• The Korean Journal of Nuclear Medicine Technology
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• v.21 no.2
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• pp.74-79
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• 2017

Purpose Proton therapy can deliver an optimal dose to tumor while reducing unnecessary dose to normal tissue as compared the conventional photon therapy. As proton beams are irradiated into tissue, various positron emitters are produced via nuclear fragmentation reactions. These positron emitters could be used for the dose verification by using PET. However, the short half-life of the radioisotopes makes it hard to obtain the enough amounts of events. The aim of this study is to investigate the effect of off-line PET imaging scan time on the PET image quality. Materials and Methods The various diameters of spheres (D=37, 28, 22 mm) filled with distilled water were inserted in a 2001 IEC body phantom. Then proton beams (100 MU) were irradiated into the center of the each sphere using the wobbling technique with the gantry angle of $0^{\circ}$. The modulation widths of the spread out bragg peak were 16.4, 14.7 and 9.3 cm for the spheres of 37, 28 and 22 mm in diameters respectively. After 5 min of the proton irradiation, the PET images of the IEC body phantom were obtained for 50 min. The PET images with different time courses (0-10 min, 11-20 min, 21-30 min, 31-40 min and 41-50 min) were obtained by dividing the frame with a duration of 10 min. In order to evaluate the off-line PET image quality with the different time courses, the contrast-to-noise ratio (CNR) of the PET image calculated for each sphere. Results The CNRs of the sphere (D=37 mm) were 0.43, 0.42, 0.40, 0.31 and 0.21 for the time courses of 0-10 min, 11-20 min, 21-30 min, 31-40 min and 41-50 min respectively. The CNRs of the sphere (D=28 mm) were 0.36, 0.32, 0.27, 0.19 and 0.09 for the time courses of 0-10 min, 11-20 min, 21-30 min, 31-40 min and 41-50 min respectively. The CNR of 37 mm sphere was decreased rapidly after 30 min of the proton irradiation. In case of the spheres of 28 mm and 22 mm, the CNR was decreased drastically after 20 min of the irradiation. Conclusion The off-line PET imaging time is an important factor for the monitoring of the proton therapy. In case of the lesion diameter of 22 mm, the off-line PET image should be obtained within 25 min after the proton irradiation. When it comes to small size of tumor, the long PET imaging time will be beneficial for the proton therapy treatment monitoring.

• Progress in Medical Physics
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• v.10 no.3
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• pp.133-140
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• 1999

In this paper, as a preliminary study for developing a full 3D electron dose calculation algorithm, We developed 2.5D electron dose calculation algorithm by extending 2D pencil-beam model to consider three dimensional geometry such as air-gap and obliquity appropriately. The dose calculation algorithm was implemented using the IDL5.2(Research Systems Inc., USA), For calculation of the Hogstrom's pencil-beam algorithm, the measured data of the central-axis depth-dose for 12 MeV(Siemens M6740) and the linear stopping power and the linear scattering power of water and air from ICRU report 35 was used. To evaluate the accuracy of the implemented program, we compared the calculated dose distribution with the film measurements in the three situations; the normal incident beam, the 45$^{\circ}$ oblique incident beam, and the beam incident on the pit-shaped phantom. As results, about 120 seconds had been required on the PC (Pentium III 450MHz) to calculate dose distribution of a single beam. It needs some optimizing methods to speed up the dose calculation. For the accuracy of dose calculation, in the case of the normal incident beam of the regular and irregular shaped field, at the rapid dose gradient region of penumbra, the errors were within $\pm$3 mm and the dose profiles were agreed within 5%. However, the discrepancy between the calculation and the measurement were about 10% for the oblique incident beam and the beam incident on the pit-shaped phantom. In conclusions, we expended 2D pencil-beam algorithm to take into account the three dimensional geometry of the patient. And also, as well as the dose calculation of irregular field, the irregular shaped body contour and the air-gap could be considered appropriately in the implemented program. In the near future, the more accurate algorithm will be implemented considering inhomogeneity correction using CT, and at that time, the program can be used as a tool for educational and research purpose. This study was supported by a grant (＃HMP-98-G-1-016) of the HAN(Highly Advanced National) Project, Ministry of Health & Welfare, R.O.K.

• Journal of the Korean Society of Radiology
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• v.14 no.1
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• pp.23-29
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• 2020

The standard uptake values (SUVs) strongly depend on positron emission tomographs (PETs) and image reconstruction methods. Various image reconstruction algorithms in GE Discovery MIDR (DMIDR) and Discovery Ste (DSte) installed at Department of Nuclear Medicine, Seoul Samsung Medical Center were applied to measure the SUVs in an anthropomorphic torso phantom. The measured SUVs in the heart, liver, and background were compared to the actual SUVs. Applied image reconstruction algorithms were VPFX-S (TOF+PSF), QCFX-S-350 (Q.Clear+TOF+PSF), QCFX-S-50, VPHD-S (OSEM+PSF) for DMIDR, and VUE Point (OSEM) and FORE-FBP for DSte. To reduce the radiation exposure to radiation technologists, only the small amount of radiation source ¹⁸F-FDG was mixed with the distilled water: 2.28 MBq in the 52.5 ml heart, 20.3 MBq in the 1,290 ml liver and 45.7 MBq for the 9,590 ml in the background region. SUV values in the heart with the algorithms of VPFX-S, QCFX-S-350, QCFX-S-50, VPHD-S, VUE Point, and FOR-FBP were 27.1, 28.0, 27.1, 26.5, 8.0, and 7.4 with the expected SUV of 5.9, and in the background 4.2, 4.1, 4.2, 4.1, 1.1, and 1.2 with the expected SUV of 0.8, respectively. Although the SUVs in each region were different for the six reconstruction algorithms in two PET/CTs, the SUV ratios between heart and background were found to be relatively consistent; 6.5, 6.8, 6.5, 6.5, 7.3, and 6.2 for the six reconstruction algorithms with the expected ratio of 7.8, respectively. Mean SNRs (Signal to Noise Ratios) in the heart were 8.3, 12.8, 8.3, 8.4, 17.2, and 16.6, respectively. In conclusion, the performance of PETs may be checked by using with the SUV ratios between two regions and a relatively small amount of radioactivity.

• The Korean Journal of Nuclear Medicine
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• v.33 no.1
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• pp.65-75
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• 1999

Purpose: The aim of this study is to demonstrate the feasibility of 2-[fluorine-18] fluoro-2-deoxy-D-glucose (F-18-FDG) whole body scan (FDG W/B Scan) using dual-head gamma camera equipped with ultra high energy collimator in patients with various cancers, and compare the results with those of coincidence imaging. Materials and Methods: Phantom studies of planar imaging with ultra high energy and coincidence tomography (FDG CoDe PET) were performed. Fourteen patients with known or suspected malignancy were examined. F-18-FDG whole body scan was performed using dual-head gamma camera with high energy (511 keV) collimators and regional FDG CoDe PET immediately followed it Radiological, clinical follow up and histologic results were correlated with F-18-FDG findings. Results: Planar phantom study showed 13.1 mm spatial resolution at 10 cm with a sensitivity of 2638 cpm/MBq/ml. In coincidence PET, spatial resolution was 7.49 mm and sensitivity was 5351 cpm/MBq/ml. Eight out of 14 patients showed hypermetabolic sites in primary or metastatic tumors in FDG CoDe PET. The lesions showing no hypermetabolic uptake of FDG in both methods were all less than 1 cm except one lesion of 2 cm sized metastatic lymph node. The metastatic lymph nodes of positive FDG uptake were more than 1.5 cm in size or conglomerated lesions of lymph nodes less than 1cm in size. FDG W/B scan showed similar results but had additional false positive and false negative cases. FDG W/B scan could not visualize liver metastasis in one case that showed multiple metastatic sites in FDG CoDe PET. Conclusion: FDG W/B scan with specially designed collimators depicted some cancers and their metastatic sites, although it had a limitation in image quality compared to that of FDG CoDe PET. This study suggests that F-18-FDG positron imaging using dual-head gamma camera is feasible in oncology and helpful if it should be more available by regional distribution of FDG.

• Progress in Medical Physics
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• v.13 no.4
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• pp.209-217
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• 2002

There have been many studies on the application of the reciprocal advantages of multimodality image to define accurate target volume in the Process of radiation treatment planning. For the proper use of the multimodality images, the registration works between different modality images should be performed in advance. In this study, we selected chamfer matching method and mutual information method as most popular methods in recent image registration studies considering the registration accuracy and clinical practicality. And the two registration methods were analyzed to deduce the optimal registration method according to the characteristics of images. Lung phantom of which multimodality images could be acquired was fabricated and CT, MRI and SPECT images of the phantom were used in this study. We developed the registration program which can perform the two registration methods properly and analyzed the registration results which were produced by the developed program in many different images' conditions. Although the overall accuracy of the registration in both chamfer matching method and mutual information method was acceptable, the registration errors in SPECT images which had lower resolution and in degraded images of which data were removed in some part were increased when chamfer matching method was applied. Especially in the case of degraded reference image, chamfer matching methods produce relatively large errors compared with mutual information method. Mutual information method can be estimated as more robust registration method than chamfer matching method in this study because it did not need the prerequisite works, the extraction of accurate contour points, and it produced more accurate registration results consistently regardless of the images' characteristics. The analysis of the registration methods in this study can be expected to provide useful information to the utilization of multimodality images in delineating target volume for radiation treatment planning and in many other clinical applications.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.7-13
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• 2023

Purpose: In this study, we evaluated the effect of using a customized bolus on dose delivery in the treatment plan when cervical cancer protruded out of the body along with the uterus and evaluated reproducibility in patient set-up. Materials & Methods: The treatment plan used the Eclipse Treatment Planning System (Version 15.5.0, Varian, USA) and the treatment machine was VitalBeam (Varian Medical Systems, USA). The radiotherapy technique used 6 MV energy in the AP/PA direction with 3D-CRT. The prescribed dose is 1.8 Gy/fx and the total dose is 50.4 Gy/28 fx. Semiflex TM31010 (PTW, Germany) was used as the ion chamber, and the dose distribution was analyzed and evaluated by comparing the planned and measured dose according to each position movement and the tumor center dose. The first measurement was performed at the center by applying a customized bolus to the phantom, and the measurement was performed while moving in the range of -2 cm to +2 cm in the X, Y, and Z directions from the center assuming a positional error. It was measured at intervals of 0.5 cm, the Y-axis direction was measured up to ±3 cm, and the situation in which Bolus was set-up incorrectly was also measured. The measured doses were compared based on doses corrected to CT Hounsfield Unit (HU) 240 of silicon instead of the phantom's air cavity. Result: The treatment dose distribution was uniform when the customized bolus was used, and there was no significant difference between the prescribed dose and the actual measured value even when positional errors occurred. It was confirmed that the existing sheet-type bolus is difficult to compensate for irregularly shaped tumors protruding outside the body, but customized Bolus is found to be useful in delivering treatment doses uniformly.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.329-336
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• 2014

Purpose : To evaluate the dose on a contralateral breast and the usefulness of shielding according to the distance between the contralateral breast and the side of the beam by breast size when patients who got breast implant receive radiation therapy. Materials and Methods : We equipped 200 cc, 300 cc, 400 cc, and 500 cc breast model on the human phantom (Rando-phantom), acquired CT images (philips 16channel, Netherlands) and established the radiation treatment plan, 180 cGy per day on the left breast (EclipseTM ver10.0.42, Varian Medical Systems, USA) by size. We set up each points, A, B, C, and D on the right(contralateral) breast model for measurement by size and by the distance from the beam and attached MOSFET at each points. The 6 MV, 10 MV and 15 MV X-ray were irradiated to the left(target) breast model and we measured exposure dose of contralateral breast model using MOSFET. Also, at the same condition, we acquired the dose value after shielding using only Pb 2 mm and bolus 3 mm under the Pb 2 mm together. Results : As the breast model is bigger from 200 cc to 500 cc, The surface of the contralateral breast is closer to the beam. As a result, from 200 cc to 500 cc, on 180 cGy basis, the measurement value of the scattered ray inclined by 3.22 ~ 4.17% at A point, 4.06 ~ 6.22% at B point, 0.4~0.5% at C point, and was under 0.4% at D point. As the X-ray energy is higher, from 6 MV to 15 MV, on 180 cGy basis, the measurement value of the scattered ray inclined by 4.06~5% at A point, 2.85~4.94% at B point, 0.74~1.65% at C point, and was under 0.4% at D point. As using Pb 2 mm for shield, scattered ray declined by average 9.74% at A and B point, 2.8% at C point, and is under 1% at D point. As using Pb 2 mm and bolus together for shield, scattered ray declined by average 9.76% at A and B point, 2.2% at C point, and is under 1% at D point. Conclusion : Commonly, in case of patients who got breast implant, there is a distance difference by breast size between the contralateral breast and the side of beam. As the distance is closer to the beam, the scattered ray inclined. At the same size of the breast, as the X-ray energy is higher, the exposure dose by scattered ray tends to incline. As a result, as low as possible energy wihtin the plan dose is good for reducing the exposure dose.

• Journal of the Korean Society of Radiology
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• v.7 no.2
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• pp.121-129
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• 2013

In this study measured patient exposure dose for purpose exposure area and peripheral critical organs by using optically stimulated luminescence dosimeters (OSLDs) from computed tomography (CT), based on the measurement results, we predicted the radiobiological effects, and would like to advised ways of reduction strategies. In order to experiment, OSLDs received calibration factor were attached at left and right lens, thyroid, field center, and sexual gland in human body standard phantom that is recommended in ICRP, and we simulated exposure dose of patients in same condition that equal exposure condition according to examination area. Average calibration factor of OSLDs were $1.0058{\pm}0.0074$. In case of left and right lens, equivalent dose was measure in 50.49 mGy in skull examination, 0.24 mGy in chest, under standard value in abdomen, lumbar spine and pelvis. In case of thyroid, equivalent dose was measured in 10.89 mGy in skull examination, 7.75 mGy in chest, 0.06 mGy in abdomen, under standard value in lumber spine and pelvis. In case of sexual gland, equivalent dose was measured in 21.98 mGy, 2.37 mGy in lumber spine, 6.29 mGy in abdomen, under standard value in skull examination. Reduction strategies about diagnosis reference level (DRL) in CT examination needed fair interpretation and institutional support recommending international organization. So, we met validity for minimize exposure of patients, systematize influence about exposure dose of patients and minimize unnecessary exposure of tissue.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.183-188
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• 2012

Purpose: The concern of improving the quality of life and reducing side effects related to cancer treatment has been a subject of interest in recent years with advances in cancer treatment techniques and increasing survival time. This study is an analysis of differing scattered dose to the contralateral breast using common different treatment techniques. Materials and Methods: Eclipse 10.0 (Varian, USA) based $30^{\circ}$ EDW (Enhanced dynamic wedge) plan, $15^{\circ}$ wedge plan, $30^{\circ}$ wedge plan, Open beam plan, FiF (field in field) plan were established using CT image of breast phantom which in our hospital. Each treatment plan were designed to exposure 400 cGy using CL-6EX (VARIAN, USA) and we measured scattered dose at 1 cm, 3 cm, 5 cm, 9 cm away from medial side of the phantom at 1 cm depth using ionization chamber (FC 65G, IBA). We carried out measurement by separating effect of medial tangential field and lateral tangential field and analyze. Results: The evaluation of scattered dose to contralateral breast, $30^{\circ}$ EDW plan, $15^{\circ}$ wedge plan, $30^{\circ}$ wedge plan, Open beam plan, FIF plan showed 6.55%, 4.72%, 2.79%, 2.33%, 1.87% about prescription dose of each treatment plan. The result of scattered dose measurement by separating effect of medial tangential field and lateral tangential field results were 4.94%, 3.33%, 1.55%, 1.17%, 0.77% about prescription dose at medial tangential field and 1.61%, 1.40%, 1.24%, 1.16%, 1.10% at lateral tangential field along with measured distance. Conclusion: In our experiment, FiF treatment technique generates minimum of scattered dose to contralateral breast which come from mainly phantom scatter factor. Whereas $30^{\circ}$ wedge plan generates maximum of scattered doses to contralateral breast and 3.3% of them was scattered from gantry head. The description of treatment planning system showed a loss of precision for a relatively low scatter dose region. Scattered dose out of Treatment radiation field is relatively lower than prescription dose but, in decision of radiation therapy, it cannot be ignored that doses to contralateral breast are related with probability of secondary cancer.

• Progress in Medical Physics
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• v.26 no.4
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• pp.258-266
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• 2015

The modern radiotherapy technique which delivers a large amount of dose to patients asks to confirm the positions of patients or tumors more accurately by using X-ray projection images of high-definition. However, a rapid increase in patient's exposure and image information for CT image acquisition may be additional burden on the patient. In this study, by introducing structural similarity (SSIM) index that can effectively extract the structural information of the image, we analyze the differences between daily acquired x-ray images of a patient to verify the accuracy of patient positioning. First, for simulating a moving target, the spherical computational phantoms changing the sizes and positions were created to acquire projected images. Differences between the images were automatically detected and analyzed by extracting their SSIM values. In addition, as a clinical test, differences between daily acquired x-ray images of a patient for 12 days were detected in the same way. As a result, we confirmed that the SSIM index was changed in the range of 0.85~1 (0.006~1 when a region of interest (ROI) was applied) as the sizes or positions of the phantom changed. The SSIM was more sensitive to the change of the phantom when the ROI was limited to the phantom itself. In the clinical test, the daily change of patient positions was 0.799~0.853 in SSIM values, those well described differences among images. Therefore, we expect that SSIM index can provide an objective and quantitative technique to verify the patient position using simple x-ray images, instead of time and cost intensive three-dimensional x-ray images.