로봇사이버나이프를 이용한 간 종양의 실시간 움직임 측정과 방사선수술 시 호흡추적장치의 정확성 평가

김가중(Gha jung Kim),심수정(Su Jung Shim),김정호(Jeong Ho Kim),민철기(Chul Kee Min),정원규(Weon-kuu Chung) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.4

목 적: 본 연구에서는 로봇 사이버나이프의 호흡추적장치(SynchronyTM Respiratory motion tracking system)을 이용 하여 방사선수술을 시행한 간 종양환자를 대상으로 치료 중 실시간 종양의 움직임을 정량적으로 측정하고 방사선 수술시 호흡추적장치의 정확성을 평가하고자 한다. 대상 및 방법: 사이버나이프 치료를 시행한 간 종양 환자 24명을 대상으로 호흡추적 장치를 이용하여 총 64회의 시술을 시행하였다. 모든 환자에서 초음파를 이용하여 간 종양 근처에 4∼6개의 금침을 삽입하였고 치료계획용 컴퓨터 단층촬영 영상을 이용하여 치료계획을 세웠다. 매 치료 시 금침의 위치는 치료계획 시 만들어진 디지털 재구성 방사선 영상(Digitally Reconstructed Radiography; DRR)과 실시간으로 촬영되어진 방사선영상(X-ray Image)으로 확인하고, 이 결과를 MTS (Motion Tracking System)을 통해 Mtsmain.log 치료파일 형식으로 저장하여 종양의 움직임을 측정하였다. 또한 사이버나이프를 이용한 방사선 수술 시 호흡추적장치의 정확성은 실시간 금침의 위치와 미리 예측된 좌표 사이의 상관관계 오차(Correlation Error)로 평가하였다. 결 과: 간 종양의 직선형태 움직임은 SI (Superior-Inferior)방향으로 최대 23.5 mm, 평균 13.9±5.5 mm, LR (Left-Right)방향으로 최대 3.9 mm, 평균 1.9±0.9 mm, AP (Anterior-Posterior)방향으로 최대 8.3 mm, 평균 4.9 ± 1.9 mm 였으며 간 종양의 회전 운동 정도는 X (Left-Right)축 회전은 최대 3.3o, 평균 2.6±1.3o, Y (Cranio-Caudal)축회전은 최대 4.8o, 평균 2.3±1.0o, Z (Anterior-Posterior)축 회전은 최대 3.9o, 평균 2.8±1.1o로 측정되었다. 또한 치료의 정확성을 평가하는 상관관계 오차는 평균 1.1±0.7 mm였다. 결 론: 본 연구에서 방사선 수술 중 간 종양의 실시간 움직임을 정량적으로 확인할 수 있었고 로봇 사이버나이프의 호흡추적 장치를 이용한 방사선 수술의 정확성을 평가할 수 있었다. 이를 토대로 간 종양의 방사선 수술이나 일반적인 방사선치료에 있어서 치료용적의 결정과 움직임에 대한 유용한 정보를 제공할 것이라 생각된다. Purpose: This study aimed to quantitatively measure the movement of tumors in real-time and evaluate the treatment accuracy, during the treatment of a liver tumor patient, who underwent radiosurgery with a Synchrony Respiratory motion tracking system of a robot CyberKnife. Materials and Methods: The study subjects included 24 liver tumor patients who underwent CyberKnife treatment, which included 64 times of treatment with the Synchrony Respiratory motion tracking system (SynchronyTM). The treatment involved inserting 4 to 6 acupuncture needles into the vicinity of the liver tumor in all the patients using ultrasonography as a guide. A treatment plan was set up using the CT images for treatment planning uses. The position of the acupuncture needle was identified for every treatment time by Digitally Reconstructed Radiography (DRR) prepared at the time of treatment planning and X-ray images photographed in real-time. Subsequent results were stored through a Motion Tracking System (MTS) using the Mtsmain.log treatment file. In this way, movement of the tumor was measured. Besides, the accuracy of radiosurgery using CyberKnife was evaluated by the correlation errors between the real-time positions of the acupuncture needles and the predicted coordinates. Results: The maximum and the average translational movement of the liver tumor were measured 23.5 mm and 13.9±5.5 mm, respectively from the superior to the inferior direction, 3.9 mm and 1.9±0.9 mm, respectively from left to right, and 8.3 mm and 4.9±1.9 mm, respectively from the anterior to the posterior direction. The maximum and the average rotational movement of the liver tumor were measured to be 3.3o and 2.6±1.3o, respectively for X (Left-Right) axis rotation, 4.8o and 2.3±1.0o, respectively for Y (Cranio-Caudal) axis rotation, 3.9o and 2.8±1.1o, respectively for Z (Anterior-Posterior) axis rotation. In addition, the average correlation error, which represents the treatment’s accuracy was 1.1±0.7 mm. Conclusion: In this study real-time movement of a liver tumor during the radiosurgery could be verified quantitatively and the accuracy of the radiosurgery with the Synchrony Respiratory motion tracking system of robot could be evaluated. On this basis, the decision of treatment volume in radiosurgery or conventional radiotherapy and useful information on the movement of liver tumor are supposed to be provided.

CT 영상을 이용한 불균질 조직의 선량보정 평가

김가중,Kim, Gha-Jung 대한방사선치료학회 2006 대한방사선치료학회지 Vol.18 No.2

Purpose: In radiation therapy, precise calculation of dose toward malignant tumors or normal tissue would be a critical factor in determining whether the treatment would be successful. The Radiation Treatment Planning (RTP) system is one of most effective methods to make it effective to the correction of dose due to CT number through converting linear attenuation coefficient to density of the inhomogeneous tissue by means of CT based reconstruction. Materials and Methods: In this study, we carried out the measurement of CT number and calculation of mass density by using RTP system and the homemade inhomogeneous tissue Phantom and the values were obtained with reference to water. Moreover, we intended to investigate the effectiveness and accuracy for the correction of inhomogeneous tissue by the CT number through comparing the measured dose (nC) and calculated dose (Percentage Depth Dose, PDD) used CT image during radiation exposure with RTP. Results: The difference in mass density between the calculated tissue equivalent material and the true value was ranged from $0.005g/cm^3\;to\;0.069g/cm^3$. A relative error between PDD of RTP and calculated dose obtained by radiation therapy of machine ranged from -2.8 to +1.06%(effective range within 3%). Conclusion: In conclusion, we confirmed the effectiveness of correction for the inhomogeneous tissues through CT images. These results would be one of good information on the basic outline of Quality Assurance (QA) in RTP system.

영상유도 방사선치료장치(IGRT)를 이용한 흉 · 복부 종양의 움직임과 외부호흡과의 상관관계 분석

김가중(Gha-jung Kim),홍주연(Ju-youn Hong),한상현(Sang-hyun Han) 한국콘텐츠학회 2014 한국콘텐츠학회논문지 Vol.14 No.9

본 연구는 자유로운 호흡 상태에서 사이버나이프 영상유도 방사선 치료장치(IGRT)를 이용하여 흉·복부종양의 움직임과 외부호흡과의 상관관계 측정하여 분석하였다. 대상은 방사선 치료를 시행한 폐종양(n=10), 간종양(n=10), 췌장암(n=10) 환자 총 30명으로, 종양추적시스템(MTS)의 로그 데이터를 변환하여 분석하였다. 자유로운 호흡 중에서 폐종양과 외부호흡의 Peason 상관관계는 두미 방향 0.646(p This study measured and analyzed the correlation coefficient between movements of thoracoabdominal tumors and external respiration in a free-breathing state, using cyberknife image guided radiotherapy(IGRT). This study subjects included a total of 30 patients with lung tumors(n=10), liver tumors(n=10) and pancreatic tumor(n=10) who underwent radiotherapy, and the movements of tumors were analyzed using converted log data of the tumor motion tracking system(MTS). In a free-breathing state, In relation to Peason"s correlation coefficient between external respiration and lung tumors in the entire treatment process, the correlation coefficient was 0.646(p

영상유도 방사선 치료(IGRT)에 따른 정상 조직의 추가 피폭에 대한 연구

김가중(Gha-Jung Kim),류준민(Jun-Min Ryu),최준구(Jun-Gu Choi),홍동희(Dong-Hee Hong) 한국콘텐츠학회 2016 한국콘텐츠학회논문지 Vol.16 No.1

최근 방사선 치료 분야에서는 다양한 영상유도 방사선 치료(IGRT) 장치들을 이용한 환자 셋업으로 고도의 정밀성이 보장된 치료가 가능해 졌다. 그러나 환자의 정상 조직에 받는 추가 선량 또한 더불어 증가되고 있다. 이에 본 연구에서는 영상유도 방사선 치료 장치 중 OBI, CBCT, ExacTrac를 이용한 환자 셋업에 주변 정상 조직에 받는 피폭선량을 측정하였다. 결과 팬텀 중심부의 선량이 CBCT의 경우 두부 12.57 mGy, 흉부 20.82 mGy, 복부 82.93 mGy, 골반부위 52.70 mGy로 측정되었으며 OBI는 0.76 ~ 8.58 mGy, ExacTrac의 경우 0.14 ~ 0.63 mGy로 CBCT의 피폭선량이 다른 장비에 비해 월등히 높게 나타나는 것을 알 수 있었다. 표면 선량의 경우에서도 CBCT가 다른 장비에 비해 높게 나타났으나 입사 피부표면 선량(Enterance skin dose)의 경우 OBI도 CBCT의 피폭선량과 거의 비슷한 흡수선량이 측정 되었다. The recent radiation therapy field can provide treatment which guarantees a high degree of accuracy, due to patient set-up using various image guided radiation therapy(IGRT) instruments. But the additional absorbed dose to patient’s normal tissues is increasing. Therefore, this study measured the absorbed dose to surrounding normal tissues which is caused by patient set-up using OBI, CBCT, ExacTrac, among various IGRT instruments. The absorbed dose to the head, the chest, the abdomen, and the pelvis from CBCT was 12.57 mGy, 20.82 mGy, 82.93 mGy, and 52.70 mGy, respectively. Also, the absorbed dose from OBI and ExacTrac ranged from 0.76 to 8.58 mGy and from 0.14 to 0.63 mGy, respectively. As a result, CBCT’s absorbed dose was far higher than other instruments. CBCT’s surface dose was far higher than others, too, but OBI’s entrance skin dose was almost the same as CBCT’s

사이버나이프 Synchrony™ 호흡 추적 장치를 이용한 폐종양 방사선수술의 유용성 평가

김가중(Gha-Jung Kim),배석환(Seok-Hwan Bae),최준구(Jun-Gu Choi),채홍인(Hong-In Chae) 대한방사선과학회(구 대한방사선기술학회) 2010 방사선기술과학 Vol.33 No.4

본 연구는 사이버나이프 Synchrony 호흡추적 장치를 이용하여 방사선 수술을 시행한 폐종양 환자 48명을 대상으로 전 치료기간 중 종양의 움직임과 방사선수술의 정확성을 평가하였다. 폐종양의 움직임은 종양이나 종양주변에 삽입된 금침의 좌표를 사이버나이프 영상유도 장치로 측정하였으며, 방사선수술의 정확성은 움직임 추적 컴퓨터(MTS)로 계산된 상관관계 오차로 평가하였다. 폐종양의 움직임은 두미방향으로 평균 2.63± 1.87 mm며, 좌우방향 1.13±0.71 mm, 전후방향 1.74±1.16 mm의 움직임을 보였으며, 회전 움직임 정도는 X축 1.66±1.66°, Y축 1.20±0.97°, Z축 1.18±0.73°로 측정되었다. 직선 움직임의 벡터 값은 평균 3.78± 2.00 mm값을 나타냈다. 연구 결과에서 두미방향(p<0.001)과 전후방향(p<0.029), 3차원 벡터 값(p<0.002)들은 종양의 위치가 상부보다 하부의 움직임이 크게 나타나 통계적 유의성을 보였다. 사이버나이프 Synchrony 호흡추적 장치를 이용한 폐종양의 방사선 수술시 상관관계 오차는 전체 평균 0.95±0.62 mm로 매우 정확한 조사로 종양의 움직임을 보상하여 방사선 수술이 이루어졌으며 그 유용성을 확인할 수 있었다. This study evaluated the motion of tumors during the entire period of therapy and the accuracy of radiosurgery among forty eight lung tumor patients who were underwent radiosurgery using the CyberKnife ynchrony Respiratory Tracking System. The motion of lung tumor was measured by the coordinates of a gold acupuncture needle inserted into the tumor or the area around the tumor using the CyberKnife image guided system. Then the accuracy of radiosurgery was evaluated based on the error of correlation computed with the motion tracking system. The lung tumor motion is Cranio-Caudal direction by an average of 2.63±1.87 mm, moved left-right direction by 1.13±0.71 mm, and anterior-posterior direction by 1.74±1.16 mm. The degree of rotational movement was 1.66±1.66° on X axis, 1.20±0.97° on Y axis, and 1.18±0.73° on Z axis. The vector of translation movement was measured to be 3.78±2.00 mm on the average. The results show that directions of Cranio-Caudal(p < 0.001), anterior-posterior direction(p < 0.029), and three dimensional vector value(p < 0.002) showed statistical significance, because the lower side of tumor showed more intensive movement compared to the upper side of tumor. The radiosurgery was carried out by compensating the motion of tumor after accurate investigation of the correlation error with the average of 0.95±0.62 mm during the lung tumor radiosurgery with the CyberKnife Synchrony Respiratory Tracking System.

공작실에서 실내 및 작업종사자의 중금속 오염도에 관한 고찰

김정호,김가중,김성기,배석환,Kim Jeong-Ho,Kim Gha-Jung,Kim Sung-Ki,Bea Suk-Hwan 대한방사선치료학회 2005 대한방사선치료학회지 Vol.17 No.2

Purpose : Heavy metal use when producing the block from the workshop. At this time, production of heavy metal dust and fume gives risk in human. This like heavy metal to improve seriousness through measurement and analysis. And by the quest in solution is purpose of this thesis. Materials and Methods : Organization is Inductively Coupled Plasma Atomic Emission Spectrometer, and the object is Deajeon city 4 workshops in university hospital radiation oncology (Bismuth, Lead, Tin and cadmium). Method is the ppb the pumping it does at unit, comparison analysis. And the Calculation heavy metal standard level in air through heavy metal standard level in body and blood, so Heavy metal temporary standard set. Results : Subterranean existence room air quality the administration laws appointed Lead and Cadmium's exposure recommend that it is $3{\mu}g/m^3\;and\;2{\mu}g/m^3$. And Bismuth and Tin decides $7{\mu}g/m^3\;and\;6{\mu}g/m^3$ through standard level in air heavy metal and standard level in body and blood. Heavy metal measurement level of workshops in 4 university hospital Daejeon city compares with work existence and nonexistence. On work nonexistence almost measurement level is below the recommend level. But work existence case express high level. Also consequently in composition ratio of the block is continuous with the detection ratio. Conclusion : Worker's heavy metal contamination imbrued serious for solution founds basic part. In hospital may operation on local air exhauster and periodical efficiency check, protector offer, et al. And worker have a correct understanding part of heavy metal contamination, and have continuous interest, health control. Finally, learned society sphere administer to establishment standard level and periodical measurement. And it founds basic solution plan of periodical special health checkup.

방사성의약품 검사 시 진단(CT)영상에 미치는 영향

이은혜,이예슬,김가중,최준구,Lee, Eun-Hye,Lee, Ye-Seul,Kim, Gha-Jung,Choi, Jun-Gu 대한디지털의료영상학회 2010 대한디지털의료영상학회논문지 Vol.12 No.2

This research attempts to qualitatively evaluate the intensity change by radiopharmaceuticals and obtain computed tomography using phantom injected with various nuclide. Cylindrical phantom is used for comparing and analysing the effect on diagnosis image during radiopharmaceuticals inspection. Inside of the phantom, water is injected and computed tomography image is scanned. During nuclear medicine invitro, frequently used radiopharmaceuticals, $^{99m}TcO_4$ 20 mCi and $^{18}F$ 14 mCi, is diluted in the water phantom and scanned in the same method. Traverse image obtained by CT scan is divided into six traverse image in the same slice of each scanned image. CT-number(HU) value of 10 measuring point is measured in 2 cm interval based on the center of the phantom. Measured HU value, based on the water phantom, is compared with the image after injecting $^{99m}TcO_4$ and $^{18}F$. Average scale of water is 2.8~1.6 HU, $^{99m}TcO_4$ is 3.0~1.6 HU and $^{18}F$ is 1.2~0 HU. Average of water is $2.3{\pm}0.17$ HU, $^{99m}TcO_4$ is $2.2{\pm}0.85$ HU and F-18 is $0.7{\pm}0.95$ HU. Based on water, reduced value of about 0.1 HU and about 0.5 HU is acquired from $^{99m}TcO_4$ and F-18. Radionuclide used in nuclear medicine inspection utilizes 100~200 KeV energy and obtains image through scintillation camera and PET-CT utilizes 511 KeV positron annihilation energy to obtain image. What we learned from this research is that gamma rays from these energies used in CT scan for diagnosis purpose or radioactive therapy plan can change the intensity of the image. The nuclear medicine inspection for reducing the effect of emitted gamma ray diagnosis image should be obtained after a period of time considering half-life which would be reduced distortion or changed in image.

두경부 IMRT 및 VMAT 시 체적 감소가 전산화치료계획에 미치는 영향

엄기천(Ki-Cheon Um),김가중(Gha-Jung Kim),백금문(Geum-Mun Back) 대한방사선과학회(구 대한방사선기술학회) 2023 방사선기술과학 Vol.46 No.3

CT Volume data를 이용한 3D Printer 형상 연구

김형균(Hyeong-gyun Kim),김가중(Gha-jung Kim),최준구(Jun-gu Choi),홍동회(Dong-hee Hong),정재은(Jae-eun Jung) 한국방사선학회 2015 한국방사선학회 학술대회 논문집 Vol.2015 No.추계

최근 3D 프린팅 기술은 의료에 여러 방향으로 접목되고 있다. 이에 본 연구에서는 의료영상의 표준인 DICOM 영상을 이용하여 만든 3차원 영상을, 3D 프린팅으로 출력하여 그 형상표면의 정밀성을 검토하고자 하였다. 실험은 동물 뼈를 피사체로 의료영상을 획득 하였으며, 3D 프린팅 출력을 위해 DICOM 파일을 STL 파일로 변환하는 과정을 거친 후 피사체 형상을 출력하였다. 최종적으로 원본 동물 뼈 와 3D 프린팅에서 얻은 3차원 형상을 3D Scanner로 획득한 후 3차원 모델링을 서로 병합(Merge)하고 그 차이를 비교하였다. Recent 3D printing technology has been grafting onto various medical practices. In light of this trend, this research is intended to examine the figuration surface's accuracy of 3D images made by using DICOM images after printing by 3D printing. The medical images were obtained from animal bone objects, while the objects were printed after undergoing STL file conversion for 3D printing purposes. Ultimately, after the 3D figuration, which was obtained by the original animal bones and 3D printing, was scanned by 3D scanner, 3D modeling was merged each other and the differences were compared.

방사선 DICOM 영상을 이용한 3차원 프린팅 출력물의 형상 비교에 관한 연구

김형균(Hyeong-Gyun Kim),최준구(Jun-Gu Choi),김가중(Gha-Jung Kim) 한국콘텐츠학회 2016 한국콘텐츠학회논문지 Vol.16 No.2

최근 3D 프린팅 기술은 의료에 여러 방향으로 접목되고 있다. 이에 본 연구에서는 의료영상의 표준인 DICOM 영상을 이용하여 만든 3차원 영상을, 3D 프린팅으로 출력하여 그 형상표면의 정밀성을 검토하고자 하였다. 실험은 동물 뼈를 피사체로 의료영상을 획득하였으며, 3D 프린팅 출력을 위해 STL 파일로 변환하는 과정을 거친 후 피사체 형상을 출력하였다. 최종적으로 원본 동물 뼈 와 3D 프린팅에서 얻은 3차원 형상을 3D Scanner로 획득한 후 3차원 모델링을 서로 병합(Merge)하고 그 차이를 비교하였다. 결과분석은 시각적 형상비교, 모델링의 Scale 값에 대한 색상(Color)비교, 수치적 형상비교를 하였다. 형상표면은 시각적으로는 구분이 어려웠으며, 수치적 형상비교는 X, Y, Z 좌표가 있는 임의의 4곳에서 측정된 값으로 비교하였다. 병합된 모델링의 형상표면은 원본 피사체(동물 뼈)에 비해 평균 –0.49 ㎜ 만큼 3D프린팅으로 출력된 형상에서 작게 나타났다. 하지만 모든 형상 표면이 균일하게 작아지진 않았으며, 실험에서는 그 차이가 –0.83 ㎜ 내에 있었다. Recent 3D printing technology has been grafting onto various medical practices. In light of this trend, this research is intended to examine the figuration surface’s accuracy of 3D images made by using DICOM images after printing by 3D printing. The medical images were obtained from animal bone objects, while the objects were printed after undergoing STL file conversion for 3D printing purposes. Ultimately, after the 3D figuration, which was obtained by the original animal bones and 3D printing, was scanned by 3D scanner, 3D modeling was merged each other and the differences were compared. The result analysis was conducted by visual figuration comparison, color comparison of modeling’s scale value, and numerical figuration comparison. The shape surface was not visually distinguished; the numerical figuration comparison was made from the values measured from the four different points on the X, Y and Z coordinates. The shape surface of the merged modeling was smaller than the original object (the animal bone) by average of -0.49 ㎜ in the 3D printed figuration. However, not all of the shape surface was uniformly reduced in size and the differences was within range of –0.83 ㎜ on the experiment.