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  • Review Article 2017-12-31 2017-12-31 \ 4 \ 595 \ 375

    Physical Modeling of Chemical Exchange Saturation Transfer Imaging

    Geon-Ho Jahng, Jang-Hoon Oh

    https://doi.org/10.14316/pmp.2017.28.4.135

    Abstract

    Chemical Exchange Saturation Transfer (CEST) imaging is a method to detect solutes based on the chemical exchange of mobile protons with water. The solute protons exchange with three different patterns, which are fast, slow, and intermediate rates. The CEST contrast can be obtained from the exchangeable protons, which are hydroxyl protons, amine protons, and amide protons. The CEST MR imaging is useful to evaluate tumors, strokes, and other diseases. The purpose of this study is to review the mathematical model for CEST imaging and for measurement of the chemical exchange rate, and to measure the chemical exchange rate using a 3T MRI system on several amino acids. We reviewed the mathematical models for the proton exchange. Several physical models are proposed to demonstrate a two-pool, three-pool, and four-pool models. The CEST signals are also evaluated by taking account of the exchange rate, pH and the saturation efficiency. Although researchers have used most commonly in the calculation of CEST asymmetry, a quantitative analysis is also developed by using Lorentzian fitting. The chemical exchange rate was measured in the phantoms made of asparagine (Asn), glutamate (Glu), γ-aminobutyric acid (GABA), glycine (Gly), and myoinositol (MI). The experiment was performed at a 3T human MRI system with three different acidity conditions (pH 5.6, 6.2, and 7.4) at a concentration of 50 mM. To identify the chemical exchange rate, the “lsqcurvefit” built-in function in MATLAB was used to fit the pseudo-first exchange rate model. The pseudo-first exchange rate of Asn and Gly was increased with decreasing acidity. In the case of GABA, the largest result was observed at pH 6.2. For Glu, the results at pH 5.6 and 6.2 did not show a significant difference, and the results at pH 7.4 were almost zero. For MI, there was no significant difference at pH 5.6 or 7.4, however, the results at pH 6.2 were smaller than at the other pH values. For the experiment at 3T, we were only able to apply 1 s as the maximum saturation duration due to the limitations of the MRI system. The measurement of the chemical exchange rate was limited in a clinical 3T MRI system because of a hardware limitation.

  • Original Article 2017-12-31 2017-12-31 \ 0 \ 862 \ 456

    Dosimetric Impact of Ti Mesh on Proton Beam Therapy

    Shinhaeng Cho, Youngmoon Goh, Chankyu Kim, Haksoo Kim, Jong Hwi Jeong, Young Kyung Lim, Se Byeong Lee, Dongho Shin

    https://doi.org/10.14316/pmp.2017.28.4.144

    Abstract

    When a high density metallic implant is placed in the path of the proton beam, spatial heterogeneity can be caused due to artifacts in three dimensional (3D) computed tomography (CT) scans. These artifacts result in range uncertainty in dose calculation in treatment planning system (TPS). And this uncertainty may cause significant underdosing to the target volume or overdosing to normal tissue beyond the target. In clinical cases, metal implants must be placed in the beam path in order to preserve organ at risk (OARs) and increase target coverage for tumors. So we should introduce Ti-mesh. In this paper, we measured the lateral dose profile for proton beam using an EBT3 film to confirm dosimetric impact of Ti-mesh when the Ti-mesh plate was placed in the proton beam pathway. The effect of Ti-mesh on the proton beam was investigated by comparing the lateral dose profile calculated from TPS with the film-measured value under the same conditions.

  • Original Article 2017-12-31 2017-12-31 \ 1 \ 900 \ 448

    Quantitative Evaluation of Patient Positioning Error Using CBCT 3D Gamma Density Analysis in Radiotherapy

    Soon Sung Lee, Chul Kee Min, Gyu Suk Cho, Soorim Han, Kum Bae Kim, Haijo Jung, Sang Hyoun Choi

    https://doi.org/10.14316/pmp.2017.28.4.149

    Abstract

    Radiotherapy patients should maintain their treatment position as patient setup is very important for accurate treatment. In this study, we evaluated patient setup error quantitatively according to Cone-Beam Computed Tomography (CBCT) Gamma Density Analysis using Mobius CBCT. The adjusted setup error to the QUASAR™ phantom was moved artificially in the superior and lateral direction, and then we acquired the CBCT image according to the phantom setup error. To analyze the treatment setup error quantitatively, we compared values suggested in the CBCT system with the Mobius CBCT. This allowed us to evaluate the setup error using CBCT Gamma Density Analysis by comparing the planning CT with the CBCT. In addition, we acquired the 3D-gamma density passing rate according to the gamma density criteria and phantom setup error. When the movement was adjusted to only the phantom body or 3 cm diameter target inserted in the phantom, the CBCT system had a difference of approximately 1 mm, while Mobius CBCT had a difference of under 0.5 mm compared to the real setup error. When the phantom body and target moved 20 mm in the Mobius CBCT, there are 17.9 mm and 13.5 mm differences in the lateral and superior directions, respectively. The CBCT gamma density passing rate was reduced according to the increase in setup error, and the gamma density criteria of 0.1 g/cc/3 mm has 10% lower passing rate than the other density criteria. Mobius CBCT had a 2 mm setup error compared with the actual setup error. However, the difference was greater than 10 mm when the phantom body moved 20 mm with the target. Therefore, we should pay close attention when the patient’s anatomy changes.

  • Original Article 2017-12-31 2017-12-31 \ 1 \ 650 \ 471

    A Study on the Usefulness of Development of a Steam Sterilizer Equipped with an Electronic Bowie-Dick Test System

    Young Ok Bae, Jun Soo Hwang, Sung Il Kim, Joon Ha Lee

    https://doi.org/10.14316/pmp.2017.28.4.156

    Abstract

    To verify the usefulness of a steam sterilizer equipped with an electronic Bowie-Dick test system, this study was carried out using two methods, utilizing both a steam sterilizer and an electronic Bowie-Dick tester. The first method is to confirm the error detection of the chemical Bowie-Dick test pack and the electronic Bowie-Dick tester in a malfunctioning sterilizer environment. For this purpose, the Bowie-Dick test program for the steam sterilizer was used to test three types of test packs commonly used in hospitals and the electronic Bowie-Dick tester by changing the set values of temperature, time, and vacuum frequency. The second is an experiment to check the sterilizer’s normal operation with the electronic Bowie-Dick tester and the usefulness of grasping the cause of the malfunction. The results showed that the sterilization temperature was the same as that of the test pack at a temperature 1~6°C lower than the reference temperature of 134°C. In the test with the sterilization exposure time as a variable, there was a normal discoloration at a time difference of 30~90 s. In the experiment using the number of vacuum cycles, the test was correct by performing the normal discoloration only at the normal condition of 3 times. The test results of 30 hospitals were 100 failure tests by a total of 291 Bowie-Dick tests. Of these, the failure factors related to an internal temperature that the chemical test packs could not detect were the greatest, and the four factors related to temperature, including the internal temperature, were found to be 71.18% of total malfunctions. In addition, the Bowie-Dick tester was provided within 30 min after the start of the Bowie-Dick test to confirm the performance of the sterilizer and the detailed cause. A steam sterilizer equipped with an electronic Bowie-Dick test system is used to manage individual sterilizers. In the current steam sterilizer with many temperature-related errors, it is possible to check the malfunction of the temperature difference that the test pack cannot detect, and the cause of error for the sterilizer is immediately detected after the test. The steam sterilizer equipped with the electronic Bowie-Dick test system assists with infection control with accurate sterilizer performance assurance.

  • Original Article 2017-12-31 2017-12-31 \ 1 \ 665 \ 330

    Dosimetric Analysis on the Effect of Target Motion in the Delivery of Conventional IMRT, RapidArc and Tomotherapy

    Ju-Young Song

    https://doi.org/10.14316/pmp.2017.28.4.164

    Abstract

    One of the methods to consider the effect of respiratory motion of a tumor target in radiotherapy is to establish a treatment plan with the internal target volume (ITV) created based on an accurate analysis of the target motion displacement. When this method is applied to intensity modulated radiotherapy (IMRT), it is expected to yield a different treatment dose distribution under the motion condition according to the IMRT method. In this study, we prepared ITV-based IMRT plans with conventional IMRT using fixed gantry angle beams, RapidArc using volumetric modulated arc therapy, and tomotherapy using helical therapy. Then, the variation in dose distribution caused by the target motion was analyzed by the dose measurement in the actual motion condition. A delivery quality assurance plan was prepared for the established IMRT plan and the dose distribution in the actual motion condition was measured and analyzed using a two-dimensional diode detector placed on a moving phantom capable of simulating breathing movements. The dose measurement was performed considering only a uniform target shape and motion in the superior-inferior (SI) direction. In this condition, it was confirmed that the error of the dose distribution due to the target motion is minimum in tomotherapy. This is thought to be due to the characteristic of tomotherapy that treats the target sequentially by dividing it into several slices. When the target shape is uniform and the main target motion direction is SI, it is considered that tomotherapy for the ITV-based IMRT method has a characteristic which can reduce the dose difference compared with the plan dose under the target motion condition.

  • Original Article 2017-12-31 2017-12-31 \ 1 \ 871 \ 385

    Simulation and Experimental Studies of Real-Time Motion Compensation Using an Articulated Robotic Manipulator System

    Minsik Lee, Min-Seok Cho, Hoyeon Lee, Hyekyun Chung, Byungchul Cho

    https://doi.org/10.14316/pmp.2017.28.4.171

    Abstract

    The purpose of this study is to install a system that compensated for the respiration motion using an articulated robotic manipulator couch which enables a wide range of motions that a Stewart platform cannot provide and to evaluate the performance of various prediction algorithms including proposed algorithm. For that purpose, we built a miniature couch tracking system comprising an articulated robotic manipulator, 3D optical tracking system, a phantom that mimicked respiratory motion, and control software. We performed simulations and experiments using respiratory data of 12 patients to investigate the feasibility of the system and various prediction algorithms, namely linear extrapolation (LE) and double exponential smoothing (ES2) with averaging methods. We confirmed that prediction algorithms worked well during simulation and experiment, with the ES2-averaging algorithm showing the best results. The simulation study showed 43% average and 49% maximum improvement ratios with the ES2-averaging algorithm, and the experimental study with the QUASARTM phantom showed 51% average and 56% maximum improvement ratios with this algorithm. Our results suggest that the articulated robotic manipulator couch system with the ES2-averaging prediction algorithm can be widely used in the field of radiation therapy, providing a highly efficient and utilizable technology that can enhance the therapeutic effect and improve safety through a noninvasive approach.

  • Original Article 2017-12-31 2017-12-31 \ 1 \ 624 \ 371

    Evaluation of Dynamic Delivery Quality Assurance Process for Internal Target Volume Based RapidArc

    Ju-Young Song

    https://doi.org/10.14316/pmp.2017.28.4.181

    Abstract

    The conventional delivery quality assurance (DQA) process for RapidArc (Varian Medical Systems, Palo Alto, USA), has the limitation that it measures and analyzes the dose in a phantom material and cannot analyze the dosimetric changes under the motional organ condition. In this study, a DQA method was designed to overcome the limitations of the conventional DQA process for internal target volume (ITV) based RapidArc. The dynamic DQA measurement device was designed with a moving phantom that can simulate variable target motions. The dose distribution in the real volume of the target and organ-at-risk (OAR)s were reconstructed using 3DVH with the ArcCHECK (SunNuclear, Melbourne, USA) measurement data under the dynamic condition. A total of 10 ITV-based RapidArc plans for liver-cancer patients were analyzed with the designed dynamic DQA process. The average pass rate of gamma evaluation was 81.55±9.48% when the DQA dose was measured in the respiratory moving condition of the patient. Appropriate method was applied to correct the effect of moving phantom structures in the dose calculation, and DVH data of the real volume of target and OARs were created with the recalculated dose by the 3DVH program. We confirmed the valid dose coverage of a real target volume in the ITV-based RapidArc. The variable difference of the DVH of the OARs showed that dose variation can occur differently according to the location, shape, size and motion range of the target. The DQA process devised in this study can effectively evaluate the DVH of the real volume of the target and OARs in a respiratory moving condition in addition to the simple verification of the accuracy of the treatment machine. This can be helpful to predict the prognosis of treatment by the accurate dose analysis in the real target and OARs.

  • Original Article 2017-12-31 2017-12-31 \ 2 \ 1057 \ 375

    Implementation of AAPM’s TG-51 Protocol on Co-60 MRI-Guided Radiation Therapy System

    Jin Dong Cho, Jong Min Park,ΙΙ, Chang Heon Choi,ΙΙ, Jung-in Kim,ΙΙ, Hong-Gyun Wu,
    So-Yeon Park

    https://doi.org/10.14316/pmp.2017.28.4.190

    Abstract

    For the ViewRay® system (ViewRay Inc., Cleveland, OH, USA) which is representative of magnetic resonance (MR) guided radiotherapy machine, it is important to evaluate effectiveness of AAPM’s TG-51 protocol and the effect of the magnetic field on absolute dosimetry. In order to measure the absolute dose, MR-compatible chamber and water phantom system manufactured in this study were used. The materials of the water phantom system were plastic of polymethyl methacrylate (PMMA) and non-ferrous materials. Due to the inherent feature of the ViewRay®, all Co-60 sources are not located at gantry angle of 0° while being located at gantry angle of 90°. For this reason, absolute dosimetry was performed based on the measurements in solid water phantom (SWP) and water which determine the SWP to water correction factor. For evaluation of output constancy with gantry angle, measurements were made with ionization chamber inserted in cylindrical water-equivalent phantom. For measured doses in water, the values of dose deviation according to a reference dose of 200 cGy for Head 1, Head 2 and Head 3 were −0.27%, −0.45% and −0.22%, respectively. For measured doses in SWP, the values of dose deviation according to a reference dose of 200 cGy for Head 1, Head 2 and Head 3 were −1.91%, −2.07% and −1.84%, respectively. All values of dose measured in SWP tended to be less than those measured in water by −1.63%. With the reference gantry angles of 0° and 90°, the maximum values of deviation for Head 1, Head 2 and Head 3 were 0.48%, 1.06% and 0.40%, respectively. The measurement agreement is within the range of results obtainable for conventional treatment machines. The low strength of the magnetic field does not affect dose measurements. Using the SWP to water correction factor, absolute doses for ViewRay® system can be measured.

  • Original Article 2017-12-31 2017-12-31 \ 3 \ 1542 \ 477

    Proposal on Guideline for Quality Assurance of Radiation Treatment Planning System

    Yoonjin Oh, Dong Oh Shin, Juhye Kim, Nahye Kwon, Soon Sung Lee,ΙΙ, Sang Hyoun ChoiΙΙ, Sohyun Ahn, Dong-wook Park, Dong Wook Kim

    https://doi.org/10.14316/pmp.2017.28.4.197

    Abstract

    We develop guidelines for the quality assurance of radiation treatment planning systems (TPS) by comparing and reviewing recommendations from major countries and organizations, as well as by analyzing the AAPM, ESTRO, and IAEA TPS quality assurance guidelines. We establish quality assurance items for acceptance testing, commissioning, periodic testing, system management, and security, and propose methods to perform each item within acceptable standards. Acceptance includes tests of hardware and network environments, data transmission, software, and benchmarking as specified by the system supplier, and apply the IAEA classification criteria. Commissioning includes dosimetric and non-dosimetric items for assessing TPS performance by applying the AAPM classification criteria and the latest technical items from the IAEA. Periodic quality assurance tests include daily, weekly, monthly, yearly, and occasional items by applying the AAPM classification criteria. System management and security items include the state and network connectivity of TPS, periodic data backup, and data access security. The guidelines for TPS quality assurance proposed in this study will help to improve the safety and quality of radiotherapy by preventing incidents related to radiotherapy.

  • Original Article 2017-12-31 2017-12-31 \ 1 \ 618 \ 285

    Correction of Prompt Gamma Distribution for Improving Accuracy of Beam Range Determination in Inhomogeneous Phantom

    Jong Hoon Park, Sung Hun Kim, Youngmo Ku, Hyun Su Lee, Young-su Kim, Chan Hyeong Kim, Dong Ho Shin, Se Byeong Lee, Jong Hwi Jeong

    https://doi.org/10.14316/pmp.2017.28.4.207

    Abstract

    For effective patient treatment in proton therapy, it is therefore important to accurately measure the beam range. For measuring beam range, various researchers determine the beam range by measuring the prompt gammas generated during nuclear reactions of protons with materials. However, the accuracy of the beam range determination can be lowered in heterogeneous phantoms, because of the differences with respect to the prompt gamma production depending on the properties of the material. In this research, to improve the beam range determination in a heterogeneous phantom, we derived a formula to correct the prompt-gamma distribution using the ratio of the prompt gamma production, stopping power, and density obtained for each material. Then, the prompt-gamma distributions were acquired by a multi-slit prompt-gamma camera on various kinds of heterogeneous phantoms using a Geant4 Monte Carlo simulation, and the deduced formula was applied to the prompt-gamma distributions. For the case involving the phantom having bone-equivalent material in the soft tissue-equivalent material, it was confirmed that compared to the actual range, the determined ranges were relatively accurate both before and after correction. In the case of a phantom having the lung-equivalent material in the soft tissue-equivalent material, although the maximum error before correction was 18.7 mm, the difference was very large. However, when the correction method was applied, the accuracy was significantly improved by a maximum error of 4.1 mm. Moreover, for a phantom that was constructed based on CT data, after applying the calibration method, the beam range could be generally determined within an error of 2.5 mm. Simulation results confirmed the potential to determine the beam range with high accuracy in heterogeneous phantoms by applying the proposed correction method. In future, these methods will be verified by performing experiments using a therapeutic proton beam.

Korean Society of Medical Physics

Vol.35 No.4
2017-12-31

pISSN 2508-4445
eISSN 2508-4453
Formerly ISSN 1226-5829

Frequency: Quarterly

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