THE purpose of this paper is to describe our installation at Stanford University Hospital, which we believe excels in ease and steadiness of operation and safety for the patient. The Generator For the production of undirectional current at 200,000 volts we have made use of a “Rieber” booster set, but feed it 100,000 volt current rectified by valve tubes instead of by a rotating switch. This is done in order to avoid the surges which are set up by sparking in any rotary switch. We are actually using universal Coolidge tubes instead of Kenotrons because they require only about a quarter the wattage to light. Heated to pass 10 milliamperes at a few thousand volts' drop, they will not pass more than about 50 milliamperes at full voltage. This limits any gas surges in the therapy tube, which may be important in tube life. Controls The voltage is adjusted by means of an autotransformer feeding the four 50,000 volt transformers in parallel. Supply is at 240 volts from an individual 25 kilowatt pole transformer with 00 leads in from the street, specially installed by the power company. Thus we avoid gross voltage fluctuations due to changes in outside load. The voltage is read by spark gap between 125 mm. spheres installed within the machine closet, but moved and read from the operator's hall outside. The treatment tube filament is heated by a Rieber Stabilizer (not shown in diagram) and filament transformer, which gives a constant heating current irrespective of line voltage fluctuations. The tube current is read from two milliammeters connected in series in the grounded neutral. There is also a milliammeter in one high voltage lead for a check (not shown in diagram). Time is marked and the current cut off automatically by means of an A.C. motor and train of reduction gears, which run only when the transformer current is switched on. As a final and direct check on the indirect measurement of X-ray production, there is mounted inside the tube shield, just within the filter, a small metal ionization chamber charged to 500 volts from a dry battery and connected to a sensitive galvanometer. This gives continuous readings of actual X-ray production. The Patient Complete X-ray and electrical protection for the patient has been attained by mounting the tube in the axis of a drum lined with 1/4 inch of lead and by enclosing the high voltage leads completely. In order to obtain maximum flexibility in use, the high voltage current enters the drum at the ends, so that it can be rotated through 360° and treatments conducted through a port in the side of the drum with the patient below, above or at the side. The couch is on castors and has an up-and-down adjustment on notched posts of 16 inches. To provide for long focus skin distances when the patient is underneath, the tube is mounted high. This necessitates raising the patient rather far toward the ceiling when the back is to be treated.
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