• Radiation Oncology Journal
• /
• v.19 no.1
• /
• pp.53-65
• /
• 2001

Purpose : To improve the local control of patients with nasopharyngeal cancer, we have implemented 3-D conformal radiotherapy and forward intensity modulated radiation therapy (IMRT) to used of compensating filters. Three dimension conformal radiotherapy with intensity modulation is a new modality for cancer treatments. We designed 3-D treatment planning with 3-D RTP (radiation treatment planning system) and evaluation dose distribution with tumor control probability (TCP) and normal tissue complication probability (NTCP). Material and Methods : We have developed a treatment plan consisting four intensity modulated photon fields that are delivered through the compensating tilters and block transmission for critical organs. We get a full size CT imaging including head and neck as 3 mm slices, and delineating PTV (planning target volume) and surrounding critical organs, and reconstructed 3D imaging on the computer windows. In the planning stage, the planner specifies the number of beams and their directions including non-coplanar, and the prescribed doses for the target volume and the permissible dose of normal organs and the overlap regions. We designed compensating filter according to tissue deficit and PTV volume shape also dose weighting for each field to obtain adequate dose distribution, and shielding blocks weighting for transmission. Therapeutic gains were evaluated by numerical equation of tumor control probability and normal tissue complication probability. The TCP and NTCP by DVH (dose volume histogram) were compared with the 3-D conformal radiotherapy and forward intensity modulated conformal radiotherapy by compensator and blocks weighting. Optimization for the weight distribution was peformed iteration with initial guess weight or the even weight distribution. The TCP and NTCP by DVH were compared with the 3-D conformal radiotherapy and intensitiy modulated conformal radiotherapy by compensator and blocks weighting. Results : Using a four field IMRT plan, we have customized dose distribution to conform and deliver sufficient dose to the PTV. In addition, in the overlap regions between the PTV and the normal organs (spinal cord, salivary grand, pituitary, optic nerves), the dose is kept within the tolerance of the respective organs. We evaluated to obtain sufficient TCP value and acceptable NTCP using compensating filters. Quality assurance checks show acceptable agreement between the planned and the implemented MLC(multi-leaf collimator). Conclusion : IMRT provides a powerful and efficient solution for complex planning problems where the surrounding normal tissues place severe constraints on the prescription dose. The intensity modulated fields can be efficaciously and accurately delivered using compensating filters.

• Proceedings of the Korean Society of Medical Physics Conference
• /
• 1999.11a
• /
• pp.88-89
• /
• 1999

• Proceedings of the Korean Society of Medical Physics Conference
• /
• 2002.09a
• /
• pp.11-12
• /
• 2002

Accidental overexposures by radiotherapy have gathered attention recently in Japan. The widely publicized accidents have occurred at the government official benefit society hospital and at the hospital affiliated to a medical school. The accident at the government official benefit society hospital occurred when one of two existing accelerators was renewed. A radiotherapy planning system was also introduced at that time. Then treatment planning for the old and the new linear accelerator was performed using the system. There were variations in wedge factors for the 30 degrees wedge filter between the old and the new linear accelerator. That is, the difference in the structure of the wedge filter (30 degrees) resulted in variations of the wedge factors between both accelerators. In order to keep strength, a lead board was backed to the lead wedge filter for the new linear accelerator, whereas the wedge filter for the old one was made of the iron. The X-ray attenuation of the iron wedge filter is smaller than that of the lead wedge filter. The basic beam data of the old linear accelerator, however, wasn't delivered properly between the user and the maker. Then, the accident took place because the same wedge factor was used for the old and the new linear accelerator. On the other hand, the accident which occurred at the university hospital was brought about by the input mistake in initialization of the computer system when a linear accelerator was introduced. The input mistake was found when the software of the system was updated. If the dose had been measured and confirmed adequately, the accidents could have been prevented in both cases.

• Progress in Medical Physics
• /
• v.30 no.1
• /
• pp.1-6
• /
• 2019

Purpose: This study conducts a comparative evaluation of the skin dose in CyberKnife (CK) and Helical Tomotherapy (HT) to predict the accurate dose of radiation and minimize skin burns in head-and-neck stereotactic body radiotherapy. Materials and Methods: Arbitrarily-defined planning target volume (PTV) close to the skin was drawn on the planning computed tomography acquired from a head-and-neck phantom with 19 optically stimulated luminescent dosimeters (OSLDs) attached to the surface (3 OSLDs were positioned at the skin close to PTV and 16 OSLDs were near sideburns and forehead, away from PTV). The calculation doses were obtained from the MultiPlan 5.1.2 treatment planning system using raytracing (RT), finite size pencil beam (FSPB), and Monte Carlo (MC) algorithms for CK. For HT, the skin dose was estimated via convolution superposition (CS) algorithm from the Tomotherapy planning station 5.0.2.5. The prescribed dose was 8 Gy for 95% coverage of the PTV. Results and Conclusions: The mean differences between calculation and measurement values were $-1.2{\pm}3.1%$, $2.5{\pm}7.9%$, $-2.8{\pm}3.8%$, $-6.6{\pm}8.8%$, and $-1.4{\pm}1.8%$ in CS, RT, RT with contour correction (CC), FSPB, and MC, respectively. FSPB showed a dose error comparable to RT. CS and RT with CC led to a small error as compared to FSPB and RT. Considering OSLDs close to PTV, MC minimized the uncertainty of skin dose as compared to other algorithms.

• Asian Pacific Journal of Cancer Prevention
• /
• v.13 no.4
• /
• pp.1159-1166
• /
• 2012

Research on radiation oncologists has indicated that there is a shortage in supply of specialist workers in this field internationally, and also within Australia. However, there are no current estimates as to what the future Australian radiotherapy workforce will look like. This paper aims to review the current status and capacity of the three main disciplines that make up the radiation oncology workforce in Australia and project the workforce supply and demand for 2014 and 2019. Using data on the workforce from a survey of all radiotherapy facilities operating in Australia in 2008 a workforce model was constructed. This study found that there will be a future shortfall of radiation oncologists, radiation therapists and radiation oncology medical physicists working in radiation oncology treatment. By 2014 there will be 109 fewer radiation oncologists than what will be demanded, and by 2019 this figure will increase to a shortfall of 155 radiation oncologists. There was a projected shortfall of 612 radiation therapists by 2014, with this figure slightly decreasing to a shortfall of 593 radiation therapists in 2019. In 2014, there was projected to be a deficit of 104 radiation oncology medical physicists with a persisting shortfall of 78 in 2019. This future projected shortage highlights the need for radiation oncology workforce planning.

• Proceedings of the Korean Society of Medical Physics Conference
• /
• 2002.09a
• /
• pp.90-93
• /
• 2002

In particle radiotherapy, a shape of the beam to conform the irradiation field is statically defined by the compensator, collimator and potal devices at the outside of the patient body. However the target such as lung or liver cancer moves along with respiration. This increases the irradiated volume of normal tissue. Prior discussions about organ motions along with respiration have been mainly focused on inferior-superior movement that was usually perpendicular to beam axis. On the other hand, the change of the target depth along the beam axis is very important especially in particle radiotherapy, because the range end of beam (Bragg peak) is so sharp as to be matched to distal edge of the target. In treatment planning, the range of the particle beam inside the body is calculated using a calibration curve relating CT number and water equivalent path length (WEL) to correct the inhomogeneities of tissues. The variation in CT number along the beam path would cause the uncertainties of range calculation at treatment planning for particle radiotherapy. To estimate the uncertainties of the range calculation associated with patient breathing, we proposed the method using sequential CT images with respiration waveform, and analyzed organ motions and WELs at patients that had lung or liver cancer. The variation of the depth along the beam path was presented in WEL rather than geometrical length. In analyzed cases, WELs around the diaphragm were remarkably changed depending on the respiration, and the magnitude of these WEL variations was almost comparable to inferior-superior movement of diaphragm. The variation of WEL around the lung was influenced by heartbeat.

• Asian Pacific Journal of Cancer Prevention
• /
• v.13 no.7
• /
• pp.3061-3064
• /
• 2012

Aim: An epidemiological shift has resulted in increase in the prevalence of non-communicable diseases (NCD). Unlike other NCDs which are easily and definitely preventable, the knowledge of cancer prevention is still limited at present. Various aetiological factors are difficult to control since those are habit forming. Hence an available remedy remains its secondary and tertiary prevention for which appropriate planning is of paramount importance. Evidence based planning requires careful analysis of data with a view to prioritize various cancers. Keeping in view the fact that the adaptation of smoking free status in Chandigarh city might have a far reaching positive effect on the cancer related morbidity of the people, the following study was undertaken to provide base line data to be used for future comparisons. Methods: The registers maintained in the Department of Radiotherapy were checked and those belonging to the years 1999 to 2009 were utilized to analyze the cancer morbidity in respect to age, sex, and year of presentation to health care facility. Results: A total of 4,600 cancer patients (males=2276, females=2324) demonstrated a gradual increase in the number of cancer cases from 150 in the year 1999 to 783 in the year 2009. The most common cancers amongst males were cancer of gastro-intestinal tract (GIT) and lung (including larynx) constituting 37.3% and 27.1% of the total, respectively. In females these were cancers of breast and cervix representing 33.3% & 17.6% of total cancer cases, respectively, and lung cancer constituted 5.3%. The maximum cases of bone cancer (53.8% of all bone cancers) were observed amongst children aged less than 20 years and lung cancer (48.2% of all lung cancers) among the elderly aged 60-69 years. The.

• Progress in Medical Physics
• /
• v.32 no.4
• /
• pp.130-136
• /
• 2021

Purpose: The Halcyon radiotherapy platform at Groote Schuur Hospital was delivered with a factory-configured analytical anisotropic algorithm (AAA) beam model for dose calculation. In a recent system upgrade, the Acuros XB (AXB) algorithm was installed. Both algorithms adopt fundamentally different approaches to dose calculation. This study aimed to compare the dose distributions of cervical carcinoma RapidArc plans calculated using both algorithms. Methods: A total of 15 plans previously calculated using the AAA were retrieved and recalculated using the AXB algorithm. Comparisons were performed using the planning target volume (PTV) maximum (max) and minimum (min) doses, D95%, D98%, D50%, D2%, homogeneity index (HI), and conformity index (CI). The mean and max doses and D2% were compared for the bladder, bowel, and femoral heads. Results: The AAA calculated slightly higher targets, D98%, D95%, D50%, and CI, than the AXB algorithm (44.49 Gy vs. 44.32 Gy, P=0.129; 44.87 Gy vs. 44.70 Gy, P=0.089; 46.00 Gy vs. 45.98 Gy, P=0.154; and 0.51 vs. 0.50, P=0.200, respectively). For target min dose, D2%, max dose, and HI, the AAA scored lower than the AXB algorithm (41.24 Gy vs. 41.30 Gy, P=0.902; 47.34 Gy vs. 47.75 Gy, P<0.001; 48.62 Gy vs. 50.14 Gy, P<0.001; and 0.06 vs. 0.07, P=0.002, respectively). For bladder, bowel, and left and right femurs, the AAA calculated higher mean and max doses. Conclusions: Statistically significant differences were observed for PTV D2%, max dose, HI, and bowel max dose (P>0.05).

• Proceedings of the Korean Society of Medical Physics Conference
• /
• 2002.09a
• /
• pp.450-453
• /
• 2002

In radiotherapy treatment planning, it is critical to deliver the radiation dose to tumor and protect surrounding normal tissue. Recent developments in functional imaging and radiotherapy treatment technology have been raising chances to control tumor saving normal tissues. A brain phantom which could be used for image registration technique of CT-MR and CT-SPECT images using surface matching was developed. The brain phantom was specially designed to obtain imaging dataset of CT, MR, and SPECT. The phantom had an external frame with 4 N-shaped pipes filled with acryl rods, Pb rods for CT, MR, and SPECT imaging, respectively. 8 acrylic pipes were inserted into the empty space of the brain phantom to be imaged for geometric evaluation of the matching. For an optimization algorithm of image registration, we used Downhill simplex algorithm suggested as a fast surface matching algorithm. Accuracy of image fusion was assessed by the comparison between the center points of the section of N-shaped bars in the external frame and the inserted pipes of the phantom and minimized cost functions of the optimization algorithm. Technique with partially transparent, mixed images using color on gray was used for visual assessment of the image registration process. The errors of image registration of CT-MR and CT-SPECT were within 2mm and 4mm, respectively. Since these errors were considered within a reasonable margin from the phantom study, the phantom is expected to be used for conventional image registration between multimodal image datasets..

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.4
• /
• pp.2243-2248
• /
• 2013

Background: To compare the dosimetric coverage of target volumes and organs at risk in the radical treatment of nasopharyngeal carcinoma (NPC) between intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT). Materials and Methods: Data from 10 consecutive patients treated with IMRT from June-October 2011 in Penang General Hospital were collected retrospectively for analysis. For each patient, dose volume histograms were generated for both the IMRT and 3DCRT plans using a total dose of 70Gy. Comparison of the plans was accomplished by comparing the target volume coverage (5 measures) and sparing of organs at risk (17 organs) for each patient using both IMRT and 3DCRT. The means of each comparison target volume coverage measures and organs at risk measures were obtained and tested for statistical significance using the paired Student t-test. Results: All 5 measures for target volume coverage showed marked dosimetric superiority of IMRT over 3DCRT. V70 and V66.5 for PTV70 showed an absolute improvement of 39.3% and 24.1% respectively. V59.4 and V56.4 for PTV59.4 showed advantages of 18.4% and 16.4%. Moreover, the mean PTV70 dose revealed a 5.1 Gy higher dose with IMRT. Only 4 out of 17 organs at risk showed statistically significant difference in their means which were clinically meaningful between the IMRT and 3DCRT techniques. IMRT was superior in sparing the spinal cord (less 5.8Gy), V30 of right parotid (less 14.3%) and V30 of the left parotid (less 13.1%). The V55 of the left cochlea was lower with 3DCRT (less 44.3%). Conclusions: IMRT is superior to 3DCRT due to its dosimetric advantage in target volume coverage while delivering acceptable doses to organs at risk. A total dose of 70Gy with IMRT should be considered as a standard of care for radical treatment of NPC.