British Journal of Radiology (BRIT J RADIOL )

Publisher: British Institute of Radiology

Description

The British Journal of Radiology is the official peer reviewed journal of the British Institute of Radiology covering all clinical and technical aspects of diagnostic imaging, radiotherapy and radiobiology.

Impact factor 1.53

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    Impact factor
  • 5-year impact
    1.94
  • Cited half-life
    0.00
  • Immediacy index
    0.26
  • Eigenfactor
    0.01
  • Article influence
    0.61
  • Website
    British Journal of Radiology website
  • Other titles
    British journal of radiology, BJR
  • ISSN
    0007-1285
  • OCLC
    1537310
  • Material type
    Periodical
  • Document type
    Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: To commission a grid block for spatially fractionated grid radiation therapy (SFGRT) treatments and describe its clinical implementation and verification through the record and verify (R&V) system. SFGRT was developed as a treatment modality for bulky tumours that cannot be easily controlled with conventionally fractionated radiation. Treatment is delivered in the form of open-closed areas. Currently, SFGRT is performed by either using a commercially available grid block or a multileaf collimator (MLC) of a linear accelerator. In this work, 6-MV photon beam was used to study dosimetric characteristics of the grid block. We inserted the grid block into a commercially available treatment planning system (TPS), and the feasibility of delivering such treatment plans on a linear accelerator using a R&V system was verified. Dose measurements were performed using a miniature PinPoint(TM) ion chamber (PTW, Freiburg, Germany) in a water phantom and radiochromic film within solid water slabs. PinPoint ion chamber was used to measure the output factors, percentage depth dose (PDD) curves and beam profiles at two depths, depth of maximum dose (zmax) and 10 cm. Film sheets were used to measure dose profiles at zmax and 10-cm depth. The largest observed percentage difference between output factors for the grid block technique calculated by the TPS and measured with the PinPoint ion chamber was 3.6% for the 5 × 5-cm(2) field size. Relatively significant discrepancies between measured and calculated PDD values appear only in the build-up region, which was found to amount to <4%, while a good agreement (differences <2%) at depths beyond zmax was observed. Dose verification comparisons performed between calculated and measured dose distributions were in clinically acceptable agreements. When comparing the MLC-based with the grid block technique, the advantage of treating large tumours with a single field reduces treatment time by at least 3-5 times, having significant impact on patient throughput. The proposed method supports and helps to standardize the clinical implementation of the grid block in a safer and more accurate way. This work describes the method to implement treatment planning for the grid block technique in radiotherapy departments.
    British Journal of Radiology 01/2015; 88(1045):20140363.
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    ABSTRACT: Purpose: To evaluate the diagnostic accuracy of three-dimensional (3D) enhanced T1-high resolution isotropic volume excitation (eTHRIVE) shoulder MR in comparison to two-dimensional (2D) fast spin echo T2 fat saturation MR (T2 FS). Materials and Methods: This retrospective study included 73 patients who underwent shoulder MRI using the eTHRIVE technique. We evaluated anatomic identification and image quality of the shoulder joint on routine MR imaging sequences (axial and oblique coronal T2 FS images) and compared them to the reformatted eTHRIVE images.The images were scored on a four-point scale (0, poor; 1, questionable; 2, adequate; 3, excellent) according to the degree of homogeneous and sufficient fat saturation to penetrate bone and soft tissue, visualization of the glenoid labrum, and distinction of the supraspinatus tendon (SST). The diagnostic accuracy of eTHRIVE images compared to routine MR imaging sequences was evaluated in the setting of rotator cuff tears, glenoid labral injuries, and calcific tendonitis of the SST. Results: Fat saturation scores for eTHRIVE were significantly higher than those of the T2 FS for both radiologists. The sensitivity and accuracy of the T2 FS in diagnosing rotor cuff tears were greater than 90%, whereas sensitivity and accuracy of the eTHRIVE method were significantly lower. The specificity of both images for the diagnosis of labral injuries and calcific tendonitis was higher than the sensitivities. Conclusion: The accuracy of 3D eTHRIVE imaging was comparable to that of 2D FSE T2 FS for the diagnosis of glenoid labral injury and calcific tendonitis of SST. The 3D eTHRIVE technique was superior to 2D FSE T2 FS in terms of fat saturation. Overall, 3D eTHRIVE was inferior to T2FS in the evaluation of rotator cuff tears because of poor contrast between joint fluid and tendons. Advances in knowledge: The accuracy of 3D eTHRIVE imaging is comparable to that of 2D FSE T2 FS for the diagnosis of glenoid labral injury and calcific tendonitis of SST.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Objective: The aim of this study was to investigate a practical method for incorporating radiographers' reports with radiologists' readings of digital mammograms. Methods: This simulation study was conducted using data from a free-response receiver operating characteristic (FROC) observer study obtained with 75 cases (25 malignant, 25 benign, and 25 normal cases) of digital mammograms. Each of the rating scores obtained by six breast radiographers was utilized as a second opinion for four radiologists' readings with the radiographers' reports. A logical "OR" operation with various criteria settings was simulated for deciding an appropriate method to select a radiographer's report in all combinations of radiologists and radiographers. The average figure of merit (FOM) of the radiologists' performances was statistically analyzed using a jackknife procedure (JAFROC) to verify the clinical utility of using radiographers' reports. Results: Potential improvement of the average FOM of the radiologists' performances for identifying malignant microcalcifications could be expected when using radiographers' reports as a second opinion. When the threshold value of 2.6 in BI-RADS assessment was applied to adopt/reject a radiographer's report, FOMs of radiologists' performances were further improved. Conclusion: When using breast radiographers' reports as a second opinion, radiologists' performances potentially improved when reading digital mammograms. It could be anticipated that radiologists' performances were improved further by setting a threshold value on the BI-RADS assessment provided by the radiographers. Advances in knowledge: For the effective use of a radiographer's report as a second opinion, radiographer's rating scores and its criteria setting for adoption/rejection would be necessary.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Peripheral vascular malformations (PVMs) encompass a wide spectrum of lesions that can present as an incidental finding or produce potentially life- or limb-threatening complications. They can have intra articular and intraosseous extensions, which will result in more diverse symptomology and present greater therapeutic challenges. Developments in classification, imaging and interventional techniques have helped to improve outcome. The onus is now placed on appropriate detailed preliminary imaging, diagnosis and classification, to direct management and exclude other more common mimics. Radiologists are thus playing an increasingly important role in multidisciplinary teams charged with the care of these patients. By fully understanding the imaging characteristics and image-guided procedures available, radiologist will be armed with the tools to meet these responsibilities. This review highlights the recent advances made in imaging and options available in interventional therapy.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Objectives: To evaluate involvement of extraocular muscle (EOM) using Diffusion-weighted Imaging (DWI), to determine whether correlation with conventional orbital Magnetic Resonance Imaging (MRI) and Apparent Diffusion Coefficient (ADC) values in patients Graves' Ophthalmopathy (GO). Methods: 35 patients known clinically GO and 21 healthy controls were studied. Patients were assessed with Clinical Activity Scores (CAS). All subjects underwent conventional MRI and DWI study. Involvement of EOM were evaluated. The patients were classified as involved or uninvolved on orbital MRI and compared to ADC values in DWI. Results: There was significant difference in the mean ADC value of all EOM in patients versus controls. The ADC values of the all EOM were higher in patients. There were significant differences in ADC values between uninvolved muscles on conventional MRI and controls in all muscles except inferior rectus muscle. ADC values of medial, lateral and superior rectus muscles were increased. Conclusion: Increased ADC values of EOM in patients with GO suggested that EOM damage begins at a very early stage before being detected on routine orbital MRI. The routine MRI added DWI sequence will be useful adjunct in the selection of a group of patients most likely to benefit from early treatment. Advances in knowledge: This study can help to evaluate the involvement of Graves ophthalmopathy in early period with magnetic resonance imaging added the diffusion weighted imaging.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Chromatin, the structure formed by the wrapping of approximately 146 base pairs of DNA around an octamer of histones, has a profound impact on numerous DNA based processes. Chromatin modifications and chromatin remodellers have recently been implicated in important aspects of the DNA damage response including facilitating the initial sensing of the damage as well as subsequent recruitment of repair factors. Radiation is an effective cancer therapy for a large number of tumours and there is considerable interest in finding approaches that might further increase the efficacy of radiotherapy. The use of radiation leads to the generation of DNA damage and, therefore, agents that can affect the sensing and repair of DNA damage may have an impact on overall radiation efficacy. The chromatin modifications as well as chromatin modifiers that have been associated with the DNA damage response will be summarised in this review. An emphasis will be placed on those processes that can be pharmacologically manipulated with currently available inhibitors. The rationale for the use of these inhibitors in combination with radiation will also be described.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Obliterative portal venopathy (OPV) is an important cause of non-cirrhotic portal hypertension which is often erroneously misdiagnosed as cryptogenic cirrhosis. It has a worldwide distribution with majority of cases hailing from the Asian subcontinent. However, recently the disease has gained global attention especially because of its association with HIV infection and use of anti-retroviral drug therapy (didanosine). As the name suggest the disorder is characterized by sclerosis and obliteration of the intrahepatic portal vein branches (with attendant periportal fibrosis) leading to portal hypertension amid intriguingly little liver dysfunction. It primarily affects young adults who present with clinically significant portal hypertension in the form of episodes of variceal bleed; however, contrasting liver cirrhosis the liver function and liver structure remain normal or near normal until late. Radiological findings during advanced disease are often indistinguishable from cirrhosis often warranting a liver biopsy. Nevertheless, recent studies have suggested that certain imaging manifestations, if present, can help us to prospectively suggest the possibility of OPV. At imaging, OPV is characterized by a wide range of intrahepatic and/or extrahepatic portal venous abnormalities with attendant changes in liver and splenic volume and stiffness. We shall through this pictorial essay appraise the literature and illustrate the germane radiological manifestations of OPV that can be seen using various imaging modalities including ultrasonography, CT, MRI, elastography and hepatic hemodynamic studies.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Purpose: To investigate comparatively the percent gamma passing rate (%GP) of 2D and 3D pretreatment volumetric modulated arc therapy (VMAT) dosimetric verification, and their correlation and sensitivity with percent dosimetric errors (%DE) Materials and methods: %GP of 2D and 3D pretreatment VMAT QA with different acceptance criteria were obtained by ArcCHECK for twenty nasopharyngeal cancer (NPC) patients and 20 esophageal cancer patients. %DE were calculated from planned dose-volume histogram (DVH) and patients' predicted DVH calculated by 3DVH software. Correlation and sensitivity between %GP and %DE was investigated using Pearson's correlation coefficient (r) and receiver operating characteristics (ROC). Results: Relatively higher %DE on some DVH based metrics were observed for both NPC and esophageal cancer patients. Except for 2%/2mm criterion, the average %GPs for all VMAT patients was acceptable with average rates of 97.11%±1.54% and 97.39%±1.37% for 2D and 3D 3%/3mm criterion, respectively. The number of correlation of 3D was higher than that of 2D (21 vs.8). However, the general correlation was still poor for all the analyzed metrics (9 out of 26 for 3D 3%/3mm criterion). The average area under curve (AUC) of ROCs were 0.66±0.12 and 0.71±0.21 for 2D and 3D, respectively. Conclusion: There is a lack of correlation between %GP and %DE for both 2D and 3D pretreatment VMAT dosimetric evaluation. DVH-based dose metrics evaluation obtained from 3DVH will provide more useful analysis. Advances in knowledge: Correlation and sensitivity of %GP with %DE for VMAT QA were studied for the first time.
    British Journal of Radiology 12/2014;
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    ABSTRACT: The partial-volume effect (PVE) is a consequence of limited (i.e. finite) spatial resolution. PVE can lead to quantitative underestimation of activity concentrations in reconstructed images, which may result in misinterpretation of Positron Emission Tomography (PET) scan images, especially in the brain. The PVE becomes significant when the dimensions of a source region are less than two to three times the full-width at half-maximum (FWHM) spatial resolution of the imaging system. Objective: In the current study, the ability of superresolution (SR) image reconstruction to compensate for PVE in PET was characterized. Methods: The ability of the SR image reconstruction technique to recover activity concentrations in small structures was evaluated by comparing images before and after image reconstruction in the NEMA/IEC phantom, the Hoffman brain phantom and in 4 human brain subjects (3 normal subjects and 1 atrophic brain subject) in terms of apparent recovery coefficient (ARC) and percentage yield. Results: Both the ARC and percentage yield are improved after SR implementation in NEMA/IEC phantom and Hoffman brain phantom. When tested in normal subjects, SR implementation can improve the intensity and justify SR efficiency to correct PVE. Conclusion: SR algorithm can be used to effectively correct PVE in PET images. Advances in knowledge: The current research focused on brain PET scanning exclusively; future work will extend to whole-body imaging.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Objectives: To evaluate the risk of radiation pneumonitis (RP) after stereotactic radiotherapy (SBRT) for patients presenting with severe pulmonary emphysema. Methods: This study included 40 patients with stage I non-small cell lung cancer (NSCLC) who underwent SBRT, 75 Gy given in 30 fractions, at Tokyo Medical University between February 2010 and February 2013. The median age of patients was 79 years (range, 49-90), and the male/female ratio was 24/16. There were 20 T1 and 20 T2 tumors. Seventeen patients had emphysema, 6 had slight interstitial changes on CT images, and the remaining 17 had no underlying lung disease. The level of emphysema was classified into three groups according to the modified Goddard's criteria (severe: 3 patients, moderate: 8 patients, mild: 6 patients). Changes in the irradiated lung following SBRT were evaluated by CT. Results: On CT images, RP was detected in thirty-four (85%) patients, and not in six (15%) patients, during a median observation period of 313 days. Of the six patients, three had severe emphysema and three had no underlying lung disease. Patients with severe emphysema had less risk of RP than those with moderate emphysema (P = 0.01), mild emphysema (P = 0.04), and no underlying lung disease (P = 0.01). Conclusions: Patients with severe emphysema had a low risk of RP following SBRT. Advances in knowledge: Little is known about the association between radiation pneumonitis and pulmonary emphysema. Patients with severe emphysema had less risk of radiation pneumonitis than those with no underlying lung disease.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Objectives: The aim of this study is to use diffusion-weighted MRI to assess the ADC values in the head, body, and tail sections of healthy subjects' pancreas and the relationships between these values and the age, gender, and body mass index (BMI) of the cases. Methods: This study was conducted on 82 participants who referred to Tabesh Medical Imaging Center, Tabriz during 2013. Echo-planar Diffusion-Weighted Imaging (DWI) of the pancreas was done with b-values of 50, 400, and 800 s/mm(2), and ADC values were assessed for the head, body, and tail of the pancreas. Results: The ADC values for the pancreas head, body, and tail in the female participants were significantly greater than male subjects (P < 0.05). ADC values for these parts among subjects with different BMI levels were differed significantly (P < 0.05). Regarding age, there were no statistically meaningful differences among the ADC values for the three parts (P > 0.05). Conclusions: Gender and BMI are effective on the ADC values of these three parts. Thus, regarding special cases and further future studies, knowledge of the basic values based on gender and BMI can help to better diagnostic. Having looked at age factor, it seems that the ADC values were not significantly different. Advances in knowledge: According to mentioned statements it can be clearly said that pancreatic ADC values appear to be influenced by gender and BMI but not by age factor.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Objective: The aim of this study was to identify sources of anatomical misrepresentation due to the location of camera mounting, tumour motion velocity and image processing artefacts in order to optimise the 4DCT scan protocol and improve geometrical-temporal accuracy. Methods: A phantom with an imaging insert was driven with a sinusoidal superior-inferior motion of varying amplitude and period for 4DCT scanning. The length of a high density cube within the insert was measured using treatment planning software to determine the accuracy of its spatial representation. Scan parameters were varied including the tube rotation period and the cine time between reconstructed images. A CT image quality phantom was used to measure various image quality signatures under the scan parameters tested. Results: No significant difference in spatial accuracy was found for 4DCT scans carried out using the wall mounted or couch mounted camera for sinusoidal target motion. Greater spatial accuracy was found for 4DCT scans carried out using a tube rotation speed of 0.5s rather than 1.0s. The reduction in image quality when using a faster rotation speed was not enough to require an increase in patient dose. Conclusions: 4DCT accuracy may be increased by optimising scan parameters, including choosing faster tube rotation speeds. Peak misidentification in the recorded breathing trace leads to spatial artefacts and this risk can be reduced by using a couch mounted infrared camera. Advances in knowledge: This study explicitly shows that 4DCT scan accuracy is improved by scanning with a faster CT tube rotation speed.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Objectives: To compare six different scenarios for correcting for breathing-motion in abdominal Dual-Energy (DE) CT-perfusion measurements. Methods: Rigid (RRComm(80kVp)) and non-rigid (NRComm(80kVp)) registration of commercially available CT-perfusion software, custom non-rigid registration (NRCustom(80kVp), demons algorithm), and a control group (CG(80kVp)) without motion-correction were evaluated using 80kVp images. Additionally, NRCustom was applied to DE-blended (NRCustom(DE)) and virtual non-contrast images (NRCustom(VNC)), yielding six evaluated scenarios. After motion-correction, perfusion maps were calculated using a combined Maximum-Slope/Patlak-model. For qualitative evaluation, three blinded radiologists independently rated motion-correction quality and resulting perfusion maps on a 4-point scale (4=best, 1=worst). For quantitative evaluation, relative changes in metric values, R(2), and residuals of perfusion model fits were calculated. Results: For motion-corrected images mean ratings differed significantly (NRCustom(80kVp) and NRCustom(DE) 3.3, NRComm(80kVp) 3.1, NRCustom(VNC) 2.9, RRComm(80kVp) 2.7, CG(80kVp) 2.7; all p<0.05), except when comparing NRCustom(80kVp) to NRCustom(DE), and RRComm(80kVp) to CG(80kVp). NRCustom(80kVp) and NRCustom(DE) achieved the highest reduction in metric values (NRCustom(80kVp) 48.5%, NRCustom(DE) 45.6%, NRComm(80kVp) 29.2%, NRCustom(VNC) 22.8%, RRComm(80kVp) 0.6%, CG(80kVp) 0%). Regarding perfusion maps, NRCustom(80kVp) and NRCustom(DE) were rated highest (NRCustom(80kVp) 3.1, NRCustom(DE) 3.0, NRComm(80kVp) 2.8, NRCustom(VNC) 2.6, CG(80kVp) 2.5, RRComm(80kVp) 2.4) and had significantly higher R(2) and lower residuals. Correlation between qualitative and quantitative evaluation was low to moderate. Conclusions: Non-rigid motion-correction improves spatial alignment of the target region and fit of CT perfusion models. Using DE-blended and DE-VNC images for deformable registration offers no significant improvement. Advances in knowledge: Non-rigid algorithms improve the quality of abdominal CT-perfusion measurements, but do not benefit from DECT post-processing.
    British Journal of Radiology 12/2014;
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    ABSTRACT: Lung ablation can be used to treat both primary and secondary thoracic malignancies. Evidence to support its use, particularly for metastases from colonic primary tumours, is now strong, with survival data in selected cases, approaching that seen after surgery. Because of this the use of ablative techniques (particularly thermal ablation) is growing and the Royal College of Radiologists predict that the number of patients who could benefit from such treatment may reach in excess of 5000 per year in the UK. Treatment is often limited to larger regional centres and general radiologists often have limited awareness of the current indications and the techniques involved. Furthermore radiologists without any prior experience are frequently expected to interpret post treatment imaging, often performed in the context of acute complications which have occurred after discharge. This review aims to provide an overview of the current indications for pulmonary ablation, together with the techniques involved and the range of post procedural appearances.
    British Journal of Radiology 12/2014;
  • British Journal of Radiology 11/2014;
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    ABSTRACT: Objective: to evaluate the superiority of transcutaneous oxygen pressure (TcPO2) before, during, and after peripheral transluminal angioplasty (PTA) in comparison with ankle brachial index (ABI) in diabetic patients. Methods: 40 consecutive diabetic patients treated by PTA where included. This study show results before, during, and after PTA and their progression for 8 weeks. Results: The TcPO2 increased from 28.11 ± 8.1 mmHg to 48.03 ± 8.4 mm Hg, 8 weeks after PTA (p<0.001). The ABI increased from 0.48 ± 0.38 to 0.77 ± 0.39 after PTA (p<0.001). After PTA, the stenosis of the vessel decreased from 58.33 ± 20.07% to 21.87 ± 13.57% (p<0.001). TcPO2 was determined in all the patients but ABI could not be determined in all patients. Furthermore we determined patients with "false negatives" with an improvement in ABI and "false positives" in 12.5% of patients. Additionally in this study we monitored TcPO2 while performing PTA revealing variations in each phase of the radiological procedure. Conclusions: The increase in TcPO2 measurements following PTA procedure has more specificity and sensitivity than ABI. The use of TcPO2 may represent a more accurate alternative than traditional methods (ABI) used in assessing PTA results. The TcPO2 also allows the radiologist to assess changes in tissue oxygenation during PTA, allowing changes to the procedure and subsequent treatment. Advances in knowledge: This is the first time that a graph is shown with TcPO2 results during PTA performance in many patients.
    British Journal of Radiology 11/2014;
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    ABSTRACT: Objectives: To identify predictive factors for the development of pericardial effusion (PCE) in oesophageal cancer patients treated with chemotherapy and radiotherapy (RT). Methods: From March 2006 to November 2012, oesophageal cancer patients treated with CRT using the following criteria were evaluated: radiation dose more than 50 Gy; heart included in the radiation field; dose volume histogram (DVH) data available for analysis; no previous thoracic surgery; and no PCE before treatment. The diagnosis of PCE was independently determined by two radiologists. Clinical factors, the percentage of heart volume receiving more than 5-60 Gy in increments of 5 Gy (V5-60, respectively), maximum heart dose, and mean heart dose were analysed. Results: A total of 143 oesophageal cancer patients was reviewed retrospectively. The median follow-up by CT was 15 months (range 2.1 - 72.6 months) after RT. PCE developed in 55 patients (38.5%) after RT, and the median time to develop PCE was 3.5 months (range 0.2 - 9.9 months). On univariate analysis, DVH parameters except for V60 were significantly associated with the development of PCE (p < 0.001). No clinical factor was significantly related to the development of PCE. Recursive partitioning analysis including all DVH parameters as variables showed a V10 cut-off value of 72.8% to be the most influential factor Conclusions: The present results showed that DVH parameters are strong independent predictive factors for the development of PCE in patients with oesophageal cancer treated with CRT. Advances in knowledge: Pericardial effusion, Oesophageal cancer, Radiotherapy, Dose volume histogram.
    British Journal of Radiology 11/2014;