• Progress in Medical Physics
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• v.21 no.4
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• pp.332-339
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• 2010

We aimed to setup an adaptive radiation therapy platform using cone-beam CT (CBCT) and multileaf collimator (MLC) log data and also intended to analyze a trend of dose calculation errors during the procedure based on a phantom study. We took CT and CBCT images of Catphan-600 (The Phantom Laboratory, USA) phantom, and made a simple step-and-shoot intensity-modulated radiation therapy (IMRT) plan based on the CT. Original plan doses were recalculated based on the CT ($CT_{plan}$) and the CBCT ($CBCT_{plan}$). Delivered monitor unit weights and leaves-positions during beam delivery for each MLC segment were extracted from the MLC log data then we reconstructed delivered doses based on the CT ($CT_{recon}$) and CBCT ($CBCT_{recon}$) respectively using the extracted information. Dose calculation errors were evaluated by two-dimensional dose discrepancies ($CT_{plan}$ was the benchmark), gamma index and dose-volume histograms (DVHs). From the dose differences and DVHs, it was estimated that the delivered dose was slightly greater than the planned dose; however, it was insignificant. Gamma index result showed that dose calculation error on CBCT using planned or reconstructed data were relatively greater than CT based calculation. In addition, there were significant discrepancies on the edge of each beam while those were less than errors due to inconsistency of CT and CBCT. $CBCT_{recon}$ showed coupled effects of above two kinds of errors; however, total error was decreased even though overall uncertainty for the evaluation of delivered dose on the CBCT was increased. Therefore, it is necessary to evaluate dose calculation errors separately as a setup error, dose calculation error due to CBCT image quality and reconstructed dose error which is actually what we want to know.

• Progress in Medical Physics
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• v.24 no.3
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• pp.162-170
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• 2013

Dedicated single-photon emission computed tomography (SPECT) systems based on pixelated semiconductors are being developed for studying small animal models of human disease. To clarify the possibility of using a SPECT system with CdTe for a high resolution low-dose small animal imaging, we compared the quality of reconstructed images from pixelated CdTe detector to those from a small SPECT system with NaI(Tl). The CdTe detector was $44.8{\times}44.8$ mm and the pixels were $0.35{\times}0.35{\times}5$ mm. The intrinsic resolution of the detector was 0.35 mm, which is equal to the pixel size. GATE simulations were performed to assess the image quality of both SPECT systems. The spatial resolutions and sensitivities for both systems were evaluated using a 10 MBq $^{99m}Tc$ point source. The quantitative comparison with different injected dose was performed using a voxelized MOBY phantom, and the absorbed doses for each organ were evaluated. The spatial resolution of the SPECT with NaI(Tl) was about 1.54 mm FWHM, while that of the SPECT with a CdTe detector was about 1.32 mm FWHM at 30 mm. The sensitivity of NaI(Tl) based SPECT was 83 cps/MBq, while that of the CdTe detector based SPECT was 116 cps/MBq at 30 mm. The image statistics were evaluated by calculating the CNR of the image from both systems. When the injected activity for the striatum in the mouse brain was 160 Bq/voxel, the CNR of CdTe based SPECT was 2.30 while that of NaI(Tl) based SPECT was 1.85. The CNR of SPECT with CdTe was overall higher than that of the NaI(Tl) based SPECT. In addition, the absorbed dose was higher from SPECT with CdTe than those from NaI(Tl) based SPECT to acquire the same quantitative values. Our simulation results indicated that the SPECT with CdTe detector showed overall high performance compared to the SPECT with NaI(Tl). Even though the validation study is needed, the SPECT system with CdTe detector appeared to be feasible for high resolution low-dose small animal imaging.

• Investigative Magnetic Resonance Imaging
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• v.18 no.4
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• pp.332-340
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• 2014

Purpose : A relative increase in deoxyhemoglobin levels in hypoperfused tissue can cause prominent hypointense signals in the draining veins (PHSV) within areas of impaired perfusion in susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of SWI in patients with acute cerebral infarction by evaluating PHSV within areas of impaired perfusion and to investigate the usefulness of PHSV in predicting prognosis of cerebral infarction. Materials and Methods: In 18 patients with acute cerebral infarction who underwent brain MRI with diffusion-weighted imaging and SWI and follow-up brain MRI or CT, we reviewed the presence and location of the PHSV within and adjacent to areas of cerebral infarction qualitatively and measured the signal intensity difference ratio of PHSVs to contralateral normal appearing cortical veins quantitatively on SWI. The relationship between the presence of the PHSV and the change in the extent of infarction in follow-up images was analyzed. Results: Of the 18 patients, 10 patients showed progression of the infarction, and 8 patients showed little change on follow- up imaging. On SWI, of the 10 patients with progression 9 patients showed peripheral PHSV and the newly developed infarctions corresponded well to area with peripheral PHSV on initial SWI. Only one patient without peripheral PHSV showed progression of the infarct. The patients with infarction progression revealed significantly higher presence of peripheral PHSV (p=0.0001) and higher mean signal intensity difference ratio (p=0.006) comparing to the patients with little change. Conclusion: SWI can demonstrate a peripheral PHSV as a marker of penumbra and with this finding we can predict the prognosis of acute infarction. The signal intensity difference of PHSV to brain tissue on SWI can be used in predicting prognosis of acute cerebral infarction.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.6
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• pp.293-301
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• 2006

Purpose: The aim of the study was to evaluate the hemodynamic changes after successful bypass surgery in patients with atherosclerotic stenosis in ICA using $^{99m}Tc-ECD$ SPECT. Materials and Methods: Fourteen patients (M:F=8:6, mean age; $60{\pm}9$ years) who underwent STA-MCA anastomosis for unilateral atherosclerotic cerebrovascular disease were enrolled. $^{99m}Tc-ECD$ basal/acetazolamide perfusion SPECT studies were performed before, 10 days and 6 months after bypass surgery. Perfusion reserve was defined as the % changes after acetazolamide over rest image. Regional cerebral blood flow and perfusion reserve were compared preoperative, early-postoperative and late-postoperative scans. Results: The mean resting perfusion and decrease in perfusion reserve in affected ICA territory on preoperative scan was $52.4{\pm}3.5\;and\;-7.9{\pm}4.7%$, respectively. The resting perfusion was significantly improved after surgery on early-postoperative scan (mean $53.7{\pm}2.7$) and late-postoperative scan (mean $53.3{\pm}2.5$) compared with preoperative images (p<0.05, respectively). Resting perfusion did not showed further improvement on late-postoperative scan compared with early-postoperative scan. The perfusion reserve was $-3.7{\pm}2.6%$ on early-postoperative scan, and $-1.6{\pm}2.3%$ on late-postoperative scan, which was significantly improved after surgery. Additionally, further improvement of perfusion reserved as observed on late-postoperative scan (p<0.05). While, in the unaffected ICA territory, no significant changes in the resting perfusion and perfusion reserve was observed. Conclusion: The improvement of resting perfusion and perfusion reserve in early-postoperative scan reflects the immediate restoration of the cerebral blood flow by bypass surgery. In contrasts, further improvement of perfusion reserve showing on late-postoperative scan may indicate a good collateral development after surgery, which may indicate good surgical outcome after surgery.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.6
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• pp.302-308
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• 2006

Purpose: Although several neuroanatomical models of panic disorder have been proposed, little is known regarding the neurological mechanisms underlying cognitive-behavioral therapy (CBT) in patients with panic disorder. This study was performed to identify the brain structures that show changes of regnioal cerebral blood flow (rCBF) after CBT in patients with panic disorder. Materials and Methods: Seven patients who were diagnosed as panic disorder by DSM-IV were treated with CBT for 8 weeks and twelve healthy volunteers joined in this study. Serial $^{99m}Tc-ECD$ brain perfusion SPECT images were acquisited and PDSS-SR (Self-Report version of Panic Disorder Severity Scale) and ACQ (Agoraphobic Cognitive Question) scores were measured just before and after CBT in all patients. Data were analyzed using SPM2. Results: Subjective symptoms were improved, and PDSS-SR and ACQ scores were significantly reduced ($14.9{\pm}3.9\;vs.\;7.0{\pm}1.8$, p<0.05; $30.3{\pm}8.5\;vs.\;21.6{\pm}3.4$, p<0.05, respectively) after CBT in panic patients. Before CBT, a significant increase of rCBF was found in the cingulate gylus, thalamus, midbrain, both medial frontal and temporal lobes of the panic patients compared to the normal volunteers. After CBT, we observed a significant rCBF decrease in the left parahippocamus, right insula and cingulate gyrus, both frontal and temporal lobes, and a significant rCBF increase in both the occipital lobes, left insula, both frontal and left parietal lobes. Conclusion: These data suggested that CBT is effective for panic disorder and diminish the activity of the brain areas associated with fear in panic disorder.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.6
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• pp.309-315
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• 2006

Purpose: Accurate evaluation of cervical lymph node (LN) metastasis of head and neck squamous cell canter (SCC) is important to treatment planning. We evaluated the diagnostic accuracy of F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the detection of cervical LN metastasis of head and neck SCC and performed a retrospective comparison with CT/MRI findings. Materials & Methods: Seventeen patients with pathologically proven head and neck SCC underwent F-18 FDG PET/CT and CT/MRI within 4 week before surgery. We recorded lymph node metastases according to the neck level system of imaging-based nodal classification. F-18 FDG PET/CT images were analyzed visually for assessment of regional tracer uptake in LN. We analyzed the differences in sensitivity and specificity between F-18 FDG PET/CT and CT/MRI using the Chi-square test. Results: Among the 17 patients, a total of 123 LN levels were dissected, 29 of which showed metastatic involvement. The sensitivity and specificity of F-18 FDG PET/CT for detecting cervical LN metastasis on a level-by-level basis were 69% (20/29) and 99% (93/94). The sensitivity and specificity of CT/MRI were 62% (18/29) and 96% (90/94). There was no significant difference in diagnostic accuracy between F-18 FDG PET/CT and CT/MRI. Interestingly, F-18 FDG PET/CT detected double primary tumor (hepatocellular carcinoma) and rib metastasis, respectively. Conclusion: There was not statistically significant difference of diagnostic accuracy between F-18 FDG PET/CT and CT/MRI for the detection of cervical LN metastasis of head and neck SCC. The low sensitivity of F-18 FDG PET/CT was due to limited resolution for small metastatic deposits.

• Journal of Global Scholars of Marketing Science
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• v.18 no.4
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• pp.33-59
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• 2008

This paper aims to analyse the preference for German farm tourism among the German population. For this reason, we conducted an empirical study in Germany during summer 2007 and we applieda structural equation model based on partial leasts quares(PLS) to analyse the data. In the following chapters we will introduce the literature review and our conceptual frame work. We will then outline the procedures we adopted and the results of the empirical analysis. In the final part so me conclusions will be presented and a discussion will follow in order to draw the future directions of our research. According to our hypotheses, the possibility that agri-tourism enters in the evoked set of an individual is higher: H1: The higher the information degree about it. H2: The lower the influence of the social stimuli. H3: The higher the physical exposure to it (experience). H4: The higher the wellness image of agri-tourism. H5: The higher the traditional image of agri-tourism. H6: The higher the exciting image of agri-tourism. H7: The higher the perceived value for money. Our further hypotheses affirm that the possibility that agri-tourism enters in the evoked set of an individual is higher: H8: The lower the perceived risk. H9: The higher the motive to enjoy a holiday in the nature. H10: The higher the motive to enjoy a sport holiday. H11: The lower the motive to have an organized holiday. H12: The lower the motive to have a holiday abroad. H13: The lower the motive of action and night life. H14: The higher the motive to spend a holiday with the family. H15: The lower the motive to spend a city holiday. Finally, our model has some socio-demographics data. As we mentioned before, German agri-tourism has traditionally been the travel destination of large-size families, with low-to-middle income. For that reason, our final hypothesises are the following: the possibility that agri-tourism enters in the evoked-set of an individual is higher: H16: The higher the number of family members. H17: The lower the family income. Since in this study we use a path model with a PLS approach, we are able to state some interrelations among the exogenous latent variables: H18: The motive of sport holiday has a positive influence towards nature motives. H19: The physical exposition to agri-tourism has a positive influence toward information. H20: The motive of family holiday has a negative influence toward the motive of action and night life. H21: Social stimuli have a positive influence towards individuals risk perceptions. H22: Social stimuli have negative influence towards experience. Data for this study were gathered via administrated questionnaires during the summer 2007 within the frame of an academic "marketing research" course. The corresponding t-values are assessed using the bootstrapping method with 500 re-samples. In our model 61% of the degree of appreciation of German agri-tourism (evoked set) is explained by five independent variables: value for money ($0.335^{{\ast}{\ast}{\ast}}$) (H7) experience ($0.267^{{\ast}{\ast}}$) (H3), exciting image ($0.204^{\ast}$) (H6) organisation ($-0.162^{\ast}$) (H11) and holiday abroad ($-0.156^{\ast}$) (H12). The variance explained ($R^2$) for the other endogenous variables are the following: nature 24.3%, information 14.1%, action holiday 13.8%, risk perception 5.8% and experience 2.4%. An overview can be inferred from table 5. The results also allow us to test each of the proposed hypotheses. With exception of organization and abroad, none of the others travel style factors (H9 to H15) seem to have any significant impact towards evoked set which leads to the rejection of the respective hypotheses. As expected, social stimuli have a significant influence on individuals' risk perception (H21 accepted), however neither the former nor the latter have a valuable impact on evoked set (rejection of H2 and H8). Besides, since the influence of social stimuli towards experience is not significant, also H22 has to be rejected. Experience influences information (H19 accepted) but the latter does not affect significantly the evoked set (H1 rejected). Both H4 as well as H5, referring respectively to the perceived images of German agri-tourism as a wellness destination and the traditional image of the German farm tourism have to be rejected. Finally, none of the demographic data included in the model explains significantly the variance of the factor evoked set. Therefore neither H16 nor H17 has been accepted. As far as the interrelation between sport and nature (H18) and family and action (H20) are concerned, the stated relationship among these variables has been statistically confirmed. Our path model based on partial least squares shows the factors influencing the preference for farm tourism in Germany. Among others value for money and experience are the most significant ones. Practical implications are discussed.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.35 no.2
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• pp.82-87
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• 2013

Purpose: This study evaluated postoperative maxillary stabilities in patients with skeletal Class III malocclusion who were taken both maxillary advancement surgery and mandibular retrusive surgery, using Le Fort I osteotomy, through three-dimensional computed tomography. Methods: We selected 14 patients who were taken postoperative three-dimensional computerized tomography at the time before surgery, immediately after surgery, six months after surgery among the patients undergone both maxillary advancement surgery using Le Fort I osteotomy and mandibular retrusive surgery using bilateral sagittal split ramus osteotomy. We measured and compared the vertical distance of A-point and posterior nasal spine (PNS), the horizontal distance of A-point and PNS in transverse plane and coronal plane of the three-dimensional reconstructed images, respectively. Results: In transverse plane, the distance difference between immediately after surgery ($S_1$) and immediately before surgery ($S_0$) of A-point was $-0.04{\pm}1.80$ mm, $S_2$ and $S_0$ was $-0.15{\pm}1.69$ mm, and between $S_1$ and $S_2$ was $0.11{\pm}0.58$ mm. There were no significant differences between these data (P>0.05). In transverse plane, the distance between $S_1-S_0$ of PNS was $-3.87{\pm}2.37$ mm, $S_2-S_0$ of PNS was $-3.79{\pm}2.39$ mm, and $S_1-S_2$ of PNS was $-0.08{\pm}0.18$ mm. There were significant differences between these data (P<0.05). In coronal plane, the distance between $S_1-S_0$ of A-point was $3.99{\pm}0.86$ mm, $S_2-S_0$ was $3.57{\pm}1.09$ mm, and $S_1-S_2$ was $0.42{\pm}0.42$ mm. There were significant differences between these data (P<0.05). In coronal plane, the distance between $S_1-S_0$ of PNS was $3.82{\pm}0.96$ mm, $S_2-S_0$ was $3.43{\pm}0.91$ mm, and $S_1S_2$ was $0.39{\pm}0.49$ mm. There were significant differences between these data (P<0.05). In transverse plane, it was estimated that PNS has no statistical postoperative stability in the same direction. In coronal plane, it was estimated that both A-point and PNS had no statistical postoperative stability (P<0.05). Conclusion: Clinically, the operation plan needs to take into account of the maxillary relapse.

• Progress in Medical Physics
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• v.17 no.2
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• pp.61-66
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• 2006

To evaluate the T1, T2 magnetic relaxation properties of water molecule according to molecular weight of paramagnetic complex. 4-aminomethyicyclohexane carboxylic acid (0.63 g, 4 mmol) was mixed with the suspension solution of DMF (15 ml) and DTPA-bis-anhydride (0.71 g, 2 mmol) to synthesize the ligand. The ligand was then mixed with $Gd_2O_3$ (0.18 g, 0.5 mmol) to synthesize Gd-chelate. For the measurement of magnetic relaxivity of paramagnetic compounds, the compounds were diluted to 1 mM and then the relaxation times were measured at 1.57 (64 MHz). Inversion-recovery pulse sequence was employed for T1 relaxation measurement and CPMG (Carr-Purcell-Meiboon-Gill) pulse sequence was employed for T2 relaxation measurement. In case of inversion recovery sequence, total 35 images with different inversion time(T1)s ranging from 50 msec to 1,750 msec. To estimate the relaxation times, the signal intensity of each sample was measured using region of Interest (ROI) and then fitted by non-linear least square method to yield T1, T2 relaxation times and also R1 and R2. Compared to T1=($205.1{\pm}2.57$) msec and T2=($209.4{\pm}4.28$) msec of Omniscan (Gadodiamide), which is commercially available paramagnetic MR agent, T1 and T2 values of new paramagnetic complexes were reduced along with their molecular weight. That is, T1 value was ranged from $(96.35{\pm}2.04)\;to\;(79.38{\pm}1.55)$ msec and T2 value was ranged from $(91.02{\pm}2.08)\;to\;(76.66{\pm}1.84)$ msec. Among new paramagnetic complexes, there is a tendency that the R1 and R2 increase as the molecular weight is increases. As molecular weight of paramagnetic complex increases, T1 and T2 relaxation times reduce and thus the increase of relaxivity (R1 and R2) Is proportional to molecular weight.

• Progress in Medical Physics
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• v.26 no.1
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• pp.6-11
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• 2015

The purpose of this study was to analyze the rotational errors of roll, pitch, and yaw in the whole breast cancer treated by the three-dimensional radiation therapy (3D-CRT) using TomoDirect (TD). Twenty-patient previously treated with TD 3D-CRT was selected. We performed a retrospective clinical analysis based on 80 images of megavoltage computed tomography (MVCT) including the systematic and random variation with patient setup errors and treatment setup margin (mm). In addition, a rotational error (degree) for each patient was analyzed using the automatic image registration. The treatment margin of X, Y, and Z directions were 4.2 mm, 6.2 mm, and 6.4 mm, respectively. The mean value of the rotational error for roll, pitch, and yaw were $0.3^{\circ}$, $0.5^{\circ}$, $0.1^{\circ}$, and all of systematic and random error was within $1.0^{\circ}$. The errors of patient positioning with the Y and Z directions have generally been mainly higher than the X direction. The percentage in treatment fractions in less than $2^{\circ}$ at roll, pitch, and yaw are 95.1%, 98.8%, and 97.5%, respectively. However, the edge of upper and lower (i.e., bottom) based on the center of therapy region (point) will quite a possibility that it is expected to twist even longer as the length of treatment region. The patient-specific characters should be considered for the accuracy and reproducibility of treatment and it is necessary to confirm periodically the rotational errors, including patient repositioning and repeating MVCT scan.