• 의료법학
• /
• 제13권1호
• /
• pp.125-153
• /
• 2012

The adult guardianship system has been introduced through amendments of Korean Civil Code for the first time in the March 2011(Act No. 10429, 7. 1. 2013. enforcement). The adult guardianship system has the main purposes to provide a lot of help vulnerable adults and elderly, and protect them on the welfare related with property act, treatment, care, etc. There could be a controversy about whether the protection Legal Guardian's consent(formerly known as the Mental Health Act) or permission of the Family Court(revised Civil Code) are required to, or the Mental Health Act should be revised, when mental patient will be hospitalized forcibly. The author proposes that mental patient with Adult guardians should be determined by Legal Guardian's consent and approval of the Family Court, but mental patient without Adult guardians could be determined by Legal Guardian's consent. The issue of Withdrawing of life-sustaining treatment could be occurred due to the aging society and the development of modern medicine, and this has provided difficult, various problems to mankind in Legal, ethical, and social welfare aspects. The need of Death with dignity law or Natural death law has been reduced for a revision of the Civil Code. Therefore, on the issue of Withdrawing of life-sustaining treatment, in the future, intervention of the court is necessary in accordance with the revised Civil Code Section, and Organ Transplantation Act and the brain death criteria may serve as an important criterion.

• Asian-Australasian Journal of Animal Sciences
• /
• 제23권1호
• /
• pp.74-81
• /
• 2010

The effects of different levels of natural clay enterosorbent on the growth, nutrient availability, and genital organs of post-weaning female pigs fed with an addition of zearalenone (ZEA) were investigated in the study. A total of thirty-five post-weaning gilts ($L{\times}Y{\times}D$) with an average body weight of 12.36${\pm}$1.46 kg were used in the test. The gilts were raised individually in metabolism cages and fed a corn-soybean meal-whey basal diet with an addition of 0 or 1 mg/kg of ZEA for 24 d with four levels of natural clay enterosorbent added in the feed. The treatments were: i) control; ii) control+2.5 g/kg clay; iii) control+1 mg/kg ZEA; iv) control+1 mg/kg ZEA+1.25 g/kg clay; v) control+1 mg/kg ZEA+2.5 g/kg clay; vi) control+1 mg/kg ZEA+5.0 g/kg clay; vii) control+1 mg/kg ZEA +10 g/kg clay. Pigs fed diets contaminated with additional purified ZEA had significantly reduced apparent digestibility of crude protein (CP), gross energy (GE) and apparent metabolic rate of GE (ME/GE, p<0.05) without changes of net protein utilization (NPU, p>0.05). Final body weight, average daily gain (ADG), average daily feed intake (ADFI), vulva length, vulva width, vulva area, relative weights of genital organ and proliferative changes of the ovary tissues in gilts fed ZEA-contaminated diet were increased (p<0.05) compared to the gilts fed the control diet. Addition of natural clay enterosorbent in the ZEA-contaminated diet showed a positive protection effect on ZEA feeding, and the protection was increased linearly or quadratically as clay content increased. However, in pigs fed a diet with clay alone at 2.5 g/kg level there was no significant impact (p>0.05) on all the parameters as compared to the control. It is suggested that feeding ZEA at about 1.0 mg/kg for 24 days might result in a deleterious effect in pigs, and addition of 5 or 10 g clay enterosorbent per kg diet can effectively neutralize the detrimental effects of the ZEA feeding.

• Journal of Radiation Protection and Research
• /
• 제31권4호
• /
• pp.165-171
• /
• 2006

국내에서는 현재 물리적 인형 모의피폭체와 수십 개의 소형 MOSFET 선량계를 이용하여 유효선량(Effective Dose)을 실시간으로 정확하게 측정할 수 있는 시스템을 개발 중에 있다. 이때 사용되는 MOSFET 선량계는 그 크기가 매우 작으며, 상대적으로 높은 민감도를 가지고 선량을 실시간으로 측정할 수 있다는 장점이 있는 반면, 검출부위가 조직등가 물질이 아닌 실리콘으로 이루어져 있어 저에너지 광자에 대하여 적절한 보정이 필요하다. 본 연구에서는 몬테칼로 전산모사 방법을 사용하여 증기발생기 수실 내부의 에너지 스펙트럼에 대한 MOSFET 선량계의 선량보정인자 값들을 계산하였으며, 이렇게 계산된 보정인자 값들을 선행 연구에서 구한 값, 즉 0.662 MeV와 1.25 MeV의 광자만을 이용하여 구한 선량보정인자 값들과 비교하여 보았다. 비교 결과, 두 서로 다른 조건에서의 선량보정인자들은 큰 차이를 보이지 않았으며$(\leq1.5%)$, 따라서 선행 연구에서 구한 선량보정인자들을 원자력발전소의 증기발생기 수실에 그대로 적용하여도 큰 문제가 없음을 알 수 있었다. 또한, 증기발생기 수실에 대하여 결정된 선량보정인자들을 실측된 MOSFET 선량계의 선량값들에 적용하여 선량보정에 따라 유효선량이 어느 정도 변화하는 가를 확인한 결과, 유효선량은 선량보정인자를 적용할 경우가 적용하지 않을 경우에 비해 약 7% 정도 낮게 평가됨을 알 수 있었다.

• Journal of Radiation Protection and Research
• /
• 제14권1호
• /
• pp.16-23
• /
• 1989

방사성 물질 체내 오염에 대한 진단에 필요한 기초 자료를 얻기 위하여 $^{85}SrCl_2\;1{\mu}Ci$를 NIH(GP) 마우스의 복강내 투여로 체내 오염시키고, $CaNa_3DTPA$ 8.4 mg, sodium alginate 5 mg 및 saline 5 ml등을 병행 투여로 응급 처치한 후 경과 시간에 따라 도살 부검하여 중요 장기 및 배설물의 방사능을 측정하였다. 그 결과 방사성 스트론튬에 대한 단기간의 유효 반감기는 33 시간으로 나타났으며 각 처치제의 배설효과는 $CaNa_3DTPA$가 4.7배, sodium alginate가 1.7배, 그리고 saline이 2.4배 이었다. 스트론튬 단독 투여군의 체내 축적은 척추(脊椎), 대퇴골(大腿骨), 흉골(胸骨), 간장(肝臟)의 순이었으며, 배설 경로는 요(尿) 35.4%, 변(便) 64.4% 및 기타 0.2%이었고, $CaNa_3DTPA$ 및 saline 투여군은 주로 뇨, 그리고 sodium alginate 투여군은 변(便)을 통하여 배설하였다. 이로부터 방사성 스트론튬 체내 오염에 대한 응급 처치는 $CaNa_3DTPA$, sodium alginate 및 saline등을 병행 투여함으로써 방사선 피폭을 경감시킬 것으로 사료 되었다.

• Journal of Radiation Protection and Research
• /
• 제27권3호
• /
• pp.155-164
• /
• 2002

몬테칼로 모사를 통해 여러 가지 진단X선 검사를 받는 성인의 유효선량을 평가하는 방법체계를 구축하였다. 피사체 인형팬텀으로서 MIRD5 남성 팬텀과 ORNL 여성팬텀이 이용되었고 사용 X선 스펙트럼은 SPEC78 코드로 생산하였다. 같은 진단절차에 대해 NRPB 평가결과와 비교함으로써 계산체계를 검증하였다. 계산체계를 이용하여 흉곽, 복부, 두부 및 척추의 진단에서 AP, PA, LLAT 및 RLAT 방향으로 입사하는 X선에 대한 장기 등가선량과 유효선량을 평가하였으며 가장 보편적인 흉곽 PA와 복부 AP의 경우 유효선량이 각각 0.029mSv와 0.44mSv로 나타났다. 흉곽 PA 1회 촬영 시 피폭하는 선량이 전통적 평가치인 0.3mSv(또는 30mrem)보다 매우 작게 나타나는 것은 진단방사선 기술의 발전뿐만 아니라 적용하는 선량개념의 차이에 기인하는 것으로서 여러 방사선 의료절차에 대한 집중적인 환자선량 평가의 필요성을 강조하는 것이다. 여기서 개발된 선량평가 체계는 CT 선량, 임부의 진단으로 인한 태아의 선량, 소아과 X선에 의한 선공 등 다른 방사선 의료절차에도 용이하게 응용될 수 있다.

• Journal of Radiation Protection and Research
• /
• 제26권4호
• /
• pp.417-424
• /
• 2001

세기 조절 방사선 치료 최적화 대상 함수로 이용하기 위하여 유사 생물학적 대상 함수를 고안하여, 그 가능성을 살펴보았다. 치료 계획 장치는 본 연구진이 개발한 RTP Tool Box(RTB)를 사용하였다. 수학적으로 생물학적 대상 함수와 비슷하나, 사용하는 상수들은 물리적인 인자를 사용한 유사 생물학적(Pseudo-biologic) 대상 함수를 도입하였다. 치료하고자 하는 표적에 대하여는 표적 포함인자(TCI, Target Coverage Index) 개념을 도입하였고, 정상 장기에 대해서는 조직성적 인자(OSI, Organ Score Index) 개념을 도입하였다. 또한 TCI와 OSI 개념을 사용하여 대상함수 S를 정의하였다. 어떤 종류의 대상 함수를 사용하든 표적 선량의 분포는 비슷한 추세를 보였으나, 유사 생물학적 대상 함수를 사용한 경우 정상 조직의 선량 분포가 물리적인 대상 함수를 사용한 치료 계획보다 낮게 나와 세기조절 방사선 치료의 대상 함수로 사용할 수 있음을 보였다.

• Journal of Radiation Protection and Research
• /
• 제44권3호
• /
• pp.103-109
• /
• 2019

Background: Four-dimensional computed tomographic (4DCT) images are increasingly used in clinic with the growing need to account for the respiratory motion of the patient during radiation treatment. One of the reason s that makes the dose evaluation using 4DCT inaccurate is a change of the patient respiration during the treatment session, i.e., intrafractional uncertainty. Especially, when the amplitude of the patient respiration is greater than the respiration range during the 4DCT acquisition, such an organ motion from the larger respiration is difficult to be represented with the 4DCT. In this paper, the method to generate images expecting the organ motion from a respiration with extended amplitude was proposed and examined. Materials and Methods: We propose a method to generate extra-phase images from a given set of the 4DCT images using deformable image registration (DIR) and linear extrapolation. Deformation vector fields (DVF) are calculated from the given set of images, then extrapolated according to respiratory surrogate. The extra-phase images are generated by applying the extrapolated DVFs to the existing 4DCT images. The proposed method was tested with the 4DCT of a physical 4D phantom. Results and Discussion: The tumor position in the generated extra-phase image was in a good agreement with that in the gold-standard image which is separately acquired, using the same 4DCT machine, with a larger range of respiration. It was also found that we can generate the best quality extra-phase image by using the maximum inhalation phase (T0) and maximum exhalation phase (T50) images for extrapolation. Conclusion: In the present study, a method to construct extra-phase images that represent expanded respiratory motion of the patient has been proposed and tested. The movement of organs from a larger respiration amplitude can be predicted by the proposed method. We believe the method may be utilized for realistic simulation of radiation therapy.

• Radiation Oncology Journal
• /
• 제34권4호
• /
• pp.313-321
• /
• 2016

Purpose: Total scalp irradiation (TSI) is a rare but challenging indication. We previously reported that non-coplanar intensity-modulated radiotherapy (IMRT) was superior to coplanar IMRT in organ-at-risk (OAR) protection and target dose distribution. This consecutive treatment planning study compared IMRT with volumetric-modulated arc therapy (VMAT). Materials and Methods: A retrospective treatment plan databank search was performed and 5 patient cases were randomly selected. Cranial imaging was restored from the initial planning computed tomography (CT) and target volumes and OAR were redelineated. For each patients, three treatment plans were calculated (coplanar/non-coplanar IMRT, VMAT; prescribed dose 50 Gy, single dose 2 Gy). Conformity, homogeneity and dose volume histograms were used for plan. Results: VMAT featured the lowest monitor units and the sharpest dose gradient (1.6 Gy/mm). Planning target volume (PTV) coverage and homogeneity was better in VMAT (coverage, 0.95; homogeneity index [HI], 0.118) compared to IMRT (coverage, 0.94; HI, 0.119) but coplanar IMRT produced the most conformal plans (conformity index [CI], 0.43). Minimum PTV dose range was 66.8%-88.4% in coplanar, 77.5%-88.2% in non-coplanar IMRT and 82.8%-90.3% in VMAT. Mean dose to the brain, brain stem, optic system (maximum dose) and lenses were 18.6, 13.2, 9.1, and 5.2 Gy for VMAT, 21.9, 13.4, 14.5, and 6.3 Gy for non-coplanar and 22.8, 16.5, 11.5, and 5.9 Gy for coplanar IMRT. Maximum optic chiasm dose was 7.7, 8.4, and 11.1 Gy (non-coplanar IMRT, VMAT, and coplanar IMRT). Conclusion: Target coverage, homogeneity and OAR protection, was slightly superior in VMAT plans which also produced the sharpest dose gradient towards healthy tissue.

• Journal of Radiation Protection and Research
• /
• 제22권1호
• /
• pp.47-58
• /
• 1997

MCNP4A 코드를 이용하여 MIRD 인형팬텀의 정면과 후방에서 입사하는 넓고 평행한 감마선빔에 대한 단위 공기커마당 유효선량 환산계수와 단위 플르언스당 장기의 등가선량을 계산하였다. 본 연구에서 고려한 감마선은 0.03-10 MeV 에너지 구간에서 20개의 단일에너지에 대해 수행되었다. 환산계수의 계산결과를 ICRP/ICRU의 연구결과 발표예정 출판물에 주어진 해당되는 값과 비교한 결과 편차 10%이내에서 일치하고 있다. 결과의 차이가 발생한 이유는 MIRD 팬텀과 ADAM/EVE 팬텀의 기하학적 차이가 주원인이며 또한 계산에 사용된 전산코드와 단면적 차이 등으로 판단된다. 특정 식도 모델을 사용한 결과로부터 얻어진 유효선량과 흉선과 췌장에 대한 등가선량을 채택함으로써 얻어지는 유효선량은 약간(최고 5%)의 차이를 보인다. 기타장기로부터 상부대장을 제외했을 때 본 연구에서 다루었던 감마선 선량학적 측면의 경우에서는 중요하지 않은 것으로 나타났다.

• Journal of Radiation Protection and Research
• /
• 제40권3호
• /
• pp.147-154
• /
• 2015

The scatter photons and photoneutrons from high energy photon beams (more than 10 MV) will increase the undesired dose to the patient and the staff working in linear accelerator room. This undesired dose which is found at out-of-field area can increase the probability of secondary malignancy. The purpose of this study is to determine the equivalent dose of scatter photons and neutrons generated by 3 different treatment techniques: 3D-conformal, intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). The measurement was performed using two types of the optically stimulation luminescence detectors (OSL and OSLN) in the Alderson Rando phantom that was irradiated by 3 different treatment techniques following the actual prostate cancer treatment plans. The scatter photon and neutron equivalent dose were compared among the 3 treatments techniques at the surface in the out-of-field area and the critical organs. Maximum equivalent dose of scatter photons and neutrons was found when using the IMRT technique. The scatter neutrons showed average equivalent doses of 0.26, 0.63 and $0.31mSv{\cdot}Gy^{-1}$ at abdominal surface region which was 20 cm from isocenter for 3D, IMRT and VMAT, respectively. The scattered photons equivalent doses were 6.94, 10.17 and $6.56mSv{\cdot}Gy^{-1}$ for 3D, IMRT and VMAT, respectively. For the 5 organ dose measurements, the scattered neutron and photon equivalent doses in out of field from the IMRT plan were highest. The result revealed that the scatter equivalent doses for neutron and photon were higher for IMRT. So the suitable treatment techniques should be selected to benefit the patient and the treatment room staff.