Objective To explore the effects of improvements on setup error ( SE ) and clinical target ( CTV ) margin of supraclavicular field ( SCF ) by using moisture-cured resin cushion and breast bracket for lower neck fixation in breast cancer patients who underwent post-mastectomy radiotherapy. Methods Totally 13 patients with breast cancer who underwent post-mastectomy radiotherapy were enrolled. All patients were immobilized by breast bracket and moisture-cured resin cushion. Firstly, each patient′s lower neck and head was fixed well by moisture-cured resin cushion, filling the gap between the neck and breast bracket. Secondly,each patient underwent the cone-beam CT ( CBCT) at the first, tenth and twentieth treatment after positioning. Then these CBCT images were registered to the planning CT to determine setup errors in translational and rotational directions, and SCF CTV margins by the systematic and random errors were evaluated. Results The setup errors in x (left-right), y (superior-inferior), z (anterior-posterior) translational directions were (2. 16 ± 1. 25), (1. 50 ± 1. 28), (1. 94 ± 1. 12) mm and (1. 76 ±1. 87)°, (1. 82 ±1. 12)°, (0. 99 ±0. 58)°, respectively in θ (pitch degree),Ф(roll degree),ψ( yaw degree) rotational directions. Non-parametric rank test ( Mann-Whitney U test) was performed with previous data, the differences of the setup error in y, z,θ directions were statistically significant ( Z =4. 152, 3. 415, 2. 053, P<0. 05). The margins from CTV were 4. 07, 4. 03 and 3. 73 mm in x, y and z directions, respectively. Compared with the previous study on SCF, CTV margin required 8, 8 and 6 mm in x, y and z axis directions, the volume of CTV to PTV were decreased by 32. 73% on average. Conclusions Compared with plastic circular pillow alone, moisture-cured resin cushion with breast bracket locating method could reduce setup errors in SCF target region. The margins from CTV to PTV weredecreased to 4. 07, 4. 03 and 3. 73 mm in x, y and z axis directions at least.

Objective:To investigate the current situation of nurses′ death attitudes, death competency and death education need in tertiary care hospitals, and analyze their relationship and to provide suggestions and guidance for clinical death education.Methods:This was a cross-sectional survey. From January to March 2022, a random sample of 1 902 nurses from five tertiary hospitals in Hunan Province Changsha City was selected as the study population. The general information questionnaire the Death Attitude Profile-Revised (DAP-R), Coping with Death Scale (CDS) and Death Education Needs Scale were used to investigate the current situation of nurses′ death attitudes, death competency and death education needs in tertiary hospitals, and the correlations among them were analyzed.Results:The 1 837 valid questionnaires were finally collected. The total score of death attitude was (91.37 ± 11.26) points, the total score of death competency was (109.25 ± 21.67) points and the total score of death education needs was (214.13 ± 28.64) points. Natural acceptance was positively correlated with death education needs ( r=0.458, P<0.05), escape acceptance was positively correlated with death education needs ( r=0.312, P<0.05), convergent acceptance was positively correlated with death education needs ( r=0.347, P<0.05), death avoidance was negatively correlated with death education needs ( r=-0.291, P<0.05), and death competency was positively correlated with death education needs ( r=0.356, P<0.05). Conclusions:Nurses had some degree of positive death attitudes, moderate level of death competency and higher need for death education. The death education need was positively correlated with positive death attitudes and death competency. The death education should be strengthened to cultivate positive death attitudes and improve death competency to improve the quality of end-of-life care and the quality of patient death.