• Journal of Radiation Protection and Research
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• v.44 no.3
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• pp.103-109
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• 2019

Background: Four-dimensional computed tomographic (4DCT) images are increasingly used in clinic with the growing need to account for the respiratory motion of the patient during radiation treatment. One of the reason s that makes the dose evaluation using 4DCT inaccurate is a change of the patient respiration during the treatment session, i.e., intrafractional uncertainty. Especially, when the amplitude of the patient respiration is greater than the respiration range during the 4DCT acquisition, such an organ motion from the larger respiration is difficult to be represented with the 4DCT. In this paper, the method to generate images expecting the organ motion from a respiration with extended amplitude was proposed and examined. Materials and Methods: We propose a method to generate extra-phase images from a given set of the 4DCT images using deformable image registration (DIR) and linear extrapolation. Deformation vector fields (DVF) are calculated from the given set of images, then extrapolated according to respiratory surrogate. The extra-phase images are generated by applying the extrapolated DVFs to the existing 4DCT images. The proposed method was tested with the 4DCT of a physical 4D phantom. Results and Discussion: The tumor position in the generated extra-phase image was in a good agreement with that in the gold-standard image which is separately acquired, using the same 4DCT machine, with a larger range of respiration. It was also found that we can generate the best quality extra-phase image by using the maximum inhalation phase (T0) and maximum exhalation phase (T50) images for extrapolation. Conclusion: In the present study, a method to construct extra-phase images that represent expanded respiratory motion of the patient has been proposed and tested. The movement of organs from a larger respiration amplitude can be predicted by the proposed method. We believe the method may be utilized for realistic simulation of radiation therapy.

• Journal of radiological science and technology
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• v.30 no.4
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• pp.381-389
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• 2007

The purpose of this study is investigation of radiation dose in CT scan. Data were collected from various references and organizations. Doses measured by CT scanners of each medical organization were analyzed and they were calculated through the examination protocol. The results are as follows : 1. $CTDI_W$ value per 100mAs measured by Head Phantom was the highest in <4-slice MDCT scanner> of 24.20 mGy. $CTDI_W$ values were significantly different among scanner generations(p < 0.01). 2. $CTDI_W$ value per 100 mAs measured using body phantom was the highest in <4-slice MDCT scanner> of 13.58 mGy and the $CTDI_W$ values were significantly different among scanner generations(p < 0.01). 3. When contrast medium was not used, the highest scanner was <16 slice MDCT> of $818.83\;mGy{\codt}cm$ in exposure dose in brain scan(p < 0.05). When the contrast medium was used, the highest scanner was <4 slice MDCT> and its average was $1,460.77\;mGy{\cdot}cm$(p < 0.1). 4. When the contrast medium was not used, the highest scanner was <16-slice MDCT> of $521.63\;mGy{\cdot}cm$ on average in terms of the exposure dose in chest inspection(p<0.05). when the contrast medium was used, the highest scanner was found in 8 slice MDCT scanner and its average was $1,174.70\;mGy{\cdot}cm$. There was no statistically significant difference among scanners. 5. When the contrast medium was not used, the highest scanner was <16-slice MDCT> and its average was $856.27\;mGy{\cdot}cm$ in exposure dose on the abdomen-pelvis(p<0.05). when the contrast medium was used, the highest scanner was <16-slice MDCT> and its average was $1,720.64\;mGy{\cdot}cm$ on average (p < 0.05). 6. When the contrast medium was not used, the highest scanner was <8-slice MDCT> and its average was $612.07\;mGy{\cdot}cm$ in exposure dose in liver inspection(p < 0.05). when the contrast medium was used, the highest scanner was <8-slice MDCT scanner> and its average was $2,197.93\;mGy{\cdot}cm$ in exposure dose(p < 0.1). seventy six point two percent of medical facilities were in risk of radiation exposure while the number of phase was three to four times in their dose inspection of contrast medium.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.3
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• pp.201-208
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• 2007

Purpose: We investigated whether the diagnostic performance of SPECT scintimammography (SMM) can be improved by adding computer-aided diagnosis (CAD) of ultrasonography (US). Materials and methods: We reviewed breast SPECT SMM images and corresponding US images from 40 patients with breast masses (21 malignant and 19 benign tumors). The quantitative data of SPECT SMM were obtained as the uptake ratio of lesion to contralateral normal breast. The morphologic features of the breast lesions on US were extracted and quantitated using the automated CAD software program. The diagnostic performance of SPECT SMM and CAD of US alone was determined using receiver operating characteristic (ROC) curve analysis. The best discriminating parameter (D-value) combining SPECT SMM and the CAD of US was created. The sensitivity, specificity and accuracy of combined two diagnostic modalities were compared to those of a single one. Results: Both SPECT SMM and CAD of US showed a relatively good diagnostic performance (area under curve = 0.846 and 0.831, respectively). Combining the results of SPECT SMM and CAD of US resulted in improved diagnostic performance (area under curve =0.860), but there was no statistical differerence in sensitivity, specificity and accuracy between the combined method and a single modality. Conclusion: It seems that combining the results of SPECT SMM and CAD of breast US do not significantly improve the diagnostic performance for diagnosis of breast cancer, compared with that of SPECT SMM alone. However, SPECT SMM and CAD of US may complement each other in differential diagnosis of breast cancer.

• Tuberculosis and Respiratory Diseases
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• v.49 no.3
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• pp.290-297
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• 2000

Background : Current non-invasive methods for evaluating the mediastinum by computed tomographic (CT) scan have limited sensitivity and specificity. The recently introduced PET was reported to be a more sensitive and specific method for the mediastinal staging of NSCLC (sensitivity : 76-100 %, specificity : 81-100%) than CT or MRI. We assessed the usefulness of PET in the mediastinal staging of NSCLC. Methods : We reviewed the medical records of NSCLC patients that had undertaken staging work-up by both CT and PET before thoracotomy between January 1997 and December 1998. A total of 23 patients were enrolled in the study (14 males and 7 females) with a mean age of 61$\pm$9 years. By comparing the clinical(CT and PET) and pathologic stagings, we evaluated the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET in thoracic nodal staging. Results : Sensitivity, specificity, positive predicted value and negative predicted value were 38%, 40%, 25% and 50% respectively for computed tomography, and 50%, 60%, 30% and 69% for PET. The accuracy of FDG-PET in our study was lower than that reported by previous other studies. Conclusion : The addition of FDG-PET to CT scanning has limited benefit for the thoracic nodal staging of NSCLC, but its value in our study was lower than that observed by others.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.2
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• pp.228-235
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• 2004

The development and proliferation of the mandibular condyle can be altered by changes in the biomechanical environment of the temporomandibular joint. The biomechanical loads were varied by feeding diets of different consistencies. The purpose of the present study was to determine whether changes of masticatory forces by feeding a soft diet can alter the trabecular bone morphology of the growing mouse mandibular condyle, by means of micro-computed tomography. Thirty-six female, 21 days old, C57BL/6 mice were randomly divided into two groups. Mice in the hard-diet control group were fed standard hard rodent pellets for 8 weeks. The soft-diet group mice were given soft ground diets for 8 weeks and their lower incisors were shortened by cutting with a wire cutter twice a week to reduce incision. After 8 weeks all animals were killed after they were weighed. Following sacrifice, the right mandibular condyle was removed. High spatial resolution tomography was done with a Skyscan Micro-CT 1072. Cross-sections were scanned and three-dimensional images were reconstructed from 2D sections. Morphometric and nonmetric parameters such as bone volume(BV), bone surface(BS), total volume(TV), bone volume fraction(BV/TV), surface to volume ratio(BS/BV), trabecular thickness(Tb. Th.), structure model index(SMI) and degree of anisotropy(DA) were directly determined by means of the software package at the micro-CT system. From directly determined indices the trabecular number(Tb. N.) and trabecular separation(Tb. Sp.) were calculated according to parallel plate model of Parfitt et al.. After micro-tomographic imaging, the samples were decalcified, dehydrated, embedded and sectioned for histological observation. The results were as follow: 1. The bone volume fraction, trabecular thickness(Tb. Th.) and trabecular number(Tb. N.) were significantly decreased in the soft-diet group compared with that of the control group (p<0.05). 2. The trabecular separation(Tb. Sp.) was significantly increased in the soft-diet group(p<0.05). 3. There was no significant differences in the surface to volume ratio(BS/BV), structure model index(SMI) and degree of anisotropy(DA) between the soft-diet group and hard-diet control group (p>0.05). 4. Histological sections showed that the thickness of the proliferative layer and total cartilage thickness were significantly reduced in the soft-diet group.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.442-447
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• 1999

Introduction: Understanding the normal distribution of the tracheal diameter and crross- sectional area is one of the key elements in the management of various tracheal pathologies or tracheal reconstruction for the patients in growing age. However, data for Korean standard has been lacking. This study was designed to analyze retrospectively the distribution of tracheal diameter and cross-sectional area in young Koreans, which can afford fundamental data for the management of tracheal diseases. Material and Method: Of the patients who underwent computerized tomogram of the chest between May 1996 and August 1998, one hundred six young patients(age range: 0-20 years) were included. Patients with any conditions which might affect the tracheal cross-sectional area or diameter, such as tracheal disease, previous operation, mediastinal tumor, or obstructive lung disease were excluded from the study. Gender distribution was 69 males and 37 females. Tracheal diameters, anterior-posterior and transverse, were measured at the level of the thoracic inlet(level I) and the aortic arch(level II). Types of the trachea were divided into round, oval, or horseshoe shaped on cross-sectional view, and the dimension was calculated by using the equation of A=1/4$\pi$ab(A; area, $\pi$; 3.14, a; anterior-posterior diameter, b; transverse diameter). We analyzed the distribution of the diameter at each level and compared the cross-sectional area with respect to age and gender. A p-value lower than 0.05 wa considered significant. Result: The trachea of patients less than 5 years old were round in shape at both of level I and II, and no differences in cross-sectional area was observed between the levels(p=NS). As the age increased, the trachea become oval in shape at level I while it remained round in shape at level II(p=0.020). The tracheal diameter and cross-sectional area increased as the age increased with a linear correlation(r>0.9). In patients less than 5 years of age, female patients showed larger cross-sectional area than male patients (p=0.020), and it was reversed in patients older than 15 years of age(p=0.002). Conclusion: From the above results, we suggest chest computerized tomogram as a safe and reliable tool in measuring the tracheal diameter and cross-sectional area. We also provide the data as a standard for distribution of the tracheal diameter and cross-sectional area in young Korean population.

• Clinical and Experimental Pediatrics
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• v.51 no.7
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• pp.736-741
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• 2008

Purpose : The incidence of thromboembolic episodes in children with nephrotic syndrome (NS) is low; however, these episodes are often severe. Moreover, both pulmonary thromboembolism (PTE) and renal vein thrombosis (RVT) rarely show clinical symptoms. This study was performed to determine the benefits of routine screening in the detection of thrombosis in childhood NS. Methods : Among 62 children with nephrotic syndrome, a total of 54 children (43 males, 11 females) were included in this study. When the patients experienced their first NS episode, we performed renal Doppler ultrasonography in order to detect RVT. To rule out the possibility of PTE, a lung perfusion scan was performed. Computed tomographic (CT) pulmonary angiography was recommended to patients who showed possible signs of PTE. All patients were evaluated for clinical signs of thrombosis, biochemical indicators of renal disease, as well as clotting and thrombotic parameters. Results : RVT or related clinical symptoms were not observed in any children. Based on the findings of the lung perfusion scans, 15 patients (27.8%) were observed with as a high probability of PTE. We were able to perform a CT pulmonary angiography only on 12 patients, and 5 patients were diagnosed with PTE (prevalence 8.1%). The serum fibrinogen level in the group with PTE was significantly higher ($776.7{\pm}382.4mg/dL$, P<0.05) than that in the group without PTE, and other parameters were not significantly different between each group. Conclusion : Further studies are required for clarifying the role of renal Doppler ultrasonography for the detection of RVT in NS. Children with NS who developed non-specific respiratory symptoms should be evaluated for the diagnosis of PTE. In the management of NS, a lung perfusion scan should be performed at the time of the initial episode of NS regardless of the pulmonary symptoms, since patients having PTE are either often asymptomatic, or present with nonspecific symptoms.

• Radiation Oncology Journal
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• v.11 no.1
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• pp.79-82
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• 1993

From October 1989 to March 1992, ten patients diagnosed as primary central nervous system (CNS) lymphoma were treated with radiation therapy at Asan Medical Center. To obtain pathologic diagnosis, five patients had stereotactic biopsy and the others underwent craniotomy & tumor removal. According to the classification by International Working Formulation, seven of 10 patients showed diffuse large cell types and the remaining 3 had diffuse mixed cell types. Computed tomographic scans of the brain disclosed solitary (6 cases) or multiple (4 cases) intracranial lesions. All patients received 4000 cGy/20 fx to the whole brain followed by an additional 2000 cGy/10 fx boost to the primary lesion. Six patients with initial cerebrospinal fluid (CSF involvement were treated with whole brain irradiation and intrathecal Methotrexate (IT-MTX) chemotherapy. One of them received an additional spinal irradiation after 3 cycles of IT-MTX chemotherapy because of MTX induced arachnoiditis. One patient received 3 cycles of systemic chemotherapy prior to rodiation therapy and one received 5 cycles of salvage chemotherapy for recurrence. With a median follow up time of 8 months, all patients were followed from 7 to 26 months. Radiologically seven patients showed complete remission and the remaining three showed partial remission at one month after radiotherapy. The 1 and 2 year survival rate was $86{\%}\;and\;69{\%}$ respectively. Until now, two patients expired at 7 and 14 months. These patients developed extensive CSF seeding followed by local failure. Considering initial good response to radiation therapy and low incidence of extraneural dissemination in primary CNS lymphoma, we propose to increase total tumor dose to the primary lesion by hyperfractionated radiotherapy or stereotactic radiosurgery. For the patients with CSF involvement at diagnosis, we propose craniospinal irradiation with IT MTX chemotherapy.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.5
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• pp.459-467
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• 2009

Purpose: The maximum likelihood-expectation maximization (ML-EM) is the statistical reconstruction algorithm derived from probabilistic model of the emission and detection processes. Although the ML-EM has many advantages in accuracy and utility, the use of the ML-EM is limited due to the computational burden of iterating processing on a CPU (central processing unit). In this study, we developed a parallel computing technique on GPU (graphic processing unit) for ML-EM algorithm. Materials and Methods: Using Geforce 9800 GTX+ graphic card and CUDA (compute unified device architecture) the projection and backprojection in ML-EM algorithm were parallelized by NVIDIA's technology. The time delay on computations for projection, errors between measured and estimated data and backprojection in an iteration were measured. Total time included the latency in data transmission between RAM and GPU memory. Results: The total computation time of the CPU- and GPU-based ML-EM with 32 iterations were 3.83 and 0.26 see, respectively. In this case, the computing speed was improved about 15 times on GPU. When the number of iterations increased into 1024, the CPU- and GPU-based computing took totally 18 min and 8 see, respectively. The improvement was about 135 times and was caused by delay on CPU-based computing after certain iterations. On the other hand, the GPU-based computation provided very small variation on time delay per iteration due to use of shared memory. Conclusion: The GPU-based parallel computation for ML-EM improved significantly the computing speed and stability. The developed GPU-based ML-EM algorithm could be easily modified for some other imaging geometries.

• Journal of Periodontal and Implant Science
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• v.36 no.2
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• pp.345-359
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• 2006

Loss of maxillary molar teeth leads to rapid loss of crestal bone and inferior expansion of the maxillary sinus floor (secondary pneumatization). Rehabilitation of the site with osseointegrated dental implants often represents a clinical challenge because of the insufficient bone volume resulted from this phenomenon. Boyne & James proposed the classic procedure for maxillary sinus floor elevation entails preparation of a trap door including the Schneiderian membrane in the lateral sinus wall. Summers proposed another non-invasive method using a set of osteotome and the osteotome sinus floor elevation (OSFE) was proposed for implant sites with at least 5-6mm of bone between the alveolar crest and the maxillary sinus floor. The change of grafted material in maxillary sinus is important for implant survival and the evaluation of graft height after maxillary sinus floor elevation is composed of histologic evaluation and radiomorphometric evaluation. The aim of the present study was radiographically evaluate the graft height change after maxillary sinus floor elevation and the influence of the graft material type in height change and the bone remodeling of grafts in sinus. A total of 59 patients (28 in lateral approach and 31 in crestal approach) who underwent maxillary sinus floor elevation composed of lateral approach and crestal approach were radiographically followed for up to about 48 months. Change in sinusgraft height were calculated with respect to implant length (IL) and grafted sinus height(BL). It was evaluated the change of the graft height according to time, the influence of the approach technique (staged approach and simultaneous approach) in lateral approach to change of the graft height, and the influence of the type of graft materials to change of the graft height. Patients were divided into three class based on the height of the grafted sinus floor relative to the implant apex and evaluated the proportion change of that class (Class I, in which the grafted sinus floor was above the implant apex; Class II, in which the implant apex was level with the grafted sinus floor; and Class III, in which the grafted sinus floor was below the implant apex). And it was evaluated th bone remodeling in sinus during 12 months using SGRl(by $Br\ddot{a}gger$ et al). The result was like that; Sinus graft height decreased significantly in both lateral approach and crestal approach in first 12 months (p$MBCP^{TM}$ had minimum height loss. Class III and Class II was increased by time in both lateral and crestal approach and Class I was decreased by time. SGRI was increased statistically significantly from baseline to 3 months and 3 months(p<0.05) to 12 months(p$ICB^{(R)}$ single use, more reduction of sinusgraft height was appeared. Therefore we speculated that the mixture of graft materials is preferable as a reduction of graft materials. Increasing of the SGRI as time goes by explains the stability of implant, but additional histologic or computed tomographic study will be needed for accurate conclusion. From the radiographic evaluation, we come to know that placement of dental implant with sinus floor elevation is an effective procedure in atrophic maxillary reconstruction.