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Spectral characterization of flash and high flux x-ray radiographic sources with a magnetic Compton spectrometer

In this article, we present a new analysis method applied to revitalize permanent magnet Compton spectrometers used to measure photon energy spectra in the MeV range. The inversion of the measured electron distribution to determine the original photon distribution is achieved via a method of consistent coupled radiation transport and magnetic field mapping of the input photon spectra to the measured electron distribution. The method of linear least squares was used to perform the unfolding of the electron distribution to the initial photon spectra, without any assumptions made regarding the electron distribution. We present an application of this method to data from a nominal 19.4 MeV flash radiographic source (the first axis of the Dual Axis Radiographic Hydro-Test Facility) capable of generating 500 R @ 1 m in ~60 ns and a medical therapy source (a Scanditronix M22, Microtron) capable of variable energies with nominal endpoints of 6, 10, 15, and 20 MeV and an output of ~1000–2000 R/min @ 1 m. The results provide agreement between the modeled and unfolded experimentally measured photon spectra as quantified by statistical tests, from 1.5 to 20 MeV. Experimental results are presented as well as a discussion of the novel MCNP6-based simulations and methods for reconstruction of the spectra.

47 OTHER INSTRUMENTATION↗

Interactive XCMS Online: Simplifying Advanced Metabolomic Data Processing and Subsequent Statistical Analyses

XCMS Online (xcmsonline.scripps.edu) is a cloud-based informatic platform designed to process and visualize mass-spectrometry-based, untargeted metabolomic data. Initially, the platform was developed for two-group comparisons to match the independent, “control” versus “disease” experimental design. Here, we introduce an enhanced XCMS Online interface that enables users to perform dependent (paired) two-group comparisons, meta-analysis, and multigroup comparisons, with comprehensive statistical output and interactive visualization tools. Newly incorporated statistical tests cover a wide array of univariate analyses. Multigroup comparison allows for the identification of differentially expressed metabolite features across multiple classes of data while higher order meta-analysis facilitates the identification of shared metabolic patterns across multiple two-group comparisons. Given the complexity of these data sets, we have developed an interactive platform where users can monitor the statistical output of univariate (cloud plots) and multivariate (PCA plots) data analysis in real time by adjusting the threshold and range of various parameters. On the interactive cloud plot, metabolite features can be filtered out by their significance level (p-value), fold change, mass-to-charge ratio, retention time, and intensity. The variation pattern of each feature can be visualized on both extracted-ion chromatograms and box plots. The interactive principal component analysis includes scores, loadings, and scree plots that can be adjusted depending on scaling criteria. The utility of XCMS functionalities is demonstrated through the metabolomic analysis of bacterial stress response and the comparison of lymphoblastic leukemia cell lines.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Feasibility study for test rig assessments of fish passage conditions in a Kaplan turbine

The assessment of fish passage conditions in hydroelectric turbines consists of identifying and quantifying physical magnitudes leading to increased risks of injury of fish passing through turbines in operation. Such assessments are usually carried out either with the use of computer-based methods during design or with field testing of live fish and sensors passing through prototypes. A method in between consists of test rig experimentation, which is critical for testing fish-focused design concepts and offers the opportunity for implementing the most effective design measures for improved fish survivability. However, fish-related assessments in test rigs are not sufficiently documented for industrial applications. This work presents the main findings of an experimental campaign to quantify fish-related hydraulic magnitudes in a physical model of a Kaplan turbine in a commercial test rig. Two operating conditions were tested by releasing miniaturized autonomous sensor devices (termed Sensor Fish Mini) at the turbine intake flow, passing them through the runner in motion and recovering them at the draft tube exit. During passage, time series of acceleration, absolute pressure and rotational velocity were recorded. The recordings were then interpreted to determine the magnitude and likely location of hydraulic stressors hazardous to fish. The statistical tests on the reported measurements indicated that low pressure, collisions on the runner and rotations in the draft tube were not different between the two tested operating points. On the other hand, pressure drop and collision rates on the distributor differed considerably as a function of net head. The outcomes of this investigation showed that test rig evaluations of fish-related properties with Sensor Fish Mini can contribute to an evidence-based development of turbine geometries designed for providing safer passage conditions. Future work will investigate the scaling of test rig measurements to hydraulically equivalent magnitudes in the prototype and their biological consequences.

13 HYDRO ENERGY↗

SU-E-J-85: Leave-One-Out Perturbation (LOOP) Fitting Algorithm for Absolute Dose Film Calibration

Purpose: To introduce an outliers-recognition fitting routine for film dosimetry. It cannot only be flexible with any linear and non-linear regression but also can provide information for the minimal number of sampling points, critical sampling distributions and evaluating analytical functions for absolute film-dose calibration. Methods: The technique, leave-one-out (LOO) cross validation, is often used for statistical analyses on model performance. We used LOO analyses with perturbed bootstrap fitting called leave-one-out perturbation (LOOP) for film-dose calibration . Given a threshold, the LOO process detects unfit points (“outliers”) compared to other cohorts, and a bootstrap fitting process follows to seek any possibilities of using perturbations for further improvement. After that outliers were reconfirmed by a traditional t-test statistics and eliminated, then another LOOP feedback resulted in the final. An over-sampled film-dose- calibration dataset was collected as a reference (dose range: 0-800cGy), and various simulated conditions for outliers and sampling distributions were derived from the reference. Comparisons over the various conditions were made, and the performance of fitting functions, polynomial and rational functions, were evaluated. Results: (1) LOOP can prove its sensitive outlier-recognition by its statistical correlation to an exceptional better goodness-of-fit as outliers being left-out. (2) With sufficient statistical information, the LOOP can correct outliers under some low-sampling conditions that other “robust fits”, e.g. Least Absolute Residuals, cannot. (3) Complete cross-validated analyses of LOOP indicate that the function of rational type demonstrates a much superior performance compared to the polynomial. Even with 5 data points including one outlier, using LOOP with rational function can restore more than a 95% value back to its reference values, while the polynomial fitting completely failed under the same conditions. Conclusion: LOOP can cooperate with any fitting routine functioning as a “robust fit”. In addition, it can be set as a benchmark for film-dose calibration fitting performance.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

THE BURSTY NATURE OF SOLAR FLARE X-RAY EMISSION. II. THE NEUPERT EFFECT

We carry out a novel statistical test of the Neupert effect based on multifractal spectra. The multifractal spectrum is the number distribution of the strengths (i.e., the Hölder exponents) of bursts in a signal. This is tested on simulations and carried out on RHESSI X-ray data from a well observed GOES X4.8 magnitude flare. The multifractal spectra is ideally suited to quantifying the relative smooth and bursty signals typically found in (thermal) soft X-ray and (non-thermal) hard X-ray data of solar flares. We show that light curves from all energies between 3 keV and 25 keV are statistically similar, suggesting that all these signals are dominated by the same (presumably thermal) emission. Emission lying between 25 keV and 100 keV probably contains some contribution from both thermal and non-thermal sources. The multifractal spectrum of a signal and that of its (cumulative) temporal integration are statistically similar (i.e., low residuals upon subtraction), but shifted by one in the peak Hölder exponent. We find the pairs of 3-6 keV and 100-300 keV emissions, the 6-12 keV and 100-300 keV emissions and the 12-25 keV and 100-300 keV emissions are all consistent with the Neupert effect. The best agreement with the Neupert effect is between the 12-25 keV and 100-300 keV pair, although possibly with some secondary source of thermal emission present.

79 ASTRONOMY AND ASTROPHYSICS↗

The look-elsewhere effect from a unified Bayesian and frequentist perspective

When searching over a large parameter space for anomalies such as events, peaks, objects, or particles, there is a large probability that spurious signals with seemingly high signi ficance will be found. This is known as the look-elsewhere effect and is prevalent throughout cosmology, (astro)particle physics, and beyond. To avoid making false claims of detection, one must account for this effect when assigning the statistical significance of an anomaly. This is typically accomplished by considering the trials factor, which is generally computed numerically via potentially expensive simulations. In this paper we develop a continuous generalization of the Bonferroni and Sidak corrections by applying the Laplace approximation to evaluate the Bayes factor, and in turn relating the trials factor to the prior-to-posterior volume ratio. Here, we use this to define a test statistic whose frequentist properties have a simple interpretation in terms of the global p-value, or statistical significance. We apply this method to various physics-based examples and show it to work well for the full range of p-values, i.e. in both the asymptotic and non-asymptotic regimes. We also show that this method naturally accounts for other model complexities such as additional degrees of freedom, generalizing Wilks' theorem. This provides a fast way to quantify statistical significance in light of the look-elsewhere effect, without resorting to expensive simulations.

79 ASTRONOMY AND ASTROPHYSICS↗

WE-FG-BRA-08: Potential Role of the Glycolytic Oscillator in Acute Hypoxia in Tumors

Purpose: Oscillatory dynamics in acute hypoxia have been observed, but poorly understood. They have mostly been attributed to vascular perturbations, but no link has yet been made to metabolic causes. We set out to determine the fundamental frequencies and test for coherence in tumor oxygen dynamics and spatial properties. Methods: Severe combined immunodeficient (SCID) mice were inoculated onto bilateral flanks with human derived head and neck carcinoma (UW-SCC22) cell line xenografts. Oxygen dynamics were monitored in the tumor every minute for an hour using three modalities: blood oxygen level dependent - magnetic resonance imaging (BOLD-MRI), hemoglobin oxygen saturation photoacoustic, and locally manufactured optical probes for spectral fitting. A statistical test was used to separate fluctuating from non-fluctuating voxels and pixels in BOLD-MRI and photoacoustic data respectively. The power spectrum density (PSD) and the autocorrelation functions were calculated for the time series of each voxel, pixel and region, of the BOLD-MRI, photoacoustic or fiber optic data respectively. Results: Using all three techniques, intermittent oxygen dynamics with both coherent and incoherent signatures was observed in the tumors. Upon averaging the PSDs of fluctuating voxels and pixels, it was found that these oscillations occurred with periods of minutes to tens of minutes from all three approaches. Observations from the BOLD-MRI and photoacoustic data showed that clusters of voxels oscillated in a synchronized manner. Conclusion: We were able to use three different modalities to show that fluctuation in tumor oxygen is both coherent and incoherent, with periods of minutes to tens of minutes. These periods are very similar to those from the well-established metabolic, non-linear biomechanical phenomenon called the glycolytic oscillator. This may provide an additional explanation to the cause of cyclic hypoxia. Such dynamics could have profound implications in hypofractionated radiotherapy regiments and could help guide treatment and make it more patient specific. The authors would like to thank the University of Wisconsin Carbone Cancer Center (UWCCC) for the funds to complete this project. This work is also supported in part by NIH/NCI P30 CA014520- UW Comprehensive Cancer Center Support”.

60 APPLIED LIFE SCIENCES↗

Detectability of standing accretion shock instabilities activity in supernova neutrino signals

We introduce a novel methodology for establishing the presence of standing accretion shock instabilities (SASI) in the dynamics of a core collapse supernova from the observed neutrino event rate at water- or ice- based neutrino detectors. The methodology uses a likelihood ratio in the frequency domain as a test- statistics; it is also employed to assess the potential to estimate the frequency and the amplitude of the SASI modulations of the neutrino signal. The parameter estimation errors are consistent with the minimum possible errors as evaluated from the inverse of the Fisher information matrix, and close to the theoretical minimum for the SASI amplitude. Using results from a core-collapse simulation of a 15 solar-mass star by Kuroda et al. [Astrophys. J. 851, 62 (2017).] as a test bed for the method, we find that SASI can be identified with high confidence for a distance to the supernova of up to ~6 kpc for IceCube and up to ~3 kpc for a 0.4 Mt mass water Cherenkov detector. This methodology will aid the investigation of a future galactic supernova.

72 PHYSICS OF ELEMENTARY PARTICLES AND FIELDS↗

WE-H-207A-03: The Universality of the Lognormal Behavior of [F-18]FLT PET SUV Measurements

Purpose: Log transforming [F-18]FDG PET standardized uptake values (SUVs) has been shown to lead to normal SUV distributions, which allows utilization of powerful parametric statistical models. This study identified the optimal transformation leading to normally distributed [F-18]FLT PET SUVs from solid tumors and offers an example of how normal distributions permits analysis of non-independent/correlated measurements. Methods: Forty patients with various metastatic diseases underwent up to six FLT PET/CT scans during treatment. Tumors were identified by nuclear medicine physician and manually segmented. Average uptake was extracted for each patient giving a global SUVmean (gSUVmean) for each scan. The Shapiro-Wilk test was used to test distribution normality. One parameter Box-Cox transformations were applied to each of the six gSUVmean distributions and the optimal transformation was found by selecting the parameter that maximized the Shapiro-Wilk test statistic. The relationship between gSUVmean and a serum biomarker (VEGF) collected at imaging timepoints was determined using a linear mixed effects model (LMEM), which accounted for correlated/non-independent measurements from the same individual. Results: Untransformed gSUVmean distributions were found to be significantly non-normal (p<0.05). The optimal transformation parameter had a value of 0.3 (95%CI: −0.4 to 1.6). Given the optimal parameter was close to zero (which corresponds to log transformation), the data were subsequently log transformed. All log transformed gSUVmean distributions were normally distributed (p>0.10 for all timepoints). Log transformed data were incorporated into the LMEM. VEGF serum levels significantly correlated with gSUVmean (p<0.001), revealing log-linear relationship between SUVs and underlying biology. Conclusion: Failure to account for correlated/non-independent measurements can lead to invalid conclusions and motivated transformation to normally distributed SUVs. The log transformation was found to be close to optimal and sufficient for obtaining normally distributed FLT PET SUVs. These transformations allow utilization of powerful LMEMs when analyzing quantitative imaging metrics.

60 APPLIED LIFE SCIENCES↗

Statistical Modeling and Analysis of k -Layer Coverage of Two-Dimensional Materials in Inkjet Printing Processes

Two-dimensional layered materials/flakes, also known as crystalline atom-thick layer nanosheets, have recently been receiving great attention in electronics fabrication due to their unique and intriguing properties. The k-layer coverage area (i.e., the area covered by k number of overlapping layers) of the printed flake pattern significantly impacts on the properties of the printed electronics. In this work, we constructed a statistical model to describe the k-layer coverage of randomly distributed two-dimensional materials. A series of results are obtained to provide not only the expectation but also the variance of the coverage area. The boundary effects on the random flakes coverage are also studied. In addition, an approximated statistical testing approach is also developed in this work to detect abnormal coverage patterns. Furthermore, the case studies based on simulated data and real flakes images obtained from the inkjet printing process demonstrate the accuracy and effectiveness of the proposed model and analysis methods.

36 MATERIALS SCIENCE↗

Five groups of red giants with distinct chemical composition in the globular cluster NGC 2808

The chemical composition of multiple populations in the massive globular cluster (GC) NGC 2808 is addressed with the homogeneous abundance reanalysis of 140 red giant branch stars. UVES spectra for 31 stars and GIRAFFE spectra for the other giants were analyzed with the same procedures used for about 2500 giants in 23 GCs in our FLAMES survey, deriving abundances of Fe, O, Na, Mg, Si, Ca, Ti, Sc, Cr, Mn, and Ni. Iron, elements from α capture, and those in the Fe group do not show intrinsic scatter. On our UVES scale, the metallicity of NGC 2808 is [Fe/H] = −1.129±0.005±0.034 (± statistical ± systematic error) with σ = 0.030 (31 stars). The main features related to proton-capture elements are retrieved, but the improved statistics and the smaller associated internal errors allow us to uncover five distinct groups of stars along the Na–O anticorrelation. We observe large depletions in Mg, anticorrelated with enhancements of Na and also Si, suggestive of unusually high temperatures for proton captures. About 14% of our sample is formed by giants with solar or subsolar [Mg/Fe] ratios. Using the [Na/Mg] ratios, we confirm the presence of five populations with different chemical compositions that we call P1, P2, I1, I2, and E in order of decreasing Mg and increasing Na abundances. Statistical tests show that the mean ratios in any pair of groups cannot be extracted from the same parent distribution. The overlap with the five populations recently detected from UV photometry is good but not perfect, confirming that more distinct components probably exist in this complex GC.

79 ASTRONOMY AND ASTROPHYSICS↗

Regression for Radioactive Source Detection

Detection of radioactive sources is an important capability that led to the deployment of networks for detecting and localizing low-level, hazardous radiation sources. It is generally expected that such networks outperform the individual detectors by intelligently fusing information from several dispersed sensors. In this paper, we develop a network detection method that uses the slope of a linear regression fit as a test statistic for detecting a point radioactive source within a field of detectors. In our regression model, we compute a least-squared linear fit between the average radiation counts at the detectors and the inverse-squared distances of known detector locations to an estimated source location. We show that the slope of this regression fit is an estimate of the source intensity and can be used as a threshold for source detection purposes. We compare performance of our proposed detection method with that of a fusion-based Sequential Probability Ratio Test (SPRT) method. For performance analyses, two datasets from the Domestic Nuclear Detection Ofces Intelligence Radiation Sensors Systems (IRSS) outdoor tests are used. Each of these tests consists of several runs of a single radioactive source moving in and out of a detector network. We present receiver operating characteristic (ROC) curves and optimal threshold values for the performance each detection method, and determine that our detection method using linear regression fit has slightly better overall performance than SPRT method.

Cordone, G.↗

Galvanic corrosion of structural non-stoichiometric silicon nitride thin films and its implications on reliability of microelectromechanical devices

This paper describes a reliability assessment and failure analysis of a poly-Si/non-stoichiometric silicon nitride thin film composite structure. A set of poly-Si/SiN{sub x} thin film structures were exposed to a mixed flowing gas (MFG) environment, which simulates outdoor environments, for 90 days, and an elevated temperature and humidity (85 °C/95% R.H.) test for 140 days. The mechanical integrity of the thin films was observed to degrade during exposure to the chemically reactive atmospheres. The degree of degradation was analyzed with nanoindentation tests. Statistical analysis of the forces required to initiate a fracture in the thin films indicated degradation due to the exposure to the MFG environment in the SiN{sub x} part of the films. Scanning electron microscopy revealed a porous-like reaction layer on top of SiN{sub x}. The morphology of the reaction layer resembled that of galvanically corroded poly-Si. Transmission electron microscopy further clarified the microstructure of the reaction layer which had a complex multi-phase structure extending to depths of ∼100 nm. Furthermore, the layer was oxidized two times deeper in a 90 days MFG-tested sample compared to an untested reference. The formation of the layer is proposed to be caused by galvanic corrosion of elemental silicon in non-stoichiometric silicon nitride during hydrofluoric acid etching. The degradation is proposed to be due uncontrolled oxidation of the films during the stress tests.

36 MATERIALS SCIENCE↗

Stent Retriever Thrombectomy in Different Thrombus Locations of Anterior Cerebral Circulation

BackgroundMechanical thrombectomy (MT) is a safe and efficient treatment for acute ischemic stroke in patients with proximal anterior occlusion and large penumbra. We evaluated the technical and clinical success of MT in relation to the location of the occlusion (internal carotid artery, M1 and M2 segments of the middle cerebral artery).MethodsWe prospectively reviewed 130 patients of whom 105 met the inclusion criteria. Baseline clinical, procedural and imaging variables, technical outcome (TICI, thrombolysis in cerebral infarction), 24 h imaging outcome and three-month clinical outcome (mRS, modified Rankin Scale) were recorded. Differences between the groups were studied with statistical tests according to the type of the variable.ResultsThere were 37, 46 and 22 patients in the internal carotid artery (ICA), M1 and M2 groups, respectively. TICI 2b or 3 was achieved in 92 cases (88 %) with a non-significant trend towards a better recanalization outcome in the ICA and M1 groups. Overall, 57 of the 105 patients (55 %) experienced favorable clinical outcome (mRS ≤ 2) with no significant differences between the groups. Excellent outcome (mRS ≤ 1) was seen in 40 patients (39 %) and there proportionally more patients with excellent outcome in the ICA and M1 groups (ICA: 44 %, M1: 41 %, M2: 23 % of patients, p = 0.22).ConclusionsThere were no statistically significant differences in the technical or clinical outcomes between the different sites of occlusion (ICA, M1 or M2). There was a non-significant trend towards achieving excellent clinical outcome (3-month mRS ≤ 1) more often and better recanalization results in the two more proximal locations.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

SU-E-I-33: Establishment of CT Diagnostic Reference Levels in Province Nova Scotia

Purpose: To evaluate patient radiation dose from the most frequently performed CT examinations and to establish provincial diagnostic reference levels (DRLs) as a tool for protocol optimization. Methods: The study investigated the following CT examinations: head, chest, abdomen/pelvis, and chest/abdomen/pelvis (CAP). Dose data, volume CT dose index (CTDIvol) and dose-length product (DLP), were collected from 15 CT scanners installed during 2004–2014 in 11 hospital sites of Nova Scotia. All scanners had dose modulation options and multislice capability (16–128 detector rows). The sample for each protocol included 15 average size patients (70±20 kg). Provincial DRLs were calculated as the 75th percentile of patient dose distributions. The differences in dose between hospitals were evaluated with a single factor ANOVA statistical test. Generalized linear modeling was used to determine the factors associated with higher radiation dose. A sample of 36 abdominal studies performed on three different scanners was blinded and randomized for an assessment by an experienced radiologist who graded the imaging quality of anatomic structures. Results: Data for 900 patients were collected. The DRLs were proposed using CTDIvol (mGy) and DLP (mGy*cm) values for CT head (67 and 1049, respectively), chest (12 and 393), abdomen/pelvis (16 and 717), and CAP (14 and 1034). These DRLs were lower than the published national data except for the head CTDIvol. The differences between the means of the dose distributions from each scanner were statistically significant (p<0.05) for all examinations. A very weak correlation was found between the dose and the scanner age or the number of slices with Pearson’s correlation coefficients of 0.011–0.315. The blinded analysis of image quality demonstrated no clinically significant difference except for the noise category. Conclusion: Provincial DRLs were established for typical CT examinations. The variations in dose between the hospitals suggested a large potential for optimization of examinations. Radiology Research Foundation grant.

60 APPLIED LIFE SCIENCES↗

Changes in a suite of indicators of extreme temperature and precipitation under 1.5 and 2 degrees warming

Following the 2015 Paris agreement, the Intergovernmental Panel on Climate Change was tasked with assessing climate change impacts and mitigation options for a world that limits warming to 1.5 &deg;Cina special report. To aid the scientific assessment process three low-warming ensembles were generated over the 21st century based on the Paris targets using NCAR-DOE community model, CESM1-CAM5. This study used those simulation results and computed ten extreme climate indices, from deinitions created by the Expert Team on Climate Change Detection and Indices, to determine if the three different scenarios cause different intensity and frequency of extreme precipitation or temperature over the 21 st century. After computing the indices, statistical tests were used to determine if significant changes affect their characteristics. It was found that at the grid point level significant changes emerge in all scenarios, for nearly all indices. The temperature indices show widespread significant change, while the behavior of precipitation indices reflects the larger role that internal variability plays, even by the end of the century. Nonetheless differences can be assessed, in substantial measure for many of these indices: changes in nearly all indices have a strong correlation to global mean temperature, so that scenarios and times with greater temperature change experience greater index changes for many regions. This is particularly true of the temperature-related indices, but can be assessed for some regions also for the indices related to precipitation intensity. These results thus show that even for scenarios that are separated by only half of a degree in global average temperature, the statistics of extremes are significantly different.

54 ENVIRONMENTAL SCIENCES↗

IS QUASAR OPTICAL VARIABILITY A DAMPED RANDOM WALK?

The damped random walk (DRW) model is increasingly used to model the variability in quasar optical light curves, but it is still uncertain whether the DRW model provides an adequate description of quasar optical variability across all timescales. Using a sample of OGLE quasar light curves, we consider four modifications to the DRW model by introducing additional parameters into the covariance function to search for deviations from the DRW model on both short and long timescales. We find good agreement with the DRW model on timescales that are well sampled by the data (from a month to a few years), possibly with some intrinsic scatter in the additional parameters, but this conclusion depends on the statistical test employed and is sensitive to whether the estimates of the photometric errors are correct to within {approx}10%. On very short timescales (below a few months), we see some evidence of the existence of a cutoff below which the correlation is stronger than the DRW model, echoing the recent finding of Mushotzky et al. using quasar light curves from Kepler. On very long timescales (>a few years), the light curves do not constrain models well, but are consistent with the DRW model.

79 ASTRONOMY AND ASTROPHYSICS↗

Smoking, Alcohol, and Biliary Tract Cancer Risk: A Pooling Project of 26 Prospective Studies

Abstract Background Tobacco and alcohol are well-established risk factors for numerous cancers, yet their relationship to biliary tract cancers remains unclear. Methods We pooled data from 26 prospective studies to evaluate associations of cigarette smoking and alcohol consumption with biliary tract cancer risk. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with smoking and alcohol consumption were calculated. Random-effects meta-analysis produced summary estimates. All statistical tests were two-sided. Results Over a period of 38 369 156 person-years of follow-up, 1391 gallbladder, 758 intrahepatic bile duct, 1208 extrahepatic bile duct, and 623 ampulla of Vater cancer cases were identified. Ever, former, and current smoking were associated with increased extrahepatic bile duct and ampulla of Vater cancers risk (eg, current vs never smokers HR = 1.69, 95% CI = 1.34 to 2.13 and 2.22, 95% CI = 1.69 to 2.92, respectively), with dose-response effects for smoking pack-years, duration, and intensity (all Ptrend < .01). Current smoking and smoking intensity were also associated with intrahepatic bile duct cancer (eg, >40 cigarettes per day vs never smokers HR = 2.15, 95 % CI = 1.15 to 4.00; Ptrend = .001). No convincing association was observed between smoking and gallbladder cancer. Alcohol consumption was only associated with intrahepatic bile duct cancer, with increased risk for individuals consuming five or more vs zero drinks per day (HR = 2.35, 95%CI = 1.46 to 3.78; Ptrend = .04). There was evidence of statistical heterogeneity among several cancer sites, particularly between gallbladder cancer and the other biliary tract cancers. Conclusions Smoking appears to increase the risk of developing all biliary tract cancers except gallbladder cancer. Alcohol may increase the risk of intrahepatic bile duct cancer. Findings highlight etiologic heterogeneity across the biliary tract.

McGee, Emma E.↗