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DOE OSTI2023

Technologist in Residence for Advanced Manufacturing and Materials in Unconventional Oil and Gas Equipment and Infrastructure

The DOE Technologist in Residence (TIR) program pairs a senior technical staff member from a National Laboratory (Lab Technologist), and a senior technical staff member(s) from a clean energy manufacturing company or consortium of companies (Industry Technologist). Each technologist may represent single or multiple national laboratories, or single or multiple companies. These pairs of Lab and industry technologists work together for a period of 18 to 24 months to accomplish several goals: 1) Identify the participating company’s (or companies’) technical priorities and challenges, and the resources and capabilities in DOE’s National Laboratories that may be highly suitable to address them; 2) Propose collaborative R&D efforts to develop science-based solutions to the company’s (or companies’) most strategic scientific, technological, and business issues; and 3) Develop a general framework agreement and begin developing specific scopes of work for the proposed collaborative R&D efforts. The proposed R&D will then take place outside of the program and will not use TIR program funds. Oak Ridge National Laboratory (ORNL) and Pioneer Natural Resources were awarded a TIR project by DOE in late 2016 and the CRADA component of the project was initiated in 2017. This report describes work performed under the CRADA agreement between 2017 and 2020.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗
DOE OSTI2023

Inaugural Technologist in Communities Scanning Tour: Automated and Electrified On-Demand Mobility (Follow-On Summary Report: April 24-25, 2023) [Slides]

In 2023, the Technologist in Communities (TIC) program hosted its inaugural scanning tour across the American Southwest, with a goal of investigating the region's leading public mobility systems and their integration with on-demand public mobility services. The scanning tour concept was inspired by and named after a U.S. Department of Transportation Federal Highway Administration practice of hosting "scanning tours," both domestically and abroad, to explore innovative transportation practices throughout the 1990s and early 2000s. Guided by the idea that "seeing is believing," scanning tours created opportunities for government and industry representatives to collectively experience new technologies and best practices firsthand. In 2023, the National Renewable Energy Laboratory (NREL) followed suit by leading the inaugural TIC scanning tour. TIC, part of the Technology Integration program within the U.S. Department of Energy's (DOE's) Vehicle Technologies Office, supports positive energy and mobility outcomes in communities across rural to urban contexts. TIC enables technical experts to work directly with leaders and stakeholders in communities and assist them in implementing promising new technologies. This first TIC scanning tour invited NREL, DOE, and industry experts to survey innovative public mobility practices and their integration into public transit systems across the Southwest. The tour's goals included examining the state of innovation in public mobility in cities, communities, and airports; facilitating collaboration between entities; and sparking potential new partnerships. The following report summarizes key findings from the scanning tour.

24 POWER TRANSMISSION AND DISTRIBUTION↗
DOE OSTI2016

MO-DE-BRA-01: Flipped Physics Courses Within a Radiologic Technologist Program: Video Production and Long Term Outcomes

Purpose: To determine if the flipped class format has an effect on examination results for a radiologic technologist (RT) program and discuss benefits from creating video resources. Methods: From 2001–2015, students had taken both a radiological physics and quality control (QC) class as a part of their didactic training. In 2005/2006, the creation of videos of didactic lectures and QC test demonstrations allowed for a flip where content was studied at home while exercises and reviews were done in-class. Final examinations were retrospectively reviewed from this timeframe. 12 multiple choice physics questions (MCP) and 5 short answer QC questions (SAQC) were common to pre and post flip exams. The RT program’s ARRT exam scores were also obtained and compared to national averages. Results: In total, 36 lecture videos and 65 quality control videos were created for the flipped content. Data was ∼2.4GB and distributed to students via USB or CD media. For MCP questions, scores improved by 7.9% with the flipped format and significance (Student’s t-test, p<0.05) was found for 3 of the 12 questions. SAQC questions showed improvement by 14.6% and significance was found for 2 of the 5 questions. Student enrollment increased from ∼14 (2001–2004) to ∼23 students (2005–15). Content was continuously added post-flip due to the efficiency of delivery. The QC class in 2003 covered 45 test setups in-class while 65 were covered with video segments in 2014. Flipped materials are currently being repurposed. In 2015, this video content was restructured into an ARRT exam review guide and in 2016, the content was reorganized for fluoroscopy training for physicians. Conclusion: We believe that flipped classes can improve efficiency of content delivery and improve student performance even with an increase in class size. This format allows for flexibility in learning as well as re-use in multiple applications.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2021

Acceptable Knowledge Technologist Procedure

Process acceptable knowledge (AK) is a waste stream characterization method that can be used to meet all or part of the waste analysis requirements appropriate for the waste. The method may include documented knowledge of process (KOP), additional characterization data, and/or facility records of analysis. LANL will use process AK to ensure chemical compatibility; assign matrix parameter categories and Environmental Protection Agency (EPA) hazardous waste numbers (HWNs) commonly referred to as EPA codes to waste streams; and determine the waste material parameters and radionuclides present in waste streams.

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗
DOE OSTI2014

SU-E-I-95: Personalized Radiography Technical Parameters for Each Patient and Exam

Purpose: To determine exact electrical parameters (kV, mAs) a radiological technologist shall use taking account the exam and patient's structure, with guarantee of minimum dose and adequate quality image. Methods: A patient's absorbed dose equation was developed by means of Entrance Skin Dose (ESD), irradiated area and patient width for specific anatomy. ESD is calculated from a developed equation, where entrance surface air-KERMA and backscatter factor are included, with air-to-skin coefficient conversion. We developed specific Lambert-Beer attenuation equations derived from mass energy-absorption coefficients data for skin, fat, and muscle and bone as one tissue. Anatomy tissue thickness distribution at central X-ray location in anteroposterior incidence for hand and chest, was estimate by discounting constant skin and bone thickness from patient measured width, assuming the result as muscle and fat. A clinical research at a big hospital were executed when real parameters (kV, mAs, filtration, ripple) used by technologists were combined with the image quality and patient's data: anatomy width, height and weight. A correlation among the best images acquired and electrical parameters used were confronted with patient's data and dose estimation. The best combinations were used as gold standards. Results: For each anatomy, two equations were developed to calculate voltage (kV) and exposure (mAs) to reproduce and interpolate the gold standards. Patient is measured and data are input into equations, giving radiological technologists the right set of electrical parameters for that specific exam. Conclusion: This work indicates that radiological technologist can personalize the exact electrical parameters for each patient exam, instead of using standard values. It also guarantee that patients under or over-sized measures will receive the right dose for the best image. It will stop wrong empiric adjusts technologists do when examining a non-standard patient and reduce probability of radiography retaken because of over or under exposition.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Ongoing quality control in digital radiography: Report of AAPM Imaging Physics Committee Task Group 151

Quality control (QC) in medical imaging is an ongoing process and not just a series of infrequent evaluations of medical imaging equipment. The QC process involves designing and implementing a QC program, collecting and analyzing data, investigating results that are outside the acceptance levels for the QC program, and taking corrective action to bring these results back to an acceptable level. The QC process involves key personnel in the imaging department, including the radiologist, radiologic technologist, and the qualified medical physicist (QMP). The QMP performs detailed equipment evaluations and helps with oversight of the QC program, the radiologic technologist is responsible for the day-to-day operation of the QC program. The continued need for ongoing QC in digital radiography has been highlighted in the scientific literature. The charge of this task group was to recommend consistency tests designed to be performed by a medical physicist or a radiologic technologist under the direction of a medical physicist to identify problems with an imaging system that need further evaluation by a medical physicist, including a fault tree to define actions that need to be taken when certain fault conditions are identified. The focus of this final report is the ongoing QC process, including rejected image analysis, exposure analysis, and artifact identification. These QC tasks are vital for the optimal operation of a department performing digital radiography.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-P-06: Moving From Computed Radiography to Digital Radiography: A Collaborative Approach to Improve Image Quality

Purpose: To bring together radiologists, technologists, and physicists to utilize post-processing techniques in digital radiography (DR) in order to optimize image acquisition and improve image quality. Methods: Sub-optimal images acquired on a new General Electric (GE) DR system were flagged for follow-up by radiologists and reviewed by technologists and medical physicists. Various exam types from adult musculoskeletal (n=35), adult chest (n=4), and pediatric (n=7) were chosen for review. 673 total images were reviewed. These images were processed using five customized algorithms provided by GE. An image score sheet was created allowing the radiologist to assign a numeric score to each of the processed images, this allowed for objective comparison to the original images. Each image was scored based on seven properties: 1) overall image look, 2) soft tissue contrast, 3) high contrast, 4) latitude, 5) tissue equalization, 6) edge enhancement, 7) visualization of structures. Additional space allowed for additional comments not captured in scoring categories. Radiologists scored the images from 1 – 10 with 1 being non-diagnostic quality and 10 being superior diagnostic quality. Scores for each custom algorithm for each image set were summed. The algorithm with the highest score for each image set was then set as the default processing. Results: Images placed into the PACS “QC folder” for image processing reasons decreased. Feedback from radiologists was, overall, that image quality for these studies had improved. All default processing for these image types was changed to the new algorithm. Conclusion: This work is an example of the collaboration between radiologists, technologists, and physicists at the University of New Mexico to add value to the radiology department. The significant amount of work required to prepare the processing algorithms, reprocessing and scoring of the images was eagerly taken on by all team members in order to produce better quality images and improve patient care.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

Establishing radiation therapy advanced practice in New Zealand

Introduction: Advanced practice (AP) is of increasing interest to many radiation therapists (RTs) both nationally and internationally. In New Zealand, initial research (2005–2008) showed strong support for the development of an AP role for medical radiation technologists (MRTs). Here, we report on a nationwide survey in which RTs validated and prioritised nine AP profiles for future development. Methods: All registered RTs in New Zealand (n = 260) were invited to take part in a survey in December 2011; 73 of whom returned a complete response. Results: RTs supported the implementation of AP roles in New Zealand and the requirement of a Master's degree qualification to underpin clinical knowledge. Most RTs endorsed the criteria attributed to each of the nine proposed AP profiles. The study identified that activities may qualify as either advanced practice or standard practice depending on the department. All participants agreed that an advanced practitioner should be a leader in the field, able to initiate and facilitate future developments within as well as outside this specific role. Acceptance of the AP roles by RTs and other health professionals as well as the availability of resources for successful implementation, were concerns expressed by some RTs. Conclusion: The authors recommend (1) the development of one scope of practice titled ‘advanced practitioner’ with generic and specialist criteria for each profile as the future career pathway, (2) promotion and support for the AP pathway by the New Zealand Institute of Medical Radiation Technology and the New Zealand Medical Radiation Technologists Board.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

Establishing advanced practice for medical imaging in New Zealand

Introduction: This article presents the outcome and recommendations following the second stage of a role development project conducted on behalf of the New Zealand Institute of Medical Radiation Technology (NZIMRT). The study sought to support the development of profiles and criteria that may be used to formulate Advanced Scopes of Practice for the profession. It commenced in 2011, following on from initial research that occurred between 2005 and 2008 investigating role development and a possible career structure for medical radiation technologists (MRTs) in New Zealand (NZ). Methods: The study sought to support the development of profiles and criteria that could be used to develop Advanced Scopes of Practice for the profession through inviting 12 specialist medical imaging groups in NZ to participate in a survey. Results: Findings showed strong agreement on potential profiles and on generic criteria within them; however, there was less agreement on specific skills criteria within specialist areas. Conclusions: The authors recommend that one Advanced Scope of Practice be developed for Medical Imaging, with the establishment of generic and specialist criteria. Systems for approval of the overall criteria package for any individual Advanced Practitioner (AP) profile, audit and continuing professional development requirements need to be established by the Medical Radiation Technologists Board (MRTB) to meet the local needs of clinical departments. It is further recommended that the NZIMRT and MRTB promote and support the need for an AP pathway for medical imaging in NZ.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

Radiation Therapy Infrastructure and Human Resources in Low- and Middle-Income Countries: Present Status and Projections for 2020

Purpose: Radiation therapy, a key component of cancer management, is required in more than half of new cancer patients, particularly in low- and middle-income countries (LMICs). The projected rise in cancer incidence over the next decades in LMICs will result in an increasing demand for radiation therapy services. Considering the present cancer incidence and that projected for 2020 (as listed in GLOBOCAN), we evaluated the current and anticipated needs for radiation therapy infrastructure and staffing by 2020 for each of the LMICs. Methods and Materials: Based on World Bank classification, 139 countries fall in the category of LMICs. Details of teletherapy, radiation oncologists, medical physicists, and radiation therapy technologists were available for 84 LMICs from the International Atomic Energy Agency–Directory of Radiotherapy Centres (IAEA-DIRAC) database. Present requirements and those for 2020 were estimated according to recommendations from the IAEA and European Society for Radiotherapy and Oncology (ESTRO-QUARTS). Results: Only 4 of the 139 LMICs have the requisite number of teletherapy units, and 55 (39.5%) have no radiation therapy facilities at present. Patient access to radiation therapy in the remaining 80 LMICs ranges from 2.3% to 98.8% (median: 36.7%). By 2020, these 84 LMICs would additionally need 9169 teletherapy units, 12,149 radiation oncologists, 9915 medical physicists, and 29,140 radiation therapy technologists. Moreover, de novo radiation therapy facilities would have to be considered for those with no services. Conclusions: Twelve pragmatic steps are proposed for consideration at national and international levels to narrow the gap in radiation therapy access. Multipronged and coordinated action from all national and international stakeholders is required to develop realistic strategies to curb this impending global crisis.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2016

Health Literacy and Patient Preparation in Radiology

Health literacy is the capacity of an individual to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Unfortunately, more than half of Canadians cannot adequately navigate the health care system because they have limited health literacy. Patients with low health literacy may have limited reading abilities and poorer comprehension of written preparation documents. An important consideration in the radiation sciences for these patients is the ability to follow preparation requirements for diagnostic imaging procedures. It has been suggested that patients with limited health literacy are often less prepared for diagnostic examinations, and as a result, tend to have examinations of poorer diagnostic quality. Medical radiation technologists play an important role in educating patients regarding medical imaging examinations and helping them to properly prepare for these procedures. The purpose of this article is to define health literacy, provide some practical strategies to help medical radiation technologists identify patients with limited health literacy, and how to address limited health literacy issues to improve the quality of diagnostic imaging examinations.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

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↗
DOE OSTI2014

SU-E-I-88: Mammography Imaging: Does Positioning Matter?

Purpose: In mammography, compression is imperative for quality images and glandular radiation exposure dose. The thickness of the compressed breast directly determines mammography acquisition parameters. The compressed thickness varies due to variation in technologist practice, even for the same patient imaged at different time. This study is to investigate potential effect of the variation in breast positioning on radiation dose and image quality. Methods: Radiation dose at different thicknesses was measured with a BR-12 breast phantom for both conventional craniocaudal view and tomosynthesis in a Hologic Tomosynthesis mammography system. The CIRS stereotactic needle biopsy training phantom embedded dense masses and microcalcification in various sizes were imaged for image quality evaluation. Radiologists evaluated images. Clinical mammograms from the same patient but acquired at different time were retrospectively retrieved to evaluate potential effects of variation in positioning. Results: Acquisition parameters (kVp and mAs) increase with the increased phantom thickness. Radiation exposure increases following an exponential trend. The stereotactic phantom images showed loss of spatial and contrast resolution with inappropriate positioning. The compressed pressure may not be a good indicator for appropriate positioning. The inclusion of different amount of pectoralis muscle may lead to the same compressed pressure but different compressed thickness. The initial retrospective study of 3 patients showed that there were potential large variations in positioning the same patient at different examination time, resulting in large variations in patient radiation dose and image quality. Conclusion: Variations in patient positioning potentially influence patient radiation dose and image quality. The technologist has the critical responsibility to position patient to provide quality images in spite of different breast and body types. To reduce intra and inter practice variations in positioning patient, a training program among each breast imaging center may be a need.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

MO-F-16A-06: Implementation of a Radiation Exposure Monitoring System for Surveillance of Multi-Modality Radiation Dose Data

Purpose: We have implemented a commercially available Radiation Exposure Monitoring System (REMS) to enhance the processes of radiation dose data collection, analysis and alerting developed over the past decade at our sites of practice. REMS allows for consolidation of multiple radiation dose information sources and quicker alerting than previously developed processes. Methods: Thirty-nine x-ray producing imaging modalities were interfaced with the REMS: thirteen computed tomography scanners, sixteen angiography/interventional systems, nine digital radiography systems and one mammography system. A number of methodologies were used to provide dose data to the REMS: Modality Performed Procedure Step (MPPS) messages, DICOM Radiation Dose Structured Reports (RDSR), and DICOM header information. Once interfaced, the dosimetry information from each device underwent validation (first 15–20 exams) before release for viewing by end-users: physicians, medical physicists, technologists and administrators. Results: Before REMS, our diagnostic physics group pulled dosimetry data from seven disparate databases throughout the radiology, radiation oncology, cardiology, electrophysiology, anesthesiology/pain management and vascular surgery departments at two major medical centers and four associated outpatient clinics. With the REMS implementation, we now have one authoritative source of dose information for alerting, longitudinal analysis, dashboard/graphics generation and benchmarking. REMS provides immediate automatic dose alerts utilizing thresholds calculated through daily statistical analysis. This has streamlined our Closing the Loop process for estimated skin exposures in excess of our institutional specific substantial radiation dose level which relied on technologist notification of the diagnostic physics group and daily report from the radiology information system (RIS). REMS also automatically calculates the CT size-specific dose estimate (SSDE) as well as provides two-dimensional angulation dose maps for angiography/interventional procedures. Conclusion: REMS implementation has streamlined and consolidated the dosimetry data collection and analysis process at our institutions while eliminating manual entry error and providing immediate alerting and access to dosimetry data to both physicists and physicians. Brent Stewart has funded research through GE Healthcare.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

TH-C-18A-08: A Management Tool for CT Dose Monitoring, Analysis, and Protocol Review

Purpose: To develop a customizable tool for enterprise-wide managing of CT protocols and analyzing radiation dose information of CT exams for a variety of quality control applications Methods: All clinical CT protocols implemented on the 11 CT scanners at our institution were extracted in digital format. The original protocols had been preset by our CT management team. A commercial CT dose tracking software (DoseWatch,GE healthcare,WI) was used to collect exam information (exam date, patient age etc.), scanning parameters, and radiation doses for all CT exams. We developed a Matlab-based program (MathWorks,MA) with graphic user interface which allows to analyze the scanning protocols with the actual dose estimates, and compare the data to national (ACR,AAPM) and internal reference values for CT quality control. Results: The CT protocol review portion of our tool allows the user to look up the scanning and image reconstruction parameters of any protocol on any of the installed CT systems among about 120 protocols per scanner. In the dose analysis tool, dose information of all CT exams (from 05/2013 to 02/2014) was stratified on a protocol level, and within a protocol down to series level, i.e. each individual exposure event. This allows numerical and graphical review of dose information of any combination of scanner models, protocols and series. The key functions of the tool include: statistics of CTDI, DLP and SSDE, dose monitoring using user-set CTDI/DLP/SSDE thresholds, look-up of any CT exam dose data, and CT protocol review. Conclusion: our inhouse CT management tool provides radiologists, technologists and administration a first-hand near real-time enterprise-wide knowledge on CT dose levels of different exam types. Medical physicists use this tool to manage CT protocols, compare and optimize dose levels across different scanner models. It provides technologists feedback on CT scanning operation, and knowledge on important dose baselines and thresholds.

60 APPLIED LIFE SCIENCES↗