• Progress in Medical Physics
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• v.14 no.1
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• pp.8-14
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• 2003

The spinal cord dose is the one of the limiting factor for the radiation treatment of the head ＆ neck or the thorax region. It is not an easy task to maintain the spinal cord dose below tolerance and to keep the clinically acceptable dose to the PTV in this region. To overcome this problem, the spinal cord partial block technique (PBT) with the dynamic Multi-Leaf Collimator (dMLC) has been developed. This technique is an extension of the conventional treatment planning. In the beginning the beam directions are selected as same as the conventional treatment planning to encompass the PTV, then the partial block are designed to shield the spinal cord. The plan comparisons between the conventional therapy plan and the PTB plan were performed to evaluate the validity of this technique. The mean dose and the dose volume histogram (DVH) were used as the plan comparison indices. A series of quality assurance (QA) was performed to guarantee the reliable treatment. The QA consisted of the film dosimetry for the verification of the dose distribution and the point measurements. The PBT plan generated better results than the conventional treatment plan and it was proved to be useful for the H＆N region.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.313-320
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• 2014

Purpose : The purpose of the study is to evaluate the efficiency of Coaxial MLC VMAT plan (Using $273^{\circ}$ and $350^{\circ}$ collimator angle) That the leaf motion direction aligned with axis of OAR (Organ at risk, It means spinal cord or cauda equine in this study.) compare to Universal MLC VMAT plan (using $30^{\circ}$ and $330^{\circ}$ collimator angle) for spine SBRT. Materials and Methods : The 10 cases of spine SBRT that treated with VMAT planned by Coaxial MLC and Varian TBX were enrolled. Those cases were planned by Eclipse (Ver. 10.0.42, Varian, USA), PRO3 (Progressive Resolution Optimizer 10.0.28) and AAA (Anisotropic Analytic Algorithm Ver. 10.0.28) with coplanar $360^{\circ}$ arcs and 10MV FFF (Flattening filter free). Each arc has $273^{\circ}$ and $350^{\circ}$ collimator angle, respectively. The Universal MLC VMAT plans are based on existing treatment plans. Those plans have the same parameters of existing treatment plans but collimator angle. To minimize the dose difference that shows up randomly on optimizing, all plans were optimized and calculated twice respectively. The calculation grid is 0.2 cm and all plans were normalized to the target V100%=90%. The indexes of evaluation are V10Gy, D0.03cc, Dmean of OAR (Organ at risk, It means spinal cord or cauda equine in this study.), H.I (Homogeneity index) of the target and total MU. All Coaxial VMAT plans were verified by gamma test with Mapcheck2 (Sun Nuclear Co., USA), Mapphan (Sun Nuclear Co., USA) and SNC patient (Sun Nuclear Co., USA Ver 6.1.2.18513). Results : The difference between the coaxial and the universal VMAT plans are follow. The coaxial VMAT plan is better in the V10Gy of OAR, Up to 4.1%, at least 0.4%, the average difference was 1.9% and In the D0.03cc of OAR, Up to 83.6 cGy, at least 2.2 cGy, the average difference was 33.3 cGy. In Dmean, Up to 34.8 cGy, at least -13.0 cGy, the average difference was 9.6 cGy that say the coaxial VMAT plans are better except few cases. H.I difference Up to 0.04, at least 0.01, the average difference was 0.02 and the difference of average total MU is 74.1 MU. The coaxial MLC VMAT plan is average 74.1 MU lesser then another. All IMRT verification gamma test results for the coaxial MLC VMAT plan passed over 90.0% at 1mm / 2%. Conclusion : Coaxial MLC VMAT treatment plan appeared to be favorable in most cases than the Universal MLC VMAT treatment planning. It is efficient in lowering the dose of the OAR V10Gy especially. As a result, the Coaxial MLC VMAT plan could be better than the Universal MLC VMAT plan in same MU.

• Progress in Medical Physics
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• v.27 no.3
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• pp.169-174
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• 2016

The aim of this study is to investigate the delivery accuracy of intensity-modulated radiation therapy (IMRT) plans in the two-headed mode of the ViewRay$^{TM}$ system in comparison with that of the normal operation treatment plan of the machine. For this study, a total of eight IMRT plans and corresponding verification plans were generated (four head and neck, two liver, and two prostate IMRT plans). The delivered dose distributions were measured using ArcCHECK$^{TM}$ with the insertion of an ionization chamber. We measured the delivered dose distributions in three-headed mode (normal operation of the machine), two-headed mode with head 1 disabled, two-headed mode with head 2 disabled, and two-headed mode with head 3 disabled. Therefore, a total of four measurements were performed for each IMRT plan. The global gamma passing rates (3%/3 mm) in three-headed mode, head 1 disabled, head 2 disabled, and head 3 disabled were $99.9{\pm}0.1%$, $99.8{\pm}0.3%$, $99.6{\pm}0.7%$, and $99.7{\pm}0.4%$, respectively. The difference in the gamma passing rates of the three- and two-headed modes was insignificant. With 2%/2 mm, the rates were $96.6{\pm}3.6%$, $97.2{\pm}3.5%$, $95.7{\pm}6.2%$, and $95.5{\pm}4.3%$, respectively. Between three-headed mode and head 3 disabled, a statistically significant difference was observed with a p-value of 0.02; however, the difference was minimal (1.1%). The chamber readings showed differences of approximately 1% between three- and two-headed modes, which were minimal. Therefore, the treatment plan delivery in the two-headed mode of the ViewRay$^{TM}$ system seems accurate and robust.

• Journal of the Korean Society of Radiology
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• v.9 no.7
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• pp.449-457
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• 2015

In this study, to evaluate the usefulness of the treatment plan of tomotherapy and volumetric modulated arc therapy (VMAT) in the radiotherapy for prostate cancer, the absorbed dose, dose volume histogram (DVH), treatment efficiency, and the results of dose verification accuracy using MapCHECK2 were compared and analyzed. Of the prostate cancer patients who underwent tomotherapy treatment in the Radiologic Oncology of H University Hospital between July 2014 and December 2014, 12 patients were randomly selected. As a result of analyzing the absorbed dose and DVH, both radiologic treatment plans showed slight differences in the treatment of the cancer tissues and the bladder, but the difference was in the error range of -5% to +3%, and did not exceed the side effect guideline or the tolerance dose limit. VMAT showed higher treatment efficiency than tomotherapy with a 2.5 times shorter treatment time and a 10.3 times less monitor unit (MU). Both showed 95% or higher dose accuracy satisfying the standard. VMAT showed 2.3% higher efficiency than tomotherapy. In both tomotherapy and VMAT, appropriate doses were absorbed for cancer tissues, and did not exceed the tolerance dose for normal tissues showing no significant difference in dose distribution. However, considering the shorter treatment time, lower total MU, and better treatment efficiency and dose verification accuracy, VMAT may be more useful than tomotherapy in cancer treatments.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.68-73
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• 2002

In standard teletherapy, a treatment plan is generated with the aid of a treatment planning system, but it is common to perform an independent monitor unit verification calculation (MUVC). In exact analogy, we propose and demonstrate that a simple and accurate MUVC in Intensity Modulated Radiotherapy (IMRT) is possible. We introduce a concept of Modified Clarkson Integration (MCI). In MCI, we exploit the rotational symmetry of scattering to simplify the dose calculation. For dose calculation along a central axis (CAX), we first replace the incident IMRT fluence by an azimuthally averaged fluence. Second, the Clarkson Integration is carried over annular sectors instead of over pie sectors. We wrote a computer code, implementing the MCI technique, in order to perform a MUVC for IMRT purposes. We applied the code to IMRT plans generated by CORVUS. The input to the code consists of CORVUS plan data (e.g., DMLC files, jaw settings, MU for each IMRT field, depth to isocenter for each IMRT field), and the output is dose contribution by individual IMRT field to the isocenter. The code uses measured beam data for Sc, Sp, TPR, (D/Mu)$\_$ref/ and includes effects from MLC transmission, and radiation field offset. On a 266 MHZ desktop computer, the code takes less than 15 sec to calculate a dose. The doses calculated with MCI algorithm agreed within +/- 3% with the doses calculated by CORVUS, which uses a 1cm x 1cm pencil beam in dose calculation. In the present version of MCI, skin contour variations and inhomogeneities were neglected.

• Progress in Medical Physics
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• v.32 no.4
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• pp.116-121
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• 2021

Purpose: To investigate the effects of dose rate on intensity-modulated radiation therapy (IMRT) quality assurance (QA). Methods: We performed gamma tests using portal dose image prediction and log files of a multileaf collimator. Thirty treatment plans were randomly selected for the IMRT QA plan, and three verification plans for each treatment plan were generated with different dose rates (200, 400, and 600 monitor units [MU]/min). These verification plans were delivered to an electronic portal imager attached to a Varian medical linear accelerator, which recorded and compared with the planned dose. Root-mean-square (RMS) error values of the log files were also compared. Results: With an increase in dose rate, the 2%/2-mm gamma passing rate decreased from 90.9% to 85.5%, indicating that a higher dose rate was associated with lower radiation delivery accuracy. Accordingly, the average RMS error value increased from 0.0170 to 0.0381 cm as dose rate increased. In contrast, the radiation delivery time reduced from 3.83 to 1.49 minutes as the dose rate increased from 200 to 600 MU/min. Conclusions: Our results indicated that radiation delivery accuracy was lower at higher dose rates; however, the accuracy was still clinically acceptable at dose rates of up to 600 MU/min.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.217-224
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• 2014

Purpose : Conventional, IMRT, at CSI treatment with VMAT, this study compare the treatment plan with dose changes measured at Junction field according to the error of Setup. Materials and Methods : This study established Conventional, the IMRT, VMAT treatment planning for CSI therapy using the Eclipse 10.0 (Eclipse10.0, Varian, USA) and chose person in Seoul National University Hospital. Verification plan was also created to apply IMRT QA phantom for each treatment plan to the film measurements. At this time, the error of Setup was applied to the 2, 4, 6mm respectively with the head and foot direction. ("+" direction of the head, "-" means that the foot direction.) Using IMRT QA Phantom and EBT2 film, was investigated by placing the error of Setup for each Junction. We check the consistency of the measured Film and plan dose distribution by gamma index (Gamma index, ${\gamma}$). In addition, we compared the error of Setup by the dose distribution, and analyzing the uniformity of the dose distribution within the target by calculating the Homogeneity Index (HI). Results : It was figured out that 90.49%-gamma index we obtained with film is agreement with film scan score and dose distribution of treatment plan. Also, depend on the dose distribution on distance, if we make the error of Setup 2, 4, 6mm in the head direction, it showed that 3.1, 4.5, 8.1 at $^*Diff$(%) of Conventional, 1.1, 3.5, 6.3 at IMRT, and 1.6, 2.5, 5.7 at VMAT. In the same way, if we make the error of Setup 2, 4, 6mm in the foot direction, it showed that -1.6, -2.8, -4.4 at $^*Diff$(%) of Conventional, -0.9, -1.6, -2.9 at IMRT, and -0.5, -2.2, -2.5 at VMAT. Homogeneity Index(HI)s are 1.216 at Conventional, 1.095 at IMRT and 1.069 at VMAT. Discussion and Conclusion : The dose-change depend on the error of Setup at the CSI RT(radiation therapy) using IMRT and VMAT which have advantages, Dose homogeneity and the gradual dose gradients on the Junction part is lower than that of Conventional CSI RT. This a little change of dose means that there is less danger on patients despite of the error of Setup generated at the CSI RT.

• Progress in Medical Physics
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• v.27 no.4
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• pp.213-219
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• 2016

The position verification of the radiation source utilized in brachytherapy forms a critical factor in determining the therapeutic efficiency. Currently, films are used to verify the source position; however, this method is encumbered by the lengthy time interval required from film scanning to analysis, which makes real-time position verification difficult. In general, the source position accuracy is usually tested in a monthly quality assurance check. In this context, this study investigates the feasibility of the real-time position verification of the radiation source in high dose rate (HDR) brachytherapy with the use of scintillating fibers. To this end, we construct a system consisting of scintillating fibers and a silicon photomultiplier (SiPM), optimize the dosimetric software setup and radiation system characteristics to obtain maximum measurement accuracy, and determine the relative ratio of the measured signals dependent upon the position of the scintillating fiber. According to the dosimetric results based on a treatment plan, in which the dwell time is set at 30 and 60 s at two dwell positions, the number of signals is 31.5 and 83, respectively. In other words, the signal rate roughly doubles in proportion to the dwell time. The source position can also be confirmed at the same time. With further improvements in the spatial resolution and scintillating fiber array, the source position can be verified in real-time in clinical settings with the use of a scintillating fiber-based system.

• Progress in Medical Physics
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• v.29 no.4
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• pp.137-142
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• 2018

This study aimed to evaluate and verify a process for correcting the extended source-to-imager distance (SID) in portal dosimetry (PD). In this study, eight treatment plans (four volumetric modulated arc therapy and four intensity-modulated radiation therapy plans) at different treatment sites and beam energies were selected for measurement. A Varian PD system with portal dose image prediction (PDIP) was used for the measurement and verification. To verify the integrity of the plan, independent measurements were performed with the MapCHECK device. The predicted and measured fluence were evaluated using the gamma passing rate. The output ratio was defined as the ratio of the absolute dose of the reference SID (100 cm) to that of each SID (120 cm or 140 cm). The measured fluence for each SID was absolutely and relatively compared. The average SID output ratios were 0.687 and 0.518 for 120 SID and 140 SID, respectively; the ratio showed less than 1% agreement with the calculation obtained by using the inverse square law. The resolution of the acquired EPIDs were 0.336, 0.280, and 0.240 for 100, 120, and 140 SID, respectively. The gamma passing rates with PD and MapCHECK exceeded 98% for all treatment plans and SIDs. When autoalignment was performed in PD, the X-offset showed no change, and the Y-offset decreased with increasing SID. The PD-generated PDIP can be used for extended SID without additional correction.

• Progress in Medical Physics
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• v.17 no.1
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• pp.17-23
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• 2006

In Vivo dosimetry is a method to evaluate the radiotherapy; it is used to find the dosimetric and mechanical errors of radiotherapy unit. In this study, on-line In Vivo dosimetry was enabled by measuring the skin dose with MOSFET detectors attached to patient's skin during treatment. MOSFET dosimeters were found to be reproducible and independent on beam directions. MOSFET detectors were positioned on patient's skin underneath of the dose build-up material which was used to minimize dosimetric error. Delivered dose calculated by the plan verification function embedded in the radiotherapy treatment planning system (RTPs), was compared with measured data point by point. The dependency of MOSFET detector used in this study for energy and dose rate agrees with the specification provided by manufacturer within 2% error. Comparing the measured and the calculated point doses of each patient, discrepancy was within 5%. It was enabled to verify the IMRT by using MOSFET detector. However, skin dosimetry using conventional ion chamber and diode detector is limited to the simple radiotherapy.