334 CLINICAL RADIOLOGY

Book Reviews Atlas of Computed Tomography Variants. By Lawrence R. Kuhns and

Joachim Seeger. Year Book Medical Publishers, Chicago, 1983. xii+256 pp., 216 figs. £44.00.

Expertise in the interpretation of radiographs begins with an appreciation of what is normal. Only 15 years after the discovery of X-rays Dr Alban K6hler published his first illustrated account of 'those findings which exhibit or appear to exhibit slight.. , divergencies from the normal anatomical picture'. Eight years after the introduction of whole-body computed tomography, Drs Kuhns and Seeger have made a very commendable attempt to produce a similar source of reference for CT appearances. Like K6hler, the present authors recognise that variations in appearances are not only caused by differences in anatomy; technical factors (particularly volume averaging in CT) and physiological effects (such as variations in lung anatomy with respiration) must also be taken into account. Furthermore, defining what is 'normal' is an exercise in philosophy; what the practising radiologist needs is the facility to distinguish between the genuine pathology and those appearances which, although unusual, are insignificant in the context of the patient's complaint.

As the title indicates, this book is an illustrative account of the more commonly encountered variations in CT appearances. In all, a little over 200 variants are described in four major categories: head, neck and spine, extremities, thorax, abdomen and pelvis. In general, the illustrations are of good quality and, even though some were obtained on second-generation scanners, the specific points made in each individual case are clearly visible. Each figure is accompanied by a detailed caption describing the features of the variation in question and, in most cases, providing one or more references. The reference list at the end of each major section is greatly enhanced by summaries in one or two pithy sentences of the relevant points from each paper.

The content of the book ranges from commonplace problems (unopacified bowel loops) to infrequent and more contentious difficulties (the range in size and shape of the normal adult thymus). Problems which the authors have not discussed in any detail include the size and shape of the normal uterus, the difficult question of the size limits of a normal lymph node and the dubious significance of the unfused ventral pancreas. Future editions will, no doubt, include many further variants.

A computed tomographic examination produces an enormous number of data for analysis and proficiency in CT interpretation is largely a matter of learning what can safely be ignored. This book will be a great help to radiologists learning this technique; an invaluable bench book for all CT departments.

P. J. Robinson

Body CT - A Handbook. By Adrian K. Dixon. Churchill Livingston, Edinburgh, 1983. 167 pp. £12.00.

Amongst the awesome welter of books on computed tomography (CI') from across the Atlantic comes this breezy little handbook from Cambridge, England, aimed at radiologists in training, senior radiographers and consultants who are planning, or about to take over, their first CT installation. It is a very personal account of the subject by a highly competent, enthusiastic and experienced young radiologist who clearly has a firm grasp of the whole compass of modern imaging. The latter is combined with a good clinical knowledge which allows a clear assessment of the relative merits of CT in different clinical situations. This combination of attributes is essential if the 'imager' is to fulfil his important role of decision making in the clinical investigative field.

The early chapters deal very briefly with definition of terms, referral and selection of patients and their preparation for CT; then come chapters dealing with specific areas of investigation and, finally, there are chapters on radiotherapy planning, interventional procedures, documentation and reporting and the staffing and layout of a CT department.

All areas of the body are covered except the skull, brain and orbits because, correctly, the author feels that this specialised field should, be left to the neuroradiologist. In practice, however, few non-teaching hospitals have a home-based neuroradiologist on the staff and the 'partial expert' imager will be expected to report cogently in regard to cerebral atrophy, haemorrhage and all manner of cerebral tumours. Cerebral problems will account for more than 30% of CT requests in a large general hospital.

Every chapter starts with a brief, helpful introduction followed by a tabulated technique programme for the clinical problem under CT investigation. Reasons for the use of contrast media are presented clearly and convincingly. Important warnings are given concerning possible diagnostic hazards which might lead to serious misinterpreta- tion and sensible suggestions are put forward so that these errors may be avoided. It becomes very clear than an adequate CT examination demands the presence of a good CT 'imager' all the time.

The reproductions are excellent and well chosen. None is superfluous to the text and all are well placed within the text so that continuity of reading is not disturbed.

Some of the comment concerning handling the patient may sound somewhat patronising to the medical reader. The constant use of the first person singular is most unusual in a medical textbook but it does emphasise the very personal account of the subject. Phrases like ' . . . I then fly through the images on the console. . . ' or ' . . . there is little rhyme or reason. . . ' enliven the text to create an atmosphere of an informal seminar or coffee-time chat rather than a cool scientific communication. I forgive the author the many split infinitives, the occasional transatlantic deviations and the wayward style of writing because this little book is very good and fills a void that requires filling.

I recommend it without hesitation and with considerable enthusiasm to all who are interested in CT, to those who are about to set up a CT unit and to senior radiographers who will be in technical charge of such a unit. It is of less value to those who have yet to make the acquaintance of the FRCR examiners because it is strictly a book of practical instruction and not a pictorial display of common conditions.

The cognoscenti of CT are well served by the impressive and expensive tomes of erudition arriving from the USA but the rest of us, the almost silent (and ignorant) majority, can now start at the beginning full of confidence derived from this little paperback in our pockets.

B. Strickland

Atlas of Pathological Computer Tomography, Vol. 3. Computer Tomography of Neck, Chest, Spine and Limbs. By L. Jeanmart, A. L. Baert and A. Wackenheim. Springer-Verlag, Berlin, Heidelberg, New York, Tokyo, 1983. xi+194 pp., 545 figs. $85.40.

Professors Jeanmart, Baert and Wackenheim and their distinguished team of European radiologists have, yet again, produced an extremely attractive collection of interesting CT images. It marries well with their two preceding volumes in the Atlas of Pathological Computer Tomography Series (Vol. 1: Head, Vol. 2: Abdomen, both published in 1980). The atlas is composed of seven chapters which vary substantially in length; each chapter covers several key topics. These chapters are: 'Neck' (mainly larynx), 'Lungs', 'Pleura and Thoracic Wall', 'Mediastinum' (emphasis on vessels), 'Spine', 'Musculoskeletal System' (much on acetabular anteversion and torsion problems) and 'Myopathies'. There are short sections of text introducing each topic, with useful points on technique and anatomy. The bulk of the information is provided in the detailed legends relating to the examples illustrated. Each chapter closes with a comprehensive list of references.

It is, of course (Springer-Verlag), beautifully presented with excellent glossy image reproduction. Occasionally, the layout of the legends does not quite tally with that of the images. Minor problems inevitably arise with translation, but most readers are becoming familiar with the new Euro-medical language. The only real irritaton is the sudden left-right switch in the chapter on the spine. Here, thoracic images appear to be viewed in body mode (i.e. from below) while lumbar images are viewed in head mode (from above). What happens at the thoraco-lumbar junction I am not too sure! The RSNA, in its journal Radiology, has given us a strong lead to ensure worldwide uniformity on this point. Surely it should be the responsibility of all radiologists, manufacturers and publishers to respond to the hilt?

There is, however, one major difference between this volume and the widely aeclaimd Vol. 2 (which our department bought). That is the passage of three years. During that period there has been an explosion of CT literature including many heavyweight bibles (e.g. Lee, Stanley and Sagel) making the need for a reference collection of abnormal images perhaps less pressing. Nevertheless, this informative (albeit expensive) book is recommended for those starting CT and it provides painless revision for all.

Adrian Dixon