• The Journal of Korean Society for Radiation Therapy
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• v.22 no.2
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• pp.131-134
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• 2010

Purpose: TOMO therapy treatment for a relatively long run Beam time and temperature-sensitive detector, such as CT clinics in optimal temperature ($20~21^{\circ}$) to maintain a constant temperature in addition to its own Chamber Cooling system is activating. TOMO This clinic has been reduced in the patients' body temperature to keep the sheets and covers over the treated area. Therefore, these materials for any changes in the organization gives the dose were analyzed. Materials and Methods: To compare changes in the organization Dose Phantom cheese (Cheese Phantom) were used, CT-simulation taking the center point of the cheese phantom PTV (Planning Target Volume, treatment planning target volume) by setting Daily dose 200 cGy, 3 meetings planned treatment. PTV, PTV +7 cm, PTV +14 cm, the total count points on the phantom using the Ion chamber cover without any substance to measure the dose, and one of the most commonly used treatment, including the frequently used four kinds of bedding materials (febric 0.8 mm, gown 1.4 mm, rug, 3.3 mm, blanket 13.7 mm) and covered with a phantom and the dose measured at the same location were analyzed 3 times each. Results: PTV, PTV +7 cm, PTV +14 cm from the point of any substance measured in the state are covered with four kinds of materials (fabric, gown, rug, blanket) was measured in the covered states and compares their results, PTV respectively -0.17%, -0.44%, -0.53% and -0.9% change, PTV +7 cm, respectively -0.04%, +0.07%, +0.06%, +0.07%, were changed, PTV +14 cm, respectively 0%, -0.06%, -0.02%, +0.6%, respectively. Conclusion: These results TOMO treatment to patients to maintain their body mass by using PTV thickness of the material decreased in proportion to. PTV +7 cm, but showed slight changes in the point, PTV +14 cm at the point of the dose was increased a little. Sejijeom all the difference in treatment tolerance ${\pm}3%$ range, this is confirmed in the coming treatment will not affect the larger should be considered.

• The Journal of Korean Society for Radiation Therapy
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• v.22 no.2
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• pp.75-83
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• 2010

Purpose: It aims to evaluate the location change and tendency of hepatic and intrahepatic tumors according to gastric volume and change of location. Materials and Methods: It studied 9 patients with hepatic tumors who visited Gangnam Severance Hospital from March 2009 to April 2010 and who underwent CT or PET (Positron Emission Tomography) within 2 weeks before CT-simulation. The patients fasted for 6 hours before CT-simulation and drank 240~250 cc of water just before CT or PET for image fusion. Those two types of images were fused to RTP (Radiation Treatment Planning, Pinnacle 8.0h) focusing on bone structure of individual patients. Results: They drank 240~260 cc of water but their stomach volume after drinking water varied from 259.3 cc to 495.4 cc. Even though individual differences existed in the change of stomach volume before and after drinking water, the volume was increased by 130 cc (174%) on average. The change in absolute distance between the centers of tumors ranged from 0.52 cm to 3.04 cm (1.52 cm on average); from 0.1 cm to 1.35 cm (0.44 cm on average) in cranial-caudal direction; from 0.05 cm to 2.75 cm (1.22 cm on average) in left-right direction; and from 0.05 cm to 1.85 cm (0.33 cm on average) in ventral-dorsal direction. Conclusion: It is hard to predict the movement of tumors by observing stomach movement, due to great individual differences; however, it was observed that the location of hepatic tumors was right-sided as the stomach was filled with water. Thus, it is recommended to maintain the fastened state to secure the accuracy of hepatic tumor treatment. If it cannot maintain the fastened state, it is recommended to measure stomach volumes and movement in the patient to consider the movement of hepatic tumors before radiation treatment.

• Radiation Oncology Journal
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• v.27 no.4
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• pp.228-239
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• 2009

Purpose: 4DCT scans performed for radiotherapy were retrospectively analyzed to assess the possible benefits of respiratory gating in non-small cell lung cancer (NSCLC) and established the predictive factors for identifying patients who could benefit from this approach. Materials and Methods: Three treatment planning was performed for 15 patients with stage I~III NSCLC using different planning target volumes (PTVs) as follows: 1) PTVroutine, derived from the addition of conventional uniform margins to gross tumor volume (GTV) of a single bin, 2) PTVall phases (patient-specific PTV), derived from the composite GTV of all 6 bins of the 4DCT, and 3) PTVgating, derived from the composite GTV of 3 consecutive bins at end-exhalation. Results: The reductions in PTV were 43.2% and 9.5%, respectively, for the PTVall phases vs. PTVroutine and PTVgating vs. PTVall phases. Compared to PTVroutine, the use of PTVall phases and PTVgating reduced the mean lung dose (MLD) by 18.1% and 21.6%, and $V_{20}$ by 18.2% and 22.0%, respectively. Significant correlations were seen between certain predictive factors selected from the tumor mobility and volume analysis, such as the 3D mobility vector, the reduction in 3D mobility and PTV with gating, and the ratio of GTV overlap between 2 extreme bins and additional reductions in both MLD and $V_{20}$ with gating. Conclusion: The additional benefits with gating compared to the use of patient-specific PTV were modest; however, there were distinct correlations and differences according to the predictive factors. Therefore, these predictive factors might be useful for identifying patients who could benefit from respiratory-gated radiotherapy.

• Radiation Oncology Journal
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• v.27 no.4
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• pp.194-200
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• 2009

Purpose: This aim of this study was to evaluate changes in gastric volume and organ position as a result of delayed gastric emptying after a subtotal gastrectomy performed as part of the treatment of stomach cancer. Materials and Methods: The medical records of 32 patients who underwent concurrent chemoradiotherapy after a subtotal gastrectomy from March 2005 to December 2008 were reviewed. Of these, 5 patients that had more than 50 cc of residual gastric food detected at computed tomography (CT) simulation, were retrospectively enrolled in this study. Gastric volume and organ location was measured from CT images obtained before radiotherapy, twice weekly. In addition, authors evaluated the change of radiation dose distribution to planning the target volume and normal organ in a constant radiation therapy plan regardless of gastric volume variation. Results: A variation in the gastric volume was observed during the radiotherapy period (64.2~340.8 cc; mean, 188.2 cc). According to the change in gastric volume, the location of the left kidney was shifted up to 0.7 - 2.2 cm (mean, 1.2 cm) in the z-axis. Under-dose to planning target volume (V43, 79.5${\pm}$10.4%) and over-dose to left kidney (V20, 34.1${\pm}$12.1%; Mean dose, 23.5${\pm}$8.3 Gy) was expected, given that gastric volume change due to delayed gastric emptying wasn't taken into account. Conclusion: This study has shown that a great change in gastric volume and left kidney location may occur during the radiation therapy period following a subtotal gastrectomy, as a result of delayed gastric emptying. Detection of patients who experienced delayed gastric emptying and the application of gastric volume variation to radiation therapy planning will be very important.

• Radiation Oncology Journal
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• v.25 no.4
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• pp.201-205
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• 2007

Purpose: This retrospective study was conducted to assess outcome and to determine the prognostic factors in patients with a desmoid tumor treated with postoperative radiotherapy. Materials and Methods: Twenty-seven patients with a desmoid tumor who were treated with postoperative radiotherapy between June 1984 and October 2005 were analyzed. There were 13 male and 14 female patients. The age of the patients ranged from 3 to 79 years (median age, 28 years). Tumors were located in an extra-abdominal area (21 cases), and in the abdominal walls (6 cases). The tumor size ranged from 2.5 to 25 cm (median size, 7.5 cm) in the largest linear dimension. Thirteen cases received radiotherapy after initial surgery, and 14 recurrent cases received radiotherapy after additional surgery. The total radiation dose given was $45{\sim}66$ Gy (median dose, 59.4 Gy), and the fraction size was $1.8{\sim}2.0$ Gy. Results: The median follow-up period was 61 months (range, $12{\sim}203$ months). Two patients developed local progression and six patients experienced local recurrence. The 5-year disease-free survival rate and the 5-year progression-free survival rate were 61 % and 70%, respectively. Wide local excision was associated with better disease free survival with statistical significance (p=0.028). Radiotherapy after initial surgery (p=0.046) and a higher radiation dose of more than 60 Gy (p=0.049) were associated with better progression free survival with statistical significance. At the time of the last follow-up, the number of additional surgeries was higher in patients that received radiotherapy after reoperation (p<0.001). Conclusion: Radiotherapy after the initial operation improved local control and decreased the number of subsequent operations. Thus, postoperative radiotherapy after an initial operation is recommended in patients with a high risk of recurrence for a desmoid tumor.

• Radiation Oncology Journal
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• v.25 no.4
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• pp.206-212
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• 2007

Purpose: Heterotopic ossification is a well-known postoperative and post-traumatic complication of the elbow. We reviewed the treatment outcome for the use of low-dose radiation after surgical intervention of the elbow to prevent recurrence of heterotopic ossification (HO). Materials and Methods: Forty-five patients with HO underwent surgical intervention and postoperative radiotherapy of the elbow. The median age of the patients was 29 years ($16{\sim}75$ years), and 27 of the patients were men and 18 were women. The occurrence of HO was mainly due to surgery after fracture (24/45) and traumatic injury (21/45). Limitation of the range of motion (ROM) was the most common symptom of the patients. Thirty-four patients received postoperative radiotherapy with a dose of 8 Gy in 2 fractions; 5 patients received a dose of 10 Gy in 5 fractions and 6 patients received a dose of 7 Gy in 1 fraction. Postoperative radiotherapy was given on the first two postoperative days for most of the patients. Sixteen patients were not given anti-inflammatory medication and 29 patients were given NSAIDs for $1{\sim}8$ months. Results: After a median follow-up period of 18 months (range $6{\sim}72$ months), 41 patients showed clinical improvement and two patients did not show improvement. Assessment of the ROM showed a mean improvement from $0{\sim}135^{\circ}$ to $60{\sim}145^{\circ}$ (p=0.028), and assessment of the functional outcome according to MEPI was from ($15{\sim}95$) to ($80{\sim}100$) (p<0.0001). Two of the 34 patients that were followed-up with radiography had mild radiological recurrence of heterotopic ossification. No complications were observed after the radiotherapy. Conclusion: These results suggested that low-dose radiation administered after surgical intervention is safe and effective to prevent the recurrence of HO in the elbow.

• Pediatric Infection and Vaccine
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• v.5 no.1
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• pp.96-103
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• 1998

Purpose : We performed this study to evaluate the immune responses and protective efficacies of the HBV vaccine in infants born from hepatitis B virus(HBV) carrier mothers. Methods : Seventy eight infants born from HBV carrier mothers, who were able to follow up for 12months in the Catholic University St. Vincents hospital, were involved in this study from July 1995 to December 1996. Samples were collected at birth, 4, 8 and 12months after injection of HBIG and HBV heat-inactivated plasma derived vaccines. We evaluated the changes and relationships of viral markers detecting by enzyme immunoassay and radioimmunoassay between HBV carrier mothers and their infants. Results : 1) A total of 5.0%(106/2,117) of pregnant women were found to be a HBV carrier. The rates of HBeAg positive and negative were 38.5%(37/96) and 61.5%(59/96), respectively. 2) The seroconversion rates of anti-HBs with infants of HBV carrier mothers at 4, 8 and 12 months were 85.9%(67/78), 75.6%(59/78) and 73.1%(57/78), respectively. Although these were statistically significant differences(P<0.05), they were not related to HBeAg status of the mothers. The geometric mean titers of anti-HBs at 8 and 12 months were significantly higher than at 4 months, statistically(P<0.05). The protective efficacy of the HBV vaccine and HBIG at 12 months in infants from HBeAg positive and negative mothers were 89.8% and 100%, respectively. 3) Five of 78(6.4%) infants became infected by HBV from only HBeAg positive mothers during the follow up period of 12 months. Three of 5 infected infants became HBV carriers. HBsAg positive at birth from HBeAg positive and negative mother were 4 infants, respectively. Three of 4 infants became infected by HBV from only HBeAg positive mothers. Conclusion : We confirmed that the seroconversion rate of HBV heat-inactivated plasma derived vaccine which was one of other vaccines manufacturing in Korea was 85.9%. The protective efficacy of this HBV vaccine and HBIG at 12 months in infants from HBeAg positive and negative mothers were 89.8% and 100%, respectively.

• Childhood Kidney Diseases
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• v.11 no.2
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• pp.280-287
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• 2007

Purpose : Urinary lithiasis is uncommon in children, however, it may lead to chronic renal insufficiency and even end stage renal disease. The etiology of stone formation in children is largely unknown; although the most common causes are known to be associated with congenital anomalies of the genito-urinary(G-U) tract, urinary tract infections(UTI), and metabolic diseases. Methods : A total of 73 children(male:female=42:31, mean age $6.6{\pm}5.3$ years) presented with urinary lithiasis between Sep. 1998 and Jul. 2007 at Seoul National University Children's Hospital. The medical records were reviewed retrospectively. Results : The most common presenting symptoms were gross hematuria(28/73, 38%) and flank or abdominal pain(23/73, 32%). The stones were located in the upper urinary tract in 48 patients(66%), in the bladder in 18(24%), and in both the bladder and upper urinary tract in 2 (3%). Congenital anomalies of the G-U tract with/without UTI were detected in 30 children (41%), hypercalciuria with/without hypercalcemia in 15(20%), and other metabolic diseases in 8(11%). In 17 patients(23%), no underlying cause of stone formation was detected. The majority of stones were infected stones(24/36, 67%), which were followed by calcium stones(8/36, 22%), uric acid stones(3/36, 8%). and cystine stones(1/36, 3%). Thirty-four patients(46%) underwent surgical procedures and/or extracorporeal shockwave lithotripsy for stone removal, and 13(18%) passed stones spontaneously with/without medical management. Stones recurred in 6 patients(8%): 4 with neurogenic bladder augmented by ileocystoplasty, 1 with cystinuria, and 1 with unknown etiology. Conclusion : The common causes of urinary lithiasis in children were congenital anomalies of the G-U tract with/without UTI and metabolic disorders including hypercalciuria/hypercalcemia. For the management of stones, minimally invasive procedures should be chosen on the basis of accompanying symptoms and the composition, locations and etiology of stones.

• Korean Security Journal
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• no.18
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• pp.73-99
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• 2009

There are three assassination and treatening cases in this thesis introduced as analysis data. They are shooting accidents of the U.S.A's President Reagun (1981,3.30), and the President Park Jeong Hee of South Korea(1974.8.15), assassination of the Prime Minister Lavin of Israel (1995.11.4) In March 30, 1981, there was an accident where criminal, Hinckley, fired ball cartridges right before the President Reagan got into the car to move to White House after completing the announcement of Hilton Hotel of Washington. As a result, the chest of president was shot and public information secretary and safeguard were wounded. In August, 15, pm 10:23, where the 29th 8.15 independent anniversay event was being celebrated by the people at the National theater in Jangchungdong, Seoul, the criminal Moon Sekwang fired ball cartridges, he failed to assassinate the President Park Jeong Hee of Korea, but shot the First lady Yuk Young Soo. She was wounded right part of head and died. In November 4, Saturday, pm 22:00 the Prime Minster Lavin had finished the supporting event of Middle Asia's Peace project and was taking on the car when he was killed by the criminal Amir's shooting, The accidents left very important lesson from the aspect of security analysis and it has been frequently used as a material for the education and training of safeguard organization. In Korea, as well as Presidential Security Service, national security departments have selected it as an important model for the subjects such as 'Security Analysis, 'Security Practice' and 'Security Methodology'. In the performance of security duty, security skill is the most important matter. Moreover, it has a close relationship with politics, society and culture. The purpose of this study is to analyze and reevaluate the case, which has been treated as a usual model from the aspect of security analysis, beyond its introduction. Attempted assassination of President Reagan was evaluated as a positive success example because of its rapid response of adjacent guards to evacuate Reagan, who is a guard target, within 10 seconds after the shot. When comparing it to President Kennedy Assassination of 1963, it was evaluated that guards were significantly specialized. In the study, however, it was possible to found many problems such as carelessness of guard, who is in charge of external area of event place, idle attitude for frequently used event place, confusion of wireless communication, risk of wireless security disclose, insufficient provision of compulsory record file, insufficient profiling of dangerous person and unsecured hospital and first-aid room.

• Radiation Oncology Journal
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• v.25 no.2
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• pp.134-144
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• 2007

[ $\underline{Purpose}$ ]: Immobilization devices that improve the setup reproducibility of pelvic cancer patients and that provide comfort to patients during radiotherapy were designed and the feasibility of the devices was evaluated. $\underline{Materials\;and\;Methods}$: A customized device was designed to immobilize a knee, thigh, and foot of a patient. Sixty-one patients with prostate cancer were selected and were divided into two groups-with or without devices. The setup errors were measured with respect to bony landmarks. The difference between digitally reconstructed radiographs (DRR) and simulation films, and the differences between DRR and portal films were measured. $\underline{Results}$: The left-right (LR), anterior-posterior (AP) and craniocaudal (CC) errors between the DRR and simulation films were $1.5{\pm}0.9\;mm$, $3.0{\pm}3.6\;mm$, and $1.6{\pm}0.9\;mm$, respectively without devices. The errors were reduced to $1.3{\pm}1.9\;mm$, $1.8{\pm}1.5\;mm$ and $1.1{\pm}1.1\;mm$, respectively with the devices. The errors between DRR and portal films were $1.6{\pm}1.2\;mm$, $4.0{\pm}4.1\;mm$, and $4.2{\pm}5.5\;mm$, respectively without the devices and were reduced to $1.0{\pm}1.8\;mm$, $1.2{\pm}0.9\;mm$, and $1.2{\pm}0.8\;mm$, respectively, with the devices. The standard deviations among the portal films were 1.1 mm, 2.1 mm, and 1.0 mm at each axis without the devices and 0.9 mm, 1.6 mm and 0.8 mm with the devices. The percentage of setup errors larger than 3 mm and 5 mm were significantly reduced by use of the immobilization devices. $\underline{Conclusion}$: The designed devices improved the setup reproducibility for all three directions and significantly reduced critical setup errors.