• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.421-429
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• 2001

Since Non-Extraction treatment in some orthodontic case shows unstable result and unfavorable profile, extraction is selected as inevitable treatment option for the harmonious profile, facial skeleton, and the stable dentition on both arches. For the achievement of proper goal, premolars, molars, sometimes incisors or canines are selected to be extracted. The first Premolar is usually extracted for relieving the crowded dentition with which the molar relations are class I to gain stable dentition and proper profile, but often results in the depression of profile or the loss of vortical dimension. On the contrary, the extracton of the second molar helps maintaining the fullness of profile and the vertical dimension, prevents additional space closural procedures which often make the procedures complicated, relieves both anterior and posterior crowding, and substitutes the extraction fossae for newly erupting 3rd molars. From the point of recurrence, the second molar extraction procedure, therefore, is more beneficial. This cases showed the good results of second molar extraction procedures in the patients with class I crowding.

• Radiation Oncology Journal
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• v.21 no.3
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• pp.238-244
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• 2003

Purpose: The Planning of High-Dose-Rate (HDR) brachytherapy treatments are becoming individualized and more dependent on the treatment planning system. Therefore, computer software has been developed to perform independent point dose calculations with the integration of an isodose distribution curve display into the patient anatomy images. Meterials and Methods: As primary input data, the program takes patients'planning data including the source dwell positions, dwell times and the doses at reference points, computed by an HDR treatment planning system (TPS). Dosimetric calculations were peformed in a $10\times12\times10\;Cm^3$ grid space using the Interstitial Collaborative Working Group (ICWG) formalism and an anisotropy table for the HDR Iridium-192 source. The computed doses at the reference points were automatically compared with the relevant results of the TPS. The MR and simulation film images were then imported and the isodose distributions on the axial, sagittal and coronal planes intersecting the point selected by a user were superimposed on the imported images and then displayed. The accuracy of the software was tested in three benchmark plans peformed by Gamma-Med 12i TPS (MDS Nordion, Germany). Nine patients'plans generated by Plato (Nucletron Corporation, The Netherlands) were verified by the developed software. Results: The absolute doses computed by the developed software agreed with the commercial TPS results within an accuracy of $2.8\%$ in the benchmark plans. The isodose distribution plots showed excellent agreements with the exception of the tip legion of the source's longitudinal axis where a slight deviation was observed. In clinical plans, the secondary dose calculations had, on average, about a $3.4\%$ deviation from the TPS plans. Conclusion: The accurate validation of complicate treatment plans is possible with the developed software and the qualify of the HDR treatment plan can be improved with the isodose display integrated into the patient anatomy information.

• Radiation Oncology Journal
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• v.28 no.3
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• pp.177-183
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• 2010

Purpose: Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. Materials and Methods: Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inframammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. Results: The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. Conclusion: The use of 3D CT based planning reduced the radiation field in early breast cancer patients with small breasts in relation to conventional planning. Though a coherent definition of the breast is needed, CT-based planning generated the better plan in terms of reducing the irradiation volume of normal tissue. Moreover it was possible that 3D CT based planning showed better CTV coverage including postoperative change.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.87-95
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• 2015

Purpose : This study presents the usefulness assessment of secondary shield for the lens exposure dose reduction during radiation treatment of peripheral orbit. Materials and Methods : We accomplished IMRT treatment plan similar with a real one through the computed treatment planning system after CT simulation using human phantom. For the secondary shield, we used Pb plate (thickness 3mm, diameter 25mm) and 3 mm tungsten eye-shield block. And we compared lens dose using OSLD between on TPS and on simulation. Also, we irradiated 200 MU(6 MV, SPD(Source to Phantom Distance)=100 cm, $F{\cdot}S\;5{\times}5cm$) on a 5cm acrylic phantom using the secondary shielding material of same condition, 3mm Pb and tungsten eye-shield block. And we carried out the same experiment using 8cm Pb block to limit effect of leakage & transmitted radiation out of irradiation field. We attached OSLD with a 1cm away from the field at the side of phantom and applied a 3mm bolus equivalent to the thickness of eyelid. Results : Using human phantom, the Lens dose on IMRT treatment plan is 315.9cGy and the real measurement value is 216.7cGy. And after secondary shield using 3mm Pb plate and tungsten eye-shield block, each lens dose is 234.3, 224.1 cGy. The result of a experiment using acrylic phantom, each value is 5.24, 5.42 and 5.39 cGy in case of no block, 3mm Pb plate and tungsten eye-shield block. Applying O.S.B out of the field, each value is 1.79, 2.00 and 2.02 cGy in case of no block, 3mm Pb plate and tungsten eye-shield block. Conclusion : When secondary shielding material is used to protect critical organ while irradiating photon, high atomic number material (like metal) that is near by critical organ can be cause of dose increase according to treatment region and beam direction because head leakage and collimator & MLC transmitted radiation are exist even if it's out of the field. The attempt of secondary shield for the decrease of exposure dose was meaningful, but untested attempt can have a reverse effect. So, a preliminary inspection through Q.A must be necessary.

• The Journal of Korean Society for Radiation Therapy
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• v.13 no.1
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• pp.122-125
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• 2001

I. 목적 : Primus의 Multi Leaf Collimator는 X측이 29쌍으로 이루어 져 있으며 그중27쌍의 leaf은 1cm이고 2쌍은 6.5cm의 leaf으로 구성되어있다. 이러한 이유로 Paraaortic node를 포함하는 자궁경부암 치료시 현재는 Y가 27cm 이상인 경우는 차폐블럭을 제작하여 치료를 시행하나 차폐 블럭의 제작에 따른 업무의 지연과 차폐 블럭이 무거워져 치료시 환자에게 떨어질 위험을 제거 하기 위해 Asymmetric Field로 Multi Leaf Collimator를 사용한 결과를 보고하고자 한다. II. 재료 및 방법 : 모의 치료(Ximatron, Varian, USA)시 $Y_1$측을 15cm을 기준으로 하여 $Y_2$측을 변경하면서 Field size를 결정한다. ($Y_2$측은 20cm가 최대, 즉 Y측은 35cm까지 적용) 이러한 방법으로 Multi Leaf Collimator를 사용한 환자와 기존의 차폐블럭을 제작하여 치료한 환자와의 업무 개선사항을 확인하기 위하여 실제 공작실 업무 담당자의 블럭 제작 시간과 Beam Shaper를 이 용해 Multi Leaf Collimator를 입력하는 시간을 상호 비교하여 단축된 시간을 조사하였다. III. 결과 : 차폐블럭을 대신해 Multi Leaf Collimator를 이용함으로써 치료실에서 환자에 대한 위험요소(차폐블럭이 무겁다)를 사전에 제거 할 수 있었고 공작실에서 블럭 제작 시간과 LANTIS를 이용해 MLC를 입력하는 시간을 실측 한 결과업무의 시간이 120분에서 5분으로 단축되는 효과가 있었다. 전산화 계획 실에서 선량 계산시 OAR Factor값을 고려하여야 한다. IV. 결론 : Paraaortic node를 포함한 자궁경부암 환자의 차폐부위는 모양이 거의 일직선이기 때문에 Mu]ti Leaf Collimator를 사용하기에 용이 한 치료 부위이다. 하지만 큰 Field size로 인한 불편함이 있었다. 이러한 제 약성을 Asymmetric Field를 이용해서 Multi Leaf Collimator의 사용을 가능하게 하고 차폐 블록의 제작과정과 치료 시에 발생되는 근무자의 업무의 손실을 줄이고 환자에 대한 위험성 을 해결하였다.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.2
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• pp.147-153
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• 2005

Purpose : We should use a computed tomography-simulator for the body measure and compensator manufacture process was practiced with TBI's positioning in process and to estimate the availability.,Materials and Methods : Patient took position that lied down. and got picture through computed tomography-simulator. This picture transmitted to Somavision and measured about body measure point on the picture. Measurement was done with skin, and used the image to use measure the image about lungs. We decided thickness of compensator through value that was measured by the image. Also, We decided and confirmed position of compensator through image. Finally, We measured dosage with TLD in the treatment department.,Results : About thickness at body measure point. we could find difference of $1{\sim}2$ cm relationship general measure and image measure. General measure and image measure of body length was seen difference of $3{\sim}4$ cm. Also, we could paint first drawing of compensator through the image. The value of dose measurement used TLD on head, neck, axilla, chest(lungs inclusion), knee region were measured by $92{\sim}98%$ and abdomen, pelvis, inquinal region, feet region were measured by $102{\sim}109%$.,Conclusion : It was useful for TBI's positioning to use an image of computed tomography-simulator in the process. There was not that is difference of body thickness measure point, but measure about length was achieved definitely. Like this, manufacture of various compensator that consider body density if use image is available. Positioning of compensator could be done exactly. and produce easily without shape of compensator is courted Positioning in the treatment department could shortened overall $15\{sim}20$ minute time. and reduce compensator manufacture time about 15 minutes.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.65-75
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• 2016

Purpose : By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Materials and Methods : Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. Results : The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. Conclusion : As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

• The Journal of the Korea Contents Association
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• v.9 no.12
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• pp.742-749
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• 2009

The use of cone-beam computed tomography(CBCT) has been proposed for guiding the delivery of radiation therapy. A kilovoltage imaging system capable of radiography, fluoroscopy, and cone-beam computed tomography(CT) has been integrated with a medical linear accelerator. A standard clinical linear accelerator, operating in arc therapy mode, and an amorphous-silicon (a-Si) with an on-board electronic portal imager can be used to treat palliative patient and verify the patient's position prior to treatment. On-board CBCT images are used to generate patient geometric models to assist patient setup. The image data can also, potentially, be used for dose reconstruction in combination with the fluence maps from treatment plan. In this study, the accuracy of Hounsfield Units of CBCT images as well as the accuracy of dose calculations based on CBCT images of a phantom and compared the results with those of using CT simulator images. Phantom and patient studies were carried out to evaluate the achievable accuracy in using CBCT and CT stimulator for dose calculation. Relative electron density as a function of HU was obtained for both planning CT stimulator and CBCT using a Catphan-600 (The Phantom Laboratory, USA) calibration phantom. A clinical treatment planning system was employed for CT stimulator and CBCT based dose calculations and subsequent comparisons. The dosimetric consequence as the result of HU variation in CBCT was evaluated by comparing MU/cCy. The differences were about 2.7% (3-4MU/100cGy) in phantom and 2.5% (1-3MU/100cGy) in patients. The difference in HU values in Catphan was small. However, the magnitude of scatter and artifacts in CBCT images are affected by limitation of detector's FOV and patient's involuntary motions. CBCT images included scatters and artifacts due to In addition to guide the patient setup process, CBCT data acquired prior to the treatment be used to recalculate or verify the treatment plan based on the patient anatomy of the treatment area. And the CBCT has potential to become a very useful tool for on-line ART.)

• Progress in Medical Physics
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• v.10 no.2
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• pp.89-94
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• 1999

We developed a sterotactic radiosurgery system which is comprised of 1) collimators with small circular aperture, 2) an angiographic target localizer, 3) a target localizer used for alignment of planned target position with isocenter of treatment machine, and 4) a treatment planning system named LinaPel. In this study, we performed a series of treatment simulations to specify and analyze geometrical errors contained our in-house radiosurgery system. As results, 1) using Geometrical Phantom(Radionics,USA), the accuracy of target localization by LinaPel was determined as Avg. =(equation omitted) the accuracy of mechanical isocenter was found out to be 0.6 $\pm$ 0.2 mm, 3) the positional difference of target localization which determined by CT and angiography was 0.8 mm, and their size difference was 1.5 mm, and 4) the positional error during whole treatment was found out to be 0.9 $\pm$ 0.3 mm. With these results, we concluded that our in-house radiosurgery system can be used clinically. However, these range of accuracies need periodical quality assurance strongly.

• The korean journal of orthodontics
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• v.32 no.3 s.92
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• pp.155-163
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• 2002

This study was performed to assess the accuracy of computer-based treatment prediction for soft tissue profile using Quick Ceph Image $Pro^{TM}\;&\;Quick\;Ceph\;2000^{TM}$ in bimaxillary protrusion cases. The Ore- and post-treatment lateral cephalograms of 21 female adults treated by low first premolar extraction were imaged and 9 landmarks and 27 specific soft tissue mesurements were digitized for comparing actual treatment results with computer simulations. The results of this study showed that Quick Ceph Image $Pro^{TM}\;&\;Quick\;Ceph\;2000^{TM}$ tends to overestimeate horizontal changes and underestimate vertical changes. In the computer simulation, upper lip showed rolling tendency. The upper lip measurements were disposed to be regular direction hut lower lip measurements were varied case by case even if it was statistically insignificant.