• Journal of the Korean Society of Radiology
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• v.10 no.7
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• pp.477-482
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• 2016

This study is tried to determine whether the management of medical radiation is well handled by comparison the guidelines of KFDA(korea food & drug administration) with analysis of dose indicator in mammography. As a method, it is analysed that kVp, exposure time, mAs, compressed breast thickness, average glandular dose and body mass index that were classified in the examination of both breasts by CC(cranio-caudal) and MLO(medio-lateral oblique) with EMR(electronic medical record) and dose report that were sent to the PACS(picture archiving communication system). As a result, in the site inspection according to the age, Compressed breast thickness in CC and MLO were the thickest of 45.6 mm and 49.6 mm in the 50-59 year old respectively. In the overall average compressed breast thickness, CC were 44.2 mm and MLO were 48.9 mm. MLO has more thick by 4.7 mm. In average glandular dose, CC were 1.05 mGy and MLO were 1.14 mGy. MLO has higher by 0.09 mGy than CC. As the compressed breast thickness increases 10mm, CC and MLO increases 0.15 mGy and 0.17 mGy respectively. When it was compared with the average glandular dose of 1.16 mGy per 1 film presented by KFDA, CC was showed 1.05 mGy. However, the 60 mm or more was found to exceed a 1.30 mGy. Also, As the compressed breast thickness was higher, body mass index showed high score. And in the case of 25 or more in the obese body index according to body mass index, it was showed obesity in case of the compressed breast thickness was more than 50mm.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.89-97
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• 2021

Purpose: The purpose of this study is to compare and evaluate the dose change according to the gas volume variations in the rectum, which was not included in the treatment plan during radiation therapy for cervical cancer. Materials and methods: Static Intensity Modulated Radiation Therapy (S-IMRT) using a 9-field and Volumetric Modulated Arc Therapy (VMAT) using 2 full-arcs were established with treatment planning system on Computed Tomography images of a human phantom. Random gas parameters were included in the Planning Target Volume(PTV) with a maximum change of 2.0 cm in increments of 0.5 cm. Then, the Conformity Index (CI), Homogeneity Index (HI) and PTV D_max for the target volume were calculated, and the minimum dose (D_min), mean dose (D_mean) and Maximum Dose (D_max) were calculated and compared for OAR(organs at risk). For statistical analysis, T-test was performed to obtain a p-value, where the significance level was set to 0.05. Result: The HI coefficients of determination(R²) of S-IMRT and VMAT were 0.9423 and 0.8223, respectively, indicating a relatively clear correlation, and PTV D_max was found to increase up to 2.8% as the volume of a given gas parameter increased. In case of OAR evaluation, the dose in the bladder did not change with gas volume while a significant dose difference of more than D_mean 700 cGy was confirmed in rectum using both treatment plans at gas volumes of 1.0 cm or more. In all values except for D_mean of bladder, p-value was less than 0.05, confirming a statistically significant difference. Conclusion: In the case of gas generation not considered in the reference treatment plan, as the amount of gas increased, the dose difference at PTV and the dose delivered to the rectum increased. Therefore, during radiation therapy, it is necessary to make efforts to minimize the dose transmission error caused by a large amount of gas volumes in the rectum. Further studies will be necessary to evaluate dose transmission by not only varying the gas volume but also where the gas was located in the treatment field.

• Progress in Medical Physics
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• v.32 no.3
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• pp.70-81
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• 2021

Purpose: This study was designed to investigate the dosimetric difference between intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in head and neck cancer (HNC). The study primarily focuses on low-dose spillage evaluation between these two techniques. Methods: This retrospective study involved 45 patients with HNC. The treatment plans were generated using the IMRT and VMAT techniques for all patients. Dosimetric comparisons were performed in terms of target coverage, organ-at-risk (OAR) sparing, and various parameters, including conformity index, uniformity index, homogeneity index, conformation number, low-dose volumes, and normal tissue integral dose (NTID). Results: No significant (P>0.05) difference in planning target volume coverage (D_95%) was observed between IMRT and VMAT plans for supraglottic larynx, hard palate, and tongue cancers. A decrease in dose volumes ranging from 1 Gy to 30 Gy was observed for VMAT plans compared with those for IMRT plans, except for V_1Gy and V_30Gy for supraglottic larynx cancer and V_1Gy for tongue cancer. Moreover, decreases (P<0.05) in NTID were observed for VMAT plans compared with that for IMRT plans in supraglottic larynx (4.50%), hard palate (12.80%), and tongue (7.76%) cancers. In contrast, a slight increase in monitor units for VMAT compared with those for IMRT in supraglottic larynx (0.46%), hard palate (2.54%), and tongue (7.56%) cancers. Conclusions: For advanced-stage HNC, both IMRT and VMAT offer satisfactory clinical plans. VMAT offers a conformal and homogeneous dose distribution with comparable OAR sparing and higher dose falloff outside the target volume than IMRT, which provides an edge to reduce the risk of secondary malignancies for HNC over IMRT.

• Journal of the Korean Society of Radiology
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• v.11 no.6
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• pp.453-458
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• 2017

Computed Tomography (CT) provides information on the Diagnostic Reference Level Computed Tomography Dose Index (CTDI) and Dose Length Product (DLP) for accurate diagnosis of patients. However, it does not provide a dose change according to the table height for the diagnostic reference level provided by the CT equipment. The purpose of this study was to evaluate the image and dose according to the table height change using phantom (PMMA: Polymethyl Methacrylate) in order to find the optimal image and the minimum dose during computed tomography examination. When examining using a 32 cm PMMA phantom with the same thickness as the abdomen of an adult, there was little change in dose with table height. However, the noise evaluation of the image caused a high fluctuation of noise depending on the table height. and in the case of the 16 cm PMMA phantom, the change of the noise was small, but the dose change was about 30%. In conclusion, the location of the patient and the center of the detector are important during computed tomography (CT) examinations. In addition, table height setting is considered to be important for examinations with optimized image and minimum dose.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.13-20
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• 2022

Purpose : IMRT using Tomotherapy during nasopharyngeal cancer radiation therapy irradiate an accurate dose to tumor tissues and is effective to reduce a dose rapidly in normal tissues. However, this has high MU and long Beam On Time. This study aims to analyze differences in tumors, normal tissues and low-dose distributions and the efficiency of Split VMAT after applying Helical IMRT (Tomotherapy), VMAT (Linac : 2Arc) and Split VMAT (Linac : 4Arc) plans. Materials and Methods : This study targeted ten nasopharyngeal cancer patients of this hospital and compared three treatment plans (Helical IMRT, VMAT, Split VMAT). For Helical IMRT planning, Precision^® (Version 1.1.1.1, Accuray, USA) was used, and for VMAT and Split VMAT planning, Pinnacle^3® (Version 9.10, Philips, USA) was used. The total dose applied was 38.4 Gy / 32 Gy (Daily Dose 2.4 Gy (GTV + 0.3 cm) / 2 Gy (CTV + 0.3 cm) 16Fx), and for GTV + 0.3 cm (P_GTV), 95% of V_38.4Gy was prescribed. VMAT with an angle of 360° 2Arc was applied, and for Split VMAT, the field was divided into the right, the left, the top and the bottom and an angle of 360° 4Arc, 6MV was set. For evaluating the quality of the treatment plans, differences in tumors, normal tissues and low-dose area were compared, and Beam On Time was measured to analyze the efficiency. Results : When calculating the mean values of evaluation items of the three treatment plans (Helical IMRT, VMAT, Split VMAT) for the patients, the H.I (Homogeneity Index) of P_GTV was 1.04, 1.11 and 1.1 respectively, and the C.I (Confomity Index) of P_CTV was 1.03, 0.99 and 1.00 respectively. The mean dose of RT Parotid Gland (Gy) was 14.54, 17.06 and 14.76 respectively, the mean dose of LT Parotid Gland (Gy) was 14.32, 17.32 and 15.09 respectively, the maximum dose of P_Cord (Spinal Cord + 0.3 cm) (Gy) was 20.57, 22.59 and 21.06 respectively, and the maximum dose of Brain Stem (Gy) was 22.35, 23.99 and 21.68 respectively. The 50% isodose curve (cc) was 1332, 1132.5 and 1065.2 respectively. Beam On Time (sec) was 373.7, 130.7 and 254.4 respectively. Conclusion : Displaying a similar treatment plan quality to Helical IMRT, which is used a lot for head and neck treatment, Split VMAT reduced the low-dose area and Beam On Time and produced a better result than VMAT. Therefore, it is considered that Split VMAT is effective not only for nasopharyngeal cancer but also for other head and neck cancers.

• Radiation Oncology Journal
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• v.30 no.3
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• pp.146-151
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• 2012

Purpose: This treatment planning study was undertaken to evaluate the impact of beam angle configuration of intensity-modulated radiotherapy (IMRT) on the dose of the normal liver in hepatocellular carcinoma (HCC). Materials and Methods: The computed tomography datasets of 25 patients treated with IMRT for HCC were selected. Two IMRT plans using five beams were made in each patient; beams with equidistance of $72^{\circ}$ (Plan I), and beams with a $30^{\circ}$ angle of separation entering the body near the tumor (Plan II). Both plans were generated using the same constraints in each patient. Conformity index (CI), homogeneity index (HI), gamma index, mean dose of the normal liver (Dmean_NL), Dmean_NL difference between the two plans, and percentage normal liver volumes receiving at least 10, 20, and 30 Gy (V10, V20, and V30) were evaluated and compared. Results: Dmean_NL, V10, and V20 were significantly better for Plan II. The Dmean_NL was significantly lower for peripheral (p = 0.001) and central tumors (p = 0.034). Dmean_NL differences between the two plans increased in proportion to gross tumor volume to normal liver volume ratios (p = 0.002). CI, HI, and gamma indices were not significantly different for the two plans. Conclusion: The IMRT plan based on beams with narrow separations reduced the irradiated dose of the normal liver, which would allow radiation dose escalation for HCC.

• Journal of Radiation Protection and Research
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• v.43 no.3
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• pp.107-113
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• 2018

Background: The purpose of our study was to compare the dosimetric advantages of Flattening filter free (FFF) beams for trigeminal neuralgia patients using 4 mm conical collimators over previously treated patients with 6 MV SRS beam. Materials and Methods: A retrospective study was conducted for 5 TN patients who had been previously treated at our institution using frame-based, LINAC-based stereotactic radiosurgery (SRS) on Novalis Tx using 6 MV SRS beam were replanned on 6X FFF beams on Edge Linear accelerator with same beam angles and dose constraints using 4 mm conical collimator. The total number of monitor units along with the beam on time was compared for both Edge and Novalis Tx by redelivering the plans in QA mode of LINAC to compare the delivery efficiency. Plan quality was evaluated by homogeneity index (HI) and Paddick gradient index (GI) for each plan. We also analyzed the doses to brainstem and organ at risks (OARs). Results and Discussion: A 28% beam-on time reduction was achieved using 6X FFF when compared with 6X SRS beam of Novalis Tx. A sharp dose fall off with gradient index value of $3.4{\pm}0.27$ for 4 mm Varian conical collimator while $4.17{\pm}0.20$ with BrainLab cone. Among the 5 patients treated with a 4 mm cone, average maximum brainstem dose was 10.24 Gy for Edge using 6X FFF and 14.28 Gy for Novalis Tx using 6X SRS beam. Conclusion: The use of FFF beams improves delivery efficiency and conical collimator reduces dose to OAR's for TN radiosurgery. Further investigation is warranted with larger sample patient data.

• Journal of radiological science and technology
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• v.44 no.3
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• pp.183-187
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• 2021

The field size of the lumbar spine X-ray examination, which belongs to the most frequent examination in general radiography, is 5 times wider than the width of the lumbar spine. Exposure index (EI) as per International Electrotechnical Commission has a proportional relationship with the dose incident on the image receptor for clinical protocols in addition to RQA5, which is a calibration beam quality. In this study, the effectiveness of the set field size was evaluated through the change of EI according to the size of field during lumbar spine X-ray examinations. Lumbar anterior-posterior and lateral examinations was performed using a whole-body phantom, and the national average exposure conditions of Korea investigated in 2017 were introduced for the X-ray exposure. As a result of comparing the EI displayed on the console of digital radiography system for the three field size in ① 18 × 36 cm2 ② 25 × 36 cm2 ③ 36 × 36 cm2, the EI values showed a tendency to increase as the field size increased. Since the patient dose, such as organ dose around the lumbar spine, increases as the field size becomes larger, thus, if the EI obtained from the field size at a level that does not interfere with diagnosis is set as a reference, the effectiveness of the field size can be evaluated through the EI displayed on the console when the lumbar spine X-ray examination is conducted.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.2
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• pp.163-173
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• 2021

Objective: This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. Methods: This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-E_max, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. Results: The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women's age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. Conclusion: Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.

• Journal of Pharmacopuncture
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• v.16 no.3
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• pp.23-29
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• 2013

Objectives: Dyslipidemia in diabetes mellitus is a significant risk factor for the development of cardiovascular complications. The aim of this study was to evaluate the effect of the ethyl-acetate fraction of an ethanolic extract from Streospermum suaveolens on lipid metabolism in streptozotocin (STZ)-induced diabetic rats. Methods: Diabetes was induced by intraperitonial injection of STZ (50 mg/kg). Diabetic rats were treated with an ethyl-acetate fraction orally at doses of 200 and 400 mg/kg daily for 14 days. On the $15^{th}$ day, serum lipid profiles, such as total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), were estimated in experimental rats. The atherogenic (AI) and the coronary risk (CRI) indices were also evaluated. Results: The ethyl-acetate fraction at doses of 200 and 400 mg/kg significantly (P < 0.001) and dose-dependently reduced serum cholesterol, triglycerides and LDL, but increased HDL towards near normal levels as compared to diabetic control rats. The fraction also significantly (P < 0.001) lowered the atherogenic index (AI) and coronary risk index (CAI) in a dose-dependent manner. Conclusion: The present study demonstrated that the ethyl-acetate fraction of Stereospermum suaveolens exhibits a potent antihyperlipidemic activity in hyperglycemic rats and suggests that the plant may have therapeutic value in treating the diabetic complication of hyperlipidemia.