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The practice of nuclear medicine
Book reviews ingredient, without which communication (in the broadest sense) would be impossible. Considered in detail, the application of information theory to new fields seems highly promising. I n the opinion of the reviewer, it is well worth taking seriously, especially in subjects like biology and medicine where the basic material is essentially multifarious. What may finally emerge is still a matter for speculation. The Symposium on Information Theory in Biology presents a fascinating collection of over thirty papers, starting off with an elementary introduction to t h e subject in Part I. I n Part II, dealing with "Storage and Transfer of Information", there are discussions of a cryptographic approach to the problems of protein synthesis, negative feedback in liver regeneration, and fluctuations in neural thresholds. Part I I I contains a number of biochemical applications, including the discrimination of states and reactivities at low temperatures, the pathways of co-factors, and antigenic specificity. Parts IV and V cover several aspects of radiation phenomena, such as the inactivation of proteins, ageing, thermal killing, mutation and cancer. Part VI investigates a probability model for morphogenesis and the determination of pattern in mosaic receptors. This is then followed by a short general discussion. It will be seen that a very wide range of topics is subjected to the information theoretic approach. The total effect, on the reviewer at any rate, is extremely stimulating and encouraging. It must be admitted, however, (as indeed explicitly indicated in the discussion) that information theory has not so far produced any new facts or results in the biological field, although there are many cases in which the new approach will produce known results more easily. At the same time one feels intuitively that the new way of looking at things does provide fresh insights that may easily prove extremely fruitful. The main obstacle to handling biological investigations quantitatively is the inescapable variety and complexity of the material. Some difficulties have been overcome by a judicious use of statistical theory. A great many others seem likely to yield in due course to the methods of information theory. For this reason the application of information theory to biological problems is well worth serious consideration. And the Symposium under review goes a long way towards encouraging the understanding and development of this new approach. NORMAN T . J . BAILEY E. H. O mMBY, S. FEITELBERGand S. SILVER: Radioa c t i v e I s o t o p e s i n C l i n i c a l Practice. Lea and Febiger, Philadelphia, 1958. 451 pp. $10.00. THE authors have had a wide and varied experience
47
in the use of radioactive materials in medicine. This background has resulted in an authoritative and well conceived book. Many of the procedures which involve the use of radioactive materials in diagnosis and therapy have been original contributions by the authors. Approximately one-half of the book is devoted to the basic physics related to radioactivity, its measurement, interaction with matter and radiobiology. The text is written clearly and permits the reader with the ordinary scientific background' to achieve a good understanding of radiation physics. Part two is concerned more directly with specific instrumentation for making measurements in vitro and in vivo. The final section is devoted to clinical applications and has been written for the physician who has had little or no previous training or experience in the use of radioactive isotopes and whose background in mathematics is limited. The techniques for estimating thyroid function make up by far the greatest part of the discussion. However other diagnostic and therapeutic uses are described and an adequate bibliography given to permit consultation of original published material. This book should find an important place in the libraries of physicians interested in entering the field and will serve as a reference book for those already using radioisotopes in clinical medicine. JOHN A. D. COOPER WILLIAM H. BLAHD, FRANZ K. BAUERand BENEDICT CASSEN: T h e Practice o f N u c l e a r Medicine. Charles C. Thomas, Springfield, Ill.; Blackwell, Oxford; Ryerson Press, Toronto, 1958. xix + 407 pp. 95s. IN an introduction to this book Paul C. Aebersold of the United States Atomic Energy Commission remarks " I n the field of medicine over a million patients per year are being diagnosed or treated with radioisotopes". The authors of the book, who have evidently had wide first-hand experience, survey critically a large number of the diagnostic and therapeutic procedures, involvingradioactive isotopes, to which these patients are being submitted. About 200 pages are devoted to discussions &some 35 types of diagnostic procedure, 100 pages to therapeutic methods and 100 pages to basic physical principles, instrumentation, handling and laboratory design. As the title indicates, emphasis throughout is on medical practice, but the authors endeavour to give the' historical background for the various isotope techniques and to emphasize their limitations as well as their advantages. A reader's chief impression from the diagnostic
48
Book reviews
section must be that so much ingenuity has had, as yet, a disappointing reward. For example, in a chapter of 27 pages on "Tumour localizing procedures" diagnostic tests for 10 different sites in the body are described in careful detail. Yet of these it is evident that the authors can at present recommend, without considerable qualification, only two as clinically practical, namely the localization of brain tumours using in particular radio-iodinated human serum albumin and the localization of cerebrospinal fluid fistulae also by means of RIHSA. The authors' comments on tests for the diagnosis of abnormal gastrointestinal function range from "indications for this test are somewhat limited", applied to the determination of gall bladder function using I TM di-iodofiuorescein or I TM labelled rosebengal, to quite enthusiastic support for the use of the latter compound in a test of liver function. Similar critical appraisal is given to isotope methods that have been tested in the diagnosis of haematological disease, abnormal cardiovascular and renal function, thyroid function and to isotope dilution techniques. Since about nine of the tests described involve RIHSA it is surprising to find no reference to the possibility of self-radiation effects in this compound. It is also surprising that no mention is made of Co 5s as a practicable, shorter lived substitute for Co6° in labelled vitamin B-12. In the shorter therapeutic section of the book, the treatment of hyperthyroidism, of euthyroid cardiac disease and the management of thyroid cancer with radioactive iodine are quite fully discussed from the clinical point of view. The useful account of the therapeutic uses of colloids rightly draws attention to the possible advantages of chromic phosphate 1~z over colloidal gold Au 19s and to the technical difficulties met in the attempts to produce satisfactory yttrium yg0 colloids. The authors point out that for the proper therapeutic use of discrete radioactive sources, by implantation, applicators or teletherapy, the resources of a large medical centre are necessary, and for this reason they give only a summary of recent advances in this field. They suggest that "source therapy is still in its infancy; the boundaries of this vast field have yet to be explored." Laboratories and counting equipment are systematicaUy, if superficially, described, but the chapter devoted to units, dosimetry and radiation biology is very brief (9 pages) and only one reference is given. The authors refer from time to time to the possible radiation hazards of radioactive isotope diagnostic tests, but remark "clearly, present methods of determining maximum allowable doses of isotopes in medicine rest on a shaky foundation". They feel that "perhaps a sounder approach" (p. 40) is to administer the least quantity, in a specific diagnostic procedure
that will give a useful answer. I n discussing the treatment of haemolytic and malignant disease with radioactive phosphorus, the curious statement (p. 281 ) is made "1 pc of radiophosphorus is equal, in terms ofionisation, to 37 r of X-ray". There is an alchemical air about their remark that ps2 "may be produced by the exposure of stable sulfur to the emanations of a uranium pile". The emphasis is undoubtedly on medicine rather than the nucleus and readers will need to go elsewhere, particularly to the original literature, for many technical details and virtually the whole of dosimetry. However, the book, which is beautifully produced and has more than 100 illustrations and 400 references, should prove useful to many physicians and other medical men as a guide to the role of radioactive isotopes in medicine at the present time. N. G. TROTT Notes for A u t h o r s (Revised edition). Institute of Physics, London, 1959. 36 pp. 3s. 6d. ThE Institute of Physics has just published a 36-page revised edition of its booklet to assist less experienced authors and to serve as a reference booklet for all those who wish to contribute to the Institute's publications. Under its new title "Notes for authors", it gives hints on the preparation of scripts and diagrams, on the layout of mathematics, the correction of proofs and so on. I n addition to a bibliography of reference books and works on technical writing, the pamphlet also contains lists of the spellings, symbols and abbreviations used by the Institute. Copies of this booklet are obtainable from The Institute of Physics, 47 Belgrave Square, London, S.W.I, price 3s. 6d, including postage. Source Material for R a d i o c h e m l s t r y . Nuclear Science Series Report No. 27 (March 1959). 23 pp. Available free from: Division of Physical Sciences, National Research Council, 2101 Constitution Ave., Washington 25, D.C., U.S.A. Tins is a compilation of references by a subcommittee of the U.S. National Academy of Sciences in "an attempt to list current source material of interest to the radiochemist". It consists mainly of references to review articles, conference reports and symposia with very brief abstracts and details of availability of each publication. The present list contains almost exclusively American references (all but four), but future revision is anticipated and the compilers invite suggestions of other references to be added to the list. J. L. PIJTMAN
47
in the use of radioactive materials in medicine. This background has resulted in an authoritative and well conceived book. Many of the procedures which involve the use of radioactive materials in diagnosis and therapy have been original contributions by the authors. Approximately one-half of the book is devoted to the basic physics related to radioactivity, its measurement, interaction with matter and radiobiology. The text is written clearly and permits the reader with the ordinary scientific background' to achieve a good understanding of radiation physics. Part two is concerned more directly with specific instrumentation for making measurements in vitro and in vivo. The final section is devoted to clinical applications and has been written for the physician who has had little or no previous training or experience in the use of radioactive isotopes and whose background in mathematics is limited. The techniques for estimating thyroid function make up by far the greatest part of the discussion. However other diagnostic and therapeutic uses are described and an adequate bibliography given to permit consultation of original published material. This book should find an important place in the libraries of physicians interested in entering the field and will serve as a reference book for those already using radioisotopes in clinical medicine. JOHN A. D. COOPER WILLIAM H. BLAHD, FRANZ K. BAUERand BENEDICT CASSEN: T h e Practice o f N u c l e a r Medicine. Charles C. Thomas, Springfield, Ill.; Blackwell, Oxford; Ryerson Press, Toronto, 1958. xix + 407 pp. 95s. IN an introduction to this book Paul C. Aebersold of the United States Atomic Energy Commission remarks " I n the field of medicine over a million patients per year are being diagnosed or treated with radioisotopes". The authors of the book, who have evidently had wide first-hand experience, survey critically a large number of the diagnostic and therapeutic procedures, involvingradioactive isotopes, to which these patients are being submitted. About 200 pages are devoted to discussions &some 35 types of diagnostic procedure, 100 pages to therapeutic methods and 100 pages to basic physical principles, instrumentation, handling and laboratory design. As the title indicates, emphasis throughout is on medical practice, but the authors endeavour to give the' historical background for the various isotope techniques and to emphasize their limitations as well as their advantages. A reader's chief impression from the diagnostic
48
Book reviews
section must be that so much ingenuity has had, as yet, a disappointing reward. For example, in a chapter of 27 pages on "Tumour localizing procedures" diagnostic tests for 10 different sites in the body are described in careful detail. Yet of these it is evident that the authors can at present recommend, without considerable qualification, only two as clinically practical, namely the localization of brain tumours using in particular radio-iodinated human serum albumin and the localization of cerebrospinal fluid fistulae also by means of RIHSA. The authors' comments on tests for the diagnosis of abnormal gastrointestinal function range from "indications for this test are somewhat limited", applied to the determination of gall bladder function using I TM di-iodofiuorescein or I TM labelled rosebengal, to quite enthusiastic support for the use of the latter compound in a test of liver function. Similar critical appraisal is given to isotope methods that have been tested in the diagnosis of haematological disease, abnormal cardiovascular and renal function, thyroid function and to isotope dilution techniques. Since about nine of the tests described involve RIHSA it is surprising to find no reference to the possibility of self-radiation effects in this compound. It is also surprising that no mention is made of Co 5s as a practicable, shorter lived substitute for Co6° in labelled vitamin B-12. In the shorter therapeutic section of the book, the treatment of hyperthyroidism, of euthyroid cardiac disease and the management of thyroid cancer with radioactive iodine are quite fully discussed from the clinical point of view. The useful account of the therapeutic uses of colloids rightly draws attention to the possible advantages of chromic phosphate 1~z over colloidal gold Au 19s and to the technical difficulties met in the attempts to produce satisfactory yttrium yg0 colloids. The authors point out that for the proper therapeutic use of discrete radioactive sources, by implantation, applicators or teletherapy, the resources of a large medical centre are necessary, and for this reason they give only a summary of recent advances in this field. They suggest that "source therapy is still in its infancy; the boundaries of this vast field have yet to be explored." Laboratories and counting equipment are systematicaUy, if superficially, described, but the chapter devoted to units, dosimetry and radiation biology is very brief (9 pages) and only one reference is given. The authors refer from time to time to the possible radiation hazards of radioactive isotope diagnostic tests, but remark "clearly, present methods of determining maximum allowable doses of isotopes in medicine rest on a shaky foundation". They feel that "perhaps a sounder approach" (p. 40) is to administer the least quantity, in a specific diagnostic procedure
that will give a useful answer. I n discussing the treatment of haemolytic and malignant disease with radioactive phosphorus, the curious statement (p. 281 ) is made "1 pc of radiophosphorus is equal, in terms ofionisation, to 37 r of X-ray". There is an alchemical air about their remark that ps2 "may be produced by the exposure of stable sulfur to the emanations of a uranium pile". The emphasis is undoubtedly on medicine rather than the nucleus and readers will need to go elsewhere, particularly to the original literature, for many technical details and virtually the whole of dosimetry. However, the book, which is beautifully produced and has more than 100 illustrations and 400 references, should prove useful to many physicians and other medical men as a guide to the role of radioactive isotopes in medicine at the present time. N. G. TROTT Notes for A u t h o r s (Revised edition). Institute of Physics, London, 1959. 36 pp. 3s. 6d. ThE Institute of Physics has just published a 36-page revised edition of its booklet to assist less experienced authors and to serve as a reference booklet for all those who wish to contribute to the Institute's publications. Under its new title "Notes for authors", it gives hints on the preparation of scripts and diagrams, on the layout of mathematics, the correction of proofs and so on. I n addition to a bibliography of reference books and works on technical writing, the pamphlet also contains lists of the spellings, symbols and abbreviations used by the Institute. Copies of this booklet are obtainable from The Institute of Physics, 47 Belgrave Square, London, S.W.I, price 3s. 6d, including postage. Source Material for R a d i o c h e m l s t r y . Nuclear Science Series Report No. 27 (March 1959). 23 pp. Available free from: Division of Physical Sciences, National Research Council, 2101 Constitution Ave., Washington 25, D.C., U.S.A. Tins is a compilation of references by a subcommittee of the U.S. National Academy of Sciences in "an attempt to list current source material of interest to the radiochemist". It consists mainly of references to review articles, conference reports and symposia with very brief abstracts and details of availability of each publication. The present list contains almost exclusively American references (all but four), but future revision is anticipated and the compilers invite suggestions of other references to be added to the list. J. L. PIJTMAN