الملخص
Objective:To investigate the variations and related influencing factors of the volumes, positions, and morphologies of geometries formed by surgical clips in intensity-modulated radiation therapy (IMRT) for whole breasts after breast-conserving surgery.Methods:A retrospective analysis was conducted on 18 patients treated with IMRT from October 2021 to September 2022 after breast-conserving surgery. Set-up errors were obtained by reading the coordinate information of tumor bed surgical clips according to the cone beam CT (CBCT) images at 0, 10, 20, 30, 40, and 50 Gy sequentially. Geometries were constructed using the convex hull program, and the volumes ( Vct and V0-5) of geometries were then calculated based on the localization CT images and the six CBCT images, respectively. The centroid displacements ( D0-5) and degrees of inclusion ( DI0-5) of these geometries were compared. The t-test or rank-sum test was used to analyze the effects of radiation doses on V0-5, D0-5, and DI0-5. The Pearson correlation analysis was conducted to analyze the correlations between D0-5 and corresponding set-up errors in three-dimensional directions, and the correlations of average V0-5 variation ( AV), average D0-5 ( AD), and average DI0-5 ( ADI) with the body mass index (BMI), the volume of a breast ( VB), the breast axial height ( H), and the time interval from surgery to radiotherapy ( T) each. The influences of quadrants ( Q) where geometries are located and states ( S) of geometries adhering to or away from the chest walls on AV, AD, and ADI were analyzed through one-way ANOVA. Results:The differences between D5 and D0, between D5 and D1, and between D5 and D2 were statistically significant ( t = -3.27, -4.52, -3.38, P < 0.05), respectively. The differences between DI5 and DI0, between DI5 and DI1, between DI5 and DI2 were statistically significant ( t = 2.53, 2.70, 2.64, P < 0.05), respectively. D1 and D4 correlated with the set-up errors in the superior-inferior dimension, and D3 correlated with the set-up errors in the left-right dimension ( r = 0.50, 0.56, 0.53, P < 0.05). The AD was related to BMI, VB, and H ( r = 0.54, 0.48, 0.50, P < 0.05). There were statistically significant differences in AV and ADI of geometries away from ( S3) and near ( S2) chest walls ( F = 2.66, 3.83, P < 0.05). The AD differences of geometries between S3 and the state adhering to chest walls ( S1) and between S3 and S2 were statistically significant ( F = 7.46, P < 0.05), respectively. Conclusions:The geometries are relatively constant volumes during whole-breast radiotherapy. However, their positions and morphologies vary greatly in the late course. The volume variation ratios, centroid displacements, and degrees of inclusion of geometries are all affected by the states of their attachments to the chest walls. The centroid displacements correlate with breast morphologies and BMI. The radiotherapy plan modification can be individualized.
الملخص
Objective:To explore the affects of the filling degree of the abdominal and pelvic cavity to the position of the diaphragm.Methods:The computed tomography (CT) images of 25 patients from 137 CT scans stored in the Picture Archiving and Communication System of the First Affiliated Hospital of Soochow University from March 2018 to September 2020 were reviewed and analyzed retrospectively. Every patient was scanned 4-7 times. The outline of the abdominal and pelvic cavity from the diaphragmatic dome to the superior margin of pubic symphysis was drawn at every cross section, and then the filling volumes of the abdominal and pelvic cavities and the overall filling volume were calculated. For the same patient within 4-7 CT scans, per pair of different images was compared randomly and 379 comparison pairs were obtained. The volume change rate (△ VR) of the abdominal and pelvic cavity and the height difference (△ H) of the diaphragmatic dome were calculated. The images with "larger overall filling volume of the abdominal and pelvic cavity and higher diaphragmatic dome" were defined as consistent group, and those with "larger overall filling volume and lower diaphragmatic dome" were defined as inconsistent group. The percentage of images in the consistent group in all samples and the percentage of images showing deep inspiration in the inconsistent group in all samples were calculated. △ VR and △ H were compared between the consistent and inconsistent groups. △ VR of the abdomen and pelvic cavities in the consistent group was compared using the Mann-Whitney test. The correlations between △ VR of the abdomen and pelvic cavities and the elevation of the diaphragmatic dome in the consistent group were analyzed using Spearman correlation analysis. The average elevation of the diaphragmatic dome in all samples and the consistent group was simulated if the filling volume of the abdomen and pelvic cavity was increased by 500 ml. Results:The percentage of images in the consistent group in all samples was 67.28%. The percentage of images showing deep inspiration in the inconsistent group in all samples was 26.39%. There were significant differences in △ VR and △ H of the abdomen and pelvic cavity between the consistent and inconsistent groups ( Z=-4.95, -5.49, P<0.05). In the consistent group, there were significant differences in △ VR between the abdominal cavity and pelvic cavity ( Z=-7.53, P<0.05), and the elevation of the diaphragmatic dome was correlated with the △ VR of the abdominal cavity ( rs=0.43, P<0.05). The simulated calculation showed that an average increase of 500 ml in the filling volume of the abdominal and pelvic cavity result ed in an average elevation of 4.54 and 8.43 mm in the diaphragmatic dome in all samples and the consistent group, respectively. Conclusions:The filling degree of the abdominal and pelvic cavity may be one of the main factors affecting the position of the diaphragm and the precision of radiotherapy for relevant organs near the diaphragm, especially the filling degree of the abdominal cavity. It is recommended to repeat the filling degree of the abdominal and pelvic cavity by CT localization scanning as much as possible during radiotherapy.
الملخص
Objective:To analyze the activity of skin markers at different parts of the body surface and the correlations between their displacement deviations and pelvic filling volumes during conventional abdominal and pelvic radiotherapy.Methods:A retrospective analysis was conducted on 15 patients receiving abdominal and pelvic radiotherapy with four times of computed tomography (CT) in the First Affiliated Hospital of Soochow University from January 2020 to January 2022. All CT images were divided into nine parts from the upper edge of L3 to the upper edge of the pubic symphysis: upper, middle, and lower parts in the right portion; upper, middle, and lower parts in the central portion; and upper, middle, and lower parts in the left part portions, No. 1-9 in sequence. The same blood-vessel or fascia intersection points near the same skin parts receiving the same dose fraction were used as the markers for skin positioning during simulated radiotherapy. The relative coordinates of the markers were measured, with the same point at the lower edge behind the L5 vertebral body set as the coordinate origin. Through pairwise comparison of each patient′s four CT images, the three-dimensional displacement deviations and activity were calculated for all markers. In the left-right (L-R), superior-inferior (S-I), and anterior-posterior (A-P) directions, the differences in the displacement activity of the markers in the nine parts were compared using both the non-parametric Kruskal-Wallis test and the Descriptives. The correlations between the three-dimensional displacement deviations of all markers and the A-P displacement deviations of the No. 5 marker were analyzed using the Pearson correlation analysis.Results:Differences existed in the displacement activity of the nine-part markers in the L-R, S-I, and A-P directions ( H=36.66, 66.20, 92.15, P<0.05). No. 3 and 9 markers exhibited lower overall three-dimensional displacement activity (median: 2.40-3.75 mm) than other markers. The No. 5 marker manifested the highest A-P displacement activity, with a median of 9.20 mm. The A-P displacement deviation of No. 5 marker was correlated using the L-R displacement deviations of the No. 1, 2, 3, 7, 8 and 9 markers ( r=-0.36 to 0.49, P<0.05), the S-I displacement deviations of the No. 4, 5, 6, and 9 markers ( r=-0.34 to -0.24, P<0.05), and the A-P displacement deviations of the No. 1, 2, 3, 4, 6, 7, 8 and 9 markers ( r=0.33-0.91, P<0.05). Conclusions:Skin markers drawn in bilateral acetabular regions serve as the best choices for reposition in pelvic radiotherapy. Conventional skin markers made at the central parts are prone to suffer deviations in the S-I direction due to the influence of the abdominal and pelvic filling volumes.
الملخص
Objective To establish and investigate C57 BL/6 mice model of radiation induced heart injury and ser-um marker. Methods Twenty eight female C57BL/6 mice were randomly divided into 3 groups:normal group (n=4 ) , 18 Gy radiation therapy group ( n=12 ) , 25 Gy radiation therapy group ( n=12 ) . The mice were weighed every week. Respectively, 0, 8 and 16 weeks after irradiation, the pathological changes of myocardial tissue were observed by hemetoxylin-eosin( HE) staining and made pathological score. Inferior vena cava blood was collected to take cardiac troponin I ( cTnI) test. Results Compared with the normal group,the weight of radiation group went down first then went up slowly. The myocardial tissue from mice had obvious histopathological changes. Acute in-flammation was the main change in the early days. At the late stage, progressive fibrosis was the main characteris-tic. With the increase of the dose, the inflammatory reaction and fibrosis degree had aggravated, pathological chan-ges had occurred earlier. cTnI showed a trend of higher performance over time, and had a correlation with patholo-gy. Conclusion We successfully established radiation induced myocaridal injury model. As a noninvasive serum marker, cTnI can be used as the evaluation standard of radiation induced myocardial injury animal model.
الملخص
Objective] To explore the treatment of cough caused by fire-evil from its pathogenic characteristics. [Method] To analyze the specificity about fire-evil invading lung for cough cases during the Qing Dynasty and Modern Times, with the basic theory of TCM and the discussion of past dynasties. [Results] Lung covering other viscera, fire flaming upward,cough easily caused by fire-evil, these are due to yin deficiency to see more, such as kidney-yin deficiency, heart-yin deficiency, liver-yin deficiency, there is also excess fire from the dyspepsia. The treatment should be fire-clearing, gas-dropping, yin-nourishing and removing food retention. [Conclusion] In the cough caused by other evil,it can also be modeled on the analysis of its pathogenesis and therapeutic rule.