• Korean Journal of Veterinary Research
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• v.60 no.1
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• pp.39-42
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• 2020

This report describes a three-month-old Korean domestic kitten presented with dehydration and poor body condition. Physical examination revealed abdominal distension. Rectal diagnosis was unachievable due to the small rectum diameter. X-ray radiography and endoscopy confirmed presence of abdominal distension and indicated a stricture located 1.5 cm from the anus. A balloon was gently inserted into the rectum and inflated several times followed by triamcinolone injection. Four months later, same procedures were repeated. This report is the first to describe the use of balloon dilation of a rectal stricture followed by intralesional triamcinolone injection in a small cat with poor condition.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2004.11a
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• pp.136-139
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• 2004

In this study, we used the rectal balloon to overcome the dose limit of the radiation therapy in the prostate cancer. Using the rectal balloon, we could minimize the planning target volume (PTV) by minimizing the internal motion of prostate and increased the gap between the rectum wall and the high dose region. To this purpose, we analyzed the position reproducibility of rectal balloon during the patient setup. Moreover, we studied the clinical feasibility of rectal balloon by performing the IMRT plan.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.215-218
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• 2022

The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.2
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• pp.113-124
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• 2005

Purpose : The using of endo-rectal balloon has proposed as optimal method that minimized the motion of prostate and the dose of rectum wall volume for treated prostate cancer patients, so we make the customized rectal balloon device. In this study, we analyzed the efficiency of the Self-customized rectal balloon in the aspects of its reproducibility. Materials and Methods : In 5 patients, for treatment planning, each patient was acquired CT slice images in state of with and without rectal balloon. Also they had CT scanning samely repeated third times in during radiation treatment (IMRT). In each case, we analyzed the deviation of rectal ballon position and verified the isodose distribution of rectum wall at closed prostate. Results : Using the rectal balloon, we minimized the planning target volume (PTV) by decreased the internal motion of prostate and overcome the dose limit of radiation therapy in prostate cancer by increased the gap between the rectum wall and high dose region. Conclusion : The using of rectal balloon, although, was reluctant to treat by patients. View a point of immobilization of prostate internal motion and dose escalation of GTV (gross tumor volume), its using consider large efficients for treated prostate cancer patients.

• Journal of the Korean Society of Radiology
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• v.16 no.6
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• pp.735-740
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• 2022

In order to reduce side effects such as rectal bleeding in the Brachytherapy, the rectal retractor and wet gauze have been used to increase the distance between the rectum and the tandem. However, there were disadvantages that it was difficult to insert through a narrow entrance into the vagina and poor reproducibility. Also, based on the CT image of the selected catheter, the distance from the tandem to the rectum with or without the balloon catheter was checked and the reduction of the dose to the rectum was confirmed. As a result of the experiment, catheter No. 7 was selected considering the maximum balloon size at a level that does not affect the distance between the start point of the balloon and the end of the catheter, and the ovoid applicator. Based on the CT image of the selected catheter, the degree of expansion according to the presence or absence of the balloon catheter was compared, and it was found that the distance difference was 0.3 - 1 cm. In addition, it was confirmed that a decrease of about 32% was observed due to this distance difference. Therefore, the actual clinical application of the selected catheter can be used as a substitute for the existing rectal retractor and wet gauze.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.187-197
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• 2014

Purpose: We aimed to analyze the treatment outcome and long-term toxicity of 70 Gy hypofractionated intensity-modulated radiotherapy (IMRT) for localized prostate cancer using a customized rectal balloon. Materials and Methods: We reviewed medical records of 86 prostate cancer patients who received curative radiotherapy between January 2004 and December 2011 at our institution. Patients were designated as low (12.8%), intermediate (20.9%), or high risk (66.3%). Thirty patients received a total dose of 70 Gy in 28 fractions over 5 weeks via IMRT (the Hypo-IMRT group); 56 received 70.2 Gy in 39 fractions over 7 weeks via 3-dimensional conformal radiotherapy (the CF-3DRT group, which served as a reference for comparison). A customized rectal balloon was placed in Hypo-IMRT group throughout the entire radiotherapy course. Androgen deprivation therapy was administered to 47 patients (Hypo-IMRT group, 17; CF-3DRT group, 30). Late genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated according to the Radiation Therapy Oncology Group criteria. Results: The median follow-up period was 74.4 months (range, 18.8 to 125.9 months). The 5-year actuarial biochemical relapse-free survival rates for low-, intermediate-, and high-risk patients were 100%, 100%, and 88.5%, respectively, for the Hypo-IMRT group and 80%, 77.8%, and 63.6%, respectively, for the CF-3DRT group (p < 0.046). No patient presented with acute or late GU toxicity ${\geq}$grade 3. Late grade 3 GI toxicity occurred in 2 patients (3.6%) in the CF-3DRT group and 1 patient (3.3%) in the Hypo-IMRT group. Conclusion: Hypo-IMRT with a customized rectal balloon resulted in excellent biochemical control rates with minimal toxicity in localized prostate cancer patients.

• Journal of Veterinary Clinics
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• v.33 no.2
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• pp.129-130
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• 2016

A 5-year-old male Laika dog was referred with chief complaint of dyschezia and tenesmus. The dog had rectal prolapse and it was corrected with rectal resection and anastomosis, a year ago. On rectal examination, the stricture of rectum was identified. The irregular scar tissues on serosal and muscular layers of rectum were noted and they were dispersed with partial thickness incision around rectum. Then, the colopexy and mechanical dilation with balloon catheter were applied. No recurrence of rectal prolapse and other complications were noted during follow up periods of 1 year. This report described a successfully corrected anastomotic rectal stricture in a dog.

• The Journal of Korean Society for Radiation Therapy
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• v.19 no.2
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• pp.99-106
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• 2007

Purpose: The patient's position and anatomy during the treatment course little bit varies to some extend due to setup uncertainties and organ motions. These factors could affected to not only the dose coverage of the gross tumor but over dosage of normal tissue. Setup uncertainties and organ motions can be minimized by precise patient positioning and rigid immobilization device but some anatomical site such as prostate, the internal organ motion due to physiological processes are challenge. In planning procedure, the clinical target volume is a little bit enlarged to create a planning target volume that accounts for setup uncertainties and organ motion as well. These uncertainties lead to differences between the calculated dose by treatment planning system and the actually delivered dose. The purpose of this study was to evaluate the differences of interfractional displacement of organ and GTV based on the tomoimages. Materials and Methods: Over the course of 3 months, 3 patients, those who has applied rectal balloon, treated for prostatic cancer patient's tomoimage were studied. During the treatment sessions 26 tomoimages per patient, Total 76 tomoimages were collected. Tomoimage had been taken everyday after initial setup with lead marker attached on the patient's skin center to comparing with C-T simulation images. Tomoimage was taken after rectal balloon inflated with 60 cc of air for prostate gland immobilization for daily treatment just before treatment and it was used routinely in each case. The intrarectal balloon was inserted to a depth of 6 cm from the anal verge. MVCT image was taken with 5 mm slice thickness after the intrarectal balloon in place and inflated. For this study, lead balls are used to guide the registration between the MVCT and CT simulation images. There are three image fusion methods in the tomotherapy, bone technique, bone/tissue technique, and full image technique. We used all this 3 methods to analysis the setup errors. Initially, image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours and then the radiation therapist registered the MVCT images with the CT simulation images based on the bone based, rectal balloon based and GTV based respectively and registered image was compared with each others. The average and standard deviation of each X, Y, Z and rotation from the initial planning center was calculated for each patient. The image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours. Results: There was a significant difference in the mean variations of the rectal balloon among the methods. Statistical results based on the bone fusion shows that maximum x-direction shift was 8 mm and 4.2 mm to the y-direction. It was statistically significant (P=<0.0001) in balloon based fusion, maximum X and Y shift was 6 mm, 16mm respectively. One patient's result was more than 16 mm shift and that was derived from the rectal expansions due to the bowl gas and stool. GTV based fusion results ranging from 2.7 to 6.6 mm to the x-direction and 4.3$\sim$7.8 mm to the y-direction respectively. We have checked rotational error in this study but there are no significant differences among fusion methods and the result was 0.37$\pm$0.36 in bone based fusion and 0.34$\pm$0.38 in GTV based fusion.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.45-52
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• 2015

Purpose : The dose distribution of organ at risk (OAR) and normal tissue is affected by treatment technique in postoperative radiation therapy for prostate cancer. The aim of this study was to compare dose distribution characteristic and to evaluate treatment efficiency by devising VMAT plans according to applying differed number of arc and IMRT plan for postoperative patient of prostate cancer radiation therapy using a rectal balloon. Materials and Methods : Ten patients who received postoperative prostate radiation therapy in our hospital were compared. CT images of patients who inserted rectal balloon were acquired with 3 mm thickness and 10 MV energy of HD120MLC equipped Truebeam STx (Varian, Palo Alto, USA) was applied by using Eclipse (Version 11.0, Varian, Palo Alto, USA). 1 Arc, 2 Arc VMAT plans and 7-field IMRT plan were devised for each patient and same values were applied for dose volume constraint and plan normalization. To evaluate these plans, PTV coverage, conformity index (CI) and homogeneity index (HI) were compared and $R_{50%}$ was calculated to assess low dose spillage as per treatment plan. $D_{25%}$ of rectum and bladder Dmean were compared on OAR. And to evaluate the treatment efficiency, total monitor units(MU) and delivery time were considered. Each assessed result was analyzed by average value of 10 patients. Additionally, portal dosimetry was carried out for accuracy verification of beam delivery. Results : There was no significant difference on PTV coverage and HI among 3 plans. Especially CI and $R_{50%}$ on 7F-IMRT were the highest as 1.230, 3.991 respectively(p=0.00). Rectum $D_{25%}$ was similar between 1A-VMAT and 2A-VMAT. But approximately 7% higher value was observed on 7F-IMRT compare to the others(p=0.02) and bladder Dmean were similar among the all plan(P>0.05). Total MU were 494.7, 479.7, 757.9 respectively(P=0.00) for 1A-VMAT, 2A-VMAT, 7F-IMRT and at the most on 7F-IMRT. The delivery time were 65.2sec, 133.1sec, 145.5sec respectively(p=0.00). The obvious shortest time was observed on 1A-VMAT. All plans indicated over 99.5%(p=0.00) of gamma pass rate (2 mm, 2%) in portal dosimetry quality assurance. Conclusion : As a result of study, postoperative prostate cancer radiation therapy for patient using a rectal balloon, there was no significant difference of PTV coverage but 1A-VMAT and 2A-VMAT were more efficient for dose reduction of normal tissue and OARs. Between VMAT plans. $R_{50%}$ and MU were little lower in 2A-VMAT but 1A-VMAT has the shortest delivery time. So it is regarded to be an effective plan and it can reduce intra-fractional motion of patient also.

• The Journal of Korean Society for Radiation Therapy
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• v.20 no.1
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• pp.25-29
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• 2008

Purpose: To monitor the changes of location of prostate gland using DIPS and to examine the adjustment and proton beam therapy depending on the movement of prostate gland in proton beam therapy for prostate gland in which a fiducial gold marker was inserted. Materials and Methods: This study was conducted in ten patients with prostate cancer who received proton beam therapy since April of 2008. To monitor the change of prostate location, three fiducial gold markers were inserted prior to the treatment. To minimize the movement of prostate gland, patients were recommended to urinate prior to the treatment, to intake a certain amount of water and to concomitantly undergo rectal balloon. In these patients, the set-up position was identical to that for a CT-simulation. The PA (posterior-anterior) and lateral images were obtained using both DIPS (digital image positioning system) and a plain radiography, and they were compared between the two imaging modalities. Thus, the changes of the location of fiducial gold marker were assessed based on three coordinates (x, y, z) and then adjusted. This was followed by proton beam therapy. Results: Images which were taken using a plain radiography were compared with those which were taken using DIPS. In ten patients, according to a reference bony marker, the mean changes of the location of fiducial gold marker based on an iso-center were X-axis: $\pm$0.116 cm, Y-axis: $\pm$0.19 cm and Z-axis: $\pm$0.176 cm. These ten patients showed a difference in the changes of location of prostate gland and it ranged between RT: 0.04 cm and RT: 0.24 cm on the X-axis; between Inf: 0.03 cm and Sup: 0.42 cm on the Y-axis; and Post: 0.05 cm and Ant: 0.35 cm on the Z-axis. Conclusion: To minimize the movement of prostate gland, as the pre-treatment prior to the treatment. In all the patients, however, three fiducial gold markers showed a daily variation which were inserted in the prostate gland. Based on the above data, Thus, the requirement of gold marker matching system depending on the daily variation in the proton beam therapy for which more accurate establishment of target was confirmed. It is assumed that an accurate effect of proton beam therapy would be enhanced by adjusting the target-center depending on the location change of prostate gland using DIPS which was used in the current study.