• Journal of Chest Surgery
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• v.13 no.4
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• pp.346-355
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• 1980

It has been proposed that wide individual variation in response to heparin be not considered in the conventional set protocol for the control of heparin and protamine during extracorporeal circulation. In this paper, two protocol of heparin and protamine therapy were compared to assess the role of the Activated Clotting Time [ACT] in relation to heparin, protamine, and postoperative blood loss and transfusion. The study groups consisted of the 31 patients [adults 15 and children 16] anticoagulated with the conventional heparin protocol and the 31 patients [adults 15 and children 16] anticoagulated with ACT protocol during extracorporeal circulation. In the conventional heparin protocol, two mg of heparin per kg was administered initially with an additional 0.75 mg of heparin per kg every 30 minutes of extracorporeal circulation, and reversal was accomplished with protamine in a dose of 1.5 times the total milligram of heparin. In the ACT protocol, two mg of heparin per kg was administered initially with an additional dose of heparin enough to reach an ACT of 480 seconds [within safe zone 300 to 600 seconds] from the patient`s dose response curve every 1 hour of extracorporeal circulation, and reversal was done with protamine in a dose of 1.3 times the milligram of the residual heparin. The results were summarized as follows. After a dose of 2 mg per kg of heparin, the patient`s ACT varied from 240 to 600 seconds in adults and from 240 t~ 660 seconds in children. In the ACT group the total amount of heparin administered was markedly reduced when compared to the conventional group, and less protamine was required to neutralize heparin. The dose of heparin administered decreased from 7.07 [SE 0.42] mg/kg of the conventional group to 4.92 [SE 0.32] mg/k8 of the ACT group in adults and from 10.17 [SE 1.15] mg/kg to 5.23 [SE 0.24] mg/kg in children, which represent 30.4% and 48.6% decrease respectively. The dose of protamine administered for reversal decreased from 10.6 [SE 0.63] mg/kg of the conventional group to 3.35 [SE 0.35] mg/kg of the ACT group in adults and from 15.7 [SE 1.70] mg/kg to 3.26 [SE 0.27] mg/kg in children, which represent 68.4% and 79.2% respectively. The ratio of protamine to heparin administered in the conventional group was 1.50:1 in adults and 1.54:1 in children, but in the ACT group 0.68:1 in adults and 0.62:1 in children. Postoperative blood loss and transfusion revealed no statistically significant difference between the two groups. Although six patients in the conventional group and one in the ACT group needed re-exploration for continuous hemorrhage, no case of generalized oozing was encountered, and in each case a definite bleeding site was identified. Author would like emphasizing the value of the ACT protocol in controlling heparin and protamine administration during extracorporeal circulation.

• Journal of radiological science and technology
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• v.38 no.1
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• pp.1-6
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• 2015

Whole spine scanography (WSS) is a radiological examination that exposes the whole body of the individual being examined to x-ray radiation. WSS is often repeated during the treatment period, which results in a much greater radiation exposure than that in routine x-ray examinations. The aims of the current study were to evaluate the patient dose of WSS using computer simulation, image magnification and angulation of phantom image using different patient position. We evaluated the effective dose(ED) of 23 consecutive patients (M : F = 13:10) who underwent WSS, based on the automatic image pasting method for multiple exposure digital radiography. The Anterior-Posterior position(AP) and Posterior-Anterior position( PA) projection EDs were evaluated based on the PC based Monte Carlo simulation. We measured spine transverse process distance and angulation using DICOM measurement. For all patient, the average ED was 0.069 mSv for AP position and 0.0361 mSv for PA position. AP position calculated double exposure then PA position. For male patient, the average ED was 0.089 mSv(AP) and 0.050 mSv(PA). For female patient, the average ED was 0.0431 mSv(AP) and 0.026 mSv(PA). The transverse process of PA spine image measured 5% higher than AP but angulation of transverse process was no significant differences. In clinical practice, just by change the patient position was conformed to reduce the ED of patient. Therefor we need to redefine of protocol for digital radiography such as WSS. whole spine scanography, effective dose, patient exposure dose, exposure direction. protocol optimization.

• Progress in Medical Physics
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• v.20 no.1
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• pp.7-13
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• 2009

This work is for the preliminary study for the calibration of an $^{192}Ir$ brachytherapy source based on an absorbed dose to water standards. In order to calibrate brachytherapy sources based on absorbed dose to water standards using a clyndirical ionization chamber, the beam quality correction factor $k_{Q,Q_0}$ is needed. In this study $k_{Q,Q_0}s$ were determined by both Monte carlo simulation and semiexperimental methods because of the realistic difficulties to use primary standards to measure an absolute dose at a specified distance. The 5 different serial numbers of the PTW30013 chamber type were selected for this study. While chamber to chamber variations ran up to maximum 4.0% with the generic $k^{gen}_{Q,Q_0}$, the chamber to chamber variations were within a maximum deviation of 0.5% with the individual $k^{ind}_{Q,Q_0}$. The results show why and how important ionization chambers must be calibrated individually for the calibration of $^{192}Ir$ brachytherapy sources based on absorbed dose to water standards. We hope that in the near future users will be able to calibrate the brachytherapy sources in terms of an absorbed dose to water, the quantity of interest in the treatment, instead of an air kerma strength just as the calibration in the high energy photon and electron beam.

• Toxicological Research
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• v.20 no.2
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• pp.89-100
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• 2004

The comet assay (also called the single-cell gel electrophoresis assay) has been widely used for detecting DNA damage and repair in individual cells. Since the conventional methods of evaluating comet assay data using frequency statistics are unsatisfactory we developed a new quantitative measure of DNA damage/repair that is based on all information residing in the dose/time-response curves of a comet experiment. Blood samples were taken from 25 breast cancer patients before undergoing radiotherapy. The comet assay was performed under alkaline conditions using isolated lymphocytes. Tail DNA, tail length, tail moment and tail inertia of the comet were measured for each patient at four doses of $\gamma$-rays (0, 2, 4 and 8 Gy) and at four time points after irradiation (0, 10, 20 and 30 min) using 100 cells each. The resulting three-dimensional dose-time response surface was modeled by multiple regression, and the second derivative, termed 2D, on dose and time was determined. A software module was programmed in SAS/AF to compute 2D values. We applied the new method successfully to data obtained from cancer patients to be assessed for their radiation sensitivity. We computed the 2D values for the four damage measures, i.e., tail moment, tail length, tail DNA and tail inertia, and examined the pairwise correlation coefficients of 2D both on the log scale and the unlogged scale. 2D values based on tail moment and tail DNA showed a high correlation and, therefore, these two damage measures can be used interchangeably as far as DNA repair is concerned. 2D values based on tail inertia have a correlation profile different from the other 2D values which may reflect different facets of DNA damage/repair. Using the dose-time response surface, other statistical models, e.g., the proportional hazards model, become applicable for data analysis. The 2D approach can be applied to all DNA repair measures, Le., tail moment, tail length, tail DNA and tail inertia, and appears to be superior to conventional evaluation methods as it integrates all data of the dose/time-response curves of a comet assay.

• The Journal of the Korea Contents Association
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• v.9 no.6
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• pp.247-255
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• 2009

This study aims to provide basic data for establishing the safety and health plan by investigating the exposure conditions in the facilities registering business about handling radiations and radioactive isotopes in Korea. dose levels(working space, worker location) of the workers in 153 facilities were measured using surveymeter, and individual exposure concentration[(shallow dose(SD), depth dose(DD)] in 27 facilities using thermal luminescence dosimeter(TLD). In accordance with the measurement results by business type[fire fighting prevention business(FFPB, n=10), financial insurance business(FIB, n=3) and other facilities(n=140)] using surveymeter, those three business type groups showed difference (p<0.000). Dose levels of worker location for FFPB and FIB were significantly higher than 10.0 ${\mu}Sv$/hr, the allowable standard for radiations and radioactive isotopes, and they were higher 109.3 times(p<0.000) and 187.5 times(p<0.000) than those in other facilities. The concentration of TLD[FFPB(n=10), other facility (n=17)] in DD of FFPB was significantly higher than that in other facility(p=0.05). In accordance with the analysis result on relationship between surveymeter and TLD, the dose on working space and worker location(r=0.406, p<0.05), worker location dose and SD(r=0.453, p<0.05), worker location dose and DD(r=0.553, p<0.01), and SD and DD(r=0.927, p<0.001) had all related each other. It is urgently required to change FFPB and FIB from the facilities requiring registration for handling radiations and radioactive isotopes to the facilities that shall get permission for handling radiations and radioactive isotopes by reestablishing the legal administration area, for safety and health of radiation occupants.

• Journal of Nuclear Fuel Cycle and Waste Technology(JNFCWT)
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• v.17 no.1
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• pp.107-120
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• 2019

The decommissioning of one nuclear power plant in a multi-unit nuclear power plant (multi-unit NPP) site may pose radiation exposure risk to decommissioning workers. Thus, it is essentially required to evaluate the exposure dose of decommissioning workers of operating multi-unit NPPs nearby. The ENDOS program is a dose evaluation code developed by the Korea Atomic Energy Research Institute (KAERI). As two sub-programs of ENDOS, ENDOS-ATM to anticipate atmospheric transport and ENDOS-G to calculate exposure dose by gaseous radioactive effluents are used in this study. As a result, the annual maximum individual dose for decommissioning workers is estimated to be $2.31{\times}10^{-3}mSv{\cdot}y^{-1}$, which is insignificant compared with the effective dose limit of $1mSv{\cdot}y^{-1}$ for the public. Although it is revealed that the exposure dose of operating multi-unit NPPs does not result in a significant impact on decommissioning workers, closer examination of the effect of additional exposure due to actual demolition work is required. The calculation method of this study is expected to be utilized in the future for planned decommissioning projects in Korea. Because domestic NPPs are located in multi-unit sites, similar situations may occur.

• Journal of radiological science and technology
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• v.35 no.4
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• pp.327-333
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• 2012

Purpose: To analyze the correlation between dose volume histograms(DVH) based on organ outer wall contour and organ wall delineation for bladder and rectum, and to compare the doses to these organs with the absorbed doses at the bladder and rectum. Material and methods: Individual CT based brachytherapy treatment planning was performed in 13 patients with cervical cancer as part of a prospective comparative trial. The external contours and the organ walls were delineated for the bladder and rectum in order to compute the corresponding dose volume histograms. The minimum dose in 0.1 $cm^3$, 1 $cm^3$, 2 $cm^3$, 5 $cm^3$, 10 $cm^3$ volumes receiving the highest dose were compared with the absorbed dose at the rectum and bladder reference point. Results: The bladder and rectal doses derived from organ outer wall contour and computed for volumes of 2 $cm^3$, provided a good estimate for the doses computed for the organ wall contour only. This correspondence was no longer true when large volumes were considered. Conclusion: For clinical applications, when volumes smaller than 5 $cm^2$ are considered, the dose-volume histograms computed from external organ contours for the bladder and rectum can be used instead of dose -volume histograms computed for the organ walls only. External organ contours are indeed easier to obtain. The dose at the ICRU rectum reference point provides a good estimate of the rectal dose computed for volumes smaller than 2 $cm^2$ only for a midline position of the rectum. The ICRU bladder reference point provides a good estimate of the dose computed for the bladder wall only in cases of appropriate balloon position.

• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.45-50
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• 2011

Purpose: It appears the different value when the injection dose is calculating for patients on each PET/CT systems. It directly affects the technologists' radiation exposed dose. We studied the effect of the variable injection doses from several PET/CT systems to exposure dose for technologists. Materials and Methods: Six technologists have worked for 5 months through unit rotations with 3 PET/CT systems {Scanner 1 (S1): 0.15 mCi/kg, Scanner 2 (S2): 0.17 mCi/kg, Scanner 3 (S3): 0.12 mCi/kg}. Eighteen to 19 patients have had examinations per a day on each PET/CT systems. Examination parameters were adjusted to the same. TLDs were used for checking the exposure dose of technologists. Results: Each technologists' the monthly average exposure dose was as follows; S1: 0.76 mSv, S2: 0.93 mSv, S3: 0.47 mSv. The maximum exposure dose was 1.12 mSv, and minimum was 0.42 mSv. The results showed significance in the correlation between the PET/CT system and the exposure dose (p<0.005). Conclusion: When the amount of injection dose was small, the exposure dose was decreased not only the patients but also the technologists. The exposure dose was decreased by the individual proficiency of technologists. However, the low injection dose can highly reduce the exposure dose for technologist so that there will be needed to following studies.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.275-286
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• 2001

Purpose : To setup procedures of quality assurance (OA) for implementing intensity modulated radiation therapy (IMRT) clinically, report OA procedures peformed for one patient with prostate cancer. Materials and methods : $P^3IMRT$ (ADAC) and linear accelerator (Siemens) with multileaf collimator are used to implement IMRT. At first, the positional accuracy, reproducibility of MLC, and leaf transmission factor were evaluated. RTP commissioning was peformed again to consider small field effect. After RTP recommissioning, a test plan of a C-shaped PTV was made using 9 intensity modulated beams, and the calculated isocenter dose was compared with the measured one in solid water phantom. As a patient-specific IMRT QA, one patient with prostate cancer was planned using 6 beams of total 74 segmented fields. The same beams were used to recalculate dose in a solid water phantom. Dose of these beams were measured with a 0.015 cc micro-ionization chamber, a diode detector, films, and an array detector and compared with calculated one. Results : The positioning accuracy of MLC was about 1 mm, and the reproducibility was around 0.5 mm. For leaf transmission factor for 10 MV photon beams, interleaf leakage was measured $1.9\%$ and midleaf leakage $0.9\%$ relative to $10\times\;cm^2$ open filed. Penumbra measured with film, diode detector, microionization chamber, and conventional 0.125 cc chamber showed that $80\~20\%$ penumbra width measured with a 0.125 cc chamber was 2 mm larger than that of film, which means a 0.125 cc ionization chamber was unacceptable for measuring small field such like 0.5 cm beamlet. After RTP recommissioning, the discrepancy between the measured and calculated dose profile for a small field of $1\times1\;cm^2$ size was less than $2\%$. The isocenter dose of the test plan of C-shaped PTV was measured two times with micro-ionization chamber in solid phantom showed that the errors upto $12\%$ for individual beam, but total dose delivered were agreed with the calculated within $2\%$. The transverse dose distribution measured with EC-L film was agreed with the calculated one in general. The isocenter dose for the patient measured in solid phantom was agreed within $1.5\%$. On-axis dose profiles of each individual beam at the position of the central leaf measured with film and array detector were found that at out-of-the-field region, the calculated dose underestimates about $2\%$, at inside-the-field the measured one was agreed within $3\%$, except some position. Conclusion : It is necessary more tight quality control of MLC for IMRT relative to conventional large field treatment and to develop QA procedures to check intensity pattern more efficiently. At the conclusion, we did setup an appropriate QA procedures for IMRT by a series of verifications including the measurement of absolute dose at the isocenter with a micro-ionization chamber, film dosimetry for verifying intensity pattern, and another measurement with an array detector for comparing off-axis dose profile.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.983-994
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• 2021

Objective : The effectiveness of gamma knife radiosurgery (GKR) in the treatment of brain metastases is well established. The aim of this study was to evaluate the efficacy and safety of maximizing the radiation dose in GKR and the factors influencing tumor control in cases of small and medium-sized brain metastases from non-small cell lung cancer (NSCLC). Methods : We analyzed 230 metastatic brain tumors less than 5 mL in volume in 146 patients with NSCLC who underwent GKR. The patients had no previous radiation therapy for brain metastases. The pathologies of the tumors were adenocarcinoma (n=207), squamous cell carcinoma (n=18), and others (n=5). The radiation doses were classified as 18, 20, 22, and 24 Gy, and based on the tumor volume, the tumors were categorized as follows : small-sized (less than 1 mL) and medium-sized (1-3 and 3-5 mL). The progression-free survival (PFS) of the individual 230 tumors and 146 brain metastases was evaluated after GKR depending on the pathology, Eastern Cooperative Oncology Group (ECOG) performance score (PS), tumor volume, radiation dose, and anti-cancer regimens. The radiotoxicity after GKR was also evaluated. Results : After GKR, the restricted mean PFS of individual 230 tumors at 24 months was 15.6 months (14.0-17.1). In small-sized tumors, as the dose of radiation increased, the tumor control rates tended to increase (p=0.072). In medium-sized tumors, there was no statistically difference in PFS with an increase of radiation dose (p=0.783). On univariate analyses, a statistically significant increase in PFS was associated with adenocarcinomas (p=0.001), tumors with ECOG PS 0 (p=0.005), small-sized tumors (p=0.003), radiation dose of 24 Gy (p=0.014), synchronous lesions (p=0.002), and targeted therapy (p=0.004). On multivariate analyses, an improved PFS was seen with targeted therapy (hazard ratio, 0.356; 95% confidence interval, 0.150-0.842; p=0.019). After GKR, the restricted mean PFS of brain at 24 months was 9.8 months (8.5-11.1) in 146 patients, and the pattern of recurrence was mostly distant within the brain (66.4%). The small and medium-sized tumors treated with GKR showed radiotoxicitiy in five out of 230 tumors (2.2%), which were controlled with medical treatment. Conclusion : The small-sized tumors were effectively controlled without symptomatic radiation necrosis as the radiation dose was increased up to 24 Gy. The medium-sized tumors showed potential for symptomatic radiation necrosis without signifcant tumor control rate, when greater than 18 Gy. GKR combined targeted therapy improved the tumor control of GKR-treated tumors.