• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.183-189
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• 2014

Purpose : Intravenous contrast medium is a substance used to enhance the contrast of normal tissues or malignant tissues within the body. For this reason, intravenous contrast media have been extensively used form treatment-planning CT. However, when the patient is receiving proton therapy, there is no contrast medium in that moment. In this study, evaluate the influence of intravenous contrast medium on proton range and Spread-Out Bragg peak(SOBP) in Treatment Planning System(TPS). Materials and Methods : Hounsfield Unit(HU) value were measured by 20 liver cancer patients with phase change. and evaluate the proton range and SOBP on 5 liver proton treatment plan. By using the hand made water phantom measure the proton range and SOBP on proton treatment plan with changing HU and Depth. Results : Changing value(Pre contrast, Arterial phase, Portal phase) in liver cancer patient were ($58{\pm}5.7$, $75{\pm}9.5$, $117{\pm}14.6$ for liver tissue) and ($40{\pm}6.1$, $279{\pm}49.0$, $154{\pm}22.8$ for aorta), respectively. The mean difference of range was 2.5mm and SOBP was 1.4mm according to HU change. In phantom study, proton range was shorter and SOBP was narrowed with increasing HU. Conclusion : We verify that HU change lead to range and SOBP change in TPS. Additional study is required to verify that change of HU make range and SOBP be changed in actual substance.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.51-57
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• 2014

Purpose : In the case of treating pancreatic cancer, the importance is put on the spread of dose. Changes take place in duodenum in accordance with respiration. Thus, in this paper, I am going to trace the positioning of duodenum and the changes in bulks of body per dose by scanning the patients' Kilovoltage Cone-Beam CT using the hospital equipped CT-on rail System. Materials and Methods : Seeing three patients, I have acquired KVCBCT by using CT-on rail System and spotted the change in positioning at duodenum after comparing with the preliminary image of treatment plan by using SYNGO Software. Then, I followed the change in the bulk of duodenum and analyzed the changes in bulks of body on the same dose by transmitting the acquired KVCBCT into Pinnacle, a treatment plan system. Results : The changes in the positioning shall be as set forth like this: 1.2cm, 1.0cm in Left-Right Direction, 0cm, 0.8cm in Craniocaudal Direction, 0.1cm, and 1.0cm in Anterior-Posterior Direction. Patient number one showed that his bulks in body had increased by maximum 460%, minimum 120%, the bulks in patient number two had increased bymaximum 490%, minimum 160%, and the bulks of patient number three had increased by maximum 150%. But Minimum volume decreased 30%. Patient number one showed only a little bit of change at first when compared with the preliminary treatment plan. However, the dose increased the bulks in the patient's body: $V_{10}$ 118%, $V_{20}$ 117%, $V_{30}$ 400%, and $V_{40}$ 480% Conclusion : In treating patients with radiation therapy using 3D-CRT, the dose amount penetrated into duodenum needs to be minimized by planning appropriate treatment beforehand. In order to establish an appropriate treatment plan it is required to comprehend the changes at positioning of the duodenum by respiration and predict the changes in the bulks of duodenum by setting precise Planning Target Volume.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.94-99
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• 2003

Purpose : To explore a 3D conformal radiotherapy technique for a posterior fossa boost, and the potential advantages of a prone position for such radiotherapy. Materials and Methods :A CT simulator and 3D conformal radiotherapy Planning system was used for the posterior fossa boost treatment on a 13-year-old medulloblastoma patient. He was placed In the prone position and Immobilized with an aquaplast mask and immobilization mold. CT scans were obtained of the brain from the top of the skull to the lower neck, with IV contrast enhancement. The target volume and normal structures were delineated on each slice, with treatment planning peformed using non-coplanar conformal beams. Results : The CT scans, and treatment In the prone position, were peformed successfully. In the prone position, the definition of the target volume was made easier due to the well enhanced tentorium, In audition, the posterior fossa was located anteriorly, and with the greater choice of beam arrangements, more accurate treatment planning was possible as the primary beams were not obstructed by the treatment table. Conclusion : .A posterior fossa boost, in the prone position, Is feasible in cooperating patients, but further evaluation is needed to define the optimal and most comfortable treatment positions.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.127-135
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• 2014

Purpose : By taking advantage of each imaging modality, the use of fused CT/MRI image has increased in prostate cancer radiation therapy. However, fusion uncertainty may cause partial target miss or normal organ overdose. In order to complement such limitation, our hospital acquired MRI image (Planning MRI) by setting up patients with the same fixing tool and posture as CT simulation. This study aims to evaluate the usefulness of the Planning MRI through comparing and analyzing the diagnostic MRI image and Planning MRI image. Materials and Methods : This study targeted 10 patients who had been diagnosed with prostate cancer and prescribed nonhormone and definitive RT 70 Gy/28 fx from August 2011 to July 2013. Each patient had both CT and MRI simulations. The MRI images were acquired within one half hour after the CT simulation. The acquired CT/MRI images were fused primarily based on bony structure matching. This study measured the volume of prostate in the images of Planning MRI and diagnostic MRI. The diameters at the craniocaudal, anteroposterior and left-to-right directions from the center of prostate were measured in order to compare changes in the shape of prostate. Results : As a result of comparing the volume of prostate in the images of Planning MRI and diagnostic MRI, they were found to be $25.01cm^3$(range $15.84-34.75cm^3$) and $25.05cm^3$(range $15.28-35.88cm^3$) on average respectively. The diagnostic MRI had an increase of 0.12 % as compared with the Planning MRI. On the planning MRI, there was an increase in the volume by $7.46cm^3$(29 %) at the transition zone directions, and there was a decrease in the volume by $8.52cm^3$(34 %) in the peripheral zone direction. As a result of measuring the diameters at the craniocaudal, anteroposterior and left-to-right directions in the prostate, the Planning MRI was found to have on average 3.82cm, 2.38cm and 4.59cm respectively and the diagnostic MRI was found to have on average 3.37cm, 2.76cm and 4.51cm respectively. All three prostate diameters changed and the change was significant in the Planning MRI. On average, the anteroposterior prostate diameter decrease by 0.38cm(13 %). The mean right-to-left and craniocaudal diameter increased by 0.08cm(1.6 %) and 0.45cm(13 %), respectively. Conclusion : Based on the results of this study, it was found that the total volumes of prostate in the Planning MRI and the diagnostic MRI were not significantly different. However, there was a change in the shape and partial volume of prostate due to the insertion of prostate balloon tube to the rectum. Thus, if the Planning MRI images were used when conducting the fusion of CT/MRI images, it would be possible to include the target in the CTV without a loss as much as the increased volume in the transition zone. Also, it would be possible to reduce the radiation dose delivered to the rectum through separating more clearly the reduction of peripheral zone volume. Therefore, the author of this study believes that acquisition of Planning MRI image should be made to ensure target delineation and localization accuracy.

• The Journal of Korean Society for Radiation Therapy
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• v.21 no.2
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• pp.83-88
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• 2009

Purpose: Cone beam computed tomography (CBCT) using an on board imager (OBI) can check the movement and setup error in patient position and target volume by comparing with the image of computer simulation treatment in real.time during patient treatment. Thus, this study purposed to check the change and movement of patient position and target volume using CBCT in IMRT and calculate difference from the treatment plan, and then to correct the position using an automated match system and to test the accuracy of position correction using an electronic portal imaging device (EPID) and examine the usefulness of CBCT in IMRT and the accuracy of the automatic match system. Materials and Methods: The subjects of this study were 3 head and neck patients and 1 pelvis patient sampled from IMRT patients treated in our hospital. In order to investigate the movement of treatment position and resultant displacement of irradiated volume, we took CBCT using OBI mounted on the linear accelerator. Before each IMRT treatment, we took CBCT and checked difference from the treatment plan by coordinate by comparing it with the image of CT simulation. Then, we made correction through the automatic match system of 3D/3D match to match the treatment plan, and verified and evaluated using electronic portal imaging device. Results: When CBCT was compared with the image of CT simulation before treatment, the average difference by coordinate in the head and neck was 0.99 mm vertically, 1.14 mm longitudinally, 4.91 mm laterally, and 1.07o in the rotational direction, showing somewhat insignificant differences by part. In testing after correction, when the image from the electronic portal imaging device was compared with DRR image, it was found that correction had been made accurately with error less than 0.5 mm. Conclusion: By comparing a CBCT image before treatment with a 3D image reconstructed into a volume instead of a 2D image for the patient's setup error and change in the position of the organs and the target, we could measure and correct the change of position and target volume and treat more accurately, and could calculate and compare the errors. The results of this study show that CBCT was useful to deliver accurate treatment according to the treatment plan and to increase the reproducibility of repeated treatment, and satisfactory results were obtained. Accuracy enhanced through CBCT is highly required in IMRT, in which the shape of the target volume is complex and the change of dose distribution is radical. In addition, further research is required on the criteria for match focus by treatment site and treatment purpose.

• Progress in Medical Physics
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• v.13 no.4
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• pp.202-208
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• 2002

The purpose of this study is to evaluate the monitor unit obtained from various methods for the treatment of superficial cancers using electron beams. Thirty-three breast cancer patients who were treated in our institution with 6, 9, and 12 MeV electron beams, were selected for this study. For each patient, irregularly shaped treatment blocks were drawn on simulation film and constructed. Using the irregular blocks, monitor units to deliver 100 cGy to the dose maximum (dmax) were calculated from measurement and three-dimensional radiation treatment planning (3D RTP) system (PINNACLE 6.0, ADAC Laboratories, Milpitas CA) Measurements were made in solid water phantom with plane parallel (PP) chamber (Roos, OTW Germany) at 100 cm source-to surface distances. CT data was used to investigate the effect of heterogeneity. Monitor units were calculated by overriding CT values with 1 g/㎤ and in the presence of heterogeneity. The monitor unit values obtained by the above methods were compared. The dose, obtained from measurement in solid water phantom was higher than that of RTP values for irregularly shaped blocks. The maximum differences between monitor unit calculated in flat water phantom at gantry zero position were 4% for 6 MeV and 2% for 9 and 12 MeV electrons. When CT data was used at a various gantry angle the agreement between the TPS data with and without density correction was within 3% for all energies. These results indicate that there are no significant difference in terms of monitor unit when density is corrected for the treatment of breast cancer patients with electrons.

• The Journal of the Korea Contents Association
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• v.11 no.7
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• pp.234-238
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• 2011

This paper will evaluate the usefulness of 3D target of CBCT by comparing human body's posture and position when simulated treatment is being carried out as well as human phantom posture and position using CBCT which is applying OBI. From the Rando Phantom which is located in the datum point moved in parallel and rotationary direction using CBCT. Then the mean and standard deviation difference on images location difference that are acquired were compared with real the Rando Phantom' moved distance. To make a plan of simulated treatment with the same procedure of real radiation therapy, we are going to setup the Rando Phantom. With an assumption that the position is set in accurate place, we measured the setup errors accroding to the change of the translation and rotation. Tests are repeated 10 times to get the standard deviation of the error values. The variability in couch shift after positioning equivalent to average residual error showed lateral $0.2{\pm}0.2$mm, longitudinal $0.4{\pm}0.3$mm, vertical $-0.4{\pm}0.1$mm. The average rotation erroes target localization after simulated $0.4{\pm}0.2$ mm, $0.3{\pm}0.3$ mm, and $0.3{\pm}0.4$ mm. The detection error by rotation is $0{\sim}0.6^{\circ}$ CBCT 3D/3D matching using the Rando Phantom minimized the errors by realizing accurate matching during simulated treatment and patient caring.

• The Journal of Korean Society for Radiation Therapy
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• v.16 no.2
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• pp.9-17
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• 2004

Purpose : Although Improve of CT, MRI Radio-diagnosis and Radiation Therapy Planing, but we still use ICRU38 Planning system(2D film-based) broadly. 3-Dimensional ICR plan(CT image based) is not only offer tumor and normal tissue dose but also support DVH information. On this study, we plan irradiation-goal dose on CTV(CTV plan) and irradiation-goal dose on ICRU 38 point(ICRU38 plan) by use CT image. And compare with tumor-dose, rectal-dose, bladder-dose on both planning, and analysis DVH Method and Material : Sample 11 patients who treated by Ir-192 HDR. After 40Gy external radiation therapy, ICR plan established. All the patients carry out CT-image scanned by CT-simulator. And we use PLATO(Nucletron) v.14.2 planing system. We draw CTV, rectum, bladder on the CT image. And establish plan irradiation-$100\%$ dose on CTV(CTV plan) and irradiation-$100\%$ dose on A-point(ICRU38 plan) Result : CTV volume($average{\pm}SD$) is $21.8{\pm}26.6cm^3$, rectum volume($average{\pm}SD$) is $60.9{\pm}25.0cm^3$, bladder volume($average{\pm}SD$) is $116.1{\pm}40.1cm^3$ sampled 11 patients. The volume including $100\%$ dose is $126.7{\pm}18.9cm^3$ on ICRU plan and $98.2{\pm}74.5cm^3$ on CTV plan. On ICRU planning, the other one's $22.0cm^3$ CTV volume who residual tumor size excess 4cm is not including $100\%$ isodose. 8 patient's $12.9{\pm}5.9cm^3$ tumor volume who residual tumor size belows 4cm irradiated $100\%$ dose. Bladder dose(recommended by ICRU 38) is $90.1{\pm}21.3\%$ on ICRU plan, $68.7{\pm}26.6\%$ on CTV plan, and rectal dose is $86.4{\pm}18.3\%,\;76.9{\pm}15.6\%$. Bladder and Rectum maximum dose is $137.2{\pm}50.1\%,\;101.1{\pm}41.8\%$ on ICRU plan, $107.6{\pm}47.9\%,\;86.9{\pm}30.8\%$ on CTV plan. Therefore CTV plan more less normal issue-irradiated dose than ICRU plan. But one patient case who residual tumor size excess 4cm, Normal tissue dose more higher than critical dose remarkably on CTV plan. $80\%$over-Irradiated rectal dose(V80rec) is $1.8{\pm}2.4cm^3$ on ICRU plan, $0.7{\pm}1.0cm^3$ on CTV plan. $80\%$over-Irradiated bladder dose(V80bla) is $12.2{\pm}8.9cm^3$ on ICRU plan, $3.5{\pm}4.1cm^3$ on CTV plan. Likewise, CTV plan more less irradiated normal tissue than ICRU38 plan. Conclusion : Although, prove effect and stability about previous ICRU plan, if we use CTV plan by CT image, we will reduce normal tissue dose and irradiated goal-dose at residual tumor on small residual tumor case. But bigger residual tumor case, we need more research about effective 3D-planning.

• Radiation Oncology Journal
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• v.27 no.1
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• pp.42-48
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• 2009

Purpose: The introduction of image guided radiation therapy/four-dimensional radiation therapy (IGRT/4DRT) potentially increases the accumulated dose to patients from imaging and verification processes as compared to conventional practice. It is therefore essential to investigate the level of the imaging dose to patients when IGRT/4DRT devices are installed. The imaging dose level was monitored and was compared with the use of pre-IGRT practice. Materials and Methods: A four-dimensional CT (4DCT) unit (GE, Ultra Light Speed 16), a simulator (Varian Acuity) and Varian IX unit with an on-board imager (OBI) and cone beam CT (CBCT) were installed. The surface doses to a RANDO phantom (The Phantom Laboratory, Salem, NY USA) were measured with the newly installed devices and with pre-existing devices including a single slice CT scanner (GE, Light Speed), a simulator (Varian Ximatron) and L-gram linear accelerator (Varian, 2100C Linac). The surface doses were measured using thermo luminescent dosimeters (TLDs) at eight sites-the brain, eye, thyroid, chest, abdomen, ovary, prostate and pelvis. Results: Compared to imaging with the use of single slice non-gated CT, the use of 4DCT imaging increased the dose to the chest and abdomen approximately ten-fold ($1.74{\pm}0.34$ cGy versus $23.23{\pm}3.67$cGy). Imaging doses with the use of the Acuity simulator were smaller than doses with the use of the Ximatron simulator, which were $0.91{\pm}0.89$ cGy versus $6.77{\pm}3.56$ cGy, respectively. The dose with the use of the electronic portal imaging device (EPID; Varian IX unit) was approximately 50% of the dose with the use of the L-gram linear accelerator ($1.83{\pm}0.36$ cGy versus $3.80{\pm}1.67$ cGy). The dose from the OBI for fluoroscopy and low-dose mode CBCT were $0.97{\pm}0.34$ cGy and $2.3{\pm}0.67$ cGy, respectively. Conclusion: The use of 4DCT is the major source of an increase of the radiation (imaging) dose to patients. OBI and CBCT doses were small, but the accumulated dose associated with everyday verification need to be considered.

• Journal of the Korean Society of Radiology
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• v.11 no.7
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• pp.627-635
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• 2017

Brachytherapy is generally performed in conjunction with external radiation therapy, and the treatment course is very complicated, which can lead to radiation accidents. In order to solve this problem, we designed the process map by applying the failure mode and effects analysis (FMEA) method to the Brachytherapy and scored the risk priority number (RPN) for each treatment course based on this process map. The process map consisted of five steps, Patient consulting", "Brachytherapy simulation", "CT simulation", "Brachytherapy treatment planning" and "Treatment". In order to calculate the RPN, doctor, medical physicist, dose planners, therapist, and nurse participated in the study and evaluated occurrence, severity, and lack of detectability at each detail step. Overall, the process map is preceded by a patient identification procedure at each treatment stage, which can be mistaken for another patient, and a different treatment plan may be established to cause a radiation accident. As a result of evaluating the RPN for the detailed steps based on the process map, overall "Patient consulting" and "Brachytherapy treatment planning" step were evaluated as high risk. The nurses showed a tendency to be different from each other, and the nurses had a risk of 55 points or more for all the procedures except "Treatment", and the "Brachytherapy simulation" step was the highest with 88.8 points. Since the treatment stage differs somewhat for each medical institution performing radiotherapy, it is thought that the risk management should be performed intensively by preparing the process map for each institution and calculating the risk RPN.