• Radiation Oncology Journal
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• v.20 no.4
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• pp.391-395
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• 2002

Purpose : To confirm the accuracy of the radiation dose at the isocenter by the standard linear accelerator-based stereotactic radiosurgery technique which was developed at Seoul National University Hospital. Materials and Methods : Radiation dosimetry was undertaken during standard 5-arc radiosurgery using 6 MV X-ray beam from CL2100C linac. The treatment head was attached with circular tertiary collimators of 10 and 20 mm diameter. We measured the absorbed dose at the isocenter of a multi-purpose phantom using two kinds of detector : a 0.125 co ionization chamber and a silicon diode detector. Results : The dose differences at each arc plane between the planned dose and the measured dose at the isocenter raged from $-0.73\%\;to\;-2.69\%$ with the 0.125 cc ion chamber, and from $-1.29\%\;to\;-2.91\%$ with the diode detector during radiosurgery with the tertiary collimator of 20 mm diameter. Those with the 10-mm tertiary collimator ranged from $-2.39\%\;to\;-4.25\%$ with the diode. Conclusion : The dose accuracy at the isocenter was ${\pm}3\%$. Therefore, further efforts such ws modification in processing of the archived image through DICOM3.0 format are required to lessen the dose difference.

• The Journal of Korean Society for Radiation Therapy
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• v.12 no.1
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• pp.144-146
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• 2000

삼차원 입체조형치료는 정상조직의 장해를 최소화하고 종양부위에 집중적으로 조사할 수 있는 장점을 가지고 있어 임상 적용범위가 넓어지고 있다. 일반적으로 정상조직의 장해를 줄이기 위해 다양한 방사선 조사방향이 사용되며 특히 비 동일면상에서의 조사가 많이 이루어진다. 따라서 couch 회전이 동반되며 couch는 선형가속기의 다른 기계적 오차보다 많은 오차를 유발할 수 있는 잠재적인 위험을 안고 있다. 저자는 이러한 오차의 정도를 파악하고 이를 개선할 수 있는 방법에 대해 알아보고자 했다. couch 회전에 따른 Isocenter의 변화를 평가하기 위해 3대(Primus, Simens, USA/CL600c & 2100c, Varian, USA)의 선형가속기를 이용하였으며 이중 1대의 장비에는 couch 회전시 오차를 줄이기 위해 고안된 couch 고정장치를 장착하였다. 환자가 테이블에 부하를 주지 않은 상태에서 회전을 실시하여 Isocenter의 변화를 측정하고 환자가 테이블에 누워있는 상황을 재현하기 위해 human phantom을 위치시킨 후 동일한 회전검사를 실시하여 각각의 오차를 비교 분석하였다. 각 실험은 10회씩 반복 측정하여 평균치를 얻었으며 오차의 분석은 AAPM 권고안인 오차중심의 반경으로 표현했다. 3대의 선형가속기를 이용하여 얻은 결과 테이블에 부하를 주지 않은 상태의 회전오차는 평균 2mm, 3.2mm, 2mm로 측정되었으며 휴먼 phantom을 올려놓고 부하를 준 상태에서의 오차는 평균 2.1mm, 4mm, 2.1 mm이였다. 또한 고정장치를 이용한 상태에서의 평균오차는 1.9mm로 나타났다. 삼차원 입체조형치료 시 couch 회전에 따른 Isocenter 오차는 장비의 종류 및 작업자의 사용방법에 따라 다르게 나타났으며 테이블의 부하가 클수록 많은 오차를 보였다. 또한 couch 고정장치를 부착한 장비에서의 결과치 만이 AAPM에서 권고하는 오차의 한계에(${\le}2mm$) 들어감을 알 수 있었다. 따라서 정기적인 QA가 필수적이며 Couch Locking System과 같이 오차를 줄일 수 있는 보조장치의 부착이 많은 도움을 줄 것으로 생각된다. 아울러 이러한 오차를 보정할 수 있는 방법이 강구되어야 할 것으로 사료된다.

• Radiation Oncology Journal
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• v.1 no.1
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• pp.29-36
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• 1983

The treatment of tumors along curved surfaces with stationary electron beams using cone collimation may lead to non-uniform dose distributions due to a varying air gap between the cone surface and patient. For large tumors, more than one port may have to be used in irradiation of the chest wall, often leading to regions of high or low dose at the junction of the adjacent ports. Electron-beam arc therapy may elimination many of these fixed port problems. When treating breast tumors with electrons, the energy of the internal mammary port is usually higher than that of the chest wall port. Bolus is used to increase the skin dose or limit the range of the electrons. We invertiaged the effect of various arc beam parameters in the isodose distributions, and combined into a single arc port for adjacent fixed ports of different electron beam eneries. The higher fixed port energy would be used as the arc beam energy while the beam penetration in the lower energy region would be controlled by a proper thickness of bolus. We obtained the results of following: 1. It is more uniform dose distribution of electron to use rotation than stationary irradiation. 2. Increasing isocenter depth on arc irradiation, increased depth of maximum dose, reduction in surface dose and an increasing penetration of the linear portion of the curve. 3. The deeper penetration of the depth dose curve and higher X-ray background for the smaller field sized. 4. If the isocenter depth increase, the field effect is small. 5. The decreasing arc beam penetration with decreasing isocenter depth and the isocenter depth effect appears at a greater depth as the energy increases. 6. The addition of bolus produces a shift in the penetration that is the same for all depths leaving the shape of the curves unchanged. 7. Lead strips 5 mm thick were placed at both ends of the arc to produce a rapid dose drop-off.

• The Journal of Korean Society for Radiation Therapy
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• v.7 no.1
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• pp.45-53
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• 1995

목적 : 뇌정위 방사선수술은 AVM(ateriovenous malformation)이나 작은 크기의 종양에 1회에 고선량의 방사선을 조사하는 기술이다. 선형가속기를 이용한 방사선 수술을 하기 위하여 최근 본원에 설치한 Philips SL 75-5 선형가속기와 isocentric sub system(ISS)에 의한 뇌정위 방사선 수술에 있어서 표적의 위치선정과, gantry와 couch의 회전시 기하학적 오차가 중요시 되는데 isocentric sub system의 오차를 분석 하였다. 대상 및 방법 : 방사선원으로는 Philips SL 75-5 선형가속기의 5MV 광자선을 사용하였고, 원형의 작은 광자선속을 위하여 isocenter에서의 직경이 26mm인 secondary cone을 gimbal baaring에 삽입하여 사용하였다. 표적의 크기와 좌표를 정하기 위하여 CT나 angio localizer를 이용하고, 표적좌표 선정을 위하여 BRW phantom base와 target pointer를 이용하여 임의의 BRW-coordinator를 바꾸어 가면서 gantry angle와 ISS head 각도를 임의로 바꾸어 가면서 film에 방사선을 조사하였다. 흑화된 film을 view box 위에 놓고 광학판독기구로 film 가장자리의 오차를 scale 확대경으로 측정하여 오차를 분석하였다. 결과 : 표적좌표 선정의 정확도를 확인하기 위하여 임의의 표적좌표에 gantry의 10개각도 ISShead의 10개각도에서 각각 광자선을 조사시켜 film을 이용하여 오차를 측정한 결과 collimator cone의 직경이 26mm일때 전체 평균오차가 0.219+-0.03mm이었다. 결론 : Isocentric sub system은 gantry head와 ISS arm 사이에 gimbal bearing이 있어서 이 부위를 flexible하게 연결함으로 gantry의 회전에 무관하게 정확한 isocenter를 유지시켜 주고 ISS head는 couch와 독립되어 움직이므로 isocentric sub system isocenter의 오차를 최대한 줄일수 있음을 알았다.

• Progress in Medical Physics
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• v.25 no.4
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• pp.281-287
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• 2014

The Winston Lutz test, which checks the accuracy of the isocenter for stereotactic radiosurgery (SRS), was performed with the commercial electronic portal imaging device (EPID). The usual Winston Lutz test with film was also performed for comparison with the test with EPID. The maximum difference in isocenter between the two methods was 0.32 mm. The Winston Lutz test using EPID is practical as it can reduce time and avoid human errors compared to the test with film.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2004.11a
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• pp.75-77
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• 2004

Stereotactic radiosurgery(SRS) is a technique to deliver a high dose to a particular target region and a low dose to the critical organ using only one or a few irradiations while the patient is fixed with a stereotactic frame. The optimized plan is decided by repetitive work to combine the beam parameters and identify prescribed doses level in a tumor, which is usually called a trial and error method. This requires a great deal of time, effort, and experience. Therefore, we developed the automatic arrangement of multi-isocenter within irregularly shaped tumor. At the arbitrary targets, which is this method based on the voxel unit of the space, well satisfies the dose conformity and dose homogeneity to the targets relative to the RTOG radiosurgery plan guidelines

• Radiation Oncology Journal
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• v.28 no.2
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• pp.99-105
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• 2010

Purpose: To compare radiation dose of the brain and lens among various conventional whole brain radiotherapy (WBRT) techniques. Materials and Methods: Treatment plans for WBRT were generated with planning computed tomography scans of 11 patients. A traditional plan with an isocenter located at the field center and a parallel anterior margin at the lateral bony canthus was generated (P1). Blocks were automatically generated with a 1 cm margin on the brain (5 mm for the lens). Subsequently, the isocenter was moved to the lateral bony canthus (P2), and the blocks were replaced into the multileaf collimator (MLC) with a 5 mm leaf width in the craniocaudal direction (P3). For each patient plan, 30 Gy was prescribed at the isocenter of P1. Dose volume histogram (DVH) parameters of the brain and lens were compared by way of a paired t-test. Results: Mean values of $D_{max}$ and $V_{105}$ of the brain in P1 were 111.9% and 23.6%, respectively. In P2 and P3, $D_{max}$ and $V_{105}$ of the brain were significantly reduced to 107.2% and 4.5~4.6%, respectively (p<0.001). The mean value of $D_{mean}$ of the lens was 3.1 Gy in P1 and 2.4~2.9 Gy in P2 and P3 (p<0.001). Conclusion: WBRT treatment plans with an isocenter located at the lateral bony canthus have dosimetric advantages for both the brain and lens without any complex method changes.

• Radiation Oncology Journal
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• v.16 no.4
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• pp.517-529
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• 1998

Purpose : Although many studies have investigated the dosimetric aspects of stereotactic radiosurgery in terms of target volume, the absorbed doses at extracranial sites: especially the lens or thyroid - which are sensitive to radiation for deterministic or stochastic effect -have infrequently been reported. The aim of this study is to evaluate what effects the parameters of radiosurgery have on the absorbed doses of the lens and thyroid in patients treated by stereotactic radiosurgery, using a systematic plan in a humanoid phantom. Materials and Methods : Six isocenters were selected and radiosurgery was planned using the stereotactic radiosurgery system which the Department of Therapeutic Radiology at Seoul National University College of Medicine developed. The experimental radiosurgery plan consisted of 6 arc planes per one isocenter, 100 degrees for each arc range and an accessory collimator diameter size of 2 cm. After 250 cGy of irradiation from each arc, the doses absorbed at the lens and thyroid were measured by thermoluminescence dosimetry. Results : The lens dose was 0.23$\pm$0.08$\%$ of the maximum dose for each isocenter when the exit beam did not pass through the lens and was 0.76$\pm$0.12$\%$ of the maximum dose for each isocenter when the exit beam passed through the lens. The thyroid dose was 0.18$\pm$0.05$\%$ of the maximum dose for each isocenter when the exit beam did not pass through the thyroid and was 0.41$\pm$0.04$\%$ of the maximum dose for each isocenter when the exit beam Passed through the thyroid. The passing of the exit beam is the most significant factor of organ dose and the absorbed dose by an arc crossing organ decides 80$\%$ of the total dose. The absorbed doses of the lens and thyroid were larger as the isocenter sites and arc planes were closer to each organ. There were no differences in the doses at the surface and 5 mm depth from the surface in the eyelid and thyroid areas. Conclusion : As the isocenter and arc plane were placed closer to the lens and thyroid, the doses increased. Whether the exit beams passed through the lens or thyroid greatly influenced the lens and thyroid dose. The surface dose of the lens and thyroid consistently represent the tissue dose. Even when the exit beam passes through the lens and thyroid, the doses are less than 1$\%$ of the maximum dose and therefore, are too low to evoke late complications, but nevertheless, we should try to minimize the thyroid dose in children, whenever possible.

• Journal of radiological science and technology
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• v.26 no.2
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• pp.37-42
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• 2003

Purpose : Computed tomographic equipment is essential for diagnosis by means of radiation. With passage of time and development of science computed tomographic was developed time and again and in future examination by means of this equipment is expected to increase. In this connection these authors measured rate of scatter ray generation at front of lead glass for patients within control room of computed tomographic equipment room and outside of entrance door for exit and entrance of patients and attempted to ind out method for minimizing exposure to scatter ray. Material and Method : From November 2001 twenty five units of computed tomographic equipments which were already installed and operation by 13 general hospitals and university hospitals in Seoul were subjected to this study. As condition of photographing those recommended by manufacturer for measuring exposure to sauter ray was use. At the time objects used DALI CT Radiation Dose Test Phantom fot Head (${\oint}16\;cm$ Plexglas) and Phantom for Stomache(${\oint}32\;cm$ Plexglas) were used. For measurement of scatter ray Reader (Radiation Monitor Controller Model 2026) and G-M Survey were used to Survey Meter of Radical Corporation, model $20{\times}5-1800$, Electrometer/Ion Chamber, S/N 21740. Spots for measurement of scatter ray included front of lead glass for patients within control room of computed tomographic equipment room which is place where most of work by gradiographic personnel are carried out and is outside of entrance door for exit and entrance of patients and their guardians and at spot 100 cm off from isocenter at the time of scanning the object. The results : Work environment within computed tomography room which was installed and under operation by each hospital showed considerable difference depending on circumstances of pertinent hospitals and status of scatter ray was as follows. 1) From isocenter of computed tomographic equipment to lead glass for patients within control room average distance was 377 cm. At that time scatter ray showed diverse distribution from spot where no presence was detected to spot where about 100 mR/week was detected. But it met requirement of weekly tolerance $2.58{\times}10^{-5}\;C/kg$(100 mR/week). 2) From isocenter of computed tomographic equipment to outside of entrance door where patients and their guardians exit and enter was 439 cm in average, At that time scatter ray showed diverse distribution from spot where almost no presence was detected to spot with different level but in most of cases it satisfied requirement of weekly tolerance of $2.58{\times}10^{-6}\;C/kg$(100 mR/week). 3) At the time of scanning object amount of scatter ray at spot with 100 cm distance from isocenter showed considerable difference depending on equipments. Conclusion : Use of computed tomographic equipment as one for generation of radiation for diagnosis is increasing daily. Compared to other general X-ray photographing field of diagnosis is very high but there is a high possibility of exposure to radiation and scatter ray. To be free from scatter ray at computed tomographic equipment room even by slight degree it is essential to secure sufficient space and more effort should be exerted for development of variety of skills to enable maximum photographic image at minimum cost.

• The Journal of Korean Society for Radiation Therapy
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• v.9 no.1
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• pp.25-28
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• 1997

With the advances in radiation therapy technology and equipment, the need for more accurate and safer radiation delivery to the target region has been continuously growing. Stereotactic Radiosurgery(SRS) is a good example of $^{\ast}Accuracy^{\ast}$ but has a substantial risk of causing severe late neurological damages. Fractionated Stereotactic Radiation Therapy(FSRT) is a modification of SRS enabling conventional fractionation with maintaining accuracy using noninvasive and relocatable frame. Verification of mechanical accuracy in FSRT has been done according to the manufacture's recommendations using RLPP, LTLF, and Depth-helmet. In order to reinforce this, we have developed additional novel verification procedure using Linac-grams with the Angiolocalizer attached on the GTC frame, which are then digitized into the planning software(X-Knife) to generate the three dimensional coordinates for cmoparison. This method has been successful in such ways that the anatomical landmarks are identifiable on the Linac-gram films and that the serial comparisons of the stereotactic coordinates of the isocenter are possible with more certainty a along the FSRT course than before.