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Sci-Thur PM – Colourful Interactions: Highlights 07: Canadian Computed Tomography Survey: National Diagnostic Reference Levels

Purpose: The Canadian Computed (CT) Tomography Survey sought to collect CT technology and dose index data (CTDI and DLP) at the national level in order to establish national diagnostic reference levels (DRLs) for seven common CT examinations of standard-sized adults and pediatric patients. Methods: A single survey booklet (consisting of four sections) was mailed to and completed for each participating CT scanner. Survey sections collected data on (i) General facility and scanner information, (ii) routine protocols (as available), (iii) individual patient data (as applied) and (iv) manual CTDI measurements. Results: Dose index (CTDIvol and DLP) and associated patient data from 24 280 individual patient exam sequences was analyzed for seven common CT examinations performed in Canada: Adult Head, Chest, Abdomen/Pelvis, and Chest/Abdomen/Pelvis, and Pediatric Head, Chest, and Abdomen. Pediatric examination data was sub-divided into three age ranges: 0–3, 3–7 and 7–13 years. DRLs (75th percentile of dose index distributions) were found for all thirteen groups. Further analysis also permitted segmentation of examination data into 8 sub-groups, whose dose index data was displayed along with group histograms – showing relative contribution of axial vs. helical, contrast use (C+ vs. C-), and application of fixed current vs. dose reduction (DR) – 75th percentiles of DR sub-groups were, in almost all cases, lower than whole group (examination) DRLs. Conclusions: The analysis and summaries presented in the pending survey report can serve to aid local CT imaging optimization efforts within Canada and also contribute further to international efforts in radiation protection of patients.

60 APPLIED LIFE SCIENCES↗

TU-F-201-02: Applications in SRS, SBRT, IMRT, VMAT, and KV Imaging

Since the introduction of radiochromic films (RCF) for radiation dosimetry, the scope of RCF dosimetry has expanded steadily to include many medical applications, such as radiation therapy and diagnostic radiology. The AAPM Task Group (TG) 55 published a report on the recommendations for RCF dosimetry in 1998. As the technology is advancing rapidly, and its routine clinical use is expanding, TG 235 has been formed to provide an update to TG-55 on radiochromic film dosimetry. RCF dosimetry applications in clinical radiotherapy have become even more widespread, expanding from primarily brachytherapy and radiosurgery applications, and gravitating towards (but not limited to) external beam therapy (photon, electron and protons), such as quality assurance for IMRT, VMAT, Tomotherapy, SRS/SRT, and SBRT. In addition, RCF applications now extend to measurements of radiation dose in particle beams and patients undergoing medical exams, especially fluoroscopically guided interventional procedures and CT. The densitometers/scanners used for RCF dosimetry have also evolved from the He-Ne laser scanner to CCD-based scanners, including roller-based scanner, light box-based digital camera, and flatbed color scanner. More recently, multichannel RCF dosimetry introduced a new paradigm for external beam dose QA for its high accuracy and efficiency. This course covers in detail the recent advancements in RCF dosimetry. Learning Objectives: Introduce the paradigm shift on multichannel film dosimetry Outline the procedures to achieve accurate dosimetry with a RCF dosimetry system Provide comprehensive guidelines on RCF dosimetry for various clinical applications One of the speakers has a research agreement from Ashland Inc., the manufacturer of Gafchromic film.

60 APPLIED LIFE SCIENCES↗

SU-F-J-110: MRI-Guided Single-Session Simulation, Online Adaptation, and Treatment

Purpose: To develop a combined simulation and treatment workflow for MRI-guided radiation therapy using the ViewRay treatment planning and delivery system. Methods: Several features of the ViewRay MRIdian planning and treatment workflows are used to simulate and treat patients that require emergent radiotherapy. A simple “pre-plan” is created on diagnostic imaging retrieved from radiology PACS, where conformal fields are created to target a volume defined by a physician based on review of the diagnostic images and chart notes. After initial consult in radiation oncology, the patient is brought to the treatment room, immobilized, and imaged in treatment position with a volumetric MR. While the patient rests on the table, the pre-plan is applied to the treatment planning MR and dose is calculated in the treatment geometry. After physician review, modification of the plan may include updating the target definition, redefining fields, or re-balancing beam weights. Once an acceptable treatment plan is finalized and approved, the patient is treated. Results: Careful preparation and judicious choices in the online planning process allow conformal treatment plans to be created and delivered in a single, thirty-minute session. Several advantages have been identified using this process as compared to conventional urgent CT simulation and delivery. Efficiency gains are notable, as physicians appreciate the predictable time commitment and patient waiting time for treatment is decreased. MR guidance in a treatment position offers both enhanced contrast for target delineation and reduction of setup uncertainties. The MRIdian system tools designed for adaptive radiotherapy are particularly useful, enabling plan changes to be made in minutes. Finally, the resulting plans, typically 6 conformal beams, are delivered as quickly as more conventional AP/PA beam arrangements with comparatively superior dose distributions. Conclusion: The ViewRay treatment planning software and delivery system can accommodate a fast simulation and treatment workflow.

60 APPLIED LIFE SCIENCES↗

Radiation protection program for early detection of breast cancer in a mammography facility

Mammography is the best tool for early detection of Breast Cancer. In this diagnostic radiology modality it is necessary to establish the criteria to ensure the proper use and operation of the equipment used to obtain mammographic images in order to contribute to the safe use of ionizing radiation. The aim of the work was to implement at FUCAM-AC the radiation protection program which must be established for patients and radiation workers according to Mexican standards [1–4]. To achieve this goal, radiation protection and quality control manuals were elaborated [5]. Furthermore, a quality control program (QCP) in the mammography systems (analog/digital), darkroom included, has been implemented. Daily sensitometry, non-variability of the image quality, visualizing artifacts, revision of the equipment mechanical stability, compression force and analysis of repetition studies are some of the QCP routine tests that must be performed by radiological technicians of this institution as a set of actions to ensure the protection of patients. Image quality and patients dose assessment were performed on 4 analog equipment installed in 2 mobile units. In relation to dose assessment, all equipment passed the acceptance criteria (<3 mGy per projection). The image quality test showed that most images (70%)– presented artifacts. A brief summary of the results of quality control tests applied to the equipment and film processor are presented. To maintain an adequate level of quality and safety at FUCAM-AC is necessary that the proposed radiation protection program in this work is applied.

60 APPLIED LIFE SCIENCES↗

Sci-Fri AM: MRI and Diagnostic Imaging - 01: Estimating the Transverse Relaxation Time of Taurine Protons in Rat Brain at 9.4 T with Optimized PRESS Sequence Timings

Purpose: To investigate the response of taurine (Tau) protons as a function of PRESS echo times, TE{sub 1} and TE{sub 2}, to determine two TE combinations that can be employed to estimate the T{sub 2} (transverse relaxation) value of Tau at 9.4 T. The Tau protons are involved in J-coupling interactions; therefore, the two timing combinations should result in similar signal losses due to J-coupling. Methods: Experiments were performed with a 9.4 T animal MRI scanner. Numerical calculations of the response of Tau as a function of PRESS TE{sub 1} and TE{sub 2} were calculated and two TE combinations that yield a similar area for the 3.42 ppm Tau resonance were selected as optimal. The timings were verified on a 50 mM Tau/10 mM Cr (creatine) phantom. In-vivo experiments were performed on four rats. Spectra were acquired with the timings from a voxel placed in the rat brain and Tau peak areas were fit to monoexponentially decaying functions to obtain T{sub 2} values. Results: The PRESS TE combinations selected for Tau T{sub 2} determination are (TE{sub 1}, TE{sub 2}) = (17 ms, 10 ms) and (80 ms, 70 ms); the signal yield for the two timings differs by 5 % theoretically. The average Tau T{sub 2} for the four rats was found to be 106 ms with a standard deviation of 12 ms. Conclusions: We have demonstrated that acquiring PRESS spectra with (TE{sub 1}, TE{sub 2}) = (17 ms, 10 ms) and (TE{sub 1}, TE{sub 2}) = (80 ms, 70 ms) enables T{sub 2} corrected measures of Tau to be obtained at 9.4 T.

60 APPLIED LIFE SCIENCES↗

Constancy of built-in luminance meter measurements in diagnostic displays

Purpose: Liquid crystal displays used to interpret medical images are often equipped with built-in luminance meters to evaluate luminance response and Grayscale Standard Display Function conformance. This work evaluates agreement between luminance reported by the built-in meters and external measurements. Methods: The white level luminance was measured using a built-in meter and an external meter for 93 primary review workstations (Models MFGD 3420 and MDCG 3120-CB) with between 117 and 49 336 backlight hours (BLH). Measured luminance values were compared viat-test for displays with less than 25 000 BLH and those with more than 25 000 BLH. Bias between meters was also evaluated. Changes in luminance uniformity with increasing backlight hours were explored by determining the maximum luminance deviation (MLD) for subsets of these displays with less than 800 BLH and greater than 35 000 BLH. Results: The mean difference between built-in and external luminance measurements was 5.84% and 38.92% for displays with less than 25 000 and greater than 25 000 BLH, respectively, with a statistically significant difference in the means (p < 0.001). For displays with low BLH, a statistically significant bias was observed (p < 0.001) between built-in and external measurements. A high degree of correlation was observed between measurements made with two separate external meters (r = 0.999). The mean MLD was 9.5% and 11.2% for MDCG 3120-CB displays with less than 800 and greater than 35 000 BLH, respectively. The difference in the mean values was not statistically significant (p < 0.001). Conclusions: Disagreement between the white level luminance measured using the built-in and external meter increased with BLH. Consequently, reliance on values reported by the built-in luminance meter may result in a reduction in image contrast with time. Recommendations have been proposed regarding luminance response testing and corrective action for failing displays.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

MO-DE-207A-02: A Feature-Preserving Image Reconstruction Method for Improved Pancreaticlesion Classification in Diagnostic CT Imaging

Purpose: To develop a feature-preserving model based image reconstruction (MBIR) method that improves performance in pancreatic lesion classification at equal or reduced radiation dose. Methods: A set of pancreatic lesion models was created with both benign and premalignant lesion types. These two classes of lesions are distinguished by their fine internal structures; their delineation is therefore crucial to the task of pancreatic lesion classification. To reduce image noise while preserving the features of the lesions, we developed a MBIR method with curvature-based regularization. The novel regularization encourages formation of smooth surfaces that model both the exterior shape and the internal features of pancreatic lesions. Given that the curvature depends on the unknown image, image reconstruction or denoising becomes a non-convex optimization problem; to address this issue an iterative-reweighting scheme was used to calculate and update the curvature using the image from the previous iteration. Evaluation was carried out with insertion of the lesion models into the pancreas of a patient CT image. Results: Visual inspection was used to compare conventional TV regularization with our curvature-based regularization. Several penalty-strengths were considered for TV regularization, all of which resulted in erasing portions of the septation (thin partition) in a premalignant lesion. At matched noise variance (50% noise reduction in the patient stomach region), the connectivity of the septation was well preserved using the proposed curvature-based method. Conclusion: The curvature-based regularization is able to reduce image noise while simultaneously preserving the lesion features. This method could potentially improve task performance for pancreatic lesion classification at equal or reduced radiation dose. The result is of high significance for longitudinal surveillance studies of patients with pancreatic cysts, which may develop into pancreatic cancer. The Senior Author receives financial support from Siemens GmbH Healthcare.

60 APPLIED LIFE SCIENCES↗

Three dimensional full-wave nonlinear acoustic simulations: Applications to ultrasound imaging

Characterization of acoustic waves that propagate nonlinearly in an inhomogeneous medium has significant applications to diagnostic and therapeutic ultrasound. The generation of an ultrasound image of human tissue is based on the complex physics of acoustic wave propagation: diffraction, reflection, scattering, frequency dependent attenuation, and nonlinearity. The nonlinearity of wave propagation is used to the advantage of diagnostic scanners that use the harmonic components of the ultrasonic signal to improve the resolution and penetration of clinical scanners. One approach to simulating ultrasound images is to make approximations that can reduce the physics to systems that have a low computational cost. Here a maximalist approach is taken and the full three dimensional wave physics is simulated with finite differences. This paper demonstrates how finite difference simulations for the nonlinear acoustic wave equation can be used to generate physically realistic two and three dimensional ultrasound images anywhere in the body. A specific intercostal liver imaging scenario for two cases: with the ribs in place, and with the ribs removed. This configuration provides an imaging scenario that cannot be performed in vivo but that can test the influence of the ribs on image quality. Several imaging properties are studied, in particular the beamplots, the spatial coherence at the transducer surface, the distributed phase aberration, and the lesion detectability for imaging at the fundamental and harmonic frequencies. The results indicate, counterintuitively, that at the fundamental frequency the beamplot improves due to the apodization effect of the ribs but at the same time there is more degradation from reverberation clutter. At the harmonic frequency there is significantly less improvement in the beamplot and also significantly less degradation from reverberation. It is shown that even though simulating the full propagation physics is computationally challenging it is necessary to quantify ultrasound image quality and its sources of degradation.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

SU-F-I-53: Coded Aperture Coherent Scatter Spectral Imaging of the Breast: A Monte Carlo Evaluation of Absorbed Dose

Purpose: Coherent scatter based imaging has shown improved contrast and molecular specificity over conventional digital mammography however the biological risks have not been quantified due to a lack of accurate information on absorbed dose. This study intends to characterize the dose distribution and average glandular dose from coded aperture coherent scatter spectral imaging of the breast. The dose deposited in the breast from this new diagnostic imaging modality has not yet been quantitatively evaluated. Here, various digitized anthropomorphic phantoms are tested in a Monte Carlo simulation to evaluate the absorbed dose distribution and average glandular dose using clinically feasible scan protocols. Methods: Geant4 Monte Carlo radiation transport simulation software is used to replicate the coded aperture coherent scatter spectral imaging system. Energy sensitive, photon counting detectors are used to characterize the x-ray beam spectra for various imaging protocols. This input spectra is cross-validated with the results from XSPECT, a commercially available application that yields x-ray tube specific spectra for the operating parameters employed. XSPECT is also used to determine the appropriate number of photons emitted per mAs of tube current at a given kVp tube potential. With the implementation of the XCAT digital anthropomorphic breast phantom library, a variety of breast sizes with differing anatomical structure are evaluated. Simulations were performed with and without compression of the breast for dose comparison. Results: Through the Monte Carlo evaluation of a diverse population of breast types imaged under real-world scan conditions, a clinically relevant average glandular dose for this new imaging modality is extrapolated. Conclusion: With access to the physical coherent scatter imaging system used in the simulation, the results of this Monte Carlo study may be used to directly influence the future development of the modality to keep breast dose to a minimum while still maintaining clinically viable image quality.

60 APPLIED LIFE SCIENCES↗

SU-D-207B-04: Morphological Features of MRI as a Correlate of Capsular Contracture in Breast Cancer Patients with Implant-Based Reconstructions

Purpose: Capsular contracture (CC) is a serious complication in patients receiving implant-based reconstruction for breast cancer. The goal of this study was to identify image-based correlates of CC using MRI imaging in breast cancer patients who received both MRI and clinical evaluation following reconstructive surgery. Methods: We analyzed a retrospective dataset of 50 patients who had both a diagnostic MR and a plastic surgeon’s evaluations of CC score (Baker’s score) within a six month period following mastectomy and reconstructive surgery. T2w sagittal MRIs (TR/TE = 3500/102 ms, slice thickness = 4 mm) were used for morphological shape features (roundness, eccentricity, solidity, extent and ratio-length) and histogram features (median, skewness and kurtosis) of the implant and the pectoralis muscle overlying the implant. Implant and pectoralis muscles were segmented in 3D using Computation Environment for Radiological Research (CERR) and shape and histogram features were calculated as a function of Baker’s score. Results: Shape features such as roundness and eccentricity were statistically significant in differentiating grade 1 and grade 2 (p = 0.009; p = 0.06) as well as grade 1 and grade 3 CC (p = 0.001; p = 0.006). Solidity and extent were statistically significant in differentiating grade 1 and grade 3 CC (p = 0.04; p = 0.04). Ratio-length was statistically significant in differentiating all grades of CC except grade 2 and grade 3 that showed borderline significance (p = 0.06). The muscle thickness, median intensity and kurtosis were significant in differentiating between grade 1 and grade 3 (p = 0.02), grade 1 and grade 2 (p = 0.03) and grade 1 and grade 3 (p = 0.01) respectively. Conclusion: Morphological shape features described on MR images were associated with the severity of CC. MRI may be important in objectively evaluating outcomes in breast cancer patients who undergo implant reconstruction.

60 APPLIED LIFE SCIENCES↗

The Importance of Imaging in Radiation Oncology for National Clinical Trials Network Protocols

Imaging is essential in successfully executing radiation therapy (RT) in oncology clinical trials. As technically sophisticated diagnostic imaging and RT were incorporated into trials, quality assurance in the National Clinical Trials Network groups entered a new era promoting image acquisition and review. Most trials involving RT require pre- and post-therapy imaging for target validation and outcome assessment. The increasing real-time (before and during therapy) imaging and RT object reviews are to ensure compliance with trial objectives. Objects easily transmit digitally for review from anywhere in the world. Physician interpretation of imaging and image application to RT treatment plans is essential for optimal trial execution. Imaging and RT data sets are used to credential RT sites to confirm investigator and institutional ability to meet trial target volume delineation and delivery requirements. Real-time imaging and RT object reviews can be performed multiple times during a trial to assess response to therapy and application of RT objects. This process has matured into an effective data management mechanism. When necessary, site and study investigators review objects together through web media technologies to ensure the patient is enrolled on the appropriate trial and the intended RT is planned and executed in a trial-compliant manner. Real-time imaging review makes sure: (1) the patient is entered and eligible for the trial, (2) the patient meets trial-specific adaptive therapy requirements, if applicable, and (3) the intended RT is according to trial guidelines. This review ensures the study population is uniform and the results are believable and can be applied to clinical practice.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Hybrid detection of lung nodules on CT scan images

Purpose: The diversity of lung nodules poses difficulty for the current computer-aided diagnostic (CAD) schemes for lung nodule detection on computed tomography (CT) scan images, especially in large-scale CT screening studies. We proposed a novel CAD scheme based on a hybrid method to address the challenges of detection in diverse lung nodules. Methods: The hybrid method proposed in this paper integrates several existing and widely used algorithms in the field of nodule detection, including morphological operation, dot-enhancement based on Hessian matrix, fuzzy connectedness segmentation, local density maximum algorithm, geodesic distance map, and regression tree classification. All of the adopted algorithms were organized into tree structures with multi-nodes. Each node in the tree structure aimed to deal with one type of lung nodule. Results: The method has been evaluated on 294 CT scans from the Lung Image Database Consortium (LIDC) dataset. The CT scans were randomly divided into two independent subsets: a training set (196 scans) and a test set (98 scans). In total, the 294 CT scans contained 631 lung nodules, which were annotated by at least two radiologists participating in the LIDC project. The sensitivity and false positive per scan for the training set were 87% and 2.61%. The sensitivity and false positive per scan for the testing set were 85.2% and 3.13%. Conclusions: The proposed hybrid method yielded high performance on the evaluation dataset and exhibits advantages over existing CAD schemes. We believe that the present method would be useful for a wide variety of CT imaging protocols used in both routine diagnosis and screening studies.

60 APPLIED LIFE SCIENCES↗

Sepsis reconsidered: Identifying novel metrics for behavioral landscape characterization with a high-performance computing implementation of an agent-based model

Objectives: Sepsis affects nearly 1 million people in the United States per year, has a mortality rate of 28–50% and requires more than $20 billion a year in hospital costs. Over a quarter century of research has not yielded a single reliable diagnostic test or a directed therapeutic agent for sepsis. Central to this insufficiency is the fact that sepsis remains a clinical/physiological diagnosis representing a multitude of molecularly heterogeneous pathological trajectories. Advances in computational capabilities offered by High Peformance Computing (HPC) platforms call for an evolution in the investigation of sepsis to attempt to define the boundaries of traditional research (bench, clinical and computational) through the use of computational proxy models. We present a novel investigatory and analytical approach, derived from how HPC resources and simulation are used in the physical sciences, to identify the epistemic boundary con- ditions of the study of clinical sepsis via the use of a proxy agent-based model of systemic inflammation. Design: Current predictive models for sepsis use correlative methods that are limited by patient heterogeneity and data sparseness. We address this issue by using an HPC version of a system-level validated agent-based model of sepsis, the Innate Immune Response ABM (IIRBM), as a proxy system in order to identify boundary conditions for the possible behavioral space for sepsis. We then apply advanced analysis derived from the study of Random Dynamical Systems (RDS) to identify novel means for characterizing system behavior and providing insight into the tractability of traditional investigatory methods. Results: The behavior space of the IIRABM was examined by simulating over 70 million sepsis patients for up to 90 days in a sweep across the following parameters: cardio-respiratory-metabolic resilience; microbial invasiveness; microbial toxigenesis; and degree of nosocomial exposure. In addition to using established methods for describing parameter space, we developed two novel methods for characterizing the behavior of a RDS: Probabilistic Basins of Attraction (PBoA) and Stochastic Trajectory Analysis (STA). Computationally generated behavioral landscapes demonstrated attractor structures around stochastic re- gions of behavior that could be described in a complementary fashion through use of PBoA and STA. The stochasticity of the boundaries of the attractors highlights the challenge for correlative attempts to characterize and classify clinical sepsis. Conclusions: HPC simulations of models like the IIRABM can be used to generate approximations of the behavior space of sepsis to both establish “boundaries of futility” with respect to existing investi- gatory approaches and apply system engineering principles to investigate the general dynamic properties of sepsis to provide a pathway for developing control strategies. Here, the issues that bedevil the study and treatment of sepsis, namely clinical data sparseness and inadequate experimental sampling of system behavior space, are fundamental to nearly all biomedical research, manifesting in the “Crisis of Reproducibility” at all levels. HPC-augmented simulation-based research offers an investigatory strategy more consistent with that seen in the physical sciences (which combine experiment, theory and simulation), and an opportunity to utilize the leading advances in HPC, namely deep machine learning and evolutionary computing, to form the basis of an iterative scientific process to meet the full promise of Precision Medicine (right drug, right patient, right time).

59 BASIC BIOLOGICAL SCIENCES↗

The Texas A&M Radioisotope Production and Radiochemistry Program

The main motivation of the project at Texas A&M University was to carry out the production of critically needed radioisotopes used in medicine for diagnostics and therapy, and to establish an academic program in radionuclide production and separation methods. After a lengthy battle with the Texas A&M University Radiation Safety Office, the Texas Department of State Health Services granted us a license for the production of radionuclides in July 2015, allowing us to work in earnest in our project objectives. Experiments began immediately after licensing, and we started the assembly and testing of our target systems. There were four analytical/theoretical projects and two experimental target systems. These were for At-211 production and for Zn-62/Cu-62 production. The theoretical projects were related to the production of Mo-99/Tc-99m using a) a subcritical aqueous target system and b) production of Tc-99m from accelerator-generated Mo-99 utilizing a photon-neutron interaction with enriched Mo-100 targets. The two experimental projects were the development of targetry systems and production of At-211 and Zn-62/Cu-62 generator. The targetry system for At-211 has been tested and production of At-211 is chronic depending of availability of beam time at the cyclotron. The installation and testing of the targetry system for the production of Zn-62/Cu-62 has not been finalized. A description of the systems is described. The academic program in radionuclide production and separation methods was initiated in the fall of 2011 and, due to the lack of a radiochemistry laboratory, it was suspended. We expect to re-start the academic program at the Texas A&M Institute for Preclinical Studies under the Molecular Imaging Program.

38 RADIATION CHEMISTRY, RADIOCHEMISTRY, AND NUCLEA↗

Recent use of NSAID and NOAC medications are associated with a positive CT arteriogram

Background: Computed tomography angiography (CTA) is a diagnostic modality utilized in patients with suspected active lower gastrointestinal (GI) bleeding. CTA use in clinical practice is limited by the risk of contrast-induced nephropathy, and the loss of patients from direct physician observation while undergoing the test. Identifying clinical predictors of a positive result would be useful in guiding physician utilization of CTA studies. Methods: We performed a single-center retrospective study to determine which clinical predictors are associated with a positive CTA. Binary logistical regression modeling was used to identify the independent predictors and the results were expressed as adjusted odds ratios with corresponding 95% CI . Results: 262 patients met inclusion criteria and there were 61 (23.3%) positive CTA exams. In unadjusted analysis those who were CTA positive were more likely to require management in the intensive care unit (85.2% vs. 14.8%, p < 0.01) and being CTA positive was associated with a significantly increased in-hospital mortality (14.8% vs. 4.5%, p < 0.01). The use of a novel oral anticoagulant (NOAC) in the week prior to presentation was associated with a positive CTA after adjustment for confounders (adjusted odds ratio = 3.89; 95% CI 1.05–14.43). Similarly, the use of a non-steroidal anti-inflammatory drug (NSAID) was associated with a positive CTA (OR 2.36; 1.03–5.41). Only 8% of patients experienced contrast-induced nephropathy. Conclusion: Use of either NOACs or NSAIDs in the previous week is independently associated with a positive CTA in the setting of acute lower GI bleeding. CTA exams appear to confer a low risk of contrast-induced nephropathy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-E-E-01: ABR Diagnostic Radiology Core Exam: Was Our Redesigned Physics Course Successful in Teaching Physics to Radiology Residents?

Purpose: Our purpose is to evaluate the effectiveness of our two year physics course in preparing radiology residents for the American Board of Radiology (ABR) diagnostic radiology exam. Methods: We designed a new two-year physics course that integrates radiology clinical content and practice and is primarily based on the AAPM curriculum and RSNA/AAPM physics modules. Biweekly classes focus on relevant concepts from assigned reading and use audience response systems to encourage participation. Teaching efficiency is optimized through lecturer rotations of physicists, radiologists, and guest speakers. An emphasis is placed on clinical relevance by requiring lab work and providing equipment demonstrations. Periodic quiz were given during the course. The course website was also redesigned for usability, and physics review lectures were conducted two weeks before the board exam to refresh key concepts. At the completion of our first two-year course, we conducted a confidential evaluation of the faculty and course. The evaluation assessed metrics such as overall organization, clinical relevance of content, and level of difficulty, with a rating scale from poor to excellent. Results: Our evaluation indicated that the redesigned course provided effective board exam preparation, with most responses between good and excellent. There was some criticism on the course length and on chronological discontinuity, but the review lectures were appreciated by the residents. All of our residents passed the physics component of the ABR exam with scores exceeding the minimum passing score by a significant margin. Conclusion: The course evaluation and board exam results indicate that our new two-year course format provides valuable board exam preparation. This is possible thanks to the time and effort taken by the physics faculty on ensuring the residents get quality physics education.

60 APPLIED LIFE SCIENCES↗

SU-G-IeP3-02: Characteristics of In-Vivo MOSFET Dosimeters for Diagnostic X-Ray Low-Dose Measurements

Purpose: To correct in-vivo metal-oxide-semiconductor field-effect transistor (MOSFET) dosimeters dependence on X-ray energy, dose and dose rate, and temperature in order to measure doses or exposures on several anatomic points of interest undergoing some routine radiographs. Methods: A mobile MOSFET system (BEST Medical) was carefully calibrated with X-ray at kVp of 70, 80, 100, 120, and 138 kVp, phantom temperatures at 0, 21, and 43 oC, and exposure range from 0.01 to 10 R confirmed with Raysafe and RadCal dosimeters. The MOSFETS were placed on the midline bladder or uterus, left pelvic iliac artery, left abdominal above iliac crest, abdominal midline anterior at inferior margin of stomach, and left pectoral of a large and a small body-size cadavers undergoing AP/PA chest and lumber spine radiographs using manual and automatic exposure control (AEC) with and without lead shielding. MOSTFETs and TLD chips were also placed on the stomach, sigmoid, pubic symphysis, left and right pelvic walls of another cadaver for AP pelvic manual or AEC radiography prior to and after a left hip metal implant. Results: Individual MOSFET detectors had various low-dose limits in ranged from 0.03 to 0.08 R, nonlinear response to X-ray energy, and significant temperature effect of 15%. By accumulating 10 manual exposures and 20 AEC exposures, we achieved dose measured accuracy of 6%. There were up to 8 fold increases for AEC exposure of spine and chest X-ray procedure from no shielding to with shielding. For pelvic radiography, exposure to public symphysis was the highest even higher than that of the skin. After hip implant, AEC pelvic radiograph increase exposure by 30 to 200% consistent with results of TLDs. Conclusion: Dependence of energy, temperature and dose limit were accurately corrected. We have found significant exposure for those clinical pr°ocedures and the study provided evidences for developing new clinical procedures.

60 APPLIED LIFE SCIENCES↗

WE-AB-213-00: Developments in International Medical Physics Collaborations in Africa and Latin America

The African Affairs Subcommittee (AA-SC) of the AAPM will present a multi-institutional approach to medical physics support in Africa. Current work to increase the quality of care and level of safety for the medical physics practice in Senegal, Ghana, and Zimbabwe will be presented, along with preliminary projects in Nigeria and Botswana. Because the task of addressing the needs of medical physics in countries across Africa is larger than one entity can accomplish on its own, the AA-SC has taken the approach of joining forces with multiple organizations such as Radiating Hope and TreatSafely (NGO’s), the IAEA, companies like BrainLab, Varian and Elekta, medical volunteers and academic institutions such as NYU and Washington University. Elements of current projects include: 1) Distance training and evaluation of the quality of contouring and treatment planning, teaching treatment planning and other subjects, and troubleshooting using modern telecommunications technology in Senegal, Ghana, and Zimbabwe; 2) Assistance in the transition from 2D to 3D in Senegal and Zimbabwe; 3) Assistance in the transition from 3D to IMRT using in-house compensators in Senegal; 4) Modernizing the cancer center in Senegal and increasing safety and; 5) Training on on 3D techniques in Ghana; 6) Assisting a teaching and training radiation oncology center to be built in Zimbabwe; 7) Working with the ISEP Program in Sub-Saharan Africa; 8) Creating instructional videos on linac commissioning; 9) Working on a possible collaboration to train physicists in Nigeria. Building on past achievements, the subcommittee seeks to make a larger impact on the continent, as the number and size of projects increases and more human resources become available. The State of Medical Physics Collaborations and Projects in Latin America Sandra Guzman (Peru) The lack of Medical Physicists (MP) in many Latin American (LA) countries leads to recruitment of professionals with incomplete education. In most LA countries only one MP responsible for each Center is currently mandated. Currently there is a large disparity among MP training programs and there is significant debate about the standards of MP graduate education in many LA countries. There are no commonly recognized academic programs, not enough clinical training sites and clinical training is not typically considered as part of the MP work. Economic pressures and high workloads also impede the creation of more training centers. The increasing need of qualified MPs require establishing a coordinated system of national Education & Training Centers (ETC), to meet the international standards of education and training in Medical Physics. This shortfall calls for support of organizations such as the IOMP, AAPM, ALFIM, IAEA, etc. Examples from various LA countries, as well as some proposed solutions, will be presented. In particular, we will discuss the resources that the AAPM and its members can offer to support regional programs. The ‘Medical Imaging’ physicist in the emerging world: Challenges and opportunities - Caridad Borrás (WGNIMP Chair) While the role of radiation therapy physicists in the emerging world is reasonably well established, the role of medical imaging physicists is not. The only perceived needs in radiology departments are equipment quality control and radiation protection, tasks that can be done by a technologist or a service engineer. To change the situation, the International Basic Safety Standard, which is adopted/adapted world-wide as national radiation protection regulations, states: “For diagnostic radiological procedures and image guided interventional procedures, the requirements of these Standards for medical imaging, calibration, dosimetry and quality assurance, including the acceptance and commissioning of medical radiological equipment, are fulfilled by or under the oversight of, or with the documented advice of a medical physicist, whose degree of involvement is determined by the complexity of the radiological procedures and the associated radiation risks”. Details on how these requirements can be carried out in resource-limited settings will be described. IAEA support to medical physics in Africa and Latin America: achievements and challenges Ahmed Meghzifene (IAEA) Shortage of clinically qualified medical physicists in radiotherapy and imaging, insufficient and inadequate education and training programs, as well as a lack of professional recognition were identified as the main issues to be addressed by the IAEA. The IAEA developed a series of integrated projects aiming specifically at promoting the essential role of medical physicists in health care, developing harmonized guidelines on dosimetry and quality assurance, and supporting education and clinical training programs. The unique feature of the IAEA approach is support it provides for implementation of guidelines and education programs in Member States through its technical cooperation project. The presentation will summarize IAEA support to Latin America and Africa in the field of medical physics and will highlight how the new International Basic Safety Standards are expected to impact the medical physics practice in low and middle income countries. Learning Objectives: Learn about the shortage of qualified Medical Physicists in Africa and Latin America. Understand the reasons of this shortage. Learn about the ways to improve the situation and AAPM role in this process.

60 APPLIED LIFE SCIENCES↗