• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.191-199
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• 2018

Purpose : In this study, we evaluated the usefulness of colloid gel(slime) as a compensator for irregular patient surfaces in radiation therapy. Materials and Methods : For this study, colloid gel suitable for treatment was made and four experiments were conducted to evaluate the applicability of radiation therapy. Trilogy(Varian) and CT(SOMATOM, Siemens) were used as treatment equipment and CT equipment. First, the homogeneity according to the composition of colloid gel was measured using EBT3 Film(RIT). Second, the Hounsfield Unit(HU) value of colloid gel was measured and confirmed by CRIS phantom, Eclipse RTP(Eclipse 13.1, Varian) and CT. Third, to measure the deformation and degeneration of colloid gel during the treatment period, it was measured 3 times daily for 2 weeks using an ion chamber(PTW-30013, PTW). The fourth experiment was compared the treatment plan and measured dose distributions using bolus, rice, colloid gel and additional, dose profiles in an environment similar to actual treatment using our own acrylic phantom. Result : First experiment, density of the colloid gel cases 1, 2 and 3 was $1.02g/cm^3$, $0.99g/cm^3$ and $0.96g/cm^3$. When the homogeneity was measured at 6 MV and 9 MeV, case 1 was more homogeneous than the other cases, as 1.55 and 1.98. In the second experiment, the HU values of case 1, 2, 3 were 15 and when the treatment plan was compared with the measured doses, the difference was within 1 % at all 9, 12 MeV and a difference of -1.53 % and -1.56 % within the whole 2 % at 6 MV. In the third experiment, the dose change of colloid gel was measured to be about 1 % for 2 weeks. In the fourth experiment, the dose difference between the treatment plan and EBT3 film was similar for both colloid gel and bolus, rice at 6 MV. But colloid gel showed less dose difference than bolus and rice at 9 MeV. Also, dose profile of colloid gel showed a more uniform dose distribution than the bolus and rice. Conclusion : In this study, the density of colloid gel prepared for radiation therapy was $1.02g/cm^3$ similar to the density of water, and alteration or deformation was not observed during the radiotherapy process. Although we pay attention to the density when manufacturing colloid gel, it is sufficient in that it can deliver the dose uniformly through the compensation of the patient's body surface more than the bolus and rice, and can be manufactured at low cost. Further studies and studies for clinical applications are expected to be applicable to radiation therapy.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.273-280
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• 2014

Purpose : To verify the skin dose in Tomotherapy-based radiation treatment according to the change in tumor locations, skin dose was measured by using Gafchromic EBT3 film and compared with the planned doses to find out the gap between them. Materials and Methods : In this study, to measure the skin dose, I'm RT Phantom(IBA Dosimetry, Germany) was utilized. After obtaining the 2.5mm CT images, tumor locations and skin dose measuring points were set by using Pinnacle(ver 9.2, Philips Medical System, USA). The tumor location was decided to be 5mm and 10mm away from surface of the phantom and center. Considering the attenuation of a Tomo-couch, we ensured a symmetric placement between the ceiling and floor directions of the phantom. The measuring point of skin doses was set to have 3mm and 5mm thickness from the surface. Measurement was done 3 times. By employing TomoHD(TomoHD treatment system, Tomotherapy Inc., Madison, Wisconsin, USA), we devised Tomotherapy plans, measured 3 times by inserting Gafchromic EBT3 film into the phantom and compared the measurement with the skin dose treatment plans. Results : The skin doses in the upper part of the phantom, when the tumor was located in the center, were found to be 7.53 cGy and 7.25 cGy in 5mm and 3mm respectively. If placed 5mm away from the skin in the ceiling direction, doses were 18.06 cGy and 16.89 cGy; if 10mm away, 20.37 cGy and 18.27 cGy, respectively. The skin doses in the lower part of the phantom, when the tumor was located in the center, recorded 8.82 cGy and 8.29 cGy in 5mm and 3mm, each; if located 5mm away from the lower part skin, 21.69 cGy and 19.78 cGy were respectively recorded; and if 10mm away, 20.48 cGy and 19.57 cGy were recorded. If the tumor was placed in the center, skin doses were found to increase by 3.2~17.1% whereas if the tumor is 5mm away from the ceiling part, the figure decreased to 2.8~9.0%. To the Tomo-couch direction, skin doses showed an average increase of 11% or over, compared to the planned treatment. Conclusion : This study found gaps between planned skin doses and actual doses in the Tomotherapy treatment planning. Especially to the Tomo-cocuh direction, skin doses were found to be larger than the planned doses. Thus, during the treatment of tumors near the Tomo-couch, doses will need to be more accurately calculated and more efforts to verify skin doses will be required as well.

• Progress in Medical Physics
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• v.23 no.4
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• pp.234-238
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• 2012

A tumor on the eyelid is often treated using a high-energy electron beam, with a metallic eye shield inserted between the eyelid and the eyeball to preserve the patient's sight. Pretreatment quality assurance of the inner eyelid dose on the metallic shield requires a very small dosimetry tool. For enhanced accuracy, a flexible device fitting the curved interface between the eyelid and the shield is also required. The radiochromic film is the best candidate for this device. To measure the doses along the curved interface and small area, a 3-mm-wide strip of EBT2 film was inserted between the phantom eyelid and the shield. After irradiation with 6 MeV electron beams, the film was evaluated for the dose profile. An acrylic eye shield of the same size as the real eye shield was machined, and CT images free from metal artifacts were obtained. Monte Carlo simulation was performed on the CT images, taking into account eye shield material, such as tungsten, aluminum, and steel. The film-based interface dose distribution agreed with the MC calculation within 2.1%. In the small (millimeter scale) and curved region, radiochromic film dosimetry promises a satisfactory result with easy handling.

• Progress in Medical Physics
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• v.23 no.3
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• pp.138-144
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• 2012

Dose distribution throughout the clinical organ range of motion was analyzed using a respiratory-motion simulator that was equipped with a polymer gel dosimeter and EBT2 film. The normoxic polymer gel dosimeter was synthesized from gelatin, MAA, HQ, THPC and HPLC. The gel dosimeter and EBT2 film were irradiated with Co-60 gamma rays that were moved along the x-axis and y-axis in ${\pm}1.5cm$ steps at five-second intervals. The field size was $5{\times}5cm^2$. The SSD was 80 cm and set to 10 Gy at a depth of 2 cm. The PDD at a depth of 50 mm was 75.2% in the ion chamber, 82.3% in the static state and 86.1% in the dynamic state in the gel dosimeter. The penumbra for the dynamic state target, which was measured using the gel dosimeter, averaged 10.89 mm, this is a 40.5% increase over the penumbra of the static state target of 7.74 mm. In addition, when measuring with gel dosimetry, the value for the penumbra is 36.6% smaller in the static state and 29.4% smaller in the dynamic state compared to measuring with film. The aim of this study was to investigate the dosimetric properties of a normoxic polymethacrylic acid gel dosimeter in static and dynamic states and to evaluate the potentiality as a relative dosimeter for dynamic therapeutic radiation.

• Progress in Medical Physics
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• v.27 no.4
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• pp.189-195
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• 2016

This paper aims to verify the clinical feasibility of a custom-made film created by a laser cutting tool for End-to-End (E2E) quality assurance in robotic intensity modulated radiation therapy system. The custom-made film was fabricated from the Gafchromic EBT3 film with the size of $8^{{\prime}{\prime}}{\times}10^{{\prime}{\prime}}$ using a drawing that is identical to the shape and scale of the original E2E film. The drawing was created by using a computer aided design program with the image file, which is obtained by scanning original E2E film. Beam delivery and evaluations were respectively performed with the original film and the custom-made film using fixed-cone collimator on three tracking modes: 6D skull (6DS), Xsight spine (XS), and Xsight lung (XL). The differences between total targeting errors of the original and custom-made films were recorded as 0.17 mm, 0.3 mm, and 0.17 mm at 6DS, XS, and XL tracking modes, respectively. This indicates that the custom-made film could yield nearly equivalent results to those of the original E2E film, given the uncertainties caused by distortions during film scanning and vibrations associated with film cutting. By confirming the clinical feasibility of a custom-made film for E2E testing, it can be expected that economic efficiency of the testing will increase accordingly.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.77-81
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• 2014

Purpose : In the current whole brain Radiation Therapy, Optimold was used to immobilize the head. However, skin dose was increased about 22% due to the scattering radiation by the Optimold. Since the minimum dose causing cataracts was 2 Gy, it could be seen that the effects were large especially on the lens. Therefore, in the whole brain Radiation Therapy, it was to compare and to evaluate the lens absorbed dose according to the presence of Optimold in the eyeball part. Materials and Methods : In order to compare and to evaluate the lens absorbed dose according to the presence of Optimold in the eyeball part, the Optimold mask was made ??up to 5mm bolus on the part of the eye lens in the human model phantom (Anderson Rando Phantom, USA). In the practice treatment, to measure the lens dose, the simulation therapy was processed by placing the GafChromic EBT3 film under bolus, and after the treatment plan was set up through the treatment planning system (Pinnacle, PHILIPS, USA), the treatments were measured repeatedly three times in the same way. After removing the Optimold mask in the eyeball part, it was measured in the same way as above. After scanning the film and measuring the dose by using the Digital Flatbed Scanner (Expression 10000XL, EPSON, USA), the doses were compared and evaluated according to the presence of Optimold mask in the eyeball part. Results : When there was the Optimold mask in the eyeball part, it was measured at $10.2cGy{\pm}1.5$ in the simulation therapy, and at $24.8cGy{\pm}2.7$ in the treatment, and when the Optimold mask was removed in the eye part, it was measured at $12.9cGy{\pm}2.2$ in the simulation therapy, and at $17.6cGy{\pm}1.5$ in the treatment. Conclusion : In case of removing the Optimold mask in the eyeball part, the dose was increased approximately 3 cGy in the simulation therapy and was reduced approximately 7 cGy in the treatment in comparison to the case that the Optimold mask was not removed. During the whole treatment, since the lens absorbed dose was reduced about 27%, the chance to cause cataracts and side effects was considered to be reduced due to decrease of the absorbed dose to the eye lens which had the high sensitivity on the radiation.

• Progress in Medical Physics
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• v.31 no.4
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• pp.153-162
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• 2020

Purpose: We aim to evaluate the accuracy and effectiveness of an automatically converted radiation therapy plan between Radixact machines by comparing the original plan with the transferred plan. Methods: The study involved a total of 20 patients for each randomly selected treatment site who received radiation treatment with Radixact. We set up the cheese phantom (Gammex RMI, Middleton, WI, USA) with an Exradin A1SL ion chamber (Standard Imaging, Madison, WI, USA) and GAFCHROMIC EBT3 film (International Specialty Products, Wayne, NJ, USA) inserted. We used three methods to evaluate an automatically converted radiation therapy plan using the features of the Plan transfer. First, we evaluated and compared Planning target volume (PTV) coverage (homogeneity index, HI; conformity index, CI) and organs at risk (OAR) dose statistics. Second, we compared the absolute dose using an ion chamber. Lastly, we analyzed gamma passing rates using film. Results: Our results showed that the difference in PTV coverage was 1.72% in HI and 0.17% in CI, and majority of the difference in OAR was within 1% across all sites. The difference (%) in absolute dose values was averaging 0.74%. In addition, the gamma passing rate was 99.64% for 3%/3 mm and 97.08% for 2%/2 mm. Conclusions: The Plan transfer function can be reliably used in appropriate situations.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.225-232
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• 2014

Purpose : The purpose of this study was to evaluate the surface and superficial dose for patients requiring postmastectomy radiation therapy(PMRT) with different treatment techniques. Materials and Methods : Computed tomography images were acquired for the phantom(I'mRT, IBA) consisting of tissue equivalent material. Hypothetical chestwall and lung were outlined and modified. Five treatment techniques(Wedged Tangential; WT, 4-field IMRT, 7-field IMRT, TOMO DIRECT, TOMO HELICAL) were evaluated using only 6MV photon beam. GafChromic EBT3 film was used for dose measurements at the surface and superficial dose. Surface dose profiles around the phantom were obtained for each treatment technique. For superficial dose measurements, film were used inside the phantom and analyzed superficial region for depth from 1-6mm. Results : TOMO DIRECT showed the highest surface dose by 47~70% of prescribed dose, while 7-field IMRT showed the lowest by 35~46% of prescribed dose. For the WT, 4-field IMRT and 7-field IMRT, superficial dose were measured over 60%, 70%, and 80% for 1mm, 2mm, and 5mm depth, respectively. In case of TOMO DIRECT and TOMO HELICAL, over 75%, 80%, and 90% of prescribed dose was measured, respectively. Surface and superficial dose range were uniform in overall chestwall for the 7-field IMRT and TOMO HELICAL. In contrast, Because of the dose enhancement effect with oblique incidence, The dose was gradually increased toward the obliquely tangential angle for the WT and TOMO DIRECT. Conclusion : For PMRT, TOMO DIRECT and TOMO HELICAL deliver the higher surface and superficial doses than treatment techniques based linear accelerator. It showed adequate dose(over 75% of prescribed dose) at 1mm depth in skin region.

• 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.

• Progress in Medical Physics
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• v.30 no.4
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• pp.112-119
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• 2019

Purpose: The advantages of ocular proton therapy are that it spares the optic nerve and delivers the minimal dose to normal surrounding tissues. In this study, it developed a solid eye phantom that enabled us to perform quality assurance (QA) to verify the dose and beam range for passive single scattering proton therapy using a single phantom. For this purpose, a new solid eye phantom with a polymethyl-methacrylate (PMMA) wedge was developed using film dosimetry and an ionization chamber. Methods: The typical beam shape used for eye treatment is approximately 3 cm in diameter and the beam range is below 5 cm. Since proton therapy has a problem with beam range uncertainty due to differences in the stopping power of normal tissue, bone, air, etc, the beam range should be confirmed before treatment. A film can be placed on the slope of the phantom to evaluate the Spread-out Bragg Peak based on the water equivalent thickness value of PMMA on the film. In addition, an ionization chamber (Pin-point, PTW 31014) can be inserted into a hole in the phantom to measure the absolute dose. Results: The eye phantom was used for independent patient-specific QA. The differences in the output and beam range between the measurement and the planned treatment were less than 1.5% and 0.1 cm, respectively. Conclusions: An eye phantom was developed and the performance was successfully validated. The phantom can be employed to verify the output and beam range for ocular proton therapy.