• 제목/요약/키워드: Radiation Benefit

검색결과 151건 처리시간 0.024초

Triplet Platinum-based Combination Sequential Chemotherapy Improves Survival Outcome and Quality of Life of Advanced Non-small Cell Lung Cancer Patients

  • Chen, Li-Kun;Liang, Ying;Yang, Qun-Ying;Xu, Fei;Zhou, Ning-Ning;Xu, Guang-Chuan;Liu, Guo-Zhen;Wei, Wei-Dong
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권5호
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    • pp.1863-1867
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    • 2012
  • Background: Maintenance chemotherapy is one strategy pursued in recent years with intent to break through the chemotherapy plateau for advanced non-small cell lung cancer (NSCLC). However, given the toxicity, platinum-based combinations are rarely given for this purpose. We carried out the present prospective study of triplet platinum-based combination sequential chemotherapy in advanced NSCLC to investigate if patients could tolerate and benefit from such intensive treatment. Methods: From Dec 2003 to Dec 2007, 190 stage IIIB and IV NSCLC patients in Sun yat-sen University sequentially received the 3 platinum-based combination (TP-NP-GP) treatment (T: paclitaxol175$mg/m^2$ d1; N: vinorelbine25$mg/m^2$ d1 and 8; G: gemcitabine1$g/m^2$ d1 and 8; P: cisplatin20$mg/m^2$ d1-5; repeated every 3 weeks). Patients were followed up to at least 3 years to obtain survival data. Treatment toxicities and the quality of life (QOL) were assessed during the whole treatment. Results: There were 187 patients evaluable. The TP, NP and GP response rates with sequential use were 42.8% (80/187), 41.1% (65/158) and 28.8% (21/73) respectively. Median survival time was 18.2 months and the 1, 2 and 3 year overall survival (OS) rates were 78.7%, 38.5% and 21.3%. Patients receiving > 6 cycles of chemotherapy had significantly longer OS and TTP (MST 25.3 vs. 14.5 months, TTP 15.1 vs. 9.1 months). The QOL on the whole for the patients was improved after chemotherapy. Conclusions: The sequential chemotherapy strategy with triplet platinum-based combination regimens can improve the survival outcome and the quality of life of advanced non-small cell lung cancer patients.

Efficacy and Safety of Sorafenib for Advanced Non-Small Cell Lung Cancer: a Meta-analysis of Randomized Controlled Trials

  • Wang, Wei-Lan;Tang, Zhi-Hui;Xie, Ting-Ting;Xiao, Bing-Kun;Zhang, Xin-Yu;Guo, Dai-Hong;Wang, Dong-Xiao;Pei, Fei;Si, Hai-Yan;Zhu, Man
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권14호
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    • pp.5691-5696
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    • 2014
  • Background: Many clinical trials have been conducted to evaluate sorafenib for the treatment of advanced NSCLC, but the results for efficacy have been inconsistent. The aim of this study was to evaluate the efficacy and safety of sorafenib in patients with advanced NSCLC in more detail by meta-analysis. Methods: This meta-analysis of randomized controlled trials (RCTs) was performed after searching PubMed, EMBASE, ASCO Abstracts, ESMO Abstracts, and the proceedings of major conferences for relevant clinical trials. Two reviewers independently assessed the quality of the trials. Outcomes analysis were disease control rate (DCR), progression- free survival (PFS), overall survival (OS) with 95% confidence intervals (CI) and major toxicity. Subgroup analysis was conducted according to sorafenib monotherapy, in combination with chemotherapy or EGFR-TKI to investigate the preferred therapy strategy. Results: Results reported from 6 RCTs involving 2, 748 patients were included in the analysis. Compared to sorafenib-free group, SBT was not associated with higher DCR (RR 1.31 (0.96- 1.79), p=0.09), PFS (HR 0.82 (0.66-1.02), p=0.07) and OS (HR 1.01 (0.92-1.12), p=0.77). In terms of subgroup results, sorafenib monotherapy was associated with significant superior DCR and longer PFS, but failed to show advantage with regard to OS. Grade 3 or greater sorafenib-related adverse events included fatigue, hypertension, diarrhea, oral mucositis, rash and HFSR. Conclusions: SBT was revealed to yield no improvement in DCR, PFS and OS. However, sorafenib as monotherapy showed some activity in NSCLC. Further evaluation may be considered in subsets of patients who may benefit from this treatment. Sorafenib combined inhibition therapy should be limited unless the choice of platinum-doublet regimen, administration sequence or identification of predictive biomarkers are considered to receive better anti-tumor activity and prevention of resistance mechanisms.

미국의 원전해체 비용평가 기초자료 및 동향 분석 (Status of Nuclear Power Plant Decommissioning Cost Analysis in USA)

  • 신상화;김순영
    • 한국방사선학회논문지
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    • 제12권2호
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    • pp.139-148
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    • 2018
  • 원전의 안전한 해체 관리를 위해 원전 해체 비용 평가는 매우 중요하다. 가장 많은 원전 해체 경험을 갖고 있는 미국의 경우 1970년대부터 원자력시설의 해체를 위하여 비용평가 연구를 진행하였다. 미국 NRC는 다양한 로형 및 원자력시설에 대한 해체 기술, 안전성 및 비용에 대한 연구를 수행하였다. 전체 해체 비용에서 운영허가종료비용이 가장 큰 비중을 차지하며, 그 다음으로는 사용후핵연료 관리, 부지복원순으로 평가되었다. 해체비용은 전체비용에 있어 운영허가종료가 제일 큰 비중을 차지하며 사용후핵연료관리, 부지복원 순으로 평가되었다. 즉시해체의 경우 지연해체에 비해 사용후핵연료관리 비용이 증가하였으며 지연해체의 경우 운영허가종료의 비용이 증가하였다. 전반적으로 즉시해체에 비해 지연해체의 경우가 뚜렷하게 이득이 보이지 않고 있다. 국내 원전 해체 비용 평가시 부지 조건에 따른 평가를 고려해야할 필요가 있다고 판단된다. 또한 국내의 경우 IAEA의 권고사항을 적용하여 방사성폐기물 분류체계를 재정비하였다. 이에 따라 해체시 발생하는 방사성폐기물 물량 산정시, 선행 미국 원전해체 자료를 신분류체계에 적합하게 활용하기 위한 방법을 개발해야할 필요가 있다. 특히 자체처분 대상폐기물 평가 방법론 설정은 해체비용의 정확성을 확보하는 중요한 인자로 작용할 것이다. 또한 국내 원전해체 비용 평가를 위하여 시설 특성과 작업 특성에 적용할 수 있는 정보자료 구축이 필요하다.

N2 종격동 림프절 전이가 있는 제 III A 병기 비소세포폐암에 있어 수술전 동시화학방사선요법 후 폐적출술의 조기 성적 (Early Result of Surgical Resection after Pre-Operative Concurrent chemoradiotherapy for N2-Positive Stage IIIA NSCLC)

  • 차대원;김진국;심영목;김관민;박근칠;안용찬
    • Journal of Chest Surgery
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    • 제33권8호
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    • pp.662-668
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    • 2000
  • Background: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. Material and Method: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs(43∼70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy(24) and CT scans(7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. Result: All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects(6), refusal(1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. Conclusion: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.

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편백림의 식생구조 특성 분석 (Characteristics of Vegetation Structure in Chamaecyparis Obtusa Stands)

  • 박석곤;강현미
    • 한국환경생태학회지
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    • 제29권6호
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    • pp.907-916
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    • 2015
  • 본 연구에서는 인공조림된 편백림을 대상으로 식생구조 및 식생천이, 종다양성의 특성을 밝히고자 전남지역의 8곳에 편백림을 대상으로 식생조사를 실시하였다. 이 식생조사 데이터를 활용하여 군집분석 및 서열분석을 실시한 결과 5개 군락으로 단순화되었다. 군락I은 다른 군락에 비해 종다양성지수가 상당히 낮았는데 이는 교목층에 우점한 편백의 수관이 울폐되어 하층식생이 발달하지 않았거나 잡초목(경쟁 자생수종) 제거로 하층식생이 거의 남아있지 않았기 때문이었다. 반면, 군락 II~IV는 하층에 다양한 자생수종이 유입되어 아교목층과 관목층에서 서로 경쟁하여 어느 정도 안정되거나 식생발달 초기라서 종다양성지수가 높은 편이었다. 마지막, 군락 V는 휴양림으로서 이용강도가 높아 식생구조가 단순하였다. 또한, 임상에 유입되는 광합성유효광과 출현종수 종다양성지수 사이에는 정의 상관관계를 보였다. 이러한 편백림의 식생구조 특성은 과거 개벌 이후 묘목심기, 솎아베기, 풀베기 등의 산림시업과 밀접하게 관련된다. 편백림의 산림시업에 의한 교란빈도와 함께 식생천이프로세스 회전시간에 따라 군락별 식생구조와 종다양성은 약간의 차이를 보였지만, 천연림에 비해 편백림은 단순한 식생구조를 보였다. 인공림은 생물다양성이 낮고 생태계 서비스가 취약하기 때문에 공익적 기능을 발휘할 수 있는 인공림으로 전환하는 한 가지 수단으로써 생태적 관리가 필요할 것이다.

축분뇨처리를 위한 Bin형 부숙조- Sundry 시스템의 퇴비화효율 평가 (Composting Effectiveness of A Sundry System with A Bin-type Composter for Recyle of Animal Wastes)

  • 최홍림;김현태;정영윤
    • 한국농공학회지
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    • 제35권2호
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    • pp.92-103
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    • 1993
  • A sunday system with a horizontal bin-type composter was constructed and operated to evaluate its composting performance for four days for each test in October, 1992. A sundry system is one of popular systems for composting livestock manure, of which main benefit is to utilize unlimited, clean, and free solar radiation. A rectangular concrete bin(composter) with dimension of 300cm(length) X90cm(width) X60cm(height) was bedded alternatively with four lanes of aeration pipes and heating pipes, and was insulated at three walls with 50mm styrofoam. Each aeration pipe of a diameter of 25mm had 4mm perforated holes at every 15cm longitudinally, and supplied air of about 2m$^3$/min to the composter to maintain aerobic condition . A stirrer rotating at 1 rpm made one round trip every 20 minutes on the conveying chain along the the length of the composter. Five tests (Test 1~Test 5) were implemented to evaluate the composting effectiveness of a sundry system with a horizontal bin-type composter. Treatments of two levels of the mixture ratio of swine manure and paper sludge cakes(manure : paper sludge cakes= 1 : 4 and 1 : 2) and two levels of the water content(W/C ; 70% and 50%) were made to test the significance of the physicochemical properties for decomposition of the mixture materials. Temperature, C/N ratio, water content, microbial activity of the composting materials were taken measurements to evaluate its performance with the lapse of composting time for tests. A small-scale sundry system with a bin-type composter did not appear to be an appropriate system for composting livestock manure. Since heat generation by the composting materials could not overcome heat loss due to areation in a small-scale composter, a proper thermal enviroment could not be maintained to propagate massively thermopilic microorganism relatively in a short period of time. Different from the result of Chol et al.(1992) 6), a temperature variation of the composting materials did not show the peak clearly and C/N ratio didn't lower with time as expected. Mesophilic microoragnism seemed to play an important role for decomposition of the mixture materials. A sundry system with a bin-type composter may be good for a large-scale livestock farm household which may produce enough animal manure. Therefore a decision should be made very carefully to choose a system for composting livestock waste.

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Immunological Characteristics of Hyperprogressive Disease in Patients with Non-small Cell Lung Cancer Treated with Anti-PD-1/PD-L1 Abs

  • Kyung Hwan Kim;Joon Young Hur;Jiae Koh;Jinhyun Cho;Bo Mi Ku;June Young Koh;Jong-Mu Sun;Se-Hoon Lee;Jin Seok Ahn;Keunchil Park;Myung-Ju Ahn;Eui-Cheol Shin
    • IMMUNE NETWORK
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    • 제20권6호
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    • pp.48.1-48.11
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    • 2020
  • Hyperprogressive disease (HPD) is a distinct pattern of progression characterized by acceleration of tumor growth after treatment with anti-PD-1/PD-L1 Abs. However, the immunological characteristics have not been fully elucidated in patients with HPD. We prospectively recruited patients with metastatic non-small cell lung cancer treated with anti-PD-1/PD-L1 Abs between April 2015 and April 2018, and collected peripheral blood before treatment and 7-days post-treatment. HPD was defined as ≥2-fold increase in both tumor growth kinetics and tumor growth rate between pre-treatment and post-treatment. Peripheral blood mononuclear cells were analyzed by multi-color flow cytometry to phenotype the immune cells. Of 115 patients, 19 (16.5%) developed HPD, 52 experienced durable clinical benefit (DCB; partial response or stable disease ≥6 months), and 44 experienced non-hyperprogressive progression (NHPD). Patients with HPD had significantly lower progression-free survival (p<0.001) and overall survival (p<0.001). When peripheral blood immune cells were examined, the pre-treatment frequency of CD39+ cells among CD8+ T cells was significantly higher in patients with HPD compared to those with NHPD, although it showed borderline significance to predict HPD. Other parameters regarding regulatory T cells or myeloid derived suppressor cells did not significantly differ among patient groups. Our findings suggest high pre-treatment frequency of CD39+CD8+ T cells might be a characteristic of HPD. Further investigations in a larger cohort are needed to confirm our results and better delineate the immune landscape of HPD.

수술과 항암요법으로 치료한 국소 진행된 위함 환자에서의 치료실패 양상분석 : 수술후 방사선 치료의 역할에 대한 연구 (The Analysis of Failure Pattern in Locally Advanced Stomach Cancer Treated with Surgery and Post-Op Chemotherapy: To Explore The Role of Post-Op Irradiation)

  • 최은경;장혜숙;서처원;이규형;이정신;김상희;;김명환;민영열;김진천;이승규;박건춘
    • Radiation Oncology Journal
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    • 제9권2호
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    • pp.249-252
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    • 1991
  • 수수로가 항암요법만으로 치료한 국소 진행된 위암환자에서 치료실패의 양상을 분석해봄으로써 수술후 방사선치료의 가능성을 알아보기 위하여 1989년 6월부터 1990년 8월까지 치료받은 107명의 환자를 대상으로 후향적 분석을 시행하였다. 제2기 ($T_2N_1,\;T_3N_0$)환자는 20이었으며 제3기 ($T_3N_1,\;T_3N_2$(환자는 87명이었다 16명은 수술후 추적이 어려워 91명에 대한 분석을 시행하였다. 모든 환자는 근치적 절제술을 시행받았고 이중 57명은 수술후 항암요법을 시행하고 24명은 계속적 추적 관찰만을 하였다. 국소재발율은 항암 요법 시행군에서는 $321\%$, 추적관찰군에서는 $24\%$로 차이가 없었고 원격전이는 항암요법 시행군에서는 $12\%$ 추적관찰군에서는 $26\%$로 항앙요법 시행군에서 원격 전이가 적어지는 것을 관찰할 수 있었다. 국소 재발환자의 $52\%$는 anastomosis site에서 재발하였고 원격 전이시 가장 많이 침범되는 장기는 간이었다. 아직 추적 관찰 기간이 짧으나 수술후 방사선 치료가 최소한 $20\%$이상의 환자에서 도움이 될것으로 생각된다.

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국한성 병기 소세포폐암의 방사선치료시 분할 조사방식에 따른 치료성적 (Once vs. Twice Daily Thoracic Irradiation in Limited Stage Small Cell Lung Cancer)

  • 김준상;김재성;김주옥;김선영;조문준
    • Radiation Oncology Journal
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    • 제16권3호
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    • pp.291-301
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    • 1998
  • 목적 : 국한성 병기 소세포폐암으로 복합 화학요법과 방사선치료를 받은 환자들에서 통상적 방사선치료와 다분할 방사선치료 간의 종양 관해율, 생존율, 재발율 및 부작용에 대해 비교분석하고자 하였다. 대상 및 방법 : 1989년 11월부터 1996년 12월까지 충남대학교 병원 치료방사선과에서 국한성병기 소세포폐암으로 치료받았던 78명 환자 중 고식적 방사선치료 및 재발성 병변으로 치료받았던 10명을 제외한 68명을 대상으로 후향성 분석을 하였다. 대상환자 중 통상적 방사선치료군(A군)은 26명, 다분할 방사선치료군 (B군)은 42명 이었다. 전체 환자의 연령, 성별 및 ECOG 활동지수는 각각 32-75세 (중앙값 58세), 남자 58명 여자 10명, ECOG 0-1이 58명 2 이상이 10명 이었으며 두군 간에 유사한 분포를 보였다. 방사선치료로서 A군은 총 조사선량 5040-6940 cGy (중앙값 5040 cGy), 180 cGy/fx 로 치료하였고 B군은 총 조사선량 4320-5100 cGy (중앙값 4560 cGy)으로 29명 (69$\%$)은 120 cGy/fx 로, 13명 (31$\%$)은 150 cGy/fx 로 1일 2회 조사하였다. 화학요법은 전체 68명 중 65명에서 VPP (cisplatin 60 mg/$m^2$, etoposide 100 mg/$m^2$) 요법과 CAV (cytoxan 1000 mg/$m^2$, adriamycin 40 mg/$m^2$, vincristine 1 mg/$m^2$) 요법을 교대로 시행하였으며, 화학요법 횟수는 A군 3-10회 (중앙값 6회), B군은 1-11회 (중앙값 6회) 시행하였다. 화학요법 시기는 A군에서 23명이 연속 화학요법을, B군에서는 39명이 동시 화학요법을 시행하였다. 예방적 전뇌조사는 두군 모두에서 완전관해 후 시행하였는데 A군 8명, B군 16명에서 조사선량 2500 cGy/10fx 로 조사하였다. 추적기간은 2-99개월 (중앙값 14개월)였다. 결과 : 종양 관해는 완전관해율, 부분관해율이 각각 A군 35$\%$ (9/26), 54$\%$ (14/26), B군 43$\%$ (18/42), 55$\%$ (23/42)(p=0.119) 였다. 중앙생존기간 및 2년 생존율은 전체환자에서 15개월, 26.8$\%$였고, A군 17개월, 26.9$\%$, B군 15개월, 28$\%$ 0=0.51)였다. 전체환자 중 완전관해 및 부분관해 환자의 2년 생존율은 각각, 35$\%$ 와 24.2$\%$ (p=0.05)였다. 실패양상으로 두 군간에 국소재발 및 원격전이의 통계적인 차이는 없었다 (p=0.125, 0.335). 방사선치료중 발생한 급성합병증으로 RTOG criteria상 중등도 이상의 식도염 및 백혈구 감소가 B 군에서 더 높게 나타났다 (p=0.028, 0.003). 결론 : 국한성 병기 소세포폐암의 복합 화학요법과 방사선치료시 종양의 부분관해 이상의 반응율이 연속화학요법을 받은 통상적 방사선 치료군과 동시화학요법을 받은 다분할 방사선 치료군 모두에서 높게 나타났다. 그러나 두 군간의 생존율에는 통계적인 차이를 보이지 않았다. 급성합병증으로서 식도염과 백혈구 감소가 동시화학요법을 받은 다분할 방사선치료군에서 더 높게났지만, 국한성 병기 소세포폐암에서 동시화학요법과 다분할 방사선치료가 적절한 치료의 한 방법이 될 수 있을 것으로 사료된다. 그러나 국한성 병기 소세포폐암에서 다분할 방사선치료의 장점을 밝히기 위하여 좀더 많은 대상환자와 추적관찰이 필요할 것으로 사료된다.

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PET 이용 현황 및 전망 (Current Status and Future Perspective of PET)

  • 이명철
    • 대한핵의학회지
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    • 제36권1호
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    • pp.1-7
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    • 2002
  • Positron Emission Tomography (PET) is a nuclear medicine imaging modality that consists of systemic administration to a subject of a radiopharmaceutical labeled with a positron-emitting radionuclide. Following administration, its distribution in the organ or structure under study can be assessed as a function of time and space by (1) defecting the annihilation radiation resulting from the interaction of the positrons with matter, and (2) reconstructing the distribution of the radioactivity from a series of that used in computed tomography (CT). The nuclides most generally exhibit chemical properties that render them particularly desirable in physiological studies. The radionuclides most widely used in PET are F-18, C-11, O-15 and N-13. Regarding to the number of the current PET Centers worldwide (based on ICP data), more than 300 PET Centers were in operation in 2000. The use of PET technology grew rapidly compared to that in 1992 and 1996, particularly in the USA, which demonstrates a three-fold rise in PET installations. In 2001, 194 PET Centers were operating in the USA. In 1994, two clinical and research-oriented PET Centers at Seoul National University Hospital and Samsung Medical Center, was established as the first dedicated PET and Cyclotron machines in Korea, followed by two more PET facilities at the Korea Cancer Center Hospital, Ajou Medical Center, Yonsei University Medical Center, National Cancer Center and established their PET Center. Catholic Medical School and Pusan National University Hospital have finalized a plan to install PET machine in 2002, which results in total of nine PET Centers in Korea. Considering annual trends of PET application in four major PET centers in Korea in Asan Medical Center recent six years (from 1995 to 2000), a total of 11,564 patients have been studied every year and the number of PET studies has shown steep growth year upon year. We had 1,020 PET patients in 1995. This number increased to 1,196, 1,756, 2,379, 3,015 and 4,414 in 1996,1997,1998,1999 and 2000, respectively. The application in cardiac disorders is minimal, and among various neuropsychiatric diseases, patients with epilepsy or dementia can benefit from PET studios. Recently, we investigated brain mapping and neuroreceptor works. PET is not a key application for evaluation of the cardiac patients in Korea because of the relatively low incidence of cardiac disease and less costly procedures such as SPECT can now be performed. The changes in the application of PET studios indicate that, initially, brain PET occupied almost 60% in 1995, followed by a gradual decrease in brain application. However, overall PET use in the diagnosis and management of patients with cancer was up to 63% in 2000. The current medicare coverage policy in the USA is very important because reimbursement policy is critical for the promotion of PET. In May 1995, the Health Care Financing Administration (HCFA) began covering the PET perfusion study using Rubidium-82, evaluation of a solitary pulmonary nodule and pathologically proven non-small cell lung cancer. As of July 1999, Medicare's coverage policy expanded to include additional indications: evaluation of recurrent colorectal cancer with a rising CEA level, staging of lymphoma and detection of recurrent or metastatic melanoma. In December of 2001, National Coverage decided to expand Medicare reimbursement for broad use in 6 cancers: lung, colorecctal, lymphoma, melanoma, head and neck, and esophageal cancers; for determining revascularization in heart diseases; and for identifying epilepsy patients. In addition, PET coverage is expected to further expand to diseases affecting women, such as breast, ovarian, uterine and vaginal cancers as well as diseases like prostate cancer and Alzheimer's disease.