• Title/Summary/Keyword: Coverage Planning

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Strategies for Public Health Service Development in the Times of Local Autonomy (지방자치시대의 공공보건사업 발전 전략)

  • 박정한
    • Health Policy and Management
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    • v.12 no.3
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    • pp.1-22
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    • 2002
  • Health is a fundamental human right and a sine qua non for happiness of people and for national development. Government has a responsibility for the provision of health services for their people. Recent changes of disease pattern, i.e. decrease of Infectious diseases and increase of chronic and degenerative diseases Including cancer and cardiovascular diseases, together with universal coverage of health insurance and improved living standard have prompted medical care utilization and skyrocketed the national health expenses. The goal of national health policy is improving the quality of life through the betterment of health level. To achieve this goal it is necessary to establish a healthcare system for lifetime, to improve the efficiency of healthcare delivery system, and to strengthen the public health services for disease prevention and health promotion. The current public health service programs are Inefficient due to an inconsistent policy for health service program, lack of health information system, irrational health program planning and evaluation, and Inadequate training of health workers. Local government has a legal responsibility for health service program planning and promoting the competence of health workers. Thus, municipal and provincial health departments should expand their roles and strengthen their function. The strategies for developing public health service programs at local level are ${\circled}1$ stipulating the goals of health policy, ${\circled}2$ promoting the ability for health program planning and evaluation, ${\circled}3$ establishing health information and surveillance system, ${\circled}4$ training of health workers, ${\circled}5$ establishing an institution for health information management and training of health workers, and ${\circled}61$ collaboration with local universities.

Daily Setup Uncertainties and Organ Motion Based on the Tomoimages in Prostatic Radiotherapy (전립선암 치료 시 Tomoimage에 기초한 Setup 오차에 관한 고찰)

  • Cho, Jeong-Hee;Lee, Sang-Kyu;Kim, Sei-Joon;Na, Soo-Kyung
    • The Journal of Korean Society for Radiation Therapy
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    • v.19 no.2
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    • pp.99-106
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    • 2007
  • Purpose: The patient's position and anatomy during the treatment course little bit varies to some extend due to setup uncertainties and organ motions. These factors could affected to not only the dose coverage of the gross tumor but over dosage of normal tissue. Setup uncertainties and organ motions can be minimized by precise patient positioning and rigid immobilization device but some anatomical site such as prostate, the internal organ motion due to physiological processes are challenge. In planning procedure, the clinical target volume is a little bit enlarged to create a planning target volume that accounts for setup uncertainties and organ motion as well. These uncertainties lead to differences between the calculated dose by treatment planning system and the actually delivered dose. The purpose of this study was to evaluate the differences of interfractional displacement of organ and GTV based on the tomoimages. Materials and Methods: Over the course of 3 months, 3 patients, those who has applied rectal balloon, treated for prostatic cancer patient's tomoimage were studied. During the treatment sessions 26 tomoimages per patient, Total 76 tomoimages were collected. Tomoimage had been taken everyday after initial setup with lead marker attached on the patient's skin center to comparing with C-T simulation images. Tomoimage was taken after rectal balloon inflated with 60 cc of air for prostate gland immobilization for daily treatment just before treatment and it was used routinely in each case. The intrarectal balloon was inserted to a depth of 6 cm from the anal verge. MVCT image was taken with 5 mm slice thickness after the intrarectal balloon in place and inflated. For this study, lead balls are used to guide the registration between the MVCT and CT simulation images. There are three image fusion methods in the tomotherapy, bone technique, bone/tissue technique, and full image technique. We used all this 3 methods to analysis the setup errors. Initially, image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours and then the radiation therapist registered the MVCT images with the CT simulation images based on the bone based, rectal balloon based and GTV based respectively and registered image was compared with each others. The average and standard deviation of each X, Y, Z and rotation from the initial planning center was calculated for each patient. The image fusions were based on the visual alignment of lead ball, CT anatomy and CT simulation contours. Results: There was a significant difference in the mean variations of the rectal balloon among the methods. Statistical results based on the bone fusion shows that maximum x-direction shift was 8 mm and 4.2 mm to the y-direction. It was statistically significant (P=<0.0001) in balloon based fusion, maximum X and Y shift was 6 mm, 16mm respectively. One patient's result was more than 16 mm shift and that was derived from the rectal expansions due to the bowl gas and stool. GTV based fusion results ranging from 2.7 to 6.6 mm to the x-direction and 4.3$\sim$7.8 mm to the y-direction respectively. We have checked rotational error in this study but there are no significant differences among fusion methods and the result was 0.37$\pm$0.36 in bone based fusion and 0.34$\pm$0.38 in GTV based fusion.

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A COMPARISON OF DECISIONS FOR PRIMARY ANTERIOR TEETH BETWEEN PEDIATRIC DENTISTS AND GENERAL DENTISTS (유전치 우식에 대한 치과의사들의 치료 선택 현황 조사)

  • Kim, Seong-Hee;Kim, Young-Jong;Kim, Shin;Jeong, Tae-Sung
    • Journal of the korean academy of Pediatric Dentistry
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    • v.39 no.3
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    • pp.242-248
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    • 2012
  • Children usually have varying degree of caries in primary anterior teeth, and treatment planning for each case prescribed by each dentist can also be varied. This survey was conducted to compare the preferred treatment method and restorative materials between general dentists and pediatric dentists in regard to the treatment of primary incisors. The questionnaires, composed of 18 questions were sent to 45 general dentists and 50 pediatric dentists. Among which 30 and 31 questionnaires were retrieved respectively. The collected data were analyzed by rate and the results were as follows: 1. For the teeth with initial caries without cavitation, general dentists showed the tendency to prefer restorative treatment(30%) or observation without any treatment(42%), whereas pediatric dentists prefer preventive treatment(76%). 2. The primary factor in choosing restorative materials by both groups was its manipulativeness. 3. For anterior esthetic restoration, general dentists seldom use the full-coverage restoration(13%) but resin restoration(75%), whereas pediatric dentists frequently used full-coverage crow(64%). 4. In the treatment of dentinal caries, pediatric dentist did not perform the treatment lesser than 2.0 years before the exfoliation (compared to 1.2 years of general dentist). 5. In the treatment of 1 year children, both pediatric and general dentists tend to select preventive procedure as first choice of treatment(84%, 52%). When treating primary incisor caries, it is shown that pediatric dentists are more interested in restorative/preventive treatment than general dentists are.

Scalp Dose Evaluation According Radiation Therapy Technique of Whole Brain Radiation Therapy (전뇌 방사선치료 시 치료방법에 따른 두피선량평가)

  • Jang, Joon-Yung;Park, Soo-Yun;Kim, Jong-Sik;Choi, Byeong-Gi;Song, Gi-Won
    • The Journal of Korean Society for Radiation Therapy
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    • v.23 no.2
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    • pp.103-108
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    • 2011
  • Purpose: Opposing portal irradiation with helmet field shape that has been given to a patient with brain metastasis can cause excess dose in patient's scalp, resulting in hair loss. For this reason, this study is to quantitatively analyze scalp dose for effective prevention of hair loss by comparing opposing portal irradiation with scalp-shielding shape and tomotherapy designed to protect patient's scalp with conventional radiation therapy. Materials and Methods: Scalp dose was measured by using three therapies (HELMET, MLC, TOMO) after five thermo-luminescence dosimeters were positioned along center line of frontal lobe by using RANDO Phantom. Scalp dose and change in dose distribution were compared and analyzed with DVH after radiation therapy plan was made by using Radiation Treatment Planning System (Pinnacle3, Philips Medical System, USA) and 6 MV X-ray (Clinac 6EX, VARIAN, USA). Results: When surface dose of scalp by using thermo-luminescence dosimeters was measured, it was revealed that scalp dose decreased by average 87.44% at each point in MLC technique and that scalp dose decreased by average 88.03% at each point in TOMO compared with HELMET field therapy. In addition, when percentage of volume (V95%, V100%, V105% of prescribed dose) was calculated by using Dose Volume Histogram (DVH) in order to evaluate the existence or nonexistence of hotspot in scalp as to three therapies (HELMET, MLC, TOMO), it was revealed that MLC technique and TOMO plan had good dose coverage and did not have hot spot. Conclusion: Reducing hair loss of a patient who receives whole brain radiotherapy treatment can make a contribution to improve life quality of the patient. It is expected that making good use of opposing portal irradiation with scalp-shielding shape and tomotherapy to protect scalp of a patient based on this study will reduce hair loss of a patient.

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A Study of the Radiotherapy Techniques for the Breast Including Internal Mammary Lymph Nodes (유방 보존술 후 내유림프절을 포함하는 방사선치료 기법에 관한 연구)

  • Jeong, Kyoung-Keun;Shim, Su-Jung;You, Sei-Hwan;Kim, Yong-Bae;Keum, Ki-Chang;Kim, Jong-Dae;Suh, Chang-Ok
    • Radiation Oncology Journal
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    • v.27 no.1
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    • pp.35-41
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    • 2009
  • Purpose: This study was designed to determine the optimum radiotherapy technique for internal mammary node (IMN) irradiation after breast-conserving surgery. Materials and Methods: We selected ten cases of early stage partial mastectomy for plan comparison. Five of the patients were treated to the right-side breast and the rest of the patients were treated to the left-side breast. For each case, four different treatment plans were made to irradiate the entire breast, IMNs and supraclavicular lymph nodes (SCLs). The four planning techniques include a standard tangential field (STF), wide tangential field (WTF), partially wide tangential field (PWT) and a photon-electron mixed field (PEM). We prescribed a dose of 50.4 Gy to the SCL field at a 3 cm depth and isocenter of the breast field. Results: The dose distribution showed clear characteristics depending on the technique used. All of the techniques covered the breast tissue well. IMN coverage was also good, except for the STF, which was not intended to cover IMNs. For the cases of the left-side breasts, the volume of the heart that received more than 30 Gy was larger (in order) for the WTF, PWT, PEM and STF. For radiation pneumonitis normal tissue complication probability (NTCP), the PWT showed the best results followed by the STF. Conclusion: Despite the variety of patient body shapes, the PWT technique showed the best results for coverage of IMNs and for reducing the lung and heart dose.

Influences of Environmental Factors on Soil Erosion of the Logging Road in Timber Harvested Area (성숙임목벌채지(成熟林木伐採地)에서 운재로(運材路)의 침식(浸蝕)에 미치는 환경요인(環境要因)의 영향(影響))

  • Park, Jae-Hyeon;Woo, Bo-Myeong;Jeong, Do-Hyun
    • Journal of Korean Society of Forest Science
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    • v.84 no.2
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    • pp.239-246
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    • 1995
  • This research aimed at the contribution to obtaining the scientifical data which were required for planning she environmentally sound and sustainable management, particularly in the field of the logging road construction. Main natural environmental variables including natural vegetation, rainfall, soil runoff were measured in the logging road on-sites and analysed. This project was carried out at the (mt.)Paekunsan Research sorest of Seoul National University, located in Gwangyang, Chollanam-do in southern part of Korea, from 1993 to 1994. 1. The explanatory variables for erosion and sedimentation on logging road surface were accumulated rainfall, erosion distance, cross-sectional gradient, and soil hardness. The erosion and sedimentation on logging road was increasing positively in proportion to the accumulated rainfall, soil distance from starting point of the logging road, and cross-sectional gradient. 2. On cut-slope of logging road, cut-slope shape, part of the slope, plant coverage, soil hardness, sand content, accumulated rainfall, clay content, and silt content were effective factors. Cut-slope erosion and sedimentation on logging roam increased as with the lower plant coverage, the lower accumulated rainfall, the high sand content in the soil. 3. On fill-slope of logging road, there were three significant variables such as total rainfall and number of rainfall-storm. Fill-slope erosion and sedimentation had a positive correlation with the amount of rainfall, the number of rainfall, the soil hardness. 4. The total erosion and sedimentation on logging road were $5.04{\times}10^{-2}m^2/m^2$ in logging road construction year, $7.37{\times}10^{-2}m^2/m^2$ in next year. The erosion and sedimentation on logging road surface were 32.7% of total erosion and sedimentation on Logging road in construction year, and 57.1% in next year, respectively. The erosion and sedimentation on cut-slopes were 30.4% on logging road in construction year, fill-slopes of total erosion and sedimentation and 21.0% in next year, respectively. The erosion and sedimentation on fill-slopes were 36.9% on logging road in construction year, 21.9 in next year. To decrease the erosion and sedimentation at the logging road from the beginning stage of construction, the effective revegetation works should be implemented on the cut-slope and fill slopes, and erosion control measures such as optima. road design must be constructed on read surface.

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Interstitial Vaginal Needle Implantation in Gynecological Tumors : Design and Construction of Applicator (부인과암에서 조직내 삽입 방사선치료 - Applicator의 고안 및 제작-)

  • Kang, Seung-Hee;Chun, Mi-Son;Kang, Hae-Jin;Jung, Chil;Son, Jeong-Hyae
    • Radiation Oncology Journal
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    • v.16 no.2
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    • pp.167-175
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    • 1998
  • Purpose : It is not a simple task to achieve the ideal isodose curve with a standard vaginal applicator or sing1e plane needle impant in the paravaginal tissue when primary or recurrent gynecological neoplasms(cervical cancers, vaginal cancers and vulvar cancers) are treated as a boost following external beam radiotherapy. The authors introduce the development and construction of a simple, inexpensive, customized applicator for volume implant to maximize the radiation dose to the tumor while minimizing the dose to the rectum and the bladder. Materials and Methods : Nine patients underwent Ir-192 transperineal interstitial implantation for either recurrent(5 cases) or primary(3 cases) cervical cancers or primary vaginal cancer(1 case) between August 1994 and February 1998 at Ajou university hospital. First 3 cases were performed with a sing1e plane implant guided by digital palpation. Because of inadequate isodose coverage in the tumor volume in first 3 cases, we designed and constructed interstitial vaginal applicator for volume implant to improve tumor dose distribution and homogeneity while sparing the surrounding normal tissue. Our applicators consist of vaginal obturator and perineal template that made of the clear acrylamide and dental mold material$(Provil^{(R)})$. The applicators were customized individually according to the tumor size and its location Both HDR and LDR irradiation were given with these applicators accomodating 6 Fr needles(Microselectron Nucletron). The pretreatment planning prior to actual implant was performed whenever possible. Results : Needles can be inserted easily and evenly into the tumor volume through the holes of templates, requiring less efforts and time for the implant procedure. Our applicators made of materials available from commercial vendors. These have an advantage that require easy procedure, and spend relatively short time to construct. Also it was possible to fabricate applicators to individualize according to the tumor size and its location and to achieve the ideal isodose coverage. We found an accurate needle arrangement and ideal dose distribution through the CT scan that was obtained in 3 cases after needle implant. Three patients with primary cervical and vaginal cancers were controlled locally at final follow up. But all recurrent cases failed to do so. Conclusion : The authors introduce inexpensive, simple interstitial vaginal templates which were self-designed and constructed using materials available from commercial vendors such as acrylanide and dental mold material $(Provil^{(R)})$.

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Evaluation of Electron Boost Fields based on Surgical Clips and Operative Scars in Definitive Breast Irradiation (유방보존술 후 방사선치료에서 수술 흉터와 삽입된 클립을 이용한 전자설 추가 방사선 조사야 평가)

  • Lee, Re-Na;Chung, Eun-Ah;Lee, Ji-Hye;Suh, Hyun-Suk
    • Radiation Oncology Journal
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    • v.23 no.4
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    • pp.236-242
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    • 2005
  • Purpose: To evaluate the role of surgical clips and scars in determining electron boost field for early stage breast cancer undergoing conserving surgery and postoperative radiotherapy and to provide an optimal method in drawing the boost field. Materials and Methods: Twenty patients who had $4{\sim}7$ surgical clips in the excision cavity were selected for this study. The depth informations were obtained to determine electron energy by measuring the distance from the skin to chest wall (SCD) and to the clip implanted in the most posterior area of tumor bed. Three different electron fields were outlined on a simulation film. The radiological tumor bed was determined by connecting all the clips implanted during surgery Clinical field (CF) was drawn by adding 3 cm margin around surgical scar. Surgical field (SF) was drawn by adding 2 cm margin around surgical clips and an Ideal field (IF) was outlined by adding 2 cm margin around both scar and clips. These fields were digitized into our planning system to measure the area of each separate field. The areas of the three different electron boost fields were compared. Finally, surgical clips were contoured on axial CT images and dose volume histogram was plotted to investigate 3-dimensional coverage of the clips. Results : The average depth difference between SCD and the maximal clip location was $0.7{\pm}0.55cm$. Greater difference of 5 mm or more was seen in 12 patients. The average shift between the borders of scar and clips were 1.7 1.2, 1.2, and 0.9 cm in superior, inferior, medial, and lateral directions, respectively. The area of the CF was larger than SF and IF in 6y20 patients. In 15/20 patients, the area difference between SF and if was less than 5%. One to three clips were seen outside the CF in 15/20 patients. In addition, dosimetrically inadequate coverage of clips (less than 80% of prescribed dose) were observed in 17/20 patients when CF was used as the boost field. Conclusion: The electron field determined from clinical scar underestimates the tumor bed in superior-inferior direction significantly and thereby underdosing the tissue at risk. The electron field obtained from surgical clips alone dose not cover the entire scar properly As a consequence, our technique, which combines the surgical clips and clinical scars in determining electron boost field, was proved to be effective in minimizing the geographical miss as well as normal tissue complications.

A Study on the Generalization of Multiple Linear Regression Model for Monthly-runoff Estimation (선형회귀모형(線型回歸模型)에 의한 하천(河川) 월(月) 유출량(流出量) 추정(推定)의 일반화(一般化)에 관한 연구(硏究))

  • Kim, Tai Cheol
    • Korean Journal of Agricultural Science
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    • v.7 no.2
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    • pp.131-144
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    • 1980
  • The Linear Regression Model to extend the monthly runoff data in the short-recorded river was proposed by the author in 1979. Here in this study generalization precedure is made to apply that model to any given river basin and to any given station. Lengthier monthly runoff data generated by this generalized model would be useful for water resources assessment and waterworks planning. The results are as follows. 1. This Linear Regression Model which is a transformed water-balance equation attempts to represent the physical properties of the parameters and the time and space varient system in catchment response lumpedly, qualitatively and deductively through the regression coefficients as component grey box, whereas deterministic model deals the foregoings distributedly, quantitatively and inductively through all the integrated processes in the catchment response. This Linear Regression Model would be termed "Statistically deterministic model". 2. Linear regression equations are obtained at four hydrostation in Geum-river basin. Significance test of equations is carried out according to the statistical criterion and shows "Highly" It is recognized th at the regression coefficients of each parameter vary regularly with catchment area increase. Those are: The larger the catchment area, the bigger the loss of precipitation due to interception and detention storage in crease. The larger the catchment area, the bigger the release of baseflow due to catchment slope decrease and storage capacity increase. The larger the catchment area, the bigger the loss of evapotranspiration due to more naked coverage and soil properties. These facts coincide well with hydrological commonsenses. 3. Generalized diagram of regression coefficients is made to follow those commonsenses. By this diagram, Linear Regression Model would be set up for a given river basin and for a given station (Fig.10).

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A Study on the Planning Methods of Community Greenway in Nam-Gu, Incheon (인천광역시 남구 커뮤니티형 그린웨이 조성방안 연구)

  • Park, Suk-Hyeon;Han, Bong-Ho;Choi, Jin-Woo;Choi, Tae-Young
    • Journal of the Korean Institute of Landscape Architecture
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    • v.43 no.1
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    • pp.16-28
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    • 2015
  • This study is suggested to enlarge the green area and to connect and improve the present green areas by deriving the lines of community greenway using living areas and community spaces close to the life of residence in Nam-gu. The purpose of this paper is to suggest the method of establishing greenway for the formation of community in which the residence can grow the community spirit and love their living space much more. Land-use status, green coverage ratio, and impermeability paving ratio are investigated. The community facilities are classified. The highest is educational facility, which is 7.7%, the green facility is 1.9% and the total area of community facilities which is 21.4%. The total area of Nam-gu is divided into 31 zones in total according to the administrative districts, the mail roads and reserved land of railroad and urban development. The total 20 lines of community greenway lines are chosen and the total length of lines is 18.2km. Finally, the characteristics of community greenway lines are analysed, the characteristics of community greenway lines are overall estimated according to the land-use, the street environment and the community facility. The classification system of community greenway is established on the basis on the function and purpose of greenway, the present status of land-use and the type of community facility. Based on the field investigation, the 6 greenway types are suggested considering the interconnection. The method of establishment of community greenway is suggested according to the principle of function and purpose, the principle of land-use and the principle of use of the facilities. Furthermore, the planting methods suitable to each greenway type are suggested in the building planting case of wall planting, roof planting, veranda planting, etc., and in the complex planting of parks, schools, roads, parking lots and other small areas.