Korean Society of Medical Physics

Original Article

Influence of Two-Dimensional and Three-Dimensional Acquisitions of Radiomic Features for Prediction Accuracy

Progress in Medical Physics 2023; 34(3): 23-32

Technical Note

Comparison between Old and New Versions of Electron Monte Carlo (eMC) Dose Calculation

Progress in Medical Physics 2023; 34(2): 15-22

Technical Note

Clinical Impact of Patient’s Head Position in Supraclavicular Irradiation of the Whole Breast Radiotherapy

Progress in Medical Physics 2023; 34(1): 10-13

Original Article

Feasibility of a Linear Diode Array Detector for Commissioning of a Radiotherapy Planning System

Progress in Medical Physics 2023; 34(1): 1-9

Original Article 2023-09-30

Influence of Two-Dimensional and Three-Dimensional Acquisitions of Radiomic Features for Prediction Accuracy

Ryohei Fukui , Ryutarou Matsuura , Katsuhiro Kida , Sachiko Goto

Progress in Medical Physics 2023; 34(3): 23-32
https://doi.org/10.14316/pmp.2023.34.3.23

Abstract

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Purpose: In radiomics analysis, to evaluate features, and predict genetic characteristics and survival time, the pixel values of lesions depicted in computed tomography (CT) and magnetic resonance imaging (MRI) images are used. CT and MRI offer three-dimensional images, thus producing three-dimensional features (Features_3d) as output. However, in reports, the superiority between Features_3d and two-dimensional features (Features_2d) is distinct. In this study, we aimed to investigate whether a difference exists in the prediction accuracy of radiomics analysis of lung cancer using Features_2d and Features_3d.
Methods: A total of 38 cases of large cell carcinoma (LCC) and 40 cases of squamous cell carcinoma (SCC) were selected for this study. Two- and three-dimensional lesion segmentations were performed. A total of 774 features were obtained. Using least absolute shrinkage and selection operator regression, seven Features_2d and six Features_3d were obtained.
Results: Linear discriminant analysis revealed that the sensitivities of Features_2d and Features_3d to LCC were 86.8% and 89.5%, respectively. The coefficients of determination through multiple regression analysis and the areas under the receiver operating characteristic curve (AUC) were 0.68 and 0.70 and 0.93 and 0.94, respectively. The P-value of the estimated AUC was 0.87.
Conclusions: No difference was found in the prediction accuracy for LCC and SCC between Features_2d and Features_3d.
Original Article 2023-09-30

Initial Dosimetry of a Prototype Ultra-High Dose Rate Electron-Beam Irradiator for FLASH RT Preclinical Studies

Hyun Kim , Heuijin Lim , Sang Koo Kang , Sang Jin Lee , Tae Woo Kang , Seung Wook Kim , Wung-Hoa Park , Manwoo Lee , Kyoung Won Jang , Dong Hyeok Jeong

Progress in Medical Physics 2023; 34(3): 33-39
https://doi.org/10.14316/pmp.2023.34.3.33

Abstract

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Purpose: FLASH radiotherapy (RT) using ultra-high dose rate (>40 Gy/s) radiation is being studied worldwide. However, experimental studies such as preclinical studies using small animals are difficult to perform due to the limited availability of irradiation devices and methods for generating a FLASH beam. In this paper, we report the initial dosimetry results of a prototype electron linear accelerator (LINAC)-based irradiation system to perform ultra-high dose rate (UHDR) preclinical experiments.
Methods: The present study used the prototype electron LINAC developed by the Research Center of Dongnam Institute of Radiological and Medical Sciences (DIRAMS) in Korea. We investigated the beam current dependence of the depth dose to determine the optimal beam current for preclinical experiments. The dose rate in the UHDR region was measured by film dosimetry.
Results: Depth dose measurements showed that the optimal beam current for preclinical experiments was approximately 33 mA, corresponding to a mean energy of 4.4 MeV. Additionally, the average dose rates of 80.4 Gy/s and 162.0 Gy/s at a source-to-phantom surface distance of 30 cm were obtained at pulse repetition frequencies of 100 Hz and 200 Hz, respectively. The dose per pulse and instantaneous dose rate were estimated to be approximately 0.80 Gy and 3.8×10⁵ Gy/s, respectively.
Conclusions: Film dosimetry verified the appropriate dose rates to perform FLASH RT preclinical studies using the developed electron-beam irradiator. However, further research on the development of innovative beam monitoring systems and stabilization of the accelerator beam is required.

Original Article 2021-12-31

A Comparison between Portal Dosimetry and Mobius3D Results for Patient-Specific Quality Assurance in Radiotherapy

Sung Yeop Kim¹ , Jaehyeon Park^2,3 , Jae Won Park^2,3 , Ji Woon Yea^2,3 , Se An Oh^2,3

Progress in Medical Physics 2021; 32(4): 107-115
https://doi.org/10.14316/pmp.2021.32.4.107

Abstract

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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.
Original Article 2021-12-31

Dosimetric Comparison between Varian Halcyon Analytical Anisotropic Algorithm and Acuros XB Algorithm for Planning of RapidArc Radiotherapy of Cervical Carcinoma

Jonathan Mbewe , Sakhele Shiba

Progress in Medical Physics 2021; 32(4): 130-136
https://doi.org/10.14316/pmp.2021.32.4.130

Abstract

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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).
Review Article 2022-06-30

Halide Perovskites for X‑ray Detection: The Future of Diagnostic Imaging

Nam Joong Jeon¹ , Jung Min Cho² , Jung-Keun Lee³

Progress in Medical Physics 2022; 33(2): 11-24
https://doi.org/10.14316/pmp.2022.33.2.11

Abstract

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X-ray detection has widely been applied in medical diagnostics, security screening, nondestructive testing in the industry, etc. Medical X-ray imaging procedures require digital flat detectors operating with low doses to reduce radiation health risks. Recently, metal halide perovskites (MHPs) have shown great potential in high-performance X-ray detection because of their attractive properties, such as strong X-ray absorption, high mobility–lifetime product, tunable bandgap, lowtemperature fabrication, near-unity photoluminescence quantum yields, and fast photoresponse. In this paper, we review and introduce the development status of new perovskite X-ray detectors and imaging, which have emerged as a new promising high-sensitivity X-ray detection technology. We discuss the latest progress and future perspective of MHP-based X-ray detection in medical imaging. Finally, we compare the conventional detection methods with quantum-enhanced detection, pointing out the challenges and perspectives for future research directions toward perovskite-based X-ray applications.
Original Article 2022-09-30

Comparison of Dose Statistics of Intensity-Modulated Radiation Therapy Plan from Varian Eclipse Treatment Planning System with Novel Python-Based Indigenously Developed Software

Sougoumarane Dashnamoorthy¹ , Karthick Rajamanickam¹ , Ebenezar Jeyasingh² , Vindhyavasini Prasad Pandey³ , Kathiresan Nachimuthu¹ , Imtiaz Ahmed⁴ , Pitchaikannu Venkatraman⁵

Progress in Medical Physics 2022; 33(3): 25-35
https://doi.org/10.14316/pmp.2022.33.3.25

Abstract

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Purpose: Planning for radiotherapy relies on implicit estimation of the probability of tumor control and the probability of complications in adjacent normal tissues for a given dose distribution.
Methods: The aim of this pilot study was to reconstruct dose-volume histograms (DVHs) from text files generated by the Eclipse treatment planning system developed by Varian Medical Systems and to verify the integrity and accuracy of the dose statistics.
Results: We further compared dose statistics for intensity-modulated radiotherapy of the head and neck between the Eclipse software and software developed in-house. The dose statistics data obtained from the Python software were consistent, with deviations from the Eclipse treatment planning system found to be within acceptable limits.
Conclusions: The in-house software was able to provide indices of hotness and coldness for treatment planning and store statistical data generated by the software in Oracle databases. We believe the findings of this pilot study may lead to more accurate evaluations in planning for radiotherapy.
Original Article 2021-12-31

Evaluating the Effects of Dose Rate on Dynamic Intensity-Modulated Radiation Therapy Quality Assurance

Kwon Hee Kim^1,2 , Tae Seong Back² , Eun Ji Chung² , Tae Suk Suh¹ , Wonmo Sung¹

Progress in Medical Physics 2021; 32(4): 116-121
https://doi.org/10.14316/pmp.2021.32.4.116

Abstract

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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.
Technical Note 2022-12-31

50–300 kVp X-ray Transmission Ratios for Lead, Steel and Concrete

Tae Hwan Kim^2,5 , Kum Bae Kim³ , Geun Beom Kim¹ , Dong Wook Kim³ , Sang Rok Kim² , Sang Hyoun Choi¹

Progress in Medical Physics 2022; 33(4): 164-171
https://doi.org/10.14316/pmp.2022.33.4.164

Abstract

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The number of facilities using radiation generators increases and related regulations are strengthened, the establishment of a shielding management and evaluation technology has become important. The characteristics of the radiation generator used in previous report differ from those of currently available high-frequency radiation generators. This study aimed to manufacture lead, iron, and concrete shielding materials for the re-verification of half-value layers, tenth-value layers, and attenuation curve. For a comparison of attenuation ratio, iron, lead, and concrete shields were manufactured in this study. The initial dose was measured without shielding materials, and doses measured under different types and thicknesses of shielding material were compared with the initial dose to calculate the transmission rate on 50–300 kVp X-ray. All the three shielding materials showed a tendency to require greater shielding thickness for higher energy. The attenuation graph showed an exponential shape as the thickness decreased and a straight line as the thickness increased. The difference between the measurement results and the previous study, except in extrapolated parts, may be due to the differences in the radiation generation characteristics between the generators used in the two studies. The attenuated graph measured in this study better reflects the characteristics of current radiation generators, which would be more effective for shield designing.
Review Article 2022-12-31

Image Guided Radiation Therapy

Ui-Jung Hwang¹ , Byong Jun Min² , Meyoung Kim³ , Ki-Hwan Kim¹

Progress in Medical Physics 2022; 33(4): 37-52
https://doi.org/10.14316/pmp.2022.33.4.37

Abstract

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Over the past decades, radiation therapy combined with imaging modalities that ensure optimal image guidance has revolutionized cancer treatment. The two major purposes of using imaging modalities in radiotherapy are to clearly delineate the target prior to treatment and set up the patient during radiation delivery. Image guidance secures target position prior to and during the treatment. High quality images provide an accurate definition of the treatment target and the possibility to reduce the treatment margin of the target volume, further lowering radiation toxicity and improving the quality of life of cancer patients. In this review, the various types of image guidance modalities used in radiation therapy are distinguished into ionized (kilovoltage and megavoltage image) and nonionized imaging (magnetic resonance image, ultrasound, surface imaging, and radiofrequency). The functional aspects, advantages, and limitation of imaging using these modalities are described as a subsection of each category. This review only focuses on the technological viewpoint of these modalities and any clinical aspects are omitted. Image guidance is essential, and its importance is rapidly increasing in modern radiotherapy. The most important aspect of using image guidance in clinical settings is to monitor the performance of image quality, which must be checked during the periodic quality assurance process.
Review Article 2021-12-31

Status of Domestic and International Recommendations for Protection Design and Evaluation of Medical Linear Accelerator Facilities

Sang Hyoun Choi¹ , Dong Oh Shin² , Jae-ik Shin³ , Na Hye Kwon³ , So Hyun Ahn³ , Dong Wook Kim³

Progress in Medical Physics 2021; 32(4): 83-91
https://doi.org/10.14316/pmp.2021.32.4.83

Abstract

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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.
Original Article 2021-12-31

Measurements of Neutron Activation and Dose Rate Induced by High-Energy Medical Linear Accelerator

Na Hye Kwon¹ , Young Jae Jang^2,4 , Jinsung Kim¹ , Kum Bae Kim⁴ , Jaeryong Yoo³ , So Hyun Ahn¹ , Dong Wook Kim¹ , Sang Hyoun Choi⁴

Progress in Medical Physics 2021; 32(4): 145-152
https://doi.org/10.14316/pmp.2021.32.4.145

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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.
Original Article 2021-12-31

Effect of Total Collimation Width on Relative Electron Density, Effective Atomic Number, and Stopping Power Ratio Acquired by Dual-Layer Dual-Energy Computed Tomography

Seongmoon Jung^1,2,3 , Bitbyeol Kim¹ , Euntaek Yoon⁴ , Jung-in Kim^1,2,3 , Jong Min Park^1,2,3,4,5,6 , Chang Heon Choi^1,2,3

Progress in Medical Physics 2021; 32(4): 165-171
https://doi.org/10.14316/pmp.2021.32.4.165

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Purpose: This study aimed to evaluate the effect of collimator width on effective atomic number (EAN), relative electron density (RED), and stopping power ratio (SPR) measured by dual-layer dual-energy computed tomography (DL-DECT).
Methods: CIRS electron density calibration phantoms with two different arrangements of material plugs were scanned by DL-DECT with two different collimator widths. The first phantom included two dense bone plugs, while the second excluded dense bone plugs. The collimator widths selected were 64 mm×0.625 mm for wider collimators and 16 mm×0.625 mm for narrow collimators. The scanning parameters were 120 kVp, 0.33 second gantry rotation, 3 mm slice thickness, B reconstruction filter, and spectral level 4. An image analysis portal system provided by a computed tomography (CT) manufacturer was used to derive the EAN and RED of the phantoms from the combination of low energy and high energy CT images. The EAN and RED were compared between the images scanned using the two different collimation widths.
Results: The CT images with the wider collimation width generated more severe artifacts, particularly with high-density material (i.e., dense bone). RED and EAN for tissues (excluding lung and bones) with the wider collimation width showed significant relative differences compared to the theoretical value (4.5% for RED and 20.6% for EAN), while those with the narrow collimation width were closer to the theoretical value of each material (2.2% for EAN and 2.3% for RED). Scanning with narrow collimation width increased the accuracy of SPR estimation even with highdensity bone plugs in the phantom.
Conclusions: The effect of CT collimation width on EAN, RED, and SPR measured by DL-DECT was evaluated. In order to improve the accuracy of the measured EAN, RED, and SPR by DL-DECT, CT scanning should be performed using narrow collimation widths.
Original Article 2021-12-31

Characteristic Evaluation of Pressure Mapping System for Patient Position Monitoring in Radiation Therapy

Seonghee Kang^1,2,3 , Chang Heon Choi^1,2,3 , Jong Min Park^1,2,3 , Jin-Beom Chung⁴ , Keun-Yong Eom⁴ , Jung-in Kim^1,2,3

Progress in Medical Physics 2021; 32(4): 153-158
https://doi.org/10.14316/pmp.2021.32.4.153

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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.
Original Article 2021-12-31

Development of a Beam Source Modeling Approach to Calculate Head Scatter Factors for a 6 MV Unflattened Photon Beam

So-Yeon Park , Noorie Choi , Na Young Jang

Progress in Medical Physics 2021; 32(4): 137-144
https://doi.org/10.14316/pmp.2021.32.4.137

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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.
Review Article 2022-12-31

Review of Shielding Evaluation Methodology for Facilities Using kV Energy Radiation Generating Devices Based on the NCRP-49 Report

Na Hye Kwon^1,2 , Hye Sung Park³ , Taehwan Kim^4,5 , Sang Rok Kim⁵ , Kum Bae Kim^6,7 , Jin Sung Kim^1,2,8 , Sang Hyoun Choi^6,7 , Dong Wook Kim^1,2

Progress in Medical Physics 2022; 33(4): 53-62
https://doi.org/10.14316/pmp.2022.33.4.53

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In this study, we have investigated the shielding evaluation methodology for facilities using kV energy generators. We have collected and analysis of safety evaluation criteria and methodology for overseas facilities using radiation generators. And we investigated the current status of shielding evaluation of domestic industrial radiation generators. According to the statistical data from the Radiation Safety Information System, as of 2022, a total of 7,679 organizations are using radiation generating devices. Among them, 6,299 facilities use these devices for industrial purposes, which accounts for a considerable portion of radiation. The organizations that use these devices evaluate whether the exposure dose for workers and frequent visitors is suitable as per the limit regulated by the Nuclear Safety Act. Moreover, during this process, the safety shields are evaluated at the facilities that use the radiation generating devices. However, the facilities that use radiating devices having energy less than or equal to 6 MV for industrial purposes are still mostly evaluated and analyzed according to the National Council on Radiation Protection and Measurements 49 (NCRP 49) report published in 1976. We have investigated the technical standards of safety management, including the maximum permissible dose and parameters assessment criteria for facilities using radiation generating devices, based on the NCRP 49 and the American National Standards Institute/Health Physics Society N.43.3 reports, which are the representative reports related to radiation shielding management cases overseas.
Original Article 2022-03-31

Effective Volume of the Korea Research Institute of Standards and Science Free Air Chamber L1 for Low-Energy X-Ray Measurement

Chul-Young Yi¹ , Yun Ho Kim¹ , Don Yeong Jeong²

Progress in Medical Physics 2022; 33(1): 1-9
https://doi.org/10.14316/pmp.2022.33.1.1

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Purpose: To evaluate the effective volume of the Korea Research Institute of Standards and Science free air chamber (KRISS FAC) L1 used for the primary standard device of the low-energy X-ray air kerma.
Methods: The mechanical dimensions were measured using a 3-dimensional coordinate measuring machine (3-d CMM, Model UMM 500, Carl Zeiss). The diameter of the diaphragm was measured by a ring gauge calibrator (Model KRISS-DM1, KRISS). The elongation of the collector length due to electric field distortion was determined from the capacitance measurement of the KRISS FAC considering the result of the finite element method (FEM) analysis using the code QuickField v6.4.
Results: The measured length of the collector was 15.8003±0.0014 mm with a 68% confidence level (k =1). The aperture diameter of the diaphragm was 10.0021±0.0002 mm (k =1). The mechanical measurement volume of the KRISS FAC L1 was 1.2415±0.0006 cm³ (k =1). The elongated length of the collector due to the electric field distortion was 0.170±0.021 mm. Considering the elongated length, the effective measurement volume of the KRISS FAC L1 was 1.2548±0.0019 cm³ (k =1).
Conclusions: The effective volume of the KRISS FAC L1 was determined from the mechanically measured value by adding the elongated volume due to the electric field distortion in the FAC. The effective volume will replace the existing mechanically determined volume in establishing and maintaining the primary standard of the low-energy X-ray.
Original Article 2021-12-31

Estimation of Noise Level and Edge Preservation for Computed Tomography Images: Comparisons in Iterative Reconstruction

Sihwan Kim¹ , Chulkyun Ahn² , Woo Kyoung Jeong³ , Jong Hyo Kim^1,4,5,6,7 , Minsoo Chun^7,8

Progress in Medical Physics 2021; 32(4): 92-98
https://doi.org/10.14316/pmp.2021.32.4.92

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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.
Original Article 2021-12-31

Dosimetric Study Using Patient-Specific Three-Dimensional-Printed Head Phantom with Polymer Gel in Radiation Therapy

Yona Choi^1,2 , Kook Jin Chun² , Eun San Kim² , Young Jae Jang^1,2 , Ji-Ae Park³ , Kum Bae Kim¹ , Geun Hee Kim⁴ , Sang Hyoun Choi¹

Progress in Medical Physics 2021; 32(4): 99-106
https://doi.org/10.14316/pmp.2021.32.4.99

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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.
Original Article 2021-12-31

Design of Multipurpose Phantom for External Audit on Radiotherapy

Sangwook Lim

Progress in Medical Physics 2021; 32(4): 122-129
https://doi.org/10.14316/pmp.2021.32.4.122

Abstract

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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.
Original Article 2022-12-31

Measurement of Proton Beam Dose-Averaged Linear Energy Transfer Using a Radiochromic Film

Seohyeon An^1,2 , Sang-il Pak¹ , Seonghoon Jeong¹ , Soonki Min³ , Tae Jeong Kim² , Dongho Shin¹ , Youngkyung Lim¹ , Jong Hwi Jeong¹ , Haksoo Kim¹ , Se Byeong Lee¹

Progress in Medical Physics 2022; 33(4): 80-87
https://doi.org/10.14316/pmp.2022.33.4.80

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Purpose: Proton therapy has different relative biological effectiveness (RBE) compared with X-ray treatment, which is the standard in radiation therapy, and the fixed RBE value of 1.1 is widely used. However, RBE depends on a charged particle’s linear energy transfer (LET); therefore, measuring LET is important. We have developed a LET measurement method using the inefficiency characteristic of an EBT3 film on a proton beam’s Bragg peak (BP) region.
Methods: A Gafchromic EBT3 film was used to measure the proton beam LET. It measured the dose at a 10-cm pristine BP proton beam in water to determine the quenching factor of the EBT3 film as a reference beam condition. Monte Carlo (MC) calculations of dose-averaged LET (LET_d) were used to determine the quenching factor and validation. The dose-averaged LETs at the 12-, 16-, and 20-cm pristine BP proton beam in water were calculated with the quenching factor.
Results: Using the passive scattering proton beam nozzle of the National Cancer Center in Korea, the LET_d was measured for each beam range. The quenching factor was determined to be 26.15 with 0.3% uncertainty under the reference beam condition. The dose-averaged LETs were measured for each test beam condition.
Conclusions: We developed a method for measuring the proton beam LET using an EBT3 film. This study showed that the magnitude of the quenching effect can be estimated using only one beam range, and the quenching factor determined under the reference condition can be applied to any therapeutic proton beam range.
Original Article 2021-12-31

Assessing Commercial CLEANBOLUS Based on Silicone for Clinical Use

Jaeman Son^1,2 , Seongmoon Jung^1,2 , Jong Min Park^1,2,3,4 , Chang Heon Choi^1,2,3 , Jung-in Kim^1,2,3

Progress in Medical Physics 2021; 32(4): 159-164
https://doi.org/10.14316/pmp.2021.32.4.159

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Purpose: We investigated the properties of CLEANBOLUS based on silicone with suitable characteristics for clinical use.
Methods: We evaluated the characteristics of CLEANBOLUS and compared the results with the commercial product (Super-Flex bolus). Also, we conducted physical evaluations, including shore hardness, element composition, and elongation break. Transparency was investigated through the measured absorbance within the visible region (400–700 nm). Also, dosimetric characteristics were investigated with surface dose and beam quality. Finally, the volume of unwanted air gap was investigated based on computed tomography images for breast, chin, and nose using Super-Flex bolus and CELANBOLUS.
Results: CLEANBOLUS showed excellent physical properties for a low shore hardness (000–35) and elongation break (>1,000%). Additionally, it was shown that CLEANBOLUS is more transparent than Super-Flex bolus. Dosimetric results obtained through measurement and calculation have an electron density similar to water in CLEANBOLUS. Finally, CLEANBOLUS showed that the volume of unwanted air gap between the phantom and each bolus is smaller than Super-Flex bolus for breast, chin, and nose.
Conclusions: The physical properties of CLEANBOLUS, including excellent adhesive strength and lower shore hardness, reduce unwanted air gaps and ensure accurate dose distribution. Therefore, it would be an alternative to other boluses, thus improving clinical use efficiency.
Original Article 2021-12-31

Synthetic Computed Tomography Generation while Preserving Metallic Markers for Three-Dimensional Intracavitary Radiotherapy: Preliminary Study

Hyeongmin Jin¹ , Seonghee Kang¹ , Hyun-Cheol Kang¹ , Chang Heon Choi^1,2

Progress in Medical Physics 2021; 32(4): 172-178
https://doi.org/10.14316/pmp.2021.32.4.172

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Purpose: This study aimed to develop a deep learning architecture combining two task models to generate synthetic computed tomography (sCT) images from low-tesla magnetic resonance (MR) images to improve metallic marker visibility.
Methods: Twenty-three patients with cervical cancer treated with intracavitary radiotherapy (ICR) were retrospectively enrolled, and images were acquired using both a computed tomography (CT) scanner and a low-tesla MR machine. The CT images were aligned to the corresponding MR images using a deformable registration, and the metallic dummy source markers were delineated using threshold-based segmentation followed by manual modification. The deformed CT (dCT), MR, and segmentation mask pairs were used for training and testing. The sCT generation model has a cascaded three-dimensional (3D) U-Net-based architecture that converts MR images to CT images and segments the metallic marker. The performance of the model was evaluated with intensity-based comparison metrics.
Results: The proposed model with segmentation loss outperformed the 3D U-Net in terms of errors between the sCT and dCT. The structural similarity score difference was not significant.
Conclusions: Our study shows the two-task-based deep learning models for generating the sCT images using low-tesla MR images for 3D ICR. This approach will be useful to the MR-only workflow in high-dose-rate brachytherapy.
Original Article 2022-12-31

Dosimetric Evaluation of Synthetic Computed Tomography Technique on Position Variation of Air Cavity in Magnetic Resonance-Guided Radiotherapy

Hyeongmin Jin^1,2 , Hyun Joon An¹ , Eui Kyu Chie^1,2,3 , Jong Min Park^1,2,3 , Jung-in Kim^1,2

Progress in Medical Physics 2022; 33(4): 142-149
https://doi.org/10.14316/pmp.2022.33.4.142

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Purpose: This study seeks to compare the dosimetric parameters of the bulk electron density (ED) approach and synthetic computed tomography (CT) image in terms of position variation of the air cavity in magnetic resonance-guided radiotherapy (MRgRT) for patients with pancreatic cancer.
Methods: This study included nine patients that previously received MRgRT and their simulation CT and magnetic resonance (MR) images were collected. Air cavities were manually delineated on simulation CT and MR images in the treatment planning system for each patient. The synthetic CT images were generated using the deep learning model trained in a prior study. Two more plans with identical beam parameters were recalculated with ED maps that were either manually overridden by the cavities or derived from the synthetic CT. Dose calculation accuracy was explored in terms of dose-volume histogram parameters and gamma analysis.
Results: The D_95% averages were 48.80 Gy, 48.50 Gy, and 48.23 Gy for the original, manually assigned, and synthetic CT-based dose distributions, respectively. The greatest deviation was observed for one patient, whose D_95% to synthetic CT was 1.84 Gy higher than the original plan.
Conclusions: The variation of the air cavity position in the gastrointestinal area affects the treatment dose calculation. Synthetic CT-based ED modification would be a significant option for shortening the time-consuming process and improving MRgRT treatment accuracy.
Original Article 2023-03-31

Feasibility of a Linear Diode Array Detector for Commissioning of a Radiotherapy Planning System

Seung Mo Hong , Uiseob Lee , Sung-woo Kim , Youngmoon Goh , Min-Jae Park , Chiyoung Jeong , Jungwon Kwak , Byungchul Cho

Progress in Medical Physics 2023; 34(1): 1-9
https://doi.org/10.14316/pmp.2023.34.1.1

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Purpose: Although ionization chambers are widely used to measure beam commissioning data, point-by-point measurements of all the profiles with various field size and depths are timeconsuming tasks. As an alternative, we investigated the feasibility of a linear diode array for commissioning a treatment planning system.
Methods: The beam data of a Varian TrueBeam^® radiotherapy system at 6 and 10 MV with/without a flattening filter were measured for commissioning of an Eclipse Analytical Anisotropic Algorithm (AAA) ver.15.6. All of the necessary beam data were measured using an IBA CC13 ionization chamber and validated against Varian “Golden Beam” data. After validation, the measured CC13 profiles were used for commissioning the Eclipse AAA (AAA_CC13). In addition, an IBA LDA-99SC linear diode array detector was used to measure all of the beam profiles and for commissioning a separate model (AAA_LDA99). Finally, the AAA_CC13 and AAA_LDA99 dose calculations for each of the 10 clinical plans were compared.
Results: The agreement of the CC13 profiles with the Varian Golden Beam data was confirmed within 1% except in the penumbral region, where ≤2% of a discrepancy related to machinespecific jaw calibration was observed. Since the volume was larger for the CC13 chamber than for the LDA-99SC chamber, the penumbra widths were larger in the CC13 profiles, resulting in ≤5% differences. However, after beam modeling, the penumbral widths agreed within 0.1 mm. Finally the AAA_LDA99 and AAA_CC13 dose distributions agreed within 1% for all voxels inside the body for the 10 clinical plans.
Conclusions: In conclusion, the LDA-99SC diode array detector was found to be accurate and efficient for measuring photon beam profiles to commission treatment planning systems.
Original Article 2022-12-31

Proficiency Test for the Dosimetry Audit Service Provider

Chul-Young Yi , In Jung Kim , Jong In Park , Yun Ho Kim , Young Min Seong

Progress in Medical Physics 2022; 33(4): 72-79
https://doi.org/10.14316/pmp.2022.33.4.72

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Purpose: The proficiency test was conducted to assess the performance of the dosimetry audit service provider in the readout practice of the dose delivered to patients in medical institutions.
Methods: A certain amount of the absorbed dose to water for the high-energy X-ray from the medical linear accelerator (LINAC) installed in the Korea Research Institute of Standards and Science (KRISS) was delivered to the postal dose audit package given by the dosimetry audit service provider, in which the radio-photoluminescence (RPL) glass dosimeters were mounted. The dosimetry audit service provider read the RPL glass dosimeters and sent the readout dose value with its uncertainty to KRISS. The performance of the dosimetry audit service provider was evaluated based on the E_n number given in ISO/IEC 17043:2010.
Results: The evaluated E_n number was −0.954. Based on the ISO/IEC 17043, the performance of the dosimetry service provider is “satisfactory.”
Conclusions: As part of the conformity assessment, the KRISS performed the proficiency test over the postal dose audit practice run by the dosimetry audit service provider. The proficiency test is in line with confirming the traceability of the medical institutions to the primary standard of absorbed dose to the water of the KRISS and ensuring the confidence of the dosimetry audit service provider.
Technical Note 2022-12-31

TET2DICOM-GUI: Graphical User Interface Based TET2DICOM Program to Convert Tetrahedral-Mesh-Phantom to DICOM-RT Dataset

Se Hyung Lee^1,2 , Bo-Wi Cheon³ , Chul Hee Min³ , Haegin Han¹ , Chan Hyeong Kim¹ , Min Cheol Han⁴ , Seonghoon Kim⁵

Progress in Medical Physics 2022; 33(4): 172-179
https://doi.org/10.14316/pmp.2022.33.4.172

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Recently, tetrahedral phantoms have been newly adopted as international standard mesh-type reference computational phantoms (MRCPs) by the International Commission on Radiological Protection, and a program has been developed to convert them to computational tomography images and DICOM-RT structure files for application of radiotherapy. Through this program, the use of the tetrahedral standard phantom has become available in clinical practice, but utilization has been difficult due to various library dependencies requiring a lot of time and effort for installation. To overcome this limitation, in this study a newly developed TET2DICOM-GUI, a TET2DICOM program based on a graphical user interface (GUI), was programmed using only the MATLAB language so that it can be used without additional library installation and configuration. The program runs in the same order as TET2DICOM and has been optimized to run on a personal computer in a GUI environment. A tetrahedron-based male international standard human phantom, MRCP-AM, was used to evaluate TET2DICOM-GUI. Conversion into a DICOM-RT dataset applicable in clinical practice in about one hour with a personal computer as a basis was confirmed. Also, the generated DICOM-RT dataset was confirmed to be effectively implemented in the radiotherapy planning system. The program developed in this study is expected to replace actual patient data in future studies.
Technical Note 2021-12-31

Dosimetric Characteristics of Flexible Radiochromic Film Based on LiPCDA

Seongmoon Jung^1,3,4 , Jin Dong Cho^2,3,4 , Jung-in Kim^1,3,4 , Jong Min Park^1,3,4,5,6 , Chang Heon Choi^1,3,4

Progress in Medical Physics 2021; 32(4): 179-184
https://doi.org/10.14316/pmp.2021.32.4.179

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This study aimed to determine the optimal thickness of the active layer and scan mode for a flexible radiochromic film (F-RCF) based on the active lithium salt of pentacosa-10,12-diynoic acid (LiPCDA). F-RCFs of 90, 120, 140, and 170-μm thickness were fabricated using LiPCDA. Several pieces of the F-RCFs were exposed to doses ranging from 0 to 3 Gy. Transmission and reflection modes were used to scan the irradiated F-RCFs. Their dose-response curves were obtained using a second-order polynomial equation. Their sensitivity was evaluated for both scanning modes, and the uniformity of the batch was also examined. For both the transmission and reflection modes, the sensitivity increased as the film thickness increased. For the reflection mode, the dose response increased dramatically under 1 Gy. The value of the net optical density varied rapidly as the thickness of the film increased. However, the dose-response curves showed a supralinear-curve relationship at doses greater than 2 Gy. The sensitivity of the reflection scan at doses greater than 2 Gy was higher than that of the reflection scan within 0–2 Gy. The sensitivity steadily decreased with increasing doses, and the sensitivity of the two modes was within 0.1 to 0.2 at 2 Gy and was saturated beyond that. For the transmission scan, the sensitivity was approximately 0.2 at 3 Gy. For the intra-batch test result, the maximum net optical density difference of the intra-batch was 5.5% at 2 Gy and 7.4% at 0.2 Gy in the transmission and reflection scans, respectively. In the low-dose range, film thickness of more than 120-μm was proper in the transmission mode. In contrast, the transmission mode showed a better result compared to the reflection mode. Therefore, the proper scan mode should be selected according to the dose range.
Original Article 2022-12-31

Dead Layer Thickness and Geometry Optimization of HPGe Detector Based on Monte Carlo Simulation

Suah Yu^1,2 , Na Hye Kwon³ , Young Jae Jang¹ , Byungchae Lee⁴ , Jihyun Yu⁴ , Dong-Wook Kim³ , Gyu-Seok Cho¹ , Kum-Bae Kim¹ , Geun Beom Kim¹ , Cheol Ha Baek² , Sang Hyoun Choi¹

Progress in Medical Physics 2022; 33(4): 129-135
https://doi.org/10.14316/pmp.2022.33.4.129

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Purpose: A full-energy-peak (FEP) efficiency correction is required through a Monte Carlo simulation for accurate radioactivity measurement, considering the geometrical characteristics of the detector and the sample. However, a relative deviation (RD) occurs between the measurement and calculation efficiencies when modeling using the data provided by the manufacturers due to the randomly generated dead layer. This study aims to optimize the structure of the detector by determining the dead layer thickness based on Monte Carlo simulation.
Methods: The high-purity germanium (HPGe) detector used in this study was a coaxial p-type GC2518 model, and a certified reference material (CRM) was used to measure the FEP efficiency. Using the MC N-Particle Transport Code (MCNP) code, the FEP efficiency was calculated by increasing the thickness of the outer and inner dead layer in proportion to the thickness of the electrode.
Results: As the thickness of the outer and inner dead layer increased by 0.1 mm and 0.1 µm, the efficiency difference decreased by 2.43% on average up to 1.0 mm and 1.0 µm and increased by 1.86% thereafter. Therefore, the structure of the detector was optimized by determining 1.0 mm and 1.0 µm as thickness of the dead layer.
Conclusions: The effect of the dead layer on the FEP efficiency was evaluated, and an excellent agreement between the measured and calculated efficiencies was confirmed with RDs of less than 4%. It suggests that the optimized HPGe detector can be used to measure the accurate radioactivity using in dismantling and disposing medical linear accelerators.
Original Article 2022-12-31

Development of a Breath Control Training System for Breath-Hold Techniques and Respiratory-Gated Radiation Therapy

Hyung Jin Choun¹ , Jung-in Kim^2,3,4 , Jong Min Park^2,3,4 , Jaeman Son^2,3,4

Progress in Medical Physics 2022; 33(4): 136-141
https://doi.org/10.14316/pmp.2022.33.4.136

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Purpose: This study aimed to develop a breath control training system for breath-hold technique and respiratory-gated radiation therapy wherein the patients can learn breath-hold techniques in their convenient environment.
Methods: The breath control training system comprises a sensor device and software. The sensor device uses a loadcell sensor and an adjustable strap around the chest to acquire respiratory signals. The device connects via Bluetooth to a computer where the software is installed. The software visualizes the respiratory signal in near real-time with a graph. The developed system can signal patients through visual (software), auditory (buzzer), and tactile (vibrator) stimulation when breath-holding starts. A motion phantom was used to test the basic functions of the developed breath control training system. The relative standard deviation of the maxima of the emulated free breathing data was calculated. Moreover, a relative standard deviation of a breath-holding region was calculated for the simulated breath-holding data.
Results: The average force of the maxima was 487.71 N, and the relative standard deviation was 4.8%, while the average force of the breath hold region was 398.5 N, and the relative standard deviation was 1.8%. The data acquired through the sensor was consistent with the motion created by the motion phantom.
Conclusions: We have developed a breath control training system comprising a sensor device and software that allow patients to learn breath-hold techniques in their convenient environment.
Technical Note 2023-03-31

Clinical Impact of Patient’s Head Position in Supraclavicular Irradiation of the Whole Breast Radiotherapy

Surega Anbumani , Lohith G. Reddy , Priyadarshini V , Sasikala P , Ramesh S. Bilimagga

Progress in Medical Physics 2023; 34(1): 10-13
https://doi.org/10.14316/pmp.2023.34.1.10

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Patients with breast cancer can be positioned with their head turned to the contra lateral side or with their head straight during the radiation therapy treatment set-up. In our hospital, patients with locally advanced breast cancer who were receiving radiation therapy have experienced swallowing difficulty after 2 weeks of irradiation. In this pilot study, the impact of head position on reducing dysphagia occurrence was dosimetrically evaluated. Patients were divided into two groups viz., HT (head turned to the contra lateral side of the breast) and HS (head straight) with 10 members in each. Treatment planning was performed, and the dosimetric parameters such as Dmin, Dmax, Dmean, V₅, V₁₀, V₂₀, V₃₀, V₄₀, and V₅₀ of both groups were extracted from the dose volume histogram (DVH) of esophagus. The target coverage in the supraclavicular fossa (SCF) region was analyzed using D₉₅ and D₉₈; moreover, the dose heterogeneity was assessed with D₂ from the DVHs. The average values of the dose volume parameters were 27.6%, 58.6%, 35.4%, 19%, 13.8%, 14.1%, 11.8%, 8.4%, and 8.1% higher in the HT group compared with those in the HS group. Furthermore, for the SCF, the mean values of D₉₈, D₉₅, and D₂ were 42.4, 47.5, and 54 Gy, respectively, in the HS group and 38.9, 45.35, and 55.5 Gy, respectively, in the HT group. This pilot study attempts to give a solution for the poor quality of life of patients after breast radiotherapy due to dysphagia. The findings confirm that the head position could play a significant role in alleviating esophageal toxicity without compromising tumor control.
Original Article 2022-12-31

Evaluation of Treatment Plan Quality between Magnetic Resonance-Guided Radiotherapy and Volumetric Modulated Arc Therapy for Prostate Cancer

Chang Heon Choi^1,2,3 , Jin Ho Kim^1,3 , Jaeman Son^1,2,3 , Jong Min Park^1,2,3,4 , Jung-in Kim^1,2,3

Progress in Medical Physics 2022; 33(4): 121-128
https://doi.org/10.14316/pmp.2022.33.4.121

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Purpose: T his s tudy e valuated t he q uality of plans based on magnetic resonance-guided radiotherapy (MRgRT) tri-Co-60, linac, and conventional linac-based volumetric modulated arc therapy (linac-VMAT) for prostate cancer.
Methods: Twenty patients suffering from prostate cancer with intermediate risk who were treated by MAT were selected. Additional treatment plans (primary and boost plans) were generated based on MRgRT-tri-Co-60 and MRgRT-linac. The planning target volume (PTV) of MRgRT-based plans was created by adding a 3 mm margin from the clinical target volume (CTV) due to high soft-tissue contrast and real-time motion imaging. On the other hand, the PTV of conventional linac was generated based on a 1 cm margin from CTV. The targets of primary and boost plans were prostate plus seminal vesicle and prostate only, respectively. All plans were normalized to cover 95% of the target volume by 100% of the prescribed dose. Dosimetric characteristics were evaluated for each of the primary, boost, and sum plans.
Results: For target coverage and conformity, the three plans showed similar results. In the sum plans, the average value of V_65Gy of the rectum of MRgRT-linac (2.62%±2.21%) was smaller than those of MRgRT tri-Co-60 (9.04%±3.01%) and linac-VMAT (9.73%±7.14%) (P<0.001). In the case of bladder, the average value of V_65Gy of MRgRT-linac was also smaller.
Conclusions: In terms of organs at risk sparing, MRgRT-linac shows the best value while maintaining comparable target coverage among the three plans.
Original Article 2022-12-31

Monte Carlo Algorithm-Based Dosimetric Comparison between Commissioning Beam Data across Two Elekta Linear Accelerators with Agility^TM MLC System

Geum Bong Yu¹ , Chang Heon Choi^1,2,3 , Jung-in Kim^1,2,3 , Jin Dong Cho^1,2 , Euntaek Yoon⁴ , Hyung Jin Choun^2,4 , Jihye Choi^5,6 , Soyeon Kim^5,6 , Yongsik Kim⁶ , Do Hoon Oh⁷ , Hwajung Lee⁷ , Lee Yoo⁷ , Minsoo Chun^3,7

Progress in Medical Physics 2022; 33(4): 150-157
https://doi.org/10.14316/pmp.2022.33.4.150

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Purpose: Elekta synergy^® was commissioned in the Seoul National University Veterinary Medical Teaching Hospital. Recently, Chung-Ang University Gwang Myeong Hospital commissioned Elekta Versa HD^TM. The beam characteristics of both machines are similar because of the same Agility^TM MLC Model. We compared measured beam data calculated using the Elekta treatment planning system, Monaco^®, for each institute.
Methods: Beam of the commissioning Elekta linear accelerator were measured in two independent institutes. After installing the beam model based on the measured beam data into the Monaco^®, Monte Carlo (MC) simulation data were generated, mimicking the beam data in a virtual water phantom. Measured beam data were compared with the calculated data, and their similarity was quantitatively evaluated by the gamma analysis.
Results: We compared the percent depth dose (PDD) and off-axis profiles of 6 MV photon and 6 MeV electron beams with MC calculation. With a 3%/3 mm gamma criterion, the photon PDD and profiles showed 100% gamma passing rates except for one inplane profile at 10 cm depth from VMTH. Gamma analysis of the measured photon beam off-axis profiles between the two institutes showed 100% agreement. The electron beams also indicated 100% agreement in PDD distributions. However, the gamma passing rates of the off-axis profiles were 91%–100% with a 3%/3 mm gamma criterion.
Conclusions: The beam and their comparison with MC calculation for each institute showed good performance. Although the measuring tools were orthogonal, no significant difference was found.