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Some years ago it was decided that a European curriculum should be developed for medical physicists professionally engaged in the support of clinical diagnostic imaging departments. With this in mind, EFOMP (European Federation of Organisations for Medical Physics) in association with ESR (European Society of Radiology) nominated an expert working group. This curriculum is now to hand. The curriculum is intended to promote best patient care in radiology departments through the harmonization of education and training of medical physicists to a high standard in diagnostic radiology. It is recommended that a medical physicist working in a radiology department should have an advanced level of professional expertise in X-ray imaging, and additionally, depending on local availability, should acquire knowledge and competencies in overseeing ultrasound imaging, nuclear medicine, and MRI technology. By demonstrating training to a standardized curriculum, medical physicists throughout Europe will enhance their mobility, while maintaining local high standards of medical physics expertise. This document also provides the basis for improved implementation of articles in the European medical exposure directives related to the medical physics expert. The curriculum is divided into three main sections: The first deals with general competencies in the principles of medical physics. The second section describes specific knowledge and skills required for a medical physicist (medical physics expert) to operate clinically in a department of diagnostic radiology. The final section outlines research skills that are also considered to be necessary and appropriate competencies in a career as medical physicist.

Purpose: Multimodality imaging represents an area of rapid growth with important professional implication for both nuclear medicine physicians and radiologists throughout Europe. As a preliminary step for future action aimed at improving the quality and accessibility of PET/SPECT/CT multimodality imaging practice in Europe, the European Association of Nuclear Medicine (EANM) and the European Society of Radiology (ESR) performed a survey among the individual membership of both societies to obtain information on the status of multimodality imaging in their facilities and their future visions on training for combined modalities., Methods: A questionnaire was forwarded to all individual members of the EANM and ESR. The main subject matter of the questionnaire related to: (1) study performance,current procedures, current equipment including its supervisory personnel at respondents' individual facilities and (2)vision of future practice, performance and the potential for combined interdisciplinary viewing and training for future professionals., Results: The reporting and the billing procedures of multimodality imaging studies are very heterogeneous in European countries. The majority of the members of both societies believe that the proportion of PET/CT conducted as a full diagnostic CT with contrast enhancement will increase over time. As expected, (18)F-FDG is the most commonly used PET tracer for clinical applications. The large majority of respondents were in favour of an interdisciplinary training programme being developed on a European level together by the EANM and the ESR and the respective sections of the European Union of Medical Specialists., Conclusion: The results of this survey show that there is wide heterogeneity in the current practice of multimodality imaging in Europe. This situation may limit the full potential and integration of multimodality imaging within the clinical arena. There is a strong desire within both specialties for the development of interdisciplinary training to address some of these issues.

Mesenteric panniculitis is a rare disease of the bowel mesentery, characterized by tumor-like infiltration by chronic inflammatory cells, fat necrosis, and fibrosis. Reported cases cited clinical presentation ranging from abdominal pain to fever of unknown origin, the majority of which were idiopathic and associated with a benign prognosis. We report the case of a 43-yr-old male who presented with malaise, weight loss, microcytic anemia, and a high erythrocyte sedimentation rate. Radiographic and histological investigations revealed typical features of mesenteric panniculitis. Initial treatment with high-dose oral prednisolone led to rapid and complete resolution of symptomatology, radiographic, and laboratory anomalies. Within 6 months, the patient presented again with anemia, renal failure, and hypercalcemia. A diagnosis of IgA kappa chain myeloma was made. Despite chemotherapy and restoration of normocalcemia, he died from refractory pulmonary edema. This is the first report of a hematological malignancy initially presenting with features of mesenteric panniculitis culminating in an aggressive course and a fatal outcome.

Previous studies on the association of ankylosing spondylitis and abnormalities of the lung parenchyma have been based largely on plain radiography and pulmonary function testing. This study, although uncontrolled, is the first to use high-resolution computed tomography to examine the entire lung parenchyma in ankylosing spondylitis patients, and to correlate the findings with clinical assessment, plain radiography and pulmonary function testing. The study population comprised 26 patients meeting the New York criteria for idiopathic ankylosing spondylitis who attended the out-patient department at our institution. High-resolution computed tomography examination revealed abnormalities in 19 patients (70%): these included interstitial lung disease (n = 4), bronchiectasis (n = 6), emphysema (n = 4), apical fibrosis (n = 2), mycetoma (n = 1) and non-specific interstitial lung disease (n = 12). Plain radiography was abnormal in only four patients and failed to identify any patient with interstitial lung disease. All patients with interstitial lung disease on high-resolution computed tomography had respiratory symptoms and three of the four had evidence of a restrictive process on pulmonary function testing. This study raises, for the first time, the possible association between interstitial lung disease and ankylosing spondylitis, and highlights the use of high-resolution computed tomography in detecting such disease in ankylosing spondylitis patients.

Objective: The aims of this study were to identify the spectrum of abnormalities seen on high-resolution CT in patients with ankylosing spondylitis and to compare our findings with reports of plain film pulmonary manifestations of the disease., Subjects and Methods: We prospectively studied 26 patients with documented ankylosing spondylitis. All patients underwent plain chest radiography (posteroanterior and lateral views), thoracic helical CT, high-resolution CT, and pulmonary function tests., Results: High-resolution CT revealed abnormalities in 18 patients (69%), whereas plain chest radiography revealed abnormalities in four patients (15%). The most common abnormalities seen on CT were interstitial lung disease (ILD) (n = 4), bronchial wall thickening and bronchiectasis (n = 6), paraseptal emphysema (n = 3), mediastinal lymphadenopathy (n = 3), tracheal dilatation (n = 2), and apical fibrosis (n = 2)., Conclusion: This study, which describes high-resolution CT findings in patients with ankylosing spondylitis, reveals a spectrum of abnormalities unlike those described in previous reports in which researchers used plain chest radiographs as the sole imaging technique. In addition to apical fibrosis, high-resolution CT revealed nonapical ILD, bronchiectasis, paraseptal emphysema, and tracheobronchomegaly. Of these new findings, we believe that identification of ILD is the most important. We suggest that nonapical ILD should be actively sought as an explanation for pulmonary symptoms developing in patients with ankylosing spondylitis. High-resolution CT should form an integral part of such workup.

Four cases of oesophageal small cell carcinoma are described. Radiological features at presentation included oesophageal strictures in association with bulky intrathoracic and intraabdominal lymphadenopathy. The subject is reviewed and the radiologically relevant features are emphasized.

Conduit volvulus is a very rare complication of ileal loop diversion. To date it has not been described in association with parastomal herniae. We report two such cases. Antegrade nephrostogram established the diagnosis and nephrostomy drainage facilitated spontaneous resolution of the volvulus with return to baseline renal function in both patients. Percutaneous drainage was the only intervention required in one case. For the second patient, percutaneous decompression permitted elective surgical refashioning of the conduit following clinical stabilization. Conduit volvulus in association with a parastomal hernia is a potentially reversible cause of renal impairment in patients with urinary diversions. The diagnosis depends on accurate radiological evaluation. The initial treatment of choice is percutaneous drainage with elective surgery when the patient's clinical status has improved.

The authors illustrate the value of computed tomography (CT) of the retroperitoneum in patients presenting with femoral nerve signs. They describe 28 such patients, examined at a tertiary-care hospital between June 1990 and January 1993, in whom CT of the retroperitoneum contributed significantly to the diagnosis. The patients, 19 males and 9 females, ranged in age from 11 to 81 years. CT showed disease of the psoas compartment in 17 cases; the condition was due to a malignant lesion in 9 cases and was secondary to infection in 5 and to other causes in 3. Disease of the iliacus compartment was shown in 11 cases; it was due to a malignant lesion in 6 cases and was secondary to hemorrhage in 2, to infection in 1 and to a bursa in 1. The diagnostic features of the diseases encountered are discussed, and the importance of performing CT early is stressed.

Objective: We report two cases of cystic renal masses considered indeterminate on sonography and CT, in which haemorrhagic contents were demonstrated on MRI., Materials and Methods: Spin echo T1-weighted axial and coronal (TR 700 ms; TE 17 ms) and T2-weighted axial (TR 3,000 ms; TE 90 ms) upper abdominal scans were obtained on a 1.5 T MR machine., Results: Cyst contents were of high signal on both T1- and T2-weighted sequences, indicating internal haemorrhage, which was confirmed at surgery., Conclusion: There is a high propensity for haemorrhagic renal masses to mask carcinoma. By distinguishing blood from other contents, MRI had a noninvasive role in diagnosis and further management.

It is now a decade since the American Thoracic Society (ATS) lymph node map was first described. Recently it has been upgraded to include supraclavicular and superior diaphragmatic lymph nodes. By standardising terminology the map aids in the provision of a more valid data base to evaluate diagnostic techniques and therapeutic protocols. Despite these potential benefits the map has failed to gain widespread use amongst European radiologists. This essay illustrates the relationship of the nodal stations to normal anatomy utilizing calcified nodes on CT scans. The ease with which the map can be applied to cross-sectional anatomy is emphasized. It is hoped that the images will act as a teaching aid to promote greater acceptance and use of the ATS map. The relationship of the nodal stations to the new American Joint Classification of disease extent is also outlined.

This review covers the papers that we believe represent the most interesting and innovative developments in hilar and mediastinal imaging over the past year. One of the most exciting of these is the expanded role for sonography in imaging extracardiac mediastinal pathology. A number of reports highlight its use in directing mediastinal biopsy, for tissue characterization, and for staging lymphoma. The comparative merits of CT and MR imaging in staging bronchogenic carcinoma have been further clarified. The past year has also seen further attempts to characterize tumor versus postobstructive pneumonitis or collapse using MR imaging and CT. Other useful clinical work includes the documentation of signs distinguishing paramediastinal lung masses from primary mediastinal pathology. References are also made to clinically relevant aspects of MR scanning and advances in imaging of the airway, particularly cine and high-resolution CT of the trachea.

Though transthoracic needle biopsy (TNAB) is a well established method for obtaining pathologic diagnosis in lung masses, very often the procedure is only performed after a previous negative bronchoscopic biopsy (BB) attempt. In this study we analyzed the results of TNAB in 129 consecutive patients where one or more inconclusive BB had been performed. TNAB was diagnostic in 115 of 129 lesions (89%) and the yield was not significantly affected by size, cell type or tumour location. In 97 patients who underwent thoracotomy, cytologic specimens obtained by TNAB accurately reflected histologic tumour type in all cases. A false negative rate for malignancy on TNAB was 5%. Awaiting inconclusive BB results caused an average delay of three in-hospital days before TNAB. In those patients in whom a biopsy is warranted, TNAB is most useful as an initial diagnostic procedure in masses that are peripheral and in pleural based tumours, in mediastinal adenopathy associated with a lung mass and instead of a repeat, previously failed bronchoscopy.

A patient with pathologically proven pulmonary embolism that was diagnosed on computed tomography (CT) is presented. The clot in an artery with a diameter less than 1 cm was clearly demonstrated as was an associated pulmonary infarct, which appeared hyperdense on contrast enhanced scan. The potential of CT to noninvasively demonstrate pulmonary embolism, particularly in smaller arteries, is discussed.

Difficulty in repositioning makes a major contribution to reproducibility errors in measurements of bone mineral by computed tomography (CT). The magnitude of measurement variations arising from incremental movements in each of three directions of displacement and two directions of rotation were investigated using two sections of cadaver spines each including three vertebral bodies. Within the range of variation in position readily attainable by currently available scan plane selection techniques, changes in measured attenuation were small. Estimated variations resulting from compounded errors of different movements averaged 8.3 Hounsfield units for a single vertebra and 4.9 Hounsfield units for three adjacent vertebrae. The largest change in measured attenuation which could be attributed with 95% confidence to repositioning error within the quoted limits of scan plane selection was estimated to be approximately 15HU for a single vertebra and 8HU for three adjacent vertebrae.

Radiographs taken on the day of admission on 52 patients with acute pancreatitis have been compared with similar radiographs of 30 patients with acute cholecystitis and 22 patients with perforated duodenal ulcer. Two radiologists, who were unaware of the clinical features, looked specifically for the presence of 30 radiological signs. The only abdominal signs seen more frequently in acute pancreatitis were fluid levels in the stomach and duodenum, usually associated with dilatation. Duodenal abnormalities were seen in 42% of patients with acute pancreatitis and 21% of the controls (P less than 0.05) while gastric dilatation with a fluid level was seen in 29% of cases of acute pancreatitis compared with 12% of controls (P less than 0.05). Seventy per cent of the patients with severe acute pancreatitis had an abnormal chest radiograph on admission compared with 18% of those with mild disease. Left pleural effusion was the most common abnormality in severe pancreatitis (43%) and was seen significantly more often than in mild pancreatitis (P less than 0.01) and the control group (P less than 0.05). Therefore, consideration of the admission chest radiograph may help at an early stage to distinguish patients with severe pancreatitis from those with mild disease.

We report a patient in whom spontaneous extrusion of a staghorn calculus into the flank soft tissues was diagnosed by CT. The stone was demonstrable on CT as fragments of calcific density appearing in the subcutaneous area. To our knowledge this complication of renal calculus disease has not been previously reported.

A prototype digital unit dedicated to chest radiography was used to examine 50 selected patients for a comparison study of the capability of digital images and conventional chest radiographs to reveal normal anatomic structures and a variety of pathologic states. The images in both modes were submitted for interpretation to seven experienced radiologists and a standardized questionnaire completed for each. Visibility of seven anatomic structures in the mediastinum was consistently better on the digital images than on the conventional radiographs. With minor exceptions, pathologic states were equally well seen in the two systems. Despite the less familiar viewing format of the digital images, the mean confidence levels achieved were higher than for those on the conventional radiographs; this difference was statistically significant both for normal anatomic structures (p = 0.001) and pathologic states (p = 0.01). The advantages and disadvantages of the digital technique are discussed.

The radiology of 13 patients with cryptogenic obliterative bronchiolitis is reviewed. The changes on the plain chest radiograph consist of diminished mid and lower zone vasculature with evidence of mild over-inflation. On bronchography pruning of the fifth and sixth generation bronchi is seen inthe absence of features of other Obstructive airways diseases. It is concluded that this uncommon and sometimes lethal disease should be considered in patients developing respiratory outflow obstruction in the absence of any other recognised cause.

Fifty children with urinary stones have been reviewed. Most stones were found in boys and there was a peak incidence in the first year of life. Urinary infection was present in 80% and haematuria was the presenting symptom in more than a quarter. Congenital metabolic abnormalities were rare but primary non-refluxing wide ureter was present in 10%. The adult intravenous urogram pattern of acute ureteric obstruction was not seen. The importance of bringing a child back for repeat control films after a drink in order to detect all the stones is stressed.

Pathologic and computed tomographic correlation of an obstructing common bile duct mass, found to be malignant melanoma, is presented. No tumour was demonstrated elsewhere. Such a pattern of presentation has not previously been described in this condition. Malignant melanoma, even in the absence of disease elsewhere, should be considered in the differential diagnosis of such lesions seen on computed tomography.

Esophagopericardial fistula is a rare complication of benign esophageal disease. It has not previously been described occurring in achalasia. The authors present such a case. This cause should be considered in the differential diagnosis of pneumopericardium in patients with achalasia. Early diagnosis is stressed and esophagoscopic examination should be performed if the result of barium swallow test is negative.