• Journal of the Korean Society of Radiology
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• v.11 no.1
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• pp.9-17
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• 2017

A high degree of precision and accuracy in Gamma Knife Radiosurgery(GKRS) is a fundamental requirement for therapeutical success. Elaborate radiation delivery and dose gradients with the steep fall-off of radiation are clinically applied thus necessitating a dedicated Quality Assurance(QA) program in order to guarantee dosimetric and geometric accuracy and reduce all the risk factors that can occur in GKRS. In this study, as a part of QA we verified the accuracy of single-shot dose profiles used in the algorithm of Gamma Knife Perfexion(PFX) treatment planning system employing Variable Ellipsoid Modeling Technique(VEMT). We evaluated the dose distributions of single-shots in a spherical ABC phantom with diameter 160 mm on Gamma Knife PFX. The single-shots were directed to the center of ABC phantom. Collimating configurations of 4, 8, and 16 mm sizes along x, y, and z axes were studied. Gamma Knife PFX treatment planning system being used in GKRS is called Leksell GammaPlan(LGP) ver 10.1.1. From the verification like this, the accuracy of GKRS will be doubled. Then the clinical application must be finally performed based on precision and accuracy of GKRS. Specifically the width at the 50% isodose level, that is, Full-Width-of-Half-Maximum(FWHM) was verified under such conditions that a patient's head is simulated as a sphere with diameter 160mm. All the data about dose profiles along x, y, and z axes predicted through VEMT were excellently consistent with dose profiles from LGP within specifications(${\leq}1mm$ at 50% isodose level) except for a little difference of FWHM and PENUMBRA(isodose level: 20%~80%) along z axis for 4 mm and 8mm collimating configurations. The maximum discrepancy of FWHM was less than 2.3% at all collimating configurations. The maximum discrepancy of PENUMBRA was given for the 8 mm collimator along z axis. The difference of FWHM and PENUMBRA in the dose distributions obtained with VEMT and LGP is too small to give the clinical significance in GKRS. The results of this study are considered as a reference for medical physicists involved in GKRS in the whole world. Therefore we can work to confirm the validity of dose distributions for all collimating configurations determined through the regular preventative maintenance program using the independent verification method VEMT for the results of LGP and clinically assure the perfect treatment for patients of GKRS. Thus the use of VEMT is expected that it will be a part of QA that can verify and operate the system safely.

• Journal of the Korean Society of Radiology
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• v.16 no.7
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• pp.843-849
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• 2022

In this study, the probability of secondary carcinogenesis was analyzed by measuring the exposure dose of surrounding normal organs during radiosurgery using a gamma knife. A pediatric phantom (Model 706-G, CIRS, USA) composed of human tissue-equivalent material was set to four tumor volumes of 0.25 cm³, 0.51 cm³, 1.01 cm³, and 2.03 cm³, and the average dose was 18.4 ± 3.4 Gy. After installing the Rando phantom on the table of the gamma knife surgical equipment, the OSLD nanoDot dosimeters were placed in the right eye, left eye, thyroid, thymus gland, right lung, and left lung to measure each exposure dose. The probability of cancer occurrence due to radiation exposure of surrounding normal organs during gamma knife radiosurgery for acoustic schwannoma disease was 4.08 cancers per 100,000 at a tumor volume of 2.03 cm³. This study is expected to be used as useful data in relation to stochastic effects in the future by studying the risk of secondary radiation exposure that can occur during stereotactic radiosurgery.

• Journal of the Korean Society of Radiology
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• v.10 no.7
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• pp.521-529
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• 2016

Since Gamma Knife(R) radiosurgery(GKRS) is based on a single-fraction high dose treatment strategy, independent verification for the results of Leksell GammaPlan(R) (LGP) is an important procedure in assuring patient safety and minimizing the risk of treatment errors. Several verification methods have been developed and reported previously. Thus these methods were tested statistically and tried on Leksell Gamma Knife(LGK) target treatments through the embodiment of the previously proposed algorithms(PPA). The purpose of this study was to apply and evaluate the accuracy of verification methods for LGK target treatments using PPA. In the study 10 patients with intracranial lesion treated by GKRS were included. We compared the data from PPA and LGP in terms of maximum dose, arbitrary point dose, and treatment time at the isocenter locations. All data were analyzed by Paired t-test, which is statistical method used to compare two different measurement techniques. No statistical significance in maximal dose at 10 cases was observed between PPA and LGP. Differences in average maximal dose ranged from -0.53 Gy to 3.71 Gy. The arbitrary point dose calculated by PPA and LGP was not statistically significant too. But we found out the statistical difference with p=0.021 between TMR and LGP for treatment time at the isocenter locations. PPA can be incorporated as part of a routine quality assurance(QA) procedure to minimize the chance of a wrong overdose. Statistical analyses demonstrated that PPA was in excellent agreement with LGP when considering the maximal dose and the arbitrary point dose for the best plan of GKRS. Due to the easy applicability we hope PPA can be widely used.

• Journal of Korean Neurosurgical Society
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• v.29 no.9
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• pp.1228-1232
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• 2000

Objective : This study was undertaken to analysis gamma knife radiosurgery(GKR) effect for trigeminal neuralgia after long term follow-up. Methods : There were 11 trigeminal neuralgia patients. The authors irradiated 67-85 Gy maximally to the nerve root entry zone(NREZ) using single 4mm collimator, just 1-6mm lateral side from the junction of the trigeminal nerve and pons. For the first 3 cases, we targeted the junction between the nerve and the pons. In theses cases, the pons was irradiated 56 or 60 gray in the surface. In the later 8 cases, the isocenter is positioned more distal side so that the brain stem surface would receive less than the 20% isodose. Results : The average follow-up duration was 25 months(13-50 months). Pain relief was noticed within a week to 5 months. In 3 patients, pain was relieved completely and in other 3 patients, mark improvement was achieved(80-90%). Remaining 4 patients showed significant improvement(30-50%). There was recurrence in only one case and she complained with similar intensity of pain at the last follow-up. There was no significant complication related to GKR. Conclusion : GKR is considered effective for trigeminal neuralgia based on the long term follow-up evaluation, but more clinical experience is needed to evaluate the efficacy of GKR for trigeminal neuralgia as a primary treatment modality.

• Radioisotope journal
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• v.7 no.4
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• pp.24-30
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• 1992

• Progress in Medical Physics
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• v.14 no.3
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• pp.184-188
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• 2003

It is strongly recommended that periodic quality assurance should be carried out in the Gamma Knife that is used in radiosurgery since high radiation is delivered in one session. Since the protocols for Gamma Knife recommended by associations or agencies on quality assurance are absent in Korea, hospitals possessing the Gamma Knife have developed their own protocols. In order to develop a quality assurance protocol suitable for Korea, we reviewed the protocols of the Gamma Knife manufacturer, USA and Japan. we categorized the periodic items into three parts,: radiation dose, mechanical and safety part. The USA recommended and regulated more strict than the manufacturer. Japan recommended the items and frequency based on the USA. In conclusion, we tried to suggest a basic Gamma Knife quality assurance protocol suitable for Korea.

• Journal of the Korean Society of Radiology
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• v.13 no.5
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• pp.801-809
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• 2019

Existing Gamma Knife Radiosurgery(GKRS) for large lesions is often conducted in stages with volume or dose partitions. Often in case of volume division the target used to be divided into sub-volumes which are irradiated under the determined prescription dose in multi-sessions separated by a day or two, 3~6 months. For the entire course of treatment, treatment informations of the previous stages needs to be reflected to subsequent sessions on the newly mounted stereotactic frame through coordinate transformation between sessions. However, it is practically difficult to implement the previous dose distributions with existing Gamma Knife system except in the same stereotactic space. The treatment area is expanding because it is possible to perform the multistage treatment using the latest Gamma Knife Platform(GKP). The purpose of this study is to introduce the image-coregistration based on the stereotactic spaces and the strategy of multistage GKRS such as the determination of prescription dose at each stage using new GKP. Usually in image-coregistration either surgically-embedded fiducials or internal anatomical landmarks are used to determine the transformation relationship. Author compared the accuracy of coordinate transformation between multi-sessions using four or six anatomical landmarks as an example using internal anatomical landmarks. Transformation matrix between two stereotactic spaces was determined using PseudoInverse or Singular Value Decomposition to minimize the discrepancy between measured and calculated coordinates. To evaluate the transformation accuracy, the difference between measured and transformed coordinates, i.e., ${\Delta}r$, was calculated using 10 landmarks. Four or six points among 10 landmarks were used to determine the coordinate transformation, and the rest were used to evaluate the approaching method. Each of the values of ${\Delta}r$ in two approaching methods ranged from 0.6 mm to 2.4 mm, from 0.17 mm to 0.57 mm. In addition, a method of determining the prescription dose to give the same effect as the treatment of the total lesion once in case of lesion splitting was suggested. The strategy of multistage treatment in the same stereotactic space is to design the treatment for the whole lesion first, and the whole treatment design shots are divided into shots of each stage treatment to construct shots of each stage and determine the appropriate prescription dose at each stage. In conclusion, author confirmed the accuracy of prescribing dose determination as a multistage treatment strategy and found that using as many internal landmarks as possible than using small landmarks to determine coordinate transformation between multi-sessions yielded better results. In the future, the proposed multistage treatment strategy will be a great contributor to the frameless fractionated treatment of several Gamma Knife Centers.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.60-60
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• 2003

목적 : 감마나이프 치료계획용 소프트웨어인 감마플렌에서 처방선량을 계산하는 단위와 실제 시간을 설정하는 하드웨어인 조정판의 시간설정 단위의 차이에 의한 실제 처방선량에 끼치는 영향을 계산하였다. 대상 및 방법 : 감마나이프는 주어진 4 개의 헬멧을 가지고 최소 한번 또는 최대 20 번 이상의 방사선 조합으로 한번에 많은 방사선을 목표물에 조사한다. 감마나이프 방사선 수술을 위한 치료계획용 소프트웨어인 감마플렌 5.32에서는 처방선량에 대한 치료시간을 최대 지점 또는 지정하는 지점에 규격화하여 소숫점 두 자리 즉 0.6 초까지 계산한다. 그러나 실제 치료를 위한 조정판의 시간설정은 모델 B 에서는 소숫점 한자리까지 가능하게 되어있다. 그러므로 모델 B를 사용하는 기관의 치료계획 컴퓨터인 감마플렌에서는 소숫점 한자리로 만들기 위해 반올림과 내림을 하게 되며 이것을 프린트하여 사용하게 된다. 실제 임상에서 멀티삿에 대한 반올림과 내림에 대한 효과를 선량으로 환산하여 처방선량에 끼치는 영향을 연구하였다. 치료 계획에 서 처방선량을 입력한 후 계산된 각 조사에 대한 소숫점 두자리 시간을 화면에 표시한 후 스냅tit으로 스크린 캡쳐하여 프린트하였으며, 소숫점 한자리로 된 최종 치료계획을 프린트하여 서로 비교 계산하였다. 결과 : 20 여명의 환자에 대한 치료 결과에 대한 분석은 조사의 수나 처방선량에 관계하지 않고 우연히 올림이 많으냐 내림이 많으냐에 의존하였다. 최대지점에 대하여 분석한 결과는 -0.48부터 +0.47로 -2%부터 +1.9%의 정도로 영향을 끼쳤다. 결론 : 반올림과 내림의 결과는 처방선량을 줄일 수도 있고 늘일 수도 있었다. 그러나 이 연구는 최대선량 지점에 대해 비교를 하였으나 실제로는 각 조사의 위치가 서로 다르므로 영향은 이보다 훨씬 적을 것으로 생각되어 소숫점 한자리로 치료하여도 무방할 것으로 보인다.mm, AP 방향에서는 2.1$\pm$0.82 mm이었다. 그리고 복부의 later의 방향에서는 7.0$\pm$2.1 mm, AP 방향에서는 6.5$\pm$2.2 mm 이었다. 또한 표적 위치측정을 위해서 환자의 피부에 임의의 가상표적을 부착하고 CT 촬영한 영상결과, 프레임으로 가상표 적에 대한 위치를 정확히 파악할 수 있었다. 결론 : 제작된 프레임을 적용하여 방사선투과율 측정실험, 환자 외부자세에 대한 오차 측정실험, 가상표적 위치측정 실험 등을 수행하였다. 환자 외부자세에 대한 오차 측정실험 경우, 더 많은 Volunteer를 적용하여 보다 정확한 오차 측정실험이 수행되어야 할 것이며 정확한 표적 위치 측정실험을 위해서 내부 마커를 삽입한 환자를 적용한 임상실험이 수행되어야 할 것이다. 또한 위치결정에서 획득한 좌표값의 정확성을 알아보기 위해서 팬톰을 이용한 방사선조사 실험이 추후에 실행되어져야 할 것이다. 그리고 제작된 프레임에 Rotating X선 시스템과 내부 장기의 움직임을 계량화하고 PTV에서의 최적 여유폭을 설정함으로써 정위 방사선수술 및 3 차원 업체 방사선치료에 대한 병소 위치측정과 환자의 자세에 대한 setup 오차측정 결정에 도움이 될 수 있을 것이라고 사료된다. 상대적으로 우수한 것으로 나타났으며, 혼합충전재는 암모니아의 경우 코코넛과 펄라이트의 비율이 7：3인 혼합 재료 3번과 소나무수피와 펄라이트의 비율이 7：3인 혼합 재료 6번에서 다른 혼합 재료에 비하여 우수한 것으로 나타났다. 4. 코코넛과 소나무수피의 경우 암모니아 가스에 대한 흡착 능력은 거의 비슷한 것으로 사료되며, 코코넛의 경우 전량을 수입에 의존하고 있다는 점에서 국내 조달이 용이하며, 구입 비용도 적게 소요되는 소나무수피를 사용하는 것이 경제적이라고 사료된다. 5. 마지막으로

• Journal of the Korean Society of Radiology
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• v.17 no.2
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• pp.243-248
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• 2023

This study aims to analyze the secondary carcinogenesis rate caused by exposure of organs at risk of damage using a glass dosimeter during radiosurgery in vestibular schwannoma disease. Using a pediatric phantom of human tissue equivalent material, the volume of the tumor was set to a total of three volumes: 0.506 cm³, 1.008 cm³, and 2.032 cm³, and a radiosurgery plan was established with an average dose of 18.4 ± 3.4 Gy. After mounting the human body phantom on the table of surgical equipment, glass dosimeters were placed on the right eye, left eye, thyroid gland, thymus, right lung, and left lung to measure the exposure dose, respectively. In this study, the incidence of secondary cancer due to exposure to damaged organs during gamma knife radiosurgery in vestibular schwannoma disease with the largest tumor volume of 2.032 cm³ was measured with a glass dosimeter. This study studies the risk of secondary radiation exposure dose that can occur during stereotactic radiosurgery, and it is considered that it will be used as basic data in the field of radiation damage related to the stochastic effect of radiation in the future.

• Journal of the Korean Society of Radiology
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• v.13 no.7
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• pp.901-907
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• 2019

The aim of this study is to evaluate the ability of target localizations of Leksell GammaPlan(LGP) in Gamma Knife Subthalamotomy(or Pallidotomy, Thalamotomy) of functional diseases. To evaluate the accuracy of LGP's location settings, the difference Δr of the target coordinates calculated by LGP (or LSP) and author's algorithm was reviewed for 10 patients who underwent Deep Brain Stimulation(DBS) surgery. Δr ranged from 0.0244663 mm to 0.107961 mm. The average of Δr was 0.054398 mm. Transformation matrix between stereotactic space and brain atlas space was calculated using PseudoInverse or Singular Value Decomposition of Mathematica to determine the positional relationship between two coordinate systems. Despite the precise frame positioning, the misalignment of yaw from -3.44739 degree to 1.82243 degree, pitch from -4.57212 degree to 0.692063 degree, and rolls from -6.38239 degree to 7.21426 degree appeared. In conclusion, a simple in-house algorithm was used to test the accuracy for location settings of LGP(or LSP) in Gamma Knife platform and the possibility for Gamma Knife Subthalamotomy. The functional diseases can be treated with Gamma Knife Radiosurgery with safety and efficacy. In the future, the proposed algorithm for target localizations' QA will be a great contributor to movement disorders' treatment of several Gamma Knife Centers.