• Title/Summary/Keyword: treatment planning

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Effect of Dose Rate Variation on Dose Distribution in IMRT with a Dynamic Multileaf Collimator (동적다엽콜리메이터를 이용한 세기변조방사선 치료 시 선량분포상의 선량률 변화에 따른 효과)

  • Lim, Kyoung-Dal;Jae, Young-Wan;Yoon, Il-Kyu;Lee, Jae-Hee;Yoo, Suk-Hyun
    • The Journal of Korean Society for Radiation Therapy
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    • v.24 no.1
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    • pp.1-10
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    • 2012
  • Purpose: To evaluate dose distribution differences when the dose rates are randomly changed in intensity-modulated radiation therapy using a dynamic multileafcollimator. Materials and Methods: Two IMRT treatment plans including small-field and large-field plans were made using a commercial treatment planning system (Eclipse, Varian, Palo Alto, CA). Each plan had three sub-plans according to various dose rates of 100, 400, and 600 MU/min. A chamber array (2D-Array Seven729, PTW-Freiburg) was positioned between solid water phantom slabs to give measurement depth of 5 cm and backscattering depth of 5 cm. Beam deliveries were performed on the array detector using a 6 MV beam of a linear accelerator (Clinac 21EX, Varian, Palo Alto, CA) equipped with 120-leaf MLC (Millenium 120, Varian). At first, the beam was delivered with same dose rates as planned to obtain reference values. After the standard measurements, dose rates were then changed as follows: 1) for plans with 100 MU/min, dose rate was varied to 200, 300, 400, 500 and 600 MU/min, 2) for plans with 400 MU/min, dose rate was varied to 100, 200, 300, 500 and 600 MU/min, 3) for plans with 600 MU/min, dose rate was varied to 100, 200, 300, 400 and 500 MU/min. Finally, using an analysis software (Verisoft 3.1, PTW-Freiburg), the dose difference and distribution between the reference and dose-rate-varied measurements was evaluated. Results: For the small field plan, the local dose differences were -0.8, -1.1, -1.3, -1.5, and -1.6% for the dose rate of 200, 300, 400, 500, 600 MU/min, respectively (for 100 MU/min reference), +0.9, +0.3, +0.1, -0.2, and -0.2% for the dose rate of 100, 200, 300, 500, 600 MU/min, respectively (for 400 MU/min reference) and +1.4, +0.8, +0.5, +0.3, and +0.2% for the dose rate of 100, 200, 300, 400, 500 MU/min, respectively (for 600 MU/min reference). On the other hand, for the large field plan, the pass-rate differences were -1.3, -1.6, -1.8, -2.0, and -2.4% for the dose rate of 200, 300, 400, 500, 600 MU/min, respectively (for 100 MU/min reference), +2.0, +1.8, +0.5, -1.2, and -1.6% for the dose rate of 100, 200, 300, 500, 600 MU/min, respectively (for 400 MU/min reference) and +1.5, +1.9, +1.7, +1.9, and +1.2% for the dose rate of 100, 200, 300, 400, 500 MU/min, respectively (for 600 MU/min reference). In short, the dose difference of dose-rate variation was measured to the -2.4~+2.0%. Conclusion: Using the Varian linear accelerator with 120 MLC, the IMRT dose distribution is differed a little <(${\pm}3%$) even though the dose-rate is changed.

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The Irradiated Lung Volume in Tangential Fields for the Treatment of a Breast (유방암의 접선 조사시 피폭 폐용적)

  • Oh Young Taek;Kim Juree;Kang Haejin;Sohn Jeong Hye;Kang Seung Hee;Chun Mison
    • Radiation Oncology Journal
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    • v.15 no.2
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    • pp.137-143
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    • 1997
  • Purpose : Radiation pneumonitis is one of the complications caused by radiation therapy that includes a Portion of the lung tissue. The severity of radiation induced pulmonary dysfunction depends on the irradiated lung volume, total dose, dose rate and underlying Pulmonary function. It also depends on whether chemotherapy is done or not. The irradiated lung volume is the most important factor to predict the pulmonary dysfunction in breast cancer Patients following radiation therapy. There are some data that show the irradiated lung volume measured from CT scans as a part of treatment Planning with the tangential beams. But such data have not been reported in Korea. We planned to evaluate the irradiated lung volume quantitatively using CT scans for the breast tangential field and search for useful factors that could Predict the irradiated lung volume Materials and Methods : The lung volume was measured for 25 patients with breast cancer irradiated with tangential field from Jan.1995 to Aug.1996. Parameters that can predict the irradiated lung volume included; (1) the peruendicular distance from the Posterior tangential edge to the posterior part of the anterior chest wall at the center of the field (CLD) ; (2) the maximum perpendicular distance from the posterior tangential field edge to the posterior Part of the anterior chest wall (MLD) ; (3) the greatest perpendicular distance from the Posterior tangential edge to the posterior part of anterior chest wall on CT image at the center of the longitudinal field (GPD) ; (4) the length of the longitudinal field (L). The irradiated lung volume(RV), the entire both lung volume(EV) and the ipsilateral lung volume(IV) were measured using dose volume histogram. The relationship between the irradiated lung volume and predictors was evaluated by regression analysis. Results :The RV is 61-279cc (mean 170cc), the RV/EV is $2.9-13.0\%\;(mean\;5.8\%)$ and the RV/IV is $4.9-29.0\%\;(mean\;12.2\%)$. The CLD, the MLD and the GPD ave 1.9-3.3cm, 1.9-3.3cm and 1.4-3.1cm respectively. The significant relations between the irradiated lung volume such as RV. RV/EV, RV/IV and parameters such as CLD, MLD, GPO, L. $CLD\timesL,\;MLD\timesL\;and\;GPD\timesL$ are not found with little variances in parameters. The RV/IV of the left breast irradiation is significantly larger than that of the right but the RV/EVS do not show the differences. There is no symptomatic radiation pneumonitis at least during 6 months follow up. Conclusion : The significant relationship between the irradiated lung volume and predictors is not found with little variation on parameters. The irradiated lung volume in the tangential held is liss than $10\%$ of entire lung volume when CLO is less than 3cm. The RV/IV of the left tangential field is larger than that of the right but there was no significant differences in RV/EVS. Symptomatic radiation pneumonitis has not occurred during minimum 6 months follow up.

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Comparison of Virtual Wedge versus Physical Wedge Affecting on Dose Distribution of Treated Breast and Adjacent Normal Tissue for Tangential Breast Irradiation (유방암의 방사선치료에서 Virtual Wedge와 Physical Wedge사용에 따른 유방선량 및 주변조직선량의 차이)

  • Kim Yeon-Sil;Kim Sung-Whan;Yoon Sel-Chul;Lee Jung-Seok;Son Seok-Hyun;Choi Ihl-Bong
    • Radiation Oncology Journal
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    • v.22 no.3
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    • pp.225-233
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    • 2004
  • Purpose: The Ideal breast irradiation method should provide an optimal dose distribution In the treated breast volume and a minimum scatter dose to the nearby normal tissue. Physical wedges have been used to Improve the dose distribution In the treated breast, but unfortunately Introduce an Increased scatter dose outside the treatment yield, pavllculariy to the contralateral breast. The typical physical wedge (FW) was compared with 4he virtual wedge (VW) to do)ermine the difference In the dose distribution affecting on the treated breast and the contralateral breast, lung, heart and surrounding perlpheral soft tissue. Methods and Materials: The data collected consisted of a measurement taken with solid water, a Humanoid Alderson Rando phantom and patients. The radiation doses at the ipsllateral breast and skin, contralateral breast and skin, surrounding peripheral soft tissue, and Ipsllateral lung and heart were compared using the physical wedge and virtual wedge and the radiation dose distribution and DVH of the treated breast were compared. The beam-on time of each treatment technique was also compared Furthermore, the doses at treated breast skin, contralateral breast skin and skin 1.5 cm away from 4he field margin were also measured using TLD in 7 patients of tangential breast Irradiation and compared the results with phantom measurements. Results: The virtual wedge showed a decreased peripheral dose than those of a typical physical wedge at 15$^{\circ}$, 30$^{\circ}$, 45$^{\circ}$, and 60$^{\circ}$. According to the TLD measurements with 15$^{\circ}$ and 30$^{\circ}$ virtual wedge, the Irradiation dose decreased by 1.35$\%$ and 2.55$\%$ In the contralateral breast and by 0.87$\%$ and 1.9$\%$ In the skin of the contralateral breast respectively. Furthermore, the Irradiation dose decreased by 2.7$\%$ and 6.0$\%$ in the Ipsllateral lung and by 0.96$\%$ and 2.5$\%$ in the heart. The VW fields had lower peripheral doses than those of the PW fields by 1.8$\%$ and 2.33$\%$. However the skin dose Increased by 2.4$\%$ and 4.58$\%$ In the Ipsliateral breast. VW fields, In general, use less monitor units than PW fields and shoriened beam-on time about half of PW. The DVH analysis showed that each delivery technique results In comparable dose distribution in treated breast. Conclusion: A modest dose reduction to the surrounding normal tissue and uniform target homogeneity were observed using the VW technique compare to the PW beam in tangential breast Irradiation The VW field is dosmetrically superlor to the PW beam and can be an efficient method for minimizing acute, late radiation morbidity and reduce 4he linear accelerator loading bV decreasing the radiation delivery time.

Reconstruction of Stereo MR Angiography Optimized to View Position and Distance using MIP (최대강도투사를 이용한 관찰 위치와 거리에 최적화 된 입체 자기공명 뇌 혈관영상 재구성)

  • Shin, Seok-Hyun;Hwang, Do-Sik
    • Investigative Magnetic Resonance Imaging
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    • v.16 no.1
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    • pp.67-75
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    • 2012
  • Purpose : We studied enhanced method to view the vessels in the brain using Magnetic Resonance Angiography (MRA). Noticing that Maximum Intensity Projection (MIP) image is often used to evaluate the arteries of the neck and brain, we propose a new method for view brain vessels to stereo image in 3D space with more superior and more correct compared with conventional method. Materials and Methods: We use 3T Siemens Tim Trio MRI scanner with 4 channel head coil and get a 3D MRA brain data by fixing volunteers head and radiating Phase Contrast pulse sequence. MRA brain data is 3D rotated according to the view angle of each eyes. Optimal view angle (projection angle) is determined by the distance between eye and center of the data. Newly acquired MRA data are projected along with the projection line and display only the highest values. Each left and right view MIP image is integrated through anaglyph imaging method and optimal stereoscopic MIP image is acquired. Results: Result image shows that proposed method let enable to view MIP image at any direction of MRA data that is impossible to the conventional method. Moreover, considering disparity and distance from viewer to center of MRA data at spherical coordinates, we can get more realistic stereo image. In conclusion, we can get optimal stereoscopic images according to the position that viewers want to see and distance between viewer and MRA data. Conclusion: Proposed method overcome problems of conventional method that shows only specific projected image (z-axis projection) and give optimal depth information by converting mono MIP image to stereoscopic image considering viewers position. And can display any view of MRA data at spherical coordinates. If the optimization algorithm and parallel processing is applied, it may give useful medical information for diagnosis and treatment planning in real-time.

Evaluation of the reconstruction of image acquired from CT simulator to reduce metal artifact (Metal artifact 감소를 위한 CT simulator 영상 재구성의 유용성 평가)

  • Choi, Ji Hun;Park, Jin Hong;Choi, Byung Don;Won, Hui Su;Chang, Nam Jun;Goo, Jang Hyun;Hong, Joo Wan
    • The Journal of Korean Society for Radiation Therapy
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    • v.26 no.2
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    • pp.191-197
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    • 2014
  • Purpose : This study presents the usefulness assessment of metal artifact reduction for orthopedic implants(O-MAR) to decrease metal artifacts from materials with high density when acquired CT images. Materials and Methods : By CT simulator, original CT images were acquired from Gammex and Rando phantom and those phantoms inserted with high density materials were scanned for other CT images with metal artifacts and then O-MAR was applied to those images, respectively. To evaluate CT images using Gammex phantom, 5 regions of interest(ROIs) were placed at 5 organs and 3 ROIs were set up at points affected by artifacts. The averages of standard deviation(SD) and CT numbers were compared with a plan using original image. For assessment of variations in dose of tissue around materials with high density, the volume of a cylindrical shape was designed at 3 places in images acquired from Rando phantom by Eclipse. With 6 MV, 7-fields, $15{\time}15cm2$ and 100 cGy per fraction, treatment planning was created and the mean dose were compared with a plan using original image. Results : In the test with the Gammex phantom, CT numbers had a few difference at established points and especially 3 points affected by artifacts had most of the same figures. In the case of O-MAR image, the more reduction in SD appeared at all of 8 points than non O-MAR image. In the test using the Rando Phantom, the variations in dose of tissue around high density materials had a few difference between original CT image and CT image with O-MAR. Conclusion : The CT images using O-MAR were acquired clearly at the boundary of tissue around high density materials and applying O-MAR was useful for correcting CT numbers.

Clinical Application of Dose Reconstruction Based on Full-Scope Monte Carlo Calculations: Composite Dose Reconstruction on a Deformed Phantom (몬테칼로 계산을 통한 흡수선량 재구성의 임상적 응용: 변형된 팬텀에서의 총제적 선량재구성)

  • Yeo, Inhwan;Xu, Qianyi;Chen, Yan;Jung, Jae Won;Kim, Jong Oh
    • Progress in Medical Physics
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    • v.25 no.3
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    • pp.139-142
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    • 2014
  • The purpose of this study was to develop a system of clinical application of reconstructed dose that includes dose reconstruction, reconstructed dose registration between fractions of treatment, and dose-volume-histogram generation and to demonstrate the system on a deformable prostate phantom. To achieve this purpose, a deformable prostate phantom was embedded into a 20 cm-deep and 40 cm-wide water phantom. The phantom was CT scanned and the anatomical models of prostate, seminal vesicles, and rectum were contoured. A coplanar 4-field intensity modulated radiation therapy (IMRT) plan was used for this study. Organ deformation was simulated by inserting a "transrectal" balloon containing 20 ml of water. A new CT scan was obtained and the deformed structures were contoured. Dose responses in phantoms and electronic portal imaging device (EPID) were calculated by using the XVMC Monte Carlo code. The IMRT plan was delivered to the two phantoms and integrated EPID images were respectively acquired. Dose reconstruction was performed on these images using the calculated responses. The deformed phantom was registered to the original phantom using an in-house developed software based on the Demons algorithm. The transfer matrix for each voxel was obtained and used to correlate the two sets of the reconstructed dose to generate a cumulative reconstructed dose on the original phantom. Forwardly calculated planning dose in the original phantom was compared to the cumulative reconstructed dose from EPID in the original phantom. The prescribed 200 cGy isodose lines showed little difference with respect to the "prostate" and "seminal vesicles", but appreciable difference (3%) was observed at the dose level greater than 210 cGy. In the rectum, the reconstructed dose showed lower volume coverage by a few percent than the plan dose in the dose range of 150 to 200 cGy. Through this study, the system of clinical application of reconstructed dose was successfully developed and demonstrated. The organ deformation simulated in this study resulted in small but observable dose changes in the target and critical structure.

Environmental Impact Assessment and Evaluation of Environmental Risks (환경영향평가와 환경위험의 평가)

  • Niemeyer, Adelbert
    • Journal of Environmental Impact Assessment
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    • v.4 no.3
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    • pp.41-48
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    • 1995
  • In former times the protection of our environment didn't play an important role due to the fact that emissions and effluents were not considered as serious impacts. However, opinions and scientific measurements meanwhile confirmed that the impacts are more serious than expected. Thus measures to protect our earth has to be taken into consideration. A part of these measures in the Environmental Impact Assessment (EIA). One of the most important parts of the EIA is the collection of basic datas and the following evaluation. Experience out of the daily business of Gerling Consulting Group shows that the content of the EIA has to be revised and enlarged in certain fields. The historical development demonstrated that in areas in which the population and the industrial activities reached high concentration there is a high necessity to develop strict environmental laws and regulations. Maximum values of the concentration of hazardous materials were fixed concerning the emission into and water. Companies not following these regulations were punished. The total amount of environmental offences increased rapidly during the last decade, at least in Germany. During this development the public consciousness concerning environmental affairs increased as well in the industrialized countries. But it could clearly be seen that the development in the field of environmental protection went into the wrong direction. The technologies to protect the environment became more and more sophisticated and terms as: "state of the art" guided more and more to lower emissions, Filtertechnologies and wastewater treatment for example reached a high technical level-but all these sophisticated technologies has one and the same characteristic: they were end-of-the pipe solutions. A second effect was that this kind of environmental protection costs a lot of money. High investments are necessary to reduce the dust emission by another ppm! Could this be the correct way? In Germany the discussion started that the environmental laws reduce the attractivity to invest or to enlarge existing investments within the country. Other countries seem to be not so strict with controlling the environmental laws which means it's simply cheaper to produce in Portugal or Greece. Everybody however knows that this is not the correct way and does not solve the environmental problems. Meanwhile the general picture changes a little bit and we think it changes into the correct direction "End-of-the-pipe" solutions are still necessary but this word received a real negative touch and nobody wants to be brought into connection with this word received a real negative touch and nobody wants to be brought into connection with this word especially in connection with environmental management and safety. Modern actual environmental management starts in a different way. Thoughts about emissions start in the very beginning of the production, they start with the design of the product and modification of traditional modes of production. Basis of these ideas are detailed analyses of products and processes. Due to the above mentioned facts that the public environmental consciousness changed dramatically a continous environmental improvement of each single production plant has to be guarantied. This question is already an important question of the EIA. But it was never really checked in a wholistic approach. Environmental risks have to be taken into considerations during the execution of an EIA. This means that the environmental risks have to be reduced down to a capable risk-level. Environmental risks have to be considered within the phase of planning, during the operation of a plant and after shut down. The experience shows that most of the environmental relevant accidents were and caused by human fault. Even in highly protected plants the human risk-factor can not be excluded during evaluation of the risk-potential. Thus the approach of an EIA has to regard technical evaluations as well as organizational thoughts and the human factor. An environmental risk is a threat to the environment. An analysis of the risk concerning the organizational and human aspect however never was properly executed during an EIA. A possible solution could be to use an instrument as the actual EMAS (Environmental Management System) of the EC for more accurate evaluation of the impact to the environment during an EIA. Organizations or investors could demonstrate by an approved EMAS or even by showing their installment of EMAS that not only the technical level of the planned investment meets the requested standards but as well the actual or planned management is able to reduce the environmental impact down to a bearable level.

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Evaluation of Factors Used in AAPM TG-43 Formalism Using Segmented Sources Integration Method and Monte Carlo Simulation: Implementation of microSelectron HDR Ir-192 Source (미소선원 적분법과 몬테칼로 방법을 이용한 AAPM TG-43 선량계산 인자 평가: microSelectron HDR Ir-192 선원에 대한 적용)

  • Ahn, Woo-Sang;Jang, Won-Woo;Park, Sung-Ho;Jung, Sang-Hoon;Cho, Woon-Kap;Kim, Young-Seok;Ahn, Seung-Do
    • Progress in Medical Physics
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    • v.22 no.4
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    • pp.190-197
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    • 2011
  • Currently, the dose distribution calculation used by commercial treatment planning systems (TPSs) for high-dose rate (HDR) brachytherapy is derived from point and line source approximation method recommended by AAPM Task Group 43 (TG-43). However, the study of Monte Carlo (MC) simulation is required in order to assess the accuracy of dose calculation around three-dimensional Ir-192 source. In this study, geometry factor was calculated using segmented sources integration method by dividing microSelectron HDR Ir-192 source into smaller parts. The Monte Carlo code (MCNPX 2.5.0) was used to calculate the dose rate $\dot{D}(r,\theta)$ at a point ($r,\theta$) away from a HDR Ir-192 source in spherical water phantom with 30 cm diameter. Finally, anisotropy function and radial dose function were calculated from obtained results. The obtained geometry factor was compared with that calculated from line source approximation. Similarly, obtained anisotropy function and radial dose function were compared with those derived from MCPT results by Williamson. The geometry factor calculated from segmented sources integration method and line source approximation was within 0.2% for $r{\geq}0.5$ cm and 1.33% for r=0.1 cm, respectively. The relative-root mean square error (R-RMSE) of anisotropy function obtained by this study and Williamson was 2.33% for r=0.25 cm and within 1% for r>0.5 cm, respectively. The R-RMSE of radial dose function was 0.46% at radial distance from 0.1 to 14.0 cm. The geometry factor acquired from segmented sources integration method and line source approximation was in good agreement for $r{\geq}0.1$ cm. However, application of segmented sources integration method seems to be valid, since this method using three-dimensional Ir-192 source provides more realistic geometry factor. The anisotropy function and radial dose function estimated from MCNPX in this study and MCPT by Williamson are in good agreement within uncertainty of Monte Carlo codes except at radial distance of r=0.25 cm. It is expected that Monte Carlo code used in this study could be applied to other sources utilized for brachytherapy.

Origin and Storage of Large Woody Debris in a Third-order Mountain Stream Network, Gangwon-do, Korea (강원도 산지계류 내 유목의 기원과 현존량)

  • Kim, Suk Woo;Chun, Kun Woo;Seo, Jung Il;Lim, Young Hyup;Nam, Sooyoun;Jang, Su Jin;Kim, Yong Suk;Lee, Jae Uk
    • Korean Journal of Environment and Ecology
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    • v.34 no.3
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    • pp.249-258
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    • 2020
  • This study aims to provide reference material for effective forest management techniques at the catchment scale, based on the field investigation of large woody debris (LWD) in 11 streams within a third-order forest catchment in Gangwon Province, Korea. To achieve this aim, we analyzed the morphological features of LWD pieces, and the storage and distribution status of LWD by stream order throughout the entire investigation. As a result, a total of 1,207 individual pieces of LWD were categorized into three types as follows: (ⅰ) 1,142 pieces (95%) as only trunk and 65 pieces (5%) as a trunk with root wad, (ⅱ) 1,015 pieces (84%) as non-thinned and 192 pieces (16%) as the thinned, and (ⅲ) 1,050 pieces (87%) as conifer and 157 pieces (13%) as broadleaf. Additionally, in-stream LWD loads (㎥/ha) decreased with increasing stream order, yielding 105.4, 71.3, and 35.6 for first-, second-, and third-order streams, respectively. On the other hand, the ratio of LWD jams to the total LWD volume increased with increasing stream order, yielding 11%, 43%, and 49% for first-, second-, and third-order streams, respectively. Finally, a comparison of the in-stream LWD load with previous studies in several countries around the world indicated that in-stream LWD load was positively correlated with forest stand age even though the climate, topography, forest soil type, forest composition, stand growth rate, disturbance regime, and forest management practices were different. These results could contribute to understanding the significance of LWD as a by-product of forest ecosystems and an indicator of riparian forest disturbance. Based on this, we conclude that advanced forest management techniques, including treatment of thinning slash and stand density control of riparian forest by site location (hillslope and riparian zone, or stream order), should be established in the future, taking the forest ecosystem and the aquatic environment from headwater streams to low land rivers into consideration.

Dosimetric effects of couch attenuation and air gaps on prone breast radiation therapy (Prone Breast Phantom을 이용한 couch 산란영향 평가)

  • Kim, Min Seok;Jeon, Soo Dong;Bae, Sun Myeong;Baek, Geum Mun;Song, Heung Gwon
    • The Journal of Korean Society for Radiation Therapy
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    • v.29 no.2
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    • pp.43-51
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    • 2017
  • Purpose: The purpose of this study is to evaluate the dosimetric effects of couch attenuation and air gaps using 3D phantom for prone breast radiation therapy. Materials and method: A 3D printer(Builder Extreme 1000) and computed tomography (CT) images of a breast cancer patient were used to manufacture the customized breast phantom. Eclipse External Beam Planning 13.6 (Varian Medical Systems Palo Alto, CA, USA) was used to create the treatment plan with a dose of 200 cGy per fraction with 6 MV energy. The Optically Stimulated Luminescence Detector(OSLD) was used to measure the skin dose at four points (Med 1, Med 2, Lat 1, Lat 2) on the 3D phantom and ion-chamber (FC65-G) were used to perform the in-vivo dosimetry at the two points (Anterior, Posterior). The Skin dose and in-vivo dosimetry were measured with reference air gap (3 cm) and increased air gaps (1, 2, 3, 4, 5, 6 cm) from reference distance between the couch and 3D phantom. Results: As a result, measurement for the skin dose at lateral point showed a similar value within ${\pm}4%$ compared to the plan. While the air gap increased, skin dose at medial 1 was reduced. And it was also reduced over 7 % when the air gap was more than 3 cm compared to radiation therapy plan. At medial 2 it was reduced over 4 % as well. The changes of dose from variety of the air gap showed similar value within ${\pm}1%$ at posterior. As the air gap was increased, the dose at anterior was also increased and it was increased by 1 % from the air gap distance more than 3 cm. Conclusion: Dosimetrical measurement using 3D phantom is very useful to evaluate the dosimetric effects of couch attenuation and air gaps for prone breast radiation therapy. And it is possible to reduce the skin dose and increase the accuracy of the radiation dose delivery by appling the optimized air gap.

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