• The Journal of Korean Society for Radiation Therapy
• /
• v.31 no.1
• /
• pp.17-24
• /
• 2019

Purpose: The present study aims to assess the level of coherency and the accuracy of Point dose of the Isocenter of VERO, a linear accelerator developed for the purpose of the Stereotactic Body Radiation Therapy(SBRT). Materials and Method: The study was conducted randomly with 10 treatment plans among SBRT patients in Kyungpook National University Chilgok Hospital, using VERO, a linear accelerator between June and December, 2018. In order to assess the equipment's power stability level, we measured the output constancy by using PTW-LinaCheck, an output detector. We also attempted to measure the level of accuracy of the equipment's Laser, kV(Kilo Voltage) imaging System, and MV(Mega Voltage) Beam by using Tofu Phantom(BrainLab, Germany) to assess the accuracy level of geometrical Isocenter. We conducted a comparative analysis to assess the accuracy level of the dose by using an acrylic Phantom($30{\times}30{\times}20cm$), a calibrated ion chamber CC-01(IBA Dosimetry), and an Electrometer(IBA, Dosimetry). Results: The output uniformity of VERO was calculated to be 0.66 %. As for geometrical Isocenter accuracy, we analyzed the error values of ball Isocenter of inner Phantom, and the results showed a maximum of 0.4 mm, a minimum of 0.0 mm, and an average of 0.28 mm on X-axis, and a maximum of -0.4 mm, a minimum of 0.0 mm, and an average of -0.24 mm on Y-axis. A comparison and evaluation of the treatment plan dose with the actual measured dose resulted in a maximum of 0.97 % and a minimum of 0.08 %. Conclusion: The equipment's average output dose was calculated to be 0.66 %, meeting the ${\pm}3%$ tolerance, which was considered as a much uniform fashion. As for the accuracy assessment of the geometric Isocenter, the results met the recommended criteria of ${\pm}1mm$ tolerance, affirming a high level of reproducibility of the patient's posture. The difference between the treatment plan dose and the actual measurement dose was calculated to be 0.52 % on average, significantly less than the 3 % tolerance, confirming that it obtained predicted does. The current study suggested that VERO equipment is suitable for SBRT, and would result in notable therapeutic effect.

• The Journal of Korean Society for Radiation Therapy
• /
• v.31 no.1
• /
• pp.67-74
• /
• 2019

Purpose: The purpose is to correct for position errors caused by long treatment times. By correcting the target motion that can occur during lung SBRT using IntraFraction CBCT. Methods and materials: We analyzed retrospectively the IFM data of 14 patients with two treatment arc in the treatment plan for lung cancer with stereotactic radiotherapy. An IntraFraction Motion was applied to the Arccheck phantom to acquire the Gamma index data. Results : IntraFraction Motion during the first treatment arc is in the left-right(LR), superiorinferior(SI), anterior-posterior(AP) directions were $0.16{\pm}0.05cm$, 0.72 cm(max error), $0.2{\pm}0.14cm$, 1.26 cm, $0.24{\pm}0.08cm$, 0.82 cm and rotational directions was $0.84{\pm}0.23^{\circ}$, $2.8^{\circ}$(pitch), $0.72{\pm}0.23^{\circ}$, $2.5^{\circ}$(yaw), $0.7{\pm}0.19^{\circ}$, $2^{\circ}$(roll). IntraFraction Motion during the second treatment arc is in the LR, SI, AP directions were $0.1{\pm}0.04cm$, 0.37 cm, $0.14{\pm}0.17cm$, 2 cm, $0.12{\pm}0.04cm$, 0.5 cm and rotational directions was $0.45{\pm}0.12^{\circ}$, $1.3^{\circ}$, $0.37{\pm}0.1^{\circ}$, $1^{\circ}$, $0.35{\pm}0.1^{\circ}$, $1.2^{\circ}$. Gamma index pass rates were $82.64{\pm}10.51%$, 48.4 %. Conclusions : In this study, we examined the validity of IntraFraction Motion correction in lung SBRT and the efficiency of IntraFraction CBCT. Due to the nature of SBRT treatment, IFM may increase due to the increased treatment time. It is believed that the increase in IFM with the increase in treatment time can be improved with the use of FFF Beam and additional position correction using CBCT during treatment.

• Journal of the Korean Society of Radiology
• /
• v.13 no.1
• /
• pp.81-86
• /
• 2019

In X-ray image, the role of filtration through the filter is to reduce the exposure of the patient by using photon which is useful in formation of the image, and at the same time, enhance the contrast of the image. During interaction between photon and object, low energy X-rays are absorbed from the site of a few cm of the first patient's tissue, and high energy X-rays are the one which form the image. Therefore, the radiation filter absorbs low energy X-ray in order to lower the exposure of the patient and improve the quality of the image. The purpose of this study is to compare the effect on the image quality by differences of added filter through simulation image and actual radiation image. For that purpose, we used Geant4 Application for Tomographic Emission (GATE) as a tool for Monte Carlo simulation. We set actual size, shape and material of Polymethylmethacrylate (PMMA) Phantom on GATE and differentiated the parameter of added filter. Also, we took image of PMMA phantom with same parameter of added filter by digital radiography (DR). Than we performed contrast-to-noise ratio (CNR) evaluation on both simulation image and actual DR image by Image J. Finally, we observed the effect on image quality due to different thickness of added filter, and compared two images' CNR evaluation's transitions of change. The result of this experiment showed decreasing in the progress of CNR on both DR and simulation image. It is ultimately caused by decreasing in contrast on image. In theory, contrast decrease with kVp increased. Given that condition, this study found out that filter makes not only decreasing total dose by absorbing low energy of X-ray, but also increasing average energy of X-ray.

• Journal of the Korean Society of Radiology
• /
• v.13 no.1
• /
• pp.111-118
• /
• 2019

Chest digital tomosynthesis has become a practical imaging modality because it can solve the problem of anatomy overlapping in conventional chest radiography. However, because of both limited scan angle and finite-size detector, a portion of chest cannot be represented in some or all of the projection. These bring a discontinuity in intensity across the field of view boundaries in the reconstructed slices, which we refer to as the truncation artifacts. The purpose of this study was to reduce truncation artifacts using a weighted normalization approach and to investigate the performance of this approach for our prototype chest digital tomosynthesis system. The system source-to-image distance was 1100 mm, and the center of rotation of X-ray source was located on 100 mm above the detector surface. After obtaining 41 projection views with ${\pm}20^{\circ}$ degrees, tomosynthesis slices were reconstructed with the filtered back projection algorithm. For quantitative evaluation, peak signal to noise ratio and structure similarity index values were evaluated after reconstructing reference image using simulation, and mean value of specific direction values was evaluated using real data. Simulation results showed that the peak signal to noise ratio and structure similarity index was improved respectively. In the case of the experimental results showed that the effect of artifact in the mean value of specific direction of the reconstructed image was reduced. In conclusion, the weighted normalization method improves the quality of image by reducing truncation artifacts. These results suggested that weighted normalization method could improve the image quality of chest digital tomosynthesis.

• The Journal of Korean Society for Radiation Therapy
• /
• v.32
• /
• pp.61-71
• /
• 2020

Purpose: To investigate the effect of collimator angle on plan quality of PAN-Pelvis Multi-isocenter VMAT plan, dose reproducibility at the junction and impact on set-up error at the junction. Material and method: 10 adult patients with whole pelvis cancer including PAN were selected for the study. Using Trubeam STx equipped with HD MLC, we changed the collimator angle to 20°, 30°, and 45° except 10° which was the default collimator angle in the Eclipse(version 13.7) and all other treatment conditions were set to be the same for each patient and four plans were established also. To evaluate these plans, PTV coverage, coverage index(CVI) and homogeneity index (HI) were compared and clinical indicators for each treatment sites in normal tissues were analyzed. To evaluate dose reproducibility at the junction, the absolute dose was measured using a Falmer type ionization chamber and dose changes at the junction were evaluated by moving the position of the isocenter in and out 1~3mm and setting up the virtual volume at the junction. Result: CVI mean value was PTV-45 0.985±0.004, PTV-55 0.998±0.003 at 45° and HI mean value was PTV-45 1.140±0.074, and PTV-55 1.031±0.074 at 45° which were closest to 1. V20Gy of the kidneys decreased by 9.66% and average dose of bladder and V30 decreased by 1.88% and 2.16% at 45° compared to 10° for the critical organs. The dose value at the junction of the plan and the actual measured were within 0.3% and within tolerance. At the junction, due to set-up error the maximum dose increased to 14.56%, 9.88%, 8.03%, and 7.05%, at 10°, 20°, 30°, 45°, and the minimum dose decreased to 13.18%, 10.91%, 8.42%, and 4.53%, at 10°, 20°, 30°, 45° Conclusion: In terms of CVI, HI of PTV and critical organ protection, overall improved values were shown as the collimator angle increased. The impact on set-up error at the junction by collimator angle decreased as the angle increased and it will help improve the anxiety about the set up error. In conclusion, the collimator angle should be recognized as a factor that can affect the quality of the multi-isocenter VMAT plan and the dose at the junction, and be careful in setting the collimator angle in the treatment plan.

• The Journal of Korean Society for Radiation Therapy
• /
• v.33
• /
• pp.89-97
• /
• 2021

Purpose: The purpose of this study is to compare and evaluate the dose change according to the gas volume variations in the rectum, which was not included in the treatment plan during radiation therapy for cervical cancer. Materials and methods: Static Intensity Modulated Radiation Therapy (S-IMRT) using a 9-field and Volumetric Modulated Arc Therapy (VMAT) using 2 full-arcs were established with treatment planning system on Computed Tomography images of a human phantom. Random gas parameters were included in the Planning Target Volume(PTV) with a maximum change of 2.0 cm in increments of 0.5 cm. Then, the Conformity Index (CI), Homogeneity Index (HI) and PTV D_max for the target volume were calculated, and the minimum dose (D_min), mean dose (D_mean) and Maximum Dose (D_max) were calculated and compared for OAR(organs at risk). For statistical analysis, T-test was performed to obtain a p-value, where the significance level was set to 0.05. Result: The HI coefficients of determination(R²) of S-IMRT and VMAT were 0.9423 and 0.8223, respectively, indicating a relatively clear correlation, and PTV D_max was found to increase up to 2.8% as the volume of a given gas parameter increased. In case of OAR evaluation, the dose in the bladder did not change with gas volume while a significant dose difference of more than D_mean 700 cGy was confirmed in rectum using both treatment plans at gas volumes of 1.0 cm or more. In all values except for D_mean of bladder, p-value was less than 0.05, confirming a statistically significant difference. Conclusion: In the case of gas generation not considered in the reference treatment plan, as the amount of gas increased, the dose difference at PTV and the dose delivered to the rectum increased. Therefore, during radiation therapy, it is necessary to make efforts to minimize the dose transmission error caused by a large amount of gas volumes in the rectum. Further studies will be necessary to evaluate dose transmission by not only varying the gas volume but also where the gas was located in the treatment field.

• The Journal of Korean Society for Radiation Therapy
• /
• v.33
• /
• pp.25-33
• /
• 2021

Purpose : The purpose of this study is to evaluate the accuracy and usefulness of the Trigger mode for the Respiratory Gated Radiation Therapy (RGRT) Materials and methods : A QUASAR respiratory phantom that inserted a 3 mm fiducial marker (a gold marker) was used to estimate the accuracy of the Trigger mode. And the 20 bpm was used as reference respiration rate in this study. The marker that placed at the center of the phantom was contoured, and the lower threshold of a gating window was fixed at 2.0 mm using an OBI with Truebeam STx^TM. The upper threshold was measured every 0.5 mm from 1.0 mm to 3.0 mm. The respiration rates were changed every 10 bpm from 10 bpm to 60 bpm. We repeatedly measured five times to check the error rate of the trigger mode in the same condition. Result : The differences of a distance from a peak phase to upper threshold, 1.0 to 3.0 mm at a 20 bpm as a reference for 3 days in a row were 0.68±0.05 mm, 0.91±0.03 mm, 1.23±0.03 mm, 1.42±0.04 mm, and 1.66±0.06 mm, respectively. Measurement result of changes in respiratory rate compared to baseline respiratory rate in maximum absolute difference. The coefficient of determination (R2) to estimate the correlation between the respiration velocity and variation of absolute difference was on average 0.838, 0.887, 0.770, 0.850, and 0.906. The p-values of all the variables were below 0.05. Conclusion : Using Trigger mode during respiratory gated radiation therapy (RGRT), accuracy and usefulness of trigger mode at reference breathing rate were confirmed. However, inaccuracies depending on the rate of breathing it could be uncertain in case of respiration rate is faster than 20 bpm as a standard respiration rate compared to slower than 20 bpm. Consequently, when conducting a RGRT using the trigger mode, real time monitoring is required with well educated respiration.

• Journal of the Korean Society of Radiology
• /
• v.16 no.7
• /
• pp.897-904
• /
• 2022

The purpose of this study is to compare the difference in dose and image quality when applying the diagnostic reference level (DRL) test conditions for head radiography in a digital radiation environment and the test conditions currently applied in clinical practice. I would like to review the conditions of radiographic examination. In this study, the head model phantom was targeted, and the investigation conditions were divided into clinical conditions (Clinic), DRL value (DRL₇₅), and DRL average value (DRL_mean). For dose, Enterance surface dose (ESD) was measured, and for image quality, signal-to-noise ratio and contrast-to-noise ratio were measured and analyzed for comparison. The average values of skull anterior posterior(AP) ESD according to the changes in test conditions were Clinic 1214.03±4.21 µGy, DRL₇₅ 3017.83±8.14 µGy, DRL_mean 2283.50±7.09 µGy, and skull lateral (Lat). The average value of ESD was statistically significant with Clinic 762.79±3.54 µGy, DRL₇₅ 2168.57±10.83 µGy, and DRL_mean 1654.43±6.48 µGy (p<0.01). The average values of SNR and CNR measured in the orbital, maxillary sinus, frontal sinus, and sella turcica were statistically significant (p<0.01). As a result of this study, compared to DRL, the conditions used in clinical practice showed lower dose levels of about 58% for AP and about 70% for Lat., and there was no qualitative difference in terms of image quality. Through this study, it is necessary to consider a new diagnostic reference level suitable for the digital radiation environment, and it is considered that the dose should be reduced accordingly.

• The Journal of Korean Society for Radiation Therapy
• /
• v.34
• /
• pp.31-42
• /
• 2022

Purpose: This study measures and compares the surface dose values in the virtual target volume using Tomotherapy, Halcyon, and TrueBeam equipment using 6MV-Flattening Filter-Free(FFF) energy. Materials and Methods: CT scan was performed under three conditions of without bolus, 0.5 cm bolus, and 1 cm bolus using an IMRT phantom (IBA, Germany). The Planning Target Volume (PTV) was set at the virtual target depth, and the treatment plan was established at 200 cGy at a time. For surface dosimetry, the Gafchromic EBT3 film was placed in the same section as the treatment planning system and repeated measurements were performed 10 times and then analyzed. Result: As a result of measuring the surface dose for each equipment, without, 0.5 cm, 1 cm bolus is in this order, and the result of Tomotherapy is 115.2±2.0 cGy, 194.4±3.3 cGy, 200.7±2.9 cGy, The result in Halcyon was 104.7±3.0 cGy, 180.1±10.8 cGy, 187.0±10.1 cGy, and the result in TrueBeam was 92.4±3.2 cGy, 148.6±5.7 cGy, 155.8±6.1 cGy, In all three conditions, the same as the treatment planning system, Tomotherapy, Halcyon, TreuBeam was measured highly in that order. Conclusion: Higher surface doses were measured in Tomotherapy and Halcyon compared to TrueBeam equipment. If the characteristics of each equipment are considered according to the treatment site and treatment purpose, it is expected that the treatment efficiency of the patient will increase as well as the treatment satisfaction of the patient.

• Journal of the Korean Society of Radiology
• /
• v.82 no.6
• /
• pp.1477-1492
• /
• 2021

Purpose Dedicated breast CT is an emerging volumetric X-ray imaging modality for diagnosis that does not require any painful breast compression. To improve the detection rate of weakly enhanced lesions, an adaptive image rescaling (AIR) technique was proposed. Materials and Methods Two disks containing five identical holes and five holes of different diameters were scanned using 60/100 kVp to obtain single-energy CT (SECT), dual-energy CT (DECT), and AIR images. A piece of pork was also scanned as a subclinical trial. The image quality was evaluated using image contrast and contrast-to-noise ratio (CNR). The difference of imaging performances was confirmed using student's t test. Results Total mean image contrast of AIR (0.70) reached 74.5% of that of DECT (0.94) and was higher than that of SECT (0.22) by 318.2%. Total mean CNR of AIR (5.08) was 35.5% of that of SECT (14.30) and was higher than that of DECT (2.28) by 222.8%. A similar trend was observed in the subclinical study. Conclusion The results demonstrated superior image contrast of AIR over SECT, and its higher overall image quality compared to DECT with half the exposure. Therefore, AIR seems to have the potential to improve the detectability of lesions with dedicated breast CT.