• Journal of Korean Physical Therapy Science
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• v.17 no.1_2
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• pp.33-39
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• 2010

Purpose: The purpose of this study was to analyze the effects of a balance training program using the TARGET Balance Trainer(TBT), which utilizes a visual target, on the balancing ability of normal, healthy individuals. Methods: Twelve healthy female students with an average of 20.7 years(SD=0.25), were participated in this study. They were randomly divided into two groups(6 subjects in each group); experimental group, control group. The experimental group underwent a 3-week training program using the TBT, while the control group trained using only a dynamic air cushion(DAC). Results: Compared to those who trained using only the DAC, participants who trained with the TBT had a smaller difference between the weights distributed(N) to their left and right foot while normal standing with their eyes open. The TBT group also showed a smaller discrepancy between the weights distributed(N) to their left and right sides while standing on one leg with their eyes open, and also with their eyes closed by eye band. Conclusions: TBT is effective to reduce the degree of weight shifting between left and right side in each group. This study is expected to provide a model for future clinical studies.

• Physical Therapy Korea
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• v.17 no.1
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• pp.36-42
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• 2010

The aim of this study was to investigate effects of reaching distance on movement time and trunk kinematics in hemiplegic patients. Eight hemiplegic patients participated in this study. The independent variables were side (sound side vs. affected side) and target distance (70%, 90%, 110%, and 130% of upper limb). The dependent variables were movement time measured by pressure switch and trunk kinematics measured by motion analysis device. Two-way analysis of variance with repeated measures was used with Bonferroni post-hoc test. (1) There were significant main effects in side and reaching distance for movement time (p=.01, p=.02). Post-hoc test revealed that there was a significant difference between 110% and 130% of reaching distance (p=.01). (2) There was a significant main effect in side and reaching distance for trunk flexion (p=.01, p=.00). Post-hoc test revealed that there were significant differences in all pair-wise reaching distance comparison. (3) There was a significant side by target distance interaction for trunk rotation (p=.04). There was a significant main effect in target distance (p=.00). Post-hoc test revealed that there were significant differences between 70% and 110%, 70% and 130%, 90% and 110%, 90% and 130% of target distance. It was known that trunk flexion is used more than trunk rotation during reaching task in hemiplegic patients from the findings of this study. It is also recommended that reaching training is performed with limiting trunk movement within 90% of target distance whereas reaching training is performed incorporating with trunk movement beyond 90% of target distance in patients with hemiplegia.

• Nuclear Engineering and Technology
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• v.38 no.4
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• pp.327-342
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• 2006

Radiation therapy is an important part of cancer treatment in which cancer patients are treated using high-energy radiation such as x-rays, gamma rays, electrons, protons, and neutrons. Currently, about half of all cancer patients receive radiation treatment during their whole cancer care process. The goal of radiation therapy is to deliver the necessary radiation dose to cancer cells while minimizing dose to surrounding normal tissues. Success of radiation therapy highly relies on how accurately 1) identifies the target and 2) aim radiation beam to the target. Both tasks are strongly dependent of imaging technology and many imaging modalities have been applied for radiation therapy such as CT (Computed Tomography), MRI (Magnetic Resonant Image), and PET (Positron Emission Tomogaphy). Recently, many researchers have given significant amount of effort to develop and improve imaging techniques for radiation therapy to enhance the overall quality of patient care. For example, advances in medical imaging technology have initiated the development of the state of the art radiation therapy techniques such as intensity modulated radiation therapy (IMRT), gated radiation therapy, tomotherapy, and image guided radiation therapy (IGRT). Capability of determining the local tumor volume and location of the tumor has been significantly improved by applying single or multi-modality imaging fur static or dynamic target. The use of multi-modality imaging provides a more reliable tumor volume, eventually leading to a better definitive local control. Image registration technique is essential to fuse two different image modalities and has been In significant improvement. Imaging equipments and their common applications that are in active use and/or under development in radiation therapy are reviewed.

• Physical Therapy Korea
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• v.15 no.3
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• pp.44-52
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• 2008

The purpose of this study was to investigate the effects of different objects and target location of dominant hand on the non-dominant hand movement kinematics in a bimanual reaching task. Fifteen right-handed volunteers were asked to reach from same starting point to the different target point of right and left hand with grasping the objects of different size. Independent variables were 1) three different object types (small mug cup, name pen, and PET bottle), and 2) three different target locations (shorter distance, same distance, and longer distance than the non-dominant hand) of the dominant hand. Dependent variables were movement time (MT), movement distance (MD), movement mean velocity ($MV_{mean}$), and movement peak velocity ($MV_{peak}$) of the non-dominant hand. Repeated measures two-way analysis of variance (ANOVA) was used to test for differences in the non-dominant hand movement kinematics during bimanual reaching. The results of this study were as follows: 1) MT of the non-dominant hand was increased significantly when traveling with grasping the mug cup and reaching the far target location, and was decreased significantly when traveling with grasping the PET bottle and reaching the near target location of the dominant hand. 2) MD of the non-dominant hand was significantly increased during reaching the far target location, and significantly decreased during reaching the near target location with dominant hand. 3) $MV_{mean}$ of the non-dominant hand was increased significantly when traveling with grasping the PET bottle, and was decreased significantly when traveling with grasping the mug cup of the dominant hand. Therefore, it can be concluded that the changes of the ipsilateral hand movement have influence on coupling of the contralateral hand movement in bimanual reaching.

• Progress in Medical Physics
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• v.28 no.4
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• pp.144-148
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• 2017

When a high density metallic implant is placed in the path of the proton beam, spatial heterogeneity can be caused due to artifacts in three dimensional (3D) computed tomography (CT) scans. These artifacts result in range uncertainty in dose calculation in treatment planning system (TPS). And this uncertainty may cause significant underdosing to the target volume or overdosing to normal tissue beyond the target. In clinical cases, metal implants must be placed in the beam path in order to preserve organ at risk (OARs) and increase target coverage for tumors. So we should introduce Ti-mesh. In this paper, we measured the lateral dose profile for proton beam using an EBT3 film to confirm dosimetric impact of Ti-mesh when the Ti-mesh plate was placed in the proton beam pathway. The effect of Ti-mesh on the proton beam was investigated by comparing the lateral dose profile calculated from TPS with the film-measured value under the same conditions.

• Physical Therapy Korea
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• v.1 no.1
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• pp.92-97
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• 1994

It is well known that visual cues can improve the motor performance of Parkinsonian patients. Previous laboratory studies have examined the effects of visual cueing to the floor. This case study examined the effects of using a visual cue above eye level on the gait of a Parkinsonian man. It was found that cueing the patient to a target above eye level while waking not only improved the kinematic parameters of the gait cycle but also facilitated a more functional gait pattern with re-intergration of arm swing, rhythm, heel strike and a more erect posture. Visual targeting above eye level may serve as an important clinical tool for physiotherapists treating Parkinsonian patients.

• Progress in Medical Physics
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• v.33 no.4
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• pp.37-52
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• 2022

Over the past decades, radiation therapy combined with imaging modalities that ensure optimal image guidance has revolutionized cancer treatment. The two major purposes of using imaging modalities in radiotherapy are to clearly delineate the target prior to treatment and set up the patient during radiation delivery. Image guidance secures target position prior to and during the treatment. High quality images provide an accurate definition of the treatment target and the possibility to reduce the treatment margin of the target volume, further lowering radiation toxicity and improving the quality of life of cancer patients. In this review, the various types of image guidance modalities used in radiation therapy are distinguished into ionized (kilovoltage and megavoltage image) and nonionized imaging (magnetic resonance image, ultrasound, surface imaging, and radiofrequency). The functional aspects, advantages, and limitation of imaging using these modalities are described as a subsection of each category. This review only focuses on the technological viewpoint of these modalities and any clinical aspects are omitted. Image guidance is essential, and its importance is rapidly increasing in modern radiotherapy. The most important aspect of using image guidance in clinical settings is to monitor the performance of image quality, which must be checked during the periodic quality assurance process.

• Journal of radiological science and technology
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• v.34 no.1
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• pp.51-58
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• 2011

The aim of the study is to analyze the dose delivery error depending on the depth variation according to target positions and arc trajectories by comparing the simulated treatment planning with the actual dose delivery in conformal arc therapy. We simulated the conformal arc treatment planning with the three target positions (center, 2.5 cm, and 5 cm in the phantom). For the experiments, IMRT body phantom (I’mRT Phantom, Wellhofer Dosimetry, Germany) was used for treatment planning with CT (Computed Tomography, Light speed 16, GE, USA). The simulated treatment plans were established by three different target positions using treatment planning system (Eclipse, ver. 6.5, VMS, Palo Alto, USA). The radiochromic film (Gafchromic EBT2, ISP, Wayne, USA) and dose analysis software (OmniPro-IMRT, ver. 1.4, Wellhofer Dosimetry, Germany) were used for the measurement of the planned arc delivery using 6 MV photon beam from linear accelerator (CL21EX, VMS, Palo Alto, USA). Gamma index (DD: 3%, DTA: 2 mm) histogram and dose profile were evaluated for a quantitative analysis. The dose distributions surrounded by targets were also compared with each plans and measurements by conformity index (CI), and homogeneity index (HI). The area covered by 100% isodose line was compared to the whole target area. The results for the 5 cm-shifted target plan show that 23.8%, 35.6%, and 37% for multiple conformal arc therapy (MCAT), single conformal arc therapy (SCAT), and multiple static beam therapy, respectively. In the 2.5 cm-shifted target plan, it was shown that 61%, 21.5%, and 14.2%, while in case of center-located target, 70.5%, 14.1%, and 36.3% for MCAT, SCAT, and multiple static beam therapy, respectively. The values were resulted by most superior in the MCAT, except the case of the 5 cm-shifted target. In the analysis of gamma index histogram, it was resulted of 37.1, 27.3, 29.2 in the SCAT, while 9.2, 8.4, 10.3 in the MCAT, for the target positions of center, shifted 2.5 cm and 5 cm, respectively. The fail proportions of the SCAT were 2.8 to 4 times as compared to those of the MCAT. In conclusion, dose delivery error could be occurred depending on the target positions and arc trajectories. Hence, if the target were located in the biased position, the accurate dose delivery could be performed through the optimization of depth according to arc trajectory.

• Progress in Medical Physics
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• v.20 no.3
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• pp.180-190
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• 2009

Depth of prostate volume from the skin can vary due to intra-fractional and inter-fractional movements, which may result in dose reduction to the target volume. Therefore we evaluated the feasibility of automated depth determination-based adaptive proton therapy to minimize the effect of inter-fractional movements of the prostate. Based on the center of mass method, using three fiducial gold markers in the prostate target volume, we determined the differences between the planning and treatment stages in prostate target location. Thirty-eight images from 10 patients were used to assess the automated depth determination method, which was also compared with manually determined depth values. The mean differences in prostate target location for the left to right (LR) and superior to inferior (SI) directions were 0.9 mm and 2.3 mm, respectively, while the maximum discrepancies in location in individual patients were 3.3 mm and 7.2 mm, respectively. In the bilateral beam configuration, the difference in the LR direction represents the target depth changes from 0.7 mm to 3.3 mm in this study. We found that 42.1%, 26.3% and 2.6% of thirty-eight inspections showed greater than 1 mm, 2 mm and 3 mm depth differences, respectively, between the planning and treatment stages. Adaptive planning based on automated depth determination may be a solution for inter-fractional movements of the prostate in proton therapy since small depth changes of the target can significantly reduce target dose during proton treatment of prostate cancer patients.

• 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.