• Title/Summary/Keyword: Multi-therapy

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Tackling range uncertainty in proton therapy: Development and evaluation of a new multi-slit prompt-gamma camera (MSPGC) system

  • Youngmo Ku;Sehoon Choi;Jaeho Cho;Sehyun Jang;Jong Hwi Jeong;Sung Hun Kim;Sungkoo Cho;Chan Hyeong Kim
    • Nuclear Engineering and Technology
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    • v.55 no.9
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    • pp.3140-3149
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    • 2023
  • In theory, the sharp dose falloff at the distal end of a proton beam allows for high conformal dose to the target. However, conformity has not been fully achieved in practice, primarily due to beam range uncertainty, which is approximately 4% and varies slightly across institutions. To address this issue, we developed a new range verification system prototype: a multi-slit prompt-gamma camera (MSPGC). This system features high prompt-gamma detection sensitivity, an advanced range estimation algorithm, and a precise camera positioning system. We evaluated the range measurement precision of the prototype for single spot beams with varying energies, proton quantities, and positions, as well as for spot-scanning proton beams in a simulated SSPT treatment using a phantom. Our results demonstrated high accuracy (<0.4 mm) in range measurement for the tested beam energies and positions. Measurement precision increased significantly with the number of protons, achieving 1% precision with 5 × 108 protons. For spot-scanning proton beams, the prototype ensured more than 5 × 108 protons per spot with a 7 mm or larger spot aggregation, achieving 1% range measurement precision. Based on these findings, we anticipate that the clinical application of the new prototype will reduce range uncertainty (currently approximately 4%) to 1% or less.

Replantation of Multi-level Amputated Digit (다중절단수지의 재접합술)

  • Kwon, Soon-Beom;Park, Ji-Ung;Cho, Sang-Hun;Seo, Hyung-Kyo;Whang, Jong-Ick
    • Archives of Plastic Surgery
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    • v.38 no.5
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    • pp.642-648
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    • 2011
  • Purpose: The recent advances in microsurgical techniques and their refinement over the past decade have greatly expanded the indications for digital replantations and have enabled us to salvage severed fingers more often. Many studies have reported greater than 80% viability rates in replantation surgery with functional results. However, replantation of multi-level amputations still remain a challenging problem and the decision of whether or not to replant an amputated part is difficult even for an experienced reconstructive surgeon because the ultimate functional result is unpredictable. Methods: Between January of 2002 and May of 2008, we treated 10 multi-level amputated digits of 7 patients. After brachial plexus block, meticulous replantation procedure was performed under microscopic magnification. Postoperatively, hand elevation, heat lamp, drug therapy and hyperbaric oxygen therapy were applied with careful observation of digital circulation. Early rehabilitation protocol was performed for functional improvement. Results: Among the 19 amputated segments of 10 digits, 16 segments survived completely without any complications. Overall survival rate was 84%. Complete necrosis of one finger tip segment and partial necrosis of two distal amputated segments developed and subsequent surgical interventions such as groin flap, local advancement flap and skin graft were performed. The overall result was functionally and aesthetically satisfactory. Conclusion: We experienced successful replantations of multi-level amputated digits. When we encounter a multi-level amputation, the key question is whether or not it is a contraindication to replantation. Despite the demand for skillful microsurgical technique and longer operative time, the authors' results prove it is worth attempting replantations in multi-level amputation because of the superiority in aesthetic and functional results.

The effects of Breif, Intense Transecutaneous Electrical Nerve Stimulation on Nerve conduction, Pain Threshold in Healthy subjects (Brief, Intense TENS 자극이 신경전도, 통증역치의 변화에 미치는 효과)

  • Kim Tae-Youl;Hwang Tae-Yeun;Huh Choon-Bok
    • The Journal of Korean Physical Therapy
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    • v.6 no.1
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    • pp.171-183
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    • 1994
  • Purphose. This present study examines the effect of brief, intense transcutaneous electrical nerve stimulation(BTENS) on sensory nerve conduction, electrical pain threshold, and two-point discrimination measured at the superficial radial nevre distribution in 20 healthy subjects. Subjects. Twenty volunteercs, (10 females and 10 males(age range : 20-38 years : $mean{\pm}SD\;:\;27.00{\pm}5.12$), only subjects without prior traumatological and pathological were eligible to participated in this study. Methods. Nerve conduction were determined for the right superficial radial nerve. Electrical pain threshold were determined for the right wrist ipsilateral to the site of BTENS. Small disc electrodes were attached to the surface of the skin stradding the end of the radius. Square wave electrical pulses were delivered from an isolated stimulator through a constant current device at a frequency of 2 Hz(5 ms pulse width). Two-point discrimination, measured on the sensory distribution of superficial radial nerve. BTENS was delivered using a Max-SD( Medical design co.) portable battery powered stimulator. A cicular Ag/AgCl electrode in contact with hypertonic saline gel was attached to the lateral(radial side) surface of the forearm. Results. No significant effects were observed between stimulation methods in the prestimulation cycle(multi-way ANOVA repeated measures : distal latency ; F1.14=0.332. amplitude ; F 0.80=0.445, pain threshold ; F0.06=0.940.2 point discrimination ; F1.50=0.236). Highly significant effects were observed time with the pretreatment and 6 posttreatment cycles(p<0.01). Mighty significants differences in nerve conduction and pain threshold were found using un multi-way ANOVA repeated measures among stimulation methods for each cycles(p<0.01). Conclusion and Discussion The authors concludes that both nerve conduction and pain threshold changes are associated with therapy (stimulation) level of BTENS.

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The effect of the multi intervention program applying to dementia elderly (치매노인에게 적용한 복합 중재프로그램의 효과 비교 연구)

  • Kim, Hee-Jung;Lee, Chun-Yeop;Jung, Hye-Rim;Lee, Gyu-Han;Kim, Dong-Hyun
    • The Journal of Korean society of community based occupational therapy
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    • v.5 no.2
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    • pp.11-21
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    • 2015
  • Objective : We tried to know the effect on the ability of work performance, cognitive, balance, depression, ability of daily living, the quality of life, and time usage after applying the group cognitive therapy that based on lifestyle redesign to dementia elderly. Methods : We performanced the group cognitive therapy that based on lifestyle redesign to 15 dementia elderly for 12weeks by total 5 steps. We evaluated the ability of work performance(COPM), cognitive(MMSE-DS), balance(BBS), depression(GDS-K), ability of daily living(MBI), the quality of life(GQOL-D), and time usage(OQ) of before and after the programme. Results : There was a significant difference of the ability of work performance, balance, the quality of life, and locomotive area of time usage after applying the group cognitive therapy that based on lifestyle redesign to dementia elderly. Conclusion : The group cognitive therapy that based on lifestyle redesign programme is effective for satisfaction of work performance and improvement of the quality of life and balance ability. The programme is also effective for locomotive area of time usage. We found out the effect of the programme in variety of the life of dementia elderly.

Paraaortic node를 포함하는 자궁 경부암 치료시 효율적인 MLC사용에 대한 고찰

  • 최지민;김종식;조현상;박영환
    • The Journal of Korean Society for Radiation Therapy
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    • v.13 no.1
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    • pp.122-125
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    • 2001
  • I. 목적 : Primus의 Multi Leaf Collimator는 X측이 29쌍으로 이루어 져 있으며 그중27쌍의 leaf은 1cm이고 2쌍은 6.5cm의 leaf으로 구성되어있다. 이러한 이유로 Paraaortic node를 포함하는 자궁경부암 치료시 현재는 Y가 27cm 이상인 경우는 차폐블럭을 제작하여 치료를 시행하나 차폐 블럭의 제작에 따른 업무의 지연과 차폐 블럭이 무거워져 치료시 환자에게 떨어질 위험을 제거 하기 위해 Asymmetric Field로 Multi Leaf Collimator를 사용한 결과를 보고하고자 한다. II. 재료 및 방법 : 모의 치료(Ximatron, Varian, USA)시 $Y_1$측을 15cm을 기준으로 하여 $Y_2$측을 변경하면서 Field size를 결정한다. ($Y_2$측은 20cm가 최대, 즉 Y측은 35cm까지 적용) 이러한 방법으로 Multi Leaf Collimator를 사용한 환자와 기존의 차폐블럭을 제작하여 치료한 환자와의 업무 개선사항을 확인하기 위하여 실제 공작실 업무 담당자의 블럭 제작 시간과 Beam Shaper를 이 용해 Multi Leaf Collimator를 입력하는 시간을 상호 비교하여 단축된 시간을 조사하였다. III. 결과 : 차폐블럭을 대신해 Multi Leaf Collimator를 이용함으로써 치료실에서 환자에 대한 위험요소(차폐블럭이 무겁다)를 사전에 제거 할 수 있었고 공작실에서 블럭 제작 시간과 LANTIS를 이용해 MLC를 입력하는 시간을 실측 한 결과업무의 시간이 120분에서 5분으로 단축되는 효과가 있었다. 전산화 계획 실에서 선량 계산시 OAR Factor값을 고려하여야 한다. IV. 결론 : Paraaortic node를 포함한 자궁경부암 환자의 차폐부위는 모양이 거의 일직선이기 때문에 Mu]ti Leaf Collimator를 사용하기에 용이 한 치료 부위이다. 하지만 큰 Field size로 인한 불편함이 있었다. 이러한 제 약성을 Asymmetric Field를 이용해서 Multi Leaf Collimator의 사용을 가능하게 하고 차폐 블록의 제작과정과 치료 시에 발생되는 근무자의 업무의 손실을 줄이고 환자에 대한 위험성 을 해결하였다.

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Fabry disease: current treatment and future perspective

  • Han-Wook Yoo
    • Journal of Genetic Medicine
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    • v.20 no.1
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    • pp.6-14
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    • 2023
  • Fabry disease (FD), a rare X-linked lysosomal storage disorder, is caused by mutations in the α-galactosidase A gene gene encoding α-galactosidase A (α-Gal A). The functional deficiency of α-Gal A results in progressive accumulation of neutral glycosphingolipids, causing multi-organ damages including cardiac, renal, cerebrovascular systems. The current treatment is comprised of enzyme replacement therapy (ERT), oral pharmacological chaperone therapy and adjunctive supportive therapy. ERT has been introduced 20 years ago, changing the outcome of FD patients with proven effectiveness. However, FD patients have many unmet needs. ERT needs a life-long intravenous therapy, inefficient bio-distribution, and generation of anti-drug antibodies. Migalastat, a pharmacological chaperone, augmenting α-Gal A enzyme activity only in patients with mutations amenable to the therapy, is now available for clinical practice. Furthermore, these therapies should be initiated before the organ damage becomes irreversible. Development of novel drugs aim at improving the clinical effectiveness and convenience of therapy. Clinical trial of next generation ERT is underway. Polyethylene glycolylated enzyme has a longer half-life and potentially reduced antigenicity, compared with standard preparations with longer dosing interval. Moss-derived enzyme has a higher affinity for mannose receptors, and seems to have more efficient access to podocytes of kidney which is relatively resistant to reach by conventional ERT. Substrate reduction therapy is currently under clinical trial. Gene therapy has now been started in several clinical trials using in vivo and ex vivo technologies. Early results are emerging. Other strategic approaches at preclinical research level are stem cell-based therapy with genome editing and systemic mRNA therapy.

New algorithm to estimate proton beam range for multi-slit prompt-gamma camera

  • Ku, Youngmo;Jung, Jaerin;Kim, Chan Hyeong
    • Nuclear Engineering and Technology
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    • v.54 no.9
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    • pp.3422-3428
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    • 2022
  • The prompt gamma imaging (PGI) technique is considered as one of the most promising approaches to estimate the range of proton beam in the patient and unlock the full potential of proton therapy. In the PGI technique, a dedicated algorithm is required to estimate the range of the proton beam from the prompt gamma (PG) distribution acquired by a PGI system. In the present study, a new range estimation algorithm was developed for a multi-slit prompt-gamma camera, one of PGI systems, to estimate the range of proton beam with high accuracy. The performance of the developed algorithm was evaluated by Monte Carlo simulations for various beam/phantom combinations. Our results generally show that the developed algorithm is very robust, showing very high accuracy and precision for all the cases considered in the present study. The range estimation accuracy of the developed algorithm was 0.5-1.7 mm, which is approximately 1% of beam range, for 1×109 protons. Even for the typical number of protons for a spot (1×108), the range estimation accuracy of the developed algorithm was 2.1-4.6 mm and smaller than the range uncertainties and typical safety margin, while that of the existing algorithm was 2.5-9.6 mm.

An Implementation of Art-Therapy Service Based on Multi-Agent Technology (멀티 에이전트 기술을 이용한 Art-Therapy 서비스의 구현)

  • Ha, J.L.;Bae, J.S.;Yoon, S.I.;Kim, S.H.
    • Electronics and Telecommunications Trends
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    • v.19 no.3 s.87
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    • pp.107-116
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    • 2004
  • 지금까지의 정보통신 서비스는 사용자에게 필요한 정보를 제공하거나 사용자와 사용자를 연결해주는 통로로서의 서비스를 제공하여 왔으나, 유비쿼터스 컴퓨팅과 유비쿼터스 네트워크 기술을 기반으로 한 유비쿼터스 서비스는 사용자가 처한 상황에 기반하여 정보 제공은 물론 필요한 행위까지도 제공하여 사용자의 욕구에 가장 근접한 서비스 제공에 초점을 두는 컨시어지형 서비스가 될 것이다. 이러한 서비스는 사용자의 기호 및 상태, 또는 상황 등의 다양한 정보에 근거하여 서비스를 제공할 수 있어야 하며, 이를 위한 효과적인 접근 방법으로는 사용자의 다양한 정보를 각각의 대리자에게 처리를 하게 하는 멀티 에이전트 기술일 것이다. 본 연구에서는 음악이나 그림을 활용하여 신체적, 정신적 질환을 치료하는 음악 치료나 그림 치료인 Art-Therapy를 유비쿼터스 서비스의 구현 사례로 기술한다. 사용자의 신체적 또는 정신적 상태 및 환경 정보를 센서를 활용하여 측정하고 그 측정된 데이터에 근거하여 사용자의 상태를 판단하고 이에 따라 음악 및 미술 작품을 시청각으로 제공함으로써 치료 효과를 얻는다. 본 연구에서의 Art-Therapy 서비스는 FIPA에서 제안한 멀티 에이전트 기반 구조인 에이전트 플랫폼을 기반으로 구현하였다.