Computer-based collection of mammographic exposure data for quality assurance and dosimetry

PURPOSE

There is potentially more to quality assurance in mammography than the MQSA mandated tests. In this paper we describe a method of capturing individual mammogram technical parameters and the creation of new measures. These include the numbers of images required for each screening examination by technologist, median compression by technologist, and the radiation dose of the examination to the general population of patients.

METHOD/MATERIALS

With this method we describe a semiautomated method of the collection of technical data from mammography exposures. The data that are automatically created by the mammography unit are saved on a computer for later analysis. The method was used on 2738 consecutive screening mammography examinations and 13 621 exposures from one machine. Data were obtained from November 1998 through December 1999.

RESULTS

Using standard methods, the mean glandular dose (MGD) per exposure was 2.62 mGy (SD 1.2). The mean dose per bilateral screening examination was 6.53 mGy (SD 3.07), the median dose was 6.11 mGy, and the dose range was 1.13-34.23 mGy. Rhodium filtration was used for 18% of the exposures. The average and median breast thickness was 4.9 cm. The ACR phantom MGD for this machine was 2.44 mGy at 25 kVp, and 1.97 mGy at 26 kVp. The mean number of exposures for a bilateral mammogram was 4.9, and varied by a technologist from 4.7 to 5.2. The mean compression pressure varied by technologist from 13 to 30 lbs (58-134 N).

CONCLUSIONS

The mean dose per mammogram is slightly greater than the ACR phantom dose at 25 kVp. Almost five exposures were necessary for a standard bilateral examination, and this varied by technologist. The compression used also varied by technologist. The semiautomated collection of technical data can aid in maintaining an effective mammography QA program.

CT scanning: patterns of use and dose

CT scanning is a relatively high-dose procedure. In spite of the use of magnetic resonance imaging, with faster CT scanners and helical techniques CT is becoming more common. There are few data from practice in the United States regarding the age and sex distribution of patients receiving CT scans, what type of scan and how many scans they receive, or how much radiation dose CT scans contribute. We reviewed over 33,700 consecutive CT examinations done at our institution in 1998 and 1999. Information on the types of scans as well as the age and sex distribution of the patients was determined. Between 1990 and 1999, CT examinations in our institution increased from 6.1% to 11.1% of all radiology procedures. Nineteen per cent of all patients seen in our department in the last year had at least one CT scan and more than half had multiple scans on the same day. Thirty-six per cent of all patients had a prior CT examination done on an earlier date. The male/female ratio of patients was 56/44. Studies of children age 0-15 years comprised 11.2% of scans. The highest percentage of scans was done in the 36-50-year-old age group. CT scanning accounted for 67% of the effective dose from diagnostic radiology. In most large hospitals in the United States CT scanning probably accounts for more than 10% of diagnostic radiology examinations and about two-thirds of the radiation dose. Most patients have multiple scan sequences. Studies done on children are probably more common than previously thought.

Xenon spill distribution and room clearance

The purpose of these studies was to investigate actual xenon gas clearance times under different exhaust conditions, to compare them with the calculated clearance times, to observe the distribution of the xenon gas while it was being exhausted from the room, and to determine the cause of a stationary xenon cloud that appeared on some clinical images. Clearance times with and without a flexible exhaust hose placed next to a simulated 133Xe gas spill were compared with clearance times measured in a room with all exhaust closed off. Two gamma cameras were used to observe the transport and exhaust of xenon following a simulated spill. Clearance times with the flexible exhaust hose were less than one minute because the xenon gas was removed before it had a chance to disperse into the room. Conventional room clearance calculations based on uniform mixing and measured exhaust rates yielded a clearance time of 22 min. The source of an artifactual stationary cloud image was discovered to be a small amount of xenon trapped between the collimator and camera face. A negative pressure and dedicated exhaust can be even more effective in exhausting spilled xenon from a room than air transfer calculations predict. The authors believe the flexible hose should always be used.

Effects of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: review of 183,134 screening mammograms in Albuquerque, New Mexico

PURPOSE

To examine how common patient factors affect screening mammographic sensitivity and cancer stage at diagnosis.

MATERIALS AND METHODS

The authors used a population-based database of 183,134 screening mammograms and a statewide tumor registry to identify 807 breast cancers detected at screening mammography.

RESULTS

Sensitivity varied significantly with ethnicity, use of estrogen replacement therapy, mammographic breast density, and age. Sensitivity was 54% (13 of 24) in women younger than 40 years, 77% (121 of 157) in women aged 40-49 years, 78% (224 of 286) in women aged 50-64 years, and 81% (277 of 340) in women older than 64 years. Sensitivity was 68% (162 of 237) for dense breasts and 85% (302 of 356) for nondense breasts and 74% (180 of 244) in estrogen replacement therapy users and 81% (417 of 513) in nonusers. Sensitivity was most markedly reduced with the combination of dense breasts and estrogen replacement therapy use; there was little difference when only one factor was present. Median cancer size and the percentage of early cancers showed little change with any factors.

CONCLUSION

Age is a minor determinant of mammographic sensitivity in women aged 40 years or older. Sensitivity is substantially decreased with the combination of higher breast density and estrogen replacement therapy use. There was not a notable shift in cancer outcomes in the groups with lower mammographic sensitivity. These data do not support different screening recommendations in women aged 40-49 years or in estrogen replacement therapy users.

Distinguishing hantavirus pulmonary syndrome from acute respiratory distress syndrome by chest radiography: are there different radiographic manifestations of increased alveolar permeability?

Hantavirus infection may cause diffuse air space disease, termed hantavirus pulmonary syndrome (HPS). The authors sought to determine if chest radiographs could differentiate HPS from typical acute respiratory distress syndrome (ARDS). The authors identified patients with either HPS (n = 11) or acute ARDS (n = 32) and selected the earliest chest radiograph showing diffuse airspace disease, and a chest radiograph taken 24 to 48 hours previously. Thoracic and general radiologists first viewed the chest radiograph showing diffuse air space disease, and ranked the likelihood that each case represented HPS versus ARDS. Afterward, readers viewed earlier chest radiographs and rescored each case. Receiver operating characteristic (ROC) curves from both scoring sessions were generated. The mean areas under the ROC curves for the entire group was 0.83 +/- 0.12 initially, and improved to 0.87 +/- 0.09 (p < 0.05) after viewing prior chest radiographs. Receiver operating characteristic curves of thoracic radiologists described greater areas than those of general radiologists both before and after viewing prior chest radiographs; 0.95 +/- 0.01 versus 0.78 +/- 0.08 (p < 0.05) and 96 +/- 0.02 versus 0.80 +/- 0.05 (p < 0.05). The mean sensitivity and specificity of chest radiograph interpretation for HPS was 86 +/- 13% and 74 +/- 11%, respectively. Chest radiographs can differentiate HPS from ARDS. Accuracy is improved by the use of serial radiographs and more highly trained readers. The chest radiograph findings may represent differences in the extent of alveolar epithelial damage seen in HPS and ARDS.

192IrCl acid skin burn: case report and review of the literature

A worker was contaminated following a chemical explosion that splashed an HNO3 radioactive solution containing approximately 180 MBq (5 mCi) 192Ir onto the left side of his face. Initial efforts reduced the contamination at least fivefold. Removal of a patch of contaminated hair was necessary. Most of the contamination was fixed to the skin; only a small amount of contamination was absorbed.

Benefits versus risks from mammography: a critical reassessment

BACKGROUND

The use of mammography has increased rapidly over the last decade. The justification for mammographic examinations is the potential benefit they provide in detecting breast cancer at an early stage and reducing mortality. However, this benefit must be balanced against the associated potential risk of radiation carcinogenesis, economic costs, and a number of other factors. Most publications to date have used radiation risk factors and data from studies that were published over a decade ago, which now have been superseded by the results of more recent epidemiological studies.

METHODS

This report examines the current literature regarding the benefits of cancer detection and the risk of radiation carcinogenesis, and calculates the ratio of benefit and risk for women who begin annual mammography screening at different ages. We have used current data to calculate the expected individual benefits and radiation risks associated with annual mammographic screening.

RESULTS

It now appears that there is little risk of breast cancer associated with radiation exposure from annual mammography in women over the age of 35, although there is some indication that exposure of younger women may pose a risk for those women in a genetically sensitive subgroup.

CONCLUSIONS

New data document that for a woman beginning annual mammographic screening at age 50 and continuing until age 75, the benefit exceeds the radiation risk by a factor of almost 100. Even for a woman who begins annual screening at age 35 and continues until age 75, the benefit of reduced mortality is projected to exceed the radiation risk by factor of more than 25.

Radiation dose and image quality of double-loaded cassettes

Some U.S. hospitals double-load x-ray cassettes for certain procedures. Loading two films in the same cassette for portable emergency room (ER), intensive care unit (ICU), or operating room radiographs provides both the referring clinicians and the radiologists with immediate images. Our study demonstrates a cost increase of 15%, an increase in air kerma for a chest x ray from 0.12 to 0.35 mGy (12-35 mrad), slight differences in optical density, image contrast, and spatial resolution under double-loading conditions. Our study shows that double loading cassettes may improve patient care by economically expediting the communication of radiographic findings. The decision to double load portable ICU or ER cassettes must be based on a balance of factors.

Metallic foreign bodies in the orbits of patients undergoing MR imaging: prevalence and value of radiography and CT before MR

OBJECTIVE

The purpose of this study was to measure the prevalence of metallic foreign bodies in the orbits of 15,024 patients who were scheduled for MR imaging during a 4-year period and to determine if screening by plain radiography, CT, or both before MR imaging is efficacious.

MATERIALS AND METHODS

Records of 15,024 patients scheduled for MR imaging were reviewed. A total of 1593 patients who had identified themselves as being at risk for an intraorbital metallic foreign body had undergone plain radiography or CT of the orbits. Plain radiographs and/or CT scans of patients reported as having orbital metal were reviewed to confirm the presence of a metallic foreign body and to identify its location.

RESULTS

Metallic foreign bodies were discovered in 40 patients. Six of these patients had impaired vision in the involved eye. Ten patients had a metallic foreign body in or near the orbit but well away from the globe and were thought to be at low risk for movement of the foreign body as a result of MR imaging. The other 24 patients had metallic foreign bodies adjacent to or within the globe and were thought to be at risk for movement of the metallic foreign body as a result of MR imaging.

CONCLUSION

The prevalence of intraorbital metallic foreign bodies in our study population was low (0.27%). Even in those patients identified as being at risk, the prevalence was only 2.5%. Based on the number of MR examinations performed annually in the United States and on data indicating that no radiographic screening is performed at 5% of institutions, we extrapolate that more than 2400 patients with intraorbital metallic foreign bodies have undergone MR imaging since 1986 without report of injury. These data allow us to infer that the risk of eye damage for patients who have intraorbital metal is low and that radiographic screening before MR imaging is not needed as often as it is done.

Use of radiology in U.S. general short-term hospitals: 1980-1990

PURPOSE

To determine changes in usage of radiologic services between 1980 and 1990.

MATERIALS AND METHODS

Complete data were obtained from 107 (42%) hospitals and incomplete data from eight (3%) (total survey response rate, 45%). Information was requested about the number of general radiologic examinations; specific modalities of computed tomography (CT), magnetic resonance (MR) imaging, nuclear medicine, and ultrasonography (US); and numbers of CT, MR imaging, and US machines.

RESULTS

The number of general radiologic examinations in hospitals increased from approximately 126 million to 179 million (> 42%); for CT, from 3.6 million to 13.3 million; nuclear medicine, from 6.4 million to 7.4 million; and US, from 4.3 million to 11.8 million. MR imaging examinations performed during 1990 were estimated at 1.8 million.

CONCLUSION

The number of radiologic examinations performed in U.S. hospitals increased by 30%-60% between 1980 and 1990, mainly due to increased usage of CT, MR imaging, and US.

Fine needle biopsy without syringe aspiration

Aspiration biopsies of fresh disease-free bovine hepatic liver were performed with three commercially available, small-gauge biopsy needles. A syringe was used to create a negative pressure when using Chiba and Sure-cut needles. A syringe was not used when using PercuCut needles which create an internal negative pressure equivalent to a 1.5 ml syringe when the stylet is partially withdrawn. The PercuCut and Chiba needle yielded a significantly larger specimen size than the Sure-Cut needle. There was no significant difference in sample size between the PercuCut and Chiba needles. All samples were of diagnostic quality.

Ocular hazard of metallic fragments during MR imaging at 0.06 T

The hazard of magnetic resonance (MR) imaging at low field strength (0.06 T) was examined by using both in vitro and in vivo animal experiments. Ferromagnetic fragments, 0.25-2.2 mm in diameter, were placed in vitreous humor obtained from excised cow eyes and in rabbit eyes. The magnetic field strength at which motion occurred was measured for each fragment size. Two types of motion, rotation and translation, were observed. The authors found that fragments that could not be seen on plain radiographs did not appear to move enough to be a significant ocular hazard during MR imaging at a field strength of 0.06 T.

Flexible protective gloves: the emperor's new clothes?

The risk of developing skin cancer is estimated for interventional radiologists who do and do not wear thin, flexible protective leaded gloves. The use of these gloves is extremely expensive in terms of dollars per potential cancer prevented. Good radiographic practice without the use of flexible protective gloves provides adequate protection.

Miniature radiation dosimeter for in vivo radiation measurements

We have made initial characterization measurements on a miniature radiation dosimeter which can be used for in vivo radiation measurements. It consists of a radiation sensing field effect transistor (RADFET) mounted in a 0.8 mm OD plastic catheter. The RADFET acts as a dosimeter by storing trapped charge proportional to absorbed dose. The stored charge signal can be differentiated to give dose rate. We report on the techniques for mounting, a circuit for dose readout, drift of the readings, linearity of response, temperature and angular dependence, and unpowered operation of the device.

Follow-up chest radiographs in Vietnam veterans: are they useful?

Agent Orange exposure and its long-term health consequences on Vietnam veterans have been widely discussed in the past few years. Myriad physical and mental disabilities have been studied with regard to exposure to various herbicides. The number of persons potentially exposed is large, since 2.4-2.8 million U.S. military personnel served in Vietnam. A case-control study was undertaken to determine if persons who served in the U.S. military in Vietnam have either cardiovascular or pulmonary effects that can be demonstrated on long-term follow-up chest radiographs. Information regarding military service in Vietnam was obtained from interviews and, in some cases, review of military records. Vietnam veterans did not have an increased prevalence of abnormalities on follow-up chest radiographs. A subset of Vietnam veterans who had greater estimated opportunities for Agent Orange exposure also did not appear to be at greater risk than the control population.

Chest radiographs obtained with shaped filters: evaluation by observer performance tests

The effectiveness of a shaped filter in improving nodule and infiltrate detection was measured by observer performance testing. Seven observers read 152 test radiographs of the chest obtained from human volunteers. Half the test radiographs had target images. Observer performance in detecting nodule or infiltrate images was compared with the shaped-filter system and with a conventional chest imaging system. The results were analyzed using receiver operating characteristic (ROC) techniques and indicate that the filter technique was not significantly different from the conventional technique in infiltrate depiction. Observer performance in detecting nodules was slightly worse on images obtained with the shaped-filter system.

Thyroid radiation absorbed dose from diagnostic procedures in U.S. population

According to a 1981 survey of thyroid imaging methods in the United States, radionuclide thyroid scans and uptake studies increased 250%-300% between 1966 and 1981, while the U.S. population increased only 17%. Collective absorbed dose decreased from 18 X 10(6) rad (18 X 10(4) Gy) in 1966 to 13.9 X 10(6) rad (13.9 X 10(4) Gy) in 1981. The decrease was due to the use of iodine 123 and technetium 99m pertechnetate rather than iodine 131 (I-131 was used for 100% of scans and uptake studies in 1966 and 10% and 54%, respectively, in 1981) and also to fewer free-standing thyroid uptake studies (150,000 in 1966 and 33,000 in 1981). Even with reduced usage, I-131 still accounted for 93% of the collective absorbed dose in 1981. If I-131 were eliminated from diagnostic procedures, the annual absorbed dose would decrease to 1.4 X 10(6) rad (1.4 X 10(4) Gy). The number of radiation-induced cancer cases would also be reduced.

ROC and contrast detail image evaluation tests compared

Using both contrast detail and receiver operating characteristic (ROC) evaluation tests, we evaluated different quality images, produced with different film-screen combinations. ROC curves were obtained for six observers who were attempting to detect lung nodules and pulmonary infiltrates. The contrast detail curves were obtained from images of regular circular test patterns of differing contrast, which had been presented to the observers. Our results indicate that contrast detail tests can be used for relative ranking of image systems prior to detailed ROC testing.

Trends and utilization of nuclear medicine in the United States: 1972-1982

In the decade 1972-1982, in vivo nuclear medicine procedures in the United States increased from 3.3 million to about 7.5 million per annum. This growth has been the result of a markedly increased frequency in some types of examinations; particularly bone, liver, lung, and cardiovascular imaging. The only type of imaging in which a decrease in frequency has been observed has been in radionuclide brain imaging. Examination of these trends illustrates the difficulty in forecasting, even over time periods as short as 5 years. Competing tests have largely replaced radionuclide imaging in some areas; although in other areas, such as cardiac nuclear medicine, competing technologies appear to have been additive in terms of the frequency of examinations. Comparison with recent data from other countries indicates that the frequency of nuclear medicine procedures in the United States is probably the highest in the world.

Radiation exposure during fluoroscopically controlled percutaneous lithotripsy

Radiation measurements in the vicinity of a standard urologic table modified for fluoroscopic-guided lithotripsy demonstrate radiation levels as high as 3000 mrem per hour at the edge of the table. Excessive radiation exposure to the physician, exceeding the annual maximum permissible dose to the eyes and thyroid, can be expected after only 10 cases. Suggested radiation protection measures include the use of finger, wrist and neck radiation monitors, eye and thyroid shields and improved shielding of both collimator and patient scatter radiation.

Factors affecting perception of pulmonary lesions

The authors review some of the factors that influence the perception of pulmonary lesions: the observer and his environment, the film or other image-recording and display media, the lesion and its qualities, and the technique or modality of examination used.

Anticrossover emulsions evaluated by observer performance tests

Observer performance in the detection of pulmonary nodules and infiltrates was measured using film coated with anticrossover emulsion, a recent innovation in radiographic film that is expected to produce sharper images because of improved resolution. Test radiographs of an anthropomorphic phantom were shown to six experienced observers. Radiographs containing pseudonodule and pseudoinfiltrate images were obtained with the anticrossover film and the same type of film without the anticrossover coating. Test images contained single nodules, single infiltrates, or both; approximately 45% of the test radiographs were normal. Individual receiver operating characteristic (ROC) curves were formed, and sensitivity and specificity values were calculated. The results demonstrated an improvement in observer performance with the anticrossover film as measured by sensitivity and the area under the average ROC curves.

Cost-effectiveness of stereoscopic radiographs in detection of lung nodules

Detection of lung nodules was assessed using a series of radiographs which were either normal or showed only one nodule. Stereoscopic pairs were obtained in 26 cases (10 positive and 16 normal). A "singles" series comprising one radiograph from each pair was presented to each observer on three occasions. The pairs were later presented side by side and finally were viewed stereoscopically. The results indicate that a second shifted radiograph improves detection of lung nodules enough to be cost-effective. The shifted radiographs do not need to be viewed stereoscopically.

Directed versus free search for nodules in chest radiographs

Nodule detection in chest radiographs was compared under free-search and directed-search conditions. In directed search, the observer was told which quadrant of the chest to examine. Each of five observers read a test series of 96 radiographs seven times. Results were analyzed in terms of signal detection theory. NOdule detection was found to be significantly more accurate in directed search than in free search. The results were compared with those of previous experiments which found no such effect or an opposite effect. The present results do not support a previously hypothesized preattentive visual mechanism with better detection capabilities than focused visual attention.

The effect of geometric errors in the reconstruction of iridium-192 seed implants

In the treatment of tumors using interstitial implants of radioactive seeds, the accuracy of computed dose distributions depends upon the accuracy with which the three-dimensional source geometries are reconstructed from radiographs of the implants. The effect of geometric reconstruction errors in iridium-192 seed implants were studied, using tumor dose as the measure. Tumor dose was defined as the average dose around the periphery of the treatment volume. Three ideal mathematical implants and five actual patient implants were used. The implants were distorted by randomly moving a specified number of seeds a specified distance. Tumor doses were directly calculated for the ideal implants. For the actual implants, isodose distributions were plotted and were read by a radiotherapist. For both types of implants, percentage errors in the tumor doses were calculated for the distorted reconstructions relative to the correct reconstructions. It was found that the tumor dose was accurate to within 5% if all the seeds were reconstructed to within 0.5 cm of their actual positions. Furthermore, up to 5% of the seeds could be mismatched between films, or otherwise incorrectly reconstructed, with position errors as large as 20 cm, and not change the tumor dose by more than 5%.

Observer Performance as a function of viewing distance

The performance of observers in detecting solitary lung nodules of 1.0 and 1.5 cm diameter has been measured for viewing distances of 46, 91, 183, and 470 cm. The data indicate that observer accuracy for detection of 1.5-cm nodules as measured by the area under the ROC curves is essentially unchanged for the three closest viewing distances and falls of by about 30% at the largest viewing distance. Observer performance for detection of 1.0 cm nodules, however, improves as the viewing distance is increased from 46 to 91 cm and then decreases at larger viewing distances.

A computerized data base system for medical diagnostic studies (Diastu)

A computerized database system (DIASTU) has been developed for the storage and selective retrieval of the results of medical diagnostic studies. The system is being used to analyze the disease process and the efficacy and yield of selected diagnostic studies. The system runs on a DEC PDP-11/60 computer. It consists of three FORTRAN IV programs linked to a general-purpose assembly language database handler. One program, DSENT, interactively modifies the information in the database. The second, DSLIST, prints all or portions of the database. The third program, DSTAT, interactively assembles the parameters for selective searches of the database and executes them. A query language is used that allows the use of time and size specifications and Boolean operators in nested loops.

CT scanner selection and specification for radiation therapy

The underlying considerations necessary for selecting a CT scanner for radiation therapy treatment planning are analyzed and discussed. To obtain best value for funds expended it is desirable to compare CT scanner mechanical characteristics, data quality, and data handling capabilities. Specifications can be written to ensure prompt delivery of a unit containing all essential features without adding to the cost or complexity of the unit.

Computer interface for a linear accelerator

A computer interface for the Clinac-18 linear accelerator has been developed, using a standard CAMAC interface plus buffer amplifiers to isolate the CAMAC from the accelerator electronics. Buffer amplifiers are employed because direct connection of the CAMAC system to the accelerator was found to affect accelerator operation. The total interface accommodates the four gantry position analog signals and thirteen digital signals describing all available treatment options. The interface also allows the computer to inhibit beam operation.

Computation of dose distributions for radioactive seed implants

An interactive treatment planning program for the computation of dose distributions for 125I and 192Ir seed implants of up to 300 sources is described. The seed coordinates are entered using either the keyboard or a sonic digitizer from either orthogonal or stereo films. The program produces a dose matrix which can be displayed and plotted directly or combined with the putput of other treatment planning programs to provide composite plans for treatments using multiple modalities. Seeds of different activities can be combined within a single plan. The program uses two-letter mnemonics for specifying the available options, among which are commands for choosing standard antero-posterior, lateral, and transverse plans.

Gray-scale ultrasonography in the evaluation of neoplastic invasion of the base of the tongue

Patients with primary carcinoma of the base of the tongue or direct invasion from contiguous areas were examined clinically and with ultrasound, and in some cases with computed tomography (CT), xerography, and polytomography. In all cases, multiple biopsy specimens were obtained. Utrasonography was better than the other imaging methods in delineating disease extent in the tongue itself, while CT and tomography were more useful in evaluating the retropharyngeal and lateral pharyngeal regions. It is suggested that ultrasound be used in the initial evaluation of such patients.

Accuracy of a two-sensor sonic digitizer

Digitizing devices are typically used in radiotherapy computer treatment planning for entering patient anatomy, the locations of internal radioactive source, and the outlines of irregularly shaped external beams. The errors encountered in the use of a large-area two-sensor sonic digitizer for computer input have been studied. Conversion of data from triangular to Cartesian coordinates makes the precision of the digitizer nonuniform over the sensitive area. The response of each senor has been measured and found to be a nonlinear function of distance. The assumption of linearity in computing the triangular distances from the sensor readings produces errors in the computed distances of up to 0.8%. An alternative method of computing the distances using a fitted cubic function reduces the errors to less than 0.1%. For a test pattern, the maximum position error was reduced from 0.5 to 0.1 cm.

Measurement of the effect of inhomogeneities and compensating bolus in clinical pion beams

Measurement of the effects of Telfon and air inhomogeneities on the ionization distributions of clinical negative-pion beams have been made at the Los Alamos Meson Physics Facility. Inhomogeneity location and pion-beam energy vary the effect of multiple coulomb scattering on the dose distribution lying in the penumbra of the inhomogeneity. CH2 bolus adequately corrects for the effects of these inhomogeneities. Bolus misalignment less than 0.5 cm does not seem critical because of large multiple coulomb scattering of the pion beam. However, this and secondary particles emitted from pion stars prevent the pion beam from being precisely shaped with sharp edges, as demonstrated by measurements under a patient bolus.

Performance of a gas target neutron source for radiotherapy

The performance of a compact and efficient neutron generator, using the 3H(d, n) reaction and a gas target, is reported. The target is formed in a windowless, differentially pumped vessel pressurised to 7.5 Torr. An extended source of 15 MeV neutrons is produced when the target is bombarded by a 10 mA beam of 210 keV deuterons. Measurements are reported of the neutron energy spectra, neutron and gamma-ray dose rates, target lifetime and tritium handling. The neutron flux distribution of the extended target was measured and compared with the predictions of a simple beam-gas interaction model. The measured neutron source strength is 1.7 +/- 0.4 X 10(12) neutrons per second. The source output is limited by target beam current, not target power considerations.

Some effects of method on the measured conspicuity of chest lesions

Both the magnitude and the precision of the conspicuity of a series of solitary chest nodules depends on the number and spacing of the measurement points. Observer accuracy in detecting 1.0 cm and 1.5 cm psuedo chest lesions does not correlate well with conspicuity.

Effect of fatigue and alcohol on observer perception

A test series of chest radiographs containing pseudonodules was used to establish baseline sensitivity, specificity, and accuracy rates for individual observers. This experiment studies the effect of fatigue (as subjectively measured) and alcohol (as measured by blood alcohol levels) on observer perception and performance. The results indicate that the fatigue encountered in the course of ordinary professional activities has no significant effect on diagnostic accuracy. Modest quantities of alcohol may adversely influence diagnostic sensitivity, but the effect is unpredictable. Subjective estimates of the influence of fatigue or alcohol on performance by individual observers are frequently erroneous.

A whole body repositioning system

A versatile and easily used whole body repositioning system is described. It may be quickly and inexpensively constructed. The system has been found to be particularly helpful in the extended field treatment of Hodgkin disease, head and neck treatments, and in tumors of the abdomen and pelvis.

Perception of simulated lung lesions

Two series of test radiographs were produced, each containing a single nodular lesion. Each series was identical except that the lesions were spatially shifted with respect to adjacent structures, resulting in matched pairs of chest radiographs simulating a stereoscopic examination. Observation of each set singly and in pairs (non-stereoscopically) demonstrated a marked improvement in observer performance when the shifted pairs were viewed side-by-side.

Current status of clinical pion radiotherapy

An RBE for acute skin reaction to peak pions, for a specific fractionation scheme, has been established at 1.40-1.44. The time of development of acute skin reactions varied in 2 patients with 30 metastatic skin nodules treated with doses varying from 1,175 to 1,951 peak pions and 2,350 to 3,901 rads of 100 kVp x rays. The reactions reached their peak approximately one week apart at all dose levels with both forms of radiation. No untoward effects have been seen in epidermis or subcutaneous tissues as late as 169 days after the start of treatment. All nodules disappeared and have not returned 169 days after treatment. There is a strong suggestion that the response of thick tumors is sensitive to the proportion of high LET radiation deposited at various levels in the tumor.

Dosimetry of pion therapy beams

Cellular, animal, and human radiobiology studies are in progress at the Los Alamos Meson Physics Facility as part of a joint University of New Mexico and Los Alamos Scientific Laboratory pion therapy project. To support these activities, dosimetry has been performed on many different pion beam configurations. The effect of both static and dynamic momentum spreaders and of collimators on beam profiles, depth-dose distributions, and peak-to-plateau ratios have been studied. The absorbed dose is obtained by the application of Bragg-Gray cavity theory to ionization chamber measurements. Calculations have been made for the effective W values and average mass-stopping-power ratios needed for the Bragg-Gray equation. Kerma corrections are applied to transform the dose from the chamber wall to dose in muscle.

Effect of size and position on chest lesion detection

A test series of radiographs was developed by duplicating normal chest radiographs with superimposed masks containing either a 0.5, 1.0, or 1.5 cm pseudolesion. Nine observers participated in the study. Receiver operating characteristic curves were formed and the responses from radiologists and physicists compared. The accuracy rate for detecting 1.0 and 1.5 cm lesions was 44%; for 0.5 cm lesions, 8%. Lesions located in the upper left quadrant were detected with an accuracy of 56% compared to 29% for those in the lower left quadrant.