• Progress in Medical Physics
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• v.18 no.4
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• pp.194-201
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• 2007

Although Gamma Knife irradiates much more radiation in a single session than conventional radiotherapy, there were only a few studies to measure absolute dose of a Gamma Knife. Especially, there is no report of application of International Atomic Energy Agency (IAEA) TRS-398 which requires to use a water phantom in radiation measurement to Gamma Knife. In this article, the authors reported results of the experiments to measure the absorbed dose to water of a Gamma Knife Model C using the IAEA TRS-398 protocol. The absorbed dose to water of a Gamma Knife model C was measured using a water phantom under conditions as close as possible to the IAEA TRS-398 protocol. The obtained results were compared with values measured using the plastic phantom provided by the Gamma Knife manufacturer. Two Capintec PR-05P mini-chambers and a PTW UNIDOS electrometer were used in measurements. The absorbed dose to water of a Gamma Knife model C inside the water phantom was 1.38% larger than that of the plastic phantom. The current protocol provided by the manufacturer has an intrinsic error stems from the fact that a plastic phantom is used instead of a water phantom. In conclusion, it is not possible to fully apply IAEA TRS-398 to measurement of absorbed dose of a Gamma Knife. Instead, it can be a practical choice to build a new protocol for Gamma Knife or to provide a conversion factor from a water phantom to the plastic phantom. The conversion factor can be obtained in one or two standard laboratories.

• Progress in Medical Physics
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• v.14 no.3
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• pp.184-188
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• 2003

It is strongly recommended that periodic quality assurance should be carried out in the Gamma Knife that is used in radiosurgery since high radiation is delivered in one session. Since the protocols for Gamma Knife recommended by associations or agencies on quality assurance are absent in Korea, hospitals possessing the Gamma Knife have developed their own protocols. In order to develop a quality assurance protocol suitable for Korea, we reviewed the protocols of the Gamma Knife manufacturer, USA and Japan. we categorized the periodic items into three parts,: radiation dose, mechanical and safety part. The USA recommended and regulated more strict than the manufacturer. Japan recommended the items and frequency based on the USA. In conclusion, we tried to suggest a basic Gamma Knife quality assurance protocol suitable for Korea.

• Journal of the Korean Society of Radiology
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• v.11 no.1
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• pp.9-17
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• 2017

A high degree of precision and accuracy in Gamma Knife Radiosurgery(GKRS) is a fundamental requirement for therapeutical success. Elaborate radiation delivery and dose gradients with the steep fall-off of radiation are clinically applied thus necessitating a dedicated Quality Assurance(QA) program in order to guarantee dosimetric and geometric accuracy and reduce all the risk factors that can occur in GKRS. In this study, as a part of QA we verified the accuracy of single-shot dose profiles used in the algorithm of Gamma Knife Perfexion(PFX) treatment planning system employing Variable Ellipsoid Modeling Technique(VEMT). We evaluated the dose distributions of single-shots in a spherical ABC phantom with diameter 160 mm on Gamma Knife PFX. The single-shots were directed to the center of ABC phantom. Collimating configurations of 4, 8, and 16 mm sizes along x, y, and z axes were studied. Gamma Knife PFX treatment planning system being used in GKRS is called Leksell GammaPlan(LGP) ver 10.1.1. From the verification like this, the accuracy of GKRS will be doubled. Then the clinical application must be finally performed based on precision and accuracy of GKRS. Specifically the width at the 50% isodose level, that is, Full-Width-of-Half-Maximum(FWHM) was verified under such conditions that a patient's head is simulated as a sphere with diameter 160mm. All the data about dose profiles along x, y, and z axes predicted through VEMT were excellently consistent with dose profiles from LGP within specifications(${\leq}1mm$ at 50% isodose level) except for a little difference of FWHM and PENUMBRA(isodose level: 20%~80%) along z axis for 4 mm and 8mm collimating configurations. The maximum discrepancy of FWHM was less than 2.3% at all collimating configurations. The maximum discrepancy of PENUMBRA was given for the 8 mm collimator along z axis. The difference of FWHM and PENUMBRA in the dose distributions obtained with VEMT and LGP is too small to give the clinical significance in GKRS. The results of this study are considered as a reference for medical physicists involved in GKRS in the whole world. Therefore we can work to confirm the validity of dose distributions for all collimating configurations determined through the regular preventative maintenance program using the independent verification method VEMT for the results of LGP and clinically assure the perfect treatment for patients of GKRS. Thus the use of VEMT is expected that it will be a part of QA that can verify and operate the system safely.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.39-39
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• 2003

목 적 : 병소가 바깥쪽 측면(far-lateral targets)에 위치한 경우 감마나이프 방사선 시술이 어렵다. 저자들은 새로운 식을 도입하여 치료 좌표계를 변환시키고 환자를 측면으로 눕혀 시술이 가능함을 보고하고자 한다. 대상 : 통상적으로 병소 위치가 X축 좌표 51.5mm-148.5mm 범위 내에 있는 경우, 감마나이프는 반듯이 누운 자세에서 시술을 한다. 그러나 병소가 바깥쪽 측면에 위치한 경우(51.5mm-148.5mm 범위를 벗어난 경우) 환자는 측면으로 굽혀진 상태에서만 시술이 가능하며 이때 환자 머리에 고정한 정위기구의 전면부분은 일직선 타입이어야 한다. 환자의 치료 자세가 90도 만큼 회전된 상태이므로 X축과 Y축이 서로 치환된다. 새로운 좌표계는 감마플랜에서 계산된 방사선 조사량의 각각 좌표계들이 새로운 식에 대입하여 얻어진다. 새로운 X축 좌표는 43mm 만큼 증가하였으며 범위는 30mm-170mm 이였다. 결과 : 환자를 측면으로 눕혀서 바깥쪽 측면 병소를 시술하는 방법은 방사선 조사 중심 위치의 정확도에 영향을 미치지 않았다. 새로운 X축과 Y축 좌표계는 새로운 식으로 쉽게 치환 변환된다. 결론 : 측면으로 누워서 시술하는 방법은 X축 좌표 범위를 증가시킬 수 있었으며 감마나이프 장비에서 X축의 이축 편위 (trunnion excursion) 한계 때문에 시술을 할 수 없는 경우의 수를 줄일 수 있었다. 이 방법은 바깥쪽 측면에 위치한 병소 시술에 매우 요긴하게 사용되며 특히 여러 개의 병변을 갖고 있는 전이성 뇌종양 질환에 유용하게 사용될 수 있는 방법으로 기대된다.

• Journal of the Korean Society of Radiology
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• v.10 no.7
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• pp.521-529
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• 2016

Since Gamma Knife(R) radiosurgery(GKRS) is based on a single-fraction high dose treatment strategy, independent verification for the results of Leksell GammaPlan(R) (LGP) is an important procedure in assuring patient safety and minimizing the risk of treatment errors. Several verification methods have been developed and reported previously. Thus these methods were tested statistically and tried on Leksell Gamma Knife(LGK) target treatments through the embodiment of the previously proposed algorithms(PPA). The purpose of this study was to apply and evaluate the accuracy of verification methods for LGK target treatments using PPA. In the study 10 patients with intracranial lesion treated by GKRS were included. We compared the data from PPA and LGP in terms of maximum dose, arbitrary point dose, and treatment time at the isocenter locations. All data were analyzed by Paired t-test, which is statistical method used to compare two different measurement techniques. No statistical significance in maximal dose at 10 cases was observed between PPA and LGP. Differences in average maximal dose ranged from -0.53 Gy to 3.71 Gy. The arbitrary point dose calculated by PPA and LGP was not statistically significant too. But we found out the statistical difference with p=0.021 between TMR and LGP for treatment time at the isocenter locations. PPA can be incorporated as part of a routine quality assurance(QA) procedure to minimize the chance of a wrong overdose. Statistical analyses demonstrated that PPA was in excellent agreement with LGP when considering the maximal dose and the arbitrary point dose for the best plan of GKRS. Due to the easy applicability we hope PPA can be widely used.

• Journal of the Korean Society of Radiology
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• v.13 no.7
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• pp.901-907
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• 2019

The aim of this study is to evaluate the ability of target localizations of Leksell GammaPlan(LGP) in Gamma Knife Subthalamotomy(or Pallidotomy, Thalamotomy) of functional diseases. To evaluate the accuracy of LGP's location settings, the difference Δr of the target coordinates calculated by LGP (or LSP) and author's algorithm was reviewed for 10 patients who underwent Deep Brain Stimulation(DBS) surgery. Δr ranged from 0.0244663 mm to 0.107961 mm. The average of Δr was 0.054398 mm. Transformation matrix between stereotactic space and brain atlas space was calculated using PseudoInverse or Singular Value Decomposition of Mathematica to determine the positional relationship between two coordinate systems. Despite the precise frame positioning, the misalignment of yaw from -3.44739 degree to 1.82243 degree, pitch from -4.57212 degree to 0.692063 degree, and rolls from -6.38239 degree to 7.21426 degree appeared. In conclusion, a simple in-house algorithm was used to test the accuracy for location settings of LGP(or LSP) in Gamma Knife platform and the possibility for Gamma Knife Subthalamotomy. The functional diseases can be treated with Gamma Knife Radiosurgery with safety and efficacy. In the future, the proposed algorithm for target localizations' QA will be a great contributor to movement disorders' treatment of several Gamma Knife Centers.

• Journal of the Korean Society of Radiology
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• v.16 no.7
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• pp.843-849
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• 2022

In this study, the probability of secondary carcinogenesis was analyzed by measuring the exposure dose of surrounding normal organs during radiosurgery using a gamma knife. A pediatric phantom (Model 706-G, CIRS, USA) composed of human tissue-equivalent material was set to four tumor volumes of 0.25 cm³, 0.51 cm³, 1.01 cm³, and 2.03 cm³, and the average dose was 18.4 ± 3.4 Gy. After installing the Rando phantom on the table of the gamma knife surgical equipment, the OSLD nanoDot dosimeters were placed in the right eye, left eye, thyroid, thymus gland, right lung, and left lung to measure each exposure dose. The probability of cancer occurrence due to radiation exposure of surrounding normal organs during gamma knife radiosurgery for acoustic schwannoma disease was 4.08 cancers per 100,000 at a tumor volume of 2.03 cm³. This study is expected to be used as useful data in relation to stochastic effects in the future by studying the risk of secondary radiation exposure that can occur during stereotactic radiosurgery.

• Radioisotope journal
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• v.7 no.4
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• pp.24-30
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• 1992

• Journal of the Korean Society of Radiology
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• v.13 no.5
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• pp.801-809
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• 2019

Existing Gamma Knife Radiosurgery(GKRS) for large lesions is often conducted in stages with volume or dose partitions. Often in case of volume division the target used to be divided into sub-volumes which are irradiated under the determined prescription dose in multi-sessions separated by a day or two, 3~6 months. For the entire course of treatment, treatment informations of the previous stages needs to be reflected to subsequent sessions on the newly mounted stereotactic frame through coordinate transformation between sessions. However, it is practically difficult to implement the previous dose distributions with existing Gamma Knife system except in the same stereotactic space. The treatment area is expanding because it is possible to perform the multistage treatment using the latest Gamma Knife Platform(GKP). The purpose of this study is to introduce the image-coregistration based on the stereotactic spaces and the strategy of multistage GKRS such as the determination of prescription dose at each stage using new GKP. Usually in image-coregistration either surgically-embedded fiducials or internal anatomical landmarks are used to determine the transformation relationship. Author compared the accuracy of coordinate transformation between multi-sessions using four or six anatomical landmarks as an example using internal anatomical landmarks. Transformation matrix between two stereotactic spaces was determined using PseudoInverse or Singular Value Decomposition to minimize the discrepancy between measured and calculated coordinates. To evaluate the transformation accuracy, the difference between measured and transformed coordinates, i.e., ${\Delta}r$, was calculated using 10 landmarks. Four or six points among 10 landmarks were used to determine the coordinate transformation, and the rest were used to evaluate the approaching method. Each of the values of ${\Delta}r$ in two approaching methods ranged from 0.6 mm to 2.4 mm, from 0.17 mm to 0.57 mm. In addition, a method of determining the prescription dose to give the same effect as the treatment of the total lesion once in case of lesion splitting was suggested. The strategy of multistage treatment in the same stereotactic space is to design the treatment for the whole lesion first, and the whole treatment design shots are divided into shots of each stage treatment to construct shots of each stage and determine the appropriate prescription dose at each stage. In conclusion, author confirmed the accuracy of prescribing dose determination as a multistage treatment strategy and found that using as many internal landmarks as possible than using small landmarks to determine coordinate transformation between multi-sessions yielded better results. In the future, the proposed multistage treatment strategy will be a great contributor to the frameless fractionated treatment of several Gamma Knife Centers.

• Journal of the Korean Society of Radiology
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• v.11 no.6
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• pp.509-515
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• 2017

The purpose of this study is to measure the 3 dimensional dose distribution of Gamma knife $Perfection^{TM}$, make a comparative analysis of the result and establish the measurement method for the procedures using EBT3 film. The dose distributions of the Gamma knife $Perfection^{TM}$ installed in two hospitals were evaluated in accuracy and precision. For accuracy, the difference between the mechanical center axis and the dose center axis was assessed on a 4 mm collimator. The allowed difference in accuracy is within 0.3 mm and it was measured as 0.098 mm, 0.195 mm for A hospital and 0.229 mm, and 0.223 mm for B hospital. For precision the difference between the FWHM(Full Width at Half Maximum) of Gamma Plan and measurement in the 4, 8, and 16 mm collimators was calculated. The allowed difference in precision is less than ${\pm}1mm$. The value of the hospital A was -0.283 ~ 0.583 mm, and the hospital B was -0.857 ~ 0.810 mm. When analyzing the dose distributions using the image-j program, it is necessary to establish a clearer reference point of the measurement point, and it is considered that the comparison of the dose distribution should be performed in actual treatment irradiation dose with a high dose usable film.