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At least 145 records · Page 8

Outcomes in Women Treated With MammoSite Brachytherapy or Whole Breast Irradiation Stratified by ASTRO Accelerated Partial Breast Irradiation Consensus Statement Groups

Purpose: The American Society for Radiation Oncology published a Consensus Statement for accelerated partial breast irradiation identifying three groups: Suitable, Cautionary, and Unsuitable. The objective of this study was to compare oncologic outcomes in women treated with MammoSite brachytherapy (MB) vs. whole breast irradiation (WBI) after stratification into Statement groups. Methods: Eligible women had invasive carcinoma or ductal carcinoma in situ (DCIS) {<=}3 cm, and {<=}3 lymph nodes positive. Women were stratified by radiation modality and Statement groups. Survival analysis methods including Kaplan-Meier estimation, Cox regression, and competing risks analysis were used to assess overall survival (OS), disease-free survival (DFS), time to local failure (TTLF), and tumor bed failure (TBF). Results: A total of 459 (183 MB and 276 WBI) patients were treated from 2002 to 2009. After a median follow-up of 45 months, we found no statistical differences by stratification group or radiation modality with regard to OS and DFS. At 4 years TTLF or TBF were not statistically different between the cohorts. Univariate analysis in the MB cohort revealed that nodal positivity (pN1 vs. pN0) was related to TTLF (hazard ratio 6.39, p = 0.02). There was a suggestion that DCIS histology had an increased risk of failure when compared with invasive ductal carcinoma (hazard ratio 3.57, p = 0.06). Conclusions: MB and WBI patients stratified by Statement groups seem to combine women who will have similar outcomes regardless of radiation modality. Although outcomes were similar, we remain guarded in overinterpretation of these preliminary results until further analysis and long-term follow-up data become available. Caution should be used in treating women with DCIS or pN1 disease with MB.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Palliative Radiotherapy for Bone Metastases: An ASTRO Evidence-Based Guideline

Purpose: To present guidance for patients and physicians regarding the use of radiotherapy in the treatment of bone metastases according to current published evidence and complemented by expert opinion. Methods and Materials: A systematic search of the National Library of Medicine's PubMed database between 1998 and 2009 yielded 4,287 candidate original research articles potentially applicable to radiotherapy for bone metastases. A Task Force composed of all authors synthesized the published evidence and reached a consensus regarding the recommendations contained herein. Results: The Task Force concluded that external beam radiotherapy continues to be the mainstay for the treatment of pain and/or prevention of the morbidity caused by bone metastases. Various fractionation schedules can provide significant palliation of symptoms and/or prevent the morbidity of bone metastases. The evidence for the safety and efficacy of repeat treatment to previously irradiated areas of peripheral bone metastases for pain was derived from both prospective studies and retrospective data, and it can be safe and effective. The use of stereotactic body radiotherapy holds theoretical promise in the treatment of new or recurrent spine lesions, although the Task Force recommended that its use be limited to highly selected patients and preferably within a prospective trial. Surgical decompression and postoperative radiotherapy is recommended for spinal cord compression or spinal instability in highly selected patients with sufficient performance status and life expectancy. The use of bisphosphonates, radionuclides, vertebroplasty, and kyphoplasty for the treatment or prevention of cancer-related symptoms does not obviate the need for external beam radiotherapy in appropriate patients. Conclusions: Radiotherapy is a successful and time efficient method by which to palliate pain and/or prevent the morbidity of bone metastases. This Guideline reviews the available data to define its proper use and provide consensus views concerning contemporary controversies or unanswered questions that warrant prospective trial evaluation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Calibration of the microcalorimeter spectrometer on-board the Hitomi (Astro-H) observatory (invited)

The Hitomi Soft X-ray Spectrometer (SXS) was a pioneering non-dispersive imaging x-ray spectrometer with 5 eV FWHM energy resolution, consisting of an array of 36 silicon-thermistor microcalorimeters at the focus of a high-throughput soft x-ray telescope. Here, the instrument enabled astrophysical plasma diagnostics in the 0.3–12 keV band. We introduce the SXS calibration strategy and corresponding ground calibration measurements that took place from 2012–2015, including both the characterization of the microcalorimeter array and measurements of the x-ray transmission of optical blocking filters.

47 OTHER INSTRUMENTATION↗

MO-C-BRB-02: ASTRO President [ Diagnostic radiology and radiation oncology ]

Diagnostic radiology and radiation oncology are arguably two of the most technologically advanced specialties in medicine. The imaging and radiation medicine technologies in clinical use today have been continuously improved through new advances made in the commercial and academic research arenas. This symposium explores the translational path from research through clinical implementation. Dr. Pettigrew will start this discussion by sharing his perspectives as director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB). The NIBIB has focused on promoting research that is technological in nature and has high clinical impact. We are in the age of precision medicine, and the technological innovations and quantitative tools developed by engineers and physicists working with physicians are providing innovative tools that increase precision and improve outcomes in health care. NIBIB funded grants lead to a very high patenting rate (per grant dollar), and these patents have higher citation rates by other patents, suggesting greater clinical impact, as well. Two examples of clinical translation resulting from NIH-funded research will be presented, in radiation therapy and diagnostic imaging. Dr. Yu will describe a stereotactic radiotherapy device developed in his laboratory that is designed for treating breast cancer with the patient in the prone position. It uses 36 rotating Cobalt-60 sources positioned in an annular geometry to focus the radiation beam at the system’s isocenter. The radiation dose is delivered throughout the target volume in the breast by constantly moving the patient in a planned trajectory relative to the fixed isocenter. With this technique, the focal spot dynamically paints the dose distribution throughout the target volume in three dimensions. Dr. Jackson will conclude this symposium by describing the RSNA Quantitative Imaging Biomarkers Alliance (QIBA), which is funded in part by NIBIB and is a synergistic collaboration between medical physicists, radiologists, oncologists, industry representatives, and other stakeholders. The mission of QIBA is to improve the accuracy and practicality of quantitative image-based biomarkers by increasing precision across devices, patients, and time, an essential step in incorporating quantitative imaging biomarkers into radiology practice. Validated quantitative imaging biomarkers are necessary to support precision medicine initiatives, multimodality / multiparametric applications in medicine, treatment planning and response assessment, and radiogenomics applications. Current applications in the QIBA portfolio extend to cancer diagnosis and treatment, pulmonary diseases, and neurological disorders. The overall goal of this symposium is to illustrate the bidirectional exchange between medical research and clinical practice. Revitalizing scientific excellence in clinical medical physics challenges practitioners to identify clinical limitations, which then drive research innovation; research funded by the NIH and other agencies develops technological solutions to these limitations, which are translated to the care environment to ultimately improve clinical practice in radiology and radiation oncology.

60 APPLIED LIFE SCIENCES↗

WE-E-204-01: ASTRO Based Journals

Research papers authored by Medical Physicists address a large spectrum of oncologic, imaging, or basic research problems; exploit a wide range of physical and engineering methodologies; and often describe the efforts of a multidisciplinary research team. Given dozens of competing journals accepting medical physics articles, it may not be clear to an individual author which journal is the best venue for disseminating their work to the scientific community. Relevant factors usually include the Journal’s audience and scientific impact, but also such factors as perceived acceptance rate, interest in their topic, and quality of service. The purpose of this symposium is to provide the medical physics community with an overview of scope, review processes, and article guidelines for the following journals: Radiology, Medical Physics, International Journal of Radiation Biology and Physics, Journal of Applied Clinical Medical Physics, and Practical Radiation Oncology. Senior members of the editorial board for each journal will provide details as to the journals review process, for example: single blind versus double blind reviews; open access policies, the hierarchy of the review process in terms of editorial board structure; the reality of acceptance, in terms of acceptance rate; and the types of research the journal prefers to publish. Other journals will be discussed as well. The goal is to provide for authors guidance before they begin to write their papers, not only for proper formatting, but also that the readership is appropriate for the particular paper, hopefully increasing the quality and impact of the paper and the likelihood of publication. Learning Objectives: To review each Journal’s submission and review process Guidance as to how to increase quality, impact and chances of acceptance To help decipher which journal is appropriate for a given work A. Karellas, Research collaboration with Koning, Corporation.

61 RADIATION PROTECTION AND DOSIMETRY↗

Was Reexcision Less Frequent for Patients with Lobular Breast Cancer After Publication of the SSO-ASTRO Margin Guidelines?

Background: The Society of Surgical Oncology and American Society for Radiation Oncology consensus guidelines defined a negative margin for breast-conserving surgery (BCS) as no ink on tumor, and implementation has reduced rates of additional surgery for patients with invasive ductal cancer (IDC). The outcomes for invasive lobular cancer (ILC) patients are uncertain. Methods: This study identified patients who had stage 1 or 2 ILC treated with BCS from January 2010 to February 2018. The guidelines were adopted 1 January 2014. Clinicopathologic characteristics, margin status, and reexcisions were compared before and after adoption of the guidelines and with those of IDC patients treated from May 2013 to February 2015. Results: Among 745 early-stage ILC patients undergoing BCT, 312 (42%) were treated before the guidelines and 433 (58%) after the guidelines. Most clinicopathologic characteristics were similar between the two groups, with differences in lobular carcinoma in situ, lymphovascular invasion, and node-positivity rates. The overall rates of additional surgery declined significantly after the guidelines (31.4 to 23.1%; p = 0.01), but the difference did not reach significance for reexcisions (19.9 to 15.2%; p = 0.12) or conversions to mastectomy (11.5 to 7.9%; p = 0.099) individually. Between eras, no difference in incidence or number of tumor on ink or ≤ 2 mm margins was observed (all p = 0.2). Larger tumors, younger age, and pre-guideline era were independently associated with additional surgery. Only younger age was predictive of mastectomy. Among 431 pre-guideline and 601 post-guideline IDC patients, reexcisions declined from 21.3 to 14.8% (p = 0.008), and conversion to mastectomy was rare (0.6%). The magnitude of reduction in any additional surgery (interaction, p = 0.92) and reexcisions (interaction, p = 0.56) was similar between ILC and IDC. Conclusions: Despite differences in growth pattern and conspicuity, guideline adoption significantly reduced additional surgery among ILC patients, with a magnitude of benefit similar to that among IDC patients.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Astro Skipper-CCD Detector

Cosmologists have determined that the majority of the universe is composed of dark energy and nonbaryonic (not made of atoms) dark matter. Dark energy is an unknown form of energy, hypothesized to be the cause of the accelerating expansion of the universe. Dark matter can not be detected electromagnetically, however cosmologists are confident it exists because of its gravitational effect on galaxies. In spiral galaxies, we observe stars that orbit at speeds that can not be accounted for by the gravitational force of visible matter. This puzzling result is contrary to standard Newtonian gravity, yet makes sense if one assumes the gravitational effects of an unseen mass[1]. Better, more sensitive detectors are required to perform detailed measurements of faint stars and galaxies that will allow us to further understand these phenomena.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Automated shell theory for rotating structures (ASTROS)

A computer program for analyzing axisymmetric shells with inertial forces caused by rotation about the shell axis is developed by revising the STARS II shell program. The basic capabilities of the STARS II shell program, such as the treatment of the branched shells, stiffened wall construction, and thermal gradients, are retained.

Foster, B. J.↗

Automated Shell Theory for Rotating Structures (ASTROS)

Computer program can be used to analyze any disk or shell of revolution of arbitrary cross section under inertial loads caused by rotation about shell axis and under various static loads, including thermal gradients. Geometric shapes incorporated in program are ellipsoidal, spherical, ogival, toroidal, conical, circular plate, cylindrical, and parabolic.

Foster, B. J.↗

Applications of satellite technology for regional organizations (Project ASTRO)

The direct arithmetic processing of adaptive delta modulation (ADM) encoded signals, conversion from ADM encoded signals to pulse code modulation (PCM) encoded signals, and conversion from PCM to ADM encoded signals are discussed. It is shown that signals which are ADM encoded can be arithmetically processed directly, without first decoding. Operating on the DM bit stream, and employing only standard digital hardware, the sum, difference and product can be obtained in PCM and ADM format.

Schilling, D. L.↗

The Hopkins Ultraviolet Telescope - Performance and calibration during the Astro-1 mission

Results are reported of spectrophotometric observations, made with the Hopkins Ultraviolet Telescope (HUT), of 77 astronomical sources throughout the far-UV (912-1850 A) at a resolution of about 3 A, and, for a small number of sources, in the extreme UV (415-912 A) beyond the Lyman limit at a resolution of about 1.5 A. The HUT instrument and its performance in orbit are described. A HUT observation of the DA white dwarf G191-B2B is presented, and the photometric calibration curve for the instrument is derived from a comparison of the observation with a model stellar atmosphere. The sensitivity reaches a maximum at 1050 A, where 1 photon/sq cm s A yields 9.5 counts/s A, and remains within a factor of 2 of this value from 912 to 1600 A. The instrumental dark count measured on orbit was less than 0.001 counts/s A.

Davidsen, Arthur F.↗