• Journal of Radiation Protection and Research
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• 제39권4호
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• pp.213-217
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• 2014

중재방사선을 이용한 의료적 시술이나 진단은 꾸준히 증가하고 있다. 특히 환자에 근접하여 이루어지는 중재방사선시술의 특성상 시술자에 대한 직무피폭의 관리 및 감시가 중요하다. 개인선량계를 통해 측정되는 방사선 방호 실용량인 심부선량은 중재방사선시술의 경우 균질한 방사선장에 의해 전신에 고르게 노출되는 경우가 아니므로 유효선량을 항상 대표할 수는 없다. 따라서 본 연구에서는 C-arm을 이용한 대표적인 중재방사선시술에 대해 수학적 모의피폭체와 몬테카를로 방법을 이용한 계산과 개인선량계를 이용한 실측을 통해 개인선량당량과 장기별 선량을 평가하고자 하였다. 주요 장기별 선량평가 결과는 개인선량계로 측정된 선량 값보다 낮았으나, 갑상선과 같은 장기는 전신 연조직 선량보다 상당히 높은 것으로 평가되었다. 중재방사선시술자에 대한 적절한 방사선방호를 위해 납치마의 착용과 같은 전신 방호와 더불어 갑상선 방호와 같은 추가적인 방호조치가 고려되어야 할 것이다.

• Annals of Clinical Neurophysiology
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• 제10권2호
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• pp.83-97
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• 2008

Cervical and thoracic radiculopathies are among the most common causes of neck pain. The most common causes are cervical disc herniation and cervical spondylosis in patients with cervical radiculopathy, and diabetes mellitus and thoracic disc herniation in thoracic radiculopathy. A thorough history, physical examination, and testing that includes electrodiagnostic examination and imaging studies may distinguish radiculopathy from other pain sources. Although various electrodiagnostic examinations may help evaluate radiculopathy, needle electromyography is the most important, sensitive, and specific method. Outcome studies of conservative treatments have shown varying results and have not been well controlled or systematic. When legitimate incapacitating symptoms continue despite conservative treatment attempts, more invasive spinal procedures and intradiscal treatment may be appropriate. Surgery has been shown to have excellent clinical outcomes in patients with disc extrusion and neurological deficits. However, patients with minimal disc herniation have fair or poor surgical outcomes. In addition, conventional open disc surgery entails various inadvertent surgical related risks. Although there has not yet been a non-surgical interventional procedure developed with the therapeutic efficacy of open surgery, conservative procedures can offer substantial benefits, are less invasive, and avoid surgical complications. While more invasive procedures may be appropriate when conservative treatment fails, prospective studies evaluating cervical and thoracic radiculopathies treatment options would help guide practitioners toward optimally cost-effective patient evaluation and care.

• Clinical and Experimental Pediatrics
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• 제49권9호
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• pp.917-929
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• 2006

Over the last several decades there has been a remarkable change in the therapeutic strategy of congenital heart disease. Development of new tools and devices, accumulations of experience, technical refinement have positively affected the outcome of interventional treatment. Many procedures including atrial septostomy, balloon valvuloplasty, balloon dilation of stenotic vessel with or without stent implantation, transcatheter occlusion of abnormal vascular structure, transcatheter closure of patent arterial duct and atrial septal defect, are now performed as routine interventional procedures in many institutes. In diverse conditions, transcatheter techniques also provide complementary and additive role in combination with surgery. Intraoperative stent implantation on stenotic vessels, perventricular device insertion, and hybrid stage 1 palliative procedure for hypoplastic left heart syndrome have been employed in high risk patients for cardiac surgery with encouraging results. Transcatheter closure of ventricular septal defect has been performed safely showing comparable result with surgery. Investigational procedures such as percutaneous valve insertion and valve repair are expected to replace the role of surgery in certain group of patients in the near future. Continuous evolvement in this field will contribute to reduce the risk and suffering from congenital heart disease, while surgery will be still remained as a gold standard for significant portion of congenital heart disease.

• 제어로봇시스템학회논문지
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• 제22권8호
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• pp.603-609
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• 2016

This paper presents an optimally designed master device mechanism for teleoperated interventional robotic system. The interventional procedures using the teleoperated robotic system and the physicians' requirements are summarized. The master device should implement 5-DOF motion including 2-DOF translational motion for the entry position control, 2-DOF rotational motion for the orientation control, and 1- DOF translational motion for needle insertion. The handle assembly includes a 1-DOF translational mechanism for needle insertion and buttons for operation mode selection. The mechanisms for the 2-DOF translational motion and the 2-DOF rotational motion are designed using motors and brakes based on the various mechanisms to satisfy all the above requirements, respectively. Absolute position sensors are adopted to implement automatic initial positioning and orientation matching at the first step of needle insertion.

• 한국방사선학회논문지
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• 제6권1호
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• pp.11-17
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• 2012

중재적 방사선 시술 시 환자의 피폭선량을 시술별로 분류하여 측정 및 평가하여 안전관리 자료로 활용하고자 하였다. 검사는 시술별(TACE, EVAR, Iliac stent, Lower Limb, BAE, Embolization, PTBD, PTGBD, Abscess, Nephrostomy)로 투시시간, 면적선량, 영상획득이미지 수를 측정하였다. 시술별 분석결과 비혈관계 검사에서 전반적으로 낮은 값을 보였으며, 혈관계 검사에서는 IVC filter를 제외한 모든 검사에서 높은 값을 나타냈다. 투시시간은 EVAR가 24m30s로 가장 높았고, 면적선량 또한 EVAR가 236 $Gy/cm^2$로 가장 높았다. 면적선량률은 TACE가 22.8 $Gy/cm^2$로 높게 나타났다. 이 결과를 토대로 중재적 방사선시술시 환자피폭선량에 대한 기준선량을 제시하고자 한다.

• Journal of Radiation Protection and Research
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• 제44권3호
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• pp.110-117
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• 2019

Background: This study aimed to estimate occupational doses and patient peak skin doses (PSDs) during interventional radiology procedures. Materials and Methods: We examined data from brain embolization (n = 30), hepatic chemoembolization (n = 50), and uterine embolization (n = 12). The PSDs were measured using radiochromic film around the patient's head (group 1) or abdominal/pelvic region (group 2). Acquisition technical data and kerma-area products (KAP) were also recorded. Occupational doses were measured using $Instadose^{TM}$ dosimeters near the left eye region (LER), chest, and left ankle. Results and Discussion: The third quartile (median) KAP values were $408.1(235.3)Gy{\cdot}cm^2$ for group 1 and $584.4(449.4)Gy{\cdot}cm^2$ for group 2. The average PSDs were greatest during vascular procedures, reaching 1,004.4 (786.4) mGy, and the highest PSD was 2,352.6 mGy (during hepatic chemoembolization). The third quartile (median) occupational doses were 0.35 (0.21) mSv at the LER, 0.25 (0.15) mSv at the chest, and 1.47 (0.64) mSv at the left ankle. Occupational doses at the LER were higher than at the chest, which highlights the importance of protective glasses and suspended shields. The occupational doses at the ankle region were also high, which highlights the importance of using a lead-lined curtain attached to the table. Conclusion: The results indicate that physicians can reach, for eye region, the weekly occupational dose limit after around 15 procedures, even when using proper protection. The average PSD values were below the threshold for tissue reactions, although the complexity of these procedures emphasises the importance of considering related risks.

• 대한방사선기술학회지:방사선기술과학
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• 제39권1호
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• pp.27-33
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• 2016

심장혈관 조영술과 인터벤션은 현대 성인병의 증가로 급격히 증가하고 있다. 심장혈관 인터벤션은 장시간 동일 부위에 방사선을 조사하는 검사로 방사선으로 인한 피부상해를 일으킬 수 있다. 본 연구에서는 의료기관의 심장혈관 인터벤션의 진단참조준위를 조사하여 환자의 피폭선량을 감소시키는 도구로 사용하고자 한다. 본 연구는 147명의 환자에서 심장혈관 조영술과 인터벤션을 대상으로 누적 투시시간, 누적 투시면적선량, 영상촬영을 위한 면적선량, 누적 면적선량, 공기커마, 동영상 수, 총 영상 수에 대한 정보를 획득하여 진단참조준위를 설정하였다. 심장혈관 조영술의 진단참조준위와 인터벤션의 진단참조준위에 해당하는 면적선량 값은 각각 $44.4 Gy{\cdot}cm2$와 $298.6Gy{\cdot}cm2$로 나타났고 투시시간에 대한 진단참조준위는 각각 191.5 sec와 1935.3 sec로 나타났다. 진단참조준위는 반드시 넘으면 안 되는 값은 아니다. 하지만 진단참조준위를 제정하여 의료 기관에서 사용하고 있는 선량의 참조 값을 설정하고 이를 검토하는 과정은 환자의 불필요한 피폭선량을 감소시키는데 기여할 것이다.

• The Korean Journal of Pain
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• 제24권4호
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• pp.205-215
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• 2011

Background: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. Methods: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. Result: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. Conclusion: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

• The Korean Journal of Pain
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• 제31권4호
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• pp.244-252
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• 2018

C-arm fluoroscopy is useful equipment in interventional pain management because it helps to guide correct needle targeting for the accurate injection and drug delivery. However, due to increased use of C-arm fluoroscopy in various pain procedures, the risk of radiation exposure is a significant concern for pain physicians. The harmful biological effects of ionizing radiation on the human body are well known. It is therefore necessary to strive to reduce radiation exposure. Lead aprons with thyroid shields are the most fundamental radiation protective devices for interventional procedures, and are very effective. However, the operator's radiation safety cannot be guaranteed because pain physicians seem to lack sufficient interest, knowledge, and awareness about radiation safety. Also, inappropriate care and use of radiation protective devices may result in a higher risk of radiation exposure. The purpose of this article was to review the literature on radiation safety with a focus on lead aprons and thyroid shields and present recommendations related to those devices during C-arm fluoroscopic-guided interventions by pain physicians.

• The Korean Journal of Pain
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• 제20권1호
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• pp.31-39
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• 2007

Background: Cervical radicular pain can arise fromvarious structures, including spinal nerves, discs, zygapophyseal joints, ligaments, and myofascial connective tissue. However, no adequate experiments have been found regarding methods for the microadhesiolysis of adhesional connective tissue around the zygapophyseal joints and nerves. The first objective of this study was to ascertain the effect of fluoroscopy guided interventional microadhesiolysis and nerve stimulation (FIMS) on chronic cervical radicular pain caused by zygapophyseal joint dysfunction. The second objective was to identify the duration of pain alleviation, as well as commonly occurring regions for zygapophyseal joint dysfunction. Methods: Twenty-eight patients were diagnosed with cervical radicular pain. The cervical zygapophyseal joints and adhesional structures around the cervical zygapophyseal joints were stimulated by adhesiolysis with a rounded needle; the procedure was performed once every second week. A visual analogue scale (VAS) for pain and neck range of motion (ROM) were used as indices for evaluating the degree of pain 1 and 3 months after completion of the procedures. A relief effect of FIMS was accepted when the VAS index decreased 50% compared with a previous VAS, and when there was absence of limitation of ROM. Results: Among the patients, 52% showed zygapophyseal joint dysfunction in C5-6, 38% in C4-5, 7% in C2-3, and 3% in C6-7. After performing FIMS, the VAS index decreased in most of the patients after 1 and 3 months (92.8% and 75%, respectively), and treatment frequency was $2.7{\pm}1.2$. There was no correlation between the number of FIMS procedures and the degree of VAS. Conclusions: FIMS is considered an effective modality in patients suffering from cervical radicular pain.