• The Korean Journal of Nuclear Medicine
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• v.29 no.4
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• pp.533-540
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• 1995

Attenuation correction is important in producing quantitative positron emission tomography (PET) images. Conventionally, photon attenuation effects are corrected using transmission measurements performed before tracer administration. The pre-injection transmission measurement approach may require a time delay between transmission and emission scans for the tracer studies requiring a long uptake period, about 45 minutes for F-18 deoxyglucose study. The time delay will limit patient throughput and increase the likelihood of patient motion. A technique lot performing simultaneous transmission and emission scans (T+E method) after the tracer injection has been validated. The T+E method substracts the emission counts contaminating the transmission measurements to produce accurate attenuation correction coefficients. This method has been evaluated in experiments using a cylindrical phantom filled with background water (5750 cc) containing $0.4{\mu}Ci/cc$ of F-18 fluoride ion and one insert cylinder (276 cc) containing $4.3{\mu}Ci/cc$. GE $Advance^{TM}$ PET scanner and Ge-68 rotating pin sources for transmission scanning were used for this investigation. Post-injection transmission scan and emission scan were peformed alternatively over time. The error in emission images corrected using post-infection transmission scan to emission images corrected transmission scan was 2.6% at the concentration of $1.0{\mu}Ci/cc$. No obvious differences in image quality and noise were apparent between the two images. The attenuation correction can be accomplished with post-injection transmission measurement using rotating pin sources and this method can significantly shorten the time between transmission and omission scans and thereby reduce the likelihood of patient motion and increase scanning throughput in PET.

• The Korean Journal of Nuclear Medicine
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• v.33 no.2
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• pp.111-119
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• 1999

Purpose: As mesial temporal lobe epilepsy (TLE) shows hypometabolism of medial and lateral temporal lobe, we investigated whether symmetric uptake of F-18-FDG in medial temporal lobes can differentiate mesial from lateral TLE. Materials and Methods: In 113 patients (83 mesial TLE, 30 lateral TLE) who underwent anterior temporal lobectomy and/or corticectomy with good surgical outcome, we performed F-18-FDG PET and compared F-18-FDG uptake of medial and lateral temporal lobes. All the patients with mesial TLE had hippocampal sclerosis except one congenital abnormal hippocampus. Patients with lateral TLE revealed cerebromalacia, microdysgenesis, arteriovenous malformation, old contusion, and cortical dysplasia. Results: Sensitivity of F-18-FDG PET and MR for mesial TLE was 84% (70/83) and 73% (61/83), respectively. Sensitivity of F-18-FDG PET and MR for lateral TLE was 90% (27/30) and 66% (20/30), respectively. Twelve patients were normal on F-18-FDG PET. 101 patients had hypometabotism of lateral temporal lobe. Among 88 patients who showed hypometabolism of medial temporal lobe as well as lateral temporal lobe, 70 were mesial TLE patients and 18 were lateral TLE on pathologic examination. Positive predictive value of medial temporal hypometabolism for mesial TLE was 80%. Among 13 patients who showed hypometabolism of only lateral temporal lobe, 4 were mesial TLE and 9 were lateral TLE. Positive predictive value of hypometabolism of lateral temporal lobe for the diagnosis of lateral TLE was 69% (9/13). Normal MR findings stood against medial TLE, whose negative predictive value was 66%. Conclusion: Lateral temporal lobe epilepsy should be suspected when there is decreased F-18-FDG uptake in lateral temporal lobe with normal uptake in medial temporal lobe.

• Applied Microscopy
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• v.37 no.1
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• pp.23-33
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• 2007

The lacrimal gland are compound tubule-acinar glands. The main lacrimal function is the production of the aqueous layer, the thickest and major constituent of the precorneal tear film. The lacrimal gland also has an important function in the defense system of the ocular surface, forming a part of the conjunctival-associated hymphoid tissue. The ultrastructural characteristics of the lacrimal gland of the rabbit were described. The lacrimal tissues of rabbits were processed through the conventional techniques for transmission electron microscopy. The secretory portions consisted of three cell types: 1. Serous cells with electron dense secretory granules. 2. Seromucous cells containing variable moderately electron dense secretory granules with flocculent material. 3. Mucous rolls containing mucous secretory granules. The serous cells were situated at the basal portion of acini, and they contained electron dense granules of variable densities and sizes. The seromucous cells contained a few protein secretory granules and more mucous secretory granules. The mucous cells contained even fewer protein secretory granules and exclusively mucous secretory granules. The epithelium of the intralobular ducts showed secretory granules, junctional complexes, and large basolateral intercellular spaces with lateral folds. These study might be helpful in determining inter-relationships, similarities and differences among the orbital glands of various physiological or pathological conditions.

• The Korean Journal of Nuclear Medicine
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• v.33 no.4
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• pp.422-429
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• 1999

Purpose: The measurement of radiation absorbed dose is useful to predict the response after I-131 labeled metaiodobenzylguanidine (MIBG) therapy and determine therapy dose in patients with unresectable or malignant pheochromocytoma. We estimated the absorbed dose in tumor tissue after high dose I-131 MIBG in a patient with pheochromocytoma using a gamma camera and Medical Internal Radiation Dose (MIRD) formula. Materials and Methods: A 64-year old female patient with pheochromocytoma who had multiple metastases of mediastinum, right kidney and periaortic lymph nodes, received 74 GBq (200 mCi) of I-131 MIBG. We obtained anterior and posterior images at 0.5, 16, 24, 64 and 145 hours after treatment. Two standard sources of 37 and 74 MBq of I-131 were imaged simultaneously. Cummulated I-131 MIBG uptake in tumor tissue was calculated after the correction of background activity, attenuation, system sensitivity and count loss at a high count rate. Results: The calculated absorbed radiation dose was 32-63 Gy/ 74 GBq, which was lower than the known dose for tumor remission (150-200 Gy). follow-up studies at 1 month showed minimally reduced tumor size on computed tomography, and mildly reduced I-131 MIBG uptake. Conclusion: We estimated radiation absorbed dose after therapeutic I-131 MIBG using a gamma camera and MIRD formula, which can be peformed in a clinical nuclear medicine laboratory. Our results suggest that the measurement of radiation absorbed dose in I-131 MIBG therapy is feasible as a routine clinical practice that can guide further treatment plan. The accuracy of dose measurement and correlation with clinical outcome should be evaluated further.

• Journal of the Korean Society of Radiology
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• v.15 no.6
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• pp.891-897
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• 2021

With the development of Amyloid PET Tracer, the accuracy of Alzheimer's diagnosis can be improved through the identification of beta-amyloid neurites. However, the long image acquisition time of 20 minutes can be difficult for the patient. PET/CT scans are sensitive to patient movement and may partially affect test results. In this study, we studied the proper image acquisition time without affecting the quantitative evaluation of the image through the list mode acquisition method according to the time of the distribution of radioactive drugs in the body. The list mode includes information about time compared to the existing frame mode, and it is easy to analyze data because it can reconstruct images about the time that researchers want. The research method obtained a reconstructed image by time using a list mode of 5min frame/bed, 10min frame/bed, 15min frame/bed, and 20min frame/bed to compare the difference between signal-to-pons take ratio (SNR) and lesion-to-pons uptake ratio (LPR) and the difference in reading time to obtain an appropriate image. As a result of quantitative analysis, when measuring in list mode, SUVmean values decreased in 6 regions of interest as the image acquisition time increased, but showed the largest difference in 5 min/bed images, followed by 10 min/bed and 15 min/bed. As a result, the difference in SUVmean values decreased. Therefore, it was found that SUVmean values at 15 min/bed did not differ enough to not affect image evaluation. There was no difference in LPR values. As a result of the qualitative analysis, there was no change in the reading findings according to the PET image acquisition time and there was no significant difference in the qualitative analysis score of the image reconstruction according to time. As a result of the study, there is no significant difference between 15 min/bed and 20 min/bed images during the ¹⁸F-flutemetamol PET/CT test, so it can be said that it is clinically useful to reduce the image acquisition time selectively using 15 min/bed via list mode depending on the patient's condition.

• The Korean Journal of Nuclear Medicine Technology
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• v.23 no.2
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• pp.38-42
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• 2019

Purpose Although computed tomography (CT) is used for coronary artery calcification, it is difficult to differentiate between high risk microcalcifications. Studies have shown that $^{18}F$-sodium fluoride ($^{18}F-NaF$) is very useful for the diagnosis of microcalcifications. In this study, we aimed to evaluate the usefulness of $^{18}F-NaF$ PET imaging in quantitative evaluation of calcification. Materials and Methods A total of 45 patients ($67.1{\pm}6.9years\;old$) were injected with 250 MBq of $^{18}F-NaF$ for 1 hour and images were acquired for 30 minutes. All patients underwent CT angiography (CTAngiography, CTA) before the PET scan. The SUVmax of calcification was measured and the background radioactivity of the left atrium was measured to determine Target to Background (TBR) and quantitatively analyzed. High risk group was classified through ROC curve (Receiver Operating Characteristic Curve). Results There were 226 coronary artery calcifications in the cohort and SUVmax was $1.15{\pm}0.39$. Of the 28 patients (62%), 58 were classified as high risk (TBR > 1.25). The remaining 168 were $TBR{\leq}1.25$. Conclusion $^{18}F-NaF$ PET images were available for quantitative assessment of microcalcifications and could be classified into high-risk groups. The combination of angiographic CT and $^{18}F-NaF$ PET may be a new method for early diagnosis of high-risk microcalcifications.

• The Korean Journal of Nuclear Medicine Technology
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• v.25 no.1
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• pp.21-28
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• 2021

Purpose Brown fat, or brown adipose tissue (BAT), is involved in non-shivering thermogenesis and creates heat through glucose metabolism. BAT activation occurs stochastically by internal factors such as age, sex, and body mass index (BMI) and external factors such as temperature and environment. In this study, as a retrospective, electronic medical record (EMR) observation study, statistical analysis is conducted to confirm BAT activation and various factors. Materials and Methods From January 2018 to December 2019, EMR of patients who underwent PET/CT scan at the National Cancer Center for two years were collected, a total of 9155 patients were extracted, and 13442 case data including duplicate scan were targeted. After performing a univariable logistic regression analysis to determine whether BAT activation is affected by the environment (outdoor temperature) and the patient's condition (BMI, cancer type, sex, and age), A multivariable regression model that affects BAT activation was finally analyzed by selecting univariable factors with P<0.1. Results BAT activation occurred in 93 cases (0.7%). According to the results of univariable logistic regression analysis, the likelihood of BAT activation was increased in patients under 50 years old (P<0.001), in females (P<0.001), in lower outdoor temperature below 14.5℃ (P<0.001), in lower BMI (P<0.001) and in patients who had a injection before 12:30 PM (P<0.001). It decreased in higher BMI (P<0.001) and in patients diagnosed with lung cancer (P<0.05) In multivariable results, BAT activation was significantly increased in patients under 50 years (P<0.001), in females (P<0.001) and in lower outdoor temperature below 14.5℃ (P<0.001). It was significantly decreased in higher BMI (P<0.05). Conclusion A retrospective study of factors affecting BAT activation in patients who underwent PET/CT scan for 2 years at the National Cancer Center was conducted. The results confirmed that BAT was significantly activated in normal-weight women under 50 years old who underwent PET/CT scan in weather with an outdoor temperature of less than 14.5℃. Based on this result, the patient applied to the factor can be identified in advance, and it is thought that it will help to reduce BAT activation through several studies in the future.

• The Korean Journal of Nuclear Medicine Technology
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• v.26 no.2
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• pp.15-19
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• 2022

Purpose [⁶⁸Ga]PSMA-11 is needed the high reproducibility, excellent radiochemical yield and purity. In term of radiation safety, the radiation exposure of operator for its production also should be considered. In this work, we performed a comparative study for the fully automated synthesis of [⁶⁸Ga]PSMA-11 between non-cassette type and cassette type. Materials and Methods Two different type of modules (TRACERlab FX N pro for non-cassette type and BIKBox for cassette type) were used for the automated production of [⁶⁸Ga]PSMA-11. According to the previously identified elution profile, Only 2.5 ml with high radioactivity was used for the reaction. After adjusting the pH of the reaction solution with HEPES buffer solution, the precursor was added and reacted with at 95 ℃ for 15 minutes. The reaction mixture was separated and purified using a C18 light cartridge. The product was eluted with 50% EtOH/saline solution and diluted with saline. It was completed by sterilizing filter. In the non-cassette type, the aforementioned process must be prepared directly. However, in the cassette method, synthesis was possible simply by installing a kit that was already completed. Results Both total [⁶⁸Ga]PSMA-11 production time were 25±3(non-cassette type) and 23±3 minutes(cassette type). The radiochemical yield of the non-cassette type(65.5±5.7%) was higher than that of the cassette type(61.6±4.8%) after sterilization filter. The non-cassette type took about 120 minutes of preparation time before synthesis due to washing of synthesizer and reagent preparation. However, since the cassette type does not require washing and reagent preparation, it took about 20 minutes to prepare before synthesis. Both type of synthesizer had a radiochemical high purity(>99%). Conclusion The non-cassette type production of [⁶⁸Ga]PSMA-11 showed higher radiochemical yield and lower cost than the cassette type. However, The cassette type has an advantage in terms of preparation time, convenience, and equipment maintenance.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.110-116
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• 2010

Purpose: The X-ray attenuation coefficient based on CT images is used for attenuation correction in PET/CT. The polychromatic X-ray beam can introduce beam-hardening artifact on CT images. The aims of the study were to evaluate the effect of dental metal prostheses in phantom and patients on apparent tracer activity measured with PET/CT when using CT attenuation correction. Materials and Methods: 40 normal patients (mean age $54{\pm}12$) was scanned between Jan and Feb 2010. NEMA(National Electrical Manufactures Association) PET $Phantom^{TM}$ (NU2-1994) was filled with $^{18}F$-FDG injected into the water that insert implant and metal prostheses dental cast. Region of interest were drawn in non-artifact region, bright steak artifact region and dark streak artifact region on the same transaxial CT and PET slices. Patients and phantom with dental metal prostheses and dental implant were evaluated the change rate of CT Number and $SUV_{mean}$ in PET/CT. A paired t-test was performed to compare the ratio and the difference of the calculated values. Results: In patients with dental metal prostheses, $SUV_{mean}$ was reduced 19.64% (p<0.05) in the non-steak artifact region than the brightstreak artifact region whereas was increased 90.1% (p>0.05) in the non-steak artifact region than the dark streak artifact region. In phantom with dental metal prostheses, $SUV_{mean}$ was reduced 18.1% (p<0.05) in the non-steak artifact region than the bright streak artifact region whereas was increased 18.0% (p>0.05) in the non-steak artifact region than the dark streak artifact region. In patients with dental implant, $SUV_{mean}$ was increased 19.1% (p<0.05) in the non-steak artifact region than the bright streak artifact region whereas was increased 96.62% (p>0.05) in the non-steak artifact region than the dark streak artifact region. In phantom with dental implant, $SUV_{mean}$ was increased 14.4% (p<0.05) in the non-steak artifact region than the bright streak artifact region whereas was increased 7.0% (p>0.05) in the non-steak artifact region than the dark streak artifact region. Conclusion: When CT is used for attenuation correction in patients with dental metal prostheses, 19.1% reduced $SUV_{mean}$ is anticipated in the dark streak artifact region on CT images. The dark streak artifacts of CT by dental metal prostheses may cause false negative finding in PET/CT. We recommend that the non-attenuation corrected PET images also be evaluated for clinical use.

• The Journal of Korean Society for Radiation Therapy
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• v.23 no.1
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• pp.31-39
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• 2011

Purpose: Helical Tomotherapy allows only coplanar beam delivery because it does not allow couch rotation. We investigated a method to introduce non-coplanar beam by tilting a patient's head for Tomotherapy. The aim of this study was to compare intrafractional movement during Tomotherapy between coplanar and non-coplanar patient's setup. Materials and Methods: Helical Tomotherapy was used for treating eight patients with intracranial tumor. The subjects were divided into three groups: one group (coplanar) of 2 patients who lay on S-plate with supine position and wore thermoplastic mask for immobilizing the head, second group (non-coplanar) of 3 patients who lay on S-plate with supine position and whose head was tilted with Variable Axis Baseplate and wore thermoplastic mask, and third group (non-coplanar plus mouthpiece) of 3 patients whose head was tilted and wore a mouthpiece immobilization device and thermoplastic mask. The patients were treated with Tomotherapy after treatment planning with Tomotherapy Planning System. Megavoltage computed tomography (MVCT) was performed before and after treatment, and the intrafractional error was measured with lateral(X), longitudinal(Y), vertical(Z) direction movements and vector ($\sqrt{x^2+y^2+z^2}$) value for assessing overall movement. Results: Intrafractional error was compared among three groups by taking the error of MVCT taken after the treatment. As the correction values (X, Y, Z) between MVCT image taken after treatment and CT-simulation image are close to zero, the patient movement is small. When the mean values of movement of each direction for non-coplanar setup were compared with coplanar setup group, X-axis movement was decreased by 13%, but Y-axis and Z-axis movement were increased by 109% and 88%, respectively. Movements of Y-axis and Z-axis with non-coplanar setup were relatively greater than that of X-axis since a tilted head tended to slip down. The mean of X-axis movement of the group who used a mouthpiece was greater by 9.4% than the group who did not use, but the mean of Y-axis movement was lower by at least 64%, and the mean of Z-axis was lower by at least 67%, and the mean of Z-axis was lower by at least 67%, and the vector was lower by at least 59% with the use of a mouthpiece. Among these 8 patients, one patient whose tumor was located on left frontal lobe and left basal ganglia received reduced radiation dose of 38% in right eye, 23% in left eye, 30% in optic chiasm, 27% in brain stem, and 8% in normal brain with non-coplanar method. Conclusion: Tomotherapy only allows coplanar delivery of IMRT treatment. To complement this shortcoming, Tomotherapy can be used with non-coplanar method by artificially tilting the patient's head and using an oral immobilization instrument to minimize the movement of patient, when intracranial tumor locates near critical organs or has to be treated with high dose radiation.