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Objective To develop a network management system for tumor radiotherapy information that integrates process management and quality assurance functions, and to investigate its clinical value. Methods Based on the requirements of radiotherapy process quality assurance and control, the client-server ( C-S) pattern, along with SQL SERVER 2008 database structure, international standard DICOM 3.0, DICOM RT, and HL7 protocols, and system hardware and self-developed software in local area network, was adopted to establish the network management system for radiotherapy information, and clinical tests were performed to evaluate the operation performance of this platform.Results ( 1 ) The interactive integrated management platform and client-side functional modules with a uniform interface were developed.( 2) The safe and reliable standardized data interface was developed, which could be connected to accelerators, treatment planning systems, and hospital information systems developed by mainstream manufacturers.( 3) The modules for radiotherapy process management and quality assurance and management were designed and developed.( 4) The platform passed all the tests before operation and had been used in clinical departments for almost 3 years, which confirmed that the system was safe and stable during operation and that all functions designed were realized.Conclusions The integrated management platform meets the requirements for application and management of radiotherapy information and data, improves the overall work efficiency in radiotherapy department and the level of quality assurance and control, and holds promise for clinical application as a good tool for tumor radiotherapy departments.
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Objective To study preliminary the accuracy of clinical target volume (CTV) and internal target volume (ITV) automatically generated by an in-house deformable registration software on fourdimensional CT (4DCT),and evaluate its feasibility of clinical application.Methods Clinic treated one lung cancer patient and one liver cancer patient were selected for the study.CTV was delineated by radiation oncologist according to a single respiratory phase image of 4DCT scanning,and then deformed to the other phases and generated the CTVdefm on each phase image.Differences between the CTVdefm and CTVmanu were then compared.A composite ITVcopm was created by overlapping all the CTVdefm of 10 phases and compared with the ITVMIP which was contoured on the maximum intensity projection (MIP) CT images,including the shape,volume and geometric center position of the ITV contour.Results For the tested lung case,average volume difference between the CTVdefm and CTV was (-2.59 ± 5.02)％ for the all 10 phases,and the vector departure of the two ITV centers was (1.04 ± 0.89) mm.The ITVcomp almost completely matched the ITVMIP on the tested liver case with a volume difference smaller the 1％ and only 1.4 mm vector departure between their geometric centers.Conclusion The validity of the CTVdefm and ITVcomp gained from automatic deformation of manual delineation reference based on 4DCT images were preliminary evaluated and proved to be good enough for clinic planning.
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Objective To observe the physique and anatomy changes in patients with nasopharyngeal carcinoma (NPC) during intensity-modulated radiotherapy (IMRT), using repeated CT images and deformable registration technique, and analyze their impact on delivery dose distribution.Methods Ten NPC patients were randomly selected from those who had received IMRT treatment.Gross tumor volume of nasopharyn (GTVnx), GTV of metastastatic lymph node (GTVnd), clinical target volume (CTV) and normal tissue or organ (OAR) were re-contoured on the in-course repeated CT images using a kind of deformable registration and auto-segmentation software according to the original planning contouring.Changes in volume of treatment targets and organs at risk were evaluated and the trends were then analyzed.Dose distributions were recalculated with repeated CT images and compared to the original plans.Results The volume of GTVnx were decreased by 6.44%,10.23% and9.72%(F=1.34,P=0.278) in the 2-,4-and 6-week after IM RT comparing with before IM RT, with 6.59%, 30.98 % and 35.13 % (F = 9.22, P =0.000) in GTVnd, 0.73%, 1.86% and 1.41% (F=0.33,P=0.722) in CTV1, -1.78%, -6.47%and -9.34% (F =16.89 ,P =0.000) in CTV2, 13.96%, 32.97% and 37.77%(F=17.17,P=0.000)in the left parotid , and 3.56% , 29.57% and 35.63% (F = 13.49 , P = 0.000) in the right parotid.The mean dose change rate of GTVnx were -0.39%, 0.08% and 0.32% (F =0.15 ,P =0.860) in the 2-,4- and 6-week after IMRT comparing with planning faction dose, with 0.53%, 1.19% and 0.69% (F=0.81,P=0.455) in GTVnd, 1.95%, 2.70% and 3.78% (F=0.61,P=0.552) in the spinal cord,0.32%, 0.81% and 0.62% (F=0.03,P=0.975) in the brain stem, 4.50%, 4.66% and 7.20% (F=0.33,P=0.725) in the left parotid, 2.20%, 7.17% and 7.12% (F= 1.24,P=0.306) in the right parotid.Conclusions The GTVnd, CTV2 and parotids shrinks obviously along with the treatment times for NPC patients during IMRT.Although changes in fraction dose of GTV, CTV, spinal cord, stem and parotids are not significant, further study with larger samples is needed.
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Objective To determine the relationship between the level of plasma homocysteine and coronary calcification in patients with different blood glucose levels. Methods By measuring plasma homocysteine and coronary calcification in 30 cases of diagnosed diabetes (T2D) ,29 cases of diagnosed impaired glucose tolerance (IGT) in patients and 27 cases with normal, we compared the level of plasma homocysteine and coronary calcification in patients with different blood glucose levels. Results We found significant diffieronces among three groups of the level of plasms homocysteine and coronary calcification (P ＜ 0.01). The plasma homocysteine levels were(19.31 ±3.17) μmol/L, (13.85 ± 1.62) μmol/L, (9.80 ± 1.78) μmol/L in the T2D,IGT and normal groups,respectively. The coronary calcification scores were 207.80 ± 154.10,63.24 ± 10.46,14.47 ± 5.16 in the T2D, IGT and normal groups, respectively. The plasma homocysteine level and coronary calcification score increased with the glycosylated hemoglobin rise in the normal,IGT and T2D groups((4.51 ±0.48)%, (6.13 ±0.31)% and (7.69 ±0.81)%, respectively). Conclusions The plasma homocysteine level is a strong independent predictor of type 2 diabetes and also an important factor of coronary artery event occurrence and develepment.