Introduction. Femoral neck shaft angle (NSA) has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric), symptomatic vertebral (91), and distal forearm (67) fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm2: lumbar spine, femoral neck, and total femur) measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately), nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P=0.001), but larger in those with distal forearm fractures (129.8° versus 128.5°: P=0.01). Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

The development of conformal radiotherapy carries with it the implication of an increased number of imaging procedures at various stages throughout the overall treatment, principally for verification at some, or all, of the treatment fractions. This raises the issue of the balance between the benefit of these additional imaging exposures and the associated risk of radiocarcinogenesis arising from them. As such, it is necessary to appreciate the doses to critical organs for which individual carcinogenic risks have been estimated. In this study, doses to these organs have been measured with lithium fluoride thermoluminescence dosimetry loaded in anthropomorphic phantoms and subjected to realistic radiotherapy treatments of the larynx and breast, including concomitant CT and electronic portal imaging exposures associated with localization and verification of these treatments. Even for large numbers of concomitant images of either modality, arising from imaging at every fraction, the leakage and scatter from the radiotherapy itself is shown to dominate the overall organ dose, with imaging procedures generally contributing 5-20% of the total organ dose.

PURPOSE:to assess predictors of fracture risk and treatment for osteoporosis among elderly care home residents.SUBJECTS AND METHODS:DESIGN:cross-sectional survey;SETTING:residents of care homes in Newcastle upon Tyne, UK;PARTICIPANTS:representative sample from residential care (87), nursing homes (105) and specialist homes for elderly people with dementia [elderly mentally infirm (EMI)]: residential (124) and nursing (76);MAIN OUTCOME MEASURES:dual-energy X-ray absorptiometry bone mineral density (BMD) at calcaneum; functional assessments, including cognition, using Mini-Mental State Examination (MMSE), Clifton Assessment Procedure for the Elderly-Behaviour Rating Score (CAPE-BRS) and Functional Assessment Staging Test (FAST) scores; current drug prescription.RESULTS:MMSE, CAPE, FAST (all ANOVA P < 0.001) and weight (ANOVA P < 0.02) were lower in EMI homes. Drugs with sedative effects (chi-square, P < 0.0001) were more likely and calcium and vitamin D (CaD) supplementation (chi-square, P < 0.02) less likely in EMI care. For residential care, the odds ratio (OR) for sedative drugs in EMI was 2.13 (95% CI 1.11-4.06) with no significant difference between nursing homes. For CaD supplementation, the OR for EMI nursing homes was 0.19 (95% CI 0.05-0.72) and for EMI residential homes 0.38 (NS to 95% CI 0.12-1.27). BMD was low: mean T-score was -2.29 (95% CI -2-48 to -2.09) and Z-score -0.96 (95% CI -1.16 to -0.76) with a prevalence of osteoporosis (T-score < -1.6) of 69.2%. MMSE and FAST scores did not predict BMD. In EMI residential care, a decrease of CAPE score by 5 points was associated with a decrease in T-score by 0.6 (95% CI 0.15-1.1).CONCLUSIONS:of the tools used to assess function, only CAPE predicted low BMD in EMI residential care. Rates of CaD supplementation are particularly low in EMI care, where risk factors for fracture were the greatest. We conclude that fracture risk is neglected in these homes, and targeted education and treatment are warranted.

In 1947 Sir James Spence initiated the Newcastle Thousand Families study, which recruited all 1142 children born in the city between May and June that year. At the age of 50 years, 832 survivors were traced and invited to attend for measurement of bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA). The aim was to compare BMD measurements of men and women in this cohort, before and after adjustment for skeletal size. The femoral neck shaft angles (NSA) were also measured manually from the DXA scan printouts. A total of 171 men and 218 women agreed to participate. As expected men had greater bone mineral content and bone area at all sites (p<0.0001) and were taller and heavier (p<0.0001) than women. Men also had significantly higher BMD than women at all regions (p<0.0002), except at the femoral neck or lumbar spine. After correction for skeletal size and body weight, men had statistically significantly lower volumetric BMD at all sites. The measurement of NSA had good intra/interobserver errors and precision (coefficient of variations 0.79%, 1.2% and 1.2%). Men had significantly larger NSAs (mean 130 degrees , range 121-138 degrees ) than women (mean 128 degrees , range 119-137 degrees ). We conclude that there are gender differences in BMD, skeletal size and geometry in middle aged men and women, which together with the subsequent rate of bone loss, may influence fracture risk in later life.

Objective: To quantify the direct and indirect effects of fetal (position in family, weight, and social class at birth), childhood (breast feeding, growth, infections, and social class in childhood, age at menarche), and adult life (social class, alcohol consumption, smoking, diet, reproductive history, exercise, hormone replacement therapy use), and adult size (height, weight) on bone health at age 49–51 years, as measured by bone mineral density, total scanned bone area of the hip and lumbar spine, and femoral neck shaft angle. Design: Follow up study of the Newcastle thousand families birth cohort established in 1947. Participants: 171 men and 218 women who attended for dual energy x ray absorptiometry scanning. Main results: Fetal life explained around 6% of variation in adult bone mineral density for men, but accounted for less than 1% for women. Adult lifestyle, including effects mediated through adult weight accounted for over 10% of variation in density for men and around 6% for women. Almost half of variation in bone area for men was explained by early life. However, most of this was mediated through achieved adult height and weight. In women, less than 5% of variation in bone area was accounted for by early life, after adjusting for adult size. Most of the variation in each of the indicators for both sexes was contributed either directly or indirectly by adult lifestyle and achieved adult height and weight. Conclusions: The effect of fetal life on bone health in adulthood seems to be mediated through achieved adult height.

BACKGROUND:Osteoporosis is a common complication of Crohn's disease.AIM:To study the effect on the bone mineral density of a bisphosphonate (pamidronate) given intravenously, in combination with oral calcium and vitamin D supplements, compared with oral calcium and vitamin D supplements alone.METHODS:Seventy-four patients with Crohn's disease and low bone mineral density at the lumbar spine and/or hip were randomized to receive either a daily dose of 500 mg of calcium with 400 IU of vitamin D alone or in combination with four three-monthly infusions of 30 mg of intravenous pamidronate over the course of 12 months. The main outcome measure was the change in bone mineral density at the lumbar spine and hip, measured by dual X-ray absorptiometry, at baseline and 12 months.RESULTS:Both groups gained bone mineral density at the lumbar spine and hip after 12 months. There were significant (P < 0.05) changes in the pamidronate group, with gains of + 2.6%[95% confidence interval (CI), 1.4-3.0] at the spine and + 1.6% (95% CI, 0.6-2.5) at the hip, compared with gains of + 1.6% (95% CI, - 0.1-3.2) and + 0.9% (95% CI, - 0.4-2.1) at the spine and hip, respectively, in the group taking vitamin D and calcium supplements alone.CONCLUSIONS:In patients with Crohn's disease and low bone mineral density, intravenous pamidronate significantly increases the bone mineral density at the lumbar spine and hip.

The authors have constructed a 2D motor-controlled test object phantom holder to simulate clinical situations in which patient movement could be a cause of image degradation. The PAtient MOvement SImulation Test Object (PAMOSITO) has been constructed with modular parts to use different mobile test objects and static structures. The system allows the programming of different cycles of movement along two axes. PAMOSITO has been used in X ray equipment dedicated to interventional radiology. Those systems usually allow for different values for frame rate, pulse width or weighted frame averaging methods. The influence of selecting different values of the parameters, patient movement and its relation to patient dose and image quality has been studied. Image blurring due to motion has been evaluated with Leeds test objects TO.10 and 18FG. Spatial resolution limits and the threshold contrast detail detectability performance have been studied.

We describe 5 children who meet criteria for primary angiitis of the central nervous system (PACNS). All patients presented with headache and/or focal neurologic deficits and exhibited clinical and/or radiographic evidence of disease progression. Two patients had disease progression prior to combined treatment with cyclophosphamide and corticosteroids; one progressed while receiving intravenous cyclophosphamide and stabilized after a change to daily oral dosing; one progressed after discontinuing therapy after less than 12 months and improved after retreatment; and one progressed on steroid therapy alone but was lost to followup. Children who have frequent or severe headaches or focal neurologic deficits should be carefully evaluated and those meeting criteria for PACNS should be treated aggressively.

A largely convergent setting is proposed for crustal, tectonic and basin evolution of the intracratonic regions of north‐central Australia between 1800 and 1575 Ma. The new geodynamic model contrasts with previous proposals of widespread extension during the Leichhardt, Calvert and Isa intervals. Local transtensional to extensional structures exist, but these are best explained by a combination of flexural, thermal and dynamic processes related to an active southern margin. The development of thick accumulations of sediments (superbasins) is linked geodynamically to interpreted active margin processes (subduction and magmatic arcs) in central Australia. A synthesis of geochemical data from the 1870–1575 Ma igneous units from the Arnhem, McArthur and Mt Isa regions of north‐central Australia confirms the intracratonic setting of these units and suggests that a long‐lived thermal anomaly was responsible for the generation of both mafic and felsic magmas. The geochemical characteristics suggest the igneous units are derived from the lithospheric mantle and are not typical rift‐ or plume‐related melts. A review of the U–Pb SHRIMP ages for the entire region demonstrates the minimum distribution of correlative igneous rocks was widespread. Exotic populations in the 207Pb/206Pb isotopic data provide insights into the nature and evolution of the crust throughout north‐central Australia. Archaean inheritance is found to be nearly ubiquitous. The data support the temporal subdivision of north‐central Australia into the Leichhardt (1800–1750 Ma), Calvert (1750–1690 Ma) and Isa (1690–1575 Ma) intervals which are marked by superbasins and concomitant episodes of igneous activity. A highly heterogeneous pre‐superbasin crust is interpreted from regional, newly processed geophysical data. The cratonic portion of north‐central Australia is interpreted to consist of three broad northwest‐trending belts or elements that are further distinguished into western, central and eastern geophysically distinct provinces. A map of the superbasin distribution is derived and integrated with structural and stratigraphic data to assess the evolution of the basins and the crust through time. The superbasin successions of north‐central Australia are synchronous and widespread, although not necessarily interconnected. The tectonic model incorporates dynamic tilting of the craton during episodes of subduction and transmission of compressive intraplate stresses through the craton during intervening episodes of orogeny. These processes resulted in flexure, strike‐slip deformation and a complex thermal structure. These mechanisms account for the subsidence and basin evolution that results in widespread ramp and strike‐slip basins. The model also accounts for the thermal history recorded by magmatic events. The proposed geodynamical model provides a unifying crustal evolution scenario for central and northern Australia for approximately 225 million years of the Proterozoic.

New stratigraphic, geochemical and palaeomagnetic data from the Peters Creek Volcanics are used to revise the correlations of part of the Palaeoproterozoic of northern Australia. The revised geological history for these cover rocks of the Murphy Inller is extrapolated into the 1800-1700 Ma successions of the McArthur Basin and Mt Isa regions. New stratigraphic subdivisions and relationships are contrasted with the established lithostratigraphic schemes and also with conflicting published tectono-stratigraphic interpretations. For the first time, a plethora of stratigraphic units can be rationalised into two major superbasins, the Leichhardt and Calvert Superbasins. and into eight pseudo-chronostratigraphic basin phases (Associations A-H), There are few absolute age constraints, but lateral correlations of the units in these eight basin phases are proposed. Results from the overlying isa Superbasin (<1670 Ma) suggest that these eight associations probably represent second-order supersequences. Mixed non-marine and marine coarse clastics, deposited between about 1790 and 1780 Ma dominate Associations A and B. In the Mt Isa region these were deposited in an initial rift then a thermal relaxation or sag phase. To the northwest, however, the succession is dominated by rift facies. Association C is a widespread flood basalt and immature elastic suite that was deposited in clearly defined, north-trending half-grabens in the Mt Isa region. Along the southern edge of the Murphy Inlier, however, geophysically defined half-grabens, filled with magnetic rocks (basalt), trend orthogonal to those at Mt Isa. North of the inlier Association C is much thinner, and little can be deduced about its palaeogeography. Association D is only present in the Mt Isa region as the Myally Subgroup. Differing views on its tectonic setting and environments of deposition, as presented in recent papers, are reviewed. Association E, deposited around 1755 Ma, is a regional sag phase with mixed clastic-carbonate, shallow-marine lithofacies in ail areas. There is a major gap in the rock record between about 1750 and 1735 Ma which is probably related to widespread basin inversion. The Mid-Tawallah Compressional Event (McArthur River area) and the Wonga Extension Event (Eastern Succession, Mt Isa) are both about this age. The overlying Association F is a thin, laterally uniform, upward-fining succession that commences with shallow-marine clastics and evolves through deeper marine clastics and ends in evaporitic facies. There are broad similarities between Associations F and E so interpretation as a third regional sag is favoured. The absence of Association F at Mt Isa may indicate that basin inversion was longer lived in the southeast. The youngest associations, G and H, are complex interstratified mixtures of felsic-mafic igneous rocks and immature clastics. U-Pb zircon SHRIMP ages appear to cluster around 1725 Ma and 1710 Ma, but they may all be part of one thermal event. These eight associations may represent the tectono-magmatic response of the lithosphere during and after the Strangways Orogeny (1780-1730 Ma).

This paper reports on the identification of peperite, a breccia comprising angular to lobate variably vesiculated basalt clasts in a mudstone matrix, at the upper margin of a basalt sheet of the Sable River Basalt Formation, northern Lebombo. The peperite formed as a result of emplacement of the basalt sheet as a shallow sill that burrowed into and migrated laterally within an unconsolidated water-saturated sediment pile. Although breccias at the upper margin of basalt units are widely recognized from the Karoo of southern Africa, they have generally been interpreted as blocky 'autobreccia' or 'flow-top breccia' on lavas. Consequently, many mixed basalt-sediment breccias may have been viewed as sedimentary infill of these 'flow-top breccias'. To the best of our knowledge, this paper represents the first documentation of an intrusive or invasive mode of formation. The new shallow sill or invasive flow interpretation has significant implications on the perceived sedimentary architecture and basalt emplacement model for the Karoo, and perhaps other flood basalt provinces. It is suggested that the widespread distribution and consistent thickness of individual 'flows' in the Sable River Basalt Formation can sometimes be attributed to emplacement as shallow sills that have propagated through a regionally extensive sediment pile.

To investigate the pathogenesis and sequelae of symptomatic vertebral fractures (VF) in men, we have performed a case–control study, comparing 91 men with VF (median age 64 years, range 27–79 years) with 91 age-matched control subjects. Medical history, clinical examination and investigations were performed in all patients and control subjects, to identify potential causes of secondary osteoporosis, together with bone mineral density (BMD) measurements. BMD was lower at the lumbar spine and all sites in the hip in patients with VF than in control subjects (p<0.001). Potential underlying causes of secondary osteoporosis were found in 41% of men with VF, compared with 9% of control subjects (OR 7.1; 95% CI 3.1–16.4). Oral corticosteroid and anticonvulsant treatment were both associated with a significantly increased risk of VF (OR 6.1; 95% CI 1.3–28.4). Although hypogonadism was not associated with an increased risk of fracture, the level of sex hormone binding globulin was higher (p<0.001) and the free androgen index lower (p<0.001) in men with VF than control subjects. Other factors associated with a significantly increased risk of VF were family history of bone disease (OR 6.1; 95% CI 1.3–28.4), current smoking (OR 2.8; 95% CI 1.2–6.7) and alcohol consumption of more than 250 g/week (OR 3.8; 95% CI 1.7–8.7). Men with VF were more likely to complain of back pain (p<0.001) and greater loss of height (p<0.001) than control subjects, and had poorer (p<0.001) scores for the energy, pain, emotion, sleep and physical mobility domains of the Nottingham Health Profile. We conclude that symptomatic VF in men are associated with reduced BMD, underlying causes of secondary osteoporosis such as corticosteroid and anticonvulsant treatment, family history of bone disease, current smoking and high alcohol consumption, and that they impair the perceived health of the individual.

The McArthur Basin is a regionally extensive multiphase Proterozoic basin system in northern Australia. Existing lithostratigraphic elements are amalgamated into five coherent basin phases or 'packages', to provide a basin-wide informal and non-genetic stratigraphic framework on which future genetic models may be based. Packages are basin-scale depositional and magmatogenic rock units, equivalent in magnitude to 2nd-order basin cycles. Each package comprises a set of lithostratigraphic units with similar age, stratigraphic position, lithofacies or lithofacies associations, style and composition of volcanism, basin-fill geometry and depocentre. The Redbank package (ca 1815-1710 Ma) comprises up to similar to 6 km of shallow-marine to fluvial sandstone, and lesser lutite, conglomerate, dolostone and bimodal volcanic and shallow intrusive rocks. it forms a semi-contiguous sheet throughout most of the McArthur Basin, but thins against the large-scale basin-compartmentalising basement ridges (e.g. Murphy and Urapunga Tectonic Ridges) due to depositional onlap and/or differential erosion. The conformably overlying Goyder package (ca 1710-?1670 Ma) comprises shallow-marine to fluvial sandstone and minor lutite and carbonate. It is areally restricted with a distinct similar to 6 km-thick depocentre in the central Walker Fault Zone (the proto-Walker Trough) and is flanked by attenuated successions onlapping the adjacent shelves suggesting deposition in a synsedimentary 'rift', The conformably or disconformably overlying Glyde package (?1670-1600 Ma) comprises similar to 5 km of stromatolitic-evaporitic dolostone, siliciclastics and minor tuffaceous rocks, deposited in shallow- to moderately deep-water and locally emergent environments, it is restricted to the Walker, Batten and Urapunga Fault Zones, subsequent to deposition in the fault-bounded Walker and Batten Troughs. The unconformably to disconformably overlying Favenc package (ca 1600-?1570 Ma) is a regionally extensive, similar to 50-1600 m-thick, stromatolitic and evaporitic dolostone-sandstone succession with minor basaltic volcanics deposited in shallow-water, marginal-marine, peritidal-shelf and/or continental sabkha settings. It was deposited as a series of broad interconnected sag basins that transgressed the pre-existing tectonic framework of troughs and shelves. The Wilton package (?1500-?1400 Ma) is a widely distributed cyclic sequence of siliciclastics deposited in a shallow-marine, nearshore to shelf environment. It unconformably overlies all older basin packages, transgressing the pre-existing tectonic elements of the McArthur Basin. Distribution and depocentres have evolved significantly from the underlying packages, the Wilton package thickening to similar to 5 km in the Beetaloo Sub-basin.

The Jimbu Microgranite, a series of high-level microgranite plutons exposed in central Arnhem Land in northern Australia, was emplaced into flat-lying sandstones and lesser mudstones, carbonates and basalts of the Katherine River Group during the latter stages of deposition. New SHRIMP U–Pb zircon results indicate a crystallization and emplacement age for the Jimbu Microgranite of 1720±7Ma. Intrusion took place in an essentially static tectonic setting, and accommodation space was not created by regional extension or by consumption of the host package by the intrusion. Rather, pluton emplacement was facilitated by three distinct mechanisms: the thick basal sandstone package was updomed; overlying lutite units were laterally shortened by outward gravity slide; the uppermost sandstone unit was raised vertically above the pluton by way of a monoclinal margin and steep reverse detachment faults. Decollement at ductility transitions in the rock package is required for the coexistence of these three structural styles. The three resulting structural elements include: relatively steeply and radially outward dipping domes of lower Katherine River Group sandstones with granite cores; irregular, short-wavelength fold patterns in the overlying incompetent lutites; discrete flat-lying blocks of the uppermost sandstone unit with steeply upturned or downturned margins. Plutonism is also suspected of being the cause of similar domes elsewhere in the McArthur Basin and in the adjacent Mount Isa Inlier. The model presented here may also be partly applicable to other basins with similar geometries and volcano-sedimentary histories, where tectonism is currently invoked to explain deformation.

Aims-To examine body composition in preterm infants.Methods-Body composition was measured by dual energy alpha-ray absorptiometry (DEXA) at hospital discharge, term, 12 weeks, and at 6 and 12 months corrected age in 125 infants (birthweight less than or equal to 1750 g, gestational age less than or equal to 34 weeks).Results-Body weight derived by DEXA accurately predicted that determined by conventional scales. In both sexes lean mass (LM), fat mass (FM), %FM, bone area (BA), bone mineral mass (BMM), and bone mineral density (BMD) increased rapidly during the study; significant changes were detectable between discharge and term. At 12 months, LM, BA, and BMM, but not FM, %FM, or BMD were greater in boys than in girls. Corrected for age, LM was less than those of the reference term infant; FM and %FM were similar; BMM was greater. Corrected for weight, LM was similar to those of the reference infant, while the FM and %FM of study infants were slightly greater.Conclusions-DEXA accurately measures body mass. Body composition in preterm boys and girls differs. Interpretation of DEXA values may depend on whether age or body weight are regarded as the appropriate reference.

Little is known about the prevalence of metabolic bone disease among adults with mental retardation (now known as learning disability), although they may be at increased risk of fractures. Broadband-ultrasound attenuation (BUA) and velocity-of-sound (VOS) measurements were performed on the left heel of 170 patients in a large hospital for adults with mental retardation, For 108 of these patients, age-and gender-matched control subjects were recruited from the local community, who also underwent BUA and VOS measurements, The mean age of matched pairs of patients and control subjects was 55 (range 32-83) years for men and 53 (range 27-82) years for women. Mean +/- SEM BUA for male patients was 52 +/- 4 dB/MHz and 89 +/- 2 for control subjects, whereas for female patients it was 34 +/- 3 dB/MHz and 68 +/- 2 for control subjects. VOS was 1603 +/- 7 m/sec for male patients and 1649 +/- 5 for control subjects, and 1573 +/- 7 m/sec for female patients and 1623 +/- 5 for control subjects. All differences between patients and control subjects were significant (p < 0.005). Dual-energy X-ray absorptiometry bone mineral density (BMD) measurements were also performed in seven patients with BUA less than 50 dB/MHz, four of whom mere found to have a lumbar spine or femoral neck BR-ID more than 2.5 SD below the mean value for young adults. This study shows that patients with mental retardation have a marked reduction in BUA and VOS measurements at the heel, compared with age-matched control subjects. There is a need to identify the major causes of low bone mass in this group, as there may be potentially avoidable risk factors for osteoporosis, such as vitamin D deficiency and hypogonadism, (C) 1998 by Elsevier Science Inc. All rights reserved.

The Harshaw 6600 reader is designed for personal monitoring using whole body cards and extremity dosemeters. The latter have the potential for use in performing a large scale patient dose survey during radiographic procedures but have not previously been used for this purpose. This system has several potential advantages: fast read-out rate, reproducible time temperature profile, no mechanical contact with the dosemeter and barcode identification. This allows individual elemental correction coefficients to be applied to each chip which thereby improves the measurement precision.

OBJECTIVES:to investigate the effects of oral intermittent cyclical etidronate therapy on bone mineral density (BMD) in men with idiopathic vertebral osteoporosis.DESIGN:consecutive case series.SETTING:regional specialist clinic for metabolic bone disease.SUBJECTS:42 men aged 35-81 (median 60.5) with established vertebral crush fractures and back pain, in whom secondary causes of osteoporosis had been excluded.INTERVENTION:repeated cycles of treatment with oral disodium etidronate 400 mg daily for 14 days followed by oral calcium 500 mg as citrate daily for 76 days.OUTCOME MEASURES:BMD measurement of the lumbar spine and femoral neck by dual energy x-ray absorptiometry at 6-12-month intervals; bone biochemistry (serum calcium, phosphate, alkaline phosphatase and urine calcium/creatinine and hydroxyproline/creatinine ratios) at 6-month intervals.RESULTS:all 42 men have been treated for more than 18 months, and 35 of them for more than 24 months. Median follow-up for the group as a whole is 31 months (range 18-45). The treatment was well tolerated. BMD at the lumbar spine increased by a mean of 0.024 g/cm2 per year of follow-up (95% confidence interval 0.017-0.032 g/cm2). This is equivalent to an average annual rate of change of 3.2% of baseline values. There was a small, non-significant rise in mean BMD at the hip equivalent to 0.7% of baseline values per year. Serum alkaline phosphatase tended to fall in the first 6 months of treatment, returning to baseline values at 2 years. Serum calcium and phosphate were unchanged and no decrease in urinary calcium/creatinine ratio or hydroxyproline/creatinine ratio was seen.CONCLUSIONS:intermittent cyclical etidronate therapy increased lumbar spine BMD over a 2-year period in an unselected group of men with osteoporotic vertebral fractures. This treatment warrants further evaluation in a randomized controlled trial.

The aim of this paper is to investigate the problem of monitoring effective dose to hospital staff who are involved in the treatment of tumors using sealed sources placed inside the body (brachytherapy). In addition, the use of an unsealed source to treat the thyroid was also considered. Radiation distributions produced by both sealed sources commonly used in brachytherapy (192I, 137Cs, 226Ra) and an unsealed source used in the treatment of the thyroid (131I) were used to irradiate a Rando phantom. The brachytherapy treatments of esophageal and gynecological carcinoma were simulated. The Rando phantom was loaded with lithium fluoride thermoluminescent dosimeters at positions corresponding to a number of radiosensitive organs. Film badges and electronic personal dosimeters were attached to the Rando phantom at various anatomical sites. The Rando phantom was positioned adjacent to the patient at an angle of 90 degrees to the longitudinal axis of the patient. Irradiations were performed with and without a portable lead screen used on the radiotherapy wards. Effective dose was estimated for each simulated radiotherapy treatment and compared with the personal monitor readings. The data were used as a basis for the provision of advice on the wearing of the film badge dosimeters and the design of portable lead screens. The data also permitted a comparison between the two types of dosimeter when used for personal monitoring in brachytherapy.

The results of 180 intercomparisons of field dosemeters with an NPL secondary-standard exposure meter (type 2560, with a type 2561 chamber) have been analyzed in order to study variations in readings when ionization chambers are interchanged during the comparison process. It is suggested that the percentage standard error of the mean of the combined series of chamber intercomparisons be used to set a target uncertainty (0.3%), action level (0.5%) and limit of acceptability (1.0%). The target uncertainty is consistent with IAEA estimates of uncertainty for this part of the calibration chain. It is shown that if the calibration procedure is repeated, the percentage difference between the geometric means calculated from each calibration (i.e. a single interchange of chambers) may be as high as +/- 1%. This reinforces the need for at least one repetition of the intercomparison procedure.