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The Study of Radiation Reducing Method during Injection Radiopharmaceuticals (방사성의약품 투여 시 피폭선량 저감에 대한 연구)

  • Cho, Seok-Won;Jung, Seok;Park, June-Young;Oh, Shin-Hyun;NamKoong, Hyuk;Oh, Ki-Beak;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.16 no.1
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    • pp.80-85
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    • 2012
  • Purpose: The whole body bone scan is an examination that visualizing physiological change of bones and using bone-congenial radiopharmaceutical. The patients are intravenous injected radiopharmaceutical which labeled with radioactive isotope ($^{99m}Tc$) emitting 140 keV gammarays and scanned after injection. The 3 principles of radiation protection from external exposureare time, distance and shielding. On the 3 principles of radiation protection basis, radiopharmaceutical might just as well be injected rapidly for reducing radiation because it might be the unopened radiation source. However the radiopharmaceuticals are injected into patient directly and there is a limitation of distance control. This study confirmed the change of radiation exposure as change of distance from radiopharmaceutical and observed the change of radiation exposure afte rsetting a shelter for help to control radio-technician's exposure. Materials & methods: For calculate the average of injection time, the trained injector measured the injection time for 50 times and calculated the average (2 minutes). We made a source as filled the 99mTc-HDP 925 MBq 0.2 mL in a 1 mL syringe and measured the radiation exposure from 50 cm,100 cm,150 cm and 200 cm by using Geiger-Mueller counter (FH-40, Thermo Scientific, USA). Then we settled a lead shielding (lead equivalent 6 mm) from the source 25 cm distance and measured the radiation exposure from 50 cm distance. For verify the reproducibility, the measurement was done among 20 times. The correlation between before and after shielding was verified by using SPSS (ver. 18) as paired t-test. Results: The radiation doses according to distance during 2 minutes from the source without shielding were $1.986{\pm}0.052{\mu}$ Sv in 50 cm, $0.515{\pm}0.022{\mu}$ Sv in 100 cm, $0.251{\pm}0.012{\mu}$ Sv in 150 cm, $0.148{\pm}0.006{\mu}$ Sv in 200 cm. After setting the shielding, the radiation dose was $0.035{\pm}0.003{\mu}$ Sv. Therefore, there was a statistical significant difference between the radiation doses with shielding and without shielding ($p$<0.001). Conclusion: Because the great importance of whole body bone scan in the nuclear medicine, we should make an effort to reduce radiation exposure during radiopharmaceutical injections by referring the principles of radiation protection from external exposure. However there is a limitation of distance for direct injection and time for patients having attenuated tubules. We confirmed the reduction of radiation exposure by increasing distance. In case of setting shield from source 25 cm away, we confirmed reducing of radiation exposure. Therefore it would be better for reducing of radiation exposure to using shield during radiopharmaceutical injection.

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A Study on the Individual Radiation Exposure of Medical Facility Nuclear Workers by Job (의료기관 핵의학 종사자의 직무 별 개인피폭선량에 관한 연구)

  • Kang, Chun-Goo;Oh, Ki-Baek;Park, Hoon-Hee;Oh, Shin-Hyun;Park, Min-Soo;Kim, Jung-Yul;Lee, Jin-Kyu;Na, Soo-Kyung;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.9-16
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    • 2010
  • Purpose: With increasing medical use of radiation and radioactive isotopes, there is a need to better manage the risk of radiation exposure. This study aims to grasp and analyze the individual radiation exposure situations of radiation-related workers in a medical facility by specific job, in order to instill awareness of radiation danger and to assist in safety and radiation exposure management for such workers. Materials and Methods: 1 January 2007 to 31 December 2009 to work in medical institutions are classified as radiation workers Nuclear personal radiation dosimeter regularly, continuously administered survey of 40 workers in three years of occupation to target, Imaging Unit beautifully, age, dose sector, job function-related tasks to identify the average annual dose for a deep dose, respectively, were analyzed. The frequency analysis and ANOVA analysis was performed. Results: Imaging Unit beautifully three years the annual dose PET and PET/CT in the work room 11.06~12.62 mSv dose showed the highest, gamma camera injection room 11.72 mSv with a higher average annual dose of occupation by the clinical technicians 8.92 mSv the highest, radiological 7.50 mSv, a nurse 2.61 mSv, the researchers 0.69 mSv, received 0.48 mSv, 0.35 mSv doctors orderly, and detail work employed the average annual dose of the PET and PET/CT work is 12.09 mSv showed the highest radiation dose, gamma camera injection work the 11.72 mSv, gamma camera imaging work 4.92 mSv, treatment and safety management and 2.98 mSv, a nurse working 2.96 mSv, management of 1.72 mSv, work image analysis 0.92 mSv, reading task 0.54 mSv, with receiving 0.51 mSv, 0.29 mSv research work, respectively. Dose sector average annual dose of the study subjects, 15 people (37.5%) than the 1 mSv dose distribution and 5 people (12.5%) and 1.01~5.0 mSv with the dose distribution was less than, 5.01~10.0 mSv in the 14 people (35.0%), 10.01~20.0 mSv in the 6 people (15.0%) of the distribution were analyzed. The average annual dose according to age in occupations that radiological workers 25~34 years old have the highest average of 8.69 mSv dose showed the average annual dose of tenure of 5~9 years in jobs radiation workers in the 9.5 mSv The average was the highest dose. Conclusion: These results suggest that medical radiation workers working in Nuclear Medicine radiation safety management of the majority of the current were carried out in the effectiveness, depending on job characteristics has been found that many differences. However, this requires efforts to minimize radiation exposure, and systematic training for them and for reasonable radiation exposure management system is needed.

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A Study to Decrease Exposure Dose for the Radiotechnologist in PET/CT (PET/CT 검사에서 방사선 종사자 피폭선량 저감에 대한 방안 연구)

  • Cho, Seok-Won;Park, Hoon-Hee;Kim, Jung-Yul;Ban, Yung-Kak;Lim, Han-Sang;Oh, Ki-Beak;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.159-165
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    • 2010
  • Purpose: Positron emission tomography scan has been growing diagnostic equipment in the development of medical imaging system. Compare to $^{99m}Tc$ emitting 140 keV, Positron emission radionuclide emits 511 keV gamma rays. Because of this high energy, it needs to reduce radioactive emitting from patients for radiotechnologist. We searched the external dose rates by changing distance from patients and measure the external dose rates when we used shielder investigate change external dose rates. In this study, the external dose distribution were analyzed in order to help managing radiation protection of radiotechnologists. Materials and Methods: Ten patients were searched (mean age: $47.7{\pm}6.6$, mean height: $165.5{\pm}3.8$ cm and mean weight: $65.9{\pm}1.4$ kg). Radiation were measured on the location of head, chest, abdomen, knees and toes at the distance of 10, 50, 100, 150 and 200 cm. Then, all the procedure was given with a portable radiation shielding on the location of head, chest and abdomen at the distance of 100, 150 and 200 cm and transmittance was calculated. Results: In 10 cm, head (105.40 ${\mu}Sv/h$) was the highest and foot (15.85 ${\mu}Sv/h$) was the lowest. In 200 cm, head, chest and abdomen showed similar. On head, the measured dose rates were 9.56 ${\mu}Sv/h$, 5.23 ${\mu}Sv/h$, and 3.40 ${\mu}Sv/h$ in 100, 150 and 200 cm respectively. When using shielder, it shows 2.24 ${\mu}Sv/h$, 1.67 ${\mu}Sv/h$, and 1.27 ${\mu}Sv/h$ in 100, 150 and 200 cm on head. On chest, the measured dose rates were 8.54 ${\mu}Sv/h$, 4.90 ${\mu}Sv/h$, 3.44 ${\mu}Sv/h$ in 100, 150 and 200 cm, respectively. When using shielder, it shows 2.27 ${\mu}Sv/h$, 1.34 ${\mu}Sv/h$, and 1.13 ${\mu}Sv/h$ in 100, 150 and 200 cm on chest. On abdomen, the measured dose rates were 9.83 ${\mu}Sv/h$, 5.15 ${\mu}Sv/h$ and 3.18 ${\mu}Sv/h$ in 100, 150 and 200cm respectively. When using shielder, it shows 2.60 ${\mu}Sv/h$, 1.75 ${\mu}Sv/h$ and 1.23 ${\mu}Sv/h$ in 100, 150 and 200 cm on abdomen. Transmittance was increased as the distance was expanded. Conclusion: As the distance was further, the radiation dose were reduced. When using shielder, the dose were reduced as one-forth of without shielder. The Radio technologists are exposed of radioactivity and there were limitations on reducing the distance with Therefore, the proper shielding will be able to decrease radiation dose to the radiotechnologists.

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Treatment Outcome of Locally Advanced Non-small Cell Lung Cancer Patients Who Received Concurrent Chemoradiotherapy with Weekly Paclitaxel (Paclitaxel 매주 투여 및 방사선치료 동시요법을 받은 국소진행성 비소세포폐암 환자들의 치료 결과)

  • Kim, Su-Zy;Shim, Byoung-Yong;Kim, Chi-Hong;Song, So-Hyang;Ahn, Meyung-Im;Cho, Deog-Gon;Cho, Kyu-Do;Yoo, Jin-Young;Kim, Hoon-Kyo;Kim, Sung-Whan
    • Radiation Oncology Journal
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    • v.24 no.4
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    • pp.230-236
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    • 2006
  • $\underline{Purpose}$: To analyze the response, toxicity, patterns of failure and survival rate of patients with locally advanced non-small cell lung cancer who were treated with concurrent chemoradiotherapy with weekly paclitaxel. $\underline{Materials\;and\;Methods}$: Twenty-three patients with locally advanced non-small cell lung cancer patients who received radical chemoradiotherapy from October 1999 to September 2004 were included in this retrospective study. Patients received total $55.4{\sim}64.8$ (median 64.8) Gy (daily 1.8 Gy per fraction, 5 days per weeks) over $7{\sim}8$ weeks. 50 or $60\;mg/m^2$ of paclitaxel was administered on day 1, 8, 15, 22, 29 and 36 of radiotherapy. Four weeks after the concurrent chemoradiotherapy, three cycles of consolidation chemotherapy consisted of paclitaxel $135\;mg/m^2$ and cisplatin $75\;mg/m^2$ was administered every 3 weeks. $\underline{Results}$: Of the 23 patients, 3 patients refused to receive the treatment during the concurrent chemoradiotherapy. One patient died of bacterial pneumonia during the concurrent chemoradiotherapy. Grade 2 radiation esophagitis was observed in 4 patients (17%). Sixteen patients received consolidation chemotherapy. During the consolidation chemotherapy, 8 patients (50%) experienced grade 3 or 4 neutropenia and one of those patients died of neutropenic sepsis. Overall response rate for 20 evaluable patients was 90% including 4 complete responses (20%) and 14 partial responses (70%). Among 18 responders, 9 had local failure, 3 had local and distant failure and 2 had distant failure only. Median progression-free survival time was 9.5 months and 2-year progression-free survival rate was 19%. Eleven patients received second-line or third-line chemotherapy after the treatment failure. The median overall survival time was 21 months. 2-year and 5-year survival rate were 43% and 33%, respectively. Age, performance status, tumor size were significant prognostic factors for progression-free survival. $\underline{Conclusion}$: Concurrent chemoradiotherapy with weekly paclitaxel revealed high response rate and low toxicity rate. But local failure occurred frequently after the remission and large tumor size was a poor prognostic factor. Further investigations are needed to improve the local control.

The Characteristics and Fates of Pulmonary Tuberculosis Patients Seen at Medical Department of A Medium Sized General Hospital (부산에 한 중형 종합 병원 내과에서의 폐결핵 환자의 양상과 귀결)

  • Kim, Young-Hyo;Park, Ki-Chan;Bae, Seong;Lee, Sang-Hun;Chun, Myung-Ho;Lee, Sang-Ki;Jun, Kwang-Su;Lee, Chan-Se
    • Tuberculosis and Respiratory Diseases
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    • v.39 no.5
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    • pp.417-424
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    • 1992
  • Background: There were many reports about the clinical aspect and outcomes of pulmonary tuberculosis in health center but few in a medium sized general hospital. The purposes of this study were to find any characteristic differencies in the patients and the general outcomes of the treatments and also to give some suggestive points for the insurance policy making. Methods: We made a retrograde analysis of the medical records of 1981 patients (male 992 female 1,059) who attended our clinics of the 4th internal department, Daedong general hospital during two years from January 1989 to December 1990. Result: 1) Of 1981 patients, 96 were diagnosed as pulmonary tuberculosis taking relatively large proportion in the prevalence. The ratio of prevalence between male and female was 7.81% to 2.27%. The 61.46% were the first diagnosis & initial treatment cases and the remaining 38.54% were the retreatment cases with no statistical significance between sex. 2) The most prevalent age group was between 21~40 years old and the prevalence rate was 45.45% of male and 76.76% of female. The lowest age group in male patient was above 61 showed 3.03%, and there was no female patients above age 60 years old. This phenomena could be thought as the negligence for the treatment of pulmonary tuberculosis in the old age groups rather than true tuberculosis prevalence and it could be proved by the higher rates towards old age groups in the national tuberculosis prevalence survey. 3) There were 57.07% of the minimal case, 48.96% of the moderate, 18.75% of the far advanced. The sputum examination showed 37.07% were culture positive, 46.88% were the negative, and 15.63% of the patients had no stutum examination. Moreover, uncoperatives among the far advanced cases were notable showing 22.22% of the stutum examination, where 16.13% in the minimal cases. The stutum positive rate among the initial treatment cases were 41.07% and 55.00% for the retreatment cases. The sputum no examination rates were 17.86% and 12.50% respectively. 4) The classfication of the mode of disease onset showed 68.75% with gradual onset, 9.38% hemoptic, 3.13% acute pneumonic and 18.75% was found through the radiologic examination in various occasions. 5) The percentages of patients who continued their treatment for more than 8 month were 35.71% (for initial treatment), 25.00% (for retrement), 16.13% (for the minimal), 27.78% (for the far advanced). 6) The group of patients who were treated more than 8 months showed the negative conversion rate of 80% on sputum and marked improvement on chest x-ray in 56.67%. However, in far advanced or retreatment cases, the rate of negative conversion on sputum and the rate of improvement on chest x-ray were low being 60% and 20% for the former and 60% and 10% for the latter, each respectively. Conclusion: It would be strongly emphasized that the improvement of National medical insurance system and social welfare system in Korea must be definite to improve overall treatment and control of tuberculosis diseases as well as physician's devotious National tuberculosis control policy.

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A Study on Influence of Foodservice Managers' Emotional Intelligence on Job Attitude and Organizational Performance (급식관리자의 개인적 감성지능이 직무태도 및 조직성과에 미치는 영향)

  • Jung, Hyun-Young;Kim, Hyun-Ah
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.39 no.12
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    • pp.1880-1892
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    • 2010
  • The purposes of this study were to: a) provide evidence concerning the effects of emotional intelligence on job outcomes, b) examine the impacts of emotional intelligence on employee-related variables such as 'job satisfaction', 'organizational commitment', 'organizational performance', and 'turnover intention' c) identify the conceptual framework underlying emotional intelligence. A survey was conducted to collect data from foodservice managers (N=231). Statistical analyses were completed using SPSS Win (16.0) for descriptive analysis, reliability analysis, factor analysis, t-test, correlation analysis, cluster analysis and AMOS (16.0) for confirmatory factor analysis and structural equation modeling. The concept of emotional intelligence (EI) has been on the radar screens of many leaders and managers over the last several decades. The emotional intelligence is generally accepted to be a combination of emotional and interpersonal competencies that influence behavior, thinking and interaction with others. The main results of this study were as follows. The four EI (Emotional Intelligence) dimensions correlated significantly with age. The means of job satisfaction score were above the midpoint (3.04 point) scale. The organizational commitment score was above the midpoint (3.41 point) scale and was higher at 'loyalty' factor than 'commitment' factor. The means of organizational performance score were above the midpoint (3.34) scale. The correlations among the four EI (emotional intelligence) factors were significant with job satisfaction; organizational commitment, organizational performance and turnover intention. The test of hypothesis using structural equation modeling found that emotional intelligence produced positive effects on job attitude and job performance. Emotional intelligence enhanced organizational commitment, and in turn, managers' attitude produced positive effects on organizational performance; emotional intelligence also had a direct impact on organizational performance. This study has identified the effect of emotional intelligence on organizational performance and attitudes toward one's job.

Comparison of Treadmill and Cycle Ergometer in Male Korean College Students (한국 남자 대학생을 대상으로 시행한 Cardiopulmonary Exercise Test에서 Treadmill과 Cycle Ergometer의 비교 분석)

  • Chang, Yoon-Soo;Park, Jae-Min;Choi, Seung-Won;Ahn, Gang-Hyun;Lee, Jun-Gu;Yang, Dong-Kyu;Kim, Se-Kyu;Chang, Jun;Ahn, Chul-Min;Kim, Seong-Kyu;Lee, Won-Yong
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.1
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    • pp.26-34
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    • 1999
  • Background : Generally $VO_2$ max is higher in treadmill exercise than cycle ergometer exercise. According to Hassen and Wasserman, $VO_2$ max with treadmill exercise is higher at ratio of 1.11 than that with cycle ergometer. $VO_2$ max also is influenced by race, sociocultural background, exercise habit In this study, $VO_2$ max and AT were evaluated between Treadmill and cycle exercise in male Korean college students. Method: Study subjects were 44 male college students. We randomized them into 2 groups; 24 students did treadmill exercise at first and 1 week later did cycle ergometer. Another 20 students did in opposite method. They made symptom limited maximal exercise. Author defined maximal exercise as followings: 1) respiratory exchange ratio(RER)> 1.1, 2) plateau>30 sec, 3) heart rate reserve(HRR) <15%, or 4) breathing reserve (BR)<30%. Otherwise their results are excluded as submaximal exercise. Anaerobic threshold(AT) was estimated by V-slope method. Results: $VO_2$ max and AT was $45.1{\pm}6.66m\ell$/kg/min and $26.0{\pm}6.78m\ell$/kg/min in treadmill and $34.9{\pm}5.89m\ell$/kg/min, $19.5{\pm}4.77m\ell$/kg/min in Cycle Ergometer. The measured-$VO_2max$/pred-$VO_2max$ was $98.8{\pm}13.24%$ in treadmill; $84.4{\pm}13.42%$ in cycle ergometer. Comparing $VO_2$ max in treadmill with that obtained by Hassen's method, there were significant differences.(p<0.01). At maximal exercise there were differences in HRR, $O_2$/pulse, BR, $V_E$/MVV, $V_E/VCO_2$ between treadmill and cycle but not in $V_E/VO_2$, Vd/Vt, Ti/Ttot. At AT there were differences in $O_2$/pulse, BR, $V_E$/MVV, Ti/Ttot between treadmill and cycle, otherwise not. Conclusion: According to the result of this study, there are larger gap between treadmill and cycle ergometer in normal Korean adults than foreign data, and it needs further study to obtain reference value of Korea.

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A Study on the Factors Influencing Technology Innovation Capability on the Knowledge Management Performance of the Company: Focused on Government Small and Medium Venture Business R&D Business (기술혁신역량이 기업의 지식경영성과에 미치는 요인에 관한 연구: 정부 중소벤처기업 R&D사업을 중심으로)

  • Seol, Dong-Cheol;Park, Cheol-Woo
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.15 no.4
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    • pp.193-216
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    • 2020
  • Due to the recent mid- to long-term slump and falling growth rates in the global economy, interest in organizational structures that create new products or services as a new alternative to survive and develop in an opaque environment both internally and externally, and enhance organizational sustainability through changes in production methods and business innovation is increasing day by day. In this atmosphere, we agree that the growth of small and medium-sized venture companies has a significant impact on the national economy, and various efforts are being made to enhance the technological innovation capabilities of the members so that these small and medium-sized venture companies can enhance and sustain their performance. The purpose of this study is also to investigate how the technological innovation capabilities of small and medium-sized venture companies correlate with the performance of knowledge management and to analyze the role of network capabilities to organize the strategic activities of enterprise to obtain the resources and organizational capabilities to be used for value creation from external networks. In other words, research was conducted on the impact of technological innovation capabilities of small and medium venture companies on knowledge management performance by using network capabilities as parameters. Therefore, in this study, we would like to verify the hypothesis that innovation capabilities will have a positive impact on knowledge management performance by using network capabilities of small and medium venture companies. Economic activities based on technological innovation capabilities should respond quickly to new changes in an environment where uncertainty has increased, and lead to macro-economic growth and development as well as overcoming long-term economic downturns so that they can become the nation's new growth engine as well as sustainable growth and survival of the organization. In addition, this study was conducted by setting the most important knowledge management performance within the organization as a dependent variable. As a result, R&D and learning capabilities among technological innovation capabilities have no impact on financial performance. In contrast, it was shown that corporate innovation activities have a positive impact on both financial and non-financial performance. The fact that non-financial factors such as quality and productivity improvement are identified in the management of small and medium-sized venture companies utilizing their technological innovation capabilities is contrary to a number of studies by those corporate innovation activities affect financial performance during prior research. The reason for this result is that research companies have been out of start-up companies for more than seven years, but sales are less than 10 billion won, and unlike start-up companies, R&D and learning capabilities have more positive effects on intangible non-financial performance than financial performance. Corporate innovation activities have been shown to have a positive (+) impact on both financial and non-financial performance, while R&D and learning capabilities have a positive (+) impact on financial performance by parameters of network capability. Corporate innovation activities have been shown to have no impact on both financial and non-financial performance, and R&D and learning capabilities have no impact on non-financial performance. It could be seen that the parameter effects of network competency are limited to when R&D and learning competencies are derived from quantitative financial performance. It could be seen that the parameter effects of network competency are limited to when R&D and learning competencies are derived from quantitative financial performance.

Analysis of dose reduction of surrounding patients in Portable X-ray (Portable X-ray 검사 시 주변 환자 피폭선량 감소 방안 연구)

  • Choe, Deayeon;Ko, Seongjin;Kang, Sesik;Kim, Changsoo;Kim, Junghoon;Kim, Donghyun;Choe, Seokyoon
    • Journal of the Korean Society of Radiology
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    • v.7 no.2
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    • pp.113-120
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    • 2013
  • Nowadays, the medical system towards patients changes into the medical services. As the human rights are improved and the capitalism is enlarged, the rights and needs of patients are gradually increasing. Also, based on this change, several systems in hospitals are revised according to the convenience and needs of patients. Thus, the cases of mobile portable among examinations are getting augmented. Because the number of mobile portable examinations in patient's room, intensive care unit, operating room and recovery room increases, neighboring patients are unnecessarily exposed to radiation so that the examination is legally regulated. Hospitals have to specify that "In case that the examination is taken out of the operating room, emergency room or intensive care units, the portable medical X-ray protective blocks should be set" in accordance with the standards of radiation protective facility in diagnostic radiological system. Some keep this regulation well, but mostly they do not keep. In this study, we shielded around the Collimator where the radiation is detected and then checked the change of dose regarding that of angles in portable tube and collimator before and after shielding. Moreover, we tried to figure out the effects of shielding on dose according to the distance change between patients' beds. As a result, the neighboring areas around the collimator are affected by the shielding. After shielding, the radiation is blocked 20% more than doing nothing. When doing the portable examination, the exposure doses are increased $0^{\circ}C$, $90^{\circ}C$ and $45^{\circ}C$ in order. At the time when the angle is set, the change of doses around the collimator decline after shielding. In addition, the exposure doses related to the distance of beds are less at 1m than 0.5m. In consideration of the shielding effects, putting the beds as far as possible is the best way to block the radiation, which is close to 100%. Next thing is shielding the collimator and its effect is about 20%, and it is more or less 10% by controlling the angles. When taking the portable examination, it is better to keep the patients and guardians far enough away to reduce the exposure doses. However, in case that the bed is fixed and the patient cannot move, it is suggested to shield around the collimator. Furthermore, $90^{\circ}C$ of collimator and tube is recommended. If it is not possible, the examination should be taken at $0^{\circ}C$ and $45^{\circ}C$ is better to be disallowed. The radiation-related workers should be aware of above results, and apply them to themselves in practice. Also, it is recommended to carry out researches and try hard to figure out the ways of reducing the exposure doses and shielding the radiation effectively.

Multivessel Coronary Revascularization with Composite LITA-RA Y Graft (좌내흉동맥-요골동맥 복합이식편을 이용한 다중혈관 관상동맥우회술)

  • Lee Sub;Ko Mgo-Sung;Park Ki-Sung;Ryu Jae-Kean;Jang Jae-Suk;Kwon Oh-Choon
    • Journal of Chest Surgery
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    • v.39 no.5 s.262
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    • pp.359-365
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    • 2006
  • Background: Arterial grafts have been used to achieve better long-term results for coronary revascularization. Bilateral internal thoracic artery (ITA) grafts have a better results, but it may be not used in some situations such as diabetes and chronic obstructive pulmonary disease (COPD). We evaluated the clinical and angiographic results of composite left internal thoracic artery-radial artery (LITA-RA) Y graft. Material and Method: Between April 2002 and September 2004, 119 patients were enrolled in composite Y graft for coronary bypass surgery. The mean age was $62.6{\pm}8.8$ years old and female was 34.5%. Preoperative cardiac risk factors were as follows: hypertension 43.7%, diabetes 33.6%, smoker 41.2%, and hyperlipidemia 22.7%, There were emergency operation (14), cardiogenic shock (6), left ventricle ejection fraction (LVEF) less than 40% (17), and 17 cases of left main disease. Coronary angiography was done in 35 patients before the hospital discharge. Result: The number of distal anastomoses was $3.1{\pm}0.91$ and three patients (2.52%) died during hospital stay. The off-pump coronary artery bypass (OPCAB) was applied to 79 patients (66.4%). The LITA was anastomosed to left anterior descending system except three cases which was to lateral wall. The radial Y grafts were anastomosed to diagonal branches (4), ramus intermedius (21), obtuse marginal branches (109), posterolateral branches (12), and posterior descending coronary artery (8). Postoperative coronary angiography in 35 patients showed excellent patency rates (LITA 100%, and RA 88.5%; 3 RA grafts which anastomosed to coronary arteries <70% stenosed showed string sign with competitive flow). Conclusion: The LITA-RA Y composite graft provided good early clinical and angiographic results in multivessel coronary revascularization. But it should be cautiously used in selected patients.