Today, we'll be looking at Outstanding Problems in Sino-Tibetan Comparison. It's kind of a necessary scientific task, and we'll give you a sense of, you know, where the field is, what we've managed to achieve, and what is still staring us in the face as problems. So, sometimes it's easy, and I won't be discussing these cases. I give paragraph references to my book. Either the three languages have the same thing, then we can reconstruct that thing, like in the case of Final K, or there are straightforward correspondences that point to a merger in one or the other language, like we get in the case of Glottostop or Q. In some cases, the resident files are also pretty easy, including these reconstructions I feel less comfortable with, like the RL reconstruction, but where the correspondence is clear. That one, this RL, is the most common of the resident correspondences, which is maybe a little bit concerning, and the reconstruction is probably wrong. Okay, as we've mentioned before, in some cases, distinguishing Final R and Final RL is hard. In particular, there are two examples. In the first one, there happened to be almost identical words for neck in Tibetan, one that ends with an L and one that ends with an R. And in the second case, it's unclear whether the Chinese word should be compared to the word fare, or the word clear in Tibetan, and which comparison you choose will determine which final year we construct. Of course, maybe this points to some, I don't know, morphological process in Tibetan that needs to be looked into, but with only two examples, the chances of doing that successfully at the moment don't seem super hot. All right, now turning to vowels, we can get back to a six vowel theory pretty easily, more or less saying the proto-language was a lot like Chinese. So according to handle all languages, but Chinese merge ah and schwa, but this is not correct. Burmese changes schwa j into i's, changes i into i, and this is a distinct outcome from its a-j correspondence. Here's should be a-j, I've made a typo, but you can see that it's a-j. And note that Tongut also draws this distinction between ah and schwa in limited context. So here's the general pattern, which is something we call brightening. It seems to have happened late and independently in a bunch of languages related to Tongut. But here's the general pattern, so you have z for i rather than za in Tongut. But schwa changes to u in words like ear and love. So that means not only Burmese but also Tongut has some evidence of the schwa versus ah distinction, which means that Handel's idea is wrong. So one of the most interesting, I think, problems in sign of Tibetan is this nga ka variation. And these, I think, it's worth actually talking through every example so that you kind of have them in your mind. So for this word that means war or conflict, Burmese has let's say proto-Burmish has zik, as Tibetan points to something like zeng in the in the proto language. Similarly for heart, Tibetan and Chinese have a clear ing final, but Burmese has ik and for year, Tibetan and Chinese have ing, Burmese has ik. For wood, Burmese has ik, Tibetan and Chinese have ing, and again for new. So these are the examples I've collected. There aren't very many. And in all of them, Tibetan and Chinese have ing and Burmese has ik. So it looks like a kind of Burmese innovation. But as we talked about a couple of days ago, achong, which is closely related to Burmese, it has this word sang for tree that agrees with Chinese and Tibetan against Burmese, even though it's a language that's clearly closely related to Burmese. So this shows that this this alternation, this ing, ik thing existed at the level of proto-Burmish, or it's a loan word from Jingpo. Those are the two options. And I just want to point out that there's this little language, by long, only preserved in three poems in the Ho Han Chu from the very early part of our era. I think around 50 AD, I would have to check though. And in this language, the word for heart agrees with Tibetan. So you have a Ning for heart, but you have sick for wood like in the Burmese languages. So I think this evidence from By Long is extremely important because it shows that we're not going to be able to solve this problem with sound change. It's not going to be that like, oh, Burmese changed ing into ik in some environments. That's not going to work. The alternation has to be reconstructed at the proto-Sino-Tibetan level because it exists in proto-Burmish possibly. It exists in By Long. And then we can imagine, I think that in all of these words, there was some kind of ing, ik alternation in the proto language, and the Tibetan and Chinese went for the ing, favored the ing versions, and Burmese favored the ik versions for whatever reason. And then other languages still continue to mix maybe. So ik versus ing is not predictive of subgroup affiliation, and it can't be solved with regular phonology. So I would, or like I'm inspired to compare this to heteroclites in Indo-European. So for instance, within Germanic, we get fawn for fire in Gothic, and we get old English fire. We don't need to go into the Indo-European details, but basically they're different case forms, and you get different analogical leveling. So some languages go with the nominative, and they analogically spread it. Some go with the sort of oblique stem and analogically spread it. And I'm not saying that we had case like this in Sino-Tibetan, but I think there was clearly some kind of morphological alternation in the proto language between ing and ik in a core set of basic nouns. So that's the explanation that I currently prefer. Moving just on to other irregularities. Here we have unexpected n in Chinese. Now just keep in mind that any given n in Chinese might be better reconstructed as an r, so this isn't that big a deal. So we have unexpected n in Chinese where we have r in Tibetan, so we sort of want the n to be an r in Chinese. We also have an unexpected n in Chinese where Tibetan has an l, so again we want the Chinese to be an r, but here we would point to an rl reconstruction. And we have unexpected n in Chinese where we have an open syllable in Tibetan, and in these cases, we don't want the n. We don't want the n to be an r. We don't want the n period in Chinese. So who knows what's going on there? Probably some kind of suffix. Maybe there are a lot of n suffixes floating around in Sino-Tibetan, but in any case, it's a problem to be solved. We also have the reverse, if you like. Those are the unexpected n's in Chinese. Here are unexpected r's. And now similarly, you might suspect that maybe Baxter and Cigar have incorrectly reconstructed r here because r and n are hard to distinguish in Chinese. But we would like to have n in these cases because that's what Tibetan has and Burmese when it comes up. More examples of the same. Intriguing rare correspondence to Chinese has a final m where one expects p based on the other languages. So we have a shadow where Tibetan and Burmese point to a final p and Chinese has a final m and needle, which I think we've seen on various occasions for various reasons. And I've ignored this complication because I don't have an answer for it. Definitely these seem similar enough that one expects that they're cognates. Also, sometimes we can have an unexpected T in Chinese. And I'll just talk through these examples. We have rice where you see Chinese has a T final and Tibetan has an S final. And then pitch pipe where Chinese has a T and Tibetan has an S. Cigar makes a very good argument for the semantics of bone being cognate with pitch pipe that has to do with how you made pitch pipes in in ancient China. And then this example of dig. I have suggested in the past, I think following an idea of Simons, although I don't quite remember that Tibetan S sometimes comes from a TS cluster, and that could be invoked here for rice and for bone, but it can't be used for dig. Okay, and then sometimes Chinese has an unexpected final, like in itch, and in this word, ancient times or in the past. Okay, we also have an unexpected D in Tibetan. For instance, we in all Chinese is me, but in in Tibetan is Ned. Okay, now turning to the vowels. We have Tibetan E, where we expect an a so a where we expect all, we just saw this example of we. But there are other examples as well. And some more examples. We sometimes have proto-Burmish, where we expect off, for example, in the word for house in Tibetan, if we if we compare that to roof in Burmese remember that Burmese Oh before dealers comes from proto-Burmish. So in proto-Burmish is something like kung. I don't think it's a coincidence that roof is kung in proto-Burmish and kung in Tibetan, but we don't have any way of getting between an O and an R in that way. And similarly with be scared. Tibetan and Chinese point to an Aq final, but Burmese points to Ok. Okay, and then Chinese sometimes has an ashua where we expect an I. And again, this I think might just be that it's hard to reconstruct Chinese correctly that there are some kinds of mergers in Chinese. But I guess here are the examples. The first one crumbs prohibit in Chinese and crimes law or, or right in Tibetan. And then the second one I think is quite nice to point out because it's a grammatical affects. So, there might well have been exceptional correspondences because of vowel reduction in unstressed syllable something like that. So you have a genitive go in in Chinese and D in Tibet. Yeah, and then in these two cases, Chinese has an evil instead of an I. Sometimes we get shot shot instead of I sometimes we get E instead of I but this is this is a rare one only in these two words. So difficulties with our Tibetan sometimes has a consonant. So, particularly dealers, plus our so in sort of for the tactic terms, an initial dealer and a middle are where Burmese or Chinese have initial are. So just to look at these in a little more detail. In the first one Chinese and Tibetan have crung, but Burmese just has wrong. Similar, you have crop and crop in in Tibetan and Chinese but then you just have a rap with an interesting media y as well. In those two you see agreement between Tibetan and Chinese, but then in the in the in the third one which maybe isn't such a great comparison actually, you have gr in Tibetan but just a raw in Chinese and in the last one cold. These are definitely related grung in Tibetan and an unspecified prefix so maybe it's it's okay prefix and then everything would be fine in a sense in Chinese. Now that's one set of complications. And now another one where Tibetan has our why and Chinese has our and now maybe one solution is to just reconstruct a media or sorry a media why the Chinese words in this case but that would seem a little bit ad hoc. So, so we have flow, which is you in in let's say pre Tibetan, but rule in Chinese. And let's go down to the last one because it's quite famous hundred in pre Tibetan in Burmese and with no sign of a middle yeah in Chinese. So this is a distinction I make or the graphically where our why gives us or yeah or yeah so yeah gives us or yeah this is Lee's law. But then I also have this are superscript why to mean sort of palization, which is gives us Benedict's law and that's how I, I index these two different outcomes of Tibetan and I do think that I don't know that you might find that overly mechanical but let me tell me another solution it's clear it's clear that there were two kinds of our why in pre Tibetan if you like, and in this case, we just have our in Chinese. And rocks for night. But, but we have our why evidence for our why in both Burmese and in Tibetan now, maybe this points to that the backstroke cigar you know should be doing something else here. So they should understand maybe that palatalized are changes to you in middle Chinese and that they should not reconstruct to the end prefix who knows. But in case I think there are some interesting examples. Now PR in Tibetan and are in other languages. So we have, you know, we just mentioned 100 where Burmese is kind of missing the, the P initial for some reason. And then the same thing in in in breast or breastplate but in this case, let's say Chinese and Burmese are compatible with your viewer initial, but Tibetan has a labial. Okay, and then also with tea are where Tibetan has TR DR and the other two languages don't have the cluster. And then I think this one indigo is probably a loan word into Tibetan from Chinese. Maybe at some point where some of the things had disappeared but it was still an R and not an L I'm not sure, but I don't somehow I don't think indigo is a sign or Tibetan word. There are a lot of complicated correspondences involving are that seem to have to do with with prefixes either being maintained or not before are. Okay, we have a lot of the similar problems with L, unsurprisingly. But you can, you can see them here where, you know, generally Tibetan has more going on than the other languages but it can be more complicated in that. Let's look at arrow so an arrow to Ben and Burmese have MLA, but Chinese has some loose initial maybe it was within with an M. Also a slight semantic difference there. And in the in the last one ground. So Tibetan has a seems have a G prefix Burmese and M prefix, and Chinese, no prefix at all. So there are some complications with laterals. Maybe let's look at four, which is the second on this page so you have a be prefix in in Tibetan anchor top, nothing in Burmese and an S prefix in Chinese so some some some mysteries here that need to be solved. And then there are also cases where it's unclear whether are or L is the initial. So in the word for neck. Chinese point to an L but Chinese points to an R. And in joyful Tibetan has an R and Chinese has an L. Now, one question that we've raised earlier is whether or not to reconstruct a yeah. Actually, we're discussing it about Chinese, but now about side of Tibetan. So there are cases where Tibetan and Burmese both have yeah, and Chinese has, you know, say, something not too far from your in middle Chinese but we're back from cigar reconstruct you viewers. And Gion Jacques and Axel Schussler suggest that in these sorts of environments, we should reconstruct a yeah all the way back. Baxter and cigar kind of reply to this criticism in their answer to Schussler's review in diachronica and point out that most of the Tibetan cognates do have a G in them. So, maybe their uvularity is not so bad after all. In any case, I don't have a firm opinion on on this particular question. Now, the origin of Chinese voiceless residents. So we have voiceless residents in in Burmese but we know where they come from. Where do they come from in Chinese. Well, you would be tempted maybe, especially if you were, you know, made to Lynn, you would say these come from s clusters. So the word black, you know, muck, actually started as smuck, something like that. But that's not going to work. Because we have reconstructed s clusters in Baxter and cigar system for other reasons. So where do these voiceless residents come from. One idea that I think I saw somewhere very recently discussed although I don't remember where is it. They did it has to do with the loose tight distinction where something like this tight initial SS became voiceless residents and then loose initial SS became tight initial SS after that. And that might explain what's going on in Chinese. But in any case, it's a problem that needs to be addressed. What is the origin of voiceless residents in Chinese and and can comparisons shed any light on that. There are just a few more examples and a few more examples. Okay, and now one of the big conjectures that would relate to Ben and Burmese so this idea of Shefners that Burmese has. This is how he put it has in some cases an aspirated consonant as an initial where Tibetan uses a superscript s. In kind of more modern terminology in the framework I'm using we can state this conjecture more precisely as where proto Burmese has a pre globalized resonance to Ben has an s resident cluster. So there's a lot of evidence that supports this. There's a lot of evidence, heart knows mucus bamboo. Right. But there are also counter examples. In particular, moon and snake. In the example of moon, Lashi actually does have a pre globalized initial. So we. So there's something going on inside of Burmese. I suspect it's actually that. Yeah, you can't tell it from the, from the orthography in Burmese but this is a creaky tone in Burmese. So it, you can see that with the capital X in Lashi. And so let's assume that Lashi is something like the proto Burmese form. I wonder whether when pre globalized changed into voices resonance in Burmese, there was some kind of conditioning whereby that didn't happen in in the creaky tone, because it's sort of too many, you know, glottal features I'm not sure what we what we can say very confidently is the double moon is a counter example to she's nurse conjecture from the perspective of Burmese, but from the from but it's a kind of it's a proto Burmese to Burmese problem. It's not a sign of Tibetan problem. Whereas snake is is maybe more of a problem. So let's look at counter examples where Tibetan lacks an S as well. So let's look at borrow where Burmese points to pre globalized initial in proto Burmese, but the Tibetan word is Brnya, not business. Yeah. So you can see here paths of investigation like I don't know maybe our prefixes in Tibetan are actually rotor sized S prefixes in some cases, or maybe she's nurse conjecture only addresses some sources of pre globalized initials and in proto Burmese and in proto Burmese, there were other prefixes that they caused it, for instance, in in to where Tibetan has a velar prefix, maybe it's that velar prefix that caused the pre globalization in proto Burmese. In any case, they're counter examples to she's nurse conjecture. Now, there are circumstances where there's disagreement on the manner of the initial obstrant. So places where proto Burmese is unexpectedly voiced and now remember that Burmese doesn't have a voicing distinction so so we take an aspiration distinction Burmese back to a voicing distinction in proto Burmese because of the Burmese split. So if we look at all, we have gun in Burmese or in proto Burmese and con in Tibetan. For slave or servant, we have gun in Burmese coal in Tibetan and corons in Chinese comparisons, you know, it's it's it's tantalizing, but they don't just line up perfectly. Okay. Here are more examples where proto Burmese is unexpectedly voiced. And they include, for instance, the number one. So you have, you know, proto Burmese or, or let's say, Trans Himalayan from the Burmese perspective would give you a deck where you have tech in Chinese and good tech in in Tibetan. Okay, Chinese can be unexpectedly voiceless. So here's this example I gave from elbow. Then there's also nine. And in some of these cases you you might suspect that it's actually Tibetan has voiced for some reason. Maybe there was a little schwa before, before the application of a prefix something like that but it's a, it's a problem to solve. So unexpected voiceless initials in Chinese and a few more examples. And even some more Chinese unexpected voiceless stops. Okay, now there's an idea of Guillaume Jacques that would get rid of some of these, which is that Chinese pre nasalization corresponds to Tibetan voicing. And from the perspective of sign of Tibetan what you would say is you had pre nasalized stops you had like, you had, you had maybe voice voiceless and pre nasalized stops inside of Tibetan, and the pre nasalized stops stayed pre nasalized in Chinese. And they merged with the voice stops in Tibetan very nice idea. I wish it were unambiguously true.  And then the G comes from the pre nasalization in the word for shield or contradict, you know, we get a G in proto Burmese and Tibetan and an MK in Chinese so maybe there's maybe the voice the car in Tibetan and Burmese so it's a nice idea, but it only gets as some of the examples. And let's say. Yeah, this is just to give the evidence that actually going back presented in his paper, where he was actually presenting corresponds between pre nasalization in in gyarani clanguages with with voiced in in Tibetan which is of course, you know, not the same idea, but it's the same kind of idea which is we're talking about some of the Tibetan voiced constants as coming from pre nasalization. So, um, the problem is that many of these voiced initials in Tibetan correspond with just plain voiceless in Chinese I've gone through those examples already. They don't correspond with an and pre nasalized initial in Chinese. So, at best, this conjecture of young shocks only gets us a little bit of the way in the direction we want to go. But in his review of my book, where I where he sort of noticed that I had discussed this idea of his, and was a little bit critical of it by saying well it doesn't get us very far and here's a good example. I do let's say I discussed this example which then he has an answer for which I will, which I will present you in a moment. So father is a napa in Chinese so according to his theory, it should be bad in in Tibetan, right. So his, his theory both doesn't explain all the, the pause that need to be explained in Chinese, and it doesn't explain all the buzz need to be explained in Tibet. So, maybe not such a great theory. That's, that's what I said in my book. Yeah. But he points out that in Limbu. Father is usually prefixed in a way that's similar to for now and I've discussed in Garong but in this case we're talking about Limbu, where the prefix is a nasal prefix so you know my father is on Bob, and your father is. I don't know how to say this. Whereas just father in the abstract father as an idea the father is is is pop. So he wonders whether they're there might that this might be similar to what sign of Tibetan had, and then you have a pretty easy explanation, which is that in Chinese, they generalized the prefix form, and in Tibetan they generalized the unprefixed form, which is to put it to put this another way. And that means that we can keep our story about pre nasalization, leading to voicing in Tibetan, where we say well in this case, when that sound change happened, the end prefix was already gone into that and because of morphological And then I'll just point out that the proto-Burmish, the pro-Burmish correspondence is also irregular. So I see has why and not pop. So maybe that's some evidence of some kind of prefixing going on also in proto-Burmish. So I think this is, you know, the goal of this presentation is to sort of show you the cutting edge of sign of Tibetan and and I think this is a good story to tell We've pushed historical phonology a certain distance. And now we know which problems need to be solved. And then in looking to solve those problems, in addition to just finding more and more refined conditioning in our sound changes, we can turn to morphology. But Tibetan and Burmese are not good places to turn to for morphology, whereas Limbu and Giao Rong, they are. So I think that's the next generation of scholarship will be looking at morphology in those languages that have it, and seeing whether that morphology can explain the irregular phonology that we get. So that whole sort of discussion we just had was about where Chinese has a voiceless initial, where we expect a voiced initial, we also have Tibetan having a voiceless initial where we were where Chinese has a voiced initial. So the reverse if you like. So dig, foot, carry, uncle. One Burmese cognate agrees with Tibetan, and one agrees with Chinese. In this one, it's saddle frame where you have Tibetan call Burmese gal and Chinese guy. And then on on here it's a cut or sharp where we're here Burmese agrees with Tibetan. So to Ben has shot Chinese has zot and Burmese has shot. So it's a mess. Yeah. Okay, and then in two cases we have Tibetan and Burmese disagree. And one of them we don't have Chinese. Now, we move on to the origin of Chinese aspirant options. So, just to remind you. So to Ben basically to Ben allows many many clusters but fundamentally, in terms of manners only opposes voiced and voiceless. Whereas Burmese doesn't really allow many clusters and Burmese itself has a voiceless and voiceless aspirant, but that goes back to voice voiceless pregolodized. And that may even go back to a voiceless voiceless pregolodized voiceless pregolodized. Chinese has a three way contrast in manner voiced voiceless and voiceless aspirant. So it just these kind of broad categories don't match very well among the languages. And we would end the aspirant options in Chinese are relatively rare. So I think a lot of people feel like they're secondary and we should get rid of them somehow, but it's not clear how. So in many cases, aspirant in Chinese corresponds to a plain obstrant in the other two languages here are some examples, maybe just look at bitter which is one of the, you know, clearest best Chinese cognize out there. Sign of Tibetan cognize out there. So what why is the Chinese aspirate where the other two were on aspirate, not clear. So Chinese aspirates can correspond to voice stops into bed and Burmese, for instance, in, let's say in Bend, where you have croc in croc in Chinese and gooks into bed. Or maybe scatter divide is even better example. Try it in Chinese where you break. Sorry bra in Tibetan and bra in Burmese which goes back to bra. So the Burmese and then, and the Tibetan tend to agree and something is causing the voicing and aspiration in Chinese. So the big problem in Chinese, let's say summing up our the voiceless residents and these aspirate stuff. So now we turn to the big problems in Tibetan, which generally have to do with palalization. So there are you can understand there is being three, I think, let's say at least conceptually speaking it may not be what happened historically but conceptually we have three kinds of palalization in Tibetan we have Houghton's law which changes. No into me conditioned by some palalizing environment. And we have love changes to show conditioned by some palalizing environment, and then we have lots of other palalization. Now these palalizations we sort of aren't as interesting to look at because they don't lead to mergers they lead to splits. Yeah, so. So they're still, you know, clearly present in the, in the language, and the conditioning environment for for all of these is unclear, although you know as you would expect high front vowels sure help. There are more and more examples with it. So with it is the most examples of the others fewer examples, but there are examples with all vowels including ah, so it doesn't have to do with the vowels. I think you know, in a way the easiest thing to do is just say it's just to reconstruct the palalizing environment, all the way back and then to say that before the value it. So that palalizing feature was was automatic, you know that's that's a way that a lot of languages are analyzed synchronically including for instance, Anton Lustig's analysis of Iowa. So, with that said, we have to distinguish to palalizing environments, because the palalizations happened hundreds of years apart from each other. So Houghton's law is shared with the East Bodish languages. So, it's not the same thing that that triggered these other palalizations right so we have to have at least, you know, if we're reconstructing these mechanically, we can say well we'll just reconstruct a superscript why as whatever the palalizing environment is, we have to do two, one for Houghton's law and one for everything else. And now we're ending up with a quite sort of algebraic proto language which I don't feel super comfortable with and we need to figure out like what actually is the phonetic environment that caused Houghton's law or these other palalizations and I think that's one of the big open questions. And the examples of Houghton's law just to remind you and you see that that Kurtop agrees with Tibetan against Burmese and Chinese. So Kurtop underwent Houghton's law. Now, an idea that's worth discussing to make the correspondences nicer. Nishita points out and particularly based on this word six that Tibetan has DR where Burmese has KR. And actually Nishita thought that Burmese was innovative in these cases, but I think Chinese points points you in the direction that it's probably, it's probably Tibetan that has innovated. Now, the reason I have this proposal here and not in an earlier presentation is it's not the case that you can set this up as a, across the board innovation you know it's not like every place Burmese has KR, Tibetan has TR, DR, it's not that easy. So, there's something going on but we don't let's put it this way don't know the conditioning environment. Okay. And East Bodish does not participate in this innovation. So it's, it's quite late in the history of Tibetan. So you can say, well, for some of Tibetan purposes, we will just remember when you see DR in Tibetan, ask yourself whether it's an old DR or a new DR. And you can check that by looking at East Bodish. And yes, it's a problem but it's a problem that we can solve in the context of Tibetan and not worry about in the context of sign of Tibetan. So just to give, you know, one example will go talk about six, because you know it's the, it's the best example of this whole kettle of fish to look in Tibetan but grok in boom top, and grow in doctor. So yeah, we have a clear velar. So then, so the dental initial is late in Tibet. So now we come back to Schiffner's conjecture we did it first with the resonance. Now we're going to do with the obstrance. And it's more complicated because in in Burmese we have two sources of aspirate obstrance, right, plain voiceless obstrance and preglottalized obstrance. So, I sort of asked myself, I mean, how, how would you phrase Schiffner's conjecture. Now, if knowing more about proto Burmese than he knew and I think it would be the SP where P is any voiceless obstrant SP would correspond in Tibetan to preglottalize P in proto Burmese. So, here are examples. Just look at borrow. As one case so you have preglottalize K I why in in proto Burmese and SK why I in in Tibetan, it's quite a good, you know, seems like a very promising conjecture. Now, a complication, which is, I think quite interesting is, we also have SB corresponding to preglottalized P in in proto Burmese. So, for instance, in the word for hill. In this case we actually can't prove that the proto Burmese was preglottalized because I haven't been able to find it in other Burmese languages but let's give it the benefit of the doubt. And then, most saliently in frog. Yeah. So frog clearly goes back to a preglottalize P in proto Burmese, but an SB in in Tibetan, and this suggests. Try and say it slowly and carefully. Starting from the perspective of Burmese and working backwards. At the Burmese level, all we have is a distinction between P and pH, but at pro pro Burmese, we've been able to rewrite that as a BP distinction and realize that there's a third series preglottalized P, and that the P and the preglottalized P merge on the way to Burmese. This evidence suggests that we, and we can't reconstruct this at the proto Burmese level. It's only with some Tibetan evidence, so we can call it the sort of pre proto Burmese level that we have a fourth series, which you can understand as a preglottalized voiced obstrate so then we would have, you know, P be preglottalized P preglottalized B. So frog I think is the best comparative evidence for that. But there's also some Burmese internal evidence, having to do with causatives. So we have this verb to be afraid, good. And we have the causative to frighten or scare, which reconstructs to preglottalized crook in proto Burmese. And I think purely, you know, for reasons of elegance in terms of internal reconstruction, you can take that one a step further back and say well maybe it was actually, you know, group and preglottalized group where the preglottalization is a sign of some kind of causative prefix. You know, maybe, ultimately an s so you could reconstruct almost entirely on Burmese internal evidence you could do something like group and group, which is just to say that that then this hypothesis that has emerged from frog and the comparison with Tibetan has some Burmese internal evidence that suggests we can we can imagine that kind of pre proto Burmese, let's call it had four way manner contrast in obstruence. Okay. So that shows us that Schieffner's conjecture is is really good, you know, it's really exciting, it really gets us a lot of work done. But there are exceptions. So, we have cases where the P in Burmese is not preglottalized, for example in star. Ah, but curiously, again, like we saw in moon for the residents, Lashi shows it is preglottalized. So, it's not an exception from the from the sign of Tibetan perspective, it's a Burmese internal problem. But it doesn't always help us. So, for instance, the word green Burmese and Lashi agree that it's not preglottalized, whereas Tibetan unambiguously has an S initial. So, what do we do about that. I don't have an answer. It's an exception to Schieffner's conjecture. And then here are two more examples, but I have put them on to this slide by themselves because I'm going to talk more about them. So, the word body looks like a nice cognates right so you have SKU in Tibetan school. Maybe something like goo in Proto Burmese and then call in in Chinese. But it is an exception to Schieffner's conjecture because you would expect to have some kind of preglottalization in Proto Burmese. And then, if we look at knee. You have a spusmo in Tibetan. And then you have. It's actually pronounced in Burmese. Sorry, or actually could be. But let's go with something in terms of the spelling. So, from here again, Burmese, we would expect to have an aspirate in order to confirm conform to Schieffner's conjecture. But a few thoughts. The Burmese word might well be alone from Pali kaya as the final why indicates indigenous. Indigenous Burmese words would not have a final why in this phonotactic position. And the pre aspiration in Lashi suggests that Burmese. It has innovated. It also have lost the final T it's probably a reduction in compound right so you actually would have had something like put charge, and then it becomes a charge in compound. So, maybe these two problems aren't aren't real and I think that that shows you, you know that we can that we're posing the right questions and making some progress. Okay, we also have the reverse so these are examples where we have an S in Tibetan and we don't have a preglottalization in Burmese but we also where we have a preglottalization in Burmese but we don't have an S in Tibetan. For instance, this word for male or armor crop in Tibetan crop in in Chinese for shell, but Burmese and proto Burmese has a preglottalized initial when we don't have an explanation for that. So I won't go through the other examples. And then just to sort of end this discussion of preglottalized initials in proto Burmese and their cognates in sign of Tibetan. We, I remind you of the bizarre word otter where Lashi has a preglottalized shot. So sham, which looks very nice in comparison to serum in Tibetan, but but Burmese has Piam. So there's something there's something really strange going on in the word for otter. But it, it certainly doesn't argue against chief nurse conjecture. Now, to sibilants, Chinese only has one is S. Yeah, so sign with Tibetan from the Chinese perspective you say oh well it had S. And from Tibetans perspective you can say they're to S and show I mean to some extent that reverts to the problem I just talked about which is why does Tibetan paralyzed. Yeah. And then for proto Burmese, we have four sibilants s preglottalized s, paralyzed s and preglottalized paralyzed s. The three languages point to a very different inventory of sibilants, and the correspondences are a total mess. Here we have cognates of proto Burmese s. Here are cognates of proto Burmese preglottalized s where well we have this rock in Tibetan maybe the R has something to do with the preglottalization I don't know. We have to kill where you know maybe the G prefix in Tibetan or the R the apparent are in fix in Chinese or what's cognate with the preglottalization it's really not very clear. And then we have these show examples in proto Burmese where we have drink. Well, I think these this word is pretty clearly cognate to this Chinese word, but here we have SR in in Chinese corresponding to show rather to pre then to preglottalized s. So just to prove the the the correspondences are a mess. Yeah. And then we can't talk about sibilants in proto Burmese without again reminding ourselves about what what a strange little beast author is and here I throw in a Chinese word for which does not look like a particularly good comparison, but it sort of doesn't look particularly worse than the other comparisons so you know might as well throw it up there I thought yeah. So that's order. Just talking about S is an RS. So the book has this conjecture that Burmese show. So a voiceless are from the Burmese perspective and a preglottalized are from the proto Burmese perspective comes from SR. And he points to these two examples. Another sex or shame, which he thinks is cognitive with a shamed and shame in job and a live where you have SR in Chinese and some in Burmese, but I have another I propose another cognate for ashamed, which is that it's, it's cognitive with red in Chinese and blood in in Tibetan. And why do I propose that it seems like proposing that shame is cognitive with shame is much more straightforward right. It's because it works in terms of my proposals for historical phenology which is that you had, you know, a nice uvular onset and the uvulars dropped in Burmese and the uvular becomes a veal or into Ben so the phenology just couldn't be better. And it is extremely normal across the world to have semantic change red goes to ashamed, because people blush when when they're ashamed. Yeah. So, yeah. So, which is not to say that give me Jacques ideas are bad or even wrong. I think maybe these these these other words can be brought into the story somehow, but I feel very fond of my comparison and I'm not ready to give it up. So this second cognate proposal so you only have two examples of this corresponds. The vowels don't work. So, you know, maybe that's a problem. Yeah, you, you, what should you have gotten in in in Burmese maybe that's a good quiz item well I'll just tell you. In should have gone to in and then in should have gone to that's Dempsey's law and then in should have gone to any that's Wolfen's law so you should have gotten shun or would be pronounced. Actually be pronounced she I think in in modern Burmese but it would be RHA and tilde and tilde is what you should have gotten as the vowel correspondence. So, you know, I'm not going to say they're not cognate but it's not a great comparison. And then just to say also in my book I catalog all the one off correspondences as well, all the kind of, oh and then here's, you know, a P corresponding to an end or something like that, where you might well think that they're just bad comparisons but their comparisons exist in the literature. And, and my temptation is to say we don't want to overly clean our cognate sets, because then we won't find new things. We're going to leave some some mess in there, and then we'll have something to clean up, but you know I really didn't think it was a good use of our time or your energy to sort of take take you through individual examples of sweet generous correspondences. Those are all of the problems. So I will just kind of add a word of summary. These are the big questions. So in Chinese, they are. What's the origin of the AB distinction. What's the origin of the voiceless resonance, and what's the origin of the aspirate obstrants in Tibetan. It's basically palatalization. I also think Tibetan is probably the best place to look at oblaut and, and, and more philology should be done on the Tibetan verbal system to figure out exactly what the prefixes mean and where we find the oblauts, not only in terms of you know, naming the stems like you get the present as you get the past but actually find out what those what those things actually mean. I think that's a big desideratum in Tibetan. And then in proto-Burmish, what I talked about had a lot to do with Schieffner's conjecture of sort of linking proto-Burmish and Tibetan, but actually in the case of proto-Burmish we're lucky to have this Burmo-Changik hypothesis, where I think just figuring out the next level up, you know, we did, we did the proto-Burmish. So how does proto-Burmish relate to Lolo-ish, how does Lolo-Burmish relate to Burmo-Changik. And then I think in particular bringing the, the, the velarized, non-velarized vowel distinction that you see across Gaorong and Changik languages into the picture will be very helpful. And I think that we will end up, you know, sorting, we'll end up with, let's say a proto-Burmish Changik that's a much better starting place for comparisons to Tibetan because it will have a more gorgeous set of onsets and the sources of these pre-globalizations will be, will be more clear. And maybe we'll also have a tidier vowel system that doesn't have this imbalance that currently exists with far more correspondences in open syllables than closed syllables. That's a nice idea. Yeah. You know, I wish I'd talked to you before I wrote my book in terms of I think, I think reconstructing B for the MP correspondence, G for the, for where I have K-Schwa and D for where I have RL would lead to an overall more elegant looking Sino-Tibetan


So I'm going to talk about brachytherapy planning and quality assurance. I'll start off with planning and then we'll go into quality assurance.  And then I'll talk about modern computerized planning. We used to do planning for brachytherapy without computers, because we didn't have computers, and gradually computers came in. But the classical implant systems didn't need computers. So we could do it that way. And they still kind of exist. And then I'm going to look at the most common clinical applications of brachytherapy today. And then I'll spend some time talking about quality assurance. So let's look at classical implant systems. Well, the most famous is the Manchester system, the so-called Patterson Parker system. Not used very much today, and I'll talk a bit about it. The Quimby system, or sometimes called the Memorial system, because she worked at Memorial Hospital in New York City. And then the Paris system, basically developed in Paris.  I've never used the Paris system, but many hospitals in the United States. And it depends where the doctors trained. If the doctors trained in Paris, they'll use the Paris systems. Doctors trained in Britain, they use the Manchester system. And with the advent of computerized treatment planning, most of this is now gone, except maybe the Manchester system for the treatment of cervix cancer. And I'm sure some of you are still using some of these other systems. But with computerized systems, they've kind of gone away now. And we found the computer could do a better job. And it does a lot of work for us, because I can remember doing planning for brachytherapy. It would take me all day to do a plan for a brachytherapy patient. It was very intensive on the work of the physicist to do a good plan. Let's talk then a little bit about the Manchester system. The Manchester system aimed at producing a uniform dose within the treatment volume. Did you find a treatment volume? You put needles or tubes in the patient and try to get as uniform dose distribution as you can. And they had variable strength sources, so they weren't all the same source. You could put different strength on the outside than you put on the inside, for instance, to get a fairly uniform dose. And there were rules applied to the placement of the sources. So you had rules, place the sources, the activity of the sources to get as uniform dose distribution as possible. Now we can do all that with a computer with optimized treatment planning, much easier. And then they produced tables and you could calculate how long to leave the implant in the patient. Most of this, in fact all of this, pretty much in the old days, was for low dose rate brachytherapy. We didn't have high dose rate when most of this was done. It was originally devised for radium, but as I mentioned radium kind of disappeared. It was too dangerous, too hard to shield, and then it took over with cesium. And you get a new table produced with cesium, by the way. I hadn't thought of benching it, but the new tables that turned radium into cesium, Bob Shalik. Remember? Did you know he just died yesterday? Bob Shalik, the person who did all that work to convert the radium tables into cesium tables, unfortunately passed away yesterday. I just heard it by email this morning. I wasn't planning to mention that, but we should thank him for converting all those tables. He and Marilyn Stovall did all that work at EMD Anderson Hospital. The Quimby system, now we're talking Memorial Hospital in New York, another big center for physics. Some of the very early physicists in medicine started at the Memorial Hospital. We did Quimby was one of those pioneers. She was a lovely lady. You knew Edith Quimby, didn't you? Did you know Edith C? She had already died, okay. Edith Quimby, when I first knew her, exactly. Edith Quimby, she was a grey-haired lady, a lot older than I am now. She was probably in her 80s, late 80s, and she would still come to all the chapter meetings and sit there and ask questions and be available to talk to the younger physicists like me coming into the field. She was a wonderful lady. I always remember Edith Quimby. I haven't got time to tell you a story about Edith because you want to talk next. I don't want to take your time. It required a uniform distribution of seeds of all the same strength. So you didn't get a uniform dose distribution. You got uniform seed distribution, all the same strength. Much hotter in the middle than it was on the outside, which may be okay for most cancers because that's probably where most of the cancer cells are near the middle of the volume that you're treating. So they produced a non-uniform dose distribution. And then again, just the same as Patterson Park, you got tables that you could use and I used to use these tables all the time to calculate the treatment times and the dose distributions around the sources. They were originally devised for radium and radon seeds, but eventually extended to iridium and I-125. Lowell Anderson did a lot of work on these developing nomograms. You could use nomograms instead of tables to do the same thing. I'm not going to show that. But not many people I think are using those anymore because everything's computerized. But the nomograms can certainly still use. Yeah, I used to use them. In this system, they were designed for iridium wires and extended later to iridium seeds in a strand. So they looked like wires in terms of the distribution of the radioactivity. The sources were equidistant apart, arranged in patterns, usually squares or triangles. The dose was called the basal dose. They had this which was the minimum dose, located halfway between the sources in these patterns. So it was kind of a minimum dose in the implant. I never used a parasystem. Do you ever use a parasystem? I know of only two places in the USA that used it. Both they trained in Paris. The doctors changed the parasystem. They wanted to use the parasystem. No, they wouldn't let parasystem there. They had the memorial system. And again, they had tables provided to calculate the treatment times and to work out the dose distributions. That's the old system of dosimetry. We'll talk a little bit later about the computerized system of dosimetry. What are the most common clinical applications of brachytherapy today? I haven't got time to do them all, so I'll just pick a few. Gynecological treatments are probably very common around the world. Prostate implants are very common around the world, particularly in the United States. And breast implants is getting to be more common around the world now. We do a lot of them in the United States. So I'm going to just talk about those three. So let's talk about gynecological brachytherapy. When is it used? When is brachytherapy used? It's used for treating cervix cancer, very extensively. It's used for treating cancer cells that are in and around the vagina. Not necessarily vaginal cancer, but cells that might have spread maybe from the uterus into the vagina and endometrial cancers. So let me talk about cervix cancers first of all. And these are typical applicators that we used to use. They're now more modern, but the same kind of design. You have these tandems that are pushed into the uterine cavity and hopefully nowadays we've got iridium sources so they can be made a little bit smaller. It used to be quite painful for patients to have these pushed in when we had cesium for instance because they were quite big diameter. So these get pushed in and they have different curvatures depending on the curvature of the uterine canal. They also have these things called ovoids. Ovoids fit into the vault of the vagina and they irradiate the cervical arson around the distal end of the vagina. And then we have these so-called caps that fit onto those. Why do you want caps to fit onto those? You want to use the biggest spacing you can away from the tissues to get the best dose distribution. Remember, the further the distance the better the dose distribution. The better the penetration you get into the tissues. So you put the biggest caps on that would comfortably fit into the patient's vagina. And these are modern versions of the same thing. These are just the same thing. And you'll notice that the latest ones are CT and MR compatible. They don't have steel in them. They're made of CT and MR compatible. And notice also instead of just the ovoids, we now have rings and a lot of people use ring applicators so the ring fits into the end of the distal end of the vagina around the uterine canal sources that go into the uterine canal. We found that they were much more easy to input into a patient and the patient didn't need any anesthesia. It wasn't really painful. To put these, the bigger ovoids in could be quite painful. That's why the Hengki applicator fits in a lot easier into the patient's vagina. It's not so uncomfortable. When you're doing high dose rate practice therapy, the patient is going to be coming in maybe six or seven times. You don't want to have to keep and desatizing them every time they come in. That worked very well in our hospital. One of the ones that started with the... Another thing I haven't shown here is we used to put into the uterine canal a stent we called it. Did you use the stent? That stayed there during the maybe seven or eight treatments the patient was going to get. The intrauterine sausage would fit in very easily with no pain to the patient at all. So that worked out really well. We came from Schmitt in South Africa. And Felix made them, but Dr. Schmitt is a radiation oncologist. He basically invented them. In fact, while we're talking about inventing, correct. You didn't need to dilate the uterine canal each time, which is again a problem. If you look at this... I'm losing it. If you look at this one, there's kind of a spacer here. This pushes away the rectum from the sources. And that was invented by Jocelyn in Leeds. And you know what he did? He went to the barber shops and got shoe horns. Did you put your shoes on? Got shoe horns. And he fitted them on and found the best shoe horns. And then he bought up and they couldn't understand why there were no shoe horns in Leeds in England because he had them all in his hospital. He bought them all up and tried them all and eventually... And that's what this is. And the company then started making them to fit onto their applicators. Let's look at the Manchester system. And this is still going on today. With the Manchester system, they would calculate the dose at two points, points A and points B. And we still do it today. Even though we have advanced dosimetry systems, we still use points A and B for cervix cancer and maybe endometrial cancer as well. And point A is 2cm up from the cervical loss, which is right down the entrance point to the cervical canal there. 2cm up from there and 2cm across. And we all use that, rightly or wrongly, to represent the tumour dose. You can't have a tumour dose because this is a three-dimensional object. But that's what we represent, certainly the prescription dose. And we all think of it as a tumour dose. And then they have this other point, B, further out over here, 5cm out from the centre. Manchester had a reason for that point, but we kind of always thought that that has been the normal tissue dose. You're outside the tumour now, and that's where some normal tissues are. Well, that's easy, except most patients aren't designed like that. Most patients have a tilt to their uterine canal, their uterus, particularly if there's cancer in it. Cancer is pushing you off to one side. So most patients aren't really like that. And so what you do is you measure 2cm up along the tandem, and then 2cm at right angles to the tandem to represent point A if you like the tumour dose. Because the tumour moves. The tumour moves. The area you want to treat, the target volume, moves as the uterus moves. So that's why point A moves with the uterus, whereas point B represents the anatomy of the patient, the pelvis of the patient. So point B stays the same. Point B, you move straight up along the axis of the patient and 5cm out. So that's often an exam question. We had that so many times in our exam. I should put it in an exam, but I didn't put it in. I should have done it. I gave... All the answers in the test... Did you all know you were going to have a test? You were going to have a test? All the answers in the test we've already talked about. So you can read that. I don't intend you to read it. These are some recommended doses for low-dose rate brachytherapy for cervix cancer. And all I want you to see is that as the tumour stage goes up, the amount of external whole-pelvis dose goes up. Why? Because now you expect that some of the cells, the cancer cells might have got into the rest of the pelvis. So you treat the whole pelvis and the higher the stage of the disease, the more pelvis you treat. When you're doing that, you can't keep giving the same amount of dose to the intracavitree. You're going to have to reduce the intracavitree dose. So the intracavitree dose is decreased somewhat. The total dose actually increases because now you've got more advanced disease, you need more dose. So that's how that works. And the same thing applies to high-dose rate. This is an example for early-stage disease. Probably you don't need as much high-dose rate, some much external beam. Although I notice this table goes out to 54-gray. I just did something. Here it is. It goes all the way out to 50.4-gray. Early-stage service cancer probably doesn't need that much external beam. You're probably better off treating it mainly with high-dose rate. And the brachytherapy is the most efficient way to deliver radiation.  So brachytherapy is a very conformal type of therapy. So the more brachytherapy you can use, the better. So my department would never have treated very high doses to the external beam, oh, this is now advanced disease. I've moved on. Advanced disease now, you need the external beam. And so you've got a lot of external beam. And as you increase the external beam, you decrease the dose or the dose per fraction accordingly to get a constant dose. I've got strange things happening here, okay? Now let's talk about irradiating the vagina. It can be treated low-dose rate. But probably nowadays mostly it's treated with high-dose rate. Low-dose rate is a problem because the patient is lying in bed, the nursing staff has a problem coming in and seeing the patient. Although pulse-dose rate is often used here. So I should have said you can't do it with pulse-dose rate. But most times we use high-dose rate for vaginal brachytherapy. We usually use a cylindrical applicator of an appropriate diameter and I'll explain that in a minute what's appropriate, okay? And then you have this stepping pattern with a high-dose rate remover afterloader or a pulse-dose rate remover afterloader that can design a dose distribution around it to get a uniform dose distribution in the tissue around the vaginal vault. And typically we define the dose as half a centimeter outside. Okay, remember inverse square law again. So this is what these applicators look like, these cylinders and you use the largest diameter applicator that will fit comfortably into the patient's vagina because you want a better dose distribution. You get a better depth dose with a larger applicator. And then finally, endometrial brachytherapy and this can be treated low-dose rate again, most commonly nowadays high-dose rate. For patients who have lost their uterus, so post-historectomy patients, we just treat the vagina, the upper end of the vaginal cuff because maybe before they removed the uterus, some of the cancer cells are gone down into the vaginal walls. For patients who have an intact uterus, then we treat both the vagina and the uterine cavity. And this will give you a picture of what we're talking about here. This is a picture of a patient's uterus, this is the uterus here and this is the vagina down here. And the endometrium is all this tissue surrounding the uterine cavity and it can spread down into the vagina. So we want a system that will actually open up in the uterine cavity up here. So this is what the system looked like. What did we used to call this? Not Hensky. Is that it loudly? The type of applicator that spreads out, what was it called? See, we've both forgotten. We used to have to do this and we've forgotten what it's called now. It's not Hensky. Correct. So what happens is you push this in through the uterine canal and then you push a little trigger and the bottom bit opens out to push against the walls so that you can treat the vaginal vault, the far end. And I think I've got a picture of the dose distribution. Here's the dose distribution that you'll get from a typical and you can see it's spreading out at the far end. So this is the far end, this is the vaginal, this is the vault of the uterus and you've got these sources spread out here. Typically we would define the dose two centimetres lateral to the middle of the uterine applicators. So that would be a typical point to define. You might want to give 500 centigrade per fraction there or something, that would be how you define it. And what are the guidelines? Guidelines published everywhere. I'm just quoting American Brachytherapy because I can get hold of them very easily. So if you don't add any external beam to these patients, these are the number of high dose rate fractions of different doses that people are using and that the American Brachytherapy Society say are appropriate for these patients. Remember it's half a centimetre away from this centre, sorry, two centimetres away from the centre of the uterine canal in the middle. So these are typical views. So that's gynecological Brachytherapy. Very common, I would say one of the most common applications of Brachytherapy. Maybe the most common now is prostate because we found certainly in North America prostate is correct. So we're now using a lot of prostate cancer because prostate cancer is very common in North America partly because it's overdiagnosed and we treat a lot of prostate cancer patients that would never die of prostate cancer because these are usually older gentlemen and they would probably die of older age or heart attack or something before there because prostate cancer is a very slow-growing cancer but we treat a lot of them because their PSA goes up and then they get frightened that they've got cancer, treat me and they go in for treatment and one of the most common treatments prostate cancer is Brachytherapy. So there are two major alternatives, a Brachytherapy. We can treat with permanent implants with either iodine or palladium or we can treat with temporary high-dose rate implants. You can do it high-dose rate or you can do electronic Brachytherapy which is basically high-dose rate as we mentioned before. And how do we do it? Well, the most common method is ultrasound-guided trans-perineal prostate Brachytherapy. Sounds very complicated. All you do is you put an ultrasound device into the patient's rectum and you look at the ultrasound outline of the prostate at different points in the rectum and then you design your treatment accordingly and put in, you have a template like this that you push up against the perineum of the patient so it's trans-perineal. You push it up against the perineal and under ultrasound guidance you put needles in to where you want the sources to go. Drop the sources off if you're doing a permanent implant or leave the catheters in to see if you're going to do a high-dose rate treatment. And this is what the ultrasound pictures will look like when you get them at different points along the rectum and you see that. And then you can use this to plan where you put the seeds. You can use it for planning. In fact, here we go. This is used for planning and you can put seeds to get the distribution that you want. You have an optimization program that would do this for you to tell you where to drop off. If you're doing a permanent implant you're going to drop off seeds. They're going to stay there for the rest of the life of the patient. So you just drop them off where the planning system tells you to drop off the seeds. And this is just a, I won't spend a lot of time doing this because we haven't got a lot of time, but basically what we start off with is we have the ultrasound scan of the prostate. We do the contouring of the prostate, all this in the treatment planning computer. And then you develop a plan. You look at the dosimetry. If the dosimetry is what you wanted, okay. If it's not, then you go back and plan again. But let's just say it's okay. And then you record all that data. You're going to have to go in and implant the seeds with real-time dosimetry. So you can do this real-time or not real-time, but most of the time nowadays it's done real-time. So you have the ultrasound system there in the patient's rectum showing you where you're actually dumping the seeds. So you can see where they go, okay. Then you review this, see if it's okay. Maybe use some fluoroscopy, see if the seeds are in the right place. If the dosimetry is acceptable, you record all the data and then send the patient home because you can't do anything about it now because the seeds are there permanently. So it's the way it's done in practice. And medical physicists get involved all the time with this. They're in the room with the patient. One of the few times that the physicist actually gets in with the patient and sees the patient. We did the ultrasound with the intravascular and brachytherapy. Yes, we used to do intravascular brachytherapy and the physicist would always have to be there to do it. But that's died out because the vascular experts have found a better way to treat the patients rather than radiation, so we don't... Anybody doing intravascular, putting radioactive sources into blood vessels to open them up? Nobody does it anymore. They were so exciting when we first... About 20 years ago. It was great. Very exciting. It's close to 20 years ago because we stopped doing it 15 years ago. I think we pretty much stopped. It lasted for about five years. Right. They came up with stents that they could put in that had a chemotherapy on them and it would open up the blood vessels with chemotherapy rather than with radiation. You know why they stopped it? Because they didn't need the radiation oncologist or the physicist. So in America, that means that they get all the reimbursement. They get all the money from that procedure. They don't have to share it with other people. Which is another logistic issue. Another logistic issue. In neurosurgeons, which we used to do that because of the brain, the seed implants in the brain. They didn't want anybody to tell them what to do. We were telling them what to do. Well, it was the law in America in most states, probably all states that the radiation oncologist had to actually do the procedure. So reimbursement for them was great because that's all they did. They didn't have to worry about the patient from then on. That was after the patient. Which is kind of nice. Let's talk about prostate permanent implants with I-125, half-life is 60 days. The dose is delivered over many months. The dose is delivered over the lifetime of the source, which is forever. A little bit. Forever, because it's exponential. But the useful dose is delivered over many months. With palladium, the useful dose is delivered over many weeks. If you have a more rapidly growing prostate cancer, you would use palladium, slower growing, most of them are slower growing, use I-125. The total dose delivered to infinity is very simple. It's the initial dose rate times the mean life. Makes it very easy for a physicist to calculate the dose. But it gets very complicated when you've got a tumor that's repopulating while you're treating it. Because then you have to calculate what effective dose is. So, examples. If the initial dose rate of I-125 is seven centigrade per hour, then the total dose is initial dose rate times the mean life is 145 grade, which is what we mentioned before is what we now use. And the same thing with palladium. The initial dose rate is 21 centigrade per hour. You get about 123 grade. When prostate cancer treatments first began with palladium, nobody knew what dose to give. I calculated with the linear quadratic model and came up with exactly the dose that we give today. So the LQ model sometimes works really well. And it's still used today, right? And then these are some recommendations. Let's not go over them in detail of what kind of doses to give if you're just giving the seeds or if you're combining seeds with some external beam radiation. You won't use external beam radiation at all unless you think that the cancer spread outside the prostate. If you think it spread outside the prostate they need some external beam too because you're only putting the seeds into the prostate. They won't irradiate anything outside. So HDR for monotherapy there are a variety of different fractionation schemes that you could use. And the American Bracket Therapies published these in case people don't know what to use and they haven't done much. HDR therapy for prostate cancer then they can use these these doses. So this is a task group of the American Bracket Therapies side. He said, what do you do if you're going to have to give some external beam because of the spread outside of the prostate and these are some of the numbers that they give you depending on what external beam that you've had. So I'll just show you that. These are all published and you don't even need to know. That's the physician who's going to prescribe these doses. They need to know this. They need to know where to get this information. And I'm sure other organizations, Europeans have different publications to do this. Now I'm going to talk about accelerated partial breast irradiation APBI as we call it in the United States is Bracket Therapy for breast cancer and it's used after a lumpectomy. Now we've discovered that we don't need to irradiate the whole breast in probably the majority of breast cancer patients. Just take out the tumor and it leaves a cavity inside and treat the walls of the cavity in case the surgeon has left some cancer cells in the walls of the cavity. The two major techniques one is to put needles in and I'll show you that interstitial bracket therapy or the other is to put a special applicator that actually makes the cavity into roughly spherical shape which is very convenient in terms of dosimetry because if it's roughly a spherical shape and you put a source in the middle you pretty much get a spherical dose distribution and so the dose distribution in the cavity is pretty much uniform around. So I'm very interesting and I don't know how wide that spread this is outside of the USA we use it a lot in the USA. Balloons. Well I'm going to show you some examples. So let's look at the technique for interstitial and this is just one example. You have a template that you attach to the breast and compress the breast and then you put the needles in through that template must be very painful for the patient. Presumably they get enough sedation. We'll never go through this. Well no, we do it in the transperineum. Come on. Prostate. And you can see the distribution of the needles in here and then if you're doing high dose rate for instance it would be easy to optimize the dose distribution to irradiate around the cavity. Here the cavity is an irregular shape you haven't made the cavity into a sphere here so it's an irregular shape. I see the templates in the superior view. Yes, this is Bob Kusky in Wisconsin. He used to be in New Orleans that's when I first knew him and he invented this method and took it with him to Wisconsin. Actually my son's a medical physicist used to work with him and he was very unhappy with my son left because he was the one physicist that really understood this method. He worked with him a lot. So this is what it looks like when you finish putting the needles into the patient. Look how they've shaped it around the cavity. Your right hand diagram there is a round cavity so you get a fairly uniform distribution around the cavity and then you do this high dose rate with maybe five fractions in a week, something like that. And the American Brachytherapist Society again has come up with some examples. Now the blue method that Jakov was discussing is relatively new probably the last six or seven years and at the time of surgery when the patients just had the lump removed you insert a deflated balloon into the cavity. Then you sticks the patient up and a week later the patient comes back after the wound has started to heal the patient comes back and then you inflate the balloon and then that makes the cavity nice and spherical so you can treat it. This is the mammocyte system used to just be one source or done high dose rate and then they've changed it now and you've got various catheters that spread out inside there and it's very similar actually to this system which is called the Contura system which has four different catheters that are spread out inside the balloon and a central one and you can get a dose distribution that you designed for that cavity. It's not quite spherical but you can get it spherical. Right. So the Contura displaces the shape of the tissue more or less spherical doesn't have to be spherical because you can do optimization of the dose distribution you've got lots of potential source positions. There's another method called the Savvy that doesn't use a balloon but uses this system that you can expand inside the cavity. You expand it and it pushes the cavity up to be roughly spherical again and get it and again it doesn't have to be exactly spherical because you have different source positions you can optimize the dose distribution very easily and it finally is another one that I haven't actually used called the Clear Path and it's very similar to that again it's something you can expand inside to create something that looks like a cylinder a spherical system and you've got this little pink thing there which actually protects the tubes when the patient because this is going to be probably a weak treatment come in once a day for a treatment you want to protect it and it's not so ugly because it kind of covers up the tubes that are in the patient but that's about all that's for Yeah this looks like a big incision as I said I haven't got any experience of using that because that's a but remember this is all done in surgery this is when the patient's having surgery you insert it and then you wait a week and eventually when it's taken out the doctor will stitch it back up again so you haven't got a hole left in the patient typical doses that are used typically if you do it low dose rate not many people are doing it low dose rate but you can and high dose rate everybody almost in the United States is using 34 gray one centimeter outside the cavity okay think about it that means closer to the cavity wall you get a much higher dose maybe as high as 50 or 60 gray closer and that's very clever because you expect the higher density of cancer cells to be closer to the cavity because that's where they might have been left by the surgeon so it's very clever that you actually have this dose distribution and it works very well so I'm going to finish very little on quality assurance because some of you are coming to the demonstration this afternoon we do quite a bit of quality assurance in the demonstration this afternoon so it's needed to ensure the safety of the patient the public and the staff positional accuracy of the sources temporal accuracy so they've got to be in place for a certain time temporal accuracy of the sources and then dose delivery accuracy in general so there are guidelines to do this Astro has some guidelines you can find these free online similarly AAPM has a task group report and you can get all those online and they look at daily or quarterly and so on quality assurance safety of the public and staff you're taught next I should stop now because error avoidance is very important to avoid errors and make errors in brachytherapy as you didn't present them in that but a lot of big errors have been made in brachytherapy patients have actually died because they left the source in the patient and sent the patient home bad news clear prescriptions and you've heard all about this for external beam the same thing applies to brachytherapy emergency, got to have emergency procedures to make sure you know what to do if the source gets stuck which it does I usually send in my junior staff into the room to get the source out of the patient I don't want to do it he's quicker than me too and he's got longer arms, Gary is hell has very long arms because you get a lot of radiation there with a high dose rate source you have to do it fast and you have to train the staff to do it radiation safety in general room shielding and so on additional accuracy you've got to make sure that the machine is programmed properly and you've got to check it that the sources go to the right place, lots of systems for doing that the catheters are all the correct lengths errors made because of that and then all the applications are in the correct place and you have to do this per patient, not just per week or per day, you have to do it for every patient and make sure that each patient gets the right treatment that you're planning and there's a tool for doing this I think you've probably seen one like this this afternoon, those of you who go over to the hospital very similar to this using gaff chromic film for instance you can see where the source stopped and you know where you meant it to stop and you can check is it within a millimeter of where you meant it to go the same thing with time, low dose rate this is important make sure that you take the sources out low dose rate when they're supposed to be taken out you don't leave them in the patient for an extra day or two because you forgot to tell somebody to take them out and we did that once and I had to go in and take them out myself instead of the doctor because the doctor was on vacation and he forgot so I had to do it that doesn't happen very often fortunately I had good records remote afterloading everything has to be has to be checked for quality assurance program and transit dose is the dose that the patient gets as the source is moving in the patient, not when it's stationary when the source stops, but when it's moving to the stop positions, there's some dose and we need to know what that is it's an added dose to the patient and then accurate transfer of the data from the treatment planning computer and in dose delivery accuracy, physical aspects make sure everything's right source strength for that particular patient and all the data's in there and if you're taking account of the attenuation in the applicators, that should all be a part of your quality assurance program and then clinical aspects every patient, you've got to know how accurate that data is if you're using imaging data and you're transferring it to the treatment planning computer make sure that it's all right and then source strength calibration I already talked about source strength primary standards lab or secondary standards lab has the ability to do this accurately, you don't in your department, they do it and then they calibrate your equipment that you're using to do it so typically this is done by the primary lab and then you have dosimeters like these well-typed sanitization chambers that you can put the sources in they have been calibrated by the standards lab to represent the dose that they measure equivalent to measuring at one meter from the source to get the source strength and these are just three of the I don't know what one I'm sure you can see one this afternoon if you come to the demonstration the calibration lab surprise you with lots of data and I'll just show you one of them the sweet spot localization location inside your chamber there's a sweet spot a spot where it doesn't change much with position which is where you want to work and they'll tell you about that and you should measure that too moving your source in and out until you get the maximum and that's where it's more like you've got less error in positioning and then for each patient you need to check everything make sure you've got the right patient as we heard before everything has to be as it was prescribed so the patient gets the right dose everything that you check you need double check by an independent expert and if you can do a manual check and I mentioned how you might do that at one point just to manually check that it's giving you the right information for that patient and then make sure everything gets signed at the end we have to do that in the United States because it's a law I don't know about other countries but we always make sure everything's signed the other reason we make sure everything's signed is you can't get reimbursed unless you've signed it the law in the United States says you didn't do it unless you signed it so they apply for reimbursement and if they get reimbursed then that's against the law and then they get into trouble and this has been happening a lot in the USA a lot of people the tax man has been catching up with them for getting reimbursed and then kind of hiding it, not very good and then imaging I won't go into any details but there are lots of papers on imaging for various reasons you use imaging for planning use imaging for guiding the applications like we did ultrasound earlier and then you define the final treatment plan using your images and then finally you can do some quality assurance using the imaging system that you have so the general flow of a treatment is you prepare the patient, if the patient needs anesthesia you give them anesthesia you do some QA on the equipment make sure it's working right and then you apply it with or without image guidance you might be localizing while you're doing it it might be foroscopy, it might be ultrasound for instance, some people now have CT scans when they can do it while actively while the patient is being treated and then define the target and the organs at risk with the imaging system do your planning, validate the plan, make sure it's what you intended to use and then give the treatment and then document everything so let me summarize quickly so that you can get on with your talk about how to avoid errors classical systems are relatively little used today except maybe the digestive system for cervix cancer computerized planning is pretty much taken over you buy a high dose rate unit you buy the computerized planning system with it for instance and then you need a really good QA program for the individual patient and for all the patients so that's got to be done regularly by the physicist and we have daily checks, monthly checks checks per patient, annual checks on the plans and this is all published by Astro and published by the AAPM


Hey guys, welcome back to Come Again. I got your tour review this week. It is the 1990s Playmates Dick Tracy based on the 1990 film. These figures were really cool. They're very unique in the fact that the line concentrated more on the villains than they did the actual heroes. In fact, out of the 14 figures in the line, we only got two good guys in the entire line. That being Dick Tracy and Sam. Gotcha. In this line, we actually have 14 figures. Now you'll notice on the table, I'll give you a second to count, there's only 13 here. I consider this the complete set for one simple reason. The blank was never produced here in the United States. Produced but not in the States. This was a Canada exclusive action figure. Reason being is Walt Disney did not want the surprise of the identity of the blank to become known until after the movie came out. The blank, which is the only figure in the line that had any sort of action feature, is mass came out to refill the bad guy. When the figures didn't sell well, they decided to put out where they had, and the blank went to Canada as opposed to spreading it out. This line being involved with playmates, you'll notice some interesting and very similar features. First off, let's go over articulation. Articulation is very basic. Head moves right to left, arms up and down, and the legs move out. You'll notice the short stock you build on these figures are very reminiscent of another playmate's toy line, Teenage Mutant Ninja Turtles. Now these figures actually, if you wanted to do so, you can actually have these as the human bad guys for the Ninja Turtles, which they did fight later on in the ITV series, and it would work perfectly.  They also each had unique belts, like belts full of bullets. We had holsters for their guns. The line also featured two vehicles, one for the good side, one for the bad side. I don't currently own them, but I am looking for that.  The main villain, Big Boy, had his escaping car. So that being said, let's go over some packaging. Okay, as you'll notice here, or not, because the camera is, I got it. So we have, the packaging was pretty cool with the artwork here. We had the Dick Tracy logo here, coppers and gangsters, which again, as I noted, there were only two actual coppers in the line. Of course, our hero is highlighted here on the side with the name of the character on the front, and of course, the figure inside with the billister. Turn it over. We've got a little paragraph here of Dick Tracy, and of course, what was really cool about these is a little comic strip that kind of highlighted the story with the action figure. We've got a most wanted cut out, and of course, all the action figures that were currently in the line. Let's talk a little bit about detail on the figure. The details here, these did have some very unique details. You got the little strap here highlighted as fast. We got Dick Tracy's badge. We got handcuffs. The only thing they even have is signature wristwatch. Now, the only thing that really upset me about this action figure is the one main thing that the character was known for, his big yellow trench coat. Even something he wore in the movie, the figure did not come with a trench coat. Now, I'm not sure why they did it that way. It was just cost-cutter, and perhaps maybe they were playing on another version of the figure in a second series, which would have been nice to see. And you know, John, if you notice, a lot of these figures actually do look like the actors who portrayed them, whereas Dick Tracy, it doesn't really resemble Warren Beatty. No. I mean, this one was Dustin Hoffman. We've got any big boy there. We got Robert De Niro. I believe we got Robert De Niro. And those that they couldn't get the likeness rights to is also okay, because look at that. He looks like he came straight out of the comic strip. So, all in all, pretty cool. I'm a huge Dick Tracy fan. I've got not just the action figures. I carry them around in my Dick Tracy lunchbox here. And if you notice, if I could find, if I could find it, I found it one time on eBay, but I didn't have the money to grab it. There is a carrying case for this that's also served as a play set. So, I'd like to be able to find that. And as you notice on all the packaging, there is a little calling Dick Tracy. On this one, it's the influences hypnotizing and armored car driver. The Tramp is stinky. And this is something that, again, comes straight out of the comic strip because influence was known for his hypnotic powers. What could they get with the fingerprint? To my knowledge, there was nothing. They didn't have any type of, like the turtles, you were able to save the save points. Usually that was G.I. Joe as well. To my knowledge, nothing. I think they had something planned for second series. Which, yeah, all 14, 13, whatever, figures were all part of the first run. I had never heard anything about a second run. I think it would have been nice if we got, say, Tess Truhar and Junior. That would have been nice to get some more good guy figures in there. They did, however, have, maybe you could get the watch. I have the watch. I don't have the band anymore, but I do have the watch. I do remember the watch was the coolest thing. They even came out with Dick Tracy lottery tickets at the time. It was a digital watch. And at the bottom, it had a speaker. When you push the button, it glue, it lit up. So still have that. I think I might have had the watch at one time. It was a birthday present. It was a birthday present. I got that. I also have some cards from like the 1930s or was it was a card game? I got an official book, the manuals there. So these figures go pretty cheap online, actually. Unless you're interested in trying to find the blank, the blank is currently available on eBay for about $1,000, $2,000. I also found all 14 figures online for around $300 to $400 because the blank was in it, loose. But the blank alone goes anywhere from about five to a grand, usually, because it is such a rare figure. It is one of the rarest action figures, not just in the line Dick Tracy line, but period. But yeah, these are pretty, pretty easy to find. I managed to get these completed earlier than the year. I don't only a few of them, I actually got the weapons too. I didn't really care about the completion. I just wanted the figures. I think I get the weapons later. Looking back, I kind of wish I would have had the weapons because some of them came with dynamite, some of them came with cement shoes, which is kind of funny. No one came up with bags of money, so that's something I might be looking forward to. In fact, it was Mumbles who got the cement shoes, right? No, Lipsmanals actually got them. Because in the movie, they actually poured cement on them to kill them. Right. Mumbles was the one who got arrested by Dick Tracy and got put in front of the light. Got in front of the light and he slowed down the tape to where he said, Big Boy did it. Big Boy did it. So it was a surprise cameo too by Dustin Hoffman. The movie was a huge hit in 1990, which they wanted to continue, obviously the blockbuster, because the year before was Batman. And Dustin Hoffman went on to star in Hook? Hook, another Disney film. So those are some action figures I used to have. I wish I still had. I do review on those too. They were horrible. They really were. I only had two of them. I had Peter Pan, flying Peter Pan. I had Captain Hook with a Swiss Army Hook. I had Peter Pan. I had both hooks. I had Rufio and I had Ace. I couldn't find Rufio. In the second line, I didn't have any of the vehicles. Some other things I'd like to get a hold of are some Robin Hood men, Prince of Thieves figures, because mostly I wanted their tree for because you know what that was. That was the Ewok Village. Really? It was just repackaged. It was a repackaged Ewok Village is all that was. I did not know that. Yeah. And I think that's actually cheaper to get than the actual Ewok Village. But this race, if you're interested, like I said, the 13 figures released in the stage are fairly cheap. You can get them anywhere between literally like two to $15. While you were talking about these, I was actually going around looking to see if you had any of the Ninja Turtle toys here, because usually you do. I was going to bring one over and actually compare. Yeah. Yeah. Unfortunately, I have nothing else to compare these figures to. But like I said, you can tell and you can tell that these are the same sculpt. The arms are the same sculpt. Some of the shoes are the same just repainted. And of course, you know, the main buck here, the main body is, you know, not the same, but the arms and the hands, the exception of Dick Tracy's watch, they're all molded in the same, same shape. They're all have that trigger finger here and they have one where they can hold, like I say, a club or something like that. But there you go.  I was actually one of the few kids in my class when the movie came out who already knew who Dick Tracy was. There you go. Side note on Dick Tracy, just recently within the last few years, five or 10 years, teamed up for the first time with Daddy Warbucks from Annie to find Annie, who in her last comic strip, having kidnapped. And Daddy Warbucks hired Dick Tracy to find her. Nice. So.  And to my knowledge, that might have been the first comic strip crossover, which would have been cool to see Garfield Heathcliff crossover, but to have Annie and Dick Tracy, and to finally confirm that those two are in the same universe is kind of cool. Yeah. All right, we'll be back guys, where we'll talk about Dr. Who, the return of Dr. Fantasmo. That'd be me. I'm Dr. Fantasmo. He's gonna talk about me. Stay tuned. Hey guys, if you like this video, make sure you hit that like button, maybe put a comment below and hit that subscribe button. And be sure to head on over to our Facebook page. Links are in the description below.


Thank you. You had talked about working on your release point a lot. Did you feel like that improved this evening? I felt like it was a lot better today for sure. I Was more into the moment, you know, I was I was delivering the ball pretty good. I thought I threw really good pictures today My father was good Splater was was really good to today. He said he considered sending you out there for one more How did you feel physically? Did you feel like you had more left in the tank? I felt I felt pretty good, you know And I think I'm gonna pitch count, you know, just cuz like I haven't really pitched a lot And but like I felt I felt pretty good. I'm just good. So we made us all the matters right now You've mentioned the other day that you were excited to pitch in this rivalry Did the atmosphere to the environment live up to to what you thought it would? I definitely feel the energy for sure It was it was pretty nice to be out there and Pitch, you know, the crowd was was really good. It was amazing. So I was I was really looking forward to that After the start in St. Louis, you told us that you're disappointed because you didn't show your new teammates who you are Did you come closer to doing that tonight? I'm getting there. I think I can be much better than that for sure but we got a win we got a great win tonight and Just keep celebrating with the boys pitch wise. What were you happiest with today? To be honest, I was happy with all my pitches. I feel like my sinker was good Forcing was theirs later was there. I threw a couple good sliders, too


J thinning off the bat Greg bird. Do you think that that's a grand slam right there? Yes, I did. I was really proud of him He was prepared for the situation that we wanted him in and Get it back right there.  I know you use both Walker and bird as pinch hit options in that inning Did you guys go into today saying that it was a no-day for Stanton or was he available? No, he was available, but we were gonna make sure that it was to either win the game or and we you know Thought the matchup was good for birdie right there. If we would have got to Higgy in the ninth G prior to hit right there, but if you don't mind just talking a little bit into the mic. Thank you Today was a struggle for Lance Lynn. He faced 20 batters 10 of them reached base What's your assessment what you saw from him?  So again You know rough day for him, but you know, we believe in him a lot and he's gonna be a big part of this thing moving forward I know this is not your decision, but Brian Cashman is fond of saying Everyone is constantly evaluated Do you think with Lynn's struggles in his last four the area is over nine that the next time that rotation spot comes Around there'll be some discussion about what you guys have to do I just think what we try to do here is put guys in the best possible, you know Match up and the best possible way to succeed. So when we get to that point, we'll see Dan to the left Going with Tarpley there in the ninth with after you know after the little bit of the rally Was there any discussion with going with you know, someone else in the bullpen? I mean we if we would have got to within you know, two we were talking about going to greener right there But you know with leverage right there and you know We want him to get his feet wet and get out there and to be honest with you I think he gave up, you know four ground balls and an aligned drive So at the end of the day, you know, we we were trying to reset our bullpen a little bit today because we've been riding those guys Pretty hard and partly because we've been winning a lot of games, you know Wally Josh just to clarify on the decision to use bird there and the eighth any Because that would have put that was a go-ahead that bat there was that basically a matchup decision? yes, and I think that there was a little bit of we were trying to give G a day and You know at the end of the if we would have had a matchup that we really really liked for G He probably would have hit there, but we like the matchup there and birdie hit the ball hard Susan Greg has had really no results, but has hit the ball really hard for the blasts released last week How do you keep the confidence up when you don't have the results there? I just think that for him. He's got to keep fighting, you know I mean this is the big leagues and and you know Luke's really been productive and We're gonna try to pick our spots to find areas for both of them And I think that the at-bat quality has been better for birdie and and so I hope he takes that in his encouragement But he's gonna have to fight for it all the way to the left Dave Josh Did you would do is a green up at the one point? It was okay. Was anybody else up at that point? He just him green just just green and tarp Lee and you know down three in the ninth We're not gonna bring in one of our hot leverage guys Julio in the middle. How do you evaluate the Tiberias defense today? I thought it was great Yeah, I mean I think that he's gonna be a huge huge part of what we're gonna do here And I think that you know last yesterday He doesn't touch the ball and we win the game because he's in the game because we can put You know waiter at second and then we can move guys over and GT goes to second makes a great play yesterday So he's he's a big part of this Anyone else Jack Josh you guys have been a dominant team at home this year second best record in the major leagues You finished this homestand three and four what did you think about the way you guys played across the last week? You know, I think it was frustrating because you know we coming in against Detroit You know it's a team that really chases a lot and we had a we had a hard time expanding on them And and if you look at it, they didn't really you know hit a bunch of home runs and stuff But they kind of singled us to death and and we had a hard time as far as getting that But you know it's it's part of the ebbs and flows of the season and we got to get ready for the flight across country and Get ready to go tomorrow Anyone else walley. Yes, Josh just out of curiosity. When did you find out you were managing today? And what was the experience like considering the kind of game it turned out to be yesterday and you know It's really no different. I mean our process, you know stays the same and and so yeah Okay, thank you Josh