• Journal of Yeungnam Medical Science
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• v.25 no.2
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• pp.85-91
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• 2008

Intensity-modulated radiation therapy (IMRT) is believed to be one of the best radiation treatment techniques. IMRT is able to deliver fatal doses of radiation to the tumor region with minimal exposure of critical organs. It is essential to have a comprehensive quality assurance program to assure precision and accuracy in treatment, due to the character of IMRT. We applied quality assurance technique to the Eclipse treatment planning system and sought to determine its effectiveness in patient treatment planning. An acrylic phantom, film, and an ionization chamber were used in this study.

• Radiation Oncology Journal
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• v.20 no.1
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• pp.81-90
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• 2002

Purpose : To establish and verify the proper and the practical IMRT (Intensity--modulated radiation therapy) patient QA (Quality Assurance). Materials and Methods : An IMRT QA which consists of 3 steps and 16 items were designed and examined the validity of the program by applying to 9 patients, 12 IMRT cases of various sites. The three step OA program consists of RTP related QA, treatment information flow QA, and a treatment delivery QA procedure. The evaluation of organ constraints, the validity of the point dose, and the dose distribution are major issues in the RTP related QA procedure. The leaf sequence file generation, the evaluation of the MLC control file, the comparison of the dry run film, and the IMRT field simulate image were included in the treatment information flow procedure QA. The patient setup QA, the verification of the IMRT treatment fields to the patients, and the examination of the data in the Record & Verify system make up the treatment delivery QA procedure. Results : The point dose measurement results of 10 cases showed good agreement with the RTP calculation within $3\%$. One case showed more than a $3\%$ difference and the other case showed more than $5\%$, which was out side the tolerance level. We could not find any differences of more than 2 mm between the RTP leaf sequence and the dry run film. Film dosimetry and the dose distribution from the phantom plan showed the same tendency, but quantitative analysis was not possible because of the film dosimetry nature. No error had been found from the MLC control file and one mis-registration case was found before treatment. Conclusion : This study shows the usefulness and the necessity of the IMRT patient QA program. The whole procedure of this program should be peformed, especially by institutions that have just started to accumulate experience. But, the program is too complex and time consuming. Therefore, we propose practical and essential QA items for institutions in which the IMRT is performed as a routine procedure.

• 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.

• Radiation Oncology Journal
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• v.27 no.3
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• pp.120-125
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• 2009

Purpose: We wanted to present the preliminary results of intensity-modulated radiotherapy (IMRT) for the treatment of tonsillar cancer. Materials and Methods: We retrospectively analyzed 12 patients who underwent IMRT for tonsillar cancer at Asan Medical Center between November 2002 and February 2007. Seven patients (58%) received definitive treatment, and five (42%) were treated in the postoperative setting. Among the definitively treated patients, 6 patients received cisplatin-based chemotherapy regimens. Simultaneous modulated accelerated radiation therapy (SMART) was used in nine patients. The prescribed dose was 72 Gy at 2.4 Gy/fraction for the definitively treated cases and 61.6 Gy at 2.2 Gy/fraction for the postoperative cases. The median follow-up period was 34 months. Results: All twelve patients completed treatment without interruption, and eleven showed a complete response. One patient had persistent loco-regional disease after treatment. The three-year estimates of loco-regional control, disease-free survival and overall survival were 91.7%, 91.7%, and 100%. The worst acute mucositis was Grade 1 in four patients, Grade 2 in five patients, Grade 3 in two patients and Grade 4 in one patient. Grade 3 xerostomia was observed in six patients. Conclusion: Intensity-modulated radiotherapy was shown to be a safe and effective treatment modality for tonsillar cancer. Further studies with a larger number of patients and a longer follow-up period are needed to evaluate the ultimate tumor control and late toxicity of IMRT for treating tonsillar cancer.

• Journal of radiological science and technology
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• v.46 no.3
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• pp.239-246
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• 2023

In this study, we assessed the effect of reduction of tumor volume in the head and neck cancer by using RANDO phantom in Static Intensity-Modulated Radiation Therapy (S-IMRT) and Volumetric-Modulated Arc Therapy (VMAT) planning. RANDO phantom's body and protruding volumes were delineated by using Contour menu of Eclipse™ (Varian Medical System, Inc., Version 15.6, USA) treatment planning system. Inner margins of 2 mm to 10 mm from protruding volumes of the reference were applied to generate the parameters of reduced volume. In addition, target volume and Organ at Risk (OAR) volumes were delineated. S-IMRT plan and VMAT plan were designed in reference. These plans were assigned in the reduced volumes and dose was calculated in reduced volumes using preset Monitor unit (MU). Dose Volume Histogram (DVH) was generated to evaluate treatment planning. Conformity Index (CI) and R² in reference S-IMRT were 0.983 and 0.015, respectively. There was no significant relationship between CI and the reduced volume. Homogeneity Index (HI) and R² were 0.092 and 0.960, respectively. The HI increased when volume reduced. In reference VMAT, CI and R² were 0.992 and 0.259, respectively. There was no relationship between the volume reduction and CI. On the other hand, HI and R² were 0.078 and 0.895, respectively. The value of HI increased when the volume reduced. There was significant difference (p<0.05) between parameters (D_mean and D_max) of normal organs of S-IMRT and VMAT except brain stem. Volume reduction affected the CI, HI and OAR dose. In the future, additional studies are necessary to incorporate the reduction of the volume in the clinical setting.

• Progress in Medical Physics
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• v.23 no.4
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• pp.219-228
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• 2012

The tangential breast intensity modulated radiotherapy (T-B IMRT) technique, which uses the same tangential fields as conventional 3-dimensional conformal radiotherapy (3D-CRT) plans with physical wedges, was analyzed in terms of the calculated dose distribution feature and dosimetric accuracy of beam delivery during treatment. T-B IMRT plans were prepared for 15 patients with breast cancer who were already treated with conventional 3D-CRT. The homogeneity of the dose distribution to the target volume was improved, and the dose delivered to the normal tissues and critical organs was reduced compared with that in 3D-CRT plans. Quality assurance (QA) plans with the appropriate phantoms were used to analyze the dosimetric accuracy of T-B IMRT. An ionization chamber placed at the hole of an acrylic cylindrical phantom was used for the point dose measurement, and the mean error from the calculated dose was $0.7{\pm}1.4%$. The accuracy of the dose distribution was verified with a 2D diode detector array, and the mean pass rate calculated from the gamma evaluation was $97.3{\pm}2.9%$. We confirmed the advantages of a T-B IMRT in the dose distribution and verified the dosimetric accuracy from the QA performance which should still be regarded as an important process even in the simple technique as T-B IMRT in order to maintain a good quality.

• Radiation Oncology Journal
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• v.22 no.3
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• pp.165-176
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• 2004

Purpose: Firstly, to analyze facto in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma, Secondly, to explore an effective salvage treatment for these relapses. Materials and Methods: Two patients who had high-risk disease (T3bMl, T3bM3) were treated with combined chemoradiotherapy CT-simulation based radiation-treatment planning (RTP) was peformed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. Results: Review of radiotherapy Portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume, When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. Conclusion: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.

• Journal of the Korean Society of Radiology
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• v.10 no.4
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• pp.233-239
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• 2016

Comparison of the dose aspect that radiation therapy treatments using IMRT, tomotherapy, mArc (modulated arc therapy). The experimental subject is non-small cell lung cancer patient. The prescription dose is 58.0 Gy to the volume of PTV(planning target volume). and spinal cord, esophagus, and liver organ is the normal organ(OAR, organ at risk). Average PTV value is 57.60 Gy in mArc and 61.04 Gy in tomotherapy and 58.95 Gy in IMRT. The average dose of the Esophagus is 2.84 Gy in m-Arc, 5.14 Gy in tomotherapy, 1.84 Gy in IMRT. The average dose of the Liver is 19.44 Gy in m-Arc, 12.22 Gy in tomotherapy, 21.97 Gy in IMRT. The average dose of the Spinal cord is 5.72 Gy in m-Arc, 7.08 Gy in tomotherapy, 6.15 Gy in IMRT. Results of this study is no significant difference between mArc and tomotherapy and Linac based IMRT in dose study and also, mArc's dose coverage and dose volume histogram is better than IMRT and tomotherapy. but, This study is limited to a disease of cancer. in addition, fewer number of groups. The wide range the more research can be developed patient-specific treatment techniques and be applied to the patients

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.1
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• pp.25-31
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• 2013

Purpose: The aim of this study is to evaluate the dosimetric properties of robust planning strategy for plain intensity-modulated proton therapy (IMPT) taking into account of the uncertainties of effective proton range and set up error as compared to photon intensity-modulated radiation therapy (photon-IMRT) in prostate cancer treatment. Materials and Methods: The photon-IMRT (7 beams, step & shoot), plain-IMPT (2, 4, and 7 portals), and robust- IMPT plans, which was recalculated the plain-IMPT based on the uncertainties of range error (${\pm}5%$) and set up error (0.5 cm), were evaluated for five prostate cancer patients prescribed by 70 Gy/35 fractions. To quantitatively evaluate the dose distributions, several parameters such as maximum dose, minimum dose, mean dose, conformity index (CI), and homogeneity index (HI) for PTV as well as dose-volume index of VxGy for OARs were calculated from dose-volume histograms. Results: Robust-IMPT showed superior dose distributios in the PTV and OARs as compared to plain-IMPT and photon-IMRT. Like plain-IMPT, robust-IMPT were resulted in dose fluctuation around OARs, while better homogeneity and conformity in PTVs and lower mean dose in OARs as compared to photon-IMRT. Conclusion: In consideration with the effective range correction and set up movement using robustness in IMPT plan, the dosimetric uncertainties from plain-IMPT could substantially reduce and suggest more effective solutions than photon-IMRT in prostate cancer treatment.

• Journal of radiological science and technology
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• v.37 no.2
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• pp.125-134
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• 2014

This study is to provide basic information regarding photoneutron doses in terms of radiation treatment techniques and the number of portals in intensity-modulated radiation therapy (IMRT) by measuring the photoneutron doses. Subjects of experiment were 10 patients who were diagnosed with prostate cancer and have received radiation treatment for 5 months from September 2013 to January 2014 in the department of radiation oncology in S hospital located in Seoul. Thus, radiation treatment plans were created for 3-Dimensional Conformal Radiotherapy (3D-CRT), Volumetric-Modulated Arc Radiotherapy (VMAT), IMRT 5, 7, and 9 portals. The average difference of photoneutron dose was compared through descriptive statistics and variance analysis, and analyzed influence factors through correlation analysis and regression analysis. In summarized results, 3D-CRT showed the lowest average photoneutron dose, while IMRT caused the highest dose with statistically significance (p <.01). The photoneutron dose by number of portals of IMRT was $4.37{\pm}1.08mSv$ in average and statistically showed very significant difference among the number of portals (p <.01). Number of portals and photoneutron dose are shown that the correlation coefficient is 0.570, highly statistically significant positive correlation (p <.01). As a result of the linear regression analysis of number of portals and photoneutron dose, it showed that photoneutron dose significantly increased by 0.373 times in average as the number of portals increased by 1 stage. In conclusion, this study can be expected to be used as a quantitative basic data to select an appropriate IMRT plans regarding photoneutron dose in radiation treatment for prostate cancer.