• Radiation Oncology Journal
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• v.12 no.3
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• pp.387-392
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• 1994

Purpose : This study was done to confirm the reference point variation according to variation in applicator configuration in each fractioation of HDR ICR. Materials and Methods : We analyzed the treatment planning of HDRICR for 33 uterine cervical cancer patients treated in department of therapeutic radiology from January 1992 to February 1992. Analysis was done with respect to three view points-Interfractionation A point variation, interfractionation bladder and rectum dose ratio variation, interfractionation treatment volume variation. Interfractionation A point variation was defined as difference between maximum and minimum distance from fixed rectal point to A point in each patient. Interfractionation bladder and rectum dose ratio variation was defined as difference between maximum and minimum dose ratio of bladder or rectum to A point dose in each patient, Interfractionation treatment volume variation was defined as difference between miximum and minimum treatment volume which absorbed over the described dose-that is, 350 cGy or 400 cGy-in each patient. Results The mean of distance from rectum to A point was 4.44cm, and the mean of interfractionation distance variation was 1.14 cm in right side,1.09 cm in left side. The mean of bladder and rectum dose ratio was $63.8\%$ and $63.1\%$ and the mean of interfractionation variation was $14.9\%$ and $15.8\%$ respectively. With fixed planning administration of same planning to all fractionations as in first fractionation planning-mean of bladder and rectum dose ratio was $64.9\%$ and $72.3\%$.and the mean of interfraction variation was $28.1\%$ and $48.1\%$ reapectively. The mean of treatment volume was $84.15cm^3$ and the interfractionation variation was $21.47cm^2$. Conclusion : From these data, it was confirmed that there should be adapted planning for every fractionation ,and that confirmation device installed in ICR room would reduce the interfractionation variation due to more stable applicator configuration.

• Nuclear Engineering and Technology
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• v.48 no.2
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• pp.525-532
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• 2016

High-energy linear accelerators are increasingly used in the medical field. However, the unwanted photo-neutrons can also be contributed to the dose delivered to the patients during their treatments. In this study, neutron fluxes were measured in a solid water phantom placed at the isocenter 1-m distance from the head of an18-MV linac using the foil activation method. The produced activities were measured with a calibrated well-type Ge detector. From the measured fluxes, the total neutron fluence was found to be $(1.17{\pm}0.06){\times}10^7n/cm^2$ per Gy at the phantom surface in a $20{\times}20cm^2$ X-ray field size. The maximum photo-neutron dose was measured to be $0.67{\pm}0.04$ mSv/Gy at $d_{max}=5cm$ depth in the phantom at isocenter. The present results are compared with those obtained for different field sizes of $10{\times}10cm^2$, $15{\times}15cm^2$, and $20{\times}20cm^2$ from 10-, 15-, and 18-MV linacs. Additionally, ambient neutron dose equivalents were determined at different locations in the room and they were found to be negligibly low. The results indicate that the photo-neutron dose at the patient position is not a negligible fraction of the therapeutic photon dose. Thus, there is a need for reduction of the contaminated neutron dose by taking some additional measures, for instance, neutron absorbing-protective materials might be used as aprons during the treatment.

• Progress in Medical Physics
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• v.24 no.2
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• pp.92-98
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• 2013

The experimental verification of treatment planning on the treatment spot is the ultimate method to assure quality of radiotherapy, so in-vivo skin dose measurement is the essential procedure to confirm treatment dose. In this study, glass rod dosimeter (GRD), which is a kind of photo-luminescent based dosimeters, was studied to produce a guideline to use GRDs in vivo dosimetry for quality assurance of radiotherapy. The pre-processing procedure is essential to use GRDs. This is a heating operation for stabilization. Two kinds of pre-processing methods are recommended by manufacturer: a heating method (70 degree, 30 minutes) and a waiting method (room temperature, 24 hours). We equally irradiated 1.0 Gy to 20 GRD elements, and then different preprocessing were performed to 10 GRDs each. In heating method, reading deviation of GRDs at same time were relatively high, but the deviation was very low as time went on. In waiting method, the deviation among GRDs was low, but the deviation was relatively high as time went on. The meaningful difference was found between mean reading values of two pre-processing methods. Both methods present mean dose deviation under 5%, but the relatively high effect by reading time was observed in waiting method. Finally, GRD is best to perform in-vivo dosimetry in the viewpoint of accuracy and efficiency, and the understanding of how pre-processing affect the accuracy is asked to perform most accurate in-vivo dosimetry. The further study is asked to acquire more stable accuracy in spite of different irradiation conditions for GRD usage.

• Progress in Medical Physics
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• v.14 no.2
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• pp.90-98
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• 2003

Purpose : A new virtual simulation technique for craniospinal irradiation (CSI) that uses a CT-simulator was developed to improve the accuracy of field and shielding placement as well as patient positioning. Materials and Methods : A CT simulator (CT-SIM) and a 3-D conformal radiation treatment planning system (3D-CRT) were used to develop CSI. The head and neck were immobilized with a thermoplastic mask while the rest of the body was immobilized with a Vac-Loc. A volumetric image was then obtained with the CT simulator. In order to improve the reproducibility of the setup, datum lines and points were marked on the head and body. Virtual fluoroscopy was performed with the removal of visual obstacles, such as the treatment table or immobilization devices. After virtual simulation, the treatment isocenters of each field were marked on the body and on the immobilization devices at the conventional simulation room. Each treatment fields was confirmed by comparing the fluoroscopy images with the digitally reconstructed radiography (DRR) and digitally composited radiography (DCR) images from virtual simulation. Port verification films from the first treatment were also compared with the DRR/DCR images for geometric verification. Results : We successfully performed virtual simulations on 11 CSI patients by CT-SIM. It took less than 20 minutes to affix the immobilization devices and to obtain the volumetric images of the entire body. In the absence of the patient, virtual simulation of all fields took 20 min. The DRRs were in agreement with simulation films to within 5 mm. This not only reducee inconveniences to the patients, but also eliminated position-shift variables attendant during the long conventional simulation process. In addition, by obtaining CT volumetric image, critical organs, such as the eyes and the spinal cord, were better defined, and the accuracy of the port designs and shielding was improved. Differences between the DRRs and the portal films were less than 3 m in the vertebral contour. Conclusion : Our analysis showed that CT simulation of craniospinal fields was accurate. In addition, CT simulation reduced the duration of the patient's immobility. During the planning process. This technique can improve accuracy in field placement and shielding by using three-dimensional CT-aided localization of critical and target structures. Overall, it has improved staff efficiency and resource utilization by standard protocol for craniospinal irradiation.

• Progress in Medical Physics
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• v.25 no.4
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• pp.298-303
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• 2014

In this study, we examine the trends and types of incidents frequently occur during radiation therapy by using the data from the radiation oncology safety information system (ROSIS), according to discovery method explores the development direction of future research accident cause factor control method. This study was carried out analysis of incident data in ROSIS nearly 1163 cases in last 11 years from 2003 to 2013. We categorized into treatment methods, found the time, discoverer of occupations and finding ways to analyze the data. Then, we calculate the percentage and the classification for each item. About 1163 cases of incident cases including the near miss cases, external radiation therapy, brachytherapy and other were 97%, 2% and 1%. In the case was improperly planned dose delivery was 44% (497 cases) which 429 cases (86%) was found before 3 fractions and 13 cases were found after 11 fractions. The investigation was found to be distributed in various a found times. Approximately 42% of found time was during treatment and 29% of patients were found the problem during inspection chart. Occupation to discover the most radiation accidents was the radiation therapist (53%) who works in treatment room. Among 1163 incidence cases, 24% cases were found the accident before the treatment, therefore most of accident were found after of during the treatment (70%, 813 cases). This trend is acquired through ROSIS analysis, is expected to be not significantly different in the case of Korea, so it is necessary more diverse and systematic research for the prevention and early detection by using the ROSIS data.

• Progress in Medical Physics
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• v.19 no.1
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• pp.35-41
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• 2008

The main benefit of proton therapy over photon beam radiotherapy is the absence of exit dose, which offers the opportunity for highly conformal dose distributions to target volume while simultaneously irradiating less normal tissue. For proton beam therapy two patient specific beam modifying devices are used. The aperture is used to shape the transverse extension of the proton beam to the shape of the tumor target and a patient-specific compensator attached to the block aperture when required and used to modify the beam range as required by the treatment plan for the patient. A block of range shifting material, shaped on one face in such a way that the distal end of the proton field in the patient takes the shape of the distal end of the target volume. The mechanical quality assurance of range compensator is an essential procedure to confirm the 3 dimensional patient-specific dose distributions. We proposed a new quality assurance method for range compensator based on image processing using X-ray tube of proton therapy treatment room. The depth information, boundaries of each depth of plan compensatorfile and x-ray image of compensator were analyzed and presented over 80% matching results with proposed QA program.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.248-250
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• 2002

A 56 year-old man complaining of dry cough, dyspnea, chest pain, fever, and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy and subsequent radiotherapy because of an esophageal cancer. After the emergency echocardiography revealed a small amount of pericardial effusion and pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach and the pericardium, and an emergency operation was done under the diagnosis of gastropericardial fistula. The patient expired postoperative seven days later. Gastropericardial fistula caused by a peptic ulcer perforation after the esophagectomy and esophagogastrostomy operation is a very rare complication and brings forth a disastrous result. Early detection using the chest radiography, electrocardiogram, upper Gl study, echocardiography and a review of physical examination, and an immediate treatment are therefore mandatory.

• Tuberculosis and Respiratory Diseases
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• v.63 no.3
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• pp.242-250
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• 2007

Background: Abnormal angiogenesis can induce hypoxia within a highly proliferating tumor mass, and these hypoxic conditions can in turn create clinical problems, such as resistance to chemotherapy. However, the mechanism by which hypoxia induces these changes has not yet been determined. Therefore, this study was conducted to determine how hypoxia induces changes in cell viability and extracellular microenvironments in an in vitro culture system using non-small cell lung cancer cells. Methods: The non-small cell lung cancer cell line, A549 was cultured in DMEM or RPMI-1640 media that contained fetal bovine serum. A decrease in the oxygen tension of the media that contained the culture was then induced in a hypoxia microchamber using a $CO_2-N_2$ gas mixture. A gas analysis and an MTT assay were then conducted. Results: (1) The decrease in oxygen tension was checked the anaerobic gas mixture for 30 min and then reoxygenation was induced by adding a 5% $CO_2-room$ air gas mixture to the chamber. (2) Purging with the anaerobic gas mixture was found to decrease the further oxygen tension of cell culture media. (3) The low oxygen tension resulted in a low pH, lactic acidosis and a decreased glucose concentration in the media. (4) The decrease in glucose concentration that was observed as a result of hypoxia was markedly different when different types of media were evaluated. (5) The decrease in oxygen tension inhibited proliferation of A549 cells. Conclusion: These data suggests that tumor hypoxia is associated with acidosis and hypoglycemia, which have been implicated in the development of resistance to chemotherapy and radiotherapy.

• Progress in Medical Physics
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• v.2 no.2
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• pp.109-120
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• 1991

Total body irradiation is operated to irradicate malignant cells of bone marrow of patients to be treated with bone marrow transplantation. Field size of a linear accelerator or cobalt teletherapy unit with normal geometry for routine technique is too small to cover whole body of a patient. So, any special method to cover patient whole body must be developed. Because such environments as room conditions and machine design are not universal, some characteristic method of TBI for each hospital could be developed. At Seoul National University Hospital, at present, only a cobalt unit is available for TBI because source head of the unit could be tilted. When the head is tilted outward by 90$^{\circ}$, beam direction is horizontal and perpendicular to opposite wall. Then, the distance from cobalt source to the wall was 319 cm. Provided that the distance from the wall to midsagittal plane of a patient is 40cm, nominal field size at the plane(SCD 279cm) is 122cm$\times$122cm but field size by measurement of exposure profile was 130cm$\times$129cm and vertical profile was not symmetric. That field size is large enough to cover total body of a patient when he rests on a couch in a squatting posture. Assuming that average lateral width of patients is 30cm, percent depth dose for SSD 264cm and nominal field size 115.5cm$\times$115.5cm was measured with a plane-parallel chamber in a polystyrene phantom and was linear over depth range 10～20cm. An anthropomorphic phantom of size 25cm wide and 30cm deep. Depth of dose maximum, surface dose and depth of 50% dose were 0.3cm, 82% and 16.9cm, respectively. A dose profile on beam axis for two opposing beams was uniform within 10% for mid-depth dose. Tissue phantom ratio with reference depth 15cm for maximum field size at SCD 279cm was measured in a small polystyrene phantom and was linear over depth range 10～20cm. An anthropomorphic phantom with TLD chips inserted in holes on the largest coronal plane was bilaterally irradiated by 15 minute in each direction by cobalt beam aixs in line with the cross line of the coronal plane and contact surface of sections No. 27 and 28. When doses were normalized with dose at mid-depth on beam axis, doses in head/neck, abdomen and lower lung region were close to reference dose within $\pm$ 10% but doses in upper lung, shoulder and pelvis region were lower than 10% from reference dose. Particulaly, doses in shoulder region were lower than 30%. On this result, the conclusion such that under a geometric condition for TBI with cobalt beam as SNUH radiotherapy departement, compensators for head/neck and lung shielding are not required but boost irradiation to shoulder is required could be induced.

• Progress in Medical Physics
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• v.19 no.4
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• pp.209-218
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• 2008

According to improved radiation therapy technology such as IMRT and proton therapy, the accuracy of patient alignment system is more emphasized and IGRT is dominated research field in radiation oncology. We proposed to study the feasibility of cone-beam CT system using simple x-ray imaging systems for image guided proton therapy at National Cancer Center. 180 projection views ($2,304{\times}3,200$, 14 bit with 127 ${\mu}m$ pixel pitch) for the geometrical calibration phantom and humanoid phantoms (skull, abdomen) were acquired with $2^{\circ}$ step angle using x-ray imaging system of proton therapy gantry room ($360^{\circ}$ for 1 rotation). The geometrical calibration was performed for misalignments between the x-ray source and the flat-panel detector, such as distances and slanted angle using available algorithm. With the geometrically calibrated projection view, Feldkamp cone-beam algorithm using Ram-Lak filter was implemented for CBCT reconstruction images for skull and abdomen phantom. The distance from x-ray source to the gantry isocenter, the distance from the flat panel to the isocenter were calculated as 1,517.5 mm, 591.12 mm and the rotated angle of flat panel detector around x-ray beam axis was considered as $0.25^{\circ}$. It was observed that the blurring artifacts, originated from the rotation of the detector, in the reconstructed toomographs were significantly reduced after the geometrical calibration. The demonstrated CBCT images for the skull and abdomen phantoms are very promising. We performed the geometrical calibration of the large gantry rotation system with simple x-ray imaging devices for CBCT reconstruction. The CBCT system for proton therapy will be used as a main patient alignment system for image guided proton therapy.