• 대한방사선치료학회:학술대회논문집
• /
• 2005.06a
• /
• pp.33-34
• /
• 2005

• The Journal of Korean Society for Radiation Therapy
• /
• v.32
• /
• pp.7-15
• /
• 2020

Purpose: In modern radiotherapy technology, several methods of image guided radiation therapy (IGRT) are used to deliver accurate doses to tumor target locations and normal organs, including CBCT (Cone Beam Computed Tomography) and other devices, ExacTrac System, other than CBCT equipped with linear accelerators. In previous studies comparing the two systems, positional errors were analysed rearwards using Offline-view or evaluated only with a Yaw rotation with the X, Y, and Z axes. In this study, when using CBCT and ExacTrac to perform 6 Degree of the Freedom(DoF) Online IGRT in a treatment center with two equipment, the difference between the set-up calibration values seen in each system, the time taken for patient set-up, and the radiation usefulness of the imaging device is evaluated. Materials and Methods: In order to evaluate the difference between mobile calibrations and exposure radiation dose, the glass dosimetry and Rando Phantom were used for 11 cancer patients with head circumference from March to October 2017 in order to assess the difference between mobile calibrations and the time taken from Set-up to shortly before IGRT. CBCT and ExacTrac System were used for IGRT of all patients. An average of 10 CBCT and ExacTrac images were obtained per patient during the total treatment period, and the difference in 6D Online Automation values between the two systems was calculated within the ROI setting. In this case, the area of interest designation in the image obtained from CBCT was fixed to the same anatomical structure as the image obtained through ExacTrac. The difference in positional values for the six axes (SI, AP, LR; Rotation group: Pitch, Roll, Rtn) between the two systems, the total time taken from patient set-up to just before IGRT, and exposure dose were measured and compared respectively with the RandoPhantom. Results: the set-up error in the phantom and patient was less than 1mm in the translation group and less than 1.5° in the rotation group, and the RMS values of all axes except the Rtn value were less than 1mm and 1°. The time taken to correct the set-up error in each system was an average of 256±47.6sec for IGRT using CBCT and 84±3.5sec for ExacTrac, respectively. Radiation exposure dose by IGRT per treatment was measured at 37 times higher than ExacTrac in CBCT and ExacTrac at 2.468mGy and 0.066mGy at Oral Mucosa among the 7 measurement locations in the head and neck area. Conclusion: Through 6D online automatic positioning between the CBCT and ExacTrac systems, the set-up error was found to be less than 1mm, 1.02°, including the patient's movement (random error), as well as the systematic error of the two systems. This error range is considered to be reasonable when considering that the PTV Margin is 3mm during the head and neck IMRT treatment in the present study. However, considering the changes in target and risk organs due to changes in patient weight during the treatment period, it is considered to be appropriately used in combination with CBCT.

• Progress in Medical Physics
• /
• v.19 no.4
• /
• pp.209-218
• /
• 2008

According to improved radiation therapy technology such as IMRT and proton therapy, the accuracy of patient alignment system is more emphasized and IGRT is dominated research field in radiation oncology. We proposed to study the feasibility of cone-beam CT system using simple x-ray imaging systems for image guided proton therapy at National Cancer Center. 180 projection views ($2,304{\times}3,200$, 14 bit with 127 ${\mu}m$ pixel pitch) for the geometrical calibration phantom and humanoid phantoms (skull, abdomen) were acquired with $2^{\circ}$ step angle using x-ray imaging system of proton therapy gantry room ($360^{\circ}$ for 1 rotation). The geometrical calibration was performed for misalignments between the x-ray source and the flat-panel detector, such as distances and slanted angle using available algorithm. With the geometrically calibrated projection view, Feldkamp cone-beam algorithm using Ram-Lak filter was implemented for CBCT reconstruction images for skull and abdomen phantom. The distance from x-ray source to the gantry isocenter, the distance from the flat panel to the isocenter were calculated as 1,517.5 mm, 591.12 mm and the rotated angle of flat panel detector around x-ray beam axis was considered as $0.25^{\circ}$. It was observed that the blurring artifacts, originated from the rotation of the detector, in the reconstructed toomographs were significantly reduced after the geometrical calibration. The demonstrated CBCT images for the skull and abdomen phantoms are very promising. We performed the geometrical calibration of the large gantry rotation system with simple x-ray imaging devices for CBCT reconstruction. The CBCT system for proton therapy will be used as a main patient alignment system for image guided proton therapy.

• Radiation Oncology Journal
• /
• v.33 no.1
• /
• pp.1-11
• /
• 2015

With the progress of image-guided localization, body immobilization system, and computerized delivery of intensity-modulated radiation delivery, it became possible to perform spine radiosurgery. The next question is how to translate the high technology treatment to the clinical application. Clinical trials have been performed to demonstrate the feasibility of spine radiosurgery and efficacy of the treatment in the setting of spine metastasis, leading to the randomized trials by a cooperative group. Radiosurgery has also demonstrated its efficacy to decompress the spinal cord compression in selected group of patients. The experience indicates that spine radiosurgery has a potential to change the clinical practice in the management of spine metastasis and spinal cord compression.

• The Journal of Korean Society for Radiation Therapy
• /
• v.19 no.1
• /
• pp.43-49
• /
• 2007

Purpose: The aim of this study was the clinical implementation of IGRT using KV CBCT for setup correction in radiation therapy. Materials and Methods: We selected 9 patients (3 patient for each region; head, body, pelvis)and acquired 135 CBCT images with CLINAC iX (Varian medical system, USA). During the scan, the required time was measured. We analyzed the result in 3 direction; vertical, longitudinal, lateral. Results: The mean setup errors at the couch position of vertical, lateral, and longitudinal direction were 0.07, 0.12, and 0.1 cm in the head region, 0.3, 0.26, and 0.22 cm in the body region, 0.21, 0.18, and 0.15 cm in the pelvis region respectively. The mean time required for CBCT was $6{\sim}7$ minute. Conclusion: The CBCT on the LINAC provides the capacity for soft tissue imaging in the treatment position and real time monitoring during treatment delivery. With presented workflow, the setup correction within reasonable time for more accurate radiation therapy is possible. And it's image can be very useful for adaptive radiation therapy(ART) in the future with improved image quality.

• The Journal of Korean Society for Radiation Therapy
• /
• v.26 no.2
• /
• pp.289-295
• /
• 2014

Purpose : Cone Beam Computed Tomography(CBCT) in Image Guided Radiation Therapy(IGRT), Set-up error can be reduced but exposure dose of the patient due to CBCT will increase. Through this study, we are to evaluate by making a scenario with the implementation period of CBCT as every other day. Materials and Methods : Of prostate cancer patients, 9 patients who got a Intensity Modulated Radiation Therapy(IMRT) with CBCT in IGRT were analyzed. Based on values corrected by analyzing set-up error by using CBCT every day during actual treatment, we created a scenario that conducts CBCT every other day. After applying set-up error values of the day not performing CBCT in the scenario to the treatment planning system(Pinnacle 9.2, Philips, USA) by moving them from the treatment iso-center during actual treatment, we established re-treatment plan under the same conditions as actual treatment. Based on this, the dose distribution of normal organs and Planning Target Volume(PTV) was compared and analyzed. Results : In the scenario that performs CBCT every other day based on set-up error values when conducting CBCT every day, average X-axis : $0.2{\pm}0.73mm$, Y-axis : $0.1{\pm}0.58mm$, Z-axis : $-1.3{\pm}1.17mm$ difference was shown. This was applied to the treatment planning to establish re-treatment plan and dose distribution was evaluated and as a result, Dmean : -0.17 Gy, D99% : -0.71 Gy of PTV difference was shown in comparison with the result obtained when carrying out CBCT every day. As for normal organs, V66 : 1.55% of rectal wall, V66 : -0.76% of bladder difference was shown. Conclusion : In case of a CBCT perform every other day could reduce exposure dose and additional treatment time. And it is thought to be able to consider the application depending on the condition of the patient because the difference in the dose distribution of normal organs, PTV is not large.

• The Journal of Korean Society for Radiation Therapy
• /
• v.26 no.2
• /
• pp.199-206
• /
• 2014

Purpose : According to the rapid increase recently in image-guided radiation therapy, It is necessary to control of the image guidance system completely. In particular for the main subject to the accuracy of image guided radiation therapy device to be done essentially the quality assurance. We made efficient phantom in AMC for the management of the accurate and efficient. Materials and Methods : By setting up of five very important as a quality assurance inventory of the Image guidance system, we made (AMC G-Box) phantom for quality assurance efficient and accurate. Quality assurance list were the Iso-center align, the real measurement, the center align of four direction, the accuracy of table movement and the reproducibility of Hounsfield Unit. The rectangular phantom; acrylic with a thickness of 1 cm to $10cm{\time}10cm{\time}10cm$ was inserted the three materials with different densities respectively for measure the CBCT HU. The phantom was to perform a check of consistency centered by creating a marker that indicates the position of the center fixed. By performing the quality assurance using the phantom of existing, comparing the resulting value to the different resulting value using the AMC G-Box, experiment was analyzed time and problems. Therapy equipment was used Varian device. It was measured twice at 1-week intervals. Results : When implemented quality assurance of an image guidance system using AMC G-Box and a phantom existing has been completed, the quality assurance result is similar in $0.2mm{\pm}0.1$. In the case of the conventional method, it was 45 minutes at 30 minutes. When using AMC G-Box, it takes 20 minutes 15 minutes, and declined to 50% of the time. Conclusion : The consistency and accurate of image guidance system tend to decline using device. Therefore, We need to perform thoroughly on the quality assurance related. It needs to be checked daily to consistency check especially. When using the AMC G-Box, It is possible to enhance the accuracy of the patient care and equipment efficiently performing accurate quality assurance.

• Journal of Radiation Protection and Research
• /
• v.46 no.4
• /
• pp.151-159
• /
• 2021

Background: Computed tomography (CT) is one of the crucial diagnostic tools in modern medicine. However, careful monitoring of radiation dose for CT patients is essential since the procedure involves ionizing radiation, a known carcinogen. Materials and Methods: The most desirable CT dose descriptor for risk analysis is the organ absorbed dose. A variety of CT organ dose calculators currently available were reviewed in this article. Results and Discussion: Key common elements included in CT dose calculators were discussed and compared, such as computational human phantoms, CT scanner models, organ dose database, effective dose calculation methods, tube current modulation modeling, and user interface platforms. Conclusion: It is envisioned that more research needs to be conducted to more accurately map CT coverage on computational human phantoms, to automatically segment organs and tissues for patient-specific dose calculations, and to accurately estimate radiation dose in the cone beam computed tomography process during image-guided radiation therapy.

• The Journal of Korean Society for Radiation Therapy
• /
• v.24 no.1
• /
• pp.15-21
• /
• 2012

Purpose: Image Guided Radiation Therapy (IGRT) has been carried out using On-Board Imager system (OBI) in Asan Medical Center. For this reason, This study was to analyze and evaluate the impact on Cone-Beam CT according to variation of material and respiration. Materials and Methods: This study was to acquire and analyze Cone-Beam CT three times for two material: Cylider acryl (lung equvalent material, diameter 3 cm), Fiducial Marker (using clinic) under Motion Phantom able to adjust respiration pattern randomly was varying period, amplitude and baseline vis-a-vis reference respiration pattern. Results: First, According to a kind of material, when being showed 100% in the acryl and 120% in the Fiducial Marker under the condition of same movement of the motion phantom. Second, According to the respiratory alteration, when being showed 1.13 in the baseline shift 1.8 mm and 1.27 in the baseline shift 3.3 mm for acryl. when being showed 1.01 in 1 sec of period and 1.045 in 2.5 sec of period for acryl. When being showed 0.86 in 0.7 times the standard of amplitude and 1.43 in 1.7 times the standard of amplitude for acryl. when being showed 1.18 in the baseline shift 1.8 mm and 1.34 in the baseline shift 3.3 mm for Fiducial Marker. when being showed 1.0 in 1 sec of period and 1.0 in 2.5 sec of period for Fiducial Marker. When being showed 0.99 in 0.7 times the standard of amplitude and 1.66 in 1.7 times the standard of amplitude for Fiducial Marker. Conclusion: The effect of image size of CBCT was 20% in the case of Fiducial marker. The impact of changes in breathing pattern was minimum 13% - maximum 43% for Arcyl, min. 18% - max. 66% for Fiducial marker. This difference makes serious uncertainty. So, Must be stabilized breathing of patient before acquiring CBCT. also must be monitored breathing of patient in the middle of acquire. If you observe considerable change of breathing when acquiring CBCT. After Image Guided, must be need to check treatment site using fluoroscopy. If a change is too big, re-acquiring CBCT.

• Nuclear Engineering and Technology
• /
• v.46 no.2
• /
• pp.255-262
• /
• 2014

During image-guided radiation therapy, the patient is exposed to unwanted radiation from imaging devices built into the medical LINAC. In the present study, the effective dose delivered to a patient from a cone beam computed tomography (CBCT) machine was measured. Absorbed doses in specific organs listed in ICRP Publication 103 were measured with glass dosimeters calibrated with kilovolt (kV) X-rays using a whole body physical phantom for typical radiotherapy sites, including the head and neck, chest, and pelvis. The effective dose per scan for the head and neck, chest, and pelvis were $3.37{\pm}0.29$, $7.36{\pm}0.33$, and $4.09{\pm}0.29$ mSv, respectively. The results highlight the importance of the compensation of treatment dose by managing imaging dose.