• Radiation Oncology Journal
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• v.17 no.1
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• pp.78-83
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• 1999

Purpose : We have compared the characteristics of Siemens virtual wedge device with physical wedges for clinical application. Materials and Methods : We investigated the characteristics of virtual and physical wedges for various wedge angles (15, 30, 45, and 60$^{\circ}$) using 6- and 15MV photon beams. Wedge factors were measured in water using an ion chamber for various field sizes and depths. In case of virtual wedge device, as upper jaw moves during irradiation, wedge angles were estimated by accumulated doses. These measurements were performed at off-axis points perpendicular to the beam central axis in water for a 15cm${\times}$20cm radiation field size at the depth of loom. Surface doses without and with virtual or physical wedges were measured using a parallel plate ion chamber at surface. Field size was 15cm H20cm and a polystyrene phantom was used. Results : For various field sizes, virtual and physical wedge factors were changed by maximum 2.1% and 3.9%) , respectively. For various depths, virtual and physical wedge factors were changed by maximum 1.9% and 2.9%, respectively. No major difference was found between the virtual and physical wedge angles and the difference was within 0.5$^{\circ}$ . Suface dose with physical wedge was reduced by maximum 20% (x-ray beam :6 MV, wedge angle:45$^{\circ}$, 550: 80 cm) relative to one with virtual wedge or without wedge. Conclusions : Comparison of the characteristics of Siemens virtual wedge device with physical wedges was performed. Depth dependence of virtual wedge factor was smaller than that of physical wedge factor. Virtual and physical wedge factors were nearly independent of field sizes. The accuracy of virtual and physical wedge angles was excellent. Surface dose was found to be reduced using physical wedge.

• Progress in Medical Physics
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• v.25 no.2
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• pp.72-78
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• 2014

The aim of the study is to test a hypothesis that quasi-breath-hold (QBH) biofeedback improves the residual respiratory motion management in gated 3D thoracic MR imaging, reducing respiratory motion artifacts with insignificant acquisition time alteration. To test the hypothesis five healthy human subjects underwent two gated MR imaging studies based on a T2 weighted SPACE MR pulse sequence using a respiratory navigator of a 3T Siemens MRI: one under free breathing and the other under QBH biofeedback breathing. The QBH biofeedback system utilized the external marker position on the abdomen obtained with an RPM system (Real-time Position Management, Varian) to audio-visually guide a human subject for 2s breath-hold at 90% exhalation position in each respiratory cycle. The improvement in the upper liver breath-hold motion reproducibility within the gating window using the QBH biofeedback system has been assessed for a group of volunteers. We assessed the residual respiratory motion management within the gating window and respiratory motion artifacts in 3D thoracic MRI both with/without QBH biofeedback. In addition, the RMSE (root mean square error) of abdominal displacement has been investigated. The QBH biofeedback reduced the residual upper liver motion within the gating window during MR acquisitions (~6 minutes) compared to that for free breathing, resulting in the reduction of respiratory motion artifacts in lung and liver of gated 3D thoracic MR images. The abdominal motion reduction in the gated window was consistent with the residual motion reduction of the diaphragm with QBH biofeedback. Consequently, average RMSE (root mean square error) of abdominal displacement obtained from the RPM has been also reduced from 2.0 mm of free breathing to 0.7 mm of QBH biofeedback breathing over the entire cycle (67% reduction, p-value=0.02) and from 1.7 mm of free breathing to 0.7 mm of QBH biofeedback breathing in the gated window (58% reduction, p-value=0.14). The average baseline drift obtained using a linear fit was reduced from 5.5 mm/min with free breathing to 0.6 mm/min (89% reduction, p-value=0.017) with QBH biofeedback. The study demonstrated that the QBH biofeedback improved the upper liver breath-hold motion reproducibility during the gated 3D thoracic MR imaging. This system can provide clinically applicable motion management of the internal anatomy for gated medical imaging as well as gated radiotherapy.

• Journal of radiological science and technology
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• v.32 no.4
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• pp.461-469
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• 2009

To predict the tumor grading, various imaging modalities have been applied clinically. This study determines clinical usefulness of perfusion MRI, using relative cerebral blood volume in grading of the gliomas. We did a retrospective review of 17 patients (mean age, 57.5 years; 11 male, 6 female) who underwent perfusion MR and conventional MRI, and then correlated pathologically after operation. Statistical analysis of regional cerebral blood volume and relative cerebral blood volume(rCBV) was performed by using softwares such as PAT by SIEMENS and Xmap ver 2.0 developed by ourselves. Six patients out of 13 were low-grade gliomas while eleven patients were the high-grade gliomas. Mean relative CBV (m_rCBV/white matter) in the low-grade gliomas was 1.62, and mean relative CBV(m_rCBV/cortex) was 0.12. In the high-grade gliomas, mean relative CBV(m_rCBV/white matter) and mean relative CBV(m_rCBV/cortex) were 33.53 and 0.96. Mean relative CBV of gliomas were elevated with a statistical difference(P<.05), compared with contralateral white matter(P=.019) or cortex(P=.025). Furthermore mean relative CBV(m_rCBV/white matter) was much higher than mean relative CBV(m_rCBV/cortex). Perfusion MRI using regional cerebral blood volume and rCBV is very useful imaging modality for grading the glioma.

• The Journal of Korean Society for Radiation Therapy
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• v.15 no.1
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• pp.1-9
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• 2003

I. Purpose The multileaf collimator(MLC) has many advantages, but use of the MLC increased effective penumbra and isodose undulation in dose distribution compared with that of an alloy block. In this work, we introduced the HD-270 MLC, which can improve the above disadvantages of MLC, and reported its feasibility study. II. Method and Materials The HD-270 MLC is a technique which combines the use of the existing Siemens multileaf collimator(3D MLC) with patient translation perpendicular to the leaf plane. The technique produces a smoothed isodose distribution with the reduced isodose undulation and effective penumbra. To assess the efficacy of the HD-270 technique and determine the appropriate resolution, a polygonal shaped MLC field was made to produce field edge angles from 0 degree to 75 degree with a step of 15 degree. Each HD-270 group was generated according to the allowed resolution, i. e., 5, 3, and 2mm. The experiment was carried out on Primus, a Siemens linear accelerator configured with HD-270 MLC. The total 60 MU of 6 MV photon beam was delivered to X-Omat film(Kodak, USA) at a SAD of 100 cm and 1.5 cm depth in solid water phantom. Exposed films were scanned by Lumiscan75(LUMISYS) and analyzed using RIT113 software(Radiological Imaging Technology Inc., USA). To test the mechanical accuracy of table movement, the transverse, longitudinal, and vertical positions were controlled by a consol with ${\pm}5\;mm,\;{\pm}4\;mm,\;{\pm}3\;mm,\;and\;{\pm}2\;mm$ steps, and then measured using a dial gauge with an accuracy of 0.001 inch. During the experiments, the table loaded with about 50Kg human phantom to simulate the real treatment situation. III. Results The effective penumbra and isodose undulation became larger with increase the resolution and field edge angle. The accuracy of the table movement on each direction is good within the ${\pm}1\;mm$. IV. Conclusion Clinical use of the MLC can be increased by using of the HD-270 MLC which complements to the disadvantages of the MLC.

• The Journal of Korean Society for Radiation Therapy
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• v.16 no.1
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• pp.1-9
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• 2004

Purpose : The aim of this study is to investigate the properties of small field size and to measure the penumbra and central axis depth dose varying to the jaw setting and off axis distance for indicate this data to small field sizes radiation therapy. Material and methods : The percentage depth dose, beam profile and central axis output dose was measured by farmer type ion chamber and pinpoint chamber using Primart linac with 6MV energy. Beam quality and penumbra variations according to the central axis shift, from center to every 2cm outside increment, and field size, from $1{\times}1cm$ to $10{\times}10cm$ was investigated and compared with that of the standard geometrical condition's results Results : The differences of measured values between two ion chamber was about $37\%$ at 10cm depth with $1{\times}1cm$ field sizes but as field size increased this differences was diminished gradually. Measured data from various off axis distance with the different asymmetric collimations are not changed significantly but as size decreased the dose variation was increased and at $1{\times}1cm$ field size dose difference among off axis distance was as much as $13\%$, and as shallower the measured depth the central axis dose variations among the OAD was increased, penumbra was not changed noticeably depending on off axis distance but the percentage of penumbra from its initial field sizes was strongly dependant on field sizes and penumbra occupation rates of its own field sizes ranging from $6\%$ at $10{\times}10cm$ to $50\%$ at $1{\times}1cm$ field size. Conclusion : For imrt treatment, there are several numbers of different gentry angles with beams of nonuniform fluences are required and several complex factors involved. Among them the characteristics of beam output varying to the geometrical setting and design of collimators are of important to attaining a good treatment results. As mentioned in results the differences of measured values are changed significantly depends on ion chamber volume, depths and field size. For providing quality radiation treatment, especially at small field size, those factor's should have considering deliberately.

• The Korean Society of Law and Medicine
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• v.23 no.1
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• pp.81-119
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• 2022

Medical device market is strongly related with health care market. Public regulation in medical device market tends to be more lenient than health care market. In this market, competition law, administrative law and intellectual property law are intertwined, and thereby a variety of legal issues could be developed. Recently, dominant undertaking's abuse case was dealt with KFTC(Korea Fair Trade Commission) and Seoul High Court. The issues were whether dominant undertaking discriminated trading partners and this discrimination was anticompetitive. In this case, Seoul High Court revoked the KFTC's decision, holding that the undertaking did not harm competition, though it has dominant power in the relevant medical device market. This decision would be a meaningful precedent, not only that there have been small numbers of dominance abuse cases in Korea, but also that this case happened in medical device market. This case dealt with various issues like market definition, market power, alleged abuse and its anticompetitive effect. The court held that medical device markets are distinguished from medical device repairing market. However, the court did not clarify that medical device repairing market is a single branded market only for repairing the plaintiff's medical devices. Second, plaintiff's dominance is based on the lock-in effect, which means that hospitals could not switch devices like CT or MRI from plaintiff to other competitors. This could be supplemented from the fact that medical devices are expensive and the using period are significantly long. However market definition based on single branded market theory could be applied in rare and exceptional cases. Therefore the general application of single branded market theory might result in overestimate of market power. This type of abuse pattern requires improper condition contrary to resonable trade practice. KFTC asserted free charge for plaintiff's copy right. However, it is not clear whether the cases for free charge are general or not. Even if so, the intention and motive of providers for free charge should be proved. The main issue of anticompetitive effect was whether plaintiff raised rival's cost. Competitor's cost was increased due to plaintiff's copy right and its license fee. However the charge for license could be within the scope of fair and legal exercise of copy right. If competitors are excluded due to legal exercise of copy right or efficiency, the exclusionary abuse could not be proved.