• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.157-165
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• 2012

Purpose: We evaluated usefulness of abdominal compressor for stereotactic body radiotherapy (SBRT) with unresectable hepatocellular carcinoma (HCC) patients and hepato-biliary cancer and metastatic liver cancer patients. Materials and Methods: From November 2011 to March 2012, we selected HCC patients who gained reduction of diaphragm movement >1 cm through abdominal compressor (diaphragm control, elekta, sweden) for HT (Hi-Art Tomotherapy, USA). We got planning computed tomography (CT) images and 4 dimensional (4D) images through 4D CT (somatom sensation, siemens, germany). The gross tumor volume (GTV) included a gross tumor and margins considering tumor movement. The planning target volume (PTV) included a 5 to 7 mm safety margin around GTV. We classified patients into two groups according to distance between tumor and organs at risk (OAR, stomach, duodenum, bowel). Patients with the distance more than 1 cm are classified as the 1st group and they received SBRT of 4 or 5 fractions. Patients with the distance less than 1 cm are classified as the 2nd group and they received tomotherapy of 20 fractions. Megavoltage computed tomography (MVCT) were performed 4 or 10 fractions. When we verify a MVCT fusion considering priority to liver than bone-technique. We sent MVCT images to Mim_vista (Mimsoftware, ver .5.4. USA) and we re-delineated stomach, duodenum and bowel to bowel_organ and delineated liver. First, we analyzed MVCT images to check the setup variation. Second we compared dose difference between tumor and OAR based on adaptive dose through adaptive planning station and Mim_vista. Results: Average setup variation from MVCT was $-0.66{\pm}1.53$ mm (left-right) $0.39{\pm}4.17$ mm (superior-inferior), $0.71{\pm}1.74$ mm (anterior-posterior), $-0.18{\pm}0.30$ degrees (roll). 1st group ($d{\geq}1$) and 2nd group (d<1) were similar to setup variation. 1st group ($d{\geq}1$) of $V_{diff3%}$ (volume of 3% difference of dose) of GTV through adaptive planing station was $0.78{\pm}0.05%$, PTV was $9.97{\pm}3.62%$, $V_{diff5%}$ was GTV 0.0%, PTV was $2.9{\pm}0.95%$, maximum dose difference rate of bowel_organ was $-6.85{\pm}1.11%$. 2nd Group (d<1) GTV of $V_{diff3%}$ was $1.62{\pm}0.55%$, PTV was $8.61{\pm}2.01%$, $V_{diff5%}$ of GTV was 0.0%, PTV was $5.33{\pm}2.32%$, maximum dose difference rate of bowel_organ was $28.33{\pm}24.41%$. Conclusion: Despite we saw diaphragm movement more than 5 mm with flouroscopy after use an abdominal compressor, average setup_variation from MVCT was less than 5 mm. Therefore, we could estimate the range of setup_error within a 5 mm. Target's dose difference rate of 1st group ($d{\geq}1$) and 2nd group (d<1) were similar, while 1st group ($d{\geq}1$) and 2nd group (d<1)'s bowel_organ's maximum dose difference rate's maximum difference was more than 35%, 1st group ($d{\geq}1$)'s bowel_organ's maximum dose difference rate was smaller than 2nd group (d<1). When applicating SBRT to HCC, abdominal compressor is useful to control diaphragm movement in selected patients with more than 1 cm bowel_organ distance.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.2
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• pp.43-51
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• 2017

Purpose: The purpose of this study is to evaluate the dosimetric effects of couch attenuation and air gaps using 3D phantom for prone breast radiation therapy. Materials and method: A 3D printer(Builder Extreme 1000) and computed tomography (CT) images of a breast cancer patient were used to manufacture the customized breast phantom. Eclipse External Beam Planning 13.6 (Varian Medical Systems Palo Alto, CA, USA) was used to create the treatment plan with a dose of 200 cGy per fraction with 6 MV energy. The Optically Stimulated Luminescence Detector(OSLD) was used to measure the skin dose at four points (Med 1, Med 2, Lat 1, Lat 2) on the 3D phantom and ion-chamber (FC65-G) were used to perform the in-vivo dosimetry at the two points (Anterior, Posterior). The Skin dose and in-vivo dosimetry were measured with reference air gap (3 cm) and increased air gaps (1, 2, 3, 4, 5, 6 cm) from reference distance between the couch and 3D phantom. Results: As a result, measurement for the skin dose at lateral point showed a similar value within ${\pm}4%$ compared to the plan. While the air gap increased, skin dose at medial 1 was reduced. And it was also reduced over 7 % when the air gap was more than 3 cm compared to radiation therapy plan. At medial 2 it was reduced over 4 % as well. The changes of dose from variety of the air gap showed similar value within ${\pm}1%$ at posterior. As the air gap was increased, the dose at anterior was also increased and it was increased by 1 % from the air gap distance more than 3 cm. Conclusion: Dosimetrical measurement using 3D phantom is very useful to evaluate the dosimetric effects of couch attenuation and air gaps for prone breast radiation therapy. And it is possible to reduce the skin dose and increase the accuracy of the radiation dose delivery by appling the optimized air gap.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.2
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• pp.103-108
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• 2011

Purpose: Opposing portal irradiation with helmet field shape that has been given to a patient with brain metastasis can cause excess dose in patient's scalp, resulting in hair loss. For this reason, this study is to quantitatively analyze scalp dose for effective prevention of hair loss by comparing opposing portal irradiation with scalp-shielding shape and tomotherapy designed to protect patient's scalp with conventional radiation therapy. Materials and Methods: Scalp dose was measured by using three therapies (HELMET, MLC, TOMO) after five thermo-luminescence dosimeters were positioned along center line of frontal lobe by using RANDO Phantom. Scalp dose and change in dose distribution were compared and analyzed with DVH after radiation therapy plan was made by using Radiation Treatment Planning System (Pinnacle3, Philips Medical System, USA) and 6 MV X-ray (Clinac 6EX, VARIAN, USA). Results: When surface dose of scalp by using thermo-luminescence dosimeters was measured, it was revealed that scalp dose decreased by average 87.44% at each point in MLC technique and that scalp dose decreased by average 88.03% at each point in TOMO compared with HELMET field therapy. In addition, when percentage of volume (V95%, V100%, V105% of prescribed dose) was calculated by using Dose Volume Histogram (DVH) in order to evaluate the existence or nonexistence of hotspot in scalp as to three therapies (HELMET, MLC, TOMO), it was revealed that MLC technique and TOMO plan had good dose coverage and did not have hot spot. Conclusion: Reducing hair loss of a patient who receives whole brain radiotherapy treatment can make a contribution to improve life quality of the patient. It is expected that making good use of opposing portal irradiation with scalp-shielding shape and tomotherapy to protect scalp of a patient based on this study will reduce hair loss of a patient.

• Journal of Radiation Protection and Research
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• v.23 no.4
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• pp.211-218
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• 1998

The distributional effects of radioactive materials on external gamma exposure have been analyzed. An approximate method for estimating external gamma dose given from an arbitrary distribution of radioactive material has been developed. The minimum gamma exposure given from a point source is shown at 0.07 MeV if the source to receptor distance is shorter than 10 m. But if the receptor to point source distance is longer than 20 m, gamma exposure rate increases monotonously according to the average gamma energy. For the analysis of the effects of volume source, we estimated the gamma dose given from different size of hemisphere in which radioactive materials are distributed uniformly. When the radius of hemisphere is longer than 40 m, external gamma dose rate increases monotonously. The gamma dose rate given from the radioactive materials deposited on the ground shows the minimum value at 0.07 MeV in any case. The analysis shows that external gamma exposure is strongly dependent on the distribution of radioactive materials in the environment and gamma energy.

• Journal of the Korean Society of Radiology
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• v.10 no.1
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• pp.21-28
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• 2016

This study tries to evaluate the usefulness CSI treatment. Compare the standard technique and simple technique, using the volume region of a high dose of Field joints (hot spot) or low dose regions (cold Spot). In patients who agreed to this study, obtain CT image using CT simulator skull to pelvis region. Standard Technique were performed on the movement of the joint radiation field range and simple technique has set a treatment plan to secure the radiation field range and analyzed treatment planning. Under analysis standard technique occurred the area of the high dose(Hot Spot) for the area overlapping the field and simple technique showing a uniform doses. CI indices of standard technique and simple technique was 1.6~3, 1.6~1.87, CN indices was 0.32~0.53, 0.46~0.51 and HI indices was 0.11~0.33, 0.2~0.26. Therefore, adjacent to part of the dose distribution junction more equally than simple technique compared to the Standard Technique. Compare the dose distribution patterns using CI, CN, HI indices, showed a uniform dose distribution in the simple technique. so, simple technique was determined appropriate treatment the CSI.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.481-487
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• 2023

In this study, we analyzed the incidence of side effects of photoneutron dose according to the number of beams during intensity-modulated radiotherapy of prostate cancer using 15 MV. The radiation treatment plan design for intensity-modulated radiation therapy for prostate cancer was established with a prescription dose of 220 cGy per dose and a total of 7260 cGy for 33 treatments. The linear accelerator used in the experiment is Varian's True Beam STx (Varian, USA). Photoneutron dose was generated by using 15 MV energy in the planning target volume (PTV). The treatment plan was designed with IMRT 5, 7, and 9 portals using the Eclipse System (Varian Ver 10.0, USA). An optically stimulated luminescence albedo neutron dosimeter (Landauer Inc., USA) was used to measure photoneutron dose. IMRT 5 portals, 1.7 per 1,000, 7 portals, 1.8 per 1,000, 9 portals, 2.0 per 1,000 were calculated as the probability of experiencing side effects on the thyroid gland due to photoneutron dose. This study studies the risk of secondary radiation exposure dose that can occur during intensity-modulated radiation therapy, and it is considered that it will be used as useful data in relation to stochastic effects in the future.

• Journal of the Korean Society of Radiology
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• v.17 no.6
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• pp.801-808
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• 2023

In order to minimize radiation exposure and secure diagnostic value images during CT examination of the head of children, the usefulness of volume axial mode is evaluated through comparison and analysis of exposure dose and images of volume axial mode, high pitch mode, and helical mode. Image evaluation and dose evaluation were performed in CT high pitch mode, helical mode, and volume axial mode for infants under the age of 1 according to the voltages of 70, 80, and 100 kVp tubes. The image evaluation was conducted by comparing image quality by setting ROI for each image, calculating SNR and CNR, using ONE-WAY (ANOVA) to evaluated statistical significance, and cross-examining the dose evaluation using DLP values displayed in the Dose Report. When inspected using volume axial mode, DLP values were generally low, and SNR and CNR values differed by ROI and kVp. When volume axial mode evaluated the quality of the image compared to other scan modes, the difference is not uniform. For the reason, certain modes are not considered excellent, but the exposure dose was reduced the most in terms of dose. In addition, the point that the volume axial mode can be examined at its original location, short scanning time and needless of table movement is useful for CT tests for children under 1 year of age with high radiation sensitivity.

• Radiation Oncology Journal
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• v.20 no.1
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• pp.41-52
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• 2002

Purpose : 3D conformal radiotherapy, the optimum dose delivered to the tumor and provided the risk of normal tissue unless marginal miss, was restricted by organ motion. For tumors in the thorax and abdomen, the planning target volume (PTV) is decided including the margin for movement of tumor volumes during treatment due to patients breathing. We designed the respiratory gating radiotherapy device (RGRD) for using during CT simulation, dose planning and beam delivery at identical breathing period conditions. Using RGRD, reducing the treatment margin for organ (thorax or abdomen) motion due to breathing and improve dose distribution for 3D conformal radiotherapy. Materials and Methods : The internal organ motion data for lung cancer patients were obtained by examining the diaphragm in the supine position to find the position dependency. We made a respiratory gating radiotherapy device (RGRD) that is composed of a strip band, drug sensor, micro switch, and a connected on-off switch in a LINAC control box. During same breathing period by RGRD, spiral CT scan, virtual simulation, and 3D dose planing for lung cancer patients were peformed, without an extended PTV margin for free breathing, and then the dose was delivered at the same positions. We calculated effective volumes and normal tissue complication probabilities (NTCP) using dose volume histograms for normal lung, and analyzed changes in doses associated with selected NTCP levels and tumor control probabilities (TCP) at these new dose levels. The effects of 3D conformal radiotherapy by RGRD were evaluated with DVH (Dose Volume Histogram), TCP, NTCP and dose statistics. Results : The average movement of a diaphragm was 1.5 cm in the supine position when patients breathed freely. Depending on the location of the tumor, the magnitude of the PTV margin needs to be extended from 1 cm to 3 cm, which can greatly increase normal tissue irradiation, and hence, results in increase of the normal tissue complications probabiliy. Simple and precise RGRD is very easy to setup on patients and is sensitive to length variation (+2 mm), it also delivers on-off information to patients and the LINAC machine. We evaluated the treatment plans of patients who had received conformal partial organ lung irradiation for the treatment of thorax malignancies. Using RGRD, the PTV margin by free breathing can be reduced about 2 cm for moving organs by breathing. TCP values are almost the same values $(4\~5\%\;increased)$ for lung cancer regardless of increasing the PTV margin to 2.0 cm but NTCP values are rapidly increased $(50\~70\%\;increased)$ for upon extending PTV margins by 2.0 cm. Conclusion : Internal organ motion due to breathing can be reduced effectively using our simple RGRD. This method can be used in clinical treatments to reduce organ motion induced margin, thereby reducing normal tissue irradiation. Using treatment planning software, the dose to normal tissues was analyzed by comparing dose statistics with and without RGRD. Potential benefits of radiotherapy derived from reduction or elimination of planning target volume (PTV) margins associated with patient breathing through the evaluation of the lung cancer patients treated with 3D conformal radiotherapy.

• Progress in Medical Physics
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• v.25 no.3
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• pp.167-175
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• 2014

The purpose of this study is to evaluate the variation of the dose which is delivered to the patients with glottis cancer under IMRT (intensity modulated radiation therapy) by using the 3D registration with CBCT (cone beam CT) images and the DIR (deformable image registration) techniques. The CBCT images which were obtained at a one-week interval were reconstructed by using B-spline algorithm in DIR system, and doses were recalculated based on the newly obtained CBCT images. The dose distributions to the tumor and the critical organs were compared with reference. For the change of volume depending on weight at 3 to 5 weeks, there was increased of 1.38~2.04 kg on average. For the body surface depending on weight, there was decreased of 2.1 mm. The dose with transmitted to the carotid since three weeks was increased compared be more than 8.76% planned, and the thyroid gland was decreased to 26.4%. For the physical evaluation factors of the tumor, PITV, TCI, rDHI, mDHI, and CN were decreased to 4.32%, 5.78%, 44.54%, 12.32%, and 7.11%, respectively. Moreover, $D_{max}$, $D_{mean}$, $V_{67.50}$, and $D_{95}$ for PTV were increased or decreased to 2.99%, 1.52%, 5.78%, and 11.94%, respectively. Although there was no change of volume depending on weight, the change of body types occurred, and IMRT with the narrow composure margin sensitively responded to such a changing. For the glottis IMRT, the patient's weight changes should be observed and recorded to evaluate the actual dose distribution by using the DIR techniques, and more the adaptive treatment planning during the treatment course is needed to deliver the accurate dose to the patients.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.1
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• pp.31-37
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• 2012

Purpose: This study evaluated the usefulness of Helmet bolus device using Bolx-II, paraffin wax, solid thermoplastic material in total scalp irradiation. Materials and Methods: Using Rando phantom, we applied Bolx-II (Action Products, USA), paraffin wax (Densply, USA), solid thermoplastic material (Med-Tec, USA) on the whole scalp to make helmet bolus device. Computed tomography (GE, Ultra Light Speed16) images were acquired at 5 mm thickness. Then, we set up the optimum treatment plan and analyzed the variation in density of each bolus (Philips, Pinnacle). To evaluate the dose distribution, Dose-homogeneity index (DHI, $D_{90}/D_{10}$) and Conformity index (CI, $V_{95}/TV$) of Clinical Target Volume (CTV) using Dose-Volume Histogram (DVH) and $V_{20}$, $V_{30}$ of normal brain tissues. we assessed the efficiency of production process by measuring total time taken to produce. Thermoluminescent dosimeters (TLD) were used to verify the accuracy. Results: Density variation value of Bolx-II, paraffin wax, solid thermoplastic material turned out to be $0.952{\pm}0.13g/cm^3$, $0.842{\pm}0.17g/cm^3$, $0.908{\pm}0.24g/cm^3$, respectively. The DHI and CI of each helmet bolus device which used Bolx-II, paraffin wax, solid thermoplastic material were 0.89, 0.85, 0.77 and 0.86, 0.78, 0.74, respectively. The result of Bolx-II was the best. $V_{20}$ and $V_{30}$ of brain tissues were 11.50%, 10.80%, 10.07% and 7.62%, 7.40%, 7.31%, respectively. It took 30, 120, 90 minutes to produce. The measured TLD results were within ${\pm}7%$ of the planned values. Conclusion: The application of helmet bolus which used Bolx-II during total scalp irradiation not only improves homogeneity and conformity of Clinical Target Volume but also takes short time and the production method is simple. Thus, the helmet bolus which used Bolx-II is considered to be useful for the clinical trials.