Neutron time of flight (nToF) detectors for inertial fusion experiments

Neutrons generated in Inertial Confinement Fusion (ICF) experiments provide valuable information to interpret the conditions reached in the plasma. The neutron time-of-flight (nToF) technique is well suited for measuring the neutron energy spectrum due to the short time (100 ps) over which neutrons are typically emitted in ICF experiments. By locating detectors 10s of meters from the source, the neutron energy spectrum can be measured to high precision. We present a contextual review of the current state of the art in nToF detectors at ICF facilities in the United States, outlining the physics that can be measured, the detector technologies currently deployed and analysis techniques used.

Design of a multi-detector, single line-of-sight, time-of-flight system to measure time-resolved neutron energy spectra

In the dynamic environment of burning, thermonuclear deuterium-tritium plasmas, diagnosing the time-resolved neutron energy spectrum is of critical importance. Strategies exist for this diagnosis in magnetic confinement fusion plasmas, which presently have a lifetime of ∼10¹² longer than inertial confinement fusion (ICF) plasmas. Here, we present a novel concept for a simple, precise, and scale-able diagnostic to measure time-resolved neutron spectra in ICF plasmas. The concept leverages general tomographic reconstruction techniques adapted to time-of-flight parameter space, and then employs an updated Monte Carlo algorithm and National Ignition Facility-relevant constraints to reconstruct the time-evolving neutron energy spectrum. Reconstructed spectra of the primary 14.028 MeV n_DT peak are in good agreement with the exact synthetic spectra. The technique is also used to reconstruct the time-evolving downscattered spectrum, although the present implementation shows significantly more error.

Constraining time-dependent ion temperature measurements in inertial confinement fusion (ICF) implosions with an intermediate distance neutron time-of-flight (nToF) detector

A concept for using an intermediate distance (0.3-3.0 m) neutron time-of-flight (nToF) to provide a constraint on the measurement of the time-dependence of ion temperature in inertial confinement fusion implosions is presented. Simulated nToF signals at different distances are generated and, with a priori knowledge of the burn-averaged quantities and burn history, analyzed to determine requirements for a future detector. Results indicate a signal-to-noise ratio >50 and time resolution <20 ps to constrain the ion temperature gradient to ∼±25% (0.5 keV/100 ps).

Construction and study of instrument response functions for analysis of the National Ignition Facility (NIF) neutron time-of-flight detectors

The analysis of the National Ignition Facility (NIF) neutron time-of-flight (nToF) detectors uses a forward-fit routine that depends critically on the instrument response functions (IRFs) of the diagnostics. The details of the IRFs used can have large impacts on measurements such as ion temperature and down-scattered ratio (DSR). Here, we report on the recent steps taken to construct and validate nToF IRFs at the NIF to an increased degree of accuracy, as well as remove the need for fixed DSR baseline offsets. The IRF is treated in two parts: a "core," measured experimentally with an x-ray impulse source, and a "tail" that occurs later in time and has limited experimental data. The tail region is calibrated with the data from indirect drive exploding pusher shots, which have little neutron scattering and are traditionally assumed to have zero DSR. Using analytic modeling estimates, the non-zero DSR for these shots is estimated. The impact of varying IRF tail components on DSR is investigated with a systematic parameter study, and good agreement is found with the non-zero DSR estimates. These approaches will be used to improve the precision and uncertainty of NIF nToF DSR measurements.

Observation of Hydrodynamic Flows in Imploding Fusion Plasmas on the National Ignition Facility

Inertial confinement fusion implosions designed to have minimal fluid motion at peak compression often show significant linear flows in the laboratory, attributable per simulations to percent-level imbalances in the laser drive illumination symmetry. We present experimental results which intentionally varied the mode 1 drive imbalance by up to 4% to test hydrodynamic predictions of flows and the resultant imploded core asymmetries and performance, as measured by a combination of DT neutron spectroscopy and high-resolution x-ray core imaging. Neutron yields decrease by up to 50%, and anisotropic neutron Doppler broadening increases by 20%, in agreement with simulations. Furthermore, a tracer jet from the capsule fill-tube perturbation that is entrained by the hot-spot flow confirms the average flow speeds deduced from neutron spectroscopy.

Three-dimensional diagnostics and measurements of inertial confinement fusion plasmas

Recent inertial confinement fusion measurements have highlighted the importance of 3D asymmetry effects on implosion performance. One prominent example is the bulk drift velocity of the deuterium-tritium plasma undergoing fusion ("hotspot"), v_HS. Upgrades to the National Ignition Facility neutron time-of-flight diagnostics now provide v_HS to better than 1 part in 10⁴ and enable cross correlations with other measurements. This work presents the impact of v_HS on the neutron yield, downscatter ratio, apparent ion temperature, electron temperature, and 2D x-ray emission. The necessary improvements to diagnostic suites to take these measurements are also detailed. The benefits of using cross-diagnostic analysis to test hotspot models and theory are discussed, and cross-shot trends are shown.

The Randomized AMBORA Trial: Impact of Pharmacological/Pharmaceutical Care on Medication Safety and Patient-Reported Outcomes During Treatment With New Oral Anticancer Agents

PURPOSE

Oral anticancer drugs (eg, kinase inhibitors) play an important role in cancer therapy. However, considerable challenges regarding medication safety of oral anticancer drugs have been reported. Randomized, controlled, multicenter studies on the impact of intensified clinical pharmacological/pharmaceutical care on patient safety and patient treatment perception are lacking.

METHODS

Patients were eligible for the randomized, multicenter AMBORA study, if they were newly started on any of the oral anticancer drugs approved in 2001 or later without restriction to certain tumor entities. Patients were randomly assigned to receive either standard of care (control group) or an additional, intensified clinical pharmacological/pharmaceutical care, which included medication management and structured patient counseling, over a period of 12 weeks (intervention group). Primary end points were the number of antitumor drug-related problems (ie, side effects and unresolved medication errors) and patient treatment satisfaction with the oral anticancer therapy after 12 weeks measured with the Treatment Satisfaction Questionnaire for Medication, category convenience.

RESULTS

Two hundred two patients were included. Antitumor drug-related problems were significantly lower in the intervention compared with the control group (3.85 v 5.81 [mean], P < .001). Patient treatment satisfaction was higher in the intervention group (Treatment Satisfaction Questionnaire for Medication, convenience; 91.6 v 74.4 [mean], P < .001). The hazard ratio for the combined end point of severe side effects (Common Terminology Criteria for Adverse Events ≥ 3), treatment discontinuation, unscheduled hospital admission, and death was 0.48 (95% CI, 0.32 to 0.71, P < .001) in favor of the intervention group.

CONCLUSION

Treatment with oral anticancer drugs is associated with a broad range of medication errors and side effects. An intensified clinical pharmacological/pharmaceutical care has considerable, positive effects on the number of medication errors, patient treatment perception, and severe side effects.

Interpolating individual line-of-sight neutron spectrometer measurements onto the "sky" at the National Ignition Facility (NIF)

Nuclear diagnostics provide measurements of inertial confinement fusion implosions used as metrics of performance for the shot. The interpretation of these measurements for shots with low mode asymmetries requires a way of combining the data to produce a "sky map" where the individual line-of-sight values are used to interpolate to other positions in the sky. These interpolations can provide information regarding the orientation of the low mode asymmetries. We describe the interpolation method, associated uncertainties, and correlations between different metrics, e.g., T_ion, down scatter ratio, and hot-spot velocity direction. This work is also related to recently reported studies [H. G. Rinderknecht et al., Phys. Rev. Lett. 124, 145002 (2020) and K. M. Woo et al., Phys. Plasmas 27, 062702 (2020)] of low mode asymmetries. We report an analysis that makes use of a newly commissioned line of sight, a scheme for incorporating multiple neutron spectrum measurement types, and recent work on the sources of implosion asymmetry to provide a more complete picture of implosion performance.

Optimal choice of multiple line-of-sight measurements determining plasma hotspot velocity at the National Ignition Facility

The measurement of plasma hotspot velocity provides an important diagnostic of implosion performance for inertial confinement fusion experiments at the National Ignition Facility. The shift of the fusion product neutron mean kinetic energy as measured along multiple line-of-sight time-of-flight spectrometers provides velocity vector components from which the hotspot velocity is inferred. Multiple measurements improve the hotspot velocity inference; however, practical considerations of available space, operational overhead, and instrumentation costs limit the number of possible line-of-sight measurements. We propose a solution to this classical "experiment design" problem that optimizes the precision of the velocity inference for a limited number of measurements.

Neutron Time-of-Flight Measurements of Charged-Particle Energy Loss in Inertial Confinement Fusion Plasmas

Neutron spectra from secondary ^{3}H(d,n)α reactions produced by an implosion of a deuterium-gas capsule at the National Ignition Facility have been measured with order-of-magnitude improvements in statistics and resolution over past experiments. These new data and their sensitivity to the energy loss of fast tritons emitted from thermal ^{2}H(d,p)^{3}H reactions enable the first statistically significant investigation of charged-particle stopping via the emitted neutron spectrum. Radiation-hydrodynamic simulations, constrained to match a number of observables from the implosion, were used to predict the neutron spectra while employing two different energy loss models. This analysis represents the first test of stopping models under inertial confinement fusion conditions, covering plasma temperatures of k_{B}T≈1-4  keV and particle densities of n≈(12-2)×10^{24}  cm^{-3}. Under these conditions, we find significant deviations of our data from a theory employing classical collisions whereas the theory including quantum diffraction agrees with our data.

Imatinib dose reduction in major molecular response of chronic myeloid leukemia: results from the German Chronic Myeloid Leukemia-Study IV

Standard first-line therapy of chronic myeloid leukemia is treatment with imatinib. In the randomized German Chronic Myeloid Leukemia-Study IV, more potent BCR-ABL inhibition with 800 mg (‘high-dose’) imatinib accelerated achievement of a deep molecular remission. However, whether and when a de-escalation of the dose intensity under high-dose imatinib can be safely performed without increasing the risk of losing deep molecular response is unknown. To gain insights into this clinically relevant question, we analyzed the outcome of imatinib dose reductions from 800 mg to 400 mg daily in the Chronic Myeloid Leukemia-Study IV. Of the 422 patients that were randomized to the 800 mg arm, 68 reduced imatinib to 400 mg after they had achieved at least a stable major molecular response. Of these 68 patients, 61 (90%) maintained major molecular remission on imatinib at 400 mg. Five of the seven patients who lost major molecular remission on the imatinib standard dose regained major molecular remission while still on 400 mg imatinib. Only two of 68 patients had to switch to more potent kinase inhibition to regain major molecular remission. Importantly, the lengths of the intervals between imatinib high-dose treatment before and after achieving major molecular remission were associated with the probabilities of maintaining major molecular remission with the standard dose of imatinib. Taken together, the data support the view that a deep molecular remission achieved with high-dose imatinib can be safely maintained with standard dose in most patients. Study protocol registered at clinicaltrials.gov 00055874.

Ab initio response functions for Cherenkov-based neutron detectors

Neutron time-of-flight diagnostics at the NIF were recently outfitted with Cherenkov detectors. A fused silica radiator delivers sub-nanosecond response time and is optically coupled to a microchannel plate photomultiplier tube with gain from ∼1 to 10⁴. Capitalizing on fast time response and gamma-ray sensitivity, these systems can provide better than 30 ps precision for measuring first moments of neutron distributions. Generation of ab initio instrument response functions (IRFs) is critical to meet the <1% uncertainty needed. A combination of Monte Carlo modeling, benchtop characterization, and in situ comparison is employed. Close agreement is shown between the modeled IRFs and in situ measurements using the NIF's short-pulse advanced radiographic capability beams. First and second moments of neutron spectra calculated using ab initio IRFs agree well with established scintillator measurements. Next-step designs offer increased sensitivity and time-response.

Uncertainty analysis of response functions and γ -backgrounds on Tion and t0 measurements from Cherenkov neutron detectors at the National Ignition Facility (NIF)

Cherenkov radiators deployed to measure the neutron time-of-flight spectrum have response times associated with the neutron transit across the detector and are free from long time response tails characteristic of scintillation detectors. The Cherenkov radiation results from simple physical processes which makes them amenable to high fidelity Monte Carlo simulation. The instrument response function of neutron time-of-flight systems is a major contributor to both the systematic and statistical uncertainties of the parameters used to describe these spectra; in particular, the first and second moments of these distributions are associated with arrival time, t₀, and ion temperature, T_ion. We present the results of uncertainty analysis showing the significant reduction of the uncertainty in determining these quantities in the Cherenkov detector system recently deployed at NIF. The increased sensitivity to gamma radiation requires additional consideration of the effect of this background to the uncertainties in both t₀ and T_ion.

Using multiple neutron time of flight detectors to determine the hot spot velocity

An important diagnostic value of a shot at the National Ignition Facility is the resultant center-of-mass motion of the imploding capsule. This residual velocity reduces the efficiency of converting laser energy into plasma temperature. A new analysis method extracts the effective hot spot motion by using information from multiple neutron time-of-flight (nToF) lines-of-sight (LoSs). This technique fits a near Gaussian spectrum to the nToF scope traces and overcomes reliance on models to relate the plasma temperature to the mean energy of the emitted neutrons. This method requires having at least four nToF LoSs. The results of this analysis will be compared to an approach where each LoS is analyzed separately and a model is used to infer the mean energy of the emitted neutrons.

A fused silica Cherenkov radiator for high precision time-of-flight measurement of DT γ and neutron spectra (invited)

A fused silica Cherenkov radiator has been implemented at the National Ignition Facility to provide a new high precision measurement of the time-of-flight spectrum of 14.1 MeV DT fusion neutrons. This detector enables a high precision (<30 ps) co-registered measurement of both a thresholded γ-ray and a neutron spectrum on a single record. Other methods typically require γ and neutron signals to be co-registered via other diagnostics and/or dedicated timing experiments. Analysis of the co-registered γ and neutron signals allows precise extraction of the mean neutron energy and bulk hot-spot velocity, both of which were not possible with prior scintillator technologies. Initial measurements demonstrate the feasibility of this measurement and indicate that combined detection of neutrons and γ-rays on multiple lines-of-sight should enable the bulk vector velocity of the implosion hot-spot to be determined to ≈5 km/s and reduced uncertainty in the spectral width ≈0.1 keV.

Testing a Cherenkov neutron time-of-flight detector on OMEGA

A Cherenkov neutron time-of-flight (nTOF) detector developed and constructed at Lawrence Livermore National Laboratory was tested at 13 m from the target in a collimated line of sight (LOS) and at 5.3 m from the target in the open space inside the OMEGA Target Bay. Neutrons interacting with the quartz rod generate gammas, which through Compton scattering produce relativistic electrons that give rise to Cherenkov light. A photomultiplier tube (PMT) transferred the Cherenkov light into an amplified electrical signal. The Cherenkov nTOF detector consists of an 8-mm-diam, 25-cm quartz hexagonal prism coupled with a Hamamatsu gated PMT R5916U-52. The tests were performed with DT direct-drive implosions with cryogenic and room-temperature targets, producing a wide range of neutron yields and ion temperatures. The results of the tests and comparison with other nTOF detectors on OMEGA are presented. In the collimated LOS at 13 m from the target, the Cherenkov nTOF detector demonstrated good precision measurement in both the yield and ion temperature for DT yields above 3 × 10¹³.

Characterization of photodetector temporal response for neutron time-of-flight (nToF) diagnostics at the National Ignition Facility

The temporal response of a microchannel plate photomultiplier tube used in the suite of neutron time of flight (nToF) diagnostics at the National Ignition Facility has been characterized to reduce uncertainty in, and understanding of, shot parameters obtained from nTOF data. A short pulse laser, neutral density glass filters, and electrical attenuators were used to gather statistically significant samples of photodetector impulse response functions (IRF) in rapid succession. Individual components have been absolutely calibrated to minimize systematic uncertainties. The zeroth (collected charge), first (transit time), and second central moments (transit time spread) of the IRF were calculated as either the bias voltage or the amount of light incident on the detector was varied. Timing reference was provided by a monitor photodiode viewing a pickoff of the incident laser pulse. The primary sources of uncertainty are jitter in the monitor photodiode and the statistical variation across our measurement period. The spreads in the first moment, with respect to the timing photodiode, and the square root of the second central moment were found to be less than 50 ps and 150 ps, respectively.

Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants

Chronic myeloid leukemia (CML)-study IV was designed to explore whether treatment with imatinib (IM) at 400 mg/day (n=400) could be optimized by doubling the dose (n=420), adding interferon (IFN) (n=430) or cytarabine (n=158) or using IM after IFN-failure (n=128). From July 2002 to March 2012, 1551 newly diagnosed patients in chronic phase were randomized into a 5-arm study. The study was powered to detect a survival difference of 5% at 5 years. After a median observation time of 9.5 years, 10-year overall survival was 82%, 10-year progression-free survival was 80% and 10-year relative survival was 92%. Survival between IM400 mg and any experimental arm was not different. In a multivariate analysis, risk group, major-route chromosomal aberrations, comorbidities, smoking and treatment center (academic vs other) influenced survival significantly, but not any form of treatment optimization. Patients reaching the molecular response milestones at 3, 6 and 12 months had a significant survival advantage. For responders, monotherapy with IM400 mg provides a close to normal life expectancy independent of the time to response. Survival is more determined by patients' and disease factors than by initial treatment selection. Although improvements are also needed for refractory disease, more life-time can currently be gained by carefully addressing non-CML determinants of survival.

Calibration of scintillation-light filters for neutron time-of-flight spectrometers at the National Ignition Facility

Sixty-four neutral density filters constructed of metal plates with 88 apertures of varying diameter have been radiographed with a soft x-ray source and CCD camera at National Security Technologies, Livermore. An analysis of the radiographs fits the radial dependence of the apertures' image intensities to sigmoid functions, which can describe the rapidly decreasing intensity towards the apertures' edges. The fitted image intensities determine the relative attenuation value of each filter. Absolute attenuation values of several imaged filters, measured in situ during calibration experiments, normalize the relative quantities which are now used in analyses of neutron spectrometer data at the National Ignition Facility.

Uncertainty analysis of signal deconvolution using a measured instrument response function

A common analysis procedure minimizes the ln-likelihood that a set of experimental observables matches a parameterized model of the observation. The model includes a description of the underlying physical process as well as the instrument response function (IRF). In the case investigated here, the National Ignition Facility (NIF) neutron time-of-flight (nTOF) spectrometers, the IRF is constructed from measurements and models. IRF measurements have a finite precision that can make significant contributions to determine the uncertainty estimate of the physical model's parameters. We apply a Bayesian analysis to properly account for IRF uncertainties in calculating the ln-likelihood function used to find the optimum physical parameters.

High-resolution measurements of the DT neutron spectrum using new CD foils in the Magnetic Recoil neutron Spectrometer (MRS) on the National Ignition Facility

The Magnetic Recoil neutron Spectrometer (MRS) on the National Ignition Facility measures the DT neutron spectrum from cryogenically layered inertial confinement fusion implosions. Yield, areal density, apparent ion temperature, and directional fluid flow are inferred from the MRS data. This paper describes recent advances in MRS measurements of the primary peak using new, thinner, reduced-area deuterated plastic (CD) conversion foils. The new foils allow operation of MRS at yields 2 orders of magnitude higher than previously possible, at a resolution down to ∼200 keV FWHM.

Indications of flow near maximum compression in layered deuterium-tritium implosions at the National Ignition Facility

An accurate understanding of burn dynamics in implosions of cryogenically layered deuterium (D) and tritium (T) filled capsules, obtained partly through precision diagnosis of these experiments, is essential for assessing the impediments to achieving ignition at the National Ignition Facility. We present measurements of neutrons from such implosions. The apparent ion temperatures T_{ion} are inferred from the variance of the primary neutron spectrum. Consistently higher DT than DD T_{ion} are observed and the difference is seen to increase with increasing apparent DT T_{ion}. The line-of-sight rms variations of both DD and DT T_{ion} are small, ∼150eV, indicating an isotropic source. The DD neutron yields are consistently high relative to the DT neutron yields given the observed T_{ion}. Spatial and temporal variations of the DT temperature and density, DD-DT differential attenuation in the surrounding DT fuel, and fluid motion variations contribute to a DT T_{ion} greater than the DD T_{ion}, but are in a one-dimensional model insufficient to explain the data. We hypothesize that in a three-dimensional interpretation, these effects combined could explain the results.

Development of a comprehensive prognostic index for patients with chronic lymphocytic leukemia

In addition to clinical staging, a number of biomarkers predicting overall survival (OS) have been identified in chronic lymphocytic leukemia (CLL). The multiplicity of markers, limited information on their independent prognostic value, and a lack of understanding of how to interpret discordant markers are major barriers to use in routine clinical practice. We therefore performed an analysis of 23 prognostic markers based on prospectively collected data from 1948 CLL patients participating in phase 3 trials of the German CLL Study Group to develop a comprehensive prognostic index. A multivariable Cox regression model identified 8 independent predictors of OS: sex, age, ECOG status, del(17p), del(11q), IGHV mutation status, serum β2-microglobulin, and serum thymidine kinase. Using a weighted grading system, a prognostic index was derived that separated 4 risk categories with 5-year OS ranging from 18.7% to 95.2% and having a C-statistic of 0.75. The index stratified OS within all analyzed subgroups, including all Rai/Binet stages. The validity of the index was externally confirmed in a series of 676 newly diagnosed CLL patients from Mayo Clinic. Using this multistep process including external validation, we developed a comprehensive prognostic index with high discriminatory power and prognostic significance on the individual patient level. The studies were registered as follows: CLL1 trial (NCT00262782, http://clinicaltrials.gov), CLL4 trial (ISRCTN 75653261, http://www.controlled-trials.com), and CLL8 trial (NCT00281918, http://clinicaltrials.gov).

Measurement of the T + T neutron spectrum using the national ignition facility

Neutron time-of-flight spectra from inertial confinement fusion experiments with tritium-filled targets have been measured at the National Ignition Facility. These spectra represent a significant improvement in energy resolution and statistics over previous measurements, and afford the first definitive observation of a peak resulting from sequential decay through the ground state of (5)He at low reaction energies E(c.m.) 100 </~ keV. To describe the spectrum, we have developed an R-matrix model that accounts for interferences from fermion symmetry and intermediate states, and show these effects to be non-negligible. We also find the spectrum can be described by sequential decay through ℓ=1 states in (5)He, which differs from previous interpretations.

Neutron spectrometry--an essential tool for diagnosing implosions at the National Ignition Facility (invited)

DT neutron yield (Y(n)), ion temperature (T(i)), and down-scatter ratio (dsr) determined from measured neutron spectra are essential metrics for diagnosing the performance of inertial confinement fusion (ICF) implosions at the National Ignition Facility (NIF). A suite of neutron-time-of-flight (nTOF) spectrometers and a magnetic recoil spectrometer (MRS) have been implemented in different locations around the NIF target chamber, providing good implosion coverage and the complementarity required for reliable measurements of Y(n), T(i), and dsr. From the measured dsr value, an areal density (ρR) is determined through the relationship ρR(tot) (g∕cm(2)) = (20.4 ± 0.6) × dsr(10-12 MeV). The proportionality constant is determined considering implosion geometry, neutron attenuation, and energy range used for the dsr measurement. To ensure high accuracy in the measurements, a series of commissioning experiments using exploding pushers have been used for in situ calibration of the as-built spectrometers, which are now performing to the required accuracy. Recent data obtained with the MRS and nTOFs indicate that the implosion performance of cryogenically layered DT implosions, characterized by the experimental ignition threshold factor (ITFx), which is a function of dsr (or fuel ρR) and Y(n), has improved almost two orders of magnitude since the first shot in September, 2010.

South pole bang-time diagnostic on the National Ignition Facility (invited)

The south pole bang-time diagnostic views National Ignition Facility (NIF) implosions through the lower Hohlraum laser entrance hole to measure the time of peak x-ray emission (peak compression) in indirect-drive implosions. Five chemical-vapor-deposition diamond photoconductive detectors with different filtrations and sensitivities record the time-varying x rays emitted by the target. Wavelength selecting highly oriented pyrolytic graphite crystal mirror monochromators increase the x-ray signal-to-background ratio by filtering for 11-keV emission. Diagnostic timing and the in situ temporal instrument response function are determined from laser impulse shots on the NIF. After signal deconvolution and background removal, the bang time is determined to 45-ps accuracy. The x-ray "yield" (mJ∕sr∕keV at 11 keV) is determined from the time integral of the corrected peak signal.

Deuterium-tritium neutron yield measurements with the 4.5 m neutron-time-of-flight detectors at NIF

The first several campaigns of laser fusion experiments at the National Ignition Facility (NIF) included a family of high-sensitivity scintillator∕photodetector neutron-time-of-flight (nTOF) detectors for measuring deuterium-deuterium (DD) and DT neutron yields. The detectors provided consistent neutron yield (Y(n)) measurements from below 10(9) (DD) to nearly 10(15) (DT). The detectors initially demonstrated detector-to-detector Y(n) precisions better than 5%, but lacked in situ absolute calibrations. Recent experiments at NIF now have provided in situ DT yield calibration data that establish the absolute sensitivity of the 4.5 m differential tissue harmonic imaging (DTHI) detector with an accuracy of ± 10% and precision of ± 1%. The 4.5 m nTOF calibration measurements also have helped to establish improved detector impulse response functions and data analysis methods, which have contributed to improving the accuracy of the Y(n) measurements. These advances have also helped to extend the usefulness of nTOF measurements of ion temperature and downscattered neutron ratio (neutron yield 10-12 MeV divided by yield 13-15 MeV) with other nTOF detectors.

Assembly of high-areal-density deuterium-tritium fuel from indirectly driven cryogenic implosions

The National Ignition Facility has been used to compress deuterium-tritium to an average areal density of ~1.0±0.1 g cm(-2), which is 67% of the ignition requirement. These conditions were obtained using 192 laser beams with total energy of 1-1.6 MJ and peak power up to 420 TW to create a hohlraum drive with a shaped power profile, peaking at a soft x-ray radiation temperature of 275-300 eV. This pulse delivered a series of shocks that compressed a capsule containing cryogenic deuterium-tritium to a radius of 25-35 μm. Neutron images of the implosion were used to estimate a fuel density of 500-800 g cm(-3).

Bendamustine combined with rituximab in patients with relapsed and/or refractory chronic lymphocytic leukemia: a multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group

PURPOSE

The objective of this trial was to evaluate safety and efficacy of bendamustine combined with rituximab (BR) in patients with relapsed and/or refractory chronic lymphocytic leukemia (CLL).

PATIENTS AND METHODS

Seventy-eight patients, including 22 patients with fludarabine-refractory disease (28.2%) and 14 patients (17.9%) with deletion of 17p, received BR chemoimmunotherapy. Bendamustine was administered at a dose of 70 mg/m(2) on days 1 and 2 combined with rituximab 375 mg/m(2) on day 0 of the first course and 500 mg/m(2) on day 1 during subsequent courses for up to six courses.

RESULTS

On the basis of intent-to-treat analysis, the overall response rate was 59.0% (95% CI, 47.3% to 70.0%). Complete response, partial response, and nodular partial response were achieved in 9.0%, 47.4%, and 2.6% of patients, respectively. Overall response rate was 45.5% in fludarabine-refractory patients and 60.5% in fludarabine-sensitive patients. Among genetic subgroups, 92.3% of patients with del(11q), 100% with trisomy 12, 7.1% with del(17p), and 58.7% with unmutated IGHV status responded to treatment. After a median follow-up time of 24 months, the median event-free survival was 14.7 months. Severe infections occurred in 12.8% of patients. Grade 3 or 4 neutropenia, thrombocytopenia, and anemia were documented in 23.1%, 28.2%, and 16.6% of patients, respectively.

CONCLUSION

Chemoimmunotherapy with BR is effective and safe in patients with relapsed CLL and has notable activity in fludarabine-refractory disease. Major but tolerable toxicities were myelosuppression and infections. These promising results encouraged us to initiate a further phase II trial evaluating the BR regimen in patients with previously untreated CLL.

Demonstration of ignition radiation temperatures in indirect-drive inertial confinement fusion hohlraums

We demonstrate the hohlraum radiation temperature and symmetry required for ignition-scale inertial confinement fusion capsule implosions. Cryogenic gas-filled hohlraums with 2.2 mm-diameter capsules are heated with unprecedented laser energies of 1.2 MJ delivered by 192 ultraviolet laser beams on the National Ignition Facility. Laser backscatter measurements show that these hohlraums absorb 87% to 91% of the incident laser power resulting in peak radiation temperatures of T(RAD)=300 eV and a symmetric implosion to a 100 μm diameter hot core.

Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4-year follow-up of a randomised controlled trial

BACKGROUND

Treatment with adjuvant trastuzumab for 1 year improves disease-free survival and overall survival in patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. We aimed to assess disease-free survival and overall survival after a median follow-up of 4 years for patients enrolled on the Herceptin Adjuvant (HERA) trial.

METHODS

The HERA trial is an international, multicentre, randomised, open-label, phase 3 trial comparing treatment with trastuzumab for 1 and 2 years with observation after standard neoadjuvant, adjuvant chemotherapy, or both in patients with HER2-positive early breast cancer. The primary endpoint was disease-free survival. After a positive first interim analysis at a median follow-up of 1 year for the comparison of treatment with trastuzumab for 1 year with observation, event-free patients in the observation group were allowed to cross over to receive trastuzumab. We report trial outcomes for the 1-year trastuzumab and observation groups at a median follow-up of 48·4 months (IQR 42·0-56·5) and assess the effect of the extensive crossover to trastuzumab. Our analysis was by intention-to-treat. The HERA trial is registered with the European Clinical Trials Database, number 2005-002385-11.

FINDINGS

The HERA trial population comprised 1698 patients randomly assigned to the observation group and 1703 to the 1-year trastuzumab group. Intention-to-treat analysis of disease-free survival showed a significant benefit in favour of patients in the 1-year trastuzumab group (4-year disease-free survival 78·6%) compared with the observation group (4-year disease-free survival 72·2%; hazard ratio [HR] 0·76; 95% CI 0·66-0·87; p<0·0001). Intention-to-treat analysis of overall survival showed no significant difference in the risk of death (4-year overall survival 89·3%vs 87·7%, respectively; HR 0·85; 95% CI 0·70-1·04; p=0·11). Overall, 885 patients (52%) of the 1698 patients in the observation group crossed over to receive trastuzumab, and began treatment at median 22·8 months (range 4·5-52·7) from randomisation. In a non-randomised comparison, patients in the selective-crossover cohort had fewer disease-free survival events than patients remaining in the observation group (adjusted HR 0·68; 95% CI 0·51-0·90; p=0·0077). Higher incidences of grade 3-4 and fatal adverse events were noted on 1-year trastuzumab than in the observation group. The most common grade 3 or 4 adverse events, each in less than 1% of patients, were congestive cardiac failure, hypertension, arthralgia, back pain, central-line infection, hot flush, headache, and diarrhoea.

INTERPRETATION

Treatment with adjuvant trastuzumab for 1 year after chemotherapy is associated with significant clinical benefit at 4-year median follow-up. The substantial selective crossover of patients in the observation group to trastuzumab was associated with improved outcomes for this cohort.

FUNDING

F Hoffmann-La Roche, Michelangelo Foundation.

The National Ignition Facility neutron time-of-flight system and its initial performance (invited)

The National Ignition Facility (NIF) successfully completed its first inertial confinement fusion (ICF) campaign in 2009. A neutron time-of-flight (nTOF) system was part of the nuclear diagnostics used in this campaign. The nTOF technique has been used for decades on ICF facilities to infer the ion temperature of hot deuterium (D(2)) and deuterium-tritium (DT) plasmas based on the temporal Doppler broadening of the primary neutron peak. Once calibrated for absolute neutron sensitivity, the nTOF detectors can be used to measure the yield with high accuracy. The NIF nTOF system is designed to measure neutron yield and ion temperature over 11 orders of magnitude (from 10(8) to 10(19)), neutron bang time in DT implosions between 10(12) and 10(16), and to infer areal density for DT yields above 10(12). During the 2009 campaign, the three most sensitive neutron time-of-flight detectors were installed and used to measure the primary neutron yield and ion temperature from 25 high-convergence implosions using D(2) fuel. The OMEGA yield calibration of these detectors was successfully transferred to the NIF.

National Ignition Facility neutron time-of-flight measurements (invited)

The first 3 of 18 neutron time-of-flight (nTOF) channels have been installed at the National Ignition Facility (NIF). The role of these detectors includes yield, temperature, and bang time measurements. This article focuses on nTOF data analysis and quality of results obtained for the first set of experiments to use all 192 NIF beams. Targets produced up to 2×10(10) 2.45 MeV neutrons for initial testing of the nTOF detectors. Differences in neutron scattering at the OMEGA laser facility where the detectors were calibrated and at NIF result in different response functions at the two facilities. Monte Carlo modeling shows this difference. The nTOF performance on these early experiments indicates that the nTOF system with its full complement of detectors should perform well in future measurements of yield, temperature, and bang time.

Radiation hardening of gated x-ray imagers for the National Ignition Facility (invited)

The National Ignition Facility will soon be producing x-ray flux and neutron yields higher than any produced in laser driven implosion experiments in the past. Even a non-igniting capsule will require x-ray imaging of near burning plasmas at 10(17) neutrons, requiring x-ray recording systems to work in more hostile conditions than we have encountered in past laser facilities. We will present modeling, experimental data and design concepts for x-ray imaging with electronic recording systems for this environment (ARIANE). A novel instrument, active readout in a nuclear environment, is described which uses the time-of-flight difference between the gated x-ray signal and the neutron which induces a background signal to increase the yield at which gated cameras can be used.