The British journal of radiology (Br J Radiol)

Publisher: British Institute of Radiology; HighWire Press, British Institute of Radiology

Journal 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.

Current impact factor: 2.03

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 2.026
2013 Impact Factor 1.533
2012 Impact Factor 1.217
2011 Impact Factor 1.314
2010 Impact Factor 2.062
2009 Impact Factor 2.105
2008 Impact Factor 2.366
2007 Impact Factor 1.773
2006 Impact Factor 1.279
2005 Impact Factor 1.394
2004 Impact Factor 1.232
2003 Impact Factor 1.089
2002 Impact Factor 0.925
2001 Impact Factor 0.959
2000 Impact Factor 0.951
1999 Impact Factor 1.067
1998 Impact Factor 0.867
1997 Impact Factor 0.811
1996 Impact Factor 0.794
1995 Impact Factor 0.675
1994 Impact Factor 0.766
1993 Impact Factor 0.694
1992 Impact Factor 0.671

Impact factor over time

Impact factor

Additional details

5-year impact 1.98
Cited half-life 9.20
Immediacy index 0.30
Eigenfactor 0.01
Article influence 0.67
Website British Journal of Radiology website
Other titles British journal of radiology (Online), The British journal of radiology, BJR
ISSN 1748-880X
OCLC 47629775
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

British Institute of Radiology

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • On funder's repositories, institutional repository or subject-based repositories
    • Publisher's version/PDF can be used on non-commercial open access repositories
    • Published source must be acknowledged
    • Must link to publisher version
    • Authors retain copyright
    • Author copyright and source must be acknowledged with full citation and set statement (see policy)
    • Non-commercial use
    • Publisher last contacted on 20/06/2013
  • Classification

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Determine association of MRI features of extra-abdominal desmoid tumors (DTs) with prognosis. Methods: MRIs for 90 patients with DT were retrospectively reviewed for imaging features associated with biological behavior. The primary endpoint was progression (for lesions managed with chemotherapy, radiation therapy and observation) or recurrence (following surgery). Time to event was studied using univariate and multivariable Cox proportional hazards regression models when accounting for demographic, clinicopathological, and imaging variables. Kaplan-Meier plots were used to estimate event-free rate (EFR). Results: Univariate analysis revealed a significant relationship between EFR and treatment, location, and compartment of origin (subcutaneous, superficial fascial, intramuscular, and deep fascial/intermuscular). None of the imaging features commonly associated with biological behavior of DTs (e.g., shape, enhancement, T2 signal, etc.) or surgical margins (in surgical cases) was associated with EFR. Multivariate analysis showed that treatment modality and compartment of origin were independent predictors of EFR. Superficial and deep fascial lesions had a significantly worse EFR as a group (HR: 3.9; 95% CI: 1.83-8.32; p=0.0004) compared to the subcutaneous and intramuscular lesions as a group. Five-year EFR for the fascial lesions was 18% (95% CI: 6-36%), compared to 57% (95% CI: 25%-79%) for the subcutaneous and intramuscular group. Conclusion: Intra-muscular or subcutaneous DTs may be associated with improved prognosis. If validated on multi-reader and prospective studies, these results can provide for rapid risk stratification at the time of initial MRI. Advances in knowledge: This work has shown that imaging features commonly associated with biological activity of desmoid tumors (e.g., shape, T2 signal, and enhancement) do not appear to be associated with prognosis in patients undergoing a variety of treatment modalities. The compartment of origin of the lesion, which can be determined on pre-operative MRI, was shown to be associated with prognosis, and can allow for risk stratification in patients with DTs.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150308
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The purpose of this study was to compare CT image quality for evaluating urolithiasis using filtered back projection (FBP), statistical iterative reconstruction (IR), and knowledge-based iterative model reconstruction (IMR) according to various scan parameters and radiation doses. Methods: A 5 × 5 × 5 mm(3) uric acid stone was placed in a physical human phantom at the level of the pelvis. Three tube voltages (120, 100, and 80 kV) and four current-time products (100, 70, 30, and 15 mAs) were implemented in twelve scans. Each scan was reconstructed with FBP, statistical IR (level 5, 6, 7), and knowledge-based IMR (Soft Tissue level 1, 2, 3). The radiation dose, objective image quality, and signal-to-noise ratio (SNR) were evaluated, and subjective assessments were performed. Results: The effective doses ranged from 0.095 to 2.621 mSv. Knowledge-based IMR showed better objective image noise and SNR than FBP and statistical IR. The subjective image noise of FBP was worse than that of statistical IR and knowledge-based IMR. The subjective assessment scores deteriorated after a break point of 100 kV and 30 mAs. Conclusion: At the setting of 100 kV and 30 mAs, the radiation dose can be decreased by approximately 84% while keeping the subjective image assessment. Advances in Knowledge: Patients with urolithiasis can be evaluated with ultralow-dose non-enhanced CT using a knowledge-based iterative model reconstruction algorithm at a substantially reduced radiation dose with the imaging quality preserved, thereby minimizing the risks of radiation exposure while providing clinically relevant diagnostic benefits for patients.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150527
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Our anecdotal experience from fetal neuroimaging studies suggests that there are often significant disagreements between the findings of ultrasonography (USS) and in utero MR (iuMR) imaging in cases of antenatally detected supratentorial extra-axial cysts. Although this is a relatively rare clinical situation, it warrants further investigation because of the high risk of other intracranial abnormalities that are likely to cause longterm neuro-developmental problems. Methods: We reviewed 957 consecutive referrals for iuMR of the fetal brain over a 3.5 year period and studied all cases where the referral from USS described supratentorial extra-axial cysts in the fetus. The iuMR imaging was reviewed and a comparison between the results of the two examinations was made. Results: Supratentorial extra-axial cysts were an unusual referral for iuMR occurring in only 13/957 (1.4%) of cases. The findings on USS and iuMR imaging were conflicting in all 13 cases with intracranial pathology being excluded on iuMR imaging in four cases and more significant pathology being shown in nine cases. Abnormalities of the corpus callosum were recognized in association with a cyst in eight cases and this was recognized in only two cases on ultrasonography. Six of those cases also had abnormalities of cortical formation. Conclusions: iuMR imaging should be used in the assessment of pregnancies in which a supratentorial extra-axial cyst has been detected on USS. This is based on the improved primary diagnosis and a high rate of associated brain abnormalities not detected on USS. Advances in Knowledge: Our retrospective observational study examines a range of fetal intracranial abnormalities which are better defined using iuMRI. This is a previously described spectrum of neurodevelopmental anomalies which we suggest would benefit from MR imaging.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150395
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: In Cone Beam Computed Tomography (CBCT), imperfect patient immobility, caused by involuntary movements, is one of the most important causes of artefacts and image quality degradation. Various works in literature address this topic, but seldom the nature of the movement is correlated with the type of artefact and the image degradation in a systematic manner, and the correlation analyzed and explained. Methods: All three types of movements that can occur during a scan - nodding, tilting, and rolling - were applied to a dry skull, in various manners from abrupt to gradual through the entire scan, at different times and angles, over a wide range of displacements. 84 scans were performed, with different skull movements, and the resulting images examined by two skilled radiologists, rated in a 4-point scale, and statistically analyzed. A commercial CBCT machine was used, featuring supine patient positioning. Results: Different types of movements induce different artefacts, in different parts of the anatomy. In general, movement of short duration may lead to double contours (bilateral or monolateral depending upon the angle of the scan at which they occur), while gradual movements result into blurring. Conclusions: Not all movements cause motion artefacts that equally jeopardize the image. Rolling is the type of movement that most severely affects the image diagnostic value. Advances in knowledge: These findings may help practitioners to identify the causes of motion artefacts and the resulting image degradation, and remediate them, and manufacturers to improve the patient positioning devices.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150687
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Micro-computed tomography (micro-CT) is a promising modality to determine breast tumor size of intact lumpectomy specimens in three dimensions. We compared the accuracy of tumor size measurements using specimen micro-CT with measurements using multimodality preoperative imaging. Methods: A tabletop micro-CT was used to image breast lumpectomy specimens. The largest tumor dimension on 3-dimensional reconstructed micro-CT images of the specimen was compared with the measurements determined by preoperative mammography, ultrasound and MRI. The largest dimension of pathologic invasive cancer size was used as the gold standard reference to assess the accuracy of imaging assessments. Results: 50 invasive breast cancer specimens in 50 patients had micro-CT imaging. 42 were invasive ductal carcinoma, 6 were invasive lobular carcinoma, 2 were other invasive cancer. Median patient age was 63(range 33-82) years. When compared with pathologic largest tumor dimension, micro-CT measurements had the best correlation coefficient (r = 0.82, p <0.001) followed by MRI (0.78, p <0.001), ultrasound (r = 0.61, p <0.001) and mammography (r = 0.40, p <0.01). When compared with preoperative modalities, micro-CT had the best correlation coefficient (r = 0.86, p <0.001) with MRI, followed by ultrasound (r = 0.60, p <0.001) and mammography (r = 0.54, p <0.001). Overall, Mammography and ultrasound tended to underestimate the largest tumor dimension, while MRI and micro-CT overestimated largest tumor dimension more frequently. Conclusions: Micro-CT is a potentially useful tool for accurate assessment of tumor dimensions within a lumpectomy specimen. Future studies need to be done to see if this technology could have a role in margin assessment. Advances in knowledge: Micro-CT is a promising new technique which could potentially be used for rapid assessment of breast cancer dimensions in an intact lumpectomy specimen in order to guide surgical excision.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150581
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ultrasound in the emergency room has long been recognized as a powerful screening and diagnostic tool for both physicians and radiologists. In the emergency department, since time is of the essence, it becomes a critical tool in triaging patients. Over the years, ultrasound has gained several advantages over other modalities because of its non-ionizing radiation, portability, accessibility, non-invasive method and simpler learning curve. As a result, ultrasound has become one of the most frequently used diagnostic tools in the emergency room by non-radiologist. The value of ultrasound is implemented in every acute aliment in the emergency department such as trauma, acute abdomen, acute pelvic pain, acute scrotal pain, appendicitis in children, and acute deep venous thrombosis. Our objective is to discuss the benefit of using ultrasound as the primary modality for each of these diseases.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150790
  • [Show abstract] [Hide abstract]
    ABSTRACT: Post-mortem cross-sectional imaging in the form of CT and, less frequently, MRI is an emerging facility in the evaluation of cause-of-death and human identification for the coronial service as well as in assisting the forensic investigation of suspicious deaths and homicide. There are marked differences between the radiological evaluation and interpretation of the CT and MR imaging features of the live patient (ie. ante-mortem imaging) and the evaluation and interpretation of post-mortem CT and MR imaging appearances. In addition to the absence of frequently utilised tissue enhancement following intravenous contrast administration in ante-mortem imaging, there are a number of variable changes which occur in the tissues and organs of the body as a normal process following death, some of which are, in addition, affected significantly by environmental factors. Many patients and victims will also have undergone aggressive attempts at cardiopulmonary resuscitation in the peri-mortem period which will also significantly alter post-mortem CT and MR imaging appearances. It is paramount that the radiologist and pathologist engaged in the interpretation of such post-mortem imaging are familiar with the appropriate non-pathological imaging changes germane to death, the post-mortem interval and cardiopulmonary resuscitation in order to avoid erroneously attributing such changes to trauma or pathology. Some of the more frequently encountered radiological imaging considerations of this nature will be reviewed.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150851
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ultrasound is well known as a low-cost, radiation-free and effective imaging technique to guide percutaneous procedures. The lower limb muscles represent a good target to perform such procedures under ultrasound guidance, thus allowing for clear and precise visualization of the needle during the whole path. The knowledge of guidelines and technical aspects is mandatory to act in the most safe and accurate way on target tissues that can be as small as a few millimeters. This review will focus above the local treatments of traumatic lower limb muscle injuries described in literature, focusing on new and promising approaches, such as platelet-rich plasma (PRP) treatment of muscle tears in athletes. For each procedure, a brief how-to-do practical guide will be provided, emphasizing precautions and tricks based on day-by-day experience that may help to improve the outcome of percutaneous ultrasound-guided procedures around the lower limb muscles.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150484
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: This study evaluated the radiation dose and image quality implications of dual-energy CT (DECT) use, compared with kilovoltage optimised single source/ single energy CT (SECT) on a dual source Siemens Somatom Definition Flash CT scanner. Methods: With equalised radiation dose (CTDIvol), image noise (standard deviation of CT number) and signal difference to noise ratio (SDNR) were measured and compared across three (3) techniques: 100kVp, 120kVp and 100/140kVp (dual energy). Noise in a 30cm diameter water phantom, and SDNR within unenhanced soft tissue regions of a small adult (50kg/165cm) anthropomorphic phantom were utilised for the assessment. Results: Water phantom image noise decreased with DECT compared to the lower noise SECT setting of 120kVp (p=0.046). A decrease in SDNR within the anthropomorphic phantom was demonstrated at 120kVp compared with the SECT kilovoltage optimised setting of 100kVp (p=0.001). A further decrease in SDNR was observed for the DECT technique when compared with 120kVp (p=0.01). Conclusion: On the Siemens Somatom Definition Flash system, and for equalised radiation dose conditions, image quality expressed as SDNR of unenhanced soft tissue may be compromised for DECT when compared with kilovoltage optimised SECT, particularly for smaller patients. Advancement in knowledge: DECT on a dual source CT scanner may require a radiation dose increase to maintain unenhanced soft tissue contrast detectability, particularly for smaller patients.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150486
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Risk of nodal involvement in patients with sinonasal small cell and sinonasal undifferentiated carcinomas has not been well defined due their rarity. We describe a population-based assessment of specific nodal level involvement in this group of rare neuroectodermal tumors. Methods: The Surveillance, Epidemiology and End Results (SEER) database from 2004-2011 identified patients with sinonasal undifferentiated (SNUC) and small cell carcinomas. Overall neck involvement and individual nodal level involvement at presentation were assessed, and comparison made with a contemporaneous cohort of patients with a borderline clinically significant risk of nodal involvement and recurrence. Results: Of 141 patients, 31 (22%) had gross nodal involvement at presentation (range 14-33% by site and histology). Non-nasal, non-ethmoid site with SNUC histology has the highest rates of initial nodal involvement, whereas higher stage and size do not predict for higher nodal involvement rates. Bilateral levels 2-3 for all sinonasal small cell, levels 2-3 for nasal or ethmoid SNUC, and bilateral levels 1-3 in non-nasal/non-ethmoid SNUC have the highest rates of involvement compared to a clinical reference standard. Conclusions: We find high rates of initial nodal involvement in all SNUC and sinonasal small cell carcinoma. We find higher initial involvement of levels 2 and 3 and in certain cases to the level 1 nodal levels, hypothesizing benefit for elective treatment to those levels. Advances in Knowledge: With small single-institution series reporting conflicting nodal involvement rates, our data supports high rates of nodal presentation at diagnosis, hypothesizing benefit for elective nodal treatment in this cohort.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150488
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: We aimed to analyze the peak CT number (PEAK) in CT number histogram of ground-glass nodules (GGN), meaning the most frequent density of pixels in the image of pulmonary nodule, based on three-dimensional reconstructive model preoperatively, and mean rate of PEAK change (V-PEAK) during a follow-up of GGN for differential diagnosis between pre-invasive (PIA) and invasive adenocarcinoma (IAC). Methods: CT number histogram of pixels in GGN was made automatically by 3D measurement software. Diameter, total volume, PEAK and V-PEAK were measured from CT datasets of different groups classified by pathology, subtype and number of GGNs respectively. Results: Among all 102 cases, 47 were PIA, including atypical adenomatous hyperplasia (AAH, n=29) and adenocarcinoma in situ (AIS, n=18), and 55 were IAC, including minimally invasive adenocarcinoma (MIA, n=4). By Wilcoxon test, PEAK of IAC was significantly higher than that of PIA (p<0.001). By ROC analysis, area under the curve (AUC) was 0.857 and threshold -820.50 Hounsfield units (HU) for differentiation between PIA and IAC. V-PEAK of IAC was unexpectedly remarkable smaller than that of PIA (p<0.001) with AUC and threshold being 0.810 and -0.829 HU/day respectively. Conclusion: Preoperative PEAK and V-PEAK, which interpret and evaluate the change of volume and density of pulmonary nodule simultaneously from a both exterior and interior perspective, can help to distinguish invasive adenocarcinoma from pre-invasive adenocarcinoma. Advances in knowledge: This study provided researchers of GGN another perspective taking both volume and density of nodules into consideration for pathological evaluation.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150556
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: To identify radiological parameters that should be reported on gynaecological MRI in order to create a standardized assessment pro forma for reporting CPP, which may be used in clinical practice. Methods: Chronic pelvic pain (CPP) in females is a common problem presenting a major challenge to healthcare providers. The complex multifactorial aetiology requires a multidisciplinary approach and often necessitates diagnostic laparoscopy for assessment. MRI is emerging as a potential non-invasive alternative for evaluation of CPP; however, standardization of reporting is required for it to be used in routine clinical practice. A two-generational Delphi survey with an expert panel of 28 radiologists specializing in gynaecological MRI from across the UK was used to refine a proposed reporting template for CPP. Results: 75% response rate for the first round and 79% for the second. Following the second round, agreement was reached on the structure of the pro forma and the way in which information was sought, with overall consistency of agreement between experts deemed as fair (intraclass correlation coefficient = 0.394). This was accepted as the final version by consensus. Conclusion: The standardized pro forma developed in this study will form the basis for future prospective evaluation of MRI in CPP. This template could be modified for the assessment of other benign gynaecological conditions. Advances in knowledge: Female CPP is a significant problem presenting challenges for clinicians. MRI is often used for evaluation and standardization of techniques, and reporting is required. The pro forma developed in this study will form the basis for future prospective MRI evaluation.
    The British journal of radiology 11/2015; 89(1057):20140615. DOI:10.1259/bjr.20140615
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Contrast media (CM) is a major cause of nephropathy in high-risk patients. The aim of this study was to examine the effects of carnitine in advanced nephrotoxicity due to CM administration in rats with glycerol-induced renal functional disorder. Methods: Forty rats were divided randomly into five groups (n=8): 1) healthy group; 2) glycerol only (GLY); 3) glycerol and CM (GLY+CM); 4) glycerol, CM, and 200mg/kg carnitine (CAR200); and 5) glycerol, CM, and 400mg/kg carnitine (CAR400). Kidney injury was induced with a single-dose, intramuscular injection of 10 ml/kg body weight (b.w.) of GLY. CAR was administered intraperitoneally. CM (8 ml/kg b.w. iohexol) was infused via the tail vein to the rats in groups 3, 4, and 5. Results: L-carnitine administration significantly decreased serum creatinine and blood urea nitrogen levels. Superoxide dismutase and glutathione activity increased significantly in the treatment groups compared to the nephrotoxic groups. CAR400 significantly reduced malondialdehyde levels to healthy levels. In the treatment groups, tumor necrosis factor (TNF)-α, transforming growth factor 1β, interleukin 1β, and caspase-3 gene expression decreased compared with the nephrotoxic groups. TNF-α and nuclear factor kappa-beta (NF-κB) protein expression increased after CM and CAR administration reduced both TNF-α and NF-κB expression. Histopathologically, hyaline and hemorrhagic casts and necrosis in proximal tubules increased in the nephrotoxicity groups and decreased in the CAR groups. Conclusions: The results reveal that L-carnitine protects the oxidant/antioxidant balance and decreases proinflammatory cytokines and apoptosis in CM-induced nephrotoxicity in rats with underlying pathology. Advances in knowledge: Depending on the underlying kidney pathologies, the incidence of contrast media-induced nephropathy (CIN) increases. Therefore, this is the best model to represent clinically observed CIN.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20140724
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Testing the hypothesis that CT densitometry indexes could be influenced by total lung capacity (TLC), gender, and height in normal individuals. Methods: In this ethics committee-approved prospective study, 100 healthy non-smoking volunteers who provided written informed consent were included. From a helical scan of the chest, relative area of lung with attenuation coefficients lower than -960HU and the 1(st) and 15(th) percentiles of the distribution of attenuation coefficients were calculated. Regression lines were drawn between each CT index and volunteers' height and total TLC at CT. Results: In men, there was no statistically significant correlation between any CT index and height. In women, there was a statistically significant correlation between relative area of lung with attenuation coefficients lower than -960HU and the 1(st) percentile and height but not with the 15(th) percentile. For both genders, there were significant correlations between all CT indexes and TLC. The relationships between CT indexes and TLC were different in men and in women. Conclusion: CT indexes are correlated with TLC and height but more closely with TLC than with height, and differently in men and women. Advances in knowledge: CT indexes are influenced by total lung capacity, gender, and height in normal individuals and are more closely correlated with total lung capacity than with height. The relationships between CT indexes and total lung capacity or height are different in men and women. CT indexes used to quantify emphysema should thus be adjusted according to total lung capacity and gender.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150631
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft tissue mammographic abnormalities. Methods: Women recalled for further assessment of soft tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymisation of cases, there was also a retrospective multireader review. The readers first read bilateral standard two view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five point scale. The same readers then read bilateral standard two view DM together with two view DBT. Pathology data was obtained. Differences were assessed using ROC analysis. Results: The study population was 342 lesions in 322 patients. Final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two view DM plus DBT was at least equivalent to the performance of two view DM and standard mammographic supplementary views - area under the curve (AUC) was 0.946 and 0.922 respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review - AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. Conclusion: The accuracy of GE DBT in the assessment of screen detected soft tissue abnormalities is equivalent to the use of standard supplementary mammographic views. Advances in knowledge: The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft tissue screen detected abnormalities.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150735
  • [Show abstract] [Hide abstract]
    ABSTRACT: Post-transplant lymphoproliferative disease (PTLD) is a major cause of morbidity and mortality following both solid organ and hematopoietic stem cell transplantation (HSCT). PTLD has a broad range of manifestations with extranodal involvement more common in the abdomen than nodal involvement. FDG-PET/CT is sensitive and specific to detect PTLD and can upstage or detect occult PTLD compared to conventional CT imaging. As functional imaging, FDG-PET/CT also has a role in monitoring treatment response. In this pictorial essay we will discuss the role of FDG-PET/CT in the diagnosis and staging of abdominal PTLD and describe the advantages of functional imaging in assessing response to therapy.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150844
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Investigate impact of evolving ICRP recommendations concerning calculation of effective dose (E) and compare updated typical UK values for common CT examinations with previous data. Methods: Monte Carlo simulations have provided normalised organ doses relating to 15 CT scanner models and 5 virtual reference adults. Series of representative E/DLP coefficients were derived for common examinations on the separate bases of not only older stylised mathematical phantoms and voxel phantoms presently recommended by ICRP, but also the 1977, 1990 and 2007 formulations for E. Updated E/DLP coefficients were applied to typical values of DLP from the 2011 UK survey. Results: Changes in ICRP recommendations, from improving evidence on stochastic risk, influence values of E by up to a factor 2 for CT examinations of the head and neck, although differences for the trunk typically amount to ±10%. Adoption of the voxel rather than the mathematical phantoms used previously can lead to further changes in E by a few tens of percent. Updated typical values of E for UK CT examinations range from 2 to 20 mSv. Increases by 20-400% since 2003 arise not only from increases by 30-160% in typical values of DLP, but also increases by 30-90% in relation to E/DLP coefficients for examinations of the trunk. Conclusions: Values of E, including updated typical data for UK CT, should be compared with caution in relation to their purpose and underlying factors concerning their calculation. Advances in knowledge: Updated E/DLP coefficients and typical values of E for UK CT, and an appreciation of factors influencing these data.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150346
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose/objective: Neoadjuvant 'long-course' chemoradiation is considered a standard of care in locally advanced rectal cancer. In addition to prostatectomy, external beam radiotherapy and brachytherapy with or without androgen suppression (AS) are well established in prostate cancer management. A retrospective review of ten cases was completed to explore the feasibility and safety of applying these standards in patients with dual pathology. To our knowledge this is the largest case series of synchronous rectal and prostate cancers treated with curative intent. Materials and methods: Eligible patients had synchronous histologically proven locally advanced rectal cancer (defined as cT3-4Nx; cTxN1-2) and non-metastatic prostate cancer (pelvic nodal disease permissible). Curative treatment was delivered to both sites simultaneously. Follow up was per institutional guidelines. Acute and late toxicities were reviewed and a literature search performed. Results: Pelvic EBRT 45- 50.4Gy was delivered concurrent with 5-fluorouracil (5-FU). Prostate total dose ranged from 70- 79.2Gy. No acute toxicities occurred, excluding AS-induced erectile dysfunction. Nine patients proceeded to surgery and one was managed expectantly. Three relapsed with metastatic colorectal cancer, two with metastatic prostate cancer. Five patients have no evidence of recurrence, four remain alive with metastatic disease. With median follow-up of 2.2 years (range 1.2- 6.3 years) two significant late toxicities occurred; G3 proctitis in a patient receiving palliative bevacizumab and a G3 anastomotic stricture precluding stoma reversal. Conclusions: Patients proceeding to synchronous radical treatment of both primary sites should receive 45- 50.4Gy pelvic RT with infusional 5-FU. Prostate dose escalation should be given with due consideration to the potential impact of prostate cancer on patient survival as increasing dose may result in significant late morbidity. Review of published series explores the possibility of prostate brachytherapy as an alternative method of boost delivery. Frequent use of bevacizumab in metastatic rectal cancer may compound late rectal morbidity in this cohort. Advances in knowledge: To our knowledge this is the largest case series of synchronous rectal and prostate cancers treated with curative intent. This article contributes to the understanding of how best to approach definitive treatment in these patients.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150292
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To assess the use of a commercial dose management system (GE DoseWatch) for CT dose management for six common CT examinations. Methods: Data was acquired over several months using GE DoseWatch for six common CT examinations on three CT scanners. The dose length product (DLP) was taken as the dose indicator. The data was analysed using four different filtering methods: study description, NICIP code, protocol name and a more detailed filtering method (the reference dataset). The filtering methods were compared using an ANOVA analysis and multiple comparison technique. The different scanners were compared using the reference dataset. Results: It was found that integrating DoseWatch with the RIS system provided improved results compared to using the study description. Filtering by study description was found to be a poor indicator of the mean dose for all three scanners and consistently over-estimated (p<0.05) the head and thorax-abdo-pelvis mean DLP values, despite the large sample sizes. Filtering by the NICIP code or protocol name produced mean DLPs which were not statistically different from the reference data. The scanner inter-comparison showed some significant differences between the scanners, usually due to different tube current modulation settings. Conclusion: The use of a commercial dose monitoring system provided fast and efficient filtering of substantial amounts of data. The filtering method affected the mean DLP despite large sample sizes. Advances in Knowledge: Dose management systems are relatively new in the UK and this paper shares knowledge on the use of one system.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150617
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To prospectively evaluate the ability of dual-energy computed tomography, compared with magnetic resonance imaging, to identify vertebral compression fractures in acute trauma patients. Methods: This institutional review board-approved study included 23 consecutive patients with 32 vertebral fractures who underwent both dual-energy computed tomography and magnetic resonance imaging of the spine between February 2014 and September 2014. A total of 209 vertebrae were evaluated for the presence of abnormal bone marrow attenuation on dual-energy computed tomography and signal on magnetic resonance imaging by five experienced radiologists. The specificity, sensitivity, predictive values, and intra- and inter-observer agreements were calculated. Results: MRI revealed a total of 47 vertebrae (22.4% of all vertebrae) and dual-energy computed tomography revealed 44 vertebrae (21% of all vertebrae) with edema. Using MRI as the reference standard, dual-energy computed tomography had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the detection of vertebral edema 89.3%, 98.7%, 95.4%, 96.9%, and 96.6 %, respectively. With respect to establishing the presence of edema, the inter-observer agreement was almost perfect (k = 0.82), and the intra-observer agreement was substantial (k = 0.80). Conclusion: Compared with magnetic resonance imaging, dual-energy computed tomography can provide an accurate demonstration of acute vertebral fractures and can be used as an alternative imaging modality for the assessment of vertebra fractures in patients with contraindications for magnetic resonance imaging. Advances in knowledge: Distinguishing of acute and chronic vertebral compression fracture is important for treatment choices. DECT is very fast comparing to MRI and is an alternative imaging modality for the assessment of vertebra fractures in patients with contraindications for magnetic resonance imaging.
    The British journal of radiology 11/2015; DOI:10.1259/bjr.20150300