AAPM TG-119 보고서를 통한 세기조절방사선치료(IMRT)와 부피적세기조절회전치료(VMAT)의 치료 전 환자별 정도관리 = The Patient Specific QA of IMRT and VMAT Through the AAPM Task Group Report 119

국문 초록 (Abstract)

본 연구에서는 AAPM TG-119 보고서를 통해 본원에 도입된 세기조절방사선치료(IMRT)와 부피적세기조절 회전치료(VMAT)의 치료 전 환자별 정도관리(patient specific QA)를 시행하고자 하였다. 본원의 치료계획장치를 이용해 각각의 치료계획을 수립하여 절대선량은 표적 및 위험장기에 전리함을 이용해 측정하였고 상대선량분포는 DELTA4PTbi-planar diode array를 사용하여 측정하였다. 치료계획의 평가는 선량체적히스토그램을 이용하였고 선량검증은 측정값과 계산값을 비교하여 시행하였다. 치료계획평가에서 전립선의 경우에는 두 치료법 모두 표적과 위험장기의 목표선량에 도달하였으며 두경부와 Multi target의 경우, 세기조절방사선치료는 표적에서는 목표선량에 도달하지 못하였지만 부피적세기조절 회전치료는 표적과 위험장기 모두 목표선량에 도달하였다. C-shape(easy)은 두 치료법이 표적과 위험장기 모두 목표선량에 도달하였고, C-shape(hard)의 경우엔, 두 치료법이 표적에서는 목표선량에 도달하였으나 위험장기에서는 목표선량에 도달하지 못하였다. 절대선량평가에서는 세기조절방사선치료의 경우 평균오차율의 평균값이 표적에서 1.24±2.06%, 위험장기에서 1.4±2.9%였고 신뢰구간은 표적에서 3.65%, 위험장기에서 4.39%였다. 부피적세기조절회전치료는 평균 오차율의 평균값이 표적에서 2.06±0.64%, 위험장기에서 2.21±0.74% 였고 신뢰구간은 표적에서 4.09%, 위험장기에서 3.04%로 두 치료법 모두 제안된 허용기준인 표적에서 4.5%, 위험장기에서 4.7% 이내였다. 상대선량평가에서는 세기조절방사선치료의 경우 허용기준을 통과하는 감마인덱스의 평균값은 98.3±1.5%였고 신뢰구간은 3.78%였다. 부피적세기조절회전치료의 경우엔 평균값이 98.2±1.1%였고 신뢰구간은 3.95%로 두 치료법 모두 제안된 허용기준인 7.0% 이내였다. 따라서 이번 연구에서 실시한 시험을 통해 본원의 세기조절방사선치료와 부피적세기조절회전치료가 보고서에서 제안된 허용기준에 모두 부합하고 사용에 적합함을 확인할 수 있었다.

다국어 초록 (Multilingual Abstract)

The aim of this study was to evaluate the patient specific quality assurance (QA) results of intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) through the AAPM Task Group Report 119. Using the treatment planning system, both IMRT and VMAT treatment plans were established. The absolute dose and relative dose for the target and OAR were measured by using an ion chamber and the bi-planar diode array ,respectively. The plan evaluation was used by the Dose volume histogram (DVH) and the dose verification was implemented by compare the measured value with the calculated value. For the evaluation of plan, in case of prostate, both IMRT and VMAT were closed the goal of target and OARs. In case of H&N and Multi-target, IMRT was not reached the goal of target, but VMAT was reached the goal of target and OARs. In case of C-shape(easy), both were reached the goal of target and OARs. In case of C-shape(hard) , both were reached the goal of target but not reached the goal of OARs. For the evaluation of absolute dose, in case of IMRT, the mean of relative error (%) between measured and calculated value was 1.24±2.06% and 1.4±2.9% for target and OAR, respectively. The confidence limits were 3.65% and 4.39% for target and OAR, respectively. In case of VMAT the mean of relative error was 2.06±0.64% and 2.21±0.74% for target and OAR, respectively. The confidence limits were 4.09% and 3.04% for target and OAR , respectively. For the evaluation of relative dose, in case of IMRT, the average percentage of passing gamma criteria (3mm/3%) were 98.3±1.5% and the confidence limits were 3.78%. In case of VMAT, the average percentage were 98.2±1.1% and the confidence limits were 3.95%. We performed IMRT and VMAT patient specific QA using TG-119 based procedure, all analyzed results were satisfied with acceptance criteria based on TG-119. So, the IMRT and VMAT of our institution was confirmed the accuracy.

목차 (Table of Contents)

• 국문초록
• Ⅰ. 서 론
• Ⅱ. 재료 및 방법
• Ⅲ. 결 과
• Ⅳ. 고찰 및 결론
• 참고문헌
• Abstract

참고문헌 (Reference)

1 김성진, "질환별 세기조절방사선치료의 정도관리: 을지대학병원 임상결과" 대한방사선종양학회 29 (29): 99-106, 2011

2 윤상민, "세기조절방사선치료(IMRT) 환자의 QA" 대한방사선종양학회 20 (20): 10-90, 2002

3 허승재, "방사선 치료의 국내 현황과 미래" 대한방사선종양학회 24 (24): 211-216, 2006

4 Otto K, "Volumetric modulated arc therapy IMRT in a single gantry arc" 35 (35): 310-317, 2008

5 Cehn Q, "Ultrafast convolution superposition using tabulated and exponential kernels on GPU" 38 (38): 1150-1161, 2011

6 Bortfeld T, "Realization an verification of three dimentional conformal radiotherapy with modulated field" 30 : 899-908, 1994

7 Fenoglietto P, "Persistently better treatment planning results of IMRT over 3D CRT in prostate cancer patients with significant variation of clinical target volume and OAR" 88 : 77-87, 2008

8 Agazaryan N, "Patient specific quality assurance for the delivery of intensity modulated radiotherapy" 4 : 40-50, 2003

9 Yan G, "On the sensitivity of patient specific IMRT QAto MLC positioning errors" 10 : 2915-, 2009

10 Ezzell GA, "IMRT commissioning multiple institution planning and dosimetry comparisons, a report from AAPM Task Group 119" 36 : 5359-5373, 2009

11 Mar A, "Guideline for the verification of IMRT"

12 "Delta4PT Getting Started, Scandidos"

13 Rao M, "Comparison of Elekta VMAT with helical tomotherapy and fixed field IMRT Plan quality Delivery efficiency and Accuracy" 37 (37): 1350-1359, 2010

14 Van Esch A, "Acceptance tests and QC procedures for the clinical implementation of IMRT using inverse planning and the sliding window technique experience from five radiotherapy departments" 65 : 53-70, 2002

15 Low DA, "A technique for the quantitative evaluation of dose distributions" 25 (25): 656-661, 1998