The aim of this project was to use 3D scanning data collected at incident scenes and various evidence to 1) develop surveying methods based on 3D data consisting of overall and detailed scene evidence, captured by long-range and micros-canner, which can be shared by personnel working in different fields such as forensic medicine, video analysis, physical analysis, traffic engineering, and fire investigation; 2) create digital storage for human skeletons and set the foundation for virtual anthropology; and 3) improve the credibility of 3D evidence by virtual remodeling and simulation of incident scenes and evidence to provide a basis for advanced and high-tech scientific investigation. Two complete skeletons of male and female were scanned using 3D micro-scanner. Each bone was successfully reproduced and assembled in virtual space. In addition, recreating evidence scheduled for invasive examination by creating RP (rapid prototype) was possible. These outcomes could play an important role in setting up the new field of virtual anthropology. Case-specific surveying methods were developed through analysis of 3D scanning data collected by long-range surface scanners at the scenes of vehicular accidents, falls, shootings, and violent crimes. A technique and recording method was also developed for detecting forged seals by micro-scanning the pressure exerted on the seal. Appraisal methods developed in this project could be utilized to secure 3D data of human skeletal remains and incident scenes, create a standard for application, and increase objectivity, reproducibility, and accuracy of scanning methods. We plan to develop case-specific 3D data analysis techniques to improve the credibility of analysis at the NFS and to establish a 3D data collection and analysis team.
Crime ; Data Collection ; Female ; Fires ; Forensic Medicine ; Forensic Sciences ; Humans ; Male ; Skeleton ; Statistics as Topic

A system to non-invasively fix and monitor eye by a head mounted display (HMD) with a CCD camera for stereotactic radiotherapy (SRS) of uveal melanoma has been developed and implemented clinically. The eye fixing and monitoring system consists of a HMD showing patient a screen for fixing eyeball, a CCD camera monitoring patient' s eyeball, and an immobilization mask. At first, patient' s head was immobilized with a mask. Then, patient was instructed to wear HMD, to which CCD camera was attached, on the mask and see the given reference point on its screen. While patient stared at the given point in order to fix eyeball, the camera monitored its motion. Four volunteers and one patient of uveal melanoma for SRS came into this study. For the volunteers, setup errors and the motion of eyeball were analyzed. For the patient, CT scans were performed, with patient' s wearing HMD and fixing the eye to the given point. To treat patient under the same condition, daily CT scans were also performed before every treatment and the motion of lens was compared to the planning CT. Setup errors for four volunteers were within 1 mm and the motion of eyeball was fixed within the clinically acceptable ranges. For the patient with uveal melanoma, the motion of lens was fixed within 2 mm from daily CT scans. An eye fixing and monitoring system allowed immobilizing patient as well as monitoring eyeball and was successfully implemented in the treatment of uveal melanoma for SRS.
Head* ; Humans ; Immobilization ; Masks ; Melanoma ; Radiotherapy ; Tomography, X-Ray Computed ; Volunteers

PURPOSE: To present preliminary results of intensity-modulated radiotherapy (IMRT) using the simultaneous modulated accelerated radiation therapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Twenty patients who underwent IMRT for non-metastatic NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. IMRT was delivered using the "step and shoot" SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume (GTV), 60 Gy (2 Gy/day) to the clinical target volume (CTV) and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received concurrent chemotherapy using cisplatin once per week. RESULTS: The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had RTOG grade 3 mucositis, whereas nine (45%) had grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no grade 3 or 4 chronic xerostomia. All patients showed complete response. Two patients had distant metastases and loco-regional recurrence, respectively. CONCLUSION: IMRT using the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and may also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.
Chemoradiotherapy ; Chungcheongnam-do ; Cisplatin ; Drug Therapy ; Enteral Nutrition ; Follow-Up Studies ; Humans ; Malnutrition ; Mucositis ; Neck ; Neoplasm Metastasis ; Pharyngitis ; Prospective Studies ; Radiotherapy, Intensity-Modulated ; Recurrence ; Tumor Burden ; Xerostomia

PURPOSE: It is very important to remove or to reduce the effect of organ motion due to respiration in stereotatic radiosurgery of lung. This study reports the effectiveness of the breath hold technique with a ABC for reducing the breathing effect. MATERIALS AND METHODS: Whole body stereotactic frame (Elekta, Sweden) was used for lung SRS. Patients who have tumor motion range larger than 10 mm from fluoroscopic observation were selected to apply a ABC. Seventeen patients were enrolled in this study. Passive breath hold is possible with our ABC. Automatic breath hold was set at 80% of deep inspiration. Breath hold time was 25~30 seconds depending on the patients. Three consecutive CT scans were performed as indicated in Asan Medical Center SRS procedure for each patients. Lung volume and PTV differences between with breath hold and free breath were examined for 5 patients. RESULTS: The breath hold technique with ABC could be applied for 15 patients. Inter-, intra-treatment organ motion with ABC showed 1.5 mm, while it was 2.3 mm with abdomen compress. When with breath hold technique, PTV and CTV was reduced 33.7% and 45.4%, respectively, and lung volume was increased 32.3 % compared to conventional SRS method. CONCLUSION: Better target localization could be achieved with breath hold technique in lung SRS. Tumor motion could be minimized and relative lung volume irradiation could be reduced
Abdomen ; Chungcheongnam-do ; Humans ; Lung Neoplasms* ; Lung* ; Radiosurgery ; Respiration ; Tomography, X-Ray Computed

PURPOSE: To develop the respiration simulating phantom with thermocouple for evaluating 4D radiotherapy such as gated radiotherapy, breathing control radiotherapy and dynamic tumor tracking radiotherapy. MATERIALS AND METHODS: The respiration monitoring mask (ReMM) with thermocouple was developed to monitor the patient's irregular respiration. The signal from ReMM controls the simulating phantom as organ motion of patients in real-time. The organ and the phantom motion were compared with its respiratory curves to evaluate the simulating phantom. ReMM was used to measure patients' respiration, and the movement of simulating phantom was measured by using RPM(R). The fluoroscope was used to monitor the patient's diaphragm motion. RESULTS: Comparing with the curves of respiration measured by thermocouple and those of the organ motion measured by fluoroscope and RPM, the standard deviations between the curves were 9.68% and 8.53% relative to the organ motion, respectively. The standard deviation of discrepancy between the respiratory curve and the organ motion was 8.52% of motion range. CONCLUSION: Patients felt comfortable with ReMM. The relationship between the signal from ReMM and the organ motion shows strong correlation. The phantom simulates the organ motion in real-time according to the respiratory signal from the ReMM. It is expected that the simulating phantom with ReMM could be used to verify the 4D radiotherapy.
Diaphragm ; Humans ; Masks* ; Radiotherapy ; Respiration*

PURPOSE: The aim of the study was to evaluate the treatment outcomes of stereotactic radiosurgery (SRS) using a stereotactic body frame for primary or metastatic thoracic tumors. Methods and Materials: Between January 1998 and December 2003, 101 lesions from 91 patients with primary or metastatic thoracic tumors were treated. The eligible patients included 38 with primary lung cancers and 53 with metastatic tumors from the lung, liver, gastrointestinal and other organs. All patients were immobilized using a stereotactic body frame and permitted to breathe shallowly. The respiratory movement was restricted by a diaphragm controller when the tumor movement was greater than 5 mm. Recently, for further restriction of tumor movement, an active breathing control (ABC) apparatus was used in some trained patients whose tumors located in lower lobe. Three to eight coplanar or non-coplanar photon beams were used to adequately cover the planning target volume. A dose of 10~12 Gy per fraction was given three to four times over consecutive days, to a total dose of 30~48 Gy (median 40 Gy). Local control was assessed as complete or partial responses and by a stable disease, as measured by serial chest CT scans at 1 month, and then every 3-months, and/or 18FDG-PET scans 1 month after treatment. The median follow-up period was 14 months, ranging from 4 to 56 months. RESULTS: The overall response rate was 82%, with twenty (22%) complete and 55 (60%) partial responses. The rate of crude local control in all patients was 86% and the one- and two-year local progression free survival rates were 90 and 81%, respectively. The patients who received 48 Gy showed better local progression free survival than those that received 40 Gy or less (one-year; 100% vs. 86.7%), but this was not statistically significant. Of the 21 patients with primary lung cancer, local progression was observed in 3, at 12, 21 and 26 months after treatment, and the one- and two- year local progression free survival rates were 93 and 81%, respectively. The set-up error, as checked by CT-simulation and portal films, for every treatment was within 5 mm in all directions (X, Y and Z axis). No pulmonary complications greater than RTOG toxicity criteria grade 2 were observed. CONCLUSION: From our experience of the stereotactic body frame based radiosurgery it appears a safe and promising treatment modality for the local management of primary or metastatic lung tumors. The optimal total dose, fractionation schedule and treatment volume should be modified after a longer follow-up of these results. Further study related to the optimal evaluation tools is also necessary to differentiate local tumor progression from radiation-induced pulmonary injury
Appointments and Schedules ; Diaphragm ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Liver ; Lung ; Lung Injury ; Lung Neoplasms ; Radiosurgery* ; Respiration ; Tomography, X-Ray Computed

PURPOSE: To study the feasibility of verifying real-time 2-D dose distribution measurement system with the scintillation screen for the quality assurance. MATERIALS AND METHODS: The water phantom consisted of a scintillation screen (LANEX fast screen, Kodak, USA) that was axially located in the middle of an acrylic cylinder with a diameter of 25 cm. The charge-coupled device (CCD) camera was attached to the phantom in order to capture the visible light from the scintillation screen. To observe the dose distribution in real time, the intensity of the light from the scintillator was converted to a dosage. The isodose contours of the calculations from RTP and those of the measurements using the scintillation screen were compared for the arc therapy and the intensity modulated radiation therapy (IMRT). RESULTS: The kernel, expressed as a multiplication of two error functions, was obtained in order to correct the sensitivity of the CCD of the camera and the scintillation screen. When comparing the calculated isodose and measured isodose, a discrepancy of less than 8 mm in the high dose region was observed. CONCLUSIONS: Using the 2-D dosimetry system, the relationship between the light and the dosage could be found, and real-time verification of the dose distribution was feasible.
Feasibility Studies* ; Light ; Water

PURPOSE: To evaluate the reflection of tumor motion according to the planning CT scan time. MATERIAL AND METHODS: A model of N-shape, which moved along the longitudinal axis during the ventilation caused by a mechanical ventilator, was produced. The model was scanned by planning CT, while setting the relative CT scan time (T; CT scan time/ventilatory period) to 0.33, 0.50, 0.67, 0.75, 1.00, 1.33 T, and 1.53 T. In addition, three patients with non-small cell lung cancer who received stereotactic radiosurgery in the Department of Radiation Oncology, Asan Medical Center from 03/19/2002 to 05/21/2002 were scanned. Slow (IQ Premier, Picker, scan time 2.0 seconds per slice) and fast CT scans (LightSpeed, GE Medical Systems, with a scan time of 0.8 second per slice) were performed for each patient. The magnitude of reflected movement of the N-shaped model was evaluated by measuring the transverse length, which reflected the movement of the declined bar of the model at each slice. For patients' scans, all CT data sets were registered using a stereotactic body frame scale with the gross tumor volumes delineated in one CT image set. The volume and three-dimensional diameter of the gross tumor volume were measured and analyzed between the slow and fast CT scans. RESULTS: The reflection degree of longitudinal movement of the model increased in proportion to the relative CT scan times below 1.00 T, but remained constant above 1.00 T. Assuming the mean value of scanned transverse lengths with CT scan time 1.00 T to be 100%, CT scans with scan times of 0.33, 0.50, 0.67, and 0.75 T missed the tumor motion by 30, 27, 20, and 7.0% respectively. Slow (scan time 2.0 sec) and Fast (scan time 0.8 sec) CT scans of three patients with longitudinal movement of 3, 5, and 10 mm measured by fluoroscopy revealed the increases in the diameter along the longitudinal axis increased by 6.3, 17, and 23% in the slow CT scans. CONCLUSIONS: As the relative CT scan time increased, the reflection of the respiratory tumor movement on planning CT also increased, but remained constant with relative CT scan times above 1.00 T. When setting the planning CT scan time above one respiration period (>1.00 T), only the set-up margin is needed to delineate the planning target volume. Therefore, therapeutic ratio can be increased by reducing the radiation dose delivered to normal lung tissue.
Axis, Cervical Vertebra ; Carcinoma, Non-Small-Cell Lung ; Chungcheongnam-do ; Dataset ; Fluoroscopy ; Humans ; Lung Neoplasms ; Lung* ; Radiation Oncology ; Radiosurgery ; Respiration ; Tomography, X-Ray Computed* ; Tumor Burden ; Ventilation ; Ventilators, Mechanical

PURPOSE: To analyze the radioresponse of hepatocellular carcinomas (HCC), using accurate measurements of the tumor size in extrahepatic lymph node metastasis, and to obtain information for the future treatment of primary intrahepatic lesions. MATERIALS AND METHODS: Fifty-one extrahepatic lymph node metastases from primary HCCs, which could be treated by external radiotherapy alone, were included in this study. The radiation dose ranged from 30 to 51 Gy with fraction sizes of 2.0~3.0 Gy. Responses were determined by measuring the areas on CT scans 0, 1 and 3 months after the completion of radiotherapy. The median follow-up period of the surviving patients was 10 months. RESULTS: The overall response rate was 76%, and the important factors were; total dose of radiation, time dose fractionation (TDF) value and the biologically effective dose (BED). A dose of 45 Gy or higher showed an objective response rate of 93%, and if the TDF value was higher than 90, a similar result was observed. In about half (47%) of the patients the maximum response was observed at 3 months or later. The response duration was observable in 14 patients surviving 12 months or longer. Regrowth of irradiated lesions were observed in 4 (66.7%) patients among those who received less than 45 Gy, and in 4 (50%) among those who were treated with 45 Gy or more. There was a statistically significant difference in the survivals between the responders and non-responders (p=0.008). Gastrointestinal bleeding or ulceration was observed in 8 patients, including 3 with NCI common toxicity criteria grade III or higher. CONCLUSION: Radiotherapy was an effective palliative modality for extrahepatic metastasis in HCCs. A radiation dose of 45 Gy or higher (or a TDF value > or =90), was required for a major response.
Carcinoma, Hepatocellular ; Dose Fractionation ; Follow-Up Studies ; Hemorrhage ; Humans ; Lymph Nodes* ; Neoplasm Metastasis* ; Radiotherapy ; Tomography, X-Ray Computed ; Ulcer

PURPOSE: In general, it is possible to generate better leaf sequencing from the ideal fluence map or dose distribution close to the optimized results of the radiation treatment planning (RTP) system, from the filed smaller segment size in Intensity modulated radiation therapy (IMRT). Conversely, an intra-treatment organ motion issue, which prevents the smallest segment size from being chosen, always exists. Furthermore, the question has been raised regarding the proper target margin for IMRT cases with a moving target, as the field itself moves while the target moves, unlike traditional static fields. In this study, the effects of intra-treatment target motion on the segment size have been examined. MATERIALS AND METHODS: Various sizes of rectangular patterns were designed for an IMRT fluence map. A leaf sequence was generated using the step and shoot beam delivery method. The intensity ratios between adjacent segments were 0.2, 0.4 and 0.8. The range of target motion was assumed to be +/-0.3~2.0 cm, in a sinusoidal shape. The dynamic leaf motion that reflected the target motion was calculated to simulate the motion. Film dosimetry was performed to analyze the motion effects. RESULTS: The intensity ratios of the adjacent segments were degraded in all cases. The dose distribution with segment sizes less than half the breathing amplitude showed a significantly degraded intensity map. With a beam irradiation time for a segment greater than two breathing cycles, the dose distribution around the target margin showed a similar tendency as the static fields. CONCLUSION: The minimum size of IMRT segments in the fluence map should be chosen taking the intra-treatment organ motion into consideration. The dose distribution with segment sizes less than half the breathing amplitude was degraded significantly in the intensity map. With a beam irradiation time for a segment greater than two breathing cycles, the target margin can be defined as the same as for a conventional static field
Film Dosimetry ; Lung Neoplasms ; Lung* ; Respiration