• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.38.1-38.10
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• 2016

Background: The aims of this study are to evaluate the lip morphology and change of lip commissure after mandibular setback surgery (MSS) for class III patients and analyze association between the amount of mandibular setback and change of lip morphology. Methods: The samples consisted of 14 class III patients treated with MSS using bilateral sagittal split ramus osteotomy. Lateral cephalogram and cone-beam CT were taken before and about 6 months after MSS. Changes in landmarks and variables were measured with 3D software program $Ondemand^{TM}$. Paired and independent t tests were performed for statistical analysis. Results: Landmarks in the mouth corner (cheilion, Ch) moved backward and downward (p < .005, p < .01). However, cheilion width was not statistically significantly changed. Landmark in labrale superius (Ls) was not altered significantly. Upper lip prominence angle (ChRt-Ls-$ChLt^{\circ}$) became acute. Landmarks in stomion (Stm), labrale inferius (Li) moved backward (p < .005, p < .001). Lower lip prominence angle (ChRt-Li-$ChLt^{\circ}$) became obtuse (p < .001). Height of the upper and lower lips was not altered significantly. Length of the upper lip vermilion was increased (p =< 0.01), and length of the lower lip vermilion was decreased (p < .05). Lip area on frontal view was not statistically significantly changed, but the upper lip area on lateral view was increased and change of the lower lip area decreased (p > .05, p < .005). On lateral view, upper lip prominent point (UP) moved downward and stomion moved backward and upward and the angle of Ls-UP-Stm ($^{\circ}$) was decreased. Lower lip prominent point (LP) moved backward and downward, and the angle of Stm-LP-Li ($^{\circ}$) was increased. Li moved backward. Finally, landmarks in the lower incisor tip (L1) moved backward and upward, but stomion moved downward. After surgery, lower incisor tip (L1) was positioned more superiorly than stomion (p < .05). There were significant associations between horizontal soft tissue and corresponding hard tissue. The posterior movement of L1 was related to statistically significantly about backward and downward movement of cheilion. Conclusions: The lip morphology of patients with dento-skeletal class III malocclusion shows a significant improvement after orthognathic surgery. Three-dimensional lip morphology changes in class III patients after MSS exhibited that cheilion moved backward and downward, upper lip projection angle became acute, lower lip projection angle became obtuse, change of upper lip area on lateral view was increased, change of lower lip area decreased, and morphology of lower lip was protruding. L1 was concerned with the lip tissue change in statistically significant way.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.57-64
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• 2016

Purpose : To evaluate the results of absorbed and effective doses using CBCT and 4D-CBCT settings for lung cancer. Materials and Methods : This experimental study. Measurements were performed using a Anderson rando phantom with OSLD(optically stimulated luminescent dosimeters). It was performed computed tomography(Lightspeed GE, USA) in order to express the major organs of the human body. Measurements were obtained a mean value is repeated three times each. Evaluations of effective dose and absorbed dose were performed the CL-IX-Thorax mode and Truebeam-Thorax mode CBCT. Additionally, compared Truebeam-Thorax mode CBCT with Truebeam-Thorax mode 4D-CBCT(Four-dimensional Cone Beam Computed Tomography) Results : Average absorbed dose in the CBCT of CL-IX was measured in lung 2.505cGy, heart 2.595cGy, liver 2.145cGy, stomach 1.934cGy, skin 2.233cGy, in case of Truebeam, It was measured lung 1.725cGy, heart 2.034cGy, liver 1.616cGy, stomach 1.470cGy, skin 1.445cGy. In case of 4D-CBCT, It was measured lung 3.849cGy, heart 4.578cGy, liver 3.497cGy, stomach 3.179cGy, skin 3.319cGy Average effective dose, considered tissue weighting and radiation weighting, in the CBCT of CL-IX was measured lung 2.164mSv, heart 2.241mSVv, liver 0.136mSv, stomach 1.668mSv, skin 0.009mSv, in case of Turebeam, it was measured lung 1.725mSv, heart 1.757mSv, liver 0.102mSv, stomach 1.270mSv, skin 0.005mSv, In case of 4D-CBCT, It was measured lung 3.326mSv, heart 3.952mSv, liver 0.223mSv, stomach 2.747mSv, skin 0.013mSv Conclusion : As a result, absorbed dose and effective Dose in the CL-IX than Truebeam was higher about 1.3 times and in the 4D-CBCT Truebeam than CBCT of Truebeam was higher about 2.2times However, a large movement of the patient and respiratory gated radiotherapy may be more accurate treatment in 4D-CBCT. Therefore, it will be appropriate to selectively used.

• Progress in Medical Physics
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• v.25 no.4
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• pp.271-280
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• 2014

Recently, digital breast tomosynthesis (DBT) has been investigated to overcome the limitation of conventional mammography for overlapping anatomical structures and high patient dose with cone-beam computed tomography (CBCT). However incomplete sampling due to limited angle leads to interference on the neighboring slices. Many studies have investigated to reduce artifacts such as interference. Moreover, appropriate filters for tomosynthesis have been researched to solve artifacts resulted from incomplete sampling. The primary purpose of this study is finding appropriate filter scheme with FBP reconstruction for DBT system to reduce artifacts. In this study, we investigated characteristics of various filter schemes with simulation and prototype digital breast tomosynthesis under same acquisition parameters and conditions. We evaluated artifacts and noise with profiles and COV (coefficinet of variation) to study characteristic of filter. As a result, the noise with parameter 0.25 of Spectral filter reduced by 10% in comparison to that with only Ramp-lak filter. Because unbalance of information reduced with decreasing B of Slice thickness filter, artifacts caused by incomplete sampling reduced. In conclusion, we confirmed basic characteristics of filter operations and improvement of image quality by appropriate filter scheme. The results of this study can be utilized as base in research and development of DBT system by providing information that is about noise and artifacts depend on various filter schemes.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.1
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• pp.67-74
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• 2019

Purpose: The purpose is to correct for position errors caused by long treatment times. By correcting the target motion that can occur during lung SBRT using IntraFraction CBCT. Methods and materials: We analyzed retrospectively the IFM data of 14 patients with two treatment arc in the treatment plan for lung cancer with stereotactic radiotherapy. An IntraFraction Motion was applied to the Arccheck phantom to acquire the Gamma index data. Results : IntraFraction Motion during the first treatment arc is in the left-right(LR), superiorinferior(SI), anterior-posterior(AP) directions were $0.16{\pm}0.05cm$, 0.72 cm(max error), $0.2{\pm}0.14cm$, 1.26 cm, $0.24{\pm}0.08cm$, 0.82 cm and rotational directions was $0.84{\pm}0.23^{\circ}$, $2.8^{\circ}$(pitch), $0.72{\pm}0.23^{\circ}$, $2.5^{\circ}$(yaw), $0.7{\pm}0.19^{\circ}$, $2^{\circ}$(roll). IntraFraction Motion during the second treatment arc is in the LR, SI, AP directions were $0.1{\pm}0.04cm$, 0.37 cm, $0.14{\pm}0.17cm$, 2 cm, $0.12{\pm}0.04cm$, 0.5 cm and rotational directions was $0.45{\pm}0.12^{\circ}$, $1.3^{\circ}$, $0.37{\pm}0.1^{\circ}$, $1^{\circ}$, $0.35{\pm}0.1^{\circ}$, $1.2^{\circ}$. Gamma index pass rates were $82.64{\pm}10.51%$, 48.4 %. Conclusions : In this study, we examined the validity of IntraFraction Motion correction in lung SBRT and the efficiency of IntraFraction CBCT. Due to the nature of SBRT treatment, IFM may increase due to the increased treatment time. It is believed that the increase in IFM with the increase in treatment time can be improved with the use of FFF Beam and additional position correction using CBCT during treatment.

• The Journal of Korean Society for Radiation Therapy
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• v.21 no.1
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• pp.33-39
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• 2009

Purpose: The aim of this study is to compare patient's body posture and its position at the time of simulation with one at the treatment room using On-board Imaging (OBI) and CT (CBCT). The detected offsets are compared with position errors of Rando Phantom that are practically applied. After that, Rando Phantom's position is selected by moving couch based on detected deviations. In addition, the errors between real measured values of Rando Phantom position and theoretical ones is compared. And we will evaluate target position's accuracy of KV X-ray imaging's 2D and CBCT's 3D one. Materials and Methods: Using the Rando Phantom (Alderson Research Laboratories Inc. Stanford. CT, USA) which simulated human body's internal structure, we will set up Rando Phantom on the treatment couch after implementing simulation and RTP according to the same ways as the real radioactive treatment. We tested Rando Phantom that are assumed to have accurate position with different 3 methods. We measured setup errors on the axis of X, Y and Z, and got mean standard deviation errors by repeating tests 10 times on each tests. Results: The difference between mean detection error and standard deviation are as follows; lateral 0.4+/-0.3 mm, longitudinal 0.6+/-0.5 mm, vertical 0.4+/-0.2 mm which all within 0~10 mm. The couch shift variable after positioning that are comparable to residual errors are 0.3+/-0.1, 0.5+/-0.1, and 0.3+/-0.1 mm. The mean detection errors by longitudinal shift between 20~40 mm are 0.4+/-0.3 in lateral, 0.6+/-0.5 in longitudinal, 0.5+/-0.3 in vertical direction. The detection errors are all within range of 0.3~0.5 mm. Residual errors are within 0.2~0.5 mm. Each values are mean values based on 3 tests. Conclusion: Phantom is based on treatment couch shift and error within the average 5mm can be gained by the diminution detected by image registration based on OBI and CBCT. Therefore, the selection of target position which depends on OBI and CBCT could be considered as useful.

• The Journal of Korean Academy of Prosthodontics
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• v.50 no.4
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• pp.271-278
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• 2012

Purpose: Recently implant surgical guides were used for accurate and atraumatic operation. In this study, the accuracy of two different types of surgical guides, positioning device fabricated and stereolithography fabricated surgical guides, were evaluated in four different types of tooth loss models. Materials and methods: Surgical guides were fabricated with stereolithography and positioning device respectively. Implants were placed on 40 models using the two different types of surgical guides. The fitness of the surgical guides was evaluated by measuring the gap between the surgical guide and the model. The accuracy of surgical guide was evaluated on a pre- and post-surgical CT image fusion. Results: The gap between the surgical guide and the model was $1.4{\pm}0.3mm$ and $0.4{\pm}0.3mm$ for the stereolithography and positioning device surgical guide, respectively. The stereolithography showed mesiodistal angular deviation of $3.9{\pm}1.6^{\circ}$, buccolingual angular deviation of $2.7{\pm}1.5^{\circ}$ and vertical deviation of $1.9{\pm}0.9mm$, whereas the positioning device showed mesiodistal angular deviation of $0.7{\pm}0.3^{\circ}$, buccolingual angular deviation of $0.3{\pm}0.2^{\circ}$ and vertical deviation of $0.4{\pm}0.2mm$. The differences were statistically significant between the two groups (P<.05). Conclusion: The laboratory fabricated surgical guides using a positioning device allow implant placement more accurately than the stereolithography surgical guides in dental clinic.

• Progress in Medical Physics
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• v.26 no.2
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• pp.79-86
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• 2015

The purpose of this study is to evaluate efficacy and feasibility of adaptive radiotherapy according to tumor volume change (TVC) in early stage non-small cell lung cancer (NSCLC) using stereotactic body radiotherapy (SBRT). Twenty-two lesions previously treated with SBRT were selected. SBRT was usually performed with a total dose of 48 Gy or 60 Gy in four fractions with an interval of three to four days between treatments. For evaluation of TVC, gross tumor volume (GTV) was contoured on each cone-beam computed tomography (CBCT) image used for image guidance. Intensity modulated radiotherapy (IMRT) planning was performed in the first CBCT (CBCT1) using a baseline plan. For ART planning (ART), re-optimization was performed at $2^{nd}$, $3^{rd}$, and $4^{th}$ CBCTs (CBCT2, CBCT3, and CBCT4) using the same angle and constraint used for the baseline plan. The ART plan was compared with the non-ART plan, which generated copying of the baseline plan to other CBCTs. Average GTV volume was 10.7 cc. Average TVC was -1.5%, 7.3%, and -25.1% in CBCT2, CBCT3, and CBCT4 and the TVC after CBCT3 was significant (p<0.05). However, the nine lesions were increased GTV in CBCT2. In the ART plan, $V_{20\;Gy}$, $D_{1500\;cc}$, and $D_{1000\;cc}$ of lung were significantly decreased (p<0.05), and $V_{30\;Gy}$ and $V_{32\;Gy}$ of the chest wall were also decreased (p<0.05). While D min of planning target volume (PTV) decreased by 8.3% in the non-ART plan of CBCT2 compared with the baseline plan in lesions with increased tumor size (p=0.021), PTV coverage was not compromised in the ART plan. Based on this result, use of the ART plan may improve target coverage and OAR saving. Thus ART using CBCT should be considered in early stage NSCLC with SBRT.

• Journal of the Korean Society of Radiology
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• v.84 no.4
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• pp.900-910
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• 2023

Purpose To assess normal CT scans with quantitative CT (QCT) analysis based on smoking habits and chronic obstructive pulmonary disease (COPD). Materials and Methods From January 2013 to December 2014, 90 male patients with normal chest CT and quantification analysis results were enrolled in our study [non-COPD never-smokers (n = 38) and smokers (n = 45), COPD smokers (n = 7)]. In addition, an age-matched cohort study was performed for seven smokers with COPD. The square root of the wall area of a hypothetical bronchus of internal perimeter 10 mm (Pi10), skewness, kurtosis, mean lung attenuation (MLA), and percentage of low attenuation area (%LAA) were evaluated. Results Among patients without COPD, the Pi10 of smokers (4.176 ± 0.282) was about 0.1 mm thicker than that of never-smokers (4.070 ± 0.191, p = 0.047), and skewness and kurtosis of smokers (2.628 ± 0.484 and 6.448 ± 3.427) were lower than never-smokers (2.884 ± 0.624, p = 0.038 and 8.594 ± 4.944, p = 0.02). The Pi10 of COPD smokers (4.429 ± 0.435, n = 7) was about 0.4 mm thicker than never-smokers without COPD (3.996 ± 0.115, n = 14, p = 0.005). There were no significant differences in MLA and %LAA between groups (p > 0.05). Conclusion Even on normal CT scans, QCT showed that the airway walls of smokers are thicker than never-smokers regardless of COPD and it preceded lung parenchymal changes.