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Nishimura T, Okamura T, Fujimura T, Miyazaki Y, Takenaka H, Akase H, Tateishi H, Mochizuki M, Uchinoumi H, Oda T, Yano M. Feasibility, reproducibility and characteristics of coronary bifurcation type assessment by three-dimensional optical coherence tomography. PLoS One 2022; 17:e0263246. [PMID: 35104282 PMCID: PMC8806074 DOI: 10.1371/journal.pone.0263246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Aim To investigate the characteristics of coronary artery bifurcation type (parallel or perpendicular type) using three-dimensional (3D) optical coherence tomography (OCT), and determine the feasibility, reproducibility, assessment time and correlation with bifurcation angles measured by 3D quantitative coronary angiography (QCA). Methods and results We evaluated 60 lesions at the coronary bifurcation that were treated by main vessel (MV) stenting with kissing balloon inflation (KBI) under OCT/optical frequency domain imaging (OFDI) guidance. Inter- and intra-observer agreement regarding the assessment of 3D bifurcation types were 0.88 and 0.94, respectively. The assessment times of 3D-OCT bifurcation type with OCT and OFDI were within about 30 seconds. 3D-OCT bifurcation types showed the greatest correlation with the distal bifurcation angle assessed by 3D-QCA among the three bifurcation angles (distal bifurcation angle, proximal bifurcation angle and main vessel angle), and the optimal cut-off distal bifurcation angle to predict a perpendicular type bifurcation, as determined by ROC analysis, was 51.0° (AUC 0.773, sensitivity 0.80, specificity 0.67). Based on this cut-off value for the distal bifurcation angle (51°), the diagnostic accuracy for perpendicular type bifurcation in cases with a BA ≥ 51° (n = 34) was 70.6% (24/34) and that of the parallel type bifurcation in cases of BA < 51° (n = 26) was 76.9% (20/26). Conclusion Performing 3D-OCT for assessment of coronary artery bifurcation type is feasible and simple, and can be done in a short time with high reproducibility.
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Affiliation(s)
- Takashi Nishimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
- * E-mail:
| | - Tatsuhiro Fujimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hitoshi Takenaka
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hideaki Akase
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroki Tateishi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Mamoru Mochizuki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hitoshi Uchinoumi
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tetsuro Oda
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masafumi Yano
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
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Poeta S, Jourani Y, De Caluwé A, Van den Begin R, Van Gestel D, Reynaert N. Split-VMAT technique to control the deep inspiration breath hold time for breast cancer radiotherapy. Radiat Oncol 2021; 16:77. [PMID: 33879209 PMCID: PMC8056647 DOI: 10.1186/s13014-021-01800-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve split-VMAT technique by optimizing treatment delivery time for deep-inspiration breath hold (DIBH) radiotherapy in left-sided breast cancer patients, when automatic beam-interruption devices are not available. METHODS Ten consecutive patients were treated with an eight partial arcs (8paVMAT) plan, standard of care in our center. A four partial arcs (4paVMAT) plan was also created and actual LINAC outputs were measured, to evaluate whether there was a dosimetric difference between both techniques and potential impact on the delivered dose. Subsequently, ten other patients were consecutively treated with a 4paVMAT plan to compare the actual treatment delivery time between both techniques. The prescribed dose was 40.05 Gy/15 fractions on the PTV breast (breast or thoracic wall), lymph nodes (LN) and intramammary lymph node chain (IMN). Treatment delivery time, PTVs coverage, conformity index (CI), organs at risk (OAR) dose, monitor units (MU), and gamma index were compared. RESULTS Both split-VMAT techniques resulted in similar dose coverage for the PTV Breast and LN, and similar CI. For PTV IMN we observed a 5% increased coverage for the volume receiving ≥ 36 Gy with 4paVMAT, with an identical volume receiving ≥ 32 Gy. There was no difference for the OAR sparing, with the exception of the contralateral organs: there was a 0.6 Gy decrease for contralateral breast mean (p ≤ 0.01) and 1% decrease for the volume of right lung receiving ≥ 5 Gy (p = 0.024). Overall, these results indicate a modest clinical benefit of using 4paVMAT in comparison to 8paVMAT. An increase in the number of MU per arc was observed for the 4paVMAT technique, as expected, while the total number of MU remained comparable for both techniques. All the plans were measured with the Delta4 phantom and passed the gamma index criteria with no significant differences. Finally, the main difference was seen for the treatment delivery time: there was a significant decrease from 8.9 to 5.4 min for the 4paVMAT plans (p < .05). CONCLUSIONS This study is mainly of interest for centers who are implementing the DIBH technique without automatic beam-holding devices and who therefore may require to manually switch the beam on and off during breast DIBH treatment. Split-VMAT technique with 4 partial arcs significantly reduces the treatment delivery time compared to 8 partial arcs, without compromising the target coverage and the OAR sparing. The technique decreases the number of breath holds per fraction, resulting in a shorter treatment session.
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Affiliation(s)
- Sara Poeta
- Medical Physics Department, Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Belgium
| | - Younes Jourani
- Medical Physics Department, Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Belgium
| | - Alex De Caluwé
- Radiation Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Robbe Van den Begin
- Radiation Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Radiation Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Nick Reynaert
- Medical Physics Department, Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Belgium
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Zhu Y, You J, Xu C, Gu X. Predictive value of carotid artery ultrasonography for the risk of coronary artery disease. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:218-226. [PMID: 33051899 DOI: 10.1002/jcu.22932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To assess carotid intima-media thickness (IMT), carotid plaques, and cardiovascular risk factors in patients with suspected coronary artery disease (CHD) to determine their association and predictive value for CHD. METHODS We performed duplex Doppler ultrasonography of the carotid arteries and coronary angiography or CT in 480 patients with suspected CHD, and investigated their personal and medical histories. Patients were then assigned to the CHD or the control group depending on the presence of coronary lesions. Ultrasonography was performed the morning after admission prior to any treatment, coronary angiography, or CT. RESULTS Carotid plaques were mainly distributed in the common carotid artery bifurcation, with a significant difference between the CHD and control groups. Plaque incidence (80%) and IMT were significantly higher (P < .001 and P = .012, respectively) in the CHD (80% and 0.84 ± 0.21 mm) than in the control group (49% and 0.76 ± 0.18 mm). The factors significantly associated with CHD were introduced into a multivariate regression model. Male subject (OR = 1.569, 95%CI 1.004-2.453; P = .048) and plaque burden (OR = 0.457, 95%CI 0.210-0.993; P = .048) were significant predictors for CHD occurrence. The presence of carotid plaques performed significantly better than IMT and the Framingham risk score for predicting CHD lesions (P < .001 for both). CONCLUSIONS CHD patients showed higher percentage of clinical (plaques) or subclinical (IMT) carotid artery wall change, and the presence of carotid plaques showed better predictive value than IMT and Framingham risk score for the presence of coronary artery lesions.
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Affiliation(s)
- Ye Zhu
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jia You
- Department of Internal Medicine, Yangzhou Maternal and Child Health Care Hospital, Yangzhou, Jiangsu, China
| | - Chao Xu
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Xiang Gu
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
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Grodecki K, Opolski MP, Staruch AD, Michalowska AM, Kepka C, Wolny R, Pregowski J, Kruk M, Debski M, Debski A, Michalowska I, Witkowski A. Comparison of Computed Tomography Angiography Versus Invasive Angiography to Assess Medina Classification in Coronary Bifurcations. Am J Cardiol 2020; 125:1479-1485. [PMID: 32276762 DOI: 10.1016/j.amjcard.2020.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022]
Abstract
The Medina classification is used to determine the presence of significant stenosis (≥50%) within each of the 3 arterial segments of coronary bifurcation in invasive coronary angiography (ICA). The utility of coronary computed tomography angiography (coronary CTA) for assessment of Medina classification is unknown. We aimed to compare the agreement and reproducibility of Medina classification between ICA and coronary CTA, and evaluate its ability to predict side branch (SB) occlusion following percutaneous coronary intervention (PCI). In total 363 patients with 400 bifurcations were included, and 28 (7%) SB occlusions among 26 patients were noted. Total agreement between CTA and ICA for assessment of Medina class was poor (kappa = 0.189), and discordance between both modalities was noted in 253 (63.3%) lesions. Larger diameter ratio between main vessel and SB in CTA, and larger bifurcation angle in ICA were independently associated with discordant Medina assessment. Whereas the interobserver agreement on Medina classification in CTA was moderate (kappa = 0.557), only fair agreement (kappa = 0.346) was observed for ICA. Finally, Medina class with any proximal involvement of main vessel and SB (1.X.1) on CTA or ICA was the most predictive of SB occlusion following PCI with no significant differences between both modalities (area under the curve 0.686 vs 0.663, p = 0.693, respectively). In conclusion, Medina classification was significantly affected by the imaging modality, and coronary CTA improved reproducibility of Medina classification compared with ICA. Both CTA and ICA-derived Medina class with any involvement of the proximal main vessel and SB was predictive of SB occlusion following PCI.
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Opolski MP, Grodecki K, Staruch AD, Michalowska AM, Kepka C, Wolny R, Knaapen P, Schumacher SP, Pregowski J, Kruk M, Debski M, Debski A, Michalowska I, Witkowski A. Accuracy of RESOLVE score derived from coronary computed tomography versus visual angiography to predict side branch occlusion in percutaneous bifurcation intervention. J Cardiovasc Comput Tomogr 2019; 14:258-265. [PMID: 31806391 DOI: 10.1016/j.jcct.2019.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/29/2019] [Accepted: 11/20/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Visually estimated angiographic V-RESOLVE score was developed as a simple and accurate prediction tool for side branch (SB) occlusion in patients undergoing coronary bifurcation intervention. Data on the use of coronary computed tomography angiography (coronary CTA) for guiding percutaneous coronary intervention in bifurcation lesions is scarce. OBJECTIVES We aimed to validate the ability of quantitative CTA-derived RESOLVE score for predicting SB occlusion in coronary bifurcation intervention and to compare its predictive value with that of the angiography-based V-RESOLVE score. METHODS We included 363 patients with 400 bifurcation lesions. Angiographic V-RESOLVE score and CTA-derived RESOLVE score were calculated utilizing the weights from the QCA-based RESOLVE score. The scoring systems were divided into quartiles, and classified as the non-high-risk group and the high-risk group. Accuracy was assessed using areas under the receiver-operator characteristic curve (AUC). SB occlusion was defined as any decrease in Thrombolysis in Myocardial Infarction flow grade (including the absence of flow) in the SB after main vessel stenting. RESULTS In total, 28 SB occlusions (7%) occurred. CTA-derived RESOLVE and V-RESOLVE scores achieved comparable predictive accuracy (0.709 vs. 0.752, respectively, p = 0.531) for predicting SB occlusion, and the analysis of AUC for each constituent element of the scores did not show any significant difference between CTA and visual angiography. The total net reclassification index was -18.6% (p = 0.194), and there were no significant differences in the rates of SB occlusion in the non-high-risk group (4.9% vs. 3.8%, p = 0.510) and the high-risk group (13.8% vs. 18.6%, p = 0.384) between CTA-derived RESOLVE and V-RESOLVE scores. CONCLUSIONS The quantitative CTA-derived RESOLVE score is an accurate and reliable alternative to the visually estimated angiographic V-RESOLVE score for prediction of SB occlusion in coronary bifurcation intervention. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03709836.
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Affiliation(s)
- Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
| | - Kajetan Grodecki
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland
| | - Adam D Staruch
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Anna M Michalowska
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland; Medical University of Warsaw, Warsaw, Poland
| | - Cezary Kepka
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Rafal Wolny
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jerzy Pregowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Debski
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Artur Debski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | | | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
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A Novel Biodegradable Multilayered Bioengineered Vascular Construct with a Curved Structure and Multi-Branches. MICROMACHINES 2019; 10:mi10040275. [PMID: 31022873 PMCID: PMC6523450 DOI: 10.3390/mi10040275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 12/18/2022]
Abstract
Constructing tissue engineered vascular grafts (TEVG) is of great significance for cardiovascular research. However, most of the fabrication techniques are unable to construct TEVG with a bifurcated and curved structure. This paper presents multilayered biodegradable TEVGs with a curved structure and multi-branches. The technique combined 3D printed molds and casting hydrogel and sacrificial material to create vessel-mimicking constructs with customizable structural parameters. Compared with other fabrication methods, the proposed technique can create more native-like 3D geometries. The diameter and wall thickness of the fabricated constructs can be independently controlled, providing a feasible approach for TEVG construction. Enzymatically-crosslinked gelatin was used as the material of the constructs. The mechanical properties and thermostability of the constructs were evaluated. Fluid-structure interaction simulations were conducted to examine the displacement of the construct’s wall when blood flows through it. Human umbilical vein endothelial cells (HUVECs) were seeded on the inner channel of the constructs and cultured for 72 h. The cell morphology was assessed. The results showed that the proposed technique had good application potentials, and will hopefully provide a novel technological approach for constructing integrated vasculature for tissue engineering.
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Wang J, Jiang J, Zhang Y, Qian YW, Zhang JF, Wang ZL. Retinal and choroidal vascular changes in coronary heart disease: an optical coherence tomography angiography study. BIOMEDICAL OPTICS EXPRESS 2019; 10:1532-1544. [PMID: 31061756 PMCID: PMC6485014 DOI: 10.1364/boe.10.001532] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 05/22/2023]
Abstract
To reveal the association between retinal microvasculature changes and coronary heart disease (CHD), we assessed the full retinal thicknesses of eight areas, the vessel density of four layers (consisting of nine areas) and the flow area in two layers with optical coherence tomography angiography (OCTA) in CHD patients and healthy controls. The mean vessel density of several layers was significantly lower in patients. The difference in choroid capillary flow (negative correlation) between the two groups was significant. Decreased vessel density and blood flow were associated with coronary artery and branch stenosis. The decreases in retinal vessel density, choroidal vessel density, and blood flow area are closely related to coronary artery and branch stenosis.
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Affiliation(s)
- J. Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - J. Jiang
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Y. Zhang
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Y. W. Qian
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - J. F. Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Z. L. Wang
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
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Li Q, Tong Y, Yin Y, Cheng P, Gong G. Definition of the margin of major coronary artery bifurcations during radiotherapy with electrocardiograph-gated 4D-CT. Phys Med 2018; 49:90-94. [PMID: 29866348 DOI: 10.1016/j.ejmp.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/03/2018] [Accepted: 05/06/2018] [Indexed: 10/16/2022] Open
Abstract
PURPOSE The aim was to measure the cardiac motion-induced displacements of major coronary artery bifurcations utilizing electrocardiography (ECG)-gated four-dimensional computed tomography (4D-CT) and to determine the margin of coronary artery bifurcations. METHODS Thirty-seven female patients who underwent retrospective ECG-gated 4D-CT in inspiratory breath hold (IBH) were enrolled. The left main coronary artery bifurcation (LM), the obtuse marginal branch bifurcation (OM), the first diagonal branch bifurcation (D1), the second diagonal branch bifurcation (D2), the caudal portion of the left anterior descending branch (APX), the first right ventricular artery bifurcation (V) and the acute marginal branch bifurcation (AM) were contoured. The center of the contour of the coronary arterial bifurcations at end systole was defined as the standard, and the margin were then calculated. RESULTS The margin in the left-right (LR), cranio-caudal (CC), and anterior-posterior (AP) coordinates were as follows: LM 3, 3, and 3 mm; D1 6, 3, and 3 mm; D2 3, 3, and 3 mm; APX 4, 4, and 4 mm; OM 4, 6, and 5 mm; V 6, 8, and 7 mm; and AM 6, 8, and 7 mm, respectively. CONCLUSION Coronary artery bifurcations should be considered a separate organ at risk (OAR), and different margin should be provided due to the differences resulting from motion displacement. The maximum margin in the LR, CC, and AP coordinates of left coronary artery bifurcations were 6, 6, and 5 mm, and those of the right coronary artery bifurcations were 6, 8, and 7 mm, respectively.
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Affiliation(s)
- Qian Li
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China; School of Nuclear Science and Technology, University of South China, Hengyang 421001, China
| | - Ying Tong
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China; School of Nuclear Science and Technology, University of South China, Hengyang 421001, China
| | - Yong Yin
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China
| | - Pinjing Cheng
- School of Nuclear Science and Technology, University of South China, Hengyang 421001, China
| | - Guanzhong Gong
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan 250117, China.
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