• Radiation Oncology Journal
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• v.19 no.2
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• pp.118-126
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• 2001

Purpose : In this study, it was investigated whether dose response relation existed or not in local radiotherapy for primary hepatocellular carcinoma. Materials and Methods : From January 1992 to March 2000, 158 patients were included in present study. Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child's class C, tumors occupying more than two thirds of the entire liver, and performance status on the ECOG scale of more than 3. Radiotherapy was given to the field including tumor with generous margin using 6, 10-MV X-ray. Mean tumor dose was $48.2{\pm}7.9\;Gy$ in daily 1.8 Gy fractions. Tumor response was based on diagnostic radiologic examinations such as CT scan, MR imaging, hepatic artery angiography at $4\~8$ weeks following completion of treatment. Statistical analysis was done to investigate the existence of dose response relationship of local radiotherapy when it was applied to the treatment of primary hepatocellular carcinoma. Results : An objective response was observed in 106 of 158 patients, giving a response rate of $67.1\%$. Statistical analysis revealed that total dose was the most significant factor in relation to tumor response when local radiotherapy was applied to the treatment of primary hepatocellular carcinoma. Only $29.2\%$ showed objective response in patients treated with dose less than 40 Gy, while $68.6\%\;and\;77.1\%$ showed major response in patients with $40\~50\;Gy$ and more than 50 Gy, respectively. Child-Pugh classification was significant factor in the development of ascites, overt radiation induced liver disease and gastroenteritis. Radiation dose was an important factor for development of radiation induced gastroduodenal ulcer. Conclusion : Present study showed the existence of dose response relationship in local radiotherapy for primary hepatocellular carcinoma. Only radiotherapy dose was a significant factor to predict the objective response. Further study is required to predict the maximal tolerance dose in consideration of liver function and non-irradiated liver volume.

• Quality Improvement in Health Care
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• v.20 no.1
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• pp.60-73
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• 2014

Objectives: This study aims at decreasing spatial dose rate through work improvement whilst spatial dose rate is the cause of increasing personal exposure dose which occurs in the process of handling radioisotope. Methods: From February 2013 until July 2013, divided into "before" and "after" the improvement, spatial dose rate in laboratory of nuclear medicine was measured in gamma image room, PET/CT-1 image room, and PET/CT-2 image room as its locations. The measurement time was 08:00, 12:00 and 17:00, and SPSS 21.0 USA was opted for its statistical analysis. Result: The spatial dose rate at distribution worktable, injection table, the entrance to the distribution room, and radioisotope storage box, which had showed high spatial dose rate, decreased by more than 43.7% a monthly average. The distribution worktable, that had showed the highest spatial dose rate in PET/CT-1 image room, dropped the rate to 42.3% as of July. The injection table and distribution worktable in the PET/CT-2 image room also showed the decline of spatial dose rate to 89% and 64.4%, respectively. Conclusion: By improving distribution process and introducing proper radiation shielding material, we were able to drop the spatial dose rate substantially at distribution worktable, injection table, and nuclide storage box. However, taking into account of steadily increasing amount of radioisotope used, strengthening radiation related regulations, and safe utilization of radioisotope, the process of system improvement needs to be maintained through continuous monitoring.

• Tuberculosis and Respiratory Diseases
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• v.71 no.1
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• pp.37-45
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• 2011

Background: Pulmonary emphysema (PE) is major cause of obstructive pulmonary function impairment (OPFI), which is diagnosed by spirometry. PE by high resolution CT is known to be correlated with OPFI. Recently, low dose CT (LDCT) has been increasingly used for screening interstitial lung diseases including PE. The aim of this study was to evaluate OPFI risks of subjects with PE detected by LDCT compared with those detected by simple digital radiography (SDR). Methods: LDCT and spirometry were administered to 266 inorganic dust exposed retired workers, from May 30, 2007 to August 31, 2008. This study was approved by our institutional review board and informed consent was obtained. OPFI risk was defined as less than 0.7 of forced expiratory volume in one second (FEV1)/forced vital capacity (FVC), and relative risk (RR) of OPFI of PE was calculated by multiple logistic regression analysis. Results: Of the 266 subjects, PE was found in 28 subjects (10.5%) by LDCT and in 11 subjects (4.1%) by SDR; agreement was relatively low (kappa value=0.32, p<0.001). FEV1 and FEV1/FVC were significantly different between PE and no PE groups determined by either SDR or LDCT. The differences between groups were larger when the groups were divided by the findings of SDR. When PE was present in either LDCT or SDR assays, the RRs of OPFI were 2.34 and 8.65, respectively. Conclusion: LDCT showed significantly higher sensitivity than SDR for detecting PE, especially low grade PE, in which pulmonary function is not affected. As a result, the OPFI risks in the PE group by LDCT was lower than that in the PE group by SDR.

• Journal of the Korean Society of Radiology
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• v.7 no.2
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• pp.145-149
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• 2013

Helical Tomotherapy is an innovative means of delivering intensity modulated radiation therapy (IMRT) using a device that merges features of a linear accelerator and helical computed tomography (CT) scanner. Hereat, during helical tomotherapy process, megavoltage computed tomography (MVCT) image are usually used for guiding the precise set-up of patient before/after treatment delivery. But which would certainly increase the total dose for patients, this study was to investigate the imaging dose of MVCT using the cylindrical "Cheese" phantom on a tomotherapy machine. A set of cylindrical "Cheese" phantom was adopted for scanning with respectively pitch value (1, 2, 3 mm) with same number slice (10 slice), same length (approximately 9 cm) and phantom set-ups on the couch of tomotherapy system. The average MVCT imaging dose were measured using A1SL ion chamber inserted in the phantom with preset geometry. The MVCT scanning average dose for the cylindrical "Cheese" phantom was 2.24 cGy, 1.02 cGy, 0.81 cGy during respectively pitch value (pitch 1, 2, 3 mm) with same number slice (10 slice), and same length's average dose was 2.47 cGy, 1.28 cGy, 0.88 cGy respectively (pitch 1, 2, 3 mm). Two major parameters, the assigned pitch numbers and scanning length, where the most important impacts to the dose variation. The MVCT dose was inversely proportional to the CT pitch value. The results may provide a reliable guidance for proper planning design of the scanning region, which is valuable to help minimize the extra dose to patient. Questionnaires were distributed to Radiology departments at hospitals with 300 sickbeds throughout the Pohang region of North Gyeongsang Province concerning awareness and performance levels of infection control. The investigation included measurements of the pollution levels of imaging equipment and assistive apparatuses in order to prepare a plan for the activation of prevention and management of hospital infections. The survey was designed to question respondents in regards to personal data, infection management prevention education, and infection management guidelines.

• Radiation Oncology Journal
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• v.23 no.4
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• pp.236-242
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• 2005

Purpose: To evaluate the role of surgical clips and scars in determining electron boost field for early stage breast cancer undergoing conserving surgery and postoperative radiotherapy and to provide an optimal method in drawing the boost field. Materials and Methods: Twenty patients who had $4{\sim}7$ surgical clips in the excision cavity were selected for this study. The depth informations were obtained to determine electron energy by measuring the distance from the skin to chest wall (SCD) and to the clip implanted in the most posterior area of tumor bed. Three different electron fields were outlined on a simulation film. The radiological tumor bed was determined by connecting all the clips implanted during surgery Clinical field (CF) was drawn by adding 3 cm margin around surgical scar. Surgical field (SF) was drawn by adding 2 cm margin around surgical clips and an Ideal field (IF) was outlined by adding 2 cm margin around both scar and clips. These fields were digitized into our planning system to measure the area of each separate field. The areas of the three different electron boost fields were compared. Finally, surgical clips were contoured on axial CT images and dose volume histogram was plotted to investigate 3-dimensional coverage of the clips. Results : The average depth difference between SCD and the maximal clip location was $0.7{\pm}0.55cm$. Greater difference of 5 mm or more was seen in 12 patients. The average shift between the borders of scar and clips were 1.7 1.2, 1.2, and 0.9 cm in superior, inferior, medial, and lateral directions, respectively. The area of the CF was larger than SF and IF in 6y20 patients. In 15/20 patients, the area difference between SF and if was less than 5%. One to three clips were seen outside the CF in 15/20 patients. In addition, dosimetrically inadequate coverage of clips (less than 80% of prescribed dose) were observed in 17/20 patients when CF was used as the boost field. Conclusion: The electron field determined from clinical scar underestimates the tumor bed in superior-inferior direction significantly and thereby underdosing the tissue at risk. The electron field obtained from surgical clips alone dose not cover the entire scar properly As a consequence, our technique, which combines the surgical clips and clinical scars in determining electron boost field, was proved to be effective in minimizing the geographical miss as well as normal tissue complications.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.91-98
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• 2014

Purpose : To compare the dosimetry for the left breast cancer treatment between three dimensional conformal radiation radiotherapy (3D-CRT) and Hybrid planning and to estimate usefulness of Hybrid planning Materials and Methods : Five patients with left breast cancer were included in the study. They were planned using several different radiotherapy techniques including: 1)open rectangular field, 2)tangential wedge-based field 3)field in field, 4)hybrid planning(energy, wedge combine). For each patient planning was using Light Speed RT-16 CT and PINNACLE planning system-ver.9.2. Hybrid plan was made using same system and using the same targets and optimization goals. We comparing the Homogeneity Index(HI), normal organs at the does-volume histogram(DVH) Results : In all plans, the Homogeneity Index(HI) of Hybrid planning was significantly better than other. Dose comparison of HI= 2D-RT:38.32, TW:38.32, FIF:29.22, HYBRID:30.57. 2D-RT, TW, FIF Hybrid$V_{75_-lung}$=112.33, 125.14, 121.3, 123.78. $V_{50_-lung}$=155.43, 159.62, 157.96, 159.06. $V_{25_-lung}$=199.86, 200.22, 198.65, 200.31. $V_{50_-heart}$=26.07, 27.1, 26.85, 27.17 $V_{30_-heart}$=33.71, 34.37, 34.15, 34.65 Conclusion : In summary, 3D-CRT, Hybrid planning techniques were found to have acceptableCTV coverage in our study. However the Hybrid planning increased radiation dose exposure to normal tissue. If you apply for treatment of inhomogeneity areas like lung, For best results will be achieved.

• Journal of the Korean Society of Radiology
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• v.12 no.4
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• pp.497-503
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• 2018

The purpose of this study was to investigate the degree of image degradation and the improvement of image quality caused by the density difference between the orthodontic filling material and the surrounding anatomical structure during the examination of the facial CT by quantitative and qualitative analysis. The teeth were scanned using 64-MDCT (Discovery 750 HD, GE HEALTH CARE, Milwaukee, USA). The teeth were scanned and compared according to tube voltage, silicone application, and MAR application. As a result, 10.36% CT value decreased at 140 kVp and 5.81% decrease at the application of silicon material. As a result of the qualitative evaluation, it was evaluated that 7 of the 10 observers and 3 of the acceptors were applied to the MAR algorithm. Therefore, it is possible to reduce the unnecessary burden on the radiation exposure dose as well as to reduce the loss of image data by reducing the high density artifacts, as well as the inspection parameters used in the current clinical application and various algorithms that can reduce the high density artifacts. It can be expected to provide a lot of image information.

• Journal of rehabilitation welfare engineering & assistive technology
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• v.10 no.3
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• pp.237-242
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• 2016

The major advantage of slip-ring technology in Spiral CT is that it facilitates continuous rotation of the x-ray tube, so that volume data can be acquired from a patient quickly. Not only for such a fast scan, but also for the dose reduction purpose, high signal-to-noise ratio and fast data acquisition system is required. In this study, we have built a multi-channel photodetector and multi-channel data acquisition system for CT application. The detector module consisted of CdWO4 crystal and Si photodiode in 16 channels. For the performance test of the preamplifier stage, both the transimpedance and switched integrator types are optimized for the photodetector modules. Switched integrator showed better noise performance in the limited bandwidth which is suitable for the current CT application. The control sequence for data acquisition and 20 bit ADC is designed with VHDL(Very High Speed Integrated Circuit Hardware Description Language) and implemented on FPGA(Field Programmable Gate Array) chip. Our Si photodiode detector module coupled to CdWO4 crystal showed comparable signal with other commercially available photodiode for CT. Switched integrator type showed higher SNR but narrower bandwidth compared to transimpedance preamplifier. Digital hardware is designed by FPGA, so that the control signal could be redesigned without hardware alteration.

• Journal of the Korean Society of Radiology
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• v.16 no.3
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• pp.203-209
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• 2022

One of the typical methods for lowering radiation dose while maintaining image quality of computed tomography (CT) is the use of model-based iterative reconstruction (MBIR). This study is to evaluate the image quality by adjusting the strength of the advanced modeled iterative reconstruction (ADMIRE), which is well known as a representative model of MBIR. The study was conducted using phantom, and CT images were obtained while adjusting the strength of ADMIRE in units of 1 to 5. Quantitative evaluation includes noise levels using coefficient of variation (COV) and contrast to noise ratio (CNR), as well as natural image quality evaluation (NIQE) and blind/referenceless image spatial quality evaluator (BRISQUE). As a result, in both noise level and blind quality evaluation results, the higher the strength of ADMIRE, the better the results were derived. In particular, it was confirmed that COV and CNR were improved 1.89 and 1.75 times at ADMIRE 5 compared to ADMIRE 1, respectively, and NIQE and BRISQUE were proved to be improved 1.35 and 1.22 times at ADMIRE 5 compared to ADMIRE 1, respectively. In conclusion, this study was proved that the reconstruction strength of ADMIRE had a great influence on the noise level and overall image quality evaluation of CT images.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.49-56
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• 2017

Purpose: To evaluate the accuracy of the Iterative Metal Artifact Reduction (IMAR) algorithm in correcting CT (computed tomography) images distorted due to a metal artifact and to evaluate the usefulness when proton therapy plan was plan using the images on which IMAR algorithm was applied. Materials and Methods: We used a CT simulator to capture the images when metal was not inserted in the CIRS model 062 Phantom and when metal was inserted in it and Artifact occurred. We compared the differences in the CT numbers from the images without metal, with a metal artifact, and with IMAR algorithm by setting ROI 1 and ROI 2 at the same position in the phantom. In addition, CT numbers of the tissue equivalents located near the metal were compared. For the evaluation of Rando Phantom, CT was taken by inserting a titanium rod into the spinal region of the Rando phantom modelling a patient who underwent spinal implant surgery. In addition, the same proton therapy plan was established for each image, and the differences in Range at three sites were compared. Results: In the evaluation of CIRS Phantom, the CT numbers were -6.5 HU at ROI 1 and -10.5 HU at ROI 2 in the absence of metal. In the presence of metal, Fe, Ti, and W were -148.1, -45.1 and -151.7 HU at ROI 1, respectively, and when the IMAR algorithm was applied, it increased to -0.9, -2.0, -1.9 HU. In the presence of metal, they were 171.8, 63.9 and 177.0 HU at ROI 2 and after the application of IMAR algorithm they decreased to 10.0 6,7 and 8.1 HU. The CT numbers of the tissue equivalents were corrected close to the original CT numbers except those in the lung located farthest. In the evaluation of the Rando Phantom, the mean CT numbers were 9.9, -202.8, and 35.1 HU at ROI 1, and 9.0, 107.1, and 29 HU at ROI 2 in the absence, presence of metal, and in the application of IMAR algorithm. The difference between the absence of metal and the range of proton beam in the therapy was reduced on the average by 0.26 cm at point 1, 0.20 cm at point 2, and 0.12 cm at point 3 when the IMAR algorithm was applied. Conclusion: By applying the IMAR algorithm, the CT numbers were corrected close to the original ones obtained in the absence of metal. In the beam profile of the proton therapy, the difference in Range after applying the IMAR algorithm was reduced by 0.01 to 3.6 mm. There were slight differences as compared to the images absence of metal but it was thought that the application of the IMAR algorithm could result in less error compared with the conventional therapy.