Objective To analyze the difference of irradiation dose and volume of organs at risk (OAR) particularly in small intestine between supine position and prone position on intensity-roodulated radiotherapy(IMRT) for cervical cancer. Methods 11 patients with Ⅱ_B-Ⅲ_B cervical cancer were scanned with supine position and prone position by CT.The CT images were transported to TPS,then target volumes were delineated and the IMRT plans were designed respectively.The prescribed dose was 95%PTV receiving 45 Gy in 23 fractions of 2 Gy.The exposure volumes of the OAR at different position and different dose levels in the dose volume histograms (DVH) were compared and analyzed.Results When tlle dose di8tributions met to the clinic request,the exposure volumes of small intestine at prone position were redueed than that at supine position in dose range 46-30 Gy(P<0.05),but this phenomenon Was not distinct in low dose range(< 20 Gy)(P>0.05).The exposure volumes of bladder, rectum, femur head and spine cord were no obviously differences at dissimilar position. Conclusion IMRT of cervical cancer should adopt prone position.because their small intestine will be protected better.

Objective To study the spatial distribution of set-up errors for cervical cancer with intensity modulated radiation therapy (IMRT) and to provide referential safety margin out of clinical tumor volume (CTV) during treatment plan design. Methods Six patients with cervical cancer were treated with IMRT in prone position, belly board and thermoplastic cast was used for immobilization. Measurement were made on a daily basis setup under five consecutive treatments with electron portal images device (EPID).Portal films from two projection (one anter-posterior and one opposite lateral)were taken. Sixty portal films were analyzed. The translational and rotational deviations were analyzed by registering and comparing the bony structures of EPID and digitally reconstructed radiographs (DRR). Results The translational deviations were (3.1 ±1.8) mm, (3.9 ±3.3) mm, (4.2 ±2.6) mm in medi-lateral, cranio-caudal and anterior-posterior directions, the rotational deviations were in coronal plane (0.8±0.9)° and sagittal plane (1.2±1)°. Conclusion For the patients with cervical cancer undergoing IMRT, the margins between the CTV and PTV should be 7.1 mm in lateral direction, 10.4 mm in cranio-caudal and 10.8 mm in anterior-posterior directions. The sign on patients body can help to reduce the setup errors.

Objective To compare the position,volume and matching index (MI) of esophagus between quiet end-inspiration and end-expiration in three dimensional CT (3D-CT) assisted with active breathing control (ABC) and the corresponding phases in four dimensional CT (4D-CT).Methods Eleven patients with peripheral lung cancer underwent 4D-CT simulation scan and 3D-CT simulation scans in end-inspiratory hold (CTEIH) and end-expiratory hold (CTEEH) in succession.The 0％ phase was defined as end-inspiratory phase (CT0),while the 50％ phase was defined as end-expiratory phase (CT50).The proximal,mid-,and distal thoracic esophagus were delineated separately on CT0,CT50,CTEIH and CTEEH images.The position,volume and MI of each segment esophagus between CT0 and CTEIH,CT50 and CTEEH were compared.Results In the left-right (x) direction,the position differences in the proximal,mid-,and distal thoracic esophagus between CT0and CTEIH were (-0.02 ±0.16)cm,(0.06 ± 0.26)cm and (0.10 ± 0.33) cm respectively,and in the anterior-posterior (y) direction,the position differences were (0.04 ±0.24)cm,(0.04 ±0.12) cm and (0.08 ±0.15) cm respectively,and the position differences in the same direction were not statistically significant.In the x direction,the position differences of the proximal,mid-,or distal thoracic esophagus between CT50 and CTEEH were (-0.02 ±0.24) cm,(0.12 ± 0.37) cm and (0.26 ± 0.33) cm respectively,and in the y direction,the position differences were (0.03 ±0.21)cm,(0.04 ±0.17)cm and (0.14 ±0.18)cm respectively,and the position differences in x and y directions of proximal and mid-thoracic esophagus between CT50 and CTEEH were not statistically significant,while the position differences in x and y directions of distal thoracic esophagus between CT50and CTEEH were both statistically significant (t =0.025,0.024,P ＜ 0.05).The volumes of the proximal,mid-and distal thoracic esophagus were all larger in CT0and CT50 than those in CTEIHand CTEEH,but without statistical differences.The MIs of the volumes of the proximal,mid-and distal thoracic esophagus between CT0 and CTEIH were (0.50 ± 0.17),(0.50 ± 0.19) and (0.56 ± 0.08),respectively,and those between CT50and CTEEH were (0.50 ±0.16),(0.47 ±0.14) and (0.51 ±0.15),respectively.The MI of each segment esophagus between CT0and CTEIHwas larger than that between CT50 and CTEEH,but without statistical differences.Conclusions The influence of breathing modes on the centroid positions of the proximal,mid-thoracic normal esophagus were not significant and there were spatial mismatches for any segment esophagus between 3D-CT assisted with ABC and 4D-CT.

Objective To eompare the dose distribution of three-dimension conformal radiation therapy(3DCRT) and common radiation therapy (CRT) of the planning target volume(PTV) and organ at risk (OAR) in recurred cervical cancer treatment planning. Methods Thirteen patients,who had cervical cancer recurred in pelvis treated with 3DCRT in Shanxi Cancer Hospital from May to August 2007, were selected. After CT simulation, the CT images were transferred into Topslane treatment system. The same physicist designed 3DCRT plan and common radiation therapy plan for every patient,total dose 50 Gy, 90 % is dose covered PTV, then compared the dose distribution of PTV and OAR.Results At the same prescribed dose of 50Gy,there were no significant differences on OAR maximum dose between 3DCRT plans and common radiation therapy plans(P >0.05), however, there was significant differences on PTV maximum dose(P <0.01). The difference of PTV uniformity were significant between 3DCRT plans and common radiation therapy plans (P <0.001). Compared the high dose region of OAR(V40), the difference was significant (P <0.001). Between 3DCRT plans and common radiation therapy plans, they showed 53.31 ml (90.69 %), 124.00 ml (79.47 %), 655.16 m1(92.22 %) median reduction in the V40 of rectum, bladder, intestine, respectively. Conclusion At the same PTV coverage of the prescribed dose, 3DCRT plans showed worse dose uniformity, however, the radiation volume to organs at risk in 3DCRT plans were smaller than common radiation therapy plans. So patients with cervical cancer recurred in pelvis received 3DCRT may be potentially diminish the Normal Tissue Complications Probability(NTCP).

Objective To measure the displacement of the silver clips guided by kV-plain film at state of moderate deep inspiration hold(mDIBH) assisted by active breathing control(ABC) and to explore the margin of clinical target volume(CTV) to planning target volume(PTV) for breast cancer patients treated with three-dimensional conformal external-beam partial breast irradiation (EB-PBI) assisted by ABC. Methods The patients undertook CT simulation assisted by ABC to get the CT images on the respiratory condition of mDIBH. Four selected silver clips in breast cavity were delineated and the cavity based on all of the clips were delineated as gross tumor volume (GTV). Before each irradiation, two orthogonal kV-plain films were taken for the patients in the respiratory condition of mDIBH assisted by ABC device. 2D-2D auto-matie registration was performed based on pixel between the kV-plain films and the digital reconstructed radi-ographs(DRR). Then manual registration was undertook to get the shifts of the four clips separately at LAT, LNG,and VRT directions. Based on the shift data,the margins of CTV to PTV at LAT,LNG and VRT direc-tions were calculated. Results The margins from CTV to PTV were 5.00 mm,7.78 mm and 9.30 mm at LAT,LNG and VRT directions based on the clip at cephal border of the cavity. The corresponding margins were 4.40 mm,6.43 mm and 6.73 mm based on the clip at bottom of the cavity;5.04 mm,8.63 mm and 10.54 mm based on the clip at lateral border of the cavity;5.40 mm,8.59 ram and 10.81 mm based on the clip at pedal border of the cavity. Conclusions The silver clips in breast cavity can be clearly showed on the kV-plain film. The displacement of the clips can be exactly measured by registration of kV-plain film and planning DRR in condition of mDIBH assisted by ABC. The margins from CTV to PTV for EB-PBI can be calculated based on the displacement of the clips.

Objective To investigate the differences in position and volume between planning target volumes (PTV) based on positron emission tomography?computed tomography (PET?CT) images with an standardized uptake value ( SUV) no less than 2?5, 20% of the maximum SUV ( SUVmax ), or 25% of SUVmax , three?dimensional ( 3D ) CT, and four?dimensional ( 4D ) CT in thoracic esophageal cancer. Methods Eighteen patients with thoracic esophageal cancer sequentially received chest 3DCT, 4DCT, and [18F]fluoro?2?deoxy?D?glucose (FDG) PET?CT scans. PTV3D was obtained by conventional expansion of 3DCT images;PTV4D was obtained by fusion of target volumes from 10 phases of 4DCT images. The internal gross tumor volumes ( IGTV) , IGTVPET2.5 , IGTVPET20%, and IGTVPET25%, were generated based on PET?CT images with an SUV no less than 2?5, 20% of SUVmax , and 25% of SUVmax , respectively. These IGTVs were expanded longitudinally by 3?5 cm and radically by 1 cm to make PTVPET2.5 , PTVPET20%, and PTVPET25%, respectively. Results PTV3D was significantly larger than both PTV4D and PTVPET(P=0?000 -0?044), while there was no significant difference between PTV4D and PTVPET ( P= 0?216 -0?633 ) . The mutual degrees of inclusion ( DIs ) between PTV3D and PTV4D were 0?70 and 0?95, respectively, which were negatively correlated with 3D?Vector ( P=0?039). The mutual DIs between PTVPET2.5, PTVPET20%, and PTVPET25% were 0?74, 0?72, 0?78, 0?73, 0?77, and 0?70, respectively, which showed no correlation with 3D?Vector (P=0?150 -0?822). The mutual DIs between PTV3D and PTVPET were 0?86, 0?84, 0?88, 0?63, 0?67, and 0?59, respectively. Conclusions It is difficult to achieve complete volumetric overlap of PTVs based on 3DCT, 4DCT and PET?CT in thoracic esophageal cancer due to different target volume information. PET scan during free breathing should be used with caution to generate PTVs in thoracic esophageal cancer.

Objective To evaluate the prognostic value of the maximum standardized uptake value decrease proportion (△SUVmax％) on 18F-fluorodeoxyglucose (FDG) PET/CT imaging and C-MYC gene in diffuse large B cell lymphoma (DLBCL),and to find the optimal time of PET/CT imaging.Methods From September 2010 to February 2016,171 patients (87 males,84 females,average age:(50.66±2.56) years)with pathologically confirmed DLBCL were analyzed.18F-FDG PET/CT were performed before and after different courses of chemotherapy (60 patients in early phase which means 1 and 2 courses;55 patients in medium phase,3 and 4 courses;56 patients in late phase,5 and 6 courses).The region of interest (ROI) was drawn and the △SUVmax％ was calculated.Patients were evaluated with Deauville 5-point scale.Fluorescence in situ hybridization (FISH) was employed to detect C-MYC gene.Patients were followed up for 6-71 months,and progression-free survival (PFS) was calculated.x2 test,one-way analysis of variance,Kaplan-Meier analysis and Spearman correlation analysis were used to analyze the data.Results There were 42 C-MYC gene rearrangement of 171 DLBCL patients.Age,Ann Arbor stage,international prognostic index (IPI) score,serum lactate dehydrogenase (LDH) level and therapeutic response were different between patients with C-MYC gene rearrangement and those without rearrangement (x2:6.139-98.339,all P＜0.05).The optimum cutoff values of the △SUVmax％ were 62.5％,87.0％ and 92.0％ respectively in the early,medium and late phases of chemotherapy.Patients with △SUVmax％ ≥≥ 62.5％,≥ 87.0％ or ≥ 92.0％ and normal C-MYC gene showed longer PFS (x2 values:21.983-61.899,all P＜0.001).The △SUVmax％ was negatively correlated with C-MYC gene rearrangement (rs =-0.801,P ＜ 0.001).Significant differences were found in △SUVmax％ (F=6.509,P＜0.01) and Deauville 5-point scale (F=19.897,P＜0.001) among patients in early,medium and late phases.No Significant differences were shown between medium and late phases (P＞0.05).Conclusion △SUVmax％ in the different phases of chemotherapy and C-MYC gene rearrangemeut have better values for predicting the prognosis of DLBCL,and 18F-FDG PET/CT imaging should be performed between 1 course and 4 courses of chemotherapy.

Objective To monitor the level of urinary iodine in pregnant women in Xiaogan area,to understand the iodine nutri-tional status of pregnant women during pregnancy,and to provide theoretical basis for scientific guidance of iodine intake in preg-nant women.Methods The urine iodine levels of 2 956 pregnant women in Xiaogan Hospital Affiliated to Wuhan University of Sci-ence and Technology from March 2016 to May 2017 were examined and analyzed.Results In Xiaogan area,the median concentra-tions of urinary iodine in the early,middle and late stages of pregnant women were 145.73 μg/L,176.88 μg/L and 170.37 μg/L. 996 pregnant women were with urinary iodine concentration of over 150 μg/L,accounting for 33.69%;1372 pregnant women were with urinary iodine concentration of 150-249 μg/L,accounting for 46.41%;556 pregnant women were with urinary iodine concen-tration of 250-499 μg/L,accounting for 18.81%;32 pregnant women were with urinary iodine concentration of over 500 μg/L,ac-counting for 1.08%.The incidence rates of iodine deficiency in pregnant women at early,middle and late stage were 42.86%, 32.95% and 40.00%,and the difference was statistically significant(P<0.05).The incidence rate of iodine deficiency was 32.33%in pregnant women with age ≤ 30 years old,the incidence of iodine deficiency was 36.89% in pregnant women with age > 30 years old,and the difference was statistically significant(P<0.05).Conclusion At this stage,in Xiaogan,there are no overall maternal i-odine deficiency,but there was iodine malnutrition in pregnant women in early pregnancy,and some pregnant women lack awareness of iodine.

Objective:To establish a disk (CD) microfluidic chip detection platform for the rapid detection of CALR-1 and CALR-2 mutations in patients with cerebral infarction, and summarize its clinical application value.Methods:Based on microfluidic technology and loop mediated isothermal amplification technology, a CD microfluidic chip detection platform for simultaneous detection of CALR-1 and CALR-2 gene mutations were established, and the sensitivity, specificity, repeatability and accuracy of the platform were verified. A total of 124 patients with cerebral infarction treated in Huashan Hospital, Shanghai Medical College, Fudan University from November 2019 to March 2021 were prospectively selected into the experimental group; and 80 healthy subjects were included in the control group. The CALR-1 and CALR-2 gene mutations in anticoagulant peripheral blood samples were detected by the CD microfluidic chip. Each chip could detect 4 samples at the same time and synchronously detect 3 indexes of each sample. The detection results could be obtained after isothermal amplification for 40 min. At the same time, sequencing method was used to verify the test results, and the consistency of the results of the two detection methods was compared.Results:Using this CD microfluidic chip platform, the synchronous amplification of 3 indexes in the sample could be completed within 40 min without the need of thermal circulation, and the whole detection process of the sample could be completed within 60 min. For samples with a high concentration of target nucleic acid, typical positive signals could be visualized after amplification for 10 min, and the test results would be available within 30 minutes after receiving the samples. The detection sensitivity of CD microfluidic chip method for CALR-1 and CALR-2 mutation load concentration was 1.0% and 0.5% respectively. Nonspecific amplification was not observed for the non-target nucleic acid samples, indicating the high specificity of this method. The coincidence rates of intra and inter batch repeatability were 100% (20/20) respectively. Two samples with CALR gene mutation were found in the cerebral infarction group, both of which were CALR-1 mutations (L367fs*46). There was no CALR-1 or CALR-2 mutation in the control group. The detection results of CD microfluidic chip method were completely consistent with the sequencing verification results (100% [204/204]).Conclusions:The CD microfluidic chip method could be used for the detection of CALR-1 and CALR-2 gene mutations in clinical samples of patients with cerebral infarction. This method has the advantages of high detection sensitivity, good detection specificity, fast detection speed and high detection flux, which is helpful to clarify the etiology of patients with cerebral infarction.