• The Journal of the Society of Korean Medicine Diagnostics
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• v.11 no.1
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• pp.146-156
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• 2007

1. The effect of variations in inspiration and expiration times on heart rate variability was studied in 78 healthy subjects (mean age $24.35{\pm}1.92$ years; 47 male) between regulated respiration group and normal respiration group as the control group. 2. The control group followed normal respiration pattern, whereas the regulated group followed three types of respiration pattern. The first pattern was long respiration(E/I ratio 1.6:1), the second pattern was short inspiration followed by long expiration (SILE), and the last pattern was long inspiration followed by short expiration(LISE). The average expiration/inspiration time ratios of SILE and LISE were 1.0 and 3.4, respectively. The respiration rate in the regulated group was approximately 10 cycles/min. 3. Respiration rate and tidal volume are respiratory variables known to modulate RSA. The results of the present study indicate that RSA can also be modulated by a third respiratory variable, the expiration/inspiratory time ratio. In this study, LF, HF, RSA, VLF is increased the most in LISE group compared to the other groups. HF and RSA increased significantly in the long respiration rate and SILE groups. However LF and VLF, which reflects the sympathetic tones, did not increase as much as the LISE group.

• Radiation Oncology Journal
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• v.27 no.1
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• pp.42-48
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• 2009

Purpose: The introduction of image guided radiation therapy/four-dimensional radiation therapy (IGRT/4DRT) potentially increases the accumulated dose to patients from imaging and verification processes as compared to conventional practice. It is therefore essential to investigate the level of the imaging dose to patients when IGRT/4DRT devices are installed. The imaging dose level was monitored and was compared with the use of pre-IGRT practice. Materials and Methods: A four-dimensional CT (4DCT) unit (GE, Ultra Light Speed 16), a simulator (Varian Acuity) and Varian IX unit with an on-board imager (OBI) and cone beam CT (CBCT) were installed. The surface doses to a RANDO phantom (The Phantom Laboratory, Salem, NY USA) were measured with the newly installed devices and with pre-existing devices including a single slice CT scanner (GE, Light Speed), a simulator (Varian Ximatron) and L-gram linear accelerator (Varian, 2100C Linac). The surface doses were measured using thermo luminescent dosimeters (TLDs) at eight sites-the brain, eye, thyroid, chest, abdomen, ovary, prostate and pelvis. Results: Compared to imaging with the use of single slice non-gated CT, the use of 4DCT imaging increased the dose to the chest and abdomen approximately ten-fold ($1.74{\pm}0.34$ cGy versus $23.23{\pm}3.67$cGy). Imaging doses with the use of the Acuity simulator were smaller than doses with the use of the Ximatron simulator, which were $0.91{\pm}0.89$ cGy versus $6.77{\pm}3.56$ cGy, respectively. The dose with the use of the electronic portal imaging device (EPID; Varian IX unit) was approximately 50% of the dose with the use of the L-gram linear accelerator ($1.83{\pm}0.36$ cGy versus $3.80{\pm}1.67$ cGy). The dose from the OBI for fluoroscopy and low-dose mode CBCT were $0.97{\pm}0.34$ cGy and $2.3{\pm}0.67$ cGy, respectively. Conclusion: The use of 4DCT is the major source of an increase of the radiation (imaging) dose to patients. OBI and CBCT doses were small, but the accumulated dose associated with everyday verification need to be considered.

• Journal of Yeungnam Medical Science
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• v.24 no.2
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• pp.344-350
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• 2007

Laryngo-tracheal perforation caused by the use of a stylet during tracheal intubation is a rare complication. We present a case of subcutaneous emphysema and connective tissue inflammation after tracheal intubation. The patient was a 41-year-old male undergoing general anesthesia for an appendectomy. The intubation was difficult during laryngoscopy (Cormack- Lehane Grade III). An assistant provided an endotracheal tube with a stylet inside while the laryngoscope was in place. During intubation, a short, dull sound was heard with a sudden loss of resistance after the distal tip of the endotracheal tube passed the rima glottis. A sonogram and computerized tomography revealed subcutaneous emphysema from the neck to the upper mediastinum and fluid collection between the trachea and the thyroid. This lesion appeared to have been caused by the protruded, loose stylet. Anesthesiologists should be aware of the damage a loose stylet protruding beyond the tip of the endotracheal tube can cause.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.61-72
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• 2022

Purpose: Conventional CBCT(Cone-beam Computed-tomography) caused an error in the target volume due to organ movement in the area affected by respiratory movement. The purpose of this paper is to evaluate the usefulness of accuracy and time spent using the Gated CBCT function, which reduces errors when performing RGRT(respiratory gated radiation therapy), and to examine the appropriateness of phase. Materials and methods: To evaluate the usefulness of Gated CBCT, the QUASAR^TM respiratory motion phantom was used in the Truebeam STx^TM. Using lead marker inserts, Gated CBCT was scaned 5 times for every 20~80% phase, 30~70% phase, and 40~60% phase to measure the blurring length of the lead marker, and the distance the lead marker moves from the top phase to the end of the phase was measured 5 times. Using Cedar Solid Tumor Inserts, 4DCT was scanned for every phase, 20-80%, 30-70%, and 40-60%, and the target volume was contoured and the length was measured five times in the axial direction (S-I direction). Result: In Gated CBCT scaned using lead marker inserts, the axial moving distance of the lead marker on average was measured to be 4.46cm in the full phase, 3.11cm in the 20-80% phase, 1.94cm in the 30-70% phase, 0.90cm in the 40-60% phase. In Fluoroscopy, the axial moving distance of the lead marker on average was 4.38cm and the distance on average from the top phase to the beam off phase was 3.342cm in the 20-80% phase, 3.342cm in the 30-70% phase, and 0.84cm in the 40-60% phase. Comparing the results, the difference in the full phase was 0.08cm, the 20~80% phase was 0.23cm, the 30~70% phase was 0.10cm, and the 40~60% phase was 0.07cm. The axial lengths of ITV(Internal Target Volume) and PTV(Planning Target Volume) contoured by 4DCT taken using cedar solid tumor inserts were measured to be 6.40cm and 7.40cm in the full phase, 4.96cm and 5.96cm in the 20~80% phase, 4.42cm and 5.42cm in the 30~70% phase, and 2.95cm and 3.95cm in the 40~60% phase. In the Gated CBCT, the axial lengths on average was measured to be 6.35 cm in the full phase, 5.25 cm in the 20-80% phase, 4.04 cm in the 30-70% phase, and 3.08 cm in the 40-60% phase. Comparing the results, it was confirmed that the error was within ±8.5% of ITV Conclusion: Conventional CBCT had a problem that errors occurred due to organ movement in areas affected by respiratory movement, but through this study, obtained an image similar to the target volume of the setting phase using Gated CBCT and verified its usefulness. However, as the setting phase decreases, the scan time was increases. Therefore, considering the scan time and the error in setting phase, It is recommended to apply it to patients with respiratory coordinated stereotactic radiation therapy using a wide phase of 30-70% or more.

• Korean Journal of Fisheries and Aquatic Sciences
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• v.12 no.2
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• pp.95-102
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• 1979

Brevibacterium flavum treated with phenol derivatives, guaiacol and o-vanillin has been revealed the marked increased ability in glutamic acid fermentation as 14.2 g/l in o-vanillin treated, 12.5 g/l in guaiacol treated while the 7.0 g/1 in nontreated cell. The increased ability of phenol derivatives treated cells in glutamic acid fermentation was ascribed to the formation of charge-transfer complex between phenols and oxygen. The charge-transfer complex effectively supply the oxygen to the fermention system in spite of high potential gradient in oxygen transfer formed by high cell concentration as insulator on film of air-liquid interface.

• The Transactions of the Korean Institute of Electrical Engineers D
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• v.53 no.10
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• pp.733-740
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• 2004

In this paper, an improved algorithm for the extraction of respiration signal from the electrocardiogram (ECG) is proposed. The whole system consists of two-lead electrocardiogram acquisition (lead Ⅰ and Ⅱ), baseline fluctuation elimination, R-wave detection, adjustment of sudden change in R-wave area using moving average, and optimal lead selection. In order to solve the problem of previous algorithms for the ECG-derived respiration (EDR) signal acquisition, we proposed a method for the optimal lead selection. An optimal EDR signal among the three EDR signals derived from each lead (and arctangent of their ratio) is selected by estimating the instantaneous frequency using the Hilbert transform, and then choosing the signal with minimum variation of the instantaneous frequency. The proposed algorithm was tested on 15 subjects, and we could obtain satisfactory respiration signals that shows high correlation (r>0.9) with the signal acquired from the chest-belt respiration sensor.

• The Journal of Korean Academy of Prosthodontics
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• v.37 no.1
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• pp.134-138
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• 1999

연구개는 그 주위조직과 더불어 생리적 기능에 있어 음성, 연하, 및 호흡 등에 중요한 역할을 한다. 종양등의 이유로 인한 연구개의 외과적 절제는 그 해부학적 크기와 모양의 영구적인 변화로 인해 여러기능의 상실을 초래한다. 이에 따른 결함은 과도한 비음, 연하중 음식물이나 유동물의 비관으로의 누출 등을 들 수 있다. 연구개와 그 주위조직의 생리적인 기능의 숙지 및 이를 응용한 보철물(Palatopharyngeal Obturator)의 적절한 제작은 이러한 기능적 결함을 수복하는데 이용되어진다. 본 증례에서는 종양으로 인해 연구개를 절제한 환자의 보철적 수복에 있어, 구강내 온도에 따라 그 형상이 변화하는 인상재를 이용하여, 측-후 인두벽의 운동을 기능적으로 인기하는 방법을 이용하였다. 이러한 방법으로 제작된 보철물은 종양으로 인한 연구개의 절제 후 생리적인 기능의 장애를, 올바른 Palatopharyngeal 폐쇠를 유도함으로써 음질의 향상, 연하등의 기능을 회복시키는데 큰 도움이 될 수 있음을 보여준다.

• Progress in Medical Physics
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• v.18 no.2
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• pp.81-86
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• 2007

The cone-beam CT (CBCT) which is acquired using on-board imager (OBI) attached to a linear accelerator is widely used for the image guided radiation therapy. In this study, the effect of respiratory motion on the quality of CBCT image was evaluated. A phantom system was constructed in order to simulate respiratory motion. One part of the system is composed of a moving plate and a motor driving component which can control the motional cycle and motional range. The other part is solid water phantom containing a small cubic phantom ($2{\times}2{\times}2cm^3$) surrounded by air which simulate a small tumor volume in the lung air cavity CBCT images of the phantom were acquired in 20 different cases and compared with the image in the static status. The 20 different cases are constituted with 4 different motional ranges (0.7 cm, 1.6 cm, 2.4 cm, 3.1 cm) and 5 different motional cycles (2, 3, 4, 5, 6 sec). The difference of CT number in the coronal image was evaluated as a deformation degree of image quality. The relative average pixel intensity values as a compared CT number of static CBCT image were 71.07% at 0.7 cm motional range, 48.88% at 1.6 cm motional range, 30.60% at 2.4 cm motional range, 17.38% at 3.1 cm motional range The tumor phantom sizes which were defined as the length with different CT number compared with air were increased as the increase of motional range (2.1 cm: no motion, 2.66 cm: 0.7 cm motion, 3.06 cm: 1.6 cm motion, 3.62 cm: 2.4 cm motion, 4.04 cm: 3.1 cm motion). This study shows that respiratory motion in the region of inhomogeneous structures can degrade the image quality of CBCT and it must be considered in the process of setup error correction using CBCT images.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.280-288
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• 2008

Purpose: To identify the inter-fractional shift pattern and to assess an adequate treatment margin in the radiotherapy of a liver tumor using mega-voltage computed tomography (MVCT) of a tomotherapy unit. Materials and Methods: Twenty-six patients were treated for liver tumors by tomotherapy from April 2006 to August 2007. The MVCT images of each patient were analyzed from the $1^{st}$ to the $10^{th}$ fraction for the assessment of the daily liver shift by four groups based on Couinard's proposal. Daily setup errors were corrected by bony landmarks as a prerequisite. Subsequently, the anterior-, posterior-, right-, and left shifts of the liver edges were measured by maximum linear discrepancies between the kilo-voltage computed tomography (KVCT) image and MVCT image. All data were set in the 2-dimensional right angle coordinate system of the transverse section of each patient's body. Results: The liver boundary shift had different patterns for each group. In group II (segment 2, 3, and 4), the anterior mean shift was $2.80{\pm}1.73\;mm$ outwards, while the left mean shift was $2.23{\pm}1.37\;mm$ inwards. In group IV (segment 7 and 8), the anterior-, posterior-, right-, and left mean shifts were $0.15{\pm}3.93\;mm$ inwards, $3.15{\pm}6.58\;mm$ inwards, $0.60{\pm}3.58\;mm$ inwards, and $4.50{\pm}5.35\;mm$ inwards, respectively. The reduced volume in group II after MVCT reassessment might be a consequence of stomach toxicity. Conclusion: Inter-fractional liver shifts of each group based on Couinard's proposal were somewhat systematic despite certain variations observed in each patient. The geometrical deformation of the liver by respiratory movement can cause shrinkage in the left margins of liver. We recommend a more sophisticated approach in free-breathing mode when irradiating the left lobe of liver in order to avoid stomach toxicity.

• The Journal of Korean Society for Radiation Therapy
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• v.35
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• pp.41-51
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• 2023

Purpose: This study compares and analyzes the image quality of 3D-CBCT(Cone Beam Computed-Tomography) and Gated CBCT according to baseline changes during SBRT(Stereotactic Body RadioTherapy) in lung cancer patients to find a useful CBCT method for correcting movement due to breathing Materials and methods : Insert a solid tumor material with a diameter of 3 cm into the QUASAR^TM phantom. 4-Dimentional Computed-Tomography(4DCT) images were taken with a speed of the phantom at period 3 sec and a maximum amplitude of 20 mm. Using the contouring menu of the computerized treatment planning system Eclipse^TM Gross Tumor Volume was outlined on solid tumor material. Set-up the same as when acquiring a 4DCT image using Truebeam STx^TM, breathing patterns with baseline changes of 1 mm, 3 mm, and 5 mm were input into the phantom to obtain 3D-CBCT (Spotlight, Full) and Gated-CBCT (Spotlight, Full) images five times repeatedly. The acquired images were compared with the Signal-to-Noise Ratio(SNR), Contrast-to-Noise Ratio(CNR), Tumor Volume Length, and Motion Blurring Ratio(MBR) based on the 4DCT image. Results: The average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Spotlight Gated CBCT images were 13.30±0.10%, 7.78±0.16%, 3.55±0.17%, 1.18±0.06%. As a result, Spotlight Gated-CBCT images according to baseline change showed better values than Spotligtht 3D-CBCT images. Also, the average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Full Gated CBCT images were 12.80±0.11%, 7.60±0.11%, 3.54±0.16%, 1.18±0.05%. As a result Full GatedCBCT images according to baseline change showed better values than Full 3D-CBCT images. Conclusion : Compared to 3D-CBCT images, Gated-CBCT images had better image quality according to the baseline change, and the effect of Motion Blurring Artifacts caused by breathing was small. Therefore, it is considered useful to image guided using Gated-CBCT when a baseline change occurs due to difficulty in regular breathing during SBRT that exposes high doses in a short period of time