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Patient-Reported Outcomes in the Acute Phase of the Randomized Hypofractionated Irradiation for Prostate Cancer (HYPRO) Trial

Many patients experience bowel and bladder toxicity during the acute phase of radiation therapy for prostate cancer. Recent literature indicates that hypofractionation (HF) might increase this acute response but little is known on patient-reported outcome during this phase with HF. We evaluated the course of patient-reported acute symptoms during HF versus standard fractionated (SF) radiation therapy within the hypofractionated irradiation for prostate cancer (HYPRO) trial.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Diagnostic, Prognostic, and Therapeutic Use of Radiopharmaceuticals in the Context of SARS-CoV-2

The coronavirus disease 2019 (COVID-19) outbreak has devastated the healthcare systems and economies of over 200 countries in just a few months. The etiological agent of COVID-19, SARS-CoV-2, is a highly contagious virus that can be transmitted by asymptomatic and symptomatic carriers alike. While in vitro testing techniques have allowed for population-wide screening, prognostic tools are required to assess the disease severity and therapeutic response, contributing to improve the patient clinical outcomes. Moreover, no specific antiviral against COVID-19 exists at the time of publication, severely limiting treatment against the infection. Hence, there is an urgent clinical need for innovative therapeutic strategies that may contribute to manage the COVID-19 outbreak and prevent future pandemics. In this work, we critically examine recent diagnostic, prognostic, and therapeutic advancements for COVID-19 in the field of radiopharmaceuticals. First, we summarize the gold standard techniques used to diagnose COVID-19, including in vitro assays and imaging techniques, and then discuss how radionuclide-based nuclear imaging provides complementary information for prognosis and treatment management of infected patients. Second, we introduce new emerging types of radiotherapies that employ radioimmunoconjugates, which have shown selective cytotoxic response in oncological studies, and critically analyze how these compounds could be used as therapeutic agents against SARS-CoV-2. Finally, this Perspective further discusses the emerging applications of radionuclides to study the behavior of pulmonary SARS-CoV-2 aerosol particles.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Safety Considerations for Advanced Material Irradiation at the Advanced Test Reactor

The Advanced Test Reactor (ATR) is a light water reactor with aluminum-clad driver fuel. A primary mission of the ATR is to support the next generation of nuclear reactors. This support necessarily requires irradiation of advanced materials such as sodium, fuel salts, and metal eutectics. Irradiation of advanced materials in the ATR environment presents a challenge when completing accident analyses and demonstrating compliance to the Safety Analysis Report (SAR). Many advanced materials have the possibility to react with the ATR protective barriers such as the cladding or primary coolant system (PCS) boundary during postulated accident scenarios. Further, molten fuel experiments fall outside of the standard regulatory framework for dose consequence analyses. ATR is currently developing new safety analysis methods to support irradiation of advanced materials. The primary considerations for this development are 1) experiment containment design requirements, 2) primary coolant system response to an experiment containment failure, and 3) dose analyses for molten fuels.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

Safety Considerations for Advanced Material Irradiation at the ATR

The Advanced Test Reactor (ATR) is a light water reactor with aluminum-clad driver fuel. A primary mission of the ATR is to support the next generation of nuclear reactors. This support necessarily requires irradiation of advanced materials such as sodium, fuel salts, and metal eutectics. Irradiation of advanced materials in the ATR environment presents a challenge when completing accident analyses and demonstrating compliance to the Safety Analysis Report (SAR). Many advanced materials have the possibility to react with the ATR protective barriers such as the cladding or primary coolant system (PCS) boundary during postulated accident scenarios. Further, molten fuel experiments fall outside of the standard regulatory framework for dose consequence analyses. ATR is currently developing new safety analysis methods to support irradiation of advanced materials. The primary considerations for this development are 1) experiment containment design requirements, 2) primary coolant system response to an experiment containment failure, and 3) dose analyses for molten fuels.

11 NUCLEAR FUEL CYCLE AND FUEL MATERIALS↗

Patterns and Predictors of Failure in Recurrent or Refractory Large B-Cell Lymphomas After Chimeric Antigen Receptor T-Cell Therapy

Chimeric antigen receptor T-cell (CAR T) therapy is capable of eliciting durable responses in patients with relapsed/refractory (R/R) lymphomas. However, most treated patients relapse. Patterns of failure after CAR T have not been previously characterized, and may provide insights into the mechanisms of resistance guiding future treatment strategies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

URC/HRC Selection Guidance

Given the importance of the URC and HRC thresholds as part of a physical security program that is designed to protect against radiological sabotage, it is important to provide guidance on how to assign those thresholds consistent with a State’s level of risk tolerance. Without such guidance, most States will be challenged to establish appropriate thresholds or appropriately establish regulations. This document provides guidance on establishing dose limits and where they apply, as well as the timeframe for which the dose limits should be measured. For dose limits, it offers examples of established thresholds based on safety and emergency response thresholds. Whereas, for timeframes, a process to identify possible timeframes is offered.

45 MILITARY TECHNOLOGY, WEAPONRY, AND NATIONAL DEF↗

NIRP Core Software Suite v.5.1

SAND2023-06610O The Nuclear Incident Response Program (NIRP) Core Software Suite is a set of code that supports multiple applications. It includes miscellaneous base code for data objects, mathematic equations, and user interface components that are used for developing large applications, including those used for data management. Among the types of applications: • Analyst Manager is used for managing contact information, which is also often included in reports and identifies the owners of calculations. • Radionuclide Viewer provides access to the Dose Coefficient File Package (DCFPAK) radiological data, and it complements the Mixture Manager tool. • Mixture Manager creates and manages radionuclides mixtures that are commonly used in other applications. • High Explosive Manager manages explosives and properties. • Chart Viewer is used for data charts such as meteorology charts and other charts specific to data needs. • Unit Converter converts numeric values to/from different units. This package includes object-oriented base code such as data objects describing the date, time, and location of an event; weather conditions; data types that support predefined ranges of values; a unit library, and others. The package also includes mathematic equations such as determining the distance between two points; erf functions; factorial functions; incidence fractions of probit curves; and others. Other features are customized user interface components for text fields; unit selectors (combo boxes); menus; panels; bug-tracking; and automated checks for software updates. Sandia National Laboratories is a multimission laboratory managed and operated by National Technology & Engineering Solutions of Sandia, LLC, a wholly owned subsidiary of Honeywell International Inc., for the U.S. Department of Energy’s National Nuclear Security Administration under contract DE-NA0003525.

Collins, Ian↗

Comparison of All Solid Cancer Mortality and Incidence Dose-Response in the Life Span Study of Atomic Bomb Survivors, 1958–2009

Recent analysis of all solid cancer incidence (1958–2009) in the Life Span Study (LSS) revealed evidence of upward curvature in the radiation dose response among males but not females. Upward curvature in sex-averaged excess relative risk (ERR) for all solid cancer mortality (1950–2003) was also observed in the 0–2 Gy dose range. As reasons for non-linearity in the LSS are not completely understood, we conducted dose response analyses for all solid cancer mortality and incidence applying similar methods (1958–2009 follow-up, DS02R1 doses, including subjects notin-city (NIC) at the time of the bombing) and statistical models. Incident cancers were ascertained from Hiroshima and Nagasaki cancer registries, while cause of death was ascertained from death certificates over entire Japan. The study included 105,444 LSS subjects who were alive and not known to have cancer before Jan 1, 1958 (80,205 with dose estimates and 25,239 NIC subjects). Between 1958 and 2009, there were 3.1 million person-years (PY) and 22,538 solid cancers for incidence analysis and 3.8 million PY and 15,419 solid cancer deaths for mortality analysis. We fitted sex-specific ERR models adjusted for smoking to both types of data. Over the entire range of doses, solid cancer mortality dose response exhibited a borderline significant upward curvature among males (P=0.062) and significant upward curvature among females (P=0.010); for solid cancer incidence, as before, we found a significant upward curvature among males (P=0.001) but not among females (P=0.624). The sex difference in magnitude of dose response curvature was statistically significant for cancer incidence (P=0.017) but not for cancer mortality (P=0.781). The results of analyses in the 0–2 Gy range and restricted lower dose ranges generally supported inferences made about the sex-specific dose response shape over the entire range of doses for each outcome. Patterns of sex-specific curvature by calendar period (1958–1987 vs 1988–2009) and age at exposure (0–19 vs 20–83) varied between mortality and incidence data, particularly among females, although for each outcome there was an indication of curvature among 0–19 year old male survivors in both calendar periods and among 0–19 year old female survivors in the recent period. Collectively, our findings indicate that the upward curvature in all solid cancer dose response in the LSS is neither specific to males nor to incidence data; it appears to depend on composition of case series and age at exposure or time. Further follow-up and site-specific analyses of cancer mortality and incidence will be important to confirm the emerging trend in dose response curvature among young survivors and unveil the contributing factors and sites.

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTAN↗

Prostate Stereotactic Body Radiation Therapy: An Overview of Toxicity and Dose Response

Ultrahypofractionationed radiation therapy for prostate cancer is increasingly studied and adopted. The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiotherapy therefore aimed to review studies examining toxicity and quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer and model its effect.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

MACCS Theory Manual

This report describes the models of the MACCS computer code as presented in MACCS Version 3.10.0. The purpose of MACCS is to simulate the impact of severe accidents at nuclear power plants on the surrounding environment. MACCS has been developed by Sandia National Laboratories for the U.S. Nuclear Regulatory Commission. From a given release of radioactive material into the atmosphere, MACCS estimates the extent and magnitude of radiological contamination, offsite doses, protective actions, socioeconomic impacts and costs, and health effects. Since the weather at the time of an accident is not predictable, MACCS supports various sampling options to run a representative set of simulations to evaluate weather variability. MACCS simulates atmospheric transport with a straight-line Gaussian plume segment model. From the estimated air and ground concentrations, MACCS models dose projections through several dose exposure pathways. These exposures can be offset by protective actions during the emergency response and long-term recovery of the accident. MACCS users directly specify the evacuation and sheltering area, while other protective actions (e.g., relocation, farmland restrictions, decontamination) are based on user-specified dose or concentration limits. While protective actions help reduce dose accumulation, they also cause social and economic impacts. MACCS models the extent of displaced individuals and land contamination, and the cost of offsite property damage, economic disruptions, and various accident expenditures caused by protective actions. Finally, from the dose accumulation, MACCS estimates early and stochastic health effects according to dose-response models. The purpose of consequence analyses is to be able to understand and estimate the impact of nuclear accidents. Consequence analysis is an essential tool to inform determinations of adequate protection of the public, to understand nuclear power hazards, to measure the value of regulations, and to help us appreciate the importance of nuclear safety. As such, MACCS has a variety of regulatory uses including environmental analyses (10 CFR 51.53, 52.47), regulatory cost-benefit analyses, backfit analyses (10 CFR 50.109), consequence analysis studies such as SOARCA (NUREG-1935), Level 3 PRA studies, and risk-informing of emergency planning (10 CFR 50 App. E and 50.47). This report updates the previous MACCS theory manual (NUREG/CR-4691 Vol. 2; Chanin, Sprung, Ritchie, & Jow, 1990) and accompanies the MACCS User's Guide (SAND-2021-1588) that describes the use and input requirements of the graphical user interface of MACCS known as WinMACCS. The MACCS User's Guide is also a reference guide that describes data input file formats, describes various software components in the MACCS code suite, and provides a set of example tutorials for running WinMACCS. Also, soon to be published is a MACCS input parameter guidance report (NUREG/CR-7270) that provides technical bases for commonly used MACCS input values. This page left blank

97 MATHEMATICS AND COMPUTING↗

Artificial neural network based isotopic analysis of airborne radioactivity measurement for radiological incident detection

Responders need tools to rapidly detect and identify airborne alpha radioactivity during consequence management scenarios. Traditional continuous air monitor systems used for this purpose compute the net counts in various energy windows to determine the presence of specified isotopes, such as 235U, 239Pu, and 241Am. These calculations rely on having a well-calibrated detector, which is challenging in low-background environments. Here an alternative approach of using artificial neural networks to classify alpha spectra is presented. Two network architectures, fully connected and convolutional networks, were trained to classify alpha spectra into four categories: background and background plus the three isotopes above. Sources were injected into measured background at various fractions of the derived response level (DRL) corresponding to early-phase Protective Action Guides. The convolutional network identifies all sources at 1% of the DRL with average probability of detection of 95% and false alarm probability of 1%. Further, the network identifies sources ranging between 0.25% and 1% of the DRL with higher than 80% probability of detection and lower than 7% false alarm probability. Most significantly, the network performance improves in low-count background conditions, increasing its minimum probability of detection to 93% and reducing the false alarm probabilities to lower than 0.25%. These results show that, once trained on datasets representing a range of detection scenarios, artificial neural networks can accurately identify alpha isotopes of interest without the need for detector calibration.

Woldegiorgis, Surafel F.↗

Constellation's best estimate alternate source term methodology overview

Safety analyses for a nuclear power plants need to consider postulated accidents that results in at risk of accidental release of radiation. The regulations require plant specific safety analysis reports to include an evaluation of the requirements of 10CFR50.67. Such a safety analysis report mandates limits such that calculated radiological consequences relative to certain dose locations do not exceed a total effective dose equivalent (TEDE) limits following a postulated release of radioactivity. Calculations are performed to estimate the radiological consequences, in terms of dose, to people and equipment to ensure the estimated doses are within the prescribed limits. Analysis should demonstrate, with reasonable assurance, that these prescribed limits are complied with. Conventional methodologies utilize conservative approaches to address lack of uncertainty quantification in the utilized approaches, methods, and/or inputs. These built-in excess conservatisms often result in compounding effects and hence overly conservative results in the estimated radiological consequences, which leads to inaccurate margin evaluation for operation and accident mitigation. Therefore, evaluating accurate dose consequences is needed for both operational and safety reasons. The research documented in this paper provides an overview of Constellation's Best Estimate Alternate Source Term (BEAST) Methodology. BEAST methodology relies upon the use of realistic yet bounding input distributions for key analysis parameters, which replaces use of conservative deterministic singular inputs that bound overall analysis domain. This approach enables evaluating a more accurate accident analysis response, while enabling a bounding licensing basis envelope via more accurate quantification of uncertainty in the application. Therefore, built-in margin for a given scenario is more accurately evaluated.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

Prognostic Implications of MRI-Detected EMVI and Tumor Deposits and Their Response to Neoadjuvant Therapy in cT3 and cT4 Rectal Cancer

Magnetic resonance imaging–detected extramural venous invasion (mrEMVI) and tumor deposits (TDs) are risk factors for the development of local recurrence and distant metastases (DMs) in rectal cancer. However, little is known about their response to neoadjuvant treatment and its relation to oncologic outcomes. This study evaluated the incidence and features of mrEMVI and TDs before and after neoadjuvant treatment in relation to the development of local recurrence and DMs.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Impact of Dose-Escalated Chemoradiation on Quality of Life in Patients With Locally Advanced Rectal Cancer: 2-Year Follow-Up of the Randomized RECTAL-BOOST Trial

Dose-escalated chemoradiation (CRT) for locally advanced rectal cancer did not result in higher complete response rates but initiated more tumor regression in the randomized RECTAL-BOOST trial (Clinicaltrials.gov NCT01951521). This study compared patient reported outcomes between patients who received dose-escalated CRT (5 × 3 gray boost + CRT) or standard CRT for 2 years after randomization.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

ALKBH5-Modified HMGB1-STING Activation Contributes to Radiation Induced Liver Disease via Innate Immune Response

Radiation therapy, which is vital for the treatment of primary liver cancer, comes with unavoidable liver injury, which limits its implementation. N6-methyladenosine (m6A) methylation is involved in many molecular functions. However, its role in radiation-induced liver diseases (RILD) remains unknown. Herein, we investigate the role of m6A methylation in RILD.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

NF-κB Blockade by NEMO Binding Domain Peptide Ameliorates Inflammation and Neurobehavioral Sequelae After Cranial Radiation Therapy in Juvenile Mice

Cranial radiation therapy (CRT) is a common treatment for pediatric brain tumor patients. However, side effects include significant neurobehavioral dysfunction in survivors. This dysfunction may in part be caused by inflammation, including increased production of tumor necrosis factor alpha (TNFα) and its receptor TNFR1, which can activate the nuclear factor kappa light-chain enhancer of activated B cells (NF-κB). The TNFα blockade abrogates this inflammatory response, although it presents immunologic risks. Thus, modulation of pathway subsets may be preferable. Here, we test whether inhibition of NF-κB activation using an NF-κB essential modulator binding domain (NBD) peptide mitigates CRT-induced neuroinflammation and improves behavioral outcomes.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Practice Consolidation Among U.S. Radiation Oncologists Over Time

Health care practices across the United States have been consolidating in response to various market forces. The degree of practice consolidation varies widely across specialties but has not been well studied within radiation oncology. This study used Medicare data to characterize the extent of practice consolidation among radiation oncologists and to investigate associated market factors.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Patterns of Initial Relapse from a Phase 3 Study of Response-Based Therapy for High-Risk Hodgkin Lymphoma (AHOD0831): A Report from the Children's Oncology Group

The Children's Oncology Group protocol AHOD0831, for pediatric patients with high-risk classical Hodgkin lymphoma (cHL), used response-adapted radiation fields, rather than larger involved-field radiation therapy (IFRT) that were historically used. This retrospective analysis of patterns of relapse among patients enrolled in the study was conducted to study the potential effect of a reduction in RT exposure.

62 RADIOLOGY AND NUCLEAR MEDICINE↗