• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.53-60
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• 2002

Motion of lung tumors from respiration has been reported in the literature to be as large as of 1-2 cm. This motion requires an additional margin between the Clinical Target Volume (CTV) and the Planning Target Volume (PTV). While such a margin is necessary, it may not be sufficient to ensure proper delivery of Intensity Modulated Radiotherapy (IMRT) to the CTV during the simultaneous movement of the DMLC. Gated treatment has been proposed to improve normal tissues sparing as well as to ensure accurate dose coverage of the tumor volume. The following questions have not been addressed in the literature: a) what is the dose error to a target volume without gated IMRT treatment\ulcorner b) what is an acceptable gating window for such treatment. In this study, we address these questions by proposing a novel technique for calculating the 3D dose error that would result if a lung IMRT plan were delivered without gating. The method is also generalized for gated treatment with an arbitrary triggering window. IMRT plans for three patients with lung tumor were studied. The treatment plans were generated with HELIOS for delivery with 6 MV on a CL2100 Varian linear accelerator with a 26 pair MLC. A CTV to PTV margin of 1 cm was used. An IMRT planning system searches for an optimized fluence map ${\Phi}$ (x,y) for each port, which is then converted into a dynamic MLC file (DMLC). The DMLC file contains information about MLC subfield shapes and the fractional Monitor Units (MUs) to be delivered for each subfield. With a lung tumor, a CTV that executes a quasi periodic motion z(t) does not receive ${\Phi}$ (x,y), but rather an Effective Incident Fluence EIF(x,y). We numerically evaluate the EIF(x,y) from a given DMLC file by a coordinate transformation to the Target's Eye View (TEV). In the TEV coordinate system, the CTV itself is stationary, and the MLC is seen to execute a motion -z(t) that is superimposed on the DMLC motion. The resulting EIF(x,y)is inputted back into the dose calculation engine to estimate the 3D dose to a moving CTV. In this study, we model respiratory motion as a sinusoidal function with an amplitude of 10 mm in the superior-inferior direction, a period of 5 seconds, and an initial phase of zero.

• Progress in Medical Physics
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• v.23 no.3
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• pp.127-137
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• 2012

A conversing beam is firstly designed for radiosurgery by a neurosugern Lars Leksell in 1949 with orthogonal x-rays tube moving through horizontal moving arc to focusing the beam at target center. After 2 decades he composits 201 source of the Co-60 for gamma knife which beams focused at locus. Sveral linac-based stereotactic radiosurgery using the circular collimated beam which size range for 0.4~4.0 cm in a diameter by non-coplanar multiarc have been developed over the decades. The irregular lesions can be treated by superimposing with several spherical shots of radiation over the tumour volume. Linac based techniques include the use of between 4 and 11 non-co-planar arcs and a dynamic rotation technique and use photon beam energies in the range of 6~10 MV. Reviews of the characteristics of several treatment techniques can be found in the literature (Podgorsak 1989, Schell 1991). More in recent, static conformal beams defined by custom shaped collimators or a mini- or micro-multileaf collimator (mMLC) have been used in SRS. Finally, in the last few years, intensity-modulated mMLC SRS has also been introduced. Today, many commercial and in-house SRS programs have also introduced non-invasive immobilization systems include the cyberknife and tomotherapy and proton beam. This document will be compared the characteristics of dose distribution of radiosurgery as introduced gamma knife, BrainLab include photon knife in-house SRS program and cyberknife in currently wide used for a cranial SRS.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.248-251
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• 2002

The intensity modulated radiation therapy (IMRT) with a multileaf collimator (MLC) requires the conversion of a radiation fluence map into a leaf sequence file that controls the movement of the MLC during radiation treatment of patients. Patient dose verification is clinically one of the most important parts in the treatment delivery of the radiation therapy. The three dimensional (3D) reconstruction of dose distribution delivered to the target helps to verify patient dose and to determine the physical characteristics of beams used in IMRT. A new method is presented for the pretreatment dosimetric verification of two dimensional distributions of photon intensity by means of Beam Intensity Scanner System (BISS) as a radiation detector with a custom-made software for dose calculation of fluorescence signals from scintillator. The scintillator is used to produce fluorescence from the irradiation of 6MV photons on a Varian Clinac 21EX. The BISS reproduces 3D- relative dose distribution from the digitized fluoroscopic signals obtained by digital video camera-based scintillator(DVCS) device in the IMRT. For the intensity modulated beams (IMBs), the calculations of absorbed dose are performed in absolute beam fluence profiles which are used for calculation of the patient dose distribution. The 3D-dose profiles of the IMBs with the BISS were demonstrated by relative measurements of photon beams and shown good agreement with radiographic film. The mechanical and dosimetric properties of the collimating of dynamic and/or step MLC system alter the generated intensity. This is mostly due to leaf transmission, leaf penumbra and geometry of leaves. The variations of output according to the multileaf opening during the irradiation need to be accounted for as well. These phenomena result in a fluence distribution that can be substantially different from the initial and calculative intensity modulation and therefore, should be taken into account by the treatment planning for accurate dose calculations delivered to the target volume in IMRT.

• The Journal of Korean Society for Radiation Therapy
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• v.24 no.1
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• pp.1-10
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• 2012

Purpose: To evaluate dose distribution differences when the dose rates are randomly changed in intensity-modulated radiation therapy using a dynamic multileafcollimator. Materials and Methods: Two IMRT treatment plans including small-field and large-field plans were made using a commercial treatment planning system (Eclipse, Varian, Palo Alto, CA). Each plan had three sub-plans according to various dose rates of 100, 400, and 600 MU/min. A chamber array (2D-Array Seven729, PTW-Freiburg) was positioned between solid water phantom slabs to give measurement depth of 5 cm and backscattering depth of 5 cm. Beam deliveries were performed on the array detector using a 6 MV beam of a linear accelerator (Clinac 21EX, Varian, Palo Alto, CA) equipped with 120-leaf MLC (Millenium 120, Varian). At first, the beam was delivered with same dose rates as planned to obtain reference values. After the standard measurements, dose rates were then changed as follows: 1) for plans with 100 MU/min, dose rate was varied to 200, 300, 400, 500 and 600 MU/min, 2) for plans with 400 MU/min, dose rate was varied to 100, 200, 300, 500 and 600 MU/min, 3) for plans with 600 MU/min, dose rate was varied to 100, 200, 300, 400 and 500 MU/min. Finally, using an analysis software (Verisoft 3.1, PTW-Freiburg), the dose difference and distribution between the reference and dose-rate-varied measurements was evaluated. Results: For the small field plan, the local dose differences were -0.8, -1.1, -1.3, -1.5, and -1.6% for the dose rate of 200, 300, 400, 500, 600 MU/min, respectively (for 100 MU/min reference), +0.9, +0.3, +0.1, -0.2, and -0.2% for the dose rate of 100, 200, 300, 500, 600 MU/min, respectively (for 400 MU/min reference) and +1.4, +0.8, +0.5, +0.3, and +0.2% for the dose rate of 100, 200, 300, 400, 500 MU/min, respectively (for 600 MU/min reference). On the other hand, for the large field plan, the pass-rate differences were -1.3, -1.6, -1.8, -2.0, and -2.4% for the dose rate of 200, 300, 400, 500, 600 MU/min, respectively (for 100 MU/min reference), +2.0, +1.8, +0.5, -1.2, and -1.6% for the dose rate of 100, 200, 300, 500, 600 MU/min, respectively (for 400 MU/min reference) and +1.5, +1.9, +1.7, +1.9, and +1.2% for the dose rate of 100, 200, 300, 400, 500 MU/min, respectively (for 600 MU/min reference). In short, the dose difference of dose-rate variation was measured to the -2.4~+2.0%. Conclusion: Using the Varian linear accelerator with 120 MLC, the IMRT dose distribution is differed a little <(${\pm}3%$) even though the dose-rate is changed.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.2
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• pp.77-82
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• 2007

Purpose: This study investigates peripheral dose from physical wedge and dynamic wedge system on a multileaf collimator (MLC) equipment linear accelerator. Materials and Methods: Measurments were performed using a 2D array ion chamber and solid water phantom for a 10$\times$10 cm, source-surface distance (SSD) 90 cm, 6 and 15 MV photon beam at depths of 0.5 cm, 5 cm through dmax. Measurments of peripheral dose at 0.5 cm and 5 cm depths were performed from 1 cm to 5 cm outside of fields for the dynamic wedge and physical wedge 15$^\circ$, 45$^\circ$. Dose profiles normalized to dose at the maximum depth. Results: At 6 MV photon beam, the average peripheral dose of dynamic wedge were lower by 1.4% and 0.1%. At 15 MV photon beam, the peripheral dose of dynamic wedge were lower by maximum 1.6%. Conclusion: This study showed that dynamic wedge can reduce scattered dose of clinical organ close to the field edge and reduced treatment time. The wedge systems produce significantly different peripheral dose that should be considered in properly choosing a wedge system for clinical use.

• Journal of radiological science and technology
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• v.39 no.4
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• pp.577-585
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• 2016

The purpose of this study is to evaluate the accuracy of beam delivery QA software using the MLC dynalog file, about the VMAT plan with AAPM TG-119 protocol. The Clinac iX with a built-in 120 MLC was used to acquire the MLC dynalog file be imported in MobiusFx(MFX). To establish VMAT plan, Oncentra RTP system was used target and organ structures were contoured in Im'RT phantom. For evaluation of dose distribution was evaluated by using gamma index, and the point dose was evaluated by using the CC13 ion chamber in Im'RT phantom. For the evaluation of point dose, the mean of relative error between measured and calculated value was $1.41{\pm}0.92%$(Target) and $0.89{\pm}0.86%$(OAR), the confidence limit were 3.21(96.79%, Target) and 2.58(97.42%, OAR). For the evaluation of dose distribution, in case of $Delta^{4PT}$, the average percentage of passing rate were $99.78{\pm}0.2%$(3%/3 mm), $96.86{\pm}1.76%$(2%/2 mm). In case of MFX, the average percentage of passing rate were $99.90{\pm}0.14%$(3%/3 mm), $97.98{\pm}1.97%$(2%/2 mm), the confidence limits(CL) were in case of $Delta^{4PT}$ 0.62(99.38%, 3%/3 mm), 6.6(93.4%, 2%/2 mm), in case of MFX, 0.38(99.62%, 3%/3 mm), 5.88(94.12%, 2%/2 mm). In this study, we performed VMAT QA method using dynamic MLC log file compare to binary diode array chamber. All analyzed results were satisfied with acceptance criteria based on TG-119 protocol.

• The Journal of Korean Society for Radiation Therapy
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• v.16 no.2
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• pp.43-61
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• 2004

Purpose : For qualify improvement in radiotherapy, it is important to set up and evaluate equipment (linac) accurately. In addition, technicians are needed to be fully aware of the equipment's detailed quality and its manual. Therefore, the result of ATP is evaluated and introduced, in order that the technicians are skilled by participating in quality assurance (QA) and understanding the quality of the equipment before clinical use. Method and Material : QA for LINAC 21EX (Varian, US) was done with suppliers its procedure was divided into radiation survey, mechanical test, radiation isocenter test, bean performance, dosimetry, and enhanced dynamic wedge and using X-omat film (Kodak), multidata, densitometer, and electrometer. QA of MLC (Millennium, 120 leaf) attached to LINAC and EPID (Portal vision) were done separately. Result : The leakage dose by survey meter was below the tolerance. In mechanical test, collimater, gantry, and couch rotation were less than 1mm, and the angles were ${\pm}0.1^{\circ}$ for digital and ${\pm}0.5^{\circ}$ for mechanical. The alignment test of the light field and crosshair were evaluated less than 1mm. The (a)symmetrical jaw field was less than ${\pm}0.5mm$. The radiation isocenter test using X-mat film was less than 1mm. The consistency of light field and radiation field was less than ${\pm}0.1mm$. PDD for photon energy was less than ${\pm}1\%$ and for electron energy of $90\%,\;80\%,\;50\%,\;and\;30\%$ were evaluated within the tolerance. Flatness for photon and electron energy was evaluated $2.3\%$ (tolerance $3\%$) and $3\%$ (tolerance $4.5\%$), respectively, and symmetry was $0.45\%$ (tolerance $2\%$) and $0.3\%$ (tolerance $2\%$), respectively. Dosimetry test for short term, MU setting, rep rate, and dose rate accuracy of photon and electron energy was within the tolerance depending on energy, MU, and gantry angle. Conclusion : Accuracy and safety for clinical use of Clinac 21EX was verified through customer acceptance procedure and the quality of the equipment was found out. These can reduce the difficulties in using the equipment. Furthermore, it is useful for clinically treatment of patients by technicians' active participations.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.64-64
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• 2003

Objectives: Patient dose verification is clinically the most important parts in the treatment delivery of radiation therapy. The three dimensional(3D) reconstruction of dose distribution delivered to target volume helps to verify patient dose and determine the physical characteristics of beams used in intensity modulated radiation therapy(IMRT). We present Beam Intensity Scanner(BInS) system for the pre treatment dosimetric verification of two dimensional photon intensity. The BInS is a radiation detector with a custom made software for relative dose conversion of fluorescence signals from scintillator. Methods: This scintillator is fabricated by phosphor Gadolinium Oxysulphide and is used to produce fluorescence from the irradiation of 6MV photons on a Varian Clinac 21EX. The digitized fluoroscopic signals obtained by digital video camera will be processed by our custom made software to reproduce 3D relative dose distribution. For the intensity modulated beam(IMB), the BInS calculates absorbed dose in absolute beam fluence, which are used for the patient dose distribution. Results: Using BInS, we performed various measurements related to IMRT and found the followings: (1) The 3D dose profiles of the IMBs measured by the BInS demonstrate good agreement with radiographic film, pin type ionization chamber and Monte Carlo simulation. (2) The delivered beam intensity is altered by the mechanical and dosimetric properties of the collimating of dynamic and/or static MLC system. This is mostly due to leaf transmission, leaf penumbra, scattered photons from the round edges of leaves, and geometry of leaf. (3) The delivered dose depends on the operational detail of how to make multileaf opening. Conclusions: These phenomena result in a fluence distribution that can be substantially different from the initial and calculative intensity modulation and therefore, should be taken into account by the treatment planing for accurate dose calculations delivered to the target volume in IMRT.

• Progress in Medical Physics
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• v.15 no.1
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• pp.1-8
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• 2004

Patient dose verification is one of the most Important responsibilities of the physician in the treatment delivery of radiation therapy. For the task, it is necessary to use an accurate dosimeter that can verify the patient dose profile, and it is also necessary to determine the physical characteristics of beams used in intensity modulated radiation therapy (IMRT) The Beam Intensity Scanner (BInS) System is presented for the dosimetric verification of the two dimensional photon beam. The BInS has a scintillator, made of phosphor Terbium-doped Gadolinium Oxysulphide (Gd$_2$O$_2$S:Tb), to produce fluorescence from the irradiation of photon and electron beams. These fluoroscopic signals are collected and digitized by a digital video camera (DVC) and then processed by custom made software to express the relative dose profile in a 3 dimensional (3D) plot. As an application of the BInS, measurements related to IWRT are made and presented in this work. Using a static multileaf collimator (SMLC) technique, the intensity modulated beam (IMB) is delivered via a sequence of static portals made by controlled leaves. Thus, when static subfields are generated by a sequence of abutting portals, the penumbras and scattered photons of the delivered beams overlap in abutting field regions and this results in the creation of “hot spots”. Using the BInS, inter-step “hot spots” inherent in SMLC are measured and an empirical method to remove them is proposed. Another major MLC technique in IMRT, the dynamic multileaf collimator (DMLC) technique, has different characteristics from SMLC due to a different leaf operation mechanism during the irradiation of photon and electron beams. By using the BInS, the actual delivered doses by SMLC and DMLC techniques are measured and compared. Even if the planned dose to a target volume is equal in our experimental setting, the actual delivered dose by DMLC technique is measured to be larger by 14.8% than that by SMLC, and this is due to scattered photons and contaminant electrons at d$_{max}$.

• Progress in Medical Physics
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• v.16 no.2
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• pp.82-88
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• 2005

In this study, the physical compensator made with the high density material, Cerrobend, and the electronic compensator realized by the movement of a dynamic multileaf collimator were analyzed in order to verify the properness of a design function in the commercial RTP (radiation treatment planning) system, Eclipse. The CT images of a phantom composed of the regions of five different thickness were acquired and the proper compensator which can make homogeneous dose distribution at the reference depth was designed in the RTP. The frame for the casting of Cerrobend compensator was made with a computerized automatic styrofoam cutting device and the Millennium MLC-120 was used for the electronic compensator. All the dose values and isodose distributions were measured with a radiographic EDR2 film. The deviation of a dose distribution was $\pm0.99 cGy\;and\;\pm1.82cGy$ in each case of a Cerrobend compensator and a electronic compensator compared with a $\pm13.93 cGy$ deviation in an open beam condition. Which showed the proper function of the designed compensators in the view point of a homogeneous dose distribution. When the absolute dose value was analyzed, the Cerrobend compensator showed a $+3.83\%$ error and the electronic compensator showed a $-4.37\%$ error in comparison with a dose value which was calculated in the RTP. These errors can be admtted as an reasonable results that approve the accuracy of the compensator design in the RTP considering the error in the process of the manufacturing of the Cerrobend compensator and the limitation of a film in the absolute dosimetry.