• Journal of the Korean Society of Radiology
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• v.12 no.5
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• pp.583-592
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• 2018

In this study, plans to apply 3D conformal radiotherapy, intensity modulated radiotherapy, and volumetric intensity modulated arc radiotherapy to esophageal cancer radiotherapy were compared. In particular, arc therapy was applied to reduce irradiated volume and spread of low-dose during intensity modulated radiation therapy and volumetric intensity modulated arc radiotherapy by limiting part of irradiated angle, in order to compare target doses and dose for surrounding normal tissues of the two methods and those of 3D conformal radiotherapy. No significant difference in target dose was found among the three methods. The 5 Gy volume(V5) of the lung showed 56.53% of conformal radiotherapy, 52.03% of intensity modulated radiotherapy, and 47.84% of volumetric modulated arc therapy(CRT-IMRT p=0.035, CRT-VMAT p<0.001, IMRT-VMAT p<0.001). The 10 Gy volume(V10) showed a significant difference in conformal radiotherapy 35.12%, intensity modulated radiotherapy 34.04%, and volumetric modulated arc radiotherapy 33.28%, showing significant difference in intensity modulated radiotherapy(p=0.018), volumetric modulated arc therapy(p=0.035), no significant difference in dose was found at 20 Gy volume. The mean dose and 20 Gy volume of the heart were not significantly different according to the treatment plan, but the 30 and 40 Gy volumes were 37.16% and 22.46% in the volumetric modulated arc radiotherapy, showing significant differences(p=0.028) in comparison with conformal radiotherapy. It is believed that, by limiting part of the irradiated angle during intensity modulated radiotherapy and volumetric intensity modulated arc radiotherapy, the irradiated volume and, thereby, the 5-10 Gy area and toxicity of the lung can be reduced while maintaining dose distribution of the target dose.

• 대한방사선치료학회:학술대회논문집
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• 2001.06a
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• pp.15-15
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• 2001

• Radiation Oncology Journal
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• v.16 no.4
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• pp.455-467
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• 1998

Purpose : To evaluate influences associated with radiation treatment planning obtained with the patient breathing freely. Materials and Methods : We compared reduction or elimination of planning target volume (PTV) margins with 2-D conventional plan with inclusion of PTV margins associated with breathing with 3-D conformal therapy. The respiratory non gated 3-D conformal treatment plans were compared with respiratory gated conventional 2-D plans in 4 patients with hepatocellular carcinomas. Isodose distribution, dose statistics, and dose volume histogram (DVH) of PTVs were used to evaluate differences between respiratory gated conventional 2-D plans and respiratory non gated 3-D conformal treatment plans. In addition. the risk of radiation exposure of surrounding normal liver and organs are evaluated by means of DVH and normal tissue complication probabilities (NTCPs). Results : The vertical movement of liver ranged 2-3 cm in all patients. We found no difference between respiratory gated 2-D plans and 3-D conformal treatment plans with the patients breathing freely. Treatment planning using DVH analysis of PTV and the normal liver was used for all patients. DVH and calculated NTCP showed no difference in respiratory gated 2-D plans and respiratory non gated 3-D conformal treatment plans. Conclusion : Respiratory gated radiation therapy was very important in hepatic tumors because radiation induced hepatitis was dependent on remaining normal liver volume. Further investigational studies for respiratory gated radiation.

• Radiation Oncology Journal
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• v.19 no.1
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• pp.53-65
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• 2001

Purpose : To improve the local control of patients with nasopharyngeal cancer, we have implemented 3-D conformal radiotherapy and forward intensity modulated radiation therapy (IMRT) to used of compensating filters. Three dimension conformal radiotherapy with intensity modulation is a new modality for cancer treatments. We designed 3-D treatment planning with 3-D RTP (radiation treatment planning system) and evaluation dose distribution with tumor control probability (TCP) and normal tissue complication probability (NTCP). Material and Methods : We have developed a treatment plan consisting four intensity modulated photon fields that are delivered through the compensating tilters and block transmission for critical organs. We get a full size CT imaging including head and neck as 3 mm slices, and delineating PTV (planning target volume) and surrounding critical organs, and reconstructed 3D imaging on the computer windows. In the planning stage, the planner specifies the number of beams and their directions including non-coplanar, and the prescribed doses for the target volume and the permissible dose of normal organs and the overlap regions. We designed compensating filter according to tissue deficit and PTV volume shape also dose weighting for each field to obtain adequate dose distribution, and shielding blocks weighting for transmission. Therapeutic gains were evaluated by numerical equation of tumor control probability and normal tissue complication probability. The TCP and NTCP by DVH (dose volume histogram) were compared with the 3-D conformal radiotherapy and forward intensity modulated conformal radiotherapy by compensator and blocks weighting. Optimization for the weight distribution was peformed iteration with initial guess weight or the even weight distribution. The TCP and NTCP by DVH were compared with the 3-D conformal radiotherapy and intensitiy modulated conformal radiotherapy by compensator and blocks weighting. Results : Using a four field IMRT plan, we have customized dose distribution to conform and deliver sufficient dose to the PTV. In addition, in the overlap regions between the PTV and the normal organs (spinal cord, salivary grand, pituitary, optic nerves), the dose is kept within the tolerance of the respective organs. We evaluated to obtain sufficient TCP value and acceptable NTCP using compensating filters. Quality assurance checks show acceptable agreement between the planned and the implemented MLC(multi-leaf collimator). Conclusion : IMRT provides a powerful and efficient solution for complex planning problems where the surrounding normal tissues place severe constraints on the prescription dose. The intensity modulated fields can be efficaciously and accurately delivered using compensating filters.

• Progress in Medical Physics
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• v.14 no.2
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• pp.90-98
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• 2003

Purpose : A new virtual simulation technique for craniospinal irradiation (CSI) that uses a CT-simulator was developed to improve the accuracy of field and shielding placement as well as patient positioning. Materials and Methods : A CT simulator (CT-SIM) and a 3-D conformal radiation treatment planning system (3D-CRT) were used to develop CSI. The head and neck were immobilized with a thermoplastic mask while the rest of the body was immobilized with a Vac-Loc. A volumetric image was then obtained with the CT simulator. In order to improve the reproducibility of the setup, datum lines and points were marked on the head and body. Virtual fluoroscopy was performed with the removal of visual obstacles, such as the treatment table or immobilization devices. After virtual simulation, the treatment isocenters of each field were marked on the body and on the immobilization devices at the conventional simulation room. Each treatment fields was confirmed by comparing the fluoroscopy images with the digitally reconstructed radiography (DRR) and digitally composited radiography (DCR) images from virtual simulation. Port verification films from the first treatment were also compared with the DRR/DCR images for geometric verification. Results : We successfully performed virtual simulations on 11 CSI patients by CT-SIM. It took less than 20 minutes to affix the immobilization devices and to obtain the volumetric images of the entire body. In the absence of the patient, virtual simulation of all fields took 20 min. The DRRs were in agreement with simulation films to within 5 mm. This not only reducee inconveniences to the patients, but also eliminated position-shift variables attendant during the long conventional simulation process. In addition, by obtaining CT volumetric image, critical organs, such as the eyes and the spinal cord, were better defined, and the accuracy of the port designs and shielding was improved. Differences between the DRRs and the portal films were less than 3 m in the vertebral contour. Conclusion : Our analysis showed that CT simulation of craniospinal fields was accurate. In addition, CT simulation reduced the duration of the patient's immobility. During the planning process. This technique can improve accuracy in field placement and shielding by using three-dimensional CT-aided localization of critical and target structures. Overall, it has improved staff efficiency and resource utilization by standard protocol for craniospinal irradiation.

• Progress in Medical Physics
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• v.9 no.4
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• pp.227-245
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• 1998

A most appropriate model of 3-D conformal radiotherapy has been induced by clinical evaluation and animal study, and therapeutic gains were evaluated by numerical equation of tumor control probability(TCP) and normal tissue complication probability (NTCP). The radiation dose to the tumor and the adjacent normal organs was accurately evaluated and compared using the dose volume histogram(DVH). The TCP and NTCP was derived from the distribution of given dosage and irradiated volume, and these numbers were used as the biological index for the assessment of the treatment effects. Ten patients with liver disease have been evaluated and 3 dogs were sacrificed for this study. Based on the 3-D images of the tumor and adjacent organs, the optimum radiation dose and the projection direction which could maximize the radiation effect while minimizing the effects to the adjacent organs could be decided. 3). The most effective collimation for the normal adjacent organs was made through the beams eye view with the use of multileaf collimator. When the dose was increased from 50Gy to 70Gy, the TCP for the conventional 2-port radiation and the 5-port multidimensional therapy was 0.982 and 0.995 respectively, while the NTCP was 0.725 and 0.142 respectively, suggesting that the 3-D conformal radiotherapy might be the appropriate therapy to apply sufficient radiation dose to the tumor while minimizing the damages to the normal areas of the liver. Positive correlation was observed between the NTCP and the actual complication of the normal liver in the animal study. The present study suggest that the use of 3-D conformal radiotherapy and the application of the mathematical models of TCP and NTCP may provide the improvements in the treatment of hepatoma with enhanced results.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2005.04a
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• pp.11-15
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• 2005

입체조형 및 세기조절 방사선치료가 보편화되어 가고 있는 현 시점에서, 치료율을 높이기 위해 종양처방선량은 증가시키는 반면 부작용은 최소화하고자 하는 요구가 증가하고 있다. 셋업오차 및 체내운동(internal motion)은 이러한 요구를 충족시키는데 대한 한계로 작용하고 있다. 4차원방사선치료(4-dimensional radiation therapy)는 체내운동을 최소화시키거나 또는 움직임을 추적하여 방사선치료를 시행함으로써 “종양선량최대화/정상조직선량최소화”라는 고정밀방사선치료의 요구에 부응할 수 있는 치료기술로 기대를 모으고 있다. 체내운동은 호흡에 의한 움직임과 같이 단기적으로 발생되는 조사분할내(intra-fraction)와 종양의 수축, 체중 변화 등과 같이 장기적으로 발생하는 조사분할간(inter-fraction)움직임으로 구분되는데, 본 연제에서는 주로 조사분할내 움직임, 즉 호흡에 의한 움직임에 대처하는 4차원방사선치료를 위한 동적영상 획득 및 방사선치료계획과정에 초점을 맞추어 소개하고자 한다.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.287-296
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• 1997

Purpose : This is study of whether 3-D conformal radiotherapy for carcino-mas of the ethmoid sinus were better than those treated with conventional 2-D plan, Materials and Methods : The 3-D conformal treatment Plans were compared with conventional 2-D plans in 4 patients with malignancy of the ethmoid sinus. Isodose distribution, dose statistics, and dose volume histogram of the planning target volume were used to evaluate differences between 2-D and 3-D plans. In addition. the risk of radiation exposure of surrounding normal critical organs are evaluated by means of point dose calculation and dose volume histogram. Results : 3-D conformal treatment plans for each patient that the better tumor coverages by the planning target volume with improved dose homo-geneity, compared to 2-D conventional treatment Plans in the same Patient. On the other hand, the radiation dose distributions to the surrounding nor-mal tissue organs, such as the orbit and optic nerves are not significantly reduced with our technique, but a substantial sparing in the brain stem and optic chiasm for each patient. Conclusion : Our findings represented the potential advantage of 3-D treatment planning for dose homogeniety as well as sparing of the normal tissue surrounding the tumor. However, further investigational studies are required to define the clinical benefit.

• Journal of the Korean Society of Radiology
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• v.16 no.7
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• pp.857-862
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• 2022

The purpose of this study was to evaluate a three-dimensional conformal radiotherapy (3D-CRT) treatment plan with regard to head tilting in whole-brain radiotherapy (WBRT) using TomoDirect (TD) mode in Tomotherapy. WBRT 3D-CRT by TD was compared for a total of five head tilt angles (-20°, -10°, 0°. +10° and +20°). The dose homogeneity index (HI) and prescription dose index (CI) were calculated to confirm the target coverage. The maximum and average doses for critical organs such as the lens, eyeball and parotid glands were calculated for different angles of head tilting. The HI and CI were closet to the result value of 1 at the head tilted angle +10° and +20°. At a head tilted angle of +10°, the dose to the lens and eyeballs decreased by about 74% and about 30%, when compared with the reference angle (0°), respectively. The results of this study suggest that a head angle of +10 with chin-up would save adequate target coverage and reduce exposure dose to the lens.

• Journal of radiological science and technology
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• v.36 no.4
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• pp.327-335
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• 2013

This study investigates the case of clinical application for TomoDirect 3D-CRT(TD-3D) and TomoHelical 3D-CRT(TH-3D) with evaluating dose distribution for clinical application in each case. Treatment plans were created for 8 patients who had 3 dimensional conformal radiation therapy using TD-3D and TH-3D mode. Each patients were treated for sarcoma, CSI(craniospinal irradiaion), breast, brain, pancreas, spine metastasis, SVC syndrome and esophagus. DVH(dose volume histogram) and isodose curve were used for comparison of each treatment modality. TD-3D shows better dose distribution over the irradiation field without junction effect because TD-3D was not influenced by target length for sarcoma and CSI case. In breast case, dosimetric results of CTV, the average value of D 99%, D 95% were $49.2{\pm}0.4$ Gy, $49.9{\pm}0.4$ Gy and V 105%, V 110% were 0%, respectively. TH-3D with the dosimetric block decreased dose of normal organ in brain, pancreas, spine metastasis case. SCV syndrome also effectively decreased dose of normal organ by using dose block to the critical organs(spinal cord <38 Gy). TH-3D combined with other treatment modalities was possible to boost irradiation and was total dose was reduced to spinal cord in esophagus case(spinal cord <45 Gy, lung V 20 <20%). 3D-CRT using Tomotherapy could overcomes some dosimetric limitations, when we faced Conventional Linac based CRT and shows clinically proper dose distribution. In conclusion, 3D-CRT using Tomotherapy will be one of the effective 3D-CRT techniques.