• The Journal of Korean Society for Radiation Therapy
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• v.19 no.1
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• pp.27-33
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• 2007

Purpose: We have performed SRS (stereotactic radiosurgery) for avm (arterry vein malformation) and brain cancer. In order to verify dose and localization of SRS, dose distributions from TPS ($X-Knife^{(R)}$ 3.0, Radionics, USA) and GafChromic $EBT^{(R)}$ film in a head phantom were compared. Materials and Methods: In this study, head and neck region of conventional humanoid phantom was modified by substituting one of 2.5 cm slap with five 0.5 cm acrylic plates to stack the GafChromic $EBT^{(R)}$ film slice by slice with 5 mm intervals. Four films and five acrylic plates were cut along the contour of head phantom in axial plane. The head phantom was fixed with SRS head ring and adapted SRS localizer as same as real SRS procedure. CT images of the head phantom were acquired in 5 mm slice intervals as film interval. Five arc 6 MV photon beams using the SRS cone with 2 cm diameter were delivered 300 cGy to the target in the phantom. Ten small pieces of the film were exposed to 0, 50, 100, 200, 300, 400, 500, 600, 700, 800, 900 cGy, respectively to calibrate the GafChromic $EBT^{(R)}$ film. The films in the phantom were digitized after 24 hours and its linearity was calibrated. The pixel values of the film were converted to the dose and compared with the dose distribution from the TPS calculation. Results: Calibration curve for the GafChromic $EBT^{(R)}$ film was linear up to 900 cGy. The R2 value was better than 0.992. Discrepancy between calculated from $X-Knife^{(R)}$ 3.0 and measured dose distributions with the film was less than 5% through all slices. Conclusion: It was possible to evaluate every slice of humanoid phantom by stacking the GafChromic EBT film which is suitable for 2 dimensional dosimetry, It was found that film dosimetry using the GafChromic $EBT^{(R)}$ film is feasible for routine dosimetric QA of stereotactic radiosurgery.

• Progress in Medical Physics
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• v.21 no.1
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• pp.113-119
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• 2010

Software for GafChromic EBT2 film dosimetry was developed in this study. The software provides film calibration functions based on color channels, which are categorized depending on the colors red, green, blue, and gray. Evaluations of the correction effects for light scattering of a flat-bed scanner and thickness differences of the active layer are available. Dosimetric results from EBT2 films can be compared with those from the treatment planning system ECLIPSE or the two-dimensional ionization chamber array MatriXX. Dose verification using EBT2 films is implemented by carrying out the following procedures: file import, noise filtering, background correction and active layer correction, dose calculation, and evaluation. The relative and absolute background corrections are selectively applied. The calibration results and fitting equation for the sensitometric curve are exported to files. After two different types of dose matrixes are aligned through the interpolation of spatial pixel spacing, interactive translation, and rotation, profiles and isodose curves are compared. In addition, the gamma index and gamma histogram are analyzed according to the determined criteria of distance-to-agreement and dose difference. The performance evaluations were achieved by dose verification in the $60^{\circ}$-enhanced dynamic wedged field and intensity-modulated (IM) beams for prostate cancer. All pass ratios for the two types of tests showed more than 99% in the evaluation, and a gamma histogram with 3 mm and 3% criteria was used. The software was developed for use in routine periodic quality assurance and complex IM beam verification. It can also be used as a dedicated radiochromic film software tool for analyzing dose distribution.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.2
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• pp.83-91
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• 2017

Objectives: The purpose of this study was to evaluate the error of the leaf position accuracy of the MLC due to the gravity effect according to the gantry angle by using picket fence test using EPID and GafChromic EBT3 film. Materials and Methods: A 5 cm solid phantom was placed on the table and the SAD was set to 100 cm. The EBT3 film was placed exactly over the solid phantom and covered a 1.5 cm solid phantom and the picket fence test was performed. The EPID was measured under the same conditions as the EBT3 film at SID 100 cm. The gantry angles were measured at $0^{\circ}$, $90^{\circ}$, $180^{\circ}$ and $270^{\circ}$ in order to evaluate the position of the MLC according to the gantry angle. For the geometric evaluation of the MLC, the leaf position accuracy of the MLC was analyzed using the analysis program. Results: In case of EPID, when the gantry angle was changed to $0^{\circ}$, $90^{\circ}$, $180^{\circ}$, $270^{\circ}$, the difference of the position errors of the leaves was 0.18 mm, 0.31 mm, 0.20 mm, 0.26 mm on the average and the maximum values of the errors were respectively 0.44 mm, 0.54 mm, 0.34 mm, 0.44 mm. In case of EBT3 film, when the gantry angle was changed to $0^{\circ}$, $90^{\circ}$, $180^{\circ}$, $270^{\circ}$, the difference of the position errors of the leaves was 0.19 mm, 0.21 mm, 0.19 mm, 0.31 mm on the average and the maximum values of the errors were respectively 0.35 mm, 0.45 mm, 0.36 mm, 0.48 mm. Conclusion: In this study, we analyzed the position error of the leaf of the MLC according to the gantry angle, and confirmed the position error of the leaf by gravity effect. As a result of comparing the leaf position accuracy using EPID and EBT3 film according to the variation of gantry angle, a larger error occurred in the error analysis method using EPID than that of EBT3 film. Therefore, in the case of IMRT based on MLC, as well as verification of accurate dosimetry should be conducted, it is considered that the quality control and verification for the precise operation of the MLC will be needed. and it is necessary to compare and verify the method of analysis.

• Progress in Medical Physics
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• v.20 no.2
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• pp.88-96
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• 2009

Radiation treatment for skin cancer has recently increased in tomotherapy. It was reported that required dose could be delivered with homogeneous dose distribution to the target without field matching using electron and photon beam. Therapeutic beam of tomotherapy, however, has several different physical characteristic and irradiation of helical beam is involved in the mechanically dynamic factors. Thus verification of skin dose is requisite using independent tools with additional verification method. Modified phantom for dose measurement was developed and skin dose verification was performed using inserted thermoluminescent dosimeters (TLDs) and GafChromic EBT films. As the homogeneous dose was delivered to the region including surface and 6 mm depth, measured dose using films showed about average 2% lower dose than calculated one in treatment planning system. Region indicating about 14% higher and lower absorbed dose was verified on measured dose distribution. Uniformity of dose distribution on films decreased as compared with that of calculated results. Dose variation affected by inhomogeneous material, Teflon, little showed. In regard to the measured dose and its distribution in tomotherapy, verification of skin dose through measurement is required before the radiation treatment for the target located at the curved surface or superficial depth.

• Progress in Medical Physics
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• v.26 no.4
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• pp.223-228
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• 2015

Double-focused micro-Multileaf Collimator (${\mu}MLC$) is able to create radiation fields having sharper dose gradients at the field edges than common MLC. Therefore, ${\mu}MLC$ has been used for the stereotactic radiosurgery (SRS) and Stereotactic Radiotherapy (SRT). We evaluated the dosimetric characteristics of a doublefocused Dynamic-${\mu}MLC$ (DMLC) attached to the Elekta Synergy linear accelerator. For this study, the dosimetric parameters including, Percent Depth Dose (PDD), Leaf leakage and penumbra, have been measured by using of the radiochromic films (GafChromic EBT2), EDGE diode detector and three-dimensional water phantom. All datas were measured on 6 MV x-ray. As a result, The DMLC shows transmission below to 1% and because of double-focused construction of the DMLC, the penumbras of fields with DMLC are independent from the field sizes. In this paper, the resulting dosimetric evaluations proved the applicability of the DMLC attached to the Elekta Synergy linear accelerator.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.77-81
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• 2014

Purpose : In the current whole brain Radiation Therapy, Optimold was used to immobilize the head. However, skin dose was increased about 22% due to the scattering radiation by the Optimold. Since the minimum dose causing cataracts was 2 Gy, it could be seen that the effects were large especially on the lens. Therefore, in the whole brain Radiation Therapy, it was to compare and to evaluate the lens absorbed dose according to the presence of Optimold in the eyeball part. Materials and Methods : In order to compare and to evaluate the lens absorbed dose according to the presence of Optimold in the eyeball part, the Optimold mask was made ??up to 5mm bolus on the part of the eye lens in the human model phantom (Anderson Rando Phantom, USA). In the practice treatment, to measure the lens dose, the simulation therapy was processed by placing the GafChromic EBT3 film under bolus, and after the treatment plan was set up through the treatment planning system (Pinnacle, PHILIPS, USA), the treatments were measured repeatedly three times in the same way. After removing the Optimold mask in the eyeball part, it was measured in the same way as above. After scanning the film and measuring the dose by using the Digital Flatbed Scanner (Expression 10000XL, EPSON, USA), the doses were compared and evaluated according to the presence of Optimold mask in the eyeball part. Results : When there was the Optimold mask in the eyeball part, it was measured at $10.2cGy{\pm}1.5$ in the simulation therapy, and at $24.8cGy{\pm}2.7$ in the treatment, and when the Optimold mask was removed in the eye part, it was measured at $12.9cGy{\pm}2.2$ in the simulation therapy, and at $17.6cGy{\pm}1.5$ in the treatment. Conclusion : In case of removing the Optimold mask in the eyeball part, the dose was increased approximately 3 cGy in the simulation therapy and was reduced approximately 7 cGy in the treatment in comparison to the case that the Optimold mask was not removed. During the whole treatment, since the lens absorbed dose was reduced about 27%, the chance to cause cataracts and side effects was considered to be reduced due to decrease of the absorbed dose to the eye lens which had the high sensitivity on the radiation.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.83-89
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• 2014

Purpose : In case of the intensity modulated radiation therapy (IMRT) using Tomotherapy and linear accelerator (Linac), it was to compare and to evaluate the imaging dose of MVCT and CBCT that were performed daily for the correct set up of the patient. Materials and Methods : The human body model Phantom (Anderson rando Phantom, USA) was divided into the three parts as Head, Thorax, pelvis, and after GafChromic EBT3 film cut to the size of $0.5{\times}0.5cm2$.in the center of the recording area were situated on the ant, post, left, and right surface of the phantom and 2cm in depth from the ant, post, left, right, and center surface of the phantom, the surface dose and inner dose were measured repeatedly three times, respectively, using the tomotherapy (Hi Art) and the OBI of NovalisTx. The measured film calculated the output value by RIP version6.0 and then the average value of the dose was calculated by the one-way analysis of variance. Results : Using the human body model phantom, the results of MVCT and CBCT performance were that measurements of MVCT inner dose were showed $15.43cGy{\pm}6.05$ in the head, $16.62cGy{\pm}3.08$ in the thorax, $16.81cGy{\pm}5.24$ in the pelvis, and measurements of CBCT inner dose were showed $13.28{\pm}3.68$ in the head, from $13.66{\pm}4.04$ in the thorax, $15.52{\pm}3.52$ in the pelvis. The measurements of surface dose were showed in case of MVCT performance, $11.64{\pm}4.05$ in the head, $12.16{\pm}4.38$ in the thorax, $12.05{\pm}2.71$ in the pelvis, and in case of CBCT performance, $14.59{\pm}3.51$ in the head, $15.82{\pm}2.89$ in the thorax, $17.48{\pm}2.80$ in the pelvis, respectively. Conclusion : In case of Inner dose, the MVCT using MV energy showed higher than the CBCT using kV energy at 1.16 times in the head, at 1.22 times in the thorax, at 1.08 times in the pelvis, and in case of surface dose, the CBCT was higher than MVCT, at 1.25 times in the head, at 1.30 times in the thorax, at 1.45 times in the pelvis. Imaging dose was a small amount compared to the therapeutic dose but it was thought to affect partially to normal tissue because it was done in daily schedule. However, IMRT treatment was necessarily parallel with the IGRT treatment through the image-guide to minimize errors between planned and actual treatment. Thus, to minimize imaging dose that the patients receive, when planning the treatment, it should be set up a treatment plan considering imaging dose, or it must be performed by minimizing the scan range when shooting MVCT.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.225-232
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• 2014

Purpose : The purpose of this study was to evaluate the surface and superficial dose for patients requiring postmastectomy radiation therapy(PMRT) with different treatment techniques. Materials and Methods : Computed tomography images were acquired for the phantom(I'mRT, IBA) consisting of tissue equivalent material. Hypothetical chestwall and lung were outlined and modified. Five treatment techniques(Wedged Tangential; WT, 4-field IMRT, 7-field IMRT, TOMO DIRECT, TOMO HELICAL) were evaluated using only 6MV photon beam. GafChromic EBT3 film was used for dose measurements at the surface and superficial dose. Surface dose profiles around the phantom were obtained for each treatment technique. For superficial dose measurements, film were used inside the phantom and analyzed superficial region for depth from 1-6mm. Results : TOMO DIRECT showed the highest surface dose by 47~70% of prescribed dose, while 7-field IMRT showed the lowest by 35~46% of prescribed dose. For the WT, 4-field IMRT and 7-field IMRT, superficial dose were measured over 60%, 70%, and 80% for 1mm, 2mm, and 5mm depth, respectively. In case of TOMO DIRECT and TOMO HELICAL, over 75%, 80%, and 90% of prescribed dose was measured, respectively. Surface and superficial dose range were uniform in overall chestwall for the 7-field IMRT and TOMO HELICAL. In contrast, Because of the dose enhancement effect with oblique incidence, The dose was gradually increased toward the obliquely tangential angle for the WT and TOMO DIRECT. Conclusion : For PMRT, TOMO DIRECT and TOMO HELICAL deliver the higher surface and superficial doses than treatment techniques based linear accelerator. It showed adequate dose(over 75% of prescribed dose) at 1mm depth in skin region.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.29-35
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• 2014

Purpose : This study has already started commercial Gated RapidArc automation equipment which was not previously in the Gated radiation therapy can be performed simultaneously with the VMAT Gated RapidArc radiation therapy to the accuracy of the analysis to evaluate the usability, Amplitude mode applied to the patient. Materials and Methods : The analysis of the distribution of radiation dose equivalent quality solid water phantom and GafChromic film was used Film QA film analysis program using the Gamma factor (3%, 3 mm). Three-dimensional dose distribution in order to check the accuracy of Matrixx dosimetry equipment and Compass was used for dose analysis program. Periodic breathing synchronized with solid phantom signals Phantom 4D Phantom and Varian RPM was created by breathing synchronized system, free breathing and breath holding at each of the dose distribution was analyzed. In order to apply to four patients from February 2013 to August 2013 with liver cancer targets enough to get a picture of 4DCT respiratory cycle and then patients are pratice to meet patient's breathing cycle phase mode using the patient eye goggles to see the pattern of the respiratory cycle to be able to follow exactly in a while 4DCT images were acquired. Gated RapidArc treatment Amplitude mode in order to create the breathing cycle breathing performed three times, and then at intervals of 40% to 60% 5-6 seconds and breathing exercises that can not stand (Fig. 5), 40% While they are treated 60% in the interval Beam On hold your breath when you press the button in a way that was treated with semi-automatic. Results : Non-respiratory and respiratory rotational intensity modulated radiation therapy technique absolute calculation dose of using computerized treatment plan were shown a difference of less than 1%, the difference between treatment technique was also less than 1%. Gamma (3%, 3 mm) and showed 99% agreement, each organ-specific dose difference were generally greater than 95% agreement. The rotational intensity modulated radiation therapy, respiratory synchronized to the respiratory cycle created Amplitude mode and the actual patient's breathing cycle could be seen that a good agreement. Conclusion : When you are treated Non-respiratory and respiratory method between volumetric intensity modulated radiation therapy rotation of the absolute dose and dose distribution showed a very good agreement. This breathing technique tuning volumetric intensity modulated radiation therapy using a rotary moving along the thoracic or abdominal breathing can be applied to the treatment of tumors is considered. The actual treatment of patients through the goggles of the respiratory cycle to create Amplitude mode Gated RapidArc treatment equipment that does not automatically apply to the results about 5-6 seconds stopped breathing in breathing synchronized rotary volumetric intensity modulated radiation therapy facilitate could see complement.