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A Modified Length-Based Grading Method for Assessing Coronary Artery Calcium Severity on Non-Electrocardiogram-Gated Chest Computed Tomography: A Multiple-Observer Study

  • Suh Young Kim;Young Joo Suh;Na Young Kim;Suji Lee;Kyungsun Nam;Jeongyun Kim;Hwan Kim;Hyunji Lee;Kyunghwa Han;Hwan Seok Yong
    • Korean Journal of Radiology
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    • v.24 no.4
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    • pp.284-293
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    • 2023
  • Objective: To validate a simplified ordinal scoring method, referred to as modified length-based grading, for assessing coronary artery calcium (CAC) severity on non-electrocardiogram (ECG)-gated chest computed tomography (CT). Materials and Methods: This retrospective study enrolled 120 patients (mean age ± standard deviation [SD], 63.1 ± 14.5 years; male, 64) who underwent both non-ECG-gated chest CT and ECG-gated cardiac CT between January 2011 and December 2021. Six radiologists independently assessed CAC severity on chest CT using two scoring methods (visual assessment and modified length-based grading) and categorized the results as none, mild, moderate, or severe. The CAC category on cardiac CT assessed using the Agatston score was used as the reference standard. Agreement among the six observers for CAC category classification was assessed using Fleiss kappa statistics. Agreement between CAC categories on chest CT obtained using either method and the Agatston score categories on cardiac CT was assessed using Cohen's kappa. The time taken to evaluate CAC grading was compared between the observers and two grading methods. Results: For differentiation of the four CAC categories, interobserver agreement was moderate for visual assessment (Fleiss kappa, 0.553 [95% confidence interval {CI}: 0.496-0.610]) and good for modified length-based grading (Fleiss kappa, 0.695 [95% CI: 0.636-0.754]). The modified length-based grading demonstrated better agreement with the reference standard categorization with cardiac CT than visual assessment (Cohen's kappa, 0.565 [95% CI: 0.511-0.619 for visual assessment vs. 0.695 [95% CI: 0.638-0.752] for modified length-based grading). The overall time for evaluating CAC grading was slightly shorter in visual assessment (mean ± SD, 41.8 ± 38.9 s) than in modified length-based grading (43.5 ± 33.2 s) (P < 0.001). Conclusion: The modified length-based grading worked well for evaluating CAC on non-ECG-gated chest CT with better interobserver agreement and agreement with cardiac CT than visual assessment.

Deep Learning-Assisted Diagnosis of Pediatric Skull Fractures on Plain Radiographs

  • Jae Won Choi;Yeon Jin Cho;Ji Young Ha;Yun Young Lee;Seok Young Koh;June Young Seo;Young Hun Choi;Jung-Eun Cheon;Ji Hoon Phi;Injoon Kim;Jaekwang Yang;Woo Sun Kim
    • Korean Journal of Radiology
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    • v.23 no.3
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    • pp.343-354
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    • 2022
  • Objective: To develop and evaluate a deep learning-based artificial intelligence (AI) model for detecting skull fractures on plain radiographs in children. Materials and Methods: This retrospective multi-center study consisted of a development dataset acquired from two hospitals (n = 149 and 264) and an external test set (n = 95) from a third hospital. Datasets included children with head trauma who underwent both skull radiography and cranial computed tomography (CT). The development dataset was split into training, tuning, and internal test sets in a ratio of 7:1:2. The reference standard for skull fracture was cranial CT. Two radiology residents, a pediatric radiologist, and two emergency physicians participated in a two-session observer study on an external test set with and without AI assistance. We obtained the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity along with their 95% confidence intervals (CIs). Results: The AI model showed an AUROC of 0.922 (95% CI, 0.842-0.969) in the internal test set and 0.870 (95% CI, 0.785-0.930) in the external test set. The model had a sensitivity of 81.1% (95% CI, 64.8%-92.0%) and specificity of 91.3% (95% CI, 79.2%-97.6%) for the internal test set and 78.9% (95% CI, 54.4%-93.9%) and 88.2% (95% CI, 78.7%-94.4%), respectively, for the external test set. With the model's assistance, significant AUROC improvement was observed in radiology residents (pooled results) and emergency physicians (pooled results) with the difference from reading without AI assistance of 0.094 (95% CI, 0.020-0.168; p = 0.012) and 0.069 (95% CI, 0.002-0.136; p = 0.043), respectively, but not in the pediatric radiologist with the difference of 0.008 (95% CI, -0.074-0.090; p = 0.850). Conclusion: A deep learning-based AI model improved the performance of inexperienced radiologists and emergency physicians in diagnosing pediatric skull fractures on plain radiographs.

Comparison of Radiological Tumor Response Based on iRECIST and RECIST 1.1 in Metastatic Clear-Cell Renal Cell Carcinoma Patients Treated with Programmed Cell Death-1 Inhibitor Therapy

  • Bingjie Zheng;Ji Hoon Shin;Hailiang Li;Yanqiong Chen;Yuan Guo;Meiyun Wang
    • Korean Journal of Radiology
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    • v.22 no.3
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    • pp.366-375
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    • 2021
  • Objective: To evaluate the radiological tumor response patterns and compare the response assessments based on immune-based therapeutics Response Evaluation Criteria in Solid Tumors (iRECIST) and RECIST 1.1 in metastatic clear-cell renal cell carcinoma (mccRCC) patients treated with programmed cell death-1 (PD-1) inhibitors. Materials and Methods: All mccRCC patients treated with PD-1 inhibitors at Henan Cancer Hospital, China, between January 2018 and April 2019, were retrospectively studied. A total of 30 mccRCC patients (20 males and 10 females; mean age, 55.6 years; age range, 37-79 years) were analyzed. The target lesions were quantified on consecutive CT scans during therapy using iRECIST and RECIST 1.1. The tumor growth rate was calculated before and after therapy initiation. The response patterns were analyzed, and the differences in tumor response assessments of the two criteria were compared. The intra- and inter-observer variabilities of iRECIST and RECIST 1.1 were also analyzed. Results: The objective response rate throughout therapy was 50% (95% confidence interval [CI]: 32.1-67.9) based on iRECIST and 30% (95% CI: 13.6-46.4) based on RECIST 1.1. The time-to-progression (TTP) based on iRECIST was longer than that based on RECIST 1.1 (median TTP: not reached vs. 170 days, p = 0.04). iRECIST and RECIST 1.1 were discordant in 8 cases, which were evaluated as immune-unconfirmed PD based on iRECIST and PD based on RECIST 1.1. Six patients (20%, 6/30) had pseudoprogression based on iRECIST, of which four demonstrated early pseudoprogression and two had delayed pseudoprogression. Significant differences in the tumor response assessments based on the two criteria were observed (p < 0.001). No patients demonstrated hyperprogression during the study period. Conclusion: Our study confirmed that the iRECIST criteria are more capable of capturing immune-related atypical responses during immunotherapy, whereas conventional RECIST 1.1 may underestimate the benefit of PD-1 inhibitors. Pseudoprogression is not rare in mccRCC patients during PD-1 inhibitor therapy, and it may last for more than the recommended maximum of 8 weeks, indicating a limitation of the current strategy for immune response monitoring.

Evaluation of Clinical Availability for Shoulder Forced Traction Method to Minimize the Beam Hardening Artifact in Cervical-spine Computed Tomography (CT) (경추부 전산화단층촬영에서 선속 경화 인공물을 최소화하기 위한 견부 강제 견인법에 대한 임상적 유용성 평가)

  • Kim, Moonjeung;Cho, Wonjin;Kang, Suyeon;Lee, Wonseok;Park, Jinwoo;Yu, Yunsik;Im, Inchul;Lee, Jaeseung;Kim, Hyeonjin;Kwak, Byungjoon
    • Journal of the Korean Society of Radiology
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    • v.7 no.1
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    • pp.37-44
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    • 2013
  • In study suggested clinical availability to shoulder forced traction method in term of quality of image, the patient's convenience and stability, according to whether to use of shoulder forced traction bend using computed tomography(CT) that X-ray calibration and various mathematic calibration algorithm application can be applied by AEC. To achieve this, 79 patients is complaining of cervical pain oriented that shoulder forced traction bend use the before and after acquires lateral projection scout image and transverse image. transverse image of a fixed size in concern field of pixel and figure the average HU value compare that quantitative analysis. Artifact and pixel and resolution to qualitative clinical estimation image analysis. the patient feel inconvenience degree that self-diagnosis survey that estimate. As a result, lateral projection scout image if you used shoulder forced traction bend for the depicted has been an increase in the number of a cervical vertebrae. transverse image concern field shoulder forced traction bend use the before and after for pixel and the average HU-value changes was judged to be almost irrelevant. Artifact and resolution and contrast, in qualitative analysis of the results relating the observer to the unusual result. So, the patients of 82.27% complained discomfort that use of shoulder forced traction bend in self-diagnosis survey. No merit of medical image by using of bend from result was analyzed quality of image to quantitative and qualitative method judged. Nowadays, CT is supplied possible revision of quality of radiation by reduction of slice and automatic exposure controller, etc and application of preconditioning filter process due to various mathematic revision algorithm. So, image noise by beam hardening artifact should not be a problem. shoulder forced traction bend of use no longer judged clinically availability because have not influence of image quality and give discomfort, have extra dangerousness.

Moult Patterns of Tail Feathers of Immature Steller's Sea Eagle(Haliaeetus pelagicus)raised in Captivity (사육상태에서 참수리(Haliaeetus pelagicus) 미성조 꼬리깃의 깃갈이 방식)

  • Kang, Seung-Gu;Lee, In-Sup
    • Korean Journal of Environment and Ecology
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    • v.22 no.4
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    • pp.435-441
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    • 2008
  • This study conducted a survey on the moulting sequence subsequent to age of Haliaeetus pelagicus raised in captivity at the Ornithology Laboratory attached to Kyungsung University for about six years from November, 2000 until July, 2006. The survey indicated that the moult of rectrices usually began in July and continued until April of the next year and most of the rectrices were replaced by one-time moult. Usually, about two thirds of the tail feathers were replaced while the rest were replaced no later than April of the next year, and the moult also continued during the wintertime. The total number of rectrices was 14, and the moult progressed alternately on a systematic basis. The progress of the moult for female & male was made on four stages and three stages respectively and the characteristic shown on every stage of the moult was that the left & right tail feathers progressed symmetrically and not until one stage of progress almost completed did the next stage began. The color of the juvenile steller's sea-eagle was dotted with black spots on its original white color and there existed regular black belt on its feather's fringes; however, it was difficult to identify its age by tail feathers only because there was almost no difference in color between feathers ranging from the first to the third generation(1st-3rd summer feathers). In addition, this research took the different amounts of black-speckled pattern appearing by individual into consideration. There existed slight black speckles in white color feathers of the fourth generation(the 4th summer feathers) while showing a big difference compared to the 3rd generation feathers. The 5th generation feathers[the 5th summer feathers]were found to be equipped with perfect tail feathers having virgin white of a steller's sea-eagle after completing its 4th molt. When observing a steller's sea-eagle in the open air, it is necessary for an observer to have a deliberate examination in judging its age belonging to the 1st-3rd generation feathers, and it is considered that the changes of other parts of feathers should be also observed besides tail feathers.

A STUDY ON THE SIZE OF THE PERMANENT TEETH (영구치의 치아크기에 관한 연구)

  • Baik, Byeong-Ju;Park, Jeong-Yeol;Kim, Jae-Gon;Lee, Doo-Cheol
    • Journal of the korean academy of Pediatric Dentistry
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    • v.30 no.3
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    • pp.502-509
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    • 2003
  • After 800 students of Chonbuk National University was examined, 86 people (male : 43, female : 43, mean age : 22.2 years old) was selected as a group of normal occlusion. From their gypsum cast, this conclusion was obtained. 1. Intra-observer measurement errors in buccolingual diameter, maxillary lateral incisors have somewhat bigger errors. In mesiodistal diameter, maxillary first molars and maxillary second molar have bigger numerical value. Mean errors of measurement are 0.051mm at buccolingual diameter of crown and 0.083mm at mesiodistal diameter. 2. Fluctuating asymmetry is 0.030 average in buccolingual diameter, and 0.037 average in mesiodistal diameter. Statistically there are no big differences. 3. Male has longer buccolingual diameter than female in every permanent teeth. Teeth which have statistical difference in buccolingual diameter are maxillary lateral incisor, maxillary canine, maxillary second molar, mandibular central incisor, mandibular canine, mandibular second premolar, and mandibular first molar. In mesiodistal diameter maxillary central incisor, maxillary canine, and mandibular first molar have statistically difference. 4. Tooth which has the biggest difference depending on gender is maxillary lateral incisor in buccolingual diameter and mandibular canine in mesiodistal diameter. 5. Both sexes have similar crown index. Male has bigger value of crown module measurement and crown area measurement in every tooth. Crown area considered as size of tooth from occlusal surface was bigger in male than in female statistically except some teeth, maxillary first premolar, mandibular lateral incisor, first premolar and second premolar.

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A study on the characteristics of attractive profiles of Korean young women to orthodontists (교정의사가 선호하는 측모의 유형에 따른 특징적 양상에 관한 연구)

  • Kim, Young-Jin;Kim, Jeong-Hwan
    • The korean journal of orthodontics
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    • v.31 no.5 s.88
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    • pp.479-487
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    • 2001
  • The perception of facial esthetics is critically important to orthodontists. A viewpoint to facial esthetics is influenced by various factors and dependent on the perception of observer. The purpose of this study was to examine the differences regarding esthetic viewpoints among orthodontists, to identify attractive profiles preferred to orthodontists and to present the characteristic aspects of attractive profiles upon the degree of facial convexity. 35 persons whose faces were judged as attractive one by S orthodontists were selected out of 133 young Korean women. Soft tissue profiles Identified as a good-profile group were measured and analyzed. And then according to the facial convexity, good-profile group was subdivided to convex (G-Sn-Pg$9^{\circ}$) and straight (G-Sn-Pg<$9^{\circ}$) groups for the purpose of this study. There were statistically no significant differences regarding esthetic viewpoints among S orthodontists(p<0.05), even if there exists prevailing concept that the standard for facial esthetics is substantially subjective. N-Pg-Sn and N-Pg-Pn, measured for determining anteroposterior relationship of midfacial convexity, showed significant differences statistically between 2 subgroups (P

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Development of Unfolding Energy Spectrum with Clinical Linear Accelerator based on Transmission Data (물질투과율 측정정보 기반 의료용 선형가속기의 에너지스펙트럼 유도기술 개발)

  • Choi, Hyun Joon;Park, Hyo Jun;Yoo, Do Hyeon;Kim, Byoung-Chul;Yi, Chul-Young;Min, Chul Hee
    • Journal of Radiation Protection and Research
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    • v.41 no.1
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    • pp.41-47
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    • 2016
  • Background: For the accurate dose assessment in radiation therapy, energy spectrum of the photon beam generated from the linac head is essential. The aim of this study is to develop the technique to accurately unfolding the energy spectrum with the transmission analysis method. Materials and Methods: Clinical linear accelerator and Monet Carlo method was employed to evaluate the transmission signals according to the thickness of the observer material, and then the response function of the ion chamber response was determined with the mono energy beam. Finally the energy spectrum was unfolded with HEPROW program. Elekta Synergy Flatform and Geant4 tool kits was used in this study. Results and Discussion: In the comparison between calculated and measured transmission signals using aluminum alloy as an attenuator, root mean squared error was 0.43%. In the comparison between unfolded spectrum using HEPROW program and calculated spectrum using Geant4, the difference of peak and mean energy were 0.066 and 0.03 MeV, respectively. However, for the accurate prediction of the energy spectrum, additional experiment with various type of material and improvement of the unfolding program is required. Conclusion: In this research, it is demonstrated that unfolding spectra technique could be used in megavoltage photon beam with aluminum alloy and HEPROW program.

Hue Shift Model and Hue Correction in High Luminance Display (고휘도 디스플레이의 색상이동모델과 색 보정)

  • Lee, Tae-Hyoung;Kwon, Oh-Seol;Park, Tae-Yong;Ha, Yeong-Ho
    • Journal of the Institute of Electronics Engineers of Korea SP
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    • v.44 no.4 s.316
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    • pp.60-69
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    • 2007
  • The human eye usually experiences a loss of color sensitivity when it is subjected to high levels of luminance, and perceives a discrepancy in color between high and normal-luminance displays, generally known as a hue shift. Accordingly, this paper models the hue-shift phenomenon and proposes a hue-correction method to provide perceptual matching between high and normal-luminance displays. The value of hue-shift is determined by perceived hue matching experiments. At first the phenomenon is observed at three lightness levels, that is, the ratio of luminance is the same between high and normal-luminance display when the perceived hue matching experiments we performed. To quantify the hue-shift phenomenon for the whole hue angle, color patches with the same lightness are first created and equally spaced inside the hue angle. These patches are then displayed one-by-one on both displays with the ratio of luminance between two displays. Next, the hue value for each patch appearing on the high-luminance display is adjusted by observers until the perceived hue for the patches on both displays appears the same visually. After obtaining the hue-shift values, these values are fit piecewise to allow shifted-hue amounts to be approximately determined for arbitrary hue values of pixels in a high-luminance display and then used for correction. Essentially, input RGB values of an image is converted to CIELAB values, and then, LCh (lightness, chroma, and hue) values are calculated to obtain the hue values for all the pixels. These hue values are shifted according to the amount calculated by the functions of the hue-shift model. Finally, the corrected CIELAB values are calculated from corrected hue values, after that, output RGB values for all pixels are estimated. For evaluation, an observer's preference test was performed with hue-shift results and Almost observers conclude that the images from hue-shift model were visually matched with images on normal luminance display.

The Characteristic and Implication of the View of Object in Oriental Medicine (한의학적(韓醫學的) 대상관(對象觀)의 특징과 성격)

  • Lee, Choong-Yeol
    • The Journal of Korean Medicine
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    • v.16 no.1 s.29
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    • pp.505-530
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    • 1995
  • Recently some people in learned circles of oriental medicine raised a Question about a terminological problem, i.e., 'oriental medical'. This question was thought as an attempt to find out the identity of oriental medicine which exists among the various current medical knowledge systems. In spite of same object, human body, there are diverse medical knowledge systems which has different concepts and theories. This come from the difference of a view of object which defines the experiences of that. The knowledge system of oriental medicine was established by the view of object in oriental medicine which depended on the way of thinking as Yin and Yang. The view of object in oriental medicine has come out in the special cultural soil, namely, the oriental world. Because of this the view of object in oriental medicine cannot be seperated from the oriental world view. What distintive feature does the oriental world view have? It can be summarized as the holistic, dynamical and organic ideas of the world. The term 'oriental medical' is being used to emphasize the characteristic and the peculiarity of the oriental medicine among the various medical knowledge systems. Can the current so called scientific method accept this peculiar and special method of oriental medicine? The efforts of philosophers who had been stimulated by the awful scientific achivements and had tried to find out the unified method penetrating through all the empirical science by mobilizing the logic and mathematics has became out of date for the raise of a question about the inductive method. On the contrary, the theses of theory-laden observation was accepted widely and the relativism was accepted as a new established theory. But the relativism has its own problem. The relativism was founded upon the concept, the incommensurability, which Khun and Feyerabend had proposed. This concept was criticized strongly by some of philosophers because of its own self-refuting. The view of object in oriental medicine has a relative characteristic in the aspect of its urge that in accordance with the perspective a different medical knowledge system can be possible. But our possible choice is the moderate conceptual relativism. Therefore if the view of object in oriental medicine includes the relative aspect, there is the 'conceptual relativity' between the knowledge system of oriental medicine and the western medicine. This preview an important aspect for the standardization and modernizing research of oriental medicine by lending the knowledge of the western medicine. And when we choose the moderate conceptual relativism, it means that we do not support the extreme relativism, that is, 'anything goes'. The concept of truth and rationality cannot be abandoned, and it plays the role of the norm on the knowledge system of oriental medicine and other knowledge systems of medicine in a limited meaning. And the view of object in oriental medicine has an organic view about the human body and the characteristic which wants to interpret the phenomena of human body by using the holistic method. But the availability of this method will be evaluated by the achievements of oriental medicine. Finally what relationship does the theory of oriental medicine have with the world the theory is applied to? It is recognized that the theory of oriental medicine has the instrumental characteristic. But it can be thought the instrumentalism is different from the oriental medical standpoint in the aspect that the instrumentalism seperates the theoretical existence from the observational existence sharply. Because in the oriental thinking way there is no seperation between the mind of observer and the object and no conflict between the idealism and the realism like the western world. For this problem there must be a further study.

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