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Sample records for blind patient sight

  1. MicroSight Optics

    ScienceCinema (OSTI)

    None

    2013-05-28

    MicroSight is an innovative gunsight technology that allows a marksman's eye to focus on both the front gunsight and the intended target. The MicroSight improves both firearm safety and performance by imaging two objects at different focal distances. The MicroSight was developed at Idaho National Laboratory, and has been licensed by Apollo Optical Systems. You can learn more about INL's research programs at http://www.facebook.com/idahonationallaboratory.

  2. Sighting optics including an optical element having a first focal length and a second focal length and methods for sighting

    DOE Patents [OSTI]

    Crandall, David Lynn

    2011-08-16

    Sighting optics include a front sight and a rear sight positioned in a spaced-apart relation. The rear sight includes an optical element having a first focal length and a second focal length. The first focal length is selected so that it is about equal to a distance separating the optical element and the front sight and the second focal length is selected so that it is about equal to a target distance. The optical element thus brings into simultaneous focus for a user images of the front sight and the target.

  3. Line-of-sight deposition method

    DOE Patents [OSTI]

    Patten, J.W.; McClanahan, E.D.; Bayne, M.A.

    1980-04-16

    A line-of-sight method of depositing a film having substantially 100% of theoretical density on a substrate. A pressure vessel contains a target source having a surface thereof capable of emitting particles therefrom and a substrate with the source surface and the substrate surface positioned such that the source surface is substantially parallel to the direction of the particles impinging upon the substrate surface, the distance between the most remote portion of the substrate surface receiving the particles and the source surface emitting the particles in a direction parallel to the substrate surface being relatively small. The pressure in the vessel is maintained less than about 5 microns to prevent scattering and permit line-of-sight deposition. By this method the angles of incidence of the particles impinging upon the substrate surface are in the range of from about 45/sup 0/ to 90/sup 0/ even when the target surface area is greatly expanded to increase the deposition rate.

  4. New Hydropower, Hidden in Plain Sight | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Hydropower, Hidden in Plain Sight New Hydropower, Hidden in Plain Sight December 16, 2015 - 10:04am Addthis New Hydropower, Hidden in Plain Sight Timothy J. Welch Hydropower Program Manager, Wind and Water Power Technologies Office What You Need to Know About Section 242 Funding The Energy Department began accepting applications today from hydropower owners and operators that produced hydroelectric power in 2014 from new equipment added to an existing dam or conduit since 2005. Applications for

  5. Clean Energy Investment Center sets sights on ambitious year | Department

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    of Energy Clean Energy Investment Center sets sights on ambitious year Clean Energy Investment Center sets sights on ambitious year January 27, 2016 - 9:42am Addthis Sanjiv Malhotra Sanjiv Malhotra Director, Clean Energy Investment Center In June 2015, the Department of Energy announced it was creating the Clean Energy Investment Center to help achieve the Administration's ambitious Clean Energy Investment Initiative. Now, we are proud to announce that the center is operational and has a

  6. Inexpensive handheld tests for diseases are in sight

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Inexpensive handheld tests for diseases are in sight Inexpensive handheld tests for diseases are in sight Los Alamos scientists are developing a prototype of handheld tests capable of diagnose multiple diseases. April 3, 2012 The technical founders of Mesa Tech International are working to execute the first proof of principle of the "DNThe technical founders of Mesa Tech International are working to execute the first proof of principle of the DNA Dipstick technology that has been licensed

  7. Environmental Management Scientist Sets His Sights on Mars | Department of

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Energy Environmental Management Scientist Sets His Sights on Mars Environmental Management Scientist Sets His Sights on Mars September 4, 2012 - 3:29pm Addthis Curiosity, left, at NASA’s Jet Propulsion Laboratory in Pasadena, California, in late November 2011. Shown here is the flight hardware that was being assembled prior to shipment to Cape Canaveral Air Force Station in Florida for the launch. | Photo Credit Dr. Robert C. Nelson Curiosity, left, at NASA's Jet Propulsion Laboratory

  8. Blind Modal ID

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Research Projects » Blind Modal ID Blind separation of high-resolution vibration modes High-resolution video camera measurement of the structural vibration (the top video) could be separated into individual, monotone, vibration modes, which enable high-resolution visualization and analysis of structural dynamics. Contact Yongchao Yang (832) 335-3003 Email David Mascarenas dmascarenas@lanl.gov (505) 665-0881 Original video = Mode 1 - 6.34 Hz + Mode 2 - 17.96 Hz + Mode 3 - 25.89 Hz (higher

  9. Blind Geothermal System | Open Energy Information

    Open Energy Info (EERE)

    Blind Geothermal System Jump to: navigation, search GEOTHERMAL ENERGYGeothermal Home Print PDF Blind Geothermal System Dictionary.png Blind Geothermal System: An area with a...

  10. Blind shaft development

    SciTech Connect (OSTI)

    Fiscor, S.

    2009-02-15

    The article discusses how Shaft Drillers International (SDI) is breaking new ground in shaft development and ground stabilization. Techniques of blind shaft drilling and raise bore shaft development developed by SDI are briefly explained. An associated company, Coastal Drilling East, deals with all types of ground improvement such as pre-grouting work for shafts, grouting of poor soil and water leaks into the mine. 3 photos.

  11. Sighting optics including an optical element having a first focal length and a second focal length

    DOE Patents [OSTI]

    Crandall, David Lynn (Idaho Falls, ID)

    2011-08-01

    One embodiment of sighting optics according to the teachings provided herein may include a front sight and a rear sight positioned in spaced-apart relation. The rear sight includes an optical element having a first focal length and a second focal length. The first focal length is selected so that it is about equal to a distance separating the optical element and the front sight and the second focal length is selected so that it is about equal to a target distance. The optical element thus brings into simultaneous focus, for a user, images of the front sight and the target.

  12. Testing the Probability of Clear Line of Sight Models with ARM...

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    the Probability of Clear Line of Sight Models with ARM Observations Y. Ma Department of Meteorology University of Maryland College Park, Maryland R. G. Ellingson Department of...

  13. Single line-of-sight dual energy backlighter for mix width experiments

    Office of Scientific and Technical Information (OSTI)

    (Journal Article) | SciTech Connect Single line-of-sight dual energy backlighter for mix width experiments Citation Details In-Document Search Title: Single line-of-sight dual energy backlighter for mix width experiments We present a diagnostic technique used to spatially multiplex two x-ray radiographs of an object onto a detector along a single line-of-sight. This technique uses a thin, <2 μm, cosputtered backlighter target to simultaneously produce both Ni and Zn He{sub α} emission.

  14. A correlation between hard gamma-ray sources and cosmic voids along the line of sight

    SciTech Connect (OSTI)

    Furniss, A.; Sutter, P. M.; Primack, J. R.; Dominguez, A.

    2014-11-25

    We estimate the galaxy density along lines of sight to hard extragalactic gamma-ray sources by correlating source positions on the sky with a void catalog based on the Sloan Digital Sky Survey (SDSS). Extragalactic gamma-ray sources that are detected at very high energy (VHE; E > 100 GeV) or have been highlighted as VHE-emitting candidates in the Fermi Large Area Telescope hard source catalog (together referred to as VHE-like sources) are distributed along underdense lines of sight at the 2.4? level. There is a less suggestive correlation for the Fermi hard source population (1.7?). A correlation between 10-500 GeV flux and underdense fraction along the line of sight for VHE-like and Fermi hard sources is found at 2.4? and 2.6?, calculated from the Pearson correlation coefficients of r = 0.57 and 0.47, respectively. The preference for underdense sight lines is not displayed by gamma-ray emitting galaxies within the second Fermi catalog, containing sources detected above 100 MeV, or the SDSS DR7 quasar catalog. We investigate whether this marginal correlation might be a result of lower extragalactic background light (EBL) photon density within the underdense regions and find that, even in the most extreme case of a entirely underdense sight line, the EBL photon density is only 2% less than the nominal EBL density. Translating this into gamma-ray attenuation along the line of sight for a highly attenuated source with opacity ?(E, z) ~ 5, we estimate that the attentuation of gamma-rays decreases no more than 10%. This decrease, although non-neglible, is unable to account for the apparent hard source correlation with underdense lines of sight.

  15. A correlation between hard gamma-ray sources and cosmic voids along the line of sight

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Furniss, A.; Sutter, P. M.; Primack, J. R.; Dominguez, A.

    2014-11-25

    We estimate the galaxy density along lines of sight to hard extragalactic gamma-ray sources by correlating source positions on the sky with a void catalog based on the Sloan Digital Sky Survey (SDSS). Extragalactic gamma-ray sources that are detected at very high energy (VHE; E > 100 GeV) or have been highlighted as VHE-emitting candidates in the Fermi Large Area Telescope hard source catalog (together referred to as “VHE-like” sources) are distributed along underdense lines of sight at the 2.4σ level. There is a less suggestive correlation for the Fermi hard source population (1.7σ). A correlation between 10-500 GeV fluxmore » and underdense fraction along the line of sight for VHE-like and Fermi hard sources is found at 2.4σ and 2.6σ, calculated from the Pearson correlation coefficients of r = 0.57 and 0.47, respectively. The preference for underdense sight lines is not displayed by gamma-ray emitting galaxies within the second Fermi catalog, containing sources detected above 100 MeV, or the SDSS DR7 quasar catalog. We investigate whether this marginal correlation might be a result of lower extragalactic background light (EBL) photon density within the underdense regions and find that, even in the most extreme case of a entirely underdense sight line, the EBL photon density is only 2% less than the nominal EBL density. Translating this into gamma-ray attenuation along the line of sight for a highly attenuated source with opacity τ(E, z) ~ 5, we estimate that the attentuation of gamma-rays decreases no more than 10%. This decrease, although non-neglible, is unable to account for the apparent hard source correlation with underdense lines of sight.« less

  16. A correlation between hard gamma-ray sources and cosmic voids along the line of sight

    SciTech Connect (OSTI)

    Furniss, A.; Sutter, P. M.; Primack, J. R.; Dominguez, A.

    2014-11-25

    We estimate the galaxy density along lines of sight to hard extragalactic gamma-ray sources by correlating source positions on the sky with a void catalog based on the Sloan Digital Sky Survey (SDSS). Extragalactic gamma-ray sources that are detected at very high energy (VHE; E > 100 GeV) or have been highlighted as VHE-emitting candidates in the Fermi Large Area Telescope hard source catalog (together referred to as VHE-like sources) are distributed along underdense lines of sight at the 2.4#27; level. There is also a less suggestive correlation for the Fermi hard source population (1.7#27;). A correlation between 10-500 GeV flux and underdense fraction along the line of sight for VHE-like and Fermi hard sources is found at 2.4#27; and 2.6#27;, calculated from the Pearson correlation coefficients of r = 0.57 and 0.47, respectively. The preference for underdense sight lines is not displayed by gamma-ray emitting galaxies within the second Fermi catalog, containing sources detected above 100 MeV, or the SDSS DR7 quasar catalog. We investigate whether this marginal correlation might be a result of lower extragalactic background light (EBL) photon density within the underdense regions and find that, even in the most extreme case of a entirely underdense sight line, the EBL photon density is only 2% less than the nominal EBL density. Translating this into gamma-ray attenuation along the line of sight for a highly attenuated source with opacity #28;(E, z) #24; 5, we estimate that the attentuation of gamma-rays decreases no more than 10%. This decrease, although non-neglible, is unable to account for the apparent hard source correlation with underdense lines of sight.

  17. Blind Geothermal System Exploration in Active Volcanic Environments...

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Blind Geothermal System Exploration in Active Volcanic Environments; Multi-phase Geophysical and Geochemical Surveys in Overt & Subtle Volcanic Systems, Hawaii & Maui Blind...

  18. DEFINING THE 'BLIND SPOT' OF HINODE EIS AND XRT TEMPERATURE MEASUREMENTS

    SciTech Connect (OSTI)

    Winebarger, Amy R.; Cirtain, Jonathan; Mulu-Moore, Fana [NASA Marshall Space Flight Center, VP 62, Huntsville, AL 35812 (United States); Warren, Harry P. [Space Science Division, Naval Research Laboratory, Washington, DC 20375 (United States); Schmelz, Joan T. [Physics Department, University of Memphis, Memphis, TN 38152 (United States); Golub, Leon [Harvard-Smithsonian Center for Astrophysics, 60 Garden St., Cambridge, MA 02138 (United States); Kobayashi, Ken, E-mail: amy.r.winebarger@nasa.gov [Center for Space Plasma and Aeronomic Research, 320 Sparkman Dr, Huntsville, AL 35805 (United States)

    2012-02-20

    Observing high-temperature, low emission measure plasma is key to unlocking the coronal heating problem. With current instrumentation, a combination of EUV spectral data from Hinode Extreme-ultraviolet Imaging Spectrometer (EIS; sensitive to temperatures up to 4 MK) and broadband filter data from Hinode X-ray Telescope (XRT; sensitive to higher temperatures) is typically used to diagnose the temperature structure of the observed plasma. In this Letter, we demonstrate that a 'blind spot' exists in temperature-emission measure space for combined Hinode EIS and XRT observations. For a typical active region core with significant emission at 3-4 MK, Hinode EIS and XRT are insensitive to plasma with temperatures greater than {approx}6 MK and emission measures less than {approx}10{sup 27} cm{sup -5}. We then demonstrate that the temperature and emission measure limits of this blind spot depend upon the temperature distribution of the plasma along the line of sight by considering a hypothetical emission measure distribution sharply peaked at 1 MK. For this emission measure distribution, we find that EIS and XRT are insensitive to plasma with emission measures less than {approx}10{sup 26} cm{sup -5}. We suggest that a spatially and spectrally resolved 6-24 Angstrom-Sign spectrum would improve the sensitivity to these high-temperature, low emission measure plasma.

  19. PROBING THE ROLE OF CARBON IN ULTRAVIOLET EXTINCTION ALONG GALACTIC SIGHT LINES

    SciTech Connect (OSTI)

    Parvathi, V. S.; Babu, B. R. S.; Sofia, U. J.; Murthy, J. E-mail: brsbabu@gmail.com E-mail: jmurthy@yahoo.com

    2012-11-20

    We report previously undetermined interstellar gas and dust-phase carbon abundances along 15 Galactic sight lines based on archival data of the strong 1334.5323 A transition observed with the Space Telescope Imaging Spectrograph. These are combined with previously reported carbon measurements along six sight lines to produce a complete sample of interstellar C II measurements determined with the 1334 A transition. Our data set includes a variety of Galactic disk environments characterized by different extinctions and samples paths ranging over three orders of magnitude in average density of hydrogen ((n(H))). Our data support the idea that dust, specifically carbon-based grains, are processed in the neutral interstellar medium. We, however, do not find that the abundance of carbon in dust or the grain-size distribution is related to the strength of the 2175 A bump. This is surprising, given that many current models have polycyclic aromatic hydrocarbons as the bump-producing dust.

  20. Data Association and Bullet Tracking Algorithms for the Fight Sight Experiment

    SciTech Connect (OSTI)

    Breitfeller, E; Roberts, R

    2005-10-07

    Previous LLNL investigators developed a bullet and projectile tracking system over a decade ago. Renewed interest in the technology has spawned research that culminated in a live-fire experiment, called Fight Sight, in September 2005. The experiment was more complex than previous LLNL bullet tracking experiments in that it included multiple shooters with simultaneous fire, new sensor-shooter geometries, large amounts of optical clutter, and greatly increased sensor-shooter distances. This presentation describes the data association and tracking algorithms for the Fight Sight experiment. Image processing applied to the imagery yields a sequence of bullet features which are input to a data association routine. The data association routine matches features with existing tracks, or initializes new tracks as needed. A Kalman filter is used to smooth and extrapolate existing tracks. The Kalman filter is also used to back-track bullets to their point of origin, thereby revealing the location of the shooter. It also provides an error ellipse for each shooter, quantifying the uncertainty of shooter location. In addition to describing the data association and tracking algorithms, several examples from the Fight Sight experiment are also presented.

  1. Multiferroic heroics put instant-on computing in sight > EMC2 News > The

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Energy Materials Center at Cornell EMC2 News Latest News Room-temperature lithium metal battery closer to reality › First self-assembled superconductor structure created › McGovern incubator embraces Embark and Ecolectro › In This Section EMC2 News Archived News Stories Multiferroic heroics put instant-on computing in sight December 18th, 2014 › By Anne Ju John Heron A conceptual illustration of magnetization reversal, given by the compasses, with an electric field (blue) applied

  2. ChemCam laser sets its sights on first martian target

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    First martian target ChemCam laser sets its sights on first martian target The successful capture of ChemCam's first 10 photos sets the stage for the first test bursts of the instrument's rock-zapping laser in the near future. August 17, 2012 Curiosity zaps Mars for vital signs: ChemCam, designed by Lab team, looks for elements such as carbon, nitrogen, and oxygen, all of which are crucial for life. Curiosity zaps Mars for vital signs: ChemCam, designed by Lab team, looks for elements such as

  3. Reflective insulating blinds for windows and the like

    DOE Patents [OSTI]

    Barnes, Paul R. (Lenoir City, TN); Shapira, Hanna B. (Oak Ridge, TN)

    1981-01-01

    Energy-conserving window blinds are provided. The blinds are fabricated from coupled and adjustable slats, each slat having an insulation layer and a reflective surface to face outwardly when the blinds are closed. A range of desired light and air transmission may be selected with the reflective surfaces of the slats adapted to direct sunlight upward toward the ceiling when the blinds are open. When the blinds are closed, the insulation of the slats reduces the heat loss or gain produced by the windows. If desired, the reflective surfaces of the slats may be concave. The edges of the slats are designed to seal against adjacent slats when the blinds are closed to ensure minimum air flow between slats.

  4. PARENT Quick Blind Round-Robin Test Report

    SciTech Connect (OSTI)

    Braatz, Brett G.; Heasler, Patrick G.; Meyer, Ryan M.

    2014-09-30

    The U.S. Nuclear Regulatory Commission has established the Program to Assess the Reliability of Emerging Nondestructive Techniques (PARENT) whose goal is to investigate the effectiveness of current and novel nondestructive examination procedures and techniques to find flaws in nickel-alloy welds and base materials. This is to be done by conducting a series of open and blind international round-robin tests on a set of piping components that include large-bore dissimilar metal welds, small-bore dissimilar metal welds, and bottom-mounted instrumentation penetration welds. The blind testing is being conducted in two segments, one is called Quick-Blind and the other is called Blind. The Quick-Blind testing and destructive analysis of the test blocks has been completed. This report describes the four Quick-Blind test blocks used, summarizes their destructive analysis, gives an overview of the nondestructive evaluation (NDE) techniques applied, provides an analysis inspection data, and presents the conclusions drawn.

  5. Blind Geothermal System Exploration in Active Volcanic Environments...

    Open Energy Info (EERE)

    Project Jump to: navigation, search Last modified on July 22, 2011. Project Title Blind Geothermal System Exploration in Active Volcanic Environments; Multi-phase Geophysical...

  6. Identification of a New Blind Geothermal System with Hyperspectral...

    Open Energy Info (EERE)

    a New Blind Geothermal System with Hyperspectral Remote Sensing and Shallow Temperature Measurements at Columbus Salt Marsh, Esmeralda County, Nevada Jump to: navigation, search...

  7. Blind Geothermal System Exploration in Active Volcanic Environments;

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Multi-phase Geophysical and Geochemical Surveys in Overt & Subtle Volcanic Systems, Hawaii & Maui | Department of Energy Blind Geothermal System Exploration in Active Volcanic Environments; Multi-phase Geophysical and Geochemical Surveys in Overt & Subtle Volcanic Systems, Hawaii & Maui Blind Geothermal System Exploration in Active Volcanic Environments; Multi-phase Geophysical and Geochemical Surveys in Overt & Subtle Volcanic Systems, Hawaii & Maui DOE Geothermal

  8. Three Blind Men and the Elephant

    SciTech Connect (OSTI)

    Long, J S

    2007-02-13

    Just like the blind men in the popular story of perceiving the elephant, the three major constituencies participating in the energy debate have greatly different perceptions of the problem. The constituency that is worried about climate change believes the energy problem is caused by profligate use of fossil fuel that has dramatically changed our atmosphere. The energy security group sees dangerous reliance on foreign sources of oil increasingly held by countries hostile to the US. The economic vitality group sees high energy prices and their effect on the economy and our life-style. Just like the blind men, each of the three constituencies perceives a different problem. And just as with the blind men, while each perspective is right as a piece of the elephant, it takes all the perspectives together to actually solve the problem. Environmentalists focus on solutions responding to the scientific consensus that greenhouse gases are creating rapid climate change. The tipping point has come: it is now a consensus position among scientists the global warming is being affected by anthropogenic activity to 90% certainty according to the last IPCC report. Although they still struggle with the prediction of how much global temperatures will rise if we do nothing--is it 5 deg or 10 under BAU? This group believes that we cannot afford to take a chance because we get only one chance. We can not afford to do this kind of experiment with the Earth. Any choice which decreases our CO{sub 2} footprint is favored, even if it means a decrease in standard of living. The energy security constituency sees the geo-politics of oil becoming increasingly dire. They look at oil money being used to fund anti-American activities of groups such as the Wahabis in Saudi Arabia, Hezbollah in Lebanon and the infamous Al Qaeda. They quip that the Iraq war is the first war where we are paying for both sides. They note Iran and the Shia throughout the Middle East seeing the possibility of controlling 2/3 of the world's oil. They see oil and gas being used by Russia to exert political power using the gas tap and Hugo Chavez in Venezuela clearly anti-American and now a virtual dictator who controls 15% of our oil imports. Conflicts in Nigeria over oil wealth and corruption affected our oil supply. Countries such as China are at best unwilling to join political action against countries such as Sudan that supply them oil, and at worst, selling them arms in order to cement their relationships with respect to importing oil. This security constituency favors ending our vulnerability by ending our ''addiction to foreign oil''. This group thinks that there is no domestic source of energy that is bad. They will be happy to see our corn turned into ethanol; our coal turned into liquid fuel for transportation. No matter that the price of tortillas doubles in Mexico, we expand corn farming at the expense of the environment, our tanks and pipes in gas stations corrode and leak, or we make liquid fuel from coal, thus increasing the carbon footprint by 30% per unit of energy. The economic vitality group sees increasing international demand for oil occurring simultaneously with a peaking supply of light sweet crude. They see an oil market where higher prices drive more production of oil which is heavier and more sour (supply follows demand). However, fast growth in world-wide demand increases even faster and prices will go up. For example, China adds 10,000 cars per month, and there is an uncanny correlation between the price of oil and the amount of oil imported by China. The security contingent also worries about reliability of supply as affected by pipeline leaks in Alaska or hurricanes or potential terrorism. This constituency thinks the problem is one of capacity and favors solutions that will increase oil production, reservoirs, pipelines and refineries. They believe that the energy system will be determined by the market and want solutions that favor investment in capacity. What the environmentalists don't seem to get is climate change by itself will fail to gather b

  9. Simultaneous neutron and x-ray imaging of inertial confinement fusion experiments along a single line of sight at Omega

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Danly, C. R.; Day, T. H.; Fittinghoff, D. N.; Herrmann, H.; Izumi, N.; Kim, Y. H.; Martinez, J. I.; Merrill, F. E.; Schmidt, D. W.; Simpson, R. A.; et al

    2015-04-16

    Neutron and x-ray imaging provide critical information about the geometry and hydrodynamics of inertial confinement fusion implosions. However, existing diagnostics at Omega and the National Ignition Facility (NIF) cannot produce images in both neutrons and x-rays along the same line of sight. This leads to difficulty comparing these images, which capture different parts of the plasma geometry, for the asymmetric implosions seen in present experiments. Further, even when opposing port neutron and x-ray images are available, they use different detectors and cannot provide positive information about the relative positions of the neutron and x-ray sources. A technique has been demonstratedmore » on implosions at Omega that can capture x-ray images along the same line of sight as the neutron images. Thus, the technique is described, and data from a set of experiments are presented, along with a discussion of techniques for coregistration of the various images. It is concluded that the technique is viable and could provide valuable information if implemented on NIF in the near future.« less

  10. Alabama Institute for Deaf and Blind Biodiesel Project Green

    SciTech Connect (OSTI)

    Edmiston, Jessica L

    2012-09-28

    Through extensive collaboration, Alabama Institute for Deaf and Blind (AIDB) is Alabama's first educational entity to initiate a biodiesel public education, student training and production program, Project Green. With state and national replication potential, Project Green benefits local businesses and city infrastructures within a 120-mile radius; provides alternative education to Alabama school systems and to schools for the deaf and blind in Appalachian States; trains students with sensory and/or multiple disabilities in the acquisition and production of biodiesel; and educates the external public on alternative fuels benefits.

  11. Gamma-ray blind beta particle probe

    DOE Patents [OSTI]

    Weisenberger, Andrew G. (Grafton, VA)

    2001-01-01

    An intra-operative beta particle probe is provided by placing a suitable photomultiplier tube (PMT), micro channel plate (MCP) or other electron multiplier device within a vacuum housing equipped with: 1) an appropriate beta particle permeable window; and 2) electron detection circuitry. Beta particles emitted in the immediate vicinity of the probe window will be received by the electron multiplier device and amplified to produce a detectable signal. Such a device is useful as a gamma insensitive, intra-operative, beta particle probe in surgeries where the patient has been injected with a beta emitting radiopharmaceutical. The method of use of such a device is also described, as is a position sensitive such device.

  12. SEP Success Story: Alabama Institute for Deaf and Blind to Launch Lighting

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Project | Department of Energy Alabama Institute for Deaf and Blind to Launch Lighting Project SEP Success Story: Alabama Institute for Deaf and Blind to Launch Lighting Project August 20, 2010 - 9:44am Addthis The Alabama Institute for Deaf and Blind is replacing almost 2,900 lights in 19 buildings across its campuses.| Photo courtesy of Alabama Institute for Deaf and Blind The Alabama Institute for Deaf and Blind is replacing almost 2,900 lights in 19 buildings across its campuses.| Photo

  13. A HUBBLE SPACE TELESCOPE/COSMIC ORIGINS SPECTROGRAPH SEARCH FOR WARM-HOT BARYONS IN THE Mrk 421 SIGHT LINE

    SciTech Connect (OSTI)

    Danforth, Charles W.; Stocke, John T.; Keeney, Brian A.; Penton, Steven V.; Shull, J. Michael; Yao Yangsen; Green, James C., E-mail: danforth@colorado.edu [CASA, Department of Astrophysical and Planetary Sciences, University of Colorado, 389-UCB, Boulder, CO 80309 (United States)

    2011-12-10

    Thermally broadened Ly{alpha} absorbers (BLAs) offer an alternate method to using highly ionized metal absorbers (O VI, O VII, etc.) to probe the warm-hot intergalactic medium (WHIM, T = 10{sup 5}-10{sup 7} K). Until now, WHIM surveys via BLAs have been no less ambiguous than those via far-UV and X-ray metal-ion probes. Detecting these weak, broad features requires background sources with a well-characterized far-UV continuum and data of very high quality. However, a recent Hubble Space Telescope/Cosmic Origins Spectrograph (COS) observation of the z = 0.03 blazar Mrk 421 allows us to perform a metal-independent search for WHIM gas with unprecedented precision. The data have high signal-to-noise ratio (S/N Almost-Equal-To 50 per {approx}20 km s{sup -1} resolution element) and the smooth, power-law blazar spectrum allows a fully parametric continuum model. We analyze the Mrk 421 sight line for BLA absorbers, particularly for counterparts to the proposed O VII WHIM systems reported by Nicastro et al. based on Chandra/Low Energy Transmission Grating observations. We derive the Ly{alpha} profiles predicted by the X-ray observations. The S/N of the COS data is high (S/N Almost-Equal-To 25 pixel{sup -1}), but much higher S/N can be obtained by binning the data to widths characteristic of the expected BLA profiles. With this technique, we are sensitive to WHIM gas over a large (N{sub H}, T) parameter range in the Mrk 421 sight line. We rule out the claimed Nicastro et al. O VII detections at their nominal temperatures (T {approx} 1-2 Multiplication-Sign 10{sup 6} K) and metallicities (Z = 0.1 Z{sub Sun }) at {approx}> 2{sigma} level. However, WHIM gas at higher temperatures and/or higher metallicities is consistent with our COS non-detections.

  14. Alabama Institute for Deaf and Blind to Launch Lighting Project

    Broader source: Energy.gov [DOE]

    For over a century, students at the Alabama Institute for Deaf and Blind (AIDB) have proudly displayed the school colors—blue and red—in the hallways, classrooms and dorm rooms. But this school year, they’re “Going Green.” The 152-year-old institute is replacing almost 2,900 lights in 19 buildings across its Talladega, Ala., campuses with energy-efficient fixtures, an upgrade expected to save the institute over $20,000 a year on utility bills.

  15. Concentric wrench for blind access opening in a turbine

    DOE Patents [OSTI]

    Laurer, Kurt Neal; Drlik, Gary Joseph; Gibler, Edward Eugene

    2001-01-01

    The concentric wrench includes an outer tube having flats at one end and a gripping surface at an opposite end. An inner tube has interior flats at one end and a gripping surface at its opposite end. With the inner and outer tubes disposed about a pressure transmitting conduit, the tubes may be inserted into a blind access opening in the outer turbine casing to engage the flats of the tubes against hex nuts of an internal fitting. By relatively rotating the tubes using the externally exposed gripping surfaces, the threaded connection between the parts of the fitting bearing the respective hex nuts can be tightened or loosened.

  16. Novel Coupled Thermochronometric and Geochemical Investigation of Blind Geothermal Resources in Fault-Controlled Dilational Corners

    Broader source: Energy.gov [DOE]

    Novel Coupled Thermochronometric and Geochemical Investigation of Blind Geothermal Resources in Fault-Controlled Dilational Corners presentation at the April 2013 peer review meeting held in Denver, Colorado.

  17. SEP Success Story: Alabama Institute for Deaf and Blind to Launch...

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Alabama Institute for Deaf and Blind to Launch Lighting Project SEP Success Story: Alabama ... SEP Success Story: Local Program Helps Alabama Manufacturers Add Jobs, Reduce Waste and ...

  18. HST/COS OBSERVATIONS OF GALACTIC HIGH-VELOCITY CLOUDS: FOUR ACTIVE GALACTIC NUCLEUS SIGHT LINES THROUGH COMPLEX C

    SciTech Connect (OSTI)

    Shull, J. Michael; Stevans, Matthew; Danforth, Charles; Penton, Steven V. [CASA, Department of Astrophysical and Planetary Sciences, University of Colorado, 389-UCB, Boulder, CO 80309 (United States); Lockman, Felix J. [National Radio Astronomy Observatory, Green Bank, WV 29444 (United States); Arav, Nahum, E-mail: michael.shull@colorado.edu, E-mail: matthew.stevans@colorado.edu, E-mail: charles.danforth@colorado.edu, E-mail: steven.penton@colorado.edu, E-mail: jlockman@nrao.edu, E-mail: arav@vt.edu [Department of Physics, Virginia Tech, Blacksburg, VA 24061 (United States)

    2011-10-01

    We report ultraviolet spectra of Galactic high-velocity clouds (HVCs) in Complex C, taken by the Cosmic Origins Spectrograph (COS) on the Hubble Space Telescope (HST), together with new 21 cm spectra from the Green Bank Telescope. The wide spectral coverage and higher signal-to-noise ratio, compared to previous HST spectra, provide better velocity definition of the HVC absorption, additional ionization species (including high ions), and improved abundances in this halo gas. Complex C has a metallicity of 10%-30% solar and a wide range of ions, suggesting dynamical and thermal interactions with hot gas in the Galactic halo. Spectra in the COS medium-resolution G130M (1133-1468 A) and G160M (1383-1796 A) gratings detect ultraviolet absorption lines from eight elements in low-ionization states (O I, N I, C II, S II, Si II, Al II, Fe II, P II) and three elements in intermediate- and high-ionization states (Si III, Si IV, C IV, N V). Our four active galactic nucleus sight lines toward Mrk 817, Mrk 290, Mrk 876, and PG 1259+593 have high-velocity H I and O VI column densities, log N{sub Hi}= 19.39-20.05 and log N{sub Ovi}= 13.58-14.10, with substantial amounts of kinematically associated photoionized gas. The high-ion abundance ratios are consistent with cooling interfaces between photoionized and collisionally ionized gas: N(C IV)/N(O VI) {approx} 0.3-0.5, N(Si IV)/N(O VI) {approx} 0.05-0.11, N(N V)/N(O VI) {approx} 0.07-0.13, and N(Si IV)/N(Si III) {approx}0.2.

  19. A FOURTH H I 21 cm ABSORPTION SYSTEM IN THE SIGHT LINE OF MG J0414+0534: A RECORD FOR INTERVENING ABSORBERS

    SciTech Connect (OSTI)

    Tanna, A.; Webb, J. K.; Curran, S. J.; Whiting, M. T.; Bignell, C.

    2013-08-01

    We report the detection of a strong H I 21 cm absorption system at z = 0.5344, as well as a candidate system at z = 0.3389, in the sight line toward the z = 2.64 quasar MG J0414+0534. This, in addition to the absorption at the host redshift and the other two intervening absorbers, takes the total to four (possibly five). The previous maximum number of 21 cm absorbers detected along a single sight line is two and so we suspect that this number of gas-rich absorbers is in some way related to the very red color of the background source. Despite this, no molecular gas (through OH absorption) has yet been detected at any of the 21 cm redshifts, although, from the population of 21 cm absorbers as a whole, there is evidence for a weak correlation between the atomic line strength and the optical-near-infrared color. In either case, the fact that so many gas-rich galaxies (likely to be damped Ly{alpha} absorption systems) have been found along a single sight line toward a highly obscured source may have far-reaching implications for the population of faint galaxies not detected in optical surveys, a possibility which could be addressed through future wide-field absorption line surveys with the Square Kilometer Array.

  20. A New Gold Pan For The West- Discovering Blind Geothermal Systems...

    Open Energy Info (EERE)

    Gold Pan For The West- Discovering Blind Geothermal Systems With Shallow Temperature Surveys Jump to: navigation, search OpenEI Reference LibraryAdd to library Conference Paper: A...

  1. The DAFT/FADA survey. I.Photometric redshifts along lines of sight to clusters in the z=[0.4,0.9] interval

    SciTech Connect (OSTI)

    Guennou, L.; Adami, C.; Ulmer, M.P.; LeBrun, V.; Durret, F.; Johnston, D.; Ilbert, O.; Clowe, D.; Gavazzi, R.; Murphy, K.; Schrabback, T.; /Leiden Observ. /Fermilab

    2010-08-01

    As a contribution to the understanding of the dark energy concept, the Dark energy American French Team (DAFT, in French FADA) has started a large project to characterize statistically high redshift galaxy clusters, infer cosmological constraints from Weak Lensing Tomography, and understand biases relevant for constraining dark energy and cluster physics in future cluster and cosmological experiments. Aims. The purpose of this paper is to establish the basis of reference for the photo-z determination used in all our subsequent papers, including weak lensing tomography studies. This project is based on a sample of 91 high redshift (z {ge} 0.4), massive ({approx}> 3 x 10{sup 14} M{sub {circle_dot}}) clusters with existing HST imaging, for which we are presently performing complementary multi-wavelength imaging. This allows us in particular to estimate spectral types and determine accurate photometric redshifts for galaxies along the lines of sight to the first ten clusters for which all the required data are available down to a limit of I{sub AB} = 24./24.5 with the LePhare software. The accuracy in redshift is of the order of 0.05 for the range 0.2 {le} z {le} 1.5. We verified that the technique applied to obtain photometric redshifts works well by comparing our results to with previous works. In clusters, photo-z accuracy is degraded for bright absolute magnitudes and for the latest and earliest type galaxies. The photo-z accuracy also only slightly varies as a function of the spectral type for field galaxies. As a consequence, we find evidence for an environmental dependence of the photo-z accuracy, interpreted as the standard used Spectral Energy Distributions being not very well suited to cluster galaxies. Finally, we modeled the LCDCS 0504 mass with the strong arcs detected along this line of sight.

  2. The 'X-Prize' Approach: Double-blind Assessment of Ductile Tearing

    Office of Scientific and Technical Information (OSTI)

    Prediction Methods. (Conference) | SciTech Connect Conference: The 'X-Prize' Approach: Double-blind Assessment of Ductile Tearing Prediction Methods. Citation Details In-Document Search Title: The 'X-Prize' Approach: Double-blind Assessment of Ductile Tearing Prediction Methods. Abstract not provided. Authors: Boyce, Brad Lee Publication Date: 2011-09-01 OSTI Identifier: 1119710 Report Number(s): SAND2011-6459C 481909 DOE Contract Number: AC04-94AL85000 Resource Type: Conference Resource

  3. The 'X-Prize' approach : double-blind evaluation of ductile tearing

    Office of Scientific and Technical Information (OSTI)

    prediction methods. (Conference) | SciTech Connect The 'X-Prize' approach : double-blind evaluation of ductile tearing prediction methods. Citation Details In-Document Search Title: The 'X-Prize' approach : double-blind evaluation of ductile tearing prediction methods. No abstract prepared. Authors: Boyce, Brad Lee Publication Date: 2010-07-01 OSTI Identifier: 1021081 Report Number(s): SAND2010-4353C TRN: US201116%%994 DOE Contract Number: AC04-94AL85000 Resource Type: Conference Resource

  4. Sight Version 0.1

    Energy Science and Technology Software Center (OSTI)

    2014-09-01

    Enables applications to emit log information into an output file and produced a structured visual summary of the log data, as well as various statistical analyses of it. This makes it easier for developers to understand the behavior of their applications.

  5. Simulations of cm-wavelength Sunyaev-Zel'dovich galaxy cluster and point source blind sky surveys and predictions for the RT32/OCRA-f and the Hevelius 100-m radio telescope

    SciTech Connect (OSTI)

    Lew, Bartosz; Kus, Andrzej; Birkinshaw, Mark; Wilkinson, Peter E-mail: Mark.Birkinshaw@bristol.ac.uk E-mail: ajk@astro.uni.torun.pl

    2015-02-01

    We investigate the effectiveness of blind surveys for radio sources and galaxy cluster thermal Sunyaev-Zel'dovich effects (TSZEs) using the four-pair, beam-switched OCRA-f radiometer on the 32-m radio telescope in Poland. The predictions are based on mock maps that include the cosmic microwave background, TSZEs from hydrodynamical simulations of large scale structure formation, and unresolved radio sources. We validate the mock maps against observational data, and examine the limitations imposed by simplified physics. We estimate the effects of source clustering towards galaxy clusters from NVSS source counts around Planck-selected cluster candidates, and include appropriate correlations in our mock maps. The study allows us to quantify the effects of halo line-of-sight alignments, source confusion, and telescope angular resolution on the detections of TSZEs. We perform a similar analysis for the planned 100-m Hevelius radio telescope (RTH) equipped with a 49-beam radio camera and operating at frequencies up to 22 GHz.We find that RT32/OCRA-f will be suitable for small-field blind radio source surveys, and will detect 33{sup +17}{sub ?11} new radio sources brighter than 0.87mJy at 30 GHz in a 1deg{sup 2} field at >5? CL during a one-year, non-continuous, observing campaign, taking account of Polish weather conditions. It is unlikely that any galaxy cluster will be detected at 3? CL in such a survey. A 60-deg{sup 2} survey, with field coverage of 2{sup 2} beams per pixel, at 15 GHz with the RTH, would find <1.5 galaxy clusters per year brighter than 60 ?Jy (at 3? CL), and would detect about 3.4נ10{sup 4} point sources brighter than 1mJy at 5? CL, with confusion causing flux density errors ?<2%(20%) in 68% (95%) of the detected sources.A primary goal of the planned RTH will be a wide-area (? sr) radio source survey at 15 GHz. This survey will detect nearly 3נ10{sup 5} radio sources at 5? CL down to 1.3 mJy, and tens of galaxy clusters, in one year of operation with typical weather conditions. Confusion will affect the measured flux densities by ?<1.5%(16%) for 68% (95%) of the point sources. We also gauge the impact of the RTH by investigating its performance if equipped with the existing RT32 receivers, and the performance of the RT32 equipped with the RTH radio camera.

  6. Preventing Blindness: A Vision of Technology | U.S. DOE Office of Science

    Office of Science (SC) Website

    (SC) Preventing Blindness: A Vision of Technology Laboratory Policy (LP) LP Home About Laboratory Appraisal Process Laboratory Planning Process Laboratory Directed Research and Development (LDRD) Frequently Asked Questions Impact Legislative History Program Contacts Management & Operating (M&O) Contracts Technology Transfer Work for Others Contact Information Laboratory Policy U.S. Department of Energy SC-32/Forrestal Building 1000 Independence Ave., SW Washington, DC 20585 P: (202)

  7. Topical Hyaluronic Acid vs. Standard of Care for the Prevention of Radiation Dermatitis After Adjuvant Radiotherapy for Breast Cancer: Single-Blind Randomized Phase III Clinical Trial

    SciTech Connect (OSTI)

    Pinnix, Chelsea; Perkins, George H.; Strom, Eric A.; Tereffe, Welela; Woodward, Wendy; Oh, Julia L.; Arriaga, Lisa; Munsell, Mark F.; Kelly, Patrick; Hoffman, Karen E.; Smith, Benjamin D.; Buchholz, Thomas A.; Yu, T. Kuan

    2012-07-15

    Purpose: To determine the efficacy of an emulsion containing hyaluronic acid to reduce the development of {>=}Grade 2 radiation dermatitis after adjuvant breast radiation compared with best supportive care. Methods and Materials: Women with breast cancer who had undergone lumpectomy and were to receive whole-breast radiotherapy to 50 Gy with a 10- to 16-Gy surgical bed boost were enrolled in a prospective randomized trial to compare the effectiveness of a hyaluronic acid-based gel (RadiaPlex) and a petrolatum-based gel (Aquaphor) for preventing the development of dermatitis. Each patient was randomly assigned to use hyaluronic acid gel on the medial half or the lateral half of the irradiated breast and to use the control gel on the other half. Dermatitis was graded weekly according to the Common Terminology Criteria v3.0 by the treating physician, who was blinded as to which gel was used on which area of the breast. The primary endpoint was development of {>=}Grade 2 dermatitis. Results: The study closed early on the basis of a recommendation from the Data and Safety Monitoring Board after 74 of the planned 92 patients were enrolled. Breast skin treated with the hyaluronic acid gel developed a significantly higher rate of {>=}Grade 2 dermatitis than did skin treated with petrolatum gel: 61.5% (40/65) vs. 47.7% (31/65) (p = 0.027). Only 1ne patient developed Grade 3 dermatitis using either gel. A higher proportion of patients had worse dermatitis in the breast segment treated with hyaluronic acid gel than in that treated with petrolatum gel at the end of radiotherapy (42% vs. 14%, p = 0.003). Conclusion: We found no benefit from the use of a topical hyaluronic acid-based gel for reducing the development of {>=}Grade 2 dermatitis after adjuvant radiotherapy for breast cancer. Additional studies are needed to determine the efficacy of hyaluronic acid-based gel in controlling radiation dermatitis symptoms after they develop.

  8. DISCOVERY OF NINE GAMMA-RAY PULSARS IN FERMI LARGE AREA TELESCOPE DATA USING A NEW BLIND SEARCH METHOD

    SciTech Connect (OSTI)

    Pletsch, H. J.; Allen, B.; Aulbert, C.; Fehrmann, H.; Guillemot, L.; Kramer, M.; Barr, E. D.; Champion, D. J.; Eatough, R. P.; Freire, P. C. C.; Ray, P. S.; Belfiore, A.; Dormody, M.; Camilo, F.; Caraveo, P. A.; Celik, Oe.; Ferrara, E. C.; Hessels, J. W. T.; Keith, M.; Kerr, M. E-mail: guillemo@mpifr-bonn.mpg.de; and others

    2012-01-10

    We report the discovery of nine previously unknown gamma-ray pulsars in a blind search of data from the Fermi Large Area Telescope (LAT). The pulsars were found with a novel hierarchical search method originally developed for detecting continuous gravitational waves from rapidly rotating neutron stars. Designed to find isolated pulsars spinning at up to kHz frequencies, the new method is computationally efficient and incorporates several advances, including a metric-based gridding of the search parameter space (frequency, frequency derivative, and sky location) and the use of photon probability weights. The nine pulsars have spin frequencies between 3 and 12 Hz, and characteristic ages ranging from 17 kyr to 3 Myr. Two of them, PSRs J1803-2149 and J2111+ 4606, are young and energetic Galactic-plane pulsars (spin-down power above 6 Multiplication-Sign 10{sup 35} erg s{sup -1} and ages below 100 kyr). The seven remaining pulsars, PSRs J0106+4855, J0622+3749, J1620-4927, J1746-3239, J2028+3332, J2030+4415, and J2139+4716, are older and less energetic; two of them are located at higher Galactic latitudes (|b| > 10 Degree-Sign ). PSR J0106+4855 has the largest characteristic age (3 Myr) and the smallest surface magnetic field (2 Multiplication-Sign 10{sup 11} G) of all LAT blind-search pulsars. PSR J2139+4716 has the lowest spin-down power (3 Multiplication-Sign 10{sup 33} erg s{sup -1}) among all non-recycled gamma-ray pulsars ever found. Despite extensive multi-frequency observations, only PSR J0106+4855 has detectable pulsations in the radio band. The other eight pulsars belong to the increasing population of radio-quiet gamma-ray pulsars.

  9. Blind Modal ID

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    high-resolution visualization and analysis of structural dynamics. Contact Yongchao Yang (832) 335-3003 Email David Mascarenas dmascarenas@lanl.gov (505) 665-0881 Original...

  10. Spectral restoration in high resolution electron energy loss spectroscopy based on iterative semi-blind Lucy-Richardson algorithm applied to rutile surfaces

    SciTech Connect (OSTI)

    Lazzari, Rmi Li, Jingfeng Jupille, Jacques

    2015-01-15

    A new spectral restoration algorithm of reflection electron energy loss spectra is proposed. It is based on the maximum likelihood principle as implemented in the iterative Lucy-Richardson approach. Resolution is enhanced and point spread function recovered in a semi-blind way by forcing cyclically the zero loss to converge towards a Dirac peak. Synthetic phonon spectra of TiO{sub 2} are used as a test bed to discuss resolution enhancement, convergence benefit, stability towards noise, and apparatus function recovery. Attention is focused on the interplay between spectral restoration and quasi-elastic broadening due to free carriers. A resolution enhancement by a factor up to 6 on the elastic peak width can be obtained on experimental spectra of TiO{sub 2}(110) and helps revealing mixed phonon/plasmon excitations.

  11. Hiding in Plain Sight: Exploiting Broadcast for Practical Host Anonymity

    SciTech Connect (OSTI)

    Shue, Craig A; Gupta, Prof. Minaxi

    2010-01-01

    Users are being tracked on the Internet more than ever before as Web sites and search engines gather pieces of information sufficient to identify and study their behavior. While many existing schemes provide strong anonymity, they are inappropriate when high bandwidth and low latency are required. In this work, we explore an anonymity scheme for end hosts whose performance makes it possible to have it always on. The scheme leverages the natural grouping of hosts in the same subnet and the universally available broadcast primitive to provide anonymity at line speeds. Our scheme is strongly resistant against all active or passive adversaries as long as they are outside the subnet. Even within the subnet, our scheme provides reasonable resistance against adversaries, providing anonymity that is suitable for common Internet applications.

  12. A Randomized Controlled Trial of Lorazepam to Reduce Liver Motion in Patients Receiving Upper Abdominal Radiation Therapy

    SciTech Connect (OSTI)

    Tsang, Derek S.; Voncken, Francine E.M.; Tse, Regina V.; Sykes, Jenna; Wong, Rebecca K.S.; Dinniwell, Rob E.; Kim, John; Ringash, Jolie; Brierley, James D.; Cummings, Bernard J.; Brade, Anthony; Dawson, Laura A.

    2013-12-01

    Purpose: Reduction of respiratory motion is desirable to reduce the volume of normal tissues irradiated, to improve concordance of planned and delivered doses, and to improve image guided radiation therapy (IGRT). We hypothesized that pretreatment lorazepam would lead to a measurable reduction of liver motion. Methods and Materials: Thirty-three patients receiving upper abdominal IGRT were recruited to a double-blinded randomized controlled crossover trial. Patients were randomized to 1 of 2 study arms: arm 1 received lorazepam 2 mg by mouth on day 1, followed by placebo 4 to 8 days later; arm 2 received placebo on day 1, followed by lorazepam 4 to 8 days later. After tablet ingestion and daily radiation therapy, amplitude of liver motion was measured on both study days. The primary outcomes were reduction in craniocaudal (CC) liver motion using 4-dimensional kV cone beam computed tomography (CBCT) and the proportion of patients with liver motion ?5 mm. Secondary endpoints included motion measured with cine magnetic resonance imaging and kV fluoroscopy. Results: Mean relative and absolute reduction in CC amplitude with lorazepam was 21% and 2.5 mm respectively (95% confidence interval [CI] 1.1-3.9, P=.001), as assessed with CBCT. Reduction in CC amplitude to ?5 mm residual liver motion was seen in 13% (95% CI 1%-25%) of patients receiving lorazepam (vs 10% receiving placebo, P=NS); 65% (95% CI 48%-81%) had reduction in residual CC liver motion to ?10 mm (vs 52% with placebo, P=NS). Patients with large respiratory movement and patients who took lorazepam ?60 minutes before imaging had greater reductions in liver CC motion. Mean reductions in liver CC amplitude on magnetic resonance imaging and fluoroscopy were nonsignificant. Conclusions: Lorazepam reduces liver motion in the CC direction; however, average magnitude of reduction is small, and most patients have residual motion >5 mm.

  13. Oral Mucositis Prevention By Low-Level Laser Therapy in Head-and-Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy: A Phase III Randomized Study

    SciTech Connect (OSTI)

    Gouvea de Lima, Aline; Villar, Rosangela Correa; Castro, Gilberto de; Antequera, Reynaldo; Gil, Erlon; Rosalmeida, Mauro Cabral; Federico, Miriam Hatsue Honda; Snitcovsky, Igor Moises Longo

    2012-01-01

    Purpose: Oral mucositis is a major complication of concurrent chemoradiotherapy (CRT) in head-and-neck cancer patients. Low-level laser (LLL) therapy is a promising preventive therapy. We aimed to evaluate the efficacy of LLL therapy to decrease severe oral mucositis and its effect on RT interruptions. Methods and Materials: In the present randomized, double-blind, Phase III study, patients received either gallium-aluminum-arsenide LLL therapy 2.5 J/cm{sup 2} or placebo laser, before each radiation fraction. Eligible patients had to have been diagnosed with squamous cell carcinoma or undifferentiated carcinoma of the oral cavity, pharynx, larynx, or metastases to the neck with an unknown primary site. They were treated with adjuvant or definitive CRT, consisting of conventional RT 60-70 Gy (range, 1.8-2.0 Gy/d, 5 times/wk) and concurrent cisplatin. The primary endpoints were the oral mucositis severity in Weeks 2, 4, and 6 and the number of RT interruptions because of mucositis. The secondary endpoints included patient-reported pain scores. To detect a decrease in the incidence of Grade 3 or 4 oral mucositis from 80% to 50%, we planned to enroll 74 patients. Results: A total of 75 patients were included, and 37 patients received preventive LLL therapy. The mean delivered radiation dose was greater in the patients treated with LLL (69.4 vs. 67.9 Gy, p = .03). During CRT, the number of patients diagnosed with Grade 3 or 4 oral mucositis treated with LLL vs. placebo was 4 vs. 5 (Week 2, p = 1.0), 4 vs. 12 (Week 4, p = .08), and 8 vs. 9 (Week 6, p = 1.0), respectively. More of the patients treated with placebo had RT interruptions because of mucositis (6 vs. 0, p = .02). No difference was detected between the treatment arms in the incidence of severe pain. Conclusions: LLL therapy was not effective in reducing severe oral mucositis, although a marginal benefit could not be excluded. It reduced RT interruptions in these head-and-neck cancer patients, which might translate into improved CRT efficacy.

  14. SU-E-J-261: Statistical Analysis and Chaotic Dynamics of Respiratory Signal of Patients in BodyFix

    SciTech Connect (OSTI)

    Michalski, D; Huq, M; Bednarz, G; Lalonde, R; Yang, Y; Heron, D

    2014-06-01

    Purpose: To quantify respiratory signal of patients in BodyFix undergoing 4DCT scan with and without immobilization cover. Methods: 20 pairs of respiratory tracks recorded with RPM system during 4DCT scan were analyzed. Descriptive statistic was applied to selected parameters of exhale-inhale decomposition. Standardized signals were used with the delay method to build orbits in embedded space. Nonlinear behavior was tested with surrogate data. Sample entropy SE, Lempel-Ziv complexity LZC and the largest Lyapunov exponents LLE were compared. Results: Statistical tests show difference between scans for inspiration time and its variability, which is bigger for scans without cover. The same is for variability of the end of exhalation and inhalation. Other parameters fail to show the difference. For both scans respiratory signals show determinism and nonlinear stationarity. Statistical test on surrogate data reveals their nonlinearity. LLEs show signals chaotic nature and its correlation with breathing period and its embedding delay time. SE, LZC and LLE measure respiratory signal complexity. Nonlinear characteristics do not differ between scans. Conclusion: Contrary to expectation cover applied to patients in BodyFix appears to have limited effect on signal parameters. Analysis based on trajectories of delay vectors shows respiratory system nonlinear character and its sensitive dependence on initial conditions. Reproducibility of respiratory signal can be evaluated with measures of signal complexity and its predictability window. Longer respiratory period is conducive for signal reproducibility as shown by these gauges. Statistical independence of the exhale and inhale times is also supported by the magnitude of LLE. The nonlinear parameters seem more appropriate to gauge respiratory signal complexity since its deterministic chaotic nature. It contrasts with measures based on harmonic analysis that are blind for nonlinear features. Dynamics of breathing, so crucial for 4D-based clinical technologies, can be better controlled if nonlinear-based methodology, which reflects respiration characteristic, is applied. Funding provided by Varian Medical Systems via Investigator Initiated Research Project.

  15. Conformal Postoperative Radiotherapy in Patients With Positive...

    Office of Scientific and Technical Information (OSTI)

    Conclusions: Postoperative high-dose conformal RT in patients with high-risk features was associated with a low risk of biochemical relapse as well as minimal morbidity. less ...

  16. New Hope for Retinitis Pigmentosa Patients

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    New Hope for Retinitis Pigmentosa Patients New Hope for Retinitis Pigmentosa Patients Print Thursday, 04 February 2016 16:26 Retinitis pigmentosa (RP) is a group of genetic disorders that affect the retina's ability to respond to light. This inherited disease causes a slow loss of vision, beginning with decreased night vision and loss of peripheral side vision. One of the causes of this disease is the misfolding and aggregation of a protein called opsin found in the retina of the eye. Using

  17. TOWARD UNBIASED GALAXY CLUSTER MASSES FROM LINE-OF-SIGHT VELOCITY DISPERSIONS

    SciTech Connect (OSTI)

    Saro, Alex; Mohr, Joseph J.; Bazin, Gurvan; Dolag, Klaus

    2013-07-20

    We study the use of red-sequence-selected galaxy spectroscopy for unbiased estimation of galaxy cluster masses by using a publicly available simulated galaxy catalog. We explore the impact of selection using galaxy color, projected separation from the cluster center, galaxy luminosity, and spectroscopic redshift. We identify and characterize each of the following sources of bias and scatter in velocity dispersion at fixed mass: the intrinsic properties of halos in the form of halo triaxiality, sampling noise, the presence of multiple kinematic populations within the cluster, and the effect of interlopers. We show that even in red-sequence and spectroscopically selected galaxy samples, the interloper fraction is significant, and that the variations in the interloper population from cluster to cluster provide the dominant contribution to the velocity dispersion scatter at fixed mass. We present measurements of the total scatter in dispersion at fixed mass as a function of the number of redshifts. Results indicate that improvements in scatter are modest beyond samples of {approx}30 redshifts per cluster. Our results show that while cluster velocity dispersions extracted from a few dozen red-sequence-selected galaxies do not provide precise masses on a single cluster basis, an ensemble of cluster velocity dispersions can be combined to produce a precise calibration of a cluster survey-mass-observable relation. Currently, disagreements in the literature on simulated subhalo velocity dispersion-mass relations place a systematic floor on velocity dispersion mass calibration at the 5% level in dispersion.

  18. Iran sets sights on 5 million b/d of crude

    SciTech Connect (OSTI)

    Not Available

    1992-09-21

    This paper reports that Iran, currently producing 3.2 million b/d of oil, has set a production target of 5 million b/d by March 1994. On the way to that target Iran's oil flow will climb to 4 million b/d by March 1993, says A. Moshtaqhian, director of exploration and production for National Iranian Oil Co. (NIOC). With oil reserves of about 100 million bbl, Iran will find it easy to increase productive capacity, Moshtaqhian told the Gulf Oil and Politics publication.

  19. Single line-of-sight dual energy backlighter for mix width experiments...

    Office of Scientific and Technical Information (OSTI)

    S. A. ; Felker, S. ; Seugling, R. ; Doane, D. ; Wallace, R. 1 ; Guymer, T. M. ; Moore, A. S. 2 ; Whiting, N. ; Sorce, C. 3 + Show Author Affiliations Lawrence Livermore ...

  20. Elastoplasty: First Experience in 12 Patients

    SciTech Connect (OSTI)

    Urlings, Thijs A. J. Linden, Edwin van der

    2013-04-15

    Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) is used increasingly for pain relief in symptomatic neoplastic or osteoporotic compression fractures. However, restoration of the stiffness of the treated vertebrae might propagate secondary fracture of adjacent vertebrae. Elastoplasty might prevent these secondary fractures. We assessed retrospectively our experience with elastoplasty in 12 patients, focusing on silicone migration. During the period from July 2011 to January 2012, all patients with an indication for vertebroplasty were treated with elastoplasty. The exclusion criterion was the presence of posterior wall defects. Chest computed tomography (CT) scans were performed to evaluate the presence of perivertebral leakage and pulmonary embolism. The prevalence of leakage was compared with the results obtained for vertebroplasty with PMMA reported in the literature. Other complications during the postprocedural period were recorded. Twenty-one vertebral bodies in 12 patients were treated with elastoplasty. Silicone pulmonary emboli were detected on the postprocedural chest CT in 60 % (6/10) of the patients. Leakage to the perivertebral venous plexus was seen in 67 % (14/21) of the treated vertebrae. One major complication occurred: severe, medication-resistant dyspnea developed in one patient with multiple peripheral silicone emboli. This preliminary evidence suggests that VK100 silicone cement should not be used in elastoplasty because of the increased risk of silicone pulmonary embolism, when compared with the use of PMMA, which occurs worldwide. The major technical disadvantage is that the time taken for the VK100 silicone material to achieve its final strength is too long for practical application.

  1. PRE-HOSPITAL PRACTICES FOR HANDLING A RADIOLOGICALLY CONTAMINATED PATIENT

    Office of Environmental Management (EM)

    Pre-hospital Practices for Handling a Pre-hospital Practices for Handling a Pre-hospital Practices for Handling a Pre-hospital Practices for Handling a Pre-hospital Practices for Handling a Radiologically Contaminated Patient Radiologically Contaminated Patient Radiologically Contaminated Patient Radiologically Contaminated Patient Radiologically Contaminated Patient DISCLAIMER DISCLAIMER DISCLAIMER DISCLAIMER DISCLAIMER Viewing this video and completing the enclosed printed study material do

  2. Energy Upgrades to Alabama Trauma Center Help Improve Patient Care

    Broader source: Energy.gov [DOE]

    In Alabama, a Recovery Act grant is helping a hospital save energy while providing better care to its patients.

  3. ROC analysis in patient specific quality assurance

    SciTech Connect (OSTI)

    Carlone, Marco; MacPherson, Miller; Cruje, Charmainne; Rangel, Alejandra; McCabe, Ryan; Nielsen, Michelle

    2013-04-15

    Purpose: This work investigates the use of receiver operating characteristic (ROC) methods in patient specific IMRT quality assurance (QA) in order to determine unbiased methods to set threshold criteria for {gamma}-distance to agreement measurements. Methods: A group of 17 prostate plans was delivered as planned while a second group of 17 prostate plans was modified with the introduction of random multileaf collimator (MLC) position errors that are normally distributed with {sigma}{approx}{+-}0.5, {+-}1.0, {+-}2.0, and {+-}3.0 mm (a total of 68 modified plans were created). All plans were evaluated using five different {gamma}-criteria. ROC methodology was applied by quantifying the fraction of modified plans reported as 'fail' and unmodified plans reported as 'pass.'Results: {gamma}-based criteria were able to attain nearly 100% sensitivity/specificity in the detection of large random errors ({sigma} > 3 mm). Sensitivity and specificity decrease rapidly for all {gamma}-criteria as the size of error to be detected decreases below 2 mm. Predictive power is null with all criteria used in the detection of small MLC errors ({sigma} < 0.5 mm). Optimal threshold values were established by determining which criteria maximized sensitivity and specificity. For 3%/3 mm {gamma}-criteria, optimal threshold values range from 92% to 99%, whereas for 2%/2 mm, the range was from 77% to 94%. Conclusions: The optimal threshold values that were determined represent a maximized test sensitivity and specificity and are not subject to any user bias. When applied to the datasets that we studied, our results suggest the use of patient specific QA as a safety tool that can effectively prevent large errors (e.g., {sigma} > 3 mm) as opposed to a tool to improve the quality of IMRT delivery.

  4. Handling and Packaging a Potentially Radiologically Contaminated Patient

    Broader source: Energy.gov [DOE]

    The purpose of this procedure is to provide guidance to EMS care providers for properly handling and packaging potentially radiologically contaminated patients.

  5. DOE-STD-1040-93 CN-1; Guide to Good Practices for Control of On-Sight Training

    Office of Environmental Management (EM)

    0-93 June 1993 CHANGE NOTICE NO. 1 December 1998 DOE STANDARD GUIDE TO GOOD PRACTICES FOR CONTROL OF ON-SHIFT TRAINING U.S. Department of Energy FSC 6910 Washington, D.C. 20585 DISTRIBUTION STATEMENT A. Approved for public release; distribution is unlimited. This document has been reproduced from the best available copy. Available to DOE and DOE contractors from ES&H Technical Information Services, U.S. Department of Energy, (800) 473-4375, fax: (301) 903-9823. Available to the public from

  6. Doctor Patient Conversation Around Breast Cancer | GE Global...

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Doctor Patient Conversation Around Breast Cancer Click to email this to a friend (Opens in new window) Share on Facebook (Opens in new window) Click to share (Opens in new window)...

  7. Intermittent patient suction system, self-contained control

    DOE Patents [OSTI]

    Lewis, Jay L. (Knoxville, TN)

    1992-01-01

    An intermittent patient suction system, a self-contained control device therefor and methods of making the same are provided, the self-contained control device having a housing that contains two restrictor units therein for respectively controlling the "on" time and "off" time that the control device applies a vacuum and does not apply a vacuum through the output of the control device to the patient.

  8. Conformal Postoperative Radiotherapy in Patients With Positive Resection

    Office of Scientific and Technical Information (OSTI)

    Margins and/or pT3-4 Prostate Adenocarcinoma (Journal Article) | SciTech Connect Conformal Postoperative Radiotherapy in Patients With Positive Resection Margins and/or pT3-4 Prostate Adenocarcinoma Citation Details In-Document Search Title: Conformal Postoperative Radiotherapy in Patients With Positive Resection Margins and/or pT3-4 Prostate Adenocarcinoma Purpose: To evaluate outcome and toxicity of high-dose conformal radiotherapy (RT) after radical prostatectomy. Methods and Materials:

  9. Emergency department management of patients internally contaminated with radioactive material

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Kazzi, Ziad; Buzzell, Jennifer; Bertelli, Luiz; Christensen, Doran

    2014-11-15

    After a radiation emergency that involves the dispersal of radioactive material, patients can become externally and internally contaminated with one or more radionuclides. Internal contamination can lead to the delivery of harmful ionizing radiation doses to various organs and tissues or the whole body. The clinical consequences can range from acute radiation syndrome (ARS) to the long term development of cancer. Estimating the amount of radioactive material absorbed into the body can guide the management of patients. Treatment includes, in addition to supportive care and long term monitoring, certain medical countermeasures like Prussian blue, Calcium DTPA and Zinc DTPA.

  10. 3 Blind Men, an Elephant and Materials Characterization | GE...

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    an Elephant and Materials Characterization Swarna Addepalli 2012.06.04 As a child in India, I grew up listening to and reading a lot of stories, which, in essence, teach how one...

  11. Exploration In A Blind Geothermal Area Near Marysville, Montana...

    Open Energy Info (EERE)

    ground magnetics, resistivity, seismic ground noise, micro-earthquake studies, and infra-red photography. The heat flow data have outlined a geothermal anomaly with heat flow...

  12. Isotope production agreement benefits medical patients | National Nuclear

    National Nuclear Security Administration (NNSA)

    Security Administration Isotope production agreement benefits medical patients | National Nuclear Security Administration Facebook Twitter Youtube Flickr RSS People Mission Managing the Stockpile Preventing Proliferation Powering the Nuclear Navy Emergency Response Recapitalizing Our Infrastructure Countering Nuclear Terrorism About Our Programs Our History Who We Are Our Leadership Our Locations Budget Our Operations Library Bios Congressional Testimony Fact Sheets Newsletters Press

  13. Investigation of saliva of patients with periodontal disease using NAA

    SciTech Connect (OSTI)

    Zamboni, C. B.; Metairon, S.; Medeiros, I. M. M. A.

    2013-05-06

    In this study the non-stimulated whole saliva of 26 healthy subjects (mean age 33.9 {+-} 11.0 years, range: 26 to 49 years) and 11 patients with periodontal disease (mean age 41.7 {+-} 11.5 years; range 29 to 55 years) was investigated using Neutron Activation Analysis (NAA) technique. The samples were obtained from donors at Sao Paulo city (Brazil). The analyses were performed in the nuclear reactor IEA-R1 (3.5-4.5MW, pool type) at IPEN/CNEN-SP (Brazil). Considerable changes in Ca and S saliva's level were identified in patients with periodontal disease suggesting they can be used as monitors of periodontal diseases.

  14. Cerebrospinal Fluid Proteome of Patients with Acute Lyme Disease

    SciTech Connect (OSTI)

    Angel, Thomas E.; Jacobs, Jon M.; Smith, Robert P.; Pasternack, Mark S.; Elias, Susan; Gritsenko, Marina A.; Shukla, Anil K.; Gilmore, Edward C.; McCarthy, Carol; Camp, David G.; Smith, Richard D.

    2012-10-05

    Acute Lyme disease results from transmission of and infection by the bacterium Borrelia burgdorferi following a tick bite. During acute infection, bacteria can disseminate to the central nervous system (CNS) leading to the development of Lyme meningitis. Here we have analyzed pooled cerebrospinal fluid (CSF) allowing for a deep view into the proteome for a cohort of patients with early-disseminated Lyme disease and CSF inflammation leading to the identification of proteins that reflect host responses, which are distinct for subjects with acute Lyme disease. Additionally, we analyzed individual patient samples and quantified changes in protein abundance employing label-free quantitative mass spectrometry based methods. The measured changes in protein abundances reflect the impact of acute Lyme disease on the CNS as presented in CSF. We have identified 89 proteins that differ significantly in abundance in patients with acute Lyme disease. A number of the differentially abundant proteins have been found to be localized to brain synapse and thus constitute important leads for better understanding of the neurological consequence of disseminated Lyme disease.

  15. Radioembolization After Portal Vein Embolization in a Patient with Multifocal Hepatocellular Carcinoma

    SciTech Connect (OSTI)

    Burgmans, Mark C. Irani, Farah G. Chan, Wan Ying Teo, Terence K.; Kao, Yung Hsiang Goh, Anthony S.W.; Chow, Pierce K.; Lo, Richard H.

    2012-12-15

    Radioembolization is an effective locoregional therapy for patients with intermediate or advanced stage hepatocellular carcinoma (HCC). It has been shown that radioembolization is safe in patients with portal vein thrombosis. This case report describes safe radioembolization after portal vein embolization in a patient with multifocal HCC.

  16. Impact of Weight Change During the Course of Concurrent Chemoradiation Therapy on Outcomes in Stage IIIB Non-Small Cell Lung Cancer Patients: Retrospective Analysis of 425 Patients

    SciTech Connect (OSTI)

    Topkan, Erkan; Parlak, Cem; Selek, Ugur

    2013-11-15

    Purpose: We retrospectively investigated the impact of weight change (WC) during concurrent chemoradiation therapy (C-CRT) on clinical outcomes of stage 3B non-small cell lung cancer (NSCLC) patients. Methods and Materials: A total of 425 patients treated with C-CRT were included. All patients received 60 to 66 Gy of thoracic radiation therapy concurrently with 1 to 3 cycles of platinum-based chemotherapy. Pre- and posttreatment weight measurements on first and last days of C-CRT were used for WC. Patients were divided into 2 groups: group 1 = weight loss (WL); group 2 = weight preservation/gain (WP) for comparative analyses. Results: Following C-CRT, 252 patients (59.3%) experienced WL, while 89 patients (20.9%) and 84 patients (19.8%) showed WP or WG. At median 24.2 months of follow-up, 142 patients (33.4%) were alive (84 WP [48.6%] and 58 WL [23.0%]), and 58 (13.6%) of them were free of disease progression (41 [23.7%] for WP and 17 [6.7%] for WL). Median overall survival (OS), locoregional progression-free survival (LRPFS), progression-free survival (PFS), and distant metastases-free survival (DMFS) for the entire population were 22.8, 14.4, 10.6, and 11.7 months, respectively. Intergroup comparisons between WP and WL cohorts revealed significantly superior OS, LRPFS, PFS, and DMFS in WP patients (P<.05 for each). On multivariate analyses, only WL and advanced T stage were associated with poor prognosis (P<.05). Conclusions: Present results in 425 stage 3B NSCLC patients demonstrated that WL during C-CRT is strongly associated with inferior survival outcomes compared to WP. This emerging finding might be useful by forming an encouraging basis for future investigations in facilitating a way to improve the outcomes of these patients experiencing WL during C-CRT.

  17. Portable, space-saving medical patient support system

    DOE Patents [OSTI]

    Bzorgi; Fariborz (Knoxville, TN)

    2011-02-01

    A support platform having a stowed configuration and a deployed configuration on a floor. The support platform is related to stretcher devices that are used for transporting, confining, or conducting medical procedures on medical patients in medical emergencies. The support platform typically includes a work surface that has a geometric extent. A base that typically includes a plurality of frame members is provided, and the frame members are disposed across the geometric extent of, and proximal to, the work surface in the stowed configuration. The frame members are typically disposed on the floor in the deployed configuration. There is a foldable bracing system engaged with the work surface and engaged with the base. At least a portion of the foldable bracing system is disposed substantially inside at least a portion of the plurality of frame members in the stowed configuration. Further, the foldable bracing system is configured for translocation of the work surface distal from the base in the deployed configuration.

  18. Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy

    SciTech Connect (OSTI)

    Lingos, T.I.; Recht, A.; Vicini, F.; Abner, A.; Silver, B.; Harris, J.R. )

    1991-07-01

    The likelihood of radiation pneumonitis and factors associated with its development in breast cancer patients treated with conservative surgery and radiation therapy have not been well established. To assess these, the authors retrospectively reviewed 1624 patients treated between 1968 and 1985. Median follow-up for patients without local or distant failure was 77 months. Patients were treated with either tangential fields alone (n = 508) or tangents with a third field to the supraclavicular (SC) or SC-axillary (AX) region (n = 1116). Lung volume treated in the tangential fields was generally limited by keeping the perpendicular distance (demagnified) at the isocenter from the deep field edges to the posterior chest wall (CLD) to 3 cm or less. Seventeen patients with radiation pneumonitis were identified (1.0%). Radiation pneumonitis was diagnosed when patients presented with cough (15/17, 88%), fever (9/17, 53%), and/or dyspnea (6/17, 35%) and radiographic changes (17/17) following completion of RT. Radiographic infiltrates corresponded to treatment portals in all patients, and in 12 of the 17 patients, returned to baseline within 1-12 months. Five patients had permanent scarring on chest X ray. No patient had late or persistent pulmonary symptoms. The incidence of radiation pneumonitis was correlated with the combined use of chemotherapy (CT) and a third field. Three percent (11/328) of patients treated with a 3-field technique who received chemotherapy developed radiation pneumonitis compared to 0.5% (6 of 1296) for all other patients (p = 0.0001). When patients treated with a 3-field technique received chemotherapy concurrently with radiation therapy, the incidence of radiation pneumonitis was 8.8% (8/92) compared with 1.3% (3/236) for those who received sequential chemotherapy and radiation therapy (p = 0.002).

  19. Optimal Timing for Assessment of Tumor Response to Neoadjuvant Chemoradiation in Patients With Rectal Cancer: Do All Patients Benefit From Waiting Longer Than 6 Weeks?

    SciTech Connect (OSTI)

    Perez, Rodrigo O.; Angelita and Joaquim Gama Institute, Sao Paulo ; Habr-Gama, Angelita; Sao Juliao, Guilherme P.; Gama-Rodrigues, Joaquim; Sousa, Afonso H.S.; Campos, Fabio Guilherme; Imperiale, Antonio R.; Lynn, Patricio B.; Proscurshim, Igor; Nahas, Sergio Carlos; Ono, Carla Rachel; Buchpiguel, Carlos Alberto; Department of Radiology and Nuclear Medicine, Hospital do Coracao, Sao Paulo

    2012-12-01

    Purpose: To estimate the metabolic activity of rectal cancers at 6 and 12 weeks after completion of chemoradiation therapy (CRT) by 2-[fluorine-18] fluoro-2-deoxy-D-glucose-labeled positron emission tomography/computed tomography ([{sup 18}FDG]PET/CT) imaging and correlate with response to CRT. Methods and Materials: Patients with cT2-4N0-2M0 distal rectal adenocarcinoma treated with long-course neoadjuvant CRT (54 Gy, 5-fluouracil-based) were prospectively studied ( (ClinicalTrials.org) identifier (NCT00254683)). All patients underwent 3 PET/CT studies (at baseline and 6 and 12 weeks from CRT completion). Clinical assessment was at 12 weeks. Maximal standard uptake value (SUVmax) of the primary tumor was measured and recorded at each PET/CT study after 1 h (early) and 3 h (late) from {sup 18}FDG injection. Patients with an increase in early SUVmax between 6 and 12 weeks were considered 'bad' responders and the others as 'good' responders. Results: Ninety-one patients were included; 46 patients (51%) were 'bad' responders, whereas 45 (49%) patients were 'good' responders. 'Bad' responders were less likely to develop complete clinical response (6.5% vs. 37.8%, respectively; P=.001), less likely to develop significant histological tumor regression (complete or near-complete pathological response; 16% vs. 45%, respectively; P=.008) and exhibited greater final tumor dimension (4.3 cm vs. 3.3 cm; P=.03). Decrease between early (1 h) and late (3 h) SUVmax at 6-week PET/CT was a significant predictor of 'good' response (accuracy of 67%). Conclusions: Patients who developed an increase in SUVmax after 6 weeks were less likely to develop significant tumor downstaging. Early-late SUVmax variation at 6-week PET/CT may help identify these patients and allow tailored selection of CRT-surgery intervals for individual patients.

  20. Retrospective analysis of 2D patient-specific IMRT verifications

    SciTech Connect (OSTI)

    Childress, Nathan L.; White, R. Allen; Bloch, Charles; Salehpour, Mohammad; Dong, Lei; Rosen, Isaac I.

    2005-04-01

    We performed 858 two-dimensional (2D) patient-specific intensity modulated radiotherapy verifications over a period of 18 months. Multifield, composite treatment plans were measured in phantom using calibrated Kodak EDR2 film and compared with the calculated dose extracted from two treatment planning systems. This research summarizes our findings using the normalized agreement test (NAT) index and the percent of pixels failing the gamma index as metrics to represent the agreement between measured and computed dose distributions. An in-house dose comparison software package was used to register and compare all verifications. We found it was important to use an automatic positioning algorithm to achieve maximum registration accuracy, and that our automatic algorithm agreed well with anticipated results from known phantom geometries. We also measured absolute dose for each case using an ion chamber. Because the computed distributions agreed with ion chamber measurements better than the EDR2 film doses, we normalized EDR2 data to the computed distributions. The distributions of both the NAT indices and the percentage of pixels failing the gamma index were found to be exponential distributions. We continue to use both the NAT index and percent of pixels failing gamma with 5%/3 mm criteria to evaluate future verifications, as these two metrics were found to be complementary. Our data showed that using 2%/2 mm or 3%/3 mm criteria produces results similar to those using 5%/3 mm criteria. Normalized comparisons that have a NAT index greater than 45 and/or more than 20% of the pixels failing gamma for 5%/3 mm criteria represent outliers from our clinical data set and require further analysis. Because our QA verification results were exponentially distributed, rather than a tight grouping of similar results, we continue to perform patient-specific QA in order to identify and correct outliers in our verifications. The data from this work could be useful as a reference for other clinics to indicate anticipated trends in 2D verifications under various conditions.

  1. ORISE: WeB-MEDIS System Allows Hospitals to Gather and Track Patient Data

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    During Emergencies WeB-MEDIS ORISE-developed system helps emergency responders and hospitals gather and track patient data during emergencies The Oak Ridge Institute for Science and Education designed, developed and deployed WeB-MEDIS-a Web-based patient tracking system designed to provide emergency responders and hospitals with a highly portable system for inputting, sharing and tracking patient data from the field. How ORISE is Making a Difference The system was originally created for the

  2. Patient-Physician Communication About Complementary and Alternative Medicine in a Radiation Oncology Setting

    SciTech Connect (OSTI)

    Ge Jin; Fishman, Jessica; Annenberg School for Communication at University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, Pennsylvania ; Vapiwala, Neha; Department of Radiation Oncology, University of Pennsylvania Health System, Philadelphia, Pennsylvania ; Li, Susan Q.; Desai, Krupali; Xie, Sharon X.; Mao, Jun J.

    2013-01-01

    Purpose: Despite the extensive use of complementary and alternative medicine (CAM) among cancer patients, patient-physician communication regarding CAM therapies remains limited. This study quantified the extent of patient-physician communication about CAM and identified factors associated with its discussion in radiation therapy (RT) settings. Methods and Materials: We conducted a cross-sectional survey of 305 RT patients at an urban academic cancer center. Patients with different cancer types were recruited in their last week of RT. Participants self-reported their demographic characteristics, health status, CAM use, patient-physician communication regarding CAM, and rationale for/against discussing CAM therapies with physicians. Multivariate logistic regression was used to identify relationships between demographic/clinical variables and patients' discussion of CAM with radiation oncologists. Results: Among the 305 participants, 133 (43.6%) reported using CAM, and only 37 (12.1%) reported discussing CAM therapies with their radiation oncologists. In multivariate analyses, female patients (adjusted odds ratio [AOR] 0.45, 95% confidence interval [CI] 0.21-0.98) and patients with full-time employment (AOR 0.32, 95% CI 0.12-0.81) were less likely to discuss CAM with their radiation oncologists. CAM users (AOR 4.28, 95% CI 1.93-9.53) were more likely to discuss CAM with their radiation oncologists than were non-CAM users. Conclusions: Despite the common use of CAM among oncology patients, discussions regarding these treatments occur rarely in the RT setting, particularly among female and full-time employed patients. Clinicians and patients should incorporate discussions of CAM to guide its appropriate use and to maximize possible benefit while minimizing potential harm.

  3. Efficacy of TACE in TIPS Patients: Comparison of Treatment Response to Chemoembolization for Hepatocellular Carcinoma in Patients With and Without a Transjugular Intrahepatic Portosystemic Shunt

    SciTech Connect (OSTI)

    Kuo, Yuo-Chen Kohi, Maureen P. Naeger, David M. Tong, Ricky T. Kolli, K. Pallav Taylor, Andrew G. Laberge, Jeanne M. Kerlan, Robert K. Fidelman, Nicholas

    2013-10-15

    Purpose: To compare treatment response after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in patients with and without a transjugular intrahepatic portosystemic shunt (TIPS). Materials and Methods: A retrospective review of patients who underwent conventional TACE for HCC between January 2005 and December 2009 identified 10 patients with patent TIPS. From the same time period, 23 patients without TIPS were selected to control for comparable Model for End-Stage Liver Disease and Child-Pugh-Turcotte scores. The two groups showed similar distribution of Barcelona Clinic Liver Cancer and United Network of Organ Sharing stages. Target HCC lesions were evaluated according to the modified response evaluation criteria in solid tumors (mRECIST) guidelines. Transplantation rate, time to tumor progression, and overall survival (OS) were documented. Results: After TACE, the rate of complete response was significantly greater in non-TIPS patients compared with TIPS patients (74 vs. 30 %, p = 0.03). Objective response rate (complete and partial response) trended greater in the non-TIPS group (83 vs. 50 %, p = 0.09). The liver transplantation rate was 80 and 74 % in the TIPS and non-TIPS groups, respectively (p = 1.0). Time to tumor progression was similar (p = 0.47) between the two groups. OS favored the non-TIPS group (p = 0.01) when censored for liver transplantation. Conclusion: TACE is less effective in achieving complete or partial response using mRECIST criteria in TIPS patients compared with those without a TIPS. Nevertheless, similar clinical outcomes may be achieved, particularly in TIPS patients who are liver-transplantation candidates.

  4. Dermatofibrosarcoma Protuberans: Long-term Outcomes of 53 Patients Treated With Conservative Surgery and Radiation Therapy

    SciTech Connect (OSTI)

    Castle, Katherine O. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Guadagnolo, B. Ashleigh, E-mail: aguadagn@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tsai, C. Jillian [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Feig, Barry W. [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zagars, Gunar K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-07-01

    Purpose: To evaluate outcomes of conservative surgery and radiation therapy (RT) treatment in patients with dermatofibrosarcoma protuberans. Methods and Materials: We retrospectively reviewed the medical records of 53 consecutive dermatofibrosarcoma protuberans patients treated with surgery and preoperative or postoperative radiation therapy between 1972 and 2010. Median tumor size was 4 cm (range, 1-25 cm). Seven patients (13%) were treated with preoperative RT (50-50.4 Gy) and 46 patients (87%) with postoperative RT (60-66 Gy). Of the 46 patients receiving postoperative radiation, 3 (7%) had gross disease, 14 (30%) positive margins, 26 (57%) negative margins, and 3 (7%) uncertain margin status. Radiation dose ranged from 50 to 66 Gy (median dose, 60 Gy). Results: At a median follow-up time of 6.5 years (range, 0.5 months-23.5 years), 2 patients (4%) had disease recurrence, and 3 patients (6%) had died. Actuarial overall survival was 98% at both 5 and 10 years. Local control was 98% and 93% at 5 and 10 years, respectively. Disease-free survival was 98% and 93% at 5 and 10 years, respectively. The presence of fibrosarcomatous change was not associated with increased risk of local or distant relapse (P=.43). One of the patients with a local recurrence had gross residual disease at the time of RT and despite RT to 65 Gy developed both an in-field recurrence and a nodal and distant recurrence 3 months after RT. The other patient with local recurrence was found to have in-field recurrence 10 years after initial treatment. Thirteen percent of patients had an RT complication at 5 and 10 years, and 9% had a moderate or severe complication at 5 and 10 years. Conclusions: Dermatofibrosarcoma protuberans is a radioresponsive disease with excellent local control after conservative surgery and radiation therapy. Adjuvant RT should be considered for patients with large or recurrent tumors or when attempts at wide surgical margins would result in significant morbidity.

  5. Patient dose estimation from CT scans at the Mexican National Neurology and Neurosurgery Institute

    SciTech Connect (OSTI)

    Alva-Sánchez, Héctor

    2014-11-07

    In the radiology department of the Mexican National Institute of Neurology and Neurosurgery, a dedicated institute in Mexico City, on average 19.3 computed tomography (CT) examinations are performed daily on hospitalized patients for neurological disease diagnosis, control scans and follow-up imaging. The purpose of this work was to estimate the effective dose received by hospitalized patients who underwent a diagnostic CT scan using typical effective dose values for all CT types and to obtain the estimated effective dose distributions received by surgical and non-surgical patients. Effective patient doses were estimated from values per study type reported in the applications guide provided by the scanner manufacturer. This retrospective study included all hospitalized patients who underwent a diagnostic CT scan between 1 January 2011 and 31 December 2012. A total of 8777 CT scans were performed in this two-year period. Simple brain scan was the CT type performed the most (74.3%) followed by contrasted brain scan (6.1%) and head angiotomography (5.7%). The average number of CT scans per patient was 2.83; the average effective dose per patient was 7.9 mSv; the mean estimated radiation dose was significantly higher for surgical (9.1 mSv) than non-surgical patients (6.0 mSv). Three percent of the patients had 10 or more brain CT scans and exceeded the organ radiation dose threshold set by the International Commission on Radiological Protection for deterministic effects of the eye-lens. Although radiation patient doses from CT scans were in general relatively low, 187 patients received a high effective dose (>20 mSv) and 3% might develop cataract from cumulative doses to the eye lens.

  6. Erlotinib Versus Radiation Therapy for Brain Metastases in Patients With EGFR-Mutant Lung Adenocarcinoma

    SciTech Connect (OSTI)

    Gerber, Naamit K.; Yamada, Yoshiya; Rimner, Andreas; Shi, Weiji; Riely, Gregory J.; Beal, Kathryn; Yu, Helena A.; Chan, Timothy A.; Zhang, Zhigang; Wu, Abraham J.

    2014-06-01

    Purpose/Objectives: Radiation therapy (RT) is the principal modality in the treatment of patients with brain metastases (BM). However, given the activity of EGFR tyrosine kinase inhibitors in the central nervous system, it is uncertain whether upfront brain RT is necessary for patients with EGFR-mutant lung adenocarcinoma with BM. Methods and Materials: Patients with EGFR-mutant lung adenocarcinoma and newly diagnosed BM were identified. Results: 222 patients were identified. Exclusion criteria included prior erlotinib use, presence of a de novo erlotinib resistance mutation, or incomplete data. Of the remaining 110 patients, 63 were treated with erlotinib, 32 with whole brain RT (WBRT), and 15 with stereotactic radiosurgery (SRS). The median overall survival (OS) for the whole cohort was 33 months. There was no significant difference in OS between the WBRT and erlotinib groups (median, 35 vs 26 months; P=.62), whereas patients treated with SRS had a longer OS than did those in the erlotinib group (median, 64 months; P=.004). The median time to intracranial progression was 17 months. There was a longer time to intracranial progression in patients who received WBRT than in those who received erlotinib upfront (median, 24 vs 16 months, P=.04). Patients in the erlotinib or SRS group were more likely to experience intracranial failure as a component of first failure, whereas WBRT patients were more likely to experience failure outside the brain (P=.004). Conclusions: The survival of patients with EGFR-mutant adenocarcinoma with BM is notably long, whether they receive upfront erlotinib or brain RT. We observed longer intracranial control with WBRT, even though the WBRT patients had a higher burden of intracranial disease. Despite the equivalent survival between the WBRT and erlotinib group, this study underscores the role of WBRT in producing durable intracranial control in comparison with a targeted biologic agent with known central nervous system activity.

  7. Incidence of Second Malignancies Among Patients Treated With Proton Versus Photon Radiation

    SciTech Connect (OSTI)

    Chung, Christine S., E-mail: chungc1@sutterhealth.org [Department of Radiation Oncology, Alta Bates Summit Medical Center, Berkeley, California (United States); Yock, Torunn I. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Nelson, Kerrie [Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts (United States); Xu, Yang [Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (United States); Keating, Nancy L. [Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (United States); Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (United States); Tarbell, Nancy J. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Office of the Executive Dean, Harvard Medical School, Boston, Massachusetts (United States)

    2013-09-01

    Purpose: Proton radiation, when compared with photon radiation, allows delivery of increased radiation dose to the tumor while decreasing dose to adjacent critical structures. Given the recent expansion of proton facilities in the United States, the long-term sequelae of proton therapy should be carefully assessed. The objective of this study was to compare the incidence of second cancers in patients treated with proton radiation with a population-based cohort of matched patients treated with photon radiation. Methods and Materials: We performed a retrospective cohort study of 558 patients treated with proton radiation from 1973 to 2001 at the Harvard Cyclotron in Cambridge, MA and 558 matched patients treated with photon therapy in the Surveillance, Epidemiology, and End Results (SEER) Program cancer registry. Patients were matched by age at radiation treatment, sex, year of treatment, cancer histology, and site. The main outcome measure was the incidence of second malignancies after radiation. Results: We matched 558 proton patients with 558 photon patients from the Surveillance, Epidemiology, and End Results registry. The median duration of follow-up was 6.7 years (interquartile range, 7.4) and 6.0 years (interquartile range, 9.3) in the proton and photon cohorts, respectively. The median age at treatment was 59 years in each cohort. Second malignancies occurred in 29 proton patients (5.2%) and 42 photon patients (7.5%). After we adjusted for sex, age at treatment, primary site, and year of diagnosis, proton therapy was not associated with an increased risk of second malignancy (adjusted hazard ratio, 0.52 [95% confidence interval, 0.32-0.85]; P=.009). Conclusions: The use of proton radiation therapy was not associated with a significantly increased risk of secondary malignancies compared with photon therapy. Longer follow-up of these patients is needed to determine if there is a significant decrease in second malignancies. Given the limitations of the study, these results should be viewed as hypothesis generating.

  8. Pretreatment Staging Positron Emission Tomography/Computed Tomography in Patients With Inflammatory Breast Cancer Influences Radiation Treatment Field Designs

    SciTech Connect (OSTI)

    Walker, Gary V.; Niikura, Naoki; Yang Wei; Rohren, Eric; Valero, Vicente; Woodward, Wendy A.; Alvarez, Ricardo H.; Lucci, Anthony; Ueno, Naoto T.; Buchholz, Thomas A.

    2012-08-01

    Purpose: Positron emission tomography/computed tomography (PET/CT) is increasingly being utilized for staging of inflammatory breast cancer (IBC). The purpose of this study was to define how pretreatment PET/CT studies affected postmastectomy radiation treatment (PMRT) planning decisions for IBC. Methods and Materials: We performed a retrospective analysis of 62 patients diagnosed with IBC between 2004 and 2009, who were treated with PMRT in our institution and who had a staging PET/CT within 3 months of diagnosis. Patients received a baseline physical examination, staging mammography, ultrasonographic examination of breast and draining lymphatics, and chest radiography; most patients also had a bone scan (55 patients), liver imaging (52 patients), breast MRI (46 patients), and chest CT (25 patients). We compared how PET/CT findings affected PMRT, assuming that standard PMRT would target the chest wall, level III axilla, supraclavicular fossa, and internal mammary chain (IMC). Any modification of target volumes, field borders, or dose prescriptions was considered a change. Results: PET/CT detected new areas of disease in 27 of the 62 patients (44%). The areas of additional disease included the breast (1 patient), ipsilateral axilla (1 patient), ipsilateral supraclavicular (4 patients), ipsilateral infraclavicular (1 patient), ipsilateral IMC (5 patients), ipsilateral subpectoral (3 patients), mediastinal (8 patients), other distant/contralateral lymph nodes (15 patients), or bone (6 patients). One patient was found to have a non-breast second primary tumor. The findings of the PET/CT led to changes in PMRT in 11 of 62 patients (17.7%). These changes included additional fields in 5 patients, adjustment of fields in 2 patients, and higher doses to the supraclavicular fossa (2 patients) and IMC (5 patients). Conclusions: For patients with newly diagnosed IBC, pretreatment PET/CT provides important information concerning involvement of locoregional lymph nodes, mediastinal lymph nodes, and unsuspected sites of distant metastasis. This information is important in the design of radiotherapy treatment fields and, therefore, we recommend that PET/CT be a component of initial staging for IBC.

  9. New Breast Cancer Recursive Partitioning Analysis Prognostic Index in Patients With Newly Diagnosed Brain Metastases

    SciTech Connect (OSTI)

    Niwinska, Anna; Murawska, Magdalena

    2012-04-01

    Purpose: The aim of the study was to present a new breast cancer recursive partitioning analysis (RPA) prognostic index for patients with newly diagnosed brain metastases as a guide in clinical decision making. Methods and Materials: A prospectively collected group of 441 consecutive patients with breast cancer and brain metastases treated between the years 2003 and 2009 was assessed. Prognostic factors significant for univariate analysis were included into RPA. Results: Three prognostic classes of a new breast cancer RPA prognostic index were selected. The median survival of patients within prognostic Classes I, II, and III was 29, 9, and 2.4 months, respectively (p < 0.0001). Class I included patients with one or two brain metastases, without extracranial disease or with controlled extracranial disease, and with Karnofsky performance status (KPS) of 100. Class III included patients with multiple brain metastases with KPS of {<=}60. Class II included all other cases. Conclusions: The breast cancer RPA prognostic index is an easy and valuable tool for use in clinical practice. It can select patients who require aggressive treatment and those in whom whole-brain radiotherapy or symptomatic therapy is the most reasonable option. An individual approach is required for patients from prognostic Class II.

  10. Percutaneous Treatment of Central Venous Stenosis in Hemodialysis Patients: Long-Term Outcomes

    SciTech Connect (OSTI)

    Kim, Young Chul; Won, Jong Yun Choi, Sun Young; Ko, Heung-kyu; Lee, Kwang-Hun; Lee, Do Yun; Kang, Byung-Chul; Kim, Seung-Jung

    2009-03-15

    The purpose of this study was to evaluate the long-term outcomes of endovascular treatment of central venous stenosis in patients with arteriovenous fistulas (AVFs) for hemodialysis. Five hundred sixty-three patients with AVFs who were referred for a fistulogram were enrolled in this study. Among them, 44 patients showed stenosis (n = 35) or occlusions (n = 9) in the central vein. For the initial treatment, 26 patients underwent percutaneous transluminal angioplasty (PTA) and 15 patients underwent stent placements. Periods between AVF formation and first intervention ranged from 3 to 144 months. Each patient was followed for 14 to 60 months. Procedures were successful in 41 of 44 patients (93.2%). Primary patency rates for PTA at 12 and 36 months were 52.1% and 20.0%, and assisted primary patency rates were 77.8% and 33.3%, respectively. Primary patency rates for stent at 12 and 36 months were 46.7% and 6.7%, and assisted primary patency rates were 60.0% and 20.0%, respectively. Fifteen of 26 patients with PTAs underwent repeated interventions because of restenosis. Fourteen of 15 patients with a stent underwent repeated interventions because of restenosis and combined migration (n = 1) and shortening (n = 6) of the first stent. There was no significant difference in patency between PTAs and stent placement (p > 0.05). Average AVF patency duration was 61.8 months and average number of endovascular treatments was 2.12. In conclusion, endovascular treatments of central venous stenosis could lengthen the available period of AVFs. There was no significant difference in patency between PTAs and stent placement.

  11. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    SciTech Connect (OSTI)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n=7), acute pancreatitis with pancreatic pseudocyst (n=2), pancreatic injury (n=1), and isolated pancreatic tuberculosis (n=1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.57.3 to 2.91.4mmHg after the procedure (P<0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 334)months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  12. Intrahepatic Left to Right Portoportal Venous Collateral Vascular Formation in Patients Undergoing Right Portal Vein Ligation

    SciTech Connect (OSTI)

    Lienden, K. P. van; Hoekstra, L. T.; Bennink, R. J.; Gulik, T. M. van

    2013-12-15

    Purpose: We investigated intrahepatic vascular changes in patients undergoing right portal vein ligation (PVL) or portal vein embolization (PVE) in conjunction with the ensuing hypertrophic response and function of the left liver lobe. Methods: Between December 2008 and October 2011, 7 patients underwent right PVL and 14 patients PVE. Computed tomographic (CT) volumetry to assess future remnant liver (FRL) and functional hepatobiliary scintigraphy were performed in all patients before and 3 weeks after portal vein occlusion. In 18 patients an intraoperative portography was performed to assess perfusion through the occluded portal branches. Results: In all patients after initially successful PVL, reperfused portal veins were observed on CT scan 3 weeks after portal occlusion. This was confirmed in all cases during intraoperative portography. Intrahepatic portoportal collaterals were identified in all patients in the PVL group and in one patient in the PVE group. In all other PVE patients, complete occlusion of the embolized portal branches was observed on CT scan and on intraoperative portography. The median increase of FRL volume after PVE was 41.6 % (range 10-305 %), and after PVL was only 8.1 % (range 0-102 %) (p = 0.179). There were no differences in FRL function between both groups. Conclusion: Preoperative PVE and PVL are both methods to induce hypertrophy of the FRL in anticipation of major liver resection. Compared to PVE, PVL seems less efficient in inducing hypertrophy of the nonoccluded left lobe. This could be caused by the formation of intrahepatic portoportal neocollateral vessels, through which the ligated portal branches are reperfused within 3 weeks.

  13. Survival Benefit for Pediatric Patients With Recurrent Ependymoma Treated With Reirradiation

    SciTech Connect (OSTI)

    Bouffet, Eric; Ballourah, Walid; Bartels, Ute K.; Tsangaris, Elena; Huang, Annie; Mabbot, Donald J.; Laperriere, Normand; Tabori, Uri

    2012-08-01

    Purpose: The outcome of recurrent ependymoma in children is dismal. Reirradiation has been proposed as an effective modality for ependymoma at relapse. However, the toxicity and outcome benefits of this approach have not been well established. Methods and Materials: We conducted a retrospective population-based study of all patients with recurrent ependymoma treated between 1986 and 2010 in our institution. Demographic, treatment, and outcome data were analyzed for the entire cohort. Results: Of 113 patients with intracranial ependymoma, 47 patients relapsed. At the time of relapse, 29 patients were treated with surgical resection and/or chemotherapy, and 18 patients received full-dose ({>=}54 Gy focal and/or craniospinal) reirradiation with or without surgery at recurrence. Reirradiation was tolerated well with no severe acute complications noticed. Three-year overall survival was 7% {+-} 6% and 81% {+-} 12% for nonreirradiated and reirradiated patients, respectively (p < 0.0001). Time to second progression after reirradiation was significantly longer than time to first progression. This surprising phenomenon was associated with improved progression-free survival for tumors with evidence of DNA damage (n = 15; p = 0.002). At a mean follow-up of 3.73 years, only 2/18 patients had endocrine dysfunction, and 1 patient required special education support. However, a decline in intellectual function from pre- to postreirradiation assessment was observed. Conclusions: Reirradiation is an effective treatment that may change the natural history of recurrent ependymoma in children. However, this change may be associated with increased neurocognitive toxicity. Additional follow-up is needed to determine the risk of late recurrence, secondary radiation-induced tumors, and long-term functional outcome of these patients.

  14. SU-C-BRD-06: Results From a 5 Patient in Vivo Rectal Wall Dosimetry...

    Office of Scientific and Technical Information (OSTI)

    SU-C-BRD-06: Results From a 5 Patient in Vivo Rectal Wall Dosimetry Study Using Plastic Scintillation Detectors Citation Details In-Document Search Title: SU-C-BRD-06: Results From...

  15. Malfunctions of Implantable Cardiac Devices in Patients Receiving Proton Beam Therapy: Incidence and Predictors

    SciTech Connect (OSTI)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Poenisch, Falk [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Pinnix, Chelsea C. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Sheu, Tommy [Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Joe Y. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Memon, Nada [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rozner, Marc A. [Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dougherty, Anne H. [Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-11-01

    Purpose: Photon therapy has been reported to induce resets of implanted cardiac devices, but the clinical sequelae of treating patients with such devices with proton beam therapy (PBT) are not well known. We reviewed the incidence of device malfunctions among patients undergoing PBT. Methods and Materials: From March 2009 through July 2012, 42 patients with implanted cardiac implantable electronic devices (CIED; 28 pacemakers and 14 cardioverter-defibrillators) underwent 42 courses of PBT for thoracic (23, 55%), prostate (15, 36%), liver (3, 7%), or base of skull (1, 2%) tumors at a single institution. The median prescribed dose was 74 Gy (relative biological effectiveness; range 46.8-87.5 Gy), and the median distance from the treatment field to the CIED was 10 cm (range 0.8-40 cm). Maximum proton and neutron doses were estimated for each treatment course. All CIEDs were checked before radiation delivery and monitored throughout treatment. Results: Median estimated peak proton and neutron doses to the CIED in all patients were 0.8 Gy (range 0.13-21 Gy) and 346 Sv (range 11-1100 mSv). Six CIED malfunctions occurred in 5 patients (2 pacemakers and 3 defibrillators). Five of these malfunctions were CIED resets, and 1 patient with a defibrillator (in a patient with a liver tumor) had an elective replacement indicator after therapy that was not influenced by radiation. The mean distance from the proton beam to the CIED among devices that reset was 7.0 cm (range 0.9-8 cm), and the mean maximum neutron dose was 655 mSv (range 330-1100 mSv). All resets occurred in patients receiving thoracic PBT and were corrected without clinical incident. The generator for the defibrillator with the elective replacement indicator message was replaced uneventfully after treatment. Conclusions: The incidence of CIED resets was about 20% among patients receiving PBT to the thorax. We recommend that PBT be avoided in pacing-dependent patients and that patients with any type of CIED receiving thoracic PBT be followed closely.

  16. Double-Layered PTFE-Covered Nitinol Stents: Experience in 32 Patients with Malignant Esophageal Strictures

    SciTech Connect (OSTI)

    Park, Jung Gu; Jung, Gyoo-Sik Oh, Kyung Seung; Park, Seon-Ja

    2010-08-15

    We evaluated the effectiveness of a double-layered polytetrafluoroethylene (PTFE)-covered nitinol stent in the palliative treatment of malignant esophageal strictures. A double-layered PTFE-covered nitinol stent was designed to reduce the propensity to migration of conventional covered stent. The stent consists of an inner PTFE-covered stent and an outer uncovered nitinol stent tube. With fluoroscopic guidance, the stent was placed in 32 consecutive patients with malignant esophageal strictures. During the follow-up period, the technical and clinical success rates, complications, and cumulative patient survival and stent patency were evaluated. Stent placement was technically successful in all patients, and no procedural complications occurred. After stent placement, the symptoms of 30 patients (94%) showed improvement. During the mean follow-up of 103 days (range, 9-348 days), 11 (34%) of 32 patients developed recurrent symptoms due to tumor overgrowth in five patients (16%), tumor ingrowth owing to detachment of the covering material (PTFE) apart from the stent wire in 3 (9%), mucosal hyperplasia in 2 (6%), and stent migration in 1 (3%). Ten of these 11 patients were treated by means of placing a second covered stent. Thirty patients died, 29 as a result of disease progression and 1 from aspiration pneumonia. The median survival period was 92 days. The median period of primary stent patency was 190 days. The double-layered PTFE-covered nitinol stent seems to be effective for the palliative treatment of malignant esophageal strictures. We believe that the double-layer configuration of this stent can contribute to decreasing the stent's migration rate.

  17. Osteoradionecrosis and Radiation Dose to the Mandible in Patients With Oropharyngeal Cancer

    SciTech Connect (OSTI)

    Tsai, Chiaojung Jillian; Hofstede, Theresa M.; Sturgis, Erich M.; Garden, Adam S.; Lindberg, Mary E.; Wei Qingyi; Tucker, Susan L.; Dong Lei

    2013-02-01

    Purpose: To determine the association between radiation doses delivered to the mandible and the occurrence of osteoradionecrosis (ORN). Methods and Materials: We reviewed the records of 402 oropharyngeal cancer patients with stage T1 or T2 disease treated with definitive radiation between January 2000 and October 2008 for the occurrence of ORN. Demographic and treatment variables were compared between patients with ORN and those without. To examine the dosimetric relationship further, a nested case-control comparison was performed. One to 2 ORN-free patients were selected to match each ORN patient by age, sex, radiation type, treatment year, and cancer subsite. Detailed radiation treatment plans for the ORN cases and matched controls were reviewed. Mann-Whitney test and conditional logistic regression were used to compare relative volumes of the mandible exposed to doses ranging from 10 Gy-60 Gy in 10-Gy increments. Results: In 30 patients (7.5%), ORN developed during a median follow-up time of 31 months, including 6 patients with grade 4 ORN that required major surgery. The median time to develop ORN was 8 months (range, 0-71 months). Detailed radiation treatment plans were available for 25 of the 30 ORN patients and 40 matched ORN-free patients. In the matched case-control analysis, there was a statistically significant difference between the volumes of mandible in the 2 groups receiving doses between 50 Gy (V50) and 60 Gy (V60). The most notable difference was seen at V50, with a P value of .02 in the multivariate model after adjustment for the matching variables and dental status (dentate or with extraction). Conclusions: V50 and V60 saw the most significant differences between the ORN group and the comparison group. Minimizing the percent mandibular volume exposed to 50 Gy may reduce ORN risk.

  18. Efficacy and Safety of Transarterial Radioembolization Versus Chemoembolization in Patients With Hepatocellular Carcinoma

    SciTech Connect (OSTI)

    Moreno-Luna, Laura E., E-mail: morenoluna.laura@gmail.com; Yang, Ju Dong; Sanchez, William [College of Medicine, Mayo Clinic, Division of Gastroenterology and Hepatology (United States); Paz-Fumagalli, Ricardo [College of Medicine, Mayo Clinic, Department of Radiology (United States); Harnois, Denise M.; Mettler, Teresa A. [College of Medicine, Mayo Clinic, Division of Gastroenterology and Hepatology (United States); Gansen, Denise N. [College of Medicine, Mayo Clinic, Department of Radiology (United States); Groen, Piet C. de; Lazaridis, Konstantinos N.; Narayanan Menon, K. V.; LaRusso, Nicholas F. [College of Medicine, Mayo Clinic, Division of Gastroenterology and Hepatology (United States); Alberts, Steven R. [College of Medicine, Mayo Clinic and Mayo Clinic Cancer Center, Department of Oncology (United States); Gores, Gregory J. [College of Medicine, Mayo Clinic, Division of Gastroenterology and Hepatology (United States); Fleming, Chad J. [College of Medicine, Mayo Clinic, Department of Radiology (United States); Slettedahl, Seth W.; Harmsen, William S.; Therneau, Terry M. [College of Medicine, Mayo Clinic, Department of Health Sciences Research (United States); Wiseman, Gregory A.; Andrews, James C. [College of Medicine, Mayo Clinic, Department of Radiology (United States); Roberts, Lewis R., E-mail: roberts.lewis@mayo.edu [College of Medicine, Mayo Clinic, Division of Gastroenterology and Hepatology (United States)

    2013-06-15

    Purpose. Intermediate-stage hepatocellular carcinoma (HCC) is usually treated with locoregional therapy using transarterial chemoembolization (TACE). Transarterial radioembolization (TARE) using {beta}-emitting yttrium-90 integral to the glass matrix of the microspheres is an alternative to TACE. This retrospective case-control study compared the outcomes and safety of TARE versus TACE in patients with unresectable HCC. Materials and Methods. Patients with unresectable HCC without portal vein thrombosis treated with TARE between 2005 and 2008 (n = 61) were retrospectively frequency-matched by age, sex, and liver dysfunction with TACE-treated patients (n = 55) in the Mayo Clinic Hepatobiliary Neoplasia Registry. Imaging studies were reviewed, and clinical and safety outcomes were abstracted from the medical records. Results. Complete tumor response was more common after TARE (12 %) than after TACE (4 %) (p = 0.17). When complete response was combined with partial response and stable disease, there was no difference between TARE and TACE. Median survival did not differ between the two groups (15.0 months for TARE and 14.4 months for TACE; p = 0.47). Two-year survival rates were 30 % for TARE and 24 % for TACE. TARE patients received fewer treatments (p < 0.001). Fifty-nine (97 %) TARE patients received outpatient treatment. In contrast, 53 (98 %) TACE patients were hospitalized for {>=}1 day (p < 0.001). Compared with TACE, TARE was more likely to induce fatigue (p = 0.003) but less likely to cause fever (p = 0.02). Conclusion. There was no significant difference in efficacy between TARE and TACE. TARE patients reported more fatigue but had less fever than TACE patients. Treatment with TARE required less hospitalization than treatment with TACE. These findings require confirmation in randomized trials.

  19. Shorter-Course Whole-Brain Radiotherapy for Brain Metastases in Elderly Patients

    SciTech Connect (OSTI)

    Rades, Dirk; Evers, Jasmin N.; Veninga, Theo; Stalpers, Lukas J.A.; Lohynska, Radka; Schild, Steven E.

    2011-11-15

    Purpose: Many patients with brain metastases receive whole-brain radiotherapy (WBRT) alone. Using 10 Multiplication-Sign 3 Gy in 2 weeks is the standard regimen in most centers. Regarding the extraordinarily poor survival prognosis of elderly patients with multiple brain metastases, a shorter WBRT regimen would be preferable. This study compared 10 Multiplication-Sign 3 Gy with 5 Multiplication-Sign 4 Gy in elderly patients ({>=}65 years). Methods and Materials: Data from 455 elderly patients who received WBRT alone for brain metastases were retrospectively analyzed. Survival and local (= intracerebral) control of 293 patients receiving 10 Multiplication-Sign 3 Gy were compared with 162 patients receiving 5 Multiplication-Sign 4 Gy. Eight additional potential prognostic factors were investigated including age, gender, Karnofsky performance score (KPS), primary tumor, number of brain metastases, interval from tumor diagnosis to WBRT, extracerebral metastases, and recursive partitioning analysis (RPA) class. Results: The 6-month overall survival rates were 29% after 5 Multiplication-Sign 4 Gy and 21% after 10 Multiplication-Sign 3 Gy (p = 0.020). The 6-month local control rates were 12% and 10%, respectively (p = 0.32). On multivariate analysis, improved overall survival was associated with KPS {>=} 70 (p < 0.001), only one to three brain metastases (p = 0.029), no extracerebral metastasis (p = 0.012), and lower RPA class (p < 0.001). Improved local control was associated with KPS {>=} 70 (p < 0.001), breast cancer (p = 0.029), and lower RPA class (p < 0.001). Conclusions: Shorter-course WBRT with 5 Multiplication-Sign 4 Gy was not inferior to 10 Multiplication-Sign 3 Gy with respect to overall survival or local control in elderly patients. 5 Multiplication-Sign 4 Gy appears preferable for the majority of these patients.

  20. Replanning During Intensity Modulated Radiation Therapy Improved Quality of Life in Patients With Nasopharyngeal Carcinoma

    SciTech Connect (OSTI)

    Yang Haihua; Hu Wei; Wang Wei; Chen Peifang; Ding Weijun; Luo Wei

    2013-01-01

    Purpose: Anatomic and dosimetric changes have been reported during intensity modulated radiation therapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). The purpose of this study was to evaluate the effects of replanning on quality of life (QoL) and clinical outcomes during the course of IMRT for NPC patients. Methods and Materials: Between June 2007 and August 2011, 129 patients with NPC were enrolled. Forty-three patients received IMRT without replanning, while 86 patients received IMRT replanning after computed tomography (CT) images were retaken part way through therapy. Chinese versions of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Head and Neck Quality of Life Questionnaire 35 were completed before treatment began and at the end of treatment and at 1, 3, 6, and 12 months after the completion of treatment. Overall survival (OS) data were compared using the Kaplan-Meier method. Results: IMRT replanning had a profound impact on the QoL of NPC patients, as determined by statistically significant changes in global QoL and other QoL scales. Additionally, the clinical outcome comparison indicates that replanning during IMRT for NPC significantly improved 2-year local regional control (97.2% vs 92.4%, respectively, P=.040) but did not improve 2-year OS (89.8% vs 82.2%, respectively, P=.475). Conclusions: IMRT replanning improves QoL as well as local regional control in patients with NPC. Future research is needed to determine the criteria for replanning for NPC patients undergoing IMRT.

  1. Self-Reported Cognitive Outcomes in Patients With Brain Metastases Before and After Radiation Therapy

    SciTech Connect (OSTI)

    Cole, Ansa Maer; Scherwath, Angela; Ernst, Gundula; Lanfermann, Heinrich; Bremer, Michael; Steinmann, Diana

    2013-11-15

    Purpose: Patients with brain metastases may experience treatment-related cognitive deficits. In this study, we prospectively assessed the self-reported cognitive abilities of patients with brain metastases from any solid primary cancer before and after irradiation of the brain. Methods and Materials: The treatment group (TG) consisted of adult patients (n=50) with brain metastases who received whole or partial irradiation of the brain without having received prior radiation therapy (RT). The control group (CG) consisted of breast cancer patients (n=27) without cranial involvement who were treated with adjuvant RT. Patients were recruited between May 2008 and December 2010. Self-reported cognitive abilities were acquired before RT and 6 weeks, 3 months, and 6 months after irradiation. The information regarding the neurocognitive status was collected by use of the German questionnaires for self-perceived deficits in attention (FEDA) and subjectively experienced everyday memory performance (FEAG). Results: The baseline data showed a high proportion of self-perceived neurocognitive deficits in both groups. A comparison between the TG and the CG regarding the course of self-reported outcomes after RT showed significant between-group differences for the FEDA scales 2 and 3: fatigue and retardation of daily living activities (P=.002) and decrease in motivation (P=.032) with an increase of attention deficits in the TG, but not in the CG. There was a trend towards significance in FEDA scale 1: distractibility and retardation of mental processes (P=.059) between the TG and the CG. The FEAG assessment presented no significant differences. An additional subgroup analysis within the TG was carried out. FEDA scale 3 showed significant differences in the time-related progress between patients with whole-brain RT and those receiving hypofractionated stereotactic RT (P=.025), with less decrease in motivation in the latter group. Conclusion: Self-reported attention declined in patients with brain metastases after RT to the brain, whereas it remained relatively stable in breast cancer patients.

  2. Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease

    SciTech Connect (OSTI)

    Chu, Hee Ho; Kim, Hyo-Cheol Jae, Hwan Jun; Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk; Chung, Jin Wook; Park, Jae Hyung

    2012-12-15

    Purpose: To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases. Methods: Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue. Results: Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients. Conclusion: Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.

  3. Cytogenetic damage in lymphocytes of patients undergoing therapy for small cell lung cancer and ovarian carcinoma

    SciTech Connect (OSTI)

    Padjas, Anna; Lesisz, Dominika; Lankoff, Anna; Banasik, Anna; Lisowska, Halina; Bakalarz, Robert; Gozdz, Stanislaw; Wojcik, Andrzej . E-mail: awojcik@pu.kielce.pl

    2005-12-01

    The level of cytogenetic damage in peripheral blood lymphocytes of patients undergoing chemotherapy has been analyzed incisively 20 years ago. The results showed that the highest level of cytogenetic damage was observed at the end of therapy. In recent years, the doses of anticancer drugs were intensified thanks to the discovery of colony stimulating factors. Therefore, it was interesting to analyze the kinetics of micronuclei formation in lymphocytes of patients undergoing modern chemotherapy. The frequencies of micronuclei were measured in lymphocytes of 6 patients with small cell lung cancer treated with a combination of cisplatin and etoposide and 7 patients with ovarian carcinoma treated with a combination of taxol and cisplatin. 3 patients with lung cancer received radiotherapy in addition to chemotherapy. Micronuclei were analyzed in lymphocytes collected before the start of therapy and 1 day before each following cycle of chemotherapy. The micronucleus frequencies were compared with the kinetics of leukocyte counts. The micronucleus frequencies showed an interindividual variability. On average, the frequencies of micronuclei increased during the first half of therapy and declined thereafter, reaching, in some patients with ovarian carcinoma, values below the pre-treatment level. Leukocyte counts decreased strongly at the beginning of therapy with an upward trend at the end. We suggest that the decline of micronuclei was due to repopulation of lymphocytes and acquired drug resistance.

  4. Percutaneous Cholangioscopy in the Management of Biliary Disease: Experience in 25 Patients

    SciTech Connect (OSTI)

    Hatzidakis, Adam A.; Alexandrakis, George; Kouroumalis, Helias; Gourtsoyiannis, Nicholas C.

    2000-11-15

    Purpose: To present our experience performing percutaneous cholangioscopy in the management of 25 patients with biliary disease.Methods: During the last 3 years, 26 percutaneous cholangioscopies were performed in 25 patients with common bile duct disease (n = 16), intrahepatic ducts disease (n = 6), and gallbladder disease (n = 4). Our patient population group included seven with common bile duct stones, three with intrahepatic lithiasis, and eight with benign strictures (six iatrogenic and two postinflammatory). In four patients malignancy was to be excluded, in two the tumor extent was to be evaluated, whereas in one case the correct placement of a metallic stent needed to be controlled. A 9.9 Fr flexible endoscope URF-P (Olympus, 1.2 mm working channel, 70-cm length) was used.Results: In total, percutaneous cholangioscopy answered 30 diagnostic questions, was technically helpful in 19 cases (performing lithotripsy or biopsy or guiding a wire), and of therapeutic help in 12 (performing stone retrieval). In 24 of 26 cases the therapeutic decision and the patient management changed because of the findings or because of the help of the method. In two cases biliary intervention failed to treat the cause of the disease. No major complication due to the use of the endoscopy was noted.Conclusions: Percutaneous cholangioscopy is a very useful tool in the management of patients with biliary disease. The method can help in diagnosis, in performing complex interventional procedures, and in making or changing therapeutic decisions.

  5. Rhabdomyosarcoma Arising in a Previously Irradiated Field: An Analysis of 43 Patients

    SciTech Connect (OSTI)

    Dang, Nguyen D.; Teh, Bin S.; Paulino, Arnold C.

    2013-03-01

    Patients with soft tissue sarcomas that arise from previously irradiated fields have traditionally been reported to have a poor prognosis. In this report, we examined the characteristics and outcomes of patients who developed a rhabdomyosarcoma in a previously irradiated field (RMS-RIF); we hypothesize that these patients should have a better outcome compared to other postradiation soft tissue sarcomas as these tumors are chemosensitive and radiosensitive. A PubMed search of the literature from 1961-2010 yielded 33 studies with data for patients with RMS-RIF. The study included 43 patients with a median age of 6.5 years at the time of radiation therapy (RT) for the initial tumor. The median RT dose was 48 Gy. The median latency period, the time from RT to development of RMS-RIF, was 8 years. The 3-year overall survival for RMS-RIF was 42%. The 3-year overall survival was 66% for patients receiving chemotherapy and local treatment (surgery and/or RT) compared to 29% for those who had systemic treatment only or local treatment only (P=.049). Other factors associated with increased 3-year overall survival included retinoblastoma initial diagnosis (P<.001), age ?18 years at diagnosis of RMS-RIF (P=.003), favorable site (P=.008), and stage 1 disease (P=.002). Age at time of RMS-RIF, retinoblastoma initial tumor, favorable site, stage 1 disease, and use of both systemic and local treatment were found to be favorable prognostic factors for 3-year overall survival.

  6. Pregnancy Following Uterine Artery Embolization with Polyvinyl Alcohol Particles for Patients with Uterine Fibroid or Adenomyosis

    SciTech Connect (OSTI)

    Kim, Man Deuk Kim, Nahk Keun; Kim, Hee Jin; Lee, Mee Hwa

    2005-06-15

    Purpose:To determine whether uterine fibroid embolization (UFE) with polyvinyl alcohol (PVA) particles affects fertility in women desiring future pregnancy.Methods:Of 288 patients managed with UFE with PVA particles for uterine myoma or adenomyosis between 1998 and 2001, 94 patients were enrolled in this study. The age range of participants was 20-40 years. The data were collected through review of medical records and telephone interviews. Mean duration of follow-up duration was 35 months (range 22-60 months). Patients using contraception and single women were excluded, and the chance of infertility caused by possible spousal infertility or other factors was disregarded. Contrast-enhanced magnetic resonance imaging was performed in all patients before and after UFE, and the size of PVA particles used was 255-700 {mu}m.Results:Among 94 patients who underwent UFE with PVA, 74 were on contraceptives, 6 had been single until the point of interview, and 8 were lost to follow-up. Of the remaining 6 patients who desired future pregnancy, 5 (83%) succeeded in becoming pregnant (1 patient became pregnant twice). Of a total of 8 pregnancies, 6 were planned pregnancies and 2 occurred after contraception failed. Five deliveries were vaginal, and 2 were by elective cesarean. Artificial abortion was performed in 1 case of unplanned pregnancy. There was 1 case of premature rupture of membrane (PROM) followed by preterm labor and delivery of an infant who was small-for-gestational-age. After UFE, mean volume reduction rates of the uterus and fibroid were 36.6% (range 0 to 62.6%) and 69.3% (range 36.3% to 93.3%), respectively.Conclusion:Although the absolute number of cases was small, UFE with PVA particles ultimately did not affect fertility in the women who underwent the procedure.

  7. Insertion of Balloon Retained Gastrostomy Buttons: A 5-Year Retrospective Review of 260 Patients

    SciTech Connect (OSTI)

    Power, Sarah Kavanagh, Liam N.; Shields, Mary C.; Given, Mark F.; Keeling, Aoife N.; McGrath, Frank P.; Lee, Michael J.

    2013-04-15

    Radiologically inserted gastrostomy (RIG) is an established way of maintaining enteral nutrition in patients who cannot maintain nutrition orally. The purpose of this study was to evaluate the safety and efficacy of primary placement of a wide bore button gastrostomy in a large, varied patient population through retrospective review. All patients who underwent gastrostomy placement from January 1, 2004 to January 1, 2009 were identified. 18-Fr gastrostomy buttons (MIC-Key G) were inserted in the majority. Follow-up ranged from 6 months to 4.5 years. A total of 260 patients (M:F 140:120, average age 59.2 years) underwent gastrostomy during the study period. Overall success rate for RIG placement was 99.6 %, with success rate of 95.3 % for primary button insertion. Indications included neurological disorders (70 %), esophageal/head and neck malignancy (21 %), and other indications (9 %). Major and minor complication rates were 1.2 and 12.8 %, respectively. Thirty-day mortality rate was 6.8 %. One third of patients underwent gastrostomy reinsertion during the study period, the main indication for which was inadvertent catheter removal. Patency rate was high at 99.5 %. The maximum number of procedures in any patient was 8 (n = 2), and the average tube dwell time was 125 days. Primary radiological insertion of a wide bore button gastrostomy is a safe technique, with high success rate, high patency rate, and low major complication rate. We believe that it is feasible to attempt button gastrostomy placement in all patients, once tract length is within limits of tube length. If difficulty is encountered, then a standard tube may simply be placed instead.

  8. Initial Clinical Experience Performing Patient Treatment Verification With an Electronic Portal Imaging Device Transit Dosimeter

    SciTech Connect (OSTI)

    Berry, Sean L.; Polvorosa, Cynthia; Cheng, Simon; Deutsch, Israel; Chao, K. S. Clifford; Wuu, Cheng-Shie

    2014-01-01

    Purpose: To prospectively evaluate a 2-dimensional transit dosimetry algorithm's performance on a patient population and to analyze the issues that would arise in a widespread clinical adoption of transit electronic portal imaging device (EPID) dosimetry. Methods and Materials: Eleven patients were enrolled on the protocol; 9 completed and were analyzed. Pretreatment intensity modulated radiation therapy (IMRT) patient-specific quality assurance was performed using a stringent local 3%, 3-mm ? criterion to verify that the planned fluence had been appropriately transferred to and delivered by the linear accelerator. Transit dosimetric EPID images were then acquired during treatment and compared offline with predicted transit images using a global 5%, 3-mm ? criterion. Results: There were 288 transit images analyzed. The overall ? pass rate was 89.1% 9.8% (average 1 SD). For the subset of images for which the linear accelerator couch did not interfere with the measurement, the ? pass rate was 95.7% 2.4%. A case study is presented in which the transit dosimetry algorithm was able to identify that a lung patient's bilateral pleural effusion had resolved in the time between the planning CT scan and the treatment. Conclusions: The EPID transit dosimetry algorithm under consideration, previously described and verified in a phantom study, is feasible for use in treatment delivery verification for real patients. Two-dimensional EPID transit dosimetry can play an important role in indicating when a treatment delivery is inconsistent with the original plan.

  9. Receipt of Guideline-Concordant Treatment in Elderly Prostate Cancer Patients

    SciTech Connect (OSTI)

    Chen, Ronald C., E-mail: Ronald_chen@med.unc.edu [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Carpenter, William R. [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Hendrix, Laura H. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Bainbridge, John [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Wang, Andrew Z. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Nielsen, Matthew E. [Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); and others

    2014-02-01

    Purpose: To examine the proportion of elderly prostate cancer patients receiving guideline-concordant treatment, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Methods and Materials: A total of 29,001 men diagnosed in 2004-2007 with localized prostate cancer, aged 66 to 79 years, were included. We characterized the proportion of men who received treatment concordant with the National Comprehensive Cancer Network guidelines, stratified by risk group and age. Logistic regression was used to examine covariates associated with receipt of guideline-concordant management. Results: Guideline concordance was 79%-89% for patients with low- or intermediate-risk disease. Among high-risk patients, 66.6% of those aged 66-69 years received guideline-concordant management, compared with 51.9% of those aged 75-79 years. Discordance was mainly due to conservative managementno treatment or hormone therapy alone. Among the subgroup of patients aged ?76 years with no measured comorbidity, findings were similar. On multivariable analysis, older age (75-79 vs 66-69 years, odds ratio 0.51, 95% confidence interval 0.50-0.57) was associated with a lower likelihood of guideline concordance for high-risk prostate cancer, but comorbidity was not. Conclusions: There is undertreatment of elderly but healthy patients with high-risk prostate cancer, the most aggressive form of this disease.

  10. The cough response to ultrasonically nebulized distilled water in heart-lung transplantation patients

    SciTech Connect (OSTI)

    Higenbottam, T.; Jackson, M.; Woolman, P.; Lowry, R.; Wallwork, J.

    1989-07-01

    As a result of clinical heart-lung transplantation, the lungs are denervated below the level of the tracheal anastomosis. It has been questioned whether afferent vagal reinnervation occurs after surgery. Here we report the cough frequency, during inhalation of ultrasonically nebulized distilled water, of 15 heart-lung transplant patients studied 6 wk to 36 months after surgery. They were compared with 15 normal subjects of a similar age and sex. The distribution of the aerosol was studied in five normal subjects using /sup 99m/technetium diethylene triamine pentaacetate (/sup 99m/Tc-DTPA) in saline. In seven patients, the sensitivity of the laryngeal mucosa to instilled distilled water (0.2 ml) was tested at the time of fiberoptic bronchoscopy by recording the cough response. Ten percent of the aerosol was deposited onto the larynx and trachea, 56% on the central airways, and 34% in the periphery of the lung. The cough response to the aerosol was strikingly diminished in the patients compared with normal subjects (p less than 0.001), but all seven patients coughed when distilled water was instilled onto the larynx. As expected, the laryngeal mucosa of heart-lung transplant patients remains sensitive to distilled water. However, the diminished coughing when the distilled water is distributed by aerosol to the central airways supports the view that vagal afferent nerves do not reinnervate the lungs after heart-lung transplantation, up to 36 months after surgery.

  11. Predicting objective function weights from patient anatomy in prostate IMRT treatment planning

    SciTech Connect (OSTI)

    Lee, Taewoo Hammad, Muhannad; Chan, Timothy C. Y.; Techna Institute for the Advancement of Technology for Health, 124-100 College Street, Toronto, Ontario M5G 1P5 ; Craig, Tim; Department of Radiation Oncology, University of Toronto, 148-150 College Street, Toronto, Ontario M5S 3S2 ; Sharpe, Michael B.; Department of Radiation Oncology, University of Toronto, 148-150 College Street, Toronto, Ontario M5S 3S2; Techna Institute for the Advancement of Technology for Health, 124-100 College Street Toronto, Ontario M5G 1P5

    2013-12-15

    Purpose: Intensity-modulated radiation therapy (IMRT) treatment planning typically combines multiple criteria into a single objective function by taking a weighted sum. The authors propose a statistical model that predicts objective function weights from patient anatomy for prostate IMRT treatment planning. This study provides a proof of concept for geometry-driven weight determination. Methods: A previously developed inverse optimization method (IOM) was used to generate optimal objective function weights for 24 patients using their historical treatment plans (i.e., dose distributions). These IOM weights were around 1% for each of the femoral heads, while bladder and rectum weights varied greatly between patients. A regression model was developed to predict a patient's rectum weight using the ratio of the overlap volume of the rectum and bladder with the planning target volume at a 1 cm expansion as the independent variable. The femoral head weights were fixed to 1% each and the bladder weight was calculated as one minus the rectum and femoral head weights. The model was validated using leave-one-out cross validation. Objective values and dose distributions generated through inverse planning using the predicted weights were compared to those generated using the original IOM weights, as well as an average of the IOM weights across all patients. Results: The IOM weight vectors were on average six times closer to the predicted weight vectors than to the average weight vector, usingl{sub 2} distance. Likewise, the bladder and rectum objective values achieved by the predicted weights were more similar to the objective values achieved by the IOM weights. The difference in objective value performance between the predicted and average weights was statistically significant according to a one-sided sign test. For all patients, the difference in rectum V54.3 Gy, rectum V70.0 Gy, bladder V54.3 Gy, and bladder V70.0 Gy values between the dose distributions generated by the predicted weights and IOM weights was less than 5 percentage points. Similarly, the difference in femoral head V54.3 Gy values between the two dose distributions was less than 5 percentage points for all but one patient. Conclusions: This study demonstrates a proof of concept that patient anatomy can be used to predict appropriate objective function weights for treatment planning. In the long term, such geometry-driven weights may serve as a starting point for iterative treatment plan design or may provide information about the most clinically relevant region of the Pareto surface to explore.

  12. Is Androgen Deprivation Therapy Necessary in All Intermediate-Risk Prostate Cancer Patients Treated in the Dose Escalation Era?

    SciTech Connect (OSTI)

    Castle, Katherine O.; Hoffman, Karen E.; Levy, Lawrence B.; Lee, Andrew K.; Choi, Seungtaek; Nguyen, Quynh N.; Frank, Steven J.; Pugh, Thomas J.; McGuire, Sean E.; Kuban, Deborah A.

    2013-03-01

    Purpose: The benefit of adding androgen deprivation therapy (ADT) to dose-escalated radiation therapy (RT) for men with intermediate-risk prostate cancer is unclear; therefore, we assessed the impact of adding ADT to dose-escalated RT on freedom from failure (FFF). Methods: Three groups of men treated with intensity modulated RT or 3-dimensional conformal RT (75.6-78 Gy) from 1993-2008 for prostate cancer were categorized as (1) 326 intermediate-risk patients treated with RT alone, (2) 218 intermediate-risk patients treated with RT and ?6 months of ADT, and (3) 274 low-risk patients treated with definitive RT. Median follow-up was 58 months. Recursive partitioning analysis based on FFF using Gleason score (GS), T stage, and pretreatment PSA concentration was applied to the intermediate-risk patients treated with RT alone. The Kaplan-Meier method was used to estimate 5-year FFF. Results: Based on recursive partitioning analysis, intermediate-risk patients treated with RT alone were divided into 3 prognostic groups: (1) 188 favorable patients: GS 6, ?T2b or GS 3+4, ?T1c; (2) 71 marginal patients: GS 3+4, T2a-b; and (3) 68 unfavorable patients: GS 4+3 or T2c disease. Hazard ratios (HR) for recurrence in each group were 1.0, 2.1, and 4.6, respectively. When intermediate-risk patients treated with RT alone were compared to intermediate-risk patients treated with RT and ADT, the greatest benefit from ADT was seen for the unfavorable intermediate-risk patients (FFF, 74% vs 94%, respectively; P=.005). Favorable intermediate-risk patients had no significant benefit from the addition of ADT to RT (FFF, 94% vs 95%, respectively; P=.85), and FFF for favorable intermediate-risk patients treated with RT alone approached that of low-risk patients treated with RT alone (98%). Conclusions: Patients with favorable intermediate-risk prostate cancer did not benefit from the addition of ADT to dose-escalated RT, and their FFF was nearly as good as patients with low-risk disease. In patients with GS 4+3 or T2c disease, the addition of ADT to dose-escalated RT did improve FFF.

  13. Measured dose rate constant from oncology patients administered 18F for positron emission tomography

    SciTech Connect (OSTI)

    Quinn, Brian; Holahan, Brian; Aime, Jean; Humm, John; St Germain, Jean; Dauer, Lawrence T.

    2012-10-15

    Purpose: Patient exposure rate measurements verify published patient dose rate data and characterize dose rates near 2-18-fluorodeoxyglucose ({sup 18}F-FDG) patients. A specific dose rate constant based on patient exposure rate measurements is a convenient quantity that can be applied to the desired distance, injection activity, and time postinjection to obtain an accurate calculation of cumulative external radiation dose. This study reports exposure rates measured at various locations near positron emission tomography (PET) {sup 18}F-FDG patients prior to PET scanning. These measurements are normalized for the amount of administered activity, measurement distance, and time postinjection and are compared with other published data. Methods: Exposure rates were measured using a calibrated ionization chamber at various body locations from 152 adult oncology patients postvoid after a mean uptake time of 76 min following injection with a mean activity of 490 MBq {sup 18}F-FDG. Data were obtained at nine measurement locations for each patient: three near the head, four near the chest, and two near the feet. Results: On contact with, 30 cm superior to and 30 cm lateral to the head, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.482 (0.511), 0.135 (0.155), and 0.193 (0.223) {mu}Sv/MBq h, respectively. On contact with, 30 cm anterior to, 30 cm lateral to and 1 m anterior to the chest, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.623 (0.709), 0.254 (0.283), 0.190 (0.218), and 0.067 (0.081) {mu}Sv/MBq h respectively. 30 cm inferior and 30 cm lateral to the feet, the mean (75th percentile) dose rates per unit injected activity at 60 min postinjection were 0.024 (0.022) and 0.039 (0.044) {mu}Sv/MBq h, respectively. Conclusions: The measurements for this study support the use of 0.092 {mu}Sv m{sup 2}/MBq h as a reasonable representation of the dose rate anterior from the chest of patients immediately following injection. This value can then be reliably scaled to the desired time and distance for planning and staff dose evaluation purposes. At distances closer than 1 m, a distance-specific dose rate constant of 0.367 {mu}Sv/MBq h at 30 cm is recommended for accurate calculations. An accurate patient-specific dose rate constant that accounts for patient-specific variables (e.g., distribution and attenuation) will allow an accurate evaluation of the dose rate from a patient injected with an isotope rather than simply utilizing a physical constant.

  14. Recursive Partitioning Analysis for New Classification of Patients With Esophageal Cancer Treated by Chemoradiotherapy

    SciTech Connect (OSTI)

    Nomura, Motoo; Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya; Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya ; Shitara, Kohei; Kodaira, Takeshi; Kondoh, Chihiro; Takahari, Daisuke; Ura, Takashi; Kojima, Hiroyuki; Kamata, Minoru; Muro, Kei; Sawada, Satoshi

    2012-11-01

    Background: The 7th edition of the American Joint Committee on Cancer staging system does not include lymph node size in the guidelines for staging patients with esophageal cancer. The objectives of this study were to determine the prognostic impact of the maximum metastatic lymph node diameter (ND) on survival and to develop and validate a new staging system for patients with esophageal squamous cell cancer who were treated with definitive chemoradiotherapy (CRT). Methods: Information on 402 patients with esophageal cancer undergoing CRT at two institutions was reviewed. Univariate and multivariate analyses of data from one institution were used to assess the impact of clinical factors on survival, and recursive partitioning analysis was performed to develop the new staging classification. To assess its clinical utility, the new classification was validated using data from the second institution. Results: By multivariate analysis, gender, T, N, and ND stages were independently and significantly associated with survival (p < 0.05). The resulting new staging classification was based on the T and ND. The four new stages led to good separation of survival curves in both the developmental and validation datasets (p < 0.05). Conclusions: Our results showed that lymph node size is a strong independent prognostic factor and that the new staging system, which incorporated lymph node size, provided good prognostic power, and discriminated effectively for patients with esophageal cancer undergoing CRT.

  15. SU-E-T-208: Incidence Cancer Risk From the Radiation Treatment for Acoustic Neuroma Patient

    SciTech Connect (OSTI)

    Kim, D; Chung, W; Shin, D; Yoon, M

    2014-06-01

    Purpose: The present study aimed to compare the incidence risk of a secondary cancer from therapeutic doses in patients receiving intensitymodulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic radiosurgery (SRS). Methods: Four acoustic neuroma patients were treated with IMRT, VMAT, or SRS. Their incidnece excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) were estimated using the corresponding therapeutic doses measured at various organs by radio-photoluminescence glass dosimeters (RPLGD) placed inside a humanoid phantom. Results: When a prescription dose was delivered in the planning target volume of the 4 patients, the average organ equivalent doses (OED) at the thyroid, lung, normal liver, colon, bladder, prostate (or ovary), and rectum were measured. The OED decreased as the distance from the primary beam increased. The thyroid received the highest OED compared to other organs. A LAR were estimated that more than 0.03% of AN patients would get radiation-induced cancer. Conclusion: The tyroid was highest radiation-induced cancer risk after radiation treatment for AN. We found that LAR can be increased by the transmitted dose from the primary beam. No modality-specific difference in radiation-induced cancer risk was observed in our study.

  16. Isolated Spontaneous Dissection of the Common Iliac Artery: Percutaneous Stent Placement in Two Patients

    SciTech Connect (OSTI)

    Kwak, Hyo-Sung; Han, Young-Min Chung, Gyung-Ho; Yu, Hee Chul; Jeong, Yeon-Jun

    2006-10-15

    Isolated spontaneous dissection of the common iliac artery (CIA) is a rare entity. Two patients with this condition were successfully treated by percutaneous stent placement. We emphasize the feasibility of nonsurgical management by percutaneous stent placement for isolated spontaneous dissection of the CIA.

  17. Iliac Artery Stent Placement Relieves Claudication in Patients with Iliac and Superficial Femoral Artery Lesions

    SciTech Connect (OSTI)

    Ichihashi, Shigeo Higashiura, Wataru; Itoh, Hirofumi; Sakaguchi, Shoji; Kichikawa, Kimihiko

    2013-06-15

    Purpose. To evaluate the efficacy of iliac artery stent placement for relief of claudication in patients with both iliac and superficial femoral artery (SFA) lesions. Methods. Stent placement for only iliac artery occlusive disease was performed in 94 limbs (74 patients) with both iliac and SFA occlusive disease on the same limb. All procedures were performed because intermittent claudication did not improve after continuation of antiplatelet medication therapy and home-based exercise for 3 months. Rutherford classification was 2 in 20 limbs and 3 in 74 limbs. Patients with critical limb ischemia were excluded. Median duration of follow-up was 40 months. Primary patency rates of the iliac stent, clinical improvement rates, and risk factors for requiring additional SFA procedures were evaluated. Results. Primary patency rates of the iliac stent at 1, 3, 5, and 7 years were 97, 93, 79, and 79 %, respectively. The initial clinical improvement rate was 87 %. Continued clinical improvement rates at 1, 3, 5, and 7 years were 87, 81, 69, and 66 %, respectively. SFA Trans-Atlantic Inter-Society Consensus (TASC) II C/D lesion was a significant risk factor for requiring additional SFA procedures. Conclusion. Intermittent claudication was relieved by iliac stent placement in most patients with both iliac and SFA lesions. Thus, the indications for treatment of the SFA intended for claudicants should be evaluated after treatment of the iliac lesion.

  18. Delayed Complications in Patients Surviving at Least 3 Years After Stereotactic Radiosurgery for Brain Metastases

    SciTech Connect (OSTI)

    Yamamoto, Masaaki; Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo ; Kawabe, Takuya; Department of Neurosurgery, Kyoto Prefectural University of Medicine Graduate School of Medical Sciences, Kyoto ; Higuchi, Yoshinori; Sato, Yasunori; Nariai, Tadashi; Barfod, Bierta E.; Kasuya, Hidetoshi; Urakawa, Yoichi

    2013-01-01

    Purpose: Little is known about delayed complications after stereotactic radiosurgery in long-surviving patients with brain metastases. We studied the actual incidence and predictors of delayed complications. Patients and Methods: This was an institutional review board-approved, retrospective cohort study that used our database. Among our consecutive series of 2000 patients with brain metastases who underwent Gamma Knife radiosurgery (GKRS) from 1991-2008, 167 patients (8.4%, 89 women, 78 men, mean age 62 years [range, 19-88 years]) who survived at least 3 years after GKRS were studied. Results: Among the 167 patients, 17 (10.2%, 18 lesions) experienced delayed complications (mass lesions with or without cyst in 8, cyst alone in 8, edema in 2) occurring 24.0-121.0 months (median, 57.5 months) after GKRS. The actuarial incidences of delayed complications estimated by competing risk analysis were 4.2% and 21.2% at the 60th month and 120th month, respectively, after GKRS. Among various pre-GKRS clinical factors, univariate analysis demonstrated tumor volume-related factors: largest tumor volume (hazard ratio [HR], 1.091; 95% confidence interval [CI], 1.018-1.154; P=.0174) and tumor volume {<=}10 cc vs >10 cc (HR, 4.343; 95% CI, 1.444-12.14; P=.0108) to be the only significant predictors of delayed complications. Univariate analysis revealed no correlations between delayed complications and radiosurgical parameters (ie, radiosurgical doses, conformity and gradient indexes, and brain volumes receiving >5 Gy and >12 Gy). After GKRS, an area of prolonged enhancement at the irradiated lesion was shown to be a possible risk factor for the development of delayed complications (HR, 8.751; 95% CI, 1.785-157.9; P=.0037). Neurosurgical interventions were performed in 13 patients (14 lesions) and mass removal for 6 lesions and Ommaya reservoir placement for the other 8. The results were favorable. Conclusions: Long-term follow-up is crucial for patients with brain metastases treated with GKRS because the risk of complications long after treatment is not insignificant. However, even when delayed complications occur, favorable outcomes can be expected with timely neurosurgical intervention.

  19. Salvage Radiosurgery for Brain Metastases: Prognostic Factors to Consider in Patient Selection

    SciTech Connect (OSTI)

    Kurtz, Goldie; Zadeh, Gelareh; Gingras-Hill, Geneviève; Millar, Barbara-Ann; Laperriere, Normand J.; Bernstein, Mark; Jiang, Haiyan; Ménard, Cynthia; Chung, Caroline

    2014-01-01

    Purpose: Stereotactic radiosurgery (SRS) is offered to patients for recurrent brain metastases after prior brain radiation therapy (RT), but few studies have evaluated the efficacy of salvage SRS or factors to consider in selecting patients for this treatment. This study reports overall survival (OS), intracranial progression-free survival (PFS), and local control (LC) after salvage SRS, and factors associated with outcomes. Methods and Materials: This is a retrospective review of patients treated from 2009 to 2011 with salvage SRS after prior brain RT for brain metastases. Survival from salvage SRS and from initial brain metastases diagnosis (IBMD) was calculated. Univariate and multivariable (MVA) analyses included age, performance status, recursive partitioning analysis (RPA) class, extracranial disease control, and time from initial RT to salvage SRS. Results: There were 106 patients included in the analysis with a median age of 56.9 years (range 32.5-82 years). A median of 2 metastases were treated per patient (range, 1-12) with a median dose of 21 Gy (range, 12-24) prescribed to the 50% isodose. With a median follow-up of 10.5 months (range, 0.1-68.2), LC was 82.8%, 60.1%, and 46.8% at 6 months, 1 year, and 3 years, respectively. Median PFS was 6.2 months (95% confidence interval [CI] = 4.9-7.6). Median OS was 11.7 months (95% CI = 8.1-13) from salvage SRS, and 22.1 months from IBMD (95% CI = 18.4-26.8). On MVA, age (P=.01; hazard ratio [HR] = 1.04; 95% CI = 1.01-1.07), extracranial disease control (P=.004; HR = 0.46; 95% CI = 0.27-0.78), and interval from initial RT to salvage SRS of at least 265 days (P=.001; HR = 2.46; 95% CI = 1.47-4.09) were predictive of OS. Conclusions: This study demonstrates that patients can have durable local control and survival after salvage SRS for recurrent brain metastases. In particular, younger patients with controlled extracranial disease and a durable response to initial brain RT are likely to benefit from salvage SRS.

  20. Correction for FDG PET dose extravasations: Monte Carlo validation and quantitative evaluation of patient studies

    SciTech Connect (OSTI)

    Silva-Rodrguez, Jess Aguiar, Pablo; Servicio de Medicina Nuclear, Complexo Hospitalario Universidade de Santiago de Compostela , 15782, Galicia; Grupo de Imaxe Molecular, Instituto de Investigacin Sanitarias , Santiago de Compostela, 15706, Galicia ; Snchez, Manuel; Mosquera, Javier; Luna-Vega, Vctor; Corts, Julia; Garrido, Miguel; Pombar, Miguel; Ruibal, lvaro; Grupo de Imaxe Molecular, Instituto de Investigacin Sanitarias , Santiago de Compostela, 15706, Galicia; Fundacin Tejerina, 28003, Madrid

    2014-05-15

    Purpose: Current procedure guidelines for whole body [18F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) state that studies with visible dose extravasations should be rejected for quantification protocols. Our work is focused on the development and validation of methods for estimating extravasated doses in order to correct standard uptake value (SUV) values for this effect in clinical routine. Methods: One thousand three hundred sixty-seven consecutive whole body FDG-PET studies were visually inspected looking for extravasation cases. Two methods for estimating the extravasated dose were proposed and validated in different scenarios using Monte Carlo simulations. All visible extravasations were retrospectively evaluated using a manual ROI based method. In addition, the 50 patients with higher extravasated doses were also evaluated using a threshold-based method. Results: Simulation studies showed that the proposed methods for estimating extravasated doses allow us to compensate the impact of extravasations on SUV values with an error below 5%. The quantitative evaluation of patient studies revealed that paravenous injection is a relatively frequent effect (18%) with a small fraction of patients presenting considerable extravasations ranging from 1% to a maximum of 22% of the injected dose. A criterion based on the extravasated volume and maximum concentration was established in order to identify this fraction of patients that might be corrected for paravenous injection effect. Conclusions: The authors propose the use of a manual ROI based method for estimating the effectively administered FDG dose and then correct SUV quantification in those patients fulfilling the proposed criterion.

  1. Prognostic Factors and Outcome in Askin-Rosai Tumor: A Review of 104 Patients

    SciTech Connect (OSTI)

    Laskar, Siddhartha; Nair, Chandrika; Mallik, Suman; Bahl, Gaurav; Pai, Suresh; Shet, Tanuja; Gupta, Tejpal; Arora, Brijesh; Bakshi, Ashish; Pramesh, C.S.; Mistry, Rajesh; Qureshi, Sajid; Medhi, Seema; Jambhekar, Nirmala; Kurkure, Purna; Banavali, Shripad; Muckaden, Mary Ann

    2011-01-01

    Purpose: To evaluate the prognostic factors and treatment outcome of patients with Askin-Rosai tumor of the chest wall treated at a single institution. Methods and Materials: Treatment comprised multiagent chemotherapy and local therapy, which was either in the form of surgery alone, radical external-beam radiotherapy (EBRT) alone, or a combination of surgery and EBRT. Thirty-two patients (40%) were treated with all three modalities, 21 (27%) received chemotherapy and radical EBRT, and 19 (24%) underwent chemotherapy followed by surgery only. Results: One hundred four consecutive patients aged 3-60 years were treated at the Tata Memorial Hospital from January 1995 to October 2003. Most (70%) were male (male/female ratio, 2.3:1). Asymptomatic swelling (43%) was the most common presenting symptom, and 25% of patients presented with distant metastasis. After a median follow-up of 28 months, local control, disease-free survival, and overall survival rates were 67%, 36%, and 45%, respectively. Median time to relapse was 25 months, and the median survival was 76 months. Multivariate analysis revealed age {>=}18 years, poor response to induction chemotherapy, and presence of pleural effusion as indicators of inferior survival. Fifty-six percent of patients with metastatic disease at presentation died within 1 month of diagnosis, with 6-month and 5-year actuarial survival of 14% and 4%, respectively. Conclusion: Primary tumor size, pleural effusion, response to chemotherapy, and optimal radiotherapy were important prognostic factors influencing outcome. The combination of neoadjuvant chemotherapy, surgery, and radiotherapy resulted in optimal outcome.

  2. The effect of valinomycin in fibroblasts from patients with fatty acid oxidation disorders

    SciTech Connect (OSTI)

    Ndukwe Erlingsson, Uzochi Chimdinma; Iacobazzi, Francesco; Department of Basic Medical Sciences, University of Bari, Piazza Giulio Cesare 11, Policlinico, I-70124 Bari ; Liu, Aiping; Ardon, Orly; Pasquali, Marzia; ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84108; Department of Pathology, University of Utah, Salt Lake City, UT 84132 ; Longo, Nicola; ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT 84108; Department of Pathology, University of Utah, Salt Lake City, UT 84132

    2013-08-09

    Highlights: Valinomycin can cause mitochondrial stress and stimulate fatty acid oxidation. Cells with VLCAD deficiency fail to increase fatty acid oxidation in response to valinomycin. Response to valinomycin can help in the diagnosis of VLCAD deficiency. -- Abstract: Disorders of the carnitine cycle and of the beta oxidation spiral impair the ability to obtain energy from fats at time of fasting and stress. This can result in hypoketotic hypoglycemia, cardiomyopathy, cardiac arrhythmia and other chronic medical problems. The in vitro study of fibroblasts from patients with these conditions is impaired by their limited oxidative capacity. Here we evaluate the capacity of valinomycin, a potassium ionophore that increases mitochondrial respiration, to increase the oxidation of fatty acids in cells from patients with inherited fatty acid oxidation defects. The addition of valinomycin to fibroblasts decreased the accumulation of the lipophilic cation tetraphenylphosphonium (TPP{sup +}) at low concentrations due to the dissipation of the mitochondrial membrane potential. At higher doses, valinomycin increased TPP{sup +} accumulation due to the increased potassium permeability of the plasma membrane and subsequent cellular hyperpolarization. The incubation of normal fibroblasts with valinomycin increased [{sup 14}C]-palmitate oxidation (measured as [{sup 14}C]O{sub 2} release) in a dose-dependent manner. By contrast, valinomycin failed to increase palmitate oxidation in fibroblasts from patients with very long chain acyl CoA dehydrogenase (VLCAD) deficiency. This was not observed in fibroblasts from patients heterozygous for this condition. These results indicate that valinomycin can increase fatty acid oxidation in normal fibroblasts and could be useful to differentiate heterozygotes from patients affected with VLCAD deficiency.

  3. SU-E-J-191: Automated Detection of Anatomic Changes in H'N Patients

    SciTech Connect (OSTI)

    Usynin, A; Ramsey, C [Thompson Cancer Survival Center Knoxville, TN (United States)

    2014-06-01

    Purpose: To develop a novel statistics-based method for automated detection of anatomical changes using cone-beam CT data. A method was developed that can provide a reliable and automated early warning system that enables a just-in-time adaptation of the treatment plan. Methods: Anatomical changes were evaluated by comparing the original treatment planning CT with daily CBCT images taken prior treatment delivery. The external body contour was computed on a given CT slice and compared against the corresponding contour on the daily CBCT. In contrast to threshold-based techniques, a statistical approach was employed to evaluate the difference between the contours using a given confidence level. The detection tool used the two-sample Kolmogorov-Smirnov test, which is a non-parametric technique that compares two samples drawn from arbitrary probability distributions. 11 H'N patients were retrospectively selected from a clinical imaging database with a total of 186 CBCT images. Six patients in the database were confirmed to have anatomic changes during the course of radiotherapy. Five of the H'N patients did not have significant changes. The KS test was applied to the contour data using a sliding window analysis. The confidence level of 0.99 was used to moderate false detection. Results: The algorithm was able to correctly detect anatomical changes in 6 out of 6 patients with an excellent spatial accuracy as early as at the 14th elapsed day. The algorithm provided a consistent and accurate delineation of the detected changes. The output of the anatomical change tool is easy interpretable, and can be shown overlaid on a 3D rendering of the patient's anatomy. Conclusion: The detection method provides the basis for one of the key components of Adaptive Radiation Therapy. The method uses tools that are readily available in the clinic, including daily CBCT imaging, and image co-registration facilities.

  4. TH-C-18A-09: Exam and Patient Parameters Affecting the DNA Damage Response Following CT Studies

    SciTech Connect (OSTI)

    Elgart, S; Adibi, A; Bostani, M; Ruehm, S; Enzmann, D; McNitt-Gray, M; Iwamoto, K

    2014-06-15

    Purpose: To identify exam and patient parameters affecting the biological response to CT studies using in vivo and ex vivo blood samples. Methods: Blood samples were collected under IRB approval from 16 patients undergoing clinically-indicated CT exams. Blood was procured prior to, immediately after and 30minutes following irradiation. A sample of preexam blood was placed on the patient within the exam region for ex vivo analysis. Whole blood samples were fixed immediately following collection and stained for ?H2AX to assess DNA damage response (DDR). Median fluorescence of treated samples was compared to non-irradiated control samples for each patient. Patients were characterized by observed biological kinetic response: (a) fast phosphorylation increased by 2minutes and fell by 30minutes, (b) slow phosphorylation continued to increase to 30minutes and (c) none little change was observed or irradiated samples fell below controls. Total dose values were normalized to exam time for an averaged dose-rate in dose/sec for each exam. Relationships between patient biological responses and patient and exam parameters were investigated. Results: A clearer dose response at 30minutes is observed for young patients (<61yoa; R2>0.5) compared to old patients (>61yoa; R{sup 2}<0.11). Fast responding patients were significantly younger than slow responding patients (p<0.05). Unlike in vivo samples, age did not significantly affect the patient response ex vivo. Additionally, fast responding patients received exams with significantly smaller dose-rate than slow responding patients (p<0.05). Conclusion: Age is a significant factor in the biological response suggesting that DDR may be more rapid in a younger population and slower as the population ages. Lack of an agerelated response ex vivo suggests a systemic response to radiation not present when irradiated outside the body. Dose-rate affects the biological response suggesting that patient response may be related to scan timing and dose delivery within an exam protocol. All authors receive(d) funding from a Master Research Agreement from Siemens Healthcare with UCLA Radiological Sciences.

  5. Internet-Based Survey Evaluating Use of Pain Medications and Attitudes of Radiation Oncology Patients Toward Pain Intervention

    SciTech Connect (OSTI)

    Simone, Charles B. Vapiwala, Neha; Hampshire, Margaret K.; Metz, James M.

    2008-09-01

    Purpose: Pain is a common symptom among cancer patients, yet many patients do not receive adequate pain management. Few data exist quantifying analgesic use by radiation oncology patients. This study evaluated the causes of pain in cancer patients and investigated the reasons patients fail to receive optimal analgesic therapy. Methods and Materials: An institutional review board-approved, Internet-based questionnaire assessing analgesic use and pain control was posted on the OncoLink (available at (www.oncolink.org)) Website. Between November 2005 and April 2006, 243 patients responded. They were predominantly women (73%), white (71%), and educated beyond high school (67%) and had breast (38%), lung (6%), or ovarian (6%) cancer. This analysis evaluated the 106 patients (44%) who underwent radiotherapy. Results: Of the 106 patients, 58% reported pain from their cancer treatment, and 46% reported pain directly from their cancer. The pain was chronic in 51% and intermittent in 33%. Most (80%) did not use medication to manage their pain. Analgesic use was significantly less in patients with greater education levels (11% vs. 36%, p = 0.002), with a trend toward lower use by whites (16% vs. 32%, p 0.082) and women (17% vs. 29%, p = 0.178). The reasons for not taking analgesics included healthcare provider not recommending medication (87%), fear of addiction or dependence (79%), and inability to pay (79%). Participants experiencing pain, but not taking analgesics, pursued alternative therapies for relief. Conclusions: Many radiation oncology patients experience pain from their disease and cancer treatment. Most study participants did not use analgesics because of concerns of addiction, cost, or failure of the radiation oncologist to recommend medication. Healthcare providers should have open discussions with their patients regarding pain symptoms and treatment.

  6. Prospective Assessment of Optimal Individual Position (Prone Versus Supine) for Breast Radiotherapy: Volumetric and Dosimetric Correlations in 100 Patients

    SciTech Connect (OSTI)

    Lymberis, Stella C.; Wyngaert, John Keith de; Parhar, Preeti; Chhabra, Arpit M.; Fenton-Kerimian, Maria; Chang Jengwha; Hochman, Tsivia; Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York ; Guth, Amber; Roses, Daniel; Goldberg, Judith D.; Department of Environmental Medicine, New York University School of Medicine and Langone Medical Center, New York, New York ; Formenti, Silvia C.

    2012-11-15

    Purpose: Damage to heart and lung from breast radiotherapy is associated with increased cardiovascular mortality and lung cancer development. We conducted a prospective study to evaluate which position is best to spare lung and heart from radiotherapy exposure. Methods and Materials: One hundred consecutive Stage 0-IIA breast cancer patients consented to participate in a research trial that required two computed tomography simulation scans for planning both supine and prone positions. The optimal position was defined as that which best covered the contoured breast and tumor bed while it minimized critical organ irradiation, as quantified by the in-field heart and lung volume. The trial was designed to plan the first 100 patients in each position to study correlations between in-field volumes of organs at risk and dose. Results: Fifty-three left and 47 right breast cancer patients were consecutively accrued to the trial. In all patients, the prone position was optimal for sparing lung volume compared to the supine setup (mean lung volume reduction was 93.5 cc for right and 103.6 cc for left breast cancer patients). In 46/53 (87%) left breast cancer patients best treated prone, in-field heart volume was reduced by a mean of 12 cc and by 1.8 cc for the other 7/53 (13%) patients best treated supine. As predicted, supine-prone differences in in-field volume and mean dose of heart and lung were highly correlated (Spearman's correlation coefficient for left breast cancer patients was 0.90 for heart and 0.94 for lung and 0.92 for right breast cancer patients for lung). Conclusions: Prone setup reduced the amount of irradiated lung in all patients and reduced the amount of heart volume irradiated in 87% of left breast cancer patients. In-field organ volume is a valid surrogate for predicting dose; the trial continued to the planned target of 400.

  7. WE-D-BRE-03: Late Toxicity Following Photon Or Proton Radiotherapy in Patients with Brain Tumors

    SciTech Connect (OSTI)

    Munbodh, R; Ding, X; Yin, L; Anamalayil, S; Dorsey, J; Lustig, R; Alonso-Basanta, M

    2014-06-15

    Purpose: To identify indicators of Late Grade 3 (LG3) toxicity, late vision and hearing changes in patients treated for primary brain tumors with photon (XRT) or proton radiotherapy (PRT). Methods: We retrospectively reviewed 102 patients who received brain XRT or PRT to doses of 54 or 59.6 Gy in daily fractions of 1.8–2 Gy. Of the 80 patients (34 XRT, 39 PRT and 7 both modalities) reviewed for indicators of LG3 toxicity, 25 developed LG3 toxicity 90 to 500 days after radiotherapy completion. 55 patients had less than LG3 toxicity > 500 days after treatment. In that time, late vision and hearing changes were seen in 44 of 75 and 25 of 78 patients, respectively. The correlation between late toxicity and prescription dose, planning target volume (PTV) size, and doses to the brainstem, brain, optic chiasm, optic nerves, eyes and cochlea was evaluated. A two-tailed Fisher's exact test and Wilcoxon rank sum test were used for the statistical analysis for XRT, PRT and all patients combined. Results: Exceeding the 54 Gy-5% dose-volume brainstem constraint, but not the optic structure constraints, was significantly correlated (p < 0.05) with late vision changes in all three groups. Exceeding maximum and mean cochlear doses of 45 and 30 Gy, respectively, was a significant indicator of hearing changes (p < 0.05) in PRT patients and all patients combined. In a sub-group of 52 patients in whom the brain was contoured, the absolute brain volume receiving ≤ 50 Gy and > 60 Gy was significantly larger in patients with LG3 toxicity for all patients combined (p < 0.05). Prescription dose, brainstem dose and PTV volume were not correlated to LG3 toxicity. Conclusion: Our results indicate the importance of minimizing the brain volume irradiated, and brainstem and cochlea doses to reduce the risk of late toxicities following brain radiotherapy.

  8. Locoregional Recurrence of Breast Cancer in Patients Treated With Breast Conservation Surgery and Radiotherapy Following Neoadjuvant Chemotherapy

    SciTech Connect (OSTI)

    Min, Sun Young; Lee, Seung Ju; Shin, Kyung Hwan; Park, In Hae; Jung, So-Youn; Lee, Keun Seok; Ro, Jungsil; Lee, Seeyoun; Kim, Seok Won; Kim, Tae Hyun; Kang, Han-Sung; Cho, Kwan Ho

    2011-12-01

    Purpose: Breast conservation surgery (BCS) and radiotherapy (RT) following neoadjuvant chemotherapy (NCT) have been linked with high locoregional recurrence (LRR) rates and ipsilateral breast tumor recurrence (IBTR) rates. The purpose of this study was to analyze clinical outcomes in patients who exhibited LRR and IBTR after being treated by BCS and RT following NCT. Methods and Materials: In total, 251 breast cancer patients treated with BCS and RT following NCT between 2001 and 2006 were included. All patients had been shown to be clinically node-positive. Clinical stage at diagnosis (2003 AJCC) was II in 68% of patients and III in 32% of patients. Of those, 50%, 35%, and 15% of patients received anthracycline-based, taxane-based, and combined anthracycline-taxane NCT, respectively. All patients received RT. Results: During follow-up (median, 55 months), 26 (10%) patients had LRR, 19 of these patients had IBTR. Five-year actuarial rates of IBTR-free and LRR-free survival were 91% and 89%, respectively. In multivariate analyses, lack of hormone suppression therapy was found to increase both LRR and IBTR rates. Hazard ratios were 7.99 (p < 0.0001) and 4.22 (p = 0.004), respectively. Additionally, pathology stage N2 to N3 increased LRR rate (hazard ratio, 4.22; p = 0.004), and clinical AJCC stage III IBTR rate (hazard ratio, 9.05; p = 0.034). Achievement of pathological complete response and presence of multifocal tumors did not affect LRR or IBTR. Conclusions: In patients with locally advanced disease, who were clinically node-positive at presentation, BCS after NCT resulted in acceptably low rates of IBTR and LRR. Mastectomy should be considered as an option in patients who present with clinical stage III tumors or who are not treated with adjuvant hormone suppression therapy, because they exhibit high IBTR rates after NCT and BCS.

  9. A New Prognostic Index and Comparison to Three Other Indices for Patients With Brain Metastases: An Analysis of 1,960 Patients in the RTOG Database

    SciTech Connect (OSTI)

    Sperduto, Paul W. Berkey, Brian M.S.; Gaspar, Laurie E.; Mehta, Minesh; Curran, Walter

    2008-02-01

    Purpose: The purpose of this study is to introduce a new prognostic index for patients with brain metastases and compare it with three published indices. Treatment for brain metastases varies widely. A sound prognostic index is thus important to guide both clinical decision making and outcomes research. Methods and Materials: A new index was developed because of limitations in the three existing indices and new data (Radiation Therapy Oncology Group 9508) are available since the others were developed. All four indices were compared using the Radiation Therapy Oncology Group database of 1,960 patients with brain metastases from five randomized trials. The ability of the four indices to distinguish its separate classes was determined statistically. Advantages and disadvantages of each index are discussed. Results: Recursive partitioning analysis (RPA) and the new Graded Prognostic Assessment (GPA) had the most statistically significant differences between classes (p < 0.001 for all classes). Conclusions: The new index, the GPA, is as prognostic as the RPA and more prognostic than the other indices. The GPA is the least subjective, most quantitative and easiest to use of the four indices. Future clinical trials should compare the GPA with the RPA to prospectively validate these findings.

  10. Genomic Prostate Cancer Classifier Predicts Biochemical Failure and Metastases in Patients After Postoperative Radiation Therapy

    SciTech Connect (OSTI)

    Den, Robert B.; Feng, Felix Y.; Showalter, Timothy N.; Mishra, Mark V.; Trabulsi, Edouard J.; Lallas, Costas D.; Gomella, Leonard G.; Kelly, W. Kevin; Birbe, Ruth C.; McCue, Peter A.; Ghadessi, Mercedeh; Yousefi, Kasra; Davicioni, Elai; Knudsen, Karen E.; Dicker, Adam P.

    2014-08-01

    Purpose: Totest the hypothesis that a genomic classifier (GC) would predict biochemical failure (BF) and distant metastasis (DM) in men receiving radiation therapy (RT) after radical prostatectomy (RP). Methods and Materials: Among patients who underwent post-RP RT, 139 were identified for pT3 or positive margin, who did not receive neoadjuvant hormones and had paraffin-embedded specimens. Ribonucleic acid was extracted from the highest Gleason grade focus and applied to a high-density-oligonucleotide microarray. Receiver operating characteristic, calibration, cumulative incidence, and Cox regression analyses were performed to assess GC performance for predicting BF and DM after post-RP RT in comparison with clinical nomograms. Results: Thearea under the receiver operating characteristic curve of the Stephenson model was 0.70 for both BF and DM, with addition of GC significantly improving area under the receiver operating characteristic curve to 0.78 and 0.80, respectively. Stratified by GC risk groups, 8-year cumulative incidence was 21%, 48%, and 81% for BF (P<.0001) and for DM was 0, 12%, and 17% (P=.032) for low, intermediate, and high GC, respectively. In multivariable analysis, patients with high GC had a hazard ratio of 8.1 and 14.3 for BF and DM. In patients with intermediate or high GC, those irradiated with undetectable prostate-specific antigen (PSA ?0.2ng/mL) had median BF survival of >8years, compared with <4years for patients with detectable PSA (>0.2ng/mL) before initiation of RT. At 8years, the DM cumulative incidence for patients with high GC and RT with undetectable PSA was 3%, compared with 23% with detectable PSA (P=.03). No outcome differences were observed for low GC between the treatment groups. Conclusion: The GC predicted BF and metastasis after post-RP irradiation. Patients withlower GC risk may benefit from delayed RT, as opposed to those with higher GC; however, this needs prospective validation. Genomic-based models may be useful forimproved decision-making for treatment of high-risk prostate cancer.

  11. A Novel Carotid Device for Embolic Diversion: Lessons Learned from a 'First in Man' Trial in Patients with Atrial Fibrillation

    SciTech Connect (OSTI)

    Sievert, Horst Franke, Jennifer; Grad, Ygael; Nishri, Boaz; Assaf, Yaron; Yodfat, Ofer; Roemer, Albrecht; Robertson, Greg C.; Stone, Gregg W.

    2012-04-15

    Purpose: This study was designed to investigate a novel device that was developed to direct emboli away from the internal carotid artery to the external carotid artery to prevent embolic stroke while avoiding the necessity for anticoagulation with warfarin. Methods: A stent-like, self-expandable filter was developed consisting of fine cobalt alloy mesh. After promising preclinical animal testing, the device was implanted into the common carotid artery extending into the external carotid artery in three patients with atrial fibrillation, each of whom were at high-risk for cerebral emboli and were suboptimal candidates for anticoagulation. Follow-up was performed clinically and with carotid duplex ultrasound. Results: The implantation was successful in all three patients. Unrestricted flow through the filter was demonstrated in each patient at 6 months by duplex sonography. However, at 7 months ultrasound demonstrated occlusion of the internal carotid artery filter in one patient, which was subsequently confirmed by angiography. Subtotal filter occlusion occurred in a second patient at 14 months. Neither patient had clinical symptoms. Both internal carotid arteries were successfully recanalized using standard angioplasty techniques without complication. The third patient had completely normal carotid blood flow at 29 months follow-up. Conclusions: Implantation of a novel device intended to divert emboli away from the internal carotid artery was feasible, but resulted in occlusive neointimal proliferation in two of three patients. These results demonstrate a discrepancy from the findings of preclinical animal studies and human investigation.

  12. RTOG 0211: A Phase 1/2 Study of Radiation Therapy With Concurrent Gefitinib for Newly Diagnosed Glioblastoma Patients

    SciTech Connect (OSTI)

    Chakravarti, Arnab; Wang, Meihua; Robins, H. Ian; Lautenschlaeger, Tim; Curran, Walter J.; Brachman, David G.; Schultz, Christopher J.; Choucair, Ali; Dolled-Filhart, Marisa; Christiansen, Jason; Gustavson, Mark; Molinaro, Annette; Ludwig Institute for Cancer Research, University of CaliforniaSan Diego, La Jolla, California ; Mischel, Paul; Dicker, Adam P.; and others

    2013-04-01

    Purpose: To determine the safety and efficacy of gefitinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, in combination with radiation for newly diagnosed glioblastoma (GBM) patients. Methods and Materials: Between March 21, 2002, and May 3, 2004, Radiation Therapy Oncology Group (RTOG) 0211 enrolled 31 and 147 GBM patients in the phase 1 and 2 arms, respectively. Treatment consisted of daily oral gefinitnib started at the time of conventional cranial radiation therapy (RT) and continued post RT for 18 months or until progression. Tissue microarrays from 68 cases were analyzed for EGFR expression. Results: The maximum tolerated dose (MTD) of gefitinib was determined to be 500 mg in patients on non-enzyme-inducing anticonvulsant drugs (non-EIAEDs). All patients in the phase 2 component were treated at a gefitinib dose of 500 mg; patients receiving EIADSs could be escalated to 750 mg. The most common side effects of gefitinib in combination with radiation were dermatologic and gastrointestinal. Median survival was 11.5 months for patients treated per protocol. There was no overall survival benefit for patients treated with gefitinib + RT when compared with a historical cohort of patients treated with RT alone, matched by RTOG recursive partitioning analysis (RPA) class distribution. Younger age was significantly associated with better outcome. Per protocol stratification, EGFR expression was not found to be of prognostic value for gefitinib + RT-treated patients. Conclusions: The addition of gefitinib to RT is well tolerated. Median survival of RTOG 0211 patients treated with RT with concurrent and adjuvant gefitinib was similar to that in a historical control cohort treated with radiation alone.

  13. Cosmetic Outcomes and Complications Reported by Patients Having Undergone Breast-Conserving Treatment

    SciTech Connect (OSTI)

    Hill-Kayser, Christine E.; Vachani, Carolyn; Hampshire, Margaret K.; Di Lullo, Gloria A.; Metz, James M.

    2012-07-01

    Purpose: Over the past 30 years, much work in treatment of breast cancer has contributed to improvement of cosmetic and functional outcomes. The goal of breast-conservation treatment (BCT) is avoidance of mastectomy through use of lumpectomy and adjuvant radiation. Modern data demonstrate 'excellent' or 'good' cosmesis in >90% of patients treated with BCT. Methods and Materials: Patient-reported data were gathered via a convenience sample frame from breast cancer survivors using a publically available, free, Internet-based tool for creation of survivorship care plans. During use of the tool, breast cancer survivors are queried as to the cosmetic appearance of the treated breast, as well as perceived late effects. All data have been maintained anonymously with internal review board approval. Results: Three hundred fifty-four breast cancer survivors having undergone BCT and voluntarily using this tool were queried with regard to breast cosmesis and perceived late effects. Median diagnosis age was 48 years, and median current age 52 years. 'Excellent' cosmesis was reported by 27% (n = 88), 'Good' by 44% (n = 144), 'Fair' by 24% (n = 81), and 'Poor' by 5% (n = 18). Of the queries posted to survivors after BCT, late effects most commonly reported were cognitive changes (62%); sexual concerns (52%); changes in texture and color of irradiated skin (48%); chronic pain, numbness, or tingling (35%); and loss of flexibility in the irradiated area (30%). Survivors also described osteopenia/osteoporosis (35%), cardiopulmonary problems (12%), and lymphedema (19%). Conclusions: This anonymous tool uses a convenience sample frame to gather patient reported assessments of cosmesis and complications after breast cancer. Among the BCT population, cosmetic assessment by survivors appears less likely to be 'excellent' or 'good' than would be expected, with 30% of BCT survivors reporting 'fair' or 'poor' cosmesis. Patient reported incidence of chronic pain, as well as cognitive and sexual changes, also appears higher than expected.

  14. Redox Protein Expression Predicts Radiotherapeutic Response in Early-Stage Invasive Breast Cancer Patients

    SciTech Connect (OSTI)

    Woolston, Caroline M.; Al-Attar, Ahmad; Storr, Sarah J.; Ellis, Ian O.; Morgan, David A.L.; Martin, Stewart G.

    2011-04-01

    Purpose: Early-stage invasive breast cancer patients have commonly undergone breast-conserving surgery and radiotherapy. In a large majority of these patients, the treatment is effective; however, a proportion will develop local recurrence. Deregulated redox systems provide cancer cells protection from increased oxidative stress, such as that induced by ionizing radiation. Therefore, the expression of redox proteins was examined in tumor specimens from this defined cohort to determine whether such expression could predict response. Methods and Materials: The nuclear and cytoplasmic expression of nine redox proteins (glutathione, glutathione reductase, glutaredoxin, glutathione peroxidase 1, 3, and 4, and glutathione S-transferase-{theta}, -{pi}, and -{alpha}) was assessed using conventional immunohistochemistry on a tissue microarray of 224 tumors. Results: A high cytoplasmic expression of glutathione S-transferase-{theta} significantly correlated with a greater risk of local recurrence (p = .008) and, when combined with a low nuclear expression (p = .009), became an independent predictive factor (p = .002) for local recurrence. High cytoplasmic expression of glutathione S-transferase-{theta} also correlated with a worse overall survival (p = .009). Low nuclear and cytoplasmic expression of glutathione peroxidase 3 (p = .002) correlated with a greater risk of local recurrence and was an independent predictive factor (p = .005). These proteins did not correlate with tumor grade, suggesting their function might be specific to the regulation of oxidative stress rather than alterations of tumor phenotype. Only nuclear (p = .005) and cytoplasmic (p = .001) expression of glutathione peroxidase 4 correlated with the tumor grade. Conclusions: Our results support the use of redox protein expression, namely glutathione S-transferase-{theta} and glutathione peroxidase 3, to predict the response to radiotherapy in early-stage breast cancer patients. If incorporated into routine diagnostic tests, they have the potential to aid clinicians in their stratification of patients into more tailored treatment regimens. Future targeted therapies to these systems might improve the efficacy of reactive oxygen species-inducing therapies, such as radiotherapy.

  15. Evaluation of atlas-based auto-segmentation software in prostate cancer patients

    SciTech Connect (OSTI)

    Greenham, Stuart; Dean, Jenna; Fu, Cheuk Kuen Kenneth; Goman, Joanne; Mulligan, Jeremy; Tune, Deanna; Sampson, David; Westhuyzen, Justin; McKay, Michael

    2014-09-15

    The performance and limitations of an atlas-based auto-segmentation software package (ABAS; Elekta Inc.) was evaluated using male pelvic anatomy as the area of interest. Contours from 10 prostate patients were selected to create atlases in ABAS. The contoured regions of interest were created manually to align with published guidelines and included the prostate, bladder, rectum, femoral heads and external patient contour. Twenty-four clinically treated prostate patients were auto-contoured using a randomised selection of two, four, six, eight or ten atlases. The concordance between the manually drawn and computer-generated contours were evaluated statistically using Pearson's productmoment correlation coefficient (r) and clinically in a validated qualitative evaluation. In the latter evaluation, six radiation therapists classified the degree of agreement for each structure using seven clinically appropriate categories. The ABAS software generated clinically acceptable contours for the bladder, rectum, femoral heads and external patient contour. For these structures, ABAS-generated volumes were highly correlated with as treated volumes, manually drawn; for four atlases, for example, bladder r = 0.988 (P < 0.001), rectum r = 0.739 (P < 0.001) and left femoral head r = 0.560 (P < 0.001). Poorest results were seen for the prostate (r = 0.401, P < 0.05) (four atlases); however this was attributed to the comparison prostate volume being contoured on magnetic resonance imaging (MRI) rather than computed tomography (CT) data. For all structures, increasing the number of atlases did not consistently improve accuracy. ABAS-generated contours are clinically useful for a range of structures in the male pelvis. Clinically appropriate volumes were created, but editing of some contours was inevitably required. The ideal number of atlases to improve generated automatic contours is yet to be determined.

  16. Radiation-induced complications in prostate cancer patients treated with radiotherapy

    SciTech Connect (OSTI)

    Azuddin, A. Yusof; Rahman, I. Abdul; Mohamed, F.; Siah, N. J.; Saadc, M.; Ismail, F.

    2014-09-03

    The purpose of the study is to determine the relationship between radiation-induced complications with dosimetric and radiobiological parameters for prostate cancer patients that underwent the conformal radiotherapy treatment. 17 prostate cancer patients that have been treated with conformal radiotherapy were retrospectively analysed. The dosimetric data was retrieved in the form of dose-volume histogram (DVH) from Radiotherapy Treatment Planning System. The DVH was utilised to derived Normal Tissue Complication Probability (NTCP) in radiobiological data. Follow-up data from medical records were used to grade the occurrence of acute gastrointestinal (GI) and genitourinary (GU) complications using Radiation Therapy Oncology Group (RTOG) scoring system. The chi-square test was used to determine the relationship between radiation-induced complication with dosimetric and radiobiological parameters. 8 (47%) and 7 (41%) patients were having acute GI and GU complications respectively. The acute GI complication can be associated with V60{sub rectum}, rectal mean dose and NTCP{sub rectum} with p-value of 0.016, 0.038 and 0.049 respectively. There are no significant relationships of acute GU complication with dosimetric and radiobiological variables. Further study can be done by increase the sample size and follow up duration for deeper understanding of the factors that effecting the GU and GI complication in prostate cancer radiotherapy.

  17. Survival analysis of colorectal cancer patients with tumor recurrence using global score test methodology

    SciTech Connect (OSTI)

    Zain, Zakiyah Ahmad, Yuhaniz; Azwan, Zairul E-mail: farhanaraduan@gmail.com Raduan, Farhana E-mail: farhanaraduan@gmail.com Sagap, Ismail E-mail: farhanaraduan@gmail.com; Aziz, Nazrina

    2014-12-04

    Colorectal cancer is the third and the second most common cancer worldwide in men and women respectively, and the second in Malaysia for both genders. Surgery, chemotherapy and radiotherapy are among the options available for treatment of patients with colorectal cancer. In clinical trials, the main purpose is often to compare efficacy between experimental and control treatments. Treatment comparisons often involve several responses or endpoints, and this situation complicates the analysis. In the case of colorectal cancer, sets of responses concerned with survival times include: times from tumor removal until the first, the second and the third tumor recurrences, and time to death. For a patient, the time to recurrence is correlated to the overall survival. In this study, global score test methodology is used in combining the univariate score statistics for comparing treatments with respect to each survival endpoint into a single statistic. The data of tumor recurrence and overall survival of colorectal cancer patients are taken from a Malaysian hospital. The results are found to be similar to those computed using the established Wei, Lin and Weissfeld method. Key factors such as ethnic, gender, age and stage at diagnose are also reported.

  18. Impact of Radiotherapy on Fertility, Pregnancy, and Neonatal Outcomes in Female Cancer Patients

    SciTech Connect (OSTI)

    Wo, Jennifer Y.; Viswanathan, Akila N.

    2009-04-01

    Purpose: Radiation has many potential long-term effects on cancer survivors. Female cancer patients may experience decreased fertility depending on the site irradiated. Oncologists should be aware of these consequences and discuss options for fertility preservation before initiating therapy. Methods and Materials: A comprehensive review of the existing literature was conducted. Studies reporting the outcomes for female patients treated with cranio-spinal, abdominal, or pelvic radiation reporting fertility, pregnancy, or neonatal-related outcomes were reviewed. Results: Cranio-spinal irradiation elicited significant hormonal changes in women that affected their ability to become pregnant later in life. Women treated with abdomino-pelvic radiation have an increased rate of uterine dysfunction leading to miscarriage, preterm labor, low birth weight, and placental abnormalities. Early menopause results from low-dose ovarian radiation. Ovarian transposition may decrease the rates of ovarian dysfunction. Conclusions: There is a dose-dependent relationship between ovarian radiation therapy (RT) and premature menopause. Patients treated with RT must be aware of the impact of treatment on fertility and explore appropriate options.

  19. SU-E-J-128: 3D Surface Reconstruction of a Patient Using Epipolar Geometry

    SciTech Connect (OSTI)

    Kotoku, J; Nakabayashi, S; Kumagai, S; Ishibashi, T; Kobayashi, T; Haga, A; Saotome, N; Arai, N

    2014-06-01

    Purpose: To obtain a 3D surface data of a patient in a non-invasive way can substantially reduce the effort for the registration of patient in radiation therapy. To achieve this goal, we introduced the multiple view stereo technique, which is known to be used in a 'photo tourism' on the internet. Methods: 70 Images were taken with a digital single-lens reflex camera from different angles and positions. The camera positions and angles were inferred later in the reconstruction step. A sparse 3D reconstruction model was locating by SIFT features, which is robust for rotation and shift variance, in each image. We then found a set of correspondences between pairs of images by computing the fundamental matrix using the eight-point algorithm with RANSAC. After the pair matching, we optimized the parameter including camera positions to minimize the reprojection error by use of bundle adjustment technique (non-linear optimization). As a final step, we performed dense reconstruction and associate a color with each point using the library of PMVS. Results: Surface data were reconstructed well by visual inspection. The human skin is reconstructed well, althogh the reconstruction was time-consuming for direct use in daily clinical practice. Conclusion: 3D reconstruction using multi view stereo geometry is a promising tool for reducing the effort of patient setup. This work was supported by JSPS KAKENHI(25861128)

  20. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Five-year Results of 100 Patients

    SciTech Connect (OSTI)

    Formenti, Silvia C.; Hsu, Howard; Fenton-Kerimian, Maria; Roses, Daniel; Guth, Amber; Jozsef, Gabor; Goldberg, Judith D.; DeWyngaert, J. Keith

    2012-11-01

    Purpose: To report the 5-year results of a prospective trial of three-dimensional conformal external beam radiotherapy (3D-CRT) to deliver accelerated partial breast irradiation in the prone position. Methods and Materials: Postmenopausal patients with Stage I breast cancer with nonpalpable tumors <2 cm, negative margins and negative nodes, positive hormone receptors, and no extensive intraductal component were eligible. The trial was offered only after eligible patients had refused to undergo standard whole-breast radiotherapy. Patients were simulated and treated on a dedicated table for prone setup. 3D-CRT was delivered at a dose of 30 Gy in five 6-Gy/day fractions over 10 days with port film verification at each treatment. Rates of ipsilateral breast failure, ipsilateral nodal failure, contralateral breast failure, and distant failure were estimated using the cumulative incidence method. Rates of disease-free, overall, and cancer-specific survival were recorded. Results: One hundred patients were enrolled in this institutional review board-approved prospective trial, one with bilateral breast cancer. One patient withdrew consent after simulation, and another patient elected to interrupt radiotherapy after receiving two treatments. Ninety-eight patients were evaluable for toxicity, and, in 1 case, both breasts were treated with partial breast irradiation. Median patient age was 68 years (range, 53-88 years); in 55% of patients the tumor size was <1 cm. All patients had hormone receptor-positive cancers: 87% of patients underwent adjuvant antihormone therapy. At a median follow-up of 64 months (range, 2-125 months), there was one local recurrence (1% ipsilateral breast failure) and one contralateral breast cancer (1% contralateral breast failure). There were no deaths due to breast cancer by 5 years. Grade 3 late toxicities occurred in 2 patients (one breast edema, one transient breast pain). Cosmesis was rated good/excellent in 89% of patients with at least 36 months follow-up. Conclusions: Five-year efficacy and toxicity of 3D-CRT delivered in prone partial breast irradiation are comparable to other experiences with similar follow-up.

  1. The 'X-Prize' Approach: Double-blind Assessment of Ductile Tearing...

    Office of Scientific and Technical Information (OSTI)

    of Ductile Tearing Prediction Methods. Abstract not provided. Authors: Boyce, Brad Lee Publication Date: 2011-09-01 OSTI Identifier: 1119710 Report Number(s): SAND2011-6459C...

  2. The 'X-Prize' approach : double-blind evaluation of ductile tearing...

    Office of Scientific and Technical Information (OSTI)

    of ductile tearing prediction methods. No abstract prepared. Authors: Boyce, Brad Lee Publication Date: 2010-07-01 OSTI Identifier: 1021081 Report Number(s): SAND2010-4353C...

  3. SU-E-T-215: Interactive Dose Shaping: Proof of Concept Study for Six Prostate Patients

    SciTech Connect (OSTI)

    Kamerling, CP [The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London (United Kingdom); German Cancer Research Center (DKFZ), Heidelberg (Germany); Ziegenhein, P; Oelfke, U [The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London (United Kingdom); Sterzing, F [German Cancer Research Center (DKFZ), Heidelberg (Germany)

    2014-06-01

    Purpose: To provide a proof of concept study for IMRT treatment planning through interactive dose shaping (IDS) by utilising the respective tools to create IMRT treatment plans for six prostate patients. Methods: The IDS planning paradigm aims to perform interactive local dose adaptations of an IMRT plan without compromising already established valuable dose features in real-time. Various IDS tools are available in our in-house treatment planning software Dynaplan and were utilised to create IMRT treatment plans for six patients with an adeno-carcinoma of the prostate. The sequenced IDS treatment plans were compared to conventionally optimised clinically approved plans (9 beams, co-planar). The starting point consisted of open fields. The IDS tools were utilised to sculpt dose out of the rectum and bladder. For each patient, several IDS plans were created, with different trade-offs between organ sparing and target coverage. The reference dose distributions were imported into Dynaplan. For each patient, the IDS treatment plan with a similar or better trade-off between target coverage and OAR sparing was selected for plan evaluation, guided by a physician. Pencil beam dose calculation was performed on a grid with a voxel size of 1.951.952.0 mm{sup 3}. D98%, D2%, mean dose and dose-volume indicators as specified by Quantec were calculated for plan evaluation. Results: It was possible to utilise the software prototype to generate treatment plans for prostate patient geometries in 1545 minutes. Individual local dose adaptations could be performed in less than one second. The average differences compared to the reference plans were for the mean dose: 0.0 Gy (boost) and 1.2 Gy (CTV), for D98%: ?1.1 Gy and for D2%: 1.1 Gy (both target volumes). The dose-volume quality indicators were well below the Quantec constraints. Conclusion: Real-time treatment planning utilising IDS is feasible and has the potential to be implemented clinically. Research at The Institute of Cancer Research is supported by Cancer Research UK under Programme C46/A10588.

  4. SU-E-J-90: MRI-Based Treatment Simulation and Patient Setup for Radiation Therapy of Brain Cancer

    SciTech Connect (OSTI)

    Yang, Y; Cao, M; Han, F; Santhanam, A; Neylon, J; Gomez, C; Kaprealian, T; Sheng, K; Agazaryan, N; Low, D; Hu, P

    2014-06-01

    Purpose: Traditional radiation therapy of cancer is heavily dependent on CT. CT provides excellent depiction of the bones but lacks good soft tissue contrast, which makes contouring difficult. Often, MRIs are fused with CT to take advantage of its superior soft tissue contrast. Such an approach has drawbacks. It is desirable to perform treatment simulation entirely based on MRI. To achieve MR-based simulation for radiation therapy, bone imaging is an important challenge because of the low MR signal intensity from bone due to its ultra-short T2 and T1, which presents difficulty for both dose calculation and patient setup in terms of digitally reconstructed radiograph (DRR) generation. Current solutions will either require manual bone contouring or multiple MR scans. We present a technique to generate DRR using MRI with an Ultra Short Echo Time (UTE) sequence which is applicable to both OBI and ExacTrac 2D patient setup. Methods: Seven brain cancer patients were scanned at 1.5 Tesla using a radial UTE sequence. The sequence acquires two images at two different echo times. The two images were processed using in-house software. The resultant bone images were subsequently loaded into commercial systems to generate DRRs. Simulation and patient clinical on-board images were used to evaluate 2D patient setup with MRI-DRRs. Results: The majority bones are well visualized in all patients. The fused image of patient CT with the MR bone image demonstrates the accuracy of automatic bone identification using our technique. The generated DRR is of good quality. Accuracy of 2D patient setup by using MRI-DRR is comparable to CT-based 2D patient setup. Conclusion: This study shows the potential of DRR generation with single MR sequence. Further work will be needed on MR sequence development and post-processing procedure to achieve robust MR bone imaging for other human sites in addition to brain.

  5. Preliminary Results of Whole Brain Radiotherapy With Concurrent Trastuzumab for Treatment of Brain Metastases in Breast Cancer Patients

    SciTech Connect (OSTI)

    Chargari, Cyrus; Idrissi, Hind Riahi; Pierga, Jean-Yves; Bollet, Marc A.; Dieras, Veronique; Campana, Francois; Cottu, Paul; Fourquet, Alain; Kirova, Youlia M.

    2011-11-01

    Purpose: To assess the use of trastuzumab concurrently with whole brain radiotherapy (WBRT) for patients with brain metastases from human epidermal growth factor receptor-2-positive breast cancer. Methods and Materials: Between April 2001 and April 2007, 31 patients with brain metastases from human epidermal growth factor receptor-2-positive breast cancer were referred for WBRT with concurrent trastuzumab. At brain progression, the median age was 55 years (range, 38-73), and all patients had a performance status of 0-2. The patients received trastuzumab 2 mg/kg weekly (n = 17) or 6 mg/kg repeated every 21 days (n = 14). In 26 patients, concurrent WBRT delivered 30 Gy in 10 daily fractions. In 6 patients, other fractionations were chosen because of either poor performance status or patient convenience. Results: After WBRT, radiologic responses were observed in 23 patients (74.2%), including 6 (19.4%) with a complete radiologic response and 17 (54.8%) with a partial radiologic response. Clinical responses were observed in 27 patients (87.1%). The median survival time from the start of WBRT was 18 months (range, 2-65). The median interval to brain progression was 10.5 months (range, 2-27). No Grade 2 or greater acute toxicity was observed. Conclusion: The low toxicity of trastuzumab concurrently with WBRT should probably not justify delays. Although promising, these preliminary data warrant additional validation of trastuzumab as a potential radiosensitizer for WBRT in brain metastases from breast cancer in the setting of a clinical trial.

  6. Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

    SciTech Connect (OSTI)

    England, Andrew; Butterfield, John S.; McCollum, Charles N.; Ashleigh, Raymond J.

    2008-07-15

    The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs {>=}18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs {>=}18 mm (p = 0.232). One-year freedom from IRSI was 92% {+-} 3% and 84% {+-} 9% for the <18-mm and {>=}18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

  7. Early Cognitive Outcomes Following Proton Radiation in Pediatric Patients With Brain and Central Nervous System Tumors

    SciTech Connect (OSTI)

    Pulsifer, Margaret B.; Sethi, Roshan V.; Kuhlthau, Karen A.; MacDonald, Shannon M.; Tarbell, Nancy J.; Yock, Torunn I.

    2015-10-01

    Purpose: To report, from a longitudinal study, cognitive outcome in pediatric patients treated with proton radiation therapy (PRT) for central nervous system (CNS) tumors. Methods and Materials: Sixty patients receiving PRT for medulloblastoma (38.3%), gliomas (18.3%), craniopharyngioma (15.0%), ependymoma (11.7%), and other CNS tumors (16.7%) were administered age-appropriate measures of cognitive abilities at or near PRT initiation (baseline) and afterward (follow-up). Patients were aged ≥6 years at baseline to ensure consistency in neurocognitive measures. Results: Mean age was 12.3 years at baseline; mean follow-up interval was 2.5 years. Treatment included prior surgical resection (76.7%) and chemotherapy (61.7%). Proton radiation therapy included craniospinal irradiation (46.7%) and partial brain radiation (53.3%). At baseline, mean Wechsler Full Scale IQ was 104.6; means of all 4 Index scores were also in the average range. At follow-up, no significant change was observed in mean Wechsler Full Scale IQ, Verbal Comprehension, Perceptual Reasoning/Organization, or Working Memory. However, Processing Speed scores declined significantly (mean 5.2 points), with a significantly greater decline for subjects aged <12 years at baseline and those with the highest baseline scores. Cognitive outcome was not significantly related to gender, extent of radiation, radiation dose, tumor location, histology, socioeconomic status, chemotherapy, or history of surgical resection. Conclusions: Early cognitive outcomes after PRT for pediatric CNS tumors are encouraging, compared with published outcomes from photon radiation therapy.

  8. A Halotyrosine Antibody that Detects Increased Protein Modifications in Asthma Patients

    SciTech Connect (OSTI)

    Jin, Hongjun; Hallstrand, Teal S.; Daly, Don S.; Matzke, Melissa M.; Nair, Parameswaran; Bigelow, Diana J.; Pounds, Joel G.; Zangar, Richard C.

    2014-01-31

    Background-Airway inflammation plays an important pathophysiological role in asthma. Eosinophils produce hypobromite and bromotyrosine while neutrophils produce hypochlorite and chlorotyrosine. Objective-To evaluate halotyrosine modifications of individual airway proteins as a marker of inflammation in asthma using an antibody-based assay. Methods-We developed a novel monoclonal antibody (BTK-94C) that binds halogenated tyrosine residues, and used this antibody in a custom enzyme-linked immunosorbent assay (ELISA) microarray platform to examine halotyrosine levels in 23 proteins in three independent sets of sputum samples (52 samples total). Results-In 15 subjects with either no asthma, or with asthma characterized by high or low sputum eosinophil counts, we found associations between increased halotyrosine levels of at least three proteins and severity of airway hyperresponsiveness (AHR). Treatment with mepolizumab in 17 patients with sputum eosinophilia markedly reduced the sputum eosinophilia and significantly reduced halotyrosine levels in one sputum protein. Further analysis of 10 subjects with neutrophilic asthma and 10 health controls demonstrated a broad increase in halotyrosine in the patients with airway neutrophilia. Conclusions-Significantly higher levels of halotyrosine are associated with asthma in the asthma phenotypes we examined. The halotyrosine levels correlated with indirect AHR in the form of exercise-induced bronchoconstriction. Clinical Implication-An antibody-based assay for tyrosine halogenation in specific proteins may prove useful for assessing airway inflammation in asthma. Capsule Summary-An antibody to measure protein monobrominated tyrosine and other halotyrosine modifications was developed and used to evaluate halogenation in specific proteins in the airways for the first time. Associations were found between levels of halotyrosine and exercise-induced bronchoconstriction, and eosinophil and neutrophil inflammation in sputum from asthma patients. The ELISA developed here can be easily translated into a clinical test.

  9. Method and system for the diagnosis of disease using retinal image content and an archive of diagnosed human patient data

    DOE Patents [OSTI]

    Tobin, Kenneth W; Karnowski, Thomas P; Chaum, Edward

    2013-08-06

    A method for diagnosing diseases having retinal manifestations including retinal pathologies includes the steps of providing a CBIR system including an archive of stored digital retinal photography images and diagnosed patient data corresponding to the retinal photography images, the stored images each indexed in a CBIR database using a plurality of feature vectors, the feature vectors corresponding to distinct descriptive characteristics of the stored images. A query image of the retina of a patient is obtained. Using image processing, regions or structures in the query image are identified. The regions or structures are then described using the plurality of feature vectors. At least one relevant stored image from the archive based on similarity to the regions or structures is retrieved, and an eye disease or a disease having retinal manifestations in the patient is diagnosed based on the diagnosed patient data associated with the relevant stored image(s).

  10. Potential for radioactive patient excreta in hospital trash and medical waste

    SciTech Connect (OSTI)

    Evdokimoff, V.; Cash, C.; Buckley, K.

    1994-02-01

    Radioactive excreta from nuclear medicine patients can enter solid waste as common trash and medical biohazardous waste. Many landfills and transfer stations now survey these waste streams with scintillation detectors which may result in rejection of a hospital`s waste. Our survey indicated that on the average either or both of Boston University Medical Center Hospital`s waste streams can contain detectable radioactive excreta on a weekly basis. To avoid potential problems, radiation detectors were installed in areas where housekeepers carting trash and medical waste must pass through to ensure no radioactivity leaves the institution. 3 refs.

  11. SU-E-J-11: A New Optical Method to Register Patient External Motion

    SciTech Connect (OSTI)

    Barbes, B; Azcona, J; Moreno, M; Prieto, E; Foronda, J; Burguete, J

    2014-06-01

    Purpose: To devise and implement a new system to measure and register the patient motion during radiotherapy treatments. Methods: The system can obtain the position of several points in the 3D-space, through their projections in the 2D-images recorded by two cameras. The algorithm needs a series of constants, that are obtained using the images of a calibrated phantom.To test the system, some adhesive labels were placed on the surface of an object. Two cameras recorded the moving object over time. An in-house developed software localized the labels in each image. In the first pair of images, the program used a first approximation given by the user. In the subsequent images, it used the last position as an approximate location. The final exact coordinates of the point were obtained in a two-step process using the contrast of the images. From the 2D-positions of the point in each frame, the 3D-trajectories of each of these marks were obtained.The system was tested with linear displacements, oscillations of a mechanical oscillator, circular trajectories of a rotating disk, and with respiratory motion of a volunteer. Results: Trajectories of several points were reproduced with sub-millimeter accuracy in the three directions of the space. The system was able to follow periodic motion with amplitudes lower than 0.5mm; and trajectories of rotating points at speeds up to 200mm/s. The software could also track accurately the respiration motion of a person. Conclusion: A new, inexpensive optical tracking system for patient motion has been demonstrated. The system detects motion with high accuracy. Installation and calibration of the system is simple and quick. Data collection is not expected to involve any discomfort for the patient, nor any delay for the treatment. The system could be also used as a method of warning for patient movements, and for gating. We acknowledge financial support from Fundacion Mutua Madrilena, Madrid, Spain.

  12. SeizAlert could give patients 4.5 hour warning of seizure

    ScienceCinema (OSTI)

    Dr. Lee Hively and Kara Kruse

    2010-01-08

    One percent of Americans, 3 million people, suffer from epilepsy. And their lives are about to be dramatically changed by scientists at Oak Ridge National Laboratory. For 15 years, Dr. Lee Hively has been working on "SeizAlert", a seizure-detecting device that resembles a common PDA. "It allows us to analyze scalp brain waves and give us up to 4.5 hours' forewarning of that event," he said. With the help of partner Kara Kruse, he's now able to help patients predict the previously unpredictable.

  13. Respiration-Correlated Image Guidance Is the Most Important Radiotherapy Motion Management Strategy for Most Lung Cancer Patients

    SciTech Connect (OSTI)

    Korreman, Stine, E-mail: korreman@ruc.dk [Department of Science, Systems and Models, Roskilde University, Roskilde (Denmark); Department of Radiation Oncology, The Finsen Centre, Rigshospitalet, Copenhagen (Denmark); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison (United States); Persson, Gitte; Nygaard, Ditte [Department of Radiation Oncology, The Finsen Centre, Rigshospitalet, Copenhagen (Denmark); Brink, Carsten [Laboratory of Radiation Physics, Odense University Hospital, Odense (Denmark); Faculty of Health Sciences, University of Southern Denmark, Odense (Denmark); Juhler-Nottrup, Trine [Department of Oncology, Herlev Hospital, Copenhagen (Denmark)

    2012-07-15

    Purpose: The purpose of this study was to quantify the effects of four-dimensional computed tomography (4DCT), 4D image guidance (4D-IG), and beam gating on calculated treatment field margins in a lung cancer patient population. Materials and Methods: Images were acquired from 46 lung cancer patients participating in four separate protocols at three institutions in Europe and the United States. Seven patients were imaged using fluoroscopy, and 39 patients were imaged using 4DCT. The magnitude of respiratory tumor motion was measured. The required treatment field margins were calculated using a statistical recipe (van Herk M, et al. Int J Radiat Oncol Biol Phys 2000;474:1121-1135), with magnitudes of all uncertainties, except respiratory peak-to-peak displacement, the same for all patients, taken from literature. Required margins for respiratory motion management were calculated using the residual respiratory tumor motion for each patient for various motion management strategies. Margin reductions for respiration management were calculated using 4DCT, 4D-IG, and gated beam delivery. Results: The median tumor motion magnitude was 4.4 mm for the 46 patients (range 0-29.3 mm). This value corresponded to required treatment field margins of 13.7 to 36.3 mm (median 14.4 mm). The use of 4DCT, 4D-IG, and beam gating required margins that were reduced by 0 to 13.9 mm (median 0.5 mm), 3 to 5.2 mm (median 5.1 mm), and 0 to 7 mm (median 0.2 mm), respectively, to a total of 8.5 to 12.4 mm (median 8.6 mm). Conclusion: A respiratory management strategy for lung cancer radiotherapy including planning on 4DCT scans and daily image guidance provides a potential reduction of 37% to 47% in treatment field margins. The 4D image guidance strategy was the most effective strategy for >85% of the patients.

  14. Predictive Factors for Acute and Late Urinary Toxicity After Permanent Prostate Brachytherapy: Long-Term Outcome in 712 Consecutive Patients

    SciTech Connect (OSTI)

    Keyes, Mira Miller, Stacy; Moravan, Veronika; Pickles, Tom; McKenzie, Michael; Pai, Howard; Liu, Mitchell; Kwan, Winkle; Agranovich, Alexander; Spadinger, Ingrid; Lapointe, Vincent; Halperin, Ross; Morris, W. James

    2009-03-15

    Purpose: To describe the frequency of acute and late Radiation Therapy Oncology Group (RTOG) urinary toxicity, associated predictive factors, and resolution of International Prostate Symptom Score (IPSS) in 712 consecutive prostate brachytherapy patients. Methods and Materials: Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). The IPSS and RTOG toxicity data were prospectively collected. The patient, treatment, and implant factors were examined for an association with urinary toxicity. The time to IPSS resolution was examined using Kaplan-Meier curves, and multivariate modeling of IPSS resolution was done using Cox proportional hazards regression analysis. Logistic regression analysis was used to examine the factors associated with urinary toxicity. Results: The IPSS returned to baseline at a median of 12.6 months. On multivariate analysis, patients with a high baseline IPSS had a quicker resolution of their IPSS. Higher prostate D90 (dose covering 90% of the prostate), maximal postimplant IPSS, and urinary retention slowed the IPSS resolution time. The rate of the actuarial 5-year late urinary (>12 months) RTOG Grade 0, 1, 2, 3, and 4 was 32%, 36%, 24%, 6.2%, and 0.1%, respectively. At 7 years, the prevalence of RTOG Grade 0-1 was 92.5%. Patients with a larger prostate volume, greater number of needles, greater baseline IPSS, and use of hormonal therapy had more acute toxicity. On multivariate analysis, the significant predictors for late greater than or equal to RTOG toxicity 2 were a greater baseline IPSS, maximal postimplant IPSS, presence of acute toxicity, and higher prostate V150 (volume of the prostate covered by 150% of the dose). More recently implanted patients had less acute urinary toxicity and patients given hormonal therapy had less late urinary toxicity (all p < 0.02). Conclusion: Most urinary symptoms resolved within 12 months after prostate brachytherapy, and significant long-term urinary toxicity was very low. Refined patient selection and greater technical experience in prostate brachytherapy were associated with less urinary toxicity.

  15. A Phase II trial of subcutaneous amifostine and radiation therapy in patients with head-and-neck cancer

    SciTech Connect (OSTI)

    Anne, Pramila Rani . E-mail: rani.anne@mail.tju.edu; Machtay, Mitchell; Rosenthal, David I.; Brizel, David M.; Morrison, William H.; Irwin, David H.; Chougule, Prakash B.; Estopinal, Noel C.; Berson, Anthony; Curran, Walter J.

    2007-02-01

    Purpose: Intravenous amifostine 200 mg/m{sup 2} reduces xerostomia in head-and-neck cancer patients. This Phase II study evaluated subcutaneous (s.c.) amifostine in a similar patient population. Patients and Methods: Patients received amifostine 500 mg, administered as two 250-mg s.c. injections 60 min before once-daily radiation for head-and-neck cancer (50-70 Gy in 5-7 weeks). The primary endpoint was the incidence of {>=}Grade 2 acute xerostomia. Results: Fifty-four patients received s.c. amifostine and radiotherapy. The incidence of {>=}Grade 2 acute xerostomia was 56% (95% CI, 43-69%) and the incidence of {>=}Grade 2 late xerostomia at 1 year was 45% (95% CI, 29-61%). The incidence of acute xerostomia was lower than reported previously with no amifostine in a controlled study; rates of acute xerostomia were similar between s.c. and i.v. amifostine in the two studies. The rate of late xerostomia with s.c. amifostine was intermediate between rates for i.v. amifostine and no amifostine, and not statistically significantly different from either historical control. Grades 1-2 nausea and emesis were the most common amifostine-related adverse events. Grade 3 amifostine-related adverse events reported by >1 patient included: dehydration (11%); rash (6%); and weight decrease, mucositis, dyspnea, and allergic reaction (each 4%). Seven patients (13%) had serious cutaneous adverse events outside the injection site. One-year rates of locoregional control, progression-free survival, and overall survival were 78%, 75%, and 85%, respectively. Conclusions: Subcutaneous amifostine provides a well-tolerated yet simpler alternative to i.v. amifostine for reducing acute xerostomia in head-and-neck cancer patients.

  16. Pain Levels Within 24 Hours After UFE: A Comparison of Morphine and Fentanyl Patient-Controlled Analgesia

    SciTech Connect (OSTI)

    Kim, Hyun S. Czuczman, Gregory J.; Nicholson, Wanda K.; Pham, Luu D.; Richman, Jeffrey M.

    2008-11-15

    The purpose of this study was to assess the presence and severity of pain levels during 24 h after uterine fibroid embolization (UFE) for symptomatic leiomyomata and compare the effectiveness and adverse effects of morphine patient-controlled analgesia (PCA) versus fentanyl PCA. We carried out a prospective, nonrandomized study of 200 consecutive women who received UFE and morphine or fentanyl PCA after UFE. Pain perception levels were obtained on a 0-10 scale for the 24-h period after UFE. Linear regression methods were used to determine pain trends and differences in pain trends between two groups and the association between pain scores and patient covariates. One hundred eighty-five patients (92.5%) reported greater-than-baseline pain after UFE, and 198 patients (99%) required IV opioid PCA. One hundred thirty-six patients (68.0%) developed nausea during the 24-h period. Seventy-two patients (36%) received morphine PCA and 128 (64%) received fentanyl PCA, without demographic differences. The mean dose of morphine used was 33.8 {+-} 26.7 mg, while the mean dose of fentanyl was 698.7 {+-} 537.4 {mu}g. Using this regimen, patients who received morphine PCA had significantly lower pain levels than those who received fentanyl PCA (p < 0.0001). We conclude that patients develop pain requiring IV opioid PCA within 24 h after UFE. Morphine PCA is more effective in reducing post-uterine artery embolization pain than fentanyl PCA. Nausea is a significant adverse effect from opioid PCA.

  17. Intra-arterial Autologous Bone Marrow Cell Transplantation in a Patient with Upper-extremity Critical Limb Ischemia

    SciTech Connect (OSTI)

    Madaric, Juraj; Klepanec, Andrej; Mistrik, Martin; Altaner, Cestmir; Vulev, Ivan

    2013-04-15

    Induction of therapeutic angiogenesis by autologous bone marrow mononuclear cell transplantation has been identified as a potential new option in patients with advanced lower-limb ischemia. There is little evidence of the benefit of intra-arterial cell application in upper-limb critical ischemia. We describe a patient with upper-extremity critical limb ischemia with digital gangrene resulting from hypothenar hammer syndrome successfully treated by intra-arterial autologous bone marrow mononuclear cell transplantation.

  18. Poster Thur Eve 16: 4DCT simulation with synchronized contrast injection of liver SBRT patients

    SciTech Connect (OSTI)

    Karotki, A.; Korol, R.; Milot, L.; Chu, W.; Chung, H. T.; Erler, D.

    2014-08-15

    Stereotactic body radiation therapy (SBRT) has recently emerged as a valid option for treating liver metastases. SBRT delivers highly conformai dose over a small number of fractions. As such it is particularly sensitive to the accuracy of target volume delineation by the radiation oncologist. However, contouring liver metastases remains challenging for the following reasons. First, the liver usually undergoes significant motion due to respiration. Second, liver metastases are often nearly indistinguishable from the surrounding tissue when using computed tomography (CT) for imaging making it difficult to identify and delineate them. Both problems can be overcome by using four dimensional CT (4DCT) synchronized with intravenous contrast injection. We describe a novel CT simulation process which involves two 4DCT scans. The first scan captures the tumor and immediately surrounding tissue which in turn reduces the 4DCT scan time so that it can be optimally timed with intravenous contrast injection. The second 4DCT scan covers a larger volume and is used as the primary CT dataset for dose calculation, as well as patient setup verification on the treatment unit. The combination of two 4DCT scans, short and long, allows visualization of the liver metastases over all phases of breathing cycle while simultaneously acquiring long enough 4DCT dataset suitable for planning and patient setup verification.

  19. Interventional Radiological Treatment of Perihepatic Vascular Stenosis or Occlusion in Pediatric Patients After Liver Transplantation

    SciTech Connect (OSTI)

    Uller, Wibke; Knoppke, Birgit; Schreyer, Andreas G.; Heiss, Peter; Schlitt, Hans J.; Melter, Michael; Stroszczynski, Christian; Zorger, Niels; Wohlgemuth, Walter A.

    2013-12-15

    Purpose: Evaluation of the efficacy and safety of percutaneous treatment of vascular stenoses and occlusions in pediatric liver transplant recipients. Methods: Fifteen children (mean age 8.3 years) underwent interventional procedures for 18 vascular complications after liver transplantation. Patients had stenoses or occlusions of portal veins (n = 8), hepatic veins (n = 3), inferior vena cava (IVC; n = 2) or hepatic arteries (n = 5). Technical and clinical success rates were evaluated. Results: Stent angioplasty was performed in seven cases (portal vein, hepatic artery and IVC), and sole balloon angioplasty was performed in eight cases. One child underwent thrombolysis (hepatic artery). Clinical and technical success was achieved in 14 of 18 cases of vascular stenoses or occlusions (mean follow-up 710 days). Conclusion: Pediatric interventional radiology allows effective and safe treatment of vascular stenoses after pediatric liver transplantation (PLT). Individualized treatment with special concepts for each pediatric patient is necessary. The variety, the characteristics, and the individuality of interventional management of all kinds of possible vascular stenoses or occlusions after PLT are shown.

  20. Evaluation of overall setup accuracy and adequate setup margins in pelvic image-guided radiotherapy: Comparison of the male and female patients

    SciTech Connect (OSTI)

    Laaksomaa, Marko; Kapanen, Mika; Tulijoki, Tapio; Peltola, Seppo; Hydynmaa, Simo; Kellokumpu-Lehtinen, Pirkko-Liisa

    2014-04-01

    We evaluated adequate setup margins for the radiotherapy (RT) of pelvic tumors based on overall position errors of bony landmarks. We also estimated the difference in setup accuracy between the male and female patients. Finally, we compared the patient rotation for 2 immobilization devices. The study cohort included consecutive 64 male and 64 female patients. Altogether, 1794 orthogonal setup images were analyzed. Observer-related deviation in image matching and the effect of patient rotation were explicitly determined. Overall systematic and random errors were calculated in 3 orthogonal directions. Anisotropic setup margins were evaluated based on residual errors after weekly image guidance. The van Herk formula was used to calculate the margins. Overall, 100 patients were immobilized with a house-made device. The patient rotation was compared against 28 patients immobilized with CIVCO's Kneefix and Feetfix. We found that the usually applied isotropic setup margin of 8 mm covered all the uncertainties related to patient setup for most RT treatments of the pelvis. However, margins of even 10.3 mm were needed for the female patients with very large pelvic target volumes centered either in the symphysis or in the sacrum containing both of these structures. This was because the effect of rotation (p ? 0.02) and the observer variation in image matching (p ? 0.04) were significantly larger for the female patients than for the male patients. Even with daily image guidance, the required margins remained larger for the women. Patient rotations were largest about the lateral axes. The difference between the required margins was only 1 mm for the 2 immobilization devices. The largest component of overall systematic position error came from patient rotation. This emphasizes the need for rotation correction. Overall, larger position errors and setup margins were observed for the female patients with pelvic cancer than for the male patients.

  1. Trends in the Quality of Treatment for Patients With Intact Cervical Cancer in the United States, 1999 Through 2011

    SciTech Connect (OSTI)

    Smith, Grace L.; Jiang, Jing; Giordano, Sharon H.; Meyer, Larissa A.; Eifel, Patricia J.

    2015-06-01

    Purpose: High-quality treatment for intact cervical cancer requires external radiation therapy, brachytherapy, and chemotherapy, carefully sequenced and completed without delays. We sought to determine how frequently current treatment meets quality benchmarks and whether new technologies have influenced patterns of care. Methods and Materials: By searching diagnosis and procedure claims in MarketScan, an employment-based health care claims database, we identified 1508 patients with nonmetastatic, intact cervical cancer treated from 1999 to 2011, who were <65 years of age and received >10 fractions of radiation. Treatments received were identified using procedure codes and compared with 3 quality benchmarks: receipt of brachytherapy, receipt of chemotherapy, and radiation treatment duration not exceeding 63 days. The Cochran-Armitage test was used to evaluate temporal trends. Results: Seventy-eight percent of patients (n=1182) received brachytherapy, with brachytherapy receipt stable over time (Cochran-Armitage P{sub trend}=.15). Among patients who received brachytherapy, 66% had high–dose rate and 34% had low–dose rate treatment, although use of high–dose rate brachytherapy steadily increased to 75% by 2011 (P{sub trend}<.001). Eighteen percent of patients (n=278) received intensity modulated radiation therapy (IMRT), and IMRT receipt increased to 37% by 2011 (P{sub trend}<.001). Only 2.5% of patients (n=38) received IMRT in the setting of brachytherapy omission. Overall, 79% of patients (n=1185) received chemotherapy, and chemotherapy receipt increased to 84% by 2011 (P{sub trend}<.001). Median radiation treatment duration was 56 days (interquartile range, 47-65 days); however, duration exceeded 63 days in 36% of patients (n=543). Although 98% of patients received at least 1 benchmark treatment, only 44% received treatment that met all 3 benchmarks. With more stringent indicators (brachytherapy, ≥4 chemotherapy cycles, and duration not exceeding 56 days), only 25% of patients received treatment that met all benchmarks. Conclusion: In this cohort, most cervical cancer patients received treatment that did not comply with all 3 benchmarks for quality treatment. In contrast to increasing receipt of newer radiation technologies, there was little improvement in receipt of essential treatment benchmarks.

  2. Alternative Techniques for Treatment of Complex Below-the Knee Arterial Occlusions in Diabetic Patients With Critical Limb Ischemia

    SciTech Connect (OSTI)

    Gandini, Roberto; Uccioli, Luigi; Spinelli, Alessio; Del Giudice, Costantino Ros, Valerio Da; Volpi, Tommaso; Meloni, Marco; Simonetti, Giovanni

    2013-02-15

    The purpose of this study was to describe alternative endovascular (EV) techniques and assess their feasibility and efficacy in minimizing failure rates in limb salvage for the treatment of complex below-the knee (BTK) occlusions that could not be crossed with a conventional antegrade access. Between December 2007 and November 2010, 1,035 patients (557 male) underwent EV treatment for critical limb ischemia in our institution. In 124 (12% [83 male], mean age 68.2 {+-} 0.5 years) patients, transfemoral antegrade revascularization attempt failed, and an alternative approach was used. Follow-up was performed at 1 and 6 months. Results were compared with 56 patients treated between November 2002 and November 2007, in whom conventional technique was unsuccessful and unconventional techniques were not adopted. Technical success was achieved in 119 (96%) patients. The limb-salvage rates were 96.8% and 83% at 1- and 6-month follow-up, respectively. Sixteen (12.9%) and 33 (26.6%) patients underwent reintervention at 1- and 6-month follow-up, respectively. Transcutaneous oxygen tension increased at 1 month (44.7 {+-} 1.1 vs. 15.7 {+-} 0.8 mmHg; p < 0.001) and remained stable at follow-up. Twenty (16.1%) patients required major amputation. Thirteen (10.4%) patients died during follow-up. In our previous experience, percutaneous transluminal angioplasty failure, amputation, and death rates were 10.9, 39.2, and 23.2%, respectively. Alternative techniques allowed a significant decrease of major amputation and death rates (p = 0.0001 and p = 0.02, respectively). The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months.

  3. A Phase 2 Trial of Once-Weekly Hypofractionated Breast Irradiation: First Report of Acute Toxicity, Feasibility, and Patient Satisfaction

    SciTech Connect (OSTI)

    Dragun, Anthony E.; Quillo, Amy R.; Riley, Elizabeth C.; Roberts, Teresa L.; Hunter, Allison M.; Rai, Shesh N.; Callender, Glenda G.; Jain, Dharamvir; McMasters, Kelly M.; Spanos, William J.

    2013-03-01

    Purpose: To report on early results of a single-institution phase 2 trial of a 5-fraction, once-weekly radiation therapy regimen for patients undergoing breast-conserving surgery (BCS). Methods and Materials: Patients who underwent BCS for American Joint Committee on Cancer stage 0, I, or II breast cancer with negative surgical margins were eligible to receive whole breast radiation therapy to a dose of 30 Gy in 5 weekly fractions of 6 Gy with or without an additional boost. Elective nodal irradiation was not permitted. There were no restrictions on breast size or the use of cytotoxic chemotherapy for otherwise eligible patients. Patients were assessed at baseline, treatment completion, and at first posttreatment follow-up to assess acute toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and quality of life (European Organization for Research and Treatment of Cancer QLQ-BR23). Results: Between January and September 2011, 42 eligible patients underwent weekly hypofractionated breast irradiation immediately following BCS (69.0%) or at the conclusion of cytotoxic chemotherapy (31.0%). The rates of grade ?2 radiation-induced dermatitis, pain, fatigue, and breast edema were 19.0%, 11.9%, 9.5%, and 2.4%, respectively. Only 1 grade 3 toxicitypain requiring a course of narcotic analgesicswas observed. One patient developed a superficial cellulitis (grade 2), which resolved with the use of oral antibiotics. Patient-reported moderate-to-major breast symptoms (pain, swelling, and skin problems), all decreased from baseline through 1 month, whereas breast sensitivity remained stable over the study period. Conclusions: The tolerance of weekly hypofractionated breast irradiation compares well with recent reports of daily hypofractionated whole-breast irradiation schedules. The regimen appears feasible and cost-effective. Additional follow-up with continued accrual is needed to assess late toxicity, cosmesis, and disease-specific outcomes.

  4. The Impact of Post-Mastectomy Radiation Therapy on Male Breast Cancer Patients-A Case Series

    SciTech Connect (OSTI)

    Yu, Edward; Suzuki, Hiromichi; Younus, Jawaid; Elfiki, Tarek; Stitt, Larry; Yau, Gary; Vujovic, Olga; Perera, Francisco; Lock, Michael; Tai, Patricia

    2012-02-01

    Objective: To assess the impact of radiation management on male breast cancer (MBC) at London Regional Cancer Program (LRCP). Methods and Materials: Men with a diagnosis of breast cancer referred to LRCP were reviewed. The seventh American Joint Committee on Cancer staging system was used. Patients treated with and without post-mastectomy radiation therapy (PMRT) were analyzed. Disease-free survival (DFS) was defined as time duration from diagnosis to first recurrence. Overall survival (OS) was defined as time duration from pathologic diagnosis to death or last follow-up with any death defined as an event. Survival estimates were obtained using Kaplan-Meier methodology. Results: From January 1977 to December 2006, 81 men had invasive ductal carcinoma. The median age was 65 (range, 35-87 years). There were 15 Stage I, 40 Stage II, 20 Stage III, and 6 Stage IV patients. Median follow-up time was 46 months (range, 1-225 months). Of the 75 patients treated with curative intent, 29 did not receive PMRT and 46 completed PMRT. Patients who received PMRT demonstrated no benefit in overall survival (p = 0.872) but significantly better local recurrence free survival (p < 0.001) compared with those who did not receive RT. There was trend toward improving locoregional recurrence with PMRT in patients with high-risk features (node-positive, advanced stage, and {<=}2 mm or unknown surgical margin). The median, 5-year, and 10-year disease-free survival and overall survival for the 75 patients were 77.7 months, 66.3%, 32.7%, and 91.2 months, 73.9%, and 36.6%, respectively. Conclusion: The experience at LRCP suggests that high-risk MBC patients should consider PMRT to improve their chance of local recurrence-free survival.

  5. SU-F-18C-06: Prospective Patient Evaluation of Iterative Reconstruction in Radiation Oncology

    SciTech Connect (OSTI)

    Price, R; Vance, S; Cattaneo, R; Schultz, L; Elshaikh, M; Chetty, I; Glide-Hurst, C

    2014-06-15

    Purpose: This work incorporates iterative reconstruction (IR) into a dose reduction study to characterize image quality metrics, delineation, and dosimetric assessment, with the goal of reducing imaging dose in Radiation Oncology. Methods: Three-dimensional noise power spectrum (NPS) analysis characterized noise magnitude/texture (120 kVp, 50200 mAs, IR levels 16 yielding noise reduction of 0.890.55 compared to filtered backprojection (FBP)). Task-specific Modulation Transfer Functions (MTFtask) were characterized across varied subject contrasts. A prospective dose reduction study (500 to 150 mAs) was conducted for 12 patients (43 inter-fraction CTs) for high-dose rate brachytherapy. Three physicians performed qualitative image assessment between full-dose FBP (FD-FBP, 500 mAs), low-dose FBP (LD-FBP, 150250 mAs), and low-dose IRL5-6 (LD-IR) scans for image noise, cuff/bladder interface detectability, spatial resolution, texture, and segmentation confidence. Comparisons between LD-FBP and LD-IR were conducted for the following metrics: delineation (bladder and rectum evaluated via overlap indices (OI) and Dice similarity coefficients (DSC)), noise, boundary changes, dose calculation, and digitally reconstructed radiographs (DRRs). Results: NPS showed ?50% reduction in noise magnitude and ?0.1 1/mm spatial frequency shift with IRL6. The largest MTFtask decrease between FBP and IR was 0.08 A.U. Qualitative patient image evaluation revealed LD-IR was equivalent or slightly worse than FD-FBP, and superior to LD-FBP for all metrics except low contrast interface and texture. The largest CT number discrepancy from FBP occurred at a bone/tissue interface using IRL6 (?1.2 4.9 HU (range: ?17.6 12.5 HU)). No significant contour differences (OIs and DSCs = 0.85 0.95) and dose calculation discrepancy (<0.02%) were observed. DRRs preserved anatomical detail and demonstrated <2% difference in intensity between LD-FBP and LD-IRL6. Conclusion: While phantom analysis showed slight noise texture differences with IR, patient results revealed that image quality, contouring ability, and dosimetric parameters were not adversely affected, thus support integrating IR into treatment planning. Research supported in part by a grant from Philips HealthCare.

  6. SU-E-T-159: Evaluation of a Patient Specific QA Tool Based On TG119

    SciTech Connect (OSTI)

    Ashmeg, S; Zhang, Y; O'Daniel, J; Yin, F; Ren, L

    2014-06-01

    Purpose: To evaluate the accuracy of a 3D patient specific QA tool by analysis of the results produced from associated software in homogenous phantom and heterogonous patient CT. Methods: IMRT and VMAT plans of five test suites introduced by TG119 were created in ECLIPSE on a solid water phantom. The ten plans -of increasing complexity- were delivered to Delta4 to give a 3D measurement. The Delta4's “Anatomy” software uses the measured dose to back-calculate the energy fluence of the delivered beams, which is used for dose calculation in a patient CT using a pencilbeam algorithm. The effect of the modulated beams' complexity on the accuracy of the “Anatomy” calculation was evaluated. Both measured and Anatomy doses were compared to ECLIPSE calculation using 3% - 3mm gamma criteria.We also tested the effect of heterogeneity by analyzing the results of “Anatomy” calculation on a Brain VMAT and a 3D conformal lung cases. Results: In homogenous phantom, the gamma passing rates were found to be as low as 74.75% for a complex plan with high modulation. The mean passing rates were 91.47% ± 6.35% for “Anatomy” calculation and 99.46% ± 0.62% for Delta4 measurements.As for the heterogeneous cases, the rates were 96.54%±3.67% and 83.87%±9.42% for Brain VMAT and 3D lung respectively. This increased error in the lung case could be due to the use of the pencil beam algorithm as opposed to the AAA used by ECLIPSE.Also, gamma analysis showed high discrepancy along the beam edge in the “Anatomy” calculated results. This suggests a poor beam modeling in the penumbra region. Conclusion: The results show various sources of errors in “Anatomy” calculations. These include beam modeling in the penumbra region, complexity of a modulated beam (shown in homogenous phantom and brain cases) and dose calculation algorithms (3D conformal lung case)

  7. Development of Patients' Decision Aid for Older Women With Stage I Breast Cancer Considering Radiotherapy After Lumpectomy

    SciTech Connect (OSTI)

    Wong, Jennifer; D'Alimonte, Laura; Angus, Jan; Paszat, Larry; Metcalfe, Kelly; Whelan, Tim; Llewellyn-Thomas, Hilary; Warner, Eiran; Franssen, Edmee; Szumacher, Ewa

    2012-09-01

    Purpose: To develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients' decision making. Methods and Materials: A PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition. Results: The PtDA is a booklet that details each adjuvant treatment option's benefits, risks, and side effects tailored to the patient's clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use. Conclusions: This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a tailored PtDA to help patients be better informed about their treatment options.

  8. Role of Salvage Radiation Therapy for Patients With Relapsed or Refractory Hodgkin Lymphoma Who Failed Autologous Stem Cell Transplant

    SciTech Connect (OSTI)

    Goda, Jayant S.; Massey, Christine; Kuruvilla, John; Gospodarowicz, Mary K.; Wells, Woodrow; Hodgson, David C.; Sun, Alexander; Keating, Armand; Crump, Michael; Tsang, Richard W.

    2012-11-01

    Purpose: To analyze, through chart review, the efficacy of salvage radiation therapy (sRT) for relapsed or progressive Hodgkin lymphoma (HL) patients who failed autologous stem cell transplant (ASCT). Patients and Methods: Among 347 patients with recurrent/refractory HL who received ASCT from 1986-2006, 163 had post-ASCT progression or relapse. Of these, 56 received sRT and form the basis of this report. Median age at sRT was 30 years (range, 17-59 years). Disease was confined to lymph nodes in 27 patients, whereas 24 had both nodal and extranodal disease. Salvage radiation therapy alone was given in 34 patients (61%), and sRT plus chemotherapy was given in 22 (39%). Median interval from ASCT to sRT was 0.8 years (range, 0.1-5.6 years). The median dose was 35 Gy (range, 8-40.3 Gy). The sRT technique was extended-field in 14 patients (25%) and involved-field in 42 (75%). Results: The median follow-up from sRT was 31.3 months (range, 0.2-205.5 months). Overall response rate was 84% (complete response: 36%; partial response: 48%). The median overall survival was 40.8 months (95% confidence interval, 34.2-56.3 months). The 5-year overall survival was 29% (95% confidence interval, 14%-44%). The 2-year progression-free survival (PFS) was 16%; the 2-year local PFS was 65%, whereas the 2-year systemic PFS was 17%. The 1-year PFS was higher in patients in whom all diseased sites were irradiated (49%) compared with those in whom only the symptomatic site was treated (22%, P=.07). Among 20 alive patients, 5 were disease free (at 6.4, 6.8, 7.4, 7.9, and 17.1 years). Conclusion: For patients with HL who fail ASCT, a selective use of RT provides a durable local control rate of 65% at 2 years and should be considered as part of the standard management plan for the palliation of incurable HL. Occasionally irradiation of truly localized disease can lead to long-term survival.

  9. Overexpression of Rac1 in leukemia patients and its role in leukemia cell migration and growth

    SciTech Connect (OSTI)

    Wang, Jiying; Rao, Qing; Wang, Min; Wei, Hui; Xing, Haiyan; Liu, Hang; Wang, Yanzhong; Tang, Kejing; Peng, Leiwen; Tian, Zheng; Wang, Jianxiang

    2009-09-04

    Rac1 belongs to the Rho family that act as critical mediators of signaling pathways controlling cell migration and proliferation and contributes to the interactions of hematopoietic stem cells with their microenvironment. Alteration of Rac1 might result in unbalanced interactions and ultimately lead to leukemogenesis. In this study, we analyze the expression of Rac1 protein in leukemia patients and determine its role in the abnormal behaviours of leukemic cells. Rac1 protein is overexpressed in primary acute myeloid leukemia cells as compared to normal bone marrow mononuclear cells. siRNA-mediated silencing of Rac1 in leukemia cell lines induced inhibition of cell migration, proliferation, and colony formation. Additionally, blocking Rac1 activity by an inhibitor of Rac1-GTPase, NSC23766, suppressed cell migration and growth. We conclude that overexpression of Rac1 contributes to the accelerated migration and high proliferation potential of leukemia cells, which could be implicated in leukemia development and progression.

  10. Insights into the respiratory tract microbiota of patients with cystic fibrosis during early Pseudomonas aeruginosa colonization

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Keravec, Marlène; Mounier, Jérôme; Prestat, Emmanuel; Vallet, Sophie; Jansson, Janet K.; Burgaud, Gaëtan; Rosec, Sylvain; Gouriou, Stéphanie; Rault, Gilles; Coton, Emmanuel; et al

    2015-08-09

    Pseudomonas aeruginosa plays a major role in cystic fibrosis (CF) progression. Therefore, it is important to understand the initial steps of P. aeruginosa infection. The structure and dynamics of CF respiratory tract microbial communities during the early stages of P. aeruginosa colonization were characterized by pyrosequencing and cloning-sequencing. The respiratory microbiota showed high diversity, related to the young age of the CF cohort (mean age 10 years). Wide inter- and intra-individual variations were revealed. A common core microbiota of 5 phyla and 13 predominant genera was found, the majority of which were obligate anaerobes. A few genera were significantly moremore » prevalent in patients never infected by P. aeruginosa. Persistence of an anaerobic core microbiota regardless of P. aeruginosa status suggests a major role of certain anaerobes in the pathophysiology of lung infections in CF. Some genera may be potential biomarkers of pulmonary infection state.« less

  11. Epidermal Growth Factor Receptor Expression As Prognostic Marker in Patients With Anal Carcinoma Treated With Concurrent Chemoradiation Therapy

    SciTech Connect (OSTI)

    Fraunholz, Ingeborg, E-mail: inge.fraunholz@kgu.de [Department of Radiotherapy and Oncology, Goethe University, Frankfurt/Main (Germany); Rdel, Franz; Kohler, Daniela [Department of Radiotherapy and Oncology, Goethe University, Frankfurt/Main (Germany); Diallo-Georgiopoulou, Margarita [Department of Radiotherapy and Oncology, Goethe University, Frankfurt/Main (Germany); Department of Radiation Oncology, Klinikum Offenbach, Offenbach/Main (Germany); Distel, Luitpold [Department of Radiation Oncology, Friedrich Alexander University, Erlangen (Germany); Falk, Stefan [Pathology Associates, Frankfurt/Main (Germany); Rdel, Claus [Department of Radiotherapy and Oncology, Goethe University, Frankfurt/Main (Germany)

    2013-08-01

    Purpose: To investigate the prognostic value of epidermal growth factor receptor (EGFR) expression in pretreatment tumor biopsy specimens of patients with anal cancer treated with concurrent 5-fluorouracil and mitomycin C-based chemoradiation therapy (CRT). Methods and Materials: Immunohistochemical staining for EGFR was performed in pretreatment biopsy specimens of 103 patients with anal carcinoma. EGFR expression was correlated with clinical and histopathologic characteristics and with clinical endpoints, including local failure-free survival (LFFS), colostomy-free survival (CFS), distant metastases-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS). Results: EGFR staining intensity was absent in 3%, weak in 23%, intermediate in 36% and intense in 38% of the patients. In univariate analysis, the level of EGFR staining was significantly correlated with CSS (absent/weak vs intermediate/intense expression: 5-year CSS, 70% vs 86%, P=.03). As a trend, this was also observed for DMFS (70% vs 86%, P=.06) and LFFS (70% vs 87%, P=.16). In multivariate analysis, N stage, tumor differentiation, and patients sex were independent prognostic factors for CSS, whereas EGFR expression only reached borderline significance (hazard ratio 2.75; P=.08). Conclusion: Our results suggest that elevated levels of pretreatment EGFR expression could be correlated with favorable clinical outcome in anal cancer patients treated with CRT. Further studies are warranted to elucidate how EGFR is involved in the response to CRT.

  12. Dose reconstruction for real-time patient-specific dose estimation in CT

    SciTech Connect (OSTI)

    De Man, Bruno Yin, Zhye; Wu, Mingye; FitzGerald, Paul; Kalra, Mannudeep

    2015-05-15

    Purpose: Many recent computed tomography (CT) dose reduction approaches belong to one of three categories: statistical reconstruction algorithms, efficient x-ray detectors, and optimized CT acquisition schemes with precise control over the x-ray distribution. The latter category could greatly benefit from fast and accurate methods for dose estimation, which would enable real-time patient-specific protocol optimization. Methods: The authors present a new method for volumetrically reconstructing absorbed dose on a per-voxel basis, directly from the actual CT images. The authors’ specific implementation combines a distance-driven pencil-beam approach to model the first-order x-ray interactions with a set of Gaussian convolution kernels to model the higher-order x-ray interactions. The authors performed a number of 3D simulation experiments comparing the proposed method to a Monte Carlo based ground truth. Results: The authors’ results indicate that the proposed approach offers a good trade-off between accuracy and computational efficiency. The images show a good qualitative correspondence to Monte Carlo estimates. Preliminary quantitative results show errors below 10%, except in bone regions, where the authors see a bigger model mismatch. The computational complexity is similar to that of a low-resolution filtered-backprojection algorithm. Conclusions: The authors present a method for analytic dose reconstruction in CT, similar to the techniques used in radiation therapy planning with megavoltage energies. Future work will include refinements of the proposed method to improve the accuracy as well as a more extensive validation study. The proposed method is not intended to replace methods that track individual x-ray photons, but the authors expect that it may prove useful in applications where real-time patient-specific dose estimation is required.

  13. Outcomes in Patients Treated With Mastectomy for Ductal Carcinoma In Situ

    SciTech Connect (OSTI)

    Owen, Dawn; Tyldesley, Scott; Breast Cancer Outcomes Unit of the British Columbia Cancer Agency and University of British Columbia, Vancouver and Victoria, British Columbia ; Alexander, Cheryl; Speers, Caroline; Truong, Pauline; Nichol, Alan; Wai, Elaine S.; Breast Cancer Outcomes Unit of the British Columbia Cancer Agency and University of British Columbia, Vancouver and Victoria, British Columbia

    2013-03-01

    Purpose: To examine, in a large, population-based cohort of women, the risk factors for recurrence after mastectomy for pure ductal carcinoma in situ (DCIS) and to identify which patients may benefit from postmastectomy radiation therapy. Methods and Materials: Data were analyzed for 637 subjects with pure DCIS, diagnosed between January 1990 and December 1999, treated initially with mastectomy. Locoregional relapse (LRR), breast cancer-specific survival, and overall survival were described using the Kaplan-Meier method. Reported risk factors for LRR (age, margins, size, Van Nuys Prognostic Index, grade, necrosis, and histologic subtype) were analyzed by univariate (log-rank) and multivariate (Cox modeling) methods. Results: Median follow-up was 12.0 years. Characteristics of the cohort were median age 55 years, 8.6% aged ?40 years, 30.5% tumors >4 cm, 42.5% grade 3 histology, 37.7% multifocal disease, and 4.9% positive margins. At 10 years, LRR was 1.0%, breast cancer-specific survival was 98.0%, and overall survival was 90.3%. All recurrences (n=12) involved ipsilateral chest wall disease, with the majority being invasive disease (11 of 12). None of the 12 patients with recurrence died of breast cancer; all were successfully salvaged (median follow-up of 4.4 years). Ten-year LRR was higher with age ?40 years (7.5% vs 1.5%; P=.003). Conclusion: Mastectomy provides excellent locoregional control for DCIS. Routine use of postmastectomy radiation therapy is not justified. Young age (?40 years) predicts slightly higher LRR, but possibly owing to the small number of cases with multiple risk factors for relapse, a subgroup with a high risk of LRR (ie, approximately 15%) was not identified.

  14. Frequent intragenic deletion of the P gene in Tanzanian patients with Type II oculocutaneous albinism (OCA2)

    SciTech Connect (OSTI)

    Spritz, R.; Fukai, K.; Holmes, S.A.

    1995-06-01

    Type II oculocutaneous albinism (OCA2) is an autosomal recessive disorder in which the biosynthesis of melanin pigment is reduced in the skin, hair, and eyes. OCA2, which results from mutations of the P gene, is the most frequent type of albinism in African and African-American patients. OCA2 is especially frequent in Tanzania, where it occurs with an incidence of {approximately}1/1,400. We have identified abnormalities of the P gene in each of 13 unrelated patients with OCA2 from Tanzania. One of these, a deletion of exon 7, is strongly predominant, accounting for {approximately}77% of mutant alleles in this group of patients. 20 refs., 2 figs.

  15. SU-E-J-204: Radiation Dose to Patients Resulting From Image Guidance Procedures and AAPM TG-180 Update

    SciTech Connect (OSTI)

    Ding, G; Alaei, P

    2014-06-01

    Purpose: Image-guided radiation therapy (IGRT) is the new paradigm for patient positioning and target localization in radiotherapy. Daily imaging procedures add additional dose to the patient's treatment volume and normal tissues and may expose the organs at risk to unaccounted doses. This presentation is to update the progress of AAPM TG-180 which aims to provide strategies to quantify and account the dose from both MV and kV imaging in patient treatment planning. Methods: Our current knowledge on image guidance dose is presented. A summary of doses from image guidance procedures delivered to patients in relationship with therapeutic doses is given. Different techniques in reducing the image guidance dose are summarized. Typical organ doses resulting from different image acquisition procedures used in IGRT are tabulated. Results: Many techniques to reduce the imaging doses are available in clinical applications. There are large variations between dose to bone and dose to soft tissues for x-rays at kilovoltage energy range. Methods for clinical implementation of accounting for the imaging dose from an imaging procedure are available. Beam data from imaging systems can be generated by combining Monte Carlo simulations and experimental measurements for commissioning imaging beams in the treatment planning. Conclusion: The current treatment planning systems are not yet equipped to perform patient specific dose calculations resulting from kV imaging procedures. The imaging dose from current kV image devices has been significantly reduced and is generally much less than that resulting from MV. Because the magnitude of kV imaging dose is significantly low and the variation between patients is modest, it is feasible to estimate dose based on imaging producers or protocols using tabulated values which provides an alternative to accomplish the task of accounting and reporting imaging doses.

  16. SciSat AM: Stereo 01: 3D Pre-treatment Dose Verification for Stereotactic Body Radiation Therapy Patients

    SciTech Connect (OSTI)

    Asuni, G; Beek, T van; Van Utyven, E; McCowan, P; McCurdy, B.M.C.

    2014-08-15

    Radical treatment techniques such as stereotactic body radiation therapy (SBRT) are becoming popular and they involve delivery of large doses in fewer fractions. Due to this feature of SBRT, a high-resolution, pre-treatment dose verification method that makes use of a 3D patient representation would be appropriate. Such a technique will provide additional information about dose delivered to the target volume(s) and organs-at-risk (OARs) in the patient volume compared to 2D verification methods. In this work, we investigate an electronic portal imaging device (EPID) based pre-treatment QA method which provides an accurate reconstruction of the 3D-dose distribution in the patient model. Customized patient plans are delivered in air and the portal images are collected using the EPID in cine mode. The images are then analysed to determine an estimate of the incident energy fluence. This is then passed to a collapsed-cone convolution dose algorithm which reconstructs a 3D patient dose estimate on the CT imaging dataset. To date, the method has been applied to 5 SBRT patient plans. Reconstructed doses were compared to those calculated by the TPS. Reconstructed mean doses were mostly within 3% of those in the TPS. DVHs of target volumes and OARs compared well. The Chi pass rates using 3%/3mm in the high dose region are greater than 97% in all cases. These initial results demonstrate clinical feasibility and utility of a robust, efficient, effective and convenient pre-treatment QA method using EPID. Research sponsored in part by Varian Medical Systems.

  17. SU-E-T-206: Improving Radiotherapy Toxicity Based On Artificial Neural Network (ANN) for Head and Neck Cancer Patients

    SciTech Connect (OSTI)

    Cho, Daniel D; Wernicke, A Gabriella; Nori, Dattatreyudu; Chao, KSC; Parashar, Bhupesh; Chang, Jenghwa [Weill Cornell Medical College, NY, NY (United States)

    2014-06-01

    Purpose/Objective(s): The aim of this study is to build the estimator of toxicity using artificial neural network (ANN) for head and neck cancer patients Materials/Methods: An ANN can combine variables into a predictive model during training and considered all possible correlations of variables. We constructed an ANN based on the data from 73 patients with advanced H and N cancer treated with external beam radiotherapy and/or chemotherapy at our institution. For the toxicity estimator we defined input data including age, sex, site, stage, pathology, status of chemo, technique of external beam radiation therapy (EBRT), length of treatment, dose of EBRT, status of post operation, length of follow-up, the status of local recurrences and distant metastasis. These data were digitized based on the significance and fed to the ANN as input nodes. We used 20 hidden nodes (for the 13 input nodes) to take care of the correlations of input nodes. For training ANN, we divided data into three subsets such as training set, validation set and test set. Finally, we built the estimator for the toxicity from ANN output. Results: We used 13 input variables including the status of local recurrences and distant metastasis and 20 hidden nodes for correlations. 59 patients for training set, 7 patients for validation set and 7 patients for test set and fed the inputs to Matlab neural network fitting tool. We trained the data within 15% of errors of outcome. In the end we have the toxicity estimation with 74% of accuracy. Conclusion: We proved in principle that ANN can be a very useful tool for predicting the RT outcomes for high risk H and N patients. Currently we are improving the results using cross validation.

  18. Risk Factors for Regional Nodal Relapse in Breast Cancer Patients With One to Three Positive Axillary Nodes

    SciTech Connect (OSTI)

    Yates, Lucy; Kirby, Anna; Crichton, Siobhan; Gillett, Cheryl; Cane, Paul; Fentiman, Ian; Sawyer, Elinor

    2012-04-01

    Purpose: In many centers, supraclavicular fossa radiotherapy (SCF RT) is not routinely offered to breast cancer patients with one to three positive lymph nodes. We aimed to identify a subgroup of these patients who are at high risk of supra or infraclavicular fossa relapse (SCFR) such that they can be offered SCFRT at the time of diagnosis to improve long term locoregional control. Methods and Materials: We performed a retrospective analysis of the pathological features of 1,065 cases of invasive breast cancer with one to three positive axillary lymph nodes. Patients underwent radical breast conserving surgery or mastectomy. A total of 45% of patients received adjuvant chest wall/breast RT. No patients received adjuvant SCFRT. The primary outcome was SCFR. Secondary outcomes were chest wall/breast recurrence, distant metastasis, all death, and breast-cancer specific death. Kaplan-Meier estimates were used to calculate actuarial event rates and survival functions compared using log-rank tests. Multivariate analyses (MVA) of factors associated with outcome were conducted using Cox proportional hazards models. Results: Median follow-up was 9.7 years. SCFR rate was 9.2%. Median time from primary diagnosis to SCFR was 3.4 years (range, 0.7-14.4 years). SCFR was associated with significantly lower 10-year survival (18% vs. 65%; p < 0.001). Higher grade and number of positive lymph nodes were the most significant predictors of SCFR on MVA (p < 0.001). 10 year SCFR rates were less than 1% in all patients with Grade 1 cancers compared with 30% in those having Grade 3 cancers with three positive lymph nodes. Additional factors associated with SCFR on univariate analysis but not on MVA included larger nodal deposits (p = 0.002) and proportion of positive nodes (p = 0.003). Conclusions: Breast cancer patients with one to three positive lymph nodes have a heterogenous risk of SCFR. Patients with two to three positive axillary nodes and/or high-grade disease may warrant consideration of SCFRT.

  19. TOPOS: A new topometric patient positioning and tracking system for radiation therapy based on structured white light

    SciTech Connect (OSTI)

    Lindl, Bastian L.; Mueller, Reinhold G.; Lang, Stephanie; Herraiz Lablanca, Maria D.; Kloeck, Stephan

    2013-04-15

    Purpose: A patient positioning system for radiation therapy based on structured white light and using off-the-shelf hardware components for flexibility and cost-effectiveness has been developed in house. Increased accuracy, patient comfort, abandonment of any skin marks, accelerated workflow, objective reading/recording, better usability and robust sensor design, compared to other positioning approaches, were the main goals of this work. Another aim was the application of a 6 degrees of freedom tracking system working without dose deposition. Methods: Two optical sensors are the main parts of the TOPOS Registered-Sign system (Topometrical Positioning, cyberTECHNOLOGIES, Germany). The components: cameras, projectors, and computers are commercial off-the-shelf products, allowing for low production costs. The black/white cameras of the prototype are capable of taking up to 240 frames per second (resolution: 640 Multiplication-Sign 488 pixels). The projector has a resolution of 1024 Multiplication-Sign 768 and a refresh rate of 120 Hz. The patient's body surface is measured continuously and registered to a reference surface, providing a transformation to superimpose the patient's surface to the reference (planning CT) surface as best as possible. The execution of the calculated transformation provides the correct patient position before the treatment starts. Due to the high-speed acquisition of the surfaces, a surveillance of the patient's (respiration) motion during treatment is also accomplished. The accuracy of the system was determined using a male mannequin. Two treatment sites were evaluated: one simulating a head and neck treatment and the other simulating a thoracic wall treatment. The mannequin was moved to predefined positions, and shift vectors given by the surface registration were evaluated. Additionally manual positioning using a color-coding system was evaluated. Results: Two prototypes have been developed, each allowing a continuous high density scan of a 500 Multiplication-Sign 500 Multiplication-Sign 400 mm{sup 3} (L Multiplication-Sign W Multiplication-Sign D) large volume with a refresh rate of 10 Hz (extendible to 20 Hz for a single sensor system). Surface and position correction display, as well as respiratory motion, is shown in real-time (delay < 200 ms) using present graphical hardware acceleration. For an intuitive view of the patient's misalignment, a fast surface registration algorithm has been developed and tested and a real-time color-coding technique is proposed and verified that allows the user to easily verify the position of the patient. Using first the surface registration and then the color coding the best results were obtained: for the head and neck case, the mean difference between the actual zero position and the final match was 0.1 {+-} 0.4, -0.2 {+-} 0.7, and -0.1 {+-} 0.3 mm in vertical, longitudinal, and lateral direction. For the thoracic case, the mean differences were 0.3 {+-} 0.5, -0.6 {+-} 1.9, 0.0 {+-} 0.4 mm. Conclusions: The presented system copes with the increasing demand for more accurate patient positioning due to more precise irradiation technologies and minimizes the preparation times for correct patient alignment, therefore optimizing the treatment workflow. Moreover, TOPOS is a versatile and cost effective image guided radiation therapy device. It allows an objective rating of the patient's position before and during the irradiation and could also be used for respiratory gating or tracking.

  20. TU-C-BRE-09: Performance Comparisons of Patient Specific IMRT QA Methodologies Using ROC Analysis

    SciTech Connect (OSTI)

    McKenzie, E; Balter, P; Stingo, F; Followill, D; Kry, S; Jones, J

    2014-06-15

    Purpose: To evaluate the ability of a selection of patient-specific QA methods to accurately classify IMRT plans as acceptable or unacceptable based on a multiple ion chamber (MIC) phantom. Methods: Twenty-four IMRT plans were selected (20 previously failed the institutional QA), and were measured on a MIC phantom to assess their dosimetric acceptability. These same plans were then measured using film (Kodak EDR2) and ion chamber (Wellhofer cc04), ArcCheck (Sun Nuclear), and MapCheck (Sun Nuclear) (delivered AP field-by-field, AP composite, and with original gantry angles). All gamma analyses were performed at 2%/2mm, 3%/3mm, and 5%/3mm. By using the MIC results as a gold standard, the sensitivity and specificity were calculated across a range of cut-off thresholds (% pixels passing for gamma analysis, and % dose difference for ion chamber), and were used to form ROC curves. Area under the curve (AUC) was used as a metric to quantify the performance of the various QA methods. Results: Grouping devices AUCs revealed two statistically significant different groups: ion chamber (AUC of 0.94), AP composite MapCheck (AUC of 0.85), ArcCheck (AUC of 0.84), and film (AUC of 0.82) were in the better performing group, while original gantry angles and AP field-by-field MapCheck (AUC of 0.65 and 0.66, respectively) matched less well with the gold standard results. Optimal cut-offs were also assessed using the ROC curves. We found that while often 90% of pixels passing is used as a criteria, the differing sensitivities of QA methods can lead to device and methodology-based optimal cutoff thresholds. Conclusion: While many methods exist to perform the same task of patient-specific IMRT QA, they utilize different strategies. This work has shown that there are inconsistencies in these methodologies in terms of their sensitivity and specificity to dosimetric acceptability. This work was supported by Public Health Service grants CA010953, CA081647, and CA21661 awarded by the National Cancer Institute, United States Department of Health and Human Services.

  1. SU-E-J-16: A Review of the Magnitude of Patient Imaging Shifts in Relation to Departmental Policy Changes

    SciTech Connect (OSTI)

    O'Connor, M; Sansourekidou, P

    2014-06-01

    Purpose: To evaluate how changes in imaging policy affect the magnitude of shifts applied to patients. Methods: In June 2012, the department's imaging policy was altered to require that any shifts derived from imaging throughout the course of treatment shall be considered systematic only after they were validated with two data points that are consistent in the same direction. Multiple additions and clarifications to the imaging policy were implemented throughout the course of the data collection, but they were mostly of administrative nature. Entered shifts were documented in MOSAIQ (Elekta AB) through the localization offset. The MOSAIQ database was queried to identify a possible trend. A total of 25,670 entries were analyzed, including four linear accelerators with a combination of MV planar, kV planar and kV three dimensional imaging. The monthly average of the magnitude of the vector was used. Plan relative offsets were excluded. During the evaluated period of time, one of the satellite facilities acquired and implemented Vision RT (AlignRT Inc). Results: After the new policy was implemented the shifts variance and standard deviation decreased. The decrease is linear with time elapsed. Vision RT implementation at one satellite facility reduced the number of overall shifts, specifically for breast patients. Conclusion: Changes in imaging policy have a significant effect on the magnitude of shifts applied to patients. Using two statistical points before applying a shift as persistent decreased the overall magnitude of the shifts applied to patients.

  2. Thymidylate Synthase Gene Polymorphism Affects the Response to Preoperative 5-Fluorouracil Chemoradiation Therapy in Patients With Rectal Cancer

    SciTech Connect (OSTI)

    Hur, Hyuk; Kang, Jeonghyun; Kim, Nam Kyu; Min, Byung Soh; Lee, Kang Young; Shin, Sang Joon; Keum, Ki Chang; Choi, Junjeong; Kim, Hoguen; Choi, Sung Ho; Lee, Mi-Young

    2011-11-01

    Purpose: This study aims to correlate thymidylate synthase (TS) gene polymorphisms with the tumor response to preoperative 5-fluorouracil (5-FU)-based chemoradiation therapy (CRT) in patients with rectal cancer. Methods and Materials: Forty-four patients with rectal cancer treated with 5-FU-based preoperative CRT were prospectively enrolled in this study. Thymidylate synthase expression and TS gene polymorphisms were evaluated in tumor obtained before preoperative CRT and were correlated with the pathologic response, as assessed by histopathologic staging (pTNM) and tumor regression grade. Results: Patients exhibited 2R/3R and 3R/3R tandem repeat polymorphisms in the TS gene. With regard to TS expression in these genotypes, 2R/3RC and 3RC/3RC were defined as the low-expression group and 2R/3RG, 3RC/3RG, and 3RG/3RG as the high-expression group. There was no significant correlation between TS expression and tumor response. There was no significant difference in the tumor response between patients homozygous for 3R/3R and patients heterozygous for 2R/3R. However, 13 of 14 patients in the low-expression group with a G>C single-nucleotide polymorphism (SNP) (2R/3RC [n = 5] or 3RC/3RC [n = 9]) exhibited a significantly greater tumor downstaging rate, as compared with only 12 of 30 patients in the high-expression group without the SNP (2R/3RG [n = 10], 3RC/3RG [n = 9], or 3RG/3RG [n = 11]) (p = 0.001). The nodal downstaging rate was also significantly greater in this low-expression group, as compared with the high-expression group (12 of 14 vs. 14 of 30, p = 0.014). However, there was no significant difference in the tumor regression grade between these groups. Conclusions: This study suggests that SNPs within the TS enhancer region affect the tumor response to preoperative 5-FU-based CRT in rectal cancer.

  3. Benefit of Adjuvant Brachytherapy Versus External Beam Radiation for Early Breast Cancer: Impact of Patient Stratification on Breast Preservation

    SciTech Connect (OSTI)

    Smith, Grace L.; Jiang, Jing; Buchholz, Thomas A.; Xu, Ying; Hoffman, Karen E.; Giordano, Sharon H.; Hunt, Kelly K.; Smith, Benjamin D.

    2014-02-01

    Purpose: Brachytherapy after lumpectomy is an increasingly popular breast cancer treatment, but data concerning its effectiveness are conflicting. Recently proposed suitability criteria guiding patient selection for brachytherapy have never been empirically validated. Methods: Using the Surveillance, Epidemiology, and End ResultsMedicare linked database, we compared women aged 66 years or older with invasive breast cancer (n=28,718) or ductal carcinoma in situ (n=7229) diagnosed from 2002 to 2007, treated with lumpectomy alone, brachytherapy, or external beam radiation therapy (EBRT). The likelihood of breast preservation, measured by subsequent mastectomy risk, was compared by use of multivariate proportional hazards, further stratified by American Society for Radiation Oncology (ASTRO) brachytherapy suitability groups. We compared 1-year postoperative complications using the ?{sup 2} test and 5-year local toxicities using the log-rank test. Results: For patients with invasive cancer, the 5-year subsequent mastectomy risk was 4.7% after lumpectomy alone (95% confidence interval [CI], 4.1%-5.4%), 2.8% after brachytherapy (95% CI, 1.8%-4.3%), and 1.3% after EBRT (95% CI, 1.1%-1.5%) (P<.001). Compared with lumpectomy alone, brachytherapy achieved a more modest reduction in adjusted risk (hazard ratio [HR], 0.61; 95% CI, 0.40-0.94) than achieved with EBRT (HR, 0.22; 95% CI, 0.18-0.28). Relative risks did not differ when stratified by ASTRO suitability group (P=.84 for interaction), although ASTRO suitable patients did show a low absolute subsequent mastectomy risk, with a minimal absolute difference in risk after brachytherapy (1.6%; 95% CI, 0.7%-3.5%) versus EBRT (0.8%; 95% CI, 0.6%-1.1%). For patients with ductal carcinoma in situ, EBRT maintained a reduced risk of subsequent mastectomy (HR, 0.40; 95% CI, 0.28-0.55; P<.001), whereas the small number of patients treated with brachytherapy (n=179) precluded definitive comparison with lumpectomy alone. In all patients, brachytherapy showed a higher postoperative infection risk (16.5% vs 9.9% after lumpectomy alone vs 11.4% after EBRT, P<.001); higher incidence of breast pain (22.9% vs 11.2% vs 16.7%, P<.001); and higher incidence of fat necrosis (15.3% vs 5.3% vs 7.7%, P<.001). Conclusions: In this study era, brachytherapy showed lesser breast preservation benefit compared with EBRT. Suitability criteria predicted differential absolute, but not relative, benefit in patients with invasive cancer.

  4. Risk of Cerebrovascular Events in Elderly Patients After Radiation Therapy Versus Surgery for Early-Stage Glottic Cancer

    SciTech Connect (OSTI)

    Hong, Julian C.; Kruser, Tim J.; Gondi, Vinai; Mohindra, Pranshu; Cannon, Donald M.; Harari, Paul M.; Bentzen, Sren M.

    2013-10-01

    Purpose: Comprehensive neck radiation therapy (RT) has been shown to increase cerebrovascular disease (CVD) risk in advanced-stage head-and-neck cancer. We assessed whether more limited neck RT used for early-stage (T1-T2 N0) glottic cancer is associated with increased CVD risk, using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Methods and Materials: We identified patients ?66 years of age with early-stage glottic laryngeal cancer from SEER diagnosed from 1992 to 2007. Patients treated with combined surgery and RT were excluded. Medicare CPT codes for carotid interventions, Medicare ICD-9 codes for cerebrovascular events, and SEER data for stroke as the cause of death were collected. Similarly, Medicare CPT and ICD-9 codes for peripheral vascular disease (PVD) were assessed to serve as an internal control between treatment groups. Results: A total of 1413 assessable patients (RT, n=1055; surgery, n=358) were analyzed. The actuarial 10-year risk of CVD was 56.5% (95% confidence interval 51.5%-61.5%) for the RT cohort versus 48.7% (41.1%-56.3%) in the surgery cohort (P=.27). The actuarial 10-year risk of PVD did not differ between the RT (52.7% [48.1%-57.3%]) and surgery cohorts (52.6% [45.2%-60.0%]) (P=.89). Univariate analysis showed an increased association of CVD with more recent diagnosis (P=.001) and increasing age (P=.001). On multivariate Cox analysis, increasing age (P<.001) and recent diagnosis (P=.002) remained significantly associated with a higher CVD risk, whereas the association of RT and CVD remained not statistically significant (HR=1.11 [0.91-1.37,] P=.31). Conclusions: Elderly patients with early-stage laryngeal cancer have a high burden of cerebrovascular events after surgical management or RT. RT and surgery are associated with comparable risk for subsequent CVD development after treatment in elderly patients.

  5. Urinary Symptom Flare in 712 {sup 125}I Prostate Brachytherapy Patients: Long-Term Follow-Up

    SciTech Connect (OSTI)

    Keyes, Mira; Miller, Stacy; Moravan, Veronika; Pickles, Tom; Liu, Mitchell; Spadinger, Ingrid; Lapointe, Vincent; Morris, W. James

    2009-11-01

    Purpose: To describe the late transient worsening of urinary symptoms ('urinary symptom flare') in 712 consecutive prostate brachytherapy patients, associated predictive factors, association with rectal and urinary toxicity, and the development of erectile dysfunction. Methods and Materials: Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). International Prostate Symptom Score (IPSS), Radiation Therapy Oncology Group (RTOG) toxicity, and erectile function data were prospectively collected. Flare was defined as an increase in IPSS of >=5 and of >=8 points greater than the post-treatment nadir. The relationships between the occurrence of flare and the patient, tumor, and treatment characteristics were examined. The Cox proportional hazards method was used to test individual variables and the multivariate models. Results: The incidence of flare was 52% and 30% using the flare definition of an IPSS of >=5 and >=8 points greater than the postimplant nadir, respectively. Of the patients with symptoms, 65% had resolution of their symptoms within 6 months and 91% within 1 year. Flares most commonly occurred 16-24 months after implantation. On multivariate analysis, a greater baseline IPSS and greater maximal postimplant IPSS were the predictors of flare, regardless of the flare definition used. Androgen suppression was a predictor for fewer flares (IPSS >=5). Diabetes and prostate edema predicted for more frequent flares (IPSS >=8). Patients with flare had a greater incidence of RTOG Grade 3 urinary toxicity and RTOG Grade 2 or greater rectal toxicity. No association was found between erectile dysfunction and the occurrence of flare. Conclusion: Urinary symptom flare is a common, transient phenomenon after prostate brachytherapy. A greater baseline IPSS and maximal postimplant IPSS were the strongest predictive factors. Flare was associated with a greater incidence of late RTOG Grade 3 urinary toxicity and greater rate of late RTOG Grade 2 or greater rectal toxicity.

  6. WE-D-18A-05: Construction of Realistic Liver Phantoms From Patient Images and a Commercial 3D Printer

    SciTech Connect (OSTI)

    Leng, S; Vrieze, T; Kuhlmann, J; Yu, L; Matsumoto, J; Morris, J; McCollough, C

    2014-06-15

    Purpose: To assess image quality and radiation dose reduction in abdominal CT imaging, physical phantoms having realistic background textures and lesions are highly desirable. The purpose of this work was to construct a liver phantom with realistic background and lesions using patient CT images and a 3D printer. Methods: Patient CT images containing liver lesions were segmented into liver tissue, contrast-enhanced vessels, and liver lesions using commercial software (Mimics, Materialise, Belgium). Stereolithography (STL) files of each segmented object were created and imported to a 3D printer (Object350 Connex, Stratasys, MN). After test scans were performed to map the eight available printing materials into CT numbers, printing materials were assigned to each object and a physical liver phantom printed. The printed phantom was scanned on a clinical CT scanner and resulting images were compared with the original patient CT images. Results: The eight available materials used to print the liver phantom had CT number ranging from 62 to 117 HU. In scans of the liver phantom, the liver lesions and veins represented in the STL files were all visible. Although the absolute value of the CT number in the background liver material (approx. 85 HU) was higher than in patients (approx. 40 HU), the difference in CT numbers between lesions and background were representative of the low contrast values needed for optimization tasks. Future work will investigate materials with contrast sufficient to emulate contrast-enhanced arteries. Conclusion: Realistic liver phantoms can be constructed from patient CT images using a commercial 3D printer. This technique may provide phantoms able to determine the effect of radiation dose reduction and noise reduction techniques on the ability to detect subtle liver lesions in the context of realistic background textures.

  7. Risk of Leptomeningeal Disease in Patients Treated With Stereotactic Radiosurgery Targeting the Postoperative Resection Cavity for Brain Metastases

    SciTech Connect (OSTI)

    Atalar, Banu; Modlin, Leslie A.; Choi, Clara Y.H.; Adler, John R.; Gibbs, Iris C.; Chang, Steven D.; Harsh, Griffith R.; Li, Gordon; Nagpal, Seema; Hanlon, Alexandra; Soltys, Scott G.

    2013-11-15

    Purpose: We sought to determine the risk of leptomeningeal disease (LMD) in patients treated with stereotactic radiosurgery (SRS) targeting the postsurgical resection cavity of a brain metastasis, deferring whole-brain radiation therapy (WBRT) in all patients. Methods and Materials: We retrospectively reviewed 175 brain metastasis resection cavities in 165 patients treated from 1998 to 2011 with postoperative SRS. The cumulative incidence rates, with death as a competing risk, of LMD, local failure (LF), and distant brain parenchymal failure (DF) were estimated. Variables associated with LMD were evaluated, including LF, DF, posterior fossa location, resection type (en-bloc vs piecemeal or unknown), and histology (lung, colon, breast, melanoma, gynecologic, other). Results: With a median follow-up of 12 months (range, 1-157 months), median overall survival was 17 months. Twenty-one of 165 patients (13%) developed LMD at a median of 5 months (range, 2-33 months) following SRS. The 1-year cumulative incidence rates, with death as a competing risk, were 10% (95% confidence interval [CI], 6%-15%) for developing LF, 54% (95% CI, 46%-61%) for DF, and 11% (95% CI, 7%-17%) for LMD. On univariate analysis, only breast cancer histology (hazard ratio, 2.96) was associated with an increased risk of LMD. The 1-year cumulative incidence of LMD was 24% (95% CI, 9%-41%) for breast cancer compared to 9% (95% CI, 5%-14%) for non-breast histology (P=.004). Conclusions: In patients treated with SRS targeting the postoperative cavity following resection, those with breast cancer histology were at higher risk of LMD. It is unknown whether the inclusion of whole-brain irradiation or novel strategies such as preresection SRS would improve this risk or if the rate of LMD is inherently higher with breast histology.

  8. A retrospective analysis for patient-specific quality assurance of volumetric-modulated arc therapy plans

    SciTech Connect (OSTI)

    Li, Guangjun; Wu, Kui; Peng, Guang; Zhang, Yingjie; Bai, Sen

    2014-01-01

    Volumetric-modulated arc therapy (VMAT) is now widely used clinically, as it is capable of delivering a highly conformal dose distribution in a short time interval. We retrospectively analyzed patient-specific quality assurance (QA) of VMAT and examined the relationships between the planning parameters and the QA results. A total of 118 clinical VMAT cases underwent pretreatment QA. All plans had 3-dimensional diode array measurements, and 69 also had ion chamber measurements. Dose distribution and isocenter point dose were evaluated by comparing the measurements and the treatment planning system (TPS) calculations. In addition, the relationship between QA results and several planning parameters, such as dose level, control points (CPs), monitor units (MUs), average field width, and average leaf travel, were also analyzed. For delivered dose distribution, a gamma analysis passing rate greater than 90% was obtained for all plans and greater than 95% for 100 of 118 plans with the 3%/3-mm criteria. The difference (mean standard deviation) between the point doses measured by the ion chamber and those calculated by TPS was 0.9% 2.0% for all plans. For all cancer sites, nasopharyngeal carcinoma and gastric cancer have the lowest and highest average passing rates, respectively. From multivariate linear regression analysis, the dose level (p = 0.001) and the average leaf travel (p < 0.001) showed negative correlations with the passing rate, and the average field width (p = 0.003) showed a positive correlation with the passing rate, all indicating a correlation between the passing rate and the plan complexity. No statistically significant correlation was found between MU or CP and the passing rate. Analysis of the results of dosimetric pretreatment measurements as a function of VMAT plan parameters can provide important information to guide the plan parameter setting and optimization in TPS.

  9. Precision Hypofractionated Radiation Therapy in Poor Performing Patients With Non-Small Cell Lung Cancer: Phase 1 Dose Escalation Trial

    SciTech Connect (OSTI)

    Westover, Kenneth D.; Loo, Billy W.; Gerber, David E.; Iyengar, Puneeth; Choy, Hak; Diehn, Maximilian; Hughes, Randy; Schiller, Joan; Dowell, Jonathan; Wardak, Zabi; Sher, David; Christie, Alana; Xie, Xian-Jin; Corona, Irma; Sharma, Akanksha; Wadsworth, Margaret E.; Timmerman, Robert

    2015-09-01

    Purpose: Treatment regimens for locally advanced non-small cell lung cancer (NSCLC) give suboptimal clinical outcomes. Technological advancements such as radiation therapy, the backbone of most treatment regimens, may enable more potent and effective therapies. The objective of this study was to escalate radiation therapy to a tumoricidal hypofractionated dose without exceeding the maximally tolerated dose (MTD) in patients with locally advanced NSCLC. Methods and Materials: Patients with stage II to IV or recurrent NSCLC and Eastern Cooperative Oncology Group performance status of 2 or greater and not candidates for surgical resection, stereotactic radiation, or concurrent chemoradiation were eligible. Highly conformal radiation therapy was given to treat intrathoracic disease in 15 fractions to a total of 50, 55, or 60 Gy. Results: Fifty-five patients were enrolled: 15 at the 50-Gy, 21 at the 55-Gy, and 19 at the 60-Gy dose levels. A 90-day follow-up was completed in each group without exceeding the MTD. With a median follow-up of 12.5 months, there were 93 grade ≥3 adverse events (AEs), including 39 deaths, although most AEs were considered related to factors other than radiation therapy. One patient from the 55- and 60-Gy dose groups developed grade ≥3 esophagitis, and 5, 4, and 4 patients in the respective dose groups experienced grade ≥3 dyspnea, but only 2 of these AEs were considered likely related to therapy. There was no association between fraction size and toxicity (P=.24). The median overall survival was 6 months with no significant differences between dose levels (P=.59). Conclusions: Precision hypofractionated radiation therapy consisting of 60 Gy in 15 fractions for locally advanced NSCLC is generally well tolerated. This treatment regimen could provide patients with poor performance status a potent alternative to chemoradiation. This study has implications for the cost effectiveness of lung cancer therapy. Additional studies of long-term safety and efficacy of this therapy are warranted.

  10. Quantitative modeling of the accuracy in registering preoperative patient-specific anatomic models into left atrial cardiac ablation procedures

    SciTech Connect (OSTI)

    Rettmann, Maryam E. Holmes, David R.; Camp, Jon J.; Cameron, Bruce M.; Robb, Richard A.; Kwartowitz, David M.; Gunawan, Mia; Johnson, Susan B.; Packer, Douglas L.; Dalegrave, Charles; Kolasa, Mark W.

    2014-02-15

    Purpose: In cardiac ablation therapy, accurate anatomic guidance is necessary to create effective tissue lesions for elimination of left atrial fibrillation. While fluoroscopy, ultrasound, and electroanatomic maps are important guidance tools, they lack information regarding detailed patient anatomy which can be obtained from high resolution imaging techniques. For this reason, there has been significant effort in incorporating detailed, patient-specific models generated from preoperative imaging datasets into the procedure. Both clinical and animal studies have investigated registration and targeting accuracy when using preoperative models; however, the effect of various error sources on registration accuracy has not been quantitatively evaluated. Methods: Data from phantom, canine, and patient studies are used to model and evaluate registration accuracy. In the phantom studies, data are collected using a magnetically tracked catheter on a static phantom model. Monte Carlo simulation studies were run to evaluate both baseline errors as well as the effect of different sources of error that would be present in a dynamicin vivo setting. Error is simulated by varying the variance parameters on the landmark fiducial, physical target, and surface point locations in the phantom simulation studies. In vivo validation studies were undertaken in six canines in which metal clips were placed in the left atrium to serve as ground truth points. A small clinical evaluation was completed in three patients. Landmark-based and combined landmark and surface-based registration algorithms were evaluated in all studies. In the phantom and canine studies, both target registration error and point-to-surface error are used to assess accuracy. In the patient studies, no ground truth is available and registration accuracy is quantified using point-to-surface error only. Results: The phantom simulation studies demonstrated that combined landmark and surface-based registration improved landmark-only registration provided the noise in the surface points is not excessively high. Increased variability on the landmark fiducials resulted in increased registration errors; however, refinement of the initial landmark registration by the surface-based algorithm can compensate for small initial misalignments. The surface-based registration algorithm is quite robust to noise on the surface points and continues to improve landmark registration even at high levels of noise on the surface points. Both the canine and patient studies also demonstrate that combined landmark and surface registration has lower errors than landmark registration alone. Conclusions: In this work, we describe a model for evaluating the impact of noise variability on the input parameters of a registration algorithm in the context of cardiac ablation therapy. The model can be used to predict both registration error as well as assess which inputs have the largest effect on registration accuracy.

  11. Prospective Preference Assessment of Patients' Willingness to Participate in a Randomized Controlled Trial of Intensity-Modulated Radiotherapy Versus Proton Therapy for Localized Prostate Cancer

    SciTech Connect (OSTI)

    Shah, Anand; Efstathiou, Jason A.; Paly, Jonathan J.; Halpern, Scott D.; Bruner, Deborah W.; Christodouleas, John P.; Coen, John J.; Deville, Curtiland; Vapiwala, Neha; Shipley, William U.; Zietman, Anthony L.; Hahn, Stephen M.; Bekelman, Justin E.

    2012-05-01

    Purpose: To investigate patients' willingness to participate (WTP) in a randomized controlled trial (RCT) comparing intensity-modulated radiotherapy (IMRT) with proton beam therapy (PBT) for prostate cancer (PCa). Methods and Materials: We undertook a qualitative research study in which we prospectively enrolled patients with clinically localized PCa. We used purposive sampling to ensure a diverse sample based on age, race, travel distance, and physician. Patients participated in a semi-structured interview in which they reviewed a description of a hypothetical RCT, were asked open-ended and focused follow-up questions regarding their motivations for and concerns about enrollment, and completed a questionnaire assessing characteristics such as demographics and prior knowledge of IMRT or PBT. Patients' stated WTP was assessed using a 6-point Likert scale. Results: Forty-six eligible patients (33 white, 13 black) were enrolled from the practices of eight physicians. We identified 21 factors that impacted patients' WTP, which largely centered on five major themes: altruism/desire to compare treatments, randomization, deference to physician opinion, financial incentives, and time demands/scheduling. Most patients (27 of 46, 59%) stated they would either 'definitely' or 'probably' participate. Seventeen percent (8 of 46) stated they would 'definitely not' or 'probably not' enroll, most of whom (6 of 8) preferred PBT before their physician visit. Conclusions: A substantial proportion of patients indicated high WTP in a RCT comparing IMRT and PBT for PCa.

  12. Influence of Lymphatic Invasion on Locoregional Recurrence Following Mastectomy: Indication for Postmastectomy Radiotherapy for Breast Cancer Patients With One to Three Positive Nodes

    SciTech Connect (OSTI)

    Matsunuma, Ryoichi; Oguchi, Masahiko; Fujikane, Tomoko; Matsuura, Masaaki; Sakai, Takehiko; Kimura, Kiyomi; Morizono, Hidetomo; Iijima, Kotaro; Izumori, Ayumi; Miyagi, Yumi; Nishimura, Seiichiro; Makita, Masujiro; Gomi, Naoya; Horii, Rie; Akiyama, Futoshi; Iwase, Takuji

    2012-07-01

    Purpose: The indication for postmastectomy radiotherapy (PMRT) in breast cancer patients with one to three positive lymph nodes has been in discussion. The purpose of this study was to identify patient groups for whom PMRT may be indicated, focusing on varied locoregional recurrence rates depending on lymphatic invasion (ly) status. Methods and Materials: Retrospective analysis of 1,994 node-positive patients who had undergone mastectomy without postoperative radiotherapy between January 1990 and December 2000 at our hospital was performed. Patient groups for whom PMRT should be indicated were assessed using statistical tests based on the relationship between locoregional recurrence rate and ly status. Results: Multivariate analysis showed that the ly status affected the locoregional recurrence rate to as great a degree as the number of positive lymph nodes (p < 0.001). Especially for patients with one to three positive nodes, extensive ly was a more significant factor than stage T3 in the TNM staging system for locoregional recurrence (p < 0.001 vs. p = 0.295). Conclusion: Among postmastectomy patients with one to three positive lymph nodes, patients with extensive ly seem to require local therapy regimens similar to those used for patients with four or more positive nodes and also seem to require consideration of the use of PMRT.

  13. Improvement of Renal Functions After Embolization of Renal AVF in a Patient Who had been on Dialysis for 5 Years

    SciTech Connect (OSTI)

    Ulusoy, Suekrue Oezkan, Guelsuem; Dinc, Hasan; Kaynar, Kuebra; Oeztuerk, Mehmet Halil; Guel, Semih; Kaplan, Safiye Tuba

    2011-02-15

    Recently, ultrasound-guided percutaneous renal biopsy has been used in the diagnosis of renal diseases. Development of an arteriovenous fistula (AVF), which is one of the post-biopsy complications, is not frequently encountered. AVFs are usually asymptomatic; however, they may lead to serious outcomes. We report a 21-year-old patient, who had been on dialysis for 5 years. Due to high blood pressure (230/160 mmHg) and a thrill in the lumbar area detected on physical examination, Doppler examination was performed and a renal AVF was detected. Because the patient had a history of renal biopsy 5 years previously, the fistula was thought to be secondary to the biopsy. After embolization of the AVF, renal functions improved enough to terminate dialysis treatment.

  14. SU-F-BRE-04: Construction of 3D Printed Patient Specific Phantoms for Dosimetric Verification Measurements

    SciTech Connect (OSTI)

    Ehler, E; Higgins, P; Dusenbery, K

    2014-06-15

    Purpose: To validate a method to create per patient phantoms for dosimetric verification measurements. Methods: Using a RANDO phantom as a substitute for an actual patient, a model of the external features of the head and neck region of the phantom was created. A phantom was used instead of a human for two reasons: to allow for dosimetric measurements that would not be possible in-vivo and to avoid patient privacy issues. Using acrylonitrile butadiene styrene thermoplastic as the building material, a hollow replica was created using the 3D printer filled with a custom tissue equivalent mixture of paraffin wax, magnesium oxide, and calcium carbonate. A traditional parallel-opposed head and neck plan was constructed. Measurements were performed with thermoluminescent dosimeters in both the RANDO phantom and in the 3D printed phantom. Calculated and measured dose was compared at 17 points phantoms including regions in high and low dose regions and at the field edges. On-board cone beam CT was used to localize both phantoms within 1mm and 1 prior to radiation. Results: The maximum difference in calculated dose between phantoms was 1.8% of the planned dose (180 cGy). The mean difference between calculated and measured dose in the anthropomorphic phantom and the 3D printed phantom was 1.9% 2.8% and ?0.1% 4.9%, respectively. The difference between measured and calculated dose was determined in the RANDO and 3D printed phantoms. The differences between measured and calculated dose in each respective phantom was within 2% for 12 of 17 points. The overlap of the RANDO and 3D printed phantom was 0.956 (Jaccard Index). Conclusion: A custom phantom was created using a 3D printer. Dosimetric calculations and measurements showed good agreement between the dose in the RANDO phantom (patient substitute) and the 3D printed phantom.

  15. Feasibility of Electromagnetic Transponder Use to Monitor Inter- and Intrafractional Motion in Locally Advanced Pancreatic Cancer Patients

    SciTech Connect (OSTI)

    Shinohara, Eric T.; Kassaee, Alireza; Mitra, Nandita; Vapiwala, Neha; Plastaras, John P.; Drebin, Jeff; Wan, Fei; Metz, James M.

    2012-06-01

    Purpose: The primary objective of this study was to determine the feasibility of electromagnetic transponder implantation in patients with locally advanced unresectable pancreatic cancer. Secondarily, the use of transponders to monitor inter- and intrafractional motion, and the efficacy of breath holding for limiting target motion, were examined. Methods and Materials: During routine screening laparoscopy, 5 patients without metastatic disease were implanted with transponders peri-tumorally. The Calypso System's localization and tracking modes were used to monitor inter- and intrafractional motion, respectively. Intrafractional motion, with and without breath holding, was also examined using Calypso tracking mode. Results: Transponder implantation was well tolerated in all patients, with minimal migration, aside from 1 patient who expulsed a single transponder. Interfractional motion based on mean shifts from setup using tattoos/orthogonal imaging to transponder based localization from 164 treatments was significant in all dimensions. Mean shift (in millimeters), followed by the standard deviation and p value, were as follows: X-axis: 4.5 mm (1.0, p = 0.01); Y axis: 6.4 mm (1.9, p = 0.03); and Z-axis 3.9 mm (0.6, p = 0.002). Mean intrafractional motion was also found to be significant in all directions: superior, 7.2 mm (0.9, p = 0.01); inferior, 11.9 mm (0.9, p < 0.01); anterior: 4.9 mm (0.5, p = 0.01); posterior, 2.9 mm (0.5, p = 0.02); left, 2.2 mm (0.4, p = 0.02); and right, 3.1 mm (0.6, p = 0.04). Breath holding during treatment significantly decreased tumor motion in all directions. Conclusions: Electromagnetic transponder implantation appears to be safe and effective for monitoring inter- and intrafractional motion. Based on these results a larger clinical trial is underway.

  16. Results of the Phase I Dose-Escalating Study of Motexafin Gadolinium With Standard Radiotherapy in Patients With Glioblastoma Multiforme

    SciTech Connect (OSTI)

    Ford, Judith M. Seiferheld, Wendy; Alger, Jeffrey R.; Wu, Genevieve; Endicott, Thyra J.; Mehta, Minesh; Curran, Walter; Phan, See-Chun

    2007-11-01

    Purpose: Motexafin gadolinium (MGd) is a putative radiation enhancer initially evaluated in patients with brain metastases. This Phase I trial studied the safety and tolerability of a 2-6-week course (10-22 doses) of MGd with radiotherapy for glioblastoma multiforme. Methods and Materials: A total of 33 glioblastoma multiforme patients received one of seven MGd regimens starting at 10 doses of 4 mg/kg/d MGd and escalating to 22 doses of 5.3 mg/kg/d MGd (5 or 10 daily doses then three times per week). The National Cancer Institute Cancer Therapy Evaluation Program toxicity and stopping rules were applied. Results: The maximal tolerated dose was 5.0 mg/kg/d MGd (5 d/wk for 2 weeks, then three times per week) for 22 doses. The dose-limiting toxicity was reversible transaminase elevation. Adverse reactions included rash/pruritus (45%), chills/fever (30%), and self-limiting vesiculobullous rash of the thumb and fingers (42%). The median survival of 17.6 months prompted a case-matched analysis. In the case-matched analysis, the MGd patients had a median survival of 16.1 months (n = 31) compared with the matched Radiation Therapy Oncology Group database patients with a median survival of 11.8 months (hazard ratio, 0.43; 95% confidence interval, 0.20-0.94). Conclusion: The maximal tolerated dose of MGd with radiotherapy for glioblastoma multiforme in this study was 5 mg/kg/d for 22 doses (daily for 2 weeks, then three times weekly). The baseline survival calculations suggest progression to Phase II trials is appropriate, with the addition of MGd to radiotherapy with concurrent and adjuvant temozolomide.

  17. The Influence of Angiography Table Shields and Height on Patient and Angiographer Irradiation During Interventional Radiology Procedures

    SciTech Connect (OSTI)

    D'Othee, Bertrand Janne Lin, Pei-Jan Paul

    2007-06-15

    Purpose. To quantify the influence of angiography table height on patient and angiographer irradiation, as compared with other routine protective measures such as the use of protective shields hanging at the tableside and from the ceiling of angiography suites. Methods. An experimental study was carried out in which a phantom (substitute for a human body) placed on the angiography table was irradiated by pulsed fluoroscopy. Entrance exposure rates were measured at the phantom surface (surrogate of patient skin exposure by incident X-ray beam) and at 60 cm from the phantom (analog to angiographer skin exposure by scatter). Exposure rates were measured at levels corresponding to the knees, testes, waist, xyphoid appendix, shoulders, and eyes of an angiographer 178 cm tall. Measurements were repeated at angiography table heights of 85, 95, 105, and 110 cm from the floor, with and without protective shields. Results. Moving the table from its highest to lowest position increased by 32% the phantom entrance exposure but decreased scatter to the angiographer. Scatter to the angiographer could be reduced most by using the protective shields (30-105 times less), but low table heights provided relatively more important protection (412-1121 {mu}Sv/hr reduction, or 15-72% scatter reduction) when shields were not used (e.g., for unprotected regions of the angiographer's body such as the hands). Conclusion. Working at lower table heights provides a little additional protection to exposed body parts of angiographers, at the cost of somewhat higher patient exposure. Although small, this incremental protection could be clinically relevant in the long term. The choice of table position should be a compromise based on multiple factors, including at least patient exposure, scatter to angiographers, and angiographer comfort.

  18. Assessment of ERCC1 and XPF Protein Expression Using Quantitative Immunohistochemistry in Nasopharyngeal Carcinoma Patients Undergoing Curative Intent Treatment

    SciTech Connect (OSTI)

    Jagdis, Amanda; Phan, Tien; Faculty of Medicine, University of Calgary, Calgary, Alberta ; Klimowicz, Alexander C.; Faculty of Medicine, University of Calgary, Calgary, Alberta ; Laskin, Janessa J.; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia ; Lau, Harold Y.; Faculty of Medicine, University of Calgary, Calgary, Alberta ; Petrillo, Stephanie K.; Siever, Jodi E.; Thomson, Thomas A.; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia ; Magliocco, Anthony M.; Faculty of Medicine, University of Calgary, Calgary, Alberta ; Hao, Desire; Faculty of Medicine, University of Calgary, Calgary, Alberta

    2013-04-01

    Purpose: We sought to evaluate the prognostic/predictive value of ERCC1 and XPF in patients with nonmetastatic nasopharyngeal carcinoma (NPC) treated with curative intent. Methods and Materials: ERCC1 and XPF protein expression was evaluated by immunofluorescence combined with automated quantitative analysis (AQUA) using the FL297 and 3F2 antibodies, respectively. ERCC1 and XPF protein expression levels were correlated with clinical outcomes. Results: Patient characteristics were as follows: mean age 52 years (range, 18-85 years), 67% male, 72% Karnofsky performance status (KPS) ?90%, World Health Organization (WHO) type 1/2/3 = 12%/28%/60%, stage III/IV 65%. With a median follow-up time of 50 months (range, 2.9 to 120 months), the 5-year overall survival (OS) was 70.8%. Median standardized nuclear AQUA scores were used as cutpoints for ERCC1 (n=138) and XPF (n=130) protein expression. Agreement between dichotomized ERCC1 and XPF scores was high at 79.4% (kappa = 0.587, P<.001). Neither biomarker predicted locoregional recurrence, DFS, or OS after adjustment for age and KPS, irrespective of stratification by stage, WHO type, or treatment. Conclusions: Neither ERCC1 nor XPF, analyzed by quantitative immunohistochemistry using the FL297 and 3F2 antibodies, was prognostic or predictive in this cohort of NPC patients.

  19. Upfront Androgen Deprivation Therapy With Salvage Radiation May Improve Biochemical Outcomes in Prostate Cancer Patients With Post-Prostatectomy Rising PSA

    SciTech Connect (OSTI)

    Jang, Joanne W.; Hwang, Wei-Ting; Guzzo, Thomas J.; Wein, Alan J.; Haas, Naomi B.; Both, Stefan; Vapiwala, Neha

    2012-08-01

    Purpose: The addition of androgen deprivation therapy (ADT) to definitive external beam radiation therapy (RT) improves outcomes in higher-risk prostate cancer patients. However, the benefit of ADT with salvage RT in post-prostatectomy patients is not clearly established. Our study compares biochemical outcomes in post-prostatectomy patients who received salvage RT with or without concurrent ADT. Methods and Materials: Of nearly 2,000 post-prostatectomy patients, we reviewed the medical records of 191 patients who received salvage RT at University of Pennsylvania between 1987 and 2007. Follow-up data were obtained by chart review and electronic polling of the institutional laboratory database and Social Security Death Index. Biochemical failure after salvage RT was defined as a prostate-specific antigen of 2.0 ng/mL above the post-RT nadir or the initiation of ADT after completion of salvage RT. Results: One hundred twenty-nine patients received salvage RT alone, and 62 patients received combined ADT and salvage RT. Median follow-up was 5.4 years. Patients who received combined ADT and salvage RT were younger, had higher pathologic Gleason scores, and higher rates of seminal vesicle invasion, lymph node involvement, and pelvic nodal irradiation compared with patients who received salvage RT alone. Patients who received combined therapy had improved biochemical progression-free survival (bPFS) compared with patients who received RT alone (p = 0.048). For patients with pathologic Gleason scores {<=}7, combined RT and ADT resulted in significantly improved bPFS compared to RT alone (p = 0.013). Conclusions: These results suggest that initiating ADT during salvage RT in the post-prostatectomy setting may improve bPFS compared with salvage RT alone. However, prospective randomized data are necessary to definitively determine whether hormonal manipulation should be used with salvage RT. Furthermore, the optimal nature and duration of ADT and the patient subgroups in which ADT could provide the most benefit remain open questions.

  20. Assessment of the point-source method for estimating dose rates to members of the public from exposure to patients with 131I thyroid treatment

    SciTech Connect (OSTI)

    Dewji, Shaheen Azim; Bellamy, Michael B.; Hertel, Nolan E.; Leggett, Richard Wayne; Sherbini, Sami; Saba, Mohammad S.; Eckerman, Keith F.

    2015-09-01

    The U.S. Nuclear Regulatory Commission (USNRC) initiated a contract with Oak Ridge National Laboratory (ORNL) to calculate radiation dose rates to members of the public that may result from exposure to patients recently administered iodine-131 (131I) as part of medical therapy. The main purpose was to compare dose rate estimates based on a point source and target with values derived from more realistic simulations that considered the time-dependent distribution of 131I in the patient and attenuation of emitted photons by the patients tissues. The external dose rate estimates were derived using Monte Carlo methods and two representations of the Phantom with Movable Arms and Legs, previously developed by ORNL and the USNRC, to model the patient and a nearby member of the public. Dose rates to tissues and effective dose rates were calculated for distances ranging from 10 to 300 cm between the phantoms and compared to estimates based on the point-source method, as well as to results of previous studies that estimated exposure from 131I patients. The point-source method overestimates dose rates to members of the public in very close proximity to an 131I patient but is a broadly accurate method of dose rate estimation at separation distances of 300 cm or more at times closer to administration.

  1. Prognostic Impact of Radiation Therapy to the Primary Tumor in Patients With Non-small Cell Lung Cancer and Oligometastasis at Diagnosis

    SciTech Connect (OSTI)

    Lopez Guerra, Jose Luis [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States) [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Gomez, Daniel, E-mail: dgomez@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhuang, Yan; Hong, David S. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Heymach, John V. [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Swisher, Stephen G. [Department of Thoracic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Thoracic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lin, Steven H.; Komaki, Ritsuko; Cox, James D.; Liao Zhongxing [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)] [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2012-09-01

    Purpose: We investigated prognostic factors associated with survival in patients with non-small cell lung cancer (NSCLC) and oligometastatic disease at diagnosis, particularly the influence of local treatment to the primary site on prognosis. Methods and Materials: From January 2000 through June 2011, 78 consecutive patients with oligometastatic NSCLC (<5 metastases) at diagnosis underwent definitive chemoradiation therapy ({>=}45 Gy) to the primary site. Forty-four of these patients also received definitive local treatment for the oligometastases. Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Results: Univariate Cox proportional hazard analysis revealed better overall survival (OS) for those patients who received at least 63 Gy of radiation to the primary site (P=.002), received definitive local treatment for oligometastasis (P=.041), had a Karnofsky performance status (KPS) score >80 (P=.007), had a gross tumor volume {<=}124 cm{sup 3} (P=.002), had adenocarcinoma histology (P=.002), or had no history of respiratory disease (P=.016). On multivariate analysis, radiation dose, performance status, and tumor volume retained significance (P=.004, P=.006, and P<.001, respectively). The radiation dose also maintained significance when patients with and without brain metastases were analyzed separately. Conclusions: Tumor volume, KPS, and receipt of at least 63 Gy to the primary tumor are associated with improved OS in patients with oligometastatic NSCLC at diagnosis. Our results suggest that a subset of such patients may benefit from definitive local therapy.

  2. SU-E-T-389: Effect of Interfractional Shoulder Motion On Low Neck Nodal Targets for Patients Treated Using Volume Modulated Arc Therapy (VMAT)

    SciTech Connect (OSTI)

    Casey, K; Wong, P; Tung, S

    2014-06-01

    Purpose: To quantify the dosimetric impact of interfractional shoulder motion on targets in the low neck for head and neck patients treated with volume modulated arc therapy (VMAT). Methods: Three patients with head and neck cancer were selected. All three required treatment to nodal regions in the low neck in addition to the primary tumor. The patients were immobilized during simulation and treatment with a custom thermoplastic mask covering the head and shoulders. One VMAT plan was created for each patient utilizing two full 360 arcs. A second plan was created consisting of two superior VMAT arcs matched to an inferior static AP supraclavicular field. A CT-on-rails alignment verification was performed weekly during each patient's treatment course. The weekly CT images were registered to the simulation CT and the target contours were deformed and applied to the weekly CT. The two VMAT plans were copied to the weekly CT datasets and recalculated to obtain the dose to the low neck contours. Results: The average observed shoulder position shift in any single dimension relative to simulation was 2.5 mm. The maximum shoulder shift observed in a single dimension was 25.7 mm. Low neck target mean doses, normalized to simulation and averaged across all weekly recalculations were 0.996, 0.991, and 1.033 (Full VMAT plan) and 0.986, 0.995, and 0.990 (Half-Beam VMAT plan) for the three patients, respectively. The maximum observed deviation in target mean dose for any individual weekly recalculation was 6.5%, occurring with the Full VMAT plan for Patient 3. Conclusion: Interfractional variation in dose to low neck nodal regions was quantified for three head and neck patients treated with VMAT. Mean dose was 3.3% higher than planned for one patient using a Full VMAT plan. A Half-Beam technique is likely a safer choice when treating the supraclavicular region with VMAT.

  3. Gamma Knife Stereotactic Radiosurgery as Salvage Therapy After Failure of Whole-Brain Radiotherapy in Patients With Small-Cell Lung Cancer

    SciTech Connect (OSTI)

    Harris, Sunit; Chan, Michael D.; Lovato, James F.; Ellis, Thomas L.; Tatter, Stephen B.; Bourland, J. Daniel; Munley, Michael T.; Guzman, Allan F. de; Shaw, Edward G.; Urbanic, James J.; McMullen, Kevin P.

    2012-05-01

    Purpose: Radiosurgery has been successfully used in selected cases to avoid repeat whole-brain irradiation (WBI) in patients with multiple brain metastases of most solid tumor histological findings. Few data are available for the use of radiosurgery for small-cell lung cancer (SCLC). Methods and Materials: Between November 1999 and June 2009, 51 patients with SCLC and previous WBI and new brain metastases were treated with GammaKnife stereotactic radiosurgery (GKSRS). A median dose of 18 Gy (range, 10-24 Gy) was prescribed to the margin of each metastasis. Patients were followed with serial imaging. Patient electronic records were reviewed to determine disease-related factors and clinical outcomes after GKSRS. Local and distant brain failure rates, overall survival, and likelihood of neurologic death were determined based on imaging results. The Kaplan-Meier method was used to determine survival and local and distant brain control. Cox proportional hazard regression was performed to determine strength of association between disease-related factors and survival. Results: Median survival time for the entire cohort was 5.9 months. Local control rates at 1 and 2 years were 57% and 34%, respectively. Distant brain failure rates at 1 and 2 years were 58% and 75%, respectively. Fifty-three percent of patients ultimately died of neurologic death. On multivariate analysis, patients with stable (hazard ratio [HR] = 2.89) or progressive (HR = 6.98) extracranial disease (ECD) had worse overall survival than patients without evidence of ECD (p = 0.00002). Concurrent chemotherapy improved local control (HR = 89; p = 0.006). Conclusions: GKSRS represents a feasible salvage option in patients with SCLC and brain metastases for whom previous WBI has failed. The status of patients' ECD is a dominant factor predictive of overall survival. Local control may be inferior to that seen with other cancer histological results, although the use of concurrent chemotherapy may help to improve this.

  4. SU-E-T-317: The Development of a DIBH Technique for Left Sided Breast Patients Undergoing Radiation Therapy Utilizing Varians RPM System in a Community Hospital

    SciTech Connect (OSTI)

    Hasson, B; Young, M; Workie, D; Geraghty, C

    2014-06-01

    Purpose: To develop and implement a Deep Inhalation Breath Hold program (DIBH) for treatment of patients with Left-sided breast cancer in a community hospital. Methods: All patients with left sided breast cancer underwent a screening free breathing CT. Evaluation of the conventional tangent treatment fields and the heart was conducted. If the heart would not be excluded using tangents, the patient then received DIBH breathe coaching. The patients returned for a 4D CT simulation. The patients breathing cycle was monitored using the Varian Real-Time position ManagementTM (RPM) system to assess duration of DIBH, amplitude, phase and recovery time to normal breathing. Then a DIBH CT was obtained at the desired amplitude. Duplicate plans were developed for both free breathing and DIBH on the Eclipse planning system and comparison DVH's were created. The plan that provided the prescribed treatment coverage and the least doses to the OAR (heart, Lt. Lung) was determined. Those patients selected to receive treatment with DIBH were set up for treatment, and breathing was monitored using the RPM system. Practice trials were used to confirm that the amplitude, phase and recovery were consistent with findings from simulation. Results: 10 patients have been treated using the DIBH procedure in our clinic. The DIBH patients had an average increase of 80% lung volume on DIBH, decreased lung volume receiving 50% of the dose, and decreases in the V20 dose. Significant reduction in the maximum and mean dose to the heart, as well as the dose to 1CC of the volume for the DIBH plans. Conclusion: Using the RPM system already available in the clinic, staff training, and patient coaching a simple DIBH program was setup. The use of DIBH has shown promise in reducing doses to the critical organs while maintaining PTV coverage for left sided breast treatments.

  5. Phase 3 Trials of Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for 1 to 4 Brain Metastases: Individual Patient Data Meta-Analysis

    SciTech Connect (OSTI)

    Sahgal, Arjun; Aoyama, Hidefumi; Kocher, Martin; Neupane, Binod; Collette, Sandra; Tago, Masao; Shaw, Prakesh; Beyene, Joseph; Chang, Eric L.

    2015-03-15

    Purpose: To perform an individual patient data (IPD) meta-analysis of randomized controlled trials evaluating stereotactic radiosurgery (SRS) with or without whole-brain radiation therapy (WBRT) for patients presenting with 1 to 4 brain metastases. Method and Materials: Three trials were identified through a literature search, and IPD were obtained. Outcomes of interest were survival, local failure, and distant brain failure. The treatment effect was estimated after adjustments for age, recursive partitioning analysis (RPA) score, number of brain metastases, and treatment arm. Results: A total of 364 of the pooled 389 patients met eligibility criteria, of whom 51% were treated with SRS alone and 49% were treated with SRS plus WBRT. For survival, age was a significant effect modifier (P=.04) favoring SRS alone in patients ≤50 years of age, and no significant differences were observed in older patients. Hazard ratios (HRs) for patients 35, 40, 45, and 50 years of age were 0.46 (95% confidence interval [CI] = 0.24-0.90), 0.52 (95% CI = 0.29-0.92), 0.58 (95% CI = 0.35-0.95), and 0.64 (95% CI = 0.42-0.99), respectively. Patients with a single metastasis had significantly better survival than those who had 2 to 4 metastases. For distant brain failure, age was a significant effect modifier (P=.043), with similar rates in the 2 arms for patients ≤50 of age; otherwise, the risk was reduced with WBRT for patients >50 years of age. Patients with a single metastasis also had a significantly lower risk of distant brain failure than patients who had 2 to 4 metastases. Local control significantly favored additional WBRT in all age groups. Conclusions: For patients ≤50 years of age, SRS alone favored survival, in addition, the initial omission of WBRT did not impact distant brain relapse rates. SRS alone may be the preferred treatment for this age group.

  6. Nomogram for Predicting the Risk of Locoregional Recurrence in Patients Treated With Accelerated Partial-Breast Irradiation

    SciTech Connect (OSTI)

    Wobb, Jessica L.; Chen, Peter Y.; Shah, Chirag; Moran, Meena S.; Shaitelman, Simona F.; Vicini, Frank A.; Beitsch, Peter

    2015-02-01

    Purpose: To develop a nomogram taking into account clinicopathologic features to predict locoregional recurrence (LRR) in patients treated with accelerated partial-breast irradiation (APBI) for early-stage breast cancer. Methods and Materials: A total of 2000 breasts (1990 women) were treated with APBI at William Beaumont Hospital (n=551) or on the American Society of Breast Surgeons MammoSite Registry Trial (n=1449). Techniques included multiplanar interstitial catheters (n=98), balloon-based brachytherapy (n=1689), and 3-dimensional conformal radiation therapy (n=213). Clinicopathologic variables were gathered prospectively. A nomogram was formulated utilizing the Cox proportional hazards regression model to predict for LRR. This was validated by generating a bias-corrected index and cross-validated with a concordance index. Results: Median follow-up was 5.5 years (range, 0.9-18.3 years). Of the 2000 cases, 435 were excluded because of missing data. Univariate analysis found that age <50 years, pre-/perimenopausal status, close/positive margins, estrogen receptor negativity, and high grade were associated with a higher frequency of LRR. These 5 independent covariates were used to create adjusted estimates, weighting each on a scale of 0-100. The total score is identified on a points scale to obtain the probability of an LRR over the study period. The model demonstrated good concordance for predicting LRR, with a concordance index of 0.641. Conclusions: The formulation of a practical, easy-to-use nomogram for calculating the risk of LRR in patients undergoing APBI will help guide the appropriate selection of patients for off-protocol utilization of APBI.

  7. SciFri PM: Dosimetry06: Commissioning of a 3D patient specific QA system for hypofractionated prostate treatments

    SciTech Connect (OSTI)

    Rivest, R; Venkataraman, S; McCurdy, B

    2014-08-15

    The objective of this work is to commission the 6MV-SRS beam model in COMPASS (v2.1, IBA-Dosimetry) and validate its use for patient specific QA of hypofractionated prostate treatments. The COMPASS system consists of a 2D ion chamber array (MatriXX{sup Evolution}), an independent gantry angle sensor and associated software. The system can either directly calculate or reconstruct (using measured detector responses) a 3D dose distribution on the patient CT dataset for plan verification. Beam models are developed and commissioned in the same manner as a beam model is commissioned in a standard treatment planning system. Model validation was initially performed by comparing both COMPASS calculations and reconstructions to measured open field beam data. Next, 10 hypofractionated prostate RapidArc plans were delivered to both the COMPASS system and a phantom with ion chamber and film inserted. COMPASS dose distributions calculated and reconstructed on the phantom CT dataset were compared to the chamber and film measurements. The mean ( standard deviation) difference between COMPASS reconstructed dose and ion chamber measurement was 1.4 1.0%. The maximum discrepancy was 2.6%. Corresponding values for COMPASS calculation were 0.9 0.9% and 2.6%, respectively. The average gamma agreement index (3%/3mm) for COMPAS reconstruction and film was 96.7% and 95.3% when using 70% and 20% dose thresholds, respectively. The corresponding values for COMPASS calculation were 97.1% and 97.1%, respectively. Based on our results, COMPASS can be used for the patient specific QA of hypofractionated prostate treatments delivered with the 6MV-SRS beam.

  8. SU-E-T-248: Near Real-Time Analysis of Radiation Delivery and Imaging, Accuracy to Ensure Patient Safety

    SciTech Connect (OSTI)

    Wijesooriya, K; Seitter, K; Desai, V; Read, P; Larner, J

    2014-06-01

    Purpose: To develop and optimize an effective software method for comparing planned to delivered control point machine parameters for all VARIAN TrueBeam treatments so as to permit (1) assessment of a large patient pool throughout their treatment course to quantify treatment technique specific systematic and random uncertainty of observables, (2) quantify the site specific daily imaging shifts required for target alignment, and (3) define tolerance levels for mechanical parameters and imaging parameters based on statistical analysis data gathered, and the dosimetric impact of variations. Methods: Treatment and imaging log files were directly compared to plan parameters for Eclipse and Pinnacle planned treatments via 3D, IMRT, control point, RapidArc, and electrons. Each control point from all beams/arcs (7984) for all fractions (1940) of all patients treated over six months were analyzed. At each control point gantry angle, collimator angle, couch angle, jaw positions, MLC positions, MU were compared. Additionally per-treatment isocenter shifts were calculated. Results were analyzed as a whole in treatment type subsets: IMRT, 3D, RapidArc; and in treatment site subsets: brain, chest/mediastinum, esophagus, H and N, lung, pelvis, prostate. Results: Daily imaging isocenter shifts from initial external tattoo alignment were dependent on the treatment site with < 0.5 cm translational shifts for H and N, Brain, and lung SBRT, while pelvis, esophagus shifts were ?1 cm. Mechanical delivery parameters were within tolerance levels for all sub-beams. The largest variations were for RapidArc plans: gantry angle 0.110.12,collimator angle 0.000.00, jaw positions 0.480.26, MLC leaf positions 0.660.08, MU 0.140.34. Conclusion: Per-control point validation reveals deviations between planned and delivered parameters. If used in a near real-time error checking system, patient safety can be improved by equipping the treatment delivery system with additional forcing functions which by-pass human error avenues.

  9. Decreased expression of RNA interference machinery, Dicer and Drosha, is associated with poor outcome in ovarian cancer patients

    SciTech Connect (OSTI)

    Merritt, William M.; Lin, Yvonne G.; Han, Liz Y.; Kamat, Aparna A.; Spannuth, Whitney A.; Schmandt, Rosemarie; Urbauer, Diana; Pennacchio, Len A.; Cheng, Jan-Fang; Zeidan, Alexandra; Wang, Hua; Mueller, Peter; Lenburg, Marc E.; Gray, Joe W.; Mok, Samuel; Birrer, Michael J.; Lopez-Berestein, Gabriel; Coleman, Robert L.; Bar-Eli, Menashe; Sood, Anil K.

    2008-05-06

    The clinical and functional significance of RNA interference (RNAi) machinery, Dicer and Drosha, in ovarian cancer is not known and was examined. Dicer and Drosha expression was measured in ovarian cancer cell lines (n=8) and invasive epithelial ovarian cancer specimens (n=111) and correlated with clinical outcome. Validation was performed with previously published cohorts of ovarian, breast, and lung cancer patients. Anti-Galectin-3 siRNA and shRNA transfections were used for in vitro functional studies. Dicer and Drosha mRNA and protein levels were decreased in 37% to 63% of ovarian cancer cell lines and in 60% and 51% of human ovarian cancer specimens, respectively. Low Dicer was significantly associated with advanced tumor stage (p=0.007), and low Drosha with suboptimal surgical cytoreduction (p=0.02). Tumors with both high Dicer and Drosha were associated with increased median patient survival (>11 years vs. 2.66 years for other groups; p<0.001). In multivariate analysis, high Dicer (HR=0.48; p=0.02), high-grade histology (HR=2.46; p=0.03), and poor chemoresponse (HR=3.95; p<0.001) were identified as independent predictors of disease-specific survival. Findings of poor clinical outcome with low Dicer expression were validated in separate cohorts of cancer patients. Galectin-3 silencing with siRNA transfection was superior to shRNA in cell lines with low Dicer (78-95% vs. 4-8% compared to non-targeting sequences), and similar in cell lines with high Dicer. Our findings demonstrate the clinical and functional impact of RNAi machinery alterations in ovarian carcinoma and support the use of siRNA constructs that do not require endogenous Dicer and Drosha for therapeutic applications.

  10. ATM Polymorphisms Predict Severe Radiation Pneumonitis in Patients With Non-Small Cell Lung Cancer Treated With Definitive Radiation Therapy

    SciTech Connect (OSTI)

    Xiong, Huihua; Liao, Zhongxing; Liu, Zhensheng; Xu, Ting; Wang, Qiming; Liu, Hongliang; Komaki, Ritsuko; Gomez, Daniel; Wang, Li-E; Wei, Qingyi

    2013-03-15

    Purpose: The ataxia telangiectasia mutated (ATM) gene mediates detection and repair of DNA damage. We investigated associations between ATM polymorphisms and severe radiation-induced pneumonitis (RP). Methods and Materials: We genotyped 3 potentially functional single nucleotide polymorphisms (SNPs) of ATM (rs1801516 [D1853N/5557G>A], rs189037 [-111G>A] and rs228590) in 362 patients with non-small cell lung cancer (NSCLC), who received definitive (chemo)radiation therapy. The cumulative severe RP probabilities by genotypes were evaluated using the Kaplan-Meier analysis. The associations between severe RP risk and genotypes were assessed by both logistic regression analysis and Cox proportional hazard model with time to event considered. Results: Of 362 patients (72.4% of non-Hispanic whites), 56 (15.5%) experienced grade ≥3 RP. Patients carrying ATM rs189037 AG/GG or rs228590 TT/CT genotypes or rs189037G/rs228590T/rs1801516G (G-T-G) haplotype had a lower risk of severe RP (rs189037: GG/AG vs AA, adjusted hazard ratio [HR] = 0.49, 95% confidence interval [CI], 0.29-0.83, P=.009; rs228590: TT/CT vs CC, HR=0.57, 95% CI, 0.33-0.97, P=.036; haplotype: G-T-G vs A-C-G, HR=0.52, 95% CI, 0.35-0.79, P=.002). Such positive findings remained in non-Hispanic whites. Conclusions: ATM polymorphisms may serve as biomarkers for susceptibility to severe RP in non-Hispanic whites. Large prospective studies are required to confirm our findings.

  11. Prospective Evaluation to Establish a Dose Response for Clinical Oral Mucositis in Patients Undergoing Head-and-Neck Conformal Radiotherapy

    SciTech Connect (OSTI)

    Narayan, Samir Lehmann, Joerg; Coleman, Matthew A.; Vaughan, Andrew; Yang, Claus Chunli; Enepekides, Danny; Farwell, Gregory; Purdy, James A.; Laredo, Grace; Nolan, Kerry A.S.; Pearson, Francesca S.; Vijayakumar, Srinivasan

    2008-11-01

    Purpose: We conducted a clinical study to correlate oral cavity dose with clinical mucositis, perform in vivo dosimetry, and determine the feasibility of obtaining buccal mucosal cell samples in patients undergoing head-and-neck radiation therapy. The main objective is to establish a quantitative dose response for clinical oral mucositis. Methods and Materials: Twelve patients undergoing radiation therapy for head-and-neck cancer were prospectively studied. Four points were chosen in separate quadrants of the oral cavity. Calculated dose distributions were generated by using AcQPlan and Eclipse treatment planning systems. MOSFET dosimeters were used to measure dose at each sampled point. Each patient underwent buccal sampling for future RNA analysis before and after the first radiation treatment at the four selected points. Clinical and functional mucositis were assessed weekly according to National Cancer Institute Common Toxicity Criteria, Version 3. Results: Maximum and average doses for sampled sites ranged from 7.4-62.3 and 3.0-54.3 Gy, respectively. A cumulative point dose of 39.1 Gy resulted in mucositis for 3 weeks or longer. Mild severity (Grade {<=} 1) and short duration ({<=}1 week) of mucositis were found at cumulative point doses less than 32 Gy. Polymerase chain reaction consistently was able to detect basal levels of two known radiation responsive genes. Conclusions: In our sample, cumulative doses to the oral cavity of less than 32 Gy were associated with minimal acute mucositis. A dose greater than 39 Gy was associated with longer duration of mucositis. Our technique for sampling buccal mucosa yielded sufficient cells for RNA analysis using polymerase chain reaction.

  12. SU-E-T-548: How To Decrease Spine Dose In Patients Who Underwent Sterotactic Spine Radiosurgery?

    SciTech Connect (OSTI)

    Acar, H; Altinok, A; Kucukmorkoc, E; Kucuk, N; Caglar, H

    2014-06-01

    Purpose: Stereotactic radiosurgery for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to dosimetrically compare stereotactic spine radiosurgery(SRS) plans using a recently new volumetric modulated arc therapy(VMAT) technique against fix-field intensity-modulated radiotherapy(IMRT). Plans were evaluated for target conformity and spinal cord sparing. Methods: Fifteen previously treated patients were replanned using the Eclipse 10.1 TPS AAA calculation algorithm. IMRT plans with 7 fields were generated. The arc plans used 2 full arc configurations. Arc and IMRT plans were normalized and prescribed to deliver 16.0 Gy in a single fraction to 90% of the planning target volume(PTV). PTVs consisted of the vertebral body expanded by 3mm, excluding the PRV-cord, where the cord was expanded by 2mm.RTOG 0631 recommendations were applied for treatment planning. Partial spinal cord volume was defined as 5mm above and below the radiosurgery target volume. Plans were compared for conformity and gradient index as well as spinal cord sparing. Results: The conformity index values of fifteen patients for two different treatment planning techniques were shown in table 1. Conformity index values for 2 full arc planning (average CI=0.84) were higher than that of IMRT planning (average CI=0.79). The gradient index values of fifteen patients for two different treatment planning techniques were shown in table 2. Gradient index values for 2 full arc planning (average GI=3.58) were higher than that of IMRT planning (average GI=2.82).The spinal cord doses of fifteen patients for two different treatment planning techniques were shown in table 3. D0.35cc, D0.03cc and partial spinal cord D10% values in 2 full arc plannings (average D0.35cc=819.3cGy, D0.03cc=965.4cGy, 10%partial spinal=718.1cGy) were lower than IMRT plannings (average D0.35cc=877.4cGy, D0.03c=1071.4cGy, 10%partial spinal=805.1cGy). Conclusions: The two arc VMAT technique is superior to 7 field IMRT technique in terms of both spinal cord sparing and better conformity and gradient indexes.

  13. Predictors of Severe Acute and Late Toxicities in Patients With Localized Head-and-Neck Cancer Treated With Radiation Therapy

    SciTech Connect (OSTI)

    Meyer, Francois, E-mail: francois.meyer@chuq.qc.ca [Laval University Cancer Research Center, Centre hospitalier universitaire de Quebec - L'Hotel-Dieu de Quebec, Quebec (Canada); Fortin, Andre; Wang, Chang Shu [Radiation Therapy Department, Centre hospitalier universitaire de Quebec - L'Hotel-Dieu de Quebec, Quebec (Canada); Liu, Geoffrey [Applied Molecular Oncology, Ontario Cancer Institute/Princess Margaret Hospital, Toronto (Canada); Bairati, Isabelle [Laval University Cancer Research Center, Centre hospitalier universitaire de Quebec - L'Hotel-Dieu de Quebec, Quebec (Canada)

    2012-03-15

    Purpose: Radiation therapy (RT) causes acute and late toxicities that affect various organs and functions. In a large cohort of patients treated with RT for localized head and neck cancer (HNC), we prospectively assessed the occurrence of RT-induced acute and late toxicities and identified characteristics that predicted these toxicities. Methods and Materials: We conducted a randomized trial among 540 patients treated with RT for localized HNC to assess whether vitamin E supplementation could improve disease outcomes. Adverse effects of RT were assessed using the Radiation Therapy Oncology Group Acute Radiation Morbidity Criteria during RT and one month after RT, and the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme at six and 12 months after RT. The most severe adverse effect among the organs/tissues was selected as an overall measure of either acute or late toxicity. Grade 3 and 4 toxicities were considered as severe. Stepwise multivariate logistic regression models were used to identify all independent predictors (p < 0.05) of acute or late toxicity and to estimate odds ratios (OR) for severe toxicity with their 95% confidence intervals (CI). Results: Grade 3 or 4 toxicity was observed in 23% and 4% of patients, respectively, for acute and late toxicity. Four independent predictors of severe acute toxicity were identified: sex (female vs. male: OR = 1.72, 95% confidence interval [CI]: 1.06-2.80), Karnofsky Performance Status (OR = 0.67 for a 10-point increment, 95% CI: 0.52-0.88), body mass index (above 25 vs. below: OR = 1.88, 95% CI: 1.22-2.90), TNM stage (Stage II vs. I: OR = 1.91, 95% CI: 1.25-2.92). Two independent predictors were found for severe late toxicity: female sex (OR = 3.96, 95% CI: 1.41-11.08) and weight loss during RT (OR = 1.26 for a 1 kg increment, 95% CI: 1.12-1.41). Conclusions: Knowledge of these predictors easily collected in a clinical setting could help tailoring therapies to reduce toxicities among patients treated with RT for HNC.

  14. SU-E-J-01: 3D Fluoroscopic Image Estimation From Patient-Specific 4DCBCT-Based Motion Models

    SciTech Connect (OSTI)

    Dhou, S; Hurwitz, M; Lewis, J; Mishra, P

    2014-06-01

    Purpose: 3D motion modeling derived from 4DCT images, taken days or weeks before treatment, cannot reliably represent patient anatomy on the day of treatment. We develop a method to generate motion models based on 4DCBCT acquired at the time of treatment, and apply the model to estimate 3D time-varying images (referred to as 3D fluoroscopic images). Methods: Motion models are derived through deformable registration between each 4DCBCT phase, and principal component analysis (PCA) on the resulting displacement vector fields. 3D fluoroscopic images are estimated based on cone-beam projections simulating kV treatment imaging. PCA coefficients are optimized iteratively through comparison of these cone-beam projections and projections estimated based on the motion model. Digital phantoms reproducing ten patient motion trajectories, and a physical phantom with regular and irregular motion derived from measured patient trajectories, are used to evaluate the method in terms of tumor localization, and the global voxel intensity difference compared to ground truth. Results: Experiments included: 1) assuming no anatomic or positioning changes between 4DCT and treatment time; and 2) simulating positioning and tumor baseline shifts at the time of treatment compared to 4DCT acquisition. 4DCBCT were reconstructed from the anatomy as seen at treatment time. In case 1) the tumor localization error and the intensity differences in ten patient were smaller using 4DCT-based motion model, possible due to superior image quality. In case 2) the tumor localization error and intensity differences were 2.85 and 0.15 respectively, using 4DCT-based motion models, and 1.17 and 0.10 using 4DCBCT-based models. 4DCBCT performed better due to its ability to reproduce daily anatomical changes. Conclusion: The study showed an advantage of 4DCBCT-based motion models in the context of 3D fluoroscopic images estimation. Positioning and tumor baseline shift uncertainties were mitigated by the 4DCBCT-based motion models, while they caused errors when using 4DCT-based motion models. Partially funded by Varian research grant.

  15. SU-E-J-30: Benchmark Image-Based TCP Calculation for Evaluation of PTV Margins for Lung SBRT Patients

    SciTech Connect (OSTI)

    Li, M; Chetty, I; Zhong, H

    2014-06-01

    Purpose: Tumor control probability (TCP) calculated with accumulated radiation doses may help design appropriate treatment margins. Image registration errors, however, may compromise the calculated TCP. The purpose of this study is to develop benchmark CT images to quantify registration-induced errors in the accumulated doses and their corresponding TCP. Methods: 4DCT images were registered from end-inhale (EI) to end-exhale (EE) using a demons algorithm. The demons DVFs were corrected by an FEM model to get realistic deformation fields. The FEM DVFs were used to warp the EI images to create the FEM-simulated images. The two images combined with the FEM DVF formed a benchmark model. Maximum intensity projection (MIP) images, created from the EI and simulated images, were used to develop IMRT plans. Two plans with 3 and 5 mm margins were developed for each patient. With these plans, radiation doses were recalculated on the simulated images and warped back to the EI images using the FEM DVFs to get the accumulated doses. The Elastix software was used to register the FEM-simulated images to the EI images. TCPs calculated with the Elastix-accumulated doses were compared with those generated by the FEM to get the TCP error of the Elastix registrations. Results: For six lung patients, the mean Elastix registration error ranged from 0.93 to 1.98 mm. Their relative dose errors in PTV were between 0.28% and 6.8% for 3mm margin plans, and between 0.29% and 6.3% for 5mm-margin plans. As the PTV margin reduced from 5 to 3 mm, the mean TCP error of the Elastix-reconstructed doses increased from 2.0% to 2.9%, and the mean NTCP errors decreased from 1.2% to 1.1%. Conclusion: Patient-specific benchmark images can be used to evaluate the impact of registration errors on the computed TCPs, and may help select appropriate PTV margins for lung SBRT patients.

  16. Aberrant Left Inferior Bronchial Artery Originating from the Left Gastric Artery in a Patient with Acute Massive Hemoptysis

    SciTech Connect (OSTI)

    Jiang, Sen Sun, Xi-Wen Yu, Dong Jie, Bing

    2013-10-15

    Massive hemoptysis is a life-threatening condition, and the major source of bleeding in this condition is the bronchial circulation. Bronchial artery embolization is a safe and effective treatment for controlling hemoptysis. However, the sites of origin of the bronchial arteries (BAs) have numerous anatomical variations, which can result in a technical challenge to identify a bleeding artery. We present a rare case of a left inferior BA that originated from the left gastric artery in a patient with recurrent massive hemoptysis caused by bronchiectasis. The aberrant BA was embolized, and hemoptysis has been controlled for 8 months.

  17. SciFri PM: Topics 02: Evaluation of Dosimetric Variations in Partial Breast Seed Implant (PBSI) due to Patient Arm Position (Up vs. Down)

    SciTech Connect (OSTI)

    Watt, E; Long, K; Husain, S; Meyer, T

    2014-08-15

    The planning for PBSI is done with the patient's ipsilateral arm raised, however, anatomical changes and variations are unavoidable as the patient resumes her daily activities, potentially resulting in significant deviations in implant geometry from the treatment plan. This study aims to quantify the impact of the ipsilateral arm position on the geometry and dosimetry of the implant at eight weeks, evaluated on post-plans using the MIM Symphony software (MIM Software, Cleveland, OH). The average dose metrics for the three patients treated at the TBCC thus far using rigid fusion and contour transfer for the arms up position were 76% for the CTV V100, 61% for the PTV V100, and 37% for the PTV V200; and for the arms down position 81% for the CTV V100, 64% for the PTV V100, and 42% for the PTV V200. Qualitative analysis of the post-implant CT for one of the three patients showed poor agreement between the seroma contour transferred from the pre-implant CT and the seroma visible on the post-implant CT. To obtain a clinically accurate plan for that patient, contour modifications were used, yielding improved dose metric averages for the arms-up position for all three patients of 87% for the CTV V100, 68% for the PTV V100, and 39% for the PTV V200. Overall, the data available shows that dosimetric parameters increase with the patient's arm down, both in terms of coverage and in terms of the hot spot, and accrual of more patients may confirm this in a larger population.

  18. Breast Cancer Patients With 10 or More Involved Axillary Lymph Nodes Treated by Multimodality Therapy: Influence of Clinical Presentation on Outcome

    SciTech Connect (OSTI)

    Geara, Fady B. . E-mail: fg00@aub.edu.lb; Nasr, Elie; Tucker, Susan L.; Charafeddine, Maya; Dabaja, Bouthaina; Eid, Toufic; Abbas, Jaber; Salem, Ziad; Shamseddine, Ali; Issa, Philip; El Saghir, Nagi

    2007-06-01

    Purpose: To analyze tumor control and survival for breast cancer patients with 10 or more positive lymph nodes without systemic disease, treated by adjuvant radiation alone or combined-modality therapy. Methods and Materials: We reviewed the records of 309 consecutive patients with these characteristics who received locoregional radiotherapy (RT) at our institution. The majority of patients had clinical Stage II or IIIA-B disease (43% and 48%, respectively). The median number of positive axillary lymph nodes was 15 (range, 10-78). Adjuvant therapy consisted of RT alone, with or without chemotherapy, tamoxifen, and/or ovarian castration. Results: The overall 5-year and 10-year disease-free survival (DFS) rates were 20% and 7%, respectively. Median DFS was higher for patients with Stage I-II compared with those with Stage IIIABC (28 vs. 19 months; p = 0.006). Median DFS for patients aged {<=}35 years was lower than that of older patients (12 vs. 24 months; p < 0.0001). Patients treated with a combination therapy had a higher 5-year DFS rate compared with those treated by RT alone (26% vs. 11%; p 0.03). In multivariate analysis, clinical stage (III vs. I, II; relative risk = 1.8, p = 0.002) and age ({<=}35 vs. others; relative risk = 2.6, p <0.001) were found to be independent variables for DFS. Conclusion: This retrospective data analysis identified young age and advanced clinical stage as pertinent and independent clinical prognostic factors for breast cancer patients with advanced axillary disease (10 or more involved nodes). These factors can be used for further prognostic classification.

  19. Outcomes of Patients With Revised Stage I Clear Cell Sarcoma of Kidney Treated in National Wilms Tumor Studies 1-5

    SciTech Connect (OSTI)

    Kalapurakal, John A., E-mail: j-kalapurakal@northwestern.edu [Northwestern University, Chicago, Illinois (United States); Perlman, Elizabeth J. [Northwestern University, Chicago, Illinois (United States)] [Northwestern University, Chicago, Illinois (United States); Seibel, Nita L. [Cancer Therapy and Evaluation Program, Bethesda, Maryland (United States)] [Cancer Therapy and Evaluation Program, Bethesda, Maryland (United States); Ritchey, Michael [Phoenix Children's Hospital, Phoenix, Arizona (United States)] [Phoenix Children's Hospital, Phoenix, Arizona (United States); Dome, Jeffrey S. [Children's National Medical Center, Washington, District of Columbia (United States)] [Children's National Medical Center, Washington, District of Columbia (United States); Grundy, Paul E. [University of Alberta, Edmonton, AB (Canada)] [University of Alberta, Edmonton, AB (Canada)

    2013-02-01

    Purpose: To report the clinical outcomes of children with revised stage I clear cell sarcoma of the kidney (CCSK) using the National Wilms Tumor Study Group (NWTS)-5 staging criteria after multimodality treatment on NWTS 1-5 protocols. Methods and Materials: All CCSK patients enrolled in the National Wilms Tumor Study Group protocols had their pathology slides reviewed, and only those determined to have revised stage I tumors according to the NWTS-5 staging criteria were included in the present analysis. All patients were treated with multimodality therapy according to the NWTS 1-5 protocols. Results: A total of 53 children were identified as having stage I CCSK. All patients underwent primary surgery with radical nephrectomy. The chemotherapy regimens used were as follows: regimen A, C, F, or EE in 4 children (8%); regimen DD or DD4A in 33 children (62%); regimen J in 4 children (8%); and regimen I in 12 children (22%). Forty-six patients (87%) received flank radiation therapy (RT). Seven children (13%) did not receive flank RT. The median delay between surgery and the initiation of RT was 9 days (range, 3-61). The median RT dose was 10.8 Gy (range, 10-36). The flank RT doses were as follows: 10.5 or 10.8 Gy in 25 patients (47%), 11-19.9 Gy in 2 patients (4%), 20-29.9 Gy in 9 patients (17%), and 30-40 Gy in 10 patients (19%). The median follow-up for the entire group was 17 years (range, 2-36). The relapse-free and cancer-specific survival rate was 100% at the last follow-up examination. Conclusions: The present results have demonstrated that children with revised stage I CCSK using the NWTS-5 staging criteria have excellent survival rates despite the use of varying RT doses and chemotherapy regimens in the NWTS 1-5 protocols.

  20. SU-E-J-32: Calypso(R) and Laser-Based Localization Systems Comparison for Left-Sided Breast Cancer Patients Using Deep Inspiration Breath Hold

    SciTech Connect (OSTI)

    Robertson, S; Kaurin, D; Sweeney, L; Kim, J; Fang, L; Tran, A; Holloway, K

    2014-06-01

    Purpose: Our institution uses a manual laser-based system for primary localization and verification during radiation treatment of left-sided breast cancer patients using deep inspiration breath hold (DIBH). This primary system was compared with sternum-placed Calypso(R) beacons (Varian Medical Systems, CA). Only intact breast patients are considered for this analysis. Methods: During computed tomography (CT) simulation, patients have BB and Calypso(R) surface beacons positioned sternally and marked for free-breathing and DIBH CTs. During dosimetry planning, BB longitudinal displacement between free breathing and DIBH CT determines laser mark (BH mark) location. Calypso(R) beacon locations from the DIBH CT are entered at the Tracking Station. During Linac simulation and treatment, patients inhale until the cross-hair and/or lasers coincide with the BH Mark, which can be seen using our high quality cameras (Pelco, CA). Daily Calypso(R) displacement values (difference from the DIBH-CT-based plan) are recorded.The displacement mean and standard deviation was calculated for each patient (77 patients, 1845 sessions). An aggregate mean and standard deviation was calculated weighted by the number of patient fractions.Some patients were shifted based on MV ports. A second data set was calculated with Calypso(R) values corrected by these shifts. Results: Mean displacement values indicate agreement within 13mm, with improvement for shifted data (Table). Conclusion: Both unshifted and shifted data sets show the Calypso(R) system coincides with the laser system within 13mm, demonstrating either localization/verification system will Resultin similar clinical outcomes. Displacement value uncertainty unilaterally reduces when shifts are taken into account.

  1. 7-Tesla Susceptibility-Weighted Imaging to Assess the Effects of Radiotherapy on Normal-Appearing Brain in Patients With Glioma

    SciTech Connect (OSTI)

    Lupo, Janine M., E-mail: janine.lupo@ucsf.edu [Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA (United States); Chuang, Cynthia F. [Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA (United States); Chang, Susan M. [Department of Neurosurgery, University of California, San Francisco, San Francisco, CA (United States); Barani, Igor J. [Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA (United States); Jimenez, Bert; Hess, Christopher P. [Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA (United States); Nelson, Sarah J. [Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA (United States); Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA (United States)

    2012-03-01

    Purpose: To evaluate the intermediate- and long-term imaging manifestations of radiotherapy on normal-appearing brain tissue in patients with treated gliomas using 7T susceptibility-weighted imaging (SWI). Methods and Materials: SWI was performed on 25 patients with stable gliomas on a 7 Tesla magnet. Microbleeds were identified as discrete foci of susceptibility that did not correspond to vessels. The number of microbleeds was counted within and outside of the T2-hyperintense lesion. For 3 patients, radiation dosimetry maps were reconstructed and fused with the 7T SWI data. Results: Multiple foci of susceptibility consistent with microhemorrhages were observed in patients 2 years after chemoradiation. These lesions were not present in patients who were not irradiated. The prevalence of microhemorrhages increased with the time since completion of radiotherapy, and these lesions often extended outside the boundaries of the initial high-dose volume and into the contralateral hemisphere. Conclusions: High-field SWI has potential for visualizing the appearance of microbleeds associated with long-term effects of radiotherapy on brain tissue. The ability to visualize these lesions in normal-appearing brain tissue may be important in further understanding the utility of this treatment in patients with longer survival.

  2. Impact of {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography Before and After Definitive Radiation Therapy in Patients With Apparently Solitary Plasmacytoma

    SciTech Connect (OSTI)

    Kim, Paul J.; Hicks, Rodney J.; Wirth, Andrew; Ryan, Gail; Seymour, John F.; Prince, H. Miles

    2009-07-01

    Purpose: To evaluate the impact of {sup 18}F-fluorodeoxyglucose positron emission tomography (FDG-PET) on management of patients with apparently isolated plasmacytoma. Methods and Materials: Twenty-one patients with apparently solitary plasmacytoma who underwent FDG-PET for staging or restaging were identified from a central PET database. They were either candidates for or had received definitive radiation therapy (RT). Results: Seventeen patients had initial staging scans for bone (n = 11) or soft tissue (n = 6) plasmacytomas, and 11 had PET scans after RT. Only 1 of 14 known untreated sites of plasmacytoma was not identified on staging PET (lesion sensitivity = 93%). Three plasmacytomas were excised before PET. Staging PET influenced management in 6 of 17 patients (35%) by showing multiple myeloma (n = 1), discouraging RT after complete resection (n = 1), excluding plasmacytoma at a second site (n = 1), by increasing RT fields (n = 2), or by suggesting sarcoidosis (n = 1). Fifteen of 17 patients with initial staging PET scans received definitive RT. Restaging PET scans after RT showed complete metabolic response in 8 of 11 cases and progressive disease in 2. Two patients with either no response or partial metabolic response had late responses. Staging sestamibi and PET scans were concordant in five of six occasions (one sestamibi scan was false negative). Conclusions: FDG-PET has value for staging and RT planning in plasmacytoma and potentially could have a role in response-assessment after RT. Slow resolution of FDG uptake posttreatment does not necessarily imply an adverse prognosis.

  3. Nanoscale mapping and organization analysis of target proteins on cancer cells from B-cell lymphoma patients

    SciTech Connect (OSTI)

    Li, Mi; Xiao, Xiubin; Liu, Lianqing; Xi, Ning; Wang, Yuechao; Dong, Zaili; Zhang, Weijing

    2013-11-01

    CD20, a membrane protein highly expressed on most B-cell lymphomas, is an effective target demonstrated in clinical practice for treating B-cell non-Hodgkin's lymphoma (NHL). Rituximab is a monoclonal antibody against CD20. In this work, we applied atomic force microscopy (AFM) to map the nanoscale distribution of CD20 molecules on the surface of cancer cells from clinical B-cell NHL patients under the assistance of ROR1 fluorescence recognition (ROR1 is a specific cell surface marker exclusively expressed on cancer cells). First, the ROR1 fluorescence labeling experiments showed that ROR1 was expressed on cancer cells from B-cell lymphoma patients, but not on normal cells from healthy volunteers. Next, under the guidance of ROR1 fluorescence, the rituximab-conjugated AFM tips were moved to cancer cells to image the cellular morphologies and detect the CD20-rituximab interactions on the cell surfaces. The distribution maps of CD20 on cancer cells were constructed by obtaining arrays of (1616) force curves in local areas (500500 nm{sup 2}) on the cell surfaces. The experimental results provide a new approach to directly investigate the nanoscale distribution of target protein on single clinical cancer cells. - Highlights: Cancer cells were recognized from healthy cells by ROR1 fluorescence labeling. The nanoscale distribution of CD20 on cancer cells was characterized. The distribution of CD20 was non-uniform on the surface of cancer cells.

  4. Preoperative Direct Puncture Embolization of Advanced Juvenile Nasopharyngeal Angiofibroma in Combination with Transarterial Embolization: An Analysis of 22 Consecutive Patients

    SciTech Connect (OSTI)

    Lv Mingming Fan, Xin-dong; Su Lixin; Chen Dong

    2013-02-15

    ObjectiveThis study was designed to evaluate the clinical application of preoperative auxiliary embolization for juvenile nasopharyngeal angiofibroma (JNA) by direct puncture embolization (DPE) of the tumor in combination with transarterial embolization (TAE). The study included 22 patients. An 18-gauge needle was used to puncture directly into the tumor, and 20-25 % N-butyl cyanoacrylate was injected under the guidance of fluoroscopy after confirming the placement of the needle into the JNA and no leaking into the surrounding tissue. Tumors were obstructed later via TAE. The supplying arteries of JNA were from branches of the internal carotid and external carotid arteries. Control angiography showed the obliteration of contrast stain in the entire tumor mass and the distal supplying arteries disappeared after DPE in combination with TAE. Surgical resection was performed within 4 days after embolization and none of the patients required blood transfusion. The use of DPE in combination with TAE was a safe, feasible, and efficacious method. It can devascularize effectively the JNAs and reduce intraoperative bleeding when JNAs are extirpated.

  5. Impact of Postmastectomy Radiation on Locoregional Recurrence in Breast Cancer Patients With 1-3 Positive Lymph Nodes Treated With Modern Systemic Therapy

    SciTech Connect (OSTI)

    Tendulkar, Rahul D.; Rehman, Sana; Shukla, Monica E.; Reddy, Chandana A.; Moore, Halle; Budd, G. Thomas; Dietz, Jill; Crowe, Joseph P.; Macklis, Roger

    2012-08-01

    Purpose: Postmastectomy radiation therapy (PMRT) remains controversial for patients with 1-3 positive lymph nodes (LN+). Methods and Materials: We conducted a retrospective review of all 369 breast cancer patients with 1-3 LN+ who underwent mastectomy without neoadjuvant systemic therapy between 2000 and 2007 at Cleveland Clinic. Results: We identified 271 patients with 1-3 LN+ who did not receive PMRT and 98 who did receive PMRT. The median follow-up time was 5.2 years, and the median number of LN dissected was 11. Of those not treated with PMRT, 79% received adjuvant chemotherapy (of whom 70% received a taxane), 79% received hormonal therapy, and 5% had no systemic therapy. Of the Her2/neu amplified tumors, 42% received trastuzumab. The 5-year rate of locoregional recurrence (LRR) was 8.9% without PMRT vs 0% with PMRT (P=.004). For patients who did not receive PMRT, univariate analysis showed 6 risk factors significantly (P<.05) correlated with LRR: estrogen receptor/progesterone receptor negative (hazard ratio [HR] 2.6), lymphovascular invasion (HR 2.4), 2-3 LN+ (HR 2.6), nodal ratio >25% (HR 2.7), extracapsular extension (ECE) (HR 3.7), and Bloom-Richardson grade III (HR 3.1). The 5-year LRR rate was 3.4% (95% confidence interval [CI], 0.1%-6.8%] for patients with 0-1 risk factor vs 14.6% [95% CI, 8.4%-20.9%] for patients with {>=}2 risk factors (P=.0006), respectively. On multivariate analysis, ECE (HR 4.3, P=.0006) and grade III (HR 3.6, P=.004) remained significant risk factors for LRR. The 5-year LRR was 4.1% in patients with neither grade III nor ECE, 8.1% with either grade III or ECE, and 50.4% in patients with both grade III and ECE (P<.0001); the corresponding 5-year distant metastasis-free survival rates were 91.8%, 85.4%, and 59.1% (P=.0004), respectively. Conclusions: PMRT offers excellent control for patients with 1-3 LN+, with no locoregional failures to date. Patients with 1-3 LN+ who have grade III disease and/or ECE should be strongly considered for PMRT.

  6. DOC-2/DAB2 Interacting Protein Status in High-Risk Prostate Cancer Correlates With Outcome for Patients Treated With Radiation Therapy

    SciTech Connect (OSTI)

    Jacobs, Corbin; Tumati, Vasu; Kapur, Payal; Yan, Jingsheng; Hong, David; Bhuiyan, Manzerul; Xie, Xian-Jin; Pistenmaa, David; Yu, Lan; Hsieh, Jer-Tsong; Saha, Debabrata; Kim, D. W. Nathan

    2014-07-15

    Purpose: This pilot study investigates the role of DOC-2/DAB2 Interacting Protein (DAB2IP) and enhancer of zeste homolog 2 (EZH2) as prognostic biomarkers in high-risk prostate cancer patients receiving definitive radiation therapy. Methods and Materials: Immunohistochemistry was performed and scored by an expert genitourinary pathologist. Clinical endpoints evaluated were freedom from biochemical failure (FFBF), castration resistance–free survival (CRFS), and distant metastasis–free survival (DMFS). Log-rank test and Cox regression were used to determine significance of biomarker levels with clinical outcome. Results: Fifty-four patients with high-risk prostate cancer (stage ≥T3a, or Gleason score ≥8, or prostate-specific antigen level ≥20 ng/mL) treated with radiation therapy from 2005 to 2012 at our institution were evaluated. Nearly all patients expressed EZH2 (98%), whereas 28% of patients revealed DAB2IP reduction and 72% retained DAB2IP. Median follow-up was 34.0 months for DAB2IP-reduced patients, 29.9 months for DAB2IP-retained patients, and 32.6 months in the EZH2 study. Reduction in DAB2IP portended worse outcome compared with DAB2IP-retained patients, including FFBF (4-year: 37% vs 89%, P=.04), CRFS (4-year: 50% vs 90%, P=.02), and DMFS (4-year: 36% vs 97%, P=.05). Stratified EZH2 expression trended toward significance for worse FFBF and CRFS (P=.07). Patients with reduced DAB2IP or highest-intensity EZH2 expression exhibited worse FFBF (4-year: 32% vs 95%, P=.02), CRFS (4-year: 28% vs 100%, P<.01), and DMFS (4-year: 39% vs 100%, P=.04) compared with the control group. Conclusion: Loss of DAB2IP is a potent biomarker that portends worse outcome despite definitive radiation therapy for patients with high-risk prostate cancer. Enhancer of zeste homolog 2 is expressed in most high-risk tumors and is a less potent discriminator of outcome in this study. The DAB2IP status in combination with degree of EZH2 expression may be useful for determining patients with worse outcome within the high-risk prostate cancer population.

  7. The Effect of Early Detection of Occult Brain Metastases in HER2-Positive Breast Cancer Patients on Survival and Cause of Death

    SciTech Connect (OSTI)

    Niwinska, Anna; Tacikowska, Malgorzata; Murawska, Magdalena

    2010-07-15

    Purpose: The aim of the study is to evaluate disease-free survival, survival from the detection of brain metastases, overall survival, and cause of death in patients with occult brain metastases (Group I) vs. patients with symptomatic brain metastases (Group II). Methods and Materials: In 80 HER2-positive breast cancer patients, treated with trastuzumab and cytostatic agents for metastatic disease, magnetic resonance imaging screening of the brain was performed, and in 29 patients (36%) occult brain metastasis was detected (Group I). Whole-brain radiotherapy was delivered to Group I. This first group was compared with 52 patients who had symptomatic brain metastases (Group II) and was treated the same way, at the same clinic, during the same time period. Results: Median disease-free survival was 17 months in Group I and 19.9 months in Group II (p = 0.58). The median time interval between the dissemination of the disease and the detection of occult or symptomatic brain metastases was 9 and 15 months, respectively (p = 0.11). When the brain metastases were detected, the median survival was 9 and 8.78 months, respectively (p = 0.80). The median overall survival was 53 and 51 months, respectively (p = 0.94). In the group with occult brain metastases (Group I) 16% of patients died because of progression within the brain. In the group with symptomatic brain metastases (Group II) the rate of cerebral death was 48% (p = 0.009). Conclusions: Whole-brain radiotherapy of occult brain metastases in HER2-positive breast cancer patients with visceral dissemination produces a three-fold decrease in cerebral deaths but does not prolong survival.

  8. Late Patient-Reported Toxicity After Preoperative Radiotherapy or Chemoradiotherapy in Nonresectable Rectal Cancer: Results From a Randomized Phase III Study

    SciTech Connect (OSTI)

    Braendengen, Morten, E-mail: mortbrae@medisin.uio.no [Oslo University Hospital, Ulleval, Cancer Centre, Oslo (Norway); Department of Oncology and Pathology, Karolinska Institutet, Stockholm (Sweden); Tveit, Kjell Magne [Oslo University Hospital, Ulleval, Cancer Centre, Oslo (Norway); Faculty of Medicine, University of Oslo, Oslo (Norway); Bruheim, Kjersti [Oslo University Hospital, Ulleval, Cancer Centre, Oslo (Norway); Cvancarova, Milada [Department of Clinical Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo (Norway); Berglund, Ake [Department of Oncology, Radiology and Clinical Immunology, University of Uppsala, Uppsala (Sweden); Glimelius, Bengt [Department of Oncology and Pathology, Karolinska Institutet, Stockholm (Sweden); Department of Oncology, Radiology and Clinical Immunology, University of Uppsala, Uppsala (Sweden)

    2011-11-15

    Purpose: Preoperative chemoradiotherapy (CRT) is superior to radiotherapy (RT) in locally advanced rectal cancer, but the survival gain is limited. Late toxicity is, therefore, important. The aim was to compare late bowel, urinary, and sexual functions after CRT or RT. Methods and Materials: Patients (N = 207) with nonresectable rectal cancer were randomized to preoperative CRT or RT (2 Gy Multiplication-Sign 25 {+-} 5-fluorouracil/leucovorin). Extended surgery was often required. Self-reported late toxicity was scored according to the LENT SOMA criteria in a structured telephone interview and with questionnaires European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30), International Index of Erectile Function (IIEF), and sexual function -vaginal changes questionnaire (SVQ). Results: Of the 105 patients alive in Norway and Sweden after 4 to 12 years of follow-up, 78 (74%) responded. More patients in the CRT group had received a stoma (73% vs. 52%, p = 0.09). Most patients without a stoma (7 of 12 in CRT group and 9 of 16 in RT group) had incontinence for liquid stools or gas. No stoma and good anal function were seen in 5 patients (11%) in the CRT group and in 11 (30%) in the RT group (p = 0.046). Of 44 patients in the CRT group, 12 (28%) had had bowel obstruction compared with 5 of 33 (15%) in the RT group (p = 0.27). One-quarter of the patients reported urinary incontinence. The majority of men had severe erectile dysfunction. Few women reported sexual activity during the previous month. However, the majority did not have concerns about their sex life. Conclusions: Fecal incontinence and erectile dysfunction are frequent after combined treatment for locally advanced rectal cancer. There was a clear tendency for the problems to be more common after CRT than after RT.

  9. Localized Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy: A Long-Term Outcome in 86 Patients With 104 Treated Eyes

    SciTech Connect (OSTI)

    Harada, Ken; Murakami, Naoya; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Yoshio, Kotaro; Inaba, Koji; Morota, Madoka; Ito, Yoshinori; Sumi, Minako; Suzuki, Shigenobu; Tobinai, Kensei; Uno, Takashi; Itami, Jun

    2014-03-01

    Purpose: To evaluate the natural history, behavior of progression, prognostic factors, and treatment-related adverse effects of primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML). Methods and Materials: Eighty-six patients with histologically proven stage I POAML treated with radiation therapy at National Cancer Center Hospital, Tokyo between 1990 and 2010 were retrospectively reviewed. The median age was 56years (range, 18-85years). The median dose administered was 30Gy (range, 30-46Gy). Seventy-seven patients (90%) were treated by radiation therapy alone. Results: The median follow-up duration was 9years (range, 0.9-22years). The 5- and 10-year overall survival (OS) rates were 97.6% and 93.5%, respectively, and no patients died of lymphoma. Patients with tumor sizes ?4cm showed a greater risk of contralateral relapse (P=.012). Six patients with contralateral relapse were seen and treated by radiation therapy alone, and all the lesions were controlled well, with follow-up times of 3 to 12years. There was 1 case of local relapse after radiation therapy alone, and 3 cases of relapse occurred in a distant site. Cataracts developed in 36 of the 65 eyes treated without lens shielding and in 12 of the 39 patients with lens shielding (P=.037). Conclusions: The majority of patients with POAML showed behavior consistent with that of localized, indolent diseases. Thirty gray of local irradiation seems to be quite effective. The initial bilateral involvement and contralateral orbital relapses can be also controlled with radiation therapy alone. Lens shielding reduces the risk of cataract.

  10. Influence of radiation therapy on the lung-tissue in breast cancer patients: CT-assessed density changes and associated symptoms

    SciTech Connect (OSTI)

    Rotstein, S.; Lax, I.; Svane, G. )

    1990-01-01

    The relative electron density of lung tissue was measured from computer tomography (CT) slices in 33 breast cancer patients treated by various techniques of adjuvant radiotherapy. The measurements were made before radiotherapy, 3 months and 9 months after completion of radiation therapy. The changes in lung densities at 3 months and 9 months were compared to radiation induced radiological (CT) findings. In addition, subjective symptoms such as cough and dyspnoea were assessed before and after radiotherapy. It was observed that the mean of the relative electron density of lung tissue varied from 0.25 when the whole lung was considered to 0.17 when only the anterior lateral quarter of the lung was taken into account. In patients with positive radiological (CT) findings the mean lung density of the anterior lateral quarter increased 2.1 times 3 months after radiotherapy and was still increased 1.6 times 6 months later. For those patients without findings, in the CT pictures the corresponding values were 1.2 and 1.1, respectively. The standard deviation of the pixel values within the anterior lateral quarter of the lung increased 3.8 times and 3.2 times at 3 months and 9 months, respectively, in the former group, as opposed to 1.2 and 1.1 in the latter group. Thirteen patients had an increase in either cough or dyspnoea as observed 3 months after completion of radiotherapy. In eleven patients these symptoms persisted 6 months later. No significant correlation was found between radiological findings and subjective symptoms. However, when three different treatment techniques were compared among 29 patients the highest rate of radiological findings was observed in patients in which the largest lung volumes received the target dose. A tendency towards an increased rate of subjective symptoms was also found in this group.

  11. Institutional, Retrospective Analysis of 777 Patients With Brain Metastases: Treatment Outcomes and Diagnosis-Specific Prognostic Factors

    SciTech Connect (OSTI)

    Antoni, Delphine; Clavier, Jean-Baptiste; Pop, Marius; Schumacher, Catherine; Lefebvre, Franois; Nol, Georges

    2013-07-15

    Purpose: To retrospectively evaluate the prognostic factors and survival of a series of 777 patients with brain metastases (BM) from a single institution. Methods and Materials: Patients were treated with surgery followed by whole-brain radiation therapy (WBRT) or with WBRT alone in 16.3% and 83.7% of the cases, respectively. The patients were RPA (recursive partitioning analysis) class I, II, and III in 11.2%, 69.6%, and 18.4% of the cases, respectively; RPA class II-a, II-b, and II-c in 8.3%, 24.8%, and 66.9% of the cases, respectively; and with GPA (graded prognostic assessment) scores of 0-1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 in 35%, 27.5%, 18.2%, and 8.6% of the cases, respectively. Results: The median overall survival (OS) times according to RPA class I, II, and III were 20.1, 5.1, and 1.3 months, respectively (P<.0001); according to RPA class II-a, II-b, II-c: 9.1, 8.9, and 4.0 months, respectively (P<.0001); and according to GPA score 0-1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0: 2.5, 4.4, 9.0, and 19.1 months, respectively (P<.0001). By multivariate analysis, the favorable independent prognostic factors for survival were as follows: for gastrointestinal tumor, a high Karnofsky performance status (KPS) (P=.0003) and an absence of extracranial metastases (ECM) (P=.003); for kidney cancer, few BM (P=.002); for melanoma, few BM (P=.01), an absence of ECM (P=.002), and few ECM (P=.0002); for lung cancer, age (P=.007), a high KPS (P<.0001), an absence of ECM (P<.0001), few ECM and BM (P<.0001 and P=.0006, respectively), and control of the primary tumor (P=.004); and for breast cancer, age (P=.001), a high KPS (P=.007), control of the primary tumor (P=.05), and few ECM and BM (P=.01 and P=.0002, respectively). The triple-negative subtype was a significant unfavorable factor (P=.007). Conclusion: Prognostic factors varied by pathology. Our analysis confirms the strength of prognostic factors used to determine the GPA score, including the genetic subtype for breast cancer.

  12. Sexual Functioning Among Endometrial Cancer Patients Treated With Adjuvant High-Dose-Rate Intra-Vaginal Radiation Therapy

    SciTech Connect (OSTI)

    Damast, Shari; Alektiar, Kaled M.; Goldfarb, Shari; Eaton, Anne; Patil, Sujata; Mosenkis, Jeffrey; Bennett, Antonia; Atkinson, Thomas; Jewell, Elizabeth; Leitao, Mario; Barakat, Richard; Carter, Jeanne; Basch, Ethan

    2012-10-01

    Purpose: We used the Female Sexual Function Index (FSFI) to investigate the prevalence of sexual dysfunction (SD) and factors associated with diminished sexual functioning in early stage endometrial cancer (EC) patients treated with simple hysterectomy and adjuvant brachytherapy. Methods and Materials: A cohort of 104 patients followed in a radiation oncology clinic completed questionnaires to quantify current levels of sexual functioning. The time interval between hysterectomy and questionnaire completion ranged from <6 months to >5 years. Multivariate regression was performed using the FSFI as a continuous variable (score range, 1.2-35.4). SD was defined as an FSFI score of <26, based on the published validation study. Results: SD was reported by 81% of respondents. The mean ({+-} standard deviation) domain scores in order of highest-to-lowest functioning were: satisfaction, 2.9 ({+-}2.0); orgasm, 2.5 ({+-}2.4); desire, 2.4 ({+-}1.3); arousal, 2.2 ({+-}2.0); dryness, 2.1 ({+-}2.1); and pain, 1.9 ({+-}2.3). Compared to the index population in which the FSFI cut-score was validated (healthy women ages 18-74), all scores were low. Compared to published scores of a postmenopausal population, scores were not statistically different. Multivariate analysis isolated factors associated with lower FSFI scores, including having laparotomy as opposed to minimally invasive surgery (effect size, -7.1 points; 95% CI, -11.2 to -3.1; P<.001), lack of vaginal lubricant use (effect size, -4.4 points; 95% CI, -8.7 to -0.2, P=.040), and short time interval (<6 months) from hysterectomy to questionnaire completion (effect size, -4.6 points; 95% CI, -9.3-0.2; P=.059). Conclusions: The rate of SD, as defined by an FSFI score <26, was prevalent. The postmenopausal status of EC patients alone is a known risk factor for SD. Additional factors associated with poor sexual functioning following treatment for EC included receipt of laparotomy and lack of vaginal lubricant use.

  13. Assessment of the point-source method for estimating dose rates to members of the public from exposure to patients with 131I thyroid treatment

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Dewji, Shaheen Azim; Bellamy, Michael B.; Hertel, Nolan E.; Leggett, Richard Wayne; Sherbini, Sami; Saba, Mohammad S.; Eckerman, Keith F.

    2015-09-01

    The U.S. Nuclear Regulatory Commission (USNRC) initiated a contract with Oak Ridge National Laboratory (ORNL) to calculate radiation dose rates to members of the public that may result from exposure to patients recently administered iodine-131 (131I) as part of medical therapy. The main purpose was to compare dose rate estimates based on a point source and target with values derived from more realistic simulations that considered the time-dependent distribution of 131I in the patient and attenuation of emitted photons by the patient’s tissues. The external dose rate estimates were derived using Monte Carlo methods and two representations of the Phantommore » with Movable Arms and Legs, previously developed by ORNL and the USNRC, to model the patient and a nearby member of the public. Dose rates to tissues and effective dose rates were calculated for distances ranging from 10 to 300 cm between the phantoms and compared to estimates based on the point-source method, as well as to results of previous studies that estimated exposure from 131I patients. The point-source method overestimates dose rates to members of the public in very close proximity to an 131I patient but is a broadly accurate method of dose rate estimation at separation distances of 300 cm or more at times closer to administration.« less

  14. Low-Dose Hyper-Radiosensitivity Is Not a Common Effect in Normal Asynchronous and G2-Phase Fibroblasts of Cancer Patients

    SciTech Connect (OSTI)

    S?onina, Dorota; Biesaga, Beata; Janecka, Anna; Kabat, Damian; Bukowska-Strakova, Karolina; Gasi?ska, Anna

    2014-02-01

    Purpose: In our previous study, using the micronucleus assay, a low-dose hyper-radiosensitivity (HRS)-like phenomenon was observed for normal fibroblasts of 2 of the 40 cancer patients investigated. In this article we report, for the first time, the survival response of primary fibroblasts from 25 of these patients to low-dose irradiation and answer the question regarding the effect of G2-phase enrichment on HRS elicitation. Methods and Materials: The clonogenic survival of asynchronous as well as G2-phase enriched fibroblast populations was measured. Separation of G2-phase cells and precise cell counting was performed using a fluorescence-activated cell sorter. Sorted and plated cells were irradiated with single doses (0.1-4 Gy) of 6-MV x-rays. For each patient, at least 4 independent experiments were performed, and the induced-repair model was fitted over the whole data set to confirm the presence of HRS effect. Results: The HRS response was demonstrated for the asynchronous and G2-phase enriched cell populations of 4 patients. For the rest of patients, HRS was not defined in either of the 2 fibroblast populations. Thus, G2-phase enrichment had no effect on HRS elicitation. Conclusions: The fact that low-dose hyper-radiosensitivity is not a common effect in normal human fibroblasts implies that HRS may be of little consequence in late-responding connective tissues with regard to radiation fibrosis.

  15. SU-E-T-04: 3D Printed Patient-Specific Surface Mould Applicators for Brachytherapy Treatment of Superficial Lesions

    SciTech Connect (OSTI)

    Cumming, I; Lasso, A; Rankin, A; Fichtinger, G [Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, Ontario (Canada); Joshi, C P; Falkson, C; Schreiner, L John [CCSEO, Kingston General Hospital and Department of Oncology, Queen's University, Kingston, Ontario (Canada)

    2014-06-01

    Purpose: Evaluate the feasibility of constructing 3D-printed patient-specific surface mould applicators for HDR brachytherapy treatment of superficial lesions. Methods: We propose using computer-aided design software to create 3D printed surface mould applicators for brachytherapy. A mould generation module was developed in the open-source 3D Slicer ( http://www.slicer.org ) medical image analysis platform. The system extracts the skin surface from CT images, and generates smooth catheter paths over the region of interest based on user-defined start and end points at a specified stand-off distance from the skin surface. The catheter paths are radially extended to create catheter channels that are sufficiently wide to ensure smooth insertion of catheters for a safe source travel. An outer mould surface is generated to encompass the channels. The mould is also equipped with fiducial markers to ensure its reproducible placement. A surface mould applicator with eight parallel catheter channels of 4mm diameters was fabricated for the nose region of a head phantom; flexible plastic catheters of 2mm diameter were threaded through these channels maintaining 10mm catheter separations and a 5mm stand-off distance from the skin surface. The apparatus yielded 3mm thickness of mould material between channels and the skin. The mould design was exported as a stereolithography file to a Dimension SST1200es 3D printer and printed using ABS Plus plastic material. Results: The applicator closely matched its design and was found to be sufficiently rigid without deformation during repeated application on the head phantom. Catheters were easily threaded into channels carved along catheter paths. Further tests are required to evaluate feasibility of channel diameters smaller than 4mm. Conclusion: Construction of 3D-printed mould applicators show promise for use in patient specific brachytherapy of superficial lesions. Further evaluation of 3D printing techniques and materials is required for constructing sufficiently thin, rigid and durable surface moulds suitable for clinical deployment.

  16. Use of the Charlson Combined Comorbidity Index To Predict Postradiotherapy Quality of Life for Prostate Cancer Patients

    SciTech Connect (OSTI)

    Wahlgren, Thomas; Levitt, Seymour; Kowalski, Jan; Nilsson, Sten; Brandberg, Yvonne

    2011-11-15

    Purpose: To determine the impact of pretreatment comorbidity on late health-related quality of life (HRQoL) scores after patients have undergone combined radiotherapy for prostate cancer, including high-dose rate brachytherapy boost and hormonal deprivation therapy. Methods and Materials: Results from the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire survey of 158 patients 5 years or more after completion of therapy were used from consecutively accrued subjects treated with curative radiotherapy at our institution, with no signs of disease at the time of questionnaire completion. HRQoL scores were compared with the Charlson combined comorbidity index (CCI), using analysis of covariance and multivariate regression models together with pretreatment factors including tumor stage, tumor grade, pretreatment prostate-specific antigen level, neoadjuvant hormonal treatment, diabetes status, cardiovascular status, and age and Charlson score as separate variables or the composite CCI. Results: An inverse correlation between the two HRQoL domains, long-term global health (QL) and physical function (PF) scores, and the CCI score was observed, indicating an impact of comorbidity in these function areas. Selected pretreatment factors poorly explained the variation in functional HRQoL in the multivariate models; however, a statistically significant impact was found for the CCI (with QL and PF scores) and the presence of diabetes (with QL and emotional function). Cognitive function and social function were not statistically significantly predicted by any of the pretreatment factors. Conclusions: The CCI proved to be valid in this context, but it seems useful mainly in predicting long-term QL and PF scores. Of the other variables investigated, diabetes had more impact than cardiovascular morbidity on HRQoL outcomes in prostate cancer.

  17. Risk of Hippocampal Metastases in Small Cell Lung Cancer Patients at Presentation and After Cranial Irradiation: A Safety Profile Study for Hippocampal Sparing During Prophylactic or Therapeutic Cranial Irradiation

    SciTech Connect (OSTI)

    Kundapur, Vijayananda; Ellchuk, Tasha; Ahmed, Shahid; Gondi, Vinai

    2015-03-15

    Purpose: Neurocognitive impairment (NI) in patients with small cell lung cancer (SCLC) after whole brain radiation treatment (WBRT) is a significant cause of morbidity. Hippocampal avoidance (HA) during WBRT may mitigate or prevent NI in such patients. However, this has not been tested in SCLC patients. The estimated risk of metastases in the HA region (HM) in patients with SCLC at diagnosis or after WBRT is unknown. Our study aimed to determine the risk of HM in patients with SCLC and to assess correlated clinical factors. Methods and Materials: Patients with SCLC who experienced brain metastases (BM) at presentation (de novo) or after WBRT treated at the Saskatoon Cancer Centre between 2005 and 2012 were studied. Relevant neuroimaging was independently reviewed by a neuroradiologist. HM was defined as metastases within 5 mm of the hippocampus. Logistic regression analysis was performed to assess correlation between various clinical variables and HM. Results: Seventy eligible patients were identified. Of 59 patients presenting with de novo BM, 3 patients (5%, 95% confidence interval [CI]: 0%-10.7%) had HM. Collectively there were 359 (range, 1-33) de novo BM with 3 (0.8%, 95% CI: 0%-1.7%) HM deposits. Twenty patients experienced progression of metastatic disease in the brain after WBRT. Of the 20 patients, only 1 patient (5%, 95% CI: 0%-14.5%) experienced HM. On logistic regression, no factors significantly correlated with HM. Conclusion: The overall incidence of HM before or after WBRT in SCLC patients is low, providing preliminary support for the safety of HA during planned clinical trials of HA-WBRT for SCLC.

  18. SU-E-CAMPUS-T-06: Initial Experience of Patient-Specific QA Using a Pencil Beam Scanning Proton Therapy System

    SciTech Connect (OSTI)

    Piskulich, F; Zhang, Y; Perles, L; Mascia, A; Lepage, R; Giebeler, A; Dong, L

    2014-06-15

    Purpose: To illustrate patient QA results for the first 10 patients treated at Scripps Proton Center by comparing point dose measurement using an ion chamber and in-house developed secondary MU program, and the measurement of 2D dose distribution using an ion chamber array. Methods: At the time of writing, 10 patient plans were approved for treatment using Varian ProBeam pencil beam scanning system and Eclipse treatment planning software. We used the IBA CC04 0.04 cm3 ion chamber and PTW Unidos E electrometer for point dose measurement in a small water tank (Sun Nuclear 1D scanner). We developed independent MU check software based on measured pencil beam dose profiles for various energies. We used PTW Octavius 729 XDR array to evaluate 2D planar dose distribution. The 3D gamma at 3%/3 mm local dose was used to compare a 3D calculated dose plan with a 2D measured dose distribution using PTW Verisoft software. All fields were exported to a verification phantom plan and delivered at 0 degrees for simplicity. Results: Comparisons between the CC04 ion chamber measurement and calculated dose agree well within 1%. The PTW Octavius 729 XDR array exhibited some dose rate dependence in high dose rate pencil beam delivery. Nevertheless, the results, used as a relative measurement, passed the gamma criteria of 3%/3mm for greater than 90% of area in all patient fields. Visual inspection showed good agreement between ion chamber dose profile and the calculated plan. The in-house secondary check for MU agreed very well with the plan dose and measurement. The results will be updated with more patients treated. Conclusion: The initial patient specific QA results are encouraging for a new pencil beam scanning only proton therapy system.

  19. Biochemical Control With Radiotherapy Improves Overall Survival in Intermediate and High-Risk Prostate Cancer Patients Who Have an Estimated 10-Year Overall Survival of >90%

    SciTech Connect (OSTI)

    Herbert, Christopher; Liu, Mitchell; Tyldesley, Scott; Morris, W. James; Joffres, Michel; Khaira, Mandip; Kwan, Winkle; Moiseenko, Vitali; Pickles, Thomas

    2012-05-01

    Purpose: To identify subgroups of patients with carcinoma of the prostate treated with radical radiotherapy that have improved overall survival when disease is biochemically controlled. Methods and Materials: A cohort of 1,060 prostate cancer patients treated with radical radiotherapy was divided into nine subgroups based on National Comprehensive Cancer Network risk category and estimated 10-year overall survival (eOS 10y) derived from the age adjusted Charlson Comorbidity Index. Patients with and without biochemical control were compared with respect to overall survival. Actuarial estimates of overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of overall survival. Results: Median follow-up was 125 months (range, 51-176 months). Only the subgroups with high or intermediate risk disease and an eOS 10y of >90% had a statistically significantly improved overall survival when prostate cancer was biochemically controlled. In all other groups, biochemical control made no significant difference to overall survival. In the subgroup with high-risk disease and eOS 10y >90%, actuarial overall survival was 86.3% (95% confidence interval [CI] 78.5%-94.1%) and 62.1% (95% CI 52.9%-71.3%) for patients with biochemical control and biochemical relapse respectively (p = 0.002). In the intermediate risk group with eOS >90%, actuarial overall survival was 95.3% (95% CI 89.0%-100%) and 79.8% (95% CI 68.0%-91.6%) for biochemically controlled and biochemically relapsed patients (p = 0.033). On multivariate analysis, National Comprehensive Cancer Network risk group (p = 0.005), biochemical control (p = 0.033) and eOS 10y (p < 0.001) were statistically significant. Conclusion: Biochemical control translates into improved overall survival in patients with high or intermediate risk disease and an estimated 10-year overall survival of >90%.

  20. Radiation Dose to the Esophagus From Breast Cancer Radiation Therapy, 1943-1996: An International Population-Based Study of 414 Patients

    SciTech Connect (OSTI)

    Lamart, Stephanie; Stovall, Marilyn; Simon, Steven L.; Smith, Susan A.; Weathers, Rita E.; Howell, Rebecca M.; Curtis, Rochelle E.; Aleman, Berthe M.P.; Travis, Lois; Kwon, Deukwoo; Morton, Lindsay M.

    2013-07-15

    Purpose: To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943-1996 in North America and Europe. Methods and Materials: We abstracted the radiation therapy treatment parameters from each patients radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were {sup 60}Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Results: Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Conclusions: Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower doses.

  1. Accuracy of Computed Tomography for Predicting Pathologic Nodal Extracapsular Extension in Patients With Head-and-Neck Cancer Undergoing Initial Surgical Resection

    SciTech Connect (OSTI)

    Prabhu, Roshan S.; Magliocca, Kelly R.; Hanasoge, Sheela; Aiken, Ashley H.; Hudgins, Patricia A.; Hall, William A.; Chen, Susie A.; Eaton, Bree R.; Higgins, Kristin A.; Saba, Nabil F.; Beitler, Jonathan J.

    2014-01-01

    Purpose: Nodal extracapsular extension (ECE) in patients with head-and-neck cancer increases the loco-regional failure risk and is an indication for adjuvant chemoradiation therapy (CRT). To reduce the risk of requiring trimodality therapy, patients with head-and-neck cancer who are surgical candidates are often treated with definitive CRT when preoperative computed tomographic imaging suggests radiographic ECE. The purpose of this study was to assess the accuracy of preoperative CT imaging for predicting pathologic nodal ECE (pECE). Methods and Materials: The study population consisted of 432 consecutive patients with oral cavity or locally advanced/nonfunctional laryngeal cancer who underwent preoperative CT imaging before initial surgical resection and neck dissection. Specimens with pECE had the extent of ECE graded on a scale from 1 to 4. Results: Radiographic ECE was documented in 46 patients (10.6%), and pECE was observed in 87 (20.1%). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 43.7%, 97.7%, 82.6%, and 87.3%, respectively. The sensitivity of radiographic ECE increased from 18.8% for grade 1 to 2 ECE, to 52.9% for grade 3, and 72.2% for grade 4. Radiographic ECE criteria of adjacent structure invasion was a better predictor than irregular borders/fat stranding for pECE. Conclusions: Radiographic ECE has poor sensitivity, but excellent specificity for pECE in patients who undergo initial surgical resection. PPV and NPV are reasonable for clinical decision making. The performance of preoperative CT imaging increased as pECE grade increased. Patients with resectable head-and-neck cancer with radiographic ECE based on adjacent structure invasion are at high risk for high-grade pECE requiring adjuvant CRT when treated with initial surgery; definitive CRT as an alternative should be considered where appropriate.

  2. Sunitinib Plus Androgen Deprivation and Radiation Therapy for Patients With Localized High-Risk Prostate Cancer: Results From a Multi-institutional Phase 1 Study

    SciTech Connect (OSTI)

    Corn, Paul G.; Song, Danny Y.; Heath, Elisabeth; Maier, Jordan; Meyn, Raymond; Kuban, Deborah; DePetrillo, Thomas A.; Mathew, Paul

    2013-07-01

    Purpose: To evaluate the feasibility of administering sunitinib in combination with androgen deprivation therapy and external-beam intensity modulated radiation therapy (XRT) in patients with localized high-risk prostate cancer. Methods and Materials: Seventeen men with localized adenocarcinoma of the prostate with cT2c-cT4 or Gleason 8-10 or prostate-specific antigen >20 ng/mL received initial androgen deprivation (leuprolide 22.5 mg every 12 weeks plus oral bicalutamide 50 mg daily) for 4-8 weeks before oral sunitinib 12.5, 25, or 37.5 mg daily for 4 weeks as lead-in, then concurrently with and 4 weeks after XRT (75.6 Gy in 42 fractions to prostate and seminal vesicles). A 3+3 sequential dose-escalation design was used to assess the frequency of dose-limiting toxicity (DLT) and establish a maximal tolerated dose of sunitinib. Results: Sunitinib at 12.5- and 25-mg dose levels was well tolerated. The first 4 patients enrolled at 37.5 mg experienced a DLT during lead-in, and a drug interaction between sunitinib and bicalutamide was suspected. The protocol was revised and concurrent bicalutamide omitted. Of the next 3 patients enrolled at 37.5 mg, 2 of 3 receiving concurrent therapy experienced DLTs during radiation: grade 3 diarrhea and grade 3 proctitis, respectively. Only 1 of 7 patients completed sunitinib at 37.5 mg daily, whereas 3 of 3 patients (25 mg as starting dose) and 3 of 4 patients (25 mg as reduced dose) completed therapy. Conclusions: The feasibility of combined vascular endothelial growth factor receptor (VEGFR)/platelet-derived growth factor receptor (PDGFR) inhibitor therapy, androgen deprivation, and radiation therapy for prostate cancer was established. Using a daily dosing regimen with lead-in, concurrent, and post-XRT therapy, the recommended phase 2 dose of sunitinib is 25 mg daily.

  3. Clinically Meaningful Differences in Patient-Reported Outcomes With Amifostine in Combination With Chemoradiation for Locally Advanced Non-Small-Cell Lung Cancer: An Analysis of RTOG 9801

    SciTech Connect (OSTI)

    Sarna, Linda [University of California, Los Angeles, CA (United States)], E-mail: lsarna@sonnet.ucla.edu; Swann, Suzanne [Radiation Therapy Oncology Group, Philadelphia, PA (United States); Langer, Corey [Fox Chase Cancer Center, Philadelphia, PA (United States); Werner-Wasik, Maria [Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA (United States); Nicolaou, Nicos [Fox Chase Cancer Center, Philadelphia, PA (United States); Komaki, Ritsuko [M.D. Anderson Cancer Center, Houston, TX (United States); Machtay, Mitchell [Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA (United States); Byhardt, Roger [Medical College of Wisconsin, Milwaukee, WI (United States); Wasserman, Todd [Washington University, St. Louis, MO (United States); Movsas, Benjamin [Henry Ford Health System, Detroit, MI (United States)

    2008-12-01

    Purpose: The purpose of this study is to analyze changes in quality of life (QOL) and symptoms from pretreatment to 6 weeks posttreatment in a Phase III randomized study (Radiation Therapy Oncology Group 9801) of amifostine (AM) vs. no AM in patients with Stages II-III non-small-cell lung cancer receiving paclitaxel and carboplatin as induction and then concurrently with hyperfractionated radiation therapy (RT). Methods and Materials: One hundred thirty-eight patients with baseline and 6-week posttreatment QOL data were analyzed. There were no significant differences in baseline demographics between those who did and did not have QOL data. The QOL and symptoms were assessed by using the European Organization for Research and Treatment of Cancer (EORTC) Global QOL and Pain subscales and the EORTC-Lung Cancer-13 symptom tool. Clinically relevant changes in QOL were characterized by 10-point differences in individual scores pre/post treatment. A daily diary of patient-rated difficulty swallowing and a weekly physician-rated dysphagia log (using National Cancer Institute Common Toxicity Criteria) were completed during treatment. Weight loss was monitored. Differences in outcomes were examined according to smoking status, alcohol use, and sex. Results: Patients receiving AM reported significantly greater pain reduction after chemoradiation (34% vs. no AM, 21%), less difficulty swallowing during chemoradiation, and less weight loss than patients not receiving AM. However, physician-rated assessments of dysphagia were not significantly different by treatment arm. There were no other significant changes in QOL or symptoms according to treatment arm, smoking status, alcohol use, or sex. Conclusions: Patient evaluations of difficulty swallowing and pain suggest benefits from AM use that are distinct from clinician-rated assessments.

  4. HSPB1 Gene Polymorphisms Predict Risk of Mortality for US Patients After Radio(chemo)therapy for Non-Small Cell Lung Cancer

    SciTech Connect (OSTI)

    Xu Ting; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas ; Wei Qingyi; Lopez Guerra, Jose Luis; Department of Radiation Oncology, Instituto Madrileno de Oncologia Wang Lie; Liu Zhensheng; Gomez, Daniel; O'Reilly, Michael; Lin, Steven Hsesheng; Zhuang Yan; Levy, Lawrence B.; Mohan, Radhe; Zhou Honghao; Liao Zhongxing

    2012-10-01

    Purpose: We investigated potential associations between single-nucleotide polymorphisms (SNPs) in the heat shock protein beta-1 (HSPB1) gene and overall survival in US patients with non-small cell lung cancer (NSCLC). Methods and Materials: Using available genomic DNA samples from 224 patients with NSCLC treated with definitive radio(chemo)therapy, we genotyped 2 SNPs of HSPB1 (NCBI SNP nos. rs2868370 and rs2868371). We used both Kaplan-Meier cumulative probability and Cox proportional hazards analyses to evaluate the effect of HSPB1 genotypes on survival. Results: Our cohort consisted of 117 men and 107 women, mostly white (79.5%), with a median age of 70 years. The median radiation dose was 66 Gy (range, 63-87.5 Gy), and 183 patients (82%) received concurrent platinum-based chemotherapy. The most common genotype of the rs2868371 SNP was CC (61%). Univariate and multivariate analyses showed that this genotype was associated with poorer survival than CG and GG genotypes (univariate hazard ratio [HR] = 1.39, 95% confidence interval [CI], 1.02-1.90; P=.037; multivariate HR = 1.39; 95% CI, 1.01-1.92; P=.045). Conclusions: Our results showed that the CC genotype of HSPB1 rs2868371 was associated with poorer overall survival in patients with NSCLC after radio(chemo)therapy, findings that contradict those of a previous study of Chinese patients. Validation of our findings with larger numbers of similar patients is needed, as are mechanical and clinical studies to determine the mechanism underlying these associations.

  5. Phase II Trial of Radiosurgery to Magnetic Resonance Spectroscopy-Defined High-Risk Tumor Volumes in Patients With Glioblastoma Multiforme

    SciTech Connect (OSTI)

    Einstein, Douglas B.; Wessels, Barry; Bangert, Barbara; Fu, Pingfu; Nelson, A. Dennis; Cohen, Mark; Sagar, Stephen; Lewin, Jonathan; Sloan, Andrew; Zheng Yiran; Williams, Jordonna; Colussi, Valdir; Vinkler, Robert; Maciunas, Robert

    2012-11-01

    Purpose: To determine the efficacy of a Gamma Knife stereotactic radiosurgery (SRS) boost to areas of high risk determined by magnetic resonance spectroscopy (MRS) functional imaging in addition to standard radiotherapy for patients with glioblastoma (GBM). Methods and Materials: Thirty-five patients in this prospective Phase II trial underwent surgical resection or biopsy for a GBM followed by SRS directed toward areas of MRS-determined high biological activity within 2 cm of the postoperative enhancing surgical bed. The MRS regions were determined by identifying those voxels within the postoperative T2 magnetic resonance imaging volume that contained an elevated choline/N-acetylaspartate ratio in excess of 2:1. These voxels were marked, digitally fused with the SRS planning magnetic resonance image, targeted with an 8-mm isocenter per voxel, and treated using Radiation Therapy Oncology Group SRS dose guidelines. All patients then received conformal radiotherapy to a total dose of 60 Gy in 2-Gy daily fractions. The primary endpoint was overall survival. Results: The median survival for the entire cohort was 15.8 months. With 75% of recursive partitioning analysis (RPA) Class 3 patients still alive 18 months after treatment, the median survival for RPA Class 3 has not yet been reached. The median survivals for RPA Class 4, 5, and 6 patients were 18.7, 12.5, and 3.9 months, respectively, compared with Radiation Therapy Oncology Group radiotherapy-alone historical control survivals of 11.1, 8.9, and 4.6 months. For the 16 of 35 patients who received concurrent temozolomide in addition to protocol radiotherapeutic treatment, the median survival was 20.8 months, compared with European Organization for Research and Treatment of Cancer historical controls of 14.6 months using radiotherapy and temozolomide. Grade 3/4 toxicities possibly attributable to treatment were 11%. Conclusions: This represents the first prospective trial using selective MRS-targeted functional SRS combined with radiotherapy for patients with GBM. This treatment is feasible, with acceptable toxicity and patient survivals higher than in historical controls. This study can form the basis for a multicenter, randomized trial.

  6. The Impact of Extent and Location of Mediastinal Lymph Node Involvement on Survival in Stage III Non-Small Cell Lung Cancer Patients Treated With Definitive Radiotherapy

    SciTech Connect (OSTI)

    Fernandes, Annemarie T.; Mitra, Nandita; Xanthopoulos, Eric; Evans, Tracey; Stevenson, James; Langer, Corey; Kucharczuk, John C.; Lin, Lilie; Rengan, Ramesh

    2012-05-01

    Purpose: Several surgical series have identified subcarinal, contralateral, and multilevel nodal involvement as predictors of poor overall survival in patients with Stage III non-small-cell lung cancer (NSCLC) treated with definitive resection. This retrospective study evaluates the impact of extent and location of mediastinal lymph node (LN) involvement on survival in patients with Stage III NSCLC treated with definitive radiotherapy. Methods and Materials: We analyzed 106 consecutive patients with T1-4 N2-3 Stage III NSCLC treated with definitive radiotherapy at University of Pennsylvania between January 2003 and February 2009. For this analysis, mediastinal LN stations were divided into four mutually exclusive groups: supraclavicular, ipsilateral mediastinum, contralateral mediastinum, and subcarinal. Patients' conditions were then analyzed according to the extent of involvement and location of mediastinal LN stations. Results: The majority (88%) of patients received sequential or concurrent chemotherapy. The median follow-up time for survivors was 32.6 months. By multivariable Cox modeling, chemotherapy use (hazard ratio [HR]: 0.21 [95% confidence interval (CI): 0.07-0.63]) was associated with improved overall survival. Increasing primary tumor [18F]-fluoro-2-deoxy-glucose avidity (HR: 1.11 [CI: 1.06-1.19]), and subcarinal involvement (HR: 2.29 [CI: 1.11-4.73]) were significant negative predictors of overall survival. On univariate analysis, contralateral nodal involvement (HR: 0.70 [CI: 0.33-1.47]), supraclavicular nodal involvement (HR: 0.78 [CI: 0.38-1.67]), multilevel nodal involvement (HR: 0.97 [CI: 0.58-1.61]), and tumor size (HR: 1.04 [CI: 0.94-1.14]) did not predict for overall survival. Patients with subcarinal involvement also had lower rates of 2-year nodal control (51.2% vs. 74.9%, p = 0.047) and 2-year distant control (28.4% vs. 61.2%, p = 0.043). Conclusions: These data suggest that the factors that determine oncologic outcome in Stage III NSCLC patients treated with definitive radiotherapy are distinct from those observed in patients who undergo surgical resection. The ultimate efficacy of radiation in locally advanced NSCLC is dependent on the intrinsic biology of the tumor.

  7. Individualized 3D Reconstruction of Normal Tissue Dose for Patients With Long-term Follow-up: A Step Toward Understanding Dose Risk for Late Toxicity

    SciTech Connect (OSTI)

    Ng, Angela; Brock, Kristy K.; Sharpe, Michael B.; Department of Radiation Oncology, University of Toronto, Toronto, Ontario ; Moseley, Joanne L.; Craig, Tim; Department of Radiation Oncology, University of Toronto, Toronto, Ontario ; Hodgson, David C.

    2012-11-15

    Purpose: Understanding the relationship between normal tissue dose and delayed radiation toxicity is an important component of developing more effective radiation therapy. Late outcome data are generally available only for patients who have undergone 2-dimensional (2D) treatment plans. The purpose of this study was to evaluate the accuracy of 3D normal tissue dosimetry derived from reconstructed 2D treatment plans in Hodgkin's lymphoma (HL) patients. Methods and Materials: Three-dimensional lung, heart, and breast volumes were reconstructed from 2D planning radiographs for HL patients who received mediastinal radiation therapy. For each organ, a reference 3D organ was modified with patient-specific structural information, using deformable image processing software. Radiation therapy plans were reconstructed by applying treatment parameters obtained from patient records to the reconstructed 3D volumes. For each reconstructed organ mean dose (D{sub mean}) and volumes covered by at least 5 Gy (V{sub 5}) and 20Gy (V{sub 20}) were calculated. This process was performed for 15 patients who had both 2D and 3D planning data available to compare the reconstructed normal tissue doses with those derived from the primary CT planning data and also for 10 historically treated patients with only 2D imaging available. Results: For patients with 3D planning data, the normal tissue doses could be reconstructed accurately using 2D planning data. Median differences in D{sub mean} between reconstructed and actual plans were 0.18 Gy (lungs), -0.15 Gy (heart), and 0.30 Gy (breasts). Median difference in V{sub 5} and V{sub 20} were less than 2% for each organ. Reconstructed 3D dosimetry was substantially higher in historical mantle-field treatments than contemporary involved-field mediastinal treatments: average D{sub mean} values were 15.2 Gy vs 10.6 Gy (lungs), 27.0 Gy vs 14.3 Gy (heart), and 8.0 Gy vs 3.2 Gy (breasts). Conclusions: Three-dimensional reconstruction of absorbed dose to organs at risk can be estimated accurately many years after exposure by using limited 2D data. Compared to contemporary involved-field treatments, normal tissue doses were significantly higher in historical mantle-field treatments. These methods build capacity to quantify the relationship between 3D normal tissue dose and observed late effects.

  8. Volumetric-Modulated Arc Therapy: Effective and Efficient End-to-End Patient-Specific Quality Assurance

    SciTech Connect (OSTI)

    O'Daniel, Jennifer; Das, Shiva; Wu, Q. Jackie; Yin Fangfang

    2012-04-01

    Purpose: To explore an effective and efficient end-to-end patient-specific quality-assurance (QA) protocol for volumetric modulated arc radiotherapy (VMAT) and to evaluate the suitability of a stationary radiotherapy QA device (two-dimensional [2D] ion chamber array) for VMAT QA. Methods and Materials: Three methods were used to analyze 39 VMAT treatment plans for brain, spine, and prostate: ion chamber (one-dimensional absolute, n = 39), film (2D relative, coronal/sagittal, n = 8), and 2D ion chamber array (ICA, 2D absolute, coronal/sagittal, n = 39) measurements. All measurements were compared with the treatment planning system dose calculation either via gamma analysis (3%, 3- to 4-mm distance-to-agreement criteria) or absolute point dose comparison. The film and ion chamber results were similarly compared with the ICA measurements. Results: Absolute point dose measurements agreed well with treatment planning system computed doses (ion chamber: median deviation, 1.2%, range, -0.6% to 3.3%; ICA: median deviation, 0.6%, range, -1.8% to 2.9%). The relative 2D dose measurements also showed good agreement with computed doses (>93% of pixels in all films passing gamma, >90% of pixels in all ICA measurements passing gamma). The ICA relative dose results were highly similar to those of film (>90% of pixels passing gamma). The coronal and sagittal ICA measurements were statistically indistinguishable by the paired t test with a hypothesized mean difference of 0.1%. The ion chamber and ICA absolute dose measurements showed a similar trend but had disparities of 2-3% in 18% of plans. Conclusions: After validating the new VMAT implementation with ion chamber, film, and ICA, we were able to maintain an effective yet efficient patient-specific VMAT QA protocol by reducing from five (ion chamber, film, and ICA) to two measurements (ion chamber and single ICA) per plan. The ICA (Matrixx Registered-Sign , IBA Dosimetry) was validated for VMAT QA, but ion chamber measurements are recommended for absolute dose comparison until future developments correct the ICA angular dependence.

  9. SU-E-T-407: Evaluation of Four Commercial Dosimetry Systems for Routine Patient-Specific Tomotherapy Delivery Quality Assurance

    SciTech Connect (OSTI)

    Xing, A; Arumugam, S; Deshpande, S; George, A; Holloway, L; Vial, P; Goozee, G

    2014-06-01

    Purpose: The purpose of this project was to evaluate the performance of four commercially available dosimetry systems for Tomotherapy delivery quality assurance (DQA). Methods: Eight clinical patient plans were chosen to represent a range of treatment sites and typical clinical plans. Four DQA plans for each patient plan were created using the TomoTherapy DQA Station (Hi-Art version 4.2.1) on CT images of the ScandiDose Delta4, IBA MatriXX Evolution, PTW Octavius 4D and Sun Nuclear ArcCHECK phantoms. Each detector was calibrated following the manufacture-provided procedure. No angular response correction was applied. All DQA plans for each detector were delivered on the Tomotherapy Hi-Art unit in a single measurement session but on different days. The measured results were loaded into the vendor supplied software for each QA system for comparison with the TPS-calculated dose. The Gamma index was calculated using 3%/3mm, 2%/2mm with 10% dose threshold of maximum TPS calculated dose. Results: Four detector systems showed comparable gamma pass rates for 3%/3m, which is recommended by AAPM TG119 and commonly used within the radiotherapy community. The averaged pass rates standard deviation for all DQA plans were (98.351.97)% for ArcCHECK, (99.9%0.87)% for Matrix, (98.5%5.09)% for Octavius 4D, (98.7%1.27)% for Delata4. The rank of the gamma pass rate for individual plans was consistent between detectors. Using 2%/2mm Gamma criteria for analysis, the Gamma pass rate decreased on average by 9%, 8%, 6.6% and 5% respectively. Profile and Gamma failure map analysis using the software tools from each dosimetry system indicated that decreased passing rate is mainly due to the threading effect of Tomo plan. Conclusion: Despite the variation in detector type and resolution, phantom geometry and software implementation, the four systems demonstrated similar dosimetric performance, with the rank of the gamma pass rate consistent for the plans considered.

  10. Treatment and Outcomes in Patients With Primary Cutaneous B-Cell Lymphoma: The BC Cancer Agency Experience

    SciTech Connect (OSTI)

    Hamilton, Sarah N.; Wai, Elaine S.; Tan, King; Alexander, Cheryl; Gascoyne, Randy D.; Connors, Joseph M.

    2013-11-15

    Purpose: To review the treatment and outcomes of patients with primary cutaneous B-cell lymphoma (CBCL). Methods and Materials: Clinical characteristics, treatment, and outcomes were analyzed for all patients referred to our institution from 1981 through 2011 with primary CBCL without extracutaneous or distant nodal spread at diagnosis (n=136). Hematopathologists classified 99% of cases using the World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) guidelines. Results: Median age at diagnosis was 62 years. Classification was 18% diffuse large B-cell leg-type (DLBCL-leg), 32% follicle center (FCCL), 45% marginal zone (MZL), and 6% nonclassifiable (OTHER). Of the 111 subjects with indolent lymphoma (FCCL, MZL, OTHER), 79% received radiation alone (RT), 11% surgery alone, 3% chemotherapy alone, 4% chemotherapy followed by RT, and 3% observation. Following treatment, 29% of subjects relapsed. In-field recurrence occurred in 2% treated with RT and in 33% treated with surgery alone. Of the 25 subjects with DLBCL-leg, 52% received chemotherapy followed by RT, 24% chemotherapy, 20% RT, and 4% surgery alone. Seventy-nine percent received CHOP-type chemotherapy (cyclophosphamide, doxorubicin or epirubicin, vincristine, prednisone), 47% with rituximab added. Overall and disease-specific survival and time to progression at 5 years were 81%, 92%, and 69% for indolent and 26%, 61%, and 54% for DLBCL-leg, respectively. On Cox regression analysis of indolent subjects, RT was associated with better time to progression (P=.05). RT dose, chemo, age >60 y, and >1 lesion were not significantly associated with time to progression. For DLBCL-leg, disease-specific survival at 5 years was 100% for those receiving rituximab versus 67% for no rituximab (P=.13). Conclusions: This review demonstrates better outcomes for indolent histology compared with DLBCL-leg, validating the prognostic utility of the WHO-EORTC classification. In the indolent group, RT was associated with 98% local control. DLBCL-leg is a more aggressive disease; the excellent results in the rituximab group suggest it has an important role in management.

  11. Transjugular Intrahepatic Porto-Systemic Shunt Placement in a Patient with Left-Lateral Split-Liver Transplant and Mesenterico-Left Portal Vein by Pass Placement

    SciTech Connect (OSTI)

    Miraglia, Roberto Maruzzelli, Luigi; Luca, Angelo

    2011-12-15

    This is a report of a successful placement of a transjugular intrahepatic porto-systemic shunt in a young patient with previous left-lateral, split-liver transplant and mesenterico-left portal vein by pass placement after posttransplant extrahepatic portal vein thrombosis.

  12. The Impact of Hypofractionated Whole Breast Radiotherapy on Local Relapse in Patients With Grade 3 Early Breast Cancer: A Population-Based Cohort Study

    SciTech Connect (OSTI)

    Herbert, Christopher; Nichol, Alan; Olivotto, Ivo; Weir, Lorna; Woods, Ryan; Speers, Caroline; Truong, Pauline; Tyldesley, Scott

    2012-04-01

    Purpose: To determine whether patients with Grade 3 early breast cancer have an inferior rate of local disease control at 10 years with hypofractionated radiotherapy compared with more conventionally fractionated schedules. Methods and Materials: Local relapse rates were compared between patients receiving hypofractionated radiotherapy or conventionally fractionated radiotherapy to the whole breast in a population-based cohort of women with early-stage (T1-T2, N0, M0) Grade 3 breast cancers diagnosed between 1990 and 2000 and referred to the British Columbia Cancer Agency. Cumulative rates of local relapse were estimated using a competing risk method, and factors significant on univariate analysis were included with fractionation group in a multivariate model. The primary end point was local control at 10 years. Results: A total of 1,335 patients with Grade 3 tumors were treated with adjuvant radiotherapy, 252 with conventional fractionation, and 1,083 with a hypofractionated schedule. The 10-year cumulative incidence of local relapse was 6.9% in the hypofractionated group and 6.2% in the conventionally fractionated group (p = 0.99). Conclusions: There is no evidence that hypofractionation is inferior to conventional fractionation for breast conserving therapy in patients with Grade 3 breast cancer in this large population-based series after 10 years of follow-up.

  13. Fibre Diffraction Analysis of Skin Offers a Very Early and Extremely Accurate Diagnostic Test for Prostate Cancer

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    James, Veronica J.; O’Malley Ford, Judith M.

    2014-01-01

    Double blind analysis of a batch of thirty skin tissue samples from potential prostate cancer sufferers correctly identified all “control” patients, patients with high and low grade prostate cancers, the presence of benign prostate hyperplasia (BPH), perineural invasions, and the one lymphatic invasion. Identification was by analysis of fibre diffraction patterns interpreted using a schema developed from observations in nine previous studies. The method, schema, and specific experiment results are reported in this paper, with some implications then drawn.

  14. Insights into the respiratory tract microbiota of patients with cystic fibrosis during early Pseudomonas aeruginosa colonization

    SciTech Connect (OSTI)

    Keravec, Marlène; Mounier, Jérôme; Prestat, Emmanuel; Vallet, Sophie; Jansson, Janet K.; Burgaud, Gaëtan; Rosec, Sylvain; Gouriou, Stéphanie; Rault, Gilles; Coton, Emmanuel; Barbier, Georges; Héry-Arnaud, Geneviève

    2015-08-09

    Pseudomonas aeruginosa plays a major role in cystic fibrosis (CF) progression. Therefore, it is important to understand the initial steps of P. aeruginosa infection. The structure and dynamics of CF respiratory tract microbial communities during the early stages of P. aeruginosa colonization were characterized by pyrosequencing and cloning-sequencing. The respiratory microbiota showed high diversity, related to the young age of the CF cohort (mean age 10 years). Wide inter- and intra-individual variations were revealed. A common core microbiota of 5 phyla and 13 predominant genera was found, the majority of which were obligate anaerobes. A few genera were significantly more prevalent in patients never infected by P. aeruginosa. Persistence of an anaerobic core microbiota regardless of P. aeruginosa status suggests a major role of certain anaerobes in the pathophysiology of lung infections in CF. Some genera may be potential biomarkers of pulmonary infection state.

  15. Predictors of Grade 3 or Higher Late Bowel Toxicity in Patients Undergoing Pelvic Radiation for Cervical Cancer: Results From a Prospective Study

    SciTech Connect (OSTI)

    Chopra, Supriya; Dora, Tapas; Chinnachamy, Anand N.; Thomas, Biji; Kannan, Sadhna; Engineer, Reena; Mahantshetty, Umesh; Phurailatpam, Reena; Paul, Siji N.; Shrivastava, Shyam Kishore

    2014-03-01

    Purpose: The present study investigates relationship between dosevolume parameters and severe bowel toxicity after postoperative radiation treatment (PORT) for cervical cancer. Methods and Materials: From June 2010 to December 2012, a total of 71 patients undergoing PORT were included. Small bowel (SB) and large bowel (LB) loops were contoured 2cm above the target volume. The volume of SB and LB that received 15Gy, 30Gy, and 40Gy was calculated (V15 SB, V15 LB, V30 SB, V30 LB, V40 SB, V 40 LB). On follow-up, bowel toxicity was scored using Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. A reciever operating characteristic (ROC) curve identified volume thresholds that predicted for grade 3 or higher toxicity with highest specificity. All data was dichotomized across these identified cut-off values. Univariate and multivariate analysis was performed using SPSS, version15. Results: The median patient age was 47years (range, 35-65years). Of the 71 patients, 46 received image-guided intensity modulated radiation therapy, and 25 received conformal radiation (50Gy in 25 fractions for 5weeks). Overall, 63 of 71 patients received concurrent chemotherapy. On a median follow-up of 18months (range, 8-29months), grade 2 or higher bowel toxicity was seen in 22 of 71 patients (30.9%) and grade 3 or higher bowel toxicity was seen in 9 patients (12.6%). On univariate analysis, V15 SB <275 cc (P=.01), V30 SB <190 cc (P=.02), V40 SB <150 cc (P=.01), and V15 LB <250 cc (P=.03), and V40 LB <90 cc (P=.04) predicted for absence of grade 3 or higher toxicity. No other patient- or treatment-related factors were statistically significant. On multivariate analysis, only V15 SB (P=.002) and V15 LB (P=.03) were statistically significant. Conclusions: V 15Gy SB and LB are independent predictors of late grade 3 or higher toxicity. Restricting V15 SB and V15 LB to <275 cc and <250 cc can reduce grade 3 or higher toxicity to less than 5%.

  16. Long-term Survival and Toxicity in Patients Treated With High-Dose Intensity Modulated Radiation Therapy for Localized Prostate Cancer

    SciTech Connect (OSTI)

    Spratt, Daniel E.; Pei, Xin; Yamada, Josh; Kollmeier, Marisa A.; Cox, Brett; Zelefsky, Michael J.

    2013-03-01

    Purpose: To report long-term survival and toxicity outcomes with the use of high-dose intensity modulated radiation therapy (IMRT) to 86.4 Gy for patients with localized prostate cancer. Methods and Materials: Between August 1997 and December 2008, 1002 patients were treated to a dose of 86.4 Gy using a 5-7 field IMRT technique. Patients were stratified by prognostic risk group based on National Comprehensive Cancer Network risk classification criteria. A total of 587 patients (59%) were treated with neoadjuvant and concurrent androgen deprivation therapy. The median follow-up for the entire cohort was 5.5 years (range, 1-14 years). Results: For low-, intermediate-, and high-risk groups, 7-year biochemical relapse-free survival outcomes were 98.8%, 85.6%, and 67.9%, respectively (P<.001), and distant metastasis-free survival rates were 99.4%, 94.1%, and 82.0% (P<.001), respectively. On multivariate analysis, T stage (P<.001), Gleason score (P<.001), and >50% of initial biopsy positive core (P=.001) were predictive for distant mestastases. No prostate cancer-related deaths were observed in the low-risk group. The 7-year prostate cancer-specific mortality (PCSM) rates, using competing risk analysis for intermediate- and high-risk groups, were 3.3% and 8.1%, respectively (P=.008). On multivariate analysis, Gleason score (P=.004), percentage of biopsy core positivity (P=.003), and T-stage (P=.033) were predictive for PCSM. Actuarial 7-year grade 2 or higher late gastrointestinal and genitourinary toxicities were 4.4% and 21.1%, respectively. Late grade 3 gastrointestinal and genitourinary toxicity was experienced by 7 patients (0.7%) and 22 patients (2.2%), respectively. Of the 427 men with full potency at baseline, 317 men (74%) retained sexual function at time of last follow-up. Conclusions: This study represents the largest cohort of patients treated with high-dose radiation to 86.4 Gy, using IMRT for localized prostate cancer, with the longest follow-up to date. Our findings indicate that this treatment results in excellent clinical outcomes with acceptable toxicity.

  17. Phase II Study of Accelerated High-Dose Radiotherapy With Concurrent Chemotherapy for Patients With Limited Small-Cell Lung Cancer: Radiation Therapy Oncology Group Protocol 0239

    SciTech Connect (OSTI)

    Komaki, Ritsuko; Paulus, Rebecca; Ettinger, David S.; Videtic, Gregory M.M.; Bradley, Jeffrey D.; Glisson, Bonnie S.; Sause, William T.; Curran, Walter J.; Choy, Hak

    2012-07-15

    Purpose: To investigate whether high-dose thoracic radiation given twice daily during cisplatin-etoposide chemotherapy for limited small-cell lung cancer (LSCLC) improves survival, acute esophagitis, and local control rates relative to findings from Intergroup trial 0096 (47%, 27%, and 64%). Patients and Methods: Patients were accrued over a 3-year period from 22 US and Canadian institutions. Patients with LSCLC and good performance status were given thoracic radiation to 61.2 Gy over 5 weeks (daily 1.8-Gy fractions on days 1-22, then twice-daily 1.8-Gy fractions on days 23-33). Cisplatin (60 mg/m{sup 2} IV) was given on day 1 and etoposide (120 mg/m{sup 2} IV) on days 1-3 and days 22-24, followed by 2 cycles of cisplatin plus etoposide alone. Patients who achieved complete response were offered prophylactic cranial irradiation. Endpoints included overall and progression-free survival; severe esophagitis (Common Toxicity Criteria v 2.0) and treatment-related fatalities; response (Response Evaluation Criteria in Solid Tumors); and local control. Results: Seventy-two patients were accrued from June 2003 through May 2006; 71 were evaluable (median age 63 years; 52% female; 58% Zubrod 0). Median survival time was 19 months; at 2 years, the overall survival rate was 36.6% (95% confidence interval [CI] 25.6%-47.7%), and progression-free survival 19.7% (95% CI 11.4%-29.6%). Thirteen patients (18%) experienced severe acute esophagitis, and 2 (3%) died of treatment-related causes; 41% achieved complete response, 39% partial response, 10% stable disease, and 6% progressive disease. The local control rate was 73%. Forty-three patients (61%) received prophylactic cranial irradiation. Conclusions: The overall survival rate did not reach the projected goal; however, rates of esophagitis were lower, and local control higher, than projected. This treatment strategy is now one of three arms of a prospective trial of chemoradiation for LSCLC (Radiation Therapy Oncology Group 0538/Cancer and Leukemia Group B 30610).

  18. TH-C-BRD-05: Reducing Proton Beam Range Uncertainty with Patient-Specific CT HU to RSP Calibrations Based On Single-Detector Proton Radiography

    SciTech Connect (OSTI)

    Doolan, P; Sharp, G; Testa, M; Lu, H-M; Bentefour, E; Royle, G

    2014-06-15

    Purpose: Beam range uncertainty in proton treatment comes primarily from converting the patient's X-ray CT (xCT) dataset to relative stopping power (RSP). Current practices use a single curve for this conversion, produced by a stoichiometric calibration based on tissue composition data for average, healthy, adult humans, but not for the individual in question. Proton radiographs produce water-equivalent path length (WEPL) maps, dependent on the RSP of tissues within the specific patient. This work investigates the use of such WEPL maps to optimize patient-specific calibration curves for reducing beam range uncertainty. Methods: The optimization procedure works on the principle of minimizing the difference between the known WEPL map, obtained from a proton radiograph, and a digitally-reconstructed WEPL map (DRWM) through an RSP dataset, by altering the calibration curve that is used to convert the xCT into an RSP dataset. DRWMs were produced with Plastimatch, an in-house developed software, and an optimization procedure was implemented in Matlab. Tests were made on a range of systems including simulated datasets with computed WEPL maps and phantoms (anthropomorphic and real biological tissue) with WEPL maps measured by single detector proton radiography. Results: For the simulated datasets, the optimizer showed excellent results. It was able to either completely eradicate or significantly reduce the root-mean-square-error (RMSE) in the WEPL for the homogeneous phantoms (to zero for individual materials or from 1.5% to 0.2% for the simultaneous optimization of multiple materials). For the heterogeneous phantom the RMSE was reduced from 1.9% to 0.3%. Conclusion: An optimization procedure has been designed to produce patient-specific calibration curves. Test results on a range of systems with different complexities and sizes have been promising for accurate beam range control in patients. This project was funded equally by the Engineering and Physical Sciences Research Council (UK) and Ion Beam Applications (Louvain-La-Neuve, Belgium)

  19. Impact of Gender, Partner Status, and Race on Locoregional Failure and Overall Survival in Head and Neck Cancer Patients in Three Radiation Therapy Oncology Group Trials

    SciTech Connect (OSTI)

    Dilling, Thomas J., E-mail: Thomas.Dilling@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Bae, Kyounghwa; Paulus, Rebecca [Department of Statistics, Radiation Therapy Oncology Group, Philadelphia, Pennsylvania (United States); Watkins-Bruner, Deborah [School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Garden, Adam S. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Forastiere, Arlene [Departments of Oncology, Radiation Oncology, and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, Maryland (United States); Kian Ang, K. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Movsas, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan (United States)

    2011-11-01

    Purpose: We investigated the impact of race, in conjunction with gender and partner status, on locoregional control (LRC) and overall survival (OS) in three head and neck trials conducted by the Radiation Therapy Oncology Group (RTOG). Methods and Materials: Patients from RTOG studies 9003, 9111, and 9703 were included. Patients were stratified by treatment arms. Covariates of interest were partner status (partnered vs. non-partnered), race (white vs. non-white), and sex (female vs. male). Chi-square testing demonstrated homogeneity across treatment arms. Hazards ratio (HR) was used to estimate time to event outcome. Unadjusted and adjusted HRs were calculated for all covariates with associated 95% confidence intervals (CIs) and p values. Results: A total of 1,736 patients were analyzed. Unpartnered males had inferior OS rates compared to partnered females (adjusted HR = 1.22, 95% CI, 1.09-1.36), partnered males (adjusted HR = 1.20, 95% CI, 1.09-1.28), and unpartnered females (adjusted HR = 1.20, 95% CI, 1.09-1.32). White females had superior OS compared with white males, non-white females, and non-white males. Non-white males had inferior OS compared to white males. Partnered whites had improved OS relative to partnered non-white, unpartnered white, and unpartnered non-white patients. Unpartnered males had inferior LRC compared to partnered males (adjusted HR = 1.26, 95% CI, 1.09-1.46) and unpartnered females (adjusted HR = 1.30, 95% CI, 1.05-1.62). White females had LRC superior to non-white males and females. White males had improved LRC compared to non-white males. Partnered whites had improved LRC compared to partnered and unpartnered non-white patients. Unpartnered whites had improved LRC compared to unpartnered non-whites. Conclusions: Race, gender, and partner status had impacts on both OS and locoregional failure, both singly and in combination.

  20. Monte Carlo study for designing a dedicated D-shaped collimator used in the external beam radiotherapy of retinoblastoma patients

    SciTech Connect (OSTI)

    Mayorga, P. A.; Departamento de Fsica Atmica, Molecular y Nuclear, Universidad de Granada, E-18071 Granada ; Brualla, L.; Sauerwein, W.; Lallena, A. M.

    2014-01-15

    Purpose: Retinoblastoma is the most common intraocular malignancy in the early childhood. Patients treated with external beam radiotherapy respond very well to the treatment. However, owing to the genotype of children suffering hereditary retinoblastoma, the risk of secondary radio-induced malignancies is high. The University Hospital of Essen has successfully treated these patients on a daily basis during nearly 30 years using a dedicated D-shaped collimator. The use of this collimator that delivers a highly conformed small radiation field, gives very good results in the control of the primary tumor as well as in preserving visual function, while it avoids the devastating side effects of deformation of midface bones. The purpose of the present paper is to propose a modified version of the D-shaped collimator that reduces even further the irradiation field with the scope to reduce as well the risk of radio-induced secondary malignancies. Concurrently, the new dedicated D-shaped collimator must be easier to build and at the same time produces dose distributions that only differ on the field size with respect to the dose distributions obtained by the current collimator in use. The scope of the former requirement is to facilitate the employment of the authors' irradiation technique both at the authors' and at other hospitals. The fulfillment of the latter allows the authors to continue using the clinical experience gained in more than 30 years. Methods: The Monte Carlo codePENELOPE was used to study the effect that the different structural elements of the dedicated D-shaped collimator have on the absorbed dose distribution. To perform this study, the radiation transport through a Varian Clinac 2100 C/D operating at 6 MV was simulated in order to tally phase-space files which were then used as radiation sources to simulate the considered collimators and the subsequent dose distributions. With the knowledge gained in that study, a new, simpler, D-shaped collimator is proposed. Results: The proposed collimator delivers a dose distribution which is 2.4 cm wide along the inferior-superior direction of the eyeball. This width is 0.3 cm narrower than that of the dose distribution obtained with the collimator currently in clinical use. The other relevant characteristics of the dose distribution obtained with the new collimator, namely, depth doses at clinically relevant positions, penumbrae width, and shape of the lateral profiles, are statistically compatible with the results obtained for the collimator currently in use. Conclusions: The smaller field size delivered by the proposed collimator still fully covers the planning target volume with at least 95% of the maximum dose at a depth of 2 cm and provides a safety margin of 0.2 cm, so ensuring an adequate treatment while reducing the irradiated volume.

  1. Multicolor flow cytometry analysis of blood cell subsets in patients given total body irradiation before bone marrow transplantation

    SciTech Connect (OSTI)

    Clave, E.; Socie, G.; Carosella, E.

    1995-11-01

    Bone marrow transplantation has often been closely linked with accidental or intentional therapeutical irradiation. In both situations, study of the radiosensitivity of human blood cell subsets is of interest. Using one-color flow cytometry analysis of B lymphocytes, T cell subsets, and natural killer cells, we previously reported that lymphocyte subsets exhibit equal radiosensitivity. Taking advantage of recent developments in the knowledge of leukocyte differentiation antigens and flow cytometry technology we undertook a study of blood cell subsets to search for rare populations exhibiting different radiosensitivity. Thirty patients, who were delivered a 12 Gy fractionated total body irradiation as part of their conditioning regimen before transplantation for malignant disorders, were studied using multicolor flow cytometry. T and B lymphocytes showed a sharp, radiation-induced decrease, with the B lymphocytes (cluster of differentiation (CD) 19+) being the most sensitive. When analyzed by multicolor flow cytometry all major lymphocyte subsets appeared equally sensitive to the in vivo irradiation. Therefore, all major lymphocyte subsets sharing the helper phenotype (naive or memory) and the cytotoxic phenotype appeared equally sensitive to in vivo whole body irradiation. In parallel, the CD34+ cell subset remained basically unchanged after whole body irradiation. Finally, the CD3{minus}, 56+, 16+ natural killer cell subset was relatively radioresistant (91 and 74% of its initial value, after 2 and 4 Gy, respectively) as compared to other lymphocyte subsets. Our study provides evidence that T and B cell subsets seem to be highly radiosensitive in vivo. The CD34+ progenitor/stem cells and NK cells seem to be more radioresistant. This latter result might provide clues to the understanding of the pathophysiogeny of radiation-induced aplasia and of the engrafment/rejection process following bone marrow transplantation. 20 refs., 3 figs., 1 tab.

  2. SU-E-T-169: Evaluation of Oncentra TPS for Nasopharynx Brachy Using Patient Specific Voxel Phantom and EGSnrc

    SciTech Connect (OSTI)

    Hadad, K; Zoherhvand, M; Faghihi, R [Shiraz University, Shiraz (Iran, Islamic Republic of)

    2014-06-01

    Purpose: Nasopharnx carcinoma (NPC) treatment is being carried out using Ir-192 HDR seeds in Mehdieh Hospital in Hamadan, Iran. The Oncentra TPS is based on optimized TG-43 formalism which disregards heterogeneity in the treatment area. Due to abundant heterogeneity in head and neck, comparison of the Oncentra TPS dose evaluation and an accurate dose calculation method in NPC brachytherapy is the objective of this study. Methods: CT DICOMs of a patient with NPC obtained from Mehdieh Hospital used to create 3D voxel phantom with CTCREATE utility of EGSnrc code package. The voxel phantom together with Ir-192 HDR brachytherapy source were the input to DOSXYZnrc to calculate the 3D dose distribution. The sources were incorporate with type 6 source in DOSXYZnrc and their dwell times were taken into account in final dose calculations. Results: The direct comparison between isodoses as well as DVHs for the GTV, PTV and CTV obtained by Oncentra and EGSnrc Monte Carlo code are made. EGSnrc results are obtained using 510{sup 9} histories to reduce the statistical error below 1% in GTV and 5% in 5% dose areas. The standard ICRP700 cross section library is employed in DOSXYZnrc dose calculation. Conclusion: A direct relationship between increased dose differences and increased material density (hence heterogeneity) is observed when isodoses contours of the TPS and DOSXYZnrc are compared. Regarding the point dose calculations, the differences range from 1.2% in PTV to 5.6% for cavity region and 7.8% for bone regions. While Oncentra TPS overestimates the dose in cavities, it tends to underestimate dose depositions within bones.

  3. SU-E-T-472: A Multi-Dimensional Measurements Comparison to Analyze a 3D Patient Specific QA Tool

    SciTech Connect (OSTI)

    Ashmeg, S; Jackson, J; Zhang, Y; Oldham, M; Yin, F; Ren, L

    2014-06-01

    Purpose: To quantitatively evaluate a 3D patient specific QA tool using 2D film and 3D Presage dosimetry. Methods: A brain IMRT case was delivered to Delta4, EBT2 film and Presage plastic dosimeter. The film was inserted in the solid water slabs at 7.5cm depth for measurement. The Presage dosimeter was inserted into a head phantom for 3D dose measurement. Delta4's Anatomy software was used to calculate the corresponding dose to the film in solid water slabs and to Presage in the head phantom. The results from Anatomy were compared to both calculated results from Eclipse and measured dose from film and Presage to evaluate its accuracy. Using RIT software, we compared the Anatomy dose to the EBT2 film measurement and the film measurement to ECLIPSE calculation. For 3D analysis, DICOM file of Anatomy was extracted and imported to CERR software, which was used to compare the Presage dose to both Anatomy calculation and ECLIPSE calculation. Gamma criteria of 3% - 3mm and 5% - 5mm was used for comparison. Results: Gamma passing rates of film vs Anatomy, Anatomy vs ECLIPSE and film vs ECLIPSE were 82.8%, 70.9% and 87.6% respectively when 3% - 3mm criteria is used. When the criteria is changed to 5% - 5mm, the passing rates became 87.8%, 76.3% and 90.8% respectively. For 3D analysis, Anatomy vs ECLIPSE showed gamma passing rate of 86.4% and 93.3% for 3% - 3mm and 5% - 5mm respectively. The rate is 77.0% for Presage vs ECLIPSE analysis. The Anatomy vs ECLIPSE were absolute dose comparison. However, film and Presage analysis were relative comparison Conclusion: The results show higher passing rate in 3D than 2D in Anatomy software. This could be due to the higher degrees of freedom in 3D than in 2D for gamma analysis.

  4. Pharmacogenetic Study in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Polymorphisms in Thymidylate Synthase, Epidermal Growth Factor Receptor, GSTP1, and DNA Repair Genes

    SciTech Connect (OSTI)

    Paez, David; Salazar, Juliana; Pare, Laia; Pertriz, Lourdes; Targarona, Eduardo; Rio, Elisabeth del; Barnadas, Agusti; Marcuello, Eugenio; Baiget, Montserrat

    2011-12-01

    Purpose: Several studies have been performed to evaluate the usefulness of neoadjuvant treatment using oxaliplatin and fluoropyrimidines for locally advanced rectal cancer. However, preoperative biomarkers of outcome are lacking. We studied the polymorphisms in thymidylate synthase, epidermal growth factor receptor, glutathione S-transferase pi 1 (GSTP1), and several DNA repair genes to evaluate their usefulness as pharmacogenetic markers in a cohort of 128 rectal cancer patients treated with preoperative chemoradiotherapy. Methods and Materials: Blood samples were obtained from 128 patients with Stage II-III rectal cancer. DNA was extracted from the peripheral blood nucleated cells, and the genotypes were analyzed by polymerase chain reaction amplification and automated sequencing techniques or using a 48.48 dynamic array on the BioMark system. The germline polymorphisms studied were thymidylate synthase, (VNTR/5 Prime UTR, 2R G>C single nucleotide polymorphism [SNP], 3R G>C SNP), epidermal growth factor receptor (Arg497Lys), GSTP1 (Ile105val), excision repair cross-complementing 1 (Asn118Asn, 8092C>A, 19716G>C), X-ray repair cross-complementing group 1 (XRCC1) (Arg194Trp, Arg280His, Arg399Gln), and xeroderma pigmentosum group D (Lys751Gln). The pathologic response, pathologic regression, progression-free survival, and overall survival were evaluated according to each genotype. Results: The Asterisk-Operator 3/ Asterisk-Operator 3 thymidylate synthase genotype was associated with a greater response rate (pathologic complete remission and microfoci residual tumor, 59% in Asterisk-Operator 3/ Asterisk-Operator 3 vs. 35% in Asterisk-Operator 2/ Asterisk-Operator 2 and Asterisk-Operator 2/ Asterisk-Operator 3; p = .013). For the thymidylate synthase genotype, the median progression-free survival was 103 months for the Asterisk-Operator 3/ Asterisk-Operator 3 patients and 84 months for the Asterisk-Operator 2/ Asterisk-Operator 2 and Asterisk-Operator 2/ Asterisk-Operator 3 patients (p = .039). For XRCC1 Arg399Gln SNP, the median progression-free survival was 101 months for the G/G, 78 months for the G/A, and 31 months for the A/A patients (p = .048). Conclusions: The thymidylate synthase genotype and XRCC1 Arg399Gln polymorphism might help to identify Stage II-III rectal cancer patients with a better outcome after preoperative concomitant chemoradiotherapy.

  5. Uterine Artery Embolization for Leiomyomata: Optimization of the Radiation Dose to the Patient Using a Flat-Panel Detector Angiographic Suite

    SciTech Connect (OSTI)

    Sapoval, Marc Pellerin, Olivier; Rehel, Jean-Luc; Houdoux, Nicolas; Rahmoune, Ghizlaine; Aubert, Bernard; Fitton, Isabelle

    2010-10-15

    The purpose of this study was to assess the ability of low-dose/low-frame fluoroscopy/angiography with a flat-panel detector angiographic suite to reduce the dose delivered to patients during uterine fibroid embolization (UFE). A two-step prospective dosimetric study was conducted, with a flat-panel detector angiography suite (Siemens Axiom Artis) integrating automatic exposure control (AEC), during 20 consecutive UFEs. Patient dosimetry was performed using calibrated thermoluminescent dosimeters placed on the lower posterior pelvis skin. The first step (10 patients; group A) consisted in UFE (bilateral embolization, calibrated microspheres) performed using the following parameters: standard fluoroscopy (15 pulses/s) and angiography (3 frames/s). The second step (next consecutive 10 patients; group B) used low-dose/low-frame fluoroscopy (7.5 pulses/s for catheterization and 3 pulses/s for embolization) and angiography (1 frame/s). We also recorded the total dose-area product (DAP) delivered to the patient and the fluoroscopy time as reported by the manufacturer's dosimetry report. The mean peak skin dose decreased from 2.4 {+-} 1.3 to 0.4 {+-} 0.3 Gy (P = 0.001) for groups A and B, respectively. The DAP values decreased from 43,113 {+-} 27,207 {mu}Gy m{sup 2} for group A to 9,515 {+-} 4,520 {mu}Gy m{sup 2} for group B (P = 0.003). The dose to ovaries and uterus decreased from 378 {+-} 238 mGy (group A) to 83 {+-} 41 mGy (group B) and from 388 {+-} 246 mGy (group A) to 85 {+-} 39 mGy (group B), respectively. Effective doses decreased from 112 {+-} 71 mSv (group A) to 24 {+-} 12 mSv (group B) (P = 0.003). In conclusion, the use of low-dose/low-frame fluoroscopy/angiography, based on a good understanding of the AEC system and also on the technique during uterine fibroid embolization, allows a significant decrease in the dose exposure to the patient.

  6. Long-term follow-up of {sup 111}In-capromab pendetide (ProstaScint) scan as pretreatment assessment in patients who undergo salvage radiotherapy for rising prostate-specific antigen after radical prostatectomy for prostate cancer

    SciTech Connect (OSTI)

    Nagda, Suneel N. . E-mail: snagda@gmail.com; Mohideen, Najeeb; Lo, Simon S.; Khan, Usman B.S.; Dillehay, Gary; Wagner, Robert; Campbell, Steven; Flanigan, Robert

    2007-03-01

    Purpose: To evaluate the long-term failure patterns in patients who underwent an {sup 111}In-capromab pendetide (ProstaScint) scan as part of their pretreatment assessment for a rising prostate-specific antigen (PSA) level after prostatectomy and subsequently received local radiotherapy (RT) to the prostate bed. Methods: Fifty-eight patients were referred for evaluation of a rising PSA level after radical prostatectomy. All patients had negative findings for metastatic disease after abdominal/pelvis imaging with CT and isotope bone scans. All patients underwent a capromab pendetide scan, and the sites of uptake were noted. All patients were treated with local prostate bed RT (median dose 66.6 Gy). Results: Of the 58 patients, 20 had biochemical failure (post-RT PSA level >0.2 ng/mL or a rise to greater than the nadir PSA), including 6 patients with positive uptake outside the bed (positive elsewhere). The 4-year biochemical relapse-free survival (bRFS) rates for patients with negative (53%), positive in the prostate bed alone (45%), or positive elsewhere (74%) scan findings did not differ significantly (p = 0.51). The positive predictive value of the capromab pendetide scan in detecting disease outside the bed was 27%. The capromab pendetide scan status had no effect on bRFS. Those with a pre-RT PSA level of <1 ng/mL had improved bRFS (p = 0.003). Conclusion: The capromab pendetide scan has a low positive predictive value in patients with positive elsewhere uptake and the 4-year bRFS was similar to that for those who did not exhibit positive elsewhere uptake. Therefore, patients with a postprostatectomy rising PSA level should considered for local RT on the basis of clinicopathologic factors.

  7. Prospective Study Evaluating Postoperative Radiotherapy Plus 2-Year Androgen Suppression for Post-Radical Prostatectomy Patients With Pathologic T3 Disease and/or Positive Surgical Margins

    SciTech Connect (OSTI)

    Choo, Richard [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States)], E-mail: choo.c@mayo.edu; Danjoux, Cyril; Gardner, Sandra; Morton, Gerard; Szumacher, Ewa; Loblaw, D. Andrew; Cheung, Patrick [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada); Pearse, Maria [Department of Radiation Oncology, Auckland Hospital, Auckland (New Zealand)

    2009-10-01

    Purpose: To determine the efficacy of a combined approach of postoperative radiotherapy (RT) plus 2-year androgen suppression (AS) for patients with pathologic T3 disease (pT3) and/or positive surgical margins (PSM) after radical prostatectomy (RP). Methods and Materials: A total of 78 patients with pT3 and/or PSM after RP were treated with RT plus 2-year AS, as per a pilot, prospective study. Androgen suppression started within 1 month after the completion of RT and consisted of nilutamide for 4 weeks and buserelin acetate depot subcutaneously every 2 months for 2 years. Relapse-free rate, including freedom from prostate-specific antigen (PSA) relapse, was estimated using the Kaplan-Meier method. A Cox regression analysis was performed to evaluate prognostic factors for relapse. Prostate-specific antigen relapse was defined as a PSA rise above 0.2 ng/mL, with two consecutive increases over a minimum of 3 months. Results: The median age was 61 years at the time of RP. The median interval between RP and postoperative RT was 4.2 months. Forty-nine patients had undetectable PSA (<0.2 ng/mL), and 29 had persistently detectable postoperative PSA at the time of the protocol treatment. Median follow-up from RT was 6.4 years. Relapse-free rates at 5 and 7 years were 94.4% and 86.3%, respectively. Survival rates were 96% at 5 years and 93.1% at 7 years. On Cox regression analysis, persistently detectable postoperative PSA and pT3b-T4 were significant predictors for relapse. Conclusion: The combined treatment of postoperative RT plus 2-year AS yielded encouraging results for patients with pT3 and/or PSM and warrants a confirmatory study.

  8. X-Ray Cross-Complementing Group 1 and Thymidylate Synthase Polymorphisms Might Predict Response to Chemoradiotherapy in Rectal Cancer Patients

    SciTech Connect (OSTI)

    Lamas, Maria J.

    2012-01-01

    Purpose: 5-Fluorouracil-based chemoradiotherapy before total mesorectal excision is currently the standard treatment of Stage II and III rectal cancer patients. We used known predictive pharmacogenetic biomarkers to identify the responders to preoperative chemoradiotherapy in our series. Methods and Materials: A total of 93 Stage II-III rectal cancer patients were genotyped using peripheral blood samples. The genes analyzed were X-ray cross-complementing group 1 (XRCC1), ERCC1, MTHFR, EGFR, DPYD, and TYMS. The patients were treated with 225 mg/m{sup 2}/d continuous infusion of 5-fluorouracil concomitantly with radiotherapy (50.4 Gy) followed by total mesorectal excision. The outcomes were measured by tumor regression grade (TRG) as a major response (TRG 1 and TRG 2) or as a poor response (TRG3, TRG4, and TRG5). Results: The major histopathologic response rate was 47.3%. XRCC1 G/G carriers had a greater probability of response than G/A carriers (odds ratio, 4.18; 95% confidence interval, 1.62-10.74, p = .003) Patients with polymorphisms associated with high expression of thymidylate synthase (2R/3G, 3C/3G, and 3G/3G) showed a greater pathologic response rate compared with carriers of low expression (odds ratio, 2.65; 95% confidence interval, 1.10-6.39, p = .02) No significant differences were seen in the response according to EGFR, ERCC1, MTHFR{sub C}677 and MTHFR{sub A}1298 expression. Conclusions: XRCC1 G/G and thymidylate synthase (2R/3G, 3C/3G, and 3G/3G) are independent factors of a major response. Germline thymidylate synthase and XRCC1 polymorphisms might be useful as predictive markers of rectal tumor response to neoadjuvant chemoradiotherapy with 5-fluorouracil.

  9. SU-E-J-217: Accuracy Comparison Between Surface and Volumetric Registrations for Patient Setup of Head and Neck Radiation Therapy

    SciTech Connect (OSTI)

    Kim, Y; Li, R; Na, Y; Jenkins, C; Xing, L; Lee, R

    2014-06-01

    Purpose: Optical surface imaging has been applied to radiation therapy patient setup. This study aims to investigate the accuracy of the surface registration of the optical surface imaging compared with that of the conventional method of volumetric registration for patient setup in head and neck radiation therapy. Methods: Clinical datasets of planning CT and treatment Cone Beam CT (CBCT) were used to compare the surface and volumetric registrations in radiation therapy patient setup. The Iterative Closest Points based on point-plane closest method was implemented for surface registration. We employed 3D Slicer for rigid volumetric registration of planning CT and treatment CBCT. 6 parameters of registration results (3 rotations and 3 translations) were obtained by the two registration methods, and the results were compared. Digital simulation tests in ideal cases were also performed to validate each registration method. Results: Digital simulation tests showed that both of the registration methods were accurate and robust enough to compare the registration results. In experiments with the actual clinical data, the results showed considerable deviation between the surface and volumetric registrations. The average root mean squared translational error was 2.7 mm and the maximum translational error was 5.2 mm. Conclusion: The deviation between the surface and volumetric registrations was considerable. Special caution should be taken in using an optical surface imaging. To ensure the accuracy of optical surface imaging in radiation therapy patient setup, additional measures are required. This research was supported in part by the KIST institutional program (2E24551), the Industrial Strategic technology development program (10035495) funded by the Ministry of Trade, Industry and Energy (MOTIE, KOREA), and the Radiation Safety Research Programs (1305033) through the Nuclear Safety and Security Commission, and the NIH (R01EB016777)

  10. SU-D-16A-01: A Novel Method to Estimate Normal Tissue Dose for Radiotherapy Patients to Support Epidemiologic Studies of Second Cancer Risk

    SciTech Connect (OSTI)

    Lee, C; Jung, J; Pelletier, C; Kim, J; Lee, C

    2014-06-01

    Purpose: Patient cohort of second cancer study often involves radiotherapy patients with no radiological images available: We developed methods to construct a realistic surrogate anatomy by using computational human phantoms. We tested this phantom images both in a commercial treatment planning system (Eclipse) and a custom Monte Carlo (MC) transport code. Methods: We used a reference adult male phantom defined by International Commission on Radiological Protection (ICRP). The hybrid phantom which was originally developed in Non-Uniform Rational B-Spline (NURBS) and polygon mesh format was converted into more common medical imaging format. Electron density was calculated from the material composition of the organs and tissues and then converted into DICOM format. The DICOM images were imported into the Eclipse system for treatment planning, and then the resulting DICOM-RT files were imported into the MC code for MC-based dose calculation. Normal tissue doses were calculation in Eclipse and MC code for an illustrative prostate treatment case and compared to each other. Results: DICOM images were generated from the adult male reference phantom. Densities and volumes of selected organs between the original phantom and ones represented within Eclipse showed good agreements, less than 0.6%. Mean dose from Eclipse and MC code match less than 7%, whereas maximum and minimum doses were different up to 45%. Conclusion: The methods established in this study will be useful for the reconstruction of organ dose to support epidemiological studies of second cancer in cancer survivors treated by radiotherapy. We also work on implementing body size-dependent computational phantoms to better represent patient's anatomy when the height and weight of patients are available.

  11. Nuclear NF-?B Expression Correlates With Outcome Among Patients With Head and Neck Squamous Cell Carcinoma Treated With Primary Chemoradiation Therapy

    SciTech Connect (OSTI)

    Balermpas, Panagiotis [Department of Radiation Therapy and Oncology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany)] [Department of Radiation Therapy and Oncology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany); Michel, Yvonne [Senckenberg Institute of Pathology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany)] [Senckenberg Institute of Pathology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany); Wagenblast, Jens [Department of Otorhinolaryngology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany)] [Department of Otorhinolaryngology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany); Seitz, Oliver [Department of Maxillofacial Surgery, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany)] [Department of Maxillofacial Surgery, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany); Sipek, Florian; Rdel, Franz; Rdel, Claus [Department of Radiation Therapy and Oncology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany)] [Department of Radiation Therapy and Oncology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany); Fokas, Emmanouil, E-mail: emmanouil.fokas@kgu.de [Department of Radiation Therapy and Oncology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany)] [Department of Radiation Therapy and Oncology, J. W. Goethe University Frankfurt am Main, Frankfurt (Germany)

    2013-07-15

    Background: To examine whether nuclear NF-?B expression correlates with outcome in patients with head and neck squamous cell carcinoma (HNSCC) treated with primary chemoradiation therapy (CRT). Methods and Materials: Between 2007 and 2010, 101 patients with locally advanced primary HNSCC were treated with definitive simultaneous CRT. Pretreatment biopsy specimens were analyzed for NF-?B p65 (RelA) nuclear immunoreactivity. A sample was assigned to be positive with more than 5% positive nuclear expression. The predictive relevance of NF-?B and clinicopathologic factors for overall survival (OS), progression-free survival (PFS), local progression-free survival (LPFS), and metastasis-free survival (DMFS) was examined by univariate and multivariate analysis. Results: No significant differences between the groups were observed with regard to age, sex, total radiation dose, fractionation mode, total chemotherapy applied, T stage or grading. Patients with p65 nuclear positive biopsy specimens showed significantly a higher rate of lymph node metastasis (cN2c or cN3 status, P=.034). Within a mean follow-up time of 25 months (range, 2.33-62.96 months) OS, PFS, and DMFS were significantly poorer in the p65 nuclear positive group (P=.008, P=.027, and P=.008, respectively). These correlations remained significant in multivariate analysis. Conclusion: NF-?B/p65 nuclear expression is associated with increased lymphatic and hematogenous tumor dissemination and decreased survival in HNSCC patients treated with primary CRT. Our results may foster further investigation of a predictive relevance of NF-?B/p65 and its role as a suitable target for a molecular-based targeted therapy in HNSCC cancer.

  12. Prognostic Importance of Gleason 7 Disease Among Patients Treated With External Beam Radiation Therapy for Prostate Cancer: Results of a Detailed Biopsy Core Analysis

    SciTech Connect (OSTI)

    Spratt, Daniel E.; Zumsteg, Zach; Ghadjar, Pirus; Pangasa, Misha; Pei, Xin; Fine, Samson W.; Yamada, Yoshiya; Kollmeier, Marisa; Zelefsky, Michael J.

    2013-04-01

    Purpose: To analyze the effect of primary Gleason (pG) grade among a large cohort of Gleason 7 prostate cancer patients treated with external beam radiation therapy (EBRT). Methods and Materials: From May 1989 to January 2011, 1190 Gleason 7 patients with localized prostate cancer were treated with EBRT at a single institution. Of these patients, 613 had a Gleason 7 with a minimum of a sextant biopsy with nonfragmented cores and full biopsy core details available, including number of cores of cancer involved, percentage individual core involvement, location of disease, bilaterality, and presence of perineural invasion. Median follow-up was 6 years (range, 1-16 years). The prognostic implication for the following outcomes was analyzed: biochemical recurrence-free survival (bRFS), distant metastasis-free survival (DMFS), and prostate cancer-specific mortality (PCSM). Results: The 8-year bRFS rate for pG3 versus pG4 was 77.6% versus 61.3% (P<.0001), DMFS was 96.8% versus 84.3% (P<.0001), and PCSM was 3.7% versus 8.1% (P=.002). On multivariate analysis, pG4 predicted for significantly worse outcome in all parameters. Location of disease (apex, base, mid-gland), perineural involvement, maximum individual core involvement, and the number of Gleason 3+3, 3+4, or 4+3 cores did not predict for distant metastases. Conclusions: Primary Gleason grade 4 independently predicts for worse bRFS, DMFS, and PCSM among Gleason 7 patients. Using complete core information can allow clinicians to utilize pG grade as a prognostic factor, despite not having the full pathologic details from a prostatectomy specimen. Future staging and risk grouping should investigate the incorporation of primary Gleason grade when complete biopsy core information is used.

  13. Practical Use of the Extended No Action Level (eNAL) Correction Protocol for Breast Cancer Patients With Implanted Surgical Clips

    SciTech Connect (OSTI)

    Penninkhof, Joan; Quint, Sandra; Baaijens, Margreet; Heijmen, Ben; Dirkx, Maarten

    2012-02-01

    Purpose: To describe the practical use of the extended No Action Level (eNAL) setup correction protocol for breast cancer patients with surgical clips and evaluate its impact on the setup accuracy of both tumor bed and whole breast during simultaneously integrated boost treatments. Methods and Materials: For 80 patients, two orthogonal planar kilovoltage images and one megavoltage image (for the mediolateral beam) were acquired per fraction throughout the radiotherapy course. For setup correction, the eNAL protocol was applied, based on registration of surgical clips in the lumpectomy cavity. Differences with respect to application of a No Action Level (NAL) protocol or no protocol were quantified for tumor bed and whole breast. The correlation between clip migration during the fractionated treatment and either the method of surgery or the time elapsed from last surgery was investigated. Results: The distance of the clips to their center of mass (COM), averaged over all clips and patients, was reduced by 0.9 {+-} 1.2 mm (mean {+-} 1 SD). Clip migration was similar between the group of patients starting treatment within 100 days after surgery (median, 53 days) and the group starting afterward (median, 163 days) (p = 0.20). Clip migration after conventional breast surgery (closing the breast superficially) or after lumpectomy with partial breast reconstructive techniques (sutured cavity). was not significantly different either (p = 0.22). Application of eNAL on clips resulted in residual systematic errors for the clips' COM of less than 1 mm in each direction, whereas the setup of the breast was within about 2 mm of accuracy. Conclusions: Surgical clips can be safely used for high-accuracy position verification and correction. Given compensation for time trends in the clips' COM throughout the treatment course, eNAL resulted in better setup accuracies for both tumor bed and whole breast than NAL.

  14. SU-F-BRE-06: Evaluation of Patient CT Dose Reconstruction From 3D Diode Array Measurements Using Anthropomorphic Phantoms

    SciTech Connect (OSTI)

    Huang, M; Benhabib, S; Cardan, R; Brezovich, I; Popple, R; Faught, A; Followill, D

    2014-06-15

    Purpose: To compare 3D reconstructed dose of IMRT plans from 3D diode array measurements with measurements in anthropomorphic phantoms. Methods: Six IMRT plans were created for the IROC Houston (RPC) head and neck (H and N) and lung phantoms following IROC Houston planning protocols. The plans included flattened and unflattened beam energies ranging from 6 MV to 15 MV and both static and dynamic MLC tecH and Niques. Each plan was delivered three times to the respective anthropomorphic phantom, each of which contained thermoluminescent dosimeters (TLDs) and radiochromic films (RCFs). The plans were also delivered to a Delta4 diode array (Scandidos, Uppsala, Sweden). Irradiations were done using a TrueBeam STx (Varian Medical Systems, Palo Alto, CA). The dose in the patient was calculated by the Delta4 software, which used the diode measurements to estimate incident energy fluence and a kernel-based pencil beam algorithm to calculate dose. The 3D dose results were compared with the TLD and RCF measurements. Results: In the lung, the average difference between TLDs and Delta4 calculations was 5% (range 2%7%). For the H and N, the average differences were 2.4% (range 0%4.5%) and 1.1% (range 0%2%) for the high- and low-dose targets, respectively, and 12% (range 10%-13%) for the organ-at-risk simulating the spinal cord. For the RCF and criteria of 7%/4mm, 5%/3mm, and 3%/3mm, the average gamma-index pass rates were 95.4%, 85.7%, and 76.1%, respectively for the H and N and 76.2%, 57.8%, and 49.5% for the lung. The pass-rate in the lung decreased with increasing beam energy, as expected for a pencil beam algorithm. Conclusion: The H and N phantom dose reconstruction met the IROC Houston acceptance criteria for clinical trials; however, the lung phantom dose did not, most likely due to the inaccuracy of the pencil beam algorithm in the presence of low-density inhomogeneities. Work supported by PHS grant CA10953 and CA81647 (NCI, DHHS)

  15. SU-E-T-318: The Effect of Patient Positioning Errors On Target Coverage and Cochlear Dose in Stereotactic Radiosurgery Treatment of Acoustic Neuromas

    SciTech Connect (OSTI)

    Dellamonica, D.; Luo, G.; Ding, G.

    2014-06-01

    Purpose: Setup errors on the order of millimeters may cause under-dosing of targets and significant changes in dose to critical structures especially when planning with tight margins in stereotactic radiosurgery. This study evaluates the effects of these types of patient positioning uncertainties on planning target volume (PTV) coverage and cochlear dose for stereotactic treatments of acoustic neuromas. Methods: Twelve acoustic neuroma patient treatment plans were retrospectively evaluated in Brainlab iPlan RT Dose 4.1.3. All treatment beams were shaped by HDMLC from a Varian TX machine. Seven patients had planning margins of 2mm, five had 11.5mm. Six treatment plans were created for each patient simulating a 1mm setup error in six possible directions: anterior-posterior, lateral, and superiorinferior. The arcs and HDMLC shapes were kept the same for each plan. Change in PTV coverage and mean dose to the cochlea was evaluated for each plan. Results: The average change in PTV coverage for the 72 simulated plans was ?1.7% (range: ?5 to +1.1%). The largest average change in coverage was observed for shifts in the patient's superior direction (?2.9%). The change in mean cochlear dose was highly dependent upon the direction of the shift. Shifts in the anterior and superior direction resulted in an average increase in dose of 13.5 and 3.8%, respectively, while shifts in the posterior and inferior direction resulted in an average decrease in dose of 17.9 and 10.2%. The average change in dose to the cochlea was 13.9% (range: 1.4 to 48.6%). No difference was observed based on the size of the planning margin. Conclusion: This study indicates that if the positioning uncertainty is kept within 1mm the setup errors may not result in significant under-dosing of the acoustic neuroma target volumes. However, the change in mean cochlear dose is highly dependent upon the direction of the shift.

  16. Comparison of Clinical Outcomes of Surgery Followed by Local Brain Radiotherapy and Surgery Followed by Whole Brain Radiotherapy in Patients With Single Brain Metastasis: Single-Center Retrospective Analysis

    SciTech Connect (OSTI)

    Hashimoto, Kenji; Narita, Yoshitaka; Miyakita, Yasuji; Ohno, Makoto; Sumi, Minako; Mayahara, Hiroshi; Kayama, Takamasa; Shibui, Soichiro

    2011-11-15

    Purpose: Data comparing the clinical outcomes of local brain radiotherapy (LBRT) and whole brain RT (WBRT) in patients with a single brain metastasis after tumor removal are limited. Patients and Methods: A retrospective analysis was performed to compare the patterns of treatment failure, cause of death, progression-free survival, median survival time, and Karnofsky performance status for long-term survivors among patients who underwent surgery followed by either LBRT or WBRT between 1990 and 2008 at the National Cancer Center Hospital. Results: A total of 130 consecutive patients were identified. The median progression-free survival period among the patients who received postoperative LBRT (n = 64) and WBRT (n = 66) was 9.7 and 11.5 months, respectively (p = .75). The local recurrence rates (LBRT, 9.4% vs. WBRT, 12.1%) and intracranial new metastasis rate (LBRT, 42.2% vs. WBRT, 33.3%) were similar in each arm. The incidence of leptomeningeal metastasis was also equivalent (LBRT, 9.4% vs. WBRT, 10.6%). The median survival time for the LBRT and WBRT patients was 13.9 and 16.7 months, respectively (p = .88). A neurologic cause of death was noted in 35.6% of the patients in the LBRT group and 36.7% of the WBRT group (p = .99). The Karnofsky performance status at 2 years was comparable between the two groups. Conclusions: The clinical outcomes of LBRT and WBRT were similar. A prospective evaluation is warranted.

  17. Definitive Chemoradiation Therapy Following Surgical Resection or Radiosurgery Plus Whole-Brain Radiation Therapy in Non-Small Cell Lung Cancer Patients With Synchronous Solitary Brain Metastasis: A Curative Approach

    SciTech Connect (OSTI)

    Parlak, Cem; Mertsoylu, Hüseyin; Güler, Ozan Cem; Onal, Cem; Topkan, Erkan

    2014-03-15

    Purpose/Objectives: The aim of this study was to evaluate the impact of definitive thoracic chemoradiation therapy following surgery or stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT) on the outcomes of patients with non-small cell lung cancer (NSCLC) with synchronous solitary brain metastasis (SSBM). Methods and Materials: A total of 63 NSCLC patients with SSBM were retrospectively evaluated. Patients were staged using positron emission tomography-computed tomography in addition to conventional staging tools. Thoracic radiation therapy (TRT) with a total dose of 66 Gy in 2 Gy fractions was delivered along with 2 cycles of cisplatin-based chemotherapy following either surgery plus 30 Gy of WBRT (n=33) or SRS plus 30 Gy of WBRT (n=30) for BM. Results: Overall, the treatment was well tolerated. All patients received planned TRT, and 57 patients (90.5%) were also able to receive 2 cycles of chemotherapy. At a median follow-up of 25.3 months (7.1-52.1 months), the median months of overall, locoregional progression-free, neurological progression-free, and progression-free survival were 28.6, 17.7, 26.4, and 14.6, respectively. Both univariate and multivariate analyses revealed that patients with a T1-T2 thoracic disease burden (P=.001), a nodal stage of N0-N1 (P=.003), and no weight loss (P=.008) exhibited superior survival. Conclusions: In the present series, surgical and radiosurgical treatments directed toward SSBM in NSCLC patients were equally effective. The similarities between the present survival outcomes and those reported in other studies for locally advanced NSCLC patients indicate the potentially curative role of definitive chemoradiation therapy for highly selected patients with SSBM.

  18. Late Toxicity and Patient Self-Assessment of Breast Appearance/Satisfaction on RTOG 0319: A Phase 2 Trial of 3-Dimensional Conformal Radiation Therapy-Accelerated Partial Breast Irradiation Following Lumpectomy for Stages I and II Breast Cancer

    SciTech Connect (OSTI)

    Chafe, Susan; Moughan, Jennifer; McCormick, Beryl; Wong, John; Pass, Helen; Rabinovitch, Rachel; Arthur, Douglas W.; Petersen, Ivy; White, Julia; Vicini, Frank A.

    2013-08-01

    Purpose: Late toxicities and cosmetic analyses of patients treated with accelerated partial breast irradiation (APBI) on RTOG 0319 are presented. Methods and Materials: Patients with stages I to II breast cancer ?3 cm, negative margins, and ?3 positive nodes were eligible. Patients received three-dimensional conformal external beam radiation therapy (3D-CRT; 38.5 Gy in 10 fractions twice daily over 5 days). Toxicity and cosmesis were assessed by the patient (P), the radiation oncologist (RO), and the surgical oncologist (SO) at 3, 6, and 12 months from the completion of treatment and then annually. National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0, was used to grade toxicity. Results: Fifty-two patients were evaluable. Median follow-up was 5.3 years (range, 1.7-6.4 years). Eighty-two percent of patients rated their cosmesis as good/excellent at 1 year, with rates of 64% at 3 years. At 3 years, 31 patients were satisfied with the treatment, 5 were not satisfied but would choose 3D-CRT again, and none would choose standard radiation therapy. The worst adverse event (AE) per patient reported as definitely, probably, or possibly related to radiation therapy was 36.5% grade 1, 50% grade 2, and 5.8% grade 3 events. Grade 3 AEs were all skin or musculoskeletal-related. Treatment-related factors were evaluated to potentially establish an association with observed toxicity. Surgical bed volume, target volume, the number of beams used, and the use of bolus were not associated with late cosmesis. Conclusions: Most patients enrolled in RTOG 0319 were satisfied with their treatment, and all would choose to have the 3D-CRT APBI again.

  19. Changes in Normal Liver and Spleen Volume after Radioembolization with {sup 90}Y-Resin Microspheres in Metastatic Breast Cancer Patients: Findings and Clinical Significance

    SciTech Connect (OSTI)

    Paprottka, Philipp M. Schmidt, G. P.; Trumm, C. G.; Hoffmann, R. T.; Reiser, M. F.; Jakobs, T. F.

    2011-10-15

    Purpose: In clinical trials with yttrium-90-resin-microspheres for the management of colorectal cancer liver metastases, it was observed that radioembolization might result in splenomegaly and an increase in portal vein size. Subclinical hepatitis in normal liver tissue as well as the effects of radioembolization and prior chemotherapy are suspected to be responsible for this phenomenon. The purpose of this study was to quantify the changes in liver and spleen volume and portal vein diameter after radioembolization. Methods: Twenty-seven patients with liver-dominant metastatic disease from breast cancer who had not responded to chemotherapy or had to abandon chemotherapy because of its toxic effects were evaluated. Changes in liver and spleen volume and portal vein diameter as well as liver tumor volume and diameter were quantified using computed tomography scans. Results: Radioembolization was associated with a significant mean decrease in the whole liver volume of 10.2% (median 16.7%; P = 0.0024), mainly caused by a reduction in the right lobe volume (mean 16.0%; P < 0.0001). These changes were accompanied by a significant increase in the diameter of the main portal vein (mean 6.8%; P < 0.0001) as well as splenic volume (mean 50.4%; P < 0.0001). Liver-tumor volume and diameter decreased by a median of 24 and 39.7%. Conclusions: Radioembolization is an effective treatment for tumor size reduction in patients with breast cancer liver metastases. Treatment is associated with changes of hepatic parenchymal volume, splenic volume, and portal vein size that appear not to represent clinically important sequelae in this patient cohort.

  20. SU-E-T-563: A Fast and Quantative Picket-Fence Test of a Submillimeter Patient Positioning System for Stereotactic Radiosurgery

    SciTech Connect (OSTI)

    Ma, L; Perez-Andujar, A; Chiu, J; McGuinness, C

    2014-06-01

    Purpose: Picket-fence test is a qualitative TG142-recommended quality assurance (QA) test for multileaf collimators. In study, we adopted the same concept and developed a fast but quantatitive QA test for an automatic patient positioning system that requires submilleter accuracy for a radiosurgical treatment. Methods: A piece of radiochromic film was first placed inside a spherical solid water phantom and then irradiated with a sequenence of linearly placed shots of same collimator size (e.g. 4-mm) via the Leskell Gamma Knife Perfexion system (PFX). The shots were positioned with either equal or non-equal gaps of approximately 4 mm to 8 mm depending on the location of the region of interest. A pattern recognization program was developed and then applied to measure the gap spacing between two adjacent shots. The measured distance was then compared with the initial preset values for the test. Results: By introducing variable systematic and random shifts of 0.1 mm to 0.5 mm to the shot sequence, the maximum gap variation from the described test was found to be 0.35 mm or less. On average the positioning uncertainty for the PFX delivery system was found to be 0.10.2 mm. No significant difference in the positioning uncertainty was noted for the centrally aligned shot sequence locations versus the peripherally aligned shot sequence locations. Conclusion: A new quantitative picket-fence type test was developed and demonstrated for routine QA of the submillimeter PFX patient positioning sytem. This test also enables independent verification of any patient-specific shot positioning for a critical treatment such as a tumor in brainstem. Dr Ma is currently on the board of international society of stereotactic Radiosurgery.

  1. Atypical and Malignant Meningioma: Outcome and Prognostic Factors in 119 Irradiated Patients. A Multicenter, Retrospective Study of the Rare Cancer Network

    SciTech Connect (OSTI)

    Pasquier, David [Department of Radiation Oncology, Centre O. Lambret and University Lille II, Lille (France)], E-mail: d-pasquier@o-lambret.fr; Bijmolt, Stefan; Veninga, Theo [Department of Radiation Oncology, Dr. Bernard Verbeeten Instituut, Tilburg (Netherlands); Rezvoy, Nicolas [Department of Radiation Oncology, Centre O. Lambret and University Lille II, Lille (France); Villa, Salvador [Department of Radiation Oncology, H.U. Germans Trias, ICO-Badalona, Barcelona (Spain); Krengli, Marco [Department of Radiotherapy, University of Piemonte Orientale, Hospital Maggiore della Carita, Novara (Italy); Weber, Damien C. [Department of Radiation Oncology, University Hospital, Geneva (Switzerland); Baumert, Brigitta G. [Department of Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht (Netherlands); Canyilmaz, Emine [Department of Radiation Oncology, Karadeniz Technical University Faculty of Medicine, Trabzon (Turkey); Yalman, Deniz [Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir (Turkey); Szutowicz, Ewa [Department of Radiation Oncology, Medical University of Gdansk, Gdansk (Poland); Tzuk-Shina, Tzahala [Northern Israel Oncology Centre, Rambam Medical Centre, Haifa (Israel); Mirimanoff, Rene O. [Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland)

    2008-08-01

    Purpose: To retrospectively analyze and assess the outcomes and prognostic factors in a large number of patients with atypical and malignant meningiomas. Methods and Materials: Ten academic medical centers participating in this Rare Cancer Network contributed 119 cases of patients with atypical or malignant meningiomas treated with external beam radiotherapy (EBRT) after surgery or for recurrence. Eligibility criteria were histologically proven atypical or anaplastic (malignant) meningioma (World Health Organization Grade 2 and 3) treated with fractionated EBRT after initial resection or for recurrence, and age >18 years. Sex ratio (male/female) was 1.3, and mean ({+-}SD) age was 57.6 {+-} 12 years. Surgery was macroscopically complete (Simpson Grades 1-3) in 71% of patients; histology was atypical and malignant in 69% and 31%, respectively. Mean dose of EBRT was 54.6 {+-} 5.1 Gy (range, 40-66 Gy). Median follow-up was 4.1 years. Results: The 5- and 10-year actuarial overall survival rates were 65% and 51%, respectively, and were significantly influenced by age >60 years (p = 0.005), Karnofsky performance status (KPS) (p = 0.01), and high mitotic rate (p = 0.047) on univariate analysis. On multivariate analysis age >60 years (p = 0.001) and high mitotic rate (p = 0.02) remained significant adverse prognostic factors. The 5- and 10-year disease-free survival rates were 58% and 48%, respectively, and were significantly influenced by KPS (p 0.04) and high mitotic rate (p = 0.003) on univariate analysis. On multivariate analysis only high mitotic rate (p = 0.003) remained a significant prognostic factor. Conclusions: In this multicenter retrospective study, age, KPS, and mitotic rate influenced outcome. Multicenter prospective studies are necessary to clarify the management and prognostic factors of such a rare disease.

  2. SU-E-T-340: Use of Intensity Modulated Proton Therapy (IMPT) for Reducing the Dose to Cochlea in Craniospinal Irradiation (CSI) of Pediatric Patients

    SciTech Connect (OSTI)

    Dormer, J; Kassaee, A; Lin, H; Ding, X; Lustig, R

    2014-06-01

    Purpose: To evaluate use of intensity modulated proton therapy (IMPT) and number of beams for sparing cochlea in treatment of whole brain for pediatric medulloblastoma patients. Methods: In our institution, craniospinal irradiation patients are treated in supine position on our proton gantries using pencil beam scanning with each beam uniformly covering the target volume (SFUD). Each treatment plan consists of two opposed lateral whole brain fields and one or two spinal fields. For sparing the cochlea for the whole brain treatment, we created three different plans using IMPT for five pediatric patients. The first plan consisted of two lateral fields, the second two lateral fields and a superior-inferior field, and the third two lateral fields and two superior oblique fields. Optimization was performed with heavy weights applied to the eye, lens and cochlea while maintaining a dose prescription of 36 Gy to the whole brain. Results: IMPT plans reduce the dose to the cochlea. Increasing the number of treatment fields was found to lower the average dose to the cochlea: 15.0, 14.5 and 12.5 Gy for the two-field, three-field, and four-field plans respectively. The D95 for the two-field plan was 98.2%, compared to 100.0% for both the three-field and four-field plan. Coverage in the mid-brain was noticeably better in the three- and four-field plans, with more dose conformality surrounding the cochlea. Conclusion: IMPT plans for CSI and the whole brain irradiations are capable of sparing cochlea and reduce the dose considerably without compromising treating brain tissues. The reduction in average dose increases with three and four field plans as compared to traditional two lateral beam plans.

  3. SU-E-T-84: Comparison of Three Different Systems for Patient-Specific Quality Assurance: Cranial Stereotactic Radiosurgery Using VMAT with Multiple Non Coplanar Arcs

    SciTech Connect (OSTI)

    Fusella, M; Fiandra, C; Giglioli, F; Ricardi, U; Ragona, R

    2014-06-01

    Purpose: Patient-specific quality assurance in volumetric modulated arc therapy (VMAT) brain stereotactic radiosurgery raises specific issues on dosimetric procedures, mainly represented by the small radiation fields associated with the lack of lateral electronic equilibrium, the need of small detectors and the high dose delivered. The purpose of the study is to compare three different dosimeters for pre-treatment QA. Methods: Nineteen patients (affected by neurinomas, brain metastases, and by meningiomas) were treated with VMAT plans computed on a Monte Carlo based TPS. Gafchromic films inside a slab phantom (GF), 3-D cylindrical phantom with two orthogonal diodes array (DA), and 3-D cylindrical phantom with a single rotating ionization chambers array (ICA), have been evaluated. The dosimeters are, respectively, characterized by a spatial resolution of: 0.4 (in our method), 5 and 2.5 mm. For GF we used a double channel method for calibration and reading protocol; for DA and ICA we used the 3-D dose distributions reconstructed by the two software sold with the dosimeters. With the need of a common system for analyze different measuring approaches, we used an in-house software that analyze a single coronal plane in the middle of the phantoms and Gamma values (2% / 2 mm and 3% / 3 mm) were computed for all patients and dosimeters. Results: The percentage of points with gamma values less than one was: 95.7% for GF, 96.8% for DA and 95% for ICA, using 3%/3mm criteria, and 90.1% for GF, 92.4% for DA and 92% for ICA, using 2% / 2mm gamma criteria. Tstudent test p-values obtained by comparing the three datasets were not statistically significant for both gamma criteria. Conclusion: Gamma index analysis is not affected by different spatial resolution of the three dosimeters.

  4. SU-E-T-12: A Feasibility Study of Patient Specific QA Using Gafchromic Film of Dynamic Feathering in Junctions of Craniospinal Irradiation

    SciTech Connect (OSTI)

    Stanford, J; Duggar, W; Yang, C

    2014-06-01

    Purpose: Cranio-spinal irradiation is the most complicated format of the conventional external beam radiation therapy because it involves matches of non-coplanar beams which are susceptible to daily setup errors. This study explores the efficacy of Gafchromic film dosimetry to quantitatively verify the junctions for cranio-spinal radiation feathered with field in field technique. Methods: 15cm in thickness of solid water phantom was scanned vertically and exported to the Pinnacle TPS as primary phantom data set. A patient cranio-spinal plan, consisted of two bilateral whole brain beams dynamically matched with a posterior spinal beam using field in field technique, was transferred to the phantom and recalculated for one fraction with set monitor units identical to the original plan. Next, planar dose distribution on the phantom was exported to the FilmQA Pro 2013 software (Ashland, Inc.) in binary format for comparison with the measured dose distribution. An EBT2 film was sandwiched in the middle of the phantom and the phantom was set up according to the QA plan based on the room laser system. The shifts instructions associated with the patient original plan were made and the beams from the patient original plan delivered to the solid water phantom via the record and verify system in QA mode. The dose distribution from the measured film was compared with the planned reference distribution using gamma analysis and profile comparison. Results: Gamma passing rate of 91 % with DTA 3mm and 5% dose difference was obtained within the junction region, significantly greater passing rate above 95 % was obtained in the homogeneous region of the brain field. Conclusion: This study confirms that Gafchromic film dosimetry can be used to validate the efficacy of FIF feathering technique for cranio-spinal treatment. FIF technique with Gafchromic dosimetry may now be the new standard for delivering efficient and accurate cranio-spinal radiation with confidence.

  5. Extended (5-year) Outcomes of Accelerated Partial Breast Irradiation Using MammoSite Balloon Brachytherapy: Patterns of Failure, Patient Selection, and Dosimetric Correlates for Late Toxicity

    SciTech Connect (OSTI)

    Vargo, John A.; Verma, Vivek; Kim, Hayeon; Kalash, Ronny; Heron, Dwight E.; Johnson, Ronald; Beriwal, Sushil

    2014-02-01

    Purpose: Accelerated partial breast irradiation (APBI) with balloon and catheter-based brachytherapy has gained increasing popularity in recent years and is the subject of ongoing phase III trials. Initial data suggest promising local control and cosmetic results in appropriately selected patients. Long-term data continue to evolve but are limited outside of the context of the American Society of Breast Surgeons Registry Trial. Methods and Materials: A retrospective review of 157 patients completing APBI after breast-conserving surgery and axillary staging via high-dose-rate {sup 192}Ir brachytherapy from June 2002 to December 2007 was made. APBI was delivered with a single-lumen MammoSite balloon-based applicator to a median dose of 34 Gy in 10 fractions over a 5-day period. Tumor coverage and critical organ dosimetry were retrospectively collected on the basis of computed tomography completed for conformance and symmetry. Results: At a median follow-up time of 5.5 years (range, 0-10.0 years), the 5-year and 7-year actuarial incidences of ipsilateral breast control were 98%/98%, of nodal control 99%/98%, and of distant control 99%/99%, respectively. The crude rate of ipsilateral breast recurrence was 2.5% (n=4); of nodal failure, 1.9% (n=3); and of distant failure, 0.6% (n=1). The 5-year and 7-year actuarial overall survival rates were 89%/86%, with breast cancerspecific survival of 100%/99%, respectively. Good to excellent cosmetic outcomes were achieved in 93.4% of patients. Telangiectasia developed in 27% of patients, with 1-year, 3-year, and 5-year actuarial incidence of 7%/24%/33%; skin dose >100% significantly predicted for the development of telangiectasia (50% vs 14%, P<.0001). Conclusions: Long-term single-institution outcomes suggest excellent tumor control, breast cosmesis, and minimal late toxicity. Skin toxicity is a function of skin dose, which may be ameliorated with dosimetric optimization afforded by newer multicatheter brachytherapy applicators and a more rigorous skin dose constraint of ?100%.

  6. Secondary Analysis of RTOG 9508, a Phase 3 Randomized Trial of Whole-Brain Radiation Therapy Versus WBRT Plus Stereotactic Radiosurgery in Patients With 1-3 Brain Metastases; Poststratified by the Graded Prognostic Assessment (GPA)

    SciTech Connect (OSTI)

    Sperduto, Paul W.; Shanley, Ryan; Luo, Xianghua; Andrews, David; Werner-Wasik, Maria; Valicenti, Richard; Bahary, Jean-Paul; Souhami, Luis; Won, Minhee; Mehta, Minesh

    2014-11-01

    Purpose: Radiation Therapy Oncology Group (RTOG) 9508 showed a survival advantage for patients with 1 but not 2 or 3 brain metastasis (BM) treated with whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) versus WBRT alone. An improved prognostic index, the graded prognostic assessment (GPA) has been developed. Our hypothesis was that if the data from RTOG 9508 were poststratified by the GPA, the conclusions may vary. Methods and Materials: In this analysis, 252 of the 331 patients were evaluable by GPA. Of those, 211 had lung cancer. Breast cancer patients were excluded because the components of the breast GPA are not in the RTOG database. Multiple Cox regression was used to compare survival between treatment groups, adjusting for GPA. Treatment comparisons within subgroups were performed with the log-rank test. A free online tool ( (brainmetgpa.com)) simplified GPA use. Results: The fundamental conclusions of the primary analysis were confirmed in that there was no survival benefit overall for patients with 1 to 3 metastases; however, there was a benefit for the subset of patients with GPA 3.5 to 4.0 (median survival time [MST] for WBRT + SRS vs WBRT alone was 21.0 versus 10.3 months, P=.05) regardless of the number of metastases. Among patients with GPA 3.5 to 4.0 treated with WBRT and SRS, the MST for patients with 1 versus 2 to 3 metastases was 21 and 14.1 months, respectively. Conclusions: This secondary analysis of predominantly lung cancer patients, consistent with the original analysis, shows no survival advantage for the group overall when treated with WBRT and SRS; however, in patients with high GPA (3.5-4), there is a survival advantage regardless of whether they have 1, 2, or 3 BM. This benefit did not extend to patients with lower GPA. Prospective validation of this survival benefit for patients with multiple BM and high GPA when treated with WBRT and SRS is warranted.

  7. Do Angiotensin-Converting Enzyme Inhibitors Reduce the Risk of Symptomatic Radiation Pneumonitis in Patients With Non-Small Cell Lung Cancer After Definitive Radiation Therapy? Analysis of a Single-Institution Database

    SciTech Connect (OSTI)

    Wang, Hongmei [Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, P.R. of China (China); Liao, Zhongxing, E-mail: zliao@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhuang, Yan; Xu, Ting; Nguyen, Quynh-Nhu; Levy, Lawrence B.; O'Reilly, Michael [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gold, Kathryn A. [Department of Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gomez, Daniel R. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-12-01

    Purpose: Preclinical studies have suggested that angiotensin-converting enzyme inhibitors (ACEIs) can mitigate radiation-induced lung injury. We sought here to investigate possible associations between ACEI use and the risk of symptomatic radiation pneumonitis (RP) among patients undergoing radiation therapy (RT) for nonsmall cell lung cancer (NSCLC). Methods and Materials: We retrospectively identified patients who received definitive radiation therapy for stages I to III NSCLC between 2004 and 2010 at a single tertiary cancer center. Patients must have received a radiation dose of at least 60 Gy for a single primary lung tumor and have had imaging and dosimetric data available for analysis. RP was quantified according to Common Terminology Criteria for Adverse Events, version 3.0. A Cox proportional hazard model was used to assess potential associations between ACEI use and risk of symptomatic RP. Results: Of 413 patients analyzed, 65 were using ACEIs during RT. In univariate analysis, the rate of RP grade ?2 seemed lower in ACEI users than in nonusers (34% vs 46%), but this apparent difference was not statistically significant (P=.06). In multivariate analysis of all patients, ACEI use was not associated with the risk of symptomatic RP (hazard ratio [HR] = 0.66; P=.07) after adjustment for sex, smoking status, mean lung dose (MLD), and concurrent carboplatin and paclitaxel chemotherapy. Subgroup analysis showed that ACEI use did have a protective effect from RP grade ?2 among patients who received a low (?20-Gy) MLD (P<.01) or were male (P=.04). Conclusions: A trend toward reduction in symptomatic RP among patients taking ACEIs during RT for NSCLC was not statistically significant on univariate or multivariate analyses, although certain subgroups may benefit from use (ie, male patients and those receiving low MLD). The evidence at this point is insufficient to establish whether the use of ACEIs does or does not reduce the risk of RP.

  8. SU-E-T-567: A Three-Field Mono-Isocentric Inverse Treatment Planning Method for the Patients with Larger Breasts

    SciTech Connect (OSTI)

    Zhang, T; Marina, O; Chen, P; Teahan, M; Liu, Q; Benedetti, L

    2014-06-01

    Purpose: The purpose of this study is to develop a three-field monoisocentric inverse breast treatment planning technique without the use of half-beam block. Methods: Conventional three-field breast treatment with supraclavicular half-beam blocked requires two isocenters when the breast is too large to be contained within half-beam. The inferior border of the supraclavicular field and superior borders of the breast fields are matched on patient's skin with the light field. This method causes a large dose variation in the matching region due to daily setup uncertainties and requires a longer treatment setup time. We developed a three-field mono-isocentric planning method for the treatment of larger breasts. The three fields share the same isocenter located in the breast. Beam matching is achieved by rotating collimator, couch and gantry. Furthermore, we employed a mixed open-IMRT inverse optimization method to improve dose uniformity and coverage. Results: Perfect geometric beam matching was achieved by rotating couch, collimator and gantry together. Treatment setup time was significantly reduced without light-field matching during treatment deliveries. Inverse mixed open-IMRT optimization method achieved better dose uniformity and PTV coverage while keeping sufficient air flash to compensate setup and breast shape changes in daily treatments. Conclusion: By eliminating light field matching, the three-field mono-isocentric treatment method can significantly reduce setup time and uncertainty for large breast patients. Plan quality is further improved by inverse IMRT planning.

  9. MR-guided Neurolytic Celiac Plexus Ablation: An Evaluation of Effect and Injection Spread Pattern in Cancer Patients with Celiac Tumor Infiltration

    SciTech Connect (OSTI)

    Akural, Etem; Ojala, Risto O.; Jaervimaeki, Voitto; Kariniemi, Juho; Tervonen, Osmo A.; Blanco Sequeiros, Roberto

    2013-04-15

    ObjectiveThe purpose of this study was to evaluate the feasibility, the initial accuracy, and the effects of the MR-guided neurolytic celiac plexus ablation as a method to treat cancer-induced chronic abdominal pain. Thirteen celiac plexus ablations were performed for 12 patients. A 0.23-T open MRI scanner with optical navigation was used for procedural guidance. As an adjunct to the MR-guided needle positioning, the needle location was confirmed with saline injection and consequent MR imaging (STIR sequence). The spread of the ablative injection material (alcohol-lidocaine mix) was observed by repeating this sequence after the therapeutic injection. Pain scores from seven patients (eight ablations) were used to assess the therapy effect. MR guidance allowed adequate needle positioning and visualization of injection material in all cases. The rest pain scores significantly decreased from 4 (median) at baseline to 1 (median) at 2 weeks (p < 0.05). Average and worst pain experienced during the past week were significantly lower at the 2-week time point compared with the baseline (p < 0.05). However, the intervention did not result in reduction of opioid use at 2 weeks.MR guidance is an accurate and safe method for celiac plexus ablation with positive therapeutic effect.

  10. Nomogram Prediction of Survival and Recurrence in Patients With Extrahepatic Bile Duct Cancer Undergoing Curative Resection Followed by Adjuvant Chemoradiation Therapy

    SciTech Connect (OSTI)

    Song, Changhoon [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Kyubo, E-mail: kyubokim@snu.ac.kr [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Chie, Eui Kyu [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul (Korea, Republic of); Kim, Jin Ho [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jang, Jin-Young; Kim, Sun Whe [Department of Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Han, Sae-Won; Oh, Do-Youn; Im, Seock-Ah; Kim, Tae-You; Bang, Yung-Jue [Department of Internal Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ha, Sung W. [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul (Korea, Republic of)

    2013-11-01

    Purpose: To develop nomograms for predicting the overall survival (OS) and relapse-free survival (RFS) in patients with extrahepatic bile duct cancer undergoing adjuvant chemoradiation therapy after curative resection. Methods and Materials: From January 1995 through August 2006, a total of 166 consecutive patients underwent curative resection followed by adjuvant chemoradiation therapy. Multivariate analysis using Cox proportional hazards regression was performed, and this Cox model was used as the basis for the nomograms of OS and RFS. We calculated concordance indices of the constructed nomograms and American Joint Committee on Cancer (AJCC) staging system. Results: The OS rate at 2 years and 5 years was 60.8% and 42.5%, respectively, and the RFS rate at 2 years and 5 years was 52.5% and 38.2%, respectively. The model containing age, sex, tumor location, histologic differentiation, perineural invasion, and lymph node involvement was selected for nomograms. The bootstrap-corrected concordance index of the nomogram for OS and RFS was 0.63 and 0.62, respectively, and that of AJCC staging for OS and RFS was 0.50 and 0.52, respectively. Conclusions: We developed nomograms that predicted survival and recurrence better than AJCC staging. With caution, clinicians may use these nomograms as an adjunct to or substitute for AJCC staging for predicting an individual's prognosis and offering tailored adjuvant therapy.

  11. SU-E-T-77: Comparison of 2D and 3D Gamma Analysis in Patient-Specific QA for Prostate VMAT Plans

    SciTech Connect (OSTI)

    Clemente, F; Perez, C

    2014-06-01

    Purpose: Patient-specific QA procedures for IMRT and VMAT are traditionally performed by comparing TPS calculations with measured single point values and plane dose distributions by means of gamma analysis. New QA devices permit us to calculate 3D dose distributions on patient anatomy as redundant secondary check and reconstruct it from measurements taken with 2D and 3D detector arrays. 3D dose calculations allow us to perform DVH-based comparisons with clinical relevance, as well as 3D gamma analysis. One of these systems (Compass, IBA Dosimetry) combines traditional 2D with new anatomical-based 3D gamma analysis. This work shows the ability of this system by comparing 2D and 3D gamma analysis in pre-treatment QA for several VMAT prostate plans. Methods: Compass is capable of calculating dose as secondary check from DICOM TPS data and reconstructing it from measurements taken by a 2D ion chamber array (MatriXX Evolution, IBA Dosimetry). Both 2D and 3D gamma tests are available to compare calculated and reconstructed dose in Compass with TPS RT Dose. Results: 15 VMAT prostate plans have been measured with Compass. Dose is reconstructed with Compass for these plans. 2D gamma comparisons can be done for any plane from dose matrix. Mean gamma passing rates for isocenter planes (axial, coronal, sagittal) are (99.70.2)%, (99.90.1)%, (99.90.1)% for reconstructed dose planes. 3D mean gamma passing rates are (98.51.7)% for PTVs, (99.11.5)% for rectum, (100.00.0)% for bladder, (99.60.7)% for femoral heads and (98.14.1)% for penile bulb. Conclusion: Compass is a powerful tool to perform a complete pre-treatment QA analysis, from 2D techniques to 3D DVH-based techniques with clinical relevance. All reported values for VMAT prostate plans are in good agreement with TPS values. This system permits us to ensure the accuracy in the delivery of VMAT treatments completing a full patient-specific QA program.

  12. SU-E-T-256: Optimizing the Combination of Targeted Radionuclide Therapy Agents Using a Multi-Scale Patient-Specific Monte Carlo Dosimetry Platform

    SciTech Connect (OSTI)

    Besemer, A; Bednarz, B; Titz, B; Grudzinski, J; Weichert, J; Hall, L

    2014-06-01

    Purpose: Combination targeted radionuclide therapy (TRT) is appealing because it can potentially exploit different mechanisms of action from multiple radionuclides as well as the variable dose rates due to the different radionuclide half-lives. The work describes the development of a multiobjective optimization algorithm to calculate the optimal ratio of radionuclide injection activities for delivery of combination TRT. Methods: The diapeutic (diagnostic and therapeutic) agent, CLR1404, was used as a proof-of-principle compound in this work. Isosteric iodine substitution in CLR1404 creates a molecular imaging agent when labeled with I-124 or a targeted radiotherapeutic agent when labeled with I-125 or I-131. PET/CT images of high grade glioma patients were acquired at 4.5, 24, and 48 hours post injection of 124I-CLR1404. The therapeutic 131I-CLR1404 and 125ICLR1404 absorbed dose (AD) and biological effective dose (BED) were calculated for each patient using a patient-specific Monte Carlo dosimetry platform. The optimal ratio of injection activities for each radionuclide was calculated with a multi-objective optimization algorithm using the weighted sum method. Objective functions such as the tumor dose heterogeneity and the ratio of the normal tissue to tumor doses were minimized and the relative importance weights of each optimization function were varied. Results: For each optimization function, the program outputs a Pareto surface map representing all possible combinations of radionuclide injection activities so that values that minimize the objective function can be visualized. A Pareto surface map of the weighted sum given a set of user-specified importance weights is also displayed. Additionally, the ratio of optimal injection activities as a function of the all possible importance weights is generated so that the user can select the optimal ratio based on the desired weights. Conclusion: Multi-objective optimization of radionuclide injection activities can provide an invaluable tool for maximizing the dosimetric benefits in multi-radionuclide combination TRT. BT, JG, and JW are affiliated with Cellectar Biosciences which owns the licensing rights to CLR1404 and related compounds.

  13. SU-E-CAMPUS-T-05: Validation of High-Resolution 3D Patient QA for Proton Pencil Beam Scanning and IMPT by Polymer Gel Dosimetry

    SciTech Connect (OSTI)

    Cardin, A; Avery, S; Ding, X; Kassaee, A; Lin, L; Maryanski, M

    2014-06-15

    Purpose: Validation of high-resolution 3D patient QA for proton pencil beam scanning and IMPT by polymer gel dosimetry. Methods: Four BANG3Pro polymer gel dosimeters (manufactured by MGS Research Inc, Madison, CT) were used for patient QA at the Robert's Proton Therapy Center (RPTC, Philadelphia, PA). All dosimeters were sealed in identical thin-wall Pyrex glass spheres. Each dosimeter contained a set of markers for 3D registration purposes. The dosimeters were mounted in a consistent and reproducible manner using a custom build holder. Two proton pencil beam scanning plans were designed using Varian Eclipse treatment planning system: 1) A two-field intensity modulated proton therapy (IMPT) plan and 2) one single field uniform dose (SFUD) plan. The IMPT fields were evaluated as a composite plan and individual fields, the SFUD plan was delivered as a single field plan.Laser CT scanning was performed using the manufacturer's OCTOPUS-IQ axial transmission laser CT scanner using a 1 mm slice thickness. 3D registration, analysis, and OD/cm to absorbed dose calibrations were perfomed using DICOM RT-Dose and CT files, and software developed by the manufacturer. 3D delta index, a metric equivalent to the gamma tool, was used for dose comparison. Results: Very good agreement with single IMPT fields and with SFUD was obtained. Composite IMPT fields had a less satisfactory agreement. The single fields had 3D delta index passing rates (3% dose difference, 3 mm DTA) of 98.98% and 94.91%. The composite 3D delta index passing rate was 80.80%. The SFUD passing rate was 93.77%. Required shifts of the dose distributions were less than 4 mm. Conclusion: A formulation of the BANG3Pro polymer gel dosimeter, suitable for 3D QA of proton patient plans is established and validated. Likewise, the mailed QA analysis service provided by the manufacturer is a practical option when required resources are unavailable. We fully disclose that the subject of this research regards a production of MGS Research, Inc.

  14. SU-E-J-160: Comparing the Setup Accuracy of Non-Ionizing Patient Localization Systems with CBCT to Reduce Imaging Dose in Prone Breast Treatments

    SciTech Connect (OSTI)

    Chung, E; Yamamoto, T; Mayadev, J; Dieterich, S

    2014-06-01

    Purpose: CBCT is the current gold standard to verify prone breast patient setup. We investigated in a phantom if non-ionizing localization systems can replace ionizing localization systems for prone breast treatments. Methods: An anthropomorphic phantom was positioned on a prone breast board. Electromagnetic transponders were attached on the left chest surface. The CT images of the phantom were imported to the treatment planning system. The isocenter was set to the center of the transponders. The positions of the isocenter and transponders transferred to the transponder tracking system. The posterior phantom surface was contoured and exported to the optical surface tracking system. A CBCT was taken for the initial setup alignment on the treatment machine. Using the electromagnetic and optical localization systems, the deviation of the phantom setup from the original CT images was measured. This was compared with the difference between the original CT and kV-CBCT images. Results: For the electromagnetic localization system, the phantom position deviated from the original CT in 1.5 mm, 0.0 mm and 0.5 mm in the anterior-posterior (AP), superior-inferior (SI) and left-right (LR) directions. For the optical localization system, the phantom position deviated from the original CT in 2.0 mm, ?2.0 mm and 0.1 mm in the AP, SI and LR directions. For the CBCT, the phantom position deviated from the original CT in 4.0 mm, 1.0 mm and ?1.0 mm in the AP, SI and LR directions. The measured values from the non-ionizing localization systems differed from those with the CBCT less than 3.0 mm in all directions. Conclusions: This phantom study showed the feasibility of using a combination of non-ionizing localization systems to achieve a similar setup accuracy as CBCT for prone breast patients. This could potentially eliminate imaging dose. As a next step, we are expanding this study to actual patients. This work has been in part supported by Departmental Research Award RODEPT1-JS001, Department of Radiation Oncology, UC Davis Medical Center.

  15. A method to synchronize signals from multiple patient monitoring devices through a single input channel for inclusion in list-mode acquisitions

    SciTech Connect (OSTI)

    OConnor, J. Michael; Pretorius, P. Hendrik; Johnson, Karen; King, Michael A.

    2013-12-15

    Purpose: This technical note documents a method that the authors developed for combining a signal to synchronize a patient-monitoring device with a second physiological signal for inclusion into list-mode acquisition. Our specific application requires synchronizing an external patient motion-tracking system with a medical imaging system by multiplexing the tracking input with the ECG input. The authors believe that their methodology can be adapted for use in a variety of medical imaging modalities including single photon emission computed tomography (SPECT) and positron emission tomography (PET). Methods: The authors insert a unique pulse sequence into a single physiological input channel. This sequence is then recorded in the list-mode acquisition along with the R-wave pulse used for ECG gating. The specific form of our pulse sequence allows for recognition of the time point being synchronized even when portions of the pulse sequence are lost due to collisions with R-wave pulses. This was achieved by altering our software used in binning the list-mode data to recognize even a portion of our pulse sequence. Limitations on heart rates at which our pulse sequence could be reliably detected were investigated by simulating the mixing of the two signals as a function of heart rate and time point during the cardiac cycle at which our pulse sequence is mixed with the cardiac signal. Results: The authors have successfully achieved accurate temporal synchronization of our motion-tracking system with acquisition of SPECT projections used in 17 recent clinical research cases. In our simulation analysis the authors determined that synchronization to enable compensation for body and respiratory motion could be achieved for heart rates up to 125 beats-per-minute (bpm). Conclusions: Synchronization of list-mode acquisition with external patient monitoring devices such as those employed in motion-tracking can reliably be achieved using a simple method that can be implemented using minimal external hardware and software modification through a single input channel, while still recording cardiac gating signals.

  16. SU-E-T-532: Validation and Implementation of Model-Based Patient Specific Quality Assurance Using Mobius3D and MobiusFX in a Clinical Setting

    SciTech Connect (OSTI)

    Galavis, P; Osterman, K; Jozsef, G; Becker, S; Dewyngaert, K

    2014-06-01

    Purpose: This work carries out the commissioning and validation of the Mobius3D and MobiusFX software tools, which can replace the time-consuming measurement-based patient specific quality assurance (PSQA). Methods: The beam model supplied by Mobius3D was validated against a 21EX linac's beam measured data. Complex patient (VMAT) plans using Eclipse treatment planning system (TPS) was used to test the consistency between Mobius3D (calculates dose using patient image and field data) and MobiusFx (calculates dose using treatment dynalog files). Dose difference and gamma analysis (3%/3mm) between Mobius3D and MobiusFx were used to assess treatment plan and treatment delivery consistency. An end-to-end test was performed to validate Mobius3D and MobiusFx against ion chamber measurements. Effect of the dosimetric leaf gap (DLG) on Mobius3D dose calculation was additionally investigated. Results: Mobius3D beam model parameters matched within 1%-3% with our beam measured data. A comparison of Mobius3D and MobiusFx dose matrices for VMAT planned prostate cases showed (0.330.07)% mean dose difference with gamma values above 95%. The end-to-end test showed dose differences of 1% between Mobius3D and MobiusFx. Dependence of Mobius3D dose calculation upon DLG was explored by introducing a 0.5 mm change in the default value for DLG. This change resulted in agreement differences above 2% Conclusion: Use of reference beam data would appear to speed up commissioning process for the clinical implementation of Mobius3D. However, careful consideration is required when comparing the information provided by the software, since large dose variations can be seen when the proper parameters are not optimized. The plan and delivered dose were in good agreement; hence MobiusFx has the potential to significantly speed up the PSQA process and at the same time helps to verify treatment parameters that are not possible with measurement-based PSQA.

  17. Modeling the Risk of Radiation-Induced Acute Esophagitis for Combined Washington University and RTOG Trial 93-11 Lung Cancer Patients

    SciTech Connect (OSTI)

    Huang, Ellen X.; Bradley, Jeffrey D.; El Naqa, Issam [Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO (United States); Hope, Andrew J.; Lindsay, Patricia E. [Princess Margaret Hospital, Toronto, ON (Canada); Bosch, Walter R.; Matthews, John W. [Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO (United States); Sause, William T. [Department of Radiation Oncology, LDS Hospital, Salt Lake City, UT (United States); Graham, Mary V. [Department of Radiation Oncology, Phelps County Regional Hospital, Rolla, MO (United States); Deasy, Joseph O., E-mail: deasyj@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-04-01

    Purpose: To construct a maximally predictive model of the risk of severe acute esophagitis (AE) for patients who receive definitive radiation therapy (RT) for non-small-cell lung cancer. Methods and Materials: The dataset includes Washington University and RTOG 93-11 clinical trial data (events/patients: 120/374, WUSTL = 101/237, RTOG9311 = 19/137). Statistical model building was performed based on dosimetric and clinical parameters (patient age, sex, weight loss, pretreatment chemotherapy, concurrent chemotherapy, fraction size). A wide range of dose-volume parameters were extracted from dearchived treatment plans, including Dx, Vx, MOHx (mean of hottest x% volume), MOCx (mean of coldest x% volume), and gEUD (generalized equivalent uniform dose) values. Results: The most significant single parameters for predicting acute esophagitis (RTOG Grade 2 or greater) were MOH85, mean esophagus dose (MED), and V30. A superior-inferior weighted dose-center position was derived but not found to be significant. Fraction size was found to be significant on univariate logistic analysis (Spearman R = 0.421, p < 0.00001) but not multivariate logistic modeling. Cross-validation model building was used to determine that an optimal model size needed only two parameters (MOH85 and concurrent chemotherapy, robustly selected on bootstrap model-rebuilding). Mean esophagus dose (MED) is preferred instead of MOH85, as it gives nearly the same statistical performance and is easier to compute. AE risk is given as a logistic function of (0.0688 Asterisk-Operator MED+1.50 Asterisk-Operator ConChemo-3.13), where MED is in Gy and ConChemo is either 1 (yes) if concurrent chemotherapy was given, or 0 (no). This model correlates to the observed risk of AE with a Spearman coefficient of 0.629 (p < 0.000001). Conclusions: Multivariate statistical model building with cross-validation suggests that a two-variable logistic model based on mean dose and the use of concurrent chemotherapy robustly predicts acute esophagitis risk in combined-data WUSTL and RTOG 93-11 trial datasets.

  18. SU-C-18A-05: Registration Accuracy of MR-Based Images to On-Board Megavoltage Cone-Beam CT for Brain Patient Setup

    SciTech Connect (OSTI)

    Pinnaduwage, D S; Chen, J; Descovich, M; Pouliot, J; Hwang, Ken-Ping

    2014-06-01

    Purpose: To quantify the difference in isocenter shifts when co-registering MR and MR-based pseudo CTs (pCT) with on-board megavoltage conebeam CT (CBCT) images. Methods: Fast Spoiled Gradient Echo MRs were used to generate pCTs (research version of Advantage Sim MD, GE Healthcare) for ten patients who had prior brain radiotherapy. The planning CT (rCT) for each was co-registered with the MR, and the plan isocenter and two other reference points were transferred to the MR and pCT. CBCT images (with the machine isocenter) from a single treatment day were coregistered with the 3 test images (MR, pCT and rCT), by two observers and by an automated registration algorithm. The reference points were used to calculate patient shifts and rotations from the registrations. The shifts calculated from the test image registrations were compared to each other and to the shifts performed by the therapists who treated the patients on that day. Results: The average difference in absolute value between the isocenter shifts from the MR-, pCT- and rCT-CBCT registrations, and the therapist shifts, were 2.02, 3.01 and 0.89 mm (craniocaudal), 1.14, 1.34 and 0.46 mm (lateral), and 1.37, 3.43 and 1.43 mm (vertical), respectively. The MR- and pCT-CBCT registrations differed by 1.99, and 2.53 mm (craniocaudal), 1.36, and 1.37 mm (lateral), and 0.74 and 2.34 mm (vertical), respectively, from the average rCT-CBCT shifts. On average, differences of 2.39 (craniocaudal), 1.28 (lateral) and 2.84 mm (vertical) were seen between the MR and pCT shifts. Rotations relative to the CBCT coordinate system were on average <2 for the MR and rCT, and <6 for the pCT. Conclusion: In this study, FSPGR MR-CBCT registrations were more precise compared to the pCT-CBCT registrations. For improved accuracy, MR sequences that are optimal for bony anatomy visualization are necessary. GE healthcare has provided a research version of Advantage Sim MD to UCSF. No financial support was provided.

  19. TU-C-BRE-06: Effect of Implementing In-House Treatment Couch Model On Patient Specific QA for Pinnacle SmartArc Treatment Plans

    SciTech Connect (OSTI)

    Ellis, A; Jacqmin, D; McDonald, D; Peng, J; Koch, N; Ashenafi, M; Vanek, K

    2014-06-15

    Purpose: Failure to model the treatment couch during VMAT QA planar dose calculation may Result in discrepancies between measured and calculated dose. These discrepancies are due to beam attenuation by the treatment couch that is not included in dose calculation. This work evaluates effects of accounting for this attenuation on patient specific VMAT QA results using an in-house created Varian Exact couch model in Pinnacl Methods: Patient specific VMAT QA results for 13 Pinnacle SmartArc plans generated for treatment on a Varian iX accelerator were studied. These plans included 3 treatment sites (7 H'N, 5 brain, 1 prostate). A Pinnacle model for Varian Exact couch was created in-house to replace the CT simulator couch. Composite arc planar doses were calculated with no couch present (NC) and with the Exact couch model (CM) in place for each plan. QA measurements were taken using IBA Matrixx Evolution ion chamber array set up in IBA MultiCube and were compared to each planar dose. Gamma passing criteria of both 3%/3mm and 2%/2mm tolerances were used. Results: Over all treatment sites, increases in gamma passing rates from NC to CM ranged from -0.4% to +27.3% at 3%/3mm and +0.1% to +30.5% at 2%/2mm. Mean increases in passing rates were +3.7% and +5.3% for 3%/3mm and 2%/2mm tolerances, respectively. Site-specific mean increases (NC to CM) in gamma passing rates were +4.4%, +3.4%, +0.4% (3%/3mm tolerance) and +6.9%, +3.7%, and +2.9% at (2%/2mm tolerance) for H'N, brain, and prostate, respectively. Conclusion: Results support use of a couch model when generating planar dose for patient specific VMAT QA analysis. The improvements were most noticeable at 2%/2mm tolerance and for the H'N and brain sites. Eliminating treatment couch beam attenuation as a source of discrepancy in QA measurements may improve the ability to recognize otherwise masked delivered dose errors.

  20. Low p53 Binding Protein 1 (53BP1) Expression Is Associated With Increased Local Recurrence in Breast Cancer Patients Treated With Breast-Conserving Surgery and Radiotherapy

    SciTech Connect (OSTI)

    Neboori, Hanmanth J.R.; Haffty, Bruce G.; Wu Hao; Yang Qifeng; Aly, Amal; Goyal, Sharad; Schiff, Devora; Moran, Meena S.; Golhar, Ryan; Chen Chunxia; Moore, Dirk; and others

    2012-08-01

    Purpose: To investigate whether the expression of p53 binding protein 1 (53BP1) has prognostic significance in a cohort of early-stage breast cancer patients treated with breast-conserving surgery and radiotherapy (BCS+RT). Methods and Materials: A tissue microarray of early-stage breast cancer treated with BCS+RT from a cohort of 514 women was assayed for 53BP1, estrogen receptor, progesterone receptor, and HER2 expression by immunohistochemistry. Through log-rank tests and univariate and multivariate models, the staining profile of each tumor was correlated with clinical endpoints, including ipsilateral breast recurrence-free survival (IBRFS), distant metastasis-free survival (DMFS), cause-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS). Results: Of the 477 (93%) evaluable tumors, 63 (13%) were scored as low. Low expression of 53BP1 was associated with worse outcomes for all endpoints studied, including 10-year IBRFS (76.8% vs. 90.5%; P=.01), OS (66.4% vs. 81.7%; P=.02), CSS (66.0% vs. 87.4%; P<.01), DMFS (55.9% vs. 87.0%; P<.01), and RFS (45.2% vs. 80.6%; P<.01). Multivariate analysis incorporating various clinico-pathologic markers and 53BP1 expression found that 53BP1 expression was again an independent predictor of all endpoints (IBRFS: P=.0254; OS: P=.0094; CSS: P=.0033; DMFS: P=.0006; RFS: P=.0002). Low 53BP1 expression was also found to correlate with triple-negative (TN) phenotype (P<.01). Furthermore, in subset analysis of all TN breast cancer, negative 53BP1 expression trended for lower IBRFS (72.3% vs. 93.9%; P=.0361) and was significant for worse DMFS (48.2% vs. 86.8%; P=.0035) and RFS (37.8% vs. 83.7%; P=.0014). Conclusion: Our data indicate that low 53BP1 expression is an independent prognostic indicator for local relapse among other endpoints in early-stage breast cancer and TN breast cancer patients treated with BCS+RT. These results should be verified in larger cohorts of patients to validate their clinical significance.

  1. BLIND DETECTIONS OF CO J = 1-0 IN 11 H-ATLAS GALAXIES AT z = 2.1-3.5 WITH THE GBT/ZPECTROMETER

    SciTech Connect (OSTI)

    Harris, A. I.; Baker, A. J.; Frayer, D. T.; Smail, Ian; Swinbank, A. M.; Riechers, D. A.; Van der Werf, P. P.; Auld, R.; Dariush, A.; Eales, S.; Baes, M.; Bussmann, R. S.; Buttiglione, S.; De Zotti, G.; Cava, A.; Clements, D. L.; Cooray, A.; Dannerbauer, H.; Dunne, L.; Dye, S. E-mail: ajbaker@physics.rutgers.edu; and others

    2012-06-20

    We report measurements of the carbon monoxide ground state rotational transition ({sup 12}C{sup 16}O J = 1-0) with the Zpectrometer ultrawideband spectrometer on the 100 m diameter Green Bank Telescope. The sample comprises 11 galaxies with redshifts between z = 2.1 and 3.5 from a total sample of 24 targets identified by Herschel-ATLAS photometric colors from the SPIRE instrument. Nine of the CO measurements are new redshift determinations, substantially adding to the number of detections of galaxies with rest-frame peak submillimeter emission near 100 {mu}m. The CO detections confirm the existence of massive gas reservoirs within these luminous dusty star-forming galaxies (DSFGs). The CO redshift distribution of the 350 {mu}m selected galaxies is strikingly similar to the optical redshifts of 850 {mu}m-selected submillimeter galaxies in 2.1 {<=} z {<=} 3.5. Spectroscopic redshifts break a temperature-redshift degeneracy; optically thin dust models fit to the far-infrared photometry indicate characteristic dust temperatures near 34 K for most of the galaxies we detect in CO. Detections of two warmer galaxies, and statistically significant nondetections, hint at warmer or molecule-poor DSFGs with redshifts that are difficult to determine from Herschel-SPIRE photometric colors alone. Many of the galaxies identified by H-ATLAS photometry are expected to be amplified by foreground gravitational lenses. Analysis of CO linewidths and luminosities provides a method for finding approximate gravitational lens magnifications {mu} from spectroscopic data alone, yielding {mu} {approx} 3-20. Corrected for magnification, most galaxy luminosities are consistent with an ultraluminous infrared galaxy classification, but three are candidate hyper-LIRGs with luminosities greater than 10{sup 13} L{sub Sun }.

  2. Prospective Randomized Double-Blind Pilot Study of Site-Specific Consensus Atlas Implementation for Rectal Cancer Target Volume Delineation in the Cooperative Group Setting

    SciTech Connect (OSTI)

    Fuller, Clifton D.; Nijkamp, Jasper; Duppen, Joop C.; Rasch, Coen R.N.; Thomas, Charles R.; Wang, Samuel J.; Okunieff, Paul; Jones, William E.; Baseman, Daniel; Patel, Shilpen; Demandante, Carlo G.N.; Harris, Anna M.; Smith, Benjamin D.; Katz, Alan W.; McGann, Camille

    2011-02-01

    Purpose: Variations in target volume delineation represent a significant hurdle in clinical trials involving conformal radiotherapy. We sought to determine the effect of a consensus guideline-based visual atlas on contouring the target volumes. Methods and Materials: A representative case was contoured (Scan 1) by 14 physician observers and a reference expert with and without target volume delineation instructions derived from a proposed rectal cancer clinical trial involving conformal radiotherapy. The gross tumor volume (GTV), and two clinical target volumes (CTVA, including the internal iliac, presacral, and perirectal nodes, and CTVB, which included the external iliac nodes) were contoured. The observers were randomly assigned to receipt (Group A) or nonreceipt (Group B) of a consensus guideline and atlas for anorectal cancers and then instructed to recontour the same case/images (Scan 2). Observer variation was analyzed volumetrically using the conformation number (CN, where CN = 1 equals total agreement). Results: Of 14 evaluable contour sets (1 expert and 7 Group A and 6 Group B observers), greater agreement was found for the GTV (mean CN, 0.75) than for the CTVs (mean CN, 0.46-0.65). Atlas exposure for Group A led to significantly increased interobserver agreement for CTVA (mean initial CN, 0.68, after atlas use, 0.76; p = .03) and increased agreement with the expert reference (initial mean CN, 0.58; after atlas use, 0.69; p = .02). For the GTV and CTVB, neither the interobserver nor the expert agreement was altered after atlas exposure. Conclusion: Consensus guideline atlas implementation resulted in a detectable difference in interobserver agreement and a greater approximation of expert volumes for the CTVA but not for the GTV or CTVB in the specified case. Visual atlas inclusion should be considered as a feature in future clinical trials incorporating conformal RT.

  3. Transforming Growth Factor ?-1 (TGF-?1) Is a Serum Biomarker of Radiation Induced Fibrosis in Patients Treated With Intracavitary Accelerated Partial Breast Irradiation: Preliminary Results of a Prospective Study

    SciTech Connect (OSTI)

    Boothe, Dustin L.; Coplowitz, Shana; Greenwood, Eleni; Barney, Christian L.; Christos, Paul J.; Parashar, Bhupesh; Nori, Dattatreyudu; Chao, K. S. Clifford; Wernicke, A. Gabriella

    2013-12-01

    Purpose: To examine a relationship between serum transforming growth factor ? -1 (TGF-?1) values and radiation-induced fibrosis (RIF). Methods and Materials: We conducted a prospective analysis of the development of RIF in 39 women with American Joint Committee on Cancer stage 0-I breast cancer treated with lumpectomy and accelerated partial breast irradiation via intracavitary brachytherapy (IBAPBI). An enzyme-linked immunoassay (Quantikine, R and D, Minneapolis, MN) was used to measure serum TGF-?1 before surgery, before IBAPBI, and during IBAPBI. Blood samples for TGF-?1 were also collected from 15 healthy, nontreated women (controls). The previously validated tissue compliance meter (TCM) was used to objectively assess RIF. Results: The median time to follow-up for 39 patients was 44 months (range, 5-59 months). RIF was graded by the TCM scale as 0, 1, 2, and 3 in 5 of 20 patients (25%), 6 of 20 patients (30%), 5 of 20 patients (25%), and 4 of 20 patients (20%), respectively. The mean serum TGF-?1 values were significantly higher in patients before surgery than in disease-free controls, as follows: all cancer patients (30,201 5889 pg/mL, P=.02); patients with any type of RIF (32,273 5016 pg/mL, P<.0001); and women with moderate to severe RIF (34,462 4713 pg/mL, P<0.0001). Patients with moderate to severe RIF had significantly elevated TGF-?1 levels when compared with those with none to mild RIF before surgery (P=.0014) during IBAPBI (P?0001), and the elevation persisted at 6 months (P?.001), 12 months (P?.001), 18 months (P?.001), and 24 months (P=.12). A receiver operating characteristic (ROC) curve of TGF-?1 values predicting moderate to severe RIF was generated with an area under the curve (AUC){sub ROC} of 0.867 (95% confidence interval 0.700-1.000). The TGF-?1 threshold cutoff was determined to be 31,000 pg/mL, with associated sensitivity and specificity of 77.8% and 90.0%, respectively. Conclusions: TGF-?1 levels correlate with the development of moderate to severe RIF. The pre-IBAPBI mean TGF-?1 levels can serve as an early biomarker for the development of moderate to severe RIF after IBAPBI.

  4. The Role of Postmastectomy Radiation Therapy After Neoadjuvant Chemotherapy in Clinical Stage II-III Breast Cancer Patients With pN0: A Multicenter, Retrospective Study (KROG 12-05)

    SciTech Connect (OSTI)

    Shim, Su Jung; Park, Won; Huh, Seung Jae; Choi, Doo Ho; Shin, Kyung Hwan; Lee, Nam Kwon; Suh, Chang-Ok; Keum, Ki Chang; Kim, Yong Bae; Ahn, Seung Do; Kim, Su Ssan; Ha, Sung W.; Chie, Eui Kyu; Kim, Kyubo; Shin, Hyun Soo; Kim, Jin Hee; Lee, Hyung-Sik

    2014-01-01

    Purpose: The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. Methods and Materials: We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the logrank test and Cox proportional regression analysis. Results: Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (?40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (?40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. Conclusions: PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.

  5. Fine localization of the locus for autosomal dominant retinitis pigmentosa on chromosome 17p

    SciTech Connect (OSTI)

    Goliath, R.; Janssens, P.; Beighton, P.

    1995-10-01

    The term {open_quotes}retintis pigmentosa{close_quotes} (RP) refers to a group of inherited retinal degenerative disorders. Clinical manifestations include night-blindness, with variable age of onset, followed by constriction of the visual field that may progress to total loss of sight in later life. Previous studies have shown that RP is caused by mutations within different genes and may be inherited as an X-linked recessive (XLRRP), autosomal recessive (ARRP), or autosomal dominant (ADRP) trait. The AD form of this group of conditions has been found to be caused by mutations within the rhodopsin gene in some families and the peripherin/RDS gene in others. In addition, some ADRP families have been found to be linked to anonymous markers on 8cen, 7p, 7q,19q, and, more recently, 17p. The ADRP gene locus on the short arm of chromosome 17 was identified in a large South African family (ADRP-SA) of British origin. The phenotypic expression of the disorder, which has been described elsewhere is consistent in the pedigree with an early onset of disease symptoms. In all affected subjects in the family, onset of symptoms commenced before the age of 10 years. 16 refs., 3 figs., 1 tab.

  6. Science and Technology Review October/November 2009

    SciTech Connect (OSTI)

    Bearinger, J P

    2009-08-21

    This month's issue has the following articles: (1) Award-Winning Collaborations Provide Solutions--Commentary by Steven D. Liedle; (2) Light-Speed Spectral Analysis of a Laser Pulse--An optical device inspects and stops potentially damaging laser pulses; (3) Capturing Waveforms in a Quadrillionth of a Second--The femtoscope, a time microscope, improves the temporal resolution and dynamic range of conventional recording instruments; (4) Gamma-Ray Spectroscopy in the Palm of Your Hand--A miniature gamma-ray spectrometer provides increased resolution at a reduced cost; (5) Building Fusion Targets with Precision Robotics--A robotic system assembles tiny fusion targets with nanometer precision; (6) ROSE: Making Compiler Technology More Accessible--An open-source software infrastructure makes powerful compiler techniques available to all programmers; (7) Restoring Sight to the Blind with an Artificial Retina--A retinal prosthesis could restore vision to people suffering from eye diseases; (8) Eradicating the Aftermath of War--A remotely operated system precisely locates buried land mines; (9) Compact Alignment for Diagnostic Laser Beams--A smaller, less expensive device aligns diagnostic laser beams onto targets; and (10) Securing Radiological Sources in Africa--Livermore and other national laboratories are helping African countries secure their nuclear materials.

  7. Tumor Volume Combined With Number of Positive Lymph Node Stations Is a More Important Prognostic Factor Than TNM Stage for Survival of Non-Small-Cell Lung Cancer Patients Treated With (Chemo)radiotherapy

    SciTech Connect (OSTI)

    Dehing-Oberije, Cary [Department of Radiotherapy, University Hospital Maastricht, University Maastricht, MAASTRO Clinic, Research Institute Growth and Development (GROW), Maastricht (Netherlands)], E-mail: cary.dehing@maastro.nl; Ruysscher, Dirk de; Weide, Hiska van der [Department of Radiotherapy, University Hospital Maastricht, University Maastricht, MAASTRO Clinic, Research Institute Growth and Development (GROW), Maastricht (Netherlands); Hochstenbag, Monique [Department of Pulmonology, University Hospital Maastricht, Maastricht (Netherlands); Bootsma, Gerben [Department of Pulmonology, Atrium Medical Centre, Heerlen (Netherlands); Geraedts, Wiel [Department of Pulmonology, Maasland Hospital, Sittard (Netherlands); Pitz, Cordula [Department of Pulmonology, Laurentius Hospital, Roermond (Netherlands); Simons, Jean [Department of Pulmonology, Sint Jans Hospital, Weert (Netherlands); Teule, Jaap [Department of Nuclear Medicine, University Hospital Maastricht, Maastricht (Netherlands); Rahmy, Ali [Department of Nuclear Medicine, Atrium Medical Centre, Heerlen (Netherlands); Thimister, Paul [Department of Nuclear Medicine, Maasland Hospital, Sittard (Netherlands); Steck, Harald [Siemens Medical Solutions, Malvern, PA (United States); Lambin, Philippe [Department of Radiotherapy, University Hospital Maastricht, University Maastricht, MAASTRO Clinic, Research Institute Growth and Development (GROW), Maastricht (Netherlands)

    2008-03-15

    Purpose: The current tumor, node, metastasis system needs refinement to improve its ability to predict survival of patients with non-small-cell lung cancer (NSCLC) treated with (chemo)radiation. In this study, we investigated the prognostic value of tumor volume and N status, assessed by using fluorodeoxyglucose-positron emission tomography (PET). Patients and Methods: Clinical data from 270 consecutive patients with inoperable NSCLC Stages I-IIIB treated radically with (chemo)radiation were collected retrospectively. Diagnostic imaging was performed using either integrated PET-computed tomography or computed tomography and PET separately. The Kaplan-Meier method, as well as Cox regression, was used to analyze data. Results: Univariate survival analysis showed that number of positive lymph node stations (PLNSs), as well as N stage on PET, was associated significantly with survival. The final multivariate Cox model consisted of number of PLNSs, gross tumor volume (i.e., volume of the primary tumor plus lymph nodes), sex, World Health Organization performance status, and equivalent radiation dose corrected for time; N stage was no longer significant. Conclusions: Number of PLNSs, assessed by means of fluorodeoxyglucose-PET, was a significant factor for survival of patients with inoperable NSCLC treated with (chemo)radiation. Risk stratification for this group of patients should be based on gross tumor volume, number of PLNSs, sex, World Health Organization performance status, and equivalent radiation dose corrected for time.

  8. Human monoclonal antibodies derived from a patient infected with 2009 pandemic influenza A virus broadly cross-neutralize group 1 influenza viruses

    SciTech Connect (OSTI)

    Pan, Yang; Sasaki, Tadahiro; Du, Anariwa; and others

    2014-07-18

    Highlights: Influenza infection can elicit heterosubtypic antibodies to group 1 influenza virus. Three human monoclonal antibodies were generated from an H1N1-infected patient. The antibodies predominantly recognized ?-helical stem of viral hemagglutinin (HA). The antibodies inhibited HA structural activation during the fusion process. The antibodies are potential candidates for future antibody therapy to influenza. - Abstract: Influenza viruses are a continuous threat to human public health because of their ability to evolve rapidly through genetic drift and reassortment. Three human monoclonal antibodies (HuMAbs) were generated in this study, 1H11, 2H5 and 5G2, and they cross-neutralize a diverse range of group 1 influenza A viruses, including seasonal H1N1, 2009 pandemic H1N1 (H1N1pdm) and avian H5N1 and H9N2. The three HuMAbs were prepared by fusing peripheral blood lymphocytes from an H1N1pdm-infected patient with a newly developed fusion partner cell line, SPYMEG. All the HuMAbs had little hemagglutination inhibition activity but had strong membrane-fusion inhibition activity against influenza viruses. A protease digestion assay showed the HuMAbs targeted commonly a short ?-helix region in the stalk of the hemagglutinin. Furthermore, Ile45Phe and Glu47Gly double substitutions in the ?-helix region made the HA unrecognizable by the HuMAbs. These two amino acid residues are highly conserved in the HAs of H1N1, H5N1 and H9N2 viruses. The HuMAbs reported here may be potential candidates for the development of therapeutic antibodies against group 1 influenza viruses.

  9. SU-E-T-570: Management of Radiation Oncology Patients with Cochlear Implant and Other Bionic Devices in the Brain and Head and Neck Regions

    SciTech Connect (OSTI)

    Guo, F.Q; Chen, Z; Nath, R

    2014-06-01

    Purpose: To investigate the current status of clinical usage of cochlear implant (CI) and other bionic devices (BD) in the brain and head and neck regions (BH and N) and their management in patients during radiotherapy to ensure patient health and safety as well as optimum radiation delivery. Methods: Literature review was performed with both CIs and radiotherapy and their variants as keywords in PubMed, INSPEC and other sources. The focus was on CIs during radiotherapy, but it also included other BDs in BHȦN, such as auditory brainstem implant, bionic retinal implant, and hearing aids, among others. Results: Interactions between CIs and radiation may cause CIs malfunction. The presence of CIs may also cause suboptimum dose distribution if a treatment plan was not well designed. A few studies were performed for the hearing functions of CIs under irradiations of 4 MV and 6 MV x-rays. However, x-rays with higher energies (10 to 18 MV) broadly used in radiotherapy have not been explored. These higher energetic beams are more damaging to electronics due to strong penetrating power and also due to neutrons generated in the treatment process. Modern CIs are designed with more and more complicated integrated circuits, which may be more susceptible to radiation damage and malfunction. Therefore, careful management is important for safety and treatment outcomes. Conclusion: Although AAPM TG-34, TG-63, and TG-203 (update of TG-34, not published yet) reports may be referenced for management of CIs and other BDs in the brain and H and N regions, a site- and device-specified guideline should be developed for CIs and other BDs. Additional evaluation of CI functions under clinically relevant set-ups should also be performed to provide clinicians with better knowledge in clinical decision making.

  10. NSIGHTS V.2.50

    Energy Science and Technology Software Center (OSTI)

    001667IBMPC01 n-dimensional Statistical Inverse Graphical Hydraulic Test Simulator https://github.com/nsights/nSIGHTS

  11. SU-E-T-198: Hippocampal-Sparing Radiotherapy (HSRT) for Patients with Head and Neck Cancer (HNC) Using Intensity-Modulated Radiation Therapy (IMRT)

    SciTech Connect (OSTI)

    Dunlop, A; Welsh, L; Nutting, C; Harrington, K; Bhide, S; Newbold, K

    2014-06-01

    Purpose: There is increasing evidence that decline in cognitive function following brain radiotherapy (RT) is related to the radiation dose delivered to the hippocampi. In this work we evaluate the feasibility of using IMRT to generate HSRT plans in HNC. Methods: A planning study was undertaken for ten representative patients with HNC previously treated with radical (chemo)-RT using standard IMRT techniques. The hippocampi were delineated according to the RTOG hippocampal contouring atlas, on a T1w- MRI scan that was registered with the RT planning CT. LINAC-based, clinically acceptable, HSRT plans were generated and assessed using the Pinnacle3 treatment planning system. Results: Using a VMAT technique, a reduction in hippocampal dose was achievable in six cases. For these cases, the EQD2-D40% of the bilateral hippocampi was significantly reduced by HSRT (p = 0.006) from a median of 18.8Gy (range 14.4–34.6) to 6.5 Gy (4.2–9.5) for the delivered and HSRT plans respectively. Plans were also generated using a fixed-field IMRT technique with non-coplanar beams that were designed to avoid the bilateral hippocampi, resulting in a median EQD2-D40% of 11.2Gy (8.0–14.5). Both HSRT techniques also resulted in lower doses to the whole brain, brain stem, and cerebellum. The HSRT plans resulted in higher doses to some regions of non-contoured normaltissue, but the magnitude of these dose differences is unlikely to be of clinical significance in terms of acute and late toxicity. Conclusion: This study has demonstrated that it is possible, in many cases, to adapt treatment plans for HNC to significantly reduce dose to the hippocampi. This reduction in dose would be predicted to Resultin a significant reduction in the probability of subsequent decline in cognitive function following RT. Our results point towards the need for the collection of prospective data on cognitive outcomes for the HNC patient population treated with radical (chemo)-RT.

  12. SU-E-J-243: Possibility of Exposure Dose Reduction of Cone-Beam Computed Tomography in An Image Guided Patient Positioning System by Using Various Noise Suppression Filters

    SciTech Connect (OSTI)

    Kamezawa, H; Arimura, H; Ohki, M; Shirieda, K; Kameda, N

    2014-06-01

    Purpose: To investigate the possibility of exposure dose reduction of the cone-beam computed tomography (CBCT) in an image guided patient positioning system by using 6 noise suppression filters. Methods: First, a reference dose (RD) and low-dose (LD)-CBCT (X-ray volume imaging system, Elekta Co.) images were acquired with a reference dose of 86.2 mGy (weighted CT dose index: CTDIw) and various low doses of 1.4 to 43.1 mGy, respectively. Second, an automated rigid registration for three axes was performed for estimating setup errors between a planning CT image and the LD-CBCT images, which were processed by 6 noise suppression filters, i.e., averaging filter (AF), median filter (MF), Gaussian filter (GF), bilateral filter (BF), edge preserving smoothing filter (EPF) and adaptive partial median filter (AMF). Third, residual errors representing the patient positioning accuracy were calculated as an Euclidean distance between the setup error vectors estimated using the LD-CBCT image and RD-CBCT image. Finally, the relationships between the residual error and CTDIw were obtained for 6 noise suppression filters, and then the CTDIw for LD-CBCT images processed by the noise suppression filters were measured at the same residual error, which was obtained with the RD-CBCT. This approach was applied to an anthropomorphic pelvic phantom and two cancer patients. Results: For the phantom, the exposure dose could be reduced from 61% (GF) to 78% (AMF) by applying the noise suppression filters to the CBCT images. The exposure dose in a prostate cancer case could be reduced from 8% (AF) to 61% (AMF), and the exposure dose in a lung cancer case could be reduced from 9% (AF) to 37% (AMF). Conclusion: Using noise suppression filters, particularly an adaptive partial median filter, could be feasible to decrease the additional exposure dose to patients in image guided patient positioning systems.

  13. Poster Thur Eve 62: A Retrospective Assessment of the Prevalence and Dosimetric Effect of Lateral Electron Disequilibrium in a Population of Lung Cancer Patients Treated by Stereotactic Body Radiation Therapy

    SciTech Connect (OSTI)

    Disher, Brandon; Wade, Laura; Hajdok, George; Gaede, Stewart; Battista, Jerry J.; Palma, David

    2014-08-15

    Stereotactic Body Radiation Therapy (SBRT) is a treatment option for early stage non-small cell lung cancer (NSCLC). SBRT uses tightly conformed megavoltage (MV) x-ray beams to ablate the tumour. However, small MV x-ray fields may produce lateral electron disequilibrium (LED) within lung tissue, which can reduce the dose to tumour. The goal of this work is to estimate the prevalence of LED in NSCLC patients treated with SBRT, and determine dose effects for patients prone or averse to LED. Thirty NSCLC patients were randomly selected for analysis. 4-dimensional CT lung images were segmented into the right and left upper and lower lobes (RUL, RLL, LUL, LLL), and the right middle lobe. Dose calculations were performed using volume-modulated arc therapy in the Pinnacle{sup 3} TPS. Most tumours were located in the upper lobes (RUL 53%, LUL 27%) where density was significantly lower (RUL ?80846 HU vs. RLL ?74371 HU; LUL ?808 56 HU vs. LLL ?74670 HU; p<0.001). In general, the prevalence of LED increased with higher beam energy. Using 6MV photons, patients with a RUL tumour experienced moderate (81 %), and mild (19%) levels of LED. At 18MV, LED became more prominent with severe (50%) and moderate (50%) LED exhibited. Dosimetrically, for patients prone to LED, poorer target coverage (i.e. increased R100 by 20%) and improved lung sparing (i.e. reduced V20 by ?46%) was observed. The common location of lung cancers in the upper lobes, coupled with lower lung density, results in the potential occurrence of LED, which may underdose the tumour.

  14. Evaluation of Single Nucleotide Polymorphisms (SNPs) in the p53 Binding Protein 1 (TP53BP1) Gene in Breast Cancer Patients Treated With Breast-Conserving Surgery and Whole-Breast Irradiation (BCS + RT)

    SciTech Connect (OSTI)

    Haffty, Bruce G.; Goyal, Sharad; Kulkarni, Diptee; Green, Camille; Vazquez, Alexi; Schiff, Devora; Moran, Meena S.; Yang Qifeng; Ganesan, Shridar; Hirsfield, Kim M.

    2011-06-01

    Purpose: TP53BP1 is a key component of radiation-induced deoxyribonucleic acid damage repair. The purpose of this study was to evaluate the significance of a known common single nucleotide polymorphism in this gene (rs560191) in patients treated with breast-conserving surgery and whole-breast irradiation (BCS + RT). Methods and Materials: The population consisted of 176 premenopausal women treated with BCS + RT (median follow-up, 12 years). Genomic deoxyribonucleic acid was processed by use of TaqMan assays. Each allele for rs560191 was either C or G, so each patient was therefore classified as CC, CG, or GG. Patients were grouped as GG if they were homozygous for the variant G allele or CC-CG if they carried at least one copy of the common C allele (CC or CG). Results: Of the 176 women, 124 (71%) were CC-CG and 52 (29%) were GG. The mean age was 44 years for GG vs. 38 years for CC-CG (p < 0.001). GG was more common in African-American women than white women (69% vs. 13%, p < 0.001) and more commonly estrogen receptor negative (70% vs. 49%, p = 0.02). There were no significant correlations of rs560191 with other critical variables. Despite the fact that GG patients were older, the 10-year rate of local relapses was higher (22% for GG vs. 12% for CC-CG, p = 0.04). Conclusions: This novel avenue of investigation of polymorphisms in radiation repair/response genes in patients treated with BCS + RT suggests a correlation to local relapse. Additional evaluation is needed to assess the biological and functional significance of these single nucleotide polymorphisms, and larger confirmatory validation studies will be required to determine the clinical implications.

  15. SU-E-T-145: Effects of Temporary Tachytherapy Inhibition Magnet On MOSFET Dose Measurements of Cardiovascular Implantable Electronic Devices (CIED) in Radiation Therapy Patients

    SciTech Connect (OSTI)

    P, Joshi; Salomons, G; Kerr, A; Peters, C; Lalonde, M

    2014-06-01

    Purpose: To determine the effects of temporary tachytherapy inhibition magnet on MOSFET dose measurements of cardiovascular implantable electronic devices (CIED) in radiation therapy patients. Methods: Infield and peripheral MOSFET dose measurements with 6MV photon beams were performed to evaluate dose to a CIED in the presence of a doughnut shaped temporary tachytherapy inhibition magnet. Infield measurements were done to quantify the effects of the magnetic field alone and shielding by the magnet. MOSFETs were placed inside a 2020cm{sup 2} field at a depth of 3cm in the isocentre plane in the presence and absence of the magnet. Peripheral dose measurements were done to determine the impact of the magnet on dose to the CIED in a clinical setting. These measurements were performed at the centre, under the rim and half way between a 1010cm{sup 2} field edge and the magnet with MOSFETS placed at the surface, 0.5cm and 1cm depths in the presence and absence of the magnet. Results: Infield measurements showed that effects of magnetic field on the MOSFET readings were within the 2% MOSFET dose measurement uncertainty; a 20% attenuation of dose under the magnet rim was observed. Peripheral dose measurements at the centre of the magnet show an 8% increase in surface dose and a 6% decrease in dose at 1cm depth. Dose under the magnet rim was reduced by approximately 68%, 45% and 25% for MOSFET placed at 0.0, 0.5 and 1.0cm bolus depths, respectively. Conclusions: The magnetic field has an insignificant effect on MOSFET dose measurements. Dose to the central region of CIED represented by centre of the magnet doughnut increases at the surface, and decreases at depths due to low energy scattering contributions from the magnet. Dose under the magnet rim, representing CIED edges, decreased significantly due to shielding.

  16. WE-G-17A-07: Investigation of the Influence of the Electron Return Effect (ERE) On the Dose Distribution in Rectal Cancer Patients On a 1.5T MR-Linac

    SciTech Connect (OSTI)

    Uilkema, S; Heide, U; Nijkamp, J; Sonke, J; Moreau, M

    2014-06-15

    Purpose: The purpose of this planning study is to investigate the influence of the ERE on the day-to-day dose distribution in rectal cancer patients, where changes in gas-pockets frequently occur. Methods: Daily CT scans of 5 patients treated neo-adjuvant with 5x5Gy for rectal cancer were used. We optimized two plans on the planning CT (Monaco, 1 mm3 dosegrid), a conventional 7-field 6MV IMRT plan (Dconv) and a plan in the presence of a 1.5T field (Dmrl). We recalculated the plans on all repeat-CT scans and evaluated under/over-dosage of the daily CTVs. Changes of more than 1% were considered significant. In the bowel area, we investigated the relative dose changes due to the ERE, where the contribution of the ERE was separated from other effects such as attenuation. Results: Both plans were comparable and compliant with ICRU 62 for all patients. For 2 fractions in one patient under-dosage in the CTV was significant, due to a disappearing gas-pocket. Here the V95 was 96.82 and 97.36% in in Dmrl compared to 98.85 and 98.66% in Dconv, respectively. For 3 fractions in another patient appearing gas-pockets resulted in significant over-dosage of the CTV. In these fractions the V107 was 1.882.68% in Dmrl compared to 0.331.27% in Dconv. In the bowel area the dose changes attributable to the ERE were approximately 5% in 1cc, at low dose levels. Conclusion: We were able to calculate acceptable treatment plans with and without a magnetic field. The ERE was present in the Dmrl, but the volumetric effect within the CTV was limited. Outside the CTV relative dose differences were similar, but on small volumes at lower, less relevant dose levels. This suggests that there is no clinical relevant ERE on dose distributions in rectal cancer patients on a 1.5T MR-Linac.

  17. SU-E-J-97: Pretreatment Test and Post-Treatment Evaluation for Iso-NTCP Dose Guided Adapive Radiotherapy (DGART), Experience with Prostate Cancer Patients Treated with Rectal Balloons

    SciTech Connect (OSTI)

    Yu, J; Hardcastle, N; Bender, E; Jeong, K; Tome', M

    2014-06-01

    Purpose: To explore the feasibility of pretreatment test for iso-NTCP DGART and to compare the pretreatment test results with post-treatment evaluations. Methods: NTCP here refers to late rectal wall toxicity only and is calculated with the ring rectal wall DVH. Simulation for one time iso- NTCP DGART starts after half of the total dose was done for 10 patients to investigate if TCP gains could be achieved. Six patients were treated using a 12-fraction 4.3Gy technique and four using 16-fraction 3.63Gy technique. For each of the 12-fraction cases a VMAT plan was generated in Pinnacle3 using the daily CT obtained prior to the 6th fraction. A pretreatment simulation was performed using only the first 6 daily CTs. The idea is to add the 6 original plan delivered doses with 6 DGART plan delivered doses by deformable dose accumulation (DDA) on each of the first 6 CTs, resulting in 6 rectal wall doses (RWDs) and NTCPs. The 95% confidence interval (95%CI) for the 6 NTCPs were computed.The posttreatment evaluation was done by: a) copy the DGART plan to 6 CTs for fraction 712 and calculate the 6 actual DGART delivered fractional doses; b) sum the 6 actual DGART doses with the 6 original plan delivered doses by DDA on each of the 12 CTs resulting in 12 post-treatment RWDs and NTCPs; c) boxplot the 12 post-treatment NTCPs. Results: Target dose gain is 0.761.93 Gy. The 95%CI widths of the pretreatment tests NTCPs were 1.12.7%. For 5 patients, the planned NTCP fell within the 95%CI. For 4 patients, the planned NTCP was lower than the 95%CI lines. Post-treatment results show that for 7 patients, the upper quartile was within the 95%CI; for 2 patients, the upper quartile were higher than the 95%CI. Conclusion: The pretreatment test yields conservative prediction of the actual delivered NTCP.

  18. The effect of head size/shape, miscentering, and bowtie filter on peak patient tissue doses from modern brain perfusion 256-slice CT: How can we minimize the risk for deterministic effects?

    SciTech Connect (OSTI)

    Perisinakis, Kostas; Seimenis, Ioannis; Tzedakis, Antonis; Papadakis, Antonios E.; Damilakis, John

    2013-01-15

    Purpose: To determine patient-specific absorbed peak doses to skin, eye lens, brain parenchyma, and cranial red bone marrow (RBM) of adult individuals subjected to low-dose brain perfusion CT studies on a 256-slice CT scanner, and investigate the effect of patient head size/shape, head position during the examination and bowtie filter used on peak tissue doses. Methods: The peak doses to eye lens, skin, brain, and RBM were measured in 106 individual-specific adult head phantoms subjected to the standard low-dose brain perfusion CT on a 256-slice CT scanner using a novel Monte Carlo simulation software dedicated for patient CT dosimetry. Peak tissue doses were compared to corresponding thresholds for induction of cataract, erythema, cerebrovascular disease, and depression of hematopoiesis, respectively. The effects of patient head size/shape, head position during acquisition and bowtie filter used on resulting peak patient tissue doses were investigated. The effect of eye-lens position in the scanned head region was also investigated. The effect of miscentering and use of narrow bowtie filter on image quality was assessed. Results: The mean peak doses to eye lens, skin, brain, and RBM were found to be 124, 120, 95, and 163 mGy, respectively. The effect of patient head size and shape on peak tissue doses was found to be minimal since maximum differences were less than 7%. Patient head miscentering and bowtie filter selection were found to have a considerable effect on peak tissue doses. The peak eye-lens dose saving achieved by elevating head by 4 cm with respect to isocenter and using a narrow wedge filter was found to approach 50%. When the eye lies outside of the primarily irradiated head region, the dose to eye lens was found to drop to less than 20% of the corresponding dose measured when the eye lens was located in the middle of the x-ray beam. Positioning head phantom off-isocenter by 4 cm and employing a narrow wedge filter results in a moderate reduction of signal-to-noise ratio mainly to the peripheral region of the phantom. Conclusions: Despite typical peak doses to skin, eye lens, brain, and RBM from the standard low-dose brain perfusion 256-slice CT protocol are well below the corresponding thresholds for the induction of erythema, cataract, cerebrovascular disease, and depression of hematopoiesis, respectively, every effort should be made toward optimization of the procedure and minimization of dose received by these tissues. The current study provides evidence that the use of the narrower bowtie filter available may considerably reduce peak absorbed dose to all above radiosensitive tissues with minimal deterioration in image quality. Considerable reduction in peak eye-lens dose may also be achieved by positioning patient head center a few centimeters above isocenter during the exposure.

  19. Neointimal Hyperplasia after Silverhawk Atherectomy versus Percutaneous Transluminal Angioplasty (PTA) in Femoropopliteal Stent Reobstructions: A Controlled, Randomized Pilot Trial

    SciTech Connect (OSTI)

    Brodmann, Marianne Rief, Peter; Froehlich, Harald; Dorr, Andreas; Gary, Thomas; Eller, Philipp; Hafner, Franz; Deutschmann, Hannes; Seinost, Gerald; Pilger, Ernst

    2013-02-15

    Due to intimal hyperplasia instent reobstruction in the femoropopliteal arterial segment is still an unsolved problem. Different techniques have been discussed in case of reintervention to guarantee longlasting patency rate. We conducted a randomized, controlled, pilot trial comparing Silverhawk atherectomy with percutaneous transluminal angioplasty (PTA) in patients with a first instent reobstruction in the femoropopliteal arterial segment, to evaluate intima media thickness (IMT) within the treated segment, as a parameter of recurrence of intimal hyperplasia. In a total 19 patients were included: 9 patients in the atherectomy device and 10 patients in the PTA arm. IMT within the treated segment was statistically significantly elevated in all patients treated with the Silverhawk device versus the patients treated with PTA. The obvious differentiation in elevation of IMT in nonfavor for patients treated with the Silverhawk device started at month 2 (max IMT SH 0.178 mm vs. IMT PTA 0.1 mm, p = 0.001) with a spike at month 5 (max IMT SH 0.206 mm vs. IMT PTA 0.145 mm, p = 0.003) and a decline once again at month 6 (max IMT SH 0.177 mm vs. IMT PTA 0.121 mm, p = 0.02). The values for mean IMT performed the same way. Although Silverhawk atherectomy provides good results at first sight, in the midterm follow-up of treatment of first instent restenosis it did not perform better than PTA as it showed elevated reoccurrence of intimal media hyperplasia.

  20. SU-E-P-06: A Novel Hybrid Planning Approach to Allow More Patients Benefited by the Intensity Modulated Proton Therapy

    SciTech Connect (OSTI)

    Jiang, S; Liao, L; Li, Y; Wang, X; Sahoo, N; Liao, Z; Grosshans, D; Frank, S; Li, H; Zhu, X; Chang, J; Zhang, X; Gillin, M; Hojo, Y; Sun, J

    2014-06-01

    Purpose: We report a hybrid scattering and scanning beam delivery approach, termed as (HimpsPT), which demonstrated that majority IMPT delivery can be potentially replaced with hybrid IMPT and PSPT delivery with similar or better plan quality. Methods: Three representative clinical cases, including head and neck (HN), skull base chordoma (CNS) and lung cancer, treated in MDACC Proton Therapy Center with IMPT were retrospectively redesigned using HimpsPT. The PSPT plans are designed with the same prescriptions as those of IMPT plans. The whole treatment can be delivered by either alternating or sequential PSPT and IMPT delivery. The dosimetric data and dose distributions of HimpsPT plans are compared with those of IMPT plans. We also performed a worst-case robust analysis for all plans. Results: The target coverages for all cases are comparable. For the HN case, the mean dose of esophagus larynx, left parotid and right submandibular, oral cavity V20, the max dose of cord is 18.0, 36.1, 23.6, 47.2, 0.1, 31.7 Gy in HimpsPT plan, and 25.5, 33.8, 24.9, 49.1, 0.2, 33.8 Gy in IMPT plan. For the lung case, the lung V5, V20, V30, mean lung dose, heart V40, esophagus V70, cord maximum dose are 50.5%, 37.0%, 31.7%, 21.3 Gy, 7.2%, 4.9%, 35.5 Gy in HimpsPT plan, and 55.4%, 36.7%, 30.1%, 21.3 Gy, 7.7%, 8.4%, 36.8Gy in IMPT plans. For the CNS case, brainstem maximum dose is 50.5 Gy in HimpsPT plan and 55.4 Gy in IMPT plan due to sharp penumbra offered by the aperture of the PSPT plan in HimpsPT technique. Conclusion: For majority disease sites, the dosimetric advantage of IMPT technique can be achieved by the hybrid PSPT and IMPT technique, which enables the centers equipped with both scattering and scanning beam facilities to treat more patients which can be benefited by the scanning beam.

  1. Acute Normal Tissue Reactions in Head-and-Neck Cancer Patients Treated With IMRT: Influence of Dose and Association With Genetic Polymorphisms in DNA DSB Repair Genes

    SciTech Connect (OSTI)

    Werbrouck, Joke Ruyck, Kim de; Duprez, Frederic; Veldeman, Liv; Claes, Kathleen; Eijkeren, Marc van; Boterberg, Tom; Willems, Petra; Vral, Anne; Neve, Wilfried de; Thierens, Hubert

    2009-03-15

    Purpose: To investigate the association between dose-related parameters and polymorphisms in DNA DSB repair genes XRCC3 (c.-1843A>G, c.562-14A>G, c.722C>T), Rad51 (c.-3429G>C, c.-3392G>T), Lig4 (c.26C>T, c.1704T>C), Ku70 (c.-1310C>G), and Ku80 (c.2110-2408G>A) and the occurrence of acute reactions after radiotherapy. Materials and Methods: The study population consisted of 88 intensity-modulated radiation therapy (IMRT)-treated head-and-neck cancer patients. Mucositis, dermatitis, and dysphagia were scored using the Common Terminology Criteria (CTC) for Adverse Events v.3.0 scale. The population was divided into a CTC0-2 and CTC3+ group for the analysis of each acute effect. The influence of the dose on critical structures was analyzed using dose-volume histograms. Genotypes were determined by polymerase chain reaction (PCR) combined with restriction fragment length polymorphism or PCR-single base extension assays. Results: The mean dose (D{sub mean}) to the oral cavity and constrictor pharyngeus (PC) muscles was significantly associated with the development of mucositis and dysphagia, respectively. These parameters were considered confounding factors in the radiogenomics analyses. The XRCC3c.722CT/TT and Ku70c.-1310CG/GG genotypes were significantly associated with the development of severe dysphagia (CTC3+). No association was found between the investigated polymorphisms and the development of mucositis or dermatitis. A risk analysis model for severe dysphagia, which was developed based on the XRCC3c.722CT/TT and Ku70c.-1310CG/GG genotypes and the PC dose, showed a sensitivity of 78.6% and a specificity of 77.6%. Conclusions: The XRCC3c.722C>T and Ku70c.-1310C>G polymorphisms as well as the D{sub mean} to the PC muscles were highly associated with the development of severe dysphagia after IMRT. The prediction model developed using these parameters showed a high sensitivity and specificity.

  2. TU-F-BRE-07: In Vivo Neutron Detection in Patients Undergoing Stereotactic Ablative Radiotherapy (SABR) for Primary Kidney Cancer Using 6Li and 7Li Enriched TLD Pairs

    SciTech Connect (OSTI)

    Lonski, P; Kron, T; Franich, R; Keehan, S; Siva, S; Taylor, M

    2014-06-15

    Purpose: Stereotactic ablative radiotherapy (SABR) for primary kidney cancer often involves the use of high-energy photons combined with a large number of monitor units. While important for risk assessment, the additional neutron dose to untargeted healthy tissue is not accounted for in treatment planning. This work aims to detect out-of-field neutrons in vivo for patients undergoing SABR with high-energy (>10 MV) photons and provides preliminary estimates of neutron effective dose. Methods: 3 variations of high-sensitivity LiF:Mg,Cu,P thermoluminescent dosimeter (TLD) material, each with varying {sup 6}Li / {sup 7}Li concentrations, were used in custom-made Perspex holders for in vivo measurements. The variation in cross section for thermal neutrons between Li isotopes was exploited to distinguish neutron from photon signal. Measurements were made out-of-field for 7 patients, each undergoing 3D-conformal SABR treatment for primary kidney cancer on a Varian 21iX linear accelerator. Results: In vivo measurements show increased signal for the {sup 6}Li enriched material for patients treated with 18 MV photons. Measurements on one SABR patient treated using only 6 MV showed no difference between the 3 TLD materials. The out-of-field photon signal decreased exponentially with distance from the treatment field. The neutron signal, taken as the difference between {sup 6}Li enriched and {sup 7}Li enriched TLD response, remains almost constant up to 50 cm from the beam central axis. Estimates of neutron effective dose from preliminary TLD calibration suggest between 10 and 30 mSv per 1000 MU delivered at 18 MV for the 7 patients. Conclusion: TLD was proven to be a useful tool for the purpose of in vivo neutron detection at out-of-field locations. Further work is required to understand the relationship between TL signal and neutron dose. Dose estimates based on preliminary TLD calibration in a neutron beam suggest the additional neutron dose was <30 mSv per 1000 MU at 18 MV.

  3. Commissioning of a proton gantry equipped with dual x-ray imagers and a robotic patient positioner, and evaluation of the accuracy of single-beam image registration for this system

    SciTech Connect (OSTI)

    Wang, Ning; Ghebremedhin, Abiel; Patyal, Baldev

    2015-06-15

    Purpose: To check the accuracy of a gantry equipped with dual x-ray imagers and a robotic patient positioner for proton radiotherapy, and to evaluate the accuracy and feasibility of single-beam registration using the robotic positioner. Methods: One of the proton treatment rooms at their institution was upgraded to include a robotic patient positioner (couch) with 6 degrees of freedom and dual orthogonal kilovoltage x-ray imaging panels. The wander of the proton beam central axis, the wander of the beamline, and the orthogonal image panel crosswires from the gantry isocenter were measured for different gantry angles. The couch movement accuracy and couch wander from the gantry isocenter were measured for couch loadings of 50300 lb with couch rotations from 0 to 90. The combined accuracy of the gantry, couch, and imagers was checked using a custom-made 30 30 30 cm{sup 3} Styrofoam phantom with beekleys embedded in it. A treatment in this room can be set up and registered at a setup field location, then moved precisely to any other treatment location without requiring additional image registration. The accuracy of the single-beam registration strategy was checked for treatments containing multiple beams with different combinations of gantry angles, couch yaws, and beam locations. Results: The proton beam central axis wander from the gantry isocenter was within 0.5 mm with gantry rotations in both clockwise (CW) and counterclockwise (CCW) directions. The maximum wander of the beamline and orthogonal imager crosswire centers from the gantry isocenter were within 0.5 and 0.8 mm, respectively, with the gantry rotations in CW and CCW directions. Vertical and horizontal couch wanders from the gantry isocenter were within 0.4 and 1.3 mm, respectively, for couch yaw from 0 to 90. For a treatment with multiple beams with different gantry angles, couch yaws, and beam locations, the measured displacements of treatment beam locations from the one based on the initial setup beam registered at the gantry at 0/180 and couch yaw at 0 were within 1.5 mm in three translations and 0.5 in three rotations for a 200 lb couch loading. Conclusions: Results demonstrate that the gantry equipped with a robotic patient positioner and dual imaging panels satisfies treatment requirements for proton radiotherapy. The combined accuracy of the gantry, couch, and imagers allows a patient to be registered at one setup position and then moved precisely to another treatment position by commanding the robotic patient positioner and delivering treatment without requiring additional image registration.

  4. A case report of motor neuron disease in a patient showing significant level of DDTs, HCHs and organophosphate metabolites in hair as well as levels of hexane and toluene in blood

    SciTech Connect (OSTI)

    Kanavouras, Konstantinos; Tzatzarakis, Manolis N.; Mastorodemos, Vasileios; Plaitakis, Andreas; Tsatsakis, Aristidis M.

    2011-11-15

    Motor neuron disease is a devastating neurodegenerative condition, with the majority of sporadic, non-familial cases being of unknown etiology. Several epidemiological studies have suggested that occupational exposure to chemicals may be associated with disease pathogenesis. We report the case of a patient developing progressive motor neuron disease, who was chronically exposed to pesticides and organic solvents. The patient presented with leg spasticity and developed gradually clinical signs suggestive of amyotrophic lateral sclerosis, which was supported by the neurophysiologic and radiological findings. Our report is an evidence based case of combined exposure to organochlorine (DDTs), organophosphate pesticides (OPs) and organic solvents as confirmed by laboratory analysis in samples of blood and hair confirming systematic exposure. The concentration of non-specific dialkylphosphates metabolites (DAPs) of OPs in hair (dimethyphopshate (DMP) 1289.4 pg/mg and diethylphosphate (DEP) 709.4 pg/mg) and of DDTs (opDDE 484.0 pg/mg, ppDDE 526.6 pg/mg, opDDD 448.4 pg/mg, ppDDD + opDDT 259.9 pg/mg and ppDDT 573.7 pg/mg) were considerably significant. Toluene and n-hexane were also detected in blood on admission at hospital and quantified (1.23 and 0.87 {mu}g/l, respectively), while 3 months after hospitalization blood testing was found negative for toluene and n-hexane and hair analysis was provided decrease levels of HCHs, DDTs and DAPs. -- Highlights: Black-Right-Pointing-Pointer Exposure to pesticides and organic solvents might be a risk factor for sporadic MND. Black-Right-Pointing-Pointer We report a patient who developed progressive upper and lower motor neuron disease. Black-Right-Pointing-Pointer The patient had a history of occupational exposure to pesticides and solvents. Black-Right-Pointing-Pointer High DDTs' levels and increased levels of DMP and DEP were measured in his hair. Black-Right-Pointing-Pointer The patients' exposure to chemicals might have played a role in MND development.

  5. SU-E-T-79: Comparison of Doses Received by the Hippocampus in Patients Treated with Single Vs Multiple Isocenter Based Stereotactic Radiation Therapy to the Brain for Multiple Brain Metastases

    SciTech Connect (OSTI)

    Algan, O; Giem, J; Young, J; Ali, I; Ahmad, S; Hossain, S

    2014-06-01

    Purpose: To investigate the doses received by the hippocampus and normal brain tissue during a course of stereotactic radiotherapy utilizing a single isocenter (SI) versus multiple isocenter (MI) in patients with multiple intracranial metastases. Methods: Seven patients imaged with MRI including SPGR sequence and diagnosed with 2–3 brain metastases were included in this retrospective study. Two sets of stereotactic IMRT treatment plans, (MI vs SI), were generated. The hippocampus was contoured on SPGR sequences and doses received by the hippocampus and whole brain were calculated. The prescribed dose was 25Gy in 5 fractions. The two groups were compared using t-test analysis. Results: There were 17 lesions in 7 patients. The median tumor, right hippocampus, left hippocampus and brain volumes were: 3.37cc, 2.56cc, 3.28cc, and 1417cc respectively. In comparing the two treatment plans, there was no difference in the PTV coverage except in the tail of the DVH curve. All tumors had V95 > 99.5%. The only statistically significant parameter was the V100 (72% vs 45%, p=0.002, favoring MI). All other evaluated parameters including the V95 and V98 did not reveal any statistically significant differences. None of the evaluated dosimetric parameters for the hippocampus (V100, V80, V60, V40, V20, V10, D100, D90, D70, D50, D30, D10) revealed any statistically significant differences (all p-values > 0.31) between MI and SI plans. The total brain dose was slightly higher in the SI plans, especially in the lower dose regions, although this difference was not statistically significant. Utilizing brain-sub-PTV volumes did not change these results. Conclusion: The use of SI treatment planning for patients with up to 3 brain metastases produces similar PTV coverage and similar normal tissue doses to the hippocampus and the brain compared to MI plans. SI treatment planning should be considered in patients with multiple brain metastases undergoing stereotactic treatment.

  6. Volume-Based Parameters of {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Improve Disease Recurrence Prediction in Postmastectomy Breast Cancer Patients With 1 to 3 Positive Axillary Lymph Nodes

    SciTech Connect (OSTI)

    Nakajima, Naomi; Kataoka, Masaaki; Sugawara, Yoshifumi; Ochi, Takashi; Kiyoto, Sachiko; Ohsumi, Shozo; Mochizuki, Teruhito

    2013-11-15

    Purpose: To determine whether volume-based parameters on pretreatment {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography in breast cancer patients treated with mastectomy without adjuvant radiation therapy are predictive of recurrence. Methods and Materials: We retrospectively analyzed 93 patients with 1 to 3 positive axillary nodes after surgery, who were studied with {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography for initial staging. We evaluated the relationship between positron emission tomography parameters, including the maximum standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and clinical outcomes. Results: The median follow-up duration was 45 months. Recurrence was observed in 11 patients. Metabolic tumor volume and TLG were significantly related to tumor size, number of involved nodes, nodal ratio, nuclear grade, estrogen receptor (ER) status, and triple negativity (TN) (all P values were <.05). In receiver operating characteristic curve analysis, MTV and TLG showed better predictive performance than tumor size, ER status, or TN (area under the curve: 0.85, 0.86, 0.79, 0.74, and 0.74, respectively). On multivariate analysis, MTV was an independent prognostic factor of locoregional recurrence-free survival (hazard ratio 34.42, 95% confidence interval 3.94-882.71, P=.0008) and disease-free survival (DFS) (hazard ratio 13.92, 95% confidence interval 2.65-103.78, P=.0018). The 3-year DFS rate was 93.8% for the lower MTV group (<53.1; n=85) and 25.0% for the higher MTV group (?53.1; n=8; P<.0001, logrank test). The 3-year DFS rate for patients with both ER-positive status and MTV <53.1 was 98.2%; and for those with ER-negative status and MTV ?53.1 it was 25.0% (P<.0001). Conclusions: Volume-based parameters improve recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive nodes. The addition of MTV to ER status or TN has potential benefits to identify a subgroup at higher risk for recurrence.

  7. On June 21, 2011, the HASQARD Focus Group approved the following...

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    PERFORMANCE EVALUATION ASSESSMENTS Performance evaluations are generally considered blind or double-blind tests introduced into a process to provide an independent evaluation...

  8. SU-E-T-632: A Dosimetric Comparison of the 3D-CRT Planning of Chest Wall in Post-Mastectomy Breast Cancer Patients, with and Without Breast Board Setup

    SciTech Connect (OSTI)

    Muzaffar, Ambreen; Masood, Asif; Ullah, Haseeb; Mehmood, Kashif; Qasim, Uzma; Afridi, M. Ali; Khan, Salim; Hameed, Abdul

    2014-06-15

    Purpose: Breast boards are used in breast radiation which increases normal lung and heart doses, when supraclavicular field is included. Therefore, in this study through dose volume histogram (DVHs), lung and heart doses comparison was done between two different setups i.e. with and without breast board, for the treatment of left chest wall and supraclavicular fossa in postmastectomy left breast cancer. Methods: In this study, CT-Simulation scans of ten breast cancer patients were done with and without breast board, at Shifa International Hospitals Islamabad, to investigate the differences between the two different setups of the irradiation of left chest wall in terms of lung and heart doses. For immobilization, support under the neck, shoulders and arms was used. Precise PLAN 2.15 treatment planning system (TPS) was used for 3D-CRT planning. The total prescribed dose for both the plans was 5000 cGy/25 fractions. The chest wall was treated with a pair of tangential photon fields and the upper supraclavicular nodal regions were treated with an anterior photon field. A mono-isocentric technique was used to match the tangential fields with the anterior field at the isocentre. The dose volume histogram was used to compare the doses of heart and ipsilateral lung. Results: Both the plans of each patient were generated and compared. DVH results showed that for the same PTV dose coverage, plans without breast board resulted in a reduction of lung and heart doses compared with the plans with breast board. There was significant reductions in V20, V<25 and mean doses for lung and V<9 and mean doses for heart. Conclusion: In comparison of both the plans, setup without breast board significantly reduced the dose-volume of the ipsilateral lung and heart in left chest wall patients. Waived registration request has been submitted.

  9. Five-Year Analysis of Treatment Efficacy and Cosmesis by the American Society of Breast Surgeons MammoSite Breast Brachytherapy Registry Trial in Patients Treated With Accelerated Partial Breast Irradiation

    SciTech Connect (OSTI)

    Vicini, Frank; Beitsch, Peter; Quiet, Coral; Gittleman, Mark; Zannis, Vic; Fine, Ricky; Whitworth, Pat; Kuerer, Henry; Haffty, Bruce; Lyden, Maureen

    2011-03-01

    Purpose: To present 5-year data on treatment efficacy, cosmetic results, and toxicities for patients enrolled on the American Society of Breast Surgeons MammoSite breast brachytherapy registry trial. Methods and Materials: A total of 1440 patients (1449 cases) with early-stage breast cancer receiving breast-conserving therapy were treated with the MammoSite device to deliver accelerated partial-breast irradiation (APBI) (34 Gy in 3.4-Gy fractions). Of 1449 cases, 1255 (87%) had invasive breast cancer (IBC) (median size, 10 mm) and 194 (13%) had ductal carcinoma in situ (DCIS) (median size, 8 mm). Median follow-up was 54 months. Results: Thirty-seven cases (2.6%) developed an ipsilateral breast tumor recurrence (IBTR), for a 5-year actuarial rate of 3.80% (3.86% for IBC and 3.39% for DCIS). Negative estrogen receptor status (p = 0.0011) was the only clinical, pathologic, or treatment-related variable associated with IBTR for patients with IBC and young age (<50 years; p = 0.0096) and positive margin status (p = 0.0126) in those with DCIS. The percentage of breasts with good/excellent cosmetic results at 60 months (n = 371) was 90.6%. Symptomatic breast seromas were reported in 13.0% of cases, and 2.3% developed fat necrosis. A subset analysis of the first 400 consecutive cases enrolled was performed (352 with IBC, 48 DCIS). With a median follow-up of 60.5 months, the 5-year actuarial rate of IBTR was 3.04%. Conclusion: Treatment efficacy, cosmesis, and toxicity 5 years after treatment with APBI using the MammoSite device are good and similar to those reported with other forms of APBI with similar follow-up.

  10. The Dept. of Energy Artificial Retina project

    ScienceCinema (OSTI)

    None

    2010-09-01

    LLNL has assisted in the development of the first long-term retinal prosthesis - called an artificial retina - that can function for years inside the harsh biological environment of the eye. This work has been done in collaboration with four national laboratories (Argonne, Los Alamos, Oak Ridge and Sandia), four universities (the California Institute of Technology, the Doheny Eye Institute at USC, North Carolina State University and the University of California, Santa Cruz), an industrial partner (Second Sight® Medical Products Inc. of Sylmar, Calif.) and the U.S. Department of Energy. With this device, application-specific integrated circuits transform digital images from a camera into electric signals in the eye that the brain uses to create a visual image. In clinical trials, patients with vision loss were able to successfully identify objects, increase mobility and detect movement using the artificial retina.

  11. A SPECTROSCOPIC SEARCH FOR LEAKING LYMAN CONTINUUM AT z {approx} 0.7

    SciTech Connect (OSTI)

    Bridge, Carrie R.; Siana, Brian; Salvato, Mara; Rudie, Gwen C.; Teplitz, Harry I.; Scarlata, Claudia; Colbert, James; Armus, Lee; Conselice, Christopher J.; Ferguson, Henry C.; Brown, Thomas M.; Giavalisco, Mauro; De Mello, Duilia F.; Gardner, Jonathan P.

    2010-09-01

    We present the results of rest-frame, UV slitless spectroscopic observations of a sample of 32 z {approx} 0.7 Lyman break galaxy (LBG) analogs in the COSMOS field. The spectroscopic search was performed with the Solar Blind Channel on the Hubble Space Telescope. We report the detection of leaking Lyman continuum (LyC) radiation from an active galactic nucleus-starburst composite. While we find no direct detections of LyC emission in the remainder of our sample, we achieve individual lower limits (3{sigma}) of the observed non-ionizing UV-to-LyC flux density ratios, f{sub {nu}} (1500 A)/f{sub {nu}}(830 A) of 20 to 204 (median of 73.5) and 378.7 for the stack. Assuming an intrinsic Lyman break of 3.4 and an intergalactic medium transmission of LyC photons along the line of sight to the galaxy of 85%, we report an upper limit for the relative escape fraction in individual galaxies of 0.02-0.19 and a stacked 3{sigma} upper limit of 0.01. We find no indication of a relative escape fraction near unity as seen in some LBGs at z {approx} 3. Our UV spectra achieve the deepest limits to date at any redshift for the escape fraction in individual sources. The contrast between these z {approx} 0.7 low escape fraction LBG analogs with z {approx} 3 LBGs suggests that either the processes conducive to high f{sub esc} are not being selected for in the z {approx}< 1 samples or the average escape fraction is decreasing from z {approx} 3 to z {approx} 1. We discuss possible mechanisms that could affect the escape of LyC photons.

  12. A permanent breast seed implant as partial breast radiation therapy for early-stage patients: A comparison of palladium-103 and iodine-125 isotopes based on radiation safety considerations

    SciTech Connect (OSTI)

    Keller, Brian; Sankreacha, Raxa; Rakovitch, Eileen; O'Brien, Peter; Pignol, Jean-Philippe . E-mail: Jean-Philippe.Pignol@sw.ca

    2005-06-01

    Purpose: A permanent breast seed implant (PBSI) technique has been developed as a new form of partial adjuvant radiation therapy for early-stage breast cancer. This study compares iodine-125 ({sup 125}I) and palladium-103 ({sup 103}Pd) isotopes by examining the exposure and effective dose (ED) to a patient's partner.Methods and Materials: A low-energy survey meter was used to measure exposure rates as a function of bolus thickness placed over {sup 103}Pd or {sup 125}I seeds. A general mathematical expression for the initial exposure rate at 1 m (x{sub o,1m}) from the skin surface as a function of the implant size, R, and the distance between the skin surface and the implant, d, was derived. Also, a second general equation is proposed to calculate the ED to the patient's partner.Results: The initial exposure rate at 1 meter and the ED are calculated as follows: x{sub o,1m} = (3{alpha})/2R{sup 3}{center_dot}{beta}{sup 3} [e{sup -{beta}}{sup (2R+d)}({beta}R + 1) + e{sup -{beta}}{sup {center_dot}}{sup d}({beta}R - 1)], and ED = aR{sup b} {center_dot} [e{sup -c(2R+d)} {center_dot} (cR + 1) + e{sup -cd} -bar (cR - 1)]. For {sup 125}I, the parameters are: {alpha} = 0.154409, {beta} = 0.388460, a = 197, b = -0.95, and c = 0.38846. For {sup 103}Pd, they are: {alpha} = 0.06877, {beta} = 0.421098, a = 18.6, b -0.78, and c = 0.421098. For implant diameters varying from 2 to 6 cm and skin-to-implant distances varying from 0.7 to 4 cm, the ED is consistently below 2.6 mSv using the {sup 103}Pd isotope, but more than 5 mSv in many instances and possibly up to 20 mSv using {sup 125}I.Conclusions: PBSI using {sup 103}Pd seeds appears safe because the patient's partner ED is consistently below 5 mSv. The{sup 125}I isotope is not recommended for PBSI.

  13. SU-E-J-39: Comparison of PTV Margins Determined by In-Room Stereoscopic Image Guidance and by On-Board Cone Beam Computed Tomography Technique for Brain Radiotherapy Patients

    SciTech Connect (OSTI)

    Ganesh, T; Paul, S; Munshi, A; Sarkar, B; Krishnankutty, S; Sathya, J; George, S; Jassal, K; Roy, S; Mohanti, B

    2014-06-01

    Purpose: Stereoscopic in room kV image guidance is a faster tool in daily monitoring of patient positioning. Our centre, for the first time in the world, has integrated such a solution from BrainLAB (ExacTrac) with Elekta's volumetric cone beam computed tomography (XVI). Using van Herk's formula, we compared the planning target volume (PTV) margins calculated by both these systems for patients treated with brain radiotherapy. Methods: For a total of 24 patients who received partial or whole brain radiotherapy, verification images were acquired for 524 treatment sessions by XVI and for 334 sessions by ExacTrac out of the total 547 sessions. Systematic and random errors were calculated in cranio-caudal, lateral and antero-posterior directions for both techniques. PTV margins were then determined using van Herk formula. Results: In the cranio-caudal direction, systematic error, random error and the calculated PTV margin were found to be 0.13 cm, 0.12 cm and 0.41 cm with XVI and 0.14 cm, 0.13 cm and 0.44 cm with ExacTrac. The corresponding values in lateral direction were 0.13 cm 0.1 cm and 0.4 cm with XVI and 0.13 cm, 0.12 cm and 0.42 cm with ExacTrac imaging. The same parameters for antero-posterior were for 0.1 cm, 0.11 cm and 0.34 cm with XVI and 0.13 cm, 0.16 cm and 0.43 cm with ExacTrac imaging. The margins estimated with the two imaging modalities were comparable within ± 1 mm limit. Conclusion: Verification of setup errors in the major axes by two independent imaging systems showed the results are comparable and within ± 1 mm. This implies that planar imaging based ExacTrac can yield equal accuracy in setup error determination as the time consuming volumetric imaging which is considered as the gold standard. Accordingly PTV margins estimated by this faster imaging technique can be confidently used in clinical setup.

  14. MO-G-17A-07: Improved Image Quality in Brain F-18 FDG PET Using Penalized-Likelihood Image Reconstruction Via a Generalized Preconditioned Alternating Projection Algorithm: The First Patient Results

    SciTech Connect (OSTI)

    Schmidtlein, CR; Beattie, B; Humm, J; Li, S; Wu, Z; Xu, Y; Zhang, J; Shen, L; Vogelsang, L; Feiglin, D; Krol, A

    2014-06-15

    Purpose: To investigate the performance of a new penalized-likelihood PET image reconstruction algorithm using the 1{sub 1}-norm total-variation (TV) sum of the 1st through 4th-order gradients as the penalty. Simulated and brain patient data sets were analyzed. Methods: This work represents an extension of the preconditioned alternating projection algorithm (PAPA) for emission-computed tomography. In this new generalized algorithm (GPAPA), the penalty term is expanded to allow multiple components, in this case the sum of the 1st to 4th order gradients, to reduce artificial piece-wise constant regions (“staircase” artifacts typical for TV) seen in PAPA images penalized with only the 1st order gradient. Simulated data were used to test for “staircase” artifacts and to optimize the penalty hyper-parameter in the root-mean-squared error (RMSE) sense. Patient FDG brain scans were acquired on a GE D690 PET/CT (370 MBq at 1-hour post-injection for 10 minutes) in time-of-flight mode and in all cases were reconstructed using resolution recovery projectors. GPAPA images were compared PAPA and RMSE-optimally filtered OSEM (fully converged) in simulations and to clinical OSEM reconstructions (3 iterations, 32 subsets) with 2.6 mm XYGaussian and standard 3-point axial smoothing post-filters. Results: The results from the simulated data show a significant reduction in the 'staircase' artifact for GPAPA compared to PAPA and lower RMSE (up to 35%) compared to optimally filtered OSEM. A simple power-law relationship between the RMSE-optimal hyper-parameters and the noise equivalent counts (NEC) per voxel is revealed. Qualitatively, the patient images appear much sharper and with less noise than standard clinical images. The convergence rate is similar to OSEM. Conclusions: GPAPA reconstructions using the 1{sub 1}-norm total-variation sum of the 1st through 4th-order gradients as the penalty show great promise for the improvement of image quality over that currently achieved with clinical OSEM reconstructions.

  15. Improved Planning Time and Plan Quality Through Multicriteria Optimization for Intensity-Modulated Radiotherapy

    SciTech Connect (OSTI)

    Craft, David L.; Hong, Theodore S.; Shih, Helen A.; Bortfeld, Thomas R.

    2012-01-01

    Purpose: To test whether multicriteria optimization (MCO) can reduce treatment planning time and improve plan quality in intensity-modulated radiotherapy (IMRT). Methods and Materials: Ten IMRT patients (5 with glioblastoma and 5 with locally advanced pancreatic cancers) were logged during the standard treatment planning procedure currently in use at Massachusetts General Hospital (MGH). Planning durations and other relevant planning information were recorded. In parallel, the patients were planned using an MCO planning system, and similar planning time data were collected. The patients were treated with the standard plan, but each MCO plan was also approved by the physicians. Plans were then blindly reviewed 3 weeks after planning by the treating physician. Results: In all cases, the treatment planning time was vastly shorter for the MCO planning (average MCO treatment planning time was 12 min; average standard planning time was 135 min). The physician involvement time in the planning process increased from an average of 4.8 min for the standard process to 8.6 min for the MCO process. In all cases, the MCO plan was blindly identified as the superior plan. Conclusions: This provides the first concrete evidence that MCO-based planning is superior in terms of both planning efficiency and dose distribution quality compared with the current trial and error-based IMRT planning approach.

  16. exploration, Los Alamos Rover

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    been life elsewhere?" Bolden also signed an agreement that extends cooperation with Spain on the Mars Science Laboratory Curiosity rover, the NASA InSight mission that will...

  17. Sandia National Laboratories: Research: International Programs

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    domestic efforts to protect our nation. And by keeping the concerns and viewpoints of the international community in our sights as we conduct our existing programs, Sandia can...

  18. Foundation Capital

    Broader source: Energy.gov (indexed) [DOE]

    tech Commercial prototype * For at least 1 sizeable market segment: * Sufficient scale * Ok feature set * Acceptable cost "in sight" Gen 1 product service * 1 st customer(s)...

  19. Industrial Steam System Process-Control Schemes: A BestPractices...

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    ... ROTARY JOINT BLOW-OFF VALVE SIGHT GLASS PRESSURE TRANSMITTER ... VACUUM BREAKER & AIR VENT HEAT EXCHANGER TEMPERATURE ... oil, and eventual transition to an emisions-free, ...

  20. Crystal structure of the [beta subscript 2] adrenergic receptor?Gs...

    Office of Scientific and Technical Information (OSTI)

    receptors (GPCRs) are responsible for the majority of cellular responses to hormones and neurotransmitters as well as the senses of sight, olfaction and taste. The...

  1. SREL Reprint #3057

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    were recorded from a combination of passive sampling traps, hand-captures, sightings, egg masses andor vocalizations. This study demonstrates that student-led opportunistic...

  2. Report Wildland Fire Area Hazard

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Sighting (check box if animal poses serious threat) Trails (accessegress) Hazard Trees (falling, fire hazard) Utilities (Lab employees: use Form 1821 (pdf) to report utility...

  3. EERE Blog | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    appliances lower compared to past holiday seasons. December 16, 2015 New Hydropower, Hidden in Plain Sight The federal government's new Section 242 Hydroelectric Production...

  4. Blog | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    our twinkling little friends, and how to fix them December 16, 2015 New Hydropower, Hidden in Plain Sight The federal government's new Section 242 Hydroelectric Production...

  5. Lowell, Massachusetts, Restaurant Exceeds Energy Savings Expectations...

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Exceeds Energy Savings Expectations The logo for Better Buildings Lowell. The Athenian Corner, a Greek restaurant owned by the Panagiotopoulos family, has been a familiar sight in...

  6. What Every Public Safety Officer Should Know About Radiation...

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    applications include cancer treatments. Industrial uses include well logging, physical prop- erty measurements, smoke detectors, and weapon night sights (tritium). Special nuclear...

  7. DOE/SC-ARM/TR-112 Changes to MFRSRCLDOD1MIN Datastream S McFarlane

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Line of Sight (MWRLOS) datastream. Although this was originally intended to be a straightforward update of the code, it became more complicated due to the following factors: * a...

  8. HNF-54234

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    cottontail (Sylvilagus nuttallii) scat, runways created or used by small mammals (rabbits or hares), and visual sightings of jackrabbits. Any significant trails or scats were...

  9. Roadrunner supercomputer puts research at a new scale

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Code run on the machine mimics brain mechanisms underlying human sight LOS ALAMOS, New ... Neurons are nerve cells that process information in the brain. Neurons communicate with ...

  10. 1

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    June 12, 2008 Code run on the machine mimics brain mechanisms underlying human sight LOS ... Neurons are nerve cells that process information in the brain. Neurons communicate with ...

  11. Fermilab Today

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    South Pole Telescope: Gravitational lensing of the cosmic microwave background by galaxy clusters Photos of the Day: Bug sightings From Physics, May 20, 2015: Synopsis:...

  12. The founder mutations 185delAG and 5382insC in BRCA1 and 6174delT in BRCA2 appear in 60% of ovarian cancer and 30% of early-onset breast cancer patients among Ashkenazi women

    SciTech Connect (OSTI)

    Abeliovich, D.; Lerer, I.; Weinberg, N.

    1997-03-01

    The mutations 185delAG, 188del11, and 5382insC in the BRCA1 gene and 6174delT in the BRCA2 gene were analyzed in 199 Ashkenazi and 44 non-Ashkenazi Jewish unrelated patients with breast and/or ovarian cancer. Of the Jewish Ashkenazi women with ovarian cancer, 62% (13/21) had one of the target mutations, as did 30% (13/43) of women with breast cancer alone diagnosed before the age 40 years and 10% (15/141) of those with breast cancer diagnosed after the age 40 years. Age at ovarian cancer diagnosis was not associated with carrier status. Of 99 Ashkenazi patients with no family history of breast and/or ovarian cancer, 10% carried one of the mutations; in two of them the mutation was proved to be paternally transmitted. One non-Ashkenazi Jewish ovarian cancer patient from Iraq carried the 185delAG mutation. Individual mutation frequencies among breast cancer Ashkenazi patients were 6.7% for 185delAG, 2.2% for 5382insC, and 4.5% for 6174delT, among ovarian cancer patients; 185delAG and 6174delT were about equally common (33% and 29%, respectively), but no ovarian cancer patient carried the 5382insC. More mutations responsible for inherited breast and ovarian cancer probably remain to be found in this population, since 79% of high-incidence breast cancer families and 35% of high-incidence breast/ovarian cancer families had none of the three known founder mutations. 25 refs., 3 figs., 6 tabs.

  13. Daily Sodium Butyrate Enema for the Prevention of Radiation Proctitis in Prostate Cancer Patients Undergoing Radical Radiation Therapy: Results of a Multicenter Randomized Placebo-Controlled Dose-Finding Phase 2 Study

    SciTech Connect (OSTI)

    Maggio, Angelo; Magli, Alessandro; Rancati, Tiziana; Fiorino, Claudio; Valvo, Francesca; Fellin, Giovanni; Ricardi, Umberto; Munoz, Fernando; Cosentino, Dorian; Cazzaniga, Luigi Franco; Valdagni, Riccardo; Vavassori, Vittorio

    2014-07-01

    Purpose: To evaluate the efficacy of sodium butyrate enemas (NABUREN) in prostate cancer radiation therapy (RT) in reducing the incidence, severity, and duration of acute RT-induced proctitis. Methods and Materials: 166 patients, randomly allocated to 1 of 4 groups (rectal sodium butyrate 1 g, 2 g, or 4 g daily or placebo), were treated with NABUREN during and 2 weeks after RT. The grade of proctitis was registered in a daily diary. The correlation between NABUREN and proctitis was investigated through χ{sup 2} statistics. The toxicity endpoints considered were as follows: total number of days with grade ≥1 proctitis (≥G1); total number of days with grade ≥2 proctitis (≥G2); ≥G1 and ≥G2 proctitis lasting at least 3 and 5 consecutive days starting from week 4 (≥G1+3d, ≥G2+3d); damaging effects of RT on rectal mucosa as measured by endoscopy. The relationship between endpoints and pretreatment morbidities, hormonal therapy, presence of diabetes or hypertension, abdominal surgery, or hemorrhoids was investigated by univariate analysis. Results: The patients were randomly allocated to the 4 arms. No difference in the distribution of comorbidities among the arms was observed (P>.09). The mean ≥G1 and ≥G2 proctitis were 7.8 and 4.9 for placebo and 8.9 and 4.7 for the NABUREN group, respectively. No favorable trend in reduction of incidence, severity, and duration of ≥G1 and ≥G2 proctitis was observed with NABUREN use. In univariate analysis, ≥G1+3d toxicity was found to be related to hemorrhoids (P=.008), and a slight correlation was found between ≥G2 proctitis and hormonal therapy (P=.06). The RT effects on rectal mucosa as based on endoscopic assessment were mainly related to diabetes (P<.01). Endoscopy data at 6 week showed no significant difference between the placebo and butyrate arms. The other investigated endpoints were not correlated with any of the clinical risk factors analyzed. Conclusion: There was no evidence of efficacy of NABUREN in reducing the incidence, severity, and duration of acute radiation proctitis. There was a correlation between some endpoints and clinical risk factors.

  14. SU-E-J-70: Feasibility Study of Dynamic Arc and IMRT Treatment Plans Utilizing Vero Treatment Unit and IPlan Planning Computer for SRS/FSRT Brain Cancer Patients

    SciTech Connect (OSTI)

    Huh, S; Lee, S; Dagan, R; Malyapa, R; Mendenhall, N; Mendenhall, W; Ho, M; Hough, D; Yam, M; Li, Z

    2014-06-01

    Purpose: To investigate the feasibility of utilizing Dynamic Arc (DA) and IMRT with 5mm MLC leaf of VERO treatment unit for SRS/FSRT brain cancer patients with non-invasive stereotactic treatments. The DA and IMRT plans using the VERO unit (BrainLab Inc, USA) are compared with cone-based planning and proton plans to evaluate their dosimetric advantages. Methods: The Vero treatment has unique features like no rotational or translational movements of the table during treatments, Dynamic Arc/IMRT, tracking of IR markers, limitation of Ring rotation. Accuracies of the image fusions using CBCT, orthogonal x-rays, and CT are evaluated less than ∼ 0.7mm with a custom-made target phantom with 18 hidden targets. 1mm margin is given to GTV to determine PTV for planning constraints considering all the uncertainties of planning computer and mechanical uncertainties of the treatment unit. Also, double-scattering proton plans with 6F to 9F beams and typical clinical parameters, multiple isocenter plans with 6 to 21 isocenters, and DA/IMRT plans are evaluated to investigate the dosimetric advantages of the DA/IMRT for complex shape of targets. Results: 3 Groups of the patients are divided: (1) Group A (complex target shape), CI's are same for IMRT, and DGI of the proton plan are better by 9.5% than that of the IMRT, (2) Group B, CI of the DA plans (1.91+/−0.4) are better than cone-based plan, while DGI of the DA plan is 4.60+/−1.1 is better than cone-based plan (5.32+/−1.4), (3) Group C (small spherical targets), CI of the DA and cone-based plans are almost the same. Conclusion: For small spherical targets, cone-based plans are superior to other 2 plans: DS proton and DA plans. For complex or irregular plans, dynamic and IMRT plans are comparable to cone-based and proton plans for complex targets.

  15. Application of a New Structural Model & Exploration Technologies to Define a Blind Geothermal System: A Viable Alternative to Grid Drilling for Geothermal Exploration: McCoy, Churchill County, NV

    Broader source: Energy.gov [DOE]

    DOE Geothermal Technologies Peer Review 2010 - Presentation. Relevance of research: Improve exploration technologies for range-hosted geothermal systems:Employ new concept models and apply existing methods in new ways; Breaking geothermal exploration tasks into new steps, segmenting the problem differently; Testing new models for dilatent structures; Utilizing shallow thermal aquifer model to focus exploration; Refining electrical interpretation methods to map shallow conductive featuresIdentifying key faults as fluid conduits; and Employ soil gas surveys to detect volatile elements and gases common to geothermal systems.

  16. Functional Polymorphisms of Base Excision Repair Genes XRCC1 and APEX1 Predict Risk of Radiation Pneumonitis in Patients With Non-Small Cell Lung Cancer Treated With Definitive Radiation Therapy

    SciTech Connect (OSTI)

    Yin Ming; Liao Zhongxing; Liu Zhensheng; Wang, Li-E; Gomez, Daniel; Komaki, Ritsuko; Wei Qingyi

    2011-11-01

    Purpose: To explore whether functional single nucleotide polymorphisms (SNPs) of base-excision repair genes are predictors of radiation treatment-related pneumonitis (RP), we investigated associations between functional SNPs of ADPRT, APEX1, and XRCC1 and RP development. Methods and Materials: We genotyped SNPs of ADPRT (rs1136410 [V762A]), XRCC1 (rs1799782 [R194W], rs25489 [R280H], and rs25487 [Q399R]), and APEX1 (rs1130409 [D148E]) in 165 patients with non-small cell lung cancer (NSCLC) who received definitive chemoradiation therapy. Results were assessed by both Logistic and Cox regression models for RP risk. Kaplan-Meier curves were generated for the cumulative RP probability by the genotypes. Results: We found that SNPs of XRCC1 Q399R and APEX1 D148E each had a significant effect on the development of Grade {>=}2 RP (XRCC1: AA vs. GG, adjusted hazard ratio [HR] = 0.48, 95% confidence interval [CI], 0.24-0.97; APEX1: GG vs. TT, adjusted HR = 3.61, 95% CI, 1.64-7.93) in an allele-dose response manner (Trend tests: p = 0.040 and 0.001, respectively). The number of the combined protective XRCC1 A and APEX1 T alleles (from 0 to 4) also showed a significant trend of predicting RP risk (p = 0.001). Conclusions: SNPs of the base-excision repair genes may be biomarkers for susceptibility to RP. Larger prospective studies are needed to validate our findings.

  17. Teppei Katori Massachusetts Institute of Technology

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    neutrino oscillation 4. SME parameters fit 5. Conclusion 14 Teppei Katori, MIT 063010 Blind analysis MiniBooNE perform 5 years blind analysis. e candidate data is not used to...

  18. Salvage/Adjuvant Brachytherapy After Ophthalmic Artery Chemosurgery for Intraocular Retinoblastoma

    SciTech Connect (OSTI)

    Francis, Jasmine H.; Barker, Christopher A.; Wolden, Suzanne L.; McCormick, Beryl; Segal, Kira; Cohen, Gil; Gobin, Y. Pierre; Marr, Brian P.; Brodie, Scott E.; Dunkel, Ira J.; Abramson, David H.

    2013-11-01

    Purpose: To evaluate the efficacy and toxicity of brachytherapy after ophthalmic artery chemosurgery (OAC) for retinoblastoma. Methods and Materials: This was a single-arm, retrospective study of 15 eyes in 15 patients treated with OAC followed by brachytherapy at (blinded institution) between May 1, 2006, and December 31, 2012, with a median 19 months' follow-up from plaque insertion. Outcome measurements included patient and ocular survival, visual function, and retinal toxicity measured by electroretinogram (ERG). Results: Brachytherapy was used as adjuvant treatment in 2 eyes and as salvage therapy in 13 eyes of which 12 had localized vitreous seeding. No patients developed metastasis or died of retinoblastoma. The Kaplan-Meier estimate of ocular survival was 79.4% (95% confidence interval 48.7%-92.8%) at 18 months. Three eyes were enucleated, and an additional 6 eyes developed out-of-target volume recurrences, which were controlled with additional treatments. Patients with an ocular complication had a mean interval between last OAC and plaque of 2.5 months (SD 2.3 months), which was statistically less (P=.045) than patients without ocular complication who had a mean interval between last OAC and plaque of 6.5 months (SD 4.4 months). ERG responses from pre- versus postplaque were unchanged or improved in more than half the eyes. Conclusions: Brachytherapy following OAC is effective, even in the presence of vitreous seeding; the majority of eyes maintained stable or improved retinal function following treatment, as assessed by ERG.

  19. The Women of Idaho National Laboratory's Space Nuclear Team ...

    Broader source: Energy.gov (indexed) [DOE]

    said. "And when the rocket took off and then roared out of visual sight through the sky, it was a truly profound and proud moment--several of us had tears of joy running down...

  20. General Relativistic Radiative Transfer and GeneralRelativistic...

    Office of Scientific and Technical Information (OSTI)

    emission where the magnetic field roughly aligns with the line-of-sight in the co-moving frame. The features move back and forth as the accretion flow evolves, but their...

  1. Apparatus for accurately measuring high temperatures

    DOE Patents [OSTI]

    Smith, D.D.

    The present invention is a thermometer used for measuring furnace temperatures in the range of about 1800/sup 0/ to 2700/sup 0/C. The thermometer comprises a broadband multicolor thermal radiation sensor positioned to be in optical alignment with the end of a blackbody sight tube extending into the furnace. A valve-shutter arrangement is positioned between the radiation sensor and the sight tube and a chamber for containing a charge of high pressure gas is positioned between the valve-shutter arrangement and the radiation sensor. A momentary opening of the valve shutter arrangement allows a pulse of the high gas to purge the sight tube of air-borne thermal radiation contaminants which permits the radiation sensor to accurately measure the thermal radiation emanating from the end of the sight tube.

  2. Homeowners: Respond to Natural Gas Disruptions | Department of...

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Sight-Look for dirt blowing in the air, bubbles in standing water, or discolored or dead grass or plants around the pipeline area. Sound-Listen for an unusual noise like roaring, ...

  3. VOLATILE-RICH CIRCUMSTELLAR GAS IN THE UNUSUAL 49 CETI DEBRIS DISK

    SciTech Connect (OSTI)

    Roberge, Aki; Grady, Carol A.; Welsh, Barry Y.; Kamp, Inga; Weinberger, Alycia J.

    2014-11-20

    We present Hubble Space Telescope Space Telescope Imaging Spectrograph far-UV spectra of the edge-on disk around 49 Ceti, one of the very few debris disks showing submillimeter CO emission. Many atomic absorption lines are present in the spectra, most of which arise from circumstellar gas lying along the line-of-sight to the central star. We determined the line-of-sight C I column density, estimated the total carbon column density, and set limits on the O I column density. Surprisingly, no line-of-sight CO absorption was seen. We discuss possible explanations for this non-detection, and present preliminary estimates of the carbon abundances in the line-of-sight gas. The C/Fe ratio is much greater than the solar value, suggesting that 49 Cet harbors a volatile-rich gas disk similar to that of ? Pictoris.

  4. Secretary Moniz Kicks Off Inaugural National Cleanup Workshop...

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    program. "We often lose sight of the fact that when this program was established in 1989, we had 107 sites and over 3,000 square miles. That's now down to 16 sites and less...

  5. ARM - Publications: Science Team Meeting Documents

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Probability of Clear Line-of-Sight Determined from the VTLC and WSI Ma, Y. and Ellingson, R.G., University of Maryland Eleventh Atmospheric Radiation Measurement (ARM) Science Team...

  6. Portable Heaters | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    of air in a room), some rely on radiant heating. Radiant heaters emit infrared radiation that directly heats objects and people within their line of sight, and are a more...

  7. Newsletter Southern Great Plains

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    by The University of Chicago under contract W-31-109-Eng-38 with the U.S. Department of Energy. Winter Storms Winter has set its sights on us, just in time to make the holidays...

  8. GE Scientists Experiment With Texas BBQ | GE Global Research

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    constant smoke velocity and more reproducible BBQ I am starting to sound like one of our manufacturing engineers. In fact, the kind of line of sight Evan is getting is just like...

  9. Search for: All records | SciTech Connect

    Office of Scientific and Technical Information (OSTI)

    ... The prevalence of line-of-sight structure is one of several biases in strong lensing ... The incidence of younger galaxies appears to be insensitive to the density of the local ...

  10. This research is for the birds-really, It Is

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    that during the report's timeframe, they observed more than 5,600 birds by sound and sight, and the largest percentage (15.3) of birds they recorded were nine types of...

  11. ARM - Defensive Shotgun - Remington 870 Operator's Guide

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    ... Raise the muzzle to the eyes' line of sight. Place the stock along your forearm and hold it roughly at waist level, depending on your build. Keep your eyes on the threat. To mount ...

  12. A comparison of cloudiness measures derived from longwave measurements and

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    shortwave sky imagers A comparison of cloudiness measures derived from longwave measurements and shortwave sky imagers Takara, Ezra Florida State University Ellingson, Robert Florida State University Ma, Yingtao University of Maryland Category: Cloud Properties In the longwave, two measures of cloudiness for single layer clouds are the probability of clear line of sight (PCLoS) and the effective cloud fraction. As the name states, the PCLoS is the probability of a clear line of sight through

  13. ARM - Facility News Article

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    ENA's Newest Instruments Support Most Extensive Marine Cloud Data Set Bookmark and Share A common sight on the steep cobbled roads of Graciosa Island are carts drawn by donkeys. A common sight on the steep cobbled roads of Graciosa Island are carts drawn by donkeys. An elderly farmer sings in Portuguese as his donkey carries him down the steep cobbled roads to a village below. Hydrangeas and cedar perfume the air around bubbling volcanic geysers and lagoons. A thousand miles from anywhere,

  14. ORISE: REAC/TS Radiation Patient Treatment Algorithm

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Skin Bioassay Samples (Start 24 hour Urine &or Fecal Collections) Whole Body External Exposure Dose Assessment Consider Cytogenetic Biodosimetry Dose Assessment (Repeat as...

  15. Treatment Outcomes After Radiotherapy Alone for Patients With...

    Office of Scientific and Technical Information (OSTI)

    hospitalized in the Cancer Center of Sun Yat-Sen University were collected and reviewed. ... Authors: Xiao Weiwei ; Han Fei 1 ; Department of Radiation Oncology, Cancer Center, Sun ...

  16. Innovative Patient Room Lighting System with Integrated Spectrally Adaptive Control

    Broader source: Energy.gov [DOE]

    Lead Performer: Philips Research North America, LLC – Briarcliff Manor, NYDOE Total Funding: $497,127Cost Share: $165,709Project Term: 9/1/2014 - 2/29/2016Funding Opportunity: SSL R&D Funding...

  17. Pre-Hospital Practices for Handling a Radiologically Contaminated Patient

    Broader source: Energy.gov [DOE]

    The purpose of this User’s Guide is to provide instructors with an overview of the key points covered in the video.  The Student Handout portion of this Guide is designed to assist the instructor...

  18. Using Clinical Data, Hypothesis Generation Tools and PubMed Trends to Discover the Association between Diabetic Retinopathy and Antihypertensive Drugs

    SciTech Connect (OSTI)

    Senter, Katherine G; Sukumar, Sreenivas R; Patton, Robert M; Chaum, Ed

    2015-01-01

    Diabetic retinopathy (DR) is a leading cause of blindness and common complication of diabetes. Many diabetic patients take antihypertensive drugs to prevent cardiovascular problems, but these drugs may have unintended consequences on eyesight. Six common classes of antihypertensive drug are angiotensin converting enzyme (ACE) inhibitors, alpha blockers, angiotensin receptor blockers (ARBs), -blockers, calcium channel blockers, and diuretics. Analysis of medical history data might indicate which of these drugs provide safe blood pressure control, and a literature review is often used to guide such analyses. Beyond manual reading of relevant publications, we sought to identify quantitative trends in literature from the biomedical database PubMed to compare with quantitative trends in the clinical data. By recording and analyzing PubMed search results, we found wide variation in the prevalence of each antihypertensive drug in DR literature. Drug classes developed more recently such as ACE inhibitors and ARBs were most prevalent. We also identified instances of change-over-time in publication patterns. We then compared these literature trends to a dataset of 500 diabetic patients from the UT Hamilton Eye Institute. Data for each patient included class of antihypertensive drug, presence and severity of DR. Graphical comparison revealed that older drug classes such as diuretics, calcium channel blockers, and -blockers were much more prevalent in the clinical data than in the DR and antihypertensive literature. Finally, quantitative analysis of the dataset revealed that patients taking -blockers were statistically more likely to have DR than patients taking other medications, controlling for presence of hypertension and year of diabetes onset. This finding was concerning given the prevalence of -blockers in the clinical data. We determined that clinical use of -blockers should be minimized in diabetic patients to prevent retinal damage.

  19. SU-D-BRE-07: Neutron Shielding Assessment for a Compact Proton Therapy Vault

    SciTech Connect (OSTI)

    Prusator, M; Ahmad, S; Chen, Y [University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States)

    2014-06-01

    Purpose: To perform a neutron shielding assessment of a commercially available compact proton therapy system. Methods: TOPAS (TOol for PArticle Simulation) beta release was used to model beam line components for Mevion S250 proton treatment system the design of which is that the cyclotron is present in the treatment room. Three neutron production sources were taken into account in the simulation. These are the cyclotron, the treatment nozzle and the patient itself, respectively. The cyclotron was modeled as a cylindrical iron target (r =5 cm, length = 8 cm). A water phantom (10 cm 10 cm 60 cm) was used to model the patient and various structures (scattering foils, range modulator wheel, applicator and compensator) defaulted in TOPAS were used to model the passive scattering treatment nozzle. Neutron fluences and energy spectra were counted in a spherical scoring geometry per incident proton in 18 angular bins (10 degree each). Fluence to dose conversion factors from ICRU publication 74 were used to acquire neutron ambient dose equivalent H*(10). A point source line of sight model was then used to calculate neutron dose at eight locations beyond shielding barriers. Results: The neutron ambient dose equivalent was calculated at the 8 points of interest around the proton treatment vault. The highest dose was found to be less than 0.781 mSv/year outside south barrier wall. However, the dose is less than 0.05 mSv/year at the control room area of the proton vault. Conclusion: All Points of interest were well under annual dose limits. This suggests that the shielding design of this compact proton therapy system is sufficient for radiation protection purpose. However, it is important to note that the workload and the occupancy factors are direct multipliers for dose calculations beyond the barrier and must be accurately estimated for validation of our results.

  20. Experiment prediction for LOFT nuclear experiments L5-1/L8-2. [PWR

    SciTech Connect (OSTI)

    Chen, T.H.; Modro, S.M.

    1982-01-01

    The LOFT Experiments L5-1 and L8-2 simulated intermediate break loss-of-coolant accidents with core uncovery. This paper compares the predictions with the measured data for these experiments. The RELAP5 code was used to perform best estimate double-blind and single-blind predictions. The double-blind calculations are performed prior to the experiment and use specified nominal initial and boundary conditions. The single-blind calculations are performed after the experiment and use measured initial and boundary conditions while maintaining all other parameters constant, including the code version. Comparisons of calculated results with experimental results are discussed; the possible causes of discrepancies are explored and explained. RELAP5 calculated system pressure, mass inventory, and fuel cladding temperature agree reasonably well with the experiment results, and only slight changes are noted between the double-blind and single-blind predictions.

  1. News Item

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Blind conformational predictions were performed for 3 new peptoids using Replica Exchange Molecular Dynamics simulation and Quantum Mechanical refinement. Subsequent comparison...

  2. Geothermal Drilling Success at Blue Mountain, Nevada | Open Energy...

    Open Energy Info (EERE)

    Jump to: navigation, search OpenEI Reference LibraryAdd to library Conference Paper: Geothermal Drilling Success at Blue Mountain, Nevada Abstract Exploration in a blind prospect...

  3. Search for: All records | SciTech Connect

    Office of Scientific and Technical Information (OSTI)

    ... : double-blind evaluation of ductile tearing prediction methods. Boyce, Brad Lee No abstract prepared. July 2010 Evaluation of Microstructure-Slip Relationships in BCC Tantalum. ...

  4. Away from the Range Front: Intra-Basin Geothermal Exploration...

    Open Energy Info (EERE)

    rock mechanical technologies from mining, geotechnical, and academic practice but novel to geothermal exploration, to locate blind geothermal resource upflow along faults...

  5. cet20121127-doe_dayabay.ppt

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    forward - Gives rise to very high IOCPU ratios - Typical HEP OO code (C++, Python, Java) - Analysis Blinding: * AD mass (Measured at fill) * Neutrino Flux (Derived from NPP...

  6. Thermal And-Or Near Infrared At Railroad Valley Area (Laney,...

    Open Energy Info (EERE)

    phenomena. The second objective relates to testing satellite thermal infrared (TIR) data for locating thermal anomalies that may be related to blind systems. A third...

  7. Monday,

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    or purchases from required sources of supply under Part 8 (e.g.. Federal Prison Industries. Committee for Purchase From People Who are Blind or Severely Disabled. and...

  8. BPA-2012-01173-FOIA Request

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    your office and procedure. I am Art Marshall. I make this request in conjunction with my duties and responsibilities as the Oregon Commission for the Blind (OCB), Business...

  9. Dewhurst Group | Open Energy Information

    Open Energy Info (EERE)

    geothermal organization that specializes in geothermal exploration using a double-blind mapping method. Coordinates: 43.220985, -88.118584 Show Map Loading map......

  10. Ground Magnetics At Marysville Mt Area (Blackwell) | Open Energy...

    Open Energy Info (EERE)

    field of the effect of the stock. References D. D. Blackwell (Unknown) Exploration In A Blind Geothermal Area Near Marysville, Montana, Usa Additional References Retrieved from...

  11. Section 77

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    of cloud and boundary layer properties associated with continental stratus. But blind application of these statistics may not be the most prudent approach for the...

  12. Tailored Terahertz Pulses from a Laser-Modulated Electron Beam

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    broadband sources of radiation in the 1012 hertz (terahertz) frequency range leaves us blind to a wide range of interesting phenomena. Filling the Terahertz Gap To "see" phenomena...

  13. Ground Gravity Survey At Marysville Mt Area (Blackwell) | Open...

    Open Energy Info (EERE)

    and with the heat flow anomaly. References D. D. Blackwell (Unknown) Exploration In A Blind Geothermal Area Near Marysville, Montana, Usa Additional References Retrieved from...

  14. Hydrothermal System | Open Energy Information

    Open Energy Info (EERE)

    of the underlying resource.1 Occurrence Models "To search efficiently for blind geothermal systems, general geographic regions must first be identified based upon...

  15. Direct-Current Resistivity Survey At Marysville Mt Area (Blackwell...

    Open Energy Info (EERE)

    with the thermal anomaly. References D. D. Blackwell (Unknown) Exploration In A Blind Geothermal Area Near Marysville, Montana, Usa Additional References Retrieved from...

  16. Geothermal resource conceptual models using surface exploration...

    Open Energy Info (EERE)

    approach is particularly effective when exploring blind prospects because it makes fuller use of more limited data and helps identify strategies to address the lack of...

  17. Geothermal Resource Conceptual Models Using Surface Exploration...

    Open Energy Info (EERE)

    approach is particularly effective when exploring blind prospects because it makes fuller use of more limited data and helps identify strategies to address the lack of...

  18. Neutrino Oscillation Search Neutrino Oscillation Search

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    dataMC comparison over oscillation fit range, still retaining blindness to oscillation signal component Step 4: disclose full information on electron candidate events and...

  19. Black Warrior: Sub-soil Gas and Fluid Inclusion Exploration and...

    Open Energy Info (EERE)

    up flow zone drilling targets in a blind geothermal prospect at Black Warrior, Churchill and Washoe Counties, Nevada. Awardees (Company Institution) Nevada Geothermal...

  20. 2-M Probe At Tungsten Mountain Area (Kratt, Et Al., 2008) | Open...

    Open Energy Info (EERE)

    Mark Coolbaugh, Chris Sladek, Rick Zehner, Robin Penfield, Ben Delwiche (2008) A New Gold Pan For The West- Discovering Blind Geothermal Systems With Shallow Temperature Surveys...

  1. 2-M Probe At Gabbs Alkali Flat Area (Kratt, Et Al., 2008) | Open...

    Open Energy Info (EERE)

    Mark Coolbaugh, Chris Sladek, Rick Zehner, Robin Penfield, Ben Delwiche (2008) A New Gold Pan For The West- Discovering Blind Geothermal Systems With Shallow Temperature Surveys...

  2. Geothermometry At Gabbs Alkali Flat Area (Kratt, Et Al., 2008...

    Open Energy Info (EERE)

    Mark Coolbaugh, Chris Sladek, Rick Zehner, Robin Penfield, Ben Delwiche (2008) A New Gold Pan For The West- Discovering Blind Geothermal Systems With Shallow Temperature Surveys...

  3. 2-M Probe At Rhodes Marsh Area (Kratt, Et Al., 2008) | Open Energy...

    Open Energy Info (EERE)

    Mark Coolbaugh, Chris Sladek, Rick Zehner, Robin Penfield, Ben Delwiche (2008) A New Gold Pan For The West- Discovering Blind Geothermal Systems With Shallow Temperature Surveys...

  4. 2-M Probe At Teels Marsh Area (Kratt, Et Al., 2008) | Open Energy...

    Open Energy Info (EERE)

    Mark Coolbaugh, Chris Sladek, Rick Zehner, Robin Penfield, Ben Delwiche (2008) A New Gold Pan For The West- Discovering Blind Geothermal Systems With Shallow Temperature Surveys...

  5. Merging High Resolution Geophysical and Geochemical Surveys to...

    Open Energy Info (EERE)

    and in combination when exploring for blind resources where structure, permeability, and temperature are the most pressing questions. The slim holes will allow testing...

  6. Data Acquisition-Manipulation At Marysville Mt Area (Blackwell...

    Open Energy Info (EERE)

    D. Blackwell (Unknown) Exploration In A Blind Geothermal Area Near Marysville, Montana, Usa Additional References Retrieved from "http:en.openei.orgwindex.php?titleDataAcqui...

  7. Thermal And-Or Near Infrared At Marysville Mt Area (Blackwell...

    Open Energy Info (EERE)

    D. Blackwell (Unknown) Exploration In A Blind Geothermal Area Near Marysville, Montana, Usa Additional References Retrieved from "http:en.openei.orgwindex.php?titleThermalAn...

  8. SEP Success Story: Innovative Investing for Energy Efficiency...

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Innovative Investing for Energy Efficiency at Pennsylvania Schools SEP Success Story: ... Alabama Institute for Deaf and Blind SEP Success Story: Alabama Institute for Deaf and ...

  9. n-dimensional Statistical Inverse Graphical Hydraulic Test Simulator

    Energy Science and Technology Software Center (OSTI)

    2012-09-12

    nSIGHTS (n-dimensional Statistical Inverse Graphical Hydraulic Test Simulator) is a comprehensive well test analysis software package. It provides a user-interface, a well test analysis model and many tools to analyze both field and simulated data. The well test analysis model simulates a single-phase, one-dimensional, radial/non-radial flow regime, with a borehole at the center of the modeled flow system. nSIGHTS solves the radially symmetric n-dimensional forward flow problem using a solver based on a graph-theoretic approach.more » The results of the forward simulation are pressure, and flow rate, given all the input parameters. The parameter estimation portion of nSIGHTS uses a perturbation-based approach to interpret the best-fit well and reservoir parameters, given an observed dataset of pressure and flow rate.« less

  10. COSMIC ORIGINS SPECTROGRAPH OBSERVATIONS OF TRANSLUCENT CLOUDS: Cyg OB2 8A

    SciTech Connect (OSTI)

    Snow, Theodore P.; Destree, Joshua D.; Burgh, Eric B.; Ferguson, Ryan M.; Danforth, Charles W. [Department of Astrophysical and Planetary Sciences, Center for Astrophysics and Space Astronomy, University of Colorado at Boulder, Campus Box 389, Boulder, CO 80309-0389 (United States); Cordiner, Martin, E-mail: tsnow@casa.colorado.ed, E-mail: destree@colorado.ed, E-mail: eric.burgh@colorado.ed, E-mail: ryan.m.ferguson@colorado.ed, E-mail: danforth@casa.colorado.ed, E-mail: martin.cordiner@nasa.go [The Goddard Center for Astrobiology, NASA Goddard Space Flight Center, Code 691, 8800 Greenbelt Road, Greenbelt, MD 20771 (United States)

    2010-09-10

    Data from the Cosmic Origins Spectrograph (COS) are presented for the first highly reddened target (Cyg OB2 8A) under the COS Science Team's guaranteed time allocation. Column densities of ionic, atomic, and molecular species are reported and implications are discussed. Data from Cyg OB2 8A demonstrate the ability to analyze highly reddened interstellar sight lines with the COS that were unavailable to previous UV instruments. Measured column densities indicate that the Cyg OB2 8A line of sight contains multiple diffuse clouds rather than a dominant translucent cloud.

  11. Tips: Air Ducts | Department of Energy

    Energy Savers [EERE]

    Air Ducts Tips: Air Ducts Air ducts: out of sight, out of mind. The unsealed ducts in your attic and crawlspaces lose air, and uninsulated ducts lose heat -- wasting energy and money. Air ducts: out of sight, out of mind. The unsealed ducts in your attic and crawlspaces lose air, and uninsulated ducts lose heat -- wasting energy and money. Your air ducts are one of the most important systems in your home, and if the ducts are poorly sealed or insulated they are likely contributing to higher

  12. Reduction of aspirin-induced fecal blood loss with low-dose misoprostol tablets in man

    SciTech Connect (OSTI)

    Cohen, M.M.; Clark, L.; Armstrong, L.; D'Souza, J.

    1985-07-01

    Misoprostol (SC-29333), a synthetic prostaglandin E1 methyl ester analog, was given simultaneously with acetylsalicylic acid in a double-blind, placebo-controlled randomized prospective study of 32 healthy human male subjects. Fecal blood loss was measured for eight days using the /sup 51/Cr-labeled red blood cell technique. Aspirin (650 mg qid) and misoprostol (25 micrograms qid) or placebo were given during days 3, 4, and 5. There was a significant (P less than 0.05) increase in median blood loss (modified Friedman test) from 0.81 to 6.05 ml/day in the aspirin with placebo group (N = 16). Median blood loss was increased (from 0.75 to 3.75 ml/day) in the aspirin with misoprostol group (N = 16), but this was significantly less (Mann-Whitney U test, P less than 0.01) than the placebo group. Mean serum salicylate concentrations in the placebo and misoprostol groups were similar (7.8 and 6.8 micrograms/ml, respectively). There were no significant changes in laboratory values in any of the subjects studied, nor were any major side-effects encountered. This study demonstrates that oral misoprostol reduces aspirin-induced gastrointestinal bleeding even when administered simultaneously and at a dose level below its threshold for significant acid inhibition. This indicates a potential role for misoprostol in the prevention of gastric mucosal damage in selected patients.

  13. Drill string enclosure

    DOE Patents [OSTI]

    Jorgensen, D.K.; Kuhns, D.J.; Wiersholm, O.; Miller, T.A.

    1993-03-02

    The drill string enclosure consists of six component parts, including; a top bracket, an upper acrylic cylinder, an acrylic drill casing guide, a lower acrylic cylinder, a bottom bracket, and three flexible ducts. The upper acrylic cylinder is optional based upon the drill string length. The drill string enclosure allows for an efficient drill and sight operation at a hazardous waste site.

  14. Unlocking the brain's mysteries: Meet the bioengineers behind next-generation neural devices

    ScienceCinema (OSTI)

    Pannu, Sat; Shah, Kedar; Tolosa, Vanessa; Tooker, Angela

    2015-02-20

    Bioengineers in the Neural Technologies Group at Lawrence Livermore are creating the next generation of clinical- and research-quality neural interfaces. The goal is to gain a fundamental understanding of neuroscience, treat a variety of debilitating neurological disorders (such as Parkinson's, depression, and epilepsy), and restore lost neural functions such as sight, hearing, and mobility.

  15. Drill string enclosure

    DOE Patents [OSTI]

    Jorgensen, Douglas K. (Idaho Falls, ID); Kuhns, Douglass J. (Idaho Falls, ID); Wiersholm, Otto (Idaho Falls, ID); Miller, Timothy A. (Idaho Falls, ID)

    1993-01-01

    The drill string enclosure consists of six component parts, including; a top bracket, an upper acrylic cylinder, an acrylic drill casing guide, a lower acrylic cylinder, a bottom bracket, and three flexible ducts. The upper acrylic cylinder is optional based upon the drill string length. The drill string enclosure allows for an efficient drill and sight operation at a hazardous waste site.

  16. Unlocking the brain's mysteries: Meet the bioengineers behind next-generation neural devices

    SciTech Connect (OSTI)

    Pannu, Sat; Shah, Kedar; Tolosa, Vanessa; Tooker, Angela

    2014-10-02

    Bioengineers in the Neural Technologies Group at Lawrence Livermore are creating the next generation of clinical- and research-quality neural interfaces. The goal is to gain a fundamental understanding of neuroscience, treat a variety of debilitating neurological disorders (such as Parkinson's, depression, and epilepsy), and restore lost neural functions such as sight, hearing, and mobility.

  17. Magnetic Resonance Imaging-Based Target Volume Delineation in Radiation Therapy Treatment Planning for Brain Tumors Using Localized Region-Based Active Contour

    SciTech Connect (OSTI)

    Aslian, Hossein; Sadeghi, Mahdi; Mahdavi, Seied Rabie; Babapour Mofrad, Farshid; Astarakee, Mahdi; Khaledi, Navid; Fadavi, Pedram

    2013-09-01

    Purpose: To evaluate the clinical application of a robust semiautomatic image segmentation method to determine the brain target volumes in radiation therapy treatment planning. Methods and Materials: A local robust region-based algorithm was used on MRI brain images to study the clinical target volume (CTV) of several patients. First, 3 oncologists delineated CTVs of 10 patients manually, and the process time for each patient was calculated. The averages of the oncologists contours were evaluated and considered as reference contours. Then, to determine the CTV through the semiautomatic method, a fourth oncologist who was blind to all manual contours selected 4-8 points around the edema and defined the initial contour. The time to obtain the final contour was calculated again for each patient. Manual and semiautomatic segmentation were compared using 3 different metric criteria: Dice coefficient, Hausdorff distance, and mean absolute distance. A comparison also was performed between volumes obtained from semiautomatic and manual methods. Results: Manual delineation processing time of tumors for each patient was dependent on its size and complexity and had a mean (SD) of 12.33 2.47 minutes, whereas it was 3.254 1.7507 minutes for the semiautomatic method. Means of Dice coefficient, Hausdorff distance, and mean absolute distance between manual contours were 0.84 0.02, 2.05 0.66 cm, and 0.78 0.15 cm, and they were 0.82 0.03, 1.91 0.65 cm, and 0.7 0.22 cm between manual and semiautomatic contours, respectively. Moreover, the mean volume ratio (=semiautomatic/manual) calculated for all samples was 0.87. Conclusions: Given the deformability of this method, the results showed reasonable accuracy and similarity to the results of manual contouring by the oncologists. This study shows that the localized region-based algorithms can have great ability in determining the CTV and can be appropriate alternatives for manual approaches in brain cancer.

  18. SU-E-J-149: Establishing the Relationship Between Pre-Treatment Lung Ventilation, Dose, and Toxicity Outcome

    SciTech Connect (OSTI)

    Mistry, N; D'Souza, W; Sornsen de Koste, J; Senan, S

    2014-06-01

    Purpose: Recently, there has been an interest in incorporating functional information in treatment planning especially in thoracic tumors. The rationale is that healthy lung regions need to be spared from radiation if possible to help achieve better control on toxicity. However, it is still unclear whether high functioning regions need to be spared or have more capacity to deal with the excessive radiation as compared to the compromised regions of the lung. Our goal with this work is to establish the tools by which we can establish a relationship between pre-treatment lung function, dose, and radiographic outcomes of lung toxicity. Methods: Treatment planning was performed using a single phase of a 4DCT scan, and follow-up anatomical CT scans were performed every 3 months for most patients. In this study, we developed the pipeline of tools needed to analyze such a large dataset, while trying to establish a relationship between function, dose, and outcome. Pre-treatment lung function was evaluated using a recently published technique that evaluates Fractional Regional Ventilation (FRV). All images including the FRV map and the individual follow-up anatomical CT images were all spatially matched to the planning CT using a diffusion based Demons image registration algorithm. Change in HU value was used as a metric to capture the effects of lung toxicity. To validate the findings, a radiologist evaluated the follow-up anatomical CT images and scored lung toxicity. Results: Initial experience in 1 patient shows a relationship between the pre-treatment lung function, dose and toxicity outcome. The results are also correlated to the findings by the radiologist who was blinded to the analysis or dose. Conclusion: The pipeline we have established to study this enables future studies in large retrospective studies. However, the tools are dependent on the fidelity of 4DCT reconstruction for accurate evaluation of regional ventilation. Patent Pending for the technique presented in this work to evaluate FRV incorporating mass correction.

  19. Recent Advances in Image Assisted Neurosurgical Procedures: Improved Navigational Accuracy and Patient Safety

    ScienceCinema (OSTI)

    Olivi, Alessandro, M.D.

    2010-09-01

    Neurosurgical procedures require precise planning and intraoperative support. Recent advances in image guided technology have provided neurosurgeons with improved navigational support for more effective and safer procedures. A number of exemplary cases will be presented.

  20. Atypical nuclear localization of VIP receptors in glioma cell lines and patients

    SciTech Connect (OSTI)

    Barbarin, Alice; Sit, Paule; Godet, Julie; Bensalma, Souheyla; Muller, Jean-Marc; Chadneau, Corinne

    2014-11-28

    Highlights: The VIP receptor VPAC1 contains a putative NLS signal. VPAC1 is predominantly nuclear in GBM cell lines but not VPAC2. Non-nuclear VPAC1/2 protein expression is correlated with glioma grade. Nuclear VPAC1 is observed in 50% of stage IV glioma (GBM). - Abstract: An increasing number of G protein-coupled receptors, like receptors for vasoactive intestinal peptide (VIP), are found in cell nucleus. As VIP receptors are involved in the regulation of glioma cell proliferation and migration, we investigated the expression and the nuclear localization of the VIP receptors VPAC1 and VPAC2 in this cancer. First, by applying Western blot and immunofluorescence detection in three human glioblastoma (GBM) cell lines, we observed a strong nuclear staining for the VPAC1 receptor and a weak nuclear VPAC2 receptor staining. Second, immunohistochemical staining of VPAC1 and VPAC2 on tissue microarrays (TMA) showed that the two receptors were expressed in normal brain and glioma tissues. Expression in the non-nuclear compartment of the two receptors significantly increased with the grade of the tumors. Analysis of nuclear staining revealed a significant increase of VPAC1 staining with glioma grade, with up to 50% of GBM displaying strong VPAC1 nuclear staining, whereas nuclear VPAC2 staining remained marginal. The increase in VPAC receptor expression with glioma grades and the enhanced nuclear localization of the VPAC1 receptors in GBM might be of importance for glioma progression.

  1. First LEU-Produced Molybdenum-99 Approved for Patient Use Arrives...

    National Nuclear Security Administration (NNSA)

    Mo-99's primary uses include the detection of disease, including heart disease and cancer, and to study organ structure and function. The isotope's short half-life and...

  2. Effect of chest physiotherapy on the removal of mucus in patients with cystic fibrosis

    SciTech Connect (OSTI)

    Rossman, C.M.; Waldes, R.; Sampson, D.; Newhouse, M.T.

    1982-07-01

    We studied the effectiveness of some of the components of a physiotherapy regimen on the removal of mucus from the lungs of 6 subjects with cystic fibrosis. On 5 randomized study days, after inhalation of a /sup 99/mTc-human serum albumin aerosol to label primarily the large airways, the removal of lung radioactivity was measured during 40 min of (a) spontaneous cough while at rest (control), (b) postural drainage, (c) postural drainage plus mechanical percussion, (d) combined maneuvers (postural drainage, deep breathing with vibrations, and percussion) administered by a physiotherapist, (e) directed vigorous cough. Measurements continued for an additional 2 h of quiet rest. Compared with the control day, all forms of intervention significantly improved the removal of mucus: cough (p less than 0.005), physiotherapy maneuvers (0.005 less than or equal to p less than 0.01), postural drainage (p less than 0.05), and postural drainage plus percussion (p less than 0.01). However, there was no significant difference between regimented cough alone and therapist-administered combined maneuvers, nor between postural drainage alone and with mechanical percussion. We conclude that in cystic fibrosis, vigorous, regimented cough sessions may be as effective as therapist-administered physiotherapy in removing pulmonary secretions. Postural drainage, although better than the control maneuver, was not as effective as cough and was not enhanced by mechanical percussion. Frequent, vigorous self-directed cough sessions are potentially as useful as more complex measures for effective bronchial toilet.

  3. Long-Term Outcomes of Early-Stage Nasopharyngeal Carcinoma Patients...

    Office of Scientific and Technical Information (OSTI)

    Authors: Su Shengfa 1 ; Department of Radiation Oncology, Cancer Center, Sun Yat-Sen ... 1 ; Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou ...

  4. Navy's Geothermal Program Office: Overview of Recovery Act (ARRA...

    Open Energy Info (EERE)

    to medium-sized (e.g. 5-50 MWe), conventional geothermal systems exist in the western U.S. Most of these may ultimately be classified as 'blind' discoveries because of their...

  5. Validation of Innovative Exploration Technologies for Newberry Volcano: Drill Site Location Map 2010

    DOE Data Explorer [Office of Scientific and Technical Information (OSTI)]

    Jaffe, Todd

    2012-01-01

    Newberry project drill site location map 2010. Once the exploration mythology is validated, it can be applied throughout the Cascade Range and elsewhere to locate and develop blind geothermal resources.

  6. CX-011339: Categorical Exclusion Determination

    Broader source: Energy.gov [DOE]

    Install Blinds in 704-L Cafeteria CX(s) Applied: B1.3 Date: 09/19/2013 Location(s): South Carolina Offices(s): Savannah River Operations Office

  7. Acquisition Guide --------------------?

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    can be met by using required sources of supply under FAR Part 8. (e.g., Federal Prison Industries, Committee for Purchase from People Who are Blind or Severely Disabled, and...

  8. CASL - CASL's presence at Nureth-14

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    papers that were down-selected from 632 abstracts and 530 draft papers thorough double-blind peer review. Several of CASL members (Jacopo Buongiorno from MIT; Yassin Hassan from...

  9. Mars Rover's ChemCam Instrument gets

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    at Los Alamos. "Without this laser rangefinder, the ChemCam instrument was somewhat blind. The main laser that creates flashes of plasma when it analyzes rocks and soils up to...

  10. Natural Gas Weekly Update, Printer-Friendly Version

    Gasoline and Diesel Fuel Update (EIA)

    July 8, through Friday, July 18,. To facilitate the work, available capacity at the Blind Canyon scheduling point in Duchesne County, Utah, will be reduced to 200,000 Dth per...

  11. NREL: Technology Deployment - Remote Shading Tool Has Potential...

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    to determine the accuracy of Solar Census' remote online shading tool. NREL conducted a blind study to determine the accuracy of the remote shading algorithms in the software and...

  12. BBAP ???for EH-53 v2.0

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    overtake slow construction vehicles Watch for impatient motorists Remember: If you cannot see the driver's side view mirror, you are in a blind spot, the trucker cannot see you...

  13. ORISE: REAC/TS Cytogenetic Biodosimetry Laboratory conducts internatio...

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    a dose estimate with a lower and upper 95 percent confidence interval. All scorers were blind to the actual dose until after they had submitted their dose estimates to REACTS...

  14. Boom And Bust With The Latest 2M Temperature Surveys- Dead Horse...

    Open Energy Info (EERE)

    of the use of two-meter temperature (2m) surveys to quickly and inexpensively reveal blind geothermal systems were documented at Dead Horse Wells, the Hawthorne Army Depot, and...

  15. Search for Large Extra Dimensions Based on Observations of Neutron...

    Office of Scientific and Technical Information (OSTI)

    are unlikely emitter of gamma rays, and emit in radio and perhaps x-rays. This talk will focus on the blind analysis we plan to perform, which has been developed using the...

  16. Property:Reference material | Open Energy Information

    Open Energy Info (EERE)

    ARRA Spreadsheet + 2-M Probe At Gabbs Alkali Flat Area (Kratt, Et Al., 2008) + A New Gold Pan For The West- Discovering Blind Geothermal Systems With Shallow Temperature Surveys...

  17. OSTI, US Dept of Energy, Office of Scientific and Technical Informatio...

    Office of Scientific and Technical Information (OSTI)

    Lehrer goes on to site recognized problems of bias in tightly controlled randomized, double-blind trials of drug efficacy, considered as "the gold-standard of medical evidence." ...

  18. Pageflex Server [document: PR5018074_00001

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    when you see a VSP doctor. Diabetic EyeCare Annual eye exams can help prevent diabetes-related blindness. If you have type 1 or type 2 diabetes, you can get both your...

  19. Pageflex Server [document: PF1888317_00001

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    when you see a VSP provider. Diabetic EyeCare Annual eye exams can help prevent diabetes related blindness. If you have type 1 or type 2 diabetes, you can get both your...

  20. New Methods In Exploration At The Socorro Peak Kgra- A Gred Iii...

    Open Energy Info (EERE)

    NW-SE through M-mountain as well as blind faults projected through the alluvial fan. IR remote sensing has also located elevated surface temperatures (<12 C above background)...

  1. CX-000667: Categorical Exclusion Determination

    Broader source: Energy.gov [DOE]

    Maui - Blind Geothermal System Exploration in Active Volcanic EnvironmentsCX(s) Applied: A9, B3.1Date: 02/08/2010Location(s): Puna, HawaiiOffice(s): Energy Efficiency and Renewable Energy, Golden Field Office

  2. New Orleans Schools Implement Energy Efficiency | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    New Orleans Schools Implement Energy Efficiency New Orleans Schools Implement Energy Efficiency Andrew Wilson Elementary School uses fixed blinds in classrooms. Andrew Wilson Elementary School uses fixed blinds in classrooms. Photo by Joe Ryan, NREL 19653 The solar installation at Warren Easton Senior High School was the first of four installations placed on local schools. The solar installation at Warren Easton Senior High School was the first of four installations placed on local schools. At

  3. Maximum Diameter Measurements of Aortic Aneurysms on Axial CT Images After Endovascular Aneurysm Repair: Sufficient for Follow-up?

    SciTech Connect (OSTI)

    Baumueller, Stephan Nguyen, Thi Dan Linh Goetti, Robert Paul; Lachat, Mario; Seifert, Burkhardt; Pfammatter, Thomas Frauenfelder, Thomas

    2011-12-15

    Purpose: To assess the accuracy of maximum diameter measurements of aortic aneurysms after endovascular aneurysm repair (EVAR) on axial computed tomographic (CT) images in comparison to maximum diameter measurements perpendicular to the intravascular centerline for follow-up by using three-dimensional (3D) volume measurements as the reference standard. Materials and Methods: Forty-nine consecutive patients (73 {+-} 7.5 years, range 51-88 years), who underwent EVAR of an infrarenal aortic aneurysm were retrospectively included. Two blinded readers twice independently measured the maximum aneurysm diameter on axial CT images performed at discharge, and at 1 and 2 years after intervention. The maximum diameter perpendicular to the centerline was automatically measured. Volumes of the aortic aneurysms were calculated by dedicated semiautomated 3D segmentation software (3surgery, 3mensio, the Netherlands). Changes in diameter of 0.5 cm and in volume of 10% were considered clinically significant. Intra- and interobserver agreements were calculated by intraclass correlations (ICC) in a random effects analysis of variance. The two unidimensional measurement methods were correlated to the reference standard. Results: Intra- and interobserver agreements for maximum aneurysm diameter measurements were excellent (ICC = 0.98 and ICC = 0.96, respectively). There was an excellent correlation between maximum aneurysm diameters measured on axial CT images and 3D volume measurements (r = 0.93, P < 0.001) as well as between maximum diameter measurements perpendicular to the centerline and 3D volume measurements (r = 0.93, P < 0.001). Conclusion: Measurements of maximum aneurysm diameters on axial CT images are an accurate, reliable, and robust method for follow-up after EVAR and can be used in daily routine.

  4. Pyrometer mount for a closed-circuit thermal medium cooled gas turbine

    DOE Patents [OSTI]

    Jones, Raymond Joseph (Duanesburg, NY); Kirkpatrick, Francis Lawrence (late of Galway, NY); Burns, James Lee (Schenectady, NY); Fulton, John Robert (Clifton Park, NY)

    2002-01-01

    A steam-cooled second-stage nozzle segment has an outer band and an outer cover defining a plenum therebetween for receiving cooling steam for flow through the nozzles to the inner band and cover therefor and return flow through the nozzles. To measure the temperature of the buckets of the stage forwardly of the nozzle stage, a pyrometer boss is electron beam-welded in an opening through the outer band and TIG-welded to the outer cover plate. By machining a hole through the boss and seating a linearly extending tube in the boss, a line of sight between a pyrometer mounted on the turbine frame and the buckets is provided whereby the temperature of the buckets can be ascertained. The welding of the boss to the outer band and outer cover enables steam flow through the plenum without leakage, while providing a line of sight through the outer cover and outer band to measure bucket temperature.

  5. Unified Parallel Software

    Energy Science and Technology Software Center (OSTI)

    2003-12-01

    UPS (Unified Paralled Software is a collection of software tools libraries, scripts, executables) that assist in parallel programming. This consists of: o libups.a C/Fortran callable routines for message passing (utilities written on top of MPI) and file IO (utilities written on top of HDF). o libuserd-HDF.so EnSight user-defined reader for visualizing data files written with UPS File IO. o ups_libuserd_query, ups_libuserd_prep.pl, ups_libuserd_script.pl Executables/scripts to get information from data files and to simplify the use ofmore » EnSight on those data files. o ups_io_rm/ups_io_cp Manipulate data files written with UPS File IO These tools are portable to a wide variety of Unix platforms.« less

  6. Quantitative measurement of binary liquid distributions using multiple-tracer x-ray fluorescence and radiography

    SciTech Connect (OSTI)

    Halls, Benjamin R.; Meyer, Terrence R.; Kastengren, Alan L.

    2015-01-01

    The complex geometry and large index-of-refraction gradients that occur near the point of impingement of binary liquid jets present a challenging environment for optical interrogation. A simultaneous quadruple-tracer x-ray fluorescence and line-of-sight radiography technique is proposed as a means of distinguishing and quantifying individual liquid component distributions prior to, during, and after jet impact. Two different pairs of fluorescence tracers are seeded into each liquid stream to maximize their attenuation ratio for reabsorption correction and differentiation of the two fluids during mixing. This approach for instantaneous correction of x-ray fluorescence reabsorption is compared with a more time-intensive approach of using stereographic reconstruction of x-ray attenuation along multiple lines of sight. The proposed methodology addresses the need for a quantitative measurement technique capable of interrogating optically complex, near-field liquid distributions in many mixing systems of practical interest involving two or more liquid streams.

  7. Quantitative measurement of binary liquid distributions using multiple-tracer x-ray fluorescence and radiography

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    Halls, Benjamin R.; Meyer, Terrence R.; Kastengren, Alan L.

    2015-01-23

    The complex geometry and large index-of-refraction gradients that occur near the point of impingement of binary liquid jets present a challenging environment for optical interrogation. A simultaneous quadruple-tracer x-ray fluorescence and line-of-sight radiography technique is proposed as a means of distinguishing and quantifying individual liquid component distributions prior to, during, and after jet impact. Two different pairs of fluorescence tracers are seeded into each liquid stream to maximize their attenuation ratio for reabsorption correction and differentiation of the two fluids during mixing. This approach for instantaneous correction of x-ray fluorescence reabsorption is compared with a more time-intensive approach of usingmorestereographic reconstruction of x-ray attenuation along multiple lines of sight. The proposed methodology addresses the need for a quantitative measurement technique capable of interrogating optically complex, near-field liquid distributions in many mixing systems of practical interest involving two or more liquid streams.less

  8. ARM - Publications: Science Team Meeting Documents

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    On the Uncertainty of Inferring Absolute Cloud Fraction from Time Series of Narrow Field of View Observations Ma, Y.-T.(a) and Ellingson, R. G.(b), University of Maryland at College Park (a), Florida State University (b) Twelfth Atmospheric Radiation Measurement (ARM) Science Team Meeting One way to parameterize longwave 3-D cloud effects is to relate the various cloud properties to a statistical cloud field parameter called the Probability of Clear Line of Sight (PCLS) and then to a simple

  9. New observatory studies universe's most energetic phenomena

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    New observatory Community Connections: Your link to news and opportunities from Los Alamos National Laboratory Latest Issue:Mar. 2016 all issues All Issues » submit New observatory studies universe's most energetic phenomena Facility replaces Milagro Observatory near Los Alamos May 1, 2015 From its perch atop the highest accessible peak in Mexico, Milagro's replacement will have 15 percent of the sky within its sights at any given time. From its perch atop the highest accessible peak in Mexico,

  10. Microsoft Word - DOE-ID-14-070 Wisconsin EC B3-6.doc

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    0 SECTION A. Project Title: Advanced Instrumentation for Transient Reactor Testing - University of Wisconsin SECTION B. Project Description The University of Wisconsin proposes to focus on five distinct task areas for advanced instrumentation for transient reactor testing: 1. Development of innovations for real-time, 'line-of-sight' imaging for a transient test using the current hodoscope concept with advancements in detection and image resolution; 2. Development of novel sensors to measure

  11. QER- Comment of Annie McCollum

    Broader source: Energy.gov [DOE]

    I urge you to take seriously scientific and community concerns about fracked gas and subsidizing infrastructure that supports its distribution. It is imperative that we fully fund efforts to build infrastructure and capacity for sustainable energy, not for more fossil fuels. The proposed pipeline expansion in New York and Massachusetts is short-sighted, unnecessary, and a step in the wrong direction. There are better ways to meet our energy needs. Annie McCollum

  12. HST/COS SPECTRA OF THREE QSOs THAT PROBE THE CIRCUMGALACTIC MEDIUM OF A SINGLE SPIRAL GALAXY: EVIDENCE FOR GAS RECYCLING AND OUTFLOW

    SciTech Connect (OSTI)

    Keeney, Brian A.; Stocke, John T.; Danforth, Charles W.; Shull, J. Michael; Green, James C. [Center for Astrophysics and Space Astronomy, Department of Astrophysical and Planetary Sciences, University of Colorado, 389 UCB, Boulder, CO 80309 (United States)] [Center for Astrophysics and Space Astronomy, Department of Astrophysical and Planetary Sciences, University of Colorado, 389 UCB, Boulder, CO 80309 (United States); Rosenberg, Jessica L. [Department of Physics and Astronomy, George Mason University, Fairfax, VA 22030 (United States)] [Department of Physics and Astronomy, George Mason University, Fairfax, VA 22030 (United States); Ryan-Weber, Emma V. [Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Mail H30, P.O. Box 218, Hawthorn, 3122 VIC (Australia)] [Centre for Astrophysics and Supercomputing, Swinburne University of Technology, Mail H30, P.O. Box 218, Hawthorn, 3122 VIC (Australia); Savage, Blair D., E-mail: brian.keeney@colorado.edu [Department of Astronomy, University of Wisconsin-Madison, 5534 Sterling Hall, 475 North Charter Street, Madison, WI 53706 (United States)

    2013-03-01

    We have used the Cosmic Origins Spectrograph (COS) to obtain far-UV spectra of three closely spaced QSO sight lines that probe the circumgalactic medium (CGM) of an edge-on spiral galaxy, ESO 157-49, at impact parameters of 74 and 93 h {sup -1} {sub 70} kpc near its major axis and 172 h {sup -1} {sub 70} kpc along its minor axis. H I Ly{alpha} absorption is detected at the galaxy redshift in the spectra of all three QSOs, and metal lines of Si III, Si IV, and C IV are detected along the two major-axis sight lines. Photoionization models of these clouds suggest metallicities close to the galaxy metallicity, cloud sizes of {approx}1 kpc, and gas masses of {approx}10{sup 4} M {sub Sun }. Given the high covering factor of these clouds, ESO 157-49 could harbor {approx}2 Multiplication-Sign 10{sup 9} M {sub Sun} of warm CGM gas. We detect no metals in the sight line that probes the galaxy along its minor axis, but gas at the galaxy metallicity would not have detectable metal absorption with ionization conditions similar to the major-axis clouds. The kinematics of the major-axis clouds favor these being portions of a 'galactic fountain' of recycled gas, while two of the three minor-axis clouds are constrained geometrically to be outflowing gas. In addition, one of our QSO sight lines probes a second more distant spiral, ESO 157-50, along its major axis at an impact parameter of 88 h {sup -1} {sub 70} kpc. Strong H I Ly{alpha} and C IV absorption only are detected in the QSO spectrum at the redshift of ESO 157-50.

  13. DE-FC26-04NT42267 | netl.doe.gov

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Remote Detection of Internal Pipeline Corrosion Using Fluidized Sensors DE-FC26-04NT42267 Goal: The goal of the project is to develop technology that will enable remote interrogation of the internal corrosion of pipelines. Non-line-of-sight pipeline wireless data transmission test setup Background: Proposed sensor concept According to the Department of Transportation Office of Pipeline Safety (OPS), internal corrosion caused about 15 percent of all gas transmission pipeline reportable incidents

  14. Crystal structure of the [beta subscript 2] adrenergic receptor–Gs protein

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    complex (Journal Article) | SciTech Connect Journal Article: Crystal structure of the [beta subscript 2] adrenergic receptor–Gs protein complex Citation Details In-Document Search Title: Crystal structure of the [beta subscript 2] adrenergic receptor–Gs protein complex G protein-coupled receptors (GPCRs) are responsible for the majority of cellular responses to hormones and neurotransmitters as well as the senses of sight, olfaction and taste. The paradigm of GPCR signalling is the

  15. Introduction

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    pre-dawn hours of January 24, 1978, a Canadian Mounted Police corporal located in Hay River, in the Canadian Northwest Territories, reported a meteor sighting. One hundred and twenty-fve miles north, in Yellowknife, a night janitor reported mysterious lights streaking across the darkened sky. What these eye-witnesses actually saw was the re-entry of the Soviet satellite Cosmos 954 into Earth's atmosphere. Background Cosmos 954 launched into orbit on September 18, 1977. The satellite was designed

  16. Multimedia

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Photo Gallery Video Gallery home / Multimedia Experience the sights and sounds of the National Ignition Facility and learn more about NIF & Photon Science in our multimedia section. High-resolution images of the facility and videos describing how NIF works are available. Photo Gallery Photo Gallery Download high-resolution versions of the images in the photo gallery by clicking "Download high-res image." If you publish or post online these images or reproductions, please credit

  17. Organic Photovoltaics | Center for Energy Efficient Materials

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Organic Photovoltaics As an overarching goal, the CEEM OPV group seeks to understand conjugated polymer and small molecule semiconductor blends that function as the active layer in solar cell devices. The effort brings together a cohesive and mutually complementary set of experts to understand what may appear at first sight to be unrelated phenomena. Indeed, the collective CEEM OPV effort very recently led to the design, processing, structural characterization, theoretical understanding and

  18. Digital Through-The-Earth Communication System | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Digital Through-The-Earth Communication System Digital Through-The-Earth Communication System System Provides Voice and Data Link for Surface to Subsurface Communications Traditional radio uses frequencies above 500 kHz and does not penetrate any significant distance into typical underground rock masses. Hard-wired links such as phone lines, coaxial cables, mining car tracks, short-range radio links, or line-of-sight communication are commonly used, but these systems restrict the mobility of an

  19. Microsoft Word - July2015News_2.docx

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    Within Sight: Manhattan Project National Historical Park Visitors to Los Alamos will begin experiencing the new Manhattan Project National Historical Park in its Los Alamos location even before it officially opens on January 1, 2016. The Department of Energy and the National Park Service are working together to create the park that will invite visitors to the historic sites of the Manhattan Project. Many of these sites are located within Los Alamos National Laboratory, and access to them and

  20. Kitchen Appliance Upgrades Improve Water Efficiency at DOD Exchange Facilities: Best Management Practice Case Study #11: Commercial Kitchen Equipment (Brochure), Federal Energy Management Program (FEMP)

    Energy Savers [EERE]

    kitchens are often forgotten when people begin to think about performing water audits. Kitchens can be out of sight, out of mind; a commercial kitchen, however, can consume large amounts of water and energy if inefficient appliances are installed. The Exchange, formerly the Army and Air Force Exchange Service (AAFES), is taking a leadership role in water efficiency improvements in their commercial kitchens by integrating water efficiency concepts into the organization's overall sustainability

  1. Lowell, Massachusetts, Restaurant Exceeds Energy Savings Expectations |

    Energy Savers [EERE]

    Department of Energy Restaurant Exceeds Energy Savings Expectations Lowell, Massachusetts, Restaurant Exceeds Energy Savings Expectations The logo for Better Buildings Lowell. The Athenian Corner, a Greek restaurant owned by the Panagiotopoulos family, has been a familiar sight in the historic district of downtown Lowell, Massachusetts, since 1974. Energy efficiency upgrades are helping the Panagiotopoulos family reduce operating costs and make their restaurant more successful. The Athenian

  2. Energy Keepers, Inc.

    Office of Environmental Management (EM)

    Keepers, Inc. General Overview March 25, 2015 Energy Keepers, Inc. 5/13/2015 2 Lower Flathead River Before Kerr Dam Kerr Dam is located on a significant sight from cultural, religious, and resource perspectives CSKT Our People * The Tribal confederacy is comprised of the Bitterroot Salish, the Pend d'Oreille, and the Kootenai Tribes. * Historically, the three tribes were allies with ancestors who shared territory in areas now known as western Montana, parts of Idaho, British Columbia, and

  3. Federal Interagency Wind Turbine Radar Interference Mitigation Strategy |

    Office of Environmental Management (EM)

    Department of Energy Federal Interagency Wind Turbine Radar Interference Mitigation Strategy Federal Interagency Wind Turbine Radar Interference Mitigation Strategy Cover of the Federal Interagency Wind Turbine Radar Interference Mitigation Strategy report Wind development located within the line of sight of radar systems can cause clutter and interference, which at some radars has resulted in significant performance degradation. As wind turbines continue to be installed, and as advances in

  4. LANL's Role in the U.S. Fissile Material Disposition Program

    SciTech Connect (OSTI)

    Whitworth, Julia; Kay, Virginia

    2015-02-18

    The process of Fissile Material Disposition is in part a result of the Advanced Recovery and Integrated Extraction System (ARIES), which is an agreement between the U.S. and Russia to dispose of excess plutonium used to make weapons. LANL is one sight that aides in the process of dismantling, storage and repurposing of the plutonium gathered from dismantled weapons. Some uses for the repurposed plutonium is fuel for commercial nuclear reactors which will provide energy for citizens.

  5. The Mystery of the Gun Turret in the Desert

    SciTech Connect (OSTI)

    Hoffman, R. D.

    2015-11-30

    The mystery of the gun turret in the desert began with an ingenious idea: to develop a reusable open-air line of sight diagnostic device to support LLNL’s early nuclear weapons development efforts. Obtained from the Mare Island Navy Shipyard (MINS) in January 1957, the gun turret traveled by ship to the Naval Construction Battalion base at Port Hueneme, California, and then by truck to Area 2 in the Yucca Flats valley at the Nevada Nuclear Security Site (NNSS).

  6. SPATIAL ANISOTROPY OF GALAXY KINEMATICS IN SLOAN DIGITAL SKY SURVEY GALAXY CLUSTERS

    SciTech Connect (OSTI)

    Skielboe, Andreas; Wojtak, Radoslaw; Pedersen, Kristian; Rozo, Eduardo; Rykoff, Eli S.

    2012-10-10

    Measurements of galaxy cluster kinematics are important in understanding the dynamical state and evolution of clusters of galaxies, as well as constraining cosmological models. While it is well established that clusters exhibit non-spherical geometries, evident in the distribution of galaxies on the sky, azimuthal variations of galaxy kinematics within clusters have yet to be observed. Here we measure the azimuthal dependence of the line-of-sight velocity dispersion profile in a stacked sample of 1743 galaxy clusters from the Sloan Digital Sky Survey (SDSS). The clusters are drawn from the SDSS DR8 redMaPPer catalog. We find that the line-of-sight velocity dispersion of galaxies lying along the major axis of the central galaxy is larger than those that lie along the minor axis. This is the first observational detection of anisotropic kinematics of galaxies in clusters. We show that the result is consistent with predictions from numerical simulations. Furthermore, we find that the degree of projected anisotropy is strongly dependent on the line-of-sight orientation of the galaxy cluster, opening new possibilities for assessing systematics in optical cluster finding.

  7. Delving into X-ray obscuration of type 2 AGN, near and far

    SciTech Connect (OSTI)

    LaMassa, Stephanie M.; Meg Urry, C.; Yaqoob, Tahir; Ptak, Andrew F.; Gandhi, Poshak

    2014-05-20

    Using self-consistent, physically motivated models, we investigate the X-ray obscuration in 19 Type 2 [O III] 5007 selected active galactic nuclei (AGNs), 9 of which are local Seyfert 2 galaxies and 10 of which are Type 2 quasar candidates. We derive reliable line-of-sight and global column densities for these objects, which is the first time this has been reported for an AGN sample; four AGNs have significantly different global and line-of-sight column densities. Five sources are heavily obscured to Compton-thick. We comment on interesting sources revealed by our spectral modeling, including a candidate 'naked' Sy2. After correcting for absorption, we find that the ratio of the rest-frame, 2-10 keV luminosity (L{sub 2-10} {sub keV,} {sub in}) to L{sub [O} {sub III]} is 1.54 0.49 dex which is essentially identical to the mean Type 1 AGN value. The Fe K? luminosity is significantly correlated with L{sub [O} {sub III]} but with substantial scatter. Finally, we do not find a trend between L {sub 2-10keV,} {sub in} and global or line-of-sight column density, between column density and redshift, between column density and scattering fraction, or between scattering fraction and redshift.

  8. Precision laser surveying instrument using atmospheric turbulence compensation by determining the absolute displacement between two laser beam components

    DOE Patents [OSTI]

    Veligdan, James T. (Manorville, NY)

    1993-01-01

    Atmospheric effects on sighting measurements are compensated for by adjusting any sighting measurements using a correction factor that does not depend on atmospheric state conditions such as temperature, pressure, density or turbulence. The correction factor is accurately determined using a precisely measured physical separation between two color components of a light beam (or beams) that has been generated using either a two-color laser or two lasers that project different colored beams. The physical separation is precisely measured by fixing the position of a short beam pulse and measuring the physical separation between the two fixed-in-position components of the beam. This precisely measured physical separation is then used in a relationship that includes the indexes of refraction for each of the two colors of the laser beam in the atmosphere through which the beam is projected, thereby to determine the absolute displacement of one wavelength component of the laser beam from a straight line of sight for that projected component of the beam. This absolute displacement is useful to correct optical measurements, such as those developed in surveying measurements that are made in a test area that includes the same dispersion effects of the atmosphere on the optical measurements. The means and method of the invention are suitable for use with either single-ended systems or a double-ended systems.

  9. Diverse properties of interstellar medium embedding gamma-ray bursts at the epoch of reionization

    SciTech Connect (OSTI)

    Cen, Renyue; Kimm, Taysun

    2014-10-10

    Analysis is performed on ultra-high-resolution large-scale cosmological radiation-hydrodynamic simulations to quantify, for the first time, the physical environment of long-duration gamma-ray bursts (GRBs) at the epoch of reionization. We find that, on parsec scales, 13% of GRBs remain in high-density (?10{sup 4} cm{sup 3}) low-temperature star-forming regions, whereas 87% of GRBs occur in low-density (?10{sup 2.5} cm{sup 3}) high-temperature regions heated by supernovae. More importantly, the spectral properties of GRB afterglows, such as the neutral hydrogen column density, total hydrogen column density, dust column density, gas temperature, and metallicity of intervening absorbers, vary strongly from sight line to sight line. Although our model explains extant limited observationally inferred values with respect to circumburst density, metallicity, column density, and dust properties, a substantially larger sample of high-z GRB afterglows would be required to facilitate a statistically solid test of the model. Our findings indicate that any attempt to infer the physical properties (such as metallicity) of the interstellar medium (ISM) of the host galaxy based on a very small number (usually one) of sight lines would be precarious. Utilizing high-z GRBs to probe the ISM and intergalactic medium should be undertaken properly, taking into consideration the physical diversities of the ISM.

  10. Towards large-cohort comparative studies to define the factors influencing the gut microbial community structure of ASD patients

    SciTech Connect (OSTI)

    McDonald, Daniel; Hornig, Mady; Lozupone, Catherine; Debelius, Justine; Gilbert, Jack A.; Knight, Rob

    2015-03-09

    Differences in the gut microbiota have been reported between individuals with autism spectrum disorders (ASD) and neurotypical controls, although direct evidence that changes in the microbiome contribute to causing ASD has been scarce to date. Here we summarize some considerations of experimental design that can help untangle causality in this complex system. In particular, large cross-sectional studies that can factor out important variables such as diet, prospective longitudinal studies that remove some of the influence of interpersonal variation in the microbiome (which is generally high, especially in children), and studies transferring microbial communities into germ-free mice may be especially useful. Controlling for the effects of technical variables, which have complicated efforts to combine existing studies, is critical when biological effect sizes are small. Large citizen-science studies with thousands of participants such as the American Gut Project have been effective at uncovering subtle microbiome effects in self-collected samples and with self-reported diet and behavior data, and may provide a useful complement to other types of traditionally funded and conducted studies in the case of ASD, especially in the hypothesis generation phase.

  11. Percutaneous Transumbilical Portal Vein Embolization in a Patient with a Ruptured Hepatocellular Carcinoma Supplied by the Portal Vein

    SciTech Connect (OSTI)

    Kim, Soo Chin; Kim, Hyo-Cheol Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung

    2011-02-15

    We describe a case of a ruptured hepatocellular carcinoma supplied by the portal vein that was successfully treated with portal vein embolization via a percutaneous transumbilical approach. A contrast material-enhanced computed tomographic (CT) scan showed the presence of a large hypervascular tumor on portal venous phase as well as right hepatic vein thrombosis and hemoperitoneum that prevented portal vein embolization by the use of the percutaneous and transjugular transhepatic approach. The use of percutaneous transumbilical portal vein embolization can be an alternative option in this situation.

  12. Characterization of acid flux in osteoclasts from patients harboring a G215R mutation in ClC-7

    SciTech Connect (OSTI)

    Henriksen, Kim [Nordic Bioscience A/S, Herlev Hovedgade 207, DK-2730 Herlev (Denmark)], E-mail: kh@nordicbioscience.com; Gram, Jeppe [Department of Endocrinology, Ribe County Hospital, Esbjerg (Denmark)], E-mail: Jeppe.Gram@svs.regionsyddanmark.dk; Neutzsky-Wulff, Anita Vibsig [Nordic Bioscience A/S, Herlev Hovedgade 207, DK-2730 Herlev (Denmark)], E-mail: avn@nordicbioscience.com; Jensen, Vicki Kaiser [Nordic Bioscience A/S, Herlev Hovedgade 207, DK-2730 Herlev (Denmark)], E-mail: vkj@nordicbioscience.com; Dziegiel, Morten H. [HS Blodbank, Copenhagen University Hospital, Copenhagen (Denmark)], E-mail: morten.dziegiel@rh.hosp.dk; Bollerslev, Jens [Section of Endocrinology, Dept. of Medicine, National University Hospital, Oslo (Norway)], E-mail: jens.bollerslev@medisin.uio.no; Karsdal, Morten A. [Nordic Bioscience A/S, Herlev Hovedgade 207, DK-2730 Herlev (Denmark)], E-mail: mk@nordicbioscience.com

    2009-01-23

    The chloride-proton antiporter ClC-7 has been speculated to be involved in acidification of the lysosomes and the resorption lacunae in osteoclasts; however, neither direct measurements of chloride transport nor acidification have been performed. Human osteoclasts harboring a dominant negative mutation in ClC-7 (G215R) were isolated, and used these to investigate bone resorption measured by CTX-I, calcium release and pit scoring. The actin cytoskeleton of the osteoclasts was also investigated. ClC-7 enriched membranes from the osteoclasts were isolated, and used to test acidification rates in the presence of a V-ATPase and a chloride channel inhibitor, using a H{sup +} and Cl{sup -} driven approach. Finally, acidification rates in ClC-7 enriched membranes from ADOII osteoclasts and their corresponding controls were compared. Resorption by the G215R osteoclasts was reduced by 60% when measured by both CTX-I, calcium release, and pit area when comparing to age and sex matched controls. In addition, the ADOII osteoclasts showed no differences in actin ring formation. Finally, V-ATPase and chloride channel inhibitors completely abrogated the H{sup +} and Cl{sup -} driven acidification. Finally, the acid influx was reduced by maximally 50% in the ClC-7 deficient membrane fractions when comparing to controls. These data demonstrate that ClC-7 is essential for bone resorption, via its role in acidification of the lysosomes and resorption lacunae in osteoclasts.

  13. Method of assaying uranium with prompt fission and thermal neutron borehole logging adjusted by borehole physical characteristics. [Patient application

    DOE Patents [OSTI]

    Barnard, R.W.; Jensen, D.H.

    1980-11-05

    Uranium formations are assayed by prompt fission neutron logging techniques. The uranium in the formation is proportional to the ratio of epithermal counts to thermal or epithermal dieaway. Various calibration factors enhance the accuracy of the measurement.

  14. Towards large-cohort comparative studies to define the factors influencing the gut microbial community structure of ASD patients

    DOE Public Access Gateway for Energy & Science Beta (PAGES Beta)

    McDonald, Daniel; Hornig, Mady; Lozupone, Catherine; Debelius, Justine; Gilbert, Jack A.; Knight, Rob

    2015-03-09

    Differences in the gut microbiota have been reported between individuals with autism spectrum disorders (ASD) and neurotypical controls, although direct evidence that changes in the microbiome contribute to causing ASD has been scarce to date. Here we summarize some considerations of experimental design that can help untangle causality in this complex system. In particular, large cross-sectional studies that can factor out important variables such as diet, prospective longitudinal studies that remove some of the influence of interpersonal variation in the microbiome (which is generally high, especially in children), and studies transferring microbial communities into germ-free mice may be especially useful.more » Controlling for the effects of technical variables, which have complicated efforts to combine existing studies, is critical when biological effect sizes are small. Large citizen-science studies with thousands of participants such as the American Gut Project have been effective at uncovering subtle microbiome effects in self-collected samples and with self-reported diet and behavior data, and may provide a useful complement to other types of traditionally funded and conducted studies in the case of ASD, especially in the hypothesis generation phase.« less

  15. Twin studies reveal specific imbalances in the mucosa-associated microbiota of patients with ileal Crohn's disease

    SciTech Connect (OSTI)

    Willing, B.; Halfvarson, J.; Dicksved, J.; Rosenquist, M.; Jarnerot, G.; Engstrand, L.; Tysk, C.; Jansson, J. K

    2008-08-15

    Large inter-individual variation in the composition of the intestinal microbiota between unrelated individuals has made it challenging to identify specific aspects of dysbiosis that lead to Crohn's disease. To reduce variations in exposure during establishment of the gut flora and influence of genotype, we studied the mucosaassociated microbiota of monozygotic twin pairs that were discordant (n=6) or concordant (n=4) for Crohn's disease. DNA was extracted from biopsies collected from 5 locations between the ileum and rectum. Bacterial 16S ribosomal RNA genes were amplified and community composition assessed by terminal-restriction fragment length polymorphism, cloning and sequencing and quantitative real-time PCR. The microbial compositions at all biopsy locations for each individual were similar, regardless of disease state, but there were differences between individuals. In particular, individuals with predominantly ileal Crohn's had a dramatically lower abundance (P<0.001) of Faecalibacterium prausnitzii and increased abundance (P<0.03) of Escherichia coli compared to healthy co-twins and those with Crohn's localized in the colon. This dysbiosis was significantly correlated to the disease phenotype rather than genotype. The reduced abundance of F. prausnitzii and increased abundance of E. coli are indicative of an ileal Crohn's disease phenotype, distinct from colonic Crohn's disease and the relative abundances of these specific bacterial populations are promising biomarker candidates for differential diagnosis of Crohn's and eventually customized treatment.

  16. Spring loaded thermocouple module

    DOE Patents [OSTI]

    McKelvey, Thomas E. (Solana Beach, CA); Guarnieri, Joseph J. (San Diego, CA)

    1985-01-01

    A thermocouple arrangement is provided for mounting in a blind hole of a specimen. The thermocouple arrangement includes a cup-like holder member, which receives an elongated thermal insulator, one end of which is seated at an end wall of the holder. A pair of thermocouple wires, threaded through passageways in the insulator, extend beyond the insulator member, terminating in free ends which are joined together in a spherical weld bead. A spring, held captive within the holder, applies a bias force to the weld bead, through the insulator member. The outside surface of the holder is threaded for engagement with the blind hole of the specimen. When the thermocouple is installed in the specimen, the spherical contact surface of the weld bead is held in contact with the end wall of the blind hole, with a predetermined bias force.

  17. Spring loaded thermocouple module

    DOE Patents [OSTI]

    McKelvey, T.E.; Guarnieri, J.J.

    1984-03-13

    A thermocouple arrangement is provided for mounting in a blind hole of a specimen. The thermocouple arrangement includes a cup-like holder member, which receives an elongated thermal insulator, one end of which is seated at an end wall of the holder. A pair of thermocouple wires, threaded through passageways in the insulator, extend beyond the insulator member, terminating in free ends which are joined together in a spherical weld bead. A spring, held captive within the holder, applies a bias force to the weld bead, through the insulator member. The outside surface of the holder is threaded for engagement with the blind hole of the specimen. When the thermocouple is installed in the specimen, the spherical contact surface of the weld bead is held in contact with the end wall of the blind hole, with a predetermined bias force.

  18. Gravity Survey of the Carson Sink - Data and Maps

    DOE Data Explorer [Office of Scientific and Technical Information (OSTI)]

    Faulds, James E.

    Preliminary Interpretation of Results: The Carson Sink is a complex composite basin with several major depocenters (Figures 15 and 16). Major depocenters are present in the south?central, east?central, and northeastern parts of the basin. The distribution of gravity anomalies suggests a complex pattern of faulting in the subsurface of the basin, with many fault terminations, step?overs, and accommodation zones. The pattern of faulting implies that other, previously undiscovered blind geothermal systems are likely in the Carson Sink. The gravity survey was completed near the end of this project. Thus, more thorough analysis of the data and potential locations of blind geothermal systems is planned for future work.

  19. Gravity Survey of the Carson Sink - Data and Maps

    DOE Data Explorer [Office of Scientific and Technical Information (OSTI)]

    Faulds, James E.

    2013-12-31

    Preliminary Interpretation of Results: The Carson Sink is a complex composite basin with several major depocenters (Figures 15 and 16). Major depocenters are present in the south?central, east?central, and northeastern parts of the basin. The distribution of gravity anomalies suggests a complex pattern of faulting in the subsurface of the basin, with many fault terminations, step?overs, and accommodation zones. The pattern of faulting implies that other, previously undiscovered blind geothermal systems are likely in the Carson Sink. The gravity survey was completed near the end of this project. Thus, more thorough analysis of the data and potential locations of blind geothermal systems is planned for future work.

  20. OSTI, US Dept of Energy, Office of Scientific and Technical Information |

    Office of Scientific and Technical Information (OSTI)

    Speeding access to science information from DOE and Beyond Clearing the Way for Medical Solutions by Sam Rosenbloom on Tue, Oct 1, 2013 The Randolph-Sheppard Act was signed into law by President Roosevelt in 1936. The act established a priority for blind vendors on Federal property. Nearly 77 years later, walking toward the snack stand operated by a blind vendor, the irony always occurs to me as I read an unusual brass plaque on the hallway that commemorates the origin of the Human Genome

  1. Improving Home Efficiency and Comfort Right After a Move | Department of

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Energy Improving Home Efficiency and Comfort Right After a Move Improving Home Efficiency and Comfort Right After a Move December 3, 2014 - 10:27am Addthis Hanging drapes or blinds soon after moving is a small step that can have an immediate effect on the comfort of your home. | Photo courtesy of iStockphoto.com/powershot. Hanging drapes or blinds soon after moving is a small step that can have an immediate effect on the comfort of your home. | Photo courtesy of iStockphoto.com/powershot.

  2. HIGH-n HYDROGEN RECOMBINATION LINES FROM THE FIRST GALAXIES

    SciTech Connect (OSTI)

    Rule, E.; Loeb, A.; Strelnitski, V. S.

    2013-09-20

    We investigate the prospects of blind and targeted searches in the radio domain (10 MHz to 1 THz) for high-n hydrogen recombination lines from the first generation of galaxies, at z ?< 10. The expected optically thin spontaneous ?-line luminosities are calculated as a function of the absolute AB magnitude of a galaxy at 1500 . For a blind search, semi-empirical luminosity functions are used to calculate the number of galaxies whose expected flux densities exceed an assumed detectability threshold. Plots of the minimum sky area, within which at least one detectable galaxy is expected at a given observing frequency, in the fiducial instantaneous passband of 10{sup 4} km s{sup 1}, allow us to assess the blind search time necessary for detection by a given facility. We show that the chances for detection are the highest in the millimeter and submillimeter domains, but finding spontaneous emission in a blind search, especially from redshifts z >> 1, is a challenge even with powerful facilities, such as the Actama Large Millimeter/Submillimeter Array and Square Kilometre Array. The probability of success is higher for a targeted search of lines with principal quantum number n ? 10 in Lyman-break galaxies amplified by gravitational lensing. Detection of more than one hydrogen line in such a galaxy will allow for line identification and a precise determination of the galaxy's redshift.

  3. CX-006407: Categorical Exclusion Determination

    Broader source: Energy.gov [DOE]

    Removal of Inactive Chromate Water Isolation Valves CRW-V-170 and CRW-V-175 and Installation of 3 Inch Blind Flanges for F-area New HillCX(s) Applied: B1.3Date: 05/12/2011Location(s): Aiken, South CarolinaOffice(s): Environmental Management, Savannah River Operations Office

  4. CX-001423: Categorical Exclusion Determination

    Broader source: Energy.gov [DOE]

    Application of a New Structural Model and Exploration Technologies to Define a Blind Geothermal System: An Alternative to Grid-Drilling for Geothermal Exploration, McCoy, Churchill County, NevadaCX(s) Applied: B3.1, A9Date: 03/29/2010Location(s): McCoy, NevadaOffice(s): Energy Efficiency and Renewable Energy, Golden Field Office

  5. CX-100493 Categorical Exclusion Determination

    Broader source: Energy.gov [DOE]

    Discovering Blind Geothermal Systems in the Great Basin Region: An Integrated Geologic and Geophysical Approach for Establishing Geothermal Play Fairways Award Number: DE-EE0006731 CX(s) Applied: B3.1, B3.2, B3.6 Geothermal Technologies Office Date: 02/25/2016 Location(s): NV Office(s): Golden Field Office

  6. Headquarters Accommodation Program | Department of Energy

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Programs » Headquarters Accommodation Program Headquarters Accommodation Program The Headquarters Accommodation Program Manager works with DOE managers, employees and visitors to provide information and assistance related to persons with disabilities. Areas of assistance include: Auxiliary services, such as sign language interpreting services, readers for the blind, or personal assistants for the physically challenged Guidance and information regarding accommodations, as well as laws and

  7. Measurements of coronal Faraday rotation at 4.6 R {sub ?}

    SciTech Connect (OSTI)

    Kooi, Jason E.; Fischer, Patrick D.; Buffo, Jacob J.; Spangler, Steven R.

    2014-03-20

    Many competing models for the coronal heating and acceleration mechanisms of the high-speed solar wind depend on the solar magnetic field and plasma structure in the corona within heliocentric distances of 5 R {sub ?}. We report on sensitive Very Large Array (VLA) full-polarization observations made in 2011 August, at 5.0 and 6.1 GHz (each with a bandwidth of 128 MHz) of the radio galaxy 3C 228 through the solar corona at heliocentric distances of 4.6-5.0 R {sub ?}. Observations at 5.0 GHz permit measurements deeper in the corona than previous VLA observations at 1.4 and 1.7 GHz. These Faraday rotation observations provide unique information on the magnetic field in this region of the corona. The measured Faraday rotation on this day was lower than our a priori expectations, but we have successfully modeled the measurement in terms of observed properties of the corona on the day of observation. Our data on 3C 228 provide two lines of sight (separated by 46'', 33,000 km in the corona). We detected three periods during which there appeared to be a difference in the Faraday rotation measure between these two closely spaced lines of sight. These measurements (termed differential Faraday rotation) yield an estimate of 2.6-4.1 GA for coronal currents. Our data also allow us to impose upper limits on rotation measure fluctuations caused by coronal waves; the observed upper limits were 3.3 and 6.4 rad m{sup 2} along the two lines of sight. The implications of these results for Joule heating and wave heating are briefly discussed.

  8. The impact of gas bulk rotation on the Ly? line

    SciTech Connect (OSTI)

    Garavito-Camargo, Juan N.; Forero-Romero, Jaime E.; Dijkstra, Mark E-mail: je.forero@uniandes.edu.co

    2014-11-10

    We present results of radiative transfer calculations to measure the impact of gas bulk rotation on the morphology of the Ly? emission line in distant galaxies. We model a galaxy as a sphere with an homogeneous mixture of dust and hydrogen at a constant temperature. These spheres undergo solid-body rotation with maximum velocities in the range 0-300 km s{sup 1} and neutral hydrogen optical depths in the range ?{sub H} = 10{sup 5}-10{sup 7}. We consider two types of source distributions in the sphere: central and homogeneous. Our main result is that rotation introduces a dependence of the line morphology with viewing angle and rotational velocity. Observations with a line of sight parallel to the rotation axis yield line morphologies similar to the static case. For lines of sight perpendicular to the rotation axis, both the intensity at the line center and the line width increase with rotational velocity. Along the same line of sight, the line becomes single peaked at rotational velocities close to half the line width in the static case. Notably, we find that rotation does not induce any spatial anisotropy in the integrated line flux, the escape fraction or the average number of scatterings. This is because Lyman scattering through a rotating solid-body proceeds identically to the static case. The only difference is the Doppler shift from the different regions in the sphere that move with respect to the observer. This allows us to derive an analytic approximation for the viewing-angle dependence of the emerging spectrum, as a function of rotational velocity.

  9. Recent N* results from photoproduction experiments at CLAS

    SciTech Connect (OSTI)

    D. Sokhan

    2011-10-01

    The recent breakthroughs in the technology of polarized targets have enabled a new generation of meson photo-production experiments to be carried out. A measurement of a full set of polarization observables off both polarized proton and neutron tar gets and in a large number of meson-production channels has come within sight. Such a measurement would very significantly reduce model-dependence in the analysis of the data and thus has the potential to resolve long-standing issues, such as the 'missing resonance' problem, and shed new light on the nucleon excitation spectrum. This has formed the motivation for the recent N* experimental programme of CLAS.

  10. Processing of hydroxylapatite coatings on titanium alloy bone prostheses

    DOE Patents [OSTI]

    Nastasi, M.A.; Levine, T.E.; Mayer, J.W.; Pizziconi, V.B.

    1998-10-06

    Processing of hydroxylapatite sol-gel films on titanium alloy bone prostheses. A method utilizing non-line-of-sight ion beam implantation and/or rapid thermal processing to provide improved bonding of layers of hydroxylapatite to titanium alloy substrates while encouraging bone ingrowth into the hydroxylapatite layers located away from the substrate, is described for the fabrication of prostheses. The first layer of hydroxylapatite is mixed into the substrate by the ions or rapidly thermally annealed, while subsequent layers are heat treated or densified using ion implantation to form layers of decreasing density and larger crystallization, with the outermost layers being suitable for bone ingrowth.

  11. History of Sandia National Laboratories` auxiliary closure mechanisms

    SciTech Connect (OSTI)

    Weydert, J.C.; Ponder, G.M.

    1993-12-01

    An essential component of a horizontal, underground nuclear test setup at the Nevada Test Site is the auxiliary closure system. The massive gates that slam shut immediately after a device has been detonated allow the prompt radiation to pass, but block debris and hot gases from continuing down the tunnel. Thus, the gates protect experiments located in the horizontal line-of-sight steel pipe. Sandia National Laboratories has been the major designer and developer of these closure systems. This report records the history of SNL`s participation in and contributions to the technology of auxiliary closure systems used in horizontal tunnel tests in the underground test program.

  12. SiteLines Looks at NNSS Successes in 2011

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    SiteLines Looks at NNSS Successes in 2011 It was a big year at the Nevada National Security Site (NNSS) for the Nevada Site Office and its contractors. From returning to nuclear operations at the Joint Actinide Shock Physics Experimental Research (JASPER) facility to the formation of the National Center for Nuclear Security to the implementation of Governance Reform, the NNSS had one of its most successful years in FY2011. Now, with its sights set on 2012, SiteLines takes a closer look at the

  13. HERSCHEL SURVEY OF GALACTIC OH{sup +}, H{sub 2}O{sup +}, AND H{sub 3}O{sup +}: PROBING THE MOLECULAR HYDROGEN FRACTION AND COSMIC-RAY IONIZATION RATE

    SciTech Connect (OSTI)

    Indriolo, Nick; Neufeld, D. A.; Gerin, M.; Falgarone, E.; Schilke, P.; Chambers, E. T.; Ossenkopf, V.; Benz, A. O.; Winkel, B.; Menten, K. M.; Black, John H.; Persson, C. M.; Bruderer, S.; Van Dishoeck, E. F.; Godard, B.; Lis, D. C.; Goicoechea, J. R.; Gupta, H.; Sonnentrucker, P.; Van der Tak, F. F. S.; and others

    2015-02-10

    In diffuse interstellar clouds the chemistry that leads to the formation of the oxygen-bearing ions OH{sup +}, H{sub 2}O{sup +}, and H{sub 3}O{sup +} begins with the ionization of atomic hydrogen by cosmic rays, and continues through subsequent hydrogen abstraction reactions involving H{sub 2}. Given these reaction pathways, the observed abundances of these molecules are useful in constraining both the total cosmic-ray ionization rate of atomic hydrogen (?{sub H}) and molecular hydrogen fraction (f{sub H{sub 2}}). We present observations targeting transitions of OH{sup +}, H{sub 2}O{sup +}, and H{sub 3}O{sup +} made with the Herschel Space Observatory along 20 Galactic sight lines toward bright submillimeter continuum sources. Both OH{sup +} and H{sub 2}O{sup +} are detected in absorption in multiple velocity components along every sight line, but H{sub 3}O{sup +} is only detected along 7 sight lines. From the molecular abundances we compute f{sub H{sub 2}} in multiple distinct components along each line of sight, and find a Gaussian distribution with mean and standard deviation 0.042 0.018. This confirms previous findings that OH{sup +} and H{sub 2}O{sup +} primarily reside in gas with low H{sub 2} fractions. We also infer ?{sub H} throughout our sample, and find a lognormal distribution with mean log (?{sub H}) = 15.75 (?{sub H} = 1.78 10{sup 16} s{sup 1}) and standard deviation 0.29 for gas within the Galactic disk, but outside of the Galactic center. This is in good agreement with the mean and distribution of cosmic-ray ionization rates previously inferred from H{sub 3}{sup +} observations. Ionization rates in the Galactic center tend to be 10-100times larger than found in the Galactic disk, also in accord with prior studies.

  14. ALSNews Vol. 335

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    5 ALSNews Vol. 335 Print Friday, 28 September 2012 00:00 A Spectacular Sight Over the ALS The space shuttle Endeavor flew past Berkeley Lab and the ALS on Friday, September 21, as it was moved from Edwards Air Force Base in the Mojave Desert to the Los Angeles International Airport. Hundreds gathered outside the ALS to watch as a NASA 747 carried the space shuttle at low altitude on its historic farewell journey. See more photos on the ALS Flickr photostream. (Photo by Roy Kaltschmidt, Berkeley

  15. ALSNews Vol. 335

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    35 Print A Spectacular Sight Over the ALS The space shuttle Endeavor flew past Berkeley Lab and the ALS on Friday, September 21, as it was moved from Edwards Air Force Base in the Mojave Desert to the Los Angeles International Airport. Hundreds gathered outside the ALS to watch as a NASA 747 carried the space shuttle at low altitude on its historic farewell journey. See more photos on the ALS Flickr photostream. (Photo by Roy Kaltschmidt, Berkeley Lab.) Tracking Living Cells as They

  16. ALSNews Vol. 335

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    5 Print A Spectacular Sight Over the ALS The space shuttle Endeavor flew past Berkeley Lab and the ALS on Friday, September 21, as it was moved from Edwards Air Force Base in the Mojave Desert to the Los Angeles International Airport. Hundreds gathered outside the ALS to watch as a NASA 747 carried the space shuttle at low altitude on its historic farewell journey. See more photos on the ALS Flickr photostream. (Photo by Roy Kaltschmidt, Berkeley Lab.) Tracking Living Cells as They Differentiate

  17. ALSNews Vol. 335

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    ALSNews Vol. 335 Print A Spectacular Sight Over the ALS The space shuttle Endeavor flew past Berkeley Lab and the ALS on Friday, September 21, as it was moved from Edwards Air Force Base in the Mojave Desert to the Los Angeles International Airport. Hundreds gathered outside the ALS to watch as a NASA 747 carried the space shuttle at low altitude on its historic farewell journey. See more photos on the ALS Flickr photostream. (Photo by Roy Kaltschmidt, Berkeley Lab.) Tracking Living Cells as

  18. PowerPoint Presentation

    Broader source: All U.S. Department of Energy (DOE) Office Webpages (Extended Search)

    HEROfor Sunday Brunch on the Columbia Gorge Sternwheeler Sunday, April 24, 2016 10 am - 12 noon Send payment (payable to HERO) to Corina Sarmiento at MSIN S5-27 For questions, contact her 373-2189 or 845-4988 Seats are not confirmed until payment is received. All payments are non-refundable. $39/adult Includes a bountiful brunch buffet prepared fresh on board, plus coffee, hot tea service, champagne, sparkling cider and orange juice. Enjoy the ever changing views and a narration of the sights.

  19. Harbec: A Fifteen Year Journey to the Beginning

    Office of Energy Efficiency and Renewable Energy (EERE) Indexed Site

    Year Pursuit of Sustainable Manufacturing Energy Summit 2014 Niagara Falls, On. HARBEC, Inc. HARBEC Energy Management Strategy  Combined Heat and Power (CHP)= reduced energy co$t through efficiency (by using the other 65% to 75%)  Renewable on sight generation = fixed energy co$t for 25 years (no constantly escalating fuel cost)  Green power from utility = free energy storage, low co$t energy insurance, co$t effective renewable energy credits Why Bother? Energy in our type of

  20. Transverse field focused system

    DOE Patents [OSTI]

    Anderson, Oscar A. (Berkeley, CA)

    1986-01-01

    A transverse field focused (TFF) system for transport or acceleration of an intense sheet beam of negative ions in which a serial arrangement of a plurality of pairs of concentric cylindrical-arc electrodes is provided. Acceleration of the sheet beam can be achieved by progressively increasing the mean electrode voltage of successive electrode pairs. Because the beam is curved by the electrodes, the system can be designed to transport the beam through a maze passage which is baffled to prevent line of sight therethrough. Edge containment of the beam can be achieved by shaping the side edges of the electrodes to produce an electric force vector directed inwardly from the electrode edges.