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Development of Conformal Radiotherapy with Respiratory Gate Device (호흡주기에 따른 방사선입체조형치료법의 개발)

  • Chu Sung Sil;Cho Kwang Hwan;Lee Chang Geol;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.20 no.1
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    • pp.41-52
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    • 2002
  • Purpose : 3D conformal radiotherapy, the optimum dose delivered to the tumor and provided the risk of normal tissue unless marginal miss, was restricted by organ motion. For tumors in the thorax and abdomen, the planning target volume (PTV) is decided including the margin for movement of tumor volumes during treatment due to patients breathing. We designed the respiratory gating radiotherapy device (RGRD) for using during CT simulation, dose planning and beam delivery at identical breathing period conditions. Using RGRD, reducing the treatment margin for organ (thorax or abdomen) motion due to breathing and improve dose distribution for 3D conformal radiotherapy. Materials and Methods : The internal organ motion data for lung cancer patients were obtained by examining the diaphragm in the supine position to find the position dependency. We made a respiratory gating radiotherapy device (RGRD) that is composed of a strip band, drug sensor, micro switch, and a connected on-off switch in a LINAC control box. During same breathing period by RGRD, spiral CT scan, virtual simulation, and 3D dose planing for lung cancer patients were peformed, without an extended PTV margin for free breathing, and then the dose was delivered at the same positions. We calculated effective volumes and normal tissue complication probabilities (NTCP) using dose volume histograms for normal lung, and analyzed changes in doses associated with selected NTCP levels and tumor control probabilities (TCP) at these new dose levels. The effects of 3D conformal radiotherapy by RGRD were evaluated with DVH (Dose Volume Histogram), TCP, NTCP and dose statistics. Results : The average movement of a diaphragm was 1.5 cm in the supine position when patients breathed freely. Depending on the location of the tumor, the magnitude of the PTV margin needs to be extended from 1 cm to 3 cm, which can greatly increase normal tissue irradiation, and hence, results in increase of the normal tissue complications probabiliy. Simple and precise RGRD is very easy to setup on patients and is sensitive to length variation (+2 mm), it also delivers on-off information to patients and the LINAC machine. We evaluated the treatment plans of patients who had received conformal partial organ lung irradiation for the treatment of thorax malignancies. Using RGRD, the PTV margin by free breathing can be reduced about 2 cm for moving organs by breathing. TCP values are almost the same values $(4\~5\%\;increased)$ for lung cancer regardless of increasing the PTV margin to 2.0 cm but NTCP values are rapidly increased $(50\~70\%\;increased)$ for upon extending PTV margins by 2.0 cm. Conclusion : Internal organ motion due to breathing can be reduced effectively using our simple RGRD. This method can be used in clinical treatments to reduce organ motion induced margin, thereby reducing normal tissue irradiation. Using treatment planning software, the dose to normal tissues was analyzed by comparing dose statistics with and without RGRD. Potential benefits of radiotherapy derived from reduction or elimination of planning target volume (PTV) margins associated with patient breathing through the evaluation of the lung cancer patients treated with 3D conformal radiotherapy.

Suggestion of Optimal Radiation Fields in Rectal Cancer Patients after Surgical Resection for the Development of the Patterns of Care Study (Patterns of Care 연구 개발을 위한 직장암의 수술 후 방사선치료 시 적정 방사선치료 조사영역 제안)

  • Kim, Jong-Hoon;Park, Jin-Hong;Kim, Dae-Yong;Kim, Woo-Cheol;Seong, JinSil;Ahn, Yong-Chan;Ryu, Mi-Ryeong;Chun, Mison;Hong, Seong-Eon;Oh, Do-Hoon;Kim, Il-Han
    • Radiation Oncology Journal
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    • v.21 no.3
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    • pp.183-191
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    • 2003
  • Purpose: To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns on Care Study. Materials and method: A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all korean hospitals (48 hospitals). Thirty three ($69\%$) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields nor rectal cancer Results: The following guidelines were developed: superior border between the lower tip on the L5 vertebral body and upper sacroiliac joint; inferior border $2\~3$ cm distal to the anastomosis in patient whose sphincter was saved, and $2\~3$ cm distal to the perineal scar In patients whose anal sphincter was sacrificed; anterior margin at the posterior lip of the symphysis pubis or $2\~3$ cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin $1.5\~2$ cm posterior to the anterior surface of the surface, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases ($70\%$), the inferior margin after sphincter saving surgery in 13 ($39\%$), the inferior margin after adbominoperineal resection in 32 ($97\%$), the lateral margin in 32 ($97\%$), the posterior margins in 32 ($97\%$) and the anterior margin in 16 ($45\%$). Conclusion: These recommendations should be tailored to each patient according to the clinical characteristics such as tumor location, pathological and operative findings, for the optimal treatment. The adequacy of these guidelines should be proved be following the Korean Patterns of Care Study.

A Clinical Review of Primary Tracheal Carcinoma (원발성 악성기관종양의 임상적 고찰)

  • Ryu, Jeong-Seon;Cho, Hyun-Myung;Yang, Dong-Gyoo;Lee, Hong-Lyeol;Kim, Se-Kyu;Chang, Joon;Ahn, Chul-Min;Shin, Kye-Chul;Kim, Sung-Kyu;Lee, Won-Young
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.4
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    • pp.766-775
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    • 1997
  • Background : Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 per cent of all malignancies of the respiratory tract. Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. Method : We have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking and respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. Results : Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then stridor or wheezing, cough. and sputum in order. The routine chest roentgenographic examinations were not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with sec and ACC were 5 months and 24.9 months respectively. We had bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression. Conclusion : We would like to perform more comprehensive diagnostic tools(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumorse(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax and waning of dyspnea according to changes of position, 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.

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A Study of Epstein-Barr Virus, and Human Leukocyte Antigen Typing in Children with Acute Infectious Mononucleosis (급성 전염성 단핵구증 환아에서 Epstein-Barr 바이러스의 감염형과 사람 백혈구 항원형 연구)

  • Hahn, Seung-Hoon;Shin, Wan-Shik;Han, Hoon;Kang, Jin-Han
    • Clinical and Experimental Pediatrics
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    • v.46 no.5
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    • pp.467-473
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    • 2003
  • Purpose : The Epstein-Barr virus(EBV), gamma herpesvirus, is an important pathogen that is widespread around the world. The EBV causes various diseases depending on the geographic location, and on the immunity or the premorbid condition of the person exposed to EBV. To evaluate EBV typing may be the most important step to figure out the pathogenesis of EBV associated diseases, and we need to re-evaluate the pathologic role of human leukocyte antigen(HLA) in developing Epstein- Barr virus associated acute infectious mononucleosis by using newly developed methods. Methods : This study included 24 children(age range : 6 to 13 years), serologically confirmed with acute infectious mononucleosis. The control group for the HLA type consisted of 200 age-matched healthy children. To classify HLA I, modified ARMs-PCR was used, while modified PCR-SSOP was utilized in typing of HLA II. Also, we performed EBV typing in study patients by using a one-step PCR. Results : The results of HLA types : In HLA class I, HLA-A24 was positive in 69 of 200 healthy children and positive in 14 of 24 patients in the study group(relative risk : 3.5724, chi-square; 5.26, P<0.05). In HLA class II, HLA-DRB1*07 was detected in 18 of 200 healthy children, and eight of 24 patients in the study group(relative risk; 506173, chi-square; 9.73, P<0.01). The results of EBV types : In the research group, 20(83.8%) of 24 patients were shedding type A virus, while 4(16.7%) were type B. Conclusion : We conclude that development of infectious mononucleosis may be associated with HLA types, and these results suggest that acute infectious mononucleosis could have hereditary traits. And we confirm that type A EBV is highly prevalent in patients with acute infectious mononucleosis in Korea. Also, our results suggest that further large scale studies, including adult groups, regarding the association between pathogenesis of EBV with HLA-DP or HLA-DQ will be warranted.

6th Industry Management Body Develop Managerial and Technical Level Metrics - by Applying AHP Analysis - (6차산업화 경영체 경영.기술수준 평가지표 개발 -AHP 분석을 적용하여-)

  • Seo, Yoon Jeong;Park, Jeong Woon;Han, Sang Yeon;Hwang, Dae Yong;Yang, Jung Hyun
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.8 no.4
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    • pp.177-191
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    • 2013
  • 6th Industry reduced agricultural income and rural areas, the economic downturn is going to be activated is attracting attention as an alternative. 6th industry means that the integrated or linked, the manufacture and processing of secondary industry based on primary industry, the distribution and service of tertiary industry. Park Geun-hye government to realize the creative economy in agriculture as an alternative to specifically evaluate the 6th industries and suggests various policy alternatives. In addition, to support the development of models and analysis of best practices, including sleep studies are in progress. However, the 6th Industry management body for performing management level, technical level, the leader in comprehensive evaluation of competencies and indicators on the development of an evaluation study is insufficient. In this regard, the present study performed 6th industry management body for the management level, technical level, the leader competency evaluation indicators to develop a comprehensive evaluation by utilizing AHP method was developed indicators. The results achieved in Korea As different countries and the FTA as cheap agricultural imports increased 6th industry revenues associated with the management body is very likely to be worse. The endless competition to survive in the most important of the strategy for each individual project management body to operate on their own, rather than to strengthen internal capacity by strengthening linkages with other industries, products, and services that promote the sale will be. This also is that you need to improve revenue management body. Thus, all 6th industry management body at the location of their efforts to gain the trust of consumers will require, moreover, for each management body to build cooperation between the various measures will be sought. In addition to the smart era rapidly changing needs of customers, depending on the life cycle of products and services are getting faster and the new consumer is getting more and more tend to find new products. Thus, customers and management body 6th industry changes quickly and accurately predict market trends, and also to market new products and services that further efforts would be needed.

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The Investigation Image-guided Radiation Therapy of Bladder Cancer Patients (방광암 환자의 영상유도 방사선치료에 관한 고찰)

  • Bae, Seong-Soo;Bae, Sun-Myoung;Kim, Jin-San;Kang, Tae-Young;Back, Geum-Mun;Kwon, Kyung-Tae
    • The Journal of Korean Society for Radiation Therapy
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    • v.24 no.1
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    • pp.39-43
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    • 2012
  • Purpose: In hospital image-guided radiation therapy in patients with bladder cancer to enhance the reproducibility of the appropriate amount, depending on the patient's condition, and image-guided injection of saline system (On-Board Imager system, OBI, VARIAN, USA) three of the Cone-Beam CT dimensional matching (3D-3D matching) to be the treatment. In this study, the treatment of patients with bladder cancer at Cone-Beam CT image obtained through the analysis of the bones based matching and matching based on the bladder to learn about the differences, the bladder's volume change injected saline solution by looking at the bladder for the treatment of patients with a more appropriate image matching is to assess how the discussion. Materials and Methods: At our hospital from January 2009 to April 2010 admitted for radiation therapy patients, 7 patients with bladder cancer using a Folly catheter of residual urine in the bladder after removing the amount determined according to individual patient enough to inject saline CT-Sim was designed after the treatment plan. After that, using OBI before treatment to confirm position with Cone-Beam CT scan was physician in charge of matching was performed in all patients. CBCT images using a total of 45 bones, bladder, based on image matching and image matching based on the difference were analyzed. In addition, changes in bladder volume of Eclipse (version 8.0, VARIAN, USA) persuaded through. Results: Bones, one based image matching based on the bladder and re-matching the X axis is the difference between the average $3{\pm}2mm$, Y axis, $1.8{\pm}1.3mm$, Z-axis travel distance is $2.3{\pm}1.7mm$ and the overall $4.8{\pm}2.0mm$, respectively. The volume of the bladder compared to the baseline showed a difference of $4.03{\pm}3.97%$. Conclusion: Anatomical location and nature of the bladder due to internal movement of the bones, even after matching with the image of the bladder occurred in different locations. In addition, the volume of saline-filled bladder showed up the difference between the 4.03 percent, but matched in both images to be included in the planned volumes were able to confirm. Thus, after injection of saline into the bladder base by providing a more accurate image matching will be able to conduct therapy.

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Present Condition of Fortress of Silla Capital and Research Direction on Landscape Architecture (신라왕경 성곽의 현황과 조경학적 차원의 연구방향)

  • Kim, Hyung-Suk;Sim, Woo-Kyung;Lee, Won-Ho;Ahn, Gye-Bog
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.33 no.1
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    • pp.1-11
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    • 2015
  • Gyeongju, Silla capital, hasn't paid much attention to a value of fortress as advanced frame of landscape all the while. All have done until now were maintaining lots of fortress including Gyeongju and setting night landscape lighting for them or building a trail in mountain fortress. Hereupon, this study tried to take a look at historical and scenic value of fortress, landscape frame of Gyeongju-Silla capital, based on Wolseong and Myeonghwalseong and find the way to contribute to it on landscape architectural level. As Wolseong(月城) and Myeonghwalseong(明活城) functioned as royal palace in Silla Dynasty, they need some research and study on fortress inside in detail rather than restoring them by simply maintaining the shapes. While Wolseong has overall excavation investigation going on, Myeonghwalseong representing mountain fortress area is losing its value due to unbefitting management to a title of world heritage. If conducting close research and study on these remains, it seems like it could contribute a lot to landscape architectural research of Silla royal palace through tracks, which will be used as royal palace. Here I suggest research direction on landscape architectural level about fortress remains in Gyeongju area as followings. Firstly, away from all research focusing on fortress shape, consecration way, etc, we need to conduct a research comprisable of inner space of fortress. As Wolseong and Myeonghwalseong functioned as royal palace in Silla Dynasty, it'll be possible to research about ponds, Nu-Jeong(樓亭), drainage facilities, oddly shaped stones, moundings, pavements, circulation systems, planting traces, etc. For this, we need to research and study through comparison with cases of China, Japan and Goguryeo of the same age. Secondly, applying garden archaeological way is possible to translate objectively regarding research of ancient garden with low literature record. But attainable achievement and information will be limited if implementing excavation based on archaeology as excavations so far regarding excavation investigation of Wolseong. The alternative to such problem is participation plan of landscaping field through the foundation of garden archaeology. We might be able to attain many results on landscape architectural level from research, if conducting research and study about Silla capital including Wolseong by applying garden archaeology such as collection of environmental sample and discovery and analysis of remains through aerial photograph, archaeological research, analysis of historical building, surface exploration, excavation technique, analysis of soil and flowerpot, etc. For this, many people majored in landscape architecture need to try and acquire archaeological knowledge. Also, we need to call attention to internal garden archaeology through international academic symposium by inviting global experts in garden archaeology field. I've suggested the study of location of Wolseong and Silla fortress in Gyeongju area, plan research on using and treating trees about the space in and out of fortress and landscape architectural research direction of Wolseong fortress.

Historical Studies on the Characteristics of Jondeokjeong in the Rear Garden of Changdeok Palace (창덕궁 후원 존덕정(尊德亭)의 조영사적 특성)

  • Song, Suk-Ho;Sim, Woo-Kyung
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.32 no.1
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    • pp.31-43
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    • 2014
  • The purposes for this research were to find the correct building background of Jondeokjeong(尊德亭) in the rear garden of Changdeok Palace(昌德宮) based on the historical facts for the area of Jondeokjeong and investigate the internal theory of construction through the metaphysical consideration. The results were as follows. 1. Building background of Jondeokjeong was related to Sohyunseja(昭顯世子) and Bongrimdaegun(鳳林大君) as forms of rear garden where was not built in the area of Jondeokjeong, bamboo pavilion, hexagonal pavilion, octagonal pavilion, etc. They were built two or three times after returning of Sohyunseja and Bongrimdaegun from China, and the area of Jondeokjeong was continuously developed by building Chunhyanggak(天香閣), Mangchunjeong(望春亭) and Cheoknoidang(滌惱堂) after Hyojong(孝宗) succeeded the royal authority of Hyunjong(顯宗) who was born in Shenyang(瀋陽) and hung a signboard of Jondeokjeong after then, etc. 2. Dazhengjeon(大政殿) of Shenyang Palace(瀋陽故宮, 1625) played the roles of major hall, Jeongjeon(正殿) which held national big events as a one-storied building with two piles of roof similar with Jondeokjeong (1644). Also, it was the building encountered when Sohyunseja and Bongrimdaegun participated in breakfasts held in the palace or banquets supervised by a king, so building background of Jondeokjeong was judged to be related with Dazhengjeon. 3. In consideration of characteristics which are shown commonly in Jondeokjeong and Dazhengjeon, relations of two buildings were verified and characteristics of Jondeokjeong were examined. First, dragon which is representatively symbolizing royal authority was formed. Therefore, Jondeokjeong was judged as a garden building which purposes were to obtain and train natural reasons, govern the nation and let people comfortable. Second, the purposes of sun dial, Ilyoungdae(日影臺) were judged to examine the accurate time and express appropriateness of the king. Third, Taechungmun(太淸門) around there is related to Samcheong(三淸) of Taoism and judged to be caused by floral wall and secular happiness accomplishment for king's longevity without disease. Fourth, for building style, one-stories pavilion of duplicated roof and building with only cylinder were to king's embodiment of supporting the sky and governing the nation.4) 4. By examining the differences between Jondeokjeong and Dazhengjeon, Jondeokjeong's own characteristics were considered. First, constructive characteristics of Jondeokjeong were changed by existing of pond and it was changed for characteristics, location and function of pavilion built in the garden while accepting oversea culture and embodied by absorbing to Joseon culture. Second, the appearance of the pond in Jondeokjeong was shown as the situation that half moon typed pond with the form of young moon is full by stream to the East. It was to express movement of moon which was always changed through the form of pond and stream of water iconographycally and it was considered as an imaginary environment method of the period.

Treatment Results of Esophageal Carcinoma Treated by Radiation Therapy (식도암의 방사선치료 성적)

  • Kim Mi Sook;Yoo Seoung Yul;Cho Chul Koo;Yoo Hyung Jun;Yang Kwang Mo;Kang Jin Oh;Ji Young Hoon;Lee Dong Han;Ryoo Baek Yeol
    • Radiation Oncology Journal
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    • v.18 no.3
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    • pp.182-186
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    • 2000
  • Purpose : To determine treatment or이ecol for inoperable esophageal cancer patients, 껜e evaluated survival rate and prognostic factors. Materials and Methods : We evaluated esophageal cancer treated by curative or palliative am in KCCH from 1992 to 1996, retrospectively. Recurrent or underdose case below 40 Gy were excluded. The number of male and female were 35 and 5, respectively. Thirty-eight patients were squamous carcinoma and 2 patients were not biopsy proven. Ten patients were treated with radiation therapy and chemotherapy Median dose of radiation therapy was 59.4 Gy and the range was $40\~60$ Gy. Results : The median survival is 6.5 months and 1-year survival rate was $28.3\%$. Age, location, radiation dose and chemotherapy were not significant prognostic factors. Median survivals of patients with below stage III and over stage IVA were 7.6 and 6.2 months respectively, but it is not significant. Conclusions : The survival for esophageal cancer is very poor. For patients with curative aim, chemotherapy must be considered. For patients with palliative aim, short-term external beam radiation therapy and/or brachytherapy must be considered.

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GIS-based Market Analysis and Sales Management System : The Case of a Telecommunication Company (시장분석 및 영업관리 역량 강화를 위한 통신사의 GIS 적용 사례)

  • Chang, Nam-Sik
    • Journal of Intelligence and Information Systems
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    • v.17 no.2
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    • pp.61-75
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    • 2011
  • A Geographic Information System(GIS) is a system that captures, stores, analyzes, manages and presents data with reference to geographic location data. In the later 1990s and earlier 2000s it was limitedly used in government sectors such as public utility management, urban planning, landscape architecture, and environmental contamination control. However, a growing number of open-source packages running on a range of operating systems enabled many private enterprises to explore the concept of viewing GIS-based sales and customer data over their own computer monitors. K telecommunication company has dominated the Korean telecommunication market by providing diverse services, such as high-speed internet, PSTN(Public Switched Telephone Network), VOLP (Voice Over Internet Protocol), and IPTV(Internet Protocol Television). Even though the telecommunication market in Korea is huge, the competition between major services providers is growing more fierce than ever before. Service providers struggled to acquire as many new customers as possible, attempted to cross sell more products to their regular customers, and made more efforts on retaining the best customers by offering unprecedented benefits. Most service providers including K telecommunication company tried to adopt the concept of customer relationship management(CRM), and analyze customer's demographic and transactional data statistically in order to understand their customer's behavior. However, managing customer information has still remained at the basic level, and the quality and the quantity of customer data were not enough not only to understand the customers but also to design a strategy for marketing and sales. For example, the currently used 3,074 legal regional divisions, which are originally defined by the government, were too broad to calculate sub-regional customer's service subscription and cancellation ratio. Additional external data such as house size, house price, and household demographics are also needed to measure sales potential. Furthermore, making tables and reports were time consuming and they were insufficient to make a clear judgment about the market situation. In 2009, this company needed a dramatic shift in the way marketing and sales activities, and finally developed a dedicated GIS_based market analysis and sales management system. This system made huge improvement in the efficiency with which the company was able to manage and organize all customer and sales related information, and access to those information easily and visually. After the GIS information system was developed, and applied to marketing and sales activities at the corporate level, the company was reported to increase sales and market share substantially. This was due to the fact that by analyzing past market and sales initiatives, creating sales potential, and targeting key markets, the system could make suggestions and enable the company to focus its resources on the demographics most likely to respond to the promotion. This paper reviews subjective and unclear marketing and sales activities that K telecommunication company operated, and introduces the whole process of developing the GIS information system. The process consists of the following 5 modules : (1) Customer profile cleansing and standardization, (2) Internal/External DB enrichment, (3) Segmentation of 3,074 legal regions into 46,590 sub_regions called blocks, (4) GIS data mart design, and (5) GIS system construction. The objective of this case study is to emphasize the need of GIS system and how it works in the private enterprises by reviewing the development process of the K company's market analysis and sales management system. We hope that this paper suggest valuable guideline to companies that consider introducing or constructing a GIS information system.