• Progress in Medical Physics
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• v.28 no.4
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• pp.149-155
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• 2017

Radiotherapy patients should maintain their treatment position as patient setup is very important for accurate treatment. In this study, we evaluated patient setup error quantitatively according to Cone-Beam Computed Tomography (CBCT) Gamma Density Analysis using Mobius CBCT. The adjusted setup error to the $QUASAR^{TM}$ phantom was moved artificially in the superior and lateral direction, and then we acquired the CBCT image according to the phantom setup error. To analyze the treatment setup error quantitatively, we compared values suggested in the CBCT system with the Mobius CBCT. This allowed us to evaluate the setup error using CBCT Gamma Density Analysis by comparing the planning CT with the CBCT. In addition, we acquired the 3D-gamma density passing rate according to the gamma density criteria and phantom setup error. When the movement was adjusted to only the phantom body or 3 cm diameter target inserted in the phantom, the CBCT system had a difference of approximately 1 mm, while Mobius CBCT had a difference of under 0.5 mm compared to the real setup error. When the phantom body and target moved 20 mm in the Mobius CBCT, there are 17.9 mm and 13.5 mm differences in the lateral and superior directions, respectively. The CBCT gamma density passing rate was reduced according to the increase in setup error, and the gamma density criteria of 0.1 g/cc/3 mm has 10% lower passing rate than the other density criteria. Mobius CBCT had a 2 mm setup error compared with the actual setup error. However, the difference was greater than 10 mm when the phantom body moved 20 mm with the target. Therefore, we should pay close attention when the patient's anatomy changes.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.109-116
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• 2021

Purpose: The purpose of this study is to evaluate the usefulness of Surface-Guided Patient Setup by comparing the patient positioning accuracy when image-guided radiation therapy was used for Markerless patients(unmarked on the skin) using Surface-Guided Patient Setup and Marker patients(marked on the skin) using Laser-Based Patient Setup. Materials And Methods: The position error during IGRT was compared between a Markerless patient initially set up with SGPS using an optical surface scanning system using three cameras and a Marker patient initially set up with LBPS that aligns the laser with the marker drawn on the patient's skin. Both SGPS and LBPS were performed on 20 prostate cancer patients and 10 Stereotactic Radiation Surgery patients, respectively, and SGPS was performed on an additional 60 breast cancer patients. All were performed IGRT using CBCT or OBI. Position error of 6 degrees of freedom was obtained using Auto-Matching System, and comparison and analysis were performed using Offline-Review in the treatment planning system. Result: The difference between the root mean square (RMS) of SGPS and LBPS in prostate cancer patients was Vrt -0.02cm, Log -0.02cm, Lat 0.01cm, Pit -0.01°, Rol -0.01°, Rtn -0.01°, SRS patients was Vrt 0.02cm, Log -0.05cm, Lat 0.00cm, Pit -0.30°, Rol -0.15°, Rtn -0.33°. there was no significant difference between the two regions. According to the IGRT standard of breast cancer patients, RMS was Vrt 0.26, Log 0.21, Lat 0.15, Pit 0.81, Rol 0.49, Rtn 0.59. Conclusion:. As a result of this study, the position error value of SGPS compared to LBPS did not show a significant difference between prostate cancer patients and SRS patients. In the case of additionally performed SGPS breast cancer patients, the position error value was not large based on IGRT. Therefore, it is considered that it will be useful to replace LBPS with SGPS, which has the great advantage of not requiring patient skin marking..

• Progress in Medical Physics
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• v.15 no.1
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• pp.30-38
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• 2004

Purpose: To develop a whole body frame for the purpose of reducing patient motion and minimizing setup error for extra-cranial stereotactic radiotherapy, and to evaluate the repositioning setup error of a patient in the frame. Materials and Methods: The developed whole body frame is composed of a base plate, immobilizer, vacuum cushion, ruler and belts. The dimension of the base plate is 130 cm in length, 50 cm in width and 1 cm in thickness. The material used in the base plate of the frame was bakelite and the immobilizer was made of acetal. In addition, Radiopaque angio-catheter wires were engraved on the base plate for a coordinate system to determine the target localization. The measurement for radiation transmission and target localization is peformed in order to test the utilization of the frame. Also, a Matlab program analyzed the patients setup error by using the patient's setup images obtained from a CCTV camera and digital record recorder (DVR). Results: A frame that is useful for CT simulation and radiation treatment was fabricated. The frame structure was designed to minimize collisions from the changes in the rotation angle of the gantry and to maximize the transmission rate of the Incident radiation at the lateral or posterior oblique direction. The lightening belts may be used for the further reduction of the patient motion, and the belts can be adjusted so that they are not in the way of beam direction. The radiation transmission rates of this frame were measured as 95% and 96% at 10 and 21 MV, respectively. The position of a test target on the skin of a volunteer is accurately determined by CT simulation using the coordinate system in the frame. The estimated setup errors by Matlab program are shown 3.69$\pm$1.60, 2.14$\pm$0.78 mm at the lateral and central chest, and 7.11 $\pm$2.10, 6.54$\pm$2.22 mm at lateral and central abdomen, respectively. The setup error due to the lateral motion of breast is shown as 6.33$\pm$ 1.55 mm. Conclusion: The development and test of a whole body frame has proven very useful and practical in the radiosurgery for extra-cranial cancers. It may be used in determining target localization, and it can be used as a patient immobilization tool. More experimental data should be obtained in order to improve and confirm the results of the patient setup error.

• Journal of the Korean Society of Radiology
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• v.3 no.3
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• pp.5-11
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• 2009

When using Image Guided Radiation Therapy, the patient is placed using skin marker first and after confirming anatomical location using OBI, the couch is moved to correct the set up. Evaluation for the error made at that moment was done. Through comparing $0^{\circ}$ and $270^{\circ}$ direction DRR image and OBI image with 2D-2D matching when therapy planning, comparison between patient's therapy plan setup and actual treatment setup was made to observe the error. Treatment confirmation on important organs such as head, neck and spinal cord was done every time through OBI setup and other organs such as chest, abdomen and pelvis was done 2 ~ 3 times a week. But corrections were all recorded on OIS so that evaluation on accuracy could be made through using skin index which was divided into head, neck, chest and abdomen-pelvis on 160 patients. Average setup error for head and neck patient on each AP, SI, RL direction was $0.2{\pm}0.2cm$, $-0.1{\pm}0.1cm$, $-0.2{\pm}0.0cm$, chest patient was $-0.5{\pm}0.1cm$, $0.3{\pm}0.3cm$, $0.4{\pm}0.2cm$, and abdomen was $0.4{\pm}0.4cm$, $-0.5{\pm}0.1cm$, $-0.4{\pm}0.1cm$. In case of pelvis, it was $0.5{\pm}0.3cm$, $0.8{\pm}0.4cm$, $-0.3{\pm}0.2cm$. In rigid body parts such as head and neck showed lesser setup error compared to chest and abdomen. Error was greater on chest in horizontal axis and in AP direction, abdomen-pelvis showed greater error. Error was greater on chest in horizontal axis because of the curve in patient's body when the setup is made. Error was greater on abdomen in AP direction because of the change in front and back location due to breathing of patient. There was no systematic error on patient setup system. Since OBI confirms the anatomical location, when focus is located on the skin, it is more precise to use skin marker to setup. When compared with 3D-3D conformation, although 2D-2D conformation can't find out the rolling error, it has lesser radiation exposure and shorter setup confirmation time. Therefore, on actual clinic, 2D-2D conformation is more appropriate.

• Progress in Medical Physics
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• v.23 no.2
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• pp.81-90
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• 2012

The effect of setup uncertainties on CTV dose and the correlation between setup uncertainties and setup margin were evaluated by Monte Carlo based numerical simulation. Patient specific information of IMRT treatment plan for rectal cancer designed on the VARIAN Eclipse planning system was utilized for the Monte Carlo simulation program including the planned dose distribution and tumor volume information of a rectal cancer patient. The simulation program was developed for the purpose of the study on Linux environment using open source packages, GNU C++ and ROOT data analysis framework. All misalignments of patient setup were assumed to follow the central limit theorem. Thus systematic and random errors were generated according to the gaussian statistics with a given standard deviation as simulation input parameter. After the setup error simulations, the change of dose in CTV volume was analyzed with the simulation result. In order to verify the conventional margin recipe, the correlation between setup error and setup margin was compared with the margin formula developed on three dimensional conformal radiation therapy. The simulation was performed total 2,000 times for each simulation input of systematic and random errors independently. The size of standard deviation for generating patient setup errors was changed from 1 mm to 10 mm with 1 mm step. In case for the systematic error the minimum dose on CTV $D_{min}^{stat{\cdot}}$ was decreased from 100.4 to 72.50% and the mean dose $\bar{D}_{syst{\cdot}}$ was decreased from 100.45% to 97.88%. However the standard deviation of dose distribution in CTV volume was increased from 0.02% to 3.33%. The effect of random error gave the same result of a reduction of mean and minimum dose to CTV volume. It was found that the minimum dose on CTV volume $D_{min}^{rand{\cdot}}$ was reduced from 100.45% to 94.80% and the mean dose to CTV $\bar{D}_{rand{\cdot}}$ was decreased from 100.46% to 97.87%. Like systematic error, the standard deviation of CTV dose ${\Delta}D_{rand}$ was increased from 0.01% to 0.63%. After calculating a size of margin for each systematic and random error the "population ratio" was introduced and applied to verify margin recipe. It was found that the conventional margin formula satisfy margin object on IMRT treatment for rectal cancer. It is considered that the developed Monte-carlo based simulation program might be useful to study for patient setup error and dose coverage in CTV volume due to variations of margin size and setup error.

• Radiation Oncology Journal
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• v.14 no.4
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• pp.333-338
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• 1996

Purpose : To evaluate the clinical implications of scallop penumbra width that comes from multileaf collimator(MLC) effect by the daily routine patient setup error. Materials and Methods : The anales of $0^{circ},{\;}15^{circ},{\;}30^{circ},{\;}45^{circ},{\;}60^{circ},{\;}and{\;}75^{circ}$ inclined -radiation blocked fields were generated using the both conventional cerrobend block and the MLC. Film dosimetry in the phantom were performed to measure penumbral widths of differences between the dose distributions from the cerrobend block and those of respect the MLC. The patient setup error effect on scallop penumbra was simulated with respect to the table of setup error distribution. Same procedures are repeated for the cerrobend block generated field. Results : There are penumbral widths of to 3mm difference between the dose distributioins from two kinds of field shaping tools, the conventional block and the MLC with 4mm setup error model and resolution of 1cm leaf at the isocenter. Conclusion : We need not additive margin for MLC, if planning target volume is selected according to the recommendation of ICRU 50. For particular cases, we can include the target volume with less than 3mm additive margin.

• Progress in Medical Physics
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• v.10 no.2
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• pp.63-71
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• 1999

For the purpose of utilization in 3-D conformal radiotherapy and whole body radiosurgery, the Whole Body 3-Dimensional Topographic Radiation Therapy System has been developed. Whole body frame was constructed in order to be installed on the couch. Radiopaque catheters were engraved on it for the dedicated coordinate system and a MeV-Green immobilizer was used for the patient setup by the help of side panels and plastic rods. By designing and constructing the whole body frame in this way, geometrical limitation to the gantry rotation in 3-D conformal radiotherapy could be minimized and problem which radiation transmission may be altered in particular incident angles was solved. By analyzing CT images containing information of patient setup with respect to the whole body frame, localization and coordination of the target is performed so that patient setup error may be eliminated between simulation and treatment. For the verification of setup, the change of patient positioning is detected and adjusted in order to minimize the setup error by means of comparison of the body outlines using 3 CCTV cameras. To enhance efficiency of treatment procedure, this work can be done in real time by watching the change of patient setup through the monitor. The method of image subtraction in IDL (Interactive Data Language) was used to visualize the change of patient setup. Rotating X-ray system was constructed for detecting target movement due to internal organ motion. Landmark screws were implanted either on the bones around target or inside target, and variation of target location with respect to markers may be visualized in order to minimize internal setup error through the anterior and the lateral image information taken from rotating X-ray system. For CT simulation, simulation software was developed using IDL on GUI(Graphic User Interface) basis for PC and includes functions of graphic handling, editing and data acquisition of images of internal organs as well as target for the preparation of treatment planning.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2006.08a
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• pp.56-56
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• 2006

• Progress in Medical Physics
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• v.32 no.2
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• pp.40-49
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• 2021

Purpose: This study aimed to develop a surface-guided radiosurgery system customized for a neurosurgery clinic that could be used as an auxiliary system for improving the accuracy, monitoring the movements of patients while performing hypofractionated radiosurgery, and minimizing the geometric misses. Methods: RGB-D cameras were installed in the treatment room and a monitoring system was constructed to perform a three-dimensional (3D) scan of the body surface of the patient and to express it as a point cloud. This could be used to confirm the exact position of the body of the patient and monitor their movements during radiosurgery. The image from the system was matched with the computed tomography (CT) image, and the positional accuracy was compared and analyzed in relation to the existing system to evaluate the accuracy of the setup. Results: The user interface was configured to register the patient and display the setup image to position the setup location by matching the 3D points on the body of the patient with the CT image. The error rate for the position difference was within 1-mm distance (min, -0.21 mm; max, 0.63 mm). Compared with the existing system, the differences were found to be as follows: x=0.08 mm, y=0.13 mm, and z=0.26 mm. Conclusions: We developed a surface-guided repositioning and monitoring system that can be customized and applied in a radiation surgery environment with an existing linear accelerator. It was confirmed that this system could be easily applied for accurate patient repositioning and inter-treatment motion monitoring.

• Journal of Magnetics
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• v.21 no.3
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• pp.425-430
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• 2016

The aim of this study was to measure the setup variation for X (lateral), Y (longitude), and Z (vertical) by taking magnetic megavoltage computed tomography (MVCT) before treating the brain, oropharynx, lung, and prostate patients on helical tomotherapy. In this study, 30 patients were chosen for each of the treatment areas, and their skin was labeled with a mark on a treatment planning reference point when taking CT. We preceded MVCT prior to tomotherapy and then conducted an auto registration based on the bony landmarks; image registration was used for automatically matching the patient's setup. Lastly, we confirmed and evaluated the translation coordinates of the images for 30 patients. The following shows the comparison result of the setup errors of each part: X (lateral) showed the highest setup errors with $3.44{\pm}2.05$ from Lung; Y (longitude) showed the highest setup errors showing $3.40{\pm}2.87mm$ from Prostate; and Z (vertical) showed the highest setup errors showing $6.62{\pm}4.38mm$ from Lung. This result verifies that the setup error can be prevented by taking MVCT before the treatment, and Planning Target Volume (PTV) margins can be reduced by referring to the resulting value of each treatment part. Ultimately, the dosage of the normal organs can be decreased as well as any side effects.