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The radioesophagogram (REG): A new dynamic technique for the study of the esophagus
Abstracts
64 Conclusion
Since the data are recorded in matrix elements of &in. dimensions, each element represents the fraction of total myocardial flow recorded from that element. Regional flow may then be determined by integrating the total elements corresponding to the region of interest. The ultimate size of the minium size of a region that can be identified, along with statistical resolution limitations, has not as yet been determined. Even with this limitation, the feasibility of determining alterations of regional myocardial flow by means of a procedure no more traumatic than a peripheral vein injection seems to well merit further investigation. References
1. DONATO L., BARTOLOMEI G., FEDERIGHI G. and TORREGGIANI G. Circulation 33, 708 (1966).
2. ISHII Y. and MACINTYRE W. J. Circulation 44, 37 (1971).
patient is instructed to suck and swallow the content of the cup in a continuous steady flow. The passage of the activity through the esophagus is observed on the monitor scope of the gamma camera and is simultaneously recorded on-line in the digital mode on video-tape. The recorded data can be replayed for further imaging and processing. Serial Polaroid scintiphotos at any desired time-interval can be made via the Polaroid camera-scope. In addition, a dynamic histogram of counts versus time can be obtained by playing-back the tape through the built-in loo-channel digital data-processor. Until the time of writing this report 30 human subjects were studied. Twelve of them were normal adult volunteers of either sex (eight males, four females). The other 18 were patients referred for radiation therapy with varying degree of dysphagia, due to esophageal or mediastinal carcinomas. On six patients, the REG was repeated after the completion of the radiation therapy. Results
The Radioesophagogram (REG): A New Dynamic Technique for the Study of the Esophagus, by I. KAZEM, with the technical assistance of G. WAGEMAKERS and E , VERBEETEN. Department of Radiation Therapy Medicine, University of Nijmegen,
and Nuclear The Nether-
lands.
The normal REG. Few seconds following the swallow of the radioactive drink the entire length of the esophagus is visualized on the serial scintiphotos ; three stages of the activity passage can be recognized. The dynamic histogram of activity versus time obtained on normal subjects reflects the pattern of the transit of activity through the esophagus. In general it represents a rather sharp rise of activity to a single or multiple plateau level depending on the timedelay period of the first and third stages. Mechanical
THE ESOPHAGUScan be visualized
by means of the gamma camera following the swallow of a radioactive drink. The passage of the activity bolus from the pharynx to the stomach can be continuouslyrecorded, offering both anatomic and functional information. This introduces a new technique for the study of the esophagus which adds valuable data to the radiologic and endoscopic findings. Materials
and
Methods
Technique. The technique of the Radioesophagogram (REG) as developed by the author does not require any special preparation of the patient. The detector surface of the gamma camera is adjusted in the vertical position such that the area of the detector would cover the anterior thoracic region of the standing-up or seated patient. A radioactive drink, consisting of 1-2 mCi of ggmT~ pertechnetate dissolved in a total volume of about lo-20 ml of tea or water is prepared. The drink is placed in a paper cup housed in a suitable lead-container. By means of a straw the
Obstruction
Regardless of whether it is due to extrinsic or intrinsic factors, mechanical obstruction have a similar pattern. In this pattern, both the serial scintiphotos and the dynamic histogram show a build-up of the activity at the level of obstruction. Functional
Obstruction
In one of the patients studied, a plastic tube was inserted in the lower third of the esophagus through the cardiac junction for the palliative treatment of a carcinoma of the cardiac end. Although radiological examination demonstrated free passage of the barium liquid through the tube, the REG showed functional obstruction at the funnel end of the rigid tube. Discussion
The passage of water through the esophagus takes a period of 3-6 s, and the cardiac sphincter requires 2-16 s to open-up. Furthermore, peristaltic waves can be seen in the lower segment of the esophagus as visualized by the REG. The hitherto information
Abstracts about the swallow-functionis derived from radiological findings obtained after a barium-swallow. Even in its thinest form the barium solution is different in It is therefore consistency compared to water. suggested that the REG is more reliable for water swallow-function.
Conclusion The REG offers a new approach for the functional and anatomic study of the esophagus which supplements the available radiologic and endoscopic methods. It is a clinical study that is particularly indicated for: The study of the swallowing function; # The evaluation of swallowing dysfunction; (3) Early detection of esophageal fistulas and leakages; and (4) The assessment of the result of treatment and the follow up of patients with dysphagia.
Windowless a-n Semiconductor Radiation Detector for the Measurement of Gaseous 14C0, in wivo and in vitro, by T. KOBAYASHI, T. SUGITA, S. TAKAYANAGI, M. IIO* and H. YAMADA * . Toshiba Research and Development Center, Kawasaki, and *Second Department of Internal Medicine, School of Medicine, University of Tokyo, Tokyo, Japan. FOR THE measurement of precise dynamic biomedical and bacteriological fermentation process with aid of radioisotopes, such as 14C and ?!j, stable windowless semiconductor detectors for low-energy beta-ray in vivo or in vitro counting were developed and the fundamental characteristics of the detecton were studied. The detectors developed have a sensitive area ranging from 4 mms to 2 cm2. The effective window (dead layer) of the detector is less than 0.3 ,um. The fundamental characteristics of counting rate vs. discriminator level and counting rate vs. temperature were studied for the detector developed, especially the O-2 ems and 2 cm2 area detectors, using either water solution, or thin solid source of 14C. The counting efficiency of the detector is proportional to the sensitive area of the detector at the constant discriminator level. The counting rate was about 200 cpm/cm2 for 3 m$X/cm2 of 14C solid source at the discriminator level of 15 keV. The experimental results show that 20 mm2 area detector is feasible for the in z&o measurement of lowenergy beta-ray, such as those emitted by 14C and 5
65
%, and that a large area detector is feasible for in vitro application, according to its high counting efficiency at room temperature. For in z&o application of windowless j-n semiconductor radiation detector, the counting system for measurement of the release of 14C02 resulting from the metabolism of 14C-glucose during bacteria growth was constructed. The counting system consists of the windowless semiconductor detector, gas container, culture vial, and associated electronic circuits to handle the data automatically. The evaluation of this instrument was carried out using blood cultures and urine samples. After the addition of the bacteria (E-coli) to 1 ml of sterile serum, 5 ,uCi of uniformly labelled 14C-glucose was added, and the culture was incubated at 37°C. Radioactive carbon dioxide (14C02) released from culture was measured automatically with chartrecorder and electronic counter. The counting rate of 14C0, was increased after 2 h of incubation time while the culture was agitated continously. However, the content of 14C02 released from the culture was less without continuous agitation. The advantage of this counting system is that continuous dynamic measurement of exhaled 14C02 or released 14COs from 14C labeled compounds can be made without complicated procedures. The culture vial which is used for automatic sequential sampling of many samples was also reported.
Renal Clearance in Mice as a Bioassay for Radiopharmaceuticals: Method and Evaluation, by T. KONIKOWSKI, H. J. GLENN, T. P. HAYNIE and L. E. FARR*. The University of Texas at Houston M. D. Anderson Hospital and Tumor Institute, Houston, Texas, and *State Department of Health, Berkeley, California. IN EVALUATING radiopharmaceuticals, there is a need for a variety of bioassays for assessing physiological distribution and turnover of radiopharmaceuticals. Those radiopharmaceuticals principally cleared by the kidney can be evaluated by classical techniques for renal clearance, including glomerular filtration rate (GFR) and renal plasma and blood flow (RPF and RBF) . Using Yale-Swiss mice we have developed and are reporting on a reproducible technique by which GFR, RPF and REF can be rapidly assessed in sequence, utilizing standard reagents such as inulin14-C-carboxyl and 1311-orthoiodohippuric acid (OIH) .
64 Conclusion
Since the data are recorded in matrix elements of &in. dimensions, each element represents the fraction of total myocardial flow recorded from that element. Regional flow may then be determined by integrating the total elements corresponding to the region of interest. The ultimate size of the minium size of a region that can be identified, along with statistical resolution limitations, has not as yet been determined. Even with this limitation, the feasibility of determining alterations of regional myocardial flow by means of a procedure no more traumatic than a peripheral vein injection seems to well merit further investigation. References
1. DONATO L., BARTOLOMEI G., FEDERIGHI G. and TORREGGIANI G. Circulation 33, 708 (1966).
2. ISHII Y. and MACINTYRE W. J. Circulation 44, 37 (1971).
patient is instructed to suck and swallow the content of the cup in a continuous steady flow. The passage of the activity through the esophagus is observed on the monitor scope of the gamma camera and is simultaneously recorded on-line in the digital mode on video-tape. The recorded data can be replayed for further imaging and processing. Serial Polaroid scintiphotos at any desired time-interval can be made via the Polaroid camera-scope. In addition, a dynamic histogram of counts versus time can be obtained by playing-back the tape through the built-in loo-channel digital data-processor. Until the time of writing this report 30 human subjects were studied. Twelve of them were normal adult volunteers of either sex (eight males, four females). The other 18 were patients referred for radiation therapy with varying degree of dysphagia, due to esophageal or mediastinal carcinomas. On six patients, the REG was repeated after the completion of the radiation therapy. Results
The Radioesophagogram (REG): A New Dynamic Technique for the Study of the Esophagus, by I. KAZEM, with the technical assistance of G. WAGEMAKERS and E , VERBEETEN. Department of Radiation Therapy Medicine, University of Nijmegen,
and Nuclear The Nether-
lands.
The normal REG. Few seconds following the swallow of the radioactive drink the entire length of the esophagus is visualized on the serial scintiphotos ; three stages of the activity passage can be recognized. The dynamic histogram of activity versus time obtained on normal subjects reflects the pattern of the transit of activity through the esophagus. In general it represents a rather sharp rise of activity to a single or multiple plateau level depending on the timedelay period of the first and third stages. Mechanical
THE ESOPHAGUScan be visualized
by means of the gamma camera following the swallow of a radioactive drink. The passage of the activity bolus from the pharynx to the stomach can be continuouslyrecorded, offering both anatomic and functional information. This introduces a new technique for the study of the esophagus which adds valuable data to the radiologic and endoscopic findings. Materials
and
Methods
Technique. The technique of the Radioesophagogram (REG) as developed by the author does not require any special preparation of the patient. The detector surface of the gamma camera is adjusted in the vertical position such that the area of the detector would cover the anterior thoracic region of the standing-up or seated patient. A radioactive drink, consisting of 1-2 mCi of ggmT~ pertechnetate dissolved in a total volume of about lo-20 ml of tea or water is prepared. The drink is placed in a paper cup housed in a suitable lead-container. By means of a straw the
Obstruction
Regardless of whether it is due to extrinsic or intrinsic factors, mechanical obstruction have a similar pattern. In this pattern, both the serial scintiphotos and the dynamic histogram show a build-up of the activity at the level of obstruction. Functional
Obstruction
In one of the patients studied, a plastic tube was inserted in the lower third of the esophagus through the cardiac junction for the palliative treatment of a carcinoma of the cardiac end. Although radiological examination demonstrated free passage of the barium liquid through the tube, the REG showed functional obstruction at the funnel end of the rigid tube. Discussion
The passage of water through the esophagus takes a period of 3-6 s, and the cardiac sphincter requires 2-16 s to open-up. Furthermore, peristaltic waves can be seen in the lower segment of the esophagus as visualized by the REG. The hitherto information
Abstracts about the swallow-functionis derived from radiological findings obtained after a barium-swallow. Even in its thinest form the barium solution is different in It is therefore consistency compared to water. suggested that the REG is more reliable for water swallow-function.
Conclusion The REG offers a new approach for the functional and anatomic study of the esophagus which supplements the available radiologic and endoscopic methods. It is a clinical study that is particularly indicated for: The study of the swallowing function; # The evaluation of swallowing dysfunction; (3) Early detection of esophageal fistulas and leakages; and (4) The assessment of the result of treatment and the follow up of patients with dysphagia.
Windowless a-n Semiconductor Radiation Detector for the Measurement of Gaseous 14C0, in wivo and in vitro, by T. KOBAYASHI, T. SUGITA, S. TAKAYANAGI, M. IIO* and H. YAMADA * . Toshiba Research and Development Center, Kawasaki, and *Second Department of Internal Medicine, School of Medicine, University of Tokyo, Tokyo, Japan. FOR THE measurement of precise dynamic biomedical and bacteriological fermentation process with aid of radioisotopes, such as 14C and ?!j, stable windowless semiconductor detectors for low-energy beta-ray in vivo or in vitro counting were developed and the fundamental characteristics of the detecton were studied. The detectors developed have a sensitive area ranging from 4 mms to 2 cm2. The effective window (dead layer) of the detector is less than 0.3 ,um. The fundamental characteristics of counting rate vs. discriminator level and counting rate vs. temperature were studied for the detector developed, especially the O-2 ems and 2 cm2 area detectors, using either water solution, or thin solid source of 14C. The counting efficiency of the detector is proportional to the sensitive area of the detector at the constant discriminator level. The counting rate was about 200 cpm/cm2 for 3 m$X/cm2 of 14C solid source at the discriminator level of 15 keV. The experimental results show that 20 mm2 area detector is feasible for the in z&o measurement of lowenergy beta-ray, such as those emitted by 14C and 5
65
%, and that a large area detector is feasible for in vitro application, according to its high counting efficiency at room temperature. For in z&o application of windowless j-n semiconductor radiation detector, the counting system for measurement of the release of 14C02 resulting from the metabolism of 14C-glucose during bacteria growth was constructed. The counting system consists of the windowless semiconductor detector, gas container, culture vial, and associated electronic circuits to handle the data automatically. The evaluation of this instrument was carried out using blood cultures and urine samples. After the addition of the bacteria (E-coli) to 1 ml of sterile serum, 5 ,uCi of uniformly labelled 14C-glucose was added, and the culture was incubated at 37°C. Radioactive carbon dioxide (14C02) released from culture was measured automatically with chartrecorder and electronic counter. The counting rate of 14C0, was increased after 2 h of incubation time while the culture was agitated continously. However, the content of 14C02 released from the culture was less without continuous agitation. The advantage of this counting system is that continuous dynamic measurement of exhaled 14C02 or released 14COs from 14C labeled compounds can be made without complicated procedures. The culture vial which is used for automatic sequential sampling of many samples was also reported.
Renal Clearance in Mice as a Bioassay for Radiopharmaceuticals: Method and Evaluation, by T. KONIKOWSKI, H. J. GLENN, T. P. HAYNIE and L. E. FARR*. The University of Texas at Houston M. D. Anderson Hospital and Tumor Institute, Houston, Texas, and *State Department of Health, Berkeley, California. IN EVALUATING radiopharmaceuticals, there is a need for a variety of bioassays for assessing physiological distribution and turnover of radiopharmaceuticals. Those radiopharmaceuticals principally cleared by the kidney can be evaluated by classical techniques for renal clearance, including glomerular filtration rate (GFR) and renal plasma and blood flow (RPF and RBF) . Using Yale-Swiss mice we have developed and are reporting on a reproducible technique by which GFR, RPF and REF can be rapidly assessed in sequence, utilizing standard reagents such as inulin14-C-carboxyl and 1311-orthoiodohippuric acid (OIH) .