• Progress in Medical Physics
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• v.13 no.4
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• pp.181-186
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• 2002

The IMRT planning depends on the algorithm of each planning system and MLC performance of each Linac system. Yonsei Cancer Center introduced an IMRT System at the beginning of February, 2002. The system consists of CORVUS (Nomos, U.S.A.) treatment planning system, LANTIS, PRIMEVIEW and PRIMART (Siemens, U.S.A) linac system. The optimization of CORVUS planning system with PRIMART is an important task to make a desirable quality treatment plan. Our Step ＆ Shoot IMRT system uses Finite Size Pencil Beams (FSPB) dose model, simulated annealing optimization algorithm and IMFAST segmentation algorithm. We constructed treatment plans for four different patient cases with two basic beamlet sizes, 1.0$\times$1.0 $\textrm{cm}^2$ and 0.5$\times$1.0 $\textrm{cm}^2$, and four intensity steps, 5%, 10%, 20%, 33%. Each case's plan was evaluated with the dose volume histograms of target volumes and delivery efficiencies. The patient case of small target volume is sensitive at the change of intensity map's segmentation and it highlighted an effective treatment plan at marrow intensity step and small basic projection beamlet.

• 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.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.15-21
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• 2023

Purpose: The purpose of this study is to compare the performance of the anisotropic analytical algorithm (AAA) and portal dose image prediction (PDIP) for patient-specific quality assurance based on electronic portal imaging device, and to evaluate the clinical feasibility of portal dosimetry using AAA. Subjects and methods: We retrospectively selected a total of 32 patients, including 15 lung cancer patients and 17 liver cancer patients. Verification plans were generated using PDIP and AAA. We obtained gamma passing rates by comparing the calculated distribution with the measured distribution and obtained MLC positional difference values. Results: The mean gamma passing rate for lung cancer patients was 99.5% ± 1.1% for 3%/3 mm using PDIP and 90.6% ± 5.8% for 1%/1 mm. Using AAA, the mean gamma passing rate was 98.9% ± 1.7% for 3%/3 mm and 87.8% ± 5.2% for 1%/1 mm. The mean gamma passing rate for liver cancer patients was 99.9% ± 0.3% for 3%/3 mm using PDIP and 96.6% ± 4.6% for 1%/1 mm. Using AAA, the mean gamma passing rate was 99.6% ± 0.5% for 3%/3 mm and 89.5% ± 6.4% for 1%/1 mm. The MLC positional difference was small at 0.013 mm ± 0.002 mm and showed no correlation with the gamma passing rate. Conclusion: The AAA algorithm can be clinically used as a portal dosimetry calculation algorithm for patientspecific quality assurance based on electronic portal imaging device.

• Progress in Medical Physics
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• v.9 no.4
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• pp.227-245
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• 1998

A most appropriate model of 3-D conformal radiotherapy has been induced by clinical evaluation and animal study, and therapeutic gains were evaluated by numerical equation of tumor control probability(TCP) and normal tissue complication probability (NTCP). The radiation dose to the tumor and the adjacent normal organs was accurately evaluated and compared using the dose volume histogram(DVH). The TCP and NTCP was derived from the distribution of given dosage and irradiated volume, and these numbers were used as the biological index for the assessment of the treatment effects. Ten patients with liver disease have been evaluated and 3 dogs were sacrificed for this study. Based on the 3-D images of the tumor and adjacent organs, the optimum radiation dose and the projection direction which could maximize the radiation effect while minimizing the effects to the adjacent organs could be decided. 3). The most effective collimation for the normal adjacent organs was made through the beams eye view with the use of multileaf collimator. When the dose was increased from 50Gy to 70Gy, the TCP for the conventional 2-port radiation and the 5-port multidimensional therapy was 0.982 and 0.995 respectively, while the NTCP was 0.725 and 0.142 respectively, suggesting that the 3-D conformal radiotherapy might be the appropriate therapy to apply sufficient radiation dose to the tumor while minimizing the damages to the normal areas of the liver. Positive correlation was observed between the NTCP and the actual complication of the normal liver in the animal study. The present study suggest that the use of 3-D conformal radiotherapy and the application of the mathematical models of TCP and NTCP may provide the improvements in the treatment of hepatoma with enhanced results.

• The Journal of Korean Society for Radiation Therapy
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• v.16 no.2
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• pp.43-61
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• 2004

Purpose : For qualify improvement in radiotherapy, it is important to set up and evaluate equipment (linac) accurately. In addition, technicians are needed to be fully aware of the equipment's detailed quality and its manual. Therefore, the result of ATP is evaluated and introduced, in order that the technicians are skilled by participating in quality assurance (QA) and understanding the quality of the equipment before clinical use. Method and Material : QA for LINAC 21EX (Varian, US) was done with suppliers its procedure was divided into radiation survey, mechanical test, radiation isocenter test, bean performance, dosimetry, and enhanced dynamic wedge and using X-omat film (Kodak), multidata, densitometer, and electrometer. QA of MLC (Millennium, 120 leaf) attached to LINAC and EPID (Portal vision) were done separately. Result : The leakage dose by survey meter was below the tolerance. In mechanical test, collimater, gantry, and couch rotation were less than 1mm, and the angles were ${\pm}0.1^{\circ}$ for digital and ${\pm}0.5^{\circ}$ for mechanical. The alignment test of the light field and crosshair were evaluated less than 1mm. The (a)symmetrical jaw field was less than ${\pm}0.5mm$. The radiation isocenter test using X-mat film was less than 1mm. The consistency of light field and radiation field was less than ${\pm}0.1mm$. PDD for photon energy was less than ${\pm}1\%$ and for electron energy of $90\%,\;80\%,\;50\%,\;and\;30\%$ were evaluated within the tolerance. Flatness for photon and electron energy was evaluated $2.3\%$ (tolerance $3\%$) and $3\%$ (tolerance $4.5\%$), respectively, and symmetry was $0.45\%$ (tolerance $2\%$) and $0.3\%$ (tolerance $2\%$), respectively. Dosimetry test for short term, MU setting, rep rate, and dose rate accuracy of photon and electron energy was within the tolerance depending on energy, MU, and gantry angle. Conclusion : Accuracy and safety for clinical use of Clinac 21EX was verified through customer acceptance procedure and the quality of the equipment was found out. These can reduce the difficulties in using the equipment. Furthermore, it is useful for clinically treatment of patients by technicians' active participations.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.1
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• pp.1-10
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• 2012

Purpose: To evaluate dose distribution differences when the dose rates are randomly changed in intensity-modulated radiation therapy using a dynamic multileafcollimator. Materials and Methods: Two IMRT treatment plans including small-field and large-field plans were made using a commercial treatment planning system (Eclipse, Varian, Palo Alto, CA). Each plan had three sub-plans according to various dose rates of 100, 400, and 600 MU/min. A chamber array (2D-Array Seven729, PTW-Freiburg) was positioned between solid water phantom slabs to give measurement depth of 5 cm and backscattering depth of 5 cm. Beam deliveries were performed on the array detector using a 6 MV beam of a linear accelerator (Clinac 21EX, Varian, Palo Alto, CA) equipped with 120-leaf MLC (Millenium 120, Varian). At first, the beam was delivered with same dose rates as planned to obtain reference values. After the standard measurements, dose rates were then changed as follows: 1) for plans with 100 MU/min, dose rate was varied to 200, 300, 400, 500 and 600 MU/min, 2) for plans with 400 MU/min, dose rate was varied to 100, 200, 300, 500 and 600 MU/min, 3) for plans with 600 MU/min, dose rate was varied to 100, 200, 300, 400 and 500 MU/min. Finally, using an analysis software (Verisoft 3.1, PTW-Freiburg), the dose difference and distribution between the reference and dose-rate-varied measurements was evaluated. Results: For the small field plan, the local dose differences were -0.8, -1.1, -1.3, -1.5, and -1.6% for the dose rate of 200, 300, 400, 500, 600 MU/min, respectively (for 100 MU/min reference), +0.9, +0.3, +0.1, -0.2, and -0.2% for the dose rate of 100, 200, 300, 500, 600 MU/min, respectively (for 400 MU/min reference) and +1.4, +0.8, +0.5, +0.3, and +0.2% for the dose rate of 100, 200, 300, 400, 500 MU/min, respectively (for 600 MU/min reference). On the other hand, for the large field plan, the pass-rate differences were -1.3, -1.6, -1.8, -2.0, and -2.4% for the dose rate of 200, 300, 400, 500, 600 MU/min, respectively (for 100 MU/min reference), +2.0, +1.8, +0.5, -1.2, and -1.6% for the dose rate of 100, 200, 300, 500, 600 MU/min, respectively (for 400 MU/min reference) and +1.5, +1.9, +1.7, +1.9, and +1.2% for the dose rate of 100, 200, 300, 400, 500 MU/min, respectively (for 600 MU/min reference). In short, the dose difference of dose-rate variation was measured to the -2.4~+2.0%. Conclusion: Using the Varian linear accelerator with 120 MLC, the IMRT dose distribution is differed a little <(${\pm}3%$) even though the dose-rate is changed.

• Progress in Medical Physics
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• v.19 no.3
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• pp.191-199
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• 2008

PTV considered for the energy, dose distribution exposed to lung and spinal cord, and the characteristic of DVH(Dose Volume Histogram) were compared and investigated by planning the intensity modulated radiation therapy (IMRT) using the photon energies of 6 MV and 10 MV according to tumor location like as the anterior, middle, and posterior regions of lung, and the mediastinum region in lung cancer patients. Our institution installed the linear accelerator (Varian 21 EX-s, USA) equipped with 120 multileaf collimator for lung cancer patients, which is producing the photon energies of 6 MV and 10 MV, and radiation therapy planning was performed with ECLIPSE system (Varian, SomaVision 6.5, USA), which support inverse treatment planning. The tomographic images of 3 mm slice thickness for lung cancer patients were acquired using planning CT, and acquired tomographic images were sent to the Varis system, and then treatment planning was performed in the ECLIPSE system. The radiation treatment planning of the IMRT was processed from various angles according to the regions of the tumor, and using various beam lines according to the size and location of the tumor. The investigation of the characteristic of dose distributions for the energy of 6 MV and 10 MV according to tumor locations in lung cancer patients resulted that the maximum dose of 10 MV energy was 1.2% less than that of 6 MV energy without depending on the tumor location of lung cancer, and the reduction effects of MU were occurred from 10 to 25 MU. Radiation dose exposed to the lung satisfied the less 30% of V20, however radiation dose in 6 MV energy was from 0.1% to 0.5% less than that in 10 MV energy. Radiation dose exposed to the spinal cord for 6 MV energy was from 0.6% to 2.1% less than that for 6 MV energy.

• Progress in Medical Physics
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• v.16 no.4
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• pp.166-175
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• 2005

The purpose of this study is to develop the optimization method for adjusting the film isocenter shift and to suggest the quantitative acceptable criteria for film dosimetry after optimization In the dynamic conformal arc radiation therapy (DCAR). The DCAR planning was peformed In 7 patients with brain metastasis. Both absolute dosimetry with ion chamber and relative film dosimetry were peformed throughout the DCAR using BrainLab's micro-multileaf collimator. An optimization method for obtaining the global minimum was used to adjust for the error in the film isocenter shift, which is the largest pan of systemic errors. The mean of point dose difference between measured value using ion chamber and calculated value acquired from planning system was $0.51{\pm}0.43\%$ and maximum was $1.14\%$ with absolute dosimetry These results were within the AAPM criteria of below $5\%$. The translation values of film isocenter shift with optimization were within ${\pm}$1 mm in all patients. The mean of average dose difference before and after optimization was $1.70{\pm}0.35\%$ and $1.34{\pm}0.20\%$, respectively, and the mean ratios over $5\%$ dose difference was $4.54{\pm}3.94\%$ and $0.11{\pm}0.12\%$, respectively. After optimization, the dose differences decreased dramatically and a ratio over $5\%$ dose difference and average dose difference was less than $2\%$. This optimization method is effective in adjusting the error of the film isocenter shift, which Is the largest part of systemic errors, and the results of this research suggested the quantitative acceptable criteria could be accurate and useful in clinical application of dosimetric verification using film dosimetry as follows; film isocenter shift with optimization should be within ${\pm}$1 mm, and a ratio over $5\%$ dose difference and average dose difference were less than $2\%$.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.1
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• pp.19-31
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• 2005

Purpose : To supply the information of EPID system and to analyze the possibility of substitution EPID for film dosimetry. Materials & Methods : With amorphous silicon(aSi) type EPID and liquid filled lonization chamber(LC) type EPID, the reproducibility according to focus detector distance(FDD) change and gantry rotation was analyzed, and also the possible range of image acquisition was analyzed with Alderson Rando phantom. The resolution and the contrast of aSi type EPID image were analyzed through Las Vegas phantom and water phantom. DMLC image was analyzed with X-Omat V film and EPID to see wether it could be applied to the qualify assurance(QA) of IMRT. Results : The reproducibility of FDD position was within 1mm, but the reproducibility of gantry rotation was ${\pm}2,\;{\pm}3mm$ respectively. The resolution and the contrast of EPID image were affected by dose rate, image acquisition time, image acquisition method and frame number. According to the possible range of image acquisition of EPID, it is verified that the EPID is easier to use than film. There is no difference between X-Omat V film and EPID images for the QA of IMRT. Conclusion : Through various evaluation, we could obtain lots of useful information about the EPID. Because the EPID has digital data, also we found that the EPID is more useful than film dosimerty for the periodical Qualify Assurance of IMRT. Especially when it is difficult to do point dose measurement with diode or ionization chamber, the EPID could be very useful substitute. And we found that the diode and ionization chamber are difficult to evaluate the sliding window images of IMRT, but the EPID was more useful to do it.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.1
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• pp.1-5
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• 2006

Purpose: IMRT quality assurance(Q.A) is consist of the absolute dosimetry using ionization chamber and relative dosimetry using the film. We have in general used 0.015 cc ionization chamber, because small size and measure the point dose. But this ionization chamber is too small to give an accurate measurement value. In this study, we have examined the degree of calculated to measured dose difference in intensity modulated radiotherapy(IMRT) based on the observed/expected ratio using various kinds of ion chambers, which were used for absolute dosimetry. Materials and Methods: we peformed the 6 cases of IMRT sliding-window method for head and neck cases. Radiation was delivered by using a Clinac 21EX unit(Varian, USA) generating a 6 MV x-ray beam, which is equipped with an integrated multileaf collimator. The dose rate for IMRT treatment is set to 300 MU/min. The ion chamber was located 5cm below the surface of phantom giving 100cm as a source-axis distance(SAD). The various types of ion chambers were used including 0.015cc(pin point type 31014, PTW. Germany), 0.125 cc(micro type 31002, PTW, Germany) and 0.6 cc(famer type 30002, PTW, Germany). The measurement point was carefully chosen to be located at low-gradient area. Results: The experimental results show that the average differences between plan value and measured value are ${\pm}0.91%$ for 0.015 cc pin point chamber, ${\pm}0.52%$ for 0.125 cc micro type chamber and ${\pm}0.76%$ for farmer type 0.6cc chamber. The 0.125 cc micro type chamber is appropriate size for dose measure in IMRT. Conclusion: IMRT Q.A is the important procedure. Based on the various types of ion chamber measurements, we have demonstrated that the dose discrepancy between calculated dose distribution and measured dose distribution for IMRT plans is dependent on the size of ion chambers. The reason is small size ionization chamber have the high signal-to-noise ratio and big size ionization chamber is not located accurate measurement point. Therefore our results suggest the 0.125 cc farmer type chamber is appropriate size for dose measure in IMRT.