Suggestion for Comprehensive Quality Assurance of Medical Linear Accelerator in Korea (국내 선형가속기의 포괄적인 품질관리체계에 대한 제언)
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- Progress in Medical Physics
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- v.26 no.4
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- pp.294-303
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- 2015
American Association of Physicists in Medicine (AAPM) Published Task Group 40 report which includes recommendations for comprehensive quality assurance (QA) for medical linear accelerator in 1994 and TG-142 report for recommendation for QA which includes procedures such as intensity-modulated radiotherapy (IMRT), stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) in 2010. Recently, Nuclear Safety and Security Commission (NSSC) published NSSC notification no. 2015-005 which is "Technological standards for radiation safety of medical field". This notification regulate to establish guidelines for quality assurance which includes organization and job, devices, methods/frequency/tolerances and action levels for QA, and to implement quality assurance in each medical institution. For this reason, all of these facilities using medical machine for patient treatment should establish items, frequencies and tolerances for proper QA for medical treatment machine that use the techniques such as non-IMRT, IMRT and SRS/SBRT, and perform quality assurance. For domestic, however, there are lack of guidelines and reports of Korean Society of Medical Physicists (KSMP) for reference to establish systematic QA report in medical institutes. This report, therefore, suggested comprehensive quality assurance system such as the scheme of quality assurance system, which is considered for domestic conditions, based the notification of NSSC and AAPM TG-142 reports. We think that the quality assurance system suggested for medical linear accelerator also help establishing QA system for another high-precision radiation treatment machines.
The requirements for medical laboratories ISO 15189 is examined in organization and a quality management system, stressing the importance of evidence, document control, and control of records and clinical material. Medical services are provided from the areas of resource management, and pre-examination, examination and post-examination processes. The main goal of ISO 15189 accreditation is to improve the quality of laboratory services provided for patients and clinical users not only through compliance with consensually developed and harmonized requirements but also by adopting the philosophy of continual improvement using the Plan-Do-Check-Act cycle. Laboratory quality should be evaluated and improved in all steps of the testing process as the state-of-the art indicates that the pre- and post-analytical phases are more vulnerable to errors than the intra-analytical phase. The Korea Laboratory Accreditation Scheme (KOLAS), a national accreditation body, provides medical laboratory accreditations for appropriate approaches to evaluating the competence of a medical laboratory in providing effective services to its customers and clinical users. Adoption of ISO 15189 in 2010s as a government policy has been delayed, and only 5 laboratories have been accredited to date in Korea. The medical laboratories should seek the adoption of ISO 15189 with a positive attitude for quality improvement and strengthening of international competitiveness.
Hanwoo young bulls are selected based on performance test using the weight at 12 months and pedigree index comprising marbling score. Pedigree index was not based on the progeny tested data but the breeding value of the proven bulls; resulting a lower accuracy. The progeny testing of the young bulls was categorized into testing at farm and at the test station. The farm tested data was difficult to compare with those from test station data. Farm tested bulls had different slaughter ages than those for test station bulls. Therefore, this study had considered a different age at slaughter for respective records on ultrasound traits. Records on body weight at 12 months, ultrasound measures at 12 and 24 months(uIMF, uEMA, uBFT, and uRFT), and carcass traits(CWT, EMA, BFT, and MS) were collected from steers and bulls of Hanwoo national improvement scheme between 2008 and 2013. Fixed effects of batch, test date, test station, personnel for measurement, personnel for judging, and a linear covariate of weight at measurement were fitted in the animal models for ultrasound traits. The ranges of heritability estimates of the ultrasound traits at 12 and 24 months were 0.21-0.43 and 0.32-0.47, respectively. Ultrasound traits at 12 and 24 months between similar carcass traits was genetically correlated at 0.52-0.75 and 0.86-0.89, respectively.
The purpose of this study is to analyze the ideological background, legal composition, and separation of powers contained within the institutional devices of The Dao Constitution based on the basic principles of the legal system, which would be embodied in The Constitution of the Republic of Korea. The ideological background of The Dao Constitution is that of the religion, Daesoon Jinrihoe. In Daesoon Jinrihoe, it is held that the Supreme God, Sangje, determined that Mutual Contention, the ruling pattern of the Former World, ran contrary to His divine will and this endangered the world as nature and humans had also fallen into Mutual Contention. As an act of divine intervention, Sangje established Mutual Beneficence so that nature and humanity could follow Mutual Beneficence as a paradigm shift culminating in a Great Opening of the universe. Sangje, the agent behind the paradigm shift, revealed His divine will that humans transform into mutually beneficent humans. Therefore, The Dao Constitution was written to be a set of fundamental norms based on the 'rights and obligations of the members of Daesoon Jinrihoe' to accept and implement the will of Sangje as it applies to each member's mission. The legal composition of The Dao Constitution consists of the body and supplementary provisions. The text consists of general rules, moral rights and obligations, origins, and institutional devices. Institutional devices include the Central Council, the Institute of Propagation and Edition, the Institute of Religious Services, Works, Financial Management, and the Institute of Audit and Inspection. The legal composition of The Dao Constitution is similar to that of the Constitution. The difference is that while the Constitution applies a 'principle of maximum rights and minimum obligations,' The Dao Constitution stipulates more obligations than rights in order to complete the mission of the members. The principle of separation of powers is applied to the institutional devices in The Dao Constitution. In The Dao Constitution, the organizational form of the central headquarters has been divided into a 'before and after' scheme surrounding the death of Dojeon. The organizational form of the central headquarters prior to Dojeon's death was similar to a Constitutional Monarchy. After the death of Dojeon, the central headquarters' organizational form became similar to a parliamentary cabinet system. The separation of powers at central headquarters is divided among a legislative power (the Central Council), an executive power (the Institute of Religious Services), and a judicial power (the Institute of Audit and Inspection). The separation of powers within the functions of the central government first occurs between the Central Council and its employees, then between the Central Council and the Institute of Auditing and Inspection, and also between the Legislative Government and the Institute of Religious Services. Furthermore, the principle of a vertical separation of powers exists between the central headquarters and the local organization.
The Naejeong, the inner court, which is one of the structures found in the temple complexes of Daesoon Jinrihoe. It serves the function of leading and controlling the operation and direction of Korean religions in general. Considering that the dictionary meaning of 'Naejeong' is 'a place to manage the affairs of the state from inside a palace,' the name and function of the structure appear to be in harmony. However, in the Daesoon Jinrihoe context, it is said that the name 'Naejeong (內庭 'Neiting' in Chinese)' is related to a verse from a Daoist scripture. It has not been revealed whether or not the scripture is historical, and what contents or contextual meanings it contains. This study tries to pursue this matter and introduce the original source of the Naejeong in Daesoon Jinrihoe as likely coming from Qianbapinxianjing (前八品仙經, The Former Scripture of the Eight Phases That Reveal the Means to Acquire Immortality). This scripture was compiled in Lüzu-quanshu(呂祖全書, The Entire Collection of Ancestor Lü). This text and its contextual meanings will also be examined. The origin of Qianbapinxianjing dates back to either the late Ming Dynasty or the early Qing. In those days, there existed a group of literati who worshipped Ancestor Lü because he had saved people and taught the art of immortality. The group organized Daoist Spirit-Writing Altars (鸞壇道敎) and invoked the spirit of Ancestor Lü. They were said to have been taught through messages received from spirit-writing sessions (降乩) with Ancestor Lü and several Daoist scriptures were composed by them in this manner. At Immortals-Gathering Pavilion (集仙樓) of Wandian (萬店) in Guangling (廣陵), China, some literati in that group conducted a spirit-writing session with Ancestor Lü between 1589 and 1626, and they produced a scripture which contained the passage, "A crow and a rabbit gather in the middle valley (烏兎結中谷) while a turtle entwined with a snake is in the inner court (龜蛇盤內庭)." They titled the scripture, The Five Movements and Filial Piety (五行端孝). This passage symbolically expresses the accomplishment of immortality in Neidan (internal alchemy) which, within the human body, combines the two energies of yin and yang which are Water and Fire in the Five Movements scheme. This kind of cultivation is said to be achieved only by maintaining the highest possible degree of filial piety. In this context, the Naejeong where a turtle is entwined with a snake (龜蛇合體) was a term that symbolically depicted a place wherein one transforms into an immortal through cultivation. The Five Movements and Filial Piety was included in Qianbapinxianjing after it had been compiled with the other scriptures containing Ancestor Lü's teachings. In 1744, Qianbapinxianjing was included in Lüzu-quanshu, the entire 32-volume collection of Ancestor Lü and printed for the first time. This underlies the belief in Ancestor Lü (呂祖信仰) which embraces the idea of the redemption of people, teaches the arts of immortality, and features Daoist Spirit-Writing Altars, filial piety, the art of Neidan, and the combination of Water and Fire.
Recently, the environment of a hospital information system is a trend to combine various SMART technologies. Accordingly, various smart devices, such as a smart phone, Tablet PC is utilized in the medical information system. Also, these environments consist of various applications executing on heterogeneous sensors, devices, systems and networks. In these hospital information system environment, applying a security service by traditional access control method cause a problems. Most of the existing security system uses the access control list structure. It is only permitted access defined by an access control matrix such as client name, service object method name. The major problem with the static approach cannot quickly adapt to changed situations. Hence, we needs to new security mechanisms which provides more flexible and can be easily adapted to various environments with very different security requirements. In addition, for addressing the changing of service medical treatment of the patient, the researching is needed. In this paper, we suggest a dynamic approach to medical information systems in smart mobile environments. We focus on how to access medical information systems according to dynamic access control methods based on the existence of the hospital's information system environments. The physical environments consist of a mobile x-ray imaging devices, dedicated mobile/general smart devices, PACS, EMR server and authorization server. The software environment was developed based on the .Net Framework for synchronization and monitoring services based on mobile X-ray imaging equipment Windows7 OS. And dedicated a smart device application, we implemented a dynamic access services through JSP and Java SDK is based on the Android OS. PACS and mobile X-ray image devices in hospital, medical information between the dedicated smart devices are based on the DICOM medical image standard information. In addition, EMR information is based on H7. In order to providing dynamic access control service, we classify the context of the patients according to conditions of bio-information such as oxygen saturation, heart rate, BP and body temperature etc. It shows event trace diagrams which divided into two parts like general situation, emergency situation. And, we designed the dynamic approach of the medical care information by authentication method. The authentication Information are contained ID/PWD, the roles, position and working hours, emergency certification codes for emergency patients. General situations of dynamic access control method may have access to medical information by the value of the authentication information. In the case of an emergency, was to have access to medical information by an emergency code, without the authentication information. And, we constructed the medical information integration database scheme that is consist medical information, patient, medical staff and medical image information according to medical information standards.y Finally, we show the usefulness of the dynamic access application service based on the smart devices for execution results of the proposed system according to patient contexts such as general and emergency situation. Especially, the proposed systems are providing effective medical information services with smart devices in emergency situation by dynamic access control methods. As results, we expect the proposed systems to be useful for u-hospital information systems and services.
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70
The wall shear stress in the vicinity of end-to end anastomoses under steady flow conditions was measured using a flush-mounted hot-film anemometer(FMHFA) probe. The experimental measurements were in good agreement with numerical results except in flow with low Reynolds numbers. The wall shear stress increased proximal to the anastomosis in flow from the Penrose tubing (simulating an artery) to the PTFE: graft. In flow from the PTFE graft to the Penrose tubing, low wall shear stress was observed distal to the anastomosis. Abnormal distributions of wall shear stress in the vicinity of the anastomosis, resulting from the compliance mismatch between the graft and the host artery, might be an important factor of ANFH formation and the graft failure. The present study suggests a correlation between regions of the low wall shear stress and the development of anastomotic neointimal fibrous hyperplasia(ANPH) in end-to-end anastomoses. 30523 T00401030523 ^x Air pressure decay(APD) rate and ultrafiltration rate(UFR) tests were performed on new and saline rinsed dialyzers as well as those roused in patients several times. C-DAK 4000 (Cordis Dow) and CF IS-11 (Baxter Travenol) reused dialyzers obtained from the dialysis clinic were used in the present study. The new dialyzers exhibited a relatively flat APD, whereas saline rinsed and reused dialyzers showed considerable amount of decay. C-DAH dialyzers had a larger APD(11.70