• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.171-176
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• 2014

Purpose : Changing the calculation grid of AAA in Lung SABR plan and to analyze the changes in target dose, and investigated the effects associated with it, and considered a suitable method of application. Materials and Methods : 4D CT image that was used to plan all been taken with Brilliance Big Bore CT (Philips, Netherlands) and in Lung SABR plan($Eclipse^{TM}$ ver10.0.42, Varian, the USA), use anisotropic analytic algorithm(AAA, ver.10, Varian Medical Systems, Palo Alto, CA, USA) and, was calculated by the calculation grid 1.0, 3.0, 5.0 mm in each Lung SABR plan. Results : Lung SABR plan of 10 cases are using each of 1.0 mm, 3.0 mm, 5.0 mm calculation grid, and in case of use a 1.0 mm calculation grid $V_{98}$. of the prescribed dose is about $99.5%{\pm}1.5%$, $D_{min}$ of the prescribed dose is about $92.5{\pm}1.5%$ and Homogeneity Index(HI) is $1.0489{\pm}0.0025$. In the case of use a 3.0 mm calculation grid $V_{98}$ dose of the prescribed dose is about $90{\pm}4.5%$, $D_{min}$ of the prescribed dose is about $87.5{\pm}3%$ and HI is about $1.07{\pm}1$. In the case of use a 5.0 mm calculation grid $V_{98}$ dose of the prescribed dose is about $63{\pm}15%$, $D_{min}$ of the prescribed dose is about $83{\pm}4%$ and HI is about $1.13{\pm}0.2$, respectively. Conclusion : The calculation grid of 1.0 mm is better improves the accuracy of dose calculation than using 3.0 mm and 5.0 mm, although calculation times increase in the case of smaller PTV relatively. As lung, spread relatively large and low density and small PTV, it is considered and good to use a calculation grid of 1.0 mm.

• Progress in Medical Physics
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• v.30 no.1
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• pp.7-13
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• 2019

Purpose: To compare the dosimetrical and radiobiological parameters among various volumetric modulated arc therapy (VMAT) techniques using restricted and continuous arc beams for left-sided breast cancer. Materials and Methods: Ten patients with left-sided breast cancer without regional nodes were retrospectively selected and prescribed the dose of 42.6 Gy in 16 fractions on the planning target volume (PTV). For each patient, three plans were generated using the $Eclipse^{TM}$ system (Varian Medical System, Palo Alto, CA) with one partial arc 1pVMAT, two partial arcs 2pVMAT, and two tangential arcs 2tVMAT. All plans were calculated through anisotropic analytic algorithm and photon optimizer with 6 MV photon beam of $VitalBEAM^{TM}$. The same dose objectives for each plan were used to achieve a fair comparison during optimization. Results: For PTV, dosimetrical parameters such as Homogeneity index, conformity index, and conformal number were superior in 2pVMAT than those in both techniques. $V_{95%}$, which indicates PTV coverage, was 91.86%, 96.60%, and 96.65% for 1pVMAT, 2pVMAT, and 2tVMAT, respectively. In most organs at risk (OARs), 2pVMAT significantly reduced the delivered doses compared with the other techniques, excluding the doses to contralateral lung. For the analysis of radiobiological parameters, a significant difference in normal tissue complication probability was observed in ipsilateral lung while no difference was observed in the other OARs. Conclusions: Our study showed that 2pVMAT had better plan quality and normal tissue sparing than 1pVMAT and 2tVMAT but not for all parameters. Therefore, 2pVMAT could be considered the priority choice for the treatment planning for left breast cancer.

• Progress in Medical Physics
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• v.25 no.2
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• pp.100-109
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• 2014

In stereotactic body radiotherapy (SBRT), the accurate location of treatment sites should be guaranteed from the respiratory motions of patients. Lots of studies on this topic have been conducted. In this letter, a new verification method simulating the real respiratory motion of heterogenous treatment regions was proposed to investigate the accuracy of lung SBRT for Volumetric Modulated Arc Therapy. Based on the CT images of lung cancer patients, lung phantoms were fabricated to equip in $QUASAR^{TM}$ respiratory moving phantom using 3D printer. The phantom was bisected in order to measure 2D dose distributions by the insertion of EBT3 film. To ensure the dose calculation accuracy in heterogeneous condition, The homogeneous plastic phantom were also utilized. Two dose algorithms; Analytical Anisotropic Algorithm (AAA) and AcurosXB (AXB) were applied in plan dose calculation processes. In order to evaluate the accuracy of treatments under respiratory motion, we analyzed the gamma index between the plan dose and film dose measured under various moving conditions; static and moving target with or without gating. The CT number of GTV region was 78 HU for real patient and 92 HU for the homemade lung phantom. The gamma pass rates with 3%/3 mm criteria between the plan dose calculated by AAA algorithm and the film doses measured in heterogeneous lung phantom under gated and no gated beam delivery with respiratory motion were 88% and 78%. In static case, 95% of gamma pass rate was presented. In the all cases of homogeneous phantom, the gamma pass rates were more than 99%. Applied AcurosXB algorithm, for heterogeneous phantom, more than 98% and for homogeneous phantom, more than 99% of gamma pass rates were achieved. Since the respiratory amplitude was relatively small and the breath pattern had the longer exhale phase than inhale, the gamma pass rates in 3%/3 mm criteria didn't make any significant difference for various motion conditions. In this study, the new phantom model of 4D dose distribution verification using patient-specific lung phantoms moving in real breathing patterns was successfully implemented. It was also evaluated that the model provides the capability to verify dose distributions delivered in the more realistic condition and also the accuracy of dose calculation.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.313-320
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• 2014

Purpose : The purpose of the study is to evaluate the efficiency of Coaxial MLC VMAT plan (Using $273^{\circ}$ and $350^{\circ}$ collimator angle) That the leaf motion direction aligned with axis of OAR (Organ at risk, It means spinal cord or cauda equine in this study.) compare to Universal MLC VMAT plan (using $30^{\circ}$ and $330^{\circ}$ collimator angle) for spine SBRT. Materials and Methods : The 10 cases of spine SBRT that treated with VMAT planned by Coaxial MLC and Varian TBX were enrolled. Those cases were planned by Eclipse (Ver. 10.0.42, Varian, USA), PRO3 (Progressive Resolution Optimizer 10.0.28) and AAA (Anisotropic Analytic Algorithm Ver. 10.0.28) with coplanar $360^{\circ}$ arcs and 10MV FFF (Flattening filter free). Each arc has $273^{\circ}$ and $350^{\circ}$ collimator angle, respectively. The Universal MLC VMAT plans are based on existing treatment plans. Those plans have the same parameters of existing treatment plans but collimator angle. To minimize the dose difference that shows up randomly on optimizing, all plans were optimized and calculated twice respectively. The calculation grid is 0.2 cm and all plans were normalized to the target V100%=90%. The indexes of evaluation are V10Gy, D0.03cc, Dmean of OAR (Organ at risk, It means spinal cord or cauda equine in this study.), H.I (Homogeneity index) of the target and total MU. All Coaxial VMAT plans were verified by gamma test with Mapcheck2 (Sun Nuclear Co., USA), Mapphan (Sun Nuclear Co., USA) and SNC patient (Sun Nuclear Co., USA Ver 6.1.2.18513). Results : The difference between the coaxial and the universal VMAT plans are follow. The coaxial VMAT plan is better in the V10Gy of OAR, Up to 4.1%, at least 0.4%, the average difference was 1.9% and In the D0.03cc of OAR, Up to 83.6 cGy, at least 2.2 cGy, the average difference was 33.3 cGy. In Dmean, Up to 34.8 cGy, at least -13.0 cGy, the average difference was 9.6 cGy that say the coaxial VMAT plans are better except few cases. H.I difference Up to 0.04, at least 0.01, the average difference was 0.02 and the difference of average total MU is 74.1 MU. The coaxial MLC VMAT plan is average 74.1 MU lesser then another. All IMRT verification gamma test results for the coaxial MLC VMAT plan passed over 90.0% at 1mm / 2%. Conclusion : Coaxial MLC VMAT treatment plan appeared to be favorable in most cases than the Universal MLC VMAT treatment planning. It is efficient in lowering the dose of the OAR V10Gy especially. As a result, the Coaxial MLC VMAT plan could be better than the Universal MLC VMAT plan in same MU.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.171-178
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• 2016

Purpose : In order to minimize the dose of femoral head as an appropriate treatment plan for rectal cancer radiation therapy, we compare and evaluate the usefulness of 3-field 3D conformal radiation therapy(below 3fCRT), which is a universal treatment method, and 5-field 3D conformal radiation therapy(below 5fCRT), and Volumetric Modulated Arc Therapy (VMAT). Materials and Methods : The 10 cases of rectal cancer that treated with 21EX were enrolled. Those cases were planned by Eclipse(Ver. 10.0.42, Varian, USA), PRO3(Progressive Resolution Optimizer 10.0.28) and AAA(Anisotropic Analytic Algorithm Ver. 10.0.28). 3fCRT and 5fCRT plan has $0^{\circ}$, $270^{\circ}$, $90^{\circ}$ and $0^{\circ}$, $95^{\circ}$, $45^{\circ}$, $315^{\circ}$, $265^{\circ}$ gantry angle, respectively. VMAT plan parameters consisted of 15MV coplanar $360^{\circ}$ 1 arac. Treatment prescription was employed delivering 54Gy to recum in 30 fractions. To minimize the dose difference that shows up randomly on optimizing, VMAT plans were optimized and calculated twice, and normalized to the target V100%=95%. The indexes of evaluation are D of Both femoral head and aceta fossa, total MU, H.I.(Homogeneity index) and C.I.(Conformity index) of the PTV. All VMAT plans were verified by gamma test with portal dosimetry using EPID. Results : D of Rt. femoral head was 53.08 Gy, 50.27 Gy, and 30.92 Gy, respectively, in the order of 3fCRT, 5fCRT, and VMAT treatment plan. Likewise, Lt. Femoral head showed average 53.68 Gy, 51.01 Gy and 29.23 Gy in the same order. D of Rt. aceta fossa was 54.86 Gy, 52.40 Gy, 30.37 Gy, respectively, in the order of 3fCRT, 5fCRT, and VMAT treatment plan. Likewise, Lt. Femoral head showed average 53.68 Gy, 51.01 Gy and 29.23 Gy in the same order. The maximum dose of both femoral head and aceta fossa was higher in the order of 3fCRT, 5fCRT, and VMAT treatment plan. C.I. showed the lowest VMAT treatment plan with an average of 1.64, 1.48, and 0.99 in the order of 3fCRT, 5fCRT, and VMAT treatment plan. There was no significant difference on H.I. of the PTV among three plans. Total MU showed that the VMAT treatment plan used 124.4MU and 299MU more than the 3fCRT and 5fCRT treatment plan, respectively. IMRT verification gamma test results for the VMAT plan passed over 90.0% at 2mm/2%. Conclusion : In rectal cancer treatment, the VMAT plan was shown to be advantageous in most of the evaluation indexes compared to the 3D plan, and the dose of the femoral head was greatly reduced. However, because of practical limitations there may be a case where it is difficult to select a VMAT treatment plan. 5fCRT has the advantage of reducing the dose of the femoral head as compared to the existing 3fCRT, without regard to additional problems. Therefore, not only would it extend survival time but the quality of life in general, if hospitals improved radiation therapy efficiency by selecting the treatment plan in accordance with the hospital's situation.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.12
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• pp.5019-5024
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• 2015

Background: The purpose of this study was to assess the dosimetric and clinical feasibility of volumetric modulated arc based hypofractionated stereotactic radiotherapy (RapidArc) treatment for large acoustic schwannoma (AS >10cc). Materials and Methods: Ten AS patients were immobilized using BrainLab mask. They were subject to multimodality imaging (magnetic resonance and computed tomography) to contour target and organs at risk (brainstem and cochlea). Volumetric modulated arc therapy (VMAT) based stereotactic plans were optimized in Eclipse (V11) treatment planning system (TPS) using progressive resolution optimizer-III and final dose calculations were performed using analytical anisotropic algorithm with 1.5 mm grid resolution. All AS presented in this study were treated with VMAT based HSRT to a total dose of 25Gy in 5 fractions (5fractions/week). VMAT plan contains 2-4 non-coplanar arcs. Treatment planning was performed to achieve at least 99% of PTV volume (D99) receives 100% of prescription dose (25Gy), while dose to OAR's were kept below the tolerance limits. Dose-volume histograms (DVH) were analyzed to assess plan quality. Treatments were delivered using upgraded 6 MV un-flattened photon beam (FFF) from Clinac-iX machine. Extensive pretreatment quality assurance measurements were carried out to report on quality of delivery. Point dosimetry was performed using three different detectors, which includes CC13 ion-chamber, Exradin A14 ion-chamber and Exradin W1 plastic scintillator detector (PSD) which have measuring volume of $0.13cm^3$, $0.009cm^3$ and $0.002cm^3$ respectively. Results: Average PTV volume of AS was 11.3cc (${\pm}4.8$), and located in eloquent areas. VMAT plans provided complete PTV coverage with average conformity index of 1.06 (${\pm}0.05$). OAR's dose were kept below tolerance limit recommend by American Association of Physicist in Medicine task group-101(brainstem $V_{0.5cc}$ < 23Gy, cochlea maximum < 25Gy and Optic pathway <25Gy). PSD resulted in superior dosimetric accuracy compared with other two detectors (p=0.021 for PSD.

• The KIPS Transactions:PartA
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• v.13A no.5 s.102
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• pp.465-472
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• 2006

Recently, many suggestions have been made in image segmentation methods for extracting human organs or disease affected area from huge amounts of medical image datasets. However, images from some areas, such as brain, which have multiple structures with ambiruous structural borders, have limitations in their structural segmentation. To address this problem, clustering technique which classifies voxels into finite number of clusters is often employed. This, however, has its drawback, the influence from noise, which is caused from voxel by voxel operations. Therefore, applying image enhancing method to minimize the influence from noise and to make clearer image borders would allow more robust structural segmentation. This research proposes an efficient structural segmentation method by filtering based clustering to extract detail structures such as white matter, gray matter and cerebrospinal fluid from brain MR. First, coherence enhancing diffusion filtering is adopted to make clearer borders between structures and to reduce the noises in them. To the enhanced images from this process, fuzzy c-means clustering method was applied, conducting structural segmentation by assigning corresponding cluster index to the structure containing each voxel. The suggested structural segmentation method, in comparison with existing ones with clustering using Gaussian or general anisotropic diffusion filtering, showed enhanced accuracy which was determined by how much it agreed with the manual segmentation results. Moreover, by suggesting fine segmentation method on the border area with reproducible results and minimized manual task, it provides efficient diagnostic support for morphological abnormalities in brain.