• The Journal of Korean Society for Radiation Therapy
• /
• v.25 no.2
• /
• pp.115-121
• /
• 2013

Purpose: Latest linear accelerator and the introduction of new measurement equipment to the agency that the introduction of this equipment in the future, by analyzing the process of confirming the usefulness of the preparation process for applying it in the clinical causes some problems, should be helpful. Materials and Methods: All measurements TrueBEAM STX (Varian, USA) was used, and a file specific to each energy, irradiation conditions, the dose distribution was calculated using a computerized treatment planning equipment (Eclipse ver 10.0.39, Varian, USA). Measuring performance and cause errors in MapCHECK 2 were analyzed and measured against. In order to verify the performance of the MapCHECK 2, 6X, 6X-FFF, 10X, 10X-FFF, 15X field size $10{\times}10$ cm, gantry $0^{\circ}$, $180^{\circ}$ direction was measured by the energy. IGRT couch of the CT values affect the measurements in order to confirm, CT number values : -800 (Carbon) & -950 (COUCH in the air), -100 & 6X-950 in the state for FFF, 15X of the energy field sizes $10{\times}10$, gantry $180^{\circ}$, $135^{\circ}$, $275^{\circ}$ directionwas measured at, MapPHAN allocated to confirm the value of HU were compared, using the treatment planning computer for, Measurement error problem by the sharp edges MapPHAN Learn gantry direction MapPHAN of dependence was measured in three ways. GANTRY $90^{\circ}$, $270^{\circ}$ in the direction of the vertically erected settings 6X-FFF, 15X respectively, and Setting the state established as a horizontal field sizes $10{\times}10$, $90^{\circ}$, $45^{\circ}$, $315^{\circ}$, $270^{\circ}$ of in the direction of the energy-6X-FFF, 15X, respectively, were measured. Without intensity modulated beam of the third open arc were investigated. Results: Of basic performance MapCHECK confirm the attenuation measured by Couch, measured from the measured HU values that are assigned to the MAP-PHAN, check for calculation accuracy for the angled edge of the MapPHAN all come in a range of valid measurement errors do not affect the could see. three ways for the Gantry direction dependence, the first of the meter built into the value of the Gantry $270^{\circ}$ (relative $0^{\circ}$), $90^{\circ}$ (relative $180^{\circ}$), 6X-FFF, 15X from each -1.51, 0.83% and -0.63, -0.22% was not affected by the AP/PA direction represented. Setting the meter horizontally Gantry $90^{\circ}$, $270^{\circ}$ from the couch, Energy 6X-FFF 4.37, 2.84%, 15X, -9.63, -13.32% the difference. By-side direction measurements MapPHAN in value is not within the valid range can not, because that could be confirmed as gamma pass rate 3% of the value is greater than the value shown. You can check the Open Arc 6X-FFF, 15X energy, field size $10{\times}10$ cm $360^{\circ}$ rotation of the dose distribution in the state to look at nearly 90% pass rate to emerge. Conclusion: Based on the above results, the MapPHAN gantry direction dependence by side in the direction of the beam relative dose distribution suitable for measuring the gamma value, but accurate measurement of the absolute dose can not be considered is. this paper, a more accurate treatment plan in order to confirm, Reduce the tolerance for VMAT, such as lateral rotation investigation in order to measure accurate absolute isodose using a combination of IMF (Isocentric Mounting Fixture) MapCHEK 2, will be able to minimize the impact due to the angular dependence.

• Radiation Oncology Journal
• /
• v.29 no.2
• /
• pp.91-98
• /
• 2011

Purpose: To assess the usefulness of implanted fiducial markers in the setup of hypofractionated radiotherapy for prostate cancer patients by comparing a fiducial marker matched setup with a pelvic bone match. Materials and Methods: Four prostate cancer patients treated with definitive hypofractionated radiotherapy between September 2009 and August 2010 were enrolled in this study. Three gold fiducial markers were implanted into the prostate and through the rectum under ultrasound guidance around a week before radiotherapy. Glycerin enemas were given prior to each radiotherapy planning CT and every radiotherapy session. Hypofractionated radiotherapy was planned for a total dose of 59.5 Gy in daily 3.5 Gy with using the Novalis system. Orthogonal kV X-rays were taken before radiotherapy. Treatment positions were adjusted according to the results from the fusion of the fiducial markers on digitally reconstructed radiographs of a radiotherapy plan with those on orthogonal kV X-rays. When the difference in the coordinates from the fiducial marker fusion was less than 1 mm, the patient position was approved for radiotherapy. A virtual bone matching was carried out at the fiducial marker matched position, and then a setup difference between the fiducial marker matching and bone matching was evaluated. Results: Three patients received a planned 17-fractionated radiotherapy and the rest underwent 16 fractionations. The setup error of the fiducial marker matching was $0.94{\pm}0.62$ mm (range, 0.09 to 3.01 mm; median, 0.81 mm), and the means of the lateral, craniocaudal, and anteroposterior errors were $0.39{\pm}0.34$ mm, $0.46{\pm}0.34$ mm, and $0.57{\pm}0.59$ mm, respectively. The setup error of the pelvic bony matching was $3.15{\pm}2.03$ mm (range, 0.25 to 8.23 mm; median, 2.95 mm), and the error of craniocaudal direction ($2.29{\pm}1.95$ mm) was significantly larger than those of anteroposterior ($1.73{\pm}1.31$ mm) and lateral directions ($0.45{\pm}0.37$ mm), respectively (p<0.05). Incidences of over 3 mm and 5 mm in setup difference among the fractionations were 1.5% and 0% in the fiducial marker matching, respectively, and 49.3% and 17.9% in the pelvic bone matching, respectively. Conclusion: The more precise setup of hypofractionated radiotherapy for prostate cancer patients is feasible with the implanted fiducial marker matching compared with the pelvic bony matching. Therefore, a less marginal expansion of planning target volume produces less radiation exposure to adjacent normal tissues, which could ultimately make hypofractionated radiotherapy safer.

• Radiation Oncology Journal
• /
• v.20 no.3
• /
• pp.221-227
• /
• 2002

Purpose : To evaluate the role of postoperative chemoradiotherapy in locally advanced rectal cancer, we retrospectively analyzed the treatment results of patients treated by curative surgical resection and postoperative chemoradiotherapy. Materials and Methods : From April 1989 through December 1998, 119 patients were treated with curative surgery and postoperative chemoradiotherapy for rectal carcinoma in Gyeongsang National University Hospital. Patient age ranged from 32 to 73 years, with a median age of 56 years. Low anterior resection was peformed in 59 patients, and abdominoperineal resection in 60. Forty-three patients were AJCC stage II and 76 were stage III. Radiation was delivered with 6 MV X rays using either AP-PA two fields, AP-PA both lateral four fields, or PA both lateral three fields. Total radiation dose ranged from 40 Gy to 56 Gy. In 73 patients, bolus infusions of 5-FU $(400\;mg/m^2)$ were given during the first and fourth weeks of radiotherapy. After completion of radiotherapy, an additional four to six cycles of 5-FU were given. Oral 5-FU (Furtulone) was given for nine months in 46 patients. Results : Forty $(33.7\%)$ of the 119 patients showed treatment failure. Local failure occurred in 16 $(13.5\%)$ patients, 1 $(2.3\%)$ of 43 stage II patients and 15 $(19.7\%)$ of 76 stage III patients. Distant failure occurred in 31 $(26.1\%)$ patients, among whom 5 $(11.6\%)$ were stage II and 26 $(34.2\%)$ were stage III. Five-year actuarial survival was $56.2\%$ overall, $71.1\%$ in stage II patients and $49.1\%$ in stage III patients (p=0.0008). Five-year disease free survival was $53.3\%$ overall, $68.1\%$ in stage II and $45.8\%$ in stage III (p=0.0006). Multivariate analysis showed that T stage and N stage were significant prognostic factors for five year survival, and that T stage, N stage, and preoperative CEA value were significant prognostic factors for five year disease free survival. Bowel complication occurred in 22 patients, and was treated surgically in 15 $(12.6\%)$, and conservatively in 7 $(5.9\%)$. Conclusion : Postoperative chemoradiotherapy was confirmed to be an effective modality for local control of rectal cancer, but the distant failure rate remained high. More effective modalities should be investigated to lower the distant failure rate.

• The Journal of Korean Society for Radiation Therapy
• /
• v.30 no.1_2
• /
• pp.201-208
• /
• 2018

Purpose : The purpose of this study is to compare and analyze the set-up errors using the Combine IGRT with ExacTrac and CBCT phased in the treatment of Stereotatic Body Radiotherapy. Methods and materials : Patient who were treated Stereotatic Body Radiotherapy in the ulsan university hospital from May 2014 to november 2017 were classified as treatment area three brain, nine spine, three pelvis. First using ExacTrac Set-up error calibrated direction of Lateral(Lat), Longitudinal(Lng), Vertical(Vrt), Roll, Pitch, Yaw, after applied ExacTrac moving data in addition to use CBCT and set-up error calibrated direction of Lat, Lng, Vrt, Rotation(Rtn). Results : When using ExacTrac, the error in the brain region is Lat $0.18{\pm}0.25cm$, Lng $0.23{\pm}0.04cm$, Vrt $0.30{\pm}0.36cm$, Roll $0.36{\pm}0.21^{\circ}$, Pitch $1.72{\pm}0.62^{\circ}$, Yaw $1.80{\pm}1.21^{\circ}$, spine Lat $0.21{\pm}0.24cm$, Lng $0.27{\pm}0.36cm$, Vrt $0.26{\pm}0.42cm$, Roll $1.01{\pm}1.17^{\circ}$, Pitch $0.66{\pm}0.45^{\circ}$, Yaw $0.71{\pm}0.58^{\circ}$, pelvis Lat $0.20{\pm}0.16cm$, Lng $0.24{\pm}0.29cm$, Vrt $0.28{\pm}0.29cm$, Roll $0.83{\pm}0.21^{\circ}$, Pitch $0.57{\pm}0.45^{\circ}$, Yaw $0.52{\pm}0.27^{\circ}$ When CBCT is performed after the couch movement, the error in brain region is Lat $0.06{\pm}0.05cm$, Lng $0.07{\pm}0.06cm$, Vrt $0.00{\pm}0.00cm$, Rtn $0.0{\pm}0.0^{\circ}$, spine Lat $0.06{\pm}0.04cm$, Lng $0.16{\pm}0.30cm$, Vrt $0.08{\pm}0.08cm$, Rtn $0.00{\pm}0.00^{\circ}$, pelvis Lat $0.06{\pm}0.07cm$, Lng $0.04{\pm}0.05cm$, Vrt $0.06{\pm}0.04cm$, Rtn $0.0{\pm}0.0^{\circ}$. Conclusion : Combine IGRT with ExacTrac in addition to CBCT during Stereotatic Body Radiotherapy showed that it was possible to reduce the set-up error of patients compared to single ExacTrac. However, the application of Combine IGRT increases patient set-up verification time and absorption dose in the body for image acquisition. Therefore, depending on the patient's situation that using Combine IGRT to reduce the patient's set-up error can increase the radiation treatment effectiveness.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.18 no.2
• /
• pp.48-56
• /
• 2014

Purpose $^{99m}Tc$-DTPA renal scintigraphy serves as a key indicator to measure a kidney donor's Glomerular Filtration Rate (GFR) and determine the possibility of kidney transplant. The Gates method utilized to measure GFR considers 3 variables of renal depth, injection dose, and net kidney counts. In this research, we seek to compare changes in kidney donors' GFR according to renal depth measurement methods of the 3 variables. Materials and Methods We investigated 32 kidney donors who had visited the hospital from October, 2013 to March, 2014 and received abdominal CT and $^{99m}Tc$-DTPA GFR examination. With the cross-section image of the CT and the lateral image from a gamma camera, we measured the renal depth and compared with renal depth calculation equations-Tonnesen, Taylor, and Itoh methods. Renal depth-specific GFR was calculated by using Xeleris Ver. 2.1220 of GE. Then the results were compared with MDRD (Modification of Diet Renal Disease) GFRs based on serum creatinine level. Results The renal depths measured based on the CT and gamma camera images showed high correlation. Tonessen equation gave the lowest GFR value while the value calculated by using the renal depth of CT image was the highest with a 16.62% gap. MDRD GFR showed no statistically significant difference among values calculated through Taylor, Itoh, CT and gamma camera renal depth application (P>0.05), but exhibited a statistically significant change in the value based on Tonnesen equation (P<0.05). Conclusion This research has found that, in GFR evaluation in kidney donors by utilizing $^{99m}Tc$-DTPA, Tonnesen equation-based Gates method underestimated the value than the MDRD GFR. Therefore, if a MDRD GFR value shows a huge difference from the actual examination value, using an image-based renal depth measurement, instead of Tonnesen equation applied to Gates method, is expected to give an accurate GFR value to kidney donors.

• The Korean Journal of Pharmacology
• /
• v.21 no.1
• /
• pp.49-61
• /
• 1985

In view of the facts that dopamine (DA) when given directly into a lateral ventricle (i.c.v.) of the rabbit brain induces antidiuresis and that haloperidol, a non-specific antagonist of DA receptors, produces anti-diuresis in smaller doses and diuresis and natriuresis in larger doses, the present study was undertaken to delineate the roles of various DA receptors involved in the center-mediated regulation of renal function. Bromocriptine (BRC), a relatively specific agonist of D-2 receptors and at the same time a D-,1 antagonist, elicited natriuresis and diuresis when given i.c.v. in doses ranging from 20 to 600 {\mu}g/kg$, roughly in dose-related fashion, while the renal perfusion and glomerular filtration progressively decreased with doses, indicating that the diuretic, natriuretic action resides in the tubules, not related to the hemodynamic effects. These diuresis and natriuresis were most marked with 200 ${\mu}g/kg$, with the fractional sodium excretion reaching about 10%. With 600 ${\mu}g/kg$, however, the diuretic, natriuretic action was preceded by a transient oliguria resulting from severe reduction of renal perfusion, concomitant with marked but transient hypertension. When given intravenously, however, BRC produced antidiuresis and antinatriuresis along with decreases in renal hemodynamics associated with systemic hypotension, thus indicating that the renal effects produced by i.c.v. BRC is not caused by a direct renal effects of the agent which might have reached the systemic circulation. In experiments in which DA was given i.c.v. prior to BRC, 150 ${\mu}g/kg$ DA did not affect the effects of BRC (200 ${\mu}g/kg$), while 500 ${\mu}g/kg$ DA abolished the BRC effect. In rabbits treated with reserpine, 1 mg/kg i.v.,24 h prior to the experiment, i.c.v. BRC could unfold its renal effects not only undiminished but rather exaggerated and more promptly. In preparations in which one kidney is deprived of nervous connection, the denervated kidney responded with marked diuresis and natriuresis, whereas the innervated, control kidney exhibited antidiuresis. These observations suggest that i.c.v. BRC influences the renal function through release of some humoral natriuretic factor as well as by increasing sympathetic tone, and that various DA receptors might be involved with differential roles in the center-mediated regulation of the renal function.

• Radiation Oncology Journal
• /
• v.19 no.1
• /
• pp.27-33
• /
• 2001

Purpose : To evaluate interim results in terms of failure, cosmetic results and survival after breast conserving operation and radiation therapy in early breast cancer. Material and Methods : From January 1992 through December 1997, seventy two patients with early stage 0, I and II breast cancer were treated with conservative surgery plus radiotherapy at Keimyung University Dongsan Medical Center. Age distribution was 25 to 77 years old with median age of 43. According to TNM stage, five patients had stage 0, thirty three were stage I, twenty five were IIa, and nine were IIb. Most patients underwent excision of all gross tumor and ipsilateral axillary dissection. Breast was irradiated through medial and lateral tangential fields of 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks. We delivered a boost irradiation dose of 10 to 16 Gy in 1 to 2 weeks to excision site. Adjuvant chemotherapy was administered in forty one patients with CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens of 6 cycles concurrently or before radiation. Cosmetic results were assessed by questionnaire to patients grading of excellent, good, fair, poor. Follow-up periods were 22 to 91 months with median 40 months. Results : Five year disease free survival rate (5YDFS) was $95.8\%$. According to stage, 5YDFS was $100\%,\;96.9\%,\;96\%\;and\;88.9\%$ in stage 0, I, IIa and IIb, respectively. Two patients had distant metastasis and one had local and distant failure. One patient with distant failure had bone and liver metastasis at 14 months after treatment and the other had lung and both supraclavicular metastasis at 21 months after treatment. Patient with local and distant failure had local recurrence on other quadrant in same breast and then salvaged with total mastectomy and chemotherapy but she died due to brain metastasis at 55 months. Complications were radiation pneumonitis in five patients (four patients of asymptomatic, one patients of symptomatic) and hand or arm edema(4 patients). Fifty nine patients answered our cosmetic result questionnaire and cosmetic results were good to excellent in fifty one patients $(86\%)$. Conclusion : We considered that conservative surgery and radiation for the treatment of early stage invasive breast cancer was safe and had excellent survival and cosmetic results. We need to assess about prognostic factors with longer follow up and with large number of patients.

• Progress in Medical Physics
• /
• v.17 no.1
• /
• pp.47-53
• /
• 2006

The accuracy of the dosimetry in the Cyberknife system is accomplishing important role from all processes of the stereotactic radiosurgery. In this study, we estimated relative output factors for Cyberknife. All measurements were peformed by six different detectors: diode detector, X-Omat V film, Gafchromic EBT film, 0.015 cc, 0.125 cc and 0.6 cc ionization chamber The diode detector and three ionization chambers peformed using water phantom at 80 cm SSD and 1.5 cm depth. When the film measurements were peformed, the water phantom was replaced with a solidwater phantom. Each collimator normalized with respect to the output factor of the largest collimator (60 mm). For the collimators over than 30 mm, the output factors from the different detectors showed a good agreement within 0.5% except 0.6 cc ion chamber For the collimators less than 15 mm, there were substantial differences In the output factors among different detectors. That is, the value of output factor for the 5 mm collimator of a diode and Gafchromic film was each $0.656{\pm}0.009$ and $0.777{\pm}0.013$. In the ion chamber and diode detector, those difference were due to the presence of large dose gradients and lack of electronic equilibrium in narrow megavoltage x-ray beams Therefore, the Gafchromic EBT film were considered more accurate than the others detectors.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.23 no.2
• /
• pp.20-24
• /
• 2019

Purpose Molecular Breast Imaging (MBI) scan is used in nuclear medicine, for which $^{99m}Tc-sestaMIBI$ is administered by intravenous injection. However, the breast uptake rate of $^{99m}Tc-sestaMIBI$ is less than 1% of the total dose administered, relying on blood flow conditions of organs. The purpose of this study is to evaluate the impact of changes to body temperature on the uptake of $^{99m}Tc-sestaMIBI$ in breast tissue. Materials and Methods We investigated 30 breast cancer patients who performed more than one follow-up MBI scan. All scans were acquired by Discovery 750B (Genral Electric Healthcare, USA). $^{99m}Tc-sestaMIBI$ injected with 740 MBq (20 mCi), after 60 minutes, gained bilateral breast CC (CranioCaudal), MLO (Medio Lateral Oblique) View. The follow-up examination was then classified into 15 body temperature control group and 15 body temperature non-control group, and gained breast image in the same way as before. The breast uptake rate was analyzed in the MLO View of the opposite side of the lesion, and blind images were evaluated. Results The breast uptake rate increased by 30.31% in the body temperature control group and it was statistically significant(P<0.05), and 0.96% in the body temperature non-control group, and it was not statistically significant(P=0.955). There was a significant difference in the uptake rate between the body temperature control and the non-control group of P value of 0.01. Evaluation of blind images showed significant results in terms of the quality of the images. Conclusion Increased breast tissue uptake was observed when the subject was kept warm. When the body temperature was raised after injection, dilation of the peripheral blood vessels can be achieved. As a result, the blood flow became smooth and the breast uptake rate increased. In addition, an increase in breast tissue uptake will improve the quality of images.