• Title/Summary/Keyword: Clinical evaluation

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Efficacy and Cost Benefits of Rapid Antigen Detection Test for Group A Streptococci Obtained from Acute Pharyngitis in Children (소아 세균성 인두 편도염의 진단에 있어 신속 항원 검출 검사의 유용성과 비용 효과의 평가)

  • Youn, Suk;Chung, Hye-Jeon;Kim, Yun-Ho;Choi, Jin-Dong;Lee, Sang-Hoon;Min, Jung-Sik;Jung, Sang-Young;Jung, Sung-Ki;Ahn, Byung-Moon;Lee, Hee-Joo;Cha, Sung-Ho
    • Pediatric Infection and Vaccine
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    • v.12 no.2
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    • pp.124-134
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    • 2005
  • Purpose : It has been known that the diagnostic confirmation of group A streptococcal pharyngitis is accompanied with the results of throat culture and/or rapid antigen detection test(RADT). This study was designed to evaluate the usefulness and cost benefits of the RADT in patients with a sore throat compared the empirical antibiotic treated group without using RADT or throat culture with the antibiotic treated group according to the results of RADT test and/or throat culture. Methods : From April 2003 to August 2003, total 369 patients were enrolled this study. They were redistributed into two groups. In one group, the RADT test and throat culture were used and the patients received antibiotic treatment according to the results of test and in the other group, no diagnostic examinations were used and the patients were treated with antibiotics which were chosen empirically. The flow sheet with questionnaire was drawing up and obtained the clinical symptoms, signs and the name of antibiotics that were administered. Results : A total of 244 patients were treated after the throat culture and/or RADT, and 125 patients were treated empirically. The prevalence of bacteriologically confirmed group A streptococcal pharyngitis was 20.1%. The sensitivity and specificity of RADT were 89.8% and 86.1%, respectively. Positive predictive value and negative predictive value were 62.0% and 97.1%, respectively. The rate of antibiotic use was high in both groups. Because the physician used the antibiotics even if the result of RADT was negative. So about 37% of reduction of antibiotics use might be possible if we used antibiotics according to the results of RADT. There were no cost differences between the RADT applied group and the empirically treated antibiotic group if we could reduce the price of RADT to 63% of the current price. Conclusion : The RADT could be applied for the easy and rapid diagnosis and prompt treatment for group A streptococcal pharyngitis, and RADT could reduced the number of antibiotics used if the price of RADT was reduced to 63% of current price. For accurate evaluation of efficacy and cost effect, further controlled study is needed.

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Research of Protocols for Optimization of Exposure Dose in Abdominopelvic CT - (복부-골반 CT검사 시 피폭선량 최적화에 관한 프로토콜 연구)

  • Hong, Dong-Hee
    • Journal of radiological science and technology
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    • v.40 no.2
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    • pp.245-251
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    • 2017
  • This study measured the exposure dose during abdominal-pelvic CT exam which occupies 70% of CT exam and tried to propose a protocol for optimized exposure dose in abdomen and pelvis without affecting the imagery interpretation. The study scanned abdomen-pelvis using the current clinical scan method, the 120 kVp, auto exposure control(AEC), as 1 phase. As for the newly proposed 2 phase scan method, the study divided into 1 phase abdomen exam and 2 phase pelvis exam and each conducted tube voltage 120 kVp, AEC for abdomen exam, and fixed tube current method in 120 kVp, 100, 150, 200, 250, 300, 350, 400 mA for pelvis exam. The exposure dose value was compared using $CTDI_{VOL}$, DLP value measured during scan, and average value of CT attenuation coefficient, noise, SNR from each scan image were obtained to evaluate the image. As for the result, scanning of 2 phase showed significant difference compared to 1 phase. In $CTDI_{VOL}$ value, the 2 phase showed 26% decrease in abdomen, 1.8~59.5% decrease in pelvis for 100~250 mA, 12.7%~30% increase in pelvis for 300~400 mA. Also, DLP value showed 53% decrease in abdomen and 41~81% decrease in pelvis when scanned by 2 phase compared to 1 phase, but it was not statistically significant. As for the SNR, when scanning 2 phase close to heart, scanning 1 phase close to pelvis, scanning and scanning 1 phase at upper and lower abdomen, it was higher when scanning 2 phase for 200~250 mA. Also, the CT number and noise was overall similar, but the noise was high close to pelvis. However, when scanning 2 phase for 250 mA close to pelvis, the noise value came out similar to 1 phase, and did not show statistically significant difference. It seems when separating pelvis to scan in 250 mA rather than 400 mA in 1 phase as before, it is expected to have reduced effect of exposure dose without difference in the quality of image. Thus, for patients who often get abdominal-pelvic CT exam, fertile women or children, this study proposes 2 phase exam for smaller exposure dose with same image quality.

Evaluation of the Long-Term Stability for the Cylindrical Ionization Chambers (교정정수 변화에 의한 원통형이온함의 안정성 평가)

  • Rah Jeong-Eun;Hong Ju-Young;Kim Gwe-Ya;Lim Chun-Il;Jeong Hee-Kyo;Shin Dong-Oh;Suh Tea-Suk
    • Radiation Oncology Journal
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    • v.24 no.2
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    • pp.138-143
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    • 2006
  • Purpose: To analyze the long-term stability of Farmer-type cylindrical ionization chambers by calibration factor provided from the KFDA (Korea Food Drug Administration) Materials and Methods: The cylindrical ionization chambers used in this study were the PTW 30001 (30006), 30013, 30002, 30004, 23333, the Capintec PR06C, the WE 2571, the Exradin A12 and the Wellhofer FC65G (IC70). We were analyzed that the $N_k$ and $N_{D.W}$ calibration factor for the cylindrical chambers and compared between the measured $N_{D.W}$ and calculated $N_{D.W}$ calibration factor. Results: We have observed that the long-term stability of the PTW 30013 (30006), the Wellhofer FC65G (IC70) and the NE 2571 has varied within 0.2%. The measured $N_{D,W}$ calibration factor was about 1.0% higher than the calculated $N_{D,W}$ that determined by the $N_k$ calibration factor. Conclusion: The study has evaluated that the long-term stability of the cylindrical chambers through analysis for the $N_k\;and\;N_{D,W}$ calibration factor. It has contributed to the improvement of clinical electron dosimetry in radiotherapy centers.

Comparison of the Efficacy of 2D Dosimetry Systems in the Pre-treatment Verification of IMRT (세기조절방사선치료의 환자별 정도관리를 위한 2차원적 선량계의 유용성 평가)

  • Hong, Chae-Seon;Lim, Jong-Soo;Ju, Sang-Gyu;Shin, Eun-Hyuk;Han, Young-Yih;Ahn, Yong-Chan
    • Radiation Oncology Journal
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    • v.27 no.2
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    • pp.91-102
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    • 2009
  • Purpose: To compare the accuracy and efficacy of EDR2 film, a 2D ionization chamber array (MatriXX) and an amorphous silicon electronic portal imaging device (EPID) in the pre-treatment QA of IMRT. Materials and Methods: Fluence patterns, shaped as a wedge with 10 steps (segments) by a multi-leaf collimator (MLC), of reference and test IMRT fields were measured using EDR2 film, the MatriXX, and EPID. Test fields were designed to simulate leaf positioning errors. The absolute dose at a point in each step of the reference fields was measured in a water phantom with an ionization chamber and was compared to the dose obtained with the use of EDR2 film, the MatriXX and EPID. For qualitative analysis, all measured fluence patterns of both reference and test fields were compared with calculated dose maps from a radiation treatment planning system (Pinnacle, Philips, USA) using profiles and $\gamma$ evaluation with 3%/3 mm and 2%/2 mm criteria. By measurement of the time to perform QA, we compared the workload of EDR2 film, the MatriXX and EPID. Results: The percent absolute dose difference between the measured and ionization chamber dose was within 1% for the EPID, 2% for the MatriXX and 3% for EDR2 film. The percentage of pixels with $\gamma$%>1 for the 3%/3 mm and 2%/2 mm criteria was within 2% for use of both EDR2 film and the EPID. However, differences for the use of the MatriXX were seen with a maximum difference as great as 5.94% with the 2%/2 mm criteria. For the test fields, EDR2 film and EPID could detect leaf-positioning errors on the order of -3 mm and -2 mm, respectively. However it was difficult to differentiate leaf-positioning errors with the MatriXX due to its poor resolution. The approximate time to perform QA was 110 minutes for the use of EDR2 film, 80 minutes for the use of the MatriXX and approximately 55 minutes for the use of the EPID. Conclusion: This study has evaluated the accuracy and efficacy of EDR2 film, the MatriXX and EPID in the pre-treatment verification of IMRT. EDR2 film and the EPID showed better performance for accuracy, while the use of the MatriXX significantly reduced measurement and analysis times. We propose practical and useful methods to establish an effective QA system in a clinical environment.

Evaluation and Comparison of Myocardial Perfusion Defects in Patients with Early Breast Cancer Subjected to Different Radiation Simulation Techniques (조기유방암 환자에서 방사선 모의치료 방법의 차이에 따른 심근관류결손의 비교 평가)

  • Nam, Ji-Ho;Ki, Yong-Kan;Kim, Dong-Won;Kim, Won-Taek
    • Radiation Oncology Journal
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    • v.25 no.1
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    • pp.26-33
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    • 2007
  • [ $\underline{Purpose}$ ]: The aim of this study is to evaluate and compare the incidence and aspects of myocardial perfusion defects in patients who were subjected to either two-dimensional or three-dimensional simulation techniques for early left-sided breast cancer. The myocardial perfusion defects were determined from using single photon emitted computerized tomography (SPECT) myocardial perfusion images. $\underline{Materials\;and\;Methods}$: Between January 2002 and August 2003, 32 patients were enrolled in this study. The patients were diagnosed as having early (AJCC stage T1-T2N0M0) left-sided breast cancer and were treated with tangential irradiation after breast-conserving surgery and systemic chemotherapy. The patients were divided into two groups according to the type of simulation received: two-dimensional simulation using an X-ray fluoroscope simulator or three-dimensional simulation with a CT simulator. All patients underwent technetium-99m-sestamibi gated perfusion SPECT at least 3 years after radiotherapy. The incidence and area of myocardial perfusion defects were evaluated and were compared in the two groups, and at the same time left ventricular ejection fraction and cardiac wall motion were also analyzed. The cardiac volume included in the radiation fields was calculated and evaluated to check for a correlation between the amount of irradiated cardiac volume and aspects of myocardial perfusion defects. $\underline{Results}$: A myocardial perfusion defect was detected in 11 of 32 patients (34.4%). There were 7 (46.7%) perfusion defect cases in 15 patients who underwent the two-dimensional simulation technique and 4 (23.5%) patients with perfusion defects in the three-dimensional simulation group (p=0.0312). In 10 of 11 patients who had myocardial perfusion changes, the perfusion defects were observed in the cardiac apex. The left ventricular ejection fraction was within the normal range and cardiac wall motion was normal in all patients. The irradiated cardiac volume of patients in the three-dimensional simulation group was less than that of patients who received the two-dimensional simulation technique, but there was no statistical significance as compared to the incidence of perfusion defects. $\underline{Conclusion}$: Radiotherapy with a CT simulator (three-dimensional simulation technique) for early left-sided breast cancer may reduce the size of the irradiated cardiac volume and the incidence of myocardial perfusion defects. Further investigation and a longer follow-up duration are needed to analyze the relationship between myocardial perfusion defects and clinical ischemic heart disease.

Clinical Evaluation of TightRope Cranial Cruciate Ligament Technique for Treatment of Cranial Cruciate Ligament Deficiency in Dogs (전방 십자인대 결손을 보이는 개에서 TightRope을 이용한 치료방법 평가)

  • Yoon, Hun-Young;Kim, Kyung-Hee;Jeong, Soon-Wuk
    • Journal of Veterinary Clinics
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    • v.29 no.6
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    • pp.455-459
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    • 2012
  • Nine dogs presented to the Veterinary Medical Teaching Hospital of Konkuk University and Woosung Animal Hospital with a history of pelvic limb lameness. On physical examination, 9 dogs all showed a consistent weight bearing lameness and mild muscle atrophy. There was cranial drawer sign with pain in 9 dogs. Mediolateral radiographic projection revealed cranial subluxation of the tibial tuberosity in a tibial compression view. The right and left stifle joints were affected in 7 dogs and 2 dogs respectively. TightRope cranial cruciate ligament (CCL) technique for treatment of CCL deficiency was performed. Polyester and nylon were used to stabilize the stifle in 3 dogs and 6 dogs respectively. Suture sizes were 0.8 mm (n = 2), 0.9 mm (n = 4), 1.1 mm (n = 2), and $1.1mm{\times}2$ strands (n = 1) in diameter. Mean (${\pm}SD$) surgical duration was $48.3{\pm}8.5$ minutes (range 35 to 60 minutes). Preoperative and postoperative mean (${\pm}SD$) cranial drawer signs were $8.6{\pm}1.6$ mm (rage 7 to 12 mm) and $1.2{\pm}1.0$ mm (rage 0 to 3 mm) respectively. Immediate postoperative radiographs of the affected limb revealed no evidence of cranial subluxation of the tibial tuberosity in a tibial compression view of 9 dogs. Normal limb function was regained in 8 dogs within 8 weeks postoperatively. A consistent weight bearing lameness resolved in all dogs after TightRope CCL technique, but reoccurred in one dog (case No. 6) 2 weeks after surgery. Cranial subluxation of the tibial tuberosity was identified in a tibial compression test. During the second surgery, breakage of surgical button was identified and a tibial wedge osteotomy was performed. Based on surgical time, complication, stifle stability, and functional recovery, the present study indicated that TightRope CCL technique is effective treatment for the dogs with CCL deficiency.

Strategic Direction and Road Map of Expanding Prevention of Winter Disease in the Summer (동병하치 확산을 위한 전략적 방향과 이행방안)

  • Song, Ho-Sueb
    • Journal of Acupuncture Research
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    • v.27 no.3
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    • pp.147-157
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    • 2010
  • Objectives : The purpose of this study was to propose appropriate strategic directions and road maps for successful achievement of programs preventing winter disease in the summer. Methods : Details on programs preventing winter disease in the summer such as clear concept, theoretical basis, current status, intervention or available prescriptions and indication/contraindication/caution were prepared through the related journal review, upon which an observational study was devised and done for simulation to find out even a trivial problem and to guarantee the safety beforehand. The experimental group was divided into 5 groups by the size of pill and the way ginger is treated; 1cm pill with ginger group, 3cm pill group without ginger, 3cm pill group dipped into ginger, 3cm pill group applying ginger to acupoints and 3cm pill group with ginger Results 1. program preventing winter disease in the summer was defined as representative winter diseases such as common cold, influenza, chronic asthma, chronic bronchitis, allergic rhinitis, emphysema, chronic gastritis and rheumatoid arthritis, and preventive care in the summer, reinforcing deficient yang qi of five viscera by using exuberant yang qi from summer heat. 2. It was based upon historically established theories which is 'nourishing yang qi in the spring and summer', 'long summer, namely rainy spell in the summer overwhelms the winter, because of earth winning water according to the five phases theory' and 'To replenish yang qi is major principle to treat winter diseases, which can be most appropriately and timely applied to the patient with deficient yang qi of five viscera inherently, especially in the three dog days of the summer, because of exuberant exterior yang qi and deficient interior yang qi in the five viscera'. 3. In the adjacent China and Taiwan, acupoint applying method in the three dog days named 'San Fu Tie' have been stirring a boom throughout the nation, in which Xiaochuan Gao was used as a basic prescription and it mainly was applied at bilateral $BL_{13}$, $_{15}$ and $_{17}$ for about 4 hours. As far as domestic current status, the necessity of adopting the above method prior to Herbal formula was also recognised, because not a few koreans have apprehension for the safety of it including medicinal herbs and are reluctant to take it any more due to negative advertisement of narrow minded doctors' association. 4. Indication of acupoint applying method in the three dog days included most of winter diseases such as common cold, influenza, chronic asthma, chronic bronchitis, allergic rhinitis, emphysema, chronic gastritis. contraindication was pregnant woman and the weak such as infants and the old. More attention was paid to grasp firmly the normal reaction following the treatment for preventing side effect and teasing blister. recommendation was also given to abstain from food inducing phlegm and dampness such as meat, shrimp and crab as well as cold drinks and foods 5. In the simulation observational study based upon the above findings following review the related articles, no blister was shown on the acupoints icluding bilateral $BL_{13}$, $_{15}$ and $_{17}$ in every experimental group during 24hr observation following the acupoint applying treatment with pills made by modified and devised prescription. At 4 hr, the effectiveness of it reached a peak showing redness and mild tenderness and there is little difference between groups 3cm pills groups regardless of the way ginger was treated. abdominal distention and growling was found in all the volunteers during the treatment at CV 8. Strategic directions and road maps : Through successful fulfillment of the program preventing winter disease in the summer, Korean traditional medicine should be integrated into mainstream national health care services. Cultural access was thought to be as important as Scientific EBM approach. First of all, To evoke potential cultural homogeneity from campaigns and press advertisement was needed for promoting public awareness about preventing winter disease in the summer by enhancing immunity via acupoint applying treatment in the three dog days, and then indigenous name as Sambokcheop, protocol, Clinical Research Form for data collection of it should be developed and prepared. Once the first step was taken this summer, through a thorough data collection and scrutinized scientific evaluation, drawbacks should be compensted for and the efficacy and safety should be substantiated.

Development of Evaluation Method of Regional Contractility of Left Ventricle Using Gated Myocardial SPECT and Assessment of Reproducibility (게이트 심근 SPECT를 이용한 좌심실의 국소탄성률 평가방법 개발 및 재현성 평가)

  • Lee, Byeong-Il;Lee, Dong-Soo;Lee, Jae-Sung;Kang, Won-Jun;Chung, June-Key;Lee, Myung-Chul;Choi, Heung-Kook
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.6
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    • pp.355-363
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    • 2003
  • Purpose: Regional contractility can be calculated using the regional volume change of left ventricle measured by gated myocardial SPECT image and curve of central artery pressure obtained from radial artery pressure data. In this study, a program to obtain the regional contractility was developed, and reproducibility of regional contractility measurement was assessed. Materials and Methods: Seven patients(male:female=5:2, $58{\pm}11.9$ years) with coronary artery diseases underwent gated Tc-99m MIBI myocardial SPECT twice without delay between two scans. Regional volume change of left ventricle was estimated using CSA (Cardiac SPECT Analyzer) software developed in this study. Regional contractility was iteratively estimated from the time-elastance curve obtained using the time-pressure curve and regional time-volume curve. Reproducibility of regional contractility measurement assessed by comparing the contractility values measured twice from the same SPECT data and by comparing those measured from the pair of SPECT data obtained from a same patient. Results: Measured regional contractility was $3.36{\pm}3.38{mm}Hg/mL$ using 15-segment model, $3.16{\pm}2.25{mm}Hg/mL$ using 7-segment model, and $3.11{\pm}2.57{mm}Hg/mL$ using 5-segment model. The harmonic average of regional contractility value was almost identical to the global contractility. Correlation coefficient of regional contractility values measured twice from the same data was greater than 0.97 for all models, and two standard deviations of contractility difference on Bland Altman plot were 1.5%, 1.0%, and 0.9% for 15-, 7-, and 5-segment models, respectively. Correlation coefficient of regional contractility values measured from the pair of SPECT data obtained from a same patient was greater than 0.95 for all models, and two standard deviations on Bland Altman plot were 2.2%, 1.0%, and 1.2%. Conclusion: Regional contractility of left ventricle measured using developed software in this study was reproducible. Regional contractility of left ventricle will be a new useful index for myocardial function after analysis of the clinical data.

Study on the radiographic evaluation of marginal bone loss around short-length implant after functional loading (기능적 부하 후 "Short Implant" 주변의 골 흡수에 대한 방사선학적 연구)

  • Park, Young-Ju;Nam, Jeong-Hun;Noh, Kyung-Lok;Yeon, Byoung-Moo;Yu, Woo-Geun;Lee, Jeong-Won;Ahn, Jang-Hun;Gang, Tae-In;Park, Mi-Hee
    • The Journal of the Korean dental association
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    • v.48 no.8
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    • pp.615-620
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    • 2010
  • Purpose: The short dental implant is considered as possible solution in the alveolar bone height deficient cases. The aim of this study was to evaluate clinical availability of short implants by measuring the marginal bone loss of short length implants and comparing with that of conventional length implants. Materials and Methods: The groups were composed of patients who had received at least one implant. The samples of this study were selected from patients who with functional loading after prosthetic treatment for 1 year follow up period. The implants with a length of 5.7 mm and 6mm were considered short. (Bicon Dental implants, USA). The experiment group was composed of $4.5{\times}6mm$, $5{\times}6mm$, $6{\times}5.7mm$ implants (total 18 implants were placed in 14 patients, 8 on maxilla, 10 on mandible). The control group was composed of $4.5{\times}8mm$, $5{\times}8mm$, $4.5{\times}11mm$, $5{\times}11mm$. All implants were selected only by implants placed on molar area. We evaluated marginal bone loss in radiographic images at baseline (implant loading) and 3, 6, 12 months after loading. Additionally, crown-to-implant ratio was evaluated, and marginal bone loss according to crown-to-implant ratio after functional loading was analyzed. Results: The short implant group had a mean marginal bone level of $-0.52{\pm}0.69mm$; the 8mm group, $-0.22{\pm}0.82mm$; and the II mm group, $-0.10{\pm}1.09mm$ after I year of functional loading. But significant differences were not detected between three groups at every follow-up period. Crown-to-implant ratio in short implant group was $1.55{\pm}0.23$; 8mm group was $1.15{\pm}0.18$; and 11mm group was $0.92{\pm}0.15$. Additionally, significant differences between three groups were founded. (P<.0001) The greatest marginal bone loss after 1 year follow-up was founded at crown-to-implant ratio 1~1.49 range in short implant. Conclusion: The marginal bone loss of short implants was comparable to that of long implants. So, the short implants can be a clinically acceptable option.

Surgical Evaluation of Squamous Cell Carcinoma of the Lung (편평상피세포 폐암의 외과적 고찰)

  • An, Byeong-Hui;Mun, Hyeong-Seon;Na, Guk-Ju;Kim, Sang-Hyeong
    • Journal of Chest Surgery
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    • v.30 no.2
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    • pp.179-186
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    • 1997
  • The frequency of primary lung cancer is increasing compared to other cancer. Complete surgical resection is the most effective method of treatment, but it is limited to only 25 to 30 percent of patients after initial clinical presentation. The survival rate is different by the subtypes of carcinoma, stages, and general condition of patients. The author investigated the survival rate of 87 patients with squamous cell carcinoma of the lung after surgery. Age ranged from 31 to 73 years, with Lean 57.1) $\pm$ 7.15 and 80.5% (70 cases) was initially diagnosed at sixth and seventh decades. Male to female ratio was 8.9'1. Initial complaints were cough with sputum in 78.1%, weight loss in 31.0%, chest pain and discomfort in 29.9%, and hemoptysis in 24.1%. The location of the tumor was right side in 44.8% and left slde in 55.2% ; LUL in 39.1%, RLL in 20.7%, LLL in'16. 1%, RUL in 14.9% and RML in 9.2%. Stage I was 19.5%, stage II 25.3%, stage olla 54.1% and stage lIIb 1.1%. Operative procedures were as follow : pneumonectomy in 52.9%, lobectomy in 47.1%, sleeve upper lobectomy in 4 cases. Single mediastinal Iymph node involvement was observed in 17 cases, and multi-level mediastinal Iymph node involvement in 23 cases. Lower paratracheal Iymph node and subcarinal Lymph node were more frequently involved in right side lung cancer, with 8 and 10 cases, respectively and subaortic Iymph node was most frequently involved in left side lung cancer with 9 cases. Operative complications were hoarseness, wound infection and chylothorax in 7, 5 and 4 cases, respectively. The operative mortality was 2.2% and the cause of death was pulmonary edema. Postoperative follow-up period ranged from 1 month to 99 months with a mean of 29.95 $\pm$ 17.21 months. Overall one-year survival rate was 75.1 % and five-year survival rate was 29.8%. One-year and five-year survival rates were 93.7% and 52.4% for stage 1, 92.2% and 30.5% for st ge ll, and 61.2% and 17.4% for stage llla, respectively. These findings correlate survival rate with tumor size, mediastinal Iymph node metastasis and surgical resectability, and long-term survival can be expected with small sized tumor, absent mediastinal Iymph node metastasis and complete surgical resection.

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