• Journal of radiological science and technology
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• v.33 no.1
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• pp.61-66
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• 2010

In this paper we evaluated small field dose characteristics of exclusive cone fields versus square fields for stereotactic radiosugery (SRS) which is based on linear accelerators (LINAC). For this test, we used a small beam detector (stereotactic fields detector : SFD) with a 6 MV photon beam and a water phantom system (IBA, Germany). Percentage depth dose (PDD) was measured for different field sets (cones : ${\Phi}1\;cm$, ${\Phi}2\;cm$, ${\Phi}3\;cm$ ; square fields : $1{\times}1\;cm^2$, $2{\times}2\;cm^2$, $3{\times}3\;cm^2$) at a source skin distance (SSD) of 100 cm. We measured the point depths at 1.5 cm, 5 cm, 10 cm, 20 cm, and 30 cm. The output factors were measured under the same geometrical conditions of the PDD and normalized at the maximum dose depth. To analyze the penumbra, we measured the dose profile with 95 cm of SSD, 5 cm of depth for each field sizes (${\Phi}1\;cm$, ${\Phi}3\;cm$, $1{\times}1\;cm^2$, and $3{\times}3\;cm^2$) using SFD. We obtained the values for every 1 mm interval in the physical field (90%) and 0.5 mm interval in the penumbra region (20 to 80%). The PDD variation of exclusive cones and square fields were 4.3 to 7.9% lesser than the standard field size ($10{\times}10\;cm^2$. The variation of PDD was reduced while the field size was increased. To compare the beam quality, we analyzed the $PDD_{20,10}$ and the results showed under the 1% of variations for all experiments except for ${\Phi}1\;cm$ cone and $1{\times}1\;cm^2$ fields. Output factors of exclusive cone were increased 3.1~4.6% than the square fields, and the penumbra region of exclusive cone was reduced 20% as compared to the square fields. As the previous researches report, it is very important for SRS and SFD that precise dosimetry in small beam fields. In this paper, we showed the effectiveness of exclusive cone, compared to square field. And we will study on the various detector characteristics for small beam fields.

• Progress in Medical Physics
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• v.23 no.3
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• pp.127-137
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• 2012

A conversing beam is firstly designed for radiosurgery by a neurosugern Lars Leksell in 1949 with orthogonal x-rays tube moving through horizontal moving arc to focusing the beam at target center. After 2 decades he composits 201 source of the Co-60 for gamma knife which beams focused at locus. Sveral linac-based stereotactic radiosurgery using the circular collimated beam which size range for 0.4~4.0 cm in a diameter by non-coplanar multiarc have been developed over the decades. The irregular lesions can be treated by superimposing with several spherical shots of radiation over the tumour volume. Linac based techniques include the use of between 4 and 11 non-co-planar arcs and a dynamic rotation technique and use photon beam energies in the range of 6~10 MV. Reviews of the characteristics of several treatment techniques can be found in the literature (Podgorsak 1989, Schell 1991). More in recent, static conformal beams defined by custom shaped collimators or a mini- or micro-multileaf collimator (mMLC) have been used in SRS. Finally, in the last few years, intensity-modulated mMLC SRS has also been introduced. Today, many commercial and in-house SRS programs have also introduced non-invasive immobilization systems include the cyberknife and tomotherapy and proton beam. This document will be compared the characteristics of dose distribution of radiosurgery as introduced gamma knife, BrainLab include photon knife in-house SRS program and cyberknife in currently wide used for a cranial SRS.

• Journal of the Korean Society of Radiology
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• v.15 no.2
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• pp.239-246
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• 2021

Portal Dosimetry was verified using EPID to secure the clinical application and reliability of the existing research dose evaluation. The dose distribution of Geant4 was compared with the measured value by 360° rotational irradiation with a 2.5 cm cone for stereotactic brain surgery. To confirm the dose distribution of patients with brain metastasis, the dose distribution investigated by inserting a Gafchromic EBT film into the parietal phantom and the dose distribution obtained from the parietal phantom using VMAT are compared and applied to actual patients. As a result of the analysis, it was confirmed that the accuracy of the beam center and the center of the couch coincide accurately with an error within 1mm as a result of QA through a pin ball. In addition, it was confirmed that the EBT3 film has excellent linearity in the range of 0 to 10 Gy according to various dose irradiation. In the same setting as the two cervical phantoms, we confirm that the implementation and simulation results calculations of dose calculations based on Geant4 using photon beams match the experimental data within the treatment planning volume (PTV). Therefore, volume modulated arc treatment (VMAT) 360° rotational irradiation was performed, and the result of iso-dose distribution analysis by rotational irradiation confirmed that it is appropriate to include a virtual tumor.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.355-362
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• 2014

Purpose : When head&neck cancer radiation therapy, thermoplastic mask is applied for patients with fixed. The purpose of this study is to evaluate usefulness of thermoplastic mask for SRS in tomotherapy by conparison with the conventional mask. Materials and Methods : Typical mask(conventional mask, C-mask) and mask for SRS are used to fix body phantom(rando phantom) on the same iso centerline, then simulation is performed. Tomotherapy plan for orbit and salivary glands is made by treatment planning system(TPS). A thick portion and a thin portion located near the treatment target relative to the mask S-mask are defined as region of interest for surface dose dosimetry. Surface dose variation depending on the type of mask was analyzed by measuring the TPS and EBT film. Results : Surface dose variation due to the type of mask from the TPS is showed in orbit and salivary glands 0.65~2.53 Gy, 0.85~1.84 Gy, respectively. In case of EBT film, -0.2~3.46 Gy, 1.04~3.02 Gy. When applied to the S-mask, in TPS and Gafchromic EBT3 film, substrantially 4.26%, 5.82% showed maximum changing trend, respectively. Conclusion : To apply S-mask for tomotherapy, surface dose is changed, but the amount is insignificant and be useful when treatment target is close critical organs because decrease inter and intra fractional variation.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.251-256
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• 2000

Purpose : To evaluate efficacy and complication of stereotactic radiosurgery using stereotactic body frame. Methods and Materials :From December 1997 to June 1999, 11 patients with primary and metastatic tumors were treated with stereotactic radiosurgery using stereotactic body frame(Precision TherapyTu). Three patients were treated with primary hepatoma and seven with metastatic tumor from liver, lung, breast, trachea and one with arteriovenous malformation on neck. We used vacuum pillow for immobilization and made skin marker on sternum and tibia area with chest marker and leg marker. Diaphragm control was used for reducing movement by respiration. CT-simulation and treatment planning were peformed. Set-up error was checked by CT-Simulator before each treatment. Dose were calculated on the 80$\~$90$\%$ isodose of isocenter dose and given consecutive 3 fractions for total dose of 30 Gy (10 Gy/fraction). Results :Median follow-up was 12 months. One patient (9$\%$) showed complete response and four Patients (36$\%$) showed partial response and others showed stable disease. Planning target volumes (PTV) ranged from 3 to 111 cc (mean 18.4 n). Set-up error was within 5 mm in all directions (X, Y, Z axis). There was no complication in all patients. Conclusion :In Primary and metastatic tumors, stereotactic body frame is very safe, accurate and effective treatment modality.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.59-59
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• 2003

목적 : 환자의 호흡에 의한 움직임 및 부정확한 환자 자세 setup 때문에 3 차원 전신 정위 방사선치료,3 차원 입체조형 방사선치료 IMRT와 같은 방사선 치료기술에서 병소에 대한 정확한 표적 위치측정은 매우 어려운 실정이다. 그러므로 본 연구는 방사선 치료시 환자의 움직임을 최대한 고정시켜 줄 수 있으며 환자 자세에 대한 setup 오차를 감소시키고 환자 전신에 산재한 병소의 위치를 좌표화할 수 있는 전신 정위 프레임 제작과 제작한 프레임에 대한 고정효과 및 재현성을 나타내는 환자 자세의 setup 오차를 평가하는데 있다. 재료 및 방법 : 자체 제작한 전신 정위 프레임 구조는 CT 영상 촬영 가능성에 중점을 두고 병소 표적의 좌표실현 및 환자체형에 따른 다양성 그리고 프레임에 대한 견고성 및 안정성 확인에 초점화하여 제작하였다. 이렇게 제작된 전신 정위 프레임에 대한 방사선 투과율 측정 실험과 CCTV 카메라와 DVR(Digital Video Recorder)를 이용해 환자 자세 변화에 대한 영상을 획득하여 matlab으로 구현한 오차분석용 프로그램으로 환자 외부자세에 대한 오차 비교 평가하고 CT 촬영에 의한 가상표적 위치측정 실험을 수행하였다. 또 한 고정벨트 추가 사용으로 인한 환자의 고정효과 정도를 살펴보았다. 결과 : 제작된 전신 정위 프레임에 대한 방사선 투과율은 마그네트론 10, 21 MeV의 에너지에서 95, 96% 의 투과율이 측정되었고 30 $^{\circ}$. 60 。각도의 경사로 빔이 전달될 때는 90.3, 94.4% 가 측정되었다. CCTV 카메라를 이용하여 흉부 및 복부의 움직임을 촬영한 영상을 Matlab프로그램으로 구현한 오차분석 프로그램을 적용한 결과, 환자 자세에 대한 오차의 평균값은 흉부의 lateral 방향에서는 3.63$\pm$1.4 mm, AP 방향에서는 2.1$\pm$0.82 mm이었다. 그리고 복부의 later의 방향에서는 7.0$\pm$2.1 mm, AP 방향에서는 6.5$\pm$2.2 mm 이었다. 또한 표적 위치측정을 위해서 환자의 피부에 임의의 가상표적을 부착하고 CT 촬영한 영상결과, 프레임으로 가상표 적에 대한 위치를 정확히 파악할 수 있었다. 결론 : 제작된 프레임을 적용하여 방사선투과율 측정실험, 환자 외부자세에 대한 오차 측정실험, 가상표적 위치측정 실험 등을 수행하였다. 환자 외부자세에 대한 오차 측정실험 경우, 더 많은 Volunteer를 적용하여 보다 정확한 오차 측정실험이 수행되어야 할 것이며 정확한 표적 위치 측정실험을 위해서 내부 마커를 삽입한 환자를 적용한 임상실험이 수행되어야 할 것이다. 또한 위치결정에서 획득한 좌표값의 정확성을 알아보기 위해서 팬톰을 이용한 방사선조사 실험이 추후에 실행되어져야 할 것이다. 그리고 제작된 프레임에 Rotating X선 시스템과 내부 장기의 움직임을 계량화하고 PTV에서의 최적 여유폭을 설정함으로써 정위 방사선수술 및 3 차원 업체 방사선치료에 대한 병소 위치측정과 환자의 자세에 대한 setup 오차측정 결정에 도움이 될 수 있을 것이라고 사료된다.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.2
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• pp.109-113
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• 2008

Purpose: To evaluate the detector dependency in the various collimator size for Stereotactic Radiosugery (SRS). Materials and Methods: This study was performed with 6 MV photon beam (Varian 21EX, Varian, US) and the measurement detectors are used by ion chamber CC01, CC13 (Wellhofer, Germany) and stereotactic diode detector (SFD, Wellhofer, Germany). SRS collimator size was used by ${\varphi}$5, 10, 20, 30 mm (Brain Lab, Germany). Percentage depth dose (PDD) was measured at SSD 100 cm and field size 10×10 cm from individual detectors. Ouput factor was measured by using same setup of PDD and with maximum dose depth. Data was normalized at field size $10{\times}10\;cm$. Beam profile was measured at SSD 100 cm in SRS collimator ${\varphi}$10, 30 mm and field $10{\times}10\;cm$ and a comparison of FWHM (full width half maximum), penumbra width (20~80%). Results: The CC13 detector was overestimated 16% than other detectors from the PDD in the 5 mm collimator. Output factors were underestimated CC01 28%, CC13 72% in the 5 mm collimator and CC01 9.6%, CC13 25% in the 10 mm collimator than the SFD. Maximum difference was 3% at the FWHM of the dose profile in the 10 mm collimator and difference of the 30 mm collimator was 0% at the FWHM. Penumbra width was increased CC01 122%, CC13 194% in the 10 mm collimator and CC01 68%, CC13 185% in the 30 mm collimator than the SFD. Conclusion: It is very important for accurate dosimetry to select a detector in small field. The SFD was considered with the most accurate dosimeter for small collimator dosimetry in this study.

• Journal of the Korean Society of Radiology
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• v.11 no.4
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• pp.235-240
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• 2017

The purpose of this study is to confirm the safety of the clinical application of image co - registration in steteotactic radiosurgery by evaluating the 3D positioning of magnetic resonance imaging using image co-registration. We performed a retrospective study using three-dimensional coordinate measurement of 32 patients who underwent stereotactic radiosurgery and performed magnetic resonance imaging follow-up using image co-registration. The 3 dimensional coordinate errors were $1.0443{\pm}0.5724mm$ (0.10 ~ 1.89) in anterior commissure and $1.0348{\pm}0.5473mm$ (0.36 ~ 2.24) in posterior commissure. The mean error of MR1 (3.0 T) was lower than that of MR2 (1.5 T). It is necessary to minimize the error of magnetic resonance imaging in the treatment planning using the image co - registration technique and to confirm it.

• Progress in Medical Physics
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• v.16 no.4
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• pp.176-182
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• 2005

Stereotactic radiosurgery (SRS) is a technique to deliver a high dose to a target region and a low dose to a critical organ through only one or a few irradiation. The SRS must be planned exactly. Currently the surgery plan is peformed by trial and error method. There are many questions about the reliability and reproducibility of the plan result. This study Improve each step of the Oh's method based on heuristic target shaping to obtain the better result. The target was reconstructed using cylinders with same height and the neighbored cylinders were combined according to the difference of each center and diameter. Then, spheres were packed within each cylinders by the packing rules. Two virtual targets were used to compare this method with Oh's method. As a result, the numbers of isocenter were successfully reduced - more than $35\%$ and $26\%$ - without serious differences of proscription isodose to tumour volume ratio (PITV) and maximum dose to proscription dose ratio (MDPD). This technique using cylinder piling and sphere packing will be a helpful tool to planner in stereotactic radiosurgery.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.2
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• pp.125-131
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• 2005

Purpose : For stereotactic radiosurgery (SRS) of a tumor in the region whose movement due to respiration is significant, like Lung lower lobe, the gated therapy, which delivers radiation dose to the selected respiratory phases when tumor motion is small, was performed using the Respiratory gating system and its clinical effectiveness was evaluated. Materials and Methods : For two SRS patients with a tumor in Lung lower lobe, a marker block (infrared reflector) was attached on the abdomen. While patient' respiratory cycle was monitored with Real-time Position Management (RPM, Varian, USA), 4D CT was performed (10 phases per a cycle). Phases in which tumor motion did not change rapidly were decided as treatment phases. The treatment volume was contoured on the CT images for selected treatment phases using maximum intensity projection (MIP) method. In order to verify setup reproducibility and positional variation, 4D CT was repeated. Results : Gross tumor volume (GTV) showed maximum movement in superior-inferior direction. For patient #1, motion of GTV was reduced to 2.6 mm in treatment phases ($30{\sim}60%$), while that was 9.4 mm in full phases ($0{\sim}90%$) and for patient #2, it was reduced to 2.3 mm in treatment phases ($30{\sim}70%$), while it was 11.7 mm in full phases ($0{\sim}90%$). When comparing two sets of CT images, setup errors in all the directions were within 3 mm. Conclusion : Since tumor motion was reduced less than 5 mm, the Respiratory gating system for SRS of Lung lower lobe is useful.