• Radiation Oncology Journal
• /
• 제36권1호
• /
• pp.79-84
• /
• 2018

Deep inspiration breathing hold (DIBH) compared to free-breathing (FB) during radiotherapy (RT) has significantly decreased radiation dose to heart and has been one of the techniques adopted for patients with breast cancer. However, patients who are unable to make suitable deep inspiration breath may not be eligible for DIBH, yet still need to spare the heart and lung during breast cancer RT (left-sided RT in particular). Continuous positive airway pressure (CPAP) is a positive airway pressure ventilator, which keeps the airways continuously open and subsequently inflates the thorax resembling thoracic changes from DIBH. In this report, authors applied CPAP instead of FB during left-sided breast cancer RT including internal mammary node in a patient who was unable to tolerate DIBH, and substantially decreased radiation dose the heart and lung with CPAP compared to FB.

• 한국의학물리학회지:의학물리
• /
• 제30권4호
• /
• pp.155-159
• /
• 2019

Radiological properties of newly introduced and existing 3-dimensional (3D) printing materials were evaluated by measuring their Hounsfield units (HUs) at varying infill densities. The six materials for 3D printing which consisted of acrylonitrile butadiene styrene (ABS), a unique ABS plastic blend manufactured by Zortrax (ULTRAT), high impact polystyrene (HIPS), polyethylene terephthalate glycol (PETG), polylactic acid (PLA), and a thermoplastic polyester elastomer manufactured by Zortrax (FLEX) were used. We used computed tomography (CT) imaging to determine the HU values of each material, and thus assess its suitability for various applications in radiation oncology. We found that several material and infill density combinations resembled the HU values of fat, soft tissues, and lungs; however, none of the tested materials exhibited HU values similar to that of bone. These results will help researchers and clinicians develop more appropriate instruments for improving the quality of radiation therapy. Using optimized infill densities will help improve the quality of radiation therapy by producing customized instruments for each field of radiation therapy.

• 한국간담췌외과학회지
• /
• 제28권1호
• /
• pp.99-103
• /
• 2024

Pancreatic resections, depending on the location of the tumor, usually require division of the vasculature of either the distal or proximal part of the stomach. In certain situations, such as total pancreatectomy and/or with splenic vein occlusion, viability of the stomach may be threatened due to inadequate venous drainage. We discuss three cases of complex pancreatic surgeries performed for carcinoma of the pancreas at a tertiary care center in India, wherein the stomach was salvaged by reimplanting the veins in two patients and preserving the only draining collateral in one case after the gastric venous drainage was compromised. The perioperative and postoperative course in these patients and the complications were analyzed. None of these 3 patients developed any complication related to gastric venous congestion, and additional gastrectomy was avoided in all these patients. Re-establishment of the Gastric venous outflow after extensive pancreatic resections helps to avoid additional gastric resection secondary to venous congestive changes.

• Journal of Korean Neurosurgical Society
• /
• 제54권6호
• /
• pp.528-531
• /
• 2013

We report a case of infantile fibrosarcoma in an 8-month-old boy manifested as a right-sided lower leg mass. Repeated local recurrence and distant metastasis were noted during the following three-year period. Whole body fluoro-deoxyglucose positron emission tomography scan revealed an asymptomatic metastasis involving the fourth lumbar vertebrae. The patient received chemotherapy (VAC regimen) with Cyberknife$^{(R)}$ stereotactic hypofractionated radiotherapy (26 Gy; 4 fractions). This treatment reduced tumor size by 23% without acute radiation toxicity even after 33 months. This case suggests that combining chemotherapy and this form of radiotherapy may be safe and effective against childhood spinal metastasis.

• Radiation Oncology Journal
• /
• 제37권4호
• /
• pp.249-253
• /
• 2019

Purpose: We aimed to analyze the trend in intensity-modulated radiation therapy (IMRT) use in Korea from 2011 to 2018. Materials and Methods: We collected data from the Health and Insurance Review and Assessment Service (HIRA) big data based on the National Health Insurance Service claims and reimbursements records using primary treatment planning codes (HD 041) for IMRT from 2011 to 2018. We analyzed the changing patterns in clinical application to specific tumor sites and regional differences in IMRT utilization. Results: The use of IMRT has exhibited an 18-fold steep rise from 1,921 patients in 2011 to 34,759 in 2018. With regard to IMRT in 2018, 70% of patients (24,248/34,759) were treated in metropolitan areas (Seoul, Incheon, and Gyeonggi Province). IMRT was most commonly used to treat breast, lung, and prostate cancers in 2018. Among these, the use of IMRT for breast cancer shows the most remarkable increase from 2016 when the National Health Insurance began to cover IMRT for all solid tumors. Conclusion: The use of IMRT is steadily increasing to treat cancer and is concentrated in metropolitan areas.

• Radiation Oncology Journal
• /
• 제15권2호
• /
• pp.167-174
• /
• 1997

목적 : 치료방사선과 의료서비스에 투입된 자원을 토대로 의료서비스별 원가를 산정하여 적절한 수가수준을 알아보고자 본 연구를 시행하였다. 대상 및 방법 : 현행 '의료보험요양급여기준 및 진료수가기준(95년 12월판)'을 검토후 적절치 못한 수가항목을 재조정하고 이를 토대로 원가조사표를 개발한 후 40개병원을 대상으로 조사를 실시하여 의뢰하여 적절한 자료가 수집된 24개 병원의 자료를 분석하였다. 원가자료는 1995년도 1년간 발생한 비용자료로서 의료서비스별 원가를 산출후 의료장비의 가동률에 근거한 조정원가를 계산하였다. 현행 보험수가와의 비교를 위하여 3차병원 가산율 30%를 적용한 후 이를 본연구 결과로 산출된 조정원가와 비교하였다. 결과 : 의료서비스별 추정원가 및 조정원가를 산출한 후 이를 현행 보험수가와 비교한 결과 방사선치료계획의 경우 5.05배-6.58배, 차폐물제작은 2.22배, 체외조사는 1.57배-2.86배, 강내치료 및 조직내치료는 3.82배-5.01배, 전신조사는 1.12배-2.55배씩 조정원가에 비하여 현행 보험수가가 낮은 가격을 보이는 것으로 나타났다. 또한 현행 진료수가기준의 진료행위 분류체계는 각 진료행위의 원가를 적절히 반영하기에는 부적절하다고 판단되며 전신조사의 경우 적절한 재분류 시약 5배의 수가 차이를 보이는 것으로 생각된다. 결론 :치료방사선과의 현행 의료보험수가제도에서의 문제점은 보험수가의 수준이 낮다는 점과 진료행위 분류체계가 부적절하게 되어있다는 점이다. 향후 수가 책정시 이러한 문제점이 적절히 반영, 해결되도록 하여야 할 것으로 판단된다.

• Radiation Oncology Journal
• /
• 제34권2호
• /
• pp.81-87
• /
• 2016

Hypofractionated whole breast irradiation (HF-WBI) has been proved effective and safe and even better for late or acute radiation toxicity for early breast cancer. Moreover, it improves patient convenience, quality of life and is expected to be advantageous in the medical care system by reducing overall cost. In this review, we examined key randomized trials of HF-WBI, focusing on adequate patient selection as suggested by the American Society of Therapeutic Radiology and Oncology (ASTRO) guideline and the radiobiologic aspects of HF-WBI in relation to its adoption into clinical settings. Further investigation to identify the current practice pattern or cost effectiveness is warranted under the national health insurance service system in Korea.

• 정신신체의학
• /
• 제25권1호
• /
• pp.56-62
• /
• 2017

Objectives : The objective of this study was to investigate the relationship between psychological distress and pain in cancer patients. Methods : 249 patients with cancer who visited National Health Insurance Service Ilsan Hospital between April 2013 and March 2014 were evaluated with National Cancer Center Psychological Symptom Inventory(NCC-PSI) which consisted of Modified Distress Thermometer(MDT) and Modified Impact Thermometer(MIT). Each scale was divided into 3 subscales targeting separate symptoms: insomnia, anxiety, and depression. Psychological distress was defined as positive for those who scored above the cutoff values in at least one of all six subscales. The Numeric Rating Scale for Pain(NRS-Pain) was used to assess the subjective severity of pain. Logistic regression was performed to investigate the association between psychological distress and pain. Results : Univariate logistic regression analysis showed that pain, gender, compliance, and two subscale scores of Hospital Anxiety and Depression Scale(HADS) were significantly associated with psychological distress. Multivariate logistic regression analysis showed that pain and HADS anxiety subscale score maintained a statistically significant association with psychological distress adjusted for variables including age, gender, years of education, Eastern Cooperative Oncology Group performance status, cancer stage, Charlson Comorbidity Index, compliance, and HADS depression subscale score. One point increase in pain was 1.31 times more likely to cause psychological distress. In secondary analysis, pain was significantly associated with all subscales of NCC-PSI, except MIT-anxiety subscale. Conclusions : This study suggests that NCC-PSI, a screening tool for psychological distress, reflects pain. We recommend that physicians who treat cancer patients consider the examination of psychological distress which provides comprehensive evaluation of various factors regarding quality of life.

• 한국의학물리학회지:의학물리
• /
• 제29권4호
• /
• pp.164-172
• /
• 2018

We evaluated the performance of various detectors for small-field dosimetry with field sizes defined by a high-definition (HD) multileaf collimator (MLC) system. For small-field dosimetry, diodes referred to as "RAZOR detectors," MOSFET detectors, and Gafchromic EBT3 films were used in this study. For field sizes less than $1{\times}1cm^2$, percent depth doses (PDDs) and lateral profiles were measured by diodes, MOSFET detectors, and films, and absolute dosimetry measurements were conducted with MOSFET detectors. For comparison purposes, the same measurements were carried out with a field size of $10{\times}10cm^2$. The dose distributions were calculated by the treatment planning system Eclipse. A comparison of the measurements with calculations yielded the percentage differences. With field sizes less than $1{\times}1cm^2$, it was shown that most of the percentage difference values were within 5% for 6-MV and 15-MV photon beams with the use of diodes. The measured lateral profiles were well matched with those calculated by Eclipse as the field sizes increased. Except for the depths of 0.5 cm and 20 cm, there was agreement in terms of the absolute dosimetry within 10% when MOSFET detectors were used. There was good agreement between the calculations and measurements conducted using diodes and EBT films. Both diode detectors and EBT3 films were found to be appropriate options for relative measurements of PDDs and for lateral profiles.

• 한국간담췌외과학회지
• /
• 제27권2호
• /
• pp.180-188
• /
• 2023

Backgrounds/Aims: The present study looked at the role of radical surgery in gallbladder cancers (GBC) with limited metastatic disease. Methods: The retrospective observational study was conducted to screen the database from 1st January 2010 to 31st December 2019. Patients of GBC found to have low-volume metastatic disease upon surgical exploration were included. Results: Of the 1,040 patients operated for GBC, 234 patients had low-volume metastatic disease (microscopic disease in station 16b1 node or N2 disease isolated port-site metastases, or low burden peritoneal disease with deposits less than 1 cm, in adjacent omentum or adjacent diaphragm or Morrison's pouch or a solitary discontinuous liver metastasis in adjacent liver parenchyma) detected intraoperative. Of these, 62 patients underwent radical surgery for R-0 metastatic disease followed by systemic therapy, while the remaining 172 patients did not undergo radical surgery and were given palliative systemic chemotherapy. Patients who underwent radical surgery had significantly superior overall survival (19 months versus 12 months, p < 0.01) and superior progression-free survival (10 months versus 5 months, p < 0.01) when compared to the rest. This difference in survival was more significant amongst patients when operated on after neoadjuvant chemotherapy. Regression analysis showed that a sub-group of patients with incidental GBC with limited metastases showed more favorable outcomes with radical surgery. Conclusions: Authors suggest a possible role for radical treatment of advanced GBC with a limited metastatic burden. Neoadjuvant chemotherapy can be used for preferentially selecting patients of favorable disease biology for curative treatment.