• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.86-89
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• 2002

The purpose is to develop a system to reduce the organ movement from the respiration during the 3DCRT or IMRT. This research reports the experience of utilizing personally developed system for mobile tumors. The patients clinical database was structured for 10 mobile tumors and patient setup error measurement and immobilization device effects were investigated. The RMRD system is composed of the respiratory motion reduction device utilized in prone position and abdominal strip device(ASD) utilized in the supine position, and the analysis program, which enables the analysis on patients setup reproducibility. Dose to normal tissue between patients with RMRDs and without RMRDs was analyzed by comparing the normal tissue volume, field margins and dose volume histogram(DVH) using fluoroscopy and CT images. And, reproducibility of patients setup verify by utilization of digital images. When patients breathed freely, average movement of diaphragm was 1.2 cm in prone position in contrast to 1.6 cm in supine position. In prone position, difference in diaphragm movement with and without RMRDs was 0.5 cm and 1.2 cm, respectively, showing that PTV margins could be reduced to as much as 0.7 cm. With RMRDs, volume of the irradiated normal tissue (lung, liver) reduced up to 20 % in DVH analysis. Also by obtaining the digital image, reproducibility of patients setup verify by visualization using the real-time image acquisition, leading to practical utilization of our software. Internal organ motion due to breathing can be reduced using RMRDs, which is simple and easy to use in clinical setting. It can reduce the organ motion-related PTV margin, thereby decrease volume of the irradiated normal tissue.

• Journal of radiological science and technology
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• v.43 no.2
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• pp.105-114
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• 2020

This study aimed to assess of beam-matching accuracy for an 8 MV beam between the same model linear accelerators(Linac) commissioned over two years. Two models were got the customer acceptance procedure(CAP) criteria. For commissioning data for beam-matched linacs, the percentage depth doses(PDDs), beam profiles, output factors, multi-leaf collimator(MLC) leaf transmission factors, and the dosimetric leaf gap(DLG) were compared. In addition, the accuracy of beam matching was verified at phantom and patient levels. At phantom level, the point doses specified in TG-53 and TG-119 were compared to evaluate the accuracy of beam modelling. At patient level, the dose volume histogram(DVH) parameters and the delivery accuracy are evaluated on volumetric modulated arc therapy(VMAT) plan for 40 patients that included 20 lung and 20 brain cases. Ionization depth curve and dose profiles obtained in CAP showed a good level for beam matching between both Linacs. The variations in commissioning beam data, such as PDDs, beam profiles, output factors, TF, and DLG were all less than 1%. For the treatment plans of brain tumor and lung cancer, the average and maximum differences in evaluated DVH parameters for the planning target volume(PTV) and the organs at risk(OARs) were within 0.30% and 1.30%. Furthermore, all gamma passing rates for both beam-matched Linacs were higher than 98% for the 2%/2 mm criteria and 99% for the 2%/3 mm criteria. The overall variations in the beam data, as well as tests at phantom and patient levels remains all within the tolerance (1% difference) of clinical acceptability between beam-matched Linacs. Thus, we found an excellent dosimetric agreement to 8 MV beam characteristics for the same model Linacs.

• Progress in Medical Physics
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• v.29 no.4
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• pp.157-163
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• 2018

Plans converted using dose-volume-histogram-based plan conversion (DPC) were evaluated by comparing them to the original plans. Changes in the dose volumetric (DV) parameters of five volumetric modulated arc therapy (VMAT) plans for head and neck (HN) cancer and five VMAT plans for prostate cancer were analyzed. For the HN plans, the homogeneity indices (HIs) of the three planning target volumes (PTV) increased by 0.03, 0.02, and 0.03, respectively, after DPC. The maximum doses to the PTVs increased by 1.20, 1.87, and 0.92 Gy, respectively, after DPC. The maximum doses to the optic chiasm, optic nerves, spinal cord, brain stem, lenses, and parotid glands increased after DPC by approximately 4.39, 3.62, 7.55, 7.96, 1.77, and 6.40 Gy, respectively. For the prostate plans after DPC, the HIs for the primary and boost PTVs increased by 0.05 and 0.03, respectively, and the maximum doses to each PTV increased by 1.84 and 0.19 Gy, respectively. After DPC, the mean doses to the rectum and femoral heads increased by approximately 6.19 and 2.79 Gy, respectively, and those to the bladder decreased by 0.20 Gy when summing the primary and boost plans. Because clinically unacceptable changes were sometimes observed after DPC, plans converted by DPC should be carefully reviewed before actual patient treatment.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.137-147
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• 2012

Purpose: Analyze the Effectiveness of Radiation Treatment Planning by dose calculation and optimization algorithm, apply consideration of actual treatment planning, and then suggest the best way to treatment planning protocol. Materials and Methods: The treatment planning system use Eclipse 10.0. (Varian, USA). PBC (Pencil Beam Convolution) and AAA (Anisotropic Analytical Algorithm) Apply to Dose calculation, DVO (Dose Volume Optimizer 10.0.28) used for optimized algorithm of Intensity Modulated Radiation Therapy (IMRT), PRO II (Progressive Resolution Optimizer V 8.9.17) and PRO III (Progressive Resolution Optimizer V 10.0.28) used for optimized algorithm of VAMT. A phantom for experiment virtually created at treatment planning system, $30{\times}30{\times}30$ cm sized, homogeneous density (HU: 0) and heterogeneous density that inserted air assumed material (HU: -1,000). Apply to clinical treatment planning on the basis of general treatment planning feature analyzed with Phantom planning. Results: In homogeneous density phantom, PBC and AAA show 65.2% PDD (6 MV, 10 cm) both, In heterogeneous density phantom, also show similar PDD value before meet with low density material, but they show different dose curve in air territory, PDD 10 cm showed 75%, 73% each after penetrate phantom. 3D treatment plan in same MU, AAA treatment planning shows low dose at Lung included area. 2D POP treatment plan with 15 MV of cervical vertebral region include trachea and lung area, Conformity Index (ICRU 62) is 0.95 in PBC calculation and 0.93 in AAA. DVO DVH and Dose calculation DVH are showed equal value in IMRT treatment plan. But AAA calculation shows lack of dose compared with DVO result which is satisfactory condition. Optimizing VMAT treatment plans using PRO II obtained results were satisfactory, but lower density area showed lack of dose in dose calculations. PRO III, but optimizing the dose calculation results were similar with optimized the same conditions once more. Conclusion: In this study, do not judge the rightness of the dose calculation algorithm. However, analyzing the characteristics of the dose distribution represented by each algorithm, especially, a method for the optimal treatment plan can be presented when make a treatment plan. by considering optimized algorithm factors of the IMRT or VMAT that needs to optimization make a treatment plan.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.2
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• pp.103-108
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• 2011

Purpose: Opposing portal irradiation with helmet field shape that has been given to a patient with brain metastasis can cause excess dose in patient's scalp, resulting in hair loss. For this reason, this study is to quantitatively analyze scalp dose for effective prevention of hair loss by comparing opposing portal irradiation with scalp-shielding shape and tomotherapy designed to protect patient's scalp with conventional radiation therapy. Materials and Methods: Scalp dose was measured by using three therapies (HELMET, MLC, TOMO) after five thermo-luminescence dosimeters were positioned along center line of frontal lobe by using RANDO Phantom. Scalp dose and change in dose distribution were compared and analyzed with DVH after radiation therapy plan was made by using Radiation Treatment Planning System (Pinnacle3, Philips Medical System, USA) and 6 MV X-ray (Clinac 6EX, VARIAN, USA). Results: When surface dose of scalp by using thermo-luminescence dosimeters was measured, it was revealed that scalp dose decreased by average 87.44% at each point in MLC technique and that scalp dose decreased by average 88.03% at each point in TOMO compared with HELMET field therapy. In addition, when percentage of volume (V95%, V100%, V105% of prescribed dose) was calculated by using Dose Volume Histogram (DVH) in order to evaluate the existence or nonexistence of hotspot in scalp as to three therapies (HELMET, MLC, TOMO), it was revealed that MLC technique and TOMO plan had good dose coverage and did not have hot spot. Conclusion: Reducing hair loss of a patient who receives whole brain radiotherapy treatment can make a contribution to improve life quality of the patient. It is expected that making good use of opposing portal irradiation with scalp-shielding shape and tomotherapy to protect scalp of a patient based on this study will reduce hair loss of a patient.

• Journal of radiological science and technology
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• v.35 no.4
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• pp.327-333
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• 2012

Purpose: To analyze the correlation between dose volume histograms(DVH) based on organ outer wall contour and organ wall delineation for bladder and rectum, and to compare the doses to these organs with the absorbed doses at the bladder and rectum. Material and methods: Individual CT based brachytherapy treatment planning was performed in 13 patients with cervical cancer as part of a prospective comparative trial. The external contours and the organ walls were delineated for the bladder and rectum in order to compute the corresponding dose volume histograms. The minimum dose in 0.1 $cm^3$, 1 $cm^3$, 2 $cm^3$, 5 $cm^3$, 10 $cm^3$ volumes receiving the highest dose were compared with the absorbed dose at the rectum and bladder reference point. Results: The bladder and rectal doses derived from organ outer wall contour and computed for volumes of 2 $cm^3$, provided a good estimate for the doses computed for the organ wall contour only. This correspondence was no longer true when large volumes were considered. Conclusion: For clinical applications, when volumes smaller than 5 $cm^2$ are considered, the dose-volume histograms computed from external organ contours for the bladder and rectum can be used instead of dose -volume histograms computed for the organ walls only. External organ contours are indeed easier to obtain. The dose at the ICRU rectum reference point provides a good estimate of the rectal dose computed for volumes smaller than 2 $cm^2$ only for a midline position of the rectum. The ICRU bladder reference point provides a good estimate of the dose computed for the bladder wall only in cases of appropriate balloon position.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.21-28
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• 2014

Purpose : For non-small cell lung cancer, if the treatment volume is large or the total lung volume is small, and the tumor is located in midline of patient's body, total lung dose tends to increase due to tolerance dose of spinal cord. The purpose of this study is to compare and evaluate the total lung dose of three dimensional conformal radiotherapy(3D CRT), intensity modulated radiotherapy(IMRT) and volumetric modulated arc therapy(VMAT) using restricted angle for non-small cell lung cancer patients. Materials and Methods : The treatment plans for four patients, being treated on TrueBeam STx($Varian^{TM}$, USA) with 10 MV and prescribed dose of 60 Gy in 30 fractions, 3D CRT, restricted angle IMRT and VAMT radiotherapy plans were established. Planning target volume(PTV), dose to total lung and spinal cord were evaluated using the dose volume histogram(DVH). Conformity index(CI), homogeneity index(HI), Paddick's index(PCI) for the PTV, $V_{30}$, $V_{20}$, $V_{10}$, $V_5$, mean dose for total lung and maximum dose for spinal cord was assessed. Results : Average value of CI, HI and PCI for PTV was $0.944{\pm}0.009$, $1.106{\pm}0.027$, $1.084{\pm}0.016$ respectively. $V_{20}$ values from 3D CRT, IMRT and VMAT plans were 30.7%, 20.2% and 21.2% for the first patient, 33.0%, 29.2% and 31.5% for second patient, 51.3%, 34.3% and 36.9% for third patient, finally 56.9%, 33.7% and 40.0% for the last patient. It was noticed that the $V_{20}$ was lowest in the IMRT plan using restricted angle. Maximum dose for spinal cord was evaluated to lower than the tolerance dose. Conclusion : For non-small cell lung cancer, IMRT with restricted angle or VMAT could minimize the lung dose and lower the dose to spinal cord below the tolerance level. Considering PTV coverage and tolerance dose to spinal cord, it was possible to obtain IMRT plan with smaller angle and this could result in lower dose to lung when compared to VMAT.

• Journal of the Korean Society of Radiology
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• v.13 no.3
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• pp.325-332
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• 2019

This study analyzed the movement of tumors using 4DCT. Appropriate uniform IM were identified using TC, II and CI depending on ITV margins. DVH and NTCP were also compared in each case. Dose analysis on tumors with uniform IM showed that the optimal treatment plan for satisfying all TC, CI, II was evaluated as 2 mm in phase 20 and 3 mm in 40%. That was compared to the dose from the normal tissues of $PTV_{20}$, $PTV_{40}$. In the 20% radiation field, V5, V10, and V20 for the lungs increased 1.49, 1.26, and 0.65%, while 40% increased by 1.9, 2.41 and 1.23%. NTCP had a dose increase of 0.57 to 0.029% from 20% and 40%. There was a dose increase in the spinal cord and heart at uniform IM, but there was no significant difference. These data suggest that the ITV setting of 20%, phase for Respiratory Gated Radiotherapy using Novalis ExacTrac system can be applied with a uniform IM 2 mm and 40% with 3 mm for optimal treatment plan.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.1
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• pp.11-14
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• 2012

Purpose: Anisotropic Analytical Algorithm (AAA) provides more accurate dose calculation regarding impact on scatter and tissue inhomogeneity in comparison to Pencil Beam Convolution (PBC) algorithm. This study tries to analyze the difference of dose distribution according to PBC algorithm and dose calculation algorithm of AAA on breast cancer tangential plan. Materials and Methods: Computerized medical care plan using Eclipse treatment planning system (version 8.9, VARIAN, USA) has been established for the 10 breast cancer patients using 6 MV energy of Linac (CL-6EX, VARIAN, USA). After treatment plan of Conventional Radiation Therapy plan (Conventional plan) and Field-in-Field Intensity Modulated Radiation Therapy plan (FiF plan) using PBC algorithm has been established, MU has been fixed, implemented dose calculation after changing it to AAA, and compared and analyzed treatment plan using Dose Volume Histogram (DVH). Results: Firstly, as a result of evaluating PBC algorithm of Conventional plan and the difference according to AAA, the average difference of CI value on target volume has been highly estimated by 0.295 on PBC algorithm and as a result of evaluating dose of lung, $V_{47Gy}$ and $V_{45Gy}$ has been highly evaluated by 5.83% and 4.04% each, Mean dose, $V_{20Gy}$, $V_{5Gy}$, $V_{3Gy}$ has been highly evaluated 0.6%, 0.29%, 6.35%, 10.23% each on AAA. Secondly, in case of FiF plan, the average difference of CI value on target volume has been highly evaluated on PBC algorithm by 0.165, and dose on ipsilateral lung, $V_{47Gy}$, $V_{45Gy}$, Mean dose has been highly evaluated 6.17%, 3.80%, 0.15% each on PBC algorithm, $V_{20Gy}$, $V_{5Gy}$, $V_{3Gy}$ has been highly evaluated 0.14%, 4.07%, 4.35% each on AAA. Conclusion: When calculating with AAA on breast cancer tangential plan, compared to PBC algorithm, Conformity on target volume of Conventional plan, FiF plan has been less evaluated by 0.295, 0.165 each. For the reason that dose of high dose region of ipsilateral lung has been showed little amount, and dose of low dose region has been showed much amount, features according to dose calculation algorithm need to be considered when we evaluate dose for the lungs.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.33-39
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• 2023

Purpose: The purpose of this study is to find out the dose variation according to thickness of the air gap between the patient's body surface and immobilization device in the treatment plan. Materials and Methods : Four conditions were created by adjusting the air gap thickness using 5 mm bolus, ranging from 0 mm to 3 mm bolus. Immobilization was placed on top in each case. And computed tomography was used to acquire images. The treatment plan that 430 cGy (Relative Biological Effectiveness,RBE) is irradiated 6 times and the dose of 2580 cGy (RBE) is delivered to 95% of Clinical Target Volume (CTV). The dose on CTV was evaluated by Full Width Half Maximum (FWHM) of the lateral dose profile and skin dose was evaluated by Dose Volume Histogram (DVH). Result: Results showed that the FWHM values of the lateral dose profile of CTV were 4.89, 4.86, 5.10, and 5.10 cm. The differences in average values at the on the four conditions were 3.25±1.7 cGy (RBE) among D_95% and 1193.5±10.2 cGy (RBE) among D_95% respectively. The average skin volume at 1% of the prescription dose was 83.22±4.8%, with no significant differences in both CTV and skin. Conclusion: When creating a solid-type immobilization device for carbon particle therapy, a slight air gap is recommended to ensure that it does not extend beyond the dose application range of the CTV.