• The Journal of Korean Society for Radiation Therapy
• /
• v.32
• /
• pp.41-52
• /
• 2020

Purpose: To find out the dosimetric usefulness, setup reproducibility and efficiency of applying 3D Bolus by comparing two treatment plans in which Commercial Bolus and 3D Bolus produced by 3D Printing Technology were applied to the neck during VMAT treatment of Hypopahrynx Cancer to evaluate the clinical applicability. Materials and Methods: Based on the CT image of the RANDO phantom to which CB was applied, 3D Bolus were fabricated in the same form. 3D Bolus was printed with a polyurethane acrylate resin with a density of 1.2g/㎤ through the SLA technique using OMG SLA 660 Printer and MaterializeMagics software. Based on two CT images using CB and 3D Bolus, a treatment plan was established assuming VMAT treatment of Hypopharynx Cancer. CBCT images were obtained for each of the two established treatment plans 18 times, and the treatment efficiency was evaluated by measuring the setup time each time. Based on the obtained CBCT image, the adaptive plan was performed through Pinnacle, a computerized treatment planning system, to evaluate target, normal organ dose evaluation, and changes in bolus volume. Results: The setup time for each treatment plan was reduced by an average of 28 sec in the 3D Bolus treatment plan compared to the CB treatment plan. The Bolus Volume change during the pretreatment period was 86.1±2.70㎤ in 83.9㎤ of CB Initial Plan and 99.8±0.46㎤ in 92.2㎤ of 3D Bolus Initial Plan. The change in CTV Min Value was 167.4±19.38cGy in CB Initial Plan 191.6cGy and 149.5±18.27cGy in 3D Bolus Initial Plan 167.3cGy. The change in CTV Mean Value was 228.3±0.38cGy in CB Initial Plan 227.1cGy and 227.7±0.30cGy in 3D Bolus Initial Plan 225.9cGy. The change in PTV Min Value was 74.9±19.47cGy in CB Initial Plan 128.5cGy and 83.2±12.92cGy in 3D Bolus Initial Plan 139.9cGy. The change in PTV Mean Value was 226.2±0.83cGy in CB Initial Plan 225.4cGy and 225.8±0.33cGy in 3D Bolus Initial Plan 224.1cGy. The maximum value for the normal organ spinal cord was the same as 135.6cGy on average each time. Conclusion: From the experimental results of this paper, it was found that the application of 3D Bolus to the irregular body surface is more dosimetrically useful than the application of Commercial Bolus, and the setup reproducibility and efficiency are excellent. If further case studies along with research on the diversity of 3D printing materials are conducted in the future, the application of 3D Bolus in the field of radiation therapy is expected to proceed more actively.

• Journal of radiological science and technology
• /
• v.39 no.2
• /
• pp.163-170
• /
• 2016

To evaluate whether the difference in geometrical characteristics between high-dose-rate (HDR) $^{192}Ir$ sources would influence the dose distributions of intracavitary brachytherapy. Two types of microSelectron HDR $^{192}Ir$ sources (classic and new models) were selected in this study. Two-dimensional (2D) treatment plans for classic and new sources were generated by using PLATO treatment planning system. We compared the point A, point B, and bladder and rectum reference points based on ICRU 38 recommendation. The radial dose function of the new source agrees with that of the classic source except difference of up to 2.6% at the nearest radial distance. The differences of anisotropy functions agree within 2% for r=1, 3, and 5 cm and $20^{\circ}$ < ${\theta}$ < $165^{\circ}$. The largest discrepancies of anisotropy functions reached up to 27% for ${\theta}$ < $20^{\circ}$ at r=0.25 cm and were up to 13%, 10%, and 7% at r=1, 3, and 5 cm for ${\theta}$ > $170^{\circ}$, respectively. There were no significant differences in doses of point A, point B, and bladder point for the treatment plans between the new and classic sources. For the ICRU rectum point, the percent dose difference was on average 0.65% and up to 1.0%. The dose discrepancies between two treatment plans are mainly affected due to the geometrical difference of the source and the sealed capsule.

• Progress in Medical Physics
• /
• v.26 no.4
• /
• pp.208-214
• /
• 2015

The aim of this study is to investigate the effect of low magnetic field on dose distribution in the partial-breast irradiation (PBI). Eleven patients with an invasive early-stage breast carcinoma were treated prospectively with PBI using 38.5 Gy delivered in 10 fractions using the $ViewRay^{(R)}$ system. For each of the treatment plans, dose distribution was calculated with magnetic field and without magnetic field, and the difference between dose and volume for each organ were evaluated. For planning target volume (PTV), the analysis included the point minimum ($D_{min}$), maximum, mean dose ($D_{mean}$) and volume receiving at least 90% ($V_{90%}$), 95% ($V_{95%}$) and 107% ($V_{107%}$) of the prescribed dose, respectively. For organs at risk (OARs), the ipsilateral lung was analyzed with $D_{mean}$ and the volume receiving 20 Gy ($V_{20\;Gy}$), and the contralateral lung was analyzed with only $D_{mean}$. The heart was analyzed with $D_{mean}$, $D_{max}$, and $V_{20\;Gy}$, and both inner and outer shells were analyzed with the point $D_{min}$, $D_{max}$ and $D_{mean}$, respectively. For PTV, the effect of low magnetic field on dose distribution showed a difference of up to 2% for volume change and 4 Gy for dose. In OARs analysis, the significant effect of the magnetic field was not observed. Despite small deviation values, the average difference of mean dose values showed significant difference (p<0.001), but there was no difference of point minimum dose values in both sehll structures. The largest deviation for the average difference of $D_{max}$ in the outer shell structure was $5.0{\pm}10.5Gy$ (p=0.148). The effect of low magnetic field of 0.35 T on dose deposition by a Co-60 beam was not significantly observed within the body for PBI IMRT plans. The dose deposition was only appreciable outside the body, where a dose build-up due to contaminated electrons generated in the treatment head and scattered electrons formed near the body surface.

• The Journal of Korean Society for Radiation Therapy
• /
• v.29 no.2
• /
• pp.43-51
• /
• 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
• /
• v.29 no.2
• /
• pp.33-41
• /
• 2017

Objectives: The aim of this study is to evaluate the reproducibility and usefulness of the images through the fusion of CT(Computed tomography) and MRI(Magnetic resonance imaging) using a self-manufactured phantom. We will also compare and analyze the target dose from acquired images. Materials and Methods: Using a self-manufactured phantom, CT images and MRI images are acquired by 1.5T and 3.0T of different magnetic fields. The reproducibility of the size and volume of the small holes present in the phantom is compared through the image from CT and 1.5T and 3.0T MRI, and dose changes are compared and analyzed on any target. Results: 13 small hole diameters were a maximum 31 mm and a minimum 27.54 mm in the CT scan and the were measured within an average of 29.28 mm 1 % compared to actual size. 1.5 T MRI images showed a maximum 31.65 mm and a minimum 24.3 mm, the average is 28.8 mm, which is within 1 %. 3.0T MRI images showed a maximum 30.2 mm and a minimum 27.92 mm, the average is 29.41 mm, which is within 1.3 %. The dose changes in the target were 95.9-102.1 % in CT images, 93.1-101.4 % in CT-1.5T MRI fusion images, and 96-102 % in CT-3.0T MRI fusion images. Conclusion: CT and MRI are applied with different algorithms for image acquisition. Also, since the organs of the human body have different densities, image distortion may occur during image acquisition. Because these inaccurate images description affects the volume range and dose of the target, accurate volume and location of the target can prevent unnecessary doses from being exposed and errors in treatment planning. Therefore, it should be applied to the treatment plan by taking advantage of the image display algorithm possessed by CT and MRI.

• Progress in Medical Physics
• /
• v.24 no.1
• /
• pp.41-47
• /
• 2013

We evaluated the influence of volume effect on the measurement of IMRT dose distribution by comparing a 2D-array ion chamber and other dosimeters. Matrix phantom which is a 2D-array ion chamber having volume effect was compared with beam image system and film for the measurement of dose distribution. Five intensity-modulated radiation therapy plans were created using five fields in thevirtual phantom. The measured dose distribution was compared with the calculated one by radiation treatment planning system and analysis program. We evaluated the conformity of dose distribution by calculating correlation coefficients and gamma values. The highest error rate of 1.3% was associated with matrix phantom in which volume effect in small field sizes was substantial.

• Radiation Oncology Journal
• /
• v.24 no.4
• /
• pp.294-299
• /
• 2006

$\underline{Purpose}$: Using cone beam CT, we can compare the position of the patients at the simulation and the treatment. In on-line image guided radiation therapy, one can utilize this compared data and correct the patient position before treatments. Using cone beam CT, we investigated the errors induced by setting up the patients when use only the markings on the patients' skin. $\underline{Materials\;and\;Methods}$: We obtained the data of three patients that received radiation therapy at the Department of Radiation Oncology in Chung-Ang University during August 2006 and October 2006. Just as normal radiation therapy, patients were aligned on the treatment couch after the simulation and treatment planning. Patients were aligned with lasers according to the marking on the skin that were marked at the simulation time and then cone beam CTs were obtained. Cone beam CTs were fused and compared with simulation CTs and the displacement vectors were calculated. Treatment couches were adjusted according to the displacement vector before treatments. After the treatment, positions were verified with kV X-ray (OBI system). $\underline{Results}$: In the case of head and neck patients, the average sizes of the setup error vectors, given by the cone beam CT, were 0.19 cm for the patient A and 0.18 cm for the patient B. The standard deviations were 0.15 cm and 0.21 cm, each. On the other hand, in the case of the pelvis patient, the average and the standard deviation were 0.37 cm and 0.1 cm. $\underline{Conclusion}$: Through the on-line IGRT using cone beam CT, we could correct the setup errors that could occur in the conventional radiotherapy. The importance of the on-line IGRT should be emphasized in the case of 3D conformal therapy and intensity-modulated radiotherapy, which have complex target shapes and steep dose gradients.

• Progress in Medical Physics
• /
• v.25 no.4
• /
• pp.193-198
• /
• 2014

The purpose of this study is to see the feasibility of the newly developed 2D dosimetry system using phosphor screen for helical tomotherapy. The cylindrical water phantom was fabricated with phosphor screen to emit the visible light during irradiation. There are three types of virtual target, one is one spot target, another is C-shaped target, and the other is multiple targets. Each target was planned to be treated at 10 Gy by treatment planning system (TPS) of tomotherapy. The cylindrical phantom was placed on the tomotherapy table and irradiated as calculations of the TPS. Every frame which acquired by CCD camera was integrated and the doses were calculated in pixel by pixel. The dose distributions from the fluorescent images were compared with the calculated dose distribution from the TPS. The discrepancies were evaluated as gamma index for each treatment. The curve for dose rate versus pixel value was not saturated until 900 MU/min. The 2D dosimetry using the phosphor screen and the CCD camera is respected to be useful to verify the dose distribution of the tomotherapy if the linearity correction of the phosphor screen improved.

• Proceedings of the Korea Society for Simulation Conference
• /
• 2000.04a
• /
• pp.154-160
• /
• 2000

기형부위의 구조적 복합성으로 인하여 부상이나 질병을 진단하거나 치료계획을 수립하는데 있어 많은 어려움이 있다. 본 논문에서는 기형부위의 정량적 분석을 위한 시뮬레이션 시스템을 설계하고 구현하였다. 본 시뮬레이션 시스템은 기형부위간 관계를 정의하고 정량적으로 분석하기 위하여 2차원 진단영상들을 공간적으로 구성하여 가시화하고 단일 객체 및 다중 객체의 이동, 회전, 확대/축소, 컬러링 등과 같은 조작기능을 제공하며, 기형부위의 길이, 체적, 각도 등의 측정치를 제공한다. 본 시뮬레이션 시스템은 사용자가 작업부하량을 줄이기 위하여 클라이언트-서버 구조로 이루어졌으며, 시스템간 사용되는 메시지 처리를 위한 메시지 제어기, 기형부위별 가시화와 조작을 위한 기형가시화 및 조작기, 기형 부위의 수치적 분석을 위한 정량적 분석기, 그리고 각종 환자 정보를 위한 영상 데이터베이스 관리기로 구성된다. 본 시뮬레이션 시스템은 기형부위의 효과적인 가시화와 조작 뿐 아니라 정량적 분석치를 제공함으로써 보다 정확한 기형분석에 많은 도움을 줄 수 있으며, 범용의 데스크탑 컴퓨터상에서 편리한 사용자 인터페이스를 통하여 서버에 접속하여 시뮬레이션 시스템을 사용함으로써 보다 많은 사용자들이 동시에 사용할 수 있는 이점이 있다.

• The Journal of Korean Society for Radiation Therapy
• /
• v.27 no.2
• /
• pp.131-143
• /
• 2015

Purpose : By comparing a CT fusion plan based on MRI with a plan based on only MRI without CT, we intended to study usefulness of a plan based on only MRI. And furthermore, we intended to realize a realtime MR-IGRT by MRI image without CT scan during the course of simulation, treatment planning, and radiation treatment. Materials and Methods : BBB CT (Brilliance Big Bore CT, 16slice, Philips), Viewray MRIdian system (Viewray, USA) were used for CT & MR simulation and Treatment plan of 11 patients (1 Head and Neck, 5 Breast, 1 Lung, 3 Liver, 1 Prostate). When scanning for treatment, Free Breathing was enacted for Head&Neck, Breast, Prostate and Inhalation Breathing Holding for Lung and Liver. Considering the difference of size between CT and Viewray, the patient's position and devices were in the same condition. Using Viewray MRIdian system, two treatment plans were established. The one was CT fusion treatment plan based on MR image. Another was MR treatment plan including electron density that [ICRU 46] recommend for Lung, Air and Bone. For Head&Neck, Breast and Prostate, IMRT was established and for Lung and Liver, Gating treatment plan was established. PTV's Homogeneity Index(HI) and Conformity Index(CI) were use to estimate the treatment plan. And DVH and dose difference of each PTV and OAR were compared to estimate the treatment plan. Results : Between the two treatment plan, each difference of PTV's HI value is 0.089% (Head&Neck), 0.26% (Breast), 0.67% (Lung), 0.2% (Liver), 0.4% (Prostate) and in case of CI, 0.043% (Head&Neck), 0.84% (Breast), 0.68% (Lung), 0.46% (Liver), 0.3% (Prostate). As showed above, it is on Head&Neck that HI and CI's difference value is smallest. Each difference of average dose on PTV is 0.07 Gy (Head&Neck), 0.29 Gy (Breast), 0.18 Gy (Lung), 0.3 Gy (Liver), 0.18 Gy (Prostate). And by percentage, it is 0.06% (Head&Neck), 0.7% (Breast), 0.29% (Lung), 0.69% (Liver), 0.44% (Prostate). Likewise, All is under 1%. In Head&Neck, average dose difference of each OAR is 0.01~0.12 Gy, 0.04~0.06 Gy in Breast, 0.01~0.21 Gy in Lung, 0.06~0.27 Gy in Liver and 0.02~0.23 Gy in Prostate. Conclusion : PTV's HI, CI dose difference on the Treatment plan using MR image is under 1% and OAR's dose difference is maximum 0.89 Gy as heterogeneous tissue increases when comparing with that fused CT image. Besides, It characterizes excellent contrast in soft tissue. So, radiation therapy using only MR image without CT scan is useful in the part like Head&Neck, partial breast and prostate cancer which has a little difference of heterogeneity.