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Determination of Therapeutic Dose of I-131 for First High Dose Radioiodine Therapy in Patients with Differentiated Thyroid Cancer: Comparison of Usefulness between Pathological Staging, Serum Thyroglobulin Level and Finding of I-123 Whole Body Scan (분화 갑상선암 수술 후 최초 고용량 방사성옥소 치료시 투여용량 결정: 병리적 병기, 혈청 갑상선글로불린치와 I-123 전신 스캔의 유용성 비교)

  • Jeong, Hwan-Jeong;Lim, Seok-Tae;Youn, Hyun-Jo;Sohn, Myung-Hee
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.4
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    • pp.301-306
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    • 2008
  • Purpose: Recently, a number of patients needed total thyroidectomy and high dose radioiodine therapy (HD-RAI) get increased more. The aim of this study is to evaluate whether pathological staging (PS) and serum thyroglobulin (sTG) level could replace the diagnostic I-123 scan for the determination of therapeutic dose of HD-RAI in patients with differentiated thyroid cancer. Materials and Methods: Fifty eight patients (M:F=13;45, age $44.5{\pm}11.5\;yrs$) who underwent total thyroidectomy and central or regional lymph node dissection due to differentiated thyroid cancer were enrolled. Diagnostic scan of I-123 and sTG assay were also performed on off state of thyroid hormone. The therapeutic doses of I-131 (TD) were determined by the extent of uptakes on diagnostic I-123 scan as a gold standard. PS was graded by the criteria recommended in 6th edition of AJCC cancer staging manual except consideration of age. For comparison of the determination of therapeutic doses, PS and sTG were compared with the results of I-123 scan. Results: All patients were underwent HD-RAI. Among them, five patients (8.6%) were treated with 100 mCi of I-131, fourty three (74.1%) with 150 mCi, six (10.3%) with 180 mCi, three (5.2%) with 200 mCi, and one (1.7%) with 250 mCi, respectively. On the assessment of PS, average TDs were $154{\pm}25\;mCi$ in stage I (n=9), $175{\pm}50\;mCi$ in stage II (n=4), $149{\pm}21\;mCi$ in stage III (n=38), and $161{\pm}20\;mCi$ in stage IV (n=7). The statistical significance was not shown between PS and TD (p=0.169). Among fifty two patients who had available sTG, 25 patients (48.1%) having below 2 ng/mL of sTG were treated with $149{\pm}26\;mCi$ of I-131, 9 patients (17.3%) having $2{\leq}\;sTG\;<5\;ng/mL$ with $156{\pm}17\;mCi$, 5 patients (9.6%) having $5{\leq}\;sTG\;<10\;ng/mL$ with $156{\pm}13\;mCi$, 7 patients (13.5%) having $10{\leq}sTG\;<50\;ng/mL$ with $147{\pm}24\;mCi$, and 6 patients (11.5%) having above 50 ng/mL with $175{\pm}42\;mCi$. The statistical significance between sTG level and TD (p=0.252) was not shown. Conclusion: In conclusion, PS and sTG could not replace the determination of TD using I-123 scan for first HD-RAI in patients with differentiated thyroid cancer.

Evaluation of the Radioimmunotherapy Using I-131 labeled Vascular Endothelial Growth Factor Receptor2 Antibody in Melanoma Xenograft Murine Model (흑색종에서의 I-131표지 혈관내피세포성장인자 수용체2항체를 이용한 방사면역치료 평가)

  • Kim, Eun-Mi;Jeong, Hwan-Jeong;Park, Eun-Hye;Cheong, Su-Jin;Lee, Chang-Moon;Jang, Kyu-Yun;Kim, Dong-Wook;Lim, Seok-Tae;Sohn, Myung-Hee
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.4
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    • pp.307-313
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    • 2008
  • Purpose: Vascular endothelial growth factor (VEGF) and its receptor, fetal liver kinase 1 (Flk-1), play an important role in vascular permeability and tumor angiogenesis. The aim of this study is to evaluate the therapeutic efficacy of $^{131}I$ labeled anti-Flk-1 monoclonal antibody (DC101) on the growth of melanoma tumor, which is known to be very aggressive in vivo. Materials and Methods: Balb/c nude mice were injected subcutaneously with melanoma cells in the right flank. Tumors were allowed to grow up to $200-250\;mm^3$ in volume. Gamma camera imaging and biodistribution studies were performed to identify an uptake of $^{131}I$-DC101 in various organs. Mice with tumor were randomly divided into five groups (10 mice per group) and injected intravenously; control PBS (group 1), $^{131}I$-DC101 $50\;{\mu}g/mouse$ (group 2), non-labeled DC101 $50\;{\mu}g/mouse$ (group 3), $^{131}I$-DC101 $30\;{\mu}g/mouse$ (group 4) and $15\;{\mu}g/mouse$ (group 5) every 3 or 4 days for 20 days. Tumor volume was measured with caliper twice a week. Results: In gamma camera images, the uptake of $^{131}I$-DC101 into tumor and thyroid was increased with time. Biodistribution results showed that the radioactivity of blood and other major organ was gradually decreased with time whereas tumor uptake was increased up to 48 hr and then decreased. After 4th injection of $^{131}I$-DC101, tumor volume of group 2 and 4 was significantly smaller than that group 1. After 5th injection, the tumor volume of group 5 also significantly reduced. Conclusion: These results indicated that delivery of $^{131}I$ to tumor using FlK-1 antibody, DC101, effectively blocks tumor growth in aggressive melanoma xenograft model.

The Content and Risk Assessment of Heavy Metals in Herbal Pills (유통 환제의 유해 중금속 함량 및 위해도 평가)

  • Lee, Sung-Deuk;Lee, Young-Ki;Kim, Moo-Sang;Park, Seok-Ki;Kim, Yeon-Sun;Chae, Young-Zoo
    • Journal of Food Hygiene and Safety
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    • v.27 no.4
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    • pp.375-387
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    • 2012
  • The objective of this study is investigation of contamination levels and assessment of health risk effects of heavy metals in herbal pills. 31 Items and 93 samples were obtained for this investigation from major herbal medicine producing areas, herbal markets and on-line supermarkets from Jan to Jun in 2010. Inductively coupled plasma mass spectrometer method was conducted for the quantitative analysis of Pb, Cd and As. In addition, the mercury analyzer system was conducted for that of Hg without sample digestion. The average contents of heavy metals in samples were as follows : 0.87 mg/kg for Pb, 0.08 mg/kg for Cd, 2.87 mg/kg for As and 0.16 mg/kg for Hg, respectively. In addition, the average contents of heavy metals in different parts of plants, including cortex, fructus, herba, radix, seed, algae and others were 0.63 mg/kg, 3.94 mg/kg, 1.42 mg/kg, 1.05 mg/kg, 0.16 mg/kg, 22.31 mg/kg and 10.17 mg/kg, respectively. After the estimations of dietary exposure, the acceptable daily intake (ADI), the average daily dose (ADD), the provisional tolerable weekly intake (PTWI) and the relative hazard of heavy metals were evaluated. As the results, the relative hazards compared to PTWI in samples were below the recommended standard of JECFA as Pb 3.1%, Cd 0.9%, Hg 0.5%. Cancer risks through slope factor (SF) by Ministry of Environment Republic Korea and Environmental Protection Agency was $4.24{\times}10^{-7}$ for Pb and $3.38{\times}10^{-4}$ for As (assuming that the total arsenic content was equal to the inorganic arsenic). Based on our results, possible Pb-induced cancer risks in herbal pills according to parts used including cortex, fructus, herba, radix, seed, algae and others were $1.95{\times}10^{-7}$, $1.45{\times}10^{-6}$, $2.14{\times}10^{-7}$, $6.27{\times}10^{-7}$, $1.99{\times}10^{-8}$, $3.61{\times}10^{-7}$ and $9.64{\times}10^{-8}$, respectively. Possible As-induced cancer risks in herbal pills by parts used including cortex, fructus, herba, radix, seed, algae and others were $1.54{\times}10^{-5}$, $7.24{\times}10^{-5}$, $1.23{\times}10^{-4}$, $2.02{\times}10^{-5}$, $3.25{\times}10^{-6}$, $2.18{\times}10^{-3}$ and $5.67{\times}10^{-6}$ respectively. Taken together, these results indicate that the majority of samples except for some samples with relative high contents of heavy metals were safe.

Changes of Proteolytic Activity and Amino Acid Composition of the Tissue Extract from Sea Cucumber Entrails during Fermentation with Salt (해삼내장(內臟)젓갈 숙성중(熟成中) 단백질분해효소(蛋白質分解酵素)의 활성(活性)과 아미노산(酸) 조성(組成)의 변화(變化))

  • Lee, Gi Chan;Cho, Deuk Moon;Byun, Dae Seok;Joo, Hyen Kyu;Pyeun, Jae Hyeung
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.12 no.4
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    • pp.342-349
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    • 1983
  • This study was undertaken to ascertain food and nutritional evaluating data on the processing of fermented sea cucumber (Stichopus japonicus) entrails. In the experiment, the crude proteolytic enzyme from the entrails tissue of raw and fermented sea cucumber during the days of ripening was extracted. The optimal activity condition for the crude enzyme and the compositional changes of amino acid of the protein and free amino acid in the raw and fermented sample were also investigated. 1. Less than three kinds of proteolytic enzymes that each enzyme has optimal activity condition at pH 3.1 $50^{\circ}C$(A-enzyme), pH 5.7 $50^{\circ}C$(B-enzyme) and pH 7.7 $45^{\circ}C$(C-enzyme), respectively were believed to be exist in the entrails tissue of sea cucumber. 2. A-enzyme and C-enzyme were strongly inhibited with the increase of the salt concentration, and B-enzyme was activated at the 1% salt concentration and was inhibited above the 5% salt concentration. 3. The result of the effect of several salt ions on the proteolytic activity showed that A-enzyme was slightly inhibited in the presence of all salt ions added, B-enzyme was activated in the presence of the all salt ions except $Cu^{2+}$ and C-enzyme was activated in the presence of $Ca^{2+}$ and $Mn^{2+}$, and inhibited by $Cu^{2+}$, $Co^{2+}$ and $Mg^{2+}$. 4. When the effects of the ripening days on the proteolytic activity of the crude enzymes were analysed, the activity of the A-enzyme was slightly weakened with the lapse of the fermentation days, whereas the B-enzyme was not influenced by the fermentation days. 5. In the analysis of amino acid composition of the protein of the samples, the 8 days fermented sea cucumber entrails showed the diminution of all kinds of amino acid. Apparently diminished amino acids were arginine, alanine, glutamic acid, glycine, serine, valine, threonine and lysine etc., and methionine, histidine and isoleucine were slightly decreased. 6. In the analysis of free amino acid composition of the 8 days fermented sample, glutamic acid, aspartic acid, leucine and lysine were rich, while histidine, methionine, proline and tyrosine were poor. The most of free amino acids were increased during the fermentation procedure and especially in lysine, histidine, threonine, glutamic acid, methionine, valine and leucine.

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Evaluation of Combine IGRT using ExacTrac and CBCT In SBRT (정위적체부방사선치료시 ExacTrac과 CBCT를 이용한 Combine IGRT의 유용성 평가)

  • Ahn, Min Woo;Kang, Hyo Seok;Choi, Byoung Joon;Park, Sang Jun;Jung, Da Ee;Lee, Geon Ho;Lee, Doo Sang;Jeon, Myeong Soo
    • The Journal of Korean Society for Radiation Therapy
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    • v.30 no.1_2
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    • pp.201-208
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    • 2018
  • Purpose : The purpose of this study is to compare and analyze the set-up errors using the Combine IGRT with ExacTrac and CBCT phased in the treatment of Stereotatic Body Radiotherapy. Methods and materials : Patient who were treated Stereotatic Body Radiotherapy in the ulsan university hospital from May 2014 to november 2017 were classified as treatment area three brain, nine spine, three pelvis. First using ExacTrac Set-up error calibrated direction of Lateral(Lat), Longitudinal(Lng), Vertical(Vrt), Roll, Pitch, Yaw, after applied ExacTrac moving data in addition to use CBCT and set-up error calibrated direction of Lat, Lng, Vrt, Rotation(Rtn). Results : When using ExacTrac, the error in the brain region is Lat $0.18{\pm}0.25cm$, Lng $0.23{\pm}0.04cm$, Vrt $0.30{\pm}0.36cm$, Roll $0.36{\pm}0.21^{\circ}$, Pitch $1.72{\pm}0.62^{\circ}$, Yaw $1.80{\pm}1.21^{\circ}$, spine Lat $0.21{\pm}0.24cm$, Lng $0.27{\pm}0.36cm$, Vrt $0.26{\pm}0.42cm$, Roll $1.01{\pm}1.17^{\circ}$, Pitch $0.66{\pm}0.45^{\circ}$, Yaw $0.71{\pm}0.58^{\circ}$, pelvis Lat $0.20{\pm}0.16cm$, Lng $0.24{\pm}0.29cm$, Vrt $0.28{\pm}0.29cm$, Roll $0.83{\pm}0.21^{\circ}$, Pitch $0.57{\pm}0.45^{\circ}$, Yaw $0.52{\pm}0.27^{\circ}$ When CBCT is performed after the couch movement, the error in brain region is Lat $0.06{\pm}0.05cm$, Lng $0.07{\pm}0.06cm$, Vrt $0.00{\pm}0.00cm$, Rtn $0.0{\pm}0.0^{\circ}$, spine Lat $0.06{\pm}0.04cm$, Lng $0.16{\pm}0.30cm$, Vrt $0.08{\pm}0.08cm$, Rtn $0.00{\pm}0.00^{\circ}$, pelvis Lat $0.06{\pm}0.07cm$, Lng $0.04{\pm}0.05cm$, Vrt $0.06{\pm}0.04cm$, Rtn $0.0{\pm}0.0^{\circ}$. Conclusion : Combine IGRT with ExacTrac in addition to CBCT during Stereotatic Body Radiotherapy showed that it was possible to reduce the set-up error of patients compared to single ExacTrac. However, the application of Combine IGRT increases patient set-up verification time and absorption dose in the body for image acquisition. Therefore, depending on the patient's situation that using Combine IGRT to reduce the patient's set-up error can increase the radiation treatment effectiveness.

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Effects of Soil Organic Matter Contents, Paddy Types and Agricultural Climatic Zone on CH4 Emissions from Rice Paddy Field (벼 논에서 토양 유기물 함량, 논 유형 및 농업기후대가 CH4 배출에 미치는 영향)

  • Ko, Jee-Yeon;Lee, Jae-Saeng;Woo, Koan-Sik;Song, Seok-Bo;Kang, Jong-Rae;Seo, Myung-Chul;Kwak, Do-Yeon;Oh, Byeong-Gun;Nam, Min-Hee
    • Korean Journal of Soil Science and Fertilizer
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    • v.44 no.5
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    • pp.887-894
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    • 2011
  • To evaluate the effects of abiotic factors of paddy fields on greenhouse gases (GHGs) emissions from rice paddy fields, $CH_4$ emission amounts were investigated from rice paddy fields by different soil organic matter contents, paddy types, and agricultural climatic zone in Yeongnam area during 3 years. $CH_4$ emission amounts according to soil organic matter contents in paddy field were conducted at having different contents of 5 soil organic matters fields (23.6, 28.7, 31.0, 34.5, and $38.0g\;kg^{-1}$), The highest $CH_4$ emission amount was recorded in the highest soil organic matters plot of $38.0g\;kg^{-1}$. High correlation coefficient (r=$0.963^{**}$) was obtained between $CH_4$ emissions from paddy fields and their soil organic matter contents. According to paddy field types, $CH_4$ emission amounts were investigated at 4 different paddy fields as wet paddy, sandy paddy, immature paddy, and mature paddy. The highest $CH_4$ emissions was recorded in wet paddy (100%) and followed as immature paddy 64.0%, mature paddy 46.8%, and sandy paddy 23.8%, respectively. For the effects of temperature on $CH_4$ emissions from paddy fields, 4 agricultural climatic zones were investigated, which were Yeongnam inland zone (YIZ), eastern coast of central zone (ECZ), plain area of Yeongnam inland mountainous zone (PMZ), and mountainous area of Yeongnam inland mountainous zone (MMZ). The order of $CH_4$ emission amounts from paddy fields by agricultural climatic zone were YIZ (100%) > ECZ (94.6%) > PMZ (91.6%) > MMZ (78.9%). The regression equation between $CH_4$ emission amounts from paddy fields and average air temperature of Jul. to Sep. of agricultural climatic zone was y = 389.7x-4,287 (x means average temperature of Jul. to Sep. of agricultural climatic zone, $R^2=0.906^*$)

NO2 and SO2 Reduction Capacities and Their Relation to Leaf Physiological and Morphological Traits in Ten Landscaping Tree Species (조경수 10개 수종에 있어 NO2, SO2 저감 능력과 잎의 생리적, 형태적 특성과의 관계)

  • Kim, Kunhyo;Jeon, Jihyeon;Yun, Chan Ju;Kim, Tae Kyung;Hong, Jeonghyun;Jeon, Gi-Seong;Kim, Hyun Seok
    • Journal of Korean Society of Forest Science
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    • v.110 no.3
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    • pp.393-405
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    • 2021
  • With increasing anthropogenic emission sources, air pollutants are emerging as a severe environmental problem worldwide. Accordingly, the importance of landscape trees is emerging as a potential solution to reduce air pollutants, especially in urban areas. This study quantified and compared NO2 and SO2 reduction abilities of ten major landscape tree species and analyzed the relationship between reduction ability and physiological and morphological characteristics. The results showed NO2 reduction per leaf area was greatest in Cornus officinalis (19.81 ± 3.84 ng cm-2 hr-1) and lowest in Pinus strobus (1.51 ± 0.81 ng cm-2 hr-1). In addition, NO2 reduction by broadleaf species (14.72 ± 1.32 ng cm-2 hr-1) was 3.1-times greater than needleleaf species (4.68 ± 1.26 ng cm-2hr-1; P < 0.001). Further, SO2 reduction per leaf area was greatest in Zelkova serrata (70.04 ± 7.74 ng cm-2 hr-1) and lowest in Pinus strobus (4.79 ± 1.02 ng cm-2 hr-1). Similarly, SO2 reduction by broadleaf species (44.21 ± 5.01 ng cm-2 hr-1) was 3.9-times greater than needleleaf species (11.47 ± 3.03 ng cm-2 hr-1; P < 0.001). Correlation analysis revealed differences in NO2 reduction was best explained by chlorophyll b content (R2 = 0.671, P = 0.003) and SO2 reduction was best described by SLA and length of margin per leaf area (R2 = 0.456, P = 0.032 and R2 = 0.437, P = 0.001, R2 = 0.872, P < 0.001, respectively). In summary, the ability of trees to reduce air pollutants was related to photosynthesis, evapotranspiration, stomatal conductance, and leaf thickness. These findings highlight effective reduction of air pollutants by landscaping trees requires comprehensively analyzing physiological and morphological species characteristics.

Analysis of the Eyeglasses Supply System for Ametropes in ROK Military (한국군 비정시자용 안경의 보급체계 분석)

  • Jin, Yong-Gab;Koo, Bon-Yeop;Lee, Woo-Chul;Yoon, Moon-Soo;Park, Jin-Tae;Lee, Hang-Seok;Lee, Kyo-Eun;Leem, Hyun-Sung;Jang, Jae-Young;Mah, Ki-Choong
    • The Korean Journal of Vision Science
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    • v.20 no.4
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    • pp.579-588
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    • 2018
  • Purpose : To analyze the eyeglasses supply system for ametropic soldiers in ROK military. Methods : We investigated and analyzed the supply system of eyeglasses for the ametropic soldiers provided by the Korean military. The refractive powers and corrected visual acuity were measured for 37 ametropic soldiers who wear insert glasses for ballistic protective and gas-masks supplied by the military based on their habitual prescriptions. Full correction of refractive error was prescribed for subjects having less than 1.0 of distance visual acuity, and comparison was held for inspecting the changes in corrected visual acuity. Suggestions were provided for solving the issues regarding current supplying system, and this study investigated the applicabilities for utilizing professional optometric manpower. Results : The new glasses supplied by army for ametropic soldiers were duplicated from the glasses they worn when entering the army. The spherical equivalent refractive powers of the conventional, ballistic protective and gas-mask insert glasses supplied for 37 ametropic soldiers were $-3.47{\pm}1.69D$, $-3.52{\pm}1.66D$ and $-3.55{\pm}1.63D$, respectively, and the spherical equivalent refractive power of full corrected glasses was $-3.79{\pm}1.66D$, which showed a significant difference(p<0.05). The distant corrected visual acuity measured at high and low contrast(logMAR) of conventional, ballistic protective and gas-mask insert glasses were $0.06{\pm}0.80$, $0.21{\pm}0.82$, $0.15{\pm}0.74$, $0.34{\pm}0.89$, $0.10{\pm}0.70$ and $0.22{\pm}0.27$, respectively, while the corrected visual acuity by full corrected glasses were increased to $0.02{\pm}1.05$, $0.10{\pm}0.07$, $0.09{\pm}0.92$, $0.26{\pm}0.10$, $0.04{\pm}1.00$ and $0.19{\pm}1.00$, respectively. There was a significant difference(p<0.05) except for the case of the low contrast corrected visual acuity of the conventional and gas-mask insert glasses. The procedure for ordering, dispensing, and supplying military glasses consists of 5 steps, and it was found that approximately two weeks or more are required to supply from the initial examination. Conclusion : The procedure of supplying the military glasses showed three issues: 1) a lack of refraction for prescription system, 2) relatively long length of time required for supplying the glasses, 3) an inaccurate power of supplied glasses. In order to solve those issues, in the short term, education is necessarily required for soldiers on the measurement of the refractive powers, and in the near future, further standard procedures for prescription of glasses as well as the securement of optometric manpower are expected.

A Study on the Differences in Breeding Call of Cicadas in Urban and Forest Areas (도시와 산림지역 매미과 번식울음 차이 연구)

  • Kim, Yoon-Jae;Ki, Kyong-Seok
    • Korean Journal of Environment and Ecology
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    • v.32 no.6
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    • pp.698-708
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    • 2018
  • The purpose of this study was to investigate differences in the breeding call characteristics of cicada species found in urban and forest areas in the central region of Korea by examining the interspecific effects and environmental factors affecting the breeding calls and breeding call patterns. The selected research sites were Gyungnam Apartment in Bangbae-dong, Seoul for the urban area and Chiak Mountain National Park in Wonju for the forest area. The research method for both sites was to record cicada breeding calls for 24 hours with a recorder installed at the site and analyze the results. Data from the Korea Meteorological Administration were used for environmental factors. The research period was from June 19, 2017 to September 30, 2017. As a result of the study, there were differences in the emergence of species between the two research sites: while Platypleura kaempferi, Hyalessa fuscata, Meimuna opalifera, Graptopsaltria nigrofuscata, and Suisha coreana were observed at both sites, Cryptotympana atrata was observed in the urban area and Leptosemia takanonis in the forest area only. The emergence periods of cicadas at the two sites were also different. The activities of P. kaempferi and L. takanonis were noticeable in the forest area. In the urban area, however, L. takanonis was not observed and the duration of activity of P. kaempferi was short. In the urban area, C. atrata appeared and sang for a long period; H. fuscata, M. opalifera, and G. nigrofuscata appeared earlier than in the forest area. S. coreana appeared earlier in the forest area than in the urban area. According to the daily call cycle analysis, even cospecific cicada showed a wide variation in their daily cycle depending on the region and the interspecific effects between different cicadas, and the environmental differences between the urban and forest areas affected the calls of cicadas. The results of correlation analysis between each cicada breeding calls and environmental factors of each site showed positive correlation with average temperature of most cicadas except P. kaempferi and C. atrata. The same species of each site showed positive correlations with more diverse weather factors such as solar irradiance. Logistic regression analysis showed that cicadas with overlapping calling times had significant effects on each other's breeding calls. C. atrata, which appeared only in the urban area, had a positive effect on the calling frequency of H. fuscata, M. opalifera, and G. nigrofuscata, which called in the same period. Additionally, L. takanonis, which appeared only in the forest area, and P. kaempferi had a positive effect on each other, and M. opalifera had a positive effect on the calling frequency of H. fuscata and G. nigrofuscata in the forest area. For the environmental factors, the calling frequency of cicadas was affected by the average temperatures of the urban and forest areas, and cicadas that appeared in the forest area were also affected by the amount of solar radiation. According to the results of statistical analysis, urban cicadas with similar activity periods are influenced by species, especially with respect to urban dominant species, C. atrata. Forest cicadas were influenced by species, mainly M. opalifera, which is a forest dominant species. The results of the meteorological impact analysis were similar to those of the correlation analysis, and were influenced mainly by the temperature, and the influence of the insolation was more increased in the forests.

Evaluating efficiency of application the skin flash for left breast IMRT. (왼쪽 유방암 세기변조방사선 치료시 Skin Flash 적용에 대한 유용성 평가)

  • Lim, Kyoung Dal;Seo, Seok Jin;Lee, Je Hee
    • The Journal of Korean Society for Radiation Therapy
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    • v.30 no.1_2
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    • pp.49-63
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    • 2018
  • Purpose : The purpose of this study is investigating the changes of treatment plan and comparing skin dose with or without the skin flash. To investigate optimal applications of the skin flash, the changes of skin dose of each plans by various thicknesses of skin flash were measured and analyzed also. Methods and Material : Anthropomorphic phantom was scanned by CT for this study. The 2 fields hybrid IMRT and the 6 fields static IMRT were generated from the Eclipse (ver. 13.7.16, Varian, USA) RTP system. Additional plans were generated from each IMRT plans by changing skin flash thickness to 0.5 cm, 1.0 cm, 1.5 cm, 2.0 cm and 2.5 cm. MU and maximum doses were measured also. The treatment equipment was 6MV of VitalBeam (Varian Medical System, USA). Measuring device was a metal oxide semiconductor field-effect transistor(MOSFET). Measuring points of skin doses are upper (1), middle (2) and lower (3) positions from center of the left breast of the phantom. Other points of skin doses, artificially moved to medial and lateral sides by 0.5 cm, were also measured. Results : The reference value of 2F-hIMRT was 206.7 cGy at 1, 186.7 cGy at 2, and 222 cGy at 3, and reference values of 6F-sIMRT were measured at 192 cGy at 1, 213 cGy at 2, and 215 cGy at 3. In comparison with these reference values, the first measurement point in 2F-hIMRT was 261.3 cGy with a skin flash 2.0 cm and 2.5 cm, and the highest dose difference was 26.1 %diff. and 5.6 %diff, respectively. The third measurement point was 245.3 cGy and 10.5 %diff at the skin flash 2.5 cm. In the 6F-sIMRT, the highest dose difference was observed at 216.3 cGy and 12.7 %diff. when applying the skin flash 2.0 cm for the first measurement point and the dose difference was the largest at the application point of 2.0 cm, not the skin flash 2.5 cm for each measurement point. In cases of medial 0.5 cm shift points of 2F-hIMRT and 6F-sIMRT without skin flash, the measured value was -75.2 %diff. and -70.1 %diff. at 2F, At -14.8, -12.5, and -21.0 %diff. at the 1st, 2nd and 3rd measurement points, respectively. Generally, both treatment plans showed an increase in total MU, maximum dose and %diff as skin flash thickness increased, except for some results. The difference of skin dose using 0.5 cm thickness of skin flash was lowest lesser than 20 % in every conditions. Conclusion : Minimizing the thickness of skin flash by 0.5 cm is considered most ideal because it makes it possible to keep down MUs and lowering maximum doses. In addition, It was found that MUs, maximum doses and differences of skin doses did not increase infinitely as skin flash thickness increase by. If the error margin caused by PTV or other factors is lesser than 1.0 cm, It is considered that there will be many advantages in with the skin flash technique comparing without it.

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