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Operational Parameters, Considerations, and Design Decisions for Resource-Constrained Ion Trap Mass Spectrometers

Mass spectrometers are increasingly finding applications in new and unique areas, often in situations where key operational resources (i.e. power, weight and size) are limited. One such example is the Mars Organic Molecule Analyzer (MOMA). This instrument is a joint venture between NASA and the European Space Agency (ESA) to develop an ion trap mass spectrometer for chemical analysis on Mars. The constraints on such an instrument are significant as are the performance requirements. While the ideal operating parameters for an ion trap are generally well characterized, methods to maintain analytical performance with limited power and system weight need to be investigated and tested. Methods Experiments have been performed on two custom ion trap mass spectrometers developed as prototypes for the MOMA instrument. This hardware consists of quadrupole ion trap electrodes that are 70% the size of common commercial instrumentation. The trapping RF voltage is created with a custom tank circuit that can be tuned over a range of RF frequencies and is driven using laboratory supplies and amplifiers. The entire instrument is controlled with custom Lab VIEW software that allows a high degree of flexibility in the definition of the scan function defining the ion trap experiment. Ions are typically generated via an internal electron ionization source, however, a laser desorption source is also in development for analysis of larger intact molecules. Preliminary Data The main goals in this work have been to reduce the power required to generate the radio frequency trapping field used in an ion trap mass spectrometer. Generally minimizing the power will also reduce the volume and mass of the electronics to support the instrument. In order to achieve optimum performance, commercial instruments typically utilize RF frequencies in the 1 MHz range. Without much concern for power usage, they simply generate the voltage required to access the mass range of interest. In order to reduce the required RF voltage (and power), operation of the ion trap at lower RF frequencies has been investigated. Surprisingly, the performance of the instrument has only been slightly degraded at RF frequencies all the way down to 500 kHz. Mass resolution is relatively stable to this point and depending on the resonant ejection point used, the peak intensity is also quite stable. To date only masses up to m/z 200 have been fully investigated, however, additional studies are planned to verify the performance with higher mass ions. The lower frequency and voltage should reduce the pseudo potential well depth, eventually affecting the trapping efficiency of the instrument -- effect that could manifest itself in significantly limiting the mass range of trapped ions. Other methods to reduce the RF power while maintaining analytical performance are also under investigation. This includes ion ejection at lower q(sub z) values to access a given mass with a lower RF voltage. The loss of mass resolution at lower q(sub eject) points has been measured and current work is underway to leverage scan speed and the use of non-linear resonances in order to counter this trend. The overall trap performance under this range of operating conditions will be presented with a goal of identifying what trade-offs are acceptable.

Danell, Ryan M.↗

Preliminary analysis of market potential for a hydropneumatic ground-level integrated diverse energy storage system

With the increasing share of renewable energy in the power grid, energy storage is considered a viable and effective solution to mitigate intermittency and improve power system stability. To quantify and estimate market potential for a recently developed Ground-Level Integrated Diverse Energy Storage (GLIDES) technology, the first operation model is developed for this hydropneumatic system and the bilinear pressure-volume terms are then linearized using the binary McCormick Relaxation method to improve solving efficiency. Based on up-to-date 5-min price data in four different real-time markets, several sets of experiments have been designed with three objective scenarios: maximize arbitrage, maximize arbitrage + reserve, maximize arbitrage + reserve + regulation. The experimental results show that the monetary value of GLIDES could be boosted by participation in ancillary markets and that regulation service might contribute more than half of the total revenue, even as high as 90% in PJM and ISONE markets. In addition, a case study for 1-day operation is used to illustrate the volume control of the GLIDES system.

25 ENERGY STORAGE↗

Coupling LaGrit unstructured mesh generation and model setup with TOUGH2 flow and transport: A case study

Furthermore, there are many applications in science and engineering modeling where an accurate representation of a complex model geometry in the form of a mesh is important. In applications of flow and transport in subsurface porous media, this is manifest in models that must capture complex geologic stratigraphy, structure (faults, folds, erosion, deposition) and infrastructure (tunnels, boreholes, excavations). Model setup, defined as the activities of geometry definition, mesh generation (creation, optimization, modification, refine, de-refine, smooth), assigning material properties, initial conditions and boundary conditions requires specialized software tools to automate and streamline the process. In addition, some model setup tools will provide more utility if they are designed to interface with and meet the needs of a particular flow and transport software suite. A control volume discretization that uses a two point flux approximation is for example most accurate when the underlying control volumes are 2D or 3D Voronoi tessellations. In this paper we will present the coupling of LaGriT, a mesh generation and model setup software suite and TOUGH2 to model subsurface flow problems and we show an example of how LaGriT can be used as a model setup tool for the generation of a Voronoi mesh for the simulation program TOUGH2. To generate the MESH file for TOUGH2 from the LaGriT output a standalone module Lagrit2Tough2 was developed, which is presented here and will be included in a future release of LaGriT. Here in this paper an alternative method to generate a Voronoi mesh for TOUGH2 with LaGriT is presented and thanks to the modular and command based structure of LaGriT this method is well suited to generating a mesh for complex models.

58 GEOSCIENCES↗

Validation of Heat Shock Protein 70 as a Tumor-Specific Biomarker for Monitoring the Outcome of Radiation Therapy in Tumor Mouse Models

Purpose: Tumor cells, in contrast to normal cells, frequently overexpress heat shock protein 70 (Hsp70) in the cytosol, present it on their cell surface, and actively release it. Therefore, soluble Hsp70 (sHsp70) was investigated as a potential tumor biomarker for monitoring the outcome of radiation therapy. Methods and Materials: Plasma from mice bearing membrane Hsp70 (mHsp70)-positive FaDu human squamous cell carcinoma of the head and neck and spontaneous pancreatic ductal adenocarcinoma (PDAC) was investigated. A cohort of mice with FaDu tumors (0.32 cm{sup 3}) was irradiated with 30 Gy, and plasma was collected 24 hours after irradiation, after the tumors had shrunk to 50% of their starting volume and after complete remission. sHsp70 levels in the plasma were quantified by enzyme-linked immunosorbent assay. Results: sHsp70 levels were significantly higher in the blood of tumor-bearing mice than that of control animals. A correlation between increasing sHsp70 plasma levels and tumor volume in the range of 0.01 cm{sup 3} to 0.66 cm{sup 3} was observed. Radiation-induced regression of the tumors was associated with significantly decreased sHsp70 levels, which returned to the level of control animals after complete remission. Conclusion: We propose sHsp70 as an innovative biomarker for detecting tumors and for monitoring the clinical outcome of radiation therapy in cancer patients.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Review of heat transfer enhancement techniques for single phase flows

The thermal energy exchange between a flowing fluid and its confining channel is a ubiquitous process in modern society. To enhance the fluid-to-wall or wall-to-fluid heat transfer, several techniques have been developed to maximize the contact area between the fluid and the inner wall and/or disrupt the flow to enhance circulation or induce turbulence. Deployment of channels having features capable of enhancing heat transfer enables the reduction of heat exchanger size while maintaining performance. Reduction in equipment size is critical due to the ability to minimize the required volume of costly working fluids and to mitigate potential safety concerns associated with total system fluid volume. Here, a comprehensive review of single-phase heat transfer enhancement techniques is presented. The article provides a thorough comparison by analyzing the heat transfer rate, pressure drop, and other operational aspects. Single-phase heat transfer enhancement methods are divided into active and passive techniques. Active methods such as electrohydrodynamic (EHD), magnetohydrodynamics (MHD), or mechanical motion require external power to create enhancement. Passive methods such as dimples, fins, or tape inserts do not require external input and rely only on surface modification. Although active methods are more expensive and difficult to implement compared to passive techniques, it enables active control of heat transfer augmentation. Finally, this review develops and summarizes key learning data for design optimization enabled by additive manufacturing and machine learning algorithms, helping to inform these next-generation heat exchanger design methodologies for a plethora of modern applications such as electrification of vehicles, computing, and classical industries.

42 ENGINEERING↗

Laser Additive Manufacturing of F/M Steels for Radiation Tolerant Nuclear Components

According to the Nuclear Energy R&D Roadmap Report submitted to Congress in 2010, one the key challenges facing the nuclear energy industry involves development of new reactor designs with reduced capital costs. Two related R&D objectives outlined in the report include: 1) Making improvements in the affordability of new reactors; and 2) Development of structural materials to withstand irradiation for longer periods. Laser additive manufacturing (LAM) is particularly well suited for more rapid and economical fabrication of reactor components relative to current fabrication methods. The proposed work involving LAM directly addresses the two R&D objectives outlined above relevant to the pertinent mission problems. The classical Materials Science approach involving development of Process/Structure/Property/Performance (P/S/P/P) relations was employed in this project. Processing included LAM and heat-treating. Thermal cycling during LAM is discussed here, and phase diagrams and continuous cooling transformation (CCT) diagrams are used to rationalize microstructural evolution. Structures were characterized including grain size & morphology, volume fraction, morphology, composition and location of carbides in as-deposited and heat-treated conditions. In the simplest sense, the goal was to control microstructures through process manipulation with a view toward optimizing properties and performance in service.

73 NUCLEAR PHYSICS AND RADIATION PHYSICS↗

Stabilization of pH in solid-matrix hydroponic systems

2-[N-morpholino]ethanesulfonic acid (MES) buffer or Amberlite DP-1 (cation-exchange resin beads) were used to stabilize substrate pH of passive-wicking, solid-matrix hydroponic systems in which small canopies of Brassica napus L. (CrGC 5-2, genome : ACaacc) were grown to maturity. Two concentrations of MES (5 or 10 mM) were included in Hoagland 1 nutrient solution. Alternatively, resin beads were incorporated into the 2 vermiculite : 1 perlite (v/v) growth medium at 6% or 12% of total substrate volume. Both strategies stabilized pH without toxic side effects on plants. Average seed yield rates for all four pH stabilization treatments (13.3 to 16.9 g m-2 day-1) were about double that of the control (8.2 g m-2 day-1), for which there was no attempt to buffer substrate pH. Both the highest canopy seed yield rate (16.9 g m-2 day-1) and the highest shoot harvest index (19.5%) occurred with the 6% resin bead treatment, even though the 10 mM MES and 12% bead treatments maintained pH within the narrowest limits. The pH stabilization methods tested did not significantly affect seed oil and protein contents.

NASA Discipline Number 93-10↗

Diffusion tensor imaging of the kidney in healthy controls and in children and young adults with autosomal recessive polycystic kidney disease

Objective: To compare diffusion tensor imaging (DTI) of the kidneys and its derived parameters in children with autosomal recessive polycystic kidney disease (ARPKD) versus healthy controls. Methods: In a prospective IRB-approved study, we evaluated the use of DTI to compare kidney parenchyma FA values in healthy controls (age-matched children with no history of renal disease) versus patients with ARPKD. A 20-direction DTI with b-values of b = 0 s/mm{sup 2} and b = 400 s/mm{sup 2} was used to acquire data in coronal direction using a fat-suppressed spin-echo echo-planar sequence. Diffusion Toolkit and TrackVis were used for analysis and segmentation. TrackVis was used to draw regions of interest (ROIs) covering the entire volume of the renal parenchyma, excluding the collecting system. Fibers were reconstructed using a deterministic fiber tracking algorithm. The FA values based on the ROI data, mean length, and volume of the tracks based on the fiber tracking data were recorded. Results: Eight healthy controls (mean age = 12.9 years ± 4.0; 1/8 males) and six ARPKD participants (mean age = 13.8 years ± 8.5; 5/6 males) were included in the study. Compared to healthy controls, patients with ARPKD had significantly lower FA values (0.33 ± 0.03 vs. 0.25 ± 0.02, p = 0.002) and mean track length (16.73 ± 3.43 vs. 11.61 ± 1.29 mm, p = 0.005). Conclusion: DTI of the kidneys shows significantly lower FA values and mean track length in children and young adults with ARPKD compared to normal subjects. DTI of the kidney offers a novel approach for characterizing renal disease based on changes in diffusion anisotropy and kidney structure.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Spot-Scanning Proton Arc (SPArc) Therapy: The First Robust and Delivery-Efficient Spot-Scanning Proton Arc Therapy

Purpose: To present a novel robust and delivery-efficient spot-scanning proton arc (SPArc) therapy technique. Methods and Materials: A SPArc optimization algorithm was developed that integrates control point resampling, energy layer redistribution, energy layer filtration, and energy layer resampling. The feasibility of such a technique was evaluated using sample patients: 1 patient with locally advanced head and neck oropharyngeal cancer with bilateral lymph node coverage, and 1 with a nonmobile lung cancer. Plan quality, robustness, and total estimated delivery time were compared with the robust optimized multifield step-and-shoot arc plan without SPArc optimization (Arc{sub multi-field}) and the standard robust optimized intensity modulated proton therapy (IMPT) plan. Dose-volume histograms of target and organs at risk were analyzed, taking into account the setup and range uncertainties. Total delivery time was calculated on the basis of a 360° gantry room with 1 revolutions per minute gantry rotation speed, 2-millisecond spot switching time, 1-nA beam current, 0.01 minimum spot monitor unit, and energy layer switching time of 0.5 to 4 seconds. Results: The SPArc plan showed potential dosimetric advantages for both clinical sample cases. Compared with IMPT, SPArc delivered 8% and 14% less integral dose for oropharyngeal and lung cancer cases, respectively. Furthermore, evaluating the lung cancer plan compared with IMPT, it was evident that the maximum skin dose, the mean lung dose, and the maximum dose to ribs were reduced by 60%, 15%, and 35%, respectively, whereas the conformity index was improved from 7.6 (IMPT) to 4.0 (SPArc). The total treatment delivery time for lung and oropharyngeal cancer patients was reduced by 55% to 60% and 56% to 67%, respectively, when compared with Arc{sub multi-field} plans. Conclusion: The SPArc plan is the first robust and delivery-efficient proton spot-scanning arc therapy technique, which could potentially be implemented into routine clinical practice.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Intrinsic and Extrinsic Factors Influencing the Dynamics of VO 2 Mott Oscillators

Oscillatory devices have gained significant interest recently as key components of computing systems based on biomimetic neuronal spiking. An understanding of the time scales underlying the spiking is essential for engineering fast, controllable, low energy devices. However, we find that the intrinsic dynamics of these devices are difficult to properly characterize, as they can be heavily influenced by the external circuitry used to measure them. Here we demonstrate these challenges using a VO 2 Mott oscillator with a sub-100 nm effective size, achieved using a nanogap cut in a metallic carbon nanotube electrode. Given the nanoscale thermal volume of this device, it would be expected to exhibit rapid oscillations. However, due to external parasitics present within commonly used current sources, we see orders of magnitude slower dynamics. Here, we outline methods for determining when measurements are dominated by extrinsic factors and discuss the operating conditions under which intrinsic oscillation frequencies may be observed.

75 CONDENSED MATTER PHYSICS, SUPERCONDUCTIVITY AND↗

SU-C-BRB-02: Automatic Planning as a Potential Strategy for Dose Escalation for Pancreas SBRT?

Purpose: Stereotactic body radiation therapy (SBRT) has been suggested to provide high rates of local control for locally advanced pancreatic cancer. However, the close proximity of highly radiosensitive normal tissues usually causes the labor-intensive planning process, and may impede further escalation of the prescription dose. The present study evaluates the potential of an automatic planning system as a dose escalation strategy. Methods: Ten pancreatic cancer patients treated with SBRT were studied retrospectively. SBRT was delivered over 5 consecutive fractions with 6 ∼ 8Gy/fraction. Two plans were generated by Pinnacle Auto-Planning with the original prescription and escalated prescription, respectively. Escalated prescription adds 1 Gy/fraction to the original prescription. Manually-created planning volumes were excluded in the optimization goals in order to assess the planning efficiency and quality simultaneously. Critical organs with closest proximity were used to determine the plan normalization to ensure the OAR sparing. Dosimetric parameters including D100, and conformity index (CI) were assessed. Results: Auto-plans directly generate acceptable plans for 70% of the cases without necessity of further improvement, and two more iterations at most are necessary for the rest of the cases. For the pancreas SBRT plans with the original prescription, autoplans resulted in favorable target coverage and PTV conformity (D100 = 96.3% ± 1.48%; CI = 0.88 ± 0.06). For the plans with the escalated prescriptions, no significant target under-dosage was observed, and PTV conformity remains reasonable (D100 = 93.3% ± 3.8%, and CI = 0.84 ± 0.05). Conclusion: Automatic planning, without substantial human-intervention process, results in reasonable PTV coverage and PTV conformity on the premise of adequate OAR sparing for the pancreas SBRT plans with escalated prescription. The results highlight the potential of autoplanning as a dose escalation strategy for pancreas SBRT treatment planning. Further investigations with a larger number of patients are necessary. The project is partially supported by Philips Medical Systems.

60 APPLIED LIFE SCIENCES↗

An inflight refill unit for replenishing research animal drinking water

This paper presents the design process and development approach for a method of maintaining sufficient quantities of water for research animals during a Shuttle mission of long duration. An inflight refill unit (IRU) consisting of two major subsystems, a fluid pumping unit (FPU) and a collapsible water reservoir (CWR), were developed. The FPU provides the system measurement and controls, pump, water lines, and plumbing necessary to collect water coming into the unit from the potable water system and pump it out into the RAHF drinking water tanks. The CWR is a Kevlar (TM) reinforced storage bladder connected to the FPU, which has a capacity of 6 liters in its expanded volume and functions to store the water collected from the potable water system, allowing for transport of the water back to the Spacelab where it is pumped into each of two research animal holding facilities. Additional components of the IRU system include the inlet and outlet fluid hoses, a power cable for providing 29V direct current spacecraft electrical power to the pump within the FPU, a tether system for the unit when in use in Spacelab, and an adapter for mating the unit to the orbiter waste collection system in order to dump excess water after use in Spacelab.

Savage, P. D.↗

Space processing applications payload equipment study. Volume 3: Programmatics

The programmatic aspects of the space processing applications program and the methods of accommodating SPA payloads aboard the Shuttle/Spacelab host vehicle are discussed. An examination of the NASA traffic model shows that there exists a potential for 178 SPA payloads from the overall total of 727 flights specified. This could represent up to one quarter of the total shuttle flights during the 12-year-long period covered by the traffic model. The SPA payload will range from austere for shared flight opportunities to dedicated where space processing will encompass the total flight payload allocations. The major modes of use to SPA will include dedicated Spacelab missions, shared Spacelab missions and shared automated payloads attached to the pallet with the necessary control and display equipment in the host vehicle. Several layout drawings and artist's renderings have been completed to illustrate the various potential configurations available to accommodate the SPA payload equipment.

Hammel, R. L.↗

WE-DE-201-08: Multi-Source Rotating Shield Brachytherapy Apparatus for Prostate Cancer

Purpose: To introduce a novel multi-source rotating shield brachytherapy (RSBT) apparatus for the precise simultaneous angular and linear positioning of all partially-shielded 153Gd radiation sources in interstitial needles for treating prostate cancer. The mechanism is designed to lower the detrimental dose to healthy tissues, the urethra in particular, relative to conventional high-dose-rate brachytherapy (HDR-BT) techniques. Methods: Following needle implantation, the delivery system is docked to the patient template. Each needle is coupled to a multi-source afterloader catheter by a connector passing through a shaft. The shafts are rotated by translating a moving template between two stationary templates. Shaft walls as well as moving template holes are threaded such that the resistive friction produced between the two parts exerts enough force on the shafts to bring about the rotation. Rotation of the shaft is then transmitted to the shielded source via several keys. Thus, shaft angular position is fully correlated with the position of the moving template. The catheter angles are simultaneously incremented throughout treatment as needed, and only a single 360° rotation of all catheters is needed for a full treatment. For each rotation angle, source depth in each needle is controlled by a multi-source afterloader, which is proposed as an array of belt-driven linear actuators, each of which drives a source wire. Results: Optimized treatment plans based on Monte Carlo dose calculations demonstrated RSBT with the proposed apparatus reduced urethral D{sub 1cc} below that of conventional HDR-BT by 35% for urethral dose gradient volume within 3 mm of the urethra surface. Treatment time to deliver 20 Gy with multi-source RSBT apparatus using nineteen 62.4 GBq {sup 153}Gd sources is 117 min. Conclusions: The proposed RSBT delivery apparatus in conjunction with multiple nitinol catheter-mounted platinum-shielded {sup 153}Gd sources enables a mechanically feasible urethra-sparing treatment technique for prostate cancer in a clinically reasonable timeframe.

60 APPLIED LIFE SCIENCES↗

IMRT for Image-Guided Single Vocal Cord Irradiation

Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose {+-} standard deviation to the planning target volume was 67 {+-} 1 Gy. The contralateral vocal cord dose was reduced from 66 {+-} 1 Gy in the conventional plans to 39 {+-} 8 Gy and 36 {+-} 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Conformal Radiotherapy in the Treatment of Advanced Juvenile Nasopharyngeal Angiofibroma With Intracranial Extension: An Institutional Experience

Purpose: To describe the results of conformal radiotherapy in advanced juvenile nasopharyngeal angiofibroma in a tertiary care institution. Methods and Materials: Retrospective chart review was conducted for 8 patients treated with conformal radiotherapy between 2006 and 2009. The median follow-up was 17 months. All patients had Stage IIIB disease with intracranial extension. Radiotherapy was considered as treatment because patients were deemed inoperable owing to extensive intracranial/intraorbital extension or proximity to optic nerve. All but 1 patient were treated with intensity-modulated radiotherapy using seven coplanar fields. Median (range) dose prescribed was 39.6 (30-46) Gy. Actuarial analysis of local control and descriptive analysis of toxicity profile was conducted. Results: Despite the large and complex target volume (median planning target volume, 292 cm{sup 3}), intensity-modulated radiotherapy achieved conformal dose distributions (median van't Reit index, 0.66). Significant sparing of the surrounding organs at risk was obtained. No significant Grade 3/4 toxicities were experienced during or after treatment. Actual local control at 2 years was 87.5%. One patient died 1 month after radiotherapy secondary to massive epistaxis. The remaining 7 patients had progressive resolution of disease and were symptom-free at last follow-up. Persistent rhinitis was the only significant toxicity, seen in 1 patient. Conclusions: Conformal radiotherapy results in good local control with minimal acute and late side effects in juvenile nasopharyngeal angiofibromas, even in the presence of advanced disease.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Long-Term Outcomes of Vestibular Schwannomas Treated With Fractionated Stereotactic Radiotherapy: An Institutional Experience

Purpose: We assessed clinical outcome and long-term tumor control after fractionated stereotactic radiotherapy (FSRT) for unilateral schwannoma. Methods and Materials: Between 1995 and 2007, 496 patients were treated with fractionated stereotactic radiotherapy at Johns Hopkins Hospital (Baltimore, MD); 385 patients had radiologic follow-up that met the inclusion criteria. The primary endpoint was treatment failure. Secondary endpoints were radiologic progression and clinical outcome. Logistic regression analysis assessed the association of age, race, tumor side, sex, and pretreatment symptoms. Results: In 11 patients (3%) treatment failed, and they required salvage (microsurgical) treatment. Radiologic progression was observed in 116 patients (30.0%), including 35 patients (9%) in whom the treatment volume more than doubled during the follow-up period, although none required surgical resection. Tumors with baseline volumes of less than 1 cm{sup 3} were 18.02 times more likely to progress than those with tumor volumes of 1 cm{sup 3} or greater (odds ratio, 18.02; 95% confidence interval, 4.25-76.32). Treatment-induced neurologic morbidity included 8 patients (1.6%) with new facial weakness, 12 patients (2.8%) with new trigeminal paresthesias, 4 patients (0.9%) with hydrocephalus (1 communicating and 3 obstructive), and 2 patients (0.5%) with possibly radiation-induced neoplasia. Conclusions: Although the rate of treatment failure is low (3%), careful follow-up shows that radiologic progression occurs frequently. When reporting outcome, the 'no salvage surgery needed' and 'no additional treatment needed' criteria for treatment success need to be complemented by the radiologic data.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Single Vocal Cord Irradiation: Image Guided Intensity Modulated Hypofractionated Radiation Therapy for T1a Glottic Cancer: Early Clinical Results

Purpose: To report, from a retrospective analysis of prospectively collected data, on the feasibility, outcome, toxicity, and voice-handicap index (VHI) of patients with T1a glottic cancer treated by a novel intensity modulated radiation therapy technique developed at our institution to treat only the involved vocal cord: single vocal cord irradiation (SVCI). Methods and Materials: Thirty patients with T1a glottic cancer were treated by means of SVCI. Dose prescription was set to 16 × 3.63 Gy (total dose 58.08 Gy). The clinical target volume was the entire vocal cord. Setup verification was done by means of an online correction protocol using cone beam computed tomography. Data for voice quality assessment were collected prospectively at baseline, end of treatment, and 4, 6, and 12 weeks and 6, 12, and 18 months after treatment using VHI questionnaires. Results: After a median follow-up of 30 months (range, 7-50 months), the 2-year local control and overall survival rates were 100% and 90% because no single local recurrence was reported and 3 patients died because of comorbidity. All patients have completed the intended treatment schedule; no treatment interruptions and no grade 3 acute toxicity were reported. Grade 2 acute dermatitis or dysphagia was reported in only 5 patients (17%). No serious late toxicity was reported; only 1 patient developed temporary grade 2 laryngeal edema, and responded to a short-course of corticosteroid. The VHI improved significantly, from 33.5 at baseline to 9.5 and 10 at 6 weeks and 18 months, respectively (P<.001). The control group, treated to the whole larynx, had comparable local control rates (92.2% vs 100%, P=.24) but more acute toxicity (66% vs 17%, P<.0001) and higher VHI scores (23.8 and 16.7 at 6 weeks and 18 months, respectively, P<.0001). Conclusion: Single vocal cord irradiation is feasible and resulted in maximal local control rate at 2 years. The deterioration in VHI scores was slight and temporary and subsequently improved to normal levels. Long-term follow-up is needed to consolidate these promising results.

62 RADIOLOGY AND NUCLEAR MEDICINE↗