This report describes the ophthalmic examination of patients receiving MeV fast neutrons for the treatment of advanced tumours of the head in which the eye was unavoidably irradiated. The treatment was given by the Medical Research Council's cyclotron, and details have been published (Catterall and Vonberg, I974;Catterall, Sutherland, and Bewley, 1975). A preliminary report on the effects of neutron irradiation on the eye has also been completed (Brown, Roth, Catterall, and Beal, 1976 Ophthalmic examinationThe symptoms and signs found on ophthalmic examination were scored in intensity on a scale of 0 to 4. The eye was examined in detail and observations quantified for analysis. Colour macrophotography was used to record superficial signs and slit-image photography to record the lens of the eye (Brown, I972). The patients were examined before treatment when possible and thereafter at first weekly, then monthly, and later at longer intervals. ResultsThe length of follow-up was not enough to include all possible late complications but we consider Address for reprints: N. Brown,

The description, technique, and advantages of an improvised, simple afterloading applicator for treatment of uterinecervical carcinoma at the King Faisal Specialist Hospital and Research Centre are outlined. A thin-walled, small diameter tandem in combination with a remodified type Manchester ovoid set, provides an afterloading system which accepts recently available, small diameter micrad cesium-137 sources. The advantages of this applicator include less need for dilation of the cervix, thus eliminating the need for general anesthesia, more accurate placement of the ovoids due to fixed spacers, different ovoid sizes and spacer combination for different patient sizes and shapes, insertion ease due to simple maneuverability, an afterloading procedure minimizing radiation exposure to personnel, and structure compatible with the algorithm upon which the computer calculations are based.

CaS0,:Tm phosphor TLD has been used, mixed with glucose, to measure neutron and gamma doses separately. The results of measurements taken on 50 patients undergoing clinical neutron therapy are reported. Comparisons with isodose estimations at entrance and exit points give standard deviations of 8.8 and 17% respectively. An analysis of the errors involved indicates that the energy sensitivity of the system is a problem, but the results obtained are encouraging enough to continue development of a system for measuring doses in the treated volume. -

Patients with advanced tumours of the head and neck have been treated with fast neutrons from the Medical Research Council's cyclotron at Hammersmith Hospital for the last 5 years. In 62 per cent of the first hundred cases there was complete regression of the tumour and in only two cases did the tumour recur (Catterall and Vonberg, 1974). The effects of these 7-5 MeV neutrons on the normal tissues which are unavoidably irradiated have also been studied and, in the relatively short period of follow-up available, these effects have been entirely acceptable in skin, mucous membranes, and bones in the great majority of cases. The ophthalmic changes seen in relation to the doses received are described in this paper. The patientAltogether 28 patients received a measurable dose of neutrons to the eyes.All the tumours were locally extensive and in ten cases involved the bony orbital cavity. Eleven were localized to the nasopharynx or were salivary gland tumours without bone involvement, and seven patients received treatment for glioblastoma multiforme. A total of 52 eyes received a measurable dose of radiation and were examined. In these patients, 47 eycs received fast neutrons and were given radical x-ray therapy.The extent of these tumours required relatively large volumes of tissue to be treated and this included the whole of one eye in ten cases. Where there were apparently no distant metastases at the start of treatment the full dose of 1555* rads of neutrons was given in twelve treatments over 26 days to the eye on the involved side without shielding. The contralateral eye was given as little radiation as possible. The exact dose received by each eye was carefully calculated by means of isodose *This I555 rads has been reported as 1440 rads in previous papers. MethodIn most cases patients were seen before treatment so that any pre-existing ocular conditions could be noted and excluded from the results given in the present study. The interval between examinations varied from a week to several months; the minimum follow-up period was 28 days and the maximum 2 years from the start of radiation. The majority were seen at intervals up to at least 6 months.Patients were questioned about symptoms before each examination. Visual acuity was tested on a Snellen chart at 6 m with distance correction if worn, and a detailed examination of the eye and ocular adnexa was carried out using standard ophthalmological apparatus and methods. Pupils were dilatated with a shortacting mydriatic and lenses examined by focal and retroillumination. Photographs were taken of optical sections of the lens using the apparatus described by Brown (1972). Abnormalities of the eye and lids were noted and scored on a points system which will be described in detail elsewhere. ResultsThe results are summarized in the Table and the dose effect on various regions of the eye is shown in the Figure. A measurable dose of neutrons (2o rads or more) was received by 37 eyes. Those receiving less than 85 rads were unaffected. Some of the eyes (see Table), wh...

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