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Performance Evaluation of Radiochromic Films and Dosimetry CheckTM for Patient-specific QA in Helical Tomotherapy (나선형 토모테라피 방사선치료의 환자별 품질관리를 위한 라디오크로믹 필름 및 Dosimetry CheckTM의 성능평가)

  • Park, Su Yeon;Chae, Moon Ki;Lim, Jun Teak;Kwon, Dong Yeol;Kim, Hak Joon;Chung, Eun Ah;Kim, Jong Sik
    • The Journal of Korean Society for Radiation Therapy
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    • v.32
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    • pp.93-109
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    • 2020
  • Purpose: The radiochromic film (Gafchromic EBT3, Ashland Advanced Materials, USA) and 3-dimensional analysis system dosimetry checkTM (DC, MathResolutions, USA) were evaluated for patient-specific quality assurance (QA) of helical tomotherapy. Materials and Methods: Depending on the tumors' positions, three types of targets, which are the abdominal tumor (130.6㎤), retroperitoneal tumor (849.0㎤), and the whole abdominal metastasis tumor (3131.0㎤) applied to the humanoid phantom (Anderson Rando Phantom, USA). We established a total of 12 comparative treatment plans by the four geometric conditions of the beam irradiation, which are the different field widths (FW) of 2.5-cm, 5.0-cm, and pitches of 0.287, 0.43. Ionization measurements (1D) with EBT3 by inserting the cheese phantom (2D) were compared to DC measurements of the 3D dose reconstruction on CT images from beam fluence log information. For the clinical feasibility evaluation of the DC, dose reconstruction has been performed using the same cheese phantom with the EBT3 method. Recalculated dose distributions revealed the dose error information during the actual irradiation on the same CT images quantitatively compared to the treatment plan. The Thread effect, which might appear in the Helical Tomotherapy, was analyzed by ripple amplitude (%). We also performed gamma index analysis (DD: 3mm/ DTA: 3%, pass threshold limit: 95%) for pattern check of the dose distribution. Results: Ripple amplitude measurement resulted in the highest average of 23.1% in the peritoneum tumor. In the radiochromic film analysis, the absolute dose was on average 0.9±0.4%, and gamma index analysis was on average 96.4±2.2% (Passing rate: >95%), which could be limited to the large target sizes such as the whole abdominal metastasis tumor. In the DC analysis with the humanoid phantom for FW of 5.0-cm, the three regions' average was 91.8±6.4% in the 2D and 3D plan. The three planes (axial, coronal, and sagittal) and dose profile could be analyzed with the entire peritoneum tumor and the whole abdominal metastasis target, with planned dose distributions. The dose errors based on the dose-volume histogram in the DC evaluations increased depending on FW and pitch. Conclusion: The DC method could implement a dose error analysis on the 3D patient image data by the measured beam fluence log information only without any dosimetry tools for patient-specific quality assurance. Also, there may be no limit to apply for the tumor location and size; therefore, the DC could be useful in patient-specific QAl during the treatment of Helical Tomotherapy of large and irregular tumors.

Genetic Properties and Antimicrobial Resistance of Campylobacter jejuni Isolates from Diarrhea Patients in Gyeonggi-do (경기도내에서 분리한 캠필로박터 제주니균의 유전적특성 및 항생제내성 연구)

  • Hur, Eun-Seon;Park, Po-Hyun;Kim, Jong-Hwa;Son, Jong-Sung;Yun, Hee-Jeong;Lee, Yea-Eun;Choi, Yun-Sook;Yoon, Mi-Hye;Lee, Jong-Bok
    • Korean Journal of Microbiology
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    • v.49 no.3
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    • pp.228-236
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    • 2013
  • Campylobacter jejuni is one of important food-borne pathogens causing human gastroenteritis. We isolated 42 strains of C. jejuni from diarrhea patients and 4 food-poisoning outbreaks in 2010, Gyeonggi-do. In this study, 42 strains were tested for genetic characteristics, the serotype distribution and antimicrobial resistant rate. The presence of hipO (100%), cdtB (100%), and mutated gyrA (95.2%) genes was detected in C. jejuni by polymerase chain reaction (PCR). Detection of mutated gyrA gene correlated with ciprofloxacin resistance. Forty isolates had mutated gyrA gene and were actually resistant to ciprofloxacin. Furthermore, comparing the gyrA DNA sequence data, ciprofloxacin-resistant isolates had a mutation of the DNA sequence from ACA (threonine) to ATA (isoleucine). But 41 strains (97.6%) of patient isolates were susceptible to erythromycin and azithromycin. A total of 35.7% among 42 C. jejuni isolates were identified into 4 different serotypes. The serotype distribution of C. jejuni strains were shown to be HS2(B), HS3(C), HS4(D), HS19(O). To investigate the genotypes of C. jejuni isolated in Gyeonggi province, repetitive sequence polymerase chain reaction (rep-PCR) analysis and SmaI-digested pulsed-filed gel electrophoresis (PFGE) profile analysis were performed. From the PFGE analysis of 42 C. jejuni strains, 12 clusters of PFGE profile were obtained. On the other hand, 11 clusters of rep-PCR profile were obtained from 42 strains of C. jejuni.

Impacts of Depression, Somatization, and Jaw Disability on Graded Chronic Pain in TMD Patients (우울, 신체화, 턱기능장애가 측두하악장애 환자의 만성통증척도에 미치는 영향)

  • Kim, Cheul;Shin, Eun-Seop;Chung, Jin-Woo
    • Journal of Oral Medicine and Pain
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    • v.30 no.3
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    • pp.353-360
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    • 2005
  • The aim of this study was to investigate the impact of depression, somatization, and jaw disability on graded chronic pain of TMD using Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Ninety-three patients (17 men and 76 women, mean$\pm$SD age of 30.1$\pm$12.5 years) diagnosed with TMD based on RDC/TMD axis I criteria were administered RDC/TMD axis II history questionnaire. The relationships between depression, somatization, jaw disability, and each parameters of graded chronic pain (e.g. pain intensity, pain days, disability score, disability days, graded chronic pain scale) were analyzed by multiple regression analysis. The obtained results were as follows: 1. Among 93 TMD patients, the prevalence of low disability group of graded chronic pain scale was 42.0% and high disability group of graded chronic pain scale was 51.5%. 2. Depression did not show any significant influences on pain intensity, pain days, disability score, disability days, and graded chronic pain scale. 3. Somatization showed a significant effect on pain intensity (p<0.01), disability days (p<0.01), and graded chronic pain scale (p<0.01) except for both pain days and disability score. 4. Jaw disability also showed a significant effect on pain intensity (P<0.001), disability days (p<0.01), and graded chronic pain scale (P<0.001) except for both pain days and disability score. Somatization and jaw disability may closely relate to the pain intensity and degree of disability that TMD patients perceive. Therefore, comprehensive understanding of psychological profile and improvement of functional limitation of jaw movements in the patient should be considered to obtain an excellent outcome of chronic TMD management.

GafChromic Film Dosimetry for Stereotactic Radiosurgery with a Linear Accelerator (선형가속기를 이용한 정위방사선 치료 시 GafChromic Film을 이용한 선량측정)

  • Han Seung Hee;Cho Byung Chul;Park Suk Won;Oh Do Hoon;Park Hee Chul;Bae Hoon Sik
    • Radiation Oncology Journal
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    • v.21 no.2
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    • pp.167-173
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    • 2003
  • Purpose: The purpose of this study was to evaluate whether a GafChromic film applied to stereotactic radiosurgery with a linear accelerator could provide information on the value for acceptance testing and quality control on the absolute dose and relative dose measurements and/or calculation of treatment planning system. Materials and methods: A spherical acrylic phantom, simulating a patient's head, was constructed from three points. The absolute and relative dose distributions could be measured by inserting a GafChromic film into the phantom. We tested the use of a calibrated GafChromic film (MD-55-2, Nuclear Associate, USA) for measuring the optical density. These measurements were achieved by irradiating the films with a dose of 0-112 Gy employing 6 MV photon. To verify the accuracy of the prescribed dose delivery to a target isocenter using a five arc beams (irradiated in 3 Gy per one beam) setup, calculated by the Linapel planning system the absolute dose and relative dose distribution using a GafChromic film were measured. All the irradiated films were digitized with a Lumiscan 75 laser digitizer and processed with the RIT113 film dosimetry system. Results: We verified the linearity of the Optical Density of a MD-55-2 GafChromic film, and measured the depth dose profile of the beam. The absolute dose delivered to the target was close to the prescribed dose of Linapel within an accuracy for the GafChromic film dosimetry (of $\pm$3$\%$), with a measurement uncertainty of $\pm$1 mm for the 50$\~$90$\%$ isodose lines. Conclusion: Our results have shown that the absolute dose and relative dose distribution curves obtained from a GafChromic film can provide information on the value for acceptance. To conclude the GafChromic flim is a convenient and useful dosimetry tool for linac based radiosurgery.

Dose Characteristics of Total-Skin Electron-Beam Irradiation with Six-Dual Electron Fields (Six-Dual 전자선 조사면에 의한 전신 피부 조사의 선량 특성)

  • Choi, Tae-Jin;Kim, Jin-Hee;Kim, Ok-Bae
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.337-345
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    • 1998
  • Purpose : To obtain the uniform dose at limited depth to entire surface of the body, the dose characteristics of degraded electron beam of the large target-skin distance and the dose distribution of the six-dual electron fields were investigated Materials and Method : The experimental dose distributions included the depth dose curve, spatial dose and attenuated electron beam were determined with 300 cm of target-skin distance (TSD) and full collimator size (35*35 $cm^2$ on TSD 100 cm) in 4 MeV electron beam energy. Actual collimated field size of 105 cm * 105 cm at the distance of 300 cm could include entire hemibody. A patient was standing on step board with hands up and holding the pole to stabilize his/her positions for the six-dual fields technique. As a scatter-degrader, 0.5 cm of acrylic plate was inserted at 20 cm from the body surface on the electron beam path to induce ray scattering and to increase the skin dose. Results : The full width at half maximum(FWHM) of dose profile was 130 cm in large field of 105*105 $cm^2$ The width of $100\pm10\%$ of the resultant dose from two adjacent fields which were separated at 25 cm from field edge for obtaining the dose unifomity was extended to 186 cm. The depth of maximum dose lies at 5 mm and the 80$\%$ depth dose lies between 7 and 8 mm for the degraded electron beam by using the 0.5 cm thickness of acrylic absorber. Total skin electron beam irradiation (TSEBI) was carried out using the six dual fields has been developed at Stanford University. The dose distribution in TSEBI showed relatively uniform around the flat region of skin except the protruding and deeply curvatured portion of the body, which showed excess of dose at the former and less dose at the latter. Conclusion : The percent depth dose, profile curves and superimposed dose distribution were investigated using the degraded electron beam through the beam absorber. The dose distribution obtained by experiments of TSEBI showed within$\pm10\%$ difference except the protruding area of skin which needs a shield and deeply curvatured region of skin which needs boosting dose.

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Evaluation of Usefulness of Iterative Metal Artifact Reduction(IMAR) Algorithm In Proton Therapy Planning (양성자 치료계획에서 Iterative Metal Artifact Reduction(IMAR) Algorithm 적용의 유용성 평가)

  • Han, Young Gil;Jang, Yo Jong;Kang, Dong Heok;Kim, Sun Young;Lee, Du Hyeon
    • The Journal of Korean Society for Radiation Therapy
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    • v.29 no.1
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    • pp.49-56
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    • 2017
  • Purpose: To evaluate the accuracy of the Iterative Metal Artifact Reduction (IMAR) algorithm in correcting CT (computed tomography) images distorted due to a metal artifact and to evaluate the usefulness when proton therapy plan was plan using the images on which IMAR algorithm was applied. Materials and Methods: We used a CT simulator to capture the images when metal was not inserted in the CIRS model 062 Phantom and when metal was inserted in it and Artifact occurred. We compared the differences in the CT numbers from the images without metal, with a metal artifact, and with IMAR algorithm by setting ROI 1 and ROI 2 at the same position in the phantom. In addition, CT numbers of the tissue equivalents located near the metal were compared. For the evaluation of Rando Phantom, CT was taken by inserting a titanium rod into the spinal region of the Rando phantom modelling a patient who underwent spinal implant surgery. In addition, the same proton therapy plan was established for each image, and the differences in Range at three sites were compared. Results: In the evaluation of CIRS Phantom, the CT numbers were -6.5 HU at ROI 1 and -10.5 HU at ROI 2 in the absence of metal. In the presence of metal, Fe, Ti, and W were -148.1, -45.1 and -151.7 HU at ROI 1, respectively, and when the IMAR algorithm was applied, it increased to -0.9, -2.0, -1.9 HU. In the presence of metal, they were 171.8, 63.9 and 177.0 HU at ROI 2 and after the application of IMAR algorithm they decreased to 10.0 6,7 and 8.1 HU. The CT numbers of the tissue equivalents were corrected close to the original CT numbers except those in the lung located farthest. In the evaluation of the Rando Phantom, the mean CT numbers were 9.9, -202.8, and 35.1 HU at ROI 1, and 9.0, 107.1, and 29 HU at ROI 2 in the absence, presence of metal, and in the application of IMAR algorithm. The difference between the absence of metal and the range of proton beam in the therapy was reduced on the average by 0.26 cm at point 1, 0.20 cm at point 2, and 0.12 cm at point 3 when the IMAR algorithm was applied. Conclusion: By applying the IMAR algorithm, the CT numbers were corrected close to the original ones obtained in the absence of metal. In the beam profile of the proton therapy, the difference in Range after applying the IMAR algorithm was reduced by 0.01 to 3.6 mm. There were slight differences as compared to the images absence of metal but it was thought that the application of the IMAR algorithm could result in less error compared with the conventional therapy.

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Comparison study of intensity modulated arc therapy using single or multiple arcs to intensity modulated radiation therapy for high-risk prostate cancer

  • Ashamalla, Hani;Tejwani, Ajay;Parameritis, Ioannis;Swamy, Uma;Luo, Pei Ching;Guirguis, Adel;Lavaf, Amir
    • Radiation Oncology Journal
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    • v.31 no.2
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    • pp.104-110
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    • 2013
  • Purpose: Intensity modulated arc therapy (IMAT) is a form of intensity modulated radiation therapy (IMRT) that delivers dose in single or multiple arcs. We compared IMRT plans versus single-arc field (1ARC) and multi-arc fields (3ARC) IMAT plans in high-risk prostate cancer. Materials and Methods: Sixteen patients were studied. Prostate ($PTV_P$), right pelvic ($PTV_{RtLN}$) and left pelvic lymph nodes ($PTV_{LtLN}$), and organs at risk were contoured. $PTV_P$, $PTV_{RtLN}$, and $PTV_{LtLN}$ received 50.40 Gy followed by a boost to $PTV_B$ of 28.80 Gy. Three plans were per patient generated: IMRT, 1ARC, and 3ARC. We recorded the dose to the PTV, the mean dose ($D_{MEAN}$) to the organs at risk, and volume covered by the 50% isodose. Efficiency was evaluated by monitor units (MU) and beam on time (BOT). Conformity index (CI), Paddick gradient index, and homogeneity index (HI) were also calculated. Results: Average Radiation Therapy Oncology Group CI was 1.17, 1.20, and 1.15 for IMRT, 1ARC, and 3ARC, respectively. The plans' HI were within 1% of each other. The $D_{MEAN}$ of bladder was within 2% of each other. The rectum $D_{MEAN}$ in IMRT plans was 10% lower dose than the arc plans (p < 0.0001). The GI of the 3ARC was superior to IMRT by 27.4% (p = 0.006). The average MU was highest in the IMRT plans (1686) versus 1ARC (575) versus 3ARC (1079). The average BOT was 6 minutes for IMRT compared to 1.3 and 2.9 for 1ARC and 3ARC IMAT (p < 0.05). Conclusion: For high-risk prostate cancer, IMAT may offer a favorable dose gradient profile, conformity, MU and BOT compared to IMRT.

Retrospective Analyses of Long-Term Use of SSRI in Children and Adolescents with Autism Spectrum Disorder (소아청소년 자폐성 스펙트럼 장애에서 SSRI 장기 사용에 대한 후향적 분석)

  • Goo, Ae-Jin;Park, Jin-Park;Lee, Jong-Il;Jhin, Hye-Kyung;Kim, Yeni
    • Korean Journal of Biological Psychiatry
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    • v.19 no.4
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    • pp.205-210
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    • 2012
  • Objectives The purpose of this study was to investigate clinical profile, efficacy, and safety of long-term treatment with selective serotonin reuptake inhibitors (SSRIs) in Korean autism spectrum disorders (ASDs) patients. Methods Effectiveness was assessed through a retrospective review of self-reported target symptom improvement at the last follow-up visit. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity (CGI-S) of illness and Clinical Global Impression-Improvement (CGI-I) Scales. Tolerability was assessed through a review of the reason for discontinuation of SSRI and documented adverse events. Results A total of 21 ASDs patients (aged 9 to 19 years) treated with SSRI during July 2010 to July 2011 in department of child and adolescent psychiatry of Seoul National Hospital were identified. The mean duration of SSRI treatment was 47.9 (standard deviation = 36.9) months (range 0.7-114.5), and the mean fluoxetine equivalent dosage of SSRIs was $27.1{\pm}10.8$ mg. Nineteen (90.5%) patients were using concomitant medication. We found that SSRIs were prescribed for symptoms of agitation, stereotyped behavior, aggression, depression, impulsivity and self-injury in ASDs. Ten patients (47.6%) reported improvement in their target symptom after SSRI treatment based on CGI-I scores (CGI-I ${\leq}$ 2). The side effects were reported in 5 patients (23.8%) ; vomiting (n = 2, 9.5%), excessive mood elevation (n = 1, 4.8%), insomnia (n = 1, 4.8%), somnolence (n = 1, 4.8%) and decreased appetite (n = 1, 4.8%). Self-injurious behavior was reported in one patient (4.8%). Conclusions The results of this study suggest that SSRIs may be used effectively in children and adolescents diagnosed with ASDs. However, safety issues need to be considered carefully when choosing SSRIs for treatment. Future controlled trials are needed to confirm these findings.

An Analysis of Research on Fatigue (피로와 관련된 논문 분석)

  • 변영순;박미숙
    • Journal of Korean Academy of Nursing
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    • v.26 no.4
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    • pp.868-877
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    • 1996
  • This study was done to analyze research trends and to suggest future perspectives for nursing research on fatigue. The author reviewed 31 Korean and foreign research papers which have been published in the literature since 1970. An analysis of the study focused on the type of research subjects, type of study design. measurement instrument, and its correlated parameters. The results of the study are summarized as follows : First, within all of the studies analayzed, 14 studies were publised in Korea and 17 were published abroad. The number of studies done abroad have been increasing rapidly since 1991. Second, an analysis of the research design of the studies showed, eight studies each, Korean and foreign used survey design. Two Korean studies and seven foreign studies used a correlational design. Four comparative studies were done in Korea, but only two experimetal studies were performed abroad. Therefore, it was found that the trend of the study design used is survey design and there are more correlational studies done abroad than in Korea. Third, the type of the study subjects ; 11 Korean and three foreign studies dealt with healthy people. In addition, three Korean and 14 foreign studies investigated patients with various illnesses. It was found that patients with various illnesses were studied more frequently in foreign studies than in Korean studies. Fourth, the measurement tool used in the Korean studies ; 13 studies used a testible tool to assess patients' subjective symtoms or complaints of fatigue. The most commonly used tool used in 10 studies, was the Fatigue Self-Perception Scale, which was designed by the Labor and Health Institute of Japan. The Visual Analogue Scale was used in two studies, and Piper Fatigue Scale, addtional with physiologic parameters, was used in one study. In the foreign studies, subjective measurement tools were used in 16 studies. A combination of a subjective measurement tool with objective parameters was used in ten studies. For the subjective measurement tool used in the foreign studies, a specific measurement tool developed by the researcher which was used in seven studies. Either Rhoten Fatigue Scale or the Visual Analog Scale were used in three studies. Additionally, in order to identify the relationship between fatigue and psychological factors, The Profile of Mood State was used in three studies. Beck Depression Inventory was used in two studies. The Self Rated Depression Scale, developed by Zung, was used in one study and other measurement tools were used to measure various psychological parameters. Rhoten fatigue Checklist was also used to observe behavior patterns. Lastly, nine studies identified correlations between fatigue and other parameters. A significant correlation was found between fatigue and psychological factors such as depression, and pain. As a result of the above findings, it can be said that research trends on fatigue are increasing internationally. The selected study designs are survey studies both in Korea and abroad. There are more correlational studies abroad than in Korea. In addition, subjective measurement tools and objective parameters are used variously and combined with each other. had, there is a significant correlation between fatigue and psychological factors such as depression, and pain. More survey and correlational studies need to be done to identify the relationship of fatigue in patients with various condition or diagnoses and to suggest a scientific basis for nursing interventions with fatigue. Also, a tool to assess patient's subjective, objective, and behavioral aspects on fatigue needs to be developed.

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Development of 2.5D Photon Dose Calculation Algorithm (2.5D 광자선 선량계산 알고리즘 개발)

  • 조병철;오도훈;배훈식
    • Progress in Medical Physics
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    • v.10 no.2
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    • pp.103-114
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    • 1999
  • In this study, as a preliminary study for developing a full 3D photon dose calculation algorithm, We developed 2.5D photon dose calculation algorithm by extending 2D calculation algorithm to allow non-coplanar configurations of photon beams. For this purpose, we defined the 3d patient coordinate system and the 3d beam coordinate system, which are appropriate to 3d treatment planning and dose calculation. and then, calculate a transformation matrix between them. For dose calculation, we extended 2d "Clarkson-Cunningham" model to 3d one, which can calculate wedge fields as well as regular and irregular fields on arbitrary plane. The simple Batho's power-law method was implemented as an inhomogeneity correction. We evaluated the accuracy of our dose model following procedures of AAPM TG#23; radiation treatment planning dosimetry verifications for 4MV of Varian Clinac-4. As results, PDDs (percent depth dose) of cubic fields, the accuracy of calculation are within 1% except buildup region, and $\pm$3% for irregular fields and wedge fields. And for 45$^{\circ}$ oblique incident beam, the deviations between measurements and calculations are within $\pm$4%. In the case of inhomogeneity correction, the calculation underestimate 7% at the lung/water boundary and overestimate 3% at the bone/water boundary. At the conclusions, we found out our model can predict dose with 5% accuracy at the general condition. we expect our model can be used as a tool for educational and research purpose.. purpose..

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