Various types of high-precision radiotherapy, such as intensity-modulated radiation therapy (IMRT), tomotherapy (Tomo), and stereotactic body radiation therapy have been available since 1997. After being covered by insurance in 2015, the number of IMRT cases rapidly increased 18-fold from 2011 to 2018 in Korea. IMRT, which uses a high-beam irradiation monitor unit, requires higher shielding conditions than conventional radiation treatments. However, to date, research on the shielding of facilities using IMRT and the current understanding of its status are insufficient, and detailed safety regulation procedures have not been established. This study investigated the recommended criteria for the shielding evaluation of facilities using medical linear accelerators (LINACs), including 1) the current status of safety management regulations and systems in domestic and international facilities using medical LINACs and 2) the current status of the recommended standards for safety management in domestic and international facilities using medical LINACs. It is necessary to develop and introduce a safety management system for facilities using LINACs for clinical applications that is suitable for the domestic medical environment and corresponds to the safety management systems for LINACs used overseas.

Purpose: This study automatically discriminates homogeneous and structure edge regions on computed tomography (CT) images, and it evaluates the noise level and edge preservation ratio (EPR) according to the different types of iterative reconstruction (IR).
Methods: The dataset consisted of CT scans of 10 patients reconstructed with filtered back projection (FBP), statistical IR (iDose⁴), and iterative model-based reconstruction (IMR). Using the 10th and 85th percentiles of the structure coherence feature, homogeneous and structure edge regions were localized. The noise level was estimated using the averages of the standard deviations for five regions of interests (ROIs), and the EPR was calculated as the ratio of standard deviations between homogeneous and structural edge regions on subtraction CT between the FBP and IR.
Results: The noise levels were 20.86±1.77 Hounsfield unit (HU), 13.50±1.14 HU, and 7.70±0.46 HU for FBP, iDose⁴, and IMR, respectively, which indicates that iDose⁴ and IMR could achieve noise reductions of approximately 35.17% and 62.97%, respectively. The EPR had values of 1.14±0.48 and 1.22±0.51 for iDose⁴ and IMR, respectively.
Conclusions: The iDose⁴ and IMR algorithms can effectively reduce noise levels while maintaining the anatomical structure. This study suggested automated evaluation measurements of noise levels and EPRs, which are important aspects in CT image quality with patients’ cases of FBP, iDose⁴, and IMR. We expect that the inclusion of other important image quality indices with a greater number of patients’ cases will enable the establishment of integrated platforms for monitoring both CT image quality and radiation dose.

Purpose: In this study, we aimed to manufacture a patient-specific gel phantom combining threedimensional (3D) printing and polymer gel and evaluate the radiation dose and dose profile using gel dosimetry.
Methods: The patient-specific head phantom was manufactured based on the patient’s computed tomography (CT) scan data to create an anatomically replicated phantom; this was then produced using a ColorJet 3D printer. A 3D polymer gel dosimeter called RTgel-100 is contained inside the 3D printing head phantom, and irradiation was performed using a 6 MV LINAC (Varian Clinac) X-ray beam, a linear accelerator for treatment. The irradiated phantom was scanned using magnetic resonance imaging (Siemens) with a magnetic field of 3 Tesla (3T) of the Korea Institute of Nuclear Medicine, and then compared the irradiated head phantom with the dose calculated by the patient's treatment planning system (TPS).
Results: The comparison between the Hounsfield unit (HU) values of the CT image of the patient and those of the phantom revealed that they were almost similar. The electron density value of the patient’s bone and brain was 996±167 HU and 58±15 HU, respectively, and that of the head phantom bone and brain material was 986±25 HU and 45±17 HU, respectively. The comparison of the data of TPS and 3D gel revealed that the difference in gamma index was 2%/2 mm and the passing rate was within 95%.
Conclusions: 3D printing allows us to manufacture variable density phantoms for patient-specific dosimetric quality assurance (DQA), develop a customized body phantom of the patient in the future, and perform a patient-specific dosimetry with film, ion chamber, gel, and so on.

Purpose: The purpose of this study was to compare the clinical quality assurance results of portal dosimetry using an electronic portal imaging device, a method that is extensively used for patientspecific quality assurance, and the newly released Mobius3D for intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT).
Methods: This retrospective study includes data from 122 patients who underwent IMRT and VMAT on the Novalis Tx and VitalBeam linear accelerators between April and June 2020. We used a paired t-test to compare portal dosimetry using an electronic portal imaging device and the average gamma passing rates of MobiusFX using log files regenerated after patient treatment.
Results: The average gamma passing rates of portal dosimetry (3%/3 mm) and MobiusFX (5%/3 mm) were 99.43%±1.02% and 99.32%±1.87% in V it alBeam and 97.53%±3.34% and 96.45%±13.94% in Novalis Tx, respectively. Comparison of the gamma passing rate results of portal dosimetry (3%/3 mm) and MobiusFX (5%/3 mm as per the manufacturer’s manual) does not show any statistically significant difference.
Conclusions: Log file-based patient-specific quality assurance, including independent dose calculation, can be appropriately used in clinical practice as a second-check dosimetry, and it is considered comparable with primary quality assurance such as portal dosimetry.

Purpose: To investigate the effects of dose rate on intensity-modulated radiation therapy (IMRT) quality assurance (QA).
Methods: We performed gamma tests using portal dose image prediction and log files of a multileaf collimator. Thirty treatment plans were randomly selected for the IMRT QA plan, and three verification plans for each treatment plan were generated with different dose rates (200, 400, and 600 monitor units [MU]/min). These verification plans were delivered to an electronic portal imager attached to a Varian medical linear accelerator, which recorded and compared with the planned dose. Root-mean-square (RMS) error values of the log files were also compared.
Results: With an increase in dose rate, the 2%/2-mm gamma passing rate decreased from 90.9% to 85.5%, indicating that a higher dose rate was associated with lower radiation delivery accuracy. Accordingly, the average RMS error value increased from 0.0170 to 0.0381 cm as dose rate increased. In contrast, the radiation delivery time reduced from 3.83 to 1.49 minutes as the dose rate increased from 200 to 600 MU/min.
Conclusions: Our results indicated that radiation delivery accuracy was lower at higher dose rates; however, the accuracy was still clinically acceptable at dose rates of up to 600 MU/min.

Purpose: This study aimed to design a multipurpose dose verification phantom for external audits to secure safe and optimal radiation therapy.
Methods: In this s tudy, we u sed I nternational Atomic Energy Agency (IAEA) LiF p owder thermoluminescence dosimeter (TLD), which is generally used in the therapeutic radiation dose assurance project. The newly designed multipurpose phantom (MPP) consists of a container filled with water, a TLD holder, and two water-pressing covers. The size of the phantom was designed to be sufficient (30×30×30 cm³). The water container was filled with water and pressed with the cover for normal incidence to be fixed. The surface of the MPP was devised to maintain the same distance from the source at all times, even in the case of oblique incidence regardless of the water level. The MPP was irradiated with 6, 10, and 15 MV photon beams from Varian Linear Accelerator and measured by a 1.25 cm³ ionization chamber to get the correction factors. Monte Carlo (MC) simulation was also used to compare the measurements.
Results: The result obtained by MC had a relatively high uncertainty of 1% at the dosimetry point, but it showed a correction factor value of 1.3% at the 5 cm point. The energy dependence was large at 6 MV and small at 15 MV. Various dosimetric parameters for external audits can be performed within an hour.
Conclusions: The results allow an objective comparison of the quality assurance (QA) of individual hospitals. Therefore, this can be employed for external audits or QA systems in radiation therapy institutions.

Purpose: The Halcyon radiotherapy platform at Groote Schuur Hospital was delivered with a factory-configured analytical anisotropic algorithm (AAA) beam model for dose calculation. In a recent system upgrade, the Acuros XB (AXB) algorithm was installed. Both algorithms adopt fundamentally different approaches to dose calculation. This study aimed to compare the dose distributions of cervical carcinoma RapidArc plans calculated using both algorithms.
Methods: A total of 15 plans previously calculated using the AAA were retrieved and recalculated using the AXB algorithm. Comparisons were performed using the planning target volume (PTV) maximum (max) and minimum (min) doses, D95%, D98%, D50%, D2%, homogeneity index (HI), and conformity index (CI). The mean and max doses and D2% were compared for the bladder, bowel, and femoral heads.
Results: The AAA calculated slightly higher targets, D98%, D95%, D50%, and CI, than the AXB algorithm (44.49 Gy vs. 44.32 Gy, P=0.129; 44.87 Gy vs. 44.70 Gy, P=0.089; 46.00 Gy vs. 45.98 Gy, P=0.154; and 0.51 vs. 0.50, P=0.200, respectively). For target min dose, D2%, max dose, and HI, the AAA scored lower than the AXB algorithm (41.24 Gy vs. 41.30 Gy, P=0.902; 47.34 Gy vs. 47.75 Gy, P<0.001; 48.62 Gy vs. 50.14 Gy, P<0.001; and 0.06 vs. 0.07, P=0.002, respectively). For bladder, bowel, and left and right femurs, the AAA calculated higher mean and max doses.
Conclusions: Statistically significant differences were observed for PTV D2%, max dose, HI, and bowel max dose (P>0.05).

Purpose: T his s tudy a imed t o i nvestigate t he a ccuracy o f h ead s catter f actor ( S_c) by applying a developed multi-leaf collimator (MLC) scatter source model for an unflattened photon beam.
Methods: Sets of S_c values were measured for various jaw-defined square and rectangular fields and MLC-defined square fields for developing dual-source model (DSM) and MLC scatter model. A 6 MV unflattened photon beam has been used. Measurements were performed using a 0.125 cm3 cylindrical ionization chamber and a mini phantom. Then, the parameters of both models have been optimized, and S_c has been calculated. The DSM and MLC scatter models have been verified by comparing the calculated values to the three S_c set measurement values of the jaw-defined field and the two S_c set measurement values of MLC-defined fields used in the existing modeling, respectively.
Results: For jaw-defined fields, the calculated S_c using the DSM was consistent with the measured S_c value. This demonstrates that the DSM was properly optimized and modeled for the measured values. For the MLC-defined fields, the accuracy between the calculated and measured S_c values with the addition of the MLC scatter source appeared to be high, but the only use of the DSM resulted in a significantly bigger differences.
Conclusions: Both the DSM and MLC models could also be applied to an unflattened beam. When considering scattered radiation from the MLC by adding an MLC scatter source model, it showed a higher degree of agreement with the actual measured S_c value than when using only DSM in the same way as in previous studies.

Purpose: During the treatments of cancer patients with a linear accelerator (LINAC) using photon beams with energies ≥8 MV, the components inside the LINAC head get activated through the interaction of photonuclear reaction (γ, n) and neutron capture (n, γ). We used spectroscopy and measured the dose rate for the LINAC in operation after the treatment ended.
Methods: We performed spectroscopy and dose rate measurements for three units of LINACs with a portable high-purity Germanium (HPGe) detector and a survey meter. The spectra were obtained after the beams were turned off. Spectroscopy was conducted for 3,600 seconds, and the dose rate was measured three times. We identified the radionuclides for each LINAC.
Results: According to gamma spectroscopy results, most of the nuclides were short-lived radionuclides with half-lives of 100 days, except for ⁶⁰Co, ⁶⁵Zn, and ¹⁸¹W nuclides. The dose rate for three LINACs obtained immediately in front of the crosshair was in the range of 0.113 to 0.129 μSv/h. The maximum and minimum dose rates measured on weekends were 0.097 μSv/h and 0.092 μSv/h, respectively. Compared with the differences in weekday data, there was no significant difference between the data measured on Saturday and Sunday.
Conclusions: Most of the detected radionuclides had half-lives <100 days, and the dose rate decreased rapidly. For equipment that primarily used energies ≤10 MV, when the equipment was transferred after at least 10 minutes after shutting it down, it is expected that there will be little effect on the workers’ exposure.

Purpose: This study evaluated the features of a pressure mapping system for patient motion monitoring in radiation therapy.
Methods: The pressure mapping system includes an MS 9802 force sensing resistor (FSR) sensor with 2,304 force sensing nodes using 48 columns and 48 rows, controller, and control PC (personal computer). Radiation beam attenuation caused by pressure mapping sensor and signal perturbation by 6 and 10 mega voltage (MV) photon beam was evaluated. The maximum relative pressure value (mRPV), average relative pressure value (aRPV), the center of pressure (COP), and area of pressure distribution were obtained with/without radiation using the upper body of an anthropomorphic phantom for 30 minutes with 15 MV.
Results: It was confirmed that the differences in attenuation induced by the FSR sensor for 6 and 10 MV photon beams were small. The differences in mRPV, aRPV, area of pressure distribution with/without radiation are about 0.6%, 1.2%, and 0.5%, respectively. The COP values with/without radiation were also similar.
Conclusions: The characteristics of a pressure mapping system during radiation treatment were evaluated on the basis of attenuation and signal perturbation using radiation. The pressure distribution measured using the FSR sensor with little attenuation and signal perturbation by the MV photon beam would be helpful for patient motion monitoring.