• Radiation Oncology Journal
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• v.23 no.3
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• pp.143-156
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• 2005

Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

• Radiation Oncology Journal
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• v.28 no.4
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• pp.238-248
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• 2010

Purpose: To compare the dose distributions between three-dimensional (3D) and four-dimensional (4D) radiation treatment plans calculated by Ray-tracing or the Monte Carlo algorithm, and to highlight the difference of dose calculation between two algorithms for lung heterogeneity correction in lung cancers. Materials and Methods: Prospectively gated 4D CTs in seven patients were obtained with a Brilliance CT64-Channel scanner along with a respiratory bellows gating device. After 4D treatment planning with the Ray Tracing algorithm in Multiplan 3.5.1, a CyberKnife stereotactic radiotherapy planning system, 3D Ray Tracing, 3D and 4D Monte Carlo dose calculations were performed under the same beam conditions (same number, directions, monitor units of beams). The 3D plan was performed in a primary CT image setting corresponding to middle phase expiration (50%). Relative dose coverage, D95 of gross tumor volume and planning target volume, maximum doses of tumor, and the spinal cord were compared for each plan, taking into consideration the tumor location. Results: According to the Monte Carlo calculations, mean tumor volume coverage of the 4D plans was 4.4% higher than the 3D plans when tumors were located in the lower lobes of the lung, but were 4.6% lower when tumors were located in the upper lobes of the lung. Similarly, the D95 of 4D plans was 4.8% higher than 3D plans when tumors were located in the lower lobes of lung, but was 1.7% lower when tumors were located in the upper lobes of lung. This tendency was also observed at the maximum dose of the spinal cord. Lastly, a 30% reduction in the PTV volume coverage was observed for the Monte Carlo calculation compared with the Ray-tracing calculation. Conclusion: 3D and 4D robotic radiotherapy treatment plans for lung cancers were compared according to a dosimetric viewpoint for a tumor and the spinal cord. The difference of tumor dose distributions between 3D and 4D treatment plans was only significant when large tumor movement and deformation was suspected. Therefore, 4D treatment planning is only necessary for large tumor motion and deformation. However, a Monte Carlo calculation is always necessary, independent of tumor motion in the lung.

• Journal of the Korean Society of Radiology
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• v.14 no.1
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• pp.7-14
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• 2020

The purpose of this study is to assess the usefulness of IR to compensate for uncertainties in inserting high density artificial objects in radiation treatment planning in the 3D-CRT treatment technique. CT images of the subjects with phantom and titanium inserted were obtained from images without IR and images with IR, and the dose evaluation factors HI, MU and volume evaluation factors Volume and PCI were compared. The results of the stainless steel and titanium phantom experiments showed that the volume of high density artificial material was reduced by 4.850% and 11.456% respectively when applying IR. MU decreased 0.924% and 1.181%. HI was down 0.106% and 0.272%. PCI decreased 0.358% and 0.867%. When IR was applied to CT images of subjects with vertebroplasty, Femur alignment pin and wrist alignment pin, the volume of artifacts decreased by 47.76%, 23.841%, and 49.339%. MU also decreased 0.924%, 0.294% and 1.675%, while HI decreased 1.232%, 0.412% and 1.695%. PCI decreases 4.022%, 0.512%, and 13.472%. In conclusion, When IR was applied to 3D-CRT treatment plan, both dose and volume in phantom and subject case with high density artificial insert were reduced.

• Progress in Medical Physics
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• v.11 no.1
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• pp.1-18
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• 2000

For wedged photon beams, the variation of the wedge factor with field size was reported by several authors. However, until now such variation with field size had not been explained quantitatively. Therefore, the variation of the wedge factor was investigated by measuring outputs with field sizes increasing from 4 cm $\times$ 4 cm to 25 cm $\times$ 25 cm for open and wedged 6 and 10MV X-ray beams. The relative outputs for wedged fields to 10 cm $\times$ 10 cm have been obtained. The results show the Increase of the wedge factor caused by the change in fluence of high energy Photon beam with field size, up to 8.0% for KD77-6MV X-ray beam. This increase could be explained as a linear function of the irradiated wedge volume except small field size up to about 10 cm. In the cases of the narrow rectangular beam parallel to the wedge direction, the wedge factor decreases slightly with increasing field size up to about 10-15 cm due to a relatively reduced photon fluence from the change of the wedge thickness. We could explain the causes of a wedge factor variation with field size as the fluences of primary photon passed throughout the wedge, contributing to the dose at the central beam axis and that the fluences were affected by the gradient of the wedge with the change of field size. For clinical use, the formula developed to describe the wedge factor variation with field size has been corrected.

• Journal of Radiation Protection and Research
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• v.14 no.1
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• pp.66-70
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• 1989

In routine testing, the radioactive neutron sources are particularly suitable for producing standard. neutron fields. The ISO TC-85 has proposed neutron reference radiation for the calibration of neutron measuring devices used for radiation protection purposes. Radiation laboratory of KSRI has installed a standard irradiation facility using $^{252}Cf$ and $^{241}Am-Be$ sources for calibrating personal dosimeters according to the recommendations given in ISO TC-85. In this study, correction factors for calibration related to neutron scattering and anisotropy are obtained by experiments with commercial rem meter for demonstration purposes.

• Progress in Medical Physics
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• v.19 no.4
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• pp.231-240
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• 2008

We developed a user-friendly program to independently verify monitor units (MUs) calculated by radiation treatment planning systems (RTPS), as well as to manage beam database in clinic. The off-axis factor, beam hardening effect, inhomogeneity correction, and the different depth correction were incorporated into the program algorithm to improve the accuracy in calculated MUs. A beam database in the program was supposed to use measured data from routine quality assurance (QA) processes for timely update. To enhance user's convenience, a graphic user interface (GUI) was developed by using Visual Basic for Application. In order to evaluate the accuracy of the program for various treatment conditions, the MU comparisons were made for 213 cases of phantom and for 108 cases of 17 patients treated by 3D conformal radiation therapy. The MUs calculated by the program and calculated by the RTPS showed a fair agreement within ${\pm}3%$ for the phantom and ${\pm}5%$ for the patient, except for the cases of extreme inhomogeneity. By using Visual Basic for Application and Microsoft Excel worksheet interface, the program can automatically generate beam data book for clinical reference and the comparison template for the beam data management. The program developed in this study can be used to verify the accuracy of RTPS for various treatment conditions and thus can be used as a tool of routine RTPS QA, as well as independent MU checks. In addition, its beam database management interface can update beam data periodically and thus can be used to monitor multiple beam databases efficiently.

• Journal of Korea Society of Industrial Information Systems
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• v.25 no.5
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• pp.31-39
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• 2020

According to lessons learned from an accident of Fukushima Daiichi nuclear power plant, it is advisable to make a comprehensive radiation survey by the accident phase for efficient response and risk management using diverse survey platforms. This study focuses on the technical status of environmental radiation monitoring using a UAV (Unmanned aerial vehicle) and the performance test of developed aerial survey system based on two detectors with an high energy resolution through the field application to contaminated areas. Finally, the performance of aerial survey at diverse flight heights was successfully achieved by introducing the correction factor to represent the results into ambient dose rate at 1m above the ground.

• Journal of Radiation Industry
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• v.18 no.3
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• pp.223-226
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• 2024

It is essential to precisely evaluate the expected dose (collective dose) before performing high-exposure tasks in nuclear power plants because those have a high potential to cause significant radiation exposure to workers. A dose evaluation method is to design the scenarios of high-exposure tasks using computational codes, which allows for the calculation of the expected collective dose. Although these computational scenarios are useful for estimating the expected radiation dose and establishing radiation protection plans, the calculated doses may not perfectly match the actual doses that workers receive during tasks due to differences between the scenario and the actual circumstances in the radiation fields. Therefore, this study presents a methodology for calculating correction factors to improve the accuracy of dose predictions from computational scenarios. This approach aims to make the predicted collective dose before the task closer to the actual dose received by workers, thereby enhancing radiation safety for personnel performing high-exposure tasks. Additionally, these correction factors will help accurately predict doses under various working conditions in the future, contributing to minimizing radiation exposure risks for nuclear power plant workers.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.1
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• pp.23-30
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• 2012

Purpose: There was a problem with using MU verification programs for the reasons that there were errors of MU when using MU verification programs based on Pencil Beam Convolution (PBC) Algorithm with radiation treatment plans around lung using Analytical Anisotropic Algorithm (AAA). On this study, we studied the methods that can verify the calculated treatment plans using AAA. Materials and Methods: Using Eclipse treatment planning system (Version 8.9, Varian, USA), for each 57 fields of 7 cases of Lung Stereotactic Body Radiation Therapy (SBRT), we have calculated using PBC and AAA with dose calculation algorithm. By developing MU of established plans, we compared and analyzed with MU of manual calculation programs. We have analyzed relationship between errors and 4 variables such as field size, lung path distance of radiation, Tumor path distance of radiation, effective depth that can affect on errors created from PBC algorithm and AAA using commonly used programs. Results: Errors of PBC algorithm have showned $0.2{\pm}1.0%$ and errors of AAA have showned $3.5{\pm}2.8%$. Moreover, as a result of analyzing 4 variables that can affect on errors, relationship in errors between lung path distance and MU, connection coefficient 0.648 (P=0.000) has been increased and we could calculate MU correction factor that is A.E=L.P 0.00903+0.02048 and as a result of replying for manual calculation program, errors of $3.5{\pm}2.8%$ before the application has been decreased within $0.4{\pm}2.0%$. Conclusion: On this study, we have learned that errors from manual calculation program have been increased as lung path distance of radiation increases and we could verified MU of AAA with a simple method that is called MU correction factor.