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Purpose: Reddit is a social media platform that allows health care professionals (HPs) to anonymously interact with patients. We analyzed content about radiation therapy (RT) on Reddit. Methods and Materials: Reddit.com/r/cancer was queried with 20 search terms related to RT: IMRT, 3D-CRT, SBRT, EBRT, XRT, radiation, radiotherapy, RT, radio, rad, rads, gamma, gamma knife, gammaknife, cyber knife, cyberknife, cyber, brachytherapy, brachy, and cobalt. The search aimed to identify all posts discussing RT. A random sample of posts and their top 3 comments was selected to generate qualitative thematic codes per author consensus, which were used to characterize all posts and their top 3 voted comments. Posts were analyzed for time to first reply, mention of any specific RT modality, whether a self-identified HP responded, and time to first highly voted comment by an HP. Results: Exactly 190 posts about RT by 178 users were shared from February 2011 to May 2018, and 468 replies by 295 users were also analyzed. Twenty-nine of these users (9.8%) were HPs; however, 48 of 181 top comments were contributed by HPs compared with 45 of 288 non–top comments by HPs (odds ratio, 1.95; 95% confidence interval [CI], 1.23-3.08; P

Purpose The American College of Surgeons Oncology Group trial Z0011 demonstrated that axillary node dissection (ALND) can be omitted in patients managed with breast conserving surgery and 1 to 2 positive sentinel lymph nodes (SLNs) without adverse effects on locoregional recurrence or disease-free survival (DFS). We investigated patients with breast cancer for whom clinicopathologic features were underrepresented in the Z0011 trial and analyzed radiation therapy treatment patterns and clinical outcomes. Methods and materials We retrospectively reviewed records of patients who underwent a lumpectomy and SLN biopsy with positive SLNs but not an ALND and completed adjuvant radiation therapy. Eligible patients had T3 tumors, >2 positive SLNs, invasive lobular carcinoma, estrogen receptor negative status, extranodal extension, Nottingham Grade 3, or were age Results We identified 105 women treated between July 2011 and July 2016 with a median follow-up time of 48.5 months (Range, 11-83 months). There were 40 women with an extranodal extension (38.9%) and 42 women with grade 3 disease (40.0%). Nineteen patients received whole breast irradiation alone (18.1%) and 86 patients were treated with modified tangent fields including the superior axilla level I/II (81.9%). Thirty-three patients (31.4%) also received a 3rd supraclavicular, nodal-directed field. Among the 86 patients who received axillary nodal irradiation, nodal volume contouring was performed in 77 patients (89.5%). Fifty-one patients (48.6%) also received adjuvant chemotherapy. The overall rates of 4-year DFS and locoregional control (LRC) were 94.3% and 98.1%, respectively. Off all patients, 1 patient experienced an internal mammary nodal recurrence, another patient a contralateral breast tumor, and two patients distant metastases. There were no axillary or ipsilateral breast tumor recurrences. Conclusions This retrospective analysis of women who were underrepresented or excluded from the Z11 trial and underwent a lumpectomy and SLN biopsy with positive SLNs demonstrated comparable rates of LRC and DFS. The high rates of LRC and DFS suggest that completion ALND may be safely omitted in this patient population but larger data sets and longer follow-up times are needed to confirm this finding.

An in-depth discussion on how an industrial network might be attacked, including possible target systems, and the potential consequences should those targets be compromised. Learn how a hacker thinks, how malware works, and what to do if your industrial network becomes infected.

An introduction to industrial networking and the unique qualities of industrial network cyber security.

There are several cyber security standards and regulations imposed by governments and industry, which provide everything from “best practices” recommendations to hard requirements that are enforced through penalties and fines. Some common standards are the North American Electric Reliability Corporation's (NERC's) Critical Infrastructure Protection (CIP) Reliability Standards, the US Department of Homeland Security's Chemical Facility Anti-Terrorism Standards (CFATS), and the Regulated Security of Nuclear Facilities by the United States. The Risk-Based Performance Standards (RBPS) for the Chemical Facilities Anti-Terrorism Standards (CFATS) outlines various controls for securing the cyber systems of chemical facilities. Specifically, RBPS Metric 8 (“Cyber”) outlines controls for security policies, access control, personnel security, awareness and training, monitoring and incident response, disaster recovery and business continuity, system development and acquisition, configuration management, and audits. Nuclear Regulatory Commission (NRC) Regulation 5.71 (RG 5.71) provides security recommendations for complying with Title 10 of the Code of Federal Regulations (CFR) 73.54. It consists of an in-depth discussion of the general requirements of cyber security, to specific requirements of planning, establishing, and implementing a cyber security program.

You cannot protect something unless you know what it is, and how it is supposed to behave. So what is an industrial network, and how does it work? A discussion of industrial control system devices and systems, control logic, process loops, and more.

The move from proprietary communications networks to more open networks means that, in order to design an industrial network for robust and reliable operation, you must first understand the basic network architecture and design principles of Ethernet and the Internet Protocol (IP). However, because of the unique nature of industrial networks, these principles must first be adapted to support industrial control and automation.

Enterprise networks have been successfully using Security Monitoring and Analytics tools for years, but these systems are not always easy to deploy or utilize within industrial networks. Learn what systems to monitor, what information to collect, and how to best use it.

Zones and conduits are a fundamental concept of industrial network cyber security. By grouping similar devices or systems into “zones” according to security levels, and controlling communications between zones, a strong foundation of security will be realized. But how do you know what belongs in what zone?

Risk management involves an understanding of threats, vulnerabilities and consequences. To effectively manage risk, therefore, you need to understand how to identify and assess the assets in your industrial network. What devices are vulnerable, and to what types of attack? How could a specific device or system be exploited, and what would the consequences of that exploitation be? Using a variety of risk management standards and methodologies, the risk of a cyber incident can be measured, and used to improve existing security policies, countermeasures, and plans.

With a properly designed and segmented network, there is still the danger of a targeted cyber-attack. To defend these important networks, it is important to know which endpoint- and network-based cyber security controls are available, and how best to use them.

Industrial network communications began with proprietary communications protocols that later evolved to operate over Ethernet and IP. By learning how these protocols work, we can identify how they might be exploited by a cyber-attacker, and also how we might be able to defend them.