• Nuclear Engineering and Technology
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• 제54권10호
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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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• 제57권2호
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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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• 제15권17호
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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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• 제17권5호
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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.

• 대한방사선치료학회지
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• 제26권1호
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• pp.21-28
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• 2014

목 적 : 비소세포 폐암의 치료용적의 크기가 크거나 폐 용적이 작고, 몸의 정중선(Mid line)에 위치한 경우 척수의 허용선량을 고려한 방사선치료계획에서 폐 선량이 많아지게 되는데, 본 연구는 비소세포 폐암 환자의 3차원입체조형치료(Three dimensional conformal radiotherapy, 3D CRT), 제한된 각도를 이용한 세기변조방사선치료(Intensity modulated radiotherapy, IMRT)와 용적변조회전치료(Volumetric Modulated Arc therapy, VMAT) 치료계획을 각각 적용하여 전체 폐 선량을 비교 및 평가하고자 한다. 대상 및 방법 : TrueBeam STx($Varian^{TM}$, USA) 10 MV 에너지를 이용하여 4명의 환자에 대하여 3D CRT, 제한된 각도를 이용한 IMRT와 VMAT 치료계획을 세우고, 총 선량 66 Gy/30 Fx 처방하였을 때, 선량용적히스토그램(Dose Volume Histogram, DVH)을 이용하여 치료계획용적(Planning Target Volume, PTV), 전체 폐 그리고 척수에 들어가는 선량을 평가하였다. PTV에 대한 처방선량지수(Conformity Index, CI), 선량균질지수(Homogeneity index, HI), 처방선량포함지수(Paddick's Conformity Index, PCI)를 구하고, 폐의 30 Gy 용적($V_{30}$), $V_{20}$, $V_{10}$, $V_5$, 평균선량(Mean dose)을 평가하고, 척수의 최대선량 값을 평가하였다. 결 과 : PTV에 대한 CI, HI, PCI의 평균값은 각각 $0.944{\pm}0.009$, $1.106{\pm}0.027$, $1.084{\pm}0.016$으로 평가되었다. 전체 폐에 대한 첫 번째 환자의 $V_{20}$은 3D CRT, IMRT, VMAT 각각 30.7%, 20.2%. 21.2%, 두 번째 환자의 $V_{20}$은 33.0%, 29.2%. 31.5%, 세 번째 환자의 $V_{20}$은 51.3%, 34.3%. 36.9%, 네 번째 환자의 $V_{20}$은 56.9%, 33.7%. 40%로 제한된 각도를 이용한 IMRT 치료계획에서 가장 낮게 평가되었다. 척수에 대한 최대선량 값은 모두 허용선량 미만으로 평가되었다. 결 론 : 비소세포 폐암의 방사선치료계획에서 3D CRT와 비교했을 때, 제한된 각도를 이용한 IMRT나 VAMT을 이용하면 척수의 허용선량을 넘지 않으면서 폐 선량을 줄여줄 수 있는 치료계획을 세울 수 있었다. IMRT와 VAMT을 비교해보면 PTV의 선량포함과 척수선량을 고려했을 때 IMRT 치료계획에서 보다 좁은 각도를 이용한 치료계획이 가능하였고, 이는 폐 선량을 좀 더 줄여줄 수 있는 결과를 얻을 수 있었다.

• 대한방사선기술학회지:방사선기술과학
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• 제32권2호
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• pp.129-140
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• 2009

전산화 단층촬영은 폐질환의 정밀진단 방법으로 사용이 증가되고 있다. 통상적으로 시행되는 CT촬영은 조기 진단을 위한 선별검사로써는 높은 방사선 노출과 고비용, 조영제 사용으로 인한 부작용 등으로 적당하지 않다. 영상의학분야에서 방사선을 이용한 CT촬영은 진단 능력이 우수한 반면 피폭선량 또한 매우 높아 선량 감축을 위한 노력이 절실하다. 그동안 많은 연구들에서 무증상기의 폐암 및 폐질환을 조기 발견하기 위한 선별검사로써 저선량 CT의 유용성에 대해 이루어져 왔고, 의미있는 결과를 보고하였다. 선량 감소에 많은 인자가 관여하고 있지만 조사선량(mAs)의 감소가 가장 많이 사용되고 있다. 이미 보고 된 많은 연구에서 저선량 CT는 폐질환을 조기 발견하기 위한 선별검사로써 임상에서 사용하기에 유용하지만, 일부 연구에서 조기 폐암을 예측할 수 있는 작은 결절을 발견하는데 낮은 민감도와 특이도를 보였고, 실제 생존율 증가에는 기여하지 못한 보고도 있었다. 따라서, 지금까지의 저선량 CT에 대한 연구결과를 토대로 다양한 위험에 노출된 집단을 대상으로 선량을 감소시키기 위한 연구가 계속적으로 이루어진다면, 향후 저선량 CT촬영은 폐암을 비롯한 폐질환의 조기진단 방법으로써 통상적으로 사용되고 있는 표준 CT촬영을 충분히 대체할 수 있을 것으로 전망한다.

• 대한방사선기술학회지:방사선기술과학
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• 제43권6호
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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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• 제40권1호
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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.

• 약학회지
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• 제50권2호
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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.

• 한국방사선학회논문지
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• 제12권4호
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• pp.443-450
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• 2018

Geant4 코드는 직선 가속기의 헤드 구조를 사용하여 이전에 구현된 BEAMnrC 데이터를 기반으로 선형가속기 (VARIAN CLINAC.)를 시뮬레이션하였다, 10MV 광자 선속에서 물팬텀의 심부선량백분율과 측면선량의 측정값과 Geant4를 비교 평가하였다. 선량 계산을 인체부위에 적용하기 위해 실제 환자의 Lung 부위를 5mm 간격으로 스캔하였다. Water phantom의 조사야($5{\times}5cm^2$), SAD 100cm에서 10MV 광자를 조사하여 Geant4 선량분포를 구하였다. 이 결과는 실제 환자의 폐(lung)에 흡수되는 선량을 측정하기는 어렵다 그래서 치료계획 시스템에 의한 선량을 비교하였다. 물 팬텀에서 측정된 심부선량 곡선과 Geant4에 의해 계산된 심부선량 곡선은 build-up 영역을 제외한 대부분의 깊이에서 ${\pm}3%$ 이내로 잘 일치하였다. 그러나 5cm와 20cm 지점에서 2.95%와 2.87%로 Geant4를 사용한 선량 계산에서 다소 높은 값을 보이고 있다. 이 두 지점은 Genat4의 geometry 파일을 통해 확인할 수 있었으며, 흉추와 흉골이 위치되어 선량이 증가된 것으로 알 수 있었다. 또한, cone beam CT를 적용한 결과에서 폐(lung)의 선량분포 오차는 3% 이내로 유사한 값을 얻었다. 따라서 Geant4를 이용하여 선량을 계산할 때 DICOM 파일에 직접 선량의 contour map이 표현될 수 있다면 Geant4의 임상적 적용이 다양하게 사용될 것이다.