• Journal of the Korean Society of Radiology
• /
• v.6 no.5
• /
• pp.365-371
• /
• 2012

The radiation therapy treatment technique is developed from 3D-CRT, IMRT to Tomotherapy. and these three technique was most widely using methods. We find out a comparison normal tissue doses and tumor dose of 3D-CRT, IMRT(Linac Based), and Tomotherapy on Head and Neck Cancer. We achieved radiological image used the Human model phantom (Anthropomorphic Phantom) and it was taken CT simulation (Slice Thickness : 3mm) and GTV was nasopharngeal region and PTV(including set-up margin) was GTV plus 2mm area. and transfer those images to the radiation planning system (3D-CRT - ADAC-Pinnacle3, Tomotherapy - Tomotherapy Hi-Art System). The prescription dose was 7020 cGy and measuring PTV's dose and nomal tissue (parotid gland, oral cavity, spinal cord). The PTV's doses was Tomotherapy, Linac Based - IMRT, 3D-CRT was 6923 cGy, 6901 cGy and 6718 cGy its dose value was meet TCP because its value was up to the 95% based on 7020 cGy, Nomal tissue (parotid gland, oral cavity, spinal cord) was 1966 cGy(Tomotherapy), 2405 cGy(IMRT), 2468 cGy(3D-CRT)[parotid gland], 2991 cGy(Tomotherapy), 3062 cGy(IMRT), 3684 cGy (3D-CRT)[oral cavity], 1768 cGy(Tomotherapy), 2151 cGy(IMRT), 4031 cGy(3D-CRT)[spinal cord] its value did not exceeded NTCP. All the treatment techniques are equated with tumor and nomal tissue doses. The 3D-CRT was worse than other techniques on dose distribution, but it is reasonable in terms of TCP and NTCP baseline Tomotherapy, IMRT -dose distribution was relatively superior- was hard to therapy to claustrophobic patients and patients with respiratory failure. Particularly, in case on Tomotherapy, it take MVCT before treatment so dose measurement will be unnecessary radiation exposure to patients. Conclusion, Tomotherapy was the best treatment technique and 2nd was IMRT, and 3rd 3D-CRT. But applicable differently depending on the the patient's condition even though dose not matter.

• The Journal of Korean Society for Radiation Therapy
• /
• v.22 no.2
• /
• pp.105-111
• /
• 2010

Purpose: There are various beam parameter in intensity modulated radiation therapy (IMRT). The aim of this study is to investigate how various dose rate affect the parotid in treatment plan of IMRT. Materials and Methods: The study was performed on 10 nasopharyngeal carcinoma patients who have undergone IMRT. CT images were scanned 3 mm of thickness in the same condition and the treatment plan was performed by Eclipse (Ver.7.1, Varian, Palo Alto, USA). The parameters for planning used 6 MV energy and 8 beams under the same dose volume constraint. The variation of dose rates were used 300, 400, 500 MU/min. The mean dose of both parotid was accessed from the calculated planning among the 10 patients. The mean dose of parotid was verificated by 2D diode array (Mapcheck from Sun Nuclear Corporation, Melbourne, Florida). Also, Total monitor unit (MU) and beam-on time was analysed. Results: According to the dose rate, the mean dose of parotid was increased by 0.8%, 2.0% each, when dose rate was changed from 300 MU/min to 400, 500 MU/min, moreover Total MU was increased by 5.4% and 10.6% each. There was also a dose upward trend in the dose measurement of parotid by 2D diode array. However, beam - on time difference of 1~2 minutes was no signigicant in the dose rate increases. Conclusion: From this study, when the dose rates increase, there was a signigicant increase of Total MU and the parotid dose accordingly, however the shortened treatment time was not significant. Hence, it is considered that there is a significant decrease of late side effect in parotid radiation therapy, if the precise dose rate in IMRT is used.

• The Journal of Korean Society for Radiation Therapy
• /
• v.28 no.2
• /
• pp.101-108
• /
• 2016

Purpose : The purpose of this study was to evaluate the Retro recon in SRS planning using BranLAB when stereotactic location error occurs by metal artifact. Materials and Methods : By CT simulator, image were acquired from head phantom(CIRS, PTW, USA). To observe stereotactic location recognizing and beam hardening, CT image were approved by SRS planning system(BrainLAB, Feldkirchen, Germany). In addition, we compared acquisition image(1.25mm slice thickness) and Retro recon image(using for 2.5 mm, 5mm slice thickness). To evaluate these three images quality, the test were performed by AAPM phantom study. In patient, it was verified stereotactic location error. Results : All the location recognizing error did not occur in scanned image of phantom. AAPM phantom scan images all showed the same trend. Contrast resolution and Spatial resolution are under 6.4 mm, 1.0 mm. In case of noise and uniformity, under 11, 5 of HU were measured. In patient, the stereotactic location error was not occurred at reconstructive image. Conclusion : For BrainLAB planning, using Retro recon were corrected stereotactic error at beam hardening. Retro recon may be the preferred modality for radiation treatment planning and approving image quality.

• The korean journal of orthodontics
• /
• v.35 no.6 s.113
• /
• pp.475-484
• /
• 2005

This study was performed to investigate the reproducibility of the horizontal and midsagittal planes, and to suggest a stable coordinate system for three-dimensional (3D) cephalometric analysis. Eighteen CT scans were taken and the coordinate system was established using 7 reference points marked by a volume model, with no more than 4 points on the same plane. The 3D landmarks were selected on V works (Cybermed Inc., Seoul, Korea), then exported to V surgery (Cybermed Inc., Seoul, Korea) to calculate the coordinate values. All the landmarks were taken twice with a lapse of 2 weeks. The horizontal and midsagittal planes were constructed and its reproducibility was evaluated. There was no significant difference in the reproducibility of the horizontal reference planes, But, FH planes were more reproducible than other horizontal planes. FH planes showed no difference between the planes constructed with 3 out of 4 points. The angle of intersection made by 2 FH planes, composed of both Po and one Or showed less than $1^{\circ}$ difference. This was identical when 2 FH planes were composed of both Or and one Po. But, the latter cases showed a significantly smaller error. The reproducibility of the midsagittal plane was reliable with an error range of 0.61 to $1.93^{\circ}$ except for 5 establishments (FMS-Nc, Na-Rh, Na-ANS, Rh-ANS, and FR-PNS). The 3D coordinate system may be constructed with 3 planes; the horizontal plane constructed by both Po and right Or; the midsagittal plane perpendicular to the horizontal plane, including the midpoint of the Foramen Spinosum and Nc; and the coronal plane perpendicular to the horizontal and midsagittal planes, including point clinoidale, or sella, or PNS.

• The Korean Journal of Nuclear Medicine
• /
• v.31 no.3
• /
• pp.372-380
• /
• 1997

The purpose of this study was to evaluate the usefulness of whole body F-18 FDG PET scan for detecting postoperative recurrence of cancer. One hundred four cancer patients after operation were enrolled(14 brain tumor, 15 head and neck cancer, 23 gynecologic cancer, 16 gastrointestinal cancer, 16 thyroid cancer, and 20 other cancers). Besides conventional images(CI) including CT and MRI, F-18 FDG PET scan was obtained on ECAT EXACT 47 scanner(Siemens-CTI), beginning 60 minutes after injection of 370MBq(10mCi) of F-18 FDG. Regional scan was also obtained with emission image. Transmission images using Ge-68 were carried out for attenuation correction in both whole body and regional images. Findings of PET, and CI were confirmed by pathology or clinical follow up. The sensitivity and specificity of PET for detecting recurrence were 94% and 92%, respectively. Contrarily, the sensitivity and specificity of CI were 78% and 68%. CI results were negative and PET results were positive in 11 cases. The biopsy or clinical follow-up of those cases confirmed recurrence of tumor. False negative cases of CI were frequent in patients with gynecologic cancers. Also we measured the serum concentration of tumor markers in patients with gynecologic cancer(CA125), thyroid cancer(thyroglobulin), and colorectal cancer(CEA). The sensitivity and specificity of tumor markers were 71% and 84%, respectively, We conclude that F-18 FDG PET can be used valuably in detecting recurrent foci of a wide variety of malignancy compared to conventional diagnostic methods.

• The Journal of Korean Academy of Prosthodontics
• /
• v.46 no.4
• /
• pp.325-334
• /
• 2008

Statement of problem & Purpose: The purpose of this study was to investigate the effect of a mouth guard material properties on the skull and brain when they were under impact loads on mandible. Material and methods: Two customized mouth protectors having different material propeerst ieach other were made for a female Korean who had no history of brain trauma, no cerebral diseases, nomal occlusion and natural dentition. The 3D finite element model of human skull and brain scanned by means of computed tomography was constructed. The FEM model of head was composed of 407,825 elements and 82,138 nodes, including skull, brain, maxilla, mandible, articular disc, teeth and mouth guard. The stress concentrations on maxillary teeth, maxilla and skull with two mouth guards were evaluated under oblique impact load of 800N onto mandibular 3 loading points for 0.1sec. And the brain relative displacement was compared in two different mouth guard materials under same condition. Result and Conclusion: The results were as follows; 1. In comparison of von Mises stress on maxillary teeth, a soft mouth guard material had significantly lower stress values on measuring point than a hard mouth protector materials (P < .05). 2. In comparison of von Mises stress on maxilla and skull, A soft mouth protector material had significantly lower stress values on measuring point than a hard mouth protector materials (P < .05). 3. For impact loads on mandible, there were more stress concentrated area on maxilla and skull with hard mouth guard than soft with mouth protector. 4. For impact loads on mandible, brain relative displacement had little relation with mouth guard material properties. In results of this study, soft mouth guard materials were superior to hard mouth guard materials for mandible impact loads for prevention of sports injuries. Although the results of this study were not enough to figure out the roles of needed mouth guard material properties for a human head, we got some knowledge of the pattern about stress concentration and distribution on maxilla and skull for impact loads with soft or hard mouth protector. More studies are needed to substantiate the relationship between the mouth guard materials and sports injuries.

• The Journal of Korean Society for Radiation Therapy
• /
• v.20 no.1
• /
• pp.1-9
• /
• 2008

Purpose: For head and neck cancer patients treated with radiation therapy, proper immobilization of intra-oral structures is crucial in reproducing treatment positions and optimizing dose distribution. We produced a man-made tongue immobilization device for each patient subjected to this study. Reproducibility of treatment positions and dose distributions at air-and-tissue interface were compared using man-made tongue immobilization devices and conventional tongue-bites. Materials and Methods: Dental alginate and putty were used in producing man-made tongue immobilization devices. In order to evaluate reproducibility of treatment positions, all patients were CT-simulated, and linac-gram was repeated 5 times with each patient in the treatment position. An acrylic phantom was devised in order to evaluate safety of man-made tongue immobilization devices. Air, water, alginate and putty were placed in the phantom and dose distributions at air-and-tissue interface were calculated using Pinnacle (version 7.6c, Phillips, USA) and measured with EBT film. Two different field sizes (3$\times$3 cm and 5$\times$5 cm) were used for comparison. Results: Evaluation of linac grams showed reproducibility of a treatment position was 4 times more accurate with man-made tongue immobilization devices compared with conventional tongue bites. Patients felt more comfortable using customized tongue immobilization devices during radiation treatment. Air-and-tissue interface dose distributions calculated using Pinnacle were 7.78% and 0.56% for 3$\times$3 cm field and 5$\times$5 cm field respectively. Dose distributions measured with EBT (international specialty products, USA) film were 36.5% and 11.8% for 3$\times$3 cm field and 5$\times$5 cm field respectively. Values from EBT film were higher. Conclusion: Using man-made tongue immobilization devices made of dental alginate and putty in treatment of head and neck cancer patients showed higher reproducibility of treatment position compared with using conventional mouth pieces. Man-made immobilization devices can help optimizing air-and-tissue interface dose distributions and compensating limited accuracy of radiotherapy planning systems in calculating air-tissue interface dose distributions.

• Pediatric Infection and Vaccine
• /
• v.11 no.1
• /
• pp.81-89
• /
• 2004

Purpose : Retropharyngeal and parapharyngeal abscesses are often distinguishable from other head and neck abscesses on clinical grounds, but these infections can combine and the presentations are similar to one another. Because of the advances of antibiotic therapy, the frequency of the diseases decreased considerably, but recently the incidence of neck abscesses has increased. We sought to describe the clinical presentation of patients with deep neck abscess, and implications on management. Methods : For 10 year periods, 94 cases of charts were reviewed retrospectively, who were diagnosed as neck abscesses aged below 16 years old(between January 1993 to August 2003) in 4 hospitals. Deep neck abscesses were diagnosed by surgical pus drainage, neck CT (homogenous, hypodense area with ring enhancement) and neck sono findings. Results : The annual incidence of deep neck abscess has been increased since 2000. The median age of the patients was 4 years(range, 26 days~15 years); 63% of the patients were younger than 5 years. Abscesses in the submandibular space(34%) were most common, followed by peritonsillar space(29.7%), retropharyngeal space(11.7%), combined(10.8%), parotid space(7.4%) and parapharyngeal space(6.4%). Fever(73.4%), sore throat(37.2%), decreased oral intake(34%) and neck pain(27.7%) were the most common symptoms. In 6 children(6.4%), there was refusal to move neck, in 6(6.4%) headache, and in 4(4.3%) torticollis. Respiratory distress was observed in only 1 patient(2.1%) and stridor in 1 other(2.1%). The most common physical examinations were neck swelling/mass(67%), pharyngitis(46.8%), tonsillitis(36.2 %), and cervical lymphadenopathy(28.7%). Neck stiffness was observed in 4 patients(4.3%). Total 35 organisms were isolated in 33 patients. The most common organisms cultured by patients' blood or pus were S. aureus(34%) and S. pyogenes(28.6%). Most organisms were gram positive, and had sensitivities in vancomycin(96.4%), cefotaxime(88.9%), cephalothin (86.4%), trimethoprime-sulfamethoxazole(83.3%), and clindamycin(77.8%). 77 patients(81.9%) underwent surgery plus antibiotics; 17 patients(18.1%) were treated with antibiotics only. There is no significant differences between two groups. In duration of admission, fever after admission, and antibiotic treatment. Conclusion : The incidence of deep neck abscess has increased recently and the major symptoms have been changed. The incidence of respiratory distress or stridor is decreasing, while the incidence of abnormal head and neck symptoms and signs like headache, neck stiffness, refusal to move neck, or torticollis are increasing. Gram positive organisms are predominant, S. aureus is the most common followed by S. pyogenes. 1st generation cephalosporin has high sensitivity on gram positive organisms. Treatment with surgery plus antibiotics dose not significantly decrease total duration of antibiotic treatment or admission compared to treatment with antibiotics alone.

• Imaging Science in Dentistry
• /
• v.49 no.4
• /
• pp.273-279
• /
• 2019

Purpose: This study was performed to investigate the effects of energy level, reconstruction kernel, and tube rotation time on Hounsfield unit (HU) values of hydroxyapatite (HA) in virtual monochromatic images (VMIs) obtained with dual-energy computed tomography (DECT)(Siemens Healthineers, Erlangen, Germany). Materials and Methods: A bone density calibration phantom with 3 HA inserts of different densities(CTWATER^®; 0, 100, and 200 mg of HA/㎤) was scanned using a twin-beam DECT scanner at 120 kVp with tube rotation times of 0.5 and 1.0 seconds. The VMIs were reconstructed by changing the energy level (with options of 40 keV, 70 keV, and 140 keV). In order to investigate the impact of the reconstruction kernel, virtual monochromatic images were reconstructed after changing the kernel from body regular 40 (Br40) to head regular 40 (Hr40) in the reconstruction phase. The mean HU value was measured by placing a circular region of interests (ROIs) in the middle of each insert obtained from the VMIs. The HU values were compared with regard to energy level, reconstruction kernel, and tube rotation time. Results: Hydroxyapatite density was strongly correlated with HU values(correlation coefficient=0.678, P<0.05). For the HA 100 and 200 inserts, HU decreased significantly at increased energy levels(correlation coefficient= -0.538, P<0.05) but increased by 70 HU when using Hr40 rather than Br40 (correlation coefficient=0.158, P<0.05). The tube rotation time did not significantly affect the HU(P>0.05). Conclusion: The HU values of hydroxyapatite were strongly correlated with hydroxyapatite density and energy level in VMIs obtained with DECT.

• Journal of the Korean Society of Radiology
• /
• v.13 no.7
• /
• pp.1025-1033
• /
• 2019

Although magnetic resonance imaging without linear hardening of CT is recognized as a method of obtaining high contrast of tissue and excellent resolution image in brain disease and head and neck examination, magnetic susceptibility artifact is generated in case of metal implants in the oral cavity, which is an obstacle to image diagnosis. Therefore, an effort was made in this thesis to find a method to reduce artifacts caused by dental implants and prosthesis in MRI. Implant-induced artifacts in magnetic resonance imaging showed that the signal size increased with shorter TE in GE technique and was inconsistent with water temperature change. In SE technique as well, the signal size of water was generally higher than that of air, but the signal to noise ratio (SNR) was not different by air and temperature. In EPI technique, images with fewer artifacts were obtained quantitatively and qualitatively when there was more water than air, and the signal to noise ratio was measured the highest, especially at water temperatures of 20° and 30°. In conclusion, when examining using the EPI technique rather than the SE or the GE technique, obtaining brain diffusion using a 20° and 30° water bag reduces the magnetic susceptibility artifacts caused by implants and prosthesis, suggesting that it may provide images with high diagnostic value.