Proceedings of the Korea Contents Association Conference
/
2009.05a
/
pp.1141-1149
/
2009
In Bone Mineral Density(BMD) measurements, accuracy and precision must be superior in order to know the small changes in bone mineral density and actual biological changes. Therefore the purpose of this study is to increase the reliability of bone mineral density inspection through appropriate management of image quality from machines and inspectors. For the machine management method, the recommended phantom from each bone mineral density machine manufacturer was used to take 10~25 measurements to determine the standard amount and permitted limit. On each inspection day, measurements were taken everyday or at least three times per week to verify the whether or not change existed in the amount of actual bone mineral density. Also evaluations following Shewhart control chart and CUSUM control chart rules were made for the bone mineral density figures from the phantoms used for measurements. Various forms of management became necessary for machine installation and movement. For the management methods of inspectors, evaluation of the measurement precision was conducted by testing the reproducibility of the exact same figures without any real biological changes occurring during reinspection. There were two measurement methods followed: patients were either measured twice with 30 measurements or three times with 15 measurements. An important point to make regarding measurements is that after the first inspection and any other inspection following, the patient was required to come off the inspection table completely and then get back on for any further measurements. With a 95% confidence level, the precision error produced from the measurement bone mineral figures produced a precision error of 2.77 times the minimum of the biological bone mineral density change (Least significant change: LSC). In order to assure reliability in inspection, there needs to be good oversight of machine management and measurer for machine operation and inspection error. Accuracy error in machines needs to be reduced to under 1% for scientific development in bone mineral density machines.
This research is conducted to identify whether an m-DIXON technique which is useful for an abdomen MRI examination compared with an existing e-THRIVE technique is a clinically useful or not. There was evaluated quantitative and qualitative to 84 subjects who had abdomen MRI exam due to their liver disease were conducted during a period from September in 2013 to February in 2014. First of all the quantitative evaluation, the m-DIXON technique's SNR was $90.42{\pm}16.90$ and the e-THRIVE technique was $60.42{\pm}11.54$ and the m-DIXON technique's CNR was $52.38{\pm}22.58$ and the e-THRIVE technique was $46.31{\pm}20.25$. Secondly in the qualitative evaluation, the m-DIXON technique's image quality was $4.06{\pm}0.34$, a artifact was $3.64{\pm}0.22$, and fat suppression was $4.16{\pm}0.15$, the e-THRIVE technique's image quality was $3.14{\pm}0.35$, a artifact was $3.06{\pm}0.38$, fat suppression was $3.14{\pm}0.30$. In conclusion, m-DIXON technique for abdomen MRI examination showed superiority over both SNR as a quantitative anaylsis, CNR and a qualitative analysis.
In this study, When acquisition thyroid scintigraphy images, a parallel hole collimator was applied, and the difference from the pinhole collimator was quantitatively analyzed under each image acquisition condition. Visual size, resolution, sensitivity, signal to noise ratio (SNR), and contrast to noise ratio (CNR) were evaluated using thyroid phantom and point source. When comparing visual size, it was confirmed that an image similar to the size of the pinhole collimator could be obtained only when a magnification ratio of about 2.00 to 2.09 times when applying a parallel hole collimator. There was no tendency in FWHM(mm) measurement using a point source, and sensitivity was high in the parallel hole collimator. SNR and CNR were high when using a low magnification ratio, matrix size of 128×128, and a parallel hole collimator. In images of similar size to the naked eye, when the matrix size was the same, both SNR and CNR were high in the pinhole collimator. Therefore, when performing a thyroid scintigraphy test, if appropriate conditions are set according to the situation of each hospital and a parallel hole collimator is applied, it can be a good option in terms of equipment utilization and work efficiency.
The image quality management of bone mineral density is the responsibility and duty of radiologists who carry out examinations. However, inaccurate conclusions due to lack of understanding and ignorance regarding the methodology of image quality management can be a fatal error to the patient. Therefore, objective of this paper is to understand proper image quality management and enumerate methods for examiners and patients, thereby ensuring the reliability of bone mineral density exams. The accuracy and precision of bone mineral density measurements must be at the highest level so that actual biological changes can be detected with even slight changes in bone mineral density. Accuracy and precision should be continuously preserved for image quality of machines. Those factors will contribute to ensure the reliability in bone mineral density exams. Proper equipment management or control methods are set with correcting equipment each morning and after image quality management, a phantom, recommended from the manufacturer, is used for ten to twenty-five measurements in search of a mean value with a permissible range of ${\pm}1.5%$ set as standard. There needs to be daily measurement inspections on the phantom or at least inspections three times a week in order to confirm the existence or nonexistence of changes in values in actual bone mineral density. in addition, bone mineral density measurements were evaluated and recorded following the rules of Shewhart control chart. This type of management has to be conducted for the installation and movement of equipment. For the management methods of inspectors, evaluation of the measurement precision was conducted by testing the reproducibility of the exact same figures without any real biological changes occurring during reinspection. Bone mineral density inspection was applied as the measurement method for patients either taking two measurements thirty times or three measurements fifteen times. An important point when taking measurements was after a measurement whether it was the second or third examination, it was required to descend from the table and then reascend. With a 95% confidence level, the precision error produced from the measurement bone mineral figures came to 2.77 times the minimum of the biological bone mineral density change. The value produced can be stated as the least significant change (LSC) and in the case the value is greater, it can be stated as a section of genuine biological change. From the initial inspection to equipment moving and shifter, management must be carried out and continued in order to achieve the effects. The enforcement of proper quality control of radiologists performing bone mineral density inspections which brings about the durability extensions of equipment and accurate results of calculations will help the assurance of reliable inspections.
Purpose: Aortic Dissection is very dangerous, prognostic disease, which the bloodstream flow out of the true lumen of the aorta by the bursting of aortic intima resulting in a rapid dissociation of inner and outer layer from the media. It is difficult to diagnose aortic dissection clinically by normal X-ray. This study was to investigate the occurrence frequency by age and number of patients who are identified to be aortic dissection by CT (Computed Tomography) scan. Materials and methods: We investigated the trend of yearly fluctuation, gender, age, and department of clinical research of the 112 patients who conducted CT scan in C- University Hospital for two years from January 2005 to December 2006. The MIP and SSD which reconstructed CT image and the VRT image were obtained for the accurate observation. The result was investigated by comparing normal X-ray and CT scan. Results and Conclusion: 1. The yearly check of 112 patients conducted CT scan showed 37 people (41.9%) in 2005, and it was increased to 65 (58.1%) in 2006 by 1.4 times. 2. The gender distribution of patients given a CT scan showed 45 males (40.1%), and female 67 (59.9 %). The aortic dissection patients were 9 (20%) out of 45 males, 21 (31.3%) out of 67 females and women were 1.6 times more than men. Women are also 1.5 times more than men in the number of examinee. 3. The age distribution of patient's who conducted CT scan revealed that there was no patient under 30 years old while 88.3% of all patients were through 41 to 80 years old. The higher the age was, the higher the occurrence of aortic dissection was. The difference in the occurrence frequency of age was statistically significant (p<0.01). 4. The departments that requested CT scan were the emergency department 46 (41.1%), circulatory internal medicine 37 (33.0%), chest surgery 13 (11.6%), and others 6 (14.3%). The combined ratio of emergency medicine and circulatory internal medicine was 74.1% of all. The results show that the aortic dissection is a very dangerous disease whose patients visit mainly via the emergency room. 5. The aortic dissection patients had normal X-ray readings in 22 (73.3%) out of 30, and only 8 (26.7 percent) are abnormal in the X-ray diagnosis. Therefore, the CT scan needs to be enforced in order to assess accurately the disease of aortic dissection.
$^{68}Ga$ was eluted from a $^{68}Ge/^{68}Ga$ radionuclide generator. $^{68}Ga$ decays into $^{68}Zn$, with a half life=67.8min. The decay is 88.9 % by ${\beta}$+ and 11.1 % by EC. The main ${\beta}$+ decay (87.7 %) is to the ground level of $^{68}Zn$ and it is a pure positron emission branch. A small fraction decays ${\beta}$+ (1.2 %) into an excited level of $^{68}Zn$, which promptly decays into the ground level with a ${\gamma}$ (1.077 Mev). This can constitute prompt gamma contamination in the PET data, if the 1.077 Mev ${\gamma}$ has a scatter interaction in the patient, and generates a lower energy ${\gamma}$ in coincidence with the positron annihilation pair. The purpose of this study was to evaluate standardized uptake value(SUV) before and after applying prompt gamma rays correction on $^{68}Ga$-DOTATOC PET/CT image. Fifty patient underwent PET/CT 1 hour after injection of the $^{68}Ga$-DOTATOC. The SUVmax and SUVmean of lesions and normal tissues (Pituitary, Lung, Liver, Spleen, Kidney, Intestine) were evaluated before and after applying prompt gamma correction on $^{68}Ga$-DOTATOC PET/CT image. Additionally, the SUVmax of each lesions and SUVmean of the soft tissues were measured on images. and target to background ratios (TBR) were calculated as quantitative indices. Among 15 patients, 25 of lesions (Pancreas, Liver, Thoracic Spine, Brain) with increased uptake on $^{68}Ga$-DOTATOC PET/CT image. SUVmax and SUVmean were increased in lesion site and normal tissue after prompt gamma rays correction. TBR was $51.51{\pm}49.28$ and $55.50{\pm}53.12$ before and after prompt gamma rays correction, respectively. (p<0.0001)
Purpose: Chronic pulmonary disease may be caused by aspiration of gastric contents secondary to gastroesophageal reflux. At present, there is no gold standard for documenting pulmonary aspiration. The purpose of this study was to investigate the usefulness of radionuclide scintigraphy in the detection of gastroesophageal reflux and pulmonary aspiration. Methods: Thirty-five patients with suspected aspiration pneumonia, and five normal control subjects, were included in the study. All subjects underwent gastroesophageal reflux scintigraphy after the ingestion of a $^{99m}Tc$-tin colloid mixture. Dynamic images to detect gastroesophageal reflux were obtained for 1 hour. Additional static images of the chest, to detect lung aspiration, were obtained at 6 and 24 hours after oral ingestion of the tin colloid. In addition to visual analysis, pulmonary aspiration was quantitated by counting the number of pixels labeled with radioactive isotope in the region of interest (ROI) of both lung fields. Aspiration index (AI) was obtained by subtracting the pixel counts of the background from the pixel counts of the ROI. Results: Among 35 patients with suspected aspiration pneumonia, 23 proved to have gastroesophageal reflux by scintigraphy. One patient showed definite pulmonary accumulation of activity by visual analysis of the 6-hour image. Thirty of 35 (85.7%) patients showed higher AI beyond the upper limit of AI in the healthy controls. When we compared the reflux group with the non-reflux group, there was a significantly higher AI at 6 hours in the reflux group (p<0.05). Conclusion: The results suggest that radionuclide scintigraphy is useful in detecting small pulmonary aspiration in patients with suspected aspiration pneumonia secondary to reflux.
Kim, Eun Ju;Kim, Daehong;Lee, Sangwoo;Heo, Dan;Lee, Young Han;Suh, Jin-Suck
Investigative Magnetic Resonance Imaging
/
v.18
no.1
/
pp.52-58
/
2014
Purpose : To establish a pH measurement system for a mouse tumor study using a clinical scanner, to develop the $^1H$ and 31P radio frequency (RF) coil system and to test pH accuracy with phantoms. Materials and Methods: The $^1H$ and the $^{31}P$ surface coils were designed to acquire signals from mouse tumors. Two coils were positioned orthogonally for geometric decoupling. The pH values of various pH phantoms were calculated using the $^1H$ decoupled $^{31}P$ MR spectrum with the Henderson-Hasselbalch equation. The calculated pH value was compared to that of a pH meter. Results: The mutual coil coupling was shown in a standard $S_{12}$. Coil coupling ($S_{12}$) were -73.0 and -62.3 dB respectively. The signal-to-noise ratio (SNR) obtained from the homogeneous phantom $^1H$ image was greater than 300. The high resolution in vivo mice images were acquired using a $^{31}P$-decoupled $^1H$ coil. The pH values calculated from the $^1H$-decoupled $^{31}P$ spectrum correlated well with the values measured by pH meter ($R^2$=0.97). Conclusion: Accurate pH values can be acquired using a $^1H$-decoupled $^{31}P$ RF coil with a clinical scanner. This two-surface coil system could be applied to other nuclear MRS or MRI.
The current PET/CT system with high quality CT images not only increases diagnostic value by providing anatomic localization, but also shortens the acquisition time for attenuation correction than primary PET system. All commercially available PET/CT system uses the CT scan for attenuation correction instead of the transmission scan using radioactive source such as $^{137}Cs,\;^{68}Ge$. However the CT scan may substantially increase the patient dose. The purpose of this study was to evaluate quality of PET images reconstructed by CT attenuation map using various tube currents. in this study, images were acquired for 3D Hoffman brain phantom and cylindrical phantom using GE DSTe PET/CT system. The emission data were acquired for 10 min using phantoms after injecting 44.03 MBq of $^{18}F-FDG$. The CT images for attenuation map were acquired by changing tube current from 10 mA to 95 mA with fixed exposure time of 8 sec and fixed tube voltage of 140 kVp. The PET images were reconstructed using these CT attenuation maps. Image quality of CT images was evaluated by measuring SD (standard deviation) of cylindrical phantom which was filled with water and $^{18}F-FDG$ solution. The PET images were evaluated by measuring the activity ratio between gray matter and white matter in Hoffman phantom images. SDs of CT images decrease by increasing tube current. When PET images were reconstructed using CT attenuation maps with various tube currents, the activity ratios between gray matter and white matter of PET images were almost same. These results indicated that the quality of the PET images using low dose CT data were comparable to the PET images using general dose CT data. Therefore, the use of low dose CT is recommended than the use of general dose CT, when the diagnostic high quality CT is not required. Further studies may need to be performed for other system, since this study is limited to the GE DSTe system used in this study.
Effects of Gamma camera imaging on gamma ray counting rates as a function of use and density of the iodine contrast medium currently in primary use for clinics, and changes in gamma ray counting rates as a function of the contrast medium status upon attenuation correction using a CT absorption coefficient in an SPECT/CT attenuation correction will be considered herein. For experimental materials used $^{99m}TcO_4$ 370 MBq and Pamiray 370 mg, Iomeron 350 mg, Visipaque 320 mg, Bonorex 300 mg of iodine contrast medium. For image acquisition, planar imaging was consecutively filmed for 1, 2, 3, 4, 5 min, respectively, 30 min after administration of $^{99m}TcO_4$. while 60 views were filmed per frame for 20 min at 55 min for the SPECT/CT imaging. In planar imaging, the gamma ray counting rates as a function of filming time were reduced showing a statistically significant difference when mixed according to the type of contrast medium density rather than when the radioactive isotope $^{99m}TcO_4$ and the saline solution were mixed. In the tomography for mixing of the radioactive isotope $^{99m}TcO_4$ and saline solution, the mean counting rate without correction by the CT absorption coefficient is $182{\pm}26counts$, while the counting rate with correction by the CT absorption coefficient is $531.3{\pm}34counts$. In the tomography for mixing of the radioactive isotope $^{99m}TcO_4$ and the saline solution with the contrast medium, the mean values before attenuation correction by CT absorption coefficient were $166{\pm}29$, $158.3{\pm}17$, $154{\pm}36$, and $150{\pm}33counts$ depending on the densities of the contrast medium, while the mean values after attenuation correction were $515{\pm}03$, $503{\pm}10$, $496{\pm}31$, and $488.7{\pm}33counts$, showing significant differences in both cases when comparatively evaluated with the imaging for no mixing of the contrast medium. Iodine contrast medium affects the rate of gamma ray. Therefore, You should always be preceded before another test on the day of dignosis.
본 웹사이트에 게시된 이메일 주소가 전자우편 수집 프로그램이나
그 밖의 기술적 장치를 이용하여 무단으로 수집되는 것을 거부하며,
이를 위반시 정보통신망법에 의해 형사 처벌됨을 유념하시기 바랍니다.
[게시일 2004년 10월 1일]
이용약관
제 1 장 총칙
제 1 조 (목적)
이 이용약관은 KoreaScience 홈페이지(이하 “당 사이트”)에서 제공하는 인터넷 서비스(이하 '서비스')의 가입조건 및 이용에 관한 제반 사항과 기타 필요한 사항을 구체적으로 규정함을 목적으로 합니다.
제 2 조 (용어의 정의)
① "이용자"라 함은 당 사이트에 접속하여 이 약관에 따라 당 사이트가 제공하는 서비스를 받는 회원 및 비회원을
말합니다.
② "회원"이라 함은 서비스를 이용하기 위하여 당 사이트에 개인정보를 제공하여 아이디(ID)와 비밀번호를 부여
받은 자를 말합니다.
③ "회원 아이디(ID)"라 함은 회원의 식별 및 서비스 이용을 위하여 자신이 선정한 문자 및 숫자의 조합을
말합니다.
④ "비밀번호(패스워드)"라 함은 회원이 자신의 비밀보호를 위하여 선정한 문자 및 숫자의 조합을 말합니다.
제 3 조 (이용약관의 효력 및 변경)
① 이 약관은 당 사이트에 게시하거나 기타의 방법으로 회원에게 공지함으로써 효력이 발생합니다.
② 당 사이트는 이 약관을 개정할 경우에 적용일자 및 개정사유를 명시하여 현행 약관과 함께 당 사이트의
초기화면에 그 적용일자 7일 이전부터 적용일자 전일까지 공지합니다. 다만, 회원에게 불리하게 약관내용을
변경하는 경우에는 최소한 30일 이상의 사전 유예기간을 두고 공지합니다. 이 경우 당 사이트는 개정 전
내용과 개정 후 내용을 명확하게 비교하여 이용자가 알기 쉽도록 표시합니다.
제 4 조(약관 외 준칙)
① 이 약관은 당 사이트가 제공하는 서비스에 관한 이용안내와 함께 적용됩니다.
② 이 약관에 명시되지 아니한 사항은 관계법령의 규정이 적용됩니다.
제 2 장 이용계약의 체결
제 5 조 (이용계약의 성립 등)
① 이용계약은 이용고객이 당 사이트가 정한 약관에 「동의합니다」를 선택하고, 당 사이트가 정한
온라인신청양식을 작성하여 서비스 이용을 신청한 후, 당 사이트가 이를 승낙함으로써 성립합니다.
② 제1항의 승낙은 당 사이트가 제공하는 과학기술정보검색, 맞춤정보, 서지정보 등 다른 서비스의 이용승낙을
포함합니다.
제 6 조 (회원가입)
서비스를 이용하고자 하는 고객은 당 사이트에서 정한 회원가입양식에 개인정보를 기재하여 가입을 하여야 합니다.
제 7 조 (개인정보의 보호 및 사용)
당 사이트는 관계법령이 정하는 바에 따라 회원 등록정보를 포함한 회원의 개인정보를 보호하기 위해 노력합니다. 회원 개인정보의 보호 및 사용에 대해서는 관련법령 및 당 사이트의 개인정보 보호정책이 적용됩니다.
제 8 조 (이용 신청의 승낙과 제한)
① 당 사이트는 제6조의 규정에 의한 이용신청고객에 대하여 서비스 이용을 승낙합니다.
② 당 사이트는 아래사항에 해당하는 경우에 대해서 승낙하지 아니 합니다.
- 이용계약 신청서의 내용을 허위로 기재한 경우
- 기타 규정한 제반사항을 위반하며 신청하는 경우
제 9 조 (회원 ID 부여 및 변경 등)
① 당 사이트는 이용고객에 대하여 약관에 정하는 바에 따라 자신이 선정한 회원 ID를 부여합니다.
② 회원 ID는 원칙적으로 변경이 불가하며 부득이한 사유로 인하여 변경 하고자 하는 경우에는 해당 ID를
해지하고 재가입해야 합니다.
③ 기타 회원 개인정보 관리 및 변경 등에 관한 사항은 서비스별 안내에 정하는 바에 의합니다.
제 3 장 계약 당사자의 의무
제 10 조 (KISTI의 의무)
① 당 사이트는 이용고객이 희망한 서비스 제공 개시일에 특별한 사정이 없는 한 서비스를 이용할 수 있도록
하여야 합니다.
② 당 사이트는 개인정보 보호를 위해 보안시스템을 구축하며 개인정보 보호정책을 공시하고 준수합니다.
③ 당 사이트는 회원으로부터 제기되는 의견이나 불만이 정당하다고 객관적으로 인정될 경우에는 적절한 절차를
거쳐 즉시 처리하여야 합니다. 다만, 즉시 처리가 곤란한 경우는 회원에게 그 사유와 처리일정을 통보하여야
합니다.
제 11 조 (회원의 의무)
① 이용자는 회원가입 신청 또는 회원정보 변경 시 실명으로 모든 사항을 사실에 근거하여 작성하여야 하며,
허위 또는 타인의 정보를 등록할 경우 일체의 권리를 주장할 수 없습니다.
② 당 사이트가 관계법령 및 개인정보 보호정책에 의거하여 그 책임을 지는 경우를 제외하고 회원에게 부여된
ID의 비밀번호 관리소홀, 부정사용에 의하여 발생하는 모든 결과에 대한 책임은 회원에게 있습니다.
③ 회원은 당 사이트 및 제 3자의 지적 재산권을 침해해서는 안 됩니다.
제 4 장 서비스의 이용
제 12 조 (서비스 이용 시간)
① 서비스 이용은 당 사이트의 업무상 또는 기술상 특별한 지장이 없는 한 연중무휴, 1일 24시간 운영을
원칙으로 합니다. 단, 당 사이트는 시스템 정기점검, 증설 및 교체를 위해 당 사이트가 정한 날이나 시간에
서비스를 일시 중단할 수 있으며, 예정되어 있는 작업으로 인한 서비스 일시중단은 당 사이트 홈페이지를
통해 사전에 공지합니다.
② 당 사이트는 서비스를 특정범위로 분할하여 각 범위별로 이용가능시간을 별도로 지정할 수 있습니다. 다만
이 경우 그 내용을 공지합니다.
제 13 조 (홈페이지 저작권)
① NDSL에서 제공하는 모든 저작물의 저작권은 원저작자에게 있으며, KISTI는 복제/배포/전송권을 확보하고
있습니다.
② NDSL에서 제공하는 콘텐츠를 상업적 및 기타 영리목적으로 복제/배포/전송할 경우 사전에 KISTI의 허락을
받아야 합니다.
③ NDSL에서 제공하는 콘텐츠를 보도, 비평, 교육, 연구 등을 위하여 정당한 범위 안에서 공정한 관행에
합치되게 인용할 수 있습니다.
④ NDSL에서 제공하는 콘텐츠를 무단 복제, 전송, 배포 기타 저작권법에 위반되는 방법으로 이용할 경우
저작권법 제136조에 따라 5년 이하의 징역 또는 5천만 원 이하의 벌금에 처해질 수 있습니다.
제 14 조 (유료서비스)
① 당 사이트 및 협력기관이 정한 유료서비스(원문복사 등)는 별도로 정해진 바에 따르며, 변경사항은 시행 전에
당 사이트 홈페이지를 통하여 회원에게 공지합니다.
② 유료서비스를 이용하려는 회원은 정해진 요금체계에 따라 요금을 납부해야 합니다.
제 5 장 계약 해지 및 이용 제한
제 15 조 (계약 해지)
회원이 이용계약을 해지하고자 하는 때에는 [가입해지] 메뉴를 이용해 직접 해지해야 합니다.
제 16 조 (서비스 이용제한)
① 당 사이트는 회원이 서비스 이용내용에 있어서 본 약관 제 11조 내용을 위반하거나, 다음 각 호에 해당하는
경우 서비스 이용을 제한할 수 있습니다.
- 2년 이상 서비스를 이용한 적이 없는 경우
- 기타 정상적인 서비스 운영에 방해가 될 경우
② 상기 이용제한 규정에 따라 서비스를 이용하는 회원에게 서비스 이용에 대하여 별도 공지 없이 서비스 이용의
일시정지, 이용계약 해지 할 수 있습니다.
제 17 조 (전자우편주소 수집 금지)
회원은 전자우편주소 추출기 등을 이용하여 전자우편주소를 수집 또는 제3자에게 제공할 수 없습니다.
제 6 장 손해배상 및 기타사항
제 18 조 (손해배상)
당 사이트는 무료로 제공되는 서비스와 관련하여 회원에게 어떠한 손해가 발생하더라도 당 사이트가 고의 또는 과실로 인한 손해발생을 제외하고는 이에 대하여 책임을 부담하지 아니합니다.
제 19 조 (관할 법원)
서비스 이용으로 발생한 분쟁에 대해 소송이 제기되는 경우 민사 소송법상의 관할 법원에 제기합니다.
[부 칙]
1. (시행일) 이 약관은 2016년 9월 5일부터 적용되며, 종전 약관은 본 약관으로 대체되며, 개정된 약관의 적용일 이전 가입자도 개정된 약관의 적용을 받습니다.