• Journal of radiological science and technology
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• v.43 no.6
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• pp.431-441
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• 2020

The purpose of this study was to construct a model of MVCT(Megavoltage Computed Tomography) dose calculation by using Dosimetry Check™, a program that radiation treatment dose verification, and establish a protocol that can be accumulated to the radiation treatment dose distribution. We acquired sinogram of MVCT after air scan in Fine, Normal, Coarse mode. Dosimetry Check™(DC) program can analyze only DICOM(Digital Imaging Communications in Medicine) format, however acquired sinogram is dat format. Thus, we made MVCT RC-DICOM format by using acquired sinogram. In addition, we made MVCT RP-DICOM by using principle of generating MLC(Multi-leaf Collimator) control points at half location of pitch in treatment RP-DICOM. The MVCT imaging dose in fine mode was measured by using ionization chamber, and normalized to the MVCT dose calculation model, the MVCT imaging dose of Normal, Coarse mode was calculated by using DC program. As a results, 2.08 cGy was measured by using ionization chamber in Fine mode and normalized based on the measured dose in DC program. After normalization, the result of MVCT dose calculation in Normal, Coarse mode, each mode was calculated 0.957, 0.621 cGy. Finally, the dose resulting from the process for acquisition of MVCT can be accumulated to the treatment dose distribution for dose evaluation. It is believed that this could be contribute clinically to a more realistic dose evaluation. From now on, it is considered that it will be able to provide more accurate and realistic dose information in radiation therapy planning evaluation by using Tomotherapy.

• Journal of the Korean Society of Radiology
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• v.16 no.7
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• pp.857-862
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• 2022

The purpose of this study was to evaluate a three-dimensional conformal radiotherapy (3D-CRT) treatment plan with regard to head tilting in whole-brain radiotherapy (WBRT) using TomoDirect (TD) mode in Tomotherapy. WBRT 3D-CRT by TD was compared for a total of five head tilt angles (-20°, -10°, 0°. +10° and +20°). The dose homogeneity index (HI) and prescription dose index (CI) were calculated to confirm the target coverage. The maximum and average doses for critical organs such as the lens, eyeball and parotid glands were calculated for different angles of head tilting. The HI and CI were closet to the result value of 1 at the head tilted angle +10° and +20°. At a head tilted angle of +10°, the dose to the lens and eyeballs decreased by about 74% and about 30%, when compared with the reference angle (0°), respectively. The results of this study suggest that a head angle of +10 with chin-up would save adequate target coverage and reduce exposure dose to the lens.

• Progress in Medical Physics
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• v.27 no.1
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• pp.14-24
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• 2016

Since the head and neck region is densely located with organs at risk (OAR), OAR-sparing is an important issue in the treatment of head and neck cancers. This study-in which different treatment plans were performed varying the head tilt angle on brain tumor patients-investigates the optimal head elevation angle for sparing normal organs (e.g. the hippocampus) and further compares the dosimetric characteristics of different types of radiation equipment. we performed 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and tomotherapy on 10 patients with brain tumors in the frontal lobe while varying the head tilt angle of patients to analyze the dosimetric characteristics of different therapy methods. In each treatment plan, 95% of the tumor volume was irradiated with a dose of 40 Gy in 10 fractions. The step and shoot technique with nine beams was used for IMRT, and the same prescription dose was delivered to the tumor volume for the 3D-CRT and tomotherapy plans. The homogeneity index, conformity index, and normal tissue complication probability (NTCP) were calculated. At a head elevation angle of $30^{\circ}$, conformity of the isodose curve to the target increased on average by 53%, 8%, and 5.4%. In 3D-CRT, the maximum dose received by the brain stem decreased at $15^{\circ}$, $30^{\circ}$, and $40^{\circ}$, compared to that observed at $0^{\circ}$. The NTCP value of the hippocampus observed in each modality was the highest at a head and neck angle of $0^{\circ}$ and the lowest at $30^{\circ}$. This study demonstrates that the elevation of the patients' head tilt angle in radiation therapy improves the target region's homogeneity of dose distribution by increasing the tumor control rate and conformity of the isodose curve to the target. Moreover, the study shows that the elevation of the head tilt angle lowers the NTCP by separating the tumor volume from the normal tissues, which helps spare OARs and reduce the delivered dose to the hippocampus.

• Journal of radiological science and technology
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• v.37 no.1
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• pp.37-47
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• 2014

The purpose of this study was to analyze translational and rotational adjustments during automatic rigid image-registration by using different control parameters for a total of five groups on TomoTherapy (Accuray Inc, Sunnyvale, CA, USA). We selected a total of 50 patients and classified them in five groups (brain, head-and-neck, lung, abdomen and pelvic) and used a total of 500 megavoltage computed tomography (MVCT) image sets for the analysis. From this we calculated the overall mean value(M) for systematic and random errors after applying the different control parameters. After randomization of the patients into the five groups, we found that the overall mean value varied according to three techniques and resolutions. The deviation for the lung, abdomen and pelvic groups was approximately greater than the deviation for the brain and head-and-neck groups in all adjustments. Overall, using a "full-image" produces smaller deviations in the rotational adjustments. We found that rotational adjustment has deviations with distinctly different control parameters. We concluded that using a combination of the "full-image" technique and "standard" resolution will be helpful in assisting with patients' repositioning and in correcting for set-up errors prior to radiotherapy on TomoTherapy.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.45-53
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• 2008

Purpose: We are trying to analyze 130 patients' conditions by using our Helical Tomotherapy, which was installed in our center in Oct. 2007. We will be statistically approach this examination and analyze so that we will be able to figure out adaptive plans according to the change in place of the tumor, GTV (gross tumor volume), total amount of time it took, vector (${\upsilon}=\surd$x2+y2+z2) and the change in size of the tumor. Materials and Methods: Objectives were the patients who were medicated with Tomotherapy in our medical center since Oct. 2007 August 2008. The Average age of the patients were 53 years old (Minimum 25 years old, Maximum 83 years old). The parts of the body we operated were could be categorized as Head&neck (n=22), Chest (n=47), Abdomen (n=25), Pelvis (n=11), Bone (n=25). MVCT had acted on 2702 times, and also had acted on our adaptive plan toward patients who showed big difference in the size of tumor. Also, after equalizing our gained MVCT and kv-CT we checked up on the range of possible mistake, using x, y, z, roll and vector. We've also investigated on Set-up, MVCT, average time of operation and target volume. Results: Mean time on table was 22.8 minutes. Mean treatment time was 13.26 minutes. Mean correction (mm) was X=-0.7, Y=-1.4, Z=5.77, roll=0.29, vector=8.66 Head&neck patients had 2.96 mm less vector value in movement than patients of Chest, Abdomen, Bone. In increasing order, Head&neck, Bone, Abdomen, Chest, Pelvis showed the vector value in movement. Also, there were 27 patients for adaptive plan, 39 patients, who had long or multiple tumor. We could know that When medical treatment is one cure plan, it takes 32 minutes, and when medical treatment is two cure plan, it takes 40 minutes that one medical treatment takes 21 minutes, and the other medical treatment takes 19 minutes. Conclusion:With our basic tools, we could bring more accurate IMRT with MVCT. Also, through our daily image, we checked up on the change in tumor so that adaptive plan could work. It was made it possible to take the cure of long or multiple tumor, the cure in a nearby OAR, and the complicated cure that should make changes of gradient dose distribution.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.2
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• pp.103-108
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• 2011

Purpose: Opposing portal irradiation with helmet field shape that has been given to a patient with brain metastasis can cause excess dose in patient's scalp, resulting in hair loss. For this reason, this study is to quantitatively analyze scalp dose for effective prevention of hair loss by comparing opposing portal irradiation with scalp-shielding shape and tomotherapy designed to protect patient's scalp with conventional radiation therapy. Materials and Methods: Scalp dose was measured by using three therapies (HELMET, MLC, TOMO) after five thermo-luminescence dosimeters were positioned along center line of frontal lobe by using RANDO Phantom. Scalp dose and change in dose distribution were compared and analyzed with DVH after radiation therapy plan was made by using Radiation Treatment Planning System (Pinnacle3, Philips Medical System, USA) and 6 MV X-ray (Clinac 6EX, VARIAN, USA). Results: When surface dose of scalp by using thermo-luminescence dosimeters was measured, it was revealed that scalp dose decreased by average 87.44% at each point in MLC technique and that scalp dose decreased by average 88.03% at each point in TOMO compared with HELMET field therapy. In addition, when percentage of volume (V95%, V100%, V105% of prescribed dose) was calculated by using Dose Volume Histogram (DVH) in order to evaluate the existence or nonexistence of hotspot in scalp as to three therapies (HELMET, MLC, TOMO), it was revealed that MLC technique and TOMO plan had good dose coverage and did not have hot spot. Conclusion: Reducing hair loss of a patient who receives whole brain radiotherapy treatment can make a contribution to improve life quality of the patient. It is expected that making good use of opposing portal irradiation with scalp-shielding shape and tomotherapy to protect scalp of a patient based on this study will reduce hair loss of a patient.

• Journal of the Korean Magnetics Society
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• v.26 no.5
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• pp.173-178
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• 2016

This study is to evaluate the effect of a Contrast Media (CM) on dose calculations and clinical significance in Radiation (Electromagnetic wave) Therapy (RT) plans for head & neck (H&N) and prostate cancer. Pinnacle 8.0 system was used to measure the change of Electron Density (ED) of the tissue for CM. To determine the effect of dose calculation due to CM, we did the RT planning for 30 patients. To compare the ED and dose calculations of RT plans, 3D CRT and IMRT plans were do with pinnacle and Tomotherapy planning system. Mean difference of ED between enhanced and unenhanced CT was less than 4%: H&N Target Volume (TV) 2.1%, parotid 1.9%, SMG 3.6%, tongue 0.9%, spinal cord 0.3%, esophagus 2.6%, mandible 0.1% and prostate TV 0.7%, lymph node 1.1%, bladder 1.2%, rectum 1.5%, small bowel 1.2%, colon 0.6%, penile bulb 0.8%, femoral head -0.2%. The dose difference between RT plan using CM and without CM showed an increase of dose in TV. The rate of increase was less than 2.5% (3D CRT: H&N 0.69~2.51%, prostate 0.04~1.14%, IMRT: H&N 0.58~1.31%, prostate 0.36~1.04%). RT plans using a CM has the insignificant effect on the organs and TV, so this error is allowable clinically. However, the much more accurate plan is possible as to image fusion (CM and without CM images) to ROI contour and when dose calculation, use the without CM image. Using the fusion of 'ROI import' perform calculations on without CM, it will be able to reduce the error (1~3%) caused by the CM.

• Progress in Medical Physics
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• v.22 no.2
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• pp.72-78
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• 2011

The aim of this study is to evaluate the patient's setup errors in TomoTherapy (Hi-Art II, TomoTherapy, USA) Bodyfix system (Medical Intelligence, Ele-kta, Schwabmuchen, Germany) pressure in the vacuum compression, depending on and were evaluated. Bodyfix immobilization system and vacuum pressure was compression applied to the patients who received Tomotherapy thoracic and abdominal area, 21 patients were selected and TomoTehpay treatment total 477 of MVCT images were obtained. The translational (medial-lateral: ML, anterior-posterior: AP, superior-inferior: SI directions) and rolling were recorded and analyzed statistically. Using Pearson's product-moment coefficient and One-way ANOVA, the degree of correlation depending on the different vacuum pressure levels were statistically analyzed for setup errors from five groups (p<0.05). The largest average and standard deviation of systematic errors were 6.00, 5.95 mm in the AP and SI directions, respectively. The largest average of random errors were 4.72 mm in the SI directions. The correlation coefficients were 0.485, 0.244, and 0.637 for the ML-Roll, AP-Vector, and SI-Vector, respectively. SI-Vector direction showed the best relationship. In the results of the different degree of vacuum pressure in five groups (Pressure range: 30~70 mbar), the setup errors between the ML, SI in both directions and Roll p=0.00 (p<0.05) were shown significant differences. The average errors of SI direction in the vacuum pressure of 40 mbar and 70 mbar group were 4.78 mm and -0.74 mm, respectively. In this study, the correlation between the vacuum pressure and the setup-errors were statistically analyzed. The fact that setup-errors in SI direction is dependent in vacuum pressure considerly setup-errors and movement of interal organs was identified. Finally, setup-errors, and it, based on the movement of internal organs in Bodyfix system we should apply more than 50 mbar vacuum pressure. Based on the results of this study, it is suggested that accuracy of the vacuum pressure and the quantitative analysis of movement of internal organs and the tumor should be studied.

• The Journal of Korean Society for Radiation Therapy
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• v.22 no.2
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• pp.131-134
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• 2010

Purpose: TOMO therapy treatment for a relatively long run Beam time and temperature-sensitive detector, such as CT clinics in optimal temperature ($20~21^{\circ}$) to maintain a constant temperature in addition to its own Chamber Cooling system is activating. TOMO This clinic has been reduced in the patients' body temperature to keep the sheets and covers over the treated area. Therefore, these materials for any changes in the organization gives the dose were analyzed. Materials and Methods: To compare changes in the organization Dose Phantom cheese (Cheese Phantom) were used, CT-simulation taking the center point of the cheese phantom PTV (Planning Target Volume, treatment planning target volume) by setting Daily dose 200 cGy, 3 meetings planned treatment. PTV, PTV +7 cm, PTV +14 cm, the total count points on the phantom using the Ion chamber cover without any substance to measure the dose, and one of the most commonly used treatment, including the frequently used four kinds of bedding materials (febric 0.8 mm, gown 1.4 mm, rug, 3.3 mm, blanket 13.7 mm) and covered with a phantom and the dose measured at the same location were analyzed 3 times each. Results: PTV, PTV +7 cm, PTV +14 cm from the point of any substance measured in the state are covered with four kinds of materials (fabric, gown, rug, blanket) was measured in the covered states and compares their results, PTV respectively -0.17%, -0.44%, -0.53% and -0.9% change, PTV +7 cm, respectively -0.04%, +0.07%, +0.06%, +0.07%, were changed, PTV +14 cm, respectively 0%, -0.06%, -0.02%, +0.6%, respectively. Conclusion: These results TOMO treatment to patients to maintain their body mass by using PTV thickness of the material decreased in proportion to. PTV +7 cm, but showed slight changes in the point, PTV +14 cm at the point of the dose was increased a little. Sejijeom all the difference in treatment tolerance ${\pm}3%$ range, this is confirmed in the coming treatment will not affect the larger should be considered.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.1
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• pp.59-66
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• 2011

Purpose: Investigation of the clinical use of tangential fields technique using TOMO direct in comparison to conventional LINAC based radiation therapy after breast partial mastectomy. Materials and Methods: Treatment plans were created for 3 left-sided breast cancer patients who had radiation therapy after breast partial mastectomy by using wedged tangential fields technique, field in field technique (FIF), TOMO Direct, TOMO Direct intensity modulated radiation therapy (IMRT) under the normalized prescription condition ($D_{90%}$: 50.4 Gy/28 fx within CTV). Dose volume histogram (DVH) and isodose curve were used to evaluate the dose to the clinical target volume (CTV), organ at risk (OAR). We compared and analyzed dosimetric parameters of CTV and OAR. Dosimetric parameters of CTV are $D_{99}$, $D_{95}$, Dose homogeneity index (DHI: $D_{10}/D_{90}$) and $V_{105}$, $V_{110}$. And dosimetric parameters of OAR are $V_{10}$, $V_{20}$, $V_{30}$, $V_{40}$ of the heart and $V_{10}$, $V_{20}$, $V_{30}$ of left lung. Results: Dosimetric results of CTV, the average value of $D_{99}$, $D_{95}$ were $47.7{\pm}1.1Gy$, $49.4{\pm}0.1Gy$ from wedged tangential fields technique (W) and FIF (F) were $47.1{\pm}0.6Gy$, $49.2{\pm}0.4Gy$. And it was $49.2{\pm}0.4$ vs. $48.6{\pm}0.8Gy$, $49.9{\pm}0.4$ vs. $49.5{\pm}0.3Gy$ Gy for the TOMO Direct (D) and TOMO Direct IMRT (I). The average value of dose homogeneity index was W: $1.1{\pm}0.02$, F: $1.07{\pm}0.02$, D: $1.03{\pm}0.001$, I: $1.05{\pm}0.02$. When we compared the average value of $V_{105}$, $V_{110}$ using each technique, it was the highest as $34.6{\pm}9.3%$, $7.5{\pm}7.9%$ for wedged tangential fields technique and the value dropped for FIF as $16.5{\pm}14.8%$, $2.1{\pm}3.5%$, TOMO direct IMRT as $7.5{\pm}8.3%$, $0.1{\pm}0.1%$ and the TOMO direct showed the lowest values for both as 0%. Dosimetric results of OAR was no significant difference among each technique. Conclusion: TOMO direct provides improved target dose homogeneity over wedged tangential field technique. It is no increase the amount of normal tissue volumes receiving low doses, as oppose to IMRT or Helical TOMO IMRT. Also, it simply performs treatment plan procedure than FIF. TOMO Direct is a clinical useful technique for breast cancer patients after partial mastectomy.