Hyperthennia is rapidly becaning the fourth IIDdality of cancer treatment, at least a useful adjuvant to radiation therapy, chEfiO therapy or surgery; at best, a new therapeutic fonn that, properly used, may open new horizons in the fight against this dreadful disease. The staging is still primitive. The devices used are after laboratory irrprovisations, and lack the precision and definition of treatment fields that will allow mass use of the m: Xiality. Clinical practices are limited to the procedural evaluations of a few pioneer groups, and basic understanding of its mechanism of action, although progressing by leaps and bounds, is still short of perfection. The challenge and the pranise are there and because of this, p engineers, physicists, biologists, physiologists and clinicians fran different specialties have a basic need for interaction, both in tenus of exchange of scientific infonnation and peer review of results and clinical trials. To satisfy this need, to act as a clearinghouse of knowledge and a fonnn for discussion, the North Alrerican Hyperthennia Group (NAHG) has been fonned. The reeting in Detroit in August 1981 represents the first gathering of the group, to be followed by a second in Salt Lake City in April 1982."

We are pleased to present this second volume of a series that has already received much interest. The application of magnetic resonance methods to the study of actual biological systems as contrasted to cell-free samples, although not entirely novel, as demonstrated by Civan and Shporer in Volume I, has taken on new dimensions with the use of phosphorus-31 and carbon-13 NMR in studying cells, tissues, and organelles. The applications of 31 P NMR to such systems is reviewed in this volume, while carbon-13 will be covered in a later one. The use of nitroxide spin labels has grown to the point where it now may be considered a common biological technique. The synthesis and applications of a new class of nitroxides is described in this volume. ESR spectroscopy of paramagnetic ions is a powerful approach to studying molecular and structural details, as the chapter by Boas, Pilbrow, and Smith on the ESR of copper in Volume 1 has shown. In this volume the ESR of molybdenum and iron is treated in a comparable fashion. In the first volume some aspects of 1 H NMR spectroscopy of certain classes of In this volume the high-resolu biological macromolecules were discussed.. tion multinuclear NMR spectra of peptides, including the physiologically significant peptide hormones, are reviewed."

The seventh annual multidisciplinary symposium on clinical oncology organised by the Royal College of Radiologists discussed the subject of malignant brain tumours. It was held in London in February 1985 and this volume collects together the edited texts of the papers which were presented at the meeting. Primary tumours of the central nervous system account for about 9070 of all malignant diseases but as much as 20% of all paediatric neoplasms. The prognosis ranges from excellent for some of the less aggressive tumours, through good for children's tumours such as medulloblastoma, to appalling for the high-grade adult astrocytomas. Improvements in pathological diagnosis and surgical and radiothera peutic techniques have led to considerable sequential improvements in outcome over those obtained in the past. In contrast the response to chemotherapy over the whole range of tumours remains disappoint ing, and clearly awaits new drugs and methods of delivery. The relative rarity of individual types of tumours, apart from the commoner high-grade adult astrocytomas, has made progress in terms of clinical trials difficult to organise. In spite of this much investigative work is in progress. The symposium, and the present volume, were designed to provide a comprehensive overview of the subject by experts, with an emphasis on the possible routes to future progress. The topics included aspects of pathology, imaging, diagno sis and treatment of both the common and uncommon primary tumours. It is hoped the papers will stimulate further interest and activity in this difficult area of clinical therapy and investigation."

In Vivo EPR (ESR) is a textbook on this relatively new subject in biomedical electron spin resonance. While a few chapters have appeared in special topics volumes in this series, this book covers the principles and theory, instrumentation as well as the latest applications at the time of its writing. The authors are world-renowned experts and pioneers in their fields. This book is divided into two major sections dealing with theory and instrumentation, and aspects of biochemistry, in vitro and in vivo applications. A significant amount of detail is devoted to clinical applications and the problems and pitfalls encountered in in vivo spectroscopy and imaging.
Key Features:

-History of In Vivo EPR,
-Principles of Imaging-Theory and Instrumentation,
-Time-domain Radio Frequency EPR Imaging,
-The Measurement of Oxygen In Vivo Using In Vivo EPR Techniques,
-Potential Medical (Clinical) Applications of EPR,
-Combining NMR and EPR/ESR for In Vivo Experiments.

An in-depth introduction to radiotherapy physics emphasizing the clinical aspects of the field. This second edition gradually and sequentially develops each of its topics in clear and concise language. It includes important mathematical analyses, yet is written so that these sections can be skipped, if desired, without compromising understanding. The book consists of seven parts covering basic physics (Parts I-II), equipment for radiotherapy (Part III), radiation dosimetry (Parts IV-V), radiation treatment planning (Part VI), and radiation safety and shielding (Part VII). An invaluable text for radiation oncologists, radiation therapists, and clinical physicists.

In June 1998 the Fourth International Workshop on Digital Mammography was held in Nijmegen, The Netherlands, where it was hosted by the department of Radiology of the University Hospital Nijmegen. This series of meetings was initiated at the 1993 SPIE Biomedical Image Processing Conference in San Jose, USA, where a number of sessions were entirely devoted to mammographic image analysis. At very successful subsequent workshops held in York, UK (1994) and Chicago, USA (1996), the scope of the conference was broadened, establishing a platform for presentation and discussion of new developments in digital mammog raphy. Topics that are addressed at these meetings are computer-aided diagnosis, image processing, detector development, system design, observer performance and clinical evaluation. The goal is to bring researchers from universities, breast cancer experts, and engineers together, to exchange information and present new scientific developments in this rapidly evolving field. This book contains all the scientific papers and posters presented at the work shop in Nijmegen. Contributions came from as many as 20 different countries and 190 participants attended the meeting. At a technical exhibit companies demon strated new products and work in progress. Abstracts of all papers were reviewed by members of the scientific committee. Many of the accepted papers had excellent quality, but due to limited space not all of them could be included as full papers in these proceedings. Papers that were rated high by the reviewers are included as long or short papers, others appear as extended abstracts in the last chapter.

Immunofluorescence, a suitable laboratory method for the microscopic demonstration of antigens and antibodies in biological materials, useable, for example, to provide evidence for the pathogenesis of disease in histological or cytological preparations and for tumour cell differentiation. For this reason immunofluorescence has a decisive role as the method of choice for the diagnosis of auto-immune diseases. This primer on immunofluorescence techniques, which first appeared in 1979, is a richly illustrated handbook suitable for everyday practical work in the laboratory, useable as both an introduction to the subject as well as an atlas. In hardly any other area of medicine are there so many new findings to report. The second edition of this book is concerned not only with the detection methods which now form an essential and established part of diagnostic techniques, but also with the most recent research results such as the discovery of antibodies against Auerbach's plexus and against podocytes...

This book provides a comprehensive up-to-date review of optical approaches used in brain imaging and therapy. It covers a variety of imaging approaches including diffuse optical imaging, laser speckle imaging, photoacoustic imaging and optical coherence tomography. A number of laser-based therapeutic techniques are reviewed, including photodynamic therapy, fluorescence guided resection and photothermal therapy. Fundamental principles and instrumentation are discussed for each imaging and therapeutic approach.

It was at Frankfurt/Mainin 1899 that Paul Ehrlich first expounded his famous "site-chain theory" -which described the basic immunological principal of antibody-antigen interactio- on the occasion of the opening of the Institute for Experimental Therapeutics (which was later named after him). Nearly 100 years have passed since, and in retrospect it can be said that the "Ehrlich Era" (first steps in immunology "Magic Bullet" concept) and the "Behring Era" (detection of antibodies and serum therapy) formed the essential basis in the development of immunology. Niels K. Jerne, the former director of the Paul Ehrlich Institute in Frankfurt/Main received, together with Georges Kohler and Cesar Milstein, the Nobel Prize in Medicine 1984. These late successors of Ehrlich and Behring first described the hybridoma technology (in 1975) which enabled one of the most important and revolutionary technological innovations in the field of immunology -the production of monoclonal antibodies. It happens that, the time of the publication of this book, just a decade has passed since the first use of radiolabelled monoclonal antibodies in man (by the Lausanne Group). Over these 10 years a tremendous progress has taken place in the field of immunoscintigraphy: A large panel of highly specific monoclonal antibodies against tumour-associated antigens as well as normal cell compounds have been developed. Enormous progress has been made in the field of radiolabelling -from iodine-131 to technetium-99mor even positron-emittingradionuclides, e. g. iodine-124.

Glossary 4 Chapter 1: Basics of Cardiac Magnetic Resonance and 6 Normal Views 1. 1 Definition and Physical Basics 6 a. Definition and historical background 6 b. Physical basics 6 1. 2 Technical Modalities 10 a. Spin echo 12 b. Gradient echo 12 c. Fast gradient echo 13 d. Specialized techniques 13 e. Techniques under clinical investigation 13 1. 3 Study Methodology: Normal Anatomy 13 a. Technical equipment 13 b. Medical personnel 13 c. Preparation of the patient 13 d. Normal MRI anatomy 17 References 17 Chapter 2: Ventricular Morphology and Function: Study of 26 Cardiomyopathies 2. 1 Morphological Study of Heart Chambers 26 a. Left ventricle 26 b. Right ventricle 31 2. 2 Ventricular Function 31 a. Left ventricular function 31 b. Right ventricular function 33 2. 3 Cardiomyopathies 33 a. Dilated cardiomyopathy 33 b. Hypertrophic cardiomyopathy 33 c. Restrictive cardiomyopathy 35 d. Arrhythmogenic dysplasia of the right ventricle 35 References 35 (f) Chapter 3: Acquired Diseases of the Aorta 38 I c 3. 1 Technical Aspects of the Aortic Study by MRI: Imaging the Normal Aorta 38 3. 2 Aortic Aneurysm 43 3. 3 Aortic Dissection and Related Entities OJ 43 a. Strategy for the study of aortic dissection by MRI 43 I b. Differential diagnosis of aortic dissection by MRI 47 References 49 c o U . ;jj Chapter 4: Study of Valvular Heart Disease 54 4. 1 Introduction 54 4. 2 Velocity Calculation and Flow Quantitation 54 4.

..". I would recommend this book for an in-depth analysis of the lumbar spine and its degenerative states ... extremely beneficial for the resident early in trainings as he or she attempts to correlate the complex anatomy of the lumbosacral region with associated pathological states ... Journal of Neurosurgery"

In recent years there have been major advances in the fields of cardiovascular nuclear medicine and cardiac magnetic resonance imaging. In nuclear cardiology more adequate tomographic systems have been designed for routine cardiac use, as well as new or improved quantitative analytic software packages both for planar and tomographic studies implemented on modern state-of-the-art workstations. In addition, artificial intelligence techniques are being applied to these images in attempts to interpret the nuclear studies in a more objective and reproducible manner. Various new radiotracers have been developed, such as antimyosin, labeled isonitriles, metabolic compounds, etc. Furthermore, alternative stress testing with dipyridamole and dobutamine has received much attention in clinical cardiac practice. Magnetic resonance imaging is a relative newcomer in cardiology and has already shown its merits, not only for anatomical information but increasingly for the functional aspects of cardiac performance. This book covers almost every aspect of quantitative cardiovascular nuclear medicine and magnetic resonance imaging. It will assist the nuclear medicine physician, the radiologist, the physicist/image processing specialist and the clinical cardiologist in understanding the nuclear medicine techniques used in cardiovascular medicine, and in increasing our knowledge of cardiac magnetic resonance imaging.

It is with pleasure that I write this foreword for the book "Magnetic Resonance Imaging in Coronary Artery Disease", edited by Dr. van der Wall and Dr. de Roos. I am pleased for two reasons. Firstly, as chairman of the Scientific Board of the Interuniversity Cardiology Institute of the Netherlands (ICIN), because ever since the technique became available for use in medicine and biology our Institute has tried and succeeded to promote the introduction and dev- opment of magnetic resonance imaging in cardiology in the Netherlands. ICIN was the first cardiological institute on the European continent to purchase its own nuclear magnetic resonance spectroscope for the study of myocardial metabolism. Secondly, because I have always been infatuated with this noninvasive technique that can produce cardiac images without ionic radiation and at the same time allows for the study of myocardial metabolism as well. And even more so because nuclear magnetic resonance imaging in medicine is one of the shining examples of medical progress as a result of breakthrough discoveries in physics and chemistry.

Despite the many advances made in the diagnosis and therapy of cancer, the mortality rate is still about half that of the incidence rate. However, the odds are not evenly distributed. Prognosis for some cancers is good, but for others, few patients will survive 12 months. This latter group of cancers is characterised by a proclivity to disseminate malignant cells in the host organ. The degree of surgery possible may be limited by the critical nature of the organ, and chemotherapy and radiotherapy are of palliative value only. In some cases systemic metastases occur, but in other cases, failure to achieve local control results in death. First among these cancers are the high grade brain tumours, astrocytoma 3,4 and glioblastoma multiforme. Local control of these tumours should lead to cure. Other cancers melanoma metastatic to the brain, for which a useful palliative therapy is not yet available, and pancreatic cancer for which localised control at an early stage could bring about improved prognosis. Patients with these cancers have little grounds for hope. Our primary objective is to reverse this situation with Neutron Capture Therapy (NCT). The purpose of this fourth symposium is to hasten the day whereby patients with these cancers can reasonably hope for substantial remissions. The first symposium on NCT was held in Boston in 1983, followed by Tokyo in 1985 and Bremen, Germany in 1988.

This book willbcof value to anyone who wishes to consider the use of SQUID-based magnetic sensing for anyone of a number of practical applications. The focus here is to examine in detail how SQUID technology is used and how. the results of the measurements obtained can be interpreted to provide useful information in a variety of real-world applications. The concentration is on those areas that have received the most attention, namely bioma etism and nondestructive evaluation, but. the topics chosen include as well, geophysics, underwater ordnance detection, accelerometry and a few somewhat more exotic applications. To provide a reasonable perspective. an attempt has been made to consider competing technologies for most applications, and in some cases to consider how SQUID-based technology may be integrated with other technologies to provide an optimum total-system configuration. It is also the intention of the editor, that this book will be of major value to those scientists and engineers who will be required to build both the essential components and complete cryogenic SQUID systems which will be utilized in the various applications presented. Thus, there is a comprehensive review of the principles of SQUID operation, and a detailed exposition on the fabrication of high-temperature-superconducting (HTS) SQUIDs. Although the market is currently dominated by low-temperature superconducting (L TS) SQUIDs, it is reasonably certain that in the near future HTS SQUIDs will take over in most situations."

We have entered an exciting period in the study of multiple sclerosis and its treatment. Central to this progress has been the introduction of magnetic reso nance techniques. When Young and his colleagues published the first images of the brain in multiple sclerosis at the end of 1981, it was at once obvious that magnetic resonance imaging would playa major role in diagnosis. Intuitively one felt that it would also have a role in increasing our understanding of the pathogenesis of the disease and in monitoring treatment. And so it has proved. Important problems however remain, perhaps the most important of which at present is the weak predictive power of standard magnetic resonance ima ging methods in determining the possibility of progression of impairment and disability. Recently, there have been advances which promise to overcome some of these problems, but decisions about what approach to adopt in selecting patients for clinical trials and which techniques to use in monitoring treatment during their course are still difficult. In this book, Dr. Filippi and his colleagues have assembled an outstanding group of contributors whose work is central to the progress that is being made. The coverage of the issues involved in the use of magnetic resonance techniques in assessing therapeutic effect is comprehensive and, though the field is chan ging rapidly, the principles and much of the detail in the book are likely to have lasting value."

This is the first textbook entirely dedicated to the endovascular treatment of complications related to arteriovenous accesses for hemodialysis (native fistulas and prosthetic grafts). The book addresses the anatomy of upper limb arteries and veins as well as the clinical presentation of patients and the way to perform and read a fistulogram. Many details and illustrations are provided, clarifying the subtleties in catheterization and the dilation of stenoses. From a strategic point of view, it is explained for the first time that many stenoses must either be ignored or deliberately underdilated. A wealth of images helps to understand the different stages of access recovery from thrombosis. As the number of incident dialysis patients is increasing by 5% every year, this is a field of growing interest. In testament to this there are several annual or bi-annual meetings held by numerous national and international societies (vascularaccesssociety.com, sfav.org, vasamd.org, dialysiscontroversies.org, asdin.org).

Endoscopic neurosurgical interventions gain in importance. This book gives adetailed description of the recent indi- cations of endoscopic procedures inmodern neurosurgery. They include endoscopic stereotaxy, endoscopic evacuations of intracerebral hematomas, cysts and abscesses as well as endoscopic interventions on brain tumors. An extended over- view about the usable endoscopes and the operative equipment is pointed out

Parameters such as membrane transport, metabolism and protein incorporation govern the fate of amino acids in living tissue. Is it possible to use positron tomography to measure some of them, and what is their meaning in normal and pathological situations? These questions have been addressed for a long time and no satisfactory answer has yet been given. This book, which derives from an EEC workshop organized in the frame of the Concerted Action on PET Investigation of Cellular Regeneration and Degeneration', held in Lyon in February 1992, gives the present state of knowledge in this field based on the most recent studies. Contributions from 24 leading European and American scientists are presented and discussed in the following four parts: biochemistry and animal studies; amino acids labelling with positron emittors, quality control and metabolites measurement; kinetic modelling of amino acids transport, metabolism, and protein incorporation; clinical use of amino acids. This book will aid and interest biochemists, radiochemists, pharmacologists, neurologists, oncologists and medical imaging scientists.

In the last few years, increasing effort has been devoted to better define the characteristics of tissue damage occurring outside MRI-visible lesions in patients with multiple sclerosis (MS) and, as a consequence, to improve our understanding of the disease pathobiology and of the mechanisms leading to the accumulation of irreversible disability. This book provides an updated review of the results obtained by leading research groups in this field. The potential clinical applications of what has been shown so far, as well as the areas for future research in the study of normal-appearing white and gray matter damage in MS are extensively discussed, making this book a valuable tool for clinical neurologists who are involved in the daily-life care of MS patients and for neuroscientists involved in MS research.

MRI is assuming a dominant role in imaging of the larynx. Its superior soft tissue contrast resolution makes it ideal for differentiating invasion of tumors of the larynx from normal or more sharply circumscribed configuration of most of the benign lesions. Over ten years ago CT made a major impact on laryngeal examination because it was the first time that Radiologists were beginning to look at submucosal disease. All of the previous examinations duplicated the infor mation that was available to the clinician via direct and in-direct laryngo scopy. With the advent of rigid and flexible endoscopes, clinical examination became sufficiently precise that there was little need to perform studies such as laryngography which merely showed surface anatomy. The status of deep structures by these techniques was implied based on function. Fortunately laryngography is now behind us together with all of the gagging and contrast reactions which we would all like to forget. CT is still an excellent method of examining the larynx but it is unfortunately limited to the axial plane. With presently available CT techniques motion deteriorates any reformatting in sagittal or coronal projections. The latter two planes are extremely helpful in delineating the vertical extent of submucosal spreads. MRI has proven extremely valuable by producing all three basic projections, plus superior soft tissue contrast. Although motion artifacts still degrade the images in some patients, newer pulsing sequences that permit faster scanning are elimi nating most of these problems."

During the last two decades significant advances have been made in the in vivo-diagnosis of gastrointestinal diseases. Although Ultrasound and CT as well as Endoscopy have had a major impact on the evaluation of liver, pancreas and bile diseases, there are a lot of indications for Nuclear Medicine procedures. These include new investigational procedures like esophageal scintigraphy, proof of bleeding sites, scintigraphy of inflammatory diseases, and intestinal resorption tests. Further, immunoscintigraphy with radiol- elled antibodies has gained wide-spread application especially in colon cancer. The differential diagnosis of liver tumors like haemangioma and focal nodular hyperplasia by means of blood pool and HID A-scintigraphy is nowadays a routine procedure. Other established methods like hepatobiliary scintigraphy and liver perfusion scintigraphy have proved to be reliable tools in the pre-and postoperative evaluation of patients with bile duct obstruction and portal hypertension. The aim of this book is to present the entire spectrum of Nuclear Medicine in Gastroenterology to our colleagues from internal medicine and surgery. Ultrasound and Sonography as well as CT will rule the field of gastroenterology, but there remain a certain number of unanswered questions. Nuclear Medicine provides a lot of reliable answers. H. J. Biersack and P. H. Cox July 1990 VB List of contributors Duncan M. Ackery, Department of Nuclear Medicine, Southampton General Hospital, Tremona Road, Southampton, Hampshire S09 4XY, U. K. Roland Bares (co-author: U. Buell), Department of Nuclear Medicine, Te- nical University of Aachen, Pauwelsstr. 1, DW-5100 Aachen, Germany.

Agreed standards and guidelines are the heart and soul of improving the differing training systems and to harmonize neurosurgical training in the European countries. Such standards and guidelines have been laid down in the European Training Charter of the European Union of Medical Specialists and recently novellated. This book, written by experienced neurosurgeons, offers all those concerned with neurosurgical training - trainers and trainees - practical advice to implement the above mentioned standards and recommendations. It has been written as a manual: "How to do it." It describes the tasks of a chairman (programme director), the tasks of the teaching staff, the organisation of a training curriculum, a rotation plan or a morbidity and mortality conference, the periodic progress evaluation, the course of an external audit and many more important topics. It contains a lot of practical tips, check lists and useful examples. Well educated young colleagues offer "safe neurosurgery" to our patients.

It is now 150 years ago, on 25th May 1842, that the son of a Salzburg ston emason presented a scientific work "On the coloured light of the double stars and certain other heavenly bodies" at a meeting of the Royal Bo hemian Society of Sciences held in Prague. Christian Andreas Doppler, then professor at the Prague Technical Institute, set a milestone in scien tific history in the meeting room of the Royal Society in the Charles Uni versity, just a few meters from the National Theatre where another genius from Salzburg, Wolfgang Amadeus Mozart, had celebrated his musical triumph with the premiere of his opera Don Giovanni fifty-five years earlier. Doppler's lecture set out in brilliant simplicity what we now call the Doppler principle, which since has found numerous uses in astronomy, which was of primary interest to Christian Doppler. In addition, it has found countless practical applications in physics, navigation, aeronautics, geodesy, medicine, science and technology. In medicine alone, Doppler sonography is now an established diagnostic procedure in the fields of childbirth, cardiology and diseases of the blood vessels, neurology, neuro surgery and vascular surgery, and is continually finding new medical appli cations in today's world of high technology."

Ultrasound (US) prenatal screening has been proposed as the most effective technique for Trisomy 21 early assessment. Assessment of Nuchal Translucency (NT) offers promising non-invasive method for fetal abnormalities detection up to 75%. Nevertheless, current clinician practice of NT examination by locating the sonogram calipers on 2D US image requires highly trained and competent operators by adhering to a standard tedious protocol; therefore it is prone to errors and hence it decreases the reliability in intra- and inter-observer repeatability. This Brief provides the basic knowledge regarding Trisomy 21 diseases and its existing detection methods. The restrictions and disadvantages of each method are discussed accordingly. Therefore, a non-invasive early detection method using 3D ultrasound reconstruction of Nuchal Translucency is introduced. This new method for 3D NT assessments has an edge over the previous 2D methods, and entails the composite function in visualizing the explicit internal marker structure. Further, image processing techniques covered from data acquisition, pre-processing, speckle noise reduction and 3D segmentation are also discussed. This should be especially useful for students and professional researchers in the Biomedical and image processing fields.