• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.197-203
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• 2012

Purpose: In this study, we considerate our radiation therapy process for the breast cancer patient implanted a pacemaker applying the machine movement surgery, shielding, beam selection. Materials and Methods: We perform radiation therapy to a 54 years old, breast cancer patient implanted a pacemaker. The patient underwent a surgery to move the position of a pacemaker to right side breast after consultation with cardiology department. Prescribed dose was 5,040 cGy and daily dose 180 cGy for 28 fractions. The 10 MV photon energy, field size 0/$9.5{\times}20$ cm, half beam and opposing portal irradiation are used. To find out appropriate thickness of shielding board, we carried out an experiment using a solid water phantom ($30{\times}30{\times}7$ cm), a Farmer-type chamber (TN30013, PTW, Germany) and a shielding board (Pb $28{\times}27{\times}0.1$ cm). We calculated expected absorbed dose to te pacemaker with absorb ratio and shielding ratio. In the PTP system (Eclipse, Varian, USA), we figured out how much radiation would be absorbed to the machine with and without shielding. First day of the radiation therapy, we measured head scatter to the pacemaker with MOSFET Dose Verification System (TN-RD-70-W, Medical Canada Ltd., Canada). Results: In the phantom measurement, we found out appropriate thickness was 2 mm of shielding board. In the RTP, when using 2 mm shielding the pacemaker will be absorbed 11.5~38.2 cGy and DVH is 77.3 cGy. In the first day of the therapy, 4.3 cGy was measured so 120.4 cGy was calculated during total therapy. The patient was free from any side effects, and the machine also normally functioned. Conclusion: As the report of association which have public confidence became superannuated, there is lack of data about new machine. We believe that radiation therapy to thiese kind of patients could be done successfully with co-operation, patient-suitable planning, accurate QA, frequent in-vivo dosimetry and monitoring.

• Progress in Medical Physics
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• v.18 no.3
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• pp.179-185
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• 2007

The purpose of this study is to investigate the spectra of a magnetic resonance spectroscopy (MRS) in accordance with the variance of TE and the volumes of metabolites in a localized voxel for the quality assurance using a designed single voxel spectroscopy QA phantom. Because a cone-shade phantom is designed as the volume of metabolite in a localized voxel is changeable, we try to analyze the peaks of each metabolite (NAA, Cr, Cho, Lac, etc.) in accordance with metabolite volume in a localized voxel as well as echo time (TE). All data were obtained using a 3T MRI/MRS machine and analyzed using $jMRUI^{(R)}$. The results of this study show that TE is in inverse proportion to the noise of MRS and the longer TE and the less metabolite volume in the localized voxel, the peak intensities of each metabolite decrease. In case of the lactate, its peak was observed on the all TE only if the greatest metabolite is included in the localized voxel. Then, the intensity of a metabolite is more sensitive to the metabolite volume in the localized voxel than the TE. These obtained in vitro MRS data is provide the guideline that is important for in vivo metabolite quantification. But, in the edge of cone-shape vial air bubbles were observed and spectrum could not obtained. Therefore our cone-shape MRS phantom needs to be modified in order to solve these problems.

• Journal of radiological science and technology
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• v.36 no.2
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• pp.123-129
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• 2013

This study investigated the rate of setup variance by the rotating unbalance of gantry in image-guided radiation therapy. The equipments used linear accelerator(Elekta Synergy TM, UK) and a three-dimensional volume imaging mode(3D Volume View) in cone beam computed tomography(CBCT) system. 2D images obtained by rotating $360^{\circ}$and $180^{\circ}$ were reconstructed to 3D image. Catpan503 phantom and homogeneous phantom were used to measure the setup errors. Ball-bearing phantom was used to check the rotation axis of the CBCT. The volume image from CBCT using Catphan503 phantom and homogeneous phantom were analyzed and compared to images from conventional CT in the six dimensional view(X, Y, Z, Roll, Pitch, and Yaw). The variance ratio of setup error were difference in X 0.6 mm, Y 0.5 mm Z 0.5 mm when the gantry rotated $360^{\circ}$ in orthogonal coordinate. whereas rotated $180^{\circ}$, the error measured 0.9 mm, 0.2 mm, 0.3 mm in X, Y, Z respectively. In the rotating coordinates, the more increased the rotating unbalance, the more raised average ratio of setup errors. The resolution of CBCT images showed 2 level of difference in the table recommended. CBCT had a good agreement compared to each recommended values which is the mechanical safety, geometry accuracy and image quality. The rotating unbalance of gentry vary hardly in orthogonal coordinate. However, in rotating coordinate of gantry exceeded the ${\pm}1^{\circ}$ of recommended value. Therefore, when we do sophisticated radiation therapy six dimensional correction is needed.

• Progress in Medical Physics
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• v.29 no.1
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• pp.8-15
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• 2018

This work reports the acceptance testing and commissioning experience of the Robotic Intensity-Modulated Radiation Therapy (IMRT) M6 system with a newly released $InCise^{TM}2$ Multileaf Collimator (MLC) installed at the Yonsei Cancer Center. Acceptance testing included a mechanical interdigitation test, leaf positional accuracy, leakage check, and End-to-End (E2E) tests. Beam data measurements included tissue-phantom ratios (TPRs), off-center ratios (OCRs), output factors collected at 11 field sizes (the smallest field size was $7.6mm{\times}7.7mm$ and largest field size was $115.0mm{\times}100.1mm$ at 800 mm source-to-axis distance), and open beam profiles. The beam model was verified by checking patient-specific quality assurance (QA) in four fiducial-inserted phantoms, using 10 intracranial and extracranial patient plans. All measurements for acceptance testing satisfied manufacturing specifications. Mean leaf position offsets using the Garden Fence test were found to be $0.01{\pm}0.06mm$ and $0.07{\pm}0.05mm$ for X1 and X2 leaf banks, respectively. Maximum and average leaf leakages were 0.20% and 0.18%, respectively. E2E tests for five tracking modes showed 0.26 mm (6D Skull), 0.3 mm (Fiducial), 0.26 mm (Xsight Spine), 0.62 mm (Xsight Lung), and 0.6 mm (Synchrony). TPRs, OCRs, output factors, and open beams measured under various conditions agreed with composite data provided from the manufacturer to within 2%. Patient-specific QA results were evaluated in two ways. Point dose measurements with an ion chamber were all within the 5% absolute-dose agreement, and relative-dose measurements using an array ion chamber detector all satisfied the 3%/3 mm gamma criterion for more than 90% of the measurement points. The Robotic IMRT M6 system equipped with the $InCise^{TM}2$ MLC was proven to be accurate and reliable.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.2
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• pp.75-80
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• 2006

Purpose: In radiation therapy, precise calculation of dose toward malignant tumors or normal tissue would be a critical factor in determining whether the treatment would be successful. The Radiation Treatment Planning (RTP) system is one of most effective methods to make it effective to the correction of dose due to CT number through converting linear attenuation coefficient to density of the inhomogeneous tissue by means of CT based reconstruction. Materials and Methods: In this study, we carried out the measurement of CT number and calculation of mass density by using RTP system and the homemade inhomogeneous tissue Phantom and the values were obtained with reference to water. Moreover, we intended to investigate the effectiveness and accuracy for the correction of inhomogeneous tissue by the CT number through comparing the measured dose (nC) and calculated dose (Percentage Depth Dose, PDD) used CT image during radiation exposure with RTP. Results: The difference in mass density between the calculated tissue equivalent material and the true value was ranged from $0.005g/cm^3\;to\;0.069g/cm^3$. A relative error between PDD of RTP and calculated dose obtained by radiation therapy of machine ranged from -2.8 to +1.06%(effective range within 3%). Conclusion: In conclusion, we confirmed the effectiveness of correction for the inhomogeneous tissues through CT images. These results would be one of good information on the basic outline of Quality Assurance (QA) in RTP system.

• Journal of radiological science and technology
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• v.39 no.4
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• pp.601-606
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• 2016

Because of non-coplanar therapy with couch rotation in respiratory gated radiation therapy, the recognition of marker movement due to the change in the distance between the infrared camera and the marker due to the rotation of the couch is called RPM (Real-time The purpose of this paper is to evaluate the accuracy of motion reflections (baseline changes) of 2D gating configuration (two dot marker block) and 3D gating configuration (six dot marker block). The motion was measured by varying the couch angle in the clockwise and counterclockwise directions by $10^{\circ}$ in the 2D gating configuration. In the 3D gating configuration, the couch angle was changed by $10^{\circ}$ in the clockwise direction and compared with the baseline at the reference $0^{\circ}$. The reference amplitude was 1.173 to 1.165, the couch angle at $20^{\circ}$ was 1.132, and the couch angle at $1.0^{\circ}$ was 1.083. At $350^{\circ}$ counterclockwise, the reference amplitude was 1.168 to 1.157, the couch angle at $340^{\circ}$ was 1.124, and the couch angle at $330^{\circ}$ was 1.079. In this study, the phantom is used to quantitatively evaluate the value of the amplitude according to couch change.

• Progress in Medical Physics
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• v.28 no.2
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• pp.54-60
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• 2017

This study was designed to measure transit dose with an electronic portal imaging device (EPID) in eight patients treated with intensity modulated radiotherapy (IMRT), and to verify the accuracy of dose delivery to patients. The calculated dose map of the treatment planning system (TPS) was compared with the EPID based dose measured on the same plane with a gamma index method. The plan for each patient was verified prior to treatment with a diode array (MapCHECK) and portal dose image prediction (PDIP). To simulate possible patient positioning errors during treatment, outcomes were evaluated after an anthropomorphic phantom was displaced 5 and 10 mm in various directions. Based on 3%/3 mm criteria, the $mean{\pm}SD$ passing rates of MapCHECK, PDIP (pre-treatment QA) for 47 IMRT were $99.8{\pm}0.1%$, $99.0{\pm}0.7%$, and, respectively. Besides, passing rates using transit dosimetry was $90.0{\pm}1.5%$ for the same condition. Setup errors of 5 and 10 mm reduced the mean passing rates by 1.3% and 3.0% (inferior to superior), 2.2% and 4.3% (superior to inferior), 5.9% and 10.9% (left to right), and 8.9% and 16.3% (right to left), respectively. These findings suggest that the transit dose-based IMRT verification method using EPID, in which the transit dose from patients is compared with the dose map calculated from the TPS, may be useful in verifying various errors including setup and/or patient positioning error, inhomogeneity and target motions.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.17-23
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• 2008

Purpose: Cone-beam CT using linear accelerator attached to on-board imager is a image guided therapy equipment. Because it is to check the patient's set-up error, correction, organ and target movement. but imaging dose should be cause of the secondary cancer when taking a image. The aim of this study is investigation of appropriate cone beam CT scan mode to compare and estimate the image quality and skin dose. Materials and Methods: Measurement by Thermoluminescence dosimeter (TLD-100, Harshaw) with using the Rando phantom are placed on each eight sites in seperately H&N, thoracic, abdominal section. each 4 methods of scan modes of are measured the for skin dose in three time. Subsequently, obtained average value. Following image quality QA protocol of equipment manufacturers using the catphan 504 phantom, image quality of each scan mode is compared and analyzed. Results: The results of the measured skin dose are described in here. The skin dose of Head & Neck are measured mode A: 8.96 cGy, mode B: 4.59 cGy, mode C: 3.46 cGy mode D: 1.76 cGy and thoracic mode A: 9.42 cGy, mode B: 4.58 cGy, mode C: 3.65 cGy, mode D: 1.85 cGy, and abdominal mode A: 9.97 cGy, mode B: 5.12 cGy, mode C: 4.03 cGy, mode D: 2.21 cGy. Approximately, dose of mode B are reduced 50%, mode C are reduced 60%, mode D are reduced 80% a point of reference dose of mode A. the results of analyzed HU reproducibility, low contrast resolution, spatial resolution (high contrast resolution), HU uniformity in evaluation item of image quality are within the tolerance value by recommended equipment manufacturer in all scan mode. Conclusion: Maintaining the image quality as well as reducing the image dose are very important in cone beam CT. In the result of this study, we are considered when to take mode A when interested in soft tissue. And we are considered to take mode D when interested in bone scan and we are considered to take mode B, C when standard scan. Increasing secondary cancer risk due to cone beam CT scan should be reduced by low mAs technique.

• Progress in Medical Physics
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• v.19 no.4
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• pp.231-240
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• 2008

We developed a user-friendly program to independently verify monitor units (MUs) calculated by radiation treatment planning systems (RTPS), as well as to manage beam database in clinic. The off-axis factor, beam hardening effect, inhomogeneity correction, and the different depth correction were incorporated into the program algorithm to improve the accuracy in calculated MUs. A beam database in the program was supposed to use measured data from routine quality assurance (QA) processes for timely update. To enhance user's convenience, a graphic user interface (GUI) was developed by using Visual Basic for Application. In order to evaluate the accuracy of the program for various treatment conditions, the MU comparisons were made for 213 cases of phantom and for 108 cases of 17 patients treated by 3D conformal radiation therapy. The MUs calculated by the program and calculated by the RTPS showed a fair agreement within ${\pm}3%$ for the phantom and ${\pm}5%$ for the patient, except for the cases of extreme inhomogeneity. By using Visual Basic for Application and Microsoft Excel worksheet interface, the program can automatically generate beam data book for clinical reference and the comparison template for the beam data management. The program developed in this study can be used to verify the accuracy of RTPS for various treatment conditions and thus can be used as a tool of routine RTPS QA, as well as independent MU checks. In addition, its beam database management interface can update beam data periodically and thus can be used to monitor multiple beam databases efficiently.

• Journal of radiological science and technology
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• v.39 no.4
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• pp.577-585
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• 2016

The purpose of this study is to evaluate the accuracy of beam delivery QA software using the MLC dynalog file, about the VMAT plan with AAPM TG-119 protocol. The Clinac iX with a built-in 120 MLC was used to acquire the MLC dynalog file be imported in MobiusFx(MFX). To establish VMAT plan, Oncentra RTP system was used target and organ structures were contoured in Im'RT phantom. For evaluation of dose distribution was evaluated by using gamma index, and the point dose was evaluated by using the CC13 ion chamber in Im'RT phantom. For the evaluation of point dose, the mean of relative error between measured and calculated value was $1.41{\pm}0.92%$(Target) and $0.89{\pm}0.86%$(OAR), the confidence limit were 3.21(96.79%, Target) and 2.58(97.42%, OAR). For the evaluation of dose distribution, in case of $Delta^{4PT}$, the average percentage of passing rate were $99.78{\pm}0.2%$(3%/3 mm), $96.86{\pm}1.76%$(2%/2 mm). In case of MFX, the average percentage of passing rate were $99.90{\pm}0.14%$(3%/3 mm), $97.98{\pm}1.97%$(2%/2 mm), the confidence limits(CL) were in case of $Delta^{4PT}$ 0.62(99.38%, 3%/3 mm), 6.6(93.4%, 2%/2 mm), in case of MFX, 0.38(99.62%, 3%/3 mm), 5.88(94.12%, 2%/2 mm). In this study, we performed VMAT QA method using dynamic MLC log file compare to binary diode array chamber. All analyzed results were satisfied with acceptance criteria based on TG-119 protocol.