• Journal of radiological science and technology
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• v.37 no.4
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• pp.331-339
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• 2014

To test feasibility of proton arc therapy (PAT) in the treatment of para-aortic lymph node tumor and compare its dosimetric properties with advanced radiotherapy techniques such as intensity modulated radiation therapy (IMRT) and conventional 3D conformal proton beam therapy (PBT). The treatment plans for para-aortic lymph node tumor were planned for 9 patients treated at our institution using IMRT, PBT, and PAT. Feasibility test and dosimetric evaluation were based on comparisons of dose volume histograms (DVHs) which reveal mean dose, $D_{30%}$, $D_{60%}$, $D_{90%}$, $V_{30%}$, $V_{60%}$, $V_{90%}$, organ equivalent doses (OEDs), normal tissue complication probability (NTCP), homogeneity index (HI) and conformity index (CI). The average doses delivered by PAT to the liver, kidney, small bowel, duodenum, stomach were 7.6%, 3%, 17.3%, 26.7%, and 14.4%, of the prescription dose (PD), respectively, which is higher than the doses delivered by IMRT (0.4%, 7.2%, 14.2%, 15.9%, and 12.8%, respectively) and PBT (4.9%, 0.5%, 14.12%, 16.1% 9.9%, respectively). The average homogeneity index and conformity index of tumor using PAT were 12.1 and 1.21, respectively which were much better than IMRT (21.5 and 1.47, respectively) and comparable to PBT (13.1 and 1.23, respectively). The result shows that both NTCP and OED of PAT are generally lower than IMRT and PBT. This study demonstrates that PAT is better in target conformity and homogeneity than IMRT and PBT but worse than IMRT and PBT for most of dosimetric factor which indicate that PAT is not recommended for the treatment of para-aortic lymph node tumor.

• Progress in Medical Physics
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• v.23 no.1
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• pp.48-53
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• 2012

The pencil beam convolution (PBC) algorithms in radiation treatment planning system have been widely used to calculate the radiation dose. A new photon dose calculation algorithm, referred to as the anisotropic analytical algorithm (AAA), was released for use by the Varian medical system. The aim of this paper was to investigate the difference in dose calculation between the AAA and PBC algorithm using the intensity modulated radiation therapy (IMRT) plan for lung cancer cases that were inhomogeneous in the low density. We quantitatively analyzed the differences in dose using the eclipse planning system (Varian Medical System, Palo Alto, CA) and I'mRT matirxx (IBA, Schwarzenbruck, Germany) equipment to compare the gamma evaluation. 11 patients with lung cancer at various sites were used in this study. We also used the TLD-100 (LiF) to measure the differences in dose between the calculated dose and measured dose in the Alderson Rando phantom. The maximum, mean, minimum dose for the normal tissue did not change significantly. But the volume of the PTV covered by the 95% isodose curve was decreased by 6% in the lung due to the difference in the algorithms. The difference dose between the calculated dose by the PBC algorithms and AAA algorithms and the measured dose with TLD-100 (LiF) in the Alderson Rando phantom was -4.6% and -2.7% respectively. Based on the results of this study, the treatment plan calculated using the AAA algorithms is more accurate in lung sites with a low density when compared to the treatment plan calculated using the PBC algorithms.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.11-19
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• 2014

Purpose : To derive the most appropriate factors by considering the effects of the major factors when applied to the optimization algorithm, thereby aiding the effective designing of a ideal treatment plan. Materials and Methods : The eclipse treatment planning system(Eclipse 10.0, Varian, USA) was used in this study. The PBC (Pencil Beam Convolution) algorithm was used for dose calculation, and the DVO (Dose Volume Optimizer 10.0.28) Optimization algorithm was used for intensity modulated radiation therapy. The experimental group consists of patients receiving intensity modulated radiation therapy for the head and neck cancer and dose prescription to two planned target volume was 2.2 Gy and 2.0 Gy simultaneously. Treatment plan was done with inverse dose calculation methods utilizing 6 MV beam and 7 fields. The optimal algorithm parameter of the established plan was selected based on volume dose-priority(Constrain), dose fluence smooth value and the impact of the treatment plan was analyzed according to the variation of each factors. Volume dose-priority determines the reference conditions and the optimization process was carried out under the condition using same ratio, but different absolute values. We evaluated the surrounding normal organs of treatment volume according to the changing conditions of the absolute values of the volume dose-priority. Dose fluence smooth value was applied by simply changing the reference conditions (absolute value) and by changing the related volume dose-priority. The treatment plan was evaluated using Conformal Index, Paddick's Conformal Index, Homogeneity Index and the average dose of each organs. Results : When the volume dose-priority values were directly proportioned by changing the absolute values, the CI values were found to be different. However PCI was $1.299{\pm}0.006$ and HI was $1.095{\pm}0.004$ while D5%/D95% was $1.090{\pm}1.011$. The impact on the prescribed dose were similar. The average dose of parotid gland decreased to 67.4, 50.3, 51.2, 47.1 Gy when the absolute values of the volume dose-priority increased by 40,60,70,90. When the dose smooth strength from each treatment plan was increased, PCI value increased to $1.338{\pm}0.006$. Conclusion : The optimization algorithm was more influenced by the ratio of each condition than the absolute value of volume dose-priority. If the same ratio was maintained, similar treatment plan was established even if the absolute values were different. Volume dose-priority of the treatment volume should be more than 50% of the normal organ volume dose-priority in order to achieve a successful treatment plan. Dose fluence smooth value should increase or decrease proportional to the volume dose-priority. Volume dose-priority is not enough to satisfy the conditions when the absolute value are applied solely.

• Progress in Medical Physics
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• v.18 no.3
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• pp.126-133
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• 2007

A head-and-neck phantom was designed in order to evaluate remotely the quality of the delivery dose of intensity modulated radiation therapy (IMRT) in each institution. The phantom is homogeneous or inhomogeneous by interchanging the phantom material with the substructure like an air or bone plug. Monte Carlo simulations were executed for one beam and three beams to the phantom and compared with ion chamber and thermoluminescent dosimeter (TLD) measurements of which readings were from two independent institutions. For single beam, the ion chamber results and the MC simulations agreed to within about 2% TLDs agreed with the MC results to within 2% or 7% according to which institution read the TLDs. For three beams, the ion chamber results showed -5% maximum discrepancy and those of TLDs were $+2{\sim}+3%$. The accuracy of the TLD leadings should be increased for the remote dose monitoring. MC simulations are a valuable tool to acquire the reliability of the measurements in developing a new phantom.

• The Journal of Korean Society for Radiation Therapy
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• v.22 no.1
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• pp.41-46
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• 2010

Purpose: To analyze differences in the dose uniformity for the computed breast radiation therapy planning with tangential beam between conventional RT using wedge filter and FiF-IMRT using multileaf collimator based onsizes and volumes of breasts. Materials and Methods: Thirty breast cancer patients were classified according to the sizes and volumes of the breasts using Eclipse treatment planning system ($Varian^{TM}$, USA, V8.0). Conformity Index and Homogeneity Index were computed along with Dose Volume Histogram. Results: No differencein CI (${\pm}1.2%$) was observed. However, lower mean HI (1.67%) in FiF-IMRT was observed compared to that of the conventional RT. Statically significant (P<0.01) correlation was identified between the values of ${\Delta}HI$ (%) and physical parameters such as breast volumes and separations. Conclusion: Increase in breast volume and separation improves the dose uniformities in computed radiation therapy planning for FiF-IMRT. Physical dimension of the breast should be considered to optimize the compured radiation therapy planning.

• Progress in Medical Physics
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• v.26 no.3
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• pp.153-159
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• 2015

This study is to evaluate thedosiemtric leaf gap (DLG) at different depths for dynamic intensity-modulated radiation therapy (IMRT) in order to evaluate the absolute dose and dose distribution according to the different positions of tumors and compare the measured and planned the multileaf collimator (MLC) transmission factor (T.F.) and DLG values. We used the 6 MV and 15 MV photon beam from linear accelerator with a Millenium 120 MLC system. After the import the DICOM RT files, we measured the absolute dose at different depths (2 cm, 5 cm, 10 cm, and 15 cm) to calculate the MLC T. F. and DLG. For 6 MV photon beam, the measured both MLC T. F. and DLG were increased with the increase the measured depths. When applying to treatment planning systemas fixed transmission factor with its value measured under the reference condition at depth of 5 cm, although the difference fixed and varied transmission factor is not significant, the dosiemtric effect could be presented according to the depth that the tumor is placed. Therefore, we are planning to investigate the treatment planning system whichthe T. F. and DLG factor according to at the different depths can be applied in the patient-specific treatment plan.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.1
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• pp.33-41
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• 2019

Purpose : To evaluate the effectiveness of Jaw-tracking(JT) technique in Intensity-modulated radiation therapy(IMRT) and Volumetric-modulated arc therapy(VMAT) for radiation therapy of esophageal cancer by analyzing volume dose of perimetrical normal organs along with the low-dose volume regions. Materials and Method: A total of 27 patients were selected who received radiation therapy for esophageal cancer with using $VitalBeam^{TM}$(Varian Medical System, U.S.A) in our hospital. Using Eclipse system(Ver. 13.6 Varian, U.S.A), radiation treatment planning was set up with Jaw-tracking technique(JT) and Non-Jaw-tracking technique(NJT), and was conducted for the patients with T-shaped Planning target volume(PTV), including Supraclavicular lymph nodes(SCL). PTV was classified into whether celiac area was included or not to identify the influence on the radiation field. To compare the treatment plans, Organ at risk(OAR) was defined to bilateral lung, heart, and spinal cord and evaluated for Conformity index(CI) and Homogeneity index(HI). Portal dosimetry was performed to verify a clinical application using Electronic portal imaging device(EPID) and Gamma analysis was performed with establishing thresholds of radiation field as a parameter, with various range of 0 %, 5 %, and 10 %. Results: All treatment plans were established on gamma pass rates of 95 % with 3 mm/3 % criteria. For a threshold of 10 %, both JT and NJT passed with rate of more than 95 % and both gamma passing rate decreased more than 1 % in IMRT as the low dose threshold decreased to 5 % and 0 %. For the case of JT in IMRT on PTV without celiac area, $V_5$ and $V_{10}$ of both lung showed a decrease by respectively 8.5 % and 5.3 % in average and up to 14.7 %. A $D_{mean}$ decreased by $72.3{\pm}51cGy$, while there was an increase in radiation dose reduction in PTV including celiac area. A $D_{mean}$ of heart decreased by $68.9{\pm}38.5cGy$ and that of spinal cord decreased by $39.7{\pm}30cGy$. For the case of JT in VMAT, $V_5$ decreased by 2.5 % in average in lungs, and also a little amount in heart and spinal cord. Radiation dose reduction of JT showed an increase when PTV includes celiac area in VMAT. Conclusion: In the radiation treatment planning for esophageal cancer, IMRT showed a significant decrease in $V_5$, and $V_{10}$ of both lungs when applying JT, and dose reduction was greater when the irradiated area in low-dose field is larger. Therefore, IMRT is more advantageous in applying JT than VMAT for radiation therapy of esophageal cancer and can protect the normal organs from MLC leakage and transmitted doses in low-dose field.

• Progress in Medical Physics
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• v.29 no.3
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• pp.92-100
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• 2018

The manufacturer of a linear accelerator (LINAC) has reported that the target melting phenomenon could be caused by a non-recommended output setting and the excessive use of monitor unit (MU) with intensity-modulated radiation therapy (IMRT). Due to these reasons, we observed an unexpected beam interruption during the treatment of a patient in our institution. The target status was inspected and a replacement of the target was determined. After the target replacement, the beam profile was adjusted to the machine commissioning beam data, and the absolute doses-to-water for 6 MV and 10 MV photon beams were calibrated according to American Association of Physicists in Medicine (AAPM) Task Group (TG)-51 protocol. To verify the beam data after target replacement, the beam flatness, symmetry, output factor, and percent depth dose (PDD) were measured and compared with the commissioning data. The difference between the referenced and measured data for flatness and symmetry exhibited a coincidence within 0.3% for both 6 MV and 10 MV, and the difference of the PDD at 10 cm depth ($PDD_{10}$) was also within 0.3% for both photon energies. Also, patient-specific quality assurances (QAs) were performed with gamma analysis using a 2-D diode and ion chamber array detector for eight patients. The average gamma passing rates for all patients for the relative dose distribution was $99.1%{\pm}1.0%$, and those for absolute dose distribution was $97.2%{\pm}2.7%$, which means the gamma analysis results were all clinically acceptable. In this study, we recommend that the beam characteristics, such as beam profile, depth dose, and output factors, should be examined. Further, patient-specific QAs should be performed to verify the changes in the overall beam delivery system when a target replacement is inevitable; although it is more important to check the beam output in a daily routine.

• Progress in Medical Physics
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• v.31 no.3
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• pp.54-62
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• 2020

Dose calculation algorithms play an important role in radiation therapy and are even the basis for optimizing treatment plans, an important feature in the development of complex treatment technologies such as intensity-modulated radiation therapy. We reviewed the past and current status of dose calculation algorithms used in the treatment planning system for radiation therapy. The radiation-calculating dose calculation algorithm can be broadly classified into three main groups based on the mechanisms used: (1) factor-based, (2) model-based, and (3) principle-based. Factor-based algorithms are a type of empirical dose calculation that interpolates or extrapolates the dose in some basic measurements. Model-based algorithms, represented by the pencil beam convolution, analytical anisotropic, and collapse cone convolution algorithms, use a simplified physical process by using a convolution equation that convolutes the primary photon energy fluence with a kernel. Model-based algorithms allowing side scattering when beams are transmitted to the heterogeneous media provide more precise dose calculation results than correction-based algorithms. Principle-based algorithms, represented by Monte Carlo dose calculations, simulate all real physical processes involving beam particles during transportation; therefore, dose calculations are accurate but time consuming. For approximately 70 years, through the development of dose calculation algorithms and computing technology, the accuracy of dose calculation seems close to our clinical needs. Next-generation dose calculation algorithms are expected to include biologically equivalent doses or biologically effective doses, and doctors expect to be able to use them to improve the quality of treatment in the near future.

• Progress in Medical Physics
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• v.21 no.4
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• pp.332-339
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• 2010

We aimed to setup an adaptive radiation therapy platform using cone-beam CT (CBCT) and multileaf collimator (MLC) log data and also intended to analyze a trend of dose calculation errors during the procedure based on a phantom study. We took CT and CBCT images of Catphan-600 (The Phantom Laboratory, USA) phantom, and made a simple step-and-shoot intensity-modulated radiation therapy (IMRT) plan based on the CT. Original plan doses were recalculated based on the CT ($CT_{plan}$) and the CBCT ($CBCT_{plan}$). Delivered monitor unit weights and leaves-positions during beam delivery for each MLC segment were extracted from the MLC log data then we reconstructed delivered doses based on the CT ($CT_{recon}$) and CBCT ($CBCT_{recon}$) respectively using the extracted information. Dose calculation errors were evaluated by two-dimensional dose discrepancies ($CT_{plan}$ was the benchmark), gamma index and dose-volume histograms (DVHs). From the dose differences and DVHs, it was estimated that the delivered dose was slightly greater than the planned dose; however, it was insignificant. Gamma index result showed that dose calculation error on CBCT using planned or reconstructed data were relatively greater than CT based calculation. In addition, there were significant discrepancies on the edge of each beam while those were less than errors due to inconsistency of CT and CBCT. $CBCT_{recon}$ showed coupled effects of above two kinds of errors; however, total error was decreased even though overall uncertainty for the evaluation of delivered dose on the CBCT was increased. Therefore, it is necessary to evaluate dose calculation errors separately as a setup error, dose calculation error due to CBCT image quality and reconstructed dose error which is actually what we want to know.