• Title, Summary, Keyword: 호흡연동

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Evaluation of Dose Distributions calculated with ITV Measurement Plan Data and PTV Measurement plan Data under the condition of Respiratory Motion during 3D for ABD Cancer (내부표적체적 기반의 치료계획과 호흡연동 기법을 적용한 치료계획과의 선량비교 분석)

  • Park, Ho-Chun;Han, Jae-Bok;Song, Jong-Nam;Choi, Nam-Gil
    • Proceedings of the Korea Contents Association Conference
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    • pp.227-228
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    • 2014
  • 방사선치료의 발전으로 3차원치료보다 진보된 호흡연동방사선치료가 시행되어지고 있다. 호흡의 규칙성과 환자의 위치 재현성이 중요한 치료적응 인자이며, 호흡연동 방사선치료의 효율을 높일 수 있는 지표이다. 국가암통계상 고령의 암환자가 증가하며, 수술, 화학요법을 병행하는 암 치료법이 널리 이용이 되고 있다. 고식적인 치료를 요하는 고령의 복부 암 환자분들에 호흡연동 방사선치료법을 사용하는데 에는 호흡의 불규칙성과 체위의 재현성의 문제점으로 인한 치료 효율의 저하를 가져온다. 본 연구에서는 호흡에 의한 종양 움직임이 있는 방사선 치료에서 내부표적체적 기반의 치료계획과 호흡연동 기법을 적용한 치료계획과의 선량비교 분석하였다. 2가지 치료법 모두 정상조직 보호선량에 부합한 것으로 나타났으며 치료체적은 처방선량의 95%이상 포함된 선량분포로 적합하였다. ITV 설정을 통한 3D Plan은 고식적 치료을 목적으로 하는 고령의 환자, 체위 및 호흡의 불안정성 환자에게 처방선량의 95% 이상의 4D Plan의 치료법 보다 짧은 시간에 치료함으로써 치료효율을 높일 수 있을 거라 사료된다. 다만 정상조직보호선량(NTCP)에 부합하는지에 대한 평가가 전제되어야 한다.

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Dosimetric Analysis of Respiratory-Gated RapidArc with Varying Gating Window Times (호흡연동 래피드아크 치료 시 빔 조사 구간 설정에 따른 선량 변화 분석)

  • Yoon, Mee Sun;Kim, Yong-Hyeob;Jeong, Jae-Uk;Nam, Taek-Keun;Ahn, Sung-Ja;Chung, Woong-Ki;Song, Ju-Young
    • Progress in Medical Physics
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    • v.26 no.2
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    • pp.87-92
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    • 2015
  • The gated RapidArc may produce a dosimetric error due to the stop-and-go motion of heavy gantry which can misalign the gantry restart position and reduce the accuracy of important factors in RapidArc delivery such as MLC movement and gantry speed. In this study, the effect of stop-and-go motion in gated RapidArc was analyzed with varying gating window time, which determines the total number of stop-and-go motions. Total 10 RapidArc plans for treatment of liver cancer were prepared. The RPM gating system and the moving phantom were used to set up the accurate gating window time. Two different delivery quality assurance (DQA) plans were created for each RapidArc plan. One is the portal dosimetry plan and the other is MapCHECK2 plan. The respiratory cycle was set to 4 sec and DQA plans were delivered with three different gating conditions: no gating, 1-sec gating window, and 2-sec gating window. The error between calculated dose and measured dose was evaluated based on the pass rate calculated using the gamma evaluation method with 3%/3 mm criteria. The average pass rates in the portal dosimetry plans were $98.72{\pm}0.82%$, $94.91{\pm}1.64%$, and $98.23{\pm}0.97%$ for no gating, 1-sec gating, and 2-sec gating, respectively. The average pass rates in MapCHECK2 plans were $97.80{\pm}0.91%$, $95.38{\pm}1.31%$, and $97.50{\pm}0.96%$ for no gating, 1-sec gating, and 2-sec gating, respectively. We verified that the dosimetric accuracy of gated RapidArc increases as gating window time increases and efforts should be made to increase gating window time during the RapidArc treatment process.

Discrepancies between Calculated and Delivered Dose Distributions of Respiratory Gated IMRT Fields according to the Target Motion Ranges for Lung and Liver Cancer Patients (호흡연동방사선치료시 폐암과 간암환자의 병소 움직임 크기에 따른 선량분포 차이 분석)

  • Kim, Youngkuk;Lim, Sangwook;Choi, Ji Hoon;Ma, Sun Young;Jeung, Tae Sig;Ro, Tae Ik
    • Progress in Medical Physics
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    • v.25 no.4
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    • pp.242-247
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    • 2014
  • To see the discrepancies between the calculated and the delivered dose distribution of IMRT fields for respiratory-induced moving target according to the motion ranges. Four IMRT plans in which there are five fields, for lung and liver patients were selected. The gantry angles were set to $0^{\circ}$ for every field and recalculated using TPS (Eclipse Ver 8.1, Varian Medical Systems, Inc., USA). The ion-chamber array detector (MatriXX, IBA Dosimetry, Germany) was placed on the respiratory simulating platform and made it to move with ranges of 1, 2, and 3 cm, respectively. The IMRT fields were delivered to the detector with 30~70% gating windows. The comparison was performed by gamma index with tolerance of 3 mm and 3%. The average pass rate was 98.63% when there's no motion. When 1.0, 2.0, 3.0 cm motion ranges were simulated, the average pass rate were 98.59%, 97.82%, and 95.84%, respectively. Therefore, ITV margin should be increased or gating windows should be decreased for targets with large motion ranges.

Quantitative Evaluation of Gated Radiation Therapy Using Gamma Index Analysis (감마지표 분석을 통한 호흡연동방사선치료의 정량적 평가)

  • Ma, Sun Young;Choi, Ji Hoon;Jeung, Tae Sig;Lim, Sangwook
    • Progress in Medical Physics
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    • v.24 no.3
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    • pp.198-203
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    • 2013
  • Generally, to evaluate gated radiation therapy, moving phantoms are used to simulate organ motion. Since the target moves in every direction, we need to take into account motion in each direction. This study proposes methods to evaluate gated radiation therapy using gamma index analysis and to visualize adequate gating window sizes according to motion ranges. The moving phantom was fabricated to simulate motion in the craniocaudal direction. This phantom consisted of a moving platform, the I'm MatriXX, and solid water phantoms. A 6 MV photon filed with a field size of $4{\times}4cm^2$ was delivered to the phantom using the gating system, while the phantom moved in the 1-, 2-, 3-, 4-, and 5-cm motion ranges. The gating windows were set at 40~60%, 30~40%, and 0~90%, respectively. The I'm MatriXX acquired the dose distributions for each scenario and the dose distributions were compared with a $4{\times}4cm^2$ static filed. The tolerance of the gamma index was set at 3%/3 mm. The greater the gating window, the lower the pass rate, and the greater the motion range, the lower the pass rate in this study. In case treatment without gated radiation therapy for the target with motion of 2 cm, the pass rate was less than 96%. But it was greater than 99% when gated radiation therapy was used. However gated radiation therapy was used for the target with motion greater than 4 cm, the pass rate could not be greater than 97% when gating window was set as 30~70%. But when the gating window set as 40~60%, the pass rate was greater than 99%.

Development of Error Analysis Program for Phase-based Respiratory Gating Radiation Therapy (위상기반 호흡연동 방사선치료 시 오차 분석 프로그램 개발)

  • Song, Ju-Young;Nah, Byung-Sik;Chung, Woong-Ki;Ahn, Sung-Ja;Nam, Taek-Keun;Yoon, Mi-Sun
    • Progress in Medical Physics
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    • v.17 no.3
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    • pp.136-143
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    • 2006
  • The respiratory gating radiation therapy which Irradiates only in the stable respiratory period with analyzing the periodic motion of a reflective marker on the patient's abdomen has been applied to the precise radiation treatment in order to minimize the effect of organ motion induced by the respiration. This respiratory gating system establishes irradiation region using the amplitude-based or phase-based method. Although phase-based method Is preferred because of the stability in the real treatment conditions, it has some limits to explain the exact correlation between the marker motion and organ motion. Even when the variation of amplitude which can introduce target motion considered as an error is produced, the phase-based method has the possibility to irradiate including the error positions. In this study, the error analysis program was developed for the verification of the tumor position's variation correlated with the variation of marker's amplitude which can be occurred during a phase-based respiratory sating treatment. The analysis program was tested with a virtual treatment record file and with a record file using moving phantom which were modified considering the irregular amplitude's variation simulating the real clinical situations. In both cases, accurate discrimination of error points and error calculation were produced. When the treatment record files of a real patient were analyzed with the program, the accurate recognition and calculation of the error points were also verified. The analysis program developed in this study will be applied as a useful tool for the analysis of errors due to the irregular variation of patients' respiration during the phase-base respiratory gating radiation treatment.

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Analysis on the Decrease of Planning Target Volume in the Case of Lung Radiation Surgery with the Application of Respiratory Gated Radiotherpy Method (폐암 환자의 방사선수술 시 호흡연동 방사선치료 방법의 적용을 통한 계획용표적체적 감소 효과 분석)

  • Song, Ju-Young;Nah, Byung-Sik;Chung, Woong-Ki;Ahn, Sung-Ja;Nam, Taek-Keun;Yoon, Mee-Sun;Jung, Jae-Uk
    • Progress in Medical Physics
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    • v.19 no.4
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    • pp.263-268
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    • 2008
  • The application of a respiratory gated radiotherpy method to the lung radiation surgery was evaluated compared with the conventional method in which the whole tumor motion range is considered in the delineation of PTV (Planning target volume). The four dimensional CT simulation images were acquired for the five NSCLC (Non-small cell lung cancer) patients for radiation surgery. The respiratory gated plan was prepared with the 50% phase CT images and the conventional method was planned based on the ITV (Internal target volume) which include all the target volumes created in each phase CT images within a whole respiratory period. The DVH (Dose volume histogram) of OAR (Organ at risk) which calculated in each method was compared for the evaluation of the plan properness. The relative decrease of OARs' DVH were verified in the application of respiratory gated method. The average decrease rate were $16.88{\pm}9.97%$ in the bronchus, $34.13{\pm}19.15%$ in the spinal cord, $28.42{\pm}18.49%$ in the chest wall and $32.48{\pm}16.66%$ in the lung. Based on these results, we can verified the applicability and the effectiveness of the respiratory gated method in the lung radiation surgery.

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Evaluation of the Accuracy for Respiratory-gated RapidArc (RapidArc를 이용한 호흡연동 회전세기조절방사선치료 할 때 전달선량의 정확성 평가)

  • Sung, Jiwon;Yoon, Myonggeun;Chung, Weon Kuu;Bae, Sun Hyun;Shin, Dong Oh;Kim, Dong Wook
    • Progress in Medical Physics
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    • v.24 no.2
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    • pp.127-132
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    • 2013
  • The position of the internal organs can change continually and periodically inside the body due to the respiration. To reduce the respiration induced uncertainty of dose localization, one can use a respiratory gated radiotherapy where a radiation beam is exposed during the specific time of period. The main disadvantage of this method is that it usually requests a long treatment time, the massive effort during the treatment and the limitation of the patient selection. In this sense, the combination of the real-time position management (RPM) system and the volumetric intensity modulated radiotherapy (RapidArc) is promising since it provides a short treatment time compared with the conventional respiratory gated treatments. In this study, we evaluated the accuracy of the respiratory gated RapidArc treatment. Total sic patient cases were used for this study and each case was planned by RapidArc technique using varian ECLIPSE v8.6 planning machine. For the Quality Assurance (QA), a MatriXX detector and I'mRT software were used. The results show that more than 97% of area gives the gamma value less than one with 3% dose and 3 mm distance to agreement condition, which indicates the measured dose is well matched with the treatment plan's dose distribution for the gated RapidArc treatment cases.

The Effect of Breathing Biofeedback on Breathing Reproducibility and Patient's Dose in Respiration-gated Radiotherapy (호흡연동 방사선 치료에서 호흡생체자기제어 방식이 호흡 재현성 및 선량에 미치는 영향 평가)

  • An, Sohyun;Yeo, Inhwan;Jung, Jaewon;Suh, Hyunsuk;Lee, Kyung Ja;Choi, Jinho;Lee, Kyu Chan;Lee, Rena
    • Progress in Medical Physics
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    • v.24 no.3
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    • pp.135-139
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    • 2013
  • We evaluated the effect of two kinds of breathing biofeedback technique such as audio-instruction and audio-visual biofeedback on breathing reproducibility and the CTV coverage during repeated treatment regimes in respiration-gated radiotherapy. In this study, the breathing data of nineteen lung cancer patients acquired from Medical College of Virginia (MCV) during five weeks were used. The dose evaluation algorithm was programmed in MATLAB. In the result, the CTV coverage was decreased as 30.0% due to the breathing irreproducibility for free-breathing. For audio-visual biofeedback, the CTV coverage was improved as 20.0% because patients can learn how control their breathing stably. And the audio-instruction was effective to preserve the breathing reproducibility.

Development of Respiratory Signal Analysis Program for Accurate Phase Reassignment in 4D CT Reconstruction (4D CT 영상 재구성 시 정확한 위상 변환을 위한 호흡 신호 분석 프로그램 개발)

  • Park, Hae-Jin;Jung, Won-Gyun;Yoon, Jai-Woong;Song, Ju-Young;Suh, Tae-Suk
    • Progress in Medical Physics
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    • v.19 no.4
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    • pp.241-246
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    • 2008
  • Patient's respiration can have an effect on movement of tumor range and peripheral organs. Therefore, the respiratory signal was acquired by relation between external markers and movement of patient's abdomen during radiational therapy in order to minimize the effect of respiration. Based on this technique, many studies of rational therapy to irradiate at particular part of stable respiratory signals have executed and they have been clinically applied. Nevertheless, the phase-based method is preferred to the amplitude-based method for the rational therapy related to respiration. Because stabilization of the respiratory signal are limited. In this study, a in-house respiratory signal analysis program was developed for the phase reassignment and the analysis of the irregular respiratory signals. Various irregular respiratory patterns was obtained from clinical experimental volunteers. After then, the in-house program analyzed the factors affecting to phase assignment which is directly related to irradiated sector. Subsequently, accuracy of phase assignment was improved with removement of irregular signals by self-developed algorithm. This study is considered to be useful for not only image reconstruction and elevation of irradiating accuracy through phase assignment of RPM system but also analysis of respiratory signals. Moreover, development of 4D CT image is planed with phantom researches or clinical experiments based on this program.

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Dosimetric Evaluation of Amplitude-based Respiratory Gating for Delivery of Volumetric Modulated Arc Therapy (진폭 기반 호흡연동 체적변조회전방사선치료의 선량학적 평가)

  • Lee, Chang Yeol;Kim, Woo Chul;Kim, Hun Jeong;Park, Jeong Hoon;Min, Chul Kee;Shin, Dong Oh;Choi, Sang Hyoun;Park, Seungwoo;Huh, Hyun Do
    • Progress in Medical Physics
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    • v.26 no.3
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    • pp.127-136
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    • 2015
  • The purpose of this study is to perform a dosimetric evaluation of amplitude-based respiratory gating for the delivery of volumetric modulated arc therapy (VMAT). We selected two types of breathing patterns, subjectively among patients with respiratory-gated treatment log files. For patients that showed consistent breathing patterns (CBP) relative to the 4D CT respiration patterns, the variability of the breath-holding position during treatment was observed within the thresholds. However, patients with inconsistent breathing patterns (IBP) show differences relative to those with CBP. The relative isodose distribution was evaluated using an EBT3 film by comparing gated delivery to static delivery, and an absolute dose measurement was performed with a $0.6cm^3$ Farmer-type ion chamber. The passing rate percentages under the 3%/3 mm gamma analysis for Patients 1, 2 and 3 were respectively 93.18%, 91.16%, and 95.46% for CBP, and 66.77%, 48.79%, and 40.36% for IBP. Under the more stringent criteria of 2%/2 mm, passing rates for Patients 1, 2 and 3 were respectively 73.05%, 67.14%, and 86.85% for CBP, and 46.53%, 32.73%, and 36.51% for IBP. The ion chamber measurements were within 3.5%, on average, of those calculated by the TPS and within 2.0%, on average, when compared to the static-point dose measurements for all cases of CBP. Inconsistent breathing patterns between 4D CT simulation and treatment may cause considerable dosimetric differences. Therefore, patient training is important to maintain consistent breathing amplitude during CT scan acquisition and treatment delivery.