SU-E-T-216: TPS QC Supporting Program by a Third-Party Evaluation Agency in Japan.

PURPOSE: To equalize the quality of radiation therapy in Japan by supporting quality control of radiation treatment planning system. METHODS: Center for Cancer Control and Information Service in National Cancer Center supports the QA-QC of the cancer core hospitals in Japan as a third-party evaluation agency. Recently, a program for assessing the quality of treatment planning system (TPS) began as a part of our QA-QC supporting activities. In this program, a questionnaire about TPS was sent to 45 prefectural cancer core hospitals in Japan. The object of this questionnaire is to assess the proper commissioning, implement and applications of TPSs. The contents of the questionnaire are as follows; 1) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth with field sizes ranging from 5×5 to 30 × 30 cm2 , and obtain doses at several depths for the calculated MUs, 2) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth for wedge fields whose angles are from 15 to 60 degrees, and obtain doses at several depths with the MUs, 3) calculate MU which deliver 1000 cGy to the point of STD = 100 cm, 10 cm depth with 10×10 cm2 field size and obtain doses at several depths with the MU. RESULTS: In this program, 179 beam data from 44 facilities were collected. Data were compared in terms of dose per MU, output factor, wedge factor and TMR. It was found that 90% of the data agreed within 2%. CONCLUSIONS: The quality of the treatment planning system was investigated through the questionnaire including the information of essential beam data. We compared 179 beam data in TPSs sent from 44 facilities and 90% of the data showed good agreement.

High incidence of fatty liver and insulin resistance in long-term adult survivors of childhood SCT.

Overweight/obesity among adult survivors of childhood SCT has been considered to be predictive of eventual development of metabolic abnormalities. Fatty liver is increasingly recognized as a major cause of liver-related morbidity and mortality in the general population. However, the real incidence of fatty liver in adult survivors of SCT has not been fully elucidated. We determined whether adult survivors are at risk for overweight/obesity, metabolic abnormalities and fatty liver and whether these risks are associated with cranial radiotherapy (CRT) before SCT. Among the 51 patients (30 males), only two male patients were overweight/obese at the last evaluation. On the other hand, 9 male (30%) and 15 female (71%) patients were underweight. Fatty liver was diagnosed in 11 male (37%) and 10 female (48%) patients during the follow-up period, although patients who had fatty liver did not tend to be overweight/obese. Significantly more patients who received CRT before SCT developed fatty liver with insulin resistance than those who did not (P<0.05). Even patients who are not overweight/obese may develop fatty liver and metabolic abnormalities. We recommend that healthcare professionals recognize these risks and give life-long attention to detecting, preventing and treating late complications after SCT.

Development of large deformation in 62Cr.

The structure of neutron-rich isotopes 60Cr and 62Cr was studied via proton inelastic scattering in inverse kinematics. The deformation lengths (delta) for 60Cr and 62Cr were extracted as 1.12(16) and 1.36(14) fm, respectively, providing evidence for enhanced collectivity in these nuclei. An excited state at 1180(10) keV in 62Cr was identified for the first time. We adopted 4;{+} as its spin and parity, leading to the rapid increase of the Ex(4;{+})/E_{x}(2;{+}) ratio, which indicates the development of large deformation in 62Cr near N=40. Importance of the admixture of the gd-shell component above N=40 is also discussed by comparing with a modern shell model calculation.

Primary oral KIT-positive tumour consistent with gastrointestinal stromal tumour.

Gastrointestinal stromal tumours are characteristically positive for KIT (reflective of the c-KIT gene). A case is reported of an apparent rapidly growing gastrointestinal stromal tumour, which arose in the floor of the mouth and metastasized to the left neck without evidence of disease elsewhere.

Isolated osteochondroma near the mandibular angle.

A benign tumour of osseous and cartilaginous origins, osteochondroma generally develops in osseous tissue and is frequently found near the end of long bones. It is relatively rare in the oral and maxillofacial region but is common in the mandibular condyle and coronoid process in the pediculate form. This is a report on a rare case of osteochondroma in soft tissue near the mandibular angle without pedicle to the bone.

Vanishing N = 20 shell gap: study of excited states in (27,28)Ne.

This Letter reports on the (1)H((28)Ne, (28)Ne) and (1)H((28)Ne, (27)Ne) reactions studied at intermediate energy using a liquid hydrogen target. From the cross section populating the first 2(+) excited state of (28)Ne, and using the previously determined BE(2) value, the neutron quadrupole transition matrix element has been calculated to be M(n)=13.8 +/- 3.7 fm(2). In the neutron knockout reaction, two low-lying excited states were populated in (27)Ne. Only one of them can be interpreted by the sd shell model while the additional state may intrude from the fp shell. These experimental observations are consistent with the presence of fp shell configurations at low excitation energy in (27,28)Ne nuclei caused by a vanishing N=20 shell gap at Z=10.

Anomalously hindered E2 strength B(E2;2+(1)-->0+) in 16C.

The electric quadrupole transition from the first 2(+) state to the ground 0(+) state in 16C is studied through measurement of the lifetime by a recoil shadow method applied to inelastically scattered radioactive 16C nuclei. The measured mean lifetime is 77+/-14(stat)+/-19(syst) ps. The central value of mean lifetime corresponds to a B(E2;2+(1)-->0(+)) value of 0.63e(2) fm(4), or 0.26 Weisskopf units. The transition strength is found to be anomalously small compared to the empirically predicted value.

Excision of cervical cystic lymphangioma using injection of hydrocolloid dental impression material. A technical case report.

A lymphangioma, arising in an adult patient, was completely removed after injection of hydrocolloid dental impression material. The postoperative course was uneventful, with no sign of foreign-body reaction. The agar impression material, which had excellent tractability during operation, may be used as a filling material, as long as preoperative examinations show that the tumor does not involve major vessels or nerves.

Pitfalls in the treatment of delayed lymph-node metastases after control of small tongue carcinomas.

Between 1985 and 1992, 13 patients were treated for delayed lymph-node metastases that developed after obtaining control of primary lesions of the tongue. These lesions were treated primarily by radiotherapy or surgical resection; cervical metastases were treated mainly by delayed radical neck dissection (RND). Seven of the 13 patients survived with no evidence of recurrence. The other six patients developed tumors in the neck, and five of these patients died due to uncontrollable disease. In all but one patient, recurrence appeared between the site of the primary lesion and the region of RND, the oral floor and/or the parapharyngeal space. None of the patients with recurrence received radiotherapy in the area between the primary lesion and the site of RND. In contrast, there was no recurrence in patients who received external irradiation to the primary lesion and upper cervical lymph nodes. This review emphasizes the need to direct more attention to the area between the site of the primary lesion and the regional lymph nodes in patients receiving treatment for delayed metastases associated with small carcinomas of the tongue.

Reconstruction of the lips, oral commissure, and full-thickness cheek with a composite radial forearm palmaris longus free flap.

Reconstruction of the lower and upper lips, commissure, and full-thickness cheek defects using a composite radial forearm palmaris longus free flap with secondary commissuroplasty is described. This flap is useful for reconstruction of the total lower lip as well as larger defects that include full-thickness cheek and the commissure.

Imaging time reduction through multiple receiver coil data acquisition and image reconstruction.

A technique is described for the simultaneous acquisition of MRI data using two independent receiver coils surrounding the same region of tissue, which enables the collection of data necessary for image reconstruction in a reduced number of phase-encoded acquisitions. This results in a 50% reduction in minimum scan time and may be useful in time-critical procedures. The algorithm and imaging procedures are described, and example images are shown that illustrate the reconstruction. Signal to noise is decreased by the square root of the time savings, making this technique applicable to cases in which the need to decrease minimum scan time outweighs the signal to noise penalty.

Mediastinitis caused by odontogenic infection associated with adult respiratory distress syndrome.

A case of descending mediastinitis resulting from dental infection and complicated by adult respiratory distress syndrome (ARDS) is reported. The patient had a long history of heavy drinking. His condition was so serious that he died despite some successful therapies. The cause of ARDS appeared to be aspiration pneumonia. It is extremely rare for oral and maxillofacial surgeons to encounter a patient with ARDS.

Intraoperative coronary angiography using fluorescein.

Intraoperative coronary angiography using fluorescein was applied to evaluate the patency of saphenous vein grafts just after completion of the distal anastomosis. By this technique, the area of the revascularized myocardium was well estimated in real time. This intraoperative direct-vision examination gives us more timely and precise information during coronary artery bypass grafting.

[Problems associated with radical neck dissection in patients with tongue carcinoma: four cases of stage I tongue carcinoma that recurred in the cervical area after the dissection].

Reported are four cases of a stage I tongue carcinoma which recurred in the cervical area after a radical neck dissection (RND). In all cases, the primary lesion was controlled with radium needle implants. Clinically, these tumors manifested endophytic growth and, histologically, had a high malignant grading. In most cases, a latent lymph metastasis appeared within 6 months after initial treatment and an early metastatic lesion developed beyond the capsule of the node. The site of cervical recurrences was located in non treated areas that were outside the range of the RND.

Giant cell reaction to ameloblastoma: an immunohistochemical and ultrastructural study of a case.

Histopathologic, immunohistochemical, and ultrastructural features of the giant cells appearing in the tissue surrounding an ameloblastoma are presented. These giant cells exhibited strong activity of a highly stable form of acid phosphatase, and were positive for alpha-1-antichymotrypsin. Ultrastructurally, the cytoplasm of the giant cells contained numerous mitochondria, and the cell membrane was comparatively smooth. Therefore, it is proposed that these multinucleated giant cells are reactive to the invasion of ameloblastoma and are histiocytic in origin.