• Progress in Medical Physics
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• v.7 no.1
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• pp.3-7
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• 1996

The accuracy in target localization of CT, MR, and digital angiography were investigated for stereotactic radiosurgery. The images using CT and MR were obtained out of geometrical phantom which was designed to produce exact coordinates of several points within a 0.lmm error range. The slice interval was 3mm and FOV was 35cm for CT and 28cm for MR. These images were transferred to treatment planning computer using TCP/IP in forms of GE format. Measured 3-D coordinates of these images from planning computer were compared to known values by geometrical phantom. Anterior-posterior and lateral films were taken by digital angiography for measurement of spatial accuracy. Target localization errors were 1.2${\pm}$0.5mm with CT images, 1.7${\pm}$0.4mm with MR-coronal images, and 2.1${\pm}$0.7mm with MR-sagittal images. But, in case of MR-axial images, the target localization error was 4.7${\pm}$0.9mm. Finally, the target localization error of digital angiography was 0.9${\pm}$0.4mm. The accuracy of diagnostic machines such as CT, MR, and angiography depended on their resolutions and distortions. The target localization error mainly depended on the resolution due to slice interval with CT and the image distortion as well as the resolution with MR However, in case of digital angiography, the target localization error was closely related to the distortion of fiducial markers. The results of our study should be considered when PTV (Planning Target Volume) was determined.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.1
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• pp.27-33
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• 2007

Purpose: We have performed SRS (stereotactic radiosurgery) for avm (arterry vein malformation) and brain cancer. In order to verify dose and localization of SRS, dose distributions from TPS ($X-Knife^{(R)}$ 3.0, Radionics, USA) and GafChromic $EBT^{(R)}$ film in a head phantom were compared. Materials and Methods: In this study, head and neck region of conventional humanoid phantom was modified by substituting one of 2.5 cm slap with five 0.5 cm acrylic plates to stack the GafChromic $EBT^{(R)}$ film slice by slice with 5 mm intervals. Four films and five acrylic plates were cut along the contour of head phantom in axial plane. The head phantom was fixed with SRS head ring and adapted SRS localizer as same as real SRS procedure. CT images of the head phantom were acquired in 5 mm slice intervals as film interval. Five arc 6 MV photon beams using the SRS cone with 2 cm diameter were delivered 300 cGy to the target in the phantom. Ten small pieces of the film were exposed to 0, 50, 100, 200, 300, 400, 500, 600, 700, 800, 900 cGy, respectively to calibrate the GafChromic $EBT^{(R)}$ film. The films in the phantom were digitized after 24 hours and its linearity was calibrated. The pixel values of the film were converted to the dose and compared with the dose distribution from the TPS calculation. Results: Calibration curve for the GafChromic $EBT^{(R)}$ film was linear up to 900 cGy. The R2 value was better than 0.992. Discrepancy between calculated from $X-Knife^{(R)}$ 3.0 and measured dose distributions with the film was less than 5% through all slices. Conclusion: It was possible to evaluate every slice of humanoid phantom by stacking the GafChromic EBT film which is suitable for 2 dimensional dosimetry, It was found that film dosimetry using the GafChromic $EBT^{(R)}$ film is feasible for routine dosimetric QA of stereotactic radiosurgery.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.241-247
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• 1993

Between July 1988 and December 1992, we treated 45 patients who had deep seated inoperable or residual and/or recurrent intracranial tumors using LINAC based stereotactic radiosurgery at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College. Treated intracranial tumors included pituitary tumors (n=15), acoustic neurinomas (n=8), meningiomas (n=7), gliomas (n=6), craniopharyngiomas (n=4), pinealomas (n=3), hemangioblastomas (n=2), and solitary metastatic tumor from lung cancer (n=1). The dimension of treatment field varied from 0.23 to 42.88 $cm^3\;(mean;\;7.26\;cm^3)$. The maximum tumor doses ranging from 5 to 35.5 Gy (mean; 29.9 Gy) were given, and depended on patients' age, target volume, location of lesion and previous history of irradiation. There were 22 male and 23 female patients. The age was varied from 5 to 74 years of age (a median age; 43 years). The mean duration of follow-up was 35 months (2~55 months). To date, 18 $(39.1\%)$ of 46 intracranial tumors treated with SRS showed absent or decrease of the tumor by serial follow-up CT and/or MRI and 16 $(34.8\%)$ were stationary, e.g. growth arrest. From the view point of the clinical aspects, 34 $(73.9\%)$ of 46 tumors were considered improved status, that is, alive with no evidence of active tumor and 8 $(17.4\%)$ of them were stable, alive with disease but no deterioration as compared with before SRS. Although there showed slight increase of the tumor in size according to follow-up imagings of 4 cases (pituitary tumor 1, acoustic neurinomas 2, pinealoma 1), they still represented clinically stable status. Clinically, two $(4.4\%)$ Patients who were anaplastic astrocytoma (n=1) and metastatic brain tumor (n=1) were worsened following SRS treatment. So far, no serious complications were found after treatment. The minor degree headache which could be relieved by steroid or analgesics and transient focal hair loss were observed in a few cases. There should be meticulous long term follow-up inall cases.

• Radiation Oncology Journal
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• v.24 no.1
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• pp.11-20
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• 2006

Puroose: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT. Materials and Methods: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status ${\leq}3$ and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test. Results: The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up period (range $3{\sim}20$ months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade 3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV>80 cc (p-value<0.05). In multivariate analysis, age younger than 65 years and PTV>80 cc showed better survival rate. Conclusion: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.7-14
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• 1992

Between August 1988 and December 1991, 24 patients with intracranial tumors were treated with stereotactic radiosurgery(RS) using a 10 MV linear accelerator at Severance Hospital, Yonsei University College of Medicine. There were 5 meningiomas, 3 craniopharyngiomas, 9 glial tumors, 2 solitary metastases, 2 acoustic neurinomas, 2 pineal tumors, and 1 non-Hodgkin's lymphoma. Ten patients were treated as primary treatment after diagnosis with stereotactic biopsy or neuroimaging study. Nine patients underwent RS for post-op. residual tumors and three patients as a salvage treatment for recurrence after external irradiation. Two patients received RS as a boost followed by fractionated conventional radiotherapy. Among sixteen patients who were followed more than 6 months with neuroimage, seven patients (2 meningiomas, 4 benign glial tumors, one non-Hodgkin's lymphoma) showed complete response on neuroimage after RS and nine patients showed decreased tumor size. There was no acute treatment related side reaction. Late complications include three patients with symptomatic peritumoral brain edema and one craniopharyngioma with optic chiasmal injury. Through this early experience, we conclude that stereotactically directed single high doses of irradiation to the small intracranial tumors is effective for tumor control. However, in order to define the role of radiosurgery in the management of intracraniai tumors, we should get the long-term results available to demonstrate the benefits versus potential complications of this therapeutic modality.

• Radiation Oncology Journal
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• v.12 no.1
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• pp.109-115
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• 1994

The purpose of this paper is to develop an efficient method for the quick determination of multiple isocenters plans to provide optimal dose distribution in sterotactic radiosurgery. A Spherical dose model was developed through the use of fit to the exact dose data calculated in a 18cm diameter of spherical head phantom. It computes dose quickly for each spherical part and is useful to estimate dose distribution for multiple isocenters. An automatic computer search algorithm was developed using the relationship between the isocenter move and the change of dose shape, and adapted with a spherical dose model to determine isocenter separation and cellimator sizes quickly and automatically. A spheric81 dose model shows a comparable isodose distribution with exact dose data and permits rapid calculations of 3-D isodoses. the computer search can provide reasonable isocenter settings more quickly than trial and error types of plans, while producing steep dose gradient around target boundary. A spherical dose model can be used for the quick determination of the multiple isocenter plans with 3 computer automatic search. Our guideline is useful to determine the initial multiple isocenter plans.

• The Journal of Korean Society for Radiation Therapy
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• v.11 no.1
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• pp.43-48
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• 1999

Purpose : For practical application of the MR image for stereotactic radiosurgery, the target point achieved by acquisition of MR image in a relatively homogeneous phantom has to agree with the actual isocenter of irradiation in real radiosurgery and the amount of distortion of the MR image should be known. Materials and Methods : A dosimetric film with a random target point was inserted into a radish vertically and horizontally on axis Z and they were fixed with a headring. After image acquisition by stereotactic radiosurgery planning system, we achieved stereotactic coordinate of the target point and examined irradiation using the coordinate acquired as isocenter. After the irradiation, the film in the radish was developed and processed and the degree of coincidence between the target point marked on the film and the center of the radiation distribution. In order to measure the degree of distortion of the MR image in a different way, an acryl phantom was made and punctures were made at intervals of 1 cm and a drop of oil was dropped into it. Then, it was inserted into the radish vertically and horizontally on axis Z to acquire the MR image. Each coordinate was achieved and the estimation of distortion of MR image was made both in vertical and horizontal directions Results : The film from the radio was developed and for the one inserted vertically on axis Z, there was a good coincidence in the discrepancy between the target point marked on the film and the center of the radiation distribution. For the one inserted horizontally, the discrepancy between them was under 0.5 mm. As a result of estimating distortion of MR image using acryl, the discrepancy was under 0.45 mm in the case of the phantom inserted vertically on axis Z, and that of the one inserted horizontally was 1.4 mm. Conclusion : We were able to confirm good coincidence in homogeneous phantom in actual treatment position of radiosurgery using the MR image and the discrepancy measured in the analysis of distortion of the MR image did not exceed the permissible level. Therefore, it was evident the system of the hospital is suitable for radiosurgery using MR image.

• Radiation Oncology Journal
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• v.24 no.4
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• pp.211-216
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• 2006

$\underline{Purpose}$: An analysis of the infrastructure for radiotherapy in Korea was performed to establish a baseline plan in 2006 for future development. $\underline{Materials\;and\;Methods}$: The data were obtained from 61 radiotherapy centers. The survey covered the number of radiotherapy centers, major equipment and personnel. Centers were classified into technical level groups according to the IAEA criteria. $\underline{Results}$: 28,789 new patients were treated with radiation therapy in 2004. There were 104 megavoltage devices in 61 institutions, which included 96 linear accelerators, two Cobalt 60 units, three Tomotherapy units, two Cyberknife units and one proton accelerator in 2006. Thirty-five high dose rate remote after-loading systems and 20 CT-simulators were surveyed. Personnel included 132 radiation oncologists, 50 radiation oncology residents, 64 medical physicists, 130 nurses and 369 radiation therapy technologists. All of the facilities employed treatment-planning computers and simulators, among these thirty-two percent (20 facilities) used a CT-simulator. Sixty-six percent (40 facilities) used a PET/CT scanner, and 35% (22 facilities) had the capacity to implement intensity modulated radiation therapy. Twenty-five facilities (41%) were included in technical level 3 group (having one of intensity modulated radiotherapy, stereotactic radiotherapy or intra-operative radiotherapy system). $\underline{Conclusion}$: Radiation oncology in Korea evolved greatly in both quality and quantity recently and demand for radiotherapy in Korea is increasing steadily. The information in this analysis represents important data to develop the future planning of equipment and human resources.

• Radiation Oncology Journal
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• v.18 no.2
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• pp.101-106
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• 2000

Purpose : This study was peformed to evaluate the effectiveness and tolerance of craniospinal irradiation for patients with modulloblastoma and to define the optimal radiotherapeutic regimen. Materials and Methods : We retrospectively analyzed the records of 43 patients with modulloblastoma who were treated with external beam craniospinal radiotherapy at our institution between May, 1984 and April, 1998. Median follow up period was 47 months with range of 18 to U months. Twenty seven patients were male and sixteen patients were female, a male to female ratio of 1.7:1. Surgery consisted of biopsy alone in 5 patients, subtotal excision in 24 patients, and gross total excision in 14 patients. All of the patients were treated with craniospinal irradiation. All of the patients except four received at least 5,000 cGy to the posterior fossa and forty patients received more than 3,000 cGy to the spinal cord. Results : The overall survival rates at 5 and 7 years for entire group of patients were 57$\%$ and 56$\%$, respectively. Corresponding disease free survival rates were 60$\%$ and 51$\%$, respectively, The rates of disease control in the posterior fossa were 77$\%$ and 67$\%$ at 5 and 7 years. Gross total excision and subtotal excision resulted in 5 year overall survival rates of 76$\%$ and 66$\%$, respectively, In contrast, those patients who had biopsy alone had a 5 year survival rate of only 40$\%$. Posterior fossa was a component of failure in 11 of the 18 recurrences. Seven recurrences were isolated to the posterior fossa. Four patients had neuraxis recurrences, three had distant metastasis alone and four had multiple sites of failure, all involving the primary site. Conclusion : Craniospinal irradiation for patients with moduiloblastoma is an effective adjuvant treatment without significant treatment related toxicitles. There is room for Improvement in terms of posterior fossa control, especially in biopsy alone patients. The advances in radiotherapy including hypefractionation, stereotactic radiosurgery and 3D conformal radiotherapy would be evolved to improve the tumor control rate at primary site.

• Radiation Oncology Journal
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• v.9 no.1
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• pp.153-158
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• 1991

The first Leksell Gamma Knife unit (LGU-type B) for radiosurgery in Asia was installed in Asan Medical Center. Mechanical accuracy, output, dose profiles for each collimators were measure during acceptance test. Sixty eight patients (sixty nine cases) had undergone radiosugery from May 1990 to September 1990. AVM cases were 24 cases $(35\%)$, acoustic tumor 10 $(14\%)$, pituitary adenoma 4 $(6\%)$, metastatic tumor 18 $(26\%)$, meningioma 6$(9\%)$ and others 18 $(25\%)$. Dose of $25\;Gy\sim100\;Gy$ was delivered at one time according to disease, location and sizes.