• Progress in Medical Physics
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• v.22 no.1
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• pp.28-34
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• 2011

To perform the Adaptive Radiation Therapy (ART), a high degree of deformable registration accuracy is essential. The purpose of this study is to identify whether the change of MV CBCT intensity can improve registration accuracy using predefined modification level and filtering process. To obtain modification level, the cheese phantom images was acquired from both kilovoltage CT (kV CT), megavoltage cone-beam CT (MV CBCT). From the cheese phantom images, the modification level of MV CBCT was defined from the relationship between Hounsfield Units (HUs) of kV CT and MV CBCT images. 'Gaussian smoothing filter' was added to reduce the noise of the MV CBCT images. The intensity of MV CBCT image was changed to the intensity of the kV CT image to make the two images have the same intensity range as if they were obtained from the same modality. The demon deformable registration which was efficient and easy to perform the deformable registration was applied. The deformable lung phantom which was intentionally created in the laboratory to imitate the changes of the breathing period was acquired from kV CT and MV CBCT. And then the deformable lung phantom images were applied to the proposed method. As a result of deformable image registration, the similarity of the correlation coefficient was used for a quantitative evaluation of the result was increased by 6.07% in the cheese phantom, and 18% in the deformable lung phantom. For the additional evaluation of the registration of the deformable lung phantom, the centric coordinates of the mark which was inserted into the inner part of the phantom were measured to calculate the vector difference. The vector differences from the result were 2.23, 1.39 mm with/without modification of intensity of MV CBCT images, respectively. In summary, our method has quantitatively improved the accuracy of deformable registration and could be a useful solution to improve the image registration accuracy. A further study was also suggested in this paper.

• Progress in Medical Physics
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• v.24 no.1
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• pp.35-40
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• 2013

Recently, the uses of Multi-Detector Computed Tomography (MDCT) for radiation treatment simulation and planning which is used for intensity modulated radiation therapy with high technique are increasing. Because of the increasing uses of MDCT, additional doses are also increasing. The objective of this study is to evaluate the absorbed dose of body and skin undergoing in MDCT scans. In this study, the exposed dose at the surface and the center of the cylindrical water phantom was measured using an pencil ionization chamber, 30 cc ionization chamber and TL Powder. The results of MDCT were 31.84 mGy, 33.58 mGy and 32.73 mGy respectively. The absorbed dose at the surface showed that the TL reading value was 33.92 mGy from MDCT. These results showed that the surface dose was about 3.5% from the MDCT exposure higher than a dose which is located at the center of the phantom. These results mean that the total exposed dose undergoing MDCT 4 times (diagnostic, radiation therapy planning, follow-up et al.), is about 14 cGy, and have to be considered significantly to reduce the exposed dose from CT scan.

• Radiation Oncology Journal
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• v.20 no.4
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• pp.309-315
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• 2002

Purpose : To evaluate the result of conservative management on recurrence, survival and prognostic factors of patient with operable breast cancer. Materials and Methods : Fifty three patients, treated for localized breast cancer by lumpectomy or quadrantectomy followed by radiotherapy between January 1985 and December 1996, were retrospectively studied. All patients followed up for at least five years. Their median age was 43 years $(range\;24\~72)$. The tumor stages were as follows : T1 in 30 patients, T2 in 21, Tis in 2. Thirty-eight patients had negative and 15 had positive axillary nodes. The histological types were 42 infiltrating ductal, 2 infiltrating lobular, and 2 intraductal carcinomas with 7 other histologies. The tumor locations were the outer quadrant in 38 breasts, the inner quadrant in 13 and central in 2. Radiation doses of $46\~50\;Gy$ were given to the entire breast areas with additional doses of 14-18 Gy delivered to the tumor bed areas. Results : The overall five and 10 yea actuarial and disease free survivals were $94.3\%\;and\;92.4\%,\;91.2\%\;and\;81\%$, respectively. The overall five year survivals were $100\%$ in stage I and IIa, and $66.7\%$ in stage IIb and IIIa tumors. Seven patients failed either locally or distantly. Incidence of local failure and distant metastasis for the first failure were $7.5\%\;and\;5.7\%$, respectively. Local recurrence appeared within 2 years of treatment at the primary site and after more than 8 years outside of primary lesion, whereas distant metastasis appeared between 2 and 6 years following treatment. The overall recurrences were high at a young age (< or = 35 years), with 5 out of 12 (2 local, 3 distant), and in T2 lesions with 5 out of 21 (1 local, 3 distant, and 1 in both). Distant metastasis was high in the positive axillary lymph node group with 4 out of 15 $(26.6\%)$. A high incidence in the axillary node was noted at a young age with 7 out of 12 $(58.3\%)$ and in T2 lesions with 8 out of 21 $(38.4\%)$. A young age, positive axillary node and large tumor size were all related with poor survival. Conclusion : Based on this study, lumpectomy or quadrantectomy, followed by radiation appears to be an adequate therapeutic method in operable breast cancer. A long term follow-up is necessary because a recurrence of breast can occur long time after treatment. The poor prognostic group, especially young patients with an aggressive biological behavior needs more effective treatment modalities to improve their survival.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.3 no.2
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• pp.54-58
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• 2010

Purpose: In patients with chronic cervical pain, the facet joint is the source of the majority. Due to the difficulty of identifying the exact location of the joint that causes these symptoms, the possibility of complications and the placebo effect brings clinical application into question. In this study, we assessed the prevalence of patients with chronic cervical pain and report the diagnostic and therapeutic usefulness of ultrasonography - guided facet joint block therapy. Materials and Methods: Patients with nonspecific chronic cervical pain for more than 6 months were selected. Patients with disc herniation, sciatica-related pain were excluded from the study and 160 patients who failed in conservative treatment (physical therapy, chiropractic therapy, medication) were included in the study. Diagnostic Ultrasonography-guided facet joint block was performed with 1% lidocaine, and after two weeks, Bupivacaine 0.25% was used in patients who tested positive for lidocaine. Patients with more than 75% pain reduction during movement after facet joint block were considered positive. Results: Among the 160 patients with chronic cervical pain, 96 patients(60%) had a positive reaction after facet block using lidocaine. Among the 64 patients with a negative reaction to lidocaine, 48 patients(75%) had a positive reaction to bupivacaine. There were 48 false positive patients(50%) who showed a positive reaction to lidocaine but a negative reaction to bupivacaine. The mean VAS of the total 160 patients before blocks was 8.5, after 2 weeks follow up it decreased to 2.7 (p = 0.001) and after 4weeks 3.6 (p = 0.001). The 8 patients as an initial improvement of symptoms are not satisfied with the procedure and the 3 patients had been worsened during observation, were showed pain relief after additional ultrasonography-guided facet joint block at 4th week. Conclusion: A single ultrasonography-guided block to chronic cervical pain patients has relatively low diagnostic value since high false positive rate. The twice facet joint blocks is thought to be a useful method for interventional pain management of patients with chronic cervical pain.

• 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.

• Journal of Haehwa Medicine
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• v.9 no.1
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• pp.387-397
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• 2000

Background : Intravascular Laser Irrardiation of Blood(ILIB) is used in disorder of cerebral and peripheral blood circulation, dysfunction of brain, atherosclerosis etc., but there are little study about ILIB in oriental medicine. We wished to assess the efficacy of ILIB for the treatment of cerebral infarction. Method : The study group comprised 40 patients who arrived at hospital during 48 hours after attack. All patient were divided into two group. The control group was treated with Uhuangcheongsimhuan(牛黃淸心丸), Seonghyangjeonggisan(星香正氣散), acupuncture therapy only, while the ILIB group was treated with above therapy plus 5 days of irradiation of He-Ne Laser(1.8~2.5mW, 50min. per day). In rat model of middle cerebral artery(MCA) occlusion, the control group was not treated, while the ILIB group was treated with irradiation of He-Ne Laser(1.8~2.5mW, 24sec.). Result : 1. Symptom improve scores did not showed significant difference between control and ILIB group. 2. Vasoreactivity of carotid siphon did not showed significant difference between control and ILIB group. 3. Vasoreactivity of radial artery did not showed significant difference between control and ILIB group. 4. PT a-PTT did not showed significant changes between before and after treatment in both group. Fibrinogen significantly increased after treatment in ILIB group(p<0.05)), but it was in normal degree. 5. ILIB showed a significant decrease of brain ischemic area and edema in rat model of middle cerebral artery(MCA) occlusion. Conclusion : These findings suggest that additional treatment of ILIB is not more useful than traditional therapy only in acute cerebral infarction. But ILIB showed potential effect in rat model of MCA occlusion. So further investigation will be necessary.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.1
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• pp.67-74
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• 2019

Purpose: The purpose is to correct for position errors caused by long treatment times. By correcting the target motion that can occur during lung SBRT using IntraFraction CBCT. Methods and materials: We analyzed retrospectively the IFM data of 14 patients with two treatment arc in the treatment plan for lung cancer with stereotactic radiotherapy. An IntraFraction Motion was applied to the Arccheck phantom to acquire the Gamma index data. Results : IntraFraction Motion during the first treatment arc is in the left-right(LR), superiorinferior(SI), anterior-posterior(AP) directions were $0.16{\pm}0.05cm$, 0.72 cm(max error), $0.2{\pm}0.14cm$, 1.26 cm, $0.24{\pm}0.08cm$, 0.82 cm and rotational directions was $0.84{\pm}0.23^{\circ}$, $2.8^{\circ}$(pitch), $0.72{\pm}0.23^{\circ}$, $2.5^{\circ}$(yaw), $0.7{\pm}0.19^{\circ}$, $2^{\circ}$(roll). IntraFraction Motion during the second treatment arc is in the LR, SI, AP directions were $0.1{\pm}0.04cm$, 0.37 cm, $0.14{\pm}0.17cm$, 2 cm, $0.12{\pm}0.04cm$, 0.5 cm and rotational directions was $0.45{\pm}0.12^{\circ}$, $1.3^{\circ}$, $0.37{\pm}0.1^{\circ}$, $1^{\circ}$, $0.35{\pm}0.1^{\circ}$, $1.2^{\circ}$. Gamma index pass rates were $82.64{\pm}10.51%$, 48.4 %. Conclusions : In this study, we examined the validity of IntraFraction Motion correction in lung SBRT and the efficiency of IntraFraction CBCT. Due to the nature of SBRT treatment, IFM may increase due to the increased treatment time. It is believed that the increase in IFM with the increase in treatment time can be improved with the use of FFF Beam and additional position correction using CBCT during treatment.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.15-24
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• 2021

This study is about the introduction and usefulness evaluation of the manufacturing method of the bolus-helmet. Helmet-production for the treatment of scalp tumor patients has been tried and will continue in many creative and various ways. However, Most of the research data did not significantly reduce the psychological burden and physical and physical discomfort that the patient had to bear due to the time and economic cost required for the production of the helmet, the convenience of production, and the complexity of the process. In addition, recently, studies using more advanced technologies and equipment such as 3D-printer technology, which are being studied as a way to increase the treatment effect, are being introduced, but the time, economic cost, and psychological and physical burden are still the sole responsibility of the patient. Isn't it getting worse? The reality is that the thoughts of concern cannot be erased. Therefore, by maintaining the physical properties of the bolus and manufacturing a helmet without incurring additional costs, the physical and physical discomfort aggravated to the patient was reduced and the procedure and time for helmet manufacturing were minimized. In this way, it was possible to reduce the time, economic cost, and physical discomfort required for the production of the helmet, and it was also possible to minimize the psychological burden of the patient, although it is invisible. Additionally, in evaluating the usefulness of helmets, we are able to continuously seek and develop ways to reduce the air-gap interval, and as a result, we will be able to introduce a method to keep it within 2.0mm along with the manufacturing method through this study. I feel very welcome. Finally, I hope that anyone working in the Department of Radiation Oncology will be able to easily manufacture the helmet required for radiation therapy using a bolus through the guide-line on helmet manufacturing provided by this institute. I hope and hope that if you have any questions or inquiries that arise during the production process, please feel free to contact us through the researcher's e-mail or mobile phone at any time.

• Korea Science and Art Forum
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• v.28
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• pp.23-32
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• 2017

The purpose of this study is to contribute to the activation of sports for the disabled people in Korea through the localization of the road racing handcycles. Recently, there are no handcycles produced in Korea, and all the players are using products made in foreign countries. In the case of foreign products, it is made to fit the body shape of foreign athletes. Therefore, when domestic players are using them, they put additional parts to foreign products in order to fit their body shape. This not only adds to the cost burden, but also causes a decrease in the performance of the athletes. In order to overcome these problems, we developed the road racing handcycle in consideration of the body shape of the Koreans and conducted a comparative usability evaluation with the foreign products to evaluate the performance of the developed prototype. Therefore, we analyzed the quantitative and qualitative evaluation results of the prototype produced in the previous study, and developed the Korean road racing handcycle that can improve the competitiveness while considering the shape of domestic players. Based on the problems derived from the first prototype, this study additionally constructed a crank, an air intake part and a discharge part, and a rear anti-shake prevention device. In order to evaluate the usability, we conducted a comparative usability assessment with the foreign products used by the current standing handcycle athletes. The results were measured in the area of effectiveness, efficiency, and satisfaction, and the prototype developed through the research on efficiency and satisfaction excluding effectiveness was evaluated to be higher than those of foreign products. This study will contribute to the improvement of international competitiveness due to import substitution effects of foreign products and exports by lowering the handcycle cost of importing foreign handcycle.

• Radiation Oncology Journal
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• v.26 no.2
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• pp.104-112
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• 2008

Purpose: To assess the toxicity and tumor response induced by $DCVac/IR^{(R)}$ dendritic cell(DC) immunotherapy combined with irradiation for refractory colorectal cancer patients with multiple liver metastases. Materials and Methods: Between May 2004 and November 2006, applicants from a pool of refractory colorectal cancer patients with multiple liver metastases were enrolled. The patients were registered after having signed the informed consent form, which had been approved by the Institutional Review Board from the Dong-A University and Busan National University Hospital. DCs were obtained from peripheral blood of each patient, and then cultured in vitro. A total of $6{\times}10^6$ DCs were packed into a vial($DCVac/IR^{(R)}$, 0.5 ml) at the convenience of each patient's schedule. On the day before and on the day of each vaccination, each patient received a 4 Gy radiation dose to the target tumor. On the day of vaccination, the indicated dose of autologous DCs was injected into the irradiated tumor using ultrasound-guided needle injection procedures. A total of four vaccinations were scheduled at three 2-week intervals and one 4 week interval at the Dong-A University and Busan National University Hospital. If the tumor status was deemed to be stable or responding to therapy, an additional vaccination dose or two was approved at 4 week intervals beyond the fourth immunization. A tolerance test for DCs was conducted by injecting a range of doses($3{\times}10^6\;to\;12{\times}10^6$ DCs) after the 3rd injection. Moreover, the maximal tolerable dose was applied to additional patients. Treatment safety was evaluated in all patients who had at least one injection. Treatment feasibility was evaluated by the 10th week by assessing the response of patients having at least 4 injections. For systemic toxicities, the evaluation was performed using the National Cancer Institute Common Toxicity Criteria, whereas adverse effects were recorded using common WHO toxicity criteria. Results: Of the 24 registered patients, 22 received the DCs injections. Moreover, of the 14 patients that applied for the tolerance test, only 11 patients completed it because 3 patients withdrew their testing agreement. A grade 3 or more side effect, which was possibly related to the DC injection, did not occur in additional patients. The $12{\times}10^6$ DC injection was identified as the maximum tolerable dose, and was then injected in an additional 8 patients. Patients tolerated the injection fairly well, with no fatal side effects. In order to assess the feasibility of DC immunotherapy, the response was evaluated in other hepatic lesions outside of the targeted hepatic lesion. The response evaluation was performed in 15 of the 17 patients who received at least 4 injections. Stable and progressive disease was found in 4 and 11 patients, respectively. Conclusion: The DC-based immunotherapy and radiotherapy is theoretically synergistic for the local control and systemic control. The $DCVac/IR^{(R)}$ immunotherapy combined with irradiation was tolerable and safe in the evaluated cases of refractory colorectal cancer with multiple liver metastases. Future work should include well designed a phase II clinical trials.