초록
목 적: 움직이는 장기에 취약한 Pencil Beam Scanning(PBS)을 보완하기 위해 고안된 Layered Rescanning PBS 기법을 Moving Phantom에 적용하여 Single Scan PBS와 선량비교를 통해 Homogeneity를 비교해 본다. 대상 및 방법: Matrix X(IBA, Belgium)와 Moving Phantom(standard imaging, USA)을 이용하였다. 가상의 tumor $10{\times}10{\times}5cm$에 AP 방향에서 200 cGy의 선량을 조사하였다. 치료계획은 single scan PBS, rescan 4, 8, 12회 총 4가지로 하였고 각 치료계획별로 3번씩 반복 측정하였다. 측정 시 Moving Phantom의 호흡주기는 한 cycle당 4초로 설정 후 S-I 방향 움직임 2 cm으로 설정하였다. 추가로 beam on time을 측정하였다. 결 과: PTV 내에서 $D_{max}$의 평균값은 single scan, 4, 8, 12회 rescan 순서로 각각 $246.47{\pm}18.8cGy$, $223.43{\pm}8.92cGy$, $222.47{\pm}7.7cGy$, $213.9{\pm}6.11cGy$ $D_{min}$의 평균값은 각각 $165.53{\pm}4.32cGy$, $173.13{\pm}11.94cGy$, $184.13{\pm}8.04cGy$, $182.67{\pm}4.38cGy$으로 $D_{mean}$ $192.77{\pm}6.98cGy$, $196.7{\pm}4.01cGy$, $198.17{\pm}4.96cGy$, $195.77{\pm}3.15cGy$으로 측정되었다. 그리고 rescan 횟수가 늘어날수록 Homogeneity Index가 1에 가까워졌으며, beam on time은 평균 2분 15초, 3분 15초, 4분 30초, 5분 37초로 rescan 횟수가 증가할수록 치료시간이 증가되었다. 측정하는 과정에서 MU가 낮은 선량 layer에서는 설정한 rescan 횟수만큼 실제로 rescan하지 못하는 문제점이 발견되었다. 결 론: 장기 움직임이 있는 종양 치료 시 Layered Rescanning PBS을 적용했을 때 single scan PBS보다 균일한 선량분포를 확인할 수 있었다. 그리고 rescan 횟수가 증가할수록 균일한 선량분포를 보였다. single scan PBS와 12회 Layered rescanning 비교 시 HI 수치가 0.32 향상되었다. 추후 연구를 통하여 호흡동조 방사선치료가 불가능환자에게 적용이 가능할 것으로 사료된다.
Purpose : We apply the Layered Rescanning PBS designed to complement the Pencil Beam Scanning(PBS), which is vulnerable to moving organs with the Moving Phantom, and compare the homogeneity with the single scan PBS. Methods and materials: Matrix X (IBA, Belgium) and Moving Phantom (standard imaging, USA) were used. A dose of 200 cGy was measured in the AP direction on a hypothetical tumor $10{\times}10{\times}5cm$. The plan type was planned as 4 kinds of sinlge scan PBS, rescan number 4, 8, 12 times. Were measured three times for each types. During the measurement, the respiratory cycle of the Moving Phantom was generally set to 4 seconds per cycle, and the movement radius in the S-I direction was set to 2 cm. In addition, beam on time was measured. Results : The mean values of $D_{max}$ in the PTV were $246.47{\pm}18.8cGy$, $223.43{\pm}8.92cGy$, and $222.47{\pm}7.7cGy$, $213.9{\pm}6.11cGy$ and the mean values of $D_{min}$ were $165.53{\pm}4.32cGy$, $173.13{\pm}11.94cGy$, $184.13{\pm}8.04cGy$, $182.67{\pm}4.38cGy$ and the mean values of $D_{mean}$ $192.77{\pm}6.98cGy$, $196.7{\pm}4.01cGy$, $198.17{\pm}4.96cGy$, $195.77{\pm}3.15cGy$ respectively. As the number of rescanning increased, the Homogeneity Index converged to 1. The beam on time was measured as 2:15, 3:15, 4:30, 5:37 on average. In the measurement process, in the low dose layer of the MU, the problem was found that it was not rescanned as many times as the set number of rescan. Conclusions : In the treatment of tumors with long-term movements, the application of layered rescanning PBS showed a more uniform dose distribution than single scan PBS. And as the number of rescan increase, the distribution of homogeneity is uniform. Compared with single scan plan and 12 rescan plan, HI value was improved by 0.32. Further studies are expected to be applicable to patients who can not be treated with respiratory synchronous radiation therapy.
