• Progress in Medical Physics
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• v.12 no.2
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• pp.171-175
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• 2001

We analyze the relation of dose volume histogram, conformity index and homogeneity index based on RTOG9005 for treatment planning result between framed based stereotactic radiosurgery(SRS) system and frameless SRS/T system to verify the difference of two systems in the intracranial target. There is same treatment planning result by two treatment planning systems.

• Progress in Medical Physics
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• v.14 no.1
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• pp.28-33
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• 2003

The aim of the study was to assess the isocenter deviation between multiple arcs and conformal beams in frameless FSRT. Forty seven patients received single isocenter radiosurgery or therapy (SRS/T) using available framelss FSRT system from Aug. 1997 to Dec. 2m. In choosing multiple arc FSRT or conformal FSRT, we had considered one of two techniques with respect to tumor size and tumor shape. In multiple arc FSRT, the average and standard deviation (SD) of the isocenter deviation was 0.2 mm (SD 0.2 mm), 0.2 mm (SD 0.2) and 0.3 mm (SD 0.2 mm)in the lateral (x), anterior-posterior (y) and cranio-caudal directions (z). In conformal FSRT, the average deviation and SD of the isocenter deviation was 0.2 mm (SD 0.2 mm), 0.3 mm(0.2 mm) and 0.4 mm (SD 0.2 mm) in the x, y and z directions. The average spacial deviation ($\Delta$r) was 0.41 mm and 0.54 mm in multiple arcs and conformal beams, respectively. The isocenter deviation using frameless FSRT system was similar value between multiple arcs and conformal beams. In practice, we believed we can select the appropriate treatment technique according to tumor shape and size.

• The Journal of Korean Society for Radiation Therapy
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• v.13 no.1
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• pp.64-67
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• 2001

• Progress in Medical Physics
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• v.10 no.2
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• pp.89-94
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• 1999

We developed a sterotactic radiosurgery system which is comprised of 1) collimators with small circular aperture, 2) an angiographic target localizer, 3) a target localizer used for alignment of planned target position with isocenter of treatment machine, and 4) a treatment planning system named LinaPel. In this study, we performed a series of treatment simulations to specify and analyze geometrical errors contained our in-house radiosurgery system. As results, 1) using Geometrical Phantom(Radionics,USA), the accuracy of target localization by LinaPel was determined as Avg. =(equation omitted) the accuracy of mechanical isocenter was found out to be 0.6 $\pm$ 0.2 mm, 3) the positional difference of target localization which determined by CT and angiography was 0.8 mm, and their size difference was 1.5 mm, and 4) the positional error during whole treatment was found out to be 0.9 $\pm$ 0.3 mm. With these results, we concluded that our in-house radiosurgery system can be used clinically. However, these range of accuracies need periodical quality assurance strongly.

• Journal of radiological science and technology
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• v.39 no.4
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• pp.587-593
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• 2016

We are evaluated the usefulness of radiation treatment planning applied respiration factor for stereotactic body radiation therapy in the lung cancer. Four dimensional computed tomography images were obtained in 10 patients with lung cancer. The radiation treatment plans were established total lung volume according to respiration images (new method) and conventional method. We was analyzed in the lung volume, radiation absorbed dose of lung and main organs (ribs, tracheobronchus, esophagus, spinal cord) around the tumor, respectively. We were confirmed that lung volume and radiation absorbed dose of lung and main organs around the tumor deference according to applied respiration. In conclusion, radiation treatment planning applied respiration factor seems to be useful for stereotactic body radiation therapy in the lung cancer.

• Progress in Medical Physics
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• v.26 no.2
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• pp.79-86
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• 2015

The purpose of this study is to evaluate efficacy and feasibility of adaptive radiotherapy according to tumor volume change (TVC) in early stage non-small cell lung cancer (NSCLC) using stereotactic body radiotherapy (SBRT). Twenty-two lesions previously treated with SBRT were selected. SBRT was usually performed with a total dose of 48 Gy or 60 Gy in four fractions with an interval of three to four days between treatments. For evaluation of TVC, gross tumor volume (GTV) was contoured on each cone-beam computed tomography (CBCT) image used for image guidance. Intensity modulated radiotherapy (IMRT) planning was performed in the first CBCT (CBCT1) using a baseline plan. For ART planning (ART), re-optimization was performed at $2^{nd}$, $3^{rd}$, and $4^{th}$ CBCTs (CBCT2, CBCT3, and CBCT4) using the same angle and constraint used for the baseline plan. The ART plan was compared with the non-ART plan, which generated copying of the baseline plan to other CBCTs. Average GTV volume was 10.7 cc. Average TVC was -1.5%, 7.3%, and -25.1% in CBCT2, CBCT3, and CBCT4 and the TVC after CBCT3 was significant (p<0.05). However, the nine lesions were increased GTV in CBCT2. In the ART plan, $V_{20\;Gy}$, $D_{1500\;cc}$, and $D_{1000\;cc}$ of lung were significantly decreased (p<0.05), and $V_{30\;Gy}$ and $V_{32\;Gy}$ of the chest wall were also decreased (p<0.05). While D min of planning target volume (PTV) decreased by 8.3% in the non-ART plan of CBCT2 compared with the baseline plan in lesions with increased tumor size (p=0.021), PTV coverage was not compromised in the ART plan. Based on this result, use of the ART plan may improve target coverage and OAR saving. Thus ART using CBCT should be considered in early stage NSCLC with SBRT.

• Radiation Oncology Journal
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• v.19 no.1
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• pp.34-39
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• 2001

Purpose : It is not common to evaluate the response of the fractionated stereotactic radiotherapy (SRT) to primary hepatoma as compared with conventional radiotherapy. The purpose of the study was to take the preliminary result on the clinical trial of primary hepatoma by SRT. Materials and Methods : From July 1999 to March 2000, thirty three patients were hospitalized in the St. Mary's Hospital, and treated with SRT for extracranial tumors. Among them, 13 patients were diagnosed to primary hepatoma and then applied by frameless SRT using 6 MV linac accelerator. There were 12 male and 1 female patients. They had the age of $ 44\~66$ year old (median : 59) and the tumor size of $10\~825\;cc$ (median : 185 cc). SRT was given to them $3\~5$ fractions a week (5 Gy/fraction, $90\%$ isodose line) for $2\~3$ weeks. Median dose of SRT was 50 Gy and the range was $30\~50\;Gy$. Results : Follow-up period ranged from 3 months to 13 months with median of 8 months. After treating SRT to thirteen patients with primary hepatoma, the response of the tumor was examined by abdominal CT : they are classified by 1 complete regression $(7.7\%)$, 7 partial regression $(53.8\%)$, 4 minimal regression $(30.8\%)$, 1 stable disease $(7.7\%)$. The positive responses more than partial remission were 8 patients $(61.5\%)$ after the treatment. The level of serum alpha-fetoprotein (AFP) after the treatment as compared with pretreatment had been $92.3\%$ decreased. There was no severe complication except dyspepsia $84.6\%$, mild nausea $69.2\%$, transient decreased of hepatic function $15.4\%$ and fever $7.7\%$. Conclusion : SRT to the patients with primary hepatoma was potentially suggested to become the safe and more effective tool than the conventional radiotherapy even though there were relatively short duration of follow-up and small numbers to be tested.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.59-59
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• 2003

목적 : 환자의 호흡에 의한 움직임 및 부정확한 환자 자세 setup 때문에 3 차원 전신 정위 방사선치료,3 차원 입체조형 방사선치료 IMRT와 같은 방사선 치료기술에서 병소에 대한 정확한 표적 위치측정은 매우 어려운 실정이다. 그러므로 본 연구는 방사선 치료시 환자의 움직임을 최대한 고정시켜 줄 수 있으며 환자 자세에 대한 setup 오차를 감소시키고 환자 전신에 산재한 병소의 위치를 좌표화할 수 있는 전신 정위 프레임 제작과 제작한 프레임에 대한 고정효과 및 재현성을 나타내는 환자 자세의 setup 오차를 평가하는데 있다. 재료 및 방법 : 자체 제작한 전신 정위 프레임 구조는 CT 영상 촬영 가능성에 중점을 두고 병소 표적의 좌표실현 및 환자체형에 따른 다양성 그리고 프레임에 대한 견고성 및 안정성 확인에 초점화하여 제작하였다. 이렇게 제작된 전신 정위 프레임에 대한 방사선 투과율 측정 실험과 CCTV 카메라와 DVR(Digital Video Recorder)를 이용해 환자 자세 변화에 대한 영상을 획득하여 matlab으로 구현한 오차분석용 프로그램으로 환자 외부자세에 대한 오차 비교 평가하고 CT 촬영에 의한 가상표적 위치측정 실험을 수행하였다. 또 한 고정벨트 추가 사용으로 인한 환자의 고정효과 정도를 살펴보았다. 결과 : 제작된 전신 정위 프레임에 대한 방사선 투과율은 마그네트론 10, 21 MeV의 에너지에서 95, 96% 의 투과율이 측정되었고 30 $^{\circ}$. 60 。각도의 경사로 빔이 전달될 때는 90.3, 94.4% 가 측정되었다. CCTV 카메라를 이용하여 흉부 및 복부의 움직임을 촬영한 영상을 Matlab프로그램으로 구현한 오차분석 프로그램을 적용한 결과, 환자 자세에 대한 오차의 평균값은 흉부의 lateral 방향에서는 3.63$\pm$1.4 mm, AP 방향에서는 2.1$\pm$0.82 mm이었다. 그리고 복부의 later의 방향에서는 7.0$\pm$2.1 mm, AP 방향에서는 6.5$\pm$2.2 mm 이었다. 또한 표적 위치측정을 위해서 환자의 피부에 임의의 가상표적을 부착하고 CT 촬영한 영상결과, 프레임으로 가상표 적에 대한 위치를 정확히 파악할 수 있었다. 결론 : 제작된 프레임을 적용하여 방사선투과율 측정실험, 환자 외부자세에 대한 오차 측정실험, 가상표적 위치측정 실험 등을 수행하였다. 환자 외부자세에 대한 오차 측정실험 경우, 더 많은 Volunteer를 적용하여 보다 정확한 오차 측정실험이 수행되어야 할 것이며 정확한 표적 위치 측정실험을 위해서 내부 마커를 삽입한 환자를 적용한 임상실험이 수행되어야 할 것이다. 또한 위치결정에서 획득한 좌표값의 정확성을 알아보기 위해서 팬톰을 이용한 방사선조사 실험이 추후에 실행되어져야 할 것이다. 그리고 제작된 프레임에 Rotating X선 시스템과 내부 장기의 움직임을 계량화하고 PTV에서의 최적 여유폭을 설정함으로써 정위 방사선수술 및 3 차원 업체 방사선치료에 대한 병소 위치측정과 환자의 자세에 대한 setup 오차측정 결정에 도움이 될 수 있을 것이라고 사료된다.

• Journal of the Institute of Electronics Engineers of Korea SC
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• v.46 no.3
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• pp.44-51
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• 2009

It is very important to verify generated setup errors in cancer therapy by using a high energy radiation and to perform the precise radiation therapy. Specially, the verification of treatment position is very crucial in special therapies like fractionated stereotatic radiotherapy (FSRT). The FSRT uses normally high-dose, small field size for treating small intracranial lesions. To estimate the developed FSRT system, the isocenter accuracy of gantry, couch and collimator were performed and a total of inaccuracy was less than ${\pm}1mm$. Precise beam targeting is crucial when using high-dose, small field size FSRT for treating small intracranial lesions. The EPID image of the 3mm lead ball mounted on the isocenter with a 25mm collimator cone was acquired and detected to the extent of one pixel (0.76mm) after comparing the difference between the center of a 25mm collimator cone and a 3 mm ball after processing the EPID image. In this paper, the radiation treatment efficiency can be improved by performing precise radiation therapy with a developed video based EPID and FSRT at near real time

• Progress in Medical Physics
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• v.26 no.4
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• pp.229-233
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• 2015

We retrospectively reviewed lung cancer patients who were treated with stereotactic ablative radiotherapy (SABR). We investigated the value of response evaluation after treatment by measuring the volume change of tumors on serial chest computed tomography (CT) examinations. The study included 11 consecutive patients with early-stage (T1-T2aN0M0) non-small cell lung cancer (NSCLC) who were treated with SABR. The median dose of SABR was 6,000 cGy (range 5,000~6,400) in five fractions. Sequential follow-up was performed with chest CT scans. Median follow-up time was 28 months. Radiologic measurement was performed on 51 CT scans with a median of 3 CT scans per patient. The median time to partial response ($T_{PR}$) was 3 months and median time to complete remission ($T_{CR}$) was 5 months. Overall response rate was 90.9% (10/11). Five patients had complete remission, five had partial response, and one patient developed progressive disease without response. On follow-up, three patients (27.2%) developed progressive disease after treatment. We evaluated the the response after SABR. Our data also showed the timing of response after SABR.