Objective:To evaluate the acute toxicities and related influencing factors of vertebral-body-sparing proton craniospinal irradiation (VBSpCSI) using pencil beam scanning (PBS) technology in pediatric patients, and to assess spinal growth and survival outcomes.Methods:A retrospective analysis was conducted on 70 pediatric patients treated with PBS-based VBSpCSI at Hebei Yizhou Cancer Hospital between January 2020 and December 2022, and continued to follow up until November 2023. Acute toxicities were assessed, and linear regression analysis combined with receiver operating characteristic curve were employed to investigate the dose-effect relationship between vertebral dose and toxicities. Spinal growth after radiotherapy was evaluated by measuring the Cobb angle on follow-up MRI. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method.Results:The median age of patients at the time of irradiation was 6 years (range, 2-16 years). Two patients (3%) developed grade ≥3 gastrointestinal toxicities, while 7 patients (10%) experienced grade 1 radiation-induced esophagitis. The nadirs of white blood cell count (WBC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) during treatment were significantly negatively correlated with vertebral V 5 Gy ( P=0.009, 0.006, 0.001) and vertebral V 20 Gy ( P=0.007, 0.011, <0.001). When vertebral V 5 Gy<86.5% and vertebral V 20 Gy<73.2%, the incidence of grade ≥3 myelosuppression was significantly reduced ( P<0.001, =0.001). Additionally, younger patient age (in months) and concurrent chemotherapy were also significantly associated with increased acute hematologic toxicity. Among 43 patients with MRI follow-up, no scoliosis, kyphosis, or chronic lumbosacral pain was observed. The 3-year OS and PFS rates were 95.7% and 86.4%, respectively. Conclusions:PBS-based VBSpCSI in pediatric patients demonstrates manageable acute toxicities, with a clear dose-effect relationship between vertebral V 5 Gy , V 20 Gy and hematologic toxicities, and the incidence of non-hematological toxicities remains low. No adverse effects on spinal growth or survival outcomes were observed in the short term.

Objective:To construct a performance evaluation system based on the balanced scorecard (BSC) and key performance indicators (KPI) for medical equipment management in order to effectively measure the management level of medical institutions for medical equipment. Methods:On the basis of literature research and expert consultation,an input,process,output and outcome (IPOO) framework was constructed to describe KPI of medical equipment management based on BSC analysis method. The weights of evaluation indicators were confirmed by factor analysis,and a performance evaluation system for medical equipment management was established. Four medical institutions (hospital 1-4) in Taizhou were selected from June 2023 to October 2023 according to the research items of Kangda College of Nanjing Medical University,and the medical equipment which purchase amount exceeded 500,000 CNY of 4 hospital from 2012 to 2022 were selected. The running data of 2022 was collected,and the management level of 4 hospitals for medical equipment were assessed by this evaluation system. Results:The constructed performance evaluation system about medical equipment management included 4 first-level indicators and 28 second-level indicators. The second-level indicators included 8 input KPI,8 process KPI,6 output KPI,and 6 outcome KPI. The weights of input,process,output and outcome were respectively 0.2853,0.2783,0.2066 and 0.2298. The comprehensive scores of average performance of medical equipment management in hospital 1-4 were respectively 78.88,71.27,66.32 and 70.87 points. The management level of hospital 1 and hospital 2 was better than that of Hospital 3 and Hospital 4. Conclusion:The constructed performance evaluation system of medical equipment management can quantitatively evaluate the management process of medical equipment,and find weak links,and provide continuous improvement,which can provide direction and basis for medical engineering department in improving its performance level.

Objective:To construct a performance evaluation system based on the balanced scorecard (BSC) and key performance indicators (KPI) for medical equipment management in order to effectively measure the management level of medical institutions for medical equipment. Methods:On the basis of literature research and expert consultation,an input,process,output and outcome (IPOO) framework was constructed to describe KPI of medical equipment management based on BSC analysis method. The weights of evaluation indicators were confirmed by factor analysis,and a performance evaluation system for medical equipment management was established. Four medical institutions (hospital 1-4) in Taizhou were selected from June 2023 to October 2023 according to the research items of Kangda College of Nanjing Medical University,and the medical equipment which purchase amount exceeded 500,000 CNY of 4 hospital from 2012 to 2022 were selected. The running data of 2022 was collected,and the management level of 4 hospitals for medical equipment were assessed by this evaluation system. Results:The constructed performance evaluation system about medical equipment management included 4 first-level indicators and 28 second-level indicators. The second-level indicators included 8 input KPI,8 process KPI,6 output KPI,and 6 outcome KPI. The weights of input,process,output and outcome were respectively 0.2853,0.2783,0.2066 and 0.2298. The comprehensive scores of average performance of medical equipment management in hospital 1-4 were respectively 78.88,71.27,66.32 and 70.87 points. The management level of hospital 1 and hospital 2 was better than that of Hospital 3 and Hospital 4. Conclusion:The constructed performance evaluation system of medical equipment management can quantitatively evaluate the management process of medical equipment,and find weak links,and provide continuous improvement,which can provide direction and basis for medical engineering department in improving its performance level.

Objective:To evaluate the acute toxicities and related influencing factors of vertebral-body-sparing proton craniospinal irradiation (VBSpCSI) using pencil beam scanning (PBS) technology in pediatric patients, and to assess spinal growth and survival outcomes.Methods:A retrospective analysis was conducted on 70 pediatric patients treated with PBS-based VBSpCSI at Hebei Yizhou Cancer Hospital between January 2020 and December 2022, and continued to follow up until November 2023. Acute toxicities were assessed, and linear regression analysis combined with receiver operating characteristic curve were employed to investigate the dose-effect relationship between vertebral dose and toxicities. Spinal growth after radiotherapy was evaluated by measuring the Cobb angle on follow-up MRI. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method.Results:The median age of patients at the time of irradiation was 6 years (range, 2-16 years). Two patients (3%) developed grade ≥3 gastrointestinal toxicities, while 7 patients (10%) experienced grade 1 radiation-induced esophagitis. The nadirs of white blood cell count (WBC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) during treatment were significantly negatively correlated with vertebral V 5 Gy ( P=0.009, 0.006, 0.001) and vertebral V 20 Gy ( P=0.007, 0.011, <0.001). When vertebral V 5 Gy<86.5% and vertebral V 20 Gy<73.2%, the incidence of grade ≥3 myelosuppression was significantly reduced ( P<0.001, =0.001). Additionally, younger patient age (in months) and concurrent chemotherapy were also significantly associated with increased acute hematologic toxicity. Among 43 patients with MRI follow-up, no scoliosis, kyphosis, or chronic lumbosacral pain was observed. The 3-year OS and PFS rates were 95.7% and 86.4%, respectively. Conclusions:PBS-based VBSpCSI in pediatric patients demonstrates manageable acute toxicities, with a clear dose-effect relationship between vertebral V 5 Gy , V 20 Gy and hematologic toxicities, and the incidence of non-hematological toxicities remains low. No adverse effects on spinal growth or survival outcomes were observed in the short term.