• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• 한국유통학회지:유통연구
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• 제15권3호
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• pp.111-137
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• 2010

본 연구는 서비스 시장에서의 지각된 품질과 개인가치간의 인과적 관계 및 고객의 인지욕구에 따른 온 오프라인상의 조절효과에 대해 실증분석하였으며 이를 통해 개인가치에 대한 서비스 전략과 마케팅 관리의 중요성을 제시하고 있다. 서비스 시장에서 서비스 제공자와 구매자간의 장기적 거래관계의 중요성이 크게 부각됨에 따라 관계구축 및 강화에 매우 중요한 역할을 하는 개인가치에 관한 연구는 학계뿐만 아니라 실무적으로도 고객관계관리의 관점에서 시사하는 바가 크다고 할 수 있다. 실증분석을 위해 대형마트(할인점)와 인터넷 쇼핑몰을 이용하는 고객을 대상으로 설문을 통해 데이터를 수집하였으며 온 오프라인의 비교분석을 통한 차이검증을 위한 인과적 구성모델에 대해 구조방정식 모델분석을 통해 가설검증하였다. 구성모델에 대한 분석결과 물리적 환경, 상호작용 품질, 그리고 결과품질로 구성된 지각된 품질은 안정적 삶, 사회적 인식, 사회적 통합으로 구성된 서비스 개인가치에 통계적으로 매우 유의한 정(+)의 영향을 미치는 것으로 나타났으며 집단간 차이효과분석을 통해서도 온 오프라인에 따른 조정효과는 온라인에서보다는 오프라인에서 더 유의한 것으로 나타났다. 그리고 온라인상에서의 서비스에 대한 인지욕구가 높을 때보다는 오프라인상에서의 서비스에 대한 인지욕구가 높을 때 개인가치에 더 유의한 영향을 미치는 것으로 나타났다. 마지막으로 본 연구의 구성모델에 대한 적합도 역시 수용할만한 수준인 것으로 나타났다.

• 항공우주정책ㆍ법학회지
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• 제32권1호
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• pp.83-138
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• 2017

한 중 FTA가 2015년 12월 20일 발효되었고, 우리나라 제1위의 교역상대국인 중국과의 FTA로서 발효된 후 1년이 경과하였다. 따라서 본 연구에서는 한국과 중국 간 항공운송 교역 동향을 살펴보고, 한 중 FTA의 항공운송서비스 부문에 대한 양허내용을 검토하고, 항공운송 부문에 미치는 영향을 분석하며, 이에 대응하기 위한 우리나라 항공정책의 방향을 도출하여 제시하고자 한다. 2016년 한 중 간 항공운송 교역 동향을 살펴보면, 대중국 항공운송 수출액은 전년대비 9.3% 감소한 400.3억 달러로서, 대중국 전체 수출액의 32.2%를 차지하고 있다. 대중국 항공운송 수입액은 전년대비 9.1% 감소한 242.6억 달러로서, 대중국 전체 수입액의 27.7%를 차지하고 있다. 한 중 FTA의 항공운송서비스 부문 양허내용을 검토해 보면, 중국은 한 중 FTA 협정문 제8장 부속서 중국의 양허표에서 항공운송서비스 분야의 항공기 보수 및 유지 서비스, 컴퓨터 예약시스템(CRS)서비스에 대하여 시장접근과 내국민대우에 대한 제한을 두고 양허하였다. 한국은 한 중 FTA 협정문 제8장 부속서 한국의 양허표에서 항공운송서비스 분야의 컴퓨터 예약시스템서비스, 항공운송서비스의 판매 및 마케팅, 항공기 유지 및 보수 서비스에 대하여 시장접근과 내국민대우에 대한 제한을 두지 않고 양허하였다. 한 중 FTA가 항공운송 부문에 미치는 영향을 분석해 보면, 항공여객시장에 미친 영향으로, 2016년 국제선 중국노선 도착여객은 996만 명으로 전년대비 20.6% 증가하였고, 출발여객은 990만 명으로 전년대비 34.8% 증가하였다. 항공화물시장에 미친 영향으로, 2016년 대중국 항공화물 수출물동량은 105,220.2톤으로 전년대비 6.6% 증가하였고, 수입물동량은 133,750.9톤으로 전년대비 12.3% 증가하였다. 대중국 수출 항공화물 주요품목가운데 한 중 FTA 협정문 중국 관세양허표 상 수혜품목의 수출물동량이 증가하였고, 대중국 수입항공화물 주요품목가운데 한 중 FTA 한국 관세양허표 상 수혜품목의 수입물 동량이 증가하였다. 항공물류시장에 미친 영향으로 2016년 국내 포워더의 대중국 수출 항공화물 취급실적은 119,618톤으로 전년대비 2.1% 감소하였고, 대중국 수입 항공화물 취급실적은 79,430톤으로 전년대비 4.4% 감소하였다. 2016년 대중국 역직구(전자상거래 수출) 수출금액은 1억 916만 달러로 전년대비 27.7% 증가하였고, 대중국직구(전자상거래 수입) 수입금액은 8,943만 달러로 전년대비 72% 증가하였다. 한 중 FTA에 따른 우리나라 항공정책의 방향을 도출하여 제시해 보면 다음과 같다. 첫째 한 중 간에 항공자유화를 추진한다. 한국과 중국은 2006년 6월 중국의 산동성과 해남성에 대해 여객 및 화물 제3자유 및 제4자유를 범위로 하는 항공자유화 협정을 체결하였으며, 2010년 하계부터 양국 간 항공운항을 전면 자유화하기로 합의하였으나, 중국 측에서 항공협정 양해각서 문안의 해석 상 이의를 제기함에 따라 추가적인 항공자유화는 이루어지지 못하고 있다. 한 중 FTA와는 별도의 항공회담을 통해 중국과의 점진적 선별적 항공여객시장 및 화물시장의 항공자유화를 추진해야 할 것이다. 둘째 항공운송산업 및 공항의 경쟁력을 확보해야 한다. 한국의 항공운송산업 경쟁력의 강화방안으로 국적항공사 경쟁력의 강화를 위한 지원체계를 마련하며, 국적항공사의 새로운 공정경쟁의 기반을 조성하며, 국익기반 전략적 네트워크를 구축해야 할 것이다. 한국의 공항 특히 인천공항의 경쟁력 강화방안으로 항공수요 창출 네트워크 경쟁력을 강화하며, 공항시설과 안전인프라를 확충하며, 공항을 통한 새로운 부가가치를 창출하며, 세계 1위 수준의 서비스 수준을 유지해야 할 것이다. 셋째 항공물류업의 경쟁력을 강화한다. 한국의 항공물류업 경쟁력의 강화방안으로 산업트렌드 변화에 대응한 고부가가치 물류산업의 육성전략으로 신규 물류시장을 개척하며, 물류인프라를 확충하며, 물류전문인력을 양성한다. 또한 글로벌 물류시장의 확대전략으로 물류기업의 해외투자 지원체계를 구축하며, 글로벌 운송네트워크 확장에 따른 국제협력 강화 및 인프라를 확보해야 할 것이다. 인천공항 항공물류 경쟁력의 강화방안으로 기업의 물류단지 입주수요에 대응하며, 신 성장 화물분야의 비교우위 선점을 하며, 물류허브 역량을 강화하며, 공항 내 화물처리속도 경쟁력을 향상해야 할 것이다. 넷째 한 중 FTA 후속 협상에서 항공운송서비스 분야의 추가 개방을 확보한다. 한 중 FTA 발효 후 2년 내에 개시될 후속 협상에서 중국 측 항공운송서비스 분야의 양허수준이 중국의 기체결 FTA에 비해 미흡한 분야인 컴퓨터 예약시스템서비스 및 항공기 보수 및 유지 서비스의 양허에 대해 추가 개방을 요구하는 것이 필요할 것이다. 결론적으로 한 중 FTA가 우리나라 항공여객시장, 항공화물시장 및 항공물류시장에 미치는 영향에 대응하여 추진해야 할 정책과제로서, 국적항공사의 경쟁력과 국민 편익을 고려하여 중국과의 점진적 선별적 항공자유화를 추진하며, 항공운송산업과 공항의 경쟁력 강화를 위한 지원체계를 구축하며, 물류기업들의 항공물류시장 진출을 확대하며, 중국 측 양허수준이 낮은 항공운송서비스 분야의 추가 개방 요구를 위한 준비를 해야 할 것이다.

• Asia pacific journal of information systems
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• 제20권2호
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• pp.63-86
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• 2010

Personalized services directly and indirectly acquire personal data, in part, to provide customers with higher-value services that are specifically context-relevant (such as place and time). Information technologies continue to mature and develop, providing greatly improved performance. Sensory networks and intelligent software can now obtain context data, and that is the cornerstone for providing personalized, context-specific services. Yet, the danger of overflowing personal information is increasing because the data retrieved by the sensors usually contains privacy information. Various technical characteristics of context-aware applications have more troubling implications for information privacy. In parallel with increasing use of context for service personalization, information privacy concerns have also increased such as an unrestricted availability of context information. Those privacy concerns are consistently regarded as a critical issue facing context-aware personalized service success. The entire field of information privacy is growing as an important area of research, with many new definitions and terminologies, because of a need for a better understanding of information privacy concepts. Especially, it requires that the factors of information privacy should be revised according to the characteristics of new technologies. However, previous information privacy factors of context-aware applications have at least two shortcomings. First, there has been little overview of the technology characteristics of context-aware computing. Existing studies have only focused on a small subset of the technical characteristics of context-aware computing. Therefore, there has not been a mutually exclusive set of factors that uniquely and completely describe information privacy on context-aware applications. Second, user survey has been widely used to identify factors of information privacy in most studies despite the limitation of users' knowledge and experiences about context-aware computing technology. To date, since context-aware services have not been widely deployed on a commercial scale yet, only very few people have prior experiences with context-aware personalized services. It is difficult to build users' knowledge about context-aware technology even by increasing their understanding in various ways: scenarios, pictures, flash animation, etc. Nevertheless, conducting a survey, assuming that the participants have sufficient experience or understanding about the technologies shown in the survey, may not be absolutely valid. Moreover, some surveys are based solely on simplifying and hence unrealistic assumptions (e.g., they only consider location information as a context data). A better understanding of information privacy concern in context-aware personalized services is highly needed. Hence, the purpose of this paper is to identify a generic set of factors for elemental information privacy concern in context-aware personalized services and to develop a rank-order list of information privacy concern factors. We consider overall technology characteristics to establish a mutually exclusive set of factors. A Delphi survey, a rigorous data collection method, was deployed to obtain a reliable opinion from the experts and to produce a rank-order list. It, therefore, lends itself well to obtaining a set of universal factors of information privacy concern and its priority. An international panel of researchers and practitioners who have the expertise in privacy and context-aware system fields were involved in our research. Delphi rounds formatting will faithfully follow the procedure for the Delphi study proposed by Okoli and Pawlowski. This will involve three general rounds: (1) brainstorming for important factors; (2) narrowing down the original list to the most important ones; and (3) ranking the list of important factors. For this round only, experts were treated as individuals, not panels. Adapted from Okoli and Pawlowski, we outlined the process of administrating the study. We performed three rounds. In the first and second rounds of the Delphi questionnaire, we gathered a set of exclusive factors for information privacy concern in context-aware personalized services. The respondents were asked to provide at least five main factors for the most appropriate understanding of the information privacy concern in the first round. To do so, some of the main factors found in the literature were presented to the participants. The second round of the questionnaire discussed the main factor provided in the first round, fleshed out with relevant sub-factors. Respondents were then requested to evaluate each sub factor's suitability against the corresponding main factors to determine the final sub-factors from the candidate factors. The sub-factors were found from the literature survey. Final factors selected by over 50% of experts. In the third round, a list of factors with corresponding questions was provided, and the respondents were requested to assess the importance of each main factor and its corresponding sub factors. Finally, we calculated the mean rank of each item to make a final result. While analyzing the data, we focused on group consensus rather than individual insistence. To do so, a concordance analysis, which measures the consistency of the experts' responses over successive rounds of the Delphi, was adopted during the survey process. As a result, experts reported that context data collection and high identifiable level of identical data are the most important factor in the main factors and sub factors, respectively. Additional important sub-factors included diverse types of context data collected, tracking and recording functionalities, and embedded and disappeared sensor devices. The average score of each factor is very useful for future context-aware personalized service development in the view of the information privacy. The final factors have the following differences comparing to those proposed in other studies. First, the concern factors differ from existing studies, which are based on privacy issues that may occur during the lifecycle of acquired user information. However, our study helped to clarify these sometimes vague issues by determining which privacy concern issues are viable based on specific technical characteristics in context-aware personalized services. Since a context-aware service differs in its technical characteristics compared to other services, we selected specific characteristics that had a higher potential to increase user's privacy concerns. Secondly, this study considered privacy issues in terms of service delivery and display that were almost overlooked in existing studies by introducing IPOS as the factor division. Lastly, in each factor, it correlated the level of importance with professionals' opinions as to what extent users have privacy concerns. The reason that it did not select the traditional method questionnaire at that time is that context-aware personalized service considered the absolute lack in understanding and experience of users with new technology. For understanding users' privacy concerns, professionals in the Delphi questionnaire process selected context data collection, tracking and recording, and sensory network as the most important factors among technological characteristics of context-aware personalized services. In the creation of a context-aware personalized services, this study demonstrates the importance and relevance of determining an optimal methodology, and which technologies and in what sequence are needed, to acquire what types of users' context information. Most studies focus on which services and systems should be provided and developed by utilizing context information on the supposition, along with the development of context-aware technology. However, the results in this study show that, in terms of users' privacy, it is necessary to pay greater attention to the activities that acquire context information. To inspect the results in the evaluation of sub factor, additional studies would be necessary for approaches on reducing users' privacy concerns toward technological characteristics such as highly identifiable level of identical data, diverse types of context data collected, tracking and recording functionality, embedded and disappearing sensor devices. The factor ranked the next highest level of importance after input is a context-aware service delivery that is related to output. The results show that delivery and display showing services to users in a context-aware personalized services toward the anywhere-anytime-any device concept have been regarded as even more important than in previous computing environment. Considering the concern factors to develop context aware personalized services will help to increase service success rate and hopefully user acceptance for those services. Our future work will be to adopt these factors for qualifying context aware service development projects such as u-city development projects in terms of service quality and hence user acceptance.

• Radiation Oncology Journal
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• 제25권2호
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• pp.79-92
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• 2007

목 적: 전국 병원의 방사선종양학과에서 식도암으로 방사선 치료를 받은 환자들을 각 병원으로부터 입력 받아 세부 항목별로 분석하여 식도암 환자들의 구성과 특징을 파악하여 범국가적인 자료로 활용하는 한편 치료방침을 분석하여 향후 적절한 치료를 위한 가이드라인으로 삼고자 하였다. 대상 및 방법: 전국 병원의 방사선종양학과에서 1998년과 1999년의 2년간에 걸쳐 식도암으로 확진된 246명을 대상으로 하였다. 연간 400명 미만의 방사선치료 신환자 발생병원들을 A군, 400명 이상 900명 미만의 병원들을 B군, 그리고 900명 이상 신환자가 발생하는 병원을 C군으로 분류하여 최종적으로 A군에서 12병원, B군에서 8개 병원, 그리고 C군에서 3개의 병원이 연구에 참여하였다. 이미 개발된 Web-based Korean PCS system을 통해 각 병원으로부터 직접 자료를 입력 받아 이를 세부 항목별로 분석하였고 통계적 처리는 SPSS version 12.0.1을 사용하고 범주형 자료는 Chi-squared test를 사용하였고 연속변수는 ANOVA, Kruskal-Wallis test를 적용하였다. 결 과: 입력된 환자들의 성별 분포는 남자 224명(91.1%), 여자 22명(8.9%)이었고 연령별 중앙값은 62세 전후였다. 진단 및 병기결정을 위한 검사로는 식도 촬영술(228명, 92.7%), 식도내시경(226명, 91.9%) 및 흉부 식도 CT 스캔(238명, 96.7%)을 주로 시행하였다. 편평상피암이 대종을 이루어 237명(96.3%)의 환자에서 관찰되었고 중흉부식도(mid-thoracic esophagus)에서 발생한 식도암이 가장 많았다(110명, 44.7%). 임상 병기는 III기가 과반수 이상을 차지하였다(135명, 54.9%). 방사선 치료만 받은 경우는 57명(23.2%), 방사선 치료와 수술을 병용한 경우는 전체의 15%인 37명, 항암약물 치료와 방사선 치료를 병용한 경우는 123명(50%)이었다. 수술과 방사선 치료를 병행한 경우 전례에서 수술을 먼저 시행한 후 방사선 치료를 하였다. 항암치료를 방사선치료와 병행한 경우 반수 이상에서(70명, 56.9%) 동시항암방사선 치료를 시행하였고 31명(25.2%)에서 항암치료 후 방사선치료를 또는 항암요법 단독치료 후 동시항암방사선치료를(13명, 10.6%) 시행하였다. 방사선 치료는 6 MV (116명, 47.2%)와 10 MV (87명, 35.4%)의 X-ray가 대종을 이루었다. 방사선 치료 시 조사야는 longitudinal margin의 경우 중앙값은 7.0 cm이었지만 각 군별로 현저한 차이가 있었다(A군; 5.5 cm, B군; 8.0 cm, C군; 14.0 cm). 계획용 CT를 사용하지 않고 고식적인 AP/PA 조사야를 사용하여 치료한 경우가 대부분이었는데(206명, 83.7%) 이 때 방사선 조사량의 중앙값은 3,600 cGy이었다. 이후 추가 방사선 치료 시 계획용 CT를 사용하지 않고 2-oblique fields 사용하여 치료한 경우가 87명(35.4%)이었는데 방사선 조사량의 중앙값은 1,800 cGy이었다. 전 환자에서 1일 1회 180 cGy로 치료하였다. 전 환자에서 조사된 총 방사선량의 중앙값은 5,580 cGy이었다. 수술 후 방사선 치료를 시행한 경우 중앙값은 5,040 cGy이었고 수술을 받지 않은 환자 중앙값은 5,940 cGy이었다. 근접조사 방사선 치료는 총 34명(13.8%)에서 시행되었고, 전 환자에서 high dose rate Iridium-192를 사용하였다. 조사범위는 종양에서 longitudinal margin의 중앙값은 1 cm, prescribed isodose curve에서 axial length의 평균값은 8.25 cm, 폭은 2 cm, 그리고 전후 폭의 중앙값도 2 cm이었다. Fraction size의 중앙값은 300 cGy이었는데 B군의 경우는 500 cGy이었다. 총 분할 횟수는 $3{\sim}4$회가 대부분이었다. 한편, 방사선 치료 중 발생한 급성 부작용은 식도염이 가장 많았는데 전체 246명 환자 중 155명(63.0%)에서 발생하였다. 결 론: 전국 23개 병원의 식도암 환자 치료 Data를 분석해 본 결과 대부분의 병원에서 환자의 특징과 진단 및 병기 결정 방법, 치료의 유형 등에서 유사한 결과를 보였으며 신환 발생 수에 따른 병원 규모의 차이는 조사 결과에 큰 영향을 미치지 못하였다. 하지만 병원 규모가 클수록 10 MV 이상의 고에너지로 치료하는 경향이 많았으며 3D CT Plan도 병원 규모가 클수록 활용도가 높았다. 조사 야의 면적도 병원 군별로 차이를 보였다. 향후 더 많은 환자를 입력하여 생존율 분석까지 이루어지면 이 연구는 식도암 치료방침의 결정에 중요한 guideline을 제시해 줄 것으로 사료된다.