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Doping the 1 kton Large Volume Detector with Gd

The Large Volume Detector (LVD) in the INFN Gran Sasso National Laboratory (LNGS), Italy, is a ν observatory which has been monitoring the Galaxy since June 1992 to study neutrinos from core collapse supernovae. The experiment in the present configuration is made by 840 scintillator detectors, for a total active mass of 1000 tons. The detector sensitivity to neutrino bursts due to a core collapse supernova has been already discussed in term of maximum detectable distance. In this paper we evaluate the improvements that LVD could obtain if all its active scintillator mass was doped with a small amount (0.14% in weight) of Gadolinium. We simulated neutron captures following ν-bar {sub e} inverse beta decay reactions in one LVD counter (1.2 ton) with Gd doped liquid scintillator obtaining an efficiency for the detection of this process of η{sub n}|{sub Gd} = 80% and a mean capture time τ = 25μs, in good agreement with the results obtained by the measures. This implies a gain of a factor ∼ 20 in the signal to noise ratio for neutron capture detection with respect to the undoped liquid scintillator. We discuss how the captures of neutrons from rock radioactivity on Gd modify the background conditions of the detector and we calculate the curves expressing the sensitivity to a ν-bar {sub e} burst from core collapse supernovae depending on the distance of the collapsing star. It results that doping the 1 kton Large Volume Detector with Gd would assure a 90% detection efficiency at the distance of the Large Magellanic Cloud (50 kpc), an achievement which is equivalent to that obtained by doubling the number of counters in LVD.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Scintilla European project, the successful research results

The Scintilla FP7 project is ended in December 2014, the fruitful results of 3 years development and tests will be presented. SCINTILLA offers the capacity to finding a reliable alternative to Helium-3 based detection systems since the gas which is predominantly used in nuclear safeguards and security applications has now become very expensive, rare and nearly unavailable. SCINTILLA benchmarks results are based on international standards. Radiation Portal tests were carried out at the Joint Research Centre (JRC) in Ispra (Italy). The scintilla project addresses few mains issues. The first is to develop neutron detectors for Radiation Portal Monitor (RPM) and the second is the need of new wearable integrated solutions for Spectrometric Personal Radiation Monitor (SPRM). The partners which provide technical systems of the scintilla project are INFN-ANSALDO, CEA, SYMETRICA and SAPHYMO. For RPM, the objective is to find reliable alternatives to Helium-3 historical neutron detector and provide technical solutions which cope with tests for reliable mobile and cost effective. For Spectrometric Personal Radiation Monitor (SPRM), SCINTILLA is innovating in technology areas that offer complementary capabilities for detecting and identifying gamma, Two CZT (Cadmium Zinc Telluride) addressing contexts of used by first responder technologies, one is a wearable detector and the second is a gamma camera complemented by advanced image processing technologies. (authors)

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Complete genome sequence of Ferroglobus placidus AEDII12DO

Ferroglobus placidus belongs to the order Archaeoglobales within the archaeal phylum Euryar- chaeota. Strain AEDII12DO is the type strain of the species and was isolated from a shallow marine hydrothermal system at Vulcano, Italy. It is a hyperthermophilic, anaerobic chemoli- thoautotroph, but it can also use a variety of aromatic compounds as electron donors. Here we describe the features of this organism together with the complete genome sequence and anno- tation. The 2,196,266 bp genome with its 2,567 protein-coding and 55 RNA genes was se- quenced as part of a DOE Joint Genome Institute Laboratory Sequencing Program (LSP) project.

15 GEOTHERMAL ENERGY↗

Savoia seaplane S.55 : military or commercial

The S.55 is a two engine twin hull seaplane built by Societa Idrovolanti Alta Italia (Seaplane Company of Upper Italy). The S.55 (Santa Maria) is to be used for an around the world flight In 1927. It will have a useful load of 7,500 lbs. and a cruising speed of 100 MPH.

SAVOIA S 55 SEAPLANE (ITALY)↗

The Mars Sample Return Project

The Mars Sample Return (MSR) Project is underway. A 2003 mission to be launched on a Delta III Class vehicle and a 2005 mission launched on an Ariane 5 will culminate in carefully selected Mars samples arriving on Earth in 2008. NASA is the lead agency and will provide the Mars landed elements, namely, landers, rovers, and Mars ascent vehicles (MAVs). The French Space Agency CNES is the largest international partner and will provide for the joint NASA/CNES 2005 Mission the Ariane 5 launch and the Earth Return Mars Orbiter that will capture the sample canisters from the Mars parking orbits the MAVs place them in. The sample canisters will be returned to Earth aboard the CNES Orbiter in the Earth Entry Vehicles provided by NASA. Other national space agencies are also expected to participate in substantial roles. Italy is planning to provide a drill that will operate from the Landers to provide subsurface samples. Other experiments in addition to the MSR payload will also be carried on the Landers. This paper will present the current status of the design of the MSR missions and flight articles. c 2000 American Institute of Aeronautics and Astronautics, Inc. Published by Elsevier Science Ltd.

International Cooperation↗

The Super-B Project Accelerator Status

The SuperB project is an international effort aiming at building in Italy a very high luminosity e{sup +}e{sup -} (10{sup 36} cm{sup -2} sec{sup -1}) asymmetric collider at the Y(4S) energy in the CM. The accelerator design has been extensively studied and changed during the past year. The present design, based on the new collision scheme, with large Piwinski angle and the use of 'crab waist' sextupoles already successfully tested at the DA{Phi}NE {Phi}-Factory at LNF Frascati, provides larger flexibility, better dynamic aperture and spin manipulation sections in the Low Energy Ring (LER) for longitudinal polarization of the electron beam at the Interaction Point (IP). The Interaction Region (IR) has been further optimized in terms of apertures and reduced backgrounds in the detector. The injector complex design has been also updated. A summary of the project status will be presented in this paper. The SuperB collider can reach a peak luminosity of 10{sup 36} cm{sup -2} sec{sup -1} with beam currents and bunch lengths similar to those of the past and present e{sup +}e{sup -} Factories, through the use of smaller emittances and new scheme of crossing angle collision. The beams are stored in two rings at 6.7 GeV (HER) and 4.2 GeV (LER). Unique features of the project are the polarization of the electron beam in the LER and the possibility to decrease the energies for running at the {tau}/charm threshold. The option to reuse the PEP-II B-Factory (SLAC) hardware will allow reducing costs. The SuperB facility will require a big complex of civil infrastructure. The main construction, which will house the final part of the LINAC, the injection lines, the damping rings, and the storage rings, will be mainly underground. Two sites have been considered: the campus of Tor Vergata University near Frascati, and the INFN Frascati Laboratory. No decision has been made yet. A footprint of the possible SuperB layout on the LNF area is shown in Fig. 1.

43 PARTICLE ACCELERATORS↗

Hadronic form factor models and spectroscopy within the gauge/gravity correspondence

We show that the nonperturbative light-front dynamics of relativistic hadronic bound states has a dual semiclassical gravity description on a higher dimensional warped AdS space in the limit of zero quark masses. This mapping of AdS gravity theory to the boundary quantum field theory, quantized at fixed light-front time, allows one to establish a precise relation between holographic wave functions in AdS space and the light-front wavefunctions describing the internal structure of hadrons. The resulting AdS/QCD model gives a remarkably good accounting of the spectrum, elastic and transition form factors of the light-quark hadrons in terms of one parameter, the QCD gap scale. The light-front holographic approach described here thus provides a frame-independent first approximation to the light-front Hamiltonian problem for QCD. This article is based on lectures at the Niccolo Cabeo International School of Hadronic Physics, Ferrara, Italy, May 2011.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

Cryogenic readout techniques for germanium detectors

High Purity Germanium detectors are used in many applications, from nuclear and astro-particle physics, to homeland security or environment protection. Although quite standard configurations are often used, with cryostats, charge sensitive amplifiers and analog or digital acquisition systems all commercially available, it might be the case that a few specific applications, e.g. satellites, portable devices, cryogenic physics experiments, etc. also require the development of a few additional or complementary techniques. An interesting case is for sure GERDA, the Germanium Detector Array experiment, searching for neutrino-less double beta decay of {sup 76}Ge at the Gran Sasso National Laboratory of INFN - Italy. In GERDA the entire detector array, composed of semi-coaxial and BEGe naked crystals, is operated suspended inside a cryostat filled with liquid argon, that acts not only as cooling medium and but also as an active shield, thanks to its scintillation properties. These peculiar circumstances, together with the additional requirement of a very low radioactive background from all the materials adjacent to the detectors, clearly introduce significant constraints on the design of the Ge front-end readout electronics. All the Ge readout solutions developed within the framework of the GERDA collaboration, for both Phase I and Phase II, will be briefly reviewed, with their relative strength and weakness compared together and with respect to ideal Ge readout. Finally, the digital processing techniques developed by the GERDA collaboration for energy estimation of Ge detector signals will be recalled. (authors)

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Improved hydrogeophysical characterization and monitoring through parallel modeling and inversion of time-domain resistivity and induced-polarization data

Electrical geophysical methods have found wide use in the growing discipline of hydrogeophysics, both for characterizing the electrical properties of the subsurface, and for monitoring subsurface processes in terms of the spatiotemporal changes in subsurface conductivity, chargeability, and source currents they govern. Current multichannel and multielectrode data collections systems are able to collect large amounts of data in relatively short periods of time. However, practitioners are often unable to fully utilize these large data sets and the information they contain due to the processing limitations of standard desktop computers. This limitation can be addressed by utilizing the storage and processing capabilities of high-performance parallel computing environments. We present a parallel distributed-memory forward and inverse modeling algorithm for analyzing resistivity and time-domain induced polarization data. The primary components of the parallel computations include distributed computation of the pole solutions in forward mode, distributed storage and computation of the Jacobian matrix in inverse mode, and parallel execution of the inverse equation solver. We demonstrate the corresponding parallel code for three efforts: (1) resistivity characterization of the Hanford 300 Area Integrated Field Research Challenge site in Hanford, WA; (2) resistivity characterization of a volcanic island in the southern Tyrrhenian Sea in Italy; and (3) resistivity and IP monitoring of biostimulation at a superfund site in Brandywine, MD. Inverse analysis of each of these data sets would be limited (or impossible) in a standard serial computing environment which underscores the need for high-performance computing to fully utilize the potential of electrical geophysical methods in hydrogeophysical applications.

58 GEOSCIENCES↗

Super-B Project Overview

The SuperB project aims at the construction of an asymmetric very high luminosity B-Factory on the Frascati/Tor Vergata (Italy) area, providing a uniquely sensitive probe of New Physics in the flavour sector of the Standard Model. The luminosity goal of 10{sup 36} cm{sup -2} s{sup -1} can be reached with a new collision scheme with 'large Piwinski angle' (LPA) and the use of 'crab waist sextupoles' (CW). A LPA&CW Interaction Region (IR) has been successfully tested at the DA{Phi}NE {Phi}-Factory at LNF-Frascati in 2008. The LPA&CW scheme, together with very low {beta}*, will allow for operation with relatively low beam currents and reasonable bunch length, comparable to those of PEP-II and KEKB. In the High Energy Ring (HER), two spin rotators will bring longitudinally polarized beams into collision at the IP. The lattice has been designed with a very low intrinsic emittance and is quite compact, less than 2 km long. The tight focusing requires the final doublet quadrupoles to be very close to the IP and very compact. A Conceptual Design Report was published in March 2007, and beam dynamics and collective effects R&D studies are in progress in order to publish a Technical Design Report by the end of 2010.

43 PARTICLE ACCELERATORS↗

Additive effects of acidification and mineralogy on calcium isotopes in Triassic/Jurassic boundary limestones

The end-Triassic mass extinction coincided with a negative δ 13 C excursion, consistent with release of 13 C-depleted CO 2 from the Central Atlantic Magmatic Province. However, the amount of carbon released and its effects on ocean chemistry are poorly constrained. The co upled nature of the carbon and calcium cycles allows calcium isotopes to be used for constraining carbon cycle dynamics and vice versa. We present a high-resolution calcium isotope (δ 44/40 Ca) record from 100 m of marine limestone spanning the Triassic/Jurassic boundary in two stratigraphic sections from northern Italy. Immediately above the extinction horizon and the associated negative excursion in δ 13 C, δ 44/40 Ca decreases by ca. 0.8‰ in 20 m of section and then recovers to preexcursion values. Coupled numerical models of the geological carbon and calcium cycles demonstrate that this δ 44/40 Ca excursion is too large to be explained by changes to seawater δ 44/40 Ca alone, regardless of CO 2 injection volume and duration. Less than 20% of the δ 44/40 Ca excursion can be attributed to acidification. The remaining 80% likely reflects a higher proportion of aragonite in the original sediment, based largely on high concentrations of Sr in the samples. Our study demonstrates that coupled models of the carbon and calcium cycles have the potential to help distinguish contributions of primary seawater isotopic changes from local or diagenetic effects on the δ 44/40 Ca of carbonate sediments. Finally, differentiating between these effects is critical for constraining the impact of ocean acidification during the end-Triassic mass extinction, as well as for interpreting other environmental events in the geologic past.

58 GEOSCIENCES↗

Health, safety, and environmental risks from energy production: A year-long reality check

Large-scale carbon dioxide capture and storage (CCS) offers the benefit of reducing CO{sub 2} emissions and thereby mitigating climate change risk, but it will also bring its own health, safety, and environmental risks. Curtis M. Oldenburg, Editor-in-Chief, considers these risks in the context of the broader picture of energy production. Over the last year, there have been major acute health, safety, and environmental (HSE) consequences related to accidents involving energy production from every major primary energy source. These are, in chronological order: (i) the Upper Big Branch (coal) Mine disaster, (ii) the Gulf of Mexico Macondo (oil) well blowout, (iii) the San Bruno (natural gas) pipeline leak and explosion, and (iv) the Fukushima (nuclear) reactor radioactivity releases. Briefly, the Upper Big Branch Mine disaster occurred in West Virginia on April 5, 2010, when natural methane in the mine ignited, causing the deaths of 29 miners, the worst coal mine disaster in the USA since 1970. Fifteen days later, the Macondo oil well in the Gulf of Mexico suffered a blowout, with a gas explosion and fire on the floating drilling platform that killed 11 people. The oil and gas continued to flow out of the well at the seafloor until July 15, 2010, spilling a total of approximately 5 million barrels of oil into the sea. On September 9, 2010, a 30-inch (76-cm) buried, steel, natural gas pipeline in San Bruno, California, leaked gas and exploded in a residential neighborhood, killing 8 people in their homes and burning a total of 38 homes. Flames were up to 1000 ft (300 m) high, and the initial explosion itself reportedly measured 1.1 on the Richter scale. Finally, on March 11, 2011, a magnitude 9.0 earthquake off the coast of Japan's main island, Honshu, caused a tsunami that crippled the backup power and associated cooling systems for six reactor cores and their spent fuel storage tanks at the Fukushima nuclear power plant. At time of writing, workers trying to bring the crisis under control have been exposed to dangerous levels of radiation, and radioactive water and particulates have been released to the sea and atmosphere. These four disasters, all of which occurred within the past 12 months, were not unprecedented; similar events differing only in detail have happened around the world before, and such events will occur again. Today, developed nations primarily use fossil fuels to create affordable energy for comforts such as lighting, heating and air-conditioning, refrigeration, transportation, education, and entertainment, as well as for powering manufacturing, which creates jobs and a wealth of material goods. In addition to the risks of the existing energy infrastructure that have become obvious through these recent disasters, there is also the ongoing risk of climate change that comes from the vast emissions of greenhouse gases, primarily CO{sub 2}, from the burning of fossil fuels. The implementation of CO{sub 2} capture and storage (CCS) will help mitigate CO{sub 2} emissions from fossil fuel energy, but it also carries with it HSE risks. In my personal interactions with the public and with students, the main concern voiced is whether CO{sub 2} could leak out of the deep reservoirs into which it is injected and rise up out of the ground, smothering people and animals at the ground surface. Another concern expressed is that CO{sub 2} pipelines could fail and cause similar gaseous plumes of CO{sub 2}. The widespread concerns about CO{sub 2} leaking out over the ground surface may be inspired by events that have happened within natural systems in equatorial Africa, in Indonesia, and in Italy. Researchers have been investigating a wide variety of HSE risks of geologic CO{sub 2} storage for some time and have determined that wells are the main potential pathways for significant leakage from the deep subsurface. I discuss the acute HSE risks of CO{sub 2} leakage through wells and from pipelines, and compare the behavior of failures in CO{sub 2} wells and pipelines with oil and gas analogues from which most of our experience derives.

54 ENVIRONMENTAL SCIENCES↗

Pixel Detector Developments for Tracker Upgrades of the High Luminosity LHC

This paper reports on the INFN (Istituto Nazionale di Fisica Nucleare, Italy) research activity in collaboration with FBK foundry, which is aiming at the development of new pixel detectors for the LHC Phase-2 upgrades. The R&D covers both planar pixel devices and 3D detectors built using columnar technology. All sensors are low thickness n-in-p type, as this is the general direction envisaged for the High Luminosity LHC pixel detector upgrades. Hybrid modules with 100 $\upmu $ m and 130 $\upmu $ m active thickness, connected to the PSI46dig readout chip, have been tested on beam test experiments. Selected preliminary results from test beams are described for both planar and 3D devices. The results on the 3D pixel sensors before irradiation are very satisfactory and support the conclusion that columnar devices are very good candidates for the inner layers of the upgrade pixel detectors.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Contrast-Enhanced Ultrasonography of Hepatocellular Carcinoma After Chemoembolisation Using Drug-Eluting Beads: A Pilot Study Focused on Sustained Tumor Necrosis

The purpose of this study was to assess the use of contrast-enhanced ultrasonography (CEUS) and the sustained antitumor effect of drug-eluting beads used for transarterial chemoembolisation (TACE) of unresectable hepatocellular carcinoma (HCC). Ten patients with solitary, unresectable HCC underwent CEUS before, 2 days after, and 35 to 40 days after TACE using a standard dose (4 ml) of drug-eluting beads (DC Beads; Biocompatibles, Surrey, UK) preloaded with doxorubicin (25 mg doxorubicin/ml hydrated beads). For CEUS, a second-generation contrast agent (SonoVue, Bracco, Milan, Italy) and a low mechanical-index technique were used. A part of the tumor was characterized as necrotic if it showed complete lack of enhancement. The percentage of necrosis was calculated at the sonographic section that depicted the largest diameter of the tumor. Differences in the extent of early (2 days after TACE) and delayed (35 to 40 days after TACE) necrosis were quantitatively and subjectively assessed. Early post-TACE tumor necrosis ranged from 21% to 70% (mean 43.5% {+-} 19%). There was a statistically significant (p = 0.0012, paired Student t test) higher percentage of delayed tumor necrosis, which ranged from 24% to 88% (mean 52.3% {+-} 20.3%). Subjective evaluation showed a delayed obvious increase of the necrotic areas in 5 patients. In 2 patients, tumor vessels that initially remained patent disappeared on the delayed follow-up. A part of tumor necrosis after chemoembolisation of HCC with DEB seems to take place later than 2 days after TACE. CEUS may provide evidence for the sustained antitumor effect of DEB-TACE. Nevertheless, the ideal time for the imaging evaluation of tumor response remains to be defined.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Unenhanced and Contrast-Enhanced Ultrasonography During Hepatic Transarterial Embolization and Chemoembolization With Drug-Eluting Beads

The purpose of this study was to describe and evaluate the findings of unenhanced ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) when these modalities are applied during transarterial embolization (TAE) or transarterial chemoembolization (TACE) of liver tumors. Sixteen tumors (9 hepatocellular carcinomas, 5 metastases from colorectal cancer, and 2 hemangiomas) were treated with TAE with microspheres and/or TACE with drug-eluting beads. All of these lesions were studied with intraprocedural unenhanced US and 12 were studied with intraprocedural CEUS. For the latter, a second-generation echo-enhancer (SonoVue; Bracco, Milan, Italy) and a low mechanical index technique were used. Intraprocedural findings were classified according to an arbitrary scale and were compared with pretreatment imaging (CEUS and computed tomography or CEUS and magnetic resonance imaging), with postembolization angiography, and with follow-up results. On unenhanced intraprocedural US, 13 of 16 tumors demonstrated intralesional high-level echoes of varying extent. These feature correlated poorly (r = 0.33, p = 0.097) with and generally underestimated the actual extent of necrosis. Exceptionally, high-level echoes that occupied the largest part of the treated lesions were associated with >50% tumor necrosis. Intraprocedural CEUS clearly depicted immediate partial or complete disappearance of tumor enhancement as a result of TAE/TACE. Three of 6 tumors with complete devascularization on postembolization angiogram showed residual enhancement on intraprocedural CEUS. Intraprocedural CEUS findings correlated closely (r = 0.91, p = 0.002) with follow-up findings. Intraprocedural sonography, particularly with echo-enhancers, could be used for intraprocedural monitoring in selected cases of liver tumors that undergo TAE or TACE.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Efficacy and Safety of Two Different n-Butyl-2-Cyanoacrylates for the Embolization of Varicoceles: A Prospective, Randomized, Blinded Study

Purpose: This was a prospective, randomized, blinded comparative study of the efficacy and safety of two different n-butyl-2-cyanoacrylates (NBCAs) for embolization of varicoceles. Methods: A total of 112 insufficient spermatic veins (left-sided, n = 84; right-sided, n = 28) that were diagnosed in 83 adult males were prospectively randomized for blinded embolization with NBCA (n = 54; Histoacryl, Braun, Germany) or NBCA-MS (n = 58; Glubran2, General Enterprise Marketing, Viareggio, Lucca, Italy). Handling, embolic efficacy, and safety of both NBCAs were compared according the fulfillment of a standardized embolization plan, the occlusive effect on the spermatic vein, and the sticking to the microcatheter. Statistical analysis was performed with the Mann-Whitney U test and the Fisher's exact test. Results: Patients of both study arms were comparable for age and clinical indication. Spermatic vein characteristics were comparable for varicocele classification and embolization side. Both NBCAs were equally efficient in occluding the spermatic vein and blocking reflux (NBCA, n = 54/54, 100% vs. NBCA-MS, n = 54/57, 94.7%; P = 0.244). The embolization plan could be accomplished in an equal number of veins for both groups (NBCA, n = 45/54, 83.3% vs. NBCA-MS, n = 41/58, 70.7%; P = 0.124). Adhesiveness of the glue to the microcatheter was the same in both NBCA groups (NBCA, n = 25/54, 46.3% vs. NBCA-MS, n = 29/58, 50%; P = 0.71). No glue-related complications were noted. Conclusions: NBCA and NBCA-MS are equally efficient and safe glues for embolization of varicoceles.

61 RADIATION PROTECTION AND DOSIMETRY↗

Transcatheter Treatment of Hepatocellular Carcinoma with Doxorubicin-loaded DC Bead (DEBDOX): Technical Recommendations

Tranarterial chemoembolization (TACE) has been established by a meta-analysis of randomized controlled trials as the standard of care for nonsurgical patients with large or multinodular noninvasive hepatocellular carcinoma (HCC) isolated to the liver and with preserved liver function. Although conventional TACE with administration of an anticancer-in-oil emulsion followed by embolic agents has been the most popular technique, the introduction of embolic drug-eluting beads has provided an alternative to lipiodol-based regimens. Experimental studies have shown that TACE with drug-eluting beads has a safe pharmacokinetic profile and results in effective tumor killing in animal models. Early clinical experiences have confirmed that drug-eluting beads provide a combined ischemic and cytotoxic effect locally with low systemic toxic exposure. Recently, the clinical value of a TACE protocol performed by using the embolic microsphere DC Bead loaded with doxorubicin (DEBDOX; drug-eluting bead doxorubicin) has been shown by randomized controlled trials. An important limitation of conventional TACE has been the inconsistency in the technique and the treatment schedules. This limitation has hampered the acceptance of TACE as a standard oncology treatment. Doxorubicin-loaded DC Bead provides levels of consistency and repeatability not available with conventional TACE and offers the opportunity to implement a standardized approach to HCC treatment. With this in mind, a panel of physicians took part in a consensus meeting held during the European Conference on Interventional Oncology in Florence, Italy, to develop a set of technical recommendations for the use of DEBDOX in HCC treatment. The conclusions of the expert panel are summarized.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Risk Factors for Immediate and Delayed-Onset Fever After Percutaneous Transhepatic Biliary Drainage

ObjectivesTo prospectively investigate the pre and intra-procedural risk factors for immediate (IF) and delayed-onset (DOF) fever development after percutaneous transhepatic biliary drainage (PTBD).MethodsInstitutional review board approval and informed patient consent were obtained. Between February 2013 and February 2014, 97 afebrile patients (77 at the Sapienza University of Rome, Italy and 20 at the Sun Yat-sen University of Guangzhou, China) with benign (n = 31) and malignant (n = 66) indications for a first PTBD were prospectively enrolled. Thirty pre- and intra-procedural clinical/radiological characteristics, including the amount of contrast media injected prior to PTBD placement, were collected in relation to the development of IF (within 24 h) or DOF (after 24 h). Fever was defined as ≥37.5 °C. Binary logistic regression analysis was used to assess independent associations with IF and DOF.ResultsFourteen (14.4 %) patients developed IF and 17 (17.5 %) developed DOF. At multivariable analysis, IF was associated with pre-procedural absence of intrahepatic bile duct dilatation (OR 63.359; 95 % CI 2.658–1510.055; P = 0.010) and low INR (OR 4.7 × 10{sup −4}; 95 % CI 0.000–0.376; P = 0.025), while DOF was associated with unsatisfactory biliary drainage at the end of PTBD (OR 4.571; 95 % CI 1.161–17.992; P = 0.030).ConclusionsThe amount of contrast injected is not associated with post-PTBD fever development. Unsatisfactory biliary drainage at the end of PTBD is associated with DOF, suggesting that complete biliary tree decompression should be pursued within the first PTBD. Patients with unsatisfactory drainage and those with the absence of pre-procedural intrahepatic bile duct dilatation, which is associated with IF, require tailored post-PTBD management.

62 RADIOLOGY AND NUCLEAR MEDICINE↗