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Radiation Therapy Using M3 Wax Bolus in Patients with Malignant Scalp Tumors (악성 두피 종양(Scalp) 환자의 M3 Wax Bolus를 이용한 방사선치료)

  • Kwon, Da Eun;Hwang, Ji Hye;Park, In Seo;Yang, Jun Cheol;Kim, Su Jin;You, Ah Young;Won, Young Jinn;Kwon, Kyung Tae
    • The Journal of Korean Society for Radiation Therapy
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    • v.31 no.1
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    • pp.75-81
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    • 2019
  • Purpose: Helmet type bolus for 3D printer is being manufactured because of the disadvantages of Bolus materials when photon beam is used for the treatment of scalp malignancy. However, PLA, which is a used material, has a higher density than a tissue equivalent material and inconveniences occur when the patient wears PLA. In this study, we try to treat malignant scalp tumors by using M3 wax helmet with 3D printer. Methods and materials: For the modeling of the helmet type M3 wax, the head phantom was photographed by CT, which was acquired with a DICOM file. The part for helmet on the scalp was made with Helmet contour. The M3 Wax helmet was made by dissolving paraffin wax, mixing magnesium oxide and calcium carbonate, solidifying it in a PLA 3D helmet, and then eliminated PLA 3D Helmet of the surface. The treatment plan was based on Intensity-Modulated Radiation Therapy (IMRT) of 10 Portals, and the therapeutic dose was 200 cGy, using Analytical Anisotropic Algorithm (AAA) of Eclipse. Then, the dose was verified by using EBT3 film and Mosfet (Metal Oxide Semiconductor Field Effect Transistor: USA), and the IMRT plan was measured 3 times in 3 parts by reproducing the phantom of the head human model under the same condition with the CT simulation room. Results: The Hounsfield unit (HU) of the bolus measured by CT was $52{\pm}37.1$. The dose of TPS was 186.6 cGy, 193.2 cGy and 190.6 cGy at the M3 Wax bolus measurement points of A, B and C, and the dose measured three times at Mostet was $179.66{\pm}2.62cGy$, $184.33{\pm}1.24cGy$ and $195.33{\pm}1.69cGy$. And the error rates were -3.71 %, -4.59 %, and 2.48 %. The dose measured with EBT3 film was $182.00{\pm}1.63cGy$, $193.66{\pm}2.05cGy$ and $196{\pm}2.16cGy$. The error rates were -2.46 %, 0.23 % and 2.83 %. Conclusions: The thickness of the M3 wax bolus was 2 cm, which could help the treatment plan to be established by easily lowering the dose of the brain part. The maximum error rate of the scalp surface dose was measured within 5 % and generally within 3 %, even in the A, B, C measurements of dosimeters of EBT3 film and Mosfet in the treatment dose verification. The making period of M3 wax bolus is shorter, cheaper than that of 3D printer, can be reused and is very useful for the treatment of scalp malignancies as human tissue equivalent material. Therefore, we think that the use of casting type M3 wax bolus, which will complement the making period and cost of high capacity Bolus and Compensator in 3D printer, will increase later.

New Trends in the Production of One Hundred Fans Paintings in the Late Joseon Period: The One Hundred Fans Painting in the Museum am Rothenbaum Kulturen und Künste der Welt in Germany and Its Original Drawings at the National Museum of Korea (조선말기 백선도(百扇圖)의 새로운 제작경향 - 독일 로텐바움세계문화예술박물관 소장 <백선도(百扇圖)>와 국립중앙박물관 소장 <백선도(百扇圖) 초본(草本)>을 중심으로 -)

  • Kwon, Hyeeun
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.96
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    • pp.239-260
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    • 2019
  • This paper examines the circulation and dissemination of painting during and after the nineteenth century through a case study on the One Hundred Fans paintings produced as decorative folding screens at the time. One Hundred Fans paintings refer to depictions of layers of fans in various shapes on which pictures of diverse themes are drawn. Fans and paintings on fans were depicted on paintings before the nineteenth century. However, it was in the nineteenth century that they began to be applied as subject matter for decorative paintings. Reflecting the trend of enjoying extravagant hobbies, fans and paintings on fans were mainly produced as folding screens. The folding screen of One Hundred Fans from the collection of the Museum am Rothenbaum Kulturen und Künste der Welt (hereafter Rothenbaum Museum) in Germany was first introduced to Korean in the exhibition The City in Art, Art in the City held at the National Museum of Korea in 2016. Each panel in this six-panel folding screen features more than five different fans painted with diverse topics. This folding screen is of particular significance since the National Museum of Korea holds the original drawings. In the nineteenth century, calligraphy and painting that had formerly been enjoyed by Joseon royal family members and the nobility in private spaces began to spread among common people and was distributed through markets. In accordance with the trend of adorning households, colorful decorative paintings were preferred, leading to the popularization of the production of One Hundred Fans folding screens with pictures in different shapes and themes. A majority of the Korean collection in the Rothenbaum Museum belonged to Heinrich Constantin Eduard Meyer(1841~1926), a German businessman who served as the Joseon consul general in Germany. From the late 1890s until 1905, Meyer traveled back and forth between Joseon and Germany and collected a wide range of Korean artifacts. After returning to Germany, he sequentially donated his collections, including One Hundred Fans, to the Rothenbaum Museum. Folding screens like One Hundred Fans with their fresh and decorative beauty may have attracted the attention of foreigners living in Joseon. The One Hundred Fans at the Rothenbaum Museum is an intriguing work in that during its treatment, a piece of paper with the inscription of the place name "Donghyeon" was found pasted upside down on the back of the second panel. Donghyeon was situated in between Euljiro 1-ga and Euljiro 2-ga in present-day Seoul. During the Joseon Dynasty, a domestic handicraft industry boomed in the area based on licensed shops and government offices, including the Dohwaseo (Royal Bureau of Painting), Hyeminseo (Royal Bureau of Public Dispensary), and Jangagwon (Royal Bureau of Music). In fact, in the early 1900s, shops selling calligraphy and painting existed in Donghyeon. Thus, it is very likely that the shops where Meyer purchased his collection of calligraphy and painting were located in Donghyeon. The six-panel folding screen One Hundred Fans in the collection of the Rothenbaum Museum is thought to have acquired its present form during a process of restoring Korean artifacts works in the 1980s. The original drawings of One Hundred Fans currently housed in the National Museum of Korea was acquired by the National Folk Museum of Korea between 1945 and 1950. Among the seven drawings of the painting, six indicate the order of their panels in the margins, which relates that the painting was originally an eight-panel folding screen. Each drawing shows more than five different fans. The details of these fans, including small decorations and patterns on the ribs, are realistically depicted. The names of the colors to be applied, including 'red ocher', 'red', 'ink', and 'blue', are written on most of the fans, while some are left empty or 'oil' is indicated on them. Ten fans have sketches of flowers, plants, and insects or historical figures. A comparison between these drawings and the folding screen of One Hundred Fans at the Rothenbaum Museum has revealed that their size and proportion are identical. This shows that the Rothenbaum Museum painting follows the directions set forth in the original drawings. The fans on the folding screen of One Hundred Fans at the Rothenbaum Museum are painted with images on diverse themes, including landscapes, narrative figures, birds and flowers, birds and animals, plants and insects, and fish and crabs. In particular, flowers and butterflies and fish and crabs were popular themes favored by nineteenth century Joseon painters. It is noteworthy that the folding screen One Hundred Fans at the Rothenbaum Museum includes several scenes recalling the typical painting style of Kim Hong-do, unlike other folding screens of One Hundred Fans or Various Paintings and Calligraphy. As a case in point, the theme of "Elegant Gathering in the Western Garden" is depicted in the Rothenbaum folding screen even though it is not commonly included in folding screens of One Hundred Fans or One Hundred Paintings due to spatial limitations. The scene of "Elegant Gathering in the Western Garden" in the Rothenbaum folding screen bears a resemblance to Kim Hong-do's folding screen of Elegant Gathering in the Western Garden at the National Museum of Korea in terms of its composition and style. Moreover, a few scenes on the Rothenbaum folding screen are similar to examples in the Painting Album of Byeongjin Year produced by Kim Hong-do in 1796. The painter who drew the fan paintings on the Rothenbaum folding screen is presumed to have been influenced by Kim Hong-do since the fan paintings of a landscape similar to Sainsam Rock, an Elegant Gathering in the Western Garden, and a Pair of Pheasants are all reminiscent of Kim's style. These paintings in the style of Kim Hong-do are reproduced on the fans left empty in the original drawings. The figure who produced both the original drawings and fan paintings appears to have been a professional painter influenced by Kim Hong-do. He might have appreciated Kim's Painting Album of Byeongjin Year or created duplicates of Painting Album of Byeongjin Year for circulation in the art market. We have so far identified about ten folding screens remaining with the One Hundred Fans. The composition of these folding screens are similar each other except for a slight difference in the number and proportion of the fans or reversed left and right sides of the fans. Such uniform composition can be also found in the paintings of scholar's accoutrements in the nineteenth century. This suggests that the increasing demand for calligraphy and painting in the nineteenth century led to the application of manuals for the mass production of decorative paintings. As the demand for colorful decorative folding screens with intricate designs increased from the nineteenth century, original drawings began to be used as models for producing various paintings. These were fully utilized when making large-scale folding screens with images such as Guo Ziyi's Enjoyment-of-Life Banquet, Banquet of the Queen Mother of the West, One Hundred Children, and the Sun, Cranes and Heavenly Peaches, all of which entailed complicated patterns. In fact, several designs repeatedly emerge in the extant folding screens, suggesting the use of original drawings as models. A tendency toward using original drawings as models for producing folding screens in large quantities in accordance with market demand is reflected in the production of the folding screens of One Hundred Fans filled with fans in different shapes and fan paintings on diverse themes. In the case of the folding screens of One Hundred Paintings, bordering frames are drawn first and then various paintings are executed inside the frames. In folding screens of One Hundred Fans, however, fans in diverse forms were drawn first. Accordingly, it must have been difficult to produce them in bulk. Existing examples are relatively fewer than other folding screens. As discussed above, the folding screen of One Hundred Fans at the Rothenbaum Museum and its original drawings at the National Museum of Korea aptly demonstrate the late Joseon painting trend of embracing and employing new painting styles. Further in-depth research into the Rothenbaum painting is required in that it is a rare example exhibiting the influence of Kim Hong-do compared to other paintings on the theme of One Hundred Fans whose composition and painting style are more similar to those found in the work of Bak Gi-jun.

Consideration on Shielding Effect Based on Apron Wearing During Low-dose I-131 Administration (저용량 I-131 투여시 Apron 착용여부에 따른 차폐효과에 대한 고찰)

  • Kim, Ilsu;Kim, Hosin;Ryu, Hyeonggi;Kang, Yeongjik;Park, Suyoung;Kim, Seungchan;Lee, Guiwon
    • The Korean Journal of Nuclear Medicine Technology
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    • v.20 no.1
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    • pp.32-36
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    • 2016
  • Purpose In nuclear medicine examination, $^{131}I$ is widely used in nuclear medicine examination such as diagnosis, treatment, and others of thyroid cancer and other diseases. $^{131}I$ conducts examination and treatment through emission of ${\gamma}$ ray and ${\beta}^-$ ray. Since $^{131}I$ (364 keV) contains more energy compared to $^{99m}Tc$ (140 keV) although it displays high integrated rate and enables quick discharge through kidney, the objective of this study lies in comparing the difference in exposure dose of $^{131}I$ before and after wearing apron when handling $^{131}I$ with focus on 3 elements of external exposure protection that are distance, time, and shield in order to reduce the exposure to technicians in comparison with $^{99m}Tc$ during the handling and administration process. When wearing apron (in general, Pb 0.5 mm), $^{99m}Tc$ presents shield of over 90% but shielding effect of $^{131}I$ is relatively low as it is of high energy and there may be even more exposure due to influence of scattered ray (secondary) and bremsstrahlung in case of high dose. However, there is no special report or guideline for low dose (74 MBq) high energy thus quantitative analysis on exposure dose of technicians will be conducted based on apron wearing during the handling of $^{131}I$. Materials and Methods With patients who visited Department of Nuclear Medicine of our hospital for low dose $^{131}I$ administration for thyroid cancer and diagnosis for 7 months from Jun 2014 to Dec 2014 as its subject, total 6 pieces of TLD was attached to interior and exterior of apron placed on thyroid, chest, and testicle from preparation to administration. Then, radiation exposure dose from $^{131}I$ examination to administration was measured. Total procedure time was set as within 5 min per person including 3 min of explanation, 1 min of distribution, and 1 min of administration. In regards to TLD location selection, chest at which exposure dose is generally measured and thyroid and testicle with high sensitivity were selected. For preparation, 74 MBq of $^{131}I$ shall be distributed with the use of $2m{\ell}$ syringe and then it shall be distributed after making it into dose of $2m{\ell}$ though dilution with normal saline. When distributing $^{131}I$ and administering it to the patient, $100m{\ell}$ of water shall be put into a cup, distributed $^{131}I$ shall be diluted, and then oral administration to patients shall be conducted with the distance of 1m from the patient. The process of withdrawing $2m{\ell}$ syringe and cup used for oral administration was conducted while wearing apron and TLD. Apron and TLD were stored at storage room without influence of radiation exposure and the exposure dose was measured with request to Seoul Radiology Services. Results With the result of monthly accumulated exposure dose of TLD worn inside and outside of apron placed on thyroid, chest, and testicle during low dose $^{131}I$ examination during the research period divided by number of people, statistics processing was conducted with Wilcoxon Signed Rank Test using SPSS Version. 12.0K. As a result, it was revealed that there was no significant difference since all of thyroid (p = 0.345), chest (p = 0.686), and testicle (p = 0.715) were presented to be p > 0.05. Also, when converting the change in total exposure dose during research period into percentage, it was revealed to be -23.5%, -8.3%, and 19.0% for thyroid, chest, and testicle respectively. Conclusion As a result of conducting Wilcoxon Signed Rank Test, it was revealed that there is no statistically significant difference (p > 0.05). Also, in case of calculating shielding rate with accumulate exposure dose during 7 months, it was revealed that there is irregular change in exposure dose for inside and outside of apron. Although the degree of change seems to be high when it is expressed in percentage, it cannot be considered a big change since the unit of accumulated exposure dose is in decimal points. Therefore, regardless of wearing apron during high energy low dose $^{131}I$ administration, placing certain distance and terminating the administration as soon as possible would be of great assistance in reducing the exposure dose. Although this study restricted $^{131}I$ administration time to be within 5 min per person and distance for oral administration to be 1m, there was a shortcoming to acquire accurate result as there was insufficient number of N for statistics and it could be processed only through non-parametric method. Also, exposure dose per person during lose dose $^{131}I$ administration was measured with accumulated exposure dose using TLD rather than through direct-reading exposure dose thus more accurate result could be acquired when measurement is conducted using electronic dosimeter and pocket dosimeter.

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