• Radiation Oncology Journal
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• v.13 no.4
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• pp.391-396
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• 1995

Purpose : The Conformal Radiation Therapy has bee widely used under favour of development of computer technologies. The delivery of a large number of static radiation fields are being necessary for the conformal irradiation. In this paper we investigate dosimetric characteristics on penumbra regions of a multileaf collimator(MLC), and compare to those of lead alloy block for the optimal use of the system in 3-D conformal radiotherapy. Materials and Methods : The measurement of penumbra by MLC or lead alloy block was performed with 6 or 10 MV X-rays. The film was positioned at a dmax depth and 10 cm depth, and its optical density was determined using a scanning videodensitometer. The effective penumbra, the distance from $80{\%}$ to $20{\%}$ isodose lines and $90{\%}$ to $10{\%}$ were analyzed as a function of the angle between the direction of leaf motion and the edge defined by leaves. Results : Increasing MLC angle ($0-75^{\circ}$) was observed with increasing the penumbra widths and the scalloping effect. There was no definite differences of penumbra width from $80{\%}$ to $20{\%}$ isodose lines, while being the small increase of penumbra width from $90{\%}$ to $10{\%}$ isodose line varing the depth and energy. The effective penumbra width of lead alloy block are agree resonably with those of MLC within 4.8mm. Conclusion : The comparative qualitative study of the penumbra between MLC and lead alloy block demonstrate the clinical acceptability and suitability of the multileaf collimator for 3-D conformal radiotherapy.

• Radiation Oncology Journal
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• v.14 no.1
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• pp.77-85
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• 1996

Purpose : Multileaf collimator(MLC) is very suitable tool for conformal radio-therapy and commissioning measurements for a multileaf collimator installed on a dual energy accelerator with 6 and 10MV photons are required, For modeling the collimator with treament planning software, detailed dosimetric characterization of the multileaf collimator including the penumbra width, leaf transmission between leaf leakage and localization of the leaf ends and sides is an essential requirement. materials and Methods : Measurement of characteristic data of the MLC with 26 pair block leaves installed on CLINAC 2100C linear accelerator was performed. Low sensitive radiographic film(X-omatV) was used for the penumbra measurement and separate experiments using radiographic film and thermoluminescent dosimeters were performed to verify the dose distribution, Measured films were analized with a photodensitometer of WP700i scanner. Results : For 6 & 10 MV x-ray energies, approximately $2.0\%$ of photons incident on the multileaf collimator were transmitted and an additional $0.5\%$ leakage occurs between the leaves. Localizing the physical end of the leaves showed less than 1mm deviation from the $50\%$ decrement line and this difference is attributed to the curved shaped end on the leaves One side of a sin히e leaf corresponded to the $50\%$ decrement line, but the opposite face was aligned with a lower value. This difference is due to the tongue and groove used to decrease between leaf leakage. Alignment of the leaves to form a straight edge resulted larger penumbra at far position from isocenter as compare with divergent alloy blocks. When the MLC edge is stepped by sloping field, the isodose lines follow the leaf pattern and Produce scalloping isodose curves in tissue. The effective penumbra by 45 degree stepped MLC is about 10mm at 10cm depth for 6MV x-ray. The difference of effective penumbra in deep tissue between MLC and divergent alloy blocks is small (5mm). Conclusion : Using the characteristic data of MLC, the MLC has the clinlical acceptability and suitability for 3-D conformal radiotherapy except small field size.

• Progress in Medical Physics
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• v.15 no.3
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• pp.167-172
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• 2004

A Siemens HD-270 MLC$^{TM}$, a virtual-micro MLC, allows to the application of a smooth field edge method due to the finite leaf-width of MLC. This technique was implemented into a Pinnacle planning system in order to evaluate the dose distributions during the planning stage. The necessary dosimetric aspects, such as undulation and effective penumbra, were investigated with variations in the resolutions of a virtual-micro MLC and field edge angle. The positional accuracy of the couch movement was also assessed for clinical implementation. The overhead time for planning and treatment was confirmed as negligible.e.

• Journal of radiological science and technology
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• v.8 no.2
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• pp.71-72
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• 1985

This study was performed on the dose distribution of various field size and the effect of penumbra shield in the telecobalt unit. The results obtained are as follows. 1. Errors of the light and ${\gamma}-ray$ field size was below the regulation as 0.52 percentage. 2. The coefficient of field area was increased with the larger field area, and this coefficient was showed the more difference in larger SSD. 3. The rectangular field areas, which were described by level of the same percentage depth does, were decreased with the more elongation factor. At the same elongation factor, the compensating factor was decreased with the larger field size. 4. The lead block or extension collimator was able to shield r-ray exposure of outside field size from 50 to 80 percentage. 5. On the matching adjacent fields, while the gap between beam edges are contacted, that overlapped beam edges indicated up to 140 percentage, and while the gap was 1 cm, it could be reduced to 90 Percentage. The lead-libocking on the overlapped area was more effective to lower dose, as 80 percentage in this case. 6. Percentage depth dose of various trimming field sizes were increased linearlly according to area 1 perimeter size, but the center split field size did not maintain linearlly.

• Progress in Medical Physics
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• v.12 no.1
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• pp.71-77
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• 2001

The region, near the edge of a radiation beam, where the dose changes rapidly according to the distance from the beam axis is known as the penumbra. There is a sharp dose gradient zone even in megavoltage photon beams due to source size, collimator, lead alloy block, other accessories, and internal scatter ray. We investigate dosimetric characteristics on penumbra regions of a standard collimator and compare to those of theoritical model for the optimal use of the system in radiotherapy. Peripheral dose distribution of 6 W Photon beams represents penumbral forming function as the depth. Also we have discussed that the peripheral dose distribution of clinical photon beams, differences between calculation dose use of emperical penumbral forming function and measurements in penumbral region. Predictions by emperical penumbral forming functions are compared with measurements in 3-dimensional water phantom and it is shown that the method is capable of reproduceing the measured peripheral dose values usually to within the statistical uncertainties of the data. The semiconductor detector and ion chamber were positioned at a dmax depth, 5cm depth, 10cm depth, and its specific ratio was determined using a scanning data. The effective penumbra, the distance from 80% to 20% isodose lines were analyzed as a function of the distance. The extent of penumbra will also expand with depth increase. Difference of measurement value and model functions value according to character of the detector show small error in dose distribution of the peripheral dose.

• The Journal of Internal Korean Medicine
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• v.31 no.2
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• pp.380-387
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• 2010

The ischemic penumbra represents part of the hypoperfused region associated with focal brain ischemia. A practical approach is to define this region as that portion of the ischemic territory that can potentially be salvaged by timely intervention. For the prevention and treatment of ischemic stroke, antithrombotic therapy is prescribed. But medication of antiplatelet agent is only validated as prevention effect. Cheonghyulgangki-tang has been used for cerebral apoplexy, hypertension, etc. In this case report, an acute ischemic stroke patient was treated with an antiplatelet agent named Plavix and Cheonghyulgangki-tang and remarkable reduction of ischemic portion in the brain CT was observed. The result of this case suggests that oriental medical therapy could be a safe and effective intervention in acute ischemic stroke.

• The Journal of Korean Society for Radiation Therapy
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• v.15 no.1
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• pp.1-9
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• 2003

I. Purpose The multileaf collimator(MLC) has many advantages, but use of the MLC increased effective penumbra and isodose undulation in dose distribution compared with that of an alloy block. In this work, we introduced the HD-270 MLC, which can improve the above disadvantages of MLC, and reported its feasibility study. II. Method and Materials The HD-270 MLC is a technique which combines the use of the existing Siemens multileaf collimator(3D MLC) with patient translation perpendicular to the leaf plane. The technique produces a smoothed isodose distribution with the reduced isodose undulation and effective penumbra. To assess the efficacy of the HD-270 technique and determine the appropriate resolution, a polygonal shaped MLC field was made to produce field edge angles from 0 degree to 75 degree with a step of 15 degree. Each HD-270 group was generated according to the allowed resolution, i. e., 5, 3, and 2mm. The experiment was carried out on Primus, a Siemens linear accelerator configured with HD-270 MLC. The total 60 MU of 6 MV photon beam was delivered to X-Omat film(Kodak, USA) at a SAD of 100 cm and 1.5 cm depth in solid water phantom. Exposed films were scanned by Lumiscan75(LUMISYS) and analyzed using RIT113 software(Radiological Imaging Technology Inc., USA). To test the mechanical accuracy of table movement, the transverse, longitudinal, and vertical positions were controlled by a consol with ${\pm}5\;mm,\;{\pm}4\;mm,\;{\pm}3\;mm,\;and\;{\pm}2\;mm$ steps, and then measured using a dial gauge with an accuracy of 0.001 inch. During the experiments, the table loaded with about 50Kg human phantom to simulate the real treatment situation. III. Results The effective penumbra and isodose undulation became larger with increase the resolution and field edge angle. The accuracy of the table movement on each direction is good within the ${\pm}1\;mm$. IV. Conclusion Clinical use of the MLC can be increased by using of the HD-270 MLC which complements to the disadvantages of the MLC.

• Journal of Korean Neurosurgical Society
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• v.63 no.4
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• pp.427-432
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• 2020

Three randomized control trials (RCTs), published in 2013, investigated efficacy of mechanical thrombectomy in large vessel occlusions and did not show better results compared to intravenous (IV) recombinant tissue-type plasminogen activator (tPA) alone. However, most clinicians treating stroke consider mechanical thrombectomy as the standard treatment rather than using IV tPA alone. This paradigm shift was based on five RCTs investigating efficacy of mechanical thrombectomy in acute ischemic stroke conducted from 2010 to 2015. They demonstrated that mechanical thrombectomy was effective and safe in acute ischemic stroke with anterior circulation occlusion when performed within 6 hours of stroke onset. There are four reasons underlying the different results observed between the trials conducted in 2013 and 2015. First, the three RCTs of 2013 used low-efficiency thrombectomy devices. Second, the three RCTs used insufficient image selection criteria. Third, following the initial presentation at the hospital, reperfusion treatment required a long time. Fourth, the three RCTs showed a low rate of successful recanalization. Time is the most important factor in the treatment of acute ischemic stroke. However, current trends utilize advanced imaging techniques, such as diffusion-weighted imaging and multi-channel computer tomographic perfusion, to facilitate the detection of core infarction, penumbra, and collateral flows. These efforts demonstrate that patient selection may overcome the barriers of time in specific cases.

• Journal of Radiation Protection and Research
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• v.4 no.1
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• pp.14-20
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• 1979

For accurate and easily shielding irregular shaped organ, its minimized penumbra region and a low melting point alloy 'Lead Y' and synchronizing instrument have been developed. The 'Lead Y' is the quaternary eutectic alloy and it is composed of Lead 30.0% Tin 11.5% Bismuth 48 5% Cadmium 10.0% The density of its at $22^{\circ}C$ is $9.8g/cm^3$ and the melting temperature has $40^{\circ}C\;to\;68^{\circ}C$. The thickness of 'Lead Y' for perfect shielding of Co-60 gamma ray and LINAC 10MeV x-ray is 6cm and 7cm respectively. The 'Lead Y' shielding block is casted directly on the styrofoam from which is cut with hot wire of synchronizer device. The special features and advantages of the Lead Y shielding block could be summarized as follows; 1. The shielding block for radiotherapy is rapidly processed only with boiling water and styrofoam. 2. It is not injure one's health and not danger of a fire, because of not generating of any metals vapor and evil smelling. 3. It is very effective to minimize secondary penumbra for the protection of healthy tissue from unnecessary ionizing radiation regardless of the magnification source to skin distance. 4. The HVL of the Lead Y is 1.2cm for Co-60 gamma ray and it's shielding effect is almost same as the pure lead block. 5. The hardness of Lead Y is 1.5 times higher than lead block. 6. It's reavailability is higher than lead block and then one block of Lead Y is reavailable about 30 to 40 times. 7. It is usefull for shielding of x-ray, gamma ray, beta-ray, electron and neutron radiation. 8. The materials for Lead Y are easy to acquire with reasonable price and tractable.

• The Journal of Korean Society for Radiation Therapy
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• v.8 no.1
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• pp.29-35
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• 1996

We are often faced with the clinical situations that is inevitably extended SSD for electron beam therapy due to anatomical restriction or applicator structure. But there are some difficulties in accurately predicting output and properties. In electron beam treatment , unlike photon beam the decrease in output for extended SSD does not follow inverse-square law accurately because of a loss of side scatter equilibrium, which is particularly significant for small cone size and low energies. The purpose of our study is to analyze the output in changing with the energy, cone size, air gap beyond the standard SSD and to compare inverse-square law factor derived from calculated effective SSD, mominal SSD with measured output factor. In addition, we have analyzed the change of PDD for several cones with different SSDs which range from 100cm to 120cm with 5cm step and with different energies(6MeV, 9MeV, 12MeV, 16MeV, 20MeV). In accordance with our study, an extended SSD produces a significant change in beam output, negligible change in depth dose which range from 100cm to 120cm SSDs. In order to deliver the more accurate dose to the neoplastic tissue, first of all we recommend inverse-square law using the table of effective SSDs with cone sizes and energies respectively or simply to create a table of extended SSD air gap correction factor. The second we need to have an insight into some change of dose distribution including PPD, penumbra caused by extended SSD for electron beam therapy.