Computed tomography (CT) has been widely used in clinical diagnosis and made a great contribution to diagnosis by providing anatomical information with high-resolution.However,when metal implants exist in patients' body,reconstructed CT images are seriously interfered by metal artifacts.Metal artifacts are usually expressed as many dark and bright radiant streak artifacts which seriously reduce diagnosis reliability and bring errors into the calculation of dose distribution in radiotherapy.Therefore,the study of metal artifact reduction (MAR)is of great importance.This article reviews main methods on MAR developed in recent years,and give deep analysis on some of the methods.

With the improvement of the complexity of medical image synthesis and the demand for the accuracy of clinical radiotherapy, deep learning algorithm plays an increasingly important role in pseudo CT image synthesis and analysis. This paper classifies and analyzes the pseudo CT image synthesis technology based on deep learning method in terms of the types of image modes, and describes the ongoing application in radiotherapy.

More and more patients were treated by surgery with metal implants in clinic.Metal artifacts in CT images caused by metal implants brought challenges for postoperative evaluation and diagnosis of tumor.It also led to the possibility of missed diagnosis and misdiagnosis.In recent decades,the improved methods based on filtered-backprojection and iterative reconstruction algorithms have great progresses in reducing effects of metal artifacts.The actuality of techniques for metal artifact reduction were reviewed in this article.

Intensity-modulated radiation therapy is widely used in the treatment of tumor,and the dose distribution highly conforms to tumor target area in three-dimension.However,the factors such as complex beam,data error,algorithm error and machine error may cause large dose deviation in intensity-modulated radiation therapy,which may lead to unnecessary radiation accident.Therefore,standing on the patients' safety point of view,dose verification is usually performed before executing the treatment plan in order to ensure the safe implementation of the treatment plan and to avoid un-planned irradiation dose.Currently,there are many tools and methods of dose verification in clinic,including point dose verification tools like finger-shaped ionization chamber and thermoluminescence dosimeter;two-dimensional dose verification tools like Mapcheck,MatriXX and films;three-dimensional dose verification tools like ArcCHECK,Delta4 and the third-party software.These common clinical dose verification methods are reviewed in this paper.

Objective To study the detective sensitivity for position of multi-leave collimators ( MLC) using Delta-4. Methods First,the small positional deviation of MLC was simulated and measured using the linac (Varian,Trubeam) equipped with EPID.Then,two beam fields 2. 0 cm (x)×6. 0 cm (y), 7. 0 cm (x)×6. 0 cm (y) were designed,the x1 and x2 of MLC were expanded 0. 1 mm,0. 2 mm,0. 3 mm... 0. 9 mm and 1. 0 mm,2. 0...5. 0 mm to external simultaneously,different parameters of 3 mm/3%,2. 5 mm/2. 5%,2 mm/2%, 1. 5 mm/1. 5% and 1 mm/1% were used in Gamma analysis to analyze the difference between dose distribution detected by Delta-4 and original dose distribution with unexpanded MLC position derived from TPS. Results For 2. 0 cm ( x) × 6. 0 cm ( y) beam field, the pass rate of original dose distribution was 100%,and that decreased to 95. 5% when x1 ,x2 of MLC were expanded 0. 3 mm to external, and decreased to 89. 4% when expanded 0. 5 mm at 2. 5 mm/2. 5% statistical standards. For 7. 0 cm ( x) × 6. 0 cm ( y) beam field,the pass rate of original dose distribution was 96. 5%,and that decreased to less than 95% when x2,x2 of MLC were expanded 0. 3 mm to external,and passing rate was above 90% when MLC expanded less than 0. 5 mm at 1. 5 mm/1. 5% statistical standards. Conclusions For MLC' s positional deviation in decimillimeter level,raise standards of Gamma analysis properly may improve the capability of Delta-4 for detecting small positional deviation,but it won' t detect all the positional deviation of MLC in decimillimeter level. For different size of beam field,it is proposed to use different analytical standards for Delta-4.

Objective To study the percentage depth dose difference (PDD) between Monte Carlo method and the measurement method.Methods Based on the detail treatment head structure designing by the manufacture,the BEAMnrc Monte Carlo code was used to simulate the 6 MV photon beams of a Siemens Primus linear accelerator.DOSXYZnrc program generated 6 MV X-ray parameters such as PDD,and it was measured by MP3 three-dimensional water of PTW corporation phantom.The deviation of PDD was calculated using formulas ((measured value-simulation algorithm value)/measured value × 100％).Results Distance from the surface of the water was less than 1.2 cm,the deviation of PDD was ＞ 2％.Distance from the surface greater than 1.2 cm,the deviation of PDD was ＜ 2％.Conclusion In the built-up areas,PDD obtained by the Monte Carlo simulation algorithm is more accurate.

manual beam orientation selection, beam orientation optimization which is feasible in IMRT planning may significantly improve the efficiency and result.

Objective To reconstruct 16?bit images of metal implants using the extended function of computed tomography ( CT) imaging, and to analyze the effect of the metal CT value on calculation of dose distribution by evaluation of metal CT values in different scanning conditions. Methods A stainless steel rod and a titanium rod were inserted in a phantom. The 12?and 16?bit images and CT value distribution of metal implants were obtained by scanning the phantom using 120 kV tube voltage and 230 mA tube current. The 16?bit images and CT value distribution of metal implants were obtained by scanning the phantom using fixed tube current ( 230 mA) with varied tube voltage ( 100, 120, and 140 kV) or fixed tube voltage ( 120 kV) with varied tube current ( 180, 230, and 280 mA) . In the Varian treatment planning system, a single?field plan and a parallel?opposed field plan were designed based on the CT images. The dose distribution was calculated and compared by the paired t test. Results The CT values of the stainless steel rod and the titanium rod were both 3 071 HU in 12?bit CT images. In 16?bit CT images;however, the CT value of the stainless steel rod was significantly larger than that of the titanium rod. There were no significant differences in CT value of 16?bit image and dose distribution in radiotherapy plan between three scanning conditions with different tube currents. Under three scanning conditions with different tube voltages, the maximum CT values were 13 568, 13 127, and 12 295 HU for the stainless steel rod and 8 420, 7 140, and 6 310 HU for the titanium rod, respectively. Conclusions High?density metal implants cannot be distinguished by 12?bit images, while the distribution of metal CT value can be obtained by 16?bit images. The dose distribution of metal implants based on 12?bit images is different from that based on 16?bit images. Changes in tube voltage cause substantial changes in the CT value for metal implants, leading to changes in dose distribution in radiotherapy. Variation of tube current within a certain range causes slight changes in metal CT value and dose distribution.

Objective To study the radioseusitization effect of gold nanoparticles modified by sodium glycididazole.Methods The sodium glycididazole was connected to gold nanoparticle,in dimension of about 18 nm,that had been modified with polyethylene glycol.The nanoparticle-swallowing efficiency of lung adenocarcinoma A549 cells was observed by a scanning electron microscope.Cells were divided into four groups:sodium glycididazole group,gold nanoparticles group,sodium glycididazole-gold nanoparticles group,and no drug control group.The radiosensitivity was detected by MTT and colony formation assays.Results Sodium glycididazole-gold nanoparticles could enter the cell cytoplasm and nucleus.The concentration of 0.003 mg/ml gold nanoparticles and sodium glycididazole-gold nanoparticles had no obvious cytotoxic effect.After irradiation of 2,4,6,8 Gy,the cell survival of the sodium glycididazole-gold nanoparticle group was significantly lower than that of the other three groups (F =4.8,14.5,5.7,7.6,P ＜0.05) and the D0 and Dq values of the sodium glycididazole-gold nanoparticle group were significantly lower than those of other three groups.Conclusion Sodium glycididazole-gold nanoparticles can enhance the radiosensitivity of lung adenocarcinoma cells.

Objective To investigate the impact on registration accuracy with the different registration ranges of CBCT images and CT images.Methods CBCT and CT scans were performed on the of 5 patients.The registration ranges of five patients' images of abdomen,head and chest performed CBCT and CT scanning were processed with four modes.Mode 1:the registration range of CT images was larger than the registration range of CBCT images,mode 2:the registration range of CT images and CBCT images were equally,mode 3:taking a 5 cm translation of CT images range from mode 2,mode 4:The CBCT range and CT range reduced 2 cm both sides simultaneously from mode 2.Using the registration program from Insight Segmentation and Registration Toolkit (ITK) to the four modes,the Mean Square Difference (MSD) metric values of four modes after registration were compared and the relationship between mode 2 and another three modes was analyzed by paired t test.Results For the MSD metric values,mode 3 was maximum,mode 2 and 4 were minimum,and mode 1 was centered.The difference between the mode 2 and mode 4 was not statistically significant(P ＞ 0.05).The difference between the mode 2 and mode 1 was statistically significant(t =-4.586,-4.164,-5.618,P ＜ 0.05).The difference between the mode 2 and mode 3 was statistically significant(t =-6.423,-8.109,-19.601,P＜0.05).Conclusion The registration ranges of CBCT and CT images has a certain extent of influence on the accuracy of image registration.The closer the registration range of CBCT and CT is,the higher the registration accuracy is.