Nuclear Medicine Physics: Review of Advanced Technology

Oh, Jungsu S. Korean Society of Medical Physics 2020 의학물리 Vol.31 No.3

This review aims to provide a brief, comprehensive overview of advanced technologies of nuclear medicine physics, with a focus on recent developments from both hardware and software perspectives. Developments in image acquisition/reconstruction, especially the time-of-flight and point spread function, have potential advantages in the image signal-to-noise ratio and spatial resolution. Modern detector materials and devices (including lutetium oxyorthosilicate, cadmium zinc tellurium, and silicon photomultiplier) as well as modern nuclear medicine imaging systems (including positron emission tomography [PET]/computerized tomography [CT], whole-body PET, PET/magnetic resonance [MR], and digital PET) enable not only high-quality digital image acquisition, but also subsequent image processing, including image reconstruction and post-reconstruction methods. Moreover, theranostics in nuclear medicine extend the usefulness of nuclear medicine physics far more than quantitative image-based diagnosis, playing a key role in personalized/precision medicine by raising the importance of internal radiation dosimetry in nuclear medicine. Now that deep-learning-based image processing can be incorporated in nuclear medicine image acquisition/processing, the aforementioned fields of nuclear medicine physics face the new era of Industry 4.0. Ongoing technological developments in nuclear medicine physics are leading to enhanced image quality and decreased radiation exposure as well as quantitative and personalized healthcare.

History of Radiation Therapy Technology

Huh, Hyun Do,Kim, Seonghoon Korean Society of Medical Physics 2020 의학물리 Vol.31 No.3

Here we review the evolutionary history of radiation therapy technology through the festschrift of articles in celebration of the 30th anniversary of Korean Society of Medical Physics (KSMP). Radiation therapy technology used in clinical practice has evolved over a long period of time. Various areas of science, such as medical physics, mechanical engineering, and computer engineering, have contributed to the continual development of new devices and techniques. The scope of this review was restricted to two areas; i.e., output energy production and functional development, because it is not possible to include all development processes of this technology due to space limitations. The former includes the technological transition process from the initial technique applied to the first model to the latest technique currently used in a variety of machines. The latter has had a direct effect on treatment outcomes and safety, which changed the paradigm of radiation therapy, leading to new guidelines on dose prescriptions, innovation of dose verification tools, new measurement methods and calculation systems for radiation doses, changes in the criteria for errors, and medical law changes in all countries. Various complex developments are covered in this review. To the best of our knowledge, there have been few reviews on this topic and we consider it very meaningful to provide a review in the festschrift in celebration of the 30th anniversary of the KSMP.

Proton Therapy Review: Proton Therapy from a Medical

Lee, Se Byeong Korean Society of Medical Physics 2020 의학물리 Vol.31 No.3

With hope and concern, the first Korean proton therapy facility was introduced to the National Cancer Center (NCC) in 2007. It added a new chapter to the history of Korean radiation therapy. There have been challenging clinical trials using proton beam therapy, which has seen many impressive results in cancer treatment. Compared to the rapidly increasing number of proton therapy facilities in the world, only one more proton therapy center has been added since 2007 in Korea. The Samsung Medical Center installed a proton therapy facility in 2015. Most radiation oncology practitioners would agree that the physical properties of the proton beam provide a clear advantage in radiation treatment. But the expensive cost of proton therapy facilities is still one of the main reasons that hospitals are reluctant to introduce them in Korea. I herein introduce the history of proton therapy and the cutting edge technology used in proton therapy. In addition, I will cover the role of a medical physicist in proton therapy and the future prospects of proton therapy, based on personal experience in participating in proton therapy programs from the beginning at the NCC.

전자 빔 조사후 PEBA (Poly Ether Block Amide)의 구조 및 기계적 특성 변화

신석영,최상규,Shin, Sukyoung,Cho, SangGyu Korean Society of Medical Physics 2014 의학물리 Vol.25 No.4

의료기기에 사용되는 고분자제품은 주로 감마선 또는 전자 빔을 이용하여 살균을 하는데, 살균에 의해 재료특성이 변화한다. 카테터에 많이 사용되는 고분자 폴리머인 poly(ether-block-amides) (PEBA)는 살균에 의한 물성변화가 더욱 심하다고 알려져 있다. 따라서 본 연구에서는 살균 후 PEBA의 물성변화를 측정하여 전자선 살균이 미치는 영향에 대해 평가하였다. PEBA에 전자선을 조사하고 노화를 촉진시켜 유효기간 동안의 변화를 확인하였다. 급속노화가 이루어진 환경은 온도가 55도, 습도가 50%인 오븐에서 수행되었다. PEBA의 경도는 polyester 함량에 따라 달라지는데 본 연구에서 사용된 PEBA 시료의 경도는 35D (soft)부터 72D (hard)였다. 전자빔 살균에 의한 PEBA의 분자량 변화와 인장강도 변화를 측정 하였다. 측정결과, 노화로 인해 분자량이 현저히 감소함을 확인 하였다. 35D 시료의 경우 분자량이 54350 g/mol에서 39250 g/mol으로 감소하였다. 또한 전자 빔에 의해 살균된 PEBA의 인장 강도 및 신장율도 현저히 감소하였다. 35D PEBA시료의 인장강도 역시 28040 kPa에서 24118 kPa로 14% 이상 감소하였다. 결론적으로 전자선 빔으로 의료용으로 사용되는 PEBA제품을 살균할 경우 물성변화가 심각하게 발생하므로 전자 빔 살균은 문제가 많음을 알 수 있었다. Medical polymers require sterilization and must be able to maintain material properties for a specified shelf life. Sterilization can be achieved by using gamma or e-beam exposure. In this study, accelerated aging tests of poly(ether-block-amide) (PEBA) copolymer samples is presented. PEBA copolymer samples with different polyether content that result in Shore hardness of 35D to 72D, were sterilized using e-beam radiation followed by accelerated aging at $55^{\circ}C$. E-beam sterilization effect on molecular weight and mechanical property has performed and analyzed. The average molecular weight significantly reduced as a result of ageing. The enlarged proportion of low molecular weight chains in the aged samples is consistent with the generation of degradation products produced by oxidative chain scission. Also E-beam materials have shown decreased tensile strength and elongation. Overall, this study demonstrated that the medical grade PEBA was significantly affected by radiation exposure over aging time, particularly at high irradiation doses. For medical use in case of radiation sterilization required, it is recommended to avoid Pebax material. If Pebax material must be in use for medical device, recommend to use alternate sterilization method such as Ethylene Oxide sterilization.

Trend Analysis on Korean and International Management for Activated Material Waste from Medical Linear Accelerator

Kwon, Na Hye,Jang, Young Jae,Kim, Dong Wook,Shin, Dong Oh,Kim, Kum Bae,Kim, Jin Sung,Choi, Sang Hyoun Korean Society of Medical Physics 2020 의학물리 Vol.31 No.4

This study investigated and analyzed the Korean and international status of radioactive waste management for medical linear accelerators (linacs) and proceed prior research to suggest radiation safety regulations and guidelines for the safe use of radiation. We analyzed the number of linacs installed in the radiation oncology departments of 103 institutions. In addition, we analyzed the procedures and standards for disposal in Korea and foreign countries. For foreign countries, we analyzed the status based on reports from the United States, Japan, Europe, and Canada. A total of 182 linacs are installed in Korea and 95% of them use more than 10 MV of energy. In Korea, standards for managing radioactive waste from a linac, disposal procedures, and clearance criteria have yet to be established. Therefore, radioactive waste is disposed of in different ways depending on the hospitals where they originate. Japan, the US, and Canada have recommended clearance levels and procedures for linacs. Other countries have provided management guidelines for research or large-scale accelerators, but not for medical purposes. In this study, we investigated the management of radioactive waste from medical linacs in Korea and abroad. Several foreign countries have suggested a clearance level and criteria for disposing of waste storage drums. For the safe management of medical linacs, it is necessary to establish safety management regulations. In Korea, standards for disposal, such as radiation or dose limits, are required for medical linacs. A system for clearance when disposing at a medical institution should be created.

Proposal for Comprehensive Quality Control of Heavy-Ion Medical Accelerator

Kim, Dong-wook,Shin, Dong-oh,Shin, Young-hoon,Heo, Hyun-do Korean Society of Medical Physics 2017 의학물리 Vol.28 No.2

Prior to the introduction of a medical apparatus based on heavy-ion medical accelerator in Korea, a study is needed on quality control in clinical operation for the safe and appropriate usage of the instrument. Data relevant for the study were obtained via information sharing sessions and visits by the Particle Therapy Co-Operative Group (PTCOG) and other related academic associations. Furthermore, investigative analysis of the European and Japanese performance evaluation guidelines for heavy ion, as well as research on relevant literature, were conducted. In addition, instrumental standards were analyzed through an investigation of the current usage status of the heavy-ion medical accelerator, and further analysis was conducted on the evaluation methods for the performance, safety, and significance of the instrument. Based on these analyses, regular quality control procedures for heavy-ion medical accelerators in hospitals and other institutes were extrapolated. It is hoped that the results of this study will facilitate hospitals that have introduced heavy-ion medical accelerators, or are considering the implementation of the instrument, in their understanding of the fundamental standards and capabilities of the treatment system, as well as in establishing and carrying out quality control procedures for clinical operations such that it will contribute to the safety of patients and the efficiency of medical practitioners.

Magnetic Resonance Imaging: Historical Overview, Technical Developments, and Clinical Applications

Jahng, Geon-Ho,Park, Soonchan,Ryu, Chang-Woo,Cho, Zang-Hee Korean Society of Medical Physics 2020 의학물리 Vol.31 No.3

The authors congratulate the cerebrations for the 30 years of the Korean Society of Medical Physics (http://www.ksmp.or.kr/). The paper is published to recognize the anniversary. Geon-Ho Jahng invited Professor Z. H. Cho to join to submit this manuscript because he has been one of the leaders in the field of magnetic resonance imaging (MRI) during the last 40 years. In this review, we describe the development and clinical histories of MRI internationally and domestically. We also discuss diffusion and perfusion MRI, molecular imaging using MRI and MR spectroscopy (MRS), and the hybrid systems, such as positron emission tomography-MRI (PET-MRI), MR-guided focused ultrasound surgery (MRgFUS), and MRI-guided linear accelerators (MRI-LINACs). In each part, we discuss the historical evolution of the developments, technical developments, and clinical applications.

Postoperative Complications after Preoperative Chemoradiotherapy Combined with Hyperthermia in Locally Advanced Rectal Cancer

예지원,Yea, Ji Woon Korean Society of Medical Physics 2014 의학물리 Vol.25 No.2

국소 진행성 직장암 환자에서 수술 전 항암방사선동시요법으로 치료시 추가적인 고주파 온열치료 유무가 수술 후 부작용에 미치는 영향을 분석하였다. 1996년부터 2007년 사이, 본원에서 수술 전 항암방사선동시요법과 근치적 수술을 시행한 환자 205명을 대상으로 급, 만성부작용을 분석하였다. 총 방사선치료선량은 39.6 Gy에서 45 Gy였고 1회 내지 2회의 항암약물치료(5-fluorouracil, leucovorin)를 동시에 시행하였다. 88명의 환자가 주 2회, 8-MHz 고주파 온열치료기를 이용한 국소 온열치료를 시행하였다. 외과적 수술은 수술 전 치료 완결 후 4~6주 경과하여 시행하였다. 환자군의 나이 중앙값은 59세(18세~83세)이고 추적관찰기간 중앙값은 61개월(2개월~191개월)이었다. 전체 환자에서 5년 전체생존율과 무합병증 생존율은 77.4%와 73.7%였다. 각각의 조기 누출, 지연 누출, 연결부 협착, 누공, 소장폐쇄의 발생빈도는 1.0%, 2.9%, 1.5%, 5.9%, 그리고 17.1%였다. 온열치료는 모든 종류의 부작용을 증가시키지 않았다. 온열치료를 실시하지 않은 군과 온열치료군 간의 5년 무합병증 생존율은 71.8%와 76.3%였다(p=0.293). 온열치료는 수술전 항암방사선동시요법 후 근치적 수술을 시행하는 국소 진행 직장암 환자의 수술후 부작용을 증가시키지 않는다. We investigated whether regional hyperthermia (HT) increased post-surgical complications in patients with locally advanced rectal cancer treated with preoperative concurrent chemoradiotherapy (CCRT). Between 1996 and 2007, 205 patients treated with preoperative CCRT and curative surgery were evaluable for the analysis of acute and late toxicities. A total dose of 39.6 Gy or 45 Gy was delivered concurrently with one or two cycles of chemotherapy (5-fluorouracil, leucovorin). Eighty-eight patients received regional HT twice a week using an 8-MHz radiofrequency capacitive heating device. Surgery was performed 4~6 weeks after the completion of preoperative CCRT. The median age was 59 years (range, 18~83) and the median follow-up period was 61months (range, 2~191). The 5-year overall survival and complication-free survival rate of all patients was 77.4% and 73.7%, respectively. Early leakage, delayed leakage, anastomotic stricture, fistula, and small bowel obstruction occurred in 1.0%, 2.9%, 1.5%, 5.9%, and 17.1%, respectively. HT did not increase all kinds of complications. The 5-year complication-free survival rate was 71.8% in the non-HT group and 76.3% in the HT group (p=0.293). Regional HT did not increase postoperative complications in patients with locally advanced rectal cancer treated with preoperative CCRT followed by curative surgery.

Conceptual Study of Brain Dedicated PET Improving Sensitivity

Shin, Han-Back,Choi, Yong,Huh, Yoonsuk,Jung, Jin Ho,Suh, Tae Suk Korean Society of Medical Physics 2016 의학물리 Vol.27 No.4

The purpose of this study is to propose a novel high sensitivity neuro-PET design. The improvement of sensitivity in neuro-PET is important because it can reduce scan time and/or radiation dose. In this study, we proposed a novel PET detector design that combined conical shape detector with cylindrical one to obtain high sensitivity. The sensitivity as a function of the oblique angle and the ratio of the conical to cylindrical portion was estimated to optimize the design of brain PET using Monte Carlo simulation tool, GATE. An axial sensitivity and misplacement rate by penetration of ${\gamma}$ rays were also estimated to evaluate the performance of the proposed PET. The sensitivity was improved by 36% at the center of axial FOV. This value was similar to the calculated value. The misplacement rate of conical shaped PET was about 5% higher than the conventional PET. The results of this study demonstrated the conical detector proposed in this study could provide subsequent improvement in sensitivity which could allow to design high sensitivity PET for brain imaging.

Development Treatment Planning System Based on Monte-Carlo Simulation for Boron Neutron Capture Therapy

Kim, Moo-Sub,Kubo, Kazuki,Monzen, Hajime,Yoon, Do-Kun,Shin, Han-Back,Kim, Sunmi,Suh, Tae Suk Korean Society of Medical Physics 2016 의학물리 Vol.27 No.4

The purpose of this study is to develop the treatment planning system (TPS) based on Monte-Carlo simulation for BNCT. In this paper, we will propose a method for dose estimation by Monte-Carlo simulation using the CT image, and will evaluate the accuracy of dose estimation of this TPS. The complicated geometry like a human body allows defining using the lattice function in MCNPX. The results of simulation such as flux or energy deposition averaged over a cell, can be obtained using the features of the tally provided by MCNPX. To assess the dose distribution and therapeutic effect, dose distribution was displayed on the CT image, and dose volume histogram (DVH) was employed in our developed system. The therapeutic effect can be efficiently evaluated by these evaluation tool. Our developed TPS could be effectively performed creating the voxel model from CT image, the estimation of each dose component, and evaluation of the BNCT plan.