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Comparison of CT based-CTV plan and CT based-ICRU38 plan in brachytherapy planning of uterine cervix cancer (자궁경부암 강내조사 시 CT를 이용한 CTV에 근거한 치료계획과 ICRU 38에 근거할 치료계획의 비교)

  • Shim JinSup;Jo JungKun;Si ChangKeun;Lee KiHo;Lee DuHyun;Choi KyeSuk
    • The Journal of Korean Society for Radiation Therapy
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    • v.16 no.2
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    • pp.9-17
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    • 2004
  • Purpose : Although Improve of CT, MRI Radio-diagnosis and Radiation Therapy Planing, but we still use ICRU38 Planning system(2D film-based) broadly. 3-Dimensional ICR plan(CT image based) is not only offer tumor and normal tissue dose but also support DVH information. On this study, we plan irradiation-goal dose on CTV(CTV plan) and irradiation-goal dose on ICRU 38 point(ICRU38 plan) by use CT image. And compare with tumor-dose, rectal-dose, bladder-dose on both planning, and analysis DVH Method and Material : Sample 11 patients who treated by Ir-192 HDR. After 40Gy external radiation therapy, ICR plan established. All the patients carry out CT-image scanned by CT-simulator. And we use PLATO(Nucletron) v.14.2 planing system. We draw CTV, rectum, bladder on the CT image. And establish plan irradiation-$100\%$ dose on CTV(CTV plan) and irradiation-$100\%$ dose on A-point(ICRU38 plan) Result : CTV volume($average{\pm}SD$) is $21.8{\pm}26.6cm^3$, rectum volume($average{\pm}SD$) is $60.9{\pm}25.0cm^3$, bladder volume($average{\pm}SD$) is $116.1{\pm}40.1cm^3$ sampled 11 patients. The volume including $100\%$ dose is $126.7{\pm}18.9cm^3$ on ICRU plan and $98.2{\pm}74.5cm^3$ on CTV plan. On ICRU planning, the other one's $22.0cm^3$ CTV volume who residual tumor size excess 4cm is not including $100\%$ isodose. 8 patient's $12.9{\pm}5.9cm^3$ tumor volume who residual tumor size belows 4cm irradiated $100\%$ dose. Bladder dose(recommended by ICRU 38) is $90.1{\pm}21.3\%$ on ICRU plan, $68.7{\pm}26.6\%$ on CTV plan, and rectal dose is $86.4{\pm}18.3\%,\;76.9{\pm}15.6\%$. Bladder and Rectum maximum dose is $137.2{\pm}50.1\%,\;101.1{\pm}41.8\%$ on ICRU plan, $107.6{\pm}47.9\%,\;86.9{\pm}30.8\%$ on CTV plan. Therefore CTV plan more less normal issue-irradiated dose than ICRU plan. But one patient case who residual tumor size excess 4cm, Normal tissue dose more higher than critical dose remarkably on CTV plan. $80\%$over-Irradiated rectal dose(V80rec) is $1.8{\pm}2.4cm^3$ on ICRU plan, $0.7{\pm}1.0cm^3$ on CTV plan. $80\%$over-Irradiated bladder dose(V80bla) is $12.2{\pm}8.9cm^3$ on ICRU plan, $3.5{\pm}4.1cm^3$ on CTV plan. Likewise, CTV plan more less irradiated normal tissue than ICRU38 plan. Conclusion : Although, prove effect and stability about previous ICRU plan, if we use CTV plan by CT image, we will reduce normal tissue dose and irradiated goal-dose at residual tumor on small residual tumor case. But bigger residual tumor case, we need more research about effective 3D-planning.

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An Exploratory Study on the Competition Patterns Between Internet Sites in Korea (한국 인터넷사이트들의 산업별 경쟁유형에 대한 탐색적 연구)

  • Park, Yoonseo;Kim, Yongsik
    • Asia Marketing Journal
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    • v.12 no.4
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    • pp.79-111
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    • 2011
  • Digital economy has grown rapidly so that the new business area called 'Internet business' has been dramatically extended as time goes on. However, in the case of Internet business, market shares of individual companies seem to fluctuate very extremely. Thus marketing managers who operate the Internet sites have seriously observed the competition structure of the Internet business market and carefully analyzed the competitors' behavior in order to achieve their own business goals in the market. The newly created Internet business might differ from the offline ones in management styles, because it has totally different business circumstances when compared with the existing offline businesses. Thus, there should be a lot of researches for finding the solutions about what the features of Internet business are and how the management style of those Internet business companies should be changed. Most marketing literatures related to the Internet business have focused on individual business markets. Specifically, many researchers have studied the Internet portal sites and the Internet shopping mall sites, which are the most general forms of Internet business. On the other hand, this study focuses on the entire Internet business industry to understand the competitive circumstance of online market. This approach makes it possible not only to have a broader view to comprehend overall e-business industry, but also to understand the differences in competition structures among Internet business markets. We used time-series data of Internet connection rates by consumers as the basic data to figure out the competition patterns in the Internet business markets. Specifically, the data for this research was obtained from one of Internet ranking sites, 'Fian'. The Internet business ranking data is obtained based on web surfing record of some pre-selected sample group where the possibility of double-count for page-views is controlled by method of same IP check. The ranking site offers several data which are very useful for comparison and analysis of competitive sites. The Fian site divides the Internet business areas into 34 area and offers market shares of big 5 sites which are on high rank in each category daily. We collected the daily market share data about Internet sites on each area from April 22, 2008 to August 5, 2008, where some errors of data was found and 30 business area data were finally used for our research after the data purification. This study performed several empirical analyses in focusing on market shares of each site to understand the competition among sites in Internet business of Korea. We tried to perform more statistically precise analysis for looking into business fields with similar competitive structures by applying the cluster analysis to the data. The research results are as follows. First, the leading sites in each area were classified into three groups based on averages and standard deviations of daily market shares. The first group includes the sites with the lowest market shares, which give more increased convenience to consumers by offering the Internet sites as complimentary services for existing offline services. The second group includes sites with medium level of market shares, where the site users are limited to specific small group. The third group includes sites with the highest market shares, which usually require online registration in advance and have difficulty in switching to another site. Second, we analyzed the second place sites in each business area because it may help us understand the competitive power of the strongest competitor against the leading site. The second place sites in each business area were classified into four groups based on averages and standard deviations of daily market shares. The four groups are the sites showing consistent inferiority compared to the leading sites, the sites with relatively high volatility and medium level of shares, the sites with relatively low volatility and medium level of shares, the sites with relatively low volatility and high level of shares whose gaps are not big compared to the leading sites. Except 'web agency' area, these second place sites show relatively stable shares below 0.1 point of standard deviation. Third, we also classified the types of relative strength between leading sites and the second place sites by applying the cluster analysis to the gap values of market shares between two sites. They were also classified into four groups, the sites with the relatively lowest gaps even though the values of standard deviation are various, the sites with under the average level of gaps, the sites with over the average level of gaps, the sites with the relatively higher gaps and lower volatility. Then we also found that while the areas with relatively bigger gap values usually have smaller standard deviation values, the areas with very small differences between the first and the second sites have a wider range of standard deviation values. The practical and theoretical implications of this study are as follows. First, the result of this study might provide the current market participants with the useful information to understand the competitive circumstance of the market and build the effective new business strategy for the market success. Also it might be useful to help new potential companies find a new business area and set up successful competitive strategies. Second, it might help Internet marketing researchers take a macro view of the overall Internet market so that make possible to begin the new studies on overall Internet market beyond individual Internet market studies.

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Comparison of CT based-CTV plan and CT based-ICRU38 plan in Brachytherapy Planning of Uterine Cervix Cancer (자궁경부암 강내조사 시 CT를 이용한 CTV에 근거한 치료계획과 ICRU 38에 근거한 치료계획의 비교)

  • Cho, Jung-Ken;Han, Tae-Jong
    • Journal of Radiation Protection and Research
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    • v.32 no.3
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    • pp.105-110
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    • 2007
  • Purpose : In spite of recent remarkable improvement of diagnostic imaging modalities such as CT, MRI, and PET and radiation therapy planing systems, ICR plan of uterine cervix cancer, based on recommendation of ICRU38(2D film-based) such as Point A, is still used widely. A 3-dimensional ICR plan based on CT image provides dose-volume histogram(DVH) information of the tumor and normal tissue. In this study, we compared tumor-dose, rectal-dose and bladder-dose through an analysis of DVH between CTV plan and ICRU38 plan based on CT image. Method and Material : We analyzed 11 patients with a cervix cancer who received the ICR of Ir-192 HDR. After 40Gy of external beam radiation therapy, ICR plan was established using PLATO(Nucletron) v.14.2 planing system. CT scan was done to all the patients using CT-simulator(Ultra Z, Philips). We contoured CTV, rectum and bladder on the CT image and established CTV plan which delivers the 100% dose to CTV and ICRU plan which delivers the 100% dose to the point A. Result : The volume$(average{\pm}SD)$ of CTV, rectum and bladder in all of 11 patients is $21.8{\pm}6.6cm^3,\;60.9{\pm}25.0cm^3,\;111.6{\pm}40.1cm^3$ respectively. The volume covered by 100% isodose curve is $126.7{\pm}18.9cm^3$ in ICRU plan and $98.2{\pm}74.5cm^3$ in CTV plan(p=0.0001), respectively. In (On) ICRU planning, $22.0cm^3$ of CTV volume was not covered by 100% isodose curve in one patient whose residual tumor size is greater than 4cm, while more than 100% dose was irradiated unnecessarily to the normal organ of $62.2{\pm}4.8cm^3$ other than the tumor in the remaining 10 patients with a residual tumor less than 4cm in size. Bladder dose recommended by ICRU 38 was $90.1{\pm}21.3%$ and $68.7{\pm}26.6%$ in ICRU plan and in CTV plan respectively(p=0.001) while rectal dose recommended by ICRU 38 was $86.4{\pm}18.3%$ and $76.9{\pm}15.6%$ in ICRU plan and in CTV plan, respectively(p=0.08). Bladder and rectum maximum dose was $137.2{\pm}50.1%,\;101.1{\pm}41.8%$ in ICRU plan and $107.6{\pm}47.9%,\;86.9{\pm}30.8%$ in CTV plan, respectively. Therefore, the radiation dose to normal organ was lower in CTV plan than in ICRU plan. But the normal tissue dose was remarkably higher than a recommended dose in CTV plan in one patient whose residual tumor size was greater than 4cm. The volume of rectum receiving more than 80% isodose (V80rec) was $1.8{\pm}2.4cm^3$ in ICRU plan and $0.7{\pm}1.0cm^3$ in CTV plan(p=0.02). The volume of bladder receiving more than 80% isodose(V80bla) was $12.2{\pm}8.9cm^3$ in ICRU plan and $3.5{\pm}4.1cm^3$ in CTV plan(p=0.005). According to these parameters, CTV plan could also save more normal tissue compared to ICRU38 plan. Conclusion : An unnecessary excessive radiation dose is irradiated to normal tissues within 100% isodose area in the traditional ICRU plan in case of a small size of cervix cancer, but if we use CTV plan based on CT image, the normal tissue dose could be reduced remarkably without a compromise of tumor dose. However, in a large tumor case, we need more research on an effective 3D-planing to reduce the normal tissue dose.