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DOE OSTI2021

Privacy-Preserving Knowledge Transfer with Bootstrap Aggregation of Teacher Ensembles

There is a need to transfer knowledge among institutions and organizations to save effort in annotation and labeling or in enhancing task performance. However, knowledge transfer is difficult because of restrictions that are in place to ensure data security and privacy. Institutions are not allowed to exchange data or perform any activity that may expose personal information. With the leverage of a differential privacy algorithm in a high-performance computing environment, we propose a new training protocol, Bootstrap Aggregation of Teacher Ensembles (BATE), which is applicable to various types of machine learning models. The BATE algorithm is based on and provides enhancements to the PATE algorithm, maintaining competitive task performance scores on complex datasets with underrepresented class labels.We conducted a proof-of-the-concept study of the information extraction from cancer pathology report data from four cancer registries and performed comparisons between four scenarios: no collaboration, no privacy-preserving collaboration, the PATE algorithm, and the proposed BATE algorithm. The results showed that the BATE algorithm maintained competitive macro-averaged F1 scores, demonstrating that the suggested algorithm is an effective yet privacy-preserving method for machine learning and deep learning solutions.

Yoon, Hong-Jun↗

DOE OSTI2016

Investigating the Relationship between Need for Cognition and Skill in Ethical Hackers

As technology gets more complex and increasingly connected, there is an increasing concern with cyber security. There is also a growing demand for cyber security professionals. Unfortunately there currently are not enough skilled professionals to meet that demand. In order to prepare the next generation of cyber security professionals to meet this demand, we need to understand what characteristics make skilled cyber security professionals. For this work, we focus on professionals who take an offensive approach to cyber security, so called ethical hackers. These hackers utilize many of the same skills that the adversaries that we defend against would use, with the goal of identifying vulnerabilities and address them before they are exploited by adversaries. A commonly held belief among ethical hackers is that hackers must possess exceptional curiosity and problem solving skills in order to be successful. Curiosity is has been studied extensively in psychology, but there is no consensus on what it is and how to measure it. Further, many existing inventories for assessing curiosity are targeted at measuring curiosity in children. Although there isn’t an accepted standard to assess curiosity in adults, a related construct, called Need for Cognition (may capture what is meant when people speak of curiosity. The Need for Cognition scale also captures the tendency toward preferring complex problems (which correlates with good problem solving skills), which may provide insight into what make skilled hackers. In addition to the Need for Cognition, we used a structured interview to assess hacker skill. Hackers rated their own skill on a scale from one to ten on a predefined list of hacker skills. They were then asked to rate a peer who they felt was most skilled in each of the skills. They were asked to rate two peers for each skill, one that they worked with directly and one person that was the most skilled in the field (these could be known by reputation only). The hypothesis is that hackers have a higher than average (i.e., compared to non-hackers) Need for cognition and that Need for Cognition will be positively correlated with self-reported and peer reported skill. We interviewed 20 cyber security researchers who specialize in offensive approaches. Based on the responses to the hacker skill inventory, we generated a self-reported skill score for each participant. We also developed a peer-rating for each participant based on the number of times each individual that was interviewed was named as the most skilled in a particular area. The results indicate that the sample of ethical hackers has a high Need for Cognition and that Need for cognition was related to both self-reported skill and peer-reported skill. The results are discussed in the context of training and recruitment of cyber security professionals.

99 GENERAL AND MISCELLANEOUS↗

DOE OSTI2016

Using Social Media to Measure Student Wellbeing: A Large-Scale Study of Emotional Response in Academic Discourse

Student resilience and emotional well-being are essential for both academic and social development. Earlier studies on tracking students' happiness in academia showed that many of them struggle with mental health issues. For example, a 2015 study at the University of California Berkeley found that 47% of graduate students suffer from depression, following a 2005 study that showed 10% had considered suicide. This is the first large-scale study that uses signals from social media to evaluate students' emotional well-being in academia. This work presents fine-grained emotion and opinion analysis of 79,329 tweets produced by students from 44 universities. The goal of this study is to qualitatively evaluate and compare emotions and sentiments emanating from students' communications across different academic discourse types and across universities in the U.S. We first build novel predictive models to categorize academic discourse types generated by students into personal, social, and general categories. We then apply emotion and sentiment classification models to annotate each tweet with six Ekman's emotions -- joy, fear, sadness, disgust, anger, and surprise and three opinion types -- positive, negative, and neutral. We found that emotions and opinions expressed by students vary across discourse types and universities, and correlate with survey-based data on student satisfaction, happiness and stress. Moreover, our results provide novel insights on how students use social media to share academic information, emotions, and opinions that would pertain to students academic performance and emotional well-being.

academic discourse↗

DOE OSTI2017

A First-Order Estimate of Automated Mobility District Fuel Consumption and GHG Emission Impacts

A first of its kind, this study develops a framework to quantify the fuel consumption and greenhouse gas emission impacts of an Automated Small Vehicle Transit system on a campus area. The results show that the automated mobility district system has the potential to reduce transportation system fuel consumption and greenhouse gas emissions, but the benefits are largely dependent on the operation and ridership of the personal rapid transit system. Our study calls for more research to understand the energy and environmental benefits of such a system.

33 ADVANCED PROPULSION SYSTEMS↗

DOE OSTI2013

Expanding Human Cognition and Communication

To be able to chart the most profitable future directions for societal transformation and corresponding scientific research, five multidisciplinary themes focused on major goals have been identified to fulfill the overall motivating vision of convergence described in the previous pages. The first, “Expanding Human Cognition and Communication,” is devoted to technological breakthroughs that have the potential to enhance individuals’ mental and interaction abilities. Throughout the twentieth century, a number of purely psychological techniques were offered for strengthening human character and personality, but evaluation research has generally failed to confirm the alleged benefits of these methods (Druckman and Bjork 1992; 1994). Today, there is good reason to believe that a combination of methods, drawing upon varied branches of converging science and technology, would be more effective than attempts that rely upon mental training alone.

Spohrer, Jim↗

DOE OSTI2019

Prevalence of Eight Phthalate Monoesters in Water from the Okavango Delta, Northern Botswana

Phthalate diesters are used in personal care products, plastics, and pesticides, resulting in widespread human and wildlife exposure. Phthalate diesters leach out of these products and ultimately enter biological systems where they are quickly metabolized to phthalate monoesters and glucuronides. As such, phthalate monoesters can serve as indicators of anthropogenic activity in wilderness areas. The Okavango Delta, an inland seasonal wetland covering 5000–12,000 km{sup 2} in Botswana, provides fresh water to many species of birds, fish, reptiles, and large mammals. Water samples (N = 46) were taken from across the Okavango water system, extracted, and analyzed for eight different phthalate monoesters using liquid chromatography and isotope dilution mass spectrometry. Seven of eight phthalate monoesters were detected from the low ng/L to low µg/L levels. Phthalate monoesters were found in samples from all five sampling regions. Sources of these contaminants are unknown, but their presence indicates encroachment of human activity on the Okavango Delta.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2016

Stochastic Games for Continuous-Time Jump Processes Under Finite-Horizon Payoff Criterion

In this paper we study two-person nonzero-sum games for continuous-time jump processes with the randomized history-dependent strategies under the finite-horizon payoff criterion. The state space is countable, and the transition rates and payoff functions are allowed to be unbounded from above and from below. Under the suitable conditions, we introduce a new topology for the set of all randomized Markov multi-strategies and establish its compactness and metrizability. Then by constructing the approximating sequences of the transition rates and payoff functions, we show that the optimal value function for each player is a unique solution to the corresponding optimality equation and obtain the existence of a randomized Markov Nash equilibrium. Furthermore, we illustrate the applications of our main results with a controlled birth and death system.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

DOE OSTI2020

The impact of demographic, clinical, genetic, and imaging variables on tau PET status

Purpose: A substantial proportion of amyloid-β (Aβ)+ patients with clinically diagnosed Alzheimer’s disease (AD) dementia and mild cognitive impairment (MCI) are tau PET–negative, while some clinically diagnosed non-AD neurodegenerative disorder (non-AD) patients or cognitively unimpaired (CU) subjects are tau PET–positive. We investigated which demographic, clinical, genetic, and imaging variables contributed to tau PET status. Methods: We included 2338 participants (430 Aβ+ AD dementia, 381 Aβ+ MCI, 370 non-AD, and 1157 CU) who underwent [ 18 F]flortaucipir ( n = 1944) or [ 18 F]RO948 ( n = 719) PET. Tau PET positivity was determined in the entorhinal cortex, temporal meta-ROI, and Braak V-VI regions using previously established cutoffs. We performed bivariate binary logistic regression models with tau PET status (positive/negative) as dependent variable and age, sex, APOE ε4, Aβ status (only in CU and non-AD analyses), MMSE, global white matter hyperintensities (WMH), and AD-signature cortical thickness as predictors. Additionally, we performed multivariable binary logistic regression models to account for all other predictors in the same model. Results: Tau PET positivity in the temporal meta-ROI was 88.6% for AD dementia, 46.5% for MCI, 9.5% for non-AD, and 6.1% for CU. Among Aβ+ participants with AD dementia and MCI, lower age, MMSE score, and AD-signature cortical thickness showed the strongest associations with tau PET positivity. In non-AD and CU participants, presence of Aβ was the strongest predictor of a positive tau PET scan. Conclusion: We identified several demographic, clinical, and neurobiological factors that are important to explain the variance in tau PET retention observed across the AD pathological continuum, non-AD neurodegenerative disorders, and cognitively unimpaired persons.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2019

Association between CT-texture-derived tumor heterogeneity, outcomes, and BRCA mutation status in patients with high-grade serous ovarian cancer

Purpose: To assess the associations between inter-site texture heterogeneity parameters derived from computed tomography (CT), survival, and BRCA mutation status in women with high-grade serous ovarian cancer (HGSOC). Materials and methods: Retrospective study of 88 HGSOC patients undergoing CT and BRCA mutation status testing prior to primary cytoreductive surgery. Associations between texture metrics—namely inter-site cluster variance (SCV), inter-site cluster prominence (SCP), inter-site cluster entropy (SE)—and overall survival (OS), progression-free survival (PFS) as well as BRCA mutation status were assessed. Results: Higher inter-site cluster variance (SCV) was associated with lower PFS (p = 0.006) and OS (p = 0.003). Higher inter-site cluster prominence (SCP) was associated with lower PFS (p = 0.02) and higher inter-site cluster entropy (SE) correlated with lower OS (p = 0.01). Higher values of all three metrics were significantly associated with lower complete surgical resection status in BRCA-negative patients (SE p = 0.039, SCV p = 0.006, SCP p = 0.02), but not in BRCA-positive patients (SE p = 0.7, SCV p = 0.91, SCP p = 0.67). None of the metrics were able to distinguish between BRCA mutation carrier and non-mutation carrier. Conclusion: The assessment of tumoral heterogeneity in the era of personalized medicine is important, as increased heterogeneity has been associated with distinct genomic abnormalities and worse patient outcomes. A radiomics approach using standard-of-care CT scans might have a clinical impact by offering a non-invasive tool to predict outcome and therefore improving treatment effectiveness. However, it was not able to assess BRCA mutation status in women with HGSOC.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2019

Radiomics-based prediction of microsatellite instability in colorectal cancer at initial computed tomography evaluation

Purpose: To predict microsatellite instability (MSI) status of colon cancer on preoperative CT imaging using radiomic analysis. Methods: This retrospective study involved radiomic analysis of preoperative CT imaging of patients who underwent resection of stage II–III colon cancer from 2004 to 2012. A radiologist blinded to MSI status manually segmented the tumor region on CT images. 254 Intensity-based radiomic features were extracted from the tumor region. Three prediction models were developed with (1) only clinical features, (2) only radiomic features, and (3) “combined” clinical and radiomic features. Patients were randomly separated into training (n = 139) and test (n = 59) sets. The model was constructed from training data only; the test set was reserved for validation only. Model performance was evaluated using AUC, sensitivity, specificity, PPV, and NPV. Results: Of the total 198 patients, 134 (68%) patients had microsatellite stable tumors and 64 (32%) patients had MSI tumors. The combined model performed slightly better than the other models, predicting MSI with an AUC of 0.80 for the training set and 0.79 for the test set (specificity = 96.8% and 92.5%, respectively), whereas the model with only clinical features achieved an AUC of 0.74 and the model with only radiomic features achieved an AUC of 0.76. The model with clinical features alone had the lowest specificity (70%) compared with the model with radiomic features alone (95%) and the combined model (92.5%). Conclusions: Preoperative prediction of MSI status via radiomic analysis of preoperative CT adds specificity to clinical assessment and could contribute to personalized treatment selection.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2025

Cohort-based pan-cancer analysis and experimental studies reveal ISG15 gene as a novel biomarker for prognosis and immunotherapy efficacy prediction

Abstract ISG15, an interferon-stimulated ubiquitin-like protein, plays a multifaceted role in tumorigenesis and immune regulation. This study comprehensively evaluates ISG15 as a prognostic biomarker and predictor of immunotherapy response through pan-cancer bioinformatics analysis and experimental validation. By integrating multiomics data from TCGA, GEO, and clinical cohorts, we found that ISG15 is significantly overexpressed in multiple cancers and generally correlates with poor prognosis. Elevated ISG15 expression is associated with increased immune checkpoint gene expression, particularly PD-L1, and immune infiltration, notably M2-like tumor-associated macrophages. Immunohistochemistry and multiplexed immunofluorescence confirmed a strong positive correlation between ISG15, PD-L1, and M2-TAM infiltration in lung and gastric cancer samples. Functional analysis at the single-cell level revealed significant associations between ISG15 and tumor proliferation, angiogenesis, and immune suppression. Immunotherapy cohort analysis demonstrated that tumors with high ISG15 expression responded favorably to PD-L1 inhibitors but exhibited resistance to CTLA-4 blockade, findings further validated in lung cancer patients receiving anti-PD-1 therapy. These results suggest that ISG15 is a promising biomarker for prognosis and immunotherapy response prediction across cancers. Its integration into clinical decision-making may enhance personalized treatment strategies, improve immunotherapy outcomes, and provide new insights into the tumor immune microenvironment, cancer progression, and potential therapeutic targets for future drug development.

Immunology↗

DOE OSTI2012

Multimodality Image Fusion-Guided Procedures: Technique, Accuracy, and Applications

Personalized therapies play an increasingly critical role in cancer care: Image guidance with multimodality image fusion facilitates the targeting of specific tissue for tissue characterization and plays a role in drug discovery and optimization of tailored therapies. Positron-emission tomography (PET), magnetic resonance imaging (MRI), and contrast-enhanced computed tomography (CT) may offer additional information not otherwise available to the operator during minimally invasive image-guided procedures, such as biopsy and ablation. With use of multimodality image fusion for image-guided interventions, navigation with advanced modalities does not require the physical presence of the PET, MRI, or CT imaging system. Several commercially available methods of image-fusion and device navigation are reviewed along with an explanation of common tracking hardware and software. An overview of current clinical applications for multimodality navigation is provided.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2013

MR-Guided High-Intensity Focused Ultrasound: Current Status of an Emerging Technology

The concept of ideal tumor surgery is to remove the neoplastic tissue without damaging adjacent normal structures. High-intensity focused ultrasound (HIFU) was developed in the 1940s as a viable thermal tissue ablation approach. In clinical practice, HIFU has been applied to treat a variety of solid benign and malignant lesions, including pancreas, liver, prostate, and breast carcinomas, soft tissue sarcomas, and uterine fibroids. More recently, magnetic resonance guidance has been applied for treatment monitoring during focused ultrasound procedures (magnetic resonance-guided focused ultrasound, MRgFUS). Intraoperative magnetic resonance imaging provides the best possible tumor extension and dynamic control of energy deposition using real-time magnetic resonance imaging thermometry. We introduce the fundamental principles and clinical indications of the MRgFUS technique; we also report different treatment options and personal outcomes.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2015

Social and Demographic Factors Influencing Inferior Vena Cava Filter Retrieval at a Single Institution in the United States

PurposeRetrievable inferior vena cava filters (IVCFs) are associated with long-term adverse events that have increased interest in improving filter retrieval rates. Determining the influential patient social and demographic factors affecting IVCF retrieval is important to personalize patient management strategies and attain optimal patient care.Materials and MethodsSeven-hundred and sixty-two patients were retrospectively studied who had a filter placed at our institution between January 2011 and November 2013. Age, gender, race, cancer history, distance to residence from retrieval institution, and insurance status were identified for each patient, and those receiving retrievable IVCFs were further evaluated for retrieval rate and time to retrieval.ResultsOf the 762 filters placed, 133 were permanent filters. Of the 629 retrievable filters placed, 406 met the inclusion criteria and were eligible for retrieval. Results revealed patients with Medicare were less likely to have their filters retrieved (p = 0.031). Older age was also associated with a lower likelihood of retrieval (p < 0.001) as was living further from the medical center (p = 0.027). Patients who were white and had Medicare were more likely than similarly insured black patients to have their filters retrieved (p = 0.024).ConclusionsThe retrieval rate of IVCFs was most influenced by insurance status, distance from the medical center, and age. Race was statistically significant only when combined with insurance status. The results of this study suggest that these patient groups may need closer follow-up in order to obtain optimal IVCF retrieval rates.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2017

Peripheral Stent Thrombosis Leading to Acute Limb Ischemia and Major Amputation: Incidence and Risk Factors in the Aortoiliac and Femoropopliteal Arteries

PurposeTo report the real-world incidence and risk factors of stent thrombosis in the aortoiliac and femoropopliteal arteries in case of bare nitinol stent (BNS) or covered nitinol stent (CNS) placement from a single-centre retrospective audit.Materials and MethodsMedical records of consecutive patients treated with peripheral stent placement for claudication or critical limb ischemia were audited for definite stent thrombosis defined as imaging confirmed stent thrombosis that presented as acute limb-threatening ischemia. Cases were stratified between aortoiliac and femoropopliteal anatomy. Cox regression analysis was employed to adjust for baseline clinical and procedural confounders and identify predictors of stent thrombosis and major limb loss.Results256 patients (n = 277 limbs) were analysed over a 5-year period (2009–2014) including 117 aortoiliac stents (34 CNS; 12.8 ± 5.0 cm and 83 BNS; 7.8 ± 4.0 cm) and 160 femoropopliteal ones (60 CNS; 21.1 ± 11.0 cm and 100 BNS; 17.5 ± 11.9 cm). Median follow-up was 1 year. Overall stent thrombosis rate was 6.1% (17/277) after a median of 43 days (range 2–192 days) and affected almost exclusively the femoropopliteal segment (12/60 in the CNS cohort vs. 4/100 in the BNS; p = 0.001). Annualized stent thrombosis rates (per 100 person-years) were 12.5% in case of CNS and 1.4% in case of BNS (HR 6.3, 95% CI 2.4–17.9; p = 0.0002). Corresponding major amputations rates were 8.7 and 2.5%, respectively (HR 4.5, 95% CI 2.7–27.9; p = 0.0006). On multivariable analysis, critical leg ischemia and CNS placement were the only predictors of stent thrombosis. Diabetes, critical leg ischemia, femoropopliteal anatomy, long stents and CNS were independent predictors of major amputations.ConclusionsPlacement of long femoropopliteal covered nitinol stents is associated with an increased incidence of acute stent thrombosis and ensuing major amputation. Risks are significantly lower in the aortoiliac vessels and with use of bare nitinol stents.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2017

Real-Time Patient and Staff Radiation Dose Monitoring in IR Practice

PurposeKnowledge of medical radiation exposure permits application of radiation protection principles. In our center, the first dedicated real-time, automated patient and staff dose monitoring system (DoseWise Portal, Philips Healthcare) was installed. Aim of this study was to obtain insight in the procedural and occupational doses.Materials and MethodsAll interventional radiologists, vascular surgeons, and technicians wore personal dose meters (PDMs, DoseAware, Philips Healthcare). The dose monitoring system simultaneously registered for each procedure dose-related data as the dose area product (DAP) and effective staff dose (E) from PDMs. Use and type of shielding were recorded separately. All procedures were analyzed according to procedure type; these included among others cerebral interventions (n = 112), iliac and/or caval venous recanalization procedures (n = 68), endovascular aortic repair procedures (n = 63), biliary duct interventions (n = 58), and percutaneous gastrostomy procedure (n = 28).ResultsMedian (±IQR) DAP doses ranged from 2.0 (0.8–3.1) (percutaneous gastrostomy) to 84 (53–147) Gy cm{sup 2} (aortic repair procedures). Median (±IQR) first operator doses ranged from 1.6 (1.1–5.0) μSv to 33.4 (12.1–125.0) for these procedures, respectively. The relative exposure, determined as first operator dose normalized to procedural DAP, ranged from 1.9 in biliary interventions to 0.1 μSv/Gy cm{sup 2} in cerebral interventions, indicating large variation in staff dose per unit DAP among the procedure types.ConclusionReal-time dose monitoring was able to identify the types of interventions with either an absolute or relatively high staff dose, and may allow for specific optimization of radiation protection.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2017

Anesthesia Practices for Interventional Radiology in Europe

PurposeThe Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe.MethodsAnonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology.ResultsPredictable differences between countries and national regulations were confirmed, showing how significantly many “local” factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care.ConclusionSignificant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2018

Radiation Doses to Operators in Hepatobiliary Interventional Procedures

PurposeThe primary aim of this study is to provide a summary of operators’ radiation doses during hepatobiliary fluoroscopic guided procedures. In addition, patient dose in these procedures was also documented.Materials and MethodsA total of 283 transarterial chemoembolisation (TACE) and 302 biliary procedures, including 52 percutaneous transhepatic cholangiogram (PTC), 36 bilioplasty and 214 biliary catheter changes (BCC) performed over 14 months, were included. Electronic personal dosimeters were used to measure operator radiation doses. Effective dose (E) was calculated using modified Niklason algorithm. Patient dose was measured as dose area product (DAP) and fluoroscopy time (FT).ResultsFor TACE, E for radiologist ranged between 0 and 9.96 µSv, for radiographer 0–0.99 µSv and for nurse 0–4.65 µSv. The patient DAP and FT ranged between 1.5 and 421.9 Gy cm{sup 2} and 1.91–67.25 min. For PTC, E for the radiologist ranged between 0.33 and 55.89 µSv, for radiographer 0–38.61 µSv and for nurse 0–3.18 µSv. Patient DAP and FT ranged between 1.7 and 218.4 Gy cm{sup 2} and 2.07–71.53 min. For bilioplasty, E ranged between 0.09 and 9.24 µSv for radiologist, 0–0.84 µSv for radiographer and 0–1.38 µSv for nurse. The patients’ DAP and FT ranged from 0.7 to 52.54 Gy cm{sup 2} and 1.13–24.47 min. For BCC, E ranged from 0 to 12.78 µSv for radiologist, 0–8.43 µSv for radiographer and 0–4.05 µSv for nurse. Patient DAP and FT ranged between 0.12 and 117.3 Gy cm{sup 2} and 0.57–15.83 min.ConclusionsThis study shows that doses to all operators performing hepatobiliary interventional procedures can be very low.

62 RADIOLOGY AND NUCLEAR MEDICINE↗