• Journal of the Korean Society of Radiology
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• v.12 no.1
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• pp.23-30
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• 2018

To evaluate the effect of patient size on effective dose and image quality for Digital Chest Tomosynthesis(DTS) using additional 0.3 mm copper filtration. Eighty artificial nodules were placed in the thorax phantom("Lungman," Kyoto Kagaku, Japan), and Digital Chest Tomosynthesis(DTS) images of the phantom were acquired both with and without added 0.3 mm Cu filtration. To simulate patients of three sizes: small, average size and oversize, one or two 20-mm-thick layer of PMMA(polymethyl methacrylatek) blocks were placed on the phantom. The Effective dose was calculated using Monte Carlo simulations. Two evaluations of image quality methods have been employed. Three readers counted the number of nodules detected in the lung, and the measured contrast-to-noise ratios(CNRs) were used. Data were analyzed statistically. The ED reduced $26{\mu}Sv$ in a phantom, $33{\mu}Sv$ in one 20-mm-thick layer of PMMA block placed on the phantom, and $48{\mu}Sv$ in two 20-mm-thick layer of PMMA blocks placed on the phantom. The Effective dose(ED) differences between DTS with and without filtration were significant(p<0.05). In particular, when we used two 20-mm-thick layer of PMMA blocks placed on the phantom, the ED was significantly reduced by 36% compared with those without additional filtration. Nodule detection sensitivities were not different between with and without added filtration. Differences of CNRs were statistically insignificant(p>0.05). Use of additional filtration allows a considerable dose reduction during Digital Chest Tomosynthesis(DTS) without loss of image quality. In particular, additional filtration showed outstanding result for effective dose reduction on two 20-mm-thick layer of PMMA blocks placed on the phantom. It applies to overweight patients.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.177-182
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• 2014

Purpose : The goal of this study was to compare and analysis the dose distribution and treatment time between Tomotherapy planning with fixed jaw(FJ) and dynamic jaw(DJ). Materials and Methods : Seven patients were selected in the study including five common clinical cases(brain, head and neck(HN), lung, prostate, spine). 1) Helical Tomotherapy plans with FJ and DJ were generated with the same planning parameters such as Modulation factor, Pitch and Field width. 2) Tomo_edge plans with a larger field width were generated to compare to conventional HT delivery with fixed jaw. Dosimetric evaluation indices for target coverage are Dmin, Conformity index(CI) and for whole body including target are $V_{10%}$, $V_{25%}$, $V_{50%}$, $V_{75%}$ using Dose-volume histogram(DVH). Also, Treatment time and Cumulative MU were used for clinical review on Tomo_edge. Results : In case of using the same field width of Tomotherapy planning with FJ and DJ, the averaged variations were $V_{10%}$: -11.91%, $V_{25%}$: -7.6%, $V_{50%}$ :-4.75%, $V_{75%}$: -1.04%. Tomo_edge with a larger field width provides the averaged variations for target coverage: Dmin: -0.72%, CI: -1.25% and also shows the tendency of a sharp $V_{x%}$ decline in low dose area. The clinical improvements in the larger field width with DJ were observed in the treatment time, ranging from -51.21% to -15.11, and the Cumulative MU decrease, ranging from -57.74% to -15.31%. Conclusion : Target coverage achieved by FJ and DJ with the same field width has little differences. But integral doses on whole body efficiently decreased. Compared to the conventional HT delivery, Tomo_edge with a larger field width presents a little worse target coverage. However, it provides faster treatment delivery and improved cranial-caudal target dose conformity. Therefore, Tomo_edge mode is efficient in improving the treatment time and integral dose while maintaining comparable plan quality in clinic.

• Progress in Medical Physics
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• v.27 no.2
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• pp.93-97
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• 2016

In this study, we evaluate the effect of respiration on the dose distribution in patient target volume (PTV) during intensity-modulated radiation therapy (IMRT) and research methods to reduce this impact. The dose distributions, homogeneity index (HI), coverage index (CVI), and conformity index of the PTV, which is calculated from the dose-volume histogram (DVH), are compared between the maximum intensity projection (MIP) image-based plan and other images at respiration phases of 30%, 60% and 90%. In addition, the reducing effect of complication caused by patient respiration is estimated in the case of a bolus and the expended PTV on the skin. The HI is increased by approximately twice, and the CVI is relatively decreased without the bolus at other respiration phases. With the bolus and expended PTV, the change in the dose distribution of the PTV is relatively small with patient respiration. Therefore, the usage of the bolus and expended PTV can be considered as one of the methods to improve the accuracy of IMRT in the treatment of breast cancer patients with respiratory motion.

• Journal of the Korean Society of Radiology
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• v.10 no.7
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• pp.539-543
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• 2016

In this research, The way to decrease a patient's exposure dose by reducing the scattered radiation dosage outside a radiation field with an diagnosis X-ray was examined. The scattered radiation dosage reaching other parts outside the radiation field was to be reduced by attaching a self-produced $150{\times}190mm^2$ lead plate to the lower part of a collimator. When a lead plate was inserted additionally and the scattered radiation dosage of the X axis was measured in the direction of the central X-ray axis, It was found out to have been decreased by 26 to 36%, and in the direction of Y axis, which was vertical direction from the central axis, The scattered radiation dosage depending on whether a lead plate was used or not displayed no large differences. These results shows that the impact of the scattered radiation by the off focus X-ray that was generated around the focus was bigger than that generated by the shutter of the collimator. Therefore it has been concluded that installing an additional lead plate in the lower part of the existing collimator can decrease the scattered radiation dosage outside a radiation field.

• 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.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.34-34
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• 2003

목적 : 폐암 환자 세기변조방사선치료 과정을 소개하고, 방사선치료계획의 최적화를 위한 빔 수와 방향, 가상장기 설정 (virtual organ delineation, VOD) 및 선량 제한 인자들의 이용에 대해 평가함으로써 폐, 심장 등에 조사되는 선량을 최소화하는데 사용하는 세기변조방사선치료 (intensity modulated radiotherapy, IMRT) 기술의 유용성을 평가하고자한다. 대상 및 방법 : 종양이 종격동을 침범하여 상대적으로 장기움직임에 의한 오차가 적은 폐암환자 5 명을 대상으로 하였다. 환자고정장치는 상반신을 편안하게 유지함과 동시에 팔의 위치를 고정시킴으로써 기대할 수 있는 환자고정효과와 벨트를 이용하여 환자 상복부를 압박해줌으로써 호흡운동에 의한 장기 움직임을 감소시킬 수 있는 형태로 고안하였다. 치료계획시 빔 수와 방향은 5,7,9 문 (from 200 to 160, equispaced field, arbitrary field), 4 문 (anterior, posterior, bilateral posterior oblique field) 과 비등방 7, 9 문 (non-equispaced field, arbitrary field) 등을 사용하였다. 선량제한 ($V_{20}V_{25}$)은 문헌에 기초하여 설정하였으며, 가상장기를 적절히 사용하여 최적화된 치료계획 결과를 얻었다. 방사선치료계획 평가는 선량-체적간 히스토그람 (DVH), 등선량곡선 및 선량통계 등을 이용하여 수행하였다. 특히 가상장기 설정 전, 후의 결과 값을 분석함으로써 그 유용성을 확인하였다. 결과 : 9문 등방-IMRT와 7문 비등방-IMRT 방법이 치료계획용적의 선량균질성 (PTV dose homogeneity), 평균 폐선량 (mean lung dose) 및 $V_{20}V_{25}$ 모두에서 20% 이내의 좋은 결과를 얻을 수 있었고, 가상 장기를 설정함으로써 같은 결과를 가져옴을 알 수 있었다. 또한 폐암 세기변조방사선치료 프로토콜을 작성하여 임상에 사용함으로써 치료과정 중 발생할 수 있는 오류를 보완할 수 있음을 알 수 있었다. 결론 : 폐암 세기변조방사선치료 시 사용할 수 있는 프로토콜을 작성하였고, 적절한 가상 장기 및 조사계획 설정으로 치료계획의 최적화를 얻을 수 있음을 알 수 있었다.

• Journal of radiological science and technology
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• v.35 no.4
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• pp.299-308
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• 2012

To perform patient dose surveys in major interventional radiography procedures as a mean of inter-institutional comparison and of establishing reference dose levels with the ultimate goal of optimizing patient doses in the field of interventional radiography. We reviewed international patient dose survey data in the literature and measured patient dose in major interventional radiography procedures (TACE, AVF, PTBD, TFCA, GDC embolization). ESD(Entrance Skin Dose) was measured using TLD chips attached to the patient skin and ED(Effective Dose) was calculated using angiography unit-derived DAP. A survey of patient dose in interventional radiography procedures were also performed with a questionnaire for interventional radiologists and we proposed a guideline for optimizing patient doses in the field of interventional radiology. The patient dose survey data in interventional radiography procedures were very rare in literature compared with those in diagnostic radiography procedures. In TACE, the mean ED was 25.43 mSv and the mean ESD was 511.75 mGy. The mean ED of TACE was not high, but the cumulative dose should be checked, due to longer procedure TACE. In TFCA, the mean ED was 22.6 mSv and it was relatively high compared with data of other countries. In GDC embolization, the mean ED was not available, because GDC embolization was performed with old Image-Intensifier-type unit and there has no unit-installed ionization chamber. Also, the mean ESD of GDC embolization was up to 2,264 mGy and further studies are needed to calculate the net ED of GDC embolization. Patient dose occurred during interventional radiography procedures are high related with the difficulty of the procedure, fluoroscopy time, the number of angiographies and the treatment protocol. Therefore, continuous education and efforts should be made to optimize the patient dose in the field of interventional radiology.

• The Korean Journal of Nuclear Medicine Technology
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• v.19 no.2
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• pp.55-62
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• 2015

Purpose Various methods for reducing radiation exposure have been continuously being developed. The aim of this study is to evaluate effectiveness of dose reduction, image quality and PET SUV changes by applying combination of automatic exposure dose(AEC), automated dose-optimized selection of X-ray tube voltage(CAREkV) and sinogram affirmed iterative reconstruction(SAFIRE) which can be controled by user. Materials and Methods Torso, AAPM CT performance and IEC body phantom images were acquired using biograph mCT64, (Siemens, Germany) PET/CT scanner. Standard CT condition was 120 kV, 40 mAs. Radiation exposure and noise were evaluated by applying AEC, CAREkV(120 kV, 40 mAs) and SAFIRE(120 kV, 25 mAs) with torso phantom compare to standard CT condition. And torso, AAPM and IEC phantom images were acquired with combination of 3 methods in condition of 120 kV, 25 mAs to evaluate radiation exposure, noise, spatial resolution and SUV changes. Results When applying AEC, CTDIvol and DLP were decreased by 50.52% and 50.62% compare to images which is not applying AEC. mAs was increased by 61.5% to compensate image quality according to decreasing 20 kV when applying CAREkV. However, CTDIvol and DLP were decreased by 6.2% and 5.5%. When reference mAs was the lower and strength was the higher, reduction of radiation exposure rate was the bigger. Mean SD and DLP were decreased by 2.2% and 38% when applying SAFIRE even though mAs was decreased by 37.5%(from 40 mAs to 25 mAs). Combination of 3 methods test, SD decreased by 5.17% and there was no significant differences in spatial resolution. And mean SD and DLP were decreased by 6.7% and 36.9% compare to 120 kV, 40 mAs with AEC. For SUV test, there was no statistical differences(P>0.05). Conclusion Combination of 3 methods shows dose reduction effect without degrading image quality and SUV changes. To reduce radiation exposure in PET/CT study, continuous effort is needed by optimizing various dose reduction methods.

• Radiation Oncology Journal
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• v.29 no.2
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• pp.63-70
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• 2011

Purpose: To evaluate the extent of pain response and objective response to palliative radiotherapy (RT) for bone metastases from hepatocellular carcinoma according to RT dose. Materials and Methods: From January 2007 to June 2010, palliative RT was conducted for 103 patients (223 sites) with bone metastases from hepatocellular carcinoma. Treatment sites were divided into the high RT dose and low RT dose groups by biologically effective dose (BED) of 39 $Gy_{10}$. Pain responses were evaluated using the numeric rating scale. Pain scores before and after RT were compared and categorized into 'Decreased', 'No change' and 'Increased'. Radiological objective responses were categorized into complete response, partial response, stable disease and progression using modified RECIST (Response Evaluation Criteria In Solid Tumors) criteria; the factors predicting patients' survival were analyzed. Results: The median follow-up period was 6 months (range, 0 to 46 months), and the radiologic responses existed in 67 RT sites (66.3%) and 44 sites (89.8%) in the high and low RT dose group, respectively. A dose-response relationship was found in relation to RT dose (p=0.02). Pain responses were 75% and 65% in the high and low RT dose groups, respectively. However, no statistical difference in pain response was found between the two groups (p=0.24). There were no differences in the toxicity profiles between the high and low RT dose groups. Median survival from the time of bone metastases diagnosis was 11 months (range, 0 to 46 months). The Child-Pugh classification at the time of palliative RT was the only significant predictive factor for patient survival after RT. Median survival time was 14 months under Child-Pugh A and 2 months under Child-Pugh B and C. Conclusion: The rate of radiologic objective response was higher in the high RT dose group. Palliative AT with a high dose would provide an improvement in patient quality of life through enhanced tumor response, especially in patients with proper liver function.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.6
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• pp.2118-2123
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• 2010

Korean individual occupational exposure control is focused on the retrospective service to the over-exposed person by the reading of personal dosimeter. Since the radiophamaceuticals using in the nuclear medicine department are uncontained radiation sources, the potential exposure at working environment is very high. Moreover, a patient remains radioactive for hours or even days after the administration of a radiopharmaceutical for diagnosis or treatment. Thus, the proper working environmental exposure control must be established and executed to protect not only the affiliated employees, but also guardians accompanying patients and temporarily visiting public from the exposure by the patients. Japanese radiation protection law regulates working environmental radiation exposure by regularly measuring and filing the environmental dose for years. This study was aimed at measuring working environmental radiation dose in the nuclear medicine department of an university hospital located in Daejeon, Korea. We measured the accumulation radiation dose in air at 8 locations in the nuclear medicine department by using the same method as in Japan with glass dosimeters. The highest dose rate, 0.23 mSv per month, was measured at the waiting room, and the second one is at reception desk. Even though the doses were lower than the Korean constraint dose rate (0.3 mSv/week) at the boundary of the radiation controlled area, it was over the dose limit of public (1 mSv/y) and environment (0.25 mSv/y). Conclusionally, it was found that the new or additional procedure was necessary to less the exposure dose to the receptionist and guardians by the environmental radiation dose in the nuclear medicine department.