전립선암 치료를 위한 세기조절 양성자 로버스트 치료계획

박수연,김종식,박주영,박원,주상규,Park, Su Yeon,Kim, Jong Sik,Park, Ju Young,Park, Won,Ju, Sang Gyu 대한방사선치료학회 2013 대한방사선치료학회지 Vol.25 No.1

목 적: 양성자선의 유효비정 변화와 환자 자세의 재현성을 고려한 로버스트(robust-IMPT) 세기조절양성치료와 플레인 세기조절양성자치료(plain-IMPT) 계획과 광자선 세기조절방사선치료(photon-IMRT, step & shoot) 계획의 선량분포 특성을 비교, 분석하고자 한다. 대상 및 방법: 다섯 명의 전립선암 환자를 대상으로 표적에 70 Gy를 조사하도록 photon-IMRT (7문, step & shoot)와 plain-IMPT (2문, 4문, 7문) 및 robust-IMPT (유효 비정 오차 ${\pm}5%$ & 환자 자세 오차 0.5 cm 적용) 치료계획을 수립했다. 세 가지 치료계획으로 얻은 선량 분포 비교를 위해 PTV에 대한 선량조형지수(Conformity Index, CI), 선량균등지수(Homogeneity Index, HI) 및 최대선량, 최소선량, 평균선량과 OAR에 대한 선량-체적을 평가했다. 결 과: 모든 환자에 대해 photon-IMRT, plain-IMPT, robust-IMPT에서 PTV의 평균 최대선량은 각각 76.75 Gy (109.6%), 71.92 Gy (102.7%), 72.09 Gy (103%)였으며, 평균 최소선량은 68.21 Gy (97.4%), 68.89 Gy (98.42%), 68.13 Gy (98.13%)였으며, 전체 평균선량은 각각 71.02 Gy (101.4%), 71.32 Gy (100.4%), 70.75 Gy (101%)였다. PTV에 대한 CI 및 HI 값은 plain-IMPT가 photon-IMRT와 robust-IMPT에 비하여 1.02, 1.00으로 가장 낮았다. 또한, 정상장기에 있어 plain-IMPT가 photon-IMRT에 비하여 대부분 낮은 선량 분포를 보였으며, robust-IMPT 적용 시 정상 장기에 대한 선량 분포가 다소 변동의 폭은 있었지만 photon-IMRT에 비하여 대체로 낮은 선량 분포를 보였다. 결 론: 전립선암의 IMPT 치료 시 정확한 유효비정의 오차와 환자 자세 재현성오차를 고려한 robust-IMPT를 적용한다면 plain-IMPT의 선량학적 불확도를 줄이고 photon-IMRT에 비해 효과적인 치료를 제공할 수 있을 것이다. Purpose: The aim of this study is to evaluate the dosimetric properties of robust planning strategy for plain intensity-modulated proton therapy (IMPT) taking into account of the uncertainties of effective proton range and set up error as compared to photon intensity-modulated radiation therapy (photon-IMRT) in prostate cancer treatment. Materials and Methods: The photon-IMRT (7 beams, step & shoot), plain-IMPT (2, 4, and 7 portals), and robust- IMPT plans, which was recalculated the plain-IMPT based on the uncertainties of range error (${\pm}5%$) and set up error (0.5 cm), were evaluated for five prostate cancer patients prescribed by 70 Gy/35 fractions. To quantitatively evaluate the dose distributions, several parameters such as maximum dose, minimum dose, mean dose, conformity index (CI), and homogeneity index (HI) for PTV as well as dose-volume index of VxGy for OARs were calculated from dose-volume histograms. Results: Robust-IMPT showed superior dose distributios in the PTV and OARs as compared to plain-IMPT and photon-IMRT. Like plain-IMPT, robust-IMPT were resulted in dose fluctuation around OARs, while better homogeneity and conformity in PTVs and lower mean dose in OARs as compared to photon-IMRT. Conclusion: In consideration with the effective range correction and set up movement using robustness in IMPT plan, the dosimetric uncertainties from plain-IMPT could substantially reduce and suggest more effective solutions than photon-IMRT in prostate cancer treatment.

나선형 토모테라피 방사선치료의 환자별 품질관리를 위한 라디오크로믹 필름 및 Dosimetry Check^TM의 성능평가

박수연,채문기,임준택,권동열,김학준,정은아,김종식,Park, Su Yeon,Chae, Moon Ki,Lim, Jun Teak,Kwon, Dong Yeol,Kim, Hak Joon,Chung, Eun Ah,Kim, Jong Sik 대한방사선치료학회 2020 대한방사선치료학회지 Vol.32 No.-

목 적: 나선형 토모테라피 방사선치료를 위한 환자별 품질관리용 라디오크로믹 필름 및 3차원 분석시스템인 Dosimetry CheckTM (DC, MathResolutions, USA)의 성능평가를 시행하였다. 대상 및 방법: 인체모형팬톰(Anderson Rando Phantom, USA)을 이용하여 위치 변이가 있는 3가지 형태의 복부 종양(130.6㎤), 복막 후면 종양(849.0㎤) 및 전 복부 전이 종양(3131.0㎤)을 모델링하였다. 조사면 고정너비(field width, FW)를 2.5-cm, 5.0-cm, 피치(pitch) 0.287, 0.43으로 하여 부위별 4개씩(plan01-plan04), 총 12개의 비교용 치료계획을 수립하였다. 이온전리함(1D)과 라디오크로믹 필름(Gafchromic EBT3, Ashland Advanced Materials, USA)을 치즈팬톰 내 삽입하는 방법(2D)과 빔 플루언스 로그정보를 이용하여 CT영상 위에 선량을 3차원으로 재구성하는 방식의 DC측정을 진행하였다. 스레드효과(thread effect)를 분석을 위해 리플(ripple) 진폭(%)를 계산하였고, 선량 분포의 패턴 분석을 위해 감마인덱스 분석(DD: 3%/DTA: 3mm, 합격 문턱 값: 95%)을 수행하였다. 결 과: 리플 진폭 측정 결과 복막 후면 종양이 평균 23.1%로 가장 높았다. 라디오크로믹 필름의 분석결과, 절대 선량 평균 1.0±0.9%, 감마인덱스분석 평균 96.4±2.2%로 95% 이상 통과하였으나 전 복부 전이 종양과 같이 넓은 부위 평가에 범위의 제한적이었다. 인체모형팬톰에 적용한 DC 분석결과 FW가 5.0-cm인 세 부위의 2D 및 3D 플랜 평균이 91.8±6.4%였다. 세 단면 및 선량 프로파일 분석을 통해 복막 후면 및 전 복부 종양 표적 전체 영역에 분석이 가능하였고, 선량-용적 히스토그램을 통한 계획 선량 대 측정의 선량 오차가 FW 및 pitch에 따라 커지는 것을 확인하였다. 결 론: DC측정방법은 별도의 측정기 없이 조사 중 측정된 빔 플루언스 로그정보만으로 3차원 환자 영상 데이터 위에 선량 오류를 구현할 수 있고 종양의 위치나 크기에 제한이 없어 크고 불규칙한 종양의 나선형 토모테라피의 치료 시 환자별 품질관리 성능이 매우 우수하며 활용도가 높을 것으로 생각한다. Purpose: The radiochromic film (Gafchromic EBT3, Ashland Advanced Materials, USA) and 3-dimensional analysis system dosimetry checkTM (DC, MathResolutions, USA) were evaluated for patient-specific quality assurance (QA) of helical tomotherapy. Materials and Methods: Depending on the tumors' positions, three types of targets, which are the abdominal tumor (130.6㎤), retroperitoneal tumor (849.0㎤), and the whole abdominal metastasis tumor (3131.0㎤) applied to the humanoid phantom (Anderson Rando Phantom, USA). We established a total of 12 comparative treatment plans by the four geometric conditions of the beam irradiation, which are the different field widths (FW) of 2.5-cm, 5.0-cm, and pitches of 0.287, 0.43. Ionization measurements (1D) with EBT3 by inserting the cheese phantom (2D) were compared to DC measurements of the 3D dose reconstruction on CT images from beam fluence log information. For the clinical feasibility evaluation of the DC, dose reconstruction has been performed using the same cheese phantom with the EBT3 method. Recalculated dose distributions revealed the dose error information during the actual irradiation on the same CT images quantitatively compared to the treatment plan. The Thread effect, which might appear in the Helical Tomotherapy, was analyzed by ripple amplitude (%). We also performed gamma index analysis (DD: 3mm/ DTA: 3%, pass threshold limit: 95%) for pattern check of the dose distribution. Results: Ripple amplitude measurement resulted in the highest average of 23.1% in the peritoneum tumor. In the radiochromic film analysis, the absolute dose was on average 0.9±0.4%, and gamma index analysis was on average 96.4±2.2% (Passing rate: >95%), which could be limited to the large target sizes such as the whole abdominal metastasis tumor. In the DC analysis with the humanoid phantom for FW of 5.0-cm, the three regions' average was 91.8±6.4% in the 2D and 3D plan. The three planes (axial, coronal, and sagittal) and dose profile could be analyzed with the entire peritoneum tumor and the whole abdominal metastasis target, with planned dose distributions. The dose errors based on the dose-volume histogram in the DC evaluations increased depending on FW and pitch. Conclusion: The DC method could implement a dose error analysis on the 3D patient image data by the measured beam fluence log information only without any dosimetry tools for patient-specific quality assurance. Also, there may be no limit to apply for the tumor location and size; therefore, the DC could be useful in patient-specific QAl during the treatment of Helical Tomotherapy of large and irregular tumors.

변형기체포장에 의한 어묵의 저장성 향상 및 유통기한 연장

박수연,안덕순,강준수,이동선,Park, Su Yeon,An, Duck Soon,Kang, Jun Soo,Lee, Dong Sun 한국포장학회 2017 한국포장학회지 Vol.23 No.2

반찬이나 간식으로 이용되는 소비성이 높은 튀김어묵에 대해서 진공, 60% $N_2/40%$ $CO_2$, 100% $N_2$ 및 100% $CO_2$의 변형기체포장조건을 사용하여 저장성 향상과 유통기한 연장을 얻을 수 있는 가능성을 검토하였다. $5^{\circ}C$, $10^{\circ}C$, $15^{\circ}C$의 온도 조건에서 저장하면서 품질변화를 측정한 결과 주요 품질열화요소로서 호기성 세균 증식임이 인지되었다. 호기성 세균수 성장을 Huang의 수학적 모델을 통하여 표현하고, 포장 및 저장온도조건에 따른 모델 parameter를 구하였고, 이를 사용하여 한계 미생물 수준에 도달하는 기간으로서 포장 및 온도 조건에 따른 저장유통기한을 설정하여 제시하였다. Arrhenius 방정식으로 표현된 미생물 성장의 온도의존성에서는 유도기의 역수에 대해서 활성화 에너지 139.4 kJ/mol, 성장속도에 대한 활성화 에너지는 41.8 kJ/mol로 얻어졌다. 변형기체포장의 효과에서, $10^{\circ}C$에서 100% 이산화탄소 포장이 호기성 세균 증식을 효과적으로 억제하여 함기포장에 비하여 약 2배의 유통기한을 확보하여 저장성을 향상시킬 수 있었다. 고이산화탄소 상태에서 저온의 온도 조건을 활용하여 저장유통기한을 연장할 수 있을 것으로 확인되었다. Modified atmosphere packaging (MAP) of vacuum, 60% $N_2/40%$ $CO_2$, 100% $N_2$ and 100% $CO_2$ were examined to preserve fried fish cakes and extend their shelf life. When product packages in air were stored at 5, 10, and $15^{\circ}C$ with measurement in quality attributes, aerobic bacterial growth was found to be primary quality factor to determine the shelf life of the product. Huang's model was adopted to obtain the parameters for use in shelf life determination for a variety of packaging and storage conditions. Temperature dependence expressed in Arrhenius equation showed activation energies of 139.4 and 41.8 kJ/mol for inverse of lag time and growth rate of the microbial spoilage, respectively. MAP of 100% $CO_2$ could double the product shelf life at $10^{\circ}C$ compared to air package. High $CO_2$ concentration MAP at low temperature was found to be effective to prolong the shelf life.

가축전염병 방역 기술의 한류를 기대하며 - 아세안 가축전염병 방역기술 연수 개최결과 보고

박수연,Park, Su-Yeon 대한수의사회 2009 대한수의사회지 Vol.45 No.2

톡소플라스마 망맥락막염에서 유리체강내 클린다마이신 주입술

박수연,유호민,송지훈.Suyoun Park. MD. Ho Min Lew. MD. Ji Hun Song. MD 대한안과학회 2012 대한안과학회지 Vol.53 No.7

Purpose: To present cases of toxoplasmic retinochoroiditis (TRC) treated successfully with intravitreal clindamycin injection. Case summary: (Case 1) A 41-year-old man presented with blurred left eye vision for several months. The patient had a large chorioretinal scar with infiltrations at the boundaries, and fluorescein angiography (FA) showed active retinochoroiditis. Antitoxoplasmosis (antiTX) immunoglobulin G (IgG) was positive, and the patient was started on antiTX medication. Despite several weeks of treatment with maximum doses of antiTx, the TRC progressed and visual acuity worsened. Pars plana vitrectomy (PPV) with intravitreal clindamycin injection (1.0 mg/0.1 ml) was performed, and an additional injection was given 4 weeks later. Six weeks after the second injection, TRC wascompletely resolved with 20/20 vision. (Case 2) A 67-year-old man presented with decreased left eye vision for 1 year. Fundus examinations showed vitreous opacity and epiretinal membranes. The FA revealed retinochoroiditis and the antiTX IgG titer was elevated. The presumed diagnosis was TRC, and oral medications of trimethoprim-sulfamethoxazole, clindamycin, and prednisolone was administered. Inflammation began to improve however, as the patient was not tolerating systemic antiTx medications, an intravitreal injection of clindamycin (1.0 mg/0.1 ml) was administered with PPV. The patientdiscontinued oral medication after surgery, and the inflammation resolved 5 weeks later. Conclusions: Intravitreal clindamycin injections may be an additional treatment option for TRC in patients who are unable to tolerate systemic therapy or whose disease progresses despite systemic therapy. J Korean Ophthalmol Soc 2012;53(7):1046-1052

정상인과 녹내장 환자에서 수술 전 안구 계측치와 백내장 수술 후 안압 하강과의 관계

박수연,이마빈,안재홍,Suyoun Park,Marvin Lee,Jaehong Ahn 대한안과학회 2012 대한안과학회지 Vol.53 No.1

Purpose: To investigate the relationships between preoperative factors and intraocular pressure (IOP) reduction after phacoemulsification in normal, open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) patients. Methods: IOP was measured before and 3 months after cataract surgery in 30 normal, 24 OAG and 31 ACG patients. The relationship between IOP reduction after cataract surgery and preoperative parameters including anterior chamber depth (ACD), axial length (AL), preoperative IOP/ACD ratio (PD ratio), preoperative IOP/AL ratio (PL ratio) were investigated in the 3 groups. Results: Significant IOP reduction was observed in all 3 groups after surgery (paired sample t-test; p < 0.05), and IOP reduction was correlated with preoperative IOP level in all 3 groups (Pearson’s correlation; p < 0.05). Other preoperative parameters such as ACD and AL were not correlated with IOP reduction, and PD ratio was significantly correlated with IOP reduction only in the OAG group (Pearson’s correlation; p < 0.001). PL ratio was significantly correlated with IOP reduction in all 3 groups (Pearson’s correlation; p < 0.05) and showed the best sensitivity and specificity to predict significant reduction in IOP after cataract surgery among parameters including preoperative IOP, PD ratio and PL ratio. Conclusions: PL ratio was significantly correlated with IOP reduction after cataract surgery in all 3 groups and showed a higher predictive value for IOP reduction in the OAG group than in the other groups. J Korean Ophthalmol Soc 2012;53(1):111-119

실리콘 파브리-페로 파장가변 열광학 필터

박수연,강동헌,김영호,길상근,Park, Su-Yeon,Kang, Dong-Heon,Kim, Young-Ho,Gil, Sang-Keun 한국전기전자학회 2008 전기전자학회논문지 Vol.12 No.3

실리콘 박막 코팅을 이용한 WDM용 파장가변 실리콘 파브리-페로 열광학 필터를 제안하고 실험하였다. 실리콘 파브리-페로 파장가변 필터는 일반적인 실리콘 웨이퍼를 CMP 공정을 통해 100${\mu}m{\pm}$1%의 두께로 가공하여 양면에 거울면을 갖도록 박막 코팅하고 온도를 변화시키기 위해 PTC 써미스터를 부착하여 제작하였다. 거울면의 형성은 1550nm를 중심 파장을 갖도록 양면에 굴절율이 다른 물질 $SiO_2$($n_{low}$=1.44)와 a-Si($n_{high}$=3.48)을 ${\lambda}$/4의 두께로 증착시켜 2층 박막과 3층 박막의 거울면을 제작하였다. 실험결과, 2층 박막의 경우 FSR이 3.61nm, FWHM이 0.56nm, finesse가 6.4로 나타났고, 3층 박막의 경우 FSR이 3.36nm, FWHM이 0.13nm, finesse가 25.5로 나타났다. 열광학 효과에 의한 파장 이동은 2층 박막 거울을 가진 필터의 경우 온도가 $23^{\circ}C$에서 투과 중심 파장이 1549.73nm $30^{\circ}C$에서 1550.91nm, $60^{\circ}C$에서 1553.46nm로 파장 이동을 하였고, 3층 박막 거울을 가진 필터의 경우는 온도가 $23^{\circ}C$에서 투과 중심 파장이 1549.83nm, $30^{\circ}C$에서 1550.92nm, $60^{\circ}C$에서 1553.07nm로 파장 이동을 하였다. A silicon Fabry-Perot tunable thermo-optic filter for WDM using the thin film silicon coating is proposed and experimented. The filter is implemented by using the CMP process and polishing both sides of the commercial silicon wafer with normal thickness of 100${\mu}m{\pm}$1%. The filter also has 2-layer or 3-layer dielectrics thin film coating mirror which are alternated ${\lambda}$/4 layers of $SiO_2$($n_{low}$=1.44) and a-Si($n_{high}$=3.48) for the central wavelength of 1550nm by RF sputtering. The experiment shows that FSR is 3.61nm and FWHM is 0.56nm and the finesse is 6.4 for 2-layer mirror with the reflection of 61%, and that FSR is 3.36nm and FWHM is 0.13nm and the finesse is 25.5 for 3-layer mirror with the reflection of 89%. According to thermo-optic effect, the transmitted central wavelength of 1549.73nm at $23^{\circ}C$ is shifted to 1550.91nm at $30^{\circ}C$ and 1553.46nm at $60^{\circ}C$ for 2-layer mirror, and the transmitted central wavelength of 1549.83nm at $23^{\circ}C$ is shifted to 1550.92nm at $30^{\circ}C$ and 1553.07nm at $60^{\circ}C$ for 3-layer mirror.

上胞下垂에 關한 文獻的 考察

박수연,최정화,Park, Su-Yoen,Choi, Jung-Hwa 대한한방안이비인후피부과학회 2000 한방안이비인후피부과학회지 Vol.13 No.2

I examined and referred to literatures of every generations on the nicknames, causes, herb medications and acupucture treatments of ptosis(上胞下垂) And then the results were obtained as follows. 1. The nicknames of ptosis(上胞下垂) are hyumok(휴목), chimpung(侵風), geompye(瞼廢), geompisubok(瞼皮垂覆), posu(胞垂) and bigwon(脾倦) which corresponds to blepharoptosis in Western Medicine. 2. The congenital ptosis(上胞下垂) is mostly caused by innate disposition(稟賦不足). The acquired ptosis(上胞下垂) is mostly caused by Qi sinking of Tri-energizer(中氣下陷). And besides this, there are Blood stasis due to Qi stagnancy(氣滯血瘀), invasion of the eyelid by wind(風邪入絡), Qi and Blood deficiency(氣血不足), Phlegm syndrome due to wind(風痰阻絡), Wind syndrome due to Yang hypertrophy(陽亢動風) and Stagnation of Liver Qi(肝氣鬱結). 3. In herb medication of ptosis(上胞下垂), Bojungikgitang(補中益氣湯) was used 14 times most and its effects are nourishing the spleen to promote the flow of Qi(健脾益氣) and elevating the YangQi and activation the meridian(升陽活絡). In the following, Insamyangyeongtang(人蔘養榮湯) was done 6 times and has effects of promoting the Qi and activating the blood(益氣養血) and of promoting blood circulation and restoring flow(活血通絡). The next, Jungyongtang(正容湯) appeared 5 times and this can expel wind, resolve phlegm and restore flow(祛風滌痰通絡). As single herb, Radix glycyrrhizae(甘草) was used 66 times most. Besides this, there are a few herbs used many times like Rhizoma atractylodis macrocephalae(白朮), Radix angelicae gogantis(當歸), Radix ginseng(人蔘). Radix astragali(황기) and Rhizoma cimicifugae(升麻). 4. In acupunture treatment, Chanzhu(撰竹) was used 19 times most. Besides this acupoint, there are some points choson frequently like Zusanli(足三里), Sanyinjiao(三飮交), Yangbai(陽白), Taiyang(太陽), Tongziliao(瞳子 ), Jingming(晴明), Hegu(合谷) and Fengchi(風池).

궁귀탁리산(芎歸托裏散)의 L1210과 S-180이 이식된 마우스에 대한 항암(抗癌) 작용(作用) 연구(硏究)

박수연,김종한,최정화,박용호,Park, Su-Yeon,Kim, Jong-Han,Choi, Jung-Hwa,Park, Yong-Ho 대한한방안이비인후피부과학회 2006 한방안이비인후피부과학회지 Vol.19 No.1

Objective : The purpose of this study was to investigate effect of Gungguitakli-San(GTS) on the anti-tumor, immunocytes. Methods : This study estimated the proliferation of L1210 and S-180 cell lines, mouse splenocytes and thymocytes in vitro, and estimated the proliferation of L1210 cell, S-180 cell, thymocytes and splenocytes and body weight in S-180 cells-transplanted mice. The cytotoxicity and proliferation of cells were tested using a colorimetric tetrazoliun assay(M1T assay). Results : The results of this study were obtained as follow ; 1. GTS was significantly increased in the proliferation of thymocytes and splenocytes In vitro. 2. GTS was significantly showed cytotoxicity on the L1210 cell lines and 8-180 cell lines in vitro. 3. GTS was significantly showed cytotoxicity on the L1210 cell lines in vivo. 4. GTS was significantly increased in the weight of mice and decreased weight of sarcoma, in S-180 cells transplanted mice. 5. GTS was significantly increased in the period of survive, in S-180 cells transplanted mice. Conclusions : The author thought that GTS had action of anti-cancer by becoming immunocytes activity and by cytotoxicity of cancer cells.

척추뼈전이암 환자의 체부정위방사선치료계획 비교: 동시통합추가치료법 대 RTOG 0631 프로토콜

박수연,오동렬,박희철,김진성,김종식,신은혁,김혜영,정상훈,한영이,Park, Su Yeon,Oh, Dongryul,Park, Hee Chul,Kim, Jin Sung,Kim, Jong Sik,Shin, Eun Hyuk,Kim, Hye Young,Jung, Sang Hoon,Han, Youngyih 한국의학물리학회 2014 의학물리 Vol.25 No.3

척추뼈전이암 환자를 대상으로 본원의 동시통합추가치료법(SIB)과 RTOG 0631 프로토콜에 따른 체부정위방사선치료계획을 세우고, 선량분포를 비교하였다. 간암 원발인 척추 뼈 전이암 환자 5명을 대상으로 전산화단층촬영 영상과 자기공명영상(T1, T2)를 바탕으로 영상융합을 시행하였다. 본원에서 시행하는 SIB방법은 영상에서 보이는 종양을 GTV로 설정하고, GTV를 포함한 전체 척추체부(entire vertebral body, VB)를 CTV1로 정의하였고 GTV에 18 Gy CTV1에 10 Gy를 1회 처방하였다. RTOG 0631 프로토콜 방법은 GTV의 침윤 정도에 따라 주변부의 추근, 좌우 횡돌기 및 극돌기 등을 선택적으로 포함하여 CTV2로 정의하였고 18 Gy 1회 처방하여 체부정위방사선치료계획을 시행하였다. 선량체적화 결과값을 선량-체적 히스토그램을 통해 분석한 결과, 두 방법 모두 표적에 대하여 처방 선량을 만족하였으며, 척수 및 정상 장기에 대하여는 SIB방법이 RTOG 0631프로토콜보다는 낮은 값을 보였다. 또한, 전체 VB의 조사선량분포를 정량화한 결과, RTOG 0631프로토콜에서도 SIB방법과 동일한 처방선량 허용치 85%이상을 포함하는 것으로 나타났다. 하지만 정상 장기에 대한 선량은 RTOG 0631 프로토콜에 따른 치료 방법이 높은 편이었다. 주변부 장기의 부작용이 우려되는 임상적 상황의 경우 조사 체적이 적은 SIB방법이 좋은 선택이 될 수 있을 것이다. 결론적으로 SIB방법이나 RTOG 0631 프로토콜에 따른 표적체적 설정을 통한 체부정위방사선치료계획 모두 유사한 결과를 보였으며, 향후 다양한 연구를 통해 종양제어확률 및 부작용 확률의 차이를 분석해야 할 것이다. In this study, we compared dose distributions from simultaneously integrated boost (SIB) method versus the RTOG 0631 protocol for spine radiosurgery. Spine radiosurgery plans were performed in five patients with localized spinal metastases from hepatocellular carcinoma. The computed tomography (CT) and T1- and T2-weighted magnetic resonance imaging (MRI) were fused for delineating of GTV and spinal cord. In SIB plan, the clinical target volume (CTV1) was included the whole compartments of the involved spine, while RTOG 0631 protocol defines the CTV2 as the involved vertebral body and both left and right pedicles. The CTV2 includes transverse process and posterior element according to the extent of GTV. The doses were prescribed 18 Gy to GTV and 10 Gy to CTV1 in SIB plan, while the prescription of RTOG 0631 protocol was applied 18 Gy to CTV2. The results of dose-volume histogram (DVH) showed that there were competitive in target coverage, while the doses of spinal cord and other normal organs were lower in SIB method than in RTOG 0631 protocol. The 85% irradiated volume of VB in RTOG 0631 protocol was similar to that in the SIB plan. However, the dose to normal organs in RTOG 0631 had a tendency to higher than that in SIB plan. The SIB plan might be an alternative method in case of predictive serious complications of surrounded normal organs. In conclusion, although both approaches of SIB or RTOG 0631 showed competitive planning results, tumor control probability (TCP) and normal tissue complication probability (NTCP) through diverse clinical researches should be analyzed in the future.