PURPOSE: To develop a patients' setup verification tool (PSVT) to verify the alignment of the machine and the target isocenters, and the reproducibility of patients' setup for three dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). The utilization of this system is evaluated through phantom and patient case studies. MATERIALS AND METHODS: We developed and clinically tested a new method for patients' setup verification, using digitally reconstructed radiography (DRR), simulation, portal and digital images. The PSVT system was networked to a Pentium PC for the transmission of the acquired images to the PC for analysis. To verify the alignment of the machine and target isocenters, orthogonal pairs of simulation images were used as verification images. Errors in the isocenter alignment were measured by comparing the verification images with DRR of CT images. Orthogonal films were taken of all the patients once a week. These verification films were compared with the DRR were used for the treatment setup. By performing this procedure every treatment, using humanoid phantom and patient cases, the errors of localization can be analyzed, with adjustments made from the translation. The reproducibility of the patients' setup was verified using portal and digital images. RESULTS: The PSVT system was developed to verify the alignment of the machine and the target isocenters, and the reproducibility of the patients' setup for 3DCRT and IMRT. The results show that the localization errors are 0.8+/-0.2 mm (AP) and 1.0+/-0.3 mm (Lateral) in the cases relating to the brain and 1.1+/-0.5 mm (AP) and 1.0+/-0.6 mm (Lateral) in the cases relating to the pelvis. The reproducibility of the patients' setup was verified by visualization, using real-time image acquisition, leading to the practical utilization of our software. CONCLUSION: A PSVT system was developed for the verification of the alignment between machine and the target isocenters, and the reproducibility of the patients' setup in 3DCRT and IMRT. With adjustment of the completed GUI-based algorithm, and a good quality DRR image, our software may be used for clinical applications.
Brain ; Humans ; Pelvis ; Radiography ; Radiotherapy ; Radiotherapy, Conformal

In capacitive heating device, which considered efficient for deep heating, parallel arrangement of the electrodes is a serious limiting factor in heating for eccentrically located lesions because it causes overheating of the exposed ipsilateral skin surface, the heating pattern is also frequently inappropriate, arid the arrangement tends to be unstable due to the patient's gravity. Therefore we attempted an angular arrangement of the electordes to achieve more homogenous and efficient heating for such lesions. In phantom study, both the thermal profile and thermogram established the heating pattern in this unusual angular arrangement of the electrodes at 60degree, 90degree and 120degree angles, respectively. An angular arrangement was also clinically applied to 3 patients. The patients' tolerance was good without significant complication and the thermal distribution was satisfactory. In conclusion, this unusual arrangement of electrodes appears to be promising in the clinical application to the eccentrically located lesions.
Electrodes* ; Gravitation ; Heating* ; Hot Temperature* ; Humans ; Skin

PURPOSE: Planning target volume (PTV) for tumors in abdomen or thorax includes enough margin for breathing-related movement of tumor volumes during treatment. Depending on the location of the tumor, the magnitude of PTV margin extends from 10 mm to 30 mm, which increases substantial volume of the irradiated normal tissue hence, resulting in increase of normal tissue complication probability (NTCP). We developed a simple and handy method which can reduce PTV margins in patients with liver tumors, respiratory motion reduction device (RRD). MATERIALS AND METHODS: For 10 liver cancer patients, the data of internal organ motion were obtained by examining the diaphragm motion under fluoroscope. It was tested for both supine and prone position. A RRD was made using MeV-Green and Styrofoam panels and then applied to the patients. By analyzing the diaphragm movement from patients with RRD, the magnitude of PTV margin was determined and dose volume histogram (DVH) was computed using AcQ-Plan, a treatment planning software. Dose to normal tissue between patients with RRD and without RRD was analyzed by comparing the fraction of the normal liver receiving to 50% of the isocenter dose. DVH and NTCP for normal liver and adjacent organs were also evaluated. RESULTS: When patients breathed freely, average movement of diaphragm was 12+/-1.9 mm in prone position in contrast to 16+/-1.9 mm in supine position. In prone position, difference in diaphragm movement with and without RRD was 3+/-0.9 mm and 12 mm, respectively, showing that PTV margins could be reduced to as much as 9 mm. With RRD, volume of the irradiated normal liver reduced up to 22.7% in DVH analysis. CONCLUSION: Internal organ motion due to breathing can be reduced using RRD, which is simple and easy to use in clinical setting. It can reduce the organ motion-related PTV margin, thereby decrease volume of the irradiated normal tissue.
Abdomen ; Carcinoma, Hepatocellular* ; Diaphragm ; Humans ; Liver ; Liver Neoplasms ; Prone Position ; Respiration ; Supine Position ; Thorax

PURPOSE: The wedge filter is the most commonly used beam modifying device during radiation therapy. Recently dynamic wedge technique is available through the computer controlled asymmetric collimator, independent jaw. But dosimetric characteristics of dynamic wedge technique is not well know. Therefore we evluate dosimetric characteristics of dynamic wedge compared to conventional fixed wedge. MATERIALS AND METHODS: We evaluated dosimetric characteristics of dynamic wedge and fixed wedge by ion chamber, film dosimetry and TLD in phantoms such as water, polystyrene and average breast phantom. Six MV x-ray was used in 15X15 cm field with 15,30 and 45 degree wedge of dynamic/fixed wedge system. Dosimetric characteristics are interpreted by wellhofer Dosimetrie system WP700/WP700i and contralateral breast dose(CBD) with tangential technique was confirmed by TLD. RESULTS: 1) Percent depth dose through the dynamic wedge technique in tissue equivalent phantom was similar to open field irradiation and there was no beam hardening effect compared to fixed wedge technique. 2) Isodose line composing wedge angle of dynamic wedge is more straight than hard wedge. And dynamic wedge technique was able to make any wedge angle on any depth and field size. 3) The contralateral breast dose in primary breast irradiation was reduced by dynamic wedge technique compared to fixed wedge. When the dynamic wedge technique was applied, the scatter dose was similar to that of open field irradiation. CONCLUSION: The dynamic wedge technique was superior to fixed wedge technique in dosimetric characteristics and may be more useful in the future.
Breast ; Film Dosimetry ; Jaw ; Polystyrenes ; Water

Yonsei Cancer Center developed an RF(Radiofrequency) capacitive type heating device, GHT-RF8(Greenytherm) in cooperation with Green Cross Medical Corp., Korea in 1986 for the first time in Korea. Cooperative clinical studies of hyperthermia for the treatment of cancer using GHT-RF8 were conducted by Yonsei Cancer Center in collaboration with the Presbyterian Medical Center, Chonju, Korea. A total of forty patients with various histologically proven malignant tumors, including superficial (N = 13) and deep-seated tumors (N = 27), were treated with this newly developed heating device in conjunction with radiotherapy (N = 38) or chemotherapy (N = 2) at two different institutes between October 1986 and September 1987. These patients were locally far advanced or recurrent cases and considered to be refractory to conventional cancer treatment modalities. Radiotherapy was given in 200cGy per day, five times a week fractionations with a total tumor dose of 50-60Gy in 5-6 weeks. Within an hour after radiotherapy, the RF capacitive type of hyperthermia was given two times a week for a total of 4-10 treatment sessions and an attempt was made to maintain the tumor temperature at 41-45 degrees C for 30-60 minutes. Of forty patients treated, 14 patients with deep-seated tumors showed complete response and 20 patients showed partial response. The overall response rate was 85% (34 out of 40 patients) and only 6 patients showed no response. Complications from this treatment were mainly burns, superficial first degree burn in 2 cases, second degree in 4 cases and subcutaneous fat necrosis was observed in 2 cases.
Adolescent ; Adult ; Aged ; Equipment Design ; Female ; Heating/*instrumentation ; Human ; Hyperthermia, Induced/adverse effects/*instrumentation ; Male ; Middle Age ; Neoplasms/radionuclide imaging/therapy ; Support, Non-U.S. Gov't ; Tomography, X-Ray Computed

PURPOSE: Three-dimensional radiation dosimetry using magnetic resonance imaging of polymer gel was recently introduced. This dosimetry system is based on radiation induced chain polymerization of acrylic monomers in a muscle equivalent gel and provide accurate 3 dimensional dose distribution. We planned this study to evaluate the clinical value of this 3-dimensional dosimetry. MATERIALS AND METHODS: The polymer gel poured into a cylindrical glass flask and a spherical glass flask. The cylindrical test tubes were for dose response evaluation and the spherical flasks, which is comparable to the human head, were for isodose curves. T2 maps from MR images were calculated using software, IDL. Dose distributions have been displayed for dosimetry. The same spherical flask of gel and the same irradiation technique was used for film and TLD dosimetry and compared with each other. RESULTS: The R2 of the gel respond linearly with radiation doses in the range of 2 to 15 Gy. The repeated dosimetry of spherical gel showed the same isodose curves. These isodose curves were identical to dose distributions from treatment planning system especially high dose range. In addition, the gel dosimetry system showed comparable or superior results with the film and TLD dosimetry. CONCLUSION: The 3-dimensional dosimetry for conformal radiation therapy using MRI of polymer gel showed stable and accurate results. Although more studies are needed for convenient clinical application, it appears to be a useful tool for conformal radiation therapy.
Glass ; Head ; Humans ; Magnetic Resonance Imaging* ; Polymerization ; Polymers* ; Radiometry ; Radiotherapy, Conformal

PURPOSE: The Conformal Radiation Therapy has been widely used under favour of development of computer technologies. The delivery of a large number of static radiation fields are being necessary for the conformal irradiation. In this paper, we investigate dosimetric characteristics on penumbra regions of a multileaf collimator(MLC), and compare to those of lead alloy block for he optimal use of the system in 3-D conformal radiotherapy. MATERIALS AND METHODS: The measurement of penumbra by MLC or lead alloy block was performed with 6 or 10 MV X-rays. The film was positioned at a dmax depth and 10 cm depth, and its optical density was determined using a scanning videodensitometer. The effective penumbra, the distance from 80% to 20% isodose lines and 90 to 10 were analyzed as a function of the angle between the direction of leaf motion and the edge defined by leaves. RESULTS: Increasing MLC angle (0-75degree) was observed with increasing the penumbra widths and the scalloping effect. There was no definite differences of penumbra width from 80% to 20% isodose lines, while being the small increase of penumbra width of lead alloy block are agree reasonably with those of MLC within 4.8mm. CONCLUSION: The comparative qualitative study of the penumbra between MLC and lead alloy block demonstrate the clinical acceptability and suitability of the multileaf collimator for 3-D conformal radiotherapy.
Alloys* ; Film Dosimetry ; Pectinidae ; Radiotherapy, Conformal

PURPOSE: The Conformal Radiation Therapy has been widely used under favour of development of computer technologies. The delivery of a large number of static radiation fields are being necessary for the conformal irradiation. In this paper, we investigate dosimetric characteristics on penumbra regions of a multileaf collimator(MLC), and compare to those of lead alloy block for he optimal use of the system in 3-D conformal radiotherapy. MATERIALS AND METHODS: The measurement of penumbra by MLC or lead alloy block was performed with 6 or 10 MV X-rays. The film was positioned at a dmax depth and 10 cm depth, and its optical density was determined using a scanning videodensitometer. The effective penumbra, the distance from 80% to 20% isodose lines and 90 to 10 were analyzed as a function of the angle between the direction of leaf motion and the edge defined by leaves. RESULTS: Increasing MLC angle (0-75degree) was observed with increasing the penumbra widths and the scalloping effect. There was no definite differences of penumbra width from 80% to 20% isodose lines, while being the small increase of penumbra width of lead alloy block are agree reasonably with those of MLC within 4.8mm. CONCLUSION: The comparative qualitative study of the penumbra between MLC and lead alloy block demonstrate the clinical acceptability and suitability of the multileaf collimator for 3-D conformal radiotherapy.
Alloys* ; Film Dosimetry ; Pectinidae ; Radiotherapy, Conformal

PURPOSE: The goal of this study was to improve the accuracy of three-dimensional conformal radio therapy (3-D CRT) by measuring the treatment setup error and physiological movement of liver based on the analysis of images which were obtained by electronic portal imaging device (EPID). MATERIALS AND METHODS: For 10 patients with hepatocellular carcinoma, 4-7 portal images were obtained by using EPID during the radiotherapy from each patient daily. We analyzed the setup error and physiological movement of liver based on the verification data. We also determined the safety margin of the tumor in 3-D CRT through the analysis of physiological movement. RESULTS: The setup errors were measured as 3 mm with standard deviation 1.70 mm in x direction and 3.7 mm with standard deviation 1.88 mm in y direction respectively. Hence, deviation were smaller than 5 mm from the center of each axis. The measured range of liver movement due to the physiological motion was 8.63 mm on the average. Considering the motion of liver and setup error, the safety margin of tumor was at least 15 mm. CONCLUSION: EPID is a very useful device for the determination of the optimal margin of the tumor, and thus enhance the accuracy and stability of the 3-D CRT in patients with hepatocellular carcinoma.
Axis, Cervical Vertebra ; Carcinoma, Hepatocellular* ; Humans ; Liver* ; Radiotherapy

PURPOSE: This study is intended to understand the sensitometric charac teristics and the emulsion properties of the commercially available CEA TVS film in comparison with the Kodak X-Omat V film. MATERIAL AND METHODS: For this purpose, we have formulated an analytic expression of the characteristic curves for x-ray film exposed to mixed radiation of electrons, photons, and visible light. This mathematical expression was developed based on reaction-rate and target-hit theories. Unlike previous expressions, it relates optical density to emulsion properties such as grain size and silver bromide content. We have also developed a quantity which characterizes the film response to visible light relative to that to photons and electrons. This quantity could be expressed as a function of grain area. Thus, we have developed mathematical expressions and quantities with which the emulsion properties of the films can be revealed based on the sensitometric characteristics. Demonstrating the use of this analytical study, we exposed CEA and Kodak verification films to the mixed radiation of electrons, photons, and visible light, and interpreted the experimental results accordingly. RESULTS: We have demonstrated that: (1) the saturation density increases as the silver bromide content increases, (2) the time required to reach the threshold dose (to which the film begins to respond) when films are exposed to visible light decreases as the grain size increases, and (3) the CEA film contains more silver bromide, whereas the Kodak film contains larger grains. These findings were supported by the data provided by the manufacturers afterward. CONCLUSION: This study presented an analytical and experimental basis for understanding the response of X-ray film with respect to the emulsion properties.
Edible Grain ; Light ; Photons ; Silver ; X-Ray Film