• The Journal of Korean Society for Radiation Therapy
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• v.21 no.2
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• pp.83-88
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• 2009

Purpose: Cone beam computed tomography (CBCT) using an on board imager (OBI) can check the movement and setup error in patient position and target volume by comparing with the image of computer simulation treatment in real.time during patient treatment. Thus, this study purposed to check the change and movement of patient position and target volume using CBCT in IMRT and calculate difference from the treatment plan, and then to correct the position using an automated match system and to test the accuracy of position correction using an electronic portal imaging device (EPID) and examine the usefulness of CBCT in IMRT and the accuracy of the automatic match system. Materials and Methods: The subjects of this study were 3 head and neck patients and 1 pelvis patient sampled from IMRT patients treated in our hospital. In order to investigate the movement of treatment position and resultant displacement of irradiated volume, we took CBCT using OBI mounted on the linear accelerator. Before each IMRT treatment, we took CBCT and checked difference from the treatment plan by coordinate by comparing it with the image of CT simulation. Then, we made correction through the automatic match system of 3D/3D match to match the treatment plan, and verified and evaluated using electronic portal imaging device. Results: When CBCT was compared with the image of CT simulation before treatment, the average difference by coordinate in the head and neck was 0.99 mm vertically, 1.14 mm longitudinally, 4.91 mm laterally, and 1.07o in the rotational direction, showing somewhat insignificant differences by part. In testing after correction, when the image from the electronic portal imaging device was compared with DRR image, it was found that correction had been made accurately with error less than 0.5 mm. Conclusion: By comparing a CBCT image before treatment with a 3D image reconstructed into a volume instead of a 2D image for the patient's setup error and change in the position of the organs and the target, we could measure and correct the change of position and target volume and treat more accurately, and could calculate and compare the errors. The results of this study show that CBCT was useful to deliver accurate treatment according to the treatment plan and to increase the reproducibility of repeated treatment, and satisfactory results were obtained. Accuracy enhanced through CBCT is highly required in IMRT, in which the shape of the target volume is complex and the change of dose distribution is radical. In addition, further research is required on the criteria for match focus by treatment site and treatment purpose.

• The Korean Journal of Nuclear Medicine Technology
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• v.21 no.2
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• pp.31-36
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• 2017

Purpose Recently, the performance of PET/CT scanner has been improved and various techniques have been developed to increase the image quality such as Sensitivity and Resolution. The purpose of this study is to evaluate the usefulness of Q.Clear (a fully convergent iterative reconstruction) technique of GE Discovery IQ equipment to enhance the image quality. Materials and Methods All scans were acquired by Discovery IQ (GE Healthcare, MI, USA). In NEMA IEC Body Phantom test, Background to Hot-sphere (10 mm, 13 mm, 17 mm, 22 mm) ratio was 1:4 and scan time was 3 minutes. The images were reconstructed by VPHDs (VUE Point High-Definition + SharpIR) and Q.Clear to evaluate each Contrast. We injected 18F-FDG 187 M㏃ to PET/SPECT Performance Phantom. And then it was scanned for 4 minutes to evaluate Resolution and Uniformity. T-test statistical analysis was performed on SUVmax of small lesions less than 2 cm in 100 clinical patients regardless of disease type. Results In the NEMA IEC Body Phantom, the Contrast was $63.6{\pm}5.7%$ (VPHDs) and $75{\pm}4.8%$ (Q.Clear). In the PET/SPECT Performance Phantom, the Resolution was 9.2 mm (VPHDs) and 7.3 mm (Q.Clear). Uniformity of Q.Clear was 10.8% better than VPHDs. T-test statistic of the clinical patients showed a significant difference of p value of 0.021. Conclusion Both the phantom test and the clinical results showed that the quality of the image was improved in Q.Clear was applied. The SUVmax was highly measured in Q.Clear and the lesions were clearly distinguished visually. Therefore Q.Clear can be useful in various aspects such as dose-reduction, patients evaluation and image analysis.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.100-107
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• 2002

Purpose : The aim of this retrospective study was to assess the treatment results of 30 patients with pineal region tumors who were underwent radiation therapy under the diagnosis by either CT or MRI. There was no histological verification. We analyzed the prognostic factors that have a significant effect on the overall survival (OS) and disease free survival (DFS) rates. Materials and Methods : A total 30 patients with pineal region tumors were treated between March 1983 and August 1995. After a trial radiation therapy of $20\~30\;Gy/2\~3$ weeks, the patients were evaluated for their clinical response and radiological response by either CT or MRI and the final treatment direction was then decided. According to their response to the trial radiation therapy and the involved site, radiation treatment was given in various fields i.e., local, ventricle, whole brain and craniospinal field. The radiation dose ranged from 40.8 to 59.4 Gy (Median 50.4 Gy). The median follow up was 36.5 months $(4\~172\;months)$. Results : An improvement or stability in the clinical symptoms was observed in 28 patients $(93.3\%)$ after the trial RT. Nineteen patients $(63.3\%)$ showed a partial or complete response by CT or MRI. The two-year and five-year survival rates of the patients were $66.7\%$ and $55.1\%$, respectively. No significant difference in the survival rates according to the degree of the radiological response was abserved after the trial RT. The results of univariate analysis showed that age, the primary site, the performance status $(KPS\geq70)$, the degree of response after completing RT and the RT field were significant prognostic factors affecting the survival and disease free survival rates (p<0.05). Conclusion : The clinical and histological characteristics of pineal region tumors are quite complex and diverse. Therefore, it is difficult to predict the histological diagnosis and the possibility of radiocurability only with the initial response to RT. We think that the development of less invasive histological diagnostic techniques and tailored treatment to the histological type of each tumor are needed.

• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.25-28
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• 2011

Purpose: The aim of study is to find accuracy of pocket dosimeter in measuring exposed dose in compared with survey meter and to compare exposed dose according as Nuclear medicine exams. Materials and Method: First, radiation dose to point source(185 MBq,370 MBq, ${\ldots}$, 1665 MBq, 1850 MBq) were measured in using a pocket dosimeter and a survey meter. Second, radiation dose to 12 patients injected $^{18}F$-FDG 370 MBq were measured in using a pocket dosimeter and a survey meter. Third, radiation dose to 10 patients injected $^{99m}Tc$-DPD 925 MBq were measured in using a pocket dosimeter and a surveymeter. Result: The average is $70.12{\pm}39.36{\mu}Sv/h$ in measurement of point source with Surveymeter and $5{\pm}3.06{\mu}Sv$ in measurement of point source with Pocket dosimeter. The average is $25.04{\pm}6.16{\mu}Sv/h$ in measurement of PET/CT patients with Surveymeter and $2.41{\pm}0.51{\mu}Sv$ in measurement of PET/CT with Pocket dosimeter. The average is $8.58{\pm}0.96{\mu}Sv/h$ in measurement of Bone Scan patients with Surveymeter and $1{\mu}Sv$ in measurement of Bone Scan patients with Pocket dosimeter. Significant difference found between Survey meter value and Pocket dosimeter value in all experimentation (p<0.001). Conclusion: Accoring to rusult Wearing Pocket dosimeter is usefulnee in manerage of exposed dose in nucler medicine exams.

• The Journal of Korean Society for Radiation Therapy
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• v.13 no.1
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• pp.38-46
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• 2001

Purpose : The aim of this study is to investigate the effect of tissue inhomogeneities when appling to contrast medium among Homogeneous, Batho and ETAR dose calculation method in RTP system. Method and Material : We made customized heterogeneous phantom it filled with water or contrast medium slab. Phantom scan data have taken PQ 5000 (CT scanner, Marconi, USA) and then dose was calculated in 3D RTP (AcQ-Plan, Marconi, USA) depends on dose calculation algorithm (Homogeneous, Batho, ETAR). The dose comparisons were described in terms of 2D isodose distribution, percent depth dose data, effective path length and monitor unit. Also dose distributions were calculated with homogeneous and inhomogeneous correction algorithm, Batho and ETAR, in each patients with different clinical sites. Results : Result indicated that Batho and ETAR method gave rise to percent depth dose deviation $1.5{\sim}2.7\%,\;2.3{\sim}3.5\%$ (6MV, field size $10{\times}10cm^2$) in each status with and without contrast medium. Also show that effective path lengths were more increase in contrast status (23.14 cm) than Non-contrast (22.07 cm) about $4.9\%$ or 10.7 mm (In case Hounsfield Unit 270) and these results were similary showned in each patient with different clinical site that was lung. prostate, liver and brain region. Concliusion : In conclusion we shown that the use of inhomogeneity correction algorithm for dose calculation in status of injected contrast medium can not represent exact dose at GTV region. These results mean that patients will be more irradiated photon beam during radiation therapy.

• The Korean Journal of Nuclear Medicine Technology
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• v.21 no.2
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• pp.65-73
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• 2017

Purpose 3D 프린팅 기술은 3D 스캔이나 모델링을 통하여 적측가공 방식으로 제작하는 기공기술로서 금형 없이 직접 생산이 가능하고 빠른 시간 내에 제작이 가능하여 최근 다양한 산업분야에서 본격적으로 적용되고 있다. 3D 프린팅 기술은 의료분야에 있어, 영상의학 및 방사선 치료분야에서 다양하게 활용되고 있지만 핵의학 분야에서는 관련 연구가 미비한 실정이다. 그러므로 본 연구는 기존에 적용되고 있는 핵의학분야 팬텀과 3D 프린팅 기술로 제작된 텀의 특성을 비교하고 적용 가능성을 평가하는데 목적을 두었다. Materials and Methods 방사선 투과도 변화측정 국제기준 팬텀인 알루미늄(Aluminum) 계단 쐐기(step wedge)를 기준($140mm{\times}62mm{\times}35mm$)으로 PMMA(Poly Methyl Meta Acrylate)와 ABS(Acrylonitrile Butadiene Styrene)재질로 각각 동일한 크기의 팬텀을 제작하였다. PMMA 팬텀은 핵의학 분야에서 주로 적용되는 팬텀의 성분과 동일한 소재로 제작하였고, ABS 팬텀 제작은 3D 프린팅 기술의 액체 기반형의 SLA(Stereo Lithography Apparatus)기법을 사용하여 제작하였다. 본 연구는 SPECT/CT장비 BrightView XCT(Philips Health Care, Cleveland, USA)를 이용하였다. 영상 획득은 Rectangular Flood phantom(Biodex, New York, USA) $^{99m}TcO_4$ 3, 6 mCi와 $^{57}Co$ lood phantom(adqual, New Hampshire, USA) $^{57}Co$ 20 mCi를 이용하여 Aluminum, PMMA, ABS 팬텀에 대해 60 min 리스트모드(List mode)로 획득하였다. 획득한 영상의 분석을 위해 관심영역(ROI)을 설정하여 각 팬텀의 단계별로 평가하였다. Results 방사선원의 종류 및 방사선량에 따라 ABS 팬텀의 계수치는 PMMA 팬텀의 계수치와 유사한 값을 나타내며, 두께의 증가에 따라 선형적으로 감소하였다. Aluminum, PMMA, ABS 팬텀의 선감약계수를 비교했을 때, Aluminum 팬텀의 선감약계수는 나머지 두 팬텀보다 수치가 높았고, PMMA, ABS 팬텀에서는 근사치의 선감약계수가 나타났다. Conclusion 3D 프린팅 기술로 제작된 ABS 팬텀을 기준으로 PMMA 팬텀은 두께가 증가함에 따른 계수치의 변화가 유사하게 선형적으로 감소하였고, 선감약계수도 근사치로 나타내었다. ABS 팬텀의 핵의학적 적용 가능성을 확인할 수 있었으며, 추후 연구를 통해 세부적인 교정치(correction value)를 적용한다면 활발한 적용이 가능하리라 사료된다.

• Korean Journal of Digital Imaging in Medicine
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• v.14 no.2
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• pp.15-22
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• 2012

The purpose of this study was to measure the absorbed dose and calculate the effective dose for cone beam computed tomography (CBCT) and panorama units and to estimate usefulness of x-ray protective. Rando phantom and glass dosimeters were used for dosimetry. The absorbed doses were measured at 15 organs and 14 remainder from correspond to ICRP 2007 recommendations. The absorbed dose was highest in salivary glands as measured CBCT 2.420mGy, panorama 0.307mGy. Absorbed dose in another organs were high in order of thyroid, brain, skin, esophagus. The effective dose was CBCT 0.100mSv, panorama 0.011mSv and effective dose of panorama was higher than that of CBCT by 10 times. In case of wearing x-ray protective, reducing effective dose of CBCT by 0.066mSv (66%) and panorama by 0.008mSv (72%). Effective dose were reduced by radiological shielding but it needs further optimization studies, where dosimetric data are analyzed in combination with image quality with keep the patients' exposure as low as possible.

• Journal of radiological science and technology
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• v.43 no.4
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• pp.259-264
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• 2020

Radiation causes radiation hazards in the human body. In Korea, a case of radiation necrosis occurred in 2014. In this study, the scatter and shielding efficiency according to lead shielding were classified into epidermis and dermis for 0.511 MeV used in nuclear medicine. In this study, experiments were conducted using the slab phantom that represents calibration and the dose of human trunk. Experimental results showed that the shielding rate of 0.25 mmPb was 180% in the epidermis and 96% in the dermis. Shielding at 0.5mmPb showed shielding rates of 158%in the epidermis and 82% in the dermis. As a result of measuring the absorbed dose by subdividing the thickness of the dermis into 0.5 mm intervals, when the shielding was carried out at 0.25 mmPb, the dose appeared to be about 120% at 0.5 mm of the dermis surface, and the dose was decreased at the subsequent depth. Shielding at 0.5 mmPb, the dose appeared to be about 101% at the surface 0.5 mm, and the dose was measured to decrease at the subsequent depth. This result suggests that when lead aprons are actually used, the scattering rays would be sufficiently removed due to the spaces generated by the clothes and air, Therefore, the scattered ray generated from lead will not reach the human body. The ICRU defines the epidermis (0.07), in which the radiation-induced damage of the skin occurs, as the dose equivalent. If the radiation dose of the dermis is considered in addition, it will be helpful for the evaluation of the prognosis for radiation hazard of the skin.

• Journal of radiological science and technology
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• v.46 no.6
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• pp.527-533
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• 2023

The purpose of this study is to evaluate the clinical risk of spinal radiosurgery by calculating the dose difference due to dose calculation algorithm and multi-leaf collimator positioning error. The images acquired by the CT simulator were recalculated by correcting the multi-leaf collimator position in the dose verification program created using MATLAB and applying stoichiometric calibration and Monte Carlo algorithm. With multi-leaf collimator positioning error, the clinical target volume (CTV) showed a dose difference of up to 13% in the dose delivered to the 95% volume, while the gross tumor volume (GTV) showed a dose difference of 9%. The average dose delivered to the total volume showed dose variation from -8.9% to 9% and -10.1% to 10.2% for GTV and CTV, respectively. The maximum dose delivered to the total volume of the spinal cord showed a dose difference from -14.2% to 19.6%, and the dose delivered to the 0.35 ㎤ volume showed a dose difference from -15.5% to 19.4%. In future research, automating the linkage between treatment planning systems and dose verification programs would be useful for spinal radiosurgery.

• Radiation Oncology Journal
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• v.13 no.4
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• pp.339-348
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• 1995

Purpose : Since 1983, authors have conducted a study to evaluate the effect of external radiation therapy and to determine affected factors in management of the patients with malignant obstructive jaundice due to porta hepatis metastasis from stomach cancer. Materials and Methods : Thirty two patients with malignant obstructive jaundice due to porta hepatis metastasis from gastric cancer were presented. We have analysed 23 patients who were treated with external radiation therapy of more than 3000cGy. The radiation dose, disease extent at developement of jaundice, total bilirubin levels before radiation therapy, differentiation of histology, combind treatment, intent of primary surgery, initial stage of gastric cancer were analyzed to determine affected factors in radiation therapy. External radiation therapy was delivered with a daily dose of 180-300cGy, 5 times a week fractionation using 4 MeV linear accelerator. The radiation field included the porta hepatis with tumor mass by the abdominal ultrasonography or CT scan. In twenty three patients received more than 3000cGy, total irradiation dose was ranged from 3000cGy to 5480cGy, median 3770cGy. Among 23 patients, 13 patients were delivered more than equivalant dose of TDF 65(4140cGy/23fx). Results : Among 23 patients, complete, partial and no response were observed in 13, 5, 5 patients, respectively. The median survival for all patients was 5 momths. The significant prolongation of median survival was observed in complete responders(11 months) as compared to partial and no responders(5 months, 5 months respectively) Out of 13 patients with complete response, 6 patients lived more than a year Among 13 patients receiving more than 4140cGy equivalent dose, complete, partial and no response were observed in 10, 2 and 1 patients, respectively. The median survival for all these patients was 9.5 months. The median survival for complete responders(10/13) was 11.5 months. Among 10 patients receiving less than 4140cGy equivalent dose, complete, partial and no response were observed in 3, 3, 4 patients, respetively. The median survival for all these patients was 4.3 months Therefore, the radiation dose affected the results of treatment. For the complete response with prolongation of survival duration, at least 4140cGy equivalant dose should be delivered to porta hepatis. In evaluation of the disease extent, 7 patients of 13 complete responders showed localized disease in porta hepatis or peripancreatic area, but all patients with partial and no response showed wide extensive disease or persistant disease of primary gastric cancer. Therefore. the patients with the localized disease were the higher probability of complete response and long term survival. This study suggested that the radiation dose and the disease extent at developement of jaundice affected in radiation therapy for malignant obstructive jaundice. There were no serious complications related to external radiation therapy. Conclusion : External radiation therapy only could achieve the palliative effect in the patients with malignant obstructive jaundice due to porta hepatis metastasis from stomach cancer. This study suggested that the prolongation of survival duration could be achived in complete responders and radiation dose, extent of disease affected the results of treatment of malignant obstructive jaundice.