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Implementation and Evaluation of the Electron Arc Plan on a Commercial Treatment Planning System with a Pencil Beam Algorithm.

Sei Kwon KANG ; Soah PARK ; Taejin HWANG ; Kwang Ho CHEONG ; Me Yeon LEE ; Kyoung Ju KIM ; Do Hoon OH ; Hoonsik BAE

Korean Journal of Medical Physics.2010;21(3):304-310.

Less execution of the electron arc treatment could in large part be attributed to the lack of an adequate planning system. Unlike most linear accelerators providing the electron arc mode, no commercial planning systems for the electron arc plan are available at this time. In this work, with the expectation that an easily accessible planning system could promote electron arc therapy, a commercial planning system was commissioned and evaluated for the electron arc plan. For the electron arc plan with use of a Varian 21-EX, Pinnacle3 (ver. 7.4f), with an electron pencil beam algorithm, was commissioned in which the arc consisted of multiple static fields with a fixed beam opening. Film dosimetry and point measurements were executed for the evaluation of the computation. Beam modeling was not satisfactory with the calculation of lateral profiles. Contrary to good agreement within 1% of the calculated and measured depth profiles, the calculated lateral profiles showed underestimation compared with measurements, such that the distance-to-agreement (DTA) was 5.1 mm at a 50% dose level for 6 MeV and 6.7 mm for 12 MeV with similar results for the measured depths. Point and film measurements for the humanoid phantom revealed that the delivered dose was more than the calculation by approximately 10%. The electron arc plan, based on the pencil beam algorithm, provides qualitative information for the dose distribution. Dose verification before the treatment should be mandatory.
Electrons ; Film Dosimetry ; Particle Accelerators

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Dose Distribution of Intensity Modulated Radiation Therapy in Prostate Cancer.

Sung Kyu KIM ; Ji Hoon CHOI ; Sang Mo YUN

Korean Journal of Medical Physics.2010;21(3):298-303.

The aim of this study was to compare the dose distribution of intensity modulated radiation therapy (IMRT) with 3 dimensional conformal radiation therapy (3DCRT) in prostate cancer. The IMRT plan and the 3DCRT plan used the 9 fields technique, respectively. In IMRT, tumor dose was a total dose of 66 Gy at 2.0 Gy per day, 5 days a week for 5 weeks. All cases were following the dose volume histogram (DVH) constraints. The maximum and minimum tumor dose constraints were 6,700 cGy and 6,500 cGy, respectively. The rectum dose constraints were <35% over 50 Gy. The bladder dose constraints were <35% over 40 Gy. The femur head dose constraints were <15% over 20 Gy. Tumor dose in the 3DCRT were 66 Gy. In IMRT, the maximum dose of PTV was 104.4% and minimum dose was 89.5% for given dose. In 3DCRT, the maximum dose of PTV was 105.3% and minimum dose was 85.5% for given dose. The rectum dose was 34.0% over 50 Gy in IMRT compared with 63.3% in 3DCRT. The bladder dose was 30.1% over 40 Gy in IMRT compared with 30.6% in 3DCRT. The right femur head dose was 9.5% over 20 Gy in IMRT compared with 17.5% in 3DCRT. The left femur head dose was 10.6% over 20 Gy in IMRT compared with 18.3% in 3 DCRT. The dose of critical organs (rectum, bladder, and femur head) in IMRT showed to reduce than dose of 3DCRT. The rectum dose over 50 Gy in IMRT was reduced 29.3% than 3DCRT. The bladder dose over 40 Gy in IMRT was similar to 3DCRT. The femur head dose over 20 Gy in IMRT was reduced about 7~8% than 3DCRT.
Femur ; Femur Head ; Prostate ; Prostatic Neoplasms ; Rectum ; Urinary Bladder

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Dosimetric Influence of Implanted Gold Markers in Proton Therapy for Prostate Cancer.

Jungwon KWAK ; Jungwook SHIN ; Jin Sung KIM ; Sung Yong PARK ; Dongho SHIN ; Myonggeun YOON ; Soah PARK ; Dongwook KIM ; Young Gyeung LIM ; Se Byeong LEE

Korean Journal of Medical Physics.2010;21(3):291-297.

This study examined the dosimetric influence of implanted gold markers in proton therapy and the effects of their positions in the spread-out Bragg peak (SOBP) proton beam. The implanted cylindrical gold markers were 3 mm long and 1.2 mm in diameter. The dosimetric influence of the gold markers was determined with markers at various locations in a proton-beam field. Spatial dose distributions were measured using a three-dimensional moving water phantom and a stereotactic diode detector with an effective diameter of 0.5 mm. Also, a film dosimetry was performed using Gafchromic External Beam Treatment (EBT) film. The GEANT4 simulation toolkit was used for Monte-Carlo simulations to confirm the measurements and to construct the dose-volume histogram with implanting markers. Motion data were obtained from the portal images of 10 patients to investigate the effect of organ motions on the dosimetric influence of markers in the presence of a rectal balloon. The underdosed volume due to a single gold marker, in which the dose was less than 95% of a prescribed amount, was 0.15 cc. The underdosed volume due to the presence of a gold marker is much smaller than the target volume. However, the underdosed volume is inside the gross tumor volume and is not smeared out due to translational prostate motions. The positions of gold markers and the conditions of the proton-beam field give different impacts on the dose distribution of a target with implanted gold markers, and should be considered in all clinical proton-based therapies.
Film Dosimetry ; Humans ; Prostate ; Prostatic Neoplasms ; Proton Therapy ; Protons ; Tumor Burden ; Water

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Optimizing Imaging Conditions in Digital Tomosynthesis for Image-Guided Radiation Therapy.

Hanbean YOUN ; Jin Sung KIM ; Min Kook CHO ; Sun Young JANG ; William Y SONG ; Ho Kyung KIM

Korean Journal of Medical Physics.2010;21(3):281-290.

Cone-beam digital tomosynthesis (CBDT) has greatly been paid attention in the image-guided radiation therapy because of its attractive advantages such as low patient dose and less motion artifact. Image quality of tomograms is, however, dependent on the imaging conditions such as the scan angle (beta(scan)) and the number of projection views. In this paper, we describe the principle of CBDT based on filtered-backprojection technique and investigate the optimization of imaging conditions. As a system performance, we have defined the figure-of-merit with a combination of signal difference-to-noise ratio, artifact spread function and floating-point operations which determine the computational load of image reconstruction procedures. From the measurements of disc phantom, which mimics an impulse signal and thus their analyses, it is concluded that the image quality of tomograms obtained from CBDT is improved as the scan angle is wider than 60 degrees with a larger step scan angle (Delta beta). As a rule of thumb, the system performance is dependent on . If the exact weighting factors could be assigned to each image-quality metric, we would find the better quantitative imaging conditions.
Artifacts ; Humans ; Image Processing, Computer-Assisted ; Radiotherapy, Image-Guided ; Thumb

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Clinical Results from Single-Fraction Stereotactic Radiosurgery (SRS) of Brain Arteriovenous Malformation: Single Center Experience.

Soo Mee LIM ; Rena LEE ; Hyun Suk SUH

Korean Journal of Medical Physics.2010;21(3):274-280.

The purpose of this study was to analyze the effect of single-fraction stereotactic radiosurgery (SRS) for the treatment of 15 cases of cerebral arteriovenous malformations (AVMs). Between 2002 and 2009, of the 25 patients who had SRS for the treatment of cerebral AVM, 15 patients (6 men, 9 women) taken a digital subtraction angiography (DSA) over 12 months after SRS were included. We retrospectively evaluated the size, location, hemorrhage of nidus, angiographic changes on follow-up on the MR angiography and DSA, and clinical complications during follow-up periods. At a median follow-up of 24 months (range 12-89), complete obliteration of nidus was observed in all patients (100%) while residual draining veins was observed in 3 patients (20%). There was no clinical complication during the follow-up period except seizure in 1 patient. The mean nidus volume was 4.7cc (0.5~11.7 cc, SD 3.7 cc). The locations of nidus were in cerebral hemisphere in 11 patients, cerebellum in 2 patients, basal ganglia in 1 patient, and pons in 1 patient respectively. 9 cases were hemorrhagic, and 6 cases were non-hemorrhagic AVMs. The SRS with LINAC is a safe and effective treatment for cerebral AVMs when the follow up period is over 4 years. However, it is recommended to continue to follow up until the draining vein on arterial phase of follow up DSA disappears completely.
Angiography ; Angiography, Digital Subtraction ; Basal Ganglia ; Brain ; Cerebellum ; Cerebrum ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations ; Male ; Pons ; Radiosurgery ; Retrospective Studies ; Seizures ; Veins

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Signal and Noise Analysis of Indirect-Conversion Digital Radiography Detectors Using Linear-systems Transfer Theory.

Seungman YUN ; Chang Hwy LIM ; Jong Chul HAN ; Okla JOE ; Jung Min KIM ; Ho Kyung KIM

Korean Journal of Medical Physics.2010;21(3):261-273.

For the use of Indirect-conversion CMOS (complementary metal-oxide-semiconductor) detectors for digital x-ray radiography and their better designs, we have theoretically evaluated the spatial-frequency-dependent detective quantum efficiency (DQE) using the cascaded linear-systems transfer theory. In order to validate the developed model, the DQE was experimentally determined by the measured modulation-transfer function (MTF) and noise-power spectrum, and the estimated incident x-ray fluence under the mammography beam quality of W/Al. From the comparison between the theoretical and experimental DQEs, the overall tendencies were well agreed. Based on the developed model, we have investigated the DQEs values with respect to various design parameters of the CMOS x-ray detector such as phosphor quantum efficiency, Swank noise, photodiode quantum efficiency and the MTF of various scintillator screens. This theoretical approach is very useful tool for the understanding of the developed imaging systems as well as helpful for the better design or optimization for new development.
Mammography ; Noise ; Radiographic Image Enhancement

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Dose Verification Study of Brachytherapy Plans Using Monte Carlo Methods and CT Images.

Kwang Ho CHEONG ; Me Yeon LEE ; Sei Kwon KANG ; Hoonsik BAE ; Soah PARK ; Kyoung Joo KIM ; Tae Jin HWANG ; Do Hoon OH

Korean Journal of Medical Physics.2010;21(3):253-260.

Most brachytherapy treatment planning systems employ a dosimetry formalism based on the AAPM TG-43 report which does not appropriately consider tissue heterogeneity. In this study we aimed to set up a simple Monte Carlo-based intracavitary high-dose-rate brachytherapy (IC-HDRB) plan verification platform, focusing particularly on the robustness of the direct Monte Carlo dose calculation using material and density information derived from CT images. CT images of slab phantoms and a uterine cervical cancer patient were used for brachytherapy plans based on the Plato (Nucletron, Netherlands) brachytherapy planning system. Monte Carlo simulations were implemented using the parameters from the Plato system and compared with the EBT film dosimetry and conventional dose computations. EGSnrc based DOSXYZnrc code was used for Monte Carlo simulations. Each (192)Ir source of the afterloader was approximately modeled as a parallel-piped shape inside the converted CT data set whose voxel size was 2x2x2 mm3. Bracytherapy dose calculations based on the TG-43 showed good agreement with the Monte Carlo results in a homogeneous media whose density was close to water, but there were significant errors in high-density materials. For a patient case, A and B point dose differences were less than 3%, while the mean dose discrepancy was as much as 5%. Conventional dose computation methods might underdose the targets by not accounting for the effects of high-density materials. The proposed platform was shown to be feasible and to have good dose calculation accuracy. One should be careful when confirming the plan using a conventional brachytherapy dose computation method, and moreover, an independent dose verification system as developed in this study might be helpful.
Accounting ; Brachytherapy ; Film Dosimetry ; Humans ; Monte Carlo Method ; Organoplatinum Compounds ; Population Characteristics ; Uterine Cervical Neoplasms ; Water

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Estimate of Radiation Doses in MDCT Using Patient Weight.

Seong Ohk KWON ; Kyung Rae DONG ; Dae Cheol KWEON ; Eun Hoe GOO ; Jiwon CHOI ; Woon Kwan CHUNG

Korean Journal of Medical Physics.2010;21(3):246-252.

The purpose of this study provides measurements of radiation dose from MDCT of head, chest, abdomen and pelvic examinations. A series of dose quantities that are measured of patient weight to compare the dose received during MDCT examinations. Data collected included: weight together with CT dose descriptors, volume CT dose index (CTDIvol) and dose length product (DLP). The effective dose was also estimated and served as collective dose estimation data. Data from 1,774 adult patients attending for a CT examination of the head (n=520) or chest (n=531) or abdomen (n=724) was obtained from spiral CT units using a same CT protocol. Mean values of CTDIvol was a range of 48.6 mGy for head and 6.9, 10.5 mGy for chest, abdomen examinations, respectively. And mean values of DLP was range of 1,604 mGy.cm for head, 250 mGy.cm for chest, 575 mGy.cm for abdomen examinations, respectively. Mean effective dose values for head, chest, abdominal CT were 3.6, 4.2, and 8.6 mSv, respectively. The degree of CTDIvol and DLP was a positive correlation with weight. And there was a positive correlation for weight versus CTDIvol (r2=0.62), DLP (r2=0.694) in chest. And head was also positive correlation with weight versus CTDIvol (r2=0.691), DLP (r2=0.741). We conclude that CTDIvol and DLP is an important determinant of weight within the CT examinations. The results for this study suggest that CT protocol should be tailored according to patient weight.
Abdomen ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; Cone-Beam Computed Tomography ; Cytarabine ; Gynecological Examination ; Head ; Humans ; Subject Headings ; Thioguanine ; Thorax ; Tomography, Spiral Computed

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Comparison Study of Image Quality of Direct and Indirect Conversion Digital Mammography System.

Hye Suk PARK ; Yuna OH ; Hee Jeong JO ; Sang Tae KIM ; Yu Na CHOI ; Hee Joung KIM

Korean Journal of Medical Physics.2010;21(3):239-245.

The purpose of this study is to comprehensively compare and evaluate the characteristics of image quality for digital mammography systems which use a direct and indirect conversion detector. Three key metrics of image quality were evaluated for the direct and indirect conversion detector, the modulation transfer function (MTF), normalized noise power spectrum (NNPS), and detective quantum efficiency (DQE), which describe the resolution, noise, and signal to noise performance, respectively. DQE was calculated by using a edge phantom for MTF determination according to IEC 62220-1-2 regulation. The contrast to noise ratio (CNR) was evaluated according to guidelines offered by the Korean Institute for Accreditation of Medical Image (KIAMI). As a result, the higher MTF and DQE was measured with direct conversion detector compared to indirect conversion detector all over spatial frequency. When the average glandular dose (AGD) was the same, direct conversion detector showed higher CNR value. The direct conversion detector which has higher DQE value all over spatial frequency would provide the potential benefits for both improved image quality and lower patient dose in digital mammography system.
Accreditation ; Humans ; Mammography ; Noise

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Image Enhancement and Clinical Evaluation in Digital Chest Radiography.

Sung Hyun KIM ; Tae Suk SUH ; Bo Young CHOE ; Hyoung Koo LEE

Korean Journal of Medical Physics.2008;19(3):143-149.

The aim of this study is to suggest the method for image enhancement of digital chest radiograph and evaluate clinically the quality of the resultant image. A nonlinear iterative filter was developed in order to reduce quantum noise preserving edge. Dynamic range was adjusted and adaptive image enhancement was performed based on the property of anatomic region and the degree of compatibility with neighboring pixels. The lung fields were enhanced appropriately to visualize effectively vascular tissue, bronchus and lung tissue with the desired mediastinum enhancement. Clinic evaluation was performed by three radiologists with at least 8 years experience. The anatomic regions of 11 in PA and 9 in Lateral were observed carefully in each 100 radiographs according to ITU (International Telecommunication Union) recommendation 500 protocol. The result showed the mean 3.4 between good and adequate. This means that the clinical utility of the image quality is enough. In this study, image enhancement was carried out considering image display device and human perceptual system to prevent the loss of useful anatomic information. In order to increase the diagnostic accuracy in digital radiograph, the continuous study on image enhancement is needed.
Bronchi ; Humans ; Image Enhancement ; Lung ; Mediastinum ; Noise ; Telecommunications ; Thorax

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