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Outcomes of Combined Mitral Valve Repair and Aortic Valve Replacement (대동맥판막 치환술과 동반시행한 승모판막 성형술 결과)

  • Baek, Man-Jong;Na, Chan-Young;Oh, Sam-Se;Kim, Woong-Han;Whang, Sung-Wook;Lee, Cheol;Chang, Yun-Hee;Jo, Won-Min;Kim, Jae-Hyun;Seo, Hong-Ju;Kim, Soo-Cheol;Lim, Cheong;Kim, Wook-Sung;Lee, Young-Tak;Choi, Hyun-Seok;Moon, Hyun-Soo;Park, Young-Kwan;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.36 no.7
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    • pp.463-471
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    • 2003
  • The long-term results of combined mitral valve repair and aortic valve replacement (AVR) have not been well evaluated. This study was performed to investigate the early and long-term results of mitral valve repair with AVR. Material and Method: We retrospectively reviewed 45 patients who underwent mitral valve repair and AVR between September 1990 and April 2002. The average age was 47 years: 28 were men and 17 women. Twelve patients had atrial fibrillation and three had a previous cardiac operation. The mitral valve disease consisted of pure insufficiency (MR) in 34 patients, mitral stenosis (MS) in 3, and mixed lesion in 8. Mitral valve disease was due to rheumatic origin in 24 patients, degenerative in 11, annular dilatation in 8, and ischemia or endocarditis in 2. The functional anatomy of mitral valve was annular dilatation in 31 patients, chordal elongation in 19, leaflet thickening in 19, commissural fusion in 13, chordal fusion in 10, chordal rupture in 6, and so on. Aortic prostheses used included mechanical valve in 32 patients, tissue valve in 12, and pulmonary autograft in one. The techniques of mitral valve repair included annuloplasty in 32 patients and various valvuloplasty of 54 techniques in 29 patients. Total cardiopulmonary bypass and aortic cross clamp time were 204$\pm$62 minute and 153$\pm$57 minutes, respectively. Result: Early death was in one patient due to low output syndrome (2.2%). After follow up of 57$\pm$37 months, late death was in one patient and the actuarial survival at 10 years was 96$\pm$4%. Recurrent MR developed grade II or III in 11 patients and moderate MS in 3. Three patients required reoperation for valve-related complications. The actuarial freedom from recurrent MR, MS, and reoperation were 64$\pm$11%, 86$\pm$8%, and 89$\pm$7% respectively. Conclusion: Combined mitral valve repair with AVR offers good early and long-term survival, and adequate techniques and selection of indication of mitral valve repair, especially in rheumatic disease, are prerequisites for better long-term results.

A Pilot Study for the Feasibility of F-18 FLT-PET in Locally Advanced Breast Cancer: Comparison with F-18 FDG-PET (국소진행성 유방암에서 F-18 FLT-PET 적용 가능성에 대한 예비 연구: F-18 FDG-PET와 비교)

  • Hyuen, Lee-Jai;Kim, Euy-Nyong;Hong, Il-Ki;Ahn, Jin-Hee;Kim, Sung-Bae;Ahn, Sei-Hyun;Gong, Gyung-Yup;Kim, Jae-Seung;Oh, Seung-Jun;Moon, Dae-Hyuk;Ryu, Jin-Sook
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.1
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    • pp.29-38
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    • 2008
  • Purpose: The aim of this study was to investigate the feasibility of 3 ' -[F-18]fluoro-3 ' -deoxythymidine positron emission tomography(FLT-PET) for the detection of locally advanced breast cancer and to compare the degree of FLT and 2' -deoxy-2 ' -[F-18]fluoro-d-glucose(FDG) uptake in primary tumor, lymph nodes and other normal organs. Material & Methods: The study subjects consisted of 22 female patients (mean age; $42{\pm}6$ years) with biopsy-confirmed infiltrating ductal carcinoma between Aug 2005 and Nov 2006. We performed conventional imaging workup, FDG-PET and FLT PET/CT. Average tumor size measured by MRI was $7.2{\pm}3.4$ cm. With visual analysis, Tumor and Lymph node uptakes of FLT and FDG were determined by calculation of standardized uptake value (SUV) and tumor to background (TB) ratio. We compared FLT tumor uptake with FDG tumor uptake. We also investigated the correlation between FLT tumor uptake and FDG tumor uptake and the concordant rate with lymph node uptakes of FLT and FDG. FLT and FDG uptakes of bone marrow and liver were measured to compare the biodistribution of each other. Results: All tumor lesions were visually detected in both FLT-PET and FDG-PET. There was no significant correlation between maximal tumor size by MRI and SUVmax of FLT-PET or FDG-PET (p>0.05). SUVmax and $$SUV_{75} (average SUV within volume of interest using 75% isocontour) of FLT-PET were significantly lower than those of FDG-PET in primary tumor (SUVmax; $6.3{\pm}5.2\;vs\;8.3{\pm}4.9$, p=0.02 /$SUV_{75};\;5.3{\pm}4.3\;vs\;6.9{\pm}4.2$, p=0.02). There is significant moderate correlation between uptake of FLT and FDG in primary tumor (SUVmax; rho=0.450, p=0.04 / SUV75; rho=0.472, p=0.03). But, TB ratio of FLT-PET was higher than that of FDG-PET($11.7{\pm}7.7\;vs\;6.3{\pm}3.8$, p=0.001). The concordant rate between FLT and FDG uptake of lymph node was reasonably good (33/34). The FLT SUVs of liver and bone marrow were $4.2{\pm}1.2\;and\;8.3{\pm}4.9$. The FDG SUVs of liver and bone marrow were $1.8{\pm}0.4\;and\;1.6{\pm}0.4$. Conclusion: The uptakes of FLT were lower than those of FDG, but all patients of this study revealed good FLT uptakes of tumor and lymph node. Because FLT-PET revealed high TB ratio and concordant rate with lymph node uptakes of FDG-PET, FLT-PET could be a useful diagnostic tool in locally advanced breast cancer. But, physiological uptake and individual variation of FLT in bone marrow and liver will limit the diagnosis of bone and liver metastases.

Effect of Acutely Increased Glucose Uptake on Insulin Sensitivity in Rats (단기간의 당섭취 증가가 인슐린 감수성에 미치는 영향)

  • Kim, Yong-Woon;Ma, In-Youl;Lee, Suck-Kang
    • Journal of Yeungnam Medical Science
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    • v.14 no.1
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    • pp.53-66
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    • 1997
  • Insulin resistance is a prominent feature of diabetic state and has heterogeneous nature. However, the pathogenetic sequence of events leading to the emergence of the defect in insulin action remains controversial. It is well-known that prolonged hyperglycemia and hyperinsulinemia are one of the causes of development of insulin resistance, but both hyperglycemia and hyperinsulinemia stimulate glucose uptake in peripheral tissue. Therefore, it is hypothesized that insulin resistance may be generated by a kind of protective mechanism preventing cellular hypertrophy. In this study, to evaluate whether the acutely increased glucose uptake inhibits further glucose transport stimulated by insulin, insulin sensitivity was measured after preloaded glucose infusion for 2 hours at various conditions in rats. And also, to evaluate the mechanism of decreased insulin sensitivity, insulin receptor binding affinity and glucose transporter 4 (GLUT4) protein of plasma membrane of gastrocnemius muscle were assayed after hyperinsulinemic euglycemic clamp studies. Experimental animals were divided into five groups according to conditions of preloaded glucose infusion: group I, basal insulin ($14{\pm}1.9{\mu}U/ml$) and basal glucose ($75{\pm}0.7mg/dl$), by normal saline infusion; group II, normal insulin ($33{\pm}3.8{\mu}U/ml$) and hyperglycemia ($207{\pm}6.3mg/dl$), by somatostatin and glucose infusion; group III, hyperinsulinemia ($134{\pm}34.8{\mu}U/ml$) and hyperglycemia ($204{\pm}4.6mg/dl$), by glucose infusion; group IV, supramaximal insulin ($5006{\pm}396.1{\mu}U/ml$) and euglycemia ($l00{\pm}2.2mg/dl$), by insulin and glucose infusion; group V, supramaximal insulin ($4813{\pm}687.9{\mu}U/ml$) and hyperglycemia ($233{\pm}3.1mg/dl$), by insulin and glucose infusion. Insulin sensitivity was assessed with hyperinsulinemic euglycemic clamp technique. The amounts of preloaded glucose infusion(gm/kg) were $1.88{\pm}0.151$ in group II, $2.69{\pm}0.239$ in group III, $3.54{\pm}0.198$ in group IV, and $4.32{\pm}0.621$ in group V. Disappearance rates of glucose (Rd, mg/kg/min) at steady state of hyperinsulinemic euglycemic clamp studies were $16.9{\pm}3.88$ in group I, $13.5{\pm}1.05$ in group II, $11.2{\pm}1.17$ in group III, $13.2{\pm}2.05$ in group IV, and $10.4{\pm}1.01$ in group V. A negative correlation was observed between amount of preloaded glucose and Rd (r=-0.701, p<0.001) when all studies were combined. Insulin receptor binding affinity and content of GLUT4 were not significantly different in all experimental groups. These results suggest that increased glucose uptake may inhibit further glucose transport and lead to decreased insulin sensitivity.

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Evaluation of Usability Both Oblique Verification for Inserted Fiducial Marker of Prostate Cancer Patients (Fiducial Marker가 삽입된 전립선암 환자를 대상으로 한 양사방향 촬영의 유용성 평가)

  • Kim, Koon Joo;Lee, Jung Jin;Kim, Sung Gi;Lim, Hyun Sil;Kim, Wan Sun;Kang, Su Man
    • The Journal of Korean Society for Radiation Therapy
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    • v.25 no.2
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    • pp.123-129
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    • 2013
  • Purpose: The way check the movement of the fiducial marker insertion in the treatment of patients with prostate cancer. However the existing methods of fiducial marker verification process difficult to identify the specific location of the marker behind the femur and pelvic bone. So to study the evaluation of maker match with using kilo voltage (KV) X-ray by On-board imager to both oblique verification method. Materials and Methods: Five patients were selected for rectal ballooning and inserted fiducial marker. Compare the position of the fiducial marker of reference plan 2D/2D Anterior/Posterior verification method and 2D/2D both oblique verification method. So to measurement the shift score of X, Y, Z (axis) and measure exposure dose given to patients and compare matching time. Results: 2 dimensional OBI KV X-ray imaging using two-dimensional matching image are orthogonal, so locating fiducial marker matching clear and useful DRR (digital reconstruction radiography) OBI souce angle ($45^{\circ}/315^{\circ}$) matching most useful. 2D/2D both oblique verification method was able to see clearly marker behind the pelvic bone. Also matching time can be reduced accordingly. According to the method of each matching results for each patient in each treatment fraction, X, Y, and Z axis the Mean $value{\pm}SD$ (standard deviation) is X axis (AP/LAT: $0.4{\pm}1.67$, OBLIQUE: $0.4{\pm}1.82$) mm, Y axis (AP/LAT: $0.7{\pm}1.73$, OBLIQUE: $0.2{\pm}1.77$) mm, Z axis (AP/LAT: $0.8{\pm}1.94$, OBLIQUE:$1.5{\pm}2.8$) mm. In addition, the KV X-ray source dose radiation exposure given to the patient taking average when AP/LAT matching is (0.1/2.1) cGY, when $315^{\circ}/45^{\circ}$ matching is (0.27/0.26) cGY. Conclusion: In conclusion for inserted fiducial marker of prostate cancer patients 2D/2D both oblique matching method is more accurate verification than 2D/2D AP/LAT matching method. Also the matching time less than the 2D/2D AP/LAT matching method. Taken as the amount of radiation exposure to patients less than was possible. Suggest would improve the treatment quality of care patients more useful to establish a protocol such as case.

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The Effect of Eating Habits and Lifestyle on the Food Intake of University Students in Daejeon (대전지역 대학생들의 식생활 실태 및 생활습관이 식품섭취에 미치는 영향)

  • 박상욱
    • Journal of the East Asian Society of Dietary Life
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    • v.14 no.1
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    • pp.11-19
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    • 2004
  • To investigate the effect of eating habits and lifestyle on the food intake of university students in Daejeon, 104 male students(26.75%) and 282 female students(73.75%) were surveyed about their food intake, eating habits, and lifestyle using the questionnaire. The major food served as breakfast was steamed rice(76.05%) and there was a little significant difference between male and female. The major food served as lunch was also steamed rice(73.77%) and male students ate it more than female ones. According to the survey, 41.95% of the subjects had breakfast regularly, and 24.35% seldom, which showed no significant difference between male and female. In case of lunch, the percentile of subjects(54.55%) who had regularly eaten lunch was more than that of breakfast, and there was a little significant difference between male and female. The survey said most subjects(49.22%) had eaten dinner irregularly, which rate was higher in male students. The meal skipped usually was the breakfast(24.35%), which rate was higher in female students. The reason why the subjects skipped the meal was mainly due to the lack of sufficient time for breakfast and lunch, and for dinner to the weight loss. Among the subjects, 80% said they were non-smokers; 96.44% in female students and 35.58% in male ones. In case of drinking, most subjects said they sometimes drank(67.19%) and the frequency of drinking was once or twice a month(51.99%), which showed the significant difference between male and female. In the aspects of effects of drinking and smoking on the food intake, the drinking practice after eating was shown to be the highest(55.98%); smoking generally affected the food intake, which showed the difference between male and female. Food intake during the examination period didn't show any differences to the usual one or increased a little bit, which showed a difference between male and female. Losing appetite during the examination period was shown mainly in the female students. When they felt blue or tired, the food intake decreased, which showed a significant difference between male and female was shown. When feeling good, the food intake significantly increased, which showed a significant difference between male and female. Therefore, there was a significant difference between male and female in the actual eating habits and in the aspects of food intake.

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CLINICAL AND NEUROPSYCHOLOGICAL CHARACTERISTICS OF DSM-IV SUBTYPES OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (주의력결핍 과잉행동장애의 아형별 신경심리학적 특성 비교)

  • Cheung, Seung-Deuk;Lee, Jong-Bum;Kim, Jin-Sung;Seo, Wan-Seok;Bai, Dai-Seg;Chun, Eun-Jin;Suh, Hae-Sook
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.13 no.1
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    • pp.139-152
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    • 2002
  • Objectives:This study was conducted to compare the clinical and neuropsychological characteristics by DSM-IV subtypes of attention deficit hyperactivity disorder(ADHD) patients who did not have comorbid psychiatric disorders. Methods:5-15 year old children with ADHD were recruited at psychiatric outpatient clinic of Yeungnam University hospital and the patients with comorbidity or neurological abnormalities were excluded. Finally, total 404 children with ADHD were selected for this study. There were 234 subjects of ADHD-C(57.9%), 156 subjects of ADHD-I(38.6%) and 14 subjects of ADHD-HI(3.5%), who fulfilled the DSM-IV diagnostic criteria. The mean age of the total subjects was 9.63±2.49 years old. The psychopathology, IQ, behavioral problems, neuropsychological executive function were evaluated before pharmacological treatment. The measures were Korean Personality Inventory of Child(K-PIC) for psychopathology, 4 behavioral check lists(ADDES-HV, ACTeRS, CAP, SNAP) for behavioral symptoms of ADHD, K-ABC and KEDI-WISC for IQ and Conner's CPT, WCST, SST for neuropsychological executive functions. Results:1) The prevalence of subtypes was ADHD-C, ADHD-I, ADHD-HI in decreasing order. There was no sex difference of prevalence among three subtypes. The mean age of ADHD-I was older than other subtypes. 2) There was significant differences of psychopathology among subtypes, the ADHD-C and ADHD-HI had higher than the ADHD-I in the scores of delinquent, hyperactivity and psychosis;the ADHD-C had higher than the ADHD-I in the scores of family relation and autism, the scores of ego resilience were lower than the ADHD-I. However, there was no difference in anxiety, depression and somatization scores among them. 3) The results of behavioral symptom check lists, the ADHD-C had higher the score of inattention, hyperactivity and impulsivity than the ADHD-I. Meanwhile the results of ACTeRs, which rated by the teachers, were different. 4) There were significant differences of sequential processing scale and arithmetics among subtypes in IQ using K-ABC, but there was no significant difference between the ADHD-C and the ADHD-I after excluding the ADHD-HI due to small numbers. 5) There was numerical difference among subtypes but did not reach statistical significance in three neuropsychological executive function tests. Conclusion:In conclusion, our results revealed that there was significant difference in clinical features among three subtypes but, no significant difference in executive functions.

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CLINICAL CHARACTERISTICS OF CHILD AND ADOLESCENT PSYCHIATRIC INPATIENTS WITH MOOD DISORDER (입원한 기분장애 소아청소년의 임상특성 - 주요 우울증과 양극성장애의 우울삽화 비교를 중심으로 -)

  • Cho, Su-Chul;Paik, Ki-Chung;Lee, Kyung-Kyu;Kim, Hyun-Woo;Hong, Kang-E;Lim, Myung-Ho
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.11 no.2
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    • pp.209-220
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    • 2000
  • The purpose of this study is to find out the characteristics of depressive episode about major depression and bipolar disorder in child and adolescent. The subjects of this study were 34 major depression patients and 17 bipolar disorder patients hospitalized at child and adolescent psychiatry in OO university children's hospital from 1st March 1993 to 31st October 1999. The method of this study is to review socio-demographic characteristics, diagnostic classification, chief problems and symptoms at admission, frequency of symptoms, maternal pregnancy problem history, childhood developmental history, coexisting psychiatric disorders, family psychopathology and family history and therapeutic response through their chart. 1) The ratio of male was higher than that of female in major depressive disorder while they are similar in manic episode, bipolar disorder. 2) Average onset age of bipolar disorder was 14 years 1 month and it was 12 years 8 months in the case of major depression As a result, average onset age of major depression is lower than that of bipolar disorder. 3) The patients complained of vegetative symptoms than somatic symptoms in both bipolar disorder and depressive disorder. Also, the cases of major depression developed more suicide idea symptom while the case of bipolar disorder developed more aggressive symptoms. In the respect of psychotic symptoms, delusion was more frequently shown in major depression, but halucination was more often shown in bipolar disorder. 4) Anxiety disorder coexisted most frequently in two groups. And there coexisted symptoms such as somartoform disorder, mental retardation and personality disorder in both cases. 5) The influence of family loading was remarkable in both cases. Above all, the development of major depression had to do with child abuse history and inappropriate care of family. It is apparent that there are distinctive differences between major depression and bipolar disorder in child and adolescent through the study, just as in adult cases. Therefore the differences of clinical characteristics between two disorders is founded in coexisting disorders and clinical symptoms including onset age, somatic symptoms and vegetative symptoms.

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Study on the Effect of Deep Fertilization on Paddy Field - Efficiency of Ball Complex Fertilizer Mixed with Zeolite - (수도(水稻)에 대(對)한 심층추비효과(深層追肥効果)에 관(關)한 연구(硏究) - Zeolite 첨가(添加) Ball complex 비료(肥料)의 비효(肥効) -)

  • Kim, Tai-Soon;U., Zang-Kual
    • Korean Journal of Soil Science and Fertilizer
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    • v.10 no.1
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    • pp.61-67
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    • 1977
  • A study was conducted in order to compare the topdressing method of the conventional fertilizers as control and the deep application method of the ball complex fertilizer newly developed. The ball complex fertilizer consisted of 5% of nitrogen, 5% of phosphorus, and 7% of potassium. Basal application of nitrogen for the rice plant was the same for both control plots and ball complex plots. One ball complex fertilizer per four hills was applied at depth of 12~13cm 35days before heading stage while control plot received three times topdressing at different growth stages as usual practice. The results obtained were as follows. 1. The ball complex fertilizer applied in the soil was continuously utilized by the rice plants until harvest time while nitrogen and potassium uptake of control plots was reduced rapidly after heading stage. Daily uptake of nitrogen and potassium per hill at maturing stage were 0.45mg and 0.68mg in control plots, but 4.80mg and 7.0mg respectively in ball complex plots. 2. Dry matter productivity of the rice plant in control plots, well coinciding with nutrients uptake pattern, was maximum just after heading stage decreased at maturing stage. But dry matter productivity in ball complex plots was much higher at maturing stage than at heading stage. 3. Ball complex application increased effective tillering rate, causing higher panicle number per hill. 4. Ball complex application brought about 528kg/10a of hulled grain yield while the conventional practice 423kg/10a. 5. Deep application of ball complex was superior to usual practice in terms of yield components such as panicle number per hill, filled grain number per panicle, maturing rate, and 1,000 grain weight. 6. From the morphological characteristics point of view, the deep application of ball complex made the flag leaf and the 2nd leaf heavier, larger and broader as compared to control treatment. 7. It is considered that by applying the ball complex fertilizer at depth of 12~13cm sufficient amount of nitrogen and potassium could be utilized by rice plants during the maturing stage and assimilated in the leaf blade, consequently making the flag leaf and the 2nd leaf bigger and healthier. The fact can easily explain that the ball complex plots had higher capacity of photosynthesis, less discoloration of lower leaves, bigger leaf area index, and better grain yield as compared to the conventional practice. In conclusion the deep application method of the ball complex fertilizer was superior to the routine topdressing method of the usual fertilizers.

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Relationship between Parental Career Support, Career Self-Regulation, and Career Identity - with Student Dep. of Radiologic Technology - (부모진로지지와 진로자기조절, 진로정체감의 관계 - 방사선과 학생 대상 -)

  • Kim, In-Sook;Lee, In-Ja
    • Journal of radiological science and technology
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    • v.38 no.3
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    • pp.295-304
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    • 2015
  • This study intended to examine the correlation of career self-regulation (plan and check-up, positive thinking, career feedback, environment formation for career) and career identity (career decision, indecisiveness, career indecision) caused by parental career support (informative, emotional, financial, and empirical) among freshmen, sophomores, and juniors in the radiotechnology department. For assessment, a survey was conducted and according to the results, there existed correlation as follows. Regarding parental career support, emotional support is plan and check-up (r=.25, p<.001), Career feedback (r=.54, p<.001), and positive thinking (r=.46, p<.001) showed high positive correlation while informative support showed correlation in all factors showing high correlation with environment formation for career (r=.22, p<.001), plan and check-up (r=.20, p<.001), career feedback (r=.24, p<.001), and positive thinking (r=.26, p<.001). Financial support career feedback (r=.33, p<.001) and positive thinking (r=.34, p<.001) showed somewhat higher correlation. All factors of environment formation for career (r=.18, p<.001), plan and check-up (r=.25, p<.001), career feedback (r=.37, p<.001), and positive thinking (r=.30, p<.001) showed high correlation. Informative support showed high correlation only with career decision (r=.27, p<.001) and financial support also showed high correlation only with career decision (r=.18, p<.001). Also, empirical support was somewhat highly correlated only with career decision (r=.23, p<.001). Regarding school-year difference depending on parental career support, there was significant difference between emotional support (F=8.52, p<.001), financial support (F=8.97, p<.001), and empirical support (F=5.36, p<.05) while informative support was dismissed. Regarding school-year difference depending on career self-regulation, there was significant difference between career feedback (F=8.48, p<.001) and positive thinking (F=16.29, p<.001) while environment formation for career and plan and check-up were dismissed. Regarding school-year difference depending on career identity, there was significant difference between career indecision (F=4.01, p<.05) and career decision (F=11.72, p<.001) while indecisiveness was dismissed. According to the analysis results, parents' active support to their child like respecting and listening to their opinion on career, provision of career related experience or information, and provision of necessary financial aid for their study or academic preparation made the students plan and exploring their career, examine accomplishment progress, have positive idea to realize their objectives. In addition, the students were able to establish the objective of their career by forming the environment that helped them realize their objectives by seeking advices and encouragement from surroundings. Meanwhile, the parents' attitude to respect and listen to their child's career related opinion affected their career decision and indecision. Although informative support helped the students' career decision, financial and empirical support caused effect only to career decision.

Comparison and evaluation between 3D-bolus and step-bolus, the assistive radiotherapy devices for the patients who had undergone modified radical mastectomy surgery (변형 근치적 유방절제술 시행 환자의 방사선 치료 시 3D-bolus와 step-bolus의 비교 평가)

  • Jang, Wonseok;Park, Kwangwoo;Shin, Dongbong;Kim, Jongdae;Kim, Seijoon;Ha, Jinsook;Jeon, Mijin;Cho, Yoonjin;Jung, Inho
    • The Journal of Korean Society for Radiation Therapy
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    • v.28 no.1
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    • pp.7-16
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    • 2016
  • Purpose : This study aimed to compare and evaluate between the efficiency of two respective devices, 3D-bolus and step-bolus when the devices were used for the treatment of patients whose chest walls were required to undergo the electron beam therapy after the surgical procedure of modified radical mastectomy, MRM. Materials and Methods : The treatment plan of reverse hockey stick method, using the photon beam and electron beam, had been set for six breast cancer patients and these 6 breast cancer patients were selected to be the subjects for this study. The prescribed dose of electron beam for anterior chest wall was set to be 180 cGy per treatment and both the 3D-bolus, produced using 3D printer(CubeX, 3D systems, USA) and the self-made conventional step-bolus were used respectively. The surface dose under 3D-bolus and step-bolus was measured at 5 measurement spots of iso-center, lateral, medial, superior and inferior point, using GAFCHROMIC EBT3 film (International specialty products, USA) and the measured value of dose at 5 spots was compared and analyzed. Also the respective treatment plan was devised, considering the adoption of 3D-bolus and stepbolus and the separate treatment results were compared to each other. Results : The average surface dose was 179.17 cGy when the device of 3D-bolus was adopted and 172.02 cGy when step-bolus was adopted. The average error rate against the prescribed dose of 180 cGy was -(minus) 0.47% when the device of 3D-bolus was adopted and it was -(minus) 4.43% when step-bolus was adopted. It was turned out that the maximum error rate at the point of iso-center was 2.69%, in case of 3D-bolus adoption and it was 5,54% in case of step-bolus adoption. The maximum discrepancy in terms of treatment accuracy was revealed to be about 6% when step-bolus was adopted and to be about 3% when 3D-bolus was adopted. The difference in average target dose on chest wall between 3D-bolus treatment plan and step-bolus treatment plan was shown to be insignificant as the difference was only 0.3%. However, to mention the average prescribed dose for the part of lung and heart, that of 3D-bolus was decreased by 11% for lung and by 8% for heart, compared to that of step-bolus. Conclusion : It was confirmed through this research that the dose uniformity could be improved better through the device of 3D-bolus than through the device of step-bolus, as the device of 3D-bolus, produced in consideration of the contact condition of skin surface of chest wall, could be attached to patients' skin more nicely and the thickness of chest wall can be guaranteed more accurately by the device of 3D-bolus. It is considered that 3D-bolus device can be highly appreciated clinically because 3D-bolus reduces the dose on the adjacent organs and make the normal tissues protected, while that gives no reduction of dose on chest wall.

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