• 구강회복응용과학지
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• 제29권1호
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• pp.11-21
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• 2013

임플란트 식립 후 상부구조 제작 시기를 결정하기 위해 임플란트 고정체의 골유착과 안정성의 평가는 중요하며 임플란트 안정성이 변화하지 않는 고원(plateau) 현상이 나타나는 시점을 찾는다면 임플란트 저작하중에 안정적인 시기를 판단하는 객관적 지표가 될 수 있다. 본 연구의 목적은 1년간의 전향적인 연구를 통해 골밀도 간 임플란트 안정성 변화를 추적하여 저작하중을 부담하기에 적당한 안정된 시점을 구함으로써 상부구조 제작 시기를 예측하고자 하였다. 총 36명의 환자에게 식립된 67개의 임플란트를 대상으로 식립 직후, 2주, 6주, 10주, 14주, 1년 등 총 6회에 걸쳐 RFA를 시행하여 임플란트 안정성의 변화추이를 골밀도에 따라 비교 분석하였다. 식립 직후와 각 치유기간 동안의 ISQ값 비교에서 주관적으로 평가된 골질군 간에는 식립 10주와 14주에서 임플란트 안정성에 차이가 있었으나(P<0.01), 객관적으로 평가된 골질군 간에는 임플란트 안정성 변화에 차이가 없었다(P>0.05). 본 연구의 1년간의 추적조사에서 ISQ값의 변화는 $y=y_0+a{\times}\{1-\exp(-b{\times}x)\}$로 나타낼 수 있었으며, 이를 이용하면 임플란트식립 당시의 ISQ값으로 상부구조 제작 시점을 유추할 수 있다.

• 한국의학물리학회지:의학물리
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• 제16권4호
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• pp.192-201
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• 2005

본 연구에서는 PET/CT 시스템에서 CT 영상을 이용한 감쇠 보정 시 조영제가 PET 영상에 미치는 영향을 관찰하기 위해 팬텀실험과 모의실험을 수행하였다. 다양한 농도로 희석한 조영제를 채운 플라스틱 병을 스티로폼을 이용하여 전신 팬텀 내에 고정시킨 후 투과 영상을 획득하였다 모의실험을 위해 인체 기관 중간을 가진 수학적 방출 맵과 투과 맵을 각각 생성하였다. 조영제의 비균일 증강, 조영제의 다양한 농도 및 분포 크기, 잡음 정도, 영상의 해상도, 재구성 알고리듬, 조영제의 저-감쇠, 그리고 각각 다른 시간상에 대한 조영제의 분포의 차이와 같은 다양한 인자들에 대하여 평가하였다. 팬텀실험으로부터 CT의 Hounsfield 값이 조영제의 농도 및 전압 값에 의존함을 확인할 수 있었다. 모의실험으로부터 조영제가 감쇠 보정한 PET 영상에서 인공산물을 생성하고 영상의 질을 떨어뜨리는 것을 관찰할 수 있었다. 조영제의 영향은 조영제의 농도 및 분포 크기, 잡음 정도, 영상의 해상도 등에 의해 영향을 받는 것으로 나타났다. 본 연구 결과들은 임상적 PET/CT 영상에서 조영제로 인해 발생할 수 있는 잠재적 문제를 충분히 이해하고 이를 고려해야 함을 보여 주었다.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.423-430
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• 2008

Purpose: Computed tomography theoretically should improve detection of foreign bodies and provide more information of adjacent soft tissues. And the CT scanner and PACS program proved to be an excellent instrument for detection and localization of most facial foreign bodies above certain minimum levels of detectability. The severity of injury in penetrating trauma to the face, it is often underestimated by physical examination. Diagnosis of a retained foreign object is always critical. Methods: From March, 2005 to February 2008 a study was done with 200 patients who had facial trauma. Axial and coronal CT images were obtained with a General Electric(Milwaukee, Wis) 9800 CT scanner at 130 kV, 90 mA, with a 2-mm section thickness and a $512{\times}512$ matrix. Results: Axial and coronal CT images at various window widths should be used as the first imaging modality to detect facial foreign bodies. The attenuation coefficients for the metallic and nonmetallic foreign bodies ranged from -437 to +3071 HU. As a general rule, metallic foreign bodies produced more Hounsfield artifacts than nonmetallic foreign bodies, thus providing a clue to their composition. All of the metallic foreign bodies were represented by a single peak and had a maximum attenuation coefficient of +3071 HU. Of the nonmetallic foreign bodies, glass had an attenuation coefficient that ranged from +105 to +2039, while plastic had a much lower coefficient that ranged from -62 to -35. wood had the lowest range of attenuation coefficients: -491 to -437. Conclusion: The PACS program allows one to distinguish metallic from nonmetallic foreign bodies and to individually identify the specific composition of many nonmetallic foreign bodies. This program does not, however, allow identification of the specific composition of a metallic foreign body. We recommend this type of software program for CT scanning of any patient with an injury to the face in which a foreign body is suspected.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.380-384
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• 2010

Purpose: Distinguishing different types of implants and assessing the position and size of implants by radiologic exam after orbital wall reconstruction is important in determining the surgery outcome and forecasting prognosis. We observed time-dependent density changes in three types of implants (porous polyethylene, resorbing plate and titanium mesh plate) by performing facial bone CT after orbital wall reconstructions. Methods: A total of 32 patients, who had underwent orbital wall fracture surgery from October 2006 to March 2009 and received facial bone CT as outpatients at 1 postoperative year were included in the study. Follow-up facial bone CT was performed on the patients pre- operatively, 1 month post-operatively, and 1 year post-operatively to observe the status of the orbital implants. Medpor $^{(R)}$ (Porex Surgical, Inc., Newnan, Ga.) was used as porous polyethylene and followed-up in 14 cases; for resorbing plate, Synthes mesh plate (Synthes, Oberdorf, Switzerland) was used in the reconstruction, and followed-up in 11 cases; and titanium mesh plate usage was followed-up in 7 cases. Computed tomographic scan (CT) and water's view were done for radiography, and hounsfield unit (HU) was used to compare density of those facial bone CT. Wilcoxon signed rank test was applied to statistically verify measurement difference in each group of hounsfield units. Results: Facial bone CT examination performed in 1 month post-operative showed that the density of porous polyethylene, resorbing plate and titanium mesh plate were -42.07, 105.67 and 539.48 on average, respectively. Among the three types of implants, titanium mesh plate showed the highest density due to its radiopaque feature. Following up the density of three types of implants in CT during 1 year after the orbital wall fracture surgery, the density of porous polyethylene increased in 10.52 House Field Units and the resorbing plate was decreased in 26.87 HouseField Units. There were no significant differences between densities in 1 month post-operatively and 1 year post-operatively in each group ($p{\geq}0.05$). Conclusion: We performed facial bone CT on patients with orbital fractures during follow-up period, distinguishing the types of implants by the different concentration of implant density, and the densities showed little change even at 1 year post-operative. To observe how implant densities change in facial bone CT, further studies with longer follow-up periods should be carried out.

• 한국의학물리학회지:의학물리
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• 제23권4호
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• pp.269-278
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• 2012

두경부암 방사선치료 시 공동 경계면 및 주변 치료 부위의 선량 균일도 향상을 위하여 조직 등가의 thermoplastic 구강 보상체를 개발하였다. Thermoplastic의 유용성 평가를 위해, 기존에 사용해 오던 치과용 인상재료인 paraffin, alginate, 그리고 putty로 제작한 각 구강 보상체의 물성 및 선량 분포 향상도를 비교하였다. 물성 평가에는 강도 평가(압축 실험, 낙하 실험)와 자연변형도(시간에 따른 체적 변화) 평가를 수행하였으며, 개발한 선량 검증용 팬톰에 삽입한 유리선량계와 Gafchromic EBT2 필름을 이용하여 표면선량, 공동 경계면 선량 및 빔 측면도를 측정하여 전달 선량을 평가하였다. 두 달간 각 구강 보상체의 자연변형도 평가하였을 때, alginate는 수분증발로 최대 80% 체적 변화를 보였으나, thermoplastic을 포함한 나머지 조직 등가 물질은 체적 변화가 3% 미만으로 나타났다. 강도 평가 중 5회 반복한 1.5 m 높이의 자유 낙하실험에서 paraffin은 충격에 의하여 파손이 발생되었으나, thermoplastic은 낙하에 의한 파손이 발생되지 않았으며, 압축 강도 실험에서도 paraffin에 비하여 8배 이상의 높은 힘에서도 파손되지 않았다. 유리선량계를 이용한 선량 검증 결과, 1문 조사 시 조직등가[약 80 HU (Hounsfield Unit)]의 thermoplastic은 동일한 처방 선량 전달 시 약 1,000 HU 이상의 값을 나타내는 putty에 비해 4% 낮은 출력계수(monitor unit) 전달로 약 4.9%의 낮은 표면 선량을 전달하였다. 또한 빔 입사 방향을 기준으로 할 때, 구강 통과 후 경계면의 빔 측면도에서 선량 균일도 평가를 위해 측정한 조사영역 편평도는 air, thermoplastic, putty에서 각각 11.41, 3.98, 4.30으로 나타났다. Thermoplastic 구강 보상체는 조직 등가 물질로 기존에 사용해오던 구강 보상체에 비하여 강도가 높고 물질 변형 확률이 적으며, 구강을 포함을 경계면 및 주변 부위에 균일한 선량 분포를 형성할 수 있으므로 균일한 처방 선량 전달 및 피부 선량 감소가 가능하다.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.86-90
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• 2014

Objective : The spot sign is related with the risk of hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, not all spot sign positive patients undergo hematoma expansion. Thus, the present study investigates the specific factors enhancing the spot sign positivity in predicting hematoma expansion. Methods : We retrospectively studied 316 consecutive patients who presented between March 2009 to March 2011 with primary ICH and whose initial computed tomography brain angiography (CTA) was performed at our Emergency Department. Of these patients, 47 primary ICH patients presented spot signs in their CTA. We classified these 47 patients into two groups based on the presence of hematoma expansion then analyzed them with the following factors : gender, age, initial systolic blood pressure, history of anti-platelet therapy, volume and location of hematoma, time interval from symptom onset to initial CTA, spot sign number, axial dimension, and Hounsfield Unit (HU) of spot signs. Results : Of the 47 spot sign positive patients, hematoma expansion occurred in 26 patients (55.3%) while the remaining 21 (44.7%) showed no expansion. The time intervals from symptom onset to initial CTA were $2.42{\pm}1.24$ hours and $3.69{\pm}2.57$ hours for expansion and no expansion, respectively (p=0.031). The HU of spot signs were $192.12{\pm}45.97$ and $151.10{\pm}25.14$ for expansion and no expansion, respectively (p=0.001). Conclusions : The conditions of shorter time from symptom onset to initial CTA and higher HU of spot signs are the emphasizing factors for predicting hematoma expansion in spot sign positive patients.

• 대한방사선치료학회지
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• 제14권1호
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• pp.15-22
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• 2002

1. 목적 : 방사선종양학과에서 3차원 치료계획용 전산화단층촬영 시 조영제 주입율에 따른 CT 값(hounsfield unit, H.U) 변화를 정량적으로 평가하여 최적의 영상증강효과 및 방사선치료계획을 위한 기초 프로토콜을 제시하고자 한다. 2. 대상 및 방법: 연세암센터 방사선종양학과에서 3차원 치료계획용 전산화단층촬영을 시행한 상복부(폐암)환자 20명을 대상으로 하였다. 조영제 양(130mL)은 일정하게 고정하였고, 조영제주입율을 1.2, 1.5, 2.0 mL/sec로 변화시켜가며 조영제를 주입하면서 3차원 방사선치료계획영상에 적합한 조영제주입율(contrast flow rate)과 지연시간(delay time)을 도출하였고, CT 값을 측정하여 정량적 평가를 시행하였다. 관심부위는 폐동맥과 폐정맥으로 하였다. 그리고, 환자 기본정보, 조영제주입율, H.U 등 영상증강에 영향을 미치는 인자들을 통계처리 프로그램인 SPSS를 이용하여 최적의 영상을 획득할 수 있는 기초 프로토콜을 작성하였다. 3. 결과 : 폐암환자의 전산화단층촬영영상 획득 시 3차원 방사선치료계획에 적합한 영상을 얻을 수 있는 조건중 조영제주입율은 1.5 mL/sec 이었고, 지연시간은 $60{\sim}70$초이었다. 통계처리를 수행한 결과 환자의 기본정보 및 조영제주입율 등이 영상증강에 영향을 미치는 인자임을 알 수 있었다. 본 연구에서 작성한 기초 프로토콜을 이용하여 3차원 방사선치료계획 시 정확한 종양 및 정상조직 설정이 용이하게 되어 방사선치료 효율을 극대화 할 수 있었다. 4. 결론 : 방사선종양학과에서 3차원 치료계획용 전산화단층촬영 시 사용할 수 있는 기초적인 영상획득 프로토콜을 도출하였고, 향후 더 많은 임상경험과 정량적 평가가 수반된다면 임상에 적극 사용할 수 있을 것이라 사료된다.

• 한국멀티미디어학회논문지
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• 제9권12호
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• pp.1588-1595
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• 2006

In this paper, we proposed a liver extracting procedure for computer aided liver diagnosis system. Extraction of liver region in an abdominal CT image is difficult due to interferences of other organs. For this reason, liver region is extracted in a region of interest(ROI). ROI is selected by the window which can measure the distribution of Hounsfield Unit(HU) value of liver region in an abdominal CT image. The distribution is measured by an existential probability of HU value of lever region in the window. If the probability of any window is over 50%, the center point of the window would be assigned to ROI. Actually, liver region is not clearly discerned from the adjacent organs like muscle, spleen, and pancreas in an abdominal CT image. Liver region is extracted by the watershed segmentation algorithm which is effective in this situation. Because it is very sensitive to the slight valiance of contrast, it generally produces over segmentation regions. Therefore these regions are required to merge into the significant regions for optimal segmentation. Finally, a liver region can be selected and extracted by prier information based on anatomic information.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.1609-1614
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• 2013

Objective: To evaluate the effect of intravenous contrast on dose calculation in radiation treatment planning for oesophageal cancer. Methods: A total of 22 intravein-contrasted patients with oesophageal cancer were included. The Hounsfield unit (HU) value of the enhanced blood stream in thoracic great vessels and heart was overridden with 45 HU to simulate the non-contrast CT image, and 145 HU, 245 HU, 345 HU, and 445 HU to model the different contrast-enhanced scenarios. 1000 HU and -1000 HU were used to evaluate two non-physiologic extreme scenarios. Variation in dose distribution of the different scenarios was calculated to quantify the effect of contrast enhancement. Results: In the contrast-enhanced scenarios, the mean variation in dose for planning target volume (PTV) was less than 1.0%, and those for the total lung and spinal cord were less than 0.5%. When the HU value of the blood stream exceeded 245 the average variation exceeded 1.0% for the heart V40. In the non-physiologic extreme scenarios, the dose variation of PTV was less than 1.0%, while the dose calculations of the organs at risk were greater than 2.0%. Conclusions: The use of contrast agent does not significantly influence dose calculation of PTV, lung and spinal cord. However, it does have influence on dose accuracy for heart.

• 한국의학물리학회지:의학물리
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• 제30권4호
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• pp.160-166
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• 2019

This study examined the clinical use of two newly installed computed tomography (CT) simulators in the Department of Radiation Oncology. The accreditation procedure was performed by the Korean Institute for Accreditation of Medical Imaging. An Xi R/F dosimeter was used to measure the CT dose index for each plug of the CT dose index phantom. Image qualities such as the Hounsfield unit (HU) value of water, noise level, homogeneity, existence of artifacts, spatial resolution, contrast, and slice thickness were evaluated by scanning a CT performance phantom. All test items were evaluated as to whether they were within the required tolerance level. CT calibration curves-the relationship between CT number and relative electron density-were obtained for dose calculations in the treatment planning system. The positional accuracy of the lasers was also evaluated. The volume CT dose indices for the head phantom were 22.26 mGy and 23.70 mGy, and those for body phantom were 12.30 mGy and 12.99 mGy for the first and second CT simulators, respectively. HU accuracy, noise, and homogeneity for the first CT simulator were -0.2 HU, 4.9 HU, and 0.69 HU, respectively, while those for second CT simulator were 1.9 HU, 4.9 HU, and 0.70 HU, respectively. Five air-filled holes with a diameter of 1.00 mm were used for assessment of spatial resolution and a low contrast object with a diameter of 6.4 mm was clearly discernible by both CT scanners. Both CT simulators exhibited comparable performance and are acceptable for clinical use.