• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.161-169
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• 2016

Purpose : To quantify the inter-fractional variation in prostate displacement and their dosimetric effects for prostate cancer treatment. Materials and Methods : A total of 176 daily cone-beam CT (CBCT) sets acquired for 6 prostate cancer patients treated with volumetric-modulated arc therapy (VMAT) were retrospectively reviewed. For each patient, the planning CT (pCT) was registered to each daily CBCT by aligning the bony anatomy. The prostate, rectum, and bladder were delineated on daily CBCT, and the contours of these organs in the pCT were copied to the daily CBCT. The concordance of prostate displacement, deformation, and size variation between pCT and daily CBCT was evaluated using the Dice similarity coefficient (DSC). Results : The mean volume of prostate was 37.2 cm3 in the initial pCT, and the variation was around ${\pm}5%$ during the entire course of treatment for all patients. The mean DSC was 89.9%, ranging from 70% to 100% for prostate displacement. Although the volume change of bladder and rectum per treatment fraction did not show any correlation with the value of DSC (r=-0.084, p=0.268 and r=-0.162, p=0.032, respectively), a decrease in the DSC value was observed with increasing volume change of the bladder and rectum (r=-0.230,p=0.049 and r=-0.240,p=0.020, respectively). Conclusion : Consistency of the volume of the bladder and rectum cannot guarantee the accuracy of the treatment. Our results suggest that patient setup with the registration between the pCT and daily CBCT should be considered aligning soft tissue.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.59-67
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• 2014

Purpose : This study aims to evaluate 3D dosimetric impact for MIP image and each phase image in stereotactic body radiotherapy (SBRT) for lung cancer using volumetric modulated arc therapy (VMAT). Materials and Methods : For each of 5 patients with non-small-cell pulmonary tumors, a respiration-correlated four-dimensional computed tomography (4DCT) study was performed. We obtain ten 3D CT images corresponding to phases of a breathing cycle. Treatment plans were generated using MIP CT image and each phases 3D CT. We performed the dose verification of the TPS with use of the Ion chamber and COMPASS. The dose distribution that were 3D reconstructed using MIP CT image compared with dose distribution on the corresponding phase of the 4D CT data. Results : Gamma evaluation was performed to evaluate the accuracy of dose delivery for MIP CT data and 4D CT data of 5 patients. The average percentage of points passing the gamma criteria of 2 mm/2% about 99%. The average Homogeneity Index difference between MIP and each 3D data of patient dose was 0.03~0.04. The average difference between PTV maximum dose was 3.30 cGy, The average different Spinal Coad dose was 3.30 cGy, The average of difference with $V_{20}$, $V_{10}$, $V_5$ of Lung was -0.04%~2.32%. The average Homogeneity Index difference between MIP and each phase 3d data of all patient was -0.03~0.03. The average PTV maximum dose difference was minimum for 10% phase and maximum for 70% phase. The average Spain cord maximum dose difference was minimum for 0% phase and maximum for 50% phase. The average difference of $V_{20}$, $V_{10}$, $V_5$ of Lung show bo certain trend. Conclusion : There is no tendency of dose difference between MIP with 3D CT data of each phase. But there are appreciable difference for specific phase. It is need to study about patient group which has similar tumor location and breathing motion. Then we compare with dose distribution for each phase 3D image data or MIP image data. we will determine appropriate image data for treatment plan.

• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.61-71
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• 2020

Purpose: To investigate the effect of collimator angle on plan quality of PAN-Pelvis Multi-isocenter VMAT plan, dose reproducibility at the junction and impact on set-up error at the junction. Material and method: 10 adult patients with whole pelvis cancer including PAN were selected for the study. Using Trubeam STx equipped with HD MLC, we changed the collimator angle to 20°, 30°, and 45° except 10° which was the default collimator angle in the Eclipse(version 13.7) and all other treatment conditions were set to be the same for each patient and four plans were established also. To evaluate these plans, PTV coverage, coverage index(CVI) and homogeneity index (HI) were compared and clinical indicators for each treatment sites in normal tissues were analyzed. To evaluate dose reproducibility at the junction, the absolute dose was measured using a Falmer type ionization chamber and dose changes at the junction were evaluated by moving the position of the isocenter in and out 1~3mm and setting up the virtual volume at the junction. Result: CVI mean value was PTV-45 0.985±0.004, PTV-55 0.998±0.003 at 45° and HI mean value was PTV-45 1.140±0.074, and PTV-55 1.031±0.074 at 45° which were closest to 1. V20Gy of the kidneys decreased by 9.66% and average dose of bladder and V30 decreased by 1.88% and 2.16% at 45° compared to 10° for the critical organs. The dose value at the junction of the plan and the actual measured were within 0.3% and within tolerance. At the junction, due to set-up error the maximum dose increased to 14.56%, 9.88%, 8.03%, and 7.05%, at 10°, 20°, 30°, 45°, and the minimum dose decreased to 13.18%, 10.91%, 8.42%, and 4.53%, at 10°, 20°, 30°, 45° Conclusion: In terms of CVI, HI of PTV and critical organ protection, overall improved values were shown as the collimator angle increased. The impact on set-up error at the junction by collimator angle decreased as the angle increased and it will help improve the anxiety about the set up error. In conclusion, the collimator angle should be recognized as a factor that can affect the quality of the multi-isocenter VMAT plan and the dose at the junction, and be careful in setting the collimator angle in the treatment plan.

• Progress in Medical Physics
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• v.25 no.4
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• pp.233-241
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• 2014

The aim of this study is to develop a new software tool for 3D dose verification using $PRESAGE^{REU}$ Gel dosimeter. The tool included following functions: importing 3D doses from treatment planning systems (TPS), importing 3D optical density (OD), converting ODs to doses, 3D registration between two volumetric data by translational and rotational transformations, and evaluation with 3D gamma index. To acquire correlation between ODs and doses, CT images of a $PRESAGE^{REU}$ Gel with cylindrical shape was acquired, and a volumetric modulated arc therapy (VMAT) plan was designed to give radiation doses from 1 Gy to 6 Gy to six disk-shaped virtual targets along z-axis. After the VMAT plan was delivered to the targets, 3D OD data were reconstructed from 512 projection data from $Vista^{TM}$ optical CT scanner (Modus Medical Devices Inc, Canada) per every 2 hours after irradiation. A curve for converting ODs to doses was derived by comparing TPS dose profile to OD profile along z-axis, and the 3D OD data were converted to the absorbed doses using the curve. Supra-linearity was observed between doses and ODs, and the ODs were decayed about 60% per 24 hours depending on their magnitudes. Measured doses from the $PRESAGE^{REU}$ Gel were well agreed with the TPS doses at central region, but large under-doses were observed at peripheral region at the cylindrical geometry. Gamma passing rate for 3D doses was 70.36% under the gamma criteria of 3% of dose difference and 3 mm of distance to agreement. The low passing rate was resulted from the mismatching of the refractive index between the PRESAGE gel and oil bath in the optical CT scanner. In conclusion, the developed software was useful for 3D dose verification from PRESAGE gel dosimetry, but further improvement of the Gel dosimetry system were required.

• Journal of radiological science and technology
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• v.39 no.4
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• pp.577-585
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• 2016

The purpose of this study is to evaluate the accuracy of beam delivery QA software using the MLC dynalog file, about the VMAT plan with AAPM TG-119 protocol. The Clinac iX with a built-in 120 MLC was used to acquire the MLC dynalog file be imported in MobiusFx(MFX). To establish VMAT plan, Oncentra RTP system was used target and organ structures were contoured in Im'RT phantom. For evaluation of dose distribution was evaluated by using gamma index, and the point dose was evaluated by using the CC13 ion chamber in Im'RT phantom. For the evaluation of point dose, the mean of relative error between measured and calculated value was $1.41{\pm}0.92%$(Target) and $0.89{\pm}0.86%$(OAR), the confidence limit were 3.21(96.79%, Target) and 2.58(97.42%, OAR). For the evaluation of dose distribution, in case of $Delta^{4PT}$, the average percentage of passing rate were $99.78{\pm}0.2%$(3%/3 mm), $96.86{\pm}1.76%$(2%/2 mm). In case of MFX, the average percentage of passing rate were $99.90{\pm}0.14%$(3%/3 mm), $97.98{\pm}1.97%$(2%/2 mm), the confidence limits(CL) were in case of $Delta^{4PT}$ 0.62(99.38%, 3%/3 mm), 6.6(93.4%, 2%/2 mm), in case of MFX, 0.38(99.62%, 3%/3 mm), 5.88(94.12%, 2%/2 mm). In this study, we performed VMAT QA method using dynamic MLC log file compare to binary diode array chamber. All analyzed results were satisfied with acceptance criteria based on TG-119 protocol.

• Progress in Medical Physics
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• v.25 no.4
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• pp.210-217
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• 2014

This study investigated the dosimetric effects of different dose calculation algorithm for lung stereotactic ablative radiotherapy (SABR) using flattening filter-free (FFF) beams. A total of 10 patients with lung cancer who were treated with SABR were evaluated. All treatment plans were created using an Acuros XB (AXB) of an Eclipse treatment planning system. An additional plans for comparison of different alagorithm recalcuated with anisotropic analytic algorithm (AAA) algorithm. To address both algorithms, the cumulative dose-volume histogram (DVH) was analyzed for the planning target volume (PTV) and organs at risk (OARs). Technical parameters, such as the computation times and total monitor units (MUs), were also evaluated. A comparison analysis of DVHs from these plans revealed the PTV for AXB estimated a higher maximum dose (5.2%) and lower minimum dose (4.2%) than that of the AAA. The highest dose difference observed 7.06% for the PTV $V_{105%}$. The maximum dose to the lung was also slightly larger in the AXB plans. The percentate volumes of the ipsilateral lung ($V_5$, $V_{10}$, $V_{20}$) receiving 5, 10, and 20 Gy were also larger in AXB plans than for AAA plans. However, these parameters were comparable between both AAA and AXB plans for the contralateral lung. The differences of the maximum dose for the spinal cord and heart were also small. The computation time of AXB plans was 13.7% shorter than that of AAA plans. The average MUs were 3.47% larger for AXB plans than for AAA plans. The results of this study suggest that AXB algorithm can provide advantages such as accurate dose calculations and reduced computation time in lung SABR plan using FFF beams, especially for volumetric modulated arc therapy technique.