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At least 541 records · Page 30

Dose Maps In/Around Target and Test Cell for DONES During the Operation

DONES (DEMO-Oriented Neutron Source) is to be constructed in order to investigate materials that are intended to be used for DEMO (DEMOnstration Power Plant) since they will be irradiated with very high fluxes of neutrons. A deuteron beam will bombard a lithium target situated in the so called Test Cell (TC) shielded with concrete. Monte Carlo simulations by means of the MCNP (Monte Carlo N-Particle) code were carried out to calculate both horizontal and vertical radiation dose maps in and around of the TC facility. Three geometrical configurations of the shielding and two kinds of concrete (ordinary and magnetite ones) were examined. For each case a spatial dose distribution and an accompanying errors map were provided. Advanced techniques of variance reduction were applied to compute doses in and outside of thick concrete walls. On the grounds of the obtained results a final configuration of the shielding was selected.

07 ISOTOPE AND RADIATION SOURCES↗

SU-E-T-159: Evaluation of a Patient Specific QA Tool Based On TG119

Purpose: To evaluate the accuracy of a 3D patient specific QA tool by analysis of the results produced from associated software in homogenous phantom and heterogonous patient CT. Methods: IMRT and VMAT plans of five test suites introduced by TG119 were created in ECLIPSE on a solid water phantom. The ten plans -of increasing complexity- were delivered to Delta4 to give a 3D measurement. The Delta4's “Anatomy” software uses the measured dose to back-calculate the energy fluence of the delivered beams, which is used for dose calculation in a patient CT using a pencilbeam algorithm. The effect of the modulated beams' complexity on the accuracy of the “Anatomy” calculation was evaluated. Both measured and Anatomy doses were compared to ECLIPSE calculation using 3% - 3mm gamma criteria.We also tested the effect of heterogeneity by analyzing the results of “Anatomy” calculation on a Brain VMAT and a 3D conformal lung cases. Results: In homogenous phantom, the gamma passing rates were found to be as low as 74.75% for a complex plan with high modulation. The mean passing rates were 91.47% ± 6.35% for “Anatomy” calculation and 99.46% ± 0.62% for Delta4 measurements.As for the heterogeneous cases, the rates were 96.54%±3.67% and 83.87%±9.42% for Brain VMAT and 3D lung respectively. This increased error in the lung case could be due to the use of the pencil beam algorithm as opposed to the AAA used by ECLIPSE.Also, gamma analysis showed high discrepancy along the beam edge in the “Anatomy” calculated results. This suggests a poor beam modeling in the penumbra region. Conclusion: The results show various sources of errors in “Anatomy” calculations. These include beam modeling in the penumbra region, complexity of a modulated beam (shown in homogenous phantom and brain cases) and dose calculation algorithms (3D conformal lung case)

60 APPLIED LIFE SCIENCES↗

Annular Core Research Reactor (ACRR) Pulse Curve Characterization

Reactor pulse characterization at the Annular Core Research Reactor (ACRR) at Sandia Technical Area V (TA-V) is commonly done through photo conductive detection (PCD) and calorimeter detectors. Each of these offer a mode of analyzing a digital signal with different advantages/methods for determination of integrated dose or temporal based metrology. This report outlines a method and code that takes the millions of data points from such detectors and delivers a characteristic pulse trendline through two main methods: digital signal filtration and machine learning, in particular, Support Vector Machines (SVMs). Each method's endpoint is to deliver a characteristic curve for the many bucket environments of ACRR while considering other points of interest including delayed gamma removal for prompt dose metrics. This work draws and adds on previous work detailing the delayed gamma fraction contributions from CINDER simulations of the ACRR. Results from this project show a method to determine characteristic curves in a way that has previously been limited by data set size.

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗

SU-E-T-372: Evaluation and Comparison of Second-Check Monitor Unit Calculation Software with Pinnacle Treatment Planning System

Purpose: The purpose of this study was to evaluate and compare the accuracy of dose calculation algorithms in the second check software programs Radcalc, Diamond, IMSure, and MUcheck, against the Pinnacle3 treatment planning system (TPS). Methods: Baseline accuracy of the second check software was established by comparison against Pinnacle TPS data using open square fields of 5, 10, 20, 30 and 40cm in a SAD setup. 18 previously treated patients’ files were exported from the Pinnacle3 TPS to each of the four second check softwares, consisting of 146 step and shoot intensity modulated radiotherapy (IMRT) beams and 60 Smart Arcs. Monitor unit (MU) calculated in each of the software were compared with the TPS and the values were represented as a percent difference. Open fields were calculated as a baseline for each software’s accuracy using 5×5, 10×10, 20×20, 30×30, and 40×40 fields. Box plots, Pearson correlation, and Bland-Altman analysis were used for comparison of the results. Results: The baseline accuracy was established to within 0.6%, −1.4%, −0.2%, and −1.0% for Diamond, IMSure,MUcheck, and Radcalc, respectively. In the clinical data, the dose difference represented as mean ± 1 standard deviation were 0.7%±0.1%, −0.3%±0.1%, −1.5%±0.1%, and 0.4%±0.0% for Diamond, IMSure, MUcheck, and Radcalc, respectively Conclusion: The implementation of Clarkson algorithm for the dose calculation between each of the software in question can vary considerably. The currently used second check software, Radcalc has shown the best agreement on average, variance, and smallest percent range from Pinnacle3 TPS values. The closest in average percent difference from the TPS data was the IMSure software, but has significantly larger variance and percent range. The mean percent differences in Diamond and MUcheck were significantly larger than Radcalc and IMSure.

60 APPLIED LIFE SCIENCES↗

Dose reduction of scattered photons from concrete walls lined with lead: Implications for improvement in design of megavoltage radiation therapy facility mazes

Purpose: This study explores the possibility of using lead to cover part of the radiation therapy facility maze walls in order to absorb low energy photons and reduce the total dose at the maze entrance of radiation therapy rooms. Methods: Experiments and Monte Carlo simulations were utilized to establish the possibility of using high-Z materials to cover the concrete walls of the maze in order to reduce the dose of the scattered photons at the maze entrance. The dose of the backscattered photons from a concrete wall was measured for various scattering angles. The dose was also calculated by the FLUKA and EGSnrc Monte Carlo codes. The FLUKA code was also used to simulate an existing radiotherapy room to study the effect of multiple scattering when adding lead to cover the concrete walls of the maze. Monoenergetic photons were used to represent the main components of the x ray spectrum up to 10 MV. Results: It was observed that when the concrete wall was covered with just 2 mm of lead, the measured dose rate at all backscattering angles was reduced by 20% for photons of energy comparable to Co-60 emissions and 70% for Cs-137 emissions. The simulations with FLUKA and EGS showed that the reduction in the dose was potentially even higher when lead was added. One explanation for the reduction is the increased absorption of backscattered photons due to the photoelectric interaction in lead. The results also showed that adding 2 mm lead to the concrete walls and floor of the maze reduced the dose at the maze entrance by up to 90%. Conclusions: This novel proposal of covering part or the entire maze walls with a few millimeters of lead would have a direct implication for the design of radiation therapy facilities and would assist in upgrading the design of some mazes, especially those in facilities with limited space where the maze length cannot be extended to sufficiently reduce the dose.

07 ISOTOPE AND RADIATION SOURCES↗

Study of Neutron-Induced Stable and Radioactive Nuclides in a Post Detonation Urban Environment

In the event of a nuclear detonation in an urban environment, response time for triage by first responders, and forensic sample collection are of the utmost importance. When it comes to response planning, decision makers within the government need to have the most up-to-date information regarding several quantities of interest so that the maximum amount of lives can be saved. Quantities of interest in a post-detonation scenario include the spatial distribution of neutron-induced stable and radioactive isotopes in the environment, fallout patterns, blast and re damage zones [1]. The UMPRINDER toolkit is developed to calculate the prompt neutron-induced stable and radioactive isotopes in the surrounding environment in a nuclear forensics post-detonation scenario. The distribution of these isotopes in the environment can be used to provide guidance in determining best routes for first responders in order to minimize dose, debris sample collection routes for subsequent radiochemical analysis, and provide initial radionuclide inventories to fallout codes in order to improve fallout zone fidelity. Other methods have approached isotope transmutation on unstructured mesh for the fusion community concerning shutdown dose rates associated with fusion reactors. UMPRINDER is the first method to be focused on calculating some of the quantities of interest for the nuclear forensics and weapon effects communities.

61 RADIATION PROTECTION AND DOSIMETRY↗

Cerebral Cortex Regions Selectively Vulnerable to Radiation Dose-Dependent Atrophy

Purpose and Objectives: Neurologic deficits after brain radiation therapy (RT) typically involve decline in higher-order cognitive functions such as attention and memory rather than sensory defects or paralysis. We sought to determine whether areas of the cortex critical to cognition are selectively vulnerable to radiation dose-dependent atrophy. Methods and Materials: We measured change in cortical thickness in 54 primary brain tumor patients who underwent fractionated, partial brain RT. The study patients underwent high-resolution, volumetric magnetic resonance imaging (T1-weighted; T2 fluid-attenuated inversion recovery, FLAIR) before RT and 1 year afterward. Semiautomated software was used to segment anatomic regions of the cerebral cortex for each patient. Cortical thickness was measured for each region before RT and 1 year afterward. Two higher-order cortical regions of interest (ROIs) were tested for association between radiation dose and cortical thinning: entorhinal (memory) and inferior parietal (attention/memory). For comparison, 2 primary cortex ROIs were also tested: pericalcarine (vision) and paracentral lobule (somatosensory/motor). Linear mixed-effects analyses were used to test all other cortical regions for significant radiation dose-dependent thickness change. Statistical significance was set at α = 0.05 using 2-tailed tests. Results: Cortical atrophy was significantly associated with radiation dose in the entorhinal (P=.01) and inferior parietal ROIs (P=.02). By contrast, no significant radiation dose-dependent effect was found in the primary cortex ROIs (pericalcarine and paracentral lobule). In the whole-cortex analysis, 9 regions showed significant radiation dose-dependent atrophy, including areas responsible for memory, attention, and executive function (P≤.002). Conclusions: Areas of cerebral cortex important for higher-order cognition may be most vulnerable to radiation-related atrophy. This is consistent with clinical observations that brain radiation patients experience deficits in domains of memory, executive function, and attention. Correlations of regional cortical atrophy with domain-specific cognitive functioning in prospective trials are warranted.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Proteomic-based mechanistic investigation of low-dose radiation-induced cellular responses/effects

The goal of our project is to apply our unique systems investigation strategy to reveal the molecular mechanisms underlying the radiation induction and transmission of oxidative damage, adaptive response, and bystander effect at low-doses. Beginning with simple in vitro systems such as fibroblast or epithelial pure culture, our amino acid-coded mass tagging (AACT) comparative proteomic platform will be used to measure quantitatively proteomic changes at high- or low-dose level with respect to their endogenous damage levels respectively, in which a broad range of unique regulated proteins sensitive to low-dose IR will be distinguished. To zoom in how these regulated proteins interact with other in the form of networks in induction/transmission pathways, these regulated proteins will be selected as baits for making a series of fibroblast cell lines that stably express each of them. Using our newly developed method of 'dual-tagging' quantitative proteomics that integrate the capabilities of natural complex expression/formation, simple epitope affinity isolation (not through tandem affinity purification or TAP), and 'in-spectra' AACT quantitative measurements using mass spectrometry (MS), we will be able to distinguish systematically interacting proteins with each bait in real time. Further, in addition to both proteome-wide (global differentially expressed proteins) and pathway-scale (bait-specific) profiling information, we will perform a computational network analysis to elucidate a global pathway/mechanisms underlying cellular responses to real-time low-dose IR. Similarly, we will extend our scheme to investigate systematically those induction/transmission pathways occurring in a fibroblast-epithelial interacting model in which the bystander cell (fibroblast) monitor the IR damage to the target cell (epithelial cell). The results will provide the proteome base (molecular mechanisms/pathways for signaling) for the low dose radiation-induced essential tissue environment interactions, including cell-cell, extracellular matrix and extracellular paracrine interactions.

59 BASIC BIOLOGICAL SCIENCES↗

SU-E-T-355: Efficient Scatter Correction for Direct Ray-Tracing Based Dose Calculation

Purpose: To propose a scatter correction method with linear computational complexity for direct-ray-tracing (DRT) based dose calculation. Due to its speed and simplicity, DRT is widely used as a dose engine in the treatment planning system (TPS) and monitor unit (MU) verification software, where heterogeneity correction is applied by radiological distance scaling. However, such correction only accounts for attenuation but not scatter difference, causing the DRT algorithm less accurate than the model-based algorithms for small field size in heterogeneous media. Methods: Inspired by the convolution formula derived from an exponential kernel as is typically done in the collapsed-cone-convolution-superposition (CCCS) method, we redesigned the ray tracing component as the sum of TERMA scaled by a local deposition factor, which is linear with respect to density, and dose of the previous voxel scaled by a remote deposition factor, D(i)=aρ(i)T(i)+(b+c(ρ(i)-1))D(i-1),where T(i)=e(-αr(i)+β(r(i))2) and r(i)=Σ-(j=1,..,i)ρ(j).The two factors together with TERMA can be expressed in terms of 5 parameters, which are subsequently optimized by curve fitting using digital phantoms for each field size and each beam energy. Results: The proposed algorithm was implemented for the Fluence-Convolution-Broad-Beam (FCBB) dose engine and evaluated using digital slab phantoms and clinical CT data. Compared with the gold standard calculation, dose deviations were improved from 20% to 2% in the low density regions of the slab phantoms for the 1-cm field size, and within 2% for over 95% of the volume with the largest discrepancy at the interface for the clinical lung case. Conclusion: We developed a simple recursive formula for scatter correction for the DRT-based dose calculation with much improved accuracy, especially for small field size, while still keeping calculation to linear complexity. The proposed calculator is fast, yet accurate, which is crucial for dose updating in IMRT optimization.

60 APPLIED LIFE SCIENCES↗

Argonne National Laboratory Site Environmental report for calendar year 2009.

This report discusses the status and the accomplishments of the environmental protection program at Argonne National Laboratory for calendar year 2009. The status of Argonne environmental protection activities with respect to compliance with the various laws and regulations is discussed, along with the progress of environmental corrective actions and restoration projects. To evaluate the effects of Argonne operations on the environment, samples of environmental media collected on the site, at the site boundary, and off the Argonne site were analyzed and compared with applicable guidelines and standards. A variety of radionuclides were measured in air, surface water, on-site groundwater, and bottom sediment samples. In addition, chemical constituents in surface water, groundwater, and Argonne effluent water were analyzed. External penetrating radiation doses were measured, and the potential for radiation exposure to off-site population groups was estimated. Results are interpreted in terms of the origin of the radioactive and chemical substances (i.e., natural, Argonne, and other) and are compared with applicable environmental quality standards. A U.S. Department of Energy (DOE) dose calculation methodology, based on International Commission on Radiological Protection recommendations and the U.S. Environmental Protection Agency's (EPA) CAP-88 Version 3 (Clean Air Act Assessment Package-1988) computer code, was used in preparing this report.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

A study on leakage radiation dose at ELV-4 electron accelerator bunker

Shielding is an important aspect in the safety of an accelerator and the most important aspects of a bunker shielding is the door. The bunker’s door should be designed properly to minimize the leakage radiation and shall not exceed the permitted limit of 2.5μSv/hr. In determining the leakage radiation dose that passed through the door and gaps between the door and the wall, 2-dimensional manual calculations are often used. This method is hard to perform because visual 2-dimensional is limited and is also very difficult in the real situation. Therefore estimation values are normally performed. In doing so, the construction cost would be higher because of overestimate or underestimate which require costly modification to the bunker. Therefore in this study, two methods are introduced to overcome the problem such as simulation using MCNPX Version 2.6.0 software and manual calculation using 3-dimensional model from Autodesk Inventor 2010 software. The values from the two methods were eventually compared to the real values from direct measurements using Ludlum Model 3 with Model 44-9 probe survey meter.

71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗

SU-E-T-343: Valencia Applicator Commissioning Using a Micro-Chamber Array

Purpose: In the commissioning and QA of surface isotope-based applicators, source-indexer distance (SID) has a great influence in the flatness, symmetry and output. To these purposes, methods described in the literature are the use of a special insert at the entrance of dwell chamber or radiochromic films. Here we present the experience with a micro-chamber array to perform the commissioning and QA of Valencia applicators. Methods: Valencia applicators have been used, the classic and the new extra-shielded version. A micro-chamber array has been employed, 1000 SRS (PTW), with 977 liquid filled, 2.3×2.3×0.5 mm{sup 3} sized ion chambers covering 11×11 cm{sup 2}, which spacing is 2.5 mm in the central 5.5×5.5 cm{sup 2}, dedicated mainly in principle, in conjunction with Octavius 4D (PTW), to IMRT, VMAT, SBRT verifications. Verisoft software that allows for 3D and planar analysis has been used to evaluate the results. Applicators were located on the surface of the array. To verify the SID, measurements corresponding to the reference value, SID ± 1 mm and SID ± 2 mm were acquired (integration time was fixed in order to discard the influence of the source entrance/exit). Once SID was determined, standard protocol treatments corresponding to 3 Gy and 7 Gy were acquired in order to establish typical patient dose distribution. Results: The method is fast and sensitive. The SID obtained was 1321 mm which is the nominal value included in the applicator manual. For example at 1319 mm an asymmetry of ±8% with respect to the central value was measured, along with a central deviation of −4% referred to 1321 mm. Conclusion: A practical method for the commissioning and QA of Valencia applicators has been described. It has been shown that it is an efficient and accurate tool for these purposes as well as for the verification of the absolute output constancy.

60 APPLIED LIFE SCIENCES↗

Design Analysis of SNS Target StationBiological Shielding Monoligh with Proton Power Uprate

This report documents the analysis of the dose rate in the experiment area outside the Spallation Neutron Source (SNS) target station shielding monolith with proton beam energy of 1.3 GeV. The analysis implemented a coupled three dimensional (3D)/two dimensional (2D) approach that used both the Monte Carlo N-Particle Extended (MCNPX) 3D Monte Carlo code and the Discrete Ordinates Transport (DORT) two dimensional deterministic code. The analysis with proton beam energy of 1.3 GeV showed that the dose rate in continuously occupied areas on the lateral surface outside the SNS target station shielding monolith is less than 0.25 mrem/h, which complies with the SNS facility design objective. However, the methods and codes used in this analysis are out of date and unsupported, and the 2D approximation of the target shielding monolith does not accurately represent the geometry. We recommend that this analysis is updated with modern codes and libraries such as ADVANTG or SHIFT. These codes have demonstrated very high efficiency in performing full 3D radiation shielding analyses of similar and even more difficult problems.

42 ENGINEERING↗

SU-F-I-38: Patient Organ Specific Dose Assessment in Coronary CT Angiograph Using Voxellaized Volume Dose Index in Monte Carlo Simulation

Purpose: Clinical use of multi detector computed tomography(MDCT) in diagnosis of diseases due to high speed in data acquisition and high spatial resolution is significantly increased. Regarding to the high radiation dose in CT and necessity of patient specific radiation risk assessment, the adoption of new method in the calculation of organ dose is completely required and necessary. In this study by introducing a conversion factor, patient organ dose in thorax region based on CT image data using MC system was calculated. Methods: The geometry of x-ray tube, inherent filter, bow tie filter and collimator were designed using EGSnrc/BEAMnrc MC-system component modules according to GE-Light-speed 64-slices CT-scanner geometry. CT-scan image of patient thorax as a specific phantom was voxellised with 6.25mm3 in voxel and 64×64×20 matrix size. Dose to thorax organ include esophagus, lung, heart, breast, ribs, muscle, spine, spinal cord with imaging technical condition of prospectively-gated-coronary CT-Angiography(PGT) as a step and shoot method, were calculated. Irradiation of patient specific phantom was performed using a dedicated MC-code as DOSXYZnrc with PGT-irradiation model. The ratio of organ dose value calculated in MC-method to the volume CT dose index(CTDIvol) reported by CT-scanner machine according to PGT radiation technique has been introduced as conversion factor. Results: In PGT method, CTDIvol was 10.6mGy and Organ Dose/CTDIvol conversion factor for esophagus, lung, heart, breast, ribs, muscle, spine and spinal cord were obtained as; 0.96, 1.46, 1.2, 3.28. 6.68. 1.35, 3.41 and 0.93 respectively. Conclusion: The results showed while, underestimation of patient dose was found in dose calculation based on CTDIvol, also dose to breast is higher than the other studies. Therefore, the method in this study can be used to provide the actual patient organ dose in CT imaging based on CTDIvol in order to calculation of real effective dose(ED) based on organ dose. This work has been supported by the research chancellor of tehran university of medical sciences(tums), school of medicine, Tehran, Iran.

60 APPLIED LIFE SCIENCES↗

SU-F-T-51: Investigating the Effect of Eye Size and Eccentricity On Normal Tissue Doses From Eye Plaque Brachytherapy

Purpose: This study investigates the effect of eye size and eccentricity on doses to critical tissues by simulating doses in the Plaque Simulator (v. 6.3.1) software. Present OHSU plaque brachytherapy treatment focuses on delivering radiation to the tumor measured with ocular ultrasound plus a small margin and assumes the orbit has the dimensions of a “standard eye.” Accurately modeling the dimensions of the orbit requires a high resolution ocular CT. This study quantifies how standard differences in equatorial diameters and eccentricity affect calculated doses to critical structures in order to query the justification of the additional CT scan to the treatment planning process. Methods: Tumors of 10 mm × 10 mm × 5 mm were modeled at the 12:00:00 hour with a latitude of 45 degrees. Right eyes were modeled at a number of equatorial diameters from 17.5 to 28 mm for each of the standard non-notched COMS plaques with silastic inserts. The COMS plaques were fully loaded with uniform activity, centered on the tumor, and prescribed to a common tumor dose (85 Gy/100 hours). Variations in the calculated doses to normal structures were examined to see if the changes were significant. Results: The calculated dose to normal structures show a marked dependence on eye geometry. This is exemplified by fovea dose which more than doubled in the smaller eyes and nearly halved in the larger model. Additional significant dependence was found in plaque size on the calculated dose in spite of all plaques giving the same dose to the prescription point. Conclusion: The variation in dose with eye dimension fully justifies the addition of a high resolution ocular CT to the planning technique. Additional attention must be made to plaque size beyond simply covering the tumor when considering normal tissue dose.

60 APPLIED LIFE SCIENCES↗

SU-F-T-111: Investigation of the Attila Deterministic Solver as a Supplement to Monte Carlo for Calculating Out-Of-Field Radiotherapy Dose

Purpose: To use the Attila deterministic solver as a supplement to Monte Carlo for calculating out-of-field organ dose in support of epidemiological studies looking at the risks of second cancers. Supplemental dosimetry tools are needed to speed up dose calculations for studies involving large-scale patient cohorts. Methods: Attila is a multi-group discrete ordinates code which can solve the 3D photon-electron coupled linear Boltzmann radiation transport equation on a finite-element mesh. Dose is computed by multiplying the calculated particle flux in each mesh element by a medium-specific energy deposition cross-section. The out-of-field dosimetry capability of Attila is investigated by comparing average organ dose to that which is calculated by Monte Carlo simulation. The test scenario consists of a 6 MV external beam treatment of a female patient with a tumor in the left breast. The patient is simulated by a whole-body adult reference female computational phantom. Monte Carlo simulations were performed using MCNP6 and XVMC. Attila can export a tetrahedral mesh for MCNP6, allowing for a direct comparison between the two codes. The Attila and Monte Carlo methods were also compared in terms of calculation speed and complexity of simulation setup. A key perquisite for this work was the modeling of a Varian Clinac 2100 linear accelerator. Results: The solid mesh of the torso part of the adult female phantom for the Attila calculation was prepared using the CAD software SpaceClaim. Preliminary calculations suggest that Attila is a user-friendly software which shows great promise for our intended application. Computational performance is related to the number of tetrahedral elements included in the Attila calculation. Conclusion: Attila is being explored as a supplement to the conventional Monte Carlo radiation transport approach for performing retrospective patient dosimetry. The goal is for the dosimetry to be sufficiently accurate for use in retrospective epidemiological investigations.

60 APPLIED LIFE SCIENCES↗

Applicability of Public Dose Limits to Individuals on the Nevada National Security Site

Historically all persons working on the Nevada National Security Site (NNSS) were considered subject to worker dose limits when calculations of potential dose from the air pathway were conducted to demonstrate compliance with Title 42 United States Code (USC) Chapter 85, “The Clean Air Act,” and Title 40 Code of Federal Regulations (CFR) Part 61, Subpart H, “National Emission Standards for Hazardous Air Pollutants (NESHAP).” Calculations were also conducted for the all-pathways potential dose to demonstrate compliance with U.S. Department of Energy (DOE) Order DOE O 458.1 Chg. 3, “Radiation Protection of the Public and the Environment.” The need to evaluate environmental air sampling locations and past regulator questions about the existence of persons potentially subject to public dose limits being on the NNSS drove this assessment (letter from EPA [U.S. Environmental Protection Agency] Region 9 to DOE/Nevada Operations Office, dated September 3, 1999). This assessment also supports determining those persons subject to public dose limits from the all pathways perspective. A person that is a member of the public is subject to public dose limits.

61 RADIATION PROTECTION AND DOSIMETRY↗

Radiotherapy Breast Boost With Reduced Whole-Breast Dose Is Associated With Improved Cosmesis: The Results of a Comprehensive Assessment From the St. George and Wollongong Randomized Breast Boost Trial

Purpose: To evaluate comprehensively the effect of a radiotherapy boost on breast cosmetic outcomes after 5 years in patients treated with breast-conserving surgery. Methods: The St. George and Wollongong trial (NCT00138814) randomized 688 patients with histologically proven Tis-2, N 0-1, M0 carcinoma to the control arm of 50 Gy in 25 fractions (342 patients) and the boost arm of 45 Gy in 25 fractions to the whole breast followed by a 16 Gy in 8 fraction electron boost (346 patients). Five-year cosmetic outcomes were assessed by a panel subjectively in 385 patients and objectively using pBRA (relative breast retraction assessment). A subset of patients also had absolute BRA measurements. Clinician assessment and patient self-assessment of overall cosmetic and specific items as well as computer BCCT.core analysis were also performed. Results: The boost arm had improved cosmetic overall outcomes as scored by the panel and BCCT.core software with 79% (p = 0.016) and 81% (p = 0.004) excellent/good cosmesis respectively compared with 68% in no-boost arm. The boost arm also had lower pBRA and BRA values with a mean difference of 0.60 and 1.82 mm, respectively, but was not statistically significant. There was a very high proportion of overall excellent/good cosmetic outcome in 95% and 93% in the boost and no-boost arms using patient self-assessment. However, no difference in overall and specific items scored by clinician assessment and patient self-assessment was found. Conclusion: The results show the negative cosmetic effect of a 16-Gy boost is offset by a lower whole-breast dose of 45 Gy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗