几种应用于X-射线立体定向放射手术治疗系统中的立体定位精度测试方法

本文介绍了几种应用于立体定向放射手术治疗系统中的立体定位精度测试方法，包括钨球测试，胶片测试，电离室测试，并对各种测试方法的优缺点进行了分析。     

奥沃XK—1型以医用直线加速器为辐射源的立体定向放射手术治疗系统的研制

本文叙述了奥沃XK－1型立体定向放射手术治疗系统（简称X－刀系统）的系统构成、工作原理及主要设计计算方法，并给出了相关的计算公式说明。     

γ射线立体定向治疗系统放射防护检测结果与分析

目的 检测和分析目前运行的几种国产型号γ射线立体定向治疗系统放射防护状况,从放射卫生防护最优化角度提出放射防护建议.方法 依据国家相关放射卫生标准进行放射卫生防护监测.结果 所监测的γ射线立体定向治疗系统机房防护均符合国家有关标准.放射工作人员年个人剂量范围为0.11～1.86 mSv,其中由机房泄漏附加给工作人员的剂量范围约为0.01～0.07 mSv/a.结论 对个人剂量贡献的主要环节为治疗机房室内操作,构成比重大于90%,应重视和加强其放射防护.     

JX—300型高精度脑立体定向手术系统的研制

系统利用三维在像技术，在ＣＴ，ＭＲＩ或ＤＳＡ影像指导下，运用定位精确的弧形定向手术仪进行各种脑部手术，它不仅具有病变显示直观，定位准确，使用方便的显著优点，而且具有精度自保证的手术仿真校验，极大地保证了手术的安全和准确。     

立体定向毁损术治疗帕金森病围手术期的护理

帕金森病(Parkinson's Disease,PD)是一种慢性神经系统常见病,多发于40岁以后,主要症状包括震颤、肌僵直和行动迟缓等.以微电极导向的立体定向毁损术是目前治疗原发性帕金森病(PD)最有效的方法.毁损部位为脑组织的丘脑腹外侧核,为重要的脑组织结构.     

手术治疗高血压基底节脑出血立体定向钻空引流的疗效分析

目的比较非手术治疗与立体定向手术治疗中小量高血压基底节脑出血的临床疗效。 方法回顾性分析聊城市人民医院脑科医院神经内、外科2016年7月至2019年7月收治的182例高血压基底节性脑出血(20～40 mL)患者临床资料,其中男性102例,女性80例;年龄38～79岁,平均(52.9±1.9)岁。按照患者所接受的治疗方案将研究对象进行分组：90例采用了规范药物治疗者为非手术治疗组,92例接受了立体定向钻孔引流手术者为定向引流组。分别根据动态电子计算机断层扫描(CT)评价其排空率,在院期间再出血率和颅内感染率评价其临床安全性,平均住院日及费用评价其社会经济负担;全部随访6个月,根据病死率、改良Rankin量表评分(modified Rankin scale, mRs)评价其远期预后。 结果与非手术治疗组比较,定向引流组在发病后第7天的血肿排空率更高[(90.67±3.31)%比(25.23±2.41)%]、平均住院日缩短[(10.1±2.8)d比(20.3±3.9)d]、平均住院费降低[(18 158.1±2 171.3)元比(21 493.3±3 729.5)元],差异均有统计学意义(P<0.05),但两组的在院期间再出血率(6.7%比5.4%)和颅内感染率[1.1%(1/90)比3.3%(3/92)]的差异均无统计学意义(P>0.05)。治疗6月后,定向引流组的mRs[(2.57±0.56)分比(3.42±0.21)分]和病死率[10.0%(9/90)、2.2%(2/92)]均低于非手术治疗组,差异均有统计学意义(P<0.05)。 结论针对中小量高血压基底节性脑出血,与非手术治疗比较,立体定向手术在具备安全性的同时,临床预后更好、经济负担更低。     

四川地区立体定向手术治疗阿片类药物依赖的短期效果及其影响因素研究

目的调查四川地区立体定向手术戒除阿片类药物依赖(以下简称手术戒毒)患者的一般特征,患者术前术后复吸的原因,手术的短期戒毒效果及其影响因素。方法使用统一的问卷,采用面谈、电话访问的方法调查了208名(共228名患者参加手术)患者,并且查阅患者的病案。采用t检验、χ2检验以及logistic回归等统计方法分析数据。结果(1)患者男181人,女27人,平均年龄(29·5±5·5)岁,高中以上文化者居多,主要来自四川及周边省区,职业多样。(2)患者均有吸食阿片类毒品的历史,平均吸毒时间(7·6±3·4)年。患者均有自愿戒毒或强制戒毒史,平均戒毒(13·9±5·2)次,每次戒毒后均有复吸。(3)患者术前复吸的主要原因为不吸毒无法忍受和无法忍受戒断症状,而术后复吸的主要原因为想通过吸最后一口来证明疗效和吸毒环境的诱发。(4)手术并发症发生率为38·0%(79/208),多为一过性,在出院前消失或治愈。术后82·7%的患者无吸毒的欲望,84·6%的患者无戒断症状。手术后7个月患者的复吸率为22·1%(46/208),复吸患者的复吸次数、复吸量、对毒品的主观感觉以及复吸的欣快感较术前均有明显的降低。经单因素和多因素回归分析,文化背景(OR=3·259)、手术时间(OR=2·451)、社会支持(OR=23·256)及患者能否从事以前的工作或生活(OR=3·328),为患者发生复吸的最可能的影响因素。结论手术戒毒去除了大部分患者的对毒品的心理渴求及戒断症状。患者的复吸率有很大降低,无严重特异性手术并发症,短期疗效比较满意。发生复吸可能与患者的文化背景、手术时间、精神心理因素以及所处社会环境等有关,因此家庭和社会应加强对其的关心、理解和支持,给他们创造良好的生活、工作环境,以有利于他们彻底戒毒。     

立体定向伽马射线全身治疗系统治疗原发性肝癌的超声表现及价值

目的探讨立体定向伽马射线全身治疗系统(以下简称SGS-I)治疗原发性肝癌的超声表现及价值。方法32例原发性肝癌患者接受SGS-I治疗前后行超声检查,对比治疗前后超声改变。对3例治疗效果欠佳的病灶术后行病灶切除,观察其病理组织学改变,并与超声表现对照。结果治疗后5例(5/32,15.6%)肿块基本消失;21例(21/32,65.6%)病灶体积缩小,血流消失;27例(27/32,84.4%)病灶体积未见明显改变,但病灶回声见不同程度减低,肿块内部分出现暗区,声晕不明显,血流减少或消失,未见动脉型血流频谱。2例(2/3,66.7%)门静脉癌栓消散,9例(9/11,81.8%)少量腹水吸收。术后体积未见明显改变的27例病灶中有3例行组织病理学检查,发现SGS-I治疗区内肿瘤组织出现凝固性坏死。结论超声可以反映SGS-I治疗原发性肝癌后瘤体组织学与血供变化,对评价SGS-I治疗原发性肝癌的效果及预后具有重要价值。     

美国新一代立体定向放射外科技术——GammaART-6000~（TM）非对称性旋转伽玛系统

伽玛刀技术1967自诞生以来奠定了立体定向放射外科技术的地位。而近20年随着调强放疗技术的发展和成熟,伽玛刀技术吸收调强放疗成为了新的发展趋势。美国GAMMAART-6000TM非对称性旋转伽玛系统就从放射源的非对称分布设计、自动病人定位系统（APS）、治疗计划系统（TPS）以及QA系统方面将调强放疗技术有机的结合在了伽玛刀技术中,从而代表了立体定向放射外科技术的最新发展。     

伽玛刀剂量场测量分析及验证系统的设计和研究

介绍伽玛刀剂量场测量分析及其验证系统,同时介绍若干关键技术,并结合自行开发的检测工具和分析软件,测量分析华源伽玛刀的剂量场参数,得到较为满意的结果.     

Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy with a micro-multileaf collimator for brain metastasis in the primary motor cortex

This study aimed to assess the clinical outcomes of linear accelerators (linac)-based, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for brain metastasis in the primary motor cortex (BMPMC). Thirty-five consecutive patients with BMPMC who were treated by linac-based SRS or fSRT between January 2012 and March 2020 were analyzed. BMPMC was defined as a tumor located in the precentral gyrus on gadolinium-enhanced magnetic resonance imaging (MRI) and T2-weghted imaging (T2WI). In total, 35 patients with 37 metastases were analyzed. The median follow-up time was 13 (range: 1–97) months. The tumor volume was 0.05–26.5 (median: 0.62) cm³. All patients were treated with SRS or fSRT using 35 Gy with 7 Gy per fraction daily. The median survival time (MST) was 16.9 months. The pretreatment KPS and RPA class significantly differed in terms of MST on the log-rank tests. Seven symptomatic patients had hemiparesis before SRS or fSRT. All symptomatic patients, except one with facial paresis and one who died within 3 months, experienced improvement at a 3 month follow-up. None of the patients presented with persistent radiation injury at the final follow-up. Two patients presented with grade 3 radiation-related central nervous system necrosis, which was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. In BMPMC, SRS and fSRT had good tumor control and did not cause serious complications. Therefore, they are suitable treatment options with an acceptable safety profile.     

Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy for vestibular schwannomas: comparative observations of 139 patients treated at a single institution

Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) have been recognized as an alternative to surgery for small to medium sized vestibular schwannoma (VS). This study analysed and compared the outcomes of VS treated with the first Thailand installation of a dedicated Linac-based stereotactic radiation machine using single-fraction radiosurgery (SRS), hypofraction stereotactic radiotherapy (HSRT) and conventional fraction stereotactic radiotherapy (CSRT). From 1997 to 2010, a total of 139 consecutive patients with 146 lesions of VS were treated with X-Knife at Ramathibodi hospital, Bangkok, Thailand. SRS was selected for 39 lesions (in patients with small tumors ≤3 cm and non-serviceable hearing function), whereas HSRT (79 lesions) and CSRT (28 lesions) were given for the remaining lesions that were not suitable for SRS. With a median follow-up time of 61 months (range, 12–143), the 5-year local control rate was 95, 100 and 95% in the SRS, HSRT and CSRT groups, respectively. Hearing preservation was observed after SRS in 75%, after HSRT in 87% and after CSRT in 63% of the patients. Cranial nerve complications were low in all groups. There were no statistically significant differences in local control, hearing preservation or complication between the treatment schedules. In view of our results, it may be preferable to use HSRT over CSRT for patients with serviceable hearing because of the shorter duration of treatment.     

The clinical outcome of intracranial hemangioblastomas treated with linac-based stereotactic radiosurgery and radiotherapy

Recent publications have reported stereotactic radiosurgery as an effective and safe treatment for intracranial hemangioblastomas. However, because of the low incidence of these particular tumors, reports on large patient number studies have not yet been available. The objective of this study was to analyze the clinical results of 14 patients with 56 intracranial hemangioblastomas treated with linear accelerator (linac)-based stereotactic radiosurgery (SRS) and radiotherapy (SRT) in the same institute. The median age of patients was 41 years (range, 28–73 years). Nine of the patients (64%) had von Hippel-Lindau disease. A total of 39 lesions (70%) were treated with CyberKnife (CK), and 17 lesions (30%) were treated with X-Knife. The median pretreatment volume was 0.26 cm³ (range, 0.026–20.4 cm³). The median marginal dose was 20 Gy (range, 10–32 Gy) in 1 fraction (range, 1–10 fractions). The median follow-up time was 24 months (range, 11–89 months). At the last follow-up, 47 tumors (84%) were stable, 7 (13%) decreased and 2 (4%) increased. The 1-, 2- and 6-year local control rates were 98%, 88% and 73%, respectively. No radiation complications were observed in this study. There was a trend toward local failure only in cystic tumors, but this trend was not found to be statistically significant. SRS/SRT achieved a high local control rate in intracranial hemangioblastomas without radiation-induced complications.     

伽玛刀3.0T磁共振定位降低皮肤灼伤与感染发生率的方法

目的 控制磁共振射频能量(SAR)影响参数,以降低头部伽玛刀治疗时,在3.0T磁共振定位中局部皮肤的灼伤与感染发生率.方法 对200例伽玛刀3.0T磁共振定位患者进行临床随机分组研究,试验组100例患者选择合适扫描序列、调整TR参数等措施以控制射频能量进行磁共振定位,对照组100例患者采用常规方法磁共振定位.结果 试验组手术后7例患者有头架固定头钉部的局部轻度灼伤,发生率为7.0％;对照组常规方法定位有28例患者头架固定头钉部的局部轻度灼伤,发生率为28.0％,两组间感染发生率差异有统计学意义(P＜0.01).结论 合理调整SAR影响参数,控制射频能量,可以明显控制伽玛刀3.0T磁共振定位中的局部灼伤与感染,使患者缩短住院床日,早日康复出院.     

医用加速器反光镜的替代及对X线PDD的影响

目的探讨国产玻璃镜片替代进口加速器反光镜后,对射野等中心、对称性、均整性、重合性及MV级X射线百分深度剂量的影响。方法在不同厚度和材质的镜片及机头不同角度条件下,使用胶片法及三维水箱OAR、PDD测量法进行数据采集,分析比较不同镜片的影响情况。结果普通玻璃4mm镜片对射野PDD影响误差最大为6%;经8MVX线720Gy剂量照射后,灯光野出现双影十字线,亮度变暗。石英玻璃1.5mm镜片对射野PDD、OAR、等中心无明显影响,PDD误差<1%。接受同等剂量,灯光野无明显变化。结论普通4mm玻璃镜片不宜作MV级X线医用加速器的反光镜。采用薄型石英玻璃替代进口加速器反光镜较佳,PDD误差小。     

发展性测评体系在护生病理学实验教学中的应用

为提高学护生的能力,笔者在护理专业病理实验课中,积极开展体现培养的卫生职业人才目标的发展性测评体系教学,结果发现此种测评法的教学能明显促进护生的全面发展.     

化工系列精品期刊的整体规划与经营特点

【目的】探索科技期刊规模化的可行之道。【方法】以化学工业出版社化工系列精品期刊建设为例,总结了在合理的整体规划下每种期刊的办刊特色,探索化工期刊系列化的途径。【结果】从整体规划出发,以建构合理的化工刊群为目标,夯实《化工学报》、《中国化学工程学报》（英文版）的学术基础,以名刊带动新刊发展,提高社会效益;以技术期刊《化工进展》为平台,提升经营能力和经济效益;以创办新兴交叉学科新刊《生物产业技术》和《储能科学与技术》为增长点,实现刊群的可持续发展。【结论】走规模化办刊之路是科技期刊在现行体制下的一种现实选择。     

The development and testing of a measure assessing clinician beliefs about patient self-management

Background  Clinicians have been slow to embrace support for patient self-management.
Objective  To explore clinicians' beliefs about patient self-management and specifically assess which patient competencies clinicians believe are most important for their patients.
Methods  Using items adapted from the Patient Activation Measure (PAM) as a basis, a new measure that assesses clinicians' beliefs about patient self-management was created using Rasch analysis. The development and testing of the new measure Clinician Support for Patient Activation Measure (CS-PAM) is described here. Primary care clinicians from the UK and the USA were recruited to participate in the survey ( n  = 175).
Findings  The CS-PAM reliably measures clinician attitudes about the patient role in the care process. Clinicians strongly endorse that patients should follow medical advice but are less likely to endorse that patients should be able to make independent judgements or take independent actions. Endorsed to a lesser degree was the idea that patients should be able to function as a member of the care team. Least endorsed was the notion that patients should be independent information seekers.
Discussion  Clinicians' views appear to be out of step with current policy directions and professional codes. Clinicians need support to transition to understand the need to support patients as independent actors.