Background:The spastic cerebral palsy isconsidered the most common of cerebral palsy types. Spasticity of upper limbs is major problem in children that affected on hand function during grasping and through using assistive devices as walker and canes. Shock wave treatment on spastic muscles of upper limbs in stroke patients performed a significant decrease in muscle tone.The aim of current study was to determine the impact of extracorporeal shock wave therapy (ESWT) on spastic muscle of hand in children with spastic cerebral palsy.Methods:Thirty twohemiplegic spastic cerebral palsy patients from both sexes were recruited in this study.The children were divided randomly into two groups equal in number; GroupӀ(control)consisted of 16 children(7 boys and 9 girls) with mean±standard deviation age of 6.68±2.63years received exercises program only (3sessions/week for two months, GroupӀӀ(experimental)included (10 boys and 6 girls)with mean±standard deviation age of 6.37±1.44 years received the same exercises program in addition to sessions by extracorporeal shock wave therapy(BTL-6000WT) with energy flux(0.003mJ/mm²),frequency (10Hz)and (one session/week) for 8 weeks .The two groups were evaluated before and after therapy by Modified Ashworth Scale (MAS) and Modified House function Classification (MHC).Results:The results showed a statistically significant improvement in spasticity and hand function post treatment.Conclusion:We concluded that the ESWT is effective in decreasingspasticity(muscle tone) of upper extremities and enhancinghand function for patients with spastic cerebral palsyto help those children become independent and participate in different daily activities as grasping of walker or canes.

Intensity modulated radiation therapy (IMRT) is an effective treatment planning technique for various types of tumors such as head and neck (H&N) or pelvis. A complexity algorithm was invented to predict the deliverability and the accuracy for IMRT plans called the Modulation Complexity Score ranging from 0 to 1. The %GP is a metric depends on %DD /DTA to find the variation between the calculated dose from TPS and the measured dose from the phantom during the QA. This study is trying to assess the correlation between the MCS and planning verification outcome. Thirty-four patients treated with step and shoot IMRT technique for anatomical sites: H&N and pelvis. The planning process performed using Monaco 5.1 TPS then exported to Elekta Synergy linear accelerator. The phantom is used for the QA procedure is Octavius 4D-1500 with Verisoft 7.1 software analysis to evaluate the gamma passing rate for commonly used criteria 3%/3 mm at a 5% threshold. The MCS calculated using MATLAB 2019a. It results that the H&N plans are significantly more complex than the pelvis once with p-value 0.0192. The analysis shows a weak correlation between the MCS and MU for both treated sites. The complex H&N plans give a good value for %GP. Also, simpler pelvis plans obtain better global %GP results. Thus, modulation Complexity score can give a simple indication for pretreatment verifications of the IMRT plans for H&N and pelvis sites.

Each Intensity Modulated Radiation Therapy (IMRT) plan needs to be tested and verified before any treatment to check its quality. Octavius 4D-1500 phantom detector is a modern and qualified device for quality assurance procedure. This study aims to compare the common dosimetric criteria 3%/3 mm with 2%/2 mm for H&N plans for the IMRT technique. Twenty-five patients with head and neck (H&N) tumor were with 6MV x-ray photon beam using Monaco 5.1 treatment planning software and exported to Elekta synergy linear accelerator then tested for pretreatment verification study using Octavius 4D-1500 phantom detector. The difference between planned and measured dose were assessed by using local and global gamma index (GI) analysis method at threshold 10%. The DD/DTA criteria are performed with 3%/3 mm and 2%/2 mm. A significant difference is shown between the measured and calculated point dose for the treatment plans. A comparison made between the gamma passing rate between the 2%/2 mm and 3%/3 mm shows a significant difference for local and global which shows that the 2%/2 mm are more sensitive to dose variation than 3%/3 mm. The total monitor unit (MU) shows a negative linear relationship with both criteria and %GP types. A significant correlation is shown between the total MU and global %GP at 2%/2 mm criterion. The conclusion of the study indicates that 2%/2 mm criterion is more sensitive to the dose distribution changes than the 3%/3 mm. The total number of monitor units should be taken into consideration during the planning of H&N tumors using the IMRT plans.

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