The purpose of this study is to evaluate the variation of radiation dose distribution for liver tumor located in liver dome and for the interest organs(normal liver, kidney, stomach) with the pencil beam convolution (PBC) algorithm versus anisotropic Analyticalal algorithm (AAA) of the Varian Eclipse treatment planning system, The target volumes from 20 liver cancer patients were used to create treatment plans. Treatment plans for 10 patients were performed in Stereotactic Body Radiation Therapy (SBRT) plan and others were performed in 3 Dimensional Conformal Radiation Therapy (3DCRT) plan. dose calculation was recalculated by AAA algorithm after dose calculation was performed by PBC algorithm for 20 patients. Plans were optimized to 100% of the PTV by the Prescription Isodose in Dose Calculation with the PBC algorithm. Plans were recalculated with the AAA, retaining identical beam arrangements, monitor units, field weighting and collimator condition. In this study, Total PTV was to be statistically significant (SRS: p=0.018, 3DCRT: p=0.006) between PBC and AAA algorithm. and in the case of PTV, ITV in liver dome, plans for 3DCRT were to be statistically significant respectively (p=0.013, p=0.024). normal liver and kidney were to be statistically significant (p=0.009, p=0.037). For the predictive index of dose variation, CVF ratio was to be statistically significant for PTV in the liver dome versus PTV (SRS r=0.684, 3DCRT r=0.732, p<0.01) and CVF ratio for Tumor size was to be statistically significant (SRS r=-0.193, p=0.017, 3DCRT r=0.237, p=0.023).
Humans ; Kidney ; Liver ; Liver Neoplasms ; Organothiophosphorus Compounds ; Population Characteristics ; Prescriptions

We investigated the influence of photon energy, couch and collimator angle differences between arcs on dose distribution of RapidArc treatment planning for prostate cancer. RapidArc plans were created for 6 MV and 10 MV photons using 2 arcs coplanar and noncoplanar fields. The collimator angle differences between two arcs were 0degrees, 15degrees, 30degrees, 45degrees, 60degrees, 75degrees and 90degrees. The plans were optimized using same dose constrains for target and OAR (organ at risk). To evaluate the dose distribution, plans were analyzed using CI (conformity index), HI (homogeneity index), QOC (quality of coverage), etc. Photon energy, couch and collimator angle differences between arcs had a little influence on the target and OAR. The difference of dosimetric indices was less than 3.6% in the target and OAR. However, there was significant increase in the region exposed to low dose. The increase of V15% in the femur was 6.4% (left) and 5.5% (right) for the 6 MV treatment plan and 23.4% (left), 24.1% (right) for the noncoplanar plan. The increase of V10% in the Far Region distant from target was 54.2 cc for the 6 MV photon energy, 343.4 cc for the noncoplanar and 457.8 cc for the no collimator rotation between arcs.
Femur ; Photons ; Prostate ; Prostatic Neoplasms

Verification of internal organ motion during treatment and its feedback is essential to accurate dose delivery to the moving target. We developed an offline based internal organ motion verification system (IMVS) using cine EPID images and evaluated its accuracy and availability through phantom study. For verification of organ motion using live cine EPID images, a pattern matching algorithm using an internal surrogate, which is very distinguishable and represents organ motion in the treatment field, like diaphragm, was employed in the self-developed analysis software. For the system performance test, we developed a linear motion phantom, which consists of a human body shaped phantom with a fake tumor in the lung, linear motion cart, and control software. The phantom was operated with a motion of 2 cm at 4 sec per cycle and cine EPID images were obtained at a rate of 3.3 and 6.6 frames per sec (2 MU/frame) with 1,024x768 pixel counts in a linear accelerator (10 MVX). Organ motion of the target was tracked using self-developed analysis software. Results were compared with planned data of the motion phantom and data from the video image based tracking system (RPM, Varian, USA) using an external surrogate in order to evaluate its accuracy. For quantitative analysis, we analyzed correlation between two data sets in terms of average cycle (peak to peak), amplitude, and pattern (RMS, root mean square) of motion. Averages for the cycle of motion from IMVS and RPM system were 3.98+/-0.11 (IMVS 3.3 fps), 4.005+/-0.001 (IMVS 6.6 fps), and 3.95+/-0.02 (RPM), respectively, and showed good agreement on real value (4 sec/cycle). Average of the amplitude of motion tracked by our system showed 1.85+/-0.02 cm (3.3 fps) and 1.94+/-0.02 cm (6.6 fps) as showed a slightly different value, 0.15 (7.5% error) and 0.06 (3% error) cm, respectively, compared with the actual value (2 cm), due to time resolution for image acquisition. In analysis of pattern of motion, the value of the RMS from the cine EPID image in 3.3 fps (0.1044) grew slightly compared with data from 6.6 fps (0.0480). The organ motion verification system using sequential cine EPID images with an internal surrogate showed good representation of its motion within 3% error in a preliminary phantom study. The system can be implemented for clinical purposes, which include organ motion verification during treatment, compared with 4D treatment planning data, and its feedback for accurate dose delivery to the moving target.
Diaphragm ; Human Body ; Lung ; Particle Accelerators ; Track and Field

The effect of setup uncertainties on CTV dose and the correlation between setup uncertainties and setup margin were evaluated by Monte Carlo based numerical simulation. Patient specific information of IMRT treatment plan for rectal cancer designed on the VARIAN Eclipse planning system was utilized for the Monte Carlo simulation program including the planned dose distribution and tumor volume information of a rectal cancer patient. The simulation program was developed for the purpose of the study on Linux environment using open source packages, GNU C++ and ROOT data analysis framework. All misalignments of patient setup were assumed to follow the central limit theorem. Thus systematic and random errors were generated according to the gaussian statistics with a given standard deviation as simulation input parameter. After the setup error simulations, the change of dose in CTV volume was analyzed with the simulation result. In order to verify the conventional margin recipe, the correlation between setup error and setup margin was compared with the margin formula developed on three dimensional conformal radiation therapy. The simulation was performed total 2,000 times for each simulation input of systematic and random errors independently. The size of standard deviation for generating patient setup errors was changed from 1 mm to 10 mm with 1 mm step. In case for the systematic error the minimum dose on CTV Dstat/Dmin was decreased from 100.4 to 72.50% and the mean dose Dsyst was decreased from 100.45% to 97.88%. However the standard deviation of dose distribution in CTV volume was increased from 0.02% to 3.33%. The effect of random error gave the same result of a reduction of mean and minimum dose to CTV volume. It was found that the minimum dose on CTV volume Drand/Dmin was reduced from 100.45% to 94.80% and the mean dose to CTV Drand was decreased from 100.46% to 97.87%. Like systematic error, the standard deviation of CTV dose DeltaDrand was increased from 0.01% to 0.63%. After calculating a size of margin for each systematic and random error the "population ratio" was introduced and applied to verify margin recipe. It was found that the conventional margin formula satisfy margin object on IMRT treatment for rectal cancer. It is considered that the developed Monte-carlo based simulation program might be useful to study for patient setup error and dose coverage in CTV volume due to variations of margin size and setup error.
Humans ; Rectal Neoplasms ; Statistics as Topic ; Tumor Burden ; Uncertainty

In order to verify exact dose distributions in the state-of-the-art radiation techniques, a newly designed three-dimensional dosimeter and technique has been took strongly into consideration. The main purpose of our study is to verify the optimized parameters of polymer gel as a real volumetric dosimeter in terms of the various study of MRI. We prepared a gel dosimeter by combing 8% of gelatin, 8% of MAA, and 10 mM of THPC. We used a Co-60 gamma-ray teletherapy unit and delivered doses of 0, 2, 4, 6, 8, 10, 12, and 14 Gy to each polymer gel with a solid phantom. We used a fast spin-echo pulse to acquire the characterized T2 time of MRI. The signal noise ratio (SNR) of the head & neck coil was a relatively lower sensitivity than the body coil; therefore the dose uncertainty of head & neck coil would be lower than body coil's. But the dose uncertainty and resolution of the head & neck coil were superior to the body coil in this study. The TR time between 1,500 ms and 2,000 ms showed no significant difference in the dose resolution, but TR of 1,500 ms showed less dose uncertainty. For the slice thickness of 2.5 mm, less dose uncertainty of TE times was at 4 Gy, as well, it was the lowest result over 4 Gy at TE of 12 ms. The dose uncertainty was not critical up to 6 Gy, but the best dose resolution was obtained at 20 ms up to 8 Gy. The dose resolution shows the lowest value was over 20 ms and was an excellent result in the number of excitation (NEX) of three. The NEX of two was the highest dose resolution. We concluded that the better result of slice thickness versus NEX was related to the NEX increment and thin slice thickness.
Animals ; Comb and Wattles ; Gelatin ; Head ; Neck ; Noise ; Organophosphorus Compounds ; Polymers ; Uncertainty

The dose re-calculation process using Megavoltage cone-beam CT images is inevitable process to perform the Adaptive Radiation Therapy (ART). The purpose of this study is to improve dose re-calculation accuracy using MVCBCT images by applying intensity calibration method and three dimensional rigid body transform and filtering process. The three dimensional rigid body transform and Gaussian smoothing filtering process to MVCBCT Rando phantom images was applied to reduce image orientation error and the noise of the MVCBCT images. Then, to obtain the predefined modification level for intensity calibration, the cheese phantom images from kilo-voltage CT (kV CT), MVCBCT was acquired. From these cheese phantom images, the calibration table for MVCBCT images was defined from the relationship between Hounsfield Units (HUs) of kV CT and MVCBCT images at the same electron density plugs. The intensity of MVCBCT images from Rando phantom was calibrated using the predefined modification level as discussed above to have the intensity of the kV CT images to make the two images have the same intensity range as if they were obtained from the same modality. Finally, the dose calculation using kV CT, MVCBCT with/without intensity calibration was applied using radiation treatment planning system. As a result, the percentage difference of dose distributions between dose calculation based on kVCT and MVCBCT with intensity calibration was reduced comparing to the percentage difference of dose distribution between dose calculation based on kVCT and MVCBCT without intensity calibration. For head and neck, lung images, the percentage difference between kV CT and non-calibrated MVCBCT images was 1.08%, 2.44%, respectively. In summary, our method has quantitatively improved the accuracy of dose calculation and could be a useful solution to enhance the dose calculation accuracy using MVCBCT images.
Calibration ; Cheese ; Cone-Beam Computed Tomography ; Electrons ; Head ; Lung ; Neck ; Noise ; Orientation

A polymer gel dosimeter was fabricated. A 3-dimensional dosimetry experiment was performed in the small field of the photon of the cyberknife. The dosimeter was installed in a head and neck phantom. It was manufactured from the acrylic and it was used in dosimetry. By using the head and neck CT protocol of the CyberKnife system, CT images of the head and neck phantom were obtained and delivered to the treatment planning system. The irradiation to the dosimeter in the treatment planning was performed, and then, the image was obtained by using 3.0T magnetic resonance imaging (MRI) after 24 hours. The dose distribution of the phantom was analyzed by using MATLAB. The results of this measurement were compared to the results of calculation in the treatment planning. In the isodose curve on the axial direction, the dose distribution coincided with the high dose area, 0.76mm difference on 80%, rather than the low dose area, 1.29 mm difference on 40%. In this research, the fact that the polymer gel dosimeter and MRI can be applied for analyzing a small field in a 3 dimensional dosimetry was confirmed. Moreover, the feasibility of using these for the therapeutic radiation quality control was also confirmed.
Antineoplastic Combined Chemotherapy Protocols ; Cytarabine ; Head ; Magnetic Resonance Imaging ; Neck ; Polymers ; Quality Control ; Thioguanine

The pencil beam convolution (PBC) algorithms in radiation treatment planning system have been widely used to calculate the radiation dose. A new photon dose calculation algorithm, referred to as the anisotropic analytical algorithm (AAA), was released for use by the Varian medical system. The aim of this paper was to investigate the difference in dose calculation between the AAA and PBC algorithm using the intensity modulated radiation therapy (IMRT) plan for lung cancer cases that were inhomogeneous in the low density. We quantitatively analyzed the differences in dose using the eclipse planning system (Varian Medical System, Palo Alto, CA) and I'mRT matirxx (IBA, Schwarzenbruck, Germany) equipment to compare the gamma evaluation. 11 patients with lung cancer at various sites were used in this study. We also used the TLD-100 (LiF) to measure the differences in dose between the calculated dose and measured dose in the Alderson Rando phantom. The maximum, mean, minimum dose for the normal tissue did not change significantly. But the volume of the PTV covered by the 95% isodose curve was decreased by 6% in the lung due to the difference in the algorithms. The difference dose between the calculated dose by the PBC algorithms and AAA algorithms and the measured dose with TLD-100 (LiF) in the Alderson Rando phantom was -4.6% and -2.7% respectively. Based on the results of this study, the treatment plan calculated using the AAA algorithms is more accurate in lung sites with a low density when compared to the treatment plan calculated using the PBC algorithms.
Humans ; Lung ; Lung Neoplasms

In this paper, Acousto-Optical tomography is modeled by a linear integral equation and an inverse problem involving a diffusion equation in n-spatial dimensions. We make two-step mathematical model. First, we solve a linear integral equation. Assuming the optical energy fluence rate has been recovered from the previous equation, the absorption coefficient micro is then reconstructed by solving an inverse problem. Numerical experiments are presented for the case n=2. The traditional gradient descent method is used for the numerical simulations. The result of the gradient descent method produces the blurring effect. To get rid of the blurring effect, we suggest the total variation regularization for the minimization problem.
Absorption ; Diffusion ; Drug Combinations ; Models, Theoretical ; Piperonyl Butoxide ; Pyrethrins

For applying the quality assurance (QA) of volumetric modulated arc therapy (VMAT) introduced in Eulji Hospital, we classify it into three different QA steps, treatment planning QA, pretreatment delivering QA, and treatment verifying QA. These steps are based on the existing intensity modulated radiation therapy (IMRT) QA that is currently used in our hospital. In each QA step, the evaluated items that are from QA program are configured and documented. In this study, QA program is not only applied to actual patient treatment, but also evaluated to establish a reference of clinical acceptance in pretreatment delivering QA. As a result, the confidence limits (CLs) in the measurements for the high-dose and low-dose regions are similar to the conventional IMRT level, and the clinical acceptance references in our hospital are determined to be 3 to 5% for the high-dose and the low-dose regions, respectively. Due to the characteristics of VMAT, evaluation of the intensity map was carried out using an ArcCheck device that was able to measure the intensity map in all directions, 360degrees. With a couple of dosimetric devices, the gamma index was evaluated and analyzed. The results were similar to the result of individual intensity maps in IMRT. Mapcheck, which is a 2-dimensional (2D) array device, was used to display the isodose distributions and gave very excellent local CL results. Thus, in our hospital, the acceptance references used in practical clinical application for the intensity maps of 360degrees directions and the coronal isodose distributions were determined to be 93% and 95%, respectively. To reduce arbitrary uncertainties and system errors, we had to evaluate the local CLs by using a phantom and to cooperate with multiple organizations to participate in this evaluation. In addition, we had to evaluate the local CLs by dividing them into different sections about the patient treatment points in practical clinics.
Humans ; Radiotherapy, Intensity-Modulated