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Search indexed NASA NTRS and DOE OSTI research on propulsion, heat transfer, battery materials and energy systems. Follow report and document links to the original sources.

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At least 307 records · Page 17
All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-J-237: Image Feature Based DRR and Portal Image Registration

Purpose: Two-dimensional (2D) matching of the kV X-ray and digitally reconstructed radiography (DRR) images is an important setup technique for image-guided radiotherapy (IGRT). In our clinics, mutual information based methods are used for this purpose on commercial linear accelerators, but with often needs for manual corrections. This work proved the feasibility that feature based image transform can be used to register kV and DRR images. Methods: The scale invariant feature transform (SIFT) method was implemented to detect the matching image details (or key points) between the kV and DRR images. These key points represent high image intensity gradients, and thus the scale invariant features. Due to the poor image contrast from our kV image, direct application of the SIFT method yielded many detection errors. To assist the finding of key points, the center coordinates of the kV and DRR images were read from the DICOM header, and the two groups of key points with similar relative positions to their corresponding centers were paired up. Using these points, a rigid transform (with scaling, horizontal and vertical shifts) was estimated. We also artificially introduced vertical and horizontal shifts to test the accuracy of our registration method on anterior-posterior (AP) and lateral pelvic images. Results: The results provided a satisfactory overlay of the transformed kV onto the DRR image. The introduced vs. detected shifts were fit into a linear regression. In the AP image experiments, linear regression analysis showed a slope of 1.15 and 0.98 with an R2 of 0.89 and 0.99 for the horizontal and vertical shifts, respectively. The results are 1.2 and 1.3 with R2 of 0.72 and 0.82 for the lateral image shifts. Conclusion: This work provided an alternative technique for kV to DRR alignment. Further improvements in the estimation accuracy and image contrast tolerance are underway.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2011

The Essential Role of Radiotherapy in the Treatment of Merkel Cell Carcinoma: A Study From the Rare Cancer Network

Purpose: To evaluate the role of postoperative radiotherapy (RT) in Merkel cell carcinoma (MCC). Methods and Materials: A retrospective multicenter study was performed in 180 patients with MCC treated between February 1988 and September 2009. Patients who had had surgery alone were compared with patients who received surgery and postoperative RT or radical RT. Local relapse-free survival (LRFS), regional relapse-free survival (RRFS), and distant metastasis-free survival (DMFS) rates were assessed together with disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates. Results: Seventy-nine patients were male and 101 patients were female, and the median age was 73 years old (range, 38-93 years). The majority of patients had localized disease (n = 146), and the remaining patients had regional lymph node metastasis (n = 34). Forty-nine patients underwent surgery for the primary tumor without postoperative RT to the primary site; the other 131 patients received surgery for the primary tumor, followed by postoperative RT (n = 118) or a biopsy of the primary tumor followed by radical RT (n = 13). Median follow-up was 5 years (range, 0.2-16.5 years). Patients in the RT group had improved LRFS (93% vs. 64%; p < 0.001), RRFS (76% vs. 27%; p < 0.001), DMFS (70% vs. 42%; p = 0.01), DFS (59% vs. 4%; p < 0.001), and CSS (65% vs. 49%; p = 0.03) rates compared to patients who underwent surgery for the primary tumor alone; LRFS, RRFS, DMFS, and DFS rates remained significant with multivariable Cox regression analysis. However OS was not significantly improved by postoperative RT (56% vs. 46%; p = 0.2). Conclusions: After multivariable analysis, postoperative RT was associated with improved outcome and seems to be an important component in the multimodality treatment of MCC.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

F-18 FDG PET for assessment of disease activity of large vessel vasculitis: A systematic review and meta-analysis

Background: The aim of this study is to investigate the performance of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) or positron emission tomography/computed tomography (PET/CT) for the assessment of disease activity in patients with large vessel vasculitis (LVV) through a meta-analysis. Methods: The MEDLINE via PubMed and EMBASE were searched for the studies evaluating the performance of F-18 FDG PET or PET/CT in the assessment of disease activity in patients with LVV. Pooled sensitivity, specificity, diagnostic odds ratios (DORs), and summary receiver-operating characteristic (sROC) curve were estimated across the included studies. Possible publication bias was assessed by Deek’s funnel plot asymmetry tests. Results: A total of 439 PET images from 298 patients pooled from nine studies showed that the pooled sensitivity was 0.88 [95% confidence interval (CI) 0.79-0.93] without heterogeneity (χ{sup 2} = 14.42, P = .07) and the pooled specificity was 0.81 (95% CI 0.64-0.91) with heterogeneity (χ{sup 2} = 63.72, P = .00) for the detection of active LVV. The pooled DOR was 30 (95% CI 8-107). Hierarchical sROC curve indicates that the area under the curve was 0.91 (95% CI 0.89-0.94). There was no significant publication bias (P = .42), and meta-regression analysis revealed that none of the variables was the source of the study heterogeneity. Conclusions: F-18 FDG PET has a good performance for the detection of active disease status in patients with LVV. Revised criteria for the assessment of disease activity incorporated with F-18 FDG PET or PET/CT should be introduced and validated. Further studies are warranted to determine if PET-based treatment of LVV can improve outcomes.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2018

HOXC10 promotes gastric cancer cell invasion and migration via regulation of the NF-κB pathway

Homeobox gene C10 (HOXC10), known to regulate cell differentiation and proliferation, is upregulated in gastric cancer (GC). The mechanism underlying HOXC10 involvement in GC metastasis is unclear. Herein, we found that HOXC10 is overexpressed in GC relative to normal controls. In the 73 GC patients tissue microarrays (TMA) tested, HOXC10 expression was closely related with tumor-node-metastasis (TNM) stage, lymph node metastasis, and distant metastasis. HOXC10 overexpression tended to associate with low 5-year cumulative survival. Cox regression analysis identified HOXC10 as an independent prognostic factor for poor patient survival. HOXC10 promoted GC cell invasion and migration, regulated the expression of activated ATM and markers of NF-κB signaling. HOXC10 may promote invasion and migration of GC by regulating ATM/NF-κB signaling pathway. HOXC10 should be explored as a clinical marker of GC prognosis.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Is Intermediate Radiation Dose Escalation With Concurrent Chemotherapy for Stage III Non–Small-Cell Lung Cancer Beneficial? A Multi-Institutional Propensity Score Matched Analysis

Purpose: The clinical benefits and risks of dose escalation (DE) for stage III non–small-cell lung cancer (NSCLC) remain uncertain despite the results from Radiation Therapy Oncology Group (RTOG) protocol 0617. There is significant heterogeneity of practice, with many clinicians prescribing intermediate dose levels between the 0617 study arms of 60 and 74 Gy. This study investigated whether this strategy is associated with any survival benefits/risks by analyzing a large multi-institutional database. Methods and Materials: An individual patient database of stage III NSCLC patients treated with radical intent concurrent chemoradiation therapy was created (13 institutions, n=1274 patients). Patients were divided into 2 groups based on tumor Biological Effective Dose at 10 Gy (BED 10): those receiving standard dose (SD; n=552), consisting of 72Gy ≤ BED 10 ≤ 76.8 Gy (eg 60-64 Gy/30-32 fractions [fr]), and those receiving intermediate dose (ID; n=497), consisting of 76.8Gy < BED 10 < 100.8 Gy (eg >64 Gy/32 fr and <74 Gy/37 fr), with lower-dose patients (n=225) excluded from consideration. Patients were then matched using propensity scores, leading to 2 matched groups of 196 patients. Outcomes were compared using various statistics including interquartile range (IQR), Kaplan-Meier curves, and adjusted Cox regression analysis. Results: Matched groups were found to be balanced except for N stage (more N3 disease in SD), median treatment year (SD in 2003; ID in 2007), platinum and taxane chemotherapy (SD in 28%; ID in 39%), and median follow-up (SD were 89 months; ID were 40 months). Median dose fractionation was 60 Gy/30 fr in SD (BED 10 IQR: 72.0-75.5 Gy) and 66 Gy/33 fr (BED 10 IQR: 78.6-79.2 Gy) in ID. Survival curves for SD and ID matched cohorts were statistically similar (P=.27); however, a nonstatistically significant trend toward better survival for ID was observed after 15 months (median survival SD: 19.3 months; ID: 21.0 months). There was an increase in grades III to V lung toxicity associated with ID (13.0% vs 4.9%, respectively). Conclusions: No significant overall survival benefits were found with intermediate DE; however, more grade III or greater lung toxicity was observed. The separation of survival curves after 15 months of follow-up suggests that a small overall survival improvement associated with intermediate DE cannot be excluded.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial Perfusion imaging: Final 3-year report of the J-ACCESS 3 study

Background: Myocardial perfusion imaging (MPI) is considered useful for risk stratification among patients with chronic kidney disease (CKD), without renal deterioration by contrast media. Methods and Results: The Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS 3) is a multicenter, prospective cohort study investigating the ability of MPI to predict cardiac events in 529 CKD patients without a definitive coronary artery disease. All patients were assessed by stress and rest MPI with {sup 99m}Tc-tetrofosmin and data were analyzed using a defect scoring method and QGS software. Major cardiac events were analyzed for 3 years after registration. The mean eGFR was 29.0 ± 12.8 (mL/minute/1.73 m{sup 2}). The mean summed stress/rest/difference (SSS, SRS, SDS) scores were 1.9 ± 3.8, 1.1 ± 3.0, and 0.8 ± 1.8, respectively. A total of 60 cardiac events (three cardiac deaths, six sudden deaths, five nonfatal myocardial infarctions, 46 hospitalization cases for heart failure) occurred. The event-free survival rate was lower among patients with kidney dysfunction, higher SSS, and higher CRP values. Multivariate Cox regression analysis independently associated SSS ≥8, eGFR <15 (mL/minute/1.73 m{sup 2}), and CRP ≥0.3 (mg/dL) with cardiac events. Conclusions: Together with eGFR and CRP, MPI can predict cardiac events in patients with CKD.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Evaluation and comparison of benchmark QSAR models to predict a relevant REACH endpoint: The bioconcentration factor (BCF)

The bioconcentration factor (BCF) is an important bioaccumulation hazard assessment metric in many regulatory contexts. Its assessment is required by the REACH regulation (Registration, Evaluation, Authorization and Restriction of Chemicals) and by CLP (Classification, Labeling and Packaging). We challenged nine well-known and widely used BCF QSAR models against 851 compounds stored in an ad-hoc created database. The goodness of the regression analysis was assessed by considering the determination coefficient (R{sup 2}) and the Root Mean Square Error (RMSE); Cooper's statistics and Matthew's Correlation Coefficient (MCC) were calculated for all the thresholds relevant for regulatory purposes (i.e. 100 L/kg for Chemical Safety Assessment; 500 L/kg for Classification and Labeling; 2000 and 5000 L/kg for Persistent, Bioaccumulative and Toxic (PBT) and very Persistent, very Bioaccumulative (vPvB) assessment) to assess the classification, with particular attention to the models' ability to control the occurrence of false negatives. As a first step, statistical analysis was performed for the predictions of the entire dataset; R{sup 2}>0.70 was obtained using CORAL, T.E.S.T. and EPISuite Arnot–Gobas models. As classifiers, ACD and log P-based equations were the best in terms of sensitivity, ranging from 0.75 to 0.94. External compound predictions were carried out for the models that had their own training sets. CORAL model returned the best performance (R{sup 2}{sub ext}=0.59), followed by the EPISuite Meylan model (R{sup 2}{sub ext}=0.58). The latter gave also the highest sensitivity on external compounds with values from 0.55 to 0.85, depending on the thresholds. Statistics were also compiled for compounds falling into the models Applicability Domain (AD), giving better performances. In this respect, VEGA CAESAR was the best model in terms of regression (R{sup 2}=0.94) and classification (average sensitivity>0.80). This model also showed the best regression (R{sup 2}=0.85) and sensitivity (average>0.70) for new compounds in the AD but not present in the training set. However, no single optimal model exists and, thus, it would be wise a case-by-case assessment. Yet, integrating the wealth of information from multiple models remains the winner approach. - Highlights: • REACH encourages the use of in silico methods in the assessment of chemicals safety. • The performances of nine BCF models were evaluated on a benchmark database of 851 chemicals. • We compared the models on the basis of both regression and classification performance. • Statistics on chemicals out of the training set and/or within the applicability domain were compiled. • The results show that QSAR models are useful as weight-of-evidence in support to other methods.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2016

SU-F-I-31: Reproducibility of An Automatic Exposure Control Technique in the Low-Dose CT Scan of Cardiac PET/CT Exams

Purpose: Two separate low-dose CT scans are usually performed for attenuation correction of rest and stress N-13 ammonia PET/CT myocardial perfusion imaging (PET/CT). We utilize an automatic exposure control (AEC) technique to reduce CT radiation dose while maintaining perfusion image quality. Our goal is to assess the reproducibility of displayed CT dose index (CTDI) on same-day repeat CT scans (CT1 and CT2). Methods: Retrospectively, we reviewed CT images of PET/CT studies performed on the same day. Low-dose CT utilized AEC technique based on tube current modulation called Smart-mA. The scan parameters were 64 × 0.625mm collimation, 5mm slice thickness, 0.984 pitch, 1-sec rotation time, 120 kVp, and noise index 50 with a range of 10–200 mA. The scan length matched with PET field of view (FOV) with the heart near the middle of axial FOV. We identified the reference slice number (RS) for an anatomical landmark (carina) and used it to estimate axial shift between two CTs. For patient size, we measured an effective diameter on the reference slice. The effect of patient positioning to CTDI was evaluated using the table height. We calculated the absolute percent difference of the CTDI (%diff) for estimation of the reproducibility. Results: The study included 168 adults with an average body-mass index of 31.72 ± 9.10 (kg/m{sup 2}) and effective diameter was 32.72 ± 4.60 cm. The average CTDI was 1.95 ± 1.40 mGy for CT1 and 1.97 ± 1.42mGy for CT2. The mean %diff was 7.8 ± 6.8%. Linear regression analysis showed a significant correlation between the table height and %diff CTDI. (r=0.82, p<0.001) Conclusion: We have shown for the first time in human subjects, using two same-day CT images, that the AEC technique in low-dose CT is reproducible within 10% and significantly depends on the patient centering.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2017

Extending the Calibration of C iv-based Single-epoch Black Hole Mass Estimators for Active Galactic Nuclei

We provide an updated calibration of C iv λ1549 broad emission line–based single-epoch (SE) black hole (BH) mass estimators for active galactic nuclei (AGNs) using new data for six reverberation-mapped AGNs at redshift z=0.005--0.028 with BH masses (bolometric luminosities) in the range 10{sup 6.5}--10{sup 7.5} M{sub ⊙} (10{sup 41.7}--10{sup 43.8} erg s{sup −1}). New rest-frame UV-to-optical spectra covering 1150–5700 Å for the six AGNs were obtained with the Hubble Space Telescope (HST). Multicomponent spectral decompositions of the HST spectra were used to measure SE emission-line widths for the C iv, Mg ii, and Hβ lines, as well as continuum luminosities in the spectral region around each line. We combine the new data with similar measurements for a previous archival sample of 25 AGNs to derive the most consistent and accurate calibrations of the C iv-based SE BH mass estimators against the Hβ reverberation-based masses, using three different measures of broad-line width: full width at half maximum (FWHM), line dispersion (σ{sub line}), and mean absolute deviation (MAD). The newly expanded sample at redshift z=0.005--0.234 covers a dynamic range in BH mass (bolometric luminosity) of logM{sub BH}/M{sub ⊙}=6.5--9.1 (logL{sub bol}/ erg s{sup −1} = 41.7--46.9), and we derive the new C iv-based mass estimators using a Bayesian linear regression analysis over this range. We generally recommend the use of σ{sub line} or MAD rather than FWHM to obtain a less biased velocity measurement of the C iv emission line, because its narrow-line component contribution is difficult to decompose from the broad-line profile.

79 ASTRONOMY AND ASTROPHYSICS↗
DOE OSTI2015

SU-E-T-131: Artificial Neural Networks Applied to Overall Survival Prediction for Patients with Periampullary Carcinoma

Purpose: Artificial neural networks (ANN) can be used to discover complex relations within datasets to help with medical decision making. This study aimed to develop an ANN method to predict two-year overall survival of patients with peri-ampullary cancer (PAC) following resection. Methods: Data were collected from 334 patients with PAC following resection treated in our institutional pancreatic tumor registry between 2006 and 2012. The dataset contains 14 variables including age, gender, T-stage, tumor differentiation, positive-lymph-node ratio, positive resection margins, chemotherapy, radiation therapy, and tumor histology.After censoring for two-year survival analysis, 309 patients were left, of which 44 patients (∼15%) were randomly selected to form testing set. The remaining 265 cases were randomly divided into training set (211 cases, ∼80% of 265) and validation set (54 cases, ∼20% of 265) for 20 times to build 20 ANN models. Each ANN has one hidden layer with 5 units. The 20 ANN models were ranked according to their concordance index (c-index) of prediction on validation sets. To further improve prediction, the top 10% of ANN models were selected, and their outputs averaged for prediction on testing set. Results: By random division, 44 cases in testing set and the remaining 265 cases have approximately equal two-year survival rates, 36.4% and 35.5% respectively. The 20 ANN models, which were trained and validated on the 265 cases, yielded mean c-indexes as 0.59 and 0.63 on validation sets and the testing set, respectively. C-index was 0.72 when the two best ANN models (top 10%) were used in prediction on testing set. The c-index of Cox regression analysis was 0.63. Conclusion: ANN improved survival prediction for patients with PAC. More patient data and further analysis of additional factors may be needed for a more robust model, which will help guide physicians in providing optimal post-operative care. This project was supported by PA CURE Grant.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2011

Primary Analysis of a Phase II Randomized Trial Radiation Therapy Oncology Group (RTOG) 0212: Impact of Different Total Doses and Schedules of Prophylactic Cranial Irradiation on Chronic Neurotoxicity and Quality of Life for Patients With Limited-Disease Small-Cell Lung Cancer

Purpose: To determine the effect of dose and fractionation schedule of prophylactic cranial irradiation (PCI) on the incidence of chronic neurotoxicity (CNt) and changes in quality of life for selected patients with limited-disease small-cell lung cancer (LD SCLC). Methods and Materials: Patients with LD SCLC who achieved a complete response after chemotherapy and thoracic irradiation were eligible for randomization to undergo PCI to a total dose of 25 Gy in 10 daily fractions (Arm 1) vs. the experimental cohort of 36 Gy. Those receiving 36 Gy underwent a secondary randomization between daily 18 fractions (Arm 2) and twice-daily 24 fractions (Arm 3). Enrolled patients participated in baseline and follow-up neuropsychological test batteries along with quality-of-life assessments. Results: A total of 265 patients were accrued, with 131 in Arm 1, 67 in Arm 2, and 66 in Arm 3 being eligible. There are 112 patients (42.2%) alive with 25.3 months of median follow-up. There were no significant baseline differences among groups regarding quality-of-life measures and one of the neuropsychological tests, namely the Hopkins Verbal Learning Test. However, at 12 months after PCI there was a significant increase in the occurrence of CNt in the 36-Gy cohort (p = 0.02). Logistic regression analysis revealed increasing age to be the most significant predictor of CNt (p = 0.005). Conclusions: Because of the increased risk of developing CNt in study patients with 36 Gy, a total PCI dose of 25 Gy remains the standard of care for patients with LD SCLC attaining a complete response to initial chemoradiation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Comparison of classical statistical methods and artificial neural network in traffic noise prediction

Traffic is the main source of noise in urban environments and significantly affects human mental and physical health and labor productivity. Therefore it is very important to model the noise produced by various vehicles. Techniques for traffic noise prediction are mainly based on regression analysis, which generally is not good enough to describe the trends of noise. In this paper the application of artificial neural networks (ANNs) for the prediction of traffic noise is presented. As input variables of the neural network, the proposed structure of the traffic flow and the average speed of the traffic flow are chosen. The output variable of the network is the equivalent noise level in the given time period L{sub eq}. Based on these parameters, the network is modeled, trained and tested through a comparative analysis of the calculated values and measured levels of traffic noise using the originally developed user friendly software package. It is shown that the artificial neural networks can be a useful tool for the prediction of noise with sufficient accuracy. In addition, the measured values were also used to calculate equivalent noise level by means of classical methods, and comparative analysis is given. The results clearly show that ANN approach is superior in traffic noise level prediction to any other statistical method. - Highlights: • We proposed an ANN model for prediction of traffic noise. • We developed originally designed user friendly software package. • The results are compared with classical statistical methods. • The results are much better predictive capabilities of ANN model.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2012

A Prolonged Time Interval Between Trauma and Prophylactic Radiation Therapy Significantly Increases the Risk of Heterotopic Ossification

Purpose: To ascertain whether the time from injury to prophylactic radiation therapy (RT) influences the rate of heterotopic ossification (HO) after operative treatment of displaced acetabular fractures. Methods and Materials: This is a single-institution, retrospective analysis of patients referred for RT for the prevention of HO. Between January 2000 and January 2009, 585 patients with displaced acetabular fractures were treated surgically followed by RT for HO prevention. We analyzed the effect of time from injury on prevention of HO by RT. In all patients, 700 cGy was prescribed in a single fraction and delivered within 72 hours postsurgery. The patients were stratified into five groups according to time interval (in days) from the date of their accident to the date of RT: Groups A {<=}3, B {<=}7, C {<=}14, D {<=}21, and E >21days. Results: Of the 585 patients with displaced acetabular fractures treated with RT, (18%) 106 patients developed HO within the irradiated field. The risk of HO after RT increased from 10% for RT delivered {<=}3 days to 92% for treatment delivered >21 days after the initial injury. Wilcoxon test showed a significant correlation between the risk of HO and the length of time from injury to RT (p < 0.0001). Chi-square test and multiple logistic regression analysis showed no significant association between all other factors and the risk of HO (race, gender, cause and type of fracture, surgical approach, or the use of indomethacin). Conclusions: Our data suggest that there is higher incidence and risk of HO if prophylactic RT is significantly delayed after a displaced acetabular fracture. Thus, RT should be administered as early as clinically possible after the trauma. Patients undergoing RT >3 weeks from their displaced acetabular fracture should be informed of the higher risk (>90%) of developing HO despite prophylaxis.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2019

Effects of Soil Properties on Cadmium Toxicity to Folsomia candida (Collembola)

The study was endeavored to investigate the effects of soil properties on the acute and chronic cadmium (Cd) toxicities to Folsomia candida (Collembola F. candida). Results of the present study indicated that 10% lethal concentrations (LC10) in a period of 7 days were ranged from 68.6 to > 1000 mg/kg Cd. Soil Cd concentrations that halve F. candida reproductions (EC50, 28 days) were ranged from 41.4 to 146.8 mg/kg. Stepwise regression analysis between the thresholds of Cd toxicity and soil properties revealed that the pH and organic matter (OM) were two fundamental factors for the assessment of biological threats posed by Cd. The exchangeable Cd was mainly affected by soil pH. The reproduction inhibition and adult mortality ratios of F. candida were positively correlated with soil exchangeable Cd. The development of a comprehensive pedotransfer function based on pH and OM values would be suitable for accurately assessing the biological risks arising from Cd contamination.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2016

SU-F-T-128: Dose-Volume Constraints for Particle Therapy Treatment Planning

Purpose: Determine equivalent Organ at Risk (OAR) tolerance dose (TD) constraints for MV x-rays and particle therapy. Methods: Equivalent TD estimates for MV x-rays are determined from an isoeffect, regression-analysis of published and in-house constraints for various fractionation schedules (n fractions). The analysis yields an estimate of (α/β) for an OAR. To determine equivalent particle therapy constraints, the MV x-ray TD(n) values are divided by the RBE for DSB induction (RBE{sub DSB}) or cell survival (RBE{sub S}). Estimates of (RBE{sub DSB}) are computed using the Monte Carlo Damage Simulation, and estimates of RBES are computed using the Repair-Misrepair-Fixation (RMF) model. A research build of the RayStation™ treatment planning system implementing the above model is used to estimate (RBE{sub DSB}) for OARs of interest in 16 proton therapy patient plans (head and neck, thorax, prostate and brain). Results: The analysis gives an (α/β) estimate of about 20 Gy for the trachea and heart and 2–4 Gy for the esophagus, spine, and brachial plexus. Extrapolation of MV x-ray constraints (n = 1) to fast neutrons using RBE{sub DSB} = 2.7 are in excellent agreement with clinical experience (n = 10 to 20). When conventional (n > 30) x-ray treatments are used as the reference radiation, fast neutron RBE increased to a maximum of 6. For comparison to a constant RBE of 1.1, the RayStation™ analysis gave estimates of proton RBE{sub DSB} from 1.03 to 1.33 for OARs of interest. Conclusion: The presented system of models is a convenient formalism to synthesize from multiple sources of information a set of self-consistent plan constraints for MV x-ray and hadron therapy treatments. Estimates of RBE{sub DSB} from the RayStation™ analysis differ substantially from 1.1 and vary among patients and treatment sites. A treatment planning system that incorporates patient and anatomy-specific corrections in proton RBE would create opportunities to increase the therapeutic ratio. The research build of the RayStation used in the study was made available to the University of Washington free of charge. RaySearch Laboratories did not provide any monetary support for the reported studies.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

Impact of Using Audit Data to Improve the Evidence-Based Use of Single-Fraction Radiation Therapy for Bone Metastases in British Columbia

Purpose: To assess the impact of a population-based intervention to increase the consistency and use of single-fraction radiation therapy (SFRT) for bone metastases. Methods and Materials: In 2012, an audit of radiation therapy prescriptions for bone metastases in British Columbia identified significant interphysician and -center (26%-73%) variation in the use of SFRT. Anonymous physician-level and identifiable regional cancer center SFRT use data were presented to all radiation oncologists, together with published guidelines, meta-analyses, and recommendations from practice leaders. The use of SFRT for bone metastases from 2007 through 2011 was compared with use of SFRT in 2013, to assess the impact of the audit and educational intervention. Multilevel logistic regression was used to assess the relationship between the usage of SFRT and the timing of the radiation while controlling for potentially confounding variables. Physician and center were included as group effects to account for the clustered structure of the data. Results: A total of 16,898 courses of RT were delivered from 2007 through 2011, and 3200 courses were delivered in 2013. The rates of SFRT use in 2007, 2008, 2009, 2010, 2011, and 2013 were 50.5%, 50.9%, 48.3%, 48.5%, 48.0%, and 59.7%, respectively (P<.001). Use of SFRT increased in each of 5 regional centers: A: 26% to 32%; B: 36% to 56%; C: 39% to 57%; D: 49% to 56%; and E: 73% to 85.0%. Use of SFRT was more consistent; 3 of 5 centers used SFRT for 56% to 57% of bone metastases RT courses. The regression analysis showed strong evidence that the usage of SFRT increased after the 2012 intervention (odds ratio 2.27, 95% confidence interval 2.06-2.50, P<.0001). Conclusion: Assessed on a population basis, an audit-based intervention increased utilization of SFRT for bone metastases. The intervention reversed a trend to decreasing SFRT use, reduced costs, and improved patient convenience. This suggests that dissemination of programmatic quality indicators in oncology can lead to increased utilization of evidence-based practice.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-D-204-01: Dual-Energy Calibration for Breast Density Measurement Using Spectral Mammography

Purpose: To investigate the feasibility of minimizing the systematic errors in dual-energy breast density quantification induced by the use of tissue-equivalent plastic phantoms as the calibration basis materials. Methods: Dual-energy calibration using tissue-equivalent plastic phantoms was performed on a spectral mammography system based on scanning multi-slit Si strip photon-counting detectors. The plastic phantom calibration used plastic water and adipose-equivalent phantoms as the basis materials, which have different x-ray attenuation properties compared to water and lipid in actual breast tissue. Two methods were used to convert the dual-energy decomposition measurements in plastic phantom thicknesses into true water and lipid basis. The first method was based entirely on the theoretical x-ray attenuation coefficients of the investigated materials in the mammographic energy range. The conversion matrix was determined from least-squares fitting of the target material using the reported attenuation coefficients of water and lipid. The second method was developed based on experimental calibrations, which measured the low-and high-energy signals of pure water and lipid of known thicknesses. A non-linear rational function was used to correlate the decomposed thicknesses to the known values, so that the conversion coefficients can be determined. Both methods were validated using independent measurements of water and lipid mixture phantoms. The correlation of the dual-energy decomposition measurements and the known values were studied with linear regression analysis. Results: There was an excellent linear correlation between the converted water thicknesses and the known values. The slopes of the linear fits were determined to be 0.63 and 1.03 for the simulation and experimental results, respectively. The non-linear fitting in the experimental approach reduced the root-mean-square (RMS) errors from approximately 3.4 mm to 1.5 mm. Conclusion: The results suggested that conversion of the dual-energy measurements into water and lipid thicknesses minimized the systematic errors in tissue decomposition studies.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2019

Correlation between SACE (Subjective Angiographic Chemoembolization Endpoint) score and tumor response and its impact on survival after DEB-TACE in patients with hepatocellular carcinoma

Purpose: To asses angiographic and computed tomographic success criteria during and after transcatheter arterial drug-eluting bead chemoembolization (DEB-TACE) in patients with hepatocellular carcinoma (HCC) and its impact on progression-free survival (PFS) and overall survival (OS). Methods: In this retrospective single-center study, 50 patients with unresectable HCC having undergone DEB-TACE from January 2010 to July 2015 were assessed. The angiographic endpoint was classified by Subjective Angiographic Chemoembolization Endpoint (SACE) scale. Relative tumor density in arterial (D{sub Art}) and portal venous phase (D{sub PV}) computed tomography post- versus pre-DEB-TACE were calculated, respectively. Tumor response according to modified Response Criteria in Solid Tumors (mRECIST) was assessed. Univariate Kaplan–Meier and Cox regression analysis were carried out. Results: SACE scores I, II, III, and IV were found in 1 (2%), 20 (40%), 15 (30%), and 14 (28%) patients, respectively. Median OS and PFS were 14.2 and 5.5 months, respectively. Death rates at 6 months, 1 year and 2 years were 24%, 38%, and 52%, respectively. SACE score during DEB-TACE significantly correlated with local and overall mRECIST results (local: p < 0.001, r = 0.49, overall: p = 0.042, r = 0.29) and inversely correlated with D{sub PV} (p = 0.005, r = − 0.40). In univariate analysis, progressive disease (PD) according to mRECIST and increase of D{sub Art} and D{sub PV} were associated with significantly shorter PFS. Modified RECIST independently predicted OS (hazard ratio for complete remission vs. PD = 0.15, 95% confidence interval 0.03–0.68, p = 0.014). Conclusions: A direct impact of SACE on PFS or OS could not be shown. However, SACE significantly correlated with local and overall mRECIST tumor response that again significantly predicted OS. We therefore postulate an indirect impact of SACE on OS. Consequently, complete embolization should be attempted.

62 RADIOLOGY AND NUCLEAR MEDICINE↗