• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.171-178
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• 2016

Purpose : In order to minimize the dose of femoral head as an appropriate treatment plan for rectal cancer radiation therapy, we compare and evaluate the usefulness of 3-field 3D conformal radiation therapy(below 3fCRT), which is a universal treatment method, and 5-field 3D conformal radiation therapy(below 5fCRT), and Volumetric Modulated Arc Therapy (VMAT). Materials and Methods : The 10 cases of rectal cancer that treated with 21EX were enrolled. Those cases were planned by Eclipse(Ver. 10.0.42, Varian, USA), PRO3(Progressive Resolution Optimizer 10.0.28) and AAA(Anisotropic Analytic Algorithm Ver. 10.0.28). 3fCRT and 5fCRT plan has $0^{\circ}$, $270^{\circ}$, $90^{\circ}$ and $0^{\circ}$, $95^{\circ}$, $45^{\circ}$, $315^{\circ}$, $265^{\circ}$ gantry angle, respectively. VMAT plan parameters consisted of 15MV coplanar $360^{\circ}$ 1 arac. Treatment prescription was employed delivering 54Gy to recum in 30 fractions. To minimize the dose difference that shows up randomly on optimizing, VMAT plans were optimized and calculated twice, and normalized to the target V100%=95%. The indexes of evaluation are D of Both femoral head and aceta fossa, total MU, H.I.(Homogeneity index) and C.I.(Conformity index) of the PTV. All VMAT plans were verified by gamma test with portal dosimetry using EPID. Results : D of Rt. femoral head was 53.08 Gy, 50.27 Gy, and 30.92 Gy, respectively, in the order of 3fCRT, 5fCRT, and VMAT treatment plan. Likewise, Lt. Femoral head showed average 53.68 Gy, 51.01 Gy and 29.23 Gy in the same order. D of Rt. aceta fossa was 54.86 Gy, 52.40 Gy, 30.37 Gy, respectively, in the order of 3fCRT, 5fCRT, and VMAT treatment plan. Likewise, Lt. Femoral head showed average 53.68 Gy, 51.01 Gy and 29.23 Gy in the same order. The maximum dose of both femoral head and aceta fossa was higher in the order of 3fCRT, 5fCRT, and VMAT treatment plan. C.I. showed the lowest VMAT treatment plan with an average of 1.64, 1.48, and 0.99 in the order of 3fCRT, 5fCRT, and VMAT treatment plan. There was no significant difference on H.I. of the PTV among three plans. Total MU showed that the VMAT treatment plan used 124.4MU and 299MU more than the 3fCRT and 5fCRT treatment plan, respectively. IMRT verification gamma test results for the VMAT plan passed over 90.0% at 2mm/2%. Conclusion : In rectal cancer treatment, the VMAT plan was shown to be advantageous in most of the evaluation indexes compared to the 3D plan, and the dose of the femoral head was greatly reduced. However, because of practical limitations there may be a case where it is difficult to select a VMAT treatment plan. 5fCRT has the advantage of reducing the dose of the femoral head as compared to the existing 3fCRT, without regard to additional problems. Therefore, not only would it extend survival time but the quality of life in general, if hospitals improved radiation therapy efficiency by selecting the treatment plan in accordance with the hospital's situation.

• Proceedings of the KSEEG Conference
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• 2001.05b
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• pp.42-63
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• 2001

The detail survey on the Songsanri tomb site including the Muryong royal tomb was carried out during the period from May 1 , 1996 to April 30, 1997. A quantitative analysis was tried to find changes of tomb itself since the excavation. Main subjects of the survey are to find out the cause of infiltration of rain water and groundwater into the tomb and the tomb site, monitoring of the movement of tomb structure and safety, removal method of the algae inside the tomb, and air controlling system to solve high humidity condition and dew inside the tomb. For these purposes, detail survery inside and outside the tombs using a electronic distance meter and small airplane, monitoring of temperature and humidity, geophysical exploration including electrical resistivity, geomagnetic, gravity and georadar methods, drilling, measurement of physical and chemical properties of drill core and measurement of groundwater permeability were conducted. We found that the center of the subsurface tomb and the center of soil mound on ground are different 4.5 meter and 5 meter for the 5th tomb and 7th tomb, respectively. The fact has caused unequal stress on the tomb structure. In the 7th tomb (the Muryong royal tomb), 435 bricks were broken out of 6025 bricks in 1972, but 1072 bricks are broken in 1996. The break rate has been increased about 250% for just 24 years. The break rate increased about 290% in the 6th tomb. The situation in 1996 is the result for just 24 years while the situation in 1972 was the result for about 1450 years. Status of breaking of bircks represents that a severe problem is undergoing. The eastern wall of the Muryong royal tomb is moving toward inside the tomb with the rate of 2.95 mm/myr in rainy season and 1.52 mm/myr in dry season. The frontal wall shows biggest movement in the 7th tomb having a rate of 2.05 mm/myr toward the passage way. The 6th tomb shows biggest movement among the three tombs having the rate of 7.44mm/myr and 3.61mm/myr toward east for the high break rate of bricks in the 6th tomb. Georadar section of the shallow soil layer represents several faults in the top soil layer of the 5th tomb and 7th tomb. Raninwater flew through faults tnto the tomb and nearby ground and high water content in nearby ground resulted in low resistance and high humidity inside tombs. High humidity inside tomb made a good condition for algae living with high temperature and moderate light source. The 6th tomb is most severe situation and the 7th tomb is the second in terms of algae living. Artificial change of the tomb environment since the excavation, infiltration of rain water and groundwater into the tombsite and bad drainage system had resulted in dangerous status for the tomb structure. Main cause for many problems including breaking of bricks, movement of tomb walls and algae living is infiltration of rainwater and groundwater into the tomb site. Therefore, protection of the tomb site from high water content should be carried out at first. Waterproofing method includes a cover system over the tomvsith using geotextile, clay layer and geomembrane and a deep trench which is 2 meter down to the base of the 5th tomb at the north of the tomv site. Decrease and balancing of soil weight above the tomb are also needed for the sfety of tomb structures. For the algae living inside tombs, we recommend to spray K101 which developed in this study on the surface of wall and then, exposure to ultraviolet light sources for 24 hours. Air controlling system should be changed to a constant temperature and humidity system for the 6th tomb and the 7th tomb. It seems to much better to place the system at frontal room and to ciculate cold air inside tombs to solve dew problem. Above mentioned preservation methods are suggested to give least changes to tomb site and to solve the most fundmental problems. Repairing should be planned in order and some special cares are needed for the safety of tombs in reparing work. Finally, a monitoring system measuring tilting of tomb walls, water content, groundwater level, temperature and humidity is required to monitor and to evaluate the repairing work.