Cost effectiveness and the role of the National Institute of Health and Care Excellence (NICE) in interventional radiology.

Healthcare expenditure is continually increasing and projected to accelerate in the future, with an increasing proportion being spent on interventional radiology. The role of cost effectiveness studies in ensuring the best allocation of resources is discussed, and the role of National Institute of Health and Care Excellence (NICE) in determining this. Issues with demonstrating cost effectiveness have been discussed, and it has been found that there is significant scope for improving cost effectiveness, with suggestions made for how this can be achieved. In this way, more patients can benefit from better treatment given limited healthcare budgets.

The role of computed tomography in modern paediatric uroradiology.

Computed tomography (CT) has developed a well-recognised role within paediatric uroradiology, especially in imaging of trauma, malignancy (in particular Wilms' tumour), atypical infection, and congenital urogenital abnormalities. CT can also be used for problem solving in nephrolithiasis and renal transplant assessment. These applications are illustrated and discussed, with an emphasis on particular information that can be gained from the CT study.

Landmark-based morphometrics of the normal adult brain using MRI.

We describe the application of statistical shape analysis to homologous landmarks on the cortical surface of the adult human brain. Statistical shape analysis has a sound theoretical basis. Landmarks are identified on the surface of a 3-D reconstruction of the segmented cortical surface from magnetic resonance image (MRI) data. Using publicly available software (morphologika) the location and size dependence of the landmarks are removed and the differences in landmark distribution across subjects are analysed using principal component analysis. These differences, representing shape differences between subjects, can be visually assessed using wireframe models and transformation grids. The MRI data of 58 adult brains (27 female and 15 left handed) were examined. Shape differences in the whole brain are described which concern the relative orientation of frontal lobe sulci. Analysis of all 116 hemispheres revealed a statistically significant difference (P < 0.001) between left and right hemispheres. This finding was significant for right- but not left-handed subjects alone. No other significant age, gender, handedness, or brain-size correlations with shape differences were found.

Identifying homologous anatomical landmarks on reconstructed magnetic resonance images of the human cerebral cortical surface.

Guided by a review of the anatomical literature, 36 sulci on the human cerebral cortical surface were designated as homologous. These sulci were assessed for visibility on 3-dimensional images reconstructed from magnetic resonance imaging scans of the brains of 20 normal volunteers by 2 independent observers. Those sulci that were found to be reproducibly identifiable were used to define 24 landmarks around the cortical surface. The interobserver and intraobserver variabilities of measurement of the 24 landmarks were calculated. These reliably reproducible landmarks can be used for detailed morphometric analysis, and may prove helpful in the analysis of suspected cerebral cortical structured abnormalities in patients with such conditions as epilepsy.

Changing interpretations of the human cortical pattern.

There has been a long historical succession of scientific description of the cerebral cortex, usually accompanied by conflicting speculations on its function. It was noted by Thomas S. Kuhn that scientific descriptions are phrased in terms of the prevailing scientific paradigm and that disagreement about the interpretation of observed phenomena is what drives scientists to formulate new theories. The objectives of this study were to examine how the observation of Kuhn can help to gain insight into historical concepts of brain functioning from contemporary descriptions of the cortical gyrations, to examine how these historical concepts are relevant to neurology today, and to demonstrate how subjective these concepts are because they are based on interpretations that may be wrong. The method used here is examination of historical sources that give descriptions and illustrations of the cerebral cortex and contemporary theories of brain function. I have found that the emphases on cortical description have varied according to the prevailing contemporary paradigm. Debates about and between different paradigms mirror some themes in current neuroscience. In conclusion, the observations of Kuhn help to interpret descriptions to shed light on theories of cerebral cortical functioning, and they demonstrate that a scientific description is necessarily highly subjective (since it is phrased in terms of the current paradigm). The insights that can be gained are relevant to modern neurology and neuroscience research.