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The patient was a 70-year-old man who had unresectable locally advanced large-cell lung cancer with aorta and mediastimun invasion(T4N2M0). He had left shoulder pain and obstructive pneumonitis caused by lung cancer.We performed 60 Gy/ 35 Fr radiotherapy with concurrent low-dose cyclophosphamide(5mg/body/day). After chemoradiotherapy, the main tumor has been decreasing gradually. Seven years and six months after chemoradiotherapy, we detected the soft tissue mass lesion on his chest CT, but could not find abnormal accumulation on his 18F-FDG-PET. The local control was improved gradually and he had no respiratory symptoms or pain for a long period. There has been no recurrence for 10 years now. We recommend radiation and/or low-dose chemotherapy as useful treatments for the advanced non-small lung cancer in elderly patients.

The purposes of this study were to evaluate the image quality of five types of liquid-crystal display (LCD) monitors by utilizing the normalized-rank approach and to investigate the effect of LCD monitor specifications, such as display colors, luminance, and resolution, on the evaluators' ranking. The LCD monitors used in this study were 2, 3 and 5 mega-pixel monochrome LCD monitors, and 2 and 3 mega-pixel color LCD monitors (Eizo Nanao Corporation). All LCD monitors were calibrated to the grayscale standard display function (GSDF) with different maximum luminance (recommended luminance) settings. Also, four kinds of radiographs were used for observer study based on the normalized-rank approach: three adult chest radiographs, three pediatric chest radiographs, three ankle joint radiographs, and four double-contrasted upper gastrointestinal radiographs. Ten radiological technologists participated in the observer study. Monochrome LCD monitors exhibited superior ranking with statistically significant differences (p<0.05) compared to color LCD monitors in all kinds of radiographs. The major difference between monochrome and color monitors was luminance. Therefore, it is considered that the luminance of LCD monitors affects observers' evaluations based on image quality. Moreover, in the case of radiographs that include high frequency image components, the monitor resolution also affects the evaluation. In clinical practice, it is necessary to optimize the luminance and choose appropriate LCD monitors for diagnostic images.

The purpose of this study was to examine the correlation between the basic imaging properties of two digital radiographic X-ray systems with a direct conversion flat-panel detector and their image qualities, which were evaluated by the observer in hard copy and soft copy studies. The subjective image quality was evaluated and compared in terms of the low-contrast detectability and image sharpness in the two digital radiographic X-ray systems. We applied the radiographs of a contrast detail phantom to the evaluation of low-contrast detectability and analyzed the contrast detail diagrams. Finally, low-contrast detectability was evaluated by the image quality figure (IQF) calculated from the contrast detail diagrams. Also, the subjective image sharpness of human dry bones of two systems was examined and evaluated by the normalized-rank method. The results indicated that System A tended to provide superior subjective image quality compared to System B in both observer studies. We also found high correlations between IQFs and basic imaging properties, such as the noise power spectrum (NPS) and the noise equivalent quantum (NEQ). In conclusion, the low-contrast detectability of the two digital radiographic X-ray systems with a direct conversion flat-panel detector corresponded to the NPS and the NEQ in both outputs (soft copy and hard copy). On the other hand, the subjective image sharpness of human dry bones was affected by their noise properties.

We report a case of drug eruption (erythema multiforme type) in a 54-year-old woman, following concurrent chemoradiotherapy for squamous cell carcinoma of the anal canal. Chemotherapy comprised one cycle of mitomycin C 10 mg/m2/day (intravenous bolus injection)on day 1 and 5-fluorouracil(5-FU)1, 000 mg/m 2/day (continuous intravenous infusion) on days 1-4 of radiotherapy. External irradiation of the pelvic space was performed, using daily fractions of 1. 5 Gy(total dose, 33 Gy). From day 4 after chemoradiotherapy, erythema appeared proximal to the forearm site used for drug administration. On day 6, erythema was noted on the trunk, hip and thigh. We suspected erythema multiforme based on the appearance of wheals and target lesions of the skin and a patient history of chemoradiotherapy. Steroids were administered orally, which resolved systemic eruption at week 2. The patient also experienced grade 3 leukocytopenia, neutropenia, thrombopenia, diarrhea, and anorexia. Although we could not provide sufficient chemotherapy and radiation therapy due to severe side effects, squamous cell carcinoma of the anal canal responded extremely well with a marked decrease in complete response. We surmise that the drug eruption was associated with 5-FU. Concurrent chemoradiotherapy is safe and effective for squamous cell carcinoma of the anal canal, but care is required to prevent drug eruption during treatment.

We evaluated an appropriate region of interest (ROI) size for the measurement of full width at half maximum (FWHM) in the bead method (0.1 mm and 0.5 mm diameter; lead) and the microdisk method (0.05 mm thickness and 1.0 mm diameter; tungsten) using multislice computed tomography (CT). The FWHM of preset slice thicknesses 0.625 mm, 1.25 mm, 5.0 mm and 7.5 mm were measured by varying helical pitch, location of measurement [center and off-center of scan field of view (SFOV)] and ROI size, and they were compared with the tolerance stated in the Japanese Industrial Standards (JIS). It was conlcuded that the appropriate ROI size was influenced by preset slice thickness in this study. At the center of SFOV, measurements of FWHM were enabled within the tolerance of the JIS with small variations in all preset slice thicknesses if the ROI sizes were set between 0.4 times and equal to the size of the bead or microdisk indicating the maximum CT value in the series of CT images. At the off-center of SFOV, the tendency of increasing FWHM was confirmed, but it was shown that variations of the off-center in thicker slice thickness were larger regardless of helical pitch when the orbital synchronized helical scan technique was not used.

PURPOSE/AIM OF THE EXHIBIT: The purpose of this exhibit is: 1. To explain "resampling", an image data processing, performed by the digital radiographic system based on flat panel detector (FPD). 2. To show the influence of "resampling" on the basic imaging properties. 3. To present accurate measurement methods of the basic imaging properties of the FPD system., Content Organization: 1. The relationship between the matrix sizes of the output image and the image data acquired on FPD that automatically changes depending on a selected image size (FOV). 2. The explanation of the image data processing of "resampling". 3. The evaluation results of the basic imaging properties of the FPD system using two types of DICOM image to which "resampling" was performed: characteristic curves, presampled MTFs, noise power spectra, detective quantum efficiencies. CONCLUSION/SUMMARY: The major points of the exhibit are as follows: 1. The influence of "resampling" should not be disregarded in the evaluation of the basic imaging properties of the flat panel detector system. 2. It is necessary for the basic imaging properties to be measured by using DICOM image to which no "resampling" is performed.

A 77-year-old woman who underwent a right modified radical mastectomy 23 years ago with no further adjuvant treatment presented with a right chest wall mass (3 x 4 x 2 cm) at the scar. She had no symptoms nor metastasis. The laboratory data were normal including tumor marker. The mass was diagnosed as compatible with a local recurrence tumor from the previous breast cancer on the ultrasonography and chest CT. After obtaining her informed consent for the therapy, we performed 60 Gy/30 fr radiotherapy on the recurrent tumor on her right chest wall with concurrent oral chemo-endocrine therapy. The first regimens were tamoxifen 20 mg/day and 5'-DFUR 600 mg/day, followed by toremifene 80 mg/day and 5'-DFUR 600 mg/day, and then the tumor disappeared. But three years later, we found tumor regrowth. We changed the regimen, giving 5'-DFUR 1,200 mg/day and cyclophosphamide 100 mg/day for 2 weeks followed by a 1-week drug-free period, then added 10 Gy/5 fr radiotherapy and hyperthermia twice a week. Final regimens were anastrozole 1 mg/day and capecitabine 900 mg/day. The recurrent tumor decreased and the disease stabilized. After these therapies, she had very good quality of life. We recommend radiation and/or hyperthermia with concurrent oral chemo-endocrine therapy as useful for the delayed recurrence of elderly breast cancer after a modified radical mastectomy.

The purpose of this study was to evaluate the basic imaging properties of the two latest digital radiographic X-ray systems, namely, the DynaDirect Winscope 6000 (abbr. as System A, Toshiba Medical Systems) and the Sonialvision Safire Multi (abbr. as System B, Shimadzu Corp.). These systems were based on a direct-conversion flat panel detector (FPD) of amorphous selenium. The basic imaging properties of the two systems were evaluated by measuring characteristic curves, presampled modulation transfer functions (MTFs), and noise power spectra (NPS) using DICOM images to which no resampling was performed with a matrix size of 2048x2048. In addition, noise equivalent quanta (NEQ) and detective quantum efficiency (DQE) calculated from the result of the basic imaging properties were evaluated. The characteristic curves of the two systems showed quite high linearity. The MTFs of the two systems indicated high-resolution properties, as is well known to be an advantage of the direct conversion FPD system. However, the NPS of System A showed better performance than System B under the same exposures. Therefore, the DQE of System A was higher than that of System B at all spatial frequencies.

Determination of the region of interest (ROI) for dynamic renal function has been highly discordant among operators because of the dependence on factors such as the rate of injection of radioactive medicines, constitution, and renal function. To simplify this problem, we developed a computer algorithm that provides automatic analysis for both localization of the kidney and automatic determination of ROIs using computed tomographic (CT) images. The bilateral kidneys were extracted from enhanced CT images, and the CT pixel size was adjusted to dynamic renal function images. The template-matching technique was used for these images, and the kidney renal location was analyzed on additional functional images constructed by dynamic renal function images. As a result, we were able to obtain time-activity curves of both renal function and quantified glomerular filtration rate (GFR). In conclusion, the computer algorithm we developed was considered to provide reliable results, apart from the variability among operators, because of its good reproducibility.

We investigated the effect on image data resampling in an evaluation of the basic imaging properties for a digital radiographic system based on a flat panel detector (FPD). One of the latest digital radiographic systems was used in this study. This system was based on a direct-conversion FPD of amorphous selenium. The basic imaging properties of the system were evaluated by measuring characteristic curve, presampled modulation transfer function (MTF), and Wiener spectrum (WS) using DICOM image with a matrix size of 2048 x 2048. The evaluations were performed under two conditions because matrix size automatically changes according to the selection of imaging size. One of the conditions was a different matrix size between image data acquired on the FPD and the output image (DICOM image for which resampling was performed). The other condition was that these matrices be the same size (DICOM image with no resampling performed). Resampling did not affect the characteristic curves. However, MTF and the WS obtained from the resampled data were different from those of the one not resampled, which is considered to be the "inherent" basic imaging properties, and this phenomenon was remarkable, especially in terms of the MTFs. Our study indicates that the effect on resampling should not be disregarded in evaluating the basic imaging properties of digital radiographic systems. Therefore, it is mandatory to use DICOM images for which no resampling was performed in order to evaluate the inherent basic imaging properties for digital radiographic systems.

Thirty patients with intraductal papillary-mucinous tumor (IPMT) of the pancreas underwent multidetector-row CT (MD-CT) in addition to endoscopic retrograde pancreatography (ERP), and, in 27 cases magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS). The usefulness of MD-CT was investigated by comparing various imaging methods of the communication from the main pancreatic duct (MPD) to patulous/bulging papilla in addition to the indices for benign or malignant disease, the degree of dilation of the MPD, localization and size of cystic lesions, and presence or absence of neoplastic lesions, such as thickened walls and septa, intramural nodule, solid mass. With MD-CT, dilation of the MPD and localization and size of cystic lesions were accurately assessed, even in patients with obstruction of the main pancreatic duct in whom ERP was difficult to perform regardless of the presence or absence of massive amount of mucus. MD-CT with reconstructive imaging, such as MPR imaging and CPR imaging, allowed us to assess communication with the MPD and patulous/bulging papilla easier than MRCP. In our study, MD-CT was useful in the evaluation of thickened walls and septa that are predictive factors of malignancy in IPMT.

Recent progress in radiation therapy has been greatly enhanced in many facilities by the development of new machines for treatment, improved computer technology for radiotherapy treatment planning systems (RTPs), increased accuracy of radiation therapy such as stereotactic irradiation, and intensity-modulated radiation therapy (IMRT). Quality control (QC) of the isocenter, which has consisted of gantry rotation and limiting the radiation field, is important for greater accuracy of these radiation therapy technologies. Star-shot analyses using computed radiography (CR) for evaluation of the isocenter were employed in this study. Devices to support CR were created, and a method of automatically analyzing images obtained by the star-shot technique, which calculated the error (distance) from the isocenter and the incident beam angle, were developed. In terms of the accuracy of our method, the average maximum error was 0.33 mm (less than 2 pixels: 0.35 mm), the average absolute error and incident beam angle errors were 0.3 mm and 0.4 degrees at maximum and at one standard deviation (SD), respectively. In this study, the processing times were 16 sec at minimum, 152 sec at maximum, 18 sec at most frequencies, and 23.6 sec on average. In conclusion, it was considered that our newly developed method for analyzing star-shot images using CR enabled immediate, quantitative evaluation of the isocenter.

The temporal image subtraction technique was applied to bone scintigraphy, using Photoshop (commercially available image processing software) and Morpher (public domain warping software). For the temporal subtraction images, 81 subtraction images (19 cases) were prepared by a method used to subtract the previous images from the current ones. Registration of the current and previous images was performed by manual operation using Photoshop, and warping was done using the warping function of Morpher. In addition, difference images prepared after correcting the distributions of radioactive isotopes of the current and previous images using the count of the pelvic region were also examined. Compared with manual operation, alignment of images by warping improved registration and reduced the generation of pseudo-images of subtraction images. The rate of identification of abnormal accumulation-enhanced regions and subjective evaluation by doctors was improved for warping more than for manual operation. Furthermore, abnormal hot regions, which are difficult to find in film images, could be found in three subtraction images. In addition, it was confirmed that abnormal hot regions become more visible in many cases by preparing subtraction images after correcting the count between images using the count of the pelvic region. Thus, it is suggested that the temporal image subtraction technique in bone scintigraphy enables more accurate observation of enhancement of or changes in abnormal hot regions, which will support diagnostic reading. It is considered that enhancement of or changes in abnormal hot regions will be more accurately understood through further detailed discussion in the future.

Purpose: To evaluate the usefulness of diffusion-weighted MRI in distinguishing different components and in differentiating benign from malignant musculoskeletal tumors., Materials and Methods: Fifty-seven patients with musculoskeletal tumors underwent MR at our institution from October 1999 to April 2002. We evaluated 57 tumors (9 bone tumors and 48 soft tissue tumors). All tumors were classified into 8 groups (myxomatous, fibrous, cystic, cartilaginous, fatty components, hematomas, other benign tumors, and other malignant tumors). MR examinations were performed with a 1.5-Tesla system. Diffusion-weighted single-shot EPI images were obtained in all patients. Apparent diffusion coefficients (ADCs) were calculated by using b factors of 0 and 1,000 sec/mm2., Results: ADC values of myxomatous, cystic, and cartilaginous components were significantly higher than those of other tumors. In cartilaginous tumors, malignant tumor ADC values (2.33 +/- 0.44) were higher than those of benign tumors (2.13 +/- 0.13). However, there was no significant difference between benign and malignant tumors. Except for high-intensity components on T1-weighted imaging and low or homogeneously very high intensity components on T2-weighted imaging, there was a significant difference in ADC between malignant (1.35 +/- 0.40) and benign (1.97 +/- 0.50) tumors., Conclusion: Within the limited number of cases, there was a significant difference in ADC between malignant and benign tumors.

Magnetization transfer contrast (MTC) was evaluated by changing the off-set frequency and pulse intensity of MTC with the spoiled gradient echo (SPGR) sequence (T2*-weighted image) using an experimental phantom that included olive oil, protein, fiber, collagen, and pure water. The intensity of pure water reached a constant level just above the off-set frequency (1200 Hz) regardless of MT pulse power. The contrast-to-noise ratio (CNR) in each of the phantom materials was maximal at the MT pulse power of 2500 degrees (equivalent flip angle). The CNR and image noise obtained by body coil were inferior to those obtained with an extremity coil. In clinical application, the MTC effect on chondrosarcoma was higher (MT ratio, ROI-1:0.448, ROI-2:0.382) than those of other cases in this study. Since the image contrast was improved between the malignant fibrous histiocytoma (MFH, MT ratio, ROI-1:0.282, ROI-2:0.289) and peripheral tissues, extraskeletal extension could be observed more easily than without MTC imaging. In conclusion, the effects of MTC might be in providing useful information, in presuming composed tissues, differential diagnoses, and extent to the surrounding structures because of changing the image contrast to surrounding tissues corresponding to the rate of included bound water.

We report a case of early-stage carcinoma of the external auditory canal treated by intracavitary irradiation with high-dose-rate (HDR) 192Ir-RALS after 40 Gy by external irradiation. We made an applicator that was inserted into the external auditory canal for the intracavitary irradiation, using a 9 Fr silicone catheter and resin. The total intracavitary radiation dosages were 20 Gy/8 Fr/4 weeks. No severe side effects were noted, and the tumor disappeared. RALS may be indicated for early carcinoma of the external auditory canal for its efficacy and lack of side effects.

The clinical usefulness of three dimensional images was widely recognized. The three dimensional digital subtraction angiography (3D-DSA) well demonstrated anatomical structures of cerebral arteries with high special resolution. This 3D observation allowed high quality planning for aneurysmal coil packing and neck clipping. Because of the bony structure and curvy arterial anatomy in the skull base region, 3D-CTA and MRA was sometimes distureved the demonstration of the anatomical relationship adjacent to the aneurysm. However, 3D-DSA not only demonstrated arterial anatomy, but also analyzed of vascular structure, quantifiably. And it was useful in radiation dose reduction by reduction of DSA exposure number. We believe that 3D-DSA should provided useful information for planning of surgical and endovascular treatment in the field of cerebro-vascular disease.

Since mucosal (T1a) esophageal cancer is well controlled by endoscopic treatment, chemoradiotherapy (CRTx) is not indicated. However, for a submucosal (T1b, N0) esophageal cancer, CRTx may be the first line of treatment, since it can provide a good response rate, with an excellent survival rate comparable to that after esophagectomy. Definitive CRTx is also in the first line of treatment for a T4 esophageal cancer, because there was no difference in the survival rate between CRTx with surgery and CRTx without surgery in our trial. Esophagectomy is indicated only for non-responders or recurrence-salvage surgery. For patients with a potentially-resectable (T2-T3) esophageal cancer, esophagectomy offered a longer survival rate than CRTx did, in our series. However, there remains controversy over the efficacy of CRTx for a T2-T3 esophageal cancer. It has been reported by the National Cancer Center Hospital East Group that definitive CRTx provided the same survival rate as esophagectomy. A prospective trial comparing the survival rate after esophagectomy and that after CRTx for a T2-T3 esophageal cancer is needed.

Rotational three-dimensional digital subtraction angiography (3D-DSA) is very useful for interventional neuroradiology, especially in the endovascular therapy of cerebral aneurysms. However, pseudo-stenosis artifact on the vessel, which runs vertically to the rotational axis, was observed clinically. In this study, this artifact was confirmed in an experiment with 4.5-millimeter diameter vessel phantoms. The attenuation of the phantom at each degree of exposure (44 directions) was measured on the workstation (DSA pixel value). DSA pixel values were plotted from data of 10, 20, 30, 40, and 50 millimeter lengths, respectively. The saturated DSA pixel value of tangent projection on phantoms of 30 millimeters or more in length was observed. This phenomenon induces pseudo-stenosis artifact on 3D-DSA. The maximum reduction in the diameter of the phantom was 27.4% on the length of 50 millimeters. We confirmed that the two-dimensional data vertical to the rotational axis were inaccurate when a straight-coursed, long, segmented vessel was present. Under this special condition, vessels on 3D-DSA were displayed as smaller than their actual diameter.

Purpose: To evaluate the laser-radiation combined therapy for T2N0M0 laryngeal-glottic cancer in order to preserve the larynx., Methods and Materials: The subjects consisted of 52 patients with T2N0M0 laryngeal-glottic cancer treated with laser-radiation combined therapy between 1980 and 1999. Patients ranged in age from 40-88 years, with a median of 70 years, and included 51 men and one woman. During this period, treatment was administered with different radiation devices(60Co or 4 MV-X ray), and 40-72 Gy (median, 60 Gy) of radiation therapy ware administered. Tumor and treatment characteristics were correlated with local control at a median follow-up of 61 months(range 12-210 months). Concurrent chemotherapy was administered to 32 patient; 29 were treated with 5-FU and vitamin A(FAR), and 3 were treated with low-dose CDDP. Post treatment vocal function was examined in 37 patients. The voice was evaluated in terms of four parameters: maximum phonation time (MPT), mean air flow rate during phonation over a comfortable duration(MFR), fundamental frequency range of phonation(F0 range), and sound pressure level range of phonation (SPL range)., Results: The five-year cause-specific-survival rate was 98.0%, and the local control rate was 91.8%. Three of 4 patients who had locally relapsed were administered total laryngectomy as salvage therapy. One patient was administered the tracheostomy for late complication. The actuarial laryngeal preservation rate was 92.3%. We did not find any significant relationship between local relapse and extent of disease, subglottic extension, or anterior commissure involvement. Concurrent chemotherapy was not a significant prognostic factor. Laser debulking followed by radiation therapy did not change the voice significantly except the F0 range., Conclusion: We conclude that the laser-radiation combined therapy for T2N0M0 laryngeal-glottic cancer was effective therapy for not only preservation of the voice but also for vocal function.

We have investigated the performance characteristic of the heavy metal filters with higher atomic numbers by comparing their patient exposures, tube loadings, radiographic contrasts, and noise Wiener spectra with those of a combination of copper and aluminum filter which has been used widely in chest radiography. Seven heavy metal filters were used for this study. As for a tungsten filter, two filters different in thickness were used. One is 0.05 mm thick, and the other 0.10 mm. The other metal filters were respectively combined with a tungsten filter with a thickness of 0.05 mm. Among the all filters investigated, tube loading of tungsten filter with 0.05 mm thick is minimum. Tungsten with 0.1 mm thick and tungsten with 0.05 mm+ barium show the larger advantages in patient exposure than those of the other filters. It was found that the magnitude of patient exposure varied slightly with the difference of image receptor used. The use of heavy metal filters showed the small advantages in the patient exposure reduction ( approximately 20%) compared with that of conventional copper filter. The use of heavy metal filters showed increasing tube loading ( approximately 5 times) compared with that of conventional copper filter. Noise Wiener spectra of heavy metal filters showed comparable with those of conventional copper filter. In conclusion, the use of heavy metal filter combinations offer no significant advantages over optimal conventional filters.

A 46-year-old-woman underwent breast preserving mastectomy for advanced breast cancer. Seven months after operation, pulmonary metastases were found. The patient was admitted and treated with combined chemotherapy of 5-fluorouracil and low-dose cisplatin for 4 weeks. After discharge, UFT 300 mg orally every day and cisplatin 5 mg div once week were administered for 2 years on an outpatient basis. The result was disappearance of the pulmonary metastases. Five years after operation, the patient is alive without any sign of the pulmonary metastasis.

In responders to neoadjuvant chemoradiotherapy for locally-advanced esophageal cancer, there was no significant difference in the long-term outcome between patients who underwent esophagectomy and those who did not. Esophagectomy might be unnecessary for patients who achieve a complete response with chemoradiotherapy for an esophageal cancer, in cases when salvage surgery is considered in order to treat any future recurrence.

In this study, the optimal volume of contrast medium in the liver for three-dimensional (3D) imaging of the hepatic and portal veins by helical CT were determined by intravenous injection using the MIP technique. In the 48 cases examined, CT images of the liver were obtained following the administration of contrast medium (90, 120, or 150 ml and 1.0 <, < or = 1.5 ml; 1.5 <, < or = 2.0 ml; 2.0 <, < or = 2.5 ml or 2.5 <, < or = 3.0 ml/kg) for determination of the optimal volume. The mean body weight of the patients was 59 kg. Contrast medium (Iopamidol 300 mgl/ml) was injected at a rate of 3 ml/sec, and scanning was initiated 70 sec after the beginning of injection. Images were obtained throughout the entire liver using 5-mm collimation. MIP images were graded from poor to excellent based on their visualization of the hepatic vessels. Images produced with 120 ml of contrast medium presented excellent images of hepatic vessels, superior to those produced with 90 ml (hepatic vein: p < .001, portal vein: p < .001). Images produced with 2.0 <, < or = 2.5 ml/kg of contrast medium presented excellent images of the portal vein, superior to those produced with 1.5 <, < or = 2.0 ml/kg ml (p < 0.05). It is evident from the present data that a contrast medium volume of more than 120 ml or 2.0 <, < or = 2.5 ml/kg is sufficient for three-dimensional imaging of hepatic vessels. These images may be a useful diagnostic tool in patients with hepatic disease.

Routine chest radiographs of a 52-year-old woman displayed abnormal opacities in the right lower lung field. A computed tomographic (CT) scan of the chest disclosed irregular nodular opacities in the peripheral zone of the right S6. Reconstructed three-dimensional images obtained by helical CT displayed the lesions as agglutinated small nodules, with other small nodules near the bronchi appearing as "tree-in-bud" formations. Specimens obtained by transbronchial lung biopsy of the right B6b revealed atypical glandular structures, thus leading to suspected adenocarcinoma of primary lung cancer. A right lower lobectomy was performed; cut-surface specimens of the resected tissues showed multiple lobulate, milky-white nodules near the bronchi. Histopathologic examination found no malignant cells. PAS staining revealed numerous cryptococcal organisms, thus yielding the final diagnosis of primary pulmonary cryptococcosis.

Twenty patients with early-stage breast cancer treated with breast conservation surgery and definite radiation, underwent computed tomography (added HR-CT) of the lungs before, immediately after, and at one, six, and twelve months after radiotherapy. During the follow-up period, 17 (85%) of the patients developed parenchymal alterations in the irradiated lung volume. We classified the parenchymal alterations into seven patterns: pattern 1 = septal line, 2 = nodular opacity, 3 = ground-glass opacity, 4 = consolidation, 5 = curvilinear opacity, 6 = aircyst accumulation, and 7 = irregularity of pleural surface. From one to six months after radiotherapy, 14 patients developed nodular opacities and ground glass opacities in the irradiated lung field. At 12 months after radiotherapy, fourteen patients were found to have aircyst accumulation and irregularity of the pleural surface. In this study, none of the patients presented any abnormal findings immediately after irradiation. There was no relationship between central lung distance or boost irradiation and the parenchymal alterations in the lung. On the other hand, there was a close relationship between oral anti-cancer agents and lung lesions. In conclusion, HR-CT was useful to evaluate morphologic changes in the irradiated lung.

Helical CT makes possible imaging of the entire liver in as few as 20 seconds during a single breath hold. This method is thus superior to conventional dynamic CT. In this study, optimal late scanning time and optimal volume of contrast medium in the liver were determined with helical CT in routine studies. (1) Optimal late scanning time In 50 cases, CT images of the liver were obtained at various times following the administrations of contrast medium (1.4 ml/kg). Scanning was started at 60,90,120,150 and 180 seconds after injection. Enhancement of the liver and detection of hepatic and portal veins were best at 60 seconds, followed at 90 seconds. However, a scanning delay of 60 seconds still had an effect on the arterial phase. The optimal late scanning time was thus concluded to be at 90 seconds. (2) Optimal volume of contrast medium In 40 cases, CT images of the liver were obtained following the administration of various amounts of contrast medium (1.0 ml, 1.2 ml, 1.4 ml, 1.6 ml/kg) to determine the optimal volume. No significant difference was found between 1.6 ml/kg compared and 1.4 ml/kg of administered contrast medium. It is evident from the present data that a scanning delay of 90 seconds appears to be optimal and a contrast medium volume of 1.4 ml/kg (body weight) is best for conducting helical dynamic CT on the liver.

Left lateral chest radiographs with normal studies were evaluated in 100 Japanese (50 females and 50 males) to compare the radiolucency of the retrosternal space (RSS) with that of the retrocardiac space (RCS) and to measure the RSS. In 56 (56%) cases, the RSS was equally radiolucent to the RCS. In 40 (40%) cases, the RSS was less radiolucent than the RCS (33 of 50 females and 7 of 50 males). The difference between the sexes was statistically significant (p = 0.0001). The RSS was more radiolucent than the RCS in only 4 (4%) males. Frontal chest radiographs of 50 females were classified into one of three groups (Small, Medium, or Large) depending on the size of soft tissue opacity of the breast. The differences between the radiolucency of the RSS and RCS were statistically significant between the Small and Medium and the Small and Large groups (both p < 0.0001). The strength of the relationship between the radiolucency and body-to-fat ratio was statistically significant (p = 0.0028). Results of data comparison between females and males remained significant when adjusted for differences in body-to-fat ratio (p < 0.0001). The distance on the chest radiograph from the sternum to the most anterior aortic border (the distance of RSS) could be measured on only 37 (37%) lateral chest radiographs, and the averages and standard deviations were as follows: 2.2 +/- 0.5 in all cases, 2.0 +/- 0.5 in females, and 2.4 +/- 0.5 in males. The difference between the sexes was statistically significant (p < 0.05). In conclusion, an RSS that is more opaque (less radiolucent) than the RCS is a frequent normal finding because of the opacity of the breast and fat tissue, especially in females, and the length of the RSS is shorter in females than in males.

We evaluated the detectability of colon cancer by using transabdominal ultrasonography (US). Fifty-three cases of proven advanced colon cancer were examined in this study. Screening by US was carried out in 27 of 53 cases and US was performed in all cases after the definite diagnosis. Lesions of the colon were examined by using a 3.5 MHz convex and 5 MHz or 7.5 MHz linear probe (Yokogawa RT-2800, RT-4600). Localized hypertrophy of the irregular wall of more than 10 mm or massive tumor without the normal layered structure was defined as colon cancer on US. The rate of detection by screening test was 52%. The detection rate by US after definite diagnosis was 75%. A high detection rate was obtained in cases with a tumor diameter of more than 4 cm. Eight of 13 cases which were not detected by the screening test were visualized by US after definite diagnosis. US examination is useful for the detection of certain extended lesions of colon cancer. With technical improvements of the examination method, it is considered that cancer in the gastrointestinal tract may be discovered early on screening tests using US.

We examined the usefulness of cine-MR imaging for evaluation of the invasion of esophageal cancer to the aorta in 12 cases. We used the technique of field echo pulse sequence. When the low intensity stripe was recognized between the tumor and the wall of aorta, we interpreted it as negative finding of the direct tumor invasion. By using this criteria, 11 of the 12 cases (92%) of the esophageal cancer for aortic wall invasion were correctly diagnosed as compared with 75% correct diagnosis by conventional MR imaging.

Fifty-one patients with clinical stage I B-cell lymphomas were treated between 1980 and 1988. For the entire group, the actuarial 5-year survival rate and 5-year freedom from relapse rate were 78% and 64%, respectively. Primary site, tumor bulk and performance status were the prognostic factors. Twenty-three patients were intensively treated with local radiotherapy alone, because (1) they had histologically low grade (7 patients) or follicular large cell (1 patients) tumors, (2) Waldeyer's ring was the site of the primary (11 patients) or (3) the tumor was less than 4 cm in maximum diameter (4 patients). Among them, only one patient died due to lymphoma (5-year survival rate: 95%), and 19 remained disease free (5-year freedom from relapse rate: 80%). In contrast, of the remaining 23 patients treated with both radiation therapy and combination chemotherapy (VEMP or CHOP), the 5-year survival rate and 5-year freedom from relapse rate were 70% and 54%, respectively. These results suggest that high-risk patients should be treated with more aggressive combination chemotherapy as well as radiotherapy. However, low-risk patients with stage I B-cell lymphomas can be treated by local radiotherapy alone.

Between 1980 and 1988, we treated 68 patients with clinical stage I non-Hodgkin lymphomas. Fifteen patients had lesions classified as T-cell type lymphomas, and the remainder as B-cell type lymphomas. The actuarial 5-year survival rate was 42% for patients with T-cell type and 78% for patients with B-cell (p less than 0.03), and freedom from relapse was 25% and 67%, respectively (p less than 0.01). The main relapse sites for patients with T-cell type were extranodal (5 patients) and multiple sites (2 patients). These results suggest that patients with T-cell type lymphomas should be treated by aggressive combination chemotherapy as well as radiotherapy, even though their disease may appear to be limited to one region.

Sixty-four patients with stages I and II non-Hodgkin's lymphomas (NHL) involving Waldeyer's ring treated between 1970 and 1987 were reviewed. Patients with stage II NHL were subdivided into stage II 1 (limited type) and stage II2 (advanced type) from the state of neck nodes. Stage II1 was defined as involvement of unilateral cervical nodes less than 4 cm in diameter as well as Waldeyer's ring involvement. Other stage II cases were classified as stage II2. All 17 patients with stage I NHL were treated with radiation therapy alone. Their diseases were well controlled, and none of them died of causes related to the lymphoma. Among 14 patients with stage II1 NHL, the 5-year survival rate for the 9 patients treated with radiation therapy alone was 87.5%. Until 1982, 19 of 21 patients with stage II2 NHL treated with radiation therapy alone or radiation therapy and adjuvant chemotherapy (VEMP or COPP) died within 5 years mainly of disseminated diseases. Since 1983, CHOP has been used as the main treatment as well as radiotherapy for the 12 stage II2 NHL patients. So far, only 3 of them relapsed and 2 of them died of causes related to the lymphoma. Only 1 of these 12 patients was T-cell lymphoma compared to 7 of 9 stage II2 patients before 1982. This suggests that patients with stage I and those with limited stage II can be safely treated with radiotherapy. Also aggressive chemotherapy as well as radiotherapy should be used for patients with advanced stage II NHL involving Waldeyer's ring.

Incidence of rib fracture was analyzed for 118 postoperated breast cancer patients who were tangentially irradiated at the Department of Radiology, Kyushu University, from 1961 to 1976 and followed more than 5 years. Rib fracture was observed in 5% and 50% of cases treated with total radiation doses of 32.5 Gy and 52.5 Gy respectively.

The clinical features of 102 patients with low grade non-Hodgkin's lymphomas treated from 1972 to 1981 among the hospitals belonging to the JLRTG were retrospectively reviewed. According to the Rappaport classification, there were 29 cases of NPDL, 26 of NM and 47 of DWDL. The survival rate and relapse-free survival rate for all patients at 10 years were 49% and 41%, respectively. No obvious difference in survival rate was seen by histologic type, but patients with DWDL had a better relapse-free survival rate than those with NM (P less than 0.01). This study also suggested that patients with stages I and II low grade lymphomas might be treated by irradiation alone, if they are staged properly.

During the years 1972-81, 118 patients with stage I (78 cases) and II (40) nodal non-Hodgkin's lymphoma originated in the neck were treated with radiation. 5 year survival rates were 74% for stage I and 40% for stage II. Favorable histology group showed better prognosis than unfavorable one. Among stage I patients with unfavorable histology group, prognostic factors were studied and tumor size larger than 4 cm is found to be a sole prognostic factor.

Results of treatment of 25 Hodgkin's disease patients at Kyushu University Hospital from 1981 to 1985 were reviewed. Total nodal irradiation or MOPP chemotherapy was used mainly. The actuarial 5-year survival rate, 87.2%, was significantly better than the 41.0% of 61 patients treated between 1966 and 1980 (P less than 0.01). However, 12 of the 24 patients in remission eventually relapsed. To further improve the survival rates of patients with Hodgkin's disease, technical improvements in total nodal irradiation and altering Adriamycin-containing chemotherapy protocol from MOPP chemotherapy are advisable.

A total of 234 patients of Hodgkin's disease treated at 7 institutions from 1972 through 1985 were analyzed. Male to female ratio was 157: 77, mean age was 39.8 years, and overall 5- and 10-year survival were 67% and 56%, respectively. Of 126 patients treated by radiotherapy with more than 36 Gy, alone or preceded to other treatments, 5- and 10-year survival rates were 84% and 80% for Stage I (43 patients), 79% and 69% for Stage II (71 pts.), and 52% and none for Stage III (12 pts.), respectively. Survival rate was better for LP, NS and MC histologies as compared to LD, better for patients without constitutional symptoms, as compared to patients with B, and better for patients with ages younger than 59 years as compared to those with ages over 60 years. Relapse was observed in 57 out of 126 patients. Relapse within the irradiation field was observed in only 4, and nodal areas outside the field, especially of abdomen (1/3), were the most common sites. Half of the relapses occurred within 20 months, and 80%, 40 months. Five-year survival of patients after relapse to lower torso lymph nodes (19 patients) was 37%, which was worse than patients after relapse to upper torso lymph nodes (15 patients: 63%) (z = 1.507, N.S.).

Incidence of telangiectasia and ulcer among 118 postoperated breast cancer patients, who were tangentially irradiated at Department of Radiology, Kyushu University from 1961 to 1980, followed more than 5 years were evaluated. Telangiectasia occurred in 5% at 20-35 Gy, in 50% at 50-55 Gy. Ulcer occurred in 5% at 50-55 Gy, in 50% at 70-75 Gy. Skin tolerance dose in Rubin's Table (1972) is correct.

The role of lymphography for patients with malignant lymphomas involving Waldeyer's ring was retrospectively reviewed. The materials were 97 patients who were treated at Kyushu University Hospital from January, 1966 to December 1982. Lymphography was performed in 72 patients. Abnormal retroperitoneal nodes were detected only in 13 of them (18%). Six of the 7 patients (86%) with gastrointestinal involvement as well as Waldeyer's ring had positive lymphography, whereas only 6 of the 51 patients (12%) without gastrointestinal involvement had such findings. Although there was a significant difference in survival by cervical and inguinal lymph node status, no such discrepancy was seen between 41 stage II patients staged after lymphography and 16 stage II patients staged clinically. All these results suggest that lymphography is not always essential for patients with malignant lymphomas involving Waldeyer's ring.

563 patients with Stage I and II non-Hodgkin's lymphoma were treated by radiotherapy. 34 recurrences that occurred after 3 years from initial treatment were seen in those patients. 15 (44%) of 34 recurrences occurred after 5 years. 20 patients (59%) had remission by re-treatment, and 13 (38%) survived more than 2 years. 20 (59%) of recurrences were seen on head and neck lesions and superficial lymph nodes.