• Journal of the Korean Society of Radiology
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• v.7 no.4
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• pp.259-264
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• 2013

Total body irradiation in the treatment of childhood leukemia, which is one of the pre-treatment with stem cell transplantation is being used, the current organization using compensators are treated. However, under the terms of the compensator organization long-term impact on the human body, it is difficult to assess directly. In this study, we use the mathematical simulation of radiation exposures body energy and the distance to the crew and the patient (source surface distance, SSD), and patients with tissue compensators change of the distance along the body of the organ doses were evaluated. As a result, the surface dose of energy 4 MV, SSD 280 cm, tissue compensators and the patient when the distance 30 cm 5.84 G / min showed the highest levels. In addition, patients with tissue compensators and the distance apart when 30 cm TBI represents the ideal dose distribution was found.

• Radiation Oncology Journal
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• v.15 no.2
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• pp.167-174
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• 1997

Purpose : The main Purpose of this study is to develop new payment rates for services of Radiation Oncology, considering costs of treating patients. Material and Methods : A survey of forty hospitals has been conducted in order to analyze the costs of treating patients. Before conducting the survey, we evaluated and reclassified the individual service items currently using as Payments units on the fee-for-service reimbursement system. This study embodies the analysis of replies received from the twenty four hospitals. The survey contains informations about the hospitals' costs of 1995 for the reclassified service items on Radiation Oncology. After we adjust the hospital costs by the operating rate of medical equipment, we compare the adjusted costs with the current Payment rates of individual services. Results : The current payment rates were 5.05-6.58 times lower than the adjusted costs in treatment planning services, 2.22 times lower in block making service, 1.57-2.86 times lower in external beam irradiation services, 3.82-5.01 times lower in intracavitary and interstitial irradiation and 1.12-2.55 times lower in total body irradiation. Conclusion : We could conclude that the current payment system on Radiation Oncology does not only reflect the costs of treating patients appropriately but also classify the service items correctly. For an example, when the appropriate costs and classification are applied to TBI, the payment rates of TBI should be increased five times more than current level.

• Radiation Oncology Journal
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• v.20 no.3
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• pp.253-263
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• 2002

Purpose : In order to understand in vivo radiation damage modifying of bFGF on jejunal mucosa, bone marrow and the effect of bFGF on the growth of transplanted mouse sarcoma 180 tumor in mice. Materials and Methods : Mice were treated with $6\;{\mu}g$ of bFGF at 24 hours and 4 hours before exposing to 600 cGy, 800 cGy and 1,000 cGy total body irradiation (TBI), and then exposed to 3,000 cGy local radiation therapy on the tumor bearing thigh. Survival and tumor growth curve were plotted in radiation alone group and combined group of bFGF and irradiation (RT). Histologic examination was performed in another experimental group. Experimental groups consisted of normal control, tumor control, RT (radiation therapy) alone, $6\;{\mu}g$ bFGF alone, combined group of $3\;{\mu}g$ bFGF and irradiation (RT), combined group of $6\;{\mu}g$ bFGF and irradiation (RT). Histologic examination was peformed with H-E staining in marrow, jejunal mucosa, lung and sarcoma 180 bearing tumor. Radiation induced apoptosis was determined in each group with the DNA terminal transferase nick-end labeling method ($ApopTag^{\circledR}$ S7100-kit, Intergen Co.) Results : The results were as follows 1) $6\;{\mu}g$ bFGF given before TBI significantly improved the survival of lethally irradiated mice. bFGF would protect against lethal bone marrow syndrome. 2) $6\;{\mu}g$ bFGF treated group showed a significant higher crypt depth and microvilli length than RT alone group (p<0.05). 3) The bone marrow of bFGF treated group showed less hypocellularity than radiation alone group on day 7 and 14 after TBI (p<0.05), and this protective effect was more evident in $6\;{\mu}g$ bFGF treated group than that of $3\;{\mu}g$ bFGF treated group. 4) bFGF protected against early radiation induced apoptosis in intestinal crypt cell but might have had no antiapoptotic effect in bone marrow stem cell and pulmonary endothelial cells. 5) There was no significant differences in tumor growth rate between tumor control and bFGF alone groups (p>0.05). 6) There were no significant differences in histopathologic findings of lung and mouse sarcoma 180 tumor between radiation alone group and bFGF treated group. Conclusions : Our results suggest that bFGF protects small bowel and bone marrow from acute radiation damage without promoting the inoculated tumor growth in C3H mice. Improved recovery of early responding normal tissue and reduced number of radiation induced apoptosis may be possible mechanism of radioprotective effect of bFGF.

• Journal of the Korean Society of Radiology
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• v.8 no.5
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• pp.265-269
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• 2014

The therapy of total body irradiation on leukemia carries out to kill harmful bacteria or suppression of immune system by external beam therapy, which is a preparatory stage to reconstitute bone marrow before a pre-treatment of bone marrow transplantation to patients with health bone marrow cells. In case of this kind of radiation therapy, the spoiler use to increase surface dose of patient which varies depending on distance and thickness between patient and spoiler. In this study, the change was investigated the surface dose according to thickness of spoiler. The 0.5% increase of surface dose was observed with each 2.0 cm when the spioler in acrylic was prepared from 0.5 cm to 3.0 cm at intervals of 0.5 cm was evaluated. Based on this result, it suggests that this kind of application will be somewhat limited on clinical trials directly but proper surface dose can be useful method when is applied on patients of treatment prognosis who are required each different surface dose.

• Radiation Oncology Journal
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• v.12 no.2
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• pp.209-217
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• 1994

Between July 1987 and December 1992, we treated 22 patients with chronic myelogenous leukemia; 14 in the chronic phase and 8 with more advanced disease. All were received with allogeneic bone marrow transplantation from HLA-identical sibling donors after a total body irradiation(TBI) cyclophosphamide conditioning regimen. Patients were non-randomly assigned to either 1200 cGy/6fractions/3days (6 patients) or 1320 cGy/8 fractions/4days (16 patients) by dose of TBI. Of the 22 patients, 8 were prepared with cyclophosphamide alone, 14 were conditioned with additional adriamycin or daunorubicin. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with methotrexate. The actuarial survival and leukemic-free survival at four years were $58.5\%$ and $41.2\%$, respectively, and the relapse rate was $36\%$ among 22 patients. There was a statistically significant difference in survival between the patients in chronic phase and more advanced phase ($76\%\;vs\;33\%$, p=0.05). The relapse rate of patients receiving splenectomy was higher than that of patients receiving splenic irradiation ($50\%\;vs\;0\%$, p=0.04). We conclude that the probability of cure is highest if transplantation is performed while the patients remains in the chronic phase.

• Radiation Oncology Journal
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• v.12 no.2
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• pp.233-241
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• 1994

Purpose : This study was performed to verify dose distribution with the tissue compensator which is used for uniform dose distribution in total body irradiation(TBI). Materials and methods : The compensators were made of lead(0.8mm thickness) and aluminum(1mm or 5mm thickness) plates. The humanoid phantom of adult size was made of paraffin as a real treatment position for bilateral total body technique. The humanoid phantom was set at 360cm of source-axis distance(SAD) and irradiated with geographical field size(FS) $144{\times}144cm^2(40{\times}40cm^2$ at SAD 100cm) which covered the entire phantom. Irradiation was done with 10MV X-ray(CLINAC 1800, Varian Co., USA) of linear accelerator set at Department of Therapeutic Radiology, Chonnam University Hospital. The midline absorbed dose was checked at the various regions such as head, mouth, mid-neck, sternal notch, mid-mediastinum, xiphoid, umbilicus, pelvis, knee and ankle with or without compensator, respectively. We used exposure/exposure rate meter(model 192, Capintec Inc., USA) with ionization chamber(PR 05) for dosimetry, For the dosimetry of thorax region TLD rods of $1x1x6mm^3$ in volume(LiF, Harshaw Co., Netherland) was used at the commercially available humanoid phantom. Results : The absorbed dose of each point without tissue compensator revealed significant difference(from $-11.8\%\;to\;21.1\%$) compared with the umbilicus dose which is a dose prescription point in TBI. The absorbed dose without compensator at sternal notch including shoulder was $11.8\%$ less than the dose of umbilicus. With lead compensator the absorbed doses ranged from $+1.3\%\;to\;-5.3\%$ except mid-neck which revealed over-compensation($-7.9\%$). In case of aluminum compensator the absorbed doses were measured with less difference(from $-2.6{\%}\;to\;5.3\%$) compared with umbilicus dose. Conclusion : Both of lead and aluminum compensators applied to the skull or lower leg revealed a good compensation effect. It was recognized that boost irradiation or choosing reference point of dose prescription at sternal notch according to the lateral thickness of patient in TBI should be considered.

• Progress in Medical Physics
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• v.7 no.2
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• pp.47-55
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• 1996

Total Body Irradiation(TBI) is one of the essential treatment modalities in bone marrow transplantation for leukemia and lymphoma. Various techniques and dose regimens were introduced with sevelal advantages and disadvantages. In TBI, lung block could reduce lung dose to 75％ of original beam for decreasing lung dose with homogenous total body irradiation. Accurate provision for specified dose and the desired homogeneity are essential before clinical total body irradiation. When performed in total body irradiation, the problem obtain uniform dose distribution in brain, neck, lung, umbilicus, pelvis and leg. Authors compared to dose distribution with method 1 and method 2. The method 1 used compensating filters for homogeneous dose distribution(Minesota University Method). The method 2 used fixing frame made in aeryl developing authors. Results were following. 1. Method 1 was showed dose distribution from 95.6％ to 100％, method 2 showed dose distribution from 95.4％ to 100％. 2. Method 2 was showed different to 3.4％ at skin region and midline in the brain. In the neck, showed different to 1.5％. In the umbilicus. showed different to 2.3％.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.2
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• pp.147-153
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• 2005

Purpose : We should use a computed tomography-simulator for the body measure and compensator manufacture process was practiced with TBI's positioning in process and to estimate the availability.,Materials and Methods : Patient took position that lied down. and got picture through computed tomography-simulator. This picture transmitted to Somavision and measured about body measure point on the picture. Measurement was done with skin, and used the image to use measure the image about lungs. We decided thickness of compensator through value that was measured by the image. Also, We decided and confirmed position of compensator through image. Finally, We measured dosage with TLD in the treatment department.,Results : About thickness at body measure point. we could find difference of $1{\sim}2$ cm relationship general measure and image measure. General measure and image measure of body length was seen difference of $3{\sim}4$ cm. Also, we could paint first drawing of compensator through the image. The value of dose measurement used TLD on head, neck, axilla, chest(lungs inclusion), knee region were measured by $92{\sim}98%$ and abdomen, pelvis, inquinal region, feet region were measured by $102{\sim}109%$.,Conclusion : It was useful for TBI's positioning to use an image of computed tomography-simulator in the process. There was not that is difference of body thickness measure point, but measure about length was achieved definitely. Like this, manufacture of various compensator that consider body density if use image is available. Positioning of compensator could be done exactly. and produce easily without shape of compensator is courted Positioning in the treatment department could shortened overall $15\{sim}20$ minute time. and reduce compensator manufacture time about 15 minutes.

• Radiation Oncology Journal
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• v.17 no.4
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• pp.321-328
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• 1999

Purpose : Total body irradiation (TBI) or whole body irradiation is used to acquire immune suppression, to treat malignant lymphoma and leukemia, and as an conditioning regimen for bone marrow transplantation. For these purposes, many methods were developed to obtain homogenous dose distribution. The objective of this study was to analyze and confirm the accuracy and the homogeneity of the treatment setup, the parallel opposed lateral technique, currently used in Seoul National University Hospital. Materials and Metheods : Surface dose data, measured with a thermoluminescent dosimeter, of 8 patients among 10 patients, who were given total body irradiation with the parallel opposed lateral technique between September 1996 to August 1998, at Seoul National University Hospital were analyzed. Surface doses were measured at the head, neck, axilla, thigh, and ankle level. Surface and midline doses were measured with similar set-up and technique in the Humanoid phantom. Results : Measured surface doses relative to prescribed dose for the head, neck, axilla, thight, and ankle leve were $91.3{\pm}7.8,{\;}98.3{\pm}7.5,{\;}95.1{\pm}6.3,{\;}98.3{\pm}5.5$, and $95.3{\pm} 6.3\%$, respectively. The midline doses of the head, neck, axilla, thigh, and ankle level estimated from the surface-to-midline ratios in the Humanoid Phantom were $103.4{\pm}9.0,{\;}107.8{\pm}10.5,{\;}91.1{\pm}6.1,{\pm} 93.8{\pm}4.5,{\;}and{\;}104.5{\pm}9.3\%$, respectively. Measured surface doses and estimated midline doses ranged from $-8.9\%$ to $+7.8\%$. Midline doses at the neck and the axilia level deviated more than $5\%$ from the prescribed doses. The difference of the estimated midline doses at the neck and the axilla level and the actual doses were attributed to the thickness differences between the Humanoid phantom and the patients. Conclusion Distribution of the midline doses as well as the suface doses were measured to be within $-8.7\~{\pm}7.8\%$ range. Actual dose distribution in the patient is expected to be better than the measured dose range mainly attributed to thickness difference between the patient and the Humanoid phantom.