Magnetic resonance (MR) images of the brain in 285 patients between the ages of 2 and 25 years were retrospectively studied to determine the appearance of brain iron accumulation. The globus pallidus, red nucleus, substantia nigra, and dentate nucleus were evaluated with long TR/TE (repetition time/echo time) spin-echo sequences and staged. All four regions in most patients were initially hyperintense compared with white matter (stage I) before becoming isointense (stage II) and subsequently hypointense (stage III). The globus pallidus was the first to reach stage III, the red nucleus and substantia nigra were next, and the dentate nucleus was last. In general, decreased signal intensity (stage III) was not seen in these regions in patients less than 10 years old; in most patients it was seen by age 25 years. The dentate nucleus decreased in signal intensity more slowly and inconsistently; only one-third of patients had reached stage III by age 25 years. The temporal sequence of normal iron deposition as detected with MR imaging is helpful not only in the diagnosis of known iron-deposition diseases but also in the detection of iron-related pathologic changes.

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Qualitative findings on HRCT are independent risk factors for pulmonary complications after lobectomy. Preoperative HRCT may be useful to predict pulmonary complications.

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A technique for multiple deep-inspiration breath-hold (DIBH) volumetric modulated arc therapy (VMAT) for a lung tumor has been proposed with 10 MV flattening-filter-free beams and an image sensor measuring a distance map to thorax surface. Planning CT images were acquired under a DIBH condition and a clinical target volume (CTV) was contoured. This procedure was repeated five times and an internal target volume (ITV) among the multiple DIBHs was created by integrating the five CTVs. A planning target volume (PTV) was defined by adding an isotropic margin of 5 mm to the ITV. Immediately before treatment, a 30-second half-arc cone-beam computer tomography (CBCT) imaging was performed under another DIBH condition, and the couch was repositioned so that tumor may be located inside the PTV contours. An infrared distance measurement device having laser diodes and an image sensor was attached to the couch, and a distance map to the patient thorax surface was recorded as a reference during still another DIBH condition. A half-arc segmented VMAT beams with two beam interrupts were delivered to the patient under multiple DIBHs, where the delivery time of each of the three segmented beams was 30 seconds. During the beam delivery, the distance map was monitored in real time to confirm that the distance to the thorax surface remained unchanged. In-treatment CBCT images suggested that the tumor position at the time of tumor registration was accurately reHow to cite this