• The Journal of Korean Society for Radiation Therapy
• /
• v.24 no.2
• /
• pp.95-106
• /
• 2012

Purpose: The objective of this study was to investigate the usefulness of an IMRT treatment plan according to whether there was a shell-type pseudo target during radiation therapy for patients in Stage III or IV of non-small cell lung cancer (NSCLC). Materials and Methods: After setting an IMRT (Intensity-Modulated Radiation Therapy, IMRT) plan for when there was a shell-type pseudo target (SPT) and when there was none (WSPT) with 22 patients in Stage III or IV of NSCLC, the investigator analyzed dose-volume histograms (DVHs) and made assessment with dosimetric comparisons such as homogeneity index (HI) inside the tumor target, conformity index (CI) of the tumor target, spinal cord maximum dose, Esophagus $V_{50%}$, mean lung dose (MLD), and $V_{40%}$, $V_{30%}$, $V_{20%}$, $V_{10%}$, $V_{5%}$. Results: The mean CI of WSPT and SPT was $1.22{\pm}0.04$ and $1.16{\pm}0.032$ ($.000^*$), respectively, and the mean HI of WSPT and SPT was $1.06{\pm}0.015$ and $1.07{\pm}0.014$ ($.000^*$), respectively. In SPT, the mean of each CI difference decreased by $-5.16{\pm}2.54%$, while HI increased by average $0.81{\pm}0.47%$. Esophagus $V_{50%}$ recorded $14.54{\pm}12.01%$ (WSPT) and $12.14{\pm}11.09%$ ($.000^*$, SPT) with the mean of SPT differences dropping by $-26.37{\pm}25.05%$. Mean spinal cord maximum dose was $3,898.44{\pm}1,075.0$ cGy (WSPT) and $3,810.8{\pm}1,134.9$ cGy ($.004^*$, SPT) with SPT dropping by average $-3.36{\pm}5.81%$. As for lung $V_{X%}$, the mean of $V_{5%}$ and $V_{10%}$ differences was $-1.62{\pm}2.29%$ ($.006^*$) and $-1.98{\pm}5.02%$ ($.005^*$), respectively with SPT making a decrease. The mean of V20%, V30%, and V40% differences was $-3.51{\pm}3.07%$ ($.000^*$), $-4.84{\pm}6.01%$ ($.000^*$), and $-6.16{\pm}8.46%$ ($.001^*$), respectively, with SPT making a decrease with statistical significance. In MLD assessment, SPT also dropped by average $-2.83{\pm}2.41%$ ($.000^*$). Those results show that SPT allows for mean 169 cGy (Max: 547 cGy, Min: 6.4 cGy) prescription dose. Conclusion: An IMRT treatment plan with SPT during radiation therapy for patients in Stage III or IV of NSCLC will help to reduce the risk of lung toxicity and radiation-induced pneumonia by cutting down radiation doses entering the normal lung, reduce the local control failure rate during radiation therapy due to increasing prescription doses to a certain degree, and increase treatment effects.

• The Journal of Korean Society for Radiation Therapy
• /
• v.30 no.1_2
• /
• pp.129-138
• /
• 2018

Purpose : An aim of this study was to compare the effect of multi leaf collimator(MLC) types for high dimension radiotherapy in treatment sites used clinically. Material and Method : 70 patients with lung cancer, spine cancer, prostate cancer, whole pelvis, head and neck, breast cancer were included in this study. High definition(HD) MLC of TrueBeam STx (Varian Medical system, Palo Alto, CA) and millenium(M) MLC of VitalBeam (Varian Medical system, Palo Alto, CA) were used. Radiotherapy plans were performed for each patient under same treatment goals with Eclipse (Version 13.7, Varian Palo Alto USA, CA). To compare the indicators of the radiotherapy plans, planning target volume(PTV) coverage, conformity index(CI), homogeneity index(HI), and clinical indicators for each treatment sites in normal tissues were evaluated. To evaluate low dose distribution, $V_{30%}$ values were compared according to MLC types. Additionally, length and volume of targets for each treatment sites were investigated. Result : In stereotatictic body radiotherapy(SBRT) plan for lung, the average value of PTV coverage was reduced by 0.52 % with HD MLC. With SBRT plan using HD MLC for spine, the average value of PTV coverage decreased by 0.63 % and maximum dose decreased by 1.13 %. In the test of CI and HI, the values in SBRT plan with HD MLC for spine were 1.144, 1.079 and the values using M MLC were 1.160, 1.092 in SBRT plan for lung, The dose evaluation of critical organ was reduced by 1.48 % in the ipsilateral lung mean dose with HD MLC. In prostate cancer volumetric modulated arc therapy(VMAT) with HD MLC, the mean dose and the $V_{30}$ of bladder and the mean dose and the $V_{25}$ of rectum were reduced by 0.53 %, 1.42 %, 0.97 %, and 0.69 %, respectively (p<0.05). The average value of heart mean dose was reduced by 0.83 % in breast cancer VMAT with M MLC. Other assessment indices for treatment sites showed no significant difference between treatment plans with two types of MLC. Conclusion : Using HD MLC had a positive impact on the PTV coverage and normal tissue sparing in usually short or small targets such as lung and spine SBRT and prostate VMAT. But, there was no significant difference in targets with long and large such as lung, head and neck, and whole pelvis for VMAT.

• Economic and Environmental Geology
• /
• v.49 no.4
• /
• pp.301-314
• /
• 2016

Disused Sealed Radioactive Sources (DSRSs) are stored temporally in the centralized storage facility of Korea Radioactive Waste Agency (KORAD) and planned to be disposed in the low- and intermediate-level radioactive waste (LILW) disposal facility in Gyeongju city. In this study, preliminary post-closure safety assessment was performed for DSRSs in order to draw up an optimum disposal plan. Two types of disposal options were considered, i.e. engineered vault type disposal and rock cavern type disposal which were planned to be constructed and operated respectively in LILW disposal facility in Gyeongju city. Assessment end-point was individual effective dose of critical group and calculated by using GoldSim code. In normal scenario, the maximum dose was estimated to be approximately $1{\times}10^{-7}mSv/yr$ for both disposal options. It meant that both options had sufficient safety margin when compared with regulatory limit (0.1 mSv/yr). Otherwise, in well scenario, the maximum dose exceeded regulatory limit of 1 mSv/yr in engineered vault type disposal and the exposure dose was mainly contributed by $^{226}Ra$, $^{210}Pb$ (daughter nuclide of $^{226}Ra$) and $^{237}Np$ (daughter nuclide of $^{241}Am$). For rock cavern type disposal, even though the peak dose satisfied regulatory limit, the exposure doses by $^{14}C$ and $^{237}Np$ were relatively high above 10% of regulatory limit. Therefore, it is necessary to exclude $^{14}C$, $^{226}Ra$ and $^{241}Am$ for two type of disposal options and additional management such as long-term storage and development of disposal container for those radionuclides should be performed before permanent disposal for conservative safety and security.

• Radiation Oncology Journal
• /
• v.19 no.4
• /
• pp.319-326
• /
• 2001

Purpose : Planning target volume (PTV) for tumors in abdomen or thorax includes enough margin for breathing-related movement of tumor volumes during treatment. Depending on the location of the tumor, the magnitude of PTV margin extends from 10 mm to 30 mm, which increases substantial volume of the irradiated normal tissue hence, resulting in increase of normal tissue complication probability (NTCP). We developed a simple and handy method which can reduce PTV margins in patients with liver tumors, respiratory motion reduction device (RRD). Materials and methods : For 10 liver cancer patients, the data of internal organ motion were obtained by examining the diaphragm motion under fluoroscope. It was tested for both supine and prone position. A RRD was made using MeV-Green and Styrofoam panels and then applied to the patients. By analyzing the diaphragm movement from patients with RRD, the magnitude of PTV margin was determined and dose volume histogram (DVH) was computed using AcQ-Plan, a treatment planning software. Dose to normal tissue between patients with RRD and without RRD was analyzed by comparing the fraction of the normal liver receiving to $50\%$ of the isocenter dose. DVH and NTCP for normal liver and adjacent organs were also evaluated. Results : When patients breathed freely, average movement of diaphragm was $12{\pm}1.9\;mm$ in prone position in contrast to $16{\pm}1.9\;mm$ in supine position. In prone position, difference in diaphragm movement with and without RRD was $3{\pm}0.9\;mm$ and 12 mm, respectively, showing that PTV margins could be reduced to as much as 9 mm. With RRD, volume of the irradiated normal liver reduced up to $22.7\%$ in DVH analysis. Conclusion : Internal organ motion due to breathing can be reduced using RRD, which is simple and easy to use in clinical setting. It can reduce the organ motion-related PTV margin, thereby decrease volume of the irradiated normal tissue.

• Nuclear Medicine and Molecular Imaging
• /
• v.40 no.3
• /
• pp.169-176
• /
• 2006

Purpose: According to the development of CT scanner in PET/CT system, the role of CT unit as a diagnostic tool has been more important. To improve the diagnostic ability of CT scanner, it is a key aspect that CT scanning has to be performed with high dose energy and intravenous (IV) contrast. So we investigated the effect of IV contrast media on the maximum SUV (maxSUV) of normal tissues and pathologic lesions using PET/CT scanner with high dose CT scanning. Materials & Methods: The study enrolled 13 patients who required PET/CT evaluation. At first, the patients were performed whole body non-contrast CT (NCCT-120 kVp, 130 mAs) scan. Then contrast enhanced CT (CECT) scan was performed immediately. Finally PET scan was followed. The PET omission data were reconstructed twice, once with the NCCT and again with the CECT. We measured the maxSUV of 10 different body regions that were considered as normal in ail patients. Also pathologic lesions were investigated. Results: There were not seen focal artifacts in PET images based on CT with IV contrast agent. Firstly, 130 normal regions in 13 patients were evaluated. The maxSUV was significantly different between two PET images (p<0.00)). The maxSUV was $1.1{\pm}0.5$ in PET images with CECT-corrected attenuation and $1.0{\pm}0.5$ in PET images with NCCI-corrected attenuation. The limit of agreement was $0.1{\pm}0.3$ in Bland-Altman analysis. Especially there were significant differences in 6 of 10 regions, apex and base of the right lung, ascending aorta, segment 6 & segment 8 of the liver and spleen (p<0.05). Secondly, 39 pathologic lesions were evaluated. The maxSUV was significantly different between two PET images (p<0.001). The maxSUV was $4.7{\pm}2.0$ in PET images with CECT-corrected attenuation and $4.4{\pm}2.0$ in PET images with NCCT-corrected attenuation. The limit of agreement was $0.4{\pm}0.8$ in Bland-Altman analysis. Conclusion: Although there were increases of maxSUVs in the PET images based on CT with IV contrast agent, it was very narrow in the range of limit of agreement. So there was no significant effect to clinical interpretation for PET images that were corrected attenuation with high dose CT using IV contrast.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.6
• /
• pp.457-463
• /
• 2008

Background: The attenuation of the lung parenchyma increases on expiration as a consequence of decreased air in the lung. Expiratory CT scans have been used to show air trapping in patients with chronic airway disease and diffuse parenchymal disease and also in asymptomatic smokers. Although there have been several reports investigating the regional air trapping on a expiratory CT scan, there have been only a few reports evaluating the changes of whole lung attenuation with considering its clinical significance, and especially in healthy subjects. The purpose of this study was to evaluate the correlation of an expiratory increase of lung attenuation with age and smoking in healthy subjects. Methods: Asymptomatic subjects who underwent a low dose chest CT scan as part of a routine check-up and who showed normal spirometry and a normal inspiratory CT scan were recruited for this study. We excluded the subjects with significant regional air trapping seen on their expiratory CT scan. Lung attenuation was measured at 24 points of both the inspiratory and expiratory CT scans, respectively, for 100 subjects. The correlations between an expiratory increase of the lung attenuation and the amount of smoking, the patient's age and the results of spirometric test were assessed. Results: There were 87 men and 13 women included in this study. Their median age was 49.0 years old (range:25~71). Sixty current smokers, 24 ex-smokers and 16 non-smokers were included. As age increased, the expiratory increase of lung attenuation was reduced at every measuring points (r=-0.297~-0.487, Pearson correlation). The statistical significance was maintained after controlling for the effect of smoking. Smoking was associated with a reduction of the expiratory increase of lung attenuation. But the significance was reduced after controlling for the patient's age. The $FEV_1$, FVC, $FEV_1/FVC$ and $FEF_{25{\sim}75%}$ were not associated with an expiratory increase of lung attenuation. Conclusion: The expiratory increase of lung attenuation in subjects with a normal inspiratory CT scan was negatively correlated with age. It was also reduced in heavy smokers. It may reflect aging and the smoking related changes.

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

• Journal of the Korean Society of Radiology
• /
• v.13 no.3
• /
• pp.325-332
• /
• 2019

This study analyzed the movement of tumors using 4DCT. Appropriate uniform IM were identified using TC, II and CI depending on ITV margins. DVH and NTCP were also compared in each case. Dose analysis on tumors with uniform IM showed that the optimal treatment plan for satisfying all TC, CI, II was evaluated as 2 mm in phase 20 and 3 mm in 40%. That was compared to the dose from the normal tissues of $PTV_{20}$, $PTV_{40}$. In the 20% radiation field, V5, V10, and V20 for the lungs increased 1.49, 1.26, and 0.65%, while 40% increased by 1.9, 2.41 and 1.23%. NTCP had a dose increase of 0.57 to 0.029% from 20% and 40%. There was a dose increase in the spinal cord and heart at uniform IM, but there was no significant difference. These data suggest that the ITV setting of 20%, phase for Respiratory Gated Radiotherapy using Novalis ExacTrac system can be applied with a uniform IM 2 mm and 40% with 3 mm for optimal treatment plan.

• Radiation Oncology Journal
• /
• v.21 no.3
• /
• pp.238-244
• /
• 2003

Purpose: The Planning of High-Dose-Rate (HDR) brachytherapy treatments are becoming individualized and more dependent on the treatment planning system. Therefore, computer software has been developed to perform independent point dose calculations with the integration of an isodose distribution curve display into the patient anatomy images. Meterials and Methods: As primary input data, the program takes patients'planning data including the source dwell positions, dwell times and the doses at reference points, computed by an HDR treatment planning system (TPS). Dosimetric calculations were peformed in a $10\times12\times10\;Cm^3$ grid space using the Interstitial Collaborative Working Group (ICWG) formalism and an anisotropy table for the HDR Iridium-192 source. The computed doses at the reference points were automatically compared with the relevant results of the TPS. The MR and simulation film images were then imported and the isodose distributions on the axial, sagittal and coronal planes intersecting the point selected by a user were superimposed on the imported images and then displayed. The accuracy of the software was tested in three benchmark plans peformed by Gamma-Med 12i TPS (MDS Nordion, Germany). Nine patients'plans generated by Plato (Nucletron Corporation, The Netherlands) were verified by the developed software. Results: The absolute doses computed by the developed software agreed with the commercial TPS results within an accuracy of $2.8\%$ in the benchmark plans. The isodose distribution plots showed excellent agreements with the exception of the tip legion of the source's longitudinal axis where a slight deviation was observed. In clinical plans, the secondary dose calculations had, on average, about a $3.4\%$ deviation from the TPS plans. Conclusion: The accurate validation of complicate treatment plans is possible with the developed software and the qualify of the HDR treatment plan can be improved with the isodose display integrated into the patient anatomy information.

• The Journal of Korean Society for Radiation Therapy
• /
• v.18 no.2
• /
• pp.81-87
• /
• 2006

Purpose: Few researches have been peformed on the dose distribution of the moving organ for radiotherapy so far. In order to simulate the organ motion caused by respiratory function, multipurpose phantom and moving device was used and dosimetric measurements for dose distribution of the moving organs were conducted in this study. The purpose of our study was to evaluate how dose distributions are changed due to respiratory motion. Materials and Methods: A multipurpose phantom and a moving device were developed for the measurement of the dose distribution of the moving organ due to respiratory function. Acryl chosen design of the phantom was considered the most obvious choice for phantom material. For construction of the phantom, we used acryl and cork with density of $1.14g/cm^3,\;0.32g/cm^3$ respectively. Acryl and cork slab in the phantom were used to simulate the normal organ and lung respectively. The moving phantom system was composed of moving device, moving control system, and acryl and cork phantom. Gafchromic film and EDR2 film were used to measure dose ditrbutions. The moving device system may be driven by two directional step motors and able to perform 2 dimensional movements (x, z axis), but only 1 dimensional movement(z axis) was used for this study. Results: Larger penumbra was shown in the cork phantom than in the acryl phantom. The dose profile and isodose curve of Gafchromic EBT film were not uniform since the film has small optical density responding to the dose. As the organ motion was increased, the blurrings in penumbra, flatness, and symmetry were increased. Most of measurements of dose distrbutions, Gafchromic EBT film has poor flatness and symmetry than EDR2 film, but both penumbra distributions were more or less comparable. Conclusion: The Gafchromic EBT film is more useful as it does not need development and more radiation dose could be exposed than EDR2 film without losing film characteristics. But as response of the optical density of Gafchromic EBT film to dose is low, beam profiles have more fluctuation at Gafchromic EBT. If the multipurpose phantom and moving device are used for treatment Q.A, and its corrections are made, treatment quality should be improved for the moving organs.