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Evaluation of a Water-based Bolus Device for Radiotherapy to the Extremities in Kaposi¡¯s Sarcoma Patients
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ÀÌÀÍÀç ( Lee Ik-Jae )
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Abstract
¸ñ Àû: º» ¿¬±¸ÆÀÀº »çÁö¿¡ ¹ßº´ÇÑ Ä«Æ÷½ÃÀ°Á¾ÀÇ ¹æ»ç¼±Ä¡·á¸¦ À§ÇÏ¿©, ¹°º¼·ç½º¸¦ »ç¿ëÇÒ ¼ö ÀÖ´Â ±â±¸¸¦ °í¾ÈÇÏ¿´°í, ½Òº¼·ç½º »ç¿ë½Ã¿Í ºñ±³ÇÏ¿© À¯¿ë¼ºÀ» Æò°¡ÇÏ°íÀÚ ÇÏ¿´´Ù.
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°á °ú: °¢ ¼¼ Á¾·ù ½ÇÇèÀÇ ¹Ðµµ ÃøÁ¤°á°ú ¹°º¼·ç½º¸¦ ±âÁØÀ¸·Î ½ÒÀ» Á÷Á¢ ³ÖÀº °æ¿ì´Â 14% °¨¼ÒÇßÀ¸¸ç, ½ÒÀ» ºñ´ÒºÀÁö¿¡ ³ª´©¾î ³ÖÀº °æ¿ì´Â 18% °¨¼ÒÇÏ¿´´Ù. Çʸ§ÀÇ ºÐ¼® °á°ú ¹°º¼·ç½º°¡ ½Òº¼·ç½ºº¸´Ù ±ÕÁúµµ°¡ 4¡4.4% Á¤µµ ¿ì¼öÇÑ °ÍÀ¸·Î ³ªÅ¸³µ´Ù. ¿Çü±¤¼±·®°è ÃøÁ¤ Æò±Õ°ª ºÐ¼®°á°ú ¹°º¼·ç½º¸¦ ±âÁØÀ¸·Î ½ÒÀ» Á÷Á¢ ³ÖÀº °æ¿ì´Â 3.4% Áõ°¡ÇßÀ¸¸ç, ½ÒÀ» ºñ´ÒºÀÁö¿¡ ³ª´©¾î ³ÖÀº °æ¿ì´Â 4.3% Áõ°¡ÇÏ¿´´Ù.
°á ·Ð: ÀÚü Á¦ÀÛÇÑ ¹°º¼·ç½º ±â±¸´Â À°¾ÈÀ¸·Î Ä¡·á Á¶»ç¾ß¸¦ È®ÀÎÇÒ ¼ö ÀÖ¾î ¼Â¾÷ÀÇ Á¤È®¼ºÀ» ³ô¿´À¸¸ç, Áø°ø ¹ëºê¿Í Áø°ø ÆßÇÁ¸¦ »ç¿ëÇÏ¿© °ø±âÃþÀ» °¨¼Ò½ÃÄÑ Ä¡·áÀÇ Á¤È®¼ºÀ» ³ôÀÌ´Â µ¿½Ã¿¡ ¸ñÀû Á¾¾ç¿¡ ±ÕÁúµµ°¡ ³ôÀº ¼±·®À» ºÎ¿© ÇÒ ¼ö ÀÖ´Â ÁÁÀº ¹æ¾ÈÀ̶ó ÇÒ ¼ö ÀÖ´Ù.
Purpose: We designed a water-based bolus device for radiation therapy in Kaposi¡¯s sarcoma. This study
evaluated the usefulness of this new device and compared it with the currently used rice-based bolus.
Materials and Methods: We fashioned a polystyrene box and cut a hole in order to insert patient¡¯s extremities
while the patient was in the supine position. We used a vacuum-vinyl based polymer to reduce water leakage. Next, we eliminated air using a vacuum pump and a vacuum valve to reduce the air gap between the water and extremities in the vacuum-vinyl box. We performed CT scans to evaluate the density difference of the fabricated water-based bolus device when the device in which the rice-based bolus was placed directly, the rice-based bolus with polymer-vinyl packed rice, and the water were all put in. We analyzed the density change with the air gap volume using a planning system. In addition, we measured the homogeneity and dose in the low-extremities phantom, attached to six TLD, and wrapped film exposed in parallel-opposite fields with the LINAC under the same conditions as the set-up of the CT-simulator.
Results: The density value of the rice-based bolus with the rice put in directly was 14% lower than that of the
water-based bolus. Moreover, the value of the other experiments in the rice-based bolus with the polymer-vinyl packed rice showed an 18% reduction in density. The analysis of the EDR2 film revealed that the water-based bolus shows a more homogeneous dose plan, which was superior by 4.0¡4.4% to the rice-base bolus. The mean TLD readings of the rice-based bolus, with the rice put directly into the polystyrene box had a 3.4% higher density value. Moreover, the density value in the case of the rice-based bolus with polymer-vinyl packed rice had a 4.3% higher reading compared to the water-based bolus.
Conclusion: Our custom-made water-based bolus device increases the accuracy of the set-up by confirming
the treatment field. It also improves the accuracy of the therapy owing to the reduction of the air gap using a vacuum pump and a vacuum valve. This set-up represents a promising alternative device for delivering a homogenous dose to the target volume.
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Kaposi¡¯s sarcoma;Water-based bolus;Rice-based bolus
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