Interventional Radiology and the Care of the Oncology Patient

Interventional Radiology (IR) is occupying an increasingly prominent role in the care of patients with cancer, with involvement from initial diagnosis, right through to minimally invasive treatment of the malignancy and its complications. Adequate diagnostic samples can be obtained under image guidance by percutaneous biopsy and needle aspiration in an accurate and minimally invasive manner. IR techniques may be used to place central venous access devices with well-established safety and efficacy. Therapeutic applications of IR in the oncology patient include local tumour treatments such as transarterial chemo-embolisation and radiofrequency ablation, as well as management of complications of malignancy such as pain, organ obstruction, and venous thrombosis

A High Fraction of Ly-alpha-Emitters Among Galaxies with Extreme Emission Line Ratios at z ~ 2

Star-forming galaxies form a sequence in the [OIII]/H-beta vs. [NII]/H-alpha diagnostic diagram, with low metallicity, highly ionized galaxies falling in the upper left corner. Drawing from a large sample of UV-selected star-forming galaxies at z~2 with rest-frame optical nebular emission line measurements from Keck-MOSFIRE, we select the extreme ~5% of the galaxies lying in this upper left corner, requiring log([NII]/H-alpha) = 0.75. These cuts identify galaxies with 12 + log(O/H) <~ 8.0, when oxygen abundances are measured via the O3N2 diagnostic. We study the Ly-alpha properties of the resulting sample of 14 galaxies. The mean (median) rest-frame Ly-alpha equivalent width is 39 (36) A, and 11 of the 14 objects (79%) are Ly-alpha-emitters (LAEs) with W_Lya > 20 A. We compare the equivalent width distribution of a sample of 522 UV-selected galaxies at 2.0<z<2.6 identified without regard to their optical line ratios; this sample has mean (median) Ly-alpha equivalent width -1 (-4) A, and only 9% of these galaxies qualify as LAEs. The extreme galaxies typically have lower attenuation at Ly-alpha than those in the comparison sample, and have ~50% lower median oxygen abundances. Both factors are likely to facilitate the escape of Ly-alpha: in less dusty galaxies Ly-alpha photons are less likely to be absorbed during multiple scatterings, while the harder ionizing spectrum and higher ionization parameter associated with strong, low metallicity star formation may reduce the covering fraction or column density of neutral hydrogen, further easing Ly-alpha escape. The use of nebular emission line ratios may prove useful in the identification of galaxies with low opacity to Ly-alpha photons across a range of redshifts.Comment: 12 pages, 5 figures, 2 tables. Accepted for publication in Ap

Measuring the Physical Conditions in High-redshift Star-forming Galaxies: Insights from KBSS-MOSFIRE

We use photoionization models that are designed to reconcile the joint rest-UV-optical spectra of high-z star-forming galaxies to self-consistently infer the gas chemistry and nebular ionization and excitation conditions for ~150 galaxies from the Keck Baryonic Structure Survey (KBSS), using only observations of their rest-optical nebular spectra. We find that the majority of z ~ 2–3 KBSS galaxies are moderately O-rich, with an interquartile range in 12 + log(O/H) = 8.29–8.56, and have significantly sub-solar Fe enrichment, with an interquartile range of [Fe/H] = [−0.79, −0.53], which contributes additional evidence in favor of super-solar O/Fe in high-z galaxies. The model-inferred ionization parameters and N/O are strongly correlated with common strong-line indices (such as O32 and N2O2), with the latter exhibiting similar behavior to local extragalactic H ii regions. In contrast, diagnostics commonly used for measuring gas-phase O/H (such as N2 and O3N2) show relatively large scatter with the overall amount of oxygen present in the gas and behave differently than observed at z ~ 0. We provide a new calibration for using R23 to measure O/H in typical high-z galaxies, although it is most useful for relatively O-rich galaxies; combining O32 and R23 does not yield a more effective calibration. Finally, we consider the implications for the intrinsic correlations between physical conditions across the galaxy sample and find that N/O varies with O/H in high-z galaxies in a manner that is almost identical to local H ii regions. However, we do not find a strong anti-correlation between ionization parameter and metallicity (O/H or Fe/H) in high-z galaxies, which is one of the principal bases for using strong-line ratios to infer oxygen abundance

The Keck Lyman Continuum Spectroscopic Survey (KLCS): The Emergent Ionizing Spectrum of Galaxies at z ∼ 3

We present results of a deep spectroscopic survey quantifying the statistics of the escape of ionizing radiation from star-forming galaxies at z ~ 3. We measure the ratio of ionizing to non-ionizing UV flux density 〈f_(900)/f_(1500) 〉_(obs), where f_(900) is the mean flux density evaluated over the range [880, 910] Å. We quantify the emergent ratio of ionizing to non-ionizing UV flux density by analyzing high signal-to-noise ratio composite spectra formed from subsamples with common observed properties and numbers sufficient to reduce the statistical uncertainty in the modeled IGM+CGM correction to obtain precise values of 〈f_(900)/f_(1500) 〉_(out), including a full-sample average 〈f_(900)/f_(1500) 〉_(out) = 0.057 ± 0.006. We show that 〈f_(900)/f_(1500) 〉_(out) increases monotonically with W_ λ(Lyα), inducing an inverse correlation with UV luminosity as a by-product. We fit the composite spectra using stellar spectral synthesis together with models of the ISM in which a fraction f c of the stellar continuum is covered by gas with column density N_(H1). We show that the composite spectra simultaneously constrain the intrinsic properties of the stars (L_(900)/L_(1500))_(int) along with f_c , N_(H1), E(B - V), and f_(esc,abs), the absolute escape fraction of ionizing photons. We find a sample-averaged f-(esc,abs) = 0.09 ± 0.01, with subsamples falling along a linear relation 〈f_(esc,abs) 〉 ≃ 0.75[W_ λ(Lyα)/110 Å]. Using the far-UV luminosity function, the distribution function n(W(Lyα)), and the relationship between W_ λ(Lyα) and f_(900)/f_(1500) 〉_(out), we estimate the total ionizing emissivity of z ~ 3 star-forming galaxies with M_(uv) ≤ −19.5, which exceeds the contribution of quasi-stellar objects by a factor of ~3, and accounts for ~50% of the total ϵ_(LyC) at z ~ 3 estimated using indirect methods

Column Density, Kinematics, and Thermal State of Metal-bearing Gas within the Virial Radius of z ∼ 2 Star-forming Galaxies in the Keck Baryonic Structure Survey

We present results from the Keck Baryonic Structure Survey (KBSS) including the first detailed measurements of the column densities, kinematics, and internal energy of metal-bearing gas within the virial radius (35–100 physical kpc) of eight ~L* galaxies at z ~ 2. From our full sample of 130 metal-bearing absorbers, we infer that halo gas is kinematically complex when viewed in singly, doubly, and triply ionized species. Broad O vi and C iv absorbers are detected at velocities similar to the lower-ionization gas but with a very different kinematic structure, indicating that the circumgalactic medium (CGM) is multiphase. There is a high covering fraction of metal-bearing gas within 100 kpc, including highly ionized gas such as O vi; however, observations of a single galaxy probed by a lensed background QSO suggest the size of metal-bearing clouds is small (<400 pc for all but the O vi-bearing gas). The mass in metals found within the halo is substantial, equivalent to ≳25% of the metal mass within the interstellar medium. The gas kinematics unambiguously show that 70% of galaxies with detected metal absorption have some unbound metal-enriched gas, suggesting galactic winds may commonly eject gas from halos at z ~ 2. When modeled assuming that ions with different ionization potentials can originate within a single gaseous structure, significant thermal broadening is detected in CGM absorbers that dominates the internal energy of the gas. Some 40% of the detected gas has temperatures in the range 10^(4.5-5.5) K where cooling times are short, suggesting the CGM is dynamic, with constant heating or cooling to produce this short-lived thermal phase

Column Density, Kinematics, and Thermal State of Metal-bearing Gas within the Virial Radius of z ∼ 2 Star-forming Galaxies in the Keck Baryonic Structure Survey

We present results from the Keck Baryonic Structure Survey (KBSS) including the first detailed measurements of the column densities, kinematics, and internal energy of metal-bearing gas within the virial radius (35–100 physical kpc) of eight ~L* galaxies at z ~ 2. From our full sample of 130 metal-bearing absorbers, we infer that halo gas is kinematically complex when viewed in singly, doubly, and triply ionized species. Broad O vi and C iv absorbers are detected at velocities similar to the lower-ionization gas but with a very different kinematic structure, indicating that the circumgalactic medium (CGM) is multiphase. There is a high covering fraction of metal-bearing gas within 100 kpc, including highly ionized gas such as O vi; however, observations of a single galaxy probed by a lensed background QSO suggest the size of metal-bearing clouds is small (<400 pc for all but the O vi-bearing gas). The mass in metals found within the halo is substantial, equivalent to ≳25% of the metal mass within the interstellar medium. The gas kinematics unambiguously show that 70% of galaxies with detected metal absorption have some unbound metal-enriched gas, suggesting galactic winds may commonly eject gas from halos at z ~ 2. When modeled assuming that ions with different ionization potentials can originate within a single gaseous structure, significant thermal broadening is detected in CGM absorbers that dominates the internal energy of the gas. Some 40% of the detected gas has temperatures in the range 10^(4.5-5.5) K where cooling times are short, suggesting the CGM is dynamic, with constant heating or cooling to produce this short-lived thermal phase

Measuring the Physical Conditions in High-redshift Star-forming Galaxies: Insights from KBSS-MOSFIRE

We use photoionization models that are designed to reconcile the joint rest-UV-optical spectra of high-z star-forming galaxies to self-consistently infer the gas chemistry and nebular ionization and excitation conditions for ~150 galaxies from the Keck Baryonic Structure Survey (KBSS), using only observations of their rest-optical nebular spectra. We find that the majority of z ~ 2–3 KBSS galaxies are moderately O-rich, with an interquartile range in 12 + log(O/H) = 8.29–8.56, and have significantly sub-solar Fe enrichment, with an interquartile range of [Fe/H] = [−0.79, −0.53], which contributes additional evidence in favor of super-solar O/Fe in high-z galaxies. The model-inferred ionization parameters and N/O are strongly correlated with common strong-line indices (such as O32 and N2O2), with the latter exhibiting similar behavior to local extragalactic H ii regions. In contrast, diagnostics commonly used for measuring gas-phase O/H (such as N2 and O3N2) show relatively large scatter with the overall amount of oxygen present in the gas and behave differently than observed at z ~ 0. We provide a new calibration for using R23 to measure O/H in typical high-z galaxies, although it is most useful for relatively O-rich galaxies; combining O32 and R23 does not yield a more effective calibration. Finally, we consider the implications for the intrinsic correlations between physical conditions across the galaxy sample and find that N/O varies with O/H in high-z galaxies in a manner that is almost identical to local H ii regions. However, we do not find a strong anti-correlation between ionization parameter and metallicity (O/H or Fe/H) in high-z galaxies, which is one of the principal bases for using strong-line ratios to infer oxygen abundance

Nebular Emission Line Ratios in z ≃ 2–3 Star-forming Galaxies with KBSS-MOSFIRE: Exploring the Impact of Ionization, Excitation, and Nitrogen-to-Oxygen Ratio

We present a detailed study of the rest-optical (3600–7000 Å) nebular spectra of ~380 star-forming galaxies at z ≃ 2–3, obtained with Keck/Multi-object Spectrometer for Infrared Exploration (MOSFIRE) as part of the Keck Baryonic Structure Survey (KBSS). The KBSS-MOSFIRE sample is representative of star-forming galaxies at these redshifts, with stellar masses M_* = M^9 – M^(11.5) M_⊙ and star formation rates SFR = 3–1000 M_⊙ yr^(-1). We focus on robust measurements of many strong diagnostic emission lines for individual galaxies: [O II]λλ3727, 3729, [Ne III]λ3869, Hβ, [O III]λλ 4960, 5008, [N II]λλ 6549, 6585, Hα, and [S II]λλ6718, 6732. Comparisons with observations of typical local galaxies from the Sloan Digital Sky Survey and between subsamples of KBSS-MOSFIRE show that high-redshift galaxies exhibit a number of significant differences in addition to the well-known offset in log([O III]λ5008/Hβ) and log([N II]λ6585/Hα). We argue that the primary difference between H II regions in z ~ 2.3 galaxies and those at z ~ 0 is an enhancement in the degree of nebular excitation, as measured by [O III]/Hβ and R23 ≡ log [([O III]λλ4960, 5008+[O II]λλ3727, 3729)/Hβ]. At the same time, KBSS-MOSFIRE galaxies are ~10 times more massive than z ~ 0 galaxies with similar ionizing spectra and have higher N/O (likely accompanied by higher O/H) at fixed excitation. These results indicate the presence of harder ionizing radiation fields at fixed N/O and O/H relative to typical z ~ 0 galaxies, consistent with Fe-poor stellar population models that include massive binaries, and highlight a population of massive, high-specific star formation rate galaxies at high redshift with systematically different star formation histories than galaxies of similar stellar mass today

An assessment of medical students’ awareness of radiation exposures associated with diagnostic imaging investigations

Objectives: This study assessed students’ awareness of radiation exposures and determined the impact a curriculum in clinical radiology (CICR) had on awareness. Methods: Six hundred seventy medical students at one medical school were studied. CICR was delivered in yearly modules over the 5-year programme. Five hundred twenty-three students (years 1–5), exposed to increasing numbers of CICR modules and 147 students beginning medical school (year 0), represented the study and control groups, respectively. Students completed a multiple choice questionnaire assessing radiation knowledge and radiology teaching. Results: Most students in the study population received CICR but 87% considered they had not received radiation protection instruction. The percentage of correctly answered questions was significantly higher in the study population than the control group (59.7% versus 38%, p < 0.001). Students who received CICR achieved higher scores than those who did not (61.3% compared with 42.8%, p < 0.001). Increasing exposure to CICR with each year of medical education was associated with improved performance. Conclusions: Assessment of students’ awareness of radiation exposures in diagnostic imaging demonstrates improved performance with increasing years in medical school and/or increasing exposure to CICR. Findings support the Euroatom 97 directive position, advocating implementation of radiation protection instruction into the undergraduate medical curriculum