• Radiation Oncology Journal
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• v.16 no.4
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• pp.497-504
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• 1998

Purpose : To evaluate the usefulness of electronic portal imaging device through objective compare of the images acquired using an EPID and a conventional port film Materials and Methods : From Apr. to Oct. 1997, a total of 150 sets of images from 20 patients who received radiation therapy in the pelvis area were evaluated in the Inha University Hospital and Severance Hospital. A dual image recording technique was devised to obtain both electronic portal images and port film images simultaneously with one treatment course. We did not perform double exposure five to ten images were acquired from each patient. All images were acquired from posteroanterior (PA) view except images from two patients. A dose rate of 100-300 Mu/min and a 10-MV X-ray beam were used and 2-10 MUs were required to produce a verification image during treatment. Kodak diagnostic film with metal/film imaging cassette which was located on the top of the EPID detector was used for the port film. The source to detector distance was 140 cm. Eight anatomical landmarks (pelvic brim, sacrum, acetabulum. iliopectineal line, symphysis, ischium, obturator foramen, sacroiliac joint) were assessed. Four radiation oncologist joined to evaluate each image. The individual landmarks in the port film or in the EPID were rated - very clear (1), clear (2), visible (3), not clear (4), not visible (5). Results : Using an video camera based EPID system. there was no difference of image quality between no enhanced EPID images and port film images. However, when we provided some change with window level for the portal image, the visibility of the sacrum and obturator foramen was improved in the portal images than in the port film images. All anatomical landmarks were more visible in the portal images than in the port film when we applied the CLAHE mode enhancement. The images acquired using an matrix ion chamber type EPID were also improved image qualify after window level adjustment. Conclusion : The quality of image acquired using an electronic portal imaging device was comparable to that of the port film. When we used the enhance mode or window level adjustment. the image quality of the EPID was superior to that of the port film. EPID may replace the port film.

• Radiation Oncology Journal
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• v.16 no.4
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• pp.441-446
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• 1998

Purpose : The incidence of esophageal carcinoma is increasing. Radical surgery is the treatment of choice, but large proportion of the esophageal cancer patients are with unresectable disease at the time of initial diagnosis, so radiation therapy has been the major treatment modality. We carried out retrospective analysis to see the outcome and prognostic factors of radiation therapy alone for esophageal carcinoma. Methods and Materials : From June of 1979 through December 1992, 289 patients with esophageal carcinoma were treated with radiation therapy alone at Department of Therapeutic Radiology, Seoul National University Hospital. Of these patients, 84 patients were excluded as they were ineligible for the current analyses. Twenty-two patients had distant metastasis other than supraclavicular lymph node metastasis, 52 patients received less than 45 Gy, and 10 patient were lost from follow-up. Therefore 205 patients constituted the base population of this study. According to AJCC s1aging system, there were 2 patients with stage 1, 104 with stage IIA, 26 with stage IIB, 48 with stage III, and 25 with stage IV Radiation dose ranged from 4500 cGy to 6980 cGy with median dose of 5940 cGy. Follow-up period of the alive patients ranged from 77 to 180 months. Results : The Median survival period of all the patients was II months and the 2-, 5-, and 10-year overall survival rates were 22.4$\%$, 10.2$\%$ and 5.3$\%$, respectively. Most of the failures were local recurrences. Of 169 failures, 134 had local failure as a component and 111 had local recurrence only. The Lymph node was most common distant metastatic site and the next was the lung. The stage, T-stage, N-stage, functional status, tumor size, and aim of treatment were statistically significant prognostic factors for survival by univariate analyses. But only tumor size and N-stage were significant by multivariate analyses. Conclusion : We could get 10.2$\%$ of 5 year survival rate and 5.3$\%$ of 10 year survival rate with radiation therapy alone. The size of tumor and N-stage were statistically significant prognostic factors for survival on multivariate analyses.

• Korean Journal of Soil Science and Fertilizer
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• v.35 no.1
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• pp.38-46
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• 2002

Chrysanthemum boreale M. (hereafter, C. boreale M.), a perennial flower, has been historically used as a natural medicine in Korea. With increasing concerns for health-improving foods, the demand for C. boreale M. has become higher than ever. Howevr, the amount of wild C. boreale M. collected from mountainous areas is not enough to cover all demands. The cultivation system and fertilization strategy are required to meet increasing demand on C. boreale M. with a good quality. We investigated the effects of nitrogen application on plant growth and effective components of C. boreale M. to suggest optimum rate of nitrogen fertilization. C. boreale M. was cultivated in a pot scale (1/2000a scale), and nitrogen applied with rate of 0(N0), 50(N50), 100(N100), 150(N150), 200(N200), and $250(N250)kg\;ha^{-1}$. Phosphate and potassium were applied at the same level ($P_2O_5-K_2O=80-80kg\;ha^{-1}$) in all treatments. Maximum yield achieved in 246 and $226kg\;ha^{-1}$ N treatment on the whole plant and the flower part, a valuable part as a herbal medicine, respectively. Proline was the most abundant amino acid in the flower of C boreal M. and the contents of amino acids increased with increasing nitrogen application rate in flower. Nitrogen recovery efficiency was high more than 41% in all nitrogen treatments and increased to 61.8% in nitrogen N100 treatment. From the nitrogen content, the high nitrogen uptake, the low residue of mineral N and the reasonably good apparent fertilizer recovery, it can be inferred that C. boreale M. made efficient use of the available nitrogen. In flower, contents of Cumambrin A. which is a sesquiterpene compound and has the effect of blood-pressure reduction, decreased with increasing nitrogen application. However, the amount of Cumambrin A in flower increased as nitrogen rate increased, because of increasing flower yield. Conclusively, nitrogen fertilization could increase yields and enhance quality. The optimum nitrogen application rate might be on the range of $225{\sim}250kg\;ha^{-1}$ in a mountainous soil.

• Korean Journal of Soil Science and Fertilizer
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• v.17 no.2
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• pp.147-154
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• 1984

Two Fe-hydrous oxide A,B and one Al-hydroxide minerals were synthesized precipitating Fe $Cl_3$ and $AlCl_3$ with alkali solution(NaOH) at pH 6.0, 12.0 and 4.5 respectively, for precise understanding of physico-chemical and surface charge characteristics of soils in which these minerals are dominant. Identification of these final products, effect of free and amorphous materials on X-ray diffraction analysis, particle size distribution and surface change characterics of these minerals were performed. Fe-hydroxide A and B were identified as great deal of X-ray amorphous material and as goethite with large amount of X-ray amorphous material, respectively. Dehydration by oven at $105^{\circ}C$ of these minerals exhibited akaganeite peaks with low X-ray amorphous hump and pure goethite peaks for Fe-hydroxide A and B, respectively. Both minerals, however, turned into hematite upon firing at $550^{\circ}C$. On the other hand, Al-hydroxide identified as mixture of gibbsite and bayerite of around 7:3 ratio. Application of sodium dithionite and ammonium oxalate solutions for removal of free or amorphous Fe and Al from these minerals revealed that only peak intensities of Al-hydroxide system were enhanced upon Al-extraction by oxalate solution even though dithionite solution was much powerful to extract Fe from Fe-hydrous oxide systems. Original(wet) Fe-hydrous oxide A has the highest specific surface and surface charge development(negative and positive), and the greatest amount of less than $2{\mu}m$ sized particles. Specific surface and clay sized particles(less than $2{\mu}m$) of Fe-hydrous oxide A, however, were drastically reduced upon dehydration($P_2O_5$ and oven drying) compare to the rest minerals. The Z.P.C. of these synthetic minerals were 8.0-8.5, 7.5-8.0 and 5.5-6.0 for Fe-hydrous oxide A, B and Al-hydroxide, respectively.

• Korean Journal of Soil Science and Fertilizer
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• v.17 no.2
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• pp.125-133
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• 1984

To obtain the basic date for the improvement of cultural and managemental problems caused by soil characteristics and soil productivity in rice cultivation of Honam area, morphological characteristics of rice soils were investigated in Mangeng-Dongjin and Yeongsan Water-sheds, and compaired differences between two major Watersheds. The results obtained are summarized as follows: 1. According to U.S.D.A. Soil Taxonomy Classification System, eight great groups are distributed in rice soils of two major Watersheds. More than 50% of rice paddy soils are classified as Haplaquepts. 2. Two Watersheds are quite different in soil parent materials. In Mangeong-Dongjin Watershed, most soils (55.1%) are derived from fluvic-marine deposits. Remainders are derived from local alluvium (24.7%) and alluvium (14.2%). But in Yeongsan Watershed, the order is local alluvium>alluvium>fluvio-marine deposits. 3. Rice soils occur mostly in coastal and inland flat-site with the slope of less than 2% (57.8%) in Mangeong-Dongjin Watersheds. However, in Yeongsan Watershed, flat-site and low undulating terrace are mostly distributed (52.9%). 4. About 81.9, 61.4 and 53.3% of rice soils are classified as fine textured in Yeongsan, Dongjin, and Mangeong Watersheds, respectively. 5. More normal paddy soils and less sandy paddy soils are distributed in Yeongsan Watershed. The results indicate that more rice soils are classified as productivity classes of I and II in Yeongsan Watershed than in Mangeong-Dongjin Watersheds.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.159-193
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• 2015

Owing to causes such as population aging, increased use of various medical devices, long-term hospitalization of various patients with reduced immune function such as cancer, diabetes, and organ transplant patients, and the growing size of hospitals, hospital infections are continuing to increase. As seen in the MERS crisis of 2015, hospital infections have become a social and national problem. In order to prevent damage due to such hospital infections, it is necessary to first strictly implement measures to prevent hospital infections, while, on the other hand, providing proper relief of damage suffered due to hospital infections. However, the mainstream attitude of judicial precedents relating to hospital infection cases has been judged to in fact shift responsibility over damages due to hospital infections on the patient. In light of the philosophy of the damage compensation system, whose guiding principle if the fair and proper apportionment of damages, there is a need to seek means of drastically relaxing the burden of proof on the patient's side relative to conventional legal principles for relaxing the burden of proof, or the theory of de facto estimation. In relation to such need, the German civil code (Burgerliches Gesetzbuch), which defines contracts of medical treatment as typical contracts under the civil code, and has presumption of negligence provisions stipulating that, in cases such as hospital infections which were completely under the control of the medical care providers, if risks in general medical treatment have been realized which cause violations of the life, body, or health of patients, error on the part of the person providing medical care is presumed, was examined. Contracts of medical treatment are entered into very frequently and broadly in the everyday lives of the general public, with various disputes owing thereto arising. Therefore, it is necessary to, by defining contracts of medical treatment as typical contracts under the civil code, regulate the content of said contracts, as well as the proof of burden when disputes arise. If stipulations in the civil code are premature as of yet, an option may be to regulate through a special act, as is the case with France. In the case of hospital infection cases, it is thought that 'legal presumption of negligence' relating to 'negligence in the occurrence of hospital infections,' which will create a state close to equality of arms, will aid the resolution of the realistic issue of the de facto impossibility of remedying damages occurring due to negligence in the process of occurrence of hospital infections. Also, even if negligence is presumed by law, as the patient side is burdened with proving the causal relationships, such drastic confusion as would occur if the medical care provider side is found fully liable if a hospital infection occurs may be avoided. It is thought that, alongside such efforts, social insurance policy must be improved so as to cover the expenses of medical institutions having strictly implemented efforts to prevent hospital infections in the event that they have suffered damages due to a hospital infection accident, and that close future research and examination into this matter will be required.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.55-84
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• 2015

The tuberculosis is the infectious disease. Generally, the active tuberculosis patient can infect the 10 persons for one year within the daily activities like casual conversation and singing together. The infectivity of tuberculosis can continue for a life time, and infected persons can remain at risk for developing active tuberculosis. To control this contagious disease, along with the active tuberculosis patients, non-infectious but non-compliant patients who can be infectious if their immune systems become impaired have to be managed. To control the non-complaint patients, medical treatment order should be combined with the public order. Because tuberculosis is the risk of community health, the human rights like liberty and freedom of movement can be restricted for public welfare under the article 37(2) of constitution. Even when such restriction is imposed, no essential aspect of the freedom or right shall be violated. The degree of restriction on the rights of citizens is different what methods are chosen to non-complaint patients. For example, under the directly observed therapy program, the patients and medical staffs make an appointment and meet to confirm the drug intakes according to the schedule, which is the medical treatment combined with the mildest public order. If the patients break the appointments or have the history of disobedient, the involuntary detention can obtain the legitimate cause. The Tuberculosis Prevention Act has the two step programs on this involuntary detention, The admission order (Article 15) is issued when the patients are infectious. The quarantine order (Artle 15-2) is issued when the patients are infectious and non-complaint. The legal criteria for involuntary detention are discussed and published through the international conventions and covenants. For example, World Health Organization had made guidance on human rights and involuntary detention for tuberculosis control. The restrictions should be carried out in accordance with the our law and in the legitimate objective of public interest. And the restriction should be based on scientific evidence and not imposed in an unreasonable or discriminatory manner. We define and adopt these international criteria under our constitution and legal system. Least restrictive alternative principle, proportionality principle and the individual evaluation methods are explained through the reviews of United States court decisions. Habeas Corpus Act is reviewed and adopted as the procedural due process to protect the patient rights as a citizen. Along with that, what conditions and facilities which are needed to performed quarantine order are discussed.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.131-157
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• 2015

NHIS claimed for damages to doctors that by doing the treatment breaching medical insurance criteria caused by doctors, NHIS paid for medicine cost to pharmacy; as a result, the doctors caused the tort to NHIS. Following consecutive rulings afterwards, NHIS also argued that the medicine cost violating medical law or medical treatment expense paid to medical organizations are both the tort in civil law. NHIS claimed for all the damages, and the Supreme Court confirmed this judgment. However, within our national health insurance system, the subject of insurance payment is NHIS and the subject of medical treatment expense are also NHIS since the treatment expense is also insurance payment by asking the treatment to medical organizations. Further, national health insurance law is not made to control the violation of medical treatment cases; therefore, the breach of medical law cannot be covered by illegality of tort in civil law regarding NHIS. If that is the case, in the case that if the patients are treated according to treatment criteria via the doctors delegated the doctors' permission by Health and Welfare minister, NHIS acquired the benefits to remove the duty to give treatment payment to doctors in civil law; thus, even though the doctors have breached the medical law, NHIS does not have any damages. The fact that supreme court confirmed the ruling that the treatment is the tort in civil law towards NHIS is the judgment not counting the benefits of insurance payment as the subject but only considering the fact that NHIS paid to the doctors and this ruling have gone against the principle under civil code section 750. If the doctors have breached the medical law, the case should be sanctioned by medical law not national health insurance law, and the ruling of supreme court is assumed that they have confused both with the principle of national health insurance law and civil law.

• The Korean Society of Law and Medicine
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• v.19 no.2
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• pp.139-171
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• 2018

The 「Act on Remedies for Injuries from Medical Malpractice and Mediation of Medical Disputes」(hereinafter referred to as 'the Act on Mediation of Medical Disputes') provides that the state should compensate the victims of medical accidents occurred irresistibly in childbirth despite that health and medical service personnel fulfilled their duty of care for their damage within the range of its budget(Article 46 of the Act on Mediation of Medical Disputes). Given that victims of medical accidents could expect demage recovery only through lawsuits thus far, this act can be said to be a groundbreaking act. However, However, as 30% of the costs for such medical accident compensation projects are borne by those who have records of childbirth among the founders of health and medical institutions (Article 21 of the Act on Mediation of Medical Disputes), there has been a question about whether doctors are held responsible despite that the accidents such as the deaths of mothers and newborn babies occurred irresistibly without doctors' fault. However, recently, the Constitutional Court ruled that 'the range of founders of health and medical institutions' and 'share ratios of finances for compensation' in Article 46 (3) of the Act on Mediation of Medical Disputes' related to the imposition of the share of costs are institutional (Constitutional Court ruling dated April 26, 2018, 2015Heonga13, hereinafter referred to as 'the ruling in the case'). Although the ruling in the case was made based on only the principle of statutory reservation and the principle of ban on comprehensive authorization, this paper added a practical judgment. This paper proved that the share of costs in this case has the nature of burden charges in pursuit of study and does not infringe on the property rights of the founders of health medical institutions even in light of the principle of proportionality because there is a legitimate reason for imposing the burden charge. The imposition of the share of costs in the system for compensation for medical accidents occurred irresistibly is against the principle of liability with fault in part. However, the medical accident compensation projects are rational a national policy for the victims of medical accidents and the medical world clearly gains some benefits from the effect to terminate medical disputes. The expansion of finances for compensation through the payments of the share of costs will reduce the suffering and misunderstanding of victims of medical accidents occurred in the process of childbirth and will be very helpful to the construction of stable treatment environments of medical workers by quickly establishing the medical accident compensation projects as such.

• The Korean Society of Law and Medicine
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• v.19 no.2
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• pp.75-98
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• 2018

Recently, the antitrust tribunal of Seoul High Court revoked the disposition of Korea Fair Trade Commission(hereafter 'KFTC'). While KFTC determined that the restriction of Korea Pediatrician Association violated article 26 of the Monopoly Regulation and Fair Trade Act(Korean antitrust law), Seoul High court viewed that KFTC failed to prove the compulsory measures and the restraint of competition required in article 26. The 'restriction' of article 26 should be interpreted as 'excessive restriction'. Since entrepeneurs' organization is allowed to limit its member's activities, KFTC could regulate entrepeneurs' organization on a very exceptional basis. In addition, though entrepeneurs' organization did not use compulsory measures to enforce its resolution, its 'excessive restriction' could fit into the notion of 'restriction' of article 26. Under the current medical care system, the price of medical care is decided by Korean government. Therefore the restriction of Korea Pediatrician Association is not likely to have effect on the price. However, the resolution of Korea Pediatrician Association was aimed to decrease the supply of medical care. Therefore the resolution is capable of having effect on the competition. In this sense, though KFTC failed to submit direct evidence to support the decrease of quantity, there could be possibility of restraint of competition. The Seoul High Court's decision has important implications. The leading case on restraint of competition(Supreme Court 2002Du8628, Posco case) was delivered in 2007. However the remaining issue such as the standard and scope of restraint of competition is not clear. Through reappeal case of this decision, Supreme Court has to decide the line between competition and its restraint.