• Progress in Medical Physics
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• v.11 no.2
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• pp.147-155
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• 2000

Patient dose verification is one of the most important parts in quality assurance of the treatment delivery for radiation therapy. The dose distributions may be meaningfully improved by modulating two dimensional intensity profile of the individual high energy radiation beams In this study, a new method is presented for the pre-treatment dosimetric verification of these two dimensional distributions of beam intensity by means of a charge coupled device video camera-based fluoroscopic device (henceforth called as CCD-VCFD) as a radiation detecter with a custom-made software for dose calculation from fluorescence signals. This system of dosimeter (CCD-VCFD) could reproduce three dimensional (3D) relative dose distribution from the digitized fluoroscopic signals for small (1.0$\times$1.0 cm$^2$ square, ø 1.0 cm circular ) and large (30$\times$30cm$^2$) field sizes used in intensity modulated radiation therapy (IMRT). For the small beam sizes of photon and electron, the calculations are performed In absolute beam fluence profiles which are usually used for calculation of the patient dose distribution. The good linearity with respect to the absorbed dose, independence of dose rate, and three dimensional profiles of small beams using the CCD-VCFD were demonstrated by relative measurements in high energy Photon (15 MV) and electron (9 MeV) beams. These measurements of beam profiles with CCD-VCFD show good agreement with those with other dosimeters such as utramicro-cylindrical (UC) ionization chamber and radiographic film. The study of the radiation dosimetric technique using CCD-VCFD may provide a fast and accurate pre-treatment verification tool for the small beam used in stereotactic radiosurgery (SRS) and can be used for verification of dose distribution from dynamic multi-leaf collimation system (DMLC).

• Progress in Medical Physics
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• v.23 no.1
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• pp.62-69
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• 2012

The dose re-calculation process using Megavoltage cone-beam CT images is inevitable process to perform the Adaptive Radiation Therapy (ART). The purpose of this study is to improve dose re-calculation accuracy using MVCBCT images by applying intensity calibration method and three dimensional rigid body transform and filtering process. The three dimensional rigid body transform and Gaussian smoothing filtering process to MVCBCT Rando phantom images was applied to reduce image orientation error and the noise of the MVCBCT images. Then, to obtain the predefined modification level for intensity calibration, the cheese phantom images from kilo-voltage CT (kV CT), MVCBCT was acquired. From these cheese phantom images, the calibration table for MVCBCT images was defined from the relationship between Hounsfield Units (HUs) of kV CT and MVCBCT images at the same electron density plugs. The intensity of MVCBCT images from Rando phantom was calibrated using the predefined modification level as discussed above to have the intensity of the kV CT images to make the two images have the same intensity range as if they were obtained from the same modality. Finally, the dose calculation using kV CT, MVCBCT with/without intensity calibration was applied using radiation treatment planning system. As a result, the percentage difference of dose distributions between dose calculation based on kVCT and MVCBCT with intensity calibration was reduced comparing to the percentage difference of dose distribution between dose calculation based on kVCT and MVCBCT without intensity calibration. For head and neck, lung images, the percentage difference between kV CT and non-calibrated MVCBCT images was 1.08%, 2.44%, respectively. In summary, our method has quantitatively improved the accuracy of dose calculation and could be a useful solution to enhance the dose calculation accuracy using MVCBCT images.

• 대한두경부종양학회:학술대회논문집
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• 2002.11a
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• pp.252-252
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• 2002

• Progress in Medical Physics
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• v.27 no.4
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• pp.196-202
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• 2016

We aim to develop the breast bolus by using a 3D printer to minimize the air-gap, and compare it to commercial bolus used for patients undergoing reconstruction in breast cancer. The bolus-shaped region of interests (ROIs) were contoured at the surface of the intensity-modulated radiation therapy (IMRT) thorax phantom with 5 mm thickness, after which the digital imaging and communications in mdicine (DICOM)-RT structure file was acquired. The intensity-modulated radiation therapy (Tomo-IMRT) and direct mode (Tomo-Direct) using the Tomotherapy were established. The 13 point doses were measured by optically stimulated luminescence (OSLD) dosimetry. The measurement data was analyzed to quantitatively evaluate the applicability of 3D bolus. The percentage change of mean measured dose between the commercial bolus and 3D-bolus was 2.3% and 0.7% for the Tomo-direct and Tomo-IMRT, respectively. For air-gap, range of the commercial bolus was from 0.8 cm to 1.5 cm at the periphery of the right breast. In contrast, the 3D-bolus have occurred the air-gap (i.e., 0 cm). The 3D-bolus for radiation therapy reduces the air-gap on irregular body surface that believed to help in accurate and precise radiation therapy due to better property of adhesion.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.9-15
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• 2003

Purpose: To introduce our early experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma. Methods and Materials: Eight patients who underwent IMRT for no disseminated nasopharyngeal carcinoma at the Asan Medical Center between September 2001 and November 2002 were evaluate by prospective analysis. According to the 1997 American Joint Committee on Cancer staging classification, 5 had Stage III, and 3 had Stage IVB disease. The IMRT plans were designed to be delivered as a 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) using the 'step and shoot' technique with a MLC (multileaf collimator). Daily fractions of 2.2-2.5Gy and 1.9-2Gy were prescribed and delivered to the GTV and CTV and clinically negative neck node, respectively. The prescribed dose was 70A-79.0Gy to the gross tumor volume (GTV), 60Gy to the clinical target volume (CTV) and metastatic nodal station, and 46Gy to the clinically negative neck. All patients also received weekly cisplatin during radiotherapy. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Results: Follow-up period was ranging from 5 to 18 months. All patients showed complete response and loco-regional control rate was 100% but one patient died of malnutrition due to treatment related toxicity. There were no Grade 3 or 4 xerostomia and all patients had experienced improvement of salivary gland function. Conclusion: 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) boost intensity-modulated radiotherapy technique allows parotid sparing as evidenced both clinically and by dosimetry. Initial tumor response and loco-regional control was promising. It is clinically feasible. A larger population of patients and a long-term follow-up are needed to evaluate ultimate tumor control and late toxicity.

• 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.27 no.4
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• pp.189-195
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• 2016

This paper aims to verify the clinical feasibility of a custom-made film created by a laser cutting tool for End-to-End (E2E) quality assurance in robotic intensity modulated radiation therapy system. The custom-made film was fabricated from the Gafchromic EBT3 film with the size of $8^{{\prime}{\prime}}{\times}10^{{\prime}{\prime}}$ using a drawing that is identical to the shape and scale of the original E2E film. The drawing was created by using a computer aided design program with the image file, which is obtained by scanning original E2E film. Beam delivery and evaluations were respectively performed with the original film and the custom-made film using fixed-cone collimator on three tracking modes: 6D skull (6DS), Xsight spine (XS), and Xsight lung (XL). The differences between total targeting errors of the original and custom-made films were recorded as 0.17 mm, 0.3 mm, and 0.17 mm at 6DS, XS, and XL tracking modes, respectively. This indicates that the custom-made film could yield nearly equivalent results to those of the original E2E film, given the uncertainties caused by distortions during film scanning and vibrations associated with film cutting. By confirming the clinical feasibility of a custom-made film for E2E testing, it can be expected that economic efficiency of the testing will increase accordingly.

• Radiation Oncology Journal
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• v.35 no.4
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• pp.325-331
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• 2017

Purpose: There is controversy regarding the cosmetic outcome after accelerated partial breast radiation (APBR). We report the cosmetic outcome from a single-arm prospective clinical trial of APBR delivered using intensity-modulated radiation therapy (IMRT) in elderly patients with stage I breast cancer (BC), using a novel fractionation schedule. Materials and Methods: Forty-two patients aged ${\geq}65$, with Stage I BC who underwent breast-conserving surgery were enrolled in a phase I/II study evaluating a 2-week course of APBR. Thirty eligible patients received 40 Gy in 4 Gy daily fractions. Cosmetic outcome was assessed subjectively by physician/patient and objectively by using a computer program (BCCT.core) before APBR, during, and after completion of the treatment. Results: The median age was 72 years, the median tumor size was 0.8 cm, and the median follow-up was 50.5 months. The 5-year locoregional control in this cohort was 97% and overall survival 87%. At the last follow-up, patients and physicians rated cosmesis as 'excellent' or 'good' in 100% and 91 %, respectively. The BCCT.core program scored the cosmesis as 'excellent' or 'good' in 87% of the patients at baseline and 81% at the last follow-up. The median $V_{50}$ (20 Gy) of the whole breast volume (WBV) was 37.2%, with the median WBV $V_{100}$ (40 Gy) of 10.9%. Conclusion: An excellent rate of tumor control was observed in this prospective trial. By using multiple assessment techniques, we are showing acceptable cosmesis, supporting the use of IMRT planned APBR with daily schedule in elderly patients with early stage BC.

• Journal of the Institute of Electronics and Information Engineers
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• v.53 no.5
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• pp.143-151
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• 2016

The aim of this study is to investigate the optimal algorithm to extract medical radiation induced pixel signal from complementary metal-oxide semiconductor (CMOS) sensors of smartphones camera. The pixel intensity and pixel number of smartphone camera were measured as the X-ray dose was increased. The front camera of the smartphone camera has low noise property and excellent dose response as compared to the back camera of the smartphone. The indirect method which uses scintillation crystal in front of the smartphone camera, couldn't improve the X-ray detection efficiency as compared to the direct method which does not use any scintillator in front of the smartphone camera. When we used the algorithm which employing threshold level on the pixel intensity and pixel number, the dose linearity was more higher for the pixel intensity rather for the pixel number. The use of pixel intensity of Y color component which represents the grey scale, would be efficient in terms of the radiation detection efficiency and reducing the complexity of the image processing. We expect that the radiation dose monitoring can be managed effectively and systematically by using the proposed radiation detection algorithm, thus eventually will contribute to the public healthcare.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.85-92
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• 2017

purpose: Image Guide System offers therapy precise, especially Intensity Modulated Radiation Therapy. However, organs at pelvis have variation and uncertainties each therapy. it brings IG system for verifying patient's position. In this study, analysis the variation at pelvis during rectal cancer radiation therapy. Moreover design the patient re-setup technique and apply to patients. Material and Method: 40 rectal cancer patient who have radiation therapy. The 530 image which acquired from IG system are analyzed. The bone structure, bladder, gas in the rectum, small bowel, soft tissue, weigh loss are evaluated by the criterion. The criterion are classified by best, good, bad and figure out the ratio with count. The re-setup proceed in case of one or over the two get the bad criterion and figure out the ratio of re-setup results: The ideal of therapy ratio is 19.2 % each criterion. And the good for therapy ratio is 54.9 %, the cases of bad for therapy is 25.8 %. The bad cases are have therapy after re-setup with post process. conclusion: Each pre-treatment image that acquired IG system has different results despite of same patients. The 25.8 % need to re-setup in order to unsuitable therapy. It is implies that the IG system is necessary establishing precise treatment plan like IMRT especially rectal cancer.