• Radiation Oncology Journal
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• v.25 no.4
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• pp.249-260
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• 2007

Purpose: In order to enhance the quality of IMRT as employed in Korea, we developed a remote monitoring system. The feasibility of the system was evaluated by conducting a pilot study. Materials and Methods: The remote monitoring system consisted of a head and neck phantom and a user manual. The phantom contains a target and three OARs (organs at risk) that can be detected on CT images. TLD capsules were inserted at the center of the target and at the OARs. Two film slits for GafchromicEBT film were located on the axial and saggital planes. The user manual contained an IMRT planning guide and instructions for IMRT planning and the delivery process. After the manual and phantom were sent to four institutions, IMRT was planed and delivered. Predicted doses were compared with measured doses. Dose distribution along the two straight lines that intersected at the center of the axial film was measured and compared with the profiles predicted by the plan. Results: The measurements at the target agreed with the predicted dose within a 3% deviation. Doses at the OARs that represented the thyroid glands showed larger deviations (minimum 3.3% and maximum 19.8%). The deviation at OARs that represented the spiral cord was $0.7{\sim}1.4%$. The percentage of dose distributions that showed more than a 5% of deviation on the lines was $7{\sim}27%$ and $7{\sim}14%$ along the horizontal and vertical lines, respectively. Conculsion: Remote monitoring of IMRT using the developed system was feasible. With remote monitoring, the deviation at the target is expected to be small while the deviation at the OARs can be very large. Therefore, a method that is able to investigate the cause of a large deviation needs to be developed. In addition, a more clinically relevant measure for the two-dimensional dose comparison and pass/fail criteria need to be further developed.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.2
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• pp.99-106
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• 2007

Purpose: The patient's position and anatomy during the treatment course little bit varies to some extend due to setup uncertainties and organ motions. These factors could affected to not only the dose coverage of the gross tumor but over dosage of normal tissue. Setup uncertainties and organ motions can be minimized by precise patient positioning and rigid immobilization device but some anatomical site such as prostate, the internal organ motion due to physiological processes are challenge. In planning procedure, the clinical target volume is a little bit enlarged to create a planning target volume that accounts for setup uncertainties and organ motion as well. These uncertainties lead to differences between the calculated dose by treatment planning system and the actually delivered dose. The purpose of this study was to evaluate the differences of interfractional displacement of organ and GTV based on the tomoimages. Materials and Methods: Over the course of 3 months, 3 patients, those who has applied rectal balloon, treated for prostatic cancer patient's tomoimage were studied. During the treatment sessions 26 tomoimages per patient, Total 76 tomoimages were collected. Tomoimage had been taken everyday after initial setup with lead marker attached on the patient's skin center to comparing with C-T simulation images. Tomoimage was taken after rectal balloon inflated with 60 cc of air for prostate gland immobilization for daily treatment just before treatment and it was used routinely in each case. The intrarectal balloon was inserted to a depth of 6 cm from the anal verge. MVCT image was taken with 5 mm slice thickness after the intrarectal balloon in place and inflated. For this study, lead balls are used to guide the registration between the MVCT and CT simulation images. There are three image fusion methods in the tomotherapy, bone technique, bone/tissue technique, and full image technique. We used all this 3 methods to analysis the setup errors. Initially, image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours and then the radiation therapist registered the MVCT images with the CT simulation images based on the bone based, rectal balloon based and GTV based respectively and registered image was compared with each others. The average and standard deviation of each X, Y, Z and rotation from the initial planning center was calculated for each patient. The image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours. Results: There was a significant difference in the mean variations of the rectal balloon among the methods. Statistical results based on the bone fusion shows that maximum x-direction shift was 8 mm and 4.2 mm to the y-direction. It was statistically significant (P=<0.0001) in balloon based fusion, maximum X and Y shift was 6 mm, 16mm respectively. One patient's result was more than 16 mm shift and that was derived from the rectal expansions due to the bowl gas and stool. GTV based fusion results ranging from 2.7 to 6.6 mm to the x-direction and 4.3$\sim$7.8 mm to the y-direction respectively. We have checked rotational error in this study but there are no significant differences among fusion methods and the result was 0.37$\pm$0.36 in bone based fusion and 0.34$\pm$0.38 in GTV based fusion.

• Journal of the Korean Society of Radiology
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• v.12 no.3
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• pp.313-319
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• 2018

In radiation treatment, it is unavoidable to block the influence of scattered ray on a skin and prevent internal normal organs from being exposed to radiation. It is fair to say that radiation therapy aims to reduce an absorbed dose of normal tissues. In particular, in radiation therapy of left-sided breast cancer, the internal neighboring organs are normal breast tissues, the heart, and the lung. The side effects on the heart include cardioplegy and myocardial infarction. This study tried to observe changes in the volume and dose of the heart in general radiation therapy plan and respiratory control based radiation therapy plan for patients with left-sided breast cancer, and to find the heart's volume and dose generated by respiration. According to the 4D computer tomography (CT), a volume of the heart had $12.8{\pm}8.7cc$ on average, and its dose had $17.3{\pm}12.1cGy$ on average. The differences in the volume and dose may cause side effects in radiation treatment. Therefore, it is necessary to apply respiratory control technique to establish the radiation treatment plan based on an accurate position of the heart.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.175-180
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• 2013

Purpose: Modern radiation therapy technique such as IGRT has become a routine clinical practice on LINAC for decrease patient's set-up error. CBCT can be used to adjust patient set-up error and treat patient more accurately. The Purpose of this study is to evaluate field size of CBCT for improving Image quality and suggest reference date of CBCT field size. Materials and Methods: Image date were acquired using KV CBCT and Catphan phantom (Half fan and full fan mode were scanned from 2 ~16 cm, at intervals of 2 cm). Field size were categorized by Small field size (2 cm, 4 cm), Medium field size (8 cm, 10 cm), Large field size (more than 14 cm) and evaluate. To estimated the CTDi using CTDi phantom and Ion chamber. Results: CT number linearity of Small and Large field size are greater than Medium field size. Spatial resolution are not significantly different without Small field size. But half fan mode is more different than full fan mode. In full fan, except Medium field size, all field size exceed recommendation for HU uniformity. But half pan has stability for all field except Small field size. CTDi makes radical sign function graph in Medium field size. Conclusion: The worst result was given by Small field size for Image quality and practically. Medium field size can be useful to prevent patient from radiation exposure and give better Image quality. So this study recommends that Medium field size (8~10 cm) is more suitable for CBCT.

• Journal of the Korean Society of Radiology
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• v.1 no.3
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• pp.23-34
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• 2007

To find how much radiation was exposed the patients who visit emergency room, a measurement study was made for radiation amount toward 200 patients selected randomly among visitors to an emergency room in a university hospital from March 16 to 31st, 2006. The results are as follows ; 1. Among the subjects 50 person(25.0%) were transferred from other hospitals, 24 persons(8.3) come after traffic accident, 50 persons for other accident and 76 persons for general medical care. 2. The average frequency of X-ray taking was calculated as 6.4 time per person among transferred patients, 14.5 times per person among patients with traffic accident and 2.6 times per person among general medical care. 3. The radiation exposure amount by kind of X-ray showed 28.9mGyfor general X-ray diagnosis, 84.2mGy for CT scanning and 1.02mGy for other special radiation study. 4. Average radiation exposure amount was calculated as 24.6mGy by transferred patients, 55.2mGy by patients with traffic accident, 17.1mGy by patients with other accidents and 17.0mGy by general patients. 5. Through the comparison of radiation exposure amount among to subject with maximum allowance threshold by International Commission on X-ray Radium Protection, transferred patients exceeded 6 times than allowance in whole body except extremities and joints, blood forming organ, reproductive system, vitreous body of eye, bone, thyroid gland, skin and etc, Patient suffered from traffic accidents were exposed 10 times more than allowance. In conclusion, the radiation exposure amount during X-rat diagnosis re too much and exceeded allowance standard by International Commission on X-ray Radium Protection. So further study and preventive measure to decrease radiation exposure by patients who visit emergency room.

• Journal of the Korean Society of Radiology
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• v.10 no.3
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• pp.181-186
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• 2016

Cardiac angiography(CA) or cardiac intervention(CI) is one of the major examination methods applied to the detection of cardiovascular diseases using X-rays. These CA and CI procedures require radiation exposure to patients and physicians. We evaluated the radiation dose to cardiac operator during the each case of CA and CI procedures. The number of patients is 113 patients in CA and 34 patients in CI. Mean fluoroscopy time, mean cine time, and mean total cumulative dose area product(DAP) in patients during CA and CI was 165.9 sec vs. 1200.0 sec, 30.31 sec vs 107.5 sec, and $37130.3mGy.cm^2$ vs $213312.6mGy.cm^2$, respectively. Mean dose of thyroid, over chest apron and under chest apron in operator during CA and CI was 15.84 uSv vs 89.81 uSv, 20.16 uSv vs 123.20 uSv, and 0.30 uSv vs 2.40 uSv, respectively. Mean effective dose of operator during CI was about 6 times greater than during CA. Also there was significant inter-relationship between fluoroscopy or cine time and effective dose in operator during CA and CI(p=0.001 and p=0.001, respectively).

• Journal of Radiation Protection and Research
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• v.35 no.2
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• pp.63-68
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• 2010

The ultimate goal of radiation treatment is to use enough radiation dosage in order to examine a tumor while protecting normal tissue. Respiratory guided radiotherapy is being clinically implemented to examine a given stabilized area in order to compensate for the problems of patient breathing. This study investigates the effects of breathing movements on 40 patients with liver cancer through the actual radiation therapy plan using 4D-CT and respiratory guided radiotherapy using RPM. Using a commercial RPM respiratory gating system 4D-CT, we acquired 4D CT on multislice helical CT scanners that use different approaches to 4D CT image reconstruction. The results from analyzing forty patients according to age and direction showed no relationship between gender and transition change. The mean left-right, anteroposterior, and craniocaudal total movements were $3.19{\pm}1.29$, $5.44{\pm}2.07$, and $12.54{\pm}4.70$ mm, respectively. Changes were the largest with CC directions and as patients advanced in age, movements were larger. Therefore, as changes occur in treatment areas because of movements caused from breathing, respiratory gating system is put into operation to revise movement and can increase the radiotherapeutics effects in treating liver cancer.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.53-60
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• 2015

Purpose : The purpose of this study is to evaluate the usefulness of a 3D printed phantom for in-vivo dosimetry of a prostate cancer patient. Materials and Methods : The phantom is produced to equally describe prostate and rectum based on a 3D volume contour of an actual prostate cancer patient who is treated in Asan Medical Center by using a 3D printer (3D EDISON+, Lokit, Korea). CT(Computed tomography) images of phantom are aquired by computed tomography (Lightspeed CT, GE, USA). By using treatment planning system (Eclipse version 10.0, Varian, USA), treatment planning is established after volume of a prostate cancer patient is compared with volume of the phantom. MOSFET(Metal OXIDE Silicon Field Effect Transistor) is estimated to identify precision and is located in 4 measuring points (bladder, prostate, rectal anterior wall and rectal posterior wall) to analyzed treatment planning and measured value. Results : Prostate volume and rectum volume of prostate cancer patient represent 30.61 cc and 51.19 cc respectively. In case of a phantom, prostate volume and rectum volume represent 31.12 cc and 53.52 cc respectively. A variation of volume between a prostate cancer patient and a phantom is less than 3%. Precision of MOSFET represents less than 3%. It indicates linearity and correlation coefficient indicates from 0.99 ~ 1.00 depending on dose variation. Each accuracy of bladder, prostate, rectal anterior wall and rectal posterior wall represent 1.4%, 2.6%, 3.7% and 1.5% respectively. In- vivo dosimetry represents entirely less than 5% considering precision of MOSFET. Conclusion : By using a 3D printer, possibility of phantom production based on prostate is verified precision within 3%. effectiveness of In-vivo dosimetry is confirmed from a phantom which is produced by a 3D printer. In-vivo dosimetry is evaluated entirely less than 5% considering precision of MOSFET. Therefore, This study is confirmed the usefulness of a 3D printed phantom for in-vivo dosimetry of a prostate cancer patient. It is necessary to additional phantom production by a 3D printer and In-vivo dosimetry for other organs of patient.

• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.93-109
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• 2020

Purpose: The radiochromic film (Gafchromic EBT3, Ashland Advanced Materials, USA) and 3-dimensional analysis system dosimetry checkTM (DC, MathResolutions, USA) were evaluated for patient-specific quality assurance (QA) of helical tomotherapy. Materials and Methods: Depending on the tumors' positions, three types of targets, which are the abdominal tumor (130.6㎤), retroperitoneal tumor (849.0㎤), and the whole abdominal metastasis tumor (3131.0㎤) applied to the humanoid phantom (Anderson Rando Phantom, USA). We established a total of 12 comparative treatment plans by the four geometric conditions of the beam irradiation, which are the different field widths (FW) of 2.5-cm, 5.0-cm, and pitches of 0.287, 0.43. Ionization measurements (1D) with EBT3 by inserting the cheese phantom (2D) were compared to DC measurements of the 3D dose reconstruction on CT images from beam fluence log information. For the clinical feasibility evaluation of the DC, dose reconstruction has been performed using the same cheese phantom with the EBT3 method. Recalculated dose distributions revealed the dose error information during the actual irradiation on the same CT images quantitatively compared to the treatment plan. The Thread effect, which might appear in the Helical Tomotherapy, was analyzed by ripple amplitude (%). We also performed gamma index analysis (DD: 3mm/ DTA: 3%, pass threshold limit: 95%) for pattern check of the dose distribution. Results: Ripple amplitude measurement resulted in the highest average of 23.1% in the peritoneum tumor. In the radiochromic film analysis, the absolute dose was on average 0.9±0.4%, and gamma index analysis was on average 96.4±2.2% (Passing rate: >95%), which could be limited to the large target sizes such as the whole abdominal metastasis tumor. In the DC analysis with the humanoid phantom for FW of 5.0-cm, the three regions' average was 91.8±6.4% in the 2D and 3D plan. The three planes (axial, coronal, and sagittal) and dose profile could be analyzed with the entire peritoneum tumor and the whole abdominal metastasis target, with planned dose distributions. The dose errors based on the dose-volume histogram in the DC evaluations increased depending on FW and pitch. Conclusion: The DC method could implement a dose error analysis on the 3D patient image data by the measured beam fluence log information only without any dosimetry tools for patient-specific quality assurance. Also, there may be no limit to apply for the tumor location and size; therefore, the DC could be useful in patient-specific QAl during the treatment of Helical Tomotherapy of large and irregular tumors.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.2
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• pp.155-160
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• 2005

Purpose : Many authors have been introduced field in field technique and 3-D conformal radiotherapy that increased the tumor dose as well as decreased the dose of abutting critical organ. These technique have multiple beam direction and small beam segments even below 10 MU(monitor unit)for each field. we have confirmed the influence of low MU on dose output and beam stability. Materials and Methods : To study the dose output, the dose for each field was always 90MU, but it divided into different segment size: 1, 2, 3, 5, 10, 15 segments, 90, 45, 30, 18, 9, 6 MU the measurements were carried out for X-ray energy 4 MV, 6 MV, 10 MV of three LINAC(Varian 600C, 2100C, 2100C, 2100C/D), in addition each measurement was randomly repeated three times for each energy. To study the field symmetry and flatness, X-omat V films were irradiated. After being developed, films were scanned and analyzed using densitometer. Results : Influence of low MU on dose is slightly more increase output about $1.2{\sim}2.9%$ in cGy/mu than 90MU, but may not changed beam quality(flatness or symmetry), Output stability depends on dose rate(PRF)rather than beam energy, field size. Conclusion : Presented result are under the limits(out put<3%, flatness<${\pm}3%$, symmetry<2%). The 3 accelerators are safe to use and to perform conformal radiotherapy treatments in small segments, small MU around 10MU. but Even if the result presented here under the limits, continuous adjustments and periodic QA should be done for use of small MU