1-Di-chloro-acetyl-t-3-isopropyl-r-2,c-6-di-phenyl-piperidin-4-one.

In the title compound, C22H23Cl2NO2, the piperidine ring adopts a twist-boat conformation. The phenyl rings substituted at the 2- and 6-positions of the piperidine ring subtend dihedral angles of 60.6 (2) and 84.2 (1)°, respectively, with the mean plane of the piperidine ring. In the crystal, mol-ecules are linked by C-H⋯O inter-actions into zigzag chains running along the c-axis direction.

1-Dichloro-acetyl-t-3,t-5-dimethyl-r-2,c-6-diphenyl-piperidin-4-one.

In the title compound, C21H21Cl2NO2, the piperidine ring adopts a distorted boat conformation. The phenyl rings substituted at the 2- and 6-positions of the piperidine ring subtend angles of 87.9 (7) and 70.8 (9)°, respectively, with the best plane through the piperidine ring. In the crystal, mol-ecules are connected by C-H⋯O and C-H⋯Cl inter-actions into layers in the ab plane.

Heat Stress and Goat Welfare: Adaptation and Production Considerations.

This review attempted to collate and synthesize information on goat welfare and production constraints during heat stress exposure. Among the farm animals, goats arguably are considered the best-suited animals to survive in tropical climates. Heat stress was found to negatively influence growth, milk and meat production and compromised the immune response, thereby significantly reducing goats' welfare under extensive conditions and transportation. Although considered extremely adapted to tropical climates, their production can be compromised to cope with heat stress. Therefore, information on goat adaptation and production performance during heat exposure could help assess their welfare. Such information would be valuable as the farming communities are often struggling in their efforts to assess animal welfare, especially in tropical regions. Broadly three aspects must be considered to ensure appropriate welfare in goats, and these include (i) housing and environment; (ii) breeding and genetics and (iii) handling and transport. Apart from these, there are a few other negative welfare factors in goat rearing, which differ across the production system being followed. Such negative practices are predominant in extensive systems and include nutritional stress, limited supply of good quality water, climatic extremes, parasitic infestation and lameness, culminating in low production, reproduction and high mortality rates. Broadly two types of methodologies are available to assess welfare in goats in these systems: (i) animal-based measures include behavioral measurements, health and production records and disease symptoms; (ii) resources based and management-based measures include stocking density, manpower, housing conditions and health plans. Goat welfare could be assessed based on several indicators covering behavioral, physical, physiological and productive responses. The important indicators of goat welfare include agonistic behavior, vocalization, skin temperature, body condition score (BCS), hair coat conditions, rectal temperature, respiration rate, heart rate, sweating, reduced growth, reduced milk production and reduced reproductive efficiency. There are also different approaches available by which the welfare of goats could be assessed, such as naturalistic, functional and subjective approaches. Thus, assessing welfare in goats at every production stage is a prerequisite for ensuring appropriate production in this all-important species to guarantee optimum returns to the marginal and subsistence farmers.

VMC++ versus BEAMnrc: a comparison of simulated linear accelerator heads for photon beams.

BEAMnrc, a code for simulating medical linear accelerators based on EGSnrc, has been bench-marked and used extensively in the scientific literature and is therefore often considered to be the gold standard for Monte Carlo simulations for radiotherapy applications. However, its long computation times make it too slow for the clinical routine and often even for research purposes without a large investment in computing resources. VMC++ is a much faster code thanks to the intensive use of variance reduction techniques and a much faster implementation of the condensed history technique for charged particle transport. A research version of this code is also capable of simulating the full head of linear accelerators operated in photon mode (excluding multileaf collimators, hard and dynamic wedges). In this work, a validation of the full head simulation at 6 and 18 MV is performed, simulating with VMC++ and BEAMnrc the addition of one head component at a time and comparing the resulting phase space files. For the comparison, photon and electron fluence, photon energy fluence, mean energy, and photon spectra are considered. The largest absolute differences are found in the energy fluences. For all the simulations of the different head components, a very good agreement (differences in energy fluences between VMC++ and BEAMnrc <1%) is obtained. Only a particular case at 6 MV shows a somewhat larger energy fluence difference of 1.4%. Dosimetrically, these phase space differences imply an agreement between both codes at the <1% level, making VMC++ head module suitable for full head simulations with considerable gain in efficiency and without loss of accuracy.

Leaf transmission reduction using moving jaws for dynamic MLC IMRT.

The aim of this work is to investigate to what extent it is possible to use the secondary collimator jaws to reduce the transmitted radiation through the multileaf collimator (MLC) during an intensity modulated radiation therapy (IMRT). A method is developed and introduced where the jaws follow the open window of the MLC dynamically (dJAW method). With the aid of three academic cases (Closed MLC, Sliding-gap, and Chair) and two clinical cases (prostate and head and neck) the feasibility of the dJAW method and the influence of this method on the applied dose distributions are investigated. For this purpose the treatment planning system Eclipse and the Research-Toolbox were used as well as measurements within a solid water phantom were performed. The transmitted radiation through the closed MLC leads to an inhomogeneous dose distribution. In this case, the measured dose within a plane perpendicular to the central axis differs up to 40% (referring to the maximum dose within this plane) for 6 and 15 MV. The calculated dose with Eclipse is clearly more homogeneous. For the Sliding-gap case this difference is still up to 9%. Among other things, these differences depend on the depth of the measurement within the solid water phantom and on the application method. In the Chair case, the dose in regions where no dose is desired is locally reduced by up to 50% using the dJAW method instead of the conventional method. The dose inside the chair-shaped region decreased up to 4% if the same number of monitor units (MU) as for the conventional method was applied. The undesired dose in the volume body minus the planning target volume in the clinical cases prostate and head and neck decreased up to 1.8% and 1.5%, while the number of the applied MU increased up to 3.1% and 2.8%, respectively. The new dJAW method has the potential to enhance the optimization of the conventional IMRT to a further step.

Collapsed cone convolution and analytical anisotropic algorithm dose calculations compared to VMC++ Monte Carlo simulations in clinical cases.

The purpose of this work was to study and quantify the differences in dose distributions computed with some of the newest dose calculation algorithms available in commercial planning systems. The study was done for clinical cases originally calculated with pencil beam convolution (PBC) where large density inhomogeneities were present. Three other dose algorithms were used: a pencil beam like algorithm, the anisotropic analytic algorithm (AAA), a convolution superposition algorithm, collapsed cone convolution (CCC), and a Monte Carlo program, voxel Monte Carlo (VMC++). The dose calculation algorithms were compared under static field irradiations at 6 MV and 15 MV using multileaf collimators and hard wedges where necessary. Five clinical cases were studied: three lung and two breast cases. We found that, in terms of accuracy, the CCC algorithm performed better overall than AAA compared to VMC++, but AAA remains an attractive option for routine use in the clinic due to its short computation times. Dose differences between the different algorithms and VMC++ for the median value of the planning target volume (PTV) were typically 0.4% (range: 0.0 to 1.4%) in the lung and -1.3% (range: -2.1 to -0.6%) in the breast for the few cases we analysed. As expected, PTV coverage and dose homogeneity turned out to be more critical in the lung than in the breast cases with respect to the accuracy of the dose calculation. This was observed in the dose volume histograms obtained from the Monte Carlo simulations.

Integration of external and internal dosimetry in Switzerland.

Individual monitoring regulations in Switzerland are based on the ICRP60 recommendations. The annual limit of 20 mSv for the effective dose applies to the sum of external and internal radiation. External radiation is monitored monthly or quarterly with TLD, DIS or CR-39 dosemeters by 10 approved external dosimetry services and reported as Hp(10) and Hp(0.07). Internal monitoring is done in two steps. At the workplace, simple screening measurements are done frequently in order to recognise a possible incorporation. If a nuclide dependent activity threshold is exceeded then one of the seven approved dosimetry services for internal radiation does an incorporation measurement to assess the committed effective dose E50. The dosimetry services report all the measured or assessed dose values to the employer and to the National Dose Registry. The employer records the annually accumulated dose values into the individual dose certificate of the occupationally exposed person, both the external dose Hp(10) and the internal dose E50 as well as the total effective dose E=Hp(10)+E50. Based on the national dose registry an annual report on the dosimetry in Switzerland is published which contains the statistics for the total effective dose, as well as separate statistics for external and internal exposure.

Headache and seizure in a young woman postpartum.

A 19-year-old woman, 8 days postpartum, presented to the Emergency Department (ED) with a chief complaint of headache, decreased vision, and agitation. Past medical history was unremarkable. Physical examination was remarkable only for dry mucous membranes, decreased visual acuity, and trace pedal edema bilaterally. While in the ED, the patient experienced a generalized tonic-clonic seizure. Computed tomography (CT) scan of the head was suspicious for venous infarction. Magnetic resonance imaging (MRI) and MR venography revealed sagittal sinus and left transverse sinus thrombosis. The risk factors, clinical presentation, diagnostic evaluation, and management of cerebral venous thrombosis are reviewed.

Introduction of a novel dose saving acquisition mode for the PortalVision aS500 EPID to facilitate on-line patient setup verification.

In external beam radiotherapy, electronic portal imaging becomes more and more an indispensable tool for the verification of the patient setup. For the safe clinical introduction of high dose conformal radiotherapy like intensity modulated radiation therapy, on-line patient setup verification is a prerequisite to ensure that the planned dosimetric coverage of the tumor volume is actually realized in the patient. Since the direction of setup fields often deviates from the direction of the treatment beams, extra dose is delivered to the patient during the acquisition of these portal images which may reach clinical relevance. The aim of this work was to develop a new acquisition mode for the PortalVision aS500 electronic portal imaging device from Varian Medical Systems that allows one to take portal images with reduced dose while keeping good image quality. The new acquisition mode, called RadMode, selectively enables and disables beam pulses during image acquisition allowing one to stop wasting valuable dose during the initial acquisition of "reset frames." Images of excellent quality can be taken with 1 MU only. This low dose per image facilitates daily setup verification with considerably reduced extra dose.

Radioprotection of cultured cells by preincubation in medium containing deuterium oxide.

Pretreatment with deuterium oxide (D2O) has been shown to protect mice against lethal effects of X-rays. In contrast, X-irradiation of cultured mammalian cells in D2O-containing medium has previously been reported to result in increased cell killing. Therefore, the effects of preincubation in medium containing 20% D2O on radiosensitivity were tested, using cells of a heat-sensitive cell-cycle mutant (21-Tb) of the murine mastocytoma P 815-X2. The mutant cells proliferate at 33 degrees C and are arrested in G1 phase in a state of reversible proliferative quiescence at 39.5 degrees C. Prior to irradiation with single X-ray doses of 0-10 Gy, the cells were cultured in normal or D2O-containing medium, either for 96 h at 33 degrees C ('proliferating cells'), or for 72 h at 33 degrees C followed by 24 h at 39.5 degrees C ('arrested cells'). After X-irradiation the cells were resuspended in normal medium, and cell survival was determined by the capacity of cells to form colonies in fibrin gels. Preincubation in medium containing 20% D2O resulted in a radioprotective effect on both proliferating and arrested cells, particularly at the higher X-ray doses. This radioprotection was manifested as a decreased slope of the semilogarithmic survival curves, whereas pretreatment with D2O had no significant effect on postirradiation repair as judged from Dq values. These results support the interpretation that the increase in postirradiation survival may be attributed to incorporation of deuterium into cellular metabolites during the period of preincubation.

Monte Carlo simulation of a dynamic MLC based on a multiple source model.

Detailed knowledge of the characteristics of the radiation field shaped by a multileaf collimator (MLC) is essential in intensity modulated radiotherapy (IMRT). A previously developed multiple source model (MSM) for a 6 MV beam was extended to a 15 MV beam and supplemented with an accurate model of an 80-leaf dynamic MLC. Using the supplemented MSM and the MC code GEANT, lateral dose distributions were calculated in a water phantom and a portal water phantom. A field which is normally used for the validation of the step and shoot technique and a field from a realistic IMRT treatment plan delivered with dynamic MLC are investigated. To assess possible spectral changes caused by the modulation of beam intensity by an MLC, the energy spectra in five portal planes were calculated for moving slits of different widths. The extension of the MSM to 15 MV was validated by analysing energy fluences, depth doses and dose profiles. In addition, the MC-calculated primary energy spectrum was verified with an energy spectrum which was reconstructed from transmission measurements. MC-calculated dose profiles using the MSM for the step and shoot case and for the dynamic MLC case are in very good agreement with the measured data from film dosimetry. The investigation of a 13 cm wide field shows an increase in mean photon energy of up to 16% for the 0.25 cm slit compared to the open beam for 6 MV and of up to 6% for 15 MV, respectively. In conclusion, the MSM supplemented with the dynamic MLC has proven to be a powerful tool for investigational and benchmarking purposes or even for dose calculations in IMRT.

A multiple source model for 6 MV photon beam dose calculations using Monte Carlo.

A multiple source model (MSM) for the 6 MV beam of a Varian Clinac 2300 C/D was developed by simulating radiation transport through the accelerator head for a set of square fields using the GEANT Monte Carlo (MC) code. The corresponding phase space (PS) data enabled the characterization of 12 sources representing the main components of the beam defining system. By parametrizing the source characteristics and by evaluating the dependence of the parameters on field size, it was possible to extend the validity of the model to arbitrary rectangular fields which include the central 3 x 3 cm2 field without additional precalculated PS data. Finally, a sampling procedure was developed in order to reproduce the PS data. To validate the MSM, the fluence, energy fluence and mean energy distributions determined from the original and the reproduced PS data were compared and showed very good agreement. In addition, the MC calculated primary energy spectrum was verified by an energy spectrum derived from transmission measurements. Comparisons of MC calculated depth dose curves and profiles, using original and PS data reproduced by the MSM, agree within 1% and 1 mm. Deviations from measured dose distributions are within 1.5% and 1 mm. However, the real beam leads to some larger deviations outside the geometrical beam area for large fields. Calculated output factors in 10 cm water depth agree within 1.5% with experimentally determined data. In conclusion, the MSM produces accurate PS data for MC photon dose calculations for the rectangular fields specified.

[How strongly does the radiation burden of diagnostic x-ray studies depend on the imaging technic?]. / Wie stark hängt die Strahlenbelastung der diagnostischen Röntgenuntersuchungen von der Aufnahmetechnik ab?

The radiation burden of an individual patient caused by a radiological examination depends strongly on the technical parameters, such as kV and mAs. As an inquiry among 150 swiss physicians showed, rather different irradiation techniques are used for the same examination. Depending on these irradiation techniques, the doses may vary by almost a factor of ten. These large variations in dose indicate that in some clinics or hospitals the radiographic techniques and the film processing are at fault. This fact has to be accounted for by future efforts of quality assurance in diagnostic radiology.

The radiographic assessment of implant patients: decision-making criteria.

Indications for the most frequently used imaging modalities in implant dentistry are proposed based on clinical need and biologic risk for the patient. To calculate the biologic risk, the authors carried out dose measurements. They demonstrated that the risk from a periapical radiograph is 20% of that from a panoramic radiograph. A panoramic radiograph and a series of 4 conventional tomographs of a single-tooth gap in the molar region carry 5% and 13% of the risk from computed tomography of the maxilla, respectively. Panoramic radiography is considered the standard radiographic examination for treatment planning of implant patients, because it imparts a low dose while giving the best radiographic survey. Periapical radiographs are used to elucidate details or to complete the findings obtained from the panoramic radiograph. Other radiographic methods, such as conventional film tomography or computed tomography, are applied only in special circumstances, film tomography being preferred for smaller regions of interest and computed tomography being justified for the complete maxilla or mandible when methods for dose reduction are followed. During follow-up, intraoral radiography is considered the standard radiographic examination, particularly for implants in the anterior region of the maxilla or for scientific studies. In patients requiring more than 5 periapical images, panoramic radiography is preferred.

Comparative dose measurements by spiral tomography for preimplant diagnosis: the Scanora machine versus the Cranex Tome radiography unit.

Objective. The purpose of this study was to determine the dose profile of the Cranex Tome radiography unit and compare it with that of the Scanora machine. Study design. The radiation dose delivered by the Cranex Tome radiography unit during the cross-sectional mode was determined. Single tooth gaps in regions 3 (16) and 30 (46) were simulated. Dosimetry was carried out with 2 phantoms, a head and neck phantom and a full-body phantom loaded with 142 thermoluminescent dosimeters (TLD) and 280 TLD, respectively; all locations corresponded to radiosensitive organs or tissues. The recorded local mean organ doses were compared with those measured in another study evaluating the Scanora machine.Results. Generally, dose values from the Cranex Tome radiography unit reached only 50% to 60% of the values measured for the Scanora machine. The effective dose was calculated as 0.061 mSv and 0.04 mSv for tooth regions 3 (16) and 30 (46), respectively. Corresponding values for the Scanora machine were 0.117 mSv and 0.084 mSv.Conclusion. Cross-sectional imaging in the molar region of the upper and the lower jaw can be performed with the Cranex Tome unit, which delivers only approximately half of the dose that the Scanora machine delivers.

Effects of dose reduction on the detectability of standardized radiolucent lesions in digital panoramic radiography.

Dose reduction in digital panoramic radiography was studied. Intentional underexposure was performed with the Orthophos DS while six different human mandibles were radiographed. Exposure settings were 69 kV/15 mA (standard), 64 kV/16 mA, and 60 kV/16 mA. Standardized spherical defects, each either 1 or 1.25 mm in diameter, were simulated in 288 of 432 images, and seven observers decided whether defects were present or not. Areas under the receiver operating characteristics curves were calculated. They showed no significant differences in the detectability of the 1-mm defect at 69, 64, or 60 kV. For the 1.25-mm defect, no difference was found between the 69 and 60 kV images, but a statistically significant different detectability was found for 64 kV images in comparison with both 69 and 60 kV images. A dose reduction of up to 43% was ascertained with a Pedo-RT-Humanoid phantom when panoramic radiography was performed at 60 kV/16 mA. The conclusion is that with the Orthophos DS, it seems possible to reduce the dose rate of x-rays without loss of diagnostic quality in the case of radiolucent changes.

Monte Carlo simulation of a dynamic MLC: implementation and applications.

PURPOSE: Study of behavior and influence of a multileaf collimator (MLC) on dose calculation, verification, and portal energy spectra in the case of intensity-modulated fields obtained with a step-and-shoot or a dynamic technique. METHODS: The 80-leaf MLC for the Varian Clinac 2300 C/D was implemented in a previously developed Monte Carlo (MC) based multiple source model (MSM) for a 6 MV photon beam. Using this model and the MC program GEANT, dose distributions, energy fluence maps and energy spectra at different portal planes were calculated for three different MLC applications. RESULTS: The comparison of MC-calculated dose distributions in the phantom and portal plane, with those measured with films showed an agreement within 3% and 1.5 mm for all cases studied. The deviations mainly occur in the extremes of the intensity modulation. The MC method allows to investigate, among other aspects, dose components, energy fluence maps, tongue-and-groove effects and energy spectra at portal planes. CONCLUSION: The MSM together with the implementation of the MLC is appropriate for a number of investigations in intensity-modulated radiation therapy (IMRT).

[Radiation protection in diagnostic radiology]. / Strahlenschutz in der diagnostischen Radiologie.

For every diagnostical X-ray radiation exposure the applied dose has to be limited to the smallest possible value. Within the scope of a general Swiss survey it has been found that in the various medical practices and hospitals the applied doses varied quite strongly. The main reasons leading to an overdose were the operating conditions of the X-ray and film processing equipment, the film and foil materials and improper filming techniques. The applied single dose served as a measure for the radiation protection assessment of diagnostical X-ray exposures. To prevent this in the future, individual patients who are exposed to unnecessary radiation loads should be regularly checked in quality-ensuring tests.

[Exposure of the Swiss population to radiation from diagnostic x-ray studies]. / Die Belastung der Schweizer Bevölkerung durch diagnostische Röntgenuntersuchungen.

A new study is presently being conducted on the exposure of the Swiss population to radiation by diagnostic measures. This study is performed by the Department of Medical Radiation Physics of the University of Berne in collaboration with the Federal Health Bureau and the Swiss Institute for Health and Hospital Matters. In earlier studies the genetically significant exposure of the population and subsequently the median exposure of the red bone marrow had been investigated, whereas now the risk exposure to radiation of as far as possible practically all the risk-relevant organs will be studied. Prior to the initiation of the study, all results of earlier investigations during 1957, 1971 and 1978 were collected and analysed. It was found that the published results are hardly comparable, since the first study was based on individual X-ray examinations and the two subsequent studies on the localised X-ray examinations. To ensure that all data are now comparable, the results of the three studies were appropriately recalculated. Although certain assumptions had to be made that cannot be fully verified any more in view of the time that has elapsed, the collected results will provide a fairly reliable overview of the present-day state of knowledge in this particular field.

[Radiation burden of organs in fluoroscopic studies]. / Die Strahlenbelastung der Organe bei Schirmbildaufnahmen.

Various conventional and modern fluoroscope units had been examined with an anthropomorphic phantom to determine the applied average organ doses. The aim of our investigation was to compare these doses with those normally delivered to the patients during a conventional X-ray examination of the thorax. As was to be expected, the doses resulting from conventional fluoroscopic units are much higher than the doses from modern units. As shown by means of our measurements, the efforts of advanced technology permit to reduce the dose rate up to a factor of 30. I.e., the doses resulting from modern fluoroscopic units are even smaller than the doses received during a conventional thoracic X-ray examination, what means a great improvement for this examination technic.