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1.  Index to Authors 2012 
The British Journal of Radiology  2012;85(1020):1584-1594.
PMCID: PMC3611718
2.  Unsuspected cystic left upper quadrant mass 
The British Journal of Radiology  2012;85(1016):1201-1203.
doi:10.1259/bjr/65157937
PMCID: PMC3485545  PMID: 22815417
3.  Paraspinal volumetric modulated arc therapy 
The British Journal of Radiology  2012;85(1016):1128-1133.
Objectives
: The processes involved in the treatment of paraspinal tumours by volumetric modulated arc therapy (VMAT) are described here by means of an illustrative case.
Methods
: Az single anticlockwise arc from gantry angle 179° to 181° was constructed using SmartArc (Philips Radiation Oncology Systems, Fitchburg, WI) with control points spaced at 2°. The dose prescription was 60 Gy in 30 fractions to cover the planning target volume (PTV) as uniformly as possible while sparing the 0.3-cm planning risk volume (PRV) around the spinal cord. The plan was verified before treatment using a diode array phantom and radiochromic film. Treatment delivery was on a Synergy linear accelerator with a beam modulator head (Elekta Ltd, Crawley, UK).
Results
Homogeneous dose coverage of the PTV was achieved with a D2% of 62.0 Gy and D98% of 55.6 Gy. Maximum spinal cord dose was 49.9 Gy to 0.1 cm3 and maximum dose to the spinal cord PRV was 55.4 Gy to 0.1 cm3. At pre-treatment verification, the percentage of the high-dose region receiving a dose within 3% and 3 mm of the planned dose was 98.8% with the diode array and 93.4% with film. Delivery time was 2 min 15 s and the course of treatment was successfully completed.
Conclusions
VMAT was successfully planned, verified and delivered for this challenging tumour site. VMAT provides a very suitable method of treating complex paraspinal tumours, offering a high-quality conformal dose distribution with a short delivery time.
doi:10.1259/bjr/83207140
PMCID: PMC3587060  PMID: 22215885
4.  Imaging carotid body chemodectomas with 68Ga-DOTA-NOC PET-CT 
The British Journal of Radiology  2012;85(1016):1140-1145.
Objective
The purpose of the present study was to evaluate the role of 68-gallium-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-1-Nal3-octreotide (68Ga-DOTA-NOC) positron emission tomography CT (PET-CT) in carotid body chemodectomas (CBCs).
Methods
: 5 patients with known CBCs (conventional imaging and angiography) were evaluated retrospectively (3 males, 2 females; mean age 36.6 years). All underwent PET-CT after injection of 148 MBq (4 mCi) of 68Ga-DOTA-NOC.
Results
: At baseline there were four bilateral CBCs and one unilateral CBC with an additional glomus tympanicum and bilateral glomus jugulare tumour in these five patients. All these lesions showed intense uptake on 68Ga-DOTA-NOC PET-CT. Apart from these known lesions, additional tumours were detected in three patients; glomus jugulare in one, aortic body tumour and multiple abdominal paragangliomas in another and unsuspected vertebral metastasis in the last. Overall it led to a change in management in 3 of the 5 patients (60%).
Conclusion
: 68Ga-DOTA-NOC PET-CT is a promising non-invasive imaging modality in the detection and characterisation of CBCs.
doi:10.1259/bjr/17448792
PMCID: PMC3587100  PMID: 22096221
5.  Yttrium-90 internal pair production imaging using first generation PET/CT provides high-resolution images for qualitative diagnostic purposes 
The British Journal of Radiology  2012;85(1015):1018-1019.
Yttrium-90 (90Y) internal pair production can be imaged by positron emission tomography (PET)/CT and is superior to bremsstrahlung single-photon emission CT/CT for evaluating hepatic 90Y microsphere biodistribution. We illustrate a case of 90Y imaging using first generation PET/CT technology, producing high-quality images for qualitative diagnostic purposes.
doi:10.1259/bjr/33524085
PMCID: PMC3474067  PMID: 21976634
6.  Positioning accuracy for lung stereotactic body radiotherapy patients determined by on-treatment cone-beam CT imaging 
The British Journal of Radiology  2012;85(1014):819-823.
Stereotactic body radiotherapy for early stage non-small cell lung cancer is an emerging treatment option in the UK. Since relatively few high-dose ablative fractions are delivered to a small target volume, the consequences of a geometric miss are potentially severe. This paper presents the results of treatment delivery set-up data collected using Elekta Synergy (Elekta, Crawley, UK) cone-beam CT imaging for 17 patients immobilised using the Bodyfix system (Medical Intelligence, Schwabmuenchen, Germany). Images were acquired on the linear accelerator at initial patient treatment set-up, following any position correction adjustments, and post-treatment. These were matched to the localisation CT scan using the Elekta XVI software. In total, 71 fractions were analysed for patient set-up errors. The mean vector error at initial set-up was calculated as 5.3±2.7 mm, which was significantly reduced to 1.4±0.7 mm following image guided correction. Post-treatment the corresponding value was 2.1±1.2 mm. The use of the Bodyfix abdominal compression plate on 5 patients to reduce the range of tumour excursion during respiration produced mean longitudinal set-up corrections of −4.4±4.5 mm compared with −0.7±2.6 mm without compression for the remaining 12 patients. The use of abdominal compression led to a greater variation in set-up errors and a shift in the mean value.
doi:10.1259/bjr/54341099
PMCID: PMC3474122  PMID: 22665927
7.  “Black bone” MRI: a partial flip angle technique for radiation reduction in craniofacial imaging 
The British Journal of Radiology  2012;85(1011):272-278.
The potential harmful effects of ionising radiation continue to be highlighted. Radiation reduction techniques have largely consisted of low-dose techniques rather than a shift to non-ionising methods of imaging. CT scanning is frequently employed for imaging the craniofacial skeleton despite being one of the key anatomical regions for radiation protection in view of the radiosensitive lens and thyroid gland. We describe a low flip angle gradient echo MRI sequence which provides high image contrast between bone and other tissues but reduces the contrast between individual soft tissues. This permits the “black bone” to be easily distinguished from the uniformity of the soft tissues. While maintaining a repetition time of 8.6 ms and an echo time of 4.2 ms, the flip angle which provided optimised suppression of both fat and water was identified to be 5°. The biometric accuracy of this sequence was confirmed using a phantom to obtain direct anatomical measurements and comparable CT scanning. The average discrepancy between black bone MRI measurements and direct anatomical measurements was 0.32 mm. Black bone MRI therefore has the potential to reduce radiation exposure by replacing CT scanning when imaging the facial skeleton, with particular scope for imaging benign conditions in the young.
doi:10.1259/bjr/95110289
PMCID: PMC3473988  PMID: 22391497
8.  Vomiting—is this a good indication for CT head scans in patients with minor head injury? 
The British Journal of Radiology  2012;85(1010):183-186.
The National Institute for Health and Clinical Excellence head injury guidelines advise CT imaging within 1 h if there is more than one episode of vomiting post-head injury in adults and three or more episodes in children. Since the guideline publication, studies have found that, following head injury, vomiting alone is associated with an abnormal CT head scan in 13–45% of cases. CT head scan requests referred from the emergency department between 1 May 2009 and 30 April 2010 were retrospectively reviewed. Patients with vomiting as the sole indication for an “immediate” CT head scan performed within 1 h were included in the study. Reports produced by experienced neuroradiologists were reviewed and the detection of significant head injury was noted. There were 1264 CT head scans performed during our study period. 151 (124 adults, 27 children) were indicated owing to vomiting following head injury. 5 of the 124 adult scans and 1 of the 27 paediatric scans showed an abnormal finding, giving positive predictive values (PPV) of 4% and 3.7%, respectively. None of these patients required either acute or delayed neurosurgical intervention. In our experience, vomiting alone has a PPV of 4% for significant head injury in adults. However, none of these injuries were serious enough to warrant acute or delayed intervention. Given these findings, vomiting following head injury is a reasonable indication for a CT head scan; however, as none of the patients required acute intervention, we suggest that these scans do not usually need to be performed within 1 h of request.
doi:10.1259/bjr/56169980
PMCID: PMC3473953  PMID: 21937615
9.  Synchronous bilateral squamous cell carcinoma of the lung successfully treated using intensity-modulated radiotherapy 
The British Journal of Radiology  2012;85(1009):77-80.
We present a case of synchronous bilateral inoperable lung cancer which required treatment with external beam radiotherapy to a radical dose. Intensity-modulated radiotherapy (IMRT) was used. More conformal dose distribution within the planning target volume was obtained using IMRT than the conventional technique. Dose–volume constraints defined for the lungs were met. Treatment was subsequently delivered using a seven-field IMRT plan. The patient remains alive and disease-free 48 months after the completion of radiotherapy. IMRT can be considered an effective treatment for synchronous bilateral lung cancer.
doi:10.1259/bjr/64570729
PMCID: PMC3473933  PMID: 21937610
10.  Acknowledgment to Reviewers 
The British Journal of Radiology  2012;85(1009):97-99.
PMCID: PMC3473936
11.  Index to Authors 2011 
The British Journal of Radiology  2011;84(1008):1158-1163.
PMCID: PMC3473824
12.  Development of a fine thermocouple-needle system for real-time feedback of thermal tumour ablation margin 
The British Journal of Radiology  2011;84(1008):1139-1141.
Thermal tumour ablation techniques such as radiofrequency (RF) ablation are applied for radical removal of local tumours as an easier, less invasive alternative to surgical resection. A serious drawback of thermal ablation, however, is that the ablation area cannot be accurately assessed during the procedure. To achieve real-time feedback and exact and safe ablation, a superfine thermocouple-needle system (TNS) comprising a 0.25-mm diameter thermocouple embedded in a 22-G, 15-cm-long needle was devised and efficacy was tested in vitro using porcine livers (n = 15) and in vivo using rabbit back muscles (n = 2) and livers (n = 3). A 17-gauge RF electrode with a 2 cm active tip was used for ablation. The TNS was inserted 1 cm from the active tip of the RF electrode and liver temperature around the electrode was measured concurrently. The RF current was cut off when the temperature reached 60°C or after 5 min at ≥50°C. Porcine livers and rabbit back muscles were then cut along a plane passing through the axes of the electrode and the TNS. In rabbit livers, contrast-enhanced CT was performed to evaluate ablation areas. Ablation areas in cut surfaces of porcine livers exhibited well-defined discoloured regions and the TNS tip precisely pinpointed the margin of the ablation area. Contrast-enhanced CT of rabbit livers showed the TNS tip accurately located at the margin of areas without contrast enhancement. These results indicate that the TNS can accurately show ablation margins and that placing the TNS tip at the intended ablation margin permits exact thermal ablation.
doi:10.1259/bjr/81796498
PMCID: PMC3473833  PMID: 21937618
13.  Particle therapy 
The British Journal of Radiology  2011;84(Spec Iss 1):S001-S003.
doi:10.1259/bjr/33026369
PMCID: PMC3473890  PMID: 22479709
14.  The changing face of brain tumours 
The British Journal of Radiology  2011;84(Spec Iss 2):S079-S081.
doi:10.1259/bjr/92477419
PMCID: PMC3473908  PMID: 22988560
15.  Cardiac imaging—advancing and challenging 
The British Journal of Radiology  2011;84(Spec Iss 3):S227-S228.
doi:10.1259/bjr/36179118
PMCID: PMC3473915  PMID: 22912953
16.  MRI and cardiac pacing devices — beware the rules are changing 
The British Journal of Radiology  2011;84(1005):857-859.
doi:10.1259/bjr/22160941
PMCID: PMC3473776  PMID: 21849369
17.  An unusual cause of persistent subcutaneous fluid collection 
The British Journal of Radiology  2011;84(1005):864-866.
doi:10.1259/bjr/29764457
PMCID: PMC3473790  PMID: 21849371
18.  Head and neck lumps in an Asian male 
The British Journal of Radiology  2011;84(1004):766-767.
doi:10.1259/bjr/50300229
PMCID: PMC3473430  PMID: 21750140
19.  Development of a risk score to guide brain imaging in older patients admitted with falls and confusion 
The British Journal of Radiology  2011;84(1004):756-757.
Objectives
CT scanning of the brain is commonly performed in older people admitted to hospital with a fall, but the yield of positive findings is low. We used audit data to develop a risk-stratification score to guide more efficient use of CT scanning.
Methods
12 potential predictors of positive CT findings were derived from a literature review. Case notes of consecutive patients presenting with falls and confusion who had undergone brain imaging were reviewed as part of an ongoing audit. Correlation of each factor with positive CT findings was undertaken and a final risk score was developed. Receiver-operating characteristic analysis was undertaken, an optimum cut-off identified, and positive and negative predictive values were calculated.
Results
66 patients with a mean age of 74.8 years were included. 13 of the 66 (20%) brain imaging studies revealed a new pathology. Previous history of falls, atrial fibrillation, head or face trauma, focal neurological signs, warfarin use and a Glasgow coma score of <14 were significant univariate positive predictors. Antecedent dementia was included as a negative predictor. The final weighted score (range –1 to 8 points) gave an area under the curve of 0.83 (95% confidence interval 0.70 to 0.96, p<0.001). When using a cut-off of 3 points, sensitivity for significant new pathology on brain imaging was 83%, specificity was 89%, positive predictive value was 63% and negative predictive value was 96%.
Conclusion
A simple weighted risk score may be able to guide the need for brain imaging in older people presenting to hospital with falls. The score requires validation in a larger, prospectively collected cohort.
doi:10.1259/bjr/78864604
PMCID: PMC3473445  PMID: 21750139
20.  Normal variants of the accessory hemiazygos vein 
The British Journal of Radiology  2011;84(1003):659-660.
This short communication describes two normal variants of the accessory hemiazygous vein in a 15-year-old female. The article demonstrates that knowledge of the aberrant venous anatomy and the collateral pathway is important for the practising radiologist.
doi:10.1259/bjr/13695502
PMCID: PMC3473485  PMID: 21697414
21.  Anterior knee pain 
The British Journal of Radiology  2011;84(1003):669-670.
doi:10.1259/bjr/36248329
PMCID: PMC3473497  PMID: 21697416
22.  A patient with neutropenic fever and abdominal pain showing absent bowel wall on CT 
The British Journal of Radiology  2011;84(1001):478-480.
doi:10.1259/bjr/13586512
PMCID: PMC3473660  PMID: 21511752
23.  Lumpy breasts and headache – a crucial ultrasound 
The British Journal of Radiology  2011;84(1000):386-387.
doi:10.1259/bjr/23418860
PMCID: PMC3473467  PMID: 21415304
24.  Beware the cardiac shadow! 
The British Journal of Radiology  2011;84(999):288-290.
doi:10.1259/bjr/18062214
PMCID: PMC3473867  PMID: 21325366
25.  The lumbar sedimentation sign: spinal MRI findings in patients with subarachnoid haemorrhage with no demonstrable intracranial aneurysm 
The British Journal of Radiology  2011;84(999):279-281.
We present a new MRI finding within the lumbar spine in a series of six patients admitted with CT proven subarachnoid haemorrhage (SAH) where cerebral angiography demonstrated no aneurysm and who had not had a lumbar puncture.
A retrospective audit of 130 patients presenting to a regional neurosciences centre over a 13 month period with a suspected diagnosis of SAH was performed. Seven patients with proven SAH underwent MRI of the lumbar spine during the same admission. In six of these patients layering of haemorrhagic blood products was demonstrated within the lumbosacral spine. The process is analogous to the previously ubiquitous bedside erythrocyte sedimentation rate assay and has has been termed the “lumbar sedimentation” sign. This finding has not previously been reported in the literature in relation to SAH.
While this is a small unselected group it may provide a useful adjunct in the diagnosis of SAH.
doi:10.1259/bjr/68122723
PMCID: PMC3473883  PMID: 21325365

Results 1-25 (39)