• Radiation Oncology Journal
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• v.20 no.4
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• pp.343-352
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• 2002

Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.

• Radiation Oncology Journal
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• v.14 no.3
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• pp.191-199
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• 1996

Purpose : To evaluate 5-year survival rate, patterns of failure and complications of cervical cancer treatment, fifty nine patients treated by curative radiotherapy for the uterine cervical cancer were analyzed retrospectively. Materials and Methods : From March 1986 to May 1990, fifty nine patients with histologically proven uterine cervical cancer were analyzed. According to FIGO stage, there were 2 patients ($3.4\%$) in stage Ib, 2 patients ($3.4\%$) in stage IIa, 31 patients ($52.5\%$) in stage IIb, 15 patients ($25.4\%$) in stage IIIb, 9 patients ($15.3\%$) in stage IV. External RT was per formed by 6 MVLINAC with daily 1.8 Gy, 5 times per week and followed by ICR. A point dose of ICR was calculated to 30-43.66 Gy (median: 34.6 Gy). These techniques delivered total A Point dose of 80.4 to 109.8 Gy (median: 85 Gy). Patients had been followed up from 2 to 110 months (median: 61 months) Results : The overall 5-year survival rate & disease free survival rate were $55.9\%$ and $55.0\%$ respectively. According to FIGO stage, the 5-year survival rate for less than IIa, IIb, IIIb, IV were $75.0\%$, $74.8\%$, $26.7\%$, $33.3\%$, respectively. In univariate analysis, the 5-year survival rate for stage IIb and below versus stage IIIa and above revealed $74.8\%$, $29.2\%$ respectively (P<0.005). According to the hemoglobin level during RT, the 5-rear survival rate of was $73.3\%$ for patients with Hg 10 gm/dL or higher, in contrast to $0\%$ for those with lower than 10 gm/dL (p<0.005). In 18 patients with nonbulky tumor (<5cm), the 5-year survival rates were $71.8\%$. The 5-rear survival rates for 18 patients with 5 cm or greater in tumor diameter were $22.2\%$ (p<0.005). The 5-year survival rate for Patient age of above 50 years and below were $65.3\%$ $34.2\%$ respectively (p<0.05). ECOG performance status. pathologic finding, total dose, total treatment time were not statistically significant factors. The significant prognostic factors affecting overall 5-year survival rate by multivariate analysis showed the hemoglobin level during RT (P=0.0001), tumor size (p=0.0390), FIGO stage (p=0.0468). Total recurrence rate was $23.7\%$ local failure $15.2\%$ (9/59), distant metastasis $6.8\%$ (4/59), local and distant metastasis $1.7\%$ (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was $23.8\%$ (14/59) The late complication rate of colorectum and genitourinary tract were $15.3\%$ (9/59), $8.5\%$ (5/59), respectively: 10 patients ($17.0\%$) were grade 2, 3 Patients ($5.1\%$) were grade 3 and one patient ($1.7\%$) was grade 4. The late complications were radiation proctitis, rectal bleeding, radiation colitis, diarrhea and radiation cystitis in decreasing order. Conclusion : For improvement of therapeutic results, prospective randomized trials are recomended to discover new prognostic factors and more aggressive radiation therapeutic methods are needed for poor prognostic patients. The adjuvant chemotherapy or radiation-sensitizing agents must be considered to inhibit regional and distant metastasis.

• The Korean Journal of Nuclear Medicine
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• v.38 no.6
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• pp.486-491
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• 2004

Purpose: factor analysis and independent component analysis (ICA) has been used for handling dynamic image sequences. Theoretical advantages of a newly suggested ICA method, ensemble ICA, leaded us to consider applying this method to the analysis of dynamic myocardial $H_2^{15}O$ PET data. In this study, we quantified patients' blood flow using the ensemble ICA method. Materials and Methods: Twenty subjects underwent $H_2^{15}O$ PET scans using ECAT EXACT 47 scanner and myocardial perfusion SPECT using Vertex scanner. After transmission scanning, dynamic emission scans were initiated simultaneously with the injection of $555{\sim}740$ MBq $H_2^{15}O$. Hidden independent components can be extracted from the observed mixed data (PET image) by means of ICA algorithms. Ensemble learning is a variational Bayesian method that provides an analytical approximation to the parameter posterior using a tractable distribution. Variational approximation forms a lower bound on the ensemble likelihood and the maximization of the lower bound is achieved through minimizing the Kullback-Leibler divergence between the true posterior and the variational posterior. In this study, posterior pdf was approximated by a rectified Gaussian distribution to incorporate non-negativity constraint, which is suitable to dynamic images in nuclear medicine. Blood flow was measured in 9 regions - apex, four areas in mid wall, and four areas in base wall. Myocardial perfusion SPECT score and angiography results were compared with the regional blood flow. Results: Major cardiac components were separated successfully by the ensemble ICA method and blood flow could be estimated in 15 among 20 patients. Mean myocardial blood flow was $1.2{\pm}0.40$ ml/min/g in rest, $1.85{\pm}1.12$ ml/min/g in stress state. Blood flow values obtained by an operator in two different occasion were highly correlated (r=0.99). In myocardium component image, the image contrast between left ventricle and myocardium was 1:2.7 in average. Perfusion reserve was significantly different between the regions with and without stenosis detected by the coronary angiography (P<0.01). In 66 segment with stenosis confirmed by angiography, the segments with reversible perfusion decrease in perfusion SPECT showed lower perfusion reserve values in $H_2^{15}O$ PET. Conclusions: Myocardial blood flow could be estimated using an ICA method with ensemble learning. We suggest that the ensemble ICA incorporating non-negative constraint is a feasible method to handle dynamic image sequence obtained by the nuclear medicine techniques.

• Korean Journal of Heritage: History & Science
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• v.44 no.1
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• pp.196-221
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• 2011

The Royal Private Shrines or the Samyo(私廟), were dedicated to members of Choseon's royal family who could not be enshrined at the (official) Royal Ancestral Shrine, the Jongmyo(宗廟). The Samyo were constructed at the national level and were systematically managed as such. Because these private Shrines were dedicated to those who couldn't belong to the Jongmyo but were still very important, such as the ruling king's biological father or mother. The details of all royal constructions were included in the State Event Manuals, and with them, the two-dimensional layouts of the Samyo also. From the remaining "Hyunsa-gung Private Tomb Construction Layout Record(顯思宮別廟營建都監儀軌)" of 1824, which is the construction record of Gyeongwoo-gung Shrine(景祐宮) dedicated to Subin, the mother of King Sunjo(純祖), it became possible to investigate the so far unknown "The Painting of Gyeongwoo-gung Shrine", in terms of the year produced, materials used and other situational contexts. The investigation revealed that the "The Painting of Gyeongwoo-gung Shrine" is actually the "Hyunsa-gung Private Tomb Layout" produced by the Royal Construction Bureau. The bureau painted this to build Hyunsa-gung Private Shrine in a separately prepared site outside the court in 1824, according to the royal verdict to close down and move the temporary shrine inside the courtyard dedicated to Subin who had passed away in 1822. As the Construction Bureau must have also produced the Gyeongwoo-gung Shrine Layout, the painter(s) of this layout should exist among the official artists listed in the State Event Manual, but sadly, as their paintings have not survived to this day, we cannot compare their painting styles. The biggest stylistic character of the Painting of Gyeongwoo-gung Shrine is its perfect diagonal composition method and detailed and neat portrayalof the many palace buildings, just as seen in Donggwoldo(東闕圖, Painting of a panoramic view for Changdeokgung and Changgyeonggung Palaces). A well-perceiving architectural painting employs a specific point of view chosen to fit the purpose of the painting, or it can opt to the multi-viewpoint. Korean traditional architectural paintings in early ages utilized the diagonal composition method, the bird-eye viewpoint, or the multi-viewpoint. By the 18th century, detailed but also artistic architectural paintings utilizing the diagonal method are observed. In the early 19th century, the peak of such techniques is exhibited in Donggwoldo(Painting of a panoramic view for Changdeokgung and Changgyeonggung Palaces). From the perfect diagonal composition method employed and the details of the palace buildings numbering almost two hundreds, we can determine that the Painting of Gyeongwoo-gung Shrine also belongs to the same category of the highly technical architectural paintings as Donggwoldo(Painting of a panoramic view for Changdeokgung and Changgyeonggung Palaces). We can also confirm this hypothesis by comparing the painting techniques employed in these two paintings in detailthe way trees and houses are depicted, and the way ground texture is expressed, etc. The unique characteristic of the Painting of Gyeongwoo-gung Shrine is, however, that the area surrounding the central shrine building(正堂), the most important area of the shrine, is drawn using not the diagonal method but the bird-eye viewpoint with the buildings lying flat on both the left and right sides, just as seen in the "Buildings Below the Central Shrine(正堂以下諸處)" in the State Event Manual's Painting Method section. The same viewpoint method is discovered in some other concurrent paintings of common residential buildings, so it is not certain that this particular viewpoint had been a distinctive feature for shrine paintings in general. On the other hand, when the diagonalmethod pointing to the left direction is chosen, the top-left and bottom-right sections of the painting become inevitably empty. This has been the case for the Painting of Gyeongwoo-gung Shrine, but in contrast, Donggwoldo shows perfect screen composition with these empty margins filled up with different types of trees and other objects. Such difference is consistent with the different situational contexts of these two paintings: the Painting of Gyeongwoo-gung Shrine is a simple single-sheet painting, while Donggwoldo is a perfected work of painting book given an official title. Therefore, if Donggwoldo was produced to fulfill the role of depiction and documentation as well as the aesthetic purpose, contrastingly, the Painting of Gyeongwoo-gung Shrine only served the purpose of copying the circumstances of the architecture and projecting them onto the painting.

• Journal of the Korean Institute of Traditional Landscape Architecture
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• v.29 no.2
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• pp.81-89
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• 2011

The results of tracking the symbolism of plants in the introduction factors of Sokhwa(folk painting) are as the following. 1. The term Sokhwa(俗畵) is not only a type of painting with a strong local customs, but also carries a symbolic meaning and was discovered in "Donggukisanggukjip" of Lee, Gyu-Bo(1268~1241) in the Goryo era as well as the various usage in the "Sok Dongmunseon" in the early Chosun era, "Sasukjaejip" of Gang, Hee-mang(1424~1483), "Ilseongrok(1786)" in the late Chosun era, "Jajeo(自著)" of Yoo, Han-joon(1732~1811), and "Ojuyeonmunjangjeonsango(五洲衍文長箋散稿)" of Lee, Gyu-gyung(1788~?). Especially, according to the Jebyungjoksokhwa allegation〈題屛簇俗畵辯證說〉in the Seohwa of the Insa Edition of Ojuyeonmunjangjeonsango, there is a record that the "people called them Sokhwa." 2. Contemporarily, the Korean Sokhwa underwent the prehistoric age that primitively reflected the natural perspective on agricultural culture, the period of Three States that expressed the philosophy of the eternal spirits and reflected the view on the universe in colored pictures, the Goryo Era that religiously expressed the abstract shapes and supernatural patterns in spacein symbolism, and the Chosun Era that established the traditional Korean identity of natural perspective, aesthetic values and symbolism in a complex integration in the popular culture over time. 3. The materials that were analyzed in 1,009 pieces of Korean Sokhwa showed 35 species of plants, 37 species of animals, 6 types of natural objects and other 5 types with a total of 83 types. 4. The shape aesthetics according to the aesthetic analysis of the plants in Sokhwa reflect the primitive world view of Yin/yang and the Five Elements in the peony paintings and dynamic refinement and biological harmonies in the maehwado; the composition aesthetics show complex multi-perspective composition with a strong noteworthiness in the bookshelf paintings, a strong contrast of colors with reverse perspective drawing in the battlefield paintings, and the symmetric beauty of simple orderly patterns in nature and artificial objects with straight and oblique lines are shown in the leisurely reading paintings. In terms of color aesthetics, the five colors of directions - east, west, south, north and the center - or the five basic colors - red, blue, yellow, white and black - are often utilized in ritual or religious manners or symbolically substitute the relative relationships with natural laws. 5. The introduction methods in the Korean Sokhwa exceed the simple imitation of the natural shapes and have been sublimated to the symbolism that is related to nature based on the colloquial artistic characteristics with the suspicion of the essence in the universe. Therefore, the symbolism of the plants and animals in the Korean Sokhwas is a symbolic recognition system, not a scientific recognition system with a free and unique expression with a complex interaction among religious, philosophical, ecological and ideological aspects, as a identity of the group culture of Koreans where the past and the future coexist in the present. This is why the Koran Sokhwa or the folk paintings can be called a cultural identity and can also be interpreted as a natural and folk meaningful scenic factor that has naturally integrated into our cultural lifestyle. However, the Sokhwa(folk paintings) that had been closely related to our lifestyle drastically lost its meaning and emotions through the transitions over time. As the living lifestyle predominantly became the apartment culture and in the historical situations where the confusion of the identity has deepened, the aesthetic and the symbolic values of the Sokhwa folk paintings have the appropriateness to be transmitted as the symbolic assets that protect our spiritual affluence and establish our identity.

• Korean Journal of Heritage: History & Science
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• v.42 no.3
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• pp.154-175
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• 2009

At the present state, studies on Gyeongbok palace are being done with history of architecture, records, and art. However, these studies have limits that they can only depend on existing buildings and record, which make it hard to research whole aspect of palaces. The foundation remains(Jeoksim) of Gyeongbok palace in the ground gives important clues that can fill the gaps of these studies. Thus I analysed jeoksim of Gyeongbok palace, assorted them by type, scale, material, and construction method. I examined jeoksim used by various types of building, and looked at changes by periods. Jeoksims are classified in 21 types. The foundation(jeoksim) varies according to types of buildings, building types and material of jeoksim also varies along the periods, and the fact proves certain peroid of time has its own jeoksim style in fashion. Jeoksims of Gyeongbok palace are divided into round-shape(I), rounded square-shape(II), rectangular-shape(III), square-shape(IV), and whole foundation of building(V) by the plane shape. They can be divided again into 21 types by construction techniques and materials used. During early Joseon(I), only three types of jeoksim; round-shape riprap jeoksim(1-1), II-1(rounded square-shape), II-2a(rounded square-shape riprap+roofingingtile brick), had been built, but as 19th century begun, all 21 types of jeoksim had built. In 19th century during Emperor Gojong, different types of jeoksim by periods were built, and especially different materials were used. During Gojong year 2(1865)~year 5(1868), in which Gyeongbok palace were rebuilt, 7 out of 10 types of jeoksim used piece of roofinging tile and brick mixture, in contrast, during Gojong year 10(1873)~13(1876), or 25(1888), 3 out of 5 types of jeoksim used sandy soil with mixture of plaster. Meanwhile palace buildings have different names by the class of owner and use such as Jeon, Dang, Hap, Gak, Jae, Heon, Nu, and Jeong, which were classified by types and buildings were built according to each level. With an analysis of jeoksim by its building types, I ascertained that jeoksim were built differently in accordance to building types(Jeon, Dang, Hap, Gak, Jae, Heon, Nu, and Jeong). By the limitation of present document, only some types of buildings such as Jeon, Dang, Gak, Bang were confirmed, as for Jeon and Gak, square-shape(IV) built with rectangular parallelepiped stone, and for Dang and Bang, rounded square-shape(IV) built with roofinginginging tile and riprap were commonly used. From the fact that other jeoksim with uncertain building names, were mostly built in early Joseon, we learn that round-shape riprap jeoksim(1-1) were commonly built. Therefore, the class of building was higher if the owner was in higher class, jeoksim is also considered to be built with the strongest and best material. And for Dang and Bang, rounded square-shape jeoksim were used, Dang has lots of II-2a (riprap + piece of roofing tile and brick rounded square-shape) type which mainly used riprap and piece of roofing tile and brick, but Bang has lots of II-2b (piece of roofing tile and brick+(riprap+piece of roofing tile and brick rounded square-shape), which paved piece of roofing tile and brick by 15~20cm above. These jeoksim by building types were confirmed to have changed its construction type by period. As for Jeon and Gak, they were built with round-shape riprap jeoksim(1-1) in early Joseon(14~15c), but in late Joseon(19c), various types of Jeoksim were built, especially square-shape(IV) were commonly built. For Dang, only changes in later Joseon were confirmed, jeoksim built in Gojong year 4(1867) mostly used mixture of riprap and piece of roofing tile and brick. In Gojong year 13(1876) or year 25(1888), unique type of plaster with sand and coal and soil layered jeoksim were built that are not found in any other building types. Through this study, I learned that various construction types of jeoksim and material were developed in later Joseon compare to early Joseon. This states that construction technique of building foundation of palace has upgraded. Above all, I learned jeoksim types are all different for various kinds of buildings. This tells us that when they constructed foundation of building, they used pre-calculated construction technique.

• Radiation Oncology Journal
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• v.22 no.4
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• pp.237-246
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• 2004

Purpose: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT). Materials and Methods: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received $63\~70$ Gy (Median 66 Gy, fraction size $1.8\~2$ Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores. Results: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were $15{\pm}1.65$ and $11{\pm}0.95$ months, respectively. The was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were $21{\pm}5.03$ and $12{\pm}1.59$ months, respectively, while for Arm 2 patients they were $14{\pm}0.94$ and $10{\pm}1.63$ months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; $44.7\%$ versus $19.2\%$. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified. Conclusion: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.