• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.161-167
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• 2018

Purpose : This study evaluates the usefulness of the Modified Hybrid-VMAT scheme with consideration of background radiation when establishing a treatment plan for multiple bone metastatic cancer including multiple tumors on the same axis. Materials and Methods : The subjects of this study consisted of five patients with multiple bone metastatic cancer on the same axis. The planning target volume(PTV) prescription dose was 30 Gy, and the treatment plan was established using Ray Station(Ray station, 5.0.2.35, Sweden). In the treatment plan for each patient, two or more tumors were set as one isocenter. A volumetric modulated arc therapy(VMAT) plan, a hybrid VMAT(h) plan with no consideration of background radiation, and a modified hybrid VMAT(mh) with consideration of background radiation were established. Then, using each dose volume histogram(DVH), the PTV maximum dose($D_{max}$), mean dose($D_{mean}$), conformity index(CI), and homogeneity index(HI) were compared among the plans. In addition, the organ at risk(OAR) of each treatment site was evaluated, and the total MU(Monitor Unit) and treatment time were also analyzed. Results : The PTV $D_{max}$ values of VMAT, VMAT(h) and VMAT(mh) were 3188.33 cGy, 3526 cGy, and 3285.67 cGy, the $D_{mean}$ values were 3081 cGy, 3252 cGy, and 3094 cGy; the CI values were $1.35{\pm}0.19$, $1.43{\pm}0.12$, and $1.30{\pm}0.06$; the HI values were $1.06{\pm}0.01$, $1.14{\pm}0.06$, and $1.09{\pm}0.02$; and the VMAT(h) OAR value was increased 3 %, and VMAT(mh) OAR value was decreased 18 %, respectively. Furthermore, the mean MU values were 904.90, 911.73, and 1202.13, and the mean beam on times were $128.67{\pm}10.97$, $167.33{\pm}7.57$, and $190.33{\pm}4.51$ respectively. Conclusions : Applying Modified Hybrid-VMAT when treating multiple targets can prevent overdose by correcting the overlapping of doses. Furthermore, it is possible to establish a treatment plan that can protect surrounding normal organs more effectively while satisfying the inclusion of PTV dose. Long-term follow-up of many patients is necessary to confirm the clinical efficacy of Modified Hybrid-VMAT.

• Radiation Oncology Journal
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• v.19 no.1
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• pp.53-65
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• 2001

Purpose : To improve the local control of patients with nasopharyngeal cancer, we have implemented 3-D conformal radiotherapy and forward intensity modulated radiation therapy (IMRT) to used of compensating filters. Three dimension conformal radiotherapy with intensity modulation is a new modality for cancer treatments. We designed 3-D treatment planning with 3-D RTP (radiation treatment planning system) and evaluation dose distribution with tumor control probability (TCP) and normal tissue complication probability (NTCP). Material and Methods : We have developed a treatment plan consisting four intensity modulated photon fields that are delivered through the compensating tilters and block transmission for critical organs. We get a full size CT imaging including head and neck as 3 mm slices, and delineating PTV (planning target volume) and surrounding critical organs, and reconstructed 3D imaging on the computer windows. In the planning stage, the planner specifies the number of beams and their directions including non-coplanar, and the prescribed doses for the target volume and the permissible dose of normal organs and the overlap regions. We designed compensating filter according to tissue deficit and PTV volume shape also dose weighting for each field to obtain adequate dose distribution, and shielding blocks weighting for transmission. Therapeutic gains were evaluated by numerical equation of tumor control probability and normal tissue complication probability. The TCP and NTCP by DVH (dose volume histogram) were compared with the 3-D conformal radiotherapy and forward intensity modulated conformal radiotherapy by compensator and blocks weighting. Optimization for the weight distribution was peformed iteration with initial guess weight or the even weight distribution. The TCP and NTCP by DVH were compared with the 3-D conformal radiotherapy and intensitiy modulated conformal radiotherapy by compensator and blocks weighting. Results : Using a four field IMRT plan, we have customized dose distribution to conform and deliver sufficient dose to the PTV. In addition, in the overlap regions between the PTV and the normal organs (spinal cord, salivary grand, pituitary, optic nerves), the dose is kept within the tolerance of the respective organs. We evaluated to obtain sufficient TCP value and acceptable NTCP using compensating filters. Quality assurance checks show acceptable agreement between the planned and the implemented MLC(multi-leaf collimator). Conclusion : IMRT provides a powerful and efficient solution for complex planning problems where the surrounding normal tissues place severe constraints on the prescription dose. The intensity modulated fields can be efficaciously and accurately delivered using compensating filters.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.1
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• pp.33-41
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• 2019

Purpose : To evaluate the effectiveness of Jaw-tracking(JT) technique in Intensity-modulated radiation therapy(IMRT) and Volumetric-modulated arc therapy(VMAT) for radiation therapy of esophageal cancer by analyzing volume dose of perimetrical normal organs along with the low-dose volume regions. Materials and Method: A total of 27 patients were selected who received radiation therapy for esophageal cancer with using $VitalBeam^{TM}$(Varian Medical System, U.S.A) in our hospital. Using Eclipse system(Ver. 13.6 Varian, U.S.A), radiation treatment planning was set up with Jaw-tracking technique(JT) and Non-Jaw-tracking technique(NJT), and was conducted for the patients with T-shaped Planning target volume(PTV), including Supraclavicular lymph nodes(SCL). PTV was classified into whether celiac area was included or not to identify the influence on the radiation field. To compare the treatment plans, Organ at risk(OAR) was defined to bilateral lung, heart, and spinal cord and evaluated for Conformity index(CI) and Homogeneity index(HI). Portal dosimetry was performed to verify a clinical application using Electronic portal imaging device(EPID) and Gamma analysis was performed with establishing thresholds of radiation field as a parameter, with various range of 0 %, 5 %, and 10 %. Results: All treatment plans were established on gamma pass rates of 95 % with 3 mm/3 % criteria. For a threshold of 10 %, both JT and NJT passed with rate of more than 95 % and both gamma passing rate decreased more than 1 % in IMRT as the low dose threshold decreased to 5 % and 0 %. For the case of JT in IMRT on PTV without celiac area, $V_5$ and $V_{10}$ of both lung showed a decrease by respectively 8.5 % and 5.3 % in average and up to 14.7 %. A $D_{mean}$ decreased by $72.3{\pm}51cGy$, while there was an increase in radiation dose reduction in PTV including celiac area. A $D_{mean}$ of heart decreased by $68.9{\pm}38.5cGy$ and that of spinal cord decreased by $39.7{\pm}30cGy$. For the case of JT in VMAT, $V_5$ decreased by 2.5 % in average in lungs, and also a little amount in heart and spinal cord. Radiation dose reduction of JT showed an increase when PTV includes celiac area in VMAT. Conclusion: In the radiation treatment planning for esophageal cancer, IMRT showed a significant decrease in $V_5$, and $V_{10}$ of both lungs when applying JT, and dose reduction was greater when the irradiated area in low-dose field is larger. Therefore, IMRT is more advantageous in applying JT than VMAT for radiation therapy of esophageal cancer and can protect the normal organs from MLC leakage and transmitted doses in low-dose field.

• Journal of the Korean Society of Radiology
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• v.14 no.2
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• pp.105-109
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• 2020

Intensity-modulated radiotherapy(IMRT) has disadvantages such as increasing the low doses of irradiation to normal tissues and accumulated dose for the whole volume by leakage and transmission of the Multi Leaf Collimator (MLC). The accumulated dose and low dose may increase the occurrence of secondary malignant neoplasms. For this reasons, the jaw tracking function of the TrueBeam (Varian Medical Systems, Palo Alto, CA) was developed to reduce the leakage and transmission dose of the MLC with existing linear accelerators. But quantitative analysis of the dose reduction has not been verified. Therefore, in the present study, we intended to verify the clinical possibility of utilizing the jaw tracking function in brain tumor with comparison of treatment plans. To accomplish this, 3 types of original treatment plans were made using Eclipse11 (Varian Medical Systems, Palo Alto, CA): 1) beyond 2 cm distance from the Organs At Risk (OARs); 2) within 2 cm distance from the OARs; and 3) intersecting with the OARs. Jaw tracking treatment plans were also made with copies of the original treatment planning using Smart LMC Version 11.0.31 (Varian Medical Systems, Palo Alto, CA). A comparison between the 2 types of treatment planning methods was performed using the difference of the mean dose and maximum dose to the OARs in cumulative Dose Volume Histogram (DVH). In the DVH comparison, the maximum difference of 0.5 % was observed between the planning methods in the case of over 2 cm distance, and the maximum of 0.6 % was obtained for within the 2 cm distance. For the case intersecting with the OAR, the maximum difference of 2 % was achieved. According to these results, it could be realized that the differences of mean dose and maximum dose to the OARs was larger when the OARs and PTV were closer. Therefore, treatment plans with the jaw tracking function consistently affected the dose reduction and the clinical possibility could be verified.

• Journal of radiological science and technology
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• v.30 no.3
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• pp.213-219
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• 2007

The purpose of this study is to evaluate shielding effect of radiation protector for interventional radiologists in procedures by measuring inside and outside of radiation protector. In this study, we measured the radiation dose of 4 interventional radiologists during TACE and PTBD procedure for 4 month(2005.05-2005.09). Absorbed dose were measured by TLD placed underneath and over radiation protector such as Goggle, Thyroid protector, Apron and placed on the 4th finger of Hand. In addition, we measured background radiation dose in the control room using TLD. During TACE procedure, using 0.07 mmPb Goggle decreased average 53.8% of radiation dose rate in continuous fluoroscopic mode and decreased average 77.6% of radiation dose rate in pulse fluoroscopic mode. Using 0.5 mmPb Thyroid protector decreased average 88.9% of radiation dose rate in continuous fluoroscopic mode and decreased average 92.8% in pulse fluoroscopic mode. During PTBD procedure, using 0.07 mmPb Goggle decreased radiation dose rate average 62.7%, 87.9% by 0.5 mmPb Thyroid protector, 90.5% by 0.5 mmPb Apron. The average fluoroscopic time of PTBD was 6.14 min. shorter than TACE procedure, but radiation exposure dose rate of PTBD was 3 times higher in total body dose, and 40 times higher in hand dose rate than TACE. Interventional radiologists must wear thicker protector recommended over 0.5 mmPb. Also, they must use lead Goggle during interventional procedure. Abdomen dose decreased average 38.4% by drawing a lead curtain under the patient's table, therefore, they must draw a lead curtain to shield scattering ray. Radiation exposure dose decreased average 59.0% by using pulse fluoroscopic mode. So radiologists would better use pulse fluoroscopic mode than continuous fluoroscopic mode to decrease exposure dose.

• Journal of the Korean Society of Radiology
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• v.5 no.3
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• pp.135-141
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• 2011

If protective performance of apron cannot be good, radiation exposure of an guardian or a patient, a person engaged in radiation related industry cannot rise. Therefore, It will be evaluated protection performance to radiation protection aprons by manufacturers and lead equivalent more than 0.25mm lead equivalent. And, will show in the direction of application to clinic. The new aprons by manufacturers(H, X, I, J company) and lead equivalent(0.50mmPb, 0.35mmPb, 0.25mmPb) measured transmitted dose rate and shielding rate, uniformity under fluoroscopy and general radiography using to fluoroscopy system and digital radiography system, x-ray multifunction meter. The shielding rate measurement results, 0.5mmPb apron was Shielding rate of apron of a I company(fluoroscopy : 97.96%) was the best under six companies, and shielding rate of apron of a J company(fluoroscopy : 96.25%) was worst. 0.35mmPb Apron was Shielding rate of a I company(fluoroscopy : 96.79%) was the best under the three companies, and shielding rate of an H company(fluoroscopy : 95.81%) was the worst. 0.25mmPb Apron was Shielding rate of X company apron(fluoroscopy : 90.908%) was better than H company apron(fluoroscopy : 88.82%) than two companies. The uniformity measurement results, 0.5mmPb Aprons of X company(fluoroscopy : 0.13) and I company(fluoroscopy : 0.19) was the best under the six companies, and J company apron(fluoroscopy : 0.45) was the worst. 0.35mmPb. Along a manufacturer and lead equivalent performance of apron protection is distinguished certainly. Therefore, a patient, guardian or a person engaged in radiation related industry shall enforce experiment of a lot of ways defined or evaluation so that the maximum reduces radiation exposure. Buy the apron that protective performance is good, It will be performed through experiment and evaluation.

• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.61-71
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• 2020

Purpose: To investigate the effect of collimator angle on plan quality of PAN-Pelvis Multi-isocenter VMAT plan, dose reproducibility at the junction and impact on set-up error at the junction. Material and method: 10 adult patients with whole pelvis cancer including PAN were selected for the study. Using Trubeam STx equipped with HD MLC, we changed the collimator angle to 20°, 30°, and 45° except 10° which was the default collimator angle in the Eclipse(version 13.7) and all other treatment conditions were set to be the same for each patient and four plans were established also. To evaluate these plans, PTV coverage, coverage index(CVI) and homogeneity index (HI) were compared and clinical indicators for each treatment sites in normal tissues were analyzed. To evaluate dose reproducibility at the junction, the absolute dose was measured using a Falmer type ionization chamber and dose changes at the junction were evaluated by moving the position of the isocenter in and out 1~3mm and setting up the virtual volume at the junction. Result: CVI mean value was PTV-45 0.985±0.004, PTV-55 0.998±0.003 at 45° and HI mean value was PTV-45 1.140±0.074, and PTV-55 1.031±0.074 at 45° which were closest to 1. V20Gy of the kidneys decreased by 9.66% and average dose of bladder and V30 decreased by 1.88% and 2.16% at 45° compared to 10° for the critical organs. The dose value at the junction of the plan and the actual measured were within 0.3% and within tolerance. At the junction, due to set-up error the maximum dose increased to 14.56%, 9.88%, 8.03%, and 7.05%, at 10°, 20°, 30°, 45°, and the minimum dose decreased to 13.18%, 10.91%, 8.42%, and 4.53%, at 10°, 20°, 30°, 45° Conclusion: In terms of CVI, HI of PTV and critical organ protection, overall improved values were shown as the collimator angle increased. The impact on set-up error at the junction by collimator angle decreased as the angle increased and it will help improve the anxiety about the set up error. In conclusion, the collimator angle should be recognized as a factor that can affect the quality of the multi-isocenter VMAT plan and the dose at the junction, and be careful in setting the collimator angle in the treatment plan.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.51-60
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• 2022

Objectives: The purpose is to evaluate dosimetric performance and delivery efficiency of VMAT with Halcyon LINAC for double target spine SBRT Materials and Methods: 12 patients with spine oligometastases were retrospectively studied. Single-isocenter spine SBRT plans was established using Halcyon® with Dual Layer MLC and Truebeam® with High Definition MLC. All patients' plans were created in Eclipse TPS through the identical conditions and optimization. C.I, H.I, G.I (Gradient Index), maximal and volumetric doses to spinal cord and low dose area were evaluated for comparison of both plans. Also, total MU and BOT(Beam On Time) were evaluated. Results: Halcyon plans was no Statistical differences in C.I and H.I. However, the average of G.I was 4.64 for Halcyon, which decreased to 5.5% compared to Truebeam (P<0.001). Halcyon plans demonstrated statistically significant reduced G.I. The average of 50% and 25% isodose volume was 487.56 cc (-3.82%, P<0.001), 1859.45 cc (-4.75%, P<0.001) in Halcyon, respectively. Significantly reduced low dose spill were observed in Halcyon plans. In the evaluation of the spinal cord, the average of Dmean and V10 of Halcyon plans in the sample group with an overlap volume of less than 1 cc was 6.802 Gy (-3.504%, P=0.067), 5.766±1.683 cc (-8.199%, P=0.002), respectively. Halcyon plans demonstrated statistically significant reduced D_mean and V10. For delivery efficiency, MU and BOT(maximum dose rate for each machine), on average, increased in Halcyon plans. However, the average of BOT(800MU/min for each machine) was 648.33 sec for Halcyon (-1.74%, P<0.001). Conclusion: Halcyon plan for double-target spine SBRT demonstrated advantages in the low dose area with a steep dose gradient, while having dosimetrically equivalent target dose distribution and spinal cord protective effect. As a result, Halcyon LINAC produced a dosimetrically improved plan for double-target spine SBRT.

• Radiation Oncology Journal
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• v.29 no.2
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• pp.115-120
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• 2011

Purpose: To examine the feasibility of the treatment planning for minimizing carotid artery dose in the radiotherapy of early glottic cancer. Materials and Methods: From 2007 to 2010, computed tomography simulation images of 31 patients treated by radiotherapy for early glottic cancer were analyzed. The virtual planning was used to compare the parallel-opposing fields (POF) with the modified oblique fields (MOF) placed at angles to exclude the ipsilateral carotid arteries. Planning target volume (PTV), irradiated volume, carotid artery, and spinal cord were analyzed at a mean dose, $V_{35}$, $V_{40}$, $V_{50}$ and with a percent dose-volume. Results: The beam angles were arranged 25 degrees anteriorly in 23 patients and 30 degrees anteriorly in 8 dose-volume of carotid artery shows the significant difference (p<0.001). The mean doses of carotid artery were 38.5 Gy for POF and 26.3 Gy for MOF and the difference was statistically significant (p=0.012). Similarly, $V_{35}$, $V_{40}$, and $V_{50}$ also showed significant differences between POF and MOF. Conclusion: The modified oblique field was respected to prevent a carotid artery stenosis and reduce the incidence of a stroke based on these results.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.31-43
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• 2015

Purpose : Stereotactic body radiation therapy (SBRT) has proved its efficacy in several patient populations with primary and metastatic limited tumors. Because SBRT prescription is high dose level than Conventional radiation therapy. SBRT plan is necessary for effective Organ at risk (OAR) protection and sufficient Planning target volume (PTV) dose coverage. In particular, multi-target cases may result excessive doses to OAR and hot spot due to dose overlap. This study evaluate usefulness of Volumetric modulated arc therapy (VMAT) in dosimetric and technical considerations using Flattening filter free (FFF) beam. Materials and Methods : The treatment plans for five patients, being treated on TrueBeam STx(Varian$^{TM}$, USA) with VMAT using 10MV FFF beam and Standard conformal radiotherapy (CRT) using 15MV Flattening filter (FF) beam. PTV, liver, duodenum, bowel, spinal cord, esophagus, stomach dose were evaluated using the dose volume histogram(DVH). Conformity index(CI), homogeneity index(HI), Paddick's index(PCI) for the PTV was assessed. Total Monitor unit (MU) and beam on time was assessed. Results : Average value of CI, HI and PCI for PTV was $1.381{\pm}0.028$, $1.096{\pm}0.016$, $0.944{\pm}0.473$ in VMAT and $1.381{\pm}0.042$, $1.136{\pm}0.042$, $1.534{\pm}0.465$ in CRT respectively. OAR dose in CRT plans evaluated 1.8 times higher than VMAT. Total MU in VMAT evaluated 1.3 times increase than CRT. Average beam on time was 6.8 minute in VMAT and 21.3 minute in CRT. Conclusion : VMAT for SBRT in multi-target liver cancer using FFF beam is effective treatment techniqe in dosimetric and technical considerations. VMAT decrease intra-fraction error due to treatment time shortening using high dose rate of FFF beam.