• Korean Journal of Radiology
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• v.20 no.5
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• pp.844-853
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• 2019

Objective: To evaluate the learning curve for C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous transthoracic needle biopsy (PTNB) and to determine the amount of experience needed to develop appropriate skills for this procedure using cumulative summation (CUSUM). Materials and Methods: We retrospectively reviewed 2042 CBCT virtual navigation-guided PTNBs performed by 7 novice operators between March 2011 and December 2014. Learning curves for CBCT virtual navigation-guided PTNB with respect to its diagnostic performance and the occurrence of biopsy-related pneumothorax were analyzed using standard and risk-adjusted CUSUM (RA-CUSUM). Acceptable failure rates were determined as 0.06 for diagnostic failure and 0.25 for PTNB-related pneumothorax. Results: Standard CUSUM indicated that 6 of the 7 operators achieved an acceptable diagnostic failure rate after a median of 105 PTNB procedures (95% confidence interval [CI], 14-240), and 6 of the operators achieved acceptable pneumothorax occurrence rate after a median of 79 PTNB procedures (95% CI, 27-155). RA-CUSUM showed that 93 (95% CI, 39-142) and 80 (95% CI, 38-127) PTNB procedures were required to achieve acceptable diagnostic performance and pneumothorax occurrence, respectively. Conclusion: The novice operators' skills in performing CBCT virtual navigation-guided PTNBs improved with increasing experience over a wide range of learning periods.

• Journal of Biomedical Engineering Research
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• v.26 no.5
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• pp.265-270
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• 2005

A new Computer Integrated Surgical Robot system is composed of a surgical robot, a surgical planning system, and an optical tracking system. The system plays roles of an assisting surgeon and taking the place of surgeons for inserting a pedicle screw in spinal fusion. Compared to pure surgical navigation systems as well as conventional methods for spinal fusion, it is able to achieve better accuracy through compensating for the portending movement of the surgical target area. Furthermore, the robot can position and guide needles, drills, and other surgical instruments or conducts drilling/screwing directly. Preoperatively, the desired entry point, orientation, and depth of surgical tools for pedicle screw insertion are determined by the surgical planning system based on CT/MR images. Intra-operatively, position information on surgical instruments and targeted surgical areas is obtained from the navigation system. Two exemplary experiments employing the developed image-guided surgical robot system are conducted.

• Journal of Korean Society for Quality Management
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• v.34 no.4
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• pp.40-50
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• 2006

The authors aimed to analyze the quality improvement efficiency of wound dressing with 2-octyl cyanoacrylate(2-OCA) in stereotactic image guided linear or sigmoid incisions in a cohort of consecutive craniotomy patients, and to compare clinical results with those of iodine-dressing and silk sutured patients underwent conventional craniotomy surgery with large pedicle flap incisions without stereotactic guidance. In methods, 26 patients were involved as the study group at one hospital. We retrospectively compared their results with those of 38 consecutive control patients at the same unit. The suggested new medical material, 2-octyl cyanoacrylate(2-OCA), resultantly decreased or prevented the contaminated fluid influx from scalp outside. The mean infection rate for the control group (7.89%) was relatively higher than that of the study group (3.85%). In addition, the use of stereotactic image guided craniotomy was significant to reduce operation time, to simplify operative procedures and to decrease potential risk factors.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.2
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• pp.153-163
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• 2008

Medical imaging modalities to image either anatomical structure or functional processes have developed along somewhat independent paths. Functional images with single photon emission computed tomography (SPECT) and positron emission tomography (PET) are playing an increasingly important role in the diagnosis and staging of malignant disease, image-guided therapy planning, and treatment monitoring. SPECT and PET complement the more conventional anatomic imaging modalities of computed tomography (CT) and magnetic resonance (MR) imaging. When the functional imaging modality was combined with the anatomic imaging modality, the multimodality can help both identify and localize functional abnormalities. Combining PET with a high-resolution anatomical imaging modality such as CT can resolve the localization issue as long as the images from the two modalities are accurately coregistered. Software-based registration techniques have difficulty accounting for differences in patient positioning and involuntary movement of internal organs, often necessitating labor-intensive nonlinear mapping that may not converge to a satisfactory result. These challenges have recently been addressed by the introduction of the combined PET/CT scanner and SPECT/CT scanner, a hardware-oriented approach to image fusion. Combined PET/CT and SPECT/CT devices are playing an increasingly important role in the diagnosis and staging of human disease. The paper will review the development of multi modality instrumentations for clinical use from conception to present-day technology and the application software.

• Journal of Chest Surgery
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• v.38 no.1 s.246
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• pp.50-55
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• 2005

Thoracic actinomycosis is a rare, chronic debilitating disease and it is difficult to diagnose and treat. Material and Method: Between March 1990 to December 2003, 17 patients were diagnosed and treated for actinomycosis in our center. Except 4 patients (involving cervicofacial, and abdominopelvic area), we reviewed the clinical characteristics, diagnosis method, and treatment in 13 patients. Result: In 8 patients, the operation was required for diagnosis and treatment. 7 of 8 patients had tumor-like lesions in radiological findings and they were not distinguished as lung cancer, and 1 of 8 patients was non-responsive to the antibiotics therapy. Among the 5 medically treated patients, 4 of 5 patients were diagnosed by bronchoscopic biopsy and one by CT-guided biopsy. All of them was well-responsive by the antibiotic treatment. Conclusion: Thoracic actinomycosis is a chronic inflammatory disease that respond well to antibiotics (penicillin therapy). It should be diagnosed by the repeated biopsy (CT-guided or bronchoscopic) before starting treatment. However, if the lesion is not distinguished as the lung cancer, non-responsive to the medical treatment, and the patients experience the recurrent hemoptysis, we can consider the operation for the diagnosis and treatment.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.294-299
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• 2001

Objectives : CT-guided stereotactic evacuation for spontaneous intracerebral hemorrhage can minimize the brain damage and can be performed safely and simply under local anesthesia. But that procedure is time consuming and has a risk of rebleeding because of the stress during head pin fixation. So authors describe easy and precise guidelines for FHA of putaminal hemorrhage without stereotactic instrument. Methods and Materials : We analyzed the data of 298 patients who underwent CT-guided stereotactic aspiration of putaminal hematoma in our hospital between January 1990 and December 2000. We divided the patients into three groups according to the location of hematoma : anterior portion, middle portion and posterior portion of putamen. Total number of catheters inserted into the hematoma were 345 and there were with regard to the direction and depth of catheters. Results : Proposed guidelines of catheter insertion to putaminal hemorrhage in our institution. 1) hematoma at the anterior portion of putamen ; Direction of catheter was the midpupillary line of the eye and the point intersecting a line drawn from the burr hole to a point between external auditory meatus(EOM) and 1cm posterior to EOM. Depth of catheter was 6-6.5cm. 2) hematoma at the middle portion of putamen ; Direction of catheter was the midpupillary line of the the eye and the point intersecting a line drawn from the burr hole to a point between 1cm and 2cm posterior to EOM. Depth of catheter was 6.5-7cm. 3) hematoma at the posterior portion of putamen ; Direction of catheter was 15 degree laterally from the midpupillary line of the eye and the point intersecting a line drawn from the burr hole to a point between 2cm and 3cm posterior to EOM. Depth of catheter was 7-7.5cm. We have performed FHA of putaminal hemorrhage in 48 cases according to this guideline. All catheter were inserted exactly at the center of hematoma and average operation time was about 30 minutes. Conclusion : Our proposed guidelines for putaminal hemorrhage are considered to be safe and simple method with similar accuracy and rapid decompression compared with traditional stereotactic method. Main advantages of this technique were unnecessity of stereotactic frame application and less time requirement for hematoma removal.

• Tuberculosis and Respiratory Diseases
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• v.79 no.2
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• pp.98-100
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• 2016

We present a rare case of critically compromised airway secondary to a massively dilated sequestered colon conduit after several revision surgeries. A 71-year-old male patient had several operations after the diagnosis of gastric cancer. After initial treatment of pneumonia in the pulmonology department, he was transferred to the surgery department for feeding jejunostomy because of recurrent aspiration. However, he had respiratory failure requiring mechanical ventilation. The chest computed tomography (CT) scan showed pneumonic consolidation at both lower lungs and massive dilatation of the substernal interposed colon compressing the trachea. The dilated interposed colon was originated from the right colon, which was sequestered after the recent esophageal reconstruction with left colon interposition resulting blind pouch at both ends. It was treated with CT-guided pigtail catheter drainage via right supraclavicular route, which was left in place for 2 weeks, and then removed. The patient remained well clinically, and was discharged home.

• Journal of Korean Neurosurgical Society
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• v.42 no.6
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• pp.478-480
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• 2007

Unruptured non-traumatic dissecting aneurysm in the M4 segment of the middle cerebral artery (MCA) accompanied by complete occlusion of the ipsilateral internal cerebral artery (ICA) has never been reported. A 41-year-old man presented with an infarction manifesting as left-sided weakness and dysarthria. Magnetic resonance angiography revealed a subacute stage infarction in the right MCA territory and complete occlusion of the right ICA. Angiography demonstrated aneurysmal dilatation of the M4 segment of the right MCA. Surgery was performed to prevent hemorrhage from the aneurysm. The aneurysm was proximally clipped guided by Navigation-CT angiography and flow to the distal MCA was restored by superficial temporal artery-middle cerebral artery (STA-MCA) anastornosis. We report this rare case with literature review.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.274-276
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• 2011

Spontaneous cerebrospinal fluid (CSF) leak is a recognized cause of spontaneous intracranial hypotension (SIH). Subdural hematoma (SDH) is a serious but rare complication of SIH. An autologous epidural blood patch at the CSF-leak site can effectively relieve SIH. We report a case of bilateral SDH with SIH caused by a CSF leak originating at the C1-2 level. A 55-year-old male complained of orthostatic headache without neurological signs. His symptoms did not respond to conservative treatments including bed rest, hydration and analgesics. Magnetic resonance imaging showed a subdural hematoma in the bilateral fronto-parietal region, and computed tomography (CT) myelography showed a CSF leak originating at the C1-2 level. The patient underwent successful treatment with a CT-guided epidural blood patch at the CSF-leak site after trephination for bilateral SDH.

• Journal of Korean Neurosurgical Society
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• v.52 no.6
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• pp.555-557
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• 2012

We report an uncommon case of a 45-year-old woman who presented with spontaneous rhinorrhea. A computed tomography (CT) scan of the head revealed an abnormally large sphenoid sinus associated with a parasellar bony defect (Sternberg's canal) through which magnetic resonance imaging could detect an encephalocele of the right temporal lobe. An endoscope-assisted trans-sphenoidal approach was performed and, with the aid of image guided surgery, reduction of the encephalocele was obtained and followed by surgical repair of the dural and bony defects. The postoperative course was uneventful and the cerebrospinal fluid fistula was closed as confirmed by the postoperative CT scan and by the absence of rhinorrhea. After three years of monitoring the patient remained asymptomatic.