Objective To explore the effect of the Jaw‐tracking with RapidArc(JT‐RapidArc) plans for upper thoracic e‐sophageal cancer .Methods Treatment planning was designed by using RapidArc and JT‐RapidArc techniques for 11 consecutive patients .The dose‐volume histogram parameters of PTV and the organs at risk ,conformity index(CI) ,heterogeneity index(HI) , low dose volume of normal tissue (B‐P ) and monitor units (MU ) were compared between the different techniques . Results Compared with the RapidArc plan ,JT‐RapidArc had increased coverage of PTV1(64) D98 and HI(P<0 .05) ,lower Dmean , D2 of PTV1(64) and PTV2(54) ,but no statistically difference in CI(P>0 .05) .Plans with JT‐RapidArc had lower Lung(V5 ,V10 , V13 ,V20 ,V30 ,Dmean ,P<0 .05) ,heart(V20 ,Dmean ,P<0 .05) ,and B‐P(V5 ,V10 ,V15 ,V20 ,V30 ,P<0 .05) ,but no significantly different in spinal cord and SC‐PRV as compared with RapidArc plans(P>0 .05) .JT‐RapidArc plans increaseed the MU by 1% (349 ± 29 vs .345 ± 16 ,P>0 .05) as compared with RapidArc plans .Conclusion All of the plans had met the requirements of clinical dosime‐try .JT‐RapidArc plans as compared with RapidArc plans ,showing better part of target coverage ,part of lung and heart and B‐P sparing ,which MU was slightly increased .

Objective To compare IMSure QA and MatriXX for intensity modulated radiotherapy plans,and to investigate the credibility of IMSure QA software.Methods Ten patients receiving intensity modulated radiotherapy were randomly chosen for the quality assurance plans with IMSure QA and MatriXX.Results The overall average of percentage pass points in 3％ and 3 mm were (98.1 ± 0.8) ％ with IMSure QA,and (97.9 ±0.6)％ with MatriXX(t =0.86,P ＞0.05).Conclusion IMSure QA can be a reliable verification tool for IMRT QA.

Objective To perform a routine quality assurance procedure for Truebeam multi-leaf collimator (MLC) using MLC quality assurance (QA) phantom,verifying the reliability of MLC during the treatment.Methods MLC QA phantom was a specialized phantom for multi-leaf collimator QA,and contained five radio-opaque spheres that were embedded in an L-shape.The phantom was placed isocentrically on the Truebeam treatment couch for the tests.A quality assurance plan was settled up in the Eclipse v10.0 so that the fields for acquiring the necessary images could be created.The images were acquired by the electronic portal imaging device (EPID),and imported into the PIPSpro software for the analysis.The tests were delivered once a week for six weeks to verify consistency of the delivery,and the images were acquired in the same manner each time.Results For the leaf position test,the average position error was (0.21 ± 0.02) mm.The leaf width was measured at the isocenter,and the average error was (0.04±0.02) mm for the leaf width test.Multi-Port test showed the dynamic leaf shift error,the average error was (0.26 ± 0.04) mm.For the leaf transmission test,the average inter-leaf leakage value was 1.0％ ± 0.14％.Conclusions The MLC system of Truebeam could operate very well and the QA phantom is a useful test tool for the MLC QA.

Objective To compare the dosimetric differences of volumetric modulated arc therapy (VMAT) for preoperative radiotherapy of rectal cancer using 6MV X-ray flattening filter-free (FFF) and flattening filter (FF) modes.Methods FF-VMAT and FFF-VMAT plans were designed for 15 rectal cancer patients with preoperative radiotherapy by planning treatment system (Eclipse 10.0),respectively.Prescription dose of PTV was 50 Gy in 25 fractions.When the plans were normalized to 50 Gy to 95 ％ of PTV,the dose volume histogram (DVH),target and risk organ doses,conformity indexes (CI),homogeneity indexes (HI),low dose volume of normal tissue (B-P),monitor units (MU) and treatment time (TT) were compared between the two kinds of plans.Results FF-VMAT provided the lower Dmean,V105,HI (P ＜ 0.05),and higher CI (P ＜ 0.05) compared with FFF-VMAT.Small intestine (D5),Bladder (D5,Dmean V40,V50),L-femoral head (V40),R-femoral head (Dmean) were lower in FF-VMAT than those in FFF-VMAT (P ＜ 0.05).FF-VMAT had higher B-P (V5) compared with FFF-VMAT (P ＜ 0.05).FF-VMAT reduced the monitor units (MU) by 21％ (382±53 vs 483±26,P ＜ 0.05),as well as the treatment time (TT) in FF-VMAT was no significant difference compared with that in FFF-VMAT [(148±4) s vs (146±3) s,P ＞ 0.05)].Conclusions The qualities of FF-VMAT and FFF-VMAT plans were comparable and both clinically acceptable.When comparing two plans,FF-VMAT showed better target coverage and some of OARs sparing.The MUs of FFF-VMAT were higher than those of FF-VMAT,yet were not delivered within the same time.

Objective To evaluate the dosimetric characteristics of base dose plan compensation (BDPC) optimization method applied on the intensity-modulated radiotherapy (IMRT) for upper esophageal carcinoma,based on the Eclipse treatment planning system.Methods Nineteen patients were included.For each case initial IMRT plan was generated and further optimized respectively by the two following methods:the BDPC method and hot and cold spot control (HCSC) method.Then the BDPC and HCSC plans were compared concerning planning-target-volume (PTV) coverage,conformity index (CI),and homogeneity index (HI),as well as organ-at-risk (OAR) sparing,planning time,monitor unit (MU) and delivery time.Results Compared with the HCSC plans,the BDPC plans provided superior CI and HI (Z =-3.662,-3.745,P ＜ 0.05),as well as lower D2％ (near-maximum dose) (Z =-3.823,P ＜ 0.05) and comparable D98％ (near-minimum dose) (P ＞ 0.05) for PTV64 (high-risk PTV),and provided superiorCI (Z=-3.340,P＜0.05),lower D95％ and D98％ (Z=-3.582,-2.616,P＜0.05) for PTV54 (low-risk PTV).The BDPC plans also provided slightly lower doses to the spinal cord and lung compared with the HCSC plans (Z =-3.625--3.369,P ＜ 0.05).Moreover,the planning time [(26.05 ±0.88) min] for BDPC plans was less than that of the HCSC plans [(33.73 ± 3.24) min] (Z =-3.823,P ＜0.05).The MU of the BDPC plans (1 019 ± 167) was higher than that of the HCSC plans (1 003 ±159) (Z=-2.616,P＜0.05),while the delivery time [(3.52 ±0.29) min] was more than that of the HCSC plans [(3.50±0.28) min] (Z=-2.548,P＜0.05).Conclusions The BDPC optimization method can significantly improve target dose homogeneity and conformity with effective reduction of the dose to OARs for upper esophageal carcinoma.Moreover,it is simple and can improve the treatment planning efficiency.

Objective:To investigate the application of modified Hanley surgery in abscess of anal tube space (AATS), and its influences on anal function, interleukin (IL)-8 and IL-6.Methods:The clinical data of 96 patients with AATS from February 2020 to February 2022 in Shaoxing Central Hospital were retrospectively analyzed. Among them, 48 patients were treated with incision-thread drawing procedure (ITDP group), and 48 patients were treated with modified Hanley group (modified Hanley group). The curative effect, anal function, inflammatory factor level, neovascularization factor level and wound healing status were compared between the two groups.Results:There was no significant difference in the recovery rate between modified Hanley group and ITDP group: 100.00% (48/48) vs. 95.83% (46/48), χ2 = 0.51, P>0.05. The poor rate of anal function 2 months after surgery in modified Hanley group was significantly lower than that in ITDP group: 0 vs. 12.50% (6/48), and there was statistical difference ( P<0.05). The tumor necrosis factor-α(TNF-α), IL-8 and IL-6 24 h after surgery in modified Hanley group were significantly lower than those in ITDP group: (127.11 ± 13.96) ng/L vs. (160.59 ± 11.57) ng/L, (92.20 ± 11.62) ng/L vs. (124.33 ± 12.05) ng/L and (79.38 ± 12.47) ng/L vs. (100.07 ± 12.50) ng/L, and there were statistical differences ( P<0.01). The monocyte chemotactic protein-1 1 week after surgery in modified Hanley group was significantly lower than that in ITDP group: (92.85 ± 14.63) ng/L vs. (122.90 ± 15.59) ng/L, the vascular endothelial growth factor-A and transforming growth factor-β 1 were significantly higher than those in ITDP group: (188.06 ± 22.53) ng/L vs. (137.80 ± 19.52) ng/L and (1 897.6 ± 97.3) ng/L vs. (1 608.6 ± 98.1) ng/L, and there were statistical differences ( P<0.01). The pain score, edema score and neonatal granulation score 7, 14 and 21 d after surgery in modified Hanley were significantly lower than those in ITDP group, and there were statistical differences ( P<0.01). Conclusions:In the treatment of AATS, the modified Hanley surgery not only contributes to the thorough removal of the lesions, but also plays a positive role in protecting the anal function, reducing the level of inflammation, and promoting the recovery of endothelial function.

Objective:To explore the clinical efficacy of small incision floating line drainage for the treatment of high perianal abscess.Methods:A retrospective analysis was conducted on the clinical data of 95 patients with high perianal abscess treated at the Medical Community General Hospital of Shaoxing Central Hospital from April 2019 to April 2021. Among them, 47 cases were treated with small incision floating line drainage (experimental group), and 48 cases were treated with conventional multi incision drainage (control group). The surgical time, intraoperative bleeding, postoperative pain, urination status, anal function evaluation, wound healing status and the clinical efficacy of the patient after 2 months of treatment were compared between the two groups.Results:The surgical time, intraoperative bleeding volume in the experimental group were lower than those in the control group: (18.70 ± 0.48) min vs. (38.10 ± 2.52) min, (32.35 ± 3.56) ml vs. (51.56 ± 6.24) ml, there were statistical differences ( P<0.05). The postoperative pain, urination status, anal function evaluation in the experimental group were better than those in the control group. In the experimental group, multiple incision drainage had a greater impact on patients and the wound healing cycle was longer. After treatment for 2 months, the total effective rate in the experimental group was better than that in the control group: 100.00%(47/47) vs. 91.67%(44/48), there was statistical difference ( χ2 = 4.09, P<0.05). Conclusions:Patients with high perianal abscess and treated with small incision floating line drainage has a shorter wound healing cycle, less pain, lower anal damage, and better clinical efficacy.