• The Journal of Korean Society for Radiation Therapy
• /
• v.26 no.2
• /
• pp.163-170
• /
• 2014

Purpose : If electron, chosen for superficial oncotherapy, was applied with bolus, it could work as an important factor to a therapy result by showing a drastic change in surface dose. Hence the calculation value and the actual measurement value of surface dose of Treatment Planning System (TPS) according to four variables influencing surface dose when using bolus on an electron therapy were compared and analyzed in this paper. Materials and Methods : Four variables which frequently occur during the actual therapies (A: bolus thickness - 3, 5, 10 mm, B: field size - $6{\time}6$, $10{\time}10$, $15{\time}15cm2$, C: energy - 6, 9, 12 MeV, D: gantry angle - $0^{\circ}$, $15^{\circ}$) were set to compare the actual measurement value with TPS(Pinnacle 9.2, philips, USA). A computed tomography (lightspeed ultra 16, General Electric, USA) was performed using 16 cm-thick solid water phantom without bolus and total 54 beams where A, B, C, and D were combined after creating 3, 5 and 10 mm bolus on TPS were planned for a therapy. At this moment SSD 100 cm, 300 MU was investigated and measured twice repeatedly by placing it on iso-center by using EBT3 film(International Specialty Products, NJ, USA) to compare and analyze the actual measurement value and TPS. Measured film was analyzed with each average value and standard deviation value using digital flat bed scanner (Expression 10000XL, EPSON, USA) and dose density analyzing system (Complete Version 6.1, RIT, USA). Results : For the values according to the thickness of bolus, the actual measured values for 3, 5 and 10 mm were 101.41%, 99.58% and 101.28% higher respectively than the calculation values of TPS and the standard deviations were 0.0219, 0.0115 and 0.0190 respectively. The actual values according to the field size were $6{\time}6$, $10{\time}10$ and $15{\time}15cm2$ which were 99.63%, 101.40% and 101.24% higher respectively than the calculation values and the standard deviations were 0.0138, 0.0176 and 0.0220. The values according to energy were 6, 9, and 12 MeV which were 99.72%, 100.60% and 101.96% higher respectively and the standard deviations were 0.0200, 0.0160 and 0.0164. The actual measurement value according to beam angle were measured 100.45% and 101.07% higher at $0^{\circ}$ and $15^{\circ}$ respectively and standard deviations were 0.0199 and 0.0190 so they were measured 0.62% higher at $15^{\circ}$ than $0^{\circ}$. Conclusion : As a result of analyzing the calculation value of TPS and measurement value according to the used variables in this paper, the values calculated with TPS on 5 mm bolus, $6{\time}6cm2$ field size and low-energy electron at $0^{\circ}$ gantry angle were closer to the measured values, however, it showed a modest difference within the error bound of maximum 2%. If it was beyond the bounds of variables selected in this paper using electron and bolus simultaneously, the actual measurement value could differ from TPS according to each variable, therefore QA for the accurate surface dose would have to be performed.

• Radiation Oncology Journal
• /
• v.21 no.1
• /
• pp.82-93
• /
• 2003

Purpose : To reduce the Irradiation dose to the lungs and heart in the case of chest wail irradiation using an oppositional electron beam, we used an Individualized custom bolus, which was precisely designed to compensate for the differences In chest wall thickness. The benefits were evaluated by comparing the normal tissue complication probablilties (NTCPS) and dose statistics both with and without boluses. Materials and Methods : Boluses were made, and their effects evaluated in ten patients treated using the reverse hockey-stick technique. The electron beam energy was determined so as to administer 80% of the irradiation prescription dose to the deepest lung-chest wall border, which was usually located at the internal mammary lymph node chain. An individualized custom bolus was prepared to compensate for a chest wall thinner than the prescription depth by meticulously measuring the chest wall thickness at 1 emf intervals on the planning CT Images. A second planning CT was obtained overlying the individuailzed custom bolus for each patient's chest wall. 3-D treatment planning was peformed using ADAC-Pinnacle$^{3}$ for all patients with and without bolus. NTCPS based on 'the Lyman-Kutcher' model were analyzed and the mean, maximum, minimum doses, V$_{50}$ and V$_{95}$ for 4he heari and lungs were computed. Results .The average NTCPS in the ipsliateral lung showed a statistically significant reduction (p<0.01), from 80.2${\pm}$3.43% to 47.7${\pm}$4.61%, with the use of the individualized custom boluses. The mean lung irradiation dose to the ipsilateral iung was also significantly reduced by about 430 cGy, Trom 2757 cGy to 2,327 cGy (p<0.01). The V$_{50}$ and V$_{95}$ in the ipsilateral lung markedly decreased from the averages of 54.5 and 17.4% to 45.3 and 11.0%, respectively. The V$_{50}$ and V$_{95}$ In the heart also decreased from the averages of 16.8 and 6.1% to 9.8% and 2.2%, respectively. The NTCP In the contralateral lung and the heart were 0%, even for the cases with no bolus because of the small effective mean radiation volume values of 4.4 and 7.1%, respectively Conclusion : The use of an Individualized custom bolus in the radiotherapy of postrnastectorny chest wall reduced the NTCP of the ipsilateral lung by about 24.5 to 40.5%, which can improve the complication free cure probability of breast cancer patients.

• The Journal of Korean Society for Radiation Therapy
• /
• v.19 no.2
• /
• pp.99-106
• /
• 2007

Purpose: The patient's position and anatomy during the treatment course little bit varies to some extend due to setup uncertainties and organ motions. These factors could affected to not only the dose coverage of the gross tumor but over dosage of normal tissue. Setup uncertainties and organ motions can be minimized by precise patient positioning and rigid immobilization device but some anatomical site such as prostate, the internal organ motion due to physiological processes are challenge. In planning procedure, the clinical target volume is a little bit enlarged to create a planning target volume that accounts for setup uncertainties and organ motion as well. These uncertainties lead to differences between the calculated dose by treatment planning system and the actually delivered dose. The purpose of this study was to evaluate the differences of interfractional displacement of organ and GTV based on the tomoimages. Materials and Methods: Over the course of 3 months, 3 patients, those who has applied rectal balloon, treated for prostatic cancer patient's tomoimage were studied. During the treatment sessions 26 tomoimages per patient, Total 76 tomoimages were collected. Tomoimage had been taken everyday after initial setup with lead marker attached on the patient's skin center to comparing with C-T simulation images. Tomoimage was taken after rectal balloon inflated with 60 cc of air for prostate gland immobilization for daily treatment just before treatment and it was used routinely in each case. The intrarectal balloon was inserted to a depth of 6 cm from the anal verge. MVCT image was taken with 5 mm slice thickness after the intrarectal balloon in place and inflated. For this study, lead balls are used to guide the registration between the MVCT and CT simulation images. There are three image fusion methods in the tomotherapy, bone technique, bone/tissue technique, and full image technique. We used all this 3 methods to analysis the setup errors. Initially, image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours and then the radiation therapist registered the MVCT images with the CT simulation images based on the bone based, rectal balloon based and GTV based respectively and registered image was compared with each others. The average and standard deviation of each X, Y, Z and rotation from the initial planning center was calculated for each patient. The image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours. Results: There was a significant difference in the mean variations of the rectal balloon among the methods. Statistical results based on the bone fusion shows that maximum x-direction shift was 8 mm and 4.2 mm to the y-direction. It was statistically significant (P=<0.0001) in balloon based fusion, maximum X and Y shift was 6 mm, 16mm respectively. One patient's result was more than 16 mm shift and that was derived from the rectal expansions due to the bowl gas and stool. GTV based fusion results ranging from 2.7 to 6.6 mm to the x-direction and 4.3$\sim$7.8 mm to the y-direction respectively. We have checked rotational error in this study but there are no significant differences among fusion methods and the result was 0.37$\pm$0.36 in bone based fusion and 0.34$\pm$0.38 in GTV based fusion.

• Radiation Oncology Journal
• /
• v.15 no.4
• /
• pp.393-402
• /
• 1997

Purpose : When an x-ray beam of small field size is irradiated to target area containing an air cavity, such as larynx, the underdosing effect is observed in the region near the interfaces of air and soft tissue. With a larynx model, air cavity embedded in tissue-equivalent material, this study is intonded for examining Parameters, such as beam quality, field size, and cavity size, to affect the dose distribution near the air cavity. Materials and Methods : Three x-rar beams, 4-, 6- and 10-MV, were employed to Perform a measurement using a 2cm $(width){\times}L$ (length in cm, one side of x-ray field used 2cm (height) air cavity in the simulated larynx. A thin window parallel-plate chamber connected to an electrometer was used for a dosimetry system. A ratio of the dose at various distances from the cavity-tissue interface to the dose at the same points in a homogeneous Phantom (ebservedlexpected ratio, O/E) normalized buildup curves, and ratio of distal surface dose to dose at the maximum buildup depth were examined for various field sizes. Measurement for cavity size effect was performed by varying the height (Z) of the air cavity with the width kept constant for several field sizes. Results : No underdosing effect for 4-MV beam for fields larger than $5cm\times5cm$ was found For both 6- and 10-MV beams, the underdosing portion of the larynx at the distal surface was seen to occur for small fields, $4cm\times4cm\;and\;5cm\times5cm$. The underdosed tissue was increased in its volume with beam energy even for similar surface doses. The relative distal surface dose to maximum dose was changed to 0.99 from 0.95, 0.92, and 0.91 for 4-, 6-, and 10-MV, respectively, with increasing field size, $4cm\times4cm\;to\;8cm\times8cm$, For 6- and 10-MV beams, the dose at the surface of the cavity is measured less than the predicted by about two and three percent. respectively. but decrease was found for 4-MV beam for $5cm\times5cm$ field. For the $4cm\timesL\timesZ$ (height in cm). varying depth from 0.0 to 4.8cm, cavity, O/E> 1.0 was observed regardless of the cavity size for any field larger than about $8cm\times8cm$. Conclusion : The magnitude of underdosing depends on beam energy, field size. and cavity size for the larynx model. Based on the result of the study. caution must be used when a small field of a high quality x-ray beam is irradiated to regions including air cavities. and especially the region where the tumor extends to the surface. Low quality beam. such as. 4-MV x-ray, and larger fields can be used preferably to reduce the risk of underdosing, local failure. In the case of high quality beams such as 6- and 10-MV x-rays, however. an additional boost field is recommended to add for the compensation of the underdosing region when a typically used treatment field. $8cm\times8cm$, is employed.

• Journal of the Society of Cosmetic Scientists of Korea
• /
• v.30 no.2
• /
• pp.263-278
• /
• 2004

Ursolic acid (UA) and Oleanolic acid (ONA), known as urson, micromerol and malol, are pentacyclic triterpenoid compounds which naturally occur in a large number of vegetarian foods, medicinal herbs, and plants. They may occur in their free acid form or as aglycones for triterpenoid saponins, which are comprised of a triterpenoid aglycone, linked to one or more sugar moieties. Therefore UA and ONA are similar in pharmacological activity. Lately scientific research, which led to the identification of UA and ONA, revealed that several pharmacological effects, such as antitumor, hepato-protective, anti-inflammatory, anticarcinogenic, antimicrobial, and anti-hyperlipidemic could be attributed to UA and ONA. Here, we introduced the effect of UA and ONA on acutely barrier disrupted and normal hairless mouse skin. To evaluate the effects of UA and ONA on epidermal permeability barrier recovery, both flanks of 8-12 week-old hairless mice were topically treated with either 0.01-0.1mg/mL UA or 0.1-1mg/mL ONA after tape stripping, and TEWL (transepidermal water loss) was measured. The recovery rate increased in those UA or ONA treated groups (0.1mg/mL UA and 0.5mg/mL ONA) at 6h more than 20% compared to vehicle treated group (p < 0.05). Here, we introduced the effects of UA and ONA on acute barrier disruption and normal epidermal permeability barrier function. For verifying the effects of UA and ONA on normal epidermal barrier, hydration and TEWL were measured for 1 and 3 weeks after UA and ONA applications (2mg/mL per day). We also investigated the features of epidermis and dermis using electron microscopy (EM) and light microscopy (LM). Both samples increased hydration compared to vehicle group from 1 week without TEWL alteration (p < 0.005). EM examination using RuO4 and OsO4 fixation revealed that secretion and numbers of lamellar bodies and complete formation of lipid bilayers were most prominent (ONA=UA > vehicle). LM finding showed that thickness of stratum corneum (SC) was slightly increased and especially epidermal thickening and flattening was observed (UA > ONA > vehicle). We also observed that UA and ONA stimulate epidermal keratinocyte differentiation via PPAR Protein expression of involucrin, loricrin, and filaggrin increased at least 2 and 3 fold in HaCaT cells treated with either ONA (10${\mu}$M) or UA (10${\mu}$M) for 24 h respectively. This result suggested that the UA and ONA can improve epidermal permeability barrier function and induce the epidermal keratinocyte differentiation via PPAR Using Masson-trichrome and elastic fiber staining, we observed collagen thickening and elastic fiber elongation by UA and ONA treatments. In vitro results of collagen and elastin synthesis and elastase inhibitory activity measurements were also confirmed in vivo findings. These data suggested that the effects of UA and ONA related to not only epidermal permeability barrier functions but also dermal collagen and elastic fiber synthesis. Taken together, UA and ONA can be relevant candidates to improve epidermal and dermal functions and pertinent agents for cosmeseutical applications.

• Radiation Oncology Journal
• /
• v.9 no.1
• /
• pp.131-141
• /
• 1991

A comprehensive set of dosimetric measurements has been made on the Varian Clinac 1800 15 MV photon beam. Beam quality, percentage depth dose, dose in the build up region, output, symmetry and flatness, transmission through iead (Cerrobend), tray attenuation, isodose curves for the open and wedged fields were measured using 3 dimensional water phantom dosimetry system (including film densitometer system) and polystyrene phantoms. These dosimetric measurements sufficiently characterized the beam to permit clinical use. The depth dose characteristics of photon beam is $d_{max}$ of 3.0 cm and percentage depth dose of $76.8\%$ at 10 cm,100 cm source-surface distance, field size of $10\times10\;cm^2$ for 15 MV X-ray beam. The Output factors ranged 0.927 for $4\times4\;cm^2$ field to 1,087 for $35\times35\;cm^2$ field. The build-up level of maximum dose was at 3.0 cm and surface dose was approximately $15.5\%$ for a field size $10\times10\;cm^2$ The stability of output is $within\pm1\%$ and flatness and symmetry are $within\pm3\%$. The half value thickness (HVL) of lead is 13 mm, which corresponds to an attenuation coefficient of $0.053\;mm^{-1}$. These figures compare facorably with the manufacturesr`s specifications.

• Radiation Oncology Journal
• /
• v.27 no.2
• /
• pp.103-110
• /
• 2009

Purpose: To investigate the feasibility of helical tomotherapy on a wide curved area of the skin, and its accuracy in calculating the absorbed dose in the superficial region. Materials and Methods: Two types of treatment plans were made with the cylinder-shaped 'cheese phantom'. In the first trial, 2 Gy was prescribed to a 1-cm depth from the surface. For the other trial, 2 Gy was prescribed to a 1-cm depth from the external side of the surface by 5 mm. The inner part of the phantom was completely blocked. To measure the surface dose and the depth dose profile, an EDR2 film was inserted into the phantom, while 6 TLD chips were attached to the surface. Results: The film indicated that the surface dose of the former case was 118.7 cGy and the latter case was 130.9 cGy. The TLD chips indicated that the surface dose was higher than these, but it was due to the finite thickness of the TLD chips. In the former case, 95% of the prescribed dose was obtained at a 2.1 mm depth, while the prescribed does was at 2.2 mm in the latter case. The maximum dose was about 110% of the prescribed dose. As the depth became deeper, the dose decreased rapidly. Accordingly, at a 2-cm depth, the dose was 20 % of the prescribed dose. Conclusion: Helical tomotherapy could be a useful application in the treatment of a wide area of the skin with curvature. However, for depths up to 2 mm, the planning system overestimated the superficial dose. For shallower targets, the use of a compensator such as a bolus is required.

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

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

• Journal of the korean academy of Pediatric Dentistry
• /
• v.33 no.4
• /
• pp.643-652
• /
• 2006

The purpose of this study was to elucidate the size and morphologic characteristics of maxillary primary first molars in Korean children using three-dimensional laser scanner and compare three-dimensional image with preformed stainless steel crown. Scanned three-dimensional images of dental cast taken from 132 children(male 62, female 70) by three-dimensional laser scanner(Breuckmann opto-Top HE100, INUS, Korea) were used. Mesiodistal diameter, buccolingual diameter, occlusogingival height and crown shape of each image were calculated by Rapidform 2004 program(INUS, Korea). The values were statistically compared by independent samples t-test with 95% of significant level. The results were as follows : 1. No significant difference in crown size was found between left and right maxillay primary first molar(p>0.05). 2, Significant difference in mesiodistal diameter, buccolingual diameter, buccal occlusogingival height was found between male and female (p<0.05), and crown size of male was bigger than that of female. 3. Average image of maxillay primary first molar was shaped three-dimensionally and measured. In comparison with 3M stainless steel crown, this image was similar with No.4 or No.5 SS crown in male, No.4 in female. In comparison with ILSUNG SS crown, this image was similar with No.5 in male, No.4 in female. 4 Mesiolingual line angle area, distolingual line angle area and buccogingival ridge were more obvious in average image than 3M stainless steel crown. ILSUNG SS crown was more square and had longer mesiodistal diameter than average 3D image.