• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.305-308
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• 2002

More complex radiotherapy techniques using multi leaf collimation(MLC) such as intensity-modulated radiation therapy(IMRT) has been increasing the significance of verification of leaf position and motion. Due to the reliability and robustness, quality assurance(QA) of MLC is usually performed with portal films. However, the advantage of ease of use and capability of providing digital data of electronic portal imaging devices(EPIDs) have attracted many attentions as alternatives of films for routine quality assurance in spite of the concerns about their clinical feasibility, efficacy, and the cost to benefit ratio. In our work, the method of routine QA of MLC using electronic portal imaging(EPI) was developed. The verification of availability of EPI images for routine QA was performed by comparison with those of the portal films which were simultaneously obtained when radiation was delivered and known prescription input to MLC controller. Specially designed test patterns of dynamic MLC were applied to image acquisition. Quantitative off-line analysis using edge detection algorithm enhanced the verification procedure in addition to on-line qualitative visual assessment. In conclusion, the EPI is available enough for routine QA with the accuracy of portal films.

• Journal of the Korean Society of Radiology
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• v.16 no.4
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• pp.471-476
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• 2022

The purpose of this study was to study the probability of cancer occurrence due to photoneutron dose exposure of the colon and thyroid gland, which are normal organs, in 3D CRT, IMRT 5 portals, and IMRT 9 portals, which are radiotherapy methods for prostate cancer. The total prescribed dose for prostate cancer was 6600 cGy, 220 cGy per dose, and 30 divided irradiations were applied for the total number of times. After setting up the Rando phantom on the treatment table (couch) of the medical linear accelerator used in the experiment, an optically stimulated luminescence albedo neutron dosimeter was placed on the corresponding area of the large intestine and thyroid gland of the phantom for measurement. During 3D CRT of prostate cancer, the probability of secondary cancer due to photoneutron dose to the colon and thyroid gland, which are normal organs, was 1.8 per 10,000 people. And IMRT 5 portals were 8.7 per 10,000 people, which was about 5 times larger than 3D CRT. IMRT 9 portals derived the result that there is a probability that 1.2 people per 1,000 people will develop cancer. Based on this study, the risk of secondary radiation exposure due to the dose of photoneutrons generated during radiation therapy is studied, and it is thought that it will be used as useful data for radiation protection in relation to the stochastic effect of radiation in the future.

• Korean Journal of Head & Neck Oncology
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• v.37 no.1
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• pp.17-22
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• 2021

Background/Objectives: To evaluate clinical significance of FDG PET-CT for detection of residual cancer cells after curative radiation therapy or chemoradiotherapy for patients with squamous cell carcinoma (SCC) of Head and Neck Materials & Methods: A retrospective analysis of patients with SCC of Head and neck with curative radiotherapy or chemoradiotherpy between June 2011 and Jan. 2019 was performed. Sixty patients were treated with Intensity-modulated radiotherapy (IMRT). The Metabolic responses were evaluated on the post-treatment FDG PET-CT at 12 weeks after curative radiotherapy completion. Results: Median follow up was 51.5 months (3-102). The overall survival (OS), disease free survival (DFS), local control rate (LCR), and Distant metastasis free survival (DMFS) at 5 years were 80.5%, 80.1%, 87.7% and 89.1%. Metabolic CR was found in 43 (71.7%) and partial metabolic response (PR) was noted in 17 (14.6%). Metabolic CR was significantly correlated with OS, DFS, LCR, and DMFS. On multivariate analysis, Metabolic CR remained significant for DFS and LCR. Conclusion: Metabolic CR on post-radiotherapy FDG PET-CT is highly predictive of increased DFS and LCR in patients with head and neck cancer.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.481-487
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• 2023

In this study, we analyzed the incidence of side effects of photoneutron dose according to the number of beams during intensity-modulated radiotherapy of prostate cancer using 15 MV. The radiation treatment plan design for intensity-modulated radiation therapy for prostate cancer was established with a prescription dose of 220 cGy per dose and a total of 7260 cGy for 33 treatments. The linear accelerator used in the experiment is Varian's True Beam STx (Varian, USA). Photoneutron dose was generated by using 15 MV energy in the planning target volume (PTV). The treatment plan was designed with IMRT 5, 7, and 9 portals using the Eclipse System (Varian Ver 10.0, USA). An optically stimulated luminescence albedo neutron dosimeter (Landauer Inc., USA) was used to measure photoneutron dose. IMRT 5 portals, 1.7 per 1,000, 7 portals, 1.8 per 1,000, 9 portals, 2.0 per 1,000 were calculated as the probability of experiencing side effects on the thyroid gland due to photoneutron dose. This study studies the risk of secondary radiation exposure dose that can occur during intensity-modulated radiation therapy, and it is considered that it will be used as useful data in relation to stochastic effects in the future.

• Journal of Magnetics
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• v.21 no.1
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• pp.133-140
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• 2016

In this study the contralateral breast skin dose was decreased. It was to apply the results to the clinical study after analysis of different radiation dose amounts to contralateral breast with nonmagnetic bolus and without nonmagnetic bolus. A Rando phantom was computed tomography (CT) simulated, five treatment plans were generated: open tangents, open field in field, wedge 15, wedge 30, and intensity-modulated radiotherapy (IMRT) plan with 50.4 Gy to cover sufficient breast tissue. Contralateral breast skin dose was measured at 8 points using a glass dosimeter. The average contralateral breast dose using nonmagnetic bolus showed better excellence in decreasing the absorbed dose in the order of $168{\pm}11.1$ cGy, $131{\pm}10.2$ cGy (29%), $112{\pm}9.7$ cGy (49%), and $102{\pm}9.5$ cGy (64%) than changing the treatment plan. This study focused on decreasing the effect of scattered dose by use of a nonmagnetic bolus on the contralateral breast during radiotherapy in breast cancer patients and an intriguingly significant decrease was observed parallel to the opposed beam.

• Progress in Medical Physics
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• v.28 no.2
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• pp.54-60
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• 2017

This study was designed to measure transit dose with an electronic portal imaging device (EPID) in eight patients treated with intensity modulated radiotherapy (IMRT), and to verify the accuracy of dose delivery to patients. The calculated dose map of the treatment planning system (TPS) was compared with the EPID based dose measured on the same plane with a gamma index method. The plan for each patient was verified prior to treatment with a diode array (MapCHECK) and portal dose image prediction (PDIP). To simulate possible patient positioning errors during treatment, outcomes were evaluated after an anthropomorphic phantom was displaced 5 and 10 mm in various directions. Based on 3%/3 mm criteria, the $mean{\pm}SD$ passing rates of MapCHECK, PDIP (pre-treatment QA) for 47 IMRT were $99.8{\pm}0.1%$, $99.0{\pm}0.7%$, and, respectively. Besides, passing rates using transit dosimetry was $90.0{\pm}1.5%$ for the same condition. Setup errors of 5 and 10 mm reduced the mean passing rates by 1.3% and 3.0% (inferior to superior), 2.2% and 4.3% (superior to inferior), 5.9% and 10.9% (left to right), and 8.9% and 16.3% (right to left), respectively. These findings suggest that the transit dose-based IMRT verification method using EPID, in which the transit dose from patients is compared with the dose map calculated from the TPS, may be useful in verifying various errors including setup and/or patient positioning error, inhomogeneity and target motions.

• Journal of radiological science and technology
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• v.37 no.4
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• pp.331-339
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• 2014

To test feasibility of proton arc therapy (PAT) in the treatment of para-aortic lymph node tumor and compare its dosimetric properties with advanced radiotherapy techniques such as intensity modulated radiation therapy (IMRT) and conventional 3D conformal proton beam therapy (PBT). The treatment plans for para-aortic lymph node tumor were planned for 9 patients treated at our institution using IMRT, PBT, and PAT. Feasibility test and dosimetric evaluation were based on comparisons of dose volume histograms (DVHs) which reveal mean dose, $D_{30%}$, $D_{60%}$, $D_{90%}$, $V_{30%}$, $V_{60%}$, $V_{90%}$, organ equivalent doses (OEDs), normal tissue complication probability (NTCP), homogeneity index (HI) and conformity index (CI). The average doses delivered by PAT to the liver, kidney, small bowel, duodenum, stomach were 7.6%, 3%, 17.3%, 26.7%, and 14.4%, of the prescription dose (PD), respectively, which is higher than the doses delivered by IMRT (0.4%, 7.2%, 14.2%, 15.9%, and 12.8%, respectively) and PBT (4.9%, 0.5%, 14.12%, 16.1% 9.9%, respectively). The average homogeneity index and conformity index of tumor using PAT were 12.1 and 1.21, respectively which were much better than IMRT (21.5 and 1.47, respectively) and comparable to PBT (13.1 and 1.23, respectively). The result shows that both NTCP and OED of PAT are generally lower than IMRT and PBT. This study demonstrates that PAT is better in target conformity and homogeneity than IMRT and PBT but worse than IMRT and PBT for most of dosimetric factor which indicate that PAT is not recommended for the treatment of para-aortic lymph node tumor.

• Radiation Oncology Journal
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• v.22 no.2
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• pp.106-114
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• 2004

Purpose : This study was done to evaluate xerostomia fellowing intensity modulated radiotherapy for patients with head and neck cancer, and to analyze the correlation between the dosimetric parameters and xerostomia parameters. Materials and Methods : From February till October 2003, 13 patients with 3 months of follow-up were evaluated for xerostomia after being treated for head and neck cancer with IMRT. Their median age was 57 years(range: 43$\~$77). Xerostomia were assessed with a 4-question xerostomia questionnaire score (XQS) and a test for salivary flow rates (unstimulated and stimulated). The patients were also given a validated LENT SOMA scale (LSC) questionnaire. The evaluations were completed before radiation therapy (pre-RT) and at 1 and, 3 months after radiation therapy (RT). We evaluated xerostomia at pre-RT, 1 and, 3 months after RT. The association between the xerostomia parameters (XQS and LSC) and salivary flow rates (unstimulated and stimulated: USFR and SSFR) was assessed at 1 and 3 months after RT. Resrlts : All 13 patients showed no significant changes in XQS, LSC and Salivary Flow rates. As a result, we couldn't find out about xerostomia development. Based on the total mean parotid dose, 3,500 cGy, we divided these patients into two groups. The 8 patients (<3,500 cGy) showed no significant changes in XQS, LSC and Salivary Flow rates However, in 5 Patients ($\geq$3,500 cOGy), there was a significant increase in USFR and, SSFR at 3 months after RT, and for the XQS and, LSC at 1 and 3 months after RT. The correlation between XQS and, LSC, and USFR and, SSFR in ail patients (13) was significant at 3 months after RT. The correlation had a tendency to the decrease for USFR and, SSFR in proportion to the increase of XQS and, LSC. Conclusion : Based on the results of this study, IMRT seem to be an effective treatment to significantly decrease the xerostomia. XQS and, LSC seem to be a effective tool for predicting the xerostomia. A total parotid gland mean dose of <3,500 cGy should be a planning goal if substantial sparing of the gland function is desired. Furthermore, patients should be enrolled in a study to define a more accurate threshold dose for the parotid gland.

• Progress in Medical Physics
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• v.25 no.1
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• pp.23-30
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• 2014

The purpose of this study is to evaluate the developed dose verification program for in vivo dosimetry based on transit dose in radiotherapy. Five intensity modulated radiotherapy (IMRT) plans of lung cancer patients were used in the irradiation of a homogeneous solid water phantom and anthropomorphic phantom. Transit dose distribution was measured using electronic portal imaging device (EPID) and used for the calculation of in vivo dose in patient. The average passing rate compared with treatment planning system based on a gamma index with a 3% dose and a 3 mm distance-to-dose agreement tolerance limit was 95% for the in vivo dose with the homogeneous phantom, but was reduced to 81.8% for the in vivo dose with the anthropomorphic phantom. This feasibility study suggested that transit dose-based in vivo dosimetry can provide information about the actual dose delivery to patients in the treatment room.

• Progress in Medical Physics
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• v.19 no.2
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• pp.89-94
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• 2008

TomoTherapy has a merit to treat cancer with Intensity modulated radiation and combines precise 3-D imaging from computerized tomography (CT scanning) with highly targeted radiation beams and rotating beamlets. In this paper, we comparing the dose distribution between TomoTherapy and linear accelerator based intensity modulated radiotherapy (IMRT) for 10 Head & Neck patients using TomoTherapy which is newly installed and operated at National Cancer Center since Sept. 2006. Furthermore, we estimate how the homogeneity and Normal Tissue Complication Probability (NTCP) are changed by motion of target. Inverse planning was carried out using CadPlan planning system (CadPlan R.6.4.7, Varian Medical System Inc. 3100 Hansen Way, Palo Alto, CA 94304-1129, USA). For each patient, an inverse IMRT plan was also made using TomoTherapy Hi-Art System (Hi-Art2_2_4 2.2.4.15, TomoTherapy Incorporated, 1240 Deming Way, Madson, WI 53717-1954, USA) and using the same targets and optimization goals. All TomoTherapy plans compared favorably with the IMRT plans regarding sparing of the organs at risk and keeping an equivalent target dose homogeneity. Our results suggest that TomoTherapy is able to reduce the normal tissue complication probability (NTCP) further, keeping a similar target dose homogeneity.