Basic Physical Principles and Clinical Applications of Computed Tomography

Jung, Haijo Korean Society of Medical Physics 2021 의학물리 Vol.32 No.1

The evolution of X-ray computed tomography (CT) has been based on the discovery of X-rays, the inception of the Radon transform, and the development of X-ray digital data acquisition systems and computer technology. Unlike conventional X-ray imaging (general radiography), CT reconstructs cross-sectional anatomical images of the internal structures according to X-ray attenuation coefficients (approximate tissue density) for almost every region in the body. This article reviews the essential physical principles and technical aspects of the CT scanner, including several notable evolutions in CT technology that resulted in the emergence of helical, multidetector, cone beam, portable, dual-energy, and phase-contrast CT, in integrated imaging modalities, such as positron-emission-tomography-CT and single-photon-emission-computed-tomography-CT, and in clinical applications, including image acquisition parameters, CT angiography, image adjustment, versatile image visualizations, volumetric/surface rendering on a computer workstation, radiation treatment planning, and target localization in radiotherapy. The understanding of CT characteristics will provide more effective and accurate patient care in the fields of diagnostics and radiotherapy, and can lead to the improvement of image quality and the optimization of exposure doses.

Development and Evaluation of a Target-tracking Radiation-therapy System Using a Multileaf Collimator (MLC) Synchronized with Moving Organs

박승우,Haijo Jung,KumBae Kim,Donghan Lee,YoungHoon Ji,이레나,SooIl Kwon 한국물리학회 2009 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.55 No.2

A target-tracking radiation-therapy (RT) system that tracks the movement of a treatment target resulting from internal organ movement has been developed, and the system was evaluated for effectiveness. The developed radiation-therapy system determines the limit of the MLC (multileaf collimator) movement range with an acquired maximum displacement value of target movement during the radiotherapy planning stage and moves the MLC to continuously detect and synchronize the displacement of the abdominal by using a CCD camera monitoring system during real-time RT treatment. The system consists of a Co-60 teletherapy unit, an abdominal displacement detection system to correlate the movement of internal organs, and a MLC moving stage synchronized with the abdominal displacement. The effectiveness of the RT system was evaluated by analyzing the beam penumbra from the dose distribution on films (Gafchromic EBT) installed within a moving phantom. Penumbra widths (80%/20%) were measured for the nominal left (perpendicular to leaf motion) and right (parallel to leaf motion) directions of the x-axis and the y-axis for a fixed phantom and fixed MLC (3.3 mm/3.5 mm and 3.7 mm/3.1 mm), a moving phantom and a fixed MLC (9.0 mm/8.2 mm and 9.1 mm/8.8 mm), and a moving phantom and a moving MLC (3.7 mm/3.5 mm and 3.7 mm/3.8 mm). Percent area deviations of the 100% to 80% field of the maximum dose for the exposure condition of a fixed phantom and a fixed MLC were a relatively low value of 0.64% and a relatively high value of 15.04%, as compared to the values for a moving phantom and a fixed MLC and for a moving phantom and a moving MLC. With the method to move the MLC by passive synchronization with organ motion, the target-tracking radiation-therapy system was successfully implemented and was evaluated for performance. In future studies, various verification processes should be performed prior to the application of the system in a clinical situation.

On the Use Factor Analysis and Adequacy Evaluation of CyberKnife Shielding Design Using Clinical Data

Cho, Yu Ra,Jung, Haijo,Lee, Dong Han Korean Society of Medical Physics 2018 의학물리 Vol.29 No.4

Although the current internationally recommended standard for the use factor (U) applied to CyberKnife is 0.05 (5%), the CyberKnife shielding standard is applied more stringently. This study, based on clinical data, was aimed at examining the appropriateness of existing shielding guidelines. Sixty patients treated with G4 CyberKnife were selected. The patients were divided into two groups, according to whether they underwent skull or spine tracking. Based on the results, the use factors for each wall ranged from 0.028 (2.8%) to 0.031 (3.1%) for the intracranial treatment and 0.020 (2.0%) to 0.022 (2.2%) for the body treatment. Excessive barrier thickness resulted in inefficient use of space and higher cost to the institutions. Furthermore, because the use factor is influenced by the position of the robot, the use factor determined based on the clinical data of this study would facilitate more reasonable treatment room design.

¹³¹I 치료입원실 폐기물 방사능 오염도 분석 및 자체처분가능일자 산출

김기섭,정해조,박민석,정진성,Kim, Gi-sub,Jung, Haijo,Park, Min-seok,Jeon, Gjin-seong 대한핵의학기술학회 2013 핵의학 기술 Vol.17 No.1

Purpose: The treatment of thyroid cancer patients was continuously increased. According to the increment of thyroid cancer patients, the establishment of iodine therapy site was also increased in each hospital. This treatment involves the administration of radioactive iodine, which will be given in the form of a capsule. Therefore, protections and managements for radioactive source pollution and radiation exposure should be necessary for radiation safety. Among the many problems, the problem of disposing the radioactive wastes was occurred. In this study, The date for self-disposal for radioactive wastes, which were contaminated in clothes, bedclothes and trash, were calculated. Materials and Methods: The number of iodine therapy ward was 15 in Korea Institute of Radiological Medical and Sciences. Recently, 8 therapy wards were operated for iodine therapy patients and others were on standby for emergency treatment ward of any radiation accidents. Radioactive wastes, which were occurred in therapy ward, were clothes, bedclothes, bath cover for patients washing water and food and drink which was leftover by patients. Each sample was hold into the marinelli beaker (clothes, bedclothes, bath covers) and 90 ml beaker (food, drink, and washing water). The activities of collected samples were measured by HpGe MCA device (Multi Channel Analysis, CANBERRA, USA) Results: The storage period for the each kind of radioactive wastes was calculated by equation of storage periods based on the measurement outcomes. The average storage period was 60 days for the case of clothes, and the maximum storage period was 93 days for patient bottoms. The average storage period and the maximum storage period for the trash were 69 days and 97 days, respectively. The leftover foods and drinks had short storage period (the average storage period was 25 days and maximum storage period was 39 days), compared with other wastes. Conclusion: The proper storage period for disposing the radioactive waste (clothes, bedclothes and bath cover) was 100 days by the regulation on self-disposal of radioactive waste. In addition, the storage period for disposing the liquid radioactive waste was 120 days. The current regulation for radioactive waste self-disposing was not suitable for the circumstances of each radioactive therapy facility. Therefore, it was necessary to reduce the leftover food and drinks by adequate table setting for patients, and improve the process and regulation for disposing the short-half life radioactive wastes.

의료용 방사성폐기물 자체처분을 위한 방사능 측정 및 평가

김창범,박민석,김기섭,정해조,장성주,Kim, Changbum,Park, MinSeok,Kim, Gi-Sub,Jung, Haijo,Jang, Seongjoo 한국의학물리학회 2014 의학물리 Vol.25 No.1

의료분야에서 방사선 진료기술의 발전에 따라 방사성폐기물의 수량은 급속히 증가하고 있다. 방사성폐기물에는 주로 PET/CT에 사용하는 $^{18}F$을 비롯하여 핵의학검사에 사용하는 $^{99m}Tc$ 등과 같이 반감기가 매우 짧은 방사성동위원소가 함유되어 있다. 이를 처분하기 위하여 국제원자력기구(IAEA)는 개인선량($10{\mu}Sv/y$) 및 집단선량(1 man-Sv/y)과 핵종별 농도에 근거하여 각각 폐기물의 규제해제기준을 제시(IAEA Safety Series No 111-P-1.1, 1992 및 IAEA RS-G-1.7, 2004)하였다. 이 연구에서는 IAEA 기준에 따른 방사능농도를 측정하기 위하여, $^{18}F$, $^{99m}Tc$, $^{123}I$, $^{125}I$ 및 $^{201}TI$ 관련 방사성폐기물을 수집하고 측정용기를 준비하였다. 그리고 MCA를 이용한 감마방사능 측정, 감마계수기를 이용한 감마방사능 측정, 베타입자 방출 핵종의 방사능 측정방법 및 절차를 수립하고, 표준물질을 제작하여 교정하였다. 측정결과를 근거로 방사능 감쇠 유도식을 산출하였으며, 이를 이론식과 대비하여 고찰하였다. 이 연구 결과는 ISO 표준으로 추진할 예정이다. The amounts of radioactive wastes to be disposed in the medical institute have been increased due to development of radiation diagnosis and therapy rapidly. They are produced mostly by the very short lived radioisotopes such as $^{18}F$ used in PET/CT, $^{99m}Tc$, $^{123}I$, $^{125}I$ and $^{201}Tl$, etc. IAEA proposed a criteria for the clearance level of waste which depends on the individual ($10{\mu}Sv/y$) and collective dose (1 man-Sv/y), and concentration of each nuclide (IAEA Safety Series No 111-P-1.1, 1992 and IAEA RS-G-1.7, 2004). Radioactive wastes of $^{18}F$, $^{99m}Tc$, $^{123}I$, $^{125}I$ and $^{201}TI$ in the several types of container like Marinelli beaker, vial and plastic, were collected to measure the concentration of the waste of each nuclide in accordance with IAEA criteria. The measurement method and procedure of determining specific activity of the wastes using gamma emitters like MCA, gamma counter and beta emitters were developed. For the efficiency calibration of the detectors, CRM (certified reference material) which has the same dimension and shape was provided by Korea Research Institute of Standards and Science (KRISS). Correction factor of the radioactivity decay was calculated based on the measurement results, and the consideration of mutual relation with theoretical equation. The result of this study will be proposed as ISO standard.

방사선치료를 위한 다엽 콜리메이터의 설계 및 시뮬레이션

박승우(Seungwoo Park),한수철(Su Chul Han),정해조(Haijo Jung),김금배(Kum Bae Kim),최문식(Mun Sik Choe),김미숙(Mi sook Kim),지영훈(Young Hoon Ji) 대한전기학회 2013 대한전기학회 학술대회 논문집 Vol.2013 No.10

간 전이 암 환자의 18F-FDG PET 기반 종양 영역 정의: 영상 인자와 자동 영상 분할 기법 간의 관계분석

김희진,박승우,정해조,김미숙,유형준,지영훈,이철영,김금배,Kim, Heejin,Park, Seungwoo,Jung, Haijo,Kim, Mi-Sook,Yoo, Hyung Jun,Ji, Young Hoon,Yi, Chul-Young,Kim, Kum Bae 한국의학물리학회 2013 의학물리 Vol.24 No.2

간 전이 암은 이전에는 수술을 통한 외과적 절제가 주요 치료기법이었지만 방사선 치료 기법의 발전으로 인해 점차 방사선치료의 시행이 늘어나고 있다. 18F-FDG PET 영상은 간 전이 암 진단 시 더욱 우세한 민감도와 특이도를 보이며, 치료계획용 CT 영상과 더불어 종양조직의 위치를 정의하는 중요한 영상장비로 자리매김하고 있다. 본 연구에서는 간 전이 암의 18F-FDG PET 영상에 나타난 종양영역을 영상분할기법 적용하였으며 PET영상의 여러 인자들이 영상분할기법들에 미치는 영향을 알아보았다. 2009년부터 2012년까지 방사선 치료를 받은 간전이 환자들 중 18F-FDG PET/CT 촬영을 시행한 13명의 환자들의 치료계획용 CT와 PET/CT 영상을 얻었다. 그 뒤 PET 영상의 관심영역을 설정하기 위하여 3가지 영상 분할 기법인 상대적문턱기법, 기울기기법, 영역성장기법을 적용하였다. 이 결과들을 바탕으로 GTV와 각 영상 기법으로 구현된 종양 영역과 부피 비교를 시행하였으며 영상 분할 기법에 영향을 미치는 영상인자들과의 관계를 회귀 분석하였다. GTV (Gross Tumor Volume)의 평균 부피는 $60.9{\pm}65.9$ cc이며, 40% 상대적문턱값 기법은 $22.43{\pm}35.3$ cc, 50% 상대적문턱값 기법은 $10.11{\pm}17.9$ cc, 영역성장기법은 $32.89{\pm}36.8$ cc, 기울기기법은 $30.34{\pm}35.8$ cc로 나타났다. 기존의 GTV와 가장 유사한 영역을 나타낸 영상 분할 기법은 영역성장기법 이었다. 이 영역성장기법에 영향을 미치는 영상인자를 정량적으로 분석하기 위해 표준화 계수 ${\beta}$값을 이용하였으며, GTV의 크기, $TumorSUV_{MAX/MIN}$, $SUV_{max}$, TBR 순으로 나타났다. 이와 같은 PET 영상인자를 반영한 영상 분할 기법을 이용해서 종양 영역을 정의한다면 보다 정확하고 일관성 있는 종양그리기를 수행할 수 있으며 궁극적으로 종양에 최적화된 방사선량을 투여할 수 있을 것이다. The surgical resection was occurred mainly in liver metastasis before the development of radiation therapy techniques. Recently, Radiation therapy is increased gradually due to the development of radiation dose delivery techniques. 18F-FDG PET image showed better sensitivity and specificity in liver metastasis detection. This image modality is important in the radiation treatment with planning CT for tumor delineation. In this study, we applied automatic image segmentation methods on PET image of liver metastasis and examined the impact of image factors on these methods. We selected the patients who were received the radiation therapy and 18F-FDG PET/CT in Korea Cancer Center Hospital from 2009 to 2012. Then, three kinds of image segmentation methods had been applied; The relative threshold method, the Gradient method and the region growing method. Based on these results, we performed statistical analysis in two directions. 1. comparison of GTV and image segmentation results. 2. performance of regression analysis for relation between image factor affecting image segmentation techniques. The mean volume of GTV was $60.9{\pm}65.9$ cc and the $GTV_{40%}$ was $22.43{\pm}35.27$ cc, and the $GTV_{50%}$ was $10.11{\pm}17.92$ cc, the $GTV_{RG}$ was $32.89{\pm}36.8$4 cc, the $GTV_{GD}$ was $30.34{\pm}35.77$ cc, respectively. The most similar segmentation method with the GTV result was the region growing method. For the quantitative analysis of the image factors which influenced on the region growing method, we used the standardized coefficient ${\beta}$, factors affecting the region growing method show GTV, $TumorSUV_{MAX/MIN}$, $SUV_{max}$, TBR in order. The result of the region growing (automatic segmentation) method showed the most similar result with the CT based GTV and the region growing method was affected by image factors. If we define the tumor volume by the auto image segmentation method which reflect the PET image parameters, more accurate and consistent tumor contouring can be done. And we can irradiate the optimized radiation dose to the cancer, ultimately.

방사선치료분야에서 의학물리사의 적정인력 분석

황의중,임영경,김동욱,신동오,김성규,정해조,지영훈,Hwang, Ui-Jung,Lim, Young Gyung,Kim, Dong Wook,Shin, Dong Oh,Kim, Sung Kyu,Jung, Haijo,Ji, Young Hoon 한국의학물리학회 2012 의학물리 Vol.23 No.4

최근 방사선치료기기 및 방사선치료기술이 빠르게 발전하고 복잡해짐에 따라 방사선치료의 신뢰성을 높이고 정확한 환자 치료와 환자 및 치료관련 종사자의 방사선안전을 확보하기 위하여 자격있는 의학물리사 적정 인원에 대한 재평가가 이루어지고 있다. 방사선치료분야에서 의학물리사의 적정한 인원수준에 대하여 외국의 연구사례 및 결과에 대해 미국과 유럽을 중심으로 분석하였다. 또한 외국연구결과를 토대로 국내에 필요한 의학물리사의 적정 인원을 간접적으로 계산해 보았다. 국내 중대형 6개 병원의 현재 의학물리사 적정 인원은 국제적 적정 권고 인원의 50% 이하였다. 더욱 더 객관적인 의학물리사의 필요 인원수를 예측하기 위하여는 국내 여건에 적합한 추가적인 연구가 요구되며, 특히 지속적으로 증가되고 있는 입자방사선치료를 고려한 인원수 예측이 필요하다. Recently, an adequate number of qualified medical physicist is needed for achieving effective treatment and securing safety to the patient, staff and the public on the course of radiation therapy, since the equipment and the technique of radiation therapy are being developed fast and becoming complex. The studies on medical physics staffing level in United State and European countries were investigated. These results were applied to the domestic situation in order to anticipate indirectly the adequate number of medical physicist in Korea. The current number of medical physicists of 6 (middle to large sized) hospitals in Korea was less than 50% of number recommended in the study. Further detailed research specified on the domestic situation is needed in order to expect adequate number of medical physicist more accurately, and particle beam therapy has to be also considered in the research since the facility site is increasing gradually.

방사선치료를 위한 다엽 콜리메이터의 설계 및 시뮬레이션

박승우(Seungwoo Park),한수철(Su Chul Han),정해조(Haijo Jung),김금배(Kum Bae Kim),최문식(Mun Sik Choe),김미숙(Mi sook Kim),지영훈(Young Hoon Ji) 대한전기학회 2013 정보 및 제어 심포지엄 논문집 Vol.2013 No.10

Experimental Evaluation of a Radiophotoluminescent Glass Dosimeter in High-Energy Photon Beam

Kihong Son,Sang Hun Shin,Chang Yeol Lee,Seungwoo Park,Haijo Jung,Mi-Sook Kim,Young Hoon Ji,Kum Bae Kim 대한방사선방어학회 2010 대한방사선방어학회 학술발표회 논문요약집 Vol.2010 No.04