• Proceedings of the Korean Society of Medical Physics Conference
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• 2006.08a
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• pp.70-70
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• 2006

• Proceedings of the Korea Contents Association Conference
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• 2013.05a
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• pp.205-206
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• 2013

자궁경부암 근접치료를 시행했던 환자 10명을 대상으로 동일한 처방에 대한 기하학적 특성이 다른 Ir-192선원을 치료계획시스템을 이용하여 선량평가를 비교 분석 해 보았다.

• Journal of radiological science and technology
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• v.40 no.2
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• pp.303-309
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• 2017

To evaluate the usefulness of 3-dimensional brachytherapy(BT) planning technique based on CT in cervical cancer. Patients with cervical cancer underwent 2-D BT treatment planning and then CT scan with HDR intracavitary applicators in place with same positions. Dose was prescribed to Point A with 5Gy per fraction on 2-D BT planning. For 3-D BT planning, and dose was prescribed to the High risk CTV for BT (HR CTV) with 5Gy. The 3-D BT planning goal was to cover at least 90% of the HR CTV with target 5Gy isodose surface while limiting the dose to $2cm^3$ of bladder to less than 7.5 Gy, and $2cm^3$ of rectum to less than 5Gy. In one patient of 10 patients, $D_{2cm3}$ of rectal dose was over 5Gy and 6patients at $D_{2cm3}$ of bladder dose on 2-D BT planning. There was a tendency to underestimate ICRU bladder dose than ICRU rectal dose. CT based 3-D BT planning for cervical cancer will enable evaluation of dose distributions for tumor and critical organs at risk. So, rectal and bladder morbidity as well as geographic miss will be reduced in case of the bulky disease or uterine malposition.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.15
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• pp.6115-6120
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• 2014

Background: To compare the KKU-model rectal tube (KKU-tube) and the conventional rectal tube (CRT) for checking rectal doses during high-dose-rate intracavitary brachytherapy (HDR-ICBT) of cervical cancer. Materials and Methods: Between February 2010 and January 2011, thirty -two patients with cervical cancer were enrolled and treated with external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). The KKU-tube and CRT were applied intrarectally in the same patients at alternate sessions as references for calculation of rectal doses during ICBT. The gold standard references of rectum anatomical markers which are most proximal to radiation sources were anterior rectal walls (ARW) adjacent to the uterine cervix demonstrated by barium sulfate suspension enema. The calculated rectal doses derived from actual anterior rectal walls, CRT and the anterior surfaces of the KKU-tubes were compared by using the paired t-test. The pain caused by insertion of each type of rectal tube was assessed by the visual analogue scale (VAS). Results: The mean dose of CRT was lower than the mean dose of ARW ($Dmean_0-Dmean_1$) by $80.55{\pm}47.33cGy$ (p-value <0.05). The mean dose of the KKU-tube was lower than the mean dose of ARW ($Dmean_0-Dmean_2$) by $30.82{\pm}24.20cGy$ (p-value <0.05). The mean dose difference [($Dmean_0-Dmean_1$)-($Dmean_0-Dmean_2$)] was $49.72{\pm}51.60cGy$, which was statistically significant between 42.32 cGy -57.13 cGy with the t-value of 13.24 (p-value <0.05). The maximum rectal dose by using CRT was higher than the KKU-tube as much as 75.26 cGy and statistically significant with the t-score of 7.55 (p-value <0.05). The mean doses at the anterior rectal wall while using the CRTs and the KKU-tubes were not significantly different (p-value=0.09). The mean pain score during insertion of the CRT was significantly higher than the KKU-tube by a t-score of 6.15 (p-value <0.05) Conclusions: The KKU-model rectal tube was found to be an easily producible, applicable and reliable instrument as a reference for evaluating the rectal dose during ICBT of cervical cancer without negative effects on the patients.

• 대한방사선치료학회:학술대회논문집
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• 2005.06a
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• pp.23-26
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• 2005

Introduction: To evaluate whether modified MUPIT applicator can effectively eradicate recurrent tumor in uterine cervix cancer and reduce rectal complication after complete radiation treatment. Methods and Materials: 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 performed 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-Ir HDR) after calculated computer planning by orthogonal film. The daily dose was 600cGy and the total dose was delivered 3000cGy in tumor volume by BID. Rectal dose was measured by TLD at 5 points so that evaluated the risk of rectal complication. Result: 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 34.1cGy, 57.1cGy, 103.8cGy, 162.7cGy, 165.7cGy at each points, especially the rectal dose including previous EBRT and ICR was 34.1cGy, 57.1cGy Conclusion: Patients with locally recurrent tumor in uterine cervix cancer treated with modified MIUPIT 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

• Progress in Medical Physics
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• v.20 no.2
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• pp.112-118
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• 2009

The source position and source dwelling time in a given source arrangement in the applicators is very high effect to determine the expose time which in general is derived from the brachytherapy planning system. In high dose rate (HDR) intracavitary radiation therapy (ICRT), the treatment is often performed in based out-patient during the whole fractionation irradiations. However, the patient should be waited on coutch for ICR treatment in first start fraction as unconvinent and immobilized state until perform the dose plannings. In our experiments, the HDR source contributed dose for$55.89{\pm}4.20%$ for straight tandem source, $38.14{\pm}4.46%$ for the right ovoid soucre on the fornix and$5.97{\pm}0.50%$ for left ovoid source. It also showed the $60.33{\pm}6.53%$ for the tandem, $33.10{\pm}6.74%$ for right ovoid and $6.58{\pm}0.30%$ for the left ovoid source in 10 degrees of applicator. The authors designed the source template dose planning software for ICRT of uterine cervix results average $-0.55{\pm}2.15%$ discrepancy of the full charged brachytherapy dose planning. Developed Source temperate ICRT plaanning software guide a minimized the complains and operating times within a ${\pm}3%$ of dose discrepancies.

• Progress in Medical Physics
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• v.20 no.1
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• pp.1-6
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• 2009

For HDR intracavitary brachytherapy with ovoids and a tandem, we compared the dose discrepancy of treatment plans using two different Ir-192 sources (microSelectron, Varian) and generated on two different treatment planning systems (PLATO, BrachyVision). The treatment plans of ten patient treated from Oct. 2007 to Jan. 2008 were selected for these comparisons. For the comparison of dose calculation using different sources, the average discrepancies were $-0.91{\pm}0.09%$, $-0.27{\pm}0.07%$, $0.22{\pm}0.39%$, and $0.88{\pm}0.37%$ in total treatment time and at B-point and ICRU bladder and rectum reference point, respectively. Comparing the two systems, the average dose discrepancies between treatment planning programs were $-0.22{\pm}0.42%$, $-0.25{\pm}0.29%$, $-0.23{\pm}0.63%$, and $-0.17{\pm}0.76%$, and the average dose discrepancies between positioning methods (PLATO with film and BrachyVision with digitial image) were $-0.61{\pm}0.59%$, $-0.77{\pm}0.45%$, $-0.72{\pm}1.70%$, and $0.35{\pm}2.82%$ at A-point, B-point, and ICRU bladder and rectum reference points, respectively. The rectal dose discrepancies between two systems were reached 5.87%. The difference in the dwell position expected by each TPS are mainly affected by the differences in the positioning method in TPSs and have an effect on dose calculations of rectal and bladder located in AP direction.

• Korean Journal of Environmental Biology
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• v.24 no.4
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• pp.387-391
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• 2006

Computational and experimental dosimetry of Henschke applicator with respect to high dose rate brachytherapy using the MIRD phantom and a remote control afterloader were performed. A comparison of computational dosimetry was made between the simulated Monte Carlo dosimetry and GAMMADOT brachytherapy Planning system's dosimetry. Dose measurements was performed using ion chamber in a water phantom. Dose rates are calculated using Monte Carlo code MCNP4B and the GAMMADOT. Thecomputational models include the detailed geometry of Ir-192 source, tandem tube, and shielded ovoids for accurate estimation. And transit dose delivered during source extension to and retraction from a given dwell position was estimated by Monte Carlo simulations. Point doses at ICRU bladder/rectal pointswhich have been recommened by ICRU 38 was assessed. Calculated and measured dose distribution data agreed within 4% each other. The shielding effect of ovoids leads to 19% and 20% dose reduction at bladder surface and rectal points.

• Radiation Oncology Journal
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• v.23 no.3
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• pp.143-156
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• 2005

Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

• Radiation Oncology Journal
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• v.21 no.3
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• pp.238-244
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• 2003

Purpose: The Planning of High-Dose-Rate (HDR) brachytherapy treatments are becoming individualized and more dependent on the treatment planning system. Therefore, computer software has been developed to perform independent point dose calculations with the integration of an isodose distribution curve display into the patient anatomy images. Meterials and Methods: As primary input data, the program takes patients'planning data including the source dwell positions, dwell times and the doses at reference points, computed by an HDR treatment planning system (TPS). Dosimetric calculations were peformed in a $10\times12\times10\;Cm^3$ grid space using the Interstitial Collaborative Working Group (ICWG) formalism and an anisotropy table for the HDR Iridium-192 source. The computed doses at the reference points were automatically compared with the relevant results of the TPS. The MR and simulation film images were then imported and the isodose distributions on the axial, sagittal and coronal planes intersecting the point selected by a user were superimposed on the imported images and then displayed. The accuracy of the software was tested in three benchmark plans peformed by Gamma-Med 12i TPS (MDS Nordion, Germany). Nine patients'plans generated by Plato (Nucletron Corporation, The Netherlands) were verified by the developed software. Results: The absolute doses computed by the developed software agreed with the commercial TPS results within an accuracy of $2.8\%$ in the benchmark plans. The isodose distribution plots showed excellent agreements with the exception of the tip legion of the source's longitudinal axis where a slight deviation was observed. In clinical plans, the secondary dose calculations had, on average, about a $3.4\%$ deviation from the TPS plans. Conclusion: The accurate validation of complicate treatment plans is possible with the developed software and the qualify of the HDR treatment plan can be improved with the isodose display integrated into the patient anatomy information.