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Thirteen isolates from African AIDS patients and from the environment in Zaire were identified as members of the Mycobacterium avium complex by phenotypic tests. RFLP analysis showed that the isolates belong to a genetically homogeneous cluster. The 16S rRNA sequence analysis suggests a close relationship with the P-49 strain (ATCC 35847), a reference strain for the serotype 7 of M. avium complex. This work shows the close relationship between certain M. avium complex strains responsible for disseminated infection in AIDS patients and M. avium complex strains isolated from the environment in Zaire. Further, our findings confirm that atypical mycobacteria may disseminate in AIDS patients in Africa and suggest that infection in these patients probably originates in their environment.

Recovery of oocysts of Cryptosporidium parvum using 142 mm diameter 1.2 μm pore size acrylic copolymer membrane filters was evaluated. A mean recovery efficiency of 25.5% for oocyst concentrations of about 200 in 10 1 was achieved, making this method a simple and relatively efficient procedure compared with current standard methods.

Increasingly, physicians in emergency departments are seeing cases of injecting drug users (IDU) with dangerously high International Normalized Ratio (INR) results. Some of these patients have admitted to buying warfarin from a “street” source and taking the medication without INR monitoring. This group are known to be at significant risk of developing venous thrombo-embolic disease1 and have difficulties in …

Ethyl 5β-cholest-3-ene-5-acetate reactant: 970 mg. (2.50 mmoles) of cholest-4-en-3β-ol reactant: Triethyl orthoacetate product: ethyl 5β-cholest-3-ene-5-acetate solvent: Baker petroleum ether Keywords: esterification, unsubstituted monobasic acids; rearrangements; apparatus, for preparation, of allyl vinyl ethers and subsequent claisen rearrangement

N,N-dimethyl-5β-cholest-3-ene-5-acetamide reactant: 970 mg. (2.51 mmoles) of cholest-4-en-3β-ol product: N,N-dimethyl-5β-cholest-3-ene-5-acetamide Keywords: acetal (and thioacetal) formation; rearrangements

5β-cholest-3-ene-5-acetaldehyde reactant: 970 mg. (2.51 mmoles) of cholest-4-en-3β-ol reactant: Ethyl vinyl ether solvent: 150 ml. of petroleum ether intermediate: cholestenyl vinyl ether product: 5β-cholest-3-ene-5-acetaldehyde Keywords: rearrangements; diethyl ether; ethyl vinyl ether; mercury(II) acetate; oven, Kugelrohr

The aims of the project were threefold: to survey the use of disinfectants in the UK food industry; to assess the product and environmental microflora of selected food factories for the persistence of Listeria monocytogenes and Escherichia coli; and to determine the disinfectant resistance of any persistent strains.A survey of the use of disinfectants in the UK food industry was undertaken in which a total of 40 sites were visited and a further 77 postal questionnaires were returned from farms, food manufacture, food transport and food retail sites. Quaternary ammonium compounds (QACs) were predominantly used, applied in small volumes as a mist. Approximately 30,000 samples from the product and environment of five chilled food factories were examined for L. monocytogenes and E. coli over a 3 year period. A total of 181 L. monocytogenes and 176 E. coli isolates were ribotyped to yield 19 and 34 ribogroups, respectively. Some strains were isolated only from the product, a number only from the environment and others from both niches. Some strains were seen to be persistent for the duration of the sampling exercise (2-3 years). The most common L. monocytogenes and E. coli strains, together with two environmental L. monocytogenes strains, were assessed for any resistance to commercial disinfectants as compared with a laboratory L. monocytogenes disinfectant testing strain. The resistance of the L. monocytogenes and E. coli strains isolated from the factory were not significantly different from the laboratory control strain.Persistent strains of L. monocytogenes and E. coli are found in the UK food industry, though this persistence is not related to their increased susceptibility to the most commonly used disinfectants.The concept of a persistent microflora in food factories will have an impact on the future selection of suitable control options, including the use of biocides.

Significant advances in water treatment over the last century have resulted in massive improvements in the microbiological safety of public drinking water supplies in the UK and the developed countries. Incidences of illness due to poor treatment or post-treatment contamination are rare, but when they occur tend to attract considerable media attention. A well managed water treatment works and supply system can provide high quality drinking water wherever in the world it is located. As a rule, throughout the world, private supplies tend to be of a poorer quality than public supplies, but poorly managed public supplies have the potential to make a large number of people ill and continued effort is needed to maintain and improve drinking water quality world-wide.

Bacteriologically confirmed cases of Mycobacterium bovis in the Australian population.To evaluate the DNA fingerprinting techniques commonly used for M. bovis on isolates from humans and determine whether they were useful for determining the origin of human infection.M. bovis strains isolated between 1970 and 1994 were obtained from five Australian Reference Laboratories. Four DNA fingerprinting techniques, comprising Southern hybridisation with three different probes (the insertion sequence [IS]6110, the polymorphic guanine-cytosine-rich sequence [PGRS] and the direct repeat [DR]) and a PCR-based method (spoligotyping) were used.The PGRS, DR and IS6110 RFLP methods identified 32, 22 and 14 different types respectively from the 45 isolates available. Spoligotyping identified 18 different types. When all methods were combined 41 different strains were identified. Clear differences were found between many isolates from Australian-born patients and those from patients born overseas.The PGRS RFLP method was the most effective method for typing the human strains, but a combination of methods is recommended for maximum sensitivity. Most Australian-born patients that had worked in the meat and livestock industries were infected with strains similar to those that are commonly found in Australian cattle, confirming the occupational risk in these industries. Patients born overseas were typically infected with strains genetically different from those of patients born in Australia. This suggests that patients born overseas identified with M. bovis were presenting with reactivation of infection acquired outside Australia.

To determine the contribution of Mycobacterium bovis to active tuberculosis in the Australian population during 1970-1994, and to collate and analyse demographic data from bacteriologically proven cases.Summary data for tuberculosis cases notified by Australian public health agencies during 1970-1985 and 1991-1994 were obtained from the database of notifiable diseases maintained by the Department of Health and Family Services. More detailed demographic data for cases confirmed by bacteriology during 1970-1994 were supplied by the Australian Mycobacterium Reference Laboratory Network.At least 236 cases of bovine tuberculosis (TB) occurred in the Australian population during 1970-1994 (mean 9.4 cases; range 3-22 cases annually). The bovine strain has accounted for around 1% of Australian cases of TB during this period. Laboratory sources provided demographic data for 150 cases with positive bacteriology. For this group, the mean age was 54 years (range 22-86), and the male:female ratio was 2.4:1. The majority of cases (74%) involved pulmonary disease. Australian-born persons accounted for 68% of the total cases and typically had histories of employment in meat and/or livestock industries.M. bovis was responsible for less than 1.5% of cases of TB in the Australian population during 1970-1994. Most cases were apparently due to reactivation of infection acquired through occupational exposure. Thus, although virtual eradication of M. bovis from Australia's cattle herds has now reduced the risk of exposure, it can be expected that human cases of bovine TB will continue to be detected for years to come. The bovine strain should be considered as the possible agent of TB in foreign-born Australians.

Arylsulfatase activities (96-h reaction) of various strains of Mycobacterium avium and M. intracellulare, as identified by a DNA probe test, were measured. The enzyme activities of M. avium strains were significantly lower [corrected] than those of M. intracellulare strains (P less than 0.005 to P less than 0.025). The enzyme activities did not vary with serovar; that is, the activities of serovars 1, 2, 8, and 9 (belonging to M. avium) were similar to each other, as were the activities of serovars 7, 12, 13, 14, and 16 (belonging to M. intracellulare). The results indicate the usefulness of the arylsulfatase test in distinguishing M. avium from M. intracellulare in an accurate manner.

A doorless entry system has been designed for use in high-energy radiation therapy rooms. The doorless entry improves patient access, safety and throughput, increases the physical safety for the radiation therapists, and avoids the significant cost of heavy shielding doors. The design meets concerns relating to radiation safety, operational ease, and authorized entry. The new system is currently operating in one room housing a cobalt-60 unit and is to be employed in five additional rooms housing dual-energy accelerators (maximum energies of 10 and 18 MV). The doorless entry has received wide approval from the radiation therapists and no concerns have been expressed with respect to unauthorized entry or radiation safety.

The biochemical properties and fatty acid compositions of 16 strains of Mycobacterium haemophilum from Australian patients were studied. The strains proved to be indistinguishable from each other but could readily be differentiated from other slowly growing mycobacteria with similar cultural features. Mycolic acid analyses revealed the presence of alpha-, methoxy-, and ketomycolates. The fatty acid composition supports the validity of the fact that M. haemophilum is a distinct species. The fatty acid composition was consistent among the 16 strains, but it was unusual in that there was some resemblance to the fatty acid composition of M. leprae. The wide range of pHs (5.4 to 7.4) that supported growth of M. haemophilum on artificial medium is in keeping with suggestions that M. haemophilum exists in an environmental habitat.

Thirty-two patients with posterior fossa medulloblastoma underwent treatment with electron irradiation to the spinal field. The 5- and 10-year actuarial survival rates were 57% and 50%, respectively. Late complications observed in the 15 patients followed up for more than 5 years were short stature (six patients), decreased sitting-standing height ratio (four patients), scoliosis (two patients), poor school performance (seven patients), xerostomia (one patient), esophageal stricture (one patient), pituitary dysfunction (four patients), primary hypothyroidism (one patient), bilateral eighth-nerve deafness (one patient), and carcinoma of the thyroid (one patient). Complications following treatment with electrons to a spinal field are compared with reported complications following treatment with photons to the spinal field. Although short-term reactions were minimal, the authors found no difference in late complications. More sophisticated treatment planning may show such a long-term benefit in the future.

Restriction endonuclease analysis and seroagglutination were used to characterize strains of Mycobacterium avium and Mycobacterium intracellulare (collectively, MAI) recovered from 1 local herd and 2 imported shipments of red deer (Cervus elaphus) that developed sensitization to bovine tuberculin during skin testing. A total of 31 MAI strains were isolated from lymph node pools (head, thorax, abdomen, and peripheral regions) of 21 of 29 local deer. Similarly, 15 MAI strains were isolated from the lymph node pools of 12 deer from the 2 imported shipments. Mycobacterial strains were isolated from more than 1 of the lymph node pools of 9 local and 2 imported deer. Most of the strains (59% from local deer, 46% from imported deer) were recovered from the lymph nodes of the head region. After restriction endonuclease analysis of these isolates using the enzymes Bcl I, BstEII, and Pvu II, 26 of the strains from the local herd were separated into 3 groups, each consisting of strains with indistinguishable or closely related patterns. Seroagglutination results indicated that the first of these groups contained strains belonging to serotype 1, the second group contained strains belonging to serotype 8; and the third group of strains belonged to serotype 3 and 9. The 5 remaining strains from the local herd had unrelated restriction patterns. One of these belonged to serotype 3, whereas the remaining 4 could not be serotyped. Restriction analysis of the 15 strains from the imported deer identified 2 groups. Seroagglutination results indicated that 1 group contained strains belonging to serotype 2 and the other group contained strains belonging to serotype 8.(ABSTRACT TRUNCATED AT 250 WORDS)

1. In order to develop an improved differential sugar absorption test for simultaneously assessing intestinal permeability and lactose intolerance, methods were established for determining raffinose, lactose and L-arabinose in human urine. Using NAD(P)H-coupled enzymatic assays and fluorimetry, each sugar was measurable over a concentration range of approximately 3-300 mumol/l in diluted urine specimens. 2. After an overnight fast, 40 normal volunteers drank an iso-osmotic solution containing raffinose, lactose and L-arabinose. The median 5 h urinary sugar excretion was 0.26% of the ingested raffinose, 0.05% of lactose and 17.5% of L-arabinose. 3. In 143 patients with gastrointestinal disease, excretion of both ingested raffinose and lactose was significantly increased in coeliac disease in relapse or in partial remission and in Crohn's disease, but not in the irritable bowel syndrome, coeliac disease in remission or ulcerative colitis. Excretion of lactose, but not raffinose, was increased in patients with mucosal lactase deficiency, whereas excretion of L-arabinose was reduced in all disease groups except ulcerative colitis. 4. Discrimination between diseases was poor when based on individual sugar recoveries, but improved dramatically when excretion was expressed relative to that of L-arabinose. The raffinose/L-arabinose excretion ratio, an index of intestinal permeability, was greater than 0.08 in 15/15 untreated coeliac patients but less than 0.06 in all normal subjects and in 9/9 lactase-deficient patients, 15/16 recovered coeliac patients, 5/6 patients with ulcerative colitis, 13/16 patients with Crohn's disease and 61/62 patients with irritable bowel syndrome.

A statistical analysis has been made of ionometrically measured parameters related to the central‐axis output, the beam symmetry, the beam flatness, and the depth dose for the 6‐MV x‐ray beam from the Therac‐6 linear accelerator. The means and coefficients of variation of the measurements are determined on a monthly basis for each parameter. Mean coefficients of variation less than ± 1% have been determined and are useful in establishing the optimal limits of acceptance of these parameters. The results of this study indicate that the long‐term stability of the radiation parameters associated with this unit can be maintained within acceptable limits with a consistent quality‐assurance program.

Ionization chambers with wall materials of various electron densities have been employed to investigate the penumbral region of a cobalt-60 beam of side length 10 cm. Measurements were made in air with chambers of various inside diameters. The homogeneous walls of the ionization chambers were 0.5 g/cm2 in thickness. Extrapolation techniques to zero inside diameter and to infinite density were used, respectively, to eliminate the effect of the inside diameter of the chamber and to determine the penumbral photon-fluence distribution. The method also quantitates both the penumbral primary-dose profiles in water-equivalent media and the degradation of these profiles in media of low electron density.

The effect of dosemeter type and configuration on the measured penumbral distribution for Co‐60, 6‐MV, and 31‐MV x rays has been determined in air using equilibrium buildup caps for three commercial detection systems including a silicon diode and two ionization chambers. The diode is shown to be measuring a different parameter in the penumbral region than the ionization chambers. This fact in combination with the lateral spread of the secondary electrons and the difference in the inside diameters of the ionization chambers results in significant differences between the measured beam penumbra. The latter effect is studied in more detail with a series of specially designed ionization chambers of varying inside diameter from 0.3 to 1.4 cm. A theoretical model is described which resolves these differences, indicates a method to determine the true penumbral primary‐dose distribution and introduces the concept of an effective diameter for the ionometric measurement of high‐energy x‐ray penumbra. Recommendations are made concerning the dosemeters of choice for penumbral measurements over this range of photon energies.

Ionization chambers of varying inside diameter have been used to investigate the penumbral region of 6 0Co, 6‐MV, and 31‐MV x‐ray beams. Measurements were made in water at varying depths up to 25 cm for a square field of side length 10 cm. The dependence of the penumbral widths on both the inside diameter of the ionization chamber and the depth in water is established along with the asymmetry of the penumbral distributions about the 50% level. A standard correction is indicated to eliminate the dependence of the measured penumbral widths on the inside diameter of the ionization chamber.

An isotope scan using sucralphate labelled with technetium-99m has been compared with barium meal in the detection of peptic ulceration in 18 patients with endoscopically proven upper gastrointestinal lesions and eight controls. Gastric (75%) and duodenal (67%) ulcers were detected with identical frequency by isotope scan and barium meal but both were inferior to endoscopy. Structural, non-ulcerated lesions, were not identified by isotope scanning. The scan has potential value in duodenal ulcer disease, the serial assessment of ulcer healing and in paediatric gastroenterology.

The effects of field elongation on the central‐axis output at d max and on the depth‐dose curves for the 6‐MV x rays from the Therac 6 linear accelerator are considered. These parameters are independent of the collimator angle for both square and elongated fields. The exchange of collimator pairs results in significant output differences but has a negligible effect on the depth‐dose curves. Both the central‐axis output at d max and the depth‐dose curves agree satisfactorily with the predictions of the equivalent‐square technique. An alternative method of greater accuracy is also indicated for the prediction of central‐axis outputs at d max for elongated fields.

The zeroth-order theory of intermolecular forces is used to derive additivity relations for rotationally averaged molecular dipole properties and dispersion energy constants by assuming that a molecule is comprised of non-interacting atoms or molecules. Some of the additivity rules are new and others, for example the mixture rule for dipole oscillator strength distributions (DOSDs), Bragg's rule for stopping cross sections and Landolt's rule for molecular refractivities, are well known. The additivity rules are tested by using previously constructed DOSDs and reliable values for the dipole oscillator strength sums Sk , Lk and Ik , and dispersion energy constants C 6, for H, N, O, H2, N2, O2, NO, N2O, NH3 and H2O as models. It is found that additivity is generally unreliable for estimating molecular properties corresponding to k < -2. Generally for k ≥ -2 and for C 6, and if the hydrogen molecule is used to represent the hydrogen atom in the additivity rules, the additivity relations yield results that are...

The distribution of radioactivity after the oral administration of sucralfate labelled with technetium-99m was studied in 33 patients with Crohn's disease (13 adults, 20 children), 10 with ulcerative colitis (four adults), and 29 controls (23 with upper intestinal disease, four irritable bowel, one hypolactasia, and one malrotation of the gut). Positive scans were obtained in all patients with ulcerative colitis and 29 of 31 with active Crohn's disease. The scans of two patients with inactive Crohn's disease were negative. There were two false negative scans in patients with Crohn's colitis and one false positive scan. Overall, sensitivity was 95% and specificity 97%. Comparison with radiology in 39 patients showed similar distribution of disease in 24 and more extensive disease in 12. The scan was inexpensive, simple to perform, well tolerated, allowed small and large bowel to be visualised simultaneously, and used a lower dose of radiation than barium studies. It may prove useful as a screening test for inflammatory bowel disease and in the serial assessment of disease activity.

Dipole oscillator strength distributions (DOSDs) have been constructed for ground state Li, N, O, H2, N2, O2, NH3, H2O, NO, and N2O by using experimental and theoretical photoabsoiption and high energy electron inelastic scattering cross sections. Each DOSD is required to satisfy the Thomas–Reiche–Kuhn sum rule and additional constraints derived from available accurate experimental refractivity and dispersion measurements. The DOSDs, the data and procedure used to construct the DOSDs, and the values of the dipole oscillator strength sums Sk and Lk (for a variety of k values) and related atomic and molecular properties obtained from the DOSDs are reported. The discussion includes comments regarding the importance of the constraints imposed on the DOSD with respect to the evaluation of various dipole sums and properties and the accuracy of the results.

Percentage depth doses for 34 MV betatron X-rays were measured ionometrically for a number of square fields of side 5-20 cm. Significant differences in the depth doses for different field sizes were found in the build-up region and in the depth of maximum dose. A systematic change with depth was also indicated in the exponential region of these curves. These differences are discussed in terms of the changes in the contributions of primary radiation and of scattered radiation from both the collimator and the phantom.

Prostaglandin synthetase activity in rectal biopsy specimens from patients with ulcerative colitis has been shown to fall on treatment with sulphasalazine, local steroids, and codeine phosphate. In vitro studies have shown that sulphasalazine is an inhibitor of prostaglandin synthetase, although less potent than indomethacin, whereas prednisolone and codeine phosphate were inactive. It is suggested that the therapeutic action of sulphasalazine may be related in part to its action in inhibiting prostaglandin biosynthesis.

A 22 year old woman presenting with recurrent intestinal pseudo-obstruction is reported. Jejunal biopsy showed subtotal villous atrophy which improved markedly during a period of total parenteral nutrition and with steroid treatment. It did not relapse on a gluten free diet. The reasons why this patient represents a case of coeliac disease with secondary pseudo-obstruction, rather than primary intestinal pseudo-obstruction with secondary bacterial overgrowth, is discussed.

1. The trends of starter bacteria population during the manufacture and maturing of Cheddar cheese have been investigated. Fourteen strains consisting of Str. lactis, Str. diacetilactis and Str. cremoris have been studied.2. Physiological and morphological characteristics of the fourteen strains were examined.3. Population studies during manufacture showed that the three species of starter organism attain quite different maximum populations and at different stages of the cheesemaking process. Str. lactis (4500 millions/g.) and Str. diacetilactis (2900 millions/g.) reached their maximum half way through Cheddaring, whereas Str. cremoris (960 millions/g.) reached its maximum at milling.4. Str. lactis was shown to maintain its maximum population until the cheese left the press, whereas Str. diacetilactis and Str. cremoris steadily declined after reaching their maximum.5. Counts of the different starter cultures used showed considerable variation between and within strains, particularly in the case of Str. cremoris.6. No relationship was shown to exist between acidity development and starter populations developed.7. The study of cell distribution in the cheese curd has shown that whereas Str. lactis and Str. diacetilactis gave an even scattering of diplococci, Str. cremoris showed colony formation.8. Str. lactis strains maintained a high but declining population during maturing of the cheese, the starter beginning to die out gradually after 8 weeks. Str. diacetilactis showed similar trends but at lower populations levels. Str. cremoris, on the other hand, gave much lower populations, the starter dying out rapidly after 2 weeks, and virtually disappearing at 8 weeks.9. Persistence of starter bacteria in the cheese appears to be correlated with salt tolerance and chain length.10. Starter bacteria isolated from the cheese made with Str. lactis have shown a low proportion of slow acid-producing types in contrast to a high proportion found with Str. cremoris.11. The non-starter bacteria in the cheese were found to consist on the average of 30% micrococci and 70% lactobacilli. Negligible numbers of other genera were isolated.

An analysis of unscheduled downtime and of patient treatment data for a 6‐MV linear accelerator is presented for a 7‐yr period. Following the initial year of clinical use, the unscheduled downtime has averaged 2.4%, with a corresponding loss of 1.3% in patient treatments. The quality assurance, preventive maintenance, and repairs are handled in‐house, with an investment of approximately 500 man‐hours annually.

An analysis of unscheduled downtime and of patient treatment data for a 6-MV linear accelerator is presented for a 7-yr period. Following the initial year of clinical use, the unscheduled downtime has averaged 2.4%, with a corresponding loss of 1.3% in patient treatments. The quality assurance, preventive maintenance, and repairs are handled in-house, with an investment of approximately 500 man-hours annually.

Bronchoscopy specimens from 3 patients investigated during 1 wk at a large teaching hospital were culture positive for the same serovar of Mycobacterium intracellulare. Review of laboratory records and patient data suggested that only the first patient examined was a genuine excretor of mycobacteria; the isolates from the other 2 patients were false positives caused by inadequate disinfection of part of the collection apparatus between use. The investigations confirm the suitability of glutaraldehyde as a rapid, highly effective antimycobacterial disinfectant and illustrate the value of serotyping when dealing with mycobacterial isolates of questionable significance.

Ionization chambers of varying inside diameter have been used to investigate the penumbral region of 60Co, 6-MV, and 31-MV x-ray beams. Measurements were made in water at varying depths up to 25 cm for a square field of side length 10 cm. The dependence of the penumbral widths on both the inside diameter of the ionization chamber and the depth in water is established along with the asymmetry of the penumbral distributions about the 50% level. A standard correction is indicated to eliminate the dependence of the measured penumbral widths on the inside diameter of the ionization chamber.

An immunocompromised patient with an indwelling Hickman catheter developed Mycobacterium neoaurum bacteremia. This rapidly growing mycobacterium was previously isolated from soil, dust, and water but has not been described as a human pathogen. The infection responded to therapy with cefoxitin and gentamicin. It was not necessary to remove the Hickman catheter.

The tissue-maximum ratios for high-energy betatron x rays, measured at target-axis distances of 90, 110, and 130 cm, exhibit a strong dependence on the target-axis distance in the buildup region as well as a significant dependence in the exponential region. This dependence and the field-size dependence of the tissue-maximum ratios at a fixed target-axis distance are studied with the use of phantom and collimator scatter factors. The depth and field-size dependence of these scatter factors are determined experimentally. The measurements indicate that the collimator scatter factor is dependent on both the collimator opening and the targetaxis distance. These components are quantitated separately and are associated primarily with high-energy electron scatter from the collimating system. An equation involving these components of the collimator scatter factor is derived for the conversion of tissue-maximum ratios from one target-axis distance to another. With the use of this equation, the tissue-maximum ratios measured for one target-axis distance can be used to calculate within 1% those at other target-axis distances.

Three previously unidentified strains of pathogenic mycobacteria which had been isolated on media containing ferric ammonium citrate were found to be identical with the new species, Mycobacterium haemophilum.

Mycobacterium asiaticum was isolated from pulmonary material from 5 persons residing in Queensland, Australia. All patients had repeated positive specimens, but the organism was considered responsible for pulmonary mycobacteriosis in only 2 of them. This is the first report of disease caused by M. asiaticum. Clinical, bacteriologic, and epidemiologic details are presented.

Ionization chambers with wall materials of various electron densities have been employed to investigate the penumbral region of a cobalt-60 beam of side length 10 cm. Measurements were made in air with chambers of various inside diameters. The homogeneous walls of the ionization chambers were 0.5 g/cm2 in thickness. Extrapolation techniques to zero inside diameter and to infinite density were used, respectively, to eliminate the effect of the inside diameter of the chamber and to determine the penumbral photon-fluence distribution. The method also quantitates both the penumbral primary-dose profiles in water-equivalent media and the degradation of these profiles in media of low electron density.