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.

Alfons Staudach has been a long-time member of the Anatomic Institute of Karl Franzens University in Graz, where he has devoted particular atten tion to the deeper understanding, appreciation and visualizion of gross ana tomic details. In this work the author has achieved correspondence between sonograms and anatomic sections with a consistency and persuasiveness unequaled in all the previous literature on diagnostic ultrasound. The various planes of section andtheir characteristic features, and indeed the entire format of the text, are designed to provide even the less experienced sonographer with a valuable basis for conducting his examinations. The more experienced reader will find essential information on topographic relations and organ development that is not available in any other work dealing with fetal ana to y. I am certain that my high estimation of this volume will prove justified, and that it will provice its readers with a useful and stimulating resource. Univ. -Prof. Dr. Walter Thiel (Chairman of the Anatomic Institute of the University of Graz) Foreword Anyone setting this book down after an initial perusal must wonder why such a reference was not available ten years ago. The meticulous and fas cinating juxtaposition of gross anatomic sections with sonograms, together with explanatory drawings and many practical guidelines, should enable even the novice accurately to identify details and interpret sonographic findings with precision."

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 is now more than 40 years since Drs. Wild and Reid published their first experience with rectal ultrasonography from the Surgery Department at the University of Minnesota. Professor Owen H. Wangen steen, in whose laboratory the studies were carried out, recognized at that time the need for early detection in the treatment of cancer. Technical improvements over the past 20 years have made endoscopy the procedure of choice for examination of the hollow organs of the genital, urinary and gastrointestinal tracts. The simultaneous development of endosonography has had an equally dramatic impact on the practice of medicine and surgery. The technology has been demonstrated to be helpful in both benign and malignant conditions. One of the so-called benign conditions of the anorectum is fistula-in-ano. Fistula surgery has always relied on excellent anatomic delineation of the intramuscular tracts. There is hope that adaptation of ultrasonographic technology will aid in the surgical management of this malady. Clearly, rectal ultrasonography has considerable potential in the management of rectal carcinoma. Accuracy rates in the range of 90% for the depth of neoplastic invasion have been reported. This ability for accurate assessment will undoubtedly lead to a better definition of the population of patients that can be managed by local therapeutic means.

Only a few years ago, most treatises on sonography covered all the diagnostic applications of ultrasound, de scribing organs from the brain down to the placenta. Dr. Bruneton and his associates must be thanked for pre senting this book devoted to the spleen. It probably offers the most complete presentation of details and the richest images available in its field. This book will thus become the ultimate reference in most libraries of books on son ography. March 1988 F. Weill The authors wish to thank Christine Rostagni, Fran ise Fein, and Bernard Fontaine for their assistance in the preparation of this book. Contents 1 Sonographic Anatomy of the Normal Spleen, Normal Anatomic Variants, and Pitfalls B. Senecail . . . . . . . . . . . . . . . . . . . . . . 1 1. 1 Anatomy of the Spleen. . . . . . . . . . . . . . . . 1 1. 1. 1 Morphology and Structure . . . . . . . . . . . . . 1 1. 1. 2 Location and Relations of the Spleen. . . . . . . . 3 1. 1. 3 Average Dimensions of the Cadaver Spleen . . . . 5 1. 1. 4 Congenital Anomalies and Normal Variants. . . . 5 1. 1. 4. 1 Fissured Spleen. . . . . . . . . . . . . . . . . . . . 5 1. 1. 4. 2 Lobulated Spleen. . . . . . . . . . . . . . . . . . . 5 1. 1. 4. 3 Spleen with Two Hili. . . . . . . . . . . . . . . . . 5 1. 1. 4. 4 Wandering or Ectopic Spleen . . . . . . . . . . . . 6 1. 1. 4. 5 Numeric Anomalies . . . . . . . . . . . . . . . . . 6 Ultrasonography of the Spleen . . . . . . . . . . . 1. 2 6 1. 2. 1 Equipment . . . . . . . . . . . . . . . . . . . . . . 6 1. 2. 2 Patient Examination . . . . . . . . . . . . . . . . . 7 1. 2. 3 Scanning Technique . . . . . . . . . . . . . . . . . 7 1. 3 Sonographic Features of the Normal Spleen. . . . 7 1. 3. 1 Splenic Contour . . . . . . . . . . . . . . . . . . . 7 1. 3. 2 Echo Pattern of the Splenic Parenchyma. . . . . ."

'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.

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.

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.

Congenital hip dysplasia and dislocation are common diseases of newborns and small infants, with frequently severe consequences if orthopaedic therapy is not initiated at an early stage. Therefore many clinicians have been looking for a simple method for the investigation of the hip joint in the early neonatal period. Up to 1980 the diagnosis of hip dysplasia could usually not be made before the 3rd month of life, by means of pelvic roentgenography. Only incomplete or complete unilateral dislocations were diagnosed in the neonatal age group. In 1980, however, Graf, an Austrian orthopaedic surgeon, began using ultrasound investigation ofthe hip joint in newborns and small infants in order to make an early diagnosis and to avoid radiation exposure. The intention of the present study was to compare ultrasound of the hip joint with other established diagnostic procedures and to establish whether it is suitable as a screening procedure in newborns. 2 Incidence of Congenital Hip Dysplasia and Dislocation In 1972 Barlow reported that 90 % of hips which are unstable at birth develop to normal joints spontaneously without any therapy. Visser (1984) thus suggested determining the percentage of hip dislocations after the 2nd - 3rd month of life so that children with spontaneous stabilisation would be excluded.

Vascular diagnostics traditionally rely on x-ray angiography. This approach remains even today essential in the clinical work-up of patients with vascular pathology. Recently, however, newer imaging modalities have been intro duced to assess vascular disease. Among these the color Doppler flow and magnetic resonance imaging appear the most promising. Due to their noninva sive character both methods are ideally suited for screening as well as serial follow-up of vascular patients. The emergence of color Doppler flow and magnetic resonance vascular imaging coincides with new concepts in vascular medicine. Today, vascular prevention and percutaneous interventions are becoming the leading compo nents in modern vascular care. It is in this new and exciting environment of novel vascular concepts where the demand for reliable noninvasive vascular imaging is becoming a high priority. Color Doppler flow and magnetic reso nance vascular imaging are well on the way to satisfy this demand. This textbook provides the long awaited information on vascular imaging by color Doppler flow and magnetic resonance. The text covers the essentials of vascular anatomy, physiology and noninvasive imaging technology before providing a state-of-the-art review of their current clinical applications. All chapters are written by competent scientists and clinicians in a clear, conscise and yet thorough and exhaustive manner. The coherent and didactic composi tion of the textbook allows the reader an easy access to the elementary as well as the advanced principals and clinical applications of the modern noninvasive vascular imaging.

The second E. C. Workshop on Ultrasonic Tissue Characterization was organized for the assessment of research goals and plans as the basis to a grant proposal for a "Concerted Action" which will be forwarded to the European Commission. It should, therefore, not only be considered as a work in progress exhibition which succeeded the former activities within the E. C. (Inventory on Tissue Characterization in Europe and first Workshop). The Steering Group invited a 1 imited group of Institutes to send its group leader and a research fel low in the entitled field, who should expose the overall research program, as wei 1 as the more specific work on tissue characterization by RF signal analysis and spectroscopy. The ultimate goal of the Workshop has been the formulation of schemes of interaction among the Institutes and individuals and the definition of cooperative research programs. The remainder of the groups and some of the groups present are working in the field of analysis and processing of cl inical A- and B-mode echograms (i. e. video signals). Because this work is more closely related to the cl inical diagnostics it was decided that for that reason no preparatory workshop was needed. In the final proposal for the Concerted Action this work wi 1 1 get ample attention. Although not many clinicians were present, their positive interest in the sophisticated analysis techniques and their contribution to the dis cussions again have been a most valuable and stimulating experience."

Since the pioneering work of Donald and his first Lancet paper in 1958, the use of ultrasound in obstetrics and gynaecology has evolved rap idly. The introduction of grey scale techniques enhanced our ability to identify different tissues on the basis of their texture. However, it was the introduction of the linear array real-time scanner in the mid seven ties that changed ultrasound from being an "eccentric art form" to a readily available and usable technique. This led to the first reports of the diagnosis of neural tube defects using ultrasound by Campbell, as well as the establishment of fetal biometry. In the midst of this activity the parallel development of the transvaginal probe by Kratochwill went almost unnoticed by most gynaecologists. Yet the application of this technique has since had a major impact on many areas of gyna ecological practice, and on infertility in particular. Since the demon stration of transvaginal follicle aspiration, the vaginal route has become standard for most invasive ultrasound guided gynaecological procedures. The relatively new technical advance of transvaginal colour Doppler may potentially have just as great an impact. The introduction and use of transvaginal colour flow imaging has facili tated the study of vascular changes within the pelvis.

It will be a long time before the quality of this profusely illustrated book is overtaken and the present spate of books on the subject of obstetric ultrasound may, as a result, suffer a numerical set-back - especially with translation into English which will "deliver the milk on everyone's doorstep". Two of the authors studied in our department in Glasgow and worked like If there are any rewards for teaching, then we humble Scots who demons. have had the privilege have had more than our share as a result of the pride with which we regard our pupils. In my own old age and looking back over the last thirty years, the innumer able difficulties, set-backs and disappointments have been more than compen sated for by those who have turned the subject from a laughable eccentricity (as I have at one time experienced) into a science of increasing exactitude. This transformation has come about, not by any efforts of mine, but by the enthusiasm and ingenuity of those who would probably have achieved as much on their own if given the encouragement which I ultimately received in Glasgow University life. Limbo must be the expected lot of most of us ordinary mortals but the work lives on. And so, in this reminiscent and philosophical mood I beg leave to quote a little poem which I wrote at an age when young men do that sort of thing.

Dr. Jean Lintermans came to Seattle in 1962 from his general pediatric residency at the University of Iowa. He worked with us in clinical pediatric cardiology and in our animal physiology laboratory for the next three years. He was the most productive individual in the history of our training program, publishing seven papers in those three years, four clinical papers and three involving pulsed ultrasonic flowmeters and implanted ultrasonic displacement devices in animals. The work, from laboratory to publication, was always done with the utmost attention to accuracy, and was well developed conceptually. Although English was not his native language, Jean's mastery of English was not only excellent, I felt that he actually communicated better than many of our native physicians. During the past year, I was delighted to learn that Jean was preparing a textbook on pediatric echocardiography with Dr. van Dorp, and was even more pleased to be asked to write a foreword .. However, the greatest pleasure came from actually reading this book, and finding that it does indeed have a unique approach, and with the additional genuine benefit to the reader of a thorough, consistent, segmental approach to the diagnosis of congenital heart disease.

Medical applications of ultrasound range from therapy, foetal monitoring, diagnostic imaging and blood flow measurement, to surgery and lithotripsy. Ever since the earliest developments of medical ultrasound there has been an interest in the measurement and characterisation of the ultrasonic fields generated in these applications, either for assessment of performance of equipment or for safety. Until recently, procedures for acoustic output measurements were ill-defined, but standards are now being developed internationally by the International Electrotechnical Commission (1EC) and reliable commercial measuring equipment is becoming more widely available. The aim of this book is to introduce acoustic output measurement techniques and to provide an insight into the measurement methods. The material presented is based on a course originally run during November 1989 at the National Physical Laboratory. In addition to the lectures, the course consisted of a series of practicals to allow participants to gain experience of making measurements. Teddington, UK Roy C. Preston February 1991 Contents List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii List of Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 Safety of Diagnostic Ultrasonic Equipment: The Relevance of Acoustic Output Information to the Clinical User R. C. Preston 1. 1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1. 2 The Relevance of Acoustic Output Information. . . . . . . . . . . . . 6 1. 2. 1 What Is Acoustic Output Information? . . . . . . . . . . . . . . . . . . . 6 1. 2. 2 What Is Acoustic Output Information Used For? . . . . . . . 6 1. 2. 3 Why Should You Know the Acoustic Output Levels of Your Equipment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1. 2. 4 Are Acoustic Output Levels Really that Important? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 acute abdomen is one of the most frequent, most dangerous and most difficult problems that the diagnostic radiologist has to deal with. This comprehensive manual presents a clinico-radiologic approach to the use of diagnostic imaging techniques for acute abdominal conditions. Imaging techniques, radiologic symptoms and clinical conditions are treated separately. This lucid format, together with a detailed subject index, offer the reader a quick and reliable reference aid in daily practice. The text is clearly structured and concise in style, and provides helpful practical hints, including discussion of diagnostic pitfalls. It is supported by a wealth of illustrations covering native diagnosis, ultrasonography, computer tomography and angiography.

Since the beginnings of diagnostic ultrasound in the 1950s, each decade has seen significant advances in this technology. Commer cialization of ultrasound occurred during the 1960s with the introduction of many of the clinical uses that are in existence today. The 1970s showed the most dramatic changes with the commercial introduction of gray-scale and real-time ultrasound. In the 1980s many new advances were introduced, including color Doppler, as well as a wide variety of endoluminal approaches, including endorectal, endovaginal and transesophageal. The decade of the 1990s promises even more significant advances with further transducer miniaturization, three-dimensional ultra sound, and the introduction of a variety of ultrasound contrast agents. With such rapid changes occurring, it becomes important to disseminate knowledge in as rapid a fashion as possible, thus it was quite appropriate that a meeting such as this be held to provide an in-depth review of the many new areas of ultrasound imaging that show promise for the future. Emphasis was on the new uses of ultrasound in gastrointestinal diseases. Many of these advances will, of course, also have applications in many other areas of the body. It is hoped that those in attendance will acquire a much broader understanding of where ultrasound is now and where it is headed in the not too distant future.

Technical improvements over the past twenty years have made endos copy the procedure of choice for examination of the hollow organs of the genitourinary and gastrointestinal tracts. The development of electro surgical techniques, laser technology, injection therapy, and a wide variety of other modalities now allow the endoscopist to treat many problems that in the past required open surgery. The simultaneous development of transcutaneous abdominal sonography has had an equally dramatic impact on the practice of gastrointestinal and geni tourinary surgery. The marriage of these proven technologies, known as endoscopic sonography, provides an exciting new modality that promises to further revolutionize the diagnosis and management of many intraabdominal diseases. Endoscopic sonography opens new frontiers by overcoming the primary limitations of its parent technologies. Fiberoptic endoscopy is limited by the inability to see beyond the luminal surface, this is particularly important when considering neoplastic disease because depth of wall invasion is a key factor in determining treatment. The limiting factor in transcutaneous sonography is the distance between the transducer and the target organ. With endoscopic sonography, the transducer is placed in close proximity to the target organ. This allows the use of high frequency waves (greater than 5 MHz), which provide better tissue resolution and eliminates the image distortion caused by overlying structures.

Over a mere 5 years, neonatal cranial sonography has evolved from an obscure and largely experimental imaging possibility to the modality of preference in the examination of the young brain. The almost immediate acceptance of the ultrasound examination of the neonatal brain was based on a number of coinci dent factors, the most important of which was the emergence of a burgeoning population of premature neonates who were, for the first time, surviving be yond infancy. These delicate patients were beginning to withstand the rigors of extrauterine life when not fully prepared for it; pulmonary, cardiac, and infec tious diseases no longer claimed most of them. With survival, a new specter reared its head: Would the eventual mental and neurologic status of these same children be worth the expense and time needed to bring them through their first months? This issue became increasingly pressing as evidence mounted through the 1970s that very premature neonates were at a high risk for intracranial hemor rhage and posthemorrhagic complications. An imaging modality that could evaluate the premature brain was sorely needed. The CT scanner with its proven ability to diagnose intracranial hemorrhage was of little value in this regard. So too were static gray-scale or waterpath ultrasound units. These modalities all had the same limitation, lack of portability. As neonatal intensive care units proliferated, so did the technology that would soon allow cribside neonatal neuroimaging, the real-time sector scanner."

Very thorough knowledge of breast pathology is a sine qua non for interpretation of breast films ... progress in X-ray diagnosis could only be made by careful comparison of the film with the actual specimen. H.INGLEBY Multiplication of the same e"oneous diagnosis does not make that diagnosis co"ect. J.G.AzZOPARDI Paradoxically enough, our specialty considers the radiologist who mis takes a skin fibroma or the calcifications in a sponge kidney for a kid ney stone to lack basic knowledge, while the radiologist who imme diately calls for the surgeon because of a few white spots on a mammogram is thought to be acting according to the rules of medical practice. Misunderstandings and confusion with regard to breast pathology as well as the comfortable philosophy that superfluous biopsies are the price we have to pay for the early detection of carcinomas have in many places led to a loss of confidence in mammography. Yet this is a meth od with which carcinomas can be detected earlier than with any other imaging technique.

Echocardiography has recently become one of' the most important techniques in clinical cardiology. The major advantage of this method is its noninvasive nature enabling us to apply it under a widespread variety of clinical conditions. In the late 1960s, when research and clinical application of echo cardiography were started, and during the first decade investigations were mainly focused on the morphology of the valves and the chambers of the heart. The introduction of two-dimensional echocardiography was a major breakthrough in visualizing different portions of the heart. How ever, the poor resolution of the first devices provided only little qualitative information. With the introduction of phased array 2-D-echo-devices yielding better results and the application of computer techniques for the processing of M-mode and two-dimensional echo cardiograms, a great amount of qualitative information has become available to describe not only the morphology, but also the dynamic function of the heart in a noninvasive manner. This volume summarizes the lectures held at the International Symposium on Echocardiography, Hamburg, September 1978, endeavoring to review the current state of knowledge with regard to echo cardiography in the experimental and clinical setting. We herewith thank all lecturers, who have contributed to the publication and the Pharma-Schwarz Company which enabled us to organize this meeting by a generous subsidy."

by Dr. Donald L. King The past decade has seen the ascent of ultrasonography to a preeminent position as a diagnostic imaging modality for obstetrics and gynecology. It can be stated without qualification that modern obstetrics and gynecology cannot be practiced without the use of diagnostic ultrasound, and in particular, the use of ultrasonogra phy. Ultrasonography quickly and safely provides detailed, high resolution images of the pelvic organs and gravid uterus. The quality and quantity of diagnostic information obtained by ultra sonography far exceeds anything previously available and has had a revolutionary impact on the management of patients. High resolution static images permit the intrauterine diagnosis of fetal growth retardation and fetal abnormalities. In addition to tradi tional images, newer dynamic imaging techniques allow observa tion of fetal motion, cardiac pulsation, and respiratory efforts. The use of ultrasonography for guidance has greatly augmented the safety and utility of amniocentesis. One of the great virtues of diagnostic ultrasound has been its apparent safety. At present energy levels, diagnostic ultrasound appears to be without any injurious effect. Although all the availa ble evidence suggests that it is a very safe modality and that the benefit to risk ratio is very high, the actual safety margin for its use Vll as yet remains unknown. As a consequence, practitioners are urged to limit its use only to those situations in which genuine clinical indica tions exist and real benefit to the patient is likely to result."

This is a unique book in that it brings together the two key investigative techniques in Gynaecology and Obstetrics, namely ultrasound and endoscopy. So often in the past they were regarded by their exponents as rival techniques but it is now recognised that they are complementary to each other. Consequently future trainees in endoscopy should become efficient in transvaginal sonography and vice versa. Ultrasound can be used to study the morphology of the pelvic organs such as the endometrium, myometrium and ovaries, and being non-invasive, safe and convenient can be repeated as often as is deemed necessary to monitor changes over time; for example in the investigation of the infertile woman the development of the dominant follicle, the maturation of the endometrium and the formation of the corpus luteum can be documented throughout the menstrual cycle while growth of ovarian cysts can be precisely measured to determine the need for surgery. A seldom-mentioned strength of the ultrasound examination is its interactive quality, for example by performing abdominal palpation during the scan, the mobility of the uterus and ovaries can be assessed. Also the images as they appear can be shown to the patient to aid understanding. Ultrasound can also determine function and the use of Doppler has been used for example to access endometrial receptivity, follicular maturity and the likelihood of malignancy in the endometrium or ovary.

Diagnostic ultrasound is changing dramatically because of the development of a variety of high resolution real-time scanning instruments. Until recently the standard instrument was the articulated arm contact scanner. Real-time scanners were viewed as adjunct instruments for specific and limited pur poses. The roles are reversing with real-time instruments more frequently accepted as the primary diagnostic tool and the contact scanner becoming the ancillary instrument for use mainly for viewing a large field that cannot be scanned with real-time instruments. Two recent editorials stated that real-time instruments were used as the sole diagnostic instrument for between 80% [Cooperberg (2)] and 98% [Bartrum and Crow (1)] of their abdominal examinations. This book introduces the reader to the field of real-time scanning in the abdomen. It presupposes an understanding of basic physical concepts of ultrasound, the appearance of both normal and pathologic conditions as produced by static articulated arm contact scanning, and a familiarity with the techniques of contact scanning. It is designed to acquaint the reader with the spectrum of real-time instrumentation, provide a basic understanding of the physics of ultrasound as related to these instruments, emphasize the special skills required in the use of this equipment, and describe applications of real-time scanning for various parts of the abdomen. While numerous illustrations of both normal and pathologic anatomy are shown, the book is an all-inclusive study of abdominal pathology as demonstrated by real-time imaging.