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Aims and Objectives: To measure the reliability of pH testing to confirm ongoing nasogastric tube (NGT) position and to document associated complications. Background: Confirming NGT position is essential, as use of an incorrectly positioned tube can cause harm. Substantial evidence examines initial confirmation of NGT position, yet limited evidence exists considers NGT displacement which is identified via ongoing NGT position tests. In the NHS, pH testing is recommended to confirm ongoing NGT position; however, there may be an association with excess X‐rays and missed enteral nutrition and/or medications. Design: Prospective observational study using STROBE checklist. Methods: Data collected from medical records of 136 patients with NGTs in a London NHS Trust included pH tests, test results and complications related to ongoing pH tests which failed to confirm the tube was positioned in the stomach, that is, X‐rays, and disruptions to enteral nutrition and medication. Cohen's Kappa determined pH test reliability. Results: Of 1381 pH tests conducted to confirm NGT position, five (0.3%) correctly identified an NGT displacement, and one (0.07%) failed to identify displacement before use. The reliability of ongoing pH tests using Cohen's Kappa was minimal (0.29). Ongoing pH tests that failed to confirm a correctly positioned NGT led to 31 (22.8%) patients having X‐rays, 24 (17.6%) missing >10% of prescribed enteral nutrition and 25 (18.4%) missing a critical medication. Conclusion: Ongoing NGT position testing using pH tests did not prevent the use of a displaced tube, and more than one‐fifth of patients required X‐rays to confirm a correctly position NGT, contributing to missed medications and enteral nutrition. Relevance to Clinical Practice: Caution should be used when confirming ongoing NGT position with a pH test. Future guidelines should balance the risk of using a displaced tube with potential delays to nutrition and/or medication. More research is needed to explore alternative methods of ongoing NGT position testing. [ABSTRACT FROM AUTHOR]

High-energy Proton Beam Therapy (PBT) commenced in England in 2018 and NHS England commissions PBT for 1.5% of patients receiving radical radiotherapy. We sought expert opinion on the level of provision. Invitations were sent to 41 colleagues working in PBT, most at one UK centre, to contribute by completing a spreadsheet. 39 responded: 23 (59%) completed the spreadsheet; 16 (41%) declined, arguing that clinical outcome data are lacking, but joined six additional site-specialist oncologists for two consensus meetings. The spreadsheet was pre-populated with incidence data from Cancer Research UK and radiotherapy use data from the National Cancer Registration and Analysis Service. 'Mechanisms of Benefit' of reduced growth impairment, reduced toxicity, dose escalation and reduced second cancer risk were examined. The most reliable figure for percentage of radical radiotherapy patients likely to benefit from PBT was that agreed by 95% of the 23 respondents at 4.3%, slightly larger than current provision. The median was 15% (range 4–92%) and consensus median 13%. The biggest estimated potential benefit was from reducing toxicity, median benefit to 15% (range 4–92%), followed by dose escalation median 3% (range 0 to 47%); consensus values were 12 and 3%. Reduced growth impairment and reduced second cancer risk were calculated to benefit 0.5% and 0.1%. The most secure estimate of percentage benefit was 4.3% but insufficient clinical outcome data exist for confident estimates. The study supports the NHS approach of using the evidence base and developing it through randomised trials, non-randomised studies and outcomes tracking. Less is known about the percentage of patients who may benefit from PBT than is generally acknowledged. Expert opinion varies widely. Insufficient clinical outcome data exist to provide robust estimates. Considerable further work is needed to address this, including international collaboration; much is already underway but will take time to provide mature data. [ABSTRACT FROM AUTHOR]

Broken bones and other joint injuries are the number one reason that people seek help from a hospital emergency department (ED). [ABSTRACT FROM AUTHOR]

Background: National guidelines in England recommend prompt chest X-ray (within 14 days) in patients presenting in general practice with unexplained symptoms of possible lung cancer, including persistent cough, shortness of breath, or weight loss.Aim: To examine time to chest X-ray in symptomatic patients in English general practice before lung cancer diagnosis, and explore demographical variation.Design and Setting: Retrospective cohort study using routinely collected general practice, cancer registry, and imaging data from England.Method: Patients with lung cancer who presented symptomatically in general practice in the year pre-diagnosis and who had a pre-diagnostic chest X-ray were included. Time from presentation to chest X-ray (presentation-test interval) was determined and intervals classified based on national guideline recommendations as concordant (≤14 days) or non-concordant (>14 days). Variation in intervals was examined by age, sex, smoking status, and deprivation.Results: In a cohort of 2102 patients with lung cancer, the median presentation-test interval was 49 (interquartile range [IQR] 5-172) days. Of these, 727 (35%) patients had presentation-test intervals of ≤14 days (median 1 [IQR 0-6] day) and 1375 (65%) had presentation-test intervals of >14 days (median 128 [IQR 52-231] days). Intervals were longer among patients who smoke (equivalent to 63% longer than non-smokers; P<0.001), older patients (equivalent to 7% longer for every 10 years from age 27; P = 0.013), and females (equivalent to 12% longer than males; P = 0.016).Conclusion: In symptomatic primary care patients who underwent chest X-ray before lung cancer diagnosis, only 35% were tested within the timeframe recommended by national guidelines. Patients who smoke, older patients, and females experienced longer intervals. These findings could help guide initiatives aimed at improving timely lung cancer diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: The United Kingdom (UK) government's healthcare policy in the early 1990s paved the way adoption of the skills mix development and implementation of diagnostic radiographers' X-ray reporting service. Current clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study aimed to identify, define and assess the longitudinal macro, meso, and micro barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS) in England., Methods: Multiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL, and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database; Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS depository) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The literature was assessed against Joanna Briggs Institute's critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers., Results: The wide and diverse range of data (n = 241 papers) identified barriers and enablers of implementation, which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture, environment, and leadership., Conclusion: The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This has helped shape capacity building of the reporting workforce. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services., (© 2023. The Author(s).)

Post-pyloric feeding is recommended in critically ill patients with gastrointestinal intolerance. However, traditional placement methods are logistically difficult and carry potential risks. The authors retrospectively compared the position of post-pyloric feeding tubes (PPFTs) using an electromagnetic device that demonstrated by X-ray and analysed the complication rates, proportion of lung placements avoided and the time taken to establish enteral feeding. Forty placements in 37 mechanically ventilated patients were analysed; there was a success rate of 87.5%. Sensitivity and specificity were 77% (95% CI 59.9-89.6%) and 100% (95% CI 48.0-100%). Five lung placements were identified in real time and therefore avoided. The mean (SD) time from PPFT placement to X-ray was 134 minutes (± 139 minutes) and, to feeding, 276 minutes (± 213 minutes). In conclusion, placement of PPFT using an electromagnetic device carries a high success rate, is safe and feasible to undertake at the bedside in mechanically ventilated patients. [ABSTRACT FROM AUTHOR]

Gastric confirmation by pH is only achievable in approximately 50% of placements and X-rays are expensive and may be misinterpreted. Bedside electromagnetic (EM) guidance offers real-time confirmation. The authors determined the accuracy of guidance in predicting gastric body position from the EM trace using official Cortrak guidance (the EM trace reaches the bottom left quadrant of the anterior screen) compared with local guidance (detailed anterior-depth description of the GI flexures). X-ray, pH or an EM trace beyond the gastric body were used to independently confirm gastric position. Of 496 EM traces, 49% of tubes were in the oesophagus on entry to the lower left quadrant whereas 12% had already reached the gastric body in the upper left quadrant. Overall, predicting position by quadrant was 70% accurate whereas differentiating the pre-gastro-oesophageal junction (pre-GOJ) from the gastric body flexure was 100% accurate. Confirming gastric position by the anterior trace quadrant appears to be unsafe whereas expert differentiation of the pre-GOJ and gastric body flexures was reliable. The authors invite Corpak Medsystems (now owned by Halyard Health) to update its guidance in view of these findings. [ABSTRACT FROM AUTHOR]

Around 5% of hospital patients require enteral tube feeding, yet its efficacy and costs are poorly understood. The authors examined radio-opacity, reason for repeat X-ray and overall cost in consecutive patients having tubes confirmed by X-ray when using polyvinylchloride (PVC) Ryles tubes versus CORFLO® (CORTRAK Medsystems) polyurethane tubes (PUTs); and confirmation method and reason for tube loss over an enteral episode. Despite higher PUT cost, because more Ryles tubes required re-X-ray ± radiocontrast injection (0% compared with 26%, p=0.029), overall cost was almost identical (Corflo: £54.2 vs Ryles: £54.6). Confirmation of tube position by X-ray remains more common than pH (51% compared with 45%) and tube loss is mostly as a result of inadvertent patient removal (54%). These studies show that: a) when using X-ray confirmation, PUTs and PVC Ryles tube cost is similar; b) despite pH being taught as first-line confirmation, X-ray remains the most common method therefore PUT use may further reduce cost when staff and outcome costs are included. In addition, more reliable and repeatable bedside confirmation methods are required; c) most tube loss is potentially preventable by use of nasal bridles. Larger studies are required to establish baseline data on problems and costeffectiveness of enteral tube feeding before intervention trials. [ABSTRACT FROM AUTHOR]

In 2008 the remains of a chain pump were recovered from the wreck of the third-rate man-of-war Northumberland, which sank on the Goodwin Sands in the English Channel, during the Great Storm of November 1703. Chain pumps were vital equipment and integral to the safety of the ship. Historical evidence is mined for comparative material, and the recovery, conservation strategy, study and recording of this artefact using X-ray and CT scanning are discussed. Information gleaned, hitherto absent from the historical and archaeological record, includes details of the pump's chain, hook and swivel, valves and roller. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to close ventricular septal defects (VSDs) directly through the chest wall using magnetic resonance imaging (MRI) guidance, without cardiopulmonary bypass, sternotomy, or radiation exposure. Background: Surgical, percutaneous, and hybrid management of VSD each have limitations and known morbidity. Methods: Percutaneous muscular VSDs were created in 10 naive Yorkshire swine using a transjugular laser catheter. Under real-time MRI guidance, a direct transthoracic vascular access sheath was introduced through the chest into the heart along a trajectory suitable for VSD access and closure. Through this transthoracic sheath, muscular VSDs were occluded using a commercial nitinol device. Finally, the right ventricular free wall was closed using a commercial collagen plug intended for arterial closure. Results: Anterior, posterior, and mid-muscular VSDs (6.8 ± 1.8 mm) were created. VSDs were closed successfully in all animals. The transthoracic access sheath was displaced in 2, both fatal. Thereafter, we tested an intracameral retention sheath to prevent this complication. Right ventricular access ports were closed successfully in all, and after as many as 30 days, healed successfully. Conclusions: Real-time MRI guidance allowed closed-chest transthoracic perventricular muscular VSD closure in a clinically meaningful animal model. Once applied to patients, this approach may avoid traditional surgical, percutaneous, or open-chest transcatheter (“hybrid”) risks. [ABSTRACT FROM AUTHOR]

The fourth international workshop on Adaptive and Active X-ray & XUV Optics (ACTOP11) was held on April 4-5, 2011, at Diamond Light Source in Oxfordshire, UK. This workshop follows on from earlier, successful active optic events at SOLEIL (2006), Elettra (2008), and Osaka (2009). [ABSTRACT FROM AUTHOR]

On December 28, 1895, the German physicist Wilhelm Conrad Röntgen disclosed his discovery of X-rays to the public. Just a few months later, Guglielmo Marconi successfully demonstrated his wireless system at Salisbury Plain, England. This article traces the relations between the early histories of wireless and X-ray technology. It does so by highlighting the role played by psychic research to open the connections between different technologies and knowledges. The disclosure of occult connections between these two technologies helps to locate the cultural reception of wireless around 1900 in a wider cosmology of rays and invisible forces. [ABSTRACT FROM AUTHOR]

Abstract: X-ray phase contrast imaging solves the basic problem of conventional X-ray imaging, i.e. low image contrast arising from small absorption differences. For years X-ray phase contrast imaging was thought to be restricted to synchrotron radiation facilities, but a new approach was recently developed at UCL which makes synchrotron-like phase effects achievable with conventional sources, by introducing two separate sets of appropriately designed coded-apertures at either side of the imaged object. Although most proposed applications of X-ray phase contrast imaging are focused on medical aspects, substantial advantages can be gained in other fields, including security inspections. In this case the system has to be based around higher X-ray energies, which has an impact on the system design. This paper describes such a design. A previously developed and experimentally validated simulation program was used to estimate the image contrast that can be expected from a range of details of interest in security inspections imaged under various conditions, including beam spectrum, detector characteristics, coded-aperture design, source-to-sample and sample-to-detector distances, etc.—while taking into account the interplay between these different parameters. The conditions providing maximum image contrast were chosen and used in the ultimate system design. [Copyright &y& Elsevier]

The article discusses the possibilities that are suggested by the advent of the X-ray technology discovered by Wilhelm Conrad Röntgen in late-Victorian England. It says that the association of the X-ray with photography complicated the technology's status as an instrument of visual information. It also states that the photographic medium can be understood in the context of nineteenth-century by considering what it means to a contemporary audience and the way they complicated the definitions of objectivity, truth and document.

Introduction: The chest x-ray (CXR) is the most commonly performed x-ray examination in England, UK. Reporting radiographers provide a cost-effective and safe solution for managing CXR backlogs, but not all Trusts support this service development. This study aimed to establish the service enablers and challenges associated with training and employing radiographers to report CXR images in acute hospital sites in England, UK., Methods: Approval for this electronic survey was granted in 84 of 146 (58%) Trusts approached. The survey was open for 10 weeks during August to October 2020, comprising of qualitative and quantitative questions. Data was exported in to an Excel spreadsheet where manual thematic analysis was performed. Descriptive statistics were also generated., Results: Sample size was 75 (89% response rate). Thirty-three departments (44%) had at least one trainee. Most departments (n = 53, 71%) employ at least one CXR reporting radiographer. A total of 121/160 (76%) radiographers report CXRs. Number of reporting sessions shows progression. Factors enabling training and employment arise from service improvements, financial pressures, and developing the workforce. The main challenges relate to staffing issues with a number of associated sub-themes. A small faction indicated lack of radiographer interest to report CXRs due to litigation worries; possibly uncovering a new and emerging issue., Conclusion: Enablers and challenges associated with radiographers reporting CXRs are similar to previous studies. The growth of CXR reporting radiographers and reporting sessions indicates a continuing reliance on radiographers to contributing to managing CXR backlogs., Implications for Practice: It is recommended that potential trainees are explicitly informed of the legal protection that will be provided, to prevent accountability concerns impacting on the continuing progression in this area of advanced practice., Competing Interests: Conflict of interest statement None., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

The electron microscope was conceived and built in the Technical University of Berlin some 50 years ago. Much of its further development took place in university laboratories. Some significant contributions came to be made in the Cavendish is respect of high voltage operation and the improvement of resolution, and in microanalytical instrumentation.
Part I (Vol. 22, no. (1), pp. 3-36), covering the years, 1946-60, included some account of the prehistory of he subject, the exploration of the operation and applications of the first commercial models, the development of an X-ray microscope and, from it, the scanning microprobe analyzer Part II now continues the story, through the two following decades, the conception and construction of a high voltage electron microscope, and then its extension to an instrument capable of atomic resolution. [ABSTRACT FROM AUTHOR]

Chest X-rays are widely used in the investigation of patients with both functional and organic mental illness. For patients with dementia their routine use has been recommended by many authorities. However, the existing evidence to support such use is not strong. A prospective audit was performed to ascertain the yield of chest X-rays affecting patient management in a series of consecutive admissions covering all diagnoses. The yield of unexpected findings was substantial, but few of these led to a change in medical management and hence potentially to the course of illness. Apparently significant radiological findings did not always correlate with actual physical illness. The low yield of results affecting management does not support the routine use of chest radiography in elderly mentally ill, and its use should be limited to when functional illness is refractory to treatment or when demented patients suddenly deteriorate without obvious cause. [ABSTRACT FROM AUTHOR]

Examines the high energy neutron treatment for pelvic cancers in Wirral, England. Comparison between high energy neutron with megavoltage X ray treatment; Development of metastatic disease and treatment related morbidity; Factors affecting the stoppage of trials.

The article discusses developments in the orthopedic medicine in London, England. In 1895, the X-ray was discovered by Wilhem Conrad Röntgen. Robert Jones is considered as the father of British orthopedic surgery. The orthopedic application of tomography was started after World War II. Alexander Fleming produced the first antibiotic penicillin in 1943. It is stated that the investigation of spinal lesions is the greatest collaboration between radiologists and orthopedic surgeons.

Background: There is a risk of developing pressure ulcers from lying on an X-ray table mattress, if the mattress pressure redistribution properties are poor., Aim: To assess the pressure redistribution properties of 'new' and 'in current clinical use' X-ray table mattresses., Methods and Materials: Twenty one X-ray table mattresses, each of 2.5 cm thickness, were evaluated. An anthropomorphic human phantom of adult stature with five different weights (minimum, first quartile, mean, third quartile and maximum) was used to simulate human head, pelvis and heels (pressure ulcer jeopardy areas). Using Xsensor technology, peak pressure was measured and Interface Pressure Ratio was calculated for the three pressure ulcer jeopardy areas 'with' and 'without' an X-ray table mattress., Results: For all mattresses, statistically significant differences (p < 0.05) were found between the peak pressure values with and without using an X-ray table mattress for the three pressure ulcer jeopardy areas; similarly, for all mattresses, statistically significant differences (p < 0.05) were found between the Interface Pressure Ratio values with and without using x-ray table mattress. The type and age of the mattress was observed to have an impact on peak pressure values and Interface Pressure Ratios, with older mattresses performing worse., Conclusion: Peak pressure values and Interface Pressure Ratios are reduced significantly when using newer X-ray table mattresses. This could be because newer mattresses use more appropriate materials in their construction and/or older mattresses have lost their pressure redistribution properties. Radiology departments should consider assessing mattresses pressure redistribution properties, perhaps on an annual basis., (Copyright © 2020. Published by Elsevier Inc.)

Aims: Emerging evidence suggests that contact X-ray brachytherapy (CXB) may increase the clinical complete response rate and durability when administered after standard chemoradiotherapy in patients with rectal cancer. The addition of CXB in partial responders is therefore probably cost-effective. The affordability of widening access to CXB in the UK, however, has not been evaluated., Materials and Methods: Decision analytical modelling with Monte Carlo simulation was used to evaluate long-term costs for the management of patients with rectal cancers who were given a CXB boost when a clinical complete response was not initially achieved following chemoradiotherapy in order to facilitate a watch and wait approach. A third-party payer (National Health Service) perspective was adopted, probabilistic sensitivity analysis was carried out and a scenario analysis was performed to investigate the effect of the number of referral centres and number of patients treated with CXB., Results: We estimate that 818 (95% confidence interval 628-1021) patients per year are eligible for CXB as an adjunct to a watch and wait approach in England and Wales. As this management is less costly than surgical management for each individual patient, the more patients treated, the more affordable the technology. Even if as few as 125 patients are treated nationally in 15 centres, the cost of implementing this technology would be less than £4 million. If the average number of patients treated in each centre is 30, this technology would be cost saving within 5 years., Conclusions: The cost of CXB is not prohibitive according to the National Institute for Health and Care Excellence threshold for implementation of new technology and may even be cost saving within 5 years compared with standard surgical management, depending on the uptake of the technology and the number of referral centres., (Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Purposes: The term 'radiosensitivity' appeared for the first time at the beginning of the 20th century, few years after the discovery of X-rays. Initially used by French and German radiologists, it illustrated the risk of radiation-induced (RI) skin reactions. From the 1950s, 'radiosensitivity' was progressively found to describe other features of RI response such as RI cancers or cataracts. To date, such confusion may raise legal issues and complexify the message addressed to general public. Here, through an historical review, we aimed to better understand how this confusion appeared., Methods: To support our historical review, a quantitative and qualitative wording analysis of the 'radiosensitivity' occurrences and its derived terms was performed with Google books, Pubmed, Web of Science™ databases, and in all the ICRP publications., Conclusions: While 'radiosensitivity' was historically related to RI adverse tissue events attributable to cell death, the first efforts to quantify the RI risk specific to each organ/tissue revealed some different semantic fields that are not necessarily compatible together (e.g. adverse tissue events for skin, cataracts for eyes, RI cancer for breast or thyroid). To avoid such confusion, we propose to keep the historical definition of 'radiosensitivity' to any clinical and cellular consequences of radiation attributable to cell death and to introduce the term 'radiosusceptibility' to describe the RI cancers or any feature that is attributable to cell transformation.

Examines the reasons of requesting x-ray examinations for acute ankle injuries in London, England. Revision on the notes and radiographs of patients with ankle injuries; Assessment on the number of radiographs of the foot requested by patients; Conclusion that the absence of clinical tissue swelling indicates that no ligamentous damage is present.

This article discusses a study conducted at the Imperial College Field Station in Berkshire, England in 1959 about the detection of stem borers in gramineae by X-rays. For some years populations of dipterous stem borers have been studied at the field station by laborious dissection of the grass stems in five-inch diameter core samples of turf. To reduce the amount of work, a rapid method for sorting infested grass stems is urgently required, a single turf sample often contains several hundred stems. It was therefore decided to explore the possibilities of an X-ray technique. After radiography each plant was sketched and dissected, the location of larvae being marked on the appropriate sketch. The sketches were compared with the radiographs, and it was soon plain that larvae of 2 millimeter or longer could be detected on the radiographs.

The article reports on a poll conducted to celebrate the centenary of the Science Museum in London, England in which x-ray machines were chosen by voters as the most important scientific invention. Almost 50,000 people who participated in the poll voted in the ballot to choose from 10 innovations that the museum curators have selected. The x-ray machine built by general physician John Reynolds and his son emerged as a winner, earning 9581 votes from the poll. However, the discovery of penicillin has earned the second place.

The article reports on the use of dental x-rays in detecting osteoporosis. Hugh Devlin and his colleagues at the University of Manchester in England have developed a software-based approach to detecting osteoporosis which uses the active shape modeling technology that determines jaw cortex widths. It notes that jaw cortex widths of less than 3 mm are indicative of osteoporosis. Benefits of the test are its low cost, simplicity and automation.

The article reports that a new facility for real-time X-ray inspection of manufactured parts has been opened by Euroteck Systems UK Ltd. in Tamworth, England. The X-ray systems are rated up to 160 kV. They include both high-power systems for inspecting steel parts and smaller focal spot systems that give the capability of significant magnification without losing image quality.

Comments on the annual BINDT conference regarding radiography in Harrogate, England. Presentations of the automated digital and computed radiography theme; Use of defect recognition algorithms on digital images; Selection of the papers related to the topics discuss in the conference.

Profiles professor Roger A. Cowley of the University of Oxford in England, recipient of the 2003 Walter Hälg Prize. Original work of Cowley recognized by the European Neutron Scattering Association; Series of firsts in experiments with neutrons and X-rays and in theory by Cowley; Professional background of Cowley.

Discusses the future of Daresbury Laboratory in England as of October, 2000. Laboratory's attainment of government funding for nine collaborative projects; How Daresbury houses Great Britain's only synchrotron light source, which create X-rays to determine the structure of biological molecules; Description of the projects, including a Third Generation Proteomics project with the University of Manchester Institute of Science and Technology.

The article cites a study which reports that diagnostic likelihood of exposing the testes to radiation and are taken within one year before men father a child may have detrimental effects on the infant. Among 7,678 infants born in 1991-1992 in Avon, England, 172 had fathers who had undergone an X ray of the abdominal or pelvic area in the year before conception. The study found that these infants weighed, on average, 79 grams less at birth than those whose fathers had not had such a test. It suggest an association between men's exposure to X-rays and effects on reproductive out-comes.

Background: Most lung cancers present symptomatically, but the pathway to diagnosis in primary care can be complex and is poorly understood. Significant event audit (SEA) is a quality improvement technique widely used in UK general practice., Aim: To gain insights into the diagnostic process for lung cancer, drawn from analysis of SEA documents., Design and Setting: Qualitative analysis of SEAs from 92 general practices in the North of England Cancer Network., Method: Participating practices were provided with a standardised electronic template and asked to undertake a significant event audit related to the most recent diagnosis of lung cancer in the practice, even if that patient had since died. Reported accounts for 132 diagnoses were analysed using a modified framework approach., Results: Most SEAs demonstrated timely recognition and referral. Where this had taken longer, there were often reasonable explanations, including: chest X-rays reported as normal or with benign findings; patient-mediated factors, such as delay in re-presenting or declining earlier referral; and presentation complicated by comorbidity. Some opportunities for earlier referral were also found. Lessons drawn from these events included limitations of chest X-ray as a diagnostic tool, the need for vigilance in patients with existing morbidity, and the importance of 'safety-netting'., Conclusion: Qualitative synthesis of SEAs offered considerable value in understanding circumstances surrounding the diagnostic process for lung cancer in primary care. The most common presentation was with cough or other symptoms indicative of infection, and it is by understanding more about these patients in particular that most can be gained.