In interventional cardiology, a wide variation in patient dose for the same type of procedure has been recognised by different studies. Variation is almost due to procedure complexity, equipment performance, procedure protocol and operator skill. The SENTINEL consortium has performed a survey in nine european centres collecting information on near 2000 procedures, and a new set of reference levels (RLs) for coronary angiography and angioplasty and diagnostic electrophysiology has been assessed for air kerma-area product: 45, 85 and 35 Gy cm2, effective dose: 8, 15 and 6 mSv, cumulative dose at interventional reference point: 650 and 1500 mGy, fluoroscopy time: 6.5, 15.5 and 21 min and cine frames: 700 and 1000 images, respectively. Because equipment performance and set-up are the factors contributing to patient dose variability, entrance surface air kerma for fluoroscopy, 13 mGy min(-1), and image acquisition, 0.10 mGy per frame, have also been proposed in the set of RLs.

Plasticity of language function after brain damage can depend on maturation of the brain. Children with left-hemisphere perinatal (n = 7) or childhood stroke (n = 5) and 12 controls were investigated using functional magnetic resonance imaging. The verb generation and the sentence comprehension tasks were employed to activate the expressive and receptive language areas, respectively. Weighted laterality indices were calculated and correlated with results assessed by neuropsychological test battery. Compared to controls, children with childhood stroke showed significantly lower mean scores for the expressive (P < .05) and receptive (P = .05) language tests. On functional magnetic resonance imaging they showed left-side cortical activation, as did controls. Perinatal stroke patients showed atypical right-side or bilateral language lateralization during both tasks. Negative correlation for stroke patients was found between scores for expressive language tests and laterality index during the verb generation task. (Re)organization of language function differs in children with perinatal and childhood stroke and correlates with neurocognitive performance.

Patient doses for a few common fluoroscopy-guided procedures in interventional radiology (IR) (excluding cardiology) were collected from a few radiological departments in 13 European countries. The major aim was to evaluate patient doses for the basis of the reference levels. In total, data for 20 procedures for about 1300 patients were collected. There were many-fold variations in the number of IR equipment and procedures per population, in the entrance dose rates, and in the patient dose data (total dose area product or DAP, fluoroscopy time and number of frames). There was no clear correlation between the total DAP and entrance dose rate, or between the total DAP and fluoroscopy time, indicating that a number of parameters affect the differences. Because of the limited number of patients, preliminary reference levels were proposed only for a few procedures. There is a need to improve the optimisation of IR procedures and their definitions and grouping, in order to account for their different complexities.

Study design: Cross-sectional clinical study. Objectives: Plastic changes within cortical areas occur after traumatic spinal cord injury (TSCI). The aim of the study was to assess cortical activation in the chronic phase of TSCI using functional magnetic resonance imaging (fMRI). Setting: Tartu University Hospital, Tartu, Estonia. Methods: Ten right-handed patients with paraplegia and 18 healthy controls were studied by fMRI. Individuals performed simple flexion/extension of the right hand fingers and the right ankle during fMRI. The activation volumes, maximum t values (T max) and centres of gravity (COG) were calculated. Results: The mean time since trauma was 1848 ± 1046 days (range 388-4459). During hand movements, the volume of activation (VOA) in the contralateral primary motor cortex was significantly larger among the TSCI patients who did not recover compared with the controls (4112 vs 2777, P = 0.02). The VOA did not enlarge during the ankle movements (2420 vs 1114, P = 0.08). There was a significant relationship between the VOA in Brodmann area 4 (BA4) and American Spinal Injury Association motor score during hand movements (r = − 0.67, P = 0.03). A positive correlation was found during hand movements in the VOA of BA4 and time since injury (r = 0.62, P = 0.05). INTRODUCTIONTraumatic spinal cord injury (TSCI) leads to sensorimotor loss and disruption of autonomic nervous system. 1 Although TSCI is considered an untreatable condition, several studies in animal models have demonstrated that functional recovery is feasible if any neuronal connection has been survived or is re-established.The functional reorganisation of the nervous system after injury can be divided into early and long-term changes. 2 Such changes take place in the area of injury as well as in the brain cortex. The early changes are quite transient and reflect the reinforcement of pre-existing connections. 3 The studies in patients with TSCI in the acute phase have demonstrated different shifts in the activation and changes in the area of cortical activation. 4,5 On the other hand, in the chronic phase, new connections are forming and other neural structures take a more leading role in task performance. 3 Many neuroimaging and mapping studies have also been conducted in the chronic phase of SCI. Unfortunately, the methodology of the studies and the participants have not been homogenous. 6 In this context, we tried to study cortical activation of the similar patients with chronic TSCI whose neurological deficit bore resemblance. The aim of the study was to evaluate cortical reorganisation depending on the neurological function and time since injury.

Study design: Prospective clinical study. Background: The aim of the study was to investigate cortical reorganisation after traumatic spinal cord injury (TSCI) using functional magnetic resonance imaging (fMRI). Setting: Tartu University Hospital, Tartu, Estonia. Methods: We studied six right-handed tetraplegic TSCI patients at 1, 3 and 12 months after the injury and 12 age-and gender-matched healthy controls. Individuals performed simple test-rest cycles of flexion/extension of the right-hand fingers and flexion/extension of the right ankle during fMRI. The volumes of activation (VOA), maximum t-values, centres of gravity (COG) and weighted laterality indexes were calculated. Results: There was no recovery of neurologic function in three patients and, according to the American Spinal Injury Association (ASIA) Impairment Scale the remaining three recovered. A positive correlation between the VOA in the primary motor cortex and the ASIA Impairment Scale (1 month: r ¼ 0.82, P ¼ 0.002; 3 Month: r ¼ 0.63, P ¼ 0.03; 12 Month: r ¼ 0.23, P ¼ 0.52) was found. The study also revealed a pattern of cortical activation that was increased among the patients who recovered (in Brodmann area 4 (BA 4), P ¼ 0.06; BA 1-2-3-5, P ¼ 0.08; BA 6, P ¼ 0.05). During the hand task there was an expansion of COG laterally, anteriorly and inferiorly among the patients who recovered. During the hand movement the cortical activation was less lateralised among the patients compared with the controls (Po0.05). Conclusion: Our study has found broadening of cortical activation and shift of COG during the first year after TSCI, depending on the recovery.