DIRECT STEPHEN
CORONAL L. G.
S&Ions Department
COMPUTERIZED
ROTHMAN,
WILLIAM
E. ALLEN
TOMOGRAPHY and JOSEPH
F.
SIMEONE
of Computerized Tomography and Neuroradiology of the of Diagnostic Radiology. Yale [Jniversity School of Medicine. New Haven. Connecticut
Abstract-- The computerized tomographic examination 1s routinely performed in the axial plane. However. with several available CT units images in the coronal plane are easily obtained. These Images are especially useful in the diagnosis of diseases of the facial bones. sinuses. orbits and parasellar area. This paper describes one year’s clinical experience with direct coronal computerized tomography. Computerized
tomography
Coronal
plane
Facial
hones
Sella turckca
Orbit
INTRODUCTION
In the last several years, computerized axial tomography has become established as a routine neuroradiologic imaging procedure. By their very nature the images produced by CAT scanners are foreign to the radiologist’s eye. The axial plane. which was previously of little radiographic importance has now become the key to neurodiagnosis. It is a basic tenet of diagnostic radiology that whenever possible, anatomic structures be visualized on two right angle projections. Producing this set of perpendicular images is extremely difficult and often impossible in computerized axial tomography of the brain. Several investigators have produced computer reconstructed images of the brain in coronal and sagittal planes [l. 21. This requires a computer separate from the scanning unit and is not easily adaptable to routine clinical practice. This paper reviews OLIN experience with a second method. direct coronal computerized tomography. METHOD
AND
MATERIAL
Over the last year numerous cases have been studied at the Yale-New Haven Hospital on the “ACTA” 0100 scanner in both axial and coronal planes. Patients are placed in the prone position with their heads maximally extended. Soft foam rubber sponges are placed below the chin and neck for comfort and stability. The scanner gantry is angled forward maximally allowing a coronal section (Fig. 1). The head is immobilized with a Velcro strap and an absorbing medium upon the top of the head apposing the aluminum head rest. While not particularly comfortable most patients find this position tolerable for the duration of the study. For evaluation of the orbits and facial structures the temporal canthus of the eye is taken as a starting point and serial scans are produced extending posteriorly as far as required. For evaluation of the cerebellopontine angle and posterior fossa the external auditory meatus is the zero point. The examination is continually monitored by viewing the instantaneous display and additional scans are performed as required in the individual case. By varying the mean and window settings it is possible to clearly define the bony anatomy of the facial structures. As a general rule these scans are performed using a wide window and a relatively low mean setting. This allows best definition of bony structures but is not suitable for differentiation of small differences in absorption coefficient. Hence intracranial structures are less well defined. When both osseous and intracranial anatomy is required the data can be displayed using a dual window technique. This means that two individual sets of data are displayed. one in the range of brain density and one in the range of bone density. Two means and windows are selected. one optimized for brain density and one for bone density. The lower window is made
158
STEPHEN L. G. ROTHMAN it ul
Fig. 1. (a) and (b). Frontal and profile views of a subject positioned The scanning gantry is angled in an attempt to project the central canthomeatal line.
l’or coronal tomography. ray perpendicular to the
Direct
narrow include
coronal
computerized
to view the subtle difference in brain absorption the entire range of bone density and detail. CLINICAL
159
tomography
and
the upper
one wide to
EXAMPLES
By the above method, detailed coronal tomograms of the facial structure are produced. Figure 2 represents the normal anatomy of the paranasal sinus and nasal cavity as defined by coronal computerized tomography. Note the clearly defined turbinate and maxillary. ethmoid and sphenoid sinuses.
Fig. 2. Coronal CT scan through the paranasal sinus. The scanning gantry is angled slightly less than 90 degrees to the canthomeatal line allowing visualization of the maxillary and sphenoid sinuses. The nasal cavity and turbinates are clearly visualized.
STWHHV L. G. ROTHMAN et LII
160
Fig. 3. Axial (a) and coronal tissue
mass
(b) CT scans through the maxillary sinuses demonstrate a soft within the left maxillary sinus. There is destruction of the medial and posterior sinus walls with extension of the tumor into the nasal cavity (A).
Case I. G.J. is a 58 year old male who presented with a,one month history of painless yellow nasal discharge from his left nostril. Two weeks prior to admission he noted some bloody discharge on sneezing and his left cheek became swollen and painful. He also complained of lack of sensation over the distribution of the left intraorbital nerve. Physical examination revealed a mass on the left lateral nasal floor and a prominent inferior turbinate. No cervical adenopathy was palpable. Needle biopsy confirmed the clinical suspicion of squamous carcinoma. Coronal CT (Fig. 3) demonstrates a mass of soft tissue density within the left maxillary sinus. The tumor has destroyed the lateral antral wall but the integrity of the pterygoids is maintained.
Direct
The coronal
projection
coronal
is important
computerircd
in visualizing
161
tomography
orbital
structures
as demonstrated
by the following two cases. Ca,se _7. T.H. is a 12 year old white male who had a retinoblastoma of the right eye treated at four months of age by enucleation and a second retinoblastoma of the left eye treated by 3500 rad eight months later. At age three a recurrence of the left lesion was noted and he received another 4500 rad and chemotherapy. At age five the left sided tumor recurred for the second time and the eye was enucleated. Since that time conventional laminograms demonstrated destruction of the roof and medial walls of the left orbit. At age ten he was readmitted because of severe nasal stuffiness and a soft tissue mass was noted in the left nasal cavity. Biopsy proved this to be an osteogenic sarcoma. The mass was excised and the patient placed on chemotherapy. He presented at this time for evaluation of the paranasal sinuses for evidence of tumor recurrence. Figure 4 represents coronal CT section of the orbits and facial structures. An eye prosthesis is noted on the right (4a). The bony margins of the left orbit are absent. The more posterior section (4b) demonstrates bony density from the osteogenic sarcoma within the left half of the sphenoid. The pneumatized right sinus is clearly displayed. Cascj -1. W.F. is a 70 year old black male in good health who complained of an inflamed. burning and painful right eye two months prior to his admission. Visual acuity was 20140 at the time. Over the ensuing weeks the eye continued to swell. Physical examination at the time of admission revealed marked swelling of the lower lid, conjunctival inflammation and several palpable orbital nodules. Biopsy revealed orbital pseudotumor with no evidence of lymphoma. Routine roentgenographic studies and conventional laminograms revealed no bony destruction. Direct coronal CT (Fig. 5) demonstrated expansion of the right lower lid and downward displacement of the globe of the eye. Several contrast enhancing masses are visualized medially within the orbit. Biopsy demonstrated this to be massive orbital pseudotumor. The patient is presently being treated with steroids and radiotherapy.
Crr.w 1. Z.H. is a 57 year old female who presented in 1958 with bitemporal visual field cuts. Routine skull films revealed expansion of the sella turcica. She received 4000 rad to her pituitary with resolution of the fieid cuts. At that time her pituitary function and visual acuity were normal. She was well until 1968 when bilateral visual field cuts recurred, this time with reduction in visual acuity. Routine skull radiographs demonstrated increased enlargement of the sella. A PEG at that time showed the mass to be extending near the foramen of Monro but the lateral ventricles were not enlarged. She received 3400 I-ad more to the tumor. The visual field cuts disappeared and visual acuity again returned to normal. She was scanned now because of a dense left and a moderate right hitemporal field cut and progressive difticulties with mentation. Axial CT (Fig. 6a) defines a large contrast enhancing tumor mass above the sella. Coronal CT with contrast enhancement (Fig. 6b) demonstrates the lateral and superior margins of the recurrent tumor extending into the middle fossa bilaterally. It also delineates lateral extension of the tumor clearly above the plane of the petrous bones. The third ventricle is elevated by the mass and the lateral ventricles are dilated. Commrnt: Coronal tomography has been particularly useful in assessing the extent of parasellar masses. It provides a clearer three dimensional appreciation of extrasellar extension. It has. on several occasions. shown evidence of contrast enhancing tumor when none was apparent on the routine axial views. CNS~ i. I.Z. is a 54 year old female who was admitted with a chief complaint of “bad smelling odors”. Physical examination revealed approximately 5 mm of exophthalmos on the left. There were no field cuts. Pupils were equal and reacted normally to light. The remainder of the neurological examination was within normal limits. Plain
Fig. 4. (a). Coronal scan at the mid orbital level. There is an eye prosthesls (PI withm the right orbit. The left orbital rim is absent. (b). More posterior section through the body .)I the sphenoid. The left half of the sphenold IS very dense due to osteogenic sarcoma. Note also the sclla floor and dorsum sella. Fig. 5. Coronal CT through the orbits demonstrate downward displacement of the righ e!e by a contrast enhancing mass (T), The more anterior section (b) reveals expansion of the right lower lid. The small circular densities in the uppermost portion of the orbis (A) are the superit>r rectus muscles. Fig. 6. Axial CT scan (a) depicts a large contrast enhancing tumor in the suprasellar area. The contrast filled middle cerebral artery on the left is also seen (A). Coronal scan (b) demonstrates lateral extension of the suprasellar mass extending into the area of the right temporal lobe.
Direct
Fig. 7. Coronal ptet .ion through
coronal
CT scan demonstrates the greater sphenoidal
Fig. 8. Coronal CT scan stru, cture is the tentorium
computerized
a continuous area of hyperostosis wing. The sphenoid and maxillary
through the posterior (A). A large contrast posterior
161
tomography
extending frc ,rn the sinuses are n(or!mal.
lir 1ear fossa. The slanting contrast enhancing enhancing tumor is seen centrally with in the fossa.
STEPHEN L. G. ROTHMAN it tr/
164
radiographs of the skull revealed hyperostosis of the sphenoid bone. Selective internal and external carotid arteriography failed to demonstrate tumor hypervascularity and no mass effect could be identified aside from the expanded bone. Coronal CT demonstrates expansion of the sphenoid on the left with hyperostosis (Fig. 7). There is deformity of the body and of the greater and lesser sphenoid wings with extension of the fibrous dysplasia upward along the lateral skull wall to the pterion. There is no evidence of an intracranial soft tissue component to this mass. Comnzerzt: This case demonstrates the value of coronal tomography in establishing continuity of lesions which extend through several axial sections. While the pathology can be seen by axial CT. with coronal tomograms, a further understanding of the extent of the lesion is obtained.
Coronal CT is now routinely performed in evaluation of posterior fossa masses. The cerebellopontine angles are more easily identifiable. Curse 6. D.O. This elderly man was admitted to the hospital because of progressive ataxia and headaches. A carcinoma of the lung had previously been removed. Coronal CT (Fig. 8) demonstrates contrast enhancement within the tentorium and a large tumor mass within the posterior fossa. Co~zment: Two right angle projections allow for more accurate assessment of exact tumor location for radiation therapy planning. Localization of small lesions in the ‘afiterioposterior plane is sometimes difficult on axial CT due to variations in angulation of the head or scanning gantry. Coronal sections relate intracranial tumors to known anatomical structures.
SUMMARY
AND
CONCLUSION
Direct coronal computerized tomography is an important aid in the evaluation of cranial, facial, and orbital disorders. As a complement to the standard axial projection. it enables the observer to form a three dimensional image of the particular pathology. It also offers the possibility of calculating tumor volumes rather than surface area of individual axial sections, improving the precision of radiotherapeutic planning.
REFERENCES I. W. V. Glenn. Jr.. R. J. Johnston. P. E. Morton and S. J. Dwyer, Image generation and display techniques for CT scan data. Thin transverse and reconstructed coronal and saggittal planes. I~lu~.sr. Rrrrliol. IO, 403 416 (1975). 2. W. V. Glenn. Jr., R. J. Johnston. P. E. Morton and S. J. Dw,yer. Further investigation and initial clmical use of advanced CT display capability. IITI.L’Q.Krrtliof. 10, 479-489 (1975).
WILLIAM E. ALLEN. III. is currently an Associate Professor of Diagnostic Radiology at Yale University School of Medicine. He did his residency at Yale-New Haven Hospital and received his M.D. from the University of Tennessee in 1967.
About the Author-
~-C. CARL JA~E,C is currently an Assistant Professor of Diagnostic Radiology at Yale University School of Medicine. Prior to that he was a James Picker Foundation Fellow in Academic Radiology at the Massachusetts Institute of Technology and was an Assistant in Radiology at the Massachusetts General Hospital. He did his radiology residency at Columbia-presbyterian Medical Center in New York City and received his M.D. from the Columbia College of Physicians and Surgeons in 1969.
About the Author
About the Author-- CHARLES E. P~!TMAN is currently
an Associate Professor of Diagnostic Radioloev and Internal Medicine at Yale University School of Medicine and is also the Clinical DFector of Diagnostic Radiology at Yale-New Haven Hospital. He completed his residency in internal medicine at the University of Texas. Medical Branch and his radiology residency was completed at the University of California at San Francisco. He received his M.D. from the University of Texas. Medical Branch. in 1967.
Direct
coronal
computerized
tomography
About the Author-HELEN C. REDMAN is the Associate Chief of the Department of Radiology at Mt. Zion Hospital and Associate Professor of Radiology at UCSF and Stanford University. She did her residency at Stanford University and received her M.D. from the Columbia College of Physicians and Surgeons in 1969. About the AUthOr-STEPHEN L. G. ROTHMAN is currently an Associate Professor of Diagnostic Radiology and Director of Computerized Tomography at Yale University School of Medicine. Prior to that he was a Neuroradiology Fellow at Yale University School of Medicine. He performed his radiology residency at Yale-New Haven Hospital and received his M.D. from Albert Einstein College of Medicine in 1967. About the Author- JOSEPH F. SIMEONE is currrently a Winchester Fellow in Diagnostic Radiology at Yale University School of Medicine. He performed his residency at Yale-New Haven Hospital and received his M.D. from Yale University School of Medicine in 1973.
165
CORONAL L. G.
S&Ions Department
COMPUTERIZED
ROTHMAN,
WILLIAM
E. ALLEN
TOMOGRAPHY and JOSEPH
F.
SIMEONE
of Computerized Tomography and Neuroradiology of the of Diagnostic Radiology. Yale [Jniversity School of Medicine. New Haven. Connecticut
Abstract-- The computerized tomographic examination 1s routinely performed in the axial plane. However. with several available CT units images in the coronal plane are easily obtained. These Images are especially useful in the diagnosis of diseases of the facial bones. sinuses. orbits and parasellar area. This paper describes one year’s clinical experience with direct coronal computerized tomography. Computerized
tomography
Coronal
plane
Facial
hones
Sella turckca
Orbit
INTRODUCTION
In the last several years, computerized axial tomography has become established as a routine neuroradiologic imaging procedure. By their very nature the images produced by CAT scanners are foreign to the radiologist’s eye. The axial plane. which was previously of little radiographic importance has now become the key to neurodiagnosis. It is a basic tenet of diagnostic radiology that whenever possible, anatomic structures be visualized on two right angle projections. Producing this set of perpendicular images is extremely difficult and often impossible in computerized axial tomography of the brain. Several investigators have produced computer reconstructed images of the brain in coronal and sagittal planes [l. 21. This requires a computer separate from the scanning unit and is not easily adaptable to routine clinical practice. This paper reviews OLIN experience with a second method. direct coronal computerized tomography. METHOD
AND
MATERIAL
Over the last year numerous cases have been studied at the Yale-New Haven Hospital on the “ACTA” 0100 scanner in both axial and coronal planes. Patients are placed in the prone position with their heads maximally extended. Soft foam rubber sponges are placed below the chin and neck for comfort and stability. The scanner gantry is angled forward maximally allowing a coronal section (Fig. 1). The head is immobilized with a Velcro strap and an absorbing medium upon the top of the head apposing the aluminum head rest. While not particularly comfortable most patients find this position tolerable for the duration of the study. For evaluation of the orbits and facial structures the temporal canthus of the eye is taken as a starting point and serial scans are produced extending posteriorly as far as required. For evaluation of the cerebellopontine angle and posterior fossa the external auditory meatus is the zero point. The examination is continually monitored by viewing the instantaneous display and additional scans are performed as required in the individual case. By varying the mean and window settings it is possible to clearly define the bony anatomy of the facial structures. As a general rule these scans are performed using a wide window and a relatively low mean setting. This allows best definition of bony structures but is not suitable for differentiation of small differences in absorption coefficient. Hence intracranial structures are less well defined. When both osseous and intracranial anatomy is required the data can be displayed using a dual window technique. This means that two individual sets of data are displayed. one in the range of brain density and one in the range of bone density. Two means and windows are selected. one optimized for brain density and one for bone density. The lower window is made
158
STEPHEN L. G. ROTHMAN it ul
Fig. 1. (a) and (b). Frontal and profile views of a subject positioned The scanning gantry is angled in an attempt to project the central canthomeatal line.
l’or coronal tomography. ray perpendicular to the
Direct
narrow include
coronal
computerized
to view the subtle difference in brain absorption the entire range of bone density and detail. CLINICAL
159
tomography
and
the upper
one wide to
EXAMPLES
By the above method, detailed coronal tomograms of the facial structure are produced. Figure 2 represents the normal anatomy of the paranasal sinus and nasal cavity as defined by coronal computerized tomography. Note the clearly defined turbinate and maxillary. ethmoid and sphenoid sinuses.
Fig. 2. Coronal CT scan through the paranasal sinus. The scanning gantry is angled slightly less than 90 degrees to the canthomeatal line allowing visualization of the maxillary and sphenoid sinuses. The nasal cavity and turbinates are clearly visualized.
STWHHV L. G. ROTHMAN et LII
160
Fig. 3. Axial (a) and coronal tissue
mass
(b) CT scans through the maxillary sinuses demonstrate a soft within the left maxillary sinus. There is destruction of the medial and posterior sinus walls with extension of the tumor into the nasal cavity (A).
Case I. G.J. is a 58 year old male who presented with a,one month history of painless yellow nasal discharge from his left nostril. Two weeks prior to admission he noted some bloody discharge on sneezing and his left cheek became swollen and painful. He also complained of lack of sensation over the distribution of the left intraorbital nerve. Physical examination revealed a mass on the left lateral nasal floor and a prominent inferior turbinate. No cervical adenopathy was palpable. Needle biopsy confirmed the clinical suspicion of squamous carcinoma. Coronal CT (Fig. 3) demonstrates a mass of soft tissue density within the left maxillary sinus. The tumor has destroyed the lateral antral wall but the integrity of the pterygoids is maintained.
Direct
The coronal
projection
coronal
is important
computerircd
in visualizing
161
tomography
orbital
structures
as demonstrated
by the following two cases. Ca,se _7. T.H. is a 12 year old white male who had a retinoblastoma of the right eye treated at four months of age by enucleation and a second retinoblastoma of the left eye treated by 3500 rad eight months later. At age three a recurrence of the left lesion was noted and he received another 4500 rad and chemotherapy. At age five the left sided tumor recurred for the second time and the eye was enucleated. Since that time conventional laminograms demonstrated destruction of the roof and medial walls of the left orbit. At age ten he was readmitted because of severe nasal stuffiness and a soft tissue mass was noted in the left nasal cavity. Biopsy proved this to be an osteogenic sarcoma. The mass was excised and the patient placed on chemotherapy. He presented at this time for evaluation of the paranasal sinuses for evidence of tumor recurrence. Figure 4 represents coronal CT section of the orbits and facial structures. An eye prosthesis is noted on the right (4a). The bony margins of the left orbit are absent. The more posterior section (4b) demonstrates bony density from the osteogenic sarcoma within the left half of the sphenoid. The pneumatized right sinus is clearly displayed. Cascj -1. W.F. is a 70 year old black male in good health who complained of an inflamed. burning and painful right eye two months prior to his admission. Visual acuity was 20140 at the time. Over the ensuing weeks the eye continued to swell. Physical examination at the time of admission revealed marked swelling of the lower lid, conjunctival inflammation and several palpable orbital nodules. Biopsy revealed orbital pseudotumor with no evidence of lymphoma. Routine roentgenographic studies and conventional laminograms revealed no bony destruction. Direct coronal CT (Fig. 5) demonstrated expansion of the right lower lid and downward displacement of the globe of the eye. Several contrast enhancing masses are visualized medially within the orbit. Biopsy demonstrated this to be massive orbital pseudotumor. The patient is presently being treated with steroids and radiotherapy.
Crr.w 1. Z.H. is a 57 year old female who presented in 1958 with bitemporal visual field cuts. Routine skull films revealed expansion of the sella turcica. She received 4000 rad to her pituitary with resolution of the fieid cuts. At that time her pituitary function and visual acuity were normal. She was well until 1968 when bilateral visual field cuts recurred, this time with reduction in visual acuity. Routine skull radiographs demonstrated increased enlargement of the sella. A PEG at that time showed the mass to be extending near the foramen of Monro but the lateral ventricles were not enlarged. She received 3400 I-ad more to the tumor. The visual field cuts disappeared and visual acuity again returned to normal. She was scanned now because of a dense left and a moderate right hitemporal field cut and progressive difticulties with mentation. Axial CT (Fig. 6a) defines a large contrast enhancing tumor mass above the sella. Coronal CT with contrast enhancement (Fig. 6b) demonstrates the lateral and superior margins of the recurrent tumor extending into the middle fossa bilaterally. It also delineates lateral extension of the tumor clearly above the plane of the petrous bones. The third ventricle is elevated by the mass and the lateral ventricles are dilated. Commrnt: Coronal tomography has been particularly useful in assessing the extent of parasellar masses. It provides a clearer three dimensional appreciation of extrasellar extension. It has. on several occasions. shown evidence of contrast enhancing tumor when none was apparent on the routine axial views. CNS~ i. I.Z. is a 54 year old female who was admitted with a chief complaint of “bad smelling odors”. Physical examination revealed approximately 5 mm of exophthalmos on the left. There were no field cuts. Pupils were equal and reacted normally to light. The remainder of the neurological examination was within normal limits. Plain
Fig. 4. (a). Coronal scan at the mid orbital level. There is an eye prosthesls (PI withm the right orbit. The left orbital rim is absent. (b). More posterior section through the body .)I the sphenoid. The left half of the sphenold IS very dense due to osteogenic sarcoma. Note also the sclla floor and dorsum sella. Fig. 5. Coronal CT through the orbits demonstrate downward displacement of the righ e!e by a contrast enhancing mass (T), The more anterior section (b) reveals expansion of the right lower lid. The small circular densities in the uppermost portion of the orbis (A) are the superit>r rectus muscles. Fig. 6. Axial CT scan (a) depicts a large contrast enhancing tumor in the suprasellar area. The contrast filled middle cerebral artery on the left is also seen (A). Coronal scan (b) demonstrates lateral extension of the suprasellar mass extending into the area of the right temporal lobe.
Direct
Fig. 7. Coronal ptet .ion through
coronal
CT scan demonstrates the greater sphenoidal
Fig. 8. Coronal CT scan stru, cture is the tentorium
computerized
a continuous area of hyperostosis wing. The sphenoid and maxillary
through the posterior (A). A large contrast posterior
161
tomography
extending frc ,rn the sinuses are n(or!mal.
lir 1ear fossa. The slanting contrast enhancing enhancing tumor is seen centrally with in the fossa.
STEPHEN L. G. ROTHMAN it tr/
164
radiographs of the skull revealed hyperostosis of the sphenoid bone. Selective internal and external carotid arteriography failed to demonstrate tumor hypervascularity and no mass effect could be identified aside from the expanded bone. Coronal CT demonstrates expansion of the sphenoid on the left with hyperostosis (Fig. 7). There is deformity of the body and of the greater and lesser sphenoid wings with extension of the fibrous dysplasia upward along the lateral skull wall to the pterion. There is no evidence of an intracranial soft tissue component to this mass. Comnzerzt: This case demonstrates the value of coronal tomography in establishing continuity of lesions which extend through several axial sections. While the pathology can be seen by axial CT. with coronal tomograms, a further understanding of the extent of the lesion is obtained.
Coronal CT is now routinely performed in evaluation of posterior fossa masses. The cerebellopontine angles are more easily identifiable. Curse 6. D.O. This elderly man was admitted to the hospital because of progressive ataxia and headaches. A carcinoma of the lung had previously been removed. Coronal CT (Fig. 8) demonstrates contrast enhancement within the tentorium and a large tumor mass within the posterior fossa. Co~zment: Two right angle projections allow for more accurate assessment of exact tumor location for radiation therapy planning. Localization of small lesions in the ‘afiterioposterior plane is sometimes difficult on axial CT due to variations in angulation of the head or scanning gantry. Coronal sections relate intracranial tumors to known anatomical structures.
SUMMARY
AND
CONCLUSION
Direct coronal computerized tomography is an important aid in the evaluation of cranial, facial, and orbital disorders. As a complement to the standard axial projection. it enables the observer to form a three dimensional image of the particular pathology. It also offers the possibility of calculating tumor volumes rather than surface area of individual axial sections, improving the precision of radiotherapeutic planning.
REFERENCES I. W. V. Glenn. Jr.. R. J. Johnston. P. E. Morton and S. J. Dwyer, Image generation and display techniques for CT scan data. Thin transverse and reconstructed coronal and saggittal planes. I~lu~.sr. Rrrrliol. IO, 403 416 (1975). 2. W. V. Glenn. Jr., R. J. Johnston. P. E. Morton and S. J. Dw,yer. Further investigation and initial clmical use of advanced CT display capability. IITI.L’Q.Krrtliof. 10, 479-489 (1975).
WILLIAM E. ALLEN. III. is currently an Associate Professor of Diagnostic Radiology at Yale University School of Medicine. He did his residency at Yale-New Haven Hospital and received his M.D. from the University of Tennessee in 1967.
About the Author-
~-C. CARL JA~E,C is currently an Assistant Professor of Diagnostic Radiology at Yale University School of Medicine. Prior to that he was a James Picker Foundation Fellow in Academic Radiology at the Massachusetts Institute of Technology and was an Assistant in Radiology at the Massachusetts General Hospital. He did his radiology residency at Columbia-presbyterian Medical Center in New York City and received his M.D. from the Columbia College of Physicians and Surgeons in 1969.
About the Author
About the Author-- CHARLES E. P~!TMAN is currently
an Associate Professor of Diagnostic Radioloev and Internal Medicine at Yale University School of Medicine and is also the Clinical DFector of Diagnostic Radiology at Yale-New Haven Hospital. He completed his residency in internal medicine at the University of Texas. Medical Branch and his radiology residency was completed at the University of California at San Francisco. He received his M.D. from the University of Texas. Medical Branch. in 1967.
Direct
coronal
computerized
tomography
About the Author-HELEN C. REDMAN is the Associate Chief of the Department of Radiology at Mt. Zion Hospital and Associate Professor of Radiology at UCSF and Stanford University. She did her residency at Stanford University and received her M.D. from the Columbia College of Physicians and Surgeons in 1969. About the AUthOr-STEPHEN L. G. ROTHMAN is currently an Associate Professor of Diagnostic Radiology and Director of Computerized Tomography at Yale University School of Medicine. Prior to that he was a Neuroradiology Fellow at Yale University School of Medicine. He performed his radiology residency at Yale-New Haven Hospital and received his M.D. from Albert Einstein College of Medicine in 1967. About the Author- JOSEPH F. SIMEONE is currrently a Winchester Fellow in Diagnostic Radiology at Yale University School of Medicine. He performed his residency at Yale-New Haven Hospital and received his M.D. from Yale University School of Medicine in 1973.
165
