• Title/Summary/Keyword: delivery system

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Evaluation on the Usefulness of 6DoF Couch in V-MAT on Patients with Long length of Target (표적의 길이가 긴 환자의 용적회전변조 방사선치료 시 6DoF Couch의 유용성 평가)

  • Choi, Young Se;Park, Hyo Kuk;Kim, Se Young;Kim, Joo Ho;Lee, Sang Kyoo;Yoon, Jong Won;Cho, Jung Heui
    • The Journal of Korean Society for Radiation Therapy
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    • v.29 no.2
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    • pp.53-64
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    • 2017
  • Purpose: To evaluate the usefulness of the $HexaPOD^{TM}$ evo RT system(6DoF couch) and the tendency of dose difference according to size of rotational direction error for volumetric rotational modulated radiotherapy(V-MAT) in patients with long target lengths. Therefore, it is suggested to recommend the need for rotational error correction. Materials and Methods: Ten patients with Esophagus cancer or Breast cancer including SCL treated with HexaPOD 6DoF(Six-Degree of Freedom) couch were included in this study. 6DoF couch was used to measure the difference in dose according to the rotation error in the directions of Rx(pitch), Ry(roll), and Rz(yaw). Each rotation error was applied. Positioning variation on x, y and z axis was verified and random variations were made by 6DoF couch with positioning variation. Modified DQA is conducted and point dose and gamma value are analyzed and compared. In addition, after applying the rotation error every $1^{\circ}$ to treatment plans of each target with a diameter of 3 cm, 5, 10, 15, and 20 cm respectively, gamma passing rate is being monitored by its aspect of change according to types and sizes of the target length and rotation error. Results: Mean error of the point dose and Gamma passing rate when the position variation was applied were $2.50{\pm}1.11%$ and $84.1{\pm}7.39%$ in the Rx direction, $2.36{\pm}1.16%$, and $81.0{\pm}8.49%$ in the Ry, $2.35{\pm}1.10%$ and $84.4{\pm}6.99%$ in the Rz direction, respectively. As a result of analysis on gamma passing rate according to types and sizes of the target length and rotation error, the gamma passing rate tended to decrease with increasing rotation error in the Rx and Rz directions except Ry direction. In particular, the lowest gamma passing rate (74.2 %) was in the case of $2.5^{\circ}$ rotation error in Rz direction of the target of 10 cm. Conclusion: The correction of the rotational error is needed for volumetric modulated radiotherapy of the treatment area with a long target length, and the use of 6DoF couch will improve the reproducibility of the patient position and the quality of the treatment.

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A Comparative Analysis between Photogrammetric and Auto Tracking Total Station Techniques for Determining UAV Positions (무인항공기의 위치 결정을 위한 사진 측량 기법과 오토 트래킹 토탈스테이션 기법의 비교 분석)

  • Kim, Won Jin;Kim, Chang Jae;Cho, Yeon Ju;Kim, Ji Sun;Kim, Hee Jeong;Lee, Dong Hoon;Lee, On Yu;Meng, Ju Pil
    • Journal of the Korean Society of Surveying, Geodesy, Photogrammetry and Cartography
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    • v.35 no.6
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    • pp.553-562
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    • 2017
  • GPS (Global Positioning System) receiver among various sensors mounted on UAV (Unmanned Aerial Vehicle) helps to perform various functions such as hovering flight and waypoint flight based on GPS signals. GPS receiver can be used in an environment where GPS signals are smoothly received. However, recently, the use of UAV has been diversifying into various fields such as facility monitoring, delivery service and leisure as UAV's application field has been expended. For this reason, GPS signals may be interrupted by UAV's flight in a shadow area where the GPS signal is limited. Multipath can also include various noises in the signal, while flying in dense areas such as high-rise buildings. In this study, we used analytical photogrammetry and auto tracking total station technique for 3D positioning of UAV. The analytical photogrammetry is based on the bundle adjustment using the collinearity equations, which is the geometric principle of the center projection. The auto tracking total station technique is based on the principle of tracking the 360 degree prism target in units of seconds or less. In both techniques, the target used for positioning the UAV is mounted on top of the UAV and there is a geometric separation in the x, y and z directions between the targets. Data were acquired at different speeds of 0.86m/s, 1.5m/s and 2.4m/s to verify the flight speed of the UAV. Accuracy was evaluated by geometric separation of the target. As a result, there was an error from 1mm to 12.9cm in the x and y directions of the UAV flight. In the z direction with relatively small movement, approximately 7cm error occurred regardless of the flight speed.

Analysis on the trends and causes of inhabitant's behavioral changes in medical institutions's utilization after enforcement of regional medical insurance. (pilot-project area of regional medical insurance; mainly Kun-wi and Kwang-hwa county) (의료보험(醫療保險) 실시이후(實施以後) 지역주민(地域住民)의 의료기관이용행태(醫療機關利用行態) 변화(變化) 추이(推移)와 그 요인(要因)에 관한 조사연구(調査硏究))

  • Park, Jung-Yeon
    • Journal of Korean Public Health Nursing
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    • v.3 no.2
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    • pp.47-76
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    • 1989
  • The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and $X^2$ distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.

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Comparison of using CBCT with CT simulator for radiation dose of treatment planning (CBCT와 Simulation CT를 이용한 치료계획의 선량비교)

  • Cho, jung-keun;Kim, dae-young;Han, tae-jong
    • Proceedings of the Korea Contents Association Conference
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    • 2009.05a
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    • pp.1159-1166
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    • 2009
  • The use of cone-beam computed tomography(CBCT) has been proposed for guiding the delivery of radiation therapy. A kilovoltage imaging system capable of radiography, fluoroscopy, and cone-beam computed tomography(CT) has been integrated with a medical linear accelerator. A standard clinical linear accelerator, operating in arc therapy mode, and an amorphous-silicon (a-Si) with an on-board electronic portal imager can be used to treat palliative patient and verify the patient's position prior to treatment. On-board CBCT images are used to generate patient geometric models to assist patient setup. The image data can also, potentially, be used for dose reconstruction in combination with the fluence maps from treatment plan. In this study, the accuracy of Hounsfield Units of CBCT images as well as the accuracy of dose calculations based on CBCT images of a phantom and compared the results with those of using CT simulator images. Phantom and patient studies were carried out to evaluate the achievable accuracy in using CBCT and CT stimulator for dose calculation. Relative electron density as a function of HU was obtained for both planning CT stimulator and CBCT using a Catphan-600 (The Phantom Laboratory, USA) calibration phantom. A clinical treatment planning system was employed for CT stimulator and CBCT based dose calculations and subsequent comparisons. The dosimetric consequence as the result of HU variation in CBCT was evaluated by comparing MU/cCy. The differences were about 2.7% (3-4MU/100cGy) in phantom and 2.5% (1-3MU/100cGy) in patients. The difference in HU values in Catphan was small. However, the magnitude of scatter and artifacts in CBCT images are affected by limitation of detector's FOV and patient's involuntary motions. CBCT images included scatters and artifacts due to In addition to guide the patient setup process, CBCT data acquired prior to the treatment be used to recalculate or verify the treatment plan based on the patient anatomy of the treatment area. And the CBCT has potential to become a very useful tool for on-line ART.)

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The vertical location of the center of resistance for maxillary six anterior teeth during retraction using three dimensional finite element analysis (상악 6전치부의 후방견인시 저항중심의 수직적 위치에 관한 3차원 유한요소법적 연구)

  • Lee, Hye-Kyoung;Chung, Kyu-Rhim
    • The korean journal of orthodontics
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    • v.31 no.4 s.87
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    • pp.425-438
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    • 2001
  • The delivery of optimal orthodontic treatment is greatly influenced by clinician's ability to predict and control tooth movement by applying well-known force system to dentition. It is very important to determine the location of the centers of resistance of a tooth or teeth in order to have better understanding the nature of displacement characteristics under various force levels. In this study, three dimensional finite element analysis was used to measure the initial displacement of the consolidated teeth under loading. The purpose of this study was to define the location of the centers of resistance at the upper six anterior segment. To observe the changes of six anterior segment, 200gm, 250gm, 300gm, and 350gm forces at right and left hand side each were imposed toward lingual direction. For this study, two cases, six anterior teeth and six anterior teeth after corticotomy, were reviewed. In addition, it was reviewed the effects of changes on the location of the center of resistance in both cases based on different degree of forces aforementioned. The results were that : 1. The instantaneous center of resistance for the six anterior teeth was vertically located between level 4 and level 5, which is, at 6.76mm, $44.32\%$ apical to the cementoenamel junction level. 2. The instantaneous center of resistance for the six anterior teeth after corticotomy was located vertically between level 4 and level 5, that is, at 7.09mm $46.38\%$ apical to the cementoenamel junction level. 3. Changes of force showed little effect on the location of the center of resistance in each case. 4. It was observed that the location of the instantaneous center of resistance for the six anterior teeth after corticotomy was changed more than the six anterior teeth without corticotomy to the apical part, and the displacement of the consolidated anterior teeth moved further in case of the consolidated teeth after corticotomy.

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Cost Analysis of Home Nursing Care Patients in Rural Hospital (농촌 지역 중소병원의 가정간호사업소 등록환자의 방문비용분석)

  • Kim, Jin-Soon;Kum, Ran;HwangBo, Soo-Ja
    • Journal of agricultural medicine and community health
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    • v.24 no.1
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    • pp.91-101
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    • 1999
  • The home nursing care system is an integral part of the health care delivery system in order to meet the various needs of consummer, in particular, early discharge patient from the hospital, patient with long term care needed and the elderly. To find out the cost of home nursing care services, the home nursing care records of patients registered by home nursing care units established in public hospital with 150beds during the period of 1996 - 1997 were analyzed. The subjects were 102patients, 45 of male patients and 57 of female patients, those who live in a rural area in Kymiggi - Do The results obtained are as follows : 1. The male patients accounted for 44.1% of the total, with 45cases : group aged 60 years and more was the largest group, accounting for 79.5%. 2. The most frequent disease revealed was the osteoporosis which constitute 35.3% of the total registered patients, followed, in order, by malignant tumor, cerebrovascular disease. 3. It revealed that the cost per visit for the male was 47,764won ; the female, 46,078 won per visit. Noteworthy the cost per visit was high in the older patient. It was clearly that the gender, years of age and the cost per visit were statistically significant at 0.01 level and 0.05 level. 4. The cost per visit for the non complicated disease was slightly higher than the complicated disease, but it is not statistically significant, the cost per visit by type of disease varied, the cost per visit for COPD was the highest, followed, in order, by in malignant tumor, cancer, diabetes, osteoporosis etc. 5. It revealed that home nursing care cost for a eligible disease for home nursing care was less than the cost for hospitalization of the same disease, therefore, we expect that the home nursing care is cost efficiency. In conclusion, the home nursing care costs are needed to analyze further in comparison with the hospitalization costs for a certain disease.

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The needs for sex knowledge in the late schooler (후기 학령기 아동의 성지식 요구)

  • Lee Eun Joo
    • Child Health Nursing Research
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    • v.6 no.2
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    • pp.167-185
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    • 2000
  • The goal of this research was to provide the basic data of sexual education for late schooler by finding out what they want to know about sex, or to see, if any, its relevancy between female and male students and between each grade. The sample for this research was a total of 453 students in 4th, 5th and 6th grade from 12 different classes at two elementary schools which were located in C city and in B province. The children were requested to write down three points on what they want to know or to learn most about sex, and their answers were put through two analytical stages in order to classify and to examine. The followings are the conclusions from the data. 1. The female cluster took 44.2% out of the whole sample, and there were 151 students per each grade. The specific girl ratios for each grade were 42.4%, 50.3% and 39.7% respectively. 2. It was noted that a total of 1,195 questions were gathered from the students writings, 45% of the questions was raised by the female students. The 4th grade students raised 432questions (43.8% by the girl) while the 5th. and the 6th grade students raised 387 (53.2% by the girl) and 376 questions (42.3% by the girl) respectively. The average number of questions per students was 2.6 while the female students raised 2.8 questions which was more than the average 2.5 questions by male students. It was the 4th grade female student cluster, which raised the most question (3.0) while the 6th grade male students raised the least question (2.4) in average. 3. The questions raised by the children could be divided into seven categories of the knowledge need on sex. They were Reproduction (310 questions, 25.9%), Sexual Culture (230, 19.2%), Concept of sex (125, 18.0%), Changes of Puberty (172, 14.4%), Sexual Health (119, 10.0%), Anatomy and Physiology of Reproductive System (78, 6.5%) and Sexual Tendency and behavior (71, 5.9%). 4. 'Reproduction' was the most frequently raised questions not only by both sex groups but also by the 5th grade students. Both sexes in the 4th grade showed the highest interest in Sexual Culture while it was Changes in Puberty for the both sexes in the 6th grade. The knowledge need on sex of the children indicated what they understand sexuality. They apprehended sex as sex, gender and sexuality in an inclusive way. They showed a major interest in the biological sex and the sexual activities. It seems that the children managed to understand clearly the meaning of gender, furthermore, they even pointed out that the streotyped sex role, patrimonial system and the sexual discrimination were unreasonable. The students possessed not only the least but also the most negative understanding in regard of sexuality. Two suggestions were made from the above conclusions for the practical sex education as well as its research. 1. For the practice: The sex education for the elementary upper grade school student should be relevant with their cognitive characteristics, also it should be more specific on the reproductive organs of both sexes, the actual scenes of the pregnancy and child delivery procedures. The gender concept should be added to the biological sex education, which will lead them to understand the unreasonableness of today's male-superior phenomenon and correct them. It is also necessary to develop educational programs for this age group so as to help them to understand sex in the sense of sexuality as well. 2. For the research: It is not easy to draw out a through conclusion since this study was carried out as one-time data collection. Yet it is undeniably helpful for the sex education if we can understand what the children want to know about sex, how much they know about it by conducting deep-interview researches through a small number of sample.

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A Study on the Double-Wall Greenhouse Filled with Styrene Pellets (입자충전형 이중벽 온실에 관한 연구)

  • 이석건;이종원;이현우
    • Journal of Bio-Environment Control
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    • v.4 no.1
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    • pp.59-67
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    • 1995
  • This study was conducted to develope the automatic insulation system which control inside temperature of the greenhouse. For this purpose, the double- wall greenhouse and system which could automatically supply and discharge styrene pellets were constructed and abrasion of the pellets, blower ability, insulating property, transmittance and shading effect were analyzed by the experiments. The results obtained from this study can be summarized as follows : 1. It took an hour and fifteen minutes to supply and discharge about 2㎥ pellets in the experimental greenhouse. However, it is possible to reduce the operation time by proper selection of the blower and exhaust port, and by proper control of the supply and return pipe. 2. It was founded that the indirect delivery way was more profitable than the direct one in the supply and return of pellets. 3. When the transmittance was measured between 10 a.m. and 3 p.m., the average light transmissivity rate was 67%. 4. In winter nighttime, the inside temperature of the double- wall greenhouse with out the pellets was higher than the outside temperature by 3.4$^{\circ}C$ on an average. However, the inside temperature of the double - wall greenhouse with insulated area 73% was higher than the outside by one 6.6$^{\circ}C$ on an average, and the inside temperature of the greenhouse with insulated area 100% was higher than outside one by 13.5$^{\circ}C$ on an average. Therefore, it was proved that the insulating ability of the double - wall greenhouse in nighttime was excellent. 5. When the outside temperature was 36.9$^{\circ}C$ on an average, the inside temperature of the double- wail greenhouse with insulated area 100% was 3$0^{\circ}C$ on an average. As the inside temperature was lower than the outside one by 7$^{\circ}C$ on an average, we could know that the shading effects of the double- wall greenhouse were excellent in summer daytime.

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Structural Relationships Among Factors to Adoption of Telehealth Service (원격의료서비스 수용요인의 구조적 관계 실증연구)

  • Kim, Sung-Soo;Ryu, See-Won
    • Asia pacific journal of information systems
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    • v.21 no.3
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    • pp.71-96
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    • 2011
  • Within the traditional medical delivery system, patients residing in medically vulnerable areas, those with body movement difficulties, and nursing facility residents have had limited access to good healthcare services. However, Information and Communication Technology (ICT) provides us with a convenient and useful means of overcoming distance and time constraints. ICT is integrated with biomedical science and technology in a way that offers a new high-quality medical service. As a result, rapid technological advancement is expected to play a pivotal role bringing about innovation in a wide range of medical service areas, such as medical management, testing, diagnosis, and treatment; offering new and improved healthcare services; and effecting dramatic changes in current medical services. The increase in aging population and chronic diseases has caused an increase in medical expenses. In response to the increasing demand for efficient healthcare services, a telehealth service based on ICT is being emphasized on a global level. Telehealth services have been implemented especially in pilot projects and system development and technological research. With the service about to be implemented in earnest, it is necessary to study its overall acceptance by consumers, which is expected to contribute to the development and activation of a variety of services. In this sense, the study aims at positively examining the structural relationship among the acceptance factors for telehealth services based on the Technology Acceptance Model (TAM). Data were collected by showing audiovisual material on telehealth services to online panels and requesting them to respond to a structured questionnaire sheet, which is known as the information acceleration method. Among the 1,165 adult respondents, 608 valid samples were finally chosen, while the remaining were excluded because of incomplete answers or allotted time overrun. In order to test the reliability and validity of the assessment scale items, we carried out reliability and factor analyses, and in order to explore the causal relation among potential variables, we conducted a structural equation modeling analysis using AMOS 7.0 and SPSS 17.0. The research outcomes are as follows. First, service quality, innovativeness of medical technology, and social influence were shown to affect perceived ease of use and perceived usefulness of the telehealth service, which was statistically significant, and the two factors had a positive impact on willingness to accept the telehealth service. In addition, social influence had a direct, significant effect on intention to use, which is paralleled by the TAM used in previous research on technology acceptance. This shows that the research model proposed in the study effectively explains the acceptance of the telehealth service. Second, the research model reveals that information privacy concerns had a insignificant impact on perceived ease of use of the telehealth service. From this, it can be gathered that the concerns over information protection and security are reduced further due to advancements in information technology compared to the initial period in the information technology industry, and thus the improvement in quality of medical services appeared to ensure that information privacy concerns did not act as a prohibiting factor in the acceptance of the telehealth service. Thus, if other factors have an enormous impact on ease of use and usefulness, concerns over these results in the initial period of technology acceptance may become irrelevant. However, it is clear that users' information privacy concerns, as other studies have revealed, is a major factor affecting technology acceptance. Thus, caution must be exercised while interpreting the result, and further study is required on the issue. Numerous information technologies with outstanding performance and innovativeness often attract few consumers. A revised bill for those urgently in need of telehealth services is about to be approved in the national assembly. As telemedicine is implemented between doctors and patients, a wide range of systems that will improve the quality of healthcare services will be designed. In this sense, the study on the consumer acceptance of telehealth services is meaningful and offers strong academic evidence. Based on the implications, it can be expected to contribute to the activation of telehealth services. Further study is needed to assess the acceptance factors for telehealth services, such as motivation to remain healthy, health care involvement, knowledge on health, and control of health-related behavior, in order to develop unique services according to the categorization of customers based on health factors. In addition, further study may focus on various theoretical cognitive behavior models other than the TAM, such as the health belief model.

The Properties of Beam Intensity Scanner (BInS) for Dose Verification in Intensity Modulated Radiation Therapy (방사선 세기 조절 치료에서 선량을 규명하는 데 사용된 BlnS System의 특성)

  • 박영우;박광열;박경란;권오현;이명희;이병용;지영훈;김근묵
    • Progress in Medical Physics
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    • v.15 no.1
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    • pp.1-8
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    • 2004
  • Patient dose verification is one of the most Important responsibilities of the physician in the treatment delivery of radiation therapy. For the task, it is necessary to use an accurate dosimeter that can verify the patient dose profile, and it is also necessary to determine the physical characteristics of beams used in intensity modulated radiation therapy (IMRT) The Beam Intensity Scanner (BInS) System is presented for the dosimetric verification of the two dimensional photon beam. The BInS has a scintillator, made of phosphor Terbium-doped Gadolinium Oxysulphide (Gd$_2$O$_2$S:Tb), to produce fluorescence from the irradiation of photon and electron beams. These fluoroscopic signals are collected and digitized by a digital video camera (DVC) and then processed by custom made software to express the relative dose profile in a 3 dimensional (3D) plot. As an application of the BInS, measurements related to IWRT are made and presented in this work. Using a static multileaf collimator (SMLC) technique, the intensity modulated beam (IMB) is delivered via a sequence of static portals made by controlled leaves. Thus, when static subfields are generated by a sequence of abutting portals, the penumbras and scattered photons of the delivered beams overlap in abutting field regions and this results in the creation of “hot spots”. Using the BInS, inter-step “hot spots” inherent in SMLC are measured and an empirical method to remove them is proposed. Another major MLC technique in IMRT, the dynamic multileaf collimator (DMLC) technique, has different characteristics from SMLC due to a different leaf operation mechanism during the irradiation of photon and electron beams. By using the BInS, the actual delivered doses by SMLC and DMLC techniques are measured and compared. Even if the planned dose to a target volume is equal in our experimental setting, the actual delivered dose by DMLC technique is measured to be larger by 14.8% than that by SMLC, and this is due to scattered photons and contaminant electrons at d$_{max}$.

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