• Journal of Korean Neurosurgical Society
• /
• 제60권5호
• /
• pp.604-609
• /
• 2017

Objective : An adjustable Ghajar guide is presented to improve the accuracy of the original Ghajar guide technique. The accuracy of the adjustable Ghajar guide technique is also investigated. Methods : The coronal adjustment angle from the orthogonal catheter trajectory at Kocher's point is determined based on coronal head images using an electronic picture archiving and communication system. For the adjustable Ghajar guide, a protractor is mounted on a C-shaped basal plate that is placed in contact with the margin of a burrhole, keeping the central $0^{\circ}$ line of the protractor orthogonal to the calvarial surface. A catheter guide, which is moved along the protractor and fixed at the pre-determined adjustment angle, is then used to guide the ventricular catheter into the frontal horn adjacent to the foramen of Monro. The adjustable Ghajar guide technique was applied to 20 patients, while a freehand technique based on the surface anatomy of the head was applied to another 47 patients. The accuracy of the ventricular catheter placement was then evaluated using postoperative computed tomography scans. Results : For the adjustable Ghajar guide technique (AGT) patients, the bicaudate index ranged from 0.23 to 0.33 ($mean{\pm}standard$ deviation [SD] : $0.27{\pm}0.03$) and the adjustment angle ranged from $0^{\circ}$ to $10^{\circ}$ ($mean{\pm}SD:5.2^{\circ}{\pm}3.2^{\circ}$). All the AGT patients experienced successful cerebrospinal fluid diversion with only one pass of the catheter. Optimal placement of the ventricular catheter in the ipsilateral frontal horn approximating the foramen of Monro (grade 1) was achieved in 19 patients (95.0%), while a suboptimal trajectory into a lateral corner of the frontal horn passing along a lateral wall of the frontal horn (grade 3) occurred in 1 patient (5.0%). Thus, the AGT patients experienced a significantly higher incidence of optimal catheter placement than the freehand catheterized patients (95.0% vs. 68.3%, p=0.024). Moreover, none of the AGT patients experienced any tract hemorrhages along the catheter or procedure-related complications. Conclusion : The proposed adjustable Ghajar guide technique, using angular adjustment in the coronal plane from the orthogonal trajectory at Kocher's point, facilitates accurate freehand placement of a ventricular catheter for hydrocephalic patients.

• 한국응급구조학회지
• /
• 제13권3호
• /
• pp.77-90
• /
• 2009

Civil complaints and lawsuits filed in the process of providing emergency medical service include fall accident on the way of carrying the patient, transfer consent, refusal and rejection of rescue request, range and behavior restriction of emergency medical technicians, false registry of logbook, neglect of duty and emergency patient, and violation of traffic laws on the way of dispatch to the scene of accident. This study suggested the measures by cases as follows. 1. The accidents on the way of carrying a patient could be divided into fall of patient and fall by paramedic's mistake. In the former case, damages caused by the ambulance's shaking must be notified to the patient and guardian and recommended to fasten seat belt, in the latter case, the plan of patient's posture, route of transport, rescue and equipments should be comfirmed before fixing the patient. 2. Transfer consent must be made as implied when the patient is unconscious under delusion and was not able to consent physically, and paramedic must take an action by his judgment and record details of services on logbook. 3. When a patient refused to transfer, get 'confirmation of transfer refusal' and inform him of refusal. Paramedic should receive the signature. In addition, in case of refusal, transfer request should be made after hearing doctor's opinion and it should be notified to transfer request and superintendent of fire station after making 'confirmation of transfer refusal'. 4. Emergency medical technicians should perform their duties within the range of services prescribed by Article 41 of Law of Emergency Medical Service and Article 33 of Its Enforcement Regulations and shall not make announcement of death. In case of reporting the death to guardian, it is desirable to use record data like ECG results. 5. The best way to have protection from legal problems is making and keeping the exact records of accident and patient. Paramedic should not mention his subjective opinion about the accident-related matter. He must record correctly and keep the original medical records. 6. As emergency medical technicians are responsible for taking care of emergency patients, they must contact a briefing room when they meet a difficult situation suddenly due to vehicle stop or treatment of other patients and then must have support from neighboring hospital and other safety centers. 7. Since the ambulance operator is responsible for safety and careful driving of ambulance, he must be careful when he violates traffic regulations unavoidably. The operator should drive slowly below 10km/h at an intersection and pass it after getting way from general vehicles driving from all directions.

• Journal of Radiation Protection and Research
• /
• 제23권1호
• /
• pp.49-57
• /
• 1998

국내 최초로 중성자 개인선량계에 대한 상호비교측정시험이 수행되었다. 기준 방사선장으로 한국원자력연구소가 보유하고 있는 중수감속 $^{252}Cf$ 선원을 이용하였으며, 12개 판독기관의 선량계 13종이 상호비교시험에 참가하였다. 각 참가기관으로부터 컨트롤과 예비용을 포함하여 15개의 선량계를 제출받아, 이를 2개의 조사선량군으로 나누어 4개씩 총 8개의 선량계가 실제 조사되었다. 중성자, 감마 그리고 총선량의 항목으로 판독기관의 보고선량을 부여된 선량으로 나누어 선량계 판독결과를 비교한 결과, 각각에 대하여 그 비율이 $0.55{\sim}1.34$, $0.54{\sim}1.32$, $0.75{\sim}1.20$ 의 분포를 갖는 것으로 나타났다. 판독기관의 자체 판독능력을 기준으로 할 때 전혀 문제가 없는 것은 아니나, 현재의 상호비교시험 결과로부터 알 수 있는 것은 향후 중성자분야에 대한 개인선량계 성능시험이 시행될 경우, 판독기관들이 모두 합격범위에 들 가능성이 높은 것으로 평가되었다.

• 한국터널지하공간학회 논문집
• /
• 제22권3호
• /
• pp.277-291
• /
• 2020

쉴드 TBM은 기존 재래식 터널(Drill and Blast)에 비하여 터널을 굴착하는 지반 및 선형조건에서 적용범위가 넓은 공법으로 대단면, 대심도, 초연약지반에서의 터널링 공법으로 중요성이 부각되고 있으며, 현재 13.3 m의 대구경 slurry 쉴드 TBM이 한강 하부 통과를 위한 시공을 준비하고 있다. 쉴드 TBM은 이수압식과 토압식 쉴드 TBM으로 구분되고, 각각의 특성에 따라 시공 중 관리 항목이 달라진다. 본 논문에서는 연약지반에 주로 시공되는 이수압식 쉴드 TBM을 대상으로 장비형식, 발생기원, 적용 사례 및 트러블 사례를 분석하였다. 또한, 적정 챔버압, 장비 전방으로의 이수 분출(또는 누수)가능성을 토피고 조건에 따라 2D 및 3D 모형실험 실시하였다. 이를 토대로 연약지반 조건에서 이수압식 쉴드 TBM 시공 시 적정 굴진면 토압과 챔버압 예측을 위한 기초 및 참고자료 제공 그리고 토피고 조건에 따른 이수분출 위험 높이를 제안하여 이수분출로 인한 안정성 및 환경요인 저하원인을 최소화하기 위한 방안을 제안하였다.

• Journal of Yeungnam Medical Science
• /
• 제18권1호
• /
• pp.39-50
• /
• 2001

본 연구는 여러 가지 질병의 원인을 규명하는데 있어서 자율신경계 역할의 중요성을 인식하여 심전도 및 호흡신호의 변이를 이용하여 자율신경계를 감시할 수 있는 시스템을 개발하였다. 본 연구에서 제작된 증폭기에서는 트랜스를 사용하여 교류전원으로부터 환자를 격리시키고, 30 KHz의 고주파를 이용하여 임피던스법에 의한 호흡신호를 심전도와 동시에 처리할 수 있도록 하였으며, 아울러 서로의 채널에 대한 혼신의 영향을 최소화하도록 회로를 설계하였다. 시뮬레이터에 의한 테스트 결과에서 입력 조건에 따라 증폭기의 출력에 나타나는 시간 간격이 일치하게 나타나는 것을 확인하였다. 또 실제 서로 다른 조건을 가진 세 부류의 임상 환자의 심전도에서 R-R interval 및 호흡신호를 측정하여 추출할 수 있었다. 기존에는 주로 생체 신호 파라미터를 각각 측정하여 그 결과를 추출하였으나 본 연구에서는 R-R interval과 respiration의 파라미터를 통합하여 데이터를 수집, 처리함으로써 환자로부터 얻은 데이터를 임상 응용에 보다 효과적으로 적용할 수 있게 되었다. 따라서 향후 개발된 시스템의 보완을 통해 환자에 직접 적용하여 자율신경계 장애 환자에 대한 감시장치로 활용하고자 한다.

• 한국정보통신학회논문지
• /
• 제12권5호
• /
• pp.815-820
• /
• 2008

최근 통신용 UWB에 대한 주파수할당과 기술기준이 완료됨에 따라서 UWB 시스템에 대한 개발이 활발히 진행되고 있다. 우리나라의 경우 low band로 $3.1{\sim}4.8GHz$와 high band로 $7.2{\sim}10.2GHz$를 통신용 UWB 시스템에 할당하고 있으며, 현재의 RF 부품 기술과 제품 구현의 용이성을 고려하면 low band를 많이 이용할 것이다. 본 논문에서는 제품 구현의 용이성을 고려해서 low band를 이용하는 통신용 UWB 시스템을 위한 interdigital BPF를 설계 및 제작하였다. BPF는 low band 대역 필터와 low band 채널필터를 설계 및 제작하였다. 성능 측정 결과 low band 대역 필터는 3.1GHz와 4.8GHz에 서 각각 21.85dB와 17.91dB의 감쇠 특성을 가지며, -10dB 대역폭은 1.53GHz, 삽입 손실은 2dB이었다. Low band 대역은 500MHz 대역폭으로 3개의 채널이 할당 가능하며, 구현한 low band의 1번 채널필터는 3.1GHz에서 24.85dB의 감쇠 특성, -10dB 대역폭은 0.61GHz, 삽입 손실은 1.87dB로 측정되었다. Low band의 3번 채널필터는 4.8GHz에서 19.2dB의 감쇠특성을 가지며, 10dB 대역폭은 0.49GHz이고 2.49dB의 삽입 손실은 갖는다.

• 한국정보통신학회논문지
• /
• 제11권10호
• /
• pp.1852-1857
• /
• 2007

SSB 무선모뎀은 데이터의 디지털 전압레벨을 가청주파수로 변환하는 변조와 역으로 가청주파수를 데이터의 디지털 전압레벨로 변환하는 복조과정을 거치는데 변 복조기는 하나의 DSP 칩을 이용하여 구현하였다. SSB의 특성상 주파수가 변할 때 인접한 두 주기에서 왜곡이 발생하는데 이것은 음성통신방식에는 아무런 영향을 주지 않으나 데이터 전송할 때는 심각한 영향을 준다. 다시 말하면 인접해 있는 2주기는 데이터 전송을 할 수 없다. 그래서 2-tone FSK방식을 사용하는 경우, 1비트를 보내기 위해 최소 3주기 이상을 보내야 한다. 그러므로, 고속전송을 위해서는 1개의 tone 신호를 보내는 변형된 위상지연 방식을 사용하여 모뎀을 구현하였다. 1200bps를 전송모드에서는 1.3kHz 심볼주파수에 지연시간 0과 $187{\mu}s$을 발생시켰고 2400bps 모드에서는 1.5kHz 심볼주파수에 0, $70{\mu}s,\;130{\mu}s$ 및 $200{\mu}s$의 지연시간을 두어 구현하였다. 최고전송속도 3600bps 모드에서는 2.0kHz 심볼주파수에 0, $100{\mu}s,\;160{\mu}s$ 및 $250{\mu}s$의 지연시간을 두어 구현하였다. 이상의 방법으로 SSB 모뎀을 구현하였으며 기존 독일의 PACTOR와 미국의 CLOVER계열의 스펙트럼과 비교했을 때 SSB 통과대역폭은 거의 비슷하였고 대역폭내의 신호대잡음비를 비교한 결과 본 연구 구현한 모뎀의 파형이 20dB정도 높은 이득으로 전송되는 우수한 특성을 보였다. 실제 전송시험 결과에서도 송수신 Platform에 데이터가 정확하게 수신되고 있음을 확인하였다.

• Gut and Liver
• /
• 제12권6호
• /
• pp.722-727
• /
• 2018

Background/Aims: Although endoscopic bilateral stent-instent placement is challenging, many recent studies have reported promising outcomes regarding technical success and endoscopic re-intervention. This study aimed to evaluate the technical accessibility of stent-in-stent placement using large cell-type stents in patients with inoperable malignant hilar biliary obstruction. Methods: Forty-three patients with inoperable malignant hilar biliary obstruction from four academic centers were prospectively enrolled from March 2013 to June 2015. Results: Bilateral stent-in-stent placement using two large cell-type stents was successfully performed in 88.4% of the patients (38/43). In four of the five cases with technical failure, the delivery sheath of the second stent became caught in the hook-cross-type vertex of the large cell of the first stent, and subsequent attempts to pass a guidewire and stent assembly through the mesh failed. Functional success was achieved in all cases of technical success. Stent occlusion occurred in 63.2% of the patients (24/38), with a median patient survival of 300 days. The median stent patency was 198 days. The stent patency rate was 82.9%, 63.1%, and 32.1% at 3, 6, and 12 months postoperatively, respectively. Endoscopic re-intervention was performed in 14 patients, whereas 10 underwent percutaneous drainage. Conclusions: Large cell-type stents for endoscopic bilateral stent-in-stent placement had acceptable functional success and stent patency when technically successful. However, the technical difficulty associated with the entanglement of the second stent delivery sheath in the hook-cross-type vertex of the first stent may preclude large cell-type stents from being considered as a dedicated standard tool for stent-in-stent placement.

• 방사선산업학회지
• /
• 제10권1호
• /
• pp.29-35
• /
• 2016

Radiation generating devices must be properly shielded for their safe application. Although institutes such as US National Bureau of Standards and National Council on Radiation Protection and Measurements (NCRP) have provided guidelines for shielding X-ray tube of various purposes, industry people tend to rely on 'Half Value Layer (HVL) method' which requires relatively simple calculation compared to the case of those guidelines. The method is based on the fact that the intensity, dose, and air kerma of narrow beam incident on shielding wall decreases by about half as the beam penetrates the HVL thickness of the wall. One can adjust shielding wall thickness to satisfy outside wall dose or air kerma requirements with this calculation. However, this may not always be the case because 1) The strict definition of HVL deals with only Intensity, 2) The situation is different when the beam is not 'narrow'; the beam quality inside the wall is distorted and related changes on outside wall dose or air kerma such as buildup effect occurs. Therefore, sometimes more careful research should be done in order to verify the effect of shielding specific radiation generating device. High energy X-ray tubes which is operated at the voltage above 400 kV that are used for 'heavy' nondestructive inspection is an example. People have less experience in running and shielding such device than in the case of widely-used low energy X-ray tubes operated at the voltage below 300 kV. In this study, Air Kerma value per week, outside concrete shielding wall of various thickness surrounding 450 kVp X-ray tube were calculated using MCNP simulation with the aid of Geometry Splitting method which is a famous Variance Reduction technique. The comparison between simulated result, HVL method result, and NCRP Report 147 safety goal $0.02mGy\;wk^{-1}$ on Air Kerma for the place where the public are free to pass showed that concrete wall of thickness 80 cm is needed to achieve the safety goal. Essentially same result was obtained from the application of HVL method except that it suggest the need of additional 5 cm concrete wall thickness. Therefore, employing the result from HVL method calculation as an conservative upper limit of concrete shielding wall thickness was found to be useful; It would be easy, economic, and reasonable way to set shielding wall thickness.

• 한국어교육
• /
• 제28권3호
• /
• pp.1-24
• /
• 2017

This article explores the developmental history of TOPIK over the last 20 years and its recent trends. Over the last two decades, TOPIK underwent two major systematic reforms, achieving both quantitative and qualitative growth over the course of its 52 testing sessions. TOPIK has utilized a six-level evaluation system from its inception to the present. The evaluation system was amended from the earlier six-test set - whereby each level corresponded with a separate test (1997~2005: the $1^{st}{\sim}9^{th}$) - to the three-test set (2006~2014: the $10^{th}{\sim}34^{th}$), and finally to the two-test set (2014~present: the $35^{th}{\sim}42^{nd}$). In the earlier exams, abilities in Vocabulary Grammar, Writing, Listening, and Reading were assessed. However, beginning with the $35^{th}$ TOPIK, abilities in Listening, Reading, and Writing (only in TOPIK II) were assessed and the evaluation of the writing section was changed to a task-based process, improving TOPIK into a more qualified analysis of proficiency. Over the last 20 years, the number of countries TOPIK is administered in has greatly increased from 4 to 73 countries, and the annual number of test-takers has also significantly increased from 2,692 to 250,141. The distribution of proficiency levels of the test-takers has shifted over time - initially "Beginner>Intermediate>Advanced" in the earlier exams, to "Intermediate>Advanced>Beginner" after the mid 2000s - as the number of those studying the Korean language for specific purposes and continuing education increased. Test-takers have indicated a shift in their purpose for taking the exam, initially citing "to assess proficiency" and more recently selecting "to study abroad," and this could also correlate with changes in the proportion of test-takers' proficiency level. In general, 85~95% of beginner, 50~65% of intermediate, and 45~60% of advanced test applicants passed the respective proficiency level. To date, no practices have yet been implemented to standardize the difficulty level longitudinally across test sets.