Jeong-Hoon Park

Hearing Outcomes After Stereotactic Radiosurgery for Unilateral Intracanalicular Vestibular Schwannomas: Implication of Transient Volume Expansion

PURPOSE We evaluated the prognostic factors for hearing outcomes after stereotactic radiosurgery (SRS) for unilateral sporadic intracanalicular vestibular schwannomas (IC-VSs) as a clinical homogeneous group of VSs. METHODS AND MATERIALS Sixty consecutive patients with unilateral sporadic IC-VSs, defined as tumors in the internal acoustic canal, and serviceable hearing (Gardner-Roberson grade 1 or 2) were treated with SRS as an initial treatment. The mean tumor volume was 0.34±0.03 cm3 (range, 0.03-1.00 cm3), and the mean marginal dose was 12.2±0.1 Gy (range, 11.5-13.0 Gy). The median follow-up duration was 62 months (range, 36-141 months). RESULTS The actuarial rates of serviceable hearing preservation were 70%, 63%, and 55% at 1, 2, and 5 years after SRS, respectively. In multivariate analysis, transient volume expansion of ≥20% from initial tumor size was a statistically significant risk factor for loss of serviceable hearing and hearing deterioration (increase of pure tone average≥20 dB) (odds ratio=7.638; 95% confidence interval, 2.317-25.181; P=.001 and odds ratio=3.507; 95% confidence interval, 1.228-10.018; P=.019, respectively). The cochlear radiation dose did not reach statistical significance. CONCLUSIONS Transient volume expansion after SRS for VSs seems to be correlated with hearing deterioration when defined properly in a clinically homogeneous group of patients.

Effect of atomic hydrogen on the growth of Ge/Si(100)

Dynamically supplied atomic hydrogen was used for a surfactant growth of Ge on a Si(100) surface. The transition from three-dimensional to two-dimensional growth of Ge was observed as the hydrogen flux was increased to ∼1 ML/s in scanning tunneling microscope images. Layer-by-layer growth was successfully achieved up to 5 ML of Ge in the presence of atomic hydrogen. Observed missing dimer rows, irregular trench structures, and new “pin holes” are believed to be the product of strain relieving mechanism. The layer-by-layer growth can be understood both by energetics and kinetic pathway arguments.

The deposition behavior of SiO2–TiO2 thin film by metalorganic chemical vapor deposition method

SiO2–TiO2 thin films were deposited by metalorganic chemical vapor deposition using an alkoxide source. At 680 °C, the deposition rate curve showed parabolic behavior and the refractive index increased linearly from 1.45 to 2.35 with increasing titanium tetraisopropoxide: Ti(OC3H7)4(TTIP) ratio. Each oxide component in the film was separated analytically and its effective deposition rate, in the composite thin film, was calculated to analyze the deposition mechanism of the mixed sources. A Lorentz–Lorenz model was used to attain the composition of the film for each component separation. Effective SiO2 deposition from tetraethylorthosilicate: Si(OC2H5)4(TEOS) showed parabolic behavior with increasing TTIP ratio, while the effective TiO2 deposition did not. In addition, TTIP lowered the apparent activation energy of SiO2 deposition significantly from ∼40 to ∼10 Kcal/mol. From this, it was concluded that TTIP enhanced the TEOS decomposition, which results in the anomalous deposition behavior in composite fil...

Application of the gamma evaluation method in Gamma Knife film dosimetry.

PURPOSE Gamma Knife (GK) radiosurgery is a minimally invasive surgical technique for the treatment of intracranial lesions. To minimize neurological deficits, submillimeter accuracy is required during treatment delivery. In this paper, the delivery accuracy of GK radiosurgery was assessed with the gamma evaluation method using planning dose distribution and film measurement data. METHODS Single 4, 8, and 16 mm and composite shot plans were developed for evaluation using the GK Perfexion (PFX) treatment planning system (TPS). The planning dose distributions were exported as digital image communications in medicine - radiation therapy (DICOM RT) files using a new function of GK TPS. A maximum dose of 8 Gy was prescribed for four test plans. Irradiation was performed onto a spherical solid water phantom using Gafchromic EBT2 films in the axial and coronal planes. The exposed films were converted to absolute dose based on a 4th-order polynomial calibration curve determined using ten calibration films. The film measurement results and planning dose distributions were registered for further analysis in the same Leksell coordinate using in-house software. The gamma evaluation method was applied to two dose distributions with varying spatial tolerance (0.3-2.0 mm) and dosimetric tolerance (0.3-2.0%), to verify the accuracy of GK radiosurgery. The result of gamma evaluation was assessed using pass rate, dose gamma index histogram (DGH), and dose pass rate histogram (DPH). RESULTS The 20, 50, and 80% isodose lines found in film measurements were in close agreement with the planning isodose lines, for all dose levels. The comparison of diagonal line profiles across the axial plane yielded similar results. The gamma evaluation method resulted in high pass rates of >95% within the 50% isodose line for 0.5 mm∕0.5% tolerance criteria, in both the axial and coronal planes. They satisfied 1.0 mm∕1.0% criteria within the 20% isodose line. Our DGH and DPH also showed that low isodose lines exhibited inferior gamma indexes and pass rates compared with higher isodose lines. CONCLUSIONS The gamma evaluation method was applicable to GK radiosurgery. For all test plans, planning dose distribution and film measurement met the tolerance criteria of 0.5 mm∕0.5% within the 50% isodose line which are used for marginal dose prescription.

The Risk Factors of Symptomatic Communicating Hydrocephalus After Stereotactic Radiosurgery for Unilateral Vestibular Schwannoma: The Implication of Brain Atrophy

PURPOSE To identify the effect of brain atrophy on the development of symptomatic communicating hydrocephalus (SCHCP) after stereotactic radiosurgery (SRS) for sporadic unilateral vestibular schwannomas (VS). METHODS AND MATERIALS A total of 444 patients with VS were treated with SRS as a primary treatment. One hundred eighty-one patients (40.8%) were male, and the mean age of the patients was 53±13 years (range, 11-81 years). The mean follow-up duration was 56.8±35.8 months (range, 12-160 months). The mean tumor volume was 2.78±3.33 cm3 (range, 0.03-23.30 cm3). The cross-sectional area of the lateral ventricles (CALV), defined as the combined area of the lateral ventricles at the level of the mammillary body, was measured on coronal T1-weighted magnetic resonance images as an indicator of brain atrophy. RESULTS At distant follow-up, a total of 25 (5.6%) patients had SCHCP. The median time to symptom development was 7 months (range, 1-48 months). The mean CALV was 334.0±194.0 mm2 (range, 44.70-1170 mm2). The intraclass correlation coefficient was 0.988 (95% confidence interval [CI], 0.976-0.994; p<0.001). In multivariate analysis, the CALV had a significant relationship with the development of SCHCP (p<0.001; odds ration [OR]=1.005; 95% CI, 1.002-1.007). Tumor volume and female sex also had a significant association (p<0.001; OR=1.246; 95% CI, 1.103-1.409; p<0.009; OR=7.256; 95% CI, 1.656-31.797, respectively). However, age failed to show any relationship with the development of SCHCP (p=0.364). CONCLUSION Brain atrophy may be related to de novo SCHCP after SRS, especially in female patients with a large VS. Follow-up surveillance should be individualized, considering the risk factors involved for each patient, for prompt diagnosis of SCHCP.

Radiosurgery for Para-IAC Meningiomas: The Effect of Radiation Dose to the Cochlea on Hearing Outcome

PURPOSE This study was performed to assess the radiosurgical results of meningiomas extending into the internal acoustic canal (para-IAC meningiomas), with a particular focus on the effect of radiation dose to the cochlea on hearing outcome. METHODS AND MATERIALS A total of 50 patients who underwent radiosurgery for para-IAC meningiomas between 1998 and 2009, which were followed for 2 years, were enrolled. The mean age was 55.8 years (range, 15-75). The mean tumor volume was 6.1 cm(3) (range, 1.0-19.0), the mean tumor length in the IAC was 6.9 mm (range, 1.3-13.3), and the mean prescribed marginal dose was 13.1 Gy (range, 10-15) at an isodose line of 50%. The mean follow-up duration was 46 months (range, 24-122). RESULTS Eight (16.0%) patients had nonserviceable hearing at the time of surgery. At the last follow-up, the tumor control rate was 94%; unchanged in 17 patients, decreased in 30 patients, and increased in 3 patients. Among 42 patients with serviceable hearing at the time of radiosurgery, it was preserved in 41 (97.6%) patients at the last follow-up. The maximal and mean radiation doses to the cochleae of these 41 patients were 5.8 Gy ± 0.3 (range, 3.1-11.5) and 4.3 Gy ± 0.2 (range, 2.2-7.5), respectively. The maximal dose to the cochlea of the patient who lost hearing after radiosurgery was 4.7 Gy. CONCLUSIONS The radiation dose to the cochlea may have the minimal toxic effect on the hearing outcome in patients who undergo radiosurgery for para-IAC meningiomas.

Structural and optical properties of TiO2-SiO2 composite films deposited by chemical vapor deposition at low-SiO2-content region

We, here, present the study on the crystalline behavior of TiO2 in the presence of SiO2 and its optical property at low SiO2 content region from x equals 0 and 0.12 in the (1-x)TiO2-xSiO2 system. From X-ray diffraction, it is observed that just a small addition of SiO2 into TiO2-SiO2 films has made a rutile peak completely vanish. Anatase peaks were decreased in intensity and broadened with the increase in added SiO2 content. Besides, anatase peak was shifted to the large d-spacing and its means that Si ions have incorporated into TiO2. However, the anatase peak shift was saturated above 8 mol%. These facts confirmed that incorporated Si ions inhibited the phase transition between the rutile and the anatase and the crystallization of anatase is also suppressed with SiO2 addition. The anatase band frequency (approximately 140 cm-1) shift to the higher one in Raman spectra and the appearance of the band due to Si-O-Ti vibration in IR spectra indicates clearly that the SiO2 incorporation happens as SiO2 is added in films. The surface topography observed by SEM and AFM shows that the surface becomes smooth and the TiO2 crystallite become smaller with increasing SiO2 content. UV-Visible transmittance spectra showed that all films have good transparency up to about 90% in visible region.

A new method and device of aligning patient setup lasers in radiation therapy

The aim of this study is to develop a new method to align the patient setup lasers in a radiation therapy treatment room and examine its validity and efficiency. The new laser alignment method is realized by a device composed of both a metallic base plate and a few acrylic transparent plates. Except one, every plate has either a crosshair line (CHL) or a single vertical line that is used for alignment. Two holders for radiochromic film insertion are prepared in the device to find a radiation isocenter. The right laser positions can be found optically by matching the shadows of all the CHLs in the gantry head and the device. The reproducibility, accuracy, and efficiency of laser alignment and the dependency on the position error of the light source were evaluated by comparing the means and the standard deviations of the measured laser positions. After the optical alignment of the lasers, the radiation isocenter was found by the gantry and collimator star shots, and then the lasers were translated parallel to the isocenter. In the laser position reproducibility test, the mean and standard deviation on the wall of treatment room were 32.3±0.93 mm for the new method whereas they were 33.4±1.49 mm for the conventional method. The mean alignment accuracy was 1.4 mm for the new method, and 2.1 mm for the conventional method on the walls. In the test of the dependency on the light source position error, the mean laser position was shifted just by a similar amount of the shift of the light source in the new method, but it was greatly magnified in the conventional method. In this study, a new laser alignment method was devised and evaluated successfully. The new method provided more accurate, more reproducible, and faster alignment of the lasers than the conventional method. PACS numbers: 87.56.Fc, 87.53.Bn, 87.53.Kn, 87.53.Ly, 87.55.GhThe aim of this study is to develop a new method to align the patient setup lasers in a radiation therapy treatment room and examine its validity and efficiency. The new laser alignment method is realized by a device composed of both a metallic base plate and a few acrylic transparent plates. Except one, every plate has either a crosshair line (CHL) or a single vertical line that is used for alignment. Two holders for radiochromic film insertion are prepared in the device to find a radiation isocenter. The right laser positions can be found optically by matching the shadows of all the CHLs in the gantry head and the device. The reproducibility, accuracy, and efficiency of laser alignment and the dependency on the position error of the light source were evaluated by comparing the means and the standard deviations of the measured laser positions. After the optical alignment of the lasers, the radiation isocenter was found by the gantry and collimator star shots, and then the lasers were translated parallel to the isocenter. In the laser position reproducibility test, the mean and standard deviation on the wall of treatment room were 32.3±0.93 mm for the new method whereas they were 33.4±1.49 mm for the conventional method. The mean alignment accuracy was 1.4 mm for the new method, and 2.1 mm for the conventional method on the walls. In the test of the dependency on the light source position error, the mean laser position was shifted just by a similar amount of the shift of the light source in the new method, but it was greatly magnified in the conventional method. In this study, a new laser alignment method was devised and evaluated successfully. The new method provided more accurate, more reproducible, and faster alignment of the lasers than the conventional method. PACS numbers: 87.56.Fc, 87.53.Bn, 87.53.Kn, 87.53.Ly, 87.55.Gh.

Development of a Beam Source Modeling Technique for a Flattening Filter Free (FFF) Beam

This study was focused on a new beam source modeling technique for a flattening filter free (FFF) beam. The model was based on a previous three source model, and improved by introducing off axis ratio (OAR) of photon fluence to the primary and scattered photon sources to generate cone shaped dose profiles. The model parameters and the OAR were optimized from measured head scatter factors and a dose profile with 40 x 40 cm2 field size by using line search optimization algorithm. The model was validated by comparing various dose profiles on 6 and 10 MV FFF beam from a True Beam STx linear accelerator. Planar dose distributions for clinically used radiation fields were also calculated and compared with measured data. All calculated dose profiles were agreed with the measured data within 1.5% for 6 MV FFF beam, and within 1% for 10 MV FFF beam. The calculated planar doses showed good passing rates (> 94%) at 3%/3 mm of gamma indexing criteria. This model expected to be easily applicable to any FFF beams for treatment planning systems because it only required measured PDD, dose profiles and output factors which were easily acquired during conventional beam commissioning process.

Determination of Dose Escalation Region in Malignant Brain tumors for Radiation Treatment Planning Based on Apparent Diffusion Coefficient Map

Treatment effect of malignant brain tumors including astrocytoma and glioma has showed low survival and frequent tumor recurrence. Several clinical study, however, reported that dose escalation with chemotherapy produced better prognosis than conventional radiation therapy. Thus, we investigated feasibility and advantage of integrating apparent diffusion coefficient (ADC) map in treatment planning to determine the dose escalation region.