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Supraclavicular Brachial Plexus block with Arm-Hyperabduction (상지(上肢) 외전위(外轉位)에서 시행(施行)한 쇄골상(鎖骨上) 상완신경총차단(上腕神經叢遮斷))

  • Lim, Keoun;Lim, Hwa-Taek;Kim, Dong-Keoun;Park, Wook;Kim, Sung-Yell;Oh, Hung-Kun
    • The Korean Journal of Pain
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    • v.1 no.2
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    • pp.214-222
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    • 1988
  • With the arm in hyperabduction, we have carried out 525 procedures of supraclavicular brachial plexus block from Aug. 1976 to June 1980, whereas block with the arm in adduction has been customarily performed by other authors. The anesthetic procedure is as follows: 1) The patient lies in the dorsal recumbent position without a pillow under his head or shoulder. His arm is hyperabducted more than a 90 degree angle from his side, and his head is turned to the side opposite from that to be blocked. 2) An "X" is marked at a point 1 cm above the mid clavicle, immediately lateral to the edge of the anterior scalene muscle, and on the palpable portion of the subclavian artery. The area is aseptically prepared and draped. 3) A 22 gauge 3.5cm needle attached to a syringe filled with 2% lidocaine (7~8mg/kg of body weight) and epineprine(1 : 200,000) is inserted caudally toward the second portion of the artery where it crosses the first rib and parallel with the lateral border of the muscle until a paresthesia is obtained. 4) Paresthesia is usually elicited while inserting the needle tip about 1~2 em in depth. If so, the local anesthetic solution is injected after careful aspiration. 5) If no paresthesia is elicited, the needle is withdrawn and redirected in an attempt to elicit paresthesia. 6) If, after several attempts, no paresthesia is obtained, the local anesthetic solution is injected into the perivascular sheath after confirming that the artery is not punctured. 7) Immediately after starting surgery, Valium is injected for sedation by the intravenous route in almost all cases. The age distribution of the cases was from 11 to 80 years. Sex distribution was 476 males and 49 females (Table 1). Operative procedures consisted of 103 open reductions, 114 skin grafts combined with spinal anesthesia in 14, 87 debridements, 75 repairs, i.e. tendon (41), nerve(32), and artery (2), 58 corrections of abnormalities, 27 amputations above the elbow (5), below the elbow (3) and fingers (17), 20 primary closures, 18 incisions and curettages, 2 replantations of cut fingers. respectively (Table 2). Paresthesia was obtained in all cases. Onset of analgesia occured within 5 minutes, starting in the deltoid region in almost all cases. Complete anesthesia of the entire arm appeared within 10 minutes but was delayed 15 to 20 minutes in 5 cases and failed in one case. Thus, our success rate was nearly 100%. The duration of anesthesia after a single injection ranged from $3\frac{1}{2}$ to $4\frac{1}{2}$, hours in 94% of the cases. The operative time ranged from 0.5 to 4 hours in 92.4% of the cases(Table 3). Repeat blocks were carried out in 33 cases when operative times which were more than 4 hours in 22 cases and the others were completed within 4 hours (Table 4). Two patients of the 33 cases, who received microvasular surgery were injected twice with 2% lidocaine 20 ml for a total of $13\frac{1}{2}$ hours. The 157 patients who received surgery on the forearms or hands had pneumatic tourniquets (250 torrs) applied without tourniquet pain. There was no pneumothorax, hematoma or phrenic nerve paralysis in any of the unilateral and 27 bilateral blocks, but there was hoarseness in two, Horner's syndrome in 11 and shivering in 7 cases. No general seizures or other side effects were observed. By 20ml of 60% urcgratin study, we confirm ed the position of the needle tip to be in a safer position when the arm is in hyperabduction than when it is in adduction. And also that the humoral head caused some obstraction of the distal flow of the dye, indicating that less local anesthetic solution would be needed for satisfactory anesthesia. (Fig. 3,4).

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Compositional Variation of Arsenopyrites in Arsenic and Polymetallic Ores from the Ulsan Mine, Republic of Korea, and their Application to a Geothermometer (울산광산산(蔚山鑛山産) 유비철석(硫砒鐵石)의 조성변화(組成變化) 및 지질온도계(地質溫度計)에 대(對)한 적용(適用))

  • Choi, Seon-Gyu;Chung, Jae-Ill;Imai, Naoya
    • Economic and Environmental Geology
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    • v.19 no.3
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    • pp.199-218
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    • 1986
  • Arsenopyrite in arsenic and polymetallic ores from calcic Fe-W skarn deposit of the Ulsan mine, Republic of Korea, has been investigated by means of electron microprobe analysis and X-ray diffractometry. As a result, it is revealed that the Ulsan arsenopyrite may be classified into the following three species with different generation on the basis of its mode of occurrence, chronological order during polymetallic mineralization and chemical composition; arsenopyrites I, II and III. 1) Arsenopyrite I-(Ni, Co)-bearing species belonging to the oldest generation, which has crystallized together with (Ni, Co)-arsenides and -sulpharsenides in the early stage of polymetallic mineralization. In rare cases, it contains a negligible amount of antimony. It occurs usually as discrete grains with irregular outline, showing rarely subhedral form, and is diffused in skarn zone. The maximum contents of nickel and cobalt are 10.04 Ni and 2.45 Co (in weight percent). Occasionally, it shows compositional zoning with narrow rim of lower (Ni+Co) content. 2) Arsenopyrite II-arsenian species, in which (Ni+Co) content is almost negligible, may occur widely in arsenic ores, and its crystallization has followed that of arsenopyrite I. It usually shows subhedral to euhedral form and is closely associated with $l{\ddot{o}}llingite$, bismuth, bismuthinite, chalcopyrite, sphalerite, bismuthian tennantite, etc. It is worthy of note that arsenopyrite II occasionally contains particles consisting of both bismuth and bismuthinite. 3) Arsenopyrite III-(Ni, Co)-free, S-excess and As-deficient species is close to the stoichiometric composition, FeAsS. It occurs in late hydrothermal veins, which cut clearly the Fe-W ore pipe and the surrounding skarn zone. It shows euhedral to subhedral form, being extremely coarse-grained, and is closely associated with pyrite, "primary" monoclinic pyrrhotite, galena, sphalerite, etc. Among three species of the Ulsan arsenopyrite, arsenopyrite I does not serve as a geothermometer, because (Ni+Co) content always exceeds 1 weight percent. In spite of the absence of Fe-S minerals as sulphur-buffer assemblage, the presence of $Bi(l)-Bi_2S_3$ sulphur-buffer enables arsenopyrite II to apply successfully to the estimation of either temperature and sulphur fugacity, the results are, $T=460{\sim}470^{\circ}C$, and log $f(S_2)=-7.4{\sim}7.0$. With reference to arsenopyrite III, only arsenopyrite coexisting with pyrite and "primary" monoclinic pyrrhotite may serve to restrict the range of both temperature and sulphur fugacity, $T=320{\sim}440^{\circ}C$, log $f(S_2)=-9.0{\sim}7.0$. These temperature data are consistent with those obtained by fluid inclusion geothermometry on late grandite garnet somewhat earlier than arsenopyrite II. At the beginning of this paper, the geological environments of the ore formation at Ulsan are considered from regional and local geologic settings, and physicochemical conditions are suspected, in particular the formation pressure (lithostatic pressure) is assumed to be 0.5kb (50MPa). The present study on arsenopyrite geothermometry, however, does not bring about any contradictions against the above premises. Thus, the following genetical view on the Ulsan ore deposit previously advocated by two of the present authors (Choi and Imai) becomes more evident; the ore deposit was formed at shallow depth and relatively high-temperature with steep geothermal gradient-xenothermal conditions.

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A STUDY ON THE DISTRIBUTION OF CALCITONIN GENE-RELATED PEPTIDE CONTAINING NERVE FIBERS IN RAT PULP FOLLOWING DENTINAL INJURY (상아질 손상 후 흰쥐 대구치 치수의 calcitonin gene-related peptide(CGRP) 함유 신경섬유 분포에 관한 연구)

  • Moon, Joo-Hoon;Park, Sang-Jin;Min, Byung-Soon;Choi, Ho-Young;Cho, Gi-Woon
    • Restorative Dentistry and Endodontics
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    • v.24 no.1
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    • pp.100-115
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    • 1999
  • The purpose of this study was to investigate the distribution of calcitonin gene-related peptide containing nerve fibers in rat pulp after dentinl injury by means of immunohistochemistry and confocal laser scanning microscope. The Spague-Dawley rats weighing about 250-300gm were used. The animals were devided into normal control and experimental groups. Experimental animals were sacrified 1, 2, 4, 7, 10, 21days after dentinal injury (dentin cutting, and then acid etching with 35% phosphoric acid) on the maxillary molar teeth. The maxillary teeth and alveolar bone were removed and immersed in the 4% paraformaldehyde in 0.1M phosphate buffer (pH 7.4), then were decalcified with 15% formic acid for 10 days. Serial frozen $50{\mu}m$ thick sections were cut on a cryostat. The rabbit CGRP antibody was used as a primary antibody with a dilution of 1:2000 in 0.01M PB. The sections were incubated for 48 hours at $4^{\circ}C$, and placed into biotinylated antirabbit Ig G as a secondary anti body with dilution of 1:200 in 0.01M PB and incubated in ABC(avidin-biotin complex). The peroxidase reaction was visualized by incubating the sections in 0.05% 3,3 diaminobenzidine tetrahydrochloride containing 0.02% $H_2O_2$. For the confocal laser scanning microscopic examination, Primary antibody reaction was same as immunoperoxidase stainning, but fluorescein isothiocyanate(FITC)-conjugate antirabbit IgG as a secondary antibody was used. The confocal laser scanning microscope was used for the examination. A series of images of optical sections was collected with a 20x objective at $3{\mu}m$ intervals throughout the depth of specimen. FITC fluerescence was registrated through a 488nm and 568nm excitation filter, and images were saved on optical disk. The stereoscopic images and three dimentionnal images were reconstructed by computer software, and then were analyzed. The results were as follows : 1. In normal control group, CGRP containing nerve fibers were coursed through the root with very little branching, and then formed a dense network of terminals in coronal pulp. 2. A slight increase in CGRP containing nerve fibers at 1 and 2day postinjury was noted subjacent to the injury site. In the 4day group, there were an extensive increase in the number of reactive fibers, followed by a partial return toward normal levels at 7~10 day postinjury, and return by 21days. 3. The sprouting of the CGRP containing nerve fibers was evident within 2day after dentinal injury, and by 4days there was a maximal increased, but was decreased at 7days and returned to normal 10~21 day postinjury. 4. In confocal laser scanning microscopic exammination, the distinct distribution pattern and sprouting reaction of CGRP containing nerve fibers were observed in stereoscopic images and three dimentional images. These results suggest that CGRP containing nerve fiber can be important role in the response to dental injury and pain regulation.

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The Life Experiences of the Deaf Elderly (농아노인의 생활 경험)

  • Park, Ina;Hwang, YoungHee;Kim, Hanho
    • 한국노년학
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    • v.36 no.3
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    • pp.525-540
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    • 2016
  • The purpose of this study was to investigate what kind of experiences the deaf elderly would have in the course of life. It also aimed to promote the understanding of their living difficulties and culture among people with normal hearing and provide basic data to help them live with others as members of the community. Phenomenological qualitative research was conducted as part of the methodology. The subjects include seven deaf old people. Based on the results of in-depth interview and analysis, the life experiences of the deaf elderly were categorized into "unforgettable wounds," "life in the community," "life with the family," "marriage of the deaf elderly", and "living by adjusting to reality." First, the subcategories of "unforgettable wounds" include "receiving no treatment for fever," "damage by the Korean War," "alienation from the family," and "people's cold eyes." It turned out that the deaf elderly had led a life, suffering from the heart wounds that they could not forget. Second, the subcategories of "life in the community" include "inconvenience in life," "disadvantages in life," and "severed life." The deaf elderly were not only subjected to inconvenience and disadvantages in life, but also suffered loneliness, being cut off from the community. Third, the subcategories of "life with the family" include "not communicating with children," "being abandoned again," "being used by the family," "being lonely even with the family," and "wishing to live independently from the family." The deaf elderly were not supported by their families and were abandoned or used by them, leading a solitary life. Fourth, the subcategories of "marriage of the deaf elderly" include"send as a surrogate mother," "frequent remarriage and divorce," "lean on as a married couple." Deaf elderly form their own culture of the marriage and lean on each other. Finally, the subcategories of "living by adjusting to reality" include "getting help from neighbors," "behaving oneself right in life," "learning Hangul," "living by working," "living freely," "living by missing," and "controlling the impulse to end life," "resorting to religion." The deaf elderly made the most alienated and vulnerable group with no access to benefits due to their limitations as a linguistic and social minority, but they made efforts to form their own culture and adjust to reality for themselves. Based on those findings, the study made the following proposals: first, there is a need for practical approaches to heal the ineffaceable wounds in the hearts of deaf elderly. Second, there is a need for policies to help them experience no inconvenience and disadvantages as members of community and communicate with people with normal hearing. Third, there should be practical approaches to enable them to get recognition and support from their families and share love with them. Finally, there should be practical policy approaches to help people with normal hearing understand the culture of deaf elderly and assist the deaf elderly to receive supports from the community and live with others within the community.

A Three-year Study on the Leaf and Soil Nitrogen Contents Influenced by Irrigation Frequency, Clipping Return or Removal and Nitrogen Rate in a Creeping Bentgrass Fairway (크리핑 벤트그라스 훼어웨이에서 관수회수.예지물과 질소시비수준이 엽조직 및 토양 질소함유량에 미치는 효과)

  • 김경남;로버트쉬어만
    • Asian Journal of Turfgrass Science
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    • v.11 no.2
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    • pp.105-115
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    • 1997
  • Responses of 'Penncross' creeping bentgrass turf to various fairway cultural practices are not well-established or supported by research results. This study was initiated to evaluate the effects of irrigation frequency, clipping return or removal, and nitrogen rate on leaf and soil nitrogen con-tent in the 'Penncross' creeping bentgrass (Agrostis palustris Huds.) turf. A 'Penncross' creeping bentgrass turf was established in 1988 on a Sharpsburg silty-clay loam (Typic Argiudoll). The experiment was conducted from 1989 to 1991 under nontraffic conditions. A split-split-plot experimental design was used. Daily or biweekly irrigation, clipping return or removal, and 5, 15, or 25 g N $m-^2$ $yr-^1$ were the main-, sub-, and sub-sub-plot treatments, respectively. Treatments were replicated 3 times in a randomized complete block design. The turf was mowed 4 times weekly at a l3 mm height of cut. Leaf tissue nitrogen content was analyzed twice in 1989 and three times in both 1990 and 1991. Leaf samples were collected from turfgrass plants in the treatment plots, dried immediately at 70˚C for 48 hours, and evaluated for total-N content, using the Kjeldahl method. Concurrently, six soil cores (18mm diam. by 200 mm depth) were collected, air dried, and analyzed for total-N content. Nitrogen analysis on the soil and leaf samples were made in the Soil and Plant Analyical Laboratory, at the University of Nebraska, Lincoln, USA. Data were analyzed as a split-split-plot with analysis of variance (ANOVA), using the General Linear Model procedures of the Statistical Analysis System. The nitrogen content of the leaf tissue is variable in creeping bentgrass fairway turf with clip-ping recycles, nitrogen application rate and time after establishment. Leaf tissue nitrogen content increased with clipping return and nitrogen rate. Plots treated with clipping return had 8% and 5% more nitrogen content in the leaf tissue in 1989 and 1990, respectively, as compared to plots treated with clipping removal. Plots applied with high-N level (25g N $m-^2$ $yr-^1$)had 10%, 17%, and 13% more nitrogen content in leaf tissue in 1989, 1990, and 1991, respectively, when compared with plots applied with low-N level (5g N $m-^2$ $yr-^1$). Overall observations during the study indicated that leaf tissue nitrogen content increased at any nitrogen rate with time after establishment. At the low-N level treatment (5g N $m-^2$ $yr-^1$ ), plots sampled in 1991 had 15% more leaf nitrogen content, as compared to plots sampled in 1989. Similar responses were also found from the high-N level treatment (25g N $m-^2$ $yr-^1$ ).Plots analyzed in 1991 were 18% higher than that of plots analyzed in 1989. No significant treatment effects were observed for soil nitrogen content over the first 3 years after establishment. Strategic management application is necessary for the golf course turf, depending on whether clippings return or not. Different approaches should be addressed to turf fertilization program from a standpoint of clipping recycles. It is recommended that regular analysis of the soil and leaf tissue of golf course turf must be made and fertilization program should be developed through the interpretation of its analytic data result. In golf courses where clippings are recycled, the fertilization program need to be adjusted, being 20% to 30% less nitrogen input over the clipping-removed areas. Key words: Agrostis palustris Huds., 'Penncross' creeping bentgrass fairway, Irrigation frequency, Clipping return, Nitrogen rate, Leaf nitrogen content, Soil nitrogen content.

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Studies on the Drying Mechanism of Stratified Soil-Comparison between Bare Surface and Grass plot- (성층토양의 건조기구에 관한 연구)

  • 김철기
    • Magazine of the Korean Society of Agricultural Engineers
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    • v.15 no.1
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    • pp.2913-2924
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    • 1973
  • This study was to investigate the drying mechanism of stratified soil by investigating 'effects of the upper soil on moisture loss of the lower soil and vice versa' and at the same time by examining how the drying progressed in the stratified soils with bare surface and with vegetated surface respectively. There were six plots of the stratified soils with bare surface($A_1- A_6$ plot) and the same other six plots($B_1- B_5$ plot), with vegetated surface(white clover). These six plots were made by permutating two kinds of soils from three kinds of soils; clay loam(CL). Sandy loam(SL). Sand(s). Each layer was leveled by saturating sufficient water. Depth of each plot was 40cm by making each layer 20cm deep and its area. $90{\times}90(cm^2)$. The cell was put at the point of the central and mid-depth of the each layer in the each plot in order to measure the soil moisture by using OHMMETER. soil moisture tester, and movement of soil water from out sides was cut off by putting the vinyl on the four sides. The results obtained were as follow; 1. Drying progressed from the surface layer to the lower layer regardless of plots. There was a tendency thet drying of the upper soil was faster than that of the lower soil and drying of the plot with vegetated surface was also faster than that of the plot with bare surface. 2. Soil moisture was recovered at approximately the field capacity or moisture equivalent by infiltration in the course of drying, when there was a rainfall. 3. Effects of soil texture of the lower soil on dryness of the upper soil in the stratified soil were explained as follows; a) When the lower soil was S and the upper, CL or SL, dryness of the upper soils overlying the lower soil of S was much faster than that overlying the lower soil of SL or CL, because sandy soil, having the small field capacity value and playing a part of the layer cutting off to some extent capillary water supply. Drying of SL was remarkably faster than that of CL in the upper soil. b) When the lower soil was SL and the upper S or CL, drying of the upper soil was the slowest because of the lower SL, having a comparatively large field capacity value. Drying of CL tended to be faster than that of S in the upper soil. c) When the lower soil was CL and the upper S or SL, drying of the upper soil was relatively fast because of the lower CL, having the largest field capacity value but the slowest capillary conductivity. Drying of SL tended to be faster than that of S in the upper soil. 4. According to a change in soil moisture content of the upper soil and the lower soil during a day there was a tendency that soil moisture contents of CL and SL in the upper soil were decreased to its minimum value but that of S increased to its maximum value, during 3 hours between 12.00 and 15.00. There was another tendency that soil moisture contents of CL, SL and S in the lower soil were all slightly decreased by temperature rising and those in a cloudy day were smaller than those in a clear day. 5. The ratio of the accumulated soil moisture consumption to the accumulated guage evaporation in the plot with vegetated surface was generally larger than that in the plot with bare surface. The ratio tended to decrease in the course of time, and also there was a tendency that it mainly depended on the texture of the upper soil at the first period and the texture of the lower soil at the last period. 6. A change in the ratio of the accumulated soil moisture consumption was larger in the lower soil of SL than in the lower soil of S. when the upper soil was CL and the lower, SL and S. The ratio showed the biggest figure among any other plots, and the ratio in the lower soil plot of CL indicated sligtly bigger than that in the lower soil plot of S, when the upper soil was SL and the lower, CL and S. The ratio showed less figure than that of two cases above mentioned, when the upper soil was S and the lower CL and SL and that in the lower soil plot of CL indicated a less ratio than that in the lower soil plot of SL. As a result of this experiments, the various soil layers wero arranged in the following order with regard to the ratio of the accumulated soil moisture consumption: SL/CL>SL/S>CL/SL>CL/S$\fallingdotseq$S/SL>S/CL.

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Compare to Evaluate the Imaging dose of MVCT and CBCT (Tomotherapy MVCT와 Linac CBCT의 Imaging dose 비교평가)

  • Yoon, Bo Reum;Hong, Mi Lan;Ahn, Jong Ho;Song, Ki Won
    • The Journal of Korean Society for Radiation Therapy
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    • v.26 no.1
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    • pp.83-89
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    • 2014
  • Purpose : In case of the intensity modulated radiation therapy (IMRT) using Tomotherapy and linear accelerator (Linac), it was to compare and to evaluate the imaging dose of MVCT and CBCT that were performed daily for the correct set up of the patient. Materials and Methods : The human body model Phantom (Anderson rando Phantom, USA) was divided into the three parts as Head, Thorax, pelvis, and after GafChromic EBT3 film cut to the size of $0.5{\times}0.5cm2$.in the center of the recording area were situated on the ant, post, left, and right surface of the phantom and 2cm in depth from the ant, post, left, right, and center surface of the phantom, the surface dose and inner dose were measured repeatedly three times, respectively, using the tomotherapy (Hi Art) and the OBI of NovalisTx. The measured film calculated the output value by RIP version6.0 and then the average value of the dose was calculated by the one-way analysis of variance. Results : Using the human body model phantom, the results of MVCT and CBCT performance were that measurements of MVCT inner dose were showed $15.43cGy{\pm}6.05$ in the head, $16.62cGy{\pm}3.08$ in the thorax, $16.81cGy{\pm}5.24$ in the pelvis, and measurements of CBCT inner dose were showed $13.28{\pm}3.68$ in the head, from $13.66{\pm}4.04$ in the thorax, $15.52{\pm}3.52$ in the pelvis. The measurements of surface dose were showed in case of MVCT performance, $11.64{\pm}4.05$ in the head, $12.16{\pm}4.38$ in the thorax, $12.05{\pm}2.71$ in the pelvis, and in case of CBCT performance, $14.59{\pm}3.51$ in the head, $15.82{\pm}2.89$ in the thorax, $17.48{\pm}2.80$ in the pelvis, respectively. Conclusion : In case of Inner dose, the MVCT using MV energy showed higher than the CBCT using kV energy at 1.16 times in the head, at 1.22 times in the thorax, at 1.08 times in the pelvis, and in case of surface dose, the CBCT was higher than MVCT, at 1.25 times in the head, at 1.30 times in the thorax, at 1.45 times in the pelvis. Imaging dose was a small amount compared to the therapeutic dose but it was thought to affect partially to normal tissue because it was done in daily schedule. However, IMRT treatment was necessarily parallel with the IGRT treatment through the image-guide to minimize errors between planned and actual treatment. Thus, to minimize imaging dose that the patients receive, when planning the treatment, it should be set up a treatment plan considering imaging dose, or it must be performed by minimizing the scan range when shooting MVCT.