• Progress in Medical Physics
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• v.14 no.1
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• pp.15-19
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• 2003

High dose rate (HDR) brachytherapy for treating a cervix carcinoma has become popular, because it eliminates many of the problems associated with conventional brachytherapy. In order to improve the clinical effectiveness with HDR brachytherapy, a dose calculation algorithm, optimization procedures, and image registrations need to be verified by comparing the dose distributions from a planning computer and those from a phantom. In this study, the phantom was fabricated in order to verify the absolute doses and the relative dose distributions. The measured doses from the phantom were then compared with the treatment planning system for the dose verification. The phantom needs to be designed such that the dose distributions can be quantitatively evaluated by utilizing the dosimeters with a high spatial resolution. Therefore, the small size of the thermoluminescent dosimeter (TLD) chips with a dimension of <1/8"and film dosimetry with a spatial resolution of <1mm used to measure the radiation dosages in the phantom. The phantom called a pelvic phantom was made from water and the tissue-equivalent acrylic plates. In order to firmly hold the HDR applicators in the water phantom, the applicators were inserted into the grooves of the applicator holder. The dose distributions around the applicators, such as Point A and B, were measured by placing a series of TLD chips (TLD-to-TLD distance: 5mm) in the three TLD holders, and placing three verification films in the orthogonal planes. This study used a Nucletron Plato treatment planning system and a Microselectron Ir-192 source unit. The results showed good agreement between the treatment plan and measurement. The comparisons of the absolute dose showed agreement within $\pm$4.0 % of the dose at point A and B, and the bladder and rectum point. In addition, the relative dose distributions by film dosimetry and those calculated by the planning computer show good agreement. This pelvic phantom could be a useful to verify the dose calculation algorithm and the accuracy of the image localization algorithm in the high dose rate (HDR) planning computer. The dose verification with film dosimetry and TLD as quality assurance (QA) tools are currently being undertaken in the Catholic University, Seoul, Korea.

• Radiation Oncology Journal
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• v.29 no.2
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• pp.71-82
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• 2011

Purpose: To evaluate the biochemical control rate and the rate of side effects after performing permanent brachytherapy of localized prostate cancer. Materials and Methods: 67 patients with localized prostate cancer were treated with brachytherapy between April 2007 and December 2008. Of these, 43 patients who were followed up and did not receive external radiotherapy were evaluated for the change in prostate specific antigen (PSA) level and the occurrence of side effects. In total, 18 patients were classified as low risk, 19 patients as intermediate risk, and 6 patients as high risk. The prescription dose was 145 Gy. Results: A PSA increase greater than 2 ng/mL occurred in 2 patients (4.7%). Radiation Therapy Oncology Group (RTOG) grade 1 and 2 acute urologic complications (UC) occurred in 40 and 3 patients, respectively. Further, 5 patients had RTOG grade 1 acute rectal complication (RC). The numbers of RTOG grade 1, 2, and 3 chronic UC were 1, 4, and 1, respectively. The numbers of RTOG grade 1, 2, and 4 chronic RC were 5, 10, and 3, respectively. The statistically significant risk factors (RF) of acute RC were the minimal dose in the most irradiated 0.1 cc volume ($D_{0.1cc}$, p=0.041) and absolute volume receiving 150% of the prescribed dose ($V_{150cc}$, p=0.038) in the entire rectum (ER). The percentage ($V_{100%}$, p=0.019) and absolute volume ($V_{100cc}$, p=0.047) in the involved rectum (IR) were also statistically significant. The RF of chronic RC were $V_{100%}$ (p=0.011) in the ER and the $D_{0.1cc}$ (p=0.049), $V_{100cc}$ (p=0.023) in the IR. The number of used seeds were related with acute UC (p=0.028). Conclusion: Permanent brachytherpy of localized prostate cancer showed a favorable short term biochemical control rate. As such, selective intermediate and high risk patients can be managed with permanent brachytherapy. The effort to reduce rectal complication is also necessary.

• The Journal of Korean Society for Radiation Therapy
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• v.15 no.1
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• pp.29-33
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• 2003

I. Purpose Brachytherapy is the main component in treatment of patients with uterine cervical cancer. The reproducibility of applicator position in the same patient at repeated treatments was very important for accurate dose delivery. It was aimed to evaluate the change of applicator location between each high dose rate(HDR) brachytherapy insertion in the patients with uterine cervical cancer. II. Materials and Methods From January 1999 to October 2001, total 52 patients were treated with external beam radiotherapy and HDR brachytherapy (Microselectron, Nucletron). During six to seven times of brachytherapy, all patients had three treatment plans. From the orthogonal radiographs, we measured the following variables; height from upper border of pubic bone to os (HPO), distance from sacral promontory to tip of tandem (DST), distance from coccyx to os (DCO), distance from tip of right ovoid to os (DRO), distance from tip of left ovoid to os (DLO), and distance from center of the first tandem source to ovoid (DTO). To evaluate the reproducibility of applicator position, it was calculated the standard deviation of differences between three insertions for the 7 parameters in each patient. III. Results The ranges of standard deviations of interfractional differences for the variables were as follows. 1)HPO : $0{\sim}0.79cm$ 2)DST : $0{\sim}0.9cm$ 3)DCO : $0.06{\sim}0.76cm$ 4)DRO : $0{\sim}0.53cm$ 5)DLO : $0{\sim}0.45cm$ 6) DTO $0{\sim}0.36cm$ IV. Conclusions There was some change in applicator position on repeated implants in our study. But variation of the interfractional differences was minimal; in all parameters, there were less than 1 cm. We are continued to try for reducing the geometric variation between each procedure.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.68-76
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• 1998

Background: Patients with centrally recurred bronchogenic carcinoma make a complaint of many symptoms like hemoptysis, cough & dyspnea. At these conditions, the goal of treatment is only to relieve their symptoms. High dose rate brachytherapy(HDR-BT) is the palliative treatment modality of centrally located endobronchial tumor regardless of previous external irradiation(XRT) on the same site in symptomatic patients. Methods: We studied the effects of HDR-BT in 26 patients with symptomatic recurrent lung cancer. Patients(male: 24, mean age: 54yrs)were treated with HDR-BT underwent bronchoscopic placement of $^{192}Ir$ HDR after loading unit(Gammamed$^{(T)}$, Germany) to deliver 500cGY intraluminal irradiation at a depth of 1cm every lwk on 3 occasions. Evaluation at base line and 4wks after HDR brachytherapy included chest X-ray, bronchscopy, symptoms (Standadized Scale for dyspnea,cough,hemoptysis), and Karnofsky performance scale. Results: Endobronchial obstruction was improved in 11/26 patients(37%). Atelectasis in chest X-ray was improved in 5/15 patients(33%). Hemoptysis, dyspnea & cough were improved in 5/10 patients (50%), 5/8 patients (62%) & 10/18 patients (56%) respectively. Karnofsky performance status was changed from 76.4 scores in pretreatment to 77.6 scores after treatment. During HDR-BT, massive hemoptysis (2 patients) and pneumothorax(1 patient) were occurred as complications. Conclusion: We concluded that HDR-BT gave additional benefits for the control of symptoms and general performance and endobronchial obstruction & atelectasis. And HDR-BT will be an additional treatment for the recurrent and endobronchial obstructive lung cancer.

• Radiation Oncology Journal
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• v.20 no.3
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• pp.283-293
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• 2002

Purpose : A PC based brachytherapy planning system was developed to display dose distributions on simulation images by 2D isodose curve including the dose profiles, dose-volume histogram and 30 dose distributions. Materials and Methods : Brachytherapy dose planning software was developed especially for the Ir-192 source, which had been developed by KAERI as a substitute for the Co-60 source. The dose computation was achieved by searching for a pre-computed dose matrix which was tabulated as a function of radial and axial distance from a source. In the computation process, the effects of the tissue scattering correction factor and anisotropic dose distributions were included. The computed dose distributions were displayed in 2D film image including the profile dose, 3D isodose curves with wire frame forms and dosevolume histogram. Results : The brachytherapy dose plan was initiated by obtaining source positions on the principal plane of the source axis. The dose distributions in tissue were computed on a $200\times200\;(mm^2)$ plane on which the source axis was located at the center of the plane. The point doses along the longitudinal axis of the source were $4.5\~9.0\%$ smaller than those on the radial axis of the plane, due to the anisotropy created by the cylindrical shape of the source. When compared to manual calculation, the point doses showed $1\~5\%$ discrepancies from the benchmarking plan. The 2D dose distributions of different planes were matched to the same administered isodose level in order to analyze the shape of the optimized dose level. The accumulated dose-volume histogram, displayed as a function of the percentage volume of administered minimum dose level, was used to guide the volume analysis. Conclusion : This study evaluated the developed computerized dose planning system of brachytherapy. The dose distribution was displayed on the coronal, sagittal and axial planes with the dose histogram. The accumulated DVH and 3D dose distributions provided by the developed system may be useful tools for dose analysis in comparison with orthogonal dose planning.

• Radiation Oncology Journal
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• v.23 no.4
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• pp.223-229
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• 2005

Purpose: In this work we designed and made MPBP(Multi Purpose Brachytherapy Phantom). The MPBP enables one to reproduce the same patient set-up in MPBP as the treatment of the patient and we tried to get an exact analysis of rectal doses in the phantom without need of in-vivo dosimetry. Materials and Methods: Dose measurements were tried at a point of rectum 1, the reference point of rectum, with a diode detector for 4 patients treated with tandem and ovoid for a brachytherapy of a cervix cancer. Total 20 times of rectal dose measurements were made with 5 times a patient. The set-up variation of the diode detector was analyzed. The same patient set-ups were reproduced in self-made MPBP and then rectal doses were measured with TLD. Results: The measurement results of the diode detector showed that the set-up variation of the diode detector was the maximum $11.25{\pm}0.95mm$ in the y-direction for Patient 1 and the maximum $9.90{\pm}4.50mm,\;20.85{\pm}4.50mm,\;and\;19.15{\pm}3.33mm$ in the z-direction for Patient 2, 3, and 4, respectively. Un analyzing the degree of variation in 3 directions the more variation was showed in the z-direction than x- and y-direction except Patient 1. The results of TLD measurements in MPBP showed the relative maximum error of 8.6% and 7.7% at a point of rectum 1 for Patient 1 and 4, respectively and 1.7% and 1.2% for Patient 2 and 3, respectively. The doses measured at R1 and R2 were higher than those calculated except R point of Patient 2. this can be thought to related to the algorithm of dose calculation, whcih corrects for air and water but is guessed not to consider the correction for the scattered rays, but by considering the self-error (${\pm}5%$) TLD has the relative error of values measured and calculated was analyzed to be in a good agreement within 15%. Conclusion: The reproducibility of dose measurements under the same condition as the treatment could be achieved owing to the self-made MPMP and the dose at the point of interest could be analyzed accurately. If a treatment is peformed after achieving dose optimization using the data obtained in the phantom, dose will be able to be minimized to important organs.

• Radiation Oncology Journal
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• v.20 no.3
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• pp.237-245
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• 2002

Purpose : This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim. Materials and Methods : Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radio-therapy were analyzed. The median age was 61 years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range $30.6\~50.4\;Gy$ to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of $24\~28\;Gy$ with $6\~7$ fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy. Results : Early responses of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The overall survival (OS) rate of all patients was $82\%,\;and\;73\%$, and the disease free survival (DFS) rate was $72\%,\;and\;69\%$, at 3, and 5 years, respectively. The pelvic control rate (PCR) was $79\%$ at both 3 and 5 years. According to the FIGO stage,3 and 5 year OS were $100\%\;and\;50\%$ in CIS/IA, $100\%\;and\;100%$ in IB, $83\%\;and\;69\%$ in IIA, $87\%\;and\;80\%$ in IIB, and $62\%\;and\;62\%$ in III, respectively. The 3 year OS in 4 patients with stage IVA was $100\%$. Three-year DFS were $80\%$ in CIS/IA, $88\%$ in IB, $100\%$ in IIA, $64\%$ in IIB, $58\%$ in III, and $75\%$ in IVA. Three-year PCR were $100\%$ in CIS/IA, $94\%$ in IB, $100\%$ in IIA, $84\%$ in IIB, $69\%$ in III, and $50\%$ in IVA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant factors for DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate, treatment response and OTT were significant factors. By multivariate analysis, FIGO stage had a borderline significance for OS (p=0.0825) and treatment response had a borderline significance for DFS (0=0.0872). A total of 14 patients $(13\%)$ experienced rectal bleeding, which occurred from 3 to 44 months (median, 13 months) after the completion of radiotherapy. Conclusion : HDR brachytherapy protocol of Samsung Medical Center combined with properly optimal external beam pelvic irradiation is a safe and effective treatment for patients with uterine cervix cancer. The authors found that OTT of less than 55 days had a positive impact on pelvic control and survival rate.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.11
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• pp.4717-4721
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• 2014

Background: Dosimetric comparison of two dimensional (2D) radiography and three-dimensional computed tomography (3D-CT) based dose distributions with high-dose-rate (HDR) intracavitry radiotherapy (ICRT) for carcinoma cervix, in terms of target coverage and doses to bladder and rectum. Materials and Methods: Sixty four sessions of HDR ICRT were performed in 22 patients. External beam radiotherapy to pelvis at a dose of 50 Gray in 27 fractions followed by HDR ICRT, 21 Grays to point A in 3 sessions, one week apart was planned. All patients underwent 2D-orthogonal and 3D-CT simulation for each session. Treatment plans were generated using 2D-orthogonal images and dose prescription was made at point A. 3D plans were generated using 3D-CT images after delineating target volume and organs at risk. Comparative evaluation of 2D and 3D treatment planning was made for each session in terms of target coverage (dose received by 90%, 95% and 100% of the target volume: D90, D95 and D100 respectively) and doses to bladder and rectum: ICRU-38 bladder and rectum point dose in 2D planning and dose to 0.1cc, 1cc, 2cc, 5cc, and 10cc of bladder and rectum in 3D planning. Results: Mean doses received by 100% and 90% of the target volume were $4.24{\pm}0.63$ and $4.9{\pm}0.56$ Gy respectively. Doses received by 0.1cc, 1cc and 2cc volume of bladder were $2.88{\pm}0.72$, $2.5{\pm}0.65$ and $2.2{\pm}0.57$ times more than the ICRU bladder reference point. Similarly, doses received by 0.1cc, 1cc and 2cc of rectum were $1.80{\pm}0.5$, $1.48{\pm}0.41$ and $1.35{\pm}0.37$ times higher than ICRU rectal reference point. Conclusions: Dosimetric comparative evaluation of 2D and 3D CT based treatment planning for the same brachytherapy session demonstrates underestimation of OAR doses and overestimation of target coverage in 2D treatment planning.

• Progress in Medical Physics
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• v.19 no.4
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• pp.305-312
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• 2008

The aim of this study is to introduce the accuracy of Ir-192 source's apparent activity using the well-type chamber and the Farmer-type ionization chamber in the high dose rate brachytherapy. We measured the apparent activity of Ir-192 that each medical center in the country has and the apparent activity of calibration certificate provided by manufacturer is compared with that by our experimental measurement. The number of sources used for the activity comparison was 5. The accuracy of the measured activity was in the range of -2.8% to -1.0% and -2.1% to 0.2% for the Farmer-type chamber system (Jig) and for the well-type, respectively. The maximum difference was within 1.0% for comparison with two calibration's tool. Our results demonstrate that well-type chamber as wall as Farmer-type chamber is a appropriate system as the routine source calibration procedures in HDR brachytherapy. Whenever a new source is installed to use in clinics, by periods, a source calibration should be carried out.

• Radiation Oncology Journal
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• v.12 no.2
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• pp.243-252
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• 1994

The use of high dose rate remote afterloading system for the treatment of intraluminal lesions necessitates the need for a more accurate of dose distributions around the high intensity brachytherapy sources, doses are often prescribed to a distance of few centimeters from the linear source, and in this range the dose distribution is very difficult to assess. Accurated and optimized dose calculation with stable numerical algorithms by PC level computer was required to treatment intraluminal lesions by high dose rate brachytherapy system. The exposure rate from sources was calculated with Sievert integral and dose rate in tissue was calculated with Meisberger equation, An algorithm for generating a treatment plan with optimized dose distribution was developed for high dose rate intraluminal radiotherapy. The treatment volume becomes the locus of the constrained target surface points that is the specified radial distance from the source dwelling positions. The treatment target volume may be alternately outlined on an x-ray film of the implant dummy sources. The routine used a linear programming formulism to compute which dwell time at each position to irradiate the constrained dose rate at the target surface points while minimizing the total volume integrated dose to the patient. The exposure rate and the dose distribution to be confirmed the result of calculation with algorithm were measured with film dosimetry, TLD and small size ion chambers.