What Can Utilities Expect from New Lead Fifth-Liter Sampling Based on Historic First-Draw Data?

The United States Environmental Protection Agency recently released their most sweeping overhaul to the Lead and Copper Rule in three decades. One of the most significant changes is requiring a fifth-liter (L5) sample at homes with lead service lines (LSLs) rather than the original first-liter (L1) sample for a demonstration of compliance with water lead level (WLL) limits. We analyzed sequential sampling data from three large water systems and compliance data from Michigan utilities-which base compliance on the 90th percentile of the greater of L1 and L5 samples-to evaluate whether L5 WLLs better represent water in contact with LSLs and to explore regulatory impacts of including L5 samples in compliance monitoring. The sequential sampling data demonstrated that it is impossible to use a single sample volume within a sequential profile to universally capture the volume of water in an LSL. While L5 is not always a reliable indicator of water in contact with an LSL, Michigan compliance data showed that the L5 sample is more likely to be from an LSL and can identify utilities that benefit from an improved corrosion control treatment. Michigan compliance data indicate that it is likely that L5 sampling will result in more systems having a higher 90th percentile WLL and that a high proportion of the systems likely to exceed regulatory action levels based on L5 samples can be identified through a retrospective analysis of historic L1 data. The impact of the switch to L5 sampling on the effectiveness of corrosion control treatment over time has yet to be determined.

A simple lead dust fall method predicts children's blood lead level: New evidence from Australia.

We have measured dust fall accumulation in petri dishes (PDD) collected 6 monthly from inside residences in Sydney urban area, New South Wales, Australia as part of a 5-year longitudinal study to determine environmental associations, including soil. with blood lead (PbB) levels. The Pb loading in the dishes (n = 706) had geometric means (GM) of 24µg/m2/30d, a median value of 22µg/m2/30d with a range from 0.2 to 11,390µg/m2/30d. Observed geometric mean PbB was 2.4µg/dL at ages 2-3 years. Regression analyses showed a statistically significant relationship between predicted PbB and PDD. The predicted PbB values from dust in our study are consistent with similar analyses from the US in which floor dust was collected by wipes. Predicted PbB values from PDD indicate that an increase in PDD of about 100µg/m2/30d would increase PbB by about 1.5µg/dL or a doubling PbB at the low levels currently observed in many countries. Predicted PbB values from soil indicate that a change from 0 to 1000mg Pb/kg results in an increase of 1.7µg/dL in PbB, consistent with earlier investigations. Blood Pb levels can be predicted from dust fall accumulation (and soil) in cases where blood sampling is not always possible, especially in young children. Petri dish loading data could provide an alternative or complementary "action level" at about 100µg Pb/m2/30 days, similar to the suggested level of about 110µg Pb/m2 for surface wipes, for use in monitoring activities such as housing rehabilitation, demolition or soil resuspension.

A clinical database to assess action levels and tolerances for the ongoing use of Mobius3D.

In radiation therapy, calculation of dose within the patient contains inherent uncertainties, inaccuracies, limitations, and the potential for random error. Thus, point dose-independent verification of such calculations is a well-established process, with published data to support the setting of both action levels and tolerances. Mobius3D takes this process one step further with a full independent calculation of patient dose and comparisons of clinical parameters such as mean target dose and voxel-by-voxel gamma analysis. There is currently no published data to directly inform tolerance levels for such parameters, and therefore this work presents a database of 1000 Mobius3D results to fill this gap. The data are tested for normality using a normal probability plot and found to fit this distribution for three sub groups of data; Eclipse, iPlan and the treatment site Lung. The mean (µ) and standard deviation (σ) of these sub groups is used to set action levels and tolerances at µ ± 2σ and µ ± 3σ, respectively. A global (3%, 3 mm) gamma tolerance is set at 88.5%. The mean target dose tolerance for Eclipse data is the narrowest at ± 3%, whilst iPlan and Lung have a range of -5.0 to 2.2% and -1.8 to 5.0%, respectively. With these limits in place, future results failing the action level or tolerance will fall within the worst 5% and 1% of historical results and an informed decision can be made regarding remedial action prior to treatment.

The 50th percentile of the general population single eating occasion intake of food is optimal for the calculation of action levels for precautionary allergen labelling.

Lack of guidance regarding selection of food intake values for allergen risk assessment can lead to different outcomes for similar levels of allergens in food products. Several food consumption survey databases (United States, North-West Europe, and Netherlands) were analyzed to identify optimal food intake percentiles using a sensitivity analysis. Deterministic risk assessment scenarios using the 50th percentile up to the maximum intake per food group were compared with probabilistic risk assessment outcomes. The optimal intake percentile is the lowest percentile that results in a deterministic risk assessment outcome compliant with the predefined safety objective, i.e., the predefined risk of an objective allergic reaction at ED01, ED2.5, ED05 or ED10 doses of 14 allergenic foods. The P50 intake met these criteria in more than 99.9% of all 28,784 scenarios tested. The P50 is therefore recommended for deterministic allergen risk assessment and calculation of action levels for precautionary allergen labelling. In case a P50 value is not available, the mean is a good alternative, as analyses of the intake data showed that the mean generally is between the P50 and P65.

Evaluation of image-guided and surface-guided radiotherapy for breast cancer patients treated in deep inspiration breath-hold: A single institution experience.

INTRODUCTION: Nowadays, deep inspiratory breath-hold is a common technique to reduce heart dose in left-sided breast radiotherapy. This study evaluates the evolution of the breath-hold technique in our institute, from portal imaging during dose delivery to continuous monitoring with surface-guided radiotherapy (SGRT). MATERIALS AND METHODS: Setup data and portal imaging results were analyzed for 98 patients treated before 2014, and SGRT data for 228 patients treated between 2018 and 2020. For the pre-SGRT group, systematic and random setup errors were calculated for different correction protocols. Residual errors and reproducibility of breath-holds were evaluated for both groups. The benefit of using SGRT for initial positioning was evaluated for another cohort of 47 patients. RESULTS: Online correction reduced the population mean error from 3.9 mm (no corrections) to 1.4 mm. Despite online setup correction, deviations greater than 3 mm were observed in about 10% and 20% of the treatment beams in ventral-dorsal and cranial-caudal directions, respectively. However, these percentages were much smaller than with offline protocols or no corrections. Mean absolute differences between breath-holds within a fraction were smaller in the SGRT-group (1.69 mm) than in the pre-SGRT-group (2.10 mm), and further improved with addition of visual feedback (1.30 mm). SGRT for positioning did not improve setup accuracy, but slightly reduced the time for imaging and setup correction, allowing completion within 3.5 min for 95% of fractions. CONCLUSION: For accurate radiotherapy breast treatments using deep inspiration breath-hold, daily imaging and correction is required. SGRT provides accurate information on patient positioning during treatment and improves patient compliance with visual feedback.

Review of Remediation Goals at Contaminated Sediment Sites in the United States.

Remediation decisions for contaminated sediment sites are typically based on comparisons of in situ sediment concentrations to preliminary remediation goals (PRGs). Preliminary remediation goals are typically developed for protection of human health and the environment, with consideration of site-specific factors that play an important role in determining the sediment concentrations that are consistent with the human health and environmental protection objectives. Remediation goals are selected from among the PRGs. Sediment remediation goals for 4 common contaminants (PCBs, PAHs, Pb, and Hg) at contaminated sediment sites throughout the United States were compiled to determine significant trends and evaluate causes of those trends. Remediation goals were compiled from Records of Decision (RODs) and 5-year review reports for 77 contaminated sediment sites throughout the continental United States. Remediation goals were developed both as surface-weighted average concentrations (SWACs) and action levels (i.e., not-to-exceed values). One or both may be used to define areas requiring remediation. Remediation goals based on SWACs are typically applied to bioaccumulative chemicals for human health and wildlife receptors, whereas action levels are typically used for chemicals that result in an acute toxicity to small home range, sediment-dwelling biota. The findings from this review of remediation goals indicate that SWACs are an increasingly common approach for developing remediation goals. In addition, the findings from this review indicate that although remediation goals adopted for Pb have become more stringent over time, no trend is evident for PCBs, PAHs, and Hg. Remediation goals for PCBs, PAHs, and Hg vary among a number of factors, such as geography, habitat, human or ecological risks, and other local factors. Integr Environ Assess Manag 2019;15:772-782. © 2019 SETAC.

Radon survey in Montenegro - A base to set national radon reference and "urgent action" level.

The first nationwide indoor radon survey in Montenegro started in 2002 and year-long radon measurements with CR-39 track-etch detectors, within the national grid of 5 km × 5 km and local grids in urban areas of 0.5 km × 0.5 km, were performed in homes in half of the country's territory. The survey continued in 2014 and measurements in the rest of the country were completed at the end of 2015. The 953 valid results, obtained in the national radon survey, give an average radon activity concentration in Montenegrin homes of 110 Bq/m3. Assuming a log-normal distribution of the experimental results, geometric mean GM = 58.3 Bq/m3 and geometric standard deviation GSD = 2.91 are calculated. However, normality tests show that the experimental data are not log-normal, and that they become closest to a log-normal distribution after subtracting from them radon concentration in the outdoor air of 7 Bq/m3, which is theoretically calculated. Such a transformed distribution has GMtr = 46.7 Bq/m3 and GSDtr = 3.54. The estimations derived from positing a priory that the experimental results conform to a log-normal distribution underestimate the percentage of homes with radon concentrations at the thresholds of 300 Bq/m3 and above, which is better estimated by using GMtr and GSDtr. Based on the results of radon survey, a new national radon reference level of 300 Bq/m3 and an "urgent action level" of 1000 Bq/m3 are suggested, with estimated fractions of the national dwelling stock above these levels of 7.4% and 0.8% respectively. Fractions of homes with radon concentrations above the suggested levels are also estimated for each of the 23 municipalities in Montenegro, using appropriate GMtr and GSDtr. The six municipalities which have more than 10% of homes with radon concentration above 300 Bq/m3 are recommended as radon priority areas.

Cone-Beam CT-based position verification for oesophageal cancer: Evaluation of registration methods and anatomical changes during radiotherapy.

PURPOSE: To evaluate different registration methods, setup margins and number of corrections for CBCT-based position verification for oesophageal cancer and to evaluate anatomical changes during the course of radiotherapy treatment. METHODS: From 50 patients, 440 CBCT-scans were registered automatically using a soft tissue or bone registration algorithm and compared to the clinical match. Moreover, relevant anatomical changes were monitored. A sub-analysis was performed to evaluate if tumour location influenced setup variations. Margin calculation was performed and the number of setup corrections was estimated. Results were compared to a patient group previously treated with MV-EPID based position verification. RESULTS: CBCT-based setup variations were smaller than EPID-based setup variations, resulting in smaller setup margins of 5.9 mm (RL), 7.5 mm (CC) and 4.7 mm (AP) versus 6.0 mm, 7.8 mm and 5.5 mm, respectively. A reduction in average number of setup corrections per patient was found from 0.75 to 0.36. From all automatically registered CBCT-scans, a clipbox around PTV and vertebras combined with soft tissue registration resulted in the smallest setup margins of 5.9 mm (RL), 7.7 mm (CC), 4.8 mm (AP) and smallest average number of corrections of 0.38. For distally located tumours, a setup margin of 7.7 mm (CC) was required compared to 5.6 mm for proximal tumours. Reduction of GTV volume, heart volume and change in diaphragm position were observed in 16, 10 and 15 patients, respectively. CONCLUSIONS: CBCT-based set-up variations are smaller than EPID-based variations and vary according to tumour location. When using kV-CBCT a large variety of anatomical changes is revealed, which cannot be observed with MV-EPID.

An assessment of the magnitude of intra-fraction movement of head-and-neck IMRT cases and its implication on the action-level of the imaging protocol.

BACKGROUND AND PURPOSE: A planning margin ⩽3 mm is employed in some head-and-neck IMRT cases due to the proximity of critical structures. This study aims to explore the need to redefine the action-level in the head-and-neck imaging protocol in consideration of the intra-fraction movement. MATERIAL AND METHODS: This is a local study of 18 patients treated using the same immobilisation system and setup protocol. Post-treatment orthogonal pair of kilovoltage X-ray images was acquired on the first three days of treatment. 106 sets of pre- and post-treatment kV X-ray images acquired over 53 fractions were analysed against the treatment planning DRR for calculation of intra-fraction movement. RESULTS: Individual mean intra-fraction movement in all directions ranged from -1.8 to 1.1 mm. Population mean (median) intra-fraction movement in the x-, y-, and z-planes were -0.1 mm (0 mm), -0.3 mm (-0.3 mm) and -0.2 mm (-0.2 mm) respectively. Intra-fraction movement in all three dimensions, x-, y- and z-planes were considered statistically significant (p<0.05). 7 out of 53 fractions (13.2%) were highlighted as the combined magnitude of the intra-fraction motion with the uncorrected pre-treatment setup errors had exceeded the boundaries of given margins. CONCLUSIONS: 3 mm-AL was not adequate to account for intra-fraction movement when the CTV-PTV margin was ⩽3 mm and should be excluded from the routine imaging protocol and daily image-guided radiotherapy should be employed. Adjusting the action-level to 2 mm would allow a more confident approach in delivery of the prescribed dose in head-and-neck IMRT cases.

Matrix-normalised quantification of species by threshold-calibrated competitive real-time PCR: allergenic peanut in food as one example.

A novel method to quantify species or DNA on the basis of a competitive quantitative real-time polymerase chain reaction (cqPCR) was developed. Potentially allergenic peanut in food served as one example. Based on an internal competitive DNA sequence for normalisation of DNA extraction and amplification, the cqPCR was threshold-calibrated against 100mg/kg incurred peanut in milk chocolate. No external standards were necessary. The competitive molecule successfully served as calibrator for quantification, matrix normalisation, and inhibition control. Although designed for verification of a virtual threshold of 100mg/kg, the method allowed quantification of 10-1,000 mg/kg peanut incurred in various food matrices and without further matrix adaption: On the basis of four PCR replicates per sample, mean recovery of 10-1,000 mg/kg peanut in chocolate, vanilla ice cream, cookie dough, cookie, and muesli was 87% (range: 39-147%) in comparison to 199% (range: 114-237%) by three commercial ELISA kits.

Investigation of the areas of high radon concentration in Gyeongju.

The aim of this study was to survey the radon concentrations at 21 elementary schools in Gyeongju, Republic of Korea, to identify those schools with high radon concentrations. Considering their geological characteristics and the preliminary survey results, three schools were finally placed under close scrutiny. For these three schools, continuous measurements over 48 h were taken at the principal's and administration office. The radon concentrations at one school, Naenam, exceeded the action level (148 Bq/m(3)) established by the U.S. EPA, while those at the other two schools were below that level.