Currently there are many unanswered questions concerning contouring a target with PET/CT in radiotherapy planning. Who should contour the PET volume-the radiation oncologist or the nuclear medicine physician? Which f...Currently there are many unanswered questions concerning contouring a target with PET/CT in radiotherapy planning. Who should contour the PET volume-the radiation oncologist or the nuclear medicine physician? Which factors will contribute to the dual-observer variability between them? What should be taken as the optimal SUV threshold to demarcate a malignant tumor from the normal tissue? When the PET volume does not coincide with the local area CT findings, which portion should be contoured as the target? If a reginal lymph node,draining area or a remote region is shown to be PET positive but CT negative, or PET negative but CT positive, how is the target identified and selected? Further studies concerning the relationship between PET/CT and the cancerous tissue are needed. The long-term clinical results showing an increased therapeutic ratio will finally verify the applicability of guidelines to contour the target with PET/CT in radiotherapy planning.展开更多
Intensity-modulated particle therapy(IMPT)with carbon ions is comparatively susceptible to various uncertainties caused by breathing motion,including range,setup,and target positioning uncertainties.To determine relat...Intensity-modulated particle therapy(IMPT)with carbon ions is comparatively susceptible to various uncertainties caused by breathing motion,including range,setup,and target positioning uncertainties.To determine relative biological effectiveness-weighted dose(RWD)distributions that are resilient to these uncertainties,the reference phase-based four-dimensional(4D)robust optimization(RP-4DRO)and each phase-based 4D robust optimization(EP-4DRO)method in carbon-ion IMPT treatment planning were evaluated and compared.Based on RWD distributions,4DRO methods were compared with 4D conventional optimization using planning target volume(PTV)margins(PTV-based optimization)to assess the effectiveness of the robust optimization methods.Carbon-ion IMPT treatment planning was conducted in a cohort of five lung cancer patients.The results indicated that the EP-4DRO method provided better robustness(P=0.080)and improved plan quality(P=0.225)for the clinical target volume(CTV)in the individual respiratory phase when compared with the PTV-based optimization.Compared with the PTV-based optimization,the RP-4DRO method ensured the robustness(P=0.022)of the dose distributions in the reference breathing phase,albeit with a slight sacrifice of the target coverage(P=0.450).Both 4DRO methods successfully maintained the doses delivered to the organs at risk(OARs)below tolerable levels,which were lower than the doses in the PTV-based optimization(P<0.05).Furthermore,the RP-4DRO method exhibited significantly superior performance when compared with the EP-4DRO method in enhancing overall OAR sparing in either the individual respiratory phase or reference respiratory phase(P<0.05).In general,both 4DRO methods outperformed the PTV-based optimization in terms of OAR sparing and robustness.展开更多
Optimization of the inverse planning becomes critical because it follows the invention of intensity modulated radiotherapy(IMRT) to shorten the previous "trial-and-error" treatment process and increase effic...Optimization of the inverse planning becomes critical because it follows the invention of intensity modulated radiotherapy(IMRT) to shorten the previous "trial-and-error" treatment process and increase efficiency.In this paper, the inverse planning is used to direct aperture optimization in the ARTS(Accurate/Advanced Radiotherapy System). The objective function was quadratic, both tolerance and dose-volume constraint types are supported. The memory efficient conjugate gradient algorithm is used to cope with its large data.Furthermore, to fully exploit the solution space, a shortest path sub-procedure is coupled into the whole algorithm, thus giving further possibility decreasing the objective function. Two clinical cases are tested, indicating that the applicability of this algorithm is promising to clinical usage.展开更多
Aim: This study aims to evaluate the difference between depth data from an intraoral cone and a conventional irradiation tube calculated using a treatment planning system (TPS), and that measured using an intraoral co...Aim: This study aims to evaluate the difference between depth data from an intraoral cone and a conventional irradiation tube calculated using a treatment planning system (TPS), and that measured using an intraoral cone for electron radiotherapy. Background: A TPS is only compatible with conventional irradiation tubes. However, such systems are not suitable for determining dose distributions when a special cone is employed. Materials and Methods: Dose distributions were calculated using the beam data for mounted intraoral cones using a TPS. Then, the dose distribution by field size was calculated for a low-melting-point lead alloy using the beam data for a mounted conventional tube. The calculated data were evaluated against the measured intraoral-cone depth data based on the dose and depth differences. Results: The calculated data for the intraoral cone case did not match the measured data. However, the depth data obtained considering the field size determined for the lead alloy using the conventional tube were close to the measured values for the intraoral cone case. The difference in the depth at which the absorbed dose was 50% of the maximum value of the percentage depth dose was less than ±4 mm for the generalized Gaussian pencil beam convolution algorithm and less than ±1 mm for the electron Monte Carlo algorithm. Conclusion: It was found that the measured and calculated dose distributions were in agreement, especially when then electron Monte Carlo algorithm was used. Thus, the TPS can be employed to determine dose distributions for intraoral cone applications.展开更多
<strong>Introduction:</strong> Radiotherapy alone or combined with surgery and/or chemotherapy is being investigated in the treatment of malignant pleural mesothelioma (MPM). This study aimed to simulate a...<strong>Introduction:</strong> Radiotherapy alone or combined with surgery and/or chemotherapy is being investigated in the treatment of malignant pleural mesothelioma (MPM). This study aimed to simulate a Volumetric Modulated Arc Therapy (VMAT) treatment of a patient with MPM. <strong>Materials and Methods:</strong> CT images from a patient with intact lungs were imported via DICOM into the Pinnacle3 treatment planning (TP) system (TPS) and used as a model for MPM to delineate organs at risk (OAR) and both clinical and planning target volumes (CTV and PTV) with a margin of 5 mm. Elekta Synergy with 6 MV photons and 80 leafs MLCi2 was employed. VMAT plans were generated using two coplanar arcs with gantry rotation angles of 178<span style="font-family:Verdana, Helvetica, Arial;white-space:normal;background-color:#FFFFFF;">°</span> - 182<span style="font-family:Verdana, Helvetica, Arial;white-space:normal;background-color:#FFFFFF;">°</span>, the collimator angles of each arc were set to 90<span style="font-family:Verdana, Helvetica, Arial;white-space:normal;background-color:#FFFFFF;">°</span>, Octavius<span style="white-space:nowrap;"><sup>®</sup></span> 4D 729 was employed for quality assurance while the calculated and measured doses were compared using VeriSoft. <strong>Results:</strong> A TP was achieved. The Gamma volume analysis with criteria of 3 mm distance to agreement and 3% dose difference yielded the gamma passing rate = 99.9%. The reference isodose was 42.75 Gy with the coverage constraints for the PTV D95 and V95 = 95.0% of 45 Gy. The remaining dosimetric parameters met the recommendations from the clinically acceptable guidelines for the radiotherapy of MPM. <strong>Conclusion:</strong> Using well-defined TV and VMAT, a consistent TP compared to similar ones from publications was achieved. We obtained a high agreement between the 3D dose reconstructed and the dose calculated.展开更多
Introduction: Field-in-Field (FIF) and Intensity Modulated Radiation Therapy (IMRT) are two advanced radiation therapy planning techniques. Both of them are being used to achieve the same two related aims which are, t...Introduction: Field-in-Field (FIF) and Intensity Modulated Radiation Therapy (IMRT) are two advanced radiation therapy planning techniques. Both of them are being used to achieve the same two related aims which are, to expose the targeted tumor to the full radiation dose and to spare the nearby normal tissues (or organs) from being exposed to high amounts of radiation more than its tolerance dose limits. FIF is a forward planning while IMRT is an inverse planning and FIF is a forward IMRT. Aim: The purpose of this study was to compare between Field-in-Field and IMRT techniques in prostate cancer radiotherapy. Method: A treatment planning system supporting both inverse and forward planning facilities is used. Ten prostate cancer patients were planned with both FIF and IMRT planning techniques. Doses received by the Planning Target Volume (PTV) and Organs at Risk (OARs) were compared in the two methods quantitatively from Dose Volume Histograms (DVHs) and qualitatively from (axial cuts). Results: The results showed that the IMRT planning technique achieved better dose coverage to the PTV than the FIF planning technique but, except RT and LT Femoral Heads, FIF achieved a better protection to the Rectum and the Bladder (OARs) than IMRT. Conclusions: The results showed that the inverse planning based IMRT technique is better and recommended in the prostate cancer radiotherapy than the FIF technique.展开更多
Objective:To explore the impact of the application and implementation of risk-based cancer care planning in patients with cervical cancer radiotherapy on the complications and self-care ability of patients.Method:This...Objective:To explore the impact of the application and implementation of risk-based cancer care planning in patients with cervical cancer radiotherapy on the complications and self-care ability of patients.Method:This study recruited selected patients who came for cervical cancer radiotherapy in a tertiary hospital in Xianyang City,Shaanxi Province from November 2020 to November 2021.One hundred patients were recruited.Nursing management was carried out,and cancer care planning under the concept of conventional care and risk were applied.The effects of different nursing methods on patients were compared and analyzed.Results:The patients in the experimental group had higher scores of self-care ability and lower complication rate.All data were significantly different from those of the control group(P<0.05),and the nursing effect on the experimental group was better.Conclusion:The application and implementation of the risk-based cancer care planning in patients who received cervical cancer radiotherapy has significant clinical effects,which is beneficial to reduce the incidence of patients’adverse reactions and promote patient recovery.展开更多
AIM: To compare the volumetric-modulated arc ther- apy (VMAT) plans with conventional sliding window intensity-modulated radiotherapy (c-IMRT) plans in esophageal cancer (EC). METHODS: Twenty patients with EC ...AIM: To compare the volumetric-modulated arc ther- apy (VMAT) plans with conventional sliding window intensity-modulated radiotherapy (c-IMRT) plans in esophageal cancer (EC). METHODS: Twenty patients with EC were selected, including 5 cases located in the cervical, the upper, the middle and the lower thorax, respectively. Five plans were generated with the eclipse planning sys- tem: three using c-IMRT with 5 fields (5F), 7 fields (7F) and 9 fields (gF), and two using VMAT with a single arc (1A) and double arcs (2A). The treatment plans were designed to deliver a dose of 60 Gy to the plan-ning target volume (PTV) with the same constrains in a 2.0 Gy daily fraction, 5 d a week. Plans were normal- ized to 95% of the PTV that received 100% of the pre- scribed dose. We examined the dose-volume histogram parameters of PTV and the organs at risk (OAR) such as lungs, spinal cord and heart. Monitor units (MU) and normal tissue complication probability (NTCP) of OAR were also reported. RESULTS: Both c-IMRT and VMAT plans resulted in abundant dose coverage of PTV for EC of different Io- cations. The dose conformity to PTV was improved as the number of field in c-IMRT or rotating arc in VMAT was increased. The doses to PTV and OAR in VMAT plans were not statistically different in comparison with c-IMRT plans, with the following exceptions: in cervical and upper thoracic EC, the conformity index (CI) was higher in VMAT (1A 0.78 and 2A 0.8) than in c-IMRT (5F 0.62, 7F 0.66 and 9F 0.73) and homogeneity was slightly better in c-IMRT (7F 1.09 and 9F 1.07) than in VMAT (1A 1,1 and 2A 1.09), Lung V30 was lower in VMAT (1A 12.52 and 2A 12.29) than in c-IMRT (7F 14.35 and 9F 14.81). The humeral head doses were significantly increased in VMAT as against c-IMRT. In the middle and lower thoracic EC, CI in VMAT (1A 0.76 and 2A 0.74) was higher than in c-IMRT (5F 0.63 Gy and 7F 0.67 Gy), and homogeneity was almost similar between VMAT and c-IMRT. V20 (2A 21.49 Gy vs 7F 24.59 Gy and 9F 24.16 Gy) and V30 (2A 9.73 Gy vs 5F 12.61 Gy, 7F 11.5 Gy and 9F 11.37 Gy) of lungs in VMAT were lower than in c-IMRT, but low doses to lungs (V5 and Vl0) were increased. V30 (1A 48.12 Gy vs 5F 59.2 Gy, 7F 58.59 Gy and 9F 57.2 Gy), V40 and V50 of heart in VMAT was lower than in c-IMRT. MUs in VMAT plans were significantly reduced in comparison with c-IMRT, maximum doses to the spinal cord and mean doses of lungs were similar between the two techniques. NTCP of spinal cord was 0 for all cases. NTCP of lungs and heart in VMAT were lower than in c-IMRT. The advantage of VMAT plan was enhanced by doubling the arc. CONCLUSION: Compared with c-IMRT, VMAT, especial- ly the 2A, slightly improves the OAR dose sparing, such as lungs and heart, and reduces NTCP and MU with a better PTV coverage.展开更多
Background and Objective: In computed tomography (CT)-based radiotherapy planning for prostate cancer, it is difficult to precisely delineate the prostatic apex because of its relationship with the urogenital diaphrag...Background and Objective: In computed tomography (CT)-based radiotherapy planning for prostate cancer, it is difficult to precisely delineate the prostatic apex because of its relationship with the urogenital diaphragm and bulbospongiosus musculature. In this retrospective study, we analyzed the magnetic resonance imaging (MRI) and CT scans of the patients with prostate cancer to investigate the relationship between the prostatic apex and the anatomic structure visible on CT, and to provide evidence for localizing the prostatic apex in radiotherapy planning. Methods: MRI and CT scans of 108 patients with prostate cancer were analyzed to measure the distances between the prostatic apex and the bottom of ischial tuberosities, the bottom of obturator foramen, the bottom of pubic symphysis, and the bulb of the penis. The volume of the prostate was measured to analyze its relationship with the localization of the prostatic apex. Results: The prostatic apex was located (13.1 ± 3.3) mm above the bulb of the penis, (11.0 ± 5.4) mm above the bottom of the obturator foramen, (31.3 ± 5.5) mm above the ischial tuberosities, and (7.1 ± 4.7) mm above the bottom of the symphysis pubis. There was no correlation between the size of the prostate and the localization of the prostatic apex. Conclusions: The variance of the distance between the prostatic apex and the bulb of the penis is smaller than that of the distance between the apex and bony anatomy. Delineating the target to 6 mm above the bulb of the penis can cover the prostatic apex in 95% of the patients with prostate cancer, delineating to the bottom of obturator foramen can cover the prostatic apex in 100% of the patients.展开更多
Introduction: Intensity Modulated Radiation Therapy (IMRT) planning dose calculation process depends on IMRT dose constraints. So, if there was any structure along the treatment beam path not delineated, it would not ...Introduction: Intensity Modulated Radiation Therapy (IMRT) planning dose calculation process depends on IMRT dose constraints. So, if there was any structure along the treatment beam path not delineated, it would not be taken into account during that calculation process. During IMRT routine practical work, it is noticed that there are some non-delineated normal tissue volumes that received un-aimed dose. Aim: The purpose of this study was to study the effect of unusually delineated normal volumes in IMRT treatment for left sided breast cancer. Method: Ten left sided breast cancer patients were planned with IMRT inverse planning system. The unusually delineated normal volumes were delineated and taken into account in IMRT dose constraints as an Organ at Risk. Doses received by that volume were compared in the two methods quantitatively from Dose Volume Histograms (DVHs) and qualitatively from (axial cuts). Results: The results showed that doses received by the unusually delineated volume when they were delineated and taken into account in IMRT dose constraints were significantly higher than when they were not. Conclusions: The results showed that for IMRT planning technique used for treating left-sided breast cancer, all of the normal tissues/structures that are closed to the treatment targets must be delineated and taken into account in the IMRT planning dose constraints.展开更多
<strong>Purpose:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Radiotherapy is a widely accepted standard of care for early-sta...<strong>Purpose:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Radiotherapy is a widely accepted standard of care for early-stage prostate cancer, and it is believed that the plan quality and treatment outcome are associated with contour accuracy of both the target and organs-at-risk (OAR). The purposes of this study are to 1) assess geometric and dosimetric uncertainties due to inter-observer contour variabilities and 2) evaluate the effectiveness of geometric indicators to predict target dosimetry in prostate radiotherapy. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Twenty prostate patients were selected for this retrospective study. Five experienced clinicians created unique structure sets containing prostate, seminal vesicles, bladder, and rectum for each patient. A fully automated script and knowledge-based planning routine were utilized to create standardized and unbiased plans that could be used to evaluate changes in isodose distributions due to inter-observer variability in structure segmentation. Plans were created on a “gold-standard” structure set, as well as on each of the user-defined structure sets. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Inter-observer variability of contours during structure segmentation was very low for clearly defined organs such as the bladder but increased for organs without well-defined borders (prostate, seminal vesicles, and rectum). For plans generated with the user-defined structure sets, strong/moderate correlations were observed between the geometric indicators for target structure agreement and target coverage for both low-risk and intermediate-risk patient groups, while OAR indicators showed no correlation to final dosimetry. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Target delineation is crucial in order to maintain adequate dosimetric coverage regardless of the associated inter-observer uncertainties in OAR contours that had a limited impact upon final dosimetry.</span></span>展开更多
文摘Currently there are many unanswered questions concerning contouring a target with PET/CT in radiotherapy planning. Who should contour the PET volume-the radiation oncologist or the nuclear medicine physician? Which factors will contribute to the dual-observer variability between them? What should be taken as the optimal SUV threshold to demarcate a malignant tumor from the normal tissue? When the PET volume does not coincide with the local area CT findings, which portion should be contoured as the target? If a reginal lymph node,draining area or a remote region is shown to be PET positive but CT negative, or PET negative but CT positive, how is the target identified and selected? Further studies concerning the relationship between PET/CT and the cancerous tissue are needed. The long-term clinical results showing an increased therapeutic ratio will finally verify the applicability of guidelines to contour the target with PET/CT in radiotherapy planning.
基金supported by National Key Research and Development Program of China(No.2022YFC2401503)National Natural Science Foundation of China(Nos.11875299,61631001,U1532264,and 12005271).
文摘Intensity-modulated particle therapy(IMPT)with carbon ions is comparatively susceptible to various uncertainties caused by breathing motion,including range,setup,and target positioning uncertainties.To determine relative biological effectiveness-weighted dose(RWD)distributions that are resilient to these uncertainties,the reference phase-based four-dimensional(4D)robust optimization(RP-4DRO)and each phase-based 4D robust optimization(EP-4DRO)method in carbon-ion IMPT treatment planning were evaluated and compared.Based on RWD distributions,4DRO methods were compared with 4D conventional optimization using planning target volume(PTV)margins(PTV-based optimization)to assess the effectiveness of the robust optimization methods.Carbon-ion IMPT treatment planning was conducted in a cohort of five lung cancer patients.The results indicated that the EP-4DRO method provided better robustness(P=0.080)and improved plan quality(P=0.225)for the clinical target volume(CTV)in the individual respiratory phase when compared with the PTV-based optimization.Compared with the PTV-based optimization,the RP-4DRO method ensured the robustness(P=0.022)of the dose distributions in the reference breathing phase,albeit with a slight sacrifice of the target coverage(P=0.450).Both 4DRO methods successfully maintained the doses delivered to the organs at risk(OARs)below tolerable levels,which were lower than the doses in the PTV-based optimization(P<0.05).Furthermore,the RP-4DRO method exhibited significantly superior performance when compared with the EP-4DRO method in enhancing overall OAR sparing in either the individual respiratory phase or reference respiratory phase(P<0.05).In general,both 4DRO methods outperformed the PTV-based optimization in terms of OAR sparing and robustness.
基金Supported by National Natural Science Foundation(No.81101132)Natural Science Foundation of Anhui Province(No.11040606Q55)
文摘Optimization of the inverse planning becomes critical because it follows the invention of intensity modulated radiotherapy(IMRT) to shorten the previous "trial-and-error" treatment process and increase efficiency.In this paper, the inverse planning is used to direct aperture optimization in the ARTS(Accurate/Advanced Radiotherapy System). The objective function was quadratic, both tolerance and dose-volume constraint types are supported. The memory efficient conjugate gradient algorithm is used to cope with its large data.Furthermore, to fully exploit the solution space, a shortest path sub-procedure is coupled into the whole algorithm, thus giving further possibility decreasing the objective function. Two clinical cases are tested, indicating that the applicability of this algorithm is promising to clinical usage.
文摘Aim: This study aims to evaluate the difference between depth data from an intraoral cone and a conventional irradiation tube calculated using a treatment planning system (TPS), and that measured using an intraoral cone for electron radiotherapy. Background: A TPS is only compatible with conventional irradiation tubes. However, such systems are not suitable for determining dose distributions when a special cone is employed. Materials and Methods: Dose distributions were calculated using the beam data for mounted intraoral cones using a TPS. Then, the dose distribution by field size was calculated for a low-melting-point lead alloy using the beam data for a mounted conventional tube. The calculated data were evaluated against the measured intraoral-cone depth data based on the dose and depth differences. Results: The calculated data for the intraoral cone case did not match the measured data. However, the depth data obtained considering the field size determined for the lead alloy using the conventional tube were close to the measured values for the intraoral cone case. The difference in the depth at which the absorbed dose was 50% of the maximum value of the percentage depth dose was less than ±4 mm for the generalized Gaussian pencil beam convolution algorithm and less than ±1 mm for the electron Monte Carlo algorithm. Conclusion: It was found that the measured and calculated dose distributions were in agreement, especially when then electron Monte Carlo algorithm was used. Thus, the TPS can be employed to determine dose distributions for intraoral cone applications.
文摘<strong>Introduction:</strong> Radiotherapy alone or combined with surgery and/or chemotherapy is being investigated in the treatment of malignant pleural mesothelioma (MPM). This study aimed to simulate a Volumetric Modulated Arc Therapy (VMAT) treatment of a patient with MPM. <strong>Materials and Methods:</strong> CT images from a patient with intact lungs were imported via DICOM into the Pinnacle3 treatment planning (TP) system (TPS) and used as a model for MPM to delineate organs at risk (OAR) and both clinical and planning target volumes (CTV and PTV) with a margin of 5 mm. Elekta Synergy with 6 MV photons and 80 leafs MLCi2 was employed. VMAT plans were generated using two coplanar arcs with gantry rotation angles of 178<span style="font-family:Verdana, Helvetica, Arial;white-space:normal;background-color:#FFFFFF;">°</span> - 182<span style="font-family:Verdana, Helvetica, Arial;white-space:normal;background-color:#FFFFFF;">°</span>, the collimator angles of each arc were set to 90<span style="font-family:Verdana, Helvetica, Arial;white-space:normal;background-color:#FFFFFF;">°</span>, Octavius<span style="white-space:nowrap;"><sup>®</sup></span> 4D 729 was employed for quality assurance while the calculated and measured doses were compared using VeriSoft. <strong>Results:</strong> A TP was achieved. The Gamma volume analysis with criteria of 3 mm distance to agreement and 3% dose difference yielded the gamma passing rate = 99.9%. The reference isodose was 42.75 Gy with the coverage constraints for the PTV D95 and V95 = 95.0% of 45 Gy. The remaining dosimetric parameters met the recommendations from the clinically acceptable guidelines for the radiotherapy of MPM. <strong>Conclusion:</strong> Using well-defined TV and VMAT, a consistent TP compared to similar ones from publications was achieved. We obtained a high agreement between the 3D dose reconstructed and the dose calculated.
文摘Introduction: Field-in-Field (FIF) and Intensity Modulated Radiation Therapy (IMRT) are two advanced radiation therapy planning techniques. Both of them are being used to achieve the same two related aims which are, to expose the targeted tumor to the full radiation dose and to spare the nearby normal tissues (or organs) from being exposed to high amounts of radiation more than its tolerance dose limits. FIF is a forward planning while IMRT is an inverse planning and FIF is a forward IMRT. Aim: The purpose of this study was to compare between Field-in-Field and IMRT techniques in prostate cancer radiotherapy. Method: A treatment planning system supporting both inverse and forward planning facilities is used. Ten prostate cancer patients were planned with both FIF and IMRT planning techniques. Doses received by the Planning Target Volume (PTV) and Organs at Risk (OARs) were compared in the two methods quantitatively from Dose Volume Histograms (DVHs) and qualitatively from (axial cuts). Results: The results showed that the IMRT planning technique achieved better dose coverage to the PTV than the FIF planning technique but, except RT and LT Femoral Heads, FIF achieved a better protection to the Rectum and the Bladder (OARs) than IMRT. Conclusions: The results showed that the inverse planning based IMRT technique is better and recommended in the prostate cancer radiotherapy than the FIF technique.
文摘Objective:To explore the impact of the application and implementation of risk-based cancer care planning in patients with cervical cancer radiotherapy on the complications and self-care ability of patients.Method:This study recruited selected patients who came for cervical cancer radiotherapy in a tertiary hospital in Xianyang City,Shaanxi Province from November 2020 to November 2021.One hundred patients were recruited.Nursing management was carried out,and cancer care planning under the concept of conventional care and risk were applied.The effects of different nursing methods on patients were compared and analyzed.Results:The patients in the experimental group had higher scores of self-care ability and lower complication rate.All data were significantly different from those of the control group(P<0.05),and the nursing effect on the experimental group was better.Conclusion:The application and implementation of the risk-based cancer care planning in patients who received cervical cancer radiotherapy has significant clinical effects,which is beneficial to reduce the incidence of patients’adverse reactions and promote patient recovery.
基金Supported by The National Natural Science Foundation of China, No. 30870738
文摘AIM: To compare the volumetric-modulated arc ther- apy (VMAT) plans with conventional sliding window intensity-modulated radiotherapy (c-IMRT) plans in esophageal cancer (EC). METHODS: Twenty patients with EC were selected, including 5 cases located in the cervical, the upper, the middle and the lower thorax, respectively. Five plans were generated with the eclipse planning sys- tem: three using c-IMRT with 5 fields (5F), 7 fields (7F) and 9 fields (gF), and two using VMAT with a single arc (1A) and double arcs (2A). The treatment plans were designed to deliver a dose of 60 Gy to the plan-ning target volume (PTV) with the same constrains in a 2.0 Gy daily fraction, 5 d a week. Plans were normal- ized to 95% of the PTV that received 100% of the pre- scribed dose. We examined the dose-volume histogram parameters of PTV and the organs at risk (OAR) such as lungs, spinal cord and heart. Monitor units (MU) and normal tissue complication probability (NTCP) of OAR were also reported. RESULTS: Both c-IMRT and VMAT plans resulted in abundant dose coverage of PTV for EC of different Io- cations. The dose conformity to PTV was improved as the number of field in c-IMRT or rotating arc in VMAT was increased. The doses to PTV and OAR in VMAT plans were not statistically different in comparison with c-IMRT plans, with the following exceptions: in cervical and upper thoracic EC, the conformity index (CI) was higher in VMAT (1A 0.78 and 2A 0.8) than in c-IMRT (5F 0.62, 7F 0.66 and 9F 0.73) and homogeneity was slightly better in c-IMRT (7F 1.09 and 9F 1.07) than in VMAT (1A 1,1 and 2A 1.09), Lung V30 was lower in VMAT (1A 12.52 and 2A 12.29) than in c-IMRT (7F 14.35 and 9F 14.81). The humeral head doses were significantly increased in VMAT as against c-IMRT. In the middle and lower thoracic EC, CI in VMAT (1A 0.76 and 2A 0.74) was higher than in c-IMRT (5F 0.63 Gy and 7F 0.67 Gy), and homogeneity was almost similar between VMAT and c-IMRT. V20 (2A 21.49 Gy vs 7F 24.59 Gy and 9F 24.16 Gy) and V30 (2A 9.73 Gy vs 5F 12.61 Gy, 7F 11.5 Gy and 9F 11.37 Gy) of lungs in VMAT were lower than in c-IMRT, but low doses to lungs (V5 and Vl0) were increased. V30 (1A 48.12 Gy vs 5F 59.2 Gy, 7F 58.59 Gy and 9F 57.2 Gy), V40 and V50 of heart in VMAT was lower than in c-IMRT. MUs in VMAT plans were significantly reduced in comparison with c-IMRT, maximum doses to the spinal cord and mean doses of lungs were similar between the two techniques. NTCP of spinal cord was 0 for all cases. NTCP of lungs and heart in VMAT were lower than in c-IMRT. The advantage of VMAT plan was enhanced by doubling the arc. CONCLUSION: Compared with c-IMRT, VMAT, especial- ly the 2A, slightly improves the OAR dose sparing, such as lungs and heart, and reduces NTCP and MU with a better PTV coverage.
文摘Background and Objective: In computed tomography (CT)-based radiotherapy planning for prostate cancer, it is difficult to precisely delineate the prostatic apex because of its relationship with the urogenital diaphragm and bulbospongiosus musculature. In this retrospective study, we analyzed the magnetic resonance imaging (MRI) and CT scans of the patients with prostate cancer to investigate the relationship between the prostatic apex and the anatomic structure visible on CT, and to provide evidence for localizing the prostatic apex in radiotherapy planning. Methods: MRI and CT scans of 108 patients with prostate cancer were analyzed to measure the distances between the prostatic apex and the bottom of ischial tuberosities, the bottom of obturator foramen, the bottom of pubic symphysis, and the bulb of the penis. The volume of the prostate was measured to analyze its relationship with the localization of the prostatic apex. Results: The prostatic apex was located (13.1 ± 3.3) mm above the bulb of the penis, (11.0 ± 5.4) mm above the bottom of the obturator foramen, (31.3 ± 5.5) mm above the ischial tuberosities, and (7.1 ± 4.7) mm above the bottom of the symphysis pubis. There was no correlation between the size of the prostate and the localization of the prostatic apex. Conclusions: The variance of the distance between the prostatic apex and the bulb of the penis is smaller than that of the distance between the apex and bony anatomy. Delineating the target to 6 mm above the bulb of the penis can cover the prostatic apex in 95% of the patients with prostate cancer, delineating to the bottom of obturator foramen can cover the prostatic apex in 100% of the patients.
文摘Introduction: Intensity Modulated Radiation Therapy (IMRT) planning dose calculation process depends on IMRT dose constraints. So, if there was any structure along the treatment beam path not delineated, it would not be taken into account during that calculation process. During IMRT routine practical work, it is noticed that there are some non-delineated normal tissue volumes that received un-aimed dose. Aim: The purpose of this study was to study the effect of unusually delineated normal volumes in IMRT treatment for left sided breast cancer. Method: Ten left sided breast cancer patients were planned with IMRT inverse planning system. The unusually delineated normal volumes were delineated and taken into account in IMRT dose constraints as an Organ at Risk. Doses received by that volume were compared in the two methods quantitatively from Dose Volume Histograms (DVHs) and qualitatively from (axial cuts). Results: The results showed that doses received by the unusually delineated volume when they were delineated and taken into account in IMRT dose constraints were significantly higher than when they were not. Conclusions: The results showed that for IMRT planning technique used for treating left-sided breast cancer, all of the normal tissues/structures that are closed to the treatment targets must be delineated and taken into account in the IMRT planning dose constraints.
文摘<strong>Purpose:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Radiotherapy is a widely accepted standard of care for early-stage prostate cancer, and it is believed that the plan quality and treatment outcome are associated with contour accuracy of both the target and organs-at-risk (OAR). The purposes of this study are to 1) assess geometric and dosimetric uncertainties due to inter-observer contour variabilities and 2) evaluate the effectiveness of geometric indicators to predict target dosimetry in prostate radiotherapy. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Twenty prostate patients were selected for this retrospective study. Five experienced clinicians created unique structure sets containing prostate, seminal vesicles, bladder, and rectum for each patient. A fully automated script and knowledge-based planning routine were utilized to create standardized and unbiased plans that could be used to evaluate changes in isodose distributions due to inter-observer variability in structure segmentation. Plans were created on a “gold-standard” structure set, as well as on each of the user-defined structure sets. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Inter-observer variability of contours during structure segmentation was very low for clearly defined organs such as the bladder but increased for organs without well-defined borders (prostate, seminal vesicles, and rectum). For plans generated with the user-defined structure sets, strong/moderate correlations were observed between the geometric indicators for target structure agreement and target coverage for both low-risk and intermediate-risk patient groups, while OAR indicators showed no correlation to final dosimetry. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Target delineation is crucial in order to maintain adequate dosimetric coverage regardless of the associated inter-observer uncertainties in OAR contours that had a limited impact upon final dosimetry.</span></span>