DECEMBER 1979

Measuring radiographic bone density and irregularity in normal hands

colour television display for medical applications. Medical
and Biological Engineering, 12, 295-303.

use with microscopes, but should be adaptable for

viewing radiographs.
ACKNOWLEDGMENTS

The author would like to thank Mr. S. Tandon of the

Royal Postgraduate Medical School for his help in arranging for the radiography and for assessing the clinical
condition of the hands, and the staff of the X-ray Department, Hammersmith Hospital for their co-operation.

DICKSON, R. A., PAICE, F. and CALNAN, J. S., 1973. Quanti-

tative colour television image analyser: a new method of

measuring bone density. Journal of Bone and Joint
Surgery, 55B, 359-368.
DOYLE, H. F., 1961. Ulnar bone mineral concentration in
metabolic bone diseases. British Journal of Radiology, 34,
698-712.
KEANE, B. E., SPIEGLER, G. and DAVIS, R., 1959. Quantita-

tive evaluation of bone mineral by a radiographic method.

British Journal of Radiology, 32, 162-167.

REFERENCES
COLBERT, C. and GARRETT, C , 1969. Photodensitometry of

WING, K. R. and BIRRING, E., 1976. An electronic device for

direct readout of bone mineral content from roentgenograms scanned with a microphotodensitometer. American
Journal of Roentgenology, 126, 1269-1270.

bone roentgenograms with an on-line computer. Clinical

Orthopaedics, 65, 39-45.
COYNE, M. B., 1974. Quantitative image analyser using a

Book review
Medical Imaging. A Basic Course. Edited by Louis Kreel
with a foreword by Professor R. E. Steiner, pp. viii + 256,
330 illus., 29 tables, 1979 (H. M. & M. Publishers Ltd.,
Aylesbury, Buckinghamshire), 18-00.
ISBN 0-85602-069-9
It is now 84 years since Dr. Wilhelm Conrad Rontgen
discovered X rays. In that time conventional diagnostic
radiology has established itself as an acceptable and very
reliable imaging method and many would consider its
position in this respect unassailable. In spite of this, such has
been the impact of the introduction of the three newer
imaging methods, computerized tomography (CT), ultrasound (US), and isotopes (IS) that in this book on medical
imaging, conventional radiology hardly gets a mention. The
aim of the book is to provide a basic text which records the
available experience at the present time in the three different
scanning modalities: computerized tomography, ultrasound
and isotope imaging. A short chapter describing nuclear
magnetic resonance has also been included. The production
of the book was stimulated by the British Council course on
medical imaging held in 1977 at Northwick Park Hospital
and Clinical Research Centre, Harrow.
The book is produced primarily for radiologists. It sets
out to provide a comprehensive cover of the main topics
from experienced workers in each field and to be sufficiently
clear and detailed so that it can act as a practical guide to the
theory, equipment and science of the various scanning
techniques. It succeeds admirably in this aim so far as CT is
concerned (1 56 of the 240 pages of text are devoted to CT)
but it is much less successful with ultrasound (51 pages).
Isotope imaging gets scant treatment (only 13 pages). The 24
contributors are all experts in their field. CT is comprehensively described and beautifully illustrated; for this alone the
book is valuable.
The text is presented in eight parts. Section 1 covers the
theory, technical aspects and equipment of CT, ultrasound,
isotopes and nuclear magnetic resonance imaging, zeugmatography. Section 2 describes and illustrates the normal
axial anatomy of the brain, skull, thorax, abdomen and
pelvis. Section 3 deals with patient preparation and contrast
medium enhancement in CT. Section 4 is on CT of the head
and it includes a short description of ultrasonography of the
orbits. Section 5 covers CT of the body including the
thorax, liver, pancreas, kidneys, lymph nodes, retroperitoneum and pelvis and the applications of CT in

radiotherapy. This section ends with a short chapter on the

place of ultrasound and CT in oncology. Ultrasonography
finds a place in Section 6. This section ranges relatively
superficially compared with the previous sections on CT,
through obstetrics, the liver and pancreas, urinary tract,
retroperitoneum and pelvis, miscellaneous uses of ultrasound and echocardiography. Some of the clinical uses of
isotope imaging comprise Section 7 and in Section 8 comparison is made between the value of CT and ultrasound of
various organs.
Dr. Kreel and Dr. Meire conclude that no new technique
is infallible. In making a choice between the different
imaging methods, their availability, cost, the type of equipment, the expertise of the medical and technical staff and the
inherent capabilities of the systems have to be considered.
The most important factor in choosing between the imaging
techniques is the capability of the system to answer the
specific question required for the management of the patient.
The use and limitation of the different methods is determined by their properties. Ultrasound is limited by air and
bone and CT employs ionizing radiation, therefore ultrasound is the method of choice in obstetrics and CT for the
brain, lungs and bone. Ultrasound is preferred for examination of the lumbar aorta and inferior vena cava. Ultrasound
is also used extensively in cardiac diagnosis where CT has
little to offer. There is considerable overlap in the abdomen
in the use of ultrasound and CT. CT produces better
anatomical displays but ultrasound is more widely available
and cheaper. Ultrasound should be the initial procedure in
the liver, pancreas, kidney, bladder and orbits. If the results
are inconclusive or unobtainable, CT is indicated. CT is
particularly valuable in demonstrating lymph nodes, pancreatic and suprarenal disease. CT is more valuable for
radiotherapy planning than ultrasound. Ultrasound is still
dependent on operator skill to produce diagnostic information whereas CT is more objective and less operator dependent. In addition CT is considerably more expensive than
ultrasound. Few would disagree with these conclusions but
most will be disappointed that Dr. Kreel and Dr. Meire did
not include isotope imaging when presenting their conclusions.
This book, like the subjects with which it deals, has its
evident limitations. In spite of these it can be recommended
very highly to all those interested in medical organ imaging.
F. G. M. Ross.

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