Objective To compare the safety,effectiveness and affordability of robotic-assisted thoracic surgery and video-assisted thoracic surgery in the treatment of malignant pulmonary tumors,and provide ref-erences for the management of selection of different surgical strategies for malignant pulmonary tumors in hospitals and medical insurance departments.Methods The medical records homepages and information sys-tem data of patients with malignant pulmonary tumors who underwent major thoracic surgery in this hospital and discharged from January 1 to December 31,2022 were obtained.The patients were divided into the robotic-assistedthoracic surgery group and video-assisted thoracic surgery group according to the surgical methodolo-gies.After performing propensity score matching (PSM),no statistically significant difference was observed in baseline data between the two groups (117 cases in each group).Then the indicators of safety,effectiveness and affordability were compared between the two groups.Results Concerning the safety,the postoperative in-cision infection rate in the robotic-assisted thoracic surgery group was significantly lower than that in the vide-o-assisted thoracic surgery group (P<0.05),and the amount of intraoperative blood loss and postoperative complication rate were not significantly different between the two groups (P>0.05).Regarding the effective-ness,the average surgical duration in the robotic-assisted thoracic surgery group was appreciably shorter than that in the video-assisted thoracic surgery group (P<0.05),no patient in the two groups was converted to open thoracotomy,and there was no statistically significant difference in the average length of hospital stay and postoperative hospital stay between the two groups (P>0.05).With regard to the affordability,the aver-age inpatient expenditure per case and average daily inpatient expenditure per case in the robotic-assisted tho-racic surgery group were significantly higher than those in the video-assisted thoracic surgery group (P<0.05),and there were disparities in the cost structure between the two procedures.The medical cost,adminis-tration cost and consumables cost in the robotic-assisted thoracic surgery group were significantly higher than those in the video-assisted thoracic surgery group (P<0.05).The cost of medical technology in the robotic-assisted thoracic surgery group was significantly lower than that in the video-assisted thoracic surgery group (P<0.05).Conclusion Physicians should comprehensively consider the clinical efficacy and cost burden of patients when selecting the robotic-assisted thoracic surgery or the video-assisted thoracic surgery,and the monitoring and evaluation of the utilization of clinical robotic-assisted thoracic surgery should be strength-ened.

Objective To evaluate curative effect and related prognosis factors of synchronous colorectal cancer with liver metastasis.Methods The clinicopathological and follow-up data of 47 patients undergoing surgical treatment with synchronous colorectal cancer with liver metastasis at Shanghai Jiaotong University Affiliated Sixth People's Hospital and Tongji University Affiliated Yangpu Hospital from Jun 2013 to Jan 2018 were retrospectively analyzed.Results All 47 patients were followed up and themedian followup time was 38 months (2-65 months),after simultaneous colorectal and hepatic neoplasm radical surgery,added in 41 patients by postoperative chemotherapy.There was no perioperative mortality and the postoperative complication rate was 34％.The 1-,3-,and 5-year overall-survival rates were 87％,53％,and 15％,respectively.The disease-free survival rates were 81％,43％,and 9％,respectively.Multivariate results showed tumor differentiation,serum CEA level and adjuvant chemotherapy are independent prognostic factors for patients with synchronous colorectal cancer liver metastasis (P ＜ 0.05).Conclusions Colorectal cancer with synchronous liver metastasis treated by simultaneous resection of colorectal cancer and liver metastases are the widerly adopted treatments.Long-term survival is closely related to the degree of primary neoplasm differentiation,serum CEA level at diagnosis,and postoperative adjuvant chemotherapy.

Objective To investigate the application value of spectral computed tomography venography(CTV)in the display and staging of deep venous thrombosis(DVT)in the lower extremity.Methods Eighty-two patients with CTV were selected and ran-domly divided into group A(42 patients)and group B(40 patients).Group A:tube voltage 120 kVp.Group B:gemstone spectral ima-ging(GSI)mode,reconstruction of 50 keV and iodine(water)maps.The CT and standard deviation(SD)values of the veins were measured,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated in 120 kVp images of group A and in 50 keV images of group B.Two observers scored the image quality of the 2 groups subjectively,and Kappa test was used to examine the con-sistency.Based on the duration from the occurrence of clinical symptoms,the DVTs were classified.The CT values and iodine con-centration(IC)of DVT were measured in the 120 kVp images of group A and in the iodine(water)maps of group B,respectively.The receiver operating characteristic(ROC)curve was drawn to compare the effectiveness of CT values and IC in diagnosing DVT staging.Results CT values,SNR,and CNR of veins in group B were higher than those in group A(P<0.05).The subjective scores of the two groups were consistent(Kappa=0.926-0.955,P<0.05).The score for the display of veins and thrombus clarity in group B was 5(4,5),which was better than the score of 4(3,4)in group A(P<0.05).The efficiency of IC in diagnosing DVT staging[area under the curve(AUC)=0.973]was better than that of CT values(AUC=0.891).Conclusion The spectral CTV can improve the contrast of lower extremity deep veins and the clarity of thrombus,and can provide more objective indicators for the diagnosis of thrombus staging,which is conducive to accurate clinical diagnosis and treatment.

Objective:To study the changes of patient-related costs and the use of stents and other consumables before and after the centralized procurement of coronary stents.Methods:The inpatient medical insurance settlement case data of 1,973 patients with coronary stent implantation admitted to Daping Hospital of Army Medical University from December 2019 to October 2021 were selected.Among them,the data of 1,317 cases of percutaneous cardiovascular surgery and coronary stent implantation with serious or complications and accompanying disease group were slected according to disease diagnosis related groups(DRG),which were divided into the pre-centralized procurement group(667 cases)and the post-centralized procurement group(650 cases)according to the centralized procurement of coronary stents before and after.The costs of patients'medical consumables with the consumption of patients'medical consumables and the impact of the use of consumables such as coronary stents on the costs of medical consumables were compared.Results:There was no significant statistical difference in the hospitalization days and the average number of stents used in patients undergoing percutaneous cardiovascular procedures and coronary stent implantation with centralized procurement of coronary stents.There was a statistically significant difference in the total diagnosis and treatment cost,medical consumables cost,medicines and consumables cost and medicines cost between the pre-centralized procurement group and the post-centralized procurement group(Z=-22.316,-23.546,-22.917,-5.724,P<0.05).The cost of stents[16 260(13 300,32 272)yuan],the number of catheter guidewire balloon sheaths consumables[5(4,8)sets(pieces)],and the cost of catheter guidewire balloon sheaths consumables[8 719(5 805,15 372)yuan]in the pre-collection group were collected.There were statistically significant differences in the stent cost[1 059(590,1 770)yuan],the number of catheter guidewire balloon sheaths consumables[8(7,12)sets(pieces)],and the cost of catheter guidewire balloon sheaths consumables[5 708(3 392,12 871)yuan]between the two groups(Z=-30.452,16.582,-7.670,P<0.05).There was a statistical correlation between the cost of coronary stents and the cost of catheter guidewire balloon sheaths before and after centralized volume procurement on the cost of medical consumables for patients(r=0.903,0.473,0.785,0.953,P<0.05).The correlation coefficient between the cost of coronary stents and the cost of medical consumables for patients in the post-centralized procurement group decreased compared to the pre-centralized procurement group,the correlation coefficient between the cost of catheter guidewire balloon sheath and the cost of medical consumables for patients increased.Conclusion:The centralized procurement of coronary stents has a significant cost control effect on patients in the disease groups,and affects the cost structure of medical consumables.Combined with DRG reform,it can continuously improve the standardization and scientificity of clinical use of medical consumables.

Objective To explore the application value of deep learning image reconstruction(DLIR)algorithm in low-dose deep inferior epigastric artery(DIEA)computed tomography angiography(CTA).Methods A total of 59 patients undergoing DIEA CTA were prospectively selected and randomly divided into two groups:group A(29 cases)and group B(30 cases).Group A was the conventional radiation dose group(tube voltage 120 kVp),the tube current was dose modulation 3,and the iterative reconstruction algo-rithm was Karl 5.Group B was the low radiation dose group(tube voltage 120 kVp),the tube current was dose modulation 2,with DLIR reconstruction algorithm,and four levels of DLIR(1-4)were reconstructed and labeled as groups B1 to B4.The mean tube current,vol-ume CT dose index(CTDIvol),and dose length product(DLP)of group A and group B were recorded,and the effective dose(ED)was calculated.The CT and standard deviation(SD)values of the external iliac artery and psoas major muscle were measured on axial images of each group,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.Two observers using double-blind method independently evaluated the DIEA on volume rendering(VR)and maximum intensity projection(MIP)images of each group using a 3-point scale,and a 5-point scale was used to evaluate the overall image quality on axial images.Results Compared with group A,the mean tube current and ED in group B were decreased by 39.33％and 44.09％,respectively(P＜0.05).With the increasing of DLIR level from groups B1 to B4,the SD value of the image gradually decreased,while SNR and CNR gradually increased(P＜0.05).The CNR in groups B3 and B4 was higher than that in group A(P＜0.05).The subjective scores of the two observers were consistent(Kappa value 0.779-0.889,P＜0.05),and there was no statistical significance between group A and group B in the perforating vessels from the DIEA,intramuscular course,and the point of emergence(P＞0.05).With the increase in DLIR level,the subjective score of the overall image quality from group B1 to group B4 showed a trend of first increasing and then decreasing,and the score of group B3 was the highest(4.50±0.51)points,which had no statistical significance compared with group A(4.45±0.51)points(P＞0.05).Conclusion DLIR can effectively reduce the radiation dose of the DIEA CT A scan and ensure the image quality,among which DLIR 3 is the recommended best reconstruction grade.

Objective To investigate the influence of spectral CT monochromatic imaging technique on image quality and liver vol-ume measurement in computed tomography portal venography(CTPV).Methods A total of 120 patients who underwent contrast-enhanced abdominal CT examination were prospectively selected and randomly divided into group A and group B.The group A(n=60)was scanned with conventional parameters such as 120 kVp,Smart mA mode,and image reconstruction of 60％adaptive statistical iterative reconstruction-Veo(ASIR-V);while the group B(n=60)was with instantaneous switching 80/140 kVp,gemstone spectral imaging(GSI)Assist mode,and image reconstruction of 60％ASIR-V.In group B,six subgroups of images from 75 to 50 keV(with 5 keV interval)were recorded as subgroups B1 to B6.On the axial images,the CT values and standard deviation(SD)values of por-tal vein,liver and erector spinae were measured,and then the contrast-to-noise ratio(CNR)of portal vein and liver were calculated.The Liver Segmentation software was used to segment the liver in groups A and B,the liver volumes by automatic segmentation and manual segmentation(golden standard)were recorded,and then the volume difference rate was calculated.The overall image quality and automatic liver segmentation results were evaluated by two radiologists using a 5-point scale.Results In terms of overall image quality,subgroup B6 achieved the highest score and was superior to group A(P＜0.001).In terms of liver segmentation,subgroup B3 had the highest score and was superior to group A(P＜0.001).With the decrease of keV,the CT values,SD values and CNR of portal vein and liver in group B were gradually increased(P＜0.05),in which subgroup B6 was higher than that in group A(P＜0.001).The volume difference rate initially decreased and then increased with the decrease of keV.Except for subgroups B2 and B3,the differences were statistically significant between other subgroups and group A(P＜O.001),and the subgroup B3 had the lowest volume difference rate.Conclusion Spectral CT monochromatic ima-ging technique has an influence on CTPV image quality and liver volume measurement.The 50 keV images are the best for displaying portal vein,and the automatic liver segmentation volume of 65 keV images is closest to the real liver volume.

Objective To explore the application value of 1 024×1 024 reconstruction matrix combined with iterative reconstruc-tion algorithm(Karl)in deep inferior epigastric artery(DIEA)computed tomography angiography(CTA).Methods A total of 40 patients who underwent DIEA CTA were prospectively selected and the original data were reconstructed by grouping.Group A was reconstructed using a conventional 512×512 matrix combined with Karl 5 grade.Group B was reconstructed using 1 024×1 024 recon-struction matrix combined with Karl 5,7,and 9 grades,respectively,and 3 subgroups B1-B3 were obtained.The CT and standard devia-tion(SD)values of the external iliac artery and psoas major muscle were measured on axial images,and signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated.A 3-point scale was used to evaluate the perforating vessels from the DIEA,intramuscular course,point of emergence,superficial inferior epigastric artery(SIEA)and superficial inferior epigastric vein(SIEV)on volume ren-dering(VR)and maximum intensity projection(MIP)images by two observers,and a 5-point scale was used to evaluate the overall image quality on axial images.Results With the increase of Karl grade in groups B1 to B3,the SD value of the external iliac artery decreased gradually(P＜0.05),while SNR and CNR increased gradually(P＜0.05).The SD values of the external iliac artery in group B2 and group B3 were lower than those in group A(P＜0.05),and SNR and CNR were higher than those in group A(P＜0.05).There was a good consistency in the subjective evaluation between the two observers(Kappa values=0.773-0.872,P＜0.05).The perforating vessels from the DIEA,intramuscular course,point of emergence,SIEA and SIEV display and overall image quality subjective scores of group B2 and group B3 were better than those of group A(P＜0.05),and the scores of group B2 showed the greatest improvement.Conclusion The 1 024 × 1 024 reconstruction matrix combined with the Karl 7 reconstruction algorithm can optimize the image quality and improve the display of the DIEA and perforator microvessels.

Objective To investigate the clinical application value of posterior adaptive statistical iterative reconstruction-Veo(ASIR-V)algorithm combined with full-field organ dose modulation(ODM)technique in low-dose computed tomography urography(CTU).Methods Ninety patients who underwent urological contrast-enhanced and CTU examination were prospectively selected and divided into conventional dose group(group A,NI=11,posterior ASIR-V of 60％),low-dose group(group B,NI=15,posterior ASIR-V of 60％-100％with 10％interval,denoted as B1-B5 groups);full-field ODM low-dose group(group C,NI=15,posterior ASIR-V of 60％-100％with 10％interval,denoted as C1-C5 groups)according to the noise index(NI).The volume rendering(VR)and maximum intensity projection(MIP)images were reconstructed.The CT values and standard deviation(SD)values of the renal cortex and para-spinal muscles were measured,and the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were cal-culated.The CT values of the renal pelvis,ureter,and bladder were measured,and the SNR and CNR were calculated with the para-spinal muscles as background.The subjective score was performed on the two-dimensional and three-dimensional images to evaluate the ability of CTU to display lesions.The volume CT dose index(CTDIvol),dose length product(DLP),and effective dose(ED)of the three groups were compared.Results The bladder SNR and CNR of groups B1,C1,and C2 were lower than those of group A(P＜0.05).There was no statistically significant difference in the SNR and CNR of each tissue between groups B2,C3 and group A(P＞0.05).The SNR and CNR of each tissue in groups B4,B5,and C5 were higher than those in group A(P＜0.05).The display rate of lesions in urinary system in groups B2 and C3 could reach 100％.There was no statistically significant difference in the axial image scores between groups B2,C3 and group A(P＞0.05),while the VR and MIP image scores in each group were comparable to those in group A(P＞0.05).The CTDIvol of groups A,B and C were(6.08±2.11)mGy,(3.15±1.15)mGy,and(2.9±0.92)mGy,respectively.Conclusion CTU using the full-field ODM technique combined with posterior 80％ASIR-V can reduce the CTDIvol by 52.30％,and further reduce by 7.93％compared with group B,which is effective to reduce radiation to the gonads.

Objective:To explore the effects of the auto-prescription technique combined with noise index (NI) and adaptive statistical iterative reconstruction algorithm-veo (ASIR-V) on the radiation dose and image quality in the computed tomographic angiography (CTA) of the deep inferior epigastric artery (DIEA).Methods:The data of 150 cases who underwent DIEP CTA in the First Affiliated Hospital of Dalian Medical University were prospectively collected, and were randomized into groups A, B, and C, with 50 cases in each group. For group A, the conventional tube voltage was 120 kVp, and images were reconstructed using 40% ASIR-V. For group B, the tube voltage based on the auto-prescription technique was adopted, and images were reconstructed using 40%, 60%, and 80% ASIR-V (corresponding to the three subgroups B1-B3, respectively). For group C, the tube voltage based on the auto-prescription technique was employed, NI = 13, and images were reconstructed by 40%, 60%, and 80% ASIR-V (corresponding to subgroups C1, C2, and C3, respectively). Subsequently, the CT and SD values of the originating femoral artery of DIEA and the rectus abdominis at the same level as DIEA were measured on axial images of each group, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated, and the radiation doses of the three groups were recorded. Finally, the image quality and noise of DIEA in each group were independently and subjectively scored by two radiologists in a blinded manner.Results:Compared to group A, groups B and C exhibited higher CT values of femoral artery ( t= -5.18, -5.17, -5.06, -6.08, -6.08, -6.07, P < 0.05) and higher image SNR and CNR ( P < 0.05), which increased gradually with the upgrading of ASIR-V ( F = 55.45, 49.70, 53.47, 68.89, P < 0.05). The two radiologists offered consistent subjective evaluations (Kappa = 0.76-0.92, P < 0.05). The images of groups B and C displayed more distinct perforating branches and emerging points of DIEA and received higher subjective scores of intramuscular course compared to those of group A. The subjective scores of image noise in subgroups B2, B3, and C2 were not significantly different from those in group A. The radiation doses in groups B and C decreased by 15.10% and 52.85%, respectively compared to those in group A ( H = 75.21, P < 0.05). Conclusion:The combination of the auto-prescription technique with NI = 13 and 60% ASIR-V can reduce the radiation dose by 52.85% while ensuring a clear display of DIEA.

OBJECTIVE To analyze the grouping effect and composition of hospitalization costs for cases of patients with malignant proliferative disease under the diagnosis-related group （DRG） payment system， as well as any changes， in order to provide a basis for medical institutions to improve DRG payment-related measures， control drug costs， and for relevant departments to make decisions. METHODS The data of patients with malignant proliferative disease cases were collected from a “Third Grade Class A” hospital in 2021 and 2022， and the variation coefficient （CV） was used to evaluate the grouping of DRG. The structural variation degree and the new grey correlation analysis were used to study the structural variation of hospitalization cost and the correlation degree between the hospitalization cost and the cost of other items. RESULTS The overall reduction in variance （RIV） for the DRG group of patients with malignant proliferative disease was 79.36%； the CV of other groups were all lower than one except that the RW21 group was 1.09. Compared with 2021， the hospitalization cost for patients with malignant proliferative disease in 2022 decreased by 17.80%， and the decreases in management fees and drug costs were 32.15% and 21.30%， respectively， while the per capita medical expenses increased by 17.26%. The new grey correlation degree of drug cost decreased， but that of medical expenses increased. CONCLUSIONS Under the DRG payment system， hospitalization costs for patients with malignant proliferative disease in the sample hospital decrease， but the grouping efficiency of RW21 and other disease groups needs improvement， and the cost structure needs optimization.