1.Current status of proton therapy techniques for lung cancer
Radiation Oncology Journal 2019;37(4):232-248
Proton beams have been used for cancer treatment for more than 28 years, and several technological advancements have been made to achieve improved clinical outcomes by delivering more accurate and conformal doses to the target cancer cells while minimizing the dose to normal tissues. The state-of-the-art intensity modulated proton therapy is now prevailing as a major treatment technique in proton facilities worldwide, but still faces many challenges in being applied to the lung. Thus, in this article, the current status of proton therapy technique is reviewed and issues regarding the relevant uncertainty in proton therapy in the lung are summarized.
Lung Neoplasms
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Lung
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Proton Therapy
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Protons
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Uncertainty
2.Independent Verification Program for High-Dose-Rate Brachytherapy Treatment Plans.
Youngyih HAN ; Sung Sil CHU ; Seung Jae HUH ; Chang Ok SUH
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2003;21(3):238-244
PURPOSE: The planning of High-Dose-Rate (HDR) brachytherapy treatments are becoming individualized and more dependent on the treatment planning system. Therefore, computer software has been developed to perform independent point dose calculations with the integration of an isodose distribution curve display into the patient anatomy images. MATERIALS AND METHODS: As primary input data, the program takes patients' planning data including the source dwell positions, dwell times and the doses at reference points, computed by an HDR treatment planning system (TPS). Dosimetric calculations were performed in a 10x12x10 cm3 grid space using the Interstitial Collaborative Working Group (ICWG) formalism and an anisotropy table for the HDR Iridium-192 source. The computed doses at the reference points were automatically compared with the relevant results of the TPS. The MR and simulation film images were then imported and the isodose distributions on the axial, sagittal and coronal planes intersecting the point selected by a user were superimposed on the imported images and then displayed. The accuracy of the software was tested in three benchmark plans performed by Gamma-Med 12i TPS (MDS Nordion, Germany). Nine patients' plans generated by Plato (Nucletron Corporation, The Netherlands) were verified by the developed software. RESULTS: The absolute doses computed by the developed software agreed with the commercial TPS results within an accuracy of 2.8% in the benchmark plans. The isodose distribution plots showed excellent agreements with the exception of the tip region of the source's longitudinal axis where a slight deviation was observed. In clinical plans, the secondary dose calculations had, on average, about a 3.4% deviation from the TPS plans. CONCLUSION: The accurate validation of complicate treatment plans is possible with the developed software and the quality of the HDR treatment plan can be improved with the isodose display integrated into the patient anatomy information.
Anisotropy
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Axis, Cervical Vertebra
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Brachytherapy*
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Humans
3.Development of the DVH management software for the biologically-guided evaluation of radiotherapy plan.
Bokyong KIM ; Hee Chul PARK ; Dongryul OH ; Eun Hyuk SHIN ; Yong Chan AHN ; Jinsung KIM ; Youngyih HAN
Radiation Oncology Journal 2012;30(1):43-48
PURPOSE: To develop the dose volume histogram (DVH) management software which guides the evaluation of radiotherapy (RT) plan of a new case according to the biological consequences of the DVHs from the previously treated patients. MATERIALS AND METHODS: We determined the radiation pneumonitis (RP) as an biological response parameter in order to develop DVH management software. We retrospectively reviewed the medical records of lung cancer patients treated with curative 3-dimensional conformal radiation therapy (3D-CRT). The biological event was defined as RP of the Radiation Therapy Oncology Group (RTOG) grade III or more. RESULTS: The DVH management software consisted of three parts (pre-existing DVH database, graphical tool, and Pinnacle3 script). The pre-existing DVH data were retrieved from 128 patients. RP events were tagged to the specific DVH data through retrospective review of patients' medical records. The graphical tool was developed to present the complication histogram derived from the pre-existing database (DVH and RP) and was implemented into the radiation treatment planning (RTP) system, Pinnacle3 v8.0 (Phillips Healthcare). The software was designed for the pre-existing database to be updated easily by tagging the specific DVH data with the new incidence of RP events at the time of patients' follow-up. CONCLUSION: We developed the DVH management software as an effective tool to incorporate the phenomenological consequences derived from the pre-existing database in the evaluation of a new RT plan. It can be used not only for lung cancer patients but also for the other disease site with different toxicity parameters.
Humans
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Incidence
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Lung Neoplasms
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Medical Records
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Radiation Pneumonitis
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Retrospective Studies
4.Erratum: Acknowledgments correction.
BoKyong KIM ; Hee Chul PARK ; Dongryul OH ; Eun Hyuk SHIN ; Yong Chan AHN ; Jinsung KIM ; Youngyih HAN
Radiation Oncology Journal 2012;30(2):97-97
The funding acknowledgment in this article was partially omitted as published.
5.The Clinical Implementation of 2D Dose Distribution QA System for the Patient Specific Respiratory-gated Radiotherapy.
Jin Sung KIM ; Eunhyuk SHIN ; Jung Suk SHIN ; Sang Gyu JU ; Youngyih HAN ; Hee Chul PARK ; Doo Ho CHOI
Korean Journal of Medical Physics 2010;21(2):127-136
Emerging technologies such as four-dimensional computed tomography (4D CT) is expected to allow clinicians to accurately model interfractional motion and to quantitatively estimate internal target volumes (ITVs) for radiation therapy involving moving targets. A need exists for a 4D radiation therapy quality assurance (QA) device that can incorporate and analyze the patient specific intrafractional motion as it relate to dose delivery and respiratory gating. We built a 4D RT prototype device and analyzed the patient-specific 4D radiation therapy QA for 2D dose distributions successfully. With more improvements, the 4D RT QA prototype device could be an integral part of a 4D RT decision process to confirm the dose delivery.
Four-Dimensional Computed Tomography
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Humans
;
Polymethacrylic Acids
6.Analysis of the Imaging Dose for IGRT/Gated Treatments.
Jung Suk SHIN ; Youngyih HAN ; Sang Gyu JU ; Eunhyuk SHIN ; Chae Seon HONG ; Yong Chan AHN
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2009;27(1):42-48
PURPOSE: The introduction of image guided radiation therapy/four-dimensional radiation therapy (IGRT/4DRT) potentially increases the accumulated dose to patients from imaging and verification processes as compared to conventional practice. It is therefore essential to investigate the level of the imaging dose to patients when IGRT/4DRT devices are installed. The imaging dose level was monitored and was compared with the use of pre-IGRT practice. MATERIALS AND METHODS: A four-dimensional CT (4DCT) unit (GE, Ultra Light Speed 16), a simulator (Varian Acuity) and Varian IX unit with an on-board imager (OBI) and cone beam CT (CBCT) were installed. The surface doses to a RANDO phantom (The Phantom Laboratory, Salem, NY USA) were measured with the newly installed devices and with pre-existing devices including a single slice CT scanner (GE, Light Speed), a simulator (Varian Ximatron) and L-gram linear accelerator (Varian, 2100C Linac). The surface doses were measured using thermo luminescent dosimeters (TLDs) at eight sites-the brain, eye, thyroid, chest, abdomen, ovary, prostate and pelvis. RESULTS: Compared to imaging with the use of single slice non-gated CT, the use of 4DCT imaging increased the dose to the chest and abdomen approximately ten-fold (1.74+/-0.34 cGy versus 23.23+/-3.67 cGy ). Imaging doses with the use of the Acuity simulator were smaller than doses with the use of the Ximatron simulator, which were 0.91+/-0.89 cGy versus 6.77+/-3.56 cGy, respectively. The dose with the use of the electronic portal imaging device (EPID; Varian IX unit) was approximately 50% of the dose with the use of the L-gram linear accelerator (1.83+/-0.36 cGy versus 3.80+/-1.67 cGy). The dose from the OBI for fluoroscopy and low-dose mode CBCT were 0.97+/-0.34 cGy and 2.3+/-0.67 cGy, respectively. CONCLUSION: The use of 4DCT is the major source of an increase of the radiation (imaging) dose to patients. OBI and CBCT doses were small, but the accumulated dose associated with everyday verification need to be considered
Abdomen
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Brain
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Cone-Beam Computed Tomography
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Electronics
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Electrons
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Eye
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Female
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Fluoroscopy
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Four-Dimensional Computed Tomography
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Humans
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Light
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Ovary
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Particle Accelerators
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Pelvis
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Prostate
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Thorax
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Thyroid Gland
7.Development of Movement Analysis Program and Its Feasibility Test in Streotactic Body Radiation Threrapy.
Eunhyuk SHIN ; Youngyih HAN ; Hee Chul PARK ; Jin Sung KIM ; Jung Suk SHIN ; Sang Gyu JU ; Jihea LEE ; Jong Ho AHN ; Jaiki LEE ; Doo Ho CHOI
Korean Journal of Medical Physics 2011;22(3):107-116
Respiratory gated radiation therapy and stereotactic body radiation therapy require identical tumor motions during each treatment with the motion detected in treatment planning CT. Therefore, this study developed a tumor motion monitoring and analysis system during the treatments employing RPM data, gated setup OBI images and a data analysis software. A respiratory training and guiding program which improves the regularity of breathing was used to patients. The breathing signal was obtained by RPM and the recorded data in the 4D console was read after treatment. The setup OBI images obtained gated at 0% and 50% of breathing phases were used to detect the tumor motion range in crenio-caudal direction. By matching the RPM data recorded at the OBI imaging time, a factor which converts the RPM motion to the tumor motion was computed. RPM data was entered to the institute developed data analysis software and the maximum, minimum, average of the breathing motion as well as the standard deviation of motion amplitude and period was computed. The computed result is exported in an excel file. The conversion factor was applied to the analyzed data to estimate the tumor motion. The accuracy of the developed method was tested by using a moving phantom, and the efficacy was evaluated for 10 stereotactic body radiation therapy patients. For the sine wave motion of the phantom with 4 sec of period and 2 cm of peak-to-peak amplitude, the measurement was slightly larger (4.052 sec) and the amplitude was smaller (1.952 cm). For patient treatment, one patient was evaluated not to qualified to SBRT due to the usability of the breathing, and in one patient case, the treatment was changed to respiratory gated treatment due the larger motion range of the tumor than treatment planed motion. The developed method and data analysis program was useful to estimate the tumor motion during treatment.
Humans
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Respiration
;
Statistics as Topic
8.Improved Breast Irradiation Techniques Using Multistatic Fields or Three Dimensional Universal Compensators.
Youngyih HAN ; Jae Ho CHO ; Hee Chul PARK ; Sung Sil CHU ; Chang Ok SUH
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2002;20(1):24-33
PURPOSE: In order to improve dose homogeneity and to reduce acute toxicity in tangential whole breast radiotherapy, we evaluated two treatment techniques using multiple static fields or universal compensators. MATERIALS AND METHODS: 1) Multistatic field technique : Using a three dimensional radiation treatment planning system, Adac Pinnacle 4.0, we accomplished a conventional wedged tangential plan. Examining the isodose distributions, a third field which blocked overdose regions was designed and an opposing field was created by using an automatic function of RTPS. Weighting of the beams was tuned until an ideal dose distribution was obtained. Another pair of beams were added when the dose homogeneity was not satisfactory. 2) Universal compensator technique : The breast shapes and sizes were obtained from the CT images of 20 patients who received whole breast radiation therapy at our institution. The data obtained were averaged and a pair of universal physical compensators were designed for the averaged data. DII (Dose Inhomogeneity Index : percentage volume of PTV outside 95-105% of the prescribed dose), Dmax (the maximum point dose in the PTV) and isodose distributions for each technique were compared. RESULTS: The multistatic field technique was found to be superior to the conventional technique, reducing the mean value of DII by 14.6% ( p value<0.000) and the Dmax by 4.7% ( p value<0.000). The universal compensator was not significantly superior to the conventional technique since it decreased Dmax by 0.3% ( p value=0.867) and reduced DII by 3.7% ( p value=0.260). However, it decreased the value of DII by maximum 18% when patients' breast shapes fitted in with the compensator geometry. CONCLUSION: The multistatic field technique is effective for improving dose homogeneity for whole breast radiation therapy and is applicable to all patients, whereas the use of universal compensators is effective only in patients whose breast shapes fit inwith the universal compensator geometry, and thus has limited applicability.
Breast*
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Humans
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Radiotherapy
9.A feasibility study evaluating the relationship between dose and focal liver reaction in stereotactic ablative radiotherapy for liver cancer based on intensity change of Gd-EOB-DTPA-enhanced magnetic resonance images.
Sang Hoon JUNG ; Jeong Il YU ; Hee Chul PARK ; Do Hoon LIM ; Youngyih HAN
Radiation Oncology Journal 2016;34(1):64-75
PURPOSE: In order to evaluate the relationship between the dose to the liver parenchyma and focal liver reaction (FLR) after stereotactic ablative body radiotherapy (SABR), we suggest a novel method using a three-dimensional dose distribution and change in signal intensity of gadoxetate disodium-gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) hepatobiliary phase images. MATERIALS AND METHODS: In our method, change of the signal intensity between the pretreatment and follow-up hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI was calculated and then threshold dose (TD) for developing FLR was obtained from correlation of dose with the change of the signal intensity. For validation of the method, TDs for six patients, who had been treated for liver cancer with SABR with 45-60 Gy in 3 fractions, were calculated using the method, and we evaluated concordance between volume enclosed by isodose of TD by the method and volume identified as FLR by a physician. RESULTS: The dose to normal liver was correlated with change in signal intensity between pretreatment and follow-up MRI with a median R2 of 0.935 (range, 0.748 to 0.985). The median TD by the method was 23.5 Gy (range, 18.3 to 39.4 Gy). The median value of concordance was 84.5% (range, 44.7% to 95.9%). CONCLUSION: Our method is capable of providing a quantitative evaluation of the relationship between dose and intensity changes on follow-up MRI, as well as determining individual TD for developing FLR. We expect our method to provide better information about the individual relationship between dose and FLR in radiotherapy for liver cancer.
Evaluation Studies as Topic
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Feasibility Studies*
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Follow-Up Studies
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Gadolinium DTPA
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Humans
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Image Processing, Computer-Assisted
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Liver Neoplasms*
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Liver*
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Magnetic Resonance Imaging
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Pentetic Acid
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Radiation Effects
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Radiosurgery
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Radiotherapy*
10.In vivo verification of regional hyperthermia in the liver.
Jae Myoung NOH ; Hye Young KIM ; Hee Chul PARK ; So Hyang LEE ; Young Sun KIM ; Saet Byul HONG ; Ji Hyun PARK ; Sang Hoon JUNG ; Youngyih HAN
Radiation Oncology Journal 2014;32(4):256-261
PURPOSE: We performed invasive thermometry to verify the elevation of local temperature in the liver during hyperthermia. MATERIALS AND METHODS: Three 40-kg pigs were used for the experiments. Under general anesthesia with ultrasonography guidance, two glass fiber-optic sensors were placed in the liver, and one was placed in the peritoneal cavity in front of the liver. Another sensor was placed on the skin surface to assess superficial cooling. Six sessions of hyperthermia were delivered using the Celsius TCS electro-hyperthermia system. The energy delivered was increased from 240 kJ to 507 kJ during the 60-minute sessions. The inter-session cooling periods were at least 30 minutes. The temperature was recorded every 5 minutes by the four sensors during hyperthermia, and the increased temperatures recorded during the consecutive sessions were analyzed. RESULTS: As the animals were anesthetized, the baseline temperature at the start of each session decreased by 1.3degrees C to 2.8degrees C (median, 2.1degrees C). The mean increases in temperature measured by the intrahepatic sensors were 2.42degrees C (95% confidence interval [CI], 1.70-3.13) and 2.67degrees C (95% CI, 2.05-3.28) during the fifth and sixth sessions, respectively. The corresponding values for the intraperitoneal sensor were 2.10degrees C (95% CI, 0.71-3.49) and 2.87degrees C (1.13-4.43), respectively. Conversely, the skin temperature was not increased but rather decreased according to application of the cooling system. CONCLUSION: We observed mean 2.67degrees C and 2.87degrees C increases in temperature at the liver and peritoneal cavity, respectively, during hyperthermia. In vivo real-time thermometry is useful for directly measuring internal temperature during hyperthermia.
Anesthesia, General
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Animals
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Fever*
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Glass
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Liver*
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Peritoneal Cavity
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Skin
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Skin Temperature
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Swine
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Thermometry
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Ultrasonography