Hard X-ray operation of X-ray gas monitors at the European XFEL.

X-ray gas monitors (XGMs) are operated at the European XFEL for non-invasive single-shot pulse energy measurements and average beam-position monitoring. The underlying measurement principle is the photo-ionization of rare gas atoms at low gas pressures and the detection of the photo-ions and photo-electrons created. These are essential for tuning and sustaining self-amplified spontaneous emission (SASE) operation, machine radiation safety, and sorting single-shot experimental data according to pulse energy. In this paper, the first results from XGM operation at photon energies up to 30 keV are presented, which are far beyond the original specification of this device. Here, the Huge Aperture MultiPlier (HAMP) is used for single-shot pulse energy measurements since the standard X-ray gas monitor detectors (XGMDs) do not provide a sufficient signal-to-noise ratio, even at the highest operating gas pressures. A single-shot correlation coefficient of 0.98 is measured between consecutive XGMs operated with HAMP, which is as good as measuring with the standard XGMD detectors. An intra-train non-linearity of the HAMP signal is discovered, and operation parameters to mitigate this effect are studied. The upper repetition rate limit of HAMP operation at 2.25 MHz is also determined. Finally, the possibilities and limits for future XGM operation at photon energies up to 50 keV are discussed.

The Function of Sleep and the Treatment of Primary Insomnia.

BACKGROUND: Approximately 21 900 women and 35 300 men developed lung cancer in Germany in 2018, and 16 999 women and 27 882 men died of it. The outcome mainly depends on the tumor stage. In early stages (stage I or II), treatment can be curative; unfortunately, because early-stage lung cancers are generally asymptom - atic, 74% of women and 77% of men already have advanced-stage disease (stage III or IV) at the time of diagnosis. Screening with low-dose computed tomography is an option enabling early diagnosis and curative treatment. METHODS: This review is based on pertinent articles retrieved by a selective search of the literature on screening for lung cancer. RESULTS: In the studies of lung cancer screening that have been published to date, sensitivity ranged from 68.5% to 93.8%, and specificity from 73.4% to 99.2%. A meta-analysis by the German Federal Office for Radiation Protection revealed a 15% reduction in lung cancer mortality when low-dose computed tomography was used in persons who were judged to be at high risk for lung cancer (risk ratio [RR] 0.85, 95% confidence interval [0.77; 0.95]). 1.9% of subjects died in the screening arm of the meta-analysis, and 2.2% in the control group. The observation periods ranged from 6.6 to 10 years; false-positive rates ranged from 84.9% to 96.4%. Malignant findings were confirmed in 45% to 70% of the biopsies or resective procedures that were performed. CONCLUSION: Systematic lung cancer screening with low-dose CT lowers mortality from lung cancer in (current or former) heavy smokers. This benefit must be weighed against the high rate of false-positive findings and overdiagnoses.

Development of a photoelectron spectrometer for hard x-ray photon diagnostics.

The development and characterization of an angle-resolved photoelectron spectrometer, based on the electron time-of-flight concept, for hard x-ray photon diagnostics at the European Free-Electron Laser, are described. The instrument is meant to provide users and operators with pulse-resolved, non-invasive spectral distribution diagnostics, which in the hard x-ray regime is a challenge due to the poor cross-section and high kinetic energy of photoelectrons for the available target gases. We report on the performances of this instrument as obtained using hard x-rays at the PETRA III synchrotron at DESY in multibunch mode. Results are compared with electron trajectory simulations. We demonstrate a resolving power of 10 eV at incident photon energies up to at least 20 keV.

Hard x-ray single-shot spectrometer at the European X-ray Free-Electron Laser.

The European X-ray Free-Electron Laser Facility in Germany delivers x-ray pulses with femtosecond pulse duration at a repetition rate of up to 4.5 MHz. The free-electron laser radiation is created by the self-amplified spontaneous emission (SASE) process, whose stochastic nature gives rise to shot-to-shot fluctuations in most beam properties, including spectrum, pulse energy, spatial profile, wavefront, and temporal profile. Each spectrum consisting of many spikes varies in width and amplitude that appear differently within the envelope of the SASE spectrum. In order to measure and study the SASE spectrum, the HIgh REsolution hard X-ray single-shot (HIREX) spectrometer was installed in the photon tunnel of the SASE1 undulator beamline. It is based on diamond gratings, bent crystals as a dispersive element, and a MHz-repetition-rate strip detector. It covers a photon energy range of 3 keV-25 keV and a bandwidth of 0.5% of the SASE beam. The SASE spikes are resolved with 0.15 eV separation using the Si 440 reflection, providing a resolving power of 60 000 at a photon energy of 9.3 keV. The measured SASE bandwidth is 25 eV. In this paper, we discuss the design specifications, installation, and commissioning of the HIREX spectrometer. The spectral results using Si (110), Si (111), and C (110) crystals are presented.

Vestibular Nerve Atrophy After Vestibular Neuritis - Results from a Prospective High-Resolution MRI Study.

PURPOSE: Sudden unilateral peripheral vestibular deficit is mostly termed vestibular neuritis (VN), even if its cause or the exact location of the lesion remains unclear. Thus, therapy is mostly symptomatic. We aimed to prove if there is peripheral atrophy after VN with persistent canal paresis. METHODS: After approval by the ethics committee and according to the declaration of Helsinki and with informed consent, ten patients with persistent canal paresis after VN and ten age-matched healthy controls were included. High-resolution measurement (in-plane resolution 0.2 mm) of the internal auditory canal (IAC) using a 3 D CISS sequence at 3 Tesla was performed. The course of the pertaining nerves was reconstructed in the 3 D dataset and the measurement was performed at 60 % of the length of the IAC. The cross-sectional areas of the superior (SVN) and inferior vestibular nerve (IVN) were taken independently by two blinded readers. RESULTS: The interrater difference regarding the area was 22 %. We found significant atrophy of the SVN with a 24 % smaller area (p = 0.026) and found a smaller ratio of SVN/IVN on the symptomatic side (p = 0.017). Concerning single subject data, only 5 patients showed extensive atrophy of the NVS, while 5 patients did not. The time since symptom onset did not significantly influence the atrophy. CONCLUSION: MRI measuring of the area of the NVS after VN could detect atrophy after VN. However, only 5 patients exhibited marked atrophy, while the other 5 patients did not. With the background of stringent inclusion criteria (more than 6 months of symptom duration and proven persistent canal paresis), one has to wonder if there might be different etiologies behind the apparently identical symptoms. KEY POINTS: · MRI measuring of the area of the NVS after VN could detect atrophy after VN. · Only half of the 10 researched patients showed atrophy, while the other patients did not. · There are different etiologies to be suspected for VN. CITATION FORMAT: · Freund W, Weber F, Schneider D et al. Vestibular Nerve Atrophy After Vestibular Neuritis - Results from a Prospective High-Resolution MRI Study. Fortschr Röntgenstr 2020; 192: 854 - 861.

MCP-based detectors: calibration and first photon radiation measurements.

Detectors based on microchannel plates (MCPs) are used to detect radiation from free-electron lasers. Three MCP detectors have been developed by JINR for the European XFEL (SASE1, SASE2 and SASE3 lines). These detectors are designed to operate in a wide dynamic range from the level of spontaneous emission to the SASE saturation level (between a few nJ up to 25 mJ), in a wide wavelength range from 0.05 nm to 0.4 nm for SASE1 and SASE2, and from 0.4 nm to 4.43 nm for SASE3. The detectors measure photon pulse energies with an anode and a photodiode. The photon beam image is observed with an MCP imager with a phosphor screen. At present, the SASE1 and SASE3 MCP detectors are commissioned with XFEL beams. Calibration and first measurements of photon radiation in multibunch mode are performed with the SASE1 and SASE3 MCPs. The MCP detector for SASE2 and its electronics are installed in the XFEL tunnel, technically commissioned, and are now ready for acceptance tests with the X-ray beam.

X-ray photon diagnostics at the European XFEL.

The European X-ray Free-Electron Laser (European XFEL) (Altarelli et al., 2006; Tschentscher et al., 2017), the world's largest and brightest X-ray free-electron laser (Saldin et al., 1999; Pellegrini et al., 2016), went into operation in 2017. This article describes the as-built realization of photon diagnostics for this facility, the diagnostics commissioning and their application for commissioning of the facility, and results from the first year of operation, focusing on the SASE1 beamline, which was the first to be commissioned. The commissioning consisted of pre-beam checkout, first light from the bending magnets, X-rays from single undulator segments, SASE tuning with many undulator segments, first lasing, optics alignment for FEL beam transport through the tunnel up to the experiment hutches, and finally beam delivery to first users. The beam properties assessed by photon diagnostics throughout these phases included per-pulse intensity, beam position, shape, lateral dimensions and spectral properties. During this time period, the machine provided users with up to 14 keV photon energy, 1.5 mJ pulse energy, 300 FEL pulses per train and 4.5 MHz intra-bunch train repetition rate at a 10 Hz train repetition rate. Finally, an outlook is given into the diagnostic prospects for the future.

Operation of photon diagnostic imagers for beam commissioning at the European XFEL.

X-ray photon beam diagnostic imagers are located at 24 positions in the European XFEL beam transport system to characterize the X-ray beam properties, and to give feedback for tuning and optimization of the electron acceleration and orbit, the undulators, and the X-ray optics. One year of commissioning allowed experience to be gained with these imagers, which will be reported here. The sensitive Spontaneous Radiation imager is useful for various investigations in spontaneous radiation mode: for undulator adjustments and for low-signal imaging applications. The high-resolution Free-Electron Laser imager, 10 µm spatial resolution, is extensively used for the monitoring of beam position, spot size and shape, gain curve measurements, and also for beam-intensity monitoring. The wide field-of-view pop-in monitors (up to 200 mm) are regularly used for alignment and tuning of the various X-ray optical components like mirrors, slits and monochromators, and also for on-line beam control of a stable beam position at the instruments. The Exit Slit imager after the soft X-ray monochromator provides spectral information of the beam together with multi-channel plate based single-pulse gating. For particular use cases, these special features of the imagers are described. Some radiation-induced degradation of scintillators took place in this initial commissioning phase, providing useful information for better understanding of damage thresholds. Visible-light radiation in the beam pipe generated by upstream bending magnets caused spurious reflections in the optical system of some of the imagers which can be suppressed by aluminium-coated scintillating screens.

Commissioning of a photoelectron spectrometer for soft X-ray photon diagnostics at the European XFEL.

Commissioning and first operation of an angle-resolved photoelectron spectrometer for non-invasive shot-to-shot diagnostics at the European XFEL soft X-ray beamline are described. The objective with the instrument is to provide the users and operators with reliable pulse-resolved information regarding photon energy and polarization that opens up a variety of applications for novel experiments but also hardware optimization.

First measurements with the K-monochromator at the European XFEL.

Hard X-ray free-electron lasers (XFELs) generate intense coherent X-ray beams by passing electrons through undulators, i.e. very long periodic magnet structures, which extend over hundreds of meters. The SASE1 and SASE2 undulator systems of the European XFEL consist of 35 segments with variable-gap planar undulators which are initially tuned to precise on-axis magnetic field strengths in a magnetic measurement laboratory to keep an important quality parameter - the K-value variation from segment to segment - below a certain limit (3 × 10-4 for 12 keV photon energy). After tunnel installation only photon-based methods can determine the K-values of undulator segments with a similar accuracy. The synchrotron radiation from a single or a few segments can be spectrally filtered by a dedicated crystal monochromator (K-monochromator) and recorded with a photodiode or with an imager that provides 2D information, tuned for high sensitivity to detect low photon densities from distant single undulator segments. This instrumentation is applied for electron orbit analysis and optimization, and adjustment of individual undulators in terms of their central magnetic axis with respect to the electron beam. Single undulator segments were analysed by scanning the monochromator crystal angle and detecting the steepest slope of a photodiode signal. Alternatively, in the imaging method, an imager recorded the radiation cone of electrons passing through the undulator segment. From the spatial distribution of the radiation, the K-parameter was determined with a sufficiently high relative accuracy.

Operation of X-ray gas monitors at the European XFEL.

X-ray gas monitors (XGMs) are operated at the European XFEL for non-invasive single-shot pulse energy measurements and average beam position monitoring. They are used for tuning and maintaining the self-amplified spontaneous emission (SASE) operation and for sorting single-shot experimental data according to the pulse-resolved energy monitor data. The XGMs were developed at DESY based on the specific requirements for the European XFEL. In total, six XGM units are continuously in operation. Here, the main principle and experimental setup of an XGM are summarized, and the locations of the six XGMs at the facility are shown. Pulse energy measurements at 0.134 nm wavelength are presented, exceeding 1 mJ obtained with an absolute measurement uncertainty of 7-10%; correlations between different XGMs are shown, from which a SASE1 beamline transmission of 97% is deduced. Additionally, simultaneous position measurements close to the undulator and at the end of the tunnel are shown, along with the correlation of beam position data simultaneously acquired by an XGM and an imager.

Coronal oblique orientation of the neural foramen improves cervical spine MRI: A comparison of the sensitivity of different angulations.

OBJECTIVE: Angulated projections are used in radiography to show the cervical neural foramen. Imaging the coronal oblique planes in an MRI of the cervical spine should therefore improve visualization of neural foramen pathology. This has to be demonstrated. PATIENTS AND METHODS: A multi-center investigation of 40 patients with monoradiculopathy and 10 healthy controls was undertaken. T2-weighted sagittal, coronal oblique and axial slices were individually and separately examined by four readers blinded to the diagnosis. The statistical evaluation compared against the clinical gold standard of the neurological diagnosis of a single nerve root irritation or lesion. RESULTS: The sensitivity/specificity required to detect the relevant neural foramen pathology was 0.47/0.60 for axial, 0.57/0.90 for sagittal and 0.55/0.70 for coronal oblique scans. The readers felt significantly more confident in attributing the cause of pathology using coronal oblique planes. Interreader reliability was moderate to substantial, with the highest values for the sagittal planes (0.39-0.76) and lower values for the transversal and coronal oblique planes (0.15-0.63). Intrareader reliability was substantial, with values between 0.53 and 0.88. Reading the axial planes was significantly more time consuming than reading the other planes. CONCLUSION: The use of coronal oblique planes in cervical spine MRIs increases sensitivity and confidence in attributing the cause of neural foramen obstruction. They are easy to interpret and demand less reading time than axial planes, and so the inclusion of coronal oblique planes in the workup of cervical spine MRI is recommended, at least when neural foramen pathology is suspected.

Pulse-resolved intensity measurements at a hard X-ray FEL using semi-transparent diamond detectors.

Solid-state ionization chambers are presented based on thin diamond crystals that allow pulse-resolved intensity measurements at a hard X-ray free-electron laser (FEL), up to the 4.5 MHz repetition rate that will become available at the European XFEL. Due to the small X-ray absorption of diamond the thin detectors are semi-transparent which eases their use as non-invasive monitoring devices in the beam. FELs are characterized by strong pulse-to-pulse intensity fluctuations due to the self-amplified spontaneous emission (SASE) process and in many experiments it is mandatory to monitor the intensity of each individual pulse. Two diamond detectors with different electrode materials, beryllium and graphite, were tested as intensity monitors at the XCS endstation of the Linac Coherent Light Source (LCLS) using the pink SASE beam at 9 keV. The performance is compared with LCLS standard monitors that detect X-rays backscattered from thin SiN foils placed in the beam. The graphite detector can also be used as a beam position monitor although with rather coarse resolution.

First Report of Recurrent Intramuscular Lipoma after Decompression Surgery of the Lumbar Spine.

Intramuscular or infiltrating lipomas are rare. We present a 58-year-old man with an intramuscular lipoma developing after decompression surgery for lumbar spinal canal stenosis. One year after macroscopically complete lipoma resection, an even bigger recurrent tumor had to be removed. The lumbar paraspinal musculature is a very uncommon site for an intramuscular lipoma. A relation between surgery and the growth and recurrence of an intramuscular lipoma has not been described previously in the literature.

Response to transforaminal injection of steroids and correlation to mri findings in patients with cervical radicular pain or radiculopathy due to disc herniation or spondylosis.

OBJECTIVE: To determine the effectiveness of cervical transforaminal injection of steroids (CTFIS) and to explore possible determinants of response in patients with cervical disc herniation. DESIGN: Retrospective practice audit covering a time period of 6 months. SETTING: Single spine center in which the patients underwent CTFIS, surgery, and subsequent treatment. Magnetic resonance images were reviewed independently by a radiologist and two neurosurgeons. INTERVENTIONS: Consecutive patients with cervical radicular pain and a magnetic resonance imaging demonstrating nerve root affection received CTFIS. Evaluation in terms of pain reduction and in relation to the level and side of the affected nerve root, the duration of pain, neck or radicular pain, and the presence of sensory or motor deficits. The radiological features assessed were the location, grading, and cause of the impingement. RESULTS: Forty-eight patients were included. Only 35.4% of patients achieved at least 50% reduction in pain 1 month after treatment. The initial pain on the numeric rating scale was reduced from 6.8 to 1.8. None of the clinical or radiological features was associated with a successful outcome. 22.9% of the included patients had to undergo an operation. The duration of these patients' symptoms was significantly shorter (P = 0.01) than in patients without operation. CONCLUSION: Only a minority of patients with disc herniation or spondylosis and a proven nerve root compression benefits from CTFIS. The potential advantage for the patient must be compared with the risk of the procedure. Even with the combination of clinical and radiological findings, the prediction of a favorable outcome of CTFIS was not possible.

Regionally accentuated reversible brain grey matter reduction in ultra marathon runners detected by voxel-based morphometry.

BACKGROUND: During the 4,487 km ultra marathon TransEurope-FootRace 2009 (TEFR09), runners showed catabolism with considerable reduction of body weight as well as reversible brain volume reduction. We hypothesized that ultra marathon athletes might have developed changes to grey matter (GM) brain morphology due to the burden of extreme physical training. Using voxel-based morphometry (VBM) we undertook a cross sectional study and two longitudinal studies. METHODS: Prior to the start of the race 13 runners volunteered to participate in this study of planned brain scans before, twice during, and 8 months after the race. A group of matched controls was recruited for comparison. Twelve runners were able to participate in the scan before the start of the race and were taken into account for comparison with control persons. Because of drop-outs during the race, VBM could be performed in 10 runners covering the first 3 time points, and in 7 runners who also had the follow-up scan after 8 months. Volumetric 3D datasets were acquired using an MPRAGE sequence. A level of p < 0.05, family-wise corrected for multiple comparisons was the a priori set statistical threshold to infer significant effects from VBM. RESULTS: Baseline comparison of TEFR09 participants and controls revealed no significant differences regarding GM brain volume. During the race however, VBM revealed GM volume decreases in regionally distributed brain regions. These included the bilateral posterior temporal and occipitoparietal cortices as well as the anterior cingulate and caudate nucleus. After eight months, GM normalized. CONCLUSION: Contrary to our hypothesis, we did not observe significant differences between TEFR09 athletes and controls at baseline. If this missing difference is not due to small sample size, extreme physical training obviously does not chronically alter GM.However, during the race GM volume decreased in brain regions normally associated with visuospatial and language tasks. The reduction of the energy intensive default mode network as a means to conserve energy during catabolism is discussed. The changes were reversible after 8 months.Despite substantial changes to brain composition during the catabolic stress of an ultra marathon, the observed differences seem to be reversible and adaptive.

Ultra-marathon runners are different: investigations into pain tolerance and personality traits of participants of the TransEurope FootRace 2009.

INTRODUCTION: Susceptibility to pain varies among individuals and may predispose to a higher risk for pain disorders. Thus, it is of interest to investigate subjects who exhibit higher resistance to pain. We therefore tested pain tolerance and assessed personality traits of ultra-marathon athletes who are able to run 4487 km (2789 mi) over 64 days without resting days and compare the results to controls. METHODS: After approval of the local ethics committee and with informed consent, 11 participants of the TransEurope FootRace (TEFR09 participants) and 11 matched (age, sex, and ethnicity) controls without marathon experience in the last 5 years were enrolled. They were tested for cold pain tolerance (cold pressor [CP] test), and the 240 item trait and character inventory (TCI) as well as the general self-efficacy (GSE) test were obtained. RESULTS: TransEurope FootRace participants had a highly significant greater cold pain tolerance in the CP test than controls (P = 0.0002). While the GSE test showed no differences, the TCI test provided TEFR09 participants to be less cooperative and reward dependent but more spiritually transcendent than the controls. Significant positive correlations were found between the CP test pain score at 180 seconds and several TCI subscales showing that higher pain scores correlate with higher reward dependence, dependence, cooperativeness, empathy, and pure-hearted conscience. CONCLUSIONS: Personality profiles as well as pain tolerance of our sample of TEFR09 participants differ from normal controls and-as obtained in previous studies-probably also from chronic pain patients. Low pain perception may predispose a person to become a long-distance runner. It remains unclear, however, whether low pain perception is cause or consequence of continuous extreme training.

Substantial and reversible brain gray matter reduction but no acute brain lesions in ultramarathon runners: experience from the TransEurope-FootRace Project.

BACKGROUND: During the extremely challenging 4,487 km ultramarathon TransEurope-FootRace 2009, runners showed considerable reduction of body weight. The effects of this endurance run on brain volume changes but also possible formation of brain edema or new lesions were explored by repeated magnetic resonance imaging (MRI) studies. METHODS: A total of 15 runners signed an informed consent to participate in this study of planned brain scans before, twice during, and about 8 months after the race. Because of dropouts, global gray matter volume analysis could only be performed in ten runners covering three timepoints, and in seven runners who also had a follow-up scan. Scanning was performed on three identical 1.5 T Siemens MAGNETOM Avanto scanners, two of them located at our university. The third MRI scanner with identical sequence parameters was a mobile MRI unit escorting the runners. Volumetric 3D datasets were acquired using a magnetization prepared rapid acquisition gradient echo (MPRAGE) sequence. Additionally, diffusion-weighted (DWI) and fluid attenuated inversion recovery (FLAIR) imaging was performed. RESULTS: Average global gray matter volume as well as body weight significantly decreased by 6% during the race. After 8 months, gray matter volume returned to baseline as well as body weight. No new brain lesions were detected by DWI or FLAIR imaging. CONCLUSIONS: Physiological brain volume reduction during aging is less than 0.2% per year. Therefore a volume reduction of about 6% during the 2 months of extreme running appears to be substantial. The reconstitution in global volume measures after 8 months shows the process to be reversible. As possible mechanisms we discuss loss of protein, hypercortisolism and hyponatremia to account for both substantiality and reversibility of gray matter volume reductions. Reversible brain volume reduction during an ultramarathon suggests that extreme running might serve as a model to investigate possible mechanisms of transient brain volume changes. However, despite massive metabolic load, we found no new lesions in trained athletes participating in a multistage ultramarathon.See related commentary http://www.biomedcentral.com/1741-7015/10/171.