Determination of DNA structural detail using radioprobing

Abstract

Purpose: To put radioprobing into context as a relatively new method of determining structural detail in deoxyribonucleic acid (DNA), and to review its use since first proposed in 1997. The key feature of the method is that, by experiment or simulation, a radionuclide such as iodine-125 (¹²⁵I) is placed near the DNA at a known point relative to the DNA base sequence, and the number of resulting strand breaks in each nucleotide is determined. As the intensity of damage declines consistently with distance from the radionuclide, relative distances between the emitter and the nucleotides can be deduced, and hence potentially the topology or structural detail of the DNA. For simulation, appropriate software includes a Molecular Dynamics package, analysis and visualization tools, and a Monte Carlo track structure program. Conclusions: A review of published work and our own recent unpublished studies have shown that radioprobing is sufficiently sensitive and consistent to determine structural detail such as internal folding topology and flexing behavior, and can be applied to DNA or a DNA-protein complex in an approximation to its normal biological environment.     

Iodine-125 radioprobing of intramolecular quadruplex conformation of human telomeric DNA in the presence of cationic porphyrin TMPyP4

Purpose: A repeated, non-coding, DNA sequence d(TTAGGG)_n is present in the telomeric ends of all human chromosomes. These repeats can adopt multiple inter- and intra-molecular non-B-DNA conformations that may play an important role in biological processes. We applied ¹²⁵I -radioprobing to assess the conformation of the human telomeric DNA fragment in a complex with the quadruplex-specific drug – cationic porphyrin TMPyP4.

Material and methods: Synthetic DNA oligonucleotides containing the telomeric sequence were labeled with ¹²⁵I. The probability of DNA breaks caused by decay of ¹²⁵I is inversely related to the distance between the radionuclide and the sugar unit of the DNA backbone; hence, the conformation of the DNA backbone can be deduced from the distribution of breaks.

Results: The obtained data indicate that the telomeric oligonucleotides predominantly fold into an intramolecular quadruplex conformation in the presence of TMPyP4. We propose a mixed-type (3 + 1) conformation of telomeric quadruplex in a complex with the cationic porphyrin TMPyP4 in solution. Binding of the porphyrin overrides the counterion effect on quadruplex conformation.

Conclusions: We have demonstrated that ¹²⁵I radioprobing can be successfully applied not only to determine folding in G-quadruplexes, but also to reveal the mode of quadruplex interaction with small ligands.     

Calculated strand breaks from 125I in coiled DNA

Purpose: DNA single strand breaks (SSB) and double-strand breaks (DSB) induced by Auger electrons from incorporated ¹²⁵I decay were calculated using a B-DNA model to assess contributions from direct and OH damage and effects of higher-order structure. Three decay sites, linker DNA, nucleosome, and two adjacent nucleosomes, were assessed and compared to experimental data.

Method: A Monte Carlo track structure code for electron was used to track electrons, OH and H radicals through linear and a higher-order model of B-DNA. Direct and indirect DNA hits were scored and used to determine SSB and DSB.

Results: The three different ¹²⁵I decay locations produced different number of DSBs and fraction of radical damage. The average number of DSB per ¹²⁵I decay was 0.83, 0.86 and 1.33, respectively, for the three sites. OH radical attack contributed to or exclusively caused 70%, 57%, and 50%, of the DSBs located in the entire model. When only 10 base pairs on either side of the incorporation site were considered, radical damage contributions were 40%, 25% and 67%, respectively. Locations distant from the site of incorporation, however, consistently yielded 70–80% of the DSB from radical attack.

Conclusions: Coiling of DNA can greatly change both the absolute number of DSB per incorporated ¹²⁵I decay and the relative contributions of radical damage to the local site of decay and, to a lesser extent, the average over all DNA. Higher order structure only slightly affects the number and quality of DNA damage to distant locations, which is mostly from radical attack.     

DNA double-strand breaks induced by decay of 123I-labeled Hoechst 33342: Role of DNA topology

Purpose: To determine double-strand-break (DSB) yields produced by decay of minor-groove-bound ¹²³I-labeled Hoechst 33342 (¹²³IEH) in supercoiled (SC) and linear (L) forms of pUC19 DNA, to compare strand-break efficiency of ¹²³IEH with that of ¹²⁵IEH, and to examine the role of DNA topology in DSB induction by these Auger electron emitters.

Materials and methods: Tritium-labeled SC and L pUC19 DNA were incubated with ¹²³IEH (0–10.9 MBq) at 4°C. After ¹²³I had completely decayed (10 days), samples were analyzed on agarose gel, and single-strand-break (SSB) and DSB yields were measured.

Results: Each ¹²³I decay in SC DNA produces a DSB yield of 0.18 ± 0.01. On the basis of DSB yields for ¹²⁵IEH (0.52 ± 0.02 for SC and 1.62 ± 0.07 for L, reported previously) and dosimetric expectations, a DSB yield of ～0.5 (3 × 0.18) per ¹²³I decay is expected for L DNA. However, no DSB are observed for the L form, even after ～2 × 10¹¹ decays of ¹²³I per μg DNA, whereas a similar number of ¹²⁵I decays produces DSB in ～40% of L DNA.

Conclusion: ¹²³IEH-induced DSB yield for SC but not L DNA is consistent with the dosimetric expectations for Auger electron emitters. These studies highlight the role of DNA topology in DSB production by Auger emitters and underscore the failure of current theoretical dosimetric methods per se to predict the magnitude of DSB.     

基于实验与蒙特卡罗模拟法探究125I粒子间剂量衰减

目的 研究多颗¹²⁵I放射性粒子间剂量衰减规律.方法 利用Geant 4软件包进行蒙特卡罗模拟单颗粒子和多颗粒子周围剂量分布,将模拟结果与TG43-U1报告中推荐剂量计算方法所得结果进行对比,并利用实验测得数据验证蒙特卡罗模拟结果.结果 单颗粒子周围剂量分布的蒙特卡罗模拟结果与TG43-U1计算和实验结果差值分别在±3%和±5%以内.多颗粒子的蒙特卡罗模拟结果对比TG43-U1线性叠加结果,粒子间剂量衰减为3.8%~13.2%,平均剂量衰减为7.2%,实验所得结果与蒙特卡罗模拟结果差值在6%以内.结论 空间中存在多颗放射性¹²⁵I粒子时,由于粒子间的相互影响导致7%左右的剂量衰减,其最大值可超过13%,在人体组织中剂量衰减值会更大.因此,利用TG43-U1方法进行线性叠加计算临床中的剂量分布不够精确.     

A Monte Carlo evaluation of the dosimetric characteristics of the EchoSeed Model 6733 (125)I brachytherapy source

PURPOSE: Recently a new design of a (125)I brachytherapy source was introduced for interstitial seed implants, particularly for prostate seed implants. This new source is the EchoSeed Model 6733 (125)I brachytherapy source. Due to the differences in source design and manufacturing process from one new source to the next, their dosimetric parameters should be determined according to the American Association of Physicists in Medicine (AAPM) TG-43 guidelines. METHODS AND MATERIALS: As per AAPM recommendation, it is required to perform at least one experimental study and one Monte Carlo simulation, preferably done by two independent investigators. Other investigators have experimentally determined the dosimetric parameters of this new source. In this project, the Monte Carlo simulated dosimetric parameters of the EchoSeed Model 6733 source have been provided. RESULTS: The results of this evaluation indicate the value of the dose rate constant of 0.97 +/- 3% cGyh(-1)U(-1) in liquid water, which is in good agreement with the measured value of 0.99 +/- 8% cGyh(-1)U(-1) reported by Meigooni et al. The anisotropy constant of the EchoSeed (125)I brachytherapy source was found to be 0.960 in liquid water. CONCLUSIONS: The Monte Carlo Simulated TG-43 dosimetric parameters of the EchoSeed were determined and the results were compared with the published measured data.     

组织成分及密度对125I粒子植入剂量分布影响的研究

目的 分析组织成分及密度对¹²⁵I粒子植入剂量分布影响,为临床放射性粒子植入剂量计算和评估提供参考。方法 应用egs_brachy软件建立OncoSeed 6711型¹²⁵I放射性粒子物理模型,计算剂量率常数和水中径向剂量函数g（r）,以验证计算模型准确性;根据不同组织的元素组成及密度表,分别计算¹²⁵I粒子在水、前列腺、乳腺、肌肉、骨等不同介质中g（r）和剂量分布。结果 计算得到的剂量率常数为0.950 cGy·h^-1·U^-1、水中g（r）和吸收剂量均与文献数据近似。在同一径向位置,¹²⁵I粒子在前列腺、肌肉中吸收剂量与水中差异<5%;在距源中心0.05 cm处,骨中吸收剂量是水中的6.042倍;在近源1.7 cm内,乳腺与水中吸收剂量差异均>10%。结论 ¹²⁵I粒子在部分介质中的剂量分布与水有着较明显区别,在临床剂量计算中需考虑组织成分及密度对吸收剂量的影响。     

125I-induced DNA Double Strand Breaks: Use in Calibration of the Neutral Filter Elution Technique and Comparison with X-ray Induced Breaks

Summary

The neutral filter elution assay, for measurement of DNA double strand breakage, has been calibrated using mouse L cells and Chinese hamster V79 cells labelled with [¹²⁵I]dUrd and then held at liquid nitrogen temperature to accumulate decays. The basis of the calibration is the observation that each ¹²⁵I decay, occurring the DNA, produces a DNA double strand break. Linear relationships between ¹²⁵I decays per cell and lethal lesions per cell (minus natural logarithm survival) and the level of elution, were found. Using the calibration data, it was calculated that the yield of DNA double strand breaks after X-irradiation of both cell types was from 6 to 9 × 10^?12 DNA double strand breaks per Gy per dalton of DNA, for doses greater than 6 Gy. Neutral filter elution and survival data for X-irradiated and ¹²⁵I-labelled cells suggested that the relationships between lethal lesions and DNA double strand breakage were significantly different for both cell types. An attempt was made to study the repair kinetics for ¹²⁵I-induced DNA double strand breaks, but was frustrated by the rapid DNA degradation which occurs in cells that have been killed by the freezing-thawing process.     

Effect of distance between decaying 125I and DNA on Auger-electron induced double-strand break yield

Abstract

Purpose: To determine the possible effects of ¹²⁵I-to-DNA distance on the magnitude and mechanism of Auger-electron induced-double-strand break (DSB) production.

Materials and methods: We have synthesized a series of ¹²⁵I-labeled Hoechst (H) derivatives (¹²⁵IE–H, ¹²⁵IB–H, ¹²⁵I-C₈–H and ¹²⁵I-C₁₂–H). While all four molecules share a common DNA minor groove binding bis-benzimidazole motif, they are designed to position ¹²⁵I at varying distances from the DNA helix. Each Hoechst derivative was incubated at 4°C in phosphate buffered saline (PBS) together with supercoiled (SC) ³H-pUC19 plasmid DNA (ratio 3:1) ± the ?OH scavenger dimethyl sulfoxide (DMSO) (0.2 M). Aliquots were analyzed on agarose gels over time and DSB yields per decay of ¹²⁵I atom were determined. Docking of the iodinated compounds on a DNA molecule was carried out to determine the distance between the iodine atom and the central axis of DNA.

Results: In the absence of DMSO, the results show that the DSB yields decrease monotonically as the ¹²⁵I atom is distanced – by 10.5 Å to 13.9 Å – from the DNA helix (¹²⁵IEH: 0.52 ± 0.01; ¹²⁵IB–H: 0.24 ± 0.03; ¹²⁵I-C₈–H: 0.18 ± 0.02; ¹²⁵I-C₁₂–H: 0.10 ± 0.00). In the presence of DMSO, DSB yields for ¹²⁵IEH (0.49 ± 0.02) and ¹²⁵IB-H (0.26 ± 0.04) remain largely unchanged indicating that DSB are entirely produced by direct effects. Strikingly, ¹²⁵I-C₈–H or ¹²⁵I-C₁₂–H, did not produce detectable DSB in the presence of DMSO under similar conditions suggesting when ¹²⁵I atom is positioned >?12 Å from the DNA, DSB are entirely produced by indirect effects.

Conclusion: These results suggest that at a critical distance between the ¹²⁵I atom and the DNA helix, DSB production switches from an ‘all’ direct to an ‘all’ indirect mechanism, the latter situation being comparable to the decay of ¹²⁵I free in solution. These experimental findings were correlated with theoretical expectations based on microdosimetry.     

125I粒子植入前装载过程中医护人员的剂量监测

目的 分析1255I粒子装载过程中医护人员的受照剂量.方法 采用热释光剂量计检测125I装载过程中,与粒子槽不同距离的剂量,计算出人员的安全范围;医护人员的受照剂量、剂量率和年累积剂量.结果 与粒子槽不同距离处10、20、30、40、50和100 cm的剂量衰减率分别是77.61％、98.04％、98.79％、99.30％、99.71％和100％.医护人员的指尖、胸部、眼晶状体和甲状腺的受照剂量分别是51.08、35.50、34.73和33.78 μGy,年操作250次达到的剂量分别是12.77、8.88、8.68和8.45 mGy.铅玻璃屏内、外粒子剂量的衰减率分别是28.36％、79.60％.结论 125I粒子装载过程中,安全距离超过100 cm时检测不到辐射,铅玻璃防护是很有必要的.     

125I粒子植入组织间照射对大鼠背根神经节影响的组织形态学研究

目的 探讨125I粒子源照射对SD大鼠背根神经节组织形态学的影响.方法 把体重150～180g的12只成年雄性SD大鼠用随机表法等分成6组;在l～6组大鼠的第5腰背根神经节周围分别植入O(钛质空壳作为健康对照组)、14.8、18.5、22.2、25.9和29.6 MBq的125I粒子源,观察大鼠的行为改变,在植入后不同时期,将大鼠分批处死,用Olympus BX51生物光学显微镜观察植入不同活度粒子,照射不同时间后,神经节及周围肌肉组织的形态学改变,并估算背根神经节受到的剂量.结果 125I粒子源植入后,大鼠的运动功能没有受到影响,7d后体重自然增长.光学显微镜结果显示,钛质空壳植入后引起个别神经节细胞轻度水肿,但核仁清晰,细胞质正常.18.5 MBq的125I粒子源植入30 d后,与植入14 d相比,细胞肿胀更明显,还出现了脱水核固缩、核碎裂现象.29.6 MBq的粒子源植入60d后大量细胞核消失、细胞核溶解、细胞质失水皱缩.同时,活度越大,粒子植入时间越长,神经节周围的肌肉组织纤维化越显著.结论 受到125I粒子源的照射后,背根神经节及周围组织的损伤程度与照射强度存在剂量依赖关系.植入125I粒子源可能对各种难治性疼痛产生一定的镇痛作用.     

125I对大鼠甲状腺致瘤作用的病理研究

本文报道用雄Wistar大鼠,腹腔注射不同活度的¹²⁵I后,观察两年的结果。6个实验组动物甲状腺所受剂量分别为187、129、94、56、18,8和9,3Gy。实验结果表明l 18,8～9dGy可能是¹²⁵I的最适致癌剂量范围;56Gy可能是最适致癌剂量;9,3Gy组与对照组差别不明显。推测¹²⁵I在18,8Gy以下可能有一不致癌的剂量限值。当¹²⁵I剂量大于129Gy时甲状腺发生退行性变。¹²⁵I诱发的甲状腺癌以滤泡性腺癌和髓样癌为主。电镜观察证明,除髓样癌发自滤泡旁细胞外,其它良性瘤和恶性瘤均发自甲状腺滤泡上皮细胞。     

计算点阵网格大小对125I粒子植入剂量计算精度的影响

目的 观察 ¹²⁵I 粒子植入时,计算机治疗计划系统（TPS）软件中计算点阵网格大小对剂量计算精度的影响。方法 采用随机数字表法抽取10例粒子植入患者的验证计划,将点阵网格调整为128×128、96×96、64×64、32×32共4组,在粒子数目、位置、活度及靶区大小相同的条件下,应用TPS计算每个计划的剂量,分别得出4组D₉₀、V₉₀、V₁₀₀及V₁₅₀,并计算D₉₀的误差。结果 128×128、96×96、64×64、32×32 4组点阵网格D₉₀平均数分别为（7 178.8±2 237.7）、（7 072.7±2 240.8）、（6 889.1±2 305.5）、（6 351.0±2 515.7）cGy;D₉₀误差百分比分别为（0.74±0.6）%、（-0.89±2.2）%、（-3.85±4.7）%、（-10.46±4.8）%,组间差异有统计学意义（F=8.95,P<0.05）。4组点阵网格V₉₀分别为（93.12±0.32）%、（92.75±0.29）%、（91.87±1.28）%、（88.06±5.06）%,组间差异有统计学意义（F=7.85,P<0.05）;V₁₀₀分别为（90.21±0.14）%、（89.67±0.64）%、（88.68±1.80）%、（84.10±6.56）%,组间差异有统计学意义（F=6.64,P<0.05）;V₁₅₀分别为（73.48±3.49）%、（72.66±3.96）%、（71.33±4.83）%、（65.41±9.49）%,组间差异有统计学意义（F=3.90,P<0.05）。结论 计算点阵网格大小明显影响TPS计算剂量的准确性,在保证运算速度同时应尽量应用128×128的计算点阵网格。     

携带125I粒子导管和徒手粒子植入模拟病灶后粒子纵向间距准确性的对比研究

目的 对比携带¹²⁵I粒子的可降解导管植入和徒手粒子植入后粒子纵向间距的准确性。方法 本研究用薯蓣制成24个模拟病灶,分为徒手组和粒子导管组,每组12个模拟病灶,由3位医师完成粒子和粒子针插植,每位医师每组插植4个病灶,每组共插植60针道,并按设定粒子间距（0.5和1.0 cm）分别在两组模拟病灶内行粒子植入。术后CT复查,并测量粒子纵向间距。配对t检验分析徒手组和导管组与设定间距偏离的差异。结果 徒手组与设定间距的偏离程度分别为（0.184±0.047）和（0.127±0.051）cm,导管组与设定间距的偏离程度分别为（0.007±0.006）和（-0.003±0.006）cm,导管组粒子的偏离程度明显小于徒手组（t=3.804、2.499,P<0.05）。结论 携带¹²⁵I粒子导管的应用,使粒子纵向间距的准确性优于徒手组,受术者的影响较小。     

腹盆腔肿瘤125I粒子植入术后个体化防护临床研究

目的 研究腹盆腔肿瘤患者¹²⁵I粒子植入术后周围环境的受照剂量率及有效剂量,为不同人群的安全防护提供参考。方法 采用袖珍辐射仪,监测42例腹盆腔肿瘤患者¹²⁵I粒子植入术后24 h内,距离植入部位各方向不同距离的受照剂量率,比较不同方向不同距离的剂量率差异。对植入粒子的总活度与测量的剂量率及植入深度与标准活度下剂量率进行曲线拟合并得出关系方程。根据公式计算不同人群、不同距离受照射的剂量率与警戒时间的关系。结果 距垂直粒子植入部位30、50、100 cm的受照剂量率分别为（6.92±2.87）、（4.10±1.62）和（1.30±0.48）μSv/h,差异有统计学意义（χ²=73.71,P<0.05）。患者左、右侧面30、50、100 cm受照剂量率分别为（0.378±0.156）和（0.384±0.153）μSv/h、（0.170±0.089）和（0.176±0.086）μSv/h、（0.039±0.014）和（0.043±0.017）μSv/h,差异均有统计学意义（χ²=76.19、76.33,P<0.05）。垂直粒子植入部位的受照剂量率与植入粒子总活度及标准活度下剂量率与植入深度呈线性关系。患者对同住成年人无警戒时间,同床成年人、接触同事、同住未成年人及孕妇的警戒时间与剂量率的关系公式分别为：t（d）=-106.616+83.779lnD（t）、t（d）=26.556+85.933lnD（t）、t（d）=3.088+85.017lnD（t）。结论 ¹²⁵I粒子植入术后患者,监测其周边环境的辐射剂量在辐射安全范围内;且随着植入粒子总活度的减小及植入深度的增大剂量率减小;同时根据术后测得的剂量率或植入粒子的总活度、植入粒子的深度计算不同人群的警戒时间,进行个体化防护。     

Dosimetric characterization of a newly designed encapsulated interstitial brachytherapy source of iodine-125—model LS-1 BrachyseedTM

A newly designed encapsulated ¹²⁵I source has been introduced (Model LS-1 BrachySeed^TM manufactured by DRAXIMAGE Inc.) for interstitial brachytherapy . In this source ¹²⁵I radionuclide is contained in two ceramic beads positioned at each end of a titanium capsule. The source contains a rod of Pt–Ir, which serves as a radiographic marker for source localization in the patient. Principle photon emissions are 27.4 and 31.0 keV X-rays and a 35.5 keV gamma-ray. The 22.2 and 25.5 keV silver X-rays produced by fluorescence of the silver dopant in the ceramic bead radioisotope carriers, are also emitted. In this work, the dosimetric characteristics of the ¹²⁵I source were measured with micro LiF TLD chips and dosimetry parameters were characterized based upon the American Association of Physicists in Medicine, Task Group, No. 43 formalism. The corrected 1999 National Institute of Standards and Technology standard for low energy interstitial brachytherapy sources was used to specify the air kerma strength of the sources used in this study. The dose rate constant of the sources was determined to be 1.02±0.07 cGyh⁻¹ U⁻¹. The radial dose function was measured and was found to be similar to that of the silver-based model 6711 ¹²⁵I source. However, the anisotropy function of the Model LS-1 BrachySeed^TM source is considerably better than that of model 6711 ¹²⁵I source, especially on the points along and close to the longitudinal axis of the source. The BrachySeed^TM model LS-1 provides more isotropic angular dose distribution in tissue than model 6711 ¹²⁵I source. The anisotropy constant for the model LS-1 source was determined to be 1.006, which is considerably better than the value of 0.93 for the model 6711 source.     

The Auger effect in physical and biological research

Purpose: The paper reports on progress in physics of radiationless transitions and new Auger spectra of ¹²⁵I and ¹²⁴I. We report progress in Monte Carlo track structure simulation of low energy electrons comprising majority electrons released in decay most Auger emitters.

Materials and methods: The input data for electron capture (EC) and internal conversion(IC) were obtained from various physics data libraries. Monte Carlo technique was used for the simulation of Auger electron spectra. Similarly, electron tracks were generated using Monte Carlo track structure methods.

Results: Data are presented for the EC, IC and binding energy (BE) of radionuclides ¹²⁴I and ¹²⁵I. For each of the radionuclides ¹²⁵I and ¹²⁴I some examples of electron spectra of individual decays are given. Because most Auger electrons are low energy and short range, data and a short discussion are presented on recent Monte Carlo track structure development in condensed media and their accuracy.

Conclusions: Accuracy of electron spectra calculated in the decay of electron shower by Auger emitting radionuclides depends on availability of accurate physics data. There are many gaps in these libraries and there is a need for detailed comparison between analytical method and Monte Carlo calculations to refine the method of calculations. On simulation of electron tracks, although improved models for sub-keV electron interaction cross sections for liquid water are now available, more experimental data are needed for benchmarking. In addition, it is desirable to make data and programs for calculations of Auger spectra available online for use by students and researchers.     

携带125I粒子导管和徒手粒子植入后剂量学差异的模体研究

目的对比在实时针道计划下携带¹²⁵I粒子的可降解导管植入和徒手粒子植入后靶区各项剂量学参数的差异。方法本实验模拟病灶42个,分为徒手组21个和导管组21个。根据治疗计划系统进行粒子植入。分别记录术前、术后的最小剂量(D_min)、最大剂量(D_max)、平均剂量(D_mean)、适形指数(CI)、靶外体积指数(EI)、均匀性指数(HI)、覆盖90%靶体积的剂量(D90)、90%处方剂量覆盖靶体积的百分比(V90)。通过Bland-Altman法分析术前、术后剂量参数的一致性,组间比较采用秩和检验。结果经Bland-Altman法分析,两组术前、术后大部分参数均具有较好的一致性,仅徒手组D_min和V₉₀的一致性欠佳。但是导管组在D_max(Z=-3.824,P<0.005)、CI(Z=-1.962,P<0.005)、HI(Z=-2.352,P<0.005)、D90(Z=-2.453,P<0.005)、V90(Z=-2.845,P<0.005)的参数误差范围更小。结论实时针道计划下携带¹²⁵I粒子的可降解导管植入术前、术后剂量学参数均具有较好的一致性,且剂量参数值误差范围更小。     

CT引导125I粒子植入治疗恶性肿瘤肺转移的临床研究

目的 评价CT引导¹²⁵I放射性粒子植入(CTRISI)治疗其他原发恶性肿瘤肺转移的临床疗效及其影响因素。方法 接受¹²⁵I放射性粒子植入治疗其他脏器肿瘤肺转移的患者50例,其中,45例(90%)CTRISI单独治疗,5例手术与CTRISI联合治疗。评价5年局部控制率、5年生存率及影响生存率的因素。结果 覆盖90%靶体积时的剂量(D_90%)为(112.3±12.2)Gy,90%剂量覆盖的靶体积百分比(V₉₀)为91.3%±8.2%,术后验证匹配周边剂量(MPD)为106.2 Gy。1、2、3、4、5年局部控制率分别为95.8%、86.5%、56.6%、42.4%、31.1%。中位随访期为26个月。中位生存期为27.1个月,1、2、3、4、5年生存率分别为83.4%、52.3%、38.7%、20.3%、13.7%。病灶直径≤4 cm或>4 cm是预测总生存率(χ²=4.621,P<0.05)和无进展生存率(χ²=7.548,P<0.05)重要相关因素。结论 对其他脏器原发肿瘤肺转移且无法完全切除的患者,CTRISI或联合手术切除是一种有效的治疗方法。     

低剂量CT扫描用于胸部肿瘤粒子植入的可行性研究

目的 探讨在粒子植入过程中降低扫描条件进行手术的可行性。方法 使用GE Lightspeed RT大孔径CT,分别使用120、100和80 kV,初始毫安数为150 mA,以20 mA的间隔递减至10 mA的扫描条件组合对GEMS模体和包含不同密度组织替代物的062 M模体进行扫描。对扫描剂量进行记录,测量图像感兴趣区的CT值、噪声值,计算信噪比（SNR）值和对比噪声比（CNR）值,评估图像质量,优化出较为适合的扫描条件。结果 随着管电压和管电流的降低,图像的信噪比降低。除120 kV,150~70 mA及100 kV,150~90 mA,其余条件下图像的SNR与标准图像差异有统计学意义（t=-12.710~3.717,P<0.05）。随着管电压和管电流的降低,对比度差异较小的相邻组织的对比噪声比显著降低,当对比噪声比降到2以下时,图像质量过低无法评估。降低管电压和管电流对CT图像的高对比分辨力影响不大。结论 综合实验结果,使用管电压100 kV,管电流70 mA的扫描条件进行扫描时,其图像质量接近标准参数扫描图像。在粒子植入过程中,除第1次扫描外使用标准胸部扫描条件外,其余在反复扫描同一区域时可降低条件至100 kV,70 mA进行扫描,可使患者每次扫描接受的辐射剂量大幅下降。