• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.153-160
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• 2018

Purpose : We retrospectively analyzed doses of each radiation therapy technique used in the treatment for left breast cancer patients after partial mastectomy through dose results for normalorgans and tumor volume to use this as a clinical reference for radiation therapy of domestic left breast cancer patients. Materials and Methods : 40 patients who underwent partial mastectomy on left breast cancer were classified in 3 treatment methods. The treatment plan was evaluated by HI(homogeneity index), $D_{95%}$, and CI(conformity index), and the $V_{hot}$ for gross tumor volume and clinical target volume of each treatment method. In Cyberknife treatment, tumor volume was the same as high dose volume in the other techniques, so no consideration was given to clinical target volume. Treatment plan evaluation for normal organs were evaluated by mean dose on ipsilateral lung, heart, left anterior descending artery, opposite breast and lung, and non-target tissue. Result : Treatment with volumetric arc radiotherapy(VMAT) showed $95.84{\pm}0.75%$ of $D_{95%}$ on the clinical target volume, significantly higher than that of 3D-CRT. The $D_{95%}$ value of the total tumor volume was slightly higher than the other treatments. In Cyberknife treatment, the dose to the normal organs was significantly lower than other treatments. Overall, the maximum dose and mean dose to the heart were $26.2{\pm}6.12Gy$ and $1.88{\pm}0.2Gy$ in VMAT treatment and $20.25{\pm}9.35Gy$ and $1.04{\pm}0.19Gy$ in 3D-CRT therapy, respectively. Conclusion : In comparison on 3D-CRT and VMAT, most of the dosimetric parameters for the evaluation of the treatment plan showed similar values, so that there is no significant difference in treatment plan evaluation. It is possible to select the treatment method according to the patient's anatomical structure or possibility of breath control. Cyberknife treatment is very useful treatment for normal organs because of its accurate dose exposure to the tumor volume However, it has restrictions to treat the local area, to have relatively long treatment time and to involve invasive procedure.

• 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.

• Journal of radiological science and technology
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• v.38 no.1
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• pp.23-30
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• 2015

Positron emission tomography scan has been growing diagnostic equipment in the development of medical imaging system. Compare to 99mTc emitting 140 keV, Positron emission radionuclide emits 511 keV gamma rays. Because of this high energy, it needs to reduce radioactive emitting from patients for radio technologist. We searched the external dose rates by changing distance from patients and measure the external dose rates when we used shielder investigate change external dose rates. In this study, the external dose distribution were analyzed in order to help managing radiation protection of radio technologists. Ten patients were searched (mean age: $47.7{\pm}6.6$, mean height: $165.5{\pm}3.8cm$, mean weight: $65.9{\pm}1.4kg$). Radiation was measured on the location of head, chest, abdomen, knees and toes at the distance of 10, 50, 100, 150, and 200 cm, respectively. Then, all the procedure was given with a portable radiation shielding on the location of head, chest, and abdomen at the distance of 100, 150, and 200 cm and transmittance was calculated. In 10 cm, head ($105.40{\mu}Sv/h$) was the highest and foot($15.85{\mu}Sv/h$) was the lowest. In 200 cm, head, chest, and abdomen showed similar. On head, the measured dose rates were $9.56{\mu}Sv/h$, $5.23{\mu}Sv/h$, and $3.40{\mu}Sv/h$ in 100, 150, and 200 cm, respectively. When using shielder, it shows $2.24{\mu}Sv/h$, $1.67{\mu}Sv/h$, and $1.27{\mu}Sv/h$ in 100, 150, and 200 cm on head. On chest, the measured dose rates were $8.54{\mu}Sv/h$, $4.90{\mu}Sv/h$, $3.44{\mu}Sv/h$ in 100, 150, and 200 cm, respectively. When using shielder, it shows $2.27{\mu}Sv/h$, $1.34{\mu}Sv/h$, and $1.13{\mu}Sv/h$ in 100, 150, and 200 cm on chest. On abdomen, the measured dose rates were $9.83{\mu}Sv/h$, $5.15{\mu}Sv/h$, and $3.18{\mu}Sv/h$ in 100, 150, and 200 cm, respectively. When using shielder, it shows $2.60{\mu}Sv/h$, $1.75{\mu}Sv/h$, and $1.23{\mu}Sv/h$ in 100, 150, and 200 cm on abdomen. Transmittance was increased as the distance was expanded. As the distance was further, the radiation dose were reduced. When using shielder, the dose were reduced as one-forth of without shielder. The Radio technologists are exposed of radioactivity and there were limitations on reducing the distance with Therefore, the proper shielding will be able to decrease radiation dose to the technologists.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.7-16
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• 2016

Purpose : This study aimed to compare and evaluate between the efficiency of two respective devices, 3D-bolus and step-bolus when the devices were used for the treatment of patients whose chest walls were required to undergo the electron beam therapy after the surgical procedure of modified radical mastectomy, MRM. Materials and Methods : The treatment plan of reverse hockey stick method, using the photon beam and electron beam, had been set for six breast cancer patients and these 6 breast cancer patients were selected to be the subjects for this study. The prescribed dose of electron beam for anterior chest wall was set to be 180 cGy per treatment and both the 3D-bolus, produced using 3D printer(CubeX, 3D systems, USA) and the self-made conventional step-bolus were used respectively. The surface dose under 3D-bolus and step-bolus was measured at 5 measurement spots of iso-center, lateral, medial, superior and inferior point, using GAFCHROMIC EBT3 film (International specialty products, USA) and the measured value of dose at 5 spots was compared and analyzed. Also the respective treatment plan was devised, considering the adoption of 3D-bolus and stepbolus and the separate treatment results were compared to each other. Results : The average surface dose was 179.17 cGy when the device of 3D-bolus was adopted and 172.02 cGy when step-bolus was adopted. The average error rate against the prescribed dose of 180 cGy was -(minus) 0.47% when the device of 3D-bolus was adopted and it was -(minus) 4.43% when step-bolus was adopted. It was turned out that the maximum error rate at the point of iso-center was 2.69%, in case of 3D-bolus adoption and it was 5,54% in case of step-bolus adoption. The maximum discrepancy in terms of treatment accuracy was revealed to be about 6% when step-bolus was adopted and to be about 3% when 3D-bolus was adopted. The difference in average target dose on chest wall between 3D-bolus treatment plan and step-bolus treatment plan was shown to be insignificant as the difference was only 0.3%. However, to mention the average prescribed dose for the part of lung and heart, that of 3D-bolus was decreased by 11% for lung and by 8% for heart, compared to that of step-bolus. Conclusion : It was confirmed through this research that the dose uniformity could be improved better through the device of 3D-bolus than through the device of step-bolus, as the device of 3D-bolus, produced in consideration of the contact condition of skin surface of chest wall, could be attached to patients' skin more nicely and the thickness of chest wall can be guaranteed more accurately by the device of 3D-bolus. It is considered that 3D-bolus device can be highly appreciated clinically because 3D-bolus reduces the dose on the adjacent organs and make the normal tissues protected, while that gives no reduction of dose on chest wall.

• Journal of radiological science and technology
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• v.35 no.3
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• pp.265-273
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• 2012

Aquisition of accurate beam data is very important to calculate a reliable dose distribution of the treatment planning system for small radiation fields in intensity-modulated radiation therapy(IMRT) and stereotactic radiosurgery(SRS). For the measurement of small fields, the choice of a suitable detector is important due to the shape gradient in profile penumbra, the lack of lateral electronic equilibrium, and the effect of effective detector volume. Therefore, this study was to analyze the dosimetric characteristics of various detectors in measurement of beam data for small fields of linear accelerator. 0.01cc and 0.13cc ion chambers (CC01 and CC13) and a stereotactic diode detector(SFD) were used for measurement of small fields. The beam data, including the percent depth dose, output factor, and beam profile were acquired under 6 MV and 15 MV photon beams. Measurements were performed with the field size ranging from $2{\times}2cm^2$ to $5{\times}5cm^2$. For $2{\times}2cm^2$ field size, the differences of the ratios of $PDD_{20}$ and $PDD_{10}$ measured by CC01 and SFD detectors were 1.02% and 0.12% for 6 MV and 15 MV photon beams, respectively. For field sizes larger than $3{\times}3cm^2$, the differences of values of $PDD_{20}/PDD_{10}$ obtained from each detector were 1.15% and 0.71% for 6 MV and 15 MV photon beams, respectively. The output factors obtained from CC01 and SFD for $2{\times}2cm^2$ field size were within 0.5% and 1.5% for 6 MV and 15 MV, respectively. The differences in output factor of three detectors for $3{\times}3cm^2$ to $5{\times}5cm^2$ field sizes were within 0.5%. Profile penumbras measured by the SFD, CC01, and CC13 detectors at three depths were average 2.7 mm and 3.5 mm, 3.4 mm and 4.3 mm, and 5.2 mm and 6.1 mm for 6 MV and 15 MV photon beams, respectively. In conclusion, it could be possible to use of the CC01 and SFD detectors for the measurement of percent depth dose and output factor for $2{\times}2cm^2$ field size, and to use of three detectors for $3{\times}3cm^2$ to $5{\times}5cm^2$ field sizes. CC01 and SFD detectors, consider ably smaller than the radiation field, should be used in order to accurately measure the profile penumbra for small field sizes.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.1
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• pp.51-56
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• 2019

Purpose: The usefulness of using single-electron radiation for secondary radiotherapy of breast cancer patients after surgery is assessed and the use of a combine of different energy. Methods and materials : In this study, 40 patients (group A) using energy 6 MeV and 9 MeV, and 19 patients (group B) using a combine of 9 MeV and 12 MeV were studied among 59 patients who performed secondary care using combine electronic radiation. Each patient in each group, 6 MeV, 9 MeV, Combine(6 MeV / 9 MeV) and 9 MeV, 12 MeV, Combine (9 MeV / 12 MeV) were developed in different ways, and the maximum doses delivered to the original hospital, D95, D5, and $V_3$, $V_5$, $V_{10}$ were compared. Result: The D95 mean value of Group A treatment plan was $785.33{\pm}225.37cGy$, $1121.79{\pm}87.02cGy$ at 9 MeV, and $1010.98{\pm}111.17cGy$ at 6 MeV / 9 MeV, and the mean value at 6 MeV / 9 MeV was most appropriate for the dose. The mean values of the low dose area $V_3$ and $V_5$ in the lung of the breast direction being treated were $3.24{\pm}3.49%$ and $0.72{\pm}1.55%$ at 6 MeV, the highest 9 MeV at $7.25{\pm}4.59%$, $3.07{\pm}2.64%$, the lowest at 6 MeV. Maximum and average lung dose was $727.78{\pm}137.27cGy$ at 6 MeV / 9 MeV, $49.16{\pm}24.44cGy$, highest 9 MeV at $998.97{\pm}114.35cGy$, $85.33{\pm}41.18cGy$, and lowest 6 MeV at $387.78{\pm}208.88cGy$, $9.27{\pm}6.60cGy$. The value of $V_{10}$ was all close to zero. Group B appeared in the pattern of Group A. Conclusion: Relative differences in low-dose areas of the lungs $V_3$ and $V_5$ were seen and were most effective in the dose transfer of tumor bed in the application of combined energy. It is thought that the method of using electronic energy in further radiation treatments for breast cancer is a more effective way to use the energy effect of limiting energy resources, and that if you think about it again, it could be a little more beneficial radiation treatment for patients.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.65-76
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• 2010

Purpose: he use of PET scanners and the number of patient in Korea have been increased for recent several years dramatically. For this reason, technologists have more possibilities to be exposed to the radiation. The hospitals using PET scanners should make an effort to reduce the radiation exposure dose. The purpose of this study was to evaluate the radiation exposure does when using radiation shielding devices. The evaluation was performed through questionnaire survey and experiment. Materials and Methods: First, the technologists who had experience working in PET center in 2008-2009 were surveyed with questionnaire and TLD Figures, personal opinion of utilization of radiation shielding devices are analyzed. Second, we measured the shielding rate of shielding devices which have been using in PET study procedures. We divided the procedures into four steps; distribution, moving, injection of $^{18}F$-FDG and patient setup. Results: First, the results of this survey, using of L-block+Syringe shield, L-block, Syringe shield, No shield during the injection, were each 58.5%, 20%, 9%, 12.3%. The TLD values according to utilization of radiation shield, using both L-block+Syringe Shield and L-block showed the lower TLD values, and Syringe shield only or No shield showed the higher TLD values. Second, the results of experiments according to PET study procedures measured the shielding rates as follows. The shielding rates during the distribution using L-block, L-block+Apron shield were measured 97.4%, 97.7%. The shielding rates during the $^{18}F$-FDG delivery to the injection room using mobile Syringe shield, Syringe holder, Syringe shield carrier were each 81.7%, 98.9%, 99.7%. The shielding rates during the injection using Syringe shield, L-block, L-block+Syringe shield were measured each 51.9%, 98.3%, 98.7%. The shielding rates of Apron were measured in each 30, 60, 90, 120, 150 cm distance. The measurement were each 16.9%, 14.2%, 16.6%, 17.1%, 18.1%, 18.6%. Conclusion: The most effective method for radiation shielding is to using L-block during the $^{18}F$-FDG distribution and Syringe shield carrier during in moving $^{18}F$-FDG. For the $^{18}F$-FDG injection, L-block+Syringe shield have to be used. The shielding effect of Apron has shown average 16.4%. According to the survey of questionnaire, the operators recognized well risk of the radiation exposure but, tended ignore in working. The radiation dose according to recognition of radiation exposure risk was not relevant. but radiation dose according to utilization of radiation shield lower the more use it. The main reason of no use of shielding devices is cumbersome, 55% of the respondents answered. I'm sure, by use of radiation shield in all PET procedure, radiation exposure will be reduced considerably.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.1
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• pp.13-19
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• 2011

Purpose: It's essential to minimize the tumor motion and identify the exact location of the lesions to achieve the improvement in radiation therapy efficiency during SBRT. In this study, we made the established compression belt to reduce respiratory motion and evaluated the usefulness of clinical application in SBRT. Materials and Methods: We analyzed the merits and demerits of the established compression belt to reduce the respiratory motion and improved the reproducibility and precision in use. To evaluate the usefulness of improved compression belt for respiratory motion reduction in SBRT, firstly, we reviewed the spiral CT images acquired in inspiration and expiration states of 8 lung cancer cases, respectively, and analyzed the three dimensional tumor motion related to respiration. To evaluate isodose distribution, secondly, we also made the special phantom using EBT2 film (Gafchronic, ISP, USA) and we prepared the robot (Cartesian Robot-2 Axis, FARARCM4H, Samsung Mechatronics, Korea) to reproduce three dimensional tumor motion. And analysis was made for isodose curves and two dimensional isodose profiles with reproducibility of respiratory motion on the basis of CT images. Results: A respiratory motion reduction compression belt (Velcro type) that has convenient use and good reproducibility was developed. The moving differences of three dimensional tumor motion of lung cancer cases analyzed by CT images were mean 3.2 mm, 4.3 mm and 13 mm each in LR, AP and CC directions. The result of characteristic change in dose distribution using the phantom and rectangular coordinates robot showed that the distortion of isodose has great differences, mean length was 4.2 mm; the differences were 8.0% and 16.8% each for cranio-caudal and 8.1% and 10.9% each for left-right directions in underdose below the prescribed dose. Conclusion: In this study, we could develop the convenient and efficient compression belt that can make the organs' motion minimize. With this compression belt, we confirmed that underdose due to respiration can be coped with when CTV-PTV margins of mean 6 mm would be used. And we conclude that the respiratory motion reduction compression belt we developed can be used for clinical effective aids along with the gating system.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.25-31
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• 2019

Purpose: Metals induce metal artifact during CT-image for therapy planning, and it occurs images distortion, which affects the volumetric measurement and radiation calculation. In the case of using megavoltage computed tomography(MVCT), the volume of metals can be measured as similar to true volume due to minimal metal artifact outcome. In this study, radiation assessment was conducted by comparing teeth volume from images of kVCT and MVCT of head and neck cancer patients, then assigning to kVCT image to calculate radiation after obtaining the similar volume of true teeth volume from MVCT. Also, formal IR image was able to verify the accuracy of radiation calculation. Material and method: 5 head and neck cancer patients who had intensity-modulated radiation therapy from Radixact^® Series were of the subject in this study. Calculations of radiation when constraining true teeth volume out of kVCT image(A-CT) and when designated specific HU after teeth assigned using MVCT image were compared with formal IR image. Treatment planning was devised at the same constraints and mean dose was measured at the radiation assess points. The points were anterior of the teeth, between PTV and the teeth, the interior of PTV near the teeth, and the teeth where 5cm distance from PTV. Result: A difference of metals volume from kVCT and MVCT image was mean 3.49±2.61cc, maximum 7.43cc. PTV was limited to where the internal teeth were fully contained. The results of PTV dose evaluation showed that the average CI value of the kVCT treatment planning without the artifact correction was 0.86, and the average CI value of the kVCT with the artifact correction using MVCT image was 0.9. Conclusion: When the Treatment Planning was made without correction of metal artifacts, the dose of PTV was underestimated, indicating that dose uncertainty occurred. When the computerized treatment plan was made without correction of metal artifacts, the dose of PTV was underestimated, indicating that dose uncertainty occurred.

• 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.