The Swiss IMRT dosimetry intercomparison using a thorax phantom.

PURPOSE: In 2008, a national intensity modulated radiation therapy (IMRT) dosimetry intercomparison was carried out for all 23 radiation oncology institutions in Switzerland. It was the aim to check the treatment chain focused on the planning, dose calculation, and irradiation process. METHODS: A thorax phantom with inhomogeneities was used, in which thermoluminescence dosimeter (TLD) and ionization chamber measurements were performed. Additionally, absolute dosimetry of the applied beams has been checked. Altogether, 30 plan-measurement combinations have been used in the comparison study. The results have been grouped according to dose calculation algorithms, classified as "type a" or "type b," as proposed by Kntis et al. ["Comparison of dose calculation algorithms for treatment planning in external photon beam therapy for clinical situations," Phys. Med. Biol. 51, 5785-5807 (2006)]. RESULTS: Absolute dosimetry check under standard conditions: The mean ratio between the dose derived from the single field measurement and the stated dose, calculated with the treatment planning system, was 1.007 +/- 0.010 for the ionization chamber and 1.002 +/- 0.014 (mean+/- standard deviation) for the TLD measurements. IMRT Plan Check: In the lung tissue of the planning target volume, a significantly better agreement between measurements (TLD, ionization chamber) and calculations is shown for type b algorithms than for type a (p <0.001). In regions outside the lungs, the absolute differences between TLD measured and stated dose values, relative to the prescribed dose, [(Dm-Ds)/Dprescribed], are 1.9 +/- 0.4% and 1.4 +/- 0.3%, respectively. These data show the same degree of accuracy between the two algorithm types if low-density medium is not present. CONCLUSIONS: The results demonstrate that the performed intercomparison is feasible and confirm the calculation accuracies of type a and type b algorithms in a water equivalent and low-density environment. It is now planned to offer the intercomparison on a regular basis to all Swiss institutions using IMRT techniques.

Responses of single neurons in the parietoinsular vestibular cortex of primates.

1. Neurons activated by stimulation of the horizontal and/or vertical vestibular semicircular canals were recorded in the parietoinsular vestibular cortex in four awake Java monkeys (Macaca fascicularis) and three squirrel monkeys (Saimiri sciureus). Steady tilt in darkness or during illumination of a vertically striped cylinder or of the normal laboratory surroundings did not lead to a significant change in PIVC neuron activity. Thus vestibular input to this cortical region seems to be restricted to signals originating in the semicircular canal receptors. 2. Vestibular stimulation in the three main experimental planes (roll, yaw, and pitch) and in planes in between provided clear evidence that optimum activation can be found in planes that do not coincide with the planes of the semicircular canals but are distributed over all possible spatial planes through the head. 3. Definite evidence of clustering in subdivisions of PIVC of neurons responding to the same optimum rotation plane was obtained in squirrel monkeys and is also suggested to exist in PIVC of Java monkeys. 4. Nearly all neurons responding to vestibular stimulation were also activated by visual large-field movement (optokinetic stimulation). Responses to optokinetic stimuli were always at optimum when the direction of the movement pattern corresponded to the optimum vestibular plane. Two classes of visual-vestibular interaction were found: Synergistic neurons were those PIVC cells with the strongest response to visual movement stimulation in the opposite direction to that leading to a maximum response to vestibular stimulation. Antagonistic neurons had a response maximum when the visual stimulus was moved in the direction of optimum vestibular stimulation. 5. Most PIVC neurons responded to stimulation of the deep mechanoreceptors in the neck region. This input from the neck receptors was tested quantitatively only in the horizontal plane (trunk rotation with the head fixed in space or head rotation with the trunk fixed in space). It interacted with vestibular signals at the PIVC neurons either in an antagonistic or a synergistic manner, the latter meaning activation during rotation of the head in the same direction as that leading to activation induced by semicircular canal stimulation. 6. In addition to the direction-specific vestibular, visual, and neck receptor inputs, a rather complex somatosensory input to PIVC neurons exists, including responses to stimulation of mechanoreceptors of the skin, the muscles, and the joint receptors of legs and arms. Total body vibration also led to activation of some of the neurons.(ABSTRACT TRUNCATED AT 400 WORDS)

A test movie to study elementary abilities in perception and recognition of mimic and gestural expression.

A test movie consisting of 13 different silent movie scenes, each 10 s in duration, was developed to test in patients the elementary abilities, perception and recognition of mimic and gestural expression. Each scene was subjected to 10 (2 X 5) verbal or non-verbal multiple-choice tests. Quantitative analysis of normal control group results is described. All sub-tests were very easy for normals and resulted in error scores below 5%. Thus the test is not designed to differentiate within a group of normal subjects but to characterize a pathological reduction in mimic, gesture and person recognition in schizophrenic and brain-lesioned patients. By measuring the dependency of correct recognition of the different movie scenes on the inspection duration, it was shown that the projection time of 10 s applied in the full test led to a fairly high amount of informational redundancy. This was intentional so that stimulus material could be well perceived and recognized even by patients with somewhat fluctuating attentiveness.

Impairment of perception and recognition of faces, mimic expression and gestures in schizophrenic patients.

The perception and recognition of faces, mimic expression and gestures were investigated in normal subjects and schizophrenic patients by means of a movie test described in a previous report (Berndl et al. 1986). The error scores were compared with results from a semi-quantitative evaluation of psychopathological symptoms and with some data from the case histories. The overall error scores found in the three groups of schizophrenic patients (paranoic, hebephrenic, schizo-affective) were significantly increased (7-fold) over those of normals. No significant difference in the distribution of the error scores in the three different patient groups was found. In 10 different sub-tests following the movie the deficiencies found in the schizophrenic patients were analysed in detail. The error score for the averbal test was on average higher in paranoic patients than in the two other groups of patients, while the opposite was true for the error scores found in the verbal tests. Age and sex had some impact on the test results. In normals, female subjects were somewhat better than male. In schizophrenic patients the reverse was true. Thus female patients were more affected by the disease than male patients with respect to the task performance. The correlation between duration of the disease and error score was small; less than 10% of the error scores could be attributed to factors related to the duration of illness. Evaluation of psychopathological symptoms indicated that the stronger the schizophrenic defect, the higher the error score, but again this relationship was responsible for not more than 10% of the errors. The estimated degree of acute psychosis and overall sum of psychopathological abnormalities as scored in a semi-quantitative exploration did not correlate with the error score, but with each other. Similarly, treatment with psychopharmaceuticals, previous misuse of drugs or of alcohol had practically no effect on the outcome of the test data. The analysis of performance and test data of schizophrenic patients indicated that our findings are most likely not due to a "non-specific" impairment of cognitive function in schizophrenia, but point to a fairly selective defect in elementary cognitive visual functions necessary for averbal social communication. Some possible explanations of the data are discussed in relation to neuropsychological and neurophysiological findings on "face-specific" cortical areas located in the primate temporal lobe.

Comparative studies on recognition of faces, mimic and gestures in adolescent and middle-aged schizophrenic patients.

In adolescent and middle-aged schizophrenic patients and normals 10 different multiple-choice tests of 12 scored movie scenes lasting 10s were applied, measuring the ability to recognize faces, persons and mimic expressions. In all tests errors were significantly higher by a factor of 7 to 14 in patients as compared to normals. The relative impairment of adolescent schizophrenic patients (as compared to adolescent normals) was somewhat stronger than that of adult schizophrenics. This supports the hypothesis that the impairment found in schizophrenic patients is caused by the disease and not by other factors such as duration of illness or hospitalization.