Loucas, B. D. and Cornforth, M. N. Complex Chromosome Exchanges Induced by Gamma Rays in Human Lymphocytes: An mFISH Study. Radiat. Res. 155, 660-671 (2001). Combinatorial multi-fluor fluorescence in situ hybridization (mFISH) allows the simultaneous painting of each pair of homologous chromosomes, thereby eliminating many of the difficulties previously associated with the analysis of complex rearrangements. We employed mFISH to visualize exchanges in human lymphocytes and found significant frequencies of these aberrations after gamma-ray doses of 2 and 4 Gy. At 4 Gy, roughly half of the cells contained at least one complex exchange that required anywhere from 3 to 11 initial chromosome breaks. At this dose, more than 40% of gross cytogenetic damage, as measured by the total number of exchange breakpoints, was complex in origin. Both simple and complex exchanges were found to have nonlinear dose responses, although the latter showed significantly more upward curvature. In many cases, it could be deduced that the initial breaks leading to a particular complex exchange were proximate, meaning that the resulting broken chromosome ends all must have been capable of interacting freely during the exchange process. For other complex exchanges, the rearrangement could just as well have resulted from two or more simpler exchanges that occurred sequentially. The results demonstrate the utility of mFISH in visualizing intricacies of the exchange process, but also highlight the various sources of ambiguity concerning cytogenetic analysis that remain despite the power of this approach.