• Journal of the Korean Society of Radiology
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• v.3 no.3
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• pp.5-11
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• 2009

When using Image Guided Radiation Therapy, the patient is placed using skin marker first and after confirming anatomical location using OBI, the couch is moved to correct the set up. Evaluation for the error made at that moment was done. Through comparing $0^{\circ}$ and $270^{\circ}$ direction DRR image and OBI image with 2D-2D matching when therapy planning, comparison between patient's therapy plan setup and actual treatment setup was made to observe the error. Treatment confirmation on important organs such as head, neck and spinal cord was done every time through OBI setup and other organs such as chest, abdomen and pelvis was done 2 ~ 3 times a week. But corrections were all recorded on OIS so that evaluation on accuracy could be made through using skin index which was divided into head, neck, chest and abdomen-pelvis on 160 patients. Average setup error for head and neck patient on each AP, SI, RL direction was $0.2{\pm}0.2cm$, $-0.1{\pm}0.1cm$, $-0.2{\pm}0.0cm$, chest patient was $-0.5{\pm}0.1cm$, $0.3{\pm}0.3cm$, $0.4{\pm}0.2cm$, and abdomen was $0.4{\pm}0.4cm$, $-0.5{\pm}0.1cm$, $-0.4{\pm}0.1cm$. In case of pelvis, it was $0.5{\pm}0.3cm$, $0.8{\pm}0.4cm$, $-0.3{\pm}0.2cm$. In rigid body parts such as head and neck showed lesser setup error compared to chest and abdomen. Error was greater on chest in horizontal axis and in AP direction, abdomen-pelvis showed greater error. Error was greater on chest in horizontal axis because of the curve in patient's body when the setup is made. Error was greater on abdomen in AP direction because of the change in front and back location due to breathing of patient. There was no systematic error on patient setup system. Since OBI confirms the anatomical location, when focus is located on the skin, it is more precise to use skin marker to setup. When compared with 3D-3D conformation, although 2D-2D conformation can't find out the rolling error, it has lesser radiation exposure and shorter setup confirmation time. Therefore, on actual clinic, 2D-2D conformation is more appropriate.

• Tuberculosis and Respiratory Diseases
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• v.56 no.6
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• pp.619-627
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• 2004

Background : Corticosteroids in combination with cytotoxic drugs are the mainstays of therapy for idiopathic pulmonary fibrosis (IPF). However, there has been no regimen showing any survival benefit. The aim of this study was to describe a short-term clinical experience on interferon gamma-1b (IFN-${\gamma}1b$) therapy for IPF, as an antifibrotic agent. Methods : Medical records of 27 patients who were treated with IFN-${\gamma}1b$ (2 million IU, 3 times a week, subcutaneous injection) were retrospectively reviewed. Treatment response was assessed using ATS/ERS criteria in 17 patients who received IFN-${\gamma}1b$ for more than 6 months. In addition, we compared the efficacy of IFN-${\gamma}1b$ therapy with that of cyclophosphamide${\pm}$prednisolone therapy (n=26). Results : The median age of IFN-${\gamma}$ treated group (M:F=19:8) was 59 years (44-74 years). Compared to the patients who showed a stable response at 6 months (n=12), the deteriorated group (n=5) had worse baseline lung function (FVC, $55.4{\pm}11.3%$ vs. $70.7{\pm}10.9%$, p=0.019; DLco, $50.3{\pm}7.3%$ vs. $76.9{\pm}19.6%$, p=0.014). Lower baseline $PaO_2$ on room air breathing was observed in the deteriorated group ($68.6{\pm}7.8mmHg$ vs. $91.4{\pm}6.6mmHg$ p=0.001). Subcutaneous IFN-${\gamma}1b$ did not show better efficacy than prednisolone. Five patients discontinued IFN-${\gamma}$ because of severe side effects. ARDS developed in one patient, who eventually died. Conclusion : The administration of IFN-${\gamma}1b$ is not desirable for patients diagnosed with IPF with poor lung function. Long-term and large-scaled clinical studies are needed for its efficacy in IPF.

• Tuberculosis and Respiratory Diseases
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• v.48 no.6
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• pp.956-963
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• 2000

Backgrounds : Obstructive sleep apnea syndrome(OSA) can divided into two groups, positional(PP) and non-positional(NPP) obstructive sleep apnea syndrome, according to the body position while sleeping. In this study, we evaluated the differences of anthropometric data and polysomnographic recordings between the two types of sleep apnea syndrome. Materials : Fifty patients with OSA were divided two groups by Cartwright's criteria. The supine respiratory disturbance index (RDI) was at least two times higher than the lateral RDI in the PP group, and the supine RDI was less than twice the lateral RDI in the NPP group. This patients underwent standardized polysomnographic recordings. The anthropometric data and polysomnographic data were analyzed, statistically. Results : Of all 50 patients, 30% were found to be positional OSA. BMI was significantly higher in the PP group(p<0.05). Total sleep time was significantly longer in the PP group (350.6$\pm$28.2min, 333.3$\pm$46.0min, (p<0.05). Sleep efficiency was high in the PP group(89.6$\pm$6.4%, 85.6$\pm$9.9%, p<0.05). Deep sleep was significantly higher and light sleep was lower in the PP group than in the NPP group but no difference was observed in REM sleep between the two groups. Apnea index(AI) and RDI were significantly lower( 17.0$\pm$10.6, 28.5$\pm$13.3, p<0.05) and mean arterial oxygen saturation was higher in the PP group(92.7$\pm$1.8%. p<0.05) than in the NPP group. Conclusion : Body position during sleep has a profound effect on the frequency and severity of breathing abnormalities in OSA patients. A polysomnographic evaluation for suspected OSA patients must include monitoring of the body position. Breathing function in OSA patients can be improved by controlling their obesity and through postural therapy.

• Progress in Medical Physics
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• v.25 no.2
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• pp.100-109
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• 2014

In stereotactic body radiotherapy (SBRT), the accurate location of treatment sites should be guaranteed from the respiratory motions of patients. Lots of studies on this topic have been conducted. In this letter, a new verification method simulating the real respiratory motion of heterogenous treatment regions was proposed to investigate the accuracy of lung SBRT for Volumetric Modulated Arc Therapy. Based on the CT images of lung cancer patients, lung phantoms were fabricated to equip in $QUASAR^{TM}$ respiratory moving phantom using 3D printer. The phantom was bisected in order to measure 2D dose distributions by the insertion of EBT3 film. To ensure the dose calculation accuracy in heterogeneous condition, The homogeneous plastic phantom were also utilized. Two dose algorithms; Analytical Anisotropic Algorithm (AAA) and AcurosXB (AXB) were applied in plan dose calculation processes. In order to evaluate the accuracy of treatments under respiratory motion, we analyzed the gamma index between the plan dose and film dose measured under various moving conditions; static and moving target with or without gating. The CT number of GTV region was 78 HU for real patient and 92 HU for the homemade lung phantom. The gamma pass rates with 3%/3 mm criteria between the plan dose calculated by AAA algorithm and the film doses measured in heterogeneous lung phantom under gated and no gated beam delivery with respiratory motion were 88% and 78%. In static case, 95% of gamma pass rate was presented. In the all cases of homogeneous phantom, the gamma pass rates were more than 99%. Applied AcurosXB algorithm, for heterogeneous phantom, more than 98% and for homogeneous phantom, more than 99% of gamma pass rates were achieved. Since the respiratory amplitude was relatively small and the breath pattern had the longer exhale phase than inhale, the gamma pass rates in 3%/3 mm criteria didn't make any significant difference for various motion conditions. In this study, the new phantom model of 4D dose distribution verification using patient-specific lung phantoms moving in real breathing patterns was successfully implemented. It was also evaluated that the model provides the capability to verify dose distributions delivered in the more realistic condition and also the accuracy of dose calculation.

• Progress in Medical Physics
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• v.25 no.3
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• pp.128-138
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• 2014

In gated radiation therapy (gRT), due to residual motion, beam delivery is intended to irradiate not only the true extent of disease, but also neighboring normal tissues. It is desired that the delivery covers the true extent (i.e. clinical target volume or CTV) as a minimum, although target moves under dose delivery. The objectives of our study are to validate if the intended dose is surely delivered to the true target in gRT and to quantitatively understand the trend of dose delivery on it and neighboring normal tissues when gating window (GW), motion amplitude (MA), and CTV size changes. To fulfill the objectives, experimental and computational studies have been designed and performed. A custom-made phantom with rectangle- and pyramid-shaped targets (CTVs) on a moving platform was scanned for four-dimensional imaging. Various GWs were selected and image integration was performed to generate targets (internal target volume or ITV) for planning that included the CTVs and internal margins (IM). The planning was done conventionally for the rectangle target and IMRT optimization was done for the pyramid target. Dose evaluation was then performed on a diode array aligned perpendicularly to the gated beams through measurements and computational modeling of dose delivery under motion. This study has quantitatively demonstrated and analytically interpreted the impact of residual motion including penumbral broadening for both targets, perturbed but secured dose coverage on the CTV, and significant doses delivered in the neighboring normal tissues. Dose volume histogram analyses also demonstrated and interpreted the trend of dose coverage: for ITV, it increased as GW or MA decreased or CTV size increased; for IM, it increased as GW or MA decreased; for the neighboring normal tissue, opposite trend to that of IM was observed. This study has provided a clear understanding on the impact of the residual motion and proved that if breathing is reproducible gRT is secure despite discontinuous delivery and target motion. The procedures and computational model can be used for commissioning, routine quality assurance, and patient-specific validation of gRT. More work needs to be done for patient-specific dose reconstruction on CT images.

• The Journal of Internal Korean Medicine
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• v.16 no.2
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• pp.146-177
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• 1995

The purpose of this study was to investigate the relationship between the teeth and Zhang-Fu(臟腑), dental diseases, and the hygiene of the mouth through the literature of oriental medicine. First, the relatonship between the teeth and Zhang-Fu is reviewed as follows: The teeth are influenced by Shen(腎) because they are the end of bone and Biao(標) of Shen. Gingiva is related to Wei(胃) and Da-Chang(大腸) because it is passed by Yangming-Channel(陽明經). The growth and nutrition of teeth depends on Shen. The pathological condition of Shen causes the gingival atrophy, the loose of teeth, dedentition due to aging, withering of teeth, and tartar: whereas the pathological condition of Wei and Da-Chang causes toothache, gingivitis, inflamed gums, bad breath, and gingival hemorrhage. Second, the causes and therapies of dental diseases through the literature can be summarized as follows: The major causes of toothache are the pathogenic condition of wind-heat and wind-cold, the heat syndrome of Wei, the damp-heat of intestine, flaring-up of fire of deficiency type, rotten tooth, etc... The principal causes of dedentition and the shaking and loose of teeth are the deficiency of Shen, and the rest of causes are the damp-heat of Yangming. Gingival atrophy is caused by the deficiency of Shen, whereas the gingival hemorrhage comes from the factors in the pathogenic factor of wind-heat of Yangming-Channel, the heat syndrome of stomach, and the deficiency of Shen. The causes of grinding of teeth during sleeping are stomach-heat, and the delayed dentition and the withering result from the deficiency of Shen-Jing.(腎精) The principal therapies of toothache are removing wind and heat, clearing away heat and prompting diuresis, clearing away the stomach-heat, replenishing vital essence to tonify the Shen, relieving superficial syndrome by wind-cold, and alleviating pain by destroying parasites. For the prescription of the principal therapies, there are Xijio Dihuang Tang, Jiajian Ganlu Yin, Qufeng Wan, Qingwei San, Tiaowei Chenggi Tang Shengong Wan, Liangge San Qingwei Tang Yunu Jian, Liuwei Dihuang Wan Zuogui Yin Bawei Wan Wanshao Dan, Xixin San Badou Wan Gianghuo Fuzi Tang, Jiuzi Tang Badou Wan, etc... The therapies of dedentition and the shaking and loose of teeth are replenishing vital essence to tonify the Shen, and warming and recuperating the Shen-Yang: as the prescription, there are Liuwei Dihuang Wana Zuogui Yin, and Bawei Wan Anshen Wan Wanshao Dan Yougui Wan etc... The therapies of gingival hemorrhage are clearing away the stomach-heat, replenishing vital essence to tonify the Shen, warming and recuperating the Shen-Yang(腎陽), and moisturing and purging intence heat with the prescription of Tiaowei Chenggi Tang Xijiao Dihuang Tang, Liuwei Dihuang Wan Zuogui Yin, Bawei Wan Anshen Wan, and Yunu Jian. The therapy of gingival atrophy is replenishing vital essence to tonify the Shen in the prescription of Liuwei Wan Bawei Wan Ziyin Dabu Wan. The therapies of grinding of teeth during sleeping are clearing away the stomach-heat and purging intense heat, and invigorating the spleen through eliminating dampness in the prescription of Qingwei San, Wumei Wan, etc... The therapy of delaed dentition is replenishing vital essence to tonify the Shen with the prescription of Liuwei Wan Buyin Jian, etc... Third, clinical treatment reports of dental diseases are reviewed as follows: The toothache due to stomach-heat was treated by medical herbs like Gypsum, Natrir Sulfas, Rehmanniae, Schizonepetal Herba, Menthae Folium, Cimicifugae Rhizoma, and Scrophulariae Radix. The therapies of toothache due to flaring-up of fire in deficiency type from deficiency of Shen provided with replenishment of vital essence to tonify the Shen and clean ministerial fire, and the prescription was the kind of Liuwei Wan, which worked very well. The therapy of dedentition and loose of teeth due to deficiency of Shen was done to stablize the teeth as tonifing the Shen with the prescription of Guchi Wan. The rate of imrovement was over 90%. The destruction of periodontal tissue due to periodonititis was cured of dispelling wind, reducing heat, and alleviating pain, It was improved by taking Zizhi Xingiong Tang, Guchi Xiaotong San, Yunii Jian, and Qingwei San about 3-7 days, and the rate of improvement was over 80%. Fourth, the prevention and regimens are reviewed as follows: As a physical and breathing exercise of the teeth, tapping teeth which stimulates the circulation of Qi(氣) and Xue(血) had been used. The tapping time of 14, 17, 36, etc... has been reported, and it should be applied based on the body condition. The medical herbs for gargling and brushing teeth have been used. Specifically, Cimicifugae Rhizoma, Gypsum, Gypsum Fibrosum, and Indigo pulrelrata Lereis have been used to reduce heat, Coptidis Rhizama and Yang Jinggu to eliminate damp-heat, Amomi Semen, Cyperi Rhizoma, Flos Caryophylli, Asari Radix, Piperis Longi Fructus, Santali Albae Lignum, Meliae Fructus, Moschus, Aquillaiae Lignum, and Borneol to promote the circulation of Qi and to relieve pain, Ligustici Radix, Angelice Radix, Rhizoma Nardostachydis, Tribuli Semen to relieve superficial syndrome by means of diaphiresis, and Cnidii Rhizoma, Angelicae sinensis Radix, and Olibanum to promote blood circulation to stop pain.

• Progress in Medical Physics
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• v.22 no.1
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• pp.28-34
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• 2011

To perform the Adaptive Radiation Therapy (ART), a high degree of deformable registration accuracy is essential. The purpose of this study is to identify whether the change of MV CBCT intensity can improve registration accuracy using predefined modification level and filtering process. To obtain modification level, the cheese phantom images was acquired from both kilovoltage CT (kV CT), megavoltage cone-beam CT (MV CBCT). From the cheese phantom images, the modification level of MV CBCT was defined from the relationship between Hounsfield Units (HUs) of kV CT and MV CBCT images. 'Gaussian smoothing filter' was added to reduce the noise of the MV CBCT images. The intensity of MV CBCT image was changed to the intensity of the kV CT image to make the two images have the same intensity range as if they were obtained from the same modality. The demon deformable registration which was efficient and easy to perform the deformable registration was applied. The deformable lung phantom which was intentionally created in the laboratory to imitate the changes of the breathing period was acquired from kV CT and MV CBCT. And then the deformable lung phantom images were applied to the proposed method. As a result of deformable image registration, the similarity of the correlation coefficient was used for a quantitative evaluation of the result was increased by 6.07% in the cheese phantom, and 18% in the deformable lung phantom. For the additional evaluation of the registration of the deformable lung phantom, the centric coordinates of the mark which was inserted into the inner part of the phantom were measured to calculate the vector difference. The vector differences from the result were 2.23, 1.39 mm with/without modification of intensity of MV CBCT images, respectively. In summary, our method has quantitatively improved the accuracy of deformable registration and could be a useful solution to improve the image registration accuracy. A further study was also suggested in this paper.

• Radiation Oncology Journal
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• v.14 no.2
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• pp.123-128
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• 1996

Purpose : This is a retrospective study to compare the Palliation rates, survival rates and complications of low dose rate and high dose rate endobronchial brachytherapy in the management of malignant airway obstruction. Materials and methods : Forty three consecutive patients with malignant airway compromise from primary or metastatic lung tumors were treated with low dose rate(LDR) endobronchial Iridium-192 insertion(21 patients) between October 1988 and June 1992, and high dose rate(HDR) endobronchial brachytherapy(22 patients) between August 1992 and April 1994 with palliative aim Flexible fiberoptic bronchoscopy under fluoroscopic control was utilized in all 91 procedures. Twenty seven LDR Procedures delivered a dose of 5-7.5 Gy to a 1.0 cm radius respectively. Results : Subjective and objective responses to treatments were evaluated on follow-up examinations by clinical examination, chest x-rays and CT scan of the chest on some patients. Fifteen of 21 LDR patients and 19 of 22 HDR Patients showed subjective improvement in terms of better breathing and less Productive cough as well as complete disappearance of hemoptysis. Objective improvement on chest x-rays and CT scan of the chest had been demonstrated on 8 LDR Patients and 10 HDR patients. Conclusion : The technique of LDR and HDR endobronchial brachytherapy is simple and well tolerated procedure with minimal morbidity It Provides excellent palliation by keeping airway Patent in these short life-spanned patients.

• The Journal of the Korea Contents Association
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• v.8 no.4
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• pp.237-246
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• 2008

The purpose of this study was to develop relaxation training contents for middle and high school archery players with considering the ecological validity of social, cultural, and sports environment in Korean but also examine the effect of developing relaxation training contents through case study approach and interviews. The relaxation training contents was based on previous researches about relaxation program. In addition, in order to develop the program 3 archery experts and 2 sport psychologists had meetings. The relaxation training contents categorized as orientation, breathing regulation, progressive relaxation training, cognitive restructuring, meditation, heart rate biofeedback training, autogenic training, behavior therapy, self regulation. The experimental group were 6 male Korean national archery substitute players, who were selected in 2007. The effects was examined on competitive state anxiety inventory-2, heart rates, archery score and interviews. As the result of applying the developed program of this study on the field, competitive state anxiety, somatic state anxiety and heart rate were decreased. In the interviews athletes told that they were relaxed psychologically and physically. This result demonstrated the relaxation training program were effective.

• Progress in Medical Physics
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• v.20 no.3
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• pp.174-179
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• 2009

To track moving tumor in real time, CyberKnife system imports a technique of the synchrony respiratory tracking system. The fiducial marker which are detectable in X-ray images were demand in CyberKnife Robotic radiosurgery system. It issued as reference markers to locate and track tumor location during patient alignment and treatment delivery. Fiducial marker implantation is an invasive surgical operation that carries a relatively high risk of pneumothorax. Most recently, it was developed a direct lung tumor registration method that does not require the use of fiducials. The purpose of this study is to measure the accuracy of target applying X-sight lung tracking using the Gafchromic film in dynamic moving thorax phantom. The X-sight Lung Tracking quality assurance motion phantom simulates simple respiratory motion of a lung tumor and provides Gafchromic dosimetry film-based test capability at locations inside the phantom corresponding to a typical lung tumor. The total average error for the X-sight Lung Tracking System with a moving target was $0.85{\pm}0.22$ mm. The results were considered reliable and applicable for lung tumor treatment in CyberKnife radiosurgery system. Clinically, breathing patterns of patients may vary during radiation therapy. Therefore, additional studies with a set real patient data are necessary to evaluate the target accuracy for the X-sight Lung Tracking system.