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At least 1,495 records · Page 83

Long-term Changes in Pulmonary Function After Incidental Lung Irradiation for Breast Cancer: A Prospective Study With 7-Year Follow-up

Purpose: To evaluate late pulmonary function changes after incidental pulmonary irradiation for breast cancer. Methods and Materials: Forty-three consecutive female patients diagnosed with breast carcinoma and treated with postoperative radiation therapy (RT) at the same dose (50 Gy) and fractionation (2 Gy/fraction, 5 days/week) were enrolled. Pulmonary function tests (PFT) and ventilation/perfusion scans were performed before RT and 6, 12, 24, and 84 months afterward. Results: Forty-one patients, mean age 55 years, were eligible for the analysis. No differences were found in the baseline PFT values for age, smoking status and previous chemotherapy; women undergoing mastectomy showed baseline spirometric PFT values lower than did women treated with conservative surgery. The mean pulmonary dose was 10.9 Gy, being higher in women who also received lymph node RT (15.8 vs 8.6, P<.01). Only 1 patient experienced symptomatic pneumonitis. All PFT values showed a reduction at 6 months. From then on, the forced vital capacity and forced expiratory volume in 1 second began their recovery until reaching, and even exceeding, their baseline values at 7 years. Diffusing capacity of the lungs for carbon monoxide and ventilation/perfusion scans continued to reduce for 24 months and then partially recovered their baseline values (-3.5%, -3.8%, and -5.5%, respectively). Only the percentage difference at 7 years in the ventilation scan correlated with the dosimetric parameters studied. Other variables, such as age, smoking status, previous chemotherapy, and concomitant tamoxifen showed no significant relation with changes in PFT ({Delta}PFT) values at 7 years. Conclusions: The study of reproducible subclinical parameters, such as PFT values, shows how their figures decrease in the first 2 years but practically recover their baseline values in the long term. The extent of the reduction in PFT values was small, and there was no clear association with several dosimetric and clinical parameters.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Health-Related Quality of Life in Elderly Patients With Newly Diagnosed Glioblastoma Treated With Short-Course Radiation Therapy Plus Concomitant and Adjuvant Temozolomide

Purpose: To describe the quality of life (QOL) in elderly patients with glioblastoma (GBM) treated with an abbreviated course of radiation therapy (RT; 40 Gy in 15 fractions) plus concomitant and adjuvant temozolomide (TMZ). Methods and Materials: Health-related QOL (HRQOL) was assessed by European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30, version 3) and EORTC Quality of Life Questionnaire Brain Cancer Module (QLQ-BN20). Changes from baseline in the score of 9 preselected domains (global QLQ, social functioning, cognitive functioning, emotional functioning, physical functioning, motor dysfunction, communication deficit, fatigue, insomnia) were determined 4 weeks after RT and thereafter every 8 weeks during the treatment until disease progression. The proportion of patients with improved HRQOL scores, defined as a change of 10 points or more, and duration of changes were recorded. Results: Sixty-five patients completed the questionnaires at baseline. The treatment was consistently associated with improvement or stability in most of the preselected HRQOL domains. Global health improved over time; mean score differed by 9.6 points between baseline and 6-month follow-up (P=.03). For social functioning and cognitive functioning, mean scores improved over time, with a maximum difference of 10.4 points and 9.5 points between baseline and 6-month follow-up (P=.01 and P=.02), respectively. By contrast, fatigue worsened over time, with a difference in mean score of 5.6 points between baseline and 4-month follow-up (P=.02). Conclusions: A short course of RT in combination with TMZ in elderly patients with GBM was associated with survival benefit without a negative effect on HRQOL until the time of disease progression.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Impact of Dose to the Bladder Trigone on Long-Term Urinary Function After High-Dose Intensity Modulated Radiation Therapy for Localized Prostate Cancer

Purpose: To determine the potential association between genitourinary (GU) toxicity and planning dose–volume parameters for GU pelvic structures after high-dose intensity modulated radiation therapy in localized prostate cancer patients. Methods and Materials: A total of 268 patients who underwent intensity modulated radiation therapy to a prescribed dose of 86.4 Gy in 48 fractions during June 2004-December 2008 were evaluated with the International Prostate Symptom Score (IPSS) questionnaire. Dose–volume histograms of the whole bladder, bladder wall, urethra, and bladder trigone were analyzed. The primary endpoint for GU toxicity was an IPSS sum increase ≥10 points over baseline. Univariate and multivariate analyses were done by the Kaplan-Meier method and Cox proportional hazard models, respectively. Results: Median follow-up was 5 years (range, 3-7.7 years). Thirty-nine patients experienced an IPSS sum increase ≥10 during follow-up; 84% remained event free at 5 years. After univariate analysis, lower baseline IPSS sum (P=.006), the V90 of the trigone (P=.006), and the maximal dose to the trigone (P=.003) were significantly associated with an IPSS sum increase ≥10. After multivariate analysis, lower baseline IPSS sum (P=.009) and increased maximal dose to the trigone (P=.005) remained significantly associated. Seventy-two patients had both a lower baseline IPSS sum and a higher maximal dose to the trigone and were defined as high risk, and 68 patients had both a higher baseline IPSS sum and a lower maximal dose to the trigone and were defined as low risk for development of an IPSS sum increase ≥10. Twenty-one of 72 high-risk patients (29%) and 5 of 68 low-risk patients (7%) experienced an IPSS sum increase ≥10 (P=.001; odds ratio 5.19). Conclusions: The application of hot spots to the bladder trigone was significantly associated with relevant changes in IPSS during follow-up. Reduction of radiation dose to the lower bladder and specifically the bladder trigone seems to be associated with a reduction in late GU toxicity.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Quality of Life in a Prospective, Multicenter Phase 2 Trial of Neoadjuvant Full-Dose Gemcitabine, Oxaliplatin, and Radiation in Patients With Resectable or Borderline Resectable Pancreatic Adenocarcinoma

Purpose: To determine the health-related quality of life (QOL) during and after neoadjuvant chemoradiation therapy and surgery for patients with pancreatic adenocarcinoma. Methods and Materials: Participants of a prospective, phase 2 multi-institutional trial treated with neoadjuvant chemoradiation followed by surgery completed QOL questionnaires (European Organization for Research and Treatment in Cancer Quality of Life Questionnaire version 3.0 [EORTC-QLQ C30], EORTC-Pancreatic Cancer module [EORTC-PAN 26], and Functional Assessment of Cancer Therapy Hepatobiliary and Pancreatic subscale [FACT-Hep]) at baseline, after 2 cycles of neoadjuvant therapy, after surgery, at 6 months from initiation of therapy, and at 6-month intervals for 2 years. Mean scores were compared with baseline. A change >10% was considered a minimal clinically important difference. Results: Of 71 participants in the trial, 55 were eligible for QOL analysis. Compliance ranged from 32% to 74%. The EORTC-QLQ C30 global QOL did not significantly decline after neoadjuvant therapy, whereas the Functional Assessment of Cancer Therapy global health measure showed a statistically, but not clinically significant decline (−8, P=.02). This was in parallel with deterioration in physical functioning (−14.1, P=.001), increase in diarrhea (+16.7, P=.044), and an improvement in pancreatic pain (−13, P=.01) as per EORTC-PAN 26. Because of poor patient compliance in the nonsurgical group, long-term analysis was performed only from surgically resected participants (n=36). Among those, global QOL returned to baseline levels after 6 months, remaining near baseline through the 24-month visit. Conclusions: The study regimen consisting of 2 cycles of neoadjuvant therapy was completed without a clinically significant QOL deterioration. A transient increase in gastrointestinal symptoms and a decrease in physical functioning were seen after neoadjuvant chemoradiation. In those patients who underwent surgical resection, most domains returned back to baseline levels by 6 months.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Predictors of Liver Toxicity Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

Purpose: To identify risk factors associated with a decline in liver function after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma. Methods and Materials: Data were analyzed from patients with hepatocellular carcinoma treated on clinical trials of 6-fraction SBRT. Liver toxicity was defined as an increase in Child-Pugh (CP) score ≥2 three months after SBRT. Clinical factors, SBRT details, and liver dose-volume histogram (DVH) parameters were tested for association with toxicity using logistic regression. CP class B patients were analyzed separately. Results: Among CP class A patients, 101 were evaluable, with a baseline score of A5 (72%) or A6 (28%). Fifty-three percent had portal vein thrombus. The median liver volume was 1286 cc (range, 766-3967 cc), and the median prescribed dose was 36 Gy (range, 27-54 Gy). Toxicity was seen in 26 patients (26%). Thrombus, baseline CP of A6, and lower platelet count were associated with toxicity on univariate analysis, as were several liver DVH-based parameters. Absolute and spared liver volumes were not significant. On multivariate analysis for CP class A patients, significant associations were found for baseline CP score of A6 (odds ratio [OR], 4.85), lower platelet count (OR, 0.90; median, 108 × 10{sup 9}/L vs 150 × 10{sup 9}/L), higher mean liver dose (OR, 1.33; median, 16.9 Gy vs 14.7 Gy), and higher dose to 800 cc of liver (OR, 1.11; median, 14.3 Gy vs 6.0 Gy). With 13 CP-B7 patients included or when dose to 800 cc of liver was replaced with other DVH parameters (eg, dose to 700 or 900 cc of liver) in the multivariate analysis, effective volume and portal vein thrombus were associated with an increased risk. Conclusions: Baseline CP scores and higher liver doses (eg, mean dose, effective volume, doses to 700-900 cc) were strongly associated with liver function decline 3 months after SBRT. A lower baseline platelet count and portal vein thrombus were also associated with an increased risk.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

A New Global River Network Database for Macroscale Hydrologic modeling

Coarse resolution (upscaled) river networks are critical inputs for runoff routing in macroscale hydrologic models. Recently, Wu et al. (2011) developed a hierarchical Dominant River Tracing (DRT) algorithm for automated extraction and spatial upscaling of basin flow directions and river networks using fine-scale hydrography inputs (e.g., flow direction, river networks, and flow accumulation). The DRT was initially applied using HYDRO1K baseline fine-scale hydrography inputs and the resulting upscaled global hydrography maps were produced at several spatial scales, and verified against other available regional and global datasets. New baseline fine-scale hydrography data from HydroSHEDS are now available for many regions and provide superior scale and quality relative to HYDRO1K. However, HydroSHEDS does not cover regions above 60°N. In this study, we applied the DRT algorithms using combined HydroSHEDS and HYDRO1K global fine-scale hydrography inputs, and produced a new series of upscaled global river network data at multiple (1/16° to 2°) spatial resolutions in a consistent (WGS84) projection. The new upscaled river networks are internally consistent and congruent with the baseline fine-scale inputs. The DRT results preserve baseline fine-scale river networks independent of spatial scales, with consistency in river network, basin shape, basin area, river length, and basin internal drainage structure between upscaled and baseline fine-scale hydrography. These digital data are available online for public access (ftp://ftp.ntsg.umt.edu/pub/data/DRT/) and should facilitate improved regional to global scale hydrological simulations, including runoff routing and river discharge calculations.

macroscale hydrological modeling↗

The Changing Influence of Precipitation on Soil Moisture Drought With Warming in the Mediterranean and Western North America

Abstract Anthropogenic climate change has already affected drought severity and risk across many regions, and climate models project additional increases in drought risk with future warming. Historically, droughts are typically caused by periods of below‐normal precipitation and terminated by average or above‐normal precipitation. In many regions, however, soil moisture is projected to decrease primarily through warming‐driven increases in evaporative demand, potentially affecting the ability of negative precipitation anomalies to cause drought and positive precipitation anomalies to terminate drought. Here, we use climate model simulations from Phase Six of the Coupled Model Intercomparison Project (CMIP6) to investigate how different levels of warming (1, 2, and 3°C) affect the influence of precipitation on soil moisture drought in the Mediterranean and Western North America regions. We demonstrate that the same monthly precipitation deficits (25th percentile relative to a preindustrial baseline) at a global warming level of 2°C increase the probability of both surface and rootzone soil moisture drought by 29% in the Mediterranean and 32% and 6% in Western North America compared to the preindustrial baseline. Furthermore, the probability of a dry (25th percentile relative to a preindustrial baseline) surface soil moisture month given a high (75th percentile relative to a preindustrial baseline) precipitation month is 6 (Mediterranean) and 3 (Western North America) times more likely in a 2°C world compared to the preindustrial baseline. For these regions, warming will likely increase the risk of soil moisture drought during low precipitation periods while simultaneously reducing the efficacy of high precipitation periods to terminate droughts.

Environmental Sciences & Ecology↗

Wind Turbine Design Optimization for Hydrogen Production

To help meet the need for inexpensive green fuels, we are working on wind turbine design optimization specifically for hydrogen production. We have thus far achieved a 1.53% decrease in LCOH as compared to a turbine optimized for LCOE using the same code, design variables, and models. We accomplished this by optimizing some components of the wind turbine tower, rotor, and drivetrain design with hydrogen production and costs in the design loop.

hydrogen↗

Repeal of the Clean Power Plan: Social Cost and Distributional Implications

The Clean Power Plan (CPP) was repealed due to concerns about the “unnecessary, costly burdens” it may impose on electric utilities, thereby delaying efforts to reduce carbon dioxide emissions (CO 2 ) from the electricity sector. This paper examines the greenhouse gas and welfare implications of this repeal while incorporating the presence of the state renewable portfolio standards (RPS) in the US as the status quo. We assess the carbon abatement and welfare costs with the CPP relative to two alternative baselines: a no–policy baseline and a pre–existing policy baseline with the RPS. The CPP is implemented as a regional mass–based standard, a regional rate–based standard, or as a national mass–based standard with trading of emissions across regions over the 2022–2030 period. We find that the incremental discounted welfare costs per metric ton of CO 2 that would have been abated by the CPP relative to the RPS would be substantially lower than the global social cost of CO 2 . However, the overall costs of carbon abatement with the CPP added to the RPS would have become higher than the social cost of carbon when estimated relative to a no–policy baseline, except with a national mass–based CPP. Across all policy combinations and choice of baselines, the aggregate welfare costs were lowest under a national mass–based standard and highest under the regional rate–based standard. Here, we also find that the CPP would have imposed large welfare costs on consumers and fossil fuel producers while benefiting the renewable fuel producers.

, Q42↗

Continental United States may lose 1.8 petagrams of soil organic carbon under climate change by 2100

Abstract Aims High‐resolution information on soils’ vulnerability to climate‐induced soil organic carbon (SOC) loss can enable environmental scientists, land managers, and policy makers to develop targeted mitigation strategies. This study aims to estimate baseline and decadal changes in continental US surface SOC stocks under future emission scenarios. Location Continental United States. Time period 2014–2100. Methods We used recent SOC field observations ( n = 6,213 sites), environmental factors ( n = 32), and an ensemble machine learning (ML) approach to estimate baseline SOC stocks in surface soils across the continental United States at 100‐m spatial resolution, and decadal changes under the projected climate scenarios of Coupled Model Intercomparison Project Phase Six (CMIP6) earth system models (ESMs). Results Baseline SOC projections from ML approaches captured more than 50% of variability in SOC observations, whereas ESMs represented only 6–16% of observed SOC variability. ML estimates showed a mean total loss of 1.8 Pg C from US surface soils under the high‐emission scenario by 2100, whereas ESMs showed no significant change in SOC stocks with wide variation among ESMs. Both ML and ESM predictions agree on the direction of SOC change (net emissions or sequestration) across 46–51% of continental US land area. These differences are attributable to the high‐resolution site‐specific data used in the ML models compared to the relatively coarse grid represented in CMIP6 ESMs. Main conclusions Our high‐resolution estimates of baseline SOC stocks, identification of key environmental controllers, and projection of SOC changes from US land cover types under future climate scenarios suggest the need for high‐resolution simulations of SOC in ESMs to represent the heterogeneity of SOC. We found that the SOC change is sensitive to key soil related factors (e.g. soil drainage and soil order) that have not been historically considered as input parameters in ESMs, because currently more than 95% variability in the SOC of CMIP6 ESMs is controlled by net primary productivity, temperature, and precipitation. Using additional environmental factors to estimate the baseline SOC stocks and predict the future trajectory of SOC change can provide more accurate results.

54 ENVIRONMENTAL SCIENCES↗

SU-E-I-68: Practical Considerations On Implementation of the Image Gently Pediatric CT Protocols

Purpose: One limitation associated with the Image Gently pediatric CT protocols is practical implementation of the recommended manual techniques. Inconsistency as a result of different practice is a possibility among technologist. An additional concern is the added risk of data error that would result in over or underexposure. The Automatic Exposure Control (AEC) features automatically reduce radiation for children. However, they do not work efficiently for the patients of very small size and relative large size. This study aims to implement the Image Gently pediatric CT protocols in the practical setting while maintaining the use of AEC features for pediatric patients of varying size. Methods: Anthropomorphological abdomen phantoms were scanned in a CT scanner using the Image Gently pediatric protocols, the AEC technique with a fixed adult baseline, and automatic protocols with various baselines. The baselines were adjusted corresponding to patient age, weight and posterioranterior thickness to match the Image Gently pediatric CT manual techniques. CTDIvol was recorded for each examination. Image noise was measured and recorded for image quality comparison. Clinical images were evaluated by pediatric radiologists. Results: By adjusting vendor default baselines used in the automatic techniques, radiation dose and image quality can match those of the Image Gently manual techniques. In practice, this can be achieved by dividing pediatric patients into three major groups for technologist reference: infant, small child, and large child. Further division can be done but will increase the number of CT protocols. For each group, AEC can efficiently adjust acquisition techniques for children. This implementation significantly overcomes the limitation of the Image Gently manual techniques. Conclusion: Considering the effectiveness in clinical practice, Image Gently Pediatric CT protocols can be implemented in accordance with AEC techniques, with adjusted baselines, to achieve the goal of providing the most appropriate radiation dose for pediatric patients of varying sizes.

60 APPLIED LIFE SCIENCES↗

SU-E-I-81: Assessment of CT Radiation Dose and Image Quality for An Automated Tube Potential Selection Algorithm Using Adult Anthropomorphic and ACR Phantoms

Purpose: To assess the impact of General Electrics (GE) automated tube potential algorithm, kV assist (kVa) on radiation dose and image quality, with an emphasis on optimizing protocols based on noise texture. Methods: Radiation dose was assessed by inserting optically stimulated luminescence dosimeters (OSLs) throughout the body of an adult anthropomorphic phantom (CIRS). The baseline protocol was: 120 kVp, Auto mA (180 to 380 mA), noise index (NI) = 14, adaptive iterative statistical reconstruction (ASiR) of 20%, 0.8s rotation time. Image quality was evaluated by calculating the contrast to noise ratio (CNR) and noise power spectrum (NPS) from the ACR CT accreditation phantom. CNRs were calculated according to the steps described in ACR CT phantom testing document. NPS was determined by taking the 3D FFT of the uniformity section of the ACR phantom. NPS and CNR were evaluated with and without kVa and for all available adaptive iterative statistical reconstruction (ASiR) settings, ranging from 0 to 100%. Each NPS was also evaluated for its peak frequency difference (PFD) with respect to the baseline protocol. Results: The CNR for the adult male was found to decrease from CNR = 0.912 ± 0.045 for the baseline protocol without kVa to a CNR = 0.756 ± 0.049 with kVa activated. When compared against the baseline protocol, the PFD at ASiR of 40% yielded a decrease in noise magnitude as realized by the increase in CNR = 0.903 ± 0.023. The difference in the central liver dose with and without kVa was found to be 0.07%. Conclusion: Dose reduction was insignificant in the adult phantom. As determined by NPS analysis, ASiR of 40% produced images with similar noise texture to the baseline protocol. However, the CNR at ASiR of 40% with kVa fails to meet the current ACR CNR passing requirement of 1.0.

60 APPLIED LIFE SCIENCES↗

SU-E-T-442: Sensitivity of Quality Assurance Tools to Delivery Errors On a Magnetic Resonance-Imaging Guided Radiation Therapy (MR-IGRT) System

Purpose: To test the sensitivity of the quality assurance (QA) tools actively used on a clinical MR-IGRT system for potential delivery errors. Methods: Patient-specific QA procedures have been implemented for a commercially available Cobalt-60 MR-IGRT system. The QA tools utilized were a MR-compatible cylindrical diode-array detector (ArcCHECK) with a custom insert which positions an ionization chamber (Exradin A18) in the middle of the device, as well as an in-house treatment delivery verification program. These tools were tested to investigate their sensitivity to delivery errors. For the ArcCHECK and ion chamber, a baseline was established with a static field irradiation to a known dose. Variations of the baseline were investigated which included rotated gantry, altered field size, directional shifts, and different delivery time. In addition, similar variations were tested with the automated delivery verification program that compared the treatment parameters in the machine delivery logs to the ones in the plan. To test the software, a 3-field conformal plan was generated as the baseline. Results: ArcCHECK noted at least a 13% decrease in passing rate from baseline in the following scenarios: gantry rotation of 1 degree from plan, 5mm change in field size, 2mm lateral shift, and delivery time decrease. Ion chamber measurements remained consistent for these variations except for the 5 second decrease in delivery time scenario which resulted in an 8% difference from baseline. The delivery verification software was able to detect and report the simulated errors such as when the gantry was rotated by 0.6 degrees, the beam weighting was changed by a percent, a single multileaf collimator was moved by 1cm, and the dose was changed from 2 to 1.8Gy. Conclusion: The results show that the current tools used for patient specific QA are capable of detecting small errors in RT delivery with presence of magnetic field.

60 APPLIED LIFE SCIENCES↗

Using compressive sensing to recover images from PET scanners with partial detector rings

Purpose: Most positron emission tomography/computed tomography (PET/CT) scanners consist of tightly packed discrete detector rings to improve scanner efficiency. The authors’ aim was to use compressive sensing (CS) techniques in PET imaging to investigate the possibility of decreasing the number of detector elements per ring (introducing gaps) while maintaining image quality. Methods: A CS model based on a combination of gradient magnitude and wavelet domains (wavelet-TV) was developed to recover missing observations in PET data acquisition. The model was designed to minimize the total variation (TV) and L1-norm of wavelet coefficients while constrained by the partially observed data. The CS model also incorporated a Poisson noise term that modeled the observed noise while suppressing its contribution by penalizing the Poisson log likelihood function. Three experiments were performed to evaluate the proposed CS recovery algorithm: a simulation study, a phantom study, and six patient studies. The simulation dataset comprised six disks of various sizes in a uniform background with an activity concentration of 5:1. The simulated image was multiplied by the system matrix to obtain the corresponding sinogram and then Poisson noise was added. The resultant sinogram was masked to create the effect of partial detector removal and then the proposed CS algorithm was applied to recover the missing PET data. In addition, different levels of noise were simulated to assess the performance of the proposed algorithm. For the phantom study, an IEC phantom with six internal spheres each filled with F-18 at an activity-to-background ratio of 10:1 was used. The phantom was imaged twice on a RX PET/CT scanner: once with all detectors operational (baseline) and once with four detector blocks (11%) turned off at each of 0 °, 90 °, 180 °, and 270° (partially sampled). The partially acquired sinograms were then recovered using the proposed algorithm. For the third test, PET images from six patient studies were investigated using the same strategy of the phantom study. The recovered images using WTV and TV as well as the partially sampled images from all three experiments were then compared with the fully sampled images (the baseline). Comparisons were done by calculating the mean error (%bias), root mean square error (RMSE), contrast recovery (CR), and SNR of activity concentration in regions of interest drawn in the background as well as the disks, spheres, and lesions. Results: For the simulation study, the mean error, RMSE, and CR for the WTV (TV) recovered images were 0.26% (0.48%), 2.6% (2.9%), 97% (96%), respectively, when compared to baseline. For the partially sampled images, these results were 22.5%, 45.9%, and 64%, respectively. For the simulation study, the average SNR for the baseline was 41.7 while for WTV (TV), recovered image was 44.2 (44.0). The phantom study showed similar trends with 5.4% (18.2%), 15.6% (18.8%), and 78% (60%), respectively, for the WTV (TV) images and 33%, 34.3%, and 69% for the partially sampled images. For the phantom study, the average SNR for the baseline was 14.7 while for WTV (TV) recovered image was 13.7 (11.9). Finally, the average of these values for the six patient studies for the WTV-recovered, TV, and partially sampled images was 1%, 7.2%, 92% and 1.3%, 15.1%, 87%, and 27%, 25.8%, 45%, respectively. Conclusions: CS with WTV is capable of recovering PET images with good quantitative accuracy from partially sampled data. Such an approach can be used to potentially reduce the cost of scanners while maintaining good image quality.

60 APPLIED LIFE SCIENCES↗

SU-E-J-124: 18F-FDG PET Imaging to Improve RT Treatment Outcome for Locally Advanced Lung Cancer

Purpose: To investigate spatial correlation between high uptake regions of pre- and 10-days-post therapy{sup 1} {sup 8}F-FDG PET in recurrent lung cancer and to evaluate the feasibility of dose escalation boosting only regions with high FDG uptake identified on baseline PET. Methods: Nineteen patients with stages II– IV inoperable lung cancer were selected. Volumes of interest (VOI) on pre-therapy FDG-PET were defined using an isocontour at ≥50% of SUVmax. VOI of pre- and post-therapy PET images were correlated for the extent of overlap. A highly optimized IMRT plan to 60 Gy prescribed to PTV defined on the planning CT was designed using clinical dose constraints for the organs at risk. A boost of 18 Gy was prescribed to the VOI defined on baseline PET. A composite plan of the total 78 Gy was compared with the base 60 Gy plan. Increases in dose to the lungs, spinal cord and heart were evaluated. IMRT boost plan was compared with proton RT and SBRT boost plans. Results: Overlap fraction of baseline PET VOI with the VOI on 10 days-post therapy PET was 0.8 (95% CI: 0.7 – 0.9). Using baseline VOI as a boosting volume, dose could be escalated to 78 Gy for 15 patients without compromising the dose constraints. For 4 patients, the dose limiting factors were V20Gy and Dmean for the total lung, and Dmax for the spinal cord. An increase of the dose to OARs correlated significantly with the relative size of the boost volume. Conclusion: VOI defined on baseline 18F-FDG PET by the SUVmax-≥50% isocontour may be a biological target volume for escalated radiation dose. Dose escalation to this volume may provide improved tumor control without breaching predefined dose constraints for OARs. The best treatment outcome may be achieved with proton RT for large targets and with SBRT for small targets.

60 APPLIED LIFE SCIENCES↗

SU-E-T-636: ProteusONE Machine QA Procedure and Stabiity Study: Half Year Clinical Operation

Purpose: The objective of this study is to evaluate the stability of ProteusOne, the 1st commercial PBS proton system, throughout the daily QA and monthly over 6 month clinical operation. Method: Daily QA test includes IGRT position/repositioning, output in the middle of SOBP, beam flatness, symmetry, inplane and crossplane dimensions as well as energy range check. Daily range shifter QA consist of output, symmetry and field size checks to make sure its integrity. In 30 mins Daily QA test, all the measurements are performed using the MatriXXPT (IBA dosimetry). The data from these measurement was collected and compare over the first 6 month of clinical operation. In addition to the items check in daily QA, the summary also includes the monthly QA gantry star shots, absolute position check using a novel device, XRV-100. Results: Average machine output at the center of the spread out bragg peak was 197.5±.8 cGy and was within 1%of the baseline at 198.4 cGy. Beam flatness was within 1% cross plane with an average of 0.67±0.12% and 2% in-plane with an average of 1.08±0.17% compared to baseline measurements of 0.6 and 1.03, respectively. In all cases the radiation isocenter shift was less than or equal to 1mm. Output for the range shifter was within 2% for each individual measurement and averaged 34.4±.2cGy compare to a baseline reading of 34.5cGy. The average range shifter in and cross plane field size measurements were 19.8±0.5cm and 20.5±0.4cm compared with baseline values of 20.19cm and 20.79cm, respectively. Range shifter field symmetry had an average of less 1% for both in-plane and cross plane measurements. Conclusion: All machine metrics over the past 6 months have proved to be stable. Although, some averages are outside the baseline measurement they are within 1% tolerance and the deviation across all measurements is minimal.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Ketone monoester plus high‐dose glucose supplementation before exercise does not affect immediate post‐exercise erythropoietin concentrations versus glucose alone

Abstract The objective of this study was to examine the effect of consuming ketone monoester plus a high dose of carbohydrate from glucose (KE + CHO) on the change in erythropoietin (EPO) concentrations during load carriage exercise compared with carbohydrate (CHO) alone. Using a randomized, crossover design, 12 males consumed KE + CHO (573 mg KE/kg body mass, 110 g glucose) or CHO (110 g glucose) 30 min before 4 miles of self‐paced treadmill exercise (KE + CHO:51 ± 13%, CHO: 52 ± 12% V̇O 2peak ) wearing a weighted vest (30% body mass; 25 ± 3 kg). Blood samples for analysis were obtained under resting fasted conditions before (Baseline) consuming the KE + CHO or CHO supplement and immediately after exercise (Post). βHB increased ( p < 0.05) from Baseline to Post in KE + CHO, with no change in CHO. Glucose and glycerol increased ( p < 0.05) from Baseline to Post in CHO, with no effect of time in KE + CHO. Insulin and lactate increased ( p < 0.05) from Baseline to Post independent of treatment. EPO increased ( p < 0.05) from Baseline to Post in KE + CHO and CHO with no difference between treatments. Although KE + CHO altered βHB, glucose, and glycerol concentrations, results from this study suggest that KE + CHO supplementation before load carriage exercise does not enhance immediate post‐exercise increases in EPO compared with CHO alone.

Howard, Emily E.↗

Technical Basis for PNNL Beryllium Inventory

The Department of Energy (DOE) issued Title 10 of the Code of Federal Regulations Part 850, “Chronic Beryllium Disease Prevention Program” (the Beryllium Rule) in 1999 and required full compliance by no later than January 7, 2002. The Beryllium Rule requires the development of a baseline beryllium inventory of the locations of beryllium operations and other locations of potential beryllium contamination at DOE facilities. The baseline beryllium inventory is also required to identify workers exposed or potentially exposed to beryllium at those locations. Prior to DOE issuing 10 CFR 850, Pacific Northwest Nuclear Laboratory (PNNL) had documented the beryllium characterization and worker exposure potential for multiple facilities in compliance with DOE’s 1997 Notice 440.1, “Interim Chronic Beryllium Disease.” After DOE’s issuance of 10 CFR 850, PNNL developed an implementation plan to be compliant by 2002. In 2014, an internal self-assessment (ITS #E-00748) of PNNL’s Chronic Beryllium Disease Prevention Program (CBDPP) identified several deficiencies. One deficiency is that the technical basis for establishing the baseline beryllium inventory when the Beryllium Rule was implemented was either not documented or not retrievable. In addition, the beryllium inventory itself had not been adequately documented and maintained since PNNL established its own CBDPP, separate from Hanford Site’s program. This document reconstructs PNNL’s baseline beryllium inventory as it would have existed when it achieved compliance with the Beryllium Rule in 2001 and provides the technical basis for the baseline beryllium inventory.

Beryllium, 10 CFR 850↗