• Journal of the Korean Society of Radiology
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• v.17 no.6
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• pp.903-909
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• 2023

The purpose of this study is to compare and analyze the effect of changes in the patient's central position on the exposure dose and image quality of surrounding organs during a chest lateral examination using an Auto Exposure Control(AEC). The experiment was conducted on a human body phantom. A needle was attached to the lower part of the center of the coronal plane of the phantom, and a lead ruler was attached to the lower part of the detector so that the 50 cm point was located at the lower center of the AEC ion chamber. The exposure conditions were 125 kVp, 320 mA, the distance between the source and the image receptor was 180 cm, and the exposure field size was 14 × 17 inches. Only one AEC ion chamber was used at the bottom center, and the density was set to '0' and sensitivity to 'Middle', and the central X-ray was incident vertically toward the 6th thoracic vertebra. With AEC mode applied, the 50 cm point of the needle and lead ruler were aligned and the phantom was moved 5 cm toward the stomach (F5) and 5 cm toward the back (B5), and the dose factor was analyzed by measuring ESD. The ESD of the thyroid gland according to the change in patient center position was 232.60±2.20 μGy for Center, 231.22±1.53 μGy for F5, and 184.37±1.19 μGy for B5, and the ESD of the breast was 288.54±3.03 μGy for Center, F5 was 260.97±1.93 μGy, B5 was 229.80±1.62 μGy, and the ESD of the center of the lung was 337.02±3.25 μGy for Center, F5 was 336.09±2.29 μGy, and B5 was 261.76±1.68 μGy. As a result of comparing the average values of dose factors between each group, the difference in average values was statistically significant (p<0.01), and each group appeared to be independent. As a result of the study, there was no significant difference in the dose to the thyroid, breast, and center of the lung according to the change in the patient's central position, except for the breast (10%) when the patient moved forward about 5 cm. However, movement of about 5 cm posteriorly resulted in an average dose reduction of 23.7%. Additionally, when the patient's central position was moved to the rear, image quality deteriorated.

• Journal of radiological science and technology
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• v.38 no.3
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• pp.245-252
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• 2015

To obtain the best SNR (signal to noise ratio) due to changes in CTDI (computed tomography dose index) made for the purpose of setting the optimum image obtained by reducing the dose in abdominal CT. Abdominal CT scans of 59 patients a $400-499cm^2$ (n = 12), $500-599cm^2$ (n = 21), $600-699cm^2$ (n = 17), $700-799cm^2$ (n = 9) were separated by four groups and the effective dose was used in the Excel to get the area of the patient using the ImageJ program. Patients of CTDI, DLP, SNR, the effective dose were analyzed. Abdominal CT area was increased to 13 mGy in CTDI is 7.3 mGy, DLP to 732 in $394.4mGy{\cdot}cm$, also effective dose was 5.9 mSv increase in 11mSv. SNR is 15 dB was maintained at 12.7. CTDI according to the average of the abdominal area of 8.9 mGy, the average of the DLP was $481.54mGy{\cdot}cm$, the effective dose is calculated to be 7.2 mSV. Effective dose was calculated by multiplying the load factor of DLP in the abdomen showed no statistically significant difference of (p < .05), there was a significant difference in SNR (p > . 05). To improve image quality of abdominal CT scan image in consideration of the CTDI according to the volume of the patient it should be able to reduce the radiation exposure of the patients.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.127-135
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• 2014

Purpose : By taking advantage of each imaging modality, the use of fused CT/MRI image has increased in prostate cancer radiation therapy. However, fusion uncertainty may cause partial target miss or normal organ overdose. In order to complement such limitation, our hospital acquired MRI image (Planning MRI) by setting up patients with the same fixing tool and posture as CT simulation. This study aims to evaluate the usefulness of the Planning MRI through comparing and analyzing the diagnostic MRI image and Planning MRI image. Materials and Methods : This study targeted 10 patients who had been diagnosed with prostate cancer and prescribed nonhormone and definitive RT 70 Gy/28 fx from August 2011 to July 2013. Each patient had both CT and MRI simulations. The MRI images were acquired within one half hour after the CT simulation. The acquired CT/MRI images were fused primarily based on bony structure matching. This study measured the volume of prostate in the images of Planning MRI and diagnostic MRI. The diameters at the craniocaudal, anteroposterior and left-to-right directions from the center of prostate were measured in order to compare changes in the shape of prostate. Results : As a result of comparing the volume of prostate in the images of Planning MRI and diagnostic MRI, they were found to be $25.01cm^3$(range $15.84-34.75cm^3$) and $25.05cm^3$(range $15.28-35.88cm^3$) on average respectively. The diagnostic MRI had an increase of 0.12 % as compared with the Planning MRI. On the planning MRI, there was an increase in the volume by $7.46cm^3$(29 %) at the transition zone directions, and there was a decrease in the volume by $8.52cm^3$(34 %) in the peripheral zone direction. As a result of measuring the diameters at the craniocaudal, anteroposterior and left-to-right directions in the prostate, the Planning MRI was found to have on average 3.82cm, 2.38cm and 4.59cm respectively and the diagnostic MRI was found to have on average 3.37cm, 2.76cm and 4.51cm respectively. All three prostate diameters changed and the change was significant in the Planning MRI. On average, the anteroposterior prostate diameter decrease by 0.38cm(13 %). The mean right-to-left and craniocaudal diameter increased by 0.08cm(1.6 %) and 0.45cm(13 %), respectively. Conclusion : Based on the results of this study, it was found that the total volumes of prostate in the Planning MRI and the diagnostic MRI were not significantly different. However, there was a change in the shape and partial volume of prostate due to the insertion of prostate balloon tube to the rectum. Thus, if the Planning MRI images were used when conducting the fusion of CT/MRI images, it would be possible to include the target in the CTV without a loss as much as the increased volume in the transition zone. Also, it would be possible to reduce the radiation dose delivered to the rectum through separating more clearly the reduction of peripheral zone volume. Therefore, the author of this study believes that acquisition of Planning MRI image should be made to ensure target delineation and localization accuracy.

• 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.

• The Korean Journal of Nuclear Medicine Technology
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• v.19 no.1
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• pp.51-56
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• 2015

Purpose As medical radiation exposures on patients are being social issues an interest in a relief of radiation exposures on patients is increasing. Further, there are many cases where some patients among who are getting PET/CT tests choose to get implanted with metal artifacts in their bodies. This study is to find out effects of presence or absence of metal artifacts when dose change or CT attenuation correction for the relief of radiation exposures are applied using phantoms through changes in standard uptake value (SUV). Materials and Methods GE company's Discovery 710 machine was used for PET/CT test equipments. We used NEMA IEC body phantoms. We also used screw and mesh cage made of titanium which are used in real clinical processes for the metal artifacts. Two experiments were conducted: One is to test and measure repeatedly about SUV about differences in CT attenuation corrections according to dose changes and another is to do the same procedure for SUV about the presence and absence of the metal artifacts. We injected $^{18}F-FDG$ into NEMA IEC body phantoms with a TBR ratio of 4:1 and then put the metal material into the transformation phantoms. Once a scanning for the metal artifacts was done we eliminated the metal artifacts and went on non-metal artifacts. For the each two experiments, we scanned repeatedly with CT kVp (140, 120, 100, 80) and mA (120, 80, 40, 20, 10) for an experimental condition. For PET, we reconstructed each with standard AC (STD) technique and quantitation achieved cnsistently QAC) technique among CT attenuation correction methods. We conducted a comparative analysis on measured average values and variations which were measured through repeated measure of SUV of region 1, 2, 3 spheres for each conditions of non-metal /metal scan. Results For each kVp, 120, 80, 40 (mA) of non/metal (screw, mesh cage) showed low frequency of fluctuation rates of above 2%. In 20, 10 mA above 2% of fluctuation rates appeared in high frequency. Also, when we compared the fluctuation rates of STD and QAC techniques in non/metal (screw, mesh cage) tests QAC technique showed about 1-10% of differences for each conditions compared to STD technique. In addition, metal types did not have significant effects on fluctuation rates. Conclusion We confirmed that SUV fluctuation rates for both STD and QAC techniques increase as dosage is lower. We also found that the SUV of PET data was maintained steadily in a low dosage for QAC technique when compared with STD technique. Hence, when the low dosage is used for the relief of radiation exposures on patients QAC technique may be exploited helpfully and this could be applied in the same way for patients with metal artifacts implanted in their bodies.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.1
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• pp.59-65
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• 2016

Purpose Dynamic kidney scan is a typical imaging technique that visualizes kidney function. Reproducibility of dynamic kidney scans has been evaluated by comparing low-dose kidney scans with low-dose radiopharmaceutical and standard dynamic kidney scan. With this comparative study, if reproducibility is superb, the dynamic kidney scan method with reduced radioactivity to patients is to be utilized and radiation exposure to patient is to be reduced. Materials and Methods For gamma camera, Orbiter, SymbiaE (Siemens, Germany) was used. Among patients who had used 370 Mbq (10 mCi) from January of 2013 to February 2014 and other patients who had used 185 Mbq (5 mCi) from March of 2014 to July of 2015 with identical condition, 21 subjects using DTPA and 20 subjects using $MAG_3$, 41 subjects in total, had been selected as subjects for data. From renogram of the result image, frame of the peak point was selected. Then, region of interest of kidney and background had been selected and Kidney to Background Ratio has been calculated for comparison. Results In tests using DTPA, kidney to background ratio when using 370 Mbq was $5.67{\pm}0.8$ at average while it was $5.62{\pm}0.87$ when using 185 Mbq, which didn't show much difference. Also in the tests using $MAG_3$, kidney to background ratio when using 370 Mbq was $14.95{\pm}2.58$ at average and $14.56{\pm}2.02$ in 185 Mbq, which neither showed much difference. In paired sample t-test, p-value was 0.566 in DTPA and 0.363 in $MAG_3$, which confirmed that there was no difference between the groups. Conclusion In identical patients, when dose was decreased from 370 Mbq to 185 Mbq, reproducibility of dynamic kidney scan was proven to be excellent. Low-dose Dynamic kidney scan can achieve results with fine reproducibility without improvement in performance of gamma camera and is expected to reduce radiation exposure to patient.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.156-163
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• 1998

Background & Objectives: Frameless fractionated stereotactic radiotherapy(FFSRT) is a modification of stereotactic radiosurgery(SRS) with radiobiologic advantage of fractionation without losing mechanical accuracy of SRS. Local recurrence of head and neck cancer at or near skull base benefit from reirradiation. Main barrier to successful palliation is dose limitation secondary to normal tissue tolerance. We try to evaluate the efficacy and safety of FFSRT as a new modality of reirradaton in these challenging patients. Materials & Methods: Seven patients with recurrent head & neck cancer involving at or near skull base received FFSRT from September 1995 to November 1997. Six patients with nasopharyngeal cancer had received induction chemotherapy and curative radiation therapy. One patient with maxillary sinus cancer had received total maxillectomy and postoperative radiation therapy as a initial treatment. Follow-up ranged from 11 to 32 months with median of 24 months. Three of 7 patients received hyperfractionated radiation therapy(1.1-1.2Gy/fraction, bid, total 19.8-24Gy) just before FFSRT. All patients received FFSRT(3-5Gy/fraction, total 15-30Gy/5-10fractions). Chemotherapy(cis-platin $100mg/m^2$) were given concurrently with FFSRT in four patients. Second course of FFSRT were given in 4 patients with progression or recurrence after initial FFSRT. Because IF(irregularity factor; ratio of surface area of target to the surface area of sphere with same volume as a target) is too big to use conventional stereotactic RT using multiple arc method for protection of radiation damage to critical normal tissue, all patients received FFSRT with conformal method using irregular static ports. Results: Five of 7 patients showed complete remission in follow-up CT &/or MRI. Three of these five patients who developed marginal, in-field, and out-field recurrences, respectively. Another one of complete responders has been dead of G-I bleeding without evidence of local recurrence. One partial responder who showed progressive disease 15 months after initial FFSRT has received additional FFSRT, and then he is well-being with symptomatic improvement. One minmal responder who showed progression of locoregional disease 9 months after $1^{st}$ FFSRT has received 2nd FFSRT, and then he is alive with stable disease. Five of 7 case had showed direct invasion to skull base and had complaint headache and various symptoms of cranial nerve involvement. Four of these five case showed improvement of neurologic symptoms after FFSRT. No significant neurologic complicaltion related to FFSRT was observed during follow-up periods. Tumor volumes were ranged from 3.9 to 50.7 cc and surface area ranged from 16.1 to $114.9cm^2$. IF ranged from 1.21 to 1.74. The average ratio of volume of prescription isodose shell to target volume was 1.02 that indicated the improvement of target coverage and dose distribution with FFSRT with conformal method compared to target coverage with FFSRT with multiple arc method. Conclusion: Our initial experience suggests that FFSRT with conformal method was relatively effective and safe modality in the treatment of recurrent head and neck cancer involving at or near skull base. Treatment benefit included good palliation of symptoms and reasonable radiographic response. However, more experience and additional follow-up are needed to better assess its ultimate role in treating these challenging patients.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.1
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• pp.62-66
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• 2013

Purpose: I-131 is a radioisotope widely used for thyroid gland treatments. The physical half life is 8.01 and characterized by emitting beta and gamma rays which is used in clinical practice for the purpose of acquiring treatment and images. In order to reduce the recurrence rate after surgery in high-risk thyroid cancer patients, the remaining thyroid tissue is either removed or the I-131 is used for treatment during relapse. In cases of using a high dosage of radioactive iodine requiring hospitalization, the patient is administered dosage in the hospital isolation ward over a certain period of time preventing I-131 exposure to others. By checking the radiation amount emitted from patients before discharge, the patients are discharged after checking whether they meet the legal standards (50 uSv/h). After patients are discharged from the hospital, the contamination level is checked in many parts of the ward before the next patients are hospitalized and when necessary, decontamination operations are performed. It is expected that there is exposure to radiation when measuring the ward contamination level and dose check emitted from patients at the time of discharge whereby the radiation exposure by health workers that come from the patients in this process is the main factor. This study analyzed the correlation between discharge dose of patients and ward contamination level through a variety of factors such as renal functions, gender, age, dosage, etc.). Materials and Method: The study was conducted on 151 patients who received high-dosage radioactive iodine treatment at Soon Chun Hyang University Hospital during the period between 8/1/2011~5/31/2012 (Male: Female: 31:120, $47.5{\pm}11.9$, average dosage of $138{\pm}22.4$ mCi). As various factors expected to influence the patient discharge dose & ward contamination such as the beds, floors, bathroom floors, and washbasins, the patient renal function (GFR), age, gender, dosage, and the correlation between the expected Tg & Tg-Tb expected to reflect the remaining tissue in patients were analyzed. Results: In terms of the discharge dose and GFR, a low correlation was shown in the patient discharge dose as the GFR was higher (p < 0.0001). When comparing the group with a dosage of over 150mCi and the group with a lower dosage, the lower dosage group showed a significantly lower discharge dose ($24{\pm}10.4uSv/h$ vs $28.7{\pm}11.8uSv/h$, p<0.05). Age, gender, Tg, Tg-Tb did not show a significant relationship with discharge dose (p> 0.05). The contamination level in each spot of the treatment ward showed no significant relationship with GFR, Tg, Tg-Tb, age, gender, and dosage (p>0.05 ). Conclusion: This study says that discharge of the dose in the patient's body is low in GFR higher and Dosage 150mCi under lower. There was no case of contamination of the treatment ward, depending on the dose and renal association. This suggests that patients' lifestyles or be affected by a variety of other factors.

• Journal of Radiation Protection and Research
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• v.39 no.1
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• pp.7-13
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• 2014

Phosphate rock, phosphogypsum, and products in phosphate processing facility contain naturally occurring radioactive materials (NORM). Therefore, they may give rise to enhanced radiation dose to workers due to inhalation of airborne particulates. Internal dose due to particle inhalation varies depending on particle properties. The objective of the present study was to characterize particle properties at the largest phosphate processing facility in Korea. A cascade impactor was employed to sample airborne particulates at various processing areas in the plant. The collected samples were used for characterization of particle size distribution, particle concentration in the air, and shape analysis. Aerodynamic diameters of airborne particulates ranged 0.03-100 ${\mu}m$ with the highest concentration at the particle size range of 4.7-5.8 ${\mu}m$ (geometric mean = 5.22 ${\mu}m$) or 5.8-9.0 ${\mu}m$ (geometric mean = 7.22 ${\mu}m$). Particle concentrations in the air varied widely by sampling area up to more than two orders of magnitude. The large variation resulted from the variability of mechanical operations and building ventilations. The airborne particulates appeared as spheroids or rough spherical fragments across all sampling areas and sampled size intervals. Average mass densities of phosphate rocks, phosphogypsums, and fertilizers were 3.1-3.4, 2.1-2.6, and 1.7 $gcm^{-3}$, respectively. Radioactivity concentration of uranium series in phosphate rocks varied with country of origin, ranging 94-866 $Bqkg^{-1}$. Among the uranium series, uranium was mostly concentrated on products, including phosphoric acid or fertilizers whereas radium was concentrated on byproducts or phosphogypsum. No significant radioactivity of $^{226}Ra$ and $^{228}Ra$ were found in fertilizer. However, $^{40}K$ concentration in fertilizer was up to 5,000 Bq $g^{-1}$. The database established in this study can be used for the accurate risk assessment of workers due to inhalation of airborne particles containing NORM. In addition, the findings can be used as a basic data for development of safety standard and guide and for practical radiation safety management at the facility.

• Journal of radiological science and technology
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• v.33 no.3
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• pp.277-282
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• 2010

The study is to verify non-uniform dose distribution in Field-In-Field (FIF) technique using two-dimensional ionization chamber (MatriXX, Wellhofer Dosimetrie, Germany) for breast tangential irradiation. The MatriXX and an inverse planning system (Eclipse, ver 6.5, Varian, Palo Alto, USA) were used. Hybrid plans were made from the original twenty patients plans. To verify the non-uniform dose distribution in FIF technique, each portal prescribed doses (90 cGy) was delivered to the MatriXX. The measured doses on the MatriXX were compared to the planned doses. The quantitative analyses were done with a commercial analyzing tool (OmniPro IMRT, ver. 1.4, Wellhofer Dosimetrie, Germany). The delivered doses at the normalization points were different to average 1.6% between the calculated and the measured. In analysis of line profiles, there were some differences of 1.3-5.5% (Avg: 2.4%), 0.9-3.9% (Avg: 2.5%) in longitudinal and transverse planes respectively. For the gamma index (criteria: 3 mm, 3%) analyses, there were shown that 90.23-99.69% (avg: 95.11%, std: 2.81) for acceptable range ($\gamma$-index $\geq$ 1) through the twenty patients cases. In conclusion, through our study, we have confirmed the availability of the FIF technique by comparing the calculated with the measured using MatriXX. In the future, various clinical applications of the FIF techniques would be good trials for better treatment results.