Hospice Providers Awareness of the Benefits and Availability of Single-Fraction Palliative Radiotherapy

Radiotherapy effectively palliates malignant sources of pain. However, once enrolled on hospice, patients are rarely referred for this treatment. To develop educational strategies that can improve access to care, a survey of hospice providers investigated potential misconceptions about its benefits and availability. Individual surveys were distributed to administrators, nursing directors, and medical directors at 16 licensed hospices within 25 miles of a radiation oncology facility. Ninety-three percent of hospice professionals stated radiotherapy provides pain relief and is appropriate for patients with more than 1 month of life expectancy. However, less than 1% of their cancer patients had been referred to a radiation oncologist over the past year, citing concerns about cost and travel burden. Whereas most medical directors (75%) were aware it is just as effective when delivered in a single fraction, very few administrators (22%) and nursing directors (21%) had this knowledge. Meanwhile, reluctance of a radiation oncologist to offer single-fraction palliative radiotherapy was experienced by 43%. Access to palliative radiotherapy for this unique population can be increased by improving education for hospice administrators and nursing directors and reminding radiation oncologists that single-fraction palliative radiotherapy is acceptable and ideal for patients with limited financial resources at the end of life

RELAP5/SIMMER-III code coupling development for PbLi-water interaction

A major safety issue in the Water-Cooled Lead-Lithium Breeding Blanket (WCLL-BB) system foreseen for fusion reactor is the interaction concerning the primary coolant (water) and the neutron multiplier (PbLi), due to a hypothetical tube rupture in the coolant circuit. This scenario involves an exothermic chemical reaction between PbLi and water with the production of hydrogen, in addition to critical interactions in a complex multiphase system in non-thermal equilibrium. In recent years the PbLi/water reaction was successfully implemented in the SIMMER-III code and validated against data from the LIFUS5/Mod3 experimental campaign. However, due to limitations of SIMMER-III, this work was restricted to the prediction of the phenomena inside the vessel, neglecting the simulation of the injection line. Nevertheless, since the injection line may actually have an important effect on the development of the transient, the simulation of the whole facility would be highly desirable. Indeed, the University of Pisa recently developed a coupling methodology between the SIMMER-III and RELAP5/Mod3.3 codes and applied it to simple single-phase cases. In this paper the complete simulation of the LIFUS5/Mod3 facility is presented, with the injection line modelled through RELAP5. Furthermore, all the complex aspects of the phenomena inside the reaction tank were included: the multiphase system and the interaction between water and PbLi with the chemical reaction and the production of hydrogen were modelled by SIMMER. Preliminary results are presented, showing that the coupling methodology can be effectively employed for the prediction of the chemical and thermal-hydraulic behaviour of complex loop experimental facilities

Stereotactic body radiotherapy for primary prostate cancer

Prostate cancer is the most common non-cutaneous cancer in males. There are a number of options for patients with localized early stage disease, including active surveillance for low-risk disease, surgery, brachytherapy, and external beam radiotherapy. Increasingly, external beam radiotherapy, in the form of dose-escalated and moderately hypofractionated regimens, is being utilized in prostate cancer, with randomized evidence to support their use. Stereotactic body radiotherapy, which is a form of extreme hypofractionation, delivered with high precision and conformality typically over 1 to 5 fractions, offers a more contemporary approach with several advantages including being non-invasive, cost-effective, convenient for patients, and potentially improving patient access. In fact, one study has estimated that if half of the patients currently eligible for conventional fractionated radiotherapy in the United States were treated instead with stereotactic body radiotherapy, this would result in a total cost savings of US$250 million per year. There is also a strong radiobiological rationale to support its use, with prostate cancer believed to have a low alpha/beta ratio and therefore being preferentially sensitive to larger fraction sizes. To date, there are no published randomized trials reporting on the comparative efficacy of stereotactic body radiotherapy compared to alternative treatment modalities, although multiple randomized trials are currently accruing. Yet, early results from the randomized phase III study of HYPOfractionated RadioTherapy of intermediate risk localized Prostate Cancer (HYPO-RT-PC) trial, as well as multiple single-arm phase I/II trials, indicate low rates of late adverse effects with this approach. In patients with low-to intermediate-risk disease, excellent biochemical relapse-free survival outcomes have been reported, albeit with relatively short median follow-up times. These promising early results, coupled with the enormous potential cost savings and implications for resource availability, suggest that stereotactic body radiotherapy will take center stage in the treatment of prostate cancer in the years to come

Post-test analysis of Series D experiments in LIFUS5/Mod3 facility for SIMMER code validation of WCLL-BB In-box LOCA

The In-box LOCA for the WCLL-BB is recognized as a Design Basis Accident (DBA) and is of substantial interest to the DEMOnestration reactor design, therefore, the transient response of such an accident must be carefully investigated and addressed to ensure the safe operation and integrity of the whole system. In this way, the LIFUS5/Mod3 test facility (constructed at ENEA Brasimone Research Center) has been upgraded in the period 2018–2020 to perform a series of tests. The first set of the tests were named Series D, which are characterized by injecting specified amounts of pressurized water into the Lithium lead liquid bulk. The experimental campaign aimed at validating and qualifying the SIMMER-III code as a reliable numerical tool for the safety studies of the WCLL BB. In parallel with performing the tests, SIMMER-III Verification and Validation (V&V) was conducted according to a standard code validation procedure. SIMMER-III is a two-dimensional, multiphase, multicomponent, Eulerian, fluid-dynamics code which was firstly developed at the Japan Nuclear Cycle Development Institute (JNC). An adopted version of the original SIMMER-III code so-called Ver.3 F Mod.0.1 (which was developed at University of Pisa), was employed for the analyses. The V&V activity was successfully completed and documented as the technical reports within the past numerical analytical and experimental activities for the first three tests (D1.1, D1.2 and D1.5). In this article, the experimental data of the Tests D1.1, D1.2 and D1.5 are used for the SIMMER-III code results comparison. A qualitative analysis of the results obtained is reported according to the time trends for the most relevant parameters. The results show that the SIMMER-III code acceptably predicts the transient and the accuracies of the relevant test parameters are in agreement with the acquired experimental signals. Although that the primarily validation results are highly promising but further code assessment, development and validation are essential to approach such a qualified system code, which is suitable for fusion safety applications. The present validation work has been successfully followed by its ongoing experimental and numerical activities as a multilateral EUROfusion project

Development of a SIMMERRELAP5 coupling tool

The In-Box Loss Of Coolant (LOCA) postulated accident is considered a major concern for the safety connected with the development of EU-DEMO fusion reactor. Relating to the renewed interest in the Water-Cooled Lithium Led blanket concept, an innovative experimental campaign is under development at ENEA Brasimone laboratories aiming at investigating the consequences related to the In-Box LOCA applied to the WCLL breeding blanket. In this frame, a new coupling tool between the SIMMER-III (modified version to implement the PbLi/water chemical interaction) and the RELAP5/Mod3.3 codes (modified version to implement PbLi thermo-physical properties) has been developed together with its preliminary application to simple test cases with water as working fluid. The coupling procedure can be defined as a “two-way”, “non-overlapping”, “online” technique aiming at investigating multi-physics and multi-scales phenomena in support of the development of fusion reactor technologies

Analysis of Test D1.1 of the LIFUS5/Mod3 facility for In-box LOCA in WCLL-BB

The in-box Loss of Coolant Accident (LOCA) scenario is considered as one of the most affecting safety concerns for the Water-Cooled Lead Lithium Breeding Blanket (WCLL-BB) modules of the DEMOnstration (DEMO) reactor, which is sequentially followed by a multi-phase multi-component physical and chemical interaction. Therefore, the transient behavior of such accidents has to be carefully investigated during the design phase of the plant, to evaluate the consequences and to adopt the necessary mitigating countermeasures. This also requires a numerical predictive tool, which is capable to model such transients and predict the relevant phenomena under an operational condition and the connected safety parameters i.e. system pressure, temperature, chemical products mass, and volume fractions of all the existing components. Consequently, the SIMMER-III code was firstly improved at the University of Pisa by implementing the chemical reaction between PbLi eutectic alloy and water. In addition to this, an experimental campaign and a test-matrix have been recently designed according to the LIFUS5/Mod3 facility to perform a series of experiments and code post-test analyses. In the present work, the experimental data of the first LIFUS5/Mod3 test is used for the validation of the chemical model implemented in SIMMER-III through a comprehensive sensitivity study. The applied methodology for the code validation is based on a three-step procedure including qualitative analysis, quantitative analysis and the results from sensitivity analyses. The qualitative accuracy evaluation is performed through a systematic comparison between experimental and calculated time trends based on the engineering analysis, the resulting sequence of main events and the identification of phenomenological windows and of relevant thermo-hydraulic aspects. Afterwards, the accuracy of the code prediction is evaluated from a quantitative point of view by means of selected, widely used, figures of merit. Finally, the results from the sensitivity cases are analysed and quantified, to determine the effects of the most influencing code input options and transient parameters. Furthermore, the analysis is followed by applying the Fast Fourier Transform Method (FFTM) to the experimental signals and all the sensitivity calculations. The comparison shows a very good agreement for pressure transient between the experimental and numerical data, while for the temperature and the hydrogen production the results fall into acceptable criteria, which means that the code is reliable in capturing and predicting the transient values but not perfectly match with the experimental signals

Clinic Offering Affordable Radiation Therapy to Increase Access to Care for Patients Enrolled in Hospice

Purpose: A majority of patients enrolled in hospice have advanced cancer. Most of them are burdened by symptoms related to uncontrolled tumor growth. Although palliative radiation therapy (RT) is highly effective, only 1% of hospice patients are ever referred. Commonly cited concerns include high treatment cost, burden of travel for multiple visits, and a perceived reluctance of radiation oncologists to deliver single-fraction RT. Methods: A clinic offering affordable RT to patients in hospice was developed to simplify the intake, reduce cost, and minimize travel to a single visit. The goal was to evaluate, simulate and plan treatment, and treat patients with a single fraction of palliative RT within a 4-hour period. Results: The initial 18-month experience is reported in this Health Information Portability and Accountability Act–compliant report that was approved by the Viriginia Commonwealth University Institutional Review Board. Eight referrals were received from local hospice agencies that had not referred any patients in previous years. A telephone screening process avoided unnecessary travel for two patients who were not candidates for RT. Two additional patients who were evaluated with a same-day computed tomography simulation were not good candidates for RT. Ultimately, four patients were successfully treated with single-fraction palliative RT of 8 Gy. None had to disenroll from hospice. Conclusion: This novel program increased access to palliative RT for patients in hospice who would otherwise not have been referred. The main challenge identified was a need for ongoing educational activities at hospice agencies where staff turnover may be high and understanding about palliative RT can be limited

Experimental activities for in-box LOCA of WCLL BB in LIFUS5/Mod3 facility

The new experimental facility LIFUS5/Mod3 has been designed, manufactured and installed to investigate the phenomena connected with the thermodynamic and chemical interaction between lithium-lead and water in case of in-box LOCA (Loss of Coolant Accident) of the WCLL breeding blanket concept and to validate the chemical model implemented in SIMMER code for fusion application. In order to fulfill these objectives, the necessary step is to obtain data, suitable to code validation, by means of an experimental campaign in LIFUS5/Mod3 facility, executed with controlled initial and boundary conditions. Thus, specific instrumentation and dedicated data acquisition system are installed on the facility to provide meaningful and reliable data. The final aim of the LIFUS5/Mod3 campaign is the SIMMER code validation, applying the standard methodology to post-test analyses. Besides, the expected outcomes of the tests are the improvement of the knowledge of physical behavior and of understanding of the phenomena, the investigation of the dynamic effects of energy release towards the structures and of the chemical reaction with the consequent hydrogen production, and the enlargement of the database for code validation