• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.289-295
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• 2014

Purpose : Cone Beam Computed Tomography(CBCT) in Image Guided Radiation Therapy(IGRT), Set-up error can be reduced but exposure dose of the patient due to CBCT will increase. Through this study, we are to evaluate by making a scenario with the implementation period of CBCT as every other day. Materials and Methods : Of prostate cancer patients, 9 patients who got a Intensity Modulated Radiation Therapy(IMRT) with CBCT in IGRT were analyzed. Based on values corrected by analyzing set-up error by using CBCT every day during actual treatment, we created a scenario that conducts CBCT every other day. After applying set-up error values of the day not performing CBCT in the scenario to the treatment planning system(Pinnacle 9.2, Philips, USA) by moving them from the treatment iso-center during actual treatment, we established re-treatment plan under the same conditions as actual treatment. Based on this, the dose distribution of normal organs and Planning Target Volume(PTV) was compared and analyzed. Results : In the scenario that performs CBCT every other day based on set-up error values when conducting CBCT every day, average X-axis : $0.2{\pm}0.73mm$, Y-axis : $0.1{\pm}0.58mm$, Z-axis : $-1.3{\pm}1.17mm$ difference was shown. This was applied to the treatment planning to establish re-treatment plan and dose distribution was evaluated and as a result, Dmean : -0.17 Gy, D99% : -0.71 Gy of PTV difference was shown in comparison with the result obtained when carrying out CBCT every day. As for normal organs, V66 : 1.55% of rectal wall, V66 : -0.76% of bladder difference was shown. Conclusion : In case of a CBCT perform every other day could reduce exposure dose and additional treatment time. And it is thought to be able to consider the application depending on the condition of the patient because the difference in the dose distribution of normal organs, PTV is not large.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.159-165
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• 2013

Purpose: Abdominal compressor is used to control breathing in stereotactic body radiotherapy for lung tumors frequently. We evaluated the dynamic variation aspect of internal tumor volume by breathing. Materials and Methods: We reviewed 20 lung cancer patients (7 upper lung patients, 4 middle lung patients, 9 lower lung patients) who received stereotactic body radiotherapy using abdominal compressor between April 2012 to April 2013. Coordinate shift values were obtained by using four-dimensional cone-beam CT (4D-CBCT) to investigate treatment set-up error and moving tumor position error. To investigate how much difference of each part, we compared 95% confidence interval, maximum values and minimum values of three-dimensional vector value and analyzed conformity degree through the Pearson square correlation coefficient. Results: 95% confidence interval of three-dimensional vector value of each part is 1.8~2.9 mm in upper lobe, 2.3~5.4 mm in middle lobe and 2.2~4.0 mm in lower lobe. Conformity degree was the result that respectively is LR direction 0.75, SI direction 0.68 and AP direction 0.63 in upper lobe, LR direction 0.82, SI direction 0.51 and AP direction 0.92 in middle lobe and LR direction 0.63, SI direction 0.50 and AP direction 0.34 in lower lobe. Conclusion: We showed difference by each site in lung tumor due to respiration by using abdominal compressor. Therefore, we must correct treatment set-up error as well as moving tumor position error by breathing. It is also considered to be useful that it is the use of 4D-CBCT when correcting the error due to various dynamic variation.

• The Journal of the Korea Contents Association
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• v.9 no.12
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• pp.742-749
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• 2009

The use of cone-beam computed tomography(CBCT) has been proposed for guiding the delivery of radiation therapy. A kilovoltage imaging system capable of radiography, fluoroscopy, and cone-beam computed tomography(CT) has been integrated with a medical linear accelerator. A standard clinical linear accelerator, operating in arc therapy mode, and an amorphous-silicon (a-Si) with an on-board electronic portal imager can be used to treat palliative patient and verify the patient's position prior to treatment. On-board CBCT images are used to generate patient geometric models to assist patient setup. The image data can also, potentially, be used for dose reconstruction in combination with the fluence maps from treatment plan. In this study, the accuracy of Hounsfield Units of CBCT images as well as the accuracy of dose calculations based on CBCT images of a phantom and compared the results with those of using CT simulator images. Phantom and patient studies were carried out to evaluate the achievable accuracy in using CBCT and CT stimulator for dose calculation. Relative electron density as a function of HU was obtained for both planning CT stimulator and CBCT using a Catphan-600 (The Phantom Laboratory, USA) calibration phantom. A clinical treatment planning system was employed for CT stimulator and CBCT based dose calculations and subsequent comparisons. The dosimetric consequence as the result of HU variation in CBCT was evaluated by comparing MU/cCy. The differences were about 2.7% (3-4MU/100cGy) in phantom and 2.5% (1-3MU/100cGy) in patients. The difference in HU values in Catphan was small. However, the magnitude of scatter and artifacts in CBCT images are affected by limitation of detector's FOV and patient's involuntary motions. CBCT images included scatters and artifacts due to In addition to guide the patient setup process, CBCT data acquired prior to the treatment be used to recalculate or verify the treatment plan based on the patient anatomy of the treatment area. And the CBCT has potential to become a very useful tool for on-line ART.)

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.161-169
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• 2016

Purpose : To quantify the inter-fractional variation in prostate displacement and their dosimetric effects for prostate cancer treatment. Materials and Methods : A total of 176 daily cone-beam CT (CBCT) sets acquired for 6 prostate cancer patients treated with volumetric-modulated arc therapy (VMAT) were retrospectively reviewed. For each patient, the planning CT (pCT) was registered to each daily CBCT by aligning the bony anatomy. The prostate, rectum, and bladder were delineated on daily CBCT, and the contours of these organs in the pCT were copied to the daily CBCT. The concordance of prostate displacement, deformation, and size variation between pCT and daily CBCT was evaluated using the Dice similarity coefficient (DSC). Results : The mean volume of prostate was 37.2 cm3 in the initial pCT, and the variation was around ${\pm}5%$ during the entire course of treatment for all patients. The mean DSC was 89.9%, ranging from 70% to 100% for prostate displacement. Although the volume change of bladder and rectum per treatment fraction did not show any correlation with the value of DSC (r=-0.084, p=0.268 and r=-0.162, p=0.032, respectively), a decrease in the DSC value was observed with increasing volume change of the bladder and rectum (r=-0.230,p=0.049 and r=-0.240,p=0.020, respectively). Conclusion : Consistency of the volume of the bladder and rectum cannot guarantee the accuracy of the treatment. Our results suggest that patient setup with the registration between the pCT and daily CBCT should be considered aligning soft tissue.

• Journal of Oral Medicine and Pain
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• v.38 no.4
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• pp.357-366
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• 2013

This study is designed to evaluate the treatment outcome of occlusal stabilizing splint and to assess follow-up study of condylar bony changes using cone beam computed tomography(CBCT) in adolescents patients (12-19 years) with TMJ osteoarthritis(OA). 167 eroded condyles in 149 subjects were chosen among the patients who presented to the Department of Oral Medicine of Pasan National University Hospital, diagnosed as TMJ osteoarthritis by clinical exam, x-ray and CBCT from 2009 to 2012. They were treated conservatively with physical therapy, medication, behavioral therapy and occlusal stabilizing splint therapy. After average 9 months, CBCT was retaken and subjective symptoms and clinical findings were investigated. Condyle bony changes were classified by unchanged, less severe and more severe. The obtained results were as follow: 1. Pain, Noise, LOM(Limitation of motion) and MCO(Maximum comfortable opening) measurement of TMJ OA patients were markedly improved after conservative treatment. 2. In the occlusal stabilizing splint therapy group, Pain and LOM were statistically significant improved than non-occlusal stabilizing splint therapy group. 3. In the acute occlusal stabilizing splint therapy group, Pain and LOM were remarkably improved. 4. In comparison of CBCT1 and CBCT2 images, the transition of bone changes to lesser severe was most commonly in joint with erosive change. 5. In the non-occlusal stabilizing splint therapy group, the transition of condylar bone changes from erosion to more severe was many than occlusal stabilizing splint therapy group.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.41-51
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• 2023

Purpose: This study compares and analyzes the image quality of 3D-CBCT(Cone Beam Computed-Tomography) and Gated CBCT according to baseline changes during SBRT(Stereotactic Body RadioTherapy) in lung cancer patients to find a useful CBCT method for correcting movement due to breathing Materials and methods : Insert a solid tumor material with a diameter of 3 cm into the QUASAR^TM phantom. 4-Dimentional Computed-Tomography(4DCT) images were taken with a speed of the phantom at period 3 sec and a maximum amplitude of 20 mm. Using the contouring menu of the computerized treatment planning system Eclipse^TM Gross Tumor Volume was outlined on solid tumor material. Set-up the same as when acquiring a 4DCT image using Truebeam STx^TM, breathing patterns with baseline changes of 1 mm, 3 mm, and 5 mm were input into the phantom to obtain 3D-CBCT (Spotlight, Full) and Gated-CBCT (Spotlight, Full) images five times repeatedly. The acquired images were compared with the Signal-to-Noise Ratio(SNR), Contrast-to-Noise Ratio(CNR), Tumor Volume Length, and Motion Blurring Ratio(MBR) based on the 4DCT image. Results: The average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Spotlight Gated CBCT images were 13.30±0.10%, 7.78±0.16%, 3.55±0.17%, 1.18±0.06%. As a result, Spotlight Gated-CBCT images according to baseline change showed better values than Spotligtht 3D-CBCT images. Also, the average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Full Gated CBCT images were 12.80±0.11%, 7.60±0.11%, 3.54±0.16%, 1.18±0.05%. As a result Full GatedCBCT images according to baseline change showed better values than Full 3D-CBCT images. Conclusion : Compared to 3D-CBCT images, Gated-CBCT images had better image quality according to the baseline change, and the effect of Motion Blurring Artifacts caused by breathing was small. Therefore, it is considered useful to image guided using Gated-CBCT when a baseline change occurs due to difficulty in regular breathing during SBRT that exposes high doses in a short period of time

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.49.1-49.9
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• 2016

Background: The aim of this report is to present a new reference for aesthetic mandible surgery using three-dimensional cone-beam computed tomography-based treatment planning for orthognathic surgery which can be implemented in surgical planning and perioperative procedure. Methods: To make an objective standard for evaluating aesthetic mandibular outline, we make an aesthetic scoring criteria with consideration of asymmetry, broad mandibular border line, and prominent mandibular angle. Two maxillofacial surgeons and two orthodontists rated their aesthetical evaluation from 1 to 5. Experimental group consisting of 47 female and 38 male patients who had rotational orthognathic two-jaw surgery from 2010 to 2011 were chosen according to aesthetic scoring done by two maxillofacial surgeons and two orthodontists. A high aesthetic score (${\geq}16$) means the facial contour is symmetric, with no broad and narrow aesthetic mandible frontal profiles. Control A group consisted of ten female and ten male patients who had no orthognathic surgery experience and low aesthetic score (${\geq}10$). Control B group consisted of ten female and ten male patients who had no orthognathic surgery experience and had anaesthetic mandibular frontal profile and a high aesthetic score (${\geq}16$). The three-dimensional image of the patient was taken from dental cone-beam CT (DCT) scanning (experimental group and control A group: 6 months DCT after surgery, control B group: 1st visit DCT). Each DCT was reformatted to reorient the 3D image using 3D analyzing program (OnDemand3D, cybermed Inc, CA, USA). After selection of 12 landmarks and the construction of reoriented horizontal, vertical, and coronal reference lines, 15 measurements were taken in 3D analysis of frontal mandibular morphology. Afterwards, horizontal and vertical linear measurements and angular measurements, linear ratio were obtained. Results: Mean $Go^{\prime}_{Rt}-Me^{\prime}-Go^{\prime}_{Lt}$ angular measurement was $100.74{\pm}2.14$ in female patients and $105.37{\pm}3.62$ in male patients. These showed significant difference with control A group in both genders. Ratio of $Go^{\prime}_{Rt}-Go^{\prime}_{Lt}-Me^{\prime}$ length to some linear measurements (ratio of $Me^{\prime}-Cd^{\prime}_{Rt}Cd^{\prime}_{Lt}$ to $Me^{\prime}-Go^{\prime}_{Rt}Go^{\prime}_{Lt}$, ratio of $Me^{\prime}-Go^{\prime}$ to $Me^{\prime}-Go^{\prime}_{Rt}Go^{\prime}_{Lt}$, ratio of $Go^{\prime}_{Rt}-Go^{\prime}_{Lt}$ to $Me^{\prime}-Go^{\prime}_{Rt}Go^{\prime}_{Lt}$) showed significant difference with control A group in both genders. Conclusion: This study was intended to find some standard measurement of mandible frontal view in 3D analysis of aesthetic patient. So, these potential measurement value may be helpful for orthognathic treatment planning to have more aesthetic and perspective outcomes.

• Journal of Periodontal and Implant Science
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• v.47 no.5
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• pp.339-350
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• 2017

Purpose: The purpose of this study was to determine the critical diabetes duration in a streptozotocin (STZ)-induced diabetic rat calvarial defect model for experimentation regarding bone regeneration by evaluating the association between diabetes duration and bone healing capacity through histological and radiographic analyses. Methods: Experimental diabetes was induced in 50 of 60 rats by an STZ injection. The rats were divided into 5 groups, including a control group (group 1), according to diabetes durations of 0, 2, 4, 6, and 8 weeks, respectively. Eighteen rats survived: 4 in group 1, 4 in group 2, 4 in group 3, 5 in group 4, and 1 in group 5. Calvarial defects were created at 0, 2, 4, 6, and 8 weeks after STZ injection in groups 1-5. Cone-beam computed tomography scanning was performed at baseline and at 5 and 7 weeks after surgery. The rats were sacrificed 7 weeks after surgery, followed by histological evaluation. Results: The voxel gray values (VGVs) of group 1 and group 2 increased, whereas the VGVs of group 3 and group 4 decreased starting 5 weeks after surgery, although this trend did not reach statistical significance between groups. On the reconstructed 3-dimensional images and based on an analysis of histological features, groups 1 and 2 showed apparent bone regeneration, while groups 3-5 showed very limited bone regeneration. Conclusions: The critical diabetes duration in an STZ-induced diabetic rat calvarial defect model for experimentation regarding bone regeneration was between 2 and 4 weeks. It is suggested that researchers who use STZ-induced diabetic rats wait for more than 2 weeks following diabetes induction before placing implants or conducting bone regeneration studies to allow definite disturbances in bone healing to emerge.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.3
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• pp.334-343
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• 2018

The purpose of this study was to investigate the cause of eruption disturbance in the maxillary central incisor and establish the effective treatment plan by analyzing the vertical distance, angulation of long axis and root development of the tooth with eruption disturbance using the cone-beam CT. The average age of 134 patients diagnosed with unilaterally impacted maxillary central incisor was 7.9 years old and the male was 2.1 times higher than the female. The most common cause of eruption disorder was physical obstruction, especially mesiodens and odontoma. Of the teeth with unilateral eruption disorder, 78 cases erupted spontaneously and 56 cases erupted non-spontaneously after removal of physical obstruction. The possibility of spontaneous or non-spontaneous eruption in the unilaterally impacted maxillary central incisor depended on several factors, such as vertical distance, angulation of long axis and root development of unerupted tooth. The spontaneous eruption of the impacted maxillary cental incisor was most frequent at the angulation of long axis of 50 to 90 degrees, which is similar to the angulation of long axis of the normally erupted maxillary central incisor. In addition, the spontaneous eruption period of impacted maxillary central incisor was more influenced by the vertical distance than the angulation of long axis and the root development. Most of the teeth that showed non-spontaneous eruption had orthodontic traction, and these teeth were usually erupted within about 12 months. The period treated with orthodontic traction was no statistical significance with the vertical distance, the angulation of long axis, and the root development. This study will provide information on the cause of unilaterally impacted maxillary cental incisor and help to establish the future treatment plan.

• The Journal of Korean Society for Radiation Therapy
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• v.22 no.1
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• pp.19-24
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• 2010

Purpose: To study the efficacy of marker match with using kilovoltage (KV) X-ray among multiple image guidance that referring tree fiducial marker in radiation therapy for prostate cancer patients. Materials and Methods: KV two-dimantional images (anterior-posterior, right-left) and cone-beam CT volumetric images were acquired after setup for patients with three fiducial markers. Compare the position of the fiducial marker of reference plan computed tomography (CT) and of KV, CBCT images; then decide the shift score of X, Y, and Z. This study executed 5 times on 10 patients and analyzed the shift value. Results: In the radiation therapy using fiducial marker, The function of marker match showed the same direction tendency as the CBCT, and showed X, Y, Z difference of about 0.6, 0.7, and 0.8 (unit: mm). Conclusion: Comparing to this, the result of shift value using 2D marker match showed less than 1.0 mm difference. The function of marker match is considered more useful in time-wise and effective dose rather than CBCT. Therefore, Both methods are used to treat patients for prostate cancer.