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At least 19 records

Variance components in confocal scanning laser tomography measurements of neuro‐retinal rim area and the effect of repeated measurements on the power to detect loss over time

Abstract Purpose To estimate the variation in measurements of neuro‐retinal rim area (NRA) determined by confocal scanning laser tomography and consequences for clinical follow‐up. Methods Altogether, 24 healthy subjects were randomized on –320 μ m, Moorfields and Standard NRA plane strategies. Additionally, NRA was measured in 32 glaucoma subjects. Variance components for subjects, visits and measurements were estimated with analysis of variance. Sample sizes required to detect a 6.0 × 10 −2 mm 2 NRA change were estimated assuming a significance level of 0.05 and a power of 0.8. Consequences for independent group, and paired comparison design, respectively, were analysed. Further, precision in estimates within subjects over time was investigated. Results The variation of NRA among subjects was considerably larger than the variation among visits and measurements. For glaucoma subjects, the variation among visits and measurements were of the same order but larger than in healthy subjects. It was found that independent group comparisons require inconveniently large sample sizes. Within‐subject paired comparisons over time require sample sizes of below 15 subjects. The estimated variations for glaucoma subjects imply that 54 months of follow‐up is required for detection of change from baseline. Conclusions The variance for subjects is substantial in relation to those for visits and measurements. Cross‐sectional independent group comparisons of levels of NRA are unsuitable, due to considerable subject variation. Levels of NRA differences within subjects between visits can be estimated with acceptable precision. Neuro‐retinal rim area (NRA) measurement can be used for long‐term follow‐up of glaucoma progression.

Sandberg Melin, Camilla↗

Picometer sensitivity metrology for EUV absorber phase

With growing interest in EUV attenuated phase-shift masks due to their superior image quality for applications such as dense contact and pillar arrays, it is becoming critical to model, measure, and monitor the intensity and relative phase of multilayer and absorber reflections. We present a solution based on physical modeling of reflectometry data, which can achieve single picometer phase precision and sensitivity to changes in average film thickness below one atomic monolayer. We measure absorber and multilayer reflectivity to determine thin-film parameters with a multidimensional optimization and then acquire a new measurement of either multilayer or absorber to determine perturbations in surface contamination thickness. While it is difficult to assess the accuracy of the first step, the simplicity of the second step allows us to characterize our sensitivity to changes in contamination thickness. Thus, we apply this analysis using an initial set of measurements and repeated measurements after a period of storage. For the multilayer, the total contamination growth was 1068 pm, which occurred almost exclusively during storage (1085 pm) and decreased very slightly during repeated measurements (-17 pm). For the absorber, the behavior was quite different, with a total growth of 126 pm, which occurred much less during storage (28 pm) and primarily during repeated measurements (98 pm). Ultimately, the change in relative phase (absorber minus multilayer) was -0.86 deg for the multilayer and -1.12 deg for the absorber. We estimate the precision of the surface contamination measurement to be 3σ < 6 pm for measuring thickness and 3σ < 0.2 deg for measuring phase.

36 MATERIALS SCIENCE↗

Statistical Framework for Planning a Component Shelf Life Program.

This document outlines a statistical framework for establishing a shelf-life program for components whose performance is measured by the value of a continuous variable such as voltage or function time. The approach applies to both single measurement devices and repeated measurement devices, although additional process control charts may be useful in the case of repeated measurements. The approach is to choose a sample size that protects the margin associated with a particular variable over the life of the component. Deviations from expected performance of the measured variable are detected prior to the complete loss of margin. This ensures the reliability of the component over its lifetime.

47 OTHER INSTRUMENTATION↗

SU-F-T-180: Evaluation of a Scintillating Screen Detector for Proton Beam QA and Acceptance Testing

Purpose: To test the performance of a commercial scintillating screen detector for acceptance testing and Quality Assurance of a proton pencil beam scanning system. Method: The detector (Lexitek DRD 400) has 40cm × 40cm field, uses a thin scintillator imaged onto a 16-bit scientific CCD with ∼0.5mm resolution. A grid target and LED illuminators are provided for spatial calibration and relative gain correction. The detector mounts to the nozzle with micron precision. Tools are provided for image processing and analysis of single or multiple Gaussian spots. Results: The bias and gain of the detector were studied to measure repeatability and accuracy. Gain measurements were taken with the LED illuminators to measure repeatability and variation of the lens-CCD pair as a function with f-stop. Overall system gain was measured with a passive scattering (broad) beam whose shape is calibrated with EDR film placed in front of the scintillator. To create a large uniform field, overlapping small fields were recorded with the detector translated laterally and stitched together to cover the full field. Due to the long exposures required to obtain multiple spills of the synchrotron and very high detector sensitivity, borated polyethylene shielding was added to reduce direct radiation events hitting the CCD. Measurements with a micro ion chamber were compared to the detector’s spot profile. Software was developed to process arrays of Gaussian spots and to correct for radiation events. Conclusion: The detector background has a fixed bias, a small component linear in time, and is easily corrected. The gain correction method was validated with 2% accuracy. The detector spot profile matches the micro ion chamber data over 4 orders of magnitude. The multiple spot analyses can be easily used with plan data for measuring pencil beam uniformity and for regular QA comparison.

60 APPLIED LIFE SCIENCES↗

SU-E-T-676: Reproducibility and Consistency of Two SunNuclear 3D Scanning Tanks

Purpose: To determine if two Sun Nuclear 3D Scanning (SNC 3DS) tanks collect reproducible and consistent data and test the precision of the SNC Dosimetry auto-setup. Methods: Percent depth doses (PDDs) and profiles were collected on two SNC 3DS tanks with a Varian TrueBeam linear accelerator. SNC Dosimetry auto-setup application was used with CC13 ionization chambers. After auto-setup, collimator light field was checked manually against the position of the chamber. Comparing measured data for repeated measurements with tank 1 allowed evaluation of SNC-3DS auto-setup and tank reproducibility. Comparing measured data between tanks 1 and 2 allowed evaluation of consistency between tanks. Results: Preliminary results showed reproducibility of depth of maximum dose (Dmax) of 0.38mm for a 10cmx10cm field and 0.67mm for 30cmx30cm on a single tank. PDD values at 5cm, 10cm, and 20cm depths were reproducible within 0.26%. Consistency of Dmax between tanks was 0.17mm for a 10cmx10cm field and 0.44mm for 30cmx30cm. PDD values at 5cm, 10cm, and 20cmwere consistent within 0.06%. Profiles showed reproducibility in field width within 0.4mm for a 10cmx10cm field and 0.7mm for a 30cmx30cm field. Profiles showed consistency in field width within 0.2mm for 10cmx10cm and 30cmx30cm field sizes. Penumbra width was reproducible and consistent to under 0.5mm except for 30cmx30cm field size at 30cm depth where the reproducibility was 2.2mm and the consistency was 2.6mm. Conclusion: In conclusion, the SNC 3DS tank shows good reproducibility in measured data. Since the tank to tank variation in measured data is within the uncertainty of repeated single tank measurements the tanks also perform consistently.

07 ISOTOPE AND RADIATION SOURCES↗

TU-F-CAMPUS-T-04: Variations in Nominally Identical Small Fields From Photon Jaw Reproducibility and Associated Effects On Small Field Dosimetric Parameters

Purpose: To investigate uncertainties in small field output factors and detector specific correction factors from variations in field size for nominally identical fields using measurements and Monte Carlo simulations. Methods: Repeated measurements of small field output factors are made with the Exradin W1 (plastic scintillation detector) and the PTW microDiamond (synthetic diamond detector) in beams from the Elekta Precise linear accelerator. We investigate corrections for a 0.6x0.6 cm{sup 2} nominal field size shaped with secondary photon jaws at 100 cm source to surface distance (SSD). Measurements of small field profiles are made in a water phantom at 10 cm depth using both detectors and are subsequently used for accurate detector positioning. Supplementary Monte Carlo simulations with EGSnrc are used to calculate the absorbed dose to the detector and absorbed dose to water under the same conditions when varying field size. The jaws in the BEAMnrc model of the accelerator are varied by a reasonable amount to investigate the same situation without the influence of measurements uncertainties (such as detector positioning or variation in beam output). Results: For both detectors, small field output factor measurements differ by up to 11 % when repeated measurements are made in nominally identical 0.6x0.6 cm{sup 2} fields. Variations in the FWHM of measured profiles are consistent with field size variations reported by the accelerator. Monte Carlo simulations of the dose to detector vary by up to 16 % under worst case variations in field size. These variations are also present in calculations of absorbed dose to water. However, calculated detector specific correction factors are within 1 % when varying field size because of cancellation of effects. Conclusion: Clinical physicists should be aware of potentially significant uncertainties in measured output factors required for dosimetry of small fields due to field size variations for nominally identical fields.

07 ISOTOPE AND RADIATION SOURCES↗

ASSESSMENT OF SYSTEMATIC CHROMATIC ERRORS THAT IMPACT SUB-1% PHOTOMETRIC PRECISION IN LARGE-AREA SKY SURVEYS

Meeting the science goals for many current and future ground-based optical large-area sky surveys requires that the calibrated broadband photometry is both stable in time and uniform over the sky to 1% precision or better. Past and current surveys have achieved photometric precision of 1%–2% by calibrating the survey’s stellar photometry with repeated measurements of a large number of stars observed in multiple epochs. The calibration techniques employed by these surveys only consider the relative frame-by-frame photometric zeropoint offset and the focal plane position-dependent illumination corrections, which are independent of the source color. However, variations in the wavelength dependence of the atmospheric transmission and the instrumental throughput induce source color-dependent systematic errors. These systematic errors must also be considered to achieve the most precise photometric measurements. In this paper, we examine such systematic chromatic errors (SCEs) using photometry from the Dark Energy Survey (DES) as an example. We first define a natural magnitude system for DES and calculate the systematic errors on stellar magnitudes when the atmospheric transmission and instrumental throughput deviate from the natural system. We conclude that the SCEs caused by the change of airmass in each exposure, the change of the precipitable water vapor and aerosol in the atmosphere over time, and the non-uniformity of instrumental throughput over the focal plane can be up to 2% in some bandpasses. We then compare the calculated SCEs with the observed DES data. For the test sample data, we correct these errors using measurements of the atmospheric transmission and instrumental throughput from auxiliary calibration systems. The residual after correction is less than 0.3%. Moreover, we calculate such SCEs for Type Ia supernovae and elliptical galaxies and find that the chromatic errors for non-stellar objects are redshift-dependent and can be larger than those for stars at certain redshifts.

79 ASTRONOMY AND ASTROPHYSICS↗

Experimental Analysis of File Transfer Rates over Wide-Area Dedicated Connections

File transfers over dedicated connections, supported by large parallel file systems, have become increasingly important in high-performance computing and big data workflows. It remains a challenge to achieve peak rates for such transfers due to the complexities of file I/O, host, and network transport subsystems, and equally importantly, their interactions. We present extensive measurements of disk-to-disk file transfers using Lustre and XFS file systems mounted on multi-core servers over a suite of 10 Gbps emulated connections with 0-366 ms round trip times. Our results indicate that large buffer sizes and many parallel flows do not always guarantee high transfer rates. Furthermore, large variations in the measured rates necessitate repeated measurements to ensure confidence in inferences based on them. We propose a new method to efficiently identify the optimal joint file I/O and network transport parameters using a small number of measurements. We show that for XFS and Lustre with direct I/O, this method identifies configurations achieving 97% of the peak transfer rate while probing only 12% of the parameter space.

Rao, Nageswara S.↗

Statistical Framework for Planning a Shelf Life Program with Binary Performance Data

This document outlines a statistical framework for establishing a shelf-life program for components whose performance is measured by a binary response, usually ‘pass’ or ‘fail.’ The approach applies to both single measurement devices and repeated measurement devices. The high-level objective of these plans is to quickly detect any sizeable increase in fraction defective as the product ages. The statistical approach is to choose a sample size and monitoring technique that alarms when the fraction defective increases to an unacceptably high level, but does not alarm when the process is at nominal. The nominal (acceptable) fraction defective is used, and an increased fraction defective (unacceptable) is assumed as part of the control chart design. The control chart recommended for this problem is the Bernoulli Cumulative Sum (CUSUM) control chart.

97 MATHEMATICS AND COMPUTING↗

Continued Benefit to Rectal Separation for Prostate Radiation Therapy: Final Results of a Phase III Trial

Purpose: SpaceOAR, a Food and Drug Administration–approved hydrogel intended to create a rectal–prostate space, was evaluated in a single-blind phase III trial of image guided intensity modulated radiation therapy. A total of 222 men were randomized 2:1 to the spacer or control group and received 79.2 Gy in 1.8-Gy fractions to the prostate with or without the seminal vesicles. The present study reports the final results with a median follow-up period of 3 years. Methods and Materials: Cumulative (Common Terminology Criteria for Adverse Events, version 4.0) toxicity was evaluated using the log-rank test. Quality of life (QOL) was examined using the Expanded Prostate Cancer Index Composite (EPIC), and the mean changes from baseline in the EPIC domains were tested using repeated measures models. The proportions of men with minimally important differences (MIDs) in each domain were tested using repeated measures logistic models with prespecified thresholds. Results: The 3-year incidence of grade ≥1 (9.2% vs 2.0%; P=.028) and grade ≥2 (5.7% vs 0%; P=.012) rectal toxicity favored the spacer arm. Grade ≥1 urinary incontinence was also lower in the spacer arm (15% vs 4%; P=.046), with no difference in grade ≥2 urinary toxicity (7% vs 7%; P=0.7). From 6 months onward, bowel QOL consistently favored the spacer group (P=.002), with the difference at 3 years (5.8 points; P<.05) meeting the threshold for a MID. The control group had a 3.9-point greater decline in urinary QOL compared with the spacer group at 3 years (P<.05), but the difference did not meet the MID threshold. At 3 years, more men in the control group than in the spacer group had experienced a MID decline in bowel QOL (41% vs 14%; P=.002) and urinary QOL (30% vs 17%; P=.04). Furthermore, the control group were also more likely to have experienced large declines (twice the MID) in bowel QOL (21% vs 5%; P=.02) and urinary QOL (23% vs 8%; P=.02). Conclusions: The benefit of a hydrogel spacer in reducing the rectal dose, toxicity, and QOL declines after image guided intensity modulated radiation therapy for prostate cancer was maintained or increased with a longer follow-up period, providing stronger evidence for the benefit of hydrogel spacer use in prostate radiation therapy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗

REGULATORY TESTING AND POSTTEST ANALYSIS OF THE DPP-3 TYPE B SHIPPING CONTAINER FOR NCT AND HAC TESTS

The safe transportation of radioactive material using appropriately designed and certified transportation packages is important to protect the public and environment. Therefore, a comprehensive and rigorous system of packaging requirements are required. The purpose of this test protocol is to determine the effects of drop testing on package performance in a Type B shipping package (DPP-3). Required physical tests for the DPP-3 package include normal conditions of transport and hypothetical accident conditions test requirements. The preparation, regulatory testing, and post-test evaluation of a Type B shipping package tested to the 10 CFR 71.71 and 10 CFR 71.73 requirements will be presented. Six packages were tested and the responses when subjected to the HAC sequence of free drop, puncture, and thermal tests according to 10 CFR 71.73 were measured. The posttest helium leak test showed a leak rate less than 1 × 10-7 He-cc/sec which means that the containment boundary was maintained after the regulatory testing, therefore maintaining a leak tight environment. To determine the amount of change in the package performance measurements, statistical analyses were conducted using SPSS version 26. The null hypothesis of the testing was that there would not be a change in the measurements from pre to post-testing large enough to find statistical significance. Therefore, a finding of statistical significance indicated too much variability in the package design and was deemed an unfavorable finding. A repeated measures t-test was used to analyze the drum lids and CV torques. A one-way ANOVA was used to analyze height and diameter packages. Results of the repeated measures t-test indicated that all six containment vessel lid torques were statistically significant. However only three out of the six drum lid torques were statistically significant. Therefore, design of the lids caused more variability than necessary when subjected to the following drop tests: 1.) horizontal and cold; 2.) vertical lid down; and 3.) corner with lid up. Results of the one-way ANOVA analysis on height indicated that four out of the six CTUs were statistically significant. Thus, design of the CTUs caused more variability then necessary when subjected to the following drop tests: 1.) horizontal hot; 2.) horizontal cold; 3.) corner lid up; and 4.) corner lid down. Results of the one-way ANOVA analysis on diameter indicated that all six CTUs were statistically significant. Thus, design of the CTUs caused more variability then necessary when subjected to all of the tests. The DPP-3 design has been shown to be an acceptable design for the transport of radioactive materials. However, results of the statistical analysis reveal a possible improvement in package and test design to reduce variability in package performance measurement before and after testing.

Martinez, Oscar↗

To have value, comparisons of high-throughput phenotyping methods need statistical tests of bias and variance

The gap between genomics and phenomics is narrowing. The rate at which it is narrowing, however, is being slowed by improper statistical comparison of methods. Quantification using Pearson’s correlation coefficient ( r ) is commonly used to assess method quality, but it is an often misleading statistic for this purpose as it is unable to provide information about the relative quality of two methods. Using r can both erroneously discount methods that are inherently more precise and validate methods that are less accurate. These errors occur because of logical flaws inherent in the use of r when comparing methods, not as a problem of limited sample size or the unavoidable possibility of a type I error. A popular alternative to using r is to measure the limits of agreement (LOA). However both r and LOA fail to identify which instrument is more or less variable than the other and can lead to incorrect conclusions about method quality. An alternative approach, comparing variances of methods, requires repeated measurements of the same subject, but avoids incorrect conclusions. Variance comparison is arguably the most important component of method validation and, thus, when repeated measurements are possible, variance comparison provides considerable value to these studies. Statistical tests to compare variances presented here are well established, easy to interpret and ubiquitously available. The widespread use of r has potentially led to numerous incorrect conclusions about method quality, hampering development, and the approach described here would be useful to advance high throughput phenotyping methods but can also extend into any branch of science. The adoption of the statistical techniques outlined in this paper will help speed the adoption of new high throughput phenotyping techniques by indicating when one should reject a new method, outright replace an old method or conditionally use a new method.

59 BASIC BIOLOGICAL SCIENCES↗

Determination of Series Resistance in CdSeTe/CdTe Solar Cells by the Jsc–Voc Method

While commonly used in Si solar cell characterization, the Suns–Voc method of determining series resistance (Rs) is rarely used for CdTe and its alloys. However, it is advantageous relative to the slope method—commonly used in the CdTe community—because it measures series resistance at the maximum power point, at which a solar cell operates. Using the self-consistent predecessor to Suns–Voc, Jsc –Voc, , we determine Rs of two different CdSeTe/CdTe solar cell structures to be 0.96 and 2.72 Ωcm2, with repeated measurements showing little deviation

13 HYDRO ENERGY↗

Assessment of Low-Level Pu Isotope Ratio Measurements Using Multicollector Inductively Coupled Plasma Mass Spectrometry (MC-ICP-MS/MS) Equipped with a Pre-Mass Filter

We present an initial investigation into the performance of a multicollector inductively coupled plasmamass spectrometer equipped with a pre-mass filter (Neoma MC-ICP-MS/MS) for making plutonium (Pu) isotope ratio measurements on solutions containing low level (i.e., pg mL –1 ) Pu concentrations. This assessment was achieved by comparison of the 240 Pu/ 239 Pu, 241 Pu/ 239 Pu, and 242 Pu/ 239 Pu ratios attained over a one month period on the MC-ICP-MS/MS with the long-term (∼1 year) performance observed on the predecessor MC-ICP-MS (Neptune Plus) instrument each equipped with an equipped with an APEXΩ desolvating nebulizer for repeated measurements of certified reference materials from New Brunswick Program Office (NBL PO) CRM 136a and CRM 137. The MC-ICP-MS/MS performance of repeated measurement of CRM 136a (n = 20) resulted in mean values of 240 Pu/ 239 Pu = 0.1448 ± 0.0006, 241 Pu/ 239 Pu = 0.00371 ± 0.00006, and 242 Pu/ 239 Pu = 0.00682 ± 0.00006 (k = 2). The CRM 137 (n = 20), analyzed during the same analytical sessions, produced mean values for 240 Pu/ 239 Pu = 0.2414 ± 0.0006, 241 Pu/ 239 Pu = 0.00464 ± 0.00007, and 242 Pu/ 239 Pu = 0.0157 ± 0.0001 (k = 2). These results closely align with the certificate values for CRM 136a and CRM 137 and are within the k = 2 envelopes defined by the long-term performance of the traditional MC-ICP-MS approach (Neptune Plus). Examination of the performance of the various Pu isotope ratios as a function of total Pu content revealed accurate results (<3% relative difference, or RD) above ∼50 fg total Pu. The results presented here demonstrate the capability of the MC-ICP-MS/MS making accurate and precise low level Pu isotopic measurements. While the intent of this work was not to investigate the functionality of the collision cell, the pre-mass filter was employed. Future studies are warranted to investigate the entire capability of the MC-ICP-MS/MS collision cell and pre-cell mass filter optimization for performing low level Pu isotope measurements, even in mixed matrix samples.

CRM↗

Temperature-Dependent Light-Stabilized States in Thin-Film PV Modules: Preprint

Thin-film photovoltaic modules are known to exhibit light-induced transient behavior which interferes with accurate and repeatable measurements of power. Typically power measurements are made after a light exposure in order to target a 'light state' of the module that is representative of outdoor performance. Here we show that the concept of a unique light state is poorly defined for both CIGS and CdTe modules. Instead we find that their metastable state after a light exposure can depend on the temperature of the module during the exposure. We observe changes in power as large as 5.8% for a 20 degrees C difference in light exposure temperature. These results lead us to conclude that for applications in which reproducibility and repeatability are critical, module temperature should be tightly controlled during light exposure.

14 SOLAR ENERGY↗

Novel Technique for Developing Linearized Convex System Models from Experimentally Derived Data

This paper presents a novel technique for generating a convex system model from an experimentally derived data set which features variance among repeated measurements. The convex system model developed as a test case characterizes the dynamic system losses of a vanadium redox flow battery as a function of the active power output and the battery state of charge. The technique hinges on a pre-cleaning via clustering procedure which precedes the formation of a planar convex hull comprised of triangular simplices. The clustering procedure efficiently reduces the experimental data set while mitigating variance among repeated measurements and removes outliers. Ultimately, the lower evelope of the planar convex hull serves as the desired convex system model. The proposed technique reduces systematic model error which is otherwise present when directly developing a planar convex hull model based on an unreduced data set.

24 POWER TRANSMISSION AND DISTRIBUTION↗

Pulmonary Function After Treatment for Embryonal Brain Tumors on SJMB03 That Included Craniospinal Irradiation

Purpose: The treatment of children with embryonal brain tumors (EBT) includes craniospinal irradiation (CSI). There are limited data regarding the effect of CSI on pulmonary function. Methods: Protocol SJMB03 enrolled patients 3 to 21 years of age with EBT. Pulmonary function tests (PFTs) (forced expiratory volume in 1 second [FEV{sub 1}] and forced vital capacity [FVC] by spirometry, total lung capacity [TLC] by nitrogen washout or plethysmography, and diffusing capacity of the lung for carbon monoxide corrected for hemoglobin [DLCO{sub corr}]) were obtained. Differences between PFTs obtained immediately after the completion of CSI and 24 or 60 months after the completion of treatment (ACT) were compared using exact Wilcoxon signed-rank tests and repeated-measures models. Results: Between June 24, 2003, and March 1, 2010, 303 eligible patients (spine dose: ≤2345 cGy, 201; >2345 cGy, 102; proton beam, 20) were enrolled, 260 of whom had at least 1 PFT. The median age at diagnosis was 8.9 years (range, 3.1-20.4 years). The median thoracic spinal radiation dose was 23.4 Gy (interquartile range [IQR], 23.4-36.0 Gy). The median cyclophosphamide dose was 16.0 g/m{sup 2} (IQR, 15.7-16.0 g/m{sup 2}). At 24 and 60 months ACT, DLCO{sub corr} was <75% predicted in 23% (27/118) and 25% (21/84) of patients, FEV{sub 1} was <80% predicted in 20% (34/170) and 29% (32/109) of patients, FVC was <80% predicted in 27% (46/172) and 28% (30/108) of patients, and TLC was <75% predicted in 9% (13/138) and 11% (10/92) of patients. DLCO{sub corr} was significantly decreased 24 months ACT (median difference [MD] in % predicted, 3.00%; P=.028) and 60 months ACT (MD in % predicted, 6.00%; P=.033) compared with the end of radiation therapy. These significant decreases in DLCO{sub corr} were also observed in repeated-measures models (P=.011 and P=.032 at 24 and 60 months ACT, respectively). Conclusions: A significant minority of EBT survivors experience PFT deficits after CSI. Continued monitoring of this cohort is planned.

62 RADIOLOGY AND NUCLEAR MEDICINE↗