• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.7-15
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• 2020

Purpose: In modern radiotherapy technology, several methods of image guided radiation therapy (IGRT) are used to deliver accurate doses to tumor target locations and normal organs, including CBCT (Cone Beam Computed Tomography) and other devices, ExacTrac System, other than CBCT equipped with linear accelerators. In previous studies comparing the two systems, positional errors were analysed rearwards using Offline-view or evaluated only with a Yaw rotation with the X, Y, and Z axes. In this study, when using CBCT and ExacTrac to perform 6 Degree of the Freedom(DoF) Online IGRT in a treatment center with two equipment, the difference between the set-up calibration values seen in each system, the time taken for patient set-up, and the radiation usefulness of the imaging device is evaluated. Materials and Methods: In order to evaluate the difference between mobile calibrations and exposure radiation dose, the glass dosimetry and Rando Phantom were used for 11 cancer patients with head circumference from March to October 2017 in order to assess the difference between mobile calibrations and the time taken from Set-up to shortly before IGRT. CBCT and ExacTrac System were used for IGRT of all patients. An average of 10 CBCT and ExacTrac images were obtained per patient during the total treatment period, and the difference in 6D Online Automation values between the two systems was calculated within the ROI setting. In this case, the area of interest designation in the image obtained from CBCT was fixed to the same anatomical structure as the image obtained through ExacTrac. The difference in positional values for the six axes (SI, AP, LR; Rotation group: Pitch, Roll, Rtn) between the two systems, the total time taken from patient set-up to just before IGRT, and exposure dose were measured and compared respectively with the RandoPhantom. Results: the set-up error in the phantom and patient was less than 1mm in the translation group and less than 1.5° in the rotation group, and the RMS values of all axes except the Rtn value were less than 1mm and 1°. The time taken to correct the set-up error in each system was an average of 256±47.6sec for IGRT using CBCT and 84±3.5sec for ExacTrac, respectively. Radiation exposure dose by IGRT per treatment was measured at 37 times higher than ExacTrac in CBCT and ExacTrac at 2.468mGy and 0.066mGy at Oral Mucosa among the 7 measurement locations in the head and neck area. Conclusion: Through 6D online automatic positioning between the CBCT and ExacTrac systems, the set-up error was found to be less than 1mm, 1.02°, including the patient's movement (random error), as well as the systematic error of the two systems. This error range is considered to be reasonable when considering that the PTV Margin is 3mm during the head and neck IMRT treatment in the present study. However, considering the changes in target and risk organs due to changes in patient weight during the treatment period, it is considered to be appropriately used in combination with CBCT.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.289-295
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• 2014

Purpose : Cone Beam Computed Tomography(CBCT) in Image Guided Radiation Therapy(IGRT), Set-up error can be reduced but exposure dose of the patient due to CBCT will increase. Through this study, we are to evaluate by making a scenario with the implementation period of CBCT as every other day. Materials and Methods : Of prostate cancer patients, 9 patients who got a Intensity Modulated Radiation Therapy(IMRT) with CBCT in IGRT were analyzed. Based on values corrected by analyzing set-up error by using CBCT every day during actual treatment, we created a scenario that conducts CBCT every other day. After applying set-up error values of the day not performing CBCT in the scenario to the treatment planning system(Pinnacle 9.2, Philips, USA) by moving them from the treatment iso-center during actual treatment, we established re-treatment plan under the same conditions as actual treatment. Based on this, the dose distribution of normal organs and Planning Target Volume(PTV) was compared and analyzed. Results : In the scenario that performs CBCT every other day based on set-up error values when conducting CBCT every day, average X-axis : $0.2{\pm}0.73mm$, Y-axis : $0.1{\pm}0.58mm$, Z-axis : $-1.3{\pm}1.17mm$ difference was shown. This was applied to the treatment planning to establish re-treatment plan and dose distribution was evaluated and as a result, Dmean : -0.17 Gy, D99% : -0.71 Gy of PTV difference was shown in comparison with the result obtained when carrying out CBCT every day. As for normal organs, V66 : 1.55% of rectal wall, V66 : -0.76% of bladder difference was shown. Conclusion : In case of a CBCT perform every other day could reduce exposure dose and additional treatment time. And it is thought to be able to consider the application depending on the condition of the patient because the difference in the dose distribution of normal organs, PTV is not large.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.154-156
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• 2002

Brachytherapy has a long history in the treatment of cancer. However, the treatment planning technique for brachytherapy has lagged somewhat behind the corresponding developments for external beam therapy as far as the imaging technique is concerned. Currently, the orthogonal-film-based treatment planning is performed at most institutions even though the CT-based planning is available. The aim of this study is to evaluate the CT-based vs. the orthogonal-film-based treatment planning in cervix cancer. The doses to point A, point B, rectum and bladder points according to ICRU 38 were calculated for the two methods above. In addition, the volumetric studies such as 3D dose computation and DVH were obtained for the CT-based planning. For the bulky tumor, the isodose lines of point A prescription were not fairly covered for the CTV. The CT -based dose planning can overestimate the maximum dose delivered to bladder and rectum by 30%. The CT-based planning has several advantages over the orthogonal-film-based such as 3D dose display, DVH, and more accurate target delineation. It is suggested that the prescription point in cervix cancer be revised especially for the bulky tumor.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.29 no.2
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• pp.69-75
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• 2023

Purpose: This study examined the distance between the coracoid process and the humeral head using an ultrasonography device when shoulder active contraction were applied according to the guided direction in the end range of shoulder mobilization. This study aims to provide essential data on treating shoulder disease patients. Methods: The subjects of this study were 20 adults with healthy shoulder joints. ultrasonography (US) equipment was used to examine shoulder joint mobilization under two conditions: (1) anteroposterior (AP) joint mobilization and (2) superoinferior (SI) joint mobilization. Shoulder active contraction was assessed in the end range. The distance between the coracoid process and the humeral head was measured. A linear probe was used for US; the frequency was set to 7.5MHz, and the US image display method was set to B-mode. The US measurement values were measured in (1) the starting position, (2) the end range position, and (3) the end range position of the shoulder active contraction, and the moving distance was drawn in a straight line through the US image. The distance was determined as the measurement value, and the average values were compared. Reults: The results were as follows: (1) the measured AP Joint mobilization increased by an average of .52cm from the end range of the joint mobilization with shoulder active contraction; (2) the measured SI Joint mobilization increased by an average of .49cm from the end range of the joint. Conclusion: When shoulder mobilization is applied, the distance between the coracoid process and the humeral head increases when muscle contraction occurs through shoulder active contraction in the end range, according to the therapist's guidance. Therefore, shoulder mobilization combined with shoulder active contraction is an effective treatment method for patients with shoulder injuries.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.1
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• pp.15-21
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• 2012

Purpose: Image Guided Radiation Therapy (IGRT) has been carried out using On-Board Imager system (OBI) in Asan Medical Center. For this reason, This study was to analyze and evaluate the impact on Cone-Beam CT according to variation of material and respiration. Materials and Methods: This study was to acquire and analyze Cone-Beam CT three times for two material: Cylider acryl (lung equvalent material, diameter 3 cm), Fiducial Marker (using clinic) under Motion Phantom able to adjust respiration pattern randomly was varying period, amplitude and baseline vis-a-vis reference respiration pattern. Results: First, According to a kind of material, when being showed 100% in the acryl and 120% in the Fiducial Marker under the condition of same movement of the motion phantom. Second, According to the respiratory alteration, when being showed 1.13 in the baseline shift 1.8 mm and 1.27 in the baseline shift 3.3 mm for acryl. when being showed 1.01 in 1 sec of period and 1.045 in 2.5 sec of period for acryl. When being showed 0.86 in 0.7 times the standard of amplitude and 1.43 in 1.7 times the standard of amplitude for acryl. when being showed 1.18 in the baseline shift 1.8 mm and 1.34 in the baseline shift 3.3 mm for Fiducial Marker. when being showed 1.0 in 1 sec of period and 1.0 in 2.5 sec of period for Fiducial Marker. When being showed 0.99 in 0.7 times the standard of amplitude and 1.66 in 1.7 times the standard of amplitude for Fiducial Marker. Conclusion: The effect of image size of CBCT was 20% in the case of Fiducial marker. The impact of changes in breathing pattern was minimum 13% - maximum 43% for Arcyl, min. 18% - max. 66% for Fiducial marker. This difference makes serious uncertainty. So, Must be stabilized breathing of patient before acquiring CBCT. also must be monitored breathing of patient in the middle of acquire. If you observe considerable change of breathing when acquiring CBCT. After Image Guided, must be need to check treatment site using fluoroscopy. If a change is too big, re-acquiring CBCT.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.1
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• pp.43-49
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• 2007

Purpose: The aim of this study was the clinical implementation of IGRT using KV CBCT for setup correction in radiation therapy. Materials and Methods: We selected 9 patients (3 patient for each region; head, body, pelvis)and acquired 135 CBCT images with CLINAC iX (Varian medical system, USA). During the scan, the required time was measured. We analyzed the result in 3 direction; vertical, longitudinal, lateral. Results: The mean setup errors at the couch position of vertical, lateral, and longitudinal direction were 0.07, 0.12, and 0.1 cm in the head region, 0.3, 0.26, and 0.22 cm in the body region, 0.21, 0.18, and 0.15 cm in the pelvis region respectively. The mean time required for CBCT was $6{\sim}7$ minute. Conclusion: The CBCT on the LINAC provides the capacity for soft tissue imaging in the treatment position and real time monitoring during treatment delivery. With presented workflow, the setup correction within reasonable time for more accurate radiation therapy is possible. And it's image can be very useful for adaptive radiation therapy(ART) in the future with improved image quality.

• Radiation Oncology Journal
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• v.31 no.4
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• pp.206-215
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• 2013

Purpose: Re-irradiation (re-RT) is considered a treatment option for inoperable locoregionally recurrent head and neck cancer (HNC) after prior radiotherapy. We evaluated the efficacy and safety of re-RT using Helical Tomotherapy as image-guided intensity-modulated radiotherapy in recurrent HNC. Materials and Methods: Patients diagnosed with recurrent HNC and received re-RT were retrospectively reviewed. Primary endpoint was overall survival (OS) and secondary endpoints were locoregional control and toxicities. Results: The median follow-up period of total 9 patients was 18.7 months (range, 4.1 to 76 months) and that of 3 alive patients was 49 months (range, 47 to 76 months). Median dose of first radiotherapy and re-RT was 64.8 and 47.5 $Gy_{10}$. Median cumulative dose of the two courses of radiotherapy was 116.3 $Gy_{10}$ (range, 91.8 to 128.9 $Gy_{10}$) while the median interval between the two courses of radiation was 25 months (range, 4 to 137 months). The response rate after re-RT of the evaluated 8 patients was 75% (complete response, 4; partial response, 2). Median locoregional relapse-free survival after re-RT was 11.9 months (range, 3.4 to 75.1 months) and 5 patients eventually presented with treatment failure (in-field failure, 2; in- and out-field failure, 2; out-field failure, 1). Median OS of the 8 patients was 20.3 months (range, 4.1 to 75.1 months). One- and two-year OS rates were 62.5% and 50%, respectively. Grade 3 leucopenia developed in one patient as acute toxicity, and grade 2 osteonecrosis and trismus as chronic toxicity in another patient. Conclusion: Re-RT using Helical Tomotherapy for previously irradiated patients with unresectable locoregionally recurrent HNC may be a feasible treatment option with long-term survival and acceptable toxicities.

• The Journal of the Korea Contents Association
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• v.14 no.9
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• pp.362-370
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• 2014

This study measured and analyzed the correlation coefficient between movements of thoracoabdominal tumors and external respiration in a free-breathing state, using cyberknife image guided radiotherapy(IGRT). This study subjects included a total of 30 patients with lung tumors(n=10), liver tumors(n=10) and pancreatic tumor(n=10) who underwent radiotherapy, and the movements of tumors were analyzed using converted log data of the tumor motion tracking system(MTS). In a free-breathing state, In relation to Peason's correlation coefficient between external respiration and lung tumors in the entire treatment process, the correlation coefficient was 0.646(p<0.05) in the cranio-caudal direction, 0.365(p<0.088) in the left and right direction and 0.196(p<0.115) in the antero-posterior direction. The correlation coefficient of liver tumors was 0.841(p<0.000) in the cranio-caudal direction, 0.346 (p<0.179) in the left and right direction and 0.691(p<0.001) in the antero-posterior direction. The correlation coefficient of Pancreatic tumors was 0.683(p<0.000) in the cranio-caudal direction, 0.397(p<0.006) in the left and right direction and 0.268(p<0.127) in the antero-posterior direction. In conclusion, the measurement findings of thoracoabdominal tumor movement using IGRT would be helpful in determining an accurate target volume. Moreover, the analysis of correlation between external respiration and movements of internal tumors would provide important information to correct movements of tumors for diverse radiotherapy techniques.

• Journal of radiological science and technology
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• v.42 no.2
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• pp.137-143
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• 2019

The aim of this study was analyzed the setup error of breast cancer patients in intensity modulated radiation therapy(IMRT) with deep inspiration breath holding(DIBH) and was analyzed the dose distribution due to setup error. A total of 45 breast cancer cases were performed a retrospective clinical analysis of setup error. In addition, the re-treatment planning was carried by shifting the setup error from the isocenter at the treatment. Based on this, the dose distribution of PTV and OARs was compared and analyzed. The 3D error for small breast group and medium breast group and large breast group were 3.1 mm and 3.7 mm and 4.1 mm, respectively. The difference between the groups was statistically significant(P=0.003). DVH results showed HI, CI for the PTV difference between standard treatment plan and re-treatment plan of 14.4%, 4%. The difference in $D_5$ and $V_{20}$ of the ipsilateral lung was 5.6%, 13% respectively. The difference in $D_5$ and $V_5$ of the heart of right breast cancer patients was 6.8%, 8% respectively. The difference in $D_5$, $V_{20}$ of the heart of left breast cancer patients was 7.2%, 23.5% respectively. In this study, there was a significant association between breast size and significant setup error in breast cancer patients with DIBH. In addition, it was found that the dose distribution of the PTV and OARs varied according to the setup error.

• Radiation Oncology Journal
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• v.33 no.1
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• pp.1-11
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• 2015

With the progress of image-guided localization, body immobilization system, and computerized delivery of intensity-modulated radiation delivery, it became possible to perform spine radiosurgery. The next question is how to translate the high technology treatment to the clinical application. Clinical trials have been performed to demonstrate the feasibility of spine radiosurgery and efficacy of the treatment in the setting of spine metastasis, leading to the randomized trials by a cooperative group. Radiosurgery has also demonstrated its efficacy to decompress the spinal cord compression in selected group of patients. The experience indicates that spine radiosurgery has a potential to change the clinical practice in the management of spine metastasis and spinal cord compression.