• Radiation Oncology Journal
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• v.37 no.4
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• pp.232-248
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• 2019

Proton beams have been used for cancer treatment for more than 28 years, and several technological advancements have been made to achieve improved clinical outcomes by delivering more accurate and conformal doses to the target cancer cells while minimizing the dose to normal tissues. The state-of-the-art intensity modulated proton therapy is now prevailing as a major treatment technique in proton facilities worldwide, but still faces many challenges in being applied to the lung. Thus, in this article, the current status of proton therapy technique is reviewed and issues regarding the relevant uncertainty in proton therapy in the lung are summarized.

• Progress in Medical Physics
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• v.13 no.1
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• pp.32-36
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• 2002

For Intensity Modulated Radiation Therapy(IMRT), the spatial resolution of intensity map(IM) is limited by the width of multi-leaf collimator, which would make an effect on the conformity of the target, as well as organs at risk. Several Methods are suggested to increase the spatial resolution, which can be categorized by the hardware-dependent technique and the software-based technique. However the best solution might be to make the width of MLC finer. it has several obstacles in the respects of technical difficulty and cost. This preliminary study is designed to investigate the clinical effectiveness of the virtual-micro IMRT(VMIMRT) technique, one of the software-based technique. A particular intensity map was created, which has 42$\times$54 pixel dimension ,0.5cm pixel size and 15 intensity levels. Using this intensity map, segment fields of IMRT were generated with 1$\times$lcm, 0.5$\times$1cm, 0.5$\times$0.5cm(VMIM) beamlet size, respectively As results, we found that there was no evidence of improvement for VMIMRT, compared with the 0.5$\times$lcm beamlet size which can be delivered by 1cm width MLC. The reason seems to be due to the constraint of VMIMRT. Further study is required to prove the benefit of the VIMRT in clinical case like head and neck cancer, where is expected that higher resolution than 1cm is necessary.

• Progress in Medical Physics
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• v.32 no.3
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• pp.70-81
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• 2021

Purpose: This study was designed to investigate the dosimetric difference between intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in head and neck cancer (HNC). The study primarily focuses on low-dose spillage evaluation between these two techniques. Methods: This retrospective study involved 45 patients with HNC. The treatment plans were generated using the IMRT and VMAT techniques for all patients. Dosimetric comparisons were performed in terms of target coverage, organ-at-risk (OAR) sparing, and various parameters, including conformity index, uniformity index, homogeneity index, conformation number, low-dose volumes, and normal tissue integral dose (NTID). Results: No significant (P>0.05) difference in planning target volume coverage (D_95%) was observed between IMRT and VMAT plans for supraglottic larynx, hard palate, and tongue cancers. A decrease in dose volumes ranging from 1 Gy to 30 Gy was observed for VMAT plans compared with those for IMRT plans, except for V_1Gy and V_30Gy for supraglottic larynx cancer and V_1Gy for tongue cancer. Moreover, decreases (P<0.05) in NTID were observed for VMAT plans compared with that for IMRT plans in supraglottic larynx (4.50%), hard palate (12.80%), and tongue (7.76%) cancers. In contrast, a slight increase in monitor units for VMAT compared with those for IMRT in supraglottic larynx (0.46%), hard palate (2.54%), and tongue (7.56%) cancers. Conclusions: For advanced-stage HNC, both IMRT and VMAT offer satisfactory clinical plans. VMAT offers a conformal and homogeneous dose distribution with comparable OAR sparing and higher dose falloff outside the target volume than IMRT, which provides an edge to reduce the risk of secondary malignancies for HNC over IMRT.

• Radiation Oncology Journal
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• v.37 no.4
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• pp.249-253
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• 2019

Purpose: We aimed to analyze the trend in intensity-modulated radiation therapy (IMRT) use in Korea from 2011 to 2018. Materials and Methods: We collected data from the Health and Insurance Review and Assessment Service (HIRA) big data based on the National Health Insurance Service claims and reimbursements records using primary treatment planning codes (HD 041) for IMRT from 2011 to 2018. We analyzed the changing patterns in clinical application to specific tumor sites and regional differences in IMRT utilization. Results: The use of IMRT has exhibited an 18-fold steep rise from 1,921 patients in 2011 to 34,759 in 2018. With regard to IMRT in 2018, 70% of patients (24,248/34,759) were treated in metropolitan areas (Seoul, Incheon, and Gyeonggi Province). IMRT was most commonly used to treat breast, lung, and prostate cancers in 2018. Among these, the use of IMRT for breast cancer shows the most remarkable increase from 2016 when the National Health Insurance began to cover IMRT for all solid tumors. Conclusion: The use of IMRT is steadily increasing to treat cancer and is concentrated in metropolitan areas.

• Progress in Medical Physics
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• v.28 no.2
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• pp.61-66
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• 2017

The aim of this study is to investigate the characteristics of portal dosimetry in comparison with the MapCHECK2 measurments. In this study, a total of 65 treatment plans including both volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) were retrospectively selected and analyzed (45 VMAT plans and 20 IMRT plans). A total of 4 types of linac models (VitalBeam, Trilogy, Clinac 21EXS, and Clianc iX) were used for the comparison between portal dosimetry and the MapCHECK2 measurements. The VMAT plans were delivered with two VitalBeam linacs (VitalBeam1 and VitalBeam2) and one Trilogy while the IMRT plans were delivered with one Clinac 21EXS and one Clinacl iX. The global gamma passing rates of portal dosimetry and the MapCHECK2 measurements were analyzed with a gamma criterion of 3%/3 mm for IMRT while those were analyzed with a gamma criterion of 2%/2 mm for VMAT. Spearman's correlation coefficients (r) were calculated between the gamma passing rates of portal dosimetry and those of the MapCHECK2 measurements. For VMAT, the gamma passing rates of portal dosimetry with the VitalBeam1, VitalBeam2, and Trilogy were $97.3%{\pm}3.5%$, $97.1%{\pm}3.4%$, and $97.5%{\pm}1.9%$, respectively. Those of the MapCHECK2 measurements were $96.8%{\pm}2.5%$, $96.3%{\pm}2.7%$, and $97.4%{\pm}1.3%$, respectively. For IMRT, the gamma passing rates of portal dosimetry with Clinac 21EXS and Clinac iX were $99.7%{\pm}0.3%$ and $99.8%{\pm}0.2%$, respectively. Those of the MapCHECK2 measurements were $96.5%{\pm}3.3%$ and $97.7%{\pm}3.2%$, respectively. Except for the result with the Trilogy, no correlations were observed between the gamma passing rates of portal dosimetry and those of the MapCHECK2 measurements. Therefore, both the MapCHECK2 measurements and portal dosimetry can be used as an alternative to each other for patient-specific QA for both IMRT and VMAT.

• Proceedings of the Korean Biophysical Society Conference
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• 2002.06b
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• pp.25-26
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• 2002

The goal of radiation therapy is to maximize the tumor dose and to minimize the dose of normal tissue. In order to achieve this goal, the new radiation therapy techniques such as three dimensional conformal therapy or intensity modulated radiation therapy has been developed and tried to clinical application. The relationship between radiation dose and normal tissue response is an interesting subject in the radiation therapy field.(omitted)

• Journal of Radiation Protection and Research
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• v.46 no.2
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• pp.48-57
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• 2021

Background: In this study, the complexities of step-and-shoot intensity-modulated radiation therapy (IMRT) plans in magnetic resonance-guided radiation therapy systems were evaluated. Materials and Methods: Overall, 194 verification plans from the abdomen, prostate, and breast sites were collected using a ⁶⁰Co-based ViewRay radiotherapy system (ViewRay Inc., Cleveland, OH, USA). Various plan complexity metrics (PCMs) were calculated for each verification plan, including the modulation complexity score (MCS), plan-averaged beam area (PA), plan-averaged beam irregularity, plan-averaged edge (PE), plan-averaged beam modulation, number of segments, average area among all segments (AA/Seg), and total beam-on time (TBT). The plan deliverability was quantified in terms of gamma passing rates (GPRs) with a 1 mm/2% criterion, and the Pearson correlation coefficients between GPRs and various PCMs were analyzed. Results and Discussion: For the abdomen, prostate, and breast groups, the average GPRs with the 1 mm/2% criterion were 77.8 ± 6.0%, 79.8 ± 4.9%, and 84.7 ± 7.3%; PCMs were 0.263, 0.271, and 0.386; PAs were 15.001, 18.779, and 35.683; PEs were 1.575, 1.444, and 1.028; AA/Segs were 15.37, 19.89, and 36.64; and TBTs were 18.86, 19.33, and 5.91 minutes, respectively. The various PCMs, i.e., MCS, PA, PE, AA/Seg, and TBT, showed statistically significant Pearson correlation coefficients of 0.416, 0.627, -0.541, 0.635, and -0.397, respectively, with GPRs. Conclusion: The area-related metrics exhibited strong correlations with GPRs. Moreover, the AA/Seg metric can be used to estimate the IMRT plan accuracy without beam delivery in the ⁶⁰Co-based ViewRay radiotherapy system.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.9-15
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• 2003

Purpose: To introduce our early experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma. Methods and Materials: Eight patients who underwent IMRT for no disseminated nasopharyngeal carcinoma at the Asan Medical Center between September 2001 and November 2002 were evaluate by prospective analysis. According to the 1997 American Joint Committee on Cancer staging classification, 5 had Stage III, and 3 had Stage IVB disease. The IMRT plans were designed to be delivered as a 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) using the 'step and shoot' technique with a MLC (multileaf collimator). Daily fractions of 2.2-2.5Gy and 1.9-2Gy were prescribed and delivered to the GTV and CTV and clinically negative neck node, respectively. The prescribed dose was 70A-79.0Gy to the gross tumor volume (GTV), 60Gy to the clinical target volume (CTV) and metastatic nodal station, and 46Gy to the clinically negative neck. All patients also received weekly cisplatin during radiotherapy. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Results: Follow-up period was ranging from 5 to 18 months. All patients showed complete response and loco-regional control rate was 100% but one patient died of malnutrition due to treatment related toxicity. There were no Grade 3 or 4 xerostomia and all patients had experienced improvement of salivary gland function. Conclusion: 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) boost intensity-modulated radiotherapy technique allows parotid sparing as evidenced both clinically and by dosimetry. Initial tumor response and loco-regional control was promising. It is clinically feasible. A larger population of patients and a long-term follow-up are needed to evaluate ultimate tumor control and late toxicity.

• Journal of Magnetics
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• v.22 no.1
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• pp.141-145
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• 2017

This paper uses a glass dosimeter to evaluate the lens-absorbed dose of scattered radiation generated in tomotherapy intensity modulated radiation therapy (IMRT). The head and neck portion of the rando phantom was subjected to a CT scan. The tomotherapy plan was designed to ensure delivery of the prescribed total 70 Gy day 2.2 Gy. With the lens portion of the glass dosimeter, a 5mm bolus was subjected to the scattered radiation treatment, and the dose was measured in each of the three megavoltage CT (MVCT) modes. The result is multiplied by 30 times and was determined once as the mean value. The measurement at the MVCT Coarse mode is RT mode 10.797 mGy, that for the Normal mode is 13.360 mGy, for the Fine mode is a maximum of 22.872 mGy, and for the treatment mode is 895.830 mGy. A small amount of scattered radiation in the MVCT is measured in the lens scattered radiation, but scattered radiation during treatment was measured to be near 1 Gy on the lens. Compared to a one-time radiation treatment of 2.2 Gy, the survey showed something unexpected in that it was half the value of that research to the patient. Therefore, will be aware of how much of an influence there will be on sensitive organs, such as the lens by scattered radiation generated during intensity modulated radiation therapy.

• Progress in Medical Physics
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• v.34 no.4
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• pp.41-47
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• 2023

Purpose: This study aimed to dosimetrically compare the technique of three-dimensional conformal radiotherapy (3D CRT), which is a traditional prophylactic cranial irradiation method, and the intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques used in the last few decades with the dynamic conformal arc therapy (DCAT) technique. Methods: The 3D CRT, VMAT, IMRT, and DCAT plans were prepared with 25 Gy in 10 fractions in a Monaco planning system. The target volume and the critical organ doses were compared. A comparison of the body V₂, V₅, and V₁₀ doses, monitor unit (MU), and beam on-time values was also performed. Results: In planned target volume of the brain (PTV_Brain), the highest D99 dose value (P<0.001) and the most homogeneous (P=0.049) dose distribution according to the heterogeneity index were obtained using the VMAT technique. In contrast, the lowest values were obtained using the 3D CRT technique in the body V₂, V₅, and V₁₀ doses. The MU values were the lowest when DCAT (P=0.001) was used. These values were 0.34% (P=0.256) lower with the 3D CRT technique, 66% (P=0.001) lower with IMRT, and 72% (P=0.001) lower with VMAT. The beam on-time values were the lowest with the 3D CRT planning (P<0.001), 3.8% (P=0.008) lower than DCAT, 65% (P=0.001) lower than VMAT planning, and 76% (P=0.001) lower than IMRT planning. Conclusions: Without sacrificing the homogeneous dose distribution and the critical organ doses in IMRTs, three to four times less treatment time, less low-dose volume, less leakage radiation, and less radiation scattering could be achieved when the DCAT technique is used similar to conventional methods. In short, DCAT, which is applicable in small target volumes, can also be successfully planned in large target volumes, such as the whole-brain.