• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.7-18
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• 2017

Purpose: A QA Set was established to verify the movement accuracy of image-guided 6DoF Couch and to evaluate its usefulness. Materials and Methods: Two sets of linear accelerators equipped with 6DoF Couch and CBCT were used. Using the established QA Set, each CBCT image was obtained over 15 times through the Penta-Guide Phantom installed with off-set shift values along six translational (Translation; TX, TY, TZ) and rotational (Rotation, Pitch; RX, Roll; RY, Yaw; RZ) directions. Using this method, we compared the reference image and the registration image, and we analyzed the error calculated by measuring the positional accuracy of the modified 6DoF Couch. Results: The Air Cavity corresponding to the Pixel of the reference image and the registration image were all contained between 30 and 66, and the revealing high registration accuracy. Error between the modified off-set value of 6DoF Couch and the measured value along translational directions were $0.25{\pm}0.18mm$ in the TX direction, $0.25{\pm}0.25mm$ in the TY direction, and $0.36{\pm}0.2mm$ in the TZ direction. Misalignments along the rotational axis were $0.18{\pm}0.08^{\circ}$ in the RX direction, $0.26{\pm}0.09^{\circ}$ in the RY direction, and $0.11{\pm}0.08^{\circ}$ in the RZ direction, it was corrected precisely for any value. Conclusion: Using the YCC QA Set, we were able to verify the error of 6DoF Couch along both the translational and rotational directions in a very simple method. This system would be useful in performing Daily IGRT QA of 6DoF Couch.

• Progress in Medical Physics
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• v.24 no.4
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• pp.230-236
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• 2013

Our purpose is to present a novel technique for delivering craniospinal irradiation in the supine position using a perfect match, field-in-field (FIF) intrafractional feathering, and simple forward-optimization technique. To achieve this purpose, computed tomography simulation was performed with patients in the supine position. Half-beam, blocked, opposed, lateral, cranial fields with a collimator rotation were matched to the divergence of the superior border of an upper-spinal field. Fixed field parameters were used, and the isocenter of the upper-spinal field was placed at the same source-to-axis distance (SAD), 20 cm inferior to the cranial isocenter. For a lower-spinal field, the isocenter was placed 40 cm inferior to the cranial isocenter at a constant SAD. Both gantry and couch rotations for the lower-spinal field were used to achieve perfect divergence match with the inferior border of the upper-spinal field. A FIF technique was used to feather the craniospinal and spinal-spinal junction daily by varying the match line over 2 cm. The dose throughout the target volume was modulated using the FIF simple forward optimization technique to obtain homogenous coverage. Daily, image-guided therapy was used to assure and verify the setup. This supine-position, perfect match craniospinal irradiation technique with FIF intrafractional feathering and dose modulation provides a simple and safe way to deliver treatment while minimizing dose inhomogeneity.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.41-51
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• 2023

Purpose: This study compares and analyzes the image quality of 3D-CBCT(Cone Beam Computed-Tomography) and Gated CBCT according to baseline changes during SBRT(Stereotactic Body RadioTherapy) in lung cancer patients to find a useful CBCT method for correcting movement due to breathing Materials and methods : Insert a solid tumor material with a diameter of 3 cm into the QUASAR^TM phantom. 4-Dimentional Computed-Tomography(4DCT) images were taken with a speed of the phantom at period 3 sec and a maximum amplitude of 20 mm. Using the contouring menu of the computerized treatment planning system Eclipse^TM Gross Tumor Volume was outlined on solid tumor material. Set-up the same as when acquiring a 4DCT image using Truebeam STx^TM, breathing patterns with baseline changes of 1 mm, 3 mm, and 5 mm were input into the phantom to obtain 3D-CBCT (Spotlight, Full) and Gated-CBCT (Spotlight, Full) images five times repeatedly. The acquired images were compared with the Signal-to-Noise Ratio(SNR), Contrast-to-Noise Ratio(CNR), Tumor Volume Length, and Motion Blurring Ratio(MBR) based on the 4DCT image. Results: The average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Spotlight Gated CBCT images were 13.30±0.10%, 7.78±0.16%, 3.55±0.17%, 1.18±0.06%. As a result, Spotlight Gated-CBCT images according to baseline change showed better values than Spotligtht 3D-CBCT images. Also, the average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Full Gated CBCT images were 12.80±0.11%, 7.60±0.11%, 3.54±0.16%, 1.18±0.05%. As a result Full GatedCBCT images according to baseline change showed better values than Full 3D-CBCT images. Conclusion : Compared to 3D-CBCT images, Gated-CBCT images had better image quality according to the baseline change, and the effect of Motion Blurring Artifacts caused by breathing was small. Therefore, it is considered useful to image guided using Gated-CBCT when a baseline change occurs due to difficulty in regular breathing during SBRT that exposes high doses in a short period of time

• Journal of Radiation Protection and Research
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• v.35 no.2
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• pp.63-68
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• 2010

The ultimate goal of radiation treatment is to use enough radiation dosage in order to examine a tumor while protecting normal tissue. Respiratory guided radiotherapy is being clinically implemented to examine a given stabilized area in order to compensate for the problems of patient breathing. This study investigates the effects of breathing movements on 40 patients with liver cancer through the actual radiation therapy plan using 4D-CT and respiratory guided radiotherapy using RPM. Using a commercial RPM respiratory gating system 4D-CT, we acquired 4D CT on multislice helical CT scanners that use different approaches to 4D CT image reconstruction. The results from analyzing forty patients according to age and direction showed no relationship between gender and transition change. The mean left-right, anteroposterior, and craniocaudal total movements were $3.19{\pm}1.29$, $5.44{\pm}2.07$, and $12.54{\pm}4.70$ mm, respectively. Changes were the largest with CC directions and as patients advanced in age, movements were larger. Therefore, as changes occur in treatment areas because of movements caused from breathing, respiratory gating system is put into operation to revise movement and can increase the radiotherapeutics effects in treating liver cancer.

• Progress in Medical Physics
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• v.17 no.1
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• pp.24-31
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• 2006

Automated analysis software was developed to measure the magnitude of the intrafractional and interfractional errors during breast radiation treatments. Error analysis results are important for determining suitable planning target volumes (PTV) prior to Implementing breast-conserving 3-D conformal radiation treatment (CRT). The electrical portal imaging device (EPID) used for this study was a Portal Vision LC250 liquid-filled ionization detector (fast frame-averaging mode, 1.4 frames per second, 256X256 pixels). Twelve patients were imaged for a minimum of 7 treatment days. During each treatment day, an average of 8 to 9 images per field were acquired (dose rate of 400 MU/minute). We developed automated image analysis software to quantitatively analyze 2,931 images (encompassing 720 measurements). Standard deviations ($\sigma$) of intrafractional (breathing motion) and intefractional (setup uncertainty) errors were calculated. The PTV margin to include the clinical target volume (CTV) with 95% confidence level was calculated as $2\;(1.96\;{\sigma})$. To compensate for intra-fractional error (mainly due to breathing motion) the required PTV margin ranged from 2 mm to 4 mm. However, PTV margins compensating for intefractional error ranged from 7 mm to 31 mm. The total average error observed for 12 patients was 17 mm. The intefractional setup error ranged from 2 to 15 times larger than intrafractional errors associated with breathing motion. Prior to 3-D conformal radiation treatment or IMRT breast treatment, the magnitude of setup errors must be measured and properly incorporated into the PTV. To reduce large PTVs for breast IMRT or 3-D CRT, an image-guided system would be extremely valuable, if not required. EPID systems should incorporate automated analysis software as described in this report to process and take advantage of the large numbers of EPID images available for error analysis which will help Individual clinics arrive at an appropriate PTV for their practice. Such systems can also provide valuable patient monitoring information with minimal effort.

• Journal of radiological science and technology
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• v.37 no.1
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• pp.37-47
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• 2014

The purpose of this study was to analyze translational and rotational adjustments during automatic rigid image-registration by using different control parameters for a total of five groups on TomoTherapy (Accuray Inc, Sunnyvale, CA, USA). We selected a total of 50 patients and classified them in five groups (brain, head-and-neck, lung, abdomen and pelvic) and used a total of 500 megavoltage computed tomography (MVCT) image sets for the analysis. From this we calculated the overall mean value(M) for systematic and random errors after applying the different control parameters. After randomization of the patients into the five groups, we found that the overall mean value varied according to three techniques and resolutions. The deviation for the lung, abdomen and pelvic groups was approximately greater than the deviation for the brain and head-and-neck groups in all adjustments. Overall, using a "full-image" produces smaller deviations in the rotational adjustments. We found that rotational adjustment has deviations with distinctly different control parameters. We concluded that using a combination of the "full-image" technique and "standard" resolution will be helpful in assisting with patients' repositioning and in correcting for set-up errors prior to radiotherapy on TomoTherapy.

• The Journal of Korean Society for Radiation Therapy
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• v.21 no.2
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• pp.67-74
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• 2009

Purpose: To evaluate the results of absorbed and effective doses using two different modes, standard mode (A-mode) and low-dose mode (B-mode) settings for prostate cancer IGRT from CBCT. Materials and Methods: This experimental study was obtained using Clinac iX integrated with On Board Imager (OBI) System and CBCT. CT images were obtained using a GE Light Speed scanner. Absorbed dose to organs from ICRP recommendations and effective doses to body was performed using A-mode and B-mode CBCT. Measurements were performed using a Anderson rando phantom with TLD-100 (Thermoluminescent dosimeters). TLD-100 were widely used to estimate absorbed dose and effective dose from CBCT with TLD System 4000 HAWSHAW. TLD-100 were calibrated to know sensitivity values using photon beam. The measurements were repeated three times for prostate center. Then, Evaluations of effective dose and absorbed dose were performed among the A-mode and B-mode CBCT. Results: The prostate absorbed dose from A-mode and B mode CBCT were 5.5 cGy 1.1 cGy per scan. Respectively Effective doses to body from A mode and B-mode CBCT were 19.1 mSv, 4.4 mSv per scan. Effective dose from A-mode CBCT were approximately 4 times lower than B-mode CBCT. Conclusion: We have shown that it is possible to reduce the effective dose considerably by low dose mode(B-mode) or lower mAs CBCT settings for prostate cancer IGRT. Therefore, we should try to select B-mode or low condition setting to decrease extra patient dose during the IGRT for prostate cancer as possible.

• Progress in Medical Physics
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• v.26 no.4
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• pp.193-200
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• 2015

The aim of this study is to present commissioning results of the ViewRay system. We verified safety functions of the ViewRay system. For imaging system, we acquired signal to noise ratio (SNR) and image uniformity. In addition, we checked spatial integrity of the image. Couch movement accuracy and coincidence of isocenters (radiation therapy system, imaging system and virtual isocneter) was verified. Accuracy of MLC positioing was checked. We performed reference dosimetry according to American Association of Physicists in Medicine (AAPM) Task Group 51 (TG-51) in water phantom for head 1 and 3. The deviations between measurements and calculation of percent depth dose (PDD) and output factor were evaluated. Finally, we performed gamma evaluations with a total of 8 IMRT plans as an end-to-end (E2E) test of the system. Every safety system of ViewRay operated properly. The values of SNR and Uniformity met the tolerance level. Every point within 10 cm and 17.5 cm radii about the isocenter showed deviations less than 1 mm and 2 mm, respectively. The average couch movement errors in transverse (x), longitudinal (y) and vertical (z) directions were 0.2 mm, 0.1 mm and 0.2 mm, respectively. The deviations between radiation isocenter and virtual isocenter in x, y and z directions were 0 mm, 0 mm and 0.3 mm, respectively. Those between virtual isocenter and imaging isocenter were 0.6 mm, 0.5 mm and 0.2 mm, respectively. The average MLC positioning errors were less than 0.6 mm. The deviations of output, PDDs between mesured vs. BJR supplement 25, PDDs between measured and calculated and output factors of each head were less than 0.5%, 1%, 1% and 2%, respectively. For E2E test, average gamma passing rate with 3%/3 mm criterion was $99.9%{\pm}0.1%$.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.17-23
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• 2008

Purpose: Cone-beam CT using linear accelerator attached to on-board imager is a image guided therapy equipment. Because it is to check the patient's set-up error, correction, organ and target movement. but imaging dose should be cause of the secondary cancer when taking a image. The aim of this study is investigation of appropriate cone beam CT scan mode to compare and estimate the image quality and skin dose. Materials and Methods: Measurement by Thermoluminescence dosimeter (TLD-100, Harshaw) with using the Rando phantom are placed on each eight sites in seperately H&N, thoracic, abdominal section. each 4 methods of scan modes of are measured the for skin dose in three time. Subsequently, obtained average value. Following image quality QA protocol of equipment manufacturers using the catphan 504 phantom, image quality of each scan mode is compared and analyzed. Results: The results of the measured skin dose are described in here. The skin dose of Head & Neck are measured mode A: 8.96 cGy, mode B: 4.59 cGy, mode C: 3.46 cGy mode D: 1.76 cGy and thoracic mode A: 9.42 cGy, mode B: 4.58 cGy, mode C: 3.65 cGy, mode D: 1.85 cGy, and abdominal mode A: 9.97 cGy, mode B: 5.12 cGy, mode C: 4.03 cGy, mode D: 2.21 cGy. Approximately, dose of mode B are reduced 50%, mode C are reduced 60%, mode D are reduced 80% a point of reference dose of mode A. the results of analyzed HU reproducibility, low contrast resolution, spatial resolution (high contrast resolution), HU uniformity in evaluation item of image quality are within the tolerance value by recommended equipment manufacturer in all scan mode. Conclusion: Maintaining the image quality as well as reducing the image dose are very important in cone beam CT. In the result of this study, we are considered when to take mode A when interested in soft tissue. And we are considered to take mode D when interested in bone scan and we are considered to take mode B, C when standard scan. Increasing secondary cancer risk due to cone beam CT scan should be reduced by low mAs technique.

• Progress in Medical Physics
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• v.24 no.4
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• pp.220-229
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• 2013

Respiratory-induced dynamic tumors render free-breathing cone-beam computed tomography (FBCBCT) images with motion artifacts complicating the task of quantifying the internal target volume (ITV). The purpose of this paper is to study the visibility of the revealed ITV when the imaging dose parameters, such as the kVp and mAs, are varied. The $Trilogy^{TM}$ linear accelerator with an On-Board Imaging ($OBI^{TM}$) system was used to acquire low-imaging-dose-mode (LIDM: 110 kVp, 20 mA, 20 ms/frame) and high-imaging-dose-mode (HIDM: 125 kVp, 80 mA, 25 ms/frame) FBCBCT images of a 3-cm diameter sphere (density=0.855 $g/cm^3$) moving in accordance to various sinusoidal breathing patterns, each with an unique inhalation-to-exhalation (I/E) ratio, amplitude, and period. In terms of image ITV contrast, there was a small overall average change of the ITV contrast when going from HIDM to LIDM of $6.5{\pm}5.1%$ for all breathing patterns. As for the ITV visible volume measurements, there was an insignificant difference between the ITV of both the LIDM- and HIDM-FBCBCT images with an average difference of $0.5{\pm}0.5%$, for all cases, despite the large difference in the imaging dose (approximately five-fold difference of ~0.8 and 4 cGy/scan). That indicates that the ITV visibility is not very sensitive to changes in imaging dose. However, both of the FBCBCT consistently underestimated the true ITV dimensions by up to 34.8% irrespective of the imaging dose mode due to significant motion artifacts, and thus, this imaging technique is not adequate to accurately visualize the ITV for image guidance. Due to the insignificant impact of imaging dose on ITV visibility, a plausible, alternative strategy would be to acquire more X-ray projections at the LIDM setting to allow 4DCBCT imaging to better define the ITV, and at the same time, maintain a reasonable imaging dose, i.e., comparable to a single HIDM-FBCBCT scan.