고 에너지 방사선치료 시 GEANT4-DICOM과 TPS간 선량비교 연구

곽근탁,김양수,권형철,김정수,이선영 대한방사선과학회 2018 방사선기술과학 Vol.41 No.6

Radiation therapy is one of the beneficial choices in the treatment of cancer. This is a comparison of TPS(Treatment Planning System) and GEANT4-DICOM, which should be preceded by the best radiation therapy. A treatment plan for prostate cancer was established with Eclipse and the point doses 366.1 cGy, 189.1 cGy, 213.4 cGy, 127 cGy, 105.7 cGy of any five prostate, bladder, rectum, right femoral head and left femoral head were identified. GEANT4-DICOM simulation showed that the results of Eclipse and ± 2% dose error were confirmed. The monthly X-ray output agreement management value recommended by TG-142 is ± 2%, which means that the experimental results can be meaningful. In conclusion, GEANT4-DICOM is an infinite way to obtain more extended dose information once the time constraints are overcome in the simulation.

Lung RPO 선량전달시, Carbon Couch Side Rail과 Vac-lok이 미치는 영향

김석민,곽근탁,이승훈,김정수,권형철,김양수,이선영,Kim, Seok Min,Gwak, Geun Tak,Lee, Seung Hun,Kim, Jung Soo,Kwon, Hyoung Cheol,Kim, Yang Su,Lee, Sun Young 대한방사선치료학회 2018 대한방사선치료학회지 Vol.30 No.1

목 적 : 폐의 우측후사방향 선량전달시, Carbon Side Rail과 환자 고정기구인 Vac-lok이 미치는 영향을 보고자 한다. 대상 및 방법 : Vac-lok의 오른쪽 부분을 10, 20, 30 mm 두께로 제작하였다. 측정은 유리선량계를 이용하여 측정하였고, 측정점은 팬텀 우측 폐의 center Point를 기준으로 좌, 우, 하, 상 방향 각각 A, B, C, D Point로 설정 하였다. 각 point에 유리선량계를 삽입한 후 couch의 Side Rail을 외측(Out)으로 뺀 후 vac-lok을 놓지 않은 no vac-lok, 그리고 10, 20, 30 mm의 vac-lok 위에 팬텀을 세팅하였다. 중심점에 6 MV 광자선을 조사야 $10{\times}10cm^2$, SAD 100 cm, 겐트리 각도 $225^{\circ}$로 하여 300 MU/min 선량률과 100 MU 조사선량을 전달하였다. 측정은 5회씩 실시하였고, 마찬가지로 Side Rail을 내측(In)으로 넣은 후 각 point에 대해서도 같은 조건으로 5 회씩 측정하여 평균값을 산출하였다. 결 과 : side rail에 따라서는 중심점, A, B, C, D Point 각각 -11.8 %, -12.3 %, -4.1 %, -12.3 %, -7.3 %의 선량 감소를 보였다. Side-Rail-Out에서 10 mm vac-lok의 경우 약 -0.9 %가 감소되었고, 20 mm vac-lok 사용 시 약 -2.0 %, 30 mm vac-lock 사용 시 약 -3.0 %가 감소되었다. Side-Rail-In에서 10 mm vac-lok의 경우 약 -1.0 %가 감소되었고, 20 mm vac-lok 사용 시 약 -2.1 %, 30 mm vac-lok 사용 시 약 -3.0 %가 감소되었다. Side-Rail-In 상태의 no vac-lok 선량 값을 기준으로 Side-Rail-Out 상태의 10, 20, 30 mm vac-lok을 사용할 때, side rail에 대한 선량 감소에 더하여 중심점에서는 약 -0.9 %, -1.8 % -2.4 %, A point에서는 -0.5 %, -1.6 %, -2.1 %, B point에서는 약 -0.9 %, -2.0 %, -3.2 %, C Point에서는 -1.0 %, -2.1 %, -3.1 %, D point에서는 약 -1.0 %, -1.6 %, -3.1 %의 추가적인 선량 감소를 나타냈다. 결 론 : 폐를 비롯한 우측후사방향 방사선 치료 시 side rail에 대해 주의를 기울이고, vac-lok 제작 시 vaclok 두께에 대해 관심을 갖는다면 더 나은 치료 효과를 기대해 볼 수 있으리라 사료된다. Purpose : To evaluate the effect of carbon couch side rail and vacuum immobilization device in case of lung RPO irradiation. Materials and Methods : The 10, 20, 30 mm thickness of vac-lok's right side were obtained. To measure of doses, glass dosimeters were used and measured reference point is left lung center at the phantom. A, B, C, and D points are left, right, down, and up directions based on the center point. In the state of Side-Rail-Out, place the without vac-lok, with the thickness of 10, 20, and 30 mm vac-lok. After the glass dosimeters was inserted in center, A, B, C, and D points, 100 MU of 6 MV X-ray were irradiated to the referenced center point in the condition of $10{\times}10cm^2$ field size, SAD 100 cm, gantry angle 225, 300 MU/min dose rate. Five measurements were made for each point. In the state of Side-Rail-In, five measurement were made for each point under the same conditions. The average is measured on each of the five Side-Rail-Out and Side-Rail-In measurements. Results : In the presence of side rail, the dose reduction ratio was -11.8 %, -12.3 %, -4.1 %, -12.3 %, -7.3 % for each A, B, C, and D points. In the state of Side-Rail-Out, the dose reduction ratio for the using 10 mm thickness of vac-lok was -0.9 % than without vac-lok. The dose reduction ratio for the using 20 mm thickness of vac-lok was -2.0 %, for the using 30 mm thickness of the vac-lok was -3.0 % than without vac-lok. In the state of Side-Rail-In, the dose reduction ratio for the using 10 mm thickness of vac-lok was -1.0 % than without vac-lok. The dose reduction ratio for the using 20 mm vac-lok was -2.1 %, for the using 30 mm vac-lok was -3.0 % than without vac-lok. Based on the value of no vac-lok dose in the Side-Rail-In state, The dose reduction ratios for the using 10 mm, 20 mm and 30 mm thickness of vac-loks In the Side-Rail-Out that the center point were -12.7 %, -13.7 %, -14.2 % and -12.8 %, -13.8 %, -14.5 % respectively at point A. The dose reduction ratios for the same conditions to the B point were -4.9 %, -6.1 %, -7.1 % and -13.4 %, -14.4 %, -15.5 % respectively at point C. The dose reduction ratios for the same conditions to the D point were -8.4 %, -9.0 %, -10.4 % respectively. Conclusion : The attenuation was caused by presence of side rails and thickness of vac-lok. Pay attention to these attenuation factors, making it a more effective radiation therapy.

6 MeV 전자선의 차폐물질 원자번호와 조사야 크기에 따른 선량변화 연구

이승훈,곽근탁,박주경,김양수,차석용,Lee, Seung Hoon,Kwak, Keun Tak,Park, Ju Kyeong,Gim, Yang Soo,Cha, Seok Yong 대한방사선치료학회 2013 대한방사선치료학회지 Vol.25 No.2

목 적: 본 연구에서 우리는 6 MeV 전자선의 조사야 확대에 따른 선량변화가 차폐물질 원자번호와 관계가 있음을 알아보고 그 영향인자를 분석 하고자 한다. 대상 및 방법: 먼저 평행평판형 전리함(Exradin P11)을 $25{\times}25cm^2$ 폴리스티렌 팬텀표면에 평탄하게 끼운다. 허용투과율 5% 두께의 알루미늄, 구리, 납 물질들을 팬텀 상단에 차폐시킨 후 조사야 $6{\times}6$, $10{\times}10$ 그리고 $20{\times}20cm^2$별로 측정하였다. 조사조건은 선원-표면간거리 100 cm에서 기준조사야인 $10{\times}10cm^2$에 6 MeV 전자선을 이용하여 100 cGy 조사하였다. 다음으로 MCNP (Monte Carlo N Particle Transport Code)를 이용하여 각 물질 통과 후 발생되는 광자수, 전자수, 그리고 축적에너지를 계산하였다. 결 과: 허용투과율 5% 두께에 대한 차폐물 종류에 따른 측정결과 조사야 $10{\times}10cm^2$을 기준으로 한 $6{\times}6cm^2$과 $20{\times}20cm^2$의 두께변화율은 알루미늄에서 각각 +0.06%와 -0.06%, 구리에서 각각 +0.13%와 -0.1%, 납에서 각각 -1.53%와 +1.92%였다. 계산결과 조사야 $10{\times}10cm^2$ 대비 $6{\times}6cm^2$, $20{\times}20cm^2$의 축적에너지는 차폐를 하지 않았을 경우 각각 -4.3%와 +4.85%, 알루미늄 사용 시 각각 -0.87%와 +6.93%, 구리 사용 시 각각 -2.46%와 +4.48%, 납 사용 시 각각 -4.16%와 +5.57%였다. 광자수의 경우 차폐를 하지 않았을 경우 각각 -8.95%와 +15.92%, 알루미늄 사용 시 각각 -15.56%와 +16.06%, 구리 사용시 각각 -12.27%와 +15.53%, 납 사용 시 각각 -12.36%와 +19.81%였다. 전자수의 경우 차폐를 하지 않았을 경우 각각 -3.92%와 +4.55%, 알루미늄 사용 시 각각 +0.59%와 +6.87%, 구리 사용 시 각각 -1.59%와 +3.86%, 납 사용 시 각각 -5.15%와 +4.00%였다. 결 론: 본 연구로 조사야 증가함에 따른 차폐물 두께가 저 원자번호에서 감소하며, 고 원자번호에서는 증가함을 볼 수 있었으며, 계산을 통해 저 원자번호물질에서는 저지방사선, 고 원자번호물질에서는 산란전자가 영향을 주는 것을 알 수 있었다. Purpose: In this study, we analyzed how the dose change by field size effects on atomic number of shielding materials while using 6 MeV election beam. Materials and Methods: The parallel plate chamber is mounted in $25{\times}25cm^2$ the phantom such that the entrance window of the detector is flush with the phantom surface. phantom was covered laterally with aluminum, copper and lead which thickness have 5% of allowable transmission and then the doses were measured in field size $6{\times}6$, $10{\times}10$ and $20{\times}20cm^2$ respectively. 100 cGy was irradiated using 6 MeV electron beam and SSD (Source Surface Distance) was 100 cm with $10{\times}10cm^2$ field size. To calculate the photon flux, electron flux and Energy deposition produced after pass materals respectively, MCNPX code was used. Results: The results according to the various shielding materials which have 5% of allowable transmission are as in the following. Thickness change rate with field size of $6{\times}6cm^2$ and $20{\times}20cm^2$ that compared to the field size of $10{\times}10cm^2$ found to be +0.06% and -0.06% with aluminum, +0.13% and -0.1% with copper, -1.53% and +1.92% with lead respectively. Compare to the field size $10{\times}10cm^2$, energy deposition for $6{\times}6cm^2$ and $20{\times}20cm^2$ had -4.3% and +4.85% respectively without shielding material. With aluminum it had -0.87% and +6.93% respectively and with lead it had -4.16% and +5.57% respectively. When it comes to photon flux with $6{\times}6cm^2$ and $20{\times}20cm^2$ of field sizes the chance -8.95% and +15.92% without shielding material respectively, with aluminum the number -15.56% and +16.06% respectively and with copper the chance -12.27% and +15.53% respectively, with lead the number +12.36% and -19.81% respectively. In case of electron flux in the same condition, the number -3.92% and +4.55% respectively without shielding material respectively, with aluminum the number +0.59% and +6.87% respectively, with copper the number -1.59% and +3.86% respectively, with lead the chance -5.15% and +4.00% respectively. Conclusion: In this study, we found that the required thickness of the shielding materials got thinner with low atomic number substance as the irradiation field is increasing. On the other hand, with high atomic number substance the required thickness had increased. In addition, bremsstrahlung radiation have an influence on low atomic number materials and high atomic number materials are effected by scattered electrons.

전자선 치료 시 차폐블록 두께 변화에 따른 블록 주변 선량에 관한 연구

박시온,곽근탁,박주경,이승훈,김양수,김정수,권형철,이선영,Park, Zi On,Gwak, Geun Tak,Park, Ju Kyeong,Lee, Seung Hun,Kim, Yang Su,Kim, Jung Soo,Kwon, Hyoung Cheol,Lee, Sun Young 대한방사선치료학회 2019 대한방사선치료학회지 Vol.31 No.1

목 적: 전자선 치료에서 저 용융점 납합금과 순수 납을 이용한 차폐 시 두께증가에 따른 블록 가장자리의 산란선 영향을 알아보고자 한다. 대상 및 방법: $10{\times}10cm^2$ 어플리케이터의 Insert Frame 절반을 차폐하도록 블록을 제작하였고, 두께는 각 재질당 3, 5, 10, 15, 20 (mm)로 하였다. 공통 조건을 에너지 6 MeV, 선량률 300 MU/Min, 갠트리 각도 0, 부여선량 100 MU으로 설정하였고, 블록의 위치와 측정점의 위치, 블록재질을 각각 달리하여 블록 두께증가에 따른 상대적인 산란비율을 평행평판형 전리함과 고체팬텀으로 측정하였다. 결 과: (측정 깊이 / 블록 위치 / 블록 재질)이 (표면 / 어플리케이터 / 순수 납)일 때 블록 두께가 3, 5, 10, 15, 20 (mm) 순으로 증가함에 따라 상대선량은 15.33 nC, 15.28 nC, 15.08 nC, 15.05 nC, 15.07 nC로 측정되었다. (표면 / 어플리케이터 / 합금 납)일 때 15.19 nC, 15.25 nC, 15.15 nC, 14.96 nC, 15.15 nC로 측정되었다. (표면 / 팬텀 위 / 순수 납)일 때 15.62 nC, 15.59 nC, 15.53 nC, 15.48 nC, 15.34 nC로 측정되었다. (표면 / 팬텀 위 / 합금 납)일 때 15.56 nC, 15.55 nC, 15.51 nC, 15.42 nC, 15.39 nC로 측정되었다. (심부 / 어플리케이터 / 순수 납)일 때 16.70 nC, 16.84 nC, 16.72 nC, 16.88 nC, 16.90 nC로 측정되었다. (심부 / 어플리케이터 / 합금 납)일 때 16.83 nC, 17.12 nC, 16.89 nC, 16.77 nC, 16.52 nC로 측정되었다. (심부 / 팬텀 위 / 순수 납)일 때 17.41 nC, 17.45 nC, 17.34 nC, 17.42 nC, 17.25 nC로 측정되었다. (심부 / 팬텀 위 / 합금 납)일 때 17.45 nC, 17.44 nC, 17.47 nC, 17.43 nC, 17.35 nC로 측정되었다. 결 론: 차폐블록을 이용하여 전자선 치료를 진행할 때 블록위치는 환자 체표면보다는 어플리케이터에 삽입하고 두께는 각 사용 에너지에 해당되는 최소 적정차폐두께로 제작해야 한다. 또한 블록 가장자리 경계선으로부터 떨어진 거리에 따라 변화하는 산란선의 영향을 충분히 고려하여 치료를 시행하는 것이 바람직하다고 사료된다. Purpose: The purpose is to clarify the effect of additional scattering ratio on the edge of the block according to the increasing block thickness with low melting point lead alloy and pure lead in electron beam therapy. Methods and materials: $10{\times}10cm^2$ Shielding blocks made of low melting point lead alloy and pure lead were fabricated to shield mold frame half of applicator. Block thickness was 3, 5, 10, 15, 20 (mm) for each material. The common irradiation conditions were set at 6 MeV energy, 300 MU / Min dose rate, gantry angle of $0^{\circ}$, and dose of 100 MU. The relative scattering ratio with increasing block thickness was measured with a parallel plate type ion chamber(Exradin P11) and phantom(RW3) by varying the position of the shielding block(cone and on the phantom), the position of the measuring point(surface ans depth of $D_{max}$), and the block material(lead alloy and pure lead). Results : When (depth of measurement / block position / block material) was (surface / applicator / pure lead), the relative value(scattering ratio) was 15.33 nC(+0.33 %), 15.28 nC(0 %), 15.08 nC(-1.31 %), 15.05 nC(-1.51 %), 15.07 nC(-1.37 %) as the block thickness increased in order of 3, 5, 10, 15, 20 (mm) respectively. When it was (surface / applicator / alloy lead), the relative value(scattering ratio) was 15.19 nC(-0.59 %), 15.25 nC(-0.20 %), 15.15 nC(-0.85 %), 14.96 nC(-2.09 %), 15.15 nC(-0.85 %) respectively. When it was (surface / phantom / pure lead), the relative value(scattering ratio) was 15.62 nC(+2.23 %), 15.59 nC(+2.03 %), 15.53 nC(+1.67 %), 15.48 nC(+1.31 %), 15.34 nC(+0.39 %) respectively. When it was (surface / phantom / alloy lead), the relative value(scattering ratio) was 15.56 nC(+1.83 %), 15.55 nC(+1.77 %), 15.51 nC(+1.51 %), 15.42 nC(+0.92 %), 15.39 nC(+0.72 %) respectively. When it was (depth of $D_{max}$ / applicator / pure lead), the relative value(scattering ratio) was 16.70 nC(-10.87 %), 16.84 nC(-10.12 %), 16.72 nC(-10.78 %), 16.88 nC(-9.93 %), 16.90 nC(-9.82 %) respectively. When it was (depth of $D_{max}$ / applicator / alloy lead), the relative value(scattering ratio) was 16.83 nC(-10.19 %), 17.12 nC(-8.64 %), 16.89 nC(-9.87 %), 16.77 nC(-10.51 %), 16.52 nC(-11.85 %) respectively. When it was (depth of $D_{max}$ / phantom / pure lead), the relative value(scattering ratio) was 17.41 nC(-7.10 %), 17.45 nC(-6.88 %), 17.34 nC(-7.47 %), 17.42 nC(-7.04 %), 17.25 nC(-7.95 %) respectively. When it was (depth of $D_{max}$ / phantom / alloy lead), the relative value(scattering ratio) was 17.45 nC(-6.88 %), 17.44 nC(-6.94 %), 17.47 nC(-6.78 %), 17.43 nC(-6.99 %), 17.35 nC(-7.42 %) respectively. Conclusions: When performing electron therapy using a shielding block, the block position should be inserted applicator rather than the patient's body surface. The block thickness should be made to the minimum appropriate shielding thickness of each corresponding using energy. Also it is useful that the treatment should be performed considering the influence of scattering dose varying with distance from the edge of block.

Paraneoplastic Autoimmune Multiorgan Syndrome으로 인하여 구강 내 국소적으로 발생한 과다혈관성 궤양의 방사선 근접치료 시 자체 제작한 Mold의 유용성 평가

박주경,이선영,임석건,곽근탁,이승훈,김양수,황호인,차석용,Park, Ju-Kyeong,Lee, Sun-Young,Lim, Seok-Geon,Kwak, Geun-Tak,Lee, Seung-Hun,Kim, Yang-Su,Hwang, Ho-In,Cha, Seok-Yong 대한방사선치료학회 2009 대한방사선치료학회지 Vol.21 No.1

Purpose: Evaluate the mold we have made to improve the reproducibility of the patient position and make homogeneous dose distribution to the treatment volume effectively when treating the patient who has hypervascular ulcer on her tongue caused by paraneoplastic autoimmune multiorgan syndrome by mold brachytherapy. Materials and Methods: The mold is consisted of upper and lower parts. We inserted 2 mm of lead sheet on the gums toward the oral cavity to protect them from unnecessary irradiation during the treatment. We had planned on orthogonal images obtained the patient. 200 cGy was delivered in every fraction with a total dose of 3000 cGy. To evaluate the effect of the lead sheet, we made a measurement with a phantom that has gums and tongue made of tissue with an equivalent material (bolus). Five of TLDs were placed on the interesting points of gums to measure the dose during irradiation with lead sheet and without lead sheet for three times respectively. Results: The result of the measurement without lead sheet are A: 33.9 cGy, B: 30.1 cGy, C: 31.8 cGy, D: 23.3 cGy, E: 24.1 cGy. The results of measurement with lead sheet are A: 20.6 cGy, B: 18.8 cGy, C: 19.6 cGy, D: 14.7 cGy, E: 15.1 cGy. Conclusion: Since we are using the mold made in our department during the treatment of the patient with hypervascular ulcer on tongue, we could deliver a proper dose to the treatment volume. In addition, the mold provided highly accurate and reproducible treatment and reduced the dose to the gums and teeth. Therefore, the possibility of side effects could be decreased significantly.

음경암의 방사선치료 시 자체 제작한 Device의 산란선 차폐 효과에 대한 유용성 평가

김양수,이선영,임석건,곽근탁,박주경,이승훈,황호인,차석용,Gim, Yang-Soo,Lee, Sun-Young,Lim, Suk-Gun,Gwak, Geun-Tak,Pak, Ju-Gyeong,Lee, Seung-Hoon,Hwang, Ho-In,Cha, Seok-Yong 대한방사선치료학회 2009 대한방사선치료학회지 Vol.21 No.1

Purpose: We evaluated the device that was created for maintaining the patient's setup and protecting the testicles from scattered radiation during treatment of carcinoma of the penis. Materials and Methods: The phantom testicles were made of vaseline cotton gauze and the device consisted of 5 mm of acryl box and 4 mm of lead shielding. $3{\times}3\;cm^2$, $4{\times}4\;cm^2$, $5{\times}5\;cm^2$, $6{\times}6\;cm^2$, $7{\times}7\;cm^2$ field sizes were used for this study and measurement was made at 4, 5, 6, 7, 8, 10 cm from the lower edge of the field for 10 times with lead shielding and without the shielding respectively. 200 cGy was delivered using 6 MV photons. Results: The scatted radiation without lead shielding at 4, 5, 6, 7, 8, 10 cm from the lower edge of the field were 14.8-4.7 cGy with $3{\times}3\;cm^2$, 15.7-5.2 cGy with $4{\times}4\;cm^2$, 17.6-5.5 cGy with $5{\times}5\;cm^2$, 19.9-6.6 cGy with $6{\times}6\;cm^2$, 22.2-7.6 cGy with $7{\times}7\;cm^2$ and the measured dose without lead shielding were 7.1-2.6 cGy with $3{\times}3\;cm^2$, 8.9-3.6 cGy with $4{\times}4\;cm^2$, 12.3-4.8 cGy with $5{\times}5\;cm^2$, 14.6-5.0 cGy with $6{\times}6\;cm^2$ and 21.1~6.4 cGy with $7{\times}7\;cm^2$. As shown above, the scatted radiation decreased after using lead shielding. Depending of the range of field sizes, the resulting difference between without shielding values and with shielding values were: 7.8-1.1 cGy at 4 cm, 5.1-1.2 cGy at 5 cm, 3.8-1.1 cGy at 6 cm, 3.4-1.7 cGy at 7 cm, 2.8-1.7 cGy at 8 cm, 2.4-2.5 cGy at 9 cm and 2.1-1.8 cGy at 10 cm. In the situation as described above, the range in values depending on the distance was 7.8-1.1 cGy with $3{\times}3\;cm^2$, 6.9-1.6 cGy with $4{\times}4\;cm^2$, 5.3-0.8 cGy with $5{\times}5\;cm^2$, 5.3-1.5 cGy with $6{\times}6\;cm^2$ and 1.1-1.8 cGy with $7{\times}7\;cm^2$. Conclusion: Using the device we created to shield the testicles from scattered radiation during treatment of carcinoma of the penis, we have found that scattered radiation to the testicles is decreased by the phantom testicles, and by increasing the distance between the testicles and penis.