• The Korean Journal of Nuclear Medicine
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• v.34 no.4
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• pp.336-343
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• 2000

Purpose: Thallous-201 chloride produced at Korea Cancer Center Hospital(KCCH) is used in detecting cardiovascular disease and cancer. Thallium impurity can cause emesis, catharsis and nausea, so the presence of thallium and other metal impurities should be determined. According to USP and KP, their amounts must be less than 2 ppm in thallium and 5 ppm in total. In this study, the detection method of trace amounts of metal impurities in $[^{201}Tl]$TICI injection with polarography was optimized without environmental contamination. Materials and Methods: For the detection of metal impurities, Osteryoung Square Wave Stripping Voltammetry method was used in Bio-Analytical System (BAS) 50W polarograph. The voltammetry was composed of Dropping Mercury Electrode (DME) as a working electrode, Ag/AgCl as a reference electrode and Pt wire as a counter electrode. Square wave stripping method, which makes use of formation and deformation of amalgam, was adopted to determine the metal impurities, and pH 7 phosphate buffer was used as supporting electrolyte. Results: Tl, Cu and Pb in thallous-201 chloride solution were detected by scanning from 300 mV to -800 mV Calibration curves were made by using $TINO_3,\;CuSO_4\;and\;Pb(NO_3){_2}$ as standard solutions. Tl was confirmed at -450 mV peak potential and Cu at -50 mV Less than 2 ppm of Tl and Cu was detected and Pb was not detected in KCCH-produced thallous-201 chloride injection. Conclusion: Detection limit of thallium and copper is approximately 50 ppb with this method. As a result of this experiment, thallium and other metal impurities in thallous-201 chloride injection, produced at Korea Cancer Center Hospital, are in the regulation of USP and KP Polarograph could be applied for the determination of metal impurities in the quality control of radiopharmaceuticals conveniently without environmental contamination.

• The Korean Journal of Nuclear Medicine Technology
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• v.19 no.1
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• pp.62-66
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• 2015

Purpose Various database comparison methods(DCM) are used for analyzing functional neuro-imaging. It is possible to statistically evaluate decreased or increased metabolism of abnormal patient's brain by comparing with asymptomatic controls in DCM. And results of DCM are additionally used for easily explaining defect region. The aim of this study was to evaluate usefulness of statistical parametric mapping(SPM) and scenium. Materials and Methods Data of 15 patients($62.02{\pm}15.03year$) underwent $^{18}F-FDG$ brain PET/CT were collected and analyzed. Biograph TruePoint 40 with TrueV, (Siemens) was used as a PET/CT scanner. Scenium(version 4.0) in Syngo.via(version VA30A) and SPM99 were applied for statistical evaluation. Consistency between PET reading and result of DCM were evaluated by 5 nuclear medicine physicians through a questionnaire survey. SUV and SD changes were evaluated by changing iteration, gaussian filter and matrix size in scenium. And average required time for generating result of SPM99 and scenium was compared by 3 medical technologists. Results Consistency from the result of SPM99 and scenium showed 84% and 92.4% compare to PET reading. When iteration 4, FWHM 8 and matrix size 168, SUV and SD were decreased by 0.59%, 8.73%, 4.69%, 20.38% and 0.88%, 8.25% respectively compare to routine parameter(iteration 8, FWHM 2 and matrix size 336) of scenium. Average required time of SPM99 and Scenium took 282 seconds and 116 seconds to generate result. Conclusion Results of SPM99 and Scenium showed high consistency compare to PET reading. Various parameters can be controled by user when using SPM. However, normal database needs to be acquired. And it takes significant amount of time and effort for the first set up. On the other hand, Scenium provides normal database even though modifiable parameters are limited. Therefore, more informations could be provided for brain PET/CT if properly understanding and selecting each DCM.

• The Journal of KAIRB
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• v.3 no.2
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• pp.19-27
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• 2021

Purpose: This study aimed to analyze the knowledge levels, attitudes, and factors affecting the choices on the education of the participants who completed their education of persons conducting clinical trial workers, and to assess the problems of the current education system for clinical trial workers, leading to improvements. Methods: Clinical trial workers (including principal investigators/subinvestigators, members of the Institutional Review Board [IRB], clinical research coordinators) who were affiliated to one of the 4 university hospitals running their own clinical trial center and IRB in Daegu and completed their education of persons conducting clinical trial workers were the subjects of this study. One hundred seven online questionnaires were answered from 2021-04-02 to 2021-04-17. Descriptive statistics and Pearson correlation analysis were used to analyze the acquired data. Independent t-test and 1-way analysis of variance were used to analyze the differences in the knowledge levels and attitudes following the characteristics of the education participants. Results: The baseline characteristics of the 107 participants were as follows: the majority of the participants were female (72.0%), were in their 30s (36.4%), had a nursing major (29.0%), were clinical research coordinators (63.6%), had never experienced a principal investigator (79.4%), had participated 3 or more educations (58.9%), had completed their maintenance course (55.1%), had 5 or more years of clinical trial experiences (34.6%). The fields on which participants had low levels of objective knowledge were "types and preparations on audits of clinical trials," "regulations on clinical trials (Pharmaceutical Affairs Act, Korea Good Clinical Practice)." The difficulties that the participants faced were on "annual educations" and "lack of information regarding the educations." Factors that showed significant differences in objective knowledge were sex (p=0.02), number of educations (p=0.004), the curriculum of 2020 (p=0.001). Age (p=0.004), having experienced a principal investigator (p=0.006), number of educations (p<0.001), the curriculum of 2020 (p<0.001), clinical trial career (p=0.001) were factors that significantly affected subjective knowledge. Attitudes toward the education were positively correlated with objective knowledge (r=0.20, p=0.04) and subjective knowledge (r=0.32, p=0.001). Major sources through which information on educations was acquired were "institutional notices," and major factors affecting the choices on the education were "when the education took place" and "where the education took place." "Within the affiliated institution," "Online classes (recorded)" and "IRB and review processes" were each the most preferred place, mode, and content of the education. Conclusion: Knowledge levels varied largely among participants who completed their education of persons conducting clinical trial workers, depending on their characteristics such as the number of educations. Participants also complained about their lack of information on educations. The quality of education may be improved if clinical trial organizations are designated as education facilities. Education programs must be developed considering the knowledge level and demand of the participants. Furthermore, as offline classes may be impossible due to pandemics such as the coronavirus disease 2019, the development of diverse and sophisticated online classes is looked forward to.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.19 no.1
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• pp.20-25
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• 2019

Very-long-chain acyl-CoA dehydrogenase (VLCAD) deficiency (OMIM#201475) is an autosomal recessively inherited metabolic disorder of mitochondrial long-chain fatty acid oxidation. The clinical features of VLCAD deficiency is classified by three clinical forms according to the severity. Here, we report a case of later-onset episodic myopathic form of VLCAD deficiency whose diagnosis was confirmed by plasma acylcarnitine analysis and" multigene panel multigene panel sequencing. A 34-year old female patient visited genetics clinic for genetic evaluation for history of recurrent myopathy with intermittent rhabdomyolysis. She suffered first episode of rhabdomyolysis with acute renal failure requiring hemodialysis at twelve years old. After then, she suffered several times of recurrent rhabdomyolysis provoked by prolonged exercise or fasting. Physical and neurologic exam was normal. Serum AST/ALT and creatinine kinase (CK) levels were mildly elevated. However, according to her previous medical records, her AST/ALT, CK were highly elevated when she had rhabdomyolysis. In suspicion of fatty acid oxidation disorder, multigene panel sequencing and plasma acylcarnitine analysis were performed in non-fasting, asymptomatic condition for the differential diagnosis. Plasma acylcarnitine analysis revealed elevated levels of C14:1 ($1.453{\mu}mol/L$; reference, 0.044-0.285), and C14:2 ($0.323{\mu}mol/L$; 0.032-0.301) and upper normal level of C14 ($0.841{\mu}mol/L$; 0.065 -0.920). Two heterozygous mutation in ACADVL were detected by multigene panel sequencing and confirmed by Sanger sequencing: c.[1202G>A(;) 1349G>A] (p.[(Ser 401Asn)(;)(Arg450His)]). Diagnosis of VLCAD deficiency was confirmed and frequent meal with low-fat diet was educated for preventing acute metabolic derangement. Fatty acid oxidation disorders have diagnostic challenges due to their intermittent clinical and laboratorial presentations, especially in milder late-onset forms. We suggest that multigene panel sequencing could be a useful diagnostic tool for the genetically and clinically heterogeneous fatty acid oxidation disorders.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.18 no.3
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• pp.78-86
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• 2018

Purpose: We aimed to delineate clinical spectrum and short-term effects after enzyme replacement therapy (ERT) for 5 mucopolysaccharidosis type II (MPS II). Methods: Five patients were diagnosed with MPS II by clinical findings, enzyme activity, and genetic testing. Idursulfase was administered by intravenous infusion at a dose of 0.5 mg/kg every week. Observational chart analysis of patients, who underwent systematic investigations more than 12 months after initiation of ERT was done retrospectively. Results: Three patients were classified as having the attenuated type, and 2 patients were classified as having the severe type. The median age at the diagnosis was 9.6 years (range 3.4-26 years). Four different mutations in 5 Korean patients (4 families) with MPS II were identified, among which two were novel mutations (1 small insertion mutation: p.Thr409Hisfs*22, and 1 missense mutation: p.Gly134Glu). Two severe type sibling patients with the same mutation had different clinical manifestation. Urinary glycosaminoglycan excretion decreased within the twelve months of ERT (P=0.043). Liver and spleen volumes showed reductions that were maintained in all patients (P=0.043 and P=0.043, respectively). Improvements were also noted in left ventricular mass index (P=0.042), shoulder flexion (P=0.043), shoulder abduction (P=0.039), knee flexion (P=0.043), elbow flexion (P=0.042), and respiratory distress index (P=0.041). Conclusion: This study demonstrates that Korean patients with MPS II are clinically heterogeneous and indicates that idursulfase is relatively effective in several clinical parameters including heart size and respiratory distress index without infusion-related reactions in patients with MPS II.

• The Korean Journal of Nuclear Medicine Technology
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• v.23 no.2
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• pp.29-37
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• 2019

Purpose DMIDR(Discovery Molecular Imaging Digital Ready, General Electric Healthcare, USA) is a PET/CT scanner designed to allow application of PSF(Point Spread Function), TOF(Time of Flight) and Q.Clear algorithm. Especially, Q.Clear is a reconstruction algorithm which can overcome the limitation of OSEM(Ordered Subset Expectation Maximization) and reduce the image noise based on voxel unit. The aim of this paper is to evaluate the performance of reconstruction algorithms and optimize the algorithm combination to improve the accurate SUV(Standardized Uptake Value) measurement and lesion detectability. Materials and Methods PET phantom was filled with $^{18}F-FDG$ radioactivity concentration ratio of hot to background was in a ratio of 2:1, 4:1 and 8:1. Scan was performed using the NEMA protocols. Scan data was reconstructed using combination of (1)VPFX(VUE point FX(TOF)), (2)VPHD-S(VUE Point HD+PSF), (3)VPFX-S (TOF+PSF), (4)QCHD-S-400((VUE Point HD+Q.Clear(${\beta}-strength$ 400)+PSF), (5)QCFX-S-400(TOF +Q.Clear(${\beta}-strength$ 400)+PSF), (6)QCHD-S-50(VUE Point HD+Q.Clear(${\beta}-strength$ 50)+PSF) and (7)QCFX-S-50(TOF+Q.Clear(${\beta}-strength$ 50)+PSF). CR(Contrast Recovery) and BV(Background Variability) were compared. Also, SNR(Signal to Noise Ratio) and RC(Recovery Coefficient) of counts and SUV were compared respectively. Results VPFX-S showed the highest CR value in sphere size of 10 and 13 mm, and QCFX-S-50 showed the highest value in spheres greater than 17 mm. In comparison of BV and SNR, QCFX-S-400 and QCHD-S-400 showed good results. The results of SUV measurement were proportional to the H/B ratio. RC for SUV is in inverse proportion to the H/B ratio and QCFX-S-50 showed highest value. In addition, reconstruction algorithm of Q.Clear using 400 of ${\beta}-strength$ showed lower value. Conclusion When higher ${\beta}-strength$ was applied Q.Clear showed better image quality by reducing the noise. On the contrary, lower ${\beta}-strength$ was applied Q.Clear showed that sharpness increase and PVE(Partial Volume Effect) decrease, so it is possible to measure SUV based on high RC comparing to conventional reconstruction conditions. An appropriate choice of these reconstruction algorithm can improve the accuracy and lesion detectability. In this reason, it is necessary to optimize the algorithm parameter according to the purpose.

• The Korean Journal of Nuclear Medicine Technology
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• v.22 no.2
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• pp.74-78
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• 2018

Purpose $[^{11}C]$acetate has been proved useful in detecting the myocardial oxygen metabolism and various malignancies including prostate cancer, hepatocellular carcinoma, renal cell carcinoma and brain tumors. The purpose of study was to improve the radiosynthesis yield of $[^{11}C]$acetate on a automated radiosynthesis module. Materials and Methods $[^{11}C]$acetate was prepared by carboxylation of grignard reagent, methylmagnesium chloride, with $[^{11}C]$$CO_2$ gas, followed by hydrolysis with 1 mM acetic acid and purification using solid phase extraction cartridges. The effect of the reaction temperature ($0^{\circ}C$, $10^{\circ}C$, $-55^{\circ}C$) and cyclotron beam time (10 min, 15 min, 20 min, 25 min) on the radiosynthesis yield were investigated in the $[^{11}C]$acetate labeling reaction. Results The maximum radiosynthesis yield was obtained at $-10^{\circ}C$ of reaction temperature. The radioactivities of $[^{11}C]$acetate acquired at $-10^{\circ}C$ reaction temperature was 2.4 times higher than those of $[^{11}C]$acetate acquired at $-55^{\circ}C$. Radiosynthesis yield of $[^{11}C]$acetate increased with increasing cyclotron beam time. Conclusion This study shows that radiosynthesis yield of $[^{11}C]$acetate highly dependent on reaction temperature. The best radiosynthesis yield was obtained in reaction of grignard reagent with $[^{11}C]$$CO_2$ at $-10^{\circ}C$. This radiolabeling conditions will be ideal for routine clinical application.

• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.54-61
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• 2020

Purpose: Brown tumor is a tumor-like disease that can occur as a linked disease of hyperparathyroidism which can causes osteoporosis, osteitis fibrosa cystica, pathologic fractures. Brown tumor has been reported as a case report, but there is no comprehensive report on the exact diagnosis and principle of management for osseous lesion. The purpose of this study is to report the treatment and results of osseous lesions through 5 cases. Materials and Methods: From February 2004 to May 2015, five cases of Brown tumor were diagnosed in Chosun University Hospital and Chonnam National University Hospital orthopedic department. Medical records and radiographs were reviewed retrospectively. Parathyroid tumors were surgically removed, and surgical treatment and observation were performed for orthopedic osseous lesions. Results: The mean length of the long axis of the symptomatic osseous lesion was 6.2 cm (4.5-9.0 cm). An average of 7.6 (range, 3 to 14) of high uptake osseous lesion showed in whole body bone scan. The absolute value, T-score and Z-score of the vertebrae and proximal femur were adequate for diagnosis of osteoporosis using dual energy X-ray absorptiometry bone mineral density at diagnosis and recovered to normal at the last follow-up. In laboratory tests, serum concentrations of total calcium, ionized calcium, inorganic phosphorus, serum alkaline phosphatase, and parathyroid hormone were helpful to diagnosis and normalized upon successful removal of parathyroid adenoma or cancer. Conclusion: For accurate diagnosis of Brown tumor, it should be accompanied by systemic examination as well as clinical symptoms, laboratory tests and radiologic examination for osseous lesions. And a good prognosis can be expected if the hyperparathyroidism is treated together with the comprehensive treatment of osseous lesions.

• KIPS Transactions on Computer and Communication Systems
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• v.11 no.9
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• pp.317-322
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• 2022

The rapid development of information technology is also bringing about many changes in the medical environment. In particular, it is leading the rapid change of medical image information systems using big data and artificial intelligence (AI). The prescription delivery system (OCS), which consists of an electronic medical record (EMR) and a medical image storage and transmission system (PACS), has rapidly changed the medical environment from analog to digital. When combined with multiple solutions, PACS represents a new direction for advancement in security, interoperability, efficiency and automation. Among them, the combination with artificial intelligence (AI) using big data that can improve the quality of images is actively progressing. In particular, AI PACS, a system that can assist in reading medical images using deep learning technology, was developed in cooperation with universities and industries and is being used in hospitals. As such, in line with the rapid changes in the medical image information system in the medical environment, structural changes in the medical market and changes in medical policies to cope with them are also necessary. On the other hand, medical image information is based on a digital medical image transmission device (DICOM) format method, and is divided into a tomographic volume image, a volume image, and a cross-sectional image, a two-dimensional image, according to a generation method. In addition, recently, many medical institutions are rushing to introduce the next-generation integrated medical information system by promoting smart hospital services. The next-generation integrated medical information system is built as a solution that integrates EMR, electronic consent, big data, AI, precision medicine, and interworking with external institutions. It aims to realize research. Korea's medical image information system is at a world-class level thanks to advanced IT technology and government policies. In particular, the PACS solution is the only field exporting medical information technology to the world. In this study, along with the analysis of the medical image information system using big data, the current trend was grasped based on the historical background of the introduction of the medical image information system in Korea, and the future development direction was predicted. In the future, based on DICOM big data accumulated over 20 years, we plan to conduct research that can increase the image read rate by using AI and deep learning algorithms.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.305-314
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• 2023

With the development of medical technology and radiation treatment equipment, the frequency of high-precision radiation therapy such as intensity modulation radiation therapy has increased. Image-guided radiation therapy has become essential for radiation therapy in precise and complex treatment plans. In particular, with the introduction of imaging equipment for diagnosis in a linear accelerator, CBCT scanning became possible, which made it possible to calibrate and correct the patient's posture through 3D images. Although more precise reproduction of the patient's posture has become possible, the exposure dose delivered to the patient during the image acquisition process cannot be ignored. Radiation optimization is necessary in the field of radiation therapy, and efforts to reduce exposure are necessary. However, when acquiring 3D CBCT images by changing the imaging conditions to reduce exposure, there should be no image quality or artefacts that would make it impossible to align the patient's position. In this study, Rando phantom was used to scan and evaluate images for each shooting condition. The highest SNR was obtained at 100 kV 80 mA 25 ms F1 filter 180°. As the tube voltage and tube current increased, the noise decreased, and the bowtie filter showed the optimal effect at high tube current. Based on the actual scanned images, it was confirmed that patient alignment was possible under all imaging conditions, and that image-guided radiation therapy for patient alignment was possible under the condition of 70 kV 10 mA 20 ms F0 filter 180°, which showed the lowest SNR. In this study, image evaluation was conducted according to the imaging conditions, and low tube voltage, tube current, and small rotation angle scan are expected to be effective in reducing radiation exposure. Based on this, the patient's exposure dose should be kept as low as possible during CBCT imaging.