• Progress in Medical Physics
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• v.24 no.2
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• pp.127-132
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• 2013

The position of the internal organs can change continually and periodically inside the body due to the respiration. To reduce the respiration induced uncertainty of dose localization, one can use a respiratory gated radiotherapy where a radiation beam is exposed during the specific time of period. The main disadvantage of this method is that it usually requests a long treatment time, the massive effort during the treatment and the limitation of the patient selection. In this sense, the combination of the real-time position management (RPM) system and the volumetric intensity modulated radiotherapy (RapidArc) is promising since it provides a short treatment time compared with the conventional respiratory gated treatments. In this study, we evaluated the accuracy of the respiratory gated RapidArc treatment. Total sic patient cases were used for this study and each case was planned by RapidArc technique using varian ECLIPSE v8.6 planning machine. For the Quality Assurance (QA), a MatriXX detector and I'mRT software were used. The results show that more than 97% of area gives the gamma value less than one with 3% dose and 3 mm distance to agreement condition, which indicates the measured dose is well matched with the treatment plan's dose distribution for the gated RapidArc treatment cases.

• Journal of radiological science and technology
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• v.37 no.4
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• pp.341-348
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• 2014

Wedge filter could use to increase the dose distribution at the hot dose regions. We evaluated dose discrepancy at surface and build region in the infield and outfield that Metal Wedge (MW) and Enhance Dynamic Wedge (EDW) were interact with photon. In this paper, we used Gafchromic EBT3 film that had excellent spatial resolution, composed the water equivalent materials and changed the optical density without development. The set up conditions of linear accelerator were fixed 6 MV photon, 100 cm SSD, $10{\times}10cm^2$ field size and were irradiated 400 cGy at Dmax. The dose distribution and absorbed dose were evaluated when we compared the open field with $15^{\circ}$, $30^{\circ}$, $45^{\circ}$ metal wedge and enhanced dynamic wedge. A $15^{\circ}$ metal wedge could increase the surface and build up region dose than using a $15^{\circ}$ enhanced dynamic wedge. A $30^{\circ}$ metal wedge could decrease the surface and build up region dose than using a $30^{\circ}$ enhanced dynamic wedge. A $45^{\circ}$ metal wedge could decrease by large deviation the surface and build up region dose than using a $15^{\circ}$ enhanced dynamic wedge. The dose of penumbra region at outfield were increased on the thick side but were decreased on the thin side. It could be decrease the surface dose and build up region dose, if the metal wedge filters were properly used to make a good dose distribution and not closed the distance of surface.

• Journal of the Korean Society of Radiology
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• v.17 no.6
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• pp.809-817
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• 2023

Single source and dual source measurements using anthropomorphic phantoms in which the phantoms are lined up in human body equivalents use OSLD (Optically Stimulated Luminescence Dosimeter), so the effective dose is calculated using OSLD. For hospital images, SNR (Signal to Noise Ratio) and CNR (Contrast to Noise Ratio) were measured in MCA (Middle Cerebral Artery) for single source and dual source, and for phantom images, SNR and CNR were measured for brain parenchyma of single source and dual source. For hospital imaging, SNR and CNR were measured in MCA for both single-source and dual-source, and for phantom images, SNR and CNR were measured for brain parenchyma from single-source and dual-source. As a result of comparing the SNR and CNR of the hospital image and the phantom image, there was no statistical difference. Comparing patient doses in hospital images, the effective dose of the dual source was 53.53% less and the effective dose of the dual energy phantom was 57.94% less. The dose can be increased in other areas, but the cerebrovascular area is useful because the dose is small.

• Progress in Medical Physics
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• v.7 no.2
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• pp.3-17
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• 1996

Dose compensators have been widely used in radiotherapy fields. But, few reliable verification methods have been reported. We have developed the verification method for the evaluation of the effect of dose compensator using exit beam dose profile. The exit beam dose profiles were measured with and without dose compensator. For this purpose X-Omat V films and lead screened cassettes are used and dose distibutions are compared. Phantom data are collected using CT simulator(Picker, AcQ Sim) and compensator information can be obtained from Render Plan 3-D planning System. Aluminum Compensators are generated by computer controlled milling machine. The real dose distribution in the phantom and the exit beam dose profile can be obtained simultaneously with the films in the phantom and the opposite site of the beam. Dose compensations effects for oblique beam, parallel opposing beam and inhomogeneous human phantom can be obtained using above tools. And we could simate those effects with exit beam dose profile using the method that we have developed in this study.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.82-93
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• 2003

Purpose : To reduce the Irradiation dose to the lungs and heart in the case of chest wail irradiation using an oppositional electron beam, we used an Individualized custom bolus, which was precisely designed to compensate for the differences In chest wall thickness. The benefits were evaluated by comparing the normal tissue complication probablilties (NTCPS) and dose statistics both with and without boluses. Materials and Methods : Boluses were made, and their effects evaluated in ten patients treated using the reverse hockey-stick technique. The electron beam energy was determined so as to administer 80% of the irradiation prescription dose to the deepest lung-chest wall border, which was usually located at the internal mammary lymph node chain. An individualized custom bolus was prepared to compensate for a chest wall thinner than the prescription depth by meticulously measuring the chest wall thickness at 1 emf intervals on the planning CT Images. A second planning CT was obtained overlying the individuailzed custom bolus for each patient's chest wall. 3-D treatment planning was peformed using ADAC-Pinnacle$^{3}$ for all patients with and without bolus. NTCPS based on 'the Lyman-Kutcher' model were analyzed and the mean, maximum, minimum doses, V$_{50}$ and V$_{95}$ for 4he heari and lungs were computed. Results .The average NTCPS in the ipsliateral lung showed a statistically significant reduction (p<0.01), from 80.2${\pm}$3.43% to 47.7${\pm}$4.61%, with the use of the individualized custom boluses. The mean lung irradiation dose to the ipsilateral iung was also significantly reduced by about 430 cGy, Trom 2757 cGy to 2,327 cGy (p<0.01). The V$_{50}$ and V$_{95}$ in the ipsilateral lung markedly decreased from the averages of 54.5 and 17.4% to 45.3 and 11.0%, respectively. The V$_{50}$ and V$_{95}$ In the heart also decreased from the averages of 16.8 and 6.1% to 9.8% and 2.2%, respectively. The NTCP In the contralateral lung and the heart were 0%, even for the cases with no bolus because of the small effective mean radiation volume values of 4.4 and 7.1%, respectively Conclusion : The use of an Individualized custom bolus in the radiotherapy of postrnastectorny chest wall reduced the NTCP of the ipsilateral lung by about 24.5 to 40.5%, which can improve the complication free cure probability of breast cancer patients.

• 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.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2004.11a
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• pp.132-135
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• 2004

In this study, we investigated the effect of threshold on a delivered dose in organ with internal motion by respiration. With mathematic model for 3D dose calculation reported by Lujan et al., we had calculated the position of organ as a function of time in previous study. This result presented that the variation of organ is within 2 mm from initial exhale position to the organ position during operating 1 s. Gating threshold, in this study, is determined to the moving region of target during 1s at a primary position of exhale. This period of gating threshold is 50% of the duty cycle in a half breathing cycle which is period from the top position of exhalation to the bottom position of inhalation. Radiation fields were then delivered under three conditions; 1) existent of moving target in the region of threshold(1sec, 1.5sec), 2) existent of moving target out of the region of threshold, 3) non-moving target. The non-moving target delivery represents a dose different induced due to internal organ motion.

• Progress in Medical Physics
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• v.9 no.4
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• pp.227-245
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• 1998

A most appropriate model of 3-D conformal radiotherapy has been induced by clinical evaluation and animal study, and therapeutic gains were evaluated by numerical equation of tumor control probability(TCP) and normal tissue complication probability (NTCP). The radiation dose to the tumor and the adjacent normal organs was accurately evaluated and compared using the dose volume histogram(DVH). The TCP and NTCP was derived from the distribution of given dosage and irradiated volume, and these numbers were used as the biological index for the assessment of the treatment effects. Ten patients with liver disease have been evaluated and 3 dogs were sacrificed for this study. Based on the 3-D images of the tumor and adjacent organs, the optimum radiation dose and the projection direction which could maximize the radiation effect while minimizing the effects to the adjacent organs could be decided. 3). The most effective collimation for the normal adjacent organs was made through the beams eye view with the use of multileaf collimator. When the dose was increased from 50Gy to 70Gy, the TCP for the conventional 2-port radiation and the 5-port multidimensional therapy was 0.982 and 0.995 respectively, while the NTCP was 0.725 and 0.142 respectively, suggesting that the 3-D conformal radiotherapy might be the appropriate therapy to apply sufficient radiation dose to the tumor while minimizing the damages to the normal areas of the liver. Positive correlation was observed between the NTCP and the actual complication of the normal liver in the animal study. The present study suggest that the use of 3-D conformal radiotherapy and the application of the mathematical models of TCP and NTCP may provide the improvements in the treatment of hepatoma with enhanced results.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.1
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• pp.15-24
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• 2013

Purpose: In Asan Medical Center, Two parallel opposite beams are employed for total body irradiation. Patients are required to be in supine position where two arms are attached to mid axillary line. Normally, physical compensators are required to compensate the large dose difference for different parts of body due to the different thicknesses compared to the umbilicus separation. There was the maximum dose difference up to 30% in lung and chest wall compared to the prescription dose. In order to resolve the dose discrepancy occurring on different body regions, the feasibility of using Fieid-in-Field Technique is investigated in this study. Materials and Methods: CT scan was performed to The RANDO Phantom with fabricated two arms and sent to Eclipse treatment planning system (version 10.0, Varian, USA). Conventional plan with physical lead compensator and new plan using Field-in-Field Technique were established on TPS. AAA (Anisotropic Analytical Algorithm) dose calculation algorithm was employed for two parallel opposite beams attenuation. Results: The dose difference between two methods was compared with the prescription dose. The dose distribution of chest and anterior chest wall uncovered by patient arms was 114~124% for physical lead compensator while Field-in-Field Technique gave 106~107% of the dose distribution. In-vivo dosimetry result using TLD showed that the dose distribution to the same region was 110~117% for conventional physical compensator and 104~107% for Field-in-Field Technique. Conclusion: In this study, the feasibility of using FIF technique has been investigated with fabricated arms attached Rando phantom. The dose difference was up to 17% due to the attached arms. It is shown that the dose homogeneity is within ${\pm}10%$ with the CT based 3-dimensional 4 step FIF technique. The in-vivo dosimetry result using TLD was showed that 95~107% dose distribution compared to prescription dose. It is considered that CT based 3-dimensional Field-in-Field Technique for the total body irradiation gives much homogeneous dose distribution for different body parts than the conventional physical compensator method and might be useful to evaluate the dose on each part of patient body.

• Journal of the Korean Society of Radiology
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• v.16 no.6
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• pp.709-718
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• 2022

We evaluated the effect of high-density aluminum, titanium, and steel metal inserts on computed tomography (CT) numbers and radiation treatment plans for Tomotherapy. CT images were obtained using a cylindrical TomoPhantom comprising cylindrical rods of various densities and metal inserts. Three CT image sets were evaluated for image quality as the mean CT number and standard deviation. Dose evaluation also performed. The reference values did not significantly differ between the CT image sets with the corrected metal inserts. The higher-density material exhibited the largest difference in the mean CT number and standard deviation. The conformity index at Iterative-Metal Artifact Reduction (iMAR) was approximately 20% better than that of non-iMAR. No significant target or organ at risk dose difference was observed between non-iMAR and iMAR. Therefore, iMAR is helpful for target or organ at risk delineation and for reducing uncertainty for three-dimensional conformal radiation therapy in Tomotherapy.