The Journal of Korean Society for Radiation Therapy
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v.15
no.1
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pp.11-18
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2003
The concrete is usually used to build a radiation therapy facility and the enough concrete thickness for high energy x-ray beam is about 1 meter. But if the space is not enough to build a radiation therapy facility with concrete, the substitute for concrete is needed, and the Ledite can be a good substitute for concrete. In this study, we compared the Ledite with the concrete. The comparing list are the needed shielding thickness, the period of construction and the cost.
Purpose : The expression pattern of c-jun by ionizing radiation according to cell growth state (exponential growth vs. stationary phase) and its relationship with cell cycle redistribution were investigated. Materials and Methods : The exponential growth phase (day 4) and stationary phase (day 9) cells were determined from cell growth curve according to the elapse of days in CaSki. The cells were irradiated using 6 MV X-ray with a dose of 2 Gy at a fixed dose rate of 3 Gy/min. Northern blot analysis was peformed with total cellular RNA and cell cycle distribution was analyzed using flow cytometry according to time-course after irradiation. Results : The maximum expression of c-jun occurred 1 hour after irradiation in both exponential growth and stationary phase cells. After then c-jun expression was elevated upto 6 hours in exponential growth phase cells, but the level decreased in stationary phase cells. Movements of cells from G0-G1 to S, G2-M phase after irradiation were higher in exponential growth phase than stationary phase. Conclusion : c-jun may be involved in the regulation of cellular proliferation according to the growth states after irradiation.
Purpose: We report the results of an external audit on the absorbed dose of radiotherapy beams independently performed by third parties. For this effort, we developed a method to measure the absorbed dose to water in an easy and convenient setup of solid water phantom. Materials and Methods: In 2008, 12 radiotherapy centers voluntarily participated in the external auditing program and 47 beams of X-ray and electron were independently calibrated by the third party’s American Association of Physicists in Medicine (AAPM) task group (TG)-51 protocol. Even though the AAPM TG-51 protocol recommended the use of water, water as a phantom has a few disadvantages, especially in a busy clinic. Instead, we used solid water phantom due to its reproducibility and convenience in terms of setup and transport. Dose conversion factors between solid water and water were determined for photon and electron beams of various energies by using a scaling method and experimental measurements. Results: Most of the beams (74%) were within ${\pm}2%$ of the deviation from the third party's protocol. However, two of 20 X-ray beams and three of 27 electron beams were out of the tolerance (${\pm}3%$), including two beams with a >10% deviation. X-ray beams of higher than 6 MV had no conversion factors, while a 6 MV absorbed dose to a solid water phantom was 0.4% less than the dose to water. The electron dose conversion factors between the solid water phantom and water were determined: The higher the electron energy, the less is the conversion factor. The total uncertainty of the TG-51 protocol measurement using a solid water phantom was determined to be ${\pm}1.5%$. Conclusion: The developed method was successfully applied for the external auditing program, which could be evolved into a credential program of multi-institutional clinical trials. This dosimetry saved time for measuring doses as well as decreased the uncertainty of measurement possibly resulting from the reference setup in water.
Purpose: Tissue inhomogeneity such as lung affects tumor dose as well as transmission dose in new concept of on-line dosimetry which estimates tumor dose from transmission dose using the new algorithm. This study was carried out to confirm accuracy of correction by tissue density in tumor dose estimation utilizing transmission dose. Methods: Cork phantom (CP, density $0.202\;gm/cm^3$) having similar density with lung parenchyme and polystyrene phantom (PP, density $1.040\;gm/cm^3$) having similar density with soft tissue were used. Dose measurement was carried out under condition simulating human chest. On simulating AP-PA irradiation, PPs with 3 cm thickness were placed above and below CP, which had thickness of 5, 10, and 20 cm. On simulating lateral irradiation, 6 cm thickness of PP was placed between two 10 cm thickness CPs additional 3 cm thick PP was placed to both lateral sides. 4, 6, and 10 MV x-ray were used. Field size was in the range of $3{\times}3$ cm through $20{\times}20$ cm, and phantom-chamber distance (PCD) was 10 to 50 cm. Above result was compared with another sets of data with equivalent thickness of PP which was corrected by density. Result: When transmission dose of PP was compared with equivalent thickness of CP which was corrected with density, the average error was 0.18 (${\pm}0.27$) % for 4 MV, 0.10 (${\pm}0.43$) % for 6 MV, and 0.33 (${\pm}0.30$) % for 10 MV with CP having thickness of 5 cm. When CP was 10 cm thick, the error was 0.23 (${\pm}0.73$) %, 0.05 (${\pm}0.57$) %, and 0.04 (${\pm}0.40$) %, while for 20 cm, error was 0.55 (${\pm}0.36$) %, 0.34 (${\pm}0.27$) %, and 0.34 (${\pm}0.18$) % for corresponding energy. With lateral irradiation model, difference was 1.15 (${\pm}1.86$) %, 0.90 (${\pm}1.43$) %, and 0.86 (${\pm}1.01$) % for corresponding energy. Relatively large difference was found in case of PCD having value of 10 cm. Omitting PCD with 10 cm, the difference was reduced to 0.47 (${\pm}$1.17) %, 0.42 (${\pm}$0.96) %, and 0.55 (${\pm}$0.77) % for corresponding energy. Conclusion When tissue inhomogeneity such as lung is in tract of x-ray beam, tumor dose could be calculated from transmission dose after correction utilizing tissue density.
Purpose: To determine the patterns on evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techiniques, nationwide survey was peformed. Materials and Methods: A web-based database system for korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998$\~$1999 from 15 hospitals were reviewed. Results: The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9$\%$) followed by medullary carcinoma (4.2$\%$) and infiltrating lobular carcinoma (1.5$\%$). Pathologic T stage by AJCC was T1 in 59.7$\%$ of the casses, T2 in 29.5$\%$ of the cases, Tis in 8.8$\%$ of the cases. Axillary lymph node dissection was peformed I\in 91.2$\%$ of the cases and 69.7$\%$ were node negative. AJCC stage was 0 in 8.8$\%$ of the cases, stage I in 44.9$\%$ of the cases, stage IIa in 33.3$\%$ of the cases, and stage IIb in 8.4$\%$ of the cases. Estrogen and progesteron receptors were evaluated in 71.6$\%$, and 70.9$\%$ of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2$\%$, wide excision in 11.5$\%$, quadrantectomy in 23$\%$ and partial mastectomy in 27.5$\%$ of the cases. A pathologically confirmed negative margin was obtained in 90.8$\%$ of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one recieved more than 90$\%$ of the planned radiotherapy dose. Radiotherapy volume was breast only In 88$\%$ of the cases, breast+supraclavicular fossa (SCL) in 5$\%$ of the cases, and breast+ SCL+ posterior axillary boost in 4.2%$\%$of the cases. Only one patient received isolated internal mammary lymph node irradiation. Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45$\~$59.4 Gy (median 50.4) and boost dose was 8$\~$20 Gy (median 10 Gy). The total radiation dose delivered was 50.4$\~$70.4 Gy (median 60.4 Gy). Conclusion: There was no major deviation from current standard in the patterns of evaluation and treatment for the patients with early breast cancer treated with breast conservation method. Some varieties were identified in boost irradiation dose. Separate analysis for the datails of radiotherapy planning will be followed and the outcome of treatment is needed to evaluate the process.
In study, we investigated changes on growth and chlorophyll concentration on sprouted barley by fractionated X-ray irradiation (FXI). Group was divided into the control group (CG), 1-time irradiation group (30 Gy once), 2-time irradiation group (15 Gy 2 times), and 3-time irradiation group (10 Gy 3 times), and 20 grains were used per group. Experimental group (EG) was exposed by using linear accelerator (Clinac IS, VERIAN, USA), by 6 MV X-ray, SSD 100 cm, 18×10 cm2, 600 MU/min. Length was measured every day until 9th day, and chlorophyl was analyzed using spectrophotometer(uv-1800, shimadzu, japan) in 9th day. Data analysis was performed the One-way ANOVA using SPSS ver 26.0(Chicago, IL, USA). In the pre-germination irradiation group (Pre-GIG), the CG had greater length than the EG on all measurement days, and as the number of FXI increased, the length became shorter. In the post-germination irradiation group (Post-GIG), the length of the CG was statistically significantly greater than that of the EG on all measurement days, and as the number of FXI increased, the length also became longer. The chlorophyll concentration was higher in the Post-GIG than in the Pre-GIG, and chlorophyll concentrations of EG was higher in the Pre-GIG than in the CG, as well as and Post-GIG. In addition, the smaller the number of FXI, the higher the chlorophyll concentration in both groups. FXI was found to affect the growth and chlorophyll concentration of sprouted barley.
Intensity Modulated Radiotherapy (IMRT) is increasing its use recently due to its benefits of minimizing the dose on surrounding normal organs and being able to target a high dose specifically to the tumor. The study aims to measure and evaluate the dose distribution according to its dynamic changes in Mapcheck. In order to verify the dose distribution by EDW angle($10^{\circ}$,$15^{\circ}$,$20^{\circ}$,$25^{\circ}$,$30^{\circ}$,$45^{\circ}$,$60^{\circ}$), field size (asymmetric field) and depth changes (1.5 cm, 5.0 cm) using IMRT in Clinac ix, a solid phantom was placed on the Mapcheck and 100MU was exposed by 6 MV, 10MV X-ray. Using a 6MV, 10MV energy, the percentage depth dose according to a dynamic changes at a maximum dose depth (1.5 cm) and at 5.0 cm depth showed the value difference of maximum 0.6%, less than 1%, which was calculated by a treatment program device considering the maximum dose depth at the center as 100%, the percentage depth dose was in the range between 2.4% and 7.2%. Also, the maximum value difference of a percentage depth dose was 4.1% in Y2-OUT direction, and 1.7% in Y1-IN direction. When treating a patient using a wedge, it is considered that using an enhanced dynamic wedge is effective to reduce the scattered dose which induces unnecessary dose to the surroundings. In particular, when treating a patient at clinic, a treatment must be performed considering that the wedge dose in a toe direction is higher than the dose in a heel direction.
Purpose : This study was to evaluate survival, failure patterns, and prognostic factors of stage I squamous cell carcinoma of the glottic larynx after curative radiation therapy. Materials and Methods : A retrospective analysis was done for 57 patients with glottic cancer who were treated with curative radiation therapy from June 1985 to November 1992. There were 55 male and two female patients. Patients' age ranged from 17 to 71 years(median 39 years). Radiation therapy was delivered five times a week, 2 Gy daily, total 66 Gy using 6 MV X-ray. Results : Complete response(CR) was noted in 51 out of 57 patients (89.5%) and persistent disease (PER) in six out of 57 patients(10.5%). The disease-free survival rates at 3 and 5 years were 72.9% and 63.8%, respectively. Seven failures were observed among 51 CR patients during follow-up. Salvage total laryngectomy for six recurred patients and partial laryngectomy for one recurred patient were done with successful results, i.e., all of them were actually salvaged. Among six PER patients, salvage total laryngectomy for two patients and partial laryngectomy for two patients were done and two patients refused operation. Following salvage surgery for the four PER patients, three were salvaged and one failed locoregionally. Among the 13 failures 10(76.9%) were salvaged with surgery. The ultimate local control rate at 5 years was 92.3% and overall 47 out of 57 (82.5%) patients were able to preserve their larynx. The 5-year disease-free survival rates were 85.5% for posterior lesions, and 61.6% for anterior lesions(P<0.05). Cord mobility, involvement of anterior commissure, field size, and T stage did not impact on disease-free survival. Conclusion : Considering the high percentage of voice preservation with initial radiotherapy, radiotherapy should be the first choice in the treatment of stage 1 glottic carcinoma.
Purpose: The objective of this study is to develop an algorithm for estimation of tumor dose using measured transmission dose as a part of the development of on-line dosimetry system. Materials and Methods: Data of transmission dose were measured under various FS, Tp and PCD with a special water phantom for 6 MV and 10 MV X-ray. SCD (source-chamber distance) was set to 150 cm. Measurements were conducted with a 0.125 cc ion chamber. Results: Using measured data and regression analysis, two algorithms were developed for estimation of expected reading for measured data. Algorithm 1 consisted of the quadratic function of PCD and the tertiary function of AlP (area-perimeter ratio). Algorithm 2 consisted of the tertiary function of log(A/P)and the tertiary function of PCD. Algorithm 2 required less data set and was more accurate in comparing expected and observed dose. Conclusion: Using the algorithm developed, transmission dose can be estimated for any exposure condition, i.e. any given Tp, PCD and FS with high accuracy. To complete this algorithm, further developments are needed regarding the beam modifying device, the tissue inhomogeneity and the irregular body surface.
Proceedings of the Korean Society of Medical Physics Conference
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2002.09a
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pp.119-120
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2002
The aim is to urge the need of elaborate commissioning of 3D RTP system from the firsthand experience. A 3D RTP system requires so much data such as beam data and patient data. Most data of radiation beam are directly transferred from a 3D dose scanning system, and some other data are input by editing. In the process inputting parameters and/or data, no error should occur. For RTP system using algorithm-bas ed-on beam-modeling, careless beam-data processing could also cause the treatment error. Beam data of 3 different qualities of photon from two linear accelerators, patient data and calculated results were commissioned. For PDD, the doses by Clarkson, convolution, superposition and fast superposition methods at 10 cm for 10${\times}$10 cm field, 100 cm SSD were compared with the measured. An error in the SCD for one quality was input by the service engineer. Whole SCD defined by a physicist is SAD plus d$\sub$max/, the value was just SAD. That resulted in increase of MU by 100${\times}$((1_d$\sub$max//SAD)$^2$-1)%. For 10${\times}$10 cm open field, 1 m SSD and at 10 cm depth in uniform medium of relative electron density (RED) 1, PDDs for 4 algorithms of dose calculation, Clarkson, convolution, superposition and fast-superposition, were compared with the measured. The calculated PDD were similar to the measured. For 10${\times}$10 cm open field, 1 m SSD and at 10 cm depth with 5 cm thick inhomogeneity of RED 0.2 under 2 cm thick RED 1 medium, PDDs for 4 algorithms were compared. PDDs ranged from 72.2% to 77.0% for 4 MV X-ray and from 90.9% to 95.6% for 6 MV X-ray. PDDs were of maximum for convolution and of minimum for superposition. For 15${\times}$15 cm symmetric wedged field, wedge factor was not constant for calculation mode, even though same geometry. The reason is that their wedge factor is considering beam hardness and ray path. Their definition requires their users to change the concept of wedge factor. RTP user should elaborately review beam data and calculation algorithm in commissioning.
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