• Progress in Medical Physics
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• v.11 no.1
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• pp.59-71
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• 2000

It is possible to obtain a fast CT scan during breath holding with spiral technique. But the risk of radiation is increased due to detailed and repeated scans. However, the limitation of X-ray doses is not fully specified on CT, yet. Therefore, the purpose of the present study is to define the limitation of X-ray doses on CT The CT unit was somatom plus 4. Alderson Rando phantom, Solenoid water phantom, TLD, and reader were used. For determining adequate position and size of organs, the measurement of distance(${\pm}$2mm) from the midline of vertebral body was performed in 40 women(20~40 years). On the brain scan for 8:8(8mm slice thickness, 8mm/sec movement velocity of the table) and 10:10(10mm slice thickness, 10mm/sec movement velocity of the table) methods, the absorption doses of exposed area of the 10:10 were slightly higher than those of 8:8. The doses of unexposed uterus were negligible on the brain scan for both 8:8 and 10:10. On the chest scan for 8:8, 8:10(8mm slice thickness, 10mm/sec movement velocity of the table), 10:10, 10:12(10mm slice thickness, 12mm/sec movement velocity of the table) and 10:15(10mm slice thickness, 15mm/sec movement velocity of the table) methods, 8:8 method of the absorption doses of exposure area was the most highest and 10:15 method was the most lowest. The absorption doses of 8:10 method was relatively lower than those of the other methods. In conclusion, the 8:10 method is the most suitable to give a low radiation burden to patient without distorting image quality.

• Progress in Medical Physics
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• v.2 no.2
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• pp.109-120
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• 1991

Total body irradiation is operated to irradicate malignant cells of bone marrow of patients to be treated with bone marrow transplantation. Field size of a linear accelerator or cobalt teletherapy unit with normal geometry for routine technique is too small to cover whole body of a patient. So, any special method to cover patient whole body must be developed. Because such environments as room conditions and machine design are not universal, some characteristic method of TBI for each hospital could be developed. At Seoul National University Hospital, at present, only a cobalt unit is available for TBI because source head of the unit could be tilted. When the head is tilted outward by 90$^{\circ}$, beam direction is horizontal and perpendicular to opposite wall. Then, the distance from cobalt source to the wall was 319 cm. Provided that the distance from the wall to midsagittal plane of a patient is 40cm, nominal field size at the plane(SCD 279cm) is 122cm$\times$122cm but field size by measurement of exposure profile was 130cm$\times$129cm and vertical profile was not symmetric. That field size is large enough to cover total body of a patient when he rests on a couch in a squatting posture. Assuming that average lateral width of patients is 30cm, percent depth dose for SSD 264cm and nominal field size 115.5cm$\times$115.5cm was measured with a plane-parallel chamber in a polystyrene phantom and was linear over depth range 10～20cm. An anthropomorphic phantom of size 25cm wide and 30cm deep. Depth of dose maximum, surface dose and depth of 50% dose were 0.3cm, 82% and 16.9cm, respectively. A dose profile on beam axis for two opposing beams was uniform within 10% for mid-depth dose. Tissue phantom ratio with reference depth 15cm for maximum field size at SCD 279cm was measured in a small polystyrene phantom and was linear over depth range 10～20cm. An anthropomorphic phantom with TLD chips inserted in holes on the largest coronal plane was bilaterally irradiated by 15 minute in each direction by cobalt beam aixs in line with the cross line of the coronal plane and contact surface of sections No. 27 and 28. When doses were normalized with dose at mid-depth on beam axis, doses in head/neck, abdomen and lower lung region were close to reference dose within $\pm$ 10% but doses in upper lung, shoulder and pelvis region were lower than 10% from reference dose. Particulaly, doses in shoulder region were lower than 30%. On this result, the conclusion such that under a geometric condition for TBI with cobalt beam as SNUH radiotherapy departement, compensators for head/neck and lung shielding are not required but boost irradiation to shoulder is required could be induced.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1172-1182
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• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• Progress in Medical Physics
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• v.26 no.4
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• pp.258-266
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• 2015

The modern radiotherapy technique which delivers a large amount of dose to patients asks to confirm the positions of patients or tumors more accurately by using X-ray projection images of high-definition. However, a rapid increase in patient's exposure and image information for CT image acquisition may be additional burden on the patient. In this study, by introducing structural similarity (SSIM) index that can effectively extract the structural information of the image, we analyze the differences between daily acquired x-ray images of a patient to verify the accuracy of patient positioning. First, for simulating a moving target, the spherical computational phantoms changing the sizes and positions were created to acquire projected images. Differences between the images were automatically detected and analyzed by extracting their SSIM values. In addition, as a clinical test, differences between daily acquired x-ray images of a patient for 12 days were detected in the same way. As a result, we confirmed that the SSIM index was changed in the range of 0.85~1 (0.006~1 when a region of interest (ROI) was applied) as the sizes or positions of the phantom changed. The SSIM was more sensitive to the change of the phantom when the ROI was limited to the phantom itself. In the clinical test, the daily change of patient positions was 0.799~0.853 in SSIM values, those well described differences among images. Therefore, we expect that SSIM index can provide an objective and quantitative technique to verify the patient position using simple x-ray images, instead of time and cost intensive three-dimensional x-ray images.

• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.184-189
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• 2010

Purpose : Pseudomembranous colitis (PMC) occurs rarely in children, but its incidences are increasing due to frequent antibiotic use. We investigated the incidence and clinical characteristics of PMC accompanied by bacterial enteritis-like symptoms in children. Methods : Between November 2003 and July 2007 at the Department of Pediatrics, Dongsan Medical Center, we analyzed the medical records of consecutive patients who received antibiotics in the past 1 month, developed bacterial enteritis-like symptoms, and were diagnosed with PMC based on sigmoidoscopy examination and histological findings. Results : Among 22 patients who underwent sigmoidoscopy and biopsy examinations, 11 (50%) were diagnosed with PMC. These 11 patients were aged 2 months-12 years, among whom 5 patients (45.5%) were less than 1 year old. The clinical symptoms were bloody diarrhea (28.6%), abdominal pain or colic (28.6%), watery or mucoid diarrhea (23.8%), vomiting (9.5%), and fever (9.5%). The antibiotics used were penicillins (55.6%), macrolides (27.8%), cephalosporins (11.1%), and aminoglycosides (5.6%). The period of antibiotic use was 3-14 days. The interval between the initial antibiotic exposure and the onset of symptoms was 5-21 days. The results of stool examination of all patients were negative for Clostridium difficile toxin A. Patient distribution according to the degree of PMC was as follows: grade I, 18.2% (2 cases); grade II, 27.3% (3); grade III, 36.4% (4); and grade IV, 18.2% (2). PMC did not recur in any case.Conclusion : PMC is not a rare disease in children. If pediatric patients receiving antibiotics manifest symptoms like bacterial enteritis, PMC should be suspected. Endoscopy and biopsy should be applied as aggressive diagnostic approaches to detect this condition.

• Progress in Medical Physics
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• v.17 no.2
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• pp.89-95
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• 2006

The purpose of this study was to evaluate the radiation doses during CT transmission scan by changing tube voltage and tube current, and to estimate the radiation dose during our clinical whole body $^{137}Cs$ transmission scan and high quality CT scan. Radiation doses were evaluated for Philips GEMINI 16 slices PET/CT system. Radiation dose was measured with standard CTDI head and body phantoms in a variety of CT tube voltage and tube current. A pencil ionization chamber with an active length of 100 mm and electrometer were used for radiation dose measurement. The measurement is carried out at the free-in-air, at the center, and at the periphery. The averaged absorbed dose was calculated by the weighted CTDI ($CTDI_w=1/3CTDI_{100,c}+2/3CTDI_{100,p}$) and then equivalent dose were calculated with $CTDI_w$. Specific organ dose was measured with our clinical whole body $^{137}Cs$ transmission scan and high quality CT scan using Alderson phantom and TLDs. The TLDs used for measurements were selected for an accuracy of ${\pm}5%$ and calibrated in 10 MeV X-ray radiation field. The organ or tissue was selected by the recommendations of ICRP 60. The radiation dose during CT scan is affected by the tube voltage and the tube current. The effective dose for $^{137}Cs$ transmission scan and high qualify CT scan are 0.14 mSv and 29.49 mSv, respectively. Radiation dose during transmission scan in the PET/CT system can measure using CTDI phantom with ionization chamber and anthropomorphic phantom with TLDs. further study need to be peformed to find optimal PET/CT acquisition protocols for reducing the patient exposure with same image qualify.

• Journal of radiological science and technology
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• v.34 no.4
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• pp.277-285
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• 2011

To determine the quality control of UGIS, we acquired 105 patients sampling image at 21 general screening centers. The results of image quality evaluation table containing two countries's UGIS showed that the mean of image qualified education table of our country was 73.3 and the standard error was 4.49; In addition, 19 organizations of 21 general screening centers were given appropriate judgement. The average of image qualified education table of Japan was 58 and the standard error was 4.45. Only 8 organizations were given appropriate judgement. Although we made the image quality evaluation tables with same images, there were many differences in the result of two tables. We figured out the problem about the description of whole stomach and photograph skills. Furthermore, we analysed the situation of the UGIS at each general screening center with the acquired images. The biggest problem of the UGIS of our country was that the procedures were performed without clear medical methods. Methods of UGIS were different at every 21 general screening centers, and most of them did not take exam of anterior surface of stomach of the UGIS. In addition, some general screening centers did not include mucosal relief method or esophagography which is required to include in the image qualified education table of our country. Because polisography is used in the same body position, the problem occured about indiscreet exposure dose of patients. Therefore we have to make an effort to get X-ray images which have enough diagnosis information by the quality control of UGIS.

• Radiation Oncology Journal
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• v.16 no.2
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• pp.91-98
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• 1998

Purpose : The relationship between environmental PH on the radiation induced-apoptosis in SCK mammary adenocarcinoma cells and cell cycle dependence was investigated. Material and Methods : Mammary adenocarcinoma cells of A/J mice(SCK cells) in exponential growth phase were irradiated with a $l37^Cs$ irradiator at room temperature. The cells were irradiated 1 hour after the media was replaced with fresh media at a different pHs. After incubation at $37^{\circ}C$ for 0-48 h, the extent of apoptosis was determined using agarose gel electrophoresis and flow cytometry. The progression of cells through the cell cycle after irradiation in different pHs was also determined with flow cytometry. Bssults : The induction of apoptosis by irradiation in pH 6.6 medium was markedly less than that in pH 7.5 medium. When the cells were irradiated and maintained in pH 7.5 medium, the percentage of cells in $G_2/M$ phase rapidly increased to about $70\%$ at 12 h after an exposure to 120y and returned to control level by 36 h. The percentage of cells in G1 phase decreased as the percentage of cells in $G_2/M$ increased. On the other hand, in pH 6.6 medium the percentage of cells in G2/M phases gradually increased to about $45\%$ at 24 h after 12Gy irradiation and then slowly recessed and consequently, as much as $30-35\%$ of the cells were still in the Ga/M phase 48 h after irradiation. The percentage of cells in G1 phase then increased as the Ga/M arrest began to recede. The radiation-induced Ga/M arrest in PH 0.0 medium lasted markedly longer than that in pH 7.5 medium. Conclusion : Radiation-induced apoptosis in SCK tumor cells are reversely suppressed in an acidic environment. Radiation-induced Ga/M arrest is prolonged in an acidic environment indicating that the suppression of radiation-induced apoptosis and prolongation of radiation-induced Ga/M arrest in an acidic environment are related.

• Radiation Oncology Journal
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• v.25 no.3
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• pp.185-191
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• 2007

Purpose: This study was performed to investigate the effects of immune cell activation and the antitumor effect for the combination of treatment with X-irradiation and E/eutherococcus senticosus Maxim Root (ESMR) on mouse tumor cells. Materials and Methods: ESMR (250g) was extracted with 80% methanol, concentrated under decompression and lyophilized. To determine whether ESMR is able to activate the immune cells or not, the proliferation of splenocytes in vitro and the number of B cells and T cells in splenic lymphocytes in ESMR-pretreated mice were evaluated. X-irradiation was given to the mouse fibrosarcoma tumor cells (FSa II) by 250 kv X-irradiation machine. The cytotoxicity of ESMR was evaluated from its ability to reduce the clonogenecity of FSa II cells. In X-irradiation alone group, each 2, 4, 6 and 8 Gy was given to FSa II cells. In X-irradiation with ESMR group, 0.2 mg/ml of ESMR was exposed to FSa II cells for 1 hour before X-irradiation. Results: The proliferation of cultured mouse splenocytes and thymocytes were enhanced by the addition of ESMR in vitro. The number of B cells and T cells in mouse splenic lymphocytes was significantly increased in ESMR pretreated mice in vivo. In FSa II cells that received a combination of 0.2 mg/ml of ESMR with X-irradiation exposure, the survival fraction with a dose of 2, 4 and 6 Gy was $0.39{\pm}0.005$, $0.22{\pm}0.005$ and $0.06{\pm}0.007$, respectively. For FSa II cells treated with X-irradiation alone, the survival fraction with a dose of 2, 4 and 6 Gy was $0.76{\pm}0.02$, $0.47{\pm}0.008$ and $0.37{\pm}0.01$. The difference in the survival fraction of the mouse FSa II cells treated with and without ESMR was statistically significant (p<0.05). Conclusion: Treatment with ESMR increased cell viability of mouse splenocytes in vitro and especially the subpopulation of B cells and T cells in splenocytes in ESMR-pretreated mice. However, treatment with ESMR did not increase the level of Th and Tc subpopulations in the thymocytes. Treatment with the combination of ESMR and X-irradiation was more cytotoxic to mouse tumor cells than treatment with X-irradiation alone; this finding was statistically significant.

• Journal of Radiation Protection and Research
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• v.33 no.2
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• pp.77-86
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• 2008

This study attempted to provide reference materials for improving the behavior level in radiation safety managements by drawing a prediction model that affects the radiation safety management behavior because the radiation safety management of medical Cyclotrons, which can be used to produce radioisotopes, is an important factor that protects radiation caused diseases not only for radiological operators but average users. In addition, this study obtained follows results through the investigation applied from January 2 to January 30, 2008 for the radiation safety managers employed in 24 authorized organizations, which have already installed Cyclotrons, through applying a specific form of questionnaire in which the validity was guaranteed by reference study, site investigation, and focus discussion by related experts. The radiation safety management were configured as seven steps: Step 1 is a production preparation step, Step 2 is an RI production step, Step 3 is a synthesis step, Step 4 is a distribution step, Step 5 is a quality control step, Step 6 is a carriage container packing step, and Step 7 is a transportation step. it was recognized that the distribution step was the most exposed as 15 subjects (62.5%), the items of 'the sanction and permission related works' and 'the guarantee of installation facilities and production equipments' were the most difficult as 9 subjects (37.5%), and In the trouble steps in such exposure, the item of 'the synthesis and distribution' steps were 4 times, respectively (30.8%). In the score of the behavior level in radiation safety managements, the minimum and maximum scores were 2.42 and 4.00, respectively, and the average score was $3.46{\pm}0.47$ out of 4. Prosperity and well-being programs in the behavior and job in radiation safety managements (r=0.529) represented a significant correlation statistically. In the drawing of a prediction model based on the factors that affected the behavior in radiation safety managements, general characteristics, organization characteristics, and selfefficacy didn't show a significant path statistically in which the prosperity and well-being programs in job characteristics affected the behavior in radiation safety managements. Therefore, it is necessary to establish a strategy that improves the level of prosperity and well-being levels in job characteristics in order to increase the behavior in radiation safety managements. Thus, this study provides basic materials for the radiation safety management of Cyclotron through the full-scale investigation that is first applied in Korea.