• Korean Journal of Radiology
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• v.25 no.7
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• pp.634-643
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• 2024

Objective: This study aimed to evaluate the diagnostic efficacy and safety of low-contrast-dose, dual-source dual-energy CT before transcatheter aortic valve replacement (TAVR) in patients with compromised renal function. Materials and Methods: A total of 54 consecutive patients (female:male, 26:38; 81.9 ± 7.3 years) with reduced renal function underwent pre-TAVR dual-energy CT with a 30-mL contrast agent between June 2022 and March 2023. Monochromatic (40- and 50-keV) and conventional (120-kVp) images were reconstructed and analyzed. The subjective quality score, vascular attenuation, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were compared among the imaging techniques using the Friedman test and post-hoc analysis. Interobserver reliability for aortic annular measurement was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman analysis. The procedural outcomes and incidence of post-contrast acute kidney injury (AKI) were assessed. Results: Monochromatic images achieved diagnostic quality in all patients. The 50-keV images achieved superior vascular attenuation and CNR (P < 0.001 in all) while maintaining a similar SNR compared to conventional CT. For aortic annular measurement, the 50-keV images showed higher interobserver reliability compared to conventional CT: ICC, 0.98 vs. 0.90 for area and 0.97 vs. 0.95 for perimeter; 95% limits of agreement width, 0.63 cm² vs. 0.92 cm² for area and 5.78 mm vs. 8.50 mm for perimeter. The size of the implanted device matched CT-measured values in all patients, achieving a procedural success rate of 92.6%. No patient experienced a serum creatinine increase of ≥ 1.5 times baseline in the 48-72 hours following CT. However, one patient had a procedural delay due to gradual renal function deterioration. Conclusion: Low-contrast-dose imaging with 50-keV reconstruction enables precise pre-TAVR evaluation with improved image quality and minimal risk of post-contrast AKI. This approach may be an effective and safe option for pre-TAVR evaluation in patients with compromised renal function.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.186-190
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• 2005

Purpose : The purpose of this study was to evaluate the responses and toxicities of risk-adapted chemotherapy in pediatric intracranial germ cell tumors(IC-GCT). Methods : Fourteen patients who were diagnosed as IC-GCT from October 2002 to December 2003 received chemotherapy as an initial treatment modality. The low risk(LR) group was defined as follows : Pure germinoma and normal AFP level. Beta-hCG level 50 mIU/mL or less. The others belonged to the high risk(HR) group. Chemotherapy was composed of cisplatin, cyclophosphamide, etoposide and vincristine. Double doses of cisplatin and cyclophosphamide was used in HR patients. Results : Pathologic confirmation was done in all but one. Median age at diagnosis was 11.6 yr (1.2-18.7 yr), and nine patients belonged to the HR group. Tumor markers were normalized after chemotherapy in all patients whose tumor markers had been elevated. Four LR patients(80 percent) and seven HR patients(77.8 percent) showed complete response(CR) at the end of chemotherapy. An additional two of the three patients with partial response(PR) achieved CR after radiation therapy (RT), and the remaining one relapsed before RT. Four LR and all HR patients experienced infectious episodes that required hospitalization. Four of the nine HR patients(44.4 percent) suffered from tinnitus, three of whom developed sensorineural hearing loss. All but one are surviving, event-free, with a median follow-up of 13.9 mo(8.1-22.3 mo). Conclusion : Risk-adapted cisplatin-based chemotherapy was effective even in HR patients, but regimen modification seems to be necessary to avoid an unacceptably high toxicity rate.

• Journal of radiological science and technology
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• v.28 no.4
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• pp.293-299
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• 2005

In the present investigation, we analyzed the data of 1,318 patients (2,636 images) who underwent mammographic examinations and obtained the distribution of the patient age and compressed breast thickness. We measured also average glandular doses (AGD) as function of compressed breast thickness. In order to obtain the values of AGD, we measured half value layer (HVL) and tube output (mR/mAs) for each kVp and target/filter combination. Entrance surface air kerma (ESAK) was calculated from the tube output as measured for each voltage used under clinical conditions and from the tube loading (mAs). AGD per exposure were calculated by multiplying the ESAK values by the conversion factors tabulated by Dance. We obtained in this study the following conclusions. The mean value of compressed breast thickness for cranio-caudal (CC) view was 35.8mm and that for medio-lateral oblique (MLO) view was 43.3 mm. The mean value of AGD for CC view was 1.55 mGy and that for MLO view was 1.70 mGy. The AGD for MLO view was 0.15 mGy (10%) higher than that for CC view because the thickness for MLO view was on average 4.8 mm higher than that for CC view. The values of AGD increased with increasing compressed brest thickness. The increased AGD value was on average 0.34 mGy per 10 mm in the thickness ranges $10{\sim}80\;mm$, therefore differences between the AGD values of each thickness were relative large. Thus, it is considered to need limited doses for mammography with the upper end of exposure range at several different compressed brest thickness.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.769-776
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• 2006

Purpose : Pulse wave velocity(PWV) and ankle brachial index(ABI) are not only noninvasive methods used to assess arterial stiffness in adults, but also useful, simple ways to estimate the severity of hypertension, end stage renal disease and atherosclerosis in adults. But there are few studies on PWV and ABI in adolescents and children. In this study, hypertensive adolescents were compared to normal individuals to find out the usefulness of PWV as the index of progress in the disease. Methods : 413 teenagers were divided into three groups. The first group consisted of adolescents that only had hypertension(Group 1 : 23 teenagers). The second group consisted of the adolescents who had hypertension with obesity(Group 2 : 17 teenagers), and the last group was the normal subjects(Group 3 : 328 teenagers). Weight, height and body mass index were measured. Simultaneous measurements of systolic, diastolic and average blood pressure were obtained from the four extremities. PWV, ABI, ejection time and preejection period were also measured. Results : Right brachial-ankle PWV was significantly higher in both group 1 and group 2 compared with group 3, and significantly higher in group 2 compared with group 1. Likewise, left brachial-ankle PWV also showed significantly higher values in both group 1 and group 2 compared with group 3, and also higher values in group 2 compared with group 1. Positive correlations were found between the systolic, diastolic, average blood pressure and PWV. There were also positive correlations between the blood pressure and weight, body mass index. Conclusion : Higher PWV was demonstrated in adolescents with essential hypertension compared to normal subjects. Follow-up study is needed to evaluate the progress.

• Clinical and Experimental Pediatrics
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• v.50 no.11
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• pp.1078-1084
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• 2007

Purpose : The prevalence of childhood obesity has doubled over the last 30 years. Obesity-associated sequelae in the vasculature begins in the early stages of life. The purpose of this study was to investigate how pulse wave velocity (PWV) and ankle brachial index (ABI) change with height, weight and body mass index (BMI) in obese adolescents. Methods : Seventy-nine obese adolescents (group 1: $85th{\leq}BMI<95th$ percentile, n=40; group 2 ($BMI{\geq}95th$ percentile, n=39) were included. The control group(group 3) included 99 healthy adolescents. Brachial- ankle (ba) PWV and ABI were estimated with blood pressure from four extremities. Heart rate (HR), and pre-ejection period/ejection time (PEP/ET) were also estimated. BMI was calculated from individual height and weight. Linear regression analysis was performed to evaluate the correlations between BMI and PWV. Results : Blood pressure and baPWV were significantly higher in group 2, compared to either group 1 or group 3. However, there was no significant difference in ABI, HR and PEP/ET between the groups. PWV showed linear correlation with both BMI and body weight. Conclusion : Obesity was associated with higher arterial stiffness in adolescents, which was demonstrated by an increase in PWV. There was no significant correlation between obesity and ABI.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.13-22
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• 2015

Purpose : We investigated the safety of Intrabeam$^{TM}$ system, X-ray unit for Intraoperative Radiotheray (IORT) by measuring surface dose using Optically Stimulated Luminescent Dosimeter(OSLD). Materials and Methods : 30 patients were selected, who were in breast cancer patients and had an operation of breast conserving surgery (BCS). At the inner surface of tumor bed, 20 Gy were described, and 5 Gy at 1cm depth from the inner surface. Along the size of tumor bed which could be decided after resection of tumor, the size of applicator were determined. Usual treatment time were from 18 to 40 minutes. For the measurement of surface doses, OSLD were placed at superior(U1,2), inferior(D1,2), lateral(L1,2) and medial(M1,2) directions from the center of applicator. Each direction, two OSLD were placed at 0.5 cm and 1.5 cm from the center. Mean, maximum, and minimum doses were analyzed to be compared. Results : Mean values were U1 $2.23{\pm}0.80Gy$, U2 $1.54{\pm}0.53Gy$, D1 $1.73{\pm}0.63Gy$, D2 $1.25{\pm}0.45Gy$, L1 $1.95{\pm}0.82Gy$, L2 $1.38{\pm}0.42Gy$, M1 $2.03{\pm}0.70Gy$, and M2 $1.51{\pm}0.58Gy$. Maximum values were 4.34 Gy at U1, and Minimum values were 0.45 Gy at M2. 13.3 % of patient (4pts out of 30) were reported that surface dose were over 4 Gy. Conclusion : The fact that skin dose of all patients were less than 5 Gy based on OSLD measurement showed the safety of Intrabeam$^{TM}$ system. In the relatively small breast volume, the tendency that surface dose was increased had been shown, which was analyzed by the data of patients who irradiated over 4Gy at skin surface. Therefore, for appropriate indication for IORT, it is suggested that breast volume as well as the size and position of tumor should be carfully considered.

• Journal of Radiation Protection and Research
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• v.32 no.3
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• pp.123-133
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• 2007

Z-axis automatic tube current modulation technique automatically adjusts tube current based on size of body region scanned. The purpose of the current study was to compare noise, and radiation dose of multi-detector row CT (MDCT) of lower extremity performed with Z-axis modulation technique of automatic tube current modulation with manual selection fixed tube current. Fifty consecutive underwent MDCT venography of lower extremity with use of a MDCT scanner fixed tube current and Z-axis automatic tube current modulation technique (10, 11 and 12 HU noise index, $70{\sim}450\;mA$). Scanning parameters included 120 kVp, 0.5 second gantry rotation time, 1.35:1 beam pitch, and 1 mm reconstructed section thickness. For each subject, images obtained with Z-axis modulation were compared with previous images obtained with fixed tube current (200, 250, 300 mA) and with other parameters identical. Images were compared for noise at five levels: iliac, femoral, popliteal, tibial, and peroneal vein of lower extremity. Tube current and gantry rotation time used for acquisitions at these levels were recorded. All CT examinations of study and control groups were diagnostically acceptable, though objective noise was significantly more with Z-axis automatic tube current modulation. Compared with fixed tube current, 2-axis modulation resulted in reduction of CTDIvol (range, $-6.5%{\sim}-35.6%$) and DLP (range, $-0.2%{\sim}-20.2%$). Compared with manually selected fixed tube current, 2-axis automatic tube current modulation resulted in reduced radiation dose at MDCT of lower extremity venography.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.929-936
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• 2003

We analysed the surgical outcomes of immediate reoperations after mitral valve repair. Material and Method: Eighteen patients who underwent immediate reoperation for failed mitral valve repair from April 1995 through July 2001 were reviewed retrospectively. There were 13 female patients. The mitral valve disease was regurgitation (MR) in 12 patients, stenosis (MS) in 3, and mixed lesion in 3. The etiologies of the valve disease were rheumatic in 9 patients, degenerative in 8, and endocarditis in 1. The causes of reoperation was residual MR in 13 patients, residual MS in 4, and rupture of left ventricle in 1. Fourteen patients had rerepair for residual mitral lesions (77.8%) and four underwent replacement. Result: There was no early death. After mean follow-vp of 33 months, there was one late death. Echocardiography revealed no or grade 1 of MR (64.3%) in 9 patients and no or mild MS in 11 patients (78,6%). Reoperation was done in one patient. The cumulative survival and freedom from valve-related reoperation at 6 years were 94% and 90%, respectively. The cumulative freedom from recurrent MR and MS at 4 years were 56% and 44%, respectively. Conclusion: This study suggests that immediate reoperation for failed mitral valve repair offers good early and intermediate survival, and mitral valve rerepair can be successfully performed in most of patients. However, because mitral rerepair have high failure rate, especially in rheumatic valve disease, adequate selections of valvuloplasty technique and indication are important to reduce the failure rate of mitral rerepair.

• Journal of Preventive Medicine and Public Health
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• v.36 no.4
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• pp.339-348
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• 2003

Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

• Korean Journal of Environmental Biology
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• v.22 no.2
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• pp.247-258
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• 2004

Climatological, hydrological and planktonical research studies, measurements of primary production and photosynthetic efficiency from December 1976 to December 1978 have been carried out in two brackish lakes: Lake Etang de Berre and Lake Etang de Vaine located in the French Mediterranean coast, in the region of Carry-le-Rouet located on the north-west Mediterranean near Marseilles, and in fresh water inflows from 4 Rivers (Touloubre, Durance, Arc, Durancole) to Lake Etang de Berre. Physico-chemical parameters were measured for this study: water temperature, salinity, density, pH, alcalinity, dissolved oxygen (% saturation), phosphate, nitrate, nitrite, silicate etc. Diverse biological parameters were also studied: photosynthetic pigments, phaeopigments, specific composition and biomass of phytoplankton, primary pelagic production etc. Climatical factors were studied: air-temperature, solar-radiation, evaporation, direction (including strength) of winds, precipitation and freshwater volume of the four rivers. The changes in Lake ‘Etang de Berre’ ecosystem depend on the quality of the water in the Durance River, and on the effects of seawater near the entrance of the Caronte Canal. The water quality of the lake varies horizontally and vertically as a result of atmospheric phenomena, maritime currents and tides. The distribution of water temperatures is generally heterogeneous. Southeasterly winds and the Northeasterly Mistral wind are important in the origins of circulated and mixed water masses. These winds are both frequent and strong. They have, as a result, a great effect on the water environment of Lake Etang de Berre. In theory, the annual precipitation in this region is well over eight times the water mass of the lake. The water of the Durance River flows into Lake Etang de Berre through the EDF Canal, amounting to 90% of the precipitation. However, reduction of rainfall in dry seasons has a serious effect on the hydrological characteristics of the lake. The temperature in the winter is partially caused by the low temperature of fresh water, particularly that of the Durance River. The hydrological season of fresh and brackish water is about one month ahead of the hydrological season of sea water in its vicinity. The salinity of Lake Etang de Berre runs approximately 3$\textperthousand$, except at lower levels and near the entrance to the Caronte Canal. However, when the volume of the Durance River water is reduced in the summer and fall, the salinity rises to 15$\textperthousand$. In the lake, the ratio of fresh water to sea water is six to one (6:1). The large quantities of seston conveyed by rivers, particularly the Durance diversion, strongly reduce the transparency in the brackish waters. Although the amount of sunshine is also notable, transparency is slight because of the large amount of seston, carried chiefly by Tripton in the fresh water of the Durance River. Therefore, photosynthesis generally occurs only in the surface layer. The transparency progressively increases from freshwater to open seawater, as mineral particles sink to the bottom (about 1.7kg $m^{-2}a^{-1}$ on the average in brackish lakes). The concentration of dissolved oxygen and the rate of oxygen saturation in seawater (Carry-le-Rouet) ranged from 5.0 to 6.0 $m\ell$ㆍ.$1^{-1}$, and from 95 to 105%, respectively. The amount of dissolved oxygen in Etang de Berre oscillated between 2.9 and 268.3%. The monographs of phosphate, nitrate, nitrite and silicate were published as a part of a study on the ecology of phytoplankton in these environments. Horizontal and vertical distributions of these nutriments were studied in detail. The recent diversion of the Durance River into Lake Etang de Berre has effected a fundamental change in this formerly marine environment, which has had a great impact in its plankton populations. A total of 182 taxa were identified, including 111 Bacillariophyceae, 44 Chlorophyceae, and 15 Cyanophyceae. The most abundant species are small freshwater algae, mainly Chlorophyceae. The average density is about $10^{8}$ cells $1^{-1}$ in Lake Etang de Berre, and about double that amount in Lake Etang de Vaine. Differences in phytoplankton abundance and composition at the various stations or at various depths are slight. Cell biovolume V (equivalent to true biomass), plasma volume VP (‘useful’ biomass) and, simultaneously. the cell surface area S and S/V ratio through the measurement of cell dimensions were computed as the parameters of phytoplankton productivity and metabolism. Pigment concentrations are generally very high on account of phytoplankton blooms by Cyanophyceae, Chlorophyceae and Cryptophyceae. On the other hand, in freshwaters and marine waters, pigment concentrations are comparatively low and stable, showing slight annual variation. The variations of ATP concentration were closely related to those of chlorophyll a and phytoplankton blooms only in marine waters. The carbon uptake rates ranged between 38 and 1091 mg$Cm^{-2}d^{-1}$, with an average surface value of 256 mg; water-column carbon-uptake rates ranged between 240 and 2310 mg$Cm^{-2}d^{-1}$, with an average of 810, representing 290 mg$Cm^{-2}$, per year 45 000 tons per year of photosynthetized carbon for the whole lake. Gross photosynthetic production measured by the method of Ryther was studied over a 2-year period. The values obtained from marine water(Carry-le-Rouet) ranged from 23 to 2 337 mg$Cm^{-2}d^{-1}$, with a weighted average of 319, representing about 110 gCm$^{-2}$ per year. The values in brakish water (Etang de Berre) ranged from 14 to 1778 mg$Cm^{-2}d^{-1}$, with a weighted average of 682, representing 250 mg$Cm^{-2}$ per year and 38 400 tons per year of photosynthesized carbon for the whole lake.