Purpose: To develop a whole body frame for the purpose of reducing patient motion and minimizing setup error for extra-cranial stereotactic radiotherapy, and to evaluate the repositioning setup error of a patient in the frame. Materials and Methods: The developed whole body frame is composed of a base plate, immobilizer, vacuum cushion, ruler and belts. The dimension of the base plate is 130 cm in length, 50 cm in width and 1 cm in thickness. The material used in the base plate of the frame was bakelite and the immobilizer was made of acetal. In addition, Radiopaque angio-catheter wires were engraved on the base plate for a coordinate system to determine the target localization. The measurement for radiation transmission and target localization is peformed in order to test the utilization of the frame. Also, a Matlab program analyzed the patients setup error by using the patient's setup images obtained from a CCTV camera and digital record recorder (DVR). Results: A frame that is useful for CT simulation and radiation treatment was fabricated. The frame structure was designed to minimize collisions from the changes in the rotation angle of the gantry and to maximize the transmission rate of the Incident radiation at the lateral or posterior oblique direction. The lightening belts may be used for the further reduction of the patient motion, and the belts can be adjusted so that they are not in the way of beam direction. The radiation transmission rates of this frame were measured as 95% and 96% at 10 and 21 MV, respectively. The position of a test target on the skin of a volunteer is accurately determined by CT simulation using the coordinate system in the frame. The estimated setup errors by Matlab program are shown 3.69$\pm$1.60, 2.14$\pm$0.78 mm at the lateral and central chest, and 7.11 $\pm$2.10, 6.54$\pm$2.22 mm at lateral and central abdomen, respectively. The setup error due to the lateral motion of breast is shown as 6.33$\pm$ 1.55 mm. Conclusion: The development and test of a whole body frame has proven very useful and practical in the radiosurgery for extra-cranial cancers. It may be used in determining target localization, and it can be used as a patient immobilization tool. More experimental data should be obtained in order to improve and confirm the results of the patient setup error.
The modern radiotherapy technique which delivers a large amount of dose to patients asks to confirm the positions of patients or tumors more accurately by using X-ray projection images of high-definition. However, a rapid increase in patient's exposure and image information for CT image acquisition may be additional burden on the patient. In this study, by introducing structural similarity (SSIM) index that can effectively extract the structural information of the image, we analyze the differences between daily acquired x-ray images of a patient to verify the accuracy of patient positioning. First, for simulating a moving target, the spherical computational phantoms changing the sizes and positions were created to acquire projected images. Differences between the images were automatically detected and analyzed by extracting their SSIM values. In addition, as a clinical test, differences between daily acquired x-ray images of a patient for 12 days were detected in the same way. As a result, we confirmed that the SSIM index was changed in the range of 0.85~1 (0.006~1 when a region of interest (ROI) was applied) as the sizes or positions of the phantom changed. The SSIM was more sensitive to the change of the phantom when the ROI was limited to the phantom itself. In the clinical test, the daily change of patient positions was 0.799~0.853 in SSIM values, those well described differences among images. Therefore, we expect that SSIM index can provide an objective and quantitative technique to verify the patient position using simple x-ray images, instead of time and cost intensive three-dimensional x-ray images.
American Association of Physicists in Medicine (AAPM) Published Task Group 40 report which includes recommendations for comprehensive quality assurance (QA) for medical linear accelerator in 1994 and TG-142 report for recommendation for QA which includes procedures such as intensity-modulated radiotherapy (IMRT), stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) in 2010. Recently, Nuclear Safety and Security Commission (NSSC) published NSSC notification no. 2015-005 which is "Technological standards for radiation safety of medical field". This notification regulate to establish guidelines for quality assurance which includes organization and job, devices, methods/frequency/tolerances and action levels for QA, and to implement quality assurance in each medical institution. For this reason, all of these facilities using medical machine for patient treatment should establish items, frequencies and tolerances for proper QA for medical treatment machine that use the techniques such as non-IMRT, IMRT and SRS/SBRT, and perform quality assurance. For domestic, however, there are lack of guidelines and reports of Korean Society of Medical Physicists (KSMP) for reference to establish systematic QA report in medical institutes. This report, therefore, suggested comprehensive quality assurance system such as the scheme of quality assurance system, which is considered for domestic conditions, based the notification of NSSC and AAPM TG-142 reports. We think that the quality assurance system suggested for medical linear accelerator also help establishing QA system for another high-precision radiation treatment machines.
Lee, Soon Sung;Choi, Sang Hyoun;Min, Chul Kee;Ji, Young Hoon;Kim, Mi-Sook;Yoo, Hyoung Jun;Kim, Chan Hyeong;Kim, Kum Bae
Progress in Medical Physics
/
v.25
no.1
/
pp.53-63
/
2014
The objective of this study is to investigate the difference of ITV lengths and ITVs between 4DCT and Slow-CT images according to respiratory patterns using a respiratory motion phantom. The respiratory periods 1~4 s and target motion 1~3 cm were applied on each respiratory pattern. 4DCT and Slow-CT images were acquired for 3 times. 4DCT and Slow-CT ITVs were measured with contouring the target in the Eclipse RTP system. The measured ITV lenghts and ITVs in 4DCT and Slow-CT images were compared to the known values. For the ITV lengths and ITVs in the 4DCT, the difference of them were reduced as the respiratory period is longer and target motion is shorter. For the Slow-CT, there was same tendency with change in 4DCT ITV lengths and ITVs about target motion. However, the difference of ITV lengths and ITVs for the respiratory periods were the lowest in respiratory period 1 second and different slightly within respiratory period 2-4 seconds. According to the respiratory patterns, pattern A had the highest reproducibility. Pattern B, C and D were showed the difference similar to each other. However, for pattern E, the reproducibility was the lowest compared with other four patterns. The difference of ITV lengths and ITVs between Slow-CT and 4DCT was increased by increasing the respiratory periods and target motion for all respiratory patterns. When the difference of Slow-CT ITV lengths and ITVs were compared with that of 4DCT ITV lengths and ITVs, Slow-CT ITV lengths and ITVs were approximately 22 % smaller than 4DCT, and the representations of target were different in each pattern. In case of pattern A, B and C, length difference was 3 mm at S (superior) and I (inferior) direction, and the length difference of pattern D was 1.45 cm at only "I" direction whereas the length difference of pattern E was 5 mm longer in "S" direction than "I" direction. Therefore, the margin in SI directions should be determined by considering the respiratory patterns when the margin of Slow-CT is compensated for 4DCT ITV lengths. Afterward, we think that the result of this study will be useful to analyze the ITV lengths and ITVs from the CT images on the basis of the patient respiratory signals.
Intensity Modulated Radiotherapy (IMRT) is increasing its use recently due to its benefits of minimizing the dose on surrounding normal organs and being able to target a high dose specifically to the tumor. The study aims to measure and evaluate the dose distribution according to its dynamic changes in Mapcheck. In order to verify the dose distribution by EDW angle($10^{\circ}$,$15^{\circ}$,$20^{\circ}$,$25^{\circ}$,$30^{\circ}$,$45^{\circ}$,$60^{\circ}$), field size (asymmetric field) and depth changes (1.5 cm, 5.0 cm) using IMRT in Clinac ix, a solid phantom was placed on the Mapcheck and 100MU was exposed by 6 MV, 10MV X-ray. Using a 6MV, 10MV energy, the percentage depth dose according to a dynamic changes at a maximum dose depth (1.5 cm) and at 5.0 cm depth showed the value difference of maximum 0.6%, less than 1%, which was calculated by a treatment program device considering the maximum dose depth at the center as 100%, the percentage depth dose was in the range between 2.4% and 7.2%. Also, the maximum value difference of a percentage depth dose was 4.1% in Y2-OUT direction, and 1.7% in Y1-IN direction. When treating a patient using a wedge, it is considered that using an enhanced dynamic wedge is effective to reduce the scattered dose which induces unnecessary dose to the surroundings. In particular, when treating a patient at clinic, a treatment must be performed considering that the wedge dose in a toe direction is higher than the dose in a heel direction.
Background: In clinical trials with no upper age limit, the proportion of older patients is usually small, probably reflecting the more conservative approach adopted by clinicians when treating the elderly. An exploratory analysis of elderly patients in the RECORD-1 Trial showed that patients ${\geq}$ 65 y.o. had superior median PFS than overall RECORD-1 population (5.4 months and 4.9 months, respectively). We investigated the efficacy, relative benefit and safety of Everolimus (EVE) as sequential therapy after failure of VEGFr-TKI therapy for older patients with metastatic renal cell cancer (mRCC), in daily practice. Materials and Methods: 172 consecutive IRB approved patients with mRCC (median age 65, M:F 135/37, 78% clear cell) who received salvage EVE at 39 tertiary institutions between October 2009 and August 2011 were included in this analysis. Some 31% had progressed on sunitinib, 22% on sorafenib, 1% on axitinib, 41% on sequential therapy, and 5% had received other therapy. Patients with brain metastases were not included and 95% of the patients had a ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 or 1. Previous radiotherapy was an exclusion criterion, but prior chemotherapy was permitted. Adequate organ function and hematologic parameters were mandatory. EVE administration was approved by the institutional review board at each participating institution and signed informed consent was obtained from all patients. Results: Median time of the whole cohort to last follow-up was 3.5 months (range 0.4-15.2 months). Forty four percent were continuing to take EVE at last followup. There were 86 (50%) patients ${\geq}$ 65 y.o. and 86 (50%) <65 y.o. The percentage of patients who showed PR/SD was higher in the older group than in the younger one (5.9%/61.2% vs 1.2%/46.5%, respectively). Median survival of older patients was also significantly longer (3.5 +/- 0.31 vs 3.1 +/- 0.34, hazard ratio=0.45, CI; 0.255-0.802). Analysis using Cox regression model adjusted for gender, PS, number of metastases, site of metastases, histology, smoking history and age detected an association between age and PFS (p=0.011). The frequency of adverse events in elderly patients treated with EVE was no greater than that in younger patients, although such toxicity may have had a greater impact on their quality of life. Conclusions: Older patients should not generally be excluded from accepted therapies (mTOR inhibitors after failure of VEGFr-TKI therapy) for mRCC.
Objectives : We study the feasibility and pharmacokinetics of cisplatin concurrent chemoradiation for advanced head and neck cancer patient undergoing hemodialysis. Materials and Methods : A 57-year old male with end stage renal disease developed stage III external auditory canal cancer. Complete resection surgery was done. Postoperative 6 months, local recurrence was occurred. Despite excision and adjuvant radiotherapy, local tumor was recurred. We decided to treat a cisplatin concurrent chemoradiotherapy. Cisplatin was administered at a dose of $20mg/m^2$ for 30 min. Hemodialysis was started 30 min after completion of the cisplatin infusion and performed for 4 hours. Hemodialysis was performed on day 3 and 5 of chemotherapy. Plasma samples were collected at specified times after administration of cisplatin. Result : At the end of the third cycle of cisplatin concurrent chemoradiotherapy, the tumor size was markedly decreased. The maximum plasma concentrations of plasma platinum and free platinum were 0.74 and $0.37{\mu}g/ml$ respectively. The area under the curve of plasma platinum and free platinum were 94.7 and $11.3{\mu}g{\cdot}h/ml$ respectively. Conclusion : We report a case of Cisplatin concurrent chemoradiation for hemodialysis patient with advanced head and neck cancer and suggest full dose cisplatin concurrent chemoradiotherpay is tolerable for these patients.
Kim, Jung-Sun;Nam, Ki-Pyo;Park, Seung-Yong;Ryu, Jae-Kwang;Cha, Min-Kyeong
The Korean Journal of Nuclear Medicine Technology
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v.14
no.1
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pp.3-7
/
2010
Purpose: The usefulness of Positron Emission Tomography (PET) images in diagnosis, staging, recurrent and treatment response evaluation has already been known. However, tumors which are small size, located in lower lobe of lung or upper lobe of liver are shown misalignment, distortion and different Standard Uptake Value (SUV) by respiration in PET images. Therefore, if radiotherapy based on normal respiration, it may cause low treatment response or more side effects because targets which had to treat, out of treat range or over dose to normal tissue. The purpose of this study is to evaluate attenuation-correction with Average CT (ACT) for more accuracy SUV measurement and minimize artifact by respiration. Materials and Methods: 13 patients, who had tumors which are around the diaphragm, underwent ACT scan after Helical CT (HCT) scan with PET/CT (Discovery DSTE 8; GE Healthcare). We quantified the differences between attenuation corrected image with HCT and attenuation corrected image with ACT in artifact size and maximum SUV ($SUV_{max}$). Artifacts were evaluated by measurement of the curved photogenic area in the lower thorax of the PET images for all patients. $SUV_{max}$ was measured separately at the primary tumors. Analysis program was Advantage Workstation v4.3 (GE Healthcare). Patients were injected with 7.4 MBq (0.2 $mC_i$) per kg of $^{18}F$-FDG and scanned 1 hour after injection. The PET acquisition was 3 minute per bed. Results: Significantly lower artifact were observed in PET/ACT images than in PET/HCT images (below-thoracic artifacts caused by under corrected $1.5{\pm}3.5$ cm vs. $13.4{\pm}4.2$ cm). Significantly higher $SUV_{max}$ were noted in PET/ACT images than in PET/HCT images in the primary tumor. Compared with PET/HCT images, $SUV_{max}$ in PET/ACT images were higher by $5.3{\pm}3.9%$ (mean value) tumor. The highest difference was observed in Lower lobe of lung (7.7 to 8.7; 13%). Conclusion: Due to its significantly reduced artifacts in lower thoracic, attenuation corrected image with ACT images provided more reliable $SUV_{max}$ and may be helpful in monitoring treatment response. Moreover, ACT can separate upper lobe of liver and lower lobe of lung, it may be helpful in interpretation. ACT will be clinically useful, considering increased dose caused by ACT scan and adapt.
Lee, Soon Sung;Park, Dong Wook;Shin, Dong Oh;Kim, Dong Wook;Kim, Kum Bae;Oh, Yoon-Jin;Kim, Juhye;Kwon, Na Hye;Kim, Kyeong Min;Choi, Sang Hyoun
Journal of the Korean Society of Radiology
/
v.11
no.7
/
pp.627-635
/
2017
Brachytherapy is generally performed in conjunction with external radiation therapy, and the treatment course is very complicated, which can lead to radiation accidents. In order to solve this problem, we designed the process map by applying the failure mode and effects analysis (FMEA) method to the Brachytherapy and scored the risk priority number (RPN) for each treatment course based on this process map. The process map consisted of five steps, Patient consulting", "Brachytherapy simulation", "CT simulation", "Brachytherapy treatment planning" and "Treatment". In order to calculate the RPN, doctor, medical physicist, dose planners, therapist, and nurse participated in the study and evaluated occurrence, severity, and lack of detectability at each detail step. Overall, the process map is preceded by a patient identification procedure at each treatment stage, which can be mistaken for another patient, and a different treatment plan may be established to cause a radiation accident. As a result of evaluating the RPN for the detailed steps based on the process map, overall "Patient consulting" and "Brachytherapy treatment planning" step were evaluated as high risk. The nurses showed a tendency to be different from each other, and the nurses had a risk of 55 points or more for all the procedures except "Treatment", and the "Brachytherapy simulation" step was the highest with 88.8 points. Since the treatment stage differs somewhat for each medical institution performing radiotherapy, it is thought that the risk management should be performed intensively by preparing the process map for each institution and calculating the risk RPN.
Kim Mi Sook;Yoo Seoung Yul;Cho Chul Koo;Yoo Hyung Joon;Kim Jae Young;Shim Jae Won;Lee Choon Taek;Kang Yoon Koo;Kim Tae You
Radiation Oncology Journal
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v.15
no.3
/
pp.233-241
/
1997
Purpose : This study was done to evaluate the survival rate and Prognostic factors of patients with inoperable non-small cell lung cancer(NSCLC) treated with radiation therapy. Materials and Methods A retrospective analysis was undertaken of 62 Patients who had inoperable NSCLC treated with radiation therapy from January 1991 through December 1993. According to AJCC slaging, stage IIIA was 14 patients and stage IIIB was 48 patients. Forty Gy to 70.2Gy to the primary tumor site was delivered with daily fractions of 1.8Gy or 2Gy, 5days per week. Thirty-seven patients received neoadjuvant chemotherapy. Results : Complete, partial and no response to radiation therapy were 3 patients, 34 Patients and 25 patients, respectively The median survival period of all patients was 11 month. One rear survival rate, 2 year survival rateand 5 rear survival rate for all patients were 45.0%, 14.3%, and 6.0% respectively The median survival period was 6.5 months in stage IIIA and 13 months in stage IIIB. One year survival rates were 28.6% in stage IIIA and 50.3% in stage IIIB In univariaite analysis, prognostic factors affecting survival were T-s1aging, AJCC staging, and response after radiation therapy (P<0.05) . Pretreatment peformance status affected survival but was not statistically significant (0.05
0.1). In multivariate analysis, Pathology and response to radiation therapy are independently significant prognostic factor. T stage was marginally significant (P=0.0809). During follow-up duration, distant metastasis developed in 20 patients-bone metastasis in 10 patients, brain metastasis in 3 patients, liver mentastasis in 3 patients, contralateral lung metastasis in 1 patients and multiple metastases in 3 patients. Conclusion : Conventional radiotherapy alone or combined chemoradiotherapy are unlikely to achieve long term survival in patients with NSCLC. Surgery after concurrent chemoradiotherapy is Ivied to improve the local control in our hospital
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