• Journal of Radiation Protection and Research
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• v.31 no.4
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• pp.181-186
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• 2006

A radiophotoluminescent glass rod detector (GRD) system has recently become commercially available. We investigate the dosimetric properties of the GRD regarding the reproducibility of signal, dose linearity and energy dependence. The reproducibility of five measurements for 50 GRDs is presented by an average of one standard deviation of each GRD and it is ${\pm}1.2%$. It is found to be linear in response to doses of $^{60}Co$ beam in the range 0.5 to 50 Gy with a coefficient of linearity of 0.9998. The energy dependence of the GRD is determined by comparing the dose obtained using cylindrical chamber to that by using the GRD. The GRD response for each beam is normalized to the response for a $^{60}Co$ beam. The responses for 6 and 15 MV x-ray beams are within ${\pm}1.5%$ (1SD). The energy response of GRD for high-energy photon is almost the same as the energy dependence of LiF:Mg:Ti (TLD-100)and shows little energy dependence unlike p-type silicon diode detector. The GRDs have advantages over other detectors such diode detector, and TLD: linearity, reproducibility and energy dependency. It has been verified to be an effective device for small field dosimetry for stereotactic radiosurgery.

• Progress in Medical Physics
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• v.27 no.4
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• pp.220-223
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• 2016

Generally, it is recommended that the dosimetric effect of carbon fiber couch should be considered especially for an intensity-modulated therapy with a large portion of monitor units from posterior angles. Even a flattening filter free (FFF) beam has been used for stereotactic body radiation therapy (SBRT), the effect of carbon fiber couch for FFF beam is not well known. This work is an effort to evaluate the dosimetric effect of carbon fiber couch for flattened and FFF beam of Elekta linac empirically. The absorbed doses were measured with Farmer type chamber and water-equivalent phantoms with and without couch. And differences of the absorbed doses between with and without couch defined as "couch effect". By comparing calculated dose in treatment planning system (TPS) with measured dose, the optimal density of couch was evaluated. Finally, differences on patient's skin dose and target dose by couch were evaluated in TPS. As a result, the couch effect for 6 and 10 MV flattened beam were -2.71% and -2.32%, respectively. These values were agreed with provided data by vendor within 0.5%. The couch effect for 6 and 10 MV FFF beam were -3.75% and -2.80%, respectively. The patient's skin dose was increased as 18.6% and target dose was decreased as 0.87%, respectively. It was realized that the couch effect of FFF beam was more severe than that of flattened beam. Patient's skin dose and target dose were changed by the couch effect.

• Progress in Medical Physics
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• v.27 no.4
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• pp.180-188
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• 2016

Acuros XB advanced dose calculation algorithm (AXB, Varian Medical Systems, Palo Alto, CA) has been released recently and provided the advantages of speed and accuracy for dose calculation. For clinical use, it is important to investigate the dosimetric performance of AXB compared to the calculation algorithm of the previous version, Anisotropic Analytical Algorithm (AAA, Varian Medical Systems, Palo Alto, CA). Ten volumetric modulated arc therapy (VMAT) plans for each of the following cases were included: head and neck (H&N), prostate, spine, and lung. The spine and lung cases were treated with stereotactic body radiation therapy (SBRT) technique. For all cases, the dose distributions were calculated using AAA and two dose reporting modes in AXB (dose-to-water, $AXB_w$, and dose-to-medium, $AXB_m$) with same plan parameters. For dosimetric evaluation, the dose-volumetric parameters were calculated for each planning target volume (PTV) and interested normal organs. The differences between AAA and AXB were statistically calculated with paired t-test. As a general trend, $AXB_w$ and $AXB_m$ showed dose underestimation as compared with AAA, which did not exceed within -3.5% and -4.5%, respectively. The maximum dose of PTV calculated by $AXB_w$ and $AXB_m$ was tended to be overestimated with the relative dose difference ranged from 1.6% to 4.6% for all cases. The absolute mean values of the relative dose differences were $1.1{\pm}1.2%$ and $2.0{\pm}1.2%$ when comparing between AAA and $AXB_w$, and AAA and $AXB_m$, respectively. For almost dose-volumetric parameters of PTV, the relative dose differences are statistically significant while there are no statistical significance for normal tissues. Both $AXB_w$ and $AXB_m$ was tended to underestimate dose for PTV and normal tissues compared to AAA. For analyzing two dose reporting modes in AXB, the dose distribution calculated by $AXB_w$ was similar to those of AAA when comparing the dose distributions between AAA and $AXB_m$.

• Journal of Korean Neurosurgical Society
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• v.54 no.5
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• pp.399-404
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• 2013

Objective : The authors conducted a retrospective cohort study to determine prognostic factors and treatment outcomes of brain metastases (BM) from breast cancer (BC) after Gamma Knife radiosurgery (GKS). Methods : Pathologic and clinical features, and outcomes were analyzed in a cohort of 62 patients with BM from BC treated by GKS. The Kaplan- Meier method, the log-rank test, and Cox's proportional hazards model were used to assess prognostic factors. Results : Median survival after GKS was 73.0 weeks (95% confidence interval, 46.0-100.1). HER2+ [hazard ratio (HR) 0.441; p=0.045], Karnofsky performance scale (KPS) ${\geq}70$ (RR 0.416; p=0.050) and systemic chemotherapy after GKS (RR 0.282; p=0.001) were found to be a favorable prognostic factor of overall survival. Actuarial local control (LC) rate were $89.5{\pm}4.5%$ and $70.5{\pm}6.9%$ at 6 and 12 months after GKS, respectively. No prognostic factors were found to affect LC rate. Uni- and multivariate analysis revealed that the distant control (DC) rate was higher in patients with; a small number (${\leq}3$) of metastasis (HR 0.300; p=0.045), no known extracranial metastasis (p=0.013, log-rank test), or the HER2+ subtype (HR 0.267; p=0.027). Additional whole brain radiation therapy and metastasis volume were not found to be significantly associated with LC, DC, or overall survival. Conclusion : The treatment outcomes of patients with newly diagnosed BM from BC treated with GKS could be affected primarily by intrinsic subtype, KPS, and systemic chemotherapy. Therapeutic strategy and prognosis scoring system should be individualized based on considerations of intrinsic subtype in addition to traditionally known parameters related to stereotactic radiosurgery.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.439-448
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• 1993

The B-type gamma knife unit was installed at Kyung-Hee University Hospital in March 1992. The selective beam plugging method can be used to reduce the low percentage isodose profiles of normal sensitive organ and to modify the isodose curves of treatment volume for better shaping of the target volume. For representing the changes of the low percentage isodose profiles, the variations of dose distribution for several cases were discussed in this paper. The film dosimetry was peformed for the evaluation of calculated isodose profiles predicted by KULA dose planning system. The results were verified by RFA-3 automatic densitometry. The clinical application of selective beam shielding method was peformed in 17 patients in 100 patients who have undergone gamma knife radiosurgery for a year. The calculated and the measured isodose profiles for the high percentage regions were well consistent with each other. When the target of pituitary tumor is macro-size, the selective beam shielding method is the most applicable method. When the target size, however, is small, the correct selection of the proper helmet size is very important. All patients were exposed almost about 3~12 Gy for brain stem, and 3~11.2 Gy for optic apparatus. It is recommended that the same or other plugging patterns with multiple isocenters should be used for protection of the radiosensitive normal structures with precise treatment of CNS lesions.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.431-437
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• 1993

An important problem in radiosurgery is the utilization of the proper beam parameters, to which dose shape is sensitive. Streotactic radiosurgery techniques for a linear accelerator typically, use circular radiation fields with multiple arcs to produce an spherical radiation distribution. Target volumes are irregular in shape for a certain case, and spherical distributions can irradiate normal tissues to high dose as well as the target region. The current improvement to dose distribution utilizes treating multiple isocenters or weighting various arcs to change treatment volume shape. in this paper another promising study relies upon dynamically shaping the treatment beam to fit the beam's eye view of the target. This conformal irradiation technique was evaluated by means of visual three dimensional dose distribution, dose volume histograms to the target volume and surrounding normal brain. It is shown that using even less arcs than multiple isocenter irradiation technique, the conformal therapy yields comparable dose gradients and superior homogeneity of dose within the target volume.

• Korean Journal of Head & Neck Oncology
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• v.34 no.1
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• pp.9-13
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• 2018

Background/Objectives: Brain metastasis (BM) is a rare form of distant metastasis with papillary thyroid cancer (PTC). Patients with BM of PTC carry a poor prognosis. The aim of this study was to contribute to the understanding of this disease by analyzing patients with BM of PTC. Materials & Methods: Between March 2003 and December 2013, the patient database was conducted to identify thyroid cancer patients treated. Among the 22,758 thyroid cancer patients, 14 (0.06 %) were identified to have metastasis to the brain during follow-up. The medical records of 14 patients with BM were retrospectively reviewed, focusing on the following: patient characteristics, synchronous or previous distant metastasis, treatments including whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS) and surgery, and characteristics on radiologic findings, time interval between first diagnosis of primary thyroid cancer and BM and survival after BM. Results: The mean age at initial diagnosis and BM were $50.9{\pm}15.8years$ and $61.3{\pm}12.7years$. The mean duration between initial diagnosis and BM was $10.4{\pm}7.9years$. Patients were treated with varied combinations of surgery, SRS and WBRT except 4 patients who had refused treatment. The median overall survival (OS) time after BM diagnosis was 10 months (range 1 - 19). Patients receiving treatment (WBRT and/or surgery, SRS) had a significant longer median OS of 16.5 months in comparison to 3.5 months for those treated without treatment. (p = 0.005) Conclusion: Patients who received aggressive treatment had a longer OS than those with only supportive care. Treatment such as surgery, SRS and WBRT should be considered in patients with BM.

• Progress in Medical Physics
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• v.24 no.4
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• pp.290-294
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• 2013

Stereotactic Radiosurgery require high accuracy and precision of patient positioning and target localization. We evaluate the real time positioning accuracy of isocenter using optic guided patient positioning system, ExacTrac (BrainLab, Germany), during spinal radiosurgery procedure. The system is based on real time detect multiple body markers attached on the selected patient skin landmarks. And a custom designed patient positioning verification tool (PPVT) was used to check the patient alignment and correct the patient repositioning before radiosurgery. In this study, We investigate the selected 8 metastatic spinal tumor cases. All type of tumors commonly closed to thoracic spinal code. To evaluate the isocenter positioning, real time patient alignment and positioning monitoring was carried out for comparing the current 3-dimensional position of markers with those of an initial reference positions. For a selected patient case, we have check the isocenter positioning per every 20 millisecond for 45 seconds during spinal radiosurgery. In this study, real time average isocenter positioning translation were $0.07{\pm}0.17$ mm, $0.11{\pm}0.18$ mm, $0.13{\pm}0.26$ mm, and $0.20{\pm}0.37$ mm in the x (lateral), y (longitudinal), z (vertical) directions and mean spatial error, respectively. And body rotations were $0.14{\pm}0.07^{\circ}$, $0.11{\pm}0.07^{\circ}$, $0.03{\pm}0.04^{\circ}$ in longitudinal, lateral, table directions and mean body rotation $0.20{\pm}0.11^{\circ}$, respectively. In this study, the maximum mean deviation of real time isocenter positioning translation during spinal radiosurgery was acceptable accuracy clinically.

• Investigative Magnetic Resonance Imaging
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• v.19 no.4
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• pp.218-223
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• 2015

Purpose: To investigate whether volumetric analysis based on T2WI and contrast-enhanced (CE) T1WI can distinguish between isocitrate dehydrogenase-1 mutation-positive ($IDH1^P$) and -negative ($IDH1^N$) glioblastomas (GBMs). Materials and Methods: We retrospectively enrolled 109 patients with histopathologically proven GBMs after surgery or stereotactic biopsy and preoperative MR imaging. We measured the whole-tumor volume in each patient using a semiautomatic segmentation method based on both T2WI and CE T1WI. We compared the tumor volumes between $IDH1^P$ (n = 12) and $IDH1^N$ (n = 97) GBMs using an unpaired t-test. In addition, we performed receiver operating characteristic (ROC) analysis for the differentiation of $IDH1^P$ and $IDH1^N$ GBMs using the tumor volumes based on T2WI and CE T1WI. Results: The mean tumor volume based on T2WI was larger for $IDH1^P$ GBMs than $IDH1^N$ GBMs ($108.8{\pm}68.1$ and $59.3{\pm}37.3mm^3$, respectively, P = 0.0002). In addition, $IDH1^P$ GBMs had a larger tumor volume on CE T1WI than did $IDH1^N$ tumors ($49.00{\pm}40.14$ and $22.53{\pm}17.51mm^3$, respectively, P < 0.0001). ROC analysis revealed that the tumor volume based on T2WI could distinguish $IDH1^P$ from $IDH1^N$ with a cutoff value of 90.25 (P < 0.05): 7 of 12 $IDH1^P$ (58.3%) and 79 of 97 $IDH1^N$ (81.4%). Conclusion: Volumetric analysis of T2WI and CE T1WI could enable $IDH1^P$ GBMs to be distinguished from $IDH1^N$ GBMs. We assumed that secondary GBMs with $IDH1^P$ underwent stepwise progression and were more infiltrative than those with $IDH1^N$, which might have resulted in the differences in tumor volume.

• Journal of radiological science and technology
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• v.33 no.4
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• pp.379-386
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• 2010

This study evaluated the motion of tumors during the entire period of therapy and the accuracy of radiosurgery among forty eight lung tumor patients who were underwent radiosurgery using the CyberKnife Synchrony Respiratory Tracking System. The motion of lung tumor was measured by the coordinates of a gold acupuncture needle inserted into the tumor or the area around the tumor using the CyberKnife image guided system. Then the accuracy of radiosurgery was evaluated based on the error of correlation computed with the motion tracking system. The lung tumor motion is Cranio-Caudal direction by an average of $2.63{\pm}1.87\;mm$, moved left-right direction by $1.13{\pm}0.71\;mm$, and anterior-posterior direction by $1.74{\pm}1.16\;mm$. The degree of rotational movement was $1.66{\pm}1.66^{\circ}$ on X axis, $1.20{\pm}0.97^{\circ}$ on Y axis, and $1.18{\pm}0.73^{\circ}$ on Z axis. The vector of translation movement was measured to be $3.78{\pm}2.00\;mm$ on the average. The results show that directions of Cranio-Caudal(p < 0.001), anterior-posterior direction(p < 0.029), and three dimensional vector value(p < 0.002) showed statistical significance, because the lower side of tumor showed more intensive movement compared to the upper side of tumor. The radiosurgery was carried out by compensating the motion of tumor after accurate investigation of the correlation error with the average of $0.95{\pm}0.62\;mm$ during the lung tumor radiosurgery with the CyberKnife Synchrony Respiratory Tracking System.