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At least 415 records · Page 23

Transcatheter Embolotherapy with N-Butyl Cyanoacrylate for Ectopic Varices

PurposeTo address technical feasibility and clinical outcome of transcatheter embolotherapy with N-butyl cyanoacrylate (NBCA) for bleeding ectopic varices.MethodsThe institutional review board approved this retrospective study and waived informed consent. From January 2004 to June 2013, a total of 12 consecutive patients received transcatheter embolotherapy using NBCA for bleeding ectopic varices in our institute. Clinical and radiologic features of the endovascular procedures were comprehensively reviewed.ResultsPreprocedural computed tomography images revealed ectopic varices in the jejunum (n = 7), stoma (n = 2), rectum (n = 2), and duodenum (n = 1). The 12 procedures consisted of solitary embolotherapy (n = 8) and embolotherapy with portal decompression (main portal vein stenting in 3, transjugular intrahepatic portosystemic shunt in 1). With regard to vascular access, percutaneous transhepatic access (n = 7), transsplenic access (n = 4), and transjugular intrahepatic portosystemic shunt tract (n = 1) were used. There was no failure in either the embolotherapy or the vascular accesses (technical success rate, 100 %). Two patients died within 1 month from the procedure from preexisting fatal medical conditions. Only one patient, with a large varix that had been partially embolized by using coils and NBCA, underwent rebleeding 5.5 months after the procedure. The patient was retreated with NBCA and did not undergo any bleeding afterward for a follow-up period of 2.5 months. The remaining nine patients did not experience rebleeding during the follow-up periods (range 1.5–33.2 months).ConclusionTranscatheter embolotherapy using NBCA can be a useful option for bleeding ectopic varices.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Embolization by Direct Puncture with a Transpedicular Approach Using an Isocenter Puncture (ISOP) Method in a Patient with a Type II Endoleak After Endovascular Aortic Repair (EVAR)

BackgroundEndovascular aortic repair (EVAR) requires further intervention in 20-30 % of cases, often due to type II endoleak (T2EL). Management options for T2EL include transarterial embolization, direct puncture (DP), or transcaval embolization. We report the case of an 80-year-old man with T2EL who successfully underwent DP embolization.MethodsEmbolization by DP was performed with a transpedicular approach using an isocenter puncture (ISOP) method. An isocenter marker (ICM) was placed at a site corresponding to the aneurysm sac on fluoroscopy in two directions (frontal and lateral views). A vertebroplasty needle was inserted tangentially to the ICM under fluoroscopy and advanced to the anterior wall of the vertebral body. A 20 cm-length, 20-G-PTCD needle was inserted through the outer needle of the 13-G needle and advanced to the ICM. Sac embolization using 25 % N-buty-2-cyanoacrylate diluted with Lipiodol was performed. After complete embolization, rotational DA confirmed good filling of the sac with Lipiodol. The outer cannula and 13-G needle were removed and the procedure was completed.ResultsThe patient was discharged the next day. Contrast-enhanced computed tomography 1 and 8 months later showed no Lipiodol washout in the aneurysm sac, no endoleak recurrence, and no expansion of the excluded aneurysm.ConclusionDP with a transpedicular approach using ISOP may be useful when translumbar and transabdominal approaches prove difficult.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Severe Gastrointestinal Haemorrhage: Summary of a National Quality of Care Study with Focus on Radiological Services

Purpose of StudyTo identify the remediable factors in the quality of care provided to patients with severe gastrointestinal (GI) bleeding.MethodAll hospital admissions in the first four months of 2013 with ICD10 coding for GI bleeding who received a transfusion of 4 units or more of blood. Up to five cases/hospital randomly selected for structured case note peer review. National availability of GI bleeding services data derived from organisational questionnaire completed by all hospitals.Results4563/29,796 (15.3%) of GI bleeds received 4 or more units of blood with a mortality rate of 20.2% compared to 7.3% without blood transfusion. 30.8% of GI bleeds received a blood transfusion. 32% (60/185) of hospitals admitting acute GI bleeds lacked 24/7 endoscopy. 26% (48/185) had on-site embolisation 24/7 with a further 34% (64/185) accessing embolisation by transfer within a validated formal network. Blood product use was inappropriate in 20% (84/426). Improved management, principally earlier senior gastroenterologist review and/or endoscopy, would have reduced blood product use in 25% (113/457). 14.5% (90/618) had a CT scan which identified the site of bleeding in 32% (29/90). 7.8% (36/459) underwent an Interventional Radiology (IR) procedure but a further 6.3% (21/33) should have had IR. 6% (36/586) underwent surgery with 21/36 for uncontrolled bleeding. In 20/35 IR was not considered despite the majority being suitable for IR. Overall 44% (210/476) received an acceptable standard of care according to peer review.Conclusions26 recommendations were made to improve the quality of care in GI bleeding, with six principle recommendations.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-E-T-282: Dose Measurements with An End-To-End Audit Phantom for Stereotactic Radiotherapy

Purpose: Report on dose measurements as part of an end-to-end test for stereotactic radiotherapy, using a new audit tool, which allows audits to be performed efficiently either by an onsite team or as a postal audit. Methods: Film measurements have been performed with a new Stereotactic Cube Phantom. The phantom has been designed to perform Winston Lutz type position verification measurements and dose measurements in one setup. It comprises a plastic cube with a high density ball in its centre (used for MV imaging with film or EPID) and low density markers in the periphery (used for Cone Beam Computed Tomography, CBCT imaging). It also features strategically placed gold markers near the posterior and right surfaces, which can be used to calculate phantom rotations on MV images. Slit-like openings allow insertion of film or other detectors.The phantom was scanned and small field treatment plans were created. The fields do not traverse any inhomogeneities of the phantom on their paths to the measurement location. The phantom was setup at the delivery system using CBCT imaging. The calculated treatment fields were delivered, each with a piece of radiochromic film (EBT3) placed in the anterior film holder of the phantom. MU had been selected in planning to achieve similar exposures on all films. Calibration films were exposed in solid water for dose levels around the expected doses. Films were scanned and analysed following established procedures. Results: Setup of the cube showed excellent suitability for CBCT 3D alignment. MV imaging with EPID allowed for clear identification of all markers. Film based dose measurements showed good agreement for MLC created fields down to 0.5 mm × 0.5 mm. Conclusion: An end-to-end audit phantom for stereotactic radiotherapy has been developed and tested.

60 APPLIED LIFE SCIENCES↗

SU-F-BRA-01: A Procedure for the Fast Semi-Automatic Localization of Catheters Using An Electromagnetic Tracker (EMT) for Image-Guided Brachytherapy

Purpose: To evaluate the feasibility of brachytherapy catheter localization through use of an EMT and 3D image set. Methods: A 15-catheter phantom mimicking an interstitial implantation was built and CT-scanned. Baseline catheter reconstruction was performed manually. An EMT was used to acquire the catheter coordinates in the EMT frame of reference. N user-identified catheter tips, without catheter number associations, were used to establish registration with the CT frame of reference. Two algorithms were investigated: brute-force registration (BFR), in which all possible permutation of N identified tips with the EMT tips were evaluated; and signature-based registration (SBR), in which a distance matrix was used to generate a list of matching signatures describing possible N-point matches with the registration points. Digitization error (average of the distance between corresponding EMT and baseline dwell positions; average, standard deviation, and worst-case scenario over all possible registration-point selections) and algorithm inefficiency (maximum number of rigid registrations required to find the matching fusion for all possible selections of registration points) were calculated. Results: Digitization errors on average <2 mm were observed for N ≥5, with standard deviation <2 mm for N ≥6, and worst-case scenario error <2 mm for N ≥11. Algorithm inefficiencies were: N = 5, 32,760 (BFR) and 9900 (SBR); N = 6, 360,360 (BFR) and 21,660 (SBR); N = 11, 5.45*1010 (BFR) and 12 (SBR). Conclusion: A procedure was proposed for catheter reconstruction using EMT and only requiring user identification of catheter tips without catheter localization. Digitization errors <2 mm were observed on average with 5 or more registration points, and in any scenario with 11 or more points. Inefficiency for N = 11 was 9 orders of magnitude lower for SBR than for BFR. Funding: Kaye Family Award.

60 APPLIED LIFE SCIENCES↗

Investigation of the effect of aggregates' morphology on concrete creep properties by numerical simulations

Prestress losses due to creep of concrete is a matter of interest for long-term operations of nuclear power plants containment buildings. Experimental studies by Granger (1995) have shown that concretes with similar formulations have different creep behaviors. The aim of this paper is to numerically investigate the effect of size distribution and shape of elastic inclusions on the long-term creep of concrete. Several microstructures with prescribed size distribution and spherical or polyhedral shape of inclusions are generated. By using the 3D numerical homogenization procedure for viscoelastic microstructures proposed by Šmilauer and Bažant (2010), it is shown that the size distribution and shape of inclusions have no measurable influence on the overall creep behavior. Moreover, a mean-field estimate provides close predictions. An Interfacial Transition Zone was introduced according to the model of Nadeau (2003). It is shown that this feature of concrete's microstructure can explain differences between creep behaviors.

36 MATERIALS SCIENCE↗

NUMERICAL CONVERGENCE IN SMOOTHED PARTICLE HYDRODYNAMICS

We study the convergence properties of smoothed particle hydrodynamics (SPH) using numerical tests and simple analytic considerations. Our analysis shows that formal numerical convergence is possible in SPH only in the joint limit N → ∞, h → 0, and N{sub nb} → ∞, where N is the total number of particles, h is the smoothing length, and N{sub nb} is the number of neighbor particles within the smoothing volume used to compute smoothed estimates. Previous work has generally assumed that the conditions N → ∞ and h → 0 are sufficient to achieve convergence, while holding N{sub nb} fixed. We demonstrate that if N{sub nb} is held fixed as the resolution is increased, there will be a residual source of error that does not vanish as N → ∞ and h → 0. Formal numerical convergence in SPH is possible only if N{sub nb} is increased systematically as the resolution is improved. Using analytic arguments, we derive an optimal compromise scaling for N{sub nb} by requiring that this source of error balance that present in the smoothing procedure. For typical choices of the smoothing kernel, we find N{sub nb} ∝N {sup 0.5}. This means that if SPH is to be used as a numerically convergent method, the required computational cost does not scale with particle number as O(N), but rather as O(N {sup 1} {sup +} {sup δ}), where δ ≈ 0.5, with a weak dependence on the form of the smoothing kernel.

79 ASTRONOMY AND ASTROPHYSICS↗

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

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.

60 APPLIED LIFE SCIENCES↗

Indirect percutaneous core needle biopsy of solid pancreatic or peripancreatic lesions

Solid pancreatic or peripancreatic lesions comprise a heterogeneous group of diseases that rely on a multimodality imaging approach for subsequent tissue procurement. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA)/biopsy is an effective and safe method for tissue diagnosis in this region. The failure to obtain adequate tissue for diagnosis under EUS guidance is still a rare but important issue. Percutaneous core needle biopsy (CNB) provides an alternative pathway for adequate specimen acquisition. Because of the deep retroperitoneal location, the percutaneous biopsy of pancreatic or peripancreatic lesions may inevitably pass through visceral organs. The procedure is relatively risky and difficult for general radiologists, particularly beginners, and an adequate knowledge of the abdominal anatomy and biopsy technique is indispensable. In this review, various aspects of percutaneous CNB for solid pancreatic or peripancreatic lesions using different trans-organ approaches are reviewed to increase the chance of successful biopsy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4–L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A Study on the Use of XCT and FEA to Predict the Elastic Behavior of Additively Manufactured Parts of Cylindrical Geometry

Defining general criteria for the acceptability of defects within industrial components is often complicated, since the specific load conditions and the criticality of the given application should be considered individually. In order to minimize the risk of failure, high safety factors are commonly adopted during quality control. However this practice is likely to cause the rejection of components whose defects would be instead acceptable if a more sound knowledge of the component behaviour were achieved. Parts produced by additive manufacturing (AM) may suffer from various defects, including micro- or macro-holes, delamination and microstructural discontinuities. Such processes, which are specially suitable for one-off components, require robust and reliable inspection before a part is accepted or rejected, since the refusal of even a single part at the end of the production process represents a significant loss. For this reason, it would be very useful to simulate in a reliable way whether a certain defect is truly detrimental to the proper working of the part during operation or whether the component can still be used, despite the presence of a defect. To this purpose, the paper highlights the benefits of a synergistic interaction between Industrial X-ray computed tomography (XCT) and finite element analysis (FEA). Internal defects of additively manufactured parts can be identified in a non-destructive way by means of XCT. Then FEA can be performed on the XCT-based virtual model of the real component, rather than on the ideal CAD geometry. A proof of concept of this approach is proposed here for a reference construct produced in an Aluminium alloy by AM. Numerical results of the proposed combined XCT–FEA procedure are contrasted with experimental data from tensile tests. The findings sustain the reliability of the method and allow to assess its full provisional accuracy for parts of cylindrical geometry designed to operate in the elastic field. The paper moves a step beyond the present application limits of tomography as it is currently employed for AM parts and it evidences instead the possibility of extending the usage of tomography to acceptance testing and prediction of operative behaviour.

42 ENGINEERING↗

Inverse Thermal Analysis of Ti-6Al-4V Friction Stir Welds Using Numerical-Analytical Basis Functions with Pseudo-Advection

Inverse thermal analysis of Ti-6Al-4V friction stir welds is presented that demonstrates application of a methodology using numerical-analytical basis functions and temperature-field constraint conditions. This analysis provides parametric representation of friction-stir-weld temperature histories that can be adopted as input data to computational procedures for prediction of solid-state phase transformations and mechanical response. These parameterized temperature histories can be used for inverse thermal analysis of friction stir welds having process conditions similar those considered here. Case studies are presented for inverse thermal analysis of friction stir welds that use three-dimensional constraint conditions on calculated temperature fields, which are associated with experimentally measured transformation boundaries and weld-stir-zone cross sections.

36 MATERIALS SCIENCE↗

SU-G-IeP2-04: Dosimetric Accuracy of a Monte Carlo-Based Tool for Cone-Beam CT Organ Dose Calculation: Validation Against OSL and XRQA2 Film Measurements

Purpose: The intensive use of Cone-Beam Computed Tomography (CBCT) during radiotherapy treatments raise some questions about the dose to healthy tissues delivered during image acquisitions. We hence developed a Monte Carlo (MC)-based tool to predict doses to organs delivered by the Elekta XVI kV-CBCT. This work aims at assessing the dosimetric accuracy of the MC tool, in all tissue types. Methods: The kV-CBCT MC model was developed using the PENELOPE code. The beam properties were validated against measured lateral and depth dose profiles in water, and energy spectra measured with a CdTe detector. The CBCT simulator accuracy then required verification in clinical conditions. For this, we compared calculated and experimental dose values obtained with OSL nanoDots and XRQA2 films inserted in CIRS anthropomorphic phantoms (male, female, and 5-year old child). Measurements were performed at different locations, including bone and lung structures, and for several acquisition protocols: lung, head-and-neck, and pelvis. OSLs and film measurements were corrected when possible for energy dependence, by taking into account for spectral variations between calibration and measurement conditions. Results: Comparisons between measured and MC dose values are summarized in table 1. A mean difference of 8.6% was achieved for OSLs when the energy correction was applied, and 89.3% of the 84 dose points were within uncertainty intervals, including those in bones and lungs. Results with XRQA2 are not as good, because incomplete information about electronic equilibrium in film layers hampered the application of a simple energy correction procedure. Furthermore, measured and calculated doses (Fig.1) are in agreement with the literature. Conclusion: The MC-based tool developed was validated with an extensive set of measurements, and enables the organ dose calculation with accuracy. It can now be used to compute and report doses to organs for clinical cases, and also to drive strategies to optimize imaging protocols.

60 APPLIED LIFE SCIENCES↗

Transient responses of phosphoric acid fuel cell power plant system

An analytical and computerized study of the steady state and transient response of a phosphoric acid fuel cell (PAFC) system was completed. Parametric studies and sensitivity analyses of the PAFC system's operation were accomplished. Four non-linear dynamic models of the fuel cell stack, reformer, shift converters, and heat exchangers were developed based on nonhomogeneous non-linear partial differential equations, which include the material, component, energy balance, and electrochemical kinetic features. Due to a lack of experimental data for the dynamic response of the components only the steady state results were compared with data from other sources, indicating reasonably good agreement. A steady state simulation of the entire system was developed using, nonlinear ordinary differential equations. The finite difference method and trial-and-error procedures were used to obtain a solution. Using the model, a PAFC system, that was developed under NASA Grant, NCC3-17, was improved through the optimization of the heat exchanger network. Three types of cooling configurations for cell plates were evaluated to obtain the best current density and temperature distributions. The steady state solutions were used as the initial conditions in the dynamic model. The transient response of a simplified PAFC system, which included all of the major components, subjected to a load change was obtained. Due to the length of the computation time for the transient response calculations, analysis on a real-time computer was not possible. A simulation of the real-time calculations was developed on a batch type computer. The transient response characteristics are needed for the optimization of the design and control of the whole PAFC system. All of the models, procedures and simulations were programmed in Fortran and run on IBM 370 computers at Cleveland State University and the NASA Lewis Research Center.

Lu, Cheng-Yi↗

A non-modal analytical method to predict turbulent properties applied to the Hasegawa-Wakatani model

Linear eigenmode analysis often fails to describe turbulence in model systems that have non-normal linear operators and thus nonorthogonal eigenmodes, which can cause fluctuations to transiently grow faster than expected from eigenmode analysis. When combined with energetically conservative nonlinear mode mixing, transient growth can lead to sustained turbulence even in the absence of eigenmode instability. Since linear operators ultimately provide the turbulent fluctuations with energy, it is useful to define a growth rate that takes into account non-modal effects, allowing for prediction of energy injection, transport levels, and possibly even turbulent onset in the subcritical regime. We define such a non-modal growth rate using a relatively simple model of the statistical effect that the nonlinearities have on cross-phases and amplitude ratios of the system state variables. In particular, we model the nonlinearities as delta-function-like, periodic forces that randomize the state variables once every eddy turnover time. Furthermore, we estimate the eddy turnover time to be the inverse of the least stable eigenmode frequency or growth rate, which allows for prediction without nonlinear numerical simulation. We test this procedure on the 2D and 3D Hasegawa-Wakatani model [A. Hasegawa and M. Wakatani, Phys. Rev. Lett. 50, 682 (1983)] and find that the non-modal growth rate is a good predictor of energy injection rates, especially in the strongly non-normal, fully developed turbulence regime.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗

Numerical Analysis of Electron Runaway in the Presence of Enhanced Field in the Vicinity of a Microtip

Transition of field-emission electrons to the runaway regime in the region of enhanced electric field determined by the configuration of a microtip on a cathode is studied at several pressures of gas medium. The problem is solved using simulation of electron motion in the presence of nonuniform electric field with the aid of the Monte Carlo procedure in the 2D configuration. Nitrogen is used as a working gas. Passage through a relatively small region of the enhanced field in the vicinity of the microtip may substantially facilitate electron escape to the runaway regime, especially, at pressures of greater than 10 atm. In our opinion, the resulting runaway electrons may provide preionization of gas medium and formation of the initial stage of a 3D discharge.

70 PLASMA PHYSICS AND FUSION TECHNOLOGY↗

Introducing the New 3.5/28 Microstent Retriever for Recanalization of Distal Cerebral Arteries in Acute Stroke: Preliminary Results

Background and Purpose: To describe our first experience using a small stent retriever specifically designed for thrombectomy in cerebral arteries with a small caliber (Acandis APERIO{sup ®} 3.5/28) in patients with acute ischemic stroke. Materials and Methods: All patients with an acute ischemic stroke, who underwent endovascular recanalization using the APERIO{sup ®} thrombectomy device with a diameter of 3.5 mm, were identified in retrospect and included in the present analysis. Demographic and clinical data as well as data on the procedures performed were collected (patient sex, mean age, NIHSS, mRS, TICI score, and complications). Results: Stent retriever-based thrombectomy with the Aperio{sup ®} 3.5/28 alone (n = 10 vessels) or in combination with other devices (n = 13 vessels) was performed in 22 acute stroke patients with embolic occlusions of distal branches of the anterior and posterior circulations (median NIHSS = 8.5). For vessels treated with the Aperio{sup ®} 3.5/28, we achieved a TICI 2b/3 reperfusion rate of 73.9%. One patient suffered a symptomatic intracerebral hemorrhage after thrombectomy; otherwise, no procedure-related complications were seen. Conclusion: Our data suggest that mechanical thrombectomy of distal cerebral artery occlusions with the Aperio{sup ®} 3.5/28 is feasible and in general safe, thus offering a promising option for endovascular stroke therapy. However, multicentric studies with larger patient cohorts are necessary to evaluate the clinical benefit.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

An adaptive extended finite element method for the analysis of agglomeration of colloidal particles in a flowing fluid

Direct numerical simulations of the flow-nanoparticle interaction in a colloidal suspension are presented using an extended finite element method (XFEM) in which the dynamics of the nanoparticles is solved in a fully-coupled manner with the flow. The method is capable of accurately describing solid-fluid interfaces without the need of boundary-fitted meshes to investigate the dynamics of particles in complex flows. In order to accurately compute the high interparticle shear stresses and pressures while minimizing computing costs, an adaptive meshing technique is incorporated with the fluid-structure interaction algorithm. The particle-particle interaction at the microscopic level is modeled using the Lennard-Jones (LJ) potential and the corresponding potential parameters are determined by a scaling procedure. The study is relevant to the preparation of inks used in the fabrication of catalyst layers for fuel cells. In this paper, we are particularly interested in investigating agglomeration of the nanoparticles under external shear flow in a sliding bi-periodic Lees-Edwards frame. The results indicate that the external shear has a crucial impact on the structure formation of colloidal particles in a suspension.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗