• Progress in Medical Physics
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• v.23 no.1
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• pp.48-53
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• 2012

The pencil beam convolution (PBC) algorithms in radiation treatment planning system have been widely used to calculate the radiation dose. A new photon dose calculation algorithm, referred to as the anisotropic analytical algorithm (AAA), was released for use by the Varian medical system. The aim of this paper was to investigate the difference in dose calculation between the AAA and PBC algorithm using the intensity modulated radiation therapy (IMRT) plan for lung cancer cases that were inhomogeneous in the low density. We quantitatively analyzed the differences in dose using the eclipse planning system (Varian Medical System, Palo Alto, CA) and I'mRT matirxx (IBA, Schwarzenbruck, Germany) equipment to compare the gamma evaluation. 11 patients with lung cancer at various sites were used in this study. We also used the TLD-100 (LiF) to measure the differences in dose between the calculated dose and measured dose in the Alderson Rando phantom. The maximum, mean, minimum dose for the normal tissue did not change significantly. But the volume of the PTV covered by the 95% isodose curve was decreased by 6% in the lung due to the difference in the algorithms. The difference dose between the calculated dose by the PBC algorithms and AAA algorithms and the measured dose with TLD-100 (LiF) in the Alderson Rando phantom was -4.6% and -2.7% respectively. Based on the results of this study, the treatment plan calculated using the AAA algorithms is more accurate in lung sites with a low density when compared to the treatment plan calculated using the PBC algorithms.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.19-26
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• 2017

Purpose: The application of density override is very important to minimize dose calculation errors by fiducial markers of metal material in proton treatment plan. However, density override with actual material of the fiducial marker could make problem such as inaccurate target contouring and compensator fabrication. Therefore, we perform density override with surrounding material instead of actual material and we intend to evaluate the usefulness of density override with surrounding material of the fiducial marker by analyzing the dose distribution according to the position, material of the fiducial marker and number of beams. Materials and Method: We supposed that the fiducial marker of gold, steel, titanium is located in 1.5, 2.5, 4.0, 6.0 cm from the proton beam's end of range using water phantom. Treatment plans were created by applying density override with the surrounding material and actual material of the fiducial marker. Also, a liver cancer patient who received proton therapy was selected. We located the fiducial marker of gold, steel, titanium in 0, 1.5, 3.5 cm from the proton beam's end of range and the treatment plans were created by same method with water phantom. Homogeneity Index(HI), Conformity Index(CI) and maximum dose of Organ At Risk(OAR) in Planning Target Volume(PTV) as the evaluation index were compared according to the material, position of the fiducial marker and number of beam. Results: The HI value was more decreased when density override with surrounding material of the fiducial marker was performed comparing with density override with actual material. Especially the HI value was increased when the fiducial marker was located farther from the proton beam's end of the range for a single beam and the fiducial marker's position was closer to isocenter for two or more beams. The CI value was close to 1 and OAR maximum dose was greatly reduced when density override with surrounding material of the fiducial marker was performed comparing with density override with actual material. Conclusion: Density override with surrounding material can be expected to achieve more precise proton therapy than density override with actual material of the fiducial marker and could increase the dose uniformity and target coverage and reduce the dose to surrounding normal tissues for the small fiducial markers used in clinical practice. Most of all, it is desirable to plan the treatment by avoiding the fiducial marker of metal material as much as possible. However, if the fiducial marker have on the beam path, density override of the surrounding material can be expected to achieve more precise proton therapy.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.27-35
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• 2017

Purpose: On the left side, breast cancer patients have more side effects than those on the right side because of unnecessary doses in normal organs such as heart and lung. DIBH is performed to reduce this. To evaluate the dose of peripheral organs in the left breast cancer including supraclavicular lymph nodes and internal mammary lymph nodes according to the treatment planning method of Conventional Radiation Therapy, Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy. Materials and Methods: We performed CT-simulation using free breathing and deep inspiration breath-hold technique for 8 patients including left supraclavicular lymph nodes and internal mammary lymph nodes. Based on the acquired CT images, the contour of the body is drawn and the convention is performed so that $95%{\leftarrow}PTV$, $Dmax{\leftarrow}110%$. Conventional Radiation Therapy used a one portal technique on the supraclavicular lymph node and used a field in field technique tangential beam on the breast. Intensity Modulated Radiation Therapy was composed of 7 static fields. Volumetric Modulated Arc Therapy was planned using 2 ARC with a turning radius of $290^{\circ}$ to $179^{\circ}$. The peripheral normal organs dose was analyzed by referring to the dose volume of Eclipse. Results: By applying the deep inspiration breath-hold technique, the mean interval between the heart and chest wall increased $1.6{\pm}0.6cm$. The mean dose of lung was $19.2{\pm}1.0Gy$, which was the smallest value in Intensity Modulated Radiation Therapy. The V30 (%) of the heart was $2.0{\pm}1.9$, which was the smallest value in Intensity Modulated Radiation Therapy. In the left anterior descending coronary artery, the dose was $25.4{\pm}5.4Gy$, which was the smallest in Intensity Modulated Radiation Therapy. The maximum dose value of the Right breast was $29.7{\pm}4.3Gy$ at Intensity Modulated Radiation Therapy. Conclusion: When comparing the values of surrounding normal organs, Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy were applicable values for treatment. Among them, Intensity Modulated Radiation Therapy is considered to be a suitable treatment planning method.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.37-48
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• 2017

Purpose: The most basic conditions of radiation therapy is to prevent unnecessary exposure of normal tissue. The risk factors that are important o evaluate the dose emitted to the lung and heart from radiation therapy for breast cancer. Therefore, comparing the dose factors of a normal tissue according to the radion treatment position and Seeking an effective radiation treatment for breast cancer through the analysis of the correlation relationship. Materials and Methods: Computed tomography was conducted among 30 patients with left breast cancer in supine and prone position. Eclipse Treatment Planning System (Ver.11) was established by computerized treatment planning. Using the DVH compared the incident dose to normal tissue by position. Based on the result, Using the SPSS (ver.18) analyzed the dose in each normal tissue factors and Through the correlation analysis between variables, independent sample test examined the association. Finally The HI, CI value were compared Using the MIRADA RTx (ver. ad 1.6) in the supine, prone position Results: The results of computerized treatment planning of breast cancer in the supine position were V20, $16.5{\pm}2.6%$ and V30, $13.8{\pm}2.2%$ and Mean dose, $779.1{\pm}135.9cGy$ (absolute value). In the prone position it showed in the order $3.1{\pm}2.2%$, $1.8{\pm}1.7%$, $241.4{\pm}138.3cGy$. The prone position showed overall a lower dose. The average radiation dose 537.7 cGy less was exposured. In the case of heart, it showed that V30, $8.1{\pm}2.6%$ and $5.1{\pm}2.5%$, Mean dose, $594.9{\pm}225.3$ and $408{\pm}183.6cGy$ in the order supine, prone position. Results of statistical analysis, Cronbach's Alpha value of reliability analysis index is 0.563. The results of the correlation analysis between variables, position and dose factors of lung is about 0.89 or more, Which means a high correlation. For the heart, on the other hand it is less correlated to V30 (0.488), mean dose (0.418). Finally The results of independent samples t-test, position and dose factors of lung and heart were significantly higher in both the confidence level of 99 %. Conclusion: Radiation therapy is currently being developed state-of-the-art linear accelerator and a variety of treatment plan technology. The basic premise of the development think normal tissue protection around PTV. Of course, if you treat a breast cancer patient is in the prone position it take a lot of time and reproducibility of set-up problems. Nevertheless, As shown in the experiment results it is possible to reduce the dose to enter the lungs and the heart from the prone position. In conclusion, if a sufficient treatment time in the prone position and place correct confirmation will be more effective when the radiation treatment to patient.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.2
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• pp.113-124
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• 2005

Purpose : The using of endo-rectal balloon has proposed as optimal method that minimized the motion of prostate and the dose of rectum wall volume for treated prostate cancer patients, so we make the customized rectal balloon device. In this study, we analyzed the efficiency of the Self-customized rectal balloon in the aspects of its reproducibility. Materials and Methods : In 5 patients, for treatment planning, each patient was acquired CT slice images in state of with and without rectal balloon. Also they had CT scanning samely repeated third times in during radiation treatment (IMRT). In each case, we analyzed the deviation of rectal ballon position and verified the isodose distribution of rectum wall at closed prostate. Results : Using the rectal balloon, we minimized the planning target volume (PTV) by decreased the internal motion of prostate and overcome the dose limit of radiation therapy in prostate cancer by increased the gap between the rectum wall and high dose region. Conclusion : The using of rectal balloon, although, was reluctant to treat by patients. View a point of immobilization of prostate internal motion and dose escalation of GTV (gross tumor volume), its using consider large efficients for treated prostate cancer patients.

• Progress in Medical Physics
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• v.24 no.3
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• pp.145-153
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• 2013

Stereotactic body radiation therapy (SBRT) is increasingly used to treat spinal metastases. To achieve the highest steep dose gradients and conformal dose distributions of target tumors, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques are essential to spine radiosurgery. The purpose of the study was to qualitatively compare IMRT and VMAT techniques with International Spine Radiosurgery Consortium (ISRC) contoured consensus guidelines for target volume definition. Planning target volume (PTV) was categorized as TB, $T_{BPT}$ and $T_{ST}$ depending on sectors involved; $T_B$ (vertebral body only), $T_{BPT}$ (vertebral body+pedicle+transverse process), and $T_{ST}$ (spinous process+transverse process). Three patients treated for spinal tumor in the cervical, thoracic, and lumbar region were selected. Eacg tumor was contoured by the definition from the ISRC guideline. Maximum spinal cord dose were 12.46 Gy, 12.17 Gy and 11.36 Gy for $T_B$, $T_{BPT}$ and $T_{ST}$ sites, and 11.81 Gy, 12.19 Gy and 11.99 Gy for the IMRT, RA1 and RA2 techniques, respectively. Average fall-off dose distance from 90% to 50% isodose line for $T_B$, $T_{BPT}$, and $T_{ST}$ sites were 3.5 mm, 3.3 mm and 3.9 mm and 3.7 mm, 3.7 mm and 3.3 mm for the IMRT, RA1 and RA2 techniques, respectively. For the most complicated target $T_{BPT}$ sites in the cervical, thoracic and lumbar regions, the conformity index of the IMRT, RA1 and RA2 is 0.621, 0.761 and 0.817 and 0.755, 0.796 and 0.824 for rDHI. Both IMRT and VMAT techniques delivered high conformal dose distributions in spine stereotactic radiosurgery. However, if the target volume includes the vertebral body, pedicle, and transverse process, IMRT planning resulted in insufficient conformity index, compared to VMAT planning. Nevertheless, IMRT technique was more effective in reducing the maximum spinal cord dose compared to RA1 and RA2 techniques at most sites.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.1-5
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• 2016

A dosimetric evaluation of volumetric modulated arc therapy, intensity modulated radiation therapy, and three-dimensional conformal radiation therapy for the lower extremity soft tissue sarcoma For the lower extremity soft tissue sarcoma, volumetric modulated arc therapy, intensity modulated radiation therapy, and three-dimensional conformal radiation therapy were evaluated to compare these three treatment planning technique. The mean doses to the planning target volume and the femur were calculated to evaluate target coverage and the risk of bone fracture during radiation therapy. Volumetric modulated arc therapy can reduce the dose to the femur without compromising target coverage and reduce the treatment time compared with intensity modulated radiation therapy.

• Progress in Medical Physics
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• v.28 no.3
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• pp.100-105
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• 2017

The purpose of the present study was to develop and evaluate patient-customized helmets with a three-dimensional (3D) printer for radiation therapy of malignant scalp tumors. Computed tomography was performed in a case an Alderson RANDO phantom without bolus (Non_Bolus), in a case with a dental wax bolus on the scalp (Wax_Bolus), and in a case with a patient-customized helmet fabricated using a 3D printer (3D Printing_Bolus); treatment plans for each of the 3 cases were compared. When wax bolus was used to fabricate a bolus, a drier was used to apply heat to the bolus to make the helmet. $3-matic^{(R)}$ (Materialise) was used for modeling and polyamide 12 (PA-12) was used as a material, 3D Printing bolus was fabricated using a HP JET Fusion 3D 4200. The average Hounsfield Unit (HU) for the Wax_Bolus was -100, and that of the 3D Printing_Bolus was -10. The average radiation doses to the normal brain with the Non_Bolus, Wax_Bolus, and 3D Printing_Bolus methods were 36.3%, 40.2%, and 36.9%, and the minimum radiation dose were 0.9%, 1.6%, 1.4%, respectively. The organs at risk dose were not significantly difference. However, the 95% radiation doses into the planning target volume (PTV) were 61.85%, 94.53%, and 97.82%, and the minimum doses were 0%, 77.1%, and 82.8%, respectively. The technique used to fabricate patient-customized helmets with a 3D printer for radiation therapy of malignant scalp tumors is highly useful, and is expected to accurately deliver doses by reducing the air gap between the patient and bolus.

• Progress in Medical Physics
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• v.27 no.4
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• pp.250-257
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• 2016

The purpose of this study was to compare the patient setup errors of two different immobilization devices (Feet Fix: FF and Leg Fix: LF) for pelvic region radiotherapy in Tomotherapy. Thirty six-patients previously treated with IMRT technique were selected, and divided into two groups based on applied immobilization devices (FF versus LF). We performed a retrospective clinical analysis including the mean, systematic, random variation, 3D-error, and calculated the planning target volume (PTV) margin. In addition, a rotational error (angles, $^{\circ}$) for each patient was analyzed using the automatic image registration. The 3D-errors for the FF and the LF groups were 3.70 mm and 4.26 mm, respectively; the LF group value was 15.1% higher than in the FF group. The treatment margin in the ML, SI, and AP directions were 5.23 mm (6.08 mm), 4.64 mm (6.29 mm), 5.83 mm (8.69 mm) in the FF group (and the LF group), respectively, that the FF group was lower than in the LF group. The percentage in treatment fractions for the FF group (ant the LF group) in greater than 5 mm at ML, SI, and AP direction was 1.7% (3.6%), 3.3% (10.7%), and 5.0% (16.1%), respectively. Two different immobilization devices were affected the patient setup errors due to different fixed location in low extremity. The radiotherapy for the pelvic region by Tomotherapy should be considering variation for the rotational angles including Yaw and Pitch direction that incorrect setup error during the treatment. In addition the choice of an appropriate immobilization device is important because an unalterable rotation angle affects the setup error.

• Journal of Magnetics
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• v.21 no.2
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• pp.293-297
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• 2016

For mastectomy patients, sufficient doses of radiation should be delivered to the surface of the chest wall to prevent recurrence. A bolus is used to increase the surface dose on the chest wall, whereby the surface dose is confirmed with the use of a virtual bolus during the computerized treatment-planning process. The purpose of this study is an examination of the difference between the dose of the computerized treatment plan and the dose that is measured on the bolus. Part of the left breast of an Anderson Rando phantom was removed, followed by the attainment of computed tomography (CT) images that were used as the basis for computerized treatment plans that were established with no bolus, a 3 mm-thick bolus, a 5 mm-thick bolus, and a 10 mm-thick bolus. For the computerized treatment plan, a prescribed dose regimen was dispensed daily and planning target volume (PTV) coverage was applied according to the RTOG 1304 guidelines. Using each of the established computerized treatment plans, chest-wall doses of 5 points were measured; this chest-wall dose was used as the standard for the analysis of this study, while the level of significance was set at P < 0.05. The measurement of the chest-wall dose with no bolus is 1.6 % to 10.3 % higher, and the differences of the minimum average and the maximum average of the five measurement points are -13.8 and -1.9, respectively (P < 0.05); however, when the bolus was used, the dosage was measured as 3.7 % to 9.2 % lower, and the differences of the minimum average and the maximum average are 7.4 and 9.0, -1.2 and 17.4, and 8.1 and 19.8 for 3 mm, 5 mm, and 10 mm, respectively (P < 0.05). As the thickness of the bolus is increased, the differences of the average surface dose are further increased. There are a variety of factors that affect the surface dose on the chest wall during post-mastectomy radiation therapy, for which verification is required; in particular, a consideration of the appropriate thickness and the number of uses when a bolus is used, and which has the greatest effect on the surface dose on the chest wall, is considered necessary.