• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.73-81
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• 2018

Purpose : The aims of this study were to compare and assess the effectiveness of Volumetric Modulated Arc Therapy(VMAT) using jaw tracking(JT) and fixed jaw(FJ) in radiation therapy of multiple brain metastasis. Methode and material : Among the patients with Multiple Brain Metastasis treated with jaw tracking, 10 patients with more than 6 tumors and with the size of radiation field $14{\times}14cm^2$ or more were included. Each Treatment plans with jaw tracking(JT) and fixed jaw(FJ) was established with Eclipse (Ver. 13.6 Varian, USA). Gamma Index (3 mm, 3 % confidence interval - 95 %) and maximum dose difference were measured with an electronic portal imaging device(EPID). The $D_{max}$ and $D_{mean}$ of Organ At Risk(OAR) were assessed and compared, and the Conformity Index(CI) and Homogeneity Index(HI) were evaluated. Result : Evaluating jaw tracking(JT) and fixed jaw(FJ) outcomes, in all cases, Gamma Index met the permissible standard of 3 mm, 3 % confidence intervals of 95 %. The maximum dose difference value from the areas with leaf end transmission was measured at a maximum of 98.4 % and an average of 43.6 % in clockwise(CW), and 67.9 % and 41.0 % for each in Counter-Clockwise(CCW). With jaw tracking, the maximum value of $D_{max}$ for each normal organ in OAR decreased in 15.36 %~74.59 % with the average value decreasing in 2.84 %~39.80 %. The maximum value of $D_{mean}$ in OAR decreased in 27.90 %~65.23 %, with the average value decreasing in 7.70 %~41.71 %. No change has been found in Conformity Index and Homogeneity Index values. Conclusion : When Jaw tracking is used in treating patients with multiple brain metastasis with VMAT, the unnecessary exposure due to leakage and transmission of radiation in unspecified areas was reduced, without affecting the dose distribution of the planning target volume(PTV), and the availability of radiation therapy with lower doses in normal organs is expected.

• Journal of the Korean Society of Radiology
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• v.3 no.3
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• pp.5-11
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• 2009

When using Image Guided Radiation Therapy, the patient is placed using skin marker first and after confirming anatomical location using OBI, the couch is moved to correct the set up. Evaluation for the error made at that moment was done. Through comparing $0^{\circ}$ and $270^{\circ}$ direction DRR image and OBI image with 2D-2D matching when therapy planning, comparison between patient's therapy plan setup and actual treatment setup was made to observe the error. Treatment confirmation on important organs such as head, neck and spinal cord was done every time through OBI setup and other organs such as chest, abdomen and pelvis was done 2 ~ 3 times a week. But corrections were all recorded on OIS so that evaluation on accuracy could be made through using skin index which was divided into head, neck, chest and abdomen-pelvis on 160 patients. Average setup error for head and neck patient on each AP, SI, RL direction was $0.2{\pm}0.2cm$, $-0.1{\pm}0.1cm$, $-0.2{\pm}0.0cm$, chest patient was $-0.5{\pm}0.1cm$, $0.3{\pm}0.3cm$, $0.4{\pm}0.2cm$, and abdomen was $0.4{\pm}0.4cm$, $-0.5{\pm}0.1cm$, $-0.4{\pm}0.1cm$. In case of pelvis, it was $0.5{\pm}0.3cm$, $0.8{\pm}0.4cm$, $-0.3{\pm}0.2cm$. In rigid body parts such as head and neck showed lesser setup error compared to chest and abdomen. Error was greater on chest in horizontal axis and in AP direction, abdomen-pelvis showed greater error. Error was greater on chest in horizontal axis because of the curve in patient's body when the setup is made. Error was greater on abdomen in AP direction because of the change in front and back location due to breathing of patient. There was no systematic error on patient setup system. Since OBI confirms the anatomical location, when focus is located on the skin, it is more precise to use skin marker to setup. When compared with 3D-3D conformation, although 2D-2D conformation can't find out the rolling error, it has lesser radiation exposure and shorter setup confirmation time. Therefore, on actual clinic, 2D-2D conformation is more appropriate.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.1
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• pp.57-67
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• 2013

Purpose: Replacing the film which used to be used for checking the set-up of the patient and dosimetry during radiation therapy, more and more EPID equipped devices are in use at present. Accordingly, this article tried to evaluated the accuracy of the position check-up and the usefulness of dosimetry during the use of an electronic portal imaging device. Materials and Methods: On 50 materials acquired with the search of Korea Society Radiotherapeutic Technology, The Korean Society for Radiation Oncology, and Pubmed using "EPID", "Portal dosimetry", "Portal image", "Dose verification", "Quality control", "Cine mode", "Quality - assurance", and "In vivo dosimetry" as indexes, the usefulness of EPID was analyzed by classifying them as history of EPID and dosimetry, set-up verification and characteristics of EPID. Results: EPID is developed from the first generation of Liquid-filled ionization chamber, through the second generation of Camera-based fluoroscopy, and to the third generation of Amorphous-silicon EPID imaging modes can be divided into EPID mode, Cine mode and Integrated mode. When evaluating absolute dose accuracy of films and EPID, it was found that EPID showed within 1% and EDR2 film showed within 3% errors. It was confirmed that EPID is better in error measurement accuracy than film. When gamma analyzing the dose distribution of the base exposure plane which was calculated from therapy planning system, and planes calculated by EDR2 film and EPID, both film and EPID showed less than 2% of pixels which exceeded 1 at gamma values (r%>1) with in the thresholds such as 3%/3 mm and 2%/2 mm respectively. For the time needed for full course QA in IMRT to compare loads, EDR2 film recorded approximately 110 minutes, and EPID recorded approximately 55 minutes. Conclusion: EPID could easily replace conventional complicated and troublesome film and ionization chamber which used to be used for dosimetry and set-up verification, and it was proved to be very efficient and accurate dosimetry device in quality assurance of IMRT (intensity modulated radiation therapy). As cine mode imaging using EPID allows locating tumors in real-time without additional dose in lung and liver which are mobile according to movements of diaphragm and in rectal cancer patients who have unstable position, it may help to implement the most optimal radiotherapy for patients.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.1
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• pp.1-5
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• 2007

Purpose: The accuracy and advantages of OBI(On Board Imager) against the conventional method like film and EPID for the setup error correction were evaluated with the analysis of the accumulated data which were produced in the process of setup error correction using OBI. Materials and Methods: The results of setup error correction using OBI system were analyzed for the 130 patients who had been planned for 3 dimensional conformal radiation therapy during March 2006 and May 2006. Two kilo voltage images acquired in the orthogonal direction were fused and compared with reference setup images. The setup errors in the direction of vertical, lateral, longitudinal axis were recorded and calculated the distance from the isocenter. The corrected setup error were analyzed according to the lesion and the degree of shift variations. Results: There was no setup error in the 41.5% of total analyzed patients and setup errors between 1mm and 5mm were found in the 52.3%. 6.1% patients showed the more than 5mm shift and this error were verified as a difference of setup position and the movement of patient in a treatment room. Conclusion: The setup error analysis using OBI in this study verified that the conventional setup process in accordance with the laser and field light was not enough to get rid of the setup error. The KV images acquired using OBI provided good image quality for comparing with simulation images and much lower patients' exposure dose compared with conventional method of using EPID. These advantages of OBI system which were confirmed in this study proved the accuracy and priority of OBI system in the process of IGRT(Image Guided Radiation Therapy).

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.2
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• pp.105-112
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• 2006

Purpose: To demonstrate that water bolus in the patient surface can decrease the dose inhomogeneity by patient surface large tissue defect when the surface is in an electron-beam field. And We tried to find a easy way to water control. Methods and Materials: To demonstrate the use of water bolus in the irregular surface clinically, the case of a patient with myxofibrosarcoma of the chest wall who was treated with electrons. We obtained dose distribution using missing tissue option of PINACLE 6.2b (ADAC, USA). We fabricate a Mev-green for water bolus in patient with defect of tissue. Then put the water bolus which is vinyl packed water into the designed Mev-green. We peformed CT scan with CT-simulator. Three-dimensional (3D) dose distributions with and without water bolus in the large irregular chest wall were calculated for a representative patient. Resulting dose distributions and dose-volume histograms of water bolus were compared with missing tissue option and non bolus plans. We fabricate a new water control device. Results: Controlled Water bolus markedly decrease the dose heterogeneity, and minimizes normal tissue exposure caused by the surface irregularities of the chest wall mass. In the test case, The non bolus plan has a maximum target dose of 132%. After applying water bolus, the maximum target dose has been reduced substantially to 110.4%. The maximum target dose was reduced by 21.6% using this technique. Conclusion: The results showed that controlled water bolus could significantly improve the dose homogeneity in the PTV for patients treated with electron therapy using water control device. This technique may reduce the incidence of normal organ complications that occur after electron-beam therapy in irregular surface. And our new device shows handiness of water control.

• The Journal of Korean Society for Radiation Therapy
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• v.30 no.1_2
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• pp.153-160
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• 2018

Purpose : We retrospectively analyzed doses of each radiation therapy technique used in the treatment for left breast cancer patients after partial mastectomy through dose results for normalorgans and tumor volume to use this as a clinical reference for radiation therapy of domestic left breast cancer patients. Materials and Methods : 40 patients who underwent partial mastectomy on left breast cancer were classified in 3 treatment methods. The treatment plan was evaluated by HI(homogeneity index), $D_{95%}$, and CI(conformity index), and the $V_{hot}$ for gross tumor volume and clinical target volume of each treatment method. In Cyberknife treatment, tumor volume was the same as high dose volume in the other techniques, so no consideration was given to clinical target volume. Treatment plan evaluation for normal organs were evaluated by mean dose on ipsilateral lung, heart, left anterior descending artery, opposite breast and lung, and non-target tissue. Result : Treatment with volumetric arc radiotherapy(VMAT) showed $95.84{\pm}0.75%$ of $D_{95%}$ on the clinical target volume, significantly higher than that of 3D-CRT. The $D_{95%}$ value of the total tumor volume was slightly higher than the other treatments. In Cyberknife treatment, the dose to the normal organs was significantly lower than other treatments. Overall, the maximum dose and mean dose to the heart were $26.2{\pm}6.12Gy$ and $1.88{\pm}0.2Gy$ in VMAT treatment and $20.25{\pm}9.35Gy$ and $1.04{\pm}0.19Gy$ in 3D-CRT therapy, respectively. Conclusion : In comparison on 3D-CRT and VMAT, most of the dosimetric parameters for the evaluation of the treatment plan showed similar values, so that there is no significant difference in treatment plan evaluation. It is possible to select the treatment method according to the patient's anatomical structure or possibility of breath control. Cyberknife treatment is very useful treatment for normal organs because of its accurate dose exposure to the tumor volume However, it has restrictions to treat the local area, to have relatively long treatment time and to involve invasive procedure.

• Progress in Medical Physics
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• v.24 no.4
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• pp.278-283
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• 2013

Breast cancer is the leading cause of cancer death in women worldwide and the number of women breast cancer patient was increased continuously. Most of breast cancer patient has suffered from unnecessary radiation exposure to heart, lung. Low radiation dose to the heart could lead to the worsening of preexisting cardiovascular lesions caused by radiation induced pneumonitis. Also, several statistical reports demonstrated that left-sided breast cancer patient showed higher mortality than right-sided breast cancer patient because of heart disease. In radiation therapy, Deep Inspiration Breath Hold (DIBH) technique which the patient takes a deep inspiration and holds during treatment and could move the heart away from the chest wall and lung, has showed to lead to reduction in cardiac volume and to minimize the unnecessary radiation exposure to heart during treatment. In this study, we investigated the displacement of heart using DIBH CT data compared to free-breathing (FB) CT data and radiation exposure to heart. Treatment planning was performed on the computed tomography (CT) datasets of 10 patients who had received lumpectomy treatments. Heart, lung and both breasts were outlined. The prescribed dose was 50 Gy divided into 28 fractions. The dose distributions in all the plans were required to fulfill the International Commission on Radiation Units and Measurement specifications that include 100% coverage of the CTV with ${\geq}95%$ of the prescribed dose and that the volume inside the CTV receiving >107% of the prescribed dose should be minimized. Scar boost irradiation was not performed in this study. Displacement of heart was measured by calculating the distance between center of heart and left breast. For the evaluation of radiation dose to heart, minimum, maximum and mean dose to heart were calculated. The present study demonstrates that cardiac dose during left-sided breast radiotherapy can be reduced by applying DIBH breathing control technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.5
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• pp.396-405
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• 2010

Purpose: This study was performed to find out the effects of the Er:YAG laser (Key Laser) & Er,Cr:YSGG laser (Water Laser) on inflammatory tissues. Materials and Methods: It was performed on about 20 g, 6 weeks male ICR mouses. They were grouped into the control (negative), the inflammation induced 'control'(positive), Er,Cr:YSGG laser exposured group after inducing inflammation, Er:YAG lasere exposured group after inducing inflammation each 15 mouses. The mouses were applicated 0.5% DNFB 1 cc on ear skin twice a day for 4 days until symptom expression. After laser exposure, ear tissues were extracted and defined gene expression by RT-PCR. Then, tissue staining, lymphocytes observation, electromicroscophic laboratory were carried out. Results: Interleukin-$1{\beta}$ was expressed much less in the A-laser exposed group. Interleukin-$1{\beta}$ & Tumor Necrosis Factor-${\alpha}$ were expressed 7 times lesser in the A-laser exposed group. The number of Lymphocytes related to inflammation was decreased rapidly in the A-laser exposed group in vivo. he number of cavity recovered normal was a little bigger in the A-laser exposed group after 5 days Conclusion: The expression of IL-$1{\beta}$ & TNF-${\alpha}$, hitologic change, observation with electron microscope shows that Erbium laser exposure causes lesser inflammation with A-laser rather than B-laser.

• Radiation Oncology Journal
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• v.12 no.2
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• pp.243-252
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• 1994

The use of high dose rate remote afterloading system for the treatment of intraluminal lesions necessitates the need for a more accurate of dose distributions around the high intensity brachytherapy sources, doses are often prescribed to a distance of few centimeters from the linear source, and in this range the dose distribution is very difficult to assess. Accurated and optimized dose calculation with stable numerical algorithms by PC level computer was required to treatment intraluminal lesions by high dose rate brachytherapy system. The exposure rate from sources was calculated with Sievert integral and dose rate in tissue was calculated with Meisberger equation, An algorithm for generating a treatment plan with optimized dose distribution was developed for high dose rate intraluminal radiotherapy. The treatment volume becomes the locus of the constrained target surface points that is the specified radial distance from the source dwelling positions. The treatment target volume may be alternately outlined on an x-ray film of the implant dummy sources. The routine used a linear programming formulism to compute which dwell time at each position to irradiate the constrained dose rate at the target surface points while minimizing the total volume integrated dose to the patient. The exposure rate and the dose distribution to be confirmed the result of calculation with algorithm were measured with film dosimetry, TLD and small size ion chambers.

• Tuberculosis and Respiratory Diseases
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• v.71 no.5
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• pp.368-372
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• 2011

Acute fibrinous and organizing pneumonia is a newly recognized pattern of acute lung injury. A 49-year-old female presented with a cough and worsening dyspnea on exertion. She had no history of smoking and no specific past medical history except exposure of home humidifier containing sterilizer. A chest computed tomography scan showed patchy consolidation with fibrosis in the right lower lobe and ill-defined centrilobular ground glass opacity in both lungs. The pathological findings were patchy areas of lung parenchyma with fibrin deposits in the alveolar ducts and alveoli, and fibrin balls with hemosiderin deposition in the alveolar spaces. The histological pattern of our case is differentiated from diffuse alveolar damage by the absence of hyaline membranes, and from eosinophilic pneumonia by the lack of eosinophils. In our case, the patient was treated with corticosteroid pulse therapy. However, the clinical course became aggravated and she died within two weeks.