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DOE OSTI2016

Design and testing of a phantom and instrumented gynecological applicator based on GaN dosimeter for use in high dose rate brachytherapy quality assurance

Purpose: High dose rate brachytherapy (HDR-BT) is widely used to treat gynecologic, anal, prostate, head, neck, and breast cancers. These treatments are typically administered in large dose per fraction (>5 Gy) and with high-gradient-dose-distributions, with serious consequences in case of a treatment delivery error (e.g., on dwell position and dwell time). Thus, quality assurance (QA) or quality control (QC) should be systematically and independently implemented. This paper describes the design and testing of a phantom and an instrumented gynecological applicator for pretreatment QA and in vivo QC, respectively. Methods: The authors have designed a HDR-BT phantom equipped with four GaN-based dosimeters. The authors have also instrumented a commercial multichannel HDR-BT gynecological applicator by rigid incorporation of four GaN-based dosimeters in four channels. Specific methods based on the four GaN dosimeter responses are proposed for accurate determination of dwell time and dwell position inside phantom or applicator. The phantom and the applicator have been tested for HDR-BT QA in routine over two different periods: 29 and 15 days, respectively. Measurements in dwell position and time are compared to the treatment plan. A modified position–time gamma index is used to monitor the quality of treatment delivery. Results: The HDR-BT phantom and the instrumented applicator have been used to determine more than 900 dwell positions over the different testing periods. The errors between the planned and measured dwell positions are 0.11 ± 0.70 mm (1σ) and 0.01 ± 0.42 mm (1σ), with the phantom and the applicator, respectively. The dwell time errors for these positions do not exhibit significant bias, with a standard deviation of less than 100 ms for both systems. The modified position–time gamma index sets a threshold, determining whether the treatment run passes or fails. The error detectability of their systems has been evaluated through tests on intentionally introduced error protocols. With a detection threshold of 0.7 mm, the error detection rate on dwell position is 22% at 0.5 mm, 96% at 1 mm, and 100% at and beyond 1.5 mm. On dwell time with a dwell time threshold of 0.1 s, it is 90% at 0.2 s and 100% at and beyond 0.3 s. Conclusions: The proposed HDR-BT phantom and instrumented applicator have been tested and their main characteristics have been evaluated. These systems perform unsupervised measurements and analysis without prior treatment plan information. They allow independent verification of dwell position and time with accuracy of measurements comparable with other similar systems reported in the literature.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

TH-A-BRF-12: Assessment of 4D-MRI for Robust Motion and Volume Characterization

Purpose: Precise radiation therapy for abdominal lesions is complicated by respiratory motion and poor soft tissue contrast from 4DCT whereas 4DMRI provides superior tissue discrimination. We evaluated a novel 4D-MRI algorithm for MR-SIM motion management. Methods: Respiratory-triggered, T2-weighted single-shot Turbo Spin Echo 4D-MRI was evaluated for open high-field 1.0T MR-SIM. A programmable platform pulled objects on a trolley ∼2 cm superior-inferior (S-I) for “regular” (sinusoidal, (1-cos{sup 2}), 3-5 second periods) and “irregular” breathing patterns (exaggerated (1-cos{sup 2}) and patient curves), while a respiratory waveform was generated via a pressure sensor device. Coronal 4D-MRIs (2–12;10 phases, TE/TR/α = 35−61/6100 ms/90°, voxel=1×1×4 mm{sup 3}) were acquired for 54 unique phantom cases. Abdominal 4D−MRIs were evaluated for 5 healthy volunteers and 1 liver cancer patient (6–10 phases, TE/TR/α = 30−96/4500−6100 ms/90°, voxel=1×1×5–10 mm{sup 3}) on an IRB-approved protocol. Duty cycle, scan time, and excursion were evaluated between phase acquisitions and compared to coronal cine-MRI (∼1 frame/sec). Maximum intensity projections (MIPs) were analyzed. Results: In phantom, average duty cycle was 42.6 ± 11.4% (range: 23.6–69.1%). Regular, periodic breathing (sinusoidal, (1-cos{sup 2})) yielded higher duty cycles than irregular (48.5% and 35.9%, respectively, p<0.001) and fast periods had higher duty cycles than slow (50.4% for 3s and 39.4% for 5s, p<0.001). ∼4-fold acquisition time increase was measured for 10-phase versus 2-phase. MIP renderings revealed that SI object extent was underestimated a maximum of 4% (3mm) and 8% (6mm) for cine and 2-phase 4D-MRI, respectively, with respect to 10-phases. However, this was waveform dependent. A highly irregular breathing volunteer yielded lowest duty cycle (23%) and longest 10-phase scan time (∼14 minutes), although 6-phase acquisition for a liver cancer patient was reasonable (50% and 7.4 minutes, respectively). Conclusion: 4D-MRI offers potential for excursion characterization, although results suggest the use of adequate phases is important. Further application and clinical validation are warranted. Research supported in part by a grant from Philips HealthCare (Best, Netherlands) and an Internal Mentored Grant from Henry Ford Health System.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2014

Band offsets of n-type electron-selective contacts on cuprous oxide (Cu{sub 2}O) for photovoltaics

The development of cuprous oxide (Cu{sub 2}O) photovoltaics (PVs) is limited by low device open-circuit voltages. A strong contributing factor to this underperformance is the conduction-band offset between Cu{sub 2}O and its n-type heterojunction partner or electron-selective contact. In the present work, a broad range of possible n-type materials is surveyed, including ZnO, ZnS, Zn(O,S), (Mg,Zn)O, TiO{sub 2}, CdS, and Ga{sub 2}O{sub 3}. Band offsets are determined through X-ray photoelectron spectroscopy and optical bandgap measurements. A majority of these materials is identified as having a negative conduction-band offset with respect to Cu{sub 2}O; the detrimental impact of this on open-circuit voltage (V{sub OC}) is evaluated through 1-D device simulation. These results suggest that doping density of the n-type material is important as well, and that a poorly optimized heterojunction can easily mask changes in bulk minority carrier lifetime. Promising heterojunction candidates identified here include Zn(O,S) with [S]/[Zn] ratios >70%, and Ga{sub 2}O{sub 3}, which both demonstrate slightly positive conduction-band offsets and high V{sub OC} potential. This experimental protocol and modeling may be generalized to evaluate the efficiency potential of candidate heterojunction partners for other PV absorbers, and the materials identified herein may be promising for other absorbers with low electron affinities.

75 CONDENSED MATTER PHYSICS, SUPERCONDUCTIVITY AND↗

DOE OSTI2016

Image quality comparison between single energy and dual energy CT protocols for hepatic imaging

Purpose: Multi-detector computed tomography (MDCT) enables volumetric scans in a single breath hold and is clinically useful for hepatic imaging. For simple tasks, conventional single energy (SE) computed tomography (CT) images acquired at the optimal tube potential are known to have better quality than dual energy (DE) blended images. However, liver imaging is complex and often requires imaging of both structures containing iodinated contrast media, where atomic number differences are the primary contrast mechanism, and other structures, where density differences are the primary contrast mechanism. Hence it is conceivable that the broad spectrum used in a dual energy acquisition may be an advantage. In this work we are interested in comparing these two imaging strategies at equal-dose and more complex settings. Methods: We developed numerical anthropomorphic phantoms to mimic realistic clinical CT scans for medium size and large size patients. MDCT images based on the defined phantoms were simulated using various SE and DE protocols at pre- and post-contrast stages. For SE CT, images from 60 kVp through 140 with 10 kVp steps were considered; for DE CT, both 80/140 and 100/140 kVp scans were simulated and linearly blended at the optimal weights. To make a fair comparison, the mAs of each scan was adjusted to match the reference radiation dose (120 kVp, 200 mAs for medium size patients and 140 kVp, 400 mAs for large size patients). Contrast-to-noise ratio (CNR) of liver against other soft tissues was used to evaluate and compare the SE and DE protocols, and multiple pre- and post-contrasted liver-tissue pairs were used to define a composite CNR. To help validate the simulation results, we conducted a small clinical study. Eighty-five 120 kVp images and 81 blended 80/140 kVp images were collected and compared through both quantitative image quality analysis and an observer study. Results: In the simulation study, we found that the CNR of pre-contrast SE image mostly increased with increasing kVp while for post-contrast imaging 90 kVp or lower yielded higher CNR images, depending on the differential iodine concentration of each tissue. Similar trends were seen in DE blended CNR and those from SE protocols. In the presence of differential iodine concentration (i.e., post-contrast), the CNR curves maximize at lower kVps (80–120), with the peak shifted rightward for larger patients. The combined pre- and post-contrast composite CNR study demonstrated that an optimal SE protocol has better performance than blended DE images, and the optimal tube potential for SE scan is around 90 kVp for a medium size patients and between 90 and 120 kVp for large size patients (although low kVp imaging requires high x-ray tube power to avoid photon starvation). Also, a tin filter added to the high kVp beam is not only beneficial for material decomposition but it improves the CNR of the DE blended images as well. The dose adjusted CNR of the clinical images also showed the same trend and radiologists favored the SE scans over blended DE images. Conclusions: Our simulation showed that an optimized SE protocol produces up to 5% higher CNR for a range of clinical tasks. The clinical study also suggested 120 kVp SE scans have better image quality than blended DE images. Hence, blended DE images do not have a fundamental CNR advantage over optimized SE images.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2016

Whole-brain hippocampal sparing radiation therapy: Volume-modulated arc therapy vs intensity-modulated radiation therapy case study

The hippocampus is responsible for memory and cognitive function. An ongoing phase II clinical trial suggests that sparing dose to the hippocampus during whole-brain radiation therapy can help preserve a patient's neurocognitive function. Progressive research and advancements in treatment techniques have made treatment planning more sophisticated but beneficial for patients undergoing treatment. The aim of this study is to evaluate and compare hippocampal sparing whole-brain (HS-WB) radiation therapy treatment planning techniques using volume-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). We randomly selected 3 patients to compare different treatment techniques that could be used for reducing dose to the hippocampal region. We created 2 treatment plans, a VMAT and an IMRT, from each patient's data set and planned on the Eclipse 11.0 treatment planning system (TPS). A total of 6 plans (3 IMRT and 3 VMAT) were created and evaluated for this case study. The physician contoured the hippocampus as per the Radiation Therapy Oncology Group (RTOG) 0933 protocol atlas. The organs at risk (OR) were contoured and evaluated for the plan comparison, which included the spinal cord, optic chiasm, the right and left eyes, lenses, and optic nerves. Both treatment plans produced adequate coverage on the planning target volume (PTV) while significantly reducing dose to the hippocampal region. The VMAT treatment plans produced a more homogenous dose distribution throughout the PTV while decreasing the maximum point dose to the target. However, both treatment techniques demonstrated hippocampal sparing when irradiating the whole brain.

61 RADIATION PROTECTION AND DOSIMETRY↗

DOE OSTI2025

Heavy-Duty Hydrogen Station Equipment Performance Device (HD HyStEP) Specifications and Design Considerations

The original Hydrogen Station Equipment Performance (HyStEP) device was commissioned in 2015 and was critical for the rapid validation of light-duty (LD) hydrogen fueling stations. As applications for hydrogen as a heavy-duty (HD) transportation fuel continue to grow, new heavy-duty stations are being developed to fuel these vehicles that require larger onboard storage tank systems to meet HD transportation demands and drive cycles. The differences in size and geometry from LD vehicles have driven the creation of new hydrogen fueling protocols that will enable safe and economical fueling of HD vehicles. With the new requirements that are set out in HD fueling protocols like SAE J601-5, a new HyStEP-like device is needed to evaluate the capabilities of high-flow hydrogen stations to fuel HD vehicles to the new protocol standard. To create a heavy-duty HyStEP (HD HyStEP) device, an effort has been undertaken to evaluate the requirements that would form the basis for the design of a successful HD HyStEP device. The primary design goal of this HD HyStEP device is its capability of following a test methodology similar to what is outlined in CSA HGV 4.3, which guides the validation of LD fueling dispensers but with adjustments to verify adherence to the HD fueling protocols (SAE J2601-5) for 70 MPa and 35 MPa pressure class vehicles rather than the LD fueling protocols (SAE J2601). The design presented here aims to provide information that enables the creation of an HD HyStEP device that achieves the primary design goal while being informed by the years of experience from the current HyStEP operators.

08 HYDROGEN↗

DOE OSTI2018

International Standards Development and Its Role in Transitioning D and D Technologies to Deployment - 18315

As the need to perform deactivation and decommissioning (D and D) of the most challenging nuclear facilities worldwide is growing, facilitating the integration of state-of-the-art, cutting edge technologies will be critically important to safely, effectively, and efficiently complete this mission. However, end users in the field face significant obstacles to integrating new technologies into cleanup initiatives. By leveraging the development of international standards and testing protocols, the risks associated with implementing new technologies can be mitigated and further support the need to update existing directives and guidance handbooks to account for the tremendous recent advancements in technology development. The American Society for Testing and Materials (ASTM) International's E10.03 Subcommittee on Radiological Protection for D and D of Nuclear Facilities and Components has begun the development of standard specifications and uniform testing protocols designed to support the nuclear industry's testing and evaluation requirements for D and D technologies. The vision of the E10.03 Subcommittee is to promulgate operationally relevant, uniform testing protocols that can be leveraged by the various technology innovation and development programs across the nuclear environmental management community, and support decision makers and end users with common references in the selection and employment of those standards and associated technologies. These standards could also serve as the basis for updating existing directives and guidance documents such as the various DOE handbooks to better account for the role of cutting edge technology, and facilitate / expedite lab to market efforts that result in improved returns on investment (ROIs) for technology development programs. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

DOE OSTI2012

Technical Assistance to Developers

This task supports the allowance of technical assistance to fuel-cell component and system developers as directed by the DOE. This task includes testing of novel materials and participation in the further development and validation of single cell test protocols. This task also covers technical assistance to DOE Working Groups, the U.S. Council for Automotive Research (USCAR) and the USCAR/DOE Driving Research and Innovation for Vehicle efficiency and Energy sustainability (U.S. Drive) Fuel Cell Technology Team. Assistance includes technical validation of new fuel cell materials and methods, single cell fuel cell testing to support the development of targets and test protocols, and regular advisory participation in other working groups and reviews. This assistance is made available to PEM fuel cell developers by request and DOE Approval. The objectives are to: (1) Support technically, as directed by DOE, fuel cell component and system developers; (2) Assess fuel cell materials and components and give feedback to developers; (3) Assist the DOE Durability Working Group with the development of various new material durability Testing protocols; and (4) Provide support to the U.S. Council for Automotive Research (USCAR) and the USCAR/DOE Fuel Cell Technology Team. FY2012 specific technical objectives are: (1) Evaluate novel MPL materials; (2) Develop of startup/ shutdown protocol; (3) Test the impact of hydrophobic treatment on graphite bi-polar plates; (4) Perform complete diagnostics on metal bi-polar plates for corrosion; and (5) Participate and lead efforts in the DOE Working Groups.

08 HYDROGEN↗

DOE OSTI2025

Characterization of Arsenic and Selenium in Coal Fly Ash to Improve Evaluations for Disposal and Reuse Potential (Final Technical Report)

Coal fly ash is a high volume waste material that is discarded in landfills and surface water impoundments across the U.S. and is also widely recycled for a variety of applications. The leaching of potential of contaminants of concern, such as arsenic (As) and selenium (Se), is often the driver of risk assessments for coal ash disposal and reuse. The extent of leachable As and Se depends on several factors related to environmental conditions and fly ash characteristics. Previous studies employed various methods to delineate the concentration, chemical form, and distribution of As and Se in fly ash materials. However, few studies have attempted to directly correlate these properties to mobilization parameters relevant to disposal and reuse. Instead, the coal residuals industries often rely upon standardized leaching protocols that can be laborious or involve hazardous chemicals. The goals of the project were to: 1) Develop and evaluate a characterization protocol that can be used to screen fly ash samples for leachability of As and Se; 2) Characterize As, Se, and associated constituents of fly ash particles at multiple length scales (nanometer to micrometer) to determine if elemental associations differ as a function of the resolution of characterization; and 3) Establish a predictive model for the chemical composition of coal ash produced annually at major U.S. coal fired power facilities on 50-year national coal supply records. For the first objective, we performed leaching experiments with 52 fly ash samples collected from 15 different U.S. power plants and representing coal feedstocks from the three major domestic coal regions. For this work, we assessed the mobilization potential of As and Se in fly ash based on standardized leaching protocols and performed multivariate and lasso regression analyses to explore correlations of leachable As and Se contents with characteristics such as major element contents, loss on ignition (LOI) and pH. The results of regression models indicated that major elements (Fe, Ca, Al) for a wide range of fly ashes can serve as predictor variables for the leaching potential of As, but not for Se. LOI and pH were not important predictive variables in the models. Both regression approaches resulted in relatively strong fits for leachable As (correlation coefficient R 2 = 0.78 for both models) compared to models for leachable Se (R 2 = 0.49). Overall, these results suggest that correlation models combined with on-site elemental analysis with portable analyzers may enable a screening method for leachable As in coal ash. For the second objective, we utilized nanoscale 2-D imaging (30-50 nm spot size) with the Hard X-ray Nanoprobe (HXN) in combination with microprobe X-ray capabilities (~5 µm resolution) to determine As and Se elemental associations in fly ash particles. Speciation of As and Se was also measured at the nano- to microscale with X-ray absorption spectroscopy. The enhanced resolution of HXN showed As and Se that were diffusely located around or comingled with Ca- and Fe-rich particles. The results also showed nanoparticles of Se attached to the surface of fly ash grains. Overall, a comparison of As and Se species across scales highlights the heterogeneity and complexity of chemical associations for these trace elements of concern in coal fly ash. For the final objective, we developed a predictive model for major element composition of coal ash in reserve at disposal sites of major U.S. coal fired power plants. This model was constructed from coal purchase records of 705 power stations from 1973-2022 and was trained on coal ash composition data showing that coal ash elemental composition is strongly associated with the source of feedstock coal. The model showed regional shifts in the major element contents of ash produced by power plants in the last 50 years, particularly for calcium and iron (expressed as %CaO and %Fe 2 O 3 ), as coal-fired power stations changed their source of coal over this time frame. Our approach enables an estimation of coal ash chemical composition that is stored in waste impoundments at individual power stations. Such information can help delineate the regional market potential for material applications that would utilize coal ash harvested from disposal sites across the U.S.

01 COAL, LIGNITE, AND PEAT↗

DOE OSTI2026

Large Scale Field Demonstration Evaluation Plan

This Evaluation Plan defines practical, commissioning-oriented test protocols for in-field assessment of grid-forming (GFM) inverter-based resources (IBRs) deployed under the UNIFI Consortium Field Demonstration. The demonstration’s overarching objective is to validate multi vendor GFM technologies at impactful unit/plant scale, assess interoperability and grid-service performance, and evaluate the applicability of the UNIFI Specifications for Grid-forming Inverter-based Resources in real utility environments, including integration with operational systems and protection schemes.

24 POWER TRANSMISSION AND DISTRIBUTION↗

DOE OSTI2021

Securing Environmental IoT Data Using Masked Authentication Messaging Protocol in a DAG-Based Blockchain: IOTA Tangle

The demand for the digital monitoring of environmental ecosystems is high and growing rapidly as a means of protecting the public and managing the environment. However, before data, algorithms, and models can be mobilized at scale, there are considerable concerns associated with privacy and security that can negatively affect the adoption of technology within this domain. In this paper, we propose the advancement of electronic environmental monitoring through the capability provided by the blockchain. The blockchain’s use of a distributed ledger as its underlying infrastructure is an attractive approach to counter these privacy and security issues, although its performance and ability to manage sensor data must be assessed. We focus on a new distributed ledger technology for the IoT, called IOTA, that is based on a directed acyclic graph. IOTA overcomes the current limitations of the blockchain and offers a data communication protocol called masked authenticated messaging for secure data sharing among Internet of Things (IoT) devices. We show how the application layer employing the data communication protocol, MAM, can support the secure transmission, storage, and retrieval of encrypted environmental sensor data by using an immutable distributed ledger such as that shown in IOTA. Finally, we evaluate, compare, and analyze the performance of the MAM protocol against a non-protocol approach.

Gangwani, Pranav (ORCID:0000000159226002)↗

DOE OSTI2012

Combinations of ketamine and atropine are neuroprotective and reduce neuroinflammation after a toxic status epilepticus in mice

Epileptic seizures and status epilepticus (SE) induced by the poisoning with organophosphorus nerve agents (OP), like soman, are accompanied by neuroinflammation whose role in seizure-related brain damage (SRBD) is not clear. Antagonists of the NMDA glutamate ionotropic receptors are currently among the few compounds able to arrest seizures and provide neuroprotection even during refractory status epilepticus (RSE). Racemic ketamine (KET), in combination with atropine sulfate (AS), was previously shown to counteract seizures and SRBD in soman-poisoned guinea-pigs. In a mouse model of severe soman-induced SE, we assessed the potentials of KET/AS combinations as a treatment for SE/RSE-induced SRBD and neuroinflammation. When starting 30 min after soman challenge, a protocol involving six injections of a sub-anesthetic dose of KET (25 mg/kg) was evaluated on body weight loss, brain damage, and neuroinflammation whereas during RSE, anesthetic protocols were considered (KET 100 mg/kg). After confirming that during RSE, KET injection was to be repeated despite some iatrogenic deaths, we used these proof-of-concept protocols to study the changes in mRNA and related protein contents of some inflammatory cytokines, chemokines and adhesion molecules in cortex and hippocampus 48 h post-challenge. In both cases, the KET/AS combinations showed important neuroprotective effects, suppressed neutrophil granulocyte infiltration and partially suppressed glial activation. KET/AS could also reduce the increase in mRNA and related pro-inflammatory proteins provoked by the poisoning. In conclusion, the present study confirms that KET/AS treatment has a strong potential for SE/RSE management following OP poisoning. The mechanisms involved in the reduction of central neuroinflammation remain to be studied. -- Highlights: ► During soman-induced status epilepticus, ketamine-atropine limit brain damage. ► Molecular neuroinflammatory response is strongly decreased. ► Glial activation is not fully suppressed.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2026

Optimizing a chemical cleaning protocol to determine the nickel isotopic composition of ancient seawater from carbonates

Reconstructing the ancient marine cycle of Ni, a trace metal in the oceans essential to enzymes regulating the C, N, and O cycles, would inform how Ni bioavailability shaped early life. The Ni isotopic composition of seawater (δ 60 Ni SW ) through time could provide insight, but this approach requires sedimentary archives that faithfully record δ 60 Ni SW . Carbonates are an often-used record of seawater chemistry, but contaminants could bias the measured δ 60 Ni of bulk sediment. To isolate the true carbonate-bound δ 60 Ni signal, we optimized a chemical cleaning protocol designed to minimize non‑carbonate Ni contributions and maximize carbonate recovery. We analyzed ODP Site 1007 sediments and evaluated oxidative and reductive pre-cleaning steps and carbonate dissolution protocols. Our results show that only reductive cleaning significantly altered the subsequent carbonate leachate composition, lowering Ni/Ca ratios by up to 60% and δ 60 Ni values by as much as 0.4 ‰. In contrast, δ 60 Ni values were largely insensitive to premature carbonate dissolution during pre-cleaning or to partial leaching of silicates during carbonate dissolution, even at higher acid molarities or longer reaction times. We recommend an evidence-based protocol that removes hydro-soluble salts and clays, applies reductive cleaning and oxidative cleaning for certain sample compositions, and dissolves carbonate using 0.5 M acetic acid, adjusted to pH 5. Using these results, we infer a ∼ 0.9 ‰ Ni isotopic fractionation between chemically cleaned deep-water carbonates (+0.4 ± 0.1 ‰) and deep seawater. This method development is a key step toward accurately reconstructing ancient marine Ni cycles.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

DOE OSTI2011

Mobile C-arm cone-beam CT for guidance of spine surgery: Image quality, radiation dose, and integration with interventional guidance

Purpose: A flat-panel detector based mobile isocentric C-arm for cone-beam CT (CBCT) has been developed to allow intraoperative 3D imaging with sub-millimeter spatial resolution and soft-tissue visibility. Image quality and radiation dose were evaluated in spinal surgery, commonly relying on lower-performance image intensifier based mobile C-arms. Scan protocols were developed for task-specific imaging at minimum dose, in-room exposure was evaluated, and integration of the imaging system with a surgical guidance system was demonstrated in preclinical studies of minimally invasive spine surgery. Methods: Radiation dose was assessed as a function of kilovolt (peak) (80-120 kVp) and milliampere second using thoracic and lumbar spine dosimetry phantoms. In-room radiation exposure was measured throughout the operating room for various CBCT scan protocols. Image quality was assessed using tissue-equivalent inserts in chest and abdomen phantoms to evaluate bone and soft-tissue contrast-to-noise ratio as a function of dose, and task-specific protocols (i.e., visualization of bone or soft-tissues) were defined. Results were applied in preclinical studies using a cadaveric torso simulating minimally invasive, transpedicular surgery. Results: Task-specific CBCT protocols identified include: thoracic bone visualization (100 kVp; 60 mAs; 1.8 mGy); lumbar bone visualization (100 kVp; 130 mAs; 3.2 mGy); thoracic soft-tissue visualization (100 kVp; 230 mAs; 4.3 mGy); and lumbar soft-tissue visualization (120 kVp; 460 mAs; 10.6 mGy) - each at (0.3 x 0.3 x 0.9 mm{sup 3}) voxel size. Alternative lower-dose, lower-resolution soft-tissue visualization protocols were identified (100 kVp; 230 mAs; 5.1 mGy) for the lumbar region at (0.3 x 0.3 x 1.5 mm{sup 3}) voxel size. Half-scan orbit of the C-arm (x-ray tube traversing under the table) was dosimetrically advantageous (prepatient attenuation) with a nonuniform dose distribution ({approx}2 x higher at the entrance side than at isocenter, and {approx}3-4 lower at the exit side). The in-room dose (microsievert) per unit scan dose (milligray) ranged from {approx}21 {mu}Sv/mGy on average at tableside to {approx}0.1 {mu}Sv/mGy at 2.0 m distance to isocenter. All protocols involve surgical staff stepping behind a shield wall for each CBCT scan, therefore imparting {approx}zero dose to staff. Protocol implementation in preclinical cadaveric studies demonstrate integration of the C-arm with a navigation system for spine surgery guidance-specifically, minimally invasive vertebroplasty in which the system provided accurate guidance and visualization of needle placement and bone cement distribution. Cumulative dose including multiple intraoperative scans was {approx}11.5 mGy for CBCT-guided thoracic vertebroplasty and {approx}23.2 mGy for lumbar vertebroplasty, with dose to staff at tableside reduced to {approx}1 min of fluoroscopy time ({approx}40-60 {mu}Sv), compared to 5-11 min for the conventional approach. Conclusions: Intraoperative CBCT using a high-performance mobile C-arm prototype demonstrates image quality suitable to guidance of spine surgery, with task-specific protocols providing an important basis for minimizing radiation dose, while maintaining image quality sufficient for surgical guidance. Images demonstrate a significant advance in spatial resolution and soft-tissue visibility, and CBCT guidance offers the potential to reduce fluoroscopy reliance, reducing cumulative dose to patient and staff. Integration with a surgical guidance system demonstrates precise tracking and visualization in up-to-date images (alleviating reliance on preoperative images only), including detection of errors or suboptimal surgical outcomes in the operating room.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

DOE OSTI2015

SU-E-T-204: Comparison of Absorbed-Dose to Water in High-Energy Photon Beams Based On Addendum AAPM TG-51, IAEA TRS-398, and JSMP 12

Purpose: Several clinical reference dosimetry protocols for absorbed-dose to water have recently been published: The American Association of Physicists in Medicine (AAPM) published an Addendum to the AAPM’s TG-51 (Addendum TG-51) in April 2014, and the Japan Society of Medical Physics (JSMP) published the Japan Society of Medical Physics 12 (JSMP12), a clinical reference dosimetry protocol, in September 2012. This investigation compared and evaluated the absorbed-dose to water of high-energy photon beams according to Addendum TG-51, International Atomic Energy Agency Technical Report Series No. 398 (TRS-398), and JSMP12. Methods: Differences in the respective beam quality conversion factors with Addendum TG-51, TRS-398, and JSMP12 were analyzed and the absorbed-dose to water using 6- and 10-MV photon beams was measured according to the protocols recommended in Addendum TG-51, TRS-398, and JSMP12. The measurements were conducted using two Farmer-type ionization chambers, Exradin A12 and PTW 30013. Results: The beam quality conversion factors for both the 6- and 10-MV photon beams with Addendum TG-51 were within 0.6%, in agreement with the beam quality conversion factors with TRS-398 and JSMP12. The Exradin A12 provided an absorbed-dose to water ratio from 1.003 to 1.006 with TRS-398 / Addendum TG-51 and from 1.004 to 1.005 with JSMP 12 / Addendum TG-51, whereas the PTW 30013 provided a ratio of 1.001 with TRS-398 / Addendum TG-51 and a range from 0.997 to 0.999 with JSMP 12 / Addendum TG-51. Conclusion: Despite differences in the beam quality conversion factor, no major differences were seen in the absorbed-dose to water with Addendum TG-51, TRS-398, and JSMP12. However, Addendum TG-51 provides the most recent data for beam quality conversion factors based on Monte Carlo simulation and greater detail for the measurement protocol. Therefore, the absorbed-dose to water measured with Addendum TG-51 is an estimate with less uncertainty.

60 APPLIED LIFE SCIENCES↗

DOE OSTI2019

Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease

Urothelial carcinoma of the upper urinary tract (UUT) is a relatively uncommon genitourinary malignancy, accounting for about 5–7% of urothelial tumors. The significant features of this tumor are multifocality and high rate of recurrence. Computed tomography urography (CTU) has replaced excretory urography (EU) and retrograde pyelography (RP) for imaging of upper tract urothelial carcinoma. While many studies have confirmed high sensitivity (88–100%) and specificity (93–100%) of CTU, an optimized CT protocol is of critical importance in screening, staging, and post-operative follow-up of patients (Chlapoutakis, Eur J Radiol 73(2):334–338, 2010; Caoli and Cohan, Abdom Radiol (NY) 41(6):1100–1107, 2016). The key element of the CT protocol is to have adequate distension of the collecting system with excreted contrast, to detect subtle lesions at an early stage. In this article, we discuss the background of upper urinary tract TTC, pathogenesis, CT protocol and the role of imaging in evaluation of this malignancy, staging, as well as different imaging appearances.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2016

First Delayed Resection Findings After Irreversible Electroporation (IRE) of Human Localised Renal Cell Carcinoma (RCC) in the IRENE Pilot Phase 2a Trial

IntroductionIt is postulated that focal IRE affords complete ablation of soft-tissue tumours while protecting the healthy peritumoral tissue. Therefore, IRE may be an interesting option for minimally invasive, kidney-tissue-sparing, non-thermal ablation of renal tumours.AimWith this current pilot study (“IRENE trial”), we present the first detailed histopathological data of IRE of human RCC followed by delayed tumour resection. The aim of this interim analysis of the first three patients was to investigate the ablation efficiency of percutaneous image-guided focal IRE in RCC, to assess whether a complete ablation of T1a RCC and tissue preservation with the NanoKnife system is possible and to decide whether the ablation parameters need to be altered.MethodsFollowing resection 4 weeks after percutaneous IRE, the success of ablation and detailed histopathological description were used to check the ablation parameters.ResultsThe IRE led to a high degree of damage to the renal tumours (1 central, 2 peripheral; size range 15–17 mm). The postulated homogeneous, isomorphic damage was only partly confirmed. We found a zonal structuring of the ablation zone, negative margins and, enclosed within the ablation zone, very small tumour residues of unclear malignancy.ConclusionAccording to these initial, preliminary study results of the first three renal cases, a new zonal distribution of IRE damage was described and the curative intended, renal saving focal ablation of localised RCC below <3 cm by percutaneous IRE by the NanoKnife system appears to be possible, but needs further, systematic evaluation for this treatment method and treatment protocol.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2012

Dentalmaps: Automatic Dental Delineation for Radiotherapy Planning in Head-and-Neck Cancer

Purpose: To propose an automatic atlas-based segmentation framework of the dental structures, called Dentalmaps, and to assess its accuracy and relevance to guide dental care in the context of intensity-modulated radiotherapy. Methods and Materials: A multi-atlas-based segmentation, less sensitive to artifacts than previously published head-and-neck segmentation methods, was used. The manual segmentations of a 21-patient database were first deformed onto the query using nonlinear registrations with the training images and then fused to estimate the consensus segmentation of the query. Results: The framework was evaluated with a leave-one-out protocol. The maximum doses estimated using manual contours were considered as ground truth and compared with the maximum doses estimated using automatic contours. The dose estimation error was within 2-Gy accuracy in 75% of cases (with a median of 0.9 Gy), whereas it was within 2-Gy accuracy in 30% of cases only with the visual estimation method without any contour, which is the routine practice procedure. Conclusions: Dose estimates using this framework were more accurate than visual estimates without dental contour. Dentalmaps represents a useful documentation and communication tool between radiation oncologists and dentists in routine practice. Prospective multicenter assessment is underway on patients extrinsic to the database.

62 RADIOLOGY AND NUCLEAR MEDICINE↗