Book Review: The WHO Manual of Diagnostic Imaging: Radiographic Anatomy and Interpretation of the Chest and Pulmonary System

Authors: Stephen Ellis and Christopher Flower
Publisher: World Health Organization, 2006r
Cost: 40 Swiss francs (CHF)/$36r (CHF28 in developing countries)

This text on the thorax is part of a series of manuals commissioned by the World Health Organization in collaboration with the International Commission for Radiologic Education of the International Society of Radiology. The series is aimed at healthcare professionals who produce and interpret radiographs and include radiographers, medical personnel, and radiologists.

In its A4 layout of 147 pages, this text is best suited to be a bench book rather than a portable reference. The chapters are methodically laid out and cover the majority of common respiratory conditions, not only in the Western world but also in developing countries, which is a major target of the project. The text is well written and easy to read, but there are a few spelling mistakes. The book has a fairly detailed table of contents but lacks an index. While this may seem like a justifiable economy, the book is more comprehensive than the authors admit to in their introduction.

The emphasis is on plain chest film interpretation with appropriate reference to CT when this amplifies or clarifies the discussion. The basic principles of image production and an explanation of the silhouette sign are very well done. There is an important section on the chest radiograph in critical care situations but little mention or illustration of the supine pneumothorax signs or the "continuous diaphragm" sign of pneumomediastinum.

The book is generously illustrated throughout. Some images are unnecessarily small. For example, in the section on Langerhans' cell histiocytosis, if the high-resolution CT image were larger, it would have complemented perfectly the chest radiograph. Other images are too large and out of proportion. As is seen in many similar texts, reproducing chest radiographs is difficult, and they are occasionally too small here or demonstrate abnormalities too subtle to be adequately appreciated. Schematic diagrams would help overcome some of these difficulties.

The factual knowledge is at a basic level, and yet it is comprehensive for day-to-day practice. The authors have succeeded in making chest radiology more accessible to a wider audience and have filled a need. This manual would not be out of place as a bench book in any accident and emergency department or medical assessment unit. I enjoyed reading it and found myself revisiting basic principles. I would not hesitate in recommending the text to first- and second-year specialist registrars (residents) in radiology and to experienced radiologists who might benefit from a refresher course in chest radiology.

-By Dr. John Curtis, consultant radiologist, Aintree University Hospital, Liverpool, U.K.