• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.1
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• pp.65-68
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• 2004

CyberKnife is a stereotactic radiosurgery system which could be used to treat many tumors and lesions. It provides the surgeon unparalleled flexibility in targeting using a compact light linear accelerator mounted on a robotic arm. Advanced image guidance technology tracks patient and target position during treatment, ensuring accuracy without the use of an invasive head frame. CyberKnife with Dynamic Tracking Software is cleared to provide radiosurgery for lesions anywhere in the body when radiation treatment is indicated. It has often been used to radiosurgically treat otherwise untreatable tumors and malformations. Moreover, this instrument treats tumors at body sites, most of which are unreachable by other stereotactic systems. Compared with conventional radiotherapy, it is fundamentally different that using non-invasive, frameless, no excessive radiation exposure to normal tissue. In oral malignant neoplasm, surgical excision and radiation therapy should be tried first, additionally chemotherapy could be considered. However, after failure of conventional therapies, patients had poor systemic condition and surgical limitation. So, CyberKnife could be a suitable therapy. A 49 years man was referred in recurred mandibular cancer treated by radiotherapy. The tumor was considered inoperable, because of extensive invasion and was not expected to good response to conventional therapies. We experienced a case of CyberKnife after 4 cycle chemotherapies, so we report it with review of literature.

• Progress in Medical Physics
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• v.23 no.2
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• pp.91-98
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• 2012

Verification of internal organ motion during treatment and its feedback is essential to accurate dose delivery to the moving target. We developed an offline based internal organ motion verification system (IMVS) using cine EPID images and evaluated its accuracy and availability through phantom study. For verification of organ motion using live cine EPID images, a pattern matching algorithm using an internal surrogate, which is very distinguishable and represents organ motion in the treatment field, like diaphragm, was employed in the self-developed analysis software. For the system performance test, we developed a linear motion phantom, which consists of a human body shaped phantom with a fake tumor in the lung, linear motion cart, and control software. The phantom was operated with a motion of 2 cm at 4 sec per cycle and cine EPID images were obtained at a rate of 3.3 and 6.6 frames per sec (2 MU/frame) with $1,024{\times}768$ pixel counts in a linear accelerator (10 MVX). Organ motion of the target was tracked using self-developed analysis software. Results were compared with planned data of the motion phantom and data from the video image based tracking system (RPM, Varian, USA) using an external surrogate in order to evaluate its accuracy. For quantitative analysis, we analyzed correlation between two data sets in terms of average cycle (peak to peak), amplitude, and pattern (RMS, root mean square) of motion. Averages for the cycle of motion from IMVS and RPM system were $3.98{\pm}0.11$ (IMVS 3.3 fps), $4.005{\pm}0.001$ (IMVS 6.6 fps), and $3.95{\pm}0.02$ (RPM), respectively, and showed good agreement on real value (4 sec/cycle). Average of the amplitude of motion tracked by our system showed $1.85{\pm}0.02$ cm (3.3 fps) and $1.94{\pm}0.02$ cm (6.6 fps) as showed a slightly different value, 0.15 (7.5% error) and 0.06 (3% error) cm, respectively, compared with the actual value (2 cm), due to time resolution for image acquisition. In analysis of pattern of motion, the value of the RMS from the cine EPID image in 3.3 fps (0.1044) grew slightly compared with data from 6.6 fps (0.0480). The organ motion verification system using sequential cine EPID images with an internal surrogate showed good representation of its motion within 3% error in a preliminary phantom study. The system can be implemented for clinical purposes, which include organ motion verification during treatment, compared with 4D treatment planning data, and its feedback for accurate dose delivery to the moving target.

• Progress in Medical Physics
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• v.8 no.2
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• pp.67-76
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• 1997

We studied optical behavior of scintillation light generated in NaI(TI) crystal using Monte Carlo simulation method. The simulation was performed for the model of NaI(TI) scintillator (size: 60 mm ${\times}$ 60 mm ${\times}$ 6 mm) using an optical tracking code. The sensitivity as a function of surface treatment (Ground, Polished, Metal-0.95RC, Polished-0.98RC, Painted- 0.98RC) of the incident surface of the scintillator was compared. The effects of NaI(TI) scintillator thickness and the refractive index of light guide optically coupling between the NaI(TI) scintillator and photomultiplier tube (PMT) were simulated. We also evaluated intrinsic position resolution of the system by calculating the spread of scintillation light generated. The sensitivities of the system having the surface treatment of Ground, Polished, Metal-0.95RC, Polished-0.98RC and Painted-0.98RC were 70.9％, 73.9％, 78.6％, 80.1％ and 85.2％, respectively, and the surface treatment of Painted-0.98RC allowed the highest sensitivity. As increasing the thickness of scintillation crystal and light guide, the sensitivity of the system was decreased. As the refractive index of light guide increases, the sensitivity was increased. The intrinsic position resolution of the system was estimated to be 1.2 mm in horizontal and vertical directions. In this study, the performance of NaI(TI)-PMT detector system was evaluated using Monte Carlo simulation. Based on the results, we concluded that the NaI(TI)-PMT detector array is a favorable configuration for small gamma camera imaging breast tumor using Tc-99m labeled radiopharmaceuticals.