목 적 : 최근 시행되고 있는 가임기 여성의 유방암 토모치료 시 치료영역 외에서 발생되는 산란 및 누설에 의한 난소산란선량을 측정하여 평가하고자 한다. 대상 및 방법 : 인체모형팬텀(Aldorson Rando phantom, USA)을 대상으로 전산화단층영상 2.5 mm 획득 후, Tomotherapy Planning station(Tomotherapy, Inc, USA)을 이용하여 좌측 유방암 환자의 토모테라피 치료계획(Tomotherapy Helical & Tomotherapy Direct)을 수립하였다. 난소의 산량 선량 측정을 위한 측정 지점은 치료계획면적의 30 cm 아래 떨어진 골반의 좌우 위치로 직경 1.5 mm, 길이가 12mm인 저에너지용 보상필터가 들어있는 종류의 유리선량계 (GD-352M, ASAHI TECHNO GLASS CO, Japan)를 이용하여 각 5회씩 측정하여 평균하였으며, 선형지수-선량반응모델을 이용한 장기등가선량(organ equivalent dose: OED)으로 평가하였다. 결 과 : 토모 Helical 및 토모 Direct의 두 가지 방식으로 측정된 난소의 산란선량은 좌측 난소부위가 각각 평균 $64.94{pm}0.84mGy$, $37.64{pm}1.20mGy$이고, 우측 난소부위가 평균 $64.38{pm}1.85mGy$, $32.96{pm}1.11mGy$로 나타났다. 이는 토모치료 시 비교적 모니터 단위(MU)가 크고 조사 시간이 긴 토모Helical 방식이 토모Direct에 비하여 측정된 산란선량의 양이 보다 약 1.8배 높은 경향을 보였다. 결 론 : 가임기 여성의 유방암 토모테라피 시 발생하는 좌우측 난소의 산량선량은 ICRP 권고 선량이하로, 불임 및 2차 암 발생에 대한 우려 수준은 현저히 낮지만 향후 유방암 발생 연령층이 낮아지고, 토모테라피와 같이 고정밀 영상유도장치를 이용한 방사선치료가 발달할수록, 가임기 여성 환자의 난소산란선량에 대한 임상적 추적조사가 더욱 필요할 것으로 사료된다.
Purpose : The aim of this study is to evaluate unwanted scattered dose to ovary by scattering and leakage generated from treatment fields of Tomotherapy for childbearing woman with breast cancer. Materials and Methods : The radiation treatments plans for left breast cancer were established using Tomotherapy planning system (Tomotherapy, Inc, USA). They were generated by using helical and direct Tomotherapy methods for comparison. The CT images for the planning were scanned with 2.5 mm slice thickness using anthropomorphic phantom (Alderson-Rando phantom, The Phantom Laboratory, USA). The measurement points for the ovary dose were determined at the points laterally 30 cm apart from mid-point of treatment field of the pelvis. The measurements were repeated five times and averaged using glass dosimeters (1.5 mm diameter and 12 mm of length) equipped with low-energy correction filter. The measures dose values were also converted to Organ Equivalent Dose (OED) by the linear exponential dose-response model. Results : Scattered doses of ovary which were measured based on two methods of Tomo helical and Tomo direct showed average of $64.94{pm}0.84mGy$ and $37.64{pm}1.20mGy$ in left ovary part and average of $64.38{pm}1.85mGy$ and $32.96{pm}1.11mGy$ in right ovary part. This showed when executing Tomotherapy, measured scattered dose of Tomo Helical method which has relatively greater monitor units (MUs) and longer irradiation time are approximately 1.8 times higher than Tomo direct method. Conclusion : Scattered dose of left and right ovary of childbearing women is lower than ICRP recommended does which is not seriously worried level against the infertility and secondary cancer occurrence. However, as breast cancer occurrence ages become younger in the future and radiation therapy using high-precision image guidance equipment like Tomotherapy is developed, clinical follow-up studies about the ovary dose of childbearing women patients would be more required.
