• Progress in Medical Physics
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• v.26 no.3
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• pp.168-177
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• 2015

For evaluating the treatment planning accurately, the quality assurance for treatment planning is recommended when patients were treated with IMRT which is complex and delicate. To realize this purpose, treatment plan quality assurance software can be used to verify the delivered dose accurately before and after of treatment. The purpose of this study is to evaluate the accuracy of treatment plan quality assurance software for each IMRT plan according to MLC DLG (dosimetric leaf gap). Novalis Tx with a built-in HD120 MLC was used in this study to acquire the MLC dynalog file be imported in MobiusFx. To establish IMRT plan, Eclipse RTP system was used and target and organ structures (multi-target, mock prostate, mock head/neck, C-shape case) were contoured in I'mRT phantom. To verify the difference of dose distribution according to DLG, MLC dynalog files were imported to MobiusFx software and changed the DLG (0.5, 0.7, 1.0, 1.3, 1.6 mm) values in MobiusFx. For evaluation dose, dose distribution was evaluated by using 3D gamma index for the gamma criteria 3% and distance to agreement 3 mm, and the point dose was acquired by using the CC13 ionization chamber in isocenter of I'mRT phantom. In the result for point dose, the mock head/neck and multi-target had difference about 4% and 3% in DLG 0.5 and 0.7 mm respectively, and the other DLGs had difference less than 3%. The gamma index passing-rate of mock head/neck were below 81% for PTV and cord, and multi-target were below 30% for center and superior target in DLGs 0.5, 0.7 mm, however, inferior target of multi-target case and parotid of mock head/neck case had 100.0% passing rate in all DLGs. The point dose of mock prostate showed difference below 3.0% in all DLGs, however, the passing rate of PTV were below 95% in 0.5, 0.7 mm DLGs, and the other DLGs were above 98%. The rectum and bladder had 100.0% passing rate in all DLGs. As the difference of point dose in C-shape were 3~9% except for 1.3 mm DLG, the passing rate of PTV in 1.0 1.3 mm were 96.7, 93.0% respectively. However, passing rate of the other DLGs were below 86% and core was 100.0% passing rate in all DLGs. In this study, we verified that the accuracy of treatment planning QA system can be affected by DLG values. For precise quality assurance for treatment technique using the MLC motion like IMRT and VMAT, we should use appropriate DLG value in linear accelerator and RTP system.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.275-286
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• 2001

Purpose : To setup procedures of quality assurance (OA) for implementing intensity modulated radiation therapy (IMRT) clinically, report OA procedures peformed for one patient with prostate cancer. Materials and methods : $P^3IMRT$ (ADAC) and linear accelerator (Siemens) with multileaf collimator are used to implement IMRT. At first, the positional accuracy, reproducibility of MLC, and leaf transmission factor were evaluated. RTP commissioning was peformed again to consider small field effect. After RTP recommissioning, a test plan of a C-shaped PTV was made using 9 intensity modulated beams, and the calculated isocenter dose was compared with the measured one in solid water phantom. As a patient-specific IMRT QA, one patient with prostate cancer was planned using 6 beams of total 74 segmented fields. The same beams were used to recalculate dose in a solid water phantom. Dose of these beams were measured with a 0.015 cc micro-ionization chamber, a diode detector, films, and an array detector and compared with calculated one. Results : The positioning accuracy of MLC was about 1 mm, and the reproducibility was around 0.5 mm. For leaf transmission factor for 10 MV photon beams, interleaf leakage was measured $1.9\%$ and midleaf leakage $0.9\%$ relative to $10\times\;cm^2$ open filed. Penumbra measured with film, diode detector, microionization chamber, and conventional 0.125 cc chamber showed that $80\~20\%$ penumbra width measured with a 0.125 cc chamber was 2 mm larger than that of film, which means a 0.125 cc ionization chamber was unacceptable for measuring small field such like 0.5 cm beamlet. After RTP recommissioning, the discrepancy between the measured and calculated dose profile for a small field of $1\times1\;cm^2$ size was less than $2\%$. The isocenter dose of the test plan of C-shaped PTV was measured two times with micro-ionization chamber in solid phantom showed that the errors upto $12\%$ for individual beam, but total dose delivered were agreed with the calculated within $2\%$. The transverse dose distribution measured with EC-L film was agreed with the calculated one in general. The isocenter dose for the patient measured in solid phantom was agreed within $1.5\%$. On-axis dose profiles of each individual beam at the position of the central leaf measured with film and array detector were found that at out-of-the-field region, the calculated dose underestimates about $2\%$, at inside-the-field the measured one was agreed within $3\%$, except some position. Conclusion : It is necessary more tight quality control of MLC for IMRT relative to conventional large field treatment and to develop QA procedures to check intensity pattern more efficiently. At the conclusion, we did setup an appropriate QA procedures for IMRT by a series of verifications including the measurement of absolute dose at the isocenter with a micro-ionization chamber, film dosimetry for verifying intensity pattern, and another measurement with an array detector for comparing off-axis dose profile.

• Radiation Oncology Journal
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• v.28 no.1
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• pp.39-49
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• 2010

Purpose: This aim of this study is to analyze the dosimetric difference between intensity-modulated radiation therapy (IMRT) using 3 or 5 beams and MSF in the radiotherapy of the left breast. Materials and Methods: We performed a comparative analysis of two radiotherapy modalities that can achieve improved dose homogeneity. First is the multistatic fields technique that simultaneously uses both major and minor irradiation fields. The other is IMRT, which employs 3 or 5 beams using a fixed multileaf collimator. We designed treatment plans for 16 early left breast cancer patients who had taken breast conservation surgery and radiotherapy, and analyzed them from a dosimetric standpoint. Results: For the mean values of $V_{95}$ and dose homogeneity index, no statistically significant difference was observed among the three therapies. Extreme hot spots receiving over 110% of the prescribed dose were not found in any of the three methods. A Tukey test performed on IMRT showed a significantly larger increase in exposure dose to the ipsilateral lung and heart than multistatic fields technique (MSF) in the low-dose area, but in the high-dose area, MSF showed a slight increase. Conclusion: In order to improve dose homogeneity, the application of MSF, which can be easily planned and applied more widely, is considered an optimal alternative to IMRT for radiotherapy of early left breast cancer.

• Progress in Medical Physics
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• v.23 no.3
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• pp.127-137
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• 2012

A conversing beam is firstly designed for radiosurgery by a neurosugern Lars Leksell in 1949 with orthogonal x-rays tube moving through horizontal moving arc to focusing the beam at target center. After 2 decades he composits 201 source of the Co-60 for gamma knife which beams focused at locus. Sveral linac-based stereotactic radiosurgery using the circular collimated beam which size range for 0.4~4.0 cm in a diameter by non-coplanar multiarc have been developed over the decades. The irregular lesions can be treated by superimposing with several spherical shots of radiation over the tumour volume. Linac based techniques include the use of between 4 and 11 non-co-planar arcs and a dynamic rotation technique and use photon beam energies in the range of 6~10 MV. Reviews of the characteristics of several treatment techniques can be found in the literature (Podgorsak 1989, Schell 1991). More in recent, static conformal beams defined by custom shaped collimators or a mini- or micro-multileaf collimator (mMLC) have been used in SRS. Finally, in the last few years, intensity-modulated mMLC SRS has also been introduced. Today, many commercial and in-house SRS programs have also introduced non-invasive immobilization systems include the cyberknife and tomotherapy and proton beam. This document will be compared the characteristics of dose distribution of radiosurgery as introduced gamma knife, BrainLab include photon knife in-house SRS program and cyberknife in currently wide used for a cranial SRS.

• 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.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.2
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• pp.77-82
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• 2007

Purpose: This study investigates peripheral dose from physical wedge and dynamic wedge system on a multileaf collimator (MLC) equipment linear accelerator. Materials and Methods: Measurments were performed using a 2D array ion chamber and solid water phantom for a 10$\times$10 cm, source-surface distance (SSD) 90 cm, 6 and 15 MV photon beam at depths of 0.5 cm, 5 cm through dmax. Measurments of peripheral dose at 0.5 cm and 5 cm depths were performed from 1 cm to 5 cm outside of fields for the dynamic wedge and physical wedge 15$^\circ$, 45$^\circ$. Dose profiles normalized to dose at the maximum depth. Results: At 6 MV photon beam, the average peripheral dose of dynamic wedge were lower by 1.4% and 0.1%. At 15 MV photon beam, the peripheral dose of dynamic wedge were lower by maximum 1.6%. Conclusion: This study showed that dynamic wedge can reduce scattered dose of clinical organ close to the field edge and reduced treatment time. The wedge systems produce significantly different peripheral dose that should be considered in properly choosing a wedge system for clinical use.

• 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.

• Progress in Medical Physics
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• v.20 no.1
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• pp.43-50
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• 2009

The 4 bank mico-MLC (mMLC; Acculeaf, Direx, Isral) has been commissioned for clinical use of linac based stereotactic radiosurgery. The geometrical parameters to control the leaves were determined and comparisons between measured and calculated by the calculation model were performed in terms of absolute dose (cGy/100 MU). As a result of evaluating calculated dose for various field sizes and depths of 5 and 10 cm in water in the geometric condition of fixed SSD (source to surface distance) and fixed SCD (source to chamber distance), most of differences were within 1% for 6 MV and 15 MV x-rays. The penumbral widths at the isocenter were approximately evaluated to 0.29~0.43 cm depending on the field size for 6 MV and 0.36~0.51 cm for 15 MV x-rays. The average transmission and leakage for 6 MV and 15 MV x-rays were 6.6% and 7.4% respectively in single level of leaves fully closed. In case of dual level of leaves fully closed the measured transmission is approximately 0.5% for both 6 MV and 15 MV x-rays. Through the commissiong procedure we could verify the dose characteristics of mMLC and approximately evaluate the error ranges for treatment planning system.

• Progress in Medical Physics
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• v.17 no.2
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• pp.114-122
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• 2006

The two commonly used methods in delivering intensity modulated radiation therapy (IMRT) plan are the dynamic (sliding window) and static (stop and shoot) mode. In this study, the two IMRI delivery techniques are compared by measuring point dose and dose distributions. Using treatment planning system, clinical target volume (CTV) was created as a sphere with various diameter (3 cm, 7 cm, 12 cm). Two IMRT plans were peformed to deliver 200 cGy to the CTV in dynamic and static mode. The two plans were delivered on a phantom and central point dose and dose distributions were measured. The central point dose differences between static and dynamic IMRT delivery were 0.2%, 0.2% and 0.4% when the diameter of CTV was 3 cm, 7 cm, and 12 cm, respectively. The differences In volume receiving 90% of the proscribed dose were 2.7%, 2.2%, and 2.9% for the diameter of CTV was 3 cm, 7 cm, and 12 cm, respectively. For lung cancer patients, the differences in central point dose were 0.2%, 0.2%, and 0.4% when the volume of CTV was 35.5 cc, 296.8 cc, and 903.5 cc, respectively. The differences in volume receiving 90% of the prescribed dose were 2.7%, 4.8%, and 9.1% when the volume of CTV was 35.5 cc, 296.8 cc, and 903.5 cc, respectively. In conclusion, it was possible to deliver IMRT plans using dynamic mode of MLC operation although the loaves are In motion during radiation delivery.

• Progress in Medical Physics
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• v.13 no.4
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• pp.181-186
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• 2002

The IMRT planning depends on the algorithm of each planning system and MLC performance of each Linac system. Yonsei Cancer Center introduced an IMRT System at the beginning of February, 2002. The system consists of CORVUS (Nomos, U.S.A.) treatment planning system, LANTIS, PRIMEVIEW and PRIMART (Siemens, U.S.A) linac system. The optimization of CORVUS planning system with PRIMART is an important task to make a desirable quality treatment plan. Our Step ＆ Shoot IMRT system uses Finite Size Pencil Beams (FSPB) dose model, simulated annealing optimization algorithm and IMFAST segmentation algorithm. We constructed treatment plans for four different patient cases with two basic beamlet sizes, 1.0$\times$1.0 $\textrm{cm}^2$ and 0.5$\times$1.0 $\textrm{cm}^2$, and four intensity steps, 5%, 10%, 20%, 33%. Each case's plan was evaluated with the dose volume histograms of target volumes and delivery efficiencies. The patient case of small target volume is sensitive at the change of intensity map's segmentation and it highlighted an effective treatment plan at marrow intensity step and small basic projection beamlet.