• Progress in Medical Physics
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• v.25 no.2
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• pp.100-109
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• 2014

In stereotactic body radiotherapy (SBRT), the accurate location of treatment sites should be guaranteed from the respiratory motions of patients. Lots of studies on this topic have been conducted. In this letter, a new verification method simulating the real respiratory motion of heterogenous treatment regions was proposed to investigate the accuracy of lung SBRT for Volumetric Modulated Arc Therapy. Based on the CT images of lung cancer patients, lung phantoms were fabricated to equip in $QUASAR^{TM}$ respiratory moving phantom using 3D printer. The phantom was bisected in order to measure 2D dose distributions by the insertion of EBT3 film. To ensure the dose calculation accuracy in heterogeneous condition, The homogeneous plastic phantom were also utilized. Two dose algorithms; Analytical Anisotropic Algorithm (AAA) and AcurosXB (AXB) were applied in plan dose calculation processes. In order to evaluate the accuracy of treatments under respiratory motion, we analyzed the gamma index between the plan dose and film dose measured under various moving conditions; static and moving target with or without gating. The CT number of GTV region was 78 HU for real patient and 92 HU for the homemade lung phantom. The gamma pass rates with 3%/3 mm criteria between the plan dose calculated by AAA algorithm and the film doses measured in heterogeneous lung phantom under gated and no gated beam delivery with respiratory motion were 88% and 78%. In static case, 95% of gamma pass rate was presented. In the all cases of homogeneous phantom, the gamma pass rates were more than 99%. Applied AcurosXB algorithm, for heterogeneous phantom, more than 98% and for homogeneous phantom, more than 99% of gamma pass rates were achieved. Since the respiratory amplitude was relatively small and the breath pattern had the longer exhale phase than inhale, the gamma pass rates in 3%/3 mm criteria didn't make any significant difference for various motion conditions. In this study, the new phantom model of 4D dose distribution verification using patient-specific lung phantoms moving in real breathing patterns was successfully implemented. It was also evaluated that the model provides the capability to verify dose distributions delivered in the more realistic condition and also the accuracy of dose calculation.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.217-224
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• 2014

Purpose : Conventional, IMRT, at CSI treatment with VMAT, this study compare the treatment plan with dose changes measured at Junction field according to the error of Setup. Materials and Methods : This study established Conventional, the IMRT, VMAT treatment planning for CSI therapy using the Eclipse 10.0 (Eclipse10.0, Varian, USA) and chose person in Seoul National University Hospital. Verification plan was also created to apply IMRT QA phantom for each treatment plan to the film measurements. At this time, the error of Setup was applied to the 2, 4, 6mm respectively with the head and foot direction. ("+" direction of the head, "-" means that the foot direction.) Using IMRT QA Phantom and EBT2 film, was investigated by placing the error of Setup for each Junction. We check the consistency of the measured Film and plan dose distribution by gamma index (Gamma index, ${\gamma}$). In addition, we compared the error of Setup by the dose distribution, and analyzing the uniformity of the dose distribution within the target by calculating the Homogeneity Index (HI). Results : It was figured out that 90.49%-gamma index we obtained with film is agreement with film scan score and dose distribution of treatment plan. Also, depend on the dose distribution on distance, if we make the error of Setup 2, 4, 6mm in the head direction, it showed that 3.1, 4.5, 8.1 at $^*Diff$(%) of Conventional, 1.1, 3.5, 6.3 at IMRT, and 1.6, 2.5, 5.7 at VMAT. In the same way, if we make the error of Setup 2, 4, 6mm in the foot direction, it showed that -1.6, -2.8, -4.4 at $^*Diff$(%) of Conventional, -0.9, -1.6, -2.9 at IMRT, and -0.5, -2.2, -2.5 at VMAT. Homogeneity Index(HI)s are 1.216 at Conventional, 1.095 at IMRT and 1.069 at VMAT. Discussion and Conclusion : The dose-change depend on the error of Setup at the CSI RT(radiation therapy) using IMRT and VMAT which have advantages, Dose homogeneity and the gradual dose gradients on the Junction part is lower than that of Conventional CSI RT. This a little change of dose means that there is less danger on patients despite of the error of Setup generated at the CSI RT.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.321-327
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• 2014

Purpose : To verify the accuracy of the Ecilpse's dose calculation algorithm(AAA:Analytic anisotropic algorithm) in case of a radiation treatment on Inhomogeneous tissues using FFF beam comparing dose distribution at TPS with actual distribution. Materials and Methods : After acquiring CT images for radiation treatment by the location of tumors and sizes using the solid water phantoms, cork and chest tumor phantom made of paraffin, we established the treatment plan for 6MV photon therapy using our radiation treatment planning system for chest SABR, Ecilpse's AAA(Analytic anisotropic algorithm). According to the completed plan, using our TrueBeam STx(Varian medical system, Palo Alto, CA), we irradiated radiation on the chest tumor phantom on which EBT2 films are inserted and evaluated the dose value of the treatment plan and that of the actual phantom on Inhomogeneous tissue. Results : The difference of the dose value between TPS and measurement at the medial target is 1.28~2.7%, and, at the side of target including inhomogeneous tissues, the difference is 2.02%~7.40% at Ant, 4.46%~14.84% at Post, 0.98%~7.12% at Rt, 1.36%~4.08% at Lt, 2.38%~4.98% at Sup, and 0.94%~3.54% at Inf. Conclusion : In this study, we discovered the possibility of dose calculation's errors caused by FFF beam's characteristics and the inhomogeneous tissues when we do SBRT for inhomogeneous tissues. SBRT which is most popular therapy method needs high accuracy because it irradiates high dose radiation in small fraction. So, it is supposed that ideal treatment is possible if we minimize the errors when planning for treatment through more study about organ's characteristics like Inhomogeneous tissues and FFF beam's characteristics.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.137-143
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• 2013

Purpose: We are to find out the difference of calculated dose of treatment planning system (TPS) and measured dose in case of inhomogeneous organ structure. Materials and Methods: Inhomogeneous phantom is made with solid water phantom and cork plate. CT image of inhomogeneous phantom is acquired. Treatment plan is made with TPS (Pinnacle3 9.2. Royal Philips Electronics, Netherlands) and calculated dose of point of interest is acquired. Treatment plan was delivered in the inhomogeneous phantom by ARTISTE (Siemens AG, Germany) measured dose of each point of interest is obtained with Gafchromic EBT2 film (International Specialty Products, US) in the gap between solid water phantom or cork plate. To simulate lung cancer radiation treatment, artificial tumor target of paraffin is inserted in the cork volume of inhomogeneous phantom. Calculated dose and measured dose are acquired as above. Results: In case of inhomogeneous phantom experiment, dose difference of calculated dose and measured dose is about -8.5% at solid water phantom-cork gap and about -7% lower in measured dose at cork-solid water phantom gap. In case of inhomogeneous phantom inserted paraffin target experiment, dose difference is about 5% lower in measured dose at cork-paraffin gap. There is no significant difference at same material gap in both experiments. Conclusion: Radiation dose at the gap between two organs with different electron density is significantly lower than calculated dose with TPS. Therefore, we must be aware of dose calculation error in TPS and great care is suggested in case of radiation treatment planning on inhomogeneous organ structure.

• Progress in Medical Physics
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• v.27 no.1
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• pp.31-36
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• 2016

The paper discusses radiation dose of dual energy CT on which copper modulation layer, is mounted in order to improve diagnostic performance of the dual energy CT. The radiation dose is estimated using MCNPX and its results are compared with that of the conventional dual energy CT system. CT X-ray spectra of 80 and 120 kVp, which are usually used for thorax, abdominal, head, and neck CT scans, were generated by the SPEC78 code and were used for the source specification 'SDEF' card for MCNPX dose modeling. The copper modulation layer was located 20 cm away from a source covering half of the X-ray window. The radiation dose was measured as changing its thickness from 0.5 to 2.0 mm at intervals of 0.5 mm. Since the MCNPX tally provides only normalized values to a single particle, the dose conversion coefficients of F6 tally for the modulation layer-based dual energy CBCT should be calculated for matching the modeling results into the actual dose. The dose conversion coefficient is $7.2*10^4cGy/output$ that is obtained from dose calibration curve between F6 tally and experimental results in which GAFCHORMIC EBT3 films were exposed by an already known source. Consequently, the dose of the modulation layer-based dual energy cone beam CT is 33~40% less than that of the single energy CT system. On the basis of the results, it is considered that scattered dose produced by the copper modulation layer is very small. It shows that the modulation layer-based dual energy CBCT system can effectively reduce radiation dose, which is the major disadvantage of established dual energy CT.

• Progress in Medical Physics
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• v.20 no.4
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• pp.260-268
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• 2009

In this study, we estimated inhomogeneity correction factor in small field. And, we evaluated accuracy of treatment planning and measurement data which applied inhomogeneity correction factor or not. We developed the Inhomogeneity Correction Phantom (ICP) for insertion of inhomogeneity materials. The inhomogeneity materials were 12 types in each different electron density. This phantom is able to adapt the EBT film and 0.125 cc ion chamber for measurement of dose distribution and point dose. We evaluated comparison of planning and measurement data using ICP. When we applied to inhomogeneity correction factor or not, the average difference was 1.63% and 10.05% in each plan and film measurement data. And, the average difference of dose distribution was 10.09% in each measurement film. And the average difference of point dose was 0.43% and 2.09% in each plan and measurement data. In conclusion, if we did not apply the inhomogeneity correction factor in small field, it shows more great difference in measurement data. The planning system using this study shows good result for correction of inhomogeneity materials. In radiosurgery using small field, we should be correct the inhomogeneity correction factor, more exactly.

• Progress in Medical Physics
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• v.20 no.4
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• pp.324-330
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• 2009

In this study, we evaluated accuracy and usefulness of CyberKnife Respiratory Tracking System ($Synchrony^{TM}$, Accuray, USA) about a moving during stereotactic radiosurgery. For this study, we used moving phantom that can move the target. We also used Respiratory Tracking System called Synchrony of the Cyberknife in order to track the moving target. For treatment planning of the moving target, we obtained an image using 4D-CT. To measure dose distribution and point dose at the moving target, ion chamber (0.62 cc) and gafchromic EBT film were used. We compared dose distribution (80% isodose line of prescription dose) of static target to that of moving target in order to evaluate the accuracy of Respiratory Tracking System. We also measured the point dose at the target. The mean difference of synchronization for TLS (target localization system) and Synchrony were $11.5{\pm}3.09\;mm$ for desynchronization and $0.14{\pm}0.08\;mm$ for synchronization. The mean difference between static target plan and moving target plan using 4D CT images was $0.18{\pm}0.06\;mm$. And, the accuracy of Respiratory Tracking System was less 1 mm. Estimation of usefulness in Respiratory Tracking System was $17.39{\pm}0.14\;mm$ for inactivity and $1.37{\pm}0.11\;mm$ for activity. The mean difference of absolute dose was $0.68{\pm}0.38%$ in static target and $1.31{\pm}0.81%$ in moving target. As a conclusion, when we treat about the moving target, we consider that it is important to use 4D-CT and the Respiratory Tracking System. In this study, we confirmed the accuracy and usefulness of Respiratory Tracking System in the Cyberknife.

• Progress in Medical Physics
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• v.21 no.3
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• pp.253-260
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• 2010

Most brachytherapy treatment planning systems employ a dosimetry formalism based on the AAPM TG-43 report which does not appropriately consider tissue heterogeneity. In this study we aimed to set up a simple Monte Carlo-based intracavitary high-dose-rate brachytherapy (IC-HDRB) plan verification platform, focusing particularly on the robustness of the direct Monte Carlo dose calculation using material and density information derived from CT images. CT images of slab phantoms and a uterine cervical cancer patient were used for brachytherapy plans based on the Plato (Nucletron, Netherlands) brachytherapy planning system. Monte Carlo simulations were implemented using the parameters from the Plato system and compared with the EBT film dosimetry and conventional dose computations. EGSnrc based DOSXYZnrc code was used for Monte Carlo simulations. Each $^{192}Ir$ source of the afterloader was approximately modeled as a parallel-piped shape inside the converted CT data set whose voxel size was $2{\times}2{\times}2\;mm^3$. Bracytherapy dose calculations based on the TG-43 showed good agreement with the Monte Carlo results in a homogeneous media whose density was close to water, but there were significant errors in high-density materials. For a patient case, A and B point dose differences were less than 3%, while the mean dose discrepancy was as much as 5%. Conventional dose computation methods might underdose the targets by not accounting for the effects of high-density materials. The proposed platform was shown to be feasible and to have good dose calculation accuracy. One should be careful when confirming the plan using a conventional brachytherapy dose computation method, and moreover, an independent dose verification system as developed in this study might be helpful.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.1
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• pp.13-19
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• 2011

Purpose: It's essential to minimize the tumor motion and identify the exact location of the lesions to achieve the improvement in radiation therapy efficiency during SBRT. In this study, we made the established compression belt to reduce respiratory motion and evaluated the usefulness of clinical application in SBRT. Materials and Methods: We analyzed the merits and demerits of the established compression belt to reduce the respiratory motion and improved the reproducibility and precision in use. To evaluate the usefulness of improved compression belt for respiratory motion reduction in SBRT, firstly, we reviewed the spiral CT images acquired in inspiration and expiration states of 8 lung cancer cases, respectively, and analyzed the three dimensional tumor motion related to respiration. To evaluate isodose distribution, secondly, we also made the special phantom using EBT2 film (Gafchronic, ISP, USA) and we prepared the robot (Cartesian Robot-2 Axis, FARARCM4H, Samsung Mechatronics, Korea) to reproduce three dimensional tumor motion. And analysis was made for isodose curves and two dimensional isodose profiles with reproducibility of respiratory motion on the basis of CT images. Results: A respiratory motion reduction compression belt (Velcro type) that has convenient use and good reproducibility was developed. The moving differences of three dimensional tumor motion of lung cancer cases analyzed by CT images were mean 3.2 mm, 4.3 mm and 13 mm each in LR, AP and CC directions. The result of characteristic change in dose distribution using the phantom and rectangular coordinates robot showed that the distortion of isodose has great differences, mean length was 4.2 mm; the differences were 8.0% and 16.8% each for cranio-caudal and 8.1% and 10.9% each for left-right directions in underdose below the prescribed dose. Conclusion: In this study, we could develop the convenient and efficient compression belt that can make the organs' motion minimize. With this compression belt, we confirmed that underdose due to respiration can be coped with when CTV-PTV margins of mean 6 mm would be used. And we conclude that the respiratory motion reduction compression belt we developed can be used for clinical effective aids along with the gating system.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.13-24
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• 2019

Purpose: CT scan range is insufficient for various reasons in head and neck Tomotherapy^®. To solve that problem, Re-CT simulation is good because CT scan range affects accurate dose calculations, but there are problems such as increased exposure dose, inconvenience, and a change in treatment schedule. We would like to evaluate the minimum CT scan range required by changing the plan setup parameter of the existing CT scan range. Materials and methods: CT Simulator(Discovery CT590 RT, GE, USA) and In House Head & Neck Phantom are used, CT image was acquired by increasing the image range from 0.25cm to 3.0cm at the end of the target. The target and normal organs were registered in the Head & Neck Phantom and the treatment plan was designed using ACCURAY Precision^®. Prescription doses are Daily 2.2Gy, 27 Fxs, Total Dose 59.4Gy. Target is designed to 95%~107% of prescription dose and normal organ dose is designed according to SMC Protocol. Under the same treatment plan conditions, Treatment plans were designed by using five methods(Fixed-1cm, Fixed-2.5cm, Fixed-5cm, Dynamic-2.5cm Dynamic-5cm) and two pitches(0.43, 0.287). The accuracy of dose delivery for each treatment plan was analyzed by using EBT3 film and RIT(Complete Version 6.7, RIT, USA). Results: The accurate treatment plan that satisfying the prescribed dose of Target and the tolerance dose in normal organs(SMC Protocol) require scan range of at least 0.25cm for Fixed-1cm, 0.75cm for Fixed-2.5cm, 1cm for Dynamic-2.5cm, and 1.75cm for Fixed-5cm and Dynamic-5cm. As a result of AnalysisAnalysis by RIT. The accuracy of dose delivery was less than 3% error in the treatment plan that satisfied the SMC Protocol. Conclusion: In case of insufficient CT scan range in head and neck Tomotherapy^®, It was possible to make an accurate treatment plan by adjusting the FW among the setup parameter. If the parameter recommended by this author is applied according to CT scan range and is decide whether to re-CT or not, the efficiency of the task and the exposure dose of the patient are reduced.