Biomedical subjects

M J Engler

Publications and source records attributed to M J Engler.

At least 19 recordsLinked to original sources

PubMed2006

Effect of ractopamine HCl supplementation on fecal shedding of Escherichia coli O157:H7 and Salmonella in feedlot cattle.

The effects of the beta-agonist ractopamine, recently approved for use in feedlot cattle to improve carcass quality and performance, on fecal shedding Escherichia coli O157:H7 and Salmonella in feedlot cattle was examined. In the first study, 20 feedlot steers and heifers were randomly assigned to receive ractopamine or no ractopamine (control) by way of oral bolus for 28 days. Fecal samples were collected daily, and shedding of E. coli O157:H7 determined. When examined during the entire 28-day experimental period, ractopamine decreased (P = 0.0006) the percentage of cattle shedding E. coli O157:H7 (58% vs. 42% for control and ractopamine treatments, respectively). A second study was conducted in a commercial feedlot facility in the southwestern United States. Eighteen pens of cross-bred beef heifers (approximately 100 head/pen and 9 pens/treatment) were randomly assigned to receive either 0 (control) or 200 mg ractopamine/head x d(-1). Fresh fecal samples (30/pen) were collected off the pen floor before ractopamine supplementation and again after approximately 28 days of ractopamine supplementation (within a few days of slaughter); the samples were cultured for E. coli O157:H7 and Salmonella. The percentage of animals shedding E. coli O157:H7 was decreased when data were pooled across replicates (P = 0.05) in ractopamine-treated cattle compared with controls. The percentage of animals shedding Salmonella tended to be higher (P = 0.08) with the ractopamine treatment when data were pooled across replicates. Although further research is required to confirm these results, the potential food safety implications of this research are intriguing.

Animals↗

PubMed2006

Fecal prevalence of Escherichia coli O157, Salmonella, Listeria, and Bacteriophage Infecting E. coli O157:H7 in feedlot cattle in the Southern Plains region of the United States.

Escherichia coli O157:H7, Salmonella, and Listeria are foodborne pathogens of critical importance that often colonize cattle. E. coli O157:H7 can be specifically killed by lytic bacteriophage, and lytic bacteriophage treatment has been suggested as a pre-harvest intervention strategy to reduce foodborne pathogens in cattle. To date, no systematic approach to determine the incidence of E. coli O157:H7-infecting lytic bacteriophage has been published. Therefore, the current study was designed to determine (1) the incidence of E. coli O157, Salmonella spp., and Listeria and (2) the incidence of E. coli O157:H7-infecting bacteriophage in the feces of feedlot steers in commercial feedlots in the United States. Fecal samples (n=60) were collected from four feedlots in two Southern Great Plains states (total (n=240 fecal samples). Salmonella and E. coli O157:H7 were found in 3.8% and 11.7% of the fecal samples, respectively. Bacteriophage targeting E. coli O157:H7 were found in all four feedlots, in 15% of the individual fecal samples, and in 55% of the cattle pens. Our results indicate that such bacteriophage are widespread in feedlot cattle, suggesting that further research into the ecological role of bacteriophage in the gastrointestinal tract is needed.

Animals↗

PubMed2001

Comparison of radiobiologic modeling for one- and two-isocenter dose distributions applied to ellipsoidal radiosurgery targets.

PURPOSE: RTOG protocol 90-05 determined the maximum acutely tolerated dose of single-fraction radiosurgery in patients receiving prior fractionated large volume cranial irradiation. Data from 90-05 have suggested that patients treated with a gamma unit, compared to linac-based therapy, have a tumor control advantage and lower rates of severe complications. This study was performed to investigate the radiobiologic effect of using one vs. two isocenters in single-fraction radiosurgery of ellipsoidal targets. METHODS AND MATERIALS: For a series of ellipsoidal targets that varied by volume and radiosensitivity, single and two-isocenter treatment plans were generated to approximate those typically employed for gamma unit and linac radiosurgery. Tumor control probabilities (TCP) and normal tissue complication probabilities (NTCP) were generated automatically by the treatment planning system based on established parameter values. RESULTS: The modeling data showed that multiple-isocenter plans resulted in improved TCP with equivalent or lesser NTCP, particularly for larger, radioresistant targets. Multiple-isocenter plans reduce the amount of normal tissue that receives high dose. Also, areas within the tumor receive significantly higher doses than the prescription dose, which contributes to increased tumor cell inactivation. CONCLUSION: For ellipsoidal targets, radiobiologic modeling data are consistent with the clinical findings of the RTOG 90-05 trial, as they predict improved outcome with a multiple-isocenter plan relative to a single-isocenter plan. The benefit is most apparent with increasing target volume and decreasing tumor radiosensitivity.

Algorithms↗

PubMed2001

A formalism for independent checking of Gamma Knife dose calculations.

For stereotactic radiosurgery using the Leksell Gamma Knife system, it is important to perform a pre-treatment verification of the maximum dose calculated with the Leksell GammaPlan (DLGP) stereotactic radiosurgery system. This verification can be incorporated as part of a routine quality assurance (QA) procedure to minimize the chance of a hazardous overdose. To implement this procedure, a formalism has been developed to calculate the dose DCAL(X,Y,Z,dav,t) using the following parameters: average target depth (dav), coordinates (X,Y,Z) of the maximum dose location or any other dose point(s) to be verified, 3-dimensional (3-dim) beam profiles or off-centerratios (OCR) of the four helmets, helmet size i, output factor Oi, plug factor Pi, each shot j coordinates (x,y,z)i,j, and shot treatment time (ti,j). The average depth of the target dav was obtained either from MRI/CT images or ruler measurements of the Gamma Knife Bubble Head Frame. DCAL and DLGP were then compared to evaluate the accuracy of this independent calculation. The proposed calculation for an independent check of DLGP has been demonstrated to be accurate and reliable, and thus serves as a QA tool for Gamma Knife stereotactic radiosurgery.

Biophysical Phenomena↗

PubMed2000

Dependence of linac output on the switch rate of an intensity-modulated tomotherapy collimator.

The electro-mechanical, multivane intensity modulated collimator ("MIMiC") slit collimator with 40 vanes has been applied in the delivery of inversely planned sequential tomotherapy to over 4,000 patients. The collimator is binary in that each vane switches between fully open or closed status. Resulting beamlet patterns provide the intensity distributions imparting dose to the patient. The bouncing and damping of vanes at the two ends of their travel cause transient dose perturbations near and at the borders of the treatment field. These perturbations are not explicitly modeled by the planning system. Clinical beamlet profiles and output factors may then differ from those in the planning system and as a function of the vane switch period. A mechanical model of vane switching was developed to describe this dependency. Dose output and distribution of seven simple vane patterns with different switch times were measured with ionization chambers and radiographic films in polystyrene and anthropomorphic phantoms. Linac output dependence on switch time relative to vane open time was determined for four intensity modulated radiotherapy (IMRT) patients from measurements of an ionization chamber embedded in a cylindrical polystyrene phantom. Results demonstrate output dependence on switch time and, accordingly, on the servo mechanism for monitor units, arc length, dose rate, and gantry speed. In conclusion, the output dependence borders on clinical significance-improvements to collimator, dose calculation, commissioning, and quality assurance (QA) are suggested.

Humans↗

PubMed1999

A non-invasive immobilization system and related quality assurance for dynamic intensity modulated radiation therapy of intracranial and head and neck disease.

PURPOSE: To develop and implement a non-invasive immobilization system guided by a dedicated quality assurance (QA) program for dynamic intensity-modulated radiotherapy (IMRT) of intracranial and head and neck disease, with IMRT delivered using the NOMOS Corporation's Peacock System and MIMiC collimator. METHODS AND MATERIALS: Thermoplastic face masks are combined with cradle-shaped polyurethane foaming agents and a dedicated quality assurance program to create a customized headholder system (CHS). Plastic shrinkage was studied to understand its effect on immobilization. Fiducial points for computerized tomography (CT) are obtained by placing multiple dabs of barium paste on mask surfaces at intersections of laser projections used for patient positioning. Fiducial lines are drawn on the cradle along laser projections aligned with nasal surfaces. Lateral CT topograms are annotated with a crosshair indicating the origin of the treatment planning and delivery coordinate system, and with lines delineating the projections of superior-inferior field borders of the linear accelerator's secondary collimators, or with those of the fully open MIMiC. Port films exposed with and without the MIMIC are compared to annotated topograms to measure positional variance (PV) in superior-inferior (SI), right-left (RL), and anterior posterior (AP) directions. MIMiC vane patterns superposed on port films are applied to verify planned patterns. A 12-patient study of PV was performed by analyzing positions of 10 anatomic points on repeat CT topograms, plotting histograms of PV, and determining average PV. RESULTS AND DISCUSSION: A 1.5+/-0.3 mm SD shrinkage per 70 cm of thermoplastic was observed over 24 h. Average PV of 1.0+/-0.8, 1.2+/-1.1, and 1.3+/-0.8 mm were measured in SI, AP, and RL directions, respectively. Lateral port films exposed with and without the MIMiC showed PV of 0.2+/-1.3 and 0.8+/-2.2 mm in AP and SI directions. Vane patterns superimposed on port films consistently verified the planned patterns. CONCLUSION: The CHS provided adequately reproducible immobilization for dynamic IMRT, and may be applicable to decrease PV for other cranial and head and neck external beam radiation therapy.

Brain Neoplasms↗

PubMed1998

Dosimetric verification of the dynamic intensity-modulated radiation therapy of 92 patients.

PURPOSE: To verify that optimized dose distributions provided by an intensity-modulated radiation therapy (IMRT) system are delivered accurately to human patients. METHODS AND MATERIALS: Anthropomorphic phantoms are used to measure IMRT doses. Four types of verification are developed for: I) system commissioning with beams optimized to irradiate simulated targets in phantoms, II) plans with patient-optimized beams directed to phantoms simulating the patient, III) patient-phantom hybrid plans with patient-optimized beams calculated in phantom without further optimization, and IV) in vivo measurements. Phantoms containing dosimeters are irradiated with patient-optimized beams. Films are scanned and data were analyzed with software. Percent difference between verified and planned maximum target doses is defined as "dose discrepancy" (deltavp). The frequency distribution of type II deltavp from 204 verification films of 92 IMRT patients is fit to a Gaussian. Measurements made in vivo yield discrepancies specified as deltaivp, also fit to a Gaussian. RESULTS AND DISCUSSION: Verification methods revealed three systematic errors in plans that were corrected prior to treatment. Values of [deltavp] for verification type I are <2%. Type II verification discrepancies are characterized by a Gaussian fit with a peak 0.2% from the centroid, and 158 [deltavp] <5%. The 46 values of [deltavp] >5% arise from differences between phantom and patient geometry, and from simulation, calculation, and other errors. Values of [deltavp] for verification III are less than half of the values of [deltavp] for verification II. A Gaussian fit of deltaivp from verification IV shows more discrepancy than the fit of deltavp, attributed to dose gradients in detectors, and exacerbated by immobilization uncertainty. CONCLUSIONS: Dosimetric verification is a critical step in the quality assurance (QA) of IMRT. Hybrid Verification III is suggested as a preliminary quality standard for IMRT.

Brain Neoplasms↗

PubMed1998

Dosimetric comparison of stereotactic radiosurgery to intensity modulated radiotherapy.

To compare the dosimetry achievable with an intensity modulated radiotherapy (IMR) system to that of stereotactic radiosurgery (SRS) for an irregularly shaped moderate size target. A treatment plan was selected from 109 single fraction SRS cases having had multiple non-coplanar arc therapy using a 6 MV linear accelerator fitted with circular tertiary collimators 1.00 to 4.00 cm in diameter at isocenter. The CT scan with delineated regions of interest was then entered into an IMR treatment planning system and optimized dose distributions, using a back projection technique for dynamic multileaf collimator delivery, were generated with a stimulated annealing algorithm. Dose volume histograms (DVH), homogeneity indices (HI), conformity indices (CI), minimum and maximum doses to surrounding highly sensitive intracranial structures, as well as the volume of tissue treated to > 80, 50, and 20% of the prescription dose from the IMR plan were then compared to those from the single isocenter SRS plan used and a hypothetical three isocenter SRS plan. For an irregularly shaped target, the IMR plan produced a HI of 1.08 and CI of 1.50 compared to 1.75 and 4.41, respectively, for the single isocenter SRS plan (SRS1) and 3.33 and 3.43 for the triple isocenter SRS plan (SRS3). The maximum and minimum doses to surrounding critical structures were less with the IMR plan in comparison to both SRS plans. However, the volume of non-target tissue treated to > 80, 50, and 20% of the prescription dose with the IMR plan was 137, 170, and 163%, respectively, of that treated with the SRS1 plan and 85, 100, and 123% of the volume when compared to SRS3 plan. The IMR system provided more conformal target doses than were provided by the single isocenter or three isocenter SRS plans. IMR delivered less dose to critical normal tissues and provided increased homogeneity within the target volume for a moderate size irregularly shaped target, at the cost of a larger penumbra.

Brain↗

PubMed1997

Response of intracranial melanoma metastases to stereotactic radiosurgery.

We analyzed our recent stereotactic radiosurgery (SRS) experience to determine the radiographic response of intracranial metastatic melanomas to SRS. Twelve patients with 21 intracranial melanoma metastases treated with SRS were evaluated. Fifteen (72%) metastases were hemispheric, 3 (14%) were cerebellar, and 3 (14%) were in the basal ganglion or thalamus. All lesions were 2.5 cm or less in maximum diameter. Eleven patients also had whole brain external beam radiotherapy. Mean SRS dosage was 1,800 cGy to the 85% isodose surface and median dose was 1,800 cGy to the 80% isodose surface (range 1,100-3, 100 cGy at the 80-95% isodose surface). Overall, 12 (57%) lesions showed decrease or stabilization of tumor volume (i.e., local control), while 9 (43%) showed enlargement. Division of metastases into small (< or = 1.0 cm diameter) and large (> 1.0 cm diameter) tumors showed that the small tumors were more likely to regress than the large tumors (chi-square test; P < 0.03). Only 1 of 9 (11%) large lesions regressed as opposed to 7 of 12 (58%) small lesions regressed with SRS. We conclude that SRS is suited for small melanoma brain metastases, but lesions between 1.0 and 2.5 cm in diameter, while still generally considered appropriate for SRS, may not be as responsive to SRS at currently employed dosages.

Adult↗

PubMed1996

Use of a 1 mm collimator to test the accuracy of stereotactic radiotherapy.

PURPOSE: To develop a method of measuring locations of the center of dose in stereotactic radiotherapy relative to the center of the target, and thereby obtain a test of the accuracy of stereotactic radiotherapy (SRT). METHODS AND MATERIALS: An insert was mounted in an SRT collimator on a 6 MV linear accelerator to provide a photon beam approximately 1 mm in diameter at isocenter, and a method of measuring radiation center coordinates of arced SRT beams. To simulate a small intracranial target, two halves of a Barium paste column were embedded in two adjacent slabs of a humanoid phantom. A film was placed between the slabs to image the radiation relative to the target center. A surgical head ring and computerized tomography (CT) localizer were attached to the phantom and CT scans were obtained. The scans were entered in a three-dimensional computerized treatment-planning system and radiation isocenter coordinates determined by iteratively moving the 90% isodose surface center of arced beam dose distributions to coincide with the target center. The phantom was bolted to an SRT floorstand with isocenter coordinates obtained from the treatment plan, and then irradiated in two sets of experiments. The first set applied five 1 mm noncoplanar arced beams with and without offsets of the planned coordinates in the transverse plane. The second set applied one large transverse arc coplanar to the film with and without offsets in the craniocaudal direction. Irradiations with coordinate offsets tested the sensitivity of the method. Films were developed and digitized with a high resolution film scanner to measure the location of the radiation relative to the target center. RESULTS AND CONCLUSION: The radiation center was found from 0.0 to 0.3 mm of the target center, within requirements of our clinical quality assurance program. The measurement and evaluation of coincidence of radiation and target centers are, thus, proposed as elements of radiosurgery facility acceptance and annual quality assurance.

Models, Anatomic↗

PubMed1996

The measurement of linear accelerator isocenter motion using a three-micrometer device and an adjustable pointer.

PURPOSE: The small motions of the major axes of a linear accelerator observed during gantry and treatment table rotation were measured to improve beam-target alignment during stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Measurements of gantry isocenter motion and table rotational axis wobble were performed with an adjustable front pointer and a three-micrometer device. Nominal gantry and table isocenters were specified. The gantry motion path and table isocenter coordinates were then applied to offset simulated treatment target coordinates so as to compensate for gantry sag. Target simulation films were examined to document improvement of beam-target alignment. RESULTS: The overall precision of the measurement of gantry and table isocenter coordinates was 0.2 mm. Over gantry rotation of 0 to 360 degrees, the gantry isocenter was found to follow a pinched loop with a maximum point to point distance of 1 mm. Table axis motion was found to be negligible relative to the reproducibility of gantry isocenter motion. Thus, a table isocenter was defined that was invariant to table rotation. CONCLUSION: Results indicate that the three-micrometer device and adjustable front pointer are useful tools for three-dimensional (3D) mapping of gantry, collimator and table isocenters and their motions. It is suggested that such measurements may be useful in the quality assurance of linear accelerators, particularly to improve beam-target alignment during SRS and other high dose external beam therapy.

Algorithms↗

PubMed1996

Algorithms for the process management of sealed source brachytherapy.

Incidents and misadministrations suggest that brachytherapy may benefit from clarification of the quality management program and other mandates of the U.S. Nuclear Regulatory Commission. To that end, flowcharts of step by step subprocesses were developed and formatted with dedicated software. The overall process was similarly organized in a complex flowchart termed a general process map. Procedural and structural indicators associated with each flowchart and map were critiqued and pre-existing documentation was revised. "Step-regulation tables" were created to refer steps and subprocesses to Nuclear Regulatory Commission rules and recommendations in their sequences of applicability. Brachytherapy algorithms were specified as programmable, recursive processes, including therapeutic dose determination and monitoring doses to the public. These algorithms are embodied in flowcharts and step-regulation tables. A general algorithm is suggested as a template from which other facilities may derive tools to facilitate process management of sealed source brachytherapy.

Algorithms↗

PubMed1994

Fine tuning of linear accelerator accessories for stereotactic radiotherapy.

PURPOSE: Experience with the University of Wisconsin's stereotactic radiotherapy (SRT) accessory system was applied to build a new system, facilitate alignment of linac photon beams with a Brown-Roberts-Wells (BRW) stereotaxy, and increase the versatility and stability of the stereotaxy. METHODS AND MATERIALS: High tensile strength stainless steel was used in the floor stand to increase the range of gantry rotation relative to ranges allowed by truss-mounted stands. The collimator assembly and floor stand were each fitted with two-axis gimbal and translation adjustments in addition to the floor stand's three-axis adjustments. The head ring positioning assembly was fitted with two braces to prevent the head ring from deforming with patient motion. Six MV linac photon beam characteristics were measured with a computer-controlled scanning system and a diode in water, at source to surface distances (SSD) of 80 and 100 cm, and for 13 divergent collimators ranging in diameter from 1-4 cm at 100 cm SSD. Quality assurance software was applied to screen data for questionable consistency or symmetry. Integrity of the stereotaxy was evaluated with target simulation films and repeated measurements which were part of the quality assurance of clinical treatments. A method was developed using a glass etched contact reticle to obtain average simulated target to beam center distances (delta av) from target simulation films. RESULTS AND CONCLUSION: New aspects of the current system have improved the ability to fine tune and analyze stereotactic alignment. Beam characteristics met stringent output criteria and penumbral widths were the same or narrower than penumbral widths reported elsewhere. The precision of measuring delta av was 0.1 mm, and delta av averaged over 50 target simulation films was 0.7 +/- 0.1 mm. Results suggest that it may be useful to determine delta av from target simulation films with the method described here.

Humans↗

PubMed1991

The Saccharomyces cerevisiae SRK1 gene, a suppressor of bcy1 and ins1, may be involved in protein phosphatase function.

The Saccharomyces cerevisiae SRK1 gene, when expressed on a low-copy shuttle vector, partially suppresses the phenotype associated with elevated levels of cyclic AMP-dependent protein kinase activity and suppresses the temperature-sensitive cell cycle arrest of the ins1 mutant. SRK1 is located on chromosome IV, 3 centimorgans from gcn2. A mutant carrying a deletion mutation in srk1 is viable. SRK1 encodes a 140-kDa protein with homology to the dis3+ protein from Schizosaccharomyces pombe. The ability of SRK1 to alleviate partially the defects caused by high levels of cyclic AMP-dependent protein kinase and the similarity of its encoded protein to dis3+ suggest that SRK1 may have a role in protein phosphatase function.

Amino Acid Sequence↗

PubMed1990

Secretion and expression of the Pasteurella haemolytica Leukotoxin.

The Pasteurella haemolytica leukotoxin gene cluster (lktCABD) is homologous to the Escherichia coli hemolysin locus (hlyCABD). Since the cloned leukotoxin (LktA) is not secreted from E. coli cells, a heteroplasmid complementation system was developed that permits secretion of the leukotoxin from cells expressing the hemolysin transport proteins HlyB and HlyD. We observed that the secreted leukotoxin protein had weak hemolytic activity when activated by either the HlyC or LktC proteins and that LktC expressed in E. coli could confer weak hemolytic activity upon hemolysin. Thus, it appears that the accessory proteins of the leukotoxin and hemolysin gene clusters are functionally similar, although their expression in E. coli is not equivalent. Northern (RNA) blot analysis of the P. haemolytica leukotoxin gene cluster revealed a major 3.5-kilobase transcript that includes the lktC and lktA genes. The start site for this transcript mapped to a cytosine residue 30 nucleotides upstream from the putative start of lktC; a similar initiation site was observed in E. coli, although adjacent cytosine and adenine residues were also utilized. The 3.5-kilobase transcript terminated near the rho-independent terminator structure between lktA and lktB, but transcription may continue, via antitermination or de novo transcription initiation, into the downstream lktB and lktD genes. We propose that the lack of LktB and LktD function in E. coli is a result, at least in part, of poor lktBD transcription and suggest that a P. haemolytica-specific regulator is required for optimal expression of the leukotoxin genes.

Amino Acid Sequence↗

PubMed1987

Automated temperature scanning for hyperthermia treatment monitoring.

Ideal descriptors of hyperthermia treatments will most likely depend on complete target temperature distributions. Although these distributions can be modeled numerically, the accuracy of models is limited by the sparseness of temperatures measured in vivo. Thus, the strategy of monitoring temperatures may play a key role in improving hyperthermia therapy. Scanning temperatures by manual translations of thermometers was found to be excessively time consuming. Consequently an automated system was developed consisting of linear actuators, outriggers, guide tubes, thermometry catheters, personal computer, and dedicated hardware and software. During treatments, scan patterns were created with algorithms using temperatures measured preceding each thermometer translation. Measurement position had a noteworthy influence on thermal dose estimated by current models. Relative to manual scanning, automated scanning increased measurement efficiency, reduced probe position uncertainty, reduced operator time, and provided improved data for modeling bioheat transfer and thermal dose.

Algorithms↗

PubMed1986

A practical approach to uniform total body photon irradiation.

Photon total body irradiation (TBI) has been applied to treat several systemic malignancies. However, TBI studies have been limited by nonuniform dosimetry. A 16 MV technique was initiated to improve uniformity of dose in a practical manner. For high dose TBI, missing tissue compensators are designed from lateral tissue separations, intra-lung separations, average CT numbers of lung regions, tissue phantom ratios, and off axis ratios. A few days before treatment, CT scans are obtained and TBI is simulated in the treatment room. In the treatment room, back projections of the patient's lateral silhouette, arm outline, and CT levels are traced on a compensatory tray. Lead sheets are scribed through a schematic of the tray, cut, and fixed to their appropriate positions on the tray. Doses are verified with thermoluminescent dosemeters and ion chambers. Most measurements at the temple, chest wall, mid-thighs, and mid-knees have been within 10% of prescribed doses. About 4 hours are required for compensator fabrication and dose verification. This approach has been found practical, substantially improving dose uniformity relative to prior 60Co techniques applied at this institution.

Humans↗

PubMed1984

Dosimetry of rotational photon fields with gravity-oriented eye blocks.

Evolving radiotherapeutic technique is aimed at routine use of an eye protection accessory with uniformity of dose to facial tumors. Rotational 4 MV photon fields with gravity-oriented eye blocks are described in applications to patients and a phantom. A machine-oriented compensator with a slit and beveled edges at eye levels has been applied to increase uniformity of dose over the entire target, including partly blocked regions. Treatment planning parameters are derived from simple geometric relationships. Dose distributions and average tissue-air ratios (TAR) are calculated with a conventional radiotherapeutic treatment planning system, and measured during initial treatments via thermoluminescent dosemeters (TLD) in facial cavities. Machine monitor units of initial treatments (MU1) are calculated from prescribed dose D, TAR, percentage isodose lines, dose rates in air, and compensator transmission; for subsequent treatments, MU1 are modified using averages of unblocked target doses D measured during initial treatment: MU2 = (D/D)MU1. Doses measured on patients' eyelids have been 10 to 15% of prescribed dose. Three dimensional dose distributions were determined using TLD in an anthropomorphic phantom. With beam compensation, eye doses were 15% of unblocked target doses, doses to partly blocked target were 86 to 129% of unblocked target doses, and doses to unblocked target showed 5% mean standard deviations. In vivo and in phantom data were consistent with computer-calculated distributions. For uniformity of target dose, eye-sparing, and simplicity of irradiating tumors surrounding the eyes, the technique investigated compares favorably with conventional techniques.

Elementary Particles↗