Objective To evaluate the autocontouring accuracy using the atlas-based autosegmentation of CT images for head-and-neck cancer.Methods Ten head and neck patients with contours were selected.Two groups of autocontouring atlas were tested,the first group was for patients with own atlas,for the second group we tested the autocontouring of eight patients with other two patients atlas.Dice similarity coefficient (DSC) and overlap index (OI) were introduced to evaluate the autocontours,and the discrepancy between the two groups was evaluated through paired t-test.Results Both the DSC and OIof all the organs in the first group were ＞0.80,the result of mandible was the highest ( ＞0.91 ),the DSC of the gross tumor volume (GTV) was the lowest (0.81 ),the OI of the GTV was 0.82,and the DSC and OI of the clinical target volume (node) were 0.82 and 0,79,respectively.Only the risk organ was delineated in the second group,and spinal cord and brain stem were combined to analyze.All the DSC was about 0.70,and the DSC and OI of mandible were higher than the others,which was due to its bone anatomy.The accuracy in the second group was significantly lower than that of the first group ( t =3.24 - 8.26,P =0.014 -0.000),except the right parotid (t=2.08,P=0.075).Conclusions Automatic segmentation generates contours of sufficient accuracy for adaptive planning intensity-modulated radiotherapy (IMRT) to accommodate anatomic changes during treatment.For convention planning IMRT normal structure auto-contouring,it need to select more standard atlas in order to acquire a satisfied autocontours.

Objective To study the expression of Survivin protein and its relation with the expression of Bcl-2, Bax in the tropho- blasts of human normal placenta. Methods The normal placental tissues (8 -9week ,18-23 week and 37-40week) were fixed, embed- ded, sectioned, and Survivin, Bcl-2, and Bax in the trophoblasts were detected with immunnohistochemistry. Result As the gestational age advanced , the staining intensity of Survivin in the trophoblasts was significantly decreased from the first trimester group to the second trimes- ter group to the term group (PU value: 11.74±0.8,9.95±0.43,8. 83 ~ O. 67, respectively, P <0.01 ), while the staining intensity of Bcl-2 and Bax in trophoblast was significantly increased (PU value of Bcl-2 : 4.33±0.60, 5.00±0.75,6.87±0.45, respectively, P<0.01 and PU value of Bax: 9.82±1.12,16.00±1.05,27.48±2.10, respectively, P <0.01 ). Expression of Survivin in trophoblasts has no rela- tionship with the expression of Bcl-2 and Bax (P>0.05 ). Conclusion Survivin may take part in the development of human normal pla- centa through the way of suppressing the apoptesis in trophoblasts. Expression of Survivin in trophoblasts has no relationship with the expres- sion of Bcl-2 and Bax, which indicate that they regulate apoptesis of trophoblasts via different biological pathways.

Objective To scrutinize the positioning accuracy and reproducibility of the cone-beam computed tomography system in combination with the six-degree couch table (Hexapod Robot Treatment Table, HRTT). Methods The mechanical stability of the X-ray volume imaging (XVI) system was tested,in terms of the reproducibility. And the influence of the moveable parts, including the KV panel and the source arm, on the accuracy of the XVI image registration was analyzed. The accuracy between the bone and grey value registration was compared using a head-and-neck phantom. The accuracy of the HRTT for translational, rotational, and a combination of translational and rotational corrections was investigated in consecutive measurements. Results The performance of XVI system itself was stable with translational and rotational error of below 0. 4 mm and below 0. 3°, respectively. The mean position accuracy of the XVI system in combination with the HRTT summarized over all measurements was below 0. 6 mm and below 0. 4° for translational and rotational corrections, respectively. The grey value match was more accurate than the bone match. Conclusions The XVI image acquisition and registration procedure were highly reproducible.Both translational and rotational positioning errors can be corrected very precisely with the HRTT. The HRTT is therefore well suited to complement CBCT to take full advantage of position correction in six degrees of freedom for image guided radiotherapy.

Objective To test and evaluate the geometric accuracy of delineation of organs at risk ( OARs) in head and neck cancer using an atlas?based autosegmentation ( ABAS) software. Methods The atlases for the ABAS software was generated using images from 40 patients with head and neck cancer undergoing intensity?modulated radiotherapy. The software was tested in 40 new patients. Automatic delineation of OARs was carried out on computed tomography images by single?( one to one ) and multi?template ( ten to one) approaches. In order to evaluate the feasibility of the automatic delineation in clinical application, differences in volume (ΔV%), position (Δx,Δy, andΔz), conformability (sensitivity ( Se ), specificity ( Sp ) , and dice similarity coefficient ( DSC) ) , and delineation time were assessed between the automatic and manual delineation. The comparison between the two automatic delineation approaches was made by paried t test. Results For all OARs, the multi?template automatic delineation achieved a significantly smaller mean ΔV% value and a significantly larger mean DSC value than the single?template automatic delineation (-0.02%± 0?29% vs. -0.16%± 0?41%, P<0?05;0.74± 0?16 vs. 0.68± 0?20, P<0?05);the position differences between two automatic delineation approaches were less than 0?4 cm in all three directions except for the temporal lobe, lower jaw, and spinal cord;in the receiver operating characteristic curve defined by Se versus 1-Sp , the data points were all within the first quadrant except for the optic nerve and chiasm;automatic delineation saved 42%?72% of time compared with manual delineation. Conclusions The ABAS software achieves satisfactory results of automatic delineation for most of OARs in patients with head and neck cancer. The multi?template automatic delineation, particularly, has better outcomes than the single?template one. In addition, it greatly shortens the time the clinicians spend on delineation of OARs.

Objective To explore the measurement of(1,3)-β-D glucan in plasma for the diagnosis of pulmonary fungal infections in pulmonary tuberculosis patients. Methods 40 pulmonary tuberculosis patients with pulmonary fungal infections in Guangzhou chest hospital from January 2015 to December 2015 were enrolled as a test group,among which 35 were confirmed and 5 were suspected pulmonary fungal infections. 52 pulmonary tuber-culosis patients without fungal infections were selected as a control group.(1,3)-β-D glucan content(G test)in this 92 patients plasma were detected. The results of G tests were compared with those from etiological diagnosis to assess the performance of G test. Results 13 strains of candida albicans,13 strains of aspergillus,2 strains of candida tropicalis,2 strains of candida glabrata and 6 strains of other yeast were obtained from patients of test group,but no fungal identified from those of control group. The median of G test in test group and in control group was 126.1 and 29.56 pg/mL,respectively,the level in test group was significantly higher than that in control group (P<0.001). 35 cases were identified as positive and 5 were negative in test group by G test ,while 41 cases were identified as negative and 11 were positive in control group. The sensitivity,specificity,positive predictive value, negative predictive value ,concordance and Youden index of G test were 87.5%,78.85%,76.09%,89.13%, 82.6%and 0.663,respectively. Conclusions Candida albicans and aspergillus are more common pathogens than the other fungi isolated from pulmonary tuberculosis patients with pulmonary fungal infection. G test ,used in pul-monary tuberculosis with pulmonary fungal infections diagnosis,is reliable and fast,and has a higher sensitivity, specificity and accuracy.

ObjectiveTo learn the rpoB mutation difference in rifampicin/rifabutin cross-resistant (RIF/Rfb-R)clinical isolates and in rifampicin-resistant/rifabutin-susceptible (RIF-R/Rbo-S)clinical isolates of Mycobacterium tuberculosis.Methods To sequence the full-length genome of rpoB gene,and analyze the rpoB full-length gene mutation differences in 278 RIF/Rfb-R clinical isolates,40 RIF-R/Rfb-S clinical isolates,30 rifampicin-susceptible/rifabutin-susceptible (RIF-S/Rfb-S) and in 1 reference strain ofH37Rv.ResultsNo mutations of rpoB full-length gene were found in H37Rv reference strain and RIF-S/Rfb-S clinical isolates.In RIF/Rfb-R clinical isolates,531 (70.5％ ) and 526 (20.9％ ) were the most frequent mutation codons.223 (80.2％ ) isolates possesed single mutations as S531L,S531W,H526D,H526Y,H526R,Q513K,Q513P,Q510H,V176F,P287R,Y395C and H404Y.55 (19.8％) isolates had multiple mutations,and among these the S531L,H526 R,H526Y,H526D,D516G and Q513K were the main substitutions which were in combination with other points.In RIF-R/Rfb-S clinical isolates,516 (65.0％),526 ( 17.5％ ) and 533 ( 10.0％ ) were the most frequent mutation codons.21 (52.5％ ) isolates possesed single mutations as L533P,H526L,H526S,S522L,D516V,D516Y and D516F.19 (47.5％)isolates had multiple mutations and among these the D516V and L533P were the main substitutions which were in combination with other points.CondusionsIn our study,100％ rifamycin-resistant clinical isolates of Mycobacterium tuberculosis had rpoB mutations,but the mutations in RIF/Rfb-R clinical isolates were sharply different from RIF-R/Rfb-S clinical isolates in mutation positions or amino acids substitutions of single mutations strains,mutation positions or combination types and the most frequently mutation codons or amino acids substitutions of multiple mutations strains.Thus,DNA sequencing is instructive and meaningful to choose rifampicin or rifabutin for tuberculosis treatment.

Objective To investigate and analyze the positioning accuracy of three imaging modalities utilized in image-guided radiotherapy (IGRT):electronic portal imaging device ( EPID),kV portal image (kV planar) and the kV cone beam computed tomography (CBCT).Methods 25 groups of setup errors were simulated on the phantom images through treatment planning system. Digitally reconstructed radiographs (DRRs) were constructed from the CT data which were subsequently used as references to register the EPID and kV planar images acquired at the original position.In addition,the reconstructed 3D-CT images were used to register the CBCT images.Finally,the setup errors using several registration methods were measured to investigate and compare the accuracies of the three imaging modalities used for patient setup.Results 675 groups of residual errors were analyzed.All combinations of imaging modalities and registration method were found to be accurate.The mean residual errors in three directions were less than 1 mm.The method based on grey value match of CBCT images was found as the most accurate with an uncertainty below 0.1 mm.When the manual match was used,the performance of kV planar was more accurate than that of EPID (residual error ＜ 0.65 mm).If automatic registration was applied,kV planar generated similar results as EPID did. Conclusions The three available imaging modalities and their corresponding registration methods are all competent for the clinical application of IGRT in our department.Considering the image quality,radiation dose and the accuracy of registration,CBCT has the priority on 1GRT followed by the kV planar.

Objective To explore six-degree-of-freedom (6-DF) registration methods between planning and cone beam computed tomography (CBCT) during image-guided radiation therapy (IGRT) in esophageal cancer.Methods Thirty pairs of CBCT images acquired before radiation and the corresponding planning computed tomography (CT) images of esophageal cancer were selected for further investigation.Registration markers for 6-DF image registration were determined and contoured in those images.The results of registration as well as time cost were compared among different registration methods of bone match, gray value match, manual match, and bone plus manual match.Results Contouring bone and spinal canal posterior to the target volume of esophageal carcinoma as registration marker could make 6-DF registration quick and precise.Compared with manual match, set-up errors of v rotation in bone plus manual match (-0.55° vs.-0.88°, t=2.55, P=0.020), of x-axis and v rotation in bone match (0.12 mm vs.-2.33 mm, t=5.75, P=0.000; -0.35° vs.-0.88°, t=3.00, P=0.007), and of x-axis and w rotation in gray value match (7.20 mm vs.-2.33 mm, t=3.10, P=0.006; -0.10° vs.-0.59°, t=2.81, P =0.011) were significantly different.Compared with manual match, the coincidence rate of bone plus manual match was the highest (85.55%), followed by bone match and gray value match (74.45% and 74.45%).The time cost of each registration method from longest to shortest was:6.00 -10.00 minutes for manual match, 1.00 - 5.00 minutes for bone plus manual match, 0.75 - 1.50 minutes for gray value match, and 0.50 - 0.83 minutes for bone match.Conclusions Registration marker is useful for image registration of CBCT and planning CT in patients with esophageal cancer.Bone plus manual match may be the best registration method considering both registration time and accuracy.

Objective To compare the static intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for mid and upper thoracic esophageal cancer.Method The data of twenty esophageal cancer patients were retrospectively re-planned with VMAT(single arc and double arcs) modality using Pinnacle treatment plan system.Five of these patients were selected again to simulate single arc plans with different segment intervals (4°,3°,2°) and re-planned on other treatment planning systems (Monaco and MasterPlan).Differences of dose distribution and treatment parameters were compared.Results In comparison to IMRT and single-VMAT (S-VMAT),Double-VMAT (D-VMAT) significantly improves the dosimetric parameters for targets(P ＜ 0.05),dose homogeneity(P ＜ 0.05) and conformity(P ＜ 0.05).Though VMAT plans were slightly better than IMRT in reducing the doses to the organs at risk (OARs),no advantage was observed in the low-dose protection of lung and E-P (P ＜ 0.05).For the VMAT plans with different segment intervals,lower OAR doses were observed using an interval of 2°(P ＜ 0.05),except for the mean dose of the heart.For the VMAT plans on different treatment planning systems,Monaco-based plans protected OARs better (P ＜ 0.05).The number of monitor units (MU) and treatment time were less in VMAT cases.Conclusions VMAT plans perform better in target coverage,dose homogeneity and conformity,and can reduce the radiation dose to the spinal cord,lungs,heart and other normal tissue than IMRT plans.The VMAT plan quality could be further improved by using double arcs and smaller segment interval.Monaco-based plans provide better OAR protections under the same conditions of physical and optimization parameters.

Background and purpose:Currently, subjective questionaire is the most frequently used methods to evaluate swallowing dysfunctions after radiotherapy in nasopharyngeal carcinoma patients, while lacking of effective objective examinations. This study aimed to explore effective methods to evaluate swallowing dysfunctions after radiotherapy in nasopharyngeal carcinoma patients, and gain knowledge of the incidence and severity of swallowing dysfunctions. Methods: From Oct. 2013 to Dec. 2013, 128 consecutive outpatients with previously treated nasopharyngeal carcinoma received esophageal barium lfuoroscopy examination at there regularly follow-ups to evaluate swallowing function. Among these patients, 89 were primary treated with intensity modulated radiation therapy (IMRT) and 39 with conventional radiotherapy (CRT). In this study, each patient received esophageal barium lfuoroscopy examination for 3 times with thin, thick and pasty barium and were dynamically observed using X-ray fluoroscopy from front and lateral direction. Swallowing dysfunctions were defined as follows:①The bolus could not be swallowed and blocked in the mouth;②The dilute barium diverted to the glottis or trachea;③Residual barium delayed in the pyriform sinus and vallecula;④The movement of the hyoid bone or epiglottis were restricted;⑤Bolus prolong through the pharynx;⑥Barium slowed down when went though the esophageal entrance. Results:Of the 128 patients, incidence of dysphagia was 60.2%for the entire cohort, 52.8%for IMRT group and 76.9%for CRT group. Incidence of dysphagia for IMRT group was signiifcantly lower than CRT group (P=0.018). Dysphagia incidence within 1 year, 1 to 2 years and more than 2 years after RT were 63.1%, 33.3%and 69.0%, respectively (P=0.019). Conclusion:There was a high incidence of swallowing dysfunction for the nasopharyngeal carcinoma patients treated with radiotherapy and dysphagia incidence decreased when treated with IMRT. Esophageal barium lfuoroscopy examination is objective method to evaluate the incidence and severity of the swallowing dysfunction.