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Born in London, the son and grandson of physicians, Philip E S Palmer moved with his family to Hayle, West Cornwall, at the age of 7. He went to boarding school in Penzance and won an exhibition to Kelly College, Tavistock, Devon, where he won 10 academic prizes, served as head boy of the school, and was an outstanding athlete. In 1939 he began his medical studies at London University (Westminster Hospital) soon after the start of the second world war. He served as a stretcher bearer and ambulance driver for the London Ambulance Service during the air raids. He won the class prize in surgery in 1943 and after graduating became a house surgeon at the Westminster. In June 1944, shortly before the Normandy invasion, Philip was sent to Portsmouth for two months as anaesthetist to one of the surgical units dealing with casualties from Normandy. This led to his first published article, as joint author of a report in the Westminster Hospital Gazette on the treatment of battle casualties from Normandy. He became the Westminster Hospital’s senior medical officer, later registrar, and first surgical assistant in the radiotherapy department, leading to his qualifications in radiation therapy from the London Royal Colleges and in medical radiology from the University of London. He surprised himself by passing his US National Boards in Medicine at his first attempt in 1976. In 2004 he was awarded an honorary MD by the University of Turgu Mures in Romania. In 1946 Philip Palmer joined his father …

1. 1. The majority of the published literature on the radiotherapeutic treatment of epilepsy suffers because it has involved neither radiotherapists nor epileptologists. 2. 2. Papers have either been written describing an incidental beneficial effect (these suffer from being retrospective analyses) or by enthusiasts (where one must question patient selection). In addition there are a small number of very detailed and useful individual case reports. 3. 3. Despite the reservations it would appear that radiation can have beneficial effects on seizures, and this effects has been described for a wide variety of conditions using a wide variety of treatment modalities. 4. 4. There are ground for prospective clinical trials to test the putative therapeutic efficacy of cerebral irradiation. However, it is essential that these are carried out by a group involving an established epilepsy surgery programme and a radiotherapy department conversant with the complex issues involved in focused radiation treatment.

Aim The aim of the work was to evaluate parameters of radiotherapy simulators affecting the precision of simulation. Material and methods The test protocol has been prepared based on an appropriate IEC norm and previous works undertaken in the Medical Physics Department, additionally methodology used by service engineers was taken into account. Two radiotherapy simulators (Oldelft Simulix and Varian Ximatron) working in the Radiotherapy Department in our Center have been regularly tested for a period of over a year. Results Tests have shown that on both simulators precision of laser centrators (lights indicating the isocenter), field size (delineated by wires) and telemeter (light scale showing source-to-skin distance) varies over time, which in some situations could lead to significant inaccuracies of simulation. Inaccuracies observed during the tests were in most cases not noticed by the operators. The appropriate regulations could only be done by service engineers. Other tests such as control of gantry and collimator rotation angles, comparison of radiation vs. light field, isocenter size etc. have shown stability of the parameters under consideration. Still the tests will be carried on because they are not very time consuming and the consequences of a possible inaccuracy could be very severe. Setting tolerance limits more strict than specified the producer's acceptance procedures would make them impossible to achieve, both formally and technically. As expected, evaluation of image quality and x-ray beam parameters did not reveal any significant changes during a one year period. The measurements will be carried on and their results analyzed in longer periods, they could also serve as a reference in case of problems. Conclusions Mechanical parameters of radiotherapy simulator need to be controlled regularly, observed inaccuracies need to be corrected in cooperation with service engineers. Long-term analysis of the results is a proper method of simulator stability evaluation and may lead to modifications of the test protocol.

Purpose:Brachytherapy plays an important role in radiation therapy a wide range of tumor sits such as vaginal, cervical and endometrial cancers. The purpose of this project was to design, fabricate and verify a new phantom for dosimetric verification at small distances from GYN applicators used with GZP6 cobalt‐60 HDR system. Methods: A new phantom has been designed and fabricated from 90 slabs of 18×16×0.2 cm3 Perspex to accommodate one tandem and two ovoids. The thin layer of the slabs was chosen to place GafChromic films in between the slabs for dosimetry with GZP6 cobalt‐60 HDR system. For verification of this device, an assembly composed of a large ovoid size (3cm diameter) and tandem #1 with the least curvature was selected in this study. With this assembly, GafChromic films were exposed using a plan with 500 cGy dose delivery to point “A”. The irradiated films were scanned. The responses of the films were converted to dose by calibrating samples of these films using a cobalt‐60 teletherapy system in the range of 25 to 800 cGy dose. The measured isodose curves with the films were compared to calculated isodose lines by the treatment planning software. Results: The Result of these investigations indicated differences of up to ± 23 % between the planning and measured dosimetry at different points in GYN implant with cobalt‐60 HDR source of GZP6 system. Therefore, this phantom enabled us to confirm the accuracy of radiation delivery to the GYN patients with cobalt‐60 HDR source of GZP6 system. Conclusions: The new phantom design could be utilized for the QA procedure of the GZP6 cobalt‐60 HDR system as well as the Ir‐192 HDR system to confirmation the accuracy of dose distribution in GYN implants, especially in non‐traditional implants. The Radiotherapy Department of Shahid Beheshti University at Shohada hospital sponsored the purchase of the phantom materials and films used in the investigations.

There is no doubt that significant and important advances have been made in the evolution of brachytherapy in cervix cancer treatment in recent years. As Lindegaard and Tanderup describe, development of new applicator systems enabling dose delivery beyond Point A and the collaborative development and adoption of image-guided adaptive brachytherapy techniques by the Groupe Europ een de Curieth erapie (GEC) and the European Society for Therapeutic Radiology and Oncology (ESTRO) has renewed enthusiasm and appreciation of the benefits of brachytherapy. However, since the publication of GEC-ESTRO guidance in 2005 recent patterns of care studies suggest that the resources required to perform this complex process are beyond the reach of most (1e4). Surveys conducted in Canada, Australia, UK, and by theGynecologicCancer InterGroup (GCIG) demonstrate that between only 5% and 20% of centers in these developed countries have access to MRI and while more may be using CT-based planning, a significant proportion remain reliant on two-dimensional imaging. The initial purchase and maintenance of the increasingly technical hardware required for image-guided adaptive brachytherapy (IGABT) is costly and the acquisition of the skills to perform complex insertions is time consuming. When compared, the software required to plan and deliver complex external beam can be used throughout the radiotherapy department across tumor sites. A range of dose fractionation schedules are described for IGABT with no clear consensus on how to combine this with the external beam component of treatment. These schedules seem to offer equivalent total doses but rely on an assumption that the isoeffective dose calculation holds true irrespective of overall time. Similarly, as Lindegaard and Tanderup point out, how to combine doseevolume histogram parameters from external beam schedules with those suggested for brachytherapy remains unclear.

N. Zakharova, S.W. Duffy, J. Mackay, E. Kotlyarov, A. Filimonov, V. Belousov. State Clinical Hospital, Cancer Center, Ugra, Russian Federation; Queen Mary University of London, Wolfson Institute of Preventive Medicine Barts and The London School of Medicine and Dentistry, London, United Kingdom; University College London, Research Department of Genetics Evolution and Environment Faculty, London, United Kingdom; Khanty-Mansiysk Medical Academy, Oncology and Radiotherapy Department, Khanty-Mansiysk, Russian Federation; State Clinical Hospital, Cancer Center, Khanty-Mansiysk, Russian Federation; State Clinical Hospital, Head of the Hospital, Khanty-Mansiysk, Russian Federation

NEUTRON FLUENCE DISTRIBUTION STUDY IN A PROTON THERAPY FACILITY BUNKER J. I. Lagares1, P. Arce2, F. Sansaloni1, J. A. Terron3, M. R. Exposito4, J. J. Nieto-Camero5, A. Korf5, M. Loubser5, F. Sanchez-Doblado63 1 CIEMAT, Medical Applications Unit, Madrid, Spain 2 CIEMAT, Basic Research, Madrid, Spain 3 HOSPITAL UNIVERSITARIO VIRGEN MACARENA, Radiotherapy Department, Sevilla, Spain 4 UNIVERSIDAD DE SEVILLA, Fisiologia Medica y Biofisica, Seville, Spain 5 ITHEMBA LABS, Medical Radiation Department, Somerset West, South Africa 6 UNIVERSIDAD SEVILLA FACULDAD MEDICINA, Fisiologia Medica y Biofisica, Sevilla, Spain

Since a radiotherapy department is a clinical and technical entity, quality assurance (QA) is a team effort. This is necessary for the treatment of a patients with the required high degree of accuracy and precision. The physical and technical aspects of QA programmes performed in radiotherapy institutions have been reviewed in this paper. Firstly, the accuracy required in radiotherapy has been discussed. An increasing amount of clinical evidence indicates that an accuracy of 3.5% in the dose value at the specification points and an accuracy of less than 5 mm in the position of the field with respect to the target volume in the patient is required. Secondly, various aspects of QA programmes related to beam characteristics of treatment machines, treatment planning and treatment verification have been elucidated. It is recommended that international organizations formulate minimum and ideal QA programmes for this purpose. Finally, some recent developments in the field of treatment verification concerning portal imaging and in vivo dosimetry, partly sponsored by the CEC/AIM programme, have been illustrated in more detail. The latter project concerns the further development of an on-line electronic portal imaging device for checking the correct position of the target volume with respect to the radiation beam.

Fifteen cases of chordoma, seen between 1956 and 1990 at the Florence Radiotherapy Department are reported. Twelve of them were treated with radiotherapy and surgery, while one was left untreated. We analyzed the course of the disease in the treated cases, with particular emphasis on the problem of symptom control. The natural history of the disease seemed to be only marginally affected by the treatment and new therapeutic options are strongly needed. While actuarial survival rates at 5 and 10 years were 58% and 35% respectively (owing to the slow growth rate of this neoplasm), 10 years' symptomatic progression-free, symptom-free, and disease-free survival rates were only 25%, 17% and 8% respectively.

The records of 13 patients treated in the radiotherapy department in Newcastle 1973–1988 for primary lymphoma of bone (PLB) were reviewed. Treatment was by radiotherapy in combination with surgery and/or chemotherapy. Cause-specific disease-free survival at 5 years in 75%. Eight patients had PLB in a weight-bearing bone: four of these patients suffered pathological fractures in the treated bone. The radiological differentiation of recurrent PLB and radiation osteitis remains unsatisfactory. None of the four post-treatment pathological fractures in this series was due to recurrent PLB. None of these fractures healed spontaneously. All four patients remain disease-free but all have restricted mobility and require walking aids. PLB in weight-bearing bones is associated with long-term fragility and propylactic stabilization of the affected bone should be considered.

The sizes of radiotherapy treatment fields using customized low melting point alloy blocks have been analyzed for a broad range of treatment fields in a busy radiotherapy department (i.e., 2,000 new cases per year), from small head and neck fields to large mantle fields. The results of this study show that 90% of the blocked fields have an equivalent field size defined by the collimator less than 26 cm and 80%, less than 21 cm. Measurements of the average size of the customized blocks indicate that along one axis 90% have lengths less than 15.5 cm and 80% have lengths less than 13 cm, while for the other axis, 90% have lengths less than 7 cm and 80%, less than 6 cm.

Assessment of the quality of care and patients' satisfaction has become an increasingly needed area of research. The present study investigated various qualitative and quantitative aspects of provision of care and interaction between cancer outpatients and medical and nursing staff within a radiotherapy department in Pordenone, north-eastern Italy. A total of 368 outpatients were contacted: 258 completed the questionnaire (response rate 70%). No difference emerged between respondents and non-respondents as concerning age, sex, marital status, clinical stage, cancer type and reason for referral. Significant differences were found for education and type of work, white collar and better educated patients being more frequent among respondents. Most of the patients reported good or very good levels of satisfaction with major aspects of care provision and relationship with medical and nursing staff. Length of time spent in various administrative procedures, cost of the therapy and change of attending physician in different examinations were the issues commented upon relatively less favourably. Reported waiting time for each medical examination exceeded 1 hour in approximately half of the patients. Improvement in hospital services constituted the priority, according to male patients. Public transportation concerned most women's and elderly patients' attention. Among elderly patients, the need for better provision of care at home was also deeply felt.

A treatment planning suite in a radiotherapy department should be composed of three parts: (1) a simulator, (2) a mould room, and (3) computer planning facilities with access to a CT scanner. These three units should be sited close together and in close physical relationship to the radiotherapy department itself, so that the most efficient use is made of these facilities. The responsibility for treatment planning is a medical one, with close support from the department of medical physics. Radiotherapists, both qualified and in training, should work and plan their treatments (when appropriate) in collaboration with the technicians involved in making moulds and beam-direction shells. Each completed plan should be reproduced using the computer planning facility and this, along with the treatment prescription, should be checked by a physicist. Before the treatment begins, the final approval rests with the treating radiotherapist.

Problems with intravaginal applicators and their solution have outlasted the changes from radium applicators to afterloading techniques. The question of interest is how intravaginal afterloading applicators have to be optimized to take account of unchanged clinical necessities and new technical concepts. According to the recommendations of ICRU 38, the rectal reference point is localized 5 mm behind the dorsal vaginal wall. The reference isodose surface defines the reference volume (ICRU, 1985). It is necessary for the isodoses used in combination with a defined applicator to be adapted to this applicator. While the concept of the “optimized applicator” uses applicators manufactured according to existing isodoses (Lambert, 1988), we progressed to the adaption of the isodoses to existing applicators. In the radiotherapy department in Gottingen we use vaginal applicators which are cylindrical with a rounded, hemispherical top. From our point of view this form “unfolds” the vagina anatomically without the va...

In Quebec every radiotherapy department has to present official statistics to the government known has technical units. All actions taken by therapists generate technical units roughly related to the amount of time needed to complete the task. Technical units are defined per category and task by the officials. A commercial record and verify system, VARiS version 7.2 from Varian Medical Systems, has successfully been configured to automatically capture the required technical units in Quebec. VARiS is normally installed preconfigured to collect charges in the United States using Medicare codes and charges through the application Activity Capture. This program interacts with other applications of the R&V system to greatly ease the process of confirming chargeable activities as they are completed. Replacing the Medicare codes with the Quebec codes in the administration module was the most demanding task. At treatment machines, a window will automatically appear when a treatment session is completed to confirm the activity to be charged. The application will suggest the same codes that were completed the last time. In the case portal images were acquired, the configured code will be suggested even though the code was not used in the prior session. Technical units generated elsewhere, for example in dosimetry, are computed using a single predefined template attached to every patient. The therapist searches the template for the proper code and manually completes it so that it is taken in to account in the patient's statistics.

With the number of clinical cases increasing each year, there is pressure on all clinical staff to do more clinical service. At the same time there is a demand to train more students in all of the radiotherapy disciplines. Regulatory agencies are also demanding more continuing education and upgrading for existing staff. We have recently introduced a new clinical treatment planning system, which requires a significant amount of training for all staff members. To meet these increased demands for training all levels of learners we have developed a “Virtual Radiotherapy Department”. The Virtual Radiotherapy Department will provide on line teaching of basic physics and treatment planning for radiation therapy students, radiation oncology residents, and physicsgraduate students and residents. By using on‐line interactive tools it is possible to teach all the different students at different levels by making basic information available to all students, but linking to more advanced information for those that require it. On‐line videos have been created describing several clinical techniques using various equipment. These videos will be used to provide students instruction as well as for continuing education for existing staff or new staff. These tools will be used to provide training to all users as we introduce our new treatment planning system, showing them exactly how to complete various tasks. These videos are customized to our treatment processes; therefore, they show users exactly what is required in the most efficient manner. Funding Provided by Alberta Health and Wellness and Varian.

The present paper illustrates our attempt to design and test the reproducibility of low-cost patient positioning devices prepared in-house in our radiotherapy department. Rigid thermocole boards with angulations, scales and support were designed as breast, pelvis and head positioning devices. Reproducibility and accuracy were tested by serial electronic portal imaging detector imaging. The positioning devices (with or without superimposed moulds) showed variations within 2-3 mm on serial treatment days which were within acceptable limits. It is therefore concluded that low-cost patient positioning devices for head, breast and pelvis (the common sites of treatments in radiotherapy) can be fabricated from available materials in-house. These have been shown to be resulting in accurate immobilization, can be customized for particular techniques and are considerably cheaper than commercially available solutions.

Purpose: To design the shielding for a PET‐CT simulator in a radiation therapy department, and to verify the adequacy of shielding during acceptance testing.Method and Materials: A Discovery ST (GE Healthcare, Milwaukee, USA) PET‐CT scanner replaced a CT‐Simulator in our centre. Existing space was reconfigured to include a patient rest area for FDG uptake and a hot lab. Adjacent areas included a simulator control room, patient waiting rooms, and corridors; floors above and below contained offices and linac bunkers and control rooms. Patients were modeled as point sources; attenuation by concrete walls and lead shielding explicitly included build‐up. Design limits were set to 1 mSv per year for nuclear energy workers (NEWs), and 0.05 mSv per year for non‐NEWs. A linear 1.5‐GBq source of 18 F in scattering material was used to verify the adequacy of the shielding. Results: The control room was shielded with 6.35 mm of Pb. Two sheets of lead glass (48% Pb by weight) totaling 14 mm provided sufficient attenuation for a window. The patient uptake area and the scanner room were shielded with 4.7 mm of Pb on walls adjacent to corridors. No shielding was required on the floor and ceiling. Measurement showed that design goals were met. Conclusion: Strategic location of patients, NEWs, and low‐occupancy areas simplified design to these stringent limits. Careful consideration of workloads and occupancy factors are needed to meet the design criteria, particularly when older facilities are being redesigned. Design to such low limits unnecessarily increases construction cost.

Purpose: To investigate the feasibility of using Computed Radiography as a film replacement in a radiotherapy department. Method and Materials: A computed radiography(CR) system designed for radiotherapy has recently been introduced to the market. The CR system has separate imaging plates designed for KV imaging, low dose portal imaging (1–10mu) and high dose portal imaging (10–400mu). An evaluation of the possibility of using CR for all functions that are typically done with film in a radiotherapy department has been done. This included an evaluation of image quality of the CR system for portal imaging. It also included an evaluation of the CR system for various quality assurance issues such as gantry and collimator spoke shots, light to radiation congruence, and HDR source position accuracy. Results: The image quality provided by the CRimages was determined by both Oncologists and therapists to be acceptable for use in conventional portal imaging.Images of a contrast resolution phantom were taken with CR, film and an ASi portal imager, and are similar for all three. Quality assurance tests typically done with film can be done with CRimaging techniques. The analysis of spoke shots is possible with the existing tools, but could be streamlined with the development of some analysis software. Similarly it is possible to evaluate the light field vs radiation field congruence with the existing tools in the CR system, but this could also be made easier with some further software development. Conclusion:Computed radiography can be used as a film replacement for imaging and QA in a clinical radiotherapy department. Conflict of Interest: This work has been supported by AGFA HealthCare.

(1) A quality assurance (QA) programme is a mandatory prerequisite when aiming at high dose, high precision radiotherapy. Such a programme includes procedures monitored by the local centre staff and procedures monitored by independent experts of the cooperative group. (2) The structure of a radiotherapy department should comply with minimum requirements to ensure the feasibility of that QA Programme. The following figures, expressed with workload (number of patients treated per year) can constitute a reasonable estimate, with some adjustments depending upon local organisation and upon the ratio of curative to palliative patients): (4) The methodology of QA in radiation physics is as follows.

121 poster Development of a rapid moulage for brachytherapy when dentist's facilities are not available V. Macias, E. Delmastro, B. Baiotto, S. Costantino, S. EmanuellL G. Scielzo, P. Gabriele Radiotherapy Department, Medical Physics Department, Institute for Cancer Treatment and Research, Turin, Italy A technique of high dose rate brachytherapy mould based on thermoplastic mask is introduced for treating patients with superficial carcinoma of the nasal skin. This method is illustrated with a case report. The thermoplastic mask is carefully performed to avoid stretching on nasal area and the target surface is delineated on it. The thickness of the mask is measured and an elasto-gel bolus of the proper thickness (5-10 mm) is placed over it. Catheters are fixed on the top according to the Paris system rules. A three dimensional reconstruction of the catheters is performed from CT and isocentric radiographs with the surface of the tumor marked and a pretreatment optimized dose distribution is calculated. In this case the thickness of the lesion (3mm) was included between the 95% and 85% isodoses (dose per fraction 350 cGy). In vivo dosimetry was performed weekly in order to check any changes in the mask along the fractionated treatment and to ensure that eye's shielding was in the correct place. Previously calibrated TLDs (LiF 100 with dimensions of 3.17 x 3.17 x 0.38mm ~, read with a Harshaw 200 b/c system) were placed on the surface of the tumor and on both eyelids. Small differences on surface tumor dose between pretreatment planning and in vivo dosimetry have been found, maybe due to TLD wrapper (if increases the bolus) and poor spatial resolution of TLD. The average reading of both eyelids has been less than 27 cGy per fraction. This technique seems to be a safe, rapid and inexpensive (50 E vs 400 E) method to perform a skin applicator when dentist facilities are not available.

The EditorÐSir, In his case report on perianal Paget's disease (PPD) treated successfully with radiotherapy [1], Dr Amin notes that earlier authors (Butler et al) have stated that radiotherapy holds no place in treatment because of high recurrence rates [2]. Like most authors, we feel that surgery is generally the treatment of choice, but agree with Dr Amin that in some circumstances an alternative view may be held. The series by Jensen et al [3] used to support Butler's view that radiotherapy is of no value contained only two patients who received radiotherapy. One of these patients had invasive PPD and received a dose of only 30 Gy with no fractionation schedule included. We feel many radiotherapists would consider 30 Gy to be suboptimal radical treatment for an invasive carcinoma. In their series, Jensen et al clearly stated that the number of patients treated with radiotherapy was not large enough to allow any judgement on ef®cacy to be made. As Dr Amin's case shows, there are circumstances where radiotherapy is a curative modality. The literature, heavily dominated by surgical series, does contain a small number of patients successfully treated by radiotherapy. As primary therapy alone, Brierley and Stockdale [3] report six patients with extramammary Paget's disease affecting the perineum, four of whom had their disease eradicated with radiotherapy. Three further cases of PPD successfully treated with radiotherapy are contained within the article by Besa quoted by Dr Amin. Other instances of successful salvage following failure of surgical excision have also been reported [4]. As an alternative to abdominoperineal excision in patients who are un®t for or decline surgery, radical radiotherapy may be a reasonable alternative. Successful radiotherapy may also spare a temporary or permanent colostomy. Careful consideration of all available treatment modalities does, we feel, offer the patient the best chance of a successful and appropriate outcome. Yours etc., R S D BROWN K J LANKESTER M F SPITTLE Department of Clinical Oncology Middlesex Hospital Mortimer Street London W1N 8AA Radiotherapy Department Mount Vernon Hospital Rickmansworth Road Northwood Middlesex HA6 2RN St John's Centre St Thomas' Hospital Lambeth Palace Road London SE1 7EH UK (Received 7 January 2000 and accepted 21 January 2000)

A Quality Management (QM) program for HDR-Brachytherapy has been developed after commissioning of the Microselectron HDR unit at Radiotherapy Department of Institute of Oncology and Radiology in Belgrade, Yugoslavia. This program, based on multidisciplinary level, follows current international regulations for brachytherapy dose administration and the highest professional standards. Each procedure (step) was described as well as the role of each subject (radiotherapist, radiophysicist, technologist, nurse, etc.). From January 1993 to January 1995 more than 280 cancer patients have come for consultation to determine if interstitial/intraluminal brachytherapy was appropriate treatment modality. About 10% of patients were rejected and referred to a classic RT. In seven cases a decision was changed just before brachytherapy (in preparation and pre-planning procedure), finding inappropriate for catheter implantation (interstitial). In two patients, one implanted flexible catheter was damaged during the application or verification procedure that was followed by correction action in application and/or planning. One patient pulled out an esophageal catheter during the planning-checking procedure probably due to lack in preparation step. In eight cases deviation of the treatment time was observed during data transfer procedure (from computer to the unit), six due to the unknown change in the machine information of calibration conditions (date and/or source strength), and in two cases due to errors in manual machine data input (subjective-technologist's). This QM program scheme reduces the possibility of errors and helps avoid technical problems in brachytherapy performance from the preparation to the therapy alone. Each program step is fully documented and served not only for patient record, but as comprehensive data for further investigations.

Between 1960 and 1976, 1645 women with carcinoma of the uterine cervix were treated in the Radiotherapy Department, Edinburgh. In the earlier years the majority of patients were treated using a partially afterloaded radium line source system, combined with 4 MV external irradiation. The radium was later replaced by caesium which, from 1972, was used in a fully afterloaded line source intracavitary applicator. In recent years a computer program has been used to calculate the dose distribution, resulting in improved pelvic dosimetry and a decline in the frequency and severity of radiation reactions. Actuarial survival rates are reported by stage for a 20-year period-The 5-year survival rate for patients with Stage I disease treated by the Edinburgh method was 74.7% (71.5% for the whole group). For patients with Stage II disease, the rates were 57.1% and 51.3% and for those with Stage III disease, the rates were 40.1% and 28.0%.

A simple device that uses materials and apparatus commonly available in a radiotherapy department has been designed, fabricated and used in routine quality control relative to the activity uniformity of clinical Ir-192 seeds in ribbons. Detailed evaluation indicated that this system is easy to use and can yield relative activity measurements of individual Ir-192 seeds accurate to within 2%. With this device, activity uniformity of commercial Ir-192 seeds from two manufacturers has been assessed. For the seven shipments of Ir-192 seeds studied, the root mean square variations of individual seed strength from the average of each shipment ranged from 3.4 to 7.1 %. Variation in seed activity by more than 10 % from the average is not uncommon.

Radiotherapists are often asked to irradiate patients with metastases in lymph nodes in the cervical area from an unknown primary carcinoma. In our department we use indirect mirror examination, finger palpation and cytology of smears from the nasopharynx, in case the primary is located there. The same method is used before radiotherapy of patients with nasopharyngeal carcinoma, during treatment and at their follow up examinations. We found cytology of the nasopharynx very useful in managing these patients.

Obstructive jaundice secondary to cancer is an entity caused by obstruction of the bile ducts by primary or metastatic disease. Several procedures have been attempted for palliation of this distressing condition. Radiation therapy plays a role in the palliative management of this process, in both primary and metastatic disease. At the Radiotherapy Department of the Methodist Hospital and Baylor College of Medicine, Houston, Texas, 13 patients have been treated with local radiation therapy to the ports hepatis; 8 patients who have completed the course of radiation therapy are presented in this paper. All of these patients experienced improvement from jaundice, the symptom free interval varying from 3 weeks to 11 months. This report illustrates the beneficial effects of radiation therapy for patients suffering from this condition.

The reported occurrences of distant metastases from carcinoma of the urinary bladder are infrequent, since they usually occur late and in a high percentage of cases death intervenes from urinary tract infection long before secondary lesions have had time to develop. Among 68 recorded cases of carcinoma of the urinary bladder seen at the Kings County Hospital radiotherapy department, there were only 3 in which demonstrable clinical and radiographic evidence of metastases to distant foci was present; a fourth case occurred in the author's practice. Hinman, in his Principles and Practice of Urology (1), writes: “Metastases as a rule (from carcinoma of the bladder) are relatively uncommon…. Metastases by way of the blood stream are more frequent, the osseous system being ‘the organ of predilection.” Radiographically these metastatic lesions present no distinguishing characteristics from any other type of lytic carcinoma.” In 1918, Geraghty wrote: “It is usually noted that the bladder tumors, except in compara...

Attention has recently been drawn by Whitfield and Jones (1970) to a case of Hodgkin's disease in which lymph node calcification in the right side of the mediastinum developed nine years after radiotherapy. It may, therefore, be of interest to report the case history of another patient in whom this rare condition developed in the mediastinum as early as 20 months after her initial treatment for the same disease. The patient was a schoolgirl, aged 11, who in the middle of March, 1959 began to feel unwell with loss of energy and appetite. At this time it was noted that she had a swelling measuring 5 × 3 cm. in the left side of her neck and she was admitted to the Royal Victoria Hospital, Belfast. She presented as a rather thin, frail, young girl. The consistency of the palpable lymph nodes on the left side of the neck suggested Hodgkin's disease. Before being seen in the radiotherapy department she had been given a course of 10 mg of triethylene melamine as 2·5 mg tablets over a period of a few days. A radi...

The principle of the nomogram is applied to routine calculations normally encountered in a hospital radiotherapy department. Several nomograms are reproduced; their accuracy is discussed, and is found to be of the order of 3 per cent. in the case of small photographic copies, and less in the case of larger copies. A calculator for treatment times, based on this principle, is described which in one operation indicates the time of a deep X-ray treatment for any operating conditions, and for any surface dose, being capable of adjustment to compensate for changes of tube output.

A method has been described for the treatment of carcinoma of the cervix using intrauterine radium and a linear vaginal source combined with 4 MeV X-ray therapy. The treatment is simple and flexible, and the initial results obtained are encouraging. With the experience so gained and further modification using radioactive caesium sources it is hoped to reduce the morbidity. Using radium or radioactive caesium the method is suitable for use in underdeveloped countries where the resources and technical help of a full-scale radiotherapy department are not available.

The radiation technique described is an unconventional method of treatment for carcinoma cervix patients and is essentially external beam therapy alone, using a (60)Cobalt rotation plan. This is in contrast to the more conventional series of 2 or 3 intracavitary radium insertions, either preceded and/or followed by fixed field external beam therapy. An advantage to the patient from this treatment scheme is the avoidance of the trauma associated with the repeated anaesthetics required for uterine and vaginal radium applications. Dosage levels have also been determined to ensure minimal post-radiation complications, and the 5- and 10-year survival rates for stage II and stage III cases are comparable with the survival results published by other centres. The series was treated during 1957-64 and consisted of all stage II and III cases referred to the Westminster Radiotherapy Department during this period, together with 13 stage I cases which were considered to be poor anaesthetic risks, and 4 stage IV cases. The 5- and 10-year survival rates for 69 stage II cases were 44% and 36% respectively, and for 81 stage III cases were 38% and 23% respectively.

The International Commission on Radiological Protection has laid down certain maximum permissible doses of radiation and in doing so they have had to consider two risks and three types of population. The risks are: the risk to individual health and the risk to genetic material. The three groups are those occupationally exposed to radiation, those exposed in or near the areas in which radiation is used and the population at large. Nursing staff in a hospital may, according to the circumstances, come into any of these three groups. A properly protected diagnostic X-ray department should present no problem to the nursing staff, since the protection from radiation at all the voltages likely to be applied for diagnostic work can be so efficient that the doses received by any nurse accompanying a patient into the department should be less than the maximum permissible dose for anyone not occupationally exposed. In the radiotherapy department the occupational exposure can also be reduced to a negligible amount in...

Examination of the radiographs of 225 patients with ankylosing spondylitis attending a radiotherapy department revealed pulmonary or pleural abnormalities in 26 cases. These abnormalities were considered to be due to healed tuberculosis in 5 patients and non-tuberculous pulmonary fibrosis in 14 patients. There were 2 cases of unexplained bilateral pleural calcification and miscellaneous abnormalities in another 5 patients. Investigation of the patients with pulmonary fibrosis failed to elucidate the cause of the lung lesions, which were unilateral in 9 and upper zone in 12 of the 14 patients. Six of these patients had radiographic changes which mimicked tuberculosis, and 3 had been treated without benefit for this disease. It is concluded that non-tuberculous pulmonary fibrosis is substantially more common than pulmonary tuberculosis in ankylosing sponylitis, and it is suggested that incorrect diagnosis of pulmonary tuberculosis in patients with non-tuberculous pulmonary fibrosis may be the explanation of the previously reported high incidence of pulmonary tuberculosis in patients with ankylosing spondylitis.