• Progress in Medical Physics
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• v.23 no.1
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• pp.33-41
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• 2012

For applying the quality assurance (QA) of volumetric modulated arc therapy (VMAT) introduced in Eulji Hospital, we classify it into three different QA steps, treatment planning QA, pretreatment delivering QA, and treatment verifying QA. These steps are based on the existing intensity modulated radiation therapy (IMRT) QA that is currently used in our hospital. In each QA step, the evaluated items that are from QA program are configured and documented. In this study, QA program is not only applied to actual patient treatment, but also evaluated to establish a reference of clinical acceptance in pretreatment delivering QA. As a result, the confidence limits (CLs) in the measurements for the high-dose and low-dose regions are similar to the conventional IMRT level, and the clinical acceptance references in our hospital are determined to be 3 to 5% for the high-dose and the low-dose regions, respectively. Due to the characteristics of VMAT, evaluation of the intensity map was carried out using an ArcCheck device that was able to measure the intensity map in all directions, $360^{\circ}$. With a couple of dosimetric devices, the gamma index was evaluated and analyzed. The results were similar to the result of individual intensity maps in IMRT. Mapcheck, which is a 2-dimensional (2D) array device, was used to display the isodose distributions and gave very excellent local CL results. Thus, in our hospital, the acceptance references used in practical clinical application for the intensity maps of $360^{\circ}$ directions and the coronal isodose distributions were determined to be 93% and 95%, respectively. To reduce arbitrary uncertainties and system errors, we had to evaluate the local CLs by using a phantom and to cooperate with multiple organizations to participate in this evaluation. In addition, we had to evaluate the local CLs by dividing them into different sections about the patient treatment points in practical clinics.

• Journal of the Korean Physical Society
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• v.73 no.10
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• pp.1571-1576
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• 2018

We developed and evaluated an algorithm to calculate the target radiation dose in cancer patients by measuring the transmitted dose during 3D conformal radiation treatment (3D-CRT) treatment. The patient target doses were calculated from the transit dose, which was measured using a glass dosimeter positioned 150 cm from the source. The accuracy of the transit dose algorithm was evaluated using a solid water phantom for five patient treatment plans. We performed transit dose-based patient dose verification during the actual treatment of 34 patients who underwent 3D-CRT. These included 17 patients with breast cancer, 11 with pelvic cancer, and 6 with other cancers. In the solid water phantom study, the difference between the transit dosimetry algorithm with the treatment planning system (TPS) and the measurement was $-0.10{\pm}1.93%$. In the clinical study, this difference was $0.94{\pm}4.13%$ for the patients with 17 breast cancers, $-0.11{\pm}3.50%$ for the eight with rectal cancer, $0.51{\pm}5.10%$ for the four with bone cancer, and $0.91{\pm}3.69%$ for the other five. These results suggest that transit-dosimetry-based in-room patient dose verification is a useful application for 3D-CRT. We expect that this technique will be widely applicable for patient safety in the treatment room through improvements in the transit dosimetry algorithm for complicated treatment techniques (including intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT).

• Progress in Medical Physics
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• v.29 no.4
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• pp.106-114
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• 2018

This study aimed to compare the performance of previous optimization algorithms against new a photon optimizer (PO) algorithm for intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans for prostate cancer. Eighteen patients with prostate cancer were retrospectively selected and planned to receive 78 Gy in 39 fractions of the planning target volume (PTV). All plans for each patient optimized with the dose volume optimizer (DVO) and progressive resolution optimizer (PRO) algorithms for IMRT and VMAT were compared against plans optimized with the PO within Eclipse version 13.7. No interactive action was performed during optimization. Dosimetric and radiobiological indices for the PTV and organs at risk were analyzed. The monitor units (MU) per plan were recorded. Based on the plan quality for the target coverage, prostate IMRT and VMAT plans using the PO showed an improvement over DVO and PRO. In addition, the PO generally showed improvement in the tumor control probability for the PTV and normal tissue control probability for the rectum. From a technical perspective, the PO generated IMRT treatment plans with fewer MUs than DVO, whereas it produced slightly more MUs in the VMAT plan, compared with PRO. The PO showed over potentiality of DVO and PRO whenever available, although it led to more MUs in VMAT than PRO. Therefore, the PO has become the preferred choice for planning prostate IMRT and VMAT at our institution.

• 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.

• Journal of radiological science and technology
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• v.46 no.3
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• pp.239-246
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• 2023

In this study, we assessed the effect of reduction of tumor volume in the head and neck cancer by using RANDO phantom in Static Intensity-Modulated Radiation Therapy (S-IMRT) and Volumetric-Modulated Arc Therapy (VMAT) planning. RANDO phantom's body and protruding volumes were delineated by using Contour menu of Eclipse™ (Varian Medical System, Inc., Version 15.6, USA) treatment planning system. Inner margins of 2 mm to 10 mm from protruding volumes of the reference were applied to generate the parameters of reduced volume. In addition, target volume and Organ at Risk (OAR) volumes were delineated. S-IMRT plan and VMAT plan were designed in reference. These plans were assigned in the reduced volumes and dose was calculated in reduced volumes using preset Monitor unit (MU). Dose Volume Histogram (DVH) was generated to evaluate treatment planning. Conformity Index (CI) and R² in reference S-IMRT were 0.983 and 0.015, respectively. There was no significant relationship between CI and the reduced volume. Homogeneity Index (HI) and R² were 0.092 and 0.960, respectively. The HI increased when volume reduced. In reference VMAT, CI and R² were 0.992 and 0.259, respectively. There was no relationship between the volume reduction and CI. On the other hand, HI and R² were 0.078 and 0.895, respectively. The value of HI increased when the volume reduced. There was significant difference (p<0.05) between parameters (D_mean and D_max) of normal organs of S-IMRT and VMAT except brain stem. Volume reduction affected the CI, HI and OAR dose. In the future, additional studies are necessary to incorporate the reduction of the volume in the clinical setting.

• 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.

• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.177-183
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• 2018

Purpose : Volumetric Modulated Arc Therapy(VMAT) has the advantage of uniformly and precisely irradiating the tumor to the shape of the tumor while reducing the risk of radiation damage to normal tissues. such as brain cancer, head and neck cancer and prostate cancer, It is being used for treatment. The purpose of this study is to evaluate the usefulness of the Jaw-Tracking technique(JTT) in VMAT for brain and head and neck cancer. Materials and Methods : We selected eight patients with brain and head and neck cancer(4 Brain, 4 head and neck) who were treated with the VMAT treatment technique. Contouring information of the patient's tumor and normal organ was fused to the Rando phantom using the deformable registration of Velocity(Varian, USA). A treatment plan was developed using the Varian Eclipse(ver 15.5, Varian, USA) with the same patient actual beam parameters except for the use of jaw-tracking. As the evaluation index, the maximum dose and mean dose of target and OAR were compared and a portal dosimetry was performed for the treatment plan verification. Results : When using JTT, the relative dose of OAR decreased by 5.24 % and the maximum dose by 7.05 %, respectively, compared with the Static-Jaw technique(SJT). In the various OARs, the mean dose and maximum dose reduction ranges ranged from 0.01 to 3.16 Gy and from 0.12 to 6.27 Gy, respectively. In the case of the target, the maximum dose of GTV, CTV, PTV decreased by 0.17 %, 0.43 %, and 0.37 % in JTT, and the mean dose decreased by 0.24 %, 0.47 % and 0.47 %, respectively. Gamma analysis The JTT and SJT passing rates were $98{\pm}1.73%$ and $97{\pm}1.83%$ on the basis of 3 % / 3 mm, respectively. Comparing the doses of all OARs applied to the experiment, it was found that the use of JTT resulted in a significant decrease in dose due to additional jaw shielding besides MLC than SJT. Conclusion : In radiation therapy using VMAT treatment plan, we can apply JTT in the case of adjacent tumor and normal organs such as brain cancer and head and neck cancer, and in radiotherapy required large field and high energy caused increase leakage dose through MLC. It is considered that the target dose of PTV can be increased by lowering the dose of normal tissue surrounding the tumor.

• Journal of radiological science and technology
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• v.41 no.3
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• pp.209-214
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• 2018

The results of CBCT was obtained using image guided radiation therapy for radiation therapy in 5 prostate cancer patients. Using these results, we compared and evaluated the dose changes according to the treatment plan depending on the volume and position of bladder, rectum, and prostate. The 28 images of CBCT were acquired using On-Board Imaging device before radiotherapy. After the outline of bladder, rectum, and PTV, pCT images and CBCT images for radiotherapy were treated respectively. The volume of the bladder was increased by 105.6% and decreased by 45.2%. The volume of the rectum was increased by 30.5% and decreased by 20.3%. Prostate volume was increased by 6.3% and decreased by 12.3%. The mean dose of the rectum was higher in the CBCT than in the pCT, and V40 (equivalent to 40 Gy) of the bladder showed a reduction in all treatment regimens in the CBCT than in the pCT. Conformity treatment and homogeneity index of PTV showed better results in all treatment regimens using pCT than CBCT. It was found that the dose distribution of the pelvic internal organs varied greatly according to the patient 's condition and pretreatment.

• Progress in Medical Physics
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• v.25 no.2
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• pp.100-109
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• 2014

In stereotactic body radiotherapy (SBRT), the accurate location of treatment sites should be guaranteed from the respiratory motions of patients. Lots of studies on this topic have been conducted. In this letter, a new verification method simulating the real respiratory motion of heterogenous treatment regions was proposed to investigate the accuracy of lung SBRT for Volumetric Modulated Arc Therapy. Based on the CT images of lung cancer patients, lung phantoms were fabricated to equip in $QUASAR^{TM}$ respiratory moving phantom using 3D printer. The phantom was bisected in order to measure 2D dose distributions by the insertion of EBT3 film. To ensure the dose calculation accuracy in heterogeneous condition, The homogeneous plastic phantom were also utilized. Two dose algorithms; Analytical Anisotropic Algorithm (AAA) and AcurosXB (AXB) were applied in plan dose calculation processes. In order to evaluate the accuracy of treatments under respiratory motion, we analyzed the gamma index between the plan dose and film dose measured under various moving conditions; static and moving target with or without gating. The CT number of GTV region was 78 HU for real patient and 92 HU for the homemade lung phantom. The gamma pass rates with 3%/3 mm criteria between the plan dose calculated by AAA algorithm and the film doses measured in heterogeneous lung phantom under gated and no gated beam delivery with respiratory motion were 88% and 78%. In static case, 95% of gamma pass rate was presented. In the all cases of homogeneous phantom, the gamma pass rates were more than 99%. Applied AcurosXB algorithm, for heterogeneous phantom, more than 98% and for homogeneous phantom, more than 99% of gamma pass rates were achieved. Since the respiratory amplitude was relatively small and the breath pattern had the longer exhale phase than inhale, the gamma pass rates in 3%/3 mm criteria didn't make any significant difference for various motion conditions. In this study, the new phantom model of 4D dose distribution verification using patient-specific lung phantoms moving in real breathing patterns was successfully implemented. It was also evaluated that the model provides the capability to verify dose distributions delivered in the more realistic condition and also the accuracy of dose calculation.

• Journal of the Korean Physical Society
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• v.80
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• pp.516-525
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• 2022

This study is to assess the clinical use of commercial PerFRACTION^TM for patient-specific quality assurance of volumetric-modulated arc therapy. Forty-six pretreatment verification plans for patients treated using a TrueBeam STx linear accelerator for lesions in various treatment sites such as brain, head and neck (H&N), prostate, and lung were included in this study. All pretreatment verification plans were generated using the Eclipse treatment planning system (TPS). Dose distributions obtained from electronic portal imaging device (EPID), ArcCHECK^TM, and two-dimensional (2D)/three-dimensional (3D) PerFRACTION^TM were then compared with the dose distribution calculated from the Eclipse TPS. In addition, the correlation between the plan complexity (the modulation complexity score and the leaf travel modulation complexity score) and the gamma passing rates (GPRs) of each quality assurance (QA) system was evaluated by calculating Spearman's rank correlation coefficient (r_s) with the corresponding p-values. The gamma passing rates of 46 patients analyzed with the 2D/3D PerFRACTION^TM using the 2%/2 mm and 3%/3 mm criteria showed almost similar trends to those analyzed with the Portal dose imaging prediction (PDIP) and ArcCHECK^TM except for those analyzed with ArcCHECK^TM using the 2%/2 mm criterion. Most of weak or moderate correlations between GPRs and plan complexity were observed for all QA systems. The trend of mean rs between GPRs using PDIP and 2D/3D PerFRACTION^TM for both criteria and plan complexity indices as in the GPRs analysis was significantly similar for brain, prostate, and lung cases with lower complexity compared to H&N case. Furthermore, the trend of mean rs for 2D/3D PerFRACTION^TM for H&N case with high complexity was similar to that of ArcCHECK^TM and slightly lower correlation was observed than that of PDIP. This work showed that the performance of 2D/3D PerFRACTION^TM for pretreatment patient-specific QA was almost comparable to that of PDIP, although there was small difference from ArcCHECK^TM for some cases. Thus, we found that the PerFRACTION^TM is a suitable QA system for pretreatment patient-specific QA in a variety of treatment sites.