• Pediatric Infection and Vaccine
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• v.25 no.3
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• pp.148-155
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• 2018

Purpose: The purpose of this study was to investigate the clinical significance of Bacille Calmette-$Gu{\acute{e}}rin$ (BCG) site reaction in terms of diagnosis and outcome prediction in young children with Kawasaki disease (KD). Methods: The incidence of BCG site reaction in the respective age ranges was investigated in 1,058 patients who were admitted at Asan Medical Center between January 2006 and February 2017. The 416 patients under 18 months of age were enrolled as subjects for the analysis of the association between BCG site reaction and other laboratory and clinical findings. The analysis was performed separately in complete and incomplete KD groups. Results: The incidence rate of BCG site reaction was peaked at 6-12 months (83%) and decreased with increasing age after 12 months in 1,058 patients (P<0.001). The incidence rate was above 70% in KD aged less than 18 months and more frequent than those of cervical lymphadenopathy. The logistic regression analyses showed that the principal clinical findings including conjunctivitis (P=0.781), red lips/oral mucosa (P=0.963), rash (P=0.510), cervical lymphadenopathy (P=0.363), changes in extremities (P=0.283) and the coronary artery aneurysm (P=0.776) were not associated with the BCG site reaction. Conclusions: The BCG site reaction could be a useful diagnostic tool independent to principal clinical findings in KD developing in children aged <18 months, who underwent BCG vaccination. Outcome of KD patients was not different between groups with or without the BCG site reaction in both complete KD and incomplete KD.

• Journal of the Korean Society of Radiology
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• v.13 no.4
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• pp.573-579
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• 2019

The purpose of this study is predicted easily the entrance surface dose (ESD) in chest digital radiography. We used two detector type such as flat-panel detector (FP) and IP (Imaging plate detector). ESD was measured at each exposure condition combined tube voltage with tube current using dosimeter, after attaching on human phantom, it was repeated 3 times. Phantom images were evaluated independently by three chest radiologists after blinding image. Dose-area product (DAP) or exposure index (EI) was checked by Digital Imaging and Communications in Medicine (DICOM) header on phantom images. Statistical analysis was performed by the linear regression using SPSS ver. 19.0. ESD was significant difference between FP and IP($85.7{\mu}Gy$ vs. $124.6{\mu}Gy$, p=0.017). ESD was positively correlated with image quality in FP as well as IP. In FP, adjusted R square was 0.978 (97.8%) and linear regression model was $ESD=0.407+68.810{\times}DAP$. DAP was 4.781 by calculating the $DAP=0.021+0.014{\times}340{\mu}Gy$. In IP, adjusted R square was 0.645 (64.5%) and linear regression model was $ESD=-63.339+0.188{\times}EI$. EI was 1748.97 by calculating the $EI=565.431+3.481{\times}340{\mu}Gy$. In chest digital radiography, the ESD can be easily predicted by the DICOM header information.

• Journal of the Korean Society of Radiology
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• v.15 no.1
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• pp.63-70
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• 2021

Radiographic contrast agents are used for diagnostic purposes and are one of the factors affecting measured values in bone density tests. They are absorbed into tissues and have an effect of increasing the measured values of bone density, so they are avoided as much as possible before performing a bone density test. MRI contrast agents, which have different physical properties and mechanisms of action than radiographic contrast agents, are based on gadolinium, a metal element. They have radiopacity characteristics, so MRI are generally performed prior to examination using radiation. The purpose of this study was to investigate the effects of MRI contrast agents on bone mineral density examination using dual energy X-ray absorption. Two types of gadolinium based MRI contrast agents were injected into an acrylic water tank for each volume, and the humanoid spine phantom was inserted and the BMD and T-score from (L1-L4) were analyzed by scanning a total of 30 times, 5 times for each injection type. The average value of the measured total (L1-L4) bone density for each of the two contrast agents was 0.952±0.052, 0.957±0.050, and 0.956±0.05g/㎠, respectively, for the Gadoterate Meglumine component 0mL, 7.5mL and 15mL, when the gadobutrol components were 0mL, 5mL, and 10mL, there was no statistically significant difference at all sites at 0.953±0.001, 0.954±0.001, and 0.945±0.001g/㎠, respectively(p>0.05). The average value of total T-score was -0.46±0.05, -0.4±0, -0.42±0.04 when the Gadoterate Meglumine component was 0mL, 7.5mL and 15mL, respectively. When the Gadobutrol ingredients were 0mL, 5mL and 10mL, there was no statistically significant difference in all areas, with -0.46±0.05, -0.46±0.05, and 0.5±0.00, respectively. In this experiment, the MRI contrast agent was found to have no effect on bone density tests, using the dual-energy X-ray absorption method. There is a limitation in that physical conditions such as kidney and health conditions etc. were not taken into consideration, so further clinical research is expected to be conducted in the future.

• Journal of the Korean Orthopaedic Association
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• v.56 no.5
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• pp.398-403
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• 2021

Purpose: A biopsy is needed to diagnose soft tissue tumors. However, it is extremely difficult to pinpoint the site of a tumor due to the heterogeneity of sarcomas. Thus, even when an open biopsy is conducted, it is difficult to diagnose a soft tissue tumor. In such cases, an ultrasound (US)-guided biopsy is used to improve the diagnostic accuracy. This study evaluated the accuracy of US-guided biopsy for a diagnosis of soft tissue tumors found initially in a magnetic resonance (MR) perfusion and assessed the availability of positron emission tomography-computed tomography (PET-CT) for a diagnosis of soft tissue tumors. Materials and Methods: From January 2014 to December 2018, the US-guided biopsy was performed on 152 patients with a suspected soft tissue tumor found in an MR perfusion and 86 cases were definitively diagnosed with a soft tissue tumor. The accuracy of the US-guided biopsy was assessed retrospectively. Among the 86 cases, only MR perfusion was used before the biopsy in 50 cases, while both MR perfusion and PET-CT was conducted on 36 cases. The accuracy was analyzed to determine if the PET-CT could improve the precision of a biopsy. Results: From 86 cases, 34 out of 50 cases, in which only MR perfusion had been conducted, matched the result of the definitive diagnosis and the US-guided biopsy. 32 out of 36 cases, in which both PET-CT and MR perfusion were conducted, matched the definitive diagnosis and the US-guided biopsy. These results show significant differences in the accuracy of US-guided biopsy. In the case of soft tissue sarcomas, 6 out of 12 cases, in which only MR perfusion had been conducted, matched the result of the definitive diagnosis and the US-guided biopsy. 17 out of 18 cases, in which both PET-CT and MR perfusion were conducted, matched the definitive diagnosis. Moreover US-guided biopsy also showed significant differences in the accuracy of US-guided biopsy. Conclusion: In diagnosing soft tissue tumors, a US-guided biopsy is a well-known tool for its high accuracy. However, the heterogeneity of sarcoma makes it difficult to locate the exact site for a biopsy using only MR perfusion. Thus, the use of PET-CT will meaningfully improve the accuracy of a diagnosis by precisely targeting the site for the US-guided biopsy.

• Journal of the Korean Society of Radiology
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• v.17 no.4
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• pp.489-495
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• 2023

Radiation shielding facilities are constructed in locations where diagnostic radiation generators are installed, with the aim of preventing exposure for patients and radiation workers. The purpose of this study is seek to compare and validate the trend of attenuation thickness of lead, the primary material in these radiation shielding facilities, at different maximum tube voltages by Monte Carlo simulations and measurement. We employed the Monte Carlo N-Particle 6 simulation code. Within this simulation, we set a lead shielding arrangement, where the distance between the source and the lead sheet was set at 100 cm and the field of view was set at 10 × 10 cm². Additionally, we varied the tube voltages to encompass 80, 100, 120, and 140 kVp. We calculated energy spectra for each respective tube voltage and applied them in the simulations. Lead thicknesses corresponding to attenuation rates of 50, 70, 90, and 95% were determined for tube voltages of 80, 100, 120, and 140 kVp. For 80 kVp, the calculated thicknesses for these attenuation rates were 0.03, 0.08, 0.21, and 0.33 mm, respectively. For 100 kVp, the values were 0.05, 0.12, 0.30, and 0.50 mm. Similarly, for 120 kVp, they were 0.06, 0.14, 0.38, and 0.56 mm. Lastly, at 140 kVp, the corresponding thicknesses were 0.08, 0.16, 0.42, and 0.61 mm. Measurements were conducted to validate the calculated lead thicknesses. The radiation generator employed was the GE Healthcare Discovery XR 656, and the dosimeter used was the IBA MagicMax. The experimental results showed that at 80 kVp, the attenuation rates for different thicknesses were 43.56, 70.33, 89.85, and 93.05%, respectively. Similarly, at 100 kVp, the rates were 52.49, 72.26, 86.31, and 92.17%. For 120 kVp, the attenuation rates were 48.26, 71.18, 87.30, and 91.56%. Lastly, at 140 kVp, they were measured 50.45, 68.75, 89.95, and 91.65%. Upon comparing the simulation and experimental results, it was confirmed that the differences between the two values were within an average of approximately 3%. These research findings serve to validate the reliability of Monte Carlo simulations and could be employed as fundamental data for future radiation shielding facility construction.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.385-392
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• 2023

Caroli's disease is a fibrocystic liver disease. Autosomal recessive disorder is characterized by congenital multiple dilatation of the bile duct. Computerized tomography, magnetic resonance imaging, cholangiography and ultrasound are among the methods for diagnosing caroli disease. Computerized tomography is essential for detecting and distinguishing fibroplastic liver disease and is useful for determining intrahepatic bile duct dilatation. However, awareness of the possible side effects of using contrast mediums is necessary. A typical method of magnetic resonance cholangiography is used for magnetic resonance imaging. A non-invasive examination can reduce the pain of the patient, and the anatomical structure of the bile pancreatic duct and the presence or absence of lesions can be easily and quickly observed. Biliary contrast is an effective diagnostic method that can directly visualize various cystic dilatations throughout the enlarged bile duct. However, since this procedure is also an invasive procedure, it is recommended not for diagnosis but for treatment purposes. Ultrasonography can confirm similar findings to computerized tomography. The hepatic artery root is difficult to prove with conventional grayscale ultrasound. However, it is of clinical value in that it can not only describe dilated bile ducts with vascular roots in the tube but also easily identify color Doppler signals in the tube. With the development of video diagnostics, early diagnosis has become possible through computerized tomography, magnetic resonance imaging, cholangiography, and ultrasound. In order to further contribute to the development of video diagnostics so that long-term prognosis can be improved after treatment through early diagnosis, we examined what aspects of each test's caroli disease appear.

• Health Policy and Management
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• v.34 no.2
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• pp.141-155
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• 2024

Background: This study aimed to identified the relationship between the risk of obstructive sleep apnea, subjective health, and health-related quality of life among the middle-aged and elderly population in Korea. Methods: Adults aged 40 or older were extracted from the total 22,559 respondents to the 2019-2020 Korea National Health and Nutrition Examination Survey VIII, and secondary analysis was conducted on a total of 6,659 middle-aged and elderly people with no missing values. Logistic regression analysis and multiple regression analysis were conducted to examine the relationship between obstructive sleep apnea risk factors and subjective health as well as quality of life. Results: The subjective health status decline in the high-risk group compared to the non-risk group for obstructive sleep apnea was statistically significantly higher, with an odds ratio of 1.84 (p<0.001). The health-related quality of life was also statistically significantly lower by 0.02 points (β, -0.02; p<0.001). As a result of subgroup analysis on specific variables, the association between the risk of obstructive sleep apnea and subjective health and health-related quality of life was statistically significant depending on gender, sleep time, presence of depression, household income, and number of household members. Based on the obstructive sleep apnea risk group, women had a higher correlation with low subjective health and lower health-related quality of life scores than men. Sleeping time of more than 8 hours or less than 6 hours was more associated with low subjective health and lower health-related quality of life score than sleeping time of 6-8 hours. Patients with depression were more likely to have low subjective health than those without depression. The lower the household income level and the smaller the number of household members, the higher the association with low subjective health and the lower the health-related quality of life score. Conclusion: It is essential to recognize that the risk of obstructive sleep apnea not only directly affects sleep disorders but also impacts individuals' subjective health and quality of life. Consequently, social support and education should be provided to raise awareness of this issue. Particularly, programs for preventing and managing obstructive sleep apnea should target vulnerable groups such as women, individuals in single-person households, low household income, and those with depression, aiming to improve their subjective health and quality of life.

• Journal of the Korean Society of Radiology
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• v.82 no.3
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• pp.654-669
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• 2021

Purpose To evaluate the accuracy of MRI in predicting the pathological complete response (pCR) and the residual tumor size of breast cancer after neoadjucant chemotherapy (NAC), and to determine the factors affecting the accuarcy. Materials and Methods Eighty-eight breast cancer patients who underwent surgery after NAC at our center between 2010 and 2017 were included in this study. pCR was defined as the absence of invasive cancer on pathological evaluation. The maximum diameter of the residual tumor on post-NAC MRI was compared with the tumor size of the surgical specimen measured pathologically. Statistical analysis was performed to elucidate the factors affecting pCR and the residual tumor size-discrepancy between the MRI and the pathological measurements. Results The pCR rate was 10%. The diagnostic accuracy of MRI and the area under the curve for predicting pCR were 90.91% and 0.8017, respectively. The residual tumor sizes obtained using MRI and pathological measurements showed a strong correlation (r = 0.9, p < 0.001), especially in patients with a single mass lesion (p = 0.047). The size discrepancy between MRI and the pathological measurements was significantly greater in patients with the luminal type (p = 0.023) and multifocal tumors/non-mass enhancement on pre-NAC MRI (p = 0.047). Conclusion MRI is an accurate tool for evaluating pCR and residual tumor size in breast cancer patients who receive NAC. Tumor subtype and initial MRI features affect the accuracy of MRI.

• Korean Journal of Radiology
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• v.25 no.1
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• pp.11-23
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• 2024

Objective: To investigate whether reader training improves the performance and agreement of radiologists in interpreting unenhanced breast magnetic resonance imaging (MRI) scans using diffusion-weighted imaging (DWI). Materials and Methods: A study of 96 breasts (35 cancers, 24 benign, and 37 negative) in 48 asymptomatic women was performed between June 2019 and October 2020. High-resolution DWI with b-values of 0, 800, and 1200 sec/mm² was performed using a 3.0-T system. Sixteen breast radiologists independently reviewed the DWI, apparent diffusion coefficient maps, and T1-weighted MRI scans and recorded the Breast Imaging Reporting and Data System (BI-RADS) category for each breast. After a 2-h training session and a 5-month washout period, they re-evaluated the BI-RADS categories. A BI-RADS category of 4 (lesions with at least two suspicious criteria) or 5 (more than two suspicious criteria) was considered positive. The per-breast diagnostic performance of each reader was compared between the first and second reviews. Inter-reader agreement was evaluated using a multi-rater κ analysis and intraclass correlation coefficient (ICC). Results: Before training, the mean sensitivity, specificity, and accuracy of the 16 readers were 70.7% (95% confidence interval [CI]: 59.4-79.9), 90.8% (95% CI: 85.6-94.2), and 83.5% (95% CI: 78.6-87.4), respectively. After training, significant improvements in specificity (95.2%; 95% CI: 90.8-97.5; P = 0.001) and accuracy (85.9%; 95% CI: 80.9-89.8; P = 0.01) were observed, but no difference in sensitivity (69.8%; 95% CI: 58.1-79.4; P = 0.58) was observed. Regarding inter-reader agreement, the κ values were 0.57 (95% CI: 0.52-0.63) before training and 0.68 (95% CI: 0.62-0.74) after training, with a difference of 0.11 (95% CI: 0.02-0.18; P = 0.01). The ICC was 0.73 (95% CI: 0.69-0.74) before training and 0.79 (95% CI: 0.76-0.80) after training (P = 0.002). Conclusion: Brief reader training improved the performance and agreement of interpretations by breast radiologists using unenhanced MRI with DWI.

• Journal of the Korean Society of Radiology
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• v.84 no.5
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• pp.1094-1109
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• 2023

Purpose To investigate whether CT-based tumor regression grade (ctTRG) can be used to predict the response to neoadjuvant chemotherapy (NAC) in colon cancer. Materials and Methods A total of 53 patients were enrolled. Two radiologists independently assessed the ctTRG using the length, thickness, layer pattern, and luminal and extraluminal appearance of the tumor. Changes in tumor volume were also analyzed using the 3D Slicer software. We evaluated the association between pathologic TRG (pTRG) and ctTRG. Patients with Rödel's TRG of 2, 3, or 4 were classified as responders. In terms of predicting responder and pathologic complete remission (pCR), receiver operating characteristic was compared between ctTRG and tumor volume change. Results There was a moderate correlation between ctTRG and pTRG (ρ = -0.540, p < 0.001), and the interobserver agreement was substantial (weighted κ = 0.672). In the prediction of responder, there was no significant difference between ctTRG and volumetry (Az = 0.749, criterion: ctTRG ≤ 3 for ctTRG, Az = 0.794, criterion: ≤ -27.1% for volume, p = 0.53). Moreover, there was no significant difference between the two methods in predicting pCR (p = 0.447). Conclusion ctTRG might predict the response to NAC in colon cancer. The diagnostic performance of ctTRG was comparable to that of CT volumetry.