ROLLIS is an easily learnt, safe and effective alternative technique to standard HWL.

IntroductionPreoperative wire-guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL.MethodsFifty patients with single impalpable lesions and biopsy proven malignancy or indeterminate histology underwent WGL followed by intralesional radiopharmaceutical injection of 99m-Technetium macroaggregated albumin. Postprocedural mammography was performed to demonstrate wire position, and scintigraphy to evaluate radiopharmaceutical migration. Lymphoscintigraphy and intraoperative sentinel node biopsy were performed if indicated, followed by lesion localisation and excision using a gamma probe. Specimen imaging was performed, with immediate reexcision for visibly inadequate margins.ResultsAccurate localisation was achieved in 86% of patients with ROLL compared to 72% with WGL. All lesions were successfully removed, with clear margins in 71.8% of malignant lesions. Reexcision and intraoperative sentinel node localisation rates were equivalent to preaudit figures for WGL. ROLL was easy to perform and problems were infrequent. Inaccurate radiopharmaceutical placement necessitating WGL occurred in four patients. Minor radiopharmaceutical migration was common, but precluded using ROLL in only two cases.ConclusionsROLL is effective, simple, inexpensive, and easily learnt; however, preoperative confirmation of correct radiopharmaceutical placement using mammography and the gamma probe is important to help ensure successful lesion removal. Insertion of a backup hookwire is recommended during the initial introduction of ROLL.

Forty-one cases of clavicle fracture in newborn babies were examined by both radiographic and ultrasonic methods. No substantial difference has been found between these two modalities. It is suggested that ultra· sound should be the procedure of choice in the diag· C lavicle fracture is the most common fracture in the full-term newborn after vaginal delivery. 1 .2 The clinical signs are typical and include local findings and diminished movement of the ipsilateral arm. Clavicle fracture can be diagnosed by ultrasound. An ultrasound examination of the clavicles and the diaphragm was performed in 41 full-term newborns manifesting the typical clinical signs. METHODS AND RESULTSDuring 1986, 41 full-term newborns were examined in the first 3 days of life because they were clinically suspected to have a clavicular fracture. A chest x·ray and ultrasound examination of the clavicles were performed. The ultrasound examination was done using a sector real-time unit with 6-10-MHz transducers. The newborns were examined in the supine position with their head tilted backwards and their face rotated opposite to the examined side. The ultrasound scans were performed in both coronal and sagittal sections.

In this letter to the editor we respond to a recently published editorial by David Chung (Rolling out radioguided occult lesion localisation for breast tumours. J Med Radiat Sci 2015; 62(1): p. 1–2) discussing the advantages of ROLL over other common pre‐operative breast lesion localisation techniques.