• The Journal of Korean Society for Radiation Therapy
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• v.16 no.1
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• pp.11-19
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• 2004

Purpose : Verification within 5mm is one of the important QA process of IMRP and SRS. Therefore, we improve accuracy of patients set-up using scale point. Materials and Methods : We compare MLC scale pointer with customerized port film graticule for patients who was underwent IMRT and SRS. Results : Scale pointer using MLC showed accurate location of patients landmark including divergency of beam, and any point of patient could be certified by means of cross of MLC. Conclusion : MLC scale pointer is effective and convenient method in verification of patients set-up using L-gram.

• Journal of radiological science and technology
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• v.42 no.1
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• pp.61-66
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• 2019

The purpose of this study was to improve the unstable treatment posture by placing the Carbon fabric blanket on the couch which was used for the patient fixation for the unstable posture from the severe pain caused by the neuromuscular pressure of the spinal metastatic cancer patient and to analyze the dose difference caused by the energy loss of high energy radiation. Using a linear accelerator, a FC-65G was installed at a depth of 5 cm at a solid phantom at 6 MV and 10 MV energies. The SAD was 100 cm, Gantry angle was $0^{\circ}$, a Cotton and Carbon blanket with a thickness of 1 cm on the couch, The blankets were placed on the couch and the dose was measured according to field size. For the dose measurement, and the dose was measured at 100 MU each time, and the mean value was calculated by repeating the measurement three times in order to reduce the error. The results showed that the difference rate in dose between Carbon blanket and Cotton blanket was respectively -0.54% and -0.75% based on the absence of the blanket(Non). Therefore, it is considered that the use of Carbon fabric blanket, which reduces the patient's pain and does not affect the depth dose, may be useful during radiation therapy of the spine metastasis cancer.

• Progress in Medical Physics
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• v.29 no.4
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• pp.123-136
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• 2018

The complex dose distribution and dose transfer characteristics of intensity-modulated radiotherapy increase the importance of precise beam data measurement and review in the acceptance inspection and preparation stages. In this study, we propose a process map for the introduction and installation of high-precision radiotherapy devices and present items and guidelines for risk management at the acceptance test procedure (ATP) and commissioning stages. Based on the ATP of the Varian and Elekta linear accelerators, the ATP items were checked step by step and compared with the quality assurance (QA) test items of the AAPM TG-142 described for the medical accelerator QA. Based on the commissioning procedure, dose quality control protocol, and mechanical quality control protocol presented at international conferences, step-by-step check items and commissioning guidelines were derived. The risk management items at each stage were (1) 21 ionization chamber performance test items and 9 electrometer, cable, and connector inspection items related to the dosimetry system; (2) 34 mechanical and dose-checking items during ATP, 22 multileaf collimator (MLC) items, and 36 imaging system items; and (3) 28 items in the measurement preparation stage and 32 items in the measurement stage after commissioning. Because the items presented in these guidelines are limited in terms of special treatment, items and practitioners can be modified to reflect the clinical needs of the institution. During the system installation, it is recommended that at least two clinically qualified medical physicists (CQMP) perform a double check in compliance with the two-person rule. We expect that this result will be useful as a radiation safety management tool that can prevent radiation accidents at each stage during the introduction of radiotherapy and the system installation process.

• Radiation Oncology Journal
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• v.30 no.3
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• pp.117-123
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• 2012

Purpose: Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. Materials and Methods: We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. Results: The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. Conclusion: Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.

• Journal of radiological science and technology
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• v.30 no.4
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• pp.313-320
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• 2007

There are the Medical Radiation Health and Safety Act(the Patient Radiation Health and Safety Act, the Radiologic Technologist Act), the Medical Laboratory Technologist Act, the Physical Therapy Practice Act, and the Dental Hygienist Act, etc in America. However, Korea has only one Act for a medical radiologic technologist(including radiation therapy technologist, nuclear medicine technologist), medical laboratory technologist, physical therapist, occupational therapy examiner, dental hygienist, and so on. It is the Medical Technologist Act. Therefore, the Medical Radiation Health and Safety Act for a radiologic technologist(including radiation therapy technologist, nuclear medicine technologist) has to be enacted independently in Korea. It is the purpose of this Act to provide for the appropriate certification of persons using radioactive materials, equipment emitting ionizing radiation on humans or performing medical imaging for diagnostic and therapeutic purposes. In Korea, the radiologic technologist is a "fusion technologist" who is a person other than a licensed practitioner as a radiographer, radiation therapist, nuclear medicine technologist, computed tomography technologist, magnetic resonance technologist, mammographer, sonographer, medical dosimetrist, quality management technologist, etc. This Act will have some provisions related to the definitions, reserved title, scope of practice, specialized technologist, application for licensure, radiologic technology council, renewal, continuing education, the radiation control advisory commission, etc. This Act will ensure that quality radiation therapy treatments are delivered and that quality diagnostic information is presented for interpretation, which will lead to accurate diagnosis, treatment and cure. Accurate diagnosis can be provided only when a personnel is properly educated in technique, equipment operation and radiation safety. In the end, this Act will protect the civil right to health. By regulating the personnel responsible for performing those procedures, this Act will mean improved care for patients-higher quality images, improved accuracy, and less exposure to radiation.

• Journal of Radiation Protection and Research
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• v.42 no.4
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• pp.189-196
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• 2017

Background: The effects of radiation on tissues vary depending on the radiation type. In this study, a minipig model was used to compare the effects of ${\beta}$-rays from $^{166}Ho$ and ${\gamma}$-rays from $^{60}Co$ on the skin. Materials and Methods: In this study, the detrimental effects of ${\beta}$- and ${\gamma}$-irradiation on the skin were assessed in minipigs. The histopathological changes in the skin from 1 to 12 weeks after exposure to 50 Gy of either ${\beta}$- (using $^{166}Ho$ patches) or ${\gamma}$- (using $^{60}Co$) irradiation were assessed. Results and Discussion: The skin irradiated by ${\beta}$-rays was shown to exhibit more severe skin injury than that irradiated by ${\gamma}$-rays at 1-3 weeks post-exposure; however, while the skin lesions caused by ${\beta}$-rays recovered after 8 weeks, the ${\gamma}$-irradiated skin lesions were not repaired after this time. The observed histopathological changes corresponded with gross appearance scores. Seven days post-irradiation, apoptotic cells in the basal layer were detected more frequently in ${\beta}$-irradiated skin than in ${\gamma}$-irradiated skin. The basal cell density and skin thickness gradually decreased until 4 weeks after ${\gamma}$- and ${\beta}$- irradiation. In ${\beta}$-irradiated skin lesions, and the density and thickness increased sharply back to control levels by 6-9 weeks. However, this was not the case in ${\gamma}$-irradiated skin lesions. In ${\gamma}$-irradiated skin, cyclooxygenase-2 (COX-2) was shown to be expressed in the epidermis, endothelial cells of vessels, and fibroblasts, while ${\beta}$-irradiated lesions exhibited COX-2 expression that was mostly limited to the epidermis. Conclusion: In this study, ${\beta}$-rays were shown to induce more severe skin injury than ${\gamma}$-rays; however, the ${\beta}$-rays-induced injury was largely repaired over time, while the ${\gamma}$-rays-induced injury was not repaired and instead progressed to necrosis. These findings reveal the differential effects of ${\gamma}$- and ${\beta}$-irradiation on skin and demonstrate the use of minipigs as a beneficial experimental model for studying irradiation-induced skin damage.

• Radiation Oncology Journal
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• v.33 no.4
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• pp.276-283
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• 2015

Purpose: We evaluated the efficacy and toxicity of repeated high dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with unresectable hepatocellular carcinoma. Materials and Methods: Between 1998 and 2011, 45 patients received hepatic re-irradiation with high dose 3D-CRT in Samsung Medical Center. After excluding two ineligible patients, 43 patients were retrospectively reviewed. RT was delivered with palliative or salvage intent, and equivalent dose of 2 Gy fractions for ${\alpha}/{\beta}=10Gy$ ranged from $31.25Gy_{10}$ to $93.75Gy_{10}$ (median, $44Gy_{10}$). Tumor response and toxicity were evaluated based on the modified Response Evaluation Criteria in Solid Tumors criteria and the Common Terminology Criteria for Adverse Events (CTCAE) ver. 4.0. Results: The median follow-up duration was 11.2 months (range, 4.1 to 58.3 months). An objective tumor response rate was 62.8%. The tumor response rates were 81.0% and 45.5% in patients receiving ${\geq}45Gy_{10}$ and $<45Gy_{10}$, respectively (p = 0.016). The median overall survival (OS) of all patients was 11.2 months. The OS was significantly affected by the Child-Pugh class as 14.2 months vs. 6.1 months (Child-Pugh A vs. B, p < 0.001), and modified Union for International Cancer Control (UICC) T stage as 15.6 months vs. 8.3 months (T1-3 vs. T4, p = 0.004), respectively. Grade III toxicities were developed in two patients, both of whom received ${\geq}50Gy_{10}$. Conclusion: Hepatic re-irradiation may be an effective and tolerable treatment for patients who are not eligible for further local treatment modalities, especially in patients with Child-Pugh A and T1-3.

• Progress in Medical Physics
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• v.21 no.2
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• pp.127-136
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• 2010

Emerging technologies such as four-dimensional computed tomography (4D CT) is expected to allow clinicians to accurately model interfractional motion and to quantitatively estimate internal target volumes (ITVs) for radiation therapy involving moving targets. A need exists for a 4D radiation therapy quality assurance (QA) device that can incorporate and analyze the patient specific intrafractional motion as it relate to dose delivery and respiratory gating. We built a 4D RT prototype device and analyzed the patient-specific 4D radiation therapy QA for 2D dose distributions successfully. With more improvements, the 4D RT QA prototype device could be an integral part of a 4D RT decision process to confirm the dose delivery.

• Progress in Medical Physics
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• v.27 no.3
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• pp.156-161
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• 2016

When air discharged from a radioisotope production facility is contaminated with radiation, the public may be exposed to radiation. The objective of this study is to manage such radiation exposure. We measured the airborne radioactivity concentration at a 30 MeV cyclotron radioisotope production facility to assess whether the exhaust gas was contaminated. Additionally, we investigted the radioactive contamination of the air filter for efficient air purification and radiation safety control. To measure the airborne radiation concentration, specimens were collected weekly for 4 h after the beginning of the radioisotope production. Regarding the air purifier, five specimens were collected at different positions of each filter-pre-filter, high-efficiency particulate air filter, and charcoal filter-installed in the cyclotron production room. The concentrations of F-18, I-123, I-131, and Tl-201 generated in the radioiodine production room were $13.5Bq/m^3$, $27.0Bq/m^3$, $0.10Bq/m^3$, and $11.5Bq/m^3$, respectively; the concentrations of F-18, I-123, and I-131 produced in the radioisotope production room were $0.05Bq/m^3$, $16.1Bq/m^3$, and $0.45Bq/m^3$, correspondingly; and those of F-18, I-123, I-131, and Tl-201 generated in the accelerator room were $2.07Bq/m^3$, $53.0Bq/m^3$, $0.37Bq/m^3$, and $0.15Bq/m^3$, respectively. The maximum radiation concentration of I-123 generated in the radioiodine production room was 1,820 Bq/g, which can be disposed after 2 days. The maximum radiation concentration of Tl-202 generated in the radioisotope production room was 205 Bq/g, and this isotope must be stored for 53 days. The I-123 generated in the radioiodine production room had a maximum concentration of 1,530 Bq/g and must be stored for 2 days. The maximum radiation concentration of Na-22 generated in the radioisotope production room was 0.18 Bq/g and this isotope must be disposed after 827 days. To manage the exhaust, the efficiency of air purification must be enhanced by selecting an air purifier with a long life and determining the appropriate replacement time by examining the differential pressure through systematic measurements of the airborne radiation contamination level.

• Progress in Medical Physics
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• v.32 no.3
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• pp.70-81
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• 2021

Purpose: This study was designed to investigate the dosimetric difference between intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in head and neck cancer (HNC). The study primarily focuses on low-dose spillage evaluation between these two techniques. Methods: This retrospective study involved 45 patients with HNC. The treatment plans were generated using the IMRT and VMAT techniques for all patients. Dosimetric comparisons were performed in terms of target coverage, organ-at-risk (OAR) sparing, and various parameters, including conformity index, uniformity index, homogeneity index, conformation number, low-dose volumes, and normal tissue integral dose (NTID). Results: No significant (P>0.05) difference in planning target volume coverage (D_95%) was observed between IMRT and VMAT plans for supraglottic larynx, hard palate, and tongue cancers. A decrease in dose volumes ranging from 1 Gy to 30 Gy was observed for VMAT plans compared with those for IMRT plans, except for V_1Gy and V_30Gy for supraglottic larynx cancer and V_1Gy for tongue cancer. Moreover, decreases (P<0.05) in NTID were observed for VMAT plans compared with that for IMRT plans in supraglottic larynx (4.50%), hard palate (12.80%), and tongue (7.76%) cancers. In contrast, a slight increase in monitor units for VMAT compared with those for IMRT in supraglottic larynx (0.46%), hard palate (2.54%), and tongue (7.56%) cancers. Conclusions: For advanced-stage HNC, both IMRT and VMAT offer satisfactory clinical plans. VMAT offers a conformal and homogeneous dose distribution with comparable OAR sparing and higher dose falloff outside the target volume than IMRT, which provides an edge to reduce the risk of secondary malignancies for HNC over IMRT.