Objective To investigate the impact of statistical uncertainty per control point(SUpCP)on dose calculation on volumetric modulated arc therapy(VMAT)for rectum cancer,and to analyze the accuracy and efficiency of calculation.Methods 19 patients with rectum cancer undergoing radiotherapy were selected.The initial VMAT plans were generated on Monaco TPS using SUpCP=3,then changed SUpCP in the dose calculation process as follow:10 SUpCPs(1～10)for each patient,and totally190 VMAT dose distributions were obtained.For plan evaluation,Dmax,Dmean,D95%,V50,homogeneity index(HI),conformity index(CI)of the planning target volume(PTV),dissymmetric variations of bladder,small intestine and femoral head,and time calculation(Time)were analyzed.Patient specific quality assurance(PSQA),dose deviation of isocenter(ΔDISO)and passing rate of three-dimensional dose distribution(γ33,γ32,γ22)between calculated and delivered radiation doses were measured.Results AsSUpC increased,Dmax and HI of PTV,Dmax of bladder were increased,but D95%and V50 of PTV,Time,γ32 and γ22 were decreased(P<0.05).Dmax and CI of PTV,Dmean of bladder,Dmax and Dmean of small intestine and femoral head,ΔDISO and γ33 showed no statistical significance(P>0.05).When ΔDISO<1%,gamma passing rate>90%for all VMAT plan.When SUpCP<6,Dmax of PTV<110%of the prescribed dose was obtained;while SUpCP>2,time for dose calculation was less than 5 min.Conclusion For VMAT plan of rectum cancer on Monaco TPS using XVMC algorithm,3%～5%of statistical uncertainty per control point for dose calculation,and 3%2 mm or 2%2 mm gamma criteria for three-dimensional dose verification is recommended.This study provides clinical application basis for precise dose calculation of VMAT plan of rectum cancer.

Objective:To evaluate the impact of bladder volume on dosimetric parameters of clinical target volume (CTV) and organs at risk (OAR) of intensity modulated proton therapy (IMPT) for localized prostate cancer during the treatment planning and daily treatment.Methods:Clinical data of 25 patients with localized prostate cancer admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 and enrolled in the "Proton Therapy System" (SAPT-PS-01) registered clinical trial were retrospectively analyzed. All patients were male and the median age was 72 years old. A total of 30 sets of IMPT plans were obtained. Based on the planning CT (30 sets) and weekly verification CT during treatment (172 sets), bladder volume, CTV and OAR dose parameters were collected. Spearman correlation analysis was used to evaluate the correlation between bladder volume in CT and the dosimetric parameters of CTV and OAR during IMPT plans, and Wilcoxon-Mann-Whitney test was adopted to compare the dosimetric parameters of CTV and OAR among different bladder volume change groups.Results:The V 95% of CTV1 and CTV2 were both 100.0%±0.0% in IMPT plans. Bladder volume was significantly negatively correlated with D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder ( P<0.001, 0.003, <0.001, <0.001,<0.001), and D mean, V 50 Gy(RBE) of the small intestine (both P<0.001). During treatment, bladder D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE)( P<0.001, 0.001, <0.001, <0.001, <0.001), rectal D mean, V 50 Gy(RBE), V 40 Gy(RBE) (all P<0.001), small intestine D mean, V 50 Gy (RBE) (both P<0.001) of patients with bladder volume increase >20% compared to baseline were significantly decreased compared to those in IMPT plans. But CTV1 V 100%, and CTV2 V 95% were significantly decreased too( P=0.029, 0.020). In the bladder volume decreased>20% patients, the D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder were significantly increased compared to those in IMPT plans (all P<0.001). However, a bladder volume reduction of ≤20% and increase of ≤20% from baseline had no significant impact on CTV and OAR dosimetric parameters during treatment. Conclusions:For patients with localized prostate cancer undergoing proton therapy, a certain bladder volume should be ensured during planning CT scans. During the daily treatment, the bladder volume should be maintained between 80%-120% of the baseline level to ensure CTV coverage and good dose sparing to OAR.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To analyze the status quo and influencing factors of the equity,accessibility and sustainability of the development of medical insurance for urban and rural residents in 2021,and provide a reference for improving the management and service level of medical insurance.Methods:Firstly,the"evaluation index system of medical insurance for urban and rural residents"was constructed,and the total index of the development level of medical insurance and its three subsystem indexes of equity,accessibility and sustainability were calculated.Secondly,the Theil index was used to measure the level differences of the three major regions in the east,central and west,and the spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity distribution pattern of the total index.Finally,a geographic weighted regression model was constructed to analyze the main influencing factors.Results:There were provincial differences in the development level of medical insurance,which showed a decreasing trend from east to west in geography and a random distribution pattern in space.Policy factors,economic factors,population structure,medical resource allocation and education level had a significant impact on the development level of medical insurance.Conclusions:It is proposed to promote the fairness at multiple levels,enhance the accessibility in all directions and dynamically improve the sustainability,and further explore the policy suggestions to improve the management and service level and enhance the residents'sense of experience,sense of gain and sense of happiness.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To analyze the status quo and influencing factors of the equity,accessibility and sustainability of the development of medical insurance for urban and rural residents in 2021,and provide a reference for improving the management and service level of medical insurance.Methods:Firstly,the"evaluation index system of medical insurance for urban and rural residents"was constructed,and the total index of the development level of medical insurance and its three subsystem indexes of equity,accessibility and sustainability were calculated.Secondly,the Theil index was used to measure the level differences of the three major regions in the east,central and west,and the spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity distribution pattern of the total index.Finally,a geographic weighted regression model was constructed to analyze the main influencing factors.Results:There were provincial differences in the development level of medical insurance,which showed a decreasing trend from east to west in geography and a random distribution pattern in space.Policy factors,economic factors,population structure,medical resource allocation and education level had a significant impact on the development level of medical insurance.Conclusions:It is proposed to promote the fairness at multiple levels,enhance the accessibility in all directions and dynamically improve the sustainability,and further explore the policy suggestions to improve the management and service level and enhance the residents'sense of experience,sense of gain and sense of happiness.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To analyze the status quo and influencing factors of the equity,accessibility and sustainability of the development of medical insurance for urban and rural residents in 2021,and provide a reference for improving the management and service level of medical insurance.Methods:Firstly,the"evaluation index system of medical insurance for urban and rural residents"was constructed,and the total index of the development level of medical insurance and its three subsystem indexes of equity,accessibility and sustainability were calculated.Secondly,the Theil index was used to measure the level differences of the three major regions in the east,central and west,and the spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity distribution pattern of the total index.Finally,a geographic weighted regression model was constructed to analyze the main influencing factors.Results:There were provincial differences in the development level of medical insurance,which showed a decreasing trend from east to west in geography and a random distribution pattern in space.Policy factors,economic factors,population structure,medical resource allocation and education level had a significant impact on the development level of medical insurance.Conclusions:It is proposed to promote the fairness at multiple levels,enhance the accessibility in all directions and dynamically improve the sustainability,and further explore the policy suggestions to improve the management and service level and enhance the residents'sense of experience,sense of gain and sense of happiness.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To analyze the status quo and influencing factors of the equity,accessibility and sustainability of the development of medical insurance for urban and rural residents in 2021,and provide a reference for improving the management and service level of medical insurance.Methods:Firstly,the"evaluation index system of medical insurance for urban and rural residents"was constructed,and the total index of the development level of medical insurance and its three subsystem indexes of equity,accessibility and sustainability were calculated.Secondly,the Theil index was used to measure the level differences of the three major regions in the east,central and west,and the spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity distribution pattern of the total index.Finally,a geographic weighted regression model was constructed to analyze the main influencing factors.Results:There were provincial differences in the development level of medical insurance,which showed a decreasing trend from east to west in geography and a random distribution pattern in space.Policy factors,economic factors,population structure,medical resource allocation and education level had a significant impact on the development level of medical insurance.Conclusions:It is proposed to promote the fairness at multiple levels,enhance the accessibility in all directions and dynamically improve the sustainability,and further explore the policy suggestions to improve the management and service level and enhance the residents'sense of experience,sense of gain and sense of happiness.