• Progress in Medical Physics
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• v.29 no.2
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• pp.53-58
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• 2018

This paper evaluates patient-specific quality assurance (PSQA) in the treatment of small and multiple tumors by the CyberKnife system with fixed collimators, using an ion chamber and EBT3 films. We selected 49 patients with single or multiple brain tumors, and the treatment plans include one to four targets with total volumes ranging from 0.12 cc to 3.74 cc. All PSQA deliveries were performed with a stereotactic dose verification phantom. The A16 microchamber (Standard Imaging, WI, USA) and Gafchromic EBT3 film (Ashland ISP Advanced Materials, NJ, USA) were inserted into the phantom to measure the point dose of the target and the dose distribution, respectively. The film was scanned 1 hr after irradiation by a film digitizer scanner and analyzed using RIT software (Radiological Imaging Technology, CO, USA). The acceptance criteria was <5% for the point dose measurement and >90% gamma passing rate using 3%/3 mm and relative dose difference, respectively. The point dose errors between the calculated and measured dose by the ion chamber were in the range of -17.5% to 8.03%. The mean point dose differences for 5 mm, 7.5 mm, and 10 mm fixed cone size was -11.1%, -4.1%, and -1.5%, respectively. The mean gamma passing rates for all cases was 96.1%. Although the maximum dose distribution of multiple targets was not shown in the film, gamma distribution showed that dose verification for multiple tumors can be performed. The use of the microchamber and EBT3 film made it possible to verify the dosimetric and mechanical accuracy of small and multiple targets. In particular, the correction factors should be applied to small fixed collimators less than 10 mm.

• Journal of the Korean Society of Safety
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• v.24 no.6
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• pp.157-162
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• 2009

Radioactive medicines are used a lot owing to the increase of a PET-CT examination using glucose metabolism useful for the early diagnosis of diseases. Therefore, the spatial dose that is generated from patients and their surroundings causes the patients' guardians and health professional to be exposed to radiation. However, they get unnecessarily exposed to radiation because medical institutions lack in space for isolation and recognition of the examination. This research intended to examine the spatial dose rates by measuring the dose emitted from the patient for 48 hours to whom F-18 FDG was administered. The spatial dose rates that were measured 100cm away from the patient's body after F-18 FDG was injected were $65.88{\mu}$Sv/hr at 60-minute point, $45.13{\mu}$Sv/hr at 90-minute point, $9.88{\mu}$Sv/hr at 6-hour point, and $1.24{\mu}$Sv/hr at 12-hour point. When the dose that the guardian and health professional got was converted into the annual(240-day working) accumulative dose, it was examined that the guardian received 81.56 mSv/yr and health professional received 49.36mSv/yr. In addition, the result has revealed that the dose that the patient received from one time of PET-CT examination was 3.75mSv/yr, which is 1.5 times more when compared with the annual natural radiation exposure dose.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.1
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• pp.1-8
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• 2005

Purpose : An effect of a packing to uterine treatment of a cervical cancer using a dose-volume histogram for a point dose and a volume dose of the bladder and the rectum was analyzed by establishing a three-dimensional treatment plan using a CT image. Materials and methods : Reference points of the bladder and the rectum were marked, respectively at a treatment plan device (plato brachytherapy V14.2.4) by photographing CT(marconi, USA) when the packing was used and removed under the same condition and a treatment plan was performed to Apoint depending on ICRU38. However, in case of the rectum, a maximum point was looked up and compared with the above point because the point presented from the ICRU is not proper as a representative value of a rectum point dose. Further, the volume dose depending on volume of $50\%,\;80\%,\;and\;100\%$ point doses of the rectum and the bladder was measured. The measured values were used to analyze the effect of the packing through a Wilcoxon Signed Rank Test (a SAS statistical analysis process program). Result : The reference points at the bladder and rectum doses when the packing was removed were $116.94\;35.42\%$ and $117.59\;21.08\%$, respectively. The points when the packing was used were $107.08\;38.12\%$ and $95.19\;21.32\%$, respectively. After the packing was used, the reference points at the bladder and the rectum were decreased by $9.86\%$ and $22.4\%$, respectively. When the packing was removed, the maximum points at the bladder and the rectum were $164.51\;50.89\%,\;128.81\;33.05\%$, respectively. When the packing was used, the maximum points at the bladder and the rectum were $142.31\;44.79,\;110.08\;37.03\%$, respectively. After the packing was used, the maximum points at the bladder and the rectum were decreased by $22.2\%$ and $18.73\%$, respectively. When the packing was removed, the bladder volume at $50\%,\;80\%,\;and\;100\%$ point doses of the rectum and the bladder were $48.62{\pm}18.09\%,\;16.12{\pm}11.15\%,\;and\;7.51{\pm}6.63\%$, respectively and its rectum volume were $23.41{\pm}14.44\%,\;6.27{\pm}4.28\%,\;2.79{\pm}2.27\%$, respectively. When the packing was used, the bladder volume at $50\%,\;80\%,\;and\;100\%$ point doses of the rectum and the bladder were $40.33{\pm}16.72,\;11.63{\pm}8.72,\;and\;4.87{\pm}4.75\%$, respectively and its rectum volume were $18.96{\pm}8.37\%,\;4.75{\pm}2.58\%,\;and\;1.58{\pm}1.06\%$, respectively. After the packing was used, the bladder volume at $50\%,\;80\%,\;and\;100\%$ point doses of the rectum and the bladder were decreased by $8.29\%,\;4.49\%,\;and\;2.64\%$, respectively and its bladder volume were decreased by $4.45\%,\;1.52\%,\;and\;1.21\%$, respectively. Conclusion : Values at Reference point doses of the bladder and the rectum recommended from the ICRU 38 were 0.0781 and 0.0781, respectively and values of their maximum point doses were 0.0156 and 0.0156, respectively, as a result of which an effect of the packing using at the uterine intracavitary treatment of an uterine cervical cancer through the three-dimensional treatment plan used CT were measured. That is, the values at reference point doses and the values at maximum point doses show similar difference. However, P value was 0.15 at over $50\%,\;80\%,\;and\;100\%$ volume doses and the value shows no similar difference. In other words, the effect of the packing looks like having a difference at the point dose, but actually shows no difference at the volume dose. The reason is that the volume of the bladder and the rectum are wide but the volume of the packing is only a portion. Therefore, the effect of decreasing the point dose was not great. Further, the farer the distance is, the more weak the intensity of radiation is because the intensity of radiation is proportional to inverse square of a distance. Therefore, the effort to minimize an obstacle of the bladder and the rectum by using the packing should be made.

• Journal of Radiation Protection and Research
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• v.37 no.4
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• pp.231-236
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• 2012

This study derived measures to reduce exposure doses by identifying factors which affect the external radiation dose rate of patients treated with radiopharmaceuticals for PET-CT tests. The external radiation dose rates were measured on three parts of head, thorax and abdomen at a distance of 50cm from the surface of 60 PET-CT patients. It showed there are changes in factors affecting the external radiation dose rate over time after the administration of F-18 FDG. The external radiation dose rate was lower in the patients with more water intake than those with less water intake before the injection of radiopharmaceuticals at all three points: right after the injection of radiopharmaceuticals (average 4.17 mins), after the pre-PEET-CT urination step (average 77.47 mins), and right after the PET-CT test (average 114.15 mins). The study also found there is a need to increase the amount of water intake before the injection of radiopharmaceuticals in order to maintain a low external radiation dose rate in patients. This strategy is only possible under the assumption that the quality of the video has not changed after conducting this study on the relations between the image and quality. This study also found a need to use radiopharmaceuticals with the minimum amount needed for each patient because F-FDG doses affects the external radiation dose rate at the point right after the injection of radiopharmaceuticals. Urination frequency was the most significant factor to affect the external radiation dose rates at the point right after the PET-CT test and the point after the pre-PET-CT urination step. There is a need to realize the strategy to increase the urination frequency of patients to maintain the external radiation dose rate low (average 77.47 mins) before and after the injection of radiopharmaceuticals. In addition, at this point, there is a need to take advantage of personal strategies because the external radiation dose rate is lower if the fasting time is shorter, the contrast medium is used, and the amount of water intake is increased after the administration of radiopharmaceuticals. Finally this study found the need to be able to generalize these findings through an in-depth research on the factors affecting the external radiation dose rate, which includes radiopharmaceutical dose, urination frequency, the amount of water intake, fasting time and the use of contrast medium.

• Journal of Radiation Protection and Research
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• v.38 no.3
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• pp.157-165
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• 2013

To determine the factors affecting the external radiation dose rates of patients undergoing PET-MRI examinations and to assess the trends of these differences, we measured the changes in the dose rates of $^{18}F$-FDG during a set period of time for each body region. Consistent with theoretical predictions, the dose rate decreased over time in patients undergoing PET-MRI examinations. Furthermore, immediately after the $^{18}F$-FDG injection, the dose rate in the chest region was the highest, followed by the abdominal region, the head region, and the foot region. The dose rate decreased drastically as time passed, by 2.47-fold, from $339.23{\pm}74.70mSv\;h^{-1}$ ($6.73{\pm}5.79$ min) at the time point immediately after the $^{18}F$-FDG injection to $102.71{\pm}26.17mSv\;h^{-1}$ ($136.11{\pm}25.64$ min) after the examination. In the foot region, there were no significant changes over time, from $32.05{\pm}20.23mSv\;h^{-1}$ ($6.73{\pm}5.79$ min) at the time point immediately after the $^{18}F$-FDG injection, to $23.89{\pm}9.14mSv\;h^{-1}$ ($136.11{\pm}25.64$ min) after the examination. The dose rate is dependent on the individual characteristics of the patient, and differed depending on the body region and time point. However, the dose rates were higher in patients who had a lower body weight, shorter stature, fewer urinations, lower fluid intake, and history of diabetes mellitus. To decrease radiation exposure, it is difficult or impossible to change factors inherent to the patient, such as sex, age, height, body weight, obesity, and history of diabetes mellitus. However, factors which can be changed, such as the $^{18}F$-FDG dose, fasting time, fluid intake, number of urinations, and contrast agent dose can be controlled to minimize the external radiation exposure of the patient.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.11
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• pp.4717-4721
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• 2014

Background: Dosimetric comparison of two dimensional (2D) radiography and three-dimensional computed tomography (3D-CT) based dose distributions with high-dose-rate (HDR) intracavitry radiotherapy (ICRT) for carcinoma cervix, in terms of target coverage and doses to bladder and rectum. Materials and Methods: Sixty four sessions of HDR ICRT were performed in 22 patients. External beam radiotherapy to pelvis at a dose of 50 Gray in 27 fractions followed by HDR ICRT, 21 Grays to point A in 3 sessions, one week apart was planned. All patients underwent 2D-orthogonal and 3D-CT simulation for each session. Treatment plans were generated using 2D-orthogonal images and dose prescription was made at point A. 3D plans were generated using 3D-CT images after delineating target volume and organs at risk. Comparative evaluation of 2D and 3D treatment planning was made for each session in terms of target coverage (dose received by 90%, 95% and 100% of the target volume: D90, D95 and D100 respectively) and doses to bladder and rectum: ICRU-38 bladder and rectum point dose in 2D planning and dose to 0.1cc, 1cc, 2cc, 5cc, and 10cc of bladder and rectum in 3D planning. Results: Mean doses received by 100% and 90% of the target volume were $4.24{\pm}0.63$ and $4.9{\pm}0.56$ Gy respectively. Doses received by 0.1cc, 1cc and 2cc volume of bladder were $2.88{\pm}0.72$, $2.5{\pm}0.65$ and $2.2{\pm}0.57$ times more than the ICRU bladder reference point. Similarly, doses received by 0.1cc, 1cc and 2cc of rectum were $1.80{\pm}0.5$, $1.48{\pm}0.41$ and $1.35{\pm}0.37$ times higher than ICRU rectal reference point. Conclusions: Dosimetric comparative evaluation of 2D and 3D CT based treatment planning for the same brachytherapy session demonstrates underestimation of OAR doses and overestimation of target coverage in 2D treatment planning.

• Journal of Radiation Protection and Research
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• v.22 no.4
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• pp.299-307
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• 1997

The individual dose equivalent, $H_p$, effective dose, E, and gender specific effective dose, $E^m$ and E$^f$, were evaluated using the male and female phantoms of MIRD type located in the radial gamma radiation field near a point source. The point sources were placed at the distances of 15, 40 and 100 cm in front of the body at different heights. Two radionuclides, $^{137}Cs$ and $^{131}I$, were selected for the illustrative examples. In terms of the gender specific effective doses, $E^f$ is higher than $E^m$ with a few exceptions, e.g. the case where the point source is at the height of reproductive organs, but the differences from the sex- averaged values are not significant enough to justify use of gender specific dose conversion factors for the radial gamma field. The ratios $H_p$/E were in the range of 1 to 3 depending on the source and dosimeter positions when the dosimeter is worn on the front surface of the torso covering from chest to lower abdomen, but varied from 0.34 to 6.5 in extreme cases. When it is assumed that the typical handling procedure of radioactive source material and the typical dosimeter position(on the chest) be respected, the dosimeters calibrated against the broad parallel field appear to provide estimates with acceptable errors for the effective dose of workers exposed to radial broad gamma field around a point source.

• 대한방사선방어학회:학술대회논문집
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• 2011.11a
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• pp.208-209
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• 2011

• The Journal of Korean Society for Radiation Therapy
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• v.1 no.1
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• pp.70-78
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• 1985

The intrauterine irradiation is essential to achieve adequate tumor dose to centeral tumor mass in radio therapy for uterine malignancy. The complications of pelvic organ are known to be directly related to radiation dose and physical parameters. The comparison study of currently using 2 systems was undertaken. The simulation films and medical records of 135 patients who was treated with intrauterine irradiation at one of general hospitals in Busan and Seoul between Jan. 1983 and June 1983, were critically analized and physical parameters of low dose rate system and remote controlled high dose rate system were measured. The physical parameters include distances between lateral walls of vaginal fornices, longitudinal and lateral angles of tandem to the body axis, the distance from the external os of uterine cervix to the central axis of ovoids, the radiation dose ratio to rectum and bladder to reference point A. Followings were summary of study results: 1. In distances between lateral walls of vaginal fornices the low dose rate system showed wide distribution and relatively larger distances. In low dose rate system 5.0-5.9 cm was $55.89\%$ 6.0-6.9 cm: $23.53\%$, 4.0-4.9cm: $10.29\%$, 3.0-3.9cm: $10.29\%$, and in high dose rate system 5.0-5.9cm was $80.59\%$, 4.0-4.9cm: $17.91\%$, $6.0\~6.9\;cm:\;1.5\%$. 2. In lateral angulation of tandem to body axis, the low does system revealed mid position (the position along body axis) $64.7\%$, Lt. deviation $19.13\%$ and Rt. deviation $16.17\%$. However the high dose rate system revealed mid position $49.26\%$ Lt. deviation $40.29\%$ and Rt. deviation $10.45\%$. 3. In longitudinal angulation of tandem to body axis the mid position was $11.77\%$ and anterior angulation $88.23\%$ in low dose rate system but in high dose rate system the mid position was $1.56\%$ and anterior angulation $98.44\%$. 4. Down ward displacement of ovoids below external os was only $2.94\%$ in low dose rate system and $67.69\%$ in high dose rate system. 5. The radiation dose ration to rectum to reference point A was $102.70\%$ in high dose rate system and $70.09\%$ in low dose rate system. The dose ratio to bladder to reference point A was $78.14\%$ in high dose rate system and $75.32\%$ in low dose rate system.

• Journal of radiological science and technology
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• v.30 no.1
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• pp.33-38
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• 2007

The propose of this study is a verification of the correct calculation of the dose around source and the prescription dose of Ir-192 source in the plato treatment planning system. The source and orthogonal coordinates for lateral direction and those for the anterior posterior direction were drawn on a A4 paper and then input into the system. The prescription dose was prescribed to two points with radius 1 cm in the direction of polar angle $90^{\circ} and $270^{\circ} from the center of the source. The doses of prescription point and dose points acquired from the treatment planning system were compared with those from manual calculation using the geometry function formalism derived by Paul King et al. In this analysis, the doses of prescription point were exactly consistent with each other and those of dose points were obtained within the error point of 1.85%. And the system of accuracy was evaluated within 2% of tolerance error. Therefore, this manual dose calculation used for the geometry function formalism is considered to be useful in clinics due to its convenience and high quality assurance.