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issn:1748-880
3.  A painful forefoot mass 
The British Journal of Radiology  2013;86(1024):20110633.
doi:10.1259/bjr.20110633
PMCID: PMC3635783  PMID: 23435279
4.  CT findings of pulmonary non-tuberculous mycobacterial infection in non-AIDS immunocompromised patients: a case-controlled comparison with immunocompetent patients 
The British Journal of Radiology  2013;86(1024):20120209.
Objective:
To describe CT findings of non-tuberculous mycobacteria (NTM) pulmonary infection in non-AIDS immunocompromised patients (ICPs) and to compare these findings with those in immunocompetent patients.
Methods:
From July 2000 to August 2007, 369 patients (mean age 58.3 years; 169 males and 200 females) with pulmonary NTM infection were retrospectively reviewed. Of these 369 patients, 24 ICPs (mean age 64.8 years; 15 males and 9 females) were identified. 16 patients had diabetes mellitus, and 6 patients had received long-term steroid therapy. One had received solid organ transplantation and one had received high-dose chemotherapy for haematological disease. 24 age- and sex-matched immunocompetent patients (mean age 64.6 years; 15 males and 9 females) were selected as the control group from the same registry. CT images were reviewed in consensus by three chest radiologists, who were blinded to immune status. Each lung lobe was evaluated in terms of extent of the lesion, bronchiectasis, parenchymal opacity and the presence of ancillary findings.
Results:
A total of 287 lobes were evaluated in ICPs and the control group. The ICPs showed a higher prevalence of ill-defined nodules, with cavities and large opacity >2 cm with/without cavity (p=0.03, 0.04 and 0.02, respectively). Regardless of the immune status, the most common CT findings were bronchiectasis and ill-defined nodules without cavity.
Conclusion:
The most common CT findings of pulmonary NTM infection in ICPs were bronchiectasis and ill-defined nodules, similar to those in the control group. Ill-defined nodules with cavity and large opacity >2 cm with/without cavity were more frequently found in ICPs.
Advances in knowledge:
In patients affected by NTM infection, large opacities and cavitation in pulmonary nodules are more frequent in ICPs than in immunocompetent patients.
doi:10.1259/bjr.20120209
PMCID: PMC3635784  PMID: 23440166
5.  Improving radiotherapy quality assurance in clinical trials: assessment of target volume delineation of the pre-accrual benchmark case 
The British Journal of Radiology  2013;86(1024):20120398.
As the complexity of radiotherapy (RT) trials increases, issues surrounding target volume delineation will become more important. Some form of outlining assessment prior to trial entry is increasingly being mandated in UK RT trials. This document produced by the Outlining and Imaging Subgroup (OISG) of the National Cancer Research Institute will address methods to reduce interobserver variation in clinical trials and how to conduct an assessment of outlining through a pre-accrual benchmark case. We review currently available methods of describing the variation and identify areas where further work is needed. The OISG would encourage ongoing discussion with chief investigators in order to provide advice on individual aspects of benchmark case assessment for current and future trials.
doi:10.1259/bjr.20120398
PMCID: PMC3635785  PMID: 23392188
6.  Altered fractionation outcomes for hypoxic head and neck cancer using the HYP-RT Monte Carlo model 
The British Journal of Radiology  2013;86(1024):20120443.
Objective:
Altered fractionation radiotherapy is simulated on a set of virtual tumours to assess the total doses required for tumour control compared with clinical head and neck data and the doses required to control hypoxic vs well-oxygenated tumours with different radiobiological properties.
Methods:
The HYP-RT model is utilised to explore the impact of tumour oxygenation and the onset times of accelerated repopulation (AR) and reoxygenation (ROx) during radiotherapy. A biological effective dose analysis is used to rank the schedules based on their relative normal tissue toxicities.
Results:
Altering the onset times of AR and ROx has a large impact on the doses required to achieve tumour control. Immediate onset of ROx and 2-week onset time of AR produce results closely predicting average human outcomes in terms of the total prescription doses in clinical trials. Modifying oxygen enhancement ratio curves based on dose/fraction significantly reduces the dose (5–10 Gy) required for tumour control for hyperfractionated schedules. HYP-RT predicts 10×1.1 Gy per week to be most beneficial, whereas the conventional schedule is predicted as beneficial for early toxicity but has average–poor late toxicity.
Conclusion:
HYP-RT predicts that altered radiotherapy schedules increase the therapeutic ratio and may be used to make predictions about the prescription doses required to achieve tumour control for tumours with different oxygenation levels and treatment responses.
Advances in knowledge:
Oxic and hypoxic tumours have large differences in total radiation dose requirements, affected by AR and ROx onset times by up to 15–25 Gy for the same fractionation schedule.
doi:10.1259/bjr.20120443
PMCID: PMC3635786  PMID: 23392195
7.  Relationship between T2 relaxation and apparent diffusion coefficient in malignant and non-malignant prostate regions and the effect of peripheral zone fractional volume 
The British Journal of Radiology  2013;86(1024):20120469.
Objective:
To establish whether T2 relaxation and apparent diffusion coefficient (ADC) in normal prostate and tumour are related and to investigate the effects of glandular compression from an enlarged transition zone (TZ) on peripheral zone (PZ) T2 and ADC by correlating them with the peripheral zone fractional volume (PZFV).
Methods:
48 consecutive patients prospectively underwent multiecho T2 weighted (T2W) (echo times 20, 40, 60, 80, 100 ms) and diffusion-weighted (b=0, 100, 300, 500, 800 s mm−2) endorectal MRI. In 43 evaluable patients, single slice whole PZ, TZ and tumour (focal hypointense signal on T2W images in a biopsy-positive octant) regions of interest were transferred to T2 and ADC maps by slice matching. T2 and ADC values were correlated, and PZ values were correlated with PZFV.
Results:
T2 and ADC values were significantly different among groups [T2 mean±standard deviation (SD) PZ, 149±49 ms; TZ, 125±26 ms; tumour, 97±23 ms; PZ vs TZ, p=0.002; PZ vs tumour, p<0.0001; TZ vs tumour, p<0.0001; ADC×10−6 mm2 s−1 mean±SD PZ, 1680±215; TZ, 1478±139; tumour, 1030±205; p<0.0001]. Significant positive correlations existed between T2 and ADC for PZ, TZ, PZ and TZ together, but not for tumour (r=0.515, p<0.0001; r=0.300, p=0.03; r=0.526, p<0.0001; and r=0.239, p=0.32, respectively). No significant correlation existed between PZFV and PZ T2 (r=0.10, p=0.5) or ADC (r=0.03, p=0.8).
Conclusion:
The correlation between T2 and ADC that exists in normal prostate is absent in tumour. PZ compression by an enlarged TZ does not alter PZ T2 or ADC to affect tumour–PZ contrast.
Advances in Knowledge:
Microstructural features of tumours alter diffusivity independently of their effects on T2 relaxation.
doi:10.1259/bjr.20120469
PMCID: PMC3635787  PMID: 23426849
8.  The effective dose assessment of C-arm CT in hepatic arterial embolisation therapy 
The British Journal of Radiology  2013;86(1024):20120551.
Objective:
To assess the effective dose of the liver C-arm computed tomography (CT) scan during hepatic arterial embolisation surgery with clinical dose–area product (DAP) data from Taiwan.
Methods:
The experiment used two kinds of phantoms: RANDO® Man and RANDO Woman (The Phantom Laboratory, Salem, NY), embedded with thermoluminescent dosemeters at locations according to the International Commission on Radiological Protection 103 report. The conversion factors of DAP to effective doses for males and females, respectively, were obtained. The clinical DAP data of liver C-arm CT scan during hepatic arterial embolisation surgery were collected in a hospital in Taiwan.
Results:
There were 125 liver transarterial embolisation therapy cases, including 94 males and 31 females, from February 2009 to June 2010. C-arm CT was used 38 times for males and 17 times for females. The corresponding average and standard deviation of clinical DAP were 61.0±6.6 Gy cm2 and 52.2±8.3 Gy cm2, respectively.
Conclusion:
The DAP of RANDO Man and RANDO Woman phantoms simply scanned by C-arm CT are much lower than that of patients. After consideration of the clinical DAP of patients, the effective doses of a liver C-arm CT scan recommended for males and females in Taiwan are 11.5±2.3 mSv and 11.3±3.0 mSv, respectively.
Advances in knowledge:
The conversion factors of DAP to effective doses for males and females are 0.19±0.03 mSv Gy−1 cm−2 and 0.22±0.05 mSv Gy−1 cm−2. Only if the actual DAP value of a patient scan is multiplied by the conversion factor can the correct effective dose be determined.
doi:10.1259/bjr.20120551
PMCID: PMC3635788  PMID: 23403454
9.  Patterns of renal angiomyolipoma regression post embolisation on medium- to long-term follow-up 
The British Journal of Radiology  2013;86(1024):20120633.
Objective:
To assess the patterns of regression of renal angiomyolipoma (AML) post embolisation and report the outcomes related to the use of different embolic materials.
Methods:
A retrospective review of all patients who underwent embolisation for renal AML at our institution between January 2004 and April 2012.
Results:
13 patients underwent 16 episodes of embolisation. Coils were used as the primary embolisation material in 10 episodes and microspheres in 6 episodes. The size reduction rate highly correlated on CT follow-up between the two groups, with 25.6% vs 22.7% reduction at 12 months, 27.5% vs 25.1% at 24 months, 35.0% vs 33.0% at 36 months and 35.0% vs 36.8% at 48 months. During follow-up, all tumours reduced in size with one patient requiring subsequent embolisation whose tumour reduced by only 6.5% after 1 year and subsequently exhibited regrowth after 4 years. Two patients presented with rebleeding and underwent repeat embolisation. Our overall retreatment rate (23%) is well within the literature range (up to 37%). None of the patients underwent surgery.
Conclusion:
The majority of AML shrinkage occurs within the first year following embolisation and appears to plateau after 3 years, which could have an impact on follow-up strategy. The percentage reduction at 1 year may reflect the long-term effect of embolisation with tumours demonstrating minor size reduction more likely to relapse at long-term follow-up. Embolisation of renal AML produces durable long-term results regardless of the choice of embolic agent.
Advances in knowledge:
These findings provide information to guide CT follow-up of renal AML post embolisation.
doi:10.1259/bjr.20120633
PMCID: PMC3635789  PMID: 23392196
10.  Radiological and clinical features of adult non-puerperal mastitis 
Tan, H | Li, R | Peng, W | Liu, H | Gu, Y | Shen, X
The British Journal of Radiology  2013;86(1024):20120657.
Objective:
To describe the radiological and clinical features of adult non-puerperal mastitis and to determine the most accurate method of preventing unnecessary surgical procedures.
Methods:
Clinical and imaging findings were retrospectively reviewed in 51 females with non-puerperal mastitis, which was confirmed by biopsy/surgical pathology. All 51 patients had pre-operative MRI; 45 patients also had sonograms and 25 also had mammograms, pre-operatively.
Results:
Of the 51 cases with non-puerperal mastitis, 94.1% (48/51) were confirmed as having acute or chronic inflammation, and the other 3 had plasma cell mastitis; areola papillaris inflammation was found in 39.2% (20/51) of the cases. Overall, 6 of the 25 cases that were examined with mammography and 2 of the 45 cases that were examined with sonography appeared normal, but all 51 lesions were positively identified on MRI. Asymmetrical density (12/25) on mammograms and solitary or separated/contiguous, clustered, hypoechoic mass-like lesions (31/45) on ultrasound were the most common signs of non-puerperal mastitis. On enhanced MRI, 90.2% (46/51) of patients showed non-mass-like enhanced lesions. Multiple regional enhancements in the pattern of distribution (32/46) and separated or contiguous, clustered, rim-like enhancements in the pattern of internal enhancement (29/46) were the most common manifestations in non-mass-like enhanced lesions. Of the 51 patients, mastitis Type 1 and Type 2 in the time–signal intensity curve were detected in 47.1% and 51.0% of the patients, respectively. The breast imaging reporting and data system categories with the highest number of patients were Category 0 (9/25) on mammography, Category 4a on sonography (18/45) and Category 4a on MRI (29/51).
Conclusion:
The findings from mammography and ultrasound are non-specific; therefore, using MR can be helpful in the diagnosis, especially in the presence of non-mass-like enhancements that are multiple, regional, separated, or contiguous, clustered and rim-like.
Advances in knowledge:
Mastitis is often neglected because of the lack of typical clinical signs and symptoms. This study has assessed and described the clinical features and imaging findings of adult non-puerperal mastitis on mammograms, sonograms and MRI and found that MRI is more specific in the diagnosis of disease.
doi:10.1259/bjr.20120657
PMCID: PMC3635790  PMID: 23392197
11.  High-intensity focused ultrasound: advances in technology and experimental trials support enhanced utility of focused ultrasound surgery in oncology 
The British Journal of Radiology  2013;86(1024):20130044.
High-intensity focused ultrasound (HIFU) is a rapidly maturing technology with diverse clinical applications. In the field of oncology, the use of HIFU to non-invasively cause tissue necrosis in a defined target, a technique known as focused ultrasound surgery (FUS), has considerable potential for tumour ablation. In this article, we outline the development and underlying principles of HIFU, overview the limitations and commercially available equipment for FUS, then summarise some of the recent technological advances and experimental clinical trials that we predict will have a positive impact on extending the role of FUS in cancer therapy.
doi:10.1259/bjr.20130044
PMCID: PMC3635791  PMID: 23403455
12.  BIROpen: open access meets flexibility 
The British Journal of Radiology  2013;86(1024):20130116.
doi:10.1259/bjr.20130116
PMCID: PMC3635792  PMID: 23449439
14.  Assessment of the robustness of volumetric-modulated arc therapy for lung radiotherapy 
The British Journal of Radiology  2013;86(1023):20120498.
Volumetric-modulated arc therapy (VMAT) is increasingly popular as a treatment method in radiotherapy owing to the speed with which treatments can be delivered. However, there has been little investigation into the effect of increased modulation in lung plans with regard to interfraction organ motion. This is most likely to occur where the planning target volume (PTV) lies within areas of low density. This paper aims to investigate the effect of modulation on the dose distribution using simulated patient movement and to propose a method that is less susceptible to such movement. Simulated interfraction motion is achieved by moving the plan isocentre in steps of 0.5 cm and 1.0 cm in six directions for five clinical VMAT patients. The proposed planning method involves optimisation using a density override of 1 g cm−3, within the PTV in lung, to reduce segment boosting in the periphery of the PTV. This investigation shows that modulation can result in an increase in the maximum dose of >25%, an increase in PTV near-maximum dose of 17% and a reduction in near-minimum dose by 46%. Unacceptable organ at risk (OAR) doses are also seen. The proposed method reduces modulation, resulting in a maximum dose increase of 10%. Although safeguards are in place to prevent the increased dose to OARs from patient movement, there is nothing to prevent the increased dose as a result of modulation in lung. A simple planning method is proposed to safeguard against this effect. Investigation suggests that, where modulation exists in a plan, this method reduces it and is clinically viable.
doi:10.1259/bjr.20120498
PMCID: PMC3608059  PMID: 23392190
15.  Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement 
The British Journal of Radiology  2013;86(1023):20120428.
Objective:
This quality assurance study assesses whether CT image-guided verification has led to improvements in the technique when compared with previous studies.
Methods:
The CT images were studied from a cohort of 105 consecutive patients with endometrial cancer having adjuvant brachytherapy to the vaginal vault in 2010. Images were taken at first insertion, checked for air gaps and treatment delivered. Images were later transferred to the planning system and air gaps between vaginal mucosa and vaginal cylinder were measured. Comparisons were made with the 2008 results from this centre and the literature series.
Results:
Images from two patients were not assessable owing to artefacts from hip replacements. Air gaps >2 mm were seen in 11/103 patients. Repositioning or use of a larger cylinder reduced air gaps to 7/103 patients. In total, 96/103 patients (over 93%) were able to achieve good vaginal contact throughout the treatment volume. This shows a significant improvement in applicator positioning in our centre since 2008 and also a significant improvement over the total data published in 2010 (Pearson χ2 test=46.19; p<0.0001).
Conclusion:
The vaginal cylinder technique with CT imaging was proven to be effective for 96/103 patients. It is necessary to consider whether there is a better technique for the few patients with air gaps >2 mm.
Advances in knowledge:
For the vast majority of patients, this technique is well tolerated, without the need for analgesia, and will continue to be the first choice technique in this centre.
doi:10.1259/bjr.20120428
PMCID: PMC3608053  PMID: 23407428
16.  Subtle signs, subtle designs: future change and BJR 
The British Journal of Radiology  2013;86(1023):20130078.
doi:10.1259/bjr.20130078
PMCID: PMC3608054  PMID: 23392198
17.  Breast cancer subtypes: response to radiotherapy and potential radiosensitisation 
The British Journal of Radiology  2013;86(1023):20120601.
Radiotherapy (RT) is of critical importance in the locoregional management of early breast cancer. Over 50% of patients receive RT at some time during the treatment of their disease, equating to over 500 000 patients worldwide receiving RT each year. Unfortunately, not all patients derive therapeutic benefit and some breast cancers are resistant to treatment, as evidenced by distant metastatic spread and local recurrence. Prediction of individual responses to RT may allow a stratified approach to this treatment permitting those patients with radioresistant tumours to receive higher doses of RT (total and/or tumour cavity boost doses) and/or radiosensitising agents to optimise treatment. Also, for those patients unlikely to respond at all, it would prevent harmful side effects occurring for no therapeutic gain. More selective targeting would better direct National Health Service resources, ease the burden on heavily used treatment RT machines and reduce the economic cost of cancer treatment. Unfortunately, there are no robust and validated biomarkers for predicting RT outcome. We review the available literature to determine whether classification of breast cancers according to their molecular profile may be used to predict successful response to, or increased morbidity from, RT. Class-specific biomarkers for targeting by radiosensitising agents are also discussed.
doi:10.1259/bjr.20120601
PMCID: PMC3608055  PMID: 23392193
18.  Quantitative analysis of contrast-enhanced ultrasonography: differentiating focal nodular hyperplasia from hepatocellular carcinoma 
The British Journal of Radiology  2013;86(1023):20120536.
Objective:
To explore the potential of quantitative analysis of contrast-enhanced ultrasonography (CEUS) in differentiating focal nodular hyperplasia (FNH) from hepatocellular carcinoma (HCC).
Methods:
34 cases of FNH and 66 cases of HCC (all lesions <5 cm) were studied using CEUS to evaluate enhancement patterns and using analytic software Sonoliver® (Image-Arena™ v.4.0, TomTec Imaging Systems, Munich, Germany) to obtain quantitative features of CEUS in the region of interest. The quantitative features of maximum of intensity (IMAX), rise slope (RS), rise time (RT) and time to peak (TTP) were compared between the two groups and applied to further characterise both FNH and HCC with hypoenhancing patterns in the late phase on CEUS.
Results:
The sensitivity and specificity of CEUS for diagnosis of FNH were 67.6% and 93.9%, respectively. For quantitative analysis, IMAX and RS in FNHs were significantly higher than those in HCCs (p<0.05), while RT and TTP in FNHs were significantly shorter (p<0.05). Both the 11 FNHs and 62 HCCs with hypo-enhancing patterns in the late phase were further characterised with their quantitative features, and the sensitivity and specificity of IMAX for diagnosis of FNH were 90.9% and 43.5%, RS 81.8% and 80.6%, RT 90.9% and 71.0%, and TTP 90.9% and 71.0%, respectively.
Conclusion:
The quantitative features of CEUS in FNH and HCC were significantly different, and they could further differentiate FNH from HCC following conventional CEUS.
Advances in knowledge:
Our findings suggest that quantitative analysis of CEUS can improve the accuracy of differentiating FNH from HCC.
doi:10.1259/bjr.20120536
PMCID: PMC3608056  PMID: 23392189
19.  Perihilar branching patterns of renal artery and extrarenal length of arterial branches and tumour-feeding arteries on multidetector CT angiography 
The British Journal of Radiology  2013;86(1023):20120387.
Objective:
The purpose of our study was to assess the extrarenal length of renal arterial branches and tumour-feeding arteries on multidetector CT (MDCT) angiography, in addition to the perihilar branching patterns, with relevance to segmental artery clamping.
Methods:
MDCT angiograms of 64 patients with renal masses <4 cm were retrospectively reviewed by 2 radiologists. The perihilar branching patterns of the single main renal artery were assessed according to the number of pre-segmental and segmental arteries. The extrarenal lengths of segmental plus pre-segmental arteries and the tumour-feeding arteries, measured on volume-rendered images, were compared according to the vascular segmentation and the tumour location, respectively.
Results:
In the 116 kidneys, 1 pre-segmental plus 5 segmental arteries (n=48) was the most common branching pattern. The mean extrarenal length of the inferior segmental plus pre-segmental arteries (33.05 mm) and the posterior segmental plus pre-segmental arteries (32.30 mm) was longer than any of the other segmental plus pre-segmental arteries (apical, 23.87 mm; superior, 26.80 mm; middle, 29.23 mm) (p<0.05). The mean extrarenal length of the lower pole tumour-feeding arteries (35.94 mm) was longer than those of the upper and mid-pole tumour-feeding arteries (24.95 mm, 29.62 mm), with significant difference between the lower and the upper pole tumour-feeding arteries (p<0.05).
Conclusion:
Tumours in the lower pole, supplied by the inferior or posterior segmental artery, may be more amenable to segmental artery clamping.
Advances in knowledge:
MDCT angiography with volume rendering can demonstrate the extrarenal length of tumour-feeding arteries and may help in determining the accessibility for segmental artery clamping.
doi:10.1259/bjr.20120387
PMCID: PMC3608057  PMID: 23418206
20.  Critical appraisal of volumetric-modulated arc therapy compared with electrons for the radiotherapy of cutaneous Kaposi’s sarcoma of lower extremities with bone sparing 
The British Journal of Radiology  2013;86(1023):20120543.
Objective:
To evaluate the use of volumetric-modulated arc therapy [VMAT, RapidArc® (RA); Varian Medical Systems, Palo Alto, CA] for the treatment of cutaneous Kaposi’s sarcoma (KS) of lower extremities with adequate target coverage and high bone sparing, and to compare VMAT with electron beam therapy.
Methods:
10 patients were planned with either RA or electron beams. The dose was prescribed to 30 Gy, 10 fractions, to mean the planning target volume (PTV), and significant maximum dose to bone was limited to 30 Gy. Plans were designed for 6-MV photon beams for RA and 6 MeV for electrons. Dose distributions were computed with AcurosXB® (Varian Medical Systems) for photons and with a Monte Carlo algorithm for electrons.
Results:
V90% was 97.3±1.2 for RA plans and 78.2±2.6 for electrons; similarly, V107% was 2.5±2.2 and 37.7±3.4, respectively. RA met coverage criteria. Concerning bone sparing, D2% was 29.6±1.1 for RA and 31.0±2.4 for electrons. Although acceptable for bone involvement, pronounced target coverage violations were obtained for electron plans. Monitor units were similar for electrons and RA, although for the latter they increased when superior bone sparing was imposed. Delivery times were 12.1±4.0 min for electrons and 4.8±1.3 min for the most modulated RA plans.
Conclusion:
High plan quality was shown for KS in the lower extremities using VMAT, and this might simplify their management in comparison with the more conventional usage of electrons, particularly in institutes with limited staff resources and heavy workloads.
Advances in knowledge:
VMAT is also dosimetrically extremely advantageous in a typology of treatments where electron beam therapy is mainly considered to be effective owing to the limited penetration of the beams.
doi:10.1259/bjr.20120543
PMCID: PMC3608058  PMID: 23392192
21.  Quantitative parametric MRI of articular cartilage: a review of progress and open challenges 
The British Journal of Radiology  2013;86(1023):20120163.
With increasing life expectancies and the desire to maintain active lifestyles well into old age, the impact of the debilitating disease osteoarthritis (OA) and its burden on healthcare services is mounting. Emerging regenerative therapies could deliver significant advances in the effective treatment of OA but rely upon the ability to identify the initial signs of tissue damage and will also benefit from quantitative assessment of tissue repair in vivo. Continued development in the field of quantitative MRI in recent years has seen the emergence of techniques able to probe the earliest biochemical changes linked with the onset of OA. Quantitative MRI measurements including T1, T2 and T1ρ relaxometry, diffusion weighted imaging and magnetisation transfer have been studied and linked to the macromolecular structure of cartilage. Delayed gadolinium-enhanced MRI of cartilage, sodium MRI and glycosaminoglycan chemical exchange saturation transfer techniques are sensitive to depletion of cartilage glycosaminoglycans and may allow detection of the earliest stages of OA. We review these current and emerging techniques for the diagnosis of early OA, evaluate the progress that has been made towards their implementation in the clinic and identify future challenges in the field.
doi:10.1259/bjr.20120163
PMCID: PMC3608060  PMID: 23407427
22.  Noise-reducing algorithms do not necessarily provide superior dose optimisation for hepatic lesion detection with multidetector CT 
The British Journal of Radiology  2013;86(1023):20120500.
Objective:
To compare the dose-optimisation potential of a smoothing filtered backprojection (FBP) and a hybrid FBP/iterative algorithm to that of a standard FBP algorithm at three slice thicknesses for hepatic lesion detection with multidetector CT.
Methods:
A liver phantom containing a 9.5-mm opacity with a density of 10 HU below background was scanned at 125, 100, 75, 50 and 25 mAs. Data were reconstructed with standard FBP (B), smoothing FBP (A) and hybrid FBP/iterative (iDose4) algorithms at 5-, 3- and 1-mm collimation. 10 observers marked opacities using a four-point confidence scale. Jackknife alternative free-response receiver operating characteristic figure of merit (FOM), sensitivity and noise were calculated.
Results:
Compared with the 125-mAs/5-mm setting for each algorithm, significant reductions in FOM (p<0.05) and sensitivity (p<0.05) were found for all three algorithms for all exposures at 1-mm thickness and for all slice thicknesses at 25 mAs, with the exception of the 25-mAs/5-mm setting for the B algorithm. Sensitivity was also significantly reduced for all exposures at 3-mm thickness for the A algorithm (p<0.05). Noise for the A and iDose4 algorithms was approximately 13% and 21% lower, respectively, than for the B algorithm.
Conclusion:
Superior performance for hepatic lesion detection was not shown with either a smoothing FBP algorithm or a hybrid FBP/iterative algorithm compared with a standard FBP technique, even though noise reduction with thinner slices was demonstrated with the alternative approaches.
Advances in knowledge:
Reductions in image noise with non-standard CT algorithms do not necessarily translate to an improvement in low-contrast object detection.
doi:10.1259/bjr.20120500
PMCID: PMC3608061  PMID: 23392194
23.  Scapular free flap harvest site: recognising the spectrum of radiographic post-operative appearance 
The British Journal of Radiology  2013;86(1023):20120574.
Objective:
Scapular free flap harvesting for oral cavity cancer reconstruction is an increasingly used and versatile option. We aim to describe the appearance of the scapula harvest site on chest radiograph and CT.
Methods:
We retrospectively reviewed a surgical database of 82 patients who underwent scapular osteocutaneous flap harvesting for oral cavity cancer reconstruction and had imaging performed at our institution. We searched the picture archiving and communications system for all associated imaging.
Results:
Characteristic radiographic appearance in the immediate post-operative period as well as in the remote post-operative period is described, including an upside-down V-shaped paraglenoid notch, rectangular (or triangular) lateral border defects and a sharply pointed inferior scapular body. Additionally, common CT appearances are discussed, including an abrupt gleno-scapular interval, an absent axillary rim bulge and a Z-shaped scapula.
Conclusion:
The altered appearance of the scapular defect following surgical harvest is easily recognised. Although the description of this defect may not alter management and may reasonably be omitted, a radiologist’s comfort with these appearances may potentially enhance the understanding of patient management and recognition of superimposed complications, such as infection.
Advances in knowledge:
Scapular osteocutaneous free flap reconstruction is an increasingly used technique after oral cavity surgery.
Very few radiologists reported in our review the surgical scapular defects, and there is apparent ignorance of their appearance.
We described characteristic radiographic and CT signs of scapular free flap harvesting to increase radiologists’ familiarity with these defects, which may provide clinical information and possibly contribute to detection of complications.
doi:10.1259/bjr.20120574
PMCID: PMC3608062  PMID: 23392191

Results 1-25 (1045)