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No-Touch Radiofrequency Ablation Using Twin Cooled Wet Electrodes for Recurrent Hepatocellular Carcinoma Following Locoregional Treatments

  • Seong Jun Hong;Jae Hyun Kim;Jeong Hee Yoon;Jeong Hoan Park;Jung-Hwan Yoon;Yoon Jun Kim;Su Jong Yu;Eun Ju Cho;Jeong Min Lee
    • Korean Journal of Radiology
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    • v.25 no.5
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    • pp.438-448
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    • 2024
  • Objective: To evaluate the therapeutic outcomes of no-touch radiofrequency ablation (NT-RFA) using twin cooled wet (TCW) electrodes in patients experiencing recurrent hepatocellular carcinoma (HCC) after undergoing locoregional treatments. Materials and Methods: We conducted a prospective, single-arm study of NT-RFA involving 102 patients, with a total of 112 recurrent HCCs (each ≤ 3 cm). NT-RFA with TCW electrodes was implemented under the guidance of ultrasonography (US)-MR/CT fusion imaging. If NT-RFA application proved technically challenging, conversion to conventional tumor puncture RFA was permitted. The primary metric for evaluation was the mid-term cumulative incidence of local tumor progression (LTP) observed post-RFA. Cumulative LTP rates were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazard regression was used to explore factors associated with LTP. Considering conversion cases from NT-RFA to conventional RFA, intention-to-treat (ITT; including all patients) and per-protocol (PP; including patients not requiring conversion to conventional RFA alone) analyses were performed. Results: Conversion from NT-RFA to conventional RFA was necessary for 24 (21.4%) out of 112 tumors. Successful treatment was noted in 111 (99.1%) out of them. No major complications were reported among the patients. According to ITT analysis, the estimated cumulative incidences of LTP were 1.9%, 6.0%, and 6.0% at 1, 2, and 3 years post-RFA, respectively. In PP analysis, the cumulative incidence of LTP was 0.0%, 1.3%, and 1.3% at 1, 2, and 3 years, respectively. The number of previous locoregional HCC treatments (adjusted hazard ratio [aHR], 1.265 per 1 treatment increase; P = 0.004), total bilirubin (aHR, 7.477 per 1 mg/dL increase; P = 0.012), and safety margin ≤ 5 mm (aHR, 9.029; P = 0.016) were independently associated with LTP in ITT analysis. Conclusion: NT-RFA using TCW electrodes is a safe and effective treatment for recurrent HCC, with 6.0% (ITT analysis) and 1.3% (PP analysis) cumulative incidence of LTP at 2 and 3-year follow-ups.

Validation of Ultrasound and Computed Tomography-Based Risk Stratification System and Biopsy Criteria for Cervical Lymph Nodes in Preoperative Patients With Thyroid Cancer

  • Young Hun Jeon;Ji Ye Lee;Roh-Eul Yoo;Jung Hyo Rhim;Kyung Hoon Lee;Kyu Sung Choi;Inpyeong Hwang;Koung Mi Kang;Ji-hoon Kim
    • Korean Journal of Radiology
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    • v.24 no.9
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    • pp.912-923
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    • 2023
  • Objective: This study aimed to validate the risk stratification system (RSS) and biopsy criteria for cervical lymph nodes (LNs) proposed by the Korean Society of Thyroid Radiology (KSThR). Materials and Methods: This retrospective study included a consecutive series of preoperative patients with thyroid cancer who underwent LN biopsy, ultrasound (US), and computed tomography (CT) between December 2006 and June 2015. LNs were categorized as probably benign, indeterminate, or suspicious according to the current US- and CT-based RSS and the size thresholds for cervical LN biopsy as suggested by the KSThR. The diagnostic performance and unnecessary biopsy rates were calculated. Results: A total of 277 LNs (53.1% metastatic) in 228 patients (mean age ± standard deviation, 47.4 years ± 14) were analyzed. In US, the malignancy risks were significantly different among the three categories (all P < 0.001); however, CT-detected probably benign and indeterminate LNs showed similarly low malignancy risks (P = 0.468). The combined US + CT criteria stratified the malignancy risks among the three categories (all P < 0.001) and reduced the proportion of indeterminate LNs (from 20.6% to 14.4%) and the malignancy risk in the indeterminate LNs (from 31.6% to 12.5%) compared with US alone. In all image-based classifications, nodal size did not affect the malignancy risks (short diameter [SD] ≤ 5 mm LNs vs. SD > 5 mm LNs, P ≥ 0.177). The criteria covering only suspicious LNs showed higher specificity and lower unnecessary biopsy rates than the current criteria, while maintaining sensitivity in all imaging modalities. Conclusion: Integrative evaluation of US and CT helps in reducing the proportion of indeterminate LNs and the malignancy risk among them. Nodal size did not affect the malignancy risk of LNs, and the addition of indeterminate LNs to biopsy candidates did not have an advantage in detecting LN metastases in all imaging modalities.

A Hybrid Oversampling Technique for Imbalanced Structured Data based on SMOTE and Adapted CycleGAN (불균형 정형 데이터를 위한 SMOTE와 변형 CycleGAN 기반 하이브리드 오버샘플링 기법)

  • Jung-Dam Noh;Byounggu Choi
    • Information Systems Review
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    • v.24 no.4
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    • pp.97-118
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    • 2022
  • As generative adversarial network (GAN) based oversampling techniques have achieved impressive results in class imbalance of unstructured dataset such as image, many studies have begun to apply it to solving the problem of imbalance in structured dataset. However, these studies have failed to reflect the characteristics of structured data due to changing the data structure into an unstructured data format. In order to overcome the limitation, this study adapted CycleGAN to reflect the characteristics of structured data, and proposed hybridization of synthetic minority oversampling technique (SMOTE) and the adapted CycleGAN. In particular, this study tried to overcome the limitations of existing studies by using a one-dimensional convolutional neural network unlike previous studies that used two-dimensional convolutional neural network. Oversampling based on the method proposed have been experimented using various datasets and compared the performance of the method with existing oversampling methods such as SMOTE and adaptive synthetic sampling (ADASYN). The results indicated the proposed hybrid oversampling method showed superior performance compared to the existing methods when data have more dimensions or higher degree of imbalance. This study implied that the classification performance of oversampling structured data can be improved using the proposed hybrid oversampling method that considers the characteristic of structured data.

Distortion of the Dose Profile in a Three-dimensional Moving Phantom to Simulate Tumor Motion during Image-guided Radiosurgery (방사선수술에서 종양 움직임을 재현시킨 움직이는 팬텀을 이용하여 선량 분포의 왜곡에 대한 연구)

  • Kim, Mi-Sook;Ha, Seong-Hwan;Lee, Dong-Han;Ji, Young-Hoon;Yoo, Seong-Yul;Cho, Chul-Koo;Yang, Kwang-Mo;Yoo, Hyung-Jun;Seo, Young-Seok;Park, Chan-Il;Kim, Il-Han;Ye, Seong-Jun;Park, Jae-Hong;Kim, Kum-Bae
    • Radiation Oncology Journal
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    • v.25 no.4
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    • pp.268-277
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    • 2007
  • Purpose: Respiratory motion is a considerable inhibiting factor for precise treatment with stereotactic radiosurgery using the CyberKnife (CK). In this study, we developed a moving phantom to simulate three-dimensional breathing movement and investigated the distortion of dose profiles between the use of a moving phantom and a static phantom. Materials and Methods: The phantom consisted of four pieces of polyethylene; two sheets of Gafchromic film were inserted for dosimetry. Treatment was planned to deliver 30 Gy to virtual tumors of 20, 30, 40, and 50 mm diameters using 104 beams and a single center mode. A specially designed robot produced three-dimensional motion in the right-left, anterior-posterior, and craniocaudal directions of 5, 10 and 20 mm, respectively. Using the optical density of the films as a function of dose, the dose profiles of both static and moving phantoms were measured. Results: The prescribed isodose to cover the virtual tumors on the static phantom were 80% for 20 mm, 84% for 30 mm, 83% for 40 mm and 80% for 50 mm tumors. However, to compensate for the respiratory motion, the minimum isodose levels to cover the moving target were 70% for the $30{\sim}50$ mm diameter tumors and 60% for a 20 mm tumor. For the 20 mm tumor, the gaps between the isodose curves for the static and moving phantoms were 3.2, 3.3, 3.5 and 1.1 mm for the cranial, caudal, right, and left direction, respectively. In the case of the 30 mm tumor, the gaps were 3.9, 4.2, 2.8, 0 mm, respectively. In the case of the 40 mm tumor, the gaps were 4.0, 4.8, 1.1, and 0 mm, respectively. In the case of the 50 mm diameter tumor, the gaps were 3.9, 3.9, 0 and 0 mm, respectively. Conclusion: For a tumor of a 20 mm diameter, the 80% isodose curve can be planned to cover the tumor; a 60% isodose curve will have to be chosen due to the tumor motion. The gap between these 80% and 60% curves is 5 mm. In tumors with diameters of 30, 40 and 50 mm, the whole tumor will be covered if an isodose curve of about 70% is selected, equivalent of placing a respiratory margin of below 5 mm. It was confirmed that during CK treatment for a moving tumor, the range of distortion produced by motion was less than the range of motion itself.

Development of a New Cardiac and Torso Phantom for Verifying the Accuracy of Myocardial Perfusion SPECT (심근관류 SPECT 검사의 정확도 검증을 위한 새로운 심장.흉부 팬텀의 개발)

  • Yamamoto, Tomoaki;Kim, Jung-Min;Lee, Ki-Sung;Takayama, Teruhiko;Kitahara, Tadashi
    • Journal of radiological science and technology
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    • v.31 no.4
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    • pp.389-399
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    • 2008
  • Corrections of attenuation, scatter and resolution are important in order to improve the accuracy of single photon emission computed tomography (SPECT) image reconstruction. Especially, the heart movement by respiration and beating cause the errors in the corrections. Myocardial phantom is used to verify the correction methods, but there are many different parts in the current phantoms in actual human body. Therefore the results using a phantom are often considered apart from the clinical data. We developed a new phantom that implements the human body structure around the thorax more faithfully. The new phantom has the small mediastinum which can simulate the structure in which the lung adjoins anterior, lateral and apex of myocardium. The container was made of acrylic and water-equivalent material was used for mediastinum. In addition, solidified polyurethane foam in epoxy resin was used for lung. Five different sizes of myocardium were developed for the quantitative gated SPECT (QGS). The septa of all different cardiac phantoms were designed so that they can be located at the same position. The proposed phantom was attached with liver and gallbladder, the adjustment was respectively possible for the height of them. The volumes of five cardiac ventricles were 150.0, 137.3, 83.1, 42.7 and 38.6ml respectively. The SPECT were performed for the new phantom, and the differences between the images were examined after the correction methods were applied. The three-dimensional tomography of myocardium was well reconstructed, and the subjective evaluations were done to show the difference among the various corrections. We developed the new cardiac and torso phantom, and the difference of various corrections was shown on SPECT images and QGS results.

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Evaluation of Magnetization Transfer Ratio Imaging by Phase Sensitive Method in Knee Joint (슬관절 부위에서 자화전이 위상감도법에 의한 자화전이율 영상 평가)

  • Yoon, Moon-Hyun;Seung, Mi-Sook;Choe, Bo-Young
    • Progress in Medical Physics
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    • v.19 no.4
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    • pp.269-275
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    • 2008
  • Although MR imaging is generally applicable to depict knee joint deterioration it, is sometimes occurred to mis-read and mis-diagnose the common knee joint diseases. In this study, we employed magnetization transfer ratio (MTR) method to improve the diagnosis of the various knee joint diseases. Spin-echo (SE) T2-weighted images (TR/TE 3,400-3,500/90-100 ms) were obtained in seven cases of knee joint deterioration, FSE T2-weighted images (TR/TE 4,500-5,000/100-108 ms) were obtained in seven cases of knee joint deterioration, gradient-echo (GRE) T2-weighted images (TR/TE 9/4.56/$50^{\circ}$ flip angle, NEX 1) were obtained in 3 cases of knee joint deterioration, In six cases of knee joint deterioration, fat suppression was performed using a T2-weighted short T1/tau inverse recovery (STIR) sequence (TR/TE =2,894-3,215 ms/70 ms, NEX 3, ETL 9). Calculation of MTR for individual pixels was performed on registration of unsaturated and saturated images. After processing to make MTR images, the images were displayed in gray color. For improving diagnosis, three-dimensional isotropic volume images, the MR tristimulus color mapping and the MTR map was employed. MTR images showed diagnostic images quality to assess the patients' pathologies. The intensity difference between MTR images and conventional MRI was seen on the color bar. The profile graph on MTR imaging effect showed a quantitative measure of the relative decrease in signal intensity due to the MT pulse. To diagnose the pathologies of the knee joint, the profile graph data was shown on the image as a small cross. The present study indicated that MTR images in the knee joint were feasible. Investigation of physical change on MTR imaging enables to provide us more insight in the physical and technical basis of MTR imaging. MTR images could be useful for rapid assessment of diseases that we examine unambiguous contrast in MT images of knee disorder patients.

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Implementation of Radiotherapy Educational Contents Using Virtual Reality (가상현실 기술을 활용한 방사선치료 교육 콘텐츠 제작 구현)

  • Kwon, Soon-Mu;Shim, Jae-Goo;Chon, Kwon-Su
    • Journal of the Korean Society of Radiology
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    • v.12 no.3
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    • pp.409-415
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    • 2018
  • The development of smart devices has brought about significant changes in daily life and one of the most significant changes is the virtual reality zone. Virtual reality is a technology that creates the illusion that a 3D high-resolution image has already been created using a display device just like it does in itself. Unrealized subjects are forced to rely on audiovisual materials, resulting in a decline in the concentration of practices and the quality of classes. It used virtual reality to develop effective teaching materials for radiology students. In order to produce a video clip bridge using virtual reality, a radiology clinic was selected to conduct two exposures from July to September 2017. The video was produced taking into account the radiology and work flow chart and filming was carried out in two separate locations : in the computerized tomography unit and in the LINAC room. Prior to filming the scenario and the filming route were checked in advance to facilitate editing of the video. Modeling and mapping was performed in a PC environment using the Window XP operating system. Using two leading virtual reality camera Gopro Hero, CC pixels were produced using a 4K UHD, Adobe, followed by an 8 megapixel resolution of $3,840{\times}2,160/4,096{\times}2,160$. Total regeneration time was performed in about 5 minutes during the production of using virtual reality to prevent vomiting and dizziness. Currently developed virtual reality radiation and educational contents are being used to secure the market and extend the promotion process to be used by various institutions. The researchers will investigate the satisfaction level of radiation and educational contents using virtual reality and carry out supplementary tasks depending on the results.

CHARACTERISTICS OF THE PALATAL MORPHOLOGY OF THE CHILDREN WITH CROSSBITE IN MIXED DENTITION BY 3-DIMENSIONAL LASER SCANNER (3차원 스캐너를 이용한 혼합치열기 반대교합아동의 구개형태에 관한 연구)

  • Kim, Dong-Won;Park, Ho-Won
    • Journal of the korean academy of Pediatric Dentistry
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    • v.30 no.1
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    • pp.132-142
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    • 2003
  • This study is performed to investigate the characteristics of the palatal morphology of the children with anterior crossbite in Hellman dental age IIIA by 3-dimensional laser scanner. Totally 40 study casts were taken; 20 were from children with crossbite and another 20 were from normal occlusion as a control. Each cast was scanned by 3 dimension laser scanner and shaped by the 3 dimension image by rapidform 2000 program(INUS, Korea). And finally it was calculated by Rhino 3D program(Rhinoceros, USA). The intercanine, intermolar cross-sectioned transverse plane and sagittal plane were measured. Due to the variations in palatal morphology, each group was standardized into 25mm, 35mm, 35mm. By sectioning standardized curves of the Palatal morphology per 1mm, the palatal depth of each point was calculated. Through these complex methods, the mean curves of the palatal morphology could be obtained and the values were statistically compared and evaluated by T-test with 95% of significance level. The results were as follows: 1. In the intercanine cross-sectioned transverse plane, the mean curve of palatal morphology of crossbite group was flatter V shape than that of control group, however, there was no statistical significance was found between two groups(P>0.05). 2. In the intermolar cross-sectioned transverse plane, the mean curve of palatal morphology of crossbite was deeper all over the area than that of control group, and the statistical significance was found in the middle area from point 8 to 21(P<0.05). 3. In the sagittal plane, the mean curve of palatal morphology of crossbite group was more deepening as approaching posteriorly than that of control group, and the statistical significance was found in all over the area(P<0.01).

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The Evaluation of Usefulness of 99Mo-99mTc Generator Using(n,γ)99Mo Developed by Korea Atomic Energy Research ((n,γ)99Mo를 이용한 99Mo-99mTc발생기의 유용성 평가)

  • Seo, Han Kyung;Kim, Jeong Ho;Shim, Cheol Min;Kim, Byung Cheol;Choi, Do Cheol;Gwon, Yong Ju;Park, Yung Sun;Kim, Dong Yun
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.2
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    • pp.48-52
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    • 2013
  • Purpose: The Molybdenum which is the raw material of $^{99}Mo-^{99m}Tc$ generator is produced from the nuclear reactor. However, output has dwindled as the two nuclear reactors supplying the bulk of radioactive material-one in Chalk River, Ontario and the other in Petten, the Netherlands-have been closed for repairs or maintenance. This resulted in the enhancement of its price. So $^{99}Mo-^{99m}Tc$ generator using$(n,{\gamma})^{99}Mo$ is developed by Korea Atomic Energy Research Institute (KAERI). Medicinal availability of this generator is evaluated in this study. Materials and Methods: The radioactivity of $^{99m}Tc$ eluted in generator 1, 2 and 3 unit developed by KAERI was measured. The quality control test of generator such as appearance test, pH test, LAL test, sterility test, chemical impurity (Al) test and radiochemical purity test were performed. Planar and SPECT/CT image sof SD rat (6 weeks, Female) at 2 hr after injection of $^{99m}Tc-HDP$ (hydroxymethylenediphosphonate) (TechneScan HDP, Malinckrodt Medical, Dutch) and $^{99m}Tc-DPD$ (diphosphono-1, 2-propanedicarboxylicacid) (TECEOS, CIS bio international, France) which were labeled with $^{99m}Tc$ eluted in KAERI and commercial generator (40.5 GBq, Malinckrodt Medical, Dutch) using SPECT/CT camera (Symbia, Siemense, Germany) were obtained respectively. Results: The mean radioactivity of $^{99m}Tc$ elution generator 1unit was 4.18 GBq (113 mCi), generator 2 unit was 4.73 GBq (128 mCi) and generator 3 unit was 3.33 GBq (90 mCi). All quality control tests were within normal limit except pyrogentest. Pyrogen test was positive. Planar and SPECT/CT images of rat injected $^{99m}Tc-HDP$ which was labeled with $^{99m}Tc$ eluted in commercial generator show increased uptake in bone, stomach and bowl. Planar images show increased uptake in liver and bone in case of $^{99m}Tc-DPD$. However, images of rat injected $^{99m}Tc-HDP$ and $^{99m}Tc-DPD$ which were labelled $^{99m}Tc$ eluted in KAERI generator show increased uptake in bone, liver and spleen. Conclusion: If shortcoming is removed such as pyrogen and liver appearance, domestic role as an alternative generator is thought to be able to fill and to secure the national medical service by supplying $^{99m}Tc$ when the supply of $^{99m}Tc$ be comes short.

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Tributyltin Chloride (TBTCl) Toxicity on the Growth and Mantle Structure of the Equilateral Venus, Gomphina veneriformis (Bivalvia: Veneridae) (대복, Gomphina veneriformis의 성장과 외투막 구조에 미치는 TBTCl의 독성)

  • Park, Jung-Jun;Lee, Jung-Sick
    • The Korean Journal of Malacology
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    • v.24 no.3
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    • pp.229-241
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    • 2008
  • Changes of growth and histopathological feature in the mantle structure of the equilateral venus, Gomphina veneriformis exposed to tribultyltin chloride (TBTCl) for 36 weeks were observed. Concentrations of TBTCl were 0, 0.4, 0.6, and $0.8{\mu}g/L$. A regression analysis by power function of SPSS was shown that the growth of experimental groups was significantly decreased after 12 weeks of exposure. For histological analysis, mantle tissues were characterized using H-E stain, AB-PAS (pH 2.5) reaction and Masson's trichrome stain, and epidermal layer thickness and mucous cell distribution were analysed using the image analyser. The mantle had 4-folds (inner-inner, inner-outer, middle, and outer) and its epidermal layer consisted of simple epithlia. A periostracum was observed in the periostracal groove between middle and outer fold. Inner epidermal layer consisted of simple ciliated columnar epithelia, but the outer epidermal layer consisted of simple non-ciliated columnar epithelia. Alcian blue positive mucous cells showed blue color (7462c, 653c) in the inner fold, violet color (2583c) in the middle fold, and blue color (647c, 7455c) in inner epidermal layer (numbers in the parenthesis are codes of Pantone process coated color). Hemolymph sinus in the mantle was extended, and mucous cells in inner plica of the middle fold were stained as blue (7455c) and violet (2587c), after 12 weeks of TBTCI exposure. Cilia and striated border were disappeared, and number of mucous cells in the inner epidermal layer was reduced. Serious histopathological changes in middle and outer fold near the periostracum were observed after 36 weeks. Moreover, epidermal layer thickness and mucous cell distribution were showed decreasing tendency as exposure time to TBTCI was increased. Results of this study suggested that TBTCl induced growth disorder with histopathological changes.

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