• Radiation Oncology Journal
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• v.20 no.1
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• pp.81-90
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• 2002

Purpose : To establish and verify the proper and the practical IMRT (Intensity--modulated radiation therapy) patient QA (Quality Assurance). Materials and Methods : An IMRT QA which consists of 3 steps and 16 items were designed and examined the validity of the program by applying to 9 patients, 12 IMRT cases of various sites. The three step OA program consists of RTP related QA, treatment information flow QA, and a treatment delivery QA procedure. The evaluation of organ constraints, the validity of the point dose, and the dose distribution are major issues in the RTP related QA procedure. The leaf sequence file generation, the evaluation of the MLC control file, the comparison of the dry run film, and the IMRT field simulate image were included in the treatment information flow procedure QA. The patient setup QA, the verification of the IMRT treatment fields to the patients, and the examination of the data in the Record & Verify system make up the treatment delivery QA procedure. Results : The point dose measurement results of 10 cases showed good agreement with the RTP calculation within $3\%$. One case showed more than a $3\%$ difference and the other case showed more than $5\%$, which was out side the tolerance level. We could not find any differences of more than 2 mm between the RTP leaf sequence and the dry run film. Film dosimetry and the dose distribution from the phantom plan showed the same tendency, but quantitative analysis was not possible because of the film dosimetry nature. No error had been found from the MLC control file and one mis-registration case was found before treatment. Conclusion : This study shows the usefulness and the necessity of the IMRT patient QA program. The whole procedure of this program should be peformed, especially by institutions that have just started to accumulate experience. But, the program is too complex and time consuming. Therefore, we propose practical and essential QA items for institutions in which the IMRT is performed as a routine procedure.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.2
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• pp.101-108
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• 2017

Purpose: The proton used in proton therapy has a characteristic of giving a small dose to the normal tissue in front of the tumor site while forming a Bragg peak at the cancer tissue site and giving up the maximum dose and disappearing immediately. It is very important to verify the proton arrival position. In this study, we used the off-line PET CT method to measure the distribution of positron emitted from nucleons such as 11C (half-life = 20 min), 150 (half-life = 2 min) and 13N The range and distal falloff point of the proton were verified by measurement. Materials and Methods: In the IEC 2001 Body Phantom, 37 mm, 28 mm, and 22 mm spheres were inserted. The phantom was filled with water to obtain a CT image for each sphere size. To verify the proton range and distal falloff points, As a treatment planning system, SOBP were set at 46 mm on 37 mm sphere, 37 mm on 28 mm, and 33 mm on 22 mm sphere for each sphere size. The proton was scanned in the same center with a single beam of Gantry 0 degree by the scanning method. The phantom was scanned using PET-CT equipment. In the PET-CT image acquisition method, 50 images were acquired per minute, four ROIs including the spheres in the phantom were set, and 10 images were reconstructed. The activity profile according to the depth was compared to the dose profile according to the sphere size established in the treatment plan Results: The PET-CT activity profile decreased rapidly at the distal falloff position in the 37 mm, 28 mm, and 22 mm spheres as well as the dose profile. However, in the SOBP section, which is a range for evaluating the range, the results in the proximal part of the activity profile are different from those of the dose profile, and the distal falloff position is compared with the proton therapy plan and PET-CT As a result, the maximum difference of 1.4 mm at the 50 % point of the Max dose, 1.1 mm at the 45 % point at the 28 mm sphere, and the difference at the 22 mm sphere at the maximum point of 1.2 mm were all less than 1.5 mm in the 37 mm sphere. Conclusion: To maximize the advantages of proton therapy, it is very important to verify the range of the proton beam. In this study, the proton range was confirmed by the SOBP and the distal falloff position of the proton beam using PET-CT. As a result, the difference of the distally falloff position between the activity distribution measured by PET-CT and the proton therapy plan was 1.4 mm, respectively. This may be used as a reference for the dose margin applied in the proton therapy plan.

• Radiation Oncology Journal
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• v.21 no.3
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• pp.238-244
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• 2003

Purpose: The Planning of High-Dose-Rate (HDR) brachytherapy treatments are becoming individualized and more dependent on the treatment planning system. Therefore, computer software has been developed to perform independent point dose calculations with the integration of an isodose distribution curve display into the patient anatomy images. Meterials and Methods: As primary input data, the program takes patients'planning data including the source dwell positions, dwell times and the doses at reference points, computed by an HDR treatment planning system (TPS). Dosimetric calculations were peformed in a $10\times12\times10\;Cm^3$ grid space using the Interstitial Collaborative Working Group (ICWG) formalism and an anisotropy table for the HDR Iridium-192 source. The computed doses at the reference points were automatically compared with the relevant results of the TPS. The MR and simulation film images were then imported and the isodose distributions on the axial, sagittal and coronal planes intersecting the point selected by a user were superimposed on the imported images and then displayed. The accuracy of the software was tested in three benchmark plans peformed by Gamma-Med 12i TPS (MDS Nordion, Germany). Nine patients'plans generated by Plato (Nucletron Corporation, The Netherlands) were verified by the developed software. Results: The absolute doses computed by the developed software agreed with the commercial TPS results within an accuracy of $2.8\%$ in the benchmark plans. The isodose distribution plots showed excellent agreements with the exception of the tip legion of the source's longitudinal axis where a slight deviation was observed. In clinical plans, the secondary dose calculations had, on average, about a $3.4\%$ deviation from the TPS plans. Conclusion: The accurate validation of complicate treatment plans is possible with the developed software and the qualify of the HDR treatment plan can be improved with the isodose display integrated into the patient anatomy information.

• Progress in Medical Physics
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• v.26 no.4
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• pp.280-285
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• 2015

In radiation therapy fields, a brachytherapy is a treatment that kills lesion of cells by inserting a radioisotope that keeps emitting radiation into the body. We currently verify the consistency of radiation treatment plan and dose distribution through film/screen system (F/S system), provide therapy after checking dose. When we check dose distribution, F/S systems have radiation signal distortion because there is low resolution by penumbra depending on the condition of film developed. In this study, We fabricated a $HgI_2$ Semiconductor radiation sensor for base study in order that we verify the real dose distribution weather it's same as plans or not in brachytherapy. Also, we attempt to evaluate the feasibility of QA system by utilizing and evaluating the sensor to brachytherapy source. As shown in the result of detected signal with various source-to-detector distance (SDD), we quantitatively verified the real range of treatment which is also equivalent to treatment plans because only the low signal estimated as scatters was measured beyond the range of treatment. And the result of experiment that we access reproducibility on the same condition of ${\gamma}$-ray, we have made sure that the CV (coefficient of variation) is within 1.5 percent so we consider that the $HgI_2$ sensor is available at QA of brachytherapy based on the result.

• Journal of radiological science and technology
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• v.35 no.3
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• pp.255-263
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• 2012

The aim of this study was to evaluate the patient specific quality assurance (QA) results of intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) through the AAPM Task Group Report 119. Using the treatment planning system, both IMRT and VMAT treatment plans were established. The absolute dose and relative dose for the target and OAR were measured by using an ion chamber and the bi-planar diode array, respectively. The plan evaluation was used by the Dose volume histogram (DVH) and the dose verification was implemented by compare the measured value with the calculated value. For the evaluation of plan, in case of prostate, both IMRT and VMAT were closed the goal of target and OARs. In case of H&N and Multi-target, IMRT was not reached the goal of target, but VMAT was reached the goal of target and OARs. In case of C-shape(easy), both were reached the goal of target and OARs. In case of C-shape(hard), both were reached the goal of target but not reached the goal of OARs. For the evaluation of absolute dose, in case of IMRT, the mean of relative error (%) between measured and calculated value was $1.24{\pm}2.06%$ and $1.4{\pm}2.9%$ for target and OAR, respectively. The confidence limits were 3.65% and 4.39% for target and OAR, respectively. In case of VMAT the mean of relative error was $2.06{\pm}0.64%$ and $2.21{\pm}0.74%$ for target and OAR, respectively. The confidence limits were 4.09% and 3.04% for target and OAR, respectively. For the evaluation of relative dose, in case of IMRT, the average percentage of passing gamma criteria (3mm/3%) were $98.3{\pm}1.5%$ and the confidence limits were 3.78%. In case of VMAT, the average percentage were $98.2{\pm}1.1%$ and the confidence limits were 3.95%. We performed IMRT and VMAT patient specific QA using TG-119 based procedure, all analyzed results were satisfied with acceptance criteria based on TG-119. So, the IMRT and VMAT of our institution was confirmed the accuracy.

• Journal of Radiation Protection and Research
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• v.36 no.1
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• pp.28-34
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• 2011

The measurement-based verification for intensity modulated radiation therapy (IMRT) is a time-and labor-consuming procedure. Instead, this study aims to develop a MU fluence reconstruction method for IMRT QA. Total actual fluences from treatment planning system (TPS, Eclipse 8.6, Varian) were selected as a reference. Delivered leaf positions according to MU were extracted by the dynalog file generated after IMRT delivery. An in-house software was develop to reconstruct MU fluence from the acquired delivered leaf position data using MATLAB. We investigated five patient's plans delivered by both step-and-shoot IMRT and sliding window technologies. The total actual fluence was compared with the MU fluence reconstructed by using commercial software (Verisoft 3.1, PTW) and gamma analysis method (criteria: 3%/3 mm and 2%/1 mm). Gamma pass rates were $97.8{\pm}1.33$% and the reconstructed fluence was shown good agreement with RTP-based actual fluence. The fluence from step and shoot IMRT was shown slightly higher agreement with the actual fluence than that from sliding window IMRT. If moving from IMRT QA measurements toward independent computer calculations, the developed method can be used for IMRT QA. A point dose calculation method from reconstructed fluences is under development for the routine IMRT QA purpose.

• Progress in Medical Physics
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• v.29 no.2
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• pp.59-65
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• 2018

This paper describes the clinical use of the dose verification of multileaf collimator (MLC)-based CyberKnife plans by combining the Octavius 1000SRS detector and water-equivalent RW3 slab phantom. The slab phantom consists of 14 plates, each with a thickness of 10 mm. One plate was modified to support tracking by inserting 14 custom-made fiducials on surface holes positioned at the outer region of $10{\times}10cm^2$. The fiducial-inserted plate was placed on the 1000SRS detector and three plates were additionally stacked up to build the reference depth. Below the detector, 10 plates were placed to avoid longer delivery times caused by proximity detection program alerts. The cross-calibration factor prior to phantom delivery was obtained by performing with 200 monitor units (MU) on the field size of $95{\times}92.5mm^2$. After irradiation, the measured dose distribution of the coronal plane was compared with the dose distribution calculated by the MultiPlan treatment planning system. The results were assessed by comparing the absolute dose at the center point of 1000SRS and the 3-D Gamma (${\gamma}$) index using 220 patient-specific quality assurance (QA). The discrepancy between measured and calculated doses at the center point of 1000SRS detector ranged from -3.9% to 8.2%. In the dosimetric comparison using 3-D ${\gamma}$-function (3%/3 mm criteria), the mean passing rates with ${\gamma}$-parameter ${\leq}1$ were $97.4%{\pm}2.4%$. The combination of the 1000SRS detector and RW3 slab phantom can be utilized for dosimetry validation of patient-specific QA in the CyberKnife MLC system, which made it possible to measure absolute dose distributions regardless of tracking mode.

• Journal of Society of Preventive Korean Medicine
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• v.21 no.3
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• pp.11-18
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• 2017

Objectives : In an effort to suggest a developmental plan of Traditional Korean Medicine health promotion project(TKM-HPP), this study was conducted to identify the problems experienced by public health Traditional Korean Medicine(PH-TKM) doctors in duty and to analyze successful cases of the health promotion project. Methods : Two PH-TKM doctors in duty at the Public Health Centre branch and Public Health Centre respectively, and one TKM doctor in charge of Public Health Centre participated in the in-depth interview. The research procedure was as follows; 1) inform study objectives and interview questions to participants, 2) in-depth interview with semi-structured questions, and 3) post-confirmation and verification. The interview was recorded and transcripted. In-depth interview was composed of 6 subsections: 1) Introducing participants and share purpose of interview, 2) Confirmation of the job status and difficulty of public health centre, 3) Reflecting and sharing experiences of public health clinic job performance cases, 4) Current status and improvement needs of TKM-HPP, 5) Discussions on improvement of TKM-HPP in public health center, 6) Sharing and reconfirmation of interview results. Thematic analysis was conducted from the narratives. Results : The study showed that; 1) the support from the local government was critical for the successful TKM-HPP and participation of the PH-TKMs; 2) the major problems experienced by PH-TKMs were lack of training for TKM-HPP in the field and lack of knowledge at local government level; 3) the suggestions to provide PH-TKMs with manual to educate residents effectively and redefine roles of PH-TKMs in the project. It also suggests that TKM-HPP model should be developed by the district in a way of reflecting regional characteristics. Conclusions : Firstly, more efforts should be made on the projects rather than medical treatment in public health centers, except for areas where medical institutions are scarce. Secondly, in order to facilitate participation of PH-TKM doctors, each local office should reduce medical care and increase efforts related with projects. Thirdly, the institution has to develop feasible TKM-HPP plans that can be carried out by PH-TKMs by the manual. Lastly, pre-training should be provided to PH-TKMs to understand contents of TKM-HPP related to public health centre work before the placement.

• The Journal of Bigdata
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• v.6 no.1
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• pp.37-49
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• 2021

The number of dementia patients in Korea is estimated to be over 800,000, and the severity of dementia is becoming a social problem. However, no treatment or drug has yet been developed to cure dementia worldwide. The number of dementia patients is expected to increase further due to the rapid aging of the population. Currently, early detection of dementia and delaying the course of dementia symptoms is the best alternative. This study presented a methodology for early diagnosis of dementia by measuring and analyzing amyloid plaques. This vital protein can most clearly and early diagnose dementia in the retina through AI-based image analysis. We performed binary classification and multi-classification learning based on CNN on retina data. We also developed a deep learning algorithm that can diagnose dementia early based on pre-processed retinal data. Accuracy and recall of the deep learning model were verified, and as a result of the verification, and derived results that satisfy both recall and accuracy. In the future, we plan to continue the study based on clinical data of actual dementia patients, and the results of this study are expected to solve the dementia problem.

• Journal of the Korean Society of Radiology
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• v.17 no.1
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• pp.25-30
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• 2023

As 3D printing technology is used in the medical field, interest in metal materials is increasing. The Department of Radiation Oncology uses a shielding block to shield the patient's normal tissue from unnecessary exposure during electron beam therapy. However, problems such as handling of heavy metal materials such as lead and cadmium, reproducibility according to skill level and uncertainty of arrangement have been reported. In this study, candidate materials that can be used for metal 3D printing are selected, and the physical properties and radiation dose of each material are analyzed to develop a customized shielding block that can be used in electron beam therapy. As candidate materials, aluminum alloy (d = 2.68 g/cm³), titanium alloy (d = 4.42 g/cm³), and cobalt chromium alloy (d = 8.3 g/cm³) were selected. The thickness of the 95% shielding rate point was derived using the Monte Carlo Simulation with the irradiation surface and 6, 9, 12, and 16 energies. As a result of the simulation, among the metal 3D printing materials, cobalt chromium alloy (d = 8.3 g/cm³) was similar to the existing shielding block (d = 9.4 g/cm³) in shielding thickness for each energy. In a follow-on study, it is necessary to evaluate the usefulness in clinical practice using customized shielding blocks made by metal 3D printing and to verify experiments through various radiation treatment plan conditions.