• The Journal of Korean Society for Radiation Therapy
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• v.31 no.1
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• pp.33-41
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• 2019

Purpose : To evaluate the effectiveness of Jaw-tracking(JT) technique in Intensity-modulated radiation therapy(IMRT) and Volumetric-modulated arc therapy(VMAT) for radiation therapy of esophageal cancer by analyzing volume dose of perimetrical normal organs along with the low-dose volume regions. Materials and Method: A total of 27 patients were selected who received radiation therapy for esophageal cancer with using $VitalBeam^{TM}$(Varian Medical System, U.S.A) in our hospital. Using Eclipse system(Ver. 13.6 Varian, U.S.A), radiation treatment planning was set up with Jaw-tracking technique(JT) and Non-Jaw-tracking technique(NJT), and was conducted for the patients with T-shaped Planning target volume(PTV), including Supraclavicular lymph nodes(SCL). PTV was classified into whether celiac area was included or not to identify the influence on the radiation field. To compare the treatment plans, Organ at risk(OAR) was defined to bilateral lung, heart, and spinal cord and evaluated for Conformity index(CI) and Homogeneity index(HI). Portal dosimetry was performed to verify a clinical application using Electronic portal imaging device(EPID) and Gamma analysis was performed with establishing thresholds of radiation field as a parameter, with various range of 0 %, 5 %, and 10 %. Results: All treatment plans were established on gamma pass rates of 95 % with 3 mm/3 % criteria. For a threshold of 10 %, both JT and NJT passed with rate of more than 95 % and both gamma passing rate decreased more than 1 % in IMRT as the low dose threshold decreased to 5 % and 0 %. For the case of JT in IMRT on PTV without celiac area, $V_5$ and $V_{10}$ of both lung showed a decrease by respectively 8.5 % and 5.3 % in average and up to 14.7 %. A $D_{mean}$ decreased by $72.3{\pm}51cGy$, while there was an increase in radiation dose reduction in PTV including celiac area. A $D_{mean}$ of heart decreased by $68.9{\pm}38.5cGy$ and that of spinal cord decreased by $39.7{\pm}30cGy$. For the case of JT in VMAT, $V_5$ decreased by 2.5 % in average in lungs, and also a little amount in heart and spinal cord. Radiation dose reduction of JT showed an increase when PTV includes celiac area in VMAT. Conclusion: In the radiation treatment planning for esophageal cancer, IMRT showed a significant decrease in $V_5$, and $V_{10}$ of both lungs when applying JT, and dose reduction was greater when the irradiated area in low-dose field is larger. Therefore, IMRT is more advantageous in applying JT than VMAT for radiation therapy of esophageal cancer and can protect the normal organs from MLC leakage and transmitted doses in low-dose field.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.1
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• pp.15-24
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• 2013

Purpose: In Asan Medical Center, Two parallel opposite beams are employed for total body irradiation. Patients are required to be in supine position where two arms are attached to mid axillary line. Normally, physical compensators are required to compensate the large dose difference for different parts of body due to the different thicknesses compared to the umbilicus separation. There was the maximum dose difference up to 30% in lung and chest wall compared to the prescription dose. In order to resolve the dose discrepancy occurring on different body regions, the feasibility of using Fieid-in-Field Technique is investigated in this study. Materials and Methods: CT scan was performed to The RANDO Phantom with fabricated two arms and sent to Eclipse treatment planning system (version 10.0, Varian, USA). Conventional plan with physical lead compensator and new plan using Field-in-Field Technique were established on TPS. AAA (Anisotropic Analytical Algorithm) dose calculation algorithm was employed for two parallel opposite beams attenuation. Results: The dose difference between two methods was compared with the prescription dose. The dose distribution of chest and anterior chest wall uncovered by patient arms was 114~124% for physical lead compensator while Field-in-Field Technique gave 106~107% of the dose distribution. In-vivo dosimetry result using TLD showed that the dose distribution to the same region was 110~117% for conventional physical compensator and 104~107% for Field-in-Field Technique. Conclusion: In this study, the feasibility of using FIF technique has been investigated with fabricated arms attached Rando phantom. The dose difference was up to 17% due to the attached arms. It is shown that the dose homogeneity is within ${\pm}10%$ with the CT based 3-dimensional 4 step FIF technique. The in-vivo dosimetry result using TLD was showed that 95~107% dose distribution compared to prescription dose. It is considered that CT based 3-dimensional Field-in-Field Technique for the total body irradiation gives much homogeneous dose distribution for different body parts than the conventional physical compensator method and might be useful to evaluate the dose on each part of patient body.

• Progress in Medical Physics
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• v.27 no.2
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• pp.86-92
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• 2016

An absorbed dose calculation method using a digital phantom is implemented in normal organs. This method cannot be employed for calculating the absorbed dose of tumor. In this study, we measure the S-value for calculating the absorbed dose of each organ and tumor. We inject a radioisotope into a torso phantom and perform Monte Carlo simulation based on the CT data. The torso phantom has lung, liver, spinal, cylinder, and tumor simulated using a spherical phantom. The radioactivity of the actual absorbed dose is measured using the injected dose of the radioisotope, which is Cu-64 73.85 MBq, and detected using a glass dosimeter in the torso phantom. To perform the Monte Carlo simulation, the information on each organ and tumor acquired using the PET/CT and CT data provides anatomical information. The anatomical information is offered above mean value and manually segmented for each organ and tumor. The residence time of the radioisotope in each organ and tumor is calculated using the time activity curve of Cu-64 radioactivity. The S-values of each organ and tumor are calculated based on the Monte Carlo simulation data using the spatial coordinate, voxel size, and density information. The absorbed dose is evaluated using that obtained through the Monte Carlo simulation and the S-value and the residence time in each organ and tumor. The absorbed dose in liver, tumor1, and tumor2 is 4.52E-02, 4.61E-02, and 5.98E-02 mGy/MBq, respectively. The difference in the absorbed dose measured using the glass dosimeter and that obtained through the Monte Carlo simulation data is within 12.3%. The result of this study is that the absorbed dose obtained using an image can evaluate each difference region and size of a region of interest.

• The Journal of Korean Society for Radiation Therapy
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• v.15 no.1
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• pp.67-77
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• 2003

I. Purpose Uniform dose distribution of the whole body is essential factor for the total body irradiation(TBI). In order to achieved this goal, we used to compensation filter to compensate body contour irregularity and thickness differences. But we can not compensate components of body, namely lung or bone. The purpose of this study is evaluation of dose attenuation in bone tissue when TBI using diode detectors and TLD system. II. Materials and Methods The object of this study were 5 patients who undergo TBI at our hospital. Dosimetry system were diode detectors and TLD system. Treatment method was bilateral and delivered 10MV X-ray from linear accelerator. Measurement points were head, neck, pelvis, knees and ankles. TLD used two patients and diode detectors used three patients. III. Results Results are as followed. All measured dose value were normalized skin dose. TLD dosimetry : Measured skin dose of head, neck, pelvis, knees and ankles were $92.78{\pm}3.3,\;104.34{\pm}2.3,\;98.03{\pm}1.4,\;99.9{\pm}2.53,\;98.17{\pm}0.56$ respectably. Measured mid-depth dose of pelvis, knees and ankles were $86{\pm}1.82,\;93.24{\pm}2.53,\;91.50{\pm}2.84$ respectably. There were $6.67\%{\sim}11.65\%$ dose attenuation at mid-depth in pelvis, knees and ankles. Diode detector : Measured skin dose of head, neck, pelvis, knees and ankles were $95.23{\pm}1.18,\;98.33{\pm}0.6,\;93.5{\pm}1.5,\;87.3{\pm}1.5,\;86.90{\pm}1.16$ respectably. There were $4.53\%{\sim}12.6\%$ dose attenuation at mid-depth in pelvis, knees and ankles. IV. Conclusion We concluded that dose measurement with TLD or diode detector was inevitable when TBI treatment. Considered dose attenuation in bone tissue, We must have adequately deduction of compensator thickness that body portion involved bone tissue.

• Progress in Medical Physics
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• v.9 no.3
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• pp.155-162
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• 1998

Ho-l66 was produced by neutron reaction in a reactor at the Korea Atomic Energy Institute (Taejon, Korea). Ho-l66 emits a high energy beta particles with a maximum energy of 1.85 MeV and small proportion of gamma rays (80 keV). Therefore, the radiation absorbed dose estimation could be based on the in-vivo quantification of the activity in tumors from the gamma camera images. Approximately 1 mCi of Ho-l66 in solution was mixed into the flood phantom and planar scintigraphic images were acquired with and without patient interposed between the phantom and scintillation camera. Transmission factor over an area of interest was calculated from the ratio of counts in selected regions of the two images described above. A dual-head gamma camera(Multispect2, Siemens, Hoffman Estates, IL, USA) equipped with medium energy collimators was utilized for imaging(80 keV${\pm}$10%). Fifty-nine year old female patient with hepatoma was enrolled into the therapeutic protocol after the informed consent obtained. Thirty millicuries(110MBq) of Ho-166-CHICO was injected into the right hepatic arterial branch supplying hepatoma. When the injection was completed, anterior and posterior scintigraphic views of the chest and pelvic regions were obtained for 3 successive days. Regions of interest (ROIs) were drawn over the organs in both the anterior and posterior views. The activity in those ROIs was estimated from geometric mean, calibration factor and transmission factors. Absorbed dose was calculated using the Marinelli formula and Medical Internal Radiation Dose (MIRD) schema. Tumor dose of the patient treated with 1110 MBq(30 mCi) Ho-l66 was calculated to be 179.7 Gy. Dose distribution to normal liver, spleen, lung and bone was 9.1, 10.3, 3.9, 5.0 % of the tumor dose respectively. In conclusion, tumor dose and absorbed dose to surrounding structures were calculated by daily external imaging after the Ho-l66 therapy for hepatoma. In order to limit the thresholding dose to each surrounding organ, absorbed dose calculation provides useful information.

• Journal of radiological science and technology
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• v.35 no.2
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• pp.157-164
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• 2012

The purpose of this study is to analyze the dose distribution when wedge filter is used in the various tissue electron density materials. The dose distribution was assessed that the enhanced dynamic wedge filter and physical wedge filter were used in the solid water phantom, cork phantom, and air cavity. The film dosimetry was suitable simple to measure 2D dose distribution. Therefore, the radiochromic films (Gafchromic EBT2, ISP, NJ, USA) were selected to measure and to analyze the dose distributions. A linear accelerator using 6 MV photon were irradiated to field size of $10{\times}10cm^2$ with 400 MUs. The dose distributions of EBT2 films were analyzed the in-field area and penumbra regions by using dose analysis program. In the dose distributions of wedge field, the dose from a physical wedge was higher than that from a dynamic wedge at the same electron density materials. A dose distributions of wedge type in the solid water phantom and the cork phantom were in agreements with 2%. However, the dose distribution in air cavity showed the large difference with those in the solid water phantom or cork phantom dose distributions. Dose distribution of wedge field in air cavity was not shown the wedge effect. The penumbra width, out of the field of thick and thin, was observed larger from 1 cm to 2 cm at the thick end. The penumbra of physical wedge filter was much larger average 6% than the dynamic wedge filter. If the physical wedge filter is used, the dose was increased to effect the scatter that interacted with photon and physical wedge. In the case of difference in electron like the soft tissue, lung, and air, the transmission, absorption, and scattering were changed in the medium at high energy photon. Therefore, the treatment at the difference electron density should be inhomogeneity correction in treatment planning system.