Dose broadening due to target position variability during fractionated breath-held radiation therapy.

Recent advances in Stereotactic Radiosurgery/Conformal Radiotherapy have made it possible to deliver surgically precise radiation therapy to small lesions while preserving the surrounding tissue. However, because of physiologic motion, the application of conformal radiotherapy to extra-cranial tumors is, at present, geared toward slowing the progression of disease rather than obtaining a cure. At the University of Rochester, we are investigating the use of patient breath-holding to reduce respiratory-derived motion in fractional radiotherapy. The primary targeting problem then becomes the small variation in tumor location over repeated breath-holds. This paper describes the effects of residual target position uncertainty on the dose distribution observed by small extra-cranial tumors and their neighboring tissues during fractional radiation treatment using breath holding. We employ two computational methods to study these effects: numerical analysis via Monte Carlo simulation and analytical computation using three-dimensional convolution. These methods are demonstrated on a 2-arc, 10-fraction treatment plan used to treat a representative lung tumor in a human subject. In the same human subject, the variability in position of a representative lung tumor was measured over repeated end-expiration breath-holds using volumetric imaging. For the 7 x 7 x 10 mm margin used to treat this 12 mm diameter tumor and the measured target position variability, we demonstrated that the entire tumor volume was irradiated to at least 48 Gy-well above the tumoricidal threshold. The advantages, in terms of minimizing the volume of surrounding lung tissue that is radiated to high dose during treatment, of using end-expiration breath holding compared with end-inspiration breath-holding are demonstrated using representative tumor size and position variability parameters. It is hoped that these results will ultimately lead to improved, if not curative, treatment for small (5-20 mm diameter) lung, liver, and other extra-cranial lesions.

Cloze analysis in schizophrenic speech: scoring method and raters' education.

This report examines two methodologic concerns pertaining to use of the cloze procedure in studying the predictability of schizophrenic speech, scoring criteria and raters' education (at or below college level). We find that two strategies for scoring the predictions of raters, one requiring the exact word, the other permitting a reasonable synonym, do not appear to differ in distinguishing groups of patients. The accuracy of raters' guessing is, however, correlated with raters' education: the more educated the rater, the more accurate the guessing. Thought-disordered schizophrenic speech is significantly less predictable than that of nonthought-disordered schizophrenics and normal controls when scored by less educated raters. These differences diminish when more highly educated raters are used. We conclude that raters' education can influence the sensitivity of cloze analysis.