• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.131-136
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• 2013

Purpose: Quantitative comparative evaluation of the difference in eye lens absorbed dose when measured by MVCT and kV-CBCT, though such a dose was not included in the original IMRT treatment plan for the nasopharyngeal cancer patient. Materials and Methods: We used CT (Lightspeed Ultra 16, General Electric, USA) against an Anderson rando phantom (Alderson Research Laboratories Inc, USA) and established the plan for tomotherapy treatment (Tomotherapy, Inc, USA) and linear accelerator treatment (Pinnacle 8.0, Philips Medicle System) for the achieved CT images on the same condition with the nasopharyngeal cancer patient treatment plan. Then, align the ther-moluminescence dosimeter (TLD100 Harshaw, USA) with the eye lens, shot the lens with Tomotherapy MVCT under 3 conditions (Fine, Normal, and Coarse), and shot both lenses with kV-CBCT under 2 conditions (Low Dose Head and Standard Dose Head) 3 times each. Results: When we analyzed the eye lens absorbed dose according to MVCT and kV-CBCT images by using both Tomotherapy and Pinacle 8.0, we achieved the following result; According to Tomotherapy MVCT, RT 0.8257 cGy in the Coarse mode, LT 0.8137 cGy, RT 1.089 cGy and LT 1.188 cGy in the Normal mode, and RT 2.154 cGy and LT 2.082 cGy in the Fine mode. According to Pinacle 8.0 kV-CBCT, RT 0.2875 cGy and LT 0.1676 cGy in the Standard Dose mode and RT 0.1648 cGy and LT 0.1212 cGy in the Low-Dose mode. In short, the MVCT result was significantly different from that of kV-CBCT, up to 20 times. Conclusion: We think kV-CBCT is more effective for reducing the amount of radiation which a patient is receiving during intensity modulated radiation treatment for other purposes than treatment than MVCT, when we consider the absorbed dose only from the viewpoint of image-guided radiation therapy. Besides, we understood the amount of radiation is too sensitive to the shooting condition, even when we use the same equipment.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.57-64
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• 2016

Purpose : To evaluate the results of absorbed and effective doses using CBCT and 4D-CBCT settings for lung cancer. Materials and Methods : This experimental study. Measurements were performed using a Anderson rando phantom with OSLD(optically stimulated luminescent dosimeters). It was performed computed tomography(Lightspeed GE, USA) in order to express the major organs of the human body. Measurements were obtained a mean value is repeated three times each. Evaluations of effective dose and absorbed dose were performed the CL-IX-Thorax mode and Truebeam-Thorax mode CBCT. Additionally, compared Truebeam-Thorax mode CBCT with Truebeam-Thorax mode 4D-CBCT(Four-dimensional Cone Beam Computed Tomography) Results : Average absorbed dose in the CBCT of CL-IX was measured in lung 2.505cGy, heart 2.595cGy, liver 2.145cGy, stomach 1.934cGy, skin 2.233cGy, in case of Truebeam, It was measured lung 1.725cGy, heart 2.034cGy, liver 1.616cGy, stomach 1.470cGy, skin 1.445cGy. In case of 4D-CBCT, It was measured lung 3.849cGy, heart 4.578cGy, liver 3.497cGy, stomach 3.179cGy, skin 3.319cGy Average effective dose, considered tissue weighting and radiation weighting, in the CBCT of CL-IX was measured lung 2.164mSv, heart 2.241mSVv, liver 0.136mSv, stomach 1.668mSv, skin 0.009mSv, in case of Turebeam, it was measured lung 1.725mSv, heart 1.757mSv, liver 0.102mSv, stomach 1.270mSv, skin 0.005mSv, In case of 4D-CBCT, It was measured lung 3.326mSv, heart 3.952mSv, liver 0.223mSv, stomach 2.747mSv, skin 0.013mSv Conclusion : As a result, absorbed dose and effective Dose in the CL-IX than Truebeam was higher about 1.3 times and in the 4D-CBCT Truebeam than CBCT of Truebeam was higher about 2.2times However, a large movement of the patient and respiratory gated radiotherapy may be more accurate treatment in 4D-CBCT. Therefore, it will be appropriate to selectively used.

• The Journal of the Korean bone and joint tumor society
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• v.6 no.1
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• pp.22-29
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• 2000

Purpose : The purpose of the current study was to report the results of curettage and en bloc excision as well as to introduce how to excise the nidus percutaneously with Halo-mill. Material and Methods : Twenty patients(14 men and 6 women) were evaluated, who had operative treatments after diagnosed as osteoid osteoma from March 1990 to January 1998. These patients ranged in age from 7 to 42 years(average: 20.8 years). Locations were 9 femurs, 6 tibias, 2 vertebras, 1 ulna, 1 maxilla and 1 skull. Nine femoral lesions included 5 proximal metaphysis, 2 neck and 2 diaphysis, while 5 tibial lesions included 3 diaphysis, 1 proximal metaphysis and 1 distal metaphysis. We used simple radiography, bone scan, CT and MRI for the accurate diagnosis and localization. As for surgical treatments, while excision and curettage had to need open-exposure of lesion, the percutaneous excision of nidus did not need openexposure : guided Halo-mill into K-wire inserted to nidus under image intensifier. Results : Simple radiography showed that 10 cases had typical nidus and others had only cortical sclerosis. Bone scan was performed at 14 cases and all had hot uptake except one case. We used CT in 10 cases and MRI in 4 cases as diagnostic methods, of which 1 case didn't reveal nidus at CT. Surgical treatment consisted of 6 curettages, 11 excisions, 2 percutaneous excisions with halo-mill and 1 total elbow arthroplasty. We used 7mm sized Halo-mill. During the follow-up period, all patient relieved symptoms and there were no recurrences. All had histologically typical findings except one which had hyperostosis without nidus. Conclusion : Complete removal of the nidus is the most important factor in the treatment. We could excise the nidus percutaneously in 2 cases with the minimal injury to surrounding soft tissues. If we could evaluate the precise location, size of nidus and percutaneous acccesibility, the percutaneous excision of nidus with Halo-mill could be an alternative method as a treatment of osteoid osteoma.

• Radiation Oncology Journal
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• v.24 no.3
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• pp.185-191
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• 2006

[ $\underline{Purpose}$ ]: Standardization quality assurance (QA) program of CyberKnife for suitable circumstances in Korea has not been established. In this research, we investigated the development of QA program for CyberKnife and evaluation of the feasibility under applications. $\underline{Materials\;and\;Methods}$: Considering the feature of constitution for systems and the therapeutic methodology of CyberKnife, the list of quality control (QC) was established and divided dependent on the each period of operations. And then all these developed QC lists were categorized into three groups such as basic QC, delivery specific QC, and patient specific QC based on the each purpose of QA. In order to verify the validity of the established QA program, this QC lists was applied to two CyberKnife centers. The acceptable tolerance was based on the undertaking inspection list from the CyberKnife manufacturer and the QC results during last three years of two CyberKnife centers in Korea. The acquired measurement results were evaluated for the analysis of the current QA status and the verification of the propriety for the developed QA program. $\underline{Results}$: The current QA status of two CyberKnife centers was evaluated from the accuracy of all measurements in relation with application of the established QA program. Each measurement result was verified having a good agreement within the acceptable tolerance limit of the developed QA program. $\underline{Conclusion}$: It is considered that the developed QA program in this research could be established the standardization of QC methods for CyberKnife and confirmed the accuracy and stability for the image-guided stereotactic radiotherapy.

• Investigative Magnetic Resonance Imaging
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• v.17 no.3
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• pp.224-231
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• 2013

Purpose : To evaluate the potential effects of background parenchymal enhancement of MR imaging in diagnosed breast cancer patients on the rate of additional biopsy and resultant cancer yield. Materials and Methods: 322 patients who were diagnosed with breast cancer and had undergone breast MR imaging were included in this study. Two radiologists reviewed the MRI for degree of background parenchymal enhancement and additional suspicious lesions described as BI-RADS category 4 or 5 on radiologic reports. Biopsy was done for these lesions, pathology reports were reviewed to calculate the cancer yield. Results: Background parenchymal enhancement of MR imaging in a total of 322 patients were classified as minimal degree 47.5%, mild degree 28.9%, moderate degree 12.4% and marked degree 11.2%. Among these 332 patients, MR imaging of 70 patients showed additional suspicious malignant lesions described as BI-RADS category 4 or 5, and consequently, 66 patients underwent biopsy. Biopsy rates in those with minimal or mild background parenchymal enhancement and those with moderate and marked background parenchymal enhancement were 19.9% and 22.3% (p-value 0.77) respectively. Cancer yields in those with minimal or mild background parenchymal enhancement and those with moderate and marked background parenchymal enhancement were 6.5% and 5.2% (p value 0.88) respectively. Both these results did not show stastically significant difference between the two groups. Conclusion: The degree of background parenchymal enhancement in MR imaging of breast cancer patients did not significantly impact additional biopsy rates or cancer yields.

• Radiation Oncology Journal
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• v.25 no.4
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• pp.268-277
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• 2007

Purpose: Respiratory motion is a considerable inhibiting factor for precise treatment with stereotactic radiosurgery using the CyberKnife (CK). In this study, we developed a moving phantom to simulate three-dimensional breathing movement and investigated the distortion of dose profiles between the use of a moving phantom and a static phantom. Materials and Methods: The phantom consisted of four pieces of polyethylene; two sheets of Gafchromic film were inserted for dosimetry. Treatment was planned to deliver 30 Gy to virtual tumors of 20, 30, 40, and 50 mm diameters using 104 beams and a single center mode. A specially designed robot produced three-dimensional motion in the right-left, anterior-posterior, and craniocaudal directions of 5, 10 and 20 mm, respectively. Using the optical density of the films as a function of dose, the dose profiles of both static and moving phantoms were measured. Results: The prescribed isodose to cover the virtual tumors on the static phantom were 80% for 20 mm, 84% for 30 mm, 83% for 40 mm and 80% for 50 mm tumors. However, to compensate for the respiratory motion, the minimum isodose levels to cover the moving target were 70% for the $30{\sim}50$ mm diameter tumors and 60% for a 20 mm tumor. For the 20 mm tumor, the gaps between the isodose curves for the static and moving phantoms were 3.2, 3.3, 3.5 and 1.1 mm for the cranial, caudal, right, and left direction, respectively. In the case of the 30 mm tumor, the gaps were 3.9, 4.2, 2.8, 0 mm, respectively. In the case of the 40 mm tumor, the gaps were 4.0, 4.8, 1.1, and 0 mm, respectively. In the case of the 50 mm diameter tumor, the gaps were 3.9, 3.9, 0 and 0 mm, respectively. Conclusion: For a tumor of a 20 mm diameter, the 80% isodose curve can be planned to cover the tumor; a 60% isodose curve will have to be chosen due to the tumor motion. The gap between these 80% and 60% curves is 5 mm. In tumors with diameters of 30, 40 and 50 mm, the whole tumor will be covered if an isodose curve of about 70% is selected, equivalent of placing a respiratory margin of below 5 mm. It was confirmed that during CK treatment for a moving tumor, the range of distortion produced by motion was less than the range of motion itself.

• Sim-seong Yeon-gu
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• v.37 no.2
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• pp.99-148
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• 2022

This study aims at the psychological elucidation of some conscious aspects of the personality of Yi Sun-sin (1545-1598), the Korean national hero, and the unconscious teleologic meanings of his dreams mentioned in Nanjung Ilgi (Diary in War Time) from the viewpoint of analytical psychology of C.G. Jung. Yi Sun-sin was a man of discipline, incorporated with the spirit of Confucian filial piety, hyo (hsiao) and royalty, chung. He was a stern man but with a warm heart. In his diary, Yi Sun-sin poured forth his feelings of suffering, despair, and extreme solicitude caused by slanders of his political opponents, his grief for the loss of mother and son, and his worries about the fate of his country, which the Japanese invaders now plundered. The moon night offered him the opportunity to touch with his inner soul, by reciting poems, playing Korean string, 'Keomungo', and flute. Further, he widened his scope by asking for the answers from the 'Heaven' through divination and dream. Yi Sun-sin's attitude toward his mother who raised the future hero and maternal principles were considered in concern with the Jungian term 'mother complex'. Won Gyun, Yi Sun-sin's rival admiral, who persistently accused Yi Sun-sin of 'slanders,' certainly represents the unconscious shadow image of Yi Sun-sin. The reciprocal 'shadow' projection has intervened in the conflicting relationship between Yi and Won. In concern to the argument for the suicidal death of Yi Sun-sin, the author found no evidence supporting such an argument, No trace of latent suicidal wish was found in his dreams. For Yi Sun-sin, the determination of the life and death depends on Heaven. 32 dreams from the diary and 3 from other historical references were reviewed and analyzed in the Jungian way. Symbols of anima, Self, and individuation process were found. His dream repeatedly suggests that Yi Sun-sin is an extraordinary man chosen by the divine man (神人). In the dream, Yi Sun-sin was a disciple of the divine man receiving instructions on various strategies, and he alone could see the great thing or events. The dream of a beautiful blue and red dragon, whom he was friendly touching, indicates Yi Sun-sin's eligibility for the kingship. Yi Sun-sin seemingly did not aware of this message of the unconscious. Perhaps he sensed something special but did not identify with 'the disciple of gods' and 'royal dragon' in his dream. His modest attitude toward the dream has prevented him from falling into ego inflation. There were warning signals in two dreams that suggested disorders in the dreamer's instinctive feminine drive. Spirits of the dead father and brothers appear in the dream, giving advice or mourning for the death of Sun-sin's mother. Though Yi Sun-sin was a genuine Confucian gentleman, a dream revealed his unconscious drive to destroy the Confucian authoritative 'Persona' by trampling down the cylindrical traditional Korean hat. To the dreams of synchronicity phenomena Yi Sun-sin immediately solves the problem in concrete reality. He understood dreams as valuable messages from the superior entity, for example, the Confucian Heaven (天) or Heaven's Decree (天命). Furthermore, the 'Heaven' presumably arranged for him the way to the national hero and imposed necessary trials upon him. Both his persecutors and advocates of him guided him in the way of a hero. Yi Sun-sin followed his destiny and completed the living myth of the hero. His mother, King Seon-jo, and prime minister Liu Seong Yong, all have contributed to embodying the myth of the hero. Yi Sun-sin died and became god, the divine healer of the nation.

• Tuberculosis and Respiratory Diseases
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• v.54 no.2
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• pp.219-229
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• 2003

Background : The management of thoracic empyema and complicated parapneumonic effusion requires adequate antibiotics use and prompt drainage of infected pleural space. Tube thoracostomy for loculated empyema has low success rate and is also an invasive procedure with potential morbidity. Complications include hemothorax, perforation of intra-abdominal or intra-thoracic organs, diaphragmatic laceration, empyema, pulmonary edema, and Horner's syndrome. Given the potential morbidity of traditional chest tube insertion, use of the image-guided pigtail catheter drainage(PCD) of empyema has been employed. We retrospectively analyzed the medical records of patients with empyema or complicated parapneumonic effusion to determine the efficacy of percutaneous pigtail catheter drainage. Materials and Methods : 45 patients with complicated parapneumonic effusions or empyema were treated at Gil medical center from January 1998 to June, 1999. All were initially given PCD procedure and the following data were collected: clinical symptoms at the time of diagnosis, alcohol and smoking history, the characteristics of pleural effusion, radiologic findings (at the time of catheter insertion, removal and 1 month after catheter removal), the amount of effusion drained for initial 24 hours, the time from catheter insertion to removal and the use of surgical approach. Results : Male gender was more frequent (42 men vs. 3 women), the mean age of the study population was 52(range: 21~74) years. Empyema was found in 23 patients, complicated parapneumonic effusion in 22 patients. Four patients(three, parapneumonic effusion and one, with empyema) with PCD only treated, were cast off. Among the available patients, 36(80%) patients were treated with PCD only or PCD with urokinase. Among the 23 patients with empyema, surgical approach was required in five patients(27.1%, one required decortication, four open thoracostomy), one patient, treated with surgical procedure, died of sepsis. There was no significant difference of the duration of catheter insertion, the duration of hospital admission after catheter insertion and the mean amount of effusion drained for initial 24 hours between the patients with only PCD treated and the patients treated with PCD and urokinase. The duration of catheter insertion($9.4{\pm}5.25days$ vs. $19.2{\pm}9.42days$, p<0.05) and the duration of hospital admission after catheter insertion($15.9{\pm}10.45days$ vs. $38.6{\pm}11.46days$, p<0.01) of the patients with only PCD treated were more longer than those of the patients treated with surgical procedure after PCD. They were same between the patients treated with urokinase after PCD and the patients treated with surgical procedure after PCD($11.1{\pm}7.35days$ vs. $19.2{\pm}9.42days$, p<0.05, $17.5{\pm}9.17days$ vs. $38.6{\pm}11.46days$, p<0.01). In 16 patients(44.4%) with only PCD treated or PCD and urokinase treated, the amount of effusion at the time of catheter removal was decreased more than 75% and in 17 patients(47.2%) effusion decreased 50~75%. .In one patient effusion decreased 25~50%, in two patients effusion decreased less than 25%. One month after catheter removal, in 35 patients(97.2%, four patients were cast off), the amount of pleural effusion was successfully decreased more than 50%. There were no complications related to pigtail catheter insertion. Conclusion : In this study, PCD seemed to be an early efficacious procedure in treating the patients with complicated parapneumonic effusion or empyema without any serious procedure related complication.