彩色多普勒超声在子宫动脉化疗栓塞术治疗子宫瘢痕妊娠中的应用

目的:探讨彩色多普勒超声在子宫动脉栓塞术治疗子宫瘢痕妊娠中的应用价值。方法:回顾性分析彩色多普勒超声在30例子宫瘢痕妊娠患者子宫动脉化疗栓塞术前的诊断价值、对栓塞术后的疗效评价及超声引导下刮宫术及术后随访中的作用。结果:术前诊断:超声显示25例表现为子宫峡部包块型,5例表现为子宫峡部孕囊型;27例孕囊周边有较丰富的血流信号,25例阻力指数<0.5;峡部最薄处厚度(2.31±0.42)mm。子宫动脉栓塞术后24～72h超声表现:29例包块内或孕囊周边均未见明显血流信号,1例仍可见丰富血流信号,再次行子宫动脉栓塞术,24h后复查超声示病灶内血流消失。栓塞术后超声成功引导刮宫术,超声随访所有患者两个月内包块均消失,月经恢复。结论:超声既能准确诊断CSP又可对子宫动脉栓塞术后的疗效进行全面评价并引导清宫术及术后有效随访,值得进一步推广应用。     

呼吸运动对肺部肿瘤靶区受照剂量分布影响的研究

Objective To investigate the influence of respiratory motion on target dose distribution in radiotherapy for patients with lung tumors. Methods The Big Bore Brilliance CT with bellows system was used to gain the 4DCT sets and respiratory frequency information of the patients. The moving ranges of the tumors in left-right (LR), anterior-posterior (AP) and cranial-caudal (CC) directions were measured from the center coordinate values of gross tumor volume of ten time-phase CT sets in the treatment planning sys-tem. Then a breathing model was used to simulate the tumor motions due to respiration. A 4-dimensional motion table was used to mimic the motion of lung tumor in beams-eye-view (BEV). A 2-dimensional semi-conductor beams measurement system was fixed to the table to measure the 2-dimensional dose distribution of static and dynamic targets using the treatment beams at gantry angle of 0°. Finally, the differences of the dose distribution between the static and moving phantom were compared and analyzed with the statistical soft-ware R. Results When the amplitude (half of the moving rang) in the CC direction was 1 cm, the passing ratio of relative dose difference ≤4% in one beam field was minimal (1.1%), and there was 58% maximal relative dose absence. The 4% passing ratios media in the CC direction were 94.7%, 79.4%, 58.6% and 37.1% in <0.25, 0.25-<0.50, 0.50- <0.75 and ≥0.75 mm amplitude (X<'2>=29.20,P=0.000), but were all similar in the AP and LR directions. The mean value of the relative dose change in the high dose area was smaller than the low dose area in the 89% beam fields. When only the CC direction was consid-ered, the 4% passing ratio of 3.6 s and 8.2 s period was 72% and 60%, respectively. Conclusions The amplitude in the CC direction is a factor impacting the dose distribution of the moving target. The influence of respiratory motion on high dose area is more than that on low dose area. When the other respiratory param-eters are fixed, the motion of long period has more influence on the dose than that of short period. Special at-tention should be paid to the patients with tumor of more than 0.5 cm amplitude in the CC direction when planning the intensity modulated radiotherapy.     

呼吸运动对肺部肿瘤靶区受照剂量分布影响的研究

Objective To investigate the influence of respiratory motion on target dose distribution in radiotherapy for patients with lung tumors. Methods The Big Bore Brilliance CT with bellows system was used to gain the 4DCT sets and respiratory frequency information of the patients. The moving ranges of the tumors in left-right (LR), anterior-posterior (AP) and cranial-caudal (CC) directions were measured from the center coordinate values of gross tumor volume of ten time-phase CT sets in the treatment planning sys-tem. Then a breathing model was used to simulate the tumor motions due to respiration. A 4-dimensional motion table was used to mimic the motion of lung tumor in beams-eye-view (BEV). A 2-dimensional semi-conductor beams measurement system was fixed to the table to measure the 2-dimensional dose distribution of static and dynamic targets using the treatment beams at gantry angle of 0°. Finally, the differences of the dose distribution between the static and moving phantom were compared and analyzed with the statistical soft-ware R. Results When the amplitude (half of the moving rang) in the CC direction was 1 cm, the passing ratio of relative dose difference ≤4% in one beam field was minimal (1.1%), and there was 58% maximal relative dose absence. The 4% passing ratios media in the CC direction were 94.7%, 79.4%, 58.6% and 37.1% in <0.25, 0.25-<0.50, 0.50- <0.75 and ≥0.75 mm amplitude (X<'2>=29.20,P=0.000), but were all similar in the AP and LR directions. The mean value of the relative dose change in the high dose area was smaller than the low dose area in the 89% beam fields. When only the CC direction was consid-ered, the 4% passing ratio of 3.6 s and 8.2 s period was 72% and 60%, respectively. Conclusions The amplitude in the CC direction is a factor impacting the dose distribution of the moving target. The influence of respiratory motion on high dose area is more than that on low dose area. When the other respiratory param-eters are fixed, the motion of long period has more influence on the dose than that of short period. Special at-tention should be paid to the patients with tumor of more than 0.5 cm amplitude in the CC direction when planning the intensity modulated radiotherapy.     

超声诊断原发性腹膜癌1例

<正>原发性腹膜癌(Primary peritoneal carcinoma,PPC)是一种起源于腹膜间叶组织,并引起腹盆腔弥漫性癌变的恶性肿瘤。其发病率低,起病隐匿,患者的临床表现酷似晚期卵巢癌;加上临床医师对该病认识不足,因此术前误诊率高。为提高诊断准确率,现将本院收治的1例PPC患者资料总结如下。     

恶性腱鞘巨细胞瘤彩色多普勒超声表现1例

<正>患者,男,38岁,无意中发现左膝部包块,无疼痒不适,两月来渐增大,遂来就诊。查体:左膝内侧见大小约5.0 cm×4.0 cm×3.0 cm的包块,轻压痛,质硬光滑,活动度可,与周围组织似有粘连,局部皮温不高,皮肤色泽及感觉正常,左膝部无活动受限。超声表现:左侧膝关节内侧皮下见一大小约3.9 cm×3.2 cm×1.4 cm的低回声区,形态不规     

抓住机遇迎接挑战--科技自主创新时代的医学研究与医学期刊发展

2006年1月9日在北京人民大会堂召开的全国科学技术大会上,胡锦涛总书记明确提出到2020年使我国的自主创新能力显著增强,进入创新型国家行列,并在其后的全国人民代表大会上通过,使之成为我国未来15年科技发展的纲领性文件.     

二维超声在急性胰腺炎诊断分型中的价值探讨

目的探讨二维超声在胰腺炎的诊断价值并试图分型。方法对116例急性胰腺炎进行一次或多次B超检查。结果B超分型①急性水肿型73例(63％)，超声表现为胰腺弥漫性肿大，边缘清晰，实质回声减低。其中4例手术后，病理主要表现为胰腺间质的水肿、充血。超声表现与病理大致吻合；②出血坏死型21例(18％)，超声表现为胰腺增大，边缘模糊，回声减低且不均匀，其中16例手术，病理主要为胰腺实质的局灶性或融合性坏死，细胞结构消失。超声表现与病理吻合。结论二维超声根据超声表现，结合临床，对急性胰腺炎初步分型，能为临床提供有价值的参考。     

几种图像处理方法在照射野验证中的应用

照射野验证是实施精确放射治疗质量保证(QA)的关键步骤之一.照射野影像对比度低、图像质量差使常规照射野验证易产生误差.本文比较了直方图均衡化、开窗式转换、锯齿波转换及窗式锯齿波转换图像处理方法处理双曝光照射野影像的优劣,并说明了透视、开窗及卷帘融合显示方式的应用.对照射野影像进行图像处理可以改善图像质量,有助于进行准确的解剖登记;将经解剖登记后的照射野影像与参考影像进行融合显示有助于目测分析解剖结构配准的准确性和进行定性的验证分析,从而减小验证误差,有效提高验证的准确性.     

中国医学物理学科的建设与探索专家共识

本共识围绕医学物理学科的教育现状、专业方向建设、课程设计、实习要求及研究生毕业标准等方面探讨了中国医学物理学科的建设与发展,以应对社会对健康与医疗服务需求的增长及医疗设备国产化的挑战。目前,中国医学物理教育面临教育途径多样性、课程设计差异性、师资短缺等问题,在此,讨论了整合国际经验,构建全面、规范化的医学物理学科体系的策略,体系涵盖放射治疗物理、医学影像物理、核医学物理、放射防护物理、放射生物物理及放射工程物理等方向,并强调人工智能技术的融合,以提高诊疗的准确性和效率。此外,还探讨了医学物理研究生教育的改进,包括师资和教学环境建设、专业课程设置等;还需建立教学质量评估机构,确保教育内容与国际标准一致,反馈学生和雇主的需求。本共识提倡全面提升医学物理学科的规模和影响力,提升教育质量和专业水平,实现教育的精细化和精英化,并加强国内外合作,以期达到国际先进水平,支撑“健康中国2030”政策目标。     

前列腺癌131Cs和125I及103Pd粒子植入剂量学研究

目的 比较131Cs,125I和103Pd粒子组织问永久性植入治疗前列腺癌剂量学特性.方法 随机选择25例曾接受125I粒子永久性植入早期(T1-T2c期)前列腺癌患者,使用Prowess Brachytherpay 3.1粒子植入治疗计划系统重新设计3种粒子植入计划.经直肠超声采集横断面图像上勾画前列腺、尿道前列腺段和直肠前壁,不再在前列腺基础上外放边界勾画PTV13.Cs、125I、103Pd计划处方剂量分别为115、145、125 Gy,粒子活度分别为1.8、0.5、1.8 U.计划目标为前列腺V100=95%、D90≥100%,尿道前列腺段UD10≤150%.比较不同计划前列腺、尿道和直肠剂量分布,以及植入粒子数和植入针数.各参数间差异的统计学检验使用单因素方差分析.结果 103Pd、125I和131Cs计划的前列腺V200分别为28.7%、20.9%和19.6%(F=42.50,P=0.000),V150分别为51.9%、42.1%和39.4%(F=26.15,P=0.000),V100分别为95.4%、95.3%和95.5%(F=2.01,P=0.142),D90分别为108.9%、107.8%和108.O%(F=1.41,P=0.252).平均UV120分别为26.9%、29.5%和23.8%(F=0.37,P=0.691),平均直肠RVl册分别为0.31、0.22和0.19 cm3(F=0.43,P=0.652).每cm3前列腺体积平均植入粒子数分别为2.02、2.01和1.87(F=1.92,P=0.154)、平均粒子植入针数分别为33.6、32.9和31.6(F=0.26,P=0.772).结论 131Cs粒子永久性植入治疗前列腺癌靶Ⅸ剂量最均匀,而对直肠和尿道剂量、植入粒子数和植入针数有降低的可能.