肺屏蔽块对全身照射剂量分布的影响

目的：探讨全身照射（ＴＢＩ）中为控制肺剂量所采用肺屏蔽挡块对剂量分布的影响。方法：利用三维自动扫描水箱按实际ＴＢＩ照射条件测量三种厚度不同的肺铅挡块下，水模体中剂量分布情况。结果：加肺档块使纵膈区剂量减少，肺挡因子与测量的深度有关。结论：肺挡因子应在照射条件下测量。在全身照射总剂量与肺部限受剂量相差较大时，应注意纵膈剂量的修正。     

鼻咽癌动态调强与静态调强放疗的比较

目的：比较鼻咽癌动态调强与静态调强放疗计划设计与执行及剂量分布的区别：方法：记录从计划到实施的全过程以比较动态调强与静态调强实施难易程度及耗时长短。分别比较两者的靶区及危及器官的剂量分布差异。分别对两者进行剂量学验证，比较两者剂量验证结果的差异。结果：两者从计划到实施的方法、难易程度均相同：动态调强各个靶区的适形度、均匀度均优于或等于静态调强，静态调强的子野越多适形度、均匀度越好。各个危及器官受量大部分相同，但两侧腮腺平均剂量静态调强略小于动态调强，且静态调强的子野越少腮腺平均剂量越低。两者的剂量学验证结果基本一致。静态调强治疗时间略长于动态调强。结论：动态调强靶区剂量分布优于静态调强，静态调强子野越多靶区剂量分布越好。两者的危及器官受量大体相当，静态调强似乎更有利于保护腮腺等正常器官。总体上讲，鼻咽癌动态凋强放疗略优于静态调强。     

脑室肿瘤放射治疗的剂量分布测量

放射治疗的根本目标在于给肿瘤区域足够的精确治疗剂量，而使周围正常组织和器官受照射量最小。提高肿瘤的局部控制率，减少正常组织的放射并发症，而实现这个目标的关键是取决于治疗剂量的精确实施和脑剂量分布的优劣。本工作根据临床常用的三种治疗方案，用ＴＬＤ剂量元件和剂量胶片，利用人体等效非均匀头模，检验治疗计划系统剂量分布理论计算结果     

体元大小对基于MonteCarlo的剂量计算的影响

目的：在放射治疗计划系统中,剂量计算之前需要对人体密度数据体元化。对于蒙特卡罗方法的模拟过程,当一个自由程跨过体元界面时,会应用自由程近似。选取的体元越小,将导致越多的自由程近似。本文采用蒙特卡罗方法模拟一个虚拟射线源入射到水箱中的反应,计算水箱中的剂量分布,通过比较水箱分层和不分层两种情况下中心轴百分深度剂量分布和离轴比分布,来探讨选用不同大小的体元对剂量分布的影响。方法：本文以6MeV的方形电子射线源为外照射源、以三维水箱为介质模型。使用PENELOPE程序包模拟电子束垂直入射到水箱中引起的电子与物质的相互作用。比较水箱在分层和不分层情况下中心轴百分深度剂量和离轴比分布。结果：通过比较水箱在分层和不分层情况下中心轴百分深度剂量和离轴比分布,发现差异很小。结论：选用不同大小的体元,蒙特卡罗近似处理自由程对剂量计算精度的影响很小。研究结果对蒙特卡罗方法在放射治疗中的临床应用具有指导意义。     

基于DPM的放射治疗剂量分布计算

目的：利用蒙特卡罗方法模拟放射治疗的剂量分布。方法：通过改写蒙特卡罗剂量计算软件-DPM（dose planning method）扩展其功能。编程实现了DPM仿真模型的建市、输入文件的转化以及计算结果的可视化。结果：改写后的DPM不仅可以处理结构化介质。尤其又具有处理人体三维CT数据的能力。实验结果表明该方法的正确性、有效性。结论：探索了用DPM进行精确剂量计算的路径，对于提高放射治疗计划水平具有重要的指导意义和应用价值。     

调强放射治疗头-颈部仿生模型及临床应用

目的：为满足调强适形放射剂量分布和剂量大小的测试与验证。材料与方法：采用调强放射治疗仿真体模按中国人体50百分位参数，用透明全能谱组织等效材料制成，使体模具有高度仿生性、可视性，模拟了十个器官。既是人体解剖的模型，又是组织等效的放射诊断模型、放射治疗模型、医学影像训练模型。将病人的实际治疗计划移植在仿生体模上进行真实照射，用电离室测量归一点绝对剂量，用胶片剂量仪量仪测试某一层面相对剂量分布。结果：应用表明，可实现多种剂量仪(电离室、胶片剂量仪)的归一化对比。结论：该模型可用于放疗设备机械精度的校正；靶点、靶体积剂量验证；临近重要器官剂量分布测定；保证剂量不确定度小于5％，是调强适形放射治疗剂量验征的重要工具。     

鼻咽癌调强放疗中摆位误差对物理剂量学的影响

目的：测量头颈部肿瘤在放射治疗中的摆位误差，分析鼻咽癌（NPC）调强放射治疗（IMRT）中误差对靶区和危及器官物理剂量学的影响。方法：随机抽取76名头颈部肿瘤患者，通过比较数字重建图像（DRR）和射野图像，测量其摆位误差；从其他住院患者中随机抽取另外10名作调强治疗的鼻咽癌患者，在计划系统中模拟患者治疗时体位的三维误差，重新计算剂量分布，分析一系列相关的靶区和危及器官的剂量参数，明确摆位误差对物理剂量的影响。结果：头颈部肿瘤在左右、头脚、腹背方向的摆位误差分别是（-0．62±1．46）mm，（-0．41±1．54）mm，（-0．31±1．67）mm；鼻咽癌调强放疗中超过3mm的摆位误差对GTV的最小剂量和CTV个别剂量参数的影响有统计学意义，腹背方向的误差对脊髓和脑干受照剂量的影响有统计学意义。结论：对于鼻咽癌调强治疗的患者，摆位误差需要控制在3mm之内：在日常工作中用EPID做质量保证和质量控制工作很有必要。     

乳腺癌根治术后胸壁放疗技术与剂量分布

乳腺癌根治术后病人ＣＴ图像送入三维治疗计划系统,观察６ＭＶＸ线切线照射及电子线垂直照射胸壁时的剂量分布。包括内乳淋巴结和不包括内乳淋巴结的６ＭＶＸ线切线照射无需楔形板;单线电子线垂直照射,即使是６ＭｅＶ低能电子线,肺组织受照亦相当严重;６ＭｅＶ电子线配合皮肤表面填０．５ｃｍ厚组织等效物,肺组织受照较小,皮肤剂量提高,但内乳淋巴结与其表面皮肤剂量涌两者兼顾;９ＭｅＶ电子线配合皮肤表面填不等厚度组织等     

鼻咽癌放射治疗野中野设计的探讨

背景与目的：鼻咽癌放射治疗,面颈联合野已作为标准的射野设计,用一个中心半束射野解决了面颈联合野与颈部切线野的衔接问题,但面颈联合野内存在剂量冷点与热点,剂量均匀性差。因此本研究希望就鼻咽癌放射治疗面颈联合野中进行野中野的设计作一些探讨。方法：在设计半束照射面颈联合野时,使野的下部最大剂量保持在105%左右,再在野的上部加射野的设计方案。结果：根据治疗计划系统（treatment planning system,TPS）计算,由于是一个中心的半束射野,面颈联合野与颈部切线野的衔接处无冷热点,在面颈联合野内加入野中野和颈部切线野,故比用两个中心设计的,面颈联合野与颈部切线野,技术员摆位更简单,更准确。其剂量分布比单一的面颈联合野更均匀,更合理。95%的等剂量线包容颅底及鼻咽处肿瘤体积（gross tumor volume,GTV）时,下颈及口咽部最高点剂量为105%左右,而且高剂量区容积也小。结论：用一个中心半束面颈联合野中野和颈部切线野方法照射,比单一面颈联合野照射时,剂量分布更均匀,更合理,比两个中心面颈联合野与颈部切线野照射时,技术员摆位更简单,衔接处的剂量更准确。     

M-C方法模拟脑室肿瘤放疗的光输运过程

用蒙特卡罗方法模拟放射治疗脑室肿瘤生物组织中的光输运过程，计算选定位置处的能量沉积和剂量分布，此方法可靠，简单，经济实惠。     

Estimate of the uncertainties in the relative risk of secondary malignant neoplasms following proton therapy and intensity-modulated photon therapy

Theoretical calculations have shown that proton therapy can reduce the incidence of radiation-induced secondary malignant neoplasms (SMN) compared with photon therapy for patients with prostate cancer. However, the uncertainties associated with calculations of SMN risk had not been assessed. The objective of this study was to quantify the uncertainties in projected risks of secondary cancer following contemporary proton and photon radiotherapies for prostate cancer. We performed a rigorous propagation of errors and several sensitivity tests to estimate the uncertainty in the ratio of relative risk (RRR) due to the largest contributors to the uncertainty: the radiation weighting factor for neutrons, the dose-response model for radiation carcinogenesis and interpatient variations in absorbed dose. The interval of values for the radiation weighting factor for neutrons and the dose-response model were derived from the literature, while interpatient variations in absorbed dose were taken from actual patient data. The influence of each parameter on a baseline RRR value was quantified. Our analysis revealed that the calculated RRR was insensitive to the largest contributors to the uncertainty. Uncertainties in the radiation weighting factor for neutrons, the shape of the dose-risk model and interpatient variations in therapeutic and stray doses introduced a total uncertainty of 33% to the baseline RRR calculation.     

Characteristics of the photon beam from a new 25-MV linear accelerator

The Therac 25 is a relatively compact therapy machine, the heart of which is a double-pass electron linear accelerator. The electron beam is injected into the accelerator at the treatment head end of the machine and is accelerated back down the arm to an energy of 13 MeV. At this end of the machine a magnet system reflects the beam back into the structure where it gains up to an additional 12 MeV of energy. After leaving the linear accelerator the beam is bent by an achromatic head magnet through 270 degrees to the treatment head. The machine produces eight electron beams and a 25-MV photon beam. In this work only the parameters of the photon beam are addressed based on measurements at the first two clinical sites. Percentage depth doses, tissue phantom ratios, and beam symmetry and stability are presented and discussed.     

Dose calculation validation of Vmc++ for photon beams

The radiation therapy specific Voxel Monte Carlo (VMC+ +) dose calculation algorithm achieves a dramatic improvement in MC dose calculation efficiency for radiation therapy treatment planning dose evaluation compared with other MC algorithms. This work aims to validate VMC+ + for radiation therapy photon beam planning. VMC++ was validated with respect to the well-benchmarked EGS-based DOSXYZnrc by comparing depth dose and lateral profiles for field sizes ranging from 1 X 1 to 40 x 40 cm(2) for 6 and 18 MV beams in a homogeneous water phantom and in a simulated bone-lung-bone phantom. Patient treatment plan dose distributions were compared for five prostate plans and five head-and-neck (H/N) plans, all using intensity-modulated radiotherapy beams. For all tests, the same incident particles were used in both codes to isolate differences due to modeling of the radiation source. Voxel-by-voxel observed differences were analyzed to distinguish between systematic and purely statistical differences. Dose-volume-histogram-derived dose indices were compared for the patient plans. For the homogeneous water phantom and the bone-lung-bone phantom, the depth dose curve predicted by VMC+ + agreed with that predicted by DOSXYZnrc within expected statistical uncertainty in all voxels except the surface voxel of the water phantom, where VMC+ + predicted a lower dose. When the electron cutoff parameter was decreased for both codes, the surface voxel agreed within expected statistical uncertainty. For prostate plans, the most severe difference between the codes resulted in 55% of the voxels showing a systematic difference of 0.32% of maximum dose. For H/N plans, the largest difference observed resulted in 2% of the voxels showing a systematic difference of 0.98% of maximum dose. For the prostate plans, the most severe difference in the planning target volume D95 was 0.4%, the rectum D35 was 0.2%, the rectum DI7 was 0.2%, the bladder D50 was 0.3% and the bladder D25 was 0.3%. For the H/N plans, the most severe difference in the gross tumor volume D98 was 0.4%, the clinical target volume D90 was 0.2%, the nodes D90 was 0.2%, the parotids D95 was 0.8%, and the cord D2 was 0.8%. All of these differences are clinically insignificant. VMC++ showed an average efficiency gain over DOSXYZnrc of at least an order of magnitude without introducing significant systematic bias. VMC + + can be used for photon beam MC patient dose computations without a clinically significant loss in accuracy.     

Treatment planning intercomparison for spinal chordomas using intensity-modulated photon radiation therapy (IMRT) and carbon ions

Spinal chordomas cannot be treated with an effective dose using conventional radiation therapy (RT) without exceeding the tolerance dose of the spinal cord while ensuring sufficient target coverage at the same time. In this study we investigate the potential physical advantages of combined photon intensity-modulated radiation therapy (IMRT) and raster-scanned carbon ion RT over photon IMRT alone. For a representative patient we generated a carbon ion RT plan and a photon IMRT plan. Additionally, combined plans consisting of both carbon ions and photon IMRT were calculated using ratios of 20:40 GyE, 30:30 GyE and 40:20 GyE. The best target coverage was obtained using carbon ions alone. Using a combination of photon IMRT and carbon ions, the target coverage was better than with photon IMRT alone. Due to the applied dose constraints, the sparing of the spinal cord was comparable for all plans. Using carbon ions alone, the non-target tissue volume irradiated to at least 30 GyE/50.4 GyE was reduced by 72%/84% compared to photon IMRT alone. These advantages were evident even with combined techniques. The actually delivered dose distribution is expected to be more dependent on patient misalignment with carbon ions compared with photon IMRT. A combination of carbon ions and photon IMRT might be preferable in order to profit by the physical advantages of carbon ions while ensuring a safe treatment.     

An integrative review on current evidence of testosterone replacement therapy for the andropause

OBJECTIVES: This paper examines the evidence supporting testosterone replacement in aging males. Confounding factors contributing to low testosterone levels and challenges to diagnosis of the andropause will also be considered. METHODS: A thorough review using an integrative approach citing published literature and the ongoing work of the authors. A search was performed using National Library of Medicine PubMed. Electronic and print journals available at the Texas Medical Center library were also considered. RESULTS: Information based on collective trials in older men has added to evidence for benefits and side effects of testosterone replacement inferred from studies in younger hypogonadal patients and animal models. In general, most investigators agree with short-term safety but long-term safety is unknown. Testosterone therapy in aging males improves body composition, certain domains of brain function and may also decrease cardiovascular risk in biological models. Measurable clinical effects are less apparent. Potential risks include erythrocytosis, edema, gynecomastia, and prostate stimulation. The possibility of increased risk of clinically significant prostate cancer and cardiovascular disease has been considered. CONCLUSION: The search continues for an ideal replacement androgen and larger long-term studies are needed. At this time, androgen replacement is on a case-by-case basis and prostate cancer screening should be completed prior to instituting therapy. Routine androgen replacement therapy for aging males will have significant economic implications, and is not currently recommended.     

89^Sr联合内分泌疗法治疗前列腺癌骨转移的疗效观察

目的：探讨89^锶（89^Sr）联合内分泌疗法治疗前列腺癌骨转移性疼痛的疗效。方法：将45例确诊为前列腺癌且具有骨转移病灶并伴有疼痛的患者随机分为两组：89^Sr联合内分泌疗法治疗的治疗组23例,单纯采用内分泌治疗的对照组22例,观察治疗后两组的止痛疗效、血清PSA水平的变化、血象及生化指标的变化。结果：治疗前两组患者的疼痛级数间差异无显著性意义（P〉0.05）。治疗后治疗组患者疼痛级数及血清PSA水平较对照组显著降低（P〈0.01;P〈0.05）;治疗后治疗组患者骨转移病灶治疗有效率较对照组显著升高（P〈0.01）。结论：89^Sr联合内分泌疗法能迅速有效地缓解前列腺癌骨转移疼痛,使骨转移病灶缩小或消失,副作用小,其疗效明显优于单纯内分泌疗法。     

Single-use MOSFET radiation dosimeters for the quality assurance of megavoltage photon beams

We investigated the applicability of single-use MOSFET detectors as quality-assurance devices. Using ten accelerators available at our institution, we performed output measurements in both water and solid phantoms under photon irradiation. The MOSFET detectors performed well within the manufacturer's specifications, with average deviations of 2.1% and 0.7% for the 6 and 18 MV beams, respectively. The strength of the detector's design, including its wireless set-up, factory calibration and direct read-out, makes the system an acceptable independent quality-assurance device for use in verifying machine output within an accuracy of +/-5%. The MOSFET detectors provide a quick check of machine output, which can be efficacious in detecting gross errors in machine calibrations.     

Brachytherapy dosimetry of 125I and 103Pd sources using an updated cross section library for the MCNP Monte Carlo transport code

Permanent implantation of low energy (20-40 keV) photon emitting radioactive seeds to treat prostate cancer is an important treatment option for patients. In order to produce accurate implant brachytherapy treatment plans, the dosimetry of a single source must be well characterized. Monte Carlo based transport calculations can be used for source characterization, but must have up to date cross section libraries to produce accurate dosimetry results. This work benchmarks the MCNP code and its photon cross section library for low energy photon brachytherapy applications. In particular, we calculate the emitted photon spectrum, air kerma, depth dose in water, and radial dose function for both 125I and 103Pd based seeds and compare to other published results. Our results show that MCNP's cross section library differs from recent data primarily in the photoelectric cross section for low energies and low atomic number materials. In water, differences as large as 10% in the photoelectric cross section and 6% in the total cross section occur at 125I and 103Pd photon energies. This leads to differences in the dose rate constant of 3% and 5%, and differences as large as 18% and 20% in the radial dose function for the 125I and 103Pd based seeds, respectively. Using a partially updated photon library, calculations of the dose rate constant and radial dose function agree with other published results. Further, the use of the updated photon library allows us to verify air kerma and depth dose in water calculations performed using MCNP's perturbation feature to simulate updated cross sections. We conclude that in order to most effectively use MCNP for low energy photon brachytherapy applications, we must update its cross section library. Following this update, the MCNP code system will be a very effective tool for low energy photon brachytherapy dosimetry applications.     

Helical antenna arrays for interstitial microwave thermal therapy for prostate cancer: tissue phantom testing and simulations for treatment

Interstitial microwave therapy is an experimental treatment for prostate cancer. The objective of this work was to measure the power deposition (specific absorption rate, SAR) patterns of helical microwave antennae both individually and in array patterns that would be useful for clinical treatment protocols. Commercial helical antenna 3D SAR patterns were measured in muscle equivalent phantoms using a thermographic technique. Two array patterns were tested: a 'square' and a 'crescent' array, both surrounding the urethra. To assess the feasibility of pre-treatment planning, the measured SAR patterns were input to a treatment planning computer simulation program based on a series of trans-rectal ultrasound images from a prostate cancer patient. The simulation solved the Pennes linear bioheat heat transfer equation in prostate tissue, with the aim of achieving a target of 55 degrees C at the prostate periphery while not allowing normal surrounding tissues (bladder, urethra, rectum) to rise above 42 C. These criteria could not be met with the square array but they could be met with the crescent array, provided that the prostate was first dissected away from the rectum. This can be done with a procedure such as 'hydrodissection', where sterile saline is injected to separate the prostate and rectum. The results of these SAR measurements and heat transfer simulations indicate that arrays of helical antennae could be used for safe and effective thermal therapy for prostate cancer.