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DOE OSTI2012

Switching the Loaded Agent from Epirubicin to Cisplatin: Salvage Transcatheter Arterial Chemoembolization with Drug-eluting Microspheres for Unresectable Hepatocellular Carcinoma

Purpose: There is no consensus on switching anticancer agents loaded onto drug carriers in transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). This study aimed to evaluate the safety and clinical outcomes of TACE with cisplatin-loaded microspheres (CLM-TACE) in HCC patients refractory to TACE with epirubicin-loaded microspheres (ELM-TACE). Methods: Between February 2008 and June 2010, 85 patients with unresectable HCC refractory to ELM-TACE were enrolled to undergo CLM-TACE. The number of ELM-TACE sessions until judgment of resistance ranged from 1 to 4 (median, 2.1). CLM-TACE was performed using 50-100-{mu}m superabsorbent polymer microspheres loaded with 1 mg cisplatin/1 mg microspheres together with hepatic arterial infusion of 25 mg cisplatin and 500 mg 5-fluorouracil per patient. Tumor responses were evaluated by computed tomography according to the European Association for the Study of the Liver criteria. Results: The median number of CLM-TACE treatment sessions was 1.8 (range, 1-5), and the mean total dose of cisplatin per session was 42.8 mg (range, 30.0-59.0). After 6 months, 3 (3.5%) patients achieved complete response, 31 (36.5%) had partial response, 15 (17.6%) had stable disease, and 36 (42.4%) had progressive disease. The median overall survival and time to treatment failure after initial CLM-TACE were 13.3 and 7.2 months, respectively. Overall, 9.4% of patients experienced grade 3/4 adverse events. Conclusions: witching the loaded agent from epirubicin to cisplatin is a safe, well-tolerated, and efficacious treatment strategy for salvage TACE with drug-eluting microspheres in HCC patients refractory to ELM-TACE.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2020

Modeling Flexible Generator Operating Regions via Chance- constrained Stochastic Unit Commitment

Here, we introduce a novel chance-constrained stochastic unit commitment model to address uncertainty in renewables' production uncertainty in power systems operation. For most thermal generators,underlying technical constraints that are universally treated as "hard" by deterministic unit commitment models are in fact based on engineering judgments, such that system operators can periodically request operation outside these limits in non-nominal situations, e.g., to ensure reliability. We incorporate this practical consideration into a chance-constrained stochastic unit commitment model, specifically by in-frequently allowing minor deviations from the minimum and maximum thermal generator power output levels. We demonstrate that an extensive form of our model is computationally tractable for medium-sized power systems given modest numbers of scenarios for renewables' production. We show that the model is able to potentially save significant annual production costs by allowing infrequent and controlled violation of the traditionally hard bounds imposed on thermal generator production limits. Finally, we conduct a sensitivity analysis of optimal solutions to our model under two restricted regimes and observe similar qualitative results.

42 ENGINEERING↗

DOE OSTI2014

Quantifying the sensitivity of ephemeral streams to land disturbance activities in arid ecosystems at the watershed scale

Large areas of public lands administered by the Bureau of Land Management and located in arid regions of the southwestern United States are being considered for the development of utility-scale solar energy facilities. Land-disturbing activities in these desert, alluvium-filled valleys have the potential to adversely affect the hydrologic and ecologic functions of ephemeral streams. Regulation and management of ephemeral streams typically falls under a spectrum of federal, state, and local programs, but scientifically based guidelines for protecting ephemeral streams with respect to land-development activities are largely nonexistent. This study developed an assessment approach for quantifying the sensitivity to land disturbance of ephemeral stream reaches located in proposed solar energy zones (SEZs). The ephemeral stream assessment approach used publicly-available geospatial data on hydrology, topography, surficial geology, and soil characteristics, as well as highresolution aerial imagery. These datasets were used to inform a professional judgment-based score index of potential land disturbance impacts on selected critical functions of ephemeral streams, including flow and sediment conveyance, ecological habitat value, and groundwater recharge. The total sensitivity scores (sum of scores for the critical stream functions of flow and sediment conveyance, ecological habitats, and groundwater recharge) were used to identify highly sensitive stream reaches to inform decisions on developable areas in SEZs. Total sensitivity scores typically reflected the scores of the individual stream functions; some exceptions pertain to groundwater recharge and ecological habitats. The primary limitations of this assessment approach were the lack of high-resolution identification of ephemeral stream channels in the existing National Hydrography Dataset, and the lack of mechanistic processes describing potential impacts on ephemeral stream functions at the watershed scale.The primary strength of this assessment approach is that it allows watershed-scale planning for low-impact development in arid ecosystems; the qualitative scoring of potential impacts can also be adjusted to accommodate new geospatial data, and to allow for expert and stakeholder input into decisions regarding the identification and potential avoidance of highly sensitive stream reaches.

Arid ecosystems↗

DOE OSTI2015

Challenge clusters facing LCA in environmental decision-making—what we can learn from biofuels

Purpose: Bioenergy is increasingly used to help meet greenhouse gas (GHG) and renewable energy targets. However, bioenergy’s sustainability has been questioned, resulting in increasing use of life cycle assessment (LCA). Bioenergy systems are global and complex, and market forces can result in significant changes, relevant to LCA and policy. The goal of this paper is to illustrate the complexities associated with LCA, with particular focus on bioenergy and associated policy development, so that its use can more effectively inform policymakers. Methods: The review is based on the results from a series of workshops focused on bioenergy life cycle assessment. Expert submissions were compiled and categorized within the first two workshops. Over 100 issues emerged. Accounting for redundancies and close similarities in the list, this reduced to around 60 challenges, many of which are deeply interrelated. Some of these issues were then explored further at a policy-facing workshop in London, UK. The authors applied a rigorous approach to categorize the challenges identified to be at the intersection of biofuels/bioenergy LCA and policy. Results and discussion: The credibility of LCA is core to its use in policy. Even LCAs that comply with ISO standards and policy and regulatory instruments leave a great deal of scope for interpretation and flexibility. Within the bioenergy sector, this has led to frustration and at times a lack of obvious direction. This paper identifies the main challenge clusters: overarching issues, application and practice and value and ethical judgments. Many of these are reflective of the transition from application of LCA to assess individual products or systems to the wider approach that is becoming more common. Uncertainty in impact assessment strongly influences planning and compliance due to challenges in assigning accountability, and communicating the inherent complexity and uncertainty within bioenergy is becoming of greater importance. Conclusions: The emergence of LCA in bioenergy governance is particularly significant because other sectors are likely to transition to similar governance models. LCA is being stretched to accommodate complex and broad policy-relevant questions, seeking to incorporate externalities that have major implications for long-term sustainability. As policy increasingly relies on LCA, the strains placed on the methodology are becoming both clearer and impedimentary. The implications for energy policy, and in particular bioenergy, are large.

09 BIOMASS FUELS↗

DOE OSTI2019

Integrated Approach to Density-Based Spatial Clustering of Applications with Noise and Dynamic Time Warping for Breakout Prediction in Slab Continuous Casting

Mold breakout is a catastrophic accident that has serious impacts on smooth production, slab quality, and caster equipment. Accurate identification and prediction of an impending breakout are always top priorities in continuous casting operations. In view of crucial common features of mold copper plate temperatures during a breakout, such as time lag and space inversion, the concepts of density-based spatial clustering of applications with noise and dynamic time warping are introduced, and an integrated novel method for breakout prediction is developed. Through extracting and fusing the representative singularity and approximation of temperature variation, the typical temporal and spatial temperature characteristics during breakout can be distinguished and predicted accurately. Compared with traditional methods of logical judgment and artificial neural network, the method based on clustering does not need to modify forecast thresholds or parameters artificially, which overcomes the limitation of model dependence on human beings, and demonstrates excellent adaptability and robustness for online abnormality prevention.

36 MATERIALS SCIENCE↗

DOE OSTI2019

The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis?

Purpose of Review: Aging is associated with an increased prevalence of both cancer and heart disease. The progression of aortic valve calcification to aortic stenosis may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy with mediastinal involvement. Symptomatic aortic stenosis is occasionally diagnosed in cancer patients undergoing cardiovascular evaluation; likewise, cancer is often recognized during assessment preceding aortic valve interventions. In these complex cases, physicians face difficult treatment decisions. Due to a myriad of clinical presentations of cancer and valve disease, specific guidelines for this patient population are not currently in place. Management is currently based on clinical judgment, on an individual basis. Recent Findings: Patients with cancer in remission or with a favorable prognosis should be treated according to current cardiovascular guidelines. In these patients, aortic valve replacement can be performed either by surgery or transcatheter. Significant challenges arise in patients with active cancer, especially those receiving anti-cancer treatment. Recent data suggests that these patients can be offered aortic valve replacement, with a trend of favoring the transcatheter route in order to minimize perioperative risk and complications associated with major surgery. Patients with advanced cancer and severe aortic stenosis should be offered palliative care and can benefit from aortic balloon valvuloplasty if indicated. Modern cancer treatments associated with improved long-term prognosis may allow the appropriate cure of aortic stenosis. Summary: We discuss the protocol, outcomes, and evolving recommendations of aortic valve replacement in cancer patients with aortic stenosis.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2019

Ischemic heart disease in Latin American women current perspective and call to action

Cardiovascular diseases (CVDs) constitute the main cause of death in Latin America (LA), with ischemic heart disease (IHD) as the principal cause in most countries. Women are particularly at risk of premature death by CVDs. Nevertheless, in LA, as in other parts of the world, there is a misconception at public level of the importance of CVDs in women; thus, CVDs do not get as much coverage as breast cancer campaigns. Women frequently have atypical symptoms and nonobstructive coronary artery disease as well as inequity in medical and interventional treatments; therefore, care should be built upon these differences. We show the epidemiological situation of IHD in LA women and present a strategy to face the problem, considering the control of risk factors, the optimized utilization of available resources, and the role of research. The role of the International Atomic Energy Agency is highlighted. To adequately face the problem of CVD in LA women, a coordinated approach is necessary, involving medical professionals, governments, scientific societies, and international organizations, as well as the population concerned. In low- and middle-income countries, where the best use of available financial and technological resources is mandatory, a clinical management combining prevention, guidelines, and clinical judgment is required.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

DOE OSTI2020

Leveraging inter-firm influence in the diffusion of energy efficiency technologies: An agent-based model

Energy efficiency technologies (EETs) are crucial for saving energy and reducing carbon dioxide emissions. However, the diffusion of EETs in small and medium-sized enterprises is rather slow. Literature shows the interactions between innovation adopters and potential adopters have significant impacts on innovation diffusion. Enterprises lack the motivation to share information, and EETs usually lack observability, which suppress the inter-firm influence. Thus, an information platform, together with proper policies encouraging or forcing enterprises to disclose EET-related information, should help harness inter-firm influence to accelerate EETs' diffusion. To explore whether and how such an information platform affects EETs' diffusion in small and medium-sized enterprises, this report builds an agent-based model to mimic EET diffusion processes. Based on a series of controlled numerical experiments, some counter-intuitive phenomena are discovered and explained. The results show that the information platform is a double-edged sword that notably accelerates EETs' diffusion by approximately 47% but may also boost negative information to diffuse even faster and delay massive adoption of EETs. Increasing network density and the intensity of inter-firm influence are effective to speed EET diffusion, but their impacts diminish drastically after reaching some critical values (0.05 and 0.15 respectively) and eventually harm the stability of the system. Ultimately, the findings implicate that EET suppliers should carefully launch their promising but immature products; policies that can reduce the perceived risk by enterprises and the effort to maintain an informative rather than judgmental information platform can prominently mitigate the negative side effects brought by high fluidity of information.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2026

Virtual refrigerant charge sensor for variable-speed heat pumps based on feature selection

The refrigerant charge level in heat pump systems significantly impacts their energy efficiency. Virtual refrigerant charge (VRC) sensing technology has been comprehensively investigated and well-established due to its lower cost compared to physical sensors. However, the previous VRC research often relied on expert judgment and physical reasoning for their variable selection, which can potentially select redundant (or highly correlated) or insignificant features, and it is also primarily focused on single-speed systems. To address these challenges, this study proposes a VRC algorithm for variable-speed heat pumps that selects features through a rigorous feature selection method in combination with physical insights. We also propose a piecewise linear model structure segmented by subcooling temperature to accurately predict charge levels, particularly when subcooling temperatures are substantially low. The proposed algorithm was evaluated using experimental data of a residential R410A heat pump, and the performance was compared with two baseline VRC algorithms. The results are: (1) The proposed algorithm outperforms for the case with subcooling temperature less than 1 °C. (2) The proposed algorithm achieves a tested mean absolute percentage error (MAPE) of 4.23%, and improves the overall accuracy for cooling conditions by approximately 60%, compared with the two baseline algorithms. (3) The proposed algorithm uses two fewer features and improves the accuracy for undercharge cooling conditions by 68.0%, compared with baseline algorithm 2. These improvements enhance prediction accuracy and prevent overfitting, providing a more reliable refrigerant charge level prediction and helping improve the heat pump energy efficiency.

Liang, Chenjiyu↗

DOE OSTI2012

A combined ANP-delphi approach to evaluate sustainable tourism

The evaluation of sustainable tourism strategies promoted by National Parks (NP) related stakeholders is a key concern for NP managers. To help them in their strategic evaluation procedures, in this paper we propose a methodology based on the Analytic Network Process and a Delphi-type judgment-ensuring procedure. The approach aims at involving stakeholders in a participatory and consensus-building process. The methodology was applied to Los Roques NP in Venezuela. The problem included three sustainable tourism strategies defined by the stakeholders: eco-efficient resorts, eco-friendly leisure activities and ecological transportation systems. Representatives of eight stakeholders participated in the methodology. 13 sustainability criteria were selected. Results provide some important insights into the overall philosophy and underlying participants' conception of what sustainable development of Los Roques NP means. This conception is broadly shared by stakeholders as they coincided in the weights of most of the criteria, which were assigned individually through the questionnaire. It is particularly noteworthy that tourists and environmentalists almost fully match in their assessments of criteria but not of the alternatives. Moreover, there is a great agreement in the final assessment. This suggests that the regular contact among the different stakeholders, i.e. tourists with inhabitants, authorities with environmentalists, tour operators with representatives of the ministry, etc. has led to a common understanding of the opportunities and threats for the NP. They all agreed that the procedure enhances participation and transparency and it is a necessary source of information and support for their decisions.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

DOE OSTI2017

Mapping environmental sensitivity: A systematic online approach to support environmental assessment and planning

Environmental sensitivity analysis provides a framework for systematically and objectively determining the potential for significant environmental impacts. The higher the natural or acquired sensitivity of the receiving environment, the less capable it is to cope with human-induced change. Given that sensitivity is context- and spatially-specific, Geographic Information Systems have been applied to develop an operational Webtool to analyse it. The Webtool enables a rapid and replicable spatial examination of environmental sensitivities and potential for land-use conflicts that supports Strategic Environmental Assessment and, ultimately, informed planning and decision-making. The novelty is on the provision of an online geoprocessing Widget that enables creation of context-specific maps. Pilot testing the Webtool in land-use and renewable energy planning through stakeholder engagement has validated its applicability. Stakeholders confirmed that it enables replicating and, in some cases, improving in-house SEA mapping processes while saving time and effort. However, its full reliance on publicly available spatial datasets renders completeness and resolution issues. The Webtool provides a critical starting-point for sectoral planning discussions and for developing plan/programme alternatives that avoid or minimise potentially incompatible or unsustainable zonings, while promoting consistency and transparency in impact assessment. - Highlights: •Sensitivity mapping can enhance baseline information for environmental assessments. •A novel online geoprocessing tool supports systematic sensitivity assessment. •It enables combining context-specific environmental criteria and value judgments. •Pilot testing it through stakeholder engagement has validated its applicability. •The tool promotes assessment consistency and transparency but data issues remain.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2018

The discretionary power of the environmental assessment practitioner

Discretion is an essential and unavoidable element of most decision-making and is thus often closely related to the judgment exercised by politicians and practitioners alike. It is evident that discretionary power can be executed in different ways, leading to different results. Therefore, it also has a significant influence on the effectiveness of the environmental assessment (EA) as examined in recent environment impact assessment (EIA) and strategic environment assessment (SEA) literature. However, limited attention has been given to the practitioners' role and how they exercise their discretion, while the effectiveness and implementation of decisions has been a recurrent theme in EA literature. This article explores the connections between discretion and some of the fundamental ideas behind how EIA and SEA function in our societies. Firstly, the article develops and presents a theoretical model of discretion, allowing us to explore the phenomena of discretion from four dimensions: source, form, value and dynamics of discretion. Secondly, a review of EA literature is performed with the purpose of mapping how discretion is studied and what kind of discretion is found in the context of EA – focusing on one of the dimensions – ‘source of discretion’. The results imply that it is prevalent for practitioners to exercise rule, value and task discretion in every choice they make at each stage of the EA implementation process, which influences EA effectiveness, either positively or negatively, depending on how discretionary power is exercised and reflected in EA practitioners' practice. It draws both the management's attention to how to regulate EA policies and the practitioners' attention to how to make a difference.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2019

On choosing the resolution of normative models

Long time horizon normative models are frequently used for policy analysis, strategic planning, and system analysis. Choosing the granularity of the temporal or spatial resolution of such models is an important modeling decision, often having a first order impact on model results. This type of decision is frequently made by modeler judgment, specifically when the predictive power of alternative choices cannot be tested. In this paper, we show how the implicit tradeoffs modelers make in these formulation decisions, in particular in the tradeoff between the accuracy of representation enabled by the available data and model parsimony, may be addressed with established information theoretic ideas. The paper provides guidance for modelers making these tradeoffs or, in certain cases, enables explicit tests for assessing appropriate levels of resolution. Here, we focus on optimization based normative models in the discussion, and draw our examples from the energy and climate domain.

96 KNOWLEDGE MANAGEMENT AND PRESERVATION↗

DOE OSTI2019

Statistical change detection of building energy consumption: Applications to savings estimation

The surge in interval meter data availability and associated activity in energy data analytics has inspired new interest in advanced methods for building efficiency savings estimation. Statistical and machine learning approaches are being explored to improve the energy baseline models used to measure and verify savings. One outstanding challenge is the ability to identify and account for operational changes that may confound savings estimates. In the measurement and verification (M&V) context, ‘non-routine events’ (NREs) cause changes in building energy use that are not attributable to installed efficiency measures, and not accounted for in the baseline model’s independent variables. In the M&V process NREs must be accounted for as ‘adjustments’ to appropriately attribute the estimated energy savings to the specific efficiency interventions that were implemented. Currently this is a manual and custom process, conducted using professional judgment and engineering expertise. As such it remains a barrier in scaling and standardizing meter-based savings estimation. Here in this work, a data driven methodology was developed to (partially) automate, and therefore streamline the process of detecting NREs in the post-retrofit period and making associated savings adjustments. The proposed NRE detection algorithm is based on a statistical change point detection method and a dissimilarity metric. The dissimilarity metric measures the proximity between the actual time series of the post-retrofit energy consumption and the projected baseline, which is generated using a statistical baseline model. The suggested approach for NRE adjustment involves the NRE detection algorithm, the M&V practitioner, and a regression modeling algorithm. The performance of the detection and adjustment algorithm was evaluated using a simulation-generated test data set, and two benchmark algorithms. Results show a high true positive detection rate (75%-100% across the test cases), higher than ideal false positive detection rates (20%-70%), and low errors in energy adjustment (<0.7%). These results indicate that the algorithm holds for helping M&V practitioners to streamline the process of handling NREs. Moreover, the change point algorithm and underlying statistical principles could prove valuable for other building analytics applications such as anomaly detection and fault diagnostics.

29 ENERGY PLANNING, POLICY, AND ECONOMY↗

DOE OSTI2016

No adaptive response is induced by chronic low-dose radiation from Ra-226 in the CHSE/F fish embryonic cell line and the HaCaT human epithelial cell line

Purpose: To determine whether chronic low-dose α-particle radiation from Ra-226 over multiple cell generations can lead to an adaptive response in CHSE/F fish embryonic cells or HaCaT human epithelial cells receiving subsequent acute high-dose γ-ray radiation. Methods: CHSE/F and HaCaT cells were exposed to very low doses of Ra-226 in medium for multiple generations prior to being challenged by a higher dose γ-ray radiation. The clonogenic assay was used to test the clonogenic survival of cells with or without being pretreated by radiation from Ra-226. Results: In general, pretreatment with chronic radiation has no significant influence on the reaction of cells to the subsequent challenge radiation. Compared to unprimed cells, the change in clonogenic survival of primed cells after receiving challenge radiation is mainly due to the influence of the chronic exposure, and there's little adaptive response induced. However at several dose points, pretreatment of CHSE/F fish cells with chronic radiation resulted in a radiosensitive response to a challenge dose of γ-ray radiation, and pretreatment of HaCaT cells resulted in no effect except for a slightly radioresistant response to the challenge radiation which was not significant. Conclusion: The results suggest that chronic low-dose radiation is not effective enough to induce adaptive response. There was a difference between human and fish cells and it may be important to consider results from multiple species before making conclusions about effects of chronic or low doses of radiation in the environment. The term “radiosensitive” or “adaptive” make no judgment about whether such responses are ultimately beneficial or harmful. - Highlights: • No obvious adaptive response is induced by chronic low-dose radiation from Ra-226. • Priming radiation from Ra-226 sensitized CHSE/F cells to the challenge radiation. • Linear model is inconsistent with current work using chronic low-dose radiation.

54 ENVIRONMENTAL SCIENCES↗

DOE OSTI2026

Governing in Time: Temporal Capacity and the Feasibility of Energy Transitions

Energy systems function as both technological systems and temporal institutions that shape how societies coordinate, justify, and support collective choices over time. This paper introduces the concept of governance horizons to explain why energy transitions can remain morally supported yet become institutionally weak under increasing pressure. We argue that governability depends on institutions' capacity to synchronize across multiple timeframes - aligning short-term decisions with intermediate coordination and long-term commitments. When this synchronization fails, transitions struggle not because their goals are dismissed, but because governance lacks sufficient time to justify, coordinate, and uphold decisions. Comparative analysis of San Antonio, Texas, and Interior Alaska reveals how energy system pressures generate distinct temporal configurations: San Antonio exhibits governance horizon stretching, where institutions must simultaneously meet near-term reliability demands and long-term transformation goals, while Interior Alaska exhibits horizon compression, where extreme environmental constraints force decision-making into short stabilization cycles. In both contexts, public support for sustainability goals coexists with institutional strain because evaluative judgments are unevenly distributed over time. A temporal configuration analysis is introduced as a diagnostic analytic stance for identifying these patterns. By treating temporal alignment as an explanatory variable rather than a background condition, this approach clarifies how feasibility, sequencing, and legitimacy are shaped by constraints on institutional time. The analysis demonstrates that successful energy transitions depend not only on technological innovation or institutional support, but on governance systems’ ability to sustain credible coordination across multiple time horizons.

Comparative case study↗

DOE OSTI2021

A Statistics-Based Threshold for the RMS-Energy Oscillation Detector

System operators and reliability coordinators currently rely on extensive baselining studies to set thresholds for their oscillation detectors. The resulting thresholds are based largely on engineering judgment and may vary significantly between organizations. In this paper, statistical distribution theory is used to derive a detection threshold for the widely deployed root-mean-square (RMS)-energy detector. This expression provides a theoretical basis for the detector's configuration, simplifies the process of selecting the threshold, and enables improved consistency among organizations that need to coordinate during system-wide events. Three methods for calculating the threshold using synchrophasor measurements are also proposed. These methods ensure that the threshold can be calculated reliably for various applications. Tests with simulated and field-measured data demonstrate that the statistics-based threshold provides consistent detection of grid disturbances while maintaining a low probability of false alarm.

Follum, James D.↗

DOE OSTI2013

Agreement Among RTOG Sarcoma Radiation Oncologists in Contouring Suspicious Peritumoral Edema for Preoperative Radiation Therapy of Soft Tissue Sarcoma of the Extremity

Purpose: Peritumoral edema may harbor sarcoma cells. The extent of suspicious edema (SE) included in the treatment volume is subject to clinical judgment, balancing the risk of missing tumor cells with excess toxicity. Our goal was to determine variability in SE delineation by sarcoma radiation oncologists (RO). Methods and Materials: Twelve expert ROs were provided with T1 gadolinium and T2-weighted MR images of 10 patients with high-grade extremity soft-tissue sarcoma. Gross tumor volume, clinical target volume (CTV)3cm (3 cm longitudinal and 1.5 cm radial margin), and CTV2cm (2 cm longitudinal and 1 cm radial margin) were contoured by a single observer. Suspicious peritumoral edema, defined as abnormal signal on T2 images, was independently delineated by all 12 ROs. Contouring agreement was analyzed using the simultaneous truth and performance level estimation (STAPLE) algorithm and kappa statistics. Results: The mean volumes of GTV, CTV2cm, and CTV3cm were, respectively, 130 cm{sup 3} (7-413 cm{sup 3}), 280 cm{sup 3} and 360 cm{sup 3}. The mean consensus volume computed using the STAPLE algorithm at 95% confidence interval was 188 cm{sup 3} (24-565 cm{sup 3}) with a substantial overall agreement corrected for chance (mean kappa = 0.71; range: 0.32-0.87). The minimum, maximum, and mean volume of SE (excluding the GTV) were 4, 182, and 58 cm{sup 3} (representing a median of 29% of the GTV volume). The median volume of SE not included in the CTV2cm and in the CTV3cm was 5 and 0.3 cm{sup 3}, respectively. There were 3 large tumors with >30 cm{sup 3} of SE not included in the CTV3cm volume. Conclusion: Despite the fact that SE would empirically seem to be a more subjective volume, a substantial or near-perfect interobserver agreement was observed in SE delineation in most cases with high-grade soft-tissue sarcomas of the extremity. A median of 97% of the consensus SE is within the CTV2cm (99.8% within the CTV3cm). In a minority of cases, however, significant expansion of the CTVs is required to cover SE.

62 RADIOLOGY AND NUCLEAR MEDICINE↗