• Progress in Medical Physics
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• v.30 no.3
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• pp.65-73
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• 2019

Purpose: We evaluated the motion-induced dosimetric effects on the field-in-field (FIF) technique for whole-breast irradiation (WBI) using actual patient organ motion data obtained from cine electronic portal imaging device (cine EPID) images during treatment. Materials and Methods: Ten breast cancer patients who received WBI after breast-conserving surgery were selected. The static FIF (SFIF) plan involved the application of two parallel opposing tangential and boost FIFs. To obtain the amplitude of the internal organ motion during treatment, cine EPID images were acquired five times for each patient. The outside contour of the breast (OCB) and chest wall (CW) contour were tracked using in-house motion analysis software. Intrafractional organ motion was analyzed. The dynamic FIF (DFIF) reflecting intrafractional organ motion incorporated into the SFIF plan was calculated and compared with the SFIF in terms of the dose homogeneity index (DHI_90/10) for the target and V₂₀ for the ipsilateral lung. Results: The average motion amplitudes along the X and Y directions were 1.84±1.09 mm and 0.69±0.50 mm for OCB and 1.88±1.07 mm and 1.66±1.49 mm for CW, respectively. The maximum motion amplitudes along the X and Y directions were 5.53 and 2.08 mm for OCB and 5.22 and 6.79 mm for CW, respectively. Significant differences in DHI_90/10 values were observed between SFIF and DFIF (0.94 vs 0.95, P<0.05) in statistical analysis. The average V₂₀ for the lung in the DFIF was slightly higher than that of the SFIF in statistical analysis (19.21 vs 19.00, P<0.05). Conclusion: Our findings indicate that the FIF technique can form a safe and effective treatment method for WBI. Regular monitoring using cine EPID images can be effective in reducing motion-induced dosimetric errors.

• 대한방사선방어학회:학술대회논문집
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• 2009.11a
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• pp.120-121
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• 2009

• Progress in Medical Physics
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• v.23 no.2
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• pp.91-98
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• 2012

Verification of internal organ motion during treatment and its feedback is essential to accurate dose delivery to the moving target. We developed an offline based internal organ motion verification system (IMVS) using cine EPID images and evaluated its accuracy and availability through phantom study. For verification of organ motion using live cine EPID images, a pattern matching algorithm using an internal surrogate, which is very distinguishable and represents organ motion in the treatment field, like diaphragm, was employed in the self-developed analysis software. For the system performance test, we developed a linear motion phantom, which consists of a human body shaped phantom with a fake tumor in the lung, linear motion cart, and control software. The phantom was operated with a motion of 2 cm at 4 sec per cycle and cine EPID images were obtained at a rate of 3.3 and 6.6 frames per sec (2 MU/frame) with $1,024{\times}768$ pixel counts in a linear accelerator (10 MVX). Organ motion of the target was tracked using self-developed analysis software. Results were compared with planned data of the motion phantom and data from the video image based tracking system (RPM, Varian, USA) using an external surrogate in order to evaluate its accuracy. For quantitative analysis, we analyzed correlation between two data sets in terms of average cycle (peak to peak), amplitude, and pattern (RMS, root mean square) of motion. Averages for the cycle of motion from IMVS and RPM system were $3.98{\pm}0.11$ (IMVS 3.3 fps), $4.005{\pm}0.001$ (IMVS 6.6 fps), and $3.95{\pm}0.02$ (RPM), respectively, and showed good agreement on real value (4 sec/cycle). Average of the amplitude of motion tracked by our system showed $1.85{\pm}0.02$ cm (3.3 fps) and $1.94{\pm}0.02$ cm (6.6 fps) as showed a slightly different value, 0.15 (7.5% error) and 0.06 (3% error) cm, respectively, compared with the actual value (2 cm), due to time resolution for image acquisition. In analysis of pattern of motion, the value of the RMS from the cine EPID image in 3.3 fps (0.1044) grew slightly compared with data from 6.6 fps (0.0480). The organ motion verification system using sequential cine EPID images with an internal surrogate showed good representation of its motion within 3% error in a preliminary phantom study. The system can be implemented for clinical purposes, which include organ motion verification during treatment, compared with 4D treatment planning data, and its feedback for accurate dose delivery to the moving target.

• Journal of Biomedical Engineering Research
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• v.28 no.5
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• pp.676-683
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• 2007

A non-invasive respiratory gated radiotherapy system like those based on external anatomic motion gives better comfortableness to patients than invasive system on treatment. However, higher correlation between the external and internal anatomic motion is required to increase the effectiveness of non-invasive respiratory gated radiotherapy. Both of invasive and non-invasive methods need to track the internal anatomy with the higher precision and rapid response. Especially, the non-invasive method has more difficulty to track the target position successively because of using only image processing. So we developed the system to track the motion for a non-invasive respiratory gated system to accurately find the dynamic position of internal structures such as the diaphragm and tumor. The respiratory organ motion tracking apparatus consists of an image capture board, a fluoroscopy system and a processing computer. After the image board grabs the motion of internal anatomy through the fluoroscopy system, the computer acquires the organ motion tracking data by image processing without any additional physical markers. The patients breathe freely without any forced breath control and coaching, when this experiment was performed. The developed pattern-recognition software could extract the target motion signal in real-time from the acquired fluoroscopic images. The range of mean deviations between the real and acquired target positions was measured for some sample structures in an anatomical model phantom. The mean and max deviation between the real and acquired positions were less than 1mm and 2mm respectively with the standardized movement using a moving stage and an anatomical model phantom. Under the real human body, the mean and maximum distance of the peak to trough was measured 23.5mm and 55.1mm respectively for 13 patients' diaphragm motion. The acquired respiration profile showed that human expiration period was longer than the inspiration period. The above results could be applied to respiratory-gated radiotherapy.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2004.11a
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• pp.132-135
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• 2004

In this study, we investigated the effect of threshold on a delivered dose in organ with internal motion by respiration. With mathematic model for 3D dose calculation reported by Lujan et al., we had calculated the position of organ as a function of time in previous study. This result presented that the variation of organ is within 2 mm from initial exhale position to the organ position during operating 1 s. Gating threshold, in this study, is determined to the moving region of target during 1s at a primary position of exhale. This period of gating threshold is 50% of the duty cycle in a half breathing cycle which is period from the top position of exhalation to the bottom position of inhalation. Radiation fields were then delivered under three conditions; 1) existent of moving target in the region of threshold(1sec, 1.5sec), 2) existent of moving target out of the region of threshold, 3) non-moving target. The non-moving target delivery represents a dose different induced due to internal organ motion.

• Journal of the Korean Society for Precision Engineering
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• v.22 no.8 s.173
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• pp.57-63
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• 2005

Development of a locomotive mechanism fer the capsule type endoscopes will largely enhance the ability to diagnose disease of digestive organs. In connection with it, most of researches have focused on an installable locomotive mechanism in the capsule. In this paper, it is introduced that the movement of a capsule type endoscope in digestive organ can be manipulated by magnetic force produced outside human body. Since the magnetic force is provided by permanent magnets, no additional power supply to the capsule is required. Using a robotic manipulator for locating the external magnet, the capsule motion control system can cover the whole human digestive organs. This study is particularly concentrated on dither motion effect to improve the mobility of capsule type endoscope. It was experimentally found out that the friction coefficient between the capsule and digestive organ can be remarkably reduced by superposing yawing or rolling dither motion on the translatory motion. In this paper, the experimental results obtained with the direction, amplitude and frequency of sinusoidal dither motion changed is reported.

• Journal of Biomedical Engineering Research
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• v.28 no.1
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• pp.132-138
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• 2007

MR(magnetic resonance) image of moving organ such as heart shows serious distortion of MR image due to motion itself. To eliminate motion artifacts, MRI(magnetic resonance imaging) scan sequences requires a trigger pulse like ECG(electro-cardiography) R-wave. ECG-gating using cardiac cycle synchronizes the MRI sequence acquisition to the R-wave in order to eliminate image motion artifacts. In this paper, we designed ECG/PPG(photo-plethysmography) gating system which is for eliminating motion artifacts due to moving organ. This system uses nonmagnetic carbon electrodes, lead wire and shield case for minimizing RF(radio-frequency) pulse and gradient effect. Also, we developed a ECG circuit for preventing saturation by magnetic field and a finger plethysmography sensor using optic fiber. And then, gating pulse is generated by adaptive filtering based on NLMS(normalized least mean square) algorithm. To evaluate the developed system, we measured and compared MR imaging of heart and neck with and without ECG/PPG gating system. As a result, we could get a clean image to be used in clinically. In conclusion, the designed ECG/PPG gating system could be useful method when we get MR imaging of moving organ like a heart.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2005.06a
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• pp.1068-1073
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• 2005

Development of a locomotive mechanism for the capsule type endoscopes will largely enhance the ability to diagnose disease of digestive organs. In connection with it, most of the researches have focused on an installable locomotive mechanism in the capsule. In this paper, it is introduced that the movement of a capsule type endoscope in digestive organ can be manipulated by magnetic force produced outside human body. Since the magnetic force is provided by permanent magnets, no additional power supply to the capsule is required. Using a robotic manipulator for locating the external magnet, the capsule motion control system can cover the whole human digestive organs. This study is particularly concentrated on dither motion effect to improve the mobility of capsule type endoscope. It was experimentally found out that the friction coefficient between the capsule and digestive organ can be remarkably reduced by superposing yawing or rolling dither motion on the translatory motion. In this paper, the experimental results obtained while the direction, amplitude and frequency of sinusoidal dither motion were changed are reported.

• Progress in Medical Physics
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• v.13 no.3
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• pp.163-168
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• 2002

As for planning the radiation therapy for the tumor in the lung, inferring the motion of the organ or target due to the respiration from the motion of the skin was performed as the feasibility study with the animal. The dog weighed 20 kg was chosen for the experiment. The system, which can use the fluoroscopy and the CCD camera synchronously, was designed. With a radio-opaque marker on the skin of the dog, which indicates the lower lobe of the lung, the images of the motions for the lung were recorded in the A/P (anterior-to-posterior) and lateral view. At the same time, the images of the skin motions from CCD camera were also recorded. Skin moves periodically with the amplitude of 6 mm and the target in the lung made almost the same frequencies during its motion's amplitude of 15 mm and its direction change with the respiration. Therefore analyzed results showed strong correlation between the skin motion and the organ motion on the average of 0.85. This study indicated that the prediction of a target position in the lung, which is moving organ, is possible. For the animal study, predicting the exact target motion from the skin motion was possible and it can have the feasibility to apply to the patient clinically.

• Radiation Oncology Journal
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• v.23 no.4
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• pp.217-222
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• 2005

Purpose: To develop the respiration simulating phantom with thermocouple for evaluating 4D radiotherapy such as gated radiotherapy breathing control radiotherapy and dynamic tumor tracking radiotherapy. Materials and Methods: The respiration monitoring mask(ReMM) with thermocouple was developed to monitor the patient's irregular respiration. The signal from ReMM controls the simulating phantom as organ motion of patients in real-time. The organ and the phantom motion were compared with its respiratory curves to evaluate the simulating phantom. ReMM was used to measure patients' respiration, and the movement of simulating phantom was measured by using $RPM^{(R)}$. The fluoroscope was used to monitor the patient's diaphragm motion. relative to the organ motion, respectively. The standard deviation of discrepancy between the respiratory curve and the organ motion was 8.52% of motion range. Conclusion: Patients felt comfortable with ReMM. The relationship between the signal from ReMM and the organ motion shows strong correlation. The phantom simulates the organ motion in real-time according to the respiratory signal from the ReMM. It is expected that the simulating phantom with ReMM could be used to verify the 4D radiotherapy.