• Progress in Medical Physics
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• v.33 no.4
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• pp.150-157
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• 2022

Purpose: Elekta synergy^® was commissioned in the Seoul National University Veterinary Medical Teaching Hospital. Recently, Chung-Ang University Gwang Myeong Hospital commissioned Elekta Versa HD^TM. The beam characteristics of both machines are similar because of the same Agility^TM MLC Model. We compared measured beam data calculated using the Elekta treatment planning system, Monaco^®, for each institute. Methods: Beam of the commissioning Elekta linear accelerator were measured in two independent institutes. After installing the beam model based on the measured beam data into the Monaco^®, Monte Carlo (MC) simulation data were generated, mimicking the beam data in a virtual water phantom. Measured beam data were compared with the calculated data, and their similarity was quantitatively evaluated by the gamma analysis. Results: We compared the percent depth dose (PDD) and off-axis profiles of 6 MV photon and 6 MeV electron beams with MC calculation. With a 3%/3 mm gamma criterion, the photon PDD and profiles showed 100% gamma passing rates except for one inplane profile at 10 cm depth from VMTH. Gamma analysis of the measured photon beam off-axis profiles between the two institutes showed 100% agreement. The electron beams also indicated 100% agreement in PDD distributions. However, the gamma passing rates of the off-axis profiles were 91%-100% with a 3%/3 mm gamma criterion. Conclusions: The beam and their comparison with MC calculation for each institute showed good performance. Although the measuring tools were orthogonal, no significant difference was found.

• Radiation Oncology Journal
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• v.20 no.1
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• pp.81-90
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• 2002

Purpose : To establish and verify the proper and the practical IMRT (Intensity--modulated radiation therapy) patient QA (Quality Assurance). Materials and Methods : An IMRT QA which consists of 3 steps and 16 items were designed and examined the validity of the program by applying to 9 patients, 12 IMRT cases of various sites. The three step OA program consists of RTP related QA, treatment information flow QA, and a treatment delivery QA procedure. The evaluation of organ constraints, the validity of the point dose, and the dose distribution are major issues in the RTP related QA procedure. The leaf sequence file generation, the evaluation of the MLC control file, the comparison of the dry run film, and the IMRT field simulate image were included in the treatment information flow procedure QA. The patient setup QA, the verification of the IMRT treatment fields to the patients, and the examination of the data in the Record & Verify system make up the treatment delivery QA procedure. Results : The point dose measurement results of 10 cases showed good agreement with the RTP calculation within $3\%$. One case showed more than a $3\%$ difference and the other case showed more than $5\%$, which was out side the tolerance level. We could not find any differences of more than 2 mm between the RTP leaf sequence and the dry run film. Film dosimetry and the dose distribution from the phantom plan showed the same tendency, but quantitative analysis was not possible because of the film dosimetry nature. No error had been found from the MLC control file and one mis-registration case was found before treatment. Conclusion : This study shows the usefulness and the necessity of the IMRT patient QA program. The whole procedure of this program should be peformed, especially by institutions that have just started to accumulate experience. But, the program is too complex and time consuming. Therefore, we propose practical and essential QA items for institutions in which the IMRT is performed as a routine procedure.

• Progress in Medical Physics
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• v.21 no.3
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• pp.304-310
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• 2010

Less execution of the electron arc treatment could in large part be attributed to the lack of an adequate planning system. Unlike most linear accelerators providing the electron arc mode, no commercial planning systems for the electron arc plan are available at this time. In this work, with the expectation that an easily accessible planning system could promote electron arc therapy, a commercial planning system was commissioned and evaluated for the electron arc plan. For the electron arc plan with use of a Varian 21-EX, Pinnacle3 (ver. 7.4f), with an electron pencil beam algorithm, was commissioned in which the arc consisted of multiple static fields with a fixed beam opening. Film dosimetry and point measurements were executed for the evaluation of the computation. Beam modeling was not satisfactory with the calculation of lateral profiles. Contrary to good agreement within 1% of the calculated and measured depth profiles, the calculated lateral profiles showed underestimation compared with measurements, such that the distance-to-agreement (DTA) was 5.1 mm at a 50% dose level for 6 MeV and 6.7 mm for 12 MeV with similar results for the measured depths. Point and film measurements for the humanoid phantom revealed that the delivered dose was more than the calculation by approximately 10%. The electron arc plan, based on the pencil beam algorithm, provides qualitative information for the dose distribution. Dose verification before the treatment should be mandatory.

• Progress in Medical Physics
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• v.21 no.3
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• pp.291-297
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• 2010

This study examined the dosimetric influence of implanted gold markers in proton therapy and the effects of their positions in the spread-out Bragg peak (SOBP) proton beam. The implanted cylindrical gold markers were 3 mm long and 1.2 mm in diameter. The dosimetric influence of the gold markers was determined with markers at various locations in a proton-beam field. Spatial dose distributions were measured using a three-dimensional moving water phantom and a stereotactic diode detector with an effective diameter of 0.5 mm. Also, a film dosimetry was performed using Gafchromic External Beam Treatment (EBT) film. The GEANT4 simulation toolkit was used for Monte-Carlo simulations to confirm the measurements and to construct the dose-volume histogram with implanting markers. Motion data were obtained from the portal images of 10 patients to investigate the effect of organ motions on the dosimetric influence of markers in the presence of a rectal balloon. The underdosed volume due to a single gold marker, in which the dose was less than 95% of a prescribed amount, was 0.15 cc. The underdosed volume due to the presence of a gold marker is much smaller than the target volume. However, the underdosed volume is inside the gross tumor volume and is not smeared out due to translational prostate motions. The positions of gold markers and the conditions of the proton-beam field give different impacts on the dose distribution of a target with implanted gold markers, and should be considered in all clinical proton-based therapies.

• Progress in Medical Physics
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• v.23 no.1
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• pp.33-41
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• 2012

For applying the quality assurance (QA) of volumetric modulated arc therapy (VMAT) introduced in Eulji Hospital, we classify it into three different QA steps, treatment planning QA, pretreatment delivering QA, and treatment verifying QA. These steps are based on the existing intensity modulated radiation therapy (IMRT) QA that is currently used in our hospital. In each QA step, the evaluated items that are from QA program are configured and documented. In this study, QA program is not only applied to actual patient treatment, but also evaluated to establish a reference of clinical acceptance in pretreatment delivering QA. As a result, the confidence limits (CLs) in the measurements for the high-dose and low-dose regions are similar to the conventional IMRT level, and the clinical acceptance references in our hospital are determined to be 3 to 5% for the high-dose and the low-dose regions, respectively. Due to the characteristics of VMAT, evaluation of the intensity map was carried out using an ArcCheck device that was able to measure the intensity map in all directions, $360^{\circ}$. With a couple of dosimetric devices, the gamma index was evaluated and analyzed. The results were similar to the result of individual intensity maps in IMRT. Mapcheck, which is a 2-dimensional (2D) array device, was used to display the isodose distributions and gave very excellent local CL results. Thus, in our hospital, the acceptance references used in practical clinical application for the intensity maps of $360^{\circ}$ directions and the coronal isodose distributions were determined to be 93% and 95%, respectively. To reduce arbitrary uncertainties and system errors, we had to evaluate the local CLs by using a phantom and to cooperate with multiple organizations to participate in this evaluation. In addition, we had to evaluate the local CLs by dividing them into different sections about the patient treatment points in practical clinics.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.172-178
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• 2002

Purpose : X-ray film over responds to low-energy photons in relative photon beam dosimetry because its sensor is based on silver bromide crystals, which are high-Z molecules. This over-response becomes a significant problem in clinical photon beam dosimetry particularly in regions outside the penumbra. In intensity modulated radiation therapy (IMRT), the radiation field is characterized by multiple small fields and their outside-penumbra regions. Therefore, in order to use film dosimetry for IMRT, the nature the source of the over-response in its radiation field need to be known. This study is aimed to verify and possibly improve film dosimetry for IMRT. Materials and Method : Modulated beams were constructed by a combination of five or seven different static radiation fields using 6 MeV X-rays. In order to verify film dosimetry, we used X-ray film and an ion chamber were used to measure the dose profiles at various depths in a phantom. In addition, in order to reduce the over-response, 0.01 inch thick lead filters were placed on both sides of the film. Results : The measured dose profiles showed a film over-response at the outside-penumbra and low dose regions. The error increased with depths and approached 15% at a maximum for the field size of $15{\times}15cm^2$ at 10 cm depth. The use of filters reduced the error to 3%, but caused an under-response of the dose in a perpendicular set-up. Conclusion : This study demonstrated that film dosimetry for IMRT involves sources of error due to its over-response to low-energy Photons. The use of filers can enhance the accuracy in film dosimetry for IMRT. In this regard, the use of optimal filter conditions is recommended.

• Journal of radiological science and technology
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• v.33 no.1
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• pp.61-66
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• 2010

In this paper we evaluated small field dose characteristics of exclusive cone fields versus square fields for stereotactic radiosugery (SRS) which is based on linear accelerators (LINAC). For this test, we used a small beam detector (stereotactic fields detector : SFD) with a 6 MV photon beam and a water phantom system (IBA, Germany). Percentage depth dose (PDD) was measured for different field sets (cones : ${\Phi}1\;cm$, ${\Phi}2\;cm$, ${\Phi}3\;cm$ ; square fields : $1{\times}1\;cm^2$, $2{\times}2\;cm^2$, $3{\times}3\;cm^2$) at a source skin distance (SSD) of 100 cm. We measured the point depths at 1.5 cm, 5 cm, 10 cm, 20 cm, and 30 cm. The output factors were measured under the same geometrical conditions of the PDD and normalized at the maximum dose depth. To analyze the penumbra, we measured the dose profile with 95 cm of SSD, 5 cm of depth for each field sizes (${\Phi}1\;cm$, ${\Phi}3\;cm$, $1{\times}1\;cm^2$, and $3{\times}3\;cm^2$) using SFD. We obtained the values for every 1 mm interval in the physical field (90%) and 0.5 mm interval in the penumbra region (20 to 80%). The PDD variation of exclusive cones and square fields were 4.3 to 7.9% lesser than the standard field size ($10{\times}10\;cm^2$. The variation of PDD was reduced while the field size was increased. To compare the beam quality, we analyzed the $PDD_{20,10}$ and the results showed under the 1% of variations for all experiments except for ${\Phi}1\;cm$ cone and $1{\times}1\;cm^2$ fields. Output factors of exclusive cone were increased 3.1~4.6% than the square fields, and the penumbra region of exclusive cone was reduced 20% as compared to the square fields. As the previous researches report, it is very important for SRS and SFD that precise dosimetry in small beam fields. In this paper, we showed the effectiveness of exclusive cone, compared to square field. And we will study on the various detector characteristics for small beam fields.

• Progress in Medical Physics
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• v.26 no.2
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• pp.93-98
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• 2015

The purpose of this study is to see the usefulness of lead apron for critical organs near the breast under examining. For clinical experiment, 30 female volunteers who agreed to their participation in the experiments, were chosen and divided into two groups, 15 in group A and 15 in group B respectively. group A is to see whether each side of breast under mammography affects to other side glandular on the critical organs is same, because it is not allowed to scan the both breast for same person or to scan repeatedly. Group B is to see the effectiveness of lead apron during the mammography of right breast. Glass dosimeters were placed on the thyroid, the contralateral breast, and lower abdomen where near the breast during examining. The average glandular doses on the surface in mammography of the thyroid gland, the contralateral breast, the lower abdomen were 0.0692 mGy, 0.6790 mGy, and 0.0122 mGy, respectively, which was an extremely low level of glandular dose. In group B, as to the thyroid gland, average dose was decreased from 0.0922 mGy to 0.0158 mGy. The average dose of contralateral breast was decreased from 0.8575 mGy to 0.0286 mGy. The average doses of lower abdomen was decrease 0.0150 mGy to 0.0173 mGy. As to the lower abdomen, dose decreased from 0.0150 mGy before the use of an apron down to 0.0173 mGy after the use. As p-value was under 0.05, statistically significant difference was observed between the two groups. Wearing an apron can have the protective effects on the thyroid gland up to 20 times lower than not wearing one. Besides, it is also necessary to protect the other breast during the examination by wearing one.

• Journal of the Korean Society of Radiology
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• v.8 no.4
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• pp.181-187
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• 2014

The purpose of this study were to analyze the characteristic of the glow curves in order to the glow temperature of the thermoluminescent dosimeters (TLDs) for the absorbed dose measurement of the radiation therapy. In this study, we was used the TLDs of the LiF:Mg${\cdot}$Ti, LiF:Mg${\cdot}$Cu${\cdot}$P, $CaF_2$:Dy, $CaF_2$:Mn (Thermo Fisher Scientific Inc., USA). The source-to-solid dry phantom (RW3 slab, IBA Dosmetry, Germany) surface distance was set at 100 cm, and the exposure dose of 100 MU (monitor unit) was used 6- and 15-MV X-rays, and 6- and 12-MeV electron beams in the reference depth, respectively. After the radiations exposure, we were to analyze the glow curves by using the TL reader (Hashaw 3500, Thermo Fisher Scientific Inc., USA) at the fixed heating rate of $15^{\circ}C/sec$ from $50^{\circ}C$ to $260^{\circ}C$. The glow peaks, the trapping level in the captured electrons and holes combined with the emitted light, were discovered the two or three peak. When the definite increasing the temperature of the TLDs, the maximum glow peak representing the glow temperature was follow as; $LiF:Mg{\cdot}Ti$: $185.5{\pm}1.3^{\circ}C$, $LiF:Mg{\cdot}Ti$: $135.0{\pm}5.1^{\circ}C$, $CaF_2$:Dy: $144.0{\pm}1.6^{\circ}C$, $CaF_2$:Mn: $294.3{\pm}3.8^{\circ}C$, respectively. Because the glow emission probability of the captured electrons depend on the heating temperature after the exposure radiation, TLDs by applying the fixed heating rate, the accuracy of measurement will be able to improve within the absorbed dose measurement of the radiation therapy.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.31-42
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• 2022

Purpose: This study measures and compares the surface dose values in the virtual target volume using Tomotherapy, Halcyon, and TrueBeam equipment using 6MV-Flattening Filter-Free(FFF) energy. Materials and Methods: CT scan was performed under three conditions of without bolus, 0.5 cm bolus, and 1 cm bolus using an IMRT phantom (IBA, Germany). The Planning Target Volume (PTV) was set at the virtual target depth, and the treatment plan was established at 200 cGy at a time. For surface dosimetry, the Gafchromic EBT3 film was placed in the same section as the treatment planning system and repeated measurements were performed 10 times and then analyzed. Result: As a result of measuring the surface dose for each equipment, without, 0.5 cm, 1 cm bolus is in this order, and the result of Tomotherapy is 115.2±2.0 cGy, 194.4±3.3 cGy, 200.7±2.9 cGy, The result in Halcyon was 104.7±3.0 cGy, 180.1±10.8 cGy, 187.0±10.1 cGy, and the result in TrueBeam was 92.4±3.2 cGy, 148.6±5.7 cGy, 155.8±6.1 cGy, In all three conditions, the same as the treatment planning system, Tomotherapy, Halcyon, TreuBeam was measured highly in that order. Conclusion: Higher surface doses were measured in Tomotherapy and Halcyon compared to TrueBeam equipment. If the characteristics of each equipment are considered according to the treatment site and treatment purpose, it is expected that the treatment efficiency of the patient will increase as well as the treatment satisfaction of the patient.