• Progress in Medical Physics
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• v.26 no.3
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• pp.119-126
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• 2015

The purpose of this study is to analyze motion-induced dose error generated by each tumor motion parameters of irregular tumor motion in helical tomotherapy. To understand the effect of the irregular tumor motion, a simple analytical model was simulated. Moving cases that has tumor motion were divided into a slightly irregular tumor motion case, a large irregular tumor motion case and a patient case. The slightly irregular tumor motion case was simulated with a variability of 10% in the tumor motion parameters of amplitude (amplitude case), period (period case), and baseline (baseline case), while the large irregular tumor motion case was simulated with a variability of 40%. In the phase case, the initial phase of the tumor motion was divided into end inhale, mid exhale, end exhale, and mid inhale; the simulated dose profiles for each case were compared. The patient case was also investigated to verify the motion-induced dose error in 'clinical-like' conditions. According to the simulation process, the dose profile was calculated. The moving case was compared with the static case that has no tumor motion. In the amplitude, period, baseline cases, the results show that the motion-induced dose error in the large irregular tumor motion case was larger than that in the slightly irregular tumor motion case or regular tumor motion case. Because the offset effect was inversely proportion to irregularity of tumor motion, offset effect was smaller in the large irregular tumor motion case than the slightly irregular tumor motion case or regular tumor motion case. In the phase case, the larger dose discrepancy was observed in the irregular tumor motion case than regular tumor motion case. A larger motion-induced dose error was also observed in the patient case than in the regular tumor motion case. This study analyzed motion-induced dose error as a function of each tumor motion parameters of irregular tumor motion during helical tomotherapy. The analysis showed that variability control of irregular tumor motion is important. We believe that the variability of irregular tumor motion can be reduced by using abdominal compression and respiratory training.

• Journal of KIISE
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• v.43 no.3
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• pp.353-361
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• 2016

During image-guided radiation treatment of lung cancer patients, it is necessary to track the tumor motion because it can change during treatment as a consequence of respiratory motion and cardiac motion. In this paper, we propose a method for tracking the motion of the lung tumors based on the three-dimensional image information from planning 4D MDCT and treatment 4D CBCT images. First, to effectively track the tumor motion during treatment, the global motion of the tumor is estimated based on a tumor-specific motion model obtained from planning 4D MDCT images. Second, to increase the accuracy of the tumor motion tracking, the local motion of the tumor is estimated based on the structural information of the tumor from 4D CBCT images. To evaluate the performance of the proposed method, we estimated the tracking results of proposed method using digital phantom. The results show that the tumor localization error of local motion estimation is reduced by 45% as compared with that of global motion estimation.

• Progress in Medical Physics
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• v.28 no.1
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• pp.1-10
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• 2017

The difference between three-dimensional (3D) and four-dimensional (4D) dose could be affected by factors such as tumor size and motion. To quantitatively analyze the effects of these factors, a phantom that can independently control each factor is required. The purpose of this study is to develop a deformable lung phantom with the above attributes and evaluate the characteristics. A phantom was designed to simulate diaphragm motion with amplitude in the range 1~7 cm and period up to ${\geq}2s$ of regular breathing. To simulate different tumors sizes, custom molds were created using a 3D printer and filled with liquid silicone. The accuracy of the phantom diaphragm motion was assessed by comparing measured motion with predicted motion. Because the phantom diaphragm motion is not identical to the tumor motion, the correlation between the diaphragm and tumor motions was calculated by a curve fitting method to emulate user-intended tumor motion. Tumors of different sizes were located at same position, and tumor set-up positions were evaluated. The accuracy of phantom diaphragm motion was better than 1 mm. The diaphragm-tumor correlation showed that the tumor motion in the superior-inferior direction increased with increasing diaphragm motion. The tumor motion was larger in the $10cm^3$ tumor than in the $90cm^3$ tumor. The range of difference between the tumor set-up positions was 0 to 0.45 cm. This phantom showed independently adjusting factors such as tumor size and motion to facilitate quantitative analysis of the dosimetric impact of respiratory motion according to these factors.

• Radiation Oncology Journal
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• v.35 no.3
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• pp.274-280
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• 2017

Purpose: To see the gross tumor volume (GTV) dependency according to the phase selection and reconstruction methods, we measured and analyzed the changes of tumor volume and motion at each phase in 20 cases with lung cancer patients who underwent image-guided radiotherapy. Materials and Methods: We retrospectively analyzed four-dimensional computed tomography (4D-CT) images in 20 cases of 19 patients who underwent image-guided radiotherapy. The 4D-CT images were reconstructed by the maximum intensity projection (MIP) and the minimum intensity projection (Min-IP) method after sorting phase as 40%-60%, 30%-70%, and 0%-90%. We analyzed the relationship between the range of motion and the change of GTV according to the reconstruction method. Results: The motion ranges of GTVs are statistically significant only for the tumor motion in craniocaudal direction. The discrepancies of GTV volume and motion between MIP and Min-IP increased rapidly as the wider ranges of duty cycles are selected. Conclusion: As narrow as possible duty cycle such as 40%-60% and MIP reconstruction was suitable for lung cancer if the respiration was stable. Selecting the reconstruction methods and duty cycle is important for small size and for large motion range tumors.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2004.11a
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• pp.115-118
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• 2004

Respiratory motion in the thorax and abdomen is an important limiting factor in high-precision radiation therapy. The lung tumor and tumor(pancreas, stomach) in abdomen therefore are internal motion due to breathing. We will perform to measurement of dose distributions for these moving tumors. In preliminary study, we investigated displacement of moving tumor such as liver, lung tumor in abdomen with previously reported papers. With reference data, internal movements of tumor are displayed with phantom and moving control device(MCD), which appear three dimension (3-D) motion such as x, y and z axis. These devices are used to access dose delivered in tumor with and without internal motion. The MCD and phantom were used to evaluate a delivered dose under similar condition, although there are not same internal tumor motion. In future, we will obtain the exact evaluation of dose if improved in programed software of moving control device and measure precise internal motion using image modality such as fluoroscopy, simulator in based on this study.

• 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.

• Progress in Medical Physics
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• v.22 no.3
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• pp.107-116
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• 2011

Respiratory gated radiation therapy and stereotactic body radiation therapy require identical tumor motions during each treatment with the motion detected in treatment planning CT. Therefore, this study developed a tumor motion monitoring and analysis system during the treatments employing RPM data, gated setup OBI images and a data analysis software. A respiratory training and guiding program which improves the regularity of breathing was used to patients. The breathing signal was obtained by RPM and the recorded data in the 4D console was read after treatment. The setup OBI images obtained gated at 0% and 50% of breathing phases were used to detect the tumor motion range in crenio-caudal direction. By matching the RPM data recorded at the OBI imaging time, a factor which converts the RPM motion to the tumor motion was computed. RPM data was entered to the institute developed data analysis software and the maximum, minimum, average of the breathing motion as well as the standard deviation of motion amplitude and period was computed. The computed result is exported in an excel file. The conversion factor was applied to the analyzed data to estimate the tumor motion. The accuracy of the developed method was tested by using a moving phantom, and the efficacy was evaluated for 10 stereotactic body radiation therapy patients. For the sine wave motion of the phantom with 4 sec of period and 2 cm of peak-to-peak amplitude, the measurement was slightly larger (4.052 sec) and the amplitude was smaller (1.952 cm). For patient treatment, one patient was evaluated not to qualified to SBRT due to the usability of the breathing, and in one patient case, the treatment was changed to respiratory gated treatment due the larger motion range of the tumor than treatment planed motion. The developed method and data analysis program was useful to estimate the tumor motion during treatment.

• Korean Journal of Radiology
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• v.20 no.1
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• pp.50-57
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• 2019

In pediatric thoracic CT, respiratory motion is generally treated as a motion artifact degrading the image quality. Conversely, respiratory motion in the thorax can be used to answer important clinical questions, that cannot be assessed adequately via conventional static thoracic CT, by utilizing four-dimensional (4D) CT. However, clinical experiences of 4D thoracic CT are quite limited. In order to use 4D thoracic CT properly, imagers should understand imaging techniques, radiation dose optimization methods, and normal as well as typical abnormal imaging appearances. In this article, the imaging techniques of pediatric thoracic 4D CT are reviewed with an emphasis on radiation dose. In addition, several clinical applications of pediatric 4D thoracic CT are addressed in various thoracic functional abnormalities, including upper airway obstruction, tracheobronchomalacia, pulmonary air trapping, abnormal diaphragmatic motion, and tumor invasion. One may further explore the clinical usefulness of 4D thoracic CT in free-breathing children, which can enrich one's clinical practice.

• The Journal of the Korea Contents Association
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• v.15 no.9
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• pp.395-402
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• 2015

when the radiation therapy of chest and abdomen, evaluation of the tumor motion and the data was used to minimize damage to normal tissues by separating the tumor and normal tissue and maximize tumor therapeutic effect. Lung and liver cancer each 20 patients based on the 50% top phase using 4D-CT simulation and Light speed-16 of shooting equipment 30 ~ 70 % gating phase interval and 0 ~90 % movement in the full phase interval was measured. If the full phase 0 ~ 90% with gating phase 30~70% of tumors in the liver and lung is shown the biggest difference compared to the motion and the size of the GTV was the largest difference in the I(inferior), full phase 0~90% degree of tumor motion only when a relatively large, gating phase to 30~70% of the tumor when the movement has been found that the reduced average 7.1mm. In the 4D-CT simulation comparing the motion value when the full phase 0~90 % and gating phase 30~70 % when the motion value, twice in the gating phase 30~70 % more than full phase 0~90 % showed a small movement value. The exposure to normal tissues, based on the results obtained from the 4D-CT simulation can be significantly alleviated, After treatment will reduce pain and disability in patients with radiation is expected to be able to effective treatment.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.263-270
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• 2008

Purpose: This study aimed to quantitatively measure the movement of tumors in real-time and evaluate the treatment accuracy, during the treatment of a liver tumor patient, who underwent radiosurgery with a Synchrony Respiratory motion tracking system of a robot CyberKnife. Materials and Methods: The study subjects included 24 liver tumor patients who underwent CyberKnife treatment, which included 64 times of treatment with the Synchrony Respiratory motion tracking system ($Synchrony^{TM}$). The treatment involved inserting 4 to 6 acupuncture needles into the vicinity of the liver tumor in all the patients using ultrasonography as a guide. A treatment plan was set up using the CT images for treatment planning uses. The position of the acupuncture needle was identified for every treatment time by Digitally Reconstructed Radiography (DRR) prepared at the time of treatment planning and X-ray images photographed in real-time. Subsequent results were stored through a Motion Tracking System (MTS) using the Mtsmain.log treatment file. In this way, movement of the tumor was measured. Besides, the accuracy of radiosurgery using CyberKnife was evaluated by the correlation errors between the real-time positions of the acupuncture needles and the predicted coordinates. Results: The maximum and the average translational movement of the liver tumor were measured 23.5 mm and $13.9{\pm}5.5\;mm$, respectively from the superior to the inferior direction, 3.9 mm and $1.9{\pm}0.9mm$, respectively from left to right, and 8.3 mm and $4.9{\pm}1.9\;mm$, respectively from the anterior to the posterior direction. The maximum and the average rotational movement of the liver tumor were measured to be $3.3^{\circ}$ and $2.6{\pm}1.3^{\circ}$, respectively for X (Left-Right) axis rotation, $4.8^{\circ}$ and $2.3{\pm}1.0^{\circ}$, respectively for Y (Crania-Caudal) axis rotation, $3.9^{\circ}$ and $2.8{\pm}1.1^{\circ}$, respectively for Z (Anterior-Posterior) axis rotation. In addition, the average correlation error, which represents the treatment's accuracy was $1.1{\pm}0.7\;mm$. Conclusion: In this study real-time movement of a liver tumor during the radiosurgery could be verified quantitatively and the accuracy of the radiosurgery with the Synchrony Respiratory motion tracking system of robot could be evaluated. On this basis, the decision of treatment volume in radiosurgery or conventional radiotherapy and useful information on the movement of liver tumor are supposed to be provided.