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At least 127 records · Page 7

Delineation of the Postprostatectomy Prostate Bed Using Computed Tomography: Interobserver Variability Following the EORTC Delineation Guidelines

Purpose: The present study aims to assess the interobserver agreement of prostate bed delineation after radical prostatectomy using CT alone as proposed by the European Organization for Research and Treatment of Cancer (EORTC) guidelines. Methods and Materials: Six observers delineated the postoperative prostate bed (PB) and the original seminal vesicle position or remnants (SV) of 10 patients according to the EORTC guidelines. Contours were then compared for agreement between observers (the apparent volume overlap and generalized kappa statistics). Standard deviations were also calculated to measure the variability of the position of the outer margins. Results: The mean volume of 100% agreement ({+-}1 standard deviation, SD) was only 5.0 ({+-}3.3) ml for the PB and 0.9 ({+-}1.5) ml for the SV, whereas the mean union of all contours ({+-}1 SD) was 41.1 ({+-}11.8) ml and 25.3 ({+-}13.4) ml, respectively. The mean overall agreement corrected for chance was moderate for both the PB (mean kappa, 0.49; range, 0.35-0.62) and SV (mean kappa, 0.42; range, 0.22-0.59). The overall SD of the outer margins of the PB ranged from 4.6 to 7.0 mm Conclusion: The delineation of the postprostatectomy bed using CT shows only a moderate observer agreement when following the EORTC guidelines.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

One Decade Later: Trends and Disparities in the Application of Post-Mastectomy Radiotherapy Since the Release of the American Society of Clinical Oncology Clinical Practice Guidelines

Purpose: In 2001 ASCO published practice guidelines for post mastectomy radiotherapy (PMRT). We analyzed factors that influence the receipt of radiotherapy therapy and trends over time. Methods and Materials: We analyzed 8889 women who underwent mastectomy as primary surgical treatment for stage II or III breast cancer between 1995 and 2008 using data from the Kentucky Cancer Registry. We categorized patients according to ASCO group: group 1, PMRT not routinely recommended (T2, N0); group 2, PMRT controversial/evidence insufficient (T1-2, N1); group 3, PMRT recommended or suggested (T3-4 or N2-3). Probability of receiving PMRT was assessed using logistic regression. Results: Overall, 24.0% of women received PMRT over the study period. The rates of PMRT for group 1, 2, and 3 were 7.5%, 19.5%, and 47.3%, respectively. Since 2001, there was an increase in the use of PMRT (from 21.1%-26.5%, P<.0001), which occurred mainly among group 3 members (from 40.8%-51.2%, P<.0001). The average rate remained constant in group 1 (from 7.1%-7.4%, P=.266) and decreased in group 2 (from 20.0%-18.1%, P<.0001). On multivariate analysis, the rate of PMRT was significantly lower for women aged >70 years (vs. younger), rural Appalachia (vs. non-Appalachia) populations, and Medicaid (vs. privately insured) patients. Conclusions: ASCO guidelines have influenced practice in an underserved state; however PMRT remains underused, even for highest-risk patients. Barriers exist for elderly, rural and poor patients, which independently predict for lack of adequate care. Updated guidelines are needed to clarify the use of PMRT for patients with T1-2, N1 disease.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

International Spine Radiosurgery Consortium Consensus Guidelines for Target Volume Definition in Spinal Stereotactic Radiosurgery

Purpose: Spinal stereotactic radiosurgery (SRS) is increasingly used to manage spinal metastases. However, target volume definition varies considerably and no consensus target volume guidelines exist. This study proposes consensus target volume definitions using common scenarios in metastatic spine radiosurgery. Methods and Materials: Seven radiation oncologists and 3 neurological surgeons with spinal radiosurgery expertise independently contoured target and critical normal structures for 10 cases representing common scenarios in metastatic spine radiosurgery. Each set of volumes was imported into the Computational Environment for Radiotherapy Research. Quantitative analysis was performed using an expectation maximization algorithm for Simultaneous Truth and Performance Level Estimation (STAPLE) with kappa statistics calculating agreement between physicians. Optimized confidence level consensus contours were identified using histogram agreement analysis and characterized to create target volume definition guidelines. Results: Mean STAPLE agreement sensitivity and specificity was 0.76 (range, 0.67-0.84) and 0.97 (range, 0.94-0.99), respectively, for gross tumor volume (GTV) and 0.79 (range, 0.66-0.91) and 0.96 (range, 0.92-0.98), respectively, for clinical target volume (CTV). Mean kappa agreement was 0.65 (range, 0.54-0.79) for GTV and 0.64 (range, 0.54-0.82) for CTV (P<.01 for GTV and CTV in all cases). STAPLE histogram agreement analysis identified optimal consensus contours (80% confidence limit). Consensus recommendations include that the CTV should include abnormal marrow signal suspicious for microscopic invasion and an adjacent normal bony expansion to account for subclinical tumor spread in the marrow space. No epidural CTV expansion is recommended without epidural disease, and circumferential CTVs encircling the cord should be used only when the vertebral body, bilateral pedicles/lamina, and spinous process are all involved or there is extensive metastatic disease along the circumference of the epidural space. Conclusions: This report provides consensus guidelines for target volume definition for spinal metastases receiving upfront SRS in common clinical situations.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Are Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm Applicable to Other Malignancies—Assessment of Nodal Distribution in Gynecological Malignancies

Purpose: Intensity modulated radiation therapy is used to reduce dose to adjacent critical structures while maintaining adequate target coverage, but it requires precise target localization. We report the 3-dimensional distribution of para-aortic (PA) lymph nodes (LN) in pelvic malignancies. We propose a guideline to accurately define the PA LN by anatomic landmarks and compare our data with published guidelines for pancreatic cancer. Methods and Materials: A retrospective analysis was performed on 46 patients with pelvic malignancies and positive PA LNs. Positive LNs were defined based on size and morphology or fluorodeoxyglucose avidity. All PA LNs were characterized into 3 groups based on location: left PA (between aorta and left psoas muscle), aortocaval (between aorta and inferior vena cava), and right paracaval (between inferior vena cava and right psoas muscle). Patients with retrocrural LNs were also analyzed. Results: One hundred thirty-three positive PA LNs were evaluated. The majority of the PA LNs were in the left PA (59%) and aortocaval (35) regions, and only 8% were in the right paracaval region. All patients with positive right paracaval LNs also had involved left PA LNs, with only 1 exception. The highest PA LN involvement was at the level of the renal vessels and was seen in 28% of patients. Of these patients with disease extending to renal vessels, 38% had retrocrural LN involvement. Conclusions: The nodal contouring for the PA region should not be defined by a fixed circumferential margin around the vessels. The left PA and aortocaval spaces should be covered adequately because these are common locations of PA LNs. For microscopic disease superiorly, contouring should extend up to renal vessels rather than a fixed bony landmark. For patients who have nodal involvement at renal vessels, one can consider including retrocrural LNs. Radiation Therapy Oncology Group Para-aortic Contouring Guidelines for Pancreatic Neoplasm are not applicable to gynecological malignancies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Modern Radiation Therapy for Primary Cutaneous Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

Primary cutaneous lymphomas are a heterogeneous group of diseases. They often remain localized, and they generally have a more indolent course and a better prognosis than lymphomas in other locations. They are highly radiosensitive, and radiation therapy is an important part of the treatment, either as the sole treatment or as part of a multimodality approach. Radiation therapy of primary cutaneous lymphomas requires the use of special techniques that form the focus of these guidelines. The International Lymphoma Radiation Oncology Group has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the International Lymphoma Radiation Oncology Group steering committee on the use of radiation therapy in primary cutaneous lymphomas in the modern era.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

Guideline 36 Conformance Test v2.0

ASHRAE Guideline 36 provides guidance for how typical commercial building HVAC systems should be controlled to reduce energy costs and improve the indoor environmental quality for occupants. An industry-led effort is developing test scripts for how control manufacturers can test that the control logic in their control products follows Guideline 36. This software intends to support that effort in two ways. First, by providing a testbed for control manufacturers to run the test scripts against their own control products and compare their generated results to the expected results provided by the test scripts. Second, by providing a testbed that can be used during the development of test scripts to rapidly and repeatably verify they exercise Guideline 36 logic as desired and generate accurate expected results that control products can be compared to. An initial version of the software has already been developed and released open-source by a previous CEC-funded project that implemented the first use case (https://github.com/LBNL-ETA/guideline36_conformance_test/blob/master/LICENSE.txt), while this software disclosure will add the functionality of the second use case, as well as update the software where needed, all open-source. We intend to extend and contribute to the existing open-source software repository.

Blum, David [Lawrence Berkeley National Laboratory↗

Strategy Guideline: Transitioning HVAC Companies to Whole House Performance Contractors

This Strategy Guideline describes the findings from research that the U.S. Department of Energy’s Building America team IBACOS conducted related to heating, ventilation, and air conditioning (HVAC) companies that have made the decision to transition to whole house performance contracting (WHPC). By utilizing a house-as-a-system approach, the WHPC contractor can evaluate the total energy performance of the entire house and make upgrades on a prioritized basis, according to the energy benefit. IBACOS believes that an HVAC contractor is well suited to take on the tasks of whole house energy upgrades and to advance large-scale energy efficiency in the residential market. Because the HVAC contractor already works on one of the most technically complex systems in the house, they have already overcome the barrier of training to the complex HVAC system and can reduce the time required to transition to delivering whole house energy upgrades on a wide scale. Providing contractors with new technical skills and a revised business approach is one way to achieve change on a large scale and to help the United States meet its goals regarding job creation and energy independence. However, HVAC companies need guidance on how to transition successfully from their traditional business approach to one that includes WHPC. Research for this Strategy Guideline included a literature search of periodicals, industry trade publications, and reports available to the general public on the topic of WHPC. IBACOS created an outline of a successfully integrated HVAC company with a WHPC business and presented the outline to a group of experts currently working in the industry. The feedback received from the experts was used to identify the key areas in which guidance would be most useful to WHPC contractors, and eight of these areas were expanded for guidance. The appendices included with this Strategy Guideline present information a transitioning contractor may find useful and were collected from published periodicals, along with short and concise Fact Sheets.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Measure Guideline: Combustion Safety for Natural Draft Appliances Using Indoor Air

This Measure Guideline covers how to assess and carry out the combustion safety procedures for appliances and heating equipment that uses indoor air for combustion in low-rise residential buildings. Only appliances installed in the living space, or in an area freely communicating with the living space, vented alone or in tandem with another appliance are considered here. A separate Measure Guideline addresses combustion appliances located either within the living space in enclosed closets or side rooms or outside the living space in an adjacent area like an attic or garage that use outdoor air for combustion. This document is for inspectors, auditors, and technicians working in homes where energy upgrades are being conducted whether or not air infiltration control is included in the package of measures being applied. In the indoor combustion air case, guidelines summarized here are based on language provided in several of the codes to establish minimum requirements for the space using simplified prescriptive measures. In addition, building performance testing procedures are provided by testing agencies. The codes in combination with the test procedures offer comprehensive combustion safety coverage to address safety concerns, allowing inexperienced residential energy retrofit inspectors to effectively address combustion safety issues and allow energy retrofits to proceed.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Measure Guideline: Three High Performance Mineral Fiber Insulation Board Retrofit Solutions

This Measure Guideline describes a high performance enclosure retrofit package that uses mineral fiber insulation board. The Measure Guideline describes retrofit assembly and details for wood frame roof and walls and for cast concrete foundations. This Measure Guideline is intended to serve contractors and designers seeking guidance for non-foam exterior insulation retrofit.

&#8203↗

Measure Guideline: Combustion Safety for Natural Draft Appliances Using Indoor Air

This measure guideline covers how to assess and carry out the combustion safety procedures for appliances and heating equipment that uses indoor air for combustion in low-rise residential buildings. Only appliances installed in the living space, or in an area freely communicating with the living space, vented alone or in tandem with another appliance are considered here. A separate measure guideline addresses combustion appliances located either within the living space in enclosed closets or side rooms or outside the living space in an adjacent area like an attic or garage that use outdoor air for combustion. This document is for inspectors, auditors, and technicians working in homes where energy upgrades are being conducted whether or not air infiltration control is included in the package of measures being applied. In the indoor combustion air case, guidelines summarized here are based on language provided in several of the codes to establish minimum requirements for the space using simplified prescriptive measures. In addition, building performance testing procedures are provided by testing agencies. The codes in combination with the test procedures offer comprehensive combustion safety coverage to address safety concerns, allowing inexperienced residential energy retrofit inspectors to effectively address combustion safety issues and allow energy retrofits to proceed.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Towards improved guidelines for cost evaluation of carbon capture and storage

The white paper is an effort to draw up a set of CCS costing guidelines in three complementary areas where further guidelines and better practices are needed, and where efforts are underway to address those topics. The first area of study tackles the establishment of improved guidelines for cost evaluation of advanced low-carbon technology (such as a new CO 2 capture process or a novel power plant design). The second area of study focuses on CCS from non-power industries while the final area addresses quality assurance and uncertainty evaluations of data and models used in CCS cost analysis.

54 ENVIRONMENTAL SCIENCES↗

Hazardous Chemical Inventory Guidelines, Purpose, and Process

The Environment, Safety, and Health Planning department at Sandia National Laboratories is interested in the purchase and storage of chemicals and their potential impact following an uncontrolled release. The large number of projects conducted at SNL make tracking every chemical purchase impractical; therefore, attention is focused on hazardous substances purchased in large quantities. Chemicals and quantities of concern are determined through regulatory guidelines; e.g., the OSHA Process Safety Management list, the EPA Risk Management Plan list, and the Department of Energy Subcommittee on Consequence Assessment and Protective Actions Emergency Response Planning Guidelines. Based on these regulations, a list of chemicals with quantities of concern was created using the Aerial Locations of Hazardous Atmospheres (ALOHA) and SCREEN View chemical dispersion modelling software. The nature of this report does not draw conclusions, rather it documents the logic for a chemicals of concern list to ensure compliance with various regulations and form the basis for monitoring chemicals that may affect hazard classification. Hazardous Chemical Inventory Guidelines, Purpose, and Process 4 This page left blank.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Guidelines and Specifications for Enhanced Durability Evaluation of Insulating Glass and Vacuum Insulating Glass Units

The National Renewable Energy Laboratory (NREL) has conducted research into durability of advanced fenestration technologies for almost thirty years. NREL has recently begun to research potential methods to enhance durability evaluation of present market insulating glass units (IGU). This document outlines a proposed process flow for adoption of these methods by interested parties. The proposed evaluation process flow described below is still a topic of active research at NREL as well as with industry partners. NREL will periodically update this document based on research results, both internal and external to NREL that may inform development of improved durability evaluation. This document is also meant to serve as a guideline for interested parties who may wish to engage in enhanced durability evaluation of IGU's both internally or with external testing laboratories. NREL will work to support adoption of the suggestions in this guideline by interested partners in the hope that these practices are more broadly adopted by the industry. Further research into this area will continue to inform both adaptations of this guideline as well as development of improved durability evaluation standards.

32 ENERGY CONSERVATION, CONSUMPTION, AND UTILIZATI↗

Quality appraisal of clinical practice guidelines for the management of Dysphagia after acute stroke

Objectives Dysphagia is a common complication in stroke patients, widely affecting recovery and quality of life after stroke. The objective of this systematic review is to identify the gaps that between evidence and practice by critically assessing the quality of clinical practice guidelines (CPGs) for management of dysphagia in stroke. Methods We systematically searched academic databases and guideline repositories between January 1, 2014, and August 1, 2023. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used by two authors to independently assess CPG quality. Results In a total of 14 CPGs included, we identified that three CPGs obtained a final evaluation of “high quality,” nine CPGs achieved “moderate quality” and two CPGs received “low quality.” The domain of “scope and purpose” achieved the highest mean score (91.1%) and the highest median (IQR) of 91.7% (86.1, 94.4%), while the domain of “applicability” received the lowest mean score (55.8%) and the lowest median (IQR) of 55.4% (43.2, 75.5%). Conclusion The CPG development group should pay more attention to improving the methodological quality according to the AGREE II instrument, especially in the domain of “applicability” and “stakeholder involvement;” and each item should be refined as much as possible.

Gao, Shi-Lin↗

Innovating the next generation of commercial smart building software

Nearly 30% of commercial building energy use is wasted due to equipment faults and HVAC controls problems. The result is increased emissions, compromised comfort and productivity, and less reliable coordination of building power needs with a clean grid. The energy impact alone represents $17 billion in potential savings. Today’s smart building software provides a robust solution to address these operational deficiencies. Energy management and information systems (EMIS) are saving up to 9% on average, with two-year paybacks. They are being incorporated into energy management processes, commissioning services, and utility programs. As effective as they are, two barriers prevent even deeper benefits; limited personnel to fix problems once they are identified, and the expense and time to manually implement changes in control systems. In partnership with the research community, the EMIS industry is developing new capabilities to overcome these barriers. Moving beyond siloed products for either fault detection and diagnostics, or optimal control, these new capabilities empower users to not only automatically identify faults, but also to push corrective action, and control improvements to their buildings. In this paper, several areas for enhancements are documented: ‘one-time’ correction of faults such as setpoints, schedules, and economizer lockouts; short-term active testing for automated proportional integral derivative (PID) loop tuning and functional testing; and continuous supervisory control for demand flexibility and year-round efficiency. Results are presented from a pair of partner implementations out of a dozen providers integrating these enhancements into their products, including field tests from across the country, and insights into operator acceptance and integration into operations and maintenance practices.

Casillas, Armando↗

Space shuttle propulsion systems on-board checkout and monitoring system development study (extension). Volume 2: Guidelines for for incorporation of the onboard checkout and monitoring function on the space shuttle

Guidelines are presented for incorporation of the onboard checkout and monitoring function (OCMF) into the designs of the space shuttle propulsion systems. The guidelines consist of and identify supporting documentation; requirements for formulation, implementation, and integration of OCMF; associated compliance verification techniques and requirements; and OCMF terminology and nomenclature. The guidelines are directly applicable to the incorporation of OCMF into the design of space shuttle propulsion systems and the equipment with which the propulsion systems interface. The techniques and general approach, however, are also generally applicable to OCMF incorporation into the design of other space shuttle systems.

Source record↗

Study of space shuttle EVA/IVA support requirements. Volume 2: EVA/IVA tasks, guidelines, and constraints definition

The guidelines for EVA and IVA tasks to be performed on the space shuttle are defined. In deriving tasks, guidelines, and constraints, payloads were first identified from the mission model. Payload requirements, together with man and manipulator capabilities, vehicle characteristics and operation, and safety considerations led to a definition of candidate tasks. Guidelines and constraints were also established from these considerations. Scenarios were established, and screening criteria, such as commonality of EVA and IVA activities, were applied to derive representative planned and unplanned tasks. The whole spectrum of credible contingency situations with a potential requirement for EVA/IVA was analyzed.

Webbon, B. W.↗

Guidelines in preparing computer-generated plots for NASA technical reports with the LaRC graphics output system

To response to a need for improved computer-generated plots that are acceptable to the Langley publication process, the LaRC Graphics Output System has been modified to encompass the publication requirements, and a guideline has been established. This guideline deals only with the publication requirements of computer-generated plots. This report explains the capability that authors of NASA technical reports can use to obtain publication--quality computer-generated plots or the Langley publication process. The rules applied in developing this guideline and examples illustrating the rules are included.

Taylor, N. L.↗