선형가속기의 출력 특성에 대한 공정능력과 공정가능성을 이용한 통계적 분석

오세안,예지원,김상원,이레나,김성규,Oh, Se An,Yea, Ji Woon,Kim, Sang Won,Lee, Rena,Kim, Sung Kyu 한국의학물리학회 2014 의학물리 Vol.25 No.3

The purpose of this study is to evaluate the results for the quality assurance through a statistical analysis on the output characteristics of linear accelerators belonging to Yeungnam University Medical Center by using the Shewhart-type chart, Exponentially weighted moving average chart (EWMA) chart, and process capability indices $C_p$ and $C_{pk}$. To achieve this, we used the output values measured using respective treatment devices (21EX, 21EX-S, and Novalis Tx) by medical physicists every month from September, 2012 to April, 2014. The output characteristics of treatment devices followed the IAEA TRS-398 guidelines, and the measurements included photon beams of 6 MV, 10 MV, and 15 MV and electron beams of 4 MeV, 6 MeV, 9 MeV, 12 MeV, 16MeV, and 20 MeV. The statistical analysis was done for the output characteristics measured, and was corrected every month. The width of control limit of weighting factors and measurement values were calculated as ${\lambda}=0.10$ and L=2.703, respectively; and the process capability indices $C_p$ and $C_{pk}$ were greater than or equal to 1 for all energies of the linear accelerators (21EX, 21EX-S, and Novalis Tx). Measured values of output doses with drastic and minor changes were found through the Shewhart-type chart and EWMA chart, respectively. The process capability indices $C_p$ and $C_{pk}$ of the treatment devices in our institution were, respectively, 2.384 and 2.136 for 21EX, 1.917 and 1.682 for 21EX-S, and 2.895 and 2.473 for Novalis Tx, proving that Novalis Tx has the most stable and accurate output characteristics. 이 연구의 목적은 본원이 보유하고 있는 선형가속기들의 출력 특성을 Shewhart-type Chart, EWMA Chart, 공정능력지수 $C_p$와 $C_{pk}$을 이용한 통계적 분석으로 품질보증에 대한 결과를 평가하고자 한다. 측정값은 의학물리사에 의하여 2012년 9월부터 2014년 4월까지 매월 측정된 각각 치료기들(21EX, 21EX-S, Novalis Tx)의 출력측정값을 사용하였다. 치료기들의 출력 특성은 IAEA TRS-398의 가이드라인을 따랐으며, 측정 에너지는 광자선 6 MV, 10 MV, 15 MV와 전자선 4 MeV, 6 MeV, 9 MeV, 12 MeV, 16 MeV, 20 MeV였다. 매월 측정하여 교정한 출력특성에 대한 통계학적 분석이며, 가중인자와 측정값의 관리한계의 폭은 ${\lambda}=0.10$, L=2.703로 계산되었으며, 공정능력 $C_p$와 $C_{pk}$는 모든 선형가속기(21EX, 21EX-S, Novalis Tx)의 모든 에너지에서 1이상이었다. Shewhart-type Chart를 통하여 출력선량의 측정값의 큰 변화점을 찾을 수 있었고, EWMA Chart를 통하여 출력선량의 측정값의 미세한 변화점을 알아 볼 수 있었다. 본원의 치료기의 공정능력지수 $C_p$와 $C_{pk}$를 통하여 21EX가 2.384와 2.136, 21EX-S가 1.917과 1.682, Novalis Tx가 2.895와 2.473으로 Novalis Tx가 가장 안정적이고 정확한 출력특성을 나타내고 있었다.

Fabrication and Dosimetric Evaluations of a Dummy Eye Shield for Radiotherapy

오세안,박재원 한국물리학회 2019 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.75 No.8

The purpose of this study was to fabricate a dummy eye shield by using a 3D scanner and 3D printer and to compare the dose distribution calculated using the computed tomography (CT) value assignment function in the commercial radiation treatment planning (RTP) system with the dummy eye shield to dose distribution measured with a metal shield by using EBT 2 film. The tungsten eye shield was scanned using a 3D scanner (GOM ATOS ScanBox; GOM, Braunschweig, Germany), and the designed dummy eye shield was printed with a 3D Printer (Stratasys Object 500 Connex; Stratasys Ltd., Minnesota, USA) using VeroWhite (Stratasys Ltd., Minnesota, USA). A 6-MeV electron beam from a 21EX-S linear accelerator (Varian Medical System, Palo Alto, USA) was used in this study. For a 6-MeV electron beam, the absolute doses at a 10-mm depth from RTP system calculations, EBT2 films, and TLD chips were 18.8, 32.4, and 35.6 cGy, respectively. The dummy eye shield could be adopted effectively to treat ocular tumors with electron radiotherapy; however, its use with a commercial RTP system for calculating the dose distribution was difficult.

영남대학교병원의 환자안전을 위한 정도관리의 기초자료 분석

오세안,김성규,예지원,강민규,이준하,이레나,Oh, Se An,Kim, Sung Kyu,Yea, Ji Woon,Kang, Min Kyu,Lee, Joon Ha,Lee, Rena 한국의학물리학회 2015 의학물리 Vol.26 No.2

미국의학물리학회(AAPM) TG-100 위원회에서 제시하고 있는 가이드 라인에 준하여 환자 안전에 대한 정도관리를 수립하기 위하여 영남대학교병원 방사선종양학과에서 환자를 치료하는 중에 발생한 오류들을 중심으로 오류 유형을 분석하여, 환자중심의 방사선치료를 시행할 때 환자 안전을 위한 정도관리의 가이드 라인을 정립하고자 한다. 방사선종양학과에서 방사선 치료를 하는데 있어서 일으킬 수 있는 오류들을 분석하여 오류를 일으키는 빈도와 오류가 일어날 때 환자 에게 미치는 심각성과 오류가 일어났을 때 감지하지 못하고 지나치는 확률을 점수로 평가하고자 한다. 오류를 일으킬 수 있는 곳으로는 CT 모의치료실, 치료계획실, 치료실로 나누어 조사하였다. CT 모의치료실에서는 고정기구 사용의 오류가 위험중요지수의 값이 60으로 가장 높았고, 모의치료 정보입력의 오류가 6으로 가장 낮게 나타났다. 치료계획실에서는 선량계산 모델 선택의 오류가 위험중요지수의 값이 168로 가장 높았고, 환자의 치료 시작일 오류가 36으로 가장 낮게 나타났다. 치료실에서는 테이블 Bar 오류가 위험중요지수의 값이 252으로 가장 높았고, 체중변화 오류가 190을 나타내었으며, 배게 오류가 24로 가장 낮게 나타났다. In order to establish the quality control on patient safety following the guideline presented by American Association of Physicists in Medicine (AAPM) TG-100 committee, we aim to analyze the modes based on errors occurred during treatment of patients at the radiation oncology department at Yeungnam University Hospital and establish a quality control guideline for patient safety when patient-centered radiation treatment is conducted. We aim to analyze the errors that can occur during radiation treatment at the radiation department, and assess the frequency of error, the severity of error affecting patients, and probability of proceeding without noticing error, with scores. The places where errors can take place were divided into CT simulation treatment room, treatment planning room, and treatment room for the analysis. In CT simulation treatment room, an error from using the immobilization device showed the highest Risk Priority Number (RPN) value of 60, and an error from simulation treatment information input showed the lowest of 6. In treatment planning room, an error from selecting the radiation dose calculation model showed the highest RPN value of 168, and an error of patient treatment start date showed the lowest of 36. In treatment room, a Table Bar error showed the highest RPN value of 252, a weight change error showed 190, and a Pillow error showed the lowest of 24.

Study of the Penumbra for High-energy Photon Beams with Gafchromic™ EBT2 Films

오세안,강민규,예지원,김성규,오영기 한국물리학회 2012 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.60 No.11

The penumbra has a major impact on obtaining uniformity of isodose distributions in radiation therapy. The penumbra phenomena of intensity-modulated radiation therapy (IMRT) techniques using the multi-leaf collimator (MLC) has impact on the dose distributions in the boarder of the target volumes and the MLC. The aim of this study was to know the impact of high photon energy (6 MV, 10 MV) on penumbra at various depth and field sizes using the Pencil Beam Convolutions algorithms (eclipse 8.6) and self-developing GafchromicTM EBT2 film. For dose calculations and EBT2 measurement, we used acryl phantom at sizes 20×20×20 ㎤. The 200 cGy dose was delivered to the central depth (10㎝) of the acryl phantom. The result of this study was that increased energy, field size and depth give rise to increased penumbra (20%-80%) width. For 6 MV photon energy, the penumbra widths (20%~80%) of 1.5 ㎝, 5 ㎝, 10 ㎝ in depth was 4.2 ㎜, 4.4 ㎜, 5.7 ㎜ at the eclipse calculations, and 2.9 ㎜, 4.1 ㎜, 4.2 ㎜ at the EBT2 film measurement for the 10×10 field sizes, respectively. For 10 MV photon energy, the penumbra widths were 4.5 ㎜, 4.7 ㎜, 6.2 ㎜ at eclipse calculation and 4.1 ㎜, 4.6 ㎜, 4.9 ㎜ at EBT2 film measurement, respectively. As the field size has been changed to 3 ㎝, 5 ㎝, 7 ㎝, 10 ㎝, and 15 ㎝, the penumbra widths were 5.1 ㎜, 5.3 ㎜, 5.6 ㎜, 5.9 ㎜, 6.1 ㎜ at eclipse calculation and 2.9 ㎜, 3.3 ㎜, 3.6 ㎜, 4.2 ㎜, 5.1 ㎜ at EBT2 measurement for 10 cm depth for 6 MV photon energy. In this study, the 6 MV photon energy is preferred in the critical organs near to the target volume compared to the 10 MV photon energy in the treatment, such as the 3D conformal radiation therapy and the IMRT.

Clinical performance of FractionLab in patient-specific quality assurance for intensity-modulated radiotherapy: a retrospective study

오세안,김승엽,Jaehyeon Park,박재원,예지원 영남대학교 의과대학 2022 Yeungnam University Journal of Medicine Vol.39 No.2

Background: This study was aimed at comparing and analyzing the results of FractionLab (Varian/Mobius Medical System) with those of portal dosimetry that uses an electronic portal imaging device. Portal dosimetry is extensively used for patient-specific quality assurance (QA) in intensity-modulated radiotherapy (IMRT). Methods: The study includes 29 patients who underwent IMRT on a Novalis-Tx linear accelerator (Varian Medical System and BrainLAB) between June 2019 and March 2021. We analyzed the multileaf collimator (MLC) DynaLog files generated after portal dosimetry to evaluate the same condition using FractionLab. The results of the recently launched FractionLab at various gamma indices (0.1%/0.1 mm–1%/1 mm) are analyzed and compared with those of portal dosimetry (3%/3 mm). Results: The average gamma passing rates of portal dosimetry (3%/3 mm) and FractionLab are 98.1 (95.5%–100%) and 97.5% (92.3%–99.7%) at 0.6%/0.6 mm, respectively. The results of portal dosimetry (3%/3 mm) are statistically comparable with the QA results of FractionLab (0.6%/0.6 mm–0.9%/0.9 mm).Conclusion: This paper presents the clinical performance of FractionLab by the comparison of the QA results of FractionLab using portal dosimetry with various gamma indexes when performing patient-specific QA in IMRT treatment. Further, the appropriate gamma index when performing patient-specific QA with FractionLab is provided.

Dosimetric Verification of Enhanced Dynamic Wedges by a 2D Ion Chamber Array

오세안,김성규,강민규,예지원,김응찬 한국물리학회 2013 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.63 No.11

Wedge filters are commonly used to achieve dose uniformity in the target volume in radiotherapyand can be categorized as physical wedges (PWs) and enhanced dynamic wedges (EDWs). TheEDW generates PW-like dose profiles while moving the upper jaw in the Y directions with a varyingdose rate in the treatment beams. Task Group 53 of the AAPM (American Association ofPhysicists in Medicine) recommended that the dynamic wedge be verified before implementationin the radiation treatment planning (RTP) system. The aim of this study was to use the I’mRTMatriXX to verify the dose profiles of the EDWs manufactured by Varian. We used Pencil BeamConvolution algorithms (eclipse 8.6) for the calculation and I’mRT MatriXX with Plastic Waterrphantom MULTICube for dose measurements. The gamma indices of the calculations and the measurementsfor the EDWs were 84.84% and 86.54% in 2%/2 mm tolerance, and 99.47% and 99.64% in3%/3 mm tolerance for wedge angles of 15, 30, 45 and 60, respectively. The dose distributionsdiffered between the calculations using the system and the measurements in the penumbra and theouter beam regions of the wedge fields. We confirmed that the dosimetric verifications of the EDWwere acceptable when using the criterion for external beam dose calculations of Task Group 53.

Comparison of Intensity Modulated Radiation Therapy Dose Calculations with a PBC and AAA Algorithms in the Lung Cancer

오세안,강민규,예지원,김성훈,김기환,김성규,Oh, Se-An,Kang, Min-Kyu,Yea, Ji-Woon,Kim, Sung-Hoon,Kim, Ki-Hwan,Kim, Sung-Kyu Korean Society of Medical Physics 2012 의학물리 Vol.23 No.1

방사선치료계획장치에서 선량계산을 위해 PBC 알고리즘(pencil beam convolution)은 가장 널리 사용되고 있다. Varian (Varian Medical System, Palo Alto, CA)사는 광자의 선량 계산을 위해서 AAA 알고리즘을 새롭게 선량계산모델로 탑재하였다. 본 연구는 폐와 같은 저밀도 영역에 종양부위가 있는 환자를 대상으로 세기조절방사선치료를 시행할 경우에 PBC 알고리즘과 AAA 알고리즘으로 계산했을 때 차이를 정량적으로 알고자 하는데 목적이 있다. 두 알고리즘의 정량적 분석을 위해서 Eclipse planning system과 I'mRT matrixx (IBA, Schwarzenbruck, Germany)를 사용하였다. 또한 두 알고리즘으로 계산된 선량과 실제 측정된 선량의 차이를 확인하기 위해서 인체모형펜텀(Alderson Rando phantom)속에 TLD-100 (LiF)을 위치 시켰다. 종양부위 주위의 중요장기인 trachea, esophagus, lung, PRV spinal cord의최대선량, 평균선량, 최소선량은 알고리즘의 변화에 따라서 거의 변화가 없었으나, PTV의 V95는 PBC와 비교하여 AAA가 약 6% 감소하는 결과를 얻었다. 이러한 결과는 I'mRT matrixx를 이용하여 저밀도를 가지는 폐의 위치에서 확연하게 나타남을 확인할 수 있었다. 또한 인체모형펜텀(Alderson Rando phantom)과 TLD-100 (LiF)을 이용한 계산선량과 실제 측정치의 결과는 PBC 알고리즘은 평균 4.6%의 차이를 보였으며, AAA 알고리즘은 평균 2.7%의 차이를 보였다. 이 결과로 저밀도를 가지는 폐암에서의 세기조절방사선치료를 시행할 경우에 PBC 알고리즘보다 AAA 알고리즘이 더 유효함을 알 수 있다. The pencil beam convolution (PBC) algorithms in radiation treatment planning system have been widely used to calculate the radiation dose. A new photon dose calculation algorithm, referred to as the anisotropic analytical algorithm (AAA), was released for use by the Varian medical system. The aim of this paper was to investigate the difference in dose calculation between the AAA and PBC algorithm using the intensity modulated radiation therapy (IMRT) plan for lung cancer cases that were inhomogeneous in the low density. We quantitatively analyzed the differences in dose using the eclipse planning system (Varian Medical System, Palo Alto, CA) and I'mRT matirxx (IBA, Schwarzenbruck, Germany) equipment to compare the gamma evaluation. 11 patients with lung cancer at various sites were used in this study. We also used the TLD-100 (LiF) to measure the differences in dose between the calculated dose and measured dose in the Alderson Rando phantom. The maximum, mean, minimum dose for the normal tissue did not change significantly. But the volume of the PTV covered by the 95% isodose curve was decreased by 6% in the lung due to the difference in the algorithms. The difference dose between the calculated dose by the PBC algorithms and AAA algorithms and the measured dose with TLD-100 (LiF) in the Alderson Rando phantom was -4.6% and -2.7% respectively. Based on the results of this study, the treatment plan calculated using the AAA algorithms is more accurate in lung sites with a low density when compared to the treatment plan calculated using the PBC algorithms.

Dosimetric Verifications of the Output Factors in the Small Field Less Than $3cm^2$ Using the Gafchromic EBT2 Films and the Various Detectors

오세안,예지원,이레나,박헌보,김성규,Oh, Se An,Yea, Ji Woon,Lee, Rena,Park, Heon Bo,Kim, Sung Kyu Korean Society of Medical Physics 2014 의학물리 Vol.25 No.4

The small field dosimetry is very important in modern radiotherapy because it has been frequently used to treat the tumor with high dose hypo-fractionated radiotherapy or high dose single fraction stereotactic radiosurgery (SRS) with small size target. But, the dosimetry of a small field (< $3{\times}3cm^2$) has been great challenges in radiotherapy. Small field dosimetry is difficult because of (a) a lack of lateral electronic equilibrium, (b) steep dose gradients, and (c) partial blocking of the source. The objectives of this study were to measure and verify with the various detectors the output factors in a small field (<3 cm) for the 6 MV photon beams. Output factors were measured using the CC13, CC01, EDGE detector, thermoluminescence dosimeters (TLDs), and Gafchromic EBT2 films at the sizes of field such as $0.5{\times}0.5$, $1{\times}1$, $2{\times}2$, $3{\times}3$, $5{\times}5$, and $10{\times}10cm^2$. The differences in the output factors with the various detectors increased with decreasing field size. Our study demonstrates that the dosimetry for a small photon beam (< $3{\times}3cm^2$) should use CC01 or EDGE detectors with a small active volume. And also, Output factors with the EDGE detectors in a small field (< $3{\times}3cm^2$) coincided well with the Gafchromic EBT2 films. 소조사면의 선량검증은 고선량을 1회에 치료하는 정위적방사선수술(Stereotactic radiosurgery, SRS)과 고선량을 소분할 하여 치료하는 소분할방사선치료(hypo-fractionated radiotherapy)에서 작은 크기의 종양을 치료하기 위해서 자주 사용되기 때문에 현대의 방사선치료에서 있어서 매우 중요하다. 그러나, $3cm^2$ 이하의 소조사면에 대한 선량검증은 방사선치료에서 있어서 대단한 도전이다. 소조사면의 선량검증은 (a) 측방전자균형(lateral electronic equilibrium)의 부족, (b) 급격한 선량 기울기(steep dose gradient), (c) 선원의 부분적 차폐 때문에 어렵다. 이 연구의 목적은 6 MV 광자선의 $3cm^2$ 이하의 소조사면에서 출력비율을 다양한 검출기로 측정하고 검증하는 것이다. 출력비율은 CC13 이온함, CC01 이온함, EDGE 검출기, 열발광선량계(thermoluminescence dosimeters, TLD), Gafchromic EBT2 필름을 이용하여 $0.5{\times}0.5cm^2$, $1{\times}1cm^2$, $2{\times}2cm^2$, $3{\times}3cm^2$, $5{\times}5cm^2$, $10{\times}10cm^2$의 다양한 조사면에서 측정하였다. 출력비율의 차이는 조사면의 크기가 작아질수록 검출기간의 차이는 증가하였다. 본 연구의 결과는 $3cm^2$ 이하의 소조사면의 선량측정은 CC01 이온함, EDGE 검출기와 같은 작은 크기의 방사부부피(active volume)를 가지는 검출기를 사용해야 한다는 것을 입증하였다. 또한, $3cm^2$ 이하의 소조사면에서 EDGE 검출기의 출력비율은 Gafchromic EBT2 필름의 결과와 잘 일치하였다.

Comparison of IMRT and VMAT Techniques in Spine Stereotactic Radiosurgery with International Spine Radiosurgery Consortium Consensus Guidelines

오세안,강민규,김성규,예지원,Oh, Se An,Kang, Min Kyu,Kim, Sung Kyu,Yea, Ji Woon Korean Society of Medical Physics 2013 의학물리 Vol.24 No.3

정위적 체부 방사선치료(Stereotactic Body Radiation Therapy, SBRT)는 척추 전이암을 치료하는데 있어서 점점 증가하고 있다. 표적 종양의 급격한 선량 변화와 등선량 분포를 얻기 위해서, 세기조절방사선치료(Intensity-modulated radiation therapy, IMRT)와 체적변조회전치료(Volumetric-modulated arc therapy, VMAT)는 척추 방사선수술에 있어서 필수적인 치료기법이다. 이 연구의 목적은 표적 종양을 위한 International Spine Radiosurgery (ISRC) Consortium의 consensus guideline으로 그려진 표적에 있어서 IMRT와 VMAT의 치료기법을 질적으로 비교하고자 한다. 경부, 흉부, 요추 부위에 종양치료를 받은 3명의 환자를 선택 하였다. 표적 종양은 ISRC의 consensus guideline을 바탕으로 정의 하였다. $T_B$는 vertebral body만 포함하였고, $T_{BPT}$는 vertebral body, pedicle, transverse process를 포함하였다. 그리고 $T_{ST}$는 spinous process와 transverse process를 포함하여 그렸다. Maximum spinal cord선량은 $T_B$, $T_{BPT}$, $T_{ST}$에서 각각 12.46 Gy, 12.17 Gy, 11.36 Gy였고, IMRT, RA1, RA2에서 각각 11.81 Gy, 12.19 Gy, 11.99 Gy였다. 평균 감소(90%~50%) 선량 거리 (mm)는 $T_B$, $T_{BPT}$, $T_{ST}$에서 각각 3.5 mm, 3.3 mm, 3.9 mm였고, IMRT, RA1, RA2에서 각각 3.7 mm, 3.7 mm, 3.3 mm였다. 가장 복잡한 $T_{BPT}$의 경우에서 IMRT, RA1, RA2의 conformity index는 각각 0.621, 0.761, 0.817 이었고, rDHI는 0.755, 0.796, 0.824 였다. IMRT와 VMAT 모두 척추 정위적 방사선수술에서 표적 종양에 급격한 선량 변화와 등선량 분포를 전달하였다. 그러나 표적 종양이 vertebral body, pedicle, transverse process를 포함한다면, IMRT 치료기법은 VMAT 치료기법과 비교해서 conformity index 측면에서 불충분하였다. 그럼에도 불구하고, IMRT 치료기법은 RA1, RA2와 비교해서 대부분의 영역에서 maximum spinal cord 선량을 줄이는데 더 효과적이었다. Stereotactic body radiation therapy (SBRT) is increasingly used to treat spinal metastases. To achieve the highest steep dose gradients and conformal dose distributions of target tumors, intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques are essential to spine radiosurgery. The purpose of the study was to qualitatively compare IMRT and VMAT techniques with International Spine Radiosurgery Consortium (ISRC) contoured consensus guidelines for target volume definition. Planning target volume (PTV) was categorized as TB, $T_{BPT}$ and $T_{ST}$ depending on sectors involved; $T_B$ (vertebral body only), $T_{BPT}$ (vertebral body+pedicle+transverse process), and $T_{ST}$ (spinous process+transverse process). Three patients treated for spinal tumor in the cervical, thoracic, and lumbar region were selected. Eacg tumor was contoured by the definition from the ISRC guideline. Maximum spinal cord dose were 12.46 Gy, 12.17 Gy and 11.36 Gy for $T_B$, $T_{BPT}$ and $T_{ST}$ sites, and 11.81 Gy, 12.19 Gy and 11.99 Gy for the IMRT, RA1 and RA2 techniques, respectively. Average fall-off dose distance from 90% to 50% isodose line for $T_B$, $T_{BPT}$, and $T_{ST}$ sites were 3.5 mm, 3.3 mm and 3.9 mm and 3.7 mm, 3.7 mm and 3.3 mm for the IMRT, RA1 and RA2 techniques, respectively. For the most complicated target $T_{BPT}$ sites in the cervical, thoracic and lumbar regions, the conformity index of the IMRT, RA1 and RA2 is 0.621, 0.761 and 0.817 and 0.755, 0.796 and 0.824 for rDHI. Both IMRT and VMAT techniques delivered high conformal dose distributions in spine stereotactic radiosurgery. However, if the target volume includes the vertebral body, pedicle, and transverse process, IMRT planning resulted in insufficient conformity index, compared to VMAT planning. Nevertheless, IMRT technique was more effective in reducing the maximum spinal cord dose compared to RA1 and RA2 techniques at most sites.

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