• The Journal of Korean Society for Radiation Therapy
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• v.16 no.1
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• pp.57-65
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• 2004

Introduction : The phantom that includes high density materials such as steel was custom-made to fix lung and bone in order to evaluation inhomogeneity correction at the time of conducting radiation therapy to treat lung cancer. Using this, values resulting from the inhomogeneous correction algorithm are compared on the 2 and 3 dimensional radiation therapy planning systems. Moreover, change in dose calculation was evaluated according to inhomogeneous by comparing with the actual measurement. Materials and Methods : As for the image acquisition, inhomogeneous correction phantom(Pig's vertebra, steel(8.21g/cm3), cork(0.23 g/cm3)) that was custom-made and the CT(Volume zoom, Siemens, Germany) were used. As for the radiation therapy planning system, Marks Plan(2D) and XiO(CMS, USA, 3D) were used. To compare with the measurement value, linear accelerator(CL/1800, Varian, USA) and ion chamber were used. Image, obtained from the CT was used to obtain point dose and dose distribution from the region of interest (ROI) while on the radiation therapy planning device. After measurement was conducted under the same conditions, value on the treatment planning device and measured value were subjected to comparison and analysis. And difference between the resulting for the evaluation on the use (or non-use) of inhomogeneity correction algorithm, and diverse inhomogeneity correction algorithm that is included in the radiation therapy planning device was compared as well. Results : As result of comparing the results of measurement value on the region of interest within the inhomogeneity correction phantom and the value that resulted from the homogeneous and inhomogeneous correction, gained from the therapy planning device, margin of error of the measurement value and inhomogeneous correction value at the location 1 of the lung showed $0.8\%$ on 2D and $0.5\%$ on 3D. Margin of error of the measurement value and inhomogeneous correction value at the location 1 of the steel showed $12\%$ on 2D and $5\%$ on 3D, however, it is possible to see that the value that is not correction and the margin of error of the measurement value stand at $16\%$ and $14\%$, respectively. Moreover, values of the 3D showed lower margin of error compared to 2D. Conclusion : Revision according to the density of tissue must be executed during radiation therapy planning. To ensure a more accurate planning, use of 3D planning system is recommended more so than the 2D Planning system to ensure a more accurate revision on the therapy plan. Moreover, 3D Planning system needs to select and use the most accurate and appropriate inhomogeneous correction algorithm through actual measurement. In addition, comparison and analysis through TLD or film dosimetry are needed.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.45-53
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• 2008

Purpose: We are trying to analyze 130 patients' conditions by using our Helical Tomotherapy, which was installed in our center in Oct. 2007. We will be statistically approach this examination and analyze so that we will be able to figure out adaptive plans according to the change in place of the tumor, GTV (gross tumor volume), total amount of time it took, vector (${\upsilon}=\surd$x2+y2+z2) and the change in size of the tumor. Materials and Methods: Objectives were the patients who were medicated with Tomotherapy in our medical center since Oct. 2007 August 2008. The Average age of the patients were 53 years old (Minimum 25 years old, Maximum 83 years old). The parts of the body we operated were could be categorized as Head&neck (n=22), Chest (n=47), Abdomen (n=25), Pelvis (n=11), Bone (n=25). MVCT had acted on 2702 times, and also had acted on our adaptive plan toward patients who showed big difference in the size of tumor. Also, after equalizing our gained MVCT and kv-CT we checked up on the range of possible mistake, using x, y, z, roll and vector. We've also investigated on Set-up, MVCT, average time of operation and target volume. Results: Mean time on table was 22.8 minutes. Mean treatment time was 13.26 minutes. Mean correction (mm) was X=-0.7, Y=-1.4, Z=5.77, roll=0.29, vector=8.66 Head&neck patients had 2.96 mm less vector value in movement than patients of Chest, Abdomen, Bone. In increasing order, Head&neck, Bone, Abdomen, Chest, Pelvis showed the vector value in movement. Also, there were 27 patients for adaptive plan, 39 patients, who had long or multiple tumor. We could know that When medical treatment is one cure plan, it takes 32 minutes, and when medical treatment is two cure plan, it takes 40 minutes that one medical treatment takes 21 minutes, and the other medical treatment takes 19 minutes. Conclusion:With our basic tools, we could bring more accurate IMRT with MVCT. Also, through our daily image, we checked up on the change in tumor so that adaptive plan could work. It was made it possible to take the cure of long or multiple tumor, the cure in a nearby OAR, and the complicated cure that should make changes of gradient dose distribution.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.2
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• pp.75-80
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• 2006

Purpose: In radiation therapy, precise calculation of dose toward malignant tumors or normal tissue would be a critical factor in determining whether the treatment would be successful. The Radiation Treatment Planning (RTP) system is one of most effective methods to make it effective to the correction of dose due to CT number through converting linear attenuation coefficient to density of the inhomogeneous tissue by means of CT based reconstruction. Materials and Methods: In this study, we carried out the measurement of CT number and calculation of mass density by using RTP system and the homemade inhomogeneous tissue Phantom and the values were obtained with reference to water. Moreover, we intended to investigate the effectiveness and accuracy for the correction of inhomogeneous tissue by the CT number through comparing the measured dose (nC) and calculated dose (Percentage Depth Dose, PDD) used CT image during radiation exposure with RTP. Results: The difference in mass density between the calculated tissue equivalent material and the true value was ranged from $0.005g/cm^3\;to\;0.069g/cm^3$. A relative error between PDD of RTP and calculated dose obtained by radiation therapy of machine ranged from -2.8 to +1.06%(effective range within 3%). Conclusion: In conclusion, we confirmed the effectiveness of correction for the inhomogeneous tissues through CT images. These results would be one of good information on the basic outline of Quality Assurance (QA) in RTP system.

• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.139-151
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• 2018

Objectives : A self-made "Tomotherapy couch device" capable of correcting the Yaw direction was fabricated and evaluated for its usefulness. Materials and Methods : "Tomotherapy couch device" capable of correcting the Yaw direction is made of rigid fibreboard with a flexural strength of $200kg/cm^2$. CBCT Image from Novalis Tx and Iso-Align Phantom from MED-TEC were used to evaluate the physical accuracy. The treatment plan was designed using Accuray $Precision^{TM}$ and In House Head and Phantom. Accuray $PrecisionART^{TM}$ and $Precision^{TM}$ was used to evaluate dose. Results : Evaluation results, the self-fabricated device accurately corrected the setup error, Target dose was within 95 %~107 % of all. In order to directly evaluate the OAR dose according to the Yaw change, the absolute dose was measured. As a result, when the error in the Yaw direction was $3^{\circ}$, the specific OAR showed a maximum difference of 18.4 %. Conclusion : "Tomotherapy couch device" capable of correcting the Yaw direction can be manufactured at a lower cost compared to the effect, and it can prevent the patient's MVCT image dose for re-imaging. Accurate radiation therapy without errors can be performed.

• The Journal of Korean Society for Radiation Therapy
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• v.21 no.2
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• pp.83-88
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• 2009

Purpose: Cone beam computed tomography (CBCT) using an on board imager (OBI) can check the movement and setup error in patient position and target volume by comparing with the image of computer simulation treatment in real.time during patient treatment. Thus, this study purposed to check the change and movement of patient position and target volume using CBCT in IMRT and calculate difference from the treatment plan, and then to correct the position using an automated match system and to test the accuracy of position correction using an electronic portal imaging device (EPID) and examine the usefulness of CBCT in IMRT and the accuracy of the automatic match system. Materials and Methods: The subjects of this study were 3 head and neck patients and 1 pelvis patient sampled from IMRT patients treated in our hospital. In order to investigate the movement of treatment position and resultant displacement of irradiated volume, we took CBCT using OBI mounted on the linear accelerator. Before each IMRT treatment, we took CBCT and checked difference from the treatment plan by coordinate by comparing it with the image of CT simulation. Then, we made correction through the automatic match system of 3D/3D match to match the treatment plan, and verified and evaluated using electronic portal imaging device. Results: When CBCT was compared with the image of CT simulation before treatment, the average difference by coordinate in the head and neck was 0.99 mm vertically, 1.14 mm longitudinally, 4.91 mm laterally, and 1.07o in the rotational direction, showing somewhat insignificant differences by part. In testing after correction, when the image from the electronic portal imaging device was compared with DRR image, it was found that correction had been made accurately with error less than 0.5 mm. Conclusion: By comparing a CBCT image before treatment with a 3D image reconstructed into a volume instead of a 2D image for the patient's setup error and change in the position of the organs and the target, we could measure and correct the change of position and target volume and treat more accurately, and could calculate and compare the errors. The results of this study show that CBCT was useful to deliver accurate treatment according to the treatment plan and to increase the reproducibility of repeated treatment, and satisfactory results were obtained. Accuracy enhanced through CBCT is highly required in IMRT, in which the shape of the target volume is complex and the change of dose distribution is radical. In addition, further research is required on the criteria for match focus by treatment site and treatment purpose.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.65-65
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• 2003

목적 : 방사선치료기술이 날로 발전함에 따라 방사선치료계획시스템에 대한 주기적인 정도관리의 필요성은 증대하고 있으나, 국내 실정에 적합한 표준화된 정도관리절차서가 없는 실정이다. 따라서 본 연구에서는 방사선치료계획용 시스템에 대한 정도관리용 고체팬톰을 제작하여 주기적인 정도관리 활용 및 절차서를 제시하고자 한다. 대상 및 방법 : 체윤곽 보정을 위한 삼각기둥 모형 (30cm$\times$30cm$\times$5cm, 30cm$\times$15cm$\times$5$\times$) 및 정형ㆍ부정형, 불균질 측정이 가능한 물등가고체팬톰을 제작하였고, 컴퓨터단층촬영(AcQsim)을 통해 영상을 얻었으며, RTPS(AcQplan)에 입력하여 영상 내 기준점에서의 선량값을 계산하였다. RTPS를 통해 계산된 값의 평가를 위해 동일한 조건하에서 각 기준점에 대한 실제 측정을 이온함을 이용하여 측정하였다. 평가 항목으로는 정방형 조사면, 부정형 조사면, 쐐기 조사면, 불균질 물질 보정, 사방향 조사 등에 대해서 알고리즘별로 수행하였다. 결과 : RTPS를 이용하여 계산된 값과 실제 측정한 값을 비교하여 RTPS의 정확성을 평가한 결과로 합성의 불확도 허용 기준 (3%), 선속 중심축 상에서의 허용 기준 (2%) 등, 선진 각국 및 각 학회에서 권고하고 있는 허용 범위 내에서 잘 일치하였다. 결론 : RTPS는 측정된 심부선량과 선량분포 등 물리적인 인자에 의존하는 제한성이 있고, 실제로 선량계산 알고리즘과 기하학적 변화에 따라 계산값과 측정값 간에 차이가 발생할 수 있었다. 실제 인체의 체윤곽 불균일성과 불균질성을 모사한 팬톰을 제작하여 이용함으로써 다양한 RTPS간의 비교를 통한 치료 선량의 정확성을 평가하고, 방사선 치료의 원활하고 정확한 수행을 위해 실용적이고, 보편적인 치료계획 시스템의 정도관리 방법과 절차서를 수립하는데에 유용할 것으로 사료된다.

• Progress in Medical Physics
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• v.20 no.4
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• pp.260-268
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• 2009

In this study, we estimated inhomogeneity correction factor in small field. And, we evaluated accuracy of treatment planning and measurement data which applied inhomogeneity correction factor or not. We developed the Inhomogeneity Correction Phantom (ICP) for insertion of inhomogeneity materials. The inhomogeneity materials were 12 types in each different electron density. This phantom is able to adapt the EBT film and 0.125 cc ion chamber for measurement of dose distribution and point dose. We evaluated comparison of planning and measurement data using ICP. When we applied to inhomogeneity correction factor or not, the average difference was 1.63% and 10.05% in each plan and film measurement data. And, the average difference of dose distribution was 10.09% in each measurement film. And the average difference of point dose was 0.43% and 2.09% in each plan and measurement data. In conclusion, if we did not apply the inhomogeneity correction factor in small field, it shows more great difference in measurement data. The planning system using this study shows good result for correction of inhomogeneity materials. In radiosurgery using small field, we should be correct the inhomogeneity correction factor, more exactly.

• Progress in Medical Physics
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• v.4 no.2
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• pp.19-25
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• 1993

Treatment planning of lung cancer with density corrected Computed tomography. Eighty-seven patients with lung cnacer who had radiation therapy in Yeungnam University Medical Center between, April 1 1990 and Aug. 30 1993 were retrospectively evaluated total tumor dose, dose distribution, field correction, and loading change, compared with contour or CT image planning and density corrected CT planning. In dose distribution, higher dose was calculated in compare with density corrected CT planning less than 5% difference were found in 45 patient(52%), 5-10% in 25 patients (29%), 10-15% in 15 patients (17%) and over 15% in 2 patients (2%). Correction of treatment field was performed in 18 patients (21%) and changing of dose loading was given in 15 patients (17%). In conclusion, we emphasize that density corrected CT planning is the very important factor which contribute to increase therapeutic gain by exact selection of target volume, target dose, normal tissue dose and dose of critical organ.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.179-186
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• 2016

Purpose : To figure out if the treatment plan for rectum, bladder and prostate that have a lot of interfraction errors satisfies dosimetric limits without adaptive plan by analyzing MR image. Materials and Methods : This study was based on 5 prostate cancer patients who had IMRT(total dose: 70Gy) Using ViewRay MRIdian System(ViewRay, ViewRay Inc., Cleveland, OH, USA) The treatment plans were made on the same CT images to compare with the plan quality according to adaptive plan, and the Eclipse(Ver 10.0.42, Varian, USA) was used. After registrate the 5 treatment MR images to the CT images for treatment plan to analyze the interfraction changes of organ, we measured the dose volume histogram and the changes of the absolute volume for each organ by appling the first treatment plan to each image. Over 5 fractions, the total dose for PTV was $V_{36.25}$ Gy $${\geq_-}$$ 95%. To confirm that the prescription dose satisfies the SBRT dose limit for prostate, we measured $V_{100%}$, $V_{95%}$, $V_{90%}$ for CTV and $V_{100%}$, $V_{90%}$, $V_{80%}$ $V_{50%}$ of rectum and bladder. Results : All dose average value of CTV, rectum and bladder satisfied dose limit, but there was a case that exceeded dose limit more than one after analyzing the each image of treatment. After measuring the changes of absolute volume comparing the MR image of the first treatment plan with the one of the interfraction treatment, the difference values were maximum 1.72 times at rectum and maximum 2.0 times at bladder. In case of rectum, the expected values were planned under the dose limit, on average, $V_{100%}=0.32%$, $V_{90%}=3.33%$, $V_{80%}=7.71%$, $V_{50%}=23.55%$ in the first treatment plan. In case of rectum, the average of absolute volume in first plan was 117.9 cc. However, the average of really treated volume was 79.2 cc. In case of CTV, the 100% prescription dose area didn't satisfy even though the margin for PTV was 5 mm because of the variation of rectal and bladder volume. Conclusion : There was no case that the value from average of five fractions is over the dosimetric limits. However, dosimetric errors of rectum and bladder in each fraction was significant. Therefore, the precise delivery is needed in case of prostate SBRT. The real-time tracking and adaptive plan is necessary to meet the precision delivery.

• Journal of KIISE
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• v.43 no.3
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• pp.353-361
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• 2016

During image-guided radiation treatment of lung cancer patients, it is necessary to track the tumor motion because it can change during treatment as a consequence of respiratory motion and cardiac motion. In this paper, we propose a method for tracking the motion of the lung tumors based on the three-dimensional image information from planning 4D MDCT and treatment 4D CBCT images. First, to effectively track the tumor motion during treatment, the global motion of the tumor is estimated based on a tumor-specific motion model obtained from planning 4D MDCT images. Second, to increase the accuracy of the tumor motion tracking, the local motion of the tumor is estimated based on the structural information of the tumor from 4D CBCT images. To evaluate the performance of the proposed method, we estimated the tracking results of proposed method using digital phantom. The results show that the tumor localization error of local motion estimation is reduced by 45% as compared with that of global motion estimation.