1.Abnormalities in defecation of patient after laparoscopic cholecystectomy and its influenced factors
Modern Clinical Nursing 2017;16(4):24-27
Objective To study the abnormalities in defecation of patient after laparoscopic cholecystectomy as well as the influencing factors. Method A self-designed questionnaire and the anxiety self-rating anxiety scale (SAS) were used to investigate the defecation conditions of patients after laparoscopic cholecystectomy. Results About 40.78% of the patients were normal in defecation after the surgery. Among those with abnormalities in postoperative defecation, 30.16%had diarrhea. The influenced factors included age, preoperative gallbladder function, daily diets and anxiety. Conclusions The abnormalities in defecation of the patients after laparoscopic cholecystectomy are common. The patients with young age, the gallbladder function before laparoscopic cholecystectomy and anxiety diet without limit need more attention.
2.Development and evaluation of whole breast irradiation with volumetric modulated arc therapy-based hybrid intensity-modulated radiotherapy after breast conserving surgery for breast cancer
Yuan TIAN ; Pan MA ; Kuo MEN ; Yingjie XU ; Minghui LI ; Yixin SONG ; Jianrong DAI
Chinese Journal of Radiation Oncology 2016;25(7):728-732
Objective To develop whole breast irradiation with volumetric-modulated arc therapy (VMAT)-based hybrid intensity-modulated radiotherapy (IMRT) after breast conserving surgery for breast cancer,and to evaluate its value in clinical application.Methods Ten patients with breast cancer undergoing breast conserving surgery were enrolled.Two radiotherapy plans were designed based on hybrid fixed-beam IMRT/IMRT technique and hybrid VMAT/IMRT technique,respectively.One group received whole breast irradiation with a prescribed dose of 50 Gy in 25 fractions.The other group received whole breast irradiation with a prescribed dose of 50 Gy in 25 fractions,as well as simultaneous integrated boost to the tumor bed with 60 Gy in 25 fractions.The dosimetric parameters and delivery efficiency were compared between the two plans using paired t test.Results For patients treated with whole breast irradiation alone,there were no significant differences in conformity index and homogeneity index of target volume between the two plans (P=0.866,0.056);however,compared with the hybrid fixed-beam IMRT/IMRT technique,the hybrid VMAT/IMRT technique significantly increased the doses to organs at risk (OARs) and the number of monitor units (MUs) in the intensity-modulated field (P=0.000-0.050,P=0.002).For patients treated with whole breast irradiation with a simultaneous integrated boost to the tumor bed;however,the hybrid VMAT/IMRT technique significantly reduced the doses to the lung and spinal cord,number of MUs in intensity-modulated field,and delivery time compared with the hybrid fixed-beam IMRT/IMRT technique (P=0.004,0.001,0.000,0.000).Conclusions For patients treated with whole breast irradiation with a simultaneous integrated boost to the tumor bed,the hybrid VMAT/IMRT technique is highly promising for clinical application due to better OAR sparing and higher delivery efficiency.
3.Effects of variance reduction techniques on the efficiency and accuracy of Monte Carlo simulation for the single source channel of Gamma Knife
Yuan TIAN ; Yingjie XU ; Xinxin REN ; Pan MA ; Kuo MEN ; Jianrong DAI
Chinese Journal of Radiation Oncology 2016;25(8):855-860
Objective To evaluate the effects of four types of variance reduction techniques ( ring counter grid, high electron cutoff energy, termination of electron tracking in some structures, and emission direction?biased sampling of source) on the efficiency and accuracy of Monte Carlo simulation for the single source channel of the Leksell Gamma Knife. Methods The single source channel of the Leksell Gamma Knife was modeled using Monte Carlo software MCNP . Four types of variance reduction techniques were used to simulate the dose distribution in the water?like phantom. The computation efficiency and simulation result were compared between the four techniques. Results All techniques substantially improved the computation efficiency and had little effect on the accuracy of the simulation ( relative error less than 2. 5%) . However, if the electron cutoff energy was above 50 keV, the simulation became quite inaccurate due to neglect of the scattering of high?energy electrons and their dosimetric contribution to the penumbra. When the scattering of high?energy electrons and their dosimetric contribution to the penumbra were ignored, the dose to the Profile platform was overestimated and the dose to the penumbra was underestimated. Conclusions Rational use of variance reduction techniques can substantially improve the efficiency of Monte Carlo simulation for the single source channel of the Leksell Gamma Knife. However, the impact of variance reduction techniques on the accuracy of the simulation should be carefully evaluated.
4.Dosimetry study of volumetric-modulated arc therapy for single brain metastasis
Yingjie XU ; Jianping XIAO ; Pan MA ; Kuo MEN ; Yongqian ZHANG ; Jianrong DAI
Chinese Journal of Radiation Oncology 2015;24(3):306-309
Objective To evaluate the plan quality of volumetric modulated arc therapy (VMAT) in single brain metastasis compared with the stereotactic arc therapy (S_ARC).Methods 31 patients were replanned using VMAT and S_ARC technique.Prescription dose is 40 Gy delivered in 4 fractions covering at least 95% of the target volume while keeping minimum doses to the volume of normal brain tissue.The plans were assessed and compared using the conformity indexes (CI),gradient indexes (GI),the mean dose of normal brain tissue,the volumes of normal brain tissue receiving 4 Gy doses,the number of monitor unit and treatment times.A paired t test or non-parametric Wilcoxon signed rank test was performed to analyze the difference between these two plans.Results VMAT plans increased dose conformity,but not dose gradient,compared with S_ARC plans.The median dose conformity index values were 0.815,0.818,and 0.779 (P =0.000,0.000),and the median dose gradient score index values were 5.865,5.706,and 3.133(P =0.000,0.000,0.000),in single arc,double arc VMAT plans and S_ARC plans,respectively.The mean dose of normal brain tissue was higher in VMAT plans.And the volume of the normal brain tissue receiving doses of 4 Gy in VMAT plans was significantly larger than the volume in S_ARC plans.The VMAT plans got higher MU number (P =0.000,0.000).And the mean treatment times were (2.7 ± 0.1) min,(2.8 ± 0.1) min,and (7.6 ± 0.2) min in single arc,double arc VMAT plans and S_ ARC plans,respectively (P =0.000,0.000).Conclusions The dosimetry of VMAT plan can meet the requirements of clinical,and is recommended in the treatment of big volume single brain metastasis or single brain metastasis in cerebellum.
5. Monte Carlo simulation of accurate dose distribution with high resolution for the single source channel of Leksell 4C gamma knife
Yuan TIAN ; Yingjie XU ; Yixin SONG ; Pan MA ; Junjie MIAO ; Kuo MEN ; Zhiqiang LIU ; Jianrong DAI
Chinese Journal of Radiation Oncology 2018;27(8):780-783
Objective:
To obtain the high-resolution dose distribution for the single source channel of Leksell 4C gamma knife.
Methods:
A parallel computing platform based on the Message Passing Interface (MPI) and Monte Carlo Code MCNPX was established. The ring-shaped detector and two pre-validated variance reduction techniques (emission direction-biased sampling of source and termination of electron tracking in partial structures) were adopted to derive the high-resolution dose distribution for the single source channel of Leksell 4C gamma knife. The effect of cut-off energy for both photon and electron on the accuracy of simulation outcomes was evaluated and statistically compared.
Results:
Compared with previous findings, the spatial resolution of the dose distribution for the single source channel obtained in this study was higher (radial resolutio
6.A method of determining the prescription isodose line for stereotactic radiotherapy VMAT plan
Yuan XU ; Pan MA ; Yingjie XU ; Kuo MEN ; Jianrong DAI
Chinese Journal of Radiological Medicine and Protection 2020;40(6):477-480
Objective:To establish a method of determining the prescription isodose line for steretactic radiotherapy (SRT) volumetric modulated arc radiotherapy (VMAT) plan.Methods:Eight patients with brain metastases treated with SRT were enrolled. The volume of planning target volume (PTV) ranged from 3.5 to 11.7 cm 3 (median 6.1 cm 3). Reference VMAT plans were designed for each patient with identical prescription dose. Then, the original PTV was contracted by a few millimeters to form a new target for optimization to get plans with different IDLs. The minimum margin which was needed to be contracted to achieve optimal IDL range for each PTV was also studied. Results:To achieve the optimal IDL range, 4 or 5 mm PTV contraction was needed for all patients, and the average IDL was (66.05±0.02)%. Compared with reference plans, the average gradient index (GI) of optimal IDL plans decreased by 20% from 4.05±0.39 to 3.37±0.24 ( Z=-2.521, P<0.05). The V40, V30, V5 and mean dose in normal brain tissue decreased by 11.5% ( Z=-1.973, P<0.05), 7.2% ( Z=-2.105, P<0.05), 12.8% ( Z=-2.521, P<0.05) and 8.1%, respectively ( Z=-2.382, P<0.05), and there was no statistically significant difference with V20, V10 and conformity index ( P>0.05). Conclusions:The optimization of IDL for SRT-VMAT plan can be achieved with the method of contracting PTV to form new target for planning. 4 or 5 mm is needed to be contracted to achieve the optimal IDL range, and to get lower GI and protect the normal brain tissue.
7.Dosimetric comparison of three techniques in radiotherapy for breast cancer after modified mastectomy
Junjie MIAO ; Yingjie XU ; Yirui ZHAI ; Kuo MEN ; Shulian WANG ; Jianrong DAI
Chinese Journal of Radiation Oncology 2021;30(9):924-929
Objective:To analyze and compare the dosimetric differences based on volumetric-modulated arc therapy (VMAT), fixed field intensity-modulated radiotherapy (F_IMRT), and electron irradiation combined with VMAT (E&VMAT) in radiotherapy for breast cancer after modified mastectomy, aiming to provide reference for clinical selection of treatment plan.Methods:Ten patients with the left breast cancer who received radiotherapy after modified mastectomy were randomly selected. The target areas included chest wall and supraclavicular region, and the prescribed dose was 43.5 Gy in 15 fractions (2.9 Gy/F). Based on the Pinnacle 3 planning system, the VMAT, F_IMRT and E&VMAT plans (electron beam for chest wall, VMAT for supraclavicular area) were designed for each patient. The conformity and homogeneity of the target areas, the dose of organs at risk and treatment time were compared. Results:The VMAT plan could improve the dose distribution of the target areas. The conformity index and homogeneity index of the target dose were significantly better than those of the F_IMRT and E&VMAT plans (all P<0.05). The average dose, V 30Gy, V 20Gy, V 10Gy of the left lung in the VMAT plan were significantly better than those in the F_IMRT and E&VMAT plans (all P<0.05). The V 5Gy of the left lung in the VMAT plan was significantly better than that in the F_IMRT plan ( P<0.05). There was no statistical difference in the V 5Gy of the left lung between the VMAT and E&VMAT plans ( P>0.05). The heart, right breast and right lung of the VMAT plan could meet the clinical dose limit requirements. The treatment time of the VMAT, F_IMRT and E&VMAT plans was (326±27) s, (1 082±169) s, and (562±48) s, respectively. Conclusions:Compared with the F_IMRT and E&VMAT plans, the VMAT plan has better quality and shorter treatment time. VMAT plan has higher value in clinical application compared with the F_IMRT and E&VMAT plans.