• The Journal of Korean Society for Radiation Therapy
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• v.15 no.1
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• pp.1-9
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• 2003

I. Purpose The multileaf collimator(MLC) has many advantages, but use of the MLC increased effective penumbra and isodose undulation in dose distribution compared with that of an alloy block. In this work, we introduced the HD-270 MLC, which can improve the above disadvantages of MLC, and reported its feasibility study. II. Method and Materials The HD-270 MLC is a technique which combines the use of the existing Siemens multileaf collimator(3D MLC) with patient translation perpendicular to the leaf plane. The technique produces a smoothed isodose distribution with the reduced isodose undulation and effective penumbra. To assess the efficacy of the HD-270 technique and determine the appropriate resolution, a polygonal shaped MLC field was made to produce field edge angles from 0 degree to 75 degree with a step of 15 degree. Each HD-270 group was generated according to the allowed resolution, i. e., 5, 3, and 2mm. The experiment was carried out on Primus, a Siemens linear accelerator configured with HD-270 MLC. The total 60 MU of 6 MV photon beam was delivered to X-Omat film(Kodak, USA) at a SAD of 100 cm and 1.5 cm depth in solid water phantom. Exposed films were scanned by Lumiscan75(LUMISYS) and analyzed using RIT113 software(Radiological Imaging Technology Inc., USA). To test the mechanical accuracy of table movement, the transverse, longitudinal, and vertical positions were controlled by a consol with ${\pm}5\;mm,\;{\pm}4\;mm,\;{\pm}3\;mm,\;and\;{\pm}2\;mm$ steps, and then measured using a dial gauge with an accuracy of 0.001 inch. During the experiments, the table loaded with about 50Kg human phantom to simulate the real treatment situation. III. Results The effective penumbra and isodose undulation became larger with increase the resolution and field edge angle. The accuracy of the table movement on each direction is good within the ${\pm}1\;mm$. IV. Conclusion Clinical use of the MLC can be increased by using of the HD-270 MLC which complements to the disadvantages of the MLC.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.1
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• pp.1-5
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• 2006

Purpose: IMRT quality assurance(Q.A) is consist of the absolute dosimetry using ionization chamber and relative dosimetry using the film. We have in general used 0.015 cc ionization chamber, because small size and measure the point dose. But this ionization chamber is too small to give an accurate measurement value. In this study, we have examined the degree of calculated to measured dose difference in intensity modulated radiotherapy(IMRT) based on the observed/expected ratio using various kinds of ion chambers, which were used for absolute dosimetry. Materials and Methods: we peformed the 6 cases of IMRT sliding-window method for head and neck cases. Radiation was delivered by using a Clinac 21EX unit(Varian, USA) generating a 6 MV x-ray beam, which is equipped with an integrated multileaf collimator. The dose rate for IMRT treatment is set to 300 MU/min. The ion chamber was located 5cm below the surface of phantom giving 100cm as a source-axis distance(SAD). The various types of ion chambers were used including 0.015cc(pin point type 31014, PTW. Germany), 0.125 cc(micro type 31002, PTW, Germany) and 0.6 cc(famer type 30002, PTW, Germany). The measurement point was carefully chosen to be located at low-gradient area. Results: The experimental results show that the average differences between plan value and measured value are ${\pm}0.91%$ for 0.015 cc pin point chamber, ${\pm}0.52%$ for 0.125 cc micro type chamber and ${\pm}0.76%$ for farmer type 0.6cc chamber. The 0.125 cc micro type chamber is appropriate size for dose measure in IMRT. Conclusion: IMRT Q.A is the important procedure. Based on the various types of ion chamber measurements, we have demonstrated that the dose discrepancy between calculated dose distribution and measured dose distribution for IMRT plans is dependent on the size of ion chambers. The reason is small size ionization chamber have the high signal-to-noise ratio and big size ionization chamber is not located accurate measurement point. Therefore our results suggest the 0.125 cc farmer type chamber is appropriate size for dose measure in IMRT.

• Radiation Oncology Journal
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• v.20 no.1
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• pp.41-52
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• 2002

Purpose : 3D conformal radiotherapy, the optimum dose delivered to the tumor and provided the risk of normal tissue unless marginal miss, was restricted by organ motion. For tumors in the thorax and abdomen, the planning target volume (PTV) is decided including the margin for movement of tumor volumes during treatment due to patients breathing. We designed the respiratory gating radiotherapy device (RGRD) for using during CT simulation, dose planning and beam delivery at identical breathing period conditions. Using RGRD, reducing the treatment margin for organ (thorax or abdomen) motion due to breathing and improve dose distribution for 3D conformal radiotherapy. Materials and Methods : The internal organ motion data for lung cancer patients were obtained by examining the diaphragm in the supine position to find the position dependency. We made a respiratory gating radiotherapy device (RGRD) that is composed of a strip band, drug sensor, micro switch, and a connected on-off switch in a LINAC control box. During same breathing period by RGRD, spiral CT scan, virtual simulation, and 3D dose planing for lung cancer patients were peformed, without an extended PTV margin for free breathing, and then the dose was delivered at the same positions. We calculated effective volumes and normal tissue complication probabilities (NTCP) using dose volume histograms for normal lung, and analyzed changes in doses associated with selected NTCP levels and tumor control probabilities (TCP) at these new dose levels. The effects of 3D conformal radiotherapy by RGRD were evaluated with DVH (Dose Volume Histogram), TCP, NTCP and dose statistics. Results : The average movement of a diaphragm was 1.5 cm in the supine position when patients breathed freely. Depending on the location of the tumor, the magnitude of the PTV margin needs to be extended from 1 cm to 3 cm, which can greatly increase normal tissue irradiation, and hence, results in increase of the normal tissue complications probabiliy. Simple and precise RGRD is very easy to setup on patients and is sensitive to length variation (+2 mm), it also delivers on-off information to patients and the LINAC machine. We evaluated the treatment plans of patients who had received conformal partial organ lung irradiation for the treatment of thorax malignancies. Using RGRD, the PTV margin by free breathing can be reduced about 2 cm for moving organs by breathing. TCP values are almost the same values $(4\~5\%\;increased)$ for lung cancer regardless of increasing the PTV margin to 2.0 cm but NTCP values are rapidly increased $(50\~70\%\;increased)$ for upon extending PTV margins by 2.0 cm. Conclusion : Internal organ motion due to breathing can be reduced effectively using our simple RGRD. This method can be used in clinical treatments to reduce organ motion induced margin, thereby reducing normal tissue irradiation. Using treatment planning software, the dose to normal tissues was analyzed by comparing dose statistics with and without RGRD. Potential benefits of radiotherapy derived from reduction or elimination of planning target volume (PTV) margins associated with patient breathing through the evaluation of the lung cancer patients treated with 3D conformal radiotherapy.

• Progress in Medical Physics
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• v.18 no.1
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• pp.48-54
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• 2007

This study is to develope a phantom for MOSFET (Metal Oxide Semiconductors Field Effect Transistors) dosimetry and compare the dosimetric properties of standard MOSFET and microMOSFET with the phantom. In this study, the developed phantom have two shape: one is the shape of semi-sphere with 10cm diameters and the other one is the flat slab of $30{\times}30cm$with 1 cm thickness. The slab phantom was used for calibration and characterization measurements of reproducibility, linearity and dose rate dependency. The semi-sphere phantom was used for angular and directional dependence on the types of MOSFETs. The measurements were conducted under $10{\times}10cm^2$ fields at 100cm SSD with 6MV photon of Clinac (21EX, Varian, USA). For calibration and reproducibility, five standard MOSFETS and microMOSFETs were repeatedly Irradiated by 200cGy five times. The average calibration factor was a range of $1.09{\pm}0.01{\sim}1.12{\pm}0.02mV/cGy$ for standard MOSFETS and $2.81{\pm}0.03{\sim}2.85{\pm}0.04 mV/cGy$ for microMOSFETs. The response of reproducibility in the two types of MOSFETS was found to be maximum 2% variation. Dose linearity was evaluated In the range of 5 to 600 cGy and showed good linear response with $R^2$ value of 0.997 and 0.999. The dose rate dependence of standard MOSFET and microMOSFET was within 1% for 200 cGy from 100 to 500MU/min. For linearity, reproducibility and calibration factor, two types of MOSFETS showed similar results. On the other hand, the standard MOSFET and microMOSFET were found to be remarkable difference in angular and directional dependence. The measured angular dependence of standard MOSFET and microMOSFET was also found to be the variation of 13%, 10% and standard deviation of ${\pm}4.4%,\;{\pm}2.1%$. The directional dependence was found to be the variation of 5%, 2% and standard deviation of ${\pm}2.1%,\;{\pm}1.5%$. Therefore, dose verification of radiation therapy used multidirectional X-ray beam treatments allows for better the use of microMOSFET which has a reduced angular and directional dependence than that of standard MOSFET.

• Radiation Oncology Journal
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• v.17 no.2
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• pp.91-99
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• 1999

Propose : This study was performed to find out the prognostic factors affecting local control, survival and disease free survival rate in nasopharyngeal carcinomas treated with chemotherapy and radiation therapy. Materials and Methods : We analysed 47 patients of nasopharyngeal carcinomas, histologically confirmed and treated at Chonnam University Hospital between July 1986 and June 1996, retrospectively. Range of patients' age were from 16 to 80 years (median; 52 years). Thirty three (70$\%$) patients was male. Histological types were composed of 3 (6$\%$) keratinizing, 30 (64$\%$) nonkeratinizing squamous cell carcinoma and 13 (28$\%$) undifferentiated carcinoma. Histoiogicai type was not known in 1 patient (2$\%$). We restaged according to the staging system of 1997 American Joint Committee on Cancer Forty seven patients were recorded as follows: 71: 11 (23$\%$), T2a; 6 (13$\%$), T2b; 9 (19$\%$), 73; 7 (15$\%$), 74: 14 (30$\%$), and NO; 7 (15$\%$), Nl: 14 (30$\%$), N2; 21 (45%), N3: 5 (10%). Clinical staging was grouped as follows: Stage 1; 2 (4$\%$), IIA: 2 (4$\%$), IIB; 10 (21$\%$), III; 14 (30$\%$), IVA; 14 (30$\%$) and IVB; 5 (11$\%$). Radiation therapy was done using 6 MV and 10 MV X- ray of linear accelerator. Electron beam was used for the Iymph nodes of posterior neck after 4500 cGy. The range of total radiation dose delivered to the primary tumor was from 6120 to 7920 cGy (median; 7020 cGy). Neoadjuvant chemotherapy was performed with cisplatin +5-fluorouracil (25 patients) or cisplatin+pepleomycin (17 patients) with one to three cycles. Five patients did not received chemotherapy. Local control rate, survival and disease free suwival rate were calculated by Kaplan-Meier method. Generalized Wilcoxon test was used to evaluate the difference of survival rates between groups. multivariate analysis using Cox proportional hazard model was done for finding prognostic factors. Results: Local control rate was 81$\%$ in 5 year. Five year survival rate was 60$\%$ (median survival; 100 months). We included age, sex, cranial nerve deflicit, histologic type, stage group, chemotherapy, elapsed days between chemotherapy and radiotherapy, total radiation dose, period of radiotherapy as potential prognostic factors in multivariate analysis. As a result, cranial none deficit (P=0.004) had statistical significance in local control rate. Stage group and total radiation dose were significant prognostic factors in survival (P=0.000, P=0.012), and in disease free survival rates (P=0.003, P=0.008), respectively. Common complications were xerostomia, tooth and ear problems. Hypothyroidism was developed in 2 patients. Conclusion : In our study, cranial none deficit was a significant prognostic factor in local control rate, and stage group and total radiation dose were significant factors in both survival and disease free survival of nasopharyngeal carcinoma. We have concluded that chemotherapy and radiotherapy used in our patients were effective without any serious complication.