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All sourcesNASA NTRSDOE OSTI
NASA NTRS2024

LTV-xEVA Applied Injury Biomechanics

Beginning in Artemis V, Lunar Terrain Vehicles (LTV) will be utilized to enable astronauts to explore the lunar south pole and conduct science farther from the landing site than during the Apollo program. However, LTV operation has the potential to cause injury to the suited crew member during their Extravehicular Activity (EVA). Injury risk caused by LTV acceleration and jerk combined with blunt loading from rigid suit components needs to be better understood. An effort began to create requirements for, model, and address the injury risk caused by the LTV combined with Exploration EVA (xEVA) suits. Mitigation of crew injury is a shared responsibility between LTV and the suit since neither can accomplish this independently. The modeling completed in Fiscal Year 2023 (FY23) helped to verify the fidelity of the requirements and parse out vendor responsibility (LTV, xEVAS, or NASA) for Artemis V and beyond. The scope of the modeling in FY23 used the LTV System Requirements Document (SRD) as worst-case inputs and modeled female 5th-, male 50th-, and male 95th-percentile subjects in hard-mounted seated and semi-standing postures. Soft-mounted (i.e., lap belt) and testing to validate the analysis was determined out of scope for FY23 work.

Spacesuit↗
NASA NTRSDate not supplied

LTV-xEVA Applied Injury Biomechanics

Beginning in Artemis V, Lunar Terrain Vehicles (LTV) will be utilized to enable astronauts to explore the lunar south pole and conduct science farther from the landing site than during the Apollo program. However, LTV operation has the potential to cause injury to the suited crew member during their Extravehicular Activity (EVA). Injury risk caused by LTV acceleration and jerk combined with blunt loading from rigid suit components needs to be better understood. An effort began to create requirements for, model, and address the injury risk caused by the LTV combined with Exploration EVA (xEVA) suits. Mitigation of crew injury is a shared responsibility between LTV and the suit since neither can accomplish this independently. The modeling completed in Fiscal Year 2023 (FY23) helped to verify the fidelity of the requirements and parse out vendor responsibility (LTV, xEVAS, or NASA) for Artemis V and beyond. The scope of the modeling in FY23 used the LTV System Requirements Document (SRD) as worst-case inputs and modeled female 5th-, male 50th-, and male 95th-percentile subjects in hard-mounted seated and semi-standing postures. Soft-mounted (i.e., lap belt) and testing to validate the analysis was determined out of scope for FY23 work.

Spacesuit↗
NASA NTRSDate not supplied

Neuro-Vestibular Examination During and Following Spaceflight (Vestibular Health)

BACKGROUND Adaptation to microgravity during spaceflight causes neurological disturbances that are either directly or indirectly mediated by the vestibular system. These disturbances can include space motion sickness, spatial disorientation, and cognitive impairment, as well as changes in head-eye coordination, vestibulo-ocular reflexes, and control of posture and locomotion. Otolith-mediated reflex gains appear to adapt rapidly during spaceflight and after landing. However, animal studies have shown that structural modifications of the vestibular sensory apparatus develop during long-duration spaceflight. To date, no studies have characterized the severity of vestibular syndromes experienced by astronauts as a function of the duration of spaceflight or whether the effects are caused by changes at the peripheral end organs, midbrain, cerebellum, or vestibular cortex. OBJECTIVES We are investigating temporal vestibular changes in crewmembers of short, 6-month, and one-year missions to identify trends in adaptation of vestibular health and performance in orbit and after landing. We are also differentiating between peripheral and central vestibular forms of vertigo and oculomotor disorders. METHODS Recordings of eye, head, and body movements, as well as subjective reports of perception of motion, are being used to determine the presence of abnormal eye movements, dysmetria, motion sickness symptoms, and illusions of motion during head or body movements. This includes characterization of temporal trends in central compensation for vestibular (otolith) asymmetry. In-flight examinations are being performed early in the mission (Flight Days 1 and 30) and once every 2-3 months thereafter. Postflight examinations are performed after return (R) from the mission on R+0, R+4, R+9, and R+30. The inflight and postflight motion sickness questionnaires are customized to support data sharing across related studies. Ground-based control testing has been performed on healthy volunteers(18 females, 14 males;38.6 ± 9.2 years) in the laboratory to estimate mean normative responses, and on patients with bilateral vestibulopathy (BVP) (17 females, 13 males; 60.6 ± 13.0 years) at the University of Caen. RESULTS As of September 2024, two crewmembers have completed all preflight, inflight, and postflight testing. Additional crewmembers are currently enrolled and data collection is currently ongoing. For ground testing, BVP patients performed similarly to previous postflight astronauts on R+0 in various walking performance tasks. Three additional body movement perception tasks have been tested. For the Triangle Completion Task, BVP patients had a larger mean angle of deviation and longer mean distance than healthy controls. For the Self-Rotation Task and Distance Perception Task, BVP patients had larger errors than healthy controls. These data suggest that vestibular deficiencies impact all aspects of body movement perception tested; whereas previous studies suggest that vestibular deficiencies are only associated with directional errors, not with overall trajectories/path lengths. These data will be compared to those of crewmembers during early postflight readaptation. RELEVANCE If the observed symptoms in crewmembers are more deleterious after the year-long missions than those documented after 6-month missions, then relevant countermeasures will be required to maintain the health and operational performance of astronauts during longer missions. Depending on the etiology of the vestibular syndrome revealed by these tests, countermeasures will be proposed based on vestibular rehabilitation therapies currently used in patients with vestibular disorders, such as habituation, gaze stabilization, and/or balance training exercises. ACKNOWLEDGEMENT This work is supported by NASA’s Human Research Program Human Health Countermeasures Element.

T R Macaulay↗
NASA NTRSDate not supplied

Development and Validation of Sensorimotor Assessment Tasks Using Spaceflight Analogs

INTRODUCTION Exploration class missions will require a new level of crew autonomy to self-assess and treat their sensorimotor dysfunction around periods of gravitational transition, where sensorimotor disturbances are at their highest. There is a need to define sensorimotor assessment thresholds that indicate when performance in early extravehicular activities (EVAs) might be impacted or unsafe. The purpose of this study was to develop and validate a set of assessment tasks using sensorimotor spaceflight analogs including the Sensorimotor Disorientation Analog (SDA) and +3G x sustained centrifugation. METHODS For the SDA, forty-one healthy non-astronaut subjects (21 males, 20 females; Mean ± SD, Age: 34.0 ± 7.8 years) volunteered to participate in this study. Subjects attended two testing sessions: 1) familiarization to the tasks and baseline data collection, and 2) tasks completed under two levels of sensorimotor disorientation. Subjects performed a series of seven sensorimotor assessment tasks followed by two operationally relevant EVA analog tasks. The sensorimotor assessments tasks, ordered from least to most provocative of the sensorimotor system, included: postural stability, step test, prone/supine recovery from fall (RFF), four-square-step-test, obstacle negotiation with turns (OTT), kneel-and-reach, and augmented reality full-body coordination. The operational analog tasks included a top-hatch capsule egress and a 5-minute EVA traversal. Disorientation was applied via the SDA which utilized galvanic vestibular stimulation and weighted trunk, wrists, and ankles to target the vestibular and proprioceptive systems such that performance while wearing the SDA mimicked astronaut postflight performance at R+0 and R+1. Sixteen healthy non-astronaut subjects (10 males, 6 females; Age: 35.0 ± 9.5 years) completed +3G x 60-minute sustained centrifugation as an established spaceflight analog replicating the vestibular disruptions seen postflight. Subjects completed a pre-session which included familiarization to the tasks and a 5-minute centrifuge spin. The data collection session included, in order, a baseline data collection, 60-minute centrifuge spin, immediate post-centrifuge data collection, 45-minute seated recovery, and a final data collection. The same assessment and operational analog tasks were conducted as described above. RESULTS Pearsons’ correlation r-values were calculated between assessment and operational analog tasks. The two assessment tasks with the strongest correlations to the operational analog tasks were the RFF (SDA: r≥ 0.57, Centrifuge: r ≥0.55) and OTT (SDA: r≥ 0.66, Centrifuge: r ≥ 0.49). For brevity, repeated measures ANOVA with follow-up paired t-tests are discussed for these two assessment tasks. The SDA found significant differences between all three levels of disorientation for both RFF and OTT (p < 0.001). Significant differences were also found between baseline and immediate post centrifuge testing for both the RFF (p≤ 0.011) and OTT (p = 0.001). Additional results are forthcoming for both disorientation paradigms. DISCUSSION These validation studies provide evidence for down-selection of the assessment tasks that were able to distinguish between levels of sensorimotor disorientation and correlate to performance in operationally relevant tasks for use in upcoming Artemis missions.

S C Moudy↗
NASA NTRSDate not supplied

3D Scanning System to Assess Gravity-Dependent Body Shape Changes

The human body shows unique morphological changes when exposed to different gravity conditions, including muscle atrophy, fluid shift, and spinal elongation. Such changes need to be incorporated for human-system integration in the vehicle habitat, garment, and spacesuit designs, as inaccurate body measurements can result in suboptimal crew protection that can potentially decrease injury tolerance. However, measurement tools have not been available for accurate assessments of body shape changes. This work aimed to develop a prototype 3-D body scanning system with the configuration and performance optimized for in-flight crewmember body scanning. A scan hardware system was developed using Intel RealSense commercial off-the-shelf 3D sensors. The sensor parameters were iteratively optimized and tested to obtain the performance level needed for body scanning. A scan booth structure was fabricated, with the overall size 4 x 4 x 8 feet. The specific number of sensors and mounting positions were determined by iterative simulations, which indicated that 16 cameras can capture 94% and 96% of body surface area from the 1st percentile female and 99th percentile male crew population subject. The mounted sensors were linked through a mix of USB-C and USB-3 cables and operated for data acquisition from a Linux laptop computer. A software prototype was developed using Python and Tkinter graphical user interface toolkit. A calibration procedure was also built using a panel of QR codes. A computer vision tool detected and decoded the unique ID and pattern locations of the QR codes. The calibration information determined the position and orientation of the 3D sensors with respect to each other. The scanner performance was assessed using a set of 3D printed custom manikins. The manikin size and shape were derived from the previous ISS study, which measured the crewmembers’ anthropometry changes across the different flight phases. The average anthropometric measurements at the pre-flight and flight day 15 were sampled and projected onto the 1st percentile female and 99th percentile male body shapes. Another pair of manikins were also 3D printed to simulate the neutral body posture, estimated from ISS microgravity environments. A preliminary analysis assessed the performance of the newly developed scanner against the reference scanner, which has been used at the NASA JSC for crew and test subject anthropometry. Although the new scanner data showed several artifacts and missing geometries in the occluded body areas such as armpits and crotch, overall shape matched with the reference scan. When the manikin surface coordinates were compared, a root mean square error of 1.3 cm was observed from the manikin torso segment. Linear measurements including the stature, knee height and circumference measurements at the chest and calf showed differences from the reference scan measurements, ranging between 0.3 and 0.9 cm. Overall, this work demonstrated a development framework for an in-flight scanner with design and operation optimized for crewmember body scanning. Further improvement can potentially provide previously unavailable anthropometric data from different gravitational environments, including 0-g, 1/6-g, and 1-g. Such data can improve suit fit, habitat design, exercise efficacy quantification and sizing of orthostatic intolerance garments.

K H Kim↗
DOE OSTI2013

WILD PIG ATTACKS ON HUMANS

Attacks on humans by wild pigs (Sus scrofa) have been documented since ancient times. However, studies characterizing these incidents are lacking. In an effort to better understand this phenomenon, information was collected from 412 wild pig attacks on humans. Similar to studies of large predator attacks on humans, data came from a variety of sources. The various attacks compiled occurred in seven zoogeographic realms. Most attacks occurred within the species native range, and specifically in rural areas. The occurrence was highest during the winter months and daylight hours. Most happened under non-hunting circumstances and appeared to be unprovoked. Wounded animals were the chief cause of these attacks in hunting situations. The animals involved were typically solitary, male and large in size. The fate of the wild pigs involved in these attacks varied depending upon the circumstances, however, most escaped uninjured. Most human victims were adult males traveling on foot and alone. The most frequent outcome for these victims was physical contact/mauling. The severity of resulting injuries ranged from minor to fatal. Most of the mauled victims had injuries to only one part of their bodies, with legs/feet being the most frequent body part injured. Injuries were primarily in the form of lacerations and punctures. Fatalities were typically due to blood loss. In some cases, serious infections or toxemia resulted from the injuries. Other species (i.e., pets and livestock) were also accompanying some of the humans during these attacks. The fates of these animals varied from escaping uninjured to being killed. Frequency data on both non-hunting and hunting incidents of wild pig attacks on humans at the Savannah River Site, South Carolina, showed quantitatively that such incidents are rare.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2014

Photovoltaic module and interlocked stack of photovoltaic modules

One embodiment relates to an arrangement of photovoltaic modules configured for transportation. The arrangement includes a plurality of photovoltaic modules, each photovoltaic module including a frame. A plurality of individual male alignment features and a plurality of individual female alignment features are included on each frame. Adjacent photovoltaic modules are interlocked by multiple individual male alignment features on a first module of the adjacent photovoltaic modules fitting into and being surrounded by corresponding individual female alignment features on a second module of the adjacent photovoltaic modules. Other embodiments, features and aspects are also disclosed.

14 SOLAR ENERGY↗
DOE OSTI2014

Oxidative Stress and Skeletal Health with Low-Dose, Low-LET (Linear Energy Transfer) Ionizing Radiation

We performed in vivo and in vitro experiments to accomplish the following specific aims of this project: 1) determine if low dose, low LET radiation affects skeletal remodeling at structural, cellular and molecular levels and 2) determine if low dose, low LET radiation modulates skeletal health during aging via oxidative mechanisms. A third aim is supported by NASA supplement to this DOE grant focusing on the influence of high LET radiation on bone. A series of experiments were conducted at the NASA Space Radiation Laboratory at Brookhaven, NSRL-BNL, using iron (56Fe) or a sequential exposure to protons / iron / protons, and separate experiments at NASA Ames Research Center (ARC) using 137Cs. The following provides a summary of key findings. (1) Exposure of nine-week old female mice to priming doses of gamma radiation (10cGy x 5) did not significantly affect bone volume/total volume (BV/TV) or microarchitecture as analyzed by 3D microcomputed tomography. As expected, exposure to the challenge dose of 2 Gy gamma irradiation resulted in significant decreases in BV/TV. The priming dose combined with the 2Gy challenge dose had no further effect on BV/TV compared to challenge dose alone, with the sole exception of the Structural Model Index (SMI). SMI reflects the ratio of rods-to-plates in cancellous bone tissue, such that higher SMI values indicate a tendency toward a weaker structure compared to lower SMI values. Mice treated with both priming and challenge dose had 25% higher SMI values compared to sham-irradiated controls and 7% higher values compared to mice treated with the challenge dose alone. Thus, although this priming regimen had relatively modest effects on cancellous tissue, the difference in SMI suggests this fractionated priming doses have adverse, rather than beneficial, effects on bone structure. (2) In 10-week old male mice, a single exposure to 100cGy of 137Cs reduces trabecular bone number and connectivity density by 20% and 36% respectively one month after irradiation (IR). At four months post-IR, these animals were comparable to sham-treated controls with regards to the abovementioned structural parameters. Irradation at 1 or 10 cGy did not result in any significant changes in bone structural parameters. (3) Irradiation of 16-wk old male mice with high doses of 56Fe or proton (50 or 200cGy), but not at low doses (5 or 10cGy), showed a similar loss of cancellous BV/TV and trabecular number at five weeks post-IR. (4) Age-related bone loss overtook acute radiation-induced decrements in bone structure within four months post-IR with 100 cGy gamma and 12 months post-IR with 200 cGy iron. Transgenic mice globally overexpressing human catalase gene in mitochondria did not exhibit cancellous bone loss as assessed at four month post-IR with 10 cGy proton, 50 cGy iron, or in combination. (5) The cellular and molecular mechanisms responsible for loss of bone with radiation are mediated primarily through increased osteoclastogenesis. Our data provide evidence that there are increases in gene expression of TNF alpha and MCP1 in the bone marrow cells 24 hours post-IR and of osteoclastogenic differentiation factor RANKL by day 3. These cytokines in the marrow may stimulate mature osteoclasts or drive osteoclastogenesis from precursors. (6) Osteoblastogenesis from marrow progenitors evaluated ex vivo decreased following whole body 56Fe irradiation at a dose threshold between 20 and 50 cGy whereas osteoclastogenesis ex vivo increased with doses as low as 10cGy two days post-IR of mice. However, the latter finding was not observed in more than a single experiment. (7) Gamma irradiation of cells in vitro requires relatively high doses (200cGy) to disturb normal osteoblastogenesis and osteoclastogenesis as evidenced by decrements in mineralized nodule formation, osteoclast counts, and expression of osteoblast related genes such as runx2, col1a1. (8) We also investigated the effect of antioxidants on osteoblastogenesis following low dose in vitro gamma irradiation (15cGy) on day four bone marrow stromal cell cultures. Superoxide dismutase (SOD) was added to the cell culture medium for 2 or 3 days post-irradiation and cell colonies were counted on days 7 and 10. SOD treatment increased cell growth as measured by DNA content and colony forming units (CFU) in both irradiated cells and 0 cGy control groups. However, low dose radiation of 15cGy abolished SOD stimulatory effects on cell growth and CFU number. These results suggest that exogenous SOD increases osteoblast cell growth and colony formation and that low-dose radiation (15cGy) can interfere with the antioxidant effects. In summary, our findings indicate that acute, whole body irradiation at high doses (50-200 cGy) results in prompt tissue degradation and bone loss. Lower doses (<50 cGy) do not cause bone structural deterioration but may deplete stem/progenitor cell pools in the bone marrow.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2023

Modular base for an antenna array

A base configured to be joined with other bases to form a substrate for an antenna array comprises a body, a plurality of male interconnecting features, and a plurality of female interconnecting features. The body includes a front surface and a rear surface and a plurality of edges positioned therebetween. The front surface or the rear surface is configured to retain an antenna. The male interconnecting features of a first base connect with the female interconnecting features of a second base when the first base is joined with the second base to form the substrate or a portion of the substrate.

Furman, Nicholas J.↗
DOE OSTI2013

Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997-2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18-90) years with mean follow-up of 15 (range, 0-61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

Efficacy and Safety of a Novel Vascular Closure Device (Glubran 2 Seal) After Diagnostic and Interventional Angiography in Patients with Peripheral Arterial Occlusive Disease

To prospectively evaluate safety and efficacy of a novel vascular closure device (Glubran 2 Seal) after peripheral angiography in patients with peripheral arterial occlusive disease (PAOD). From December 2010 to June 2011, all consecutive patients with PAOD undergoing peripheral angiography were prospectively enrolled onto the study after percutaneous antegrade or retrograde puncture of the common femoral artery. After angiography, the Glubran 2 Seal device was used to achieve hemostasis. The following data were registered: technical success and manual compression duration, patients' discomfort (scale 0-5), operators' technical difficulty (scale 0-5), and vascular complications. The site of hemostasis was evaluated by clinical inspection and color-coded Duplex ultrasound performed 1 day and 1 month after the procedure. One hundred seventy-eight patients were enrolled (112 male, mean age 70.8 years) with a total of 206 puncture sites, including 104 (50.5 %) antegrade accesses. The device was successful in 198(96.1 %) of 206 procedures, with 8 cases of manual compression lasting longer than 5 min (maximum 20 min). No major vascular complications were observed, resulting in 100 % procedural success. Minor complications occurred in seven procedures (3.4 %), including two cases of pseudoaneurysms, successfully treated by ultrasound-guided glue injection. The mean {+-} standard deviation score for patients' discomfort was 0.9 {+-} 0.7, whereas the mean score for operators' difficulty was 1.2 {+-} 0.9. In patients with PAOD, the Glubran 2 Seal represents a simple, painless, and efficient vascular closure device, able to achieve hemostasis both in antegrade and retrograde accesses.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Minimally Invasive Treatment of Giant Haemangiomas of the Liver: Embolisation With Bleomycin

Purpose: The management of patients with giant haemangioma of the liver remains controversial. Although the usual treatment method for symptomatic giant haemangioma is surgery, the classical paradigm of operative resection remains. In this study, we evaluated the symptomatic improvement and size-reduction effect of embolisation with bleomycin mixed with lipiodol for the treatment of symptomatic giant hepatic haemangioma. Methods: This study included 26 patients [21 female, five male; age 41–65 years (mean 49.83 ± 1.53)] with symptomatic giant haemangioma unfit for surgery and treated with selective embolisation by bleomycin mixed with lipiodol. The patients were followed-up (mean 7.4 ± 0.81 months) clinically and using imaging methods. Statistical analysis was performed using SPSS version 16.0, and p < 0.05 was considered to indicate statistical significance. Results: Embolisation of 32 lesions in 26 patients was performed. The mean volume of the haemangiomas was 446.28 ± 88 cm{sup 3} (range 3.39–1559 cm{sup 3}) before intervention and 244.43 ± 54.38 cm{sup 3} (range 94–967 cm{sup 3}) after intervention. No mortality or morbidity related to the treatment was identified. Symptomatic improvement was observed in all patients, and significant volume reduction was achieved (p = 0.001). Conclusion: The morbidity of surgical treatment in patients with giant liver hemangioma were similar to those obtained in patients followed-up without treatment. Therefore, follow-up without treatment is preferred in most patients. Thus, minimally invasive embolisation is an alternative and effective treatment for giant symptomatic haemangioma of the liver.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Percutaneous Aspiration Thrombectomy for the Treatment of Arterial Thromboembolic Occlusions Following Percutaneous Transluminal Angioplasty

PurposeThis study was designed to evaluate the technical success and the early clinical outcome of patients undergoing percutaneous aspiration thrombectomy (PAT) for the treatment of arterial thromboembolism following percutaneous infrainguinal transluminal angioplasty (PTA).MethodsIn this single-center study, during a period of 7 years retrospectively, 47 patients (22 male, 47 %) with a mean age of 73 (range 53–96) years were identified in whom PAT was performed for the treatment of thromboembolic complications of infrainguinal PTA. Primary technical success was defined as residual stenosis of <50 % in diameter after sole PAT, whereas secondary technical success was defined as residual stenosis of <50 % in diameter after PAT and additional PTA and/or stenting. Clinical outcome parameters (e.g., need for further intervention, minor/major amputation) were evaluated for the 30-day postinterventional period.ResultsPrimary technical success was achieved in 64 % of patients (30/47); secondary technical success was obtained in 96 % of patients (45/47). Clinical outcome data were available in 38 patients. In 87 % of patients (33/38), there was no need for further intervention within the 30-day postinterventional period. In three patients, minor amputations were conducted due to preexisting ulcerations (Rutherford Category 5 respectively).ConclusionsPAT enables endovascular treatment of iatrogenic thromboembolic complications after PTA with good technical and early clinical results and minimal morbidity.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

The 10-year Trend of Periprocedural Complication Following Carotid Artery Stenting; Single Center Experience

PurposeCarotid endarterectomy and stenting are used to treat carotid stenosis, with the volume of carotid artery procedures increasing over the past decade. We investigated the 10-year trend of periprocedural complications with an increasing procedure volume of carotid stenting at a single tertiary hospital.MethodsWe collected 416 consecutive cases (384 patients) of carotid artery stenting performed for either symptomatic (231 cases, 55.5 %) or asymptomatic (185 cases, 44.5 %) internal carotid artery stenosis at a single center. Periprocedural complication was defined as any stroke, myocardial infarction, or death. Procedure-related outcome included any dissection, hemodynamic event, or periprocedural complication.ResultsThe mean age was 68.8 years (82.8 % males; range of 20–89 years); 23.9 % were older than 75 years. Before the procedure, 99.3 and 56.0 % of patients received antiplatelet and lipid-lowering medication, respectively. The overall periprocedural complication rate was 3.6 % (1.6 and 5.2 % in the asymptomatic and symptomatic group, respectively). The composite outcome of any stroke or death was 3.4 %. Periprocedural complication and procedure-related outcome showed a decremental trend with increasing procedure volume, and this trend remained after adjusting for confounders.ConclusionsOur study suggests that carotid stenting at an experienced center might reduce the periprocedural complications. Our periprocedural complication rate of carotid artery stenting may be comparable to, or somewhat lower than, that reported in other clinical trials.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Percutaneous Irreversible Electroporation of Locally Advanced Pancreatic Carcinoma Using the Dorsal Approach: A Case Report

Irreversible electroporation (IRE) is a novel image-guided ablation technique that is increasingly used to treat locally advanced pancreatic carcinoma (LAPC). We describe a 67-year-old male patient with a 5 cm stage III pancreatic tumor who was referred for IRE. Because the ventral approach for electrode placement was considered dangerous due to vicinity of the tumor to collateral vessels and duodenum, the dorsal approach was chosen. Under CT-guidance, six electrodes were advanced in the tumor, approaching paravertebrally alongside the aorta and inferior vena cava. Ablation was performed without complications. This case describes that when ventral electrode placement for pancreatic IRE is impaired, the dorsal approach could be considered alternatively.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Stent-Graft Placement with Early Debridement and Antibiotic Treatment for Femoral Pseudoaneurysms in Intravenous Drug Addicts

PurposeExplore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts.Materials and MethodsWe evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013.Results15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication.ConclusionsSG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Flat-Panel Cone-Beam Ct-Guided Radiofrequency Ablation of Very Small (≤1.5 cm) Liver Tumors: Technical Note on a Preliminary Experience

PurposeThe aim of the present study was to investigate the technical feasibility of flat-panel cone-beam CT (CBCT)-guided radiofrequency ablation (RFA) of very small (<1.5 cm) liver tumors.Materials and MethodsPatients included were candidates for hepatic percutaneous RFA as they had single biopsy-proven hepatic tumors sized ≤1.5 cm and poorly defined on ultrasonography. Following apnea induction, unenhanced CBCT scans were acquired and used to deploy the RF electrode with the aid of a virtual navigation system. If the tumor was not clearly identified on the unenhanced CBCT scan, a right retrograde arterial femoral access was established to carry out hepatic angiography and localize the tumor. Patients’ lesions and procedural variables were recorded and analyzed.ResultsThree patients (2 male and 1 female), aged 68, 76, and 87 years were included; 3 lesions (2 hepato-cellular carcinoma and 1 metastasis from colorectal cancer) were treated. One patient required hepatic angiography. Cycles of apnea used to acquire CBCT images and to deploy the electrode lasted <120 s. Mean fluoroscopic time needed to deploy the electrode was 36.6 ± 5.7 min. Mean overall procedural time was 66.0 ± 22.9 min. No peri- or post-procedural complications were noted. No cases of incomplete ablation were noted at 1-month follow-up.ConclusionPercutaneous CBCT-guided liver RFA with or without arterial hepatic angiography is technically feasible.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

Delayed-Phase Cone-Beam CT Improves Detectability of Intrahepatic Cholangiocarcinoma During Conventional Transarterial Chemoembolization

PurposeTo evaluate the detectability of intrahepatic cholangiocarcinoma (ICC) on dual-phase cone-beam CT (DPCBCT) during conventional transarterial chemoembolization (cTACE) compared to that of digital subtraction angiography (DSA) with respect to pre-procedure contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.MethodsThis retrospective study included 17 consecutive patients (10 male, mean age 64) with ICC who underwent pre-procedure CE-MRI of the liver, and DSA and DPCBCT (early-arterial phase (EAP) and delayed-arterial phase (DAP)) just before cTACE. The visibility of each ICC lesion was graded by two radiologists on a three-rank scale (complete, partial, and none) on DPCBCT and DSA images, and then compared to pre-procedure CE-MRI.ResultsOf 61 ICC lesions, only 45.9 % were depicted by DSA, whereas EAP- and DAP-CBCT yielded a significantly higher detectability rate of 73.8 % and 93.4 %, respectively (p < 0.01). Out of the 33 lesions missed on DSA, 18 (54.5 %) and 30 (90.9 %) were revealed on EAP- and DAP-CBCT images, respectively. DSA depicted only one lesion that was missed by DPCBCT due to streak artifacts caused by a prosthetic mitral valve. DAP-CBCT identified significantly more lesions than EAP-CBCT (p < 0.01). Conversely, EAP-CBCT did not detect lesions missed by DAP-CBCT. For complete lesion visibility, DAP-CBCT yielded significantly higher detectability (78.7 %) compared to EAP (31.1 %) and DSA (21.3 %) (p < 0.01).ConclusionDPCBCT, and especially the DAP-CBCT, significantly improved the detectability of ICC lesions during cTACE compared to DSA. We recommend the routine use of DAP-CBCT in patients with ICC for per-procedure detectability and treatment planning in the setting of TACE.

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