• Radiation Oncology Journal
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• v.6 no.1
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• pp.93-99
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• 1988

Some modern accerelators provide a dual energy for photon beam treatment. The main advantages of dual energy in the treatment of rectosigmoid or rectal cancer are as fellows. 1. Dose in the critical organ such as small intestine, bladder and genital organ are reduced. 2. Presacral and perineal area is fully covered. Dose distribution analysis such as calculation of dose in a target volume, isocenter, $D_{nax}$ and dose spectrum in any region of interest are possible. Examples of plan are given and results are discussed.

• Progress in Medical Physics
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• v.27 no.3
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• pp.111-116
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• 2016

This study is to evaluate the dosimetric impact of dosimetric leaf gap (DLG) and transmission factor (TF) at different measurement depths and field sizes for high definition multileaf collimator (HD MLC). Consequently, its clinical implication on dose calculation of treatment planning system was also investigated for pancreas stereotactic body radiation therapy (SBRT). The TF and DLG were measured at various depths (5, 8, 10, 12, and 15 cm) and field sizes ($6{\times}6$, $8{\times}8$, and $10{\times}10cm^2$) for various energies (6 MV, 6 MV FFF, 10 MV, 10 MV flattening filter free [FFF], and 15 MV). Fifteen pancreatic SBRT cases were enrolled in the study. For each case, the dose distribution was recomputed using a reconfigured beam model of which TF and DLG was the closest to the patient geometry, and then compared to the original plan using the results of dose-volume histograms (DVH). For 10 MV FFF photon beam, its maximum difference between 2 cm and 15 cm was within 0.9% and it is increased by 0.05% from $6{\times}6cm^2$ to $10{\times}10cm^2$ for depth of 15 cm. For 10 MV FFF photon beam, the difference in DLG between the depth of 5 cm and 15 cm is within 0.005 cm for all field sizes and its maximum difference between field size of $6{\times}6cm^2$ and $10{\times}10cm^2$ is 0.0025 cm at depth of 8 cm. TF and DLG values were dependent on the depth and field size. However, the dosimetric difference between the original and recomputed doses were found to be within an acceptable range (<0.5%). In conclusion, current beam modeling using single TF and DLG values is enough for accurate dose calculation.

• Progress in Medical Physics
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• v.17 no.1
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• pp.17-23
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• 2006

In Vivo dosimetry is a method to evaluate the radiotherapy; it is used to find the dosimetric and mechanical errors of radiotherapy unit. In this study, on-line In Vivo dosimetry was enabled by measuring the skin dose with MOSFET detectors attached to patient's skin during treatment. MOSFET dosimeters were found to be reproducible and independent on beam directions. MOSFET detectors were positioned on patient's skin underneath of the dose build-up material which was used to minimize dosimetric error. Delivered dose calculated by the plan verification function embedded in the radiotherapy treatment planning system (RTPs), was compared with measured data point by point. The dependency of MOSFET detector used in this study for energy and dose rate agrees with the specification provided by manufacturer within 2% error. Comparing the measured and the calculated point doses of each patient, discrepancy was within 5%. It was enabled to verify the IMRT by using MOSFET detector. However, skin dosimetry using conventional ion chamber and diode detector is limited to the simple radiotherapy.

• Radiation Oncology Journal
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• v.28 no.2
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• pp.99-105
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• 2010

Purpose: To compare radiation dose of the brain and lens among various conventional whole brain radiotherapy (WBRT) techniques. Materials and Methods: Treatment plans for WBRT were generated with planning computed tomography scans of 11 patients. A traditional plan with an isocenter located at the field center and a parallel anterior margin at the lateral bony canthus was generated (P1). Blocks were automatically generated with a 1 cm margin on the brain (5 mm for the lens). Subsequently, the isocenter was moved to the lateral bony canthus (P2), and the blocks were replaced into the multileaf collimator (MLC) with a 5 mm leaf width in the craniocaudal direction (P3). For each patient plan, 30 Gy was prescribed at the isocenter of P1. Dose volume histogram (DVH) parameters of the brain and lens were compared by way of a paired t-test. Results: Mean values of $D_{max}$ and $V_{105}$ of the brain in P1 were 111.9% and 23.6%, respectively. In P2 and P3, $D_{max}$ and $V_{105}$ of the brain were significantly reduced to 107.2% and 4.5~4.6%, respectively (p<0.001). The mean value of $D_{mean}$ of the lens was 3.1 Gy in P1 and 2.4~2.9 Gy in P2 and P3 (p<0.001). Conclusion: WBRT treatment plans with an isocenter located at the lateral bony canthus have dosimetric advantages for both the brain and lens without any complex method changes.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.473-479
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• 2023

In this study, the dose of photoneutrons generated during radiotherapy of prostate cancer using high energy was measured using a photo-stimulated luminescence dosimeter. In addition, this study was intended to study the probability of side effects occurring in the abdomen. A medical linear accelerator capable of generating 15 MV energy, True Beam STx (Varian Medical Systems, USA) and a radiation treatment planning system (Eclipse, Varian Medical Systems, USA) were used. A human body phantom was installed on the couch of the linear accelerator, and an Albedo Neutron Optical Stimulation Luminescence Neutron Detector (Landauer Inc., IL, USA) was used to measure the photoneutron dose. The photoneutron dose value in the abdomen of VMAT and 3C-CRT was 52.8 mSv, more than twice as high as VMAT compared to 3D-CRT. During radiotherapy of prostate cancer, the probability of causing side effects in the abdomen due to light neutron dose was calculated to be 3.2 per 1,000 for VMAT and 1.4 for 3D-CRT. By studying the abdomen, which has a major side effect that can occur during radiotherapy of prostate cancer, it is expected that it will be used as a meaningful study to study the quality of life and stochastic effect of prostate cancer patients

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.43-49
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• 2019

Purpose: This study examined changes in the position of the heat and lungs depending on the patient's breathing method during left breast cancer radiotherapy and used treatment plans to compare the resulting radiation dose. Materials and methods: The participants consisted of 10 patients with left breast cancer. A CT simulator(SIMENS SOMATOM AS, Germany) was used to obtain images when using three different breathing methods: free breathing(FB), deep inspiration breath hold(DIBH with Abches, DIBH), inspiration breath hold(IBH with CPAP, CPAP). A Ray Station(5.0.2.35, Sweden) was used for treatment planning, the treatment method was volumetric modulated arc therapy (VMAT) with one partial arc of the same angle, and the prescribed dose to the planning target volume (PTV) was a total dose of 50Gy(2Gy/day). In treatment plan analysis, the 95% dose (D95) to the PTV, the conformity index(CI), and the homogeneity index (HI) were compared. The lungs, heart, and left anterior descending artery (LAD) were selected as the organs at risk(OARs). Results: The mean volume of the ipsilateral lung for FB, DIBH, and CPAP was 1245.58±301.31㎤, 1790.09±362.43 ㎤, 1775.44±476.71 ㎤. The mean D95 for the PTV was 46.67±1.89Gy, 46.85±1.72Gy, 46.97±23.4Gy, and the mean CI and HI were 0.95±0.02, 0.96±0.02, 0.95±0.02 and 0.91±0.01, 0.90±0.01, 0.92±0.02. The V20 of Whole Lung was 10.74±4.50%, 8.29±3.14%, 9.12±3.29% and The V20 of the ipsilateral lung was 20.45±8.65%, 17.18±7.04%, 18.85±7.85%, the Dmean of the heart was 7.82±1.27Gy, 6.10±1.27Gy, 5.67±1.56Gy, and the Dmax of the LAD was 20.41±7.56Gy, 14.88±3.57Gy, 14.96±2.81Gy. The distance from the thoracic wall to the LAD was measured to be 11.33±4.70mm, 22.40±6.01mm, 20.14±6.23mm. Conclusion: During left breast cancer radiotherapy, the lung volume was 46.24% larger for DIBH than for FB, and 43.11% larger for CPAP than FB. The larger lung volume increases the distance between the thoracic wall and the heart. In this way, the LAD, which is one of the nearby OARs, can be more effectively protected while still satisfying the treatment plan. The lung volume was largest for DIBH, and the distance between the LAD and thoracic wall was also the greatest. However, when performing treatment with DIBH, the intra-fraction error cannot be ignored. Moreover, communication between the patient and the radiotherapist is also an important factor in DIBH treatment. When communication is problematic, or if the patient has difficulty holding their breath, we believe that CPAP could be used as an alternative to DIBH. In order to verify the clinical efficacy of CPAP, it will be necessary to perform long-term follow-up of a greater number of patients.

• Progress in Medical Physics
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• v.22 no.4
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• pp.190-197
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• 2011

Currently, the dose distribution calculation used by commercial treatment planning systems (TPSs) for high-dose rate (HDR) brachytherapy is derived from point and line source approximation method recommended by AAPM Task Group 43 (TG-43). However, the study of Monte Carlo (MC) simulation is required in order to assess the accuracy of dose calculation around three-dimensional Ir-192 source. In this study, geometry factor was calculated using segmented sources integration method by dividing microSelectron HDR Ir-192 source into smaller parts. The Monte Carlo code (MCNPX 2.5.0) was used to calculate the dose rate $\dot{D}(r,\theta)$ at a point ($r,\theta$) away from a HDR Ir-192 source in spherical water phantom with 30 cm diameter. Finally, anisotropy function and radial dose function were calculated from obtained results. The obtained geometry factor was compared with that calculated from line source approximation. Similarly, obtained anisotropy function and radial dose function were compared with those derived from MCPT results by Williamson. The geometry factor calculated from segmented sources integration method and line source approximation was within 0.2% for $r{\geq}0.5$ cm and 1.33% for r=0.1 cm, respectively. The relative-root mean square error (R-RMSE) of anisotropy function obtained by this study and Williamson was 2.33% for r=0.25 cm and within 1% for r>0.5 cm, respectively. The R-RMSE of radial dose function was 0.46% at radial distance from 0.1 to 14.0 cm. The geometry factor acquired from segmented sources integration method and line source approximation was in good agreement for $r{\geq}0.1$ cm. However, application of segmented sources integration method seems to be valid, since this method using three-dimensional Ir-192 source provides more realistic geometry factor. The anisotropy function and radial dose function estimated from MCNPX in this study and MCPT by Williamson are in good agreement within uncertainty of Monte Carlo codes except at radial distance of r=0.25 cm. It is expected that Monte Carlo code used in this study could be applied to other sources utilized for brachytherapy.

• Radiation Oncology Journal
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• v.20 no.1
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• pp.24-33
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• 2002

Purpose : In order to improve dose homogeneity and to reduce acute toxicity in tangential whole breast radiotherapy, we evaluated two treatment techniques using multiple static fields or universal compensators. Materials and Methods : 1) Multistatic field technique : Using a three dimensional radiation treatment planning system, Adac Pinnacle 4.0, we accomplished a conventional wedged tangential plan. Examining the isodose distributions, a third field which blocked overdose regions was designed and an opposing field was created by using an automatic function of RTPS. Weighting of the beams was tuned until an ideal dose distribution was obtained. Another pair of beams were added when the dose homogeneity was not satisfactory. 2) Universal compensator technique : The breast shapes and sizes were obtained from the CT images of 20 patients who received whole breast radiation therapy at our institution. The data obtained were averaged and a pair of universal physical compensators were designed for the averaged data. DII (Dose Inhomogeneity Index : percentage volume of PTV outside $95\~105\%$ of the prescribed dose) $D_{max}$ (the maximum point dose in the PTV) and isodose distributions for each technique were compared. Results : The multistatic field technique was found to be superior to the conventional technique, reducing the mean value of DII by $14.6\%$ (p value<0.000) and the $D_{max}$ by $4.7\%$ (p value<0.000). The universal compensator was not significantly superior to the conventional technique since it decreased $D_{max}$ by $0.3\%$ (p value=0.867) and reduced DII by $3.7\%$ (p value=0.260). However, it decreased the value of DII by maximum $18\%$ when patients' breast shapes fitted in with the compensator geometry. Conclusion : The multistatic field technique is effective for improving dose homogeneity for whole breast radiation therapy and is applicable to all patients, whereas the use of universal compensators is effective only in patients whose breast shapes fit inwith the universal compensator geometry, and thus has limited applicability.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.1-9
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• 2008

Purpose: For head and neck cancer patients treated with radiation therapy, proper immobilization of intra-oral structures is crucial in reproducing treatment positions and optimizing dose distribution. We produced a man-made tongue immobilization device for each patient subjected to this study. Reproducibility of treatment positions and dose distributions at air-and-tissue interface were compared using man-made tongue immobilization devices and conventional tongue-bites. Materials and Methods: Dental alginate and putty were used in producing man-made tongue immobilization devices. In order to evaluate reproducibility of treatment positions, all patients were CT-simulated, and linac-gram was repeated 5 times with each patient in the treatment position. An acrylic phantom was devised in order to evaluate safety of man-made tongue immobilization devices. Air, water, alginate and putty were placed in the phantom and dose distributions at air-and-tissue interface were calculated using Pinnacle (version 7.6c, Phillips, USA) and measured with EBT film. Two different field sizes (3$\times$3 cm and 5$\times$5 cm) were used for comparison. Results: Evaluation of linac grams showed reproducibility of a treatment position was 4 times more accurate with man-made tongue immobilization devices compared with conventional tongue bites. Patients felt more comfortable using customized tongue immobilization devices during radiation treatment. Air-and-tissue interface dose distributions calculated using Pinnacle were 7.78% and 0.56% for 3$\times$3 cm field and 5$\times$5 cm field respectively. Dose distributions measured with EBT (international specialty products, USA) film were 36.5% and 11.8% for 3$\times$3 cm field and 5$\times$5 cm field respectively. Values from EBT film were higher. Conclusion: Using man-made tongue immobilization devices made of dental alginate and putty in treatment of head and neck cancer patients showed higher reproducibility of treatment position compared with using conventional mouth pieces. Man-made immobilization devices can help optimizing air-and-tissue interface dose distributions and compensating limited accuracy of radiotherapy planning systems in calculating air-tissue interface dose distributions.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.1
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• pp.13-19
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• 2006

Purpose: To evaluate whether modified MUPIT applicator can effectively eradicate recurrent tumor in uterine cervix cancer and reduce rectal complication after complete radiation treatment. Materials and Methods: Modified MUPIT applicator basically consists of an acrylic cylinder with flexible brain applicator, an acrylic template with a predrilled array of holes that serve as guides for interstitial needles and interstitial needles. CT scan was peformed to determine tumor volume and the position of interstitial needles. Modified MUPIT applicator was applied to patient in operation room and the accuracy for position of interstitial needles in tumor volume was confirmed by CTscan. Brachytherapy was delivered using modified MUPIT applicator and RALS(192-lr HDR) after calculated computer planning by orthogonal film. The daily dose was 600cGy and the total dose was delivered 3,000 cGy in tumor volume by BID. Rectal dose was measured by TLD at 5 points so that evaluated the risk of rectal complication. Results: The application of modified MUPIT applicator improved dramatically dose distributions in tumor volume and follow-up of 3 month for this patient was clinically partial response without normal tissue complication, Rectal dose was measured 34.1 cGy, 57.1 cGy, 103.8 cGy, 162.7 cGy, 165.7 cGy at each points, especially the rectal dose including previous EBRT and ICR was 34.1 cGy, 57.1 cGy. Conclusion: Patients with locally recurrent tumor in uterine cervix cancel treated with modified MUPIT applicator can expect reasonable rates of local control. The advantages of the system are the fixed geometry provided by the template and cylinders. and improved dose distributions in irregular tumor volume without rectal complication.