• 한국의학물리학회지:의학물리
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• 제27권2호
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• pp.93-97
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• 2016

유방암 환자에 대한 세기조절방사선치료(IMRT)를 수행함에 있어서 환자의 호흡이 계획표적부피(PTV) 내의 선량분포에 미치는 영향을 평가하고 그 영향을 감소시킬 수 있는 방안에 대해 연구를 수행하였다. 이에 따라 호흡위상별 전산화단층 촬영술(4DCT) 영상을 획득하여 IMRT 치료계획에 적용하고 호흡위상 30%와 60%, 90%에서 PTV에 조사된 선량분포와 선량균질지수(HI), 덮힘율지수(CVI), 처방선량지수(CI)를 선량-부피히스토그램(DVH)을 이용하여 비교하였다. 또한 치료 부위의 피부에 조직보상체와 가상계획표적부피 설정을 통하여 유방암 IMRT중에 발생할 수 있는 호흡운동에 의한 부작용 감소 효과를 평가해 보았다. 조직보상체를 사용하지 않는 경우에 HI가 2배 증가하고 CVI는 상대적으로 감소하였으나 조직 보상체와 가상계획표적부피를 사용한 경우에는 환자의 호흡에 따른 표적부피 선량 변화가 상대적으로 크지 않게 평가되었다. 따라서 유방암 환자의 대한 IMRT 치료에서의 정밀도 향상을 위하여 조직보상체 및 가상계획표적부피 사용이 한가지 방안이 될 수 있을 것으로 사료된다.

• 대한방사선기술학회지:방사선기술과학
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• 제40권1호
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• pp.57-62
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• 2017

본 연구는 거대유방암 환자대상으로 환자의 움직임과 모양의 변화에 따른 선량변화를 콘빔단층촬영영상(CBCT)과 변형영상정합기법(DIR)을 적용하여 적응형방사선치료계획을 재구성하여 기존에 사용된 쐐기접선조사기법(TWF)과 종속조사면 병합치료방법(FIF) 그리고 세기조절방사선치료계획(IMRT)을 이용하여 선량비교평가를 시행하고자 하였다. CT와 CBCT를 MIM6 사용하여 변형영상정합기법영상(DIRCT)을 만들어 각각의 치료계획을 시행하였다. 계획표적체적(PTV)은 왼쪽 유방이고 균질성지표(HI), 적합성지표(CI), 조사범위지표(CVI)의 값을 확인하였다. 관심장기(OAR)는 반대쪽 유방, 폐 그리고 심장이며 평균선량, 최대선량과 장기 특성에 따른 기타 지표들을 비교 분석하였다. PTV인 유방의 HI 값은 DIRCT를 이용한 모든 치료계획방법에서 증가하였으며, CVI, CI의 결과에서는 DIRCT를 이용한 치료계획방법에서 모두 감소하였다. 폐에서의 평균선량과 최대선량은 DIRCT 이용한 IMRT 치료계획방법이 다른 치료계획보다 증가함을 보였으며, 심장의 평균선량과 최대선량은 DIRCT를 이용한 TWF와 FIF는 감소했으며, 오히려 IMRT의 결과는 증가하였다. 유방암 방사선치료 시 환자의 움직임과 셋업 오차로 인해 유방모양의 변경을 감암했을 때 TWF와 IMRT보다 FIF 방법을 이용했을 때 반대편 유방과 심장, 폐의 피해선량을 효과적으로 감소시킬 수 있을 것으로 사료된다.

• 한국의학물리학회지:의학물리
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• 제32권3호
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• pp.70-81
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• 2021

Purpose: This study was designed to investigate the dosimetric difference between intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) in head and neck cancer (HNC). The study primarily focuses on low-dose spillage evaluation between these two techniques. Methods: This retrospective study involved 45 patients with HNC. The treatment plans were generated using the IMRT and VMAT techniques for all patients. Dosimetric comparisons were performed in terms of target coverage, organ-at-risk (OAR) sparing, and various parameters, including conformity index, uniformity index, homogeneity index, conformation number, low-dose volumes, and normal tissue integral dose (NTID). Results: No significant (P>0.05) difference in planning target volume coverage (D_95%) was observed between IMRT and VMAT plans for supraglottic larynx, hard palate, and tongue cancers. A decrease in dose volumes ranging from 1 Gy to 30 Gy was observed for VMAT plans compared with those for IMRT plans, except for V_1Gy and V_30Gy for supraglottic larynx cancer and V_1Gy for tongue cancer. Moreover, decreases (P<0.05) in NTID were observed for VMAT plans compared with that for IMRT plans in supraglottic larynx (4.50%), hard palate (12.80%), and tongue (7.76%) cancers. In contrast, a slight increase in monitor units for VMAT compared with those for IMRT in supraglottic larynx (0.46%), hard palate (2.54%), and tongue (7.56%) cancers. Conclusions: For advanced-stage HNC, both IMRT and VMAT offer satisfactory clinical plans. VMAT offers a conformal and homogeneous dose distribution with comparable OAR sparing and higher dose falloff outside the target volume than IMRT, which provides an edge to reduce the risk of secondary malignancies for HNC over IMRT.

• 한국인공지능학회지
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• 제7권1호
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• pp.23-59
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• 2019

The purpose of this study is to develop a measure of service quality in the traditional market by examining previous research on the service quality of the traditional market studied so far. After defining basic concepts through definition of traditional market and existing studies, 5 categories of configuration items for SERVQUAL measurement in traditional market were made up based on existing researches related to definition of service quality and service quality of traditional market. A survey was conducted on the items that fit the intention of this study and various statistical analyzes were conducted. Statistical analysis was performed using SPSS 22.0 and AMOS 22.0. The reliability of the items was measured by the reliability test, and the predictability and accuracy of the items were examined. The validity of the measured variables was verified through confirmatory factor analysis. Reliability, empathy, responsiveness, certainty, and tangibility were the most important factors in this study. Responsiveness factors include communication, time reduction, real time, promptness. Assurance factors include the assurance of delivery, prompt answers, product knowledge items. Tangibility factors include, convenient device systems, location information, presence as a fact, and as a result, the latest modern items are adopted. The quality of service in the traditional market developed in this study was found to be good in reliability and validity test. Confirmatory factor analysis result using structural equation model also met the conformity index standard. If service satisfaction is measured based on this research, basic data can be presented to policy makers who implement policies on traditional markets to make the right decisions. In addition, it will be able to provide traditional market operators with operational strategy and marketing data. In the future, based on the traditional market service quality scale developed in this study, it is necessary to grasp the factors to be continuously managed to improve the service quality of the traditional market, user satisfaction, and intention to use.

• 한국ITS학회 논문지
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• 제15권6호
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• pp.138-149
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• 2016

본 연구는 가상주행 시뮬레이터 실험을 통해 악천후시 가변 제한속도 표출 효과를 검토하였다. 본 연구는 기상변화 없이 제한속도를 낮추어 표출한 경우와 기상이 변화되었는데도 제한속도를 낮추어 표출하지 못한 경우는 운전자의 기대심리를 위배한 것으로 기상 변화에 따라 속도를 감속 표출하는 것에 비해 상대적으로 안전 측면에서 바람직하지 못하다고 가정하고 이를 가상주행 시뮬레이터 결과를 통해 검토하였다. 본 연구는 운전자의 기대심리에 부합되는 정도를 나타내는 지표로 운전자 순응도를 선택하였고, 이를 정량화하기 위한 수단으로 표출 제한속도를 포함한 일정 속도구간 내 누적확률밀도를 이용하였다. 검토결과, 운전자의 기대심리를 위배하였다고 가정한 조건들이 비교그룹에 비해 상대적으로 운전자의 주행행태적 측면에서 부정적인 것으로 평가되었다.

• 대한방사선기술학회지:방사선기술과학
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• 제41권3호
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• pp.209-214
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• 2018

The results of CBCT was obtained using image guided radiation therapy for radiation therapy in 5 prostate cancer patients. Using these results, we compared and evaluated the dose changes according to the treatment plan depending on the volume and position of bladder, rectum, and prostate. The 28 images of CBCT were acquired using On-Board Imaging device before radiotherapy. After the outline of bladder, rectum, and PTV, pCT images and CBCT images for radiotherapy were treated respectively. The volume of the bladder was increased by 105.6% and decreased by 45.2%. The volume of the rectum was increased by 30.5% and decreased by 20.3%. Prostate volume was increased by 6.3% and decreased by 12.3%. The mean dose of the rectum was higher in the CBCT than in the pCT, and V40 (equivalent to 40 Gy) of the bladder showed a reduction in all treatment regimens in the CBCT than in the pCT. Conformity treatment and homogeneity index of PTV showed better results in all treatment regimens using pCT than CBCT. It was found that the dose distribution of the pelvic internal organs varied greatly according to the patient 's condition and pretreatment.

• Radiation Oncology Journal
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• 제36권1호
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• pp.63-70
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• 2018

Purpose: The objective of this study was to compare dosimetric characteristics of three-dimensional conformal radiotherapy (3D-CRT) and two types of intensity-modulated radiotherapy (IMRT) which are step-and-shoot intensity modulated radiotherapy (s-IMRT) and modulated arc therapy (mARC) for thoracic esophageal cancer and analyze whether IMRT could reduce organ-at-risk (OAR) dose. Materials and Methods: We performed 3D-CRT, s-IMRT, and mARC planning for ten patients with thoracic esophageal cancer. The dose-volume histogram for each plan was extracted and the mean dose and clinically significant parameters were analyzed. Results: Analysis of target coverage showed that the conformity index (CI) and conformation number (CN) in mARC were superior to the other two plans (CI, p = 0.050; CN, p = 0.042). For the comparison of OAR, lung V5 was lowest in s-IMRT, followed by 3D-CRT, and mARC (p = 0.033). s-IMRT and mARC had lower values than 3D-CRT for heart $V_{30}$ (p = 0.039), $V_{40}$ (p = 0.040), and $V_{50}$ (p = 0.032). Conclusion: Effective conservation of the lung and heart in thoracic esophageal cancer could be expected when using s-IMRT. The mARC was lower in lung $V_{10}$, $V_{20}$, and $V_{30}$ than in 3D-CRT, but could not be proven superior in lung $V_5$. In conclusion, low-dose exposure to the lung and heart were expected to be lower in s-IMRT, reducing complications such as radiation pneumonitis or heart-related toxicities.

• Asian Pacific Journal of Cancer Prevention
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• 제15권3호
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• pp.1227-1232
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• 2014

Background: Given that there are many Iranian women who have never had a Pap smear, this study was designed to develop and validate a measurement tool based on the Protection Motivation Theory to assess factors influencing the Iranian women's intention to perform first Pap testing. Materials and Methods: In this psychometric research, to determine the Content Validity Index (CVI) and the Content Validity Ratio (CVR), a panel of experts (n=10) reviewed scale items. Reliability was estimated through the Intraclass Correlation Coefficient (n=30) and internal consistency (n=240). Also, factor analysis (exploratory and conformity) was performed on the data of the sample women who had never had a Pap smear test (n=240). Results: A 26-item questionnaire was developed. The CVI and CVR scores of the scale were 0.89 and 0.90, respectively. Exploratory factor analysis loaded a 26-item with seven factors questionnaire (perceived vulnerability and severity, fear, response costs, response efficacy, self-efficacy, and protection motivation (or intention)) that jointly accounted for 72.76% of the observed variance. Confirmatory factor analysis indicated a good fit for the data. Internal consistency (range 0.70-0.93) and test-retest reliability (range 0.72-0.96) of sub-scales were acceptable. Conclusions: This study showed that the designed instrument was a valid and reliable tool for measuring the factors influencing the women's intention to perform their first Pap testing.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.179-184
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• 2011

Objective : The aim of this study is to evaluate the therapeutic effects of gamma knife radiosurgery (GKRS) in patients with multiple brain metastases and to investigate prognostic factors related to treatment outcome. Methods : We retrospectively reviewed clinico-radiological and dosimetric data of 36 patients with 4-14 brain metastases who underwent GKRS for 264 lesions between August 2008 and April 2011. The most common primary tumor site was the lung (n=22), followed by breast (n=7). At GKRS, the median Karnofsky performance scale score was 90 and the mean tumor volume was 1.2 cc (0.002-12.6). The mean prescription dose of 17.8 Gy was delivered to the mean 61.1% isodose line. Among 264 metastases, 175 lesions were assessed for treatment response by at least one imaging follow-up. Results : The overall median survival after GKRS was $9.1{\pm}1.7$ months. Among various factors, primary tumor control was a significant prognostic factor ($11.1{\pm}$1.3 months vs. $3.3{\pm}2.4$ months, p=0.031). The calculated local tumor control rate at 6 and 9 months after GKRS were 87.9% and 84.2%, respectively. Paddick's conformity index (>0.75) was significantly related to local tumor control. The actuarial peritumoral edema reduction rate was 22.4% at 6 months. Conclusion : According to our results, GKRS can provide beneficial effect for the patients with multiple (4 or more) brain metastases, when systemic cancer is controlled. And, careful dosimetry is essential for local tumor control. Therefore, GKRS can be considered as one of the treatment modalities for multiple brain metastase.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.138-140
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• 2002

The spinal cord dose is the one of the limiting factor for the radiation treatment of the head & neck (H&N) or the thorax region. Due to the fact that the cord is the elongated shaped structure, it is not an easy task to maintain the cord dose within the clinically acceptable dose range. To overcome this problem, the spinal cord partial block technique (PBT) with the dynamic Multi-Leaf Collimator (dMLC) has been developed. Three dimension (3D) conformal beam directions, which minimize the coverage of the normal organs such as the lung and the parotid gland, were chosen. The PBT field shape for each field was designed to shield the spinal cord with the dMLC. The transmission factors were determined by the forward calculation method. The plan comparisons between the conventional 3D conformal therapy plan and the PTB plan were performed to evaluate the validity of this technique. The conformity index (CI) and the dose volume histogram (DVH) were used as the plan comparison indices. A series of quality assurance (QA) was performed to guarantee the reliable treatment. The QA consisted of the film dosimetry for the verification of the dose distribution and the point measurements. The PBT plan always generated better results than the conventional 3D conformal plan. The PBT was proved to be useful for the H&N and thorax region.