• The Journal of Korean Society for Radiation Therapy
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• v.15 no.1
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• pp.1-9
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• 2003

I. Purpose The multileaf collimator(MLC) has many advantages, but use of the MLC increased effective penumbra and isodose undulation in dose distribution compared with that of an alloy block. In this work, we introduced the HD-270 MLC, which can improve the above disadvantages of MLC, and reported its feasibility study. II. Method and Materials The HD-270 MLC is a technique which combines the use of the existing Siemens multileaf collimator(3D MLC) with patient translation perpendicular to the leaf plane. The technique produces a smoothed isodose distribution with the reduced isodose undulation and effective penumbra. To assess the efficacy of the HD-270 technique and determine the appropriate resolution, a polygonal shaped MLC field was made to produce field edge angles from 0 degree to 75 degree with a step of 15 degree. Each HD-270 group was generated according to the allowed resolution, i. e., 5, 3, and 2mm. The experiment was carried out on Primus, a Siemens linear accelerator configured with HD-270 MLC. The total 60 MU of 6 MV photon beam was delivered to X-Omat film(Kodak, USA) at a SAD of 100 cm and 1.5 cm depth in solid water phantom. Exposed films were scanned by Lumiscan75(LUMISYS) and analyzed using RIT113 software(Radiological Imaging Technology Inc., USA). To test the mechanical accuracy of table movement, the transverse, longitudinal, and vertical positions were controlled by a consol with ${\pm}5\;mm,\;{\pm}4\;mm,\;{\pm}3\;mm,\;and\;{\pm}2\;mm$ steps, and then measured using a dial gauge with an accuracy of 0.001 inch. During the experiments, the table loaded with about 50Kg human phantom to simulate the real treatment situation. III. Results The effective penumbra and isodose undulation became larger with increase the resolution and field edge angle. The accuracy of the table movement on each direction is good within the ${\pm}1\;mm$. IV. Conclusion Clinical use of the MLC can be increased by using of the HD-270 MLC which complements to the disadvantages of the MLC.

• Radiation Oncology Journal
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• v.15 no.2
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• pp.159-165
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• 1997

Purpose : Secondary electrons generated by interaction between Primary X-rar beam and block tray in megavoltage irradiation, result in excess soft radiation dose to the surface layer To reduce the surface dose from the electron contamination, electron filters were attached under the tray when a customized block was used. Materials and Methods : Cu, Al or Cu/Al combined Plate with different thickness was used as a filter and the surface dose reduction was measured for each case. The measurement to find optimal filter was performed with $10m\times10cm$ field size and 78.5cm source to surface distance. The measurement points are positioned with 2mm intervals from surface to maximum build-up point. To acquire the effect of field size dependence on optimal electron filter, the measurement was performed from $4cm\times4cm\;to\;25cm\times25cm$ field sizes. Results : The surface dose was slowly increased by increasing irradiation field but rapidly increased beyond $15cm\times15cm$ field size. Al plate was found to be inadequate filter because of the failure to have surface dose kept lowering than the dose of deep area. Cu 0.5mm plate and Cu/Al=0.28mm/1.5mm combined plate were found to be optimal filters. By using these 2 filters, the absorbed dose to the surface layer was effectively reduced by $5.5\%,\;11.3\%,\;and\;22.3\%$ for the field size $4cm\times4cm,\;10m\times10cm,\;and\;25cm\times25cm$, respectively. Conclusion : The surface dose attributable to electron contamination had a dependence on field size. The electron contamination was increased when tray was used. Specially the electron contamination in the surface layer was greater when the larger field was used. 0.5mm Cu Plate and Cu/Al=0.28mm/15mm combined plates were selected as optimal electron filters. When the optimal electron filter was attached under the tray, excessive surface dose was decreased effectively The effect of these electron filters was better when a larger field was used.

• Radiation Oncology Journal
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• v.21 no.2
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• pp.167-173
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• 2003

Purpose: The purpose of this study was to evaluate whether a GafChromic film applied to stereotactic radiosurgery with a linear accelerator could provide information on the value for acceptance testing and quality control on the absolute dose and relative dose measurements and/or calculation of treatment planning system. Materials and methods: A spherical acrylic phantom, simulating a patient's head, was constructed from three points. The absolute and relative dose distributions could be measured by inserting a GafChromic film into the phantom. We tested the use of a calibrated GafChromic film (MD-55-2, Nuclear Associate, USA) for measuring the optical density. These measurements were achieved by irradiating the films with a dose of 0-112 Gy employing 6 MV photon. To verify the accuracy of the prescribed dose delivery to a target isocenter using a five arc beams (irradiated in 3 Gy per one beam) setup, calculated by the Linapel planning system the absolute dose and relative dose distribution using a GafChromic film were measured. All the irradiated films were digitized with a Lumiscan 75 laser digitizer and processed with the RIT113 film dosimetry system. Results: We verified the linearity of the Optical Density of a MD-55-2 GafChromic film, and measured the depth dose profile of the beam. The absolute dose delivered to the target was close to the prescribed dose of Linapel within an accuracy for the GafChromic film dosimetry (of $\pm$3$\%$), with a measurement uncertainty of $\pm$1 mm for the 50$\~$90$\%$ isodose lines. Conclusion: Our results have shown that the absolute dose and relative dose distribution curves obtained from a GafChromic film can provide information on the value for acceptance. To conclude the GafChromic flim is a convenient and useful dosimetry tool for linac based radiosurgery.

• Radiation Oncology Journal
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• v.23 no.4
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• pp.230-235
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• 2005

Purpose: To evaluate the contralateral breast dose using a virtual wedge compared with that using a Physical wedge and an open beam in a Siemens linear accelerator. Materials and Methods: The contralateral breast dose was measured using diodes placed on a humanoid phantom. Diodes were placed at 5.5 cm (position 1), 9.5 cm (position 2), and 14 cm (position 3) along the medial-lateral line from the medial edge of the treatment field. A 6-MV photon beam was used with tangential irradiation technique at 50 and 230 degrees of gantry angle. Asymmetrically collimated $17{\times}10cm$ field was used. for the first set of experiment, four treatment set-ups were used, which were an open medial beam with a 30-degree wedged lateral beam (physical and virtual wedges, respectively) and a 15-degree wedged medial beam with a 15-degree wedged lateral beam (physical and virtual wedges, respectively). The second set of experiment consists of setting with medial beam without wedge, a 15-degree wedge, and a 50-degree wedge (physical and virtual wedges, respectively). Identical monitor units were delivered. Each set of experiment was repeated for three times. Results: In the first set of experiment, the contralateral breast dose was the highest at the position 1 and decreased in order of the position 2 and 3. The contralateral breast dose was reduced with open beam on the medial side ($2.70{\pm}1.46%$) compared to medial beam with a wedge (both physical and virtual) ($3.25{\pm}1.59%$). The differences were larger with a physical wedge ($0.99{\pm}0.18%$) than a virtual wedge ($0.10{\pm}0.01%$) at all positions. The use of a virtual wedge reduced the contralateral breast dose by 0.12% to 1.20% of the proscribed dose compared to a physical wedge with same technique. In the second experiment, the contralateral breast dose decreased in order of the open beam, the virtual wedge, and the physical wedge at the position 1, and it decreased in order of a physical wedge, an open beam, and a virtual wedge at the position 2 and 3. Conclusion: The virtual wedge equipped in a Siemens linear accelerator was found to be useful in reducing dose to the contralateral breast. Our additional finding was that the surface dose distribution from the Siemens accelerator was different from a Varian accelerator.

• The Journal of Korean Society for Radiation Therapy
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• v.16 no.2
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• pp.33-41
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• 2004

Purpose : Film has been the primary tool in coincidence testing between the light field and the radiation field, which constitutes the quality assurance list of a linear accelerator. But there is a great chance of errors being different among the observer when using film. Thus this study set out to use the BIS(Beam Image System) in addition to film in comparing and evaluating coincidence results between the two fields and in searching for the improvement measures. Materials & Methods : Photon beam of 6 and 15MV was exposed to film and the BIS using a linear accelerator. The light and radiation fields were each $50{\times}50,\;100{\times}100,\;and\;200{\times}200mm^2$. The gantry angle was $0^{\circ}$ when using film and $0^{\circ}\;and\;270^{\circ}$ when using the BIS. The devices adopted to test coincidence between the two fields were a ruler and film scanner when using film. With the BIS, the width of the scanned light and radiation fields was measured for errors with setting the X and Y axis. Results : The visual measurements of the observer with film resulted that the radiation field was bigger than the light field and that their maximum error was 1.9mm. The results were the same with the measurements using the film scanner except for the average error, which was less than 1.9mm. On the contrary, the measurements using the BIS showed that the light field was bigger than the radiation field at the gantry angle of $0^{\circ}\;and\;270^{\circ}$. The maximum error was 0.96mm, and the error range was $<{\pm}2mm$ both in the X and Y axis. The average error of ${\Delta}X$, Y was the smallest in the order of the visual film measurements, film scanner measurements, and BIS measurements Conclusion . This requires a careful measurement for accurate quality assurance since errors are much different according to each observer that tests coincidence between visual fields with film. And an observer needs to use another image device or develop a measuring device of his own if it seems necessary for accurate measurements.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.172-178
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• 2002

Purpose : X-ray film over responds to low-energy photons in relative photon beam dosimetry because its sensor is based on silver bromide crystals, which are high-Z molecules. This over-response becomes a significant problem in clinical photon beam dosimetry particularly in regions outside the penumbra. In intensity modulated radiation therapy (IMRT), the radiation field is characterized by multiple small fields and their outside-penumbra regions. Therefore, in order to use film dosimetry for IMRT, the nature the source of the over-response in its radiation field need to be known. This study is aimed to verify and possibly improve film dosimetry for IMRT. Materials and Method : Modulated beams were constructed by a combination of five or seven different static radiation fields using 6 MeV X-rays. In order to verify film dosimetry, we used X-ray film and an ion chamber were used to measure the dose profiles at various depths in a phantom. In addition, in order to reduce the over-response, 0.01 inch thick lead filters were placed on both sides of the film. Results : The measured dose profiles showed a film over-response at the outside-penumbra and low dose regions. The error increased with depths and approached 15% at a maximum for the field size of $15{\times}15cm^2$ at 10 cm depth. The use of filters reduced the error to 3%, but caused an under-response of the dose in a perpendicular set-up. Conclusion : This study demonstrated that film dosimetry for IMRT involves sources of error due to its over-response to low-energy Photons. The use of filers can enhance the accuracy in film dosimetry for IMRT. In this regard, the use of optimal filter conditions is recommended.

• Progress in Medical Physics
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• v.25 no.2
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• pp.110-115
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• 2014

To compare 2 beam arrangements, circumferential equally angles (EA) beams or partially angles (PA) beams for stereotactic body radiation therapy (SBRT) of primary lung cancer for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques with respect to target, ipsilateral lung, contralateral lung, and organs-at-risk (OAR) dose-volume metrics, as well as treatment delivery efficiency. Data from 12 patients, four treatment plans were generated per data sets ($IMRT_{EA}$, $IMRT_{PA}$, $VMAT_{EA}$, $VMAT_{PA}$). The prescribed dose (PD) was 60 Gy in 4 fractions to 95% of the planning target volume (PTV) for a 6-MV photon beam. When compared with the IMRT and VMAT treatment plan for 2 beams, conformity index, homogeneity index, high dose spillage, D2 cm (Dmax at a distance ${\geq}2cm$ beyond the PTV), R50 (ratio of volume circumscribed by the 50% isodose line and the PTV), resulted in similar. But Dmax of the Organ at risk (OAR), spinal cord, trachea, resulted in differ between four treatment plans. Especially $HDS_{location}$ showed big difference in 21.63% vs. 26.46%.

• Journal of radiological science and technology
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• v.41 no.3
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• pp.201-207
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• 2018

The purpose of this study is to evaluate the performance of a "stealth chamber" as a novel reference chamber for measuring percentage depth dose (PDD) and profile of 6, 8 and 10 MV photon energies. The PDD curves and dose profiles with fields ranging from $3{\times}3$ to $25{\times}25cm^2$ were acquired from measurements by using the stealth chamber and CC 13 chamber as reference chamber. All measurements were performed with Varian VitalBeam linear accelerator. In order to assess the performance of stealth chamber, PDD curves and profiles measured with stealth chamber were compared with measurement data using CC13 chamber. For PPDs measured with both chambers, the dosimetric parameters such as $d_{max}$ (depth of maximum dose), $D_{50}$ (PDD at 50 mm depth), and $D_{100}$ (PDD at 100 mm depth) were analyzed. Moreover, root mean square error (RMSE) values for profiles at $d_{max}$ and 100 mm depth were evaluated. The measured PDDs and profiles between the stealth chamber and CC13 chamber as reference detector had almost comparable. For PDDs, the evaluated dosimetric parameters were observed small difference (<1%) for all energies and field sizes, except for $d_{max}$ less than 2 mm. In addition, the difference of RMSEs for profiles at $d_{max}$ and 100 mm depth was similar for both chambers. This study confirmed that the use of stealth chamber for measuring commission beam data is a feasible as reference chamber for fields ranging from $3{\times}3$ to $20{\times}20cm^2$. Furthermore, it has an advantage with respect to measurement of the small fields (less than $3{\times}3cm^2$ field) although not performed in this study.

• Radiation Oncology Journal
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• v.30 no.4
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• pp.158-164
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• 2012

Purpose: To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. Materials and Methods: Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). Results: Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. Conclusion: We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.9033-9038
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• 2014

Background: The purpose of this study was to assess the feasibility of deep inspiration breath-hold (DIBH) based volumetric modulated arc therapy (VMAT) for locally advanced left sided breast cancer patients undergoing radical mastectomy. DIBH immobilizes the tumor bed providing dosimetric benefits over free breathing (FB). Materials and Methods: Ten left sided post mastectomy patients were immobilized in a supine position with both the arms lifted above the head on a hemi-body vaclock. Two thermoplastic masks were prepared for each patient, one for normal free breathing and a second made with breath-hold to maintain reproducibility. DIBH CT scans were performed in the prospective mode of the Varian real time position management (RPM) system. The planning target volume (PTV) included the left chest wall and supraclavicular nodes and PTV prescription dose was 5000cGy in 25 fractions. DIBH-3DCRT planning was performed with the single iso-centre technique using a 6MV photon beam and the field-in-field technique. VMAT plans for FB and DIBH contained two partial arcs ($179^{\circ}-300^{\circ}CCW/CW$). Dose volume histograms of PTV and OAR's were analyzed for DIBH-VMAT, FB-VMAT and DIBH-3DCRT. In DIBH mode daily orthogonal ($0^{\circ}$ and $90^{\circ}$) KV images were taken to determine the setup variability and weekly twice CBCT to verify gating threshold level reproducibility. Results: DIBH-VMAT reduced the lung and heart dose compared to FB-VMAT, while maintaining similar PTV coverage. The mean heart $V_{30Gy}$ was $2.3%{\pm}2.7$, $5.1%{\pm}3.2$ and $3.3%{\pm}7.2$ and for left lung $V_{20Gy}$ was $18.57%{\pm}2.9$, $21.7%{\pm}3.9$ and $23.5%{\pm}5.1$ for DIBH-VMAT, FB-VMAT and DIBH-3DCRT respectively. Conclusions: DIBH-VMAT significantly reduced the heart and lung dose for left side chest wall patients compared to FB-VMAT. PTV conformity index, homogeneity index, ipsilateral lung dose and heart dose were better for DIBH-VMAT compared to DIBH-3DCRT. However, contralateral lung and breast volumes exposed to low doses were increased with DIBH-VMAT.