• Korean Journal of Radiology
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• v.24 no.5
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• pp.424-433
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• 2023

Objective: To assess the safety and efficacy of balloon dilatation under dual guidance using fluoroscopy and bronchoscopy for treating bronchial stenosis following lung transplantation (LT), and to elucidate the factors associated with patency after the procedure. Materials and Methods: From September, 2012, to April, 2021, 50 patients (mean age ± standard deviation, 54.4 ± 12.2 years) with bronchial stenosis among 361 recipients of LT were retrospectively analyzed. The safety of balloon dilatation was assessed by evaluating procedure-related complications. Efficacy was assessed by evaluating the technical success, primary patency, and secondary patency. Primary and secondary cumulative patency rates were calculated using the Kaplan-Meier method. The factors associated with patency after the procedure were evaluated using multivariable Cox hazard proportional regression analysis. Results: In total, 65 bronchi were treated with balloon dilatation in 50 patients. The total number of treatment sessions was 277 and the technical success rate was 99.3% (275/277 sessions). No major procedure-related complications were noted. During the mean follow-up period of 34.6 ± 30.8 months, primary patency was achieved in 12 of 65 bronchi (18.5%). However, the patency rate improved to 76.9% (50 of 65 bronchi) after repeated balloon dilatation (secondary patency). The 6-month, 1-year, 3-year, and 5-year secondary patency rates were 95.4%, 90.8%, 83.1%, and 78.5%, respectively. The presence of clinical symptoms was a significant prognostic factor associated with reduced primary patency (adjusted hazard ratio [HR], 0.465; 95% confidence interval [CI], 0.220-0.987). Early-stage treatment ≤ 6 months (adjusted HR, 3.588; 95% CI, 1.093-11.780) and prolonged balloon dilatation > 5 min (adjusted HR, 3.285; 95% CI, 1.018-10.598) were associated with significantly higher secondary patency. Conclusion: Repeated balloon dilatation was determined to be safe and effective for treating bronchial stenosis following LT. Early-stage treatment and prolonged balloon dilatation could significantly promote long-term patency.

• Journal of Gastric Cancer
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• v.15 no.4
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• pp.238-245
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• 2015

Purpose: This study aimed to identify time-dependent prognostic factors and demonstrate the time-dependent effects of important prognostic factors in patients with advanced gastric cancer (AGC). Materials and Methods: We retrospectively evaluated 3,653 patients with AGC who underwent curative standard gastrectomy between 1991 and 2005 at the Korea Cancer Center Hospital. Multivariate survival analysis with Cox proportional hazards regression was used in the analysis. A non-proportionality test based on the Schoenfeld residuals (also known as partial residuals) was performed, and scaled Schoenfeld residuals were plotted over time for each covariate. Results: The multivariate analysis revealed that sex, depth of invasion, metastatic lymph node (LN) ratio, tumor size, and chemotherapy were time-dependent covariates violating the proportional hazards assumption. The prognostic effects (i.e., log of hazard ratio [LHR]) of the time-dependent covariates changed over time during follow-up, and the effects generally diminished with low slope (e.g., depth of invasion and tumor size), with gentle slope (e.g., metastatic LN ratio), or with steep slope (e.g., chemotherapy). Meanwhile, the LHR functions of some covariates (e.g., sex) crossed the zero reference line from positive (i.e., bad prognosis) to negative (i.e., good prognosis). Conclusions: The time-dependent effects of the prognostic factors of AGC are clearly demonstrated in this study. We can suggest that time-dependent effects are not an uncommon phenomenon among prognostic factors of AGC.

• Nuclear Engineering and Technology
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• v.56 no.11
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• pp.4921-4928
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• 2024

The present study employed statistical methods to evaluate the possible radiological hazards linked to granitic rocks-bearing mineralization in the ELgarra region of Egypt. The geological structures influence the occurrence of uranium mineralization in this area and are primarily associated with altered granites. Gamma-ray spectrometry was utilized to examine the quantities of ²³⁸U, ²³²Th, and ⁴⁰K in granitic rock samples. The recorded levels of radioisotope activity concentrations in the analyzed regions ranged from 374 to 1740 Bq.kg^{-1 238}U, with an average of 1018 Bq.kg^-1. For ²³²Th, the range was between 71 and 163 Bq.kg^-1, with an average of 119 Bq.kg^-1. Lastly, for ⁴⁰K, the range was 756-1789 Bq.kg^-1, with an average of 1212 Bq.kg^-1. The detected levels of ²³⁸U, ²³²Th, and ⁴⁰K in the examined rock samples were observed to exceed the permissible limits of 35, 45, and 412 Bq.kg^-1, respectively. The primary radiological risks linked to these granitic rocks were attributed to the gamma rays released by the radioactive elements. Estimations of the radiological hazards in the granitic rocks were made, and statistical approaches were utilized to demonstrate the associations among radionuclides and radiological factors. The assessment confirmed that uranium, potassium, and their respective minerals in the granitic rocks were the key factors contributing to the radiological risks. As a result, the study determined that the granite rocks found in the study area needed precautions to be taken due to their high levels of radioactivity.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.108-113
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• 2015

Objective : Although the L5-S1 has distinct structural features in comparison with other lumbar spine segments, not much is known about adjacent segment degeneration (ASD) at the L5-S1 segment. The aim of study was to compare the incidence and character of ASD of the cephalad and L5-S1 segments after L5 floating lumbar fusion. Methods : From 2005 to 2010, 115 patients who underwent L5 floating lumber fusion were investigated. The mean follow-up period was 46.1 months. The incidence of radiological and clinical ASD of the cephalad and the L5-S1 segments was compared using survival analysis. Risk factors affecting ASD were analyzed using a log rank test and the Cox proportional hazard model. Results : Radiological ASD of the L5-S1 segment had a statistically significant higher survival rate than that of the cephalad segment (p=0.001). However, clinical ASD of the L5-S1 segment was significantly lower survival rates than that of the cephalad segment (p=0.038). Risk factor analysis showed that disc degeneration of the cephalad segment and preoperative spinal stenosis of the L5-S1 segment were risk factors. Conclusion : In L5 floating fusion, radiological ASD was more common in the cephalad segment and clinical ASD was more common in the L5-S1 segment. At the L5-S1 segment, the degree of spinal stenosis appears to be the most influential risk factor in ASD incidences, unlike the cephalad segment.

• Korean Journal of Radiology
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• v.24 no.9
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• pp.838-848
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• 2023

Objective: To quantitatively analyze the cardiac magnetic resonance imaging (CMR) characteristics of chemotherapy-related cardiac dysfunction (CTRCD) and explore their prognostic value for major adverse cardiovascular events (MACE). Materials and Methods: A total of 145 patients (male:female = 76:69, mean age = 63.0 years) with cancer and heart failure who underwent CMR between January 2015 and January 2021 were included. CMR was performed using a 3T scanner (Siemens). Biventricular functions, native T1 T2, extracellular volume fraction (ECV) values, and late gadolinium enhancement (LGE) of the left ventricle (LV) were compared between those with and without CTRCD. These were compared between patients with mild-to-moderate CTRCD and those with severe CTRCD. Cox proportional hazard regression analysis was used to evaluate the association between the CMR parameters and MACE occurrence during follow-up in the CTRCD patients. Results: Among 145 patients, 61 had CTRCD and 84 did not have CTRCD. Native T1, ECV, and T2 were significantly higher in the CTRCD group (1336.9 ms, 32.5%, and 44.7 ms, respectively) than those in the non-CTRCD group (1303.4 ms, 30.5%, and 42.0 ms, respectively; P = 0.013, 0.010, and < 0.001, respectively). They were not significantly different between patients with mild-to-moderate and severe CTRCD. Indexed LV mass was significantly smaller in the CTRCD group (65.0 g/m² vs. 78.9 g/mm²; P < 0.001). According to the multivariable Cox regression analysis, T2 (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 1.01-1.27; P = 0.028) and quantified LGE (HR: 1.07, 95% CI: 1.01-1.13; P = 0.021) were independently associated with MACE in the CTRCD patients. Conclusion: Quantitative parameters from CMR have the potential to evaluate myocardial changes in CTRCD. Increased T2 with reduced LV mass was demonstrated in CTRCD patients even before the development of severe cardiac dysfunction. T2 and quantified LGE may be independent prognostic factors for MACE in patients with CTRCD.

• Nuclear Engineering and Technology
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• v.50 no.5
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• pp.806-813
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• 2018

$^{222}Rn$ exists in nature in the form of a rare radioactive gas. In terms of environmental radiation, issues regarding $^{222}Rn$ have persisted because of its radiological hazardousness. Ulju County is one of the regions of Ulsan metropolitan city, with a population of 227,699. Ulju County has the highest density of industrial complexes in Korea. In this study, $^{222}Rn$ radioactivity concentration was measured and analyzed in 57 schools in Ulju County using 114 passive LR-115 type detectors to secure radiological safety and confirm basic information for reduction of resident exposure to $^{222}Rn$. The effective dose of $^{222}Rn$ was assessed to find the actual risk of the concentration surveyed in schools to human beings. The dose depended on four factors: subjects, $^{222}Rn$ concentration, dose coefficient, and time. The individuals subjected to dose estimation were classified into three types: students, teachers, and office workers. The subjects had different dwelling locations and times. The findings demonstrate that the radiological hazard to students and workers at schools in Ulju County owing to $^{222}Rn$ is negligible in terms of $^{222}Rn$ activity recommendation level.

• Journal of Korean Neurosurgical Society
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• v.60 no.2
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• pp.239-249
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• 2017

Objective : The purpose of this study is to evaluate the associations between 30-day mortality and various radiological and clinical factors in patients with traumatic acute subdural hematoma (SDH). During the 11-year study period, young patients who underwent surgery for SDH were followed for 30 days. Patients who died due to other medical comorbidities or other organ problems were not included in the study population. Methods : From January 1, 2004 to December 31, 2014, 318 consecutive surgically-treated traumatic acute SDH patients were registered for the study. The Kaplan-Meier method was used to analyze 30-day survival rates. We also estimated the hazard ratios of various variables in order to identify the independent predictors of 30-day mortality. Results : We observed a negative correlation between 30-day mortality and Glasgow coma scale score (per 1-point score increase) (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.52-0.70; p<0.001). In addition, use of antithrombotics (HR, 2.34; 95% CI, 1.27-4.33; p=0.008), history of diabetes mellitus (HR, 2.28; 95% CI, 1.20-4.32; p=0.015), and accompanying traumatic subarachnoid hemorrhage (hazard ratio, 2.13; 95% CI, 1.27-3.58; p=0.005) were positively associated with 30-day mortality. Conclusion : We found significant associations between short-term mortality after surgery for traumatic acute SDH and lower Glasgow Coma Scale scores, use of antithrombotics, history of diabetes mellitus, and accompanying traumatic subarachnoid hemorrhage at admission. We expect these findings to be helpful for selecting patients for surgical treatment of traumatic acute SDH, and for making accurate prognoses.

• Nuclear Engineering and Technology
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• v.56 no.11
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• pp.4782-4790
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• 2024

This study explored soil samples in a depth about 10-15 cm, 20 Soil samples were collected systematically from various locations to ensure a comprehensive assessment of the site within Kasik oil refinery, Nineveh Governorate, Iraq, whereby the determination of three natural radionuclides' specific activities was carried out via A p-type coaxial HPGe γ-ray spectrometer, manufactured by CANBERRA, USA. Natural radioactivity in soil is a significant factor for assessing environmental radiation exposure and potential health risks. The ²²⁶Ra, ²³²Th, and ⁴⁰K radionuclides' mean specific activities in the soil samples were in the 13.10-33.43 Bq/kg, 10.58-22.76 Bq/kg, and 104.90-442.16 Bq/kg ranges, respectively, with overall means of 21.44 Bq/kg, 15.96 Bq/kg, and 255.50 Bq/kg, which are within the worldwide mean levels. The mean radium-equivalent activity (Ra_eq) was 63.94 Bq/kg, and thus below the 370 Bq/kg international limit. All of the samples' representative level index (I_γ) and internal and external hazard indices (H_in and H_ex) were below the limit of unity, indicating low radiation hazards. The absorbed dose rate resulting from the three primordial radionuclides was in the 19.92-41.46 nGy/h range (mean: 30.20 nGy/h), with an annual effective dose of 0.04 mSv/y. The mean excess lifetime risk of cancer was found to be 0.15 × 10^-3, and thus under the 0.29 × 10^-3 world average. The study's results indicate that the natural radionuclides' measured specific activities in the soil samples are below the world recommended values, suggesting that the investigated area is safe in terms of radiological health risks.

• Journal of radiological science and technology
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• v.11 no.2
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• pp.3-15
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• 1988

When X-rays were projected into a patient, there occured the phenomena such as penetration, absorption and scattering etc. The penetrating rays were recorded on films as X-ray image used for diagnosis but scattered rays caused the radiation hazard both to the patient, specialist and technicians. The soft tissue includes many organs which are sensitive to the radiation and in may occupy $40{\sim}50%$ of body weight. Therefore X-rays should be carefully projected to the patient and it is strongly recommended to analyse the distribution of X-rays, when ever the patient is exposed to X-rays. In this study, the distribution of X-ray according to the thickness, the radiation field and the tube voltages (kVp) in soft tissue, the following results were obtained: 1. Total transmitted rays which kept the step with X-ray tube voltage (kVp) increased in proportion to the increasing of X-ray tube voltage. 2. The scattered ray rate in the total transmitted ray was not significantly found with X-ray tube voltage. 3. The affecting factors of the scattered ray rate in total transmitted ray were shown through the radiation field and the thickness. 4. The dose of scattered ray by the angle was observed more in direction of primary ray ($0^{\circ}$) and back scattering ($160^{\circ}$) than in direction of $90^{\circ}$. 5. The more the distance from phantom to the patient should be less distribution of scattered ray.

• Journal of Korean Neurosurgical Society
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• v.54 no.4
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• pp.329-335
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• 2013

Objective : Brain metastases in primary breast cancer patients are considerable sources of morbidity and mortality. Gamma knife radiosurgery (GKRS) has gained popularity as an up-front therapy in treating such metastases over traditional radiation therapy due to better neurocognitive function preservation. The aim of this study was to clarify the prognostic factors for local tumor control and survival in radiosurgery for brain metastases from primary breast cancer. Methods : From March 2001 to May 2011, 124 women with metastatic brain lesions originating from a primary breast cancer underwent GKRS at a tertiary medical center in Seoul, Korea. All patients had radiosurgery as a primary treatment or salvage therapy. We retrospectively reviewed their clinical outcomes and radiological responses. The end point of this study was the date of patient's death or the last follow-up examination. Results : In total, 106 patients (268 lesions) were available for follow-up imaging. The median follow-up time was 7.5 months. The mean treated tumor volume at the time of GKRS was 6273 $mm^3$ (range, 4.5-27745 mm3) and the median dose delivered to the tumor margin was 22 Gy (range, 20-25 Gy). Local recurrence was assessed in 86 patients (216 lesions) and found to have occurred in 36 patients (83 lesions, 38.6%) with a median time of 6 months (range, 4-16 months). A treated tumor volume >5000 $mm^3$ was significantly correlated with poor local tumor control through a multivariate analysis (hazard risk=7.091, p=0.01). Overall survival was 79.9%, 48.3%, and 15.3% at 6, 12, and 24 months, respectively. The median overall survival was 11 months after GKRS (range, 6 days-113 months). Multivariate analysis showed that the pre-GKRS Karnofsky performance status, leptomeningeal seeding prior to initial GKRS, and multiple metastatic lesions were significant prognostic factors for reduced overall survival (hazard risk=1.94, p=0.001, hazard risk=7.13, p<0.001, and hazard risk=1.46, p=0.046, respectively). Conclusion : GKRS has shown to be an effective and safe treatment modality for treating brain metastases of primary breast cancer. Most metastatic brain lesions initially respond to GKRS, though, many patients have further CNS progression in subsequent periods. Patients with poor Karnofsky performance status and multiple metastatic lesions are at risk of CNS progression and poor survival, and a more frequent and strict surveillance protocol is suggested in such high-risk groups.