• Radiation Oncology Journal
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• v.35 no.4
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• pp.368-379
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• 2017

Purpose: The purpose of this study was to explore the dosimetric difference between simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) and three-dimensional conformal radiotherapy (3DCRT), and the clinical outcomes of anal squamous cell carcinoma (ASCC) chemoradiotherapy featuring SIB-IMRT. Materials and Methods: This study included ten patients with ASCC who underwent chemoradiotherapy using SIB-IMRT with 5-fluorouracil and mitomycin C. SIB-IMRT delivered 54 Gy to each primary tumor plus metastatic lymph nodes and 45 Gy to regional lymph nodes, in 30 fractions. Four patients received additional boosts to the primary tumors and metastatic lymph nodes; the median total dose was 54 Gy (range, 54 to 60 Gy). We additionally created 3DCRT plans following the Radiation Therapy Oncology Group 9811 protocol to allow dosimetric comparisons with SIB-IMRT. Locoregional control, overall survival, and toxicity were calculated for the clinical outcome evaluation. Results: Compared to 3DCRT, SIB-IMRT significantly reduced doses to the external genitalia, bladder, and intestine, delivering the doses to target and elective nodal region. At a median follow-up time of 46 months, 3-year locoregional control and overall survival rates were 88.9% and 100%, respectively. Acute toxicities were treated conservatively. All patients completed radiotherapy with brief interruptions (range, 0 to 2 days). No patient experienced ${\geq}grade$ 3 late toxicity during the follow-up period. Conclusion: The dosimetric advantages of SIB-IMRT appeared to reduce the toxicity of chemoradiotherapy for ASCC achieving high locoregional control in the extended period.

• Journal of the Korean Society of Radiology
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• v.10 no.3
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• pp.215-222
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• 2016

X-ray mammography is the most effective method for the diagnosis of calcified lesions of various breast diseases. To reduce patient dose and to obtain optimal image required for diagnosis, the performance of the mammography system should be maintained continuously. Because the target (anode) angle of the X-ray tube is measured from the central X-ray, the effective angle can be slightly different in view of the position on the detector, which can result in degrading spatial resolution of the imaging within the field of view. In this study, we measured the MTF to examine spatial resolution for positions on the detector in the digital mammography system. For a tungsten wire of $50{\mu}m$ diameter, the highest spatial frequency was obtained. It meant that a wire diameter for measuring MTF through LSF should be small compared to the pixel size of the detector used in the mammography system. The spatial resolution showed slightly different performance according to positions on the detector. The center position gave the best spatial resolution and positions away from the center showed the degraded performance although the difference of the spatial resolution was small. The effective focal spot size of the full width at half maximum also showed similar result. It concluded that the slightly increase of the effective focal spot size gave the degradation of the spatial resolution for positions on the detector.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.9-15
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• 2003

Purpose: To introduce our early experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma. Methods and Materials: Eight patients who underwent IMRT for no disseminated nasopharyngeal carcinoma at the Asan Medical Center between September 2001 and November 2002 were evaluate by prospective analysis. According to the 1997 American Joint Committee on Cancer staging classification, 5 had Stage III, and 3 had Stage IVB disease. The IMRT plans were designed to be delivered as a 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) using the 'step and shoot' technique with a MLC (multileaf collimator). Daily fractions of 2.2-2.5Gy and 1.9-2Gy were prescribed and delivered to the GTV and CTV and clinically negative neck node, respectively. The prescribed dose was 70A-79.0Gy to the gross tumor volume (GTV), 60Gy to the clinical target volume (CTV) and metastatic nodal station, and 46Gy to the clinically negative neck. All patients also received weekly cisplatin during radiotherapy. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Results: Follow-up period was ranging from 5 to 18 months. All patients showed complete response and loco-regional control rate was 100% but one patient died of malnutrition due to treatment related toxicity. There were no Grade 3 or 4 xerostomia and all patients had experienced improvement of salivary gland function. Conclusion: 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) boost intensity-modulated radiotherapy technique allows parotid sparing as evidenced both clinically and by dosimetry. Initial tumor response and loco-regional control was promising. It is clinically feasible. A larger population of patients and a long-term follow-up are needed to evaluate ultimate tumor control and late toxicity.

• Journal of the Korean Society of Radiology
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• v.14 no.7
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• pp.1003-1011
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• 2020

This study aims to compare and evaluate the image differences between single and dual sources in applying a technique to reduce metal artifacts using dual energy CT. Discovery CT 256 (GE, USA) as a single source device and Somatom Definition Flash (Siemens Health Care, Forchheim, Germany) as a dual source device. The self-made phantom (pigs with medical titanium screws inserted) was quantitative and qualitatively evaluated under the same conditions by varying the dose under the same conditions using a dual energy CT. The evaluation method was compared by measuring SNR for metal artifacts (scattering, stripe) generated by metal inserts, divided around bones and around tissues. There was a difference in images in the method of reducing metal artifacts between single-source and dual-source devices. In a single source device, the linearized prosthesis by metal implantation showed a greater decrease than the image obtained from a double source device, and the surrounding tissue was well observed without interference from the artifact. In dual-source devices, scattering and stripe artifacts caused by metal inserts decreased more than on a single source device, and signals from adjacent tissues surrounding the metal implant were well observed without diminishing. If the examination is conducted separately between single source and dual source devices depending on whether the area to which the patient is intended to be viewed during the examination is adjacent to the metal insert or the total tissue surrounding the metal insert, it is believed that diagnostic helpful images can be obtained.

• Korean Journal of Clinical Laboratory Science
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• v.52 no.4
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• pp.317-326
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• 2020

Deep blocking of consciousness alone does not prevent a reaction to severe stimuli, and copious amounts of pain medication do not guarantee unconsciousness. Therefore, anesthesia must satisfy both: the loss of consciousness as well as muscle relaxation. Muscle relaxants improve the intra-bronchial intubation, surgical field of vision, and operating conditions, while simultaneously reducing the dose of inhalation or intravenous anesthesia. Muscle relaxants are also very important for breathing management during controlled mechanical ventilation during surgery. Excessive dosage of such muscle relaxants may therefore affect neurological examinations during surgery, but an insufficient dosage will result in movement of the patient during the procedure. Hence, muscle relaxation anesthesia depth and neurophysiological monitoring during surgery are closely related. Using excessive muscle relaxants is disadvantageous, since neurophysiological examinations during surgery could be hindered, and eliminating the effects of complete muscle relaxation after surgery is challenging. In the operation of neurophysiological monitoring during the operation, the anesthesiologist administers muscle relaxant based on what standard, it is hoped that the examination will be performed more smoothly by examining the trends in the world as well as domestic and global trends in maintaining muscle relaxant.

• Journal of the Korean Society of Radiology
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• v.17 no.1
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• pp.25-30
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• 2023

As 3D printing technology is used in the medical field, interest in metal materials is increasing. The Department of Radiation Oncology uses a shielding block to shield the patient's normal tissue from unnecessary exposure during electron beam therapy. However, problems such as handling of heavy metal materials such as lead and cadmium, reproducibility according to skill level and uncertainty of arrangement have been reported. In this study, candidate materials that can be used for metal 3D printing are selected, and the physical properties and radiation dose of each material are analyzed to develop a customized shielding block that can be used in electron beam therapy. As candidate materials, aluminum alloy (d = 2.68 g/cm³), titanium alloy (d = 4.42 g/cm³), and cobalt chromium alloy (d = 8.3 g/cm³) were selected. The thickness of the 95% shielding rate point was derived using the Monte Carlo Simulation with the irradiation surface and 6, 9, 12, and 16 energies. As a result of the simulation, among the metal 3D printing materials, cobalt chromium alloy (d = 8.3 g/cm³) was similar to the existing shielding block (d = 9.4 g/cm³) in shielding thickness for each energy. In a follow-on study, it is necessary to evaluate the usefulness in clinical practice using customized shielding blocks made by metal 3D printing and to verify experiments through various radiation treatment plan conditions.

• Korean Journal of Clinical Pharmacy
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• v.32 no.3
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• pp.215-225
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• 2022

Background: Patients with hematologic cancers have a risk of drug-related problems (DRPs) from medications associated with chemotherapy and supportive care. Although the role of oncology pharmacists has been widely documented in the literature, few studies have reported its impact on cost reduction. This study aimed to describe the activities of oncology pharmacists with respect to hematologic diseases and evaluate the associated cost avoidance. Methods: From January to July 2021, patients admitted to the department of hemato-oncology at Seoul National University, Bundang Hospital were studied. The activities of oncology pharmacists were reported by DRP type following the Pharmaceutical Care Network version 9.1 guidelines, and the acceptance rate was calculated. The avoided cost was estimated based on the cost of the pharmacy intervention, pharmacist manpower, and prescriptions associated with the intervention. Results: Pharmacists intervened in 584 prescriptions from 208 patients during the study period. The most prevalent DRP was "adverse drug event (possibly) occurring" (32.4%), followed by "effect of drug treatment not optimal" (28.6%). "Drug selection" (42.5%) and "dose selection" (30.3%) were the most common causes of DRPs. The acceptance rate of the interventions was 97.1%. The total avoidance cost was KRW 149,468,321; the net profit of the avoidance cost, excluding labor costs, was KRW 121,051,690; and the estimated cost saving was KRW 37,223,748. Conclusion: Oncology pharmacists identified and resolved various types of DRPs from prescriptions for patients with hematologic disease, by reviewing the prescriptions. Their clinical service contributed to enhanced patient safety and the avoidance of associated costs.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.285-295
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• 2023

With the development of technology, efforts to reduce the exposure dose received by patients in CT scans are continuing with the development of new reconstruction techniques. Recently, deep learning reconstruction techniques have been developed to overcome the limitations of repetitive reconstruction techniques. This study aims to evaluate the usefulness of images according to reconstruction techniques in pediatric chest CT images. Patient study conducted a study on 85 pediatric patients who underwent chest CT scan at P-Hospital in Gyeongsangnam-do from January 1, 2021 to December 31, 2022. The phantom used in the Phantom Study is the Pediatrics Whole Body Phantom PBU-70. After the test, the images were reconstructed with FBP, ASIR-V (50%) and DLIR (TF-Medium, High), and the images were evaluated by obtaining SNR and CNR values by setting ROI of the same size. As a result, TF-H of deep learning reconstruction techniques had the lowest noise value compared to ASIR-V (50%) and TF-M in all experiments, and SNR and CNR had the highest values. In pediatric chest CT scans, TF images with deep learning reconstruction techniques were less noisy than ASiR-V images with adaptive statistical iterative reconstruction techniques, CNR and SNR were higher, and the quality of images was improved compared to conventional reconstruction techniques.

• Korean Journal of Radiology
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• v.24 no.6
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• pp.529-540
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• 2023

Objective: To compare the diagnostic performance and clinical outcomes of 2-mSv computed tomography (CT) and conventional-dose CT (CDCT), following radiology residents' interpretation of CT examinations for suspected appendicitis. Materials and Methods: Altogether, 3074 patients with suspected appendicitis aged 15-44 years (28 ± 9 years, 1672 females) from 20 hospitals were randomly assigned to the 2-mSv CT (n = 1535) or CDCT (n = 1539) groups in a pragmatic trial from December 2013 and August 2016. Overall, 107 radiology residents participated in the trial as readers in the form of daily practice after online training for 2-mSv CT. They made preliminary CT reports, which were later finalized by attending radiologists via addendum reports, for 640 and 657 patients in the 2-mSv CT and CDCT groups, respectively. We compared the diagnostic performance of the residents, discrepancies between preliminary and addendum reports, and clinical outcomes between the two groups. Results: Patient characteristics were similar between the 640 and 657 patients. Residents' diagnostic performance was not significantly different between the 2-mSv CT and CDCT groups, with a sensitivity of 96.0% and 97.1%, respectively (difference [95% confidence interval {CI}], -1.1% [-4.9%, 2.6%]; P = 0.69) and specificity of 93.2% and 93.1%, respectively (0.1% [-3.6%, 3.7%]; P > 0.99). The 2-mSv CT and CDCT groups did not significantly differ in discrepancies between the preliminary and addendum reports regarding the presence of appendicitis (3.3% vs. 5.2%; -1.9% [-4.2%, 0.4%]; P = 0.12) and alternative diagnosis (5.5% vs. 6.4%; -0.9% [-3.6%, 1.8%]; P = 0.56). The rates of perforated appendicitis (12.0% vs. 12.6%; -0.6% [-4.3%, 3.1%]; P = 0.81) and negative appendectomies (1.9% vs. 1.1%; 0.8% [-0.7%, 2.3%]; P = 0.33) were not significantly different between the two groups. Conclusion: Diagnostic performance and clinical outcomes were not significantly different between the 2-mSv CT and CDCT groups following radiology residents' CT readings for suspected appendicitis.

• Korean Journal of Radiology
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• v.25 no.5
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• pp.481-492
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• 2024

Objective: To evaluate the clinical and imaging characteristics of SARS-CoV-2 breakthrough infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. Materials and Methods: This retrospective study analyzed consecutive adult patients hospitalized for COVID-19 who received at least one dose of the SARS-CoV-2 vaccine at two academic medical centers between June 2021 and December 2022. Immunocompromised patients (with active solid organ cancer, active hematologic cancer, active immune-mediated inflammatory disease, status post solid organ transplantation, or acquired immune deficiency syndrome) were compared with immunocompetent patients. Multivariable logistic regression analysis was performed to evaluate the effect of immune status on severe clinical outcomes (in-hospital death, mechanical ventilation, or intensive care unit admission), severe radiologic pneumonia (≥ 25% of lung involvement), and typical CT pneumonia. Results: Of 2218 patients (mean age, 69.5 ± 16.1 years), 274 (12.4%), and 1944 (87.6%) were immunocompromised an immunocompetent, respectively. Patients with active solid organ cancer and patients status post solid organ transplantation had significantly higher risks for severe clinical outcomes (adjusted odds ratio = 1.58 [95% confidence interval {CI}, 1.01-2.47], P = 0.042; and 3.12 [95% CI, 1.47-6.60], P = 0.003, respectively). Patient status post solid organ transplantation and patients with active hematologic cancer were associated with increased risks for severe pneumonia based on chest radiographs (2.96 [95% CI, 1.54-5.67], P = 0.001; and 2.87 [95% CI, 1.50-5.49], P = 0.001, respectively) and for typical CT pneumonia (9.03 [95% CI, 2.49-32.66], P < 0.001; and 4.18 [95% CI, 1.70-10.25], P = 0.002, respectively). Conclusion: Immunocompromised patients with COVID-19 breakthrough infection showed an increased risk of severe clinical outcome, severe pneumonia based on chest radiographs, and typical CT pneumonia. In particular, patients status post solid organ transplantation was specifically found to be associated with a higher risk of all three outcomes than hospitalized immunocompetent patients.