• Journal of Biomedical Engineering Research
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• v.23 no.5
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• pp.365-373
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• 2002

Accurate localization of target lesion is required to protect normal peripheral tissue and irradiate exactly to tumors in stereotactic radiosurgery(SRS). Digital angiography is one of the most effective diagnostic tools to detect and identify the target tumors. However, it shows pincushion distortion due to the characteristics of the image intensifier. We have implemented a simulation study for the correction of distortion using the geometric transformation. Phantom images were produced transformation. In conclusion, the geometric transformation could effectively be used for the pincushion distortion of image intensifier and there was no significant different between two methods indicating 2% correction error from the ideal image in all cases.

• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.119-122
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• 2011

We report a case of 70-year-old man with glioblastoma presenting as acute encephalitic illness. The patient exhibited sudden onset of cognitive impairment and headache for 2 days. Initial brain MRI showed left temporal lobe hyperintensity, and cerebrospinal fluid cytology revealed a mild pleocytosis. The patient had initially improved after medical treatment with a presumptive diagnosis of herpes simplex encephalitis (HSE). After 8 months, the patient complained of recurrent seizures. A follow-up brain MRI revealed marked increases in size and surrounding perilesional edema in the left temporal lesion on T2-weighted images and a new contrast-enhancing lesion on gadolinium-enhanced T1-weighted images. Stereotactic brain biopsy revealed a glioblastoma. The atypical encephalitic presentation of glioblastoma should be considered if definitive evidence for the diagnosis of HSE cannot be obtained.

• Journal of Korean Neurosurgical Society
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• v.47 no.1
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• pp.68-70
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• 2010

We report a case of intracranial dissemination developing approximately 4 months after partial removal of a spinal cord anplastic astrocytoma in a 22-year-old male. He presented with paraplegia on initial admission at a local hospital. Spinal magnetic resonance (MR) images disclosed multiple intramedullary lesions at the T3-11. The tumor was partially removed. The final histologic diagnosis was anaplastic astrocytoma. Four months after the operation, he was admitted with the symptoms of headache and deterioration of consciousness. MR images showed enhanced lesions in the anterior horn of the left lateral ventricle, and septum pellucidum. He underwent computed tomography-guided stereotactic biopsy and histological appearance was consistent with anaplastic astrocytoma. The clinical course indicates that the tumor originated in the spinal cord and extended into the subarachnoid space, first the spinal canal and later intracranial.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.101-105
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• 1992

Authors performed a stereotactic radiosurgery with multiple noncoplanar convergent photon beams of linear accelerator (NELAC-1018 18 MeV, NEC) using a specially designed Yeungnam localization device for two patients with recurrent glioblastoma multiforme. One patient had 2 cm sized and the other 4 cm sized mass on the CT images. After single session of treatment with 15 and 20 Gy, headache was improved in a few days after radiosurgery with no remarkable untoward reactions. Our experience with these two patients were encouraging and we found that our localization device, which is easily adjustable and inexpensive, could be a valuable tool for stereotactic radiosurgery particularly in the treatment of recurrent brain tumor.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.79-86
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• 2015

Purpose : The purpose of this study was to determine the proper treatment time of stereotactic body radiation therapy for spine metastasis cancer by using the image guidance system of CyberKnife(Accuray Incorporated, USA) which is able to correct movements of patients during the treatment. Materials and Methods : Fifty seven spine metastasis cancer patients who have stereotactic body radiation therapy of CyberKnife participate, 8 of them with cervical spine cancer, 26 of them with thoracic spine cancer, and 23 of them with lumbar spine cancer. X-ray images acquired during the treatment were classified by treatment site. From the starting point of treatment, motion tendency of patients is analyzed in each section which is divided into every 5 minutes. Results : In case of cervical spine, there is sudden increase of variation in 15 minutes after the treatment starts in rotational direction. In case of thoracic spine, there is no significantly variable section. However, variation increases gradually with the passage of time so that it is assumed that noticeable value comes up in approximately 40 minutes. In case of lumbar spine, sharp increase of variation is seen in 20 minutes in translational and rotational direction. Conclusion : Without having corrections during the treatment, proper treatment time is considered as less than 15 minutes for cervical spine, 40 minutes for thoracic spine, and 20 minutes for lumbar spine. If treatment time is longer than these duration, additional patient alignments are required or PTV margin should be enlarged.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.101-108
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• 2016

Purpose : The purpose of this study was to evaluate the Retro recon in SRS planning using BranLAB when stereotactic location error occurs by metal artifact. Materials and Methods : By CT simulator, image were acquired from head phantom(CIRS, PTW, USA). To observe stereotactic location recognizing and beam hardening, CT image were approved by SRS planning system(BrainLAB, Feldkirchen, Germany). In addition, we compared acquisition image(1.25mm slice thickness) and Retro recon image(using for 2.5 mm, 5mm slice thickness). To evaluate these three images quality, the test were performed by AAPM phantom study. In patient, it was verified stereotactic location error. Results : All the location recognizing error did not occur in scanned image of phantom. AAPM phantom scan images all showed the same trend. Contrast resolution and Spatial resolution are under 6.4 mm, 1.0 mm. In case of noise and uniformity, under 11, 5 of HU were measured. In patient, the stereotactic location error was not occurred at reconstructive image. Conclusion : For BrainLAB planning, using Retro recon were corrected stereotactic error at beam hardening. Retro recon may be the preferred modality for radiation treatment planning and approving image quality.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.99-108
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• 2021

Purpose: The goal of this study is to evaluate usefulness of noninvasive method instead of previous inserting Fiducial Marker Method when performing Stereotactic Partial Breast Irradiation in CyberKnife. Material and methods: For consistency of Imaging Center, we evaluated both oblique images at angle 45 and 315 acquired from 2D Simulator and CyberKnife quantitatively through dice similarity coefficient. Also, location reproducibility of Surface Fiducial Marker was analyzed from 2D Simulator, treatment plans and CyberKinfe images by using 8 Fiducial Markers made of gold attached to ATOM Phantom based on our institution's protocols. Results: The results of the estimated consistency were 0.87 and 0.9 at the oblique angle 45 and 315, respectively. For location consistency of Surface Fiducial Markers, values of horizontal vertical direction of left breast were Superior/Inferior 0.3 mm, Left/Right -0.3 mm, Anterior/Posterior 0.4 mm, and the values of rotational direction were Roll 0.3 °, Pitch 0.2 °, Yaw 0.4 °. The values of horizontal vertical direction of right breast were Superior/Inferior -0.1 mm, Left/Right -0.1 mm, Anterior/Posterior -0.1 mm, and the values of rotational direction were Roll 0.2°, Pitch 0.1°, Yaw 0.1°. Conclusions: We expect that the protocols used by Surface Fiducial Markers when performing Stereotactic Partial Breast Irradiation in CyberKnife will provide protection from pain and cut expenses for treatment and reduce treatment errors and make treatment more accurate by suggesting treatment protocols based on high consistency of Imaging Center and reproducibility of Fiducial Markers.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.17-25
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• 2016

Purpose : The purpose of this study is to evaluate the variability of tumor motion and respiration pattern in lung cancer patients undergoing Stereotactic Body RadioTherapy(SBRT) by using On-Board imager (OBI) system and Real-time Position Management (RPM) System. Materials and Methods : This study population consisted of 60 lung cancer patient treated with stereotactic body radiotherapy (48 Gy / 4 fractions). Of these, 30 were treated with gating (group 1) and 30 without gating(group2): typically the patients whose tumors showed three-dimensional respiratory motion > 10 mm were selected for gating. 4-dimensional Computed Tomography (4DCT). Cone Beam CT (CBCT) and Fluoroscopy images were used to measure the tumor motion. RPM system was used to evaluate the variability of respiration pattern on SBRT for group1. Results : The mean difference of tumor motion among 4DCT, CBCT and Fluoroscopy images in the cranio-caudal direction was 2.3 mm in group 1, 2. The maximum difference was 12.5 mm in the group 1 and 8.5 mm in group 2. The number of treatment fractions that patient's respiration pattern was within Upper-Lower threshold on SBRT in group 2 was 31 fractions. A patient who exhibited the most unstable pattern exceeded 108 times in a fraction Conclusion : Although many patients in group 1 and 2 kept the reproducibility of tumor motion within 5 mm during their treatment, some patients exhibited variability of tumor motion in the CBCT and Fluoroscopy images. It was possible to improve the accuracy of dose delivery in SBRT without gating for lung cancer patient by using RPM system.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.41-51
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• 2023

Purpose: This study compares and analyzes the image quality of 3D-CBCT(Cone Beam Computed-Tomography) and Gated CBCT according to baseline changes during SBRT(Stereotactic Body RadioTherapy) in lung cancer patients to find a useful CBCT method for correcting movement due to breathing Materials and methods : Insert a solid tumor material with a diameter of 3 cm into the QUASAR^TM phantom. 4-Dimentional Computed-Tomography(4DCT) images were taken with a speed of the phantom at period 3 sec and a maximum amplitude of 20 mm. Using the contouring menu of the computerized treatment planning system Eclipse^TM Gross Tumor Volume was outlined on solid tumor material. Set-up the same as when acquiring a 4DCT image using Truebeam STx^TM, breathing patterns with baseline changes of 1 mm, 3 mm, and 5 mm were input into the phantom to obtain 3D-CBCT (Spotlight, Full) and Gated-CBCT (Spotlight, Full) images five times repeatedly. The acquired images were compared with the Signal-to-Noise Ratio(SNR), Contrast-to-Noise Ratio(CNR), Tumor Volume Length, and Motion Blurring Ratio(MBR) based on the 4DCT image. Results: The average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Spotlight Gated CBCT images were 13.30±0.10%, 7.78±0.16%, 3.55±0.17%, 1.18±0.06%. As a result, Spotlight Gated-CBCT images according to baseline change showed better values than Spotligtht 3D-CBCT images. Also, the average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Full Gated CBCT images were 12.80±0.11%, 7.60±0.11%, 3.54±0.16%, 1.18±0.05%. As a result Full GatedCBCT images according to baseline change showed better values than Full 3D-CBCT images. Conclusion : Compared to 3D-CBCT images, Gated-CBCT images had better image quality according to the baseline change, and the effect of Motion Blurring Artifacts caused by breathing was small. Therefore, it is considered useful to image guided using Gated-CBCT when a baseline change occurs due to difficulty in regular breathing during SBRT that exposes high doses in a short period of time

• Progress in Medical Physics
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• v.11 no.1
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• pp.39-47
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• 2000

In Stereotactic Radiosurgery (SRS), there are three imaging methods of target localization, such as digital subtraction Angiography (DSA), computed tomography (CT), magnetic resonance imaging (MRI). Especially, DSA and MR images have a distortion effect generated by each modality. In this research, image properties of DSA were studied. A first essential condition in SRS is an accurate information of target locations, since high dose used to treat a patient may give a complication on critical organ and normal tissue. Hut previous localization program did not consider distortion effect which was caused by image intensifier (II) of DSA. A neurosurgeon could not have an accurate information of target locations to operate a patient. In this research, through distortion correction, we tried to calculate accurate target locations. We made a grid phantom to correct distortion, and a target phantom to evaluate localization algorithm. The grid phantom was set on the front of II, and DSA images were obtained. Distortion correction methods consist of two parts: 1. Bilinear transform for geometrical correction and bilinear interpolation for gray level correction. 2. Automatic detection method for calculating locations of grid crosses, fiducial markers, and target balls. Distortion was corrected by applying bilinear transform and bilinear interpolation to anterior-posterior and left-right image, and locations of target and fiducial markers were calculated by the program developed in this study. Localization errors were estimated by comparing target locations calculated in DSA images with absolute locations of target phantom. In the result, the error in average with and without distortion correction is $\pm$0.34 mm and $\pm$0.41 mm respectively. In conclusion, it could be verified that our localization algorithm has an improved accuracy and acceptability to patient treatment.