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At least 163 records · Page 9
All sourcesNASA NTRSDOE OSTI
DOE OSTI2019

General Handling Calculations for the Modified Hospital Can

Containers are evaluated using a Monte-Carlo N-Particle transport code (MCNP). The code calculated keff is compared to critical experiment benchmarks to determine a bias. Additional margin of safety is added to the bias to establish an upper subcritical limit (USL). Modeled cases are considered subcritical if the neutron multiplication factor plus two sigma remains below the USL. Net weight limits allow for any amount of fissile/moderator mixture to exist so long as it meets the weight requirement, therefore all mixture types must be evaluated. Cases that exceed the USL must either be controlled against or have justification why that configuration cannot reasonably exist. Current and legacy loadings and container dimensions must be taken into consideration.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗
NASA NTRS1978

Emergency Communications Console

NASA has applied its communications equipment expertise to development of a communications console that provides, in a compact package only slightly larger than an electric typewriter, all the emergency medical services communications functions needed for a regional hospital. A prototype unit, built by Johnson Space Center, has been installed in the Odessa (Texas) Medical Center Hospital. The hospital is the medical control center for the 17-county Permian Basin Emergency Medical System in west Texas. The console project originated in response to a request to NASA from the Texas governor's office, which sought a better way of providing emergency medical care in rural areas. Because ambulance travel time is frequently long in remote areas of west Texas, it is important that treatment begin at the scene of the emergency rather than at the hospital emergency room. A radio and telephone system linking ambulance emergency technicians and hospital staff makes this possible. But earlier equipment was complex, requiring specialized operators. A highly reliable system was needed to minimize breakdowns and provide controls of utmost simplicity, so that the system could be operated by physicians and nurses rather than by communications specialists. The resulting console has both radio and telephone sections. With the radio equipment, hospital personnel can communicate with ambulance drivers and paramedics, receive incoming electrocardiagrams, consult with other hospitals, page hospital staff and set up a radio-to-telephone "patch." The telephone portion of the system includes a hotline from the Permian Basin Emergency Medical Service's resource control center, an automatic dialer for contacting special care facilities in the Permian Basin network, a hospital intercom terminal and a means of relaying cardioscope displays and other data between hospitals. The integrated system also provides links with local disaster and civil defense organizations and with emergency "Dial 911" control points.

Source record↗
DOE OSTI2019

Outcomes of hypercalcemia of malignancy in patients with solid cancer: a national inpatient analysis

Hypercalcemia of malignancy (HCM) is present in one-third of cancer patients and is associated with a significant mortality risk of 50% within 1 month of diagnosis. We aimed to study the impact and outcomes of HCM in hospitalized patients with solid cancer. We analyzed data captured in the National Inpatient Sample database of the Agency of Healthcare Research and Quality. The study included all hospitalizations in adult solid cancer patients between January 2012 and September 2015 with hypercalcemia. All encounters associated with HCM were identified using the ICD-9 code (275.42) for hypercalcemia. Encounters with other known causes of hypercalcemia were excluded. The co-primary outcomes were incidence of HCM and inpatient mortality. During the study period, 7,501,209 hospitalizations met our inclusion criteria. Approximately 1.7% (n = 126,875) of these hospitalizations were related to HCM. This corresponds to approximately 1 in 59 solid malignancy associated hospitalizations. The mean age of patients with HCM was 65.7 years; 49% were females; 69% were Caucasians; 73% had metastatic disease and 22% received a palliative care consult. When compared to those without HCM, those hospitalized with HCM had a significantly longer mean hospital length of stay (7.3 days vs. 5.6 days, p < 0.001), higher inpatient mortality (12.3% vs. 5.5%, adjusted OR 1.76 (95% CI 1.69–1.84), p < 0·0001), and a greater likelihood of discharge to other facilities (27.4% vs. 16.2%, p < 0.0001). Although HCM accounts for < 2% of all hospitalizations in patients with solid cancer, those with HCM display higher mortality than those without HCM.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Risk management for outsourcing biomedical waste disposal – Using the failure mode and effects analysis

Highlights: • This study is based on a real case in hospital in Taiwan. • We use Failure Mode and Effects Analysis (FMEA) as the evaluation method. • We successfully identify the evaluation factors of bio-medical waste disposal risk. - Abstract: Using the failure mode and effects analysis, this study examined biomedical waste companies through risk assessment. Moreover, it evaluated the supervisors of biomedical waste units in hospitals, and factors relating to the outsourcing risk assessment of biomedical waste in hospitals by referring to waste disposal acts. An expert questionnaire survey was conducted on the personnel involved in waste disposal units in hospitals, in order to identify important factors relating to the outsourcing risk of biomedical waste in hospitals. This study calculated the risk priority number (RPN) and selected items with an RPN value higher than 80 for improvement. These items included “availability of freezing devices”, “availability of containers for sharp items”, “disposal frequency”, “disposal volume”, “disposal method”, “vehicles meeting the regulations”, and “declaration of three lists”. This study also aimed to identify important selection factors of biomedical waste disposal companies by hospitals in terms of risk. These findings can serve as references for hospitals in the selection of outsourcing companies for biomedical waste disposal.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗
DOE OSTI2016

Orange County Photovoltaic Project & Educational COmponent

The purpose of this report is to discuss the projects implemented, utilizing Department of Energy grant funds, to support the use and understanding of renewable energy in Orange County, Florida and the Greater Orlando Area. Orange County is located in the State of Florida and is most popularly referred to as Orlando. The greater Orlando area’s current population is 1,225,267 and in 2015 was the first destination to surpass 60 million visitors. Orange County utilized grant funds to add to the growing demand for access to charging stations by installing one level 2 dual NovaCharge CT4021 electric vehicle charging station at the Orange County/University of Florida Cooperative Extension Center. The charging station is considered a “smart” charger connected to a central network operated by a third party. Data collected includes the number of charging sessions, session start and end times, the electricity usage, greenhouse gases saved and other pertinent data used for reporting purposes. Orange County continues to support the use of electric vehicles in Metro Orlando and this project continues to bring awareness to our public regarding using alternative vehicles. Additionally, we offer all visitors to the Orange County/University of Florida Cooperative Extension Center free charges for their electric vehicles 24 hours a day. Since the operation of the charging station there have been 52 unique driver users, a total of 532.2258 kg of greenhouse gas savings and 159.03 gallons of gasoline savings. The installation of the additional electric vehicle charging station is part of a county-wide goal of promoting implementation of renewable energy technologies as well as supporting the use of electric vehicles including the Drive Electric Orlando & Florida programs. http://driveelectricorlando.com/ & ; http://www.driveelectricflorida.org/ . Grant funds were also used for Outreach and Educational efforts. Educational efforts about renewable energy were accomplished through the continued support as well as a proposed expansion and potential relocation of the Climate Change Education Center. The growth of the Climate Change Education Center focused on 2 educational subsectors. The first educational sector focused on an apprenticeship with university students. The second sector Orange County partnered with a hospitality college that held seminars to educate students in sustainability best practices that would influence the industry as a whole as students take jobs around the U.S. and other parts of the world. Orange County completed five of the originally proposed six educational seminars. The first seminar focused on community based social marketing techniques for driving sustainable behavior changes. The second seminar held was a green team workshop. The third seminar focused on urban sustainability planning. The fourth and fifth seminars held were Florida Energy Code workshops for building inspectors. A sixth transit oriented development seminar in partnership with Rollins College was explored, but was not conducted because the proposed on campus venue was not accessible for an extended period of time due to renovations. Additionally, an ENERGY STAR training program was conducted with students from the University of Central Florida; three of the five buildings assessed received ENERGY STAR ratings; one student completed the training and received their certification as an ENERGY STAR Specialist. Background: Location: Orange County is located in the central region of the State of Florida and is most popularly known for including the City of Orlando. The greater Orlando area’s current population is 1,225,267 and is home to large corporations such as Walt Disney World, Universal Studios Orlando, Ritz Carlton, Darden Restaurants, and the nation’s second largest convention center. Opportunities Identified: Encouraging Sustainability in Major Sectors: The Central Florida economy is largely dependent on the hospitality industry and in 2015 it was the first destination to surpass 60 million visitors. With over 60 million visitors each year, 120,000 hotel rooms, 4,000 restaurants, and 75 theme parks and attractions, the local hospitality industry provided a wealth of opportunity to reduce greenhouse gas emissions through building energy efficiency and renewable energy. Accordingly, Central Florida is an ideal training ground for teaching best practices for sustainability focused on the hospitality industry. Meeting the Growing Demand for Electric Vehicle Infrastructure: According to the 2014 U.S Clean Tech Leadership Index Report, nationwide electric vehicle ownership in the top 50 largest metro areas increased sharply in 2013; the Orlando Metro Area was ranked #5 in the nation in in terms of electric vehicle charging stations per one million people. Additionally, the Orange County 2014-2015 Annual Sustainable Orange County Report indicated there are 300 electric vehicle charging stations in Central Florida (roughly 300 charging stations within ~70 mile radius available to our residents of Orange County). By increasing and improving access to charging stations, Orange County supports the growing demand for renewable energy technologies. Project Achievements/Accomplishments: Installed an Electric Charging Station: Orange County utilized grant funds to install one level 2 dual NovaCharge CT4021 electric vehicle charging station at the Orange County/University of Florida Cooperative Extension Center. The charging station is considered a “smart” charger connected to a central network operated by a third party that monitors the number of charging sessions, session start and end times, the electricity usage, greenhouse gases saved and other pertinent data. During the six months of operation of the charging station there have been 52 unique driver users of the charging station; a total of 532.2258 kg of greenhouse gas savings and 159.03 gallons of gasoline savings. Operation and Potential Relocation of the Orange County Climate Change Education Center: The Climate Change Education Center, originally located within the Orange County Convention Center, served as a central place to inform and educate commercial and residential sectors of environmental, health, and economic benefits of renewable energy, energy efficiency, and greenhouse gas emission reductions. Grant funds were used to pay for the rent required to maintain a lease at the Convention Center, conduct five educational workshops, and for planned upgrades to the Center displays highlighting a number of energy efficiency and renewable energy projects implemented at the Orange County Convention Center and Downtown Orange County. An initial design concept for an upgraded Climate Change Education Center and educational displays was proposed. However, after the Convention Center determined the space occupied by the Climate Change Education Center; a feasibility study for relocation to the proposed area was conducted in October 2013. In December 2013, it was determined that the desired location of the for the Climate Change Education Center at the Orange County Extension Education Center provided too many construction challenges for relocation with too many building retrofits and access problems, including lack of access for loading and unloading exhibits as well as roof drainage relocations and sewer service connection issues. Another suitable location for relocating the Climate Change Education Center could not be located so the project was terminated. The Climate Change Education Center is no longer in existence in Orange County and has been eliminated. Grant funds were used to pay for marketing services for a state wide marketing program including solar & other renewable energy technologies for rebranding and developing marketing materials including web site design and updating. A website was maintained and updated the www.PowerUpGreenEnergy.com website (no longer in service). Sustainability Training for the Hospitality Industry and Major Sectors: To introduce energy efficiency and renewable energy concepts to the hospitality industry, Orange County partnered with a hospitality college that held seminars to educate students in sustainability best practices that would influence the industry as a whole as students take jobs around the U.S. and other parts of the world. Orange County completed five of the originally proposed six education seminars. Seminar topics included: driving sustainable behavior change through community based social marketing; green team programs; urban sustainability planning; and Florida Energy Code workshops for building inspectors. In partnership with Rollins College, a sixth seminar focused on transit-oriented development was explored, but was not conducted due to extended renovations at the proposed on-campus venue. Green Job Training Development: To promote green industry development and on-the-job training in occupations that encourage energy efficiency and resource reduction, Orange County piloted an ENERGY STAR training and apprenticeship program with students from the University of Central Florida; three students applied for the program; one student completed the training and received their certification as an ENERGY STAR specialist; three of the five buildings assessed received ENERGY STAR Ratings.

14 SOLAR ENERGY↗
DOE OSTI2017

Control and Cost-benefit Analysis of Fast Spreading Diseases: The case of Ebola

Mitigating the spread of infectious disease is of great importance for policy makers. Taking the recent outbreak of Ebola as an example, it was difficult for policy makers to identify the best course of action based on the cost-effectiveness of what was available. In effort to address the needs of policy makers to mitigate the spread of infectious disease before an outbreak becomes uncontrollable, we have devised a cost-benefit disease control model to simulate the effect of various control methods on disease incidence and the cost associated with each of the scenarios. Here, we present a case study of Ebola used to quantify the cost effectiveness of vaccination and isolation methods to minimize the spread of the disease. We evaluate the impact of changing strategy levels on the incidence of the disease and address the benefits of choosing one strategy over the other with regards to cost of vaccine and isolation. Disease. We use a general SEIRJ model for disease transmission. Here, S-Susceptible, E- Exposed (latent), IA– Infected (asymptomatic),IM– Infected (mild symptoms), IS– Infected (severe symptoms),JM– Isolated (mild symptoms at home), JS– Isolated (severe symptoms in hospital), and R- Recovered individuals. In this model, we consider the dynamics of the system and the effect of the relative transmissibility of isolated individuals (L) compared to other infected individuals. Cost. Ebola vaccination and treatment are very expensive and not widely available. Some preliminary data shows that it will take$73 million (M) to produce 27 M vaccines plus the cost for vaccine delivery and health care professionals (not included here). On the other hand, the treatment for Ebola in the U.S. would cost $25,000dollars a day per person to ensure proper isolation and adequate care(treatment, health care professionals, facilities and special equipment).Although not included in this research, the proper isolation of Ebola patients would also lead to a loss in hospital revenue of $148,000per day due to reduced patient capacity3. Here, we use $27,000 per individual hospitalized per day and $2.70 per person vaccinated. Model. To evaluate the cost-effectiveness of control methods on disease transmission, we assessed the affect of different levels of vaccination coverage on the resulting number of infected individuals. Then, we calculated the overall estimated cost of vaccination and resulting hospitalization for each scenario to identify the lowest cost-benefit ratio. Using a base population of 10 M individuals, we ran scenarios for different levels of vaccination (μ= 0.01, 0.05, 0.1) while varying the relative transmissibility of isolated individuals (L = 0.5, 0.6, 0.65).For each combination, we calculated the incidence, vaccination and hospitalization cost per individual per day (Fig 1). We note that an increase in the relative transmissibility of isolated individuals leads to a higher number of infected people and, therefore, a reduced number of candidates for vaccination and an overall increase in cost. Since the cost of vaccination is 1 ten-thousandth of the cost of hospitalization, our results clearly show the cost-benefit of vaccinating over hospital treatment. In every scenario studied, we observed a measurable reduction in disease incidence when vaccinating a higher fraction of the population compared to isolating individuals post infection. Given these preliminary results, we plan to extend the framework of our model to a dynamic control system where we consider the cost of vaccination and isolation embedded in the system of differential equations. This approach will allow us see the best available control implementation while minimizing the cost of treatment and vaccination.

EBOLA↗
NASA NTRS1978

Medical Telemetry

Telemetry is the process whereby physiological or other data is acquired by instruments, translated into radio signals and j sent to a receiving station where the signals are decoded and recorded. Extensively used in I space operations, it is finding new Earth applications, among them transmission of medical data between emergency vehicles and hospitals. For example, transmission of an electrocardiogram from an ambulance to a hospital enables a physician to read the telemetered EKG and advise ambulance attendants on emergency procedures. Central Medical Emergency Dispatch (CMED) operates as a regional emergency medical communications center for Cleveland, Ohio and Cuyahoga County. The CMED system includes radio and telephone communications from hospital-to-hospital and from ambulance-to-hospital, but for improved emergency life support CMED sought to add a county-wide telemetry capability. The problem was that there were only eight radio frequencies available for telemetry and there were more than 30 potential users in Cleveland alone. NASA's Lewis Research Center volunteered its expert assistance. The Center's engineers studied the systems of other telemetry using cities, surveyed area hospitals to assure compatibility of telemetry equipment, and advised what types of equipment would be needed in emergency vehicles and at the various hospitals. The Lewis plan suggested that CMED be designated the central coordinating agency for the Cuyahoga County system, monitoring all telemetry frequencies and, when requested, assigning one not in use or one to be used at a sufficient distance that it would create no interference problem.

Source record↗
DOE OSTI2021

How New Mexico Leveraged a COVID-19 Case Forecasting Model to Preemptively Address the Healthcare Needs of the State: Quantitative Analysis

Prior to the COVID-19 pandemic, US hospitals relied on static projections of future trends for long-term planning and were only beginning to consider forecasting methods for short-term planning of staffing and other resources. With the overwhelming burden imposed by COVID-19 on the health care system, an emergent need exists to accurately forecast hospitalization needs within an actionable timeframe. Our goal was to leverage an existing COVID-19 case and death forecasting tool to generate the expected number of concurrent hospitalizations, occupied intensive care unit (ICU) beds, and in-use ventilators 1 day to 4 weeks in the future for New Mexico and each of its five health regions. We developed a probabilistic model that took as input the number of new COVID-19 cases for New Mexico from Los Alamos National Laboratory’s COVID-19 Forecasts Using Fast Evaluations and Estimation tool, and we used the model to estimate the number of new daily hospital admissions 4 weeks into the future based on current statewide hospitalization rates. The model estimated the number of new admissions that would require an ICU bed or use of a ventilator and then projected the individual lengths of hospital stays based on the resource need. By tracking the lengths of stay through time, we captured the projected simultaneous need for inpatient beds, ICU beds, and ventilators. We used a postprocessing method to adjust the forecasts based on the differences between prior forecasts and the subsequent observed data. Thus, we ensured that our forecasts could reflect a dynamically changing situation on the ground. Forecasts made between September 1 and December 9, 2020, showed variable accuracy across time, health care resource needs, and forecast horizon. Forecasts made in October, when new COVID-19 cases were steadily increasing, had an average accuracy error of 20.0%, while the error in forecasts made in September, a month with low COVID-19 activity, was 39.7%. Across health care use categories, state-level forecasts were more accurate than those at the regional level. Although the accuracy declined as the forecast was projected further into the future, the stated uncertainty of the prediction improved. Forecasts were within 5% of their stated uncertainty at the 50% and 90% prediction intervals at the 3- to 4-week forecast horizon for state-level inpatient and ICU needs. However, uncertainty intervals were too narrow for forecasts of state-level ventilator need and all regional health care resource needs. Real-time forecasting of the burden imposed by a spreading infectious disease is a crucial component of decision support during a public health emergency. Our proposed methodology demonstrated utility in providing near-term forecasts, particularly at the state level. This tool can aid other stakeholders as they face COVID-19 population impacts now and in the future.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2017

Continuous Activity Monitoring During Concurrent Chemoradiotherapy

Purpose: To perform a prospective trial testing the feasibility and utility of acquiring activity data as a measure of health status during concurrent chemoradiotherapy. Methods and Materials: Ambulatory patients who were planned for treatment with concurrent chemoradiotherapy with curative intent for cancers of the head and neck, lung, or gastrointestinal tract were provided with activity monitors before treatment initiation. Patients were asked to wear the devices continuously throughout the radiation therapy course. Step count data were downloaded weekly during radiation therapy and 2 and 4 weeks after radiation therapy completion. The primary objective was to demonstrate feasibility, defined as collection of step counts for 80% of the days during study subjects' radiation therapy courses. Secondary objectives included establishing step count as a dynamic predictor of unplanned hospitalization risk. Results: Thirty-eight enrolled patients were treated with concurrent chemoradiotherapy. Primary diagnoses included head and neck cancer (n=11), lung cancer (n=13), and a variety of gastrointestinal cancers (n=14). Step data were collected for 1524 of 1613 days (94%) during patients' radiation therapy courses. Fourteen patients were hospitalized during radiation therapy or within 4 weeks of radiation therapy completion. Cox regression modeling demonstrated a significant association between recent step counts (3-day average) and hospitalization risk, with a 38% reduction in the risk of hospitalization for every 1000 steps taken each day (hazard ratio 0.62, 95% confidence interval 0.46-0.83, P=.002). Inferior quality of life scores and impaired performance status were not associated with increased hospitalization risk. Conclusion: Continuous activity monitoring during concurrent chemoradiotherapy is feasible and well-tolerated. Step counts may serve as powerful, objective, and dynamic indicators of hospitalization risk.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2024

Assessing the reliability of medical resource demand models in the context of COVID-19

Abstract Background Numerous medical resource demand models have been created as tools for governments or hospitals, aiming to predict the need for crucial resources like ventilators, hospital beds, personal protective equipment (PPE), and diagnostic kits during crises such as the COVID-19 pandemic. However, the reliability of these demand models remains uncertain. Methods Demand models typically consist of two main components: hospital use epidemiological models that predict hospitalizations or daily admissions, and a demand calculator that translates the outputs of the epidemiological model into predictions for resource usage. We conducted separate analyses to evaluate each of these components. In the first analysis, we validated various hospital use epidemiological models using a recent validation framework designed for epidemiological models. This allowed us to quantify the accuracy of the models in predicting critical aspects such as the date and magnitude of local COVID-19 peaks, among other factors. In the second analysis, we evaluated a range of demand calculators for ventilators, medical gowns, and COVID-19 test kits. To achieve this, we decoupled these demand calculators from the underlying epidemiological models and provided ground truth data for their inputs. This approach enabled a direct comparison of the demand calculators, comparing them against each other and actual usage data when available. The code is available athttps://doi.org/10.5281/zenodo.13712387. Results Performance varied greatly across the epidemiological models, with greater variability in COVID-19 hospital use predictions than for COVID-19 deaths as analyzed previously. Some models did not have any peaks. Among those that did, the models under-estimated date of peak approximately as often as they over-estimated, but were more likely to under-estimate magnitude of peak, with typical relative errors around 50%. Regarding demand calculator predictions, there was significant variability, including five-fold differences in predictions for gown models. Validation against actual or surrogate usage data illustrated the potential value of demand models while demonstrating their limitations. Conclusions The emerging field of demand modeling holds promise in averting medical resource shortages during future public health emergencies. However, achieving this potential necessitates focused efforts on standardization, transparency, and rigorous model validation before placing reliance on demand models in critical public health decision-making.

Medical Informatics↗
DOE OSTI2020

Dynamical model for social distancing in the U.S. during the COVID-19 epidemic

Social distancing has led to a “flattening of the curve” in many states across the U.S. This is part of a novel, massive, global social experiment which has served to mitigate the COVID-19 pandemic in the absence of a vaccine or effective anti-viral drugs. Hence it is important to be able to forecast hospitalizations reasonably accurately. We propose on phenomenological grounds a random walk/generalized diffusion equation which incorporates the effect of social distancing to describe the temporal evolution of the probability of having a given number of hospitalizations. The probability density function is log-normal in the number of hospitalizations, which is useful in describing pandemics where the number of hospitalizations is very high. We used this insight and data to make forecasts for states using Monte Carlo methods. Back testing validates our approach, which yields good results about a week into the future. States are beginning to reopen at the time of submission of this paper and our forecasts indicate possible precursors of increased hospitalizations. However, the trends we forecast for hospitalizations as well as infections thus far show moderate growth. Additionally we studied the reproducibility in New York (Italian strain) and California (Wuhan strain). We find that even if there is a difference in the transmission of the two strains, social distancing has been able to control the progression of COVID 19.

97 MATHEMATICS AND COMPUTING↗
NASA NTRS1978

Infant Transport Monitoring

The photo sequence illustrates the movement of an ill infant to a special care hospital by means of a new Pediatric Monitoring and Transport System, in which NASA technology and technical assistance are being applied to an urgent medical problem. Development of the system is a collaborative effort involving several organizations, principally, NASA Ames Research Center and Children's Hospital Medical Center, Oakland, California. Key to the system's efficacy is a custom-designed ambulance-to-hospital and hospital-to-hospital communications network, including two-way voice capability and space-derived biotelemetry; it allows a specialist at the destination hospital to monitor continuously the vital signs of the patient during transit.

Source record↗
DOE OSTI2015

Why (just) information is not enough: The contributions of information services in the management of healthcare information

Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services’ contributions to hospital environment is presented.

99 GENERAL AND MISCELLANEOUS↗
DOE OSTI2016

SU-F-I-40: Impact of Scan Length On Patient Dose in Abdomen/pelvis CT Diagnosis

Purpose: To analysis the impact of scan length on patient doses in abdomen/pelvis CT diagnosis of each hospital. Methods: Scan length of 7 hospitals from abdomen/pelvis CT diagnosis was surveyed in Korea. Surveyed scan lengths were additional distance above diaphragm and distance below pubic symphysis except for standard scan range between diaphragm and pubic symphysis. Patient dose was estimated for adult male and female according to scan length of each hospital. CT-Expo was used to estimate the patient dose under identical equipment settings (120 kVp, 100 mAs, 10 mm collimation width, etc.) except scan length. Effective dose was calculated by using tissue weighting factor of ICRP 103 recommendation. Increase rate of effective dose was calculated comparing with effective dose of standard scan range Results: Scan lengths of abdomen/pelvis CT diagnosis of each hospital were different. Also effective dose was increased with increasing the scan length. Generally increasing the distance above diaphragm caused increase of effective dose of male and female, but increasing the distance below pubic symphysis caused increase of effective dose of male. Conclusion: We estimated the patient dose according to scan length of each hospital in abdomen/pelvis CT diagnosis. Effective dose was increased by increasing the scan length because dose of organs with high tissue weighting factor such as lung, breast, testis were increased. Scan length is important factor on patient dose in CT diagnosis. If radiologic technologist interested in patient dose, decreasing the unnecessary scan length will decrease the risk of patients from radiation. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C0004).

60 APPLIED LIFE SCIENCES↗
DOE OSTI2019

Comparison of Endovascular and Open Carotid Artery Treatment in Germany: A Retrospective Analysis from 2010 to 2015

Introduction: We analyzed trends in carotid artery stenting (CAS) and carotid endarterectomy (CEA) in hospitalized cases in Germany in the years 2010–2015. Methods: Data from national statistics (DRG statistics) published by the Federal Statistical Office in Germany describing the number of hospitalized patients treated with CEA and CAS were used. In addition, numbers of patients hospitalized with the principal diagnosis stroke associated with precerebral lesions (ICD code I63), transitory cerebral ischemic attacks (G45) and precerebral carotid artery stenosis (I65) treated by CEA and CAS were analyzed for the year 2015. Results: Total number of CEA decreased by 4.0% from 24.067 (2010) to 23.104 (2015) and CAS increased by 5.1% from 5.703 to 5.992. In 2015, 79.4% of all procedures coded concerning the internal carotid artery were CEA and 21.6% CAS. From 27.798 cases hospitalized with the principal diagnosis stroke associated with precerebral lesions, CEA was performed in 3.921 (14.1%) and in 2.132 (7.7%) CAS was documented, with CAS making up one-third of all treatments within the stroke group. In 28.273 cases hospitalized with a TIA, CEA was specified in 853 (3.0%) and CAS in 255 (0.9%) cases. In 27.553 cases with an occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction, 17.036 (61.8%) had a CEA and 3.156 (11.5%) a CAS procedure. Conclusion: CEA is still the primary treatment of extracranial artery stenosis. The impact of CAS becomes mainly apparent in cases presenting with acute strokes.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Monte Carlo study for designing a dedicated “D”-shaped collimator used in the external beam radiotherapy of retinoblastoma patients

Purpose: Retinoblastoma is the most common intraocular malignancy in the early childhood. Patients treated with external beam radiotherapy respond very well to the treatment. However, owing to the genotype of children suffering hereditary retinoblastoma, the risk of secondary radio-induced malignancies is high. The University Hospital of Essen has successfully treated these patients on a daily basis during nearly 30 years using a dedicated “D”-shaped collimator. The use of this collimator that delivers a highly conformed small radiation field, gives very good results in the control of the primary tumor as well as in preserving visual function, while it avoids the devastating side effects of deformation of midface bones. The purpose of the present paper is to propose a modified version of the “D”-shaped collimator that reduces even further the irradiation field with the scope to reduce as well the risk of radio-induced secondary malignancies. Concurrently, the new dedicated “D”-shaped collimator must be easier to build and at the same time produces dose distributions that only differ on the field size with respect to the dose distributions obtained by the current collimator in use. The scope of the former requirement is to facilitate the employment of the authors' irradiation technique both at the authors' and at other hospitals. The fulfillment of the latter allows the authors to continue using the clinical experience gained in more than 30 years. Methods: The Monte Carlo codePENELOPE was used to study the effect that the different structural elements of the dedicated “D”-shaped collimator have on the absorbed dose distribution. To perform this study, the radiation transport through a Varian Clinac 2100 C/D operating at 6 MV was simulated in order to tally phase-space files which were then used as radiation sources to simulate the considered collimators and the subsequent dose distributions. With the knowledge gained in that study, a new, simpler, “D”-shaped collimator is proposed. Results: The proposed collimator delivers a dose distribution which is 2.4 cm wide along the inferior-superior direction of the eyeball. This width is 0.3 cm narrower than that of the dose distribution obtained with the collimator currently in clinical use. The other relevant characteristics of the dose distribution obtained with the new collimator, namely, depth doses at clinically relevant positions, penumbrae width, and shape of the lateral profiles, are statistically compatible with the results obtained for the collimator currently in use. Conclusions: The smaller field size delivered by the proposed collimator still fully covers the planning target volume with at least 95% of the maximum dose at a depth of 2 cm and provides a safety margin of 0.2 cm, so ensuring an adequate treatment while reducing the irradiated volume.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-P-19: A National Collaborative Academic Medical Physics Network: Structure, Activity and Outcomes

Purpose: A national Australian inter-university medical physics (MP) group was formed in 2011/12, supported by Department of Health Better Access to Radiation Oncology BARO) seed funding. Core membership includes the six universities providing postgraduate MP courses. Objectives include increasing capacity, development and efficiency of national academic MP structures/systems and hence supporting education, clinical training and research, for the MP workforce support. Although the BARO scheme focuses on Radiation Oncology, the group has wider MP interests. Methods: Two further BARO seed grants were achieved: 1) for networked academic activities, including shared-resource teaching, eg using virtual reality systems; MP outreach to schools and undergraduates; developing web-based student and registrar education/resources, etc.; and 2) for conjoint ‘translational research’ posts between universities and partner hospitals, to clinically progress advanced RT technologies and to support students and registrars. Each university received 0.5 FTE post from each grant over 2 years (total: $1.75M) and leveraged local additional partner funds. Results: Total funding: $4–5M. Overall there have been 35 (mainly overseas) postholders bringing specific expertise, beginning in early 2013. Periods in Australia have been from 0.25–2 years (median=1). As well as the education activities, research projects include lung/spine SBRT, 4D RT, FFF beams, technology assessment, complex treatment planning, imaging for radiation oncology, DIR, adaptive breast, datamining, radiomics,etc. Observed positive impacts include: increased interest in MP courses, training support, translational research infrastructure and/or clinical practice in the hospitals involved, plus increased collaboration and effectiveness between the universities. Posts are continuing beyond grant end using leveraged funds, providing the basis for sustainability of some posts. Conclusion: The BARO-funded projects have cost-effectively produced a range of positive impacts on training, research and practice in hospitals and between universities. The evaluation of the specific post roles and activities, and their outcomes, has produced focused recommendations on continuation and sustainability. Funding was from the Australian federal Department of Health; leveraged funding was from partner universities and hospitals.

60 APPLIED LIFE SCIENCES↗