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The desire to improve local tumour control and cure more cancer patients, coupled with advances in computer technology and linear accelerator design, has spurred the developments of three-dimensional conformal radiotherapy techniques. Optimized treatment plans, aiming to deliver high dose to the target while minimizing dose to the surrounding tissues, can be delivered with multiple fields each with spatially modulated beam intensities or with multiple-slice treatments. This paper introduces a new method, intensity-modulated arc therapy (IMAT), for delivering optimized treatment plans to improve the therapeutic ratio. It utilizes continuous gantry motion as in conventional arc therapy. Unlike conventional arc therapy, the field shape, which is conformed with the multileaf collimator, changes during gantry rotation. Arbitrary two-dimensional beam intensify distributions at different beam angles are delivered with multiple superimposing arcs. A system capable of delivering the IMAT has been implemented. An example is given that illustrates the feasibility of this new method. Advantages of this new technique over tomotherapy and other slice-based delivery schemes are also discussed.

Significant advances have been made in recent years to improve photon dose calculation. However, accurate prediction of dose perturbation effects near the interfaces of different media, where charged particle equilibrium is not established, remain unsolved. Furthermore, changes in atomic number, which affect the multiple Coulomb scattering of the secondary electrons, are not accounted for by current photon dose calculation algorithms. As local interface effects are mainly due to the perturbation of secondary electrons, a photon-electron cascade model is proposed which incorporates explicit electron transport in the calculation of the primary photon dose component in heterogeneous media. The primary photon beam is treated as the source of many electron pencil beams. The latter are transported using the Fermi-Eyges theory. The scattered photon dose contribution is calculated with the dose spread array [T.R. Mackie, J.W. Scrimger, and J.J. Battista, Med. Phys. 12, 188-196 (1985)] approach. Comparisons of the calculation with Monte Carlo simulation and TLD measurements show good agreement for positions near the polystyrene-aluminum interfaces.

Purpose: The purpose of this work is to develop a prescription preparation system for efficient field shaping using a multileaf collimator that can be used in community settings as well as research institutions. The efficiency advantage of the computer-controlled multileaf collimator, over cerrobend blocks, to shape radiation fields has been shown in conformal treatments, which typically require complete volumetric computerized tomographic data for three-dimensional radiation treatment planning--a utility not readily available to the general community. As a result, most patients today are treated with conventional radiation therapy. Therefore, we believe that it is very important to fully use the same efficiency advantage of multileaf collimator as a block replacement in conventional practice., Methods and Material: The multileaf collimator prescription preparation system developed by us acquires prescription images from different sources, including film scanner and radiation treatment planning systems. The multileaf collimator angle and leaf positions are set from the desired field contour defined on the prescription image, by minimizing the area discrepancies. Interactive graphical tools include manual adjustment of collimator angle and leaf positions, and definition of portions of the field edges that require maximal conformation. Data files of the final leaf positions are transferred to the multileaf collimator controller via a dedicated communication link., Results: We have implemented the field prescription preparation system and a network model for integrating the multileaf collimator and other radiotherapy modalities for routine treatments. For routine plan evaluation, isodose contours measured with film in solid water phantom at prescription depth are overlaid on the prescription image. Preliminary study indicates that the efficiency advantage of the MLC over cerrobend blocks in conformal therapy also holds true for conventional treatments., Conclusion: Our model of computer-controlled prescription, evaluation, and treatment using multileaf collimators can be effectively implemented in both community settings and research institutions. The resultant increase in treatment efficiency and accuracy is now available for conventional radiotherapy.

A mathematical model is derived for digitally controlled linear accelerators to deliver a desired photon intensity distribution by combining collimator motion and machine dose rate variations. It shows that, at any instant, the quotient of the machine dose rate and the speed of collimator motion is proportional to the gradient of the desired in-air photon fluence distribution. The model is applicable for both independently controlled collimator jaws and multileaf collimators and can be implemented by controlling different parameters to accommodate linear accelerators from different manufactures. For independent jaws, each pair of jaws creates photon fluence variations along the direction of the jaw movement. For multileaf collimators, where each leaf is independently controlled, any two-dimensional (2D) photon fluence distribution can be delivered. The model has been implemented for wedged isodose distributions using independent jaws, and 2D intensity modulation using a multileaf collimator. One-dimensional (1D) wedged isodose distributions are created by moving an independent jaw at constant speed while varying machine dose rate. 2D intensity modulation has been implemented using a 'dynamic stepping' scheme, which controls the leaf progression during irradiation at constant machine dose rate. With this automated delivery scheme, the beam delivery time for dynamic intensity modulation, which depends on the complexity of the desired intensity distribution, approaches that of conventional beam modifiers. This paper shows the derivation of the model, its application, and our delivery scheme. Examples of 1D dynamic wedges and 2D intensity modulations will be given to illustrate the versatility of the model, the simplicity of its application, and the efficiency of beam delivery. These features make this approach practical for delivering conformal therapy treatments.

Computer-controlled multileaf collimators are receiving increasing acceptance for clinical use in radiation therapy due to their efficiency in shaping radiation fields. Because of the physical leaf width of the multileaf collimator, a smooth field contour prescribed by a physician is approximated by a staircase-shaped field boundary. The point of intersection with the prescribed field contour determines the error of the approximation and may affect the outcome of the treatment. This article provides analytically optimized solutions for leaf positioning based on two different geometric object functions.

Purpose: The purpose of this work is to develop a prescription preparation system for efficient field shaping using a multileaf collimator that can be used in community settings as well as research institutions. The efficiency advantage of the computer-controlled multileaf collimator, over cerrobend blocks, to shape radiation fields has been shown in conformal treatments, which typically require complete volumetric computerized tomographic data for three-dimensional radiation treatment planning--a utility not readily available to the general community. As a result, most patients today are treated with conventional radiation therapy. Therefore, we believe that it is very important to fully use the same efficiency advantage of multileaf collimator as a block replacement in conventional practice., Methods and Material: The multileaf collimator prescription preparation systems developed by us acquires prescription images from different sources, including film scanner, and radiation treatment planning systems. The multileaf collimator angle and leaf positions are set from the desired field contour defined on the prescription image, by minimizing the area discrepancies. Interactive graphical tools include manual adjustment of collimator angle and leaf positions, and definition of portions of the field edges that require maximal conformation. Data files of the final leaf positions are transferred to the multileaf collimator controller via a dedicated communication link., Results: We have implemented the field prescription preparation system and a network model for integrating the multileaf collimator and other radiotherapy modalities for routine treatments. For routine plan evaluation, isodose contours measured with film in solid water phantom at prescription depth are overlaid on the prescription image. Preliminary study indicates that the efficiency advantage of the MLC over cerrobend blocks in conformal therapy also holds true for conventional treatments., Conclusion: Our model of computer-controlled prescription, evaluation, and treatment using multileaf collimators can be effectively implemented in both community settings and research institutions. The resultant increase in treatment efficiency and accuracy is now available for conventional radiotherapy.

The histologic features of gonads occurrence of gonadal tumor, and RIA reproductive hormone levels in 50 cases containing a Y chromosome karyotype were analysed. The correlation between gonadal tumor and Y chromosome, clinical manifestation and genotype, and the principle of diagnosis and treatment are discussed. There were seven cases of gonadal tumor in these fifty cases the frequency of gonadal tumor is 14% (7/50). All of them were present in cases with gonadal dysgenesis, with the frequency rate of 27% (7/26). Five cases were bilateral, and two were unilateral, that made a total of twelve tumors in these seven cases. Gonadoblastoma was type of tumor commonly found, about 75% (9/12). The above date suggested that there is a higher frequency of gonadal tumor in cases of gonadal dysgenesis with a Y chromosome. Both hypergonadotropins and low sex steroids levels were the feature of gonadal dysgenesis, but no relative with occurrence of the tumor. The phenotype of these fifty cases were largely due to the process of abnormal sexual differentiation not only depend on the sex chromosome complement. In treatment, prophylactic bilateral gonadectomy is emphasized.

The equivalent tissue-air-ratio (ETAR) method employs three-dimensional (3D) CT pixel information to approximate scatter dose contribution for inhomogeneity correction. In general, the calculation provides better agreement with measurements than the one-dimensional (1D) methods typically used in commercial treatment planning systems. In its original implementation, the 3D formulation of the ETAR method is modified empirically as a 2D calculation in order to reduce computation time. The modification compromises the use of the method in several treatment geometries. An examination of the ETAR formulation shows that the calculation can be expressed as a convolution and thus can be performed in 3D using fast Fourier transform (FFT) techniques. The algorithm has been implemented as a 3D FFT convolution. Making use of the symmetric properties of the FFT, the new approach shows significant savings in computation time without excessive memory requirement. Despite its fundamental limitations when applied to regions of electronic disequilibrium, the ETAR method offers a practical solution to improving current dose calculation in 3D treatment planning, particularly when the more advanced scatter ray-tracing dose calculation algorithms remain impractical for clinical use. Recent work to extend the method to approximate electron transport is also encouraging.

In the last decade, chorionic villi sampling (CVS) has been widely accepted as a new technique in prenatal diagnosis. An inconsistency in karyotypes between CVS and fetal tissue was found in clinical practice, although the chorionic villi and the fetal tissues were from the same fertilized ovum. Karyotypes from direct chromosomal preparation of chorionic villi and cultured fetal tissues in 52 artificial abortion samples were compared. Results showed two cases with karyotypic inconsistency: (1) 46, XX/46, XY in the chorionic villus direct preparation and 46, XX in the fetal tissue; (2) 46, XY in the direct preparation of chorionic villi and 45,XY, t (15q21q) de novo in the fetal tissue. Our research demonstrates that karyotype from chorionic villus direct preparation does not always reflect the fetal karyotype.

By using receptor blockade, HPLC, destroying catecholaminergic nerve terminals by 6-OHDA, autoradiography, and other techniques, the relationship between effects of the spinal PCP receptor on cardiovascular function and noradrenergic system was studied. The main results were as following. Hypotension and bradycardia induced by ith PCP were significantly antagonized by prazosin and yohimbine; the MHPG levels in spinal CSF were significantly increased during the ith PCP induced hypotension and bradycardia; pretreatment with 6-OHDA to destroy NA terminals in the spinal cord significantly decreased the ith PCP induced hypotension and bradycardia, and the density of PCP receptors in the spinal cord. The results suggest that there are PCP receptors on the NA terminals in the spinal cord, which promoted the release of NA and/or inhibited the reuptake of NA. This may be a possible mechanism underlying the influence of spinal PCP receptors on cardiovascular function.

In recent years, more and more attention has been paid to the studies about the cardiovascular function of phencyclidine (PCP) receptor, but very little about the cardiovascular function of central PCP receptor. In this study, we observed the effects of PCP on the blood pressure (BP) and heart rate (HR) by injecting the agonist or antagonist of PCP receptor into cerebral ventricle (icv) or spinal subarachnoid space (ith), to find out the cardiovascular function of central PCP receptor. It was found that icv PCP (250 nmol) elicited a slow and long lasting hypotension or fast and long lasting bradycardia. ith PCP elicited sharp hypotension and bradycardia immediately, with dose-dependent response. The hypotension and bradycardia of ith PCP (150 nmol) were significantly antagonized by ith 15 nmol dextrorphan. TCP, an agonist of PCP receptor, also elicited sharp hypotension and bradycardia immediately. However, subcutaneous injection (sc) of PCP (10 mg/kg) elicited hypertension and had no effect on HR. The results mentioned above indicate that central PCP receptors have the inhibitory effect on cardiovascular system. The cardiovascular effect of sc PCP may be the effect of combination of central and peripheral PCP receptors.

Development of a far-infrared Thomson scattering system for the study of density fluctuations in fusion plasmas is described. New data are presented of naturally occurring low-frequency microturbulence and also of electrostatic modes generated at the ion cyclotron range of frequencies (ICRF). The latter studies are important in understanding ICRF supplementary heating experiments. They have produced the first internal observation of mode-converted ion -Bernstein waves in a tokamak plasma.

An apparatus capable of measuring small fractional changes in ionization current has been used to study the effect of small inhomogeneities on photon dose in water. Small ring-shaped inhomogeneities were introduced into a water phantom and measurements have been made for 4-, 6-, and 18-MV x-rays. The results show beyond the range of secondary electrons, the dose perturbation is basically a photon transport phenomenon which becomes less important as the beam energy increases; within the range of secondary electrons, dose perturbation also involves electron transport, which has a strong dependence on atomic number and could result in a substantially large effect on dose deposition.

Based on the Fermi-Eyges theory, a set of recursion relations was derived for calculating electron distributions in the layered geometry. The electron distribution at a specific depth was obtained by convolving the upstream electron distribution with a kernel determined by the scattering parameters of the layer. Modifications were made to overcome some inherent limitations of the Fermi-Eyges theory. For each point in the medium, the most probable, or mean, path traversed by the electrons in reaching the point was derived. The skewness of the mean paths and the related energy degradation were included in a multiray model for pencil beam calculations. The resultant electron planar fluence distributions are no longer Gaussian as predicted by the original theory. The effects of edges or localized inhomogeneities are also included. Comparisons between our calculations and Monte Carlo simulations show good agreement.

A new method is described for preparing direct mitotic chromosome spreads from chorionic villous samples, which has resulted in sufficiently high yields of well-banded metaphases to permit a complete standard chromosomal diagnosis in 20 of 20 cases. A method of establishing monolayer cultures from this material that can be harvested from 3 to 7 days after initiation is also presented.