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    Radiobiology/Original Articles
  • Radiobiology/Original Articles
    The effect of X-ray on microglial M1 and M2 polarization
    HUANG Rongrong, ZHOU Yan, GUO Ling, LIU Liyuan, XUE Yizhe, LAI Panpan, JING Yuntao, XU Hui, ZHANG Qinfeng, DING Guirong
    2021, 30(3): 247-252. https://doi.org/10.13491/j.issn.1004-714X.2021.03.001
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    Objective To investigate the effect of X-ray on the polarization of mouse microglia BV-2 cells.Methods BV-2 cells at the logarithmic growth stage were randomly divided into the Sham irradiation group and 10 Gy irradiation group. The latter group was given a single X-ray irradiation at a dose of 1.28 Gy/min for 7 min 49 s. The activation rate of BV-2 cells was observed and analyzed under a microscope at 1, 3, 6, 24 h and 48 h after irradiation.The changes of cell morphology were observed by HE staining and immunofluorescence staining; The levels of M1-type activation markers (TNF-α and IL-1β) and M2-type activation marker TGF-β1 in the supernatant of BV-2 cells were detected by ELISA. The levels of polarization-related proteins of M1-type (CD86 and iNOS) and M2-type (CD206) in BV-2 cells were detected by Western blotting.Results Morphological results showed that BV-2 cells became larger, and their protrude became coarse and shorter, showing "amoeba" like changes after 10 Gy X-ray irradiation. Compared with the Sham group, the activation rate of BV-2 cells was significantly increased at 3 h, and reached the peak at 6 h, and began to recover at 48 h after irradiation. ELISA results showed an obvious increase in the level of TNF-α and TGF-β1 48 h after irradiation.The level of IL-1β showed a transient decrease at 3～6 h, increased at 24 h, and reached the peak 48 h after irradiation. Western blotting results showed that CD86 protein level did not change significantly at each time points after irradiation, and iNOS protein level increased significantly at 1, 6, 24 h and 48 h after irradiation. A fluctuating change in CD206 protein level was found after irradiation.Conclusion 10 Gy X-ray irradiation can induce the activation of BV-2 cells in vitro, and the polarization type changes with the time after irradiation.
    • Radiation Security/Original Articles
  • Radiation Security/Original Articles
    Introduction of guidelines for iodine thyroid blocking
    CHANG Chunhui, FU Ximing, CHEN Huifang, YUAN Long, HOU Yuhan, HE Lin, LEI Cuiping
    2021, 30(3): 253-257,263. https://doi.org/10.13491/j.issn.1004-714X.2021.03.002
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    During a radiological or nuclear emergency, iodine thyroid blocking is an urgent protection action to prevent or reduce the absorption of radioactive iodine by thyroid. Although potassium iodide (KI) administration is recommended by WHO guidelines for iodine prophylaxis following nuclear accidents and is also widely implemented in most national guidelines, the scientific evidence for the guidelines lacks as the guidelines are mostly based on expert opinions and recommendations. This paper introduces the development and revision of WHO guidelines for iodine thyroid blocking published in 1989 and 1999, as well as the revision methods and main recommendations of the guidelines published in 2017, which supports the use of iodine thyroid blocking during a radiological or nuclear emergency.
    • Diagnosis and Treatment/Original Articles
  • Diagnosis and Treatment/Original Articles
    The dosimetric study of radiotherapy after modified radical mastectomy for left breast cancer using the beam’s eye view in intensity-modulated radiation therapy
    YU Xiaojun, WANG Xugang, LI Xiulei
    2021, 30(3): 258-263. https://doi.org/10.13491/j.issn.1004-714X.2021.03.003
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    Objective To analyze the dosimetric features of chest wall radiotherapy after modified radical mastectomy for left breast cancer using the beam’s eye view (BEV) in intensity-modulated radiation therapy (B-IMRT).Methods A total of 13 patients treated with modified radical mastectomy for left breast cancer in the Liaocheng People’s Hospital from May 2020 to November 2020 were recruited. They were treated with postoperative radiotherapy using the plans of B-IMRT or tangential fields in intensity-modulated radiation therapy (T-IMRT). The mean dose, conformity index and homogeneity index of the target field, and dose volume parameters of left lung and heart were compared between two groups. Results Compared with those of T-IMRT group, B-IMRT significantly improved the conformity and homogeneity of the target field (P < 0.05), and their mean dose of target field was similar. In addition, V5, V10, V20, V30 and Dmean of the left-side lung, and V5, V10, V30 and Dmean of the heart in B-IMRT group were significantly reduced compared with those of T-IMRT group (P < 0.05). In comparison to those of T-IMRT, B-IMRT decreases V5, V10, V20, V30 and Dmean of the left-side lung by 9.23%, 13.29%, 9.54%, 8.28% and 10.35%, respectively, which decreases V5, V10, V30 and Dmean of the heart by 27.62%, 29.72%, 21.45% and 24.88%, respectively. Conclusion Compared with T-IMRT planning, B-IMRT presents dosimetric advantages in the conformity and homogeneity of the target field in the postoperative radiotherapy of patients treated with modified radical mastectomy for left breast cancer, especially in reducing the radiation dose and volume of the heart and lungs.
  • Diagnosis and Treatment/Original Articles
    Comparison of the automatic delineation of two kinds of stomach by the AccuContour software for patients with thoracic and abdominal tumors
    QIN Wei, ZHUANG Jieying, SHI Feiyue, ZHAO Ziting, WANG Min, ZHAO Huanyu, WEI Xiaowei
    2021, 30(3): 264-268. https://doi.org/10.13491/j.issn.1004-714X.2021.03.004
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    Objective To delineate the normal stomach and thoracic stomach structure of patients with thoracic and abdominal tumor automatically using the AccuContour software based on deep learning in order to evaluate and compare the results.Methods Thirty-six patients with choracic and abdominal tumors were chosen for this study, and were divided into two groups. Group A included 18 patients with normal stomach, and group B included the other 18 patients undergoing esophageal carcinoma operation with thoracic stomach. The stomach structures were automatically delineated by the AccuContour software in the simulation CT series. Statistical analysis was carried out to data of the differences in volume, position and shape between the automatic and manual delineations, and data of the two kinds of stomach were compared.Results For group A, the differences in volume (ΔV%) between the automatic and manual delineations was (-1.82 ±9.65)%, the total position difference (ΔL) was (0.51 ±0.37) cm, the values of dice similarity coefficient (DSC) was 0.89 ±0.04. There were significant differences in values of ΔV%、ΔL and DSC (P < 0.05).Conclusion The used version of AccuContour software in this study had a satisfactory result of automatic delineation of the normal stomach structure larger than certain volume, but could not delineate the thoracic stomach structures effectively for patients undergoing esophageal carcinoma operation.
  • Diagnosis and Treatment/Original Articles
    Bilateral filtering based sliding motion compensated 4D-CBCT: a simulation study
    YOU Tao, LI Chunmei, DAI Chunhua, CHEN Deyu, DANG Jun
    2021, 30(3): 269-275,281. https://doi.org/10.13491/j.issn.1004-714X.2021.03.005
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    Objective This study reconstructed 4D-CBCT for fully automatic compensated sliding motion by incorporating the bilateral filtering into the Deformable Vector Field (DVF).Methods First, a motion compensated simultaneous algebraic reconstruction technique (Modified Simultaneous Algebra Reconstruction Technique, mSART) was used to generate a high quality reference phase by using all phase projection stogether with the initial 4D-DVFs, which were generated via Demons registration between 0% phase and each other phaseimage. The 4D-DVF was optimized by matching the forward projection of the deformed 0% phase with the measured projection of the target phase. The loss function’s DVF smoothing constrain term contained bilateral filtering kernel that contained: 1) an spatial domain Guassian kernel; 2) animage intensity domain Guassian kernel; and 3) a DVF domain Guassian kernel. By choosing suitable kernel variances, the sliding motion can be extracted. A non-linear conjugate gradient optimizer wasused. We validated the algorithm on a Non-Uniform Rotational B- spline based Cardiac-Torso (NCAT) phantom. Quantification was evaluated by: 1) the Root-Mean-Square-Error (RMSE) together with the Maximum-Error (MaxE); 2) the Dice coefficient of the extracted lung contour from the final reconstructed images and 3) the relative reconstruction error (RE) to evaluate the algorithm's performance.Results The motion trajectory's RMSE/MaxEare 0.796/1.02 mm for bilateral filtering reconstruction; and 2.704/4.08 mm for original reconstruction. Image content such a stherib position, the hearted gedefinition, the fibrous structures all had been better corrected with bilateral filtering.Conclusion We developed a bilateral filtering based fully automatic sliding motion compensated 4D-CBCT scheme. Digital phantom study confirmed the improved motion estimation and image reconstruction ability. It can be used as a 4D-CBCT image guidance tool for lung SBRTtreatment.
  • Diagnosis and Treatment/Original Articles
    Dosimetric study on middle ear with three whole-brain radiotherapy techniques
    WU Zhe, WANG Dong, CHEN Xiaomei, MING Zhi, LIU Ke, YAN Jun
    2021, 30(3): 276-281. https://doi.org/10.13491/j.issn.1004-714X.2021.03.006
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    Objective This study aims to compare the advantages and disadvantages of the three techniques in improving the target volume dose and protecting the auris media cavity and eustachian tube isthmus region by investigating the dosimetric differences of three whole-brain radiotherapy techniques.Methods Thirty patients with whole brain metastases were randomly selected to design fixed field intensity modulated radiotherapy (ff-IMRT) plan, volumetric arc modulated therapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT) plan, and to meet a 95% PTV prescription dose (40 Gy). The dosimetric parameters and monitor units of the target volume and organ at risk (OAR) in the three groups of treatment plans were compared and analyzed.Results The Conformity Index (CI) of the ff-IMRT plan (0.93 ±0.02) was better than the VMAT plan (0.89 ±0.01) and the 3DCRT plan (0.73 ±0.03), respectively, and the difference was statistically significant (P < 0.05). The Homogeneity Index (HI) of the three plans were ff-IMRT (0.05 ±0.01)、VMAT(0.08 ±0.1) and 3DCRT (0.08 ±0.01), respectively, and the difference was not statistically significant (P > 0.05). The Gradient Index (GI) were ff-IMRT (1.77 ±0.1), VMAT (1.61 ±0.07), 3DCRT (1.39 ±0.08), respectively. The difference was statistically significant (P < 0.05). The monitor units (MU) were ff-IMRT (1551.97 ±85.02), VMAT (303.7 ±24.28) and 3DCRT (226.2 ±2.5), respectively, the difference was statistically significant (P < 0.05). The Dmax of the middle ear of the three plans were ff-IMRT (2557.54 ±477.39) cGy, VMAT (3107.9 ±362.28) cGy, 3DCRT (4055.37 ±71.45) cGy, respectively. The Dmax of the eustachian tube isthmus were ff-IMRT (2425 ±380.4) cGy, VMAT (2902.4 ±526.3) cGy and 3DCRT (3862.7 ±135.9) cGy, the difference were statistically significant (P < 0.05).Conclusion In whole-brain radiotherapy, ff-IMRT and VMAT significantly reduced the dose of the bilateral middle ear cavities and eustachian tube isthmus compared with 3DCRT. VMAT is recommended for WBRT for reducing the number of monitor units significantly.
  • Diagnosis and Treatment/Original Articles
    Effect of phantoms with different cavity thickness on dose verificationupper esophageal cancer
    HONG Jun, HAN Jihua, ZHANG Yan, ZHANG Xiaoye, ZHU Zhijian, SHI Tingting
    2021, 30(3): 282-287,302. https://doi.org/10.13491/j.issn.1004-714X.2021.03.007
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    Objective To investigate the dose calculation accuracy of two algorithms in Monaco TPS for self-made phantoms with different cavity thickness, and analyze the influence of phantoms with different cavity thickness on dose verification of upper esophageal cancer.Methods The phantoms with different cavity thickness were placed on the simulated CT positioning machine to scan and acquire images. In Monaco TPS, the irradiation fields with energy of 6 MV, 100 MU and different square field sizes were added to the acquired images. The dose of the cavity of the ionization chamber was calculated by two algorithms, and measured on the accelerator by dosimeter under the same conditions. At the same time, 20 patients with upper esophageal cancer who received dynamic intensity modulation in fixed field were randomly selected and included in the study, and two algorithms were used for dose verification on phantoms with different cavity thickness. The results were statistically analyzed by SPSS 22.0 software.Results The maximum deviations between the calculated values and the measured values were 0.66% and -1.8%, in the calculation of phantoms with different cavity thickness by algorithms of Monte Carlo and Pencil Beam. In Monte Carlo algorithm, the result of RD pair t test is P > 0.05. Paired t test of AD (0 mm, 10 mm), (5 mm, 10 mm) and (10 mm, 20 mm) groups showed no significant difference (P < 0.05). The maximum deviation was 1.1%, and the rest groups were not statisticely significant (P > 0.05); In Pencil Beam algorithm the t test results of RD (0 mm, 20 mm) and (5 mm, 20 mm) pairs were (P < 0.05), the maximum deviation was 0.58%, and the rest groups were (P > 0.05). In AD group, (P < 0.05), the maximum deviation was 2.78%; The paired t test between the two algorithms was (P < 0.05), and the maximum deviations in RD and AD groups were 2.49% and 4.14%, respectively.Conclusion Monte Carlo algorithm has accurate calculation and high gamma pass rate of dose verification, and there is no clinical difference in gamma pass rate of dose verification among phantoms with different cavity thickness, pencil Beam algorithm is not recommended in cavity phantom calculation.
  • Diagnosis and Treatment/Original Articles
    Impact of fluence smoothing on the dosimetry of cervical cancer radiotherapy
    QIU Gang, FANG Baoshuan, WEI Qiang, CHEN Li, ZHANG Xiaoxiao, CAO Can, LI Qinghao, HUAN Ran, WANG Lu
    2021, 30(3): 288-294. https://doi.org/10.13491/j.issn.1004-714X.2021.03.008
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    Objective To explore the dosimetric differences of radiotherapy plan for cervical cancer with 4 different fluence smoothing (FS) parameters using Monaco treatment planning system (Monaco TPS).Methods Fifteen patients with ⅠB2 stage cervical cancer in our hospital were enrolled in this study. And a 2 Volumetric Modulated Arc Therapy (VMAT) plan for each patient were completed by Monaco 5.11 TPS according to the X-Ray Voxel Monte Carlo (XVMC) method. For each plan was optimized by FS function, with the level of Off, Low, Medium and High. To compare the difference of plan optimization time, conformity index (CI), Homogeneity index (HI), Dmean, Dmin, D2% of PTV，dose to the organ at risk (OAR)，the number of Segments# and MU#，estimated total delivery time (ETDT), quantum Efficiency (QE) of the plans, the formation of Segments# with the same angle and verification of inserting 729 two-dimensional matrix into PTW octavius 4D module of different FS function levels, with the precondition of the Prescription isodose curve covering 95% of the target area. The data was analysed by multivariate factor analysis with the application of SPSS, and P < 0.05 was considered as statistically significant. And the Planned revenue score of different FS levels was also calculated.Results Except for the Dmin of PTV (the lowest value is (32.09 ±0.26) Gy for the Off group, and the highest value is (35.98 ±0.42) Gy for the High group), V40 of the rectum (the lowest value in the Medium group is 55.88% ±2.02%, and the highest value in the High group was 61.90% ±2.98%) and bladder (the lowest value was 45.01% ±2.08% in the Medium group, and the highest value is 50.45% ±1.98% in the High group), the V20 (the lowest value High group was 49.05% ±1.98%, the highest value Off group was 56.52%±1.75%) of femoral head (P < 0.05), there was no significant difference of the dose assessment results for PTV and OARs in 4 different FS function levels. In the High level, the ETDT, QE and MU# were showed better than other groups evidently, however, the number of Segments# showed no significant difference. The plan validation results was increased with the improvement of FS function level, and the level of High was considered to be the optimal. To compare the score of overall benefits of the plan, the level of Medium (-17.18 ±0.05) got the highest score, and the Low group (-17.58 ±0.05) and the High group (-17.42 ±0.06) have similar scores, and Off group (-18.81 ±0.08) has the lowest score.Conclusion Different FS levels of the Monaco 5.11 TPS can optimize the radiotherapy plan for cervical cancer, but the level of Medium is considered to be the most applicable.
  • Diagnosis and Treatment/Original Articles
    Impact of statistical uncertainty on esophagus cancer plan for dose to water and dose to medium
    WANG Yun, GU Peihua, WANG Jiehua, CAO Can, LI Qinghao, CHEN Li, ZHANG Xiaoxiao, WANG Lu
    2021, 30(3): 295-302. https://doi.org/10.13491/j.issn.1004-714X.2021.03.009
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    Objective To study the dosimetry effect of Dw and Dm middle and lower esophageal cancer in Monaco treatment planning system (TPS).Methods 30 patients with T3N0M0StageⅡa middle and lower esophageal cancer were selected for experiment. For each patient, optimize the plan using dose to water (Dw) and dose to medium (Dm) dose calculation mode, then rescale prescription dose to 95% volume of PTV. Compare the difference in the two mode, conformity index (CI), Homogeneity index (HI), Mean dose (Dmean), Minimum dose (Dmin), Maximum dose (D2), Dose to Organ at risk (OAR), MU, Optimization time, photon usage, and QA results of MatriXX and Arc Check. Use SPSS for multivariate analysis.Results In the dose evaluation of the middle and lower esophageal cancer cases under different dose calculation methods, the spinal cord, trachea, V20 of the whole lung, and D2 of the liver have significant dosimetric differences, the dose value, the sequential dose results were compared as (37.92 ±1.11)/(35.85 ±1.08), (59.91 ±1.43)/(60.25 ±0.98), (22.52 ±1.75)/(21.38 ±2.01), (42.89 ±0.52)/(41.73 ±0.58). In the comparison of dose cloud distribution, the difference is mainly located in the cavity and the inner wall of the lung in the target area, the dose in the target cavity in the Dw group is higher than that in the Dm group. The dose in the inner and outer walls of the lung cavity in the Dw group are slightly adducted than that in the Dm group, especially in the central area.Dose QA of MartiXX (3%-3 mm) and Arc Check (2%-2 mm) with different dose calculation methods of 60 plans of 30 cases have all passed clinical requirements. Dm Group is better than Dw group.Conclusion It is recommended to use Dm dose calculation method for Monaco 5.11 TPS in the condition of treatment planning for middle and lower esophageal cancer.
  • Diagnosis and Treatment/Original Articles
    Dosimetric differences in intensity modulated radiation therapy based on EUD and DV optimizations in lung cancer
    LI Zhenhu, REN Hongrong, YIN Haitao, ZHOU Yun, ZHOU Chong
    2021, 30(3): 303-308. https://doi.org/10.13491/j.issn.1004-714X.2021.03.010
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    Objective To compare the dosimetric difference between the biological function based on equivalent uniform dose (EUD) and the physical function based on dose volume (DV) in the intensity modulated radiotherapy for stage Ⅲ non-small cell lung cancer.Methods Four different radiotherapy plans were designed for 15 stage Ⅲ non-small cell lung cancer patients: Group A, physical function optimization (DV + DV) was used for target area and organs at risk; GroupB, in the target region, biological function optimization conditions were added on the basis of physical function optimization, and physical function optimization of organs at risk (DV－EUD + DV) was added. Group C, biological function optimization (EUD + EUD) was used for target area and organs at risk. Group D, in the target area, physical function optimization conditions were added on the basis of biological function optimization, and biological function optimization of organs at risk (EUD－DV + DV) was added. The differences in dosimetric parameters of the four plans were compared.Results Target area: PTV: D2%, D98%, D50%, D105% and Dmax values of group C (P < 0.05) is the highest while group B and group D were relatively small (P > 0.05); The homogeneity index: the results of the group B and the group D were better than those of the other two groups (P < 0.05). conformity index: The results of the four groups were similar (P>0.05). Organ at risk: lung tissue mean dose (MLD), V5, V10, V20, V30 and heart V30, V40, Dmean dose parameters were similar (P > 0.05). Spinalcord: Group C and group D D1% were better than the other two groups (P < 0.05). There was no statistical difference in the number ofmonitor unit (MU) among the four groups (P > 0.05).Conclusion The optimization method combining physical and biological function optimization in the target area can improve the conformity of the target area on the premise of ensuring the treatment. The Spinalcord load would be significantly reduced when using biological function optimization or the combination of biological function and physical function optimization.
  • Diagnosis and Treatment/Original Articles
    Development of SQL-based reporting tools and its application in radiotherapy workflow quality management
    NI Jie, ZHOU Juying, ZHAN Wei, GUO Jian, CHEN Long, GAN Guanghui, XU Yueliang, LI Yiqiu
    2021, 30(3): 309-314,325. https://doi.org/10.13491/j.issn.1004-714X.2021.03.011
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    Objective To effectively use the clinical data generated in daily operation and to realize information networking based on the existing resources of radiotherapy department. To improve quality management efficiency in radiotherapy process.Methods The radiotherapy process and required documents were analyzed. The reporting tool Microsoft Report Builder, which is based on SQL database, was applied to design the patient documents by extracting and analyzing a large number of data generated by Aria, the existing network of our radiotherapy department. PDCA Tools was used to analyze the weak links in the process. Reports with quantitative indices have been designed according to corresponding countermeasures, so as to improve quality control level of the process.Results More than one thousand patients were treated in our department since 2020. All patient documents of radiotherapy can be archived and inquired online after registration only once. 13 daily statistical reports, 5 quarters and 3 annual reports were scheduled according to practical demands. The waiting time before radiotherapy was shortened from 16.2 days to 14.8 days after operating the reporting system 3 months later. The staff could master the treatment progress of patients easily and patients who interrupted the treatment were found in time.Conclusion The reporting tools can realize patient information extraction and networked management effectively in radiotherapy process. Staff efficiency of personnel work and communication was improved. The resource allocation was optimized according to the report data in real time, improving the efficiency and quality of radiotherapy. This method is generally applicable and practical to radiotherapy department.
  • Diagnosis and Treatment/Original Articles
    The relationship of target area and lung volume ratio with prescription dose of IMRT for esophageal cancer
    SUN Jianwei, WANG Qiang, LIANG Binghua, HAN Chao, MIAO Hui, YUAN Cheng, HUI Hua, ZHANG Tao
    2021, 30(3): 315-320. https://doi.org/10.13491/j.issn.1004-714X.2021.03.012
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    Objective To study the relationship between the ratio of target volume to lung volume and the prescription dose in intensity modulated radiation therapy (IMRT) for esophageal cancer, so as to help clinicians to choose the appropriate prescription dose according to the target situation.Methods 80 patients with esophageal cancer were randomly selected. The lesion range included all types of esophageal cancer, and the target area was outlined according to ICRU (International Commission Radiological Units) 50 and ICRU62. Set statistical parameters and plan objectives. Statistical analysis was performed according to the statistical results of the parameters. The critical value of volume ratio is obtained by fitting calculation.Results there was a positive linear correlation between volume ratio and lung V5, V20, V30 and average lung dose. The critical value of volume ratio is 10% for 60 Gy and 13% for 50 Gy.Conclusion according to the research results, it can be predicted that when the ratio of target volume to lung volume is more than 10%, the prescribed dose should not be higher than 60 Gy; when the ratio of target volume to lung volume is more than 13%, the prescribed dose should be selected cautiously, meanwhile in the condition of whose target volume exceeds lung segment the prescribed dose. This provides a reference for clinicians when choose the prescription dose and target range while making the target delineation.
  • Diagnosis and Treatment/Original Articles
    Comparative study of dose distributions calculated by dual optimization modes of Monaco system by volumetric modulated arc therapy of nasopharyngeal carcinoma
    HE Ruixin, YUAN Wei, XU Chao, ZHANG Yuemei, HAN Yangpeng, TANG Fengwen, GONG Tuotuo, WANG Hu???????it???????ao
    2021, 30(3): 321-325. https://doi.org/10.13491/j.issn.1004-714X.2021.03.013
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    Objective To compare the dosimetric differences in volumetric modulated arc therapy (VMAT) of Monaco planning system for nasopharyngeal carcinoma between Pareto and Constrained optimization in order to provide a reference for future mode selection.Methods Select 20 patients with nasopharyngeal carcinoma whom were calculated by Pareto and Constrained modes in the same CT image. Prescription dose of target PGTV, PTV1 and PTV2 was 70.29、60.39 and 54.45 Gy with 33 fractions, 5 times a week. The differences in target dose, organs at-risk dose, monitor units and segments were compared in the condition of 95% of the target volume reached the prescribed dose.Results Compared with Pareto group, Constrained group achieved a better HI and CI. CI of PGTV and PTV1 signed statistical differences (P < 0.05). Dose of OARs in Constrained group were all lower than those in Pareto group except Optical-l and lens-l. The differences of spinal cord prv dose and V30 of Parotid-r between two groups was significant (P < 0.05) while the differences of monitor units and segments between two groups was not significant (P > 0.05).Conclusion The length of middle turbinate is negatively correlated with the occurrence and severity of CMS. There is no significant correlation between the degree of curling and the occurrence of CMS, but patients with lower degree of curling of middle turbinate may have more serious CMS.
  • Diagnosis and Treatment/Original Articles
    Dosimetric study of hippocampal protective whole brain radiotherapy based on Varian accelerator
    XIE Xin, LI Liang, FAN Xuemei, XU Yumei, SHA Guanchen, LIU Xiaoxiao
    2021, 30(3): 326-330. https://doi.org/10.13491/j.issn.1004-714X.2021.03.014
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    Objective The purpose of this study is to provide a reference for the selection of clinical radiotherapy plan by comparing the difference of dosimetry between coplanar dynamic intensity modulation dIMRT and coplanar VMAT plan in hippocampal protective whole brain radiotherapy (WBRT).Methods 10 patients were selected whose hippocampal were protected by WBRT, dIMRT and VMAT plans were designed for each patient, the differences of target dose, organ-endangering dose and machine hop count were compared between the two groups.Results The two technical plans PTV V30 Gy, D98% and D2% all meet the standard of RTOG 0933, which is better than the dIMRT group for the PTV HI VMAT group (P = 0.004). The hippocampal dose of dIMRT group was better than that of VMAT group, but it did not meet the standard of RGOT 0933. The average Dmax of hippocampus in dIMRT group and VMAT group was 18.44 Gy and 19.30 Gy, respectively (P = 0.004). The average value of hippocampal Dmin was 10.03 Gy and 10.77 Gy, respectively (P = 0.013), and the mean value of hippocampal Dmean was 14.20 Gy and 15.12 Gy, respectively (P = 0.002). The doses of lens, eyeball and optic nerve all met the standard of RTOG0933, and the dose of dIMRT group was significantly better than that of VMAT group (P = 0.000). The treatment time in VMAT group was significantly lower than that in dIMRT group. The treatment time in VMAT group was significantly lower than that in dIMRT group.Conclusion Varian dIMRT has more advantages in controlling hippocampal dose and protecting lens than VMAT, but PTV HI and treatment efficiency are higher in VMAT group.
  • Diagnosis and Treatment/Original Articles
    Study on setup errors for different body carcinoma radiotherapy with image guidance in TOMO-HD
    WANG Yinliang, WANG Huitao, ZHENG Anping, SUN Xiaodong, WANG Dong, LIU Haojia, QIN Yongpeng
    2021, 30(3): 331-338. https://doi.org/10.13491/j.issn.1004-714X.2021.03.015
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    Objective The literature study the setup errors of head and neck, thoracic, abdominal and pelvic tumors by megavoltage fan-beam CT based image guidance in TOMO-HD to provide the margin enlarging from clinic target volume (CTV) to planning target volume (PTV) in treatment planning system of TOMO-HD.Methods 103 patients with head and neck (30 patients), thoracic (42 patients), abdominal and pelvic (31 patients) carcinoma were enrolled. Megavoltage fan-beam CT based image guidance in tomotherapy-HD was used to acquire CT scan before every treatment. The left-right (X), superior-inferior (Y), anterior-posterior (Z) and rotation (Fy) setup errors of patients can be obtained from the tomography image automatically restructured by the system. Calculating the systematic error and the random error in the three dimensions and check whether the setup data accord with the normal distribution or not, then acquire the data expand in the three directions.Results According to 2593 fan-beam CT scans, the shift errors (μ ±s) in X, Y, Z and Fy (rotation) of three study group were [(-0.31 ±2.16) mm、(1.09 ±3.56) mm、(2.36 ±2.27) mm, (0.29 ±0.96)°] (head and neck tumor), [(-0.98 ±2.95) mm、(0.45 ±6.86) mm、(3.79 ±2.47) mm, (0.18 ±0.60)°] (thoracic cancer) and [(-0.86 ±2.85) mm、(-1.59 ±6.91) mm、(5.77 ±2.40) mm, (0.20 ±0.68)°](abdominal and pelvic carcinoma). The systematic errors (∑) and random errors (σ) in X, Y, Z dimensions of patients with head and neck, thoracic, abdominal and pelvic tumors were (1.06 mm and 1.84 mm), (1.93 mm and 3.43 mm), (2.41 mm and 2.71 mm), (1.10 mm and 2.56 mm), (3.79 mm and 5.46 mm), (1.38 mm and 1.99 mm) and (1.39 mm and 0.87 mm), (4.98 mm and 5.69 mm), (1.19 mm and 2.05 mm), respectively.Conclusion It is recommended as a reference for image guidance in TOMO-HD according to the frequency distribution of setup errors, for patients with head and neck, chest and abdominal and pelvic tumors, the maximum range of motion in three dimensions are (5.00, 5.00, 5.00) mm, (6.63, 17.25, 16.00) mm and (6.49, 16.24, 13.60) mm.
  • Diagnosis and Treatment/Original Articles
    Dosimetric comparison between dIMRT and VMAT for bilateral breast cancer
    FAN Xuemei, HOU Xin, LI Liang, XU Yumei, LI Liantao
    2021, 30(3): 339-344,360. https://doi.org/10.13491/j.issn.1004-714X.2021.03.016
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    Objective To compare the dosimetric difference of target and organs-at-risk between intensity-modulated radiotherapy (dIMRT) and volumetric modulated arc therapy (VMAT) for bilateral breast cancer, so as to discuss the clinical feasibility of radiotherapy for bilateral breast cancer.Methods The clinical data of 18 patients receiving radical or modified radical mastectomy for confirmed bilateral breast cancer were enrolled in this study. dIMRT plans and VMAT plans were designed for each patient, and discuss the dosimetric data of two radiotherapy plans.Results Both the two plans satisfied the prescription. In terms of the homogeneity index, VMAT plans (0.09 ±0.02) were superior to dIMRT plans (0.11 ±0.01, P < 0.05). In terms of the conformity index,VMAT plans (0.82 ±0.52) were superior to dIMRT plans (0.71 ±0.51, P < 0.05). Furthermore, VMAT plans (0.98 ±0.06) were superior to dIMRT plans (1.24 ±0.08, P < 0.05) in the dose gradient index. The V10、V20、V30 and Dmean of lungs in VMAT plans (39.07 ±4.92，22.19 ±4.36，12.81 ±4.71，1309.03 ±135.55) were higher than those in dIMRT plans (30.34 ±4.26，17.56 ±4.31，6.77 ±3.93，1201.39 ±166.77, P < 0.05).Meanwhile, the V5 of lungs in VMAT plans (63.36 ±9.02) was higher than that in dIMRT plans (58.01 ±7.17, P > 0.05). However, the V5、V30 and Dmean of heart in VMAT plans (51.98 ±3.60，3.78 ±1.76，885.89 ±59.84) were lower than those in dIMRT plans (77.16 ±12.11，5.22 ±2.85，1036.96 ±151.46, P < 0.05). The Dmax of spinal cord in VMAT plans (2150.42 ±136.19) was significantly lower than that in dIMRT plans (3008.23 ±304.15, P < 0.05). Monitor units in VMAT plans（792.61 ±62.53）was significantly lower than that in dIMRT plans (3225.33 ±498.66, P < 0.05).Conclusion Although VMAT has many advantages: achieves better homogeneity index and conformity index of target areas, reduces the irradiation dose of organs-at-risk, especially, the irradiation dose of heart and spinal cord is significantly reduced, however, it increases the irradiation dose of lungs. To reduce the recurrence of grade ≥ 2 radiation pneumonia, dIMRT should be better considered in the application of radiotherapy for bilateral breast cancer.
  • Diagnosis and Treatment/Original Articles
    Dosimetric comparison of left sided breast cancer after breast conserving surgery treated with 4 radiotherapy planning techniques
    REN Hongrong, YIN Haitao, RUAN Xiaobo, DING Ji, ZHOU Chong, CHEN Meng
    2021, 30(3): 345-349. https://doi.org/10.13491/j.issn.1004-714X.2021.03.017
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    Objective To explore the optimal radiotherapy method by comparing the dosimetric differences of target and organs at risk of four radiotherapy plans for left sided breast cancerafter breast-conserving surgery.Methods Twenty-three patients with left breast cancer were randomly selected and given PTV 25 fractions, 50 Gy prescription dose.TheHybrid_IMRT, rj_IMRT, VMAT and t_VMAT plans were designed for each patients. Dosimetric differences were compared, including dose volume histograms of target and OARs, target homogeneity indexes (HI), conformal indexes (CI) and the machine MUs.Results Target Dosimetric comparison, HI: t_VMAT plan target has highest HI and had significant difference (P ≤ 0.001); The target CI of VMAT plans were 0.967 ±0.016, had significant difference compared with the other 3 plans (P < 0.05). The CI of rj_ IMRT were 0.942 ±0.018 better than that of IMRT and t_VMATs. Dosimetric comparison of OARs, left_lung mean dose (MLD_L): rj_IMRT were （8.76 ±1.52） Gy which were best of 4 plans, and had statistical significance (P < 0.05). Heart mean dose: rj_IMRT were （4.68 ±0.87） Gy were better than that of VMAT (P < 0.05).Conclusion All of these four plans could be applied in clinical treatments, while the limitations of treatment equipment, patients’ physical conditions and some other factors should be considered before selecting an appropriate one.
  • Diagnosis and Treatment/Original Articles
    Dosimetric investigation of non-coplanar field technology in static intensity-modulated radiation therapy for gastric carcinoma
    LUO Yunman, WANG Jiping, HUANG Wei, CHEN Chuanxi, YANG Guodong, WANG Ping, YANG Zhiyong
    2021, 30(3): 350-355. https://doi.org/10.13491/j.issn.1004-714X.2021.03.018
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    Objective To compare the dosimetric characteristics of non-coplanar and coplanar field technology in static intensity-modulated radiotherapy of gastric cancer patients, so as to provide a reference for clinical radiotherapy plan selection.Methods Thirty-six patients with gastric cancer were selected to receive intensity-modulated radiotherapy in Huanggang Central Hospital, which was designed plan A and B. Group A used 7-field coplanar technology, while Group B used 7-field non-coplanar technology. We compared the differences of the optimized monitor unit, the dosimetry of organs at risk and target areas between group A and group B.Results Both group A and B could meet the requirements of doctors. The homogeneity index (0.14 ±0.02), the conformity index (0.98 ±0.01), Dmin (4315.21 ±16.74) cGy、Dmean (4679.28 ±28.39) cGy and Dmax(4952.30 ±33.26) cGy of target areas in group B were better than those of group A. Moreover, the monitor unit of group B was much lower than that of group A, and the difference was statistically significant (P < 0.05). The Dmax, Dmean, V15, V20 and V30 of the left and right kidneys in group B were lower than those of group A. The Dmax (3408.57 ±46.03) cGy, Dmean (1250.32 ±14.27) cGy and V20 (44.91% ±6.67%) of spinal cord and the Dmax (3408.57 ±46.03) cGy, Dmean (1720.55 ±17.42) cGy, V20 (25.31% ±7.78%) and V30 (18.52% ±1.56%) of small intestine were also lower than those of group A. The differences were statistically significant (P < 0.05).Conclusion The non-coplanar field radiation plan has more advantages in terms of target dose distribution and protection of organs so that it can be more considerably used in the process of planning and design.
  • Diagnosis and Treatment/Original Articles
    Observation on the effect of 90Sr-90Y application combined with corn paste in the treatment of corns
    ZHANG Feng, ZHANG Ling
    2021, 30(3): 356-360. https://doi.org/10.13491/j.issn.1004-714X.2021.03.019
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    Objective To evaluate the clinical efficacy and satety of 90Sr-90Y application combined with corn paste in the treatment of corns.Methods 85 patients with corns in the First People's Hospital of Tianmen from September 2019 to December 2020 were selected and randomly divided into group A, group B and group C based on random number table. In group A, 28 cases were treated with simple 90Sr-90Y application; in group B, 27 cases were treated with 90Sr-90Y application plus intermittent corns paste; in group C, 30 cases were treated with 90Sr-90Y application plus continuous corns paste.The treatment effect, recovery time, recurrence rate and incidence of adverse reactions of the three groups were compared.Results The cure rates of the three groups were 78.57% (21/28), 81.48% (22/27) and 83.33% (25/30), with no significant difference (P > 0.05); the total effective rates were 92.86% (26/28), 92.59% (25/27) and 96.67% (29/30), the difference was not significant (P > 0.05); the cure time was (5.67 ±1.80) weeks, (2.82 ±1.11) weeks and (2.24 ±1.05) weeks, the cure time of the B and C groups was significantly shorter than that of the A group (P < 0.05); The incidence of adverse reactions were 9.52% (2/21), 4.55% (1/22) and 4.00% (1/25), respectively, the difference was not significant (P > 0.05); the incidence of adverse reactions were 3.57% (1/28), 11.11% (3/27) and 26.67% (8/30), the incidence of adverse reactions in group C was higher than Group A (P < 0.05).Conclusion The combination of 90Sr-90Y application and intermittent corns paste in the treatment of corns has good curative effect, low recurrence rate, short cure time and few adverse reactions. It is worthy of clinical promotion.
    • Review Articles
  • Review Articles
    Progress of standard loading pattern of high-dose-rate brachytherapy in cervical cancer
    WANG Jinbao, ZHAO Hongfu
    2021, 30(3): 361-365. https://doi.org/10.13491/j.issn.1004-714X.2021.03.020
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    Brachytherapy plays an important role in radical radiotherapy of cervical cancer. At present, most hospitals in China use high-dose-ate brachytherapy, which irradiatevolume by simulating line source with a single approximate point source. Therefore, the dwell positions and dwell times can be optimized appropriately. However, due to various reasons, the initial state of the optimization plan must start from the standard loading pattern, and ensure that the optimized plan basically maintains the pear-shaped dose distribution. This paper introduces the standard loading pattern of intracavitary brachytherapy and intracavitary combined interstitial brachytherapy for cervical cancer through literature review, and expounds the planning optimization model and the constraints in the optimization process, to provide important reference for the planning of brachytherapy for cervical cancer.
  • Review Articles
    Research progress of MR imaging for prediction of CT imaging
    XI Qianyi, XIE Kai, GAO Liugang, SUN Jiawei, NI Xinye, JIAO Zhuqing
    2021, 30(3): 366-370. https://doi.org/10.13491/j.issn.1004-714X.2021.03.021
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    Medical images can provide clinicans with accurate and comprehensive patients’ information. Morphological or functional abnormalities caused by various diseases can be manifested in many aspects. Although MR images and CT images can highlight the medical image data of different tissue structures of patients, single MR images or CT images cannot fully reflect the complexity of diseases. Using MR image to predict CT image is one of the cross-modal prediction of medical images. In this paper, the methods of MR image prediction for CTmage are classified into four categoriesincluding registration based on atlas, based on image segmentationmethod, based on learning method and based on deep learning method. In our research, we concluded that the method based on deep learning should bemore promoted in the future by compering the existing problems and future development of MR image predicting CT image method.
  • Review Articles
    Advances on the technique of three-dimensional intracavitary brachytherapy for cervical cancer
    TAN Huayan, LU Min, DENG Ye, LIU Yanfei, FU Qingguo
    2021, 30(3): 371-376. https://doi.org/10.13491/j.issn.1004-714X.2021.03.022
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    Cervical cancer is a common female reproductive system malignant in developing countries. Radiotherapy plays a very important role in the treatment of cervical cancer, and brachytherapy is an essential part of cervical cancer radiotherapy. With the rapid development of CT and MRI imaging technology, brachytherapy cervical cancer has gradually developed from the traditional two-dimensional image-guided technology to three-dimensional image-guided technology. There are more and more treatment methods, including intracavitary brachytherapy, interstitial brachytherapy and intracavitary/interstitial brachytherapy. This paper reviews several common techniques of three-dimensional brachytherapy for cervical cancer, and discusses the dosimetric feasibility of internal and external integration irradiation.
  • Review Articles
    Research progress on pathogenesis and molecular targeted therapy of radiation-induced lung injury
    CHEN Jiazhen, WANG Yu, WANG Cunliang, HU Xudong
    2021, 30(3): 377-380,390. https://doi.org/10.13491/j.issn.1004-714X.2021.03.023
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    Radiation-induced lung injury is a common complication of radiotherapy for thoracic tumor, usually involves the radiation-induced pneumonitis at early stage and radiation-induced pulmonary fibrosis at late stage, which seriously affects the treatment and prognosis of patients. At present the common treatments for radiation-induced pulmonary fibrosis include anti-inflammatory therapy, glucocorticoid therapy, antioxidant therapy and so on. Recentlywith the further research of radiation-induced pulmonary fibrosis, more and more attention has attracted in molecular targeted therapy. Molecular targeted inhibitors is a new class of drugs for the treatment of radiation-induced lung injury, mainly targeting a variety of cytokines, signaling pathways, tyrosine kinase receptors and other targets. This article systematically reviews the pathogenesis and molecular targeted therapy of radiation-induced lung injury.
  • Review Articles
    Research progress in hematopoietic stem cell transplantation for bone marrow acute radiation syndrome
    WANG Jing, ZHOU Fang
    2021, 30(3): 381-385. https://doi.org/10.13491/j.issn.1004-714X.2021.03.024
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    As is known, the nuclear accident resulting from the explosion of a nuclear weapon or the release of nuclear material could cause acute radiation syndrome within a short time. The study had found that the dose of > 0.7 Gy radiation on human body can result in persistent myelosuppression, a kind of acute radiation syndrome, leading to pancytopenia, bleeding, infection and other injuries. Several evidences also have shown that hematopoietic stem cell is conducive to repair hematopoietic injury in bone marrow, improve hematopoietic microenvironment and promote hematopoietic reconstruction. Therefore, hematopoietic stem cell transplantation is widely considered as the main treatment of the bone marrow acute radiation syndrome. However, before a surgery of hematopoietic stem cell transplantation, it still needs more research on donor selection, formulation of preconditioning and prevention of complications such as graft-versus-host disease. This paper mainly summarizes the application and research progress of hematopoietic stem cell transplantation in treating radiation injury.
    • Expert Comments
  • Expert Comments
    Tritium protection in the operation of nuclear energy
    LIU Yulong, MA Nan
    2021, 30(3): 386-390. https://doi.org/10.13491/j.issn.1004-714X.2021.03.025
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    Tritium (3H) is an isotope of hydrogen. The main sources in the environment are natural tritium and artificial tritium.Artificially produced tritium appears as a by-product or a key fuel in the development of nuclear energy, and its release rate far exceeds that of natural tritium. The public's exposure to tritium in the environment is very low. Strategically speaking, the protection of tritium should focus on occupational exposure workers. This article briefly summarizes the nature, source, hazards, protection and pollution treatment of tritium, so that the public and radiation workers can understand relevant knowledge and do personal protection.