To assess the value of endorectal ultrasonography ( ERUS ) in predicting the pathological response to neoadjuvant chemoradiotherapy( NCRT ) for locally advanced rectal cancer( LARC) . Methods Ninety‐nine patients with LARC received NCRT and total mesorectal excision in our hospital were retrospectively analyzed . T he maximum length and thickness of rectal tumor were measured by ERUS both before NCRT ( ERUS1 ) and after NCRT following sugery ( ERUS2 ) ,and the length and thickness reduction rate were calculated . T he patients were classified into good responder group ( n ＝ 47 ) and poor responder group( n ＝ 52 ) ,or pathological complete response ( pCR) group ( n ＝ 25 ) and non‐pCR group ( n＝74) according to pathological tumor regression grade ( T RG ) . T he differences of various parameters were compared between groups . T he correlations between these parameters and T RG grading were analyzed by Spearman correlation analysis . T he ROC curve was used to evaluate the diagnostic efficacy of the parameter . Results T he length and thickness of ERUS2 were significantly shorter than that of ERUS1( all P ＜0 .05) . T he length and thickness of ERUS2 in good responder group were shorter than those in poor responder group ,while the length and thickness reduction rate were higher than those in poor responder group with significant difference ( all P ＜ 0 .05 ) . T he length and thickness of ERUS2 in pCR group were shorter than those in non‐pCR group ,w hile the length and thickness reduction rate were higher than those in non‐pCR group with significant difference ( all P ＜ 0 .05 ) . T he length and thickness of ERUS2 were positively correlated with T RG grading ( r ＝ 0 .577 ,0 .605 ; all P ＜ 0 .01 ) and the length and thickness reduction rate were negatively correlated with T RG grading ( r ＝ －0 .681 ,－0 .598 ; all P ＜0 .01 ) . ROC curve showed the cut‐off value of the length and thickness reduction rate to predict good responder were 41 .34% ,46 .46% , with corresponding AUC areas of 0 .843 ,0 .796 , sensitivity of 74 .5% ,70 .2% , and specificity of 76 .9% ,80 .8% ,respectively . ROC curve showed the cut‐off value of the length and thickness reduction rate to predict pCR were 57 .36% ,58 .52% ,with corresponding AUC areas of 0 .851 and 0 .895 , sensitivity of 68 .0% ,76 .0% ,and specificity of 94 .6% ,93 .2% ,respectively . Conclusions T he changes of length and thickness of tumor after NCRT are well correlated with treatment response . T he length and thickness reduction rate measured on ERUS present high accuracy in prediction of good response and pCR in LARC patients .

Objective To evaluate how long after iodine-131 treatment of hospitalized patients with differentiated thyroid cancer (DTC),the radiation dose in patients fit the discharged requirements,as well as the radiation levels in wards and facilities in which the patients lived.Methods A total of 143 patients with DTC were hospitalized and treated with iodine-131 from January 2015 to March 2017 in the department of nuclear medicine,third affiliated hospital of Sun Yat-sen university.The participants consisted of 46 males and 97 females aged 37.6±12.4 years.The patients were divided into three groups according to the radiation dose of iodine-131.Groups 1,2,and 3 were administered with 3.70,5.55,and 7.40 GBq,respectively.After the administration of iodine-131 for 0.5,2,4,8,12,24,36,48,72,and 80 h,the radiation dose rate was measured at 1 m in front of the patients by using a realtime radiation monitor,and the changes in radioactivity in the patients were estimated.On the day after the patients were discharged,the radiation doses on the patients' clothes,bed sheets,ward floor,and ground at the bathroom door were monitored using a surface radiation monitor.Data were subjected to variance analysis,and a P＜0.05 was considered statistically significant.Results Groups 1 [(597.5±196.3) μsv/h],2 [(794.5±254.2) μsv/h],and 3 [(1114.1±258.5) μsv/h] had significantly different radiation dose rates (F=62.757,P＜0.01) after 0.5 h of iodine-131 administration.Prolonged radiation exposure resulted in rapid exponential decrease in the radiation dose rate and gradual reduction in the differences among the data.The radiation dose rates of groups 1,2,and 3 [(13.3±10.7),(16.1±9.7),and (21.9±14.5) μ sv/h,respectively] after 72 h of iodine-131 administration were not significantly different (F=2.313,P＞0.05).The dose rate in 95.8％ of the patients (137 out of 143 patients) was less than 23.3 μSv/h after approximately 80 h of iodine-131 administration.After the patients were discharged from the hospital,the surface dose rates on the bed sheets,patients' clothes,ward floor,and ground at the bathroom door were (3.9±1.2),(4.1±1.9),(3.8±1.6),and (6.2± 2.6) μsv/h,respectively.These values were lower than the corresponding radiation limit levels.Conclusions After 80 h of treatment with no more than 7.40 GBq iodine-131,the residual dose of iodine-131 in most patients was lower than its restricted value in China.The radiation pollution level of the patients' ward grounds,bed sheets,and clothes were also lower than the radiation limit.Thus,these materials and facilities require no special treatment.

目的 分析单光子发射计算机断层成像/电子计算机断层扫描(SPECT/CT)骨显像在脊柱骨转移瘤临床诊断中的应用价值,以提高临床诊断脊柱骨转移瘤的准确度.方法 选取72例2016年1月至2017年6月医院收治的恶性肿瘤患者,给予所有患者SPECT/CT骨显像,分析患者的脊柱骨转移瘤诊断结果 .结果以手术病理结果为诊断标准,SPECT/CT骨显像诊断脊柱骨转移瘤的准确度为95.8％,灵敏度和特异度分别为97.9％、91.7％,阳性和阴性预测值分别为95.9％、95.7％.脊柱骨转移瘤的转移部位:除5例多发转移患者外,其余42例患者共发现脊柱骨转移灶73处,其中以胸腰椎转移病灶为主,腰椎有19处,胸椎有45处.结论 SPECT/CT骨显像在脊柱骨转移瘤诊断中具有较高的灵敏度和特异度,能够为临床诊治提供重要参考.

IgG4-related lung disease (IgG4-RLD) is a disease caused by the infiltration of IgG4-positive plasma cells and lymphocytes into lung tissues, which is manifested with high uptake of 18F-fluorodeoxyglucose (18F-FDG) on positron emission tomography/computed tomography (PET/CT).IgG4-RLD yields multiple forms of radiologic features on CT imaging.However, cavitary mass is a rare imaging feature and should be differentially diagnosed from cavitary malignant tumor.In this article, we reported two cases presenting with similar clinical and imaging signs to cavitary pulmonary disease with high uptake of 18F-FDG on PET/CT.One patient was eventually diagnosed with IgG4-RLD and the other case was diagnosed with lung cancer by pathological biopsy.The findings in this article prompt that elevated serum level of IgG4 and high uptake of 18F-FDG are vital features to differentially diagnose from IgG4-RLD to lung cancer.

随着现代医疗技术的发展,放射诊疗越来越频繁,与核技术相结合的核医学诊疗也得到了飞速的发展. 全国大部分的大中型医院都设置有核医学科,不仅拥有正电子发射计算机断层显像(PET)/CT、PET/磁共振成像(MRI)、单光子发射型计算机断层(SPECT)/CT等先进设备,核素治疗也迎来了前所未有的发展机遇[1]. 由于核医学的特殊性决定了所开展的大部分诊疗工作都与电离辐射密切相关, 且其辐射场主要是开放性的,置身其中工作,就不可避免地受到一定的职业照射,如何提高放射性与电离辐射剂量监测能力, 并对此进行经常性地监管,显得十分重要.

Objective To investigate the clinical value of 99mTc-MDP SPECT/CT whole body bone imaging in the diagnosis of bone metastasis of prostate cancer. Methods A total of 107 cases with prostate cancer were di-agnosed by SPECT whole body bone imaging from January 2013 to November 2016. SPECT/CT imaging of some ab-normal density collective focus found in whole body bone imaging were further carried out. Six months later ,whole body bone imaging and SPECT/CT were made again for review. In all diagnosis above ,99mTc-MDP were selected as bone imaging agent. According to the results of follow-up visit clinical and imaging diagnosis ,diagnostic perfor-mance indicators of whole body bone imaging and SPECT/CT were calculated. Results The different part of whole body bone imaging and SPECT/CT in the diagnosis of bone metastases was statistically significant(x2 = 23.000, P < 0.001). The diagnosis specificity and coincidence rate of SPECT/CT for bone metastasis were 100.0% and 98.1% respectively and they were significantly higher than those of whole body bone imaging(65.0% and 80.4%respectively). The differences were statistically significant(P < 0.05). After SPECT/CT diagnosis,a total of 193 undetermined lesions were found and 83 lesions of these were final diagnosed of bone metastases. Pelvic lesions were most in bone metastases ,accounting for 50.6%. Conclusion Whole body bone imaging can effectively determine the undetermined lesions , further SPECT/CT can significantly improve the diagnostic accuracy of prostate cancer bone metastasis.

目的比较分化型甲状腺癌术后肺转移的单光子/正电子发射断层成像术（SPECT/CT）平面与断层显像诊断价值。方法回顾性分析中山大学附属第三医院2012年1月至2016年10月收治的64例疑似分化型甲状腺癌术后肺转移患者的临床资料,所有患者均同时接受SPECT/CT平面与断层显像,对显像诊断结果进行统计分析。结果 64例患者中确诊为分化型甲状腺癌术后肺转移48例,未发生肺转移16例。SPECT/CT平面显像诊断40例为肺转移,其中12例为假阳性;24例未发生肺转移,其中20例为假阴性。SPECT/CT断层显像诊断52例为肺转移,其中48例为真阳性;12例未发生肺转移,其中4例为假阳性。分化型甲状腺癌术后肺转移的SPECT/CT断层显像的敏感度、特异度、准确性、阳性预测值、阴性预测值均显著高于SPECT/CT平面显像（χ2=12.63、4.00、11.14、3.92、11.25,P=0.032、0.033、0.024、0.042、0.013）。结论分化型甲状腺癌术后肺转移的SPECT/CT断层显像诊断价值较SPECT/CT平面显像高,值得在临床推广。

Objective To investigate the diagnostic value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT delayed imaging in the diagnosis of primary liver cancer. Methods Clinical data of 80 patients with primary liver cancer who were admitted to the Third Affiliated Hospital of Sun Yat-sen University between October 2014 and December 2016 were retrospectively analyzed. Among them, 62 cases were males and 18 were females, aged (58±12) years old on average. According to the tumor diameter, the patients were divided into the small liver cancer group (n=30), nodular liver cancer group (n=23) and large liver cancer group (n=27). The informed consents of all patients were obtained and the local ethical committee approval was received. PET/CT early imaging was performed on the patients at 40-60 min after they were intravenously injected with contrast agent 18F-FDG, and PET/CT delayed imaging was performed at 2 h later. The maximal standardized uptake values (SUVmax) of the lesions in two imagings were detected. The early imaging, delayed imaging and the imaging changes at different stages were observed and compared among three groups. The SUVmax values were compared among three groups using one-way analysis of variance and LSD-t test, and were compared between two groups using t test. The rates were compared using Chi-square test. Results The SUVmax values of the early imaging and delayed imaging were respectively 5.1±1.9 and 5.5±2.3 in the nodular liver cancer group, significantly higher than 3.9±1.4 and 4.3±2.0 in the small liver cancer group (LSD-t=2.60, 2.03; P<0.05), whereas significantly lower than 6.9±2.6 and 8.5±2.9 in the large liver cancer group (LSD-t=-2.82, -4.08; P<0.05). The SUVmax value of the delayed imaging in the large liver cancer group was significantly higher than that of the early imaging (t=2.05, P<0.05). The percentage of patients with SUVmax values of the delayed imaging higher than that of the early imaging was 93%(25/27) in the large liver cancer group, significantly higher than 53%(16/30) in the small liver cancer group and 61%(14/23) in the nodular liver cancer group (χ2=10.85, 7.28; P<0.05). Conclusions The 18F-FDG uptake of the delayed imaging increases significantly along with the tumor diameter increases. Application of 18F-FDG PET/CT delayed imaging can elevate the detection rate of liver cancer, especially large liver cancer. Key words: Liver neoplasms; Fluorodeoxyglucose F18; Delayed imaging; Positron-emission tomography

通过总结核医学临床工作中容易导致儿童核素脑单光子发射计算机断层显像(single photon emission computedtomography,SPECT)检查失败的两大影响因素,针对这些因素采取了多种心理护理及显像技巧的综合应用方法,有效地提高了该项检查的成功率,既为临床提供了可靠的诊断依据,又为核素显像积累了实用经验.

Objective To evaluate the capability of 99mTc-DTPA dynamic renal imaging Gates method and double-phase plasma method to measure glomerular filtration rate(GFR).Methods 149 patients who were measured GFR by 99mTc-DTPA dynamic renal imaging Gates method and doublephase plasma method were enrolled in this study.99mTc-DTPA dynamic renal imaging was performed after the injection of 185 MBq/1 ml 99mTc-DTPA.The image was processed by Gates method and obtained GFR(gGFR).At the same time,4 ml of venous blood was separately collected 2 hours and 4 hours after the injection of 99mTc-DTPA,then heparin anticoagulated,centrifuged and and separated.1 ml of plasma was extracted and measure the radioactivity count,and GFR(tGFR) was obtained by double-phase plasma method.The SPSS statistical tool was used to analyzethe results.Results Paired t-test showed that there was no significant differences between gGFR and tGFR (P＞0.05).Pearsonal analysis showed that there were significant correlations between gGFR and tGFR in all cases (P＜0.05).Bland-Altman test showed that there was a well consistency between gGFR and tGFR in all different level of renal function.Conclusions 99mTc-DTPA dynamic renal imaging Gates method and double-phase plasma method both could be applied to measure the GFR in patients with renal dysfunction.

Objective To investigate the causes and preventive measures against the incidence of gastrointestinal tract reaction in differentiated thyroid carcinoma patients after iodine-131 therapy.Methods In total, 479 patients diagnosed with differentiated thyroid carcinoma received iodine-131therapy after surgery.The level of thyroid function was measured before iodine-131 therapy.Before and during iodine-131 therapy, medicine treatment was delivered using metoclopramide, proton pump inhibitors (PPI), prokinetic agents and mucosal protective agents.All patients were assigned into different groups according to the type and quantity of adjuvant drugs.After iodine-131 therapy, the incidence of gastrointestinal tract reaction was observed and compared among different groups.Results During iodine-131 therapy, the incidence of gastrointestinal reaction was 11.9%, which was negatively correlated with FT3 and FT4 and positively correlated with the dose of iodine-131 (all P<0.05).Iodine-131 was an independent risk factor of the incidence of gastrointestinal reaction (OR=3.174, 95% CI=1.450-6.946, P=0.004).The risk of gastrointestinal reaction in the prokinetic agents group was significantly lower than that in their counterparts without intake of prokinetic agents (P=0.032), whereas it was considerably higher in the mucosal protective agents group compared with that in those without intake of mucosal protective agents (P=0.015).The risk of gastrointestinal reaction did not significantly differ according to the intake of metoclopramide or PPI (both P>0.05).The incidence of gastrointestinal reaction in patients receiving prokinetic agents in combination with 1 or 2 types of drugs was significantly lower than that in those intake of prokinetic agents plus three types of drugs (P=0.002, P=0.003).Conclusions Throughout the iodine-131 therapy, the incidence of gastrointestinal reaction is correlated with the level of thyroid function and dosage of iodine-131.Use of prokinetic agents can effectively reduce the risk of gastrointestinal reaction.

目的 了解分化型甲状腺癌术后131I治疗过程中胃肠道反应发生情况.方法 收集分化型甲状腺癌术后行131I治疗患者资料,观察患者治疗期间出现胃肠道反应[恶心和(或)呕吐]情况,根据患者呕吐次数将呕吐严重程度分为轻微(1~2次)、中度(3~4次)和严重(4次以上),分析患者胃肠道反应发生率及其与患者治疗次数及剂量间关系.结果 共纳入703例次,其中男210例次,女493例次,年龄(40.7±14.6)岁,中位年龄38岁.在这703例次中,共出现胃肠道反应96例次,占13.7%,其中仅表现为恶心者60例次,占8.5%,呕吐者36例次,占5.1%,以轻微呕吐者居多,占3.3%.再次治疗或多次治疗时,随着131I剂量逐渐增大(x2=342.374,P=0.000),胃肠道反应或呕吐的发生率高于初次治疗时(x2=32.780,P=0.000;x2=36.833,P=0.000).结论 分化型甲状腺癌术后患者,随着131I治疗次数和剂量增加,发生胃肠道反应可能性加大.

ObjectiveConclude the experience and methods in the process of a SPECT/CT’s Instalation and Quality Control in order to facilitate new equipment instaled and been put into use smoothly and quickly.Method (1)Plan and prepare for the instalation.(2)Instal the new SPECT/CT equipment.(3)Test and calibrate the main performance parameters of the equipment. (4) Conclude the precautions of technical training and operation of the equipment in details.Result The SPECT/CT was instaled successful and the technical training was finished both in two weeks, al of the main parameters passed the performance tests and achieved the ideal state. The detector 1 and detector 2 of the SPECT both had very good intrinsic uniformity, the intrinsic values of intrinsic uniformity in CFOV were 1.56% and 1.78%, and in UFOV were 1.85% and 1.87%, the differential values of intrinsic uniformity in CFOV were 1.25% and 1.43%, and in UFOV were 1.25% and 1.44%. The parameters of CT part were also reached the specifications.Conclusion A instalation of a SPECT/CT could be done in a short time and the equipment could be put into use quikly with a wel preparation. Either were mastering the operation of the new equipment and the quality control methods.

Objective To summarize the uniformity calibration method of daily quality control (QC) of Hawkeye device and to analyze the common causes of property drift. Methods Part of the QC data of Hawkeye device collected in our hospital from January 2013 to June 2013 was selected to make an analysis of its uniformity. The bright spot was found in the center field of Hawkeye probe in the hospital, and its CFOV (Center Field of View) uniformity values deviated greatly (23.17%). In view of this, the ITER (Iterative Calibration) procedure of Hawkeye device was initiated for correction of the CFOV uniformity values. Results The intrinsic uniformity of the device went back to normal value (CFOV<3.5%) after correction. Conclusion Effective daily QC could correct the uniformity value drift of Hawkeye device, which enables the maintenance of its uniformity in perfect status and assures its complete performance.

0引言Hawkeye（Discovery VH，GE）仪器是美国GE公司的第二代鹰眼显像系统，是一种带有符合线路的SPECT/CT，它不仅具有所有的SPECT功能，还兼具简单的PET功能和CT定位功能，可以利用X线的透射衰减原理对图像进行衰减校正。该仪器把CT图像与核医学图像成功地融合起来，将核医学影像技术在临床上的应用提高到了一个新的阶段[1－2]。

Objective To enhance the 18 F-FDG uptake capacity of hepatic carcinoma cells .Methods Hepatic carcinoma cell HepG2 and normal hepatic cell L02 were incubated for 2 h, 4 h, 6 h, 8 h, 12 h and 24 h with the dexam-ethasone of 10-8 mol/L,10-7 mol/L,10-6 mol/L,10-5 mol/L or 10-4 mol/L.The control group was treated without dexa -methasone.After that, 1 μCi 18 F -FDG was added for incubation into each group for 1 h, and the radioactivity counts were assessed subsequently.Results Dexamethasone significantly inhibited uptake capacity of the 18 F -FDG in HepG2 with the concentrations of 10-8 mol /L and 10-7 mol /L; promoted it with concentrations of 10-5 mol/L and 10-4 mol/L;and had no effect on it with the concentration of 10-6 mol/L (P <0.05).Meanwhile, Dexamethasone significantly inhibi -ted uptake capacity of the 18 F -FDG in L02 with the concentrations of 10-8 mol/L, 10-7 mol/L and 10-6 mol/L; promo-ted it with concentrations of 10-4 mol /L; and had no effect on it with the concentration of 10-5 mol/L (P <0.05).The 18 F -FDG uptake capacity of HepG2 was significantly higher than L02, and the difference was significantly enlarged by pre -treatment by dexamethasone (P <0.05).Conclusion Dexamethasone has biphasic effect on the 18 F -FDG uptake capacity of hepatocytes.The appropriate concentration of dexamethasone can enlarge the 18 F -FDG uptake difference be-tween HepG2 and L02.

Objective To evaluate image features and diagnostic value of radionuclide bone imaging for differentiating malignant and benign costovertebral joint lesions.Methods Data of 60patients with various cancers and costovertebral joints lesions in radionuclide bone imaging were retrospectively analyzed.Taken high resolution CT(HRCT),clinical follow-up and pathologic results as diagnostic standards,the image features of radionuclide bone imaging for differentiating malignant and benign costovertebral joint lesions were explored,and the sensitivity and specificity were evaluated.Results Among 60patients with radioactive anomaly concentration rib ridge joint lesions,54(54/60,90.00%)were proved bone metastases by HRCT.Rib bone imaging in spinal joints radioactive anomaly concentration center located at frame side or vertebral lateral,present as vertical and horizontal strips.When concentration with center on lateral ribs was defined as bone metastase,the sensitivity and specificity of radionuclide bone imaging was 59.26%(32/54)and 83.33%(5/6),respectively. When horizontal bar concentration was defined as positive,the sensitivity and specificity was 29.63%(16/54)and 100%(6/6),respectively.Furthermore,when center on lateral ribs concentration or horizontal bar concentration were defined as positive,the sensitivity and specificity was 88.89%(48/54)and 83.33%(5/6),respectively.Conclusion For radionuclide whole body bone imaging,radioactive anomaly consistence lesions on costovertebral joint,especially punctiform lesions with centre approaching to rib and transverse lesions are probably bone metastases.

目的：分析回旋加速器在beam on（运行状态）过程中出现的两个典型故障的原因，总结排查和解决故障的经验。方法根据故障检测软件提示初步判断故障范围，针对故障1，在beam on时，检测与分析射频电压与高频发射机停止的关系；针对故障2在Beam on时SOURCE（离子源系统）无法启动，分析output selected（输出靶位选择）错误信息的原因，分别采取相应处理对策。结果故障1为二级水冷系统工作异常所致射频电压不稳定，可造成其过流保护而导致高频发射机停止工作，通过屏蔽水流短路点后，该密封冷却水循环装置的故障得以排除。故障2是由电源故障导致SOURCE无法启动，更换电源即解决。结论根据故障检测提示寻找故障原因，针对性检测和维修，可有效地解决故障，提高工作效率。

为了适应核医学科特殊防护病房的治疗护理和防辐射需求,结合对甲状腺疾病患者核素碘-131治疗的经验,对核医学科病房的辐射防护和护理管理进行探讨,以利于更好地开展工作和提高工作效率.要点:①做好核医学科特殊防护病房内患者和医务人员的防污染、防辐射管理,以及放射性废物处理和辐射监测;②采取预约核素治疗的方法,在患者集中入院和出院时进行护理;③做好护理人员的核素防辐射知识和防护技能培训.