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Influence of Change of Atmospheric Pressure and Temperature on the Occurrence of Spontaneous Pneumothorax (기압과 기온변화가 자발성 기흉 발생에 미치는 영향)

  • Lee, Gun;Lim, Chang-Young;Lee, Hyeon-Jae
    • Journal of Chest Surgery
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    • v.40 no.2 s.271
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    • pp.122-127
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    • 2007
  • Background: Spontaneous pneumothorax is a common respiratory condition and has been postulated that it develops because of rupture of subpleural blebs. Although the morphology and ultrastructure of causative lesions are well known, the reason for rupture of sbupleural blebs is not absolutely clear. Broad consensus concerning the role of meteorological factors in spontaneous pneumothorax dose not exist. The aim of the study was to examine the influence of change of atmospheric pressure and temperature on the occurrence of spontaneous pneumothorax. Material and Method: One hundred twenty eight consecutive spontaneous pnemothorax events that occurred between January 2003 and December 2004 were selected. Changes of meteorological factors of particular days from the day before for 5 consecutive days were calculated and compared between the days with pneumothorax occurrence (SP days) and the days without pneumothorax occurrence (Non SP days). The correation between change of pressure and temperature and the occurrence of SP was evaluated. Result: SP occurred on 117 days (16.0%) in the 2-year period. Although there was no significant differences in change of pressure factors prior 4 days of SP occurrence compare to the 4 days prior Non SP day, change of mean pressure was higher (+0.934 vs. -0.191hPa, RR 1.042, Cl $1.003{\sim}1.082$, p=0.033), and change of maximum pressure fall was lower (3.280 vs. 4.791 hPa, RR 1.051, Cl $1.013{\sim}l.090$, p=0.009) on the 4 days prior SP day. There were significant differences in change of temperature factors prior 2 days and the day of SP, Changes of mean temperature (-0.576 vs.+$0.099^{\circ}C$, RR 0.886, 95% Cl $0.817{\sim}0.962$, p=0.004) and maximum temperature rise (7.231 vs. $8.079^{\circ}C$, RR 0.943 Cl $0.896{\sim}0.993$, p=0.027) were lower on the 2 days prior SP. But changes of mean temperature (0.533 vs. $-0.103^{\circ}C$, RR 1.141, Cl $1.038{\sim}l.255$, p=0.006) and maximum temperature rise (9.209 vs. $7.754^{\circ}C$, RR 1.123, Cl $1.061{\sim}1.190$, p=0.006) and maximum temperature rise (9.209 vs. $7.754^{\circ}C$ RR 1.123, Cl $1.061{\sim}l.190$, p=0.000) were higher on the SP days. Conclusion: Charge of atmospheric pressure and temperature seems to influence the chance of occurrence of SP. Meteorological phenomena that pressure rise 4 day prior to SP and following temperature fall and rise might explain the occurrence of SP. Further studies should be continued in the future.

Comparison of Left Ventricular Volume and Function between 46 Channel Multi-detector Computed Tomography (MDCT) and Echocardiography (16 채널 Multi-detector 컴퓨터 단층촬영과 심초음파를 이용한 좌심실 용적과 기능의 비교)

  • Park, Chan-Beom;Cho, Min-Seob;Moon, Mi-Hyoung;Cho, Eun-Ju;Lee, Bae-Young;Kim, Chi-Kyung;Jin, Ung
    • Journal of Chest Surgery
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    • v.40 no.1 s.270
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    • pp.45-51
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    • 2007
  • Background: Although echocardiography is usually used for quantitative assessment of left ventricular function, the recently developed 16-slice multidetector computed tomography (MDCT) is not only capable of evaluating the coronary arteries but also left ventricular function. Therefore, the objective of our study was to compare the values of left ventricular function quantified by MDCT to those by echocardiography for evaluation of its regards to clinical applications. Material and Method: From 49 patients who underwent MDCT in our hospital from November 1, 2003 to January 31, 2005, we enrolled 20 patients who underwent echocardiography during the same period for this study. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), stroke volume index (SVI), left ventricular mass index (LVMI), and ejection fraction (EF) were analyzed. Result: Average LVEDVI ($80.86{\pm}34.69mL$ for MDCT vs $60.23{\pm}29.06mL$ for Echocardiography, p<0.01), average LVESVI ($37.96{\pm}24.52mL$ for MDCT vs $25.68{\pm}16.57mL$ for Echocardiography, p<0.01), average SVI ($42.90{\pm}15.86mL$ for MDCT vs $34.54{\pm}17.94mL$ for Echocardiography, p<0.01), average LVMI ($72.14{\pm}25.35mL$ for MDCT vs $130.35{\pm}53.10mL$ for Echocardiography, p<0.01), and average EF ($55.63{\pm}12.91mL$ for MOCT vs $59.95{\pm}12.75ml$ for Echocardiography, p<0.05) showed significant difference between both groups. Average LVEDVI, average LVESVI, and average SVI were higher in MDCT, and average LVMI and average EF were higher in echocardiogram. Comparing correlation for each parameters between both groups, LVEDVI $(r^2=0.74,\;p<0.0001)$, LVESVI $(r^2=0.69,\;p<0.0001)$ and SVI $(r^2=0.55,\;p<0.0001)$ showed high relevance, LVMI $(r^2=0.84,\;p<0.0001)$ showed very high relevance, and $EF (r^2=0.45,\;p=0.0002)$ showed relatively high relevance. Conclusion: Quantitative assessment of left ventricular volume and function using 16-slice MDCT showed high relevance compared with echocardiography, therefore may be a feasible assessment method. However, because the average of each parameters showed significant difference, the absolute values between both studies may not be appropriate for clinical applications. Furthermore, considering the future development of MDCT, we expect to be able to easily evaluate the assessment of coronary artery stenosis along with left ventricular function in coronary artery disease patients.

Changes of Brain Natriuretic Peptide Levels according to Right Ventricular HemodynaMics after a Pulmonary Resection (폐절제술 후 우심실의 혈역학적 변화에 따른 BNP의 변화)

  • Na, Myung-Hoon;Han, Jong-Hee;Kang, Min-Woong;Yu, Jae-Hyeon;Lim, Seung-Pyung;Lee, Young;Choi, Jae-Sung;Yoon, Seok-Hwa;Choi, Si-Wan
    • Journal of Chest Surgery
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    • v.40 no.9
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    • pp.593-599
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    • 2007
  • Background: The correlation between levels of brain natriuretic peptide (BNP) and the effect of pulmonary resection on the right ventricle of the heart is not yet widely known. This study aims to assess the relationship between the change in hemodynamic values of the right ventricle and increased BNP levels as a compensatory mechanism for right heart failure following pulmonary resection and to evaluate the role of the BNP level as an index of right heart failure after pulmonary resection. Material and Method: In 12 non small cell lung cancer patients that had received a lobectomy or pnemonectomy, the level of NT-proBNP was measured using the immunochemical method (Elecsys $1010^{(R)}$, Roche, Germany) which was compared with hemodynamic variables determined through the use of a Swan-Garz catheter prior to and following the surgery. Echocardiography was performed prior to and following the surgery, to measure changes in right ventricular and left ventricular pressures. For statistical analysis, the Wilcoxon rank sum test and linear regression analysis were conducted using SPSSWIN (version, 11.5). Result: The level of postoperative NT-proBNP (pg/mL) significantly increased for 6 hours, then for 1 day, 2 days, 3 days and 7 days after the surgery (p=0.003, 0.002, 0.002, 0.006, 0.004). Of the hemodynamic variables measured using the Swan-Ganz catheter, the mean pulmonary artery pressure after the surgery when compared with the pressure prior to surgery significantly increased at 0 hours, 6 hours, then 1 day, 2 days, and 3 days after the surgery (p=0.002, 0,002, 0.006, 0.007, 0.008). The right ventricular pressure significantly increased at 0 hours, 6 hours, then 1 day, and 3 days after the surgery (p=0.000, 0.009, 0.044, 0.032). The pulmonary vascular resistance index [pulmonary vascular resistance index=(mean pulmonary artery pressure-mean pulmonary capillary wedge pressure)/cardiac output index] significantly increased at 6 hours, then 2 days after the surgery (p=0.008, 0.028). When a regression analysis was conducted for changes in the mean pulmonary artery pressure and NT-proBNP levels after the surgery, significance was evident after 6 hours (r=0.602, p=0.038) and there was no significance thereafter. Echocardiography displayed no significant changes after the surgery. Conclusion: There was a significant correlation between changes in the mean pulmonary artery pressure and the NT-proBNP level 6 hours after a pulmonary resection. Therefore, it can be concluded that changes in NT-proBNP level after a pulmonary resection can serve as an index that reflects early hemodynamic changes in the right ventricle after a pulmonary resection.

Combined Modality Therapy with Selective Bladder Preservation for Muscle Invading Bladder Cancer (침윤성 방광암 환자에서 방광 보존 치료)

  • Youn Seon Min;Yang Kwang Mo;Lee Hyung Sik;Hur Won Joo;Oh Sin Geun;Lee Jong Cheol;Yoon Jin Han;Kwon Heon Young;Jung Kyung Woo;Jung Se Il
    • Radiation Oncology Journal
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    • v.19 no.3
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    • pp.237-244
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    • 2001
  • Purpose : To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. Method and Materials : From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by $39.6\~45\;Gy$ pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. Results : The Patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients $(81\%)$ successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients $(58\%)$ were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were $80\%\;and\;14\%$, respectively (u=0.001). Conclusion : In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.

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Treatment Results of CyberKnife Radiosurgery for Patients with Primary or Recurrent Non-Small Cell Lung Cancer (원발 혹은 재발성 비소세포 폐암 환자에서 사이버나이프률 이용한 체부 방사선 수술의 치료 결과)

  • Kim, Woo-Chul;Kim, Hun-Jung;Park, Jeong-Hoon;Huh, Hyun-Do;Choi, Sang-Huoun
    • Radiation Oncology Journal
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    • v.29 no.1
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    • pp.28-35
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    • 2011
  • Purpose: Recently, the use of radiosurgery as a local therapy in patients with early stage non-small cell lung cancer has become favored over surgical resection. To evaluate the efficacy of radiosurgery, we analyzed the results of stereotactic body radiosurgery in patients with primary or recurrent non-small cell lung cancer. Materials and Methods: We reviewed medical records retrospectively of total 24 patients (28 lesions) with non-small cell lung cancer (NSCLC) who received stereotactic body radiosurgery (SBRT) at Inha University Hospital. Among the 24 patients, 19 had primary NSCLC and five exhibited recurrent disease, with three at previously treated areas. Four patients with primary NSCLC received SBRT after conventional radiation therapy as a boost treatment. The initial stages were IA in 7, IB in 3, IIA in 2, IIB in 2, IIIA in 3, IIIB in 1, and IV in 6. The T stages at SBRT were T1 lesion in 13, T2 lesion in 12, and T3 lesion in 3. 6MV X-ray treatment was used for SBRT, and the prescribed dose was 15~60 Gy (median: 50 Gy) for PTV1 in 3~5 fractions. Median follow up time was 469 days. Results: The median GTV was 22.9 mL (range, 0.7 to 108.7 mL) and median PTV1 was 65.4 mL (range, 5.3 to 184.8 mL). The response rate at 3 months was complete response (CR) in 14 lesions, partial response (PR) in 11 lesions, and stable disease (SD) in 3 lesions, whereas the response rate at the time of the last follow up was CR in 13 lesions, PR in 9 lesions, SD in 2 lesions, and progressive disease (PD) in 4 lesions. Of the 10 patients in stage 1, one patient died due to pneumonia, and local failure was identified in one patient. Of the 10 patients in stages III-IV, three patients died, local and loco-regional failure was identified in one patient, and regional failure in 2 patients. Total local control rate was 85.8% (4/28). Local recurrence was recorded in three out of the eight lesions that received below biologically equivalent dose 100 $Gy_{10}$. Among 20 lesions that received above 100 $Gy_{10}$, only one lesion failed locally. There was a higher recurrence rate in patients with centrally located tumors and T2 or above staged tumors. Conclusion: SBRT using a CyberKnife was proven to be an effective treatment modality for early stage patients with NSCLC based on high local control rate without severe complications. SBRT above total 100 $Gy_{10}$ for peripheral T1 stage patients with NSCLC is recommended.

Effects of insulin and IGF on growth and functional differentiation in primary cultured rabbit kidney proximal tubule cells - Effects of IGF-I on Na+ uptake - (초대배양된 토끼 신장 근위세뇨관세포의 성장과 기능분화에 대한 insulin과 IGF의 효과 - Na+ uptake에 대한 IGF-I의 효과 -)

  • Han, Ho-jae;Park, Kwon-moo;Lee, Jang-hern;Yang, IL-suk
    • Korean Journal of Veterinary Research
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    • v.36 no.4
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    • pp.783-794
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    • 1996
  • It has been suggested that ion transport systems are intimately involved in mediating the effects of growth regulatory factors on the growth of a number of different types of animal cells in vivo. The functional importance of the apical membrane $Na^+/H^+$ antiporter in the renal proximal tubule is evidenced by estimates that this transporter mediates the reabsorption of approximately one third of the filtered load of sodium and the bulk of the secretion of hydrogen ions. This study was designed to investigate the pathway utilized by IGF-I in regulating sodium transport in primary cultured renal proximal tubule cells. Results were as follows : 1. $Na^+$ was observed to accumulate in the primary cells as a function of time. Raising the concentration of extracellular NaCl induced an decrease in $Na^+$ uptake compared with control cells in a dose dependent manner. The rate of $Na^+$ uptake into the primary cells was about two times higher in the absence of NaCl($40.11{\pm}1.76pmole\;Na^+/mg\;protein/min$) than in the presence of 140mM NaCl($17.82{\pm}0.94pmole\;Na^+/mg\;protein/min$) at the 30 minute uptake. 2. $Na^+$ uptake was inhibited by IAA($1{\times}10^{-4}M$) or valinomycin($5{\times}10^{-6}M$) treatment($50.51{\pm}4.04$ and $57.65{\pm}2.27$ of that of control, respectively). $Na^+$ uptake by the primary proximal tubule cells was significantly increased by ouabain($5{\times}10^{-5}M$) treatment($140.23{\pm}3.37%$ of that of control). When actinomycin D($1{\times}10^{-7}M$) or cycloheximide($4{\times}10^{-5}M$) was applied, $Na^+$ uptake was decreased to $90.21{\pm}2.39%$ or $89.64{\pm}3.69%$ of control in IGF-I($1{\times}10^{-5}M$) treated cells, respectively. 3. Extracellular cAMP decreased $Na^+$ uptake in a dose-dependent manner($10^{-8}-10^{-4}M$). IBMX($5{\times}10^{-5}M$) also inhibited $Na^+$ uptake. Treatment of cells with pertussis toxin(50pg/ml) or cholera toxin($1{\mu}g/ml$) inhibited $Na^+$ uptake. Extracellular PMA decreased $Na^+$ uptake in a dose-dependent manner(1-100ng/ml). 100 ng/ml PMA concentration significantly inhibited $Na^+$ uptake in IGF-I treated cells. However, staurosporine($1{\times}10^{-7}M$) had no effect on $Na^+$ uptake. When PMA and staurosporine were added together, the inhibition of $Na^+$ uptake was not observed. In conclusion, sodium uptake in primary cultured rabbit renal proximal tubule cells was dependent on membrane potentials and intracellular energy levels. IGF-I stimulates sodium uptake through mechanisms that involve some degree of de novo protein and/or RNA synthesis, and cAMP and/or PKC pathway mediating the action mechanisms of IGF-I.

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Development of Selective Heribicide for Control of Weeds in Turf (잔디밭 잡초방제(雜草防除)를 위한 선택성(選擇性) 제초제(除草劑)의 개발(開發)에 관한 연구(硏究))

  • Han, Seong-Soo
    • Korean Journal of Weed Science
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    • v.7 no.2
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    • pp.186-199
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    • 1987
  • This study was carried out to investigate the growth of Korean lawn grass (Zoysia japonica Steud.), penncross bentgrass (Agrostis palustris Huda) and seaside bentgrass (Agrostis spp.) under application of 21 pre- and post-emergence herbicides and the weeding effect of 14 annual and 4 perennial weeds with them for the purpose of the systematic chemical weed control in turf. The results obtained were as follows; 1. Napropamide, napropamide + triclopyr and benefin were safe for Korean lawn grass and two kinds of bentgrasses when they were treated at 4 and 25 days after transplanting of turfgrasses. Simazine, lenacil and bentazon inhibited the growth of bentgrasses, but not Korean lawn grass. 2. The preemergence application of simazine, benefin and napropamide + simazine showed excellent control for Digitaria sanguinalis, Cyperus amuricus, Chenopodium album, Portulaca oleracea and Centipeda minima. Lenacil was excellent for control of all the tested weeds except Chenopodium album, napropamide excellent for them except Cyperus amuricus and Portulaca oleraces, and bentazon good for them except Digitaria sanguinalis. When simazine was treated with either napropamide or triclopyr at preemergence of weeds, weeding effect increased without inhibition of lawn growth. 3. The postemergence application of mecoprop, bentazon, benefin + dicamba and benefin + mecoprop was safe to bentgrasses. All the tested postemergence herbicides except simazine + atrazine did not inhibit the growth of Korean lawn grass. 4. Other postemergence herbicides mecoprop and triclopyr were excellent for the control of Echinochloa crusgalli and those except benefin and mecoprop excellent for Kummerovia striata. Digitaria sanguinalis was controlled by treating with all the tested post emergence herbicides and Cyperus amuricus controlled only by bentazon. 5. The growth rates of bentgrasses treated with simazine, lenacil and napropamide + simazine were lower than that of hand-weeded check, and those of benefin, bentazon, napropamide, napropamide + triclopyr, stomp, bensulide and triclopyr were higher than that one when applied at spring season. Korean lawn grass growth appeared to be good under application of all the tested preemergence herbicides at spring. Lanacil and bentazone showed poor control of Echinochloa crusgalli, and bensulide showed poor control of Erigeron canadensis. Also, napropamide and bentazon were not good for Kummerovia striata control. However, at the respective rates of all the tested herbicides, these three weeds were greatly controlled by 85-100% of weeding effect. 6. At the application of autumn season, bentazon, napropamide, pendimethalin, benefin, napropamide + triclopyr, bensulide and triclopyr seemed to be safe against three kinds of turfgrasses. But simazine, napropamide + simazine inhibited the growth of bentgrasses except Korean lawn grass. In terms of weed control performance, triclopyr was poor for controlling Echinochloa crusgalli and bentazon and stomp for Poa annua, napropamide, benefin and bensulide for Stellaria medico. Stellaria uliginosa and Cerastium caespitosum were well controlled by all the tested preemergence herbicides. 7. Korean lawn grass was safe when paraquat and glyphosate were treated at the dormanant season of turfgrass. These herbicides showed excellent controll of Poa annua but poor control of perennials in order of Trifolium repens < Miscanthus sinensis < Calystegia japonica < Artemisia asiatica. 8. In field test, all of 19 herbicides seemed to be safe when treated at Korean lawn grass. All of 10 preemergence herbicides were excellent for controlling annual weeds, but poor for perennial ones. All of 9 postemergence herbicides showed a excellent control for broad-leaf weeds.

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Interlaboratory Comparison of Blood Lead Determination in Some Occupational Health Laboratories in Korea (일부 산업보건기관들의 혈중연 분석치 비교)

  • Ahn, Kyu Dong;Lee, Byung Kook
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.5 no.1
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    • pp.8-15
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    • 1995
  • The reliable measurement of metal in biological media in human body is one of critical indicators for the proper evaluation of its toxic effect on human health. Recently in Korea the necessity of quality assurance of measurement in occupational health and occupational hygiene fields brought out regulatory quality control program. Lead is often used as a standard metal for the program in both fields of occupational health and hygiene. During last 20 years lead poisoning was prevalent in Korea and still is one of main heavy metal poisoning and the capability of the measurement of blood lead is one of prerequisites for institute of specialized occupational health in Korea. Furthermore blood lead is most important indicator to evaluate lead burden of human exposure to lead and the reliable and accurate analysis is most needed whenever possible. To evaluate the extent of the interlaboratory differences of blood lead measurement in several well-known institute specialized in occupational health in Korea, authors prepared 68 blood samples from two storage battery industries and all samples were divided into samples with 2 ml. One set of 68 samples were analyzed by authors's laboratory(Soonchunhyang University Institute of Industrial Medicine: SIIM) and 40 samples of other set were analyzed by C University Institute of Industrial Medicine(CIIM) and the rest 28 samples of other set were analyzed by Japanese institute(K Occupational Health Center:KOHC). Authors also prepared test bovine samples which were obtained from Japanese Federation of Occupational Health Organization (JFOHO) for quality control. Authors selected 2 other well-known occupational health laboratories and one laboratory specialized for instrumental analysis. A total of 6 laboratories joined the interlaboratory comparison of blood lead measurement and the results obtained were as follows: 1. There was no significant difference in average blood lead between SIIM and CIIM in different group of blood lead concentration, and the relative standard deviation of two laboratories was less than 3.0%. On the other hand, there was also no significant difference of average blood lead between SIIM and KOHC with relative standard deviation of 6.84% as maximum. 2. Taking less than 15% difference of mean or less than 6 ug/dl difference in below 40 ug/dl in whole blood as a criteria of agreement of measurement between two laboratories, agreement rates were 87.5%(35/40) and 78.6%(22/28) between SIIM and CIIM, SIIM and KOHC respectively. 3. The correlation of blood lead between SIIM and CIIM was 0.975 (p=0.0001) and the regression equation was SIIM = 2.19 + 0.9243 ClIM, whereas the correlation between SUM and KOHC was O.965(p=0.0001) with the equation of SIIM = 1.91 + 0.9794 KOHC. 4. Taking the reference value as a dependent variable and each of 6 laboratories's measurement value as a independent variable, the determination coefficient($R^2$) of simple regression equations of blood lead measurement for bovine test samples were very high($R^2>0.99$), and the regression coefficient(${\beta}$) was between 0.972 and 1.15 which indicated fairly good agreement of measurement results.

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Quality Assurance for Intensity Modulated Radiation Therapy (세기조절방사선치료(Intensity Modulated Radiation Therapy; IMRT)의 정도보증(Quality Assurance))

  • Cho Byung Chul;Park Suk Won;Oh Do Hoon;Bae Hoonsik
    • Radiation Oncology Journal
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    • v.19 no.3
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    • pp.275-286
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    • 2001
  • Purpose : To setup procedures of quality assurance (OA) for implementing intensity modulated radiation therapy (IMRT) clinically, report OA procedures peformed for one patient with prostate cancer. Materials and methods : $P^3IMRT$ (ADAC) and linear accelerator (Siemens) with multileaf collimator are used to implement IMRT. At first, the positional accuracy, reproducibility of MLC, and leaf transmission factor were evaluated. RTP commissioning was peformed again to consider small field effect. After RTP recommissioning, a test plan of a C-shaped PTV was made using 9 intensity modulated beams, and the calculated isocenter dose was compared with the measured one in solid water phantom. As a patient-specific IMRT QA, one patient with prostate cancer was planned using 6 beams of total 74 segmented fields. The same beams were used to recalculate dose in a solid water phantom. Dose of these beams were measured with a 0.015 cc micro-ionization chamber, a diode detector, films, and an array detector and compared with calculated one. Results : The positioning accuracy of MLC was about 1 mm, and the reproducibility was around 0.5 mm. For leaf transmission factor for 10 MV photon beams, interleaf leakage was measured $1.9\%$ and midleaf leakage $0.9\%$ relative to $10\times\;cm^2$ open filed. Penumbra measured with film, diode detector, microionization chamber, and conventional 0.125 cc chamber showed that $80\~20\%$ penumbra width measured with a 0.125 cc chamber was 2 mm larger than that of film, which means a 0.125 cc ionization chamber was unacceptable for measuring small field such like 0.5 cm beamlet. After RTP recommissioning, the discrepancy between the measured and calculated dose profile for a small field of $1\times1\;cm^2$ size was less than $2\%$. The isocenter dose of the test plan of C-shaped PTV was measured two times with micro-ionization chamber in solid phantom showed that the errors upto $12\%$ for individual beam, but total dose delivered were agreed with the calculated within $2\%$. The transverse dose distribution measured with EC-L film was agreed with the calculated one in general. The isocenter dose for the patient measured in solid phantom was agreed within $1.5\%$. On-axis dose profiles of each individual beam at the position of the central leaf measured with film and array detector were found that at out-of-the-field region, the calculated dose underestimates about $2\%$, at inside-the-field the measured one was agreed within $3\%$, except some position. Conclusion : It is necessary more tight quality control of MLC for IMRT relative to conventional large field treatment and to develop QA procedures to check intensity pattern more efficiently. At the conclusion, we did setup an appropriate QA procedures for IMRT by a series of verifications including the measurement of absolute dose at the isocenter with a micro-ionization chamber, film dosimetry for verifying intensity pattern, and another measurement with an array detector for comparing off-axis dose profile.

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Radiotherapy in Incompletely Resected Gastric Cancers (불완전 절제된 위암의 방사선 치료)

  • Kim Jong Hoon;Choi Eun Kyung;Cho Jung Gil;Kim Byung Sik;Oh Sung Tae;Kim Dong Kwan;Chang Hyesook
    • Radiation Oncology Journal
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    • v.16 no.1
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    • pp.17-25
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    • 1998
  • Purpose : Although local recurrence rates of stomach cancer after radiocal surgery have been reported in the range of $30-70\%$, the role of postoperative adjuvant therapy has not been established. We report the result of radiotherapy in resected stomach cancer with positive surgical margin to elucidate the role of postoperative radiotherapy. Materials and Methods : From June 1991 to August 1996, twenty five patients with positive surgical margins after radical gastrectomy were treated with postoperative radiotherapy and chemotherapy. Median dose of radiation was 55.8Gy and the range was 44.6-59.4Gy. Second cycle of chemotherapy was delivered concurrently with radiation and total number of six cycles were delivered. Twenty three had adenocarcinoma and the other two had leiornyosarcoma. The numbers of patients with stage I B, II, III A, III B, and IV were 1, 2, 11, 10 and 1 respectively. Positive margins at distal end of the stomach were in 17 patients and proximal in 5. The other three patients had positive margin at the sites of adjacent organ invasion Minimum and median follow-up periods were 12 months and 18 months, respectively, Results : Twenty-four of 25 patients received prescribed radiation dose and RTOG grade 3 toxicity of UGI tract was observed in 3, all of which were weight loss more than $15\%$ of their pretreatment weight. But hematemesis. melena, intestinal obstruction or grade 4 toxicity were not found. Locoregional failure within the radiation field was observed in 7 patients, and distant metastasis in 10 patients. Sites of locoregional recurrences involve anastomosis/remnant stomach in 3, tumor bed/duodenal stump in 3, regional lymph node in 1 patient Peritoneal seeding occurred in 6, liver metastases months and median disease free survival time was 26 months. Stages andradiation dose were not significant prognostic factors for locoregional in 2, and distant nodes in 2 patients. Four year disease specificsurvival rate was $40\%$ and disease free survival was $48\%$. Median survival was 35 failures. Conculsion : Although all patients in this study had positive surgical margins, locoregional failure rate was $28\%$, and 4 year disease specific survival rate was $40\%$. Considering small number of patients and relatively short follow-up period, it is not certain that postoperative radiotherapy lowered locoregional recurrences. but we could find a Possibility of the role of postoperative radiotherapy in Patients with high risk factors.

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