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16.  Correction to 2010 83: 811-813 doi: 10.1259/bjr/49490647 
The British Journal of Radiology  2011;84(1001):483.
doi:10.1259/bjr/31251127
PMCID: PMC3473644
17.  Deoxyribonucleic acid damage-associated biomarkers of ionising radiation: current status and future relevance for radiology and radiotherapy 
The British Journal of Radiology  2013;86(1027):20130173.
Diagnostic and therapeutic radiation technology has developed dramatically in recent years, and its use has increased significantly, bringing clinical benefit. The use of diagnostic radiology has become widespread in modern society, particularly in paediatrics where the clinical benefit needs to be balanced with the risk of leukaemia and brain cancer increasing after exposure to low doses of radiation. With improving long-term survival rates of radiotherapy patients and the ever-increasing use of diagnostic and interventional radiology procedures, concern has risen over the long-term risks and side effects from such treatments. Biomarker development in radiology and radiotherapy has progressed significantly in recent years to investigate the effects of such use and optimise treatment. Recent biomarker development has focused on improving the limitations of established techniques by the use of automation, increasing sensitivity and developing novel biomarkers capable of quicker results. The effect of low-dose exposure (0–100 mGy) used in radiology, which is increasingly linked to cancer incidences, is being investigated, as some recent research challenges the linear-no-threshold model. Radiotherapy biomarkers are focused on identifying radiosensitive patients, determining the treatment-associated risk and allowing for a tailored and more successful treatment of cancer patients. For biomarkers in any of these areas to be successfully developed, stringent criteria must be applied in techniques and analysis of data to reduce variation among reports and allow data sets to be accurately compared. Newly developed biomarkers can then be used in combination with the established techniques to better understand and quantify the individual biological response to exposures associated with radiology tests and to personalise treatment plans for patients.
doi:10.1259/bjr.20130173
PMCID: PMC3700735  PMID: 23659923
18.  Correlation of the clinical and physical image quality in chest radiography for average adults with a computed radiography imaging system 
The British Journal of Radiology  2013;86(1027):20130077.
Objective:
The purpose of this study was to examine the correlation between the quality of visually graded patient (clinical) chest images and a quantitative assessment of chest phantom (physical) images acquired with a computed radiography (CR) imaging system.
Methods:
The results of a previously published study, in which four experienced image evaluators graded computer-simulated postero-anterior chest images using a visual grading analysis scoring (VGAS) scheme, were used for the clinical image quality measurement. Contrast-to-noise ratio (CNR) and effective dose efficiency (eDE) were used as physical image quality metrics measured in a uniform chest phantom. Although optimal values of these physical metrics for chest radiography were not derived in this work, their correlation with VGAS in images acquired without an antiscatter grid across the diagnostic range of X-ray tube voltages was determined using Pearson’s correlation coefficient.
Results:
Clinical and physical image quality metrics increased with decreasing tube voltage. Statistically significant correlations between VGAS and CNR (R=0.87, p<0.033) and eDE (R=0.77, p<0.008) were observed.
Conclusion:
Medical physics experts may use the physical image quality metrics described here in quality assurance programmes and optimisation studies with a degree of confidence that they reflect the clinical image quality in chest CR images acquired without an antiscatter grid.
Advances in knowledge:
A statistically significant correlation has been found between the clinical and physical image quality in CR chest imaging. The results support the value of using CNR and eDE in the evaluation of quality in clinical thorax radiography.
doi:10.1259/bjr.20130077
PMCID: PMC3922182  PMID: 23568362
19.  Pressure and breast thickness in mammography—what about physics? 
The British Journal of Radiology  2013;86(1027):20130208.
doi:10.1259/bjr.20130208
PMCID: PMC3922171  PMID: 23690437
20.  Commissioning of a new wide-bore MRI scanner for radiotherapy planning of head and neck cancer 
The British Journal of Radiology  2013;86(1027):20130150.
Objective:
A combination of CT and MRI is recommended for radiotherapy planning of head and neck cancers, and optimal spatial co-registration is achieved by imaging in the treatment position using the necessary immobilisation devices on both occasions, something which requires wide-bore scanners. Quality assurance experiments were carried out to commission a newly installed 1.5-T wide-bore MRI scanner and a dedicated, flexible six-channel phased array head and neck coil.
Methods:
Signal-to-noise ratio (SNR) and spatial signal uniformity were quantified using a homogeneous aqueous phantom, and geometric distortion was quantified using a phantom with water-filled fiducials in a grid pattern. Volunteer scans were also used to determine the in vivo image quality. Clinically relevant T1 weighted and T2 weighted fat-suppressed sequences were assessed in multiple scan planes (both sequences fast spin echo based). The performance of two online signal uniformity correction schemes, one utilising low-resolution reference scans and the other not utilising low-resolution reference scans, was compared.
Results:
Geometric distortions, for a ±35-kHz bandwidth, were <1 mm for locations within 10 cm of the isocentre rising to 1.8 mm at 18 cm away. SNR was above 50, and uniformity in the axial plane was 71% and 95% before and after uniformity correction, respectively.
Conclusion:
The combined performance of the wide-bore scanner and the dedicated coil was adjudged adequate, although superior–inferior spatial coverage was slightly limited in the lower neck.
Advances in knowledge:
These results will be of interest to the increasing number of oncology centres that are seeking to incorporate MRI into planning practice using dedicated equipment.
doi:10.1259/bjr.20130150
PMCID: PMC3922172  PMID: 23690434
21.  Optimisation of coronary angiography exposures requires a multifactorial approach and careful procedural definition 
The British Journal of Radiology  2013;86(1027):20120028.
Objective:
This study investigates the factors associated with higher doses for both single-plane and biplane procedures and establishes centre-specific 75th percentile levels.
Methods:
602 patients undergoing coronary angiography in a large hospital at Sydney were recruited to the study, and causal agents for high radiation doses were investigated: gender, procedural complexity, severity of coronary artery disease, presence of coronary bypass grafts, entry approach (radial or femoral), level of operator experience; and a single-plane or a biplane imaging system was employed.
Results:
The 75th percentile levels were calculated. The results demonstrated that, for both systems, higher exposures were associated with patients who were male (p<0.001), had coronary vessel disease (p<0.001) and had a history of coronary bypass grafts (p<0.001). In addition, for biplane systems, procedural complexity (p<0.001), types of entry approach (p<0.001) and levels of operator experience (p<0.001) significantly impacted upon the dose. Biplane examinations recorded higher doses than single-plane procedures (p<0.001) and the inclusion of left-sided ventriculography contributed to the overall dose by up to 10%.
Conclusion:
The 75th percentile levels in this study represent the tentative reference levels and are 48.9, 44.2 and 56 Gy cm2 for all exposures, single-plane- and biplane-specific exposures, respectively, and compare favourably with the diagnostic reference level values established elsewhere internationally, with only the UK and Irish data being lower.
Advances in knowledge:
Specific agents have been identified for dose-reducing strategies and the importance of operator training is highlighted. The assumption that biplane procedures may reduce the patient dose should be treated with caution.
doi:10.1259/bjr.20120028
PMCID: PMC3922173  PMID: 23719084
22.  Determination and comparison of radiotherapy dose responses for hepatocellular carcinoma and metastatic colorectal liver tumours 
The British Journal of Radiology  2013;86(1027):20130147.
Objective:
The purpose of this study was to seek radiation dose responses separately for primary hepatocellular carcinoma (HCC) and metastatic (MET) colorectal liver tumours to establish tumour control probabilities (TCPs) for radiotherapy (RT) of liver tumours.
Methods:
The records of 36 HCC and 26 MET colorectal liver tumour patients were reviewed. The median dose per fraction and total dose were 4 Gy (2–10 Gy) and 52 Gy (29–83 Gy) for the HCC group and 3.6 Gy (2.0–13.0 Gy) and 55 Gy (30–80 Gy) for the MET group, respectively. Median tumour diameter was 6.6 cm (3.0–18.0 cm) and 5.0 cm (1.0–13.0 cm) for the HCC and MET groups, respectively. A logistic TCP model was fitted to the response data for each group using the maximum likelihood method.
Results:
50% and 90% probabilities of 6-month local control were estimated to be achievable by 2 Gy per fraction equivalent doses (α/β=10 Gy) of 53 Gy and 84 Gy for the HCC group and 70 Gy and 95 Gy for the MET group, respectively. Actuarial 1-year local control for the HCC and MET groups was 65% (45–85%) and 32% (6–58%), respectively, whereas median time to failure was 543 days (374–711 days) and 183 days (72–294 days), respectively.
Conclusion:
Dose–response relationships were found and modelled for the HCC and MET patient groups, with a higher dose required to control MET tumours. RT offers better local control for HCC than for MET colorectal liver tumours at our institution.
Advances in knowledge:
An improved understanding of radiation dose–response relationships for primary and MET colorectal liver tumours will help inform future dose prescriptions.
doi:10.1259/bjr.20130147
PMCID: PMC3922174  PMID: 23690438
24.  Pressure and breast thickness in mammography—what about physics? Author reply 
The British Journal of Radiology  2013;86(1027):20130267.
doi:10.1259/bjr.20130267
PMCID: PMC3922176  PMID: 23690439
25.  Percutaneous ablation of lymph node metastases using CT-guided high-dose-rate brachytherapy 
The British Journal of Radiology  2013;86(1027):20130088.
Objective:
To assess the technical feasibility, safety and clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) for achieving local tumour control (LTC) in isolated lymph node metastases.
Methods:
From January 2008 to December 2011, 10 patients (six males and four females) with isolated nodal metastases were treated with CT-HDRBT. Five lymph node metastases were para-aortic, three were at the liver hilum, one at the coeliac trunk and one was a left iliac nodal metastasis. The mean lesion diameter was 36.5 mm (range 12.0–67.0 mm). Patients were followed up by either contrast-enhanced CT or MRI 6 weeks and then every 3 months after the end of treatment. The primary end point was LTC. Secondary end points included primary technical effectiveness rate, adverse events and progression-free survival.
Results:
The first follow-up examination after 6 weeks revealed complete coverage of all nodal metastases treated. There was no peri-interventional mortality or major complications. The mean follow-up period was 13.2 months (range 4–20 months). 2 out of 10 patients (20%) showed local tumour progression 9 and 10 months after ablation. 5 out of 10 patients (50%) showed systemic tumour progression. The mean progression-free interval was 9.2 months (range 2–20 months).
Conclusion:
CT-HDRBT is a safe and effective technique for minimally invasive ablation of nodal metastases.
Advances in knowledge:
CT-HDRBT of lymph node metastases is feasible and safe. CT-HDRBT might be a viable therapeutic alternative to obtain LTC in selected patients with isolated lymph node metastases.
doi:10.1259/bjr.20130088
PMCID: PMC3922177  PMID: 23659925

Résultats 1-25 (1085)