• The korean journal of orthodontics
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• v.40 no.6
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• pp.373-382
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• 2010

Objective: The purpose of this study was to assess the dentoalveolar compensation in facial asymmetry individuals using an integration of a CBCT image and a laser scanned dental cast image. Methods: The subjects consisted of 30 adults with asymmetric mandibles and 20 adults with symmetric mandibles. The CBCT and laser scanned dental cast images were integrated with a registration technique. Canine and first molar position and angulation were assessed from reference coordinates. The differences between deviated and non-deviated sides were analyzed with the paired t-test. The differences shown according to menton deviation were also statistically analyzed using Pearson correlation analysis. Results: The experimental group showed deviated and non-deviated side differences (dev.-ndev.) in the position and angle of the canine and first molars. Menton deviation showed positive correlation with the deviation side (dev.-ndev.) for the maxillary and mandibular 1st molar angles, negative correlation with the deviation side for the vertical position of the maxillary 1st molars, transverse position of the mandibular canine, transverse position and vertical position of the mesio-lingual cusp of the mandibular 1st molars. Conclusions: The upper and lower canine and first molars of facial asymmetry individuals were compensated, so the transverse position, vertical position, and angle showed differences between the deviated/non-deviated sides.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.17-25
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• 2016

Purpose : The purpose of this study is to evaluate the variability of tumor motion and respiration pattern in lung cancer patients undergoing Stereotactic Body RadioTherapy(SBRT) by using On-Board imager (OBI) system and Real-time Position Management (RPM) System. Materials and Methods : This study population consisted of 60 lung cancer patient treated with stereotactic body radiotherapy (48 Gy / 4 fractions). Of these, 30 were treated with gating (group 1) and 30 without gating(group2): typically the patients whose tumors showed three-dimensional respiratory motion > 10 mm were selected for gating. 4-dimensional Computed Tomography (4DCT). Cone Beam CT (CBCT) and Fluoroscopy images were used to measure the tumor motion. RPM system was used to evaluate the variability of respiration pattern on SBRT for group1. Results : The mean difference of tumor motion among 4DCT, CBCT and Fluoroscopy images in the cranio-caudal direction was 2.3 mm in group 1, 2. The maximum difference was 12.5 mm in the group 1 and 8.5 mm in group 2. The number of treatment fractions that patient's respiration pattern was within Upper-Lower threshold on SBRT in group 2 was 31 fractions. A patient who exhibited the most unstable pattern exceeded 108 times in a fraction Conclusion : Although many patients in group 1 and 2 kept the reproducibility of tumor motion within 5 mm during their treatment, some patients exhibited variability of tumor motion in the CBCT and Fluoroscopy images. It was possible to improve the accuracy of dose delivery in SBRT without gating for lung cancer patient by using RPM system.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.38.1-38.10
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• 2016

Background: The aims of this study are to evaluate the lip morphology and change of lip commissure after mandibular setback surgery (MSS) for class III patients and analyze association between the amount of mandibular setback and change of lip morphology. Methods: The samples consisted of 14 class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalogram and cone-beam CT were taken before and about 6 months after MSS. Changes in landmarks and variables were measured with 3D software program $Ondemand^{TM}$. Paired and independent t tests were performed for statistical analysis. Results: Landmarks in the mouth corner (cheilion, Ch) moved backward and downward (p < .005, p < .01). However, cheilion width was not statistically significantly changed. Landmark in labrale superius (Ls) was not altered significantly. Upper lip prominence angle (ChRt-Ls-$ChLt^{\circ}$) became acute. Landmarks in stomion (Stm), labrale inferius (Li) moved backward (p < .005, p < .001). Lower lip prominence angle (ChRt-Li-$ChLt^{\circ}$) became obtuse (p < .001). Height of the upper and lower lips was not altered significantly. Length of the upper lip vermilion was increased (p =< 0.01), and length of the lower lip vermilion was decreased (p < .05). Lip area on frontal view was not statistically significantly changed, but the upper lip area on lateral view was increased and change of the lower lip area decreased (p > .05, p < .005). On lateral view, upper lip prominent point (UP) moved downward and stomion moved backward and upward and the angle of Ls-UP-Stm ($^{\circ}$) was decreased. Lower lip prominent point (LP) moved backward and downward, and the angle of Stm-LP-Li ($^{\circ}$) was increased. Li moved backward. Finally, landmarks in the lower incisor tip (L1) moved backward and upward, but stomion moved downward. After surgery, lower incisor tip (L1) was positioned more superiorly than stomion (p < .05). There were significant associations between horizontal soft tissue and corresponding hard tissue. The posterior movement of L1 was related to statistically significantly about backward and downward movement of cheilion. Conclusions: The lip morphology of patients with dento-skeletal class III malocclusion shows a significant improvement after orthognathic surgery. Three-dimensional lip morphology changes in class III patients after MSS exhibited that cheilion moved backward and downward, upper lip projection angle became acute, lower lip projection angle became obtuse, change of upper lip area on lateral view was increased, change of lower lip area decreased, and morphology of lower lip was protruding. L1 was concerned with the lip tissue change in statistically significant way.

• The Journal of Korean Academy of Prosthodontics
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• v.48 no.4
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• pp.294-300
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• 2010

Purpose: The template-guided implant surgery offers several advantages over the traditional approach. The purpose of this study was to evaluate the accuracy of coordinate synchronization procedure with 5-axis milling machine for surgical template fabrication by means of reverse engineering through universal CAD software. Materials and methods: The study was performed on ten edentulous models with imbedded gutta percha stoppings which were hidden under silicon gingival form. The platform for synchordination was formed on the bottom side of models and these casts were imaged in Cone beam CT. Vectors of stoppings were extracted and transferred to those of planned implant on virtual planning software. Depth of milling process was set to the level of one half of stoppings and the coordinate of the data was synchronized to the model image. Synchronization of milling coordinate was done by the conversion process for the platform for the synchordination located on the bottom of the model. The models were fixed on the synchordination plate of 5-axis milling machine and drilling was done as the planned vector and depth based on the synchronized data with twist drill of the same diameter as GP stopping. For the 3D rendering and image merging, the impression tray was set on the conbeam CT and pre- and post- CT acquiring was done with the model fixed on the impression body. The accuracy analysis was done with Solidworks (Dassault systems, Concord, USA) by measuring vector of stopping’s top and bottom centers of experimental model through merging and reverse engineering the planned and post-drilling CT image. Correlations among the parameters were tested by means of Pearson correlation coefficient and calculated with SPSS (release 14.0, SPSS Inc. Chicago, USA) ($\alpha$ = 0.05). Results: Due to the declination, GP remnant on upper half of stoppings was observed for every drilled bores. The deviation between planned image and drilled bore that was reverse engineered was 0.31 (0.15 - 0.42) mm at the entrance, 0.36 (0.24 - 0.51) mm at the apex, and angular deviation was 1.62 (0.54 - 2.27)$^{\circ}$. There was positive correlation between the deviation at the entrance and that at the apex (Pearson Correlation Coefficient = 0.904, P = .013). Conclusion: The coordinate synchronization 5-axis milling procedure has adequate accuracy for the production of the guided surgical template.

• 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.

• Proceedings of the Korea Contents Association Conference
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• 2009.05a
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• pp.1159-1166
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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.)

• Progress in Medical Physics
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• v.9 no.4
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• pp.267-276
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• 1998

Any detector inserted into a phantom should have such a geometry that it caused as small as possible perturbation of the electron fluence. Plane parallel chambers meet this requirement better than other chambers of configurations. IAEA protocol recommends the use of plane parallel chambers for this reason. However, the cylindrical chambers are widely used for convenient. The purpose of this study is to evaluate the absorbed dose due to the differences of four different dosimetry protocols such as IAEA protocol using cylindrical chamber, TG 21 protocol using cylindrical chamber, Markus protocol using plane parallel chamber, and TG 39 report for the calibration of plane parallel chamber in electron beams. Depth-ionization measurements for the electron beams of nominal energy 6, 9, 12, 15, and 18 MeV from Siemens accelerator with a 10$\times$10 cm$^2$ field size were made using a radiation field analyser with 0.125 cc ion chamber. Dosimetric measurements by IAEA and TG 21 protocol were made with a farmer type ionization chamber in solid water for each electron energy, respectively. Dosimetric measurements by Markus protocol were made with a plane parallel ionization chamber in solid water for each electron energy, respectively. The cavity-gas calibration factor for the plane parallel chamber was obtained with the use of 18 MeV electron beam as guided by TG 39 report. Dosimetric measurements by TG 39 were performed with a plane parallel ionization chamber in solid water for each electron energy, respectively. For all the energies and protocols, measurements were made along the central axis of the distance of 100 cm (SSD = 100 cm) with 10$\times$10 cm$^2$ field size at the depth of d$_{max}$ for each electron beam, respectively. In the case of 18 MeV, the discrepancy of 0.9 % between IAEA and TG 21 was found and the two protocols were agreed within 0.7 % for other energies. In the case of 18 MeV and 6 MeV, the discrepancies of $\pm$ 0.8 % between Markus and TG 39 was found, respectively and the two protocols were agreed within 0.5 % for other energies. Since the discrepancy of 1.6 % between cylindrical and plane parallel chamber was found for 18 MeV, it is suggested to get the calibration factor using other method as guided. by TG 39.9.

• Journal of radiological science and technology
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• v.34 no.1
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• pp.27-33
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• 2011

Along with the developments of science technology, up-to-date medical radiation equipments are introduced. Those equipments has brought many progresses in diagnosing patients not only in the quantitative aspects but in the qualitative ones. Especially, in the case of dental radiography, patients can be exposed more than CT, cone beam computed tomography (CBCT). In this study, we used human phantom and TLD-100H to measure the organ dose in each dental radiography and computed the effective dose according to ICRP (International Committee for Radioactivity Prevention) 60, 103. We measured the effective dose to be 5.1 and $29.5{\mu}Sv$ in the panoramic radiography and 11.2 and $14.4{\mu}Sv$ in the cephalometric radiography respectively. We also executed the CBCT and CT test on the maxillaries and the mandibles and found the amounts of effective dose were 53.7, 209.6, 129, and $391.5{\mu}Sv$ respectively in the CBCT and $93.3{\mu}$, 139.5, 282.7 and $489.7{\mu}Sv$ in the CT test. Consequently, it was shown that the effective dose in the CBCT test was lower than one in the CT test, but was higher in both panoramic and cephalometric radiography.

• 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.

• Journal of radiological science and technology
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• v.36 no.2
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• pp.123-129
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• 2013

This study investigated the rate of setup variance by the rotating unbalance of gantry in image-guided radiation therapy. The equipments used linear accelerator(Elekta Synergy TM, UK) and a three-dimensional volume imaging mode(3D Volume View) in cone beam computed tomography(CBCT) system. 2D images obtained by rotating $360^{\circ}$and $180^{\circ}$ were reconstructed to 3D image. Catpan503 phantom and homogeneous phantom were used to measure the setup errors. Ball-bearing phantom was used to check the rotation axis of the CBCT. The volume image from CBCT using Catphan503 phantom and homogeneous phantom were analyzed and compared to images from conventional CT in the six dimensional view(X, Y, Z, Roll, Pitch, and Yaw). The variance ratio of setup error were difference in X 0.6 mm, Y 0.5 mm Z 0.5 mm when the gantry rotated $360^{\circ}$ in orthogonal coordinate. whereas rotated $180^{\circ}$, the error measured 0.9 mm, 0.2 mm, 0.3 mm in X, Y, Z respectively. In the rotating coordinates, the more increased the rotating unbalance, the more raised average ratio of setup errors. The resolution of CBCT images showed 2 level of difference in the table recommended. CBCT had a good agreement compared to each recommended values which is the mechanical safety, geometry accuracy and image quality. The rotating unbalance of gentry vary hardly in orthogonal coordinate. However, in rotating coordinate of gantry exceeded the ${\pm}1^{\circ}$ of recommended value. Therefore, when we do sophisticated radiation therapy six dimensional correction is needed.