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Comparison and evaluation between 3D-bolus and step-bolus, the assistive radiotherapy devices for the patients who had undergone modified radical mastectomy surgery (변형 근치적 유방절제술 시행 환자의 방사선 치료 시 3D-bolus와 step-bolus의 비교 평가)

  • Jang, Wonseok;Park, Kwangwoo;Shin, Dongbong;Kim, Jongdae;Kim, Seijoon;Ha, Jinsook;Jeon, Mijin;Cho, Yoonjin;Jung, Inho
    • The Journal of Korean Society for Radiation Therapy
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    • v.28 no.1
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    • pp.7-16
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    • 2016
  • Purpose : This study aimed to compare and evaluate between the efficiency of two respective devices, 3D-bolus and step-bolus when the devices were used for the treatment of patients whose chest walls were required to undergo the electron beam therapy after the surgical procedure of modified radical mastectomy, MRM. Materials and Methods : The treatment plan of reverse hockey stick method, using the photon beam and electron beam, had been set for six breast cancer patients and these 6 breast cancer patients were selected to be the subjects for this study. The prescribed dose of electron beam for anterior chest wall was set to be 180 cGy per treatment and both the 3D-bolus, produced using 3D printer(CubeX, 3D systems, USA) and the self-made conventional step-bolus were used respectively. The surface dose under 3D-bolus and step-bolus was measured at 5 measurement spots of iso-center, lateral, medial, superior and inferior point, using GAFCHROMIC EBT3 film (International specialty products, USA) and the measured value of dose at 5 spots was compared and analyzed. Also the respective treatment plan was devised, considering the adoption of 3D-bolus and stepbolus and the separate treatment results were compared to each other. Results : The average surface dose was 179.17 cGy when the device of 3D-bolus was adopted and 172.02 cGy when step-bolus was adopted. The average error rate against the prescribed dose of 180 cGy was -(minus) 0.47% when the device of 3D-bolus was adopted and it was -(minus) 4.43% when step-bolus was adopted. It was turned out that the maximum error rate at the point of iso-center was 2.69%, in case of 3D-bolus adoption and it was 5,54% in case of step-bolus adoption. The maximum discrepancy in terms of treatment accuracy was revealed to be about 6% when step-bolus was adopted and to be about 3% when 3D-bolus was adopted. The difference in average target dose on chest wall between 3D-bolus treatment plan and step-bolus treatment plan was shown to be insignificant as the difference was only 0.3%. However, to mention the average prescribed dose for the part of lung and heart, that of 3D-bolus was decreased by 11% for lung and by 8% for heart, compared to that of step-bolus. Conclusion : It was confirmed through this research that the dose uniformity could be improved better through the device of 3D-bolus than through the device of step-bolus, as the device of 3D-bolus, produced in consideration of the contact condition of skin surface of chest wall, could be attached to patients' skin more nicely and the thickness of chest wall can be guaranteed more accurately by the device of 3D-bolus. It is considered that 3D-bolus device can be highly appreciated clinically because 3D-bolus reduces the dose on the adjacent organs and make the normal tissues protected, while that gives no reduction of dose on chest wall.

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Perception of University Students on Nutrition Information According to Food & Nutrition Labeling Systems in Family Restaurant (패밀리 레스토랑의 영양표시제도 시행에 따른 대학생들의 영양정보에 관한 인식 연구)

  • Yang, Jung-Hwa;Heo, Young-Ran
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.42 no.12
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    • pp.2068-2075
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    • 2013
  • The purpose of this study is to investigate the perception of university students on nutritional information according to food and nutrition labeling systems. A total of 310 customers, who visited family restaurant, were surveyed by a self-recorded questionnaire from March 2006 to April 2011. A total of 286 respondents were surveyed; of the respondents, 108 were males and 178 were females. Two surveys were conducted on the perception of the respondent's health: once in 2006 and once in 2011. According to these surveys, 63.6% and 54% of respondents perceived themselves as unhealthy, respectively. When ordering a meal, respondents were more concerned with price rather than taste, nutrition, new menu items, and food presentation. Compared with 2006, in 2011 more respondents felt that family restaurants provided enough nutritional information and practical use of that information to their customers. When surveyed, respondents felt that the total calories played a significantly higher role in ordering food than foods with higher nutritional values. There was a significant increase in satisfaction with the current nutrition labeling system; in 2006, $2.87{\pm}0.99$, and 2011, $3.35{\pm}0.84$. There was also a significant increase in individuals who felt that there was a need for an ingredient labeling system; $3.68{\pm}0.9$ in 2006 and $4.32{\pm}0.61$ in 2011. There was also a higher demand for nutritional information; $2.85{\pm}0.66$ in 2006, $3.06{\pm}0.65$ in 2011. From these results, it was concluded that the nutrition labeling system adopted by family restaurants did not affect the degree of customers' interest in nutritional information. Contrast to the results, the amount and frequency of nutritional information provided to customers have increased continuously since 2006. Therefore, the nutrition labeling system and recommended dietary allowance should be expanded in order to promote a healthy diet.

Characterization of Traits Related to Grain Shape in Korean Rice Varieties (국내 육성 벼 품종 입형 관련 특성 분석)

  • Lee, Chang-Min;Lee, Keon-Mi;Baek, Man-Kee;Kim, Woo-Jae;Suh, Jung-Pil;Jeong, Oh-Young;Cho, Young-Chan;Park, Hyun-Su;Kim, Suk-Man
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.65 no.3
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    • pp.199-213
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    • 2020
  • Grain size and shape are the two important components contributing to rice yield and quality. To analyze traits related to grain-shape, a total of 272 varieties derived from japonica, japonica black and Tongil-type rice accession in Korea were evaluated in this study. The traits, grain length (GL), grain width (GW), grain thickness (GT), length to width ratio (RLW), and 1000-grain weight (TGW) were measured and replicated 10 times. Genes (GW2, GS3, qGL3, qSW5, GS5, TGW6, GW7, and GW8) related to grain-shape were validated in the accessions using specific DNA marker sets. K-mean clustering of the accession based on phenotypic data revealed three groups: group 1 was classified by GW and GT and included most of japonica type, group 2 was classified by RLW and GL reached a medium size and possessed a half spindle-shaped type, and group 3 was classified by TGW, reached a long size and possessed a semi-round shape. In validation tests using the marker sets, both gw2 and tgw6 were validated in less than 1% of the tested accessions and two allelic types, qgl3 and gw8, were only verified in Tongil-type accessions. For GW8 and GW2, any different amplicons were not amplified in any japonica or Tongil-type accessions, respectively. In order to suggest the representative grain-shape gene combinations for each ecotype, the allelic combinations were evaluated by PCR analysis. Cj1 and 2 in japonica (Cj1-7), Cj_b1 and 2 in japonica-black (Cj_b1-3), and CT3 in Tongil-type (CT1-13) turned out to be the dominant combination in each ecotype, respectively. In addition, the results revealed that introgression of four genes (gw2, gs3, qSW5, and GS5) would expand the diversity of grain shape in Korean japonica varieties. The gene combinations information could be utilized practically to understand or enhance grain shape in japonica rice breeding program.

Clinical Study of Tuberculous Meningitis in Children (소아 결핵성 뇌막염의 임상적 고찰)

  • Kim, Woo Sik;Kim, Jong Hyun;Kim, Dong Un;Lee, Won Bae;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.4 no.1
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    • pp.64-72
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    • 1997
  • Purpose : The incidence of tuberculous meningitis in Korean children has been markedly decreased after 1980s, but this disease has still occurred with low rate. Therefore, it may be suspected that delayed diagnosis and treatment will be happened because of lacking of clinical experiences and indistinguishable other meningitis, so it is important to make early diagnosis and treatment of tuberculous meningitis concerning with the prognosis. In this aspect, we conducted study to concern and investigate sustainly about the diagnostic criteria, clinical characteristics, radiological findings, complications, and prognosis of typical or atypical tuberculous meningitis in children. Methods : Forty four children who were hospitalized and treated due to tuberculous meningitis in pediatric wards of Our Lady of Mercy Hospital, St. Holy Hospital, St. Vincent Hospital and Uijungbu St. Mary Hospital from January 1985 to June 1996 were included in this study. We reviewed medical records of these patients retrospectively. Results : 1) The tuberculous meningitis has occured continuosly since mid-1980s. The highest 2) The diagnosis was made by contact history of active tuberculous patients, positive tuberculin test, responses of antituberculous antibiotics and discovery of Mycobacterium tuberculosis from CSF or other specimens. Among patients, 7 children(16%) were not vaccinated with BCG, and only 18 children(40%) were positive in tuberculin test. 3) The symptoms and signs of our patients on initial examinations were fever, vomiting, headache, lethargy, poor feeding, weight loss, neck stiffness, convulsion, abdominal pain and motor deficits. 4) The findings of initial CSF samples revealed leukocyte $239.5/mm^3$(mean) with lymphocyte predominant, elevated protein levels(mean;259.5mg%) and low sugar level(mean;40.7mg%). And the ratio of CSF/blood sugar was 0.407. But, atypical CSF findings were seen in 31.8% patients. 5) On brain imaging study, 34 out of 39 children had findings of hydrocephalus, basilar meningeal enhancement, infarction and subarachnoidal inflammations etc. On chest X-ray, the findings of miliary tuberculosis(34.1%), normal finding(29.5%), parenchymal infiltrations (11.4%) and calcifications(9.1%) were showed. 6) In neurological clinical stage, there were twenty-six children(59%) in stage 1, fourteen children(32%) in stage 2 and four children(9%) in stage 3. The late sequeles were encountered by 29.5% with mild and 4.6% with severe neurological injury. The most common neurological injury was quadriplegia and the mortality rate was 6.8%. 7) The SIADH was developed in 20 children(45.5%) after the 4th hospital day. Half of all SIADH patients were symptomatic. Conclusion : Tuberculosis meningitis is still an important extrapulmonary disease with high morbidity and mortality. Early diagnosis with clinical contact history of active tuberculosis and radiological imaging examinations and early treatments are essential in order to prevent and decrase the rate of late sequeles and death.

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The 1998, 1999 Patterns of Care Study for Breast Irradiation after Mastectomy in Korea (1998, 1999년도 우리나라에서 시행된 근치적 유방 전절제술 후 방사선치료 현황 조사)

  • Keum,, Ki-Chang;Shim, Su-Jung;Lee, Ik-Jae;Park, Won;Lee, Sang-Wook;Shin, Hyun-Soo;Chung, Eun-Ji;Chie, Eui-Kyu;Kim, Il-Han;Oh, Do-Hoon;Ha, Sung-Whan;Lee, Hyung-Sik;Ahn, Sung-Ja
    • Radiation Oncology Journal
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    • v.25 no.1
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    • pp.7-15
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    • 2007
  • [ $\underline{Purpose}$ ]: To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. $\underline{Materials\;and\;Methods}$: A web- based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. $\underline{Results}$: The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was $45{\sim}59.4\;Gy$ (median 50.4 Gy), to the SCL was $45{\sim}59.4\;Gy$ (median 50.4 Gy), and to the PAB was $4.8{\sim}38.8\;Gy$, (median 9 Gy) $\underline{Conclusion}$: Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.

Operative Treatment of Congenitally Corrected Transposition of the Great Arteries(CCTGA) (교정형 대혈관 전위증의 수술적 치료)

  • 이정렬;조광리;김용진;노준량;서결필
    • Journal of Chest Surgery
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    • v.32 no.7
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    • pp.621-627
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    • 1999
  • Background: Sixty five cases with congenitally corrected transposition of the great arteries (CCTGA) indicated for biventricular repair were operated on between 1984 and september 1998. Comparison between the results of the conventional(classic) connection(LV-PA) and the anatomic repair was done. Material and Method: Retrospective review was carried out based on the medical records of the patients. Operative procedures, complications and the long-term results accoding to the combining anomalies were analysed. Result: Mean age was 5.5$\pm$4.8 years(range, 2 months to 18years). Thirty nine were male and 26 were female. Situs solitus {S,L,L} was in 53 and situs inversus{I,D,D} in 12. There was no left ventricular outflow tract obstruction(LVOTO) in 13(20%) cases. The LVOTO was resulted from pulmonary stenosis(PS) in 26(40%)patients and from pulmonary atresia(PA) in 26(40%) patients. Twenty-five(38.5%) patients had tricuspid valve regurgitation(TR) greater than the mild degree that was present preoperatively. Twenty two patients previously underwent 24 systemic- pulmonary shunts previously. In the 13 patients without LVOTO, 7 simple closure of VSD or ASD, 3 tricuspid valve replacements(TVR), and 3 anatomic corrections(3 double switch operations: 1 Senning+ Rastelli, 1 Senning+REV-type, and 1 Senning+Arterial switch opera tion) were performed. As to the 26 patients with CCTGA+VSD or ASD+LVOTO(PS), 24 classic repairs and 2 double switch operations(1 Senning+Rastelli, 1 Mustard+REV-type) were done. In the 26 cases with CCTGA+VSD+LVOTO(PA), 19 classic repairs(18 Rastelli, 1 REV-type), and 7 double switch operations(7 Senning+Rastelli) were done. The degree of tricuspid regurgitation increased during the follow-up periods from 1.3$\pm$1.4 to 2.2$\pm$1.0 in the classic repair group(p<0.05), but not in the double switch group. Two patients had complete AV block preoperatively, and additional 7(10.8%) had newly developed complete AV block after the operation. Other complications were recurrent LVOTO(10), thromboembolism(4), persistent chest tube drainage over 2 weeks(4), chylothorax(3), bleeding(3), acute renal failure(2), and mediastinitis(2). Mean follow-up was 54$\pm$49 months(0-177 months). Thirteen patients died after the operation(operative mortality rate: 20.0%(13/65)), and there were 3 additional deaths during the follow up period(overall mortality: 24.6%(16/65)). The operative mortality in patients underwent anatomic repair was 33.3%(4/12). The actuarial survival rates at 1, 5, and 10 years were 75.0$\pm$5.6%, 75.0$\pm$5.6%, and 69.2$\pm$7.6%. Common causes of death were low cardiac output syndrome(8) and heart failure from TR(5). Conclusion: Although our study could not demonstrate the superiority of each classic or anatomic repair, we found that the anatomic repair has a merit of preventing the deterioration of tricuspid valve regurgitations. Meticulous selection of the patients and longer follow-up terms are mandatory to establish the selective advantages of both strategies.

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Security and Safety Assessment of the Small-scale Offshore CO2 Storage Demonstration Project in the Pohang Basin (포항분지 해상 중소규모 CO2 지중저장 실증연구 안전성 평가)

  • Kwon, Yi Kyun;Chang, Chandong;Shinn, Youngjae
    • The Journal of Engineering Geology
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    • v.28 no.2
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    • pp.217-246
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    • 2018
  • During the selection and characterization of target formations in the Small-scale Offshore $CO_2$ Storage Demonstration Project in the Pohang Basin, we have carefully investigated the possibility of induced earthquakes and leakage of $CO_2$ during the injection, and have designed the storage processes to minimize these effects. However, people in Pohang city have a great concern on $CO_2$-injection-intrigued seismicity, since they have greatly suffered from the 5.4 magnitude earthquake on Nov. 15, 2017. The research team of the project performed an extensive self-investigation on the safety issues, especially on the possible $CO_2$ leakage from the target formation and induced earthquakes. The target formation is 10 km apart from the epicenter of the Pohang earthquake and the depth is also quite shallow, only 750 to 800 m from the sea bottom. The project performed a pilot injection in the target formation from Jan. 12 to Mar. 12, 2017, which implies that there are no direct correlation of the Pohang earthquake on Nov. 15, 2017. In addition, the $CO_2$ injection of the storage project does not fracture rock formations, instead, the supercritical $CO_2$ fluid replaces formation water in the pore space gradually. The self-investigation results show that there is almost no chance for the injection to induce significant earthquakes unless injection lasts for a very long time to build a very high pore pressure, which can be easily monitored. The amount of injected $CO_2$ in the project was around 100 metric-tonne that is irrelevant to the Pohang earthquake. The investigation result on long-term safety also shows that the induced earthquakes or the reactivation of existing faults can be prevented successfully when the injection pressure is controlled not to demage cap-rock formation nor exceed Coulomb stresses of existing faults. The project has been performing extensive studies on critical stress for fracturing neighboring formations, reactivation stress of existing faults, well-completion processes to minimize possible leakage, transport/leakage monitoring of injected $CO_2$, and operation procedures for ensuring the storage safety. These extensive studies showed that there will be little chance in $CO_2$ leakage that affects human life. In conclusion, the Small-scale Offshore $CO_2$ Storage Demonstration Project in the Pohang Basin would not cause any induced earthquakes nor signifiant $CO_2$ leakage that people can sense. The research team will give every effort to secure the safety of the storage site.

Study of Animation 3-Dimensional Motion Picture (애니메이션 입체 영화에 대한 연구)

  • Min, Kyung-Mi
    • Cartoon and Animation Studies
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    • s.9
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    • pp.127-142
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    • 2005
  • Not only in Korea but throughout the entire world millions of people are in contact with images. Images have become a medium through which to transmit anything from simple visualizations of moving images to knowledge and information. The age of the internet has arisen thanks to scientific development, and the internet generation's acquisition of information is continuously becoming faster. The spectators, ufo must choose amongst the excessive amount of available information, are changing along with it just as quickly. The method of visual transmission has changed to match the demands of the fast-changing pace of the new generation. In order to receive an instantaneous selection amongst much information, the primary requisite is attracting one's attention, and then presenting a corresponding feeling of satisfaction. The early stages of film arose from the desire to capture one's actual situation as it realty is. Unsatisfied with the still picture, people developed the motion picture. Research has succeeded in reproducing 3-dimensional images more realistic than the actual image we perceive as a result of the difference in visual perspective of both eyes and their response to rays of light From color film to 3-dimensional pictures, people enjoy the magnificent results of this. All fields within the category of film are continuously studying the human desire to pursue their visual side, namely the pursuit of visual images with a maximum sense of reality. The images that millions of people around the world see now are flat. The screen's depth and optical illusions effectively give a sense of reality while conveying information. However, although the flat screen is able to create a sense of depth using the different visual perspective of each eye for the realization of a cubic effect, there are limitations. Entering the 21s1 century, there is a quickly-arising branch within the field of image media which seeks to overcome these limitations Although 3-dimensional images began in films, entering the latter half of the 20th century, due to development of 3-dimensional images using the mediums of the animation field, cellular phones, advertisement screens, television etc., without restriction is designated as 'image.'. With research having started around 1900 and continuing for over 100 years, we are now able to witness the popularization of 3-dimensional films happening before our very eyes. Within our own country, we can frequently see them at amusement parks and museums. In the future, through the popularization of HDTV etc., there is a good outlook for practical use of 3-dimensional images in televisions with advanced picture qualify as well as in other areas. Together with the international current, research on 3-dimensional films has been activated in Korea and is rising as a main current in the film industry. Within this context, the contents and understanding of 3-dimensional images must keep in step with the pace of technical advancements. In order to accelerate of development of film contents to keep in pace with technical developments, this dissertation presents the techniques and technical aspects of future developments, and shows the need to prepare in advance to make the field grow- and thereby avoid having a lack of experts and being conquered by other nations in the field - rather than only advancing the technical aspects and importing the contents. This dissertation aims to stimulate interest and continual research by progressive-thinking people related to the film industry. Part II looks into the definition and types of 3-dimensional motion pictures, the terminology, the fundamentals of image formation, current market fluctuations, and looks into 3-dimensional techniques which can be borrowed and introduced in 3-dimensional animations. Part III concerns 3-dimensional animated films. It analyzes 3-dimensional production techniques while using the introduction of specific animation techniques in the 2004 production Lee Sun Shin and Nelson - Naval Heroes 3-dimensional animation produced in 2004 by Clay & Puppet Stop-Motion Animation & Computer Graphic. Original Korean title: 해전영웅 이순신과 넬슨. as an example, and it also looks into how current film techniques used in animations can be applied in 3-dimensional films. Additionally, the actual stages of the various fields of 3-dimensional animations are presented. Given the current direction and advancement of 3-dimensional films making use of animations and the possible realization of this field, the author plans to weigh the development of this yet unexploited new market Not looking at the current progress of the field, but rather the direction of the hypothetical types of animation techniques, the author predicts the marketability and possibility of development of each area.

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Detoxification of PSP and relationship between PSP toxicity and Protogonyaulax sp. (마비성패류독의 제독방법 및 패류독성과 원인플랑크톤과의 관계에 관한 연구)

  • CHANG Dong-Suck;SHIN Il-Shik;KIM Ji-Hoe;PYUN Jae-hueung;CHOE Wi-Kung
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.22 no.4
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    • pp.177-188
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    • 1989
  • The purpose of this study was to investigate the detoxifying effect on PSP-infested sea mussel, Mytilus edulis, by heating treatment and correlation between the PSP toxicity and the environmental conditions of shellfish culture area such as temperature, pH, salinity, density of Protogonyaulax sp. and concentration of inorganic nutrients such as $NH_4-N,\;NO_3-N,\;NO_2-N\;and\;PO_4-P$. This experiment was carried out at $Suj\u{o}ng$ in Masan, Yangdo in Jindong, $Hach\u{o}ng\;in\;K\u{o}jedo\;and\;Gamch\u{o}n$ bay in Pusan from February to June in $1987\~1989$. It was observed that the detection ratio and toxicity of PSP in sea mussel were different by the year even same collected area. The PSP was often detected when the temperature of sea water about $8.0\~14.0^{\circ}C$. Sometimes the PSP fox of sea mussel was closely related to density of Protogonyaulax sp. at $Gamch\u{o}n$ bay in Pusan from March to April in 1989, but no relationship was observed except above duration during the study period. The concentration of inorganic nutrients effects on the growth of Protogonyaulax sp., then effects of $NO_3-N$ was the strongest among them. When the PSP-infested sea mussel homogenate was heated at various temperature, the PSP toxicity was not changed significantly at below $70^{\circ}C$ for 60 min. but it was proper-tionaly decreased as the heating temperature was increased. For example, when the sea mussel homogenate was heated at $100^{\circ}C,\;121^{\circ}C$ for 10 min., the toxicity was decreased about $67\%\;and\;90\%$, respectively. On the other hand, when shellstock sea mussel contained PSP of $150{\mu}g/100g$ was boiled at $100^{\circ}C$ for 30 min. with tap water, the toxicity was not detected by mouse assay, but that of PSP of $5400{\mu}g/100g$ was reduced to $57{\mu}g/100g$ even after boiling for 120 min.

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Usefulness of Non-coplanar Helical Tomotherapy Using Variable Axis Baseplate (Variable Axis Baseplate를 이용한 Non-coplanar 토모테라피의 유용성)

  • Ha, Jin-Sook;Chung, Yoon-Sun;Lee, Ik-Jae;Shin, Dong-Bong;Kim, Jong-Dae;Kim, Sei-Joon;Jeon, Mi-Jin;Cho, Yoon-Jin;Kim, Ki-Kwang;Lee, Seul-Bee
    • The Journal of Korean Society for Radiation Therapy
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    • v.23 no.1
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    • pp.31-39
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    • 2011
  • Purpose: Helical Tomotherapy allows only coplanar beam delivery because it does not allow couch rotation. We investigated a method to introduce non-coplanar beam by tilting a patient's head for Tomotherapy. The aim of this study was to compare intrafractional movement during Tomotherapy between coplanar and non-coplanar patient's setup. Materials and Methods: Helical Tomotherapy was used for treating eight patients with intracranial tumor. The subjects were divided into three groups: one group (coplanar) of 2 patients who lay on S-plate with supine position and wore thermoplastic mask for immobilizing the head, second group (non-coplanar) of 3 patients who lay on S-plate with supine position and whose head was tilted with Variable Axis Baseplate and wore thermoplastic mask, and third group (non-coplanar plus mouthpiece) of 3 patients whose head was tilted and wore a mouthpiece immobilization device and thermoplastic mask. The patients were treated with Tomotherapy after treatment planning with Tomotherapy Planning System. Megavoltage computed tomography (MVCT) was performed before and after treatment, and the intrafractional error was measured with lateral(X), longitudinal(Y), vertical(Z) direction movements and vector ($\sqrt{x^2+y^2+z^2}$) value for assessing overall movement. Results: Intrafractional error was compared among three groups by taking the error of MVCT taken after the treatment. As the correction values (X, Y, Z) between MVCT image taken after treatment and CT-simulation image are close to zero, the patient movement is small. When the mean values of movement of each direction for non-coplanar setup were compared with coplanar setup group, X-axis movement was decreased by 13%, but Y-axis and Z-axis movement were increased by 109% and 88%, respectively. Movements of Y-axis and Z-axis with non-coplanar setup were relatively greater than that of X-axis since a tilted head tended to slip down. The mean of X-axis movement of the group who used a mouthpiece was greater by 9.4% than the group who did not use, but the mean of Y-axis movement was lower by at least 64%, and the mean of Z-axis was lower by at least 67%, and the mean of Z-axis was lower by at least 67%, and the vector was lower by at least 59% with the use of a mouthpiece. Among these 8 patients, one patient whose tumor was located on left frontal lobe and left basal ganglia received reduced radiation dose of 38% in right eye, 23% in left eye, 30% in optic chiasm, 27% in brain stem, and 8% in normal brain with non-coplanar method. Conclusion: Tomotherapy only allows coplanar delivery of IMRT treatment. To complement this shortcoming, Tomotherapy can be used with non-coplanar method by artificially tilting the patient's head and using an oral immobilization instrument to minimize the movement of patient, when intracranial tumor locates near critical organs or has to be treated with high dose radiation.

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