Lee Sang Wook;Suh Chang Ok;Chung Eun Ji;Kim Woo Cheol;Chang Sei Kyung;Keum Ki Chang;Kim Gwi Eon
Radiation Oncology Journal
/
v.14
no.3
/
pp.201-209
/
1996
Purpose : To assess the efficacy of high dose rate - intracavitary radio-therapy (HDR-ICR) in the radiotherapy of FIGO stage IB squamous cell carcinoma of uterine cervix and to determine the optimum dose combination scheme of external radiotherapy and ICR to achieve acceptable local control without severe complication. Materials and Methods : One hundred and sixty two patients with FIGO stage Ib squamous cell carcinoma of uterine cervix who received definitive radiotherapy between May 1979 and December 1990 were retrospectively analyzed. All the patients received external radiotherapy combined with HDR-ICR. External dose of 40-46 Gy in 4.5-5 weeks was given to whole pelvis(median 45 Gy) and ICR dose of 30-39 Gy in 10-13 times was given to the point A. Midline shielding was done after 20-45 Gy of external radiotherapy(median 40 Gy) Summation of external dose Plus ICR dose to the point A range were 64.20-95.00 Gy. and mean was 83.94 Gy. We analyzed the local control rate, survival rate, and late complication rate. Rusults : Initial complete response rate was $99.4\%$ for all patients. Overall 5-year survival rate was $91.1\%$ and 5-year disease free survival rate was $90.9\%$. Local failure rate was $4.9\%$ and distant failure rate was $4.3\%$. Tumor size was the only significant prognostic factor. When tumor size greater than 3cm, 5-rear survival rate was $92.6\%$ and less than 3cm, that was $79.6\%$. Late complication rate was $23.5\%$ with $18.5\%$ of rectal complication and $4.9\%$ of bladder complication. Mean rectal dose summation of external midline dose plus ICR rectal point dose was lower in the patients without rectal complication(74.88 Gr) than those with rectal complication (78.87 Gy). Complication rate was increased with low rate of improvement of survival rate when summation of external midline dose plus point A or point R dose by ICR was greater than 70-75 Gy. Conclusion : The definitive radiation therapy using high dose rate ICR in FIGO stage IB uterine cervical cancer is effective treatment modality with good local control and survival rate without severe complication.
Because the MIRD phantom, the representative mathematical phantom was developed for the calculation of internal radiation dose, and simulated by the simplified mathematical equations for rapid computation, the appropriateness of application to external dose calculation and the closeness to real human body should be justified. This study was intended to modify the MIRD phantom according to the comparison of the organ absorbed doses in the two phantoms exposed to monoenergetic broad parallel photon beams of the energy between 0.05 MeV and 10 MeV. The organ absorbed doses of the MIRD phantom and the Zubal yokel phantom were calculated for AP and PA geometries by MCNP4C, general-purpose Monte Carlo code. The MIRD phantom received higher doses than the Zubal phantom for both AP and PA geometries. Effective dose in PA geometry for 0.05 MeV photon beams showed the difference up to 50%. Anatomical axial views of the two phantoms revealed the thinner trunk thickness of the MIRD phantom than that of the Zubal phantom. To find out the optimal thickness of trunk, the difference of effective doses for 0.5 MeV photon beams for various trunk thickness of the MIRD phantom from 20 cm to 36 cm were compared. The optimal thunk thickness, 24 cm and 28 cm for AP and PA geometries, respectively, showed the minimum difference of effective doses between the two phantoms. The trunk model of the MIRD phantom was modified and the organ doses were recalculated using the modified MIRD phantom. The differences of effective dose for AP and PA geometries reduced to 7.3% and the overestimation of organ doses decreased, too. Because MIRD-type phantoms are easier to be adopted in Monte Carlo calculations and to standardize, the modifications of the MIRD phantom allow us to hold the advantage of MIRD-type phantoms over a voxel phantom and alleviate the anatomical difference and consequent disagreement in dose calculation.
This paper aimed to analyse dose sensitivity to the controllable parameters of indoor radon $(^{222}Rn)$ and its decay products (Rn-D) by applying the input~output linear system theory. Physical behaviors of $^{222}Rn\;&\;Rn-D$ were analyzed in terms of $(^{222}Rn)$ gas -generation, -migation and -infiltration to indoor environments, and the performance output-function, i. e. mean dose equivalent to Tracho-Bronchial (TB) lung region, was assessed to the following extented ranges of the controllable paramenters; a) the ventilation rate $constant({\lambda}_v)\;:\;0{\sim}50[h^{-l}].\;b)$ the attachment rate $constant({\lambda}_a)\;:\;0{\sim}500[h^{-l}].\;c)$ the unattached-deposition rate constant (${\lambda}^u_d)\;:\;0-50[h-l]$. A linear input-output model was reconstructed from the original models in literatures, as follows, which was modified into the matrices consisting of 111 nodal equations; a) indoor $^{222}Rn\;&\;Rn-D$ Behaviour; Jacobi-Porstendoerfer-Bruno model.
This study analyzed the movement of tumors using 4DCT. Appropriate uniform IM were identified using TC, II and CI depending on ITV margins. DVH and NTCP were also compared in each case. Dose analysis on tumors with uniform IM showed that the optimal treatment plan for satisfying all TC, CI, II was evaluated as 2 mm in phase 20 and 3 mm in 40%. That was compared to the dose from the normal tissues of $PTV_{20}$, $PTV_{40}$. In the 20% radiation field, V5, V10, and V20 for the lungs increased 1.49, 1.26, and 0.65%, while 40% increased by 1.9, 2.41 and 1.23%. NTCP had a dose increase of 0.57 to 0.029% from 20% and 40%. There was a dose increase in the spinal cord and heart at uniform IM, but there was no significant difference. These data suggest that the ITV setting of 20%, phase for Respiratory Gated Radiotherapy using Novalis ExacTrac system can be applied with a uniform IM 2 mm and 40% with 3 mm for optimal treatment plan.
The radiation dose received by the patient varies according to the tube current and time used during dental intraoral imaging. A large amount of tube current is required for image quality, but the radiation dose to the patient increases accordingly. Therefore, in this study, the optimal amount of tube current that can reduce the radiation dose received by the patient while securing the image quality was calculated through the evaluation of the image quality according to the tube current used during intraoral imaging through simulation. The average tube current, time, and tube voltage presented in the Guidelines for Diagnostic Reference Level for intraoral radiography were used as basic imaging conditions, and images were obtained when only the tube current was changed, and then the optimal tube current was compared and analyzed with the basic image quantity was calculated. Images were obtained by changing the tube current to 0.1, 0.5, 1, 2, 3, 4 and 5 mA under the basic conditions of 63 kV, 6 mA, and 0.29 s. The obtained image was evaluated for structural similarity index with the image taken under the condition of 6 mA using the ICY program. As a result, even under the condition of 0.5 mA tube current, the index of structural similarity with the image of 6 mA was evaluated to be high. Based on these results, it is considered that the radiation dose given to the patient can be greatly reduced if imaging is performed at 0.5 mA instead of 6 mA during dental intraoral imaging.
With the recent prevalence of helical CT and multi-slice CT, which deliver higher radiation dose than conventional CT due to overbeaming effect in X-ray exposure and interpolation technique in image reconstruction. Although multi-detector and helical CT scanner provide a variety of opportunities for patient dose reduction, the potential risk for high radiation levels in CT examination can't be overemphasized in spite of acquiring more diagnostic information. So much more concerns is necessary about dose characteristics of CT scanner, especially dose efficient design as well as dose modulation software, because dose efficiency built into the scanner's design is probably the most important aspect of successful low dose clinical performance. This study was conducted to evaluate z-axis geometric dose efficiency in single detector CT and each level multi-detector CT, as well as to compare z-axis dose efficiency with change of technical scan parameters such as focal spot size of tube, beam collimation, detector combination, scan mode, pitch size, slice width and interval. The results obtained were as follows ; 1. SDCT was most highest and 4 MDCT was most lowest in z-axis geometric dose efficiency among SDCT, 4, 8, 16, 64 slice MDCT made by GE manufacture. 2. Small focal spot was 0.67-13.62% higher than large focal spot in z-axis geometric dose efficiency at MDCT. 3. Large beam collimation was 3.13-51.52% higher than small beam collimation in z-axis geometric dose efficiency at MDCT. 4. Z-axis geometric dose efficiency was same at 4 slice MDCT in all condition and 8 slice MDCT of large beam collimation with change of detector combination, but was changed irregularly at 8 slice MDCT of small beam collimation and 16 slice MDCT in all condition with change of detector combination. 5. There was no significant difference for z-axis geometric dose efficiency between conventional scan and helical scan, and with change of pitch factor, as well as change of slice width or interval for image reconstruction. As a conclusion, for reduction of patient radiation dose delivered from CT examination we are particularly concerned with dose efficiency of equipment and have to select proper scanning parameters which increase z-axis geometric dose efficiency within the range of preserving optimum clinical information in MDCT examination.
Wedge shaped isodoses are desired in a number of clinical situations. Hard wedge filters have provided nominal angled isodoses with dosimetric consequences of beam hardening, increased peripheral dosing, nonidealized gradients at deep depths along with the practical consequendes of filter handling and placement problems. Dynamic wedging uses a combination of a moving collimator and changing monitor dose to achieve angled isodoses. The segmented treatment tables(STT) that monitor unit setting by every distance of moving collimator, was induced by numerical formular. The characteristics of dynamic wedge by STT compared with real dosimetry. Methods and Materials : The accelerator CLINAC 2100C/D at Yonsei Cancer Center has two photon energies (6MV and 10MV), currently with dynamic wedge angles of 15$^{\circ}$, 30$^{\circ}$, 45$^{\circ}$ and 60$^{\circ}$. The segmented treatment tables(STT) that drive the collimator in concert with a changing monitor unit are unique for field sizes ranging from 4.0cm to 20.0cm in 0.5cm steps. Transmission wedge factors were measured for each STT with an standard ion chamber. Isodose profiles, isodose curves, percentage depth dose for dynamic wedge filters were measured with film dosimetry. Dynamic wedge angle by STT was well coincident with film dosimetry. Percent depth doses were found to be closer to open field but more shallow than hard wedge filter. The wedge transmission factor were decreased by increased the wedge angle and more higher than hard wedge filters. Dynamic wedging probided more consistent gradients across the field compared with hard wedge filters. Dynamic wedging has practical and dosimetric advantages over hard filters for rapid setup and keeping from table collisions. Dynamic wedge filters are positive replacement for hard filters and introduction of dynamic conformal radiotherapy and intensity modulation radiotherapy in a future.
Kim, Young-Bum;Lee, Sang-Rok;Chung, Se-Young;Kwon, Young-Ho
The Journal of Korean Society for Radiation Therapy
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v.18
no.1
/
pp.35-41
/
2006
Purpose: A various find of radiotherapy treatment plans have been made to determine appropriate doses for breasts, chest walls and loco-regional lymphatics in the radiotherapy of breast cancers. The aim of this study was to evaluate the optimum radiotherapy plan technique method by analyzing dose distributions qualitatively and quantitatively. Materials and Methods: To evaluate the optimum breast cancer radiotherapy plan technique, the traditional method(two dimensional method) and computed tomography image are adopted to get breast volume, and they are compared with the three-dimensional conformal radiography (3DCRT) and the intensity modulated radiotherapy (IMRT). For this, the regions of interest (ROI) such as breasts, chest walls, loco-regional lymphatics and lungs were marked on the humanoid phantom, and the computed tomography(Volume, Siemens, USA) was conducted. Using the computed tomography image obtained, radiotherapy treatment plans (XiO 5.2.1, FOCUS, USA) were made and compared with the traditional methods by applying 3DCRT and IMRT. The comparison and analysis were made by analyzing and conducting radiation dose distribution and dose-volume histogram (DVH) based upon radiotherapy techniques (2D, 3DCRT, IMRT) and point doses for the regions of interest. Again, treatment efficiency was evaluated based upon time-labor. Results: It was found that the case of using 3DCRT plan techniques by getting breast volume is more useful than the traditional methods in terms of tumor delineation, beam direction and confirmation of field boundary. Conclusion: It was possible to present the optimum radiotherapy plan techniques through qualitative and quantitative analyses based upon radiotherapy plan techniques in case of breast cancer radiotherapy. However, further studies are required for the problems with patient setup reproducibility arising from the difficulties of planning target volume (PVT) and breast immobilization in case of three-dimensional radiotherapy planning.
Song, Yong Min;Choi, Ji Min;Kim, Jin Man;Kwon, Dong Yeol;Kim, Jong Sik;Cho, Hyun Sang;Song, Ki Won
The Journal of Korean Society for Radiation Therapy
/
v.26
no.2
/
pp.225-232
/
2014
Purpose : The purpose of this study was to evaluate the surface and superficial dose for patients requiring postmastectomy radiation therapy(PMRT) with different treatment techniques. Materials and Methods : Computed tomography images were acquired for the phantom(I'mRT, IBA) consisting of tissue equivalent material. Hypothetical chestwall and lung were outlined and modified. Five treatment techniques(Wedged Tangential; WT, 4-field IMRT, 7-field IMRT, TOMO DIRECT, TOMO HELICAL) were evaluated using only 6MV photon beam. GafChromic EBT3 film was used for dose measurements at the surface and superficial dose. Surface dose profiles around the phantom were obtained for each treatment technique. For superficial dose measurements, film were used inside the phantom and analyzed superficial region for depth from 1-6mm. Results : TOMO DIRECT showed the highest surface dose by 47~70% of prescribed dose, while 7-field IMRT showed the lowest by 35~46% of prescribed dose. For the WT, 4-field IMRT and 7-field IMRT, superficial dose were measured over 60%, 70%, and 80% for 1mm, 2mm, and 5mm depth, respectively. In case of TOMO DIRECT and TOMO HELICAL, over 75%, 80%, and 90% of prescribed dose was measured, respectively. Surface and superficial dose range were uniform in overall chestwall for the 7-field IMRT and TOMO HELICAL. In contrast, Because of the dose enhancement effect with oblique incidence, The dose was gradually increased toward the obliquely tangential angle for the WT and TOMO DIRECT. Conclusion : For PMRT, TOMO DIRECT and TOMO HELICAL deliver the higher surface and superficial doses than treatment techniques based linear accelerator. It showed adequate dose(over 75% of prescribed dose) at 1mm depth in skin region.
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