A local diagnostic reference level for velopharyngeal investigations

The purpose of this study was to derive an initial local diagnostic reference level for velopharyngeal investigations carried out as standard radiological practice in the Medical Imaging Department, Queen Victoria Hospital, East Grinstead. This is a specialist video-fluoroscopic radiological technique used to evaluate velopharyngeal dysfunction, especially for paediatric patients. A retrospective analysis over a period of 7 months involving 50 examinations yielded dose-area product values ranging from 0.04 Gy cm(2) (minimum) to 0.37 Gy cm(2) (maximum) with a mean value of 0.11 Gy cm(2) and 3rd quartile value of 0.12 Gy cm(2). The maximum effective dose was estimated as 0.016 mGy. An initial local diagnostic reference level of 0.12 Gy cm(2) has been levied.

An evaluation of correction factors applied to dose-area product meter readings for the use of sinus cones

As a result of the refurbishment of a dedicated skull radiography unit (Siemens Orbix) a dose-area product (DAP) meter was fitted into the light beam diaphragm/X-ray collimating system. Following calibration of the DAP system for X-ray beams defined by the unit's integral rectangular and octagonal iris diaphragms, DAP correction factors were obtained for the clinical use of externally fitted sinus cones. Correction factors can be derived from a simple ratio of coned to unconed beam areas, and these agree well with measured correction factors. The simple ratio of areas factor may be used in clinical practice to reduce potential errors.

Technical note: a survey of the illumination from diagnostic X-ray light-beam diaphragm systems

UK radiation protection legislation requires, where applicable, the fitting of light-beam diaphragm systems to diagnostic radiographic X-ray equipment. Measurements performed as part of a quality assurance programme showed that the level of illumination from equipment varied considerably. We decided to include a measurement of the illumination of light-beam systems as a routine part of our programme. The standard method used involved measuring the average illumination at 100 cm focus to field distance for a 25 x 25 cm light field. The results of initial measurements for 73 individual systems (44 fixed, 29 mobile) demonstrate a considerable range in levels with the ratio of maximum to minimum values being approximately 16. Mean values are 130 lux (all systems), 123 lux (fixed systems) and 141 lux (mobile systems). Comparisons are made with the limiting values specified by the Department of Health for mammographic X-ray equipment for breast screening and for new General Electric equipment. A local limiting value of 100 lux is proposed for routine testing purposes.

Relaxation and imagery in the treatment of breast cancer

OBJECTIVE

To see whether stress could be alleviated in patients being treated for early breast cancer.

DESIGN

Controlled randomised trial lasting six weeks.

SETTING

Outpatient radiotherapy department in a teaching hospital.

PATIENTS

One hundred fifty four women with breast cancer stage I or II after first session of six week course of radiotherapy, of whom 15 dropped out before end of study.

INTERVENTION

Patients saw one of two researchers once a week for six weeks. Controls were encouraged to talk about themselves; relaxation group was taught concentration on individual muscle groups; relaxation and imagery group was also taught to imagine peaceful scene of own choice to enhance relaxation. Relaxation and relaxation plus imagery groups were given tape recording repeating instructions and told to practise at least 15 minutes a day.

END POINT

Improvement of mood and of depression and anxiety on self rating scales.

MEASUREMENTS AND MAIN RESULTS

Initial scores for profile of mood states and Leeds general scales for depression and anxiety were the same in all groups. At six weeks total mood disturbance score was significantly less in the intervention groups, women in the combined intervention group being more relaxed than those receiving relaxation training only; mood in the control group was worse. Women aged 55 and over benefited most. There was no difference in Leeds scores among the groups.

CONCLUSIONS

Patients with early breast cancer benefit from relaxation training.

Psychometric ante-natal predictors of post-natal depressed mood

One hundred and nine women were studied during the course of pregnancy in an attempt to predict which of them would later rate themselves as suffering from depressed mood up to twelve months post-natally. The psychometric measures used comprised the Zung Self-Rating Scale to measure depression, the DSSI/SAD sub-scale to measure anxiety and the Hostility and Direction of Hostility Questionnaire. Post-natal depression observed up to twelve months post-partum was positively associated with first trimester ante-natal scores on all three measures. The HDHQ and the DSSI/SAD measures were good predictors of depression at six weeks post-partum and both correlated significantly at six and nine months post-partum, whereas the Zung measure predicted depression at nine and twelve months as well as at six weeks post-partum. Parity was significantly associated with severe depression at six months post-partum.

Psychophysiological ante-natal predictors of post-natal depressed mood

Forty-seven women were studied during the course of pregnancy in an attempt to predict which of them would later rate themselves as suffering from depressed mood post-natally. Psychometric and physiology measures were used in the three trimesters of pregnancy and six weeks after birth. The psychometric measures used ante-natally and post-natally comprised the Hostility and Direction of Hostility Questionnaire, and Locus of Control Scale, the DSSI/SAD sub-scale to measure anxiety, and the Zung Self-Rating Scale to measure depression. Psychophysiological measures used water heart-rate and blood pressure. Post-natal ratings of depression were associated with a high ante-natal score on overall hostility. Women with high anxiety and hostility ratings had a more pronounced response to the sound of a baby crying than to noise of similar frequency and intensity. This more pronounced heart response was also related to later post-natal depression ratings. However, by far the most useful predictive measure was the Hostility and Direction of Hostility Questionnaire: its predictive power in the first trimester of pregnancy was almost as good as in the third trimester.