• The Journal of Korean Society for Radiation Therapy
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• v.23 no.1
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• pp.59-66
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• 2011

Purpose: Investigation of the clinical use of tangential fields technique using TOMO direct in comparison to conventional LINAC based radiation therapy after breast partial mastectomy. Materials and Methods: Treatment plans were created for 3 left-sided breast cancer patients who had radiation therapy after breast partial mastectomy by using wedged tangential fields technique, field in field technique (FIF), TOMO Direct, TOMO Direct intensity modulated radiation therapy (IMRT) under the normalized prescription condition ($D_{90%}$: 50.4 Gy/28 fx within CTV). Dose volume histogram (DVH) and isodose curve were used to evaluate the dose to the clinical target volume (CTV), organ at risk (OAR). We compared and analyzed dosimetric parameters of CTV and OAR. Dosimetric parameters of CTV are $D_{99}$, $D_{95}$, Dose homogeneity index (DHI: $D_{10}/D_{90}$) and $V_{105}$, $V_{110}$. And dosimetric parameters of OAR are $V_{10}$, $V_{20}$, $V_{30}$, $V_{40}$ of the heart and $V_{10}$, $V_{20}$, $V_{30}$ of left lung. Results: Dosimetric results of CTV, the average value of $D_{99}$, $D_{95}$ were $47.7{\pm}1.1Gy$, $49.4{\pm}0.1Gy$ from wedged tangential fields technique (W) and FIF (F) were $47.1{\pm}0.6Gy$, $49.2{\pm}0.4Gy$. And it was $49.2{\pm}0.4$ vs. $48.6{\pm}0.8Gy$, $49.9{\pm}0.4$ vs. $49.5{\pm}0.3Gy$ Gy for the TOMO Direct (D) and TOMO Direct IMRT (I). The average value of dose homogeneity index was W: $1.1{\pm}0.02$, F: $1.07{\pm}0.02$, D: $1.03{\pm}0.001$, I: $1.05{\pm}0.02$. When we compared the average value of $V_{105}$, $V_{110}$ using each technique, it was the highest as $34.6{\pm}9.3%$, $7.5{\pm}7.9%$ for wedged tangential fields technique and the value dropped for FIF as $16.5{\pm}14.8%$, $2.1{\pm}3.5%$, TOMO direct IMRT as $7.5{\pm}8.3%$, $0.1{\pm}0.1%$ and the TOMO direct showed the lowest values for both as 0%. Dosimetric results of OAR was no significant difference among each technique. Conclusion: TOMO direct provides improved target dose homogeneity over wedged tangential field technique. It is no increase the amount of normal tissue volumes receiving low doses, as oppose to IMRT or Helical TOMO IMRT. Also, it simply performs treatment plan procedure than FIF. TOMO Direct is a clinical useful technique for breast cancer patients after partial mastectomy.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.15 no.2
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• pp.160-167
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• 2004

Objectives : There have been very few studies on the compliance of methylphenidate-immediate releasing form(MPH-IR), which is the most frequently used drug in Korea, in Attention Deficit Hyperactivity Disorder(ADHD). This study was conducted to investigate the compliance rate and the related factors in the one year pharmacotherapy process via OPD for children with ADHD. Method : Total 100 ADHD patients were selected randomly among patients who have been treated with MPH-IR from September in 2002 to December in 2002. All the selected patients were diagnosed with DSM-IV-ADHD criteria and fulfilled the inclusion criteria. In March, 2003(at the time of 6 month treatment), all the patients and parents received the questionnaire for the compliance and satisfaction for MPH-IR treatment. In October 2003(at time of 1 year treatment), we, investigators evaluated the socio-demographic variables, developmental data, medical data, family data, comorbid disorders, treatment variables, and compliance rate. Through these very comprehensive data, The compliance rate at the time of mean 1 year treatment and the related factors were investigated. Result : 1) In the questionnaire for compliance and satisfaction for MPND treatment, the 60% of respondents(parents) reported more than moderate degree of satisfaction in the effectiveness of MPND. Their compliance rate for the morning prescription was 81%, but the rate of afternoon prescription was 43%. 2) In the evaluation at the time of 1 year treatment(October 2003), the 38% of parents were dropped out from the OPD treatment. The mean compliance rate for the 1 year treatment was 62%. the 38% of parents were dropped out from the OPD treatment. The mean compliance rate for the 1year treatment was 62%. 3) Compared with the noncompliant group(drop-out group), compliant group showed higher total, verbal and performance IQ scores. In the treatment variables, higher reposponder rate(clinician rating), higher medication dosage and more compliance rate in afternoon prescription were found in the compliant group compared with the noncompliant group. There were no statistical differences in the demographic variables(age, sex, SES, parental education level), medical data, developmental profiles and academic function. Conclusion : To our knowledge, this is the first report about the compliance rate of the MPH-IR treatment for the children with ADHD. The compliance rate at the time of mean 1year treatment was 62%, which was comparable with other studies performed in foreign countries, especially States. In this study, the compliance related factors were IQ score, clinical treatment response, dosage of MPH-IR, and early compliance for the afternoon prescription. These results suggest that clinician plan the strategies for the promotion of the early compliance for the after prescription and enhancement of overall treatment response.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.127-135
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• 2014

Purpose : By taking advantage of each imaging modality, the use of fused CT/MRI image has increased in prostate cancer radiation therapy. However, fusion uncertainty may cause partial target miss or normal organ overdose. In order to complement such limitation, our hospital acquired MRI image (Planning MRI) by setting up patients with the same fixing tool and posture as CT simulation. This study aims to evaluate the usefulness of the Planning MRI through comparing and analyzing the diagnostic MRI image and Planning MRI image. Materials and Methods : This study targeted 10 patients who had been diagnosed with prostate cancer and prescribed nonhormone and definitive RT 70 Gy/28 fx from August 2011 to July 2013. Each patient had both CT and MRI simulations. The MRI images were acquired within one half hour after the CT simulation. The acquired CT/MRI images were fused primarily based on bony structure matching. This study measured the volume of prostate in the images of Planning MRI and diagnostic MRI. The diameters at the craniocaudal, anteroposterior and left-to-right directions from the center of prostate were measured in order to compare changes in the shape of prostate. Results : As a result of comparing the volume of prostate in the images of Planning MRI and diagnostic MRI, they were found to be $25.01cm^3$(range $15.84-34.75cm^3$) and $25.05cm^3$(range $15.28-35.88cm^3$) on average respectively. The diagnostic MRI had an increase of 0.12 % as compared with the Planning MRI. On the planning MRI, there was an increase in the volume by $7.46cm^3$(29 %) at the transition zone directions, and there was a decrease in the volume by $8.52cm^3$(34 %) in the peripheral zone direction. As a result of measuring the diameters at the craniocaudal, anteroposterior and left-to-right directions in the prostate, the Planning MRI was found to have on average 3.82cm, 2.38cm and 4.59cm respectively and the diagnostic MRI was found to have on average 3.37cm, 2.76cm and 4.51cm respectively. All three prostate diameters changed and the change was significant in the Planning MRI. On average, the anteroposterior prostate diameter decrease by 0.38cm(13 %). The mean right-to-left and craniocaudal diameter increased by 0.08cm(1.6 %) and 0.45cm(13 %), respectively. Conclusion : Based on the results of this study, it was found that the total volumes of prostate in the Planning MRI and the diagnostic MRI were not significantly different. However, there was a change in the shape and partial volume of prostate due to the insertion of prostate balloon tube to the rectum. Thus, if the Planning MRI images were used when conducting the fusion of CT/MRI images, it would be possible to include the target in the CTV without a loss as much as the increased volume in the transition zone. Also, it would be possible to reduce the radiation dose delivered to the rectum through separating more clearly the reduction of peripheral zone volume. Therefore, the author of this study believes that acquisition of Planning MRI image should be made to ensure target delineation and localization accuracy.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.29-35
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• 2014

Purpose : This study has already started commercial Gated RapidArc automation equipment which was not previously in the Gated radiation therapy can be performed simultaneously with the VMAT Gated RapidArc radiation therapy to the accuracy of the analysis to evaluate the usability, Amplitude mode applied to the patient. Materials and Methods : The analysis of the distribution of radiation dose equivalent quality solid water phantom and GafChromic film was used Film QA film analysis program using the Gamma factor (3%, 3 mm). Three-dimensional dose distribution in order to check the accuracy of Matrixx dosimetry equipment and Compass was used for dose analysis program. Periodic breathing synchronized with solid phantom signals Phantom 4D Phantom and Varian RPM was created by breathing synchronized system, free breathing and breath holding at each of the dose distribution was analyzed. In order to apply to four patients from February 2013 to August 2013 with liver cancer targets enough to get a picture of 4DCT respiratory cycle and then patients are pratice to meet patient's breathing cycle phase mode using the patient eye goggles to see the pattern of the respiratory cycle to be able to follow exactly in a while 4DCT images were acquired. Gated RapidArc treatment Amplitude mode in order to create the breathing cycle breathing performed three times, and then at intervals of 40% to 60% 5-6 seconds and breathing exercises that can not stand (Fig. 5), 40% While they are treated 60% in the interval Beam On hold your breath when you press the button in a way that was treated with semi-automatic. Results : Non-respiratory and respiratory rotational intensity modulated radiation therapy technique absolute calculation dose of using computerized treatment plan were shown a difference of less than 1%, the difference between treatment technique was also less than 1%. Gamma (3%, 3 mm) and showed 99% agreement, each organ-specific dose difference were generally greater than 95% agreement. The rotational intensity modulated radiation therapy, respiratory synchronized to the respiratory cycle created Amplitude mode and the actual patient's breathing cycle could be seen that a good agreement. Conclusion : When you are treated Non-respiratory and respiratory method between volumetric intensity modulated radiation therapy rotation of the absolute dose and dose distribution showed a very good agreement. This breathing technique tuning volumetric intensity modulated radiation therapy using a rotary moving along the thoracic or abdominal breathing can be applied to the treatment of tumors is considered. The actual treatment of patients through the goggles of the respiratory cycle to create Amplitude mode Gated RapidArc treatment equipment that does not automatically apply to the results about 5-6 seconds stopped breathing in breathing synchronized rotary volumetric intensity modulated radiation therapy facilitate could see complement.

• Journal of Intelligence and Information Systems
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• v.26 no.3
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• pp.127-147
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• 2020

The world is suffering from numerous human and economic losses due to the novel coronavirus infection (COVID-19). The Korean government established a strategy to overcome the national infectious disease crisis through research and development. It is difficult to find distinctive features and changes in a specific R&D field when using the existing technical classification or science and technology standard classification. Recently, a few studies have been conducted to establish a classification system to provide information about the investment research areas of infectious diseases in Korea through a comparative analysis of Korea government-funded research projects. However, these studies did not provide the necessary information for establishing cooperative research strategies among countries in the infectious diseases, which is required as an execution plan to achieve the goals of national health security and fostering new growth industries. Therefore, it is inevitable to study information services based on the classification system and classification model for establishing a national collaborative R&D strategy. Seven classification - Diagnosis_biomarker, Drug_discovery, Epidemiology, Evaluation_validation, Mechanism_signaling pathway, Prediction, and Vaccine_therapeutic antibody - systems were derived through reviewing infectious diseases-related national-funded research projects of South Korea. A classification system model was trained by combining Scopus data with a bidirectional RNN model. The classification performance of the final model secured robustness with an accuracy of over 90%. In order to conduct the empirical study, an infectious disease classification system was applied to the coronavirus-related research and development projects of major countries such as the STAR Metrics (National Institutes of Health) and NSF (National Science Foundation) of the United States(US), the CORDIS (Community Research & Development Information Service)of the European Union(EU), and the KAKEN (Database of Grants-in-Aid for Scientific Research) of Japan. It can be seen that the research and development trends of infectious diseases (coronavirus) in major countries are mostly concentrated in the prediction that deals with predicting success for clinical trials at the new drug development stage or predicting toxicity that causes side effects. The intriguing result is that for all of these nations, the portion of national investment in the vaccine_therapeutic antibody, which is recognized as an area of research and development aimed at the development of vaccines and treatments, was also very small (5.1%). It indirectly explained the reason of the poor development of vaccines and treatments. Based on the result of examining the investment status of coronavirus-related research projects through comparative analysis by country, it was found that the US and Japan are relatively evenly investing in all infectious diseases-related research areas, while Europe has relatively large investments in specific research areas such as diagnosis_biomarker. Moreover, the information on major coronavirus-related research organizations in major countries was provided by the classification system, thereby allowing establishing an international collaborative R&D projects.

• Journal of Intelligence and Information Systems
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• v.26 no.3
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• pp.109-125
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• 2020

The Ministry of National Defense is pushing for the Defense Acquisition Program to build strong defense capabilities, and it spends more than 10 trillion won annually on defense improvement. As the Defense Acquisition Program is directly related to the security of the nation as well as the lives and property of the people, it must be carried out very transparently and efficiently by experts. However, the excessive diversification of laws and regulations related to the Defense Acquisition Program has made it challenging for many working-level officials to carry out the Defense Acquisition Program smoothly. It is even known that many people realize that there are related regulations that they were unaware of until they push ahead with their work. In addition, the statutory statements related to the Defense Acquisition Program have the tendency to cause serious issues even if only a single expression is wrong within the sentence. Despite this, efforts to establish a sentence comparison system to correct this issue in real time have been minimal. Therefore, this paper tries to propose a "Comparison System between the Statement of Military Reports and Related Laws" implementation plan that uses the Siamese Network-based artificial neural network, a model in the field of natural language processing (NLP), to observe the similarity between sentences that are likely to appear in the Defense Acquisition Program related documents and those from related statutory provisions to determine and classify the risk of illegality and to make users aware of the consequences. Various artificial neural network models (Bi-LSTM, Self-Attention, D_Bi-LSTM) were studied using 3,442 pairs of "Original Sentence"(described in actual statutes) and "Edited Sentence"(edited sentences derived from "Original Sentence"). Among many Defense Acquisition Program related statutes, DEFENSE ACQUISITION PROGRAM ACT, ENFORCEMENT RULE OF THE DEFENSE ACQUISITION PROGRAM ACT, and ENFORCEMENT DECREE OF THE DEFENSE ACQUISITION PROGRAM ACT were selected. Furthermore, "Original Sentence" has the 83 provisions that actually appear in the Act. "Original Sentence" has the main 83 clauses most accessible to working-level officials in their work. "Edited Sentence" is comprised of 30 to 50 similar sentences that are likely to appear modified in the county report for each clause("Original Sentence"). During the creation of the edited sentences, the original sentences were modified using 12 certain rules, and these sentences were produced in proportion to the number of such rules, as it was the case for the original sentences. After conducting 1 : 1 sentence similarity performance evaluation experiments, it was possible to classify each "Edited Sentence" as legal or illegal with considerable accuracy. In addition, the "Edited Sentence" dataset used to train the neural network models contains a variety of actual statutory statements("Original Sentence"), which are characterized by the 12 rules. On the other hand, the models are not able to effectively classify other sentences, which appear in actual military reports, when only the "Original Sentence" and "Edited Sentence" dataset have been fed to them. The dataset is not ample enough for the model to recognize other incoming new sentences. Hence, the performance of the model was reassessed by writing an additional 120 new sentences that have better resemblance to those in the actual military report and still have association with the original sentences. Thereafter, we were able to check that the models' performances surpassed a certain level even when they were trained merely with "Original Sentence" and "Edited Sentence" data. If sufficient model learning is achieved through the improvement and expansion of the full set of learning data with the addition of the actual report appearance sentences, the models will be able to better classify other sentences coming from military reports as legal or illegal. Based on the experimental results, this study confirms the possibility and value of building "Real-Time Automated Comparison System Between Military Documents and Related Laws". The research conducted in this experiment can verify which specific clause, of several that appear in related law clause is most similar to the sentence that appears in the Defense Acquisition Program-related military reports. This helps determine whether the contents in the military report sentences are at the risk of illegality when they are compared with those in the law clauses.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.21-30
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• 2022

Purpose: The purpose of this study is to evaluate the effectiveness of oral positioning stent, the BinkieRT^TM in radiation treatment for head and neck cancer patients in terms of tongue positions reproducibility, tongue doses and material properties. Materials and Methods: 24 cases using BinkieRT^TM during radiation treatments were enrolled. The tongue was contoured on planning CT and CBCT images taken every 3 days during treatment, and then the DSC and center of tongue shift values were analyzed to evaluate the reproducibility of the tongue. The tongue dose was compared in terms of dose distribution when using BinkieRT^TM and different type of oral stents (mouthpiece, paraffin wax). Randomly selected respective 10 patients were measured tongue doses of initial treatment plan for nasal cavity and unilateral parotid cancer. Finally, In terms of material evaluation, HU and relative electron density were identified in RTPS. Results: As a result of DSC analysis, it was 0.8 ± 0.07, skewness -0.8, kurtosis 0.61, and 95% CI was 0.79~0.82. To analyze the deviation of the central tongue shift during the treatment period, a 95% confidence interval for shift in the LR, SI, and AP directions were indicated, and a one-sample t-test for 0, which is an ideal value in the deviation(n=144). As a result of the t-test, the mean and SD in the LR and SI directions were 0.01 ± 0.14 cm (p→.05), 0.03 ± 0.25 cm (p→.05), and -0.08 ± 0.25 cm (p ←.05) in the AP direction. In the case of unilateral parotid cancer patients, the Dmean to the tongue of patients using BinkieRT^TM was 16.92% ± 3.58% compared to the prescribed dose, and 23.99% ± 10.86% of patients with Paraffin Wax, indicating that the tongue dose was relatively lower when using BinkieRT^TM (p←.05). On the other hand, among nasal cavity cancer patients, the Dmean of tongue dose for patients who used BinkieRT^TM was 4.4% ± 5.6%, and for those who used mouthpiece, 5.9% ± 6.8%, but it was not statistically significant (p→.05). The relative electron density of Paraffin Wax, BinkieRT^TM and Putty is 0.94, 0.99, 1.26 and the mass density is 0.95, 0.99 and 1.32 (g/cc), Transmission Factor is 0.99, 0.98, 0.96 respectively. Conclusion: The result of the tongue DSC analysis over the treatment period was about 0.8 and Deviation of the center of tongue shifts were within 0.2 cm, the reproducibility was more likely excellent. In the case of unilateral head and neck cancer patients, it was found that the use of BinkieRT^TM rather than Paraffin Wax or Putty can reduce the unnecessary dose irradiated to the tongue. This study might be useful to understand of BinkieRT^TM's properties and advantages. And also it could be another considered option as oral stent to keep the reproducibility of tongue and reducing dose during head and neck radiation treatments.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.257-264
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• 2014

Purpose : Photoneutron dose in high-energy photon radiotherapy at linear accelerator increase the risk for secondary cancer. The purpose of this investigation is to evaluate the dose variation of photoneutron with different treatment method, flattening filter, dose rate and gantry angle in radiation therapy with high-energy photon beam ($E{\geq}8MeV$). Materials and Methods : TrueBeam $ST{\time}TM$(Ver1.5, Varian, USA) and Korea Tissue Equivalent Proportional Counter (KTEPC) were used to detect the photoneutron dose out of the high-energy photon field. Complex Patient plans using Eclipse planning system (Version 10.0, Varian, USA) was used to experiment with different treatment technique(IMRT, VMAT), condition of flattening filter and three different dose rate. Scattered photoneutron dose was measured at eight different gantry angles with open field (Field size : $5{\time}5cm$). Results : The mean values of the detected photoneutron dose from IMRT and VMAT were $449.7{\mu}Sv$, $2940.7{\mu}Sv$. The mean values of the detected photoneutron dose with Flattening Filter(FF) and Flattening Filter Free(FFF) were measured as $2940.7{\mu}Sv$, $232.0{\mu}Sv$. The mean values of the photoneutron dose for each test plan (case 1, case 2 and case 3) with FFF at the three different dose rate (400, 1200, 2400 MU/min) were $3242.5{\mu}Sv$, $3189.4{\mu}Sv$, $3191.2{\mu}Sv$ with case 1, $3493.2{\mu}Sv$, $3482.6{\mu}Sv$, $3477.2{\mu}Sv$ with case 2 and $4592.2{\mu}Sv$, $4580.0{\mu}Sv$, $4542.3{\mu}Sv$ with case 3, respectively. The mean values of the photoneutron dose at eight different gantry angles ($0^{\circ}$, $45^{\circ}$, $90^{\circ}$, $135^{\circ}$, $180^{\circ}$, $225^{\circ}$, $270^{\circ}$, $315^{\circ}$) were measured as $3.2{\mu}Sv$, $4.3{\mu}Sv$, $5.3{\mu}Sv$, $11.3{\mu}Sv$, $14.7{\mu}Sv$, $11.2{\mu}Sv$, $3.7{\mu}Sv$, $3.0{\mu}Sv$ at 10MV and as $373.7{\mu}Sv$, $369.6{\mu}Sv$, $384.4{\mu}Sv$, $423.6{\mu}Sv$, $447.1{\mu}Sv$, $448.0{\mu}Sv$, $384.5{\mu}Sv$, $377.3{\mu}Sv$ at 15MV. Conclusion : As a result, it is possible to reduce photoneutron dose using FFF mode and VMAT method with TrueBeam $ST{\time}TM$. The risk for secondary cancer of the patients will be decreased with continuous evaluation of the photoneutron dose.

• The Journal of Korean Society for Radiation Therapy
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• v.25 no.2
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• pp.115-121
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• 2013

Purpose: Latest linear accelerator and the introduction of new measurement equipment to the agency that the introduction of this equipment in the future, by analyzing the process of confirming the usefulness of the preparation process for applying it in the clinical causes some problems, should be helpful. Materials and Methods: All measurements TrueBEAM STX (Varian, USA) was used, and a file specific to each energy, irradiation conditions, the dose distribution was calculated using a computerized treatment planning equipment (Eclipse ver 10.0.39, Varian, USA). Measuring performance and cause errors in MapCHECK 2 were analyzed and measured against. In order to verify the performance of the MapCHECK 2, 6X, 6X-FFF, 10X, 10X-FFF, 15X field size $10{\times}10$ cm, gantry $0^{\circ}$, $180^{\circ}$ direction was measured by the energy. IGRT couch of the CT values affect the measurements in order to confirm, CT number values : -800 (Carbon) & -950 (COUCH in the air), -100 & 6X-950 in the state for FFF, 15X of the energy field sizes $10{\times}10$, gantry $180^{\circ}$, $135^{\circ}$, $275^{\circ}$ directionwas measured at, MapPHAN allocated to confirm the value of HU were compared, using the treatment planning computer for, Measurement error problem by the sharp edges MapPHAN Learn gantry direction MapPHAN of dependence was measured in three ways. GANTRY $90^{\circ}$, $270^{\circ}$ in the direction of the vertically erected settings 6X-FFF, 15X respectively, and Setting the state established as a horizontal field sizes $10{\times}10$, $90^{\circ}$, $45^{\circ}$, $315^{\circ}$, $270^{\circ}$ of in the direction of the energy-6X-FFF, 15X, respectively, were measured. Without intensity modulated beam of the third open arc were investigated. Results: Of basic performance MapCHECK confirm the attenuation measured by Couch, measured from the measured HU values that are assigned to the MAP-PHAN, check for calculation accuracy for the angled edge of the MapPHAN all come in a range of valid measurement errors do not affect the could see. three ways for the Gantry direction dependence, the first of the meter built into the value of the Gantry $270^{\circ}$ (relative $0^{\circ}$), $90^{\circ}$ (relative $180^{\circ}$), 6X-FFF, 15X from each -1.51, 0.83% and -0.63, -0.22% was not affected by the AP/PA direction represented. Setting the meter horizontally Gantry $90^{\circ}$, $270^{\circ}$ from the couch, Energy 6X-FFF 4.37, 2.84%, 15X, -9.63, -13.32% the difference. By-side direction measurements MapPHAN in value is not within the valid range can not, because that could be confirmed as gamma pass rate 3% of the value is greater than the value shown. You can check the Open Arc 6X-FFF, 15X energy, field size $10{\times}10$ cm $360^{\circ}$ rotation of the dose distribution in the state to look at nearly 90% pass rate to emerge. Conclusion: Based on the above results, the MapPHAN gantry direction dependence by side in the direction of the beam relative dose distribution suitable for measuring the gamma value, but accurate measurement of the absolute dose can not be considered is. this paper, a more accurate treatment plan in order to confirm, Reduce the tolerance for VMAT, such as lateral rotation investigation in order to measure accurate absolute isodose using a combination of IMF (Isocentric Mounting Fixture) MapCHEK 2, will be able to minimize the impact due to the angular dependence.

• Journal of agricultural medicine and community health
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• v.19 no.2
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• pp.141-158
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• 1994

To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.