• Imaging Science in Dentistry
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• 제42권2호
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• pp.65-70
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• 2012

Purpose : The aim of this study was to compare the effective dose for imaging of mandible between multi-detector computed tomography (MDCT) and cone-beam computed tomography (CBCT). An MDCT with low dose technique was also compared with them. Materials and Methods : Thermoluminescent dosimeter (TLD) chips were placed at 25 organ sites of an anthropomorphic phantom. The mandible of the phantom was exposed using 2 different types of MDCT units (Somatom Sensation 10 for standard-dose MDCT, Somatom Emotion 6 for low-dose MDCT) and 3 different CBCT units (AZ3000CT, Implagraphy, and Kavo 3D eXaM). The radiation absorbed dose was measured and the effective dose was calculated according to the ICRP 2007 report. Results : The effective dose was the highest for Somatom Sensation 10 (425.84 ${\mu}Sv$), followed by AZ3000CT (332.4 ${\mu}Sv$), Somatom Emotion 6 (199.38 ${\mu}Sv$), and 3D eXaM (111.6 ${\mu}Sv$); it was the lowest for Implagraphy (83.09 ${\mu}Sv$). The CBCT showed significant variation in dose level with different device. Conclusion : The effective doses of MDCTs were not significantly different from those of CBCTs for imaging of mandible. The effective dose of MDCT could be markedly decreased by using the low-dose technique.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제39권
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• pp.30.1-30.7
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• 2017

Background: The positions of the mandibular lingula and foramen have been set as indexes for inferior alveolar nerve (IAN) block and ramus osteotomies in orthognathic surgery. This study aimed to evaluate the anatomical structures of mandibular ramus, especially the mandibular lingula and foramen, by analyzing the cone-beam computed tomography (CBCT) data of young adults. Methods: We evaluated 121 sides of hemi-mandibular CBCT model of 106 patients (51 male and 55 female patients; 18 to 36 years old). All the measurements were performed using the 2- and 3-dimensional rulers of $OnDemand3D^{(R)}$ software. Results: Statistical analysis of the data revealed that there was no significant difference in the mandibular angle between the genders. The mandibular lingula was found to be located at the center of ramus in males, but a little posterior in relation to the center in females. The mandibular lingula was rarely located below the occlusal plane; however, the position of the mandibular foramen was more variable (84.3% below, 12.4% above, and 3.3% at the level of the occlusal plane). Conclusions: The results of this study provide a valuable guideline for IAN block anesthesia and orthognathic surgery. CBCT can be considered effective and accurate in evaluating the fine structures of the mandible.

• Imaging Science in Dentistry
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• 제51권1호
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• pp.41-47
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• 2021

Purpose: This study aimed to compare the accuracy of 3-dimensional(3D) printed models derived from multidetector computed tomography (MDCT) and cone-beam computed tomography (CBCT) systems with different fields of view (FOVs). Materials and Methods: Five human dry mandibles were used to assess the accuracy of reconstructions of anatomical landmarks, bone defects, and intra-socket dimensions by 3D printers. The measurements were made on dry mandibles using a digital caliper (gold standard). The mandibles then underwent MDCT imaging. In addition, CBCT images were obtained using Cranex 3D and NewTom 3G scanners with 2 different FOVs. The images were transferred to two 3D printers, and the digital light processing (DLP) and fused deposition modeling (FDM) techniques were used to fabricate the 3D models, respectively. The same measurements were also made on the fabricated prototypes. The values measured on the 3D models were compared with the actual values, and the differences were analyzed using the paired t-test. Results: The landmarks measured on prototypes fabricated using the FDM and DLP techniques based on all 4 imaging systems showed differences from the gold standard. No significant differences were noted between the FDM and DLP techniques. Conclusion: The 3D printers were reliable systems for maxillofacial reconstruction. In this study, scanners with smaller voxels had the highest precision, and the DLP printer showed higher accuracy in reconstructing the maxillofacial landmarks. It seemed that 3D reconstructions of the anterior region were overestimated, while the reconstructions of intra-socket dimensions and implant holes were slightly underestimated.

• 대한방사선치료학회지
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• 제25권2호
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• pp.159-165
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• 2013

목적: 복부압박장치를 적용한 정위적방사선치료 시 환자 호흡에 기인하는 내부종양용적의 동적변이 양상을 연구하고자 하였다. 대상 및 방법: 2012년 4월부터 2013년 4월까지 복부압박장치를 이용하여 정위적방사선치료를 받은 폐암 환자 20명(상엽 7명, 중엽 4명, 하엽 9명), 총 67건을 대상으로 하였다. 치료 자세의 변동과 호흡에 의해 움직이는 종양 위치 변동을 알아보기 위해 4차원 cone- beam CT (4D-CBCT)를 사용하여 좌표 이동 값을 얻었다. 각 부위별로 LR (좌우), SI (상하), AP (전후) 방향의 벡터의 95% 신뢰구간(95% Confidence interval, 95% CI), 최대값, 그리고 최소값을 통하여 비교하였으며 자세변동 보정 값과 호흡변동 보정 값 간의 피어슨 곱 상관계수를 통하여 일치도를 분석하였다. 결과: 호흡에 의한 종양용적의 각 부위별로 변동은 폐 상엽에서 1.8~2.9 mm, 중엽과 하엽에서 2.3~5.4 mm, 2.2~4.0 mm로 분석되었다(95%CI, P<0.001). 자세변동 보정 값과 호흡변동 보정 값 간의 일치도($R^2$)를 살펴보면 상엽은 LR방향, SI방향, AP 방향에서 각각 0.75, 0.68, 0.63으로 나타났고, 중엽은 각각 0.82, 0.51, 0.92로 나타났으며, 하엽은 각각 0.63, 0.50, 0.34로 나타났다. 결론: 폐암의 정위적방사선 치료 시 복부압박장치의 사용으로 폐에 위치하는 종양은 환자 호흡에 의해 각 부위별로 각기 다른 양상을 보였다. 따라서 치료 자세에 대한 보정뿐만 아니라 호흡에 의한 변동을 보정해야만 한다. 또한 이러한 각기 다른 동적변이로 인한 오차의 보정 시 4D-CBCT의 사용은 매우 유용한 것으로 사료된다.

• Imaging Science in Dentistry
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• 제53권4호
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• pp.283-289
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• 2023

The apnea-hypopnea index is widely regarded as a measure of the severity of obstructive sleep apnea (OSA), a condition characterized by recurrent episodes of apnea or hypopnea during sleep that induce airway collapse. OSA is a catastrophic problem due to the wide range of health issues it can cause, including cardiovascular disease and memory loss. This review was conducted to clarify the roles of various imaging modalities, particularly cone-beam computed tomography (CBCT), in the diagnosis of and preoperative planning for OSA. Unfortunately, 2-dimensional imaging techniques yield insufficient data for a comprehensive diagnosis, given the complex anatomy of the airway. Three-dimensional (3D) imaging is favored as it more accurately represents the patient's airway structure. Although computed tomography and magnetic resonance imaging can depict the actual 3D airway architecture, their use is limited by factors such as high radiation dose and noise associated with the scans. This review indicates that CBCT is a low-radiation imaging technique that can be used to incidentally identify patients with OSA, thereby facilitating early referral and ultimately enhancing the accuracy of surgical outcome predictions.

• 대한치과교정학회지
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• 제50권1호
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• pp.3-12
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• 2020

Objective: This study compared three prominent midsagittal planes (MSPs) to identify the MSP that best approximates the true symmetrical MSP. Methods: Forty-three patients (mean age, 23.0 ± 8.20 years) were grouped as follows: group 1 consisted of 10 patients with skeletal Class I and a menton (Me) deviation of < 2 mm; group 2, 11 patients with skeletal Class III and a Me deviation < 2 mm; group 3, nine patients with skeletal Class III and a Me deviation of 2 to less than 4 mm; and group 4, 13 patients with skeletal Class III and an Me deviation ≥ 4 mm. The candidate MSPs were established by three-dimensional (3D) cone beam computed tomography (CBCT) reorientation methods (RMs): (1) the MSP perpendicular to the Frankfort horizontal (FH) plane while passing through the crista galli and basion; (2) the MSP including the nasion, incisive foramen, and basion; (3) the MSP including the nasion, anterior nasal spine, and posterior nasal spine. The mean absolute distances (MADs) to the MSPs were calculated from the coordinates of 1,548 points on 129 CBCT images. The differences in the values of the 3D coordinates among RMs were compared. Results: The MADs of the three RMs showed significant differences (p < 0.05). Most of the differences in values of the coordinates were not significant among RMs. Conclusions: Although the differences in distance among the three MSPs were minor, the MSP perpendicular to the FH plane while passing through the crista galli and basion best approximated the true symmetrical MSP.

• 대한방사선치료학회지
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• 제32권
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• pp.41-52
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• 2020

목 적: Hypopharynx Cancer의 VMAT 치료 시 Neck 부분에 Commercial Bolus(이하 CB)와 3D Printing 기술로 제작한 3D Bolus를 각각 적용한 두 치료 계획을 비교함으로써 3D Bolus 적용의 선량학적 유용성, setup 재현성 및 효율성을 알아보고 임상적 적용 가능성을 평가하고자 한다. 대상 및 방법: CB를 적용한 RANDO phantom의 CT image를 바탕으로 3D Bolus를 동일한 형태로 제작하였다. 3D Bolus는 OMG SLA 660 Printer, MaterialiseMagics software를 이용하여 SLA기법을 통해 밀도 1.2 g/㎤의 폴리우레탄 아크릴레이트 수지로 출력하였다. CB와 3D Bolus를 적용한 두 CT image를 바탕으로 Hypopharynx Cancer의 VMAT 치료를 가정하여 치료 계획을 수립하였다. 수립한 두 치료 계획을 각각 18회에 걸쳐 CBCT image를 획득하였고, 매 회 setup time을 측정하여 치료 효율성을 평가하였다. 획득한 CBCT image를 바탕으로 전산화 치료계획 시스템 Pinnacle을 통해 Adaptive Plan을 진행함으로써 Target, 정상 장기 선량 평가와 Bolus Volume의 변화를 평가하였다. 결 과: 각 치료 계획에 대한 setup time은 CB 적용 치료 계획에 비해 3D Bolus 적용 치료 계획에서 평균 28 sec 감소하였다. 치료 전 기간 내 Bolus Volume 변화는 CB Initial Plan 83.9㎤에서 86.1±2.70㎤, 3D Bolus Initial Plan 92.2㎤에서 99.8±0.46㎤로 나타났다. CTV Min Value의 변화는 CB Initial Plan 191.6cGy에서 167.4±19.38cGy, 3D Bolus Initial Plan 167.3cGy에서 149.5±18.27cGy로 나타났다. CTV Mean Value의 변화는 CB Initial Plan 227.1cGy에서 228.3±0.38cGy, 3D Bolus Initial Plan 225.9cGy에서 227.7±0.30cGy로 나타났다. PTV Min Value의 변화는 CB Initial Plan 128.5cGy에서 74.9±19.47cGy, 3D Bolus Initial Plan 139.9cGy에서 83.2±12.92cGy로 나타났다. PTV Mean Value의 변화는 CB Initial Plan 225.4cGy에서 226.2±0.83cGy, 3D Bolus Initial Plan 224.1cGy에서 225.8±0.33cGy로 나타났다. 정상 장기 Spinal Cord에 대한 Max Value는 매 회 평균 135.6cGy로 동일하게 나타났다. 결 론: 본 논문의 실험 결과를 통해 불균등한 체표면에 대한 3D Bolus의 적용이 Commercial Bolus 적용에 비해 선량학적으로 유용하고 setup 재현성 및 효율성 또한 우수함을 알 수 있었다. 추후 3D Printing 재료의 다양성에 대한 연구와 함께 추가적인 사례 연구가 진행된다면 방사선 치료 분야에서 3D Bolus의 적용이 더욱 활발하게 진행될 것으로 사료된다.

• 치위생과학회지
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• 제22권4호
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• pp.249-255
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• 2022

Background: Sexual dimorphism is important for sex determination in the field of forensics. However, sexual dimorphism is commonly assessed using cone beam computed tomography (CBCT) rather than three-dimensional (3D) modeling software; therefore, studies using a more accurate measurement approach are necessary. This study assessed the sexual dimorphism of the MS using a 3D modeling program to obtain information that could contribute to the fields of surgery and forensics. Methods: The CBCT data of 60 patients (age, 20~29 y; 30 males and 30 females) admitted to the Department of Orthodontics at the Dankook University School of Dentistry were provided in Digital Imaging and Communications in Medicine (DICOM) format. The left MS and right MS were modeled based on the DICOM files using the Mimics (version 22; Materialise, Leuven, Belgium) 3D program and converted to stereolithography (STL) files used to measure the width, length, and height of the MS, infraorbital foramen (IOF), right MS, and left MS. The average of three repeated measurements was calculated, and a reliability test was performed to ensure data reliability (Cronbach's α=0.618). A canonical discriminant analysis was performed using a standard approach (left: Box's M=0.096; right: Box's M=0.115). Results: Males had greater values for all parameters (MS width, MS length, MS height, IOF, right MS, left MS) than females. The discriminant analysis identified six independent variables (MS width, MS height, MS length, IOF, right MS, left MS) that could identify sex. The left MS and right MS correctly identified the sex of 81.7% and 71.7% of the patients, respectively, with the left MS having higher accuracy. Conclusion: This study confirmed that, for Korean individuals, the left MS has a better ability to identify sex than the right MS. These results may contribute to sex identification in the fields of surgery and forensics.

• Radiation Oncology Journal
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• 제36권2호
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• pp.122-128
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• 2018

Purpose: To investigate positional uncertainty and its correlation with clinical parameters in spine stereotactic body radiotherapy (SBRT) using thermoplastic mask (TM) immobilization. Materials and Methods: A total of 21 patients who underwent spine SBRT for cervical or upper thoracic spinal lesions were retrospectively analyzed. All patients were treated with image guidance using cone beam computed tomography (CBCT) and 4 degrees-of-freedom (DoF) positional correction. Initial, pre-treatment, and post-treatment CBCTs were analyzed. Setup error (SE), pre-treatment residual error (preRE), post-treatment residual error (postRE), intrafraction motion before treatment (IM1), and intrafraction motion during treatment (IM2) were determined from 6 DoF manual rigid registration. Results: The three-dimensional (3D) magnitudes of translational uncertainties (mean ${\pm}$ 2 standard deviation) were $3.7{\pm}3.5mm$ (SE), $0.9{\pm}0.9mm$ (preRE), $1.2{\pm}1.5mm$ (postRE), $1.4{\pm}2.4mm$ (IM1), and $0.9{\pm}1.0mm$ (IM2), and average angular differences were $1.1^{\circ}{\pm}1.2^{\circ}$ (SE), $0.9^{\circ}{\pm}1.1^{\circ}$ (preRE), $0.9^{\circ}{\pm}1.1^{\circ}$ (postRE), $0.6^{\circ}{\pm}0.9^{\circ}$ (IM1), and $0.5^{\circ}{\pm}0.5^{\circ}$ (IM2). The 3D magnitude of SE, preRE, postRE, IM1, and IM2 exceeded 2 mm in 18, 0, 3, 3, and 1 patients, respectively. No association were found between all positional uncertainties and body mass index, pain score, and treatment location (p > 0.05, Mann-Whitney test). There was a tendency of intrafraction motion to increase with overall treatment time; however, the correlation was not statistically significant (p > 0.05, Spearman rank correlation test). Conclusion: In spine SBRT using TM immobilization, CBCT and 4 DoF alignment correction, a minimum residual translational uncertainty was 2 mm. Shortening overall treatment time and 6 DoF positional correction may further reduce positional uncertainties.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제31권2호
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• pp.158-166
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• 2009

The application of CT with basis on 3 dimensional-reconstruction is getting more widely practiced. With the data obtained from cone-beam computed tomography(CBCT), not only the diagnosis of the patient with skeletal abnormality but also the virtual simulation of the orthognathic surgery were performed and its application would be popular in orthodontic field. We reported a case, a 19-year old man who was diagnosed mandibular prognathism and required orthognatic surgery. In this case, the virtual orthognathic surgery was simulated and surgical wafer was fabricated by using CBCT data. That wafer was applied the actual orthognathic surgery. After preoperative orthodontic treatment, we prepared surgery as follows. : (l)Acquisition of 3D image data, (2)Reconstruction of 3-dimensional virtual model, (3)Virtual model surgery, (4)Extraction of stere-olithographic image, (5)Check-up for occlusal interference, (6)Fabrication of surgical stent by stereolithography. Bilateral sagittal split ramus osteotomy was operated and used stereolithographic surgical stent. 1 month later, we superimposed CBCT datas of virtual surgery and that of actual surgery, and then compared the result. CT data's application for othognathic surgery yielded satisfactory outcomes.