• Archives of Plastic Surgery
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• v.37 no.5
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• pp.577-582
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• 2010

Purpose: When reconstruction for patients who have the large contralateral breast or a following large defect after mastectomy is required, conventional pedicled TRAM flap shows the unpredictable occurrence of fat necrosis and skin flap loss in a relatively high percentage due to insufficient blood supply. In an effort to obtain more stable TRAM flap blood circulation, we have performed a supercharged technique using deep inferior epigastric perforators (DIEP) with conventional pedicled TRAM flap. Methods: From September of 2006 to December of 2008, Fourteen supercharged TRAM flap were performed for breast reconstruction after modified radical mastectomy. The contralateral DIEP was anastomosed to the internal mammary vessels in contralateral pedicled TRAM flap or thoracodorsal vessels in ipsilateral pedicled TRAM flap. Nutrient vessels were selected by Multi-Detector Computed tomography (MD-CT) modalities. For the nutrient vessel, we used deep inferior epigastric vessels (DIEV) of the ipsilateral side in 8 patients, DIEV of the contralateral side in 6 patients. In addition, for the recipient vessel, we used thoracodorsal vessels in 8 patients, internal mammary vessels in 5 patients, intercostals artery perforators in 1 patient. Results: The mean age was 46.8 years and the average follow-up interval was 14 months. There were 11 immediate and 3 delayed breast reconstructions. Fat necrosis incidence rate in supercharged TRAM group was lower than in conventional TRAM flap group. There were no differences of the incidences of abdominal hernia in both groups. Conclusion: The supercharged TRAM flap produces an improvement in vascularity that permits use of all four zones of the flap. The breast reconstruction with supercharged technique is reliable and valuable methods which provide sufficient soft tissue from abdomen without significant complications.

• Radiation Oncology Journal
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• v.33 no.2
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• pp.134-141
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• 2015

Purpose: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. Materials and Methods: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. Results: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). Conclusion: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.

• Journal of Veterinary Clinics
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• v.27 no.6
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• pp.713-717
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• 2010

Outcomes of non-surgical and surgical treatments for thoracolumbar intervertebral disc disease (IVDD) are well-reported. However, little is known regarding the outcome for treatments of cervical IVDD. This study systematically reviewed the outcomes in dogs with cervical IVDD that were managed non-surgically and surgically. Clinical success rates for surgical treatment were significantly higher (100%) than for non-surgical treatment (51.4%). In the non-surgical treatment group, clinical success rates were negatively correlated with spinal cord compression rates. Based on the results of this study, surgical treatment is deemed more effective than non-surgical treatment for dogs with cervical IVDD. Also, the degree of spinal cord compression on computed tomography or magnetic resonance imaging is a useful prognostic indicator before non-surgical treatment.

• The Journal of the Korea Contents Association
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• v.11 no.7
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• pp.234-238
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• 2011

This paper will evaluate the usefulness of 3D target of CBCT by comparing human body's posture and position when simulated treatment is being carried out as well as human phantom posture and position using CBCT which is applying OBI. From the Rando Phantom which is located in the datum point moved in parallel and rotationary direction using CBCT. Then the mean and standard deviation difference on images location difference that are acquired were compared with real the Rando Phantom' moved distance. To make a plan of simulated treatment with the same procedure of real radiation therapy, we are going to setup the Rando Phantom. With an assumption that the position is set in accurate place, we measured the setup errors accroding to the change of the translation and rotation. Tests are repeated 10 times to get the standard deviation of the error values. The variability in couch shift after positioning equivalent to average residual error showed lateral $0.2{\pm}0.2$mm, longitudinal $0.4{\pm}0.3$mm, vertical $-0.4{\pm}0.1$mm. The average rotation erroes target localization after simulated $0.4{\pm}0.2$ mm, $0.3{\pm}0.3$ mm, and $0.3{\pm}0.4$ mm. The detection error by rotation is $0{\sim}0.6^{\circ}$ CBCT 3D/3D matching using the Rando Phantom minimized the errors by realizing accurate matching during simulated treatment and patient caring.

• Progress in Medical Physics
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• v.11 no.1
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• pp.39-47
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• 2000

In Stereotactic Radiosurgery (SRS), there are three imaging methods of target localization, such as digital subtraction Angiography (DSA), computed tomography (CT), magnetic resonance imaging (MRI). Especially, DSA and MR images have a distortion effect generated by each modality. In this research, image properties of DSA were studied. A first essential condition in SRS is an accurate information of target locations, since high dose used to treat a patient may give a complication on critical organ and normal tissue. Hut previous localization program did not consider distortion effect which was caused by image intensifier (II) of DSA. A neurosurgeon could not have an accurate information of target locations to operate a patient. In this research, through distortion correction, we tried to calculate accurate target locations. We made a grid phantom to correct distortion, and a target phantom to evaluate localization algorithm. The grid phantom was set on the front of II, and DSA images were obtained. Distortion correction methods consist of two parts: 1. Bilinear transform for geometrical correction and bilinear interpolation for gray level correction. 2. Automatic detection method for calculating locations of grid crosses, fiducial markers, and target balls. Distortion was corrected by applying bilinear transform and bilinear interpolation to anterior-posterior and left-right image, and locations of target and fiducial markers were calculated by the program developed in this study. Localization errors were estimated by comparing target locations calculated in DSA images with absolute locations of target phantom. In the result, the error in average with and without distortion correction is $\pm$0.34 mm and $\pm$0.41 mm respectively. In conclusion, it could be verified that our localization algorithm has an improved accuracy and acceptability to patient treatment.

• Progress in Medical Physics
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• v.29 no.1
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• pp.1-7
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• 2018

The $TomoTherapy^{(R)}$ beam-delivery method creates helical beam-junctioning patterns in the dose distribution within the target. In addition, the dose discrepancy results in the particular region where the resonance by pattern of dose delivery occurs owing to the change in the position and shape of internal organs with a patient's respiration during long treatment times. In this study, we evaluated the dose pattern of the longitudinal profile with the change in respiration. The superior-inferior motion signal of the programmable respiratory motion phantom was obtained using AbChes as a four-dimensional computed tomography (4DCT) original moving signal. We delineated virtual targets in the phantom and planned to deliver the prescription dose of 300 cGy using field widths of 1.0 cm, 2.5 cm, and 5.0 cm. An original moving signal was fitted to reflecting the beam delivery time of the $TomoTherapy^{(R)}$. The EBT3 film was inserted into the phantom movement cassette, and static, without the movement and with the original movement, was measured with signal changes of 2.0 s, 4.0 s, and 5.0 s periods, and 2.0 mm and 4.0 mm amplitudes. It was found that a dose fluctuation within ${\pm}4.0%$ occurred in all longitudinal profiles. Compared with the original movement, the region of the gamma index above 1 partially appeared within the target and the border of the target when the period and amplitude were changed. Gamma passing rates were 95.00% or more. However, cases for a 5.0 s period and 4.0 mm amplitude at a field width of 2.5 cm and for 2.0 s and 5.0 s periods at a field width of 5.0 cm have gamma passing rates of 92.73%, 90.31%, 90.31%, and 93.60%. $TomoTherapy^{(R)}$ shows a small difference in dose distribution according to the changes of period and amplitude of respiration. Therefore, to treat a variable respiratory motion region, a margin reflecting the degree of change of respiration signal is required.

• Progress in Medical Physics
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• v.28 no.4
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• pp.149-155
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• 2017

Radiotherapy patients should maintain their treatment position as patient setup is very important for accurate treatment. In this study, we evaluated patient setup error quantitatively according to Cone-Beam Computed Tomography (CBCT) Gamma Density Analysis using Mobius CBCT. The adjusted setup error to the $QUASAR^{TM}$ phantom was moved artificially in the superior and lateral direction, and then we acquired the CBCT image according to the phantom setup error. To analyze the treatment setup error quantitatively, we compared values suggested in the CBCT system with the Mobius CBCT. This allowed us to evaluate the setup error using CBCT Gamma Density Analysis by comparing the planning CT with the CBCT. In addition, we acquired the 3D-gamma density passing rate according to the gamma density criteria and phantom setup error. When the movement was adjusted to only the phantom body or 3 cm diameter target inserted in the phantom, the CBCT system had a difference of approximately 1 mm, while Mobius CBCT had a difference of under 0.5 mm compared to the real setup error. When the phantom body and target moved 20 mm in the Mobius CBCT, there are 17.9 mm and 13.5 mm differences in the lateral and superior directions, respectively. The CBCT gamma density passing rate was reduced according to the increase in setup error, and the gamma density criteria of 0.1 g/cc/3 mm has 10% lower passing rate than the other density criteria. Mobius CBCT had a 2 mm setup error compared with the actual setup error. However, the difference was greater than 10 mm when the phantom body moved 20 mm with the target. Therefore, we should pay close attention when the patient's anatomy changes.

• Journal of Biomedical Engineering Research
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• v.38 no.4
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• pp.175-182
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• 2017

Microcurrent electrical stimulation(MES) has been used to accelerate recovery of atrophied skeletal muscle. However, convincing stimulation parameters for suppressing muscle atrophy due to injured sciatic nerve remains unclear. The objective of this study was to investigate the effective intensity of MES on restraining muscle atrophy with rat model underwent sciatic nerve injury(SNI). Twenty-5-week-old Sprague Dawley male rats were equally assigned to five groups : Control group(Control, CON, n = 4), Denervation group(Denervation, D, n = 4), Denervation with MES of $22{\mu}A$ group(Denervation + $22{\mu}A$, D+22, n = 4), Denervation with MES of $100{\mu}A$ group (Denervation + $100{\mu}A$, D+100 n = 4), Denervation with MES of $400{\mu}A$ group(Denervation + $400{\mu}A$, D+400, n = 4). To induce muscle atrophy, all rats in the D, D+22, D+100, and D+400 groups, were subjected to sciatic nerve injury on their right hindlimb and allowed to have 1 week of resting period. Following this period, rats underwent daily MES(60 min/ a day, 5times/1week) for 4 weeks. After that, we investigate morphological changes in muscle volume by using in vivo micro-computed tomography at week 0, 1, 3 and 5. After 5 weeks, the muscle volume had the highest value in D+400 group, and also noticeably increased in D+100 group compared to it in D group. The results of this study imply that MES with current intensities between $100-400{\mu}A$ can suppress muscle atrophy effectively.

• Korean Journal of Head & Neck Oncology
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• v.26 no.2
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• pp.171-177
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• 2010

연구목적 : 비인두암 환자들을 대상으로 방사선치료 시 삼차원입체조형치료기법과 용적세기조절회전치료기법을 비교하고 이하선을 포함한 정상조직 보호에 있어 그 차이점을 알아 보고자 본 연구를 시행하였다. 대상 및 방법 : 비인두암 환자 5명을 대상으로 치료계획용 CT(computed tomography)를 시행 후 삼차원입체조형방사선치료계획 과 용적세기조절회전치료계획을 시행하였다. 이를 바탕으로 얻은 선량분포, conformity index(CI) 그리고 선량체적 히스토그램을 통해 손상위험장기(organ at risk)와 계획용표적체적(planning target volume)을 비교 분석하였다. 결 과 : 분석결과 이하선에 조사되는 평균선량이 용적세기조절회전치료계획에서는 43.9%로 삼차원입체조형치료계획에서의 89.4% 보다 유의하게(p=0.043) 감소하였다. 계획용표적체적 conformity index의 경우 용적세기조절회전치료계획 (CI=1.06)에서 삼차원입체조형치료계획(CI=2.55) 보다 유의하게(p=0.043) 향상된 결과를 보였다. 결 론 : 비인두암 환자에서 용적세기조절회전 치료계획 시 삼차원입체조형치료계획 보다 유의하게 이하선에 평균선량이 줄었고 계획용 표적체적에 대한 conformity도 유의하게 향상되는 결과를 보였다. 본 연구가 적은 수의 환자를 대상으로 하였으나 용적세기조절회전치료기법을 시행 시 구강건조증의 발생을 줄일 수 있을 것으로 기대된다. 향후 더 많은 환자군을 대상으로 한 임상연구가 필요할 것으로 사료된다.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.8
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• pp.417-421
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• 2018

Carboxytherapy is very similar to mesotherapy in terms of methods, conditions it treats, and outcomes. An important difference consider, however, is that carboxytherapy administers carbon dioxide gas into the subcutaneous layer, just underneath the skin, whereas mesotherapy administers a cocktail of vitamins, minerals, and drugs and into the mesoderm of the skin. There have been many previous case reports of complications of mesotherapy such as hematoma, granulomatous panniculitis, cellulitis, and abscesses. However, complications of carboxytherapy have rarely been reported because the carbon dioxide gas is absorbed within a week and is infused into the subcutaneous and superficial layers. A 27-year-old woman who had twice undergone carboxytherapy to reduce abdominal fat (3 days and 2 weeks ago) at an oriental medical clinic visited the emergency department due to high fever, myalgia, severe back pain, and subcutaneous emphysema from the buttocks to the lower chest wall area. A computed tomography (CT) scan was performed for diagnosis and treatment. We immediately started broad spectrum antibiotics and consulted with the department of radiology, which could not rule out acute peritonitis due to needle injury. A radiologist confirmed abdominal myositis and needle puncture induced acute pyelonephritis. Pyelonephritis can even lead to septicemia, which can have fatal consequences. Therefore, if the patient has costovertebral or back pain after undergoing needle puncture or acupuncture therapy, the emergency physcians need careful initial evaluation for diagnosis and treatment.