뇌 정위적 방사선수술 시 Non-Coplanar Volumetric Modulated Arc Therapy의 유용성 평가 (The Evaluation of Non-Coplanar Volumetric Modulated Arc Therapy for Brain stereotactic radiosurgery)
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- 대한방사선치료학회지
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- 제30권1_2호
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- pp.9-16
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- 2018
목 적 : 뇌 정위적 방사선수술은 외과적 수술로 인한 합병증 발생 비율이 높은 질환을 비침습적으로 치료할 수 있다. 하지만 뇌 정위적 방사선수술은 방사선을 이용하기 때문에 분할방사선치료와 같이 방사선에 의한 부작용을 동반할 수 있다. 두경부 등의 분할방사선치료 시 방사선에 의한 부작용을 줄이기 위해 Coplanar Volumetric Modulated Arc Therapy(C-VMAT)와 Non-Coplanar Volumetric Modulated Arc Therapy(NC-VMAT)가 주변 정상조직에 미치는 영향에 대한 분석이 이루어졌지만, 뇌 정위적 방사선수술에서는 이러한 내용들이 분석되지 않았다. 본 연구에서는 뇌 정위적 방사선수술을 실시한 환자를 대상으로 C-VMAT과 NC-VMAT을 비교, 분석하여 NC-VMAT의 유용성을 평가하고자 한다. 대상 및 방법 : 뇌 정위적 방사선수술 13건을 대상으로 하였으며, C-VMAT, NC-VMAT 치료 계획을 진행하였다. 치료 계획 용적은 최소 0.78 cc에서 최대 12.26 cc의 용적을 가지고 있었으며, 처방 선량은 15~24 Gy가 처방되었다. 치료 장비는 trueBEAM Stx(Varian Medical Systems, USA)을 사용하였으며, 치료 계획에 사용된 에너지는 6 MV Flattening Filter Free(6FFF) X-선을 이용하였다. C-VMAT 치료계획은 half 2 Arc 또는 full 2 Arc를 사용하여 치료계획을 진행했으며, NC-VMAT 치료계획은
목 적 : IMRT는 일반적인 3차원 방사선 치료방법보다 Prostate 주변 중요장기(OAR)에 대한 방사선 부작용을 줄이고 Prostate Cancer에 더 많은 선량을 투여할 수 있기 때문에 Prostate Cancer Therapy에 광범위하게 사용되었다. 장비 및 치료 기술의 많은 진보로 인하여 최근에는 체적 변조 아크 치료(VMAT)가 널리 사용되어지고 있으며, VMAT은 IMRT에 비해 치료 시간을 최대 55 % 단축시킬 수 있어 치료 중 움직임에 대한 오차를 최소화 할 수 있는 장점이 있다. 대상 및 방법 : 본 실험에서는 Prostate Cancer 환자 10명에 대해 LN가 포함된 치료 Group 5명과, LN가 포함되지 않는 Group 5명으로 1 Arc와 2 Arc 치료 계획 방법을 총 4 Group으로 분류하여 MU, DVH값들을 비교 분석 하였고, ArcCHECK과 MapCHECK을 사용하여 DQA 관련 측정을 수행했다. 결 과 : Prostate patients의 Target과 OAR 선량분포 결과는 다음과 같다.
목 적 : 직장암 방사선 치료 시 대퇴골두의 선량을 최소화하기 위해, 보편적인 치료방법인 3문 입체조형치료계획(3D Conformal radiation therapy)과 5문 입체조형치료계획 그리고 용적변조방사선치료(Volumetric Modulated Arc Therapy, 이하 VMAT) 계획의 유용성을 비교, 평가하고자 한다. 대상 및 방법 : 본원에서 21EX(Varian Medical Systems, USA)를 이용하여 치료 받은 직장암 환자 10명을 대상으로 3문, 5문 입체조형치료계획과 VMAT 전산화치료계획을 각각 세우고 이에 대한 선량분포를 비교분석하였다. 전산화 치료계획은 Eclipse(Ver 10.0.42, Varian, USA)를 이용하였으며, 선량계산을 위해 PRO3(Progressive Resolution Optimizer 10.0.28), AAA(Anisotropic Analytic Algorithm Ver 10.0.28) 알고리즘을 사용하였다. 3문 치료계획은 6MV POST field 와 15MV LT, RT field를 갠트리 각도
I. Introduction Since the 1970's drug abuse among young people has increasingly become a social problem in Korea. In the 1980's, drug abuse, especially glue sniffing, has become the cause of many unfortunated incidents resulting in harm to others as well as the abusers themselves. Taking into consideration of the seriousness of this problem, the Republic of Korea National Red Cross initiated a nation-wide research programme, to understand the present situation and to raise the level of public awareness. The goal of this research was to begin a nation - wide campaign against drug abuse. The research team was composed of the Advisary Committee members and the staff of the Youth Department of the Republic of Korea National Red Cross. The data were collected in February 1988 with the collaboration of the staff and volunteers in the local Chapters. The respondents were allocated nation-wide by the quota sampling method. The questionnaires were distributed to the respondents in three groups :2, 700 to junior and senior high school students, 605 to working youths, and 916 to delinquent youths. A total of 4, 221 questionnaires were collected. II. Characteristics of the Respondents The respondents in each group were selected evenly from rural and urban areas. The general characteristics of the respondents can be described as follow: in case of students, the proportions between male and female respondents, and between senior high school and junior high school students were almost evenly distributed. In case of working youths, the proportion of females (80.5%) was higher than those of the students and the delinquents groups. Delinquent youths were defined as those currently being under custody of the centers for juvenile delinquents. Of this number, 38.8% and 68.2% were junior and senior high school drop-outs respectively. The majority of them (92.6%) were male. As for the family background of the respondents, the proportion of those residing in poverty - stricken areas, and the proportion of those from broken families were higher in case of working youths and delinquent youths than those in case of students. III. Present Patterns of Drug Abuse The following summarizes the presents of drug abuse, as tabulated from the results of the survey. 1. Smoking The percentage of youths who smoke was 36% in the student group, 32% m the working youths group, and 94.4% in the delinquent youths group. 2. Alcohol 50.3% of students, 71.6% of working youths, and 93.3% of delinquent youths has experienced drinking alcohol beverages. 3. Tonic: non - alcoholic, caffeinated beverages popular in Korea and Japan The percentage of those who have used tonic at least once was over 90% in all of the three groups. 4. Sedative About 70% of each group has used sedative with the proportion of working youths use higher than those in other groups. 5. Stimulants Those who have used stimulants comprised around 15% in each group. 6. Tranquilizers Somewhat less than 5% of students and working youths, and 28% of delinquent youths, have used tranquilizers. 7. Hypnotics The users of hypnotics amounted to 0.4% of students, 2.6% of working youths and 7.1% of delinquent youths. 8. Marihuana Those who have used marihuana indicated 0.7% of students, 0.8% of working youths, and 13% of delinquent youths. 9. Glue-sniffing The percentage of glue-sniffing was 3.7%, 5% in the students group and in the youths group respectively, but the proportion was unusually high, at 40.7% in the delinquent youths group. From the results of the survey the present situation of drug abuse in Korea can be summarized as follows: 1. A high percentage of Korean youths have experienced smoking cigarettes and drinking alcoholic beverages. 2. Tonics (non - alcoholic, caffeinated beverages), antipyretic analgesics and stimulants quite regularly used. 3. Tranquilizers, hypnotics, marihuana and glue-sniffing are more widely used among delinquent youths than the other youths. From this fact, there exists a correlation between drug abuse and juvenile delinquency. IV. Time-series Analysis of the First Experience of Drug Abuse and Deviant Behaviour The respoundents were asked when they were first exposed to drugs and when they committed deviant acts. By calculating the average age of each experience, the following pattern was found (See Figure 1). Youths are first exposed to drugs by abuse of tonic(non - alcoholic, caffeinated beverages). At the age of 13, they amoke cigarettes, the use of antipyretic analgesics begins at 14 year old, while at the age of 15, they use tranquilizers, and at 16 hynotics. The period of drug abuse which starts from drinking caffeinated beverages and smoking cigarettes and ends in the use of hypnotics takes about three years. During this period, other delinquent behaviours begin to surface, that is, at the age of 13 when smoking cigarettes begins, the delinquent behaviour pattern starts with truancy. Next, they start taking money from others by using physical force. Prior to the age of 15, they are suspended from school, become hostile to adults, begin running away from home, and start using stimulants and alcohol. Soon they become involved even in glue-sniffing and in the use of marihuana. At the age of 15, they begin to see adult videos and carry weapons. Sexual promiscuity and usage of tranquilizers follows the viewing of adult videos. Consequently, by the time they reach the age of 16, they visit drinking establishments, and are picked up by police for committing delinquent acts. And finally, they come to use hypnotic - type drugs. From the above descriptions, drug abuse can be assumed to have a close correlation with delinquent behaviour. V. Social Factors Related to Drug Abuse As for the Korean youths, glue-sniffing is found to he related to aggressive delinquency, in such cases as run - aways, being picked up by the police, and taking money by force. Smoking cigarettes and drinking alcohol is found to be related to seeing adult videos and visiting drinking establishments. Hypnotics and marihuana were found to be representive of drugs which are related to degenerational delinquency, irrespective of social delinquency. The social factors connected with these drug abuse are as follows: 1. Individual factors Male students were more heavily involved in the usage of drug than females. Youths who do not attend church were more likely to be involved in drugs than those who attend. 2. Family factors The youths who were displeased with their mothers smoking and those who thought their parents did not love each other, or those whose parents had used drugs without prescription, were more likely to he drug users. 3. School factors Those youths who found school life boring, were unsuccessful in their studies, spend most of their time with friends, feel their teachers smoke too much, those who had a positive perception of their teachers smoking were likely to he drug users. To sum up, drug abusers depend on the influence of their parents, teachers and peers. IV. Reasons for Drug Abuse Korean students have mainly used drugs to release stress (42.8%), to stay awake (19.7%), and because of the easy accessibility of drugs( 16.6%). Other reasons are due to their ignorance of the side effects of the drugs (3.6%), natural curiosity (4.2%), and to increase strength(3.O%). From the above facts, the major reasons for drug abuse among Korean youths are to release stress and to stay awake in order to prepare exams. Furthermore, since drugs are readily available, we can conclude that drug abuse is caused by the school system(such as entrance exams) in Korea. VII. Conclusion Drug usage among Korean youths are relatively less common than those of western youths. In some cases, such as, glue-sniffing and use of stimulants, the pattern of drug abuse is found. Moreover, early drug abuse is evident, and it has a close connection with deviant behaviour, resulting in juvenile delinquency. Drug abuse cannot be attributed to any one social factor. Specifically, drug abuse depends on parents, peers, teachers and other members of the community, and also is influenced by social institutions such as the entrance exam system. Every person and organization concerned with youth must participate collectively in restraining drug abuse. Finally, it is suggested that social agencial working for youth welfare should make every effort to tackle this serious problem confronted by the Korean youths today.
Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.