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Skeletal muscle metastases from pancreatic carcinoma are exceedingly rare with only a few cases reported in the published work. The case of a 59-year-old man with bilateral, symmetric gluteal muscle metastases from pancreatic carcinoma is presented. This case was clinically challenging as until skeletal muscle biopsy was carried out, the working diagnosis was that of paraneoplastic polymyositis. A brief review of the published work is also presented.

This article proposes a practical method for measuring staff radiologist workloads (clinical productivity) in teaching hospital departments of radiology in Australia. It reviews the Australian background to this, including the Royal Australian and New Zealand College of Radiologists (RANZCR) Education Board accreditation guidelines and the development of the RANZCR practice costing model. It reviews overseas methods of radiologist workload measurement and trends in radiologist workloads both in Australia and overseas. It proposes a practical and simple workload measuring method based on relative value units derived from the RANZCR model. Using a previous national workload survey in teaching hospitals, it proposes initial workload benchmarks when using this method. Strengths and weaknesses of this method and alternatives are reviewed, and a number of proposals for Australian teaching radiology departments are put forward to advance the issue of radiologist workloads in a disciplined manner.

This paper describes the current status of radiologist provision in Australia, and explores issues relating to its current adequacy, as well as analysing projections of supply and requirements, and their balancing. Data are drawn from several sources including the results of the Royal Australian and New Zealand College of Radiologists Workforce Survey 2000, and the report of the Australian Medical Workforce Advisory Committee Radiology Working Party 2001. The main conclusions to be drawn are that: (i) there is a current shortfall of radiologist supply in Australia; (ii) future requirements (taking all factors into consideration) are expected to grow at a greater rate than projected supply (based on the status quo); and (iii) supply of radiologists should therefore be increased. These conclusions are roughly in line with those from other countries, such as the UK, Canada and USA. Radiologists practising in Australia also appear to have relatively high productivity, including by some international comparisons. These findings are presented in the context of current issues in Australian medical imaging, including provider consolidation and corporatization, globalization and funding.

The authors wished to determine the proportion of patients with intermediate-category and intermediate-probability ventilation-perfusion scintigraphy (IVQS) who proceed to further imaging for investigation of thromboembolism, to identify the defining clinical parameters and to determine the proportion of patients who have a definite imaging diagnosis of thromboembolism prior to discharge from hospital on anticoagulation therapy. One hundred and twelve VQS studies performed at the Flinders Medical Centre over a 9-month period were reported as having intermediate category and probability for pulmonary embolism. Medical case notes were available for review in 99 of these patients and from these the pretest clinical probability, subsequent patient progress and treatment were recorded. Eight cases were excluded because they were already receiving anticoagulation therapy. In the remaining 91 patients the pretest clinical probability was considered to be low in 25; intermediate in 30; and high in 36 cases. In total, 51.6% (n = 47) of these patients (8% (n = 2) with low, 66% (n = 20) with intermediate, and 69.4% (n = 25) with high pretest probability) proceeded to CT pulmonary angiography (CTPA) and/or lower limb duplex Doppler ultrasound (DUS) evaluation. Of the patients with IVQS results, 30.7% (n = 28) were evaluated with CTPA. No patient with a low, all patients with a high and 46% of patients with an intermediate pretest probability initially received anticoagulation therapy. This was discontinued in three patients with high and in 12 patients with intermediate clinical probability prior to discharge from hospital. Overall, 40% of patients discharged on anticoagulation therapy (including 39% of those with a high pretest probability) had a positive imaging diagnosis of thromboembolism The results suggest that, although the majority of patients with intermediate-to-high pretest probability and IVQS proceed to further imaging investigation, CTPA is relatively underused in this group. Most patients with a high pretest clinical probability receive anticoagulation therapy irrespective of imaging findings, and less than half of all patients discharged from hospital on anticoagulation therapy have a positive imaging diagnosis of thromboembolism.

The 1998 Australian Radiologist Workforce Survey findings form the basis of the present report, prepared by the Workforce Committee of the Royal Australian and New Zealand College of Radiologists (RANZCR). A more detailed report can be accessed through the RANZCR web site (http:@www.ranzcr.edu.au). This follows similar previously published reports by the Workforce Committee in the 1990s. The issues of radiologist workforce supply and demand are examined, and benchmarks again reviewed. One of the conclusions of the present report is a possible upcoming shortage of radiologists in Australia, due to several factors, including a possible increase in the attrition rate of an ageing radiologist population, increasing female participation in the workforce, and increasing medical imaging utilization rates. In comparison with other Organization for Economic Cooperation and Development (OECD) nations, Australia had a mid-range supply of radiologists, and also medical imaging utilization, although there has been an increase in the latter. Australian radiologist annual workloads appear to be increasing.

A questionnaire was sent to all radiologists in Australia using a mailing list supplied by individual State Workforce subcommittee members. A reply rate of 72% was obtained. There are currently 1061 radiologists (1010.5 full-time equivalents) or 55.5 radiologists per million population, placing Australia in the mid-range compared with other OECD countries. This has increased slightly from 54.1 in 1994. There is a small but definite State variation. Utilizing current trainee numbers and traditional attrition rates, there is no projected change in these figures (55.3 in 2001), but the continued introduction of 'migrant' radiologists is postulated to cause an increase (56.6 with 25 migrants and 58.4 with 50 migrants in 2001). Analysis of work-practice indicates a performance rate of 14,100 procedures per year per practising radiologist. There is again a State variation. It is estimated that the total number of medical imaging procedures per 1000 population per year (rendered by radiologists) is 815. These latter two figures place Australia in the mid-range compared with the United States and Great Britain. General radiography, mammography, ultrasound, and CT are the most common procedures (in that order), and are performed by the largest proportion of radiologists.

Three cases of congenital absence of a cervical spine pedicle are described. This anomaly comprises a radiological triad of (i) the absent pedicle producing an apparently 'giant' neural foramen; (ii) a dorsally displaced ipsilateral articular mass and lamina with a dysplastic and reversed facet joint; and (iii) deficiency or absence of the ipsilateral transverse process. Recognition of this anomaly is particularly important in the context of acute injury to avoid misdiagnosis as a traumatic facet joint fracture-dislocation. The giant foramen must also be differentiated from expansion due to a neurofibroma. A correct plain radiographic diagnosis is usually possible, but in doubtful cases appearances on computed tomography are pathognomonic. Magnetic resonance imaging, performed in two of the cases, was helpful in elucidating the contents of the giant foramen, but should rarely be necessary in clinical practice.

This case documents the progression of a sacral insufficiency stress fracture, initially involving the lateral left ala and later extending across the body of the sacrum to the right ala. The 'H' shaped distribution of increased uptake on radionuclide bone scanning is characteristic of this type of fracture, although variations of this pattern are also seen according to the severity of the sacral trauma. While the differing bone scan patterns of this particular fracture type are well established, it is unusual to document the progression of this fracture on bone scan in any one patient.

A case report of cryptogenic organizing pneumonia (COP); also known as bronchiolitis obliterans organizing pneumonia (BOOP) is presented. The histopathologic findings of COP are well documented in the literature and typically consist of organizing pneumonia of uniform appearance. This case report describes, in addition to the classic findings, more acute exudative inflammation not usually associated with this condition. Variation in the evolution of the pneumonic process is one of the reasons for reporting this case. The promotion of awareness of this treatable condition is the other reason for reporting this case. When multifocal areas of consolidation are demonstrated radiologically, particularly when peripheral and basal, and in the correct clinical setting, the possibility of COP should be entertained. This condition responds dramatically to steroid therapy, and has a good prognosis.

This case report describes diffuse hepatic uptake of a diphosphonate bone scan agent (Technetium-99m-MDP) in a patient with amyloidosis associated with a plasma cell dyscrasia. Amyloid infiltration is one of the more rare, but well recognized, causes of hepatic uptake of bone scan tracer. Other causes are also discussed in this case report.

This case report describes an unusual congenital anomaly of the craniovertebral junction in a 14 year old male. Cervical radiographs showed the bony anomaly, while thin slice CT (with 2-D and 3-D reformations), MR imaging, and angiography were particularly useful in accurately assessing the bony, soft tissue and vascular anatomy, prior to and following surgery.

Cervical spondylolysis is a rare condition, characterised by the presence of a corticated cleft between the superior and inferior articular facets of the articular mass (1). This defect involves the cervical equivalent of the pars interarticularis of the lumbar spine. Associated dysplastic changes are present, suggesting that the lesion is congenital (1 and 2). This case report describes bilateral spondylolysis and associated dysplasia of C6 in an 18 year old female. The importance of this lesion lies in its differentiation from the more serious articular mass fracture or dislocation (1).