The second volume of Frontiers in European Radiology covers two very promising techniques in diagnostic radiology, namely digital radiography and nuclear mag netic resonance imaging. Leading experts in both fields from Europe and the Unit ed States were invited to give a critical overview; digital fluoroscopy is reported on mainly by American scientists since this technique has been developed primarily in the United States, while the results of nuclear magnetic resonance imaging are pre sented by British groups currently at the forefront of research in this field. The pa pers reflect the state of the art at mid-1981, when the contributors gathered for the yearly symposium on Current Topics in Diagnostic Radiology in Berne, Switzer land. Nuclear magnetic resonance imaging, also known as spin imaging or zeugmato graphy, has produced striking progress within the past few years - even within the past few months - as described in three papers of this volume. The images generally reflect the distribution of mobile protons contained within water and fats, and pro vide remarkable discrimination between different tissues. Malignant tissue might be identified with this technique, and a wide range of disorders associated with water concentration, diffusion, and flow would be amenable to study; the measurement of blood flow could be particularly interesting."

Rapid developments of new investigative techniques and diagnostic modalities such as CT and MRI have revolutionized modern diagnostic imaging. Dr. Sperber and her contributors expertly facilitate understanding of the fundamentals of pulmonary disorders and promote a realistic and appropriate use of the exciting new diagnostic modalities. Methodologies of choosing techniques are also discussed. The first section of the book reviews the applications of the various radiographic modalities. The second part is organized by disease - emphasizing the radiographic manifestations and indicating appropriate imaging techniques most useful for diagnosis.

Both the investigation and treatment of cancer of the oesophagus are comprehensively presented in Management of Oesophageal Carcinoma. This information is otherwise not easily available in one source. The chapters are written by experts in the fields of anatomy, cancer research, radiology, and thoracic surgery and give up-to-date information on this difficult disease. All aspects are covered: anatomy, epidemiology, endoscopic and radiologic diagnosis, pathology, surgical treatment, radiotherapy, palliative and laser therapy, and the management of complications. Surgeons will be especially interested in the discussion of the recent technique of oesophagectomy without formal thoracotomy, and the use of stapling devices. This complete reference is ideal for all clinics and medical centers specializing in thoracic surgery or treatment of oesophageal carcinoma.

Due to the ever increasing interest in the use of non-invasive ultrasonic methods in medical diagnostics on the one hand and the specific effects of ultrasound in medical therapy on the other, the questions of safety and optimal applications are topical and of great importance. For this reason the symposium "Ultrasound Interaction in Biology and Medicine," initiated and supported by the "International Organization of Medical Physics," took place. The organizers were the Institute of Applied Biophysics of the Martin-Luther-University, Halle (Saale), German Democratic Republic, in association with the Society for Physical and Mathematical Biology of the GDR along with other scientific organizations. Renowned and internationally noted specialists in the field of ultrasonics reported on the latest findings regarding the biological interaction of ultrasound, which promised future improvements in the methods of ultrasonic diagnostics and gave and up-to-date insight into the biological effectiveness of ultrasound. We are pleased to be able to publish selected contributions to this symposium collected in one volume. The methods of investigation, theoretical considerations and results concerning the interaction of ultrasound on molecular, cellular and system levels contained herein will remain up-to-date for a long time to come, providing thought provoking material for further inter-disciplinary basic research and medical application.

Diagnostic errors are important in all branches of medicine because they are an indication of poor patient care. As the number of malpractice cases continues to grow, radiologists will become increasingly involved in litigation. The aetiology of radiological error is multi-factorial. This book focuses on (1) some medico-legal aspects inherent to radiology (radiation exposure related to imaging procedures and malpractice issues related to contrast media administration are discussed in detail) and on (2) the spectrum of diagnostic errors in radiology. Communication issues between the radiologists and physicians and between the radiologists and patients are also presented. Every radiologist should understand the sources of error in diagnostic radiology as well as the elements of negligence that form the basis of malpractice litigation.

This timely publication fills a large gap in the ophthalmic literature which has so far lacked a monograph on the clinically very important subject of macular edema. The book presents the most up-to-date scientific concepts concerning the etiology and pathogenesis of blood retinal barrier breakdown such as tight junction associated protein dysfunction, and changes in fluid transport properties of the retinal pigment epithelium. The bulk of the book is clinically oriented and addresses novel imaging and diagnostic techniques for the detection of macular edema as well as the clinical context of a panoply of ocular diseases which induce macular edema, such as diabetes, other vasculopathies, uveitis, and many others. New light is shed on the association between highly active antiretroviral therapy and the induction of macular edema in HIV-positive patients. Novel drug treatment regimens with steroids and carbonic anhydrase inhibitors as well as new ways of applying laser and surgical therapies are also discussed in detail, and practical treatment guidelines are given. This book will be helpful for vitreoretinal specialists as well as for the practising ophthalmologist confronted with patients suffering from macular edema.

There have been remarkable achievements in CT technology, workflow management and applications in the last couple of years. The introduction of 4- and 16-row multidetector technology has substantially increased acquisition speed and provides nearly isotropic resolution. These new technical possibilities had significant impact on the clinical use of CT and have yielded a broadening of the spectrum of applications, particularly in vascular, cardiac, abdominal, and trauma imaging.

This book presents the practical experience of an international expert group of radiologists and physicists with state-of-the-art multidetector-technology. The chapters in this book will facilitate a thorough understanding of 4- and 16-slice multidetector-row CT and its clinical applications. This will help to fully exploit the diagnostic potential of this technology.

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.

Liver-Directed Therapy for Primary and Metastatic Liver Tumors is a comprehensive examination of tumors of the liver. It provides a unique multi-modality approach to management of all types of primary and secondary liver tumors. The biology of liver cancers, state of the art radiologic imaging and novel, non-surgical interventional strategies are given. There is an in depth analysis of surgical options including transplantation, resection, interstitial ablation techniques and liver-directed chemotherapy for hepatocellular carcinoma, bile duct cancers, and colorectal and neuroendocrine liver metastases. Because of the unique and comprehensive examination of liver tumors, this work is an excellent resource for surgical, transplant and medical oncologists, surgeons, gastroenterologists, and radiologists.

Synchrotron radiation has important applications in medical imaging, especially in such areas as intravenous coronary angiography, mammography, bronchography, and monochromatic computed tomography. In medicine, phase contrast imaging is a particularly exciting development, with the potential to become a new X-ray eye in the 21st century. To discuss these and related topics, medical doctors met with physicists and other researchers in Haga, Japan, in August 1997. This volume contains the proceedings of the International Workshop on Medical Applications of Synchrotron Radiation (HAGA 97), where practitioners from the world of medicine could communicate directly with researchers from the world of physics to discuss practical and theoretical aspects of medical imaging with synchrotron radiation. This volume, presenting the outcome of the discussions and presentations in the workshop, is a valuable resource to all who are interested in medical imaging and physics.

Intracranial injury, caused by a transorbital penetrating object, is a neglected topic in neurosurgery. With few exceptions, only occasional publications, often containing merely case histories, are present in the literature. Through a perusal of the world literature - for the first time - the author has collected and combined all available and relevant information, trying to give a thorough description of this rare, but extremely dangerous injury. This book is a major and definitive contribution to neurosurgery, but is also of importance to ophthalmology, neurology, traumatology, neuro-radiology and pediatrics.

Once again, the proceedings of the Badgastein Symposium, this one being the 22nd in an uninterrupted series, offer a comprehensive record of the scientific events. Highlights at this meeting were certainly reports ofthe exciting new developments ofpositron imaging with Anger cameras, both with conventional high-energy collimators and with coincidence techniques. Preliminary c1inical results are promising and seem to offer a true alternative to sophisticated PET -technology with its for many laboratories prohibitive costs. The general nature ofthe symposium is documented by the large range oftopics covered so that all major topics of interest in both the basic sciences of nuc1ear medicine and c1inical ap plication are found. In accordance with the general trends in nuc1ear medicine, there has been a substantial increase in oncological work compared to the more traditional topics. This is also reflected in the Badgastein lecture, given by Professor P. Rigo, who presented an excellent survey ofnuc1ear oncology."

The investigation of the brain by means of ultrasound has acquired increasing importance in the last years because it permits insight into the spatial relationships within the intact human skull in a short time without endangering the patient. The road from the first ultra sonic investigations on the exposed brain to the detection of intracranial midline shifts on the intact skull, the registration of echo pulsations and recently, to ultrasonotomography has been a long one already. However, this development is by no means at an end. Following the suggestion of numerous colleagues concerned with echo-encephalography in this country and abroad, the Neurosurgical Clinic of the University of Erlangen-Nuremberg organized an "International Symposium on Echo-Encephalography" on April 14th and 15th, 1967. Here there was an open exchange of experience on the results obtained up to the present. The limitations of the method and sources of error as well as the directions of future development of the ultrasonic echo procedure were discussed."

The contemporary management of patients with cancers of the head and neck is under careful scrutiny and major changes are being introduced in order to improve the potenti al not only for long-term control but also for less in the way of disfiguring and distres sing complications associated with the treatment programs. In 1988, the American Cancer Society estimates that there will be 42400 new cases of malignant tumors of the head and neck diagnosed with 12 850 deaths. In general, the prognosis for patients with malignant tumors of the head and neck re gion depends upon the site of origin, the local and regional extent of the tumor, the Kar nofsky status of the patient as well as the patient's general medical condition. The poten tial for cure for early stage tumors is extremely high particularly for those lesions involving the vocal cord, oral cavity, and the anterior two-thirds of the tongue. Major advances have been made in the management of head and neck cancer by the innovative utilization of surgery with radiation therapy. Small tumors can be cured by ei ther surgery or radiation therapy with equally good results. However, far advanced tu mors are more complicated and more difficult to cure requiring combined, integrated, multimodal programs of management. Therefore, the previously general poor prognosis for advanced tumors is becoming better with more aggressive treatment regimens."

This revised and updated second edition - now with two new chapters - is the only book to give a comprehensive overview of computer algorithms for image reconstruction. It covers the fundamentals of computerized tomography, including all the computational and mathematical procedures underlying data collection, image reconstruction and image display. Among the new topics covered are: spiral CT, fully 3D positron emission tomography, the linogram mode of backprojection, and state of the art 3D imaging results. It also includes two new chapters on comparative statistical evaluation of the 2D reconstruction algorithms and alternative approaches to image reconstruction.

Over 10 years have passed since the first edition of The Mediastinum was published in 1977. I have been very gratified by the response to the first edition and determined to do a second edition as soon as possible. However, good intentions are sometimes difficult to achieve and a decade has passed. This period has been one of enormous growth in the discipline of diagnostic imaging. In the study of the mediastinum, computed tomog raphy, and more recently magnetic resonance, have revolutionized our diagnostic capabilities. This second edition of the mediastinum is in tended to emphasize the importance of these modalities to the evalua tion of mediastinal disease. In addition, an attempt will be made to integrate into the text the many new and important observations relat ing to all aspects of mediastinal imaging which have appeared in the literature since 1977. The overall emphasis, however, will remain the same: that accurate radiologic diagnosis is based upon a thorough understanding of corre lated radiographic anatomy and pathology. No matter what the imag ing modality, this principle remains fundamental to each and every radiographic interpretation. I would like to express once again my deep appreciation to Dr. Stephen A. Kieffer, Chairman of the Department of Radiology at the State University of New York Health Science Center at Syracuse for his continued support and encouragement."

At first glance it appears that little has happened in our understanding of bronchogenic carcinoma, since five year survival rates have not changed appreciably over the past ten years. This is partially true, however the depth of our understanding has increased and will continue to do so at a rapid pace over the next five to ten years. Information on the basic tumor biology, identification of important groups at high risk and im proved delivery of cytotoxic agents in the treatment of lung cancer, will all add to improve the outcome. The purpose of this text is to provide useful background information and to serve as a reference for approaching the patient with lung cancer. Therefore it will serve as a review for some and as a beginning for others. An important starting point in any discussion of lung cancer is an epidemiological survey of the topic (Chapter I). For those who do not avoid the hazards and present with symptoms, what is the most logical approach in determining the diagnosis (Chapter II). This chapter is intended to provide a general overview of the subjects covered in detail in the remainder of the text."

In the developed world, images of brain structure are available as an everyday diagnostic aid, and the characteristic appearances of most pathological conditions can be looked up in a textbook. Functional brain imaging is to this day less widely used, partly because most pressing diagnostic questions can be answered by refer ence to the patient's cerebral anatomy, partly for reasons of technical limitations of functional techniques. PET as a technique is sufficiently resource-demanding and complex to inhibit its use as an everyday diagnostic technique. SPECT lacked suitable tracers for many years, and early systems had poor spatial resolution. However, rotating gamma camera technology has advanced to the point where images of the brain of reasonable quality can be obtained at most large hospitals, and practical tracers, particularly of regional cerebral blood flow, are easily avail able. As research advances, clinical applications are emerging. A recent report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology details a number of currently recognised clinical appli cations, some of which are dealt with in this book. Given this recognition, it is increasingly important that clinicians (particularly neuroclinicians, psychiatrists and specialists in cerebrovascular disease), nuclear medicine specialists and physicists acquire an idea of the major applications of the technique, and the research background on which these applications are based."

Primary reconstructive surgery is assuming increasing importance in the management of fractures of the spine. Analysis of the injury and thus surgical decision-making are greatly facilitated by the diagnostic power of CT and MRI. This volume provides a systemic introduction to the interpretation of CT and MRI images of injuries to the spinal column and the spinal cord, with special emphasis on the assessment or residual stability. Since survey X-rays remain the indispensable first step in radiodiagnosis, the typical appearances of spinal injuries on conventional films are also shown. This will help the reader interpret the CT and MRI images and also reflects the procedure in radiologic practice. The books classification of spinal fractures, together with the attempt to conclude how the injury happened by analyzing the damage caused, paves the way for individually oriented therapy.

Echo-encephalography, introduced by LEKS ELL in 1955, has gained increasing importance for the early detection of numerous intracranial lesions in the last decade. The main advantage of this diagnostic procedure lies in the fact that it permits a rapid orientation about the spatial relationships within the skull without stressing or endangering the patient. Although this method alone only rarely allows a complete diagnosis, the echo-encephalographic findings always indicate which further diagnostic measures are most suitable for establishing the diagnosis with the greatest accuracy in every case. However, the correct interpretation of an echo-encephalogram is possible only, if the findings which are assumed to be pathological are evaluated in the light of the clinical symptomatology. Since JEPPSSON'S excellent monograph on the origin of the midline echo and its importance for the diagnosis of intracranial expansivities, published in 1961, a great deal of work has gone into the development of echo-encephalography all over the world. For this reason the possibilities of this procedure today go far beyond the mere demonstration of a supratentorial shift. Now we can frequently outline the width of the ventricles exactly and localize tumors or hematomas by means of abnormal reflections. Since a detailed description of the technique, application and present-day diagnostic uses of echo-encephalography has not been available as yet, we undertook to fill this gap in the German literature in 1967 with a monograph summarizing the hitherto existing experience as well as our own extensive case mate rial.

The term picture archiving and communications system (PACS) was initiated during the first International conference and workshop on the topic sponsored by The International Society for Optical Engineering (SPIE) in Newport Beach, California in 1982. The research and development (R&D) progress for PACS has been slow until 1988. The earlier PACS modules were mostly off the shelf components connected together to solve a very specific clinical problem. The three major players in PACS R&D are the European countries, United States of America, and Japan. For various reasons, the European coun tries concentrated in modeling and simulation, U.S.A. pre ferred in-house development or purchased PACS modules from a manufacturer, whereas Japan organized the PACS as a national project. Between 1989 and 1990 PACS R&D took a dramatic positive turn. Large scale P ACS projects were planned and some are of implementation, especially in newly con at various stages structed hospitals. Examples are the Hokkaido University, Japan; Hammersmith Hospital, United Kingdom; Social and Medical Center East (SMZO), Vienna, Austria; the U.S. Armed Force Medical Diagnostic Imaging Support (MDIS) project; and the UCLA Medical Plaza ambulatory care center. Another phenomenon is the organization of the EC-countries which provides a tremendous impetus for the European PACS R&D efforts. This book "Hospital Integrated Picture Archiving and Communication Systems: edited by Professor M. Osteaux and others is a direct product from these efforts."

The dramatic evolution of new technology in diagnostic and therapeutic radiology has changed the whole field of medicine. Ultrasonography, computed tomography, nuclear magnetic resonance, and digital radiography are those new techniques which are undergoing continuous development, providing us with increasingly re fined methods for establishing the cause of disease and for treating the patient. Using radiologic technique, ingenious methods are continuously being developed to en sure less expensive, less traumatic, and more efficient therapy. Transluminal angio plasty, embolization of tumors or bleeding vessels, extraction or dissolution of stones, and regional infusions are some of these therapeutic methods in modem diagnostic radiology. Every day new ideas arise which are published in a multitude of papers. This heavy flow of information limits the possibility of selecting from a core of information and often prevents radiologists from communicating efficiently with their colleagues in other countries or continents. European radiologists are additionally hampered from participating in international communication because of the language barriers created by the national journals. As a result, Europe's contribution to scientific progress in this interdisciplinary field has influenced only regional developments."

"Dost thou love life? Then do not squander time, for that's the stuff life is made oj' Benjamin Franklin This book describes the technical principles and applications of echo-planar imaging (EPI) which, as much as any other technique, has shaped the develop ment of modern magnetic resonance imaging (MRI). The principle of EPI, namely, the acquisition of multiple nuclear magnetic resonance echoes from a single spin excitation, has made it possible to shorten the previously time-con suming MRI data acquisition from minutes to much less than a second. Interest ingly, EPI is one of the oldest MRI techniques, conceived in 1976 by Sir Peter Mansfield only 4 years after the initial description of the principles of MRI. One of the inventors of MRI himself, Mansfield realized that fast data acquisition would be paramount in bringing medical applications of MRI to full fruition. The technological challenges in implementing EPI, however, were formidable. Until the end of the 1980s few people believed that EPI would be clinically useful, since its complexity was far greater than that of "conventional" MRI methods."

During the past four decades knowledge about biological effects of ionizing radiations on mammalian cells, normal tissues and tumours has increased enormously and has enabled radiotherapists to obtain a better insight into the advantages and disadvantages of cancer treatments with modified regimens of irradiations and combinations with chemotherapeutic agents. Even for the older scientists and clinicians who have wit nessed all these developments and have contributed to the vast amount of information, it is difficult to integrate this knowledge and to apply it in their daily work. For younger workers it is often difficult to select the important main concepts and results from the overwhelming number of publications. It is evident that a book which provides an integrated view of basic and applied radiation oncology can be of great value to students, scientists and, most importantly, to clinicians who can devote only part of their time to the task of understanding the radiobiological background of their application of radiation in cancer treatment. This book "Radiation Oncology" is written by a radiotherapist who has for a long time participated in the integration of basic knowledge and clinical experience. He has selected radiobiological information which is considered important to radiotherapy and in the description and interpretation of normal tissue tolerance and tumour eradication probability, he illustrates how basic knowledge can be applied clinically."

The production of a textbook of the pathology of bone work with isotopic markers to refine their classifica- tion. tumours is a hard task to embark upon, but Andre In this book, the author takes up a firm position Mazabraud has certainly succeeded. about the difference between osteoid osteoma and oste- It is the outcome of a very long experience, provided oblastoma, about "tumoral associations" and about the initially by his hospital training, then by his collabora- so-called malignant forms of disorders described as tion with Rutishauser at the Institut de Pathologie at benign. His personal stamp is evident throughout the Geneva and with Dahlin at the Mayo Clinic. The bonds various chapters. he forged then have never been loosened. Certainly, treatment in the area is rapidly changing Subsequently, his duties as head of the department and advancing, but this book does not risk obsoles- of pathology at the Institut Curie directed him finally cence since treatment is not its focus. The extent and towards tumour pathology. At the Institute, he was not nature of the author's experience explain the essentially satisfied with routine examinations but very soon linked anatomo-pathological orientation taken by this semi- up with the research team and worked especially on nal book. It also provides valuable clinical information Ewing's sarcoma and the problems of ultrastructure, and a good radiological study.