36 CLINICAL RADIOLOGY

Book Reviews

Early Detection of Breast Cancer. Recent Results in Cancer Research 90. Edited by S. Briinner, B. Langfeldt and P. E. Andersen. Springer-Verlag, Berlin, 1984. 225 pp., 94 figs. $40.30.

This small volume reports the proceedings of the second Interna- tional Copenhagen Symposimn on Detection of Breast Cancer. It is full of extremely useful information on the behaviour of breast cancer, the role, technique and risks of mammography, breast cancer management and reports of various screening projects. The authors are well known in the breast cancer field and are drawn from the United States (Atlanta, Cincinnati and Philadelphia), Sweden and Denmark. Many of the chapters represent highly polished presentations which are the product of oft-repeated lec- tures and articles.

The book gets off to a good start with two chapters by S. A Feig on the benefits and risks of mammography. The author has consolidated a huge amount of info.rmation drawn from a wide variety of sources in a most readable manner. R. L. Egan then, equally pleasantly, presents his whole-breast section studies on multicentric breast cancer, showing that multifocal disease or multiple malignant breast histologies occur in up to 69% of breast cancer patients. This work was presented in Cancer in 1982 and so, like several of the other papers, is already familiar. However, here in a small volume there is collected togethcr some of the most interesting current work in breast diagnosis.

Chapters dealing with technical aspects of mammography provide clear explanations of the physical principles involved in the use of magnification and grids. Since it is likely that particularly the latter of these techniques will gain wide acceptance this is a very useful introduction to the subject.

Preliminary data are presented from a number of breast screening projects in Sweden. Much of the material with regard to the method of screening and incidence and stage of cancers detected has been reported previously. The value of these chapters is in updating the knowledge of the medical community about the progress of these projects and in identifying the problems involved for those who are new to the field.

Particularly interesting discussion concerns the selection of treat- ment of 'early' carcinoma and the meaning of 'informed consent' in the USA. As practised at the Jefferson Medical College, Phi- ladelphia, this draws the patient into the treatment selection process. Many of us would wish to be less informative and so less closely involved with the patient. However, the system discussed requires the clinician dealing with breast cancer to develop crystal- clear notions on tailor-making treatment for the individual patient.

The book is most enjoyable to read. The papers were submitted in English but in places have benefited from Danish editing. This has led to unusual phrases, such as: 'both physician and patient delay occurred treatment with regard to . . . '. Apart from small defects in proof reading of this type, the book is well presented.

Colin Parsons

Radiation Protection of the Patient in Nuclear Medicine: A Manual of Good Practice. Edited by Walter A. Langmead. Oxford University Press, Oxford, 1983. 114 pp. £5.95.

In assessments of the collective effective dose-equivalent received by human populations from both natural and artificial sources of radiation, the contribution from medical exposure, particularly in industrialised countries, figures as a substantial fraction of the total. Guidelines and recommendations in radiological protection have, for many years, drawn attention to the importance of protection of the patient during radiological procedures. In recent times, howev- er, such attention has been sharpened and a great deal of information has been published to identify those areas where improvements in standards might be sought, both in diagnostic X-radiology and in nuclear medicine. The present manual faces these challenges more directly and seeks to show what is required of the professional staff involved in nuclear medicine practice if high standards in radiological protection of the patient are to be realised.

The manual correctly identifies close cooperation between staff who carry different sets of responsibilities in nuclear medicine examinations as being of prime importance. In the first half of the main text of the manual, there are separate discussions of the nature of the responsibilities carried by the doctor requesting the examina- tion, by the nuclear medicine physician, by the medical physicist, by the radiographer, by the radiological protection supervisor and by the radiological protection adviser. In general, these discussions are well informed and helpful. The second half deals with technical aspects both imaging procedures and of in vivo investigations, thc stress being placed on how best to carry out these examinations so as to minimise unnecessary dosage to the patient. Here, again, the information and advice are sound.

There are three appendices to the manual. One of these deals with the difficult question of scheduling of examinations in relation to the so-called 10-day rule which seeks to avoid inadvertent irradiation of early pregnancies. An outline is given o[ the nature and degree of risk involved in such irradiation and, against that background, clear practical guidance is provided on scheduling policy. In the other appendices, a deal of useful information, such as radiation doses to patients, is provided about selected nuclear medicine examinations and guidance' is given on the formulation of departmental policy for the protection of the patient.

No doubt, the degree of difficulty in meeting the standards called for in this manual will vary considerably for different departments of nuclear medicine. Nevertheless, reference to the manual is recom- mended for all key staff involved in the work of such departments.

W. Anderson