• Translational and Clinical Pharmacology
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• v.26 no.4
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• pp.150-154
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• 2018

This tutorial reviews the principles of dose individualisation with an emphasis on target concentration intervention (TCI). Once a target effect is chosen then pharmacodynamics can predict the target concentration and pharmacokinetics can predict the target dose to achieve the required response. Dose individualisation can be considered at three levels: population, group and individual. Population dosing, also known as fixed dosing or "one size fits all" is often used but is poor clinical pharmacology; group dosing uses patient features such as weight, organ function and comedication to adjust the dose for a typical patient; individual dosing uses observations of patient response to inform about pharmacokinetic and pharmacodynamics in the individual and use these individual differences to individualise dose.

• Progress in Medical Physics
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• v.28 no.4
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• pp.164-170
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• 2017

One of the methods to consider the effect of respiratory motion of a tumor target in radiotherapy is to establish a treatment plan with the internal target volume (ITV) created based on an accurate analysis of the target motion displacement. When this method is applied to intensity modulated radiotherapy (IMRT), it is expected to yield a different treatment dose distribution under the motion condition according to the IMRT method. In this study, we prepared ITV-based IMRT plans with conventional IMRT using fixed gantry angle beams, RapidArc using volumetric modulated arc therapy, and tomotherapy using helical therapy. Then, the variation in dose distribution caused by the target motion was analyzed by the dose measurement in the actual motion condition. A delivery quality assurance plan was prepared for the established IMRT plan and the dose distribution in the actual motion condition was measured and analyzed using a two-dimensional diode detector placed on a moving phantom capable of simulating breathing movements. The dose measurement was performed considering only a uniform target shape and motion in the superior-inferior (SI) direction. In this condition, it was confirmed that the error of the dose distribution due to the target motion is minimum in tomotherapy. This is thought to be due to the characteristic of tomotherapy that treats the target sequentially by dividing it into several slices. When the target shape is uniform and the main target motion direction is SI, it is considered that tomotherapy for the ITV-based IMRT method has a characteristic which can reduce the dose difference compared with the plan dose under the target motion condition.

• Progress in Medical Physics
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• v.28 no.4
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• pp.181-189
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• 2017

The conventional delivery quality assurance (DQA) process for RapidArc (Varian Medical Systems, Palo Alto, USA), has the limitation that it measures and analyzes the dose in a phantom material and cannot analyze the dosimetric changes under the motional organ condition. In this study, a DQA method was designed to overcome the limitations of the conventional DQA process for internal target volume (ITV) based RapidArc. The dynamic DQA measurement device was designed with a moving phantom that can simulate variable target motions. The dose distribution in the real volume of the target and organ-at-risk (OAR)s were reconstructed using 3DVH with the ArcCHECK (SunNuclear, Melbourne, USA) measurement data under the dynamic condition. A total of 10 ITV-based RapidArc plans for liver-cancer patients were analyzed with the designed dynamic DQA process. The average pass rate of gamma evaluation was $81.55{\pm}9.48%$ when the DQA dose was measured in the respiratory moving condition of the patient. Appropriate method was applied to correct the effect of moving phantom structures in the dose calculation, and DVH data of the real volume of target and OARs were created with the recalculated dose by the 3DVH program. We confirmed the valid dose coverage of a real target volume in the ITV-based RapidArc. The variable difference of the DVH of the OARs showed that dose variation can occur differently according to the location, shape, size and motion range of the target. The DQA process devised in this study can effectively evaluate the DVH of the real volume of the target and OARs in a respiratory moving condition in addition to the simple verification of the accuracy of the treatment machine. This can be helpful to predict the prognosis of treatment by the accurate dose analysis in the real target and OARs.

• Radiation Oncology Journal
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• v.33 no.3
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• pp.226-232
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• 2015

Purpose: Toxicity of mucosa is one of the major concerns of radiotherapy (RT), when a target tumor is located near a mucosal lined organ. Energy of photon RT is transferred primarily by secondary electrons. If these secondary electrons could be removed in an internal cavity of mucosal lined organ, the mucosa will be spared without compromising the target tumor dose. The purpose of this study was to present a RT dose reduction in near target inner-surface (NTIS) of internal cavity, using Lorentz force of magnetic field. Materials and Methods: Tissue equivalent phantoms, composed with a cylinder shaped internal cavity, and adjacent a target tumor part, were developed. The phantoms were irradiated using 6 MV photon beam, with or without 0.3 T of perpendicular magnetic field. Two experimental models were developed: single beam model (SBM) to analyze central axis dose distributions and multiple beam model (MBM) to simulate a clinical case of prostate cancer with rectum. RT dose of NTIS of internal cavity and target tumor area (TTA) were measured. Results: With magnetic field applied, bending effect of dose distribution was visualized. The depth dose distribution of SBM showed 28.1% dose reduction of NTIS and little difference in dose of TTA with magnetic field. In MBM, cross-sectional dose of NTIS was reduced by 33.1% with magnetic field, while TTA dose were the same, irrespective of magnetic field. Conclusion: RT dose of mucosal lined organ, located near treatment target, could be modulated by perpendicular magnetic field.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.214-215
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• 2002

Generally uniform dose distribution is assumed to be formed in a target region when a conventional dose formation method using a broad proton beam, a fixed modulation technique, a bolus and an aperture is employed. However, actual situations differ. We usually find non-uniformity in the target region. This is due to the insertion of a range-compensating bolus before the patient. Since the range-compensating bolus has an irregular shape, the scattering in the bolus depends on the lateral position. Dose distribution is overlapping results of dose distribution of pencil-proton beams traversing different lateral positions of the bolus. The lateral extent of dose distribution of each pencil beam traversing the different position differs each other at the same depth in the target object. This is a cause of the non-uniformity of the dose distribution. Therefore the same lateral extent of dose distribution should be attained for different pencil beams at the same depth to obtain a uniform dose distribution. For that purpose, we propose here a bi-material bolus. The bi-material bolus consists of a low-Z material determining mainly the range loss and a high-Z material defining mainly the scattering in the bolus. After passing through the bi-material bolus, protons traversing different lateral positions will have different residual range yet with the same lateral spread at a certain depth. Using the optimized bi-material bolus, we can obtain a more uniform dose distribution in the target region as expected.

• The Journal of Korean Society for Radiation Therapy
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• v.5 no.1
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• pp.68-73
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• 1992

If the same weight is used in parallel opposed 6 and 10 MV x-ray beams, the lowest dose is achieved at SAD. Therefore, dose homogeneity in the target volume is decreased when SAD is taken at center of target volume than center of phantom or patient. With Standard deviation of ${\pm}6\%$ that repuesented the dose homogeneity in tarhet volume, we studied the optimized beam weights at which hot spot dose was least in parallel opposed beams. The optimized beam weights that maximally decrease the hot spot dose, wer 1.29, 1.19, 2.71, 3.50, and 4.70 in 6 MV x-ray and 1.25, 1.53, 1.90, 2.36, 3.01, and 3.7 in 10 MV x-ray, reapectively, when center of target volume was changed to 2,4,6,8,10, and 12cm from center plan of phantom along the centeral axis of beams.

• Journal of Korean Neurosurgical Society
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• v.53 no.2
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• pp.102-107
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• 2013

Objective : The Leksell Gamma Knife$^{(R)}$ (LGK) is based on a single-fraction high dose treatment strategy. Therefore, independent verification of the Leksell GammaPlan$^{(R)}$ (LGP) is important for ensuring patient safety and minimizing the risk of treatment errors. Although several verification techniques have been previously developed and reported, no method has ever been tested statistically on multiple LGK target treatments. The purpose of this study was to perform and to evaluate the accuracy of a verification method (modified variable ellipsoid modeling technique, MVEMT) for multiple target treatments. Methods : A total of 500 locations in 10 consecutive patients with multiple brain tumor targets were included in this study. We compared the data from an LGP planning system and MVEMT in terms of dose at random points, maximal dose points, and target volumes. All data was analyzed by t-test and the Bland-Altman plot, which are statistical methods used to compare two different measurement techniques. Results : No statistical difference in dose at the 500 random points was observed between LGP and MVEMT. Differences in maximal dose ranged from -2.4% to 6.1%. An average distance of 1.6 mm between the maximal dose points was observed when comparing the two methods. Conclusion : Statistical analyses demonstrated that MVEMT was in excellent agreement with LGP when planning for radiosurgery involving multiple target treatments. MVEMT is a useful, independent tool for planning multiple target treatment that provides statistically identical data to that produced by LGP. Findings from the present study indicate that MVEMT can be used as a reference dose verification system for multiple tumors.

• Progress in Medical Physics
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• v.1 no.1
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• pp.23-29
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• 1990

In order to explane the stereotactic procedure, the three steps of the procedure (target localization, dose planning, and radiation treatment) must be examined separately. The ultimate accuracy of the full procedure is dependent on each of these steps and on the consistancy of the approach The concern in this article was about dose planning, which is a important factor to the success of radiation treatment. The major factor in dose planning is a dosimetry system to evaluate the dose delivered to the target and normal tissues in the patient, while it generates an optimal dose distribution that will satisfy a set of clinical criteria for the patient. A three-dimensional treatment planning program is a prerequisite for treatment plan optimization. It must cover 3-D methods for representing the patient, the dose distributions, and beam settings. The major problems and possible modelings about 3-D factors and optimization technique were discussed to simplify and solve the problems associatied with 3-D optimization, with relative ease and efficiency. These modification can simplify the optimization problem while saving time, and can be used to develop reference dose planning system to prepare standard guideline for the selection of optimum beam parameters, such as the target position, collimator size, arc spacing, the variation in arc length and weight. The method yields good results which can then be simulated and tailored to the individual case. The procedure needed for dose planning in stereotactic radiosurgery is shown in figure 1.

• Nuclear Engineering and Technology
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• v.54 no.10
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• pp.3816-3823
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• 2022

This work analyzed the dosimetric difference between the intensity modulated radiotherapy (IMRT), partial/single/double-arc volumetric modulated arc therapy (PA/SA/DA-VMAT) techniques in treatment planning for treating more than one target of lung cancer at different isocenters. IMRT and VMAT plans at different isocenters were created systematically using a Harold heterogeneous lung phantom. The conformity index (CI), homogeneity index (HI), gradient index (GI), dose-volume histogram and mean and maximum dose of the PTV were calculated and analyzed. Furthermore, the dose-volume histogram and mean and maximum doses of the OARs such as right lung, contralateral lung and non GTV were determined from the plans. The IMRT plans showed the superior target dose coverage, higher mean and maximum values than other VMAT techniques. PA-VMAT technique shows more lung sparing and DA-VMAT increases the V_5/10/20 values of contralateral lung than other VMAT and IMRT techniques. The IMRT technique achieves highly conformal dose distribution to the target than other VMAT techniques. Comparing to the IMRT plans, the higher V_5/10/20 and mean lung dose were observed in the contralateral lung in the DA-VMAT.

• Radiation Oncology Journal
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• v.34 no.4
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• pp.313-321
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• 2016

Purpose: Total scalp irradiation (TSI) is a rare but challenging indication. We previously reported that non-coplanar intensity-modulated radiotherapy (IMRT) was superior to coplanar IMRT in organ-at-risk (OAR) protection and target dose distribution. This consecutive treatment planning study compared IMRT with volumetric-modulated arc therapy (VMAT). Materials and Methods: A retrospective treatment plan databank search was performed and 5 patient cases were randomly selected. Cranial imaging was restored from the initial planning computed tomography (CT) and target volumes and OAR were redelineated. For each patients, three treatment plans were calculated (coplanar/non-coplanar IMRT, VMAT; prescribed dose 50 Gy, single dose 2 Gy). Conformity, homogeneity and dose volume histograms were used for plan. Results: VMAT featured the lowest monitor units and the sharpest dose gradient (1.6 Gy/mm). Planning target volume (PTV) coverage and homogeneity was better in VMAT (coverage, 0.95; homogeneity index [HI], 0.118) compared to IMRT (coverage, 0.94; HI, 0.119) but coplanar IMRT produced the most conformal plans (conformity index [CI], 0.43). Minimum PTV dose range was 66.8%-88.4% in coplanar, 77.5%-88.2% in non-coplanar IMRT and 82.8%-90.3% in VMAT. Mean dose to the brain, brain stem, optic system (maximum dose) and lenses were 18.6, 13.2, 9.1, and 5.2 Gy for VMAT, 21.9, 13.4, 14.5, and 6.3 Gy for non-coplanar and 22.8, 16.5, 11.5, and 5.9 Gy for coplanar IMRT. Maximum optic chiasm dose was 7.7, 8.4, and 11.1 Gy (non-coplanar IMRT, VMAT, and coplanar IMRT). Conclusion: Target coverage, homogeneity and OAR protection, was slightly superior in VMAT plans which also produced the sharpest dose gradient towards healthy tissue.