McBride, Sean | Search NASA

DOE OSTI2023

CRITICAL FUNCTION ASSURANCE: Understanding Critical Function and Critical Function Delivery is Foundational for Meaningful ICS Security Improvement and Policy Efforts

Modern life is enabled by a complex and interdependent web of critical functions, including energy, communications, transportation, food, and water. Automation has significantly reduced or replaced human interactions in the delivery of these functions, resulting in a web of goods and services that are made available 24/7 only through unique and intentional deployments of microprocessors, software, and firmware technologies. The prospect of cyber-enabled sabotage of these processes disrupts traditional risk determination models. Critical Function Assurance (CFA) is a foundational approach to identifying, prioritizing, and mitigating the risk that is inherent in the delivery of critical functions that depend on digital technology. It provides rapid focus to what matters most and illuminates elements and areas of risk that otherwise are often overlooked. This focus enables effective application of available security resources and optimizes security strategy and policy efforts. This paper introduces CFA to decision makers and risk executives (including CEOs, COOs, CFOs, and CISOs) whose organizations support and deliver the critical functions that underpin national defense, societal health and safety, and a vibrant economy.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2016

Strategy of Using Intratreatment Hypoxia Imaging to Selectively and Safely Guide Radiation Dose De-escalation Concurrent With Chemotherapy for Locoregionally Advanced Human Papillomavirus–Related Oropharyngeal Carcinoma

Purpose: To report a small substudy of an ongoing large, multi-arm study using functional imaging to assess pre-/intratreatment hypoxia for all head and neck cancer, in which we hypothesized that pre- and early-treatment hypoxia assessment using functional positron emission tomography (PET) imaging may help select which human papillomavirus (HPV)-positive (HPV{sup +}) oropharyngeal cancer (OPC) patients can safely receive radiation de-escalation without jeopardizing treatment outcomes. Methods and Materials: Patients with HPV{sup +} oropharyngeal carcinoma were enrolled on an institutional review board–approved prospective study of which de-escalation based on imaging response was done for node(s) only. Pretreatment {sup 18}F-fluorodeoxyglucose and dynamic {sup 18}F-FMISO (fluoromisonidazole) positron emission tomography (PET) scans were performed. For patients with pretreatment hypoxia on{sup 18}F-FMISO PET (defined as a >1.2 tumor to muscle standard uptake value ratio), a repeat scan was done 1 week after chemoradiation. Patients without pretreatment hypoxia or with resolution of hypoxia on repeat scan received a 10-Gy dose reduction to metastatic lymph node(s). The 2-year local, regional, distant metastasis–free, and overall survival rates were estimated using the Kaplan-Meier product-limit method. A subset of patients had biopsy of a hypoxic node done under image guidance. Results: Thirty-three HPV{sup +} OPC patients were enrolled in this pilot study. One hundred percent showed pretreatment hypoxia (at primary site and/or node[s]), and among these, 48% resolved (at primary site and/or node[s]); 30% met criteria and received 10-Gy reduction to the lymph node(s). At the median follow-up of 32 months (range, 21-61 months), the 2-year locoregional control rate was 100%. One patient failed distantly with persistence of hypoxia on {sup 18}F-FMISO PET. The 2-year distant metastasis–free rate was 97%. The 2-year OS rate was 100%. Hypoxia on imaging was confirmed pathologically. Conclusions: Hypoxia is present in HPV{sup +} tumors but resolves within 1 week of treatment in 48% of cases either at the primary site and/or lymph node(s). Our 100% locoregional control rate suggests that intratreatment functional imaging used to selectively de-escalate node(s) to 60 Gy was confirmed safe using our stringent imaging criteria. Intratreatment functional imaging warrants further study to determine its ultimate role in de-escalation treatment strategies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗