• Nuclear Engineering and Technology
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• v.54 no.10
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• pp.3816-3823
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• 2022

This work analyzed the dosimetric difference between the intensity modulated radiotherapy (IMRT), partial/single/double-arc volumetric modulated arc therapy (PA/SA/DA-VMAT) techniques in treatment planning for treating more than one target of lung cancer at different isocenters. IMRT and VMAT plans at different isocenters were created systematically using a Harold heterogeneous lung phantom. The conformity index (CI), homogeneity index (HI), gradient index (GI), dose-volume histogram and mean and maximum dose of the PTV were calculated and analyzed. Furthermore, the dose-volume histogram and mean and maximum doses of the OARs such as right lung, contralateral lung and non GTV were determined from the plans. The IMRT plans showed the superior target dose coverage, higher mean and maximum values than other VMAT techniques. PA-VMAT technique shows more lung sparing and DA-VMAT increases the V_5/10/20 values of contralateral lung than other VMAT and IMRT techniques. The IMRT technique achieves highly conformal dose distribution to the target than other VMAT techniques. Comparing to the IMRT plans, the higher V_5/10/20 and mean lung dose were observed in the contralateral lung in the DA-VMAT.

• Tuberculosis and Respiratory Diseases
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• v.57 no.2
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• pp.118-124
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• 2004

Lung cancer is the leading cause of cancer death for men and women in the industrialized world. It is desirable to detect disease at a stage when it is not causing symptoms and when control or cure is possible. If the screening test detects patients with the disease at an early stage, they can be examined to confirm the diagnosis and intervention can alter the natural history of the disease. The results of screening programs designed to detect early lung cancer using either conventional chest radiograph or sputum cytology are disappointing for a diagnostic screening test. Because of advances in helical CT imaging techniques, screening for lung cancer has been suggested as a possible method of improving outcome. Findings in recent publications suggest that substantial dose reduction is possible in chest CT. The advantages of low-dose CT are more sensitive than chest radiograph for detecting small pulmonary nodules that may be lung cancers, shorter scanning time than conventional chest CT scan without intravenous contrast injection, cheaper cost than standard CT, low radiation dose. However, the true clinical significance of the small tumors found by screening is still unknown, and their effect on mortality awaits future investigation. Furthermore, in addition to detecting an increased number of lung cancers, low-dose CT found at least one indeterminate nodule in many of all screened patients. The majority should be benign but evaluation of all these indeterminate nodules is not a trivial problem in routine practice. In conclusion, lung cancer screening with low-dose CT is a complex subject. The true effectiveness of lung cancer screening (a reduction in mortality from lung cancer) with low-dose CT can be determined through well-designed randomized control trials with enrolment of appropriate subjects.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.17
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• pp.7371-7375
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• 2014

Background: Concurrent chemo-radiotherapy is the recommended standard treatment modality for patients with locally advanced lung cancer. The purpose of three-dimensional conformal radiotherapy (3DCRT) is to minimize normal tissue damage while a high dose can be delivered to the tumor. The most common dose limiting side effect of thoracic RT is radiation pneumonia (RP). In this study we evaluated the relationship between dose-volume histogram parameters and radiation pneumonitis. This study targeted prediction of the possible development of RP and evaluation of the relationship between dose-volume histogram (DVH) parameters and RP in patients undergoing 3DCRT. Materials and Methods: DVHs of 41 lung cancer patients treated with 3DCRT were evaluated with respect to the development of grade ${\geq}2$ RP by excluding gross tumor volume (GTV) and planned target volume (PTV) from total (TL) and ipsilateral (IPSI) lung volume. Results: Were admitted statistically significant for p<0.05. Conclusions: The cut-off values for V5, V13, V20, V30, V45 and the mean dose of TL-GTV; and V13, V20,V30 and the mean dose of TL-PTV were statistically significant for the development of Grade ${\geq}2$ RP. No statistically significant results related to the development of Grade ${\geq}2$ RP were observed for the ipsilateral lung and the evaluation of PTV volume. A controlled and careful evaluation of the dose-volume histograms is important to assess Grade ${\geq}2$ RP development of the lung cancer patients treated with concurrent chemo-radiotherapy. In the light of the obtained data it can be said that RP development may be avoided by the proper analysis of the dose volume histograms and the application of optimal treatment plans.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.5
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• pp.2573-2577
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• 2016

Objective: The aim of this study was to determine a method of dose prescription that minimizes normal tissue irradiation outside the planning target volume (PTV) during stereotactic body radiotherapy (SBRT) for patients with non-small cell lung cancer. Methods: Previous research and patients with typical T1 lung tumors with peripheral lesions in the lung were selected for analysis. A PTV and several organs at risk (OARs) were constructed for the dose calculated; six treatment plans employing intensity modulated radiotherapy (IMRT) were produced, in which the dose was prescribed to encompass the PTV, with the prescription isodose level (PIL) set at 50, 60, 70, 80, 90 or 95% of the isocenter dose. Additionally, four OARs around the PTV were constructed to evaluate the dose received in adjacent tissues. Results: The use of higher PILs for SBRT resulted in improved sparing of OARs, with the exception of the volume of lung treated with a lower dose. Conclusions: The use of lower PILs is likely to create significant inhomogeneity of the dose delivered to the target, which may be beneficial for the control of tumors with poor conformity indices.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.21-28
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• 2014

Purpose : For non-small cell lung cancer, if the treatment volume is large or the total lung volume is small, and the tumor is located in midline of patient's body, total lung dose tends to increase due to tolerance dose of spinal cord. The purpose of this study is to compare and evaluate the total lung dose of three dimensional conformal radiotherapy(3D CRT), intensity modulated radiotherapy(IMRT) and volumetric modulated arc therapy(VMAT) using restricted angle for non-small cell lung cancer patients. Materials and Methods : The treatment plans for four patients, being treated on TrueBeam STx($Varian^{TM}$, USA) with 10 MV and prescribed dose of 60 Gy in 30 fractions, 3D CRT, restricted angle IMRT and VAMT radiotherapy plans were established. Planning target volume(PTV), dose to total lung and spinal cord were evaluated using the dose volume histogram(DVH). Conformity index(CI), homogeneity index(HI), Paddick's index(PCI) for the PTV, $V_{30}$, $V_{20}$, $V_{10}$, $V_5$, mean dose for total lung and maximum dose for spinal cord was assessed. Results : Average value of CI, HI and PCI for PTV was $0.944{\pm}0.009$, $1.106{\pm}0.027$, $1.084{\pm}0.016$ respectively. $V_{20}$ values from 3D CRT, IMRT and VMAT plans were 30.7%, 20.2% and 21.2% for the first patient, 33.0%, 29.2% and 31.5% for second patient, 51.3%, 34.3% and 36.9% for third patient, finally 56.9%, 33.7% and 40.0% for the last patient. It was noticed that the $V_{20}$ was lowest in the IMRT plan using restricted angle. Maximum dose for spinal cord was evaluated to lower than the tolerance dose. Conclusion : For non-small cell lung cancer, IMRT with restricted angle or VMAT could minimize the lung dose and lower the dose to spinal cord below the tolerance level. Considering PTV coverage and tolerance dose to spinal cord, it was possible to obtain IMRT plan with smaller angle and this could result in lower dose to lung when compared to VMAT.

• Journal of radiological science and technology
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• v.32 no.2
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• pp.129-140
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• 2009

As CT has been increasingly used as an accurate screening tool for lung disease, radiation dose becomes an important issue for both radiographers and patients. Many researches have been done for a low-dose CT as a screening tool for early detection of asymptomatic lung diseases. From those studies, it has been reported that chest dose rate from the low-dose CT is considerably lower than from standard CT. The patient dose is determined by scanning parameters such as kVp, mAs, pitch, scan time and the radiation risk of lung in screening examination may not be negligible. Herein, we suggest that Low-dose CT is useful as a screening tool in routine clinical practice on the basis of published articles, but further study is necessary because Low-dose CT has poor sensitivity and specificity for screening early stage of lung cancer according to the results of the studies. This article is to provide a brief overview of the screening examinations by Low-dose CT.

• Journal of radiological science and technology
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• v.43 no.6
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• pp.443-451
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• 2020

This study is to evaluate absorbed dose from right lung for brachytherapy and to estimate the effects of tissue heterogeneities on dose distribution for Iridium-192 source using Monte Carlo simulation. The study employed Geant4 code as Monte Carlo simulation to calculate the dosimetry parameters. The dose distribution of Iridium-192 source in solid water equivalent phantom including aluminium plate or steel plate inserted was calculated and compared with the measured dose by the ion chamber at various distances. And the simulation was used to evaluate the dose of gamma radiation absorbed in the lung organ and other organs around it. The dose distribution embedded in right lung was calculated due to the presence of heart, thymus, spine, stomach as well as left lung. The geometry of the human body was made up of adult male MIRD type of the computational human phantom. The dosimetric characteristics obtained for aluminium plate inserted were in good agreement with experimental results within 4%. The simulation results of steel plate inserted agreed well with a maximum difference 2.75%. Target organ considered to receive a dose of 100%, the surrounding organs were left the left lung of 3.93%, heart of 10.04%, thymus of 11.19%, spine of 12.64% and stomach of 0.95%. When the statistical error is performed for the computational human phantom, the statistical error of value is under 1%.

• Journal of Radiation Protection and Research
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• v.40 no.1
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• pp.25-35
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• 2015

We analyzed the differential effects of histopathology, apoptosis and expression of radiation response genes after chronic low dose rate (LDR) and acute high dose rate (HDR) radiation exposure in spleen, lung and liver of rats. Female 6-week-old Sprague-Dawley rats were used. For chronic low-dose whole body irradiation, rats were maintained for 14 days in a $^{60}Co$ gamma ray irradiated room and received a cumulative dose of 2 Gy or 5 Gy. Rats in the acute whole body exposure group were exposed to an equal dose of radiation delivered as a single pulse ($^{137}Cs$-gamma). At 24 hours after exposure, spleen, lung and liver tissues were extracted for histopathologic examination, western blotting and RT-PCR analysis. 1. The spleen showed the most dramatic differential response to acute and chronic exposure, with the induction of substantial tissue damage by HDR but not by LDR radiation. Effects of LDR radiation on the lung were only apparent at the higher dose (5 Gy), but not at lower dose (2 Gy). In the liver, HDR and LDR exposure induced a similar damage response at both doses. RT-PCR analysis identified cyclin G1 as a LDR-responsive gene in the spleen of rats exposed to 2 Gy and 5 Gy gamma radiation and in the lung of animals irradiated with 5 Gy. 2. The effects of LDR radiation differed among lung, liver, and spleen tissues. The spleen showed the greatest differential effect between HDR and LDR. The response to LDR radiation may involve expression of cyclin G1.

• YAKHAK HOEJI
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• v.50 no.2
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• pp.84-92
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• 2006

The present study investigated an effect of arsenic trioxide on the urethane-induced lung carcinogenesis in mice. To understand its carcinogenesis, we examined proliferating cell nuclear antigen (PCNA), apoptotic index as well as cell cycle-related proteins (cyclin D1, p21, and p27). Urethane was injected intraperitoneally in ICR mice, and then they were sacrificed at 5, 15, or 25 weeks following treatment of arsenic trioxide. Arsenic trioxide was given with tap water at a concentration of 1 mg/l (low-dose) and 5mg/1 (high-dose) for 25 weeks. During the carcinogenesis, sequential histological changes from hyperplasia to adenomas, and ultimately to overt carcinomas were noted. The development of hyperplasias, adenomas, and carcinomas in the lung were slightly increased by the treatment of low-dose arsenic trioxide. However, there is no correlation between dose and tumor multiplicity. The administration of low-dose arsenic trioxide, significantly increased the tumor size. The proliferative index observed on 5 weeks after significantly increased. Cyclin D1 and p21 protein, cell cycle related proteins, were more significantly increased in hyperplasia and adenoma in low dose arsenic treated group than urethane alone group. The p27 protein expression did not show any significantly changes with arsenic treated or untreated group. Low dose exposure to arsenic trioxide resulted in increased expression of cyclin D1 and p21 protein. The present results indicate that low-dose treatment of arsenic trioxide, but not high dose of it, partly modulate the cellular proliferation, cyclin D1, and p21 protein expression, and that this effect may contribute to accelerated development of lung adenocarcinomas in urethane-induced mice.

• Journal of the Korean Society of Radiology
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• v.12 no.4
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• pp.443-450
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• 2018

The Geant 4 simulated the linear accelerator (VARIAN CLINAC) based on the previously implemented BEAMnrC data, using the head structure of the linear accelerator. In the 10 MV photon flux, Geant4 was compared with the measured value of the percentage of the deep dose and the lateral dose of the water phantom. In order to apply the dose calculation to the body part, the actual patient's lung area was scanned at 5 mm intervals. Geant4 dose distributions were obtained by irradiating 10 MV photons at the irradiation field ($5{\times}5cm^2$) and SAD 100 cm of the water phantom. This result is difficult to measure the dose absorbed in the actual lung of the patient so the doses by the treatment planning system were compared. The deep dose curve measured by water phantom and the deep dose curve calculated by Geant4 were well within ${\pm}3%$ of most depths except the build-up area. However, at the 5 cm and 20 cm sites, 2.95% and 2.87% were somewhat higher in the calculation of the dose using Geant4. These two points were confirmed by the geometry file of Genat4, and it was found that the dose was increased because thoracic spine and sternum were located. In cone beam CT, the dose distribution error of the lungs was similar within 3%. Therefore, if the contour map of the dose can be directly expressed in the DICOM file when calculating the dose using Geant4, the clinical application of Geant4 will be used variously.