• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.1-5
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• 2016

A dosimetric evaluation of volumetric modulated arc therapy, intensity modulated radiation therapy, and three-dimensional conformal radiation therapy for the lower extremity soft tissue sarcoma For the lower extremity soft tissue sarcoma, volumetric modulated arc therapy, intensity modulated radiation therapy, and three-dimensional conformal radiation therapy were evaluated to compare these three treatment planning technique. The mean doses to the planning target volume and the femur were calculated to evaluate target coverage and the risk of bone fracture during radiation therapy. Volumetric modulated arc therapy can reduce the dose to the femur without compromising target coverage and reduce the treatment time compared with intensity modulated radiation therapy.

• Korean Journal of Head & Neck Oncology
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• v.26 no.2
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• pp.171-177
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• 2010

연구목적 : 비인두암 환자들을 대상으로 방사선치료 시 삼차원입체조형치료기법과 용적세기조절회전치료기법을 비교하고 이하선을 포함한 정상조직 보호에 있어 그 차이점을 알아 보고자 본 연구를 시행하였다. 대상 및 방법 : 비인두암 환자 5명을 대상으로 치료계획용 CT(computed tomography)를 시행 후 삼차원입체조형방사선치료계획 과 용적세기조절회전치료계획을 시행하였다. 이를 바탕으로 얻은 선량분포, conformity index(CI) 그리고 선량체적 히스토그램을 통해 손상위험장기(organ at risk)와 계획용표적체적(planning target volume)을 비교 분석하였다. 결 과 : 분석결과 이하선에 조사되는 평균선량이 용적세기조절회전치료계획에서는 43.9%로 삼차원입체조형치료계획에서의 89.4% 보다 유의하게(p=0.043) 감소하였다. 계획용표적체적 conformity index의 경우 용적세기조절회전치료계획 (CI=1.06)에서 삼차원입체조형치료계획(CI=2.55) 보다 유의하게(p=0.043) 향상된 결과를 보였다. 결 론 : 비인두암 환자에서 용적세기조절회전 치료계획 시 삼차원입체조형치료계획 보다 유의하게 이하선에 평균선량이 줄었고 계획용 표적체적에 대한 conformity도 유의하게 향상되는 결과를 보였다. 본 연구가 적은 수의 환자를 대상으로 하였으나 용적세기조절회전치료기법을 시행 시 구강건조증의 발생을 줄일 수 있을 것으로 기대된다. 향후 더 많은 환자군을 대상으로 한 임상연구가 필요할 것으로 사료된다.

• Progress in Medical Physics
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• v.21 no.2
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• pp.183-191
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• 2010

In this study, the patient with localized prostate cancer who had previously been treated at Ajou University Hospital was randomly selected since March, 2009. we performed IMRT and 2RA plans and the same dose objectives were used for CTVs, PTVs, rectum, bladder, and femoral head of the respective plans. Arc optimizations and dose calculations were performed using Eclipse versions 8.6. In this paper, we evaluated the performance of IMRT and RA plans to investigate the clinical effect of RA for prostate cancer case. In our comparison of treatment techniques, RA was found to be superior to IMRT being better dose conformity of target volume. As for the rectum and bladder, RA was better than IMRT at decreasing the volume irradiated. RA has the ability to avoid critical organs selectively through applied same dose constraints while maximally treating the target dose. Therefore, this result suggests that there should be less rectal toxicity with RA compared with IMRT, with no compromise in tumor margin. These findings, which show more favorable rectal, bladder, and femoral head DVHs with RA, imply that should not result in excess risk of toxicity when this technique is used. Many experiences with RA have shown not only dosimetric advantage, but also improved clinical toxicity when comparing with IMRT. The main drawbacks of RA are the more complex and time-consuming treatment planning process and the need for more exact physics quality assurance (QA).

• Progress in Medical Physics
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• v.21 no.2
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• pp.165-173
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• 2010

In this paper, we evaluated the performance of 3D CRT, IMRT and three kind of RA plannings to investigate the clinical effect of RA with liver cancer case. The patient undergoing liver cancer of small volume and somewhat constant motion were selected. We performed 3D CRT, IMRT and RA plannings such as 2RA, limited triple arcs (3RA) and 3MRA with Eclipse version 8.6.15. The same dose volume objectives were defined for only CTV, PTV and body except heart, liver and partial body in IMRT and RA plannings. The steepness of dose gradient around tumor was determined by the Normal Tissue Objective function with the same parameters in place of respective definitions of dose volume objectives for the normal organs. The approach between the defined dose constraints and the practical DVH of CTV, PTV and Body was the best in 3MRA and the worst in IMRT. The DVHs were almost the same among RAs. Plans were evaluated using Conformity Index (CI), Homogeneity Index (HI) and Quality of coverage (QoC) by RTOG after prescription with dose level surrounding 98% of PTV in the respective plans. As a result, 3MRA planning showed the better favorable indices than that of the others and achieved the lowest MUs. In this study, RA planning is a technique that is possible to obtain the faster and better dose distribution than 3D CRT or IMRT techniques. Our result suggest that 3MRA planning is able to reduce the MUs further, keeping a similar or better targer dose homogeneity, conformity and sparing normal tissue than 2RA or 3RA.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.281-287
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• 2014

Purpose : The purpose of this study is to compare the plan quality of volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for the treatment of orbital lymphoma. IMRT, partial single arc(SA) and partial-double arc(DA) VMAT plans for four patients with orbital lymphoma treated at our institution were used for this study. Conformity Index(CI), Paddick's Conformity Index(PCI) and Homogeneity Index(HI) of planning target volume(PTV) were used to evaluate dosimetric quality of each plan. The Monitor Unit (MU), treatment time and dose of ipsilateral lens from each type of plan were measured for comparison. Materials and Methods : The CI of PTV for IMRT, SA and DA were measured as 0.88, 0.86, 0.92. The PCI of DA was the lowest as 1.33. Also HI of DA was the lowest in measured plans as 1.15. Mean dose of lens, lacrimal gland, optic chiasm, the opposite optic nerve and both orbit was analyzed with V30, V20, V10, V5. The result showed that the lowest dose in IMRT highest in SA in opposite lens, lacrimal gland, optic nerve, orbit. Results : Treatment time and average MU of IMRT was about three times higher than SA. Conclusion : Considering the superior plan quality as well as the delivery efficiency of VMAT compared with that of IMRT, VMAT may be the preferred modality for treating orbital lymphoma.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.89-97
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• 2021

Purpose: The purpose of this study is to compare and evaluate the dose change according to the gas volume variations in the rectum, which was not included in the treatment plan during radiation therapy for cervical cancer. Materials and methods: Static Intensity Modulated Radiation Therapy (S-IMRT) using a 9-field and Volumetric Modulated Arc Therapy (VMAT) using 2 full-arcs were established with treatment planning system on Computed Tomography images of a human phantom. Random gas parameters were included in the Planning Target Volume(PTV) with a maximum change of 2.0 cm in increments of 0.5 cm. Then, the Conformity Index (CI), Homogeneity Index (HI) and PTV D_max for the target volume were calculated, and the minimum dose (D_min), mean dose (D_mean) and Maximum Dose (D_max) were calculated and compared for OAR(organs at risk). For statistical analysis, T-test was performed to obtain a p-value, where the significance level was set to 0.05. Result: The HI coefficients of determination(R²) of S-IMRT and VMAT were 0.9423 and 0.8223, respectively, indicating a relatively clear correlation, and PTV D_max was found to increase up to 2.8% as the volume of a given gas parameter increased. In case of OAR evaluation, the dose in the bladder did not change with gas volume while a significant dose difference of more than D_mean 700 cGy was confirmed in rectum using both treatment plans at gas volumes of 1.0 cm or more. In all values except for D_mean of bladder, p-value was less than 0.05, confirming a statistically significant difference. Conclusion: In the case of gas generation not considered in the reference treatment plan, as the amount of gas increased, the dose difference at PTV and the dose delivered to the rectum increased. Therefore, during radiation therapy, it is necessary to make efforts to minimize the dose transmission error caused by a large amount of gas volumes in the rectum. Further studies will be necessary to evaluate dose transmission by not only varying the gas volume but also where the gas was located in the treatment field.

• 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.31 no.2
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• pp.51-63
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• 2019

Purpose: Radiation therapy for breast cancer should consider the change in breast shape due to breathing and swelling. In this study, we evaluate the benefit of using virtual bolus for IMRT of left breast cancer. Materials and methods: 10 patients with early breast cancer who received radiation therapy after breastconserving surgery compared the VMAT and IMRT plans using the virtual bolus method and without using it. The first analysis compared the V95%, HI, CI of treatment volume, Dmean, V5, V20, V30 of ipsilateral lung, and Dmean of heart in VMAT plan made using the virtual bolus method(VMAT_VB) to the plan without using it(VMAT_NoVB) in case there is no change in the breast. In IMRT, the same method was used. The second analysis compared TCP and NTCP based on each treatment plan in case there is 1cm expansion of treatment volume. Result: If there is no change in breast, V95% in VB Plan(VMAT_VB, IMRT_VB) and NoVB Plan(VMAT_NoVB, IMRT_NoVB) is all over 99% on each treatment plan. V95% in VMAT_NoVB and VMAT_VB is 99.80±0.17% and 99.75±0.12%, V95% in IMRT_NoVB and IMRT_VB is 99.67±0.26% and 99.51±0.15%. Difference of HI, CI is within 3%. OAR dose in VB plan is a little high than NoVB plan, and did not exceed guidelines. If there is 1cm change in breast, VMAT_NoVB and IMRT_NoVB are less effective for treatment. But VMAT_VB and IMRT_VB continue similar treatment effect compared in case no variation of breast. Conclusion: This study confirms the benefit of using a virtual bolus during VMAT and IMRT to compensate potential breast shape modification.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.247-256
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• 2014

Purpose : To assess target motion during radiotherapy by quantifying daily setup errors and inter-fractional and intra-fractional movements of pancreatic fiducials. Materials and Methods : Eleven patients were treated via stereotactic body radiotherapy (SBRT) with volumetric modulated arc therapy. Bony setup errors were calculated using cone beam computed tomography (CBCT). Inter-fractional and intrafractional fiducial (seed) motion was determined via cone beam computed tomography (CBCT) projections and orthogonal fluoroscopy. Results : Using an off-line correction protocol, setup errors were 0.0 (-1.7-4.0), 0.3 (-0.5-3.0), and 0.0 (-4.1-6.6) mm for the left-right, anterior-posterior, and superior-inferior directions respectively. Random inter-fractional setup errors in the mean fiducial positions were -0.1, -1.1, and -2.3 mm respectively. Intra-fractional fiducial margins were 9.9, 7.8, and 12.5 mm, respectively. Conclusion : Online inter-fractional and intra-fractional corrections based on daily kV images and CBCT expedites SBRT of pancreatic cancer. Importantly, inter-fractional and intra-fractional motion needs to be measured regularly during treatment of pancreatic cancer to account for variations in patient respiration.

• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.73-81
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• 2018

Purpose : The aims of this study were to compare and assess the effectiveness of Volumetric Modulated Arc Therapy(VMAT) using jaw tracking(JT) and fixed jaw(FJ) in radiation therapy of multiple brain metastasis. Methode and material : Among the patients with Multiple Brain Metastasis treated with jaw tracking, 10 patients with more than 6 tumors and with the size of radiation field $14{\times}14cm^2$ or more were included. Each Treatment plans with jaw tracking(JT) and fixed jaw(FJ) was established with Eclipse (Ver. 13.6 Varian, USA). Gamma Index (3 mm, 3 % confidence interval - 95 %) and maximum dose difference were measured with an electronic portal imaging device(EPID). The $D_{max}$ and $D_{mean}$ of Organ At Risk(OAR) were assessed and compared, and the Conformity Index(CI) and Homogeneity Index(HI) were evaluated. Result : Evaluating jaw tracking(JT) and fixed jaw(FJ) outcomes, in all cases, Gamma Index met the permissible standard of 3 mm, 3 % confidence intervals of 95 %. The maximum dose difference value from the areas with leaf end transmission was measured at a maximum of 98.4 % and an average of 43.6 % in clockwise(CW), and 67.9 % and 41.0 % for each in Counter-Clockwise(CCW). With jaw tracking, the maximum value of $D_{max}$ for each normal organ in OAR decreased in 15.36 %~74.59 % with the average value decreasing in 2.84 %~39.80 %. The maximum value of $D_{mean}$ in OAR decreased in 27.90 %~65.23 %, with the average value decreasing in 7.70 %~41.71 %. No change has been found in Conformity Index and Homogeneity Index values. Conclusion : When Jaw tracking is used in treating patients with multiple brain metastasis with VMAT, the unnecessary exposure due to leakage and transmission of radiation in unspecified areas was reduced, without affecting the dose distribution of the planning target volume(PTV), and the availability of radiation therapy with lower doses in normal organs is expected.