• Progress in Medical Physics
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• v.23 no.4
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• pp.303-308
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• 2012

The Geant4 based Monte Carlo code for the application of stereotactic radiosurgery was developed. The probability density function and cumulative density function to determine the incident photon energy were calculated from pre-calculated energy spectrum for the linac by multiplying the weighting factors corresponding to the energy bins. The messenger class to transfer the various MLC fields generated by the planning system was used. The rotation matrix of rotateX and rotateY were used for simulating gantry and table rotation respectively. We construct accelerator world and phantom world in the main world coordinate to rotate accelerator and phantom world independently. We used dicomHandler class object to convert from the dicom binary file to the text file which contains the matrix number, pixel size, pixel's HU, bit size, padding value and high bits order. We reconstruct this class object to work fine. We also reconstruct the PrimaryGeneratorAction class to speed up the calculation time. because of the huge calculation time we discard search process of the ThitsMap and used direct access method from the first to the last element to produce the result files.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2006.08a
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• pp.83-83
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• 2006

• Progress in Medical Physics
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• v.5 no.2
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• pp.57-68
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• 1994

Purpose : The purposes are to discuss the reason to measure dose distributions of circular small fields for stereotactic radiosurgery based on medical linear accelerator, finding of beam axis, and considering points on dosimetry using home-made small water phantom, and to report dosimetric results of 10MV X-ray of Clinac-18, like as TMR, OAR and field size factor required for treatment planning. Method and material : Dose-response linearity and dose-rate dependence of a p-type silicon (Si) diode, of which size and sensitivity are proper for small field dosimetry, are determined by means of measurement. Two water tanks being same in shape and size, with internal dimension, 30${\times}$30${\times}$30cm$^3$ were home-made with acrylic plates and connected by a hose. One of them a used as a water phantom and the other as a device to control depth of the Si detector in the phantom. Two orthogonal dose profiles at a specified depth were used to determine beam axis. TMR's of 4 circular cones, 10, 20, 30 and 40mm at 100cm SAD were measured, and OAR's of them were measured at 4 depths, d$\sub$max/, 6, 10, 15cm at 100cm SCD. Field size factor (FSF) defined by the ratio of D$\sub$max/ of a given cone at SAD to MU were also measured. Result : The dose-response linearity of the Si detector was almost perfect. Its sensitivity decreased with increasing dose rate but stable for high dose rate like as 100MU/min and higher even though dose out of field could be a little bit overestimated because of low dose rate. Method determining beam axis by two orthogonal profiles was simple and gave 0.05mm accuracy. Adjustment of depth of the detector in a water phantom by insertion and remove of some acryl pates under an auxiliary water tank was also simple and accurate. TMR, OAR and FSF measured by Si detector were sufficiently accurate for application to treatment planning of linac-based stereotactic radiosurgery. OAR in field was nearly independent of depth. Conclusion : The Si detector was appropriate for dosimetry of small circular fields for linac-based stereotactic radiosurgery. The beam axis could be determined by two orthogonal dose profiles. The adjustment of depth of the detector in water was possible by addition or removal of some acryl plates under the auxiliary water tank and simple. TMR, OAR and FSF were accurate enough to apply to stereotactic radiosurgery planning. OAR data at one depth are sufficient for radiosurgery planning.

• Progress in Medical Physics
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• v.18 no.2
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• pp.93-97
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• 2007

This study was designed to evaluate radiosurgery technique using multiple noncoplanar arc therapy with intensity modulated fine MLC shaped photon beam. The stereotactic radiosurgery was performed with 6-MV X-ray beams from a Clinac 21EX LINAC (Varian, Palo Alto, CA, USA) with a MLC-120, which features a full $40{\times}40cm$ field and is the first MLC for general use that offers 0.5 cm resolution for high precision treatment of small and irregular fields. We used a single isocenter and five gantry-couch combinations with a set of intensity modulated arc therapy. We investigated dosimetric characteristics of 2 cm sized spherical target volume with film (X-OMAT V2 film, Kodak Inc, Rochester NY, USA) dosimetry within $25{\times}25cm$ acrylic phantom. A simulated single isocentric treatment using inversely Planned 3D radiotherapy planning system demonstrated the ability to conform the dose distribution to an spherical target volume. The 80% dose level was adequate to encompass the target volume in frontal, sagittal, and transverse planes, and the region between the 40% and 80% isodose lines was $4.0{\sim}4.5mm$ and comparable to the dose distribution of the Boston Arcs. We expect that our radiosurgery technique could be a treatment option for irregular-shaped large intracranial target.

• Radiation Oncology Journal
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• v.20 no.4
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• pp.391-395
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• 2002

Purpose : To confirm the accuracy of the radiation dose at the isocenter by the standard linear accelerator-based stereotactic radiosurgery technique which was developed at Seoul National University Hospital. Materials and Methods : Radiation dosimetry was undertaken during standard 5-arc radiosurgery using 6 MV X-ray beam from CL2100C linac. The treatment head was attached with circular tertiary collimators of 10 and 20 mm diameter. We measured the absorbed dose at the isocenter of a multi-purpose phantom using two kinds of detector : a 0.125 co ionization chamber and a silicon diode detector. Results : The dose differences at each arc plane between the planned dose and the measured dose at the isocenter raged from $-0.73\%\;to\;-2.69\%$ with the 0.125 cc ion chamber, and from $-1.29\%\;to\;-2.91\%$ with the diode detector during radiosurgery with the tertiary collimator of 20 mm diameter. Those with the 10-mm tertiary collimator ranged from $-2.39\%\;to\;-4.25\%$ with the diode. Conclusion : The dose accuracy at the isocenter was ${\pm}3\%$. Therefore, further efforts such ws modification in processing of the archived image through DICOM3.0 format are required to lessen the dose difference.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.241-247
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• 1993

Between July 1988 and December 1992, we treated 45 patients who had deep seated inoperable or residual and/or recurrent intracranial tumors using LINAC based stereotactic radiosurgery at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College. Treated intracranial tumors included pituitary tumors (n=15), acoustic neurinomas (n=8), meningiomas (n=7), gliomas (n=6), craniopharyngiomas (n=4), pinealomas (n=3), hemangioblastomas (n=2), and solitary metastatic tumor from lung cancer (n=1). The dimension of treatment field varied from 0.23 to 42.88 $cm^3\;(mean;\;7.26\;cm^3)$. The maximum tumor doses ranging from 5 to 35.5 Gy (mean; 29.9 Gy) were given, and depended on patients' age, target volume, location of lesion and previous history of irradiation. There were 22 male and 23 female patients. The age was varied from 5 to 74 years of age (a median age; 43 years). The mean duration of follow-up was 35 months (2~55 months). To date, 18 $(39.1\%)$ of 46 intracranial tumors treated with SRS showed absent or decrease of the tumor by serial follow-up CT and/or MRI and 16 $(34.8\%)$ were stationary, e.g. growth arrest. From the view point of the clinical aspects, 34 $(73.9\%)$ of 46 tumors were considered improved status, that is, alive with no evidence of active tumor and 8 $(17.4\%)$ of them were stable, alive with disease but no deterioration as compared with before SRS. Although there showed slight increase of the tumor in size according to follow-up imagings of 4 cases (pituitary tumor 1, acoustic neurinomas 2, pinealoma 1), they still represented clinically stable status. Clinically, two $(4.4\%)$ Patients who were anaplastic astrocytoma (n=1) and metastatic brain tumor (n=1) were worsened following SRS treatment. So far, no serious complications were found after treatment. The minor degree headache which could be relieved by steroid or analgesics and transient focal hair loss were observed in a few cases. There should be meticulous long term follow-up inall cases.

• Progress in Medical Physics
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• v.13 no.3
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• pp.135-138
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• 2002

Fractionated stereotactic radiosurguy (FSRS) requires precise and reproducible patient set up. For these reasons non-invasive mask fixation methods have been used in Linac based FSRS. In this study, we measured and assessed the isocenter reproducibility using a commercial head mask fixation system based on thermoplastic materials. For the verification and the measurement of isocenter deviation a special acrylic brain phantom was designed. The designed phantom has 22 vertical rods and each rod has different lengths. At the end of the 8 rods, the monochromic film is attached and irradiated due to planned target position. Deviations of isocenter were measured separately for each direction. The mean deviation showed 0.4 mm in longitudinal direction, 0.1 mm in the lateral direction, 0.1 mm in the anterior-posterior direction of the treatment couch. The data demonstrates the high accuracy and reproducibility. This study reinforces previous literature published.

• Radiation Oncology Journal
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• v.33 no.2
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• pp.89-97
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• 2015

Purpose: To evaluate the treatment results in early stage non-small cell lung cancer patients who have undergone fiducial-less CyberKnife radiosurgery (CKRS). Materials and Methods: From June 2011 to November 2013, 58 patients underwent CKRS at Asan Medical Center for stage I lung cancer. After excluding 14 patients, we retrospectively reviewed the records of the remaining 44 patients. All analyses were performed using SPSS ver. 21. Results: The median age at diagnosis was 75 years. Most patients had inoperable primary lung cancer with a poor pulmonary function test with comorbidity or old age. The clinical stage was IA in 30 patients (68.2%), IB in 14 (31.8%). The mean tumor size was 2.6 cm (range, 1.2 to 4.8 cm), and the tumor was smaller than 2 cm in 12 patients (27.3%). The radiation dose given was 48-60 Gy in 3-4 fractions. In a median follow-up of 23.1 months, local recurrence occurred in three patients (2-year local recurrence-free survival rate, 90.4%) and distant metastasis occurred in 13 patients. All patients tolerated the radiosurgery well, only two patients developing grade 3 dyspnea. The most common complications were radiation-induced fibrosis and pneumonitis. Eight patients died due to cancer progression. Conclusion: The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker. Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

• Journal of Radiation Protection and Research
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• v.20 no.1
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• pp.25-36
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• 1995

The purpose of this research is to develop stereotactic localization and radiation measurement system for the efficient and precise radiosurgery. The algorithm to obtain a 3-D stereotactic coordinates of the target has been developed using a Fisher CT or angio localization. The procedure of stereotactic localization was programmed with PC computer, and consists of three steps: (1) transferring patient images into PC; (2) marking the position of target and reference points of the localizer from the patient image; (3) computing the stereotactic 3-D coordinates of target associated with position information of localizer. Coordinate transformation was quickly done on a real time base. The difference of coordinates computed from between Angio and CT localization method was within 2 mm, which could be generally accepted for the reliability of the localization system developed. We measured dose distribution in small fields of NEC 6 MVX linear accelerator using various detector; ion chamber, film, diode. Specific quantities measured include output factor, percent depth dose (PDD), tissue maximum ratio (TMR), off-axis ratio (OAR). There was small variation of measured data according to the different kinds of detectors used. The overall trends of measured beam data were similar enough to rely on our measurement. The measurement was performed with the use of hand-made spherical water phantom and film for standard arc set-up. We obtained the dose distribution as we expected. In conclusion, PC-based 3-D stereotactic localization system was developed to determine the stereotactic coordinate of the target. A convenient technique for the small field measurement was demonstrated. Those methods will be much helpful for the stereotactic radiosurgery.

• Progress in Medical Physics
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• v.16 no.1
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• pp.24-31
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• 2005

The stereotactic radiosurgery (SRS) describes a method of delivering a high dose of radiation to a small tar-get volume in the brain, generally in a single fraction, while the dose delivered to the surrounding normal tissue should be minimized. To perform automatic plan of the SRS, a new method of multi-isocenter/shot linear accelerator (linac) and gamma knife (GK) radiosurgery treatment plan was developed, based on a physical lattice structure in target. The optimal radiosurgical plan had been constructed by many beam parameters in a linear accelerator or gamma knife-based radiation therapy. In this work, an isocenter/shot was modeled as a sphere, which is equal to the circular collimator/helmet hole size because the dimension of the 50% isodose level in the dose profile is similar to its size. In a computer-aided system, it accomplished first an automatic arrangement of multi-isocenter/shot considering two parameters such as positions and collimator/helmet sizes for each isocenter/shot. Simultaneously, an irregularly shaped target was approximated by cubic structures through computation of voxel units. The treatment planning method by the technique was evaluated as a dose distribution by dose volume histograms, dose conformity, and dose homogeneity to targets. For irregularly shaped targets, the new method performed optimal multi-isocenter packing, and it only took a few seconds in a computer-aided system. The targets were included in a more than 50% isodose curve. The dose conformity was ordinarily acceptable levels and the dose homogeneity was always less than 2.0, satisfying for various targets referred to Radiation Therapy Oncology Group (RTOG) SRS criteria. In conclusion, this approach by physical lattice structure could be a useful radiosurgical plan without restrictions in the various tumor shapes and the different modality techniques such as linac and GK for SRS.