• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1223-1235
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• 1998

Background and Objective : Although prone positioning has been reported to improve gas exchange, prone positioning alone does not seem to be sufficient to increase systemic oxygen transport in an acute lung injury. The objective of this study was to investigate whether the combined therapy of low dose nitric oxide (NO) inhalation and prone positioning has an additive effect on the oxygenation and hemodynamics in patients with severe ARDS. Patients and Methods : Twelve patients with ARDS were included. Prone positioning alone, later combined with nitric oxide inhalation (5~10 ppm) from the supine position (baseline) were performed with serial measurement of gas exchange, respiratory mechanics and hemodynamic at sequential time points. The patient was regarded as a responder to prone positioning if an increase in $PaO_2/FiO_2$ of more than 20 mm Hg at 30 min or 120 min intervals after prone positioning was observed compared to that of the baseline. The same criterion was applied during nitric oxide inhalation. Results : Eight patients (66.5%) responded to prone positioning and ten patients (83.3%) including the eight just mentioned responded to the addition of NO inhalation. The $AaDO_2$ level also decreased promptly with the combination of prone positioning and NO inhalation compared to that of prone positioning alone ($191{\pm}109$ mm Hg vs. $256{\pm}137$ mm Hg, P<0.05). Hemodynamic parameters and lung compliance did not change significantly during prone positioning only. Following the addition of NO inhalation to prone positioning, the mean pulmonary artery pressure and pulmonary artery occlusion pressure decreased and cardiac output, stroke volume and oxygen delivery increased (P < 0.05) compared to those of prone 120 min. Conclusion : These findings indicate that NO inhalation would provide additional improvement in oxygenation and oxygen transport to mechanically ventilated patients with ARDS who are in a prone position.

• Tuberculosis and Respiratory Diseases
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• v.43 no.2
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• pp.221-227
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• 1996

Background : Measurement of pleural fluid constituents are of value in the diagnosis of pleural effusions and in the seperation of exudates from transudates. The position of the patient(sitting or lying) prior to thoracentesis may result in difference in the measurement of these constituents. The purpose of this study is to determine whether postural differences in pleural fluid constituents exist, and if so, whether they are of any clinical significance. Method : 41 patients with pleural effusions on chest roentgenography were prospectively studied. The fluid cell counts, partial gas tension, and concentrations of chemical constituents were compared in the supine and upright positions. Results : 1) A total of 10 patients were found to have an transudative effusion. In the transudates there was no significant difference in pleural fluid constituents according to posture change. 2) A total of 31 patients were found to have an exudative effusion. Statistically significant postural changes were noted in pH, WBC counts, protein, and LDH concentrations in the exudates. It may be due to postural sedimentary effect in the pleural space. 3) The PCO2 measurements and glucose concentration were not affected by changes in position in exudates or transudates. Conclusion : Postural sedimentary effect occurs in the pleural space with reference to the measurement of certain pleural fluid constituents when an inflammatory process is present. Therefore it is recommended that thoracentesis after 30 minutes in the sitting position should be performed.

• Journal of radiological science and technology
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• v.28 no.3
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• pp.203-209
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• 2005

Objective True lateral scapular image was very important to diagnosis the scapular fracture and dislocation induced by traumatic injury. The aim of this study was to know the patient rotation angle to be showing the scapular true lateral in Korean. Subjects and Materials Thirty patients(22men, 8 women, mean ages 53.4)with scapular pain, had supine anteroposterior projection taken with $32^{\circ}$, $37^{\circ}$, $42^{\circ}$ trunk rotation angle changing the manual angulation material. Radiographs were evaluated independently by 5 experienced observers(1 orthopedics surgery specialist, 1 diagnostic radiology specialist, 3 radiological technologist) They assessed overlab of vertebral border and axillary border of scapular as follows; Totally overlapping of vertebral border and axillary border is 4, partially overlapping is 3, not overlapping is 2 and oblique location with two borders is 1. All observers scored using by PACS monitor. Results $32^{\circ}$ trunk rotation was scored $1.53{\pm}0.39$, $37^{\circ}$ trunk rotation was scored $3.83{\pm}0.15$ and $42^{\circ}$trunk rotation was scored $2.17{\pm}0.43$. There was no difference(p<0.05) between group of more than 100cm of the girth of the chest and group of less than 100cm. Similarly, men and women group showed no difference(p<0.05) with trunk rotation statistically. Conclusions There was no result of trunk rotation angle to radiograph the true scapular lateral image up to date. This studies were summarized as follows; Adaptation of $37^{\circ}$ trunk rotation was the best to show the true scapular lateral image in Korean. Our results were very useful to get the true scapular lateral images in clinic.

• Journal of the Korean Society of Radiology
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• v.15 no.6
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• pp.919-926
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• 2021

In this study, we wanted to find out the optimal angle as a modified tangential projection of the patella. In the experiment, we used Kyoto Kagaku's PBU-50 phantom. In the supine position, the F-T angle was set to 95°, 105°, 115°, 125°, 135°, 145°, and Patella tangential projection images were obtained by varying the X-ray tube angle by 5° so that the angle between the X-ray centerline and tibia at each angle was 5~20°. Image J was used for image analysis and the congruence angle, lateral patellofemoral angle, patellofemoral index and contrast to noise ratio(CNR) were also measured. SPSS 22 was used for statistical analysis, and the mean values of congruence angle, patellofemoral angle, patellofemoral index, and CNR were compared with Merchant method through one-way batch analysis and corresponding sample t-test. As a result of the study, in the case of congruence angle, the angle of incidence of the knee-angle X-ray centerline was 105°-72.5° (20° tangential irradiation), 115°-72.5°, 77.5° (15, 20° tangential irradiation), 125°-82.5° (20° tangential irradiation), lateral patellofemoral angle is 115°-72.5°, 77.5° (15, 20° tangential irradiation), 125°-72.5° (10° tangential irradiation), patellofemoral index is 115°-72.5° (15° tangential irradiation) and 125°-72.5° (10° tangential irradiation) were not significantly different from Merchant method (p> .05). In case of CNR, it is not different from Merchant method at 105°-67.5°, 72.5° (15, 20° tangential irradiation), 115°-67.5°, 72.5°, 77.5° (10, 15, 20° tangential irradiation). (P> .05). Based on the results of this study, high diagnostic value images can be obtained by setting the knee angle and the angle of incidence of the X-ray tube to 115°-72.5° (15° tangential irradiation) during the modified tangential examination of the knee bone. It was confirmed.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.504-512
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• 1994

Background: It is well known that severe hypoxemia is often associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Pulmonary vascular impairments, more specifically, intrapulmonary shunting have been considered as a major mechanism. Intrapulmonary shunting arises from pulmonary vascular dilatation at the precapillary level or direct arteriovenous communication and has relationship with the characteristic skin findings of spider angioma. However, these results are mainly from Western countries where alcoholic and primary biliary cirrhosis are dominant cuases of cirrhosis. It is uncertain that the same is true in viral hepatitiss associated liver cirrhosis, which is dominant causes of liver cirrhosis in Korea. We investigated the incidences of hypoxemia and orthodeoxia in Korean cirrhotic patients dominantly composed of postnecrotic cirrhosis and the significance of intrapulmonary shunting as the suggested mechanism of hypoxemia, Method: We performed the arterial blood gas analysis separately both at the supine and errect position in 48 stable cirrhotic patients without the evidences of severe complications such as ascites, variceal bleeding, and hepatic coma. According to the results of arterial blood gas analysis, all patients were divided into hypoxemic and normoxemic group. In each group, pulmonary function test and Tc-99m-MAA whole body scan were performed. The shunting fraction was calculated based on the fact that the sum of cerebral and bilateral renal blood flow is 32% of the systemic blood flow. Results: The hypoxemia of $PaO_2$ less than 80 mmHg was observed in 9 patients(18.8%) and Orthodeoxia more than 10 mmHg was observed in 8 patients(16.7%). But there was no patient with significant hypoxemia of $PaO_2$ less than 60 mmHg. $PaO_2$ was significantly decreased in the patients with spider angioma than the pathients without spider angioma and showed no correlation with the serologic type and severities of liver function test findings. Any parameters of pulmonary function test did not demonstrate the difference between normoxemic and hypoxemic group. But hypoxemic group showed significantly increased shunt fraction of $11.4{\pm}4.1%$ than normoxemic group of $4.1{\pm}2.0%$ (p<0.05). Conclusions: Hypoxemia is not infrequently observed complication in liver cirrhosis and intrapulmonary shunting is suggested to p1ay a major ro1e in the development of hypxemia. But there was no great likelihood of clinically significant hypoxemia in our domestic cirrhotic patients predominantly composed of postnecrotic type.

• The Korean Journal of Nuclear Medicine
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• v.34 no.5
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• pp.393-402
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• 2000

Purpose: Tc-99m-MIBI (MIBI) and Tc-99m-Tetrofosmin (TF) are commonly used for scintimammog (SMM). We compared the diagnostic ability of SMM using Tc-99m-MIBI and Tc-99m-TF for the diagnosis of breast mass. Materials and Methods: The study subjects were comprised of 123 breast lesior 86 normal breasts of 114 patients who underwent SMM. Bilateral prone images and anterior supine images obtained at 5 minutes and 1 or 3 hours after intravenous injection of 740 MBq of either MIBI or TF. of tumors were not significantly different between the MIBI and TF groups. First, two observers read the SMM without clinical information (1st interpretation), then read again with information about location (2nd interpretation). Sensitivity and specificity of each radiopharmaceutical for the diagnosis of cancer were evaluated in terms of image acquisition time, tumor size, and location. Results: The SMM a good agreement between two observers for 1st and 2nd interpretation, except for TF SMM at 3 hr. first interpretation, the sensitivities at 5 min, 1 hr, and 3 hr were not significantly different between MIBI TF SMM (81.6%, 80.0%, 60.9% in MIBI vs. 88.9%, 80.6%, 42.9% in TF), although the sensitivities of images were significantly lower than 5 min images in both MIBI and TF SMM. The specificity of TF at was superior to that of MIBI (81.5%, 90.0%, 82.9% in MIBI vs. 96.7%, 100%, 90.0% in TF, p<0.01 MIBI TF at 5 min). For the second interpretation with information of mass location, the sensitivities at 3 hr were significantly lower than 5 min images (86.8%, 86.7%, 78.3% in MIBI vs. 88.9%, 93.5%, 57.1% between MIBI and TF SMM. However, there was no significant difference in the specificity (60.0%, 75.0% for MIBI vs. 86.7%, 100%, 100% for TF). MIBI and TF SMM showed lower sensitivities for the with less than 1 cm than tumors with more than 1 cm. However, the location of tumors did not sensitivity and specificity between MIBI and TF SMM. Conclusion: The ability for the differential of breast tumor is similar between MIBI and TF SMM, and delayed image is not necessary. TF may be than MIBI considering the specificity of SMM without clinical information and labeling convenience.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.43-50
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• 2014

In case of all patients who receive radiation therapy, a treatment plan is established and all steps of treatment are planned in the same geometrical condition. In case of head and neck cancer patients who undergo simulated treatment through computed tomography (CT), patients are fixed onto a table for planning, but laid on the top of the treatment table in the radiation therapy room. This study excogitated and fabricated an adjustable holder for head and neck cancer patients to fix patient's position and geometrical discrepancies when performing radiation therapy on head and neck cancer patients, and compared the error before and after adjusting the position of patients due to difference in weight to evaluate the correlation between patients' weight and range of error. Computed tomography system(High Advantage, GE, USA) is used for phantom to maintain the supine position to acquire the images of the therapy site for IMRT. IMRT 4MV X-rays was used by applying the LINAC(21EX, Varian, U.S.A). Treatment planning system (Pinnacle, ver. 9.1h, Philips, Madison, USA) was used. The setup accuracy was compared with each measurement was repeated five times for each weight (0, 15, and 30Kg) and CBCT was performed 30 times to find the mean and standard deviation of errors before and after the adjustment of each weight. SPSS ver.19.0(SPSS Inc., Chicago, IL,USA) statistics program was used to perform the Wilcoxon Rank test for significance evaluation and the Spearman analysis was used as the tool to analyze the significance evaluation of the correlation of weight. As a result of measuring the error values from CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was $0.4{\pm}0.8mm$, $0.8{\pm}0.4mm$, 0 for 0Kg before the adjustment. In 15Kg CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was $0.2{\pm}0.8mm$, $1.2{\pm}0.4mm$, $2.0{\pm}0.4mm$. After adjusting position was X,Y,Z axis was $0.2{\pm}0.4mm$, $0.4{\pm}0.5mm$, $0.4{\pm}0.5mm$. In 30Kg CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was $0.8{\pm}0.4mm$, $2.4{\pm}0.5mm$, $4.4{\pm}0.8mm$. After adjusting position was X,Y,Z axis was $0.6{\pm}0.5mm$, $1.0{\pm}0mm$, $0.6{\pm}0.5mm$. When the holder for the head and neck cancer was used to adjust the ab.0ove error value, the error values from CBCT were $0.2{\pm}0.8mm$ for the X axis, $0.40{\pm}0.54mm$ for Y axis, and 0 for Z axis. As a result of statistically analyzing each value before and after the adjustment the value was significant with p<0.034 at the Z axis with 15Kg of weight and with p<0.038 and p<0.041 at the Y and Z axes respectively with 30Kg of weight. There was a significant difference with p<0.008 when the analysis was performed through Kruscal-Wallis in terms of the difference in the adjusted values of the three weight groups. As it could reduce the errors, patients' reproduction could be improved for more precise and accurate radiation therapy. Development of an adjustable device for head and neck cancer patients is significant because it improves the reproduction of existing equipment by reducing the errors in patients' position.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.736-745
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• 1998

Background: Respiratory muscle interaction is further profoundly affected by a number of pathologic conditions. Hyperinflation may be particularly severe in chronic obstructive pulmonary disease(COPD) patients, in whom the functional residual capacity(FRC) often exceeds predicted total lung capacity(TLC). Hyperinflation reduces the diaphragmatic effectiveness as a pressure generator and reduces diaphragmatic contribution to chest wall motion. Ultrasonography has recently been shown to be a sensitive and reproducible method of assessing diaphragmatic excursion. This study was performed to evaluate how differences of diaphragmatic excursion measured by ultrasonography associate with normal subjects and COPD patients. Methods: We measured diaphragmatic excursions with ultrasonography on 28 healthy subjects(l6 medical students, 12 age-matched control) and 17 COPD patients. Ultrasonographic measurements were performed during tidal breathing and maximal respiratory efforts approximating vital capacity breathing using Aloka KEC-620 with 3.5 MHz transducer. Measurements were taken in the supine posture. The ultrasonographic probe was positioned transversely in the midclavicular line below the right subcostal margin. After detecting the right hemidiaphragm in the B-mode the ultrasound beam was then positioned so that it was approximately parallel to the movement of middle or posterior third of right diaphragm. Recordings in the M-mode at this position were made throughout the test. Measurements of diaphragmatic excursion on M-mode tracing were calculated by the average gap in 3 times-respiration cycle. Pulmonary function test(SensorMedics 2800), maximal inspiratory(PImax) and expiratory mouth pressure(PEmax, Vitalopower KH-101, Chest) were measured in the seated posture. Results: During the tidal breathing, diaphragmatic excursions were recorded $1.5{\pm}0.5cm$, $1.7{\pm}0.5cm$ and $1.5{\pm}0.6cm$ in medical students, age-matched control group and COPD patients, respectively. Diaphragm excursions during maximal respiratory efforts were significantly decreased in COPD patients ($3.7{\pm}1.3cm$) when compared with medical students, age-matched control group($6.7{\pm}1.3cm$, $5.8{\pm}1.2cm$, p< 0.05}. During maximal respiratory efforts in control subjects, diaphragm excursions were correlated with $FEV_1$, FEVl/FVC, PEF, PIF, and height. In COPD patients, diaphragm excursions during maximal respiratory efforts were correlated with PEmax(maximal expiratory pressure), age, and %FVC. In multiple regression analysis, the combination of PEmax and age was an independent marker of diaphragm excursions during maximal respiratory efforts with COPD patients. Conclusion: COPD subjects had smaller diaphragmatic excursions during maximal respiratory efforts than control subjects. During maximal respiratory efforts in COPD patients, diaphragm excursions were well correlated with PEmax. These results suggest that diaphragm excursions during maximal respiratory efforts with COPD patients may be valuable at predicting the pulmonary function.