• The Journal of Korean Society for Radiation Therapy
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• v.16 no.1
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• pp.57-65
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• 2004

Introduction : The phantom that includes high density materials such as steel was custom-made to fix lung and bone in order to evaluation inhomogeneity correction at the time of conducting radiation therapy to treat lung cancer. Using this, values resulting from the inhomogeneous correction algorithm are compared on the 2 and 3 dimensional radiation therapy planning systems. Moreover, change in dose calculation was evaluated according to inhomogeneous by comparing with the actual measurement. Materials and Methods : As for the image acquisition, inhomogeneous correction phantom(Pig's vertebra, steel(8.21g/cm3), cork(0.23 g/cm3)) that was custom-made and the CT(Volume zoom, Siemens, Germany) were used. As for the radiation therapy planning system, Marks Plan(2D) and XiO(CMS, USA, 3D) were used. To compare with the measurement value, linear accelerator(CL/1800, Varian, USA) and ion chamber were used. Image, obtained from the CT was used to obtain point dose and dose distribution from the region of interest (ROI) while on the radiation therapy planning device. After measurement was conducted under the same conditions, value on the treatment planning device and measured value were subjected to comparison and analysis. And difference between the resulting for the evaluation on the use (or non-use) of inhomogeneity correction algorithm, and diverse inhomogeneity correction algorithm that is included in the radiation therapy planning device was compared as well. Results : As result of comparing the results of measurement value on the region of interest within the inhomogeneity correction phantom and the value that resulted from the homogeneous and inhomogeneous correction, gained from the therapy planning device, margin of error of the measurement value and inhomogeneous correction value at the location 1 of the lung showed $0.8\%$ on 2D and $0.5\%$ on 3D. Margin of error of the measurement value and inhomogeneous correction value at the location 1 of the steel showed $12\%$ on 2D and $5\%$ on 3D, however, it is possible to see that the value that is not correction and the margin of error of the measurement value stand at $16\%$ and $14\%$, respectively. Moreover, values of the 3D showed lower margin of error compared to 2D. Conclusion : Revision according to the density of tissue must be executed during radiation therapy planning. To ensure a more accurate planning, use of 3D planning system is recommended more so than the 2D Planning system to ensure a more accurate revision on the therapy plan. Moreover, 3D Planning system needs to select and use the most accurate and appropriate inhomogeneous correction algorithm through actual measurement. In addition, comparison and analysis through TLD or film dosimetry are needed.

• The Journal of Korean Society for Radiation Therapy
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• v.21 no.1
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• pp.1-7
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• 2009

Purpose: The purpose is to evaluate the accuracy of correcting the targeting error through the Target Location System (TLS) for the location change error of the reference point which arises from the movement or motion of patient during the treatment using the CyberKnife. Materials and Methods: In this test, Gafchromic MD-55 film was inserted into the head and neck phantom to analyze the accuracy of the targeting, and then the 6 MV X-ray of CyberKnife (CyberKnife Robotic Radiosurgery System G4, Accuray, US) was irradiated. End to End (E2E) program was used to analyze the accuracy of targeting, which is provided by Accuray Corporation. To compute the error of the targeting, the test was carried out with the films that were irradiated 12 times by maintaining the distance within the rage of $0{\pm}0.2\;mm$ toward x, y, z from the reference point and maintaining the angle within the rage of $0{\pm}0.2^{\circ}$ toward roll, pitch, yaw, and then with the films which were irradiated 6 times by applying intentional movement. And the correlation in the average value of the reference film and the test film were analyzed through independent samples t-test. In addition, the consistency of dose distribution through gamma-index method (dose difference: 3%) was quantified, compared, and analyzed by varying the distance to agreement (DTA) to 1 mm, 1.5 mm, 2 mm, respectively. Results: E2E test result indicated that the average error of the reference film was 0.405 mm and the standard deviation was 0.069 mm. The average error of the test film was 0.413 mm with the standard deviation of 0.121 mm. The result of independent sampling t-test for both averages showed that the significant probability was P=0.836 (confidence level: 95%). Besides, by comparing the consistency of dose distribution of DTA through 1 mm, 1.5 mm, 2 mm, it was found that the average dose distribution of axial film was 95.04%, 97.56%, 98.13%, respectively in 3,314 locations of the reference film, consistent with the average dose distribution of sagittal film that was 95.47%, 97.68%, 98.47%, respectively. By comparing with the test film, it was found that the average dose distribution of axial film was 96.38%, 97.57%, 98.04%, respectively, at 3,323 locations, consistent with the average dose distribution of sagittal film which was 95.50%, 97.87%, 98.36%, respectively. Conclusion: Robotic CyberKnife traces and complements in real time the error in the location change of the reference point caused by the motion or movement of patient during the treatment and provides the accuracy with the consistency of over 95% dose distribution and the targeting error below 1 mm.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.107-114
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• 2014

Purpose : The purpose of this study is evaluation for the applicability of O-MAR(Metal artifact Reduction for Orthopedic Implants)(ver. 3.6.0, Philips, Netherlands) in head & neck radiation treatment planning CT with metal artifact created by dental implant. Materials and Methods : All of the in this study's CT images were scanned by Brilliance Big Bore CT(Philips, Netherlands) at 120kVp, 2mm sliced and Metal artifact reduced by O-MAR. To compare the original and reconstructed CT images worked on RTPS(Eclipse ver 10.0.42, Varian, USA). In order to test the basic performance of the O-MAR, The phantom was made to create metal artifact by dental implant and other phantoms used for without artifact images. To measure a difference of HU in with artifact images and without artifact images, homogeneous phantom and inhomogeneous phantoms were used with cerrobend rods. Each of images were compared a difference of HU in ROIs. And also, 1 case of patient's original CT image applied O-MAR and density corrected CT were evaluated for dose distributions with SNC Patient(Sun Nuclear Co., USA). Results : In cases of head&neck phantom, the difference of dose distibution is appeared 99.8% gamma passing rate(criteria 2 mm / 2%) between original and CT images applied O-MAR. And 98.5% appeared in patient case, among original CT, O-MAR and density corrected CT. The difference of total dose distribution is less than 2% that appeared both phantom and patient case study. Though the dose deviations are little, there are still matters to discuss that the dose deviations are concentrated so locally. In this study, The quality of all images applied O-MAR was improved. Unexpectedly, Increase of max. HU was founded in air cavity of the O-MAR images compare to cavity of the original images and wrong corrections were appeared, too. Conclusion : The result of study assuming restrained case of O-MAR adapted to near skin and low density area, it appeared image distortion and artifact correction simultaneously. In O-MAR CT, air cavity area even turned tissue HU by wrong correction was founded, too. Consequentially, It seems O-MAR algorithm is not perfect to distinguish air cavity and photon starvation artifact. Nevertheless, the differences of HU and dose distribution are not a huge that is not suitable for clinical use. And there are more advantages in clinic for improved quality of CT images and DRRs, precision of contouring OARs or tumors and correcting artifact area. So original and O-MAR CT must be used together in clinic for more accurate treatment plan.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.99-105
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• 2014

Purpose : We compared the set-up accuracy and right-left Shoulder position variation of the manufactured device and other commercial shoulder-retractors in the head and neck radiation treatment. Materials and Methods : Six patients consist of three groups which were used three different Shoulder retractors. We measured position corrections of left and right Shoulder and the couch after the image guidance by using on board imager (OBI) for six head and neck patients who has the extended target to the neck node lower region. Results : The position variation correction of left (right) Shoulder after image guidance were $1.07{\pm}3.99mm$ ($-4.35{\pm}2.09mm$), $-0.37{\pm}5.91mm$ ($1.26{\pm}5.28mm$), $-0.63{\pm}2.44mm$ ($0.25{\pm}1.61mm$) for group A, B and C. The vertical, lateral, longitudinal position and angular corrections of the couch after image guidance were $-2.06{\pm}2.68$, $-1.11{\pm}8.15$, $0.34{\pm}3.78mm$, and $0.51{\pm}0.77$ degree for group A, $-1.18{\pm}1.82$, $-0.94{\pm}2.13$, $-0.67{\pm}1.98mm$, and $0.91{\pm}1.04$ degree for group B and $0.12{\pm}2.18$, $-0.79{\pm}2.64$, $0.79{\pm}2.64$, and $0.00{\pm}0.49$ degree for group C. Conclusion : In this preliminary study, we found the positioning accuracy of the manufactured Shoulder retractor is comparable to other commercial Shoulder retractors. We expect that the reproducibility and accuracy of the patient set-up could be improved by using the home made Shoulder retractor in the head and neck radiation treatment.

• Geotechnical Engineering
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• v.2 no.1
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• pp.27-44
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• 1986

The measured soil data are analyzed to the descriptive statistics and classified into the four models of uncorrelated-normal (UNNO), uncorrelated-nonnormal (VNNN), correlatedonnormal(CONN), and correlated-nonnormal(CONN) . This paper presents the comparisons of reliability index and check points using the advanced first-order second-moment method with respect to the four models as well as BASIC Program. A sin91e-mode Performance function is consisted of the basic design variables of bearing capacity and settlements on shallow foundations and input the above analyzed soil informations. The main conclusions obtained in this study are summarized as follows: 1. In the bearing capacity mode, cohesion and bearing-capacity factors by C-U test are accepted for normal and lognormal distribution, respectively, and negatively low correlated to each other. Since the reliability index of the CONN model is the lowest one of the four model, which could be recommended a reliability.based design, whereas the other model might overestimate the geotechnical conditions. 2. In the case of settlements mode, the virgin compression ratio and preccnsolidation pressure are fitted for normal and lognormal distribution, respectively. Constraining settlements to the lower ones computed by deterministic method, The CONN model is the lowest reliability of the four models.

• Clinical and Experimental Reproductive Medicine
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• v.35 no.2
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• pp.155-162
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• 2008

Objectives: The aim of this study was to assess the change of ovarian reserve after removal of ovarian tumor using basal FSH, $E_2$, clomiphene citrate challenge test and ovarian volume. Methods: Twenty two patients with unilateral ovarian tumor, ${\leq}35$ years old, regular menstrual cycle were collected prospectively and divided into endometrioma or non-endometrioma group. We measured the ovarian volume with transvaginal ultrasonography on the day 3 of menstrual cycle within one month before and 3 months after surgery. Basal (cycle day 3) FSH, $E_2$ and CCCT were checked before surgery and repeated at least 2 spontaneous cycles later after surgery. Three patients that had been pregnant within 3 months after surgery were excluded in analysis. Results: The ovarian volume was reduced significantly after surgery in endometrioma and non-endometrioma ${\geq}10\;cm$ group ($4.79{\pm}2.57\;cm^3$ and $5.21{\pm}1.33\;cm^3$, respectively), but not in the non-endometrioma <10 cm group ($6.18{\pm}2.85\;cm^3$). After surgery, basal FSH and cycle day 10 FSH on CCCT in endometrioma and non-endometrioma were $4.25{\pm}0.20\;mIU/ml$ and $3.79{\pm}0.80\;mIU/ml$, $4.24{\pm}0.85\;mIU/ml$ and $4.28{\pm}0.92\;mIU/ml$, respectively. There were neither significant difference in comparison with the preoperative results nor between two groups. Conclusions: Enucleation of ovarian mass was associated with a significant reduction in ovarian volume in endometrioma and non-endometrioma larger than 10cm in diameter. Hormonal markers for evaluation of ovarian reserve, such as basal and cycle day 10 FSH on CCCT, were not changed significantly in each group. In reproductive age women, conservative enucleation or cystectomy rather than oophorectomy should be considered even in a large benign tumor and ovarian function could be reserved by meticulous operative technique.

• Sleep Medicine and Psychophysiology
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• v.9 no.2
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• pp.106-114
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• 2002

Objectives: Daytime sleepiness is a common symptom and is associated with sleep behavior, sleep deprivation, and night shift, etc. It is also one of the most important symptoms of sleep disorders like obstructive sleep apnea (OSA). According to our survey on Korean literature, a few studies have dealt with daytime sleepiness, and we have not been able to locate any study comparing normal subjects with polysomnography-proven sleep disorder patients regarding daytime sleepiness. We aimed at comparing daytime sleepiness among normal healthy daytime workers, medical students being expected to have daytime sleepiness due to chronic sleep deprivation, and patients having sleep disorders diagnosed with polysomnography. We also studied the association between subjective daytime sleepiness and objective polysomnographic findings in patients with sleep disorders. Methods: One hundred three hospital workers, 137 medical students, and patients with sleep disorders were studied. Sleep disorders included OSA, periodic limb movements in sleep (PLMS), insomnia, and narcolepsy. The degree of subjective sleepiness in each group was measured by the Korean version of Epworth sleepiness scale and compared. The relationship between polysomnographic findings reflecting severity of sleep disorder in each patient group and subjective sleepiness was analyzed. As for patients with narcolepsy, the relationship between the mean sleep latency and subjective sleepiness was studied. Results: There was a significant difference of ESS score (F=68.190, dF=5.752, p<0.001) among daytime workers, medical students, and sleep disorder patients. In OSA patient group, the degree of the sleepiness had no significant correlation either with mean O2 satuaration (p=0.062) or with RDI (p=0.807). In PLMS patient group, there was no correlation between periodic limb movement index (PLMI) and subjective sleepiness (p=0.761). In narcolepsy patient group, the subjective sleepiness had no correlation with mean sleep latency measured with MSLT (p=0.055). Conclusion: We found a significant difference of subjective sleepiness among daytime workers, medical students, and patients with sleep disorders. However, no consistent correlation was found between severity of subjective sleepiness and objective polysomnographic findings reflecting severity of each sleep disorder. This research confirms that the evaluation of subjective sleepiness is important clinically, but it cannot substitute the objective measures such as nocturnal polysomnography and MSLT.

• Journal of Service Research and Studies
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• v.10 no.3
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• pp.23-42
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• 2020

This study conceptualized the essence and propensity of modern management in service age, based on philosophy, and developed items to evaluate the conceptualized content. It was carried out as a new study to deepen the study of management philosophy and management theory by the new management framework. In order to establish the philosophical foundation of the modern management, the essence of the modern management was conceptualized based on the fundamental ideas of the East and West, and then an evaluation item was developed to put the essence and propensity of the modern management into practical use through analytical and empirical methods. After analyzing the representative ideas of mankind, it was derived that the Book of Change has the qualification as a philosophical model that can derive the essence of modern management. The Book of Change explains the reasoning of the world in the structure of two opposing parties, such as Taiji or Yin and Yang, and the process of acknowledging the contradictions within each opposing party and overcoming the contradictions through change is the central idea. Because you can see. After conducting a conceptual study, through empirical research, the essence and propensity of a modern manager should be conceptualized. The concept of essence and empirical study of the modern management using the leading role was conducted in two stages. First, a qualitative study using repetitive comparative analysis (CCM), focus group interview (FGI), and text mining was conducted to derive the essential and propensity conceptualization items that modern managers should possess. In addition, a quantitative study using factor analysis to develop sample items and develop measurement items through literature review and FGI was conducted to derive the essential concept of the modern management. Finally, the essence of modern management was derived: learning, preparation, challenge, inclusion, trust, morality, and sacrifice. In the future, it is necessary to conduct empirical research on the effectiveness of the essence of modern management for global and Korean representative companies.

• Journal of Genetic Medicine
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• v.7 no.1
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• pp.67-77
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• 2010

Purpose: The aims of this study are to evaluate psychological impact and quality of life according to the cancer diagnosis and mutation status in Korean families with BRCA mutations. Materials and Methods: Seventeen affected carriers (AC), 16 unaffected carriers (UC) and 13 healthy non carriers (NC) from 13 BRCA mutation families were included in the study. Outcomes were compared with regard to depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory, STAI), optimism (Reevaluation of the Life Orientation test, LOT-R), knowledge of hereditary ovarian cancer, and quality of life (QoL) (SF-36v2 Health Survey, physical component score [PCS], mental component score [MCS]) among three groups. Result: Level of depression, optimism, and PCS were similar in AC, UC, and NC. Anxiety score was elevated in all three groups. MCS was significantly low in AC than in UC and NC (P=0.009, P=0.017). Knowledge of hereditary breast and ovarian cancer was high in AC than NC (P=0.001). MCS was significantly related to whether patient was affected by cancer (P=0.043) and has occupation (P=0.008) or not in multivariable analysis. Conclusion: From this cross sectional study, psychological adverse effect was not related to the carrier status of BRCA mutation. Elevated anxiety in BRCA family members was observed but, independent to affection and the type of genetic mutation. AC showed low mental QoL. Further effort to understand psychological impact and QoL of genetic testing in BRCA family members is required for follow-up in clinical aspects.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.57-68
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• 2017

Purpose: The purpose of this study was to compare volumetric modulated arc therapy(VMAT) with fixed-field intensity modulated radiation therapy(IMRT) using non-coplanar beam when the shape of target is irregular and the location is adjacent to organ at risk(OAR). Materials and Methods: The subjects of this study were a total of 6 patients who had radiation therapy for whole scalp(2 patients), partial scalp(2 patients), and whole ventricle(2 patients) by True Beam STX(Varian Medical Systems, USA). VMAT plans consisted of coplanar or non-coplanar arcs which can minimize the volume of OAR included in beamlets. All fixed-field IMRT plans consisted of non-coplanar beams using more than 2 angles of Couch. Results: The VMAT and IMRT plans were compared with regard to the maximum dose of both lens, both optic nerves, optic chiasm, and brain stem and the mean dose of both eyeballs and hippocampus. VMAT plans showed higher dose than ncIMRT plans at more than 6 of all OARs in every patient, and the ratio was from 1.1 times to 8.2 times. In case of total scalp and partial scalp, the volume of brain which received more than 20 Gy in the VMAT plans was 2 times larger than the volume in the ncIMRT plans. In case of whole ventricle, there was no significant difference. Target coverage was satisfied in both plans($PTV_{100%}=95%$). The maximum dose in target volume and required monitor unit(MU) of ncIMRT were higher than them of VMAT plans. Conclusion: Even though ncIMRT is less efficient than VMAT with regard to required MU and treatment time, the dose to OARs is much lower than VMAT and PTV Coverage is similar with VMAT. If the shape of target is irregular and location is adjacent to OAR, comparison VMAT plan with ncIMRT plan deserves to be considered.