• 대한핵의학회:학술대회논문집
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• 2003.05b
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• pp.55-61
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• 2003

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.3
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• pp.985-992
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• 2016

Objective of the study is to evaluate volumetric and dosimetric alterations taking place during radiotherapy for locally advanced head and neck cancer (LAHNC) and to assess benefit of replanning in them. Materials and Methods: Thirty patients with LAHNC fulfilling the inclusion and exclusion criteria were enrolled in a prospective study. Planning scans were acquired both pre-treatment and after 20 fractions (mid-course) of radiotherapy. Single plan (OPLAN) based on initial CT scan was generated and executed for entire treatment course. Beam configuration of OPLAN was applied to anatomy of interim scan and a hybrid plan (HPLAN30) was generated. Adaptive replanning (RPLAN30) for remaining fractions was done and dose distribution with and without replanning compared for remaining fractions. Results: Substantial shrinkage of target volume (TV) and parotids after 4 weeks of radiotherapy was reported (p<0.05). No significant difference between planned and delivered doses was seen for remaining fractions. Hybrid plans showed increase in delivered dose to spinal cord and parotids for remaining fractions. Interim replanning improved homogeneity of treatment plan and significantly reduced doses to cord (Dmax, D2% and D1%) and ipsilateral parotid (D33%, D50% and D66%) (p<0.05). Conclusions: Use of one or two mid-treatment CT scans and replanning provides greater normal tissue sparing along with improved TV coverage.

• Journal of radiological science and technology
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• v.36 no.3
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• pp.227-235
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• 2013

In adaptive radiotherapy(ART), generated composite dose of surrounding normal tissue on overall treatment course which is using deformable image registration from multistage images. Also, compared with doses summed by each treatment plan and clinical significance is considered. From the first of May, 2011 to the last of July, 2012. Patients who were given treatment and had the head and neck cancer with 3-dimension conformal radiotherapy or intensity modulated radiotherapy, those who were carried out adaptive radiotherapy cause of tumor shrinkage and weight loss. Generated composite dose of surrounding normal tissue using deformable image registration was been possible, statistically significant difference was showed to mandible($48.95{\pm}3.89$ vs $49.10{\pm}3.55$ Gy), oral cavity($36.93{\pm}4.03$ vs $38.97{\pm}5.08$ Gy), parotid gland($35.71{\pm}6.22$ vs $36.12{\pm}6.70$ Gy) and temporomandibular joint($18.41{\pm}9.60$ vs $20.13{\pm}10.42$ Gy) compared with doses summed by each treatment plan. The results of this study show significant difference between composite dose by deformable image registration and doses summed by each treatment plan, composite dose by deformable image registration may generate more exact evaluation to surrounding normal tissue in adaptive radiotherapy.

• Progress in Medical Physics
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• v.30 no.4
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• pp.104-111
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• 2019

Purpose: Online magnetic resonance-guided adaptive radiotherapy (MRgART), an emerging technique, is used to address the change in anatomical structures, such as treatment target region, during the treatment period. However, the electron density map used for dose calculation differs from that for daily treatment, owing to the variation in organ location and, notably, air pockets. In this study, we evaluate the dosimetric effect of electron density override on air pockets during online ART for pancreatic cancer cases. Methods: Five pancreatic cancer patients, who were treated with MRgART at the Seoul National University Hospital, were enrolled in the study. Intensity modulated radiation therapy plans were generated for each patient with 60Co beams on a ViewrayTM system, with a 45 Gy prescription dose for stereotactic body radiation therapy. During the treatment, the electron density map was modified based on the daily MR image. We recalculated the dose distribution on the plan, and the dosimetric parameters were obtained from the dose volume histograms of the planning target volume (PTV) and organs at risk. Results: The average dose difference in the PTV was 0.86Gy, and the observed difference at the maximum dose was up to 2.07 Gy. The variation in air pockets during treatment resulted in an under- or overdose in the PTV. Conclusions: We recommend the re-contouring of the air pockets to deliver an accurate radiation dose to the target in MRgART, even though it is a time-consuming method.

• Radiation Oncology Journal
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• v.33 no.2
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• pp.117-125
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• 2015

Purpose: To investigate the relationship between early treatment response to definitive chemoradiotherapy (CRT) and survival outcome in patients with limited stage small cell lung cancer (LS-SCLC). Materials and Methods: We retrospectively reviewed 47 patients with LS-SCLC who received definitive CRT between January 2009 and December 2012. Patients were treated with systemic chemotherapy regimen of etoposide/carboplatin (n = 15) or etoposide/cisplatin (n = 32) and concurrent thoracic radiotherapy at a median dose of 54 Gy (range, 46 to 64 Gy). Early treatment volume reduction rate (ETVRR) was defined as the percentage change in gross tumor volume between diagnostic computed tomography (CT) and simulation CT for adaptive RT planning and was used as a parameter for early treatment response. The median dose at adaptive RT planning was 36 Gy (range, 30 to 43 Gy), and adaptive CT was performed in 30 patients (63.8%). Results: With a median follow-up of 27.7 months (range, 5.9 to 75.8 months), the 2-year locoregional progression-free survival (LRPFS) and overall survival (OS) rates were 74.2% and 56.5%, respectively. The mean diagnostic and adaptive gross tumor volumes were 117.9 mL (range, 5.9 to 447 mL) and 36.8 mL (range, 0.3 to 230.6 mL), respectively. The median ETVRR was 71.4% (range, 30 to 97.6%) and the ETVRR >45% group showed significantly better OS (p < 0.0001) and LRPFS (p = 0.009) than the other group. Conclusion: ETVRR as a parameter for early treatment response may be a useful prognostic factor to predict treatment outcome in LS-SCLC patients treated with CRT.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.2
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• pp.83-89
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• 2008

Purpose: The checking method of target and normal structure are used by MVCBCT, KVCBCT, CT On-rail System, Ultrasound in H&N cancer patient. In case of MVCT, the utilization of bone structure is valuable to check around tissue. But the utilization of soft tissue is not enough. The point of this paper is dose variation in movable parotid and changeable volume of H&N cancer patient of CT On-rail System. Materials and Methods: The object of H&N cancer patient is 5 in this hospital. The selected patient are scanned ARTISTE CT Vision (CT On-ral System) a triweekly. After CT scanning, tranfered coordinates are obtained by movable of parotid gland comparison with planning image. Checking for the changeable volume of parotid gland. A Obtained CT image are tranfered to the RTP System. So dose variation are checked by following changed volume. Results: The changes of target coordinate by the parotid gland movement are X: -0.4~0.4 cm, Y: -0.4~0.3 cm, Z: -0.3~0.3 cm. the volume of GTV is decreased to about 7.11%/week and then both parotid gland volume are shrinked about 4.81%/week (Lt), 2.91%/week (Rt). At the same time, each parotid gland are diminished in radiation dose as 3.66%/week (Lt), 2.01%/week. Conclusion: Images from CT on the rail System which are able to aquire the better quality images of soft tissue in Target area than MVCBCT. After replanning and dose redistribution by required images, It could gain not only the correction of the patient set-tup errors but exact dose distribution. Accordingly, the delivery of compensated dose, It makes that we could do Adaptive Targeting Radiotherapy and need Real Time Adaptive Targeting Radiotherapy by reduce beam delivary time.

• Progress in Medical Physics
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• v.26 no.2
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• pp.79-86
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• 2015

The purpose of this study is to evaluate efficacy and feasibility of adaptive radiotherapy according to tumor volume change (TVC) in early stage non-small cell lung cancer (NSCLC) using stereotactic body radiotherapy (SBRT). Twenty-two lesions previously treated with SBRT were selected. SBRT was usually performed with a total dose of 48 Gy or 60 Gy in four fractions with an interval of three to four days between treatments. For evaluation of TVC, gross tumor volume (GTV) was contoured on each cone-beam computed tomography (CBCT) image used for image guidance. Intensity modulated radiotherapy (IMRT) planning was performed in the first CBCT (CBCT1) using a baseline plan. For ART planning (ART), re-optimization was performed at $2^{nd}$, $3^{rd}$, and $4^{th}$ CBCTs (CBCT2, CBCT3, and CBCT4) using the same angle and constraint used for the baseline plan. The ART plan was compared with the non-ART plan, which generated copying of the baseline plan to other CBCTs. Average GTV volume was 10.7 cc. Average TVC was -1.5%, 7.3%, and -25.1% in CBCT2, CBCT3, and CBCT4 and the TVC after CBCT3 was significant (p<0.05). However, the nine lesions were increased GTV in CBCT2. In the ART plan, $V_{20\;Gy}$, $D_{1500\;cc}$, and $D_{1000\;cc}$ of lung were significantly decreased (p<0.05), and $V_{30\;Gy}$ and $V_{32\;Gy}$ of the chest wall were also decreased (p<0.05). While D min of planning target volume (PTV) decreased by 8.3% in the non-ART plan of CBCT2 compared with the baseline plan in lesions with increased tumor size (p=0.021), PTV coverage was not compromised in the ART plan. Based on this result, use of the ART plan may improve target coverage and OAR saving. Thus ART using CBCT should be considered in early stage NSCLC with SBRT.

• Progress in Medical Physics
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• v.33 no.4
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• pp.142-149
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• 2022

Purpose: This study seeks to compare the dosimetric parameters of the bulk electron density (ED) approach and synthetic computed tomography (CT) image in terms of position variation of the air cavity in magnetic resonance-guided radiotherapy (MRgRT) for patients with pancreatic cancer. Methods: This study included nine patients that previously received MRgRT and their simulation CT and magnetic resonance (MR) images were collected. Air cavities were manually delineated on simulation CT and MR images in the treatment planning system for each patient. The synthetic CT images were generated using the deep learning model trained in a prior study. Two more plans with identical beam parameters were recalculated with ED maps that were either manually overridden by the cavities or derived from the synthetic CT. Dose calculation accuracy was explored in terms of dose-volume histogram parameters and gamma analysis. Results: The D_95% averages were 48.80 Gy, 48.50 Gy, and 48.23 Gy for the original, manually assigned, and synthetic CT-based dose distributions, respectively. The greatest deviation was observed for one patient, whose D_95% to synthetic CT was 1.84 Gy higher than the original plan. Conclusions: The variation of the air cavity position in the gastrointestinal area affects the treatment dose calculation. Synthetic CT-based ED modification would be a significant option for shortening the time-consuming process and improving MRgRT treatment accuracy.

• Nuclear Engineering and Technology
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• v.47 no.4
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• pp.472-478
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• 2015

The patient dose incurred from diagnostic procedures during advanced radiotherapy has become an important issue. Many researchers in medical physics are using computational simulations to calculate complex parameters in experiments. However, extended computation times make it difficult for personal computers to run the conventional Monte Carlo method to simulate radiological images with high-flux photons such as images produced by computed tomography (CT). To minimize the computation time without degrading imaging quality, we applied a deterministic adaptation to the Monte Carlo calculation and verified its effectiveness by simulating CT image reconstruction for an image evaluation phantom (Catphan; Phantom Laboratory, New York NY, USA) and a human-like voxel phantom (KTMAN-2) (Los Alamos National Laboratory, Los Alamos, NM, USA). For the deterministic adaptation, the relationship between iteration numbers and the simulations was estimated and the option to simulate scattered radiation was evaluated. The processing times of simulations using the adaptive method were at least 500 times faster than those using a conventional statistical process. In addition, compared with the conventional statistical method, the adaptive method provided images that were more similar to the experimental images, which proved that the adaptive method was highly effective for a simulation that requires a large number of iterations-assuming no radiation scattering in the vicinity of detectors minimized artifacts in the reconstructed image.

• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.83-95
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• 2018

Purpose : After planning the Respiratory Gated Radiotherapy for Lung cancer, the movement and volume change of sparing normal structures nearby target are not often considered during dose evaluation. This study carried out 4-D dose evaluation which reflects the movement of normal structures at certain phase of Respiratory Gated Radiotherapy, by using Deformable Image Registration that is well used for Adaptive Radiotherapy. Moreover, the study discussed the need of analysis and established some recommendations, regarding the normal structures's movement and volume change due to Patient's breathing pattern during evaluation of treatment plans. Materials and methods : The subjects were taken from 10 lung cancer patients who received Respiratory Gated Radiotherapy. Using Eclipse(Ver 13.6 Varian, USA), the structures seen in the top phase of CT image was equally set via Propagation or Segmentation Wizard menu, and the structure's movement and volume were analyzed by Center-to Center method. Also, image from each phase and the dose distribution were deformed into top phase CT image, for 4-dimensional dose evaluation, via VELOCITY Program. Also, Using $QUASAR^{TM}$ Phantom(Modus Medical Devices) and $GAFCHROMIC^{TM}$ EBT3 Film(Ashland, USA), verification carried out 4-D dose distribution for 4-D gamma pass rate. Result : The movement of the Inspiration and expiration phase was the most significant in axial direction of right lung, as $0.989{\pm}0.34cm$, and was the least significant in lateral direction of spinal cord, as -0.001 cm. The volume of right lung showed the greatest rate of change as 33.5 %. The maximal and minimal difference in PTV Conformity Index and Homogeneity Index between 3-dimensional dose evaluation and 4-dimensional dose evaluation, was 0.076, 0.021 and 0.011, 0.0 respectfully. The difference of 0.0045~2.76 % was determined in normal structures, using 4-D dose evaluation. 4-D gamma pass rate of every patients passed reference of 95 % gamma pass rate. Conclusion : PTV Conformity Index was more significant in all patients using 4-D dose evaluation, but no significant difference was observed between two dose evaluations for Homogeneity Index. 4-D dose distribution was shown more homogeneous dose compared to 3D dose distribution, by considering the movement from breathing which helps to fill out the PTV margin area. There was difference of 0.004~2.76 % in 4D evaluation of normal structure, and there was significant difference between two evaluation methods in all normal structures, except spinal cord. This study shows that normal structures could be underestimated by 3-D dose evaluation. Therefore, 4-D dose evaluation with Deformable Image Registration will be considered when the dose change is expected in normal structures due to patient's breathing pattern. 4-D dose evaluation with Deformable Image Registration is considered to be a more realistic dose evaluation method by reflecting the movement of normal structures from patient's breathing pattern.