전립선 암 환자의 영상유도 방사선 치료 시 Fiducial Marker를 이용한 2D/2D Match의 유용성에 대한 연구

배선명,양오남,송흥권,백금문,Bae, Sun-Myung,Yang, Oh-Nam,Song, Heung-Kwon,Back, Geum-Mun 대한방사선치료학회 2010 대한방사선치료학회지 Vol.22 No.1

Purpose: To study the efficacy of marker match with using kilovoltage (KV) X-ray among multiple image guidance that referring tree fiducial marker in radiation therapy for prostate cancer patients. Materials and Methods: KV two-dimantional images (anterior-posterior, right-left) and cone-beam CT volumetric images were acquired after setup for patients with three fiducial markers. Compare the position of the fiducial marker of reference plan computed tomography (CT) and of KV, CBCT images; then decide the shift score of X, Y, and Z. This study executed 5 times on 10 patients and analyzed the shift value. Results: In the radiation therapy using fiducial marker, The function of marker match showed the same direction tendency as the CBCT, and showed X, Y, Z difference of about 0.6, 0.7, and 0.8 (unit: mm). Conclusion: Comparing to this, the result of shift value using 2D marker match showed less than 1.0 mm difference. The function of marker match is considered more useful in time-wise and effective dose rather than CBCT. Therefore, Both methods are used to treat patients for prostate cancer.

방광암 환자의 영상유도 방사선치료에 관한 고찰

배성수,배선명,김진산,강태영,백금문,권경태,Bae, Seong-Soo,Bae, Sun-Myoung,Kim, Jin-San,Kang, Tae-Young,Back, Geum-Mun,Kwon, Kyung-Tae 대한방사선치료학회 2012 대한방사선치료학회지 Vol.24 No.1

Purpose: In hospital image-guided radiation therapy in patients with bladder cancer to enhance the reproducibility of the appropriate amount, depending on the patient's condition, and image-guided injection of saline system (On-Board Imager system, OBI, VARIAN, USA) three of the Cone-Beam CT dimensional matching (3D-3D matching) to be the treatment. In this study, the treatment of patients with bladder cancer at Cone-Beam CT image obtained through the analysis of the bones based matching and matching based on the bladder to learn about the differences, the bladder's volume change injected saline solution by looking at the bladder for the treatment of patients with a more appropriate image matching is to assess how the discussion. Materials and Methods: At our hospital from January 2009 to April 2010 admitted for radiation therapy patients, 7 patients with bladder cancer using a Folly catheter of residual urine in the bladder after removing the amount determined according to individual patient enough to inject saline CT-Sim was designed after the treatment plan. After that, using OBI before treatment to confirm position with Cone-Beam CT scan was physician in charge of matching was performed in all patients. CBCT images using a total of 45 bones, bladder, based on image matching and image matching based on the difference were analyzed. In addition, changes in bladder volume of Eclipse (version 8.0, VARIAN, USA) persuaded through. Results: Bones, one based image matching based on the bladder and re-matching the X axis is the difference between the average $3{\pm}2mm$, Y axis, $1.8{\pm}1.3mm$, Z-axis travel distance is $2.3{\pm}1.7mm$ and the overall $4.8{\pm}2.0mm$, respectively. The volume of the bladder compared to the baseline showed a difference of $4.03{\pm}3.97%$. Conclusion: Anatomical location and nature of the bladder due to internal movement of the bones, even after matching with the image of the bladder occurred in different locations. In addition, the volume of saline-filled bladder showed up the difference between the 4.03 percent, but matched in both images to be included in the planned volumes were able to confirm. Thus, after injection of saline into the bladder base by providing a more accurate image matching will be able to conduct therapy.

세기변조방사선치료에서 Pitch와 Roll 변화에 따른 선량전달 정확성 평가

정창영,배선명,이동형,민순기,강태영,백금문,Jeong, Chang Young,Bae, Sun Myung,Lee, Dong Hyung,Min, Soon Ki,Kang, Tae Young,Baek, Geum Mun 대한방사선치료학회 2014 대한방사선치료학회지 Vol.26 No.2

Purpose : The purpose of this study is to verify the accuracy of dose delivery according to the pitch and roll rotational setup error with 6D robotic couch in Intensity Modulated Radiation Therapy (IMRT) for pelvic region in patients. Materials and Methods : Trilogy(Varian, USA) and 6D robotic couch(ProturaTM 1.4, CIVCO, USA) were used to measure and analyze the rotational setup error of 14 patients (157 setup cases) for pelvic region. The total 157 Images(CBCT 78, Radiography 79) were used to calculate the mean value and the incidence of pitch and roll rotational setup error with Microsoft Office Excel 2007. The measured data (3 mm, 3%) at the reference angle ($0^{\circ}$) without couch rotation of pitch and roll direction was compared to the others at different pitch and roll angles ($1^{\circ}$, $1.5^{\circ}$, $2^{\circ}$, $2.5^{\circ}$) to verify the accuracy of dose delivery by using 2D array ionization chamber (I'mRT Matrixx, IBA Dosimetry, Germany) and MultiCube Phantom(IBA Dosimetry, Germany). Result from the data, gamma index was evaluated. Results : The mean values of pitch and roll rotational setup error were $0.9^{\circ}{\pm}0.7$, $0.5^{\circ}{\pm}0.6$. The maximum values of them were $2.8^{\circ}$, $2.0^{\circ}$. All of the minimum values were zero. The mean values of gamma pass rate at four different pitch angles ($1^{\circ}$, $1.5^{\circ}$, $2^{\circ}$, $2.5^{\circ}$) were 97.75%, 96.65%, 94.38% and 90.91%. The mean values of gamma pass rate at four different roll angles ($1^{\circ}$, $1.5^{\circ}$, $2^{\circ}$, $2.5^{\circ}$) were 93.68%, 93.05%, 87.77% and 84.96%. when the same angles ($1^{\circ}$, $1.5^{\circ}$, $2^{\circ}$) of pitch and roll were applied simultaneously, The mean values of each angle were 94.90%, 92.37% and 87.88%, respectively. Conclusion : As a result of this study, it was able to recognize that the accuracy of dose delivered is lowered gradually as pitch and roll increases. In order to increase the accuracy of delivered dose, therefore, it is recommended to perform IGRT or correct patient's position in the pitch and roll direction, to improve the quality of treatment.

용적변조회전 방사선치료에서 선량전달의 중단 및 재시작에 따른 정확성 평가

이동형,배선명,곽정원,강태영,백금문,Lee, Dong Hyung,Bae, Sun Myung,Kwak, Jung Won,Kang, Tae Young,Back, Geum Mun 대한방사선치료학회 2013 대한방사선치료학회지 Vol.25 No.1

Purpose: The accurate movement of gantry rotation, collimator and correct application of dose rate are very important to approach the successful performance of Volumetric Modulated Arc Therapy (VMAT), because it is tightly interlocked with a complex treatment plan. The interruption and restart of dose delivery, however, are able to occur on treatment by various factors of a treatment machine and treatment plan. If unexpected problems of a treat machine or a patient interrupt the VMAT, the movement of treatment machine for delivering the remaining dose will be restarted at the start point. In this investigation, We would like to know the effect of interruptions and restart regarding dose delivery at VMAT. Materials and Methods: Treatment plans of 10 patients who had been treated at our center were used to measure and compare the dose distribution of each VMAT after converting to a form of digital image and communications in Medicine (DICOM) with treatment planning system (Eclipse V 10.0, Varian, USA). We selected the 6 MV photon energy of Trilogy (Varian, USA) and used OmniPro I'mRT system (V 1.7b, IBA dosimetry, Germany) to analyze the data that were acquired through this measurement with two types of interruptions four times for each case. The door interlock and the beam-off were used to stop and then to restart the dose delivery of VMAT. The gamma index in OmniPro I'mRT system and T-test in Microsoft Excel 2007 were used to evaluate the result of this investigation. Results: The deviations of average gamma index in cases with door interlock, beam-off and without interruption on VMAT are 0.141, 0.128 and 0.1. The standard deviations of acquired gamma values are 0.099, 0.091, 0.071 and The maximum gamma value in each case is 0.413, 0.379, 0.286, respectively. This analysis has a 95-percent confidence level and the P-value of T-test is under 0.05. Gamma pass rate (3%, 3 mm) is acceptable in all of measurements. Conclusion: As a result, We could make sure that the interruption of this investgation are not enough to seriously affect dose delivery of VMAT by analyzing the measured data. But this investigation did not reflect all cases about interruptions and errors regarding the movement of a gantry rotation, collimator and patient So, We should continuously maintain a treatment machine and program to deliver the accurate dose when we perform the VMAT for the many kinds of cancer patients.

사이버나이프 6-D Skull Tracking의 유용성 평가

이건호,배선명,송흥권,백금문,Lee, Geon Ho,Bae, Sun Myeong,Song, Heung Kwon,Baek, Geum Mun 대한방사선치료학회 2018 대한방사선치료학회지 Vol.30 No.1

Purpose : The purpose of this study is to evaluate the usefulness of 6 Dimensional Skull Tracking(6DST) in Cyberknife Stereotactic Body Radiation Therapy(SBRT) for the first and second cervical vertebrae(C1 and C2) metastasis. Methode and material : The Computed Tomography (Lightspeed VCT 64, General Electric Co. Waukesha, WI, USA) was used to acquire the CT images of the 9 patients with cervical vertebrae(C1 and C2) metastasis. Treatment plans for Xsight spine tracking and 6 Dimensional skull tracking were established with planning system (Multiplan system Version 4.6, Accuray, US). The results of XST and 6DST for each patient were analyzed with Microsoft Excel 2010. Result : The Maximum offsets of XST for C1 were 0.9 mm in Y(supero-inferior), 0.9 mm in Z(antero-posterior), 0.7 mm in X(left-right) direction, and rotations were and 1.0 degrees roll, 1.0 degrees pitch and 1.2 degrees yaw. The Maximum offsets of 6DST for C1 were 0.7 mm, 0.7 mm, 0.9 mm and $1.0^{\circ}$, $1.0^{\circ}$, $1.2^{\circ}$ for Y, Z, X and Roll, Pitch, Yaw. The Maximum offsets of XST and 6DST for C2 were 0.7 mm, 0.7 mm, 0.8 mm and $0.9^{\circ}$, $1.0^{\circ}$, $1.8^{\circ}$, and 0.9 mm, 0.7 mm, 0.9 mm and $0.9^{\circ}$, $0.9^{\circ}$, $1.0^{\circ}$ for Y, Z, X and Roll, Pitch, Yaw, respectively. Conclusion : XST and 6DST showed identical results for translations and rotations within the tolerance. It is possible to simplify the treatment time and procedure by using the 6DST. Therefore, 6DST is very useful methode with XST among the various tracking methods in Cyberknife for the patients with C1, C2 vertebral metastasis.

좌측 유방암 환자의 방사선치료 중 환자의 호흡과 심장 위치 분석을 통한 Deep inspiration breath-hold(DIBH) 기법의 재현성 평가

조재영,배선명,윤인하,이호연,강태영,백금문,배재범,Jo, Jae Young,Bae, Sun Myung,Yoon, In Ha,Lee, Ho Yeon,Kang, Tae Young,Baek, Geum Mun,Bae, Jae Beom 대한방사선치료학회 2014 대한방사선치료학회지 Vol.26 No.2

Purpose : The purpose of this study is reproducibility evaluation of deep inspiration breath-hold(DIBH) technique by respiration data and heart position analysis in radiation therapy for Left Breast cancer patients. Materials and Methods : Free breathing(FB) Computed Tomography(CT) images and DIBH CT images of three left breast cancer patients were used to evaluate the heart volume and dose during treatment planing system( Eclipse version 10.0, Varian, USA ). The signal of RPM (Real-time Position Management) Respiratory Gating System (version 1.7.5, Varian, USA) was used to evaluate respiration stability of DIBH during breast radiation therapy. The images for measurement of heart position were acquired by the Electronic portal imaging device(EPID) cine acquisition mode. The distance of heart at the three measuring points(A, B, C) on each image was measured by Offline Review (ARIA 10, Varian, USA). Results : Significant differences were found between the FB and DIBH plans for mean heart dose (6.82 vs. 1.91 Gy), heart $V_{30}$ (68.57 vs. $8.26cm^3$), $V_{20}$ (76.43 vs. $11.34cm^3$). The standard deviation of DIBH signal of each patient was ${\pm}0.07cm$, ${\pm}0.04cm$, ${\pm}0.13cm$, respectively. The Maximum and Minimum heart distance on EPID images were measured as 0.32 cm and 0.00 cm. Conclusion : Consequently, using the DIBH technique with radiation therapy for left breast cancer patients is very useful to establish the treatment plan and to reduce the heart dose. In addition, it is beneficial to using the Cine acquisition mode of EPID for the reproducibility evaluation of DIBH.

RPM System^TM을 이용한 호흡 관찰의 유용성 평가

박현준,배선명,백금문,강태영,서동린,Park, hyun jun,Bae, sun myeong,Baek, Geum Mun,Kang, tae young,Seo, Dong Rin 대한방사선치료학회 2016 대한방사선치료학회지 Vol.28 No.1

Purpose : The purpose of this study is to evaluate the variability of tumor motion and respiration pattern in lung cancer patients undergoing Stereotactic Body RadioTherapy(SBRT) by using On-Board imager (OBI) system and Real-time Position Management (RPM) System. Materials and Methods : This study population consisted of 60 lung cancer patient treated with stereotactic body radiotherapy (48 Gy / 4 fractions). Of these, 30 were treated with gating (group 1) and 30 without gating(group2): typically the patients whose tumors showed three-dimensional respiratory motion > 10 mm were selected for gating. 4-dimensional Computed Tomography (4DCT). Cone Beam CT (CBCT) and Fluoroscopy images were used to measure the tumor motion. RPM system was used to evaluate the variability of respiration pattern on SBRT for group1. Results : The mean difference of tumor motion among 4DCT, CBCT and Fluoroscopy images in the cranio-caudal direction was 2.3 mm in group 1, 2. The maximum difference was 12.5 mm in the group 1 and 8.5 mm in group 2. The number of treatment fractions that patient's respiration pattern was within Upper-Lower threshold on SBRT in group 2 was 31 fractions. A patient who exhibited the most unstable pattern exceeded 108 times in a fraction Conclusion : Although many patients in group 1 and 2 kept the reproducibility of tumor motion within 5 mm during their treatment, some patients exhibited variability of tumor motion in the CBCT and Fluoroscopy images. It was possible to improve the accuracy of dose delivery in SBRT without gating for lung cancer patient by using RPM system.

두경부암 방사선 치료 시 Aquaplastic Mask가 환자 고정에 미치는 영향

이호연,배선명,김진산,강태영,곽정원,백금문,Lee, Ho-Yeon,Bae, Sun-Myung,Kim, Jin-San,Kang, Tae-Young,Kwak, Jung-Won,Back, Geum-Mun 대한방사선치료학회 2012 대한방사선치료학회지 Vol.24 No.2

Purpose: This study aimed to analyze the influence of aquaplastic mask which is used for the radiotherapy for patients with head and neck cancer on patient positioning by analyzing the results of 2D/2D matching with the use of Exactrac 6D couch system. Materials and Methods: 2D/2D matching-based Image guidance was performed with the use of Exactrac 6D couch system on a total of 14 patients with head and neck cancer who received radiotherapy at this hospital in a period from June 2010 to June 2011. The adjusted 6D values obtained after the image guidance were classified into values related with patients and values not related with patients as to the correlation between the results. Results: In the analysis of the relation of each adjusted value to patients, the coefficient of determination ($R^2$) of longitudinal and pitch direction was 0.76, of longitudinal and yaw direction was 0.48, and of pitch and yaw direction was 0.42 although the coefficient of determination for above factors was 0.03 or less when the dependency of patients was excluded. Conclusion: It was demonstrated that intrinsic factors of aquaplastic mask had influence on the immobilization of patients by aquaplastic mask although various factors related with patients had influence on the immobilization of patients. It is believed that if these factors are adjusted, the treatment of patients with head and neck cancer can be more accurate.

호흡연동 용적변조 회전방사선치료에서 호흡주기에 따른 선량전달 정확성 검증

전수동,배선명,윤인하,강태영,백금문,Jeon, Soo Dong,Bae, Sun Myung,Yoon, In Ha,Kang, Tae Young,Baek, Geum Mun 대한방사선치료학회 2014 대한방사선치료학회지 Vol.26 No.1

Purpose : The purpose of this study is to verify the accuracy of dose delivery according to the patient's breathing cycle in Gated Volumetric Modulated Arc Therapy Materials and Methods : TrueBeam STxTM(Varian Medical System, Palo Alto, CA) was used in this experiment. The Computed tomography(CT) images that were acquired with RANDO Phantom(Alderson Research Laboratories Inc. Stamford. CT, USA), using Computerized treatment planning system(Eclipse 10.0, Varian, USA), were used to create VMAT plans using 10MV FFF with 1500 cGy/fx (case 1, 2, 3) and 220 cGy/fx(case 4, 5, 6) of doserate of 1200 MU/min. The regular respiratory period of 1.5, 2.5, 3.5 and 4.5 sec and the patients respiratory period of 2.2 and 3.5 sec were reproduced with the $QUASAR^{TM}$ Respiratory Motion Phantom(Modus Medical Devices Inc), and it was set up to deliver radiation at the phase mode between the ranges of 30 to 70%. The results were measured at respective respiratory conditions by a 2-Dimensional ion chamber array detector(I'mRT Matrixx, IBA Dosimetry, Germany) and a MultiCube Phantom(IBA Dosimetry, Germany), and the Gamma pass rate(3 mm, 3%) were compared by the IMRT analysis program(OmniPro I'mRT system software Version 1.7b, IBA Dosimetry, Germany) Results : The gamma pass rates of Case 1, 2, 3, 4, 5 and 6 were the results of 100.0, 97.6, 98.1, 96.3, 93.0, 94.8% at a regular respiratory period of 1.5 sec and 98.8, 99.5, 97.5, 99.5, 98.3, 99.6% at 2.5 sec, 99.6, 96.6, 97.5, 99.2, 97.8, 99.1% at 3.5 sec and 99.4, 96.3, 97.2, 99.0, 98.0, 99.3% at 4.5 sec, respectively. When a patient's respiration was reproduced, 97.7, 95.4, 96.2, 98.9, 96.2, 98.4% at average respiratory period of 2.2 sec, and 97.3, 97.5, 96.8, 100.0, 99.3, 99.8% at 3.5 sec, respectively. Conclusion : The experiment showed clinically reliable results of a Gamma pass rate of 95% or more when 2.5 sec or more of a regular breathing period and the patient's breathing were reproduced. While it showed the results of 93.0% and 94.8% at a regular breathing period of 1.5 sec of Case 5 and 6, it could be confirmed that the accurate dose delivery could be possible on the most respiratory conditions because based on the results of 100 patients's respiratory period analysis as no one sustained a respiration of 1.5 sec. But, pretreatment dose verification should be precede because we can't exclude the possibility of error occurrence due to extremely short respiratory period, also a training at the simulation and careful monitoring are necessary for a patient to maintain stable breathing. Consequently, more reliable and accurate treatments can be administered.

용적변조회전 방사선치료에서 Portal Dosimetry를 이용한 선량평가의 재현성 분석

김세현,배선명,서동린,강태영,백금문,Kim, Se Hyeon,Bae, Sun Myung,Seo, Dong Rin,Kang, Tae Young,Baek, Geum Mun 대한방사선치료학회 2015 대한방사선치료학회지 Vol.27 No.2

Purpose : The pre-treatment QA using Portal dosimetry for Volumetric Arc Therapy To analyze whether maintaining the reproducibility depending on various factors. Materials and Methods : Test was used for TrueBeam STx$^{TM}$ (Ver.1.5, Varian, USA). Varian Eclipse Treatment planning system(TPS) was used for planning with total of seven patients include head and neck cancer, lung cancer, prostate cancer, and cervical cancer was established for a Portal dosimetry QA plan. In order to measure these plans, Portal Dosimetry application (Ver.10) (Varian) and Portal Vision aS1000 Imager was used. Each Points of QA was determined by dividing, before and after morning treatment, and the after afternoon treatment ended (after 4 hours). Calibration of EPID(Dark field correction, Flood field correction, Dose normalization) was implemented before Every QA measure points. MLC initialize was implemented after each QA points and QA was retried. Also before QA measurements, Beam Ouput at the each of QA points was measured using the Water Phantom and Ionization chamber(IBA dosimetry, Germany). Results : The mean values of the Gamma pass rate(GPR, 3%, 3mm) for every patients between morning, afternoon and evening was 97.3%, 96.1%, 95.4% and the patient's showing maximum difference was 95.7%, 94.2% 93.7%. The mean value of GPR before and after EPID calibration were 95.94%, 96.01%. The mean value of Beam Output were 100.45%, 100.46%, 100.59% at each QA points. The mean value of GPR before and after MLC initialization were 95.83%, 96.40%. Conclusion : Maintain the reproducibility of the Portal Dosimetry as a VMAT QA tool required management of the various factors that can affect the dosimetry.