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This document is the first of a series of policy statements being issued by the Asia-Oceania Federation of Organizations for Medical Physics (AFOMP). The document was developed by the AFOMP Professional Development Committee (PDC) and was endorsed for official release by AFOMP Council in 2006. The main purpose of the document was to give guidance to AFOMP member organizations on the role and responsibilities of clinical medical physicists. A definition of clinical medical physicist has also been provided. This document discusses the following topics: professional aspects of education and training; responsibilities of the clinical medical physicist; status and organization of the clinical medical physics service and the need for clinical medical physics service.

It was the aim of this work to assess and track the workload, working conditions and professional recognition of radiation oncology medical physicists (ROMPs) in the Asia Pacific region over time. In this third survey since 2008, a structured questionnaire was mailed in 2014 to 22 senior medical physicists representing 23 countries. As in previous surveys the questionnaire covered seven themes: 1 education, training and professional certification, 2 staffing, 3 typical tasks, 4 professional organisations, 5 resources, 6 research and teaching, and 7 job satisfaction. The response rate of 100 % is a result of performing a survey through a network, which allows easy follow-up. The replies cover 4841 ROMPs in 23 countries. Compared to 2008, the number of medical physicists in many countries has doubled. However, the number of experienced ROMPs compared to the overall workforce is still small, especially in low and middle income countries. The increase in staff is matched by a similar increase in the number of treatment units over the years. Furthermore, the number of countries using complex techniques (IMRT, IGRT) or installing high end equipment (tomotherapy, robotic linear accelerators) is increasing. Overall, ROMPs still feel generally overworked and the professional recognition, while varying widely, appears to be improving only slightly. Radiation oncology medical physics practice has not changed significantly over the last 6 years in the Asia Pacific Region even if the number of physicists and the number and complexity of treatment techniques and technologies have increased dramatically.

Alumina supported molybdenum catalysts with variable loading and support particle size were prepared by the unconventional equilibrium adsorption in slurry MoO3/water. The method can be named either slurry impregnation method, SIM (when compared with impregnation in ammonium molybdate solution) or solvent assisted spreading, SAS (when compared with thermal spreading of MoO3). The maximum saturated adsorption loading achieved with alumina of surface area 172 m2 g−1 and particle size 0.16–0.32 mm was 14.4 wt% MoO3. No other crystalline phase beside γ-Al2O3 was found in XRD spectra of the catalysts. The XPS surface ratio MoAl in oxide form and the thiophene hydrodesulphurization activity in sulphide form increased linearly with the overall composition up to saturated adsorption loading. The hydrodesulphurization activity of the SIMSAS catalysts of corresponding loading was comparable or better than the activity of conventional commercial MoO3Al2O3 catalyst. All this indicated that the monolayer type catalysts are obtained by SIMSAS method. The electron probe micro analysis of the SIMSAS catalyst prepared from extrudates (1.5 mm) confirmed uniform cross sectional distribution of molybdena. This proved that the SIMSAS method can be used not only for small support particles but also for usual extrudates or tablets. The relation and advantage of the SIMSAS method as compared with other methods of preparation of monolayer molybdena catalysts were discussed.

Progress of key technologies for the past 10 years and the state of realization of PACS and teleradiology in Japan are reviewed. Even though advanced electronic technologies have brought a rapid spread of PACS and teleradiology, the total number of installations is small compared with that of the hospital information system (HIS). The reason of this is a lack of economic incentives. The merits or benefits of PACS and teleradiology have to be appreciated and paid for by reimbursement of the associated costs from health insurance companies. The progress of PACS diffusion has been very rapid for these ten years in Japan, but most systems deployed are small-sized PACS. Examples of large PACS in Japan are presented and a method for integration with the HIS and RIS (radiological information system) is described. Standardization activities on PACS such as image data transfer and filing are also introduced. A unique domestic standard in Japan for IS&C (image save and carry) and electronic filing of medical images is presented. The Japanese equivalent of the American standard DICOM is also described. Technology assessment of PACS is an important theme of study and investigation. An example of the measurement of pre- and postoperation of these systems is discussed.

Unsupported Co-Mo catalysts were prepared by impregnation of MoS2, obtained by thermal decomposition of ammonium tetrathiomolybdate, with a solution of cobalt nitrate in acetone. XRD and HREM showed that the MoS2 structure of the resulting catalysts remained intact upon addition of Co. The thiophene hydrodesulfurization and the consecutive butene hydrogenation properties indicated that the Co ions are preferentially situated at the edges of the MoS2 crystallites below Co/(Co + Mo) = 0.08 and promote the hydrodesulfurization (HDS) reaction. Further addition of Co leads to the segregation of Co9S8, which acts as a support for highly dispersed Co-promoted MoS2 crystallites. As a result of this structural effect, the Co-MoS2 crystallites become better accessible and the catalytic activity increases again above Co/(Co + Mo) = 0.2. The observed increase in activity upon physical mixing of Co-promoted MoS2 and Co9S8 might also be explained by such a structural effect, rather.than by a remote-control effect.

We propose a quantitative method to evaluate the ability of adaptive image filters for reducing noise to low-contrast objects in Multi-Detector Row Computed Tomography (MDCT). The digital phantom for evaluating the ability of a nonlinear noise reduction filter to a low-contrast object in a MDCT image was produced. The digital phantom consists of a water phantom image of MDCT and a bar pattern with a known contrast and spatial frequency. The edge-preserving adaptive filter for selectively eliminating noise in low-dose scanning known as the “Quantum Denoising System” developed by Toshiba Medical Systems was chosen as a nonlinear noise reduction filter for this paper. In this paper, two non-linear noise reduction filters, Q1 and Q2 in QDS were employed. By analyzing the power spectrum (PS) of a digital phantom, the filter performance as regards the contrast and spatial frequency of an object was investigated. The contrast-to-noise ratio from PS could express the feature of the filter briefly. That is, the validity of a filter can be shown based on the combined information of the contrast and spatial frequency of an object. Probably, this simple method will contribute to evaluating various noise reduction filters efficiently.

Unsupported Co-Mo catalysts were prepared by impregnation of MoS2, obtained by thermal decomposition of ammonium tetrathiomolybdate, with a solution of cobalt nitrate in acetone. XRD and HREM showed that the MoS2 structure of the resulting catalysts remained intact upon addition of Co. The thiophene hydrodesulfurization and the consecutive butene hydrogenation properties indicated that the Co ions are preferentially situated at the edges of the MoS2 crystallites below Co/(Co + Mo) = 0.08 and promote the hydrodesulfurization (HDS) reaction. Further addition of Co leads to the segregation of Co9S8, which acts as a support for highly dispersed Co-promoted MoS2 crystallites. As a result of this structural effect, the Co-MoS2 crystallites become better accessible and the catalytic activity increases again above Co/(Co + Mo) = 0.2. The observed increase in activity upon physical mixing of Co-promoted MoS2 and Co9S8 might also be explained by such a structural effect, rather.than by a remote-control effect.

We demonstrate two types of three-dimensional (3D) integration using chip self-assembly techniques with liquid surface tension. In reconfigured wafer-to-wafer 3D integration, many different sizes of chips having In/Au microbumps with/without TSV (through-silicon via) were temporarily placed by self-assembly on a reconfigured wafer in a back-to-face manner. The many chips can be then simultaneously transferred to an LSI wafer that is fully faced with the reconfigured wafer and has the same microbump array patterns to the self-assembled chips. On the other hand, in multichip-to-wafer 3D integration, Si chips having In/Au microbumps with sizes of 5 µm and 10 µm were directly self-assembled on another LSI wafer having the same In/Au microbumps in a face-to-face manner. After the self-assembly, these chips can be bonded at 200 °C without applying mechanical pressure. In both of the self-assembly-based 3D integration, the chips were precisely aligned and bonded to the LSI wafers through the microbump-to-microbump interconnection. We obtained good electrical characteristics using the microbump daisy chains formed between the self-assembled chips and the wafers.

In this paper we propose the phantom for quality evaluations of the nonlinear noise reduction filter in multidetector row computed tomography (MDCT). A nonlinear filter is a filter whose output is not proportional to its input (CT number or contrast value). Generally, a standard phantom for CT cannot be used for the quality evaluation of such a filter. The maximum feature of our phantom is being able to obtain edge spread functions of a maximum of six edge intensities under the influence of a certain maximum contrast by choosing a slice position...The edge-preserving adaptive filter for selectively eliminating noise in low-dose scanning known as the Quantum Denoising System (QDS) developed by Toshiba Medical Systems was chosen as a nonlinear noise reduction filter for this study. For evaluation of the filter characteristics, three types of evaluation, the noise statistical values (mean and standard deviation of CT numbers), noise characteristics (noise Wiener spectrum, WS) and resolution characteristics (modulation transfer function, MTF) were measured using the phantom. As a result, the statistics value of obtained noise, and WS and MTF were able to demonstrate the performance of the filter clearly. Further, our phantom was able to investigate the capability of edge-preserving adaptive filters such as QDS using MTFs with different edge intensities. As compared with a digital phantom, our actual phantom is considered to be a useful tool in order to know the overall processing results containing the feature of each CT scanner and reconstruction filter of manufacturing companies and the performance of a nonlinear noise reduction filter.

We have newly proposed heterogeneous multi-chip module integration technologies in which MEMS and LSI chips are mounted on Si or flexible substrates using a self-assembly method. A large numbers of chips were precisely and simultaneously self-assembled and bonded onto the substrates with high alignment accuracy of approximately 400 nm. Thick MEMS and LSI chips with a thickness of more than 100 mum were electrically connected by unique lateral interconnections formed crossing over chip edges with large step height. We evaluated fundamental electrical characteristics using daisy chains formed crossing over test chips which were face-up bonded onto the substrates by the self-assembly. We obtained excellent characteristics in these daisy chains. In addition, RF test chips with amplitude shift keying (ASK) demodulator and signal processing circuits were self-assembled onto the substrates and electrically connected by the lateral interconnections. We confirmed that these test chips work well.

A 48-year-old woman who had conscious disturbance and abnormal behaviors had been misdiagnosed as having hepatic encephalopathy due to hyperammonemia and portal-systemic shunt, and retrograde transvenous obliteration of the shunt did not improve her symptoms. Thereafter, analyses of plasma amino acids and citrin gene revealed a diagnosis of adult onset type II citrullinemia (CTLN2). She underwent auxiliary partial orthotopic liver transplantation (APOLT) using a left lobe graft from her brother, and her symptoms as well as hyperammonemia improved. Our case demonstrates the importance of CTLN2 as a differential diagnosis in patients with hyperammonemia and consciousness disturbance, even if they present with a portal-systemic shunt.

Medical physics plays an essential role in modern medicine. This is particularly evident in cancer care where medical physicists are involved in radiotherapy treatment planning and quality assurance as well as in imaging and radiation protection. Due to the large variety of tasks and interests, medical physics is often subdivided into specialties such as radiology, nuclear medicine and radiation oncology medical physics. However, even within their specialty, the role of radiation oncology medical physicists (ROMPs) is diverse and varies between different societies. Therefore, a questionnaire was sent to leading medical physicists in most countries/areas in the Asia/Pacific region to determine the education, role and status of medical physicists. Answers were received from 17 countries/areas representing nearly 2800 radiation oncology medical physicists. There was general agreement that medical physicists should have both academic (typically at MSc level) and clinical (typically at least 2 years) training. ROMPs spent most of their time working in radiotherapy treatment planning (average 17 hours per week); however radiation protection and engineering tasks were also common. Typically, only physicists in large centres are involved in research and teaching. Most respondents thought that the workload of physicists was high, with more than 500 patients per year per physicist, less than one ROMP per two oncologists being the norm, and on average, one megavoltage treatment unit per medical physicist. There was also a clear indication of increased complexity of technology in the region with many countries/areas reporting to have installed helical tomotherapy, IMRT (Intensity Modulated Radiation Therapy), IGRT (Image Guided Radiation Therapy), Gamma-knife and Cyber-knife units. This and the continued workload from brachytherapy will require growing expertise and numbers in the medical physics workforce. Addressing these needs will be an important challenge for the future.

The effects of L-arginine (Arg) derivatives on soluble guanylate cyclase from neuroblastoma N1E 115 cells were examined. The Arg derivatives were modified at the -NH2, -COOH, C alpha-proton or guanidino group of Arg. Among the synthesized derivatives, eight compounds, i.e. the 5-(dimethylamino)-1-naphthalenesulfonyl (DNS) ones, especially N-cyclohexyl-2-(N-DNSamino)-5-guanidino-2-methylvaleramide and 1-[2-(N-DNSamino)-2-(2-imino-1,2,3,4,5,6-hexahydropyrimidin- 4-yl)acetyl]- piperidine, were found to inhibit the activity of crude guanylate cyclase in the 105,000 g supernatant fraction of the cell homogenate. The enzyme, partially purified by a column of Chelex 100 Na+, was also inhibited by these eight compounds. The mode of the inhibition was competitive. The Ki values were in the range of 2-8 microM for the enzyme in the 105,000 g supernatant fraction and 3-16 microM for the partially purified enzyme, in the presence of Mg2+ as a metal cofactor. In contrast, a new derivative, methyl 2-amino-5-guanidinovalerate (M Arg ME), as well as the Arg methyl ester (Arg ME) and Arg; were found to enhance the activity of the partially purified guanylate cyclase; KA values of M Arg ME, Arg ME and Arg were approximately 9, 4 and 3 microM respectively. From these results, the free guanidino group including 2-imino-1,2,3,4,5,6-hexahydropyrimidin-4-yl or 2-imino-1,2,3,4,5,6-hexahydropyrimidin-5-yl and modification of the --NH2 residue with a hydrophobic group such as DNS seemed to be essential for inhibition of the guanylate cyclase; however, the guanidino and --NH2 residue of Arg should be free for activation by these Arg derivatives.

We have proposed a new three-dimensional (3D) integration technology based on reconfigured wafer-on-wafer bonding technique to solve several problems in 3D integration technology using the conventional wafer-on-wafer bonding technique. 3D LSIs are fabricated by bonding the reconfigured wafers onto the supporting Si wafer. The reconfigured wafer consists of many known good dies (KGDs) which are arrayed and glued on a holding Si wafer with Si steps by chip self-assembly technique. Therefore, the yield of the reconfigured wafer can be 100%. As a result, we can obtain a high production yield even after bonding many wafers. In addition, it is not necessary in the reconfigured wafer that the chip size has to be identical within the wafer. Therefore, we can stack various kinds of chips with different chip sizes, different materials and different devices in our new 3D integration technology based on the configured-wafer-on-wafer bonding technique (Reconfig. W-on-W 3D technology). We have developed key technologies to form W through-Si-Via (TSV) in the reconfigured wafer to fabricated 3D LSI test chips. We obtained excellent electrical characteristics of W-TSV using the daisy chain in 3D LSI test chip.

SummaryPrimary biliary cirrhosis (PBC) is an autoimmune disorder that specifically destroys biliary epithelial cells (BECs). In patients with PBC, the immunodominant pyruvate dehydrogenase complex E2 component (PDC-E2), identified as an antigen for disease-specific anti-mitochondrial antibody, is expressed aberrantly in the BEC cytoplasm. The present study focused on the pathophysiological role of aberrant PDC-E2 in the development of PBC. The BEC-specific cytokeratin-19 promoter and PDC-E2 gene were cloned from a mouse cDNA library. The constructed transgene was microinjected into fertilized eggs of mice, and the offspring were identified by Southern blotting and reverse transcriptase–polymerase chain reaction. The protein expression was confirmed by immunoprecipitation, immunoblotting and immunohistochemical staining. Five founder lines were identified as carrying the PDC-E2 gene, and one of these lines expressed PDC-E2 mRNA. The protein expression of exogenous PDC-E2 was detected in the liver. The transgenic mouse line showed diffuse expression of PDC-E2 in the BEC cytoplasm. Biochemical, serological and histological features of PBC were not detected. We established transgenic mice that constitutively express PDC-E2. The results indicated that aberrant PDC-E2 expression in the cytoplasm of BECs is not sufficient for the initiation of autoimmunity. Additional factors may be required to establish a model of PBC.

Current technology and perspective of future technology related to IMAC are discussed in terms of hardware as well as software. Items covered are: computers, communication, file media, data acquisition, display, image data compression, AI, opto- electronic devices, software, standardization, and future IMAC. Important specific items such as calculation speed, communication speed, archiving capability, and bit cost are quantitatively depicted and predicted. Three axes, communication speed axis, data volume axis, and time axis are taken as x, y, and z axis respectively and key technologies are expressed by vectors in this xyz space. Performance of present IMAC and prediction of it are illustrated as the sum of these vectors. Deficiency in technology, standing problems to be solved and obstacles to be broken through are pointed out and the methods in what way they could be done with are proposed. Finally, integrated IMAC systems in future inside and outside of hospitals are proposed being based upon conclete development prediction such as functional assignment of LAN for each work and ISDN application.

We had investigated autocorrelation and frequency correlation coefficients of an instantaneous received signal level with bandwidth, one of the basic wideband propagation characteristics in mobile communications, by using a delay profile model with invariable arrival wave amplitude. However, the arriving wave amplitude in an actual field was known to vary with the movement of the receiving point. We clarify the dependence of the correlation coefficients on the amplitude variation of the arriving waves by using computer simulations. Our results show that the autocorrelation coefficient is independent of the amplitude variation in the arriving wave. Furthermore, the frequency correlation coefficient increases because of the median variation in the received level.

A new three-dimensional (3D) integration technology based on wafer bonding technique has been proposed for intelligent image sensor chip with 3D stacked structure. We have developed key technologies for such 3D integration. A 3D image sensor test chip was fabricated using this 3D integration technology. Basic electric characteristics were evaluated in the 3D image sensor test chip.

Information processing in the human brain is based on advanced parallel processing with a large number of memories and interconnections. To achieve such highly advanced parallel processing, the human brain has modules with layered structures, that is, three-dimensional structures as basic processing units. The human retina and visual cortex also have layered structures with various kinds of cells. The three-dimensional (3D) integration technology reported here achieves an image processing and pattern recognition system with parts of functions of the retina and visual cortex using silicon.

We developed a new PACS linked to Electronic Patient Record system (EPR). It was a hospital-wide PACS storing all the radiological examinations. The images and reports were linked on EPR. The concept of navigation servers and segment servers was introduced for prefetchig and quick displaying. After the start of operation, increasing retrieval indicated its effectiveness on practical work in spite of remaining delivery of radiographs.

Erythromycin is reported to have an anti-inflammatory action, which may account for its clinical effectiveness in treating chronic inflammatory diseases of the respiratory tract such as diffuse panbronchiolitis (DPB) and chronic sinusitis. The evaluate the anti-inflammatory action of erythromycin, we examined apoptosis of isolated neutrophils incubated with and without erythromycin. As a result, erythromycin augmented neutrophil apoptosis in a dose-dependent manner, with a maximal effect at 10 micrograms/ml and above. The percentage of neutrophil apoptosis at 12 h was 79.2 +/- 2.3% in medium with 10 micrograms/ml of erythromycin compared with 51.2 +/- 4.1% in control medium (p0.005). In a manner similar to that of erythromycin, another macrolide antibiotic, roxithromycin, also increased neutrophil apoptosis. However, there was no effect on apoptosis induced by treatment with josamycin (macrolide antibiotic), ampicillin (beta-lactam.) and cefazolin (cephalosporin antibiotic), or gentamycin (aminoglycoside). These findings suggest that erythromycin shortens neutrophil survival by accelerating neutrophil apoptosis.

We developed a reliable system for the irradiation of xenografted tumors in mice which allows for accurate local irradiation under specific pathogen-free conditions. The system presented here consists of acrylic supports for mice and an acrylic box connected to a pump through 0.22 microns pore-sized filters. Mice with xenotransplanted tumors growing on their right hind legs were set on the supports and put into the box in a laminar flow hood. The tumors of 7 mice were irradiated simultaneously with X-rays of 6 and 10 MV generated by a linear accelerator at a dose rate of 3.1-4.7 Gy/min. The air was ventilated through filters during irradiation in the closed box. Microorganism tests confirmed that no bacteria entered or left the box. One of the significant characteristics of this setup is that it allows for irradiation under conditions of acute hypoxia, which is obtained using an integrated tourniquet. The dose variation among 7 tumors was less than 1%. The rest of the mouse's body was shielded effectively by a half-field technique and a lead block. As a result, the whole body dose for the mice was 0-4% of the total dose absorbed by the tumor. Due to the high dose rate and the ability to irradiate 7 mice simultaneously under specific pathogen-free conditions, this new system can be considered a time-saving and valuable tool for radiation oncology research.

To examine whether the Patterns of Care Study (PCS) reflects the data for the major areas in Japan, the consistency of variables in the PCS and in the major area database of the Japanese Society for Therapeutic Radiology and Oncology (JASTRO) were compared.Patients with esophageal or uterine cervical cancer were sampled from the PCS and JASTRO databases. From the JASTRO database, 147 patients with esophageal cancer and 95 patients with uterine cervical cancer were selected according to the eligibility criteria for the PCS. From the PCS, 455 esophageal and 432 uterine cervical cancer patients were surveyed. Six items for esophageal cancer and five items for uterine cervical cancer were selected for a comparative analysis of PCS and JASTRO databases.Esophageal cancer: Age (p=.0777), combination of radiation and surgery (p=.2136), and energy of the external beam (p=.6400) were consistent for PCS and JASTRO. However, the dose of the external beam for the non-surgery group showed inconsistency (p=.0467). Uterine cervical cancer: Age (p=.6301) and clinical stage (p=.8555) were consistent for the two sets of data. However, the energy of the external beam (p.0001), dose rate of brachytherapy (p.0001), and brachytherapy utilization by clinical stage (p.0001) showed inconsistencies.It appears possible that the JASTRO major area database could not account for all patients' backgrounds and factors and that both surveys might have an imbalance in the stratification of institutions including differences in equipment and staffing patterns.

The criterion for clinical evaluation of radiotherapy is defined by the authors as follows: Cost-effectiveness = Quality adjusted life year of a patient divided by the expenditure for the patient. Here, quality adjusted life year is calculated by estimating transition probabilities employing the Malkov process model. An expression model for estimation of radiotherapy effectiveness of the patient was proposed and applied. The actual cost of radiotherapy for the patient was calculated by carrying out a Care Map Study in a radiotherapy facility. The time study measures, the hours spent treating the patient by the kind of medical staff. Then, cost-effectiveness was calculated using these two variables in 2,926 patients from 147 radiotherapy facilities collected from a multi-institutional radiation oncology database developed and operated for the five years. A worksheet composed of 55 items of radiotherapy record for one site of a patient. Another worksheet for patient follow-up was composed of 14 items. Six retrospective and prospective data collections and three follow-up investigations were carried out. This study intended to determine the cost-effectiveness of radiotherapy in terms of cancer sites, diseases and treatment modalities. A further target is to expand this method to evaluate new technologies of health care at large as well as radiation oncology.

First, annual cost of electronic filing of medical images were calculated and compared with that of film storage in two hospitals under different conditions. Storage of medical images using a pixel size of 100 microns x 100 microns and 2-byte depth on the 130 mm, 650 MB magneto-optical disks costs with four times as much as the cost for film storage. However, 175 microns x 175 microns 12 bits combined with implementation of lossless compression would reduce the cost to a level equal to that for films storage. Doubled or tripled densities of MOD will improve the cost ever further. Second, the effectiveness of Hospital Information System/Radiological Information System (HIS/RIS) was evaluated. Examination time, film delivery time and the total turn-around time was markedly shortened by more than 23 hours on average. Our measurement method employing IC cards in pre-post HIS/RIS/PACS procedures is generally applicable to other hospitals. Third, to determine the optimal method of maximizing the efficacy of diagnostic imaging, 260 questionnaires were sent to the staff of 13 university hospitals. Every situation was described by both a radiologist and the physician who ordered the examination and received the reports and images. The level of technical efficacy and diagnostic accuracy of radiology strongly influenced the diagnostic thought processes of the physician.

To clarify the contribution of voluntary muscle contractions on the cardiovascular variables of humans, we measured stroke volume (SV), heart rate (HR), and cardiac output (CO) by impedance plethysmography in young males maintaining an upright standing position with 1) no voluntary muscle contractions owing to as little movement as possible (control condition), 2) voluntary muscle contractions in the calves along with a forward sway of the body, and 3) muscle contractions throughout the legs along with a backward sway. Muscle contraction in the calves did not provoke any significant increase in either SV or CO. Voluntary contractions throughout the legs, on the other hand, caused a reduction in SV and CO. From these observations we may conclude that contractions along with forward or backward swaying dose not enhance venous return unless the abdominal muscle is also contracting and unless the contractions are synchronous to one-minute wave in body fluid volume change.

To clarify the neural mechanisms involved in blood pressure regulation during head-up tilting (HUT), arterial baroreflex controls for heart rate and muscle sympathetic nerve activity (MSNA) were evaluated by applying frequency transfer function and coherence analyses to the equidistant time series data of RR-interval, MSNA and mean blood pressure during graded HUT in six healthy subjects. Coherence analysis indicated that the RR-interval and MSNA were linked linearly with mean blood pressure in the low (0.07-0.12 Hz) and high (0.23-0.27 Hz) frequency domains. Arterial baroreflex gain for the heart rate decreased significantly during HUT, while the baroreflex gain for MSNA showed no significant change. These results indicate that the preserved arterial baroreflex gain for MSNA plays an important role in maintaining blood pressure during orthostasis.

There has been a strong need for a standardized medical image exchange media. MEDIS-DC in Japan created ISC as a standard for this purpose, based on 5.25' rewritable magneto-optic discs, with many specifications such as fast speed read/write, independence of apparatus vendor, additional security features, and data format compatible to ACR-NEMA v.2 image format. ISC is already applied to many institutions, as an alternative for fast expensive networks, long term image casebases and media for teaching file distribution. The ISC committee hopes this standard will be: 1) used at clinics and hospitals, promoting exchange of information between them, 2) harmonized with other standardization activities, and 3) a basis for future electronic semantic medical records.

The round table discussions dealt with standardisation and its role in PACS and medical imaging, and with the assessment of medical imaging and targeting RD based on that. Two approaches to enable image files to be transferred were discussed in the standardisation sessions. Firstly, the standardisation efforts in Europe, USA and Japan which all focus on a single standard on image transfer and file format were discussed. A plea was made to merge these three approaches. It was also noted that the Japanese ISC standard is essentially a standard for off-line PACS. Secondly, an argument was raised that as several i age file formats are already in existence (because of the different computer platforms in use), what is needed are converters between these de-facto formats instead of striving towards one common standard. The round table on assessment focused on the changes in the radiological practices which are already emerging following the introduction of new digital imaging modalities. It was argued that PACS will cause further organisational changes because a hospital-wide PACS enables images to be viewed everywhere. The radiology meetings have been the mechanism for discussing difficult cases. In the PACS world their role may change. However, PACS will only diffuse when it offers clear advantages over the present procedures. This means that PACS, digital imaging and radiology practices evolve in parallel and incrementally.

The incidence and titer of ANCA were examined with 871 sera from patients with otorhinolaryngological diseases at our hospital. The cytoplasmic pattern of ANCA (c-ANCA) whose titer was more than 16 was detected only in the sera of patients with Wegener's granulomatosis (WG). The incidence of c-ANCA in active WG was more than 90%. The perinuclear staining pattern of ANCA (p-ANCA) was detected in almost 40% of patients with Sjögren's syndrome, 2.0% of inflammatory diseases and 1.0% of tumorous diseases. A high diagnostic value of c-ANCA in WG was found in patients with otorhinolaryngological diseases.

An experimental radiologic reporting system using oral presentations has been developed and tested. The rewritable and compact magneto-optical disk (MOD) is employed to store oral diagnostic reports together with read radiologic images. The MOD is 5.25 inches in diameter, has a 600 MB memory capacity, and is erasable, light and compact. Advantages of the system are simultaneous retrieval of oral reports by a radiologist and the images he or she interpreted, and the capability of media circulation in addition to the function of filing. Thus MOD has a multimedia function of both off-line communication and filing. When medical images are interpreted and oral presentations are registered, automatically digitized oral reports and digitized images are filed in the MOD. Referring physicians can get oral diagnostic reports and can see the images at the same time on a personal computer. Furthermore, integration with voice recognition capability is being tried in our experiment.

In clarifying the role of sympathetic nerve outflow to the muscles in the genesis of one-minute waves in body fluid volume, power spectral analysis of muscle sympathetic nerve activity (MSNA) was performed. MSNA was recorded by microneurography in an upright standing position simultaneously with the measurements of body circumference, venous pressure at the dorsum pedis veins, intrathoracic fluid volume, soleus EMG, and calf fluid volume. Subjects were seven healthy male volunteers aged 18 to 32 years. Spectral analysis revealed the one-minute oscillation in MSNA as well as in other variables. Cross spectral analysis between the soleus EMG and each variable revealed a phase order of the one-minute oscillations. It was as follows: 1) an increase in calf fluid volume; 2) a decrease in intrathoracic fluid volume; 3) an increase in venous pressure at the dorsum pedis veins; 4) an increase in the soleus EMG activation; 5) an activation of MSNA; 6) a decrease in calf fluid volume; and 7) an increase in intrathoracic fluid volume. It is concluded that sympathetic nerve activity as well as cardiovascular variables have a cyclic rhythm with a duration of one minute to maintain hemodynamic homeostasis in humans in an upright standing position.

Computer image processing was used to enhance gastric lesions in order to improve the detection of stomach cancer. Digitization was performed in 25 cases of early gastric cancer that had been confirmed surgically and pathologically. The image processing consisted of grey scale transformation, edge enhancement (Sobel operator), and high-pass filtering (unsharp masking). Gery scale transformation improved image quality for the detection of gastric lesions. The Sobel operator enhanced linear and curved margins, and consequently, suppressed the rest. High-pass filtering with unsharp masking was superior to visualization of the texture pattern on the mucosa. Eight of 10 small lesions (less than 2.0 cm) were successfully demonstrated. However, the detection of two lesions in the antrum, was difficult even with the aid of image enhancement. In the other 15 lesions (more than 2.0 cm), the tumor surface pattern and margin between the tumor and non-pathological mucosa were clearly visualized. Image processing was considered to contribute to the detection of small early gastric cancer lesions by enhancing the pathological lesions.