체부 정위방사선치료 시 호흡운동 감소를 위한 복부 압박기구 개발 및 유용성 평가

황선붕,김일환,김웅,임형서,강진묵,정성민,김기환,이아람,조유라,Hwang, Seon-Bung,Kim, Il-Hwan,Kim, Woong,Im, Hyeong-Seo,Gang, Jin-Mook,Jeong, Seong-Min,Kim, Gi-Hwan,Lee, Ah-Ram,Cho, Yu-Ra 대한방사선치료학회 2011 대한방사선치료학회지 Vol.23 No.1

Purpose: It's essential to minimize the tumor motion and identify the exact location of the lesions to achieve the improvement in radiation therapy efficiency during SBRT. In this study, we made the established compression belt to reduce respiratory motion and evaluated the usefulness of clinical application in SBRT. Materials and Methods: We analyzed the merits and demerits of the established compression belt to reduce the respiratory motion and improved the reproducibility and precision in use. To evaluate the usefulness of improved compression belt for respiratory motion reduction in SBRT, firstly, we reviewed the spiral CT images acquired in inspiration and expiration states of 8 lung cancer cases, respectively, and analyzed the three dimensional tumor motion related to respiration. To evaluate isodose distribution, secondly, we also made the special phantom using EBT2 film (Gafchronic, ISP, USA) and we prepared the robot (Cartesian Robot-2 Axis, FARARCM4H, Samsung Mechatronics, Korea) to reproduce three dimensional tumor motion. And analysis was made for isodose curves and two dimensional isodose profiles with reproducibility of respiratory motion on the basis of CT images. Results: A respiratory motion reduction compression belt (Velcro type) that has convenient use and good reproducibility was developed. The moving differences of three dimensional tumor motion of lung cancer cases analyzed by CT images were mean 3.2 mm, 4.3 mm and 13 mm each in LR, AP and CC directions. The result of characteristic change in dose distribution using the phantom and rectangular coordinates robot showed that the distortion of isodose has great differences, mean length was 4.2 mm; the differences were 8.0% and 16.8% each for cranio-caudal and 8.1% and 10.9% each for left-right directions in underdose below the prescribed dose. Conclusion: In this study, we could develop the convenient and efficient compression belt that can make the organs' motion minimize. With this compression belt, we confirmed that underdose due to respiration can be coped with when CTV-PTV margins of mean 6 mm would be used. And we conclude that the respiratory motion reduction compression belt we developed can be used for clinical effective aids along with the gating system.

영상유도 체부정위방사선 치료시 호흡동조를 위한 휴대형 호흡연습장치의 개발 및 유용성 평가

황선붕,박문규,박승우,조유라,이동한,정해조,지영훈,권수일,Hwang, Seon Bung,Park, Mun Kyu,Park, Seung Woo,Cho, Yu Ra,Lee, Dong Han,Jung, Hai Jo,Ji, Young Hoon,Kwon, Soo-Il 한국의학물리학회 2014 의학물리 Vol.25 No.4

This study developed a portable respiratory training device to improve breathing stability, which is an important element in using the CyberKnife Synchrony respiratory tracking device, one of the typical Stereotactic Radiation Therapy (SRT) devices. It produced an interface for users to be able to select one of two displays, a graph type and a bar type, supported an auditory system that helps them expect next respiration by improving a sense of rhythm of their respiratory period, and provided comfortable respiratory inducement. By targeting 5 applicants and applying individual respiratory period detected through a self-developed program, it acquired signal data of 'guide respiration' that induces breathing through signal data gained from 'free respiration' and an auditory system, and evaluated the usability by comparing deviation average values of respiratory period and respiratory amplitude. It could be identified that respiratory period decreased $55.74{\pm}0.14%$ compared to free respiration, and respiratory amplitude decreased $28.12{\pm}0.10%$ compared to free respiration, which confirmed the consistency and stability of respiratory. SBRT, developed based on these results, using the portable respiratory training device, for liver cancer or lung cancer, is evaluated to be able to help reduce delayed treatment time due to respiratory instability and improve treatment accuracy, and if it could be applied to developing respiratory training applications targeting an android-based portable device in the future, even use convenience and economic efficiency are expected. 본 연구에서는 영상유도 로봇 정위방사선치료장비(Stereotactic Radiation Therapy, SRT) 사이버나이프의 Synchrony 호흡추적장치의 사용에 있어 중요한 요소 중에 하나인 호흡의 안정성을 향상 시키고자 휴대형 호흡연습장치(portable respiratory training device)를 개발하였다. 그래프와 막대 형식의 2가지 디스플레이 중 사용자가 원하는 방식을 선택할 수 있도록 인터페이스를 제작하고, 자신의 호흡주기에 대한 리듬감을 향상 시켜 다음 호흡을 예측할 수 있도록 도와주는 청각시스템을 지원하여 편안한 호흡유도를 제공하였다. 5명의 지원자를 대상으로 자체 프로그램을 통해 검출한 개인고유 호흡주기를 적용하여, '자유호흡(free respiration)'에서 획득한 신호데이터와 시청각시스템을 통해 호흡을 유도하는 '모니터호흡(guide respiration)'의 신호데이터를 획득하고, 호흡주기(period)와 호흡깊이(amplitude)의 편차 평균값을 비교하여 유용성을 평가하였다. 호흡주기의 경우 자유호흡에 비하여 $55.74{\pm}0.14%$로 감소하였고, 호흡깊이의 경우에도 자유호흡의 비해 $28.12{\pm}0.10%$ 감소함으로써 호흡의 규칙성과, 안정성이 향상됨을 확인하였다. 이러한 결과를 바탕으로 개발한 휴대형 호흡연습장치를 이용한 간암, 폐암 등의 체부정위방사선치료에 있어, 호흡 불안정에 의해 발생되는 치료시간의 지연을 줄이고 치료정확도 향상에 도움을 줄 수 있을 것으로 평가되며, 차후 안드로이드(Android)기반의 휴대용단말기를 대상으로 한 호흡연습 어플리케이션 개발에 적용한다면 사용 편의성과 더불어 경제적 효율까지 기대할 수 있을 것으로 판단된다.

영상유도방사선치료시 확인 영상의 흡수선량평가

황선붕,김기환,김일환,김웅,임형서,한수철,강진묵,김진호,Hwang, Sun Boong,Kim, Ki Hwan,kim, il Hwan,Kim, Woong,Im, Hyeong Seo,Han, Su Chul,Kang, Jin Mook,Kim, Jinho 대한방사선치료학회 2015 대한방사선치료학회지 Vol.27 No.1

목 적 : 방사선 치료 전 종양의 정확한 위치확인을 위한 치료 전 확인영상인 2D(AP,LAT), 3D(CBCT)의 흡수선량을 평가해보았다. 대상 및 방법 : Varian 사에서 제작한 OBI(Version1.5) System, CTDI 측정 phantom및 이온chamber, 교정된 유리선량계(GD-352M)를 이용하여 두부, 흉부, 복부의 부위별 촬영조건에 따라 Rando phantom 에 $0^{\circ}$, $90^{\circ}$, $180^{\circ}$, $270^{\circ}$, 중심부에 각각 3개씩의 유리선량계를 부착하여 Field size $26.6{\times}20$, $15{\times}15$로 나누어 측정하였다. 또한 같은 방법으로 CBCT width를 16cm, 10cm로 나누어 동일하게 측정하였다. 결 과 : 2차원영상 AP 촬영은 입사방향인 $0^{\circ}$에서 가장 크게 측정되었으며 Field size 를 $26.6{\times}20$, $15{\times}15$로 변화 시켰을 때 흡수선량은 두부에서 각각 $1.44{\pm}0.26mGy$, $1.17{\pm}0.02mGy$, 흉부는 $3.08{\pm}0.86mGy$, $0.57{\pm}0.02mGy$, 복부는 $8.19{\pm}0.54mGy$ $4.19{\pm}0.08mGy$로 Field size 축소에 따라 평균 5~12%감소하였다. Lat 촬영 시에는 각각 5~8%감소하였다. 3차원영상 CBCT 에서는 width를 16 cm, 10 cm로 변화시킴에 따라 CBDI 측정값은 두부 $4.39{\pm}0.11mGy$, $3.99{\pm}0.13mGy$, 흉부(LDCT) $34.88{\pm}0.93(10.48{\pm}0.09)mGy$, $31.01{\pm}0.3(9.30{\pm}0.09)mGy$ 복부 $35.99{\pm}1.86mGy$, $32.27{\pm}1.35mGy$로 약 8~11%감소하였다. 결 론 : 2D는 조사면 크기를 줄여 5~12%, 3D는 width를 줄여줌으로써 8~11% 환자피폭선량을 감소시킬 수 있었다. 영상선량을 줄이기 위한 방사선사의 인식의 전환이 필요하고 다수의 CBCT 촬영시 치료처방선량에 영상선량의 포함여부도 고려되어야 할 것으로 사료된다. Purpose : Evaluating absorbed dose related to 2D and 3D imaging confirmation devices Materials and Methods : According to the radiographic projection conditions, absorbed doses are measured that 3 glass dosimeters attached to the centers of 0', 90', 180' and 270' in the head, thorax and abdomen each with Rando phantom are used in field size $26.6{\times}20$, $15{\times}15$. In the same way, absorbed doses are measured for width 16cm and 10cm of CBCT each. OBI(version 1.5) system and calibrated glass dosimeters are used for the measurement. Results : AP projection for 2D imaging check, In $0^{\circ}$ degree absorbed doses measured in the head were $1.44{\pm}0.26mGy$ with the field size $26.6{\times}20$, $1.17{\pm}0.02mGy$ with the field size $15{\times}15$. With the same method, absorbed doses in the thorax were $3.08{\pm}0.86mGy$ to $0.57{\pm}0.02mGy$ by reducing field size. In the abdomen, absorbed dose were reduced $8.19{\pm}0.54mGy$ to $4.19{\pm}0.09mGy$. Finally according to the field size, absorbed doses has decreased by average 5~12%. With Lateral projection, absorbed doses showed average 5~8% decrease. CBCT for 3D imaging check, CBDI in the head were $4.39{\pm}0.11mGy$ to $3.99{\pm}0.13mGy$ by reducing the width 16cm to 10cm. In the same way in thorax the absorbed dose were reduced $34.88{\pm}0.93(10.48{\pm}0.09)mGy$ to $31.01{\pm}0.3(9.30{\pm}0.09)mGy$ and $35.99{\pm}1.86mGy$ to $32.27{\pm}1.35mGy$ in the abdomen. With variation of width 16cm and 10cm, they showed 8~11% decrease. Conclusion : By means of reducing 2D field size, absorbed dose were decreased average 5~12% in 3D width size 8~11%. So that it is necessary for radiation therapists to recognize systematical management for absorbed dose for Imaging confirmation. and also for frequent CBCT, it is considered whether or not prescribed dose for RT refer to imaging dose.

자궁경부암 근접치료에서 A점과 H점을 이용한 치료계획 시 선량 비교

강지형,김일환,황선붕,김웅,임형서,강진묵,김기환,이아람,Gang, Ji-Hyeong,Gim, Il-Hwan,Hwang, Seon-Boong,Kim, Woong,Im, Hyeong-Seo,Gang, Jin-Mook,Gim, Gi-Hwan,Lee, Ah-Ram 대한방사선치료학회 2012 대한방사선치료학회지 Vol.24 No.2

목 적: 본 연구에서는 자궁강 내 근접치료 시 ABS (American Brachytherapy Society)에서 권고한 H점(point H)을 이용한 치료계획을 수립해 보았고, 이를 A점(point A)에 처방한 치료계획과 비교하고자 한다. 대상 및 방법: 2010년 3월부터 2012년 1월까지 본원에 내원한 자궁경부암 환자 중 탄뎀(tandem)과 난형체(ovoid)를 이용해 고선량률 강내 근접치료(high dose rate intracavitary brachytherapy)를 시행한 103명을 대상으로 하였다. 치료계획은 Manchester System에 따라 A점, 방광 기준점, 직장 기준점을 지정하였고, ABS의 권고에 따라 H점을 지정하였다. 또한 임의로 S자 결장기준점과 질 기준점을 설정하였다. A점과 H점의 위치가 얼마나 차이가 나는지 살펴보았으며, H점에 100%의 선량을 처방하였을 때 A점에 들어가는 선량을 계산하였다. 그리고 A점과 H점에 각각 선량을 처방하였을 때 직장, 방광, S자 결장, 질 기준점에 들어가는 선량을 비교 분석하였다. 결 과: H점이 A점보다 미측에 있는 경우 A점의 상대선량은 기존의 A점이 아닌 H점에 처방하였을 때 더 적어지는 경향을 보였다. 방광 기준점과 직장 기준점, S자결장 기준점, 질 기준점에서의 상대선량은 H점이 두측에 있는 경우 H점에 처방하였을때의 선량이 A점에 처방하였을 때보다 크며, 미측에 있는 경우 더 적어지는 양상을 보였다. 결 론: H점이 A점보다 두측에 위치할수록 주변 장기의 흡수선량이 커지고, 미측에 위치할수록 주변 장기의 흡수선량이 적어지는 경향을 보였다. 그 선량 차이가 치료에 큰 영향을 미칠 정도는 아니지만, 두 치료계획에서의 선량 분포 및 주변 장기 흡수선량 차이가 크다면 두 점의 치료계획은 비교 또는 참고할 만한 가치가 있는 것으로 생각된다. Purpose: The purpose of this study is to compare plans prescribed to point A with these prescribed to point H recommended by ABS (American Brachytherapy Society) in high dose rate intracavitary brachytherapy for cervical carcinoma. Materials and Methods: This study selected 103 patients who received HDR (High Dose Rate) brachytherapy using tandem and ovoids from March 2010 to January 2012. Point A, bladder point, and rectal point conform with Manchester System. Point H conforms with ABS recommendation. Also Sigmoid colon point, and vagina point were established arbitrarily. We examined distance between point A and point H. The percent dose at point A was calculated when 100% dose was prescribed to point H. Additionally, the percent dose at each reference points when dose is prescribed to point H and point A were calculated. Results: The relative dose at point A was lower when point H was located inferior to point A. The relative doses at bladder, rectal, sigmoid colon, and vagina points were higher when point H was located superior to point A, and lower when point H was located inferior to point A. Conclusion: This study found out that as point H got located much superior to point A, the absorbed dose of surrounding normal organs became higher, and as point H got located much inferior to point A, the absorbed dose of surrounding normal organs became lower. This differences dose not seem to affect the treatment. However, we suggest this new point is worth being considered for the treatment of HDR if dose distribution and absorbed dose at normal organs have large differences between prescribed to point A and H.