Based on the theory of engineering medicine,a consensus which takes the basic medical ethics of harm reduction as the starting point is proposed to addresses the current clinical problems of a wide variety of radiotherapy setup equipments and methods,large differences by principles,and inaccurate setup.The consensus is formed in two aspects.(1)Advocate coordination of multiple setup methods for joint setup;collect,compare,analyze and screen data on setup methods;determine the operational guidelines and methods for joint setup based on the principle of standardized and unified clinical consistency,with a view to achieving the clinical purpose of greatly ensuring the precision of radiotherapy setup and radiotherapy safety without relying on the golden standard.(2)Standardize the operational methods for tracing setup deviations,so that when the difference in setup leads to poor clinical consistency,the cause of deviation can be traced and the effectiveness of different setups can be screened.Based on the concept of engineering medicine,the consensus is expected to standardize the method of radiotherapy setup,realize accurate radiotherapy,improve treatment effect and show medical ethical care.

Based on the theory of engineering medicine,a consensus which takes the basic medical ethics of harm reduction as the starting point is proposed to addresses the current clinical problems of a wide variety of radiotherapy setup equipments and methods,large differences by principles,and inaccurate setup.The consensus is formed in two aspects.(1)Advocate coordination of multiple setup methods for joint setup;collect,compare,analyze and screen data on setup methods;determine the operational guidelines and methods for joint setup based on the principle of standardized and unified clinical consistency,with a view to achieving the clinical purpose of greatly ensuring the precision of radiotherapy setup and radiotherapy safety without relying on the golden standard.(2)Standardize the operational methods for tracing setup deviations,so that when the difference in setup leads to poor clinical consistency,the cause of deviation can be traced and the effectiveness of different setups can be screened.Based on the concept of engineering medicine,the consensus is expected to standardize the method of radiotherapy setup,realize accurate radiotherapy,improve treatment effect and show medical ethical care.

Objective:To establish a prediction model using the random forest (RF) and support vector machine (SVM) algorithms to achieve the numerical and classification predictions of the gamma passing rate (GPR) for volumetric arc intensity modulation (VMAT) validation.Methods:A total of 258 patients who received VMAT radiotherapy in the 1 st Affiliated Hospital of Wenzhou Medical University from April 2019 to August 2020 were retrospectively selected for patient-specific QA measurements, including 38 patients who received VMAT radiotherapy for head and neck, and 220 patients who received VMAT radiotherapy for chest and abdomen. Thirteen complexity parameters were extracted from the patient′s VMAT plans and the GPRs for VMAT validation under the analysis criteria of 3%/3 mm and 2%/2 mm were collected. The patients were randomly divided into a training cohort (70%) and a validation cohort (30%) , and the complexity parameters for the numerical and classification predictions were screened using the RF and minimum redundancy maximum correlation (mRMR) method, respectively. Complexity models and mixed models were established using PTV volume, subfield width, and smoothness factors based on the RF and SVM algorithms individually. The prediction performance of the established models was analyzed and compared. Results:For the validation cohort, the GPR numerical prediction errors of the complexity models based on RF and SVM under the two analysis criteria are as follows. The root-mean-square errors (RMSEs) under the analysis criterion of 3%/3 mm were 1.788% and 1.753%, respectively; the RMSEs under the analysis criterion of 2%/2 mm were 5.895% and 5.444%, respectively; the mean absolute errors (MAEs) under the analysis criterion of 3%/3 mm were 1.415% and 1.334%, respectively, and the MAEs under the analysis criteria of 2%/2 mm were 4.644% and 4.255%, respectively. For the validation cohort, the GPR numerical prediction errors of the mixed models based on RF and SVM under the two analysis criteria were as follows. The RMSEs under the analysis criterion of 3%/3 mm were 1.760% and 1.815%, respectively; the RMSEs under the analysis criterion of 2%/2 mm were 5.693% and 5.590%, respectively; the MAEs under the analysis criterion of 3%/3 mm were 1.386% and 1.319%, respectively, and the MAEs under the analysis criteria of 2%/2 mm were 4.523% and 4.310, respectively. For the validation cohort, the AUC result of the GPR classification prediction of the complexity models based on RF and SVM were 0.790 and 0.793, respectively under the analysis criterion of 3%/3 mm and were 0.763 and 0.754, respectively under the analysis criterion of 2%/2 mm. For the validation cohort, the AUC result of the GPR classification prediction of the mixed models based on RF and SVM were 0.806 and 0.859, respectively under the analysis criterion of 3%/3 mm and were 0.796 and 0.796, respectively under the analysis criterion of 2%/2 mm cohort.Conclusions:Complexity models and mixed models were developed based on the RF and SVM method. Both types of models allow for the numerical and classification predictions of the GPRs of VMAT radiotherapy plans under analysis criteria of 3%/3 mm and 2%/2 mm. The mixed models have higher prediction accuracy than the complexity models.

To compare the performance of ArcCheck and film verification for volumetric intensity modulated arc therapy (VMAT) in the treatment of nasopharyngeal carcinoma, and to study the feasibility of ArcCheck in VMAT dosimetric verification. Five patients of nasopharyngeal carcinoma treated with VMAT were enrolled in this study. Dose verification was carried out by ArcCheck and film respectively. The result showed that there were no significant differences between ArcCheck and film verification. ArcCheck software can obtain three dimensional dose distribution directly with simple operation. It is convenient for ArcCheck to be used for VMAT dosimetric verification.
Carcinoma ; Humans ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Software

OBJECTIVETo explore whether there is difference in arsenicals-induced DNA damage of human lymphocyte.

METHODSLymphocyte were sterilely collected from healthy donor and exposed to sodium arsenite (AsIII), sodium arsenate(AsV) and methyl sodium arsenate(MAsv) at 1,5,10,20 and 50 mumol/L. After incubation of 24 hours, cells were collected by centrifugation and DNA damage was detected by single cell gel electrophoresis (SCGE).

RESULTSThe comet frequency distribution of all groups except 1 mumol/L group of MAsV were significantly different from that of control. The comet length of all groups except 1 mumol/L group of AsV and 1.5 mumol/L groups of MAsV were significantly higher than that of control. There were correlations between the doses of arsenicals and the ratios of comet cell or length of comet(rAsIII = 0.8134, rAsV = 0.8734, rMAsV = 0.8994).

CONCLUSIONDNA damage in human lymphocyte were induced by all the three arsenicals. A dose-effect relationship was observed between exposure doses of the same arsenical and DNA damage. With different arsenicals but the same exposure dose, the DNA damage level was as follow: AsIII > AsV > MAsV.

Arsenates ; toxicity ; Arsenites ; toxicity ; Comet Assay ; DNA Damage ; Dose-Response Relationship, Drug ; Humans ; Lymphocytes ; drug effects ; ultrastructure

Objective To evaluate the feasibility, toxicity and clinical efficacy of simultaneous modulated accelerated radiation therapy(SMART)for nasopharyngeal carcinoma. Methods Thirty eight patients with nasopharyngeal carcinoma were treated by SMART with 2.5?Gy/fraction at gross tumor volume(GTV)to a total dose of 70?Gy and 2.0?Gy/fraction at the clinical treatment volume(CTV)to a total dose of 56?Gy in 38 days. Quantitative 99m Tc pertechnetate salivary scintigraphy was used to assess the uptake and excretion index (EI、UI) of parotid gland in order to validate the value of IMRT in parotid gland sparing. Results The mean doses delivered to the GTV and CTV were 67.2?Gy and 57.0?Gy, respectively. An average of 1% of GTV and 2% of CTV received less than 90% or 95% of the prescribed dose. The mean dose to the contralateral parotid were 23?Gy and no significant decline in EI and UI as compared with significant decline in the ipsilateral parotid by 43.6% and 26.3%(P