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. (1976). British Journal of Industrial Medicine, 33, 65-71. Accidental exposure to isocyanate fumes in a group of firemen. A total of 35 firemen involved in fighting a fire in a factory in which polyurethane foam was made were exposed to fumes of toluene di-isocyanate from two large storage tanks which were damaged during the fire, resulting in massive spillage. Most of the men experienced symptoms during the fire or during the three weeks after it. The symptoms were mainly gastrointestinal, respiratory, or neurological. Altogether 15 men described gastrointestinal symptoms which subsided within two days of onset. Respiratory symptoms were described by 31 men and were most pronounced during the three days after the fire, thereafter tending to improve. The neurological findings are described separately. When the men were reviewed at six months there was a suggestion that some of them might have sustained long-term damage to the respiratory tract, and almost four years later 20 men had persistent respiratory symptoms. Serial measurements of ventilatory capacity revealed a marked decline in the first six months although this was not sustained.A fire occurred in November 1967 at a factory manufacturing polyurethane foam, during which 35 firemen were exposed to chemical fumes including toluene di-isocyanate (TDI). The men were part-time firemen with the exception of five full-time officers. The fire started in a part of the factory where finished blocks of foam were stored and, because of the highly inflammable nature of the foam, the fire spread rapidly to the production section where several tanks of TDI and other chemicals used in the manufacturing process were stored (Table 1).The flexible polyurethane foam was manufactured by reacting toluene di-isocyanate and a propylene glycol, together with various additives. In the factory were several tanks each containing 13 500 litres TDI. When the fire had been in progress for

. (1976). British Journal of Industrial Medicine, 33,[72][73][74][75][76][77][78]. Neurological complications after a single severe exposure to toluene di-isocyanate. A total of 23 men complained of neurological symptoms after a single severe exposure to toluene di-isocyanate. Effects of exposure were immediate in five men and consisted of euphoria, ataxia, and loss of consciousness. These men and nine others complained of headache, difficulty in concentration, poor memory, and confusion during the next three weeks. Four years later it was found that nine further men had experienced symptoms that theyhad not beenawareof at threeweeks. In all, 13 men still complained of poor memory, personality change, irritability, or depression after four years. Psychometric testing showed a selective defect for relatively long-term recall in those with persistent symptoms at four years.In November 1967 a group of firemen were heavily exposed to toluene di-isocyanate (TDI) while fighting a fire in a factory where polyurethane foam was manufactured. Details of the fire and the degree of exposure to TDI are given in another paper (Axford et al., 1976) in which the gastrointestinal and respiratory symptoms in these men are described. In summary, 31 of the 35 men who were seen after the fire developed tightness in the chest, dyspnoea, or cough; 16 men complained of nausea, vomiting, or abdominal pain. These various symptoms were present either at the time of the fire or during the next day. The present paper describes the neurological syndrome which developed in some of the men. A preliminary report of the early toxic complications has already been published (McKerrow, Davies, and Parry Jones, 1970).Acute respiratory symptoms after exposure to TDI have been recognized for some time (Fuchs and Valade, 1951;Gandevia, 1963) and it has been suggested that long-term effects may also occur (Munn, 1965). Neurological complications have not previously been described. *Dr McKerrow died in July 1972Subjects Altogether 23 men who were involved in the fire complained of neurological symptoms at some time and were interviewed and examined on one or more occasions during the four years after the fire. Their ages are shown in Table 1. Half of them were in their fourth decade at the time of the fire. Two men were full-time employees in the fire service, and the remainder had other jobs in addition to part-time fire service activities.Seventeen men were seen three weeks after the fire with complaints that suggested a possible neurological origin. The symptoms were considered to be important in 14 of the 17 men. A further review was undertaken at four years, when 18 men were seen; five of the original men were lost to follow-up, but others had reported similar complaints in the intervening years. Altogether 13 men were thought to be still affected. The symptoms and their incidence are shown in Table 1.

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Purpose. To develop and demonstrate an end-to-end assessment procedure for adaptive radiotherapy (ART) within an MR-guided system. Methods and materials. A 3D printed pelvic phantom was designed and constructed for use in this study. The phantom was put through the complete radiotherapy treatment chain, with planned internal changes made to model prostate translations and shape changes, allowing an investigation into three ART techniques commonly used. Absolute dosimetry measurements were made within the phantom using both gafchromic film and alanine. Comparisons between treatment planning system (TPS) calculations and measured dose values were made using the gamma evaluation with criteria of 3 mm/3% and 2 mm/2%. Results. Gamma analysis evaluations for each type of treatment plan adaptation investigated showed a very high agreement with pass rates for each experiment ranging from 98.10% to 99.70% and 92.60% to 97.55%, for criteria of 3%/3 mm and 2%/2 mm respectively. These pass rates were consistent for both shape and position changes. Alanine measurements further supported the results, showing an average difference of 1.98% from the TPS. Conclusion. The end-to-end assessment procedure provided demanding challenges for treatment plan adaptations to demonstrate the capabilities and achieved high consistency in all findings.