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A review of Carbon Monitoring in Wet Carbon Systems using Remote Sensing

Carbon monitoring is critical for the reporting and verification of carbon stocks and change. Remote sensing is a tool increasingly used to estimate the spatial heterogeneity, extent and change of carbon stocks within and across various systems. We designate the use of the term wet carbon system to the interconnected wetlands, ocean, river and streams, lakes and ponds, and permafrost, which are carbon-dense and vital conduits for carbon throughout the terrestrial and aquatic sections of the carbon cycle. We reviewed wet carbon monitoring studies that utilize earth observation to improve our knowledge of data gaps, methods, and future research recommendations. To achieve this, we conducted a systematic review collecting 1,622 references and screening them with a combination of text matching and a panel of three experts. The search found 496 references, with an additional 78 references added by experts. Our study found considerable variability of the utilization of remote sensing and global wet carbon monitoring progress across the nine systems analyzed. The review highlighted that remote sensing is routinely used to globally map carbon in mangroves and oceans, whereas seagrass, terrestrial wetlands, tidal marshes, rivers, and permafrost would benefit from more accurate and comprehensive global maps of extent. We identified three critical gaps and twelve recommendations to continue progressing wet carbon systems and increase cross system scientific inquiry.

Anthony D. Campbell↗

Overview of the Interagency Nuclear Safety Review Board Playbook

National Security Presidential Memorandum #20 (NSPM-20) directed the NASA Administrator to establish an Interagency Nuclear Safety Review Board (INSRB), replacing the ad hoc safety review panels used for space nuclear system launch reviews since the 1960s. NSPM-20 provides over-arching direction regarding the Board’s purpose and intent. Upon formation of this new entity, its members recognized that more detailed guidance was needed to ensure predictable and reliable performance of the Board’s functions. The Board drafted and later approved a guidance document referred to as “the Playbook” for this purpose. This paper will summarize the main features of this publicly-available document, along with providing context for its initial drafting and revision. The goal of this paper is to broaden the degree of awareness by the space nuclear system community of INSRB’s activities and intents.

INSRB↗

REVIEW Of COMPUTERIZED PROCEDURE GUIDELINES FOR NUCLEAR POWER PLANT CONTROL ROOMS

Computerized procedures (CPs) are recognized as an emerging alternative to paper-based procedures for supporting control room operators in nuclear power plants undergoing life extension and in the concept of operations for advanced reactor designs. CPs potentially reduce operator workload, yield increases in efficiency, and provide for greater resilience. Yet, CPs may also adversely impact human and plant performance if not designed and implemented properly. Therefore, it is important to ensure that existing guidance is sufficient to provide for proper implementation and monitoring of CPs. In this paper, human performance issues were identified based on a review of the behavioral science literature, research on computerized procedures in nuclear and other industries, and a review of industry experience with CPs. The review of human performance issues led to the identification of a number of technical gaps in available guidance sources. To address some of the gaps, we developed 13 supplemental guidelines to support design and safety. This paper presents these guidelines and the case for further research.

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗

Hanford Double-Shell Tank Extent-of-Condition Review - 15498

During routine visual inspections of Hanford double-shell waste tank 241-AY-102 (AY-102), anomalies were identified on the annulus floor which resulted in further evaluations. Following a formal leak assessment in October 2012, Washington River Protection Solutions, LLC (WRPS) determined that the primary tank of AY-102 was leaking. A formal leak assessment, documented in RPP-ASMT-53793, Tank 241-AY-102 Leak Assessment Report, identified first-of-a-kind construction difficulties and trial-and-error repairs as major contributing factors to tank failure.1 To determine if improvements in double-shell tank (DST) construction occurred after construction of tank AY-102, a detailed review and evaluation of historical construction records was performed for Hanford’s remaining twenty-seven DSTs. Review involved research of 241 boxes of historical project documentation to better understand the condition of the Hanford DST farms, noting similarities in construction difficulties/issues to tank AY-102. Information gathered provides valuable insight regarding construction difficulties, future tank operations decisions, and guidance of the current tank inspection program. Should new waste storage tanks be constructed in the future, these reviews also provide valuable lessons-learned.

Johnson, J. M.↗

IMPLEMENTING THE NFPA 805 PROCESS: Observations of a Technical Reviewer

In June 2004 the U.S. Nuclear Regulatory Commission (NRC) amended its fire protection requirements to permit existing nuclear power reactor licensees to voluntarily adopt fire protection requirements contained in National Fire Protection Association (NFPA) Standard 805. NFPA 805 is a performance-based standard for nuclear power plant fire protection that is an alternative to the deterministic, prescriptive fire protection requirements, such as 10 CFR 50 Appendix R, that was issued in 1980. One aspect of implementing NFPA 805 is that the licensee adopts the performance goals, objectives, and criteria for nuclear safety specified in the Standard. These goals, objectives, and criteria can be met through the implementation of deterministic approaches or performance-based approaches, including engineering analyses, probabilistic risk assessment, and fire modeling. Licensees voluntarily adopting the fire protection requirements in NFPA 805 must submit a license amendment request (LAR) to the NRC. The LAR provides the new proposed fire protection licensing basis, including the methodology and results of required evaluations and analyses that show how the NFPA 805 performance criteria are met. As of August 2014, licensees have submitted LARs for 26 nuclear power plants, representing 42 nuclear reactor units. Of these, 7 nuclear power plants, representing 10 nuclear reactor units, have been issued a safety evaluation (SE) by the NRC approving transition of their fire protection licensing basis to one that complies with NFPA 805. Pacific Northwest National Laboratory (PNNL) supports the NRC staff’s technical review of the LARs in the areas of fundamental fire protection, safe shutdown analysis, and Probabilistic Risk Assessment (PRA). PNNL, of course, cannot speak for the nuclear industry and its choice of implementation strategies or the NRC staff’s assessment of the approaches being taken to adopt NFPA 805. However, as a reviewer of the technical details of these submittals, PNNL is in a position to observe the array of implementation tactics taken in these submittals, and observe different ways licensees are making the NFPA 805 process work. For example, we see differences in how fire areas are being transitioned, the kinds of plant modifications being implemented, the changes being made to plant procedures, the number and types of recovery actions being credited, and the kinds and extent of detailed modeling being performed in support of the Fire PRAs. As a caveat, we note that it is probably too early to comment on the overall success or limitations of the NFPA 805 process or provide lessons learned for the future. Furthermore, it is not our intention to endorse any particular approach taken in a submittal over another or to critique the industry or the regulator. Rather our goal in this paper is to summarize a set of interesting and useful differences across submittals that may provide context for further future discussions about what we (i.e., reviewers, industry, and regulators) have learned in being part of the NFPA process; and how to best use that information to inform future NFPA 805 activities or other risk-informed endeavors.

NFPA 805, PRA, PSA, probabilistic risk assessment,↗

Review of CTF’s Fuel Rod Modeling Using FRAPCON-4.0’s Centerline Temperature Predictions

Coolant Boiling in Rod Arrays–Two Fluid (COBRA-TF), or CTF1 [1], is a nuclear thermal hydraulic subchannel code used throughout academia and industry. CTF’s fuel rod modeling is originally developed for VIPRE code [2]. Its methodology is based on GAPCON [3] and FRAP [4] fuel performance codes, and material properties are included from MATPRO handbook [5]. This work focuses on review of CTF’s fuel rod modeling to address shortcomings in CTF’s temperaturepredictions. CTF is compared to FRAPCON which is U.S. NRC’s steady-state fuel performance code for light-water reactor fuel rods. FRAPCON calculates the changes in fuel rod variables and temperatures including the eects of cladding hoop strain, cladding oxidation, hydriding, fuel irradiation swelling, densification, fission gas release and rod internal gas pressure. It uses fuel, clad and gap material properties from MATPRO. Additionally, it has its own models for fission gas release, cladding corrosion and cladding hydrogen pickup. It allows finite dierence or finite element approaches for its mechanical model.In this study, FRAPCON-4.0 [6] is used as a reference fuel performance code. In comparison, Halden Reactor Data for IFA432 Rod 1 and Rod 3. CTF simulations are performed in two ways; informing CTF with gap conductance value from FRAPCON, and using CTF’s dynamic gap conductance model.First case is chosen to show temperature is predicted correctly with CTF’s models for thermal and cladding conductivities once gap conductance is provided. Latter is to review CTF’s dynamic gap conductance model. These Halden test cases are selected to be representative of cases with and without any physical contact between fuel-pellet and clad while reviewing functionality of CTF’s dynamic gap conductance model. Improving the CTF’s dynamic gap conductance model will allowprediction of fuel and cladding thermo-mechanical behavior under irradiation, and better temperature feedbacks from CTF in transient calculations.

Toptan, Aysenur↗

HL-LHC Computing Review Stage-2, Common Software Projects: Event Generators

This paper has been prepared by the HEP Software Foundation (HSF) Physics Event Generator Working Group (WG), as an input to the second phase of the LHCC review of High-Luminosity LHC (HL-LHC) computing, which is due to take place in November 2021. It complements previous documents prepared by the WG in the context of the first phase of the LHCC review in 2020, including in particular the WG paper on the specific challenges in Monte Carlo event generator software for HL-LHC, which has since been updated and published, and which we are also submitting to the November 2021 review as an integral part of our contribution.

72 PHYSICS OF ELEMENTARY PARTICLES AND FIELDS↗

Automated Data Review of Analytical Laboratory Results at Los Alamos National Laboratory - 20299

Newport News Nuclear BWXT-Los Alamos, LLC (N3B) collects samples in support of the U.S. Department of Energy's (DOE) Office of Environmental Management (EM) Los Alamos Legacy Cleanup Contract (LLCC). N3B receives and reviews over 1.6 million sample data points annually in support of various ongoing environmental monitoring and remediation projects of the LLCC. N3B must demonstrate and document that reported external analytical laboratory data produced for the LLCC are of sufficient quality to fulfill their intended purpose and to support defensible decision making as described in EPA QA/G4 Guidance for the Data Quality Objectives Process 1994. In 2018, N3B assumed management of the LLCC along with the Environmental Information Management (EIM) database that contains all historical and current environmental data associated with the LLCC. The entire EIM database is shared between N3B, Triad National Security, LLC (Triad), and New Mexico Environment Department (NMED). These three parties jointly manage the database, its configuration, and changes / updates. All environmental data that are entered into EIM are updated and available, on a daily basis, in the linked public database Intellus New Mexico (Intellus). The quality and defensibility of the environmental data generated from sampling activities is a key component of an effective remediation process. Providing quality data is accomplished through a data assessment process that includes examination, verification, and validation. Examination is the assessment of completeness of the deliverables, identification of any reporting errors, and determining the usability of the data based on the laboratory's evaluation of its data as described in the case narrative received with the data. Verification consists of an evaluation of the Electronic Data Deliverables (EDD) data report to determine the extent to which the external analytical laboratories met method and contract-specific quality control and reporting requirements. Validation consists of determining the data quality and the extent to which the external analytical laboratories accurately and completely reported all sample and quality control results and satisfied all contract requirements. EIM contains an automatic Data Validation Module which performs automated data review (DVM ADR). DVM ADR is a tool to assist in the validation process. When DVM ADR is used in conjunction with manual examination of sample data packages, the combination of the two will meet and exceed the requirements of verification. N3B recognized an opportunity for process improvement, focusing on DVM ADR configuration and enhancements in EIM. Testing EIM's configuration provided proof of the DVM ADR's capabilities and flexibility to accurately perform routine data checks based on analytical methods and regulatory requirements. In addition, the DVM ADR module was improved through enhancements for all analytes, particularly upgrades for radiochemistry data. Extensive testing of the DVM ADR module occurred using EDDs from actual laboratory analyses on the EIM testing site. During this process, N3B manipulated EDD information to verify that the actual outcomes matched the expected outcomes. The results of this testing were shared with the database architects, and configuration improvements were identified to address these results. During this process, N3B identified that the radiochemical DVM ADR capabilities were underutilized, and so enhanced the DVM ADR functionality with respect to radioanalytical assessment. N3B environmental data uploads to Intellus on a daily basis from EIM, once the analytical data undergoes examination and verification. As such, it is important to have a high level of confidence in the quality and defensibility of the data. The process of manual examination, along with the DVM ADR, in conjunction with full validation of a percentage the data specified through the Data Quality Objectives greatly increases efficiency of data review and confidence level of the quality of the data, and gives the project managers, governmental offices, and the public expedited access to high-quality data. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Review of CTF's Fuel Rod Modeling Using FRAPCON-4.0's Centerline Temperature Predictions

Coolant Boiling in Rod Arrays-Two Fluid (COBRA-TF), or CTF1, is a nuclear thermal hydraulic subchannel code used throughout academia and industry. CTF's fuel rod modeling is originally developed for VIPRE code. Its methodology is based on GAPCON and FRAP fuel performance codes, and material properties are included from MATPRO handbook. This work focuses on review of CTF's fuel rod modeling to address shortcomings in CTF's temperature predictions. CTF is compared to FRAPCON which is U.S. NRC's steady-state fuel performance code for light-water reactor fuel rods. FRAPCON calculates the changes in fuel rod variables and temperatures including the effects of cladding hoop strain, cladding oxidation, hydriding, fuel irradiation swelling, densification, fission gas release and rod internal gas pressure. It uses fuel, clad and gap material properties from MATPRO. Additionally, it has its own models for fission gas release, cladding corrosion and cladding hydrogen pickup. It allows finite difference or finite element approaches for its mechanical model. In this study, FRAPCON-4.0 is used as a reference fuel performance code. In comparison, Halden Reactor Data for IFA432 Rod 1 and Rod 3. CTF simulations are performed in two ways; informing CTF with gap conductance value from FRAPCON, and using CTF's dynamic gap conductance model. First case is chosen to show temperature is predicted correctly with CTF's models for thermal and cladding conductivities once gap conductance is provided. Latter is to review CTF's dynamic gap conductance model. These Halden test cases are selected to be representative of cases with and without any physical contact between fuel-pellet and clad while reviewing functionality of CTF's dynamic gap conductance model. Improving the CTF's dynamic gap conductance model will allow prediction of fuel and cladding thermo-mechanical behavior under irradiation, and better temperature feedbacks from CTF in transient calculations.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

Peer Review of X441A Fission Gas Release Data

The purpose of this document is to demonstrate completion of the independent peer review for the fission gas release measurement of fuel pins irradiated in the Experimental Breeder Reactor-II (EBR-II) as part of the X441A experiment. The specific data reviewed includes reported plenum volume and pressure from the measurement from the fuel pins. Fraction percent of fission gas release is derived in part from these measurements but is excluded from the data reviewed.

11 - NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

Paleosols and the evolution of atmospheric oxygen: a critical review

A number of investigators have used chemical profiles of paleosols to reconstruct the evolution of atmospheric oxygen levels during the course of Earth history (Holland, 1984, 1994; Kirkham and Roscoe, 1993; Ohmoto, 1996). Over the past decade Holland and his co-workers have examined reported paleosols from six localities that formed between 2.75 and 0.45 Ga. They have found that the chemical profiles of these paleosols are consistent with a dramatic change in atmospheric PO2 between 2.2 and 2.0 Ga from < or = 0.002 to > or = 0.03 atm (Holland, 1994). Ohmoto (1996) examined chemical data from twelve reported paleosols ranging in age from 2.9 to 1.8 Ga. He concluded that these chemical profiles indicate that atmospheric PO2 has not changed significantly during the past 3.0 Ga. We seek to resolve the conflict between these reconstructions through a broader examination of the paleosol literature, both to determine which reported paleosols can be definitively identified as such and to determine what these definite paleosols tell us about atmospheric evolution. We here review reports describing over 50 proposed paleosols, all but two are older than 1.7 Ga. Our review indicates that 15 of these reported paleosols can be definitively identified as ancient soils. The behavior of iron uring the formation of these 15 paleosols provides both qualitative and semiquantitative information about the evolution of the redox state of the atmosphere. Every definitely identified pre-2.44 Ga paleosol suffered significant Fe loss during weathering. This loss indicates that atmospheric PO2 was always less than about 5 x l0(-4) atm prior to 2.44 Ga. Analysis of the Hokkalampi paleosol (2.44-2.2 Ga) (Marmo, 1992) and the Ville Marie paleosol (2.38-2.215 Ga) (Rainbird, Nesbitt, and Donaldson, 1990) yield ambiguous results regarding atmospheric PO2. Loss of Fe during the weathering of the 2.245 to 2.203 Ga Hekpoort paleosol (Button, 1979) indicates that atmospheric PO2 was less than 8 x 10(-4) atm shortly before 2.2 Ga. The presence of red beds immediately overlying the Hokkalampi, Ville Marie, and Hekpoort paleosols suggests that by about 2.2 Ga there was an unquantified but substantial amount of oxygen in the atmosphere. Iron loss was negligible during formation of the 2.2 to 2.0 Ga Wolhaarkop (Holland and Beukes, 1990) and Drakenstein (Wiggering and Beukes, 1990) paleosols and during formation of all the later paleosols we previewed. Thus, atmospheric PO2 probably has been > or = 0.03 atm since sometime between 2.2 and 2.0 Ga.

Review, Academic↗

Invited review: gravitational biology of the neuromotor systems: a perspective to the next era

Earth's gravity has had a significant impact on the designs of the neuromotor systems that have evolved. Early indications are that gravity also plays a key role in the ontogenesis of some of these design features. The purpose of the present review is not to assess and interpret a body of knowledge in the usual sense of a review but to look ahead, given some of the general concepts that have evolved and observations made to date, which can guide our future approach to gravitational biology. We are now approaching an era in gravitational biology during which well-controlled experiments can be conducted for sustained periods in a microgravity environment. Thus it is now possible to study in greater detail the role of gravity in phylogenesis and ontogenesis. Experiments can range from those conducted on the simplest levels of organization of the components that comprise the neuromotor system to those conducted on the whole organism. Generally, the impact of Earth's gravitational environment on living systems becomes more complex as the level of integration of the biological phenomenon of interest increases. Studies of the effects of gravitational vectors on neuromotor systems have and should continue to provide unique insight into these mechanisms that control and maintain neural control systems designed to function in Earth's gravitational environment. A number of examples are given of how a gravitational biology perspective can lead to a clearer understanding of neuromotor disorders. Furthermore, the technologies developed for spaceflight studies have contributed and should continue to contribute to studies of motor dysfunctions, such as spinal cord injury and stroke. Disorders associated with energy support and delivery systems and how these functions are altered by sedentary life styles at 1 G and by space travel in a microgravity environment are also discussed.

Review, Tutorial↗

Invited review: what do we know about the effects of spaceflight on bone?

This review of the peer-reviewed literature focuses on the effects of spaceflight on bone. Studies performed in humans and laboratory animals have revealed abnormalities in bone and mineral metabolism that suggest that long-duration spaceflight will have detrimental effects on the skeleton. However, because of large gaps in our knowledge, it is not presently possible to estimate the magnitude of the health risk, individual variations in risk, effective countermeasures, or mechanism(s) of action. Specific recommendations are made for future research to ascertain risk and develop appropriate countermeasures.

NASA Discipline Musculoskeletal↗

Proceedings of the 2011 Monitoring Research Review: Ground-Based Nuclear Explosion Monitoring Technologies

These proceedings contain papers prepared for the Monitoring Research Review 2011: Ground-Based Nuclear Explosion Monitoring Technologies, held 13-15 September, 2011 in Tucson, Arizona. These papers represent the combined research related to ground-based nuclear explosion monitoring funded by the National Nuclear Security Administration (NNSA), Defense Threat Reduction Agency (DTRA), Air Force Research Laboratory (AFRL), US Army Space and Missile Defense Command, Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO), National Science Foundation (NSF), and other invited sponsors. The scientific objectives of the research are to improve the United States' capability to detect, locate, and identify nuclear explosions. The purpose of the meeting is to provide the sponsoring agencies, as well as potential users, an opportunity to review research accomplished during the preceding year and to discuss areas of investigation for the coming year. For the researchers, it provides a forum for the exchange of scientific information toward achieving program goals, and an opportunity to discuss results and future plans. Paper topics include: seismic regionalization and calibration; detection and location of sources; wave propagation from source to receiver; the nature of seismic sources, including mining practices; hydroacoustic, infrasound, and radionuclide methods; on-site inspection; and data processing.

45 MILITARY TECHNOLOGY, WEAPONRY, AND NATIONAL DEF↗

Risk-based area of review estimation in overpressured reservoirs to support injection well storage facility permit requirements for CO 2 storage projects

This paper by the Energy & Environmental Research Center presents a workflow and modeling approach for delineating a risk-based area of review (AOR) to support a U.S. Environmental Protection Agency (EPA) Class VI permit for a carbon dioxide (CO 2 ) storage project. The approach combines semianalytical solutions for estimating formation fluid leakage through a hypothetical leaky wellbore with the results of numerical reservoir simulations to define the AOR. The modeling utilizes 1) semianalytical solutions from the peer-reviewed literature for formation fluid leakage through abandoned wellbores by Raven (1990) and Avci (1994), 2) a FORTRAN model compiled and described in Cihan et al. (2011, 2012) called ASLMA (Analytical Solution for Leakage in Multilayered Aquifers), and 3) a computational framework for estimating a risk-based AOR first proposed by Oldenburg et al. (2014, 2016). Therefore, the approach builds upon well-established research and underlying hydrogeological principles that have been upheld for nearly three decades. Moreover, the ASLMA model has been broadly applied to an array of storage projects. The work presented herein extends these earlier works using a custom wrapper written in the software environment, R (R Core Team, 2020), which was developed to perform multiple runs of the ASLMA model using given ranges for one or more input parameters. In addition, the current work simulates the pressure buildup within the storage reservoir in response to CO 2 injection using a compositional simulator to better accommodate the temporospatial evolution of pressure buildup within the storage reservoir that is more accurately modeled using a heterogeneous geologic model and a compositional simulator that accounts for the multiphase interactions. The workflow is demonstrated using a case study for a 180,000-metric-ton-per-year storage project located in the PCOR (Plains CO 2 Reduction) Partnership region. For the storage project evaluated here, under the scenario where the leaky wellbore is open to a saline aquifer (thief zone) between the overlying seal (cap rock) and the underground sources of drinking water (USDW), the risk-based AOR essentially collapses to the areal extent of the CO 2 plume in the storage reservoir because the pressure buildup in the storage reservoir beyond the CO 2 plume is insufficient to drive formation fluids up a hypothetical leaky wellbore into the USDW. However, even under the conservative assumption that the leaky wellbore is not open to a thief zone, beyond the areal extent of the CO 2 plume, the incremental leakage is less than 400 m 3 over 20 years, which represents ~0.0001% or less of the total volume of water contained within the USDW rock volume. As discussed in the text, the threshold criterion for defining the risk-based AOR is site-specific and should be informed by the results of the sensitivity analysis and available site characterization data. The approach outlined in this paper is designed to be protective of USDWs and, therefore, comply with the Safe Drinking Water Act requirements and provisions for the U.S. EPA Class VI Underground Injection Control (UIC) Program (Class VI Rule) and North Dakota Administrative Code Chapter 43-05-01.

54 ENVIRONMENTAL SCIENCES↗

Beyond cancer treatment – a review of total lymphoid irradiation for heart and lung transplant recipients

Immunosuppressive drugs used in the management of heart and lung transplants have a large monetary and quality of life cost due to their side effects. Total lymphoid irradiation (TLI) is one method of minimising the need for or replacing post-operative immunosuppressive drugs. A literature review was conducted on electronic databases using defined search terms. The aim was to establish the indications for the use of TLI, its advantages and disadvantages and the weaknesses associated with the methods used in related research. Eight articles were located that focused on TLI usage in combating organ rejection. These studies identified that the use of TLI resulted in a reduction in early rejection. One study reported a drop in rejection episodes from 0.46 to 0.14 episodes per patient per month once the TLI was complete. While the short-term prognosis is excellent, the long-term outlook is less positive with an increased risk of organ rejection and myelodysplasia 3.5 years post-TLI. This review reminds us that radiation therapy (RT) is not exclusively indicated for cancer treatment. While TLI cannot replace immunosuppressive drug therapy, it can offer a treatment option for people that cannot tolerate immunosuppressive drugs, or when conventional anti-rejection treatment is no longer viable. Reported long-term complications suggest that TLI should be used with caution. However, this modality should not be overlooked in cases of chronic rejection. Further research is required to establish the efficacy of RT in the treatment of transplant patients who are unsuitable for drug-based anti-rejection therapies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

The cardiac dose-sparing benefits of deep inspiration breath-hold in left breast irradiation: a systematic review

Despite technical advancements in breast radiation therapy, cardiac structures are still subject to significant levels of irradiation. As the use of adjuvant radiation therapy after breast-conserving surgery continues to improve survival for early breast cancer patients, the associated radiation-induced cardiac toxicities become increasingly relevant. Our primary aim was to evaluate the cardiac-sparing benefits of the deep inspiration breath-hold (DIBH) technique. An electronic literature search of the PubMed database from 1966 to July 2014 was used to identify articles published in English relating to the dosimetric benefits of DIBH. Studies comparing the mean heart dose of DIBH and free breathing treatment plans for left breast cancer patients were eligible to be included in the review. Studies evaluating the reproducibility and stability of the DIBH technique were also reviewed. Ten studies provided data on the benefits of DIBH during left breast irradiation. From these studies, DIBH reduced the mean heart dose by up to 3.4 Gy when compared to a free breathing approach. Four studies reported that the DIBH technique was stable and reproducible on a daily basis. According to current estimates of the excess cardiac toxicity associated with radiation therapy, a 3.4 Gy reduction in mean heart dose is equivalent to a 13.6% reduction in the projected increase in risk of heart disease. DIBH is a reproducible and stable technique for left breast irradiation showing significant promise in reducing the late cardiac toxicities associated with radiation therapy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Pictorial review on abdominal applications of ferumoxytol in MR imaging

Though gadolinium-based contrast agents are the most widely used contrast media in MR for clinical use, problems with nephrogenic systemic fibrosis and tissue deposition render their safety debatable, at least in a selected patient population. Ferumoxytol has the potential to be used as an alternate contrast medium for various clinical applications across multiple organs. It has prolonged intravascular signal and delayed intracellular macrophage uptake which are unique properties compared to gadolinium-based agents. This pictorial review aims to review the current and potential clinical applications of ferumoxytol as a contrast agent in abdominal MR imaging.

62 RADIOLOGY AND NUCLEAR MEDICINE↗