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Efficient Application of Westgard Multi-Rules and Quality Control Implementation Improvement (Westgard Multi-Rules의 효율적 적용과 조치사항의 개선)

  • Jung, Heung Soo;Oh, Youn Jung;Bae, Jin Soo;Baek, Jin Young;Hwang, Bo ra;Shin, Yong Hwan
    • The Korean Journal of Nuclear Medicine Technology
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    • v.21 no.1
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    • pp.60-64
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    • 2017
  • Purpose Westgard multi-rules application based on test quality improvement and commercialized international standard has been widely used in quality control. However, it is difficult to applicate the Westgard multi-rules in nuclear medicine in vitro tests due to the larger sample sizes and the simultaneous measurement of quality control material and patient sample. This study investigated the usefulness of Westgard multi-rules application in nuclear medicine in vitro tests. Materials and Methods A total of 282 systematic error multi-rules (22s, 101s) recorded in the samsung medical center computer system from January 2013 to June 2016 along with 117 cases of corrective measure record was analyzed. The Quality control implementation is recorded in Hospital information system were divided into 4 high-level areas including quality control material error, experimental procedural error, Kit lot number management error, and others. To prevent quality control material error, the existing method that each staff used their own method was changed. The staff who in charge of managing the quality control material was designated and daily consumption amount of every test was strictly controlled by one person. To prevent other errors, every test step was standardized so that the entire test procedures are identically implemented. Results The total quality control implementation was 117 cases; As a result, 62 quality control material errors were 62 cases, experimental process errors were 24 cases, Kit lot number control errors were 18 cases, and other errors were 13 cases. The quality control material error was corrected and could be used fresh materials within 2 days after thawing. The cases of systemic error were decreased to causes as quality control material error. The quality control materials were reduced above 10 vials to a monthly average. In addition, these errors of experimental processing and Kit lot number were improved by test standardization. Consequently, the cases of 101s and 22s in systematic error rules decreased at least 2 cases to a monthly average. Conclusion To confirm of systematic error through multi-rules application quickly, it is necessary to base on management of the QC material, target values and standard deviation. Moreover, in the event of a systematic error, it was found important to record measures based on test cause analysis. The experiment results are expected to contribute to internal quality control improvement and prompt and accurate result reporting through error recording and causal analysis based on Westgard multi-rules analysis.

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Comparison of Shear Wave Elastography and Pathologic Results Using BI - RADS Category for Breast Mass (유방종괴에 대한 BI-RADS범주를 이용한 횡탄성 초음파와 병리결과 비교분석)

  • An, Hyun;Im, In-Chul
    • Journal of the Korean Society of Radiology
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    • v.12 no.2
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    • pp.217-223
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    • 2018
  • This study to search the diagnostic performance of shear wave elastography(SWE) in breast mass and to compare the biopsy result and stiffness obtained from shear wave elastography. Diagnostic breast ultrasonography and SWE were targeted for 157 patients who had breast ultrasonography was diagnosed mass from June 2017 to September 2017. Pathology results of 157 patients showed a benign 92 patients(Age, $44.54{\pm}11.84$) and a malignancy 65 patients(Age, $51.55{\pm}10.54$). Final evaluation, biopsy result, and quantitative SWE result were obtained and compared with each other according to Breast Imaging Reporting and Data System(BI-RADS) of diagnostic breast ultrasonography. Quantitative SWE value and pathologic result showed the highest diagnostic specificity of 83.70% in Emean and sensitivity of 89.23% in Emin. Quantitative SWE result and biopsy result is statistically significant.(p=0.000). The optimal cut-off value for malignant lesions was 66.3 kPa and 63.7 kPa, respectively, for the sensitivity, specificity, high maximum mean elasticity value(Emax) and mean elasticity value(Emean) and this showed the highest diagnostic area under the ROC curve(Az) value compared to other SWE measurement(p=0.000). The addition of SWE to conventional US in breast mass make a increase diagnostic specificity and reduce unnecessary biopsy. Therefore, it is expected that it will be helpful to analyze the breast mass using the above analysis and apparatus.

Evaluation of X-ray System for Nondestructive Testing on Radioactive Waste Drums (방사성폐기물 드럼 비파괴 검사를 위한 X-ray 장비 평가)

  • Park, Jong-Kil;Maeng, Seong-Jun;Lee, Yeon-Ee;Hwang, Tae-Won
    • Journal of Nuclear Fuel Cycle and Waste Technology(JNFCWT)
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    • v.6 no.3
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    • pp.189-203
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    • 2008
  • The physical and chemical properties of radioactive waste drums, which have been temporarily stored on site, should be characterized before their shipment to a disposal facility in order to prove that the properties meet the acceptance guideline. The investigation of NDT(Nondestructive Test) method was figured out that the contents in drum, the quantitative analysis of free standing water and void fraction can be examined with X-ray NDT techniques. This paper describes the characteristics of X-ray NDT such as its principles, the considerations for selection of X-ray system, etc. And then, the waste drum characteristics such as drum type and dimension, contents in drum, etc. were examined, which are necessary to estimate the optimal X-ray energy for NDT of a drum. The estimation results were that: $(R)\acute{A}$ the proper X-ray energy is under 3 MeV to test the drums of 320 ${\beta}\S$ and less; $(R)\ddot{E}$ both X-ray systems of 450 keV and/or 3 MeV might be needed considering the economical efficiency and the realization. The number of drums that can be tested with 450 keV and 3 MeV X-ray system was figured out as 42,327 and 18,105 drums (based on storage of 2006. 12), respectively. Four testing scenarios were derived considering equipment procurement method, outsourcing or not, etc. The economical and feasibility assessment for the scenarios was resulted in that an optimal scenario is dependent on the acceptance guide line, the waste generator's policy on the waste treatment and the delivery to a disposal facility, etc. For example, it might be desirable that a waste generator purchases two 450 keV mobile system to examine the drums containing low density waste, and that outsourcing examination for the high density drums, if all NDT items such as quantitative analysis for 'free standing water' and 'void fraction', and confirmation of contents in drum have to be characterized. However, one 450 keV mobile system seems to be required to test only the contents in 13,000 drums per year.

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Walking test for assessing lung function and exercise performance in patients with cardiopulmonary disease (심폐질환 환자에서 걷기검사를 이용한 폐기능 및 운동기능의 평가)

  • Jung, Hye Kyung;Chang, Jung Hyun;Cheon, Seon Hee
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.6
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    • pp.976-986
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    • 1996
  • BACKGROUND : Dyspnea is common among patients with cardiopulmonary disease, and "daily disability" is defined as a functional impairment resulting from exercise intolerance. The maximal oxygen uptake(VO2max) during exhausting work is not only the best single physical indicator of the capacity of a man for sustaining hard muscular work, but also the most objective method by which one can determine the physical fitness of an individual as reflected by his cardiovascular system. However, the expense, time and personnel requirements make this procedure prohibitive for testing large group. The walking test is well-known type of exercise and it cost nothing to perform and have good reproducibility. Thus we performed the walking test and investigated correlations with spirometry, ABG and exercise test. METHOD: We observed the walking test and exercise test by cycle ergometer in 37 patients who visited our hospital because of dyspnea. Arterial blood gas analysis and spiromety, dyspnea index were performed, too. RESULT : (1) The VO2max was significantly lower in patients with COPD and cardiovascular disease than asthma and dyspnea on exertion group(p<0.05). The walking test distance was also lower in former. (2) The 12 minute walking test was significantly correlated with VO2max, PaCO2, FVC(%), FEV1(%) in all patients(p<0.05), and the walking test was only conelated with VO2max in patients with COPD(p<0.05). (3) In COPD patients, the VO2max was best correlated with FEV1(%) and FVC(%) and significantly correlated with walking test. But there was no correlation between walking test and FEV1(%) & FVC(%). (4) The 6 minute walking test was well correlated with 12 minute walking test(r=0.92. p<0.01). CONCLUSION : The walking test is the simple method for assessing exercise performance in patient with cardiopulmonary disease and a reliable indicator for VO2max. And the walking test is practical method for assessing on everyday disability rather than maximal exercise capacity. The 6 minute walking test is highly correlated with 12 minute walking test and a less exhausting for the patients and a time-saving for the investigator.

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Usefulness of Breast Lymphoscintigraphy after Whole Body Bone Scan (유방암 환자에서 전신 뼈 검사 후 감시림프절 위치 파악 검사의 유용성)

  • Jang, Dong-Gun;Bahn, Young-Kag;Chung, Seok;Park, Hoon-Hee;Kang, Chun-Goo;Lim, Han-Sang;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.2
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    • pp.133-137
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    • 2010
  • Purpose: Breast cancer is known to be more vulnerable to bone metastasis and lymph node metastasis than other types of cancer, and nuclear examinations whole body bone scan and lymphoscintigraphy are performed commonly before and after breast cancer operation. In case whole body bone scan is performed on the day before lymphoscintigraphy, the radiopharmaceutical taken into and remaining in the bones provides anatomical information for tracking and locating sentinel lymph nodes. Thus, this study purposed to examine how much bone density affects in locating sentinel lymph nodes. Materials and Methods: The subjects of this study were 22 patients (average age $52{\pm}7.2$) who had whole body bone scan and lymphoscintigraphy over two days in our hospital during the period from January to December, 2009. In the blind test, 22 patients (average age $57{\pm}6.5$) who had lymphoscintigraphy using $^{57}Co$ flood phantom were used as a control group. In quantitative analysis, the relative ratio of the background to sentinel lymph nodes was measured by drawing ROIs on sentinel lymph nodes and the background, and in gross examination, each of a nuclear physician and a radiological technologist with five years' or longer field experience examined images through blind test in a five-point scale. Results: In the results of quantitative analysis, the relative ratio of the background to sentinel lymph nodes was 14.2:1 maximum and 8.5:1 ($SD{\pm}3.48$) on the average on the front, and 14.7:1 maximum and 8.5:1 ($SD{\pm}3.42$) on the average on the side. In the results of gross examination, when $^{57}Co$ flood phantom images were compared with images containing bones, the score was relative high as 3.86 ($SD{\pm}0.35$) point for $^{57}Co$ flood phantom images and 4.09 ($SD{\pm}0.42$) for bone images. Conclusion: When whole body bone scan was performed on the day before lymphoscintigraphy, the ratio of the background to sentinel lymph nodes was over 10:1, so there was no problem in locating lymph nodes. In addition, we expect to reduce examination procedures and improve the quality of images by indicating the location of sentinel lymph nodes using bone images as body contour without the use of a source.

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Quality Changes of Breads with Spices Powder during Storage (향신료 첨가 식빵의 저장기간별 품질특성 변화)

  • 김미림;박금순;안상희;최경호;박찬성
    • Korean journal of food and cookery science
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    • v.17 no.3
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    • pp.195-203
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    • 2001
  • The purpose of study was to improve the storage time of breads with spices. The quality of breads with garlic, ginger and cinnamon powder containing 1 % concentration were investigated using sensory and mechanical evaluation. For 14 days, total microbial count and chemical properties were analyzed at 18$^{\circ}C$. The result of sensory evaluation was not significantly different between control and breads with spices powder. But breads with spices powder were significantly higher than control in texture and acceptability. Especially, bread with cinnamon powder was most favorable in acceptability. The result of total microbial count showed that breads with spices powder were reduced with storing time passed and bread with cinnamon powder was most reduced in breads with spices powder. ks storing time passed, moisture contents and pH range were decreased and L, a and b value were decreased in all breads. Hardness, gumminess and brittleness of torture analysis were increased as storing time passed, but springiness and cohesiveness were decreased. A negative correlation was observed between the sensory and mechanical properties in general. Sensory Properties of springiness and swelling were positively correlated with the acceptability. In the analysis of correlation between the chemical and mechanical properties showed that lightness of mechanical properties had positive correlation with pH range and moisture contents. Moisture contents of chemical properties had negative correlation with hardness, but had positive correlation with cohesiveness of mechanical properties.

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Anterior Cruciate Ligament Reconsruction Using Tibialis Tendon Allograft - A Short-Term Follow-Up Result - (동종 경골건을 이용한 전방 십자 인대 재건술 -단기 추시 결과-)

  • Woo, Jong-Ken;Ko, Sang-Hun;Lew, Sog-u;Park, Moon-Soo;Jung, Kwang-Hwan;Gwak, Chang-Youl;Lee, Chae-Chil;Cho, Sung-Do
    • Journal of the Korean Arthroscopy Society
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    • v.8 no.2
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    • pp.89-93
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    • 2004
  • Purpose: To evaluate the clinical stability and function after arthroscopic anterior cruciate ligament(ACL) reconstruction using fresh-frozen tibialis tendon allograft. Materials and Methods: Of the patients who underwent ACL reconstruction using tibialis tendon allograft from July 2002 to June 2003, thirty-one patients could be evaluated and the mean follow-up period was 19 months. Evaluations included were Lysholm knee score, 2000 International knee Documentation Committee (IKDC) subjective knee score, Lachman test, pivot shift test, KT-1000 arthrometer measurement and 2000 IKDC knee examination. Results: The mean Lysholm score was 88. Twenty-eight patients (90.3%) were good or exellent for the measured parameters. Twenty-seven patients(87.1%) was over 70 in IKDC subjective knee score. Thirty patients (96.8%) had 1+ firm end or negative Lachman test. 27 patients (87.1%) had a negative pivot shift. Thirty patients (96.8%) had less than 5mm difference of maximal manual difference by KT-1000 arthrometer. Twenty -nine patients (93.5%) were nearly normal or normal grade by 2000 IKDC knee examination. Complications were 1 case of failure and 1 case of infection. Conclusion: ACL reconstruction with the double-stranded fresh-frozen tibialis tendon allograft resulted in a reliable and predictable outcome after short-term follow-up.

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Characteristics of Water- and Foodborne Disease's Reports in Korea National Notifiable Infectious Disease Surveillance System, 2012-2021 (2012-2021 전수감시 대상 수인성·식품매개감염병의 발생 신고 특징)

  • Jisu Won;Bryan Inho Kim;Hyungjun Kim;Jin Gwack;Hae-Sung Nam
    • Journal of agricultural medicine and community health
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    • v.48 no.2
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    • pp.132-143
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    • 2023
  • Objectives: We aimed to describe the reporting patterns of 6 notifiable surveillance diseases in the Republic of Korea, including water- and foodborne infections, from 2012 to 2021. Methods: For the 12,296 cases that met the reporting criteria, we calculated the number of reported cases, including the number of cases confirmed by lab tests or suspected by a physician, the number of cases with delayed reporting and their average days of delay, and the median days required to report the confirmatory test results. Results: The overall number of reported cases consistently increased over the ten years, with a significant rise in the reported cases of typhoid fever, paratyphoid fever, and EHEC. Ninety-five percent of all reported cases were timely reported within one day of diagnosis. Vibrio vulnificus had the highest rate of delayed reporting (6.8% delayed over 1 day, 3.0% delayed over 3 days), while cholera had the lowest rate (1.9% delayed over 1 day, 0.1% delayed over 3 days). The average days of delayed reporting was 6.1 days: the highest for paratyphoid fever (10.8 days) and the lowest for cholera (2.7 days). For typhoid fever and paratyphoid fever, there has been an increase in the proportion of cases with negative test results. For vibrio vulnificus, there has been an increase in the proportion of cases with confirmed positive test results. As for EHEC, there has been a recent increase in cases with no confirmatory tests. Conclusions: Reported cases of water- and foodborne infectious diseases increased, indicating improved surveillance system completeness. However, for paratyphoid fever, improvements are needed in terms of timely notification by healthcare facilities and timely reporting of confirmatory test results.

A Study on the Repeat Tests for Diagnosis at a Tertiary Hospital in Taegu City (3차진료기관(3次診療機關)과 환자의뢰기관간(患者依賴機關間)의 중복검사(重複檢査))

  • Park, Jae-Yong;Kim, Gui-Young
    • Journal of Preventive Medicine and Public Health
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    • v.26 no.3 s.43
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    • pp.457-468
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    • 1993
  • This study was conducted to investigate the repeat test rate for diagnosis at a tertiary hospital for the outpatients who were referred themselves to the hospital by the clinics and other medical facilities. The study population consisted of 498 patients who visited outpatient department of internal medicine, general surgery, orthopedic surgery and neurosurgery in the hospital between March 16 and April 11, 1992. This study was surveyed by the questionnaire about the tests for diagnosis at first level medical facilities, and then, was investigated by the medical record about the tests for diagnosis at a tertiary hospital. The proportion of test among the patients who utilized the first level medical facilities was 20.9% for the X-ray test, 10.6% for the urinalysis, 9.0% for the electrocardiogram, 3.4% for the computer tomogram and 6.4% for the ultrasonogram. At the tertiary hospital, the X-ray test was 45.2%, the liver function test was 24.1%, the urinalysis was 19.1%, and the electrocardiogram was 15.7%. The proportion of patients who possessed results of test for diagnosis at the first level medical facilities was 76.5% for the computer tomogram, and 31.3% for the ultrasonogram. As the repeat test rate between the first level medical facilities and the tertiary hospital, the thyroid function test was the first rank as 71.4%, the second rank was the routine CBC as 67.9%, and the third rank was the X-ray test as 64.4%. But among the patients that brought the result for tests at the first level medical facilities, the repeat test rate was as follow : the routine CBC was 75.0%, the liver function test was 72.1%, and the computer tomogram was 15.4%.

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Reducing error rates in general nuclear medicine imaging to increase patient satisfaction (핵의학 일반영상 검사업무 오류개선 활동에 따른 환자 만족도)

  • Kim, Ho-Sung;Im, In-Chul;Park, Cheol-Woo;Lim, Jong-Duek;Kim, Sun-Geun;Lee, Jae-Seung
    • Journal of the Korean Society of Radiology
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    • v.5 no.5
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    • pp.295-302
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    • 2011
  • To n the field of nuclear medicine, with regard to checking regular patients, from the moment they register up to the doctor's diagnosis, the person in charge of the checks can find errors in the diagnosis, reexamine, reanalyze the results or save images to PACS. Through this process, the results obtained from the readings are delayed due to checks and additional tests which occur in hospitals, causing patient satisfaction and affected reliability. Accordingly, the purpose is to include visual inspection of the results to minimize error, improve efficiency and increase patient satisfaction. Nuclear medicine and imaging tests from examines at Asan Medical Center, Seoul, from March 2008 to December 2008, were analyzed for errors. The first stage, from January 2009 to December 2009, established procedures and know-how. The second stage from January 2010 until June 2010 conducted Pre-and Post-filtering assessment, and the third stage from July 2010 until October 2010 consisted of cross-checks and attaching stickers and comparing error cases. Of 92 errors, the 1st, 2nd and 3rd stage had 32 cases, and there were 46 cases after the 4th stage, with the overall errors reduced by 74.3% from 94.6%. In the field of general nuclear medicine, where various kinds of checks are performed according to the patient's needs, analysis, image composition, differing images in PACS, etc, all have the potential for mistakes to be made. In order to decrease error rates, the image can continuously Cross-Check and Confirm diagnosis.