Objective To compare the ExacTrac X-ray and CBCT image guide system for the head and neck cancer patients in radiotherapy. Methods Twenty head and neck cancer patients were randomly chosen and divided two Group. In group A ( 10 patients) ,the cross X-ray radiation photos were matched with the DRR after positioning with the infrared markers. Obtain the setup errors on three directions and rotation errors. Then adjustment of error with 6D treatment bed,record time set-up and registration. In group B ( 10 patients) ,the CBCTimages were matched with reference CT data after manual positioning. Obtain the setup errors on three directions and around the vertical axis direction errors. Then adjustment of error,record the time of set-up and registration. Groups were compared using the paired t-test. Results For group A and B group,the translation errors were (0.59±0. 25) mm,(0.62±0. 25) mm,(1.56±0. 28) mm,and (0.52± 0. 31) mm,(0.74±0. 17) mm,(1.58±0. 34) mm on horizontal,vertical,up-down directions,respectively (P=0.43,0.21,0.90).For group A,the rotation errors were (0.54±0.17)°,(0.72±0.27)°,(0.44± 0. 22)°,respectively;with (1.26±0. 33)°on vertical directions on B group (P=0. 01).The time of set-up registration on group A was significantly less than group B ( 108. 0 s vs . 165. 8 s , P= 0. 00 ) . Conclusions For the head and neck cancer patients in raditherapy,the image guide systems is feasible. The rotation errors of ExacTrac X-ray slightly less than CBCT.The time of set-up and registration of ExacTrac X-ray significantly less than CBCT,but the image resolution of ExacTrac X-ray inferior for CBCT.

Objective To study the impact of respiratory frequency and amplitude of patients with the thoracic or abdomen tumor on 4DCT' s reconstructed image.Methods 75 thoracic or abdomen tumor patients who performed a scanning with belly belt-type respiratory gating on 4DCT between November 2012 to March 2013 in our hospital were retrieved.Reviewed their respiratory frequency,amplitude and fault distance of 4DCT' s reconstructed image and analyzed the correlation fault distance of the reconstructed image.The correlation analysis was used by bivariate Spearman method.Results Among these reconstructed images,fault distance more than 6 mm could be seen in 11 cases,fault distance ranging from 3 mm to 6 mm could be found in 46 cases,and distance less than 3 mm could be detected in 18 case.Respiratory frequency correlated significantly with the amplitude (rs =0.369,P =0.000);the respiratory rate had a tight association with the fault distance of the reconstructed image (r,=0.273,P=0.018);and respiratory amplitude was associated obviously with the fault distance of the reconstructed image (r,=0.696,P=0.000).Conclusions Both 4DCT reconstructed image and respiratory amplitude are significantly correlated to the continuity of the respiratory frequency.The smaller the respiratory frequence and amplitude change are,the better continuity will be.

Objective To study the ExacTrac X-ray image guide system for patients with head and neck cancer.Methods Ten patients were chosen foe this study.It was immoblized using the head mask and frame fixtures.The two KV X-ray units were matched with the digitally reconstructed radiographs after positioning with the infrared markers.Then the setup errors on x (horizontal axis),y (vertical axis) and z (up-down) directions and rotation errors were obtained.Paired t-test between any two direction difference errors.Results The setup errors with ExacTrac X-ray image guide system for the patients in x,y,z directions and rotation errors were (0.57 ± 0.24) mm,(0.68 ± 0.19) mm,(1.54 ± 0.29) mm,(0.54 ±0.13) °,(0.60 ± 0.23) °,(0.51 ± 0.15) °.The z-axis direction have slightly larger error (P =0.02,0.01).The others have not statistical significance (P =0.06,0.10-0.41).Conclusions To use ExacTrac X-ray image guide system cooperating with the six degree of freedom treatment couch in image guided radiotherapy for is feasible,the motion errors ＜ 2 mm,the rotation errors ＜ 2°.Reduced of the setup errors with replace the sphere or to reduce pollution of the sphere,improve the accuracy,it could provide a better quality assurance in radiation therapy.

Objective To compare the dosimetric parameters between the use of Tandem and Ring (TR;Nucletron#090.617) or Tandem and Ovoid (TO;Nucletron#189.730) applicators during three-dimensional (3D) high-dose rate (HDR) brachytherapy (BT) for cervical cancer.Methods The records of 40 cervical cancer (ⅡB-ⅣA) patients treated with 3D-image-guided HDR-BT were reviewed.Of these 40 patients, 20 were treated with the TO applicator, and 20 with the TR applicator.The D100% and V150% of the clinical target volume (CTV) and the D2 cc of organs at risk (OAR)(the rectum, bladder, and small intestine) during 3D-HDR-BT using TO and TR were compared using the independent sample t-test.ResultsOverall metrics:CTV volume:66.04±13.86 cm3(TR) vs.65.67±15.08 cm3(TO)(P=0.052);CTV D100:3.71±0.34 Gy (TR) vs.3.37±0.49 Gy (TO)(P=0.016);CTV V150%:0.54±0.02(TR) vs.0.56±0.04(TO)(P=0.034);rectum D2 cc:3.38±0.30 Gy (TR) vs.2.95±0.80 Gy (TO)P=0.037);bladder D2 cc:4.33±0.39 Gy (TR) vs.2.93±1.27 Gy (TO)(P=0.00);and small ntestine D2 cc:3.04±1.02 Gy (TR) vs.3.41±0.57 Gy (TO)(P=0.171).Conclusions TR has better CTV coverage than TO during 3D HDR brachytherapy for cervical cancer.In addition, D2 cc of the rectum and bladder were both igher with TR than with TO, though there is no significant dosimetric difference in the small intestine between the two applicators.Therefore, tumor location, extent of invasion, and vaginal conditions should be considered when selecting the suitable pplicator for the treatment of cervical cancer.

Objective To investigate the effect of CYP3A5 and MDR1 gene polymorphisms on blood concentration of tacrolimus and creatinine level in uremic patients during the early phase after kidney transplantation in real clinical practice. Methods 131 patients who underwent kidney transplantation for the first time with triple immunotherapy based on tacrolimus in single-center from 2013 to 2017 were enrolled for retrospective study. Tacrolimus daily dose, blood concentration, blood concentration-to-dose ratio, and serum level were compared according to the various genotypes of CYP3A5 and MDR1 polymorphisms in renal transplantation recipients, respectively. Results The dosage of tacrolimus in CYP3A5*3/*3 (GG) kidney transplantation recipients within 4 weeks after kidney transplantation was lower than those of CYP3A5*1/*1 (AA) and CYP3A5*1/*3 (AG). The serum creatinine levels of patients whose tacrolimus concentration in the range of 10-13 ng/ml were close to the normal value. Conclusion CYP3A5 gene polymorphism affects the blood concentrations of tacrolimus in renal transplant recipients. No association has been found between the blood concentrations of tacrolimus and MDR1 gene polymorphism. Tacrolimus concentration in the range of 10-13 ng/ml might contribute to restore the early kidney graft function.

Objective To compare set?up error and the positioning and error correction time between the infrared markers automatic positioning+ ExacTrac ( A) and the manual positioning+ cone?beam computed tomography ( CBCT) image?guided radiotherapy ( IGRT) ( B) in intensity?modulated radiotherapy ( IMRT) for lung cancer. Methods A total of 20 patients with lung cancer were randomly divided into Group A and Group B. In Group A, after automatic positioning, a group of orthogonal X?rays images were taken using kV X?rays, which matched digitally reconstructed radiographs to obtain errors before correction. In group B, after manual positioning, images were taken using CBCT, which matched reference computed tomography images to obtain errors before correction. The positioning and error correction time was recorded in both groups. After error correction, errors after correction were obtained in each group using IGRT. Between?group comparison was made using the paired t test. Results The errors in lateral, longitudinal, vertical, and spinning vertical directions were significantly reduced after correction in both Group A and B (A:1.8±1?3 vs. 0.4±0?1, P=0?000;2.7±1?9 vs. 0.5±0?1, P=0?000;2.8±1?7 vs. 0.4±0?1, P=0?000;1.6±1?0 vs. 0.3±0?9, P=0?000;B:2.6±1?9 vs. 0.5±0?5, P=0?000;3.1±2?5 vs. 0.6±0?6, P=0?000;2.1±1?8 vs. 0.5±0?5, P=0?000;0.9±0?7 vs. 0.3±0?1, P=0?000). There were no significant differences in errors after correction between Group A and Group B (0.4±0?1 vs. 0.5±0?5, P=0?204;0.5±0?1 vs. 0.6± 0?6, P=0?257;0.4± 0?1 vs. 0.5± 0?5, P=0?518;0.3± 0?9 vs. 0.3± 0?1, P=0?755 ) . However, the positioning and error correction time in Group A was significantly shorter than that in Group B (199.1±16?2 vs. 315.2±13?7, P=0?000). Conclusions The application of ExacTrac or CBCT IGRT can substantially reduce set?up errors and improve set?up accuracy in IMRT. In addition, the application of the ExacTrac system can substantially shorten the positioning and error correction time.

Objective To observethe clinical efficacy of comprehensive acupuncture treatment in treating primary open-angle glaucoma, and to objectively evaluate the therapeutic efficacy.Method Twenty-eight patients (53 eyes) who received acupuncture treatment were recruited. By adopting a self-control design, the changes of intraocular tension, mean defect (MD) of vision field, mean sensitivity (MS), vision, and score of Quality of Life Scale for Patients with Visual Impairment (QLSPVI) were observed after 3-month acupuncture treatment.ResultThe intraocular tension of the 28 patients declined obviously after the treatment (P<0.01); MD, MS and vision didn't show significant improvements after the treatment (P>0.05); the QLSPVI score dropped significantly after the treatment (P<0.01);the total effective rate was 86.8%; the therapeutic efficacy wasn't correlated with age, disease duration, and treatment duration (P>0.05).Conclusion Acupuncture treatment can effectively reduce the intraocular tension, control the deterioration of MD and MS, maintain the level of vision, and enhance the quality of life of patients with primary open-angle glaucoma; with the same disease duration, the longer the treatment, the better the therapeutic efficacy.

Objective:To compare the difference between active breathing coordinator (ABC) technique and free breathing (FB) mode combined with bodyfix stereotactic radiotherapy (SBRT) for chest tumors.Methods:40 thoracic tumor patients receiving SBRT were randomly selected and divided into the ABC technique group and FB model group. After fixation with bodyfix fixing devices in two groups, cone-beam CT (CBCT) scan images before each SBRT were matched with the plan reference images. The setup errors in the left-right (LR), superior-inferior (SI) and anterior-post (AP) directions were obtained. Then, the setup errors were corrected. SBRT was performed and split intra-fraction CBCT was conducted simultaneously, which was repeated until the end of treatment.Results:In the ABC technique group, the setup errors in the LR, SI and AP directions were (0.25±0.21) cm, (0.28±0.21) cm, and (0.21±0.24) cm, significantly less compared with (0.31±0.22) cm, (0.32±0.21) cm and (0.37±0.23) cm in the FB model group (all P<0.05). The V 30Gy of the heart, the V 20Gy and V 30Gy of the lung in the ABC technique group were significantly less than those in the FB model group (0.31%∶7.35%; 24.5%∶32.9%; 19.5%∶25.8%, all P<0.05). Conclusions:ABC technique combined with bodyfix fixation device may be superior to FB mode in SBRT for chest tumors, which remains to be validated by subsequent studies with large samples.

Objective To compare the accuracy of blood volume perfusion imaging (perfusion CT)with contrast enhanced 64-slice spiral computed tomography (CECT) in the evaluation of gross tumor volume (GTV) and clinical target volume (CTV) using rabbits with VX2 brain tumor. Methods Perfusion CT and CECT were performed in 20 rabbits with VX2 brain tumor. The GTV and CTV calculated with the maximal and minimal diameter of each tumor in the blood volume (BV) maps and CECT were measured and compared to those in pathological specimens. Results The mean value of the maximal and minimal diameter of GTV was (8.19 ± 2. 29) mm and (4.83 ± 1.31) mm in pathological specimens, (11.98 ±3.29) mmand (7.03±1.82) mm in BV maps, while (6.36±3.85) mm and (3.17±1.93) mm in CECT images, which were significantly different (pathological specimen vs. BV map, t = 7. 17,P =0. 000;pathological specimen vs. CECT, t = 8.37, P = 0. 000, respectively). The mean value of the maximal and minimal diameter of CTV in pathologic specimens was (12.87 ± 3.74) mm and (7.71 ± 2. 15) mm, which was significantly different from that of GTV and CTV in CECT (t = - 3. 18, P = 0. 005 and t = - 4. 24, P =0. 000;t= -11.59,P=0.000 and t= -9.39,P=0.000), while similar with that of GTV in BV maps (t = - 1.95,P = 0. 067; t = - 2. 06, P = 0. 054). For CECT, the margin from GTV to CTV was 81.83% ±40.33% for the maximal diameter and 276.73% ± 131.46% for the minimal. While for BV maps, the margin was 7.93% ± 17. 84% and 12.52% ± 27. 83%, which was significant different from that for CECT images (t=7.36,P=0. 000 and t= -8.78,P=0.000). Conclusions Compared with CECT, the BV map from 64-slice spiral CT peffusion imaging might have higher accuracy in target volume delineation for brain tumor.

Objective To develop double-arc volumetric modulated arc therapy ( VMAT) plans using standard phantom and standard target volume in AAPM119 report, and to investigate the dosimetric parameters of Agility and MLCi2 leafs according to the requirements for target dose in AAPM119 report. Methods The Cshape, Head and Neck, Prostate, and Multitarget structures for standard target volume delineation in AAPM119 report were used.The Elekta Agility multi-leaf collimator was used to develop plans, and then with other parameters remaining unchanged, Elekta MLCi2 was used for plan optimization and dose calculation.The target dose in AAPM119 report was used as the standard to analyze the differences in target volume and dose-volume parameters of organs at risk between the four structures for target volume delineation.Results According to the mean dose in AAPM119 report, in the Cshape, Head and Neck, and Multitarget target volumes, the radiotherapy plans developed with Agility had better dosimetric parameters compared with those developed with MLCi2.In the prostate target volume, the radiotherapy plans developed with MLCi 2 had better dosimetric parameters compared with those developed with Agility .Conclusions With the structures for target volume delineation, plan designing personnel, designing parameters, and evaluation criteria remaining the same, Elekta Agility can achieve the dose target better than Elekta MLCi2 in the aspect of strict dose limit.