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Objective:To study the change pattern of neck diameter and relevant factors in nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy, aiming to provide reference for clinical practice.Methods:Fifteen NPC patients treated with helical tomotherapy at Sun Yat-Sen University Cancer Center from November 2020 to February 2021 were enrolled in this study. The transverse diameters of NPC patients' neck contours and body weight of all patients during radiotherapy were recorded weekly. We used descriptive statistics to explore the distribution of transverse diameters of NPC patients' neck contours during radiotherapy. And Spearman correlation analysis was used to assess the association between weight loss and changes in neck contour transverse diameter.Results:During radiotherapy, the distribution of transverse diameters of NPC patients' neck contours was completely different from the initial values. Specifically, the transverse diameters were significantly reduced at the 4th week of the radiotherapy. Moreover, the reduction of transverse diameter of neck contour was highly correlated with the weight loss ( r=0.803, P<0.05), and moderately correlated with gender ( r=0.523, P<0.05). However, there was no statistical correlation between the alteration of neck diameter and age, TNM stage, and the mean dose of GTV nd-L, GTV nd-R, PTV nd-L and PTV nd-R (all P>0.05). Conclusions:The neck contours of NPC patients are altered regularly during helical tomotherapy, which are narrowed the most obviously in the 4th week. Extensive attention should be paid to the changes of neck contour during radiotherapy in clinical practice.
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Objective:To compare the difference between breast bracket combined with polyurethane foam and single polyurethane foam in the accuracy of immobilization, providing a better immobilization for breast cancer radiotherapy.Methods:Fifty breast cancer patients who received radiotherapy in Sun Yat-sen University Cancer Center from March 2021 to July 2021 were selected. Among them, 25 patients were immobilized with polyurethane foam (foam group), and the other 25 patients were immobilized with polyurethane foam combined with breast bracket (combination group). All patients were scanned by CBCT once a week to obtain setup errors in the SI, LR and AP directions for t-test. The formula M PTV=2.5 Σ+0.7 σ was used to calculate the margin of the planning target volume(M PTV). Results:The setup errors in the foam group were SI (2.0±3.26) mm, LR (0.88±2.76) mm, AP (1.22±3.55) mm, Rtn -0.24°±0.85°, Pitch 0.16°±1.11°, Roll -0.32°±1.05°, and the M PTV were 6.75 mm, 8.46 mm and 8.73 mm, respectively. The setup errors in the combination group were SI (1.0±3.01) mm, LR (0.62±2.74) mm, AP (1.82±3.21) mm, Rtn 0.64°±0.59°, Pitch 0.71°±1.22°, Roll 0.29°±0.73°, and the M PTV were 6.35 mm, 7.47 mm, and 7.61 mm, respectively. After comparing the setup errors in the three-dimensional directions between two groups, the t value of LR, SI, AP and Rtn, Pitch, Roll was -4.304, -2.681, 1.384, and -9.457, -3.683, -5.323, respectively. And the differences in the LR, SI, Rtn, Pitch and Roll directions were statistically significant (all P<0.05). Conclusions:The immobilization effect of polyurethane foam combined with breast bracket is better and the M PTV is also smaller than those of polyurethane foam alone. Therefore, it is recommended to use polyurethane foam combined with breast bracket for immobilization in breast cancer radiotherapy.
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Objective:To provide evidence for the selection of fixation devices and CTV to PTV margins (M ptv) in precision radiotherapy for pelvic tumors by analyzing three fixation devices in precision radiotherapy for prostate cancer. Methods:From April 2015 to December 2020, 133 prostate cancer patients treated with pelvic drainage area irradiation in our center were retrospectively analyzed. The patients were fixed with 1.2m vacuum bag (n=39), 1.8m vacuum bag (n=44) and personalized prone plate by our center (n=50). Each patient was asked to complete our bowel and bladder preparation process before positioning and radiotherapy. The registration of CBCT to planned CT before each treatment adopted the same registration box and algorithm. Setup errors in the SI, LR and AP directions under qualified bowel and bladder conditions were recorded. Setup errors in three directions under three fixation devices and corresponding M ptv values were analyzed. The correlation between setup errors with age and body mass index (BMI) was analyzed. Results:Analysis of 3333 setup errors data showed: in the SI and LR directions, the mean setup errors of 1.2m vacuum bag (3.26mm, 2.34mm) were greater than those of 1.8m vacuum bag (2.51mm, P<0.001; 1.90mm, P<0.001), and personalized prone plate (3.07mm, P=0.066; 2.10 mm, P=0.009). In the AP direction, the mean setup errors of 1.2m vacuum bag (supine)(2.20mm) were smaller than those of 1.8m vacuum bag (3.33mm, P<0.001) and personalized prone plate (3.61mm, P<0.001). The setup errors of 1.8m vacuum bag in all directions were smaller than those of personalized prone plate (P≤0.028). According to Van Herk's expansion formula, the M ptv of 1.2m vacuum bag in three directions was approximately 4 mm. The M ptv of 1.8m vacuum bag and personalized prone plate in the SI and LR directions was approximately 3 mm, and more than 5 mm in the AP direction. The setup errors were not correlated with age or BMI. Conclusions:From the setup errors results of three devices, 1.8m vacuum bag is the best, followed by personalized prone plate. And supine position is better than prone position in the AP direction.
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Objective:To investigate and analyze the basic occupational situation of Chinese radiotherapists and to provide references for the development and construction of the radiation therapist team in China.Methods:Between May 7, 2021 and June 15, 2021, this survey was conducted using a self-designed questionnaire, which was distributed and collected in the form of online survey to conduct a statistical analysis of the basic situation of radiotherapists in 30 provincial-level administrative regions in China.Results:A total of 2 928 valid questionnaires were collected from 30 provincial-level administrative regions. The ratio of male to female and average age of the participants were 69∶31 and 35 years (18-65), respectively. According to the survey result, 84.7% of the participants came from Tertiary A-level hospitals. In terms of educational background, the participants with doctoral, master, undergraduate, junior-college, and technical-secondary degrees accounted for 0.2%, 6.9%, 76.6%, 14.9%, and 1.4%, respectively. In terms of title, full senior technologists, associate senior technologist, technologist-in-charge, technologist, and technician in the participants accounted for 0.5%, 5.8%, 32.5%, 52.2%, and 8.2%, respectively. The participants with years of employment of 0-, 5-, 10-, 20-y accounted for 33.74%, 25.79%, 25.51%, and 14.96%, respectively. The majors of the participants included medical imaging/imaging technology (45.9%), clinical medicine (19.1%), and biomedical engineering (11.9%).Conclusions:Chinese radiotherapists tend to be younger and are rapidly increasing in number. Employers should attach importance to the career planningand continuing education of radiotherapists to improve their technical skills, in order to fully satisfy the demand for radiotherapists in the new era.
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Objective:To preliminarily observe the feasibility of different immobilization techniques for total skin irradiation (TSI) using helical tomotherapy.Methods:Three eczema scrophuloderma patients treated with TSI in Sun Yat-sen University Cancer Center were immobilized with low-temperature thermoplastic in a prone position, diving suit combined with negative pressure vacuum bag in a supine position, low-temperature thermoplastic combined with vacuum bag in a supine position, respectively. Different immobilization effects were observed. The conformity index (CI) of the target area, heterogeneity index (HI) of the target area, and the mean dose (D mean) of the target area were calculated. Results:Three immobilization methods could achieve satisfactory immobilization effects, and all the dosimetric parameters of radiation treatment plans met the clinical requirements. The average set-up errors in the left and right, head and foot, and abdomen and back directions of three patients were (0.26±3.40) mm, (-2.63±4.63) mm and (6.13±4.86) mm, respectively. The CI, HI andD mean were0.56±0.09, 1.186±0.059 and (2586.56±63.28) cGy. Conclusions:Low-temperature thermoplastic or diving suits can be combined with vacuum bags for immobilization in TSI. The epidermal dose can be increased with bolus through the dose-building effect, which can provide a safe and reliable method for TSI in helical tomotherapy.
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Neoadjuvant chemoradiotherapy (NCRT) has become the standard treatment for patients with locally advanced rectal cancer (LARC).However,the response to NCRT varies among LARC patients and a subset of patients show resistance to NCRT.NCRT may delay the timing of surgery and even reduce the overall survival.Therefore,it is of significance to identify biomarkers for predicting the clinical efficacy of NCRT,screen patients who are resistant to NCRT and perform surgery as early as possible,eventually establishing an individualized therapeutic strategy.MicroRNAs are a class of small non-coding RNAs that post-transcriptionally regulate gene expression,which areinvolved in multiple signaling pathways and DNA damage repair process and affect the radiosensitivity of rectal cancer cells.Many recent studies have evaluated the role of microRNA in predicting the response to NCRT.The purpose of this article is to review the research progress and validate the role of microRNA in predicting the clinical efficacy of NCRT for rectal cancer.
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Objective To learn the cognitive status for newborns medical pain in medical workers of neonatal intensive care unit of children′s hospitals and provide clinical basis for optimizing neonatal pain management. Methods Totally 320 medical staff in neonatal intensive care units of six children′s hospital in Wuhan, Shenzhen, Shanghai, Nanjing, Zhejiang, Chongqing were investigated using medical pain management survey questionnaires by means of convenience sampling method. Results The knowledge on neonatal pain were at quite high level, accuracy rate was (80.5 ± 18.1)%;but on pain feel, pain relief rate and anodyne-use, the accuracy rate was relatively low; chest drainage, lumbar puncture and PICC placement were generally considered to cause severe pain with scores of 8.03±2.20, 7.17±2.17, 7.09 ± 2.00, respectively. Medical staff with different degrees, having children or not, different titles and with different years of working at NICU had impact on neonatal pain assessment on heel prick and venipuncture among full-term newborns. The difference was statistically significant (χ2=6.208-23.314, P<0.05). Conclusions Neonatal pain management is gradually emphasized by clinical medical staff, but there exist a certain bias on the perception and assessment of pain. So, it needs to strengthen pain-related knowledge training on health care for newborns to prevent and reduce neonatal pain, improving neonatal pain management.
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Objective To discuss the application value of DWI and ADC on predicting therapeutic effect of radiotherapy treatment in NPC. Methods Twenty four local recurrent cases and 38 non-recurrent cases after radiotherapy treatment in NPC were reviewed. MRI and DWI-MRI were performed at pre-radiotherapy and 3, 6, 12 months after treatment, the ADC values of the lesions were analyzed by SPSS 18.0 statistical software. ROC curves based on the ADC values were measured in 3, 6, 12 months after treatment plotted to analyze the threshold ADC value for confirming recurrence. Results The recurrent group and newly diagnosed group showed significantly high signal on DWI, while the non-recurrent group acquired low or mixed signal. The ADC values of the primary tumor in the recurrent group and the non-recurrent group were (0.709 ± 0.078) × 10-3 and (0.693 ± 0.089) × 10-3mm2/s, respectively, t=-0.717,P>0.05, respectively.The ADC values of the primary and recurrent tumor in the recurrent group were (0.730± 0.068) × 10-3mm2/s and (0.709 ± 0.078) × 10-3mm2/s, t=-1.000,P>0.05 , respectively.There were statistical differences between the recurrent group and the non-recurrent group for ADC in 3, 6, 12 months after treatment:(1.128 ± 0.179) × 10-3 and (1.358 ± 0.145) × 10-3mm2/s, t=5.567,P<0.01;(1.164 ± 0.174) and (1.450 ± 0.102) × 10-3mm2/s, t=7.310,P<0.01;(1.107 ± 0.180) × 10-3 and (1.584 ± 0.125) × 10-3mm2/s, t=11.189,P<0.01;respectively. Take 1.29 × 10-3 mm2/s,1.32 × 10-3mm2/s,1.37 × 10-3mm2/s respectively in 3, 6, 12months after treatment as the diagnostic threshold to predict tumor recurrence. The sensitive , specificity, and accuracy were (83.3%, 73.7%, 77.4%), (83.3%, 89.5%, 87.1%), (100.0%, 94.7%, 96.3%).Conclusions Both DWI and ADC value are important for diagnosing and predicting recurrent NPC after radiotherapy treatment, DWI and ADC can be used to regular follow-up after radiotherapy, to further improve the rate of early diagnosis of recurrent NPC.
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Objective To investigate an appropriate megavoltage computed tomography ( MVCT ) protocol to guide helical tomotherapy ( HT) for multiple metastases. Methods According to the location of target volume, 48 patients with multiple metastases undergoing HT were divided into head/chest group ( n=15), head/pelvis group (n=15), and chest/pelvis group (n=18). Each target volume received MVCT scans during the treatment. The obtained MVCT images were registered to CT images and the setup errors were recorded. The CTV?PTV margins were calculated. Comparison was made by paired t test. Results In the head/chest group, there was no significant difference in the setup error in x?axis between the head and chest (-0.15±1?25 vs. -0.21±2?34, P=0?71), while the head had significantly smaller setup errors in y?and z?axis than the chest (0.73±1?22 vs. 1.56±2?54, P=0?00;0.93±1?44 vs. 2.65±1?88, P=0?00). In the head/pelvis group, the head had significantly smaller setup errors in x?, y?, and z?axis than the pelvis (-0.16±1?31 vs. -1.29±3?72, P=0?00;0.81±1?34 vs. 3.20±3?90, P=0?00;1.24±1?75 vs. 5.49±2?80, P=0?00) . In the chest/pelvis group, there were no significant differences in setup errors in x?or y?axis between the chest and pelvis (-0.25± 2?90 vs. -0.22± 3?65, P=0?06;0.35± 3?60 vs. 0.38± 3?78, P=0?87), while the chest had a significantly smaller setup error in z?axis than the pelvis (1.95±2?81 vs. 3.35± 3?05, P=0?00) . In the three groups, the CTV?PTV margins of lower target volume were reduced in three dimensions after the correction of upper target volume, in which y?axis showed the largest reduction of CTV?PTV margins (5?13 vs. 4?01;9?17 vs. 8?30;8?52 vs. 7?13). Conclusions The setup error of individual target volume should not be used for correction of the overall setup error in HT for multiple metastases with isolated target volume. An MVCT protocol that provides image?based guidance for multiple target volumes is recommended.
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Objective To compare the status of nurses′cognition on children′s pain between the pediatric intensive care units (PICUs) and common wards .Methods Surveys were completed by the pediatric nurses through the WeChat platform ,3 283 quali‐fied surveys from department of nursing of 11 three level of first‐class hospital in central China ,were sent back and analyzed . Results There was no statistical difference in the age ,marital status ,professional title ,highest academic qualifications ,and the dis‐tribution of professional nursing service life between PICU nurses and common ward nurses(P>0 .05) .Statistical differences were found among the sex ,the positions ,the experiences of nursing and the pediatric nursing (P0 .05) .Conclusion The knowledge of the PICU nurses and common ward nurses were both not optimistic .Specific training should be provided according to the different status of the PICU nurses and common ward nurses ,so that better pain management would be provided to the pediatric children .
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Objective To explore the emergent nursing care of peritonsillar abscess in an infant. Methods The process of observation, treatment and nursing care of an infant with peritonsillar abscess were reviewed, and the nursing experiences were summarized. Results Through close observation of the rate, rhythm and depth of the respiration, the early signs of airway obstruction, guide parents with children right, keep the children quiet, open the airway, at the same time to prepare relevant emergency use objects to be prepared for emergency surgery, we saved time for the operation. Postoperative management of the airway and observation for the signs of bleeding in the area of incision were provided. The infant recovered well and was discharged after the treatment and nursing. Conclusions This case reminds nurses to pay attention to the airway obstruction while caring for the infants with peritonsillar abscess. The key points of nursing are observation and management of the airway obstruction, emergent preoperative preparation, postoperative monitoring, management of the airway and observation for the bleeding of the incision area.
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Objective To investigate the accuracy and reliability of the image automatic matching using X-ray volumetric image (ⅩⅥ) system with the accelerator Elekta Synergy and to compare the matches with different methods and area.Methods A simulation plan using the head and neck phantom was designed and sent to ⅩⅥ system for CBCT scanning.During the scanning,the couch for certain distance was moved and the data of ⅩⅥ image automatic Matching in different matching methods and area was collected.Results The result of ⅩⅥ image automatic matching is consistent and correct to direction and distance which the couch had been moved (x:(0.11 ± 0.41) mm,y:(-0.04± 2.6) mm,z:(0.28 ± 0.74 mm)).There are not significant differences between the results that matching in different matching methods and different matching area.Conclusions The automatic image Matching of ⅩⅥ is accuracy and high reliability in recognition of offset error.But there are some significant differences on the automatic image Matching in different matching methods and different matching area.
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Objective To investigate the effect of bibliotherapy in soothing the postoperative pain in children and relieving the perioperative anxiety of children and their care givers. Methods Hospitalized children and their care givers from August 2007 to March 2009 were studied. 153 cases from August 2007 to May 2008 were assigned to the control group and the other 153 cases to the intervention group. Routine surgical nursing were applicated in the control group by introduction of perioperative nursing procedures.Bibliotherapy were applicated in the intervention group on the basis of the control group-using "bibliotherapy materials for hospitalized children" which was designed by ourselves and correspond with the theory of bibliotherapy to interfere in the 153 cases in the intervention group. The variance of preoperative anxiety of care givers and perceptions of postoperative pain of children between the two groups were compared with scales of mYPAS, STAI and FLACC and Wong- Baker Facial Scale. Results The scores of mYPAS in children of the intervention group and the control group was (35.875+4.441)and(46.796+8.606 )respectively and the variance was significant. The scores of STAI in care givers of the two groups was(38.125+4.371 )and (49.901 +7.420) respectively and revealed significant variance. The scores of Wong-Baker and FLACC in children of both groups 1 hour after operation were compared and revealed no statistical significance. The scores of Wong-Baker and FLACC in children at 6 hours and 24 hours postoperative were compared subjectively and objectively and revealed statistic significance. Conclusions Bibliotherapy can ameliorate the anxiety level of both children and their care givers, relieve the perception of postoperative pain in children and improve their comforts. Bibliotherapy thus conduces to the recovery of postoperative children.