• 대한방사선방어학회:학술대회논문집
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• 2011.11a
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• pp.94-95
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• 2011

• Journal of radiological science and technology
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• v.45 no.5
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• pp.439-448
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• 2022

The purpose of this study was to analyze the results from statistical process control (SPC) to recommend upper and lower control limits for planning parameters based on delivery quality assurance (DQA) results and establish our institutional guidelines regarding planning parameters for helical tomotherapy (HT). A total of 53 brain, 41 head and neck (H & N), and 51 pelvis cases who had passing or failing DQA measurements were selected. The absolute point dose difference (DD) and the global gamma passing rate (GPR) for all patients were analyzed. Control charts were used to evaluate upper and lower control limits (UCL and LCL) for all assessed treatment planning parameters. Treatment planning parameters were analyzed to provide its range for DQA pass cases. We confirmed that the probability of DQA failure was higher when the proportion of leaf open time (LOT) below 100 ms was greater than 30%. LOT and gantry period (GP) were significant predictor for DQA failure using the SPC method. We investigated the availability of the SPC statistic method to establish the local planning guideline based on DQA results for HT system. The guideline of each planning parameter in HT may assist in the prediction of DQA failure using the SPC statistic method in the future.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.85-93
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• 2012

Purpose: It is essential to minimize the respiratory-induced motion of involved organs in the Tomotherapy for tumor located in the chest and abdominal region. However, the application of breathing control system to Tomotherapy is limited. This study was aimed to investigate the possible application of the ABCHES system and its efficacy as a means of breathing control in the tomotherapy treatment. Materials and Methods: Five subjects who were treated with a Hi-Art Tomotherapy system for lung, liver, gallbladder and pancreatic tumors. All patients undertook trained on two breathing methodes using an ABCHES, free breathing methode and shallow breathing methode. When the patients could carry out the breathing control, 4D-CT scan was a total of 10 4D tomographic images were acquired. A radiologist resident manually drew the tumor region, including surrounding nomal organs, on each of CT images at the inhalation phase, the exhalation phase and the 40% phase (mid-inhalation) and average CT image. Those CT images were then exported to the Tomotherapy planning station. Data exported from the Tomotherapy planning station was analyzed to quantify characteristics of dose-volume histograms and motion of tumors. Organ motions under free breathing and shallow breathing were examined six directions, respectively. Radiation exposure to the surrounding organs were also measured and compared. Results: Organ motion is in the six directions with more than a 5 mm displacement. A total of 12 Organ motions occurred during free breathing while organ motions decreased to 2 times during shallow breathing under the use of Abches. Based on the quantitative analysis of the dose-volume histograms shallow breathing showed lower resulting values, compared to free breathing, in every measure. That is, treatment volume, the dose of radiation to the tumor and two surrounding normal organs (mean doses), the volume of healthy tissue exposed to radiation were lower at the shallow breathing state. Conclusion: This study proposes that the use of ABCHES is effective for the Tomotherapy treatment as it makes shortness of breathing easy for patients. Respiratory-induced tumor motion is minimized, and radiation exposure to surrounding normal tissues is also reduced as a result.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.45-53
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• 2008

Purpose: We are trying to analyze 130 patients' conditions by using our Helical Tomotherapy, which was installed in our center in Oct. 2007. We will be statistically approach this examination and analyze so that we will be able to figure out adaptive plans according to the change in place of the tumor, GTV (gross tumor volume), total amount of time it took, vector (${\upsilon}=\surd$x2+y2+z2) and the change in size of the tumor. Materials and Methods: Objectives were the patients who were medicated with Tomotherapy in our medical center since Oct. 2007 August 2008. The Average age of the patients were 53 years old (Minimum 25 years old, Maximum 83 years old). The parts of the body we operated were could be categorized as Head&neck (n=22), Chest (n=47), Abdomen (n=25), Pelvis (n=11), Bone (n=25). MVCT had acted on 2702 times, and also had acted on our adaptive plan toward patients who showed big difference in the size of tumor. Also, after equalizing our gained MVCT and kv-CT we checked up on the range of possible mistake, using x, y, z, roll and vector. We've also investigated on Set-up, MVCT, average time of operation and target volume. Results: Mean time on table was 22.8 minutes. Mean treatment time was 13.26 minutes. Mean correction (mm) was X=-0.7, Y=-1.4, Z=5.77, roll=0.29, vector=8.66 Head&neck patients had 2.96 mm less vector value in movement than patients of Chest, Abdomen, Bone. In increasing order, Head&neck, Bone, Abdomen, Chest, Pelvis showed the vector value in movement. Also, there were 27 patients for adaptive plan, 39 patients, who had long or multiple tumor. We could know that When medical treatment is one cure plan, it takes 32 minutes, and when medical treatment is two cure plan, it takes 40 minutes that one medical treatment takes 21 minutes, and the other medical treatment takes 19 minutes. Conclusion:With our basic tools, we could bring more accurate IMRT with MVCT. Also, through our daily image, we checked up on the change in tumor so that adaptive plan could work. It was made it possible to take the cure of long or multiple tumor, the cure in a nearby OAR, and the complicated cure that should make changes of gradient dose distribution.

• Radiation Oncology Journal
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• v.27 no.2
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• pp.103-110
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• 2009

Purpose: To investigate the feasibility of helical tomotherapy on a wide curved area of the skin, and its accuracy in calculating the absorbed dose in the superficial region. Materials and Methods: Two types of treatment plans were made with the cylinder-shaped 'cheese phantom'. In the first trial, 2 Gy was prescribed to a 1-cm depth from the surface. For the other trial, 2 Gy was prescribed to a 1-cm depth from the external side of the surface by 5 mm. The inner part of the phantom was completely blocked. To measure the surface dose and the depth dose profile, an EDR2 film was inserted into the phantom, while 6 TLD chips were attached to the surface. Results: The film indicated that the surface dose of the former case was 118.7 cGy and the latter case was 130.9 cGy. The TLD chips indicated that the surface dose was higher than these, but it was due to the finite thickness of the TLD chips. In the former case, 95% of the prescribed dose was obtained at a 2.1 mm depth, while the prescribed does was at 2.2 mm in the latter case. The maximum dose was about 110% of the prescribed dose. As the depth became deeper, the dose decreased rapidly. Accordingly, at a 2-cm depth, the dose was 20 % of the prescribed dose. Conclusion: Helical tomotherapy could be a useful application in the treatment of a wide area of the skin with curvature. However, for depths up to 2 mm, the planning system overestimated the superficial dose. For shallower targets, the use of a compensator such as a bolus is required.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.280-288
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• 2008

Purpose: To identify the inter-fractional shift pattern and to assess an adequate treatment margin in the radiotherapy of a liver tumor using mega-voltage computed tomography (MVCT) of a tomotherapy unit. Materials and Methods: Twenty-six patients were treated for liver tumors by tomotherapy from April 2006 to August 2007. The MVCT images of each patient were analyzed from the $1^{st}$ to the $10^{th}$ fraction for the assessment of the daily liver shift by four groups based on Couinard's proposal. Daily setup errors were corrected by bony landmarks as a prerequisite. Subsequently, the anterior-, posterior-, right-, and left shifts of the liver edges were measured by maximum linear discrepancies between the kilo-voltage computed tomography (KVCT) image and MVCT image. All data were set in the 2-dimensional right angle coordinate system of the transverse section of each patient's body. Results: The liver boundary shift had different patterns for each group. In group II (segment 2, 3, and 4), the anterior mean shift was $2.80{\pm}1.73\;mm$ outwards, while the left mean shift was $2.23{\pm}1.37\;mm$ inwards. In group IV (segment 7 and 8), the anterior-, posterior-, right-, and left mean shifts were $0.15{\pm}3.93\;mm$ inwards, $3.15{\pm}6.58\;mm$ inwards, $0.60{\pm}3.58\;mm$ inwards, and $4.50{\pm}5.35\;mm$ inwards, respectively. The reduced volume in group II after MVCT reassessment might be a consequence of stomach toxicity. Conclusion: Inter-fractional liver shifts of each group based on Couinard's proposal were somewhat systematic despite certain variations observed in each patient. The geometrical deformation of the liver by respiratory movement can cause shrinkage in the left margins of liver. We recommend a more sophisticated approach in free-breathing mode when irradiating the left lobe of liver in order to avoid stomach toxicity.

• Journal of the Korean Society of Radiology
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• v.15 no.5
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• pp.723-730
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• 2021

This study tries to compare dose distribution between arc radiation therapy and Tomotherapy, which are main radiation therapy modalities. The subjects of this study are lung cancer patients. For planning target volume (PTV), a dose of 60.0 Gy was set as a basis. The PTVmean of Arc was 61.04 Gy, and that of Tomotherapy was 58.50 Gy. The total lung capacities of Arc and Tomotherapy were 3.0 Gy and 4.24 Gy, respectively. The mean heart doses of Arc and Tomotherapy were 0.13 and 0.34, respectively; the mean trachea dose of Arc and Tomotherapy were 1.35 and 2.58, respectively; the mean esophagus dose of Arc and Tomotherapy were 0.41 and 0.86, respectively; the mean spinal cord dose of Arc and Tomotherapy were 3.65 and 4.68, respectively. With regard to the appropriateness of therapeutic effect in DHV, both modalities seemed appropriate. Tomotherapy protected normal tissues better than Arc radiation therapy. In Tomotherapy, patients need to have treatment long in a limited space. If such a point is overcome, Tomotherapy is better. Otherwise, Arc radiation therapy can be applied. This study was conducted with treatment planning images. Therefore, the results of this study are different from actual treatment results. If more research is conducted to overcome the limitation, the effects of radiation therapy are expected to increase further.

• The Journal of Korean Society for Radiation Therapy
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• v.22 no.1
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• pp.11-18
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• 2010

Purpose: In every time radiation therapy set up errors occur because internal anatomical organs move due to breathing and change of patient's position. These errors may affect the change of dose distribution between target area and normal structure. This study investigates the usefulness of body-fix in clinical treatment. Materials and Methods: Among 55~60 aged male patients who has hepatocellular carcinoma in area of liver's couinaud classification, we chose 10 patients and divided two groups by using body-fix or not. When applying body-fix, we maintained a vacuum of 80 mbar pressure by using vacuum pump (Medical intelligence, Germany). Patients had free breathing with supine position. After working to fuse and consist MV-CT (megavoltage computed tomography) with KV-CT (kilovoltage computed tomography) obtained by 5 times treatments, we compared and analyzed set up errors occurred to (Right to Left, RL) of X axis, (Anterioposterio, AP) of Z axis, (Cranicoudal, CC) of Y axis. Results: Average Set up errors through image fusion showed that group A moved $0.3{\pm}1.1\;mm$ (Cranicoudal, CC), $-1.1{\pm}0.7\;mm$ (Right to Left, RL), $-0.2{\pm}0.7\;mm$ (Anterioposterio, AP) and group B moved $0.62{\pm}1.94\;mm$ (Cranicoudal, CC), $-3.62{\pm}1.5\;mm$ (Right to Left, RL), $-0.22{\pm}1.2\;mm$ (Anterioposterio, AP). Deviations of X, Y and Z axis directions by applying body-fix indicated that maximum X axis was 5.5 mm, Y axis was 19.8 mm and Z axis was 3.2 mm. In relation to analysis of error directions, consistency doesn't exist for every patient but by using body-fix showed that the result of stable aspect in spite of changes of everyday's patient position and breathing. Conclusion: Using body-fix for liver cancer patient is considered effectively for tomotherapy. Because deviations between group A and B exist but they were stable and regular.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.13-24
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• 2019

Purpose: CT scan range is insufficient for various reasons in head and neck Tomotherapy^®. To solve that problem, Re-CT simulation is good because CT scan range affects accurate dose calculations, but there are problems such as increased exposure dose, inconvenience, and a change in treatment schedule. We would like to evaluate the minimum CT scan range required by changing the plan setup parameter of the existing CT scan range. Materials and methods: CT Simulator(Discovery CT590 RT, GE, USA) and In House Head & Neck Phantom are used, CT image was acquired by increasing the image range from 0.25cm to 3.0cm at the end of the target. The target and normal organs were registered in the Head & Neck Phantom and the treatment plan was designed using ACCURAY Precision^®. Prescription doses are Daily 2.2Gy, 27 Fxs, Total Dose 59.4Gy. Target is designed to 95%~107% of prescription dose and normal organ dose is designed according to SMC Protocol. Under the same treatment plan conditions, Treatment plans were designed by using five methods(Fixed-1cm, Fixed-2.5cm, Fixed-5cm, Dynamic-2.5cm Dynamic-5cm) and two pitches(0.43, 0.287). The accuracy of dose delivery for each treatment plan was analyzed by using EBT3 film and RIT(Complete Version 6.7, RIT, USA). Results: The accurate treatment plan that satisfying the prescribed dose of Target and the tolerance dose in normal organs(SMC Protocol) require scan range of at least 0.25cm for Fixed-1cm, 0.75cm for Fixed-2.5cm, 1cm for Dynamic-2.5cm, and 1.75cm for Fixed-5cm and Dynamic-5cm. As a result of AnalysisAnalysis by RIT. The accuracy of dose delivery was less than 3% error in the treatment plan that satisfied the SMC Protocol. Conclusion: In case of insufficient CT scan range in head and neck Tomotherapy^®, It was possible to make an accurate treatment plan by adjusting the FW among the setup parameter. If the parameter recommended by this author is applied according to CT scan range and is decide whether to re-CT or not, the efficiency of the task and the exposure dose of the patient are reduced.

• Journal of the Korean Society of Radiology
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• v.7 no.2
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• pp.145-149
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• 2013

Helical Tomotherapy is an innovative means of delivering intensity modulated radiation therapy (IMRT) using a device that merges features of a linear accelerator and helical computed tomography (CT) scanner. Hereat, during helical tomotherapy process, megavoltage computed tomography (MVCT) image are usually used for guiding the precise set-up of patient before/after treatment delivery. But which would certainly increase the total dose for patients, this study was to investigate the imaging dose of MVCT using the cylindrical "Cheese" phantom on a tomotherapy machine. A set of cylindrical "Cheese" phantom was adopted for scanning with respectively pitch value (1, 2, 3 mm) with same number slice (10 slice), same length (approximately 9 cm) and phantom set-ups on the couch of tomotherapy system. The average MVCT imaging dose were measured using A1SL ion chamber inserted in the phantom with preset geometry. The MVCT scanning average dose for the cylindrical "Cheese" phantom was 2.24 cGy, 1.02 cGy, 0.81 cGy during respectively pitch value (pitch 1, 2, 3 mm) with same number slice (10 slice), and same length's average dose was 2.47 cGy, 1.28 cGy, 0.88 cGy respectively (pitch 1, 2, 3 mm). Two major parameters, the assigned pitch numbers and scanning length, where the most important impacts to the dose variation. The MVCT dose was inversely proportional to the CT pitch value. The results may provide a reliable guidance for proper planning design of the scanning region, which is valuable to help minimize the extra dose to patient. Questionnaires were distributed to Radiology departments at hospitals with 300 sickbeds throughout the Pohang region of North Gyeongsang Province concerning awareness and performance levels of infection control. The investigation included measurements of the pollution levels of imaging equipment and assistive apparatuses in order to prepare a plan for the activation of prevention and management of hospital infections. The survey was designed to question respondents in regards to personal data, infection management prevention education, and infection management guidelines.