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Retrospective review of thoracic neural damage during lung ablation - what the interventional radiologist needs to know about neural thoracic anatomy

Background and Purpose: Radiofrequency ablation (RFA) is associated with low neural morbidity compared with surgery, which commonly causes debilitating long-term pain. The purpose was to review the thoracic neural anatomy relevant to percutaneous RFA and to retrospectively review symptomatic nerve injury after lung RFA at our institution. Materials and Methods: We retrospectively examined all symptomatic nerve injuries occurring after computed tomography (CT)-guided RFA treatment of lung tumors for 462 patients/509 procedures/708 lesions treated at our large tertiary referral centre during 10 years. Results: Eight patients experienced neurological complications after heating during the RFA procedure. These complications occurred in the phrenic (n = 1), brachial (n = 3), left recurrent (n = 1), and intercostal nerves (n = 2) and the stellate ganglion (n = 1). Three were grade 2, four grade 3 and one grade 4 injuries (CTCAE v3). Conclusion: Although rare, neurological complications can occur after RFA, and they can occasionally be severe. To prevent these complications, it is important for the interventional radiologist to be aware of the anatomy of nervous structures and to attempt to identify nerves on CT scans during the RFA procedure. Creating a pneumothorax can be useful to avoid nerve damage and related clinical complications.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Delayed-Phase Cone-Beam CT Improves Detectability of Intrahepatic Cholangiocarcinoma During Conventional Transarterial Chemoembolization

PurposeTo evaluate the detectability of intrahepatic cholangiocarcinoma (ICC) on dual-phase cone-beam CT (DPCBCT) during conventional transarterial chemoembolization (cTACE) compared to that of digital subtraction angiography (DSA) with respect to pre-procedure contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.MethodsThis retrospective study included 17 consecutive patients (10 male, mean age 64) with ICC who underwent pre-procedure CE-MRI of the liver, and DSA and DPCBCT (early-arterial phase (EAP) and delayed-arterial phase (DAP)) just before cTACE. The visibility of each ICC lesion was graded by two radiologists on a three-rank scale (complete, partial, and none) on DPCBCT and DSA images, and then compared to pre-procedure CE-MRI.ResultsOf 61 ICC lesions, only 45.9 % were depicted by DSA, whereas EAP- and DAP-CBCT yielded a significantly higher detectability rate of 73.8 % and 93.4 %, respectively (p < 0.01). Out of the 33 lesions missed on DSA, 18 (54.5 %) and 30 (90.9 %) were revealed on EAP- and DAP-CBCT images, respectively. DSA depicted only one lesion that was missed by DPCBCT due to streak artifacts caused by a prosthetic mitral valve. DAP-CBCT identified significantly more lesions than EAP-CBCT (p < 0.01). Conversely, EAP-CBCT did not detect lesions missed by DAP-CBCT. For complete lesion visibility, DAP-CBCT yielded significantly higher detectability (78.7 %) compared to EAP (31.1 %) and DSA (21.3 %) (p < 0.01).ConclusionDPCBCT, and especially the DAP-CBCT, significantly improved the detectability of ICC lesions during cTACE compared to DSA. We recommend the routine use of DAP-CBCT in patients with ICC for per-procedure detectability and treatment planning in the setting of TACE.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Digestive Tract Complications of Renal Cryoablation

We report a case each of duodenorenal and colorenal fistula that arose after computed tomography-guided percutaneous cryoablation (PCA) for renal cell carcinoma and use imaging and endoscopic findings to analyze their causes and mechanisms. Both complications occurred though the edge of the iceball did not touch the intestinal wall, and patients’ symptoms and fistula formation occurred several days after the PCA procedure. Based on imaging and endoscopy findings, we suspected the colorenal fistula resulted from bowel injury caused by ischemia from the occlusion of small vessels at the procedure’s low temperature. Both cases were resolved conservatively without surgical intervention.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Image Fusion Guidance with Pre-procedural CT with Real-Time Fluoroscopy for Adrenal Venous Sampling

PurposeTo assess the effectiveness of image fusion guidance (IF) with pre-procedural computed tomography (CT) with intraprocedural fluoroscopy for adrenal venous sampling (AVS).Materials and MethodsAVS before and after ACTH stimulation including bilateral segmental sampling of effluent tributaries was performed in 62 patients with IF. A 3D volume rendering image, including adrenal glands and veins extracted from previously obtained contrast-enhanced CT images, was manually registered to the real-time X-ray fluoroscopy. The technical success rates, procedure time, radiation exposure, and volume of contrast medium used were compared with 49 patients who underwent AVS without IF.ResultsNo significant differences in the technical success rates with and without IF were observed (98.4 vs. 91.8% for the right adrenal veins, p = 0.168, and 98.4 vs. 100% for the left adrenal veins, p = 1.000). The procedure time with IF was significantly shorter than that without IF (95.6 ± 18.8 vs. 108.4 ± 20.0 min, p = 0.001). The total dose-area product with IF was significantly lower than that without IF (43.1 ± 30.7 vs. 72.2 ± 45.3 Gy cm{sup 2}, p < 0.001). The contrast medium volume used with IF was significantly lower than that without IF (54.6 ± 21.9 vs. 65.7 ± 27.6 mL, p = 0.020).ConclusionsAlthough the contribution to improving the technical success rates was small in our study, IF can effectively reduce procedure time, radiation exposure, and volume of contrast medium during AVS.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Fusion neutron generation computations in a stellarator-mirror hybrid with neutral beam injection

In the paper [Moiseenko V.E., Noack K., Agren O. 'Stellarator-mirror based fusion driven fission reactor' J Fusion Energy 29 (2010) 65.], a version of a fusion driven system (FDS), i.e. a sub-critical fast fission assembly with a fusion plasma neutron source, is proposed. The plasma part of the reactor is based on a stellarator with a small mirror part. Hot ions with high perpendicular energy are assumed to be trapped in the magnetic mirror part. The stellarator part which connects to the mirror part and provides confinement for the bulk (deuterium) plasma. In the magnetic well of the mirror part, fusion reactions occur from collisions between a of hot ion component (tritium) with cold background plasma ions. RF heating is one option to heat the tritium. A more conventional method to sustain the hot ions is neutral beam injection (NBI), which is here studied numerically for the above-mentioned hybrid scheme. For these studies, a new kinetic code, KNBIM, has been developed. The code takes into account Coulomb collisions between the hot ions and the background plasma. The geometry of the confining magnetic field is arbitrary for the code. It is accounted for via a numerical bounce averaging procedure. Along with the kinetic calculations the neutron generation intensity and its spatial distribution are computed.

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗

Point-group sensitive orientation mapping of non-centrosymmetric crystals

We demonstrate polarity-sensitive orientation mapping of non-centrosymmetric phases by Electron Backscatter Diffraction (EBSD). The method overcomes the restrictions of kinematic orientation determination by EBSD, which is limited to the centro-symmetric Laue-groups according to Friedel's rule. Using polycrystalline GaP as an example, we apply a quantitative pattern matching approach based on simulations using the dynamical theory of electron diffraction. This procedure results in a distinct assignment of the local orientation according to the non-centrosymmetric point group of the crystal structure under investigation.

75 CONDENSED MATTER PHYSICS, SUPERCONDUCTIVITY AND↗

SU-E-P-46: Clinical Acceptance Testing and Implementation of a Portable CT Unit

Purpose: Planning for the first installation in New England of a new portable CT unit to be used in the Operating Room required the integration of many departments including Surgery, Neurosurgery, Information Services, Clinical Engineering, Radiology and Medical Physics/Radiation Safety. Acceptance testing and the quality assurance procedures were designed to optimize image quality and patient and personnel radiation exposure. Methods: The vendor’s protocols were tested using the CT Dosimetry phantoms. The system displayed the CTDIw instead of the CTDIvol while testing the unit. Radiation exposure was compared to existing CT scanners from installed CT units throughout the facility. Brainlab measures all 4 periphery slots on the CT Dosimetry phantom. The ACR measures only the superior slot for the periphery measurement. A comprehensive radiation survey was also performed for several locations. Results: The CTDIvol measurements were comparable for the following studies: brain, C-Spine, and sinuses. However, the mobile CT measurements were slightly higher than other CT units but within acceptable tolerance if measured using the ACR method.Based on scatter measurements, it was determined if any personnel were to stay in the OR Suite during image acquisition that the appropriate lead apron and thyroid shields had to be worn.In addition, to reduce unnecessary scatter, there were two mobile 6 foot wide shields (1/16″ lead equivalent) available to protect personnel in the room and adjacent areas. Conclusion: Intraoperative CT provides the physician new opportunities for evaluation of the progression of surgical resections and device placement at the cost of increasing the amount of trained personnel required to perform this procedure. It also brings with it challenges to keep the radiation exposure to the patients and staff within reasonable limits.

60 APPLIED LIFE SCIENCES↗

SU-E-T-507: Internal Dosimetry in Nuclear Medicine Using GATE and XCAT Phantom: A Simulation Study

Purpose Monte Carlo simulations are routinely used for internal dosimetry studies. These studies are conducted with humanoid phantoms such as the XCAT phantom. In this abstract we present the absorbed doses for various pairs of source and target organs using three common radiotracers in nuclear medicine. Methods The GATE software package is used for the Monte Carlo simulations. A typical female XCAT phantom is used as the input. Three radiotracers 153Sm, 131I and 99mTc are studied. The Specific Absorbed Fraction (SAF) for gamma rays (99mTc, 153Sm and 131I) and Specific Fraction (SF) for beta particles (153Sm and 131I) are calculated for all 100 pairs of source target organs including brain, liver, lung, pancreas, kidney, adrenal, spleen, rib bone, bladder and ovaries. Results The source organs themselves gain the highest absorbed dose as compared to other organs. The dose is found to be inversely proportional to distance from the source organ. In SAF results of 153Sm, when the source organ is lung, the rib bone, gain 0.0730 (Kg-1) that is more than lung itself. Conclusion The absorbed dose for various organs was studied in terms of SAF and SF. Such studies hold importance for future therapeutic procedures and optimization of induced radiotracer.

60 APPLIED LIFE SCIENCES↗

On the reliability of microvariability tests in quasars

Microvariations probe the physics and internal structure of quasars. Unpredictability and small flux variations make this phenomenon elusive and difficult to detect. Variance-based probes such as the C and F tests, or a combination of both, are popular methods to compare the light curves of the quasar and a comparison star. Recently, detection claims in some studies have depended on the agreement of the results of the C and F tests, or of two instances of the F-test, for rejecting the non-variation null hypothesis. However, the C-test is a non-reliable statistical procedure, the F-test is not robust, and the combination of tests with concurrent results is anything but a straightforward methodology. A priori power analysis calculations and post hoc analysis of Monte Carlo simulations show excellent agreement for the analysis of variance test to detect microvariations as well as the limitations of the F-test. Additionally, the combined tests yield correlated probabilities that make the assessment of statistical significance unworkable. However, it is possible to include data from several field stars to enhance the power in a single F-test, increasing the reliability of the statistical analysis. This would be the preferred methodology when several comparison stars are available. An example using two stars and the enhanced F-test is presented. These results show the importance of using adequate methodologies and avoiding inappropriate procedures that can jeopardize microvariability detections. Power analysis and Monte Carlo simulations are useful tools for research planning, as they can demonstrate the robustness and reliability of different research approaches.

79 ASTRONOMY AND ASTROPHYSICS↗

Technical Note: Multipurpose CT, ultrasound, and MRI breast phantom for use in radiotherapy and minimally invasive interventions

Purpose: To develop a multipurpose gel-based breast phantom consisting of a simulated tumor with realistic imaging properties in CT, ultrasound and MRI, or a postsurgical cavity on CT. Applications for the phantom include: deformable image registration (DIR) quality assurance (QA), autosegmentation validation, and localization testing and training for minimally invasive image-guided procedures such as those involving catheter or needle insertion. Methods: A thermoplastic mask of a typical breast patient lying supine was generated and then filled to make an array of phantoms. The background simulated breast tissue consisted of 32.4 g each of ballistic gelatin (BG) powder and Metamusil™ (MM) dissolved in 800 ml of water. Simulated tumors were added using the following recipe: 12 g of barium sulfate (1.4% v/v) plus 0.000 14 g copper sulfate plus 0.7 g of MM plus 7.2 g of BG all dissolved in 75 ml of water. The phantom was evaluated quantitatively in CT by comparing Hounsfield units (HUs) with actual breast tissue. For ultrasound and MRI, the phantoms were assessed based on subjective image quality and signal-difference to noise (SDNR) ratio, respectively. The stiffness of the phantom was evaluated based on ultrasound elastography measurements to yield an average Young’s modulus. In addition, subjective tactile assessment of phantom was performed under needle insertion. Results: The simulated breast tissue had a mean background value of 24 HU on CT imaging, which more closely resembles fibroglandular tissue (40 HU) as opposed to adipose (−100 HU). The tumor had a mean CT number of 45 HU, which yielded a qualitatively realistic image contrast relative to the background either as an intact tumor or postsurgical cavity. The tumor appeared qualitatively realistic on ultrasound images, exhibiting hypoechoic characteristics compared to background. On MRI, the tumor exhibited a SDNR of 3.7. The average Young’s modulus was computed to be 15.8 ± 0.7 kPa (1 SD). Conclusions: We have developed a process to efficiently and inexpensively produce multipurpose breast phantoms containing simulated tumors visible on CT, ultrasound, and MRI. The phantoms have been evaluated for image quality and elasticity and can serve as a medium for DIR QA, autosegmentation QA, and training for minimally invasive procedures.

60 APPLIED LIFE SCIENCES↗

TU-H-CAMPUS-IeP3-02: Neurovascular 4D Parametric Imaging Using Co-Registration of Biplane DSA Sequences with 3D Vascular Geometry Obtained From Cone Beam CT

Purpose: To create 4D parametric images using biplane Digital Subtraction Angiography (DSA) sequences co-registered with the 3D vascular geometry obtained from Cone Beam-CT (CBCT). Methods: We investigated a method to derive multiple 4D Parametric Imaging (PI) maps using only one CBCT acquisition. During this procedure a 3D-DSA geometry is stored and used subsequently for all 4D images. Each time a biplane DSA is acquired, we calculate 2D parametric maps of Bolus Arrival Time (BAT), Mean Transit Time (MTT) and Time to Peak (TTP). Arterial segments which are nearly parallel with one of the biplane imaging planes in the 2D parametric maps are co-registered with the 3D geometry. The values in the remaining vascular network are found using spline interpolation since the points chosen for co-registration on the vasculature are discrete and remaining regions need to be interpolated. To evaluate the method we used a patient CT volume data set for 3D printing a neurovascular phantom containing a complete Circle of Willis. We connected the phantom to a flow loop with a peristaltic pump, simulating physiological flow conditions. Contrast media was injected with an automatic injector at 10 ml/sec. Images were acquired with a Toshiba Infinix C-arm and 4D parametric image maps of the vasculature were calculated. Results: 4D BAT, MTT, and TTP parametric image maps of the Circle of Willis were derived. We generated color-coded 3D geometries which avoided artifacts due to vessel overlap or foreshortening in the projection direction. Conclusion: The software was tested successfully and multiple 4D parametric images were obtained from biplane DSA sequences without the need to acquire additional 3D-DSA runs. This can benefit the patient by reducing the contrast media and the radiation dose normally associated with these procedures. Partial support from NIH Grant R01-EB002873 and Toshiba Medical Systems Corp.

60 APPLIED LIFE SCIENCES↗

Tracking the Magnetic Flux in and Around Sunspots

We have developed a procedure for tracking sunspots observed by the Helioseismic and Magnetic Imager on the Solar Dynamics Observatory and for making curvature-corrected space/time maps of the associated line-of-sight magnetic field and continuum intensity. We apply this procedure to 36 sunspots, each observed continuously for nine days around its central meridian passage time, and find that the proper motions separate into two distinct components depending on their speeds. Fast (∼3–5 km s{sup −1}) motions, comparable to Evershed flows, are produced by weak vertical fluctuations of the horizontal canopy field and recur on a timescale of 12–20 min. Slow (∼0.3–0.5 km s{sup −1}) motions diverge from a sunspot-centered ring whose location depends on the size of the sunspot, occurring in the mid-penumbra for large sunspots and at the outer edge of the penumbra for small sunspots. The slow ingoing features are contracting spokes of a quasi-vertical field of umbral polarity. These inflows disappear when the sunspot loses its penumbra, and may be related to inward-moving penumbral grain. The slow outgoing features may have either polarity depending on whether they originate from quasi-vertical fields of umbral polarity or from the outer edge of the canopy. When a sunspot decays, the penumbra and canopy disappear, and the moat becomes filled with slow outflows of umbral polarity. We apply our procedure to decaying sunspots, to long-lived sunspots, and to numerical simulations of a long-lived sunspot by Rempel.

79 ASTRONOMY AND ASTROPHYSICS↗

Radiation Exposure During Transarterial Chemoembolization: Angio-CT Versus Cone-Beam CT

Introduction: Cone-beam computed tomography (CBCT) has been developed to improve reliability of many interventional radiology (IR) procedures performed with Angio system, such as transarterial chemoembolization (TACE). Angio-CT has emerged as a new imaging technology that combines a CT scanner with an Angio system in the same IR suite. The purpose of our study was to compare Angio system with CBCT capability and Angio-CT in terms of patient radiation exposure during TACE procedures. Materials and Methods: Consecutive TACE procedures performed between January 2016 and September 2017 with the two imaging modalities (Artis Zeego defining the CBCT group and Infinix-i 4D-CT defining the Angio-CT group) were reviewed. TACE and patient’s characteristics and patient radiation exposure parameters were collected. Dose-area products (DAP) and dose-length products (DLP) were converted into effective doses (ED) using conversion factors. Accuracy of tumor targeting and response was retrospectively assessed. Results: A total of 114 TACE procedures in 96 patients were included with 57 procedures in each group. The total ED in the Angio-CT group was 2.5 times lower than that in the CBCT group (median 15.4 vs. 39.2 mSv, p < 0.001). Both 2D ED and 3D ED were lower in the Angio-CT group than in the CBCT group (5.1 vs. 20 mSv, p < 0.001, and 7.4 vs. 17.9 mSv, p < 0.001, respectively). There was no significant difference neither in terms of classes of tumor targeting (p = 0.509) nor in terms of classes of tumor response (p = 0.070) between both groups. Conclusion: Angio-CT provides significant decrease in patient effective dose during TACE procedures compared to Angio system with CBCT.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Fast computation algorithms for speckle pattern simulation

We present our development of a series of efficient computation algorithms, generally usable to calculate light diffraction and particularly for speckle pattern simulation. We use mainly the scalar diffraction theory in the form of Rayleigh-Sommerfeld diffraction formula and its Fresnel approximation. Our algorithms are based on a special form of the convolution theorem and the Fast Fourier Transform. They are able to evaluate the diffraction formula much faster than by direct computation and we have circumvented the restrictions regarding the relative sizes of the input and output domains, met on commonly used procedures. Moreover, the input and output planes can be tilted each to other and the output domain can be off-axis shifted.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

Image-based spectral distortion correction for photon-counting x-ray detectors

Purpose: To investigate the feasibility of using an image-based method to correct for distortions induced by various artifacts in the x-ray spectrum recorded with photon-counting detectors for their application in breast computed tomography (CT). Methods: The polyenergetic incident spectrum was simulated with the tungsten anode spectral model using the interpolating polynomials (TASMIP) code and carefully calibrated to match the x-ray tube in this study. Experiments were performed on a Cadmium-Zinc-Telluride (CZT) photon-counting detector with five energy thresholds. Energy bins were adjusted to evenly distribute the recorded counts above the noise floor. BR12 phantoms of various thicknesses were used for calibration. A nonlinear function was selected to fit the count correlation between the simulated and the measured spectra in the calibration process. To evaluate the proposed spectral distortion correction method, an empirical fitting derived from the calibration process was applied on the raw images recorded for polymethyl methacrylate (PMMA) phantoms of 8.7, 48.8, and 100.0 mm. Both the corrected counts and the effective attenuation coefficient were compared to the simulated values for each of the five energy bins. The feasibility of applying the proposed method to quantitative material decomposition was tested using a dual-energy imaging technique with a three-material phantom that consisted of water, lipid, and protein. The performance of the spectral distortion correction method was quantified using the relative root-mean-square (RMS) error with respect to the expected values from simulations or areal analysis of the decomposition phantom. Results: The implementation of the proposed method reduced the relative RMS error of the output counts in the five energy bins with respect to the simulated incident counts from 23.0%, 33.0%, and 54.0% to 1.2%, 1.8%, and 7.7% for 8.7, 48.8, and 100.0 mm PMMA phantoms, respectively. The accuracy of the effective attenuation coefficient of PMMA estimate was also improved with the proposed spectral distortion correction. Finally, the relative RMS error of water, lipid, and protein decompositions in dual-energy imaging was significantly reduced from 53.4% to 6.8% after correction was applied. Conclusions: The study demonstrated that dramatic distortions in the recorded raw image yielded from a photon-counting detector could be expected, which presents great challenges for applying the quantitative material decomposition method in spectral CT. The proposed semi-empirical correction method can effectively reduce these errors caused by various artifacts, including pulse pileup and charge sharing effects. Furthermore, rather than detector-specific simulation packages, the method requires a relatively simple calibration process and knowledge about the incident spectrum. Therefore, it may be used as a generalized procedure for the spectral distortion correction of different photon-counting detectors in clinical breast CT systems.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Sensitivity of the diagnostic radiological index of protection to procedural factors in fluoroscopy

Purpose: To evaluate the sensitivity of the diagnostic radiological index of protection (DRIP), used to quantify the protective value of radioprotective garments, to procedural factors in fluoroscopy in an effort to determine an appropriate set of scatter-mimicking primary beams to be used in measuring the DRIP. Methods: Monte Carlo simulations were performed to determine the shape of the scattered x-ray spectra incident on the operator in different clinical fluoroscopy scenarios, including interventional radiology and interventional cardiology (IC). Two clinical simulations studied the sensitivity of the scattered spectrum to gantry angle and patient size, while technical factors were varied according to measured automatic dose rate control (ADRC) data. Factorial simulations studied the sensitivity of the scattered spectrum to gantry angle, field of view, patient size, and beam quality for constant technical factors. Average energy (E{sub avg}) was the figure of merit used to condense fluence in each energy bin to a single numerical index. Results: Beam quality had the strongest influence on the scattered spectrum in fluoroscopy. Many procedural factors affect the scattered spectrum indirectly through their effect on primary beam quality through ADRC, e.g., gantry angle and patient size. Lateral C-arm rotation, common in IC, increased the energy of the scattered spectrum, regardless of the direction of rotation. The effect of patient size on scattered radiation depended on ADRC characteristics, patient size, and procedure type. Conclusions: The scattered spectrum striking the operator in fluoroscopy is most strongly influenced by primary beam quality, particularly kV. Use cases for protective garments should be classified by typical procedural primary beam qualities, which are governed by the ADRC according to the impacts of patient size, anatomical location, and gantry angle.

60 APPLIED LIFE SCIENCES↗

Features of the application of the Monte Carlo method to calculations for large RBMK reactors and to model correction on the basis of data from in-core detectors

Statistical errors in sampling neutron fields in physically large systems like an RBMK are analyzed both qualitatively and quantitatively. Recommendations concerning the choice of parameters for calculations are given. A new procedure for Monte Carlo RBMK calculations with model corrections on the basis of data from in-core detectors is proposed. Dedicated software based on the CUDA software and hardware platform is developed for computational research. Results of testing the procedure and software in question via calculations for real RBMK reactors are discussed.

74 ATOMIC AND MOLECULAR PHYSICS↗

The Initial Development of a Computerized Operator Support System

A computerized operator support system (COSS) is a collection of resilient software technologies to assist operators in monitoring overall nuclear power plant performance and making timely, informed decisions on appropriate control actions for the projected plant condition. The COSS provides rapid assessments, computations, and recommendations to reduce workload and augment operator judgment and decision-making during fast- moving, complex events. A prototype COSS for a chemical volume control system at a nuclear power plant has been developed in order to demonstrate the concept and provide a test bed for further research. The development process identified four underlying elements necessary for the prototype, which consist of a digital alarm system, computer-based procedures, piping and instrumentation diagram system representations, and a recommender module for mitigation actions. An operational prototype resides at the Idaho National Laboratory (INL) using the U.S. Department of Energy’s (DOE) Light Water Reactor Sustainability (LWRS) Human Systems Simulation Laboratory (HSSL). Several human-machine interface (HMI) considerations are identified and incorporated in the prototype during this initial round of development.

99 GENERAL AND MISCELLANEOUS↗