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At least 955 records · Page 53

Identification and Preservation of Arm Lymphatic System in Axillary Dissection for Breast Cancer to Reduce Arm Lymphedema Events: A Randomized Clinical Trial

Background: Controversy in axillary reverse mapping in axillary lymph node dissection (ALND) possibly results from incomplete recognition of the arm lymphatic system (ALS) and its compromise to oncological safety. The iDEntification and Preservation of ARm lymphaTic system (DEPART) technique facilitates complete identification of ALS; therefore, its use may decrease the occurrence of arm lymphedema. This study aimed to examine the arm lymphedema rate, locoregional recurrence, and feasibility to perform DEPART in ALND. Methods: Patients from February 2013 to October 2017 from two tertiary referral centers were randomly assigned to two groups. In the study group, indocyanine green and methylene blue (MB) were utilized to identify arm sentinel nodes, and 0.1 ml MB was injected into the arm sentinel nodes to reveal the subsequent-echelon nodes and lymphatics. Gross arm lymph nodes were examined by intraoperative partial frozen section and were removed if positive. Arm lymphedema, local recurrence, regional recurrence, and distant metastasis were recorded at different follow-up examinations. Results: Arm sentinel nodes were identified in 573 (83.2%) patients. Subsequent-echelon nodes and lymphatics were visualized in 558 (97.4%) patients. Metastatic arm nodes were identified in 38 (6.8%) patients. The arm lymphedema rate was 3.3% (18/543) in the study group versus 15.3% (99/648) in the control group (p < 0.001) after 37-month median follow-up. Regional recurrence showed no difference between the two groups (1.4% and 1.2%, respectively) (p = 0.392). Conclusions: DEPART can benefit breast cancer patients who undergo ALND, reducing the arm lymphedema rate without adversely affecting the morbidity of regional recurrence.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Integration of a computerized two-finger gripper for robot workstation safety

A microprocessor-based controller has been developed that continuously monitors and adjusts the gripping force applied by a special two-finger gripper. This computerized force sensing gripper system enables the endeffector gripping action to be independently detected and corrected. The gripping force applied to a manipulated object is real-time monitored for problem situations, situations which can occur during both planned and errant robot arm manipulation. When unspecified force conditions occur at the gripper, the gripping force controller initiates specific reactions to cause dynamic corrections to the continuously variable gripping action. The force controller for this intelligent gripper has been interfaced to the controller of an industrial robot. The gripper and robot controllers communicate to accomplish the successful completion of normal gripper operations as well as unexpected hazardous situations. An example of an unexpected gripping condition would be the sudden deformation of the object being manipulated by the robot. The capabilities of the interfaced gripper-robot system to apply workstation safety measures (e.g., stop the robot) when these unexpected gripping effects occur have been assessed.

Sneckenberger, John E.↗

Learning infinite-horizon average-reward restless multi-action bandits via index awareness

We consider the online restless bandits with average-reward and multiple actions, where the state of each arm evolves according to a Markov decision process (MDP), and the reward of pulling an arm depends on both the current state of the corresponding MDP and the action taken. Since finding the optimal control is typically intractable for restless bandits, existing learning algorithms are often computationally expensive or with a regret bound that is exponential in the number of arms and states. In this paper, we advocate \textit{index-aware reinforcement learning} (RL) solutions to design RL algorithms operating on a much smaller dimensional subspace by exploiting the inherent structure in restless bandits. Specifically, we first propose novel index policies to address dimensionality concerns, which are provably optimal. We then leverage the indices to develop two low-complexity index-aware RL algorithms, namely, (i) GM-R2MAB, which has access to a generative model; and (ii) UC-R2MAB, which learns the model using an upper confidence style online exploitation method. We prove that both algorithms achieve a sub-linear regret that is only polynomial in the number of arms and states. A key differentiator between our algorithms and existing ones stems from the fact that our RL algorithms contain a novel exploitation that leverages our proposed provably optimal index policies for decision-makings.

Xiong, Guojun↗

Head-coupled remote stereoscopic camera system for telepresence applications

The Virtual Environment Workstation Project (VIEW) at NASA's Ames Research Center has developed a remotely controlled stereoscopic camera system that can be used for telepresence research and as a tool to develop and evaluate configurations for head-coupled visual systems associated with space station telerobots and remore manipulation robotic arms. The prototype camera system consists of two lightweight CCD video cameras mounted on a computer controlled platform that provides real-time pan, tilt, and roll control of the camera system in coordination with head position transmitted from the user. This paper provides an overall system description focused on the design and implementation of the camera and platform hardware configuration and the development of control software. Results of preliminary performance evaluations are reported with emphasis on engineering and mechanical design issues and discussion of related psychophysiological effects and objectives.

Bolas, M. T.↗

Cloud characteristics, thermodynamic controls and radiative impacts during the Observations and Modeling of the Green Ocean Amazon (GoAmazon2014/5) experiment

Abstract. Routine cloud, precipitation and thermodynamic observations collected by the Atmospheric Radiation Measurement (ARM) Mobile Facility (AMF) and Aerial Facility (AAF) during the 2-year US Department of Energy (DOE) ARM Observations and Modeling of the Green Ocean Amazon (GoAmazon2014/5) campaign are summarized. These observations quantify the diurnal to large-scale thermodynamic regime controls on the clouds and precipitation over the undersampled, climatically important Amazon basin region. The extended ground deployment of cloud-profiling instrumentation enabled a unique look at multiple cloud regimes at high temporal and vertical resolution. This longer-term ground deployment, coupled with two short-term aircraft intensive observing periods, allowed new opportunities to better characterize cloud and thermodynamic observational constraints as well as cloud radiative impacts for modeling efforts within typical Amazon wet and dry seasons.

54 ENVIRONMENTAL SCIENCES↗

A Randomized Controlled Trial of Lorazepam to Reduce Liver Motion in Patients Receiving Upper Abdominal Radiation Therapy

Purpose: Reduction of respiratory motion is desirable to reduce the volume of normal tissues irradiated, to improve concordance of planned and delivered doses, and to improve image guided radiation therapy (IGRT). We hypothesized that pretreatment lorazepam would lead to a measurable reduction of liver motion. Methods and Materials: Thirty-three patients receiving upper abdominal IGRT were recruited to a double-blinded randomized controlled crossover trial. Patients were randomized to 1 of 2 study arms: arm 1 received lorazepam 2 mg by mouth on day 1, followed by placebo 4 to 8 days later; arm 2 received placebo on day 1, followed by lorazepam 4 to 8 days later. After tablet ingestion and daily radiation therapy, amplitude of liver motion was measured on both study days. The primary outcomes were reduction in craniocaudal (CC) liver motion using 4-dimensional kV cone beam computed tomography (CBCT) and the proportion of patients with liver motion ≤5 mm. Secondary endpoints included motion measured with cine magnetic resonance imaging and kV fluoroscopy. Results: Mean relative and absolute reduction in CC amplitude with lorazepam was 21% and 2.5 mm respectively (95% confidence interval [CI] 1.1-3.9, P=.001), as assessed with CBCT. Reduction in CC amplitude to ≤5 mm residual liver motion was seen in 13% (95% CI 1%-25%) of patients receiving lorazepam (vs 10% receiving placebo, P=NS); 65% (95% CI 48%-81%) had reduction in residual CC liver motion to ≤10 mm (vs 52% with placebo, P=NS). Patients with large respiratory movement and patients who took lorazepam ≥60 minutes before imaging had greater reductions in liver CC motion. Mean reductions in liver CC amplitude on magnetic resonance imaging and fluoroscopy were nonsignificant. Conclusions: Lorazepam reduces liver motion in the CC direction; however, average magnitude of reduction is small, and most patients have residual motion >5 mm.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A Fundamental Frequency Sorting Algorithm for Capacitor Voltage Balance of Modular Multilevel Converter With Low-Frequency Carrier Phase Shift Modulation

This paper proposes a fundamental frequency sorting algorithm for balancing the floating capacitors in modular multilevel converters with low-frequency carrier phase shift modulation. The relationship between the driving pulses and submodules (SMs) is rebuilt in every fundamental period by sorting the voltage increments and present voltages. Besides, an improved and simplified strategy is proposed to predict the charging abilities of the driving pulses, so as to avoid sorting the voltage increments. Based on the proposed method, the switching frequency of each power device and the carrier frequency are identical, which reduces the operational losses for applications regarding high power. At the same time, the sorting frequency is as low as the fundamental frequency, which alleviates a large amount of computational cost, and the necessity to measure arm currents is omitted. In this case, the arm current sensors are eliminated, and simplified communication among the central controller and the local ones is set up. Finally, a three-phase 1-MVA simulation platform with 120 SMs and a down-scaled 6-kVA experimental prototype with 48 SMs are constructed to validate the proposed approach.

42 ENGINEERING↗

Fluxes of CO 2 , CH 4 , CO, BVOCs, NOx, and O 3 in an Old Growth Amazonian Forest: Ecosystem Processes, Carbon Cycle, Atmospheric Chemistry, and Feedbacks on Climate

A comprehensive, merged data set of trace gases (NO, NO 2 , CO 2 , CH 4 and O 3 ) along with has been tabulated and subjected to meticulous quality assurance and quality control (QA/QC). The merged data set is being submitted to the ARM website dedicated to the Green Ocean Experiment: https://www.arm.gov/research/campaigns/amf2014goamazon Analysis using the final data set is in progress to determine the magnitudes of the fluxes for CH 4 , H 2 O, CO 2 , O 3 , NO x , sensible and latent heat, momentum, and their seasonal variations. Here are summary statements, from the discussion above: Total NO fluxes were calculated following Keller et al., 1986. A vertical gradient is established in the mixing ratio of NO because it is emitted at the soil surface and mixed upward in the atmosphere (see above). Once in the atmosphere, the NO reacts rapidly with O 3 to produce NO 2 (NO + O 3 → NO 2 + O 2 ). Therefore, if the vertical profiles of the mixing ratios of NO and O 3 are known, the surface flux of NO may be determined. If any other reaction removes NO (e.g., deposition on leaves), FNO should estimate the lower limit to the NO flux from the soil in this forest. Our preliminary results show fluxes of NO averaged 133 x 10 9 molecules cm -2 s -1 , a factor of 4 higher than fluxes previously observed in white sand soils in the Amazon, and a factor of 3 to 14 higher than fluxes observed for yellow clay soils (Bakwin et al., 1990 and references therein). The soil in the km 67 site is predominately oxisol with pockets of sandy ultisols, both having low reduced nutrient contents, mostly due to efficient microorganism decomposition and acid leaching by rain water. Oxisols contain both oxidized and reduced forms of nitrogen, of which concentrations vary independently of leaching (Jordan et al., 1982), with most part of the cycling processes occurring in the top layers. Methane fluxes showed no statistical difference between 2015 wet and dry seasons, and the forest at this site appear to be a methane sink throughout the year. The vertical profiles suggest that if a methane source exists in this forest, it might be in the canopy. Next steps include modeling and analysis using the Master Chemical Mechanism (Jenkin et al., 1997; Saunders et al., 2003 (A/B); http://mcm.leeds.ac.uk/MCM/) and the Ecosystem Demography-2 (ED-2) model. A final manuscript with the results from this work is in preparation and expected to be submitted for publication within the next several months. Publications to date are listed below.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Manipulation of large objects

Remote manipulator control experiments have been conducted to investigate the problems related to the 'controlled collision' aspect of manipulation. A six degrees of freedom pantograph arm with a six-dimensional force-torque balance sensor and microprocessor-driven real-time graphics display are employed in the experiments. Among other results, it is found that the use of computer force-torque feedback loop for 'stop at contact' provides a nearly linear relation between load transfer to jigs at 'stop at contact', rate of motion, and preset force-torque threshold values for stop under limited motion and load conditions.

Bejczy, A. K.↗

Work capacity during 30 days of bed rest with isotonic and isokinetic exercise training

Results are presented from a study to determine whether or not short-term variable intensity isotonic and intermittent high-intensity isokinetic short-duration leg exercise is effective for the maintenance of peak O2 (VO2) uptake and muscular strength and endurance, respectively, during 30 days of -6 deg head-down bed rest deconditioning. The results show no significant changes in leg peak torque, leg mean total work, arm total peak torque, or arm mean total work for members of the isotonic, isokinetic, and controls groups. Changes are observed, however, in peak VO2 levels. The results suggest that near-peak variabile intensity, isotonic leg excercise maintains peak VO2 during 30 days of bed rest, while peak intermittent, isokinetic leg excercise protocol does not.

Greenleaf, J. E.↗

Dynamic model and cooperative control of a serially linked manipulator system

The use of a redundant manipulator to execute multiple tasks specified at different points on the manipulator is demonstrated. This is accomplished by decomposing a redundant arm at an intermediate arm location called the 'elbow' into two nonredundant local arms referred as the 'basearm' and the 'forearm'. This decomposition transforms a redundant arm into a serially linked dual-arm system, where the cooperation between the basearm and the forearm is carried out through the task distribution and the elbow control. The kinematics of a decomposed redundant manipulator are discussed, and a Cartesian space dynamic model and dynamic equation of a decomposed redundant manipulator are presented. The capability of generating Cartesian force, the local efficiency of generating Cartesian acceleration, and dynamic task distribution are discussed.

Lee, Sukhan↗

Enhanced carotid-cardiac baroreflex response and elimination of orthostatic hypotension 24 hours after acute exercise in paraplegics

To test the hypothesis that an acute bout of maximal exercise can ameliorate orthostatic hypotension consequent to prolonged wheelchair confinement, we evaluated heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure responses during 15 minutes of 70 degrees head-up tilt (HUT) in 10 paraplegic subjects 24 hours after arm crank exercise designed to elicit maximal effort, and during a control (no exercise) conditions. Additionally, the carotid baroreceptor stimulus-cardiac response relationship was determined by measurement of R-R interval during external application of graded pressures to the carotid sinuses. One week separated the treatment conditions. The maximum slope of the carotid-cardiac baroreflex response was increased (p = 0.049) by exercise (6.2 +/- 1.7 msec/mmHg) compared to control (3.3 +/- 0.6). During control HUT, HR increased from 61 +/- 1 to 90 +/- 7 bpm (p = 0.001) while SBP decreased from 118 +/- 5 to 106 +/- 9 mmHg (p = 0.025). During HUT 24 hours after exercise, HR increased from 60 +/- 2 to 90 +/- 4 bpm (p = 0.001), but the reduction in SBP was essentially eliminated (116 +/- 5 to 113 +/- 5 mmHg).

Engelke, K. A.↗

Enigma Version 12

Enigma Version 12 software combines model building, animation, and engineering visualization into one concise software package. Enigma employs a versatile user interface to allow average users access to even the most complex pieces of the application. Using Enigma eliminates the need to buy and learn several software packages to create an engineering visualization. Models can be created and/or modified within Enigma down to the polygon level. Textures and materials can be applied for additional realism. Within Enigma, these models can be combined to create systems of models that have a hierarchical relationship to one another, such as a robotic arm. Then these systems can be animated within the program or controlled by an external application programming interface (API). In addition, Enigma provides the ability to use plug-ins. Plugins allow the user to create custom code for a specific application and access the Enigma model and system data, but still use the Enigma drawing functionality. CAD files can be imported into Enigma and combined to create systems of computer graphics models that can be manipulated with constraints. An API is available so that an engineer can write a simulation and drive the computer graphics models with no knowledge of computer graphics. An animation editor allows an engineer to set up sequences of animations generated by simulations or by conceptual trajectories in order to record these to highquality media for presentation. Enigma Version 12 Lyndon B. Johnson Space Center, Houston, Texas 28 NASA Tech Briefs, September 2013 Planetary Protection Bioburden Analysis Program NASA's Jet Propulsion Laboratory, Pasadena, California This program is a Microsoft Access program that performed statistical analysis of the colony counts from assays performed on the Mars Science Laboratory (MSL) spacecraft to determine the bioburden density, 3-sigma biodensity, and the total bioburdens required for the MSL prelaunch reports. It also contains numerous tools that report the data in various ways to simplify the reports required. The program performs all the calculations directly in the MS Access program. Prior to this development, the data was exported to large Excel files that had to be cut and pasted to provide the desired results. The program contains a main menu and a number of submenus. Analyses can be performed by using either all the assays, or only the accountable assays that will be used in the final analysis. There are three options on the first menu: either calculate using (1) the old MER (Mars Exploration Rover) statistics, (2) the MSL statistics for all the assays, or This software implements penetration limit equations for common micrometeoroid and orbital debris (MMOD) shield configurations, windows, and thermal protection systems. Allowable MMOD risk is formulated in terms of the probability of penetration (PNP) of the spacecraft pressure hull. For calculating the risk, spacecraft geometry models, mission profiles, debris environment models, and penetration limit equations for installed shielding configurations are required. Risk assessment software such as NASA's BUMPERII is used to calculate mission PNP; however, they are unsuitable for use in shield design and preliminary analysis studies. The software defines a single equation for the design and performance evaluation of common MMOD shielding configurations, windows, and thermal protection systems, along with a description of their validity range and guidelines for their application. Recommendations are based on preliminary reviews of fundamental assumptions, and accuracy in predicting experimental impact test results. The software is programmed in Visual Basic for Applications for installation as a simple add-in for Microsoft Excel. The user is directed to a graphical user interface (GUI) that requires user inputs and provides solutions directly in Microsoft Excel workbooks. This work was done by Shannon Ryan of the USRA Lunar and Planetary Institute for Johnson Space Center. Further information is contained in a TSP (see page 1). MSC- 24582-1 Micrometeoroid and Orbital Debris (MMOD) Shield Ballistic Limit Analysis Program Lyndon B. Johnson Space Center, Houston, Texas Commercially, because it is so generic, Enigma can be used for almost any project that requires engineering visualization, model building, or animation. Models in Enigma can be exported to many other formats for use in other applications as well. Educationally, Enigma is being used to allow university students to visualize robotic algorithms in a simulation mode before using them with actual hardware.

Shores, David↗

The Dual-Rasp Sampling System Design with Closed Pneumatic Sample Transfer

The novel Dual-Rasp sampling system has been developed for landed missions to low gravity planetary bodies and is particularly well suited for the unique environment of Saturn’s moon Enceladus. The Dual-Rasp sampling system has two counter-rotating rasp cutters that remove material from the surface and direct it into a guide. The cuttings follow the guide into a sample collection cup. When the sampling collection completes, the tool reconfigures by rotating the guide to create a closed circuit for pneumatic sample transfer from the collection cup to science instruments on the lander. A valve opens a gas tank and the gas flows from that tank into the sample collection cup and down rigid tubing to the science instruments chamber on the lander. A two degree of freedom arm with base actuators is used to deploy the sampler and control its sampling location.

Heness, Andrew B.↗

LaserSnake2: Remote High Powered Laser Cutting in Confined Hazardous Spaces - 16161

LaserSnake2, a UK collaborative project, seeks to deliver remotely operated cutting techniques into high hazard nuclear environments. This paper describes the developments and results of combining proven robotic manipulators with high-powered laser cutting tools, to allow for selective dismantling within complex nuclear process cells. Decommissioning old and poorly catalogued nuclear plant is a problem faced the world over. Designed with little consideration for decommissioning, or adapted significantly from the original drawings, legacy plant and infrastructure is full of spaces where it is undesirable or impossible to send people. Typically, a process cell or cave will require modification to ensure suitability for human entry or deployment of heavy duty equipment to complete the decontamination processes. The process of widening access routes, or selectively moving sections of highly contaminated material, is ideally suited to remote handling technology. The results of TWI's research into fibre-delivered laser cutting techniques, and integration with a dexterous snake-arm robot, are presented. Coupled with novel laser process head design and diffractive optical elements, the result is an integrated system capable of cutting up to 100 mm thick C-Mn steel plate at significant stand-off distances, encompassing the range of infrastructure found in a typical nuclear plant. Two options have been considered for deployment of the laser cutting tool. The first is focused on a fixed installation using a standard industrial robot. The second is a large, highly flexible snake-arm robot capable of entering cluttered cells through existing penetrations. Designed to operate through a standard 11'' MSM port, the 4.5 m snake-arm robot has the capacity to carry grippers, sensors or the laser cutting tool at the tip. The snake-arm is sealed and housed within a glove box for contamination control, allowing operation within a radioactive environment. Significant technical developments and material research are presented which have led to improved operational life, payload and bend. This paper describes the series of inactive trials which have been conducted to demonstrate the LaserSnake2 system's capabilities. These include: horizontal and vertical deployment, underwater operation, object manipulation and laser cutting. With global nuclear decommissioning costs running in to the $trillions, safe and cost efficient tools such as the LaserSnake2 system are essential as part of the decommissioning toolbox. Remote handling can account for up to 20% of a decommissioning project's costs, however significant time and financial savings can be made by utilising this new technology to reduce operator exposure and reach previously inaccessible areas. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Southern Ocean Aerosols Field Campaign Report

Atmospheric processes over the Southern Ocean have a profound influence on regional and global climate. This is a part of the world where global climate models perform particularly poorly, with models persistently overpredicting the amount of sunlight reaching the Earth's surface (Regayre et al. 2020). A major challenge when trying to improve the representation of atmospheric processes in this part of the globe is the scarcity of observations capable of constraining our understanding. During 2024/25 a U.S. Department of Energy Atmospheric Radiation Measurement (ARM) User Facility field campaign (CAPE-k) deployed a suite of instrumentation at the kennaook/Cape Grim atmospheric monitoring station in Tasmania, Australia to provide detailed cloud-aerosol observations in this region in order to address the greatest source of uncertainty in climate models – atmospheric aerosols and how they influence cloud formation (Carslaw et al. 2013). In support of the ARM observations, an Australian Research Council (ARC)-funded project “Southern Ocean aerosols: sources, sinks and impact on cloud properties,” led by the Queensland University of Technology, complemented the ARM measurements with a suite of chemical measurements at the kennaook/Cape Grim site in northwestern Tasmania to provide more information on the processes controlling aerosol formation and growth. The deployment of the University of York LIF-SO2 instrument (Temple et al. 2025) in the ARM mobile facility container was part of this chemistry-focused deployment. Increased observational efforts are critical for understanding sources and sinks of Southern Ocean aerosols, in particular the role of marine micro-organisms (phytoplankton, algae) on aerosols formation, their properties and growth, cloud droplet formation, and the conversion of cloud droplets to ice crystals and precipitation. The observational focus of the ARC-funded project is aerosol chemical composition and their gaseous precursors. The remote nature of the Southern Ocean poses a significant analytical challenge when studying gaseous precursors, as low concentrations are often below the limits of detection of commercial instrumentation. Historically this has meant that observations have had to be time-averaged over days to weeks to achieve the limits of detection required. Although useful when considering overall average levels of aerosol precursors, this time-averaging obscures temporal variability that can provide insight into the controlling processes. Over recent years advances in analytical techniques have made high-time-resolution measurements of key gas-phase aerosol precursors achievable with sufficiently low limits of detection.

54 ENVIRONMENTAL SCIENCES↗

The Green Ocean: Precipitation Insights from the GoAmazon2014/5 Experiment

This study summarizes the precipitation properties collected during the GoAmazon2014/5 campaign near Manaus in central Amazonia, Brazil. Precipitation breakdowns, summary radar rainfall relationships and self-consistency concepts from a coupled disdrometer and radar wind profiler measurements are presented. The properties of Amazon cumulus and associated stratiform precipitation are discussed, including segregations according to seasonal (Wet/Dry regime) variability, cloud echo-top height and possible aerosol influences on the apparent oceanic characteristics of the precipitation drop size distributions. Overall, we observe that the Amazon precipitation straddles behaviors found during previous U.S. Department of Energy Atmospheric Radiation Measurements program (ARM) tropical deployments, with distributions favoring higher concentrations of smaller drops than ARM continental examples. Oceanic type precipitation characteristics are predominantly observed during the Amazon Wet seasons. Finally, an exploration of the controls on Wet season precipitation properties reveals that wind direction, as compared with other standard radiosonde thermodynamic parameters or aerosol count/regime classifications performed at the ARM site, provides a good indicator for those Wet season Amazon events having an oceanic character for their precipitation drop size distributions.

54 ENVIRONMENTAL SCIENCES↗

TH-AB-BRB-05: Using a Research Real-Time Control Interface to Go Beyond Dynamic MLC Tracking

Current state-of-the art digital C-arm medical linear accelerators are capable of delivering radiation treatments with high level of automation, which affords coordinated motions of gantry, couch, and multileaf collimator (MLC) with dose rate modulations. The new machine capacity has shown the potential to bring substantially improved radiation dosimetry and/or delivery efficiency to many challenging diseases. Combining an integrated beam orientation optimization algorithm with automated machine navigation, markedly improved dose conformity has been achieved using 4ρ therapy. Trajectory modulated radiation therapy (TMAT) can be used to deliver highly conformal dose to partial breast or to carve complex dose distribution for therapy involving extended volumes such as total marrow and total lymph node treatment. Dynamic electron arc radiotherapy (DEAR) not only overcomes the deficiencies of conventional electron therapy in dose conformity and homogeneity but also achieves so without patient-specific shields. The combination of MLC and couch tracking provides improved motion management of thoracic and abdominal tumors. A substantial body of work has been done in these technological advances for clinical translation. The proposed symposium will provide a timely review of these exciting opportunities. Learning Objectives: Recognize the potential of using digitally controlled linacs for clinically significant improvements in delivered dose distributions for various treatment sites. Identify existing approaches to treatment planning, optimization and delivery for treatment techniques utilizing the advanced functions of digital linacs and venues for further development and improvement. Understand methods for testing and validating delivery system performance. Identify tools available on current delivery systems for implementation and control for such treatments. Obtain the update in clinical applications, trials and regulatory approval. K. Sheng, NIH U19AI067769, NIH R43CA183390, NIH R01CA188300, Varian Medical Systems V. Yu, Varian Medical Systems, AAPM Summer Undergraduate Fellowship, NSF graduate fellowship S. Nill, Elekta AB. Cancer Research UK under Programme C33589/A19727, NIHR Biomedical Research Centre at The Royal Marsden and The Institute of Cancer Research.

60 APPLIED LIFE SCIENCES↗