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Difference in the Set-up Margin between 2D Conventional and 3D CT Based Planning in Patients with Early Breast Cancer (조기유방암환자의 이차원치료계획과 삼차원치료계획의 방사선조사범위의 차이)

  • Jo, Sun-Mi;Chun, Mi-Son;Kim, Mi-Hwa;Oh, Young-Taek;Kang, Seung-Hee;Noh, O-Kyu
    • Radiation Oncology Journal
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    • v.28 no.3
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    • pp.177-183
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    • 2010
  • Purpose: Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. Materials and Methods: Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inframammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. Results: The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. Conclusion: The use of 3D CT based planning reduced the radiation field in early breast cancer patients with small breasts in relation to conventional planning. Though a coherent definition of the breast is needed, CT-based planning generated the better plan in terms of reducing the irradiation volume of normal tissue. Moreover it was possible that 3D CT based planning showed better CTV coverage including postoperative change.

Investigation on Factors Influencing the Quality of Life of Arthritis Patients (관절염환자의 삶의 질에 영향을 미치는 요인탐색)

  • Oh, Hyun Ja
    • Korean Journal of Adult Nursing
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    • v.12 no.3
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    • pp.431-451
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    • 2000
  • In this paper, I will examine the variables influencing the Quality of Life of arthritis patients and present basic materials which help arthritis patients have positive thinking in life and ultimately lead a satisfactory life. The subjects for this study are 231 inpatients and outpatients with arthritis living in J and K city in Chonbug Province. For the analysis of collected data I employed the SAS program. The variables for characteristics and the quality of life were analysed by descriptive statistics, T-test and ANOVA, and the relations among variables were analysed through Pearson Correlation; the Regression method was employed to predict the factors affecting quality of life. For the validity of reliance on measuring equipment Cronbach Alpha was used. The results of the study are as follows : (1) The mean score of quality of life of arthritis patients is 3.09(5 in the maximum). The general characteristics which affect the quality of life are age(F=5.13, p=0.0006), standard of education(F=6.49, p=0.0003), marriage status(F=7.77, p=0.0005), monthly pay(F=4.37, p=0.0020), medical benefits (F=4.85, p=0.0087), and supports(F=4.39, p=0.0050). For the disease-related characteristics, there is a significant difference in the 6 items: pain control method(F=5.92, p= 0.0002), physical therapy(F=3.25, p=0.013), whethere or not patients exercise(F=4.62, p=0.0000), regularity of exercise(F=4.79, p=0.0000), frequency of exercise(F=6.29, p=0.0001), and amount of exercise(F=4.62, p=0.0043). Depending on the type of arthritis, there is also a significant difference in the degree of pain felt. The patients with infectious arthritis suffer from pain the most, followed by those with gout, rheumatism and degenerative arthritis, in that order. Although statistics don't show any convincing evidence, those with gout perceive that they are in best health condition, followed by those with rheumatism, degenerative arthritis, and infectious arthritis, in that order(F=2.23, p=0.0669). (2) The quality of life of arthritis patients is correlated positively with perceived health status(r=0.56, p=0.0001), health promoting behavior(r=0.53, p=0.0001), family support (r=0.46, p=0.0001), amount of exercise (r=0.36, p=0.0001), ADL(r=0.36, p=0.0001), HLOC(r=0.32, p=0.0001), frequency of exercise(r=0.32, p=0.0001)in that order, while correlated negatively with the degree of pain felt(r=-0.32, p=0.0001), the number of pain regions(r=-0.19, p= 0.0041), and the duration of pain(r=-0.14, p=0.0279). (3) Regression analysis reveals that the most powerful predictor of the quality of life is perceived health status, which account for 31.11%. The other predictors of the quality of life, which account for 60.22%, are health promoting behavior(16.51%), family support(3.81%), ADL(2.52%), gender(1.86%), the number of family members(1.36%), level of pain(1.24%), duration of pain (1.08%), and level of education(0.67%). The results of the study show that perceived health status and health promoting behavior are the two most important variables. However, considering that the perceived health condition is difficult to control by nursing intervention, it is suggested that the level of expectation for patients, must be decided first, and the health promoting behavior and the family support influencing the quality of life must be taken into account as targets for nursing intervention. As a way of controlling the quality of life, I think that a more comprehensive approach comprising the above important variables along with demographic and general characteristics is needed. I also suggest that we must continue to explore the variables affecting the quality of life and include those variables in nursing intervention.

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Identification of Interleukin 1-Responsive Genes in Human Chondrosarcoma SW1354 cells by cDNA Microarray Technology

  • Jeon, Jun-Ha;Jung, Yong-Wook;Yun, Dae-Young;Kim, Hyun-Do;Kwon, Chang-Mo;Hong, Young-Hoon;Kim, Jae-Ryong;Lee, Choong-Ki
    • Journal of Yeungnam Medical Science
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    • v.24 no.1
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    • pp.24-40
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    • 2007
  • Background : Accumulating evidence shows that interleukin(IL)-1 plays a critical role in inflammation and connective tissue destruction observed in both osteoarthritis and rheumatoid arthritis. IL-1 induces gene expression related to cytokines, chemokines and matrix metalloproteinases by activation of many different transcription factors. Materials and Methods : The chondrosarcoma cell line, SW1353, is known to be a valuable in vitro system for investigating catabolic gene regulation by IL-$1{\beta}$ in chondrocytic cells. To explore and analyze the changes in gene expression by IL-1 responsible for arthritis, SW1353 was treated with IL-1 for 1, 6 and 24 h and then total RNAs were purified for each time. The changes in gene expression were analyzed with 17k human cDNA microarrays and validated by semi-quantitative RT-PCR. Results : Greater than a two-fold change was observed in 1,200 genes including metallothioneins, matrix metalloproteinases, extracellular matrix proteins, antioxidant proteins, cytoskeleton proteins, cell cycle regulatory proteins, proteins for cell growth and apoptosis, signaling proteins and transcription factors. These changes appeared to be correlate with the pathophysiological changes observed in early osteoarthritis. Conclusion : cDNA microarray analysis revealed a marked variability in gene expression, and provided insight into the overall molecular changes. The result of this study provide initial information for further studies to identify therapeutic targets in osteoarthritis pathogenesis.

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The Effect of Value-added Promotion and Retailer Uncertainty on Customers' Perceived Value of the Product (부가가치 제공 유형별 판매촉진과 유통업체 불확실성이 제품 가치 평가에 미치는 영향 - 사은품(Freebie) 제공 판매촉진을 중심으로 -)

  • Kim, Hyang-Mi;Lee, So-Young;Kim, Jae-Wook
    • Journal of Distribution Research
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    • v.16 no.1
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    • pp.117-140
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    • 2011
  • The sales promotion strategy can be classified into two categories: cost-down and value-added promotions. Although many studies have been performed on sales promotion in the past, little attention has been given on cost-down promotion, and in particular on its strategy. Also there has been a renewed interest on value-added promotion strategy as means of attracting more customers and delivering value by providing a greater benefit. This study examines the effect of value-added promotion on the evaluation of promotional products. The topic is important because the value-added promotions are not always perceived as a benefit by consumers and they depend on the situational factors. We postulate three hypotheses on the basis of related literature. We conduct two studies: one employing experiment (study 1) and the other, quasi-experiment (study 2) to investigate the effect of two situational factors, namely the promotional package type and retailer uncertainty on the valuation of promotional products. Study 1 employs 2 promotional package types (bundled with freebie type vs. one-plus-one type) by 3 evaluation targets (overall package, a focal product and freebie) in experimental design. Also it is found that consumers devaluate the promotional product when the level of retailer uncertainty is high (t=-4.70, p=.000) as shown in Table 2. As depicted in Figure 2, the interaction effect of retailer uncertainty and package types on the evaluation of promotional product as a whole does not appear to be significant. However, when the level of retailer uncertainty is high, the focal product suffers from lower valuation if it is included in a bundle with freebie type package. The purpose of Study 2 is to cross-check the results of Study 1. The results of Study 2 also show that the consumers devaluate the promotional products as a whole when the level of retailer uncertainty is high. Furthermore, Study2 examines the consumers' willingness to purchase. The willingness to purchase of 2 different consumer groups divided by their reservation prices before and after exposure to a promotional stimuli shows no significant differences(t=1.911, p=.057). The results suggest that the consumers' reservation prices before the exposure to the promotion can be a reference prices of their's. But after the promotional events, the promotional price would become their reference prices. Furthermore, when the level of retailer uncertainty is high, consumers devaluate the promotional product as a whole. Because the promotional offerings activate the persuasion knowledge of consumers and make them incorporate negative inference about the firm's motives into their valuation and consequently, consumers tend to hesitate to purchase.

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User Centered Interface Design of Web-based Attention Testing Tools: Inhibition of Return(IOR) and Graphic UI (웹 기반 주의력 검사의 사용자 인터페이스 설계: 회귀억제 과제와 그래픽 UI를 중심으로)

  • Kwahk, Ji-Eun;Kwak, Ho-Wan
    • Korean Journal of Cognitive Science
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    • v.19 no.4
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    • pp.331-367
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    • 2008
  • This study aims to validate a web-based neuropsychological testing tool developed by Kwak(2007) and to suggest solutions to potential problems that can deteriorate its validity. When it targets a wider range of subjects, a web-based neuropsychological testing tool is challenged by high drop-out rates, lack of motivation, lack of interactivity with the experimenter, fear of computer, etc. As a possible solution to these threats, this study aims to redesign the user interface of a web-based attention testing tool through three phases of study. In Study 1, an extensive analysis of Kwak's(2007) attention testing tool was conducted to identify potential usability problems. The Heuristic Walkthrough(HW) method was used by three usability experts to review various design features. As a result, many problems were found throughout the tool. The findings concluded that the design of instructions, user information survey forms, task screen, results screen, etc. did not conform to the needs of users and their tasks. In Study 2, 11 guidelines for the design of web-based attention testing tools were established based on the findings from Study 1. The guidelines were used to optimize the design and organization of the tool so that it fits to the user and task needs. The resulting new design alternative was then implemented as a working prototype using the JAVA programming language. In Study 3, a comparative study was conducted to demonstrate the excellence of the new design of attention testing tool(named graphic style tool) over the existing design(named text style tool). A total of 60 subjects participated in user testing sessions where their error frequency, error patterns, and subjective satisfaction were measured through performance observation and questionnaires. Through the task performance measurement, a number of user errors in various types were observed in the existing text style tool. The questionnaire results were also in support of the new graphic style tool, users rated the new graphic style tool higher than the existing text style tool in terms of overall satisfaction, screen design, terms and system information, ease of learning, and system performance.

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A Study on the dose distribution produced by $^{32}$ P source form in treatment for inhibiting restenosis of coronary artery (관상동맥 재협착 방지를 위한 치료에서 $^{32}$ P 핵종의 선원 형태에 따른 선량분포에 관한 연구)

  • 김경화;김영미;박경배
    • Progress in Medical Physics
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    • v.10 no.1
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    • pp.1-7
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    • 1999
  • In this study, the dose distributions of a $^{32}$ p uniform cylindrical volume source and a surface source, a pure $\beta$emitter, were calculated in order to obtain information relevant to the utilization of a balloon catheter and a radioactive stent. The dose distributions of $^{32}$ p were calculated by means of the EGS4 code system. The sources are considered to be distributed uniformly in the volume and on the surface in the form of a cylinder with a radius of 1.5 mm and length of 20 mm. The energy of $\beta$particles emitted is chosen at random in the $\beta$ energy spectrum evaluated by the solution of the Dirac equation for the Coulomb potential. Liquid water is used to simulate the particle transport in the human body. The dose rates in a target at a 0.5mm radial distance from the surface of cylindrical volume and surface source are 12.133 cGy/s per GBq (0.449 cGy/s per mCi, uncertainty: 1.51%) and 24.732 cGy/s per GBq (0.915 cGy/s per mCi, uncertainty: 1.01%), respectively. The dose rates in the two sources decrease with distance in both radial and axial direction. On the basis of the above results, the determined initial activities were 29.69 mCi and 1.2278 $\mu$Ci for the balloon catheter and the radioactive stent using $^{32}$ P isotope, respectively. The total absorbed dose for optimal therapeutic regimen is considered to be 20 Gy and the treatment time in the case of the balloon catheter is less than 3 min. Absorbed doses in targets placed in a radial direction for the two sources were also calculated when it expressed initial activity in a 1 mCi/ml volume activity density for the cylindrical volume source and a 0.1 mCi/cm$^2$ area activity density for the surface source. The absorbed dose distribution around the $^{32}$ P cylindrical source with different size can be easily calculated using our results when the volume activity density and area activity density for the source are known.

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The Acceptance Testing of 5 Mega Pixels Primary Electronic Display Devices and the Study of Quality Control Guideline Suitable for Domestic Circumstance (5 Mega 화소 진단용 전자표시장치 인수검사 및 국내 실정에 적합한 정도관리 가이드라인 연구)

  • Jung, Hai-Jo;Kim, Hee-Joung;Kim, Sung-Kyu
    • Progress in Medical Physics
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    • v.18 no.2
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    • pp.98-106
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    • 2007
  • In June 2005, Yonsei University Medical Center, Severance Hospital upgraded a full-PACS system by adding twenty (5 mega pixels) Totoku ME511L flat panel LCD display devices for diagnostic interpretation purposes. Here we report upon the quantitative (or visual) acceptance testing of the twenty Totoku ME511L display devices for reflection, luminance response, luminance spatial dependency, resolution, noise, veiling glare, and display chromaticity based on AAPM TG 18 report. The tools used in the tests included a telescopic photometer, which was used as a colorimeter, illuminance meter, light sources for reflection assessment, light-blocking devices, and digital TG18 test patterns. For selected 8 flat panel displays, mean diffuse reflection coefficient ($R_d$) was $0.019{\pm}0.02sr^{-1}$. In the luminance response test, luminance ratio (LR), maximum luminance difference ($L_{max}$), and deviation of contrast response were $550{\pm}100,\;2.0{\pm}1.9%\;and\;5.8{\pm}1.8%$, respectively. In the luminance uniformity test, maximum luminance deviation was $14.3{\pm}5.5%$ for the 10% luminance of the TG18-UNL10 test pattern. In the resolution test with luminance measurement method, percent luminance (${\Dalta}L$) at the center was $0.94{\pm}0.64%$. In all cases of noise testing, rectangular target In every square in the three quadrants was visible and all 15 targets except the smallest one in the every corner pattern and the center pattern. The glare ratio (GR) was $12,346{\pm}1,995$. The color uniformity, (u',v'), was $0.0025{\pm}0.0008$. Also, the research results of qualify control guideline of primary disply devices suitable for domestic circumstance are presented All test results are in-line with the criteria recommended by AAPM TG18 report and are thus fully acceptable for diagnostic image interpretation. As a result, the acceptance testing schedule described provides not only an acceptance standard but also guidelines for quality control, optimized viewing conditions, and a means for determining the upgrading time of LCD display devices for diagnostic interpretation.

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How to Determine the Moving Target Exactly Considering Target Size and Respiratory Motion: A Phantom Study (종양의 움직임과 호흡주기에 따른 체적 변화에 대한 연구: 팬텀 Study)

  • Kim, Min-Su;Back, Geum-Mun;Kim, Dae-Sup;Kang, Tae-Yeong;Hong, Dong-Ki;Kwon, Kyung-Tae
    • The Journal of Korean Society for Radiation Therapy
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    • v.22 no.2
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    • pp.145-153
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    • 2010
  • Purpose: To accurately define internal target volume (ITV) for treatment of moving target considering tumor size and respiratory motion, we quantitatively investigated volume of target volume delineated on CT images from helical CT and 4D CT scans. Materials and Methods: CT images for a 1D moving phantom with diameters of 1.5, 3, and 6 cm, acryl spheres were acquired using a LightSpeed $RT^{16}CT$ simulator. To analyze effect of tumor motion on target delineation, the CT image of the phantoms with various moving distances of 1~4 cm, and respiratory periods of 3~6 seconds, were acquired. For investigating the accuracy of the target trajectory, volume ratio of the target volumes delineated on CT images to expected volumes calculated with diameters of spherical phantom and moving distance were compared. Results: Ratio$_{helical}$ for the diameter of 1, 5, 3, and 6 cm targets were $32{\pm}14%$, $45{\pm}14%$, and $58{\pm}13%$, respectively, in the all cases. As to 4DCT, RatioMIP were $98{\pm}8%$, $97{\pm}5%$, and $95{\pm}1%$, respectively. Conclusion: The target volumes delineated on MIP images well represented the target trajectory, in comparison to those from helical CT. Target volume delineation on MIP images might be reasonable especially for treatment of early stage lung cancer, with meticulous attention to small size target, large respiratory motion, and fast breathing.

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A Study on Responses of the Korean kidnapping Terror in overseas (한국인 해외인질납치테러 대응방안)

  • Jeong, Joon-Sik;Kim, Won-Ki
    • Korean Security Journal
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    • no.20
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    • pp.339-363
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    • 2009
  • The 9.11 demonstrated that terrorist attack could be more serious problem than the war in our modern life. No countries in the world have evaded being a target for terrorists today. As well as South Korea, the whole world must share attentions and responsibilities for fighting against the terrorism. Since the international terrorist groups have expanded their targets from Western countries to Koreans, civilian hostages are no longer other's affair; it became a serious threat to public. Increased Korean investment, trade, missionary, and travel overseas also expanded activity regions worldwide. It also result increased terrorist threats and possible abduction. The number of kidnapping crisis has increased since the terrorists use it as an effective method of sending a message. Piracy refers to a broad range of violent acts at sea, and has traditionally been regarded as common enemies. Piracy constitutes a great threat to the security of navigation as well as to the safety of vessels and crews. Lessons from hostage issues such as Korean hostage crisis in Somalia and Afghanistan show that it can cause criticism on moral issues if armed rescue missions fail or hostages are killed, so the governments and related corporations try to solve it by paying ransom. Terrorists and use these advantages in order to put a huge pressure on the governments. In this study we will look at essential characteristics and types of hostage abductions and recognition of national safety, lessons and solutions to previous Korean hostage cases in overseas. At the same time, it provides a guidelines of the direction in the fighting against terrorist groups and Piracy.

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Flavonoid Biosynthesis: Biochemistry and Metabolic Engineering (Flavonoid 생합성:생화학과 대사공학적 응용)

  • Park, Jong-Sug;Kim, Jong-Bum;Kim, Kyung-Hwan;Ha, Sun-Hwa;Han, Bum-Soo;Kim, Yong-Hwan
    • Journal of Plant Biotechnology
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    • v.29 no.4
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    • pp.265-275
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    • 2002
  • Flavonoid biosynthesis is one of the most extensively studied areas in the secondary metabolism. Due to the study of flavonoid metabolism in diverse plant system, the pathways become the best characterized secondary metabolites and can be excellent targets for metabolic engineering. These flavonoid-derived secondary metabolites have been considerably divergent functional roles: floral pigment, anticancer, antiviral, antitoxin, and hepatoprotective. Three species have been significant for elucidating the flavonoid metabolism and isolating the genes controlling the flavonoid genes: maize (Zea mays), snapdragon (Antirrhinum majus) and petunia (Prtunia hybrida). Recently, many genes involved in biosynthesis of flavonoid have been isolated and characterized using mutation and recombinant DNA technologies including transposon tagging and T-DNA tagging which are novel approaches for the discovery of uncharacterized genes. Metabolic engineering of flavonoid biosynthesis was approached by sense or antisense manipulation of the genes related with flavonoid pathway, or by modified expression of regulatory genes. So, the use of a variety of experimental tools and metabolic engineering facilitated the characterization of the flavonoid metabolism. Here we review recent progresses in flavonoid metabolism: confirmation of genes, metabolic engineering, and applications in the industrial use.