• Title/Summary/Keyword: primary phase

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Laparoscopy Assisted versus Open Distal Gastrectomy with D2 Lymph Node Dissection for Advanced Gastric Cancer: Design and Rationale of a Phase II Randomized Controlled Multicenter Trial (COACT 1001)

  • Nam, Byung Ho;Kim, Young-Woo;Reim, Daniel;Eom, Bang Wool;Yu, Wan Sik;Park, Young Kyu;Ryu, Keun Won;Lee, Young Joon;Yoon, Hong Man;Lee, Jun Ho;Jeong, Oh;Jeong, Sang Ho;Lee, Sang Eok;Lee, Sang Ho;Yoon, Ki Young;Seo, Kyung Won;Chung, Ho Young;Kwon, Oh Kyoung;Kim, Tae Bong;Lee, Woon Ki;Park, Seong Heum;Sul, Ji-Young;Yang, Dae Hyun;Lee, Jong Seok
    • Journal of Gastric Cancer
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    • v.13 no.3
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    • pp.164-171
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    • 2013
  • Purpose: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. Materials and Methods: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopyassisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. Discussion: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).

Development of a predictive model describing the growth of Staphylococcus aureus in processed meat product galbitang (식육추출가공품 중 갈비탕에서의 Staphylococcus aureus 성장예측모델 개발)

  • Son, Na-Ry;Kim, An-Na;Choi, Won-Seok;Yoon, Sang-Hyun;Suh, Soo-Hwan;Joo, In-Sun;Kim, Soon-Han;Kwak, Hyo-Sun;Cho, Joon-Il
    • Korean Journal of Food Science and Technology
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    • v.49 no.3
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    • pp.274-278
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    • 2017
  • In this study, predictive mathematical models were developed to estimate the kinetics of Staphylococcus aureus growth in processed meat product galbitang. Processed meat product galbitang was inoculated with 0.1 mL of S. aureus culture and stored at 4, 10, 20, $37^{\circ}C$. The ${\mu}_{max}$ (maximum specific growth rate) and LPD (lag phase duration) values were calculated. The primary model was used to develop a response surface secondary model. The growth parameters were analyzed using the square root model as a function of storage temperature. The developed model was confirmed by calculating RMSE (Root Mean Square Error) values as statistic parameters. The LPD decreased, but ${\mu}_{max}$ increased with an increase in the storage temperature. At 4, 10, 20 and $37^{\circ}C$, $R^2$ was 0.99, 0.98, 0.99 and 0.99, respectively; RMSE was 0.39. The developed predictive growth model can be used to predict the risk of S. aureus contamination in processed meat product galbitang; hence, it has potential as an input model for the risk assessment.

Development of a 2-fluid Jet Mixer for Preventing the Sedimentation in Livestock Liquid Manure Storage Tank (가축분뇨액비저장조 침전물 퇴적 방지를 위한 2류체 제트노즐식 교반장치 개발에 관한 연구)

  • Yu, B.K.;Hong, J.T.;Kim, H.J.;Kweon, J.K.;Oh, K.Y.;Park, B.K.
    • Journal of Animal Environmental Science
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    • v.18 no.3
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    • pp.207-220
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    • 2012
  • There are around 7,500 manure tanks to treat the manures from pigs in Korea. In the tank, there are too much sediments deposited on the base and wall, which causes low efficiency of stock capacity and manure fermentation. In order to minimize sediments and to ferment manure effectively, we developed a 2-fluid jet mixer for mixing sediments in liquid livestock manure tank. For developing the prototype, we tested a factorial experimental system with various nozzles, and simulated CFD models with two kinds of nozzle arrangement. From the results of factorial experiment and CFD simulation, we concluded the dia. ratio of primary : secondary nozzle should be 1:2 and the nozzles should be arranged at the same distances toward to the circumferential direction. With this results, we manufactured a 2-fluid jet mixer which is consists of four 2-phase nozzles, centrifugal slurry pump and root's type air blower. And, we carried out the performance test of the prototype in the round shaped liquid manure tank in the farm. The performance test results showed that the uniformity of TS (Total Solid) and VS (Volatile Solid) was raised from 21.3 g/L, 13.3 g/L In steady state to TS and VS to 23.0 g/L, 14.1 g/L in the mixing operation. Therefore, we could conclude that the prototype of 2-fluid mixer could make the solid material which could be sediments in the tank not to be deposited in the tank and to be contacted to air bubbles which could enhance the efficiency of the fermentation of livestock manure.

Production and evaluation of raw materials for porcelain using clay mineral (점토 광물을 이용한 도자기용 소지 제조 및 물성 평가)

  • Kim, Jong-Young
    • Journal of the Korean Crystal Growth and Crystal Technology
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    • v.29 no.6
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    • pp.317-328
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    • 2019
  • In this work, we investigated clay and raw materials from China (black clay, red clay, white clay) and Korea (Cheonan clay, Obu clay) used for the manufacture of porcelain products. According to chemical analysis results, feldspar components containing CaO, K2O, Na2O and quartz are found in clay materials besides primary clay such as kaollinte, for the clay materials from Korea, which is found more in clay materials from Korea than from China. For the Fe2O3 content, governing whiteness of porcelain products, more iron oxide (> 5 %) is found in Korean clays (Cheonan clay, obu clay, red clay) compared to those form China (black, white clay). Through X-ray diffraction analysis, kaolinite and Halloysite are found to be main phases for all the raw materials and second phases such as quartz and pyrophyllite are found. Using these clay materials, raw materials for porcelain products were produced, and the physicochemical properties were investigated for sintered samples. Absorption rate is in order of Baekja-A < Baekja-B < Yeonbuncheong < Jinbuncheong < Cheongja, and the sample, sintered at 1250℃ in reductive atmosphere, exhibits the lowest absorption rate. Comparing the color of the sintered samples, the samples sintered in oxidative atmosphere (L* value: 86~95 %) show higher whiteness value than those sintered in reductive atmosphere (L* value: 81~93 %). For the Cheongja and Buncheong, the samples sintered in reductive atmosphre shows higher whiteness, L* values, and low a*/b* value, which is due to reduction of iron oxide (Fe2O3).

The Critical Factors on Improvement of Medical institution Competitiveness (의료기관 경쟁력 향상에 영향을 미치는 핵심 요인)

  • Yeom, Jae-Kwang;Kang, Chang-Yeol
    • Korea Journal of Hospital Management
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    • v.12 no.1
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    • pp.1-30
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    • 2007
  • The study carried out a survey with employees of hospitals located in Daejeon, Chungnam, and Chungbuk from Sep. 12 to Sep. 30, 2005 in order to derive primary elements that affect the improvement of hospital's competitiveness. The study investigated and analyzed the employees' recognition on the change of competitive environment caused by the change of medical environment. The study also analyzed the elements that affect the hospital's competitiveness and the competitive strategies of the hospitals. The conclusion of this study can be summarized as follows. 1. Summary 1) Most of the employees responded that there is a rival in the competitive environment and the competitive is intense. Especially when the employees are married, live in urban areas, have an education level of university graduate or are managers, they tend to think the competitive is very intense. Also, they said that the competitive is based upon the quality of medical service. They mentioned the element that has the biggest effect on the competitiveness is the element of medical consumer and they recognized that the medical services in university and general hospitals have more competitiveness than the one-department hospitals. 2) It was investigated that the medical technique service has the most effect on the hospital's competitiveness. Also, the external service of medical techniques also has a large effect on the hospital's competitiveness. 3) When they were asked for the factors that affect the patients' decision on selecting a hospital, most of them responded "capability and technique of the medical staffs." Also, they said that "sufficient explanation from doctors" and "special center and clinic" are the factors that have big effects on the patients' decision. 4) In the SWOT analysis, most of them responded that the strength is the hospital's characteristics and the weakness is insufficient and obsolete equipment. They said the opportunity is the demands for professional medical service and the risk is the intense competitive among the hospitals. 5) In the SWOT strategy, they emphasized the strategy that uses the opportunity and the strength and the strategy that uses the opportunity while overcoming the weakness. 6) As for the basic competition strategy, most of them thought of the strategy of professionalizing the medical service most importantly. Next, they focused on the strategy of distinct service and the strategy of lower prime cost. 2. Conclusion 1) Because service competition between hospitals is happening seriously, need competitiveness security through right awareness transfer and satisfaction upgrade about medical consumer. 2) For medical technique service upgrade that equip Hospital's competitiveness but affects most, must solidify the countermeasure because professionalizing the medical service and newest medical technique induction should be achieved first, and compose task force for the external service of medical techniques improvement. 3) To improve SWOT of hospital, opportunity and the strength strategy choice that rescue hospital's characteristics heightening professionalizing the medical service level is fancied. 4) As for the basic competition strategy, will have to try in phase triangular position of hospital which is trusted medical level upgrade and excellent manpower security and finance independence through upgrade. The study was only done with hospitals in Daejeon, Chungnam and Chungbuk. Also, it is a study from the side of suppliers of medical service so there are limitations. However, the significance of the study is to present the basic data for improvement of hospital's competitiveness by examining the importance of medical techniques and external service of medical techniques that are the main effects on the improvement of hospital's competitiveness.

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A Study on Curriculum Development For Community Health Practitioners (보건진료원 직무교육 교과과정 개선을 위한 일 연구)

  • 조원정;이경자
    • Journal of Korean Academy of Nursing
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    • v.22 no.2
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    • pp.207-226
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    • 1992
  • This study was designed to develop a conceptual framework for the curriculum and develop the details of the learning content for the education of Community Health Practitioners (CHPs). Since education programs for CHPs started 10 years ago, concepts related to CHP services have changed because of changes in society. The objectives of the study were as follows : 1) to analyse the usefulness of the present education program for CHPs, 2) to analyse the Job performance and self -confidence of the CHPs, 3) to identify the health needs of the clients served by the CHPs and the community problems related to health. 4) to develop a conceptual framework for the curriculum, for the education of CHPs, 5) to develops details for the learning content of the education program for CHPs. Phase I of the study was conducted by questionnaires to 150 CHPs who have worked in remote rural areas for more than 2 years. Among them, 147 responded. Data was collected from August 16, to August 25, 1990. In order to identify the health needs of the community people, research within the last five years was reviewed and analyzed. The data on 1, 842 communities gathered by the WHO Nursing Collaborations Center of the College of Nursing, Yonsei University was utilized to identify community problems related to health and the self - confidence in job performance of the CHPs. Psase II of the study consisted of a workshop with 13 professionals including Community Health Practitioners to evaluate the existing education program and a conceptual framework of the curriculum for the job education of CHPs. The results of the study are Summariged below : 1. The only 26 among 45 content items of the education program related to job skills was used by 80% of the responding CHPs. The knowledge of $\ulcorner$Networking community organization$\lrcorner$ was used by only 53.7% of the respondents. Educational content about $\ulcorner$Mental disease$\lrcorner$ was used by less than 50% of CHPs because of a knowledge deficit. 2. The CHPs reported that their activities concentrated on clinical services during the last six months. The survey showed that they seemed to neglect the activities for health promotion and disease prevention. Thus, $\ulcorner$Education for community loaders$\lrcorner$(15.9%), $\ulcorner$Activity for eavironmental health$\lrcorner$(16.3%) and $\ulcorner$Social work for needey people$\lrcorner$(23.3%) were done by less than 30% of CHPs. 3. More than 90% of CHPs reported being self - confident for the activities of $\ulcorner$Health education and counselling$\lrcorner$, $\ulcorner$Medicine prescription$\lrcorner$ and $\ulcorner$Immunization$\lrcorner$. But 50% of CHPs reported that they were not have self - confident in $\ulcorner$Management of water and environmental health$\lrcorner$ and only 25.6% of CHPs could insert an IUD independently. 4. It was identified that respiratory diseases and the gastrointestinal diseases were most common problems for the community people, followed by musculoskeletal and skin problems. 5. The community problems were classified into eight categories : physical environmental problems, environmental hygiene, health problems, health behavior, social problem, lack of resources, financial problem and the problems of the cultural and value system. 6. The conceptual framework consisted of the target population and their health status, nursing process working site and primary health care services such as health promotion, disease prevention, treatment and rehabilitation. 7. The contents of curriculum of education program for CHPs were formulated from the results of this study.

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Doses of Coronary Study in 64 Channel Multi-Detector Computed Tomography : Reduced Radiation Dose According to Varity of Examnination Protocols (64 채널 Multi-Detector Computed Tomography를 이용한 관상동맥검사의 선량 : 검사 프로토콜 다변화에 따른 환자선량 감소)

  • Kim, Moon-Chan
    • Journal of radiological science and technology
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    • v.32 no.3
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    • pp.299-306
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    • 2009
  • Purpose : To compare radiation dose for coronary CT angiography (CTA) obtained with 6 examination protocols such as a retrospectively ECG gated helical scan, a prospectively ECG gated sequential scan, low kVp technique, and cardiac dose modulation technique. Materials and Methods : Coronary CTA was performed by using 6 current clinical protocols to evaluate effective dose and organ dose in primary beam area with anthropomorphic female phantom and glass dosimetric system in 64 channel multi-detector CT. After acquiring topograms of frontal and lateral projection with 80 kVp and 10 mA, main coronary scan was done with 0.35 sec tube rotation time, 40 mm collimation ($0.625\;mm{\times}64\;ea$), small scan field of view (32 cm diameter), 105 mm scan length. Heart beat rate of phantom was maintained 60 bpm in ECG gating. In constant mAs technique 120 kVp, 600 mA was used, and 100 kVp for low kVp technique. In a retrospectively ECG gated helical CT technique 0.22 pitch was used, peak mA (600 mA) was adopted in range of $40{\sim}80%$ of R-R interval and 120mA(80% reduction) in others with cardiac dose modulation. And 210 mAs was used without cardiac dose modulation. In a prospectively ECG gated sequential CT technique data were acquired at 75% R-R interval (middle diastolic phase in cardiac cycle), and 120 msec additional padding of the tube-on time was used. For effective dose calculation region specific conversion factor of dose length product in thorax was used, which was recommended by EUR 16262. Results : The mean effective dose for conventional coronary CTA without cardiac dose modulation in a retrospectively ECG gated helical scan was 17.8 mSv, and mean organ dose of heart was 103.8 mGy. With low kVp and cardiac dose modulation the mean effective dose showed 54.5% reduction, and heart dose showed 52.3% reduction, compared with that of conventional coronary CTA. And at the sequential scan(SnapShot pulse mode) under prospective ECG gating the mean effective dose was 4.9 mSv, this represents an 72.5% reduction compared with that of conventional coronary CTA. And heart dose was 33.8 mGy, this represents 67.4% reduction. In the sequential scan technique under prospective ECG gating with low kVp the mean effective dose was 3.0 mSv, this represents an 83.2% reduction compared with that of conventional coronary CTA. And heart dose was 17.7 mGy, this represents an 82.9% reduction. Conclusion : In coronary CTA at retrospectively ECG gated helical scan, cardiac dose modulation technique using low kVp reduced dose to 50% above compared with the conventional helical scan. And the prospectively ECG gated sequential scan offers substantially reduced dose compared with the traditional retrospectively ECG gated helical scan.

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Increased Protein of the Secretory Leukocyte Pretense Inhibitor (SLPI) and the Expression of Growth Factors in NIH3T3 Cells by LPS Stimulation (NIH3T3 세포주에서 LPS자극에 의한 분비백혈구단백분해효소억제제 (SLPI)의 단백질증가와 성장인자들의 발현)

  • Lee, Sang-Hwa;Choi, Baik-Dong;Jeong, Soon-Jeong;Jang, Hyun-Seon;Kim, Byung-Ock;Lim, Do-Seon;Park, Joo-Cheol;Wang, Guan-Lin;Jeong, Moon-Jin
    • Applied Microscopy
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    • v.36 no.3
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    • pp.165-172
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    • 2006
  • Secretory leukocyte protease inhibitor (SLPI) involves tissue protection against the destructive action of neutrophil elastase at the site of inflammation. Several studies on new functions of SLPI have demonstrated that SLPI may play a primary role in innate immunity than protease inhibitor, To identify the function of SLPI by lipopolysaccharide (LPS) stimulation in the embryonic fibroblast (NIH3T3) cells. we studied the expression of SLPI compared to other growth factors involving the LPS treatment. To address this, we performed the reverse transcriptase polymerase chain reaction (RT-PCR) and Western blots for the detection of mRNA and protein expression of the SLPI and some growth factors such as VEGF. bFGF, and PDGF-BB after LPS stimulation. NIH3T3 cells were exposed 100 ng/mL Escherichia coli LPS for 30min, 60min, 90min, 24h, and 48h, respectively. The result of RT-PCR showed that SLPI and VEGF mRNA was expressed strongly in NIH3T3 without related to LPS stimulation. mRNA of bFGF was weakly expressed such as the expression of the control. PDGF mRNA expression gradually increased follows at time course. However, SLPI protein level was increased in lysates and culture medium by LPS stimulation. Phase contrast microscopic and scanning electron microscopic observation showed that the increased cell number and cytoplasmic enlargement of the NIH3T3 cells. Therefore, it suggests that the LPS upregulates SLPI expression in NIH3T3 cells. Moreover, secreted SLPI may stimulate cell proliferation and migration.

Mantle-derived CO2-fluid Inclusions in Peridotite Xenoliths from the Alkali Basalt, Jeju Island, South Korea (제주도 현무암에 포획된 페리도타이트에 산출되는 맨틀 기원의 CO2-유체포유물)

  • Seo, Minyoung;Woo, Yonghoon;Park, Geunyeong;Kim, Eunju;Lim, Hyoun Soo;Yang, Kyounghee
    • The Journal of the Petrological Society of Korea
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    • v.25 no.1
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    • pp.39-50
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    • 2016
  • Negative crystal shaped $CO_2$-rich fluid inclusions, trapped as primary inclusions in neoblasts and as secondary inclusions in porphyroblasts, were studied in spinel peridotite xenoliths from Jeju Island. Based on microthermometric experiments, the solid phase melts at $-57.1^{\circ}C$(${\pm}0.9^{\circ}C$) with no other observable melting events, indicating that the trapped fluid is mostly $CO_2$. The homogenization temperatures show a much wider range from $-39^{\circ}C$(${\rho}=1.12g/cm^{3)}$) to $23^{\circ}C$(${\rho}=0.82g/cm^{3)}$), suggesting that most of the inclusions (originally trapped at mantle conditions) re-equilibrated to lower density values. Nevertheless, the highest density $CO_2$ in our fluid inclusions is consistent with entrapment of fluids at upper mantle pressures (and depths). The calculated trapping pressure from $CO_2$-rich fluid inclusions that appear to be free from re-equilibrium, e.g., showing the lowest homogenization temperatures, is ${\approx}0.9GPa$. Based on the petrographic evidences, the fluid entrapment can be regarded as a late stage event in the evolution of the shallow lithospheric mantle.

Comparison of Three- and Four-dimensional Robotic Radiotherapy Treatment Plans for Lung Cancers (폐암환자의 종양추적 정위방사선치료를 위한 삼차원 및 사차원 방사선치료계획의 비교)

  • Chai, Gyu-Young;Lim, Young-Kyung;Kang, Ki-Mun;Jeong, Bae-Gwon;Ha, In-Bong;Park, Kyung-Bum;Jung, Jin-Myung;Kim, Dong-Wook
    • Radiation Oncology Journal
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    • v.28 no.4
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    • pp.238-248
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    • 2010
  • Purpose: To compare the dose distributions between three-dimensional (3D) and four-dimensional (4D) radiation treatment plans calculated by Ray-tracing or the Monte Carlo algorithm, and to highlight the difference of dose calculation between two algorithms for lung heterogeneity correction in lung cancers. Materials and Methods: Prospectively gated 4D CTs in seven patients were obtained with a Brilliance CT64-Channel scanner along with a respiratory bellows gating device. After 4D treatment planning with the Ray Tracing algorithm in Multiplan 3.5.1, a CyberKnife stereotactic radiotherapy planning system, 3D Ray Tracing, 3D and 4D Monte Carlo dose calculations were performed under the same beam conditions (same number, directions, monitor units of beams). The 3D plan was performed in a primary CT image setting corresponding to middle phase expiration (50%). Relative dose coverage, D95 of gross tumor volume and planning target volume, maximum doses of tumor, and the spinal cord were compared for each plan, taking into consideration the tumor location. Results: According to the Monte Carlo calculations, mean tumor volume coverage of the 4D plans was 4.4% higher than the 3D plans when tumors were located in the lower lobes of the lung, but were 4.6% lower when tumors were located in the upper lobes of the lung. Similarly, the D95 of 4D plans was 4.8% higher than 3D plans when tumors were located in the lower lobes of lung, but was 1.7% lower when tumors were located in the upper lobes of lung. This tendency was also observed at the maximum dose of the spinal cord. Lastly, a 30% reduction in the PTV volume coverage was observed for the Monte Carlo calculation compared with the Ray-tracing calculation. Conclusion: 3D and 4D robotic radiotherapy treatment plans for lung cancers were compared according to a dosimetric viewpoint for a tumor and the spinal cord. The difference of tumor dose distributions between 3D and 4D treatment plans was only significant when large tumor movement and deformation was suspected. Therefore, 4D treatment planning is only necessary for large tumor motion and deformation. However, a Monte Carlo calculation is always necessary, independent of tumor motion in the lung.