hospital with a 3-week history of generalized malaise, confusion, lethargy, bloody and mucoid diarrhoea, anaemia, fever and cystitis.
Fluid replacement, electrolyte and glucose correction and antimicrobial therapy were initiated.
Computed tomography in the diagnosis of pyrexia of unknown origin
Authors: Williams R M J , Marshall R J , Brennan J 
Published: July 2009

A 72-year-old Caucasian man presented to a medical clinic with a 6 month history of weight loss, epigastric discomfort, poor appetite, malaise and night sweats with low grade fever. In recent weeks he had become breathless and tired on minimal exertion, and had slight cough productive of yellow phlegm. He had complained of a peculiar sensation at the back of his mouth, but there was no visible lesion on ENT or dental examination.
During the Second World War he had served in Burma and India for 4 years where he had malaria. He had never since travelled outside Europe. He had a left thoracoplasty for pulmonary tuberculosis in 1947. He had been a heavy smoker until he had a myocardial infarct 15 years previously. Since then he had had an aortobifemoral bypass for peripheral vascular disease and a mild stroke from which he had made an excellent recovery. He was taking dipyrimadole, ranitidine and frusemide—this latter for a few days because his ankles had been swollen. He did not drink alcohol.
Evolution of diagnostic radiology in a big hospital during a 5 year period, and the derived collective dose
Authors: Vañó E , Velasco A , Morán P , González L , Pedrosa C S Alvarez 
Published: July 2009

Abstract
An analysis is presented of the trends in the annual number of radiological examinations and in the average effective dose equivalent for each type of examination in a big Spanish hospital. Annual frequencies for each type of examination, annual average effective dose equivalent values for each study group, and the contribution of each examination group to the collective dose are presented. Also, sex and age distributions for several important examinations are given, and their impact on the collective dose is reviewed.
Radiation risks to personnel and public during the treatment of malignant glioma using interstitial brachytherapy
Authors: Baldock C , Hughes S W , Sofat A , Batchelor S , Badawi R D 
Published: July 2009

Abstract
125I seeds are used in brachytherapy for the treatment of malignant gliomas. The use of such radioactive sources is associated with a certain radiological hazard to both personnel and members of the public. This hazard should be quantified so that the ALARA principle of radiological protection may be implemented satisfactorily. A study was undertaken to derive isodose rate contours in the vicinity of an anthropomorphic phantom with 125I seeds positioned at typical tumour sites within the cranial cavity. These contours are illustrated for seed positions appropriate to deep and superficial temporal tumours. Results indicate that the annual doses to personnel and public should not exceed those recommended by the International Commission on Radiological Protection.