• 대한방사선기술학회지:방사선기술과학
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• 제41권6호
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• pp.567-572
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• 2018

Radiation therapy is one of the beneficial choices in the treatment of cancer. This is a comparison of TPS(Treatment Planning System) and GEANT4-DICOM, which should be preceded by the best radiation therapy. A treatment plan for prostate cancer was established with Eclipse and the point doses 366.1 cGy, 189.1 cGy, 213.4 cGy, 127 cGy, 105.7 cGy of any five prostate, bladder, rectum, right femoral head and left femoral head were identified. GEANT4-DICOM simulation showed that the results of Eclipse and ${\pm}2%$ dose error were confirmed. The monthly X-ray output agreement management value recommended by TG-142 is ${\pm}2%$, which means that the experimental results can be meaningful. In conclusion, GEANT4-DICOM is an infinite way to obtain more extended dose information once the time constraints are overcome in the simulation.

• Radiation Oncology Journal
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• 제35권4호
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• pp.306-316
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• 2017

Purpose: To investigate the predictive role of maximum standardized uptake value ($SUV_{max}$) of 2-[$^{18}F$]fluoro-2-deoxy-D-glucose($^{18}F-FDG$) positron emission tomography/computed tomography (PET/CT) in nasopharyngeal cancer patients treated with intensity-modulated radiotherapy (IMRT). Materials and Methods: Between October 2006 and April 2016, 53 patients were treated with IMRT in two institutions and their PET/CT at the time of diagnosis was reviewed. The $SUV_{max}$ of their nasopharyngeal lesions and metastatic lymph nodes (LN) was recorded. IMRT was delivered using helical tomotherapy. All patients except for one were treated with concurrent chemoradiation therapy (CCRT). Correlations between $SUV_{max}$ and patients' survival and recurrence were analyzed. Results: At a median follow-up time of 31.5 months (range, 3.4 to 98.7 months), the 3-year overall survival (OS) and disease-free survival (DFS) rates were 83.2% and 77.5%, respectively. In univariate analysis, patients with a higher nodal pre-treatment $SUV_{max}$ (${\geq}13.4$) demonstrated significantly lower 3-year OS (93.1% vs. 55.5%; p = 0.003), DFS (92.7% vs. 38.5%; p < 0.001), locoregional recurrence-free survival (100% vs. 50.5%; p < 0.001), and distant metastasis-free survival (100% vs. 69.2%; p = 0.004), respectively. In multivariate analysis, high pre-treatment nodal $SUV_{max}$ (${\geq}13.4$) was a negative prognostic factor for OS (hazard ratio [HR], 7.799; 95% confidence interval [CI], 1.506-40.397; p = 0.014) and DFS (HR, 9.392; 95% CI, 1.989-44.339; p = 0.005). Conclusions: High pre-treatment nodal $SUV_{max}$ was an independent prognosticator of survival and disease progression in nasopharyngeal carcinoma patients treated with IMRT in our cohort. Therefore, nodal $SUV_{max}$ may provide important information for identifying patients who require more aggressive treatment.

• Journal of Radiation Protection and Research
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• 제43권2호
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• pp.59-65
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• 2018

Background: We analyzed changes in the doses, structure volumes, and dose-volume histograms (DVHs) when data were transferred from one commercial treatment planning system (TPS) to another commercial TPS. Materials and Methods: A total of 22 volumetric modulated arc therapy (VMAT) plans for nasopharyngeal cancer were generated with the Eclipse system using 6-MV photon beams. The computed tomography (CT) images, dose distributions, and structure information, including the planning target volume (PTV) and organs at risk (OARs), were transferred from the Eclipse to the MRIdian system in digital imaging and communications in medicine (DICOM) format. Thereafter, DVHs of the OARs and PTVs were generated in the MRIdian system. The structure volumes, dose distributions, and DVHs were compared between the MRIdian and Eclipse systems. Results and Discussion: The dose differences between the two systems were negligible (average matching ratio for every voxel with a 0.1% dose difference criterion = $100.0{\pm}0.0%$). However, the structure volumes significantly differed between the MRIdian and Eclipse systems (volume differences of $743.21{\pm}461.91%$ for the optic chiasm and $8.98{\pm}1.98%$ for the PTV). Compared to the Eclipse system, the MRIdian system generally overestimated the structure volumes (all, p < 0.001). The DVHs that were plotted using the relative structure volumes exhibited small differences between the MRIdian and Eclipse systems. In contrast, the DVHs that were plotted using the absolute structure volumes showed large differences between the two TPSs. Conclusion: DVH interpretation between two TPSs should be performed using DVHs plotted with the absolute dose and absolute volume, rather than the relative values.

• Radiation Oncology Journal
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• 제22권1호
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• pp.33-39
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• 2004

목적 : 삼성서울병원 방사선종양학과에서는 1994년 개원 초부터 방사선치료를 받은 환자를 대상으로 자체 종양등록시스템을 운영하고 있다. 본 연구에서는 삼성서울병원 방사선종양학과 종양등록시 스템을 소개하고, 종양등록 현황을 분석하고자 하였다. 대상 및 방법 : 삼성서울병원 통합방사선관리 시스템의 한 부분이 종양등록 시스템이다 종양등록 시스템은 환자정보, 진단 정보, 치료정보로 구성되어 있으며, 모든 입력은 한 화면에서 이루어지며, 마우스만 가지고 입력이 가능하다. 2002년 7월까지 종양등록 시스템에 등록된 10,000예의 환자군에서 199명을 무작위 추출하여, 추출된 환자들의 등록된 종양정보와 실제 의무기록을 비교하여 입력이 누락되었거나 다른 정보가 등록되었는지 확인하였다. 결과 : 전체 대상 환자 199예 중 입력 오류가 발생한 경우는 15예(7.5%)에서 17건이었고, 진단정보와 치료정보에서 각각 8건, 9건이었다. 진단정보는 상병, 조직병리, AJCC 병기 및 전신수행능력이 잘못 입력된 경우였고, 치료정보중에는 병용치료 종류, 추적관찰 개시일 및 방사선치료 완결 유무 항목에서 오류가 있었다. 담당 의사별 오류를 분석하여 보았는데, 중복 점검이 시행된 경우에 모류는 3.7%에 불과하였지만 중복 점검이 되지 못한 경우는 15.6%의 오류가 있었다. 결론 : 종양등록 시스템을 이용하여 개별 항목별로는 모두 2% 이내의 오류에 불과하였다. 그러나, 정보의 질을 보다 향상시키기 위해서는 입력자의 성실성 및 종양등록에 대한 전문지식을 높이고, 주기적인 타당도 검사 및 중복점검 체계의 확립이 필요하겠다. 또한, 종합병원정보 시스템과 연계된 항목을 적극 활용할 수 있겠으나, 이를 위해서는 먼저 종합병원정보 시스템 내 종양등록 정보의 수준이 검증되어야 할 것이다.

• 대한방사선치료학회지
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• 제15권1호
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• pp.53-60
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• 2003

I. 목적 방사선치료를 함에 있어서 체내의 선량분포를 알기 위해서는 정확한 신체 단면도 제작이 반드시 필요하다. 최근에는 종양과 주변부위와의 관계가 명확하게 나타나는 C-T 영상이 치료계획에 많이 이용되고 있다. 하지만 아직도 석고나 납줄등을 이용하여 수작업으로 신체 단면도를 그리는 경우가 대부분이다. 그러나 이러한 방법은 옮기는 과정에서의 오류등으로 정확성의 신뢰도에 문제가 있고 소요시간이 길다는 단점이 있어 이를 개선하기 위해 digital 영상을 이용한 신체 단면도 제작을 시도해 보았다. II 대상 및 방법 digital camera를 이용하여 center line의 axial laser가 지나가는 면의 caudal쪽에서 center방향의 사진과 동일지점에서 QA용 phantom의 사진을 촬영한 후 image를 scanning한다. 삼각함수의 기본적인 원리를 이용하여 오차 범위를 최소화하였으며 각 지점의 X, Y좌표를 구하여 실제적인 크기의 신체 단면도를 완성하여 보았으며 여러 가지의 모양의 sample용 phantom과 실제 chest의 환자에게 적용하여 보았다. III. 결과 및 결론 기존의 납줄을 이용하여 제작한 신체단면도와 digital영상을 이용하여 제작한 신체단면도를 비교, 검토한 결과 오차범위가 실험적 오차에 있을 정도로 큰 차이가 없어 시간에 구애받지 않고 제작할 수 있는 이 방법이 보다 더 효율적이였다. 하지만 H&N등 요철이 심한 경우에 사용할 경우에는 보다 더 세심한 주의가 필요하며 영구적으로 사용하기 위해서는 두 개 이상의 camera 영상을 이용하는 photogrammatory기법의 도입 등, system적으로 좀더 수정 보완되어야 할 것으로 사료된다.

• Molecules and Cells
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• 제24권2호
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• pp.255-260
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• 2007

Bone marrow (BM) derived mesenchymal stem cells (MSC) are pluripotent cells which can differentiate into osteogenic, adipogenic and other lineages. In spite of the broad interest, the information about the changes in BM cell composition, in particularly about the variation of MSC number and their properties in relation to the age of the donor is still controversial. The aim of this study was to investigate the age associated changes in variations of BM cell composition, phenotype and differentiation capacities of MSC using a rat model. Cell populations were characterized by flow cytometry using light scattering parameters, DNA content and a set of monoclonal antibodies. Single cell analysis was performed by conventional fluorescent microscopy. In vitro culture of MSC was established and their phenotype and capability for in vitro differentiation into osteogenic and adipogenic cells was shown. Age related changes in tibiae and femurs, amount of BM tissue, BM cell composition, proportions of separated MSC and yield of MSC in 2 weeks of in vitro culture were found. At the same time, neither change in phenotype no in differentiation capacities of MSC was registered. Age-related changes of the number of MSC should be taken into account whenever MSC are intended to be used for investigations.

• 한국의학물리학회지:의학물리
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• 제33권4호
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• pp.53-62
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• 2022

In this study, we have investigated the shielding evaluation methodology for facilities using kV energy generators. We have collected and analysis of safety evaluation criteria and methodology for overseas facilities using radiation generators. And we investigated the current status of shielding evaluation of domestic industrial radiation generators. According to the statistical data from the Radiation Safety Information System, as of 2022, a total of 7,679 organizations are using radiation generating devices. Among them, 6,299 facilities use these devices for industrial purposes, which accounts for a considerable portion of radiation. The organizations that use these devices evaluate whether the exposure dose for workers and frequent visitors is suitable as per the limit regulated by the Nuclear Safety Act. Moreover, during this process, the safety shields are evaluated at the facilities that use the radiation generating devices. However, the facilities that use radiating devices having energy less than or equal to 6 MV for industrial purposes are still mostly evaluated and analyzed according to the National Council on Radiation Protection and Measurements 49 (NCRP 49) report published in 1976. We have investigated the technical standards of safety management, including the maximum permissible dose and parameters assessment criteria for facilities using radiation generating devices, based on the NCRP 49 and the American National Standards Institute/Health Physics Society N.43.3 reports, which are the representative reports related to radiation shielding management cases overseas.

• 대한방사선치료학회지
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• 제11권1호
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• pp.53-59
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• 1999

The aim of this study is to improve the accuracy of field placement and junction between adjacent fields and block shielding through the use of a computed tomography(CT) simulator and virtual simulation. The information was acquired by assessment of Alderson Rando phantom image using CT simulator (I.Q. Xtra - Picker), determination of each field by virtual fluoroscopy of voxel IQ workstation AcQsim and colored critical structures that were obtained by contouring in virtual simulation. And also using a coronal, sagittal and axial view can determine the field and adjacent field gap correctly without calculation during the procedure. With the treatment planning by using the Helax TMS 4.0, the dose in the junction among the adjacent fields and the spinal cord and cribriform plate of the critical structure was evaluated by the dose volume histogram. The pilot image of coronal and sagittal view took about 2minutes and 26minutes to get 100 images. Image translation to the virtual simulation workstation took about 6minutes. Contouring a critical structure such as cribriform plate, spinal cord using a virtual fluoroscopy were eligible to determine a correct field and shielding. The process took about 20 minutes. As the result of the Helax planning, the dose distribution in adjacent field junction was ideal, and the dose level shows almost 100 percentage in the dose volume histogram of the spinal cord and cribriform plate CT simulation can get a correct therapy area due to enhancement of critical structures such as spinal cord and cribriform plate. In addition, using a Spiral CT scanner can be saved a lot of time to plan a simulation therefore this function can reduce difficulties to keep the patient position without any movements to the patient, physician and radiotherapy technician.

• 한국의학물리학회지:의학물리
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• 제26권2호
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• pp.112-117
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• 2015

미국의학물리학회(AAPM) TG-100 위원회에서 제시하고 있는 가이드 라인에 준하여 환자 안전에 대한 정도관리를 수립하기 위하여 영남대학교병원 방사선종양학과에서 환자를 치료하는 중에 발생한 오류들을 중심으로 오류 유형을 분석하여, 환자중심의 방사선치료를 시행할 때 환자 안전을 위한 정도관리의 가이드 라인을 정립하고자 한다. 방사선종양학과에서 방사선 치료를 하는데 있어서 일으킬 수 있는 오류들을 분석하여 오류를 일으키는 빈도와 오류가 일어날 때 환자 에게 미치는 심각성과 오류가 일어났을 때 감지하지 못하고 지나치는 확률을 점수로 평가하고자 한다. 오류를 일으킬 수 있는 곳으로는 CT 모의치료실, 치료계획실, 치료실로 나누어 조사하였다. CT 모의치료실에서는 고정기구 사용의 오류가 위험중요지수의 값이 60으로 가장 높았고, 모의치료 정보입력의 오류가 6으로 가장 낮게 나타났다. 치료계획실에서는 선량계산 모델 선택의 오류가 위험중요지수의 값이 168로 가장 높았고, 환자의 치료 시작일 오류가 36으로 가장 낮게 나타났다. 치료실에서는 테이블 Bar 오류가 위험중요지수의 값이 252으로 가장 높았고, 체중변화 오류가 190을 나타내었으며, 배게 오류가 24로 가장 낮게 나타났다.

• Radiation Oncology Journal
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• 제36권4호
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• pp.295-303
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• 2018

Purpose: We evaluated prognostic value of the 8th edition of the American Joint Committee on Cancer/International Union for Cancer Control (AJCC/UICC) staging system for nasopharyngeal cancer and investigated whether tumor volume/metabolic information refined prognostication of anatomy based staging system. Materials and Methods: One hundred thirty-three patients with nasopharyngeal cancer who were staged with magnetic resonance imaging (MRI) and treated with intensity-modulated radiotherapy (IMRT) between 2004 and 2013 were reviewed. Multivariate analyses were performed to evaluate prognostic value of the 8th edition of the AJCC/UICC staging system and other factors including gross tumor volume and maximum standardized uptake value of primary tumor (GTV-T and SUV-T). Results: Median follow-up period was 63 months. In multivariate analysis for overall survival (OS), stage group (stage I-II vs. III-IVA) was the only significant prognostic factor. However, 5-year OS rates were not significantly different between stage I and II (100% vs. 96.2%), and between stage III and IVA (80.1% vs. 71.7%). Although SUV-T and GTV-T were not significant prognostic factors in multivariate analysis, those improved prognostication of stage group. The 5-year OS rates were significantly different between stage I-II, III-IV (SUV-T ≤ 16), and III-IV (SUV-T > 16) (97.2% vs. 78% vs. 53.8%), and between stage I, II-IV (GTV-T ≤ 33 mL), and II-IV (GTV-T > 33 mL) (100% vs. 87.3% vs. 66.7%). Conclusion: Current anatomy based staging system has limitations on prognostication for nasopharyngeal cancer despite the most accurate assessment of tumor extent by MRI. Tumor volume/metabolic information seem to improve prognostication of current anatomy based staging system, and further studies are needed to confirm its clinical significance.