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Conventional Versus Artificial Intelligence-Assisted Interpretation of Chest Radiographs in Patients With Acute Respiratory Symptoms in Emergency Department: A Pragmatic Randomized Clinical Trial

  • Eui Jin Hwang;Jin Mo Goo;Ju Gang Nam;Chang Min Park;Ki Jeong Hong;Ki Hong Kim
    • Korean Journal of Radiology
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    • v.24 no.3
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    • pp.259-270
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    • 2023
  • Objective: It is unknown whether artificial intelligence-based computer-aided detection (AI-CAD) can enhance the accuracy of chest radiograph (CR) interpretation in real-world clinical practice. We aimed to compare the accuracy of CR interpretation assisted by AI-CAD to that of conventional interpretation in patients who presented to the emergency department (ED) with acute respiratory symptoms using a pragmatic randomized controlled trial. Materials and Methods: Patients who underwent CRs for acute respiratory symptoms at the ED of a tertiary referral institution were randomly assigned to intervention group (with assistance from an AI-CAD for CR interpretation) or control group (without AI assistance). Using a commercial AI-CAD system (Lunit INSIGHT CXR, version 2.0.2.0; Lunit Inc.). Other clinical practices were consistent with standard procedures. Sensitivity and false-positive rates of CR interpretation by duty trainee radiologists for identifying acute thoracic diseases were the primary and secondary outcomes, respectively. The reference standards for acute thoracic disease were established based on a review of the patient's medical record at least 30 days after the ED visit. Results: We randomly assigned 3576 participants to either the intervention group (1761 participants; mean age ± standard deviation, 65 ± 17 years; 978 males; acute thoracic disease in 472 participants) or the control group (1815 participants; 64 ± 17 years; 988 males; acute thoracic disease in 491 participants). The sensitivity (67.2% [317/472] in the intervention group vs. 66.0% [324/491] in the control group; odds ratio, 1.02 [95% confidence interval, 0.70-1.49]; P = 0.917) and false-positive rate (19.3% [249/1289] vs. 18.5% [245/1324]; odds ratio, 1.00 [95% confidence interval, 0.79-1.26]; P = 0.985) of CR interpretation by duty radiologists were not associated with the use of AI-CAD. Conclusion: AI-CAD did not improve the sensitivity and false-positive rate of CR interpretation for diagnosing acute thoracic disease in patients with acute respiratory symptoms who presented to the ED.

Quality of Radiomics Research on Brain Metastasis: A Roadmap to Promote Clinical Translation

  • Chae Jung Park;Yae Won Park;Sung Soo Ahn;Dain Kim;Eui Hyun Kim;Seok-Gu Kang;Jong Hee Chang;Se Hoon Kim;Seung-Koo Lee
    • Korean Journal of Radiology
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    • v.23 no.1
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    • pp.77-88
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    • 2022
  • Objective: Our study aimed to evaluate the quality of radiomics studies on brain metastases based on the radiomics quality score (RQS), Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) checklist, and the Image Biomarker Standardization Initiative (IBSI) guidelines. Materials and Methods: PubMed MEDLINE, and EMBASE were searched for articles on radiomics for evaluating brain metastases, published until February 2021. Of the 572 articles, 29 relevant original research articles were included and evaluated according to the RQS, TRIPOD checklist, and IBSI guidelines. Results: External validation was performed in only three studies (10.3%). The median RQS was 3.0 (range, -6 to 12), with a low basic adherence rate of 50.0%. The adherence rate was low in comparison to the "gold standard" (10.3%), stating the potential clinical utility (10.3%), performing the cut-off analysis (3.4%), reporting calibration statistics (6.9%), and providing open science and data (3.4%). None of the studies involved test-retest or phantom studies, prospective studies, or cost-effectiveness analyses. The overall rate of adherence to the TRIPOD checklist was 60.3% and low for reporting title (3.4%), blind assessment of outcome (0%), description of the handling of missing data (0%), and presentation of the full prediction model (0%). The majority of studies lacked pre-processing steps, with bias-field correction, isovoxel resampling, skull stripping, and gray-level discretization performed in only six (20.7%), nine (31.0%), four (3.8%), and four (13.8%) studies, respectively. Conclusion: The overall scientific and reporting quality of radiomics studies on brain metastases published during the study period was insufficient. Radiomics studies should adhere to the RQS, TRIPOD, and IBSI guidelines to facilitate the translation of radiomics into the clinical field.

2023 Survey on User Experience of Artificial Intelligence Software in Radiology by the Korean Society of Radiology

  • Eui Jin Hwang;Ji Eun Park;Kyoung Doo Song;Dong Hyun Yang;Kyung Won Kim;June-Goo Lee;Jung Hyun Yoon;Kyunghwa Han;Dong Hyun Kim;Hwiyoung Kim;Chang Min Park;Radiology Imaging Network of Korea for Clinical Research (RINK-CR)
    • Korean Journal of Radiology
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    • v.25 no.7
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    • pp.613-622
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    • 2024
  • Objective: In Korea, radiology has been positioned towards the early adoption of artificial intelligence-based software as medical devices (AI-SaMDs); however, little is known about the current usage, implementation, and future needs of AI-SaMDs. We surveyed the current trends and expectations for AI-SaMDs among members of the Korean Society of Radiology (KSR). Materials and Methods: An anonymous and voluntary online survey was open to all KSR members between April 17 and May 15, 2023. The survey was focused on the experiences of using AI-SaMDs, patterns of usage, levels of satisfaction, and expectations regarding the use of AI-SaMDs, including the roles of the industry, government, and KSR regarding the clinical use of AI-SaMDs. Results: Among the 370 respondents (response rate: 7.7% [370/4792]; 340 board-certified radiologists; 210 from academic institutions), 60.3% (223/370) had experience using AI-SaMDs. The two most common use-case of AI-SaMDs among the respondents were lesion detection (82.1%, 183/223), lesion diagnosis/classification (55.2%, 123/223), with the target imaging modalities being plain radiography (62.3%, 139/223), CT (42.6%, 95/223), mammography (29.1%, 65/223), and MRI (28.7%, 64/223). Most users were satisfied with AI-SaMDs (67.6% [115/170, for improvement of patient management] to 85.1% [189/222, for performance]). Regarding the expansion of clinical applications, most respondents expressed a preference for AI-SaMDs to assist in detection/diagnosis (77.0%, 285/370) and to perform automated measurement/quantification (63.5%, 235/370). Most respondents indicated that future development of AI-SaMDs should focus on improving practice efficiency (81.9%, 303/370) and quality (71.4%, 264/370). Overall, 91.9% of the respondents (340/370) agreed that there is a need for education or guidelines driven by the KSR regarding the use of AI-SaMDs. Conclusion: The penetration rate of AI-SaMDs in clinical practice and the corresponding satisfaction levels were high among members of the KSR. Most AI-SaMDs have been used for lesion detection, diagnosis, and classification. Most respondents requested KSR-driven education or guidelines on the use of AI-SaMDs.

Association between coronavirus disease 2019-related workplace interventions and prevalence of depression and anxiety

  • Hyun Woo Park;Seung Hyun Park;Young Wook Kim;JunSeok Son;Chan Woo Kim;Hyoung Ouk Park;Jun Ho Lee;Young Hoo Shin;Chang Ho Chae;Eui Yup Chung;Hun Jeong
    • Annals of Occupational and Environmental Medicine
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    • v.34
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    • pp.11.1-11.9
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    • 2022
  • Background: Although coronavirus disease 2019 is causing a variety of psychological problems for workers, there are few longitudinal studies on changes in workers' mental health by workplace intervention. This study aimed to evaluate the change in the prevalence of depression and anxiety according to the active involvement of the workplace. Methods: This study was conducted on 1,978 workers at a workplace who underwent a health screening from January 2019 to August 2020, and classified depression and anxiety disorders using a self-report questionnaire. After the first pandemic, the company stopped health screening, took paid leave and telecommuting, and conducted interventions such as operating its own screening clinic. To see if this workplace intervention affects workers' mental health, we conducted generalized estimating equations to compare odds ratio (OR). Results: In the pre-intervention group, 384 people (16.86%) had depression, and 507 people (22.26%) had anxiety disorder. Based on the OR before intervention, the OR of depression decreased to 0.76 (0.66-0.87) and the OR of anxiety disorder decreased to 0.73 (0.65-0.82). Conclusions: As a result of this study, it was confirmed that workplace intervention was related to a decrease in depression and anxiety. This study provides basic data to improve workers' mental health according to workplace intervention, and further research is needed according to workplace intervention in the future.

A study on the origination and Transmission of Yu in Northeast Asia. -from the 4th Century to the 8th Century- (동북(東北)아시아 유의 기원(起源)과 그 교류(交流)에 관(關)한 연구(硏究) -$4{\sim}8$세기(世紀)를 중심(中心)으로-)

  • Cho, Sun-Hee;Park, Kyung-Ja
    • Journal of the Korean Society of Costume
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    • v.17
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    • pp.29-43
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    • 1991
  • Yu was a type of dress worn on the upper part of the body which was commonly used in Northeast Asia. It was originally used by the Northern race for the need of courtesy as well as protecting cold. It was believed that Yu in Northeast Asia, which was called Kaftan, was came from Scythai lived in North Eurasian land around the Black sea. Scythians were the first-formed horse-riding race in the world and their civilization influenced those of far Asiatic sector along the steppe route. As their power expanded, their costume culture transmitted to the East(China, Korea, Japan). The upper garment, Yu, was characterized by the left-sided collars, narrow sleeves belted at the waist to the length of the hip line and the tight trouser on the lower part, which we commonly called HoBok(胡服) style. 1. Yu in Northeast Asia was originated from the Eurasians, Scythian Culture. Being exchanged, active style costumes were widely used among Chinese, Koreans and Japanese throughout centuries' including $4{\sim}8$ century. 2. Chinese Yu had a style of wide-sleeves and right-sided collars. The traditional costumes of Han race are consisted of wide-sleeved Yu on the upper and long-skirt on the lower part of the body. Before the adoptation of HoBok during reign of King Jo Mooryung in 307. B.C., HoBok style had already found in the remains since the Sang period. There were various names among Yu during the Han period. Seup, Sean Eui, Kye, Kyu were one of the styles and several names were meant for collar and sleeves. During $4{\sim}8$ centuries, clothes of right-sided collar were found, superior to that of left-sided and narrow sleeves were widely used both the royal and the humble. Various styles of decoration were seen in Yu around neck, back and sleeves comparing other nations. 3. Yu, in Korea, was typical style of Northern-bound HoBok. Both men and women had similarity in Yu style, narrow sleeves, left-sided collar, belted at the waist and to the length of hip line. Influenced by Han race, in the $4th{\sim}8th$ centuries, dual system of collar was found. But we cannot see major change in Yu and finally was connected to the present. 4. The original design of the Japanese costumes was not similar to that of Northern nomadic hunting race, which was suitable for horse-riding activities. Owing to the climates along the island, we could see various conditions ranging from the cold and to the warm. Influenced by the climates, pulling over the neck(Pancho style) were major design in Japan. As Korea was advanced earlier than Japan, Korean landed Japanese territory showing clothes. So primitive costumes had changes in style. During the $4th{\sim}8th$ period. The Korean mode was found in Haniwa (which was built to make sacrifices to the dead King) and costumes in Jeong Chang Won. Among the costumes in Jeong Chang Won, we put 3 or more costumes to the category of Yu characterizing elements of Korea and Tang period. From the $4th{\sim}8th$ century, China, Korea, Japan fell into the same cultural category, Scythai. Styles in Yu among three nations, we saw little differences, basically along times. Originated from the West Asia, Yu was transmitted to the far East changing Chinese costumes, Koreans melted it into the traditional elements and then influenced Japan.

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The Surgical Management of Hypoplastic Left Heart Syndrome and the Results of a Fontan Operation (좌심형성부전증후군의 외과적 치료 및 폰탄수술의 결과)

  • Chung, Eui Suk;Kim, Woong-Han;Jeon, Jae-Hyun;Choi, Chang-Hyu;Lee, Chang-Ha;Lee, Young-Tak
    • Journal of Chest Surgery
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    • v.42 no.1
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    • pp.9-13
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    • 2009
  • Background: Hypoplastic left heart syndrome is uniformly fatal if this condition is not properly treated. We reviewed the surgical results of treating hypoplastic left heart syndrome, and we evaluated the hemodynamics and functional status of these patients after they underwent a Fontan operation. Material and Method: To assess the surgical results, we retrospectively reviewed the medical records of 6 (M/F=4/2) patients who underwent a staged operation, including a Norwood procedure, a bidirectional Glenn procedure and a Fontan procedure between October 1997 to May 2005. The mean age of the patients was $17.3{\pm}10.8$ days (range: 9~36 days) at the $1^{st}$ staged operation, $8.9{\pm}7.1$ months (4.6~23.3 months) at the $2^{nd}$ staged operation (the Bidirectional Glenn procedure) and $32.4{\pm}9.8$ months at the final staged operation (the Fontan procedure). During the $2^{nd}$ staged operation, one of the patients received tricuspid valve repair due to regurgitation. All the patients underwent an extracardiac Fontan procedure using Gore-Tex conduit (20 mm: 2 patients, 18 mm: 4 patients) and one of them required fenestration. Result: 21 patients underwented a Norwood procedure. There were 7 early deaths and 4 interstage deaths. Bidirectional cavopulmonary shunt was performed in 10 patients and the Fontan procedure was done in 6 (mortality: 1 patient, Flow up loss: 1 patient, Awaiting a Fontan procedure: 2 patients). After the Fontan procedure, there was no complication except for one case of post operative bleedings. All the patients had good ventricular function and 2 had grade I tricuspid regurgitation, as noted on their echocardiography. The average follow up period after the Fontan procedure was $19.6{\pm}14.9$ months (range: 1.5~39.1 month). All the patients had normal sinus rhythm and they were put on aspirin and cardiac medication. During follow up period, all the patients had a good functional status (NYHA functional class I). Conclusion: All the patients who suffered with hypoplastic left heart syndrome and who underwent a Fontan procedure achieved a good hemodynamic and functional status, even though there was a relatively high operative mortality rate after stage I Norwood palliation. Therefore, thise staged operation should be strongly recommended as an important surgical strategy for treating hypoplastic left heart syndrome.

Bronchoalveolar Cellularity and IL-8 Levels in Patients with Post-measles Wheezing (홍역 후 천명환아의 기도내 세포양상 및 IL-8치)

  • Jung, Da Eun;Kim, Byeong Eui;Chung, Ju Young;Kim, Jeong Yeon;Ma, Sang Hyuk;Kim, Chang Keun
    • Clinical and Experimental Pediatrics
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    • v.46 no.8
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    • pp.763-768
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    • 2003
  • Purpose : This study was conducted to investigate the pulmonary cellular profiles and IL-8 levels in patients with post-measles wheezing. Methods : Twelve previously healthy infants with a minimum of three episodes of wheezing after measles pneumonia(Measles wheezing, median age, 1.3 years) were recruited by a retrospective examination of hospital records. They underwent bronchoalveolar lavage(BAL) with flexible bronchoscopy, and high-resolution computed tomography(HRCT) with a mean six(1-15) months interval. Comparisons were made with seven normal controls(Control, median age : 7.4 years). BAL cell counts and differentials were determined. IL-8 levels also were measured by ELISA. Results : The BAL cellular profiles were characterized by a significantly increased percentage of neutrophils in the Measles wheezing group(median 16.0%) compared to the control group(median 3.8 %)(P<0.01). IL-8 levels were markedly increased in the Measles wheezing group($mean{\pm}SD$, $512.7{\pm}324.0pg/mL$) compared to the control group($41.7{\pm}67.7pg/mL$)(P<0.01). Furthermore, IL-8 levels correlated significantly(r=0.816, P=0.001) with neutrophil percentages in BAL fluids in the Measles wheezing group. Abnormal HRCT findings were mosaic perfusion, bronchiectasis, bronchial wall thickening, and decreased vascularity. Conclusion : These results suggest that pulmonary neutrophils and IL-8 may play an important role in the pathogenesis of the post-measles wheezing.

Investigation of Water-soluble Vitamin (B1, B2, and B3) Contents in Various Roasted, Steamed, Stir-fried, and Braised Foods Produced in Korea (국내 식품 중 구이, 찜, 볶음, 조림에 존재하는 수용성 비타민 B1, B2 그리고 B3 함량 조사)

  • Cho, Jin-Ju;Hong, Seong Jun;Boo, Chang Guk;Jeong, Yuri;Jeong, Chang Hyun;Shin, Eui-Cheol
    • Journal of Food Hygiene and Safety
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    • v.34 no.5
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    • pp.454-462
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    • 2019
  • A conventional Korean meal typically includes various roasted, steamed, stir-fried, and braised foods. For this study, we investigated the contents of water soluble vitamins, $B_1$ (thiamin), $B_2$ (riboflavin) and $B_3$ (niacin) in various roasted, steamed, stir-fried, and braised foods. Method validation for analytical data in this study showed a high linearity ($r^2$>0.999), and the limit of detection and quantification were 0.001-0.067 and $0.002-0.203{\mu}g/mL$, respectively. For accuracy and precision, analytical values using standard reference materials were in the certified ranges. Roasted foods contained 0.039-1.057 mg/100 g of thiamin, 0.058-0.686 mg/100 g of riboflavin and 0.021-21.772 mg/100 g of niacin. Steamed foods contained 0.049-1.066 mg/100 g of thiamin, 0.025-0.548 mg/100 g of riboflavin and 0.134-21.509 mg/100 g of niacin. Stir-fried foods contained 0.114-0.388 mg/100 g of thiamin, 0.014-1.258 mg/100 g of riboflavin and 0.015-2.319 mg/100 g of niacin. Braised foods contained 0.112-1.656 mg/100 g of thiamin, 0.024-0.298 mg/100 g of riboflavin and 0.322-2.157 mg/100 g of niacin. The data on water-soluble vitamins in this study can be used for a nutritional database of conventional Korean meals.

A Morphologic Study of head and face for Sasang Constitution (사상체질별(四象體質別) 두면부(頭面部)의 형태학적(形態學的) 특징(特徵))

  • Ko, Byung-Hee;Song, Il-Byung;Cho, Yong-Jin;Choi, Chang-Seok;Kim, Jong-Weon;Hong, Suck-CHull;Lee, Eui-Ju;Lee, Sang-Yong;Seo, Jeong-Sug
    • Journal of Sasang Constitutional Medicine
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    • v.8 no.1
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    • pp.101-186
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    • 1996
  • The clinical application of constitutional Diagnosis is the most important part of Sasang constitutional medicine. It has been studied in various way. However, the study of morphologic characteristics on the face is applied for the first time. For quantitative analysis of the correlation between the sasang constitution and the shape of the face, the head-facial part of 170 cases were measured by Martin's measurement and analysis of a) the measurement value of height and the component ratio from the Gnathion to each part of face by constitution. b) the measurement value of depth and the component ratio from T-projected to each part of the face by constitution. c) the measurement value of breadth and component ratio between each parts of the facial breadth by constitution. d) the ratio of square on every part of face by constitution. e) the characteristics on each part of the face by constitution. f) the contour line of the forehead. g) the result of discriminant analysis about the constitution. Authors obtained the results from the study as follows; 1. The characteristics of Taeum-IN (1) The measurement value of Height, Breadth, T-Projected had a tendency to maximum value in general. (2) The value of lower opthal height and the square of lower opthal part was maximum. (3) The value of Pronasal T-projected length and Subnasal T-projected length was minimum, so Taeum-In has characteristics of depression in middle face, nasal part. (4) In the ratio of Breadth, T-Projected, T-Projected was minimum. (5) It was maximum that the square of nose, Alare, Middle face, Lower face and it was minimum that the square of eye. The square of nose, Alare, Middle facc, Lower face was maximum and the square of eye was minimum. (6) The curvature of the eyebrow was minimum. (7) The projection of jaw (Pogonion T-projection length) was maximum. (8) The breadth of eye was minimum. (9) There was a tendency that the projection of the forehead to the right in general. 2. The characteristics of Soeum-In (1) In all cases of projected length the measurement value was minimum. (2) The value of lower opthal height and the square of lower opthal part was minimum. (3) By the Pupulare T-projected length, the value of Pronasal T-projected length and Subnasal T-projected length was minimum, so the Soeum In's face shape is flat. (4) The square of eye, mouth, forehead was maximum and the square of nose, Alare, Middle face, Lower face was minimum. (5) The curvature of the eyebrow was maximum. (6) The projection of mouth was minimum. (7) The jaw was flat. (8) The breadth of eye was maximum. (9) There was a tendency that the projection of the forehead to the left in general. 3. The characteristics of Soyang-In. (1) In most cases of 고경 length the measurement value was minimum. (2) By the Pupulare T-projected length, each ratio of projected length was maximum, so the Soyang-In's face shape has many protrusions (3) In the ratio of Breadth, T-Projected, T-Projected was maximum. (4) The square of mouth was minimum. (5) The inclination of the forehead was minimum. (6) The projection of mouth was maximum. (7) The breadth of eye was minimum. (8) There was a tendency that the projection of the forehead to the left in general. (9) The middle face was protruded. 4. Discriminant about the constitution. According to the result of discriminant, the accuracy probability of discriminant was 85.58% in total and Taeum-In was 90.5%, Soeum-In was 70.8%, Soyang-In was 89.5%. The accuracy probability of discriminant about 3 constitutional group increased by 49.03% than the accident probility 36.55% 5. Suggestion (1) The study which gather and analysis the data should be continued. (2) The study which subdivide the characteristics of each part of the face by the constitution should be continued. (3) The analysis method about Moire should be supplement. (4) The study about the morphologic characteristics of the whole body should be continued. (5) Computer program of constitution diagnosis should be developed. (6) To increase utility of this method, the measurement should be automation.

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The Study on the investigation of oriental medical theraphy(oriental medical theraphy by symptoms and signs and Sasang constitutional medicine)and the each effect of oriental medicine, occidental medicine and both joint control (뇌졸중(腦卒中)에 대(大)한 한방치료법(韓方治療法) 연구(硏究)(증치의학(證治醫學)과 사상의학(四象醫學)) 및 한방(韓方), 양방(洋方), 양(洋)·한방(韓方) 협진치료(協診治療) 효과(效果)에 관(關)한 연구(硏究))

  • Kim, Jong-won;Kim, Young-kyun;Kim, Beob-young;Lee, In-seon;Lee, In-seon;Jang, Kyung-jeon;Gwon, Jeong-Nam;Lee, Won-oe;Song, Chang-won;Park, Dong-il
    • Journal of Sasang Constitutional Medicine
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    • v.10 no.2
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    • pp.351-429
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    • 1998
  • The Purpose of Study 1. Inspection of clinical application on TCD to CVA 2. Objective Comparement and analysis about treatment effect of Western-Medicine, Korean Medicine, Cooperative consultation of Korean and Western medicice for CVA The Subject of Study We intended for the eighty six patient of CVA who had been treated in the Oriental Medical Hospital at Dong Eui Medical Center from 1997. 8. I to 1998. 7. 31 1. View of CT, MRI : the patient of Cb infarction 2. Attack Time : The patient who coming hospital falling ill within the early one week The method of study 1. Treat four group of Korean medicine, Constitution medicine, Western medicine, cooperative consultation of Korean medicine and Western medicine. 2. Application of TCD Check the result for three times, immediatly after the attack, two months later, four months later 3. Comparative analysis of each treatment effect by clinical symptoms and pathologic examination 4. The Judgement of the patient The Result From 8/1/1997 to 7/31/1998, We have the following result by clinical analysis intended for CVA 86 patients who had been treated in the Oriental Medical Hospital at Dong Eui Medical Center from 1997. 8. 1 to 1998. 7. 31 in 1. Analysis according to Age The first stage of thirties, forties, seventies is heavier than forties, fifties in improvement and Index of improvement of symptom 2. Analysis according to sex We have no special relation in an average of symptom and improvement, Index improvement 3. Analysis according to Family History We have the better result in first stage and improvement, index improvement when no family history. 4. Analysis according to Past History We have no special relation in past history like hypertension, DM, heart problem 5. Analysis devided two group, above group and under group on the basis of the average in first stage of all patient. We have the better result when the first stage is light, that the first score of barthel index and CNS is high. 6. Analysis of the effect of treatment about Korean medical treatment, Western medical treatment, cooperative treatment. In this study, the highest group of rate of treatment at four contrast groups (Korean medicine, Constitution medicine, Western medicine, cooperative treatment according to dyagnosis and range of treatment was the patient group of doing dyagnosis and method of treatment based on constitution medicine theory. This is that of doing demostation, A-Tx, po-herb-medication according to dyagnosis and treat method of constitution of Lee Je-ma In case of left, the case of dyagnosis any disease according to doctor view but, normal in TCDwas 22-beginning of attack, 20- two weeks later, 11 case-four weeks later in case of right, 15-beginning of attack, 12-two weeks later, 9 case four weeks later. So left vessel compares to right vessel is more interference, in fact more than a 1/2 of the patients of MCA disease can't do dyagnosis. In rate of imparement, the state of pacient improved but there isn't the improved case of result in TCD. 7. In TCD dyagnosis, between the case of inconsus the doctor view specially MCA in brain blood vessel is in large numbers and in total 86's patient, impossible case of dyagnosis according to interferiance of temporal is 21 case. 7. Result study about application of Kreaan medical treatment 1) The impossible patient of observation MCA blood vescular for interference temporal bone happened in large numbers. 2) There is the case having difference result to CT,MRI, MRA result. 3) Because individual difference is large, excluding to ananalogy of symptom. This is normal numerical value that has possibility of being checked as abnormal numerical value 4) there are a lot of cases that the speed of normal part is as similarly measured as that of abnormal part. It means that we cannot judge the disease by this measure 5) It is rare that this measure represent degree of improvement in patient's condition of disease. When we observe patient's condition become better, but we have no case that the result of TCD test better. 6) The result could be appear differently by the technique of the tester or by the experience of the tester 7) In the TCD test, abnormal symptoms is checked at 0 week, but at 2th week, normal symptoms is checked, again at 4th week abnormal is checked. According to the above result, CVA diagnosis is difficult only with TCD, as it appear in diagnosis error check which is suggested in the problem connected to project, for the aged persons who have the worst hardening of part of the cranium (1998. 5. 26 77 of 83 patients is 50s) there is a lot of cases that the measurement is impossible by TCD and the correction of measurement numerical value is decreased, as the age of cerebral infarction is high, TCD is inappropriate to diagnosis equipment through this study.

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