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At least 451 records · Page 25

Lunar Dust and Lunar Simulant Activation, Monitoring, Solution and Cellular Toxicity Properties

During the Apollo missions, many undesirable situations were encountered that must be mitigated prior to returning humans to the moon. Lunar dust (that part of the lunar regolith less than 20 m in diameter) was found to produce several problems with astronaut s suits and helmets, mechanical seals and equipment, and could have conceivably produced harmful physiological effects for the astronauts. For instance, the abrasive nature of the dust was found to cause malfunctions of various joints and seals of the spacecraft and suits. Additionally, though efforts were made to exclude lunar dust from the cabin of the lunar module, a significant amount of material nonetheless found its way inside. With the loss of gravity correlated with ascent of the lunar module from the lunar surface to rendezvous with the command module, much of the major portions of the contaminating soil and dust began to float, irritating the astronaut s eyes and being inhaled into their lungs. Our goal has been to understand some of the properties of lunar dust that could lead to possible hazards for humans. Due to the lack of an atmosphere, there is nothing to protect the lunar soil from ultraviolet radiation, solar wind, and meteorite impacts. These processes could all serve to activate the soil, or produce reactive surface species. In order to understand the possible toxic effects of the reactive dust, it is necessary to reactivate the dust, as samples returned during the Apollo missions were exposed to the atmosphere of the Earth. We have used grinding and UV exposure to mimic some of the processes occurring on the Moon. The level of activation has been monitored using two methods: fluorescence spectroscopy and electron paramagnetic resonance spectroscopy (EPR). These techniques allow the monitoring of hydroxyl radical production in solution. We have found that grinding of lunar dust produces 2-3 times the concentration of hydroxyl radicals as lunar simulant and 10 times that of quartz. Exposure of the lunar dust to UV radiation under vacuum was also found to lead to hydroxyl radical production. After grinding, we have also monitored loss of reactivity of the dusts by exposing them to conditions of known humidity and temperature. From these tests, it was found that the reactivity half-life of lunar simulant is approximately 3 hours, while that of quartz is approximately 2 hours. Placing lunar dust in solution could lead to effects on mechanical and physiological systems, as well as other biological systems. For instance, while it is known that lunar dust is highly abrasive and caused a variety of problems with suits and equipment during Apollo, it is unknown as to how these properties might be affected in the presence of water or other liquids. It is possible that the dust may release minerals (e.g., metallic nanophase Fe) into solution that could speed corrosion or rust. Also, as lunar dust produces hydroxyl radicals (and possibly other reactive oxygen species) in solution, these radicals could also lead to the breakdown of suit or habitat materials. In the body (i.e., in lung solution), the effects could be two-fold. First, if the lunar dust dissolves, it may release an excess of elements (such as zero-valence metallic Fe) that are necessary for bodily functions but only in certain concentration ranges. For lunar dust, the presence of nanophase iron being released into the body is a concern. Secondly, the hydroxyl radicals or other reactive oxygen species produced by the dust in solution could conceivably interact with cells, leading to various problems. We have studied the dissolution of both ground and unground lunar simulant in buffer solutions of different pH. The concentration of a number of species was determined using mass spectrometry. These studies showed that lowering the pH of the solution causes a dramatic increase in the amount of each element released into solution and that grinding also produces higher concentrations. Finally, we have perfmed initial tests aimed at understanding the effects of lunar simulant on cellular systems. Alveolar epithelial cells were cultured and exposed to different concentrations of dust suspended in cell culture media. After predetermined amounts of time, the media was removed and the concentrations of important inflammatory cytokines (IL6, IL8, and TNF-alpha ) were measured. The results of these tests are being used to develop the correct protocols for tests to be performed using lunar dust samples.

Jeevarajan, A.S.↗

Pulmonary Toxicity Studies of Lunar Dusts in Rodents

NASA will build an outpost on the Moon for prolonged human habitation and research. The lunar surface is covered by a layer of fine, reactive dust. Astronauts on the Moon will go in and out of the base for various activities, and will inevitably bring some dust into the living quarters. Depressurizing the airlock so that astronauts can exit for outdoor activities could also bring dust inside the airlock to the habitable area. Concerned about the potential health effects on astronauts exposed to airborne lunar dust, NASA directed the JSC Toxicology Laboratory to determine the pulmonary toxicity of lunar dust. The toxicity data also will be needed by toxicologists to establish safe exposure limits for astronauts residing in the lunar habitat and by environmental engineers to design an appropriate dust mitigation strategy. We conducted a study to examine biomarkers of toxicity (inflammation and cytotoxicity) in lung lavage fluids from mice intrapharyngeally instilled with lunar dust samples; we also collected lung tissue from the mice for histopathological examination 3 months after the dust instillation. Reference dusts (TiO2 and quartz) having known toxicities and industrial exposure limits were studied in parallel with lunar dust so that the relative toxicity of lunar dust can be determined. A 6-month histopathology study has been planned. These instillation experiments will be followed by inhalation studies, which are more labor intensive and technologically difficult. The animal inhalation studies will be conducted first with an appropriate lunar dust simulant to ensure that the exposure techniques to be used with actual lunar dust will be successful. The results of these studies collectively will reveal the toxicological risk of exposures and enable us to establish exposure limits on lunar dust for astronauts living in the lunar habitat.

Lam, C.-W.↗

Microgravity Analogues of Herpes Virus Pathogenicity: Human Cytomegalovirus (hCMV) and Varicella Zoster (VZV) Infectivity in Human Tissue Like Assemblies (TLAs)

The old adage we are our own worst enemies may perhaps be the most profound statement ever made when applied to man s desire for extraterrestrial exploration and habitation of Space. Consider the immune system protects the integrity of the entire human physiology and is comprised of two basic elements the adaptive or circulating and the innate immune system. Failure of the components of the adaptive system leads to venerability of the innate system from opportunistic microbes; viral, bacteria, and fungal, which surround us, are transported on our skin, and commonly inhabit the human physiology as normal and imunosuppressed parasites. The fine balance which is maintained for the preponderance of our normal lives, save immune disorders and disease, is deregulated in microgravity. Thus analogue systems to study these potential Risks are essential for our progress in conquering Space exploration and habitation. In this study we employed two known physiological target tissues in which the reactivation of hCMV and VZV occurs, human neural and lung systems created for the study and interaction of these herpes viruses independently and simultaneously on the innate immune system. Normal human neural and lung tissue analogues called tissue like assemblies (TLAs) were infected with low MOIs of approximately 2 x 10(exp -5) pfu hCMV or VZV and established active but prolonged low grade infections which spanned .7-1.5 months in length. These infections were characterized by the ability to continuously produce each of the viruses without expiration of the host cultures. Verification and quantification of viral replication was confirmed via RT_PCR, IHC, and confocal spectral analyses of the respective essential viral genomes. All host TLAs maintained the ability to actively proliferate throughout the entire duration of the experiments as is analogous to normal in vivo physiological conditions. These data represent a significant advance in the ability to study the triggering mechanisms which surround Herpes vial reactivation and proliferation. Additionally, prolonged replication of these viruses will allow the tracking of viral genomic shift.

Goodwin, T. J.↗

Prospective Evaluation of Thoracic Ultrasound in the Detection of Pneumothorax

Introduction: Pneumothorax (PTX) occurs commonly in trauma patients and is confirmed by examination and radiography. Thoracic ultrasound (VIS) has been suggested as an alternative method for rapidly diagnosing PTX when X-ray is unavailable as in rural, military, or space flight settings; however, its accuracy and specificity are not known. Methods: We evaluated the accuracy of thoracic U/S detection of PTX compared to radiography in stable, emergency patients with a high suspicion of PTX at a Level-l trauma center over a 6-month period. Following University and NASA Institutional Review Board approval, informed consent was obtained from patients with penetrating or blunt chest trauma, or with a history consistent with PTX. Whenever possible, the presence or absence of the " lung sliding" sign or the "comet tail" artifact were determined by U/S in both hemithoraces by residents instructed in thoracic U/S before standard radiologic verification of PTX. Results were recorded on data sheets for comparison to standard radiography. Results: Thoracic VIS had a 94% sensitivity; two PTX could not be reliably diagnosed due to subcutaneous air; the true negative rate was 100%. In one patient, the VIS exam was positive while X ray did not confirm PTX; a follow-up film 1 hour later demonstrated a small PTX. The average time for bilateral thoracic VIS examination was 2 to 3 minutes. Conclusions: Thoracic ultrasound reliably diagnoses pneumothorax. Presence of the "lung sliding" sign conclusively excludes pneumothorax. Expansion of the FAST examination to include the thorax should be investigated.

Schwarz, K. W.↗

Space Radiation Cancer, Circulatory Disease and CNS Risks for Near Earth Asteroid and Mars Missions: Uncertainty Estimates for Never-Smokers

The uncertainties in estimating the health risks from galactic cosmic rays (GCR) and solar particle events (SPE) are a major limitation to the length of space missions and the evaluation of potential risk mitigation approaches. NASA limits astronaut exposures to a 3% risk of exposure induced cancer death (REID), and protects against uncertainties in risks projections using an assessment of 95% confidence intervals after propagating the error from all model factors (environment and organ exposure, risk coefficients, dose-rate modifiers, and quality factors). Because there are potentially significant late mortality risks from diseases of the circulatory system and central nervous system (CNS) which are less well defined than cancer risks, the cancer REID limit is not necessarily conservative. In this report, we discuss estimates of lifetime risks from space radiation and new estimates of model uncertainties are described. The key updates to the NASA risk projection model are: 1) Revised values for low LET risk coefficients for tissue specific cancer incidence, with incidence rates transported to an average U.S. population to estimate the probability of Risk of Exposure Induced Cancer (REIC) and REID. 2) An analysis of smoking attributable cancer risks for never-smokers that shows significantly reduced lung cancer risk as well as overall cancer risks from radiation compared to risk estimated for the average U.S. population. 3) Derivation of track structure based quality functions depends on particle fluence, charge number, Z and kinetic energy, E. 4) The assignment of a smaller maximum in quality function for leukemia than for solid cancers. 5) The use of the ICRP tissue weights is shown to over-estimate cancer risks from SPEs by a factor of 2 or more. Summing cancer risks for each tissue is recommended as a more accurate approach to estimate SPE cancer risks. 6) Additional considerations on circulatory and CNS disease risks. Our analysis shows that an individual s history of smoking exposure has a larger impact on GCR risk estimates than amounts of radiation shielding or age at exposure (amongst adults). Risks for never-smokers compared to the average U.S. population are estimated to be reduced between 30% and 60% dependent on model assumptions. Lung cancer is the major contributor to the reduction for never-smokers, with additional contributions from circulatory diseases and cancers of the stomach, liver, bladder, oral cavity and esophagus, and leukemia. The relative contribution of CNS risks to the overall space radiation detriment is potentially increased for never-smokers such as most astronauts. Problems in estimating risks for former smokers and the influence of second-hand smoke are discussed. Compared to the LET approximation, the new track structure derived radiation quality functions lead to a reduced risk for relativistic energy particles and increased risks for intermediate energy particles. Revised estimates for the number of safe days in space at solar minimum for heavy shielding conditions are described for never-smokers and the average U.S. population. Results show that missions to near Earth asteroids (NEA) or Mars violate NASA's radiation safety standards with the current levels of uncertainties. Greater improvements in risk estimates for never-smokers are possible, and would be dependent on improved understanding of risk transfer models, and elucidating the role of space radiation on the various stages of disease formation (e.g. initiation, promotion, and progression).

Cucinotta, Francis A.↗

The Next Generation of Cold Immersion Dry Suit Design Evolution for Hypothermia Prevention

This new utility patent is an active design that relies on the lung's role as an organic heat exchanger for providing deep body core heating of air. It is based on the fact that the greatest heat loss mechanism for an insulated human body immersed in a cold water environment is due to heat loss through respiration. This innovation successfully merges two existing technologies (cold immersion suit and existing valve technologies) to produce a new product that helps prevent against the onset of hypothermia at sea. During normal operations, a human maintains an approximate body temperature of [98.6 F (37 C)]. A mechanism was developed to recover the warm temperature from the body and reticulate it in a survival suit. The primary intention is to develop an encompassing systems design that can both easily and cost effectively be integrated in all existing currently manufactured cold water survival suits, and as such, it should be noted that the cold water immersion suit is only used as a framework or tool for laying out the required design elements. At the heart of the suit is the Warm Air Recovery (WAR) system, which relies on a single, large Main Purge Valve (MPV) and secondary Purge Valves (PV) to operate. The main purge valve has a thin membrane, which is normally closed, and acts as a one-way check valve. When warm air is expelled from the lungs, it causes the main purge valve to open. Air forced from the MPV is dumped directly into the suit, thereby providing warmth to the torso, legs, and arms. A slight positive over-pressure in the suit causes warm waste air (or water if the suit is punctured) to be safely vented into the sea through large PVs located at the bottom of each arm and leg. The secondary purge valves act to prevent the buildup of large concentrations of CO2 gas and help guard against asphyxia. It is noted that the MPV causes the inhalation and exhalation cycles to be completely isolated from one another in the current suit design.

Galofaro, Joel↗

Pulmonary and Systemic Immune Response to Chronic Lunar Dust Inhalation

Background: Due to millennia of meteorite impact with virtually no erosive effects, the surface of the Moon is covered by a layer of ultra‐fine, reactive Lunar dust. Very little is known regarding the toxicity of Lunar dust on human physiology. Given the size and electrostatic characteristics of Lunar dust, countermeasures to ensure non‐exposure of astronauts will be difficult. To ensure astronaut safety during any future prolonged Lunar missions, it is necessary to establish the effect of chronic pulmonary Lunar dust exposure on all physiological systems. Methods: This study assessed the toxicity of airborne lunar dust exposure in rats on pulmonary and system immune system parameters. Rats were exposed to 0, 20.8, or 60.8 mg/m3 of lunar dust (6h/d; 5d/wk) for up to 13 weeks. Sacrifices occurred after exposure durations of 1day, 7 days, 4 weeks and 13 weeks post‐exposure, when both blood and lung lavage fluid were collected for analysis. Lavage and blood assays included leukocyte distribution by flow cytometry, electron/fluorescent microscopy, and cytokine concentration. Cytokine production profiles following mitogenic stimulation were performed on whole blood only. Results: Untreated lavage fluid was comprised primarily of pulmonary macrophages. Lunar dust inhalation resulted in an influx of neutrophils and lymphocytes. Although the percentage of lymphocytes increased, the T cell CD4:CD8 ratio was unchanged. Cytokine analysis of the lavage fluid showed increased levels of IL‐1b and TNFa. These alterations generally persisted through the 13 week sampling. Blood analysis showed few systemic effects from the lunar dust inhalation. By week 4, the peripheral granulocyte percentage was elevated in the treated rats. Plasma cytokine levels were unchanged in all treated rats compared to controls. Peripheral blood analysis showed an increased granulocyte percentage and altered cytokine production profiles consisting of increased in IL‐1b and IL‐6, and decreased IL‐2 production. Conclusion: Lunar dust inhalation results in significant lung inflammation, and some systemic effects, that does not resolve through 13 weeks. Lunar dust may therefore represent a crew health risk during sortie or long‐duration Lunar missions.

Crucian, Brian↗

Characterization of Particulate Matter Profiling and Alveolar Deposition from Biomass Burning in Northern Thailand: The 7-SEAS Study

Biomass burning (BB) frequently occurs in SouthEast Asia (SEA), which significantly affects the air quality and could consequently lead to adverse health effects. The aim of this study was to characterize particulate matter (PM) and black carbon (BC) emitted from BB source regions in SEA and their potential of deposition in the alveolar region of human lungs. A 31-day characterization of PM profiling was conducted at the Doi Ang Khang (DAK) meteorology station in northern Thailand in March 2013. Substantial numbers of PM (10147 +/- 5800 # per cubic centimeter) with a geometric mean diameter (GMD) of 114.4 +/- 9.2 nm were found at the study site. The PM of less than 2.5 micron in aerodynamic diameter (PM sub 2.5) hourly-average mass concentration was 78.0 +/- 34.5 per cubic microgram whereas the black carbon (BC) mass concentration was 4.4 +/- 2.6 micrograms per cubic meter. Notably, high concentrations of nanoparticle surface area (100.5 +/- 54.6 square micrometers per cubic centimeter) emitted from biomass burning can be inhaled into the human alveolar region. Significant correlations with fire counts within different ranges around DAK were found for particle number, the surface area concentration of alveolar deposition, and BC. In conclusion, biomass burning is an important PM source in SEA, particularly nanoparticles, which has high potency to be inhaled into the lung environment and interact with alveolar cells, leading to adverse respiratory effects. The fire counts within 100 to 150 km shows the highest Pearson's r for particle number and surface area concentration. It suggests 12 to 24 hr could be a fair time scale for initial aging process of BB aerosols. Importantly, the people lives in this region could have higher risk for PM exposure.

biomass burning↗

GEOS-CF Model Assessment of PM2.5 During Wildfires: Inferring the Impact of PM2.5 Exposure on Adverse Respiratory & Cardiovascular Conditions

Exposure to fine particulate matter (PM2.5) can aggravate pre-existing respiratory and cardiovascular conditions. When PM2.5 is inhaled it can cause damage to the lungs such as reduced lung function and shortness of breath. After being inhaled PM2.5 can enter the bloodstream and cause harm to the heart. One major natural source of PM2.5 exposure is from wildfire smoke. The particulates within the smoke from the wildfires can spread from the initial source region, potentially impacting communities both near and far. During and after wildfire events, PM2.5 levels can exceed the WHO air quality guidelines (10 gm^3 annual mean; 25 gm^3 daily mean), becoming hazardous to an individual's health. Global models can be used to simulate the emission and transport of these particulates and subsequently they can be valuable to air quality forecasting in highly polluted areas. The NASA Goddard Earth Observing System (GEOS) version 5 Composition Forecast (GEOS-CF) system has been used to produce near-real time air quality forecasts of atmospheric composition at a high global resolution of 25 km. The GEOS-CF system utilizes the GEOS weather forecast model coupled with GEOS-Chem (version 11) chemistry module to provide analyses and forecasts of various toxic air pollutants, including PM2.5. The GEOS-CF simulated high levels of PM2.5 (40 gm^3 to 250 gm^3 ), exceeding the WHO guidelines, during multiple recent regional and global wildfire seasons, including the 2017 Seattle, WA and Los Angeles, CA wildfire seasons, and biomass burning events in India. Furthermore, the GEOS-CF simulated PM2.5 applied to a human health assessment model, BenMAP (The Environmental Benefits Mapping and Analysis Program, version 1.3), estimates the impact on adverse respiratory health conditions due to PM2.5 exposure from wildfires. The GEOS-CF predicted PM2.5 during the wildfire season with the corresponding BenMAP results provides an assessment of the human health impact of PM2.5 exposure.

Saunders, Emily↗

NASA's GEOS Composition Model Assessment of PM2.5 During Wildfires: Inferring the Impact of PM2.5 Exposure on Adverse Respiratory & Cardiovascular Conditions

Particulate matter pollution is a mixture of solid and liquid droplets floating in the air that can lead to reduced air quality and increased adverse health impact. Fine particulate matter (PM2.5) can be emitted into the air from anthropogenic sources such as the burning of fossil fuels, motor vehicles, and powerplant emissions. Exposure to PM2.5 can aggravate pre-existing respiratory and cardiovascular conditions. When PM2.5 is inhaled it can cause damage to the lungs such as reduced lung function and shortness of breath. After being inhaled PM2.5 can enter the bloodstream and cause harm to the heart. One major natural source of PM2.5 exposure is from wildfire smoke. The particulates within the smoke from the wildfires can spread from the initial source region, potentially impacting communities both near and far. During and after wildfire events, PM2.5 levels can exceed the WHO air quality guidelines (10 m.g/m^3 annual mean; 25 m.g/m^3 daily mean), becoming hazardous to an individual's health. Global models can be used to simulate the emission and transport of these particulates and subsequently they can be valuable to air quality forecasting in highly polluted areas. The NASA Goddard Earth Observing System (GEOS) Composition Forecast (GEOS-CF) system has been used to produce near-real time air quality forecasts of atmospheric composition at a high global resolution of 25x25 km2. The GEOS-CF system utilizes the GEOS weather forecast model coupled with GEOS-Chem (version 11) chemistry module to provide analyses and forecasts of various toxic air pollutants, including PM2.5. The GEOS-CF simulated high levels of PM2.5 (40 m.g/m^3 to 250 m.g/m^3 ), exceeding the WHO guidelines, during multiple recent regional and global wildfire seasons, including the 2017 Washington State and Northern and Southern California wildfire seasons. Furthermore, the GEOS-CF simulated PM2.5 applied to a human health assessment model, BenMAP (The Environmental Benefits Mapping and Analysis Program, version 1.3), estimates the impact on adverse respiratory health conditions due to PM2.5 exposure from wildfires. The GEOS-CF predicted PM2.5 during the wildfire season with the corresponding BenMAP results provides an assessment of the human health impact of PM2.5 exposure.

Saunders, Emily↗

Bio-assessment device and method of making the device

Disclosed herein are embodiments of a device that can be used to mimic the biochemical and physiological actions of a lung organ. Also disclosed herein are embodiments of components that are included in the device as well as methods of making and using the device. Further disclosed are platform device embodiments and various components used therein that can be used in combination with the lung organ devices disclosed herein. In some embodiments, the disclosed devices can be used to determine drug toxicity and also can be used with one or more disease models to determine methods of treating disease.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

A Primer on Dose-Response Data Modeling in Radiation Therapy

An overview of common approaches used to assess a dose response for radiation therapy–associated endpoints is presented, using lung toxicity data sets analyzed as a part of the High Dose per Fraction, Hypofractionated Treatment Effects in the Clinic effort as an example. Each component presented (eg, data-driven analysis, dose-response analysis, and calculating uncertainties on model prediction) is addressed using established approaches. Specifically, the maximum likelihood method was used to calculate best parameter values of the commonly used logistic model, the profile-likelihood to calculate confidence intervals on model parameters, and the likelihood ratio to determine whether the observed data fit is statistically significant. The bootstrap method was used to calculate confidence intervals for model predictions. Correlated behavior of model parameters and implication for interpreting dose response are discussed.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Early Prediction of Acute Esophagitis for Adaptive Radiation Therapy

Acute esophagitis (AE) is a common dose-limiting toxicity in radiation therapy of locally advanced non-small cell lung cancer (LA-NSCLC). We developed an early AE prediction model from weekly accumulated esophagus dose and its associated local volumetric change.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Radiation Therapy Enhanced by NBTXR3 Nanoparticles Overcomes Anti-PD1 Resistance and Evokes Abscopal Effects

Radiation combined with PD1 blockade offers significant treatment benefits in several tumor types; however, anti-PD1 resistance precludes such benefits in many cases. Here we attempted to overcome anti-PD1 resistance by combining localized radiation with a radioenhancing nanoparticle (NBTXR3) and systemic anti-PD1 treatment to achieve abscopal effects in an anti-PD1–resistant mouse model of lung cancer.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Screening and Validation of Molecular Targeted Radiosensitizers

The development of molecular targeted drugs with radiation and chemotherapy is critically important for improving the outcomes of patients with hard-to-treat, potentially curable cancers. However, too many preclinical studies have not translated into successful radiation oncology trials. Major contributing factors to this insufficiency include poor reproducibility of preclinical data, inadequate preclinical modeling of intertumoral genomic heterogeneity that influences treatment sensitivity in the clinic, and a reliance on tumor growth delay instead of local control (TCD50) endpoints. There exists an urgent need to overcome these barriers to facilitate successful clinical translation of targeted radiosensitizers. To this end, we have used 3-dimensional (3D) cell culture assays to better model tumor behavior in vivo. Examples of successful prediction of in vivo effects with these 3D assays include radiosensitization of head and neck cancers by inhibiting epidermal growth factor receptor or focal adhesion kinase signaling, and radioresistance associated with oncogenic mutation of KRAS. To address the issue of tumor heterogeneity, we leveraged institutional resources that allow high-throughput 3D screening of radiation combinations with small-molecule inhibitors across genomically characterized cell lines from lung, head and neck, and pancreatic cancers. This high-throughput screen is expected to uncover genomic biomarkers that will inform the successful clinical translation of targeted agents from the National Cancer Institute Cancer Therapy Evaluation Program portfolio and other sources. Screening “hits” need to be subjected to refinement studies that include clonogenic assays, addition of disease-specific chemotherapeutics, target/biomarker validation, and integration of patient-derived tumor models. The chemoradiosensitizing activities of the most promising drugs should be confirmed in TCD50 assays in xenograft models with or without relevant biomarker and using clinically relevant radiation fractionation. We predict that appropriately validated and biomarker-directed targeted therapies will have a higher likelihood than past efforts of being successfully incorporated into the standard management of hard-to-treat tumors.

62 RADIOLOGY AND NUCLEAR MEDICINE↗