The impact of low-mode symmetry on inertial fusion energy output in the burning plasma state

Indirect Drive Inertial Confinement Fusion Experiments on the National Ignition Facility (NIF) have achieved a burning plasma state with neutron yields exceeding 170 kJ, roughly 3 times the prior record and a necessary stage for igniting plasmas. The results are achieved despite multiple sources of degradations that lead to high variability in performance. Results shown here, for the first time, include an empirical correction factor for mode-2 asymmetry in the burning plasma regime in addition to previously determined corrections for radiative mix and mode-1. Analysis shows that including these three corrections alone accounts for the measured fusion performance variability in the two highest performing experimental campaigns on the NIF to within error. Here we quantify the performance sensitivity to mode-2 symmetry in the burning plasma regime and apply the results, in the form of an empirical correction to a 1D performance model. Furthermore, we find the sensitivity to mode-2 determined through a series of integrated 2D radiation hydrodynamic simulations to be consistent with the experimentally determined sensitivity only when including alpha-heating.

Achievement of Target Gain Larger than Unity in an Inertial Fusion Experiment

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Energy Principles of Scientific Breakeven in an Inertial Fusion Experiment

Fusion "scientific breakeven" (i.e., unity target gain G_{target}, total fusion energy out > laser energy input) has been achieved for the first time (here, G_{target}∼1.5). This Letter reports on the physics principles of the design changes that led to the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce target gain greater than unity and exceeded the previously obtained conditions needed for ignition by the Lawson criterion. Key elements of the success came from reducing "coast time" (the time duration between the end of the laser pulse and implosion peak compression) and maximizing the internal energy delivered to the "hot spot" (the yield producing part of the fusion fuel). The link between coast time and maximally efficient conversion of kinetic energy into internal energy is explained. The energetics consequences of asymmetry and hydrodynamic-induced mixing were part of high-yield big radius implosion design experimental and design strategy. Herein, it is shown how asymmetry and mixing consolidate into one key relationship. It is shown that mixing distills into a kinetic energy cost similar to the impact of implosion asymmetry, shifting the threshold for ignition to higher implosion kinetic energy-a factor not normally included in most statements of the generalized Lawson criterion, but the key needed modifications clearly emerge.

X-ray continuum spectroscopy of inertial confinement fusion implosions at the National Ignition Facility

A methodology for measuring x-ray continuum spectra of inertial confinement fusion (ICF) implosions is described. The method relies on the use of ConSpec, a high-throughput spectrometer using a highly annealed pyrolytic graphite crystal [MacDonald et al., J. Instrum. 14, P12009 (2019)], which measures the spectra in the ≃20-30 keV range. Due to its conical shape, the crystal is sagittally focusing a Bragg-reflected x-ray spectrum into a line, which enhances the recorded x-ray emission signal above the high neutron-induced background accompanying ICF implosions at the National Ignition Facility. To improve the overall measurement accuracy, the sensitivity of the spectrometer measured in an off-line x-ray laboratory setting was revised. The error analysis was expanded to include the accuracy of the off-line measurements, the effect of the neutron-induced background, as well as the influence of possible errors in alignment of the instrument to the ICF target. We demonstrate how the improved methodology is applied in the analysis of ConSpec data with examples of a relatively low-neutron-yield implosion using a tritium-hydrogen-deuterium mix as a fuel and a high-yield deuterium-tritium (DT) implosion producing high level of the background. In both cases, the shape of the measured spectrum agrees with the exponentially decaying spectral shape of bremsstrahlung emission to within ±10%. In the case of the high-yield DT experiment, non-monotonic deviations slightly exceeding the measurement uncertainties are observed and discussed.

Diagnosing the origin and impact of low-mode asymmetries in ignition experiments at the National Ignition Facility

Inertial confinement fusion ignition requires high inflight shell velocity, good energy coupling between the hotspot and shell, and high areal density at peak compression. Three-dimensional asymmetries caused by imperfections in the drive symmetry or target can grow and damage the coupling and confinement. Recent high-yield experiments have shown that low-mode asymmetries are a key degradation mechanism and contribute to variability. We show the experimental signatures and impacts of asymmetry change with increasing implosion yield given the same initial cause. This letter has implications for improving robustness to a key degradation in ignition experiments.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Thermal Temperature Measurements of Inertial Fusion Implosions

Accurate measurement of the thermal temperature in inertially confined fusion plasmas is essential for characterizing ignition performance and validating the basic physics understanding of the stagnation conditions. We present experimental results from cryogenic deuterium-tritium implosions on the National Ignition Facility using a differential filter spectrometer designed to measure the thermal electron temperature from x-ray continuum emission from the stagnated plasma. Furthermore, electron temperature measurements, used in conjunction with the Doppler-broadened DT neutron spectra, allow one to infer the partition of energy in the hot spot between internal energy and unconverted kinetic energy.

Automated analysis of hot spot X-ray images at the National Ignition Facility

At the National Ignition Facility, the symmetry of the hot spot of imploding capsules is diagnosed by imaging the emitted x-rays using gated cameras and image plates. The symmetry of an implosion is an important factor in the yield generated from the resulting fusion process. The x-ray images are analyzed by decomposing the image intensity contours into Fourier and Legendre modes. This paper focuses on the additional protocols for the time-integrated shape analysis from image plates. For implosions with temperatures above ∼4 keV, the hard x-ray background can be utilized to infer the temperature of the hot spot.

Indications of flow near maximum compression in layered deuterium-tritium implosions at the National Ignition Facility

An accurate understanding of burn dynamics in implosions of cryogenically layered deuterium (D) and tritium (T) filled capsules, obtained partly through precision diagnosis of these experiments, is essential for assessing the impediments to achieving ignition at the National Ignition Facility. We present measurements of neutrons from such implosions. The apparent ion temperatures T_{ion} are inferred from the variance of the primary neutron spectrum. Consistently higher DT than DD T_{ion} are observed and the difference is seen to increase with increasing apparent DT T_{ion}. The line-of-sight rms variations of both DD and DT T_{ion} are small, ∼150eV, indicating an isotropic source. The DD neutron yields are consistently high relative to the DT neutron yields given the observed T_{ion}. Spatial and temporal variations of the DT temperature and density, DD-DT differential attenuation in the surrounding DT fuel, and fluid motion variations contribute to a DT T_{ion} greater than the DD T_{ion}, but are in a one-dimensional model insufficient to explain the data. We hypothesize that in a three-dimensional interpretation, these effects combined could explain the results.

Demonstration of High Performance in Layered Deuterium-Tritium Capsule Implosions in Uranium Hohlraums at the National Ignition Facility

We report on the first layered deuterium-tritium (DT) capsule implosions indirectly driven by a "high-foot" laser pulse that were fielded in depleted uranium hohlraums at the National Ignition Facility. Recently, high-foot implosions have demonstrated improved resistance to ablation-front Rayleigh-Taylor instability induced mixing of ablator material into the DT hot spot [Hurricane et al., Nature (London) 506, 343 (2014)]. Uranium hohlraums provide a higher albedo and thus an increased drive equivalent to an additional 25 TW laser power at the peak of the drive compared to standard gold hohlraums leading to higher implosion velocity. Additionally, we observe an improved hot-spot shape closer to round which indicates enhanced drive from the waist. In contrast to findings in the National Ignition Campaign, now all of our highest performing experiments have been done in uranium hohlraums and achieved total yields approaching 10^{16} neutrons where more than 50% of the yield was due to additional heating of alpha particles stopping in the DT fuel.

Thin shell, high velocity inertial confinement fusion implosions on the national ignition facility

Experiments have recently been conducted at the National Ignition Facility utilizing inertial confinement fusion capsule ablators that are 175 and 165  μm in thickness, 10% and 15% thinner, respectively, than the nominal thickness capsule used throughout the high foot and most of the National Ignition Campaign. These three-shock, high-adiabat, high-foot implosions have demonstrated good performance, with higher velocity and better symmetry control at lower laser powers and energies than their nominal thickness ablator counterparts. Little to no hydrodynamic mix into the DT hot spot has been observed despite the higher velocities and reduced depth for possible instability feedthrough. Early results have shown good repeatability, with up to 1/2 the neutron yield coming from α-particle self-heating.

Performance of high-convergence, layered DT implosions with extended-duration pulses at the National Ignition Facility

Radiation-driven, low-adiabat, cryogenic DT layered plastic capsule implosions were carried out on the National Ignition Facility (NIF) to study the sensitivity of performance to peak power and drive duration. An implosion with extended drive and at reduced peak power of 350 TW achieved the highest compression with fuel areal density of ~1.3±0.1 g/cm2, representing a significant step from previously measured ~1.0 g/cm2 toward a goal of 1.5 g/cm2. Future experiments will focus on understanding and mitigating hydrodynamic instabilities and mix, and improving symmetry required to reach the threshold for thermonuclear ignition on NIF.

Onset of hydrodynamic mix in high-velocity, highly compressed inertial confinement fusion implosions

Deuterium-tritium inertial confinement fusion implosion experiments on the National Ignition Facility have demonstrated yields ranging from 0.8 to 7×10(14), and record fuel areal densities of 0.7 to 1.3 g/cm2. These implosions use hohlraums irradiated with shaped laser pulses of 1.5-1.9 MJ energy. The laser peak power and duration at peak power were varied, as were the capsule ablator dopant concentrations and shell thicknesses. We quantify the level of hydrodynamic instability mix of the ablator into the hot spot from the measured elevated absolute x-ray emission of the hot spot. We observe that DT neutron yield and ion temperature decrease abruptly as the hot spot mix mass increases above several hundred ng. The comparison with radiation-hydrodynamic modeling indicates that low mode asymmetries and increased ablator surface perturbations may be responsible for the current performance.

Hot-spot mix in ignition-scale inertial confinement fusion targets

Mixing of plastic ablator material, doped with Cu and Ge dopants, deep into the hot spot of ignition-scale inertial confinement fusion implosions by hydrodynamic instabilities is diagnosed with x-ray spectroscopy on the National Ignition Facility. The amount of hot-spot mix mass is determined from the absolute brightness of the emergent Cu and Ge K-shell emission. The Cu and Ge dopants placed at different radial locations in the plastic ablator show the ablation-front hydrodynamic instability is primarily responsible for hot-spot mix. Low neutron yields and hot-spot mix mass between 34(-13,+50)  ng and 4000(-2970,+17 160)  ng are observed.

Neutron spectrometry--an essential tool for diagnosing implosions at the National Ignition Facility (invited)

DT neutron yield (Y(n)), ion temperature (T(i)), and down-scatter ratio (dsr) determined from measured neutron spectra are essential metrics for diagnosing the performance of inertial confinement fusion (ICF) implosions at the National Ignition Facility (NIF). A suite of neutron-time-of-flight (nTOF) spectrometers and a magnetic recoil spectrometer (MRS) have been implemented in different locations around the NIF target chamber, providing good implosion coverage and the complementarity required for reliable measurements of Y(n), T(i), and dsr. From the measured dsr value, an areal density (ρR) is determined through the relationship ρR(tot) (g∕cm(2)) = (20.4 ± 0.6) × dsr(10-12 MeV). The proportionality constant is determined considering implosion geometry, neutron attenuation, and energy range used for the dsr measurement. To ensure high accuracy in the measurements, a series of commissioning experiments using exploding pushers have been used for in situ calibration of the as-built spectrometers, which are now performing to the required accuracy. Recent data obtained with the MRS and nTOFs indicate that the implosion performance of cryogenically layered DT implosions, characterized by the experimental ignition threshold factor (ITFx), which is a function of dsr (or fuel ρR) and Y(n), has improved almost two orders of magnitude since the first shot in September, 2010.

Imaging of high-energy x-ray emission from cryogenic thermonuclear fuel implosions on the NIF

Accurately assessing and optimizing the implosion performance of inertial confinement fusion capsules is a crucial step to achieving ignition on the NIF. We have applied differential filtering (matched Ross filter pairs) to provide broadband time-integrated absolute x-ray self-emission images of the imploded core of cryogenic layered implosions. This diagnostic measures the temperature- and density-sensitive bremsstrahlung emission and provides estimates of hot spot mass, mix mass, and pressure.

Measurement of electron temperature of imploded capsules at the National Ignition Facility

The electron and ion temperatures of the imploded core plasma are two of the most important metrics of inertial confinement fusion experiments. We have developed a technique for inferring electron temperatures from the contrast of x-ray images observed through a group of x-ray filters. Generally, the plasma electron temperature exhibits spatial and temporal variations, so time-averaged and time-resolved measurements are expected to yield somewhat different results. By analyzing the intensity of images observed with both a time-integrated detector (imaging plates) and a time-resolved detector (gated micro-channel plate), we found the electron temperature observed from x-ray images to be systematically higher than the ion temperature inferred from fusion neutron spectroscopy.

Assembly of high-areal-density deuterium-tritium fuel from indirectly driven cryogenic implosions

The National Ignition Facility has been used to compress deuterium-tritium to an average areal density of ~1.0±0.1 g cm(-2), which is 67% of the ignition requirement. These conditions were obtained using 192 laser beams with total energy of 1-1.6 MJ and peak power up to 420 TW to create a hohlraum drive with a shaped power profile, peaking at a soft x-ray radiation temperature of 275-300 eV. This pulse delivered a series of shocks that compressed a capsule containing cryogenic deuterium-tritium to a radius of 25-35 μm. Neutron images of the implosion were used to estimate a fuel density of 500-800 g cm(-3).

Value of different staging systems for predicting neurological outcome in childhood tuberculous meningitis

BACKGROUND

The stage of tuberculous meningitis (TBM) at presentation is strongly associated with prognosis.

OBJECTIVE

To compare different staging systems for TBM in predicting outcome.

METHODS

The associations of different staging systems with neurological outcome were assessed using clinical, diagnostic and outcome data of 554 TBM children admitted to Tygerberg Children's Hospital from January 1985 to April 2005.

RESULTS

The refined Medical Research Council (MRC) scale after 1 week (84%, 95%CI 81-88) had the highest discriminatory power in predicting neurological morbidity. The Glasgow Coma Score (GCS) on admission, GCS after 1 week, the 'refined' MRC scale on admission and Tygerberg Children's Hospital (TCH) staging method all had excellent discriminatory powers in predicting outcome. Improvement of staging after 1 week occurred in children who did not have signs of raised intracranial pressure (P = 0.004) or brainstem dysfunction on admission (P = 0.030).

CONCLUSIONS

The 'refined' MRC scale 1 week after diagnosis showed the best association with neurological outcome after 6 months of treatment. The excellent discriminatory power of the TCH scale and its simplicity of use make it the ideal scale for use in resource-poor settings.

Demonstration of ignition radiation temperatures in indirect-drive inertial confinement fusion hohlraums

We demonstrate the hohlraum radiation temperature and symmetry required for ignition-scale inertial confinement fusion capsule implosions. Cryogenic gas-filled hohlraums with 2.2 mm-diameter capsules are heated with unprecedented laser energies of 1.2 MJ delivered by 192 ultraviolet laser beams on the National Ignition Facility. Laser backscatter measurements show that these hohlraums absorb 87% to 91% of the incident laser power resulting in peak radiation temperatures of T(RAD)=300 eV and a symmetric implosion to a 100 μm diameter hot core.

Experimental study of neutron induced background noise on gated x-ray framing cameras

A temporally gated x-ray framing camera based on a proximity focus microchannel plate is one of the most important diagnostic tools of inertial confinement fusion experiments. However, fusion neutrons produced in imploded capsules interact with structures surrounding the camera and produce background to x-ray signals. To understand the mechanisms of this neutron induced background, we tested several gated x-ray cameras in the presence of 14 MeV neutrons produced at the Omega laser facility. Differences between background levels observed with photographic film readout and charge-coupled-device readout have been studied.

A hardened gated x-ray imaging diagnostic for inertial confinement fusion experiments at the National Ignition Facility

A gated x-ray detector is under development for use at the National Ignition Facility that is intended to provide plasma emission images in the presence of neutron yields up to 10(15) expected during inertial confinement fusion experiments with layered cryogenic targets. These images are expected to provide valuable time-resolved measurements of core and fuel symmetries. Additional capabilities of this instrument will include the ability to make spatially resolved electron temperature measurements. A description of this instrument and its operation is given with emphasis on features that differentiate it from previous designs.

Development of backlighting sources for a Compton radiography diagnostic of inertial confinement fusion targets (invited)

We present scaled demonstrations of backlighter sources, emitting bremsstrahlung x rays with photon energies above 75 keV, that we will use to record x-ray Compton radiographic snapshots of cold dense DT fuel in inertial confinement fusion implosions at the National Ignition Facility (NIF). In experiments performed at the Titan laser facility at Lawrence Livermore National Laboratory, we measured the source size and the bremsstrahlung spectrum as a function of laser intensity and pulse length from solid targets irradiated at 2x10(17)-5x10(18) W/cm(2) using 2-40 ps pulses. Using Au planar foils we achieved source sizes down to 5.5 microm and conversion efficiencies of about 1x10(-13) J/J into x-ray photons with energies in the 75-100 keV spectral range. We can now use these results to design NIF backlighter targets and shielding and to predict Compton radiography performance as a function of the NIF implosion yield and associated background.

Optical properties in nonequilibrium phase transitions

An open question about the dynamical behavior of materials is how phase transition occurs in highly nonequilibrium systems. One important class of study is the excitation of a solid by an ultrafast, intense laser. The preferential heating of electrons by the laser field gives rise to initial states dominated by hot electrons in a cold lattice. Using a femtosecond laser pump-probe approach, we have followed the temporal evolution of the optical properties of such a system. The results show interesting correlation to nonthermal melting and lattice disordering processes. They also reveal a liquid-plasma transition when the lattice energy density reaches a critical value.

Charge-state distribution and Doppler effect in an expanding photoionized plasma

The charge state distributions of Fe, Na, and F are determined in a photoionized laboratory plasma using high resolution x-ray spectroscopy. Independent measurements of the density and radiation flux indicate unprecedented values for the ionization parameter xi=20-25 erg cm s(-1) under near steady-state conditions. Line opacities are well fitted by a curve-of-growth analysis which includes the effects of velocity gradients in a one-dimensional expanding plasma. First comparisons of the measured charge state distributions with x-ray photoionization models show reasonable agreement.

Single-state measurement of electrical conductivity of warm dense gold

We report on a single-state measurement of electrical conductivity of warm dense gold in the solid to plasma transition regime. This is achieved using the idealized slab plasma approach of isochoric heating of ultrathin samples by a femtosecond laser, coupled with femtosecond probe measurements of reflectivity and transmission. The experiment also reveals the time scale associated with the disassembly of laser heated solid.

Isochoric heating of solid-density matter with an ultrafast proton beam

A new technique is described for the isochoric heating (i.e., heating at constant volume) of matter to high energy-density plasma states (>10(5) J/g) on a picosecond time scale (10(-12)sec). An intense, collimated, ultrashort-pulse beam of protons--generated by a high-intensity laser pulse--is used to isochorically heat a solid density material to a temperature of several eV. The duration of heating is shorter than the time scale for significant hydrodynamic expansion to occur; hence the material is heated to a solid density warm dense plasma state. Using spherically shaped laser targets, a focused proton beam is produced and used to heat a smaller volume to over 20 eV. The technique described of ultrafast proton heating provides a unique method for creating isochorically heated high-energy density plasma states.

Determination of the charge state distribution of a highly ionized coronal Au plasma

We present the first definitive measurement of the charge state distribution of a highly ionized gold plasma in coronal equilibrium. The experiment utilized the Livermore electron beam ion trap EBIT-II in a novel configuration to create a plasma with a Maxwellian temperature of 2.5 keV. The charge balance in the plasma was inferred from spectral line emission measurements which accounted for charge exchange effects. The measured average ionization state was 46.8+/-0.75. This differs from the predictions of two modeling codes by up to four charge states.

Heating of thin foils with a relativistic-intensity short-pulse laser

K-shell x-ray spectroscopy of sub-100 nm Al foils irradiated by high contrast, spatially uniform, 150 fs, Ilambda (2)=2 x 10(18) W microm(2)/cm(2), laser pulses is obtained with 500 fs time resolution. Two distinct phases occur: At </=500 fs a broad feature comparable to the resonance transitions occurs due to satellites, and at >/=500 fs the resonance transitions dominate. Initial satellites arise from a large area, high density, low temperature (approximately 100 eV) plasma created by fast electrons. Thus, contrary to predictions, a short, high intensity laser incident on a thin foil does not create a uniform, hot dense plasma.

Time-resolved plasma spectroscopy of thin foils heated by a relativistic-intensity short-pulse laser

Time-resolved K-shell x-ray spectra are recorded from sub-100 nm aluminum foils irradiated by 150-fs laser pulses at relativistic intensities of Ilambda(2)=2 x 10(18) W microm(2)/cm(2). The thermal penetration depth is greater than the foil thickness in these targets so that uniform heating takes place at constant density before hydrodynamic motion occurs. The high-contrast, high-intensity laser pulse, broad spectral band, and short time resolution utilized in this experiment permit a simplified interpretation of the dynamical evolution of the radiating matter. The observed spectrum displays two distinct phases. At early time, < or =500 fs after detecting target emission, a broad quasicontinuous spectral feature with strong satellite emission from multiply excited levels is seen. At a later time, the He-like resonance line emission is dominant. The time-integrated data is in accord with previous studies with time resolution greater than 1 ps. The early time satellite emission is shown to be a signature of an initial large area, high density, low-temperature plasma created in the foil by fast electrons accelerated by the intense radiation field in the laser spot. We conclude that, because of this early time phenomenon and contrary to previous predictions, a short, high-intensity laser pulse incident on a thin foil does not create a uniform hot and dense plasma. The heating mechanism has been studied as a function of foil thickness, laser pulse length, and intensity. In addition, the spectra are found to be in broad agreement with a hydrodynamic expansion code postprocessed by a collisional-radiative model based on superconfiguration average rates and on the unresolved transition array formalism.

Long-term follow up of childhood tuberculous meningitis

The purpose of the present study was to determine the long-term outcome of 76 children (40 females and 36 males) diagnosed and treated with modern antituberculosis drugs. The median age of the children on admission was 29.5 months and on follow-up 9 years. Antituberculosis therapy consisted of daily isoniazid (20 mg/kg), rifampicin (20 mg/kg), ethionamide (20 mg/kg), and pyrazinamide (40 mg/kg) for 6 months. Twenty-three children received daily prednisone (2-4 mg/kg) for the first month of treatment. Raised intracranial pressure was actively monitored and treated. Patients with non-communicating hydrocephalus received ventriculo-peritoneal shunts shortly after admission while communicating hydrocephalus was treated with oral acetazolamide (100 mg/kg/day) and furosemide (1 mg/kg/day) in 3-4 divided doses. Communicating hydrocephalus that did not respond to this regimen within the first month of treatment also underwent ventriculo-peritoneal shunting. Only 20% of children were functionally completely normal at follow-up. Main areas of functional deficit were cognitive impairment (80%), poor scholastic progress (43%), and emotional disturbance (40%). Twenty-five per cent of children had evidence of motor impairment, but all could walk and only 5 of 76 children (6% of total) were unable to run. One child was blind but no child had sensori-neural deafness. It was concluded that these disabilities in children from mainly deprived socioeconomic backgrounds have serious implications for their future social, academic, and career prospects. A high index of suspicion of TBM in high tuberculosis incidence communities will help prevent the morbidity documented in this study.

Adjunctive thalidomide therapy of childhood tuberculous meningitis: possible anti-inflammatory role

The objective of this study was to determine the safety and tolerability of the immunomodulatory agent thalidomide as adjunct therapy in children with tuberculous meningitis. Children with stage 2 tuberculous meningitis received oral thalidomide for 28 days in a dose-escalating study, in addition to standard four-drug antituberculosis therapy, corticosteroids, and specific treatment of complications such as raised intracranial pressure. Clinical and laboratory evaluations were carried out. Fifteen patients (median age, 34 months) were enrolled. Thalidomide was administered via nasogastric tube in a dosage of 6 mg/kg/day, 12 mg/kg/day, or 24 mg/kg/day. The only adverse events possibly related to the study drug were transient skin rashes in two patients. Levels of tumor necrosis factor-alpha in the cerebrospinal fluid decreased markedly during thalidomide therapy. Clinical outcome and neurologic imaging showed greater improvement than that experienced with historical controls. Thalidomide appeared safe and well tolerated in children with stage 2 tuberculous meningitis and could have important anti-inflammatory effects. These promising results have led us to embark on a randomized, double-blind, placebo-controlled trial of the efficacy of thalidomide in tuberculous meningitis.

Ionization processes and charge-state distribution in a highly ionized high- Z laser-produced plasma

The charge-state distribution in a well-characterized highly ionized Au plasma was accurately determined using time-resolved x-ray spectroscopy. Simultaneous measurements of the electron temperature and density allow the first direct comparisons with nonlocal thermodynamic equilibrium model predictions for the charge-state distribution of a highly ionized high- Z plasma in a nonradiative environment. The importance of two-electron atomic processes is clearly demonstrated.

Virtual computed tomography colonoscopy: artifacts, image quality and radiation dose load in a cadaver study

The purpose of our study was to evaluate the interdependency of spatial resolution, image reconstruction artifacts, and radiation doses in virtual CT colonoscopy by comparing various CT scanning protocols. A pig's colon with several artificial polypoid lesions was imaged after air insufflation with helical CT scanning using 1-, 3-, and 5-mm collimation, and pitch values varying from 1.0 to 3.0. Virtual endoscopic images and "fly through" sequences were calculated on a Sun Sparc 20 workstation (Navigator Software, GE Medical Systems, Milwaukee, Wis.). Several reconstruction artifacts as well as overall image quality were evaluated by three independent reviewers. In addition, radiation doses for the different CT protocols were measured as multiple-scan average dose using a 10-cm ion chamber and a standard Plexiglass body phantom. Generally, image quality and reconstruction artifacts were less affected by pitch values than by beam collimation. Thus, narrow beam collimation at higher pitch values (e. g. 3 mm/2.0) seems to be a reasonable compromise between quality of virtual endoscopic images and radiation dose load.

Aneurysmal portosystemic venous shunt: a case report

A case of an aneurysmal portosystemic venous shunt detected by colour Doppler ultrasound (CDUS) is presented. A young female patient complained of postprandial fatigue and had paroxysmal tachycardia. A direct vascular communication between right portal vein and right hepatic vein was found at CDUS and confirmed by direct portal angiogram. Using detachable coils a complete occlusion of the intrahepatic shunt was obtained. Reports from the literature regarding portovenous aneurysms are reviewed.

Incidental findings on sonography of the breast: clinical significance and diagnostic workup

OBJECTIVE

The purpose of this study was to determine how often physician-performed high-resolution sonography can detect nonpalpable breast lesions not revealed by mammography. A sonographic classification scheme was tested for its accuracy in predicting malignancy of incidentally detected breast lesions.

SUBJECTS AND METHODS

Six thousand one hundred thirteen asymptomatic women with breast density grades 2-4 and 687 patients with palpable or mammographically detected breast masses underwent sonography as an adjunct to mammography. All sonographically detected, clinically and mammographically occult breast lesions that were not simple cysts were prospectively classified into benign, indeterminate, or malignant categories. Diagnoses were confirmed by sonographically guided fine-needle aspiration or core needle biopsy.

RESULTS

In 6113 asymptomatic women, 23 malignancies in 21 patients were detected with sonography only (prevalence, 0.31%). Five additional malignant lesions were found in patients with a malignant (n = 3) or a benign (n = 2) palpable or mammographically detected index lesion. The mean size of invasive malignancies detected only by sonography was 9.1 mm, which was not significantly different from the mean size of invasive cancers detected by mammography (p = .07). The sensitivity of the prospective sonographic classification for malignancy was 100%, and the specificity was 33.5%.

CONCLUSION

The use of high-resolution sonography as an adjunct to mammography in women with dense breasts may lead to detection of a significant number of otherwise occult malignancies that are no different in size from nonpalpable mammographically detected lesions. Prospective classification of these lesions based on sonographic characteristics results in a significant reduction in number of unnecessary biopsies performed.

Diagnosis of digital flexor tendon annular pulley disruption: comparison of high frequency ultrasound and MRI

PURPOSE

The objective of this study is to assess accuracy of ultrasound (US) and MRI to diagnose completely disrupted annular pulley ligaments (APL) of the flexor tendons of the fingers.

PATIENTS AND METHODS

In a prospective study 32 patients (all males 18-42 years, mean age 25 years) with clinically suspected annular pulley disruption were studied with US and MRI. As a control group we investigated 40 fingers of 10 healthy volunteers and a non-injured finger of the patients with US. A 10 MHz linear array was used for US examinations and a 1.5 Tesla unit for MRI. Imaging was performed between the accident and surgical repair within 6 weeks. Examinations were performed in an extended and forced flexed finger position.

RESULTS

Complete disruption of the APL was diagnosed by US and MRI in 14 cases confirmed by surgery. The typical sign of disruption was a marked volar displacement of the flexor tendon in the area of the torn annular pulley during forced flexion. A distance between tendon and bone at the area of the ruptured pulley of 3 mm during extension and a distance of 5 mm at flexion was typical for complete disruption.

CONCLUSION

Both diagnostic modalities, US and MRI are valuable techniques in diagnosing complete disrupted annular pulleys of the flexor tendons.

[Ruptures of the medial gastrocnemius muscle: diagnosis with high resolution ultrasound]

AIM

Evaluation of high resolution ultrasound to diagnose rupture of the medial head of gastrocnemius muscle in patients with uncharacteristic calf pain.

METHOD

66 patients with clinically unclear calf pain were examined in a prospective study.

RESULTS

Out of 66 patients, 51 showed sonographic criteria of a partial rupture of the medial gastrocnemius head. 47 ruptures were located in musculotendineus transition zone.

CONCLUSION

High resolution sonography detect minimal lesions of the medial gastrocnemius muscle in patients with clinically uncharacteristic calf pain.

Intensive short course chemotherapy in the management of tuberculous meningitis

SETTING

Short course chemotherapy for tuberculous meningitis (TBM) is advocated by several groups, but relatively few children have been so treated and followed up.

METHODS

A prospective, observational study of isoniazid (INH), rifampicin (RMP) and ethionamide (ETH) in a dosage of 20 mg/kg, and pyrazinamide (PZA) 40 mg/kg, all given once daily in hospital for 6 months. Surviving children were followed up for a year after discharge.

RESULTS

Ninety five children, 39 (41%) at stage III, 52 (55%) at stage II and 4 (4%) at stage I TBM were studied. Ten (26%) at stage III and 3 (6%) at stage II died before completion of therapy. Five surviving children (6%) moved on discharge and were untraceable; seven children (9%) were lost during follow up and three were inadvertently restarted on antituberculosis therapy. Two children with severe stage III disease died after discharge. One child experienced a probable disease recrudescence 1 month after discharge. Eighteen children (20%) developed a mildly elevated serum bilirubin concentration during the first month of treatment. In five of these children INH, RMP, ETH and PZA were stopped and streptomycin (SM) and ethambutol substituted. In all cases the original treatment was restarted without incident. One child developed overt jaundice after 5 months of treatment due to hepatitis A infection.

CONCLUSIONS

Our experience suggests that young children with TBM can be safely treated for 6 months with high doses of antituberculosis agents without overt hepatotoxicity and with a low risk of relapse.

[Doppler ultrasound determination of vascular resistance in arteriovenous shunts of the finger tip]

AIM

Doppler sonographic assessment of physiological bloodflow characteristic in arteriovenous shunts of the fingertip and calculation of vascular resistance. Identification and definition of a peripheral, physiological resistive index in healthy volunteers.

METHOD

Doppler sonographic measurement of bloodflow values in Hoyer-Grosser organs of the fingertip in 20 healthy volunteers. Measurements were repeated at normal air temperature (21 degrees C) and after submersion in water (15 degrees C). The resistive index was calculated from peak systolic velocity and minimal diastolic velocity.

RESULTS

Although bloodflow values vary in a wide range, the resistive index is constant with 0.54 (range 0.45-0.69) in healthy volunteers. Characteristic sonographic flow patterns could be achieved in all tests.

CONCLUSIONS

Colour Doppler sonography allows identification of small arterio-venous shunts of the fingertip, measurement of bloodflow in these vessels and calculation of vascular resistance. At normal air temperature the physiological resistive index is 0.54.

The Austrian Academic Computer Network and its usefulness for teleradiology

To study the value of the Austrian Academic Computer Network (ACOnet) for teleradiology, 1740 test image data-sets and 620 image data-sets were exchanged between the departments of diagnostic radiology of the Universities of Innsbruck and Graz using the ACOnet service. Data transmission was reliable and fast with an average transfer capacity of 170 kByte/s (range 94-341). During the test phase, no major problems with image transfer occurred. Assuming that problems like security of patient data-sets, data compression and data verification can be solved, the ACOnet service would be a useful additional tool for telemedicine applications throughout Austria and eastern Europe.

Sonographic appearance of an appendix carcinoma

Malignant appendix tumours are rare entities. Especially adenocarcinomas, which only appear in about 10% of appendix tumours, are very seldom. Preoperative diagnosis is very difficult due to a lack of typical clinical signs and a clinical appearance mimicking perforated appendicitis. Nevertheless, sonography is able to show indirect signs and therefore it can provide the surgeon with more information for a better operative treatment.