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.

An international meeting of experts on Cardiovascular Imaging by Ultrasound was held in Aachen from 26-27 April, 1991. It provided new and interesting insights into what has already been achieved in ultrasound-based cardiovascular diagnosis and therapy and what will be introduced in clinical practice in the near future. Since the introduction of ultrasound in clinical practice in 1984 there has been no other physical principle that has added and will continue to add so much to clinical diagnosis and therapy. Echocardiography, once established as a non-invasive diagnostic tool, is increasingly becoming an invasive technique for cardiovascular imaging. This book contains the edited contributions from 38 scientists and engineers from all over the world who presented the most up-to-date findings on 2-dimensional echocardiography, different Doppler modalities, contrast and stress echocardiography and the different modalities of transesophageal echocardiography, including mono-, bi- and multiplane TEE, as well as pulsed and CW-Doppler application via TEE. Exciting and promising developments are discussed in the field of intravascular ultrasound, tissue characterization, ultrasound ablation, ultrasound-based 3-dimensional reconstruction of the heart, and high frequency Doppler analysis.

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.

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."

This book constitutes the Proceedings of the 26th Symposium on Acoustical Imaging held inWindsor, Ontario, Canada during September 9-12, 2001. This traditional scientific event is recognized as a premier forum for the presentation of advanced research results in both theoretical and experimental development. The lAIS was conceived at a 1967Acoustical Holography meeting in the USA. Since then, these traditional symposia provide an opportunity for specialists who are working in this area to make new acquaintances, renew old friendships and present recent results of their research. Our Symposium has grown significantly in size due to a broad interest in various topics and to the quality of the presentations. For the firsttime in 40 years, the IAIS was held in the province of Ontario in Windsor, Canada's Automotive Capital and City of Roses. The 26th IAIS attracted over 100specialists from 13countries representing this interdisciplinary field in physical acoustics, image processing, applied mathematics, solid-state physics, biology and medicine, industrial applications and quality control technologies. The 26th lAIS was organized in the traditional way with only one addition-a Special Session "History of Acoustical Imaging" with the involvement of such well known scientists as Andrew Briggs, Noriyoshi Chubachi, Robert Green Jr., Joie Jones, Kenneth Erikson, and Bernhard Tittmann. Many of these speakers are well known scientists in their fields and we would like to thank them for making this session extremely successful.

Endoanal and endorectal ultrasound represents considerable progress in the field of anorectal imaging. Its importance in the staging of rectal and anal cancer, in identifying perianasto- motic neoplastic recurrences, in defining acute and chronic suppurative disease and in assessing sphincteral anatomical integrity, is now a confirmed reality. The evidence provided by endoanal and endorectal ultrasonography guides the colorectal surgeon in his choice among the various therapeutic approaches and helps in assessing the effects of the treatments applied. The great flexibility and high degree of reliability make this exploratory method an indispensable tool at all stages of the clinical course in the majority of patients with anorectal problems, including the fundamental follow-up stage. The publication of this excellent volume on intraanal and intrarectal ultrasonog- raphy is therefore to be appreciated, especially since it is in the form of an atlas. As we are dealing with imaging, it is particularly appropriate that it is the images that tell the story. Like all important things, this volume does not come out of nothing. It is the result of many years of skilled work by Drs. G.A. Santoro and G. Di Falco and is based on the experience of internationally renowned professional experts. The ten sections of the atlas begin with general information on ultrasonography, gradually progressing to the technical problems of the method and the aspects rela- tive to anorectal tumors.This last section leads to a review of traditional and mod- ern therapeutic possibilities.

The Association Internationale de Recherche sur la Circulation Osseuse, A.R.C.O., was founded in London in December 1989 by a small group of doctors, surgeons and researchers in basic sciences who had been involved for many years in the study of bone circulation and its disorders. They had met several times in Toulouse, during the International Symposia on Bone Circulation held there since 1973 and they wished to carry their contacts further. In founding A.R.C.O., they established as their primary aims the encouragement and furtherance of research, organisation of meetings and promotion of knowledge on the subject. At the present time, the Association has over a hundred members from more than bone tissue twenty countries in Europe, America and Asia. All have the conviction that and its pathology can only be truly known and studied if one has an understanding of its vascular system and the way its circulation functions. This concept, apparently beyond question, has not yet been adopted by all physicians and scientists who are interested in bone. From time to time, one comes across teaching programmes on bone patho logy which make no mention of bone circulation.

'Morphological imaging' and 'functional imaging' are current mainstays for the diagnosis, successful treatment and accurate follow-up of patients with endocrine disorders. Functional and Morphological Imaging of the Endocrine System provides the reader with comprehensive but concise insights in the application of cutting edge imaging techniques and updated imaging protocols for the diagnosis and treatment of hypersecretory hormonal syndromes and functional endocrine masses.

W. F. ARMSTRONG While stress echocardiography is not the first technique to be applied to patients for the diagnosis of coronary artery disease, it represents an impor tant clinical tool, likely to become of increasing pertinence in today's era of cost containment and mandated cost-effectiveness of diagnosis. It may be the most rapidly expanding area of clinical echocardiography today. Stress echocardiography as we know it today represents the natural con clusion and merger of observations made over fifty years ago. In 1935 Tenn ant and Wiggers demonstrated that the immediate result of a coronary oc clusion, was an instantaneous abnormality of wall motion [1]. As viewed from the surface of the heart in an open chest dog preparation, cyanosis and obvious paradoxical bulging of the left ventricular wall was noted. At a similar time Masters and co-workers, using fairly rudimentary exercise de vices, described the response of the human cardiovascular system to sustained exercise (Figure 1) [2]. These two observations diverged for four decades while clinical investigation was pursued along the two parallel lines.

The first of a two volume set, Volume 12 provides a long-awaited compilation of NMR theory to paramagnetic molecules. International experts report the latest developments in NMR methodology as applied to strongly relaxed and shifted resonances, detail the theoretical aspects of paramagnetic shift and relaxation, and discuss the interpretive bases of these molecular properties in relation to the structure and function of various paramagnetic molecules.

It was only in 1980 that the first recognisable magnetic resonance images of the human brain were published, by Moore and Holland from Nottingham University in England. There then followed a number of clinical trials of brain imaging, the most notable from the Hammersmith Hospital in London using a system designed by EMI, the original manufacturers of the first CT machines. A true revolution in medicine has ensued; in only a few years there are thousands of scanning units, and magnetic resonance imaging (MRI) has assumed a central importance in medical investigation. It is an extraordinary fact that within a few years of development, the esoteric physics of nuclear spin, angular momentum, and magnetic vector precession were harnessed to provide exquisite images of living anatomy; modem science has no greater tribute. That indisputable king of neurology and the oldest of recorded conditions, epilepsy, has not been untouched by the new technology; indeed, it is our view that the introduction of MRI of electroencephalography (EEG) in the late has been as important to epilepsy as was that 1930s. Now, for the first time, the structural and aetiological basis of the condition is susceptible to thorough investigation, and MRI can provide structural detail to parallel the functional detail of EEG. MRI has the same potential as had EEG over 50 years ago, to provide a new level of understanding of the basic mechanisms, the clinical features and the treatment of epilepsy.

Scintigraphic imaging with radiolabeled blood elements has continued to be a useful diagnostic modality. The major trust of recent investigation has been in simplifying labeling techniques and developing new agents that will label blood elements selectively in vitro. The VI Symposium of the International Society of Radiolabeled Blood Elements was held in Barcelona (Spain) during November 23 to 27, 1992.The conference was sponsored by the NATO Scientific Affairs Division, the USA Department of Energy and the Spanish National Health Service. This monograph comprises articles that represent most of the 85 papers (70 oral and 15 posters) presented during the symposium. The meeting was attended by 110 investigators hailed from 21 countries. Although lllIn-oxine and 99mTc-HMPAO remain the choice agents for labeling blood components for routine applications, there was heavy emphasis on developing new labeling agents that will either simplify the in vitro labeling procedure, or, even better, will label blood components selectively in vivo, by injecting the radioactive agents directly into patients. The degree of success in imaging target lesions in humans by using these agents has been excellent.

Avascular Necrosis (AVN) is a disease resulting from temporary or permanent loss of blood supply. It frequently affects the femoral head and in this area, if left untreated, routinely causes premature joint destruction.

In the USA, 5 to 10% of cases of hip osteoarthritis requiring total hip replacement are primarily caused by AVN. In 33 to 72% of patients, the disease is bilateral. The peak incidence is between 30 and 60 years of age, and the social costs of this pathology are remarkable. There is therefore increasing interest in hip joint preserving techniques such as conservative treatment through electromagnetic fields and shockwaves as well as joint preserving surgical techniques. This volume aims to present a complete overview of the current knowledge on AVN including therapeutic options.

The basic principles of the phenomenon "erection" have been known since the pioneering work of Kolliker, Eckhard and Langley in the nineteenth century. Nonetheless, under the influence of Freud, erectile dysfunction was predominantly at tributed to psychogenic factors. A more liberal perception of sexuality since the 1960s, the development of new and refined diagnostic techniques, and the expansion of basic research activity resulted in a new concept of erectile dysfunction, identifying arteriogenic, venogenic, endocrinologic or myopathic (cavernous smooth muscle dysfunction) factors. From this research other considerations such as autonomic innervation, cavernous endo thelial intactness or impaired neurotransmitter pool are being introduced into routine clinical assessment. A reevaluation of psychogenic etiology with a consequential new concept of psy chogenic impotence is on the rise. In this book the new concepts of basic knowledge on cavernous smooth muscle function and its supraspinal, spinal, and local control; the new diagnostic approaches in psychogenic and autonomic factors; and the new developments of reconstructive therapeutic options for the patient have been tied together. Outstanding and internationally renowned experts in the field of erectile dysfunction have given detailed insight into the latest basic and clinical developments. Well-established diagnostic and thera peutic techniques are presented by experienced colleagues. We hope that this book will help the reader to get an overview of the current concepts of erection. Furthermore, we hope that international collaboration in basic and clinical research in the field of erectile dysfunction will render an update necessary in the near future.

The fetal period of human growth and development has become an area of intense study in recent years, due in large part to the development of diagnostic ultrasound. More than 2,000 articles have been published in the last five years describing anatomy and pathology in utero, as reflected in sonographic images. Yet, no stan dard reference exists to correlate these images with fetal gross anatomy and at tempts to draw parallels from adult structure have often led to false assumptions. The dictum "the newborn is not a miniature adult" is all the more valid for the fetus. This text aims to provide a comprehensive reference for normal sectional anat omy correlated with in utero ultrasound images. In addition, magnetic resonance images of therapeutically aborted or stillborn fetuses are paired with similar gross sections to serve as a foundation upon which current in vivo studies may build. Lastly, a miscellaneous section illustrates several anatomic points useful in the understanding of fetal anatomy. These points include the changing anatomy of the fetal brain during gestation and the anatomy of the meninges, the fetal heart, and ductus venosus. It is our hope that this atlas will provide a clear picture of fetal anatomy, rectify some of the confusion which exists in antenatal diagnosis, and stimulate further interest in fetal development."

The philosophy of this NATO Advanced Research Workshop and the monograph it has yielded is that if you put a small number of very talented and creative scientists of different backgrounds and documented accomplishments together in a cloistered place for a few days to consider a very important and timely topic, many new ideas will be generated. The keynote of this conference was the Future. By this we mean the expected future developments of highly reliable sequential quantitative measurements of atherosclerotic plaque size and components in living human subjects. Some of the best minds and the most experienced and talented individuals at the leading edges of imaging of arteries were involved; some of the best scientists and students of the atherosclerotic plaque and its components participated; and some of the leading investigators of the cell biology or, as we call it in the USA, the pathobiology of atherosclerosis, contributed important new information. All of these individuals were actively involved in the conference and each obviously had carefully prepared and was able to communicate effectively.

Das Buch enth{lt eine Auswahl der Vortr{ge, die auf dem 15. Dreil{ndertreffen der deutschsprachigen Ultraschallgesellschaften gehalten wurden. Damit informiert es }ber neue technische Entwicklungen und den praktischen Einsatz in den verschiedenen medizinischen Fachgebieten.

The primary purpose of this book is to bridge the gap be tween the practice of clinical medicine and diagnostic radi ology. It is intended primarily for utilization by medical students in training and by nonradiologist physicians. In this world of rapidly expanding knowledge in the many specialties of medicine, it is becoming increasingly difficult for many physicians to stay abreast of the newer and constantly changing modalities of diagnosis as well as the therapeutic regimens of the common as well as the less common disease processes within their realm of practice. This book will enable the busy clinician to utilize the consultative services offered by his or her colleagues in diagnostic radiology with maximum effectiveness. The most common clinical applications of the more recent imag ing modalities (i. e. , nuclear medicine, ultrasound, comput erized tomography, and magnetic resonance imaging) have been categorized and condensed into a format that will be both comprehensible and useful on a daily basis for those physicians routinely requesting these diagnostic examina tions for their patients. For simplicity, the book is divided, whenever feasible, into organ systems and subdivided into the multiple classifications of pathologic states (i. e. , con genital, trauma or iatrogenic, inflammatory, and neo plasm). In addition, there are brief comments related to the vii specific advantages and disadvantages as well as the cost effectiveness of each modality.

Twenty years ago, the enzyme superoxide dismutase which uses the superoxide radical anion as its specific substrate was reported. With this discovery was born a new scientific field, in which oxygen, necessary for aerobi c 1 ife on thi s planet, had to be cons i dered also in terms of its toxicity and stresses. This stimulated the search for knowledge of active oxygen species in biology and medicine. Superoxide and other reactive oxygen species are now implicated in many disease processes. Major advances have been achieved during these past years with respect to free radical generation and mechanisms of free radical action in causing tissue injury. In parallel, the possibil ity of influencing free radical related disease processes by antioxidant treatment was studied in various in vitro and in vivo systems. This was the unique theme of a conference organized in Paris by the Society for Free Radical Research (December 9-10, 1988) which brought together experts from basic sciences and clinicians in order to evaluate the current status of antioxidant therapy. The conference emphasized fundamental processes in antioxidant action. Among the major topics were superoxide dismutase (SOD) and low molecular weight substances with such activity, called SOD mimics. Other antioxidant enzymes were also considered. Antioxidant vitamins, in particular vitamins E and C, other naturally occurri ng antioxidants and vari ous synthet i c antioxidants were included in the presentations as there is now a rapidly developing series of compounds with potentially interesting clinical applications.

The first edition of this definitive text ran to 24 chapters. The second edition, reflecting the explosive growth of interest in echo-enhancement, contains 44. The first section deals with some of the most important emerging issues and technologies and covers harmonic imaging, the use of echo-enhancers to provide quantitative information, and the application of enhanced power Doppler to tissue imaging. The second, on contrast echocardiography, explores the use of echo-enhancement during transesophageal imaging. One chapter describes the use of contrast-enhancement transesophageal imaging to determine coronary flow reserve and another gives a detailed account of the application of the technique to the evaluation of left ventricular function. Other authors describe the intraoperative use of contrast echocardiography and discuss the potential of myocardial contrast echocardiography to replace thallium scintigraphy. Another chapter covers the emerging technique of transient response imaging and its role in the assessment of myocardial perfusion, and two chapters are devoted to three-dimensional contrast echocardiographic assessment of myocardial perfusion. Use of echo-enhancement in the evaluation of peripheral circulation is discussed in chapters on carotid and peripheral arterial flow imaging and others that describe renal and hepatic vascular imaging. The newer applications of echo-enhancement outside the cardiovascular system are described in three chapters devoted to the visualization of tumour vasculature. The final chapters look to the future and cover the imaging of intramyocardial vasculature, the development of site-specific agents and the emergence of the new acoustically active agents.

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 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."

For this Workshop, the organizers have attempted to invite experts from all known centers which are engaged in neutron beam development for neutron capture therapy. The Workshop was designed around a series of nineteen invited papers which dealt with neutron source design and development and beam characterization and performance. Emphasis was placed on epithermal beams because they offer clinical advantages and are more challenging to implement than thermal beams. Fission reactor sources were the basis for the majority of the papers; however three papers dealt with accelerator neutron sources. An additional three invited papers provided a summary of clinical results of Ncr therapy in Japan between 1968 and 1989 and overviews of clinical considerations for neutron capture therapy and of the status of tumor targeting chemical agents for Ncr. Five contributed poster papers dealing with NCT beam design and performance were also presented. A rapporteurs' paper was prepared after the Workshop to attempt to summarize the major aspects, issues, and conclusions which resulted from this Workshop. Many people contributed to both the smooth functioning of the Workshop and to the preparation of these proceedings. Special thanks are reserved for Ms. Dorothy K.

The aim of this work was not an exhaustive review of all pediatric echo graphic problems but a presentation of our daily experience with ultrasonography in pediatric practice. Several teams of pediatric radiologists from France and Belgium have combined their experiences to produce a practical book. The different authors have been chosen for their specific experience and their special area of work. The different chapters express therefore personal opinions. Unresolved questions are posed and ultrasonographic examinations are used in the diagnosis of different diseases, while the discoveries and ideas of the individual authors are described. Some fields are not included, such as echocardiography. Gabriel Kalifa Contents Chapter 1. Antenatal Diagnosis by Ultrasonography . . . . . . . . . . . . . . 1 . . . Introduction ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Ultrasonography of a Normal Pregnancy ...................... 1 2.1 Timing of Successive Examinations. . . . . . . . . . . . . . . . . . . . . . . 1 2.2 Normal Fetal Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2.2.1 Central Nervous System .......................... 3 2.2.2 Chest........................................... 3 2.2.3 Abdomen....................................... 3 2.2.4 Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . .