• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.397-405
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• 2020

Objective : We retrospectively evaluated the efficacy of Gamma Knife radiosurgery (GKS) for recurrent nasopharyngeal carcinoma (NPC) in patients who previously underwent radiotherapy, and analyzed the treatment outcomes over 14 years. Methods : Ten patients with recurrent NPC who had previously received radiotherapy underwent stereotactic radiosurgery using a Gamma Knife^® (Elekta Inc, Atlanta, GA, USA) between 2005 and 2018. The median target volume was 8.2 ㎤ (range, 1.7-17.8), and the median radiation dose to the target was 18 Gy (range, 12-30). The median follow-up period was 18 months (range, 6-76 months). Overall and local failure-free survival rates were determined using the Kaplan-Meier method. Results : The NPCs recurred at the primary cancer site in seven patients (70%), as distant brain metastasis in two (20%), and as an extension into brain in one (10%). The recurrent tumors in seven of the 10 patients (70%) were found on the routine follow-up imaging studies. Two patients presented with headache and one with facial pain. Local failure after GKS occurred in five patients (50%) : two of whom died eight and 6 months after GKS, respectively. No adverse radiation effects were noted after GKS. The 1- and 3-year overall survival rates after GKS were 90% and 77%, respectively. The local failure-free survival rates at 6 months, 1 year, and 3 years after GKS were 80%, 48%, and 32%, respectively. The median interval from GKS to local failure was 8 months (range, 6-12). Univariate analysis revealed that using co-registration with positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) was associated with a lower local failure rate of recurrent NPC (p=0.027). Conclusion : GKS is an acceptable salvage treatment option for patients with recurrent NPC who previously received radiation therapy. PET-CT and MRI co-registration for dose planning can help achieve local control of recurrent NPC.

• Progress in Medical Physics
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• v.28 no.4
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• pp.226-231
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• 2017

The aim is to investigate the spectra responsibilities of QD (Quantum Dot) for the innovation of new dosimetry application for therapeutic Megavoltage X-ray range. The unique electrical and optical properties of QD are expected to make it a good sensing material for dosimeter. This study shows the spectra responsibility of toluene based ZnCd QD and PPO (2.5-diphenyloxazol) mixed liquid scintillator. The QDs of 4 sizes corresponding to an emission wavelength (ZnCdSe/ZnS:$440{\pm}5nm$, ZnCdSeS:470, 500, $570{\pm}5nm$) were utilized. A liquid scintillator for control sample was made of toluene, PPO. The Composition of QD loaded scintillators are about 99 wt% Toluene as solvent, 1 wt% of PPO as primary scintillator and 0.05, 0.1, 0.2 and 0.4 wt% of QDs as solute. For the spectra responsibility of QD scintillation, they were irradiated for 30 second with 6 MV beam from a LINAC ($Infinity^{TM}$, Elekta). With the guidance of 1.0 mm core diameter optical fiber, scintillation spectrums were measured by a compact CCD spectrometer which could measure 200~1,000 nm wavelength range (CCS200, Thorlabs). We measured the spectra responsibilities of QD loaded organic liquid scintillators in two scintillation mechanisms. First was the direct transfer and second was using wave shifter. The emission peaks from the direct transfer were measured to be much smaller luminescent intensity than based on the wavelength shift from the PPO to QDs. The emission peak was shifted from PPO emission wavelength 380 nm to each emission wavelength of loaded QD. In both mechanisms, 500 nm QD loaded samples were observed to radiate in the highest luminescence intensity. We observed the spectra responsibility of QD doped toluene based liquid scintillator in order to innovate QD dosimetry applicator. The liquid scintillator loading 0.2 wt% of 500 nm emission wavelength QD has most superior responsibility at 6 MV photon beam. In this study we observed the spectra responsibilities for therapeutic X-ray range. It would be the first step of innovating new radiation dosimetric methods for radiation treatment.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.129-132
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• 2002

The practical virtual compensator, which uses a dynamic multi-leaf collimator (dMLC) and three-dimensional radiation therapy planning (3D RTP) system, was designed. And the feasibility study of the virtual compensator was done to verify that the virtual compensator acts a role as the replacement of the physical compensator. Design procedure consists of three steps. The first step is to generate the isodose distributions from the 3D RTP system (Render Plan, Elekta). Then isodose line pattern was used as the compensator pattern. Pre-determined compensating ratio was applied to generate the fluence map for the compensator design. The second step is to generate the leaf sequence file with Ma's algorithm in the respect of optimum MU-efficiency. All the procedure was done with home-made software. The last step is the QA procedure which performs the comparison of the dose distributions which are produced from the irradiation with the virtual compensator and from the calculation by 3D RTP. In this study, a phantom was fabricated for the verification of properness of the designed compensator. It is consisted of the styrofoam part which mimics irregular shaped contour or the missing tissues and the mini water phantom. Inhomogeneous dose distribution due to the styrofoam missing tissue could be calculated with the RTP system. The film dosimetry in the phantom with and without the compensator showed significant improvement of the dose distributions. The virtual compensator designed in this study was proved to be a replacement of the physical compensator in the practical point of view.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.93-101
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• 2017

Purpose: In breast cancer radiotherapy, brass mesh bolus has been recently studied to overcome disadvantage of conventional bolus. The purpose of this study is to investigate the stability of first introduced the brass mesh in the country, and evaluate the skin surface dose of that. Materials and Methods: The measurement of skin surface dose was evaluated to verify similar thickness of the Brass mesh bolus that compared conformal tissue equivalent bolus with 5 mm thickness. We used 6 MV photons on an ELEKTA VERSA linear accelerator and optically stimulated luminescent dosimeter (OSLD). In addition, two opposed beam using IMRT phantom was applied to comparative study of brass mesh bolus between tissue equivalent bolus. Results: The results showed that similar thickness of the Brass mesh bolus was 3 mm compared with 5 mm tissue equivalent bolus by measuring the skin surface dose of solid phantom. The surface dose for IMRT thorax phantom using 3 mm brass mesh bolus was about 1.069 times greater than that using tissue equivalent bolus. Conclusion: In this study, we found that the brass mesh bolus improved better reduction of skin sparing effect and dose uniformity than tissue equivalent bolus. However evaluation for various clinic cases should be investigated.

• Journal of the Korean Society of Radiology
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• v.18 no.3
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• pp.239-248
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• 2024

Radiation therapy uses high energy, which can have side effects on the human body. Therefore, it is important to ensure that the appropriate dose is set for irradiation and to have confidence in the radiation produced by the generator. The EPR/Alanine dosimetry system is characterized by water equivalence, dose response linearity, and low fading, which makes it useful for quality control of radiation therapy equipment. In this study, we compared the signal and dose response curves of EPR/Alanine dosimetry by mass of alanine using 6 MV energy of a LINAC. An alanine dosimeter and EPR spectrometer from Burker, and a LINAC from Elekta, were used. A dose response curve and a 1st order regression equation were constructed from the irradiated dose and the EPR signal from the alanine dosimeter. We compared the signal magnitude and dose response curve with mass and checked the confidence through the measurement uncertainty of the dose response curve. As a result, it was found that the magnitude of the EPR signal increased by about 1.3 times at 64.5 mg, and the sensitivity of the dose response curve increased as the mass increased. The measurement uncertainty was evaluated to be between 5.84 % and 8.93 %. Through this study, it is expected that the EPR/alanine dosimetry system can be applied to the quality assurance and quality control of a LINAC.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.157-165
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• 2012

Purpose: We evaluated usefulness of abdominal compressor for stereotactic body radiotherapy (SBRT) with unresectable hepatocellular carcinoma (HCC) patients and hepato-biliary cancer and metastatic liver cancer patients. Materials and Methods: From November 2011 to March 2012, we selected HCC patients who gained reduction of diaphragm movement >1 cm through abdominal compressor (diaphragm control, elekta, sweden) for HT (Hi-Art Tomotherapy, USA). We got planning computed tomography (CT) images and 4 dimensional (4D) images through 4D CT (somatom sensation, siemens, germany). The gross tumor volume (GTV) included a gross tumor and margins considering tumor movement. The planning target volume (PTV) included a 5 to 7 mm safety margin around GTV. We classified patients into two groups according to distance between tumor and organs at risk (OAR, stomach, duodenum, bowel). Patients with the distance more than 1 cm are classified as the 1st group and they received SBRT of 4 or 5 fractions. Patients with the distance less than 1 cm are classified as the 2nd group and they received tomotherapy of 20 fractions. Megavoltage computed tomography (MVCT) were performed 4 or 10 fractions. When we verify a MVCT fusion considering priority to liver than bone-technique. We sent MVCT images to Mim_vista (Mimsoftware, ver .5.4. USA) and we re-delineated stomach, duodenum and bowel to bowel_organ and delineated liver. First, we analyzed MVCT images to check the setup variation. Second we compared dose difference between tumor and OAR based on adaptive dose through adaptive planning station and Mim_vista. Results: Average setup variation from MVCT was $-0.66{\pm}1.53$ mm (left-right) $0.39{\pm}4.17$ mm (superior-inferior), $0.71{\pm}1.74$ mm (anterior-posterior), $-0.18{\pm}0.30$ degrees (roll). 1st group ($d{\geq}1$) and 2nd group (d<1) were similar to setup variation. 1st group ($d{\geq}1$) of $V_{diff3%}$ (volume of 3% difference of dose) of GTV through adaptive planing station was $0.78{\pm}0.05%$, PTV was $9.97{\pm}3.62%$, $V_{diff5%}$ was GTV 0.0%, PTV was $2.9{\pm}0.95%$, maximum dose difference rate of bowel_organ was $-6.85{\pm}1.11%$. 2nd Group (d<1) GTV of $V_{diff3%}$ was $1.62{\pm}0.55%$, PTV was $8.61{\pm}2.01%$, $V_{diff5%}$ of GTV was 0.0%, PTV was $5.33{\pm}2.32%$, maximum dose difference rate of bowel_organ was $28.33{\pm}24.41%$. Conclusion: Despite we saw diaphragm movement more than 5 mm with flouroscopy after use an abdominal compressor, average setup_variation from MVCT was less than 5 mm. Therefore, we could estimate the range of setup_error within a 5 mm. Target's dose difference rate of 1st group ($d{\geq}1$) and 2nd group (d<1) were similar, while 1st group ($d{\geq}1$) and 2nd group (d<1)'s bowel_organ's maximum dose difference rate's maximum difference was more than 35%, 1st group ($d{\geq}1$)'s bowel_organ's maximum dose difference rate was smaller than 2nd group (d<1). When applicating SBRT to HCC, abdominal compressor is useful to control diaphragm movement in selected patients with more than 1 cm bowel_organ distance.

• Radiation Oncology Journal
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• v.33 no.4
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• pp.337-343
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• 2015

Purpose: The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. Materials and Methods: The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. Results: The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. Conclusion: The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.

• 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.