• 대한방사선치료학회:학술대회논문집
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• 2005.06a
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• pp.13-17
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• 2005

Introduction : For stereotactic radiosurgery (SRS) of a tumor in the region whose movement due to respiration is significant, like Lung lower lobe, the gated therapy, which delivers radiation dose to the selected respiratory phases when tumor motion is small, was peformed using the Respiratory gating system and its clinical effectiveness was evaluated. Methode and Materials : For two SRS patients with a tumor in Lung lower lobe, a marker block (infrared reflector) was attached on the abdomen. While patient' respiratory cycle was monitored with Real-time Position Management (RPM, Varian, USA), 4D CT was performed (10 phases per a cycle). Phases in which tumor motion did not change rapidly were decided as treatment phases. The treatment volume was contoured on the CT images for selected treatment phases using maximum intensity projection (MIP) method. In order to verify setup reproducibility and positional variation, 4D CT was repeated. Result : Gross tumor volume (GTV) showed maximum movement in superior-inferior direction. For patient $\#$1, motion of GTV was reduced to 2.6 mm in treatment phases ($30\%\~60\%$), while that was 9.4 mm in full phases ($0\%\~90\%$) and for patient $\#$2, it was reduced to 2.3 mm in treatment phases ($30\%\~70\%$), while it was 11.7 mm in full phases ($0\%\~90\%$). When comparing two sets of CT images, setup errors in all the directions were within 3 mm. Conclusion : Since tumor motion was reduced less than 5 mm, the Respiratory gating system for SRS of Lung lower lobe is useful.

• Progress in Medical Physics
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• v.21 no.2
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• pp.165-173
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• 2010

In this paper, we evaluated the performance of 3D CRT, IMRT and three kind of RA plannings to investigate the clinical effect of RA with liver cancer case. The patient undergoing liver cancer of small volume and somewhat constant motion were selected. We performed 3D CRT, IMRT and RA plannings such as 2RA, limited triple arcs (3RA) and 3MRA with Eclipse version 8.6.15. The same dose volume objectives were defined for only CTV, PTV and body except heart, liver and partial body in IMRT and RA plannings. The steepness of dose gradient around tumor was determined by the Normal Tissue Objective function with the same parameters in place of respective definitions of dose volume objectives for the normal organs. The approach between the defined dose constraints and the practical DVH of CTV, PTV and Body was the best in 3MRA and the worst in IMRT. The DVHs were almost the same among RAs. Plans were evaluated using Conformity Index (CI), Homogeneity Index (HI) and Quality of coverage (QoC) by RTOG after prescription with dose level surrounding 98% of PTV in the respective plans. As a result, 3MRA planning showed the better favorable indices than that of the others and achieved the lowest MUs. In this study, RA planning is a technique that is possible to obtain the faster and better dose distribution than 3D CRT or IMRT techniques. Our result suggest that 3MRA planning is able to reduce the MUs further, keeping a similar or better targer dose homogeneity, conformity and sparing normal tissue than 2RA or 3RA.

• Journal of Radiation Protection and Research
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• v.25 no.1
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• pp.31-36
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• 2000

In radiotherapy, it may happen to radiate surrounding normal tissue because of inconsistent field size by changing patient position during treatment. We are going to analyze errors reduced by using immobilization device with Electonic portal imaging device(EPID) in this study. We had treated the twenty-one patients in pelvic region with 10 MV X-ray from Aug. 1998 to Aug. 1999 at Chungnam National University Hospital. All patients were treated at supine position during treatment. They were separated to two groups, 11 patients without device and 10 patients with immobilization device. We used styrofoam for immobilization device and measured the errors of anterior direction for x, y axis and lateral direction for z, y axis from simulation film to EPID image using matching technique. For no immobilization device group, the mean deviation values of x axis and y axis are 0.19 mm. 0.48 mm, respectively and the standard deviations of systematic deviation are 2.38 mm, 2.19 mm, respectively and of random deviation for x axis and y axis are 1.92 mm. 1.29 mm, respectively. The mean deviation values of z axis and y axis are -3.61 mm. 2.07 mm, respectively and the standard deviations of systematic deviation are 3.20 mm, 2.29 mm, respectively and of random deviation for z axis and y axis are 2.73 mm. 1.62 mm, respectively. For immobilization device group, the mean deviation values of x axis and y axis are 0.71 mm. -1.07 mm, respectively and the standard deviations of systematic deviation are 1.80 mm, 2.26 mm, respectively and of random deviation for x axis and y axis are 1.56 mm. 1.27 mm, respectively. The mean deviation values of z axis and y axis are -1.76 mm. 1.08 mm, respectively and the standard deviations of systematic deviation are 1.87 mm, 2.83 mm, respectively and of random deviation for x axis and y axis are 1.68 mm, 1.65 mm, respectively. Because of reducing random and systematic error using immobilization device, we had obtained good reproducibility of patient setup during treatment so that we recommend the use of immobilization device in pelvic region of radiation treatment.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.179-185
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• 2002

Purpose : For the purpose of quality assurance of self-developed stereotactic radiosurgery system, a multi-purpose phantom was fabricated, and accuracy of radiation dose distribution during radiosurgery was measured using this phantom. Materials and Methods : A farmer chamber, a 0.125 cc ion chamber and a diode detector were used for the dosimetry. Six MV x-ray from a linear accelerator (CL2100C, Varian) with stereotactic radiosurgery technique (Green Knife) was used, and multi-purpose phantom was attached to a stereotactic frame (Fisher type). Dosimetry was done by combinations of locations of the detectors in the phantom, fixed or arc beams, gantry angles $(20^{\circ}\~100^{\circ})$, and size of the circular tertiary collimators (inner diameters of $10\~40\;mm$). Results : The measurement error was less than $0.5\%$ by Farmer chamber, $0.5\%$ for 0.125 cc ion chamber, and less than $2\%$ for diode detector for the fixed beam, single arc beam, and 5-arc beam setup. Conclusion : We confirmed the accuracy of dose distribution with the radiosurgery system developed in our institute and the data from this study would be able to be effectively used for the improvement of quality assurance of stereotactic radiosurgery or fractionated stereotactic radiotherapy system.

• Progress in Medical Physics
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• v.23 no.2
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• pp.81-90
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• 2012

The effect of setup uncertainties on CTV dose and the correlation between setup uncertainties and setup margin were evaluated by Monte Carlo based numerical simulation. Patient specific information of IMRT treatment plan for rectal cancer designed on the VARIAN Eclipse planning system was utilized for the Monte Carlo simulation program including the planned dose distribution and tumor volume information of a rectal cancer patient. The simulation program was developed for the purpose of the study on Linux environment using open source packages, GNU C++ and ROOT data analysis framework. All misalignments of patient setup were assumed to follow the central limit theorem. Thus systematic and random errors were generated according to the gaussian statistics with a given standard deviation as simulation input parameter. After the setup error simulations, the change of dose in CTV volume was analyzed with the simulation result. In order to verify the conventional margin recipe, the correlation between setup error and setup margin was compared with the margin formula developed on three dimensional conformal radiation therapy. The simulation was performed total 2,000 times for each simulation input of systematic and random errors independently. The size of standard deviation for generating patient setup errors was changed from 1 mm to 10 mm with 1 mm step. In case for the systematic error the minimum dose on CTV $D_{min}^{stat{\cdot}}$ was decreased from 100.4 to 72.50% and the mean dose $\bar{D}_{syst{\cdot}}$ was decreased from 100.45% to 97.88%. However the standard deviation of dose distribution in CTV volume was increased from 0.02% to 3.33%. The effect of random error gave the same result of a reduction of mean and minimum dose to CTV volume. It was found that the minimum dose on CTV volume $D_{min}^{rand{\cdot}}$ was reduced from 100.45% to 94.80% and the mean dose to CTV $\bar{D}_{rand{\cdot}}$ was decreased from 100.46% to 97.87%. Like systematic error, the standard deviation of CTV dose ${\Delta}D_{rand}$ was increased from 0.01% to 0.63%. After calculating a size of margin for each systematic and random error the "population ratio" was introduced and applied to verify margin recipe. It was found that the conventional margin formula satisfy margin object on IMRT treatment for rectal cancer. It is considered that the developed Monte-carlo based simulation program might be useful to study for patient setup error and dose coverage in CTV volume due to variations of margin size and setup error.

• The Journal of Korean Society for Radiation Therapy
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• v.16 no.2
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• pp.63-67
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• 2004

Purpose : New therapy technique appeared in 3D-CRT or IMRT according to a radiation treatment developing and worked. Such treatment technique requires the radiation irradiation of many direction. It has many restriction at radiation irradiation of many direction to the linear acceleration deception of now actually. Consequently We make new fix device and measure consequently the improvement of the activate range. Method and Material : We upload the fix device on a linear accelerator Couch. We fixed Gantry at 45, 90, 135 and Couch is spin and measure the clearance of the equipment. Couch is fixed at 0 45 90 and measures the clearance of Gantry. We upload the Extended head holder(EHH) on a linear accelerator Couch. and We measure with the experiment of the front. Result : The action range did not have big difference to increase Gantry45. but The activate range of Couch increases the angle in Gantry 90 and Gantry 135 when it uses EHH. The activate range of Gantry increases the angle in Couch 45 when it uses EHH. We showed good activate situation all in Couch 0 and Couch 90. The utility of EHH could keep a behind radiation diminution. Conclusion : The radiation irradiation of many direction comes to be possible the utility of the fix instrument(EHH). The safety space between the patient and equipment or between equipment and equipment increased the utility of the fix device. Also, The manufacture is possible imports to rather cheap price. and We could bring the frugality of the treatment expendable supplies.

• Progress in Medical Physics
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• v.13 no.1
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• pp.32-36
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• 2002

For Intensity Modulated Radiation Therapy(IMRT), the spatial resolution of intensity map(IM) is limited by the width of multi-leaf collimator, which would make an effect on the conformity of the target, as well as organs at risk. Several Methods are suggested to increase the spatial resolution, which can be categorized by the hardware-dependent technique and the software-based technique. However the best solution might be to make the width of MLC finer. it has several obstacles in the respects of technical difficulty and cost. This preliminary study is designed to investigate the clinical effectiveness of the virtual-micro IMRT(VMIMRT) technique, one of the software-based technique. A particular intensity map was created, which has 42$\times$54 pixel dimension ,0.5cm pixel size and 15 intensity levels. Using this intensity map, segment fields of IMRT were generated with 1$\times$lcm, 0.5$\times$1cm, 0.5$\times$0.5cm(VMIM) beamlet size, respectively As results, we found that there was no evidence of improvement for VMIMRT, compared with the 0.5$\times$lcm beamlet size which can be delivered by 1cm width MLC. The reason seems to be due to the constraint of VMIMRT. Further study is required to prove the benefit of the VIMRT in clinical case like head and neck cancer, where is expected that higher resolution than 1cm is necessary.

• Radiation Oncology Journal
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• v.26 no.3
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• pp.166-172
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• 2008

Purpose: The measurement of radiosensitivity of individuals is useful in radiation therapy. Unfortunately, the measurement of radiation survival using a clonogenic assay, which is the established standard, can be difficult and time consuming. The aim of this study is to compare radiosensitivity results obtained from the MTT and clonogenic assays, and to evaluate whether the MTT assay can be used on clinical specimens. Materials and Methods: HCT-8, LoVo, CT-26, and WiDr were the colon cancer cell lines used for this study. The clonogenic assay was performed to obtain the cell survival curves and surviving fractions at a dose of 2 Gy ($SF_2$) as the standard technique for radiosensitivity. Also, the MTT assay was performed for each of the cell lines (in vitro). To simulate clinical specimens, the cell lines were inoculated into nude mice, removed when the tumors reached 1 cm in diameter, and chopped. Next, the tumors were subjected to the same process involved with the MTT assay in vitro. The inhibition rates (IR) of 10 Gy or 20 Gy of irradiation for in vitro and ex vivo were calculated based on the optical density of the MTT assay, respectively. Results: According to $SF_2$ and the cell survival curve, the HCT-8 and WiDr cell lines were more resistant to radiation than LoVo and CT-26 (p<0.05). The IR was measured by in vitro. The MTT assay IR was 17.3%, 21%, 30% and 56.5% for the WiDr, HCT-8, LoVo and CT-26 cell lines, respectively. In addition, the IR measured ex vivo by the MTT assay was 23.5%, 26%, 38% and 53% in the HCT-8, WiDr, LoVo and CT-26 tumors, respectively. Conclusion: The radiosensitivity measured by the MTT assay was correlated with the measures obtained from the clonogenic assay. This result highlights the possibility that the MTT assay could be used in clinical specimens for individual radiosensitivity assays.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.1
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• pp.9-17
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• 2005

Purpose : Uniform dose distribution of the target volume is very important in the radiation treatment. We will evaluate the usefulness of Field-in-Field Technique use to get uniform dose distribution of the target volume and try to find Apply possibility out to a whole brain treatment patient of various thickness. Material and method : We compare the dose distribution when we applied Field-in-Field Technique and parallel opposed fields technique. establish the treatment plan to a phantom(acryl 16cm spheral phantom) and do the measurement, assessment use the TLD and Low sensitivity film. Also the assessment did Apply possibility of Field-in-Field Technique to 20 patient object of various thickness. Result : In the case to use the parallel opposed fields at the whole brain treatment $10-12\%$ high dose region appeared but reduce to $3-4\%$ lesses when we used the Field-in-Field technique. We could get similar numerical value the film and TLD measurement result also. The change of the dose distribution appeared to its ${\pm}1{\sim}2\%$ although it applied such Field-in-Field technique to various patient so that we were identical. Conclusion : We can get uniform dose distribution of in the treatment region if we apply the Field-in-Field technique at the whole brain treatment. Also alternate can play the role of the wedge filter and 3D compensator and We are thought by minimizing the obstacle to be happened due to the high dose region when radiation treatment.

• Radiation Oncology Journal
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• v.21 no.4
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• pp.291-298
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• 2003

Purpose: We report upon a web-based system for Patterns of Care Study (PCS) devised for Korean radiation oncology. This PCS was designed to establish standard tools for clinical quality assurance, to determine basic parameters for radiation oncology processes, to offer a solid system for cooperative clinical studies and a useful standard database for comparisons with other national databases. Materials and Methods: The system consisted of a main server with two back-ups in other locations. The program uses a Linux operating system and a MySQL database. Cancers with high frequencies in radiotherapy departments in Korea from 1998 to 1999 were chosen to have a developmental priority. Results: The web-based clinical PCS .system for radiotherapy in www.pcs.re.kr was developed in early 2003 for cancers of the breast, rectum, esophagus, larynx and lung, and for brain metastasis. The total number of PCS study items exceeded one thousand. Our PCS system features user-friendliness, double entry checking, data security, encryption, hard disc mirroring, double back-up, and statistical analysis. Alphanumeric data can be input as well as image data. In addition, programs were constructed for IRB submission, random sampling of data, and departmental structure. Conclusion: For the first time in the field of PCS, we have developed a web-based system and associated working programs. With this system, we can gather sample data in a short period and thus save, cost, effort and time. Data audits should be peformed to validate input data. We propose that this system should be considered as a standard method for PCS or similar types of data collection systems.