• Title/Summary/Keyword: reliable

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Lung Uptake of $^{99m}Tc-sestamibi$ during Routine Gated Exercise SPECT Imaging : Comparison with Left Ventricular Ejection Fraction and Severity of Perfusion Defect (일상적인 운동 부하 게이트 심근 관류 SPECT에서 $^{99m}Tc-sestamibi$ 폐섭취 : 좌심실 구혈률과 관류 결손 정도와의 비교)

  • Jeong, Shin-Young;Lee, Jae-Tae;Bae, Jin-Ho;Ahn, Byeong-Cheol;Lee, Kyu-Bo
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.2
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    • pp.83-93
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    • 2003
  • Background: Lung-to-heart uptake ratio (LHR) in $^{201}Tl-chloride$ myocardial perfusion scan is believed to be a reliable marker for left ventricular (LV) dysfunction, but the clinical value of LHR is controversial for $^{99m}Tc-MIBI$ imaging. Furthermore, most of results suggesting lung uptake of $^{99m}Tc-MIBI$ as a potential marker for LV dysfunction used immediate post-stress images, instead of routine images acquired 1 hour after tracer injection. The goal of our study was to investigate whether LHR evaluated with routine gated $^{99m}Tc-MIBI$ imaging can reflect the degree of perfusion defect or left ventricular performance. Subjects and Methods: 241 patients underwent exercise $^{99m}Tc-MIBI$ myocardial SPECT were classified into normal myocardial perfusion (NP, n=135) and abnormal myocardial perfusion (AP, n=106) group according to the presence of perfusion defect. LHR was calculated from anterior projection image taken at 1-hour after injection. Two legions of interest (ROIs) were placed on left lung above LV and on myocardium showing the highest radioactivity. Subjects were classified by left ventricular ejection fraction (LVEF), as Gr-I: >50%, Gr-II: 36-50%, Gr-III: <36% and by summed stress score (SSS), as Gr-A: <4, Gr-B: 4-8, Gr-C: 9-13, Gr-D: >13, LHR was compared among these groups. Results: In NP group(n=135), LHR, were higher in men than women ($men:\;0.311{\pm}0.03,\;women:\;0.296{\pm}0.03,\;p<0.05$). Significant difference, in LHR were found between NP and AP groups both for men and women ($men:\;0.311{\pm}0.03\;vs\;.\;0.331{\pm}0.06,\;women:\;0.296{\pm}0.03\;vs.\;0.321{\pm}0.07.\;p<0.05$). There were weak negative correlation between LHR and LVEF (r=-0.342, p<0.05) and weak positive correlation between LHR and SSS (r=0.478, p<0.05) in men, but not in women (LVEF: r=-0.279, p=0.100, SSS: r=0.276, p=0.103). Increased LHR was defined when for more than mean + 2SD value ($men{\geq}0.38,\;women{\geq}0.37$) of the LHR of the subject with normal perfusion. Increased LHR were observed more frequently in subjects with lower LVEF (Gr-I: 11.1%, Gr-II: 27.0%, Gr-III: 35.4%, p<0.05) and higher SSS(Gr-A: 14.0%, Gr-B: 5.7%, Gr-C: 18.2%, Gr-D: 40.7%, p<0.05). Conclusions: LHRs obtained from routine $^{99m}Tc-MIBI$ gated SPECT images were weakly correlated with LVEF and perfusion defect. Although significant overlaps were observed between normal and abnormal perfusion group, LHRs could be used as an indirect marker of severe perfusion defect or reduced left ventricular function.

Development and Assessment Individual Maximum Permissible Dose Method of I-131 Therapy in High Risk Patients with Differentiated Papillary Thyroid Cancer (물리학 선량법을 이용한 갑상선암의 개인별 최대안전용량 I-131 치료법 개발과 유용성 평가)

  • Kim, Jeong-Chul;Yoon, Jung-Han;Bom, Hee-Seung;JaeGal, Young-Jong;Song, Ho-Chun;Min, Jung-Joon;Jeong, Heong;Kim, Seong-Min;Heo, Young-Jun;Li, Ming-Hao;Park, Young-Kyu;Chung, June-Key
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.2
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    • pp.110-119
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    • 2003
  • Purpose: Radioiodine (I-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. Materials and Methods: Therapeutic effects of MPD was evaluated in 58 patients (49 females and 9 males, mean age $50{\pm}11$ years) of papillary thyroid cancer. Among them 43 patients were treated with ${\Leq}7.4GBq$, while 15 patients with ${\geq}9.25GBq$. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up I-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. Results: MPD measured by CF method using tracer and therapeutic doses were $13.3{\pm}1.9\;and\;13.8{\pm}2.1GBq$, respectively (p=0.20). They showed a significant correlation (r=0.8, p<0.0001). Exposed doses to blood measured by CF and biological methods were $1.54{\pm}0.03\;and\;1.78{\pm}0.03Gy$ (p=0.01). They also showed a significant correlation (r=0.86, p=0.01). High-dose group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (p=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, p=0.46). Conclusion: Measurement of MPD using CF method is reliable, and the high-dose I-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy.

A study of $Smartpeg^{TM}'s$ lifetime according to sterilization for implant stability (임플랜트 안정성을 위한 자기공명막대의 소독방법에 따른 수명에 관한 연구)

  • Won, Ho-Yeon;Cho, In-Ho;Lee, Joon-Seok
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.1
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    • pp.42-52
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    • 2008
  • Purpose: Resonance Frequency Analysis(RFA) technique can be used as an effective method in measuring the implant stability and documenting the clinical results. This technique also determines how stable the implant is before performing a prosthetic practice. Having become one the guidelines of the implant therapy whose final objective is the immediate loading, the $Osstell^{TM}$ mentor is giving a lot of information to the clinicians recently. In this communication, experiments were performed to investigate how reliable the measured ISQ values by $Osstell^{TM}$ mentor are, and to see if those are also stable even after sterilization. As five objectives: 1) How stable measured ISQ values after fixation $Smartpeg^{TM}s$ for 400 times. 2) How stable measured ISQ values after 'attach-detach'$Smartpeg^{TM}'s$ for 400 times. 3) How stable measured ISQ values after clinical sterilization methods. 4) How stable measured ISQ values after repeatedly sterilization in autoclave for 10 times. 5) What is the critical temperature which is lost the magnetism of $Smartpeg^{TM}$. Materials and Methods: Clinical sterilization methods(Autoclave sterilization, Dentistar sterilization, Ultra violet sterilization, Vacuum dry unit sterilization, Boiling water sterilization, combined $H_{2}O_{2}$ and Alcohol sterilization).$Smartpeg^{TM}s$. D3 Block bone($3{\times}9{\times}2cm$). Osstem implant(${\emptyset}4.1$-10mm).$Osstell^{TM}$ mentor. Individual experiment was used 8 number of $Smartpeg^{TM}s$ and they had measured to ISQ values of before experiment and after experiment. Results: 1. The measured ISQ values did not change after fixation $Smartpeg^{TM}s$ for 400 times. 2. There was no significant changes in the measured ISQ values of 'attach-detach $Smartpeg^{TM}s'$ for 400 times. 3. The measured ISQ values did not change after the usual clinical sterilization methods. 4. The measured ISQ values did not change after sterilization in autoclave for 10 times. 5. It was impossible to exactly measure the critical temperature which is lost the magnetism of $Smartpeg^{TM}s$. But, the results was resulted to lost its magnetism in higher temperature than $150^{\circ}C$/10 minute. Conclusion: The measured ISQ values showed insignificant differences in case of no changes in the magnetism of the $Smartpeg^{TM}s$. It seems that the $Smartpeg^{TM}s$ can be used repeatedly in every measurement if the original magnetisms of the $Smartpeg^{TM}s$ can be recognized. There seems to be no significant changes in the measured ISQ values of 'attach-detach $Smartpeg^{TM}s'$ only if the screw pitches were unimpaired. The clinical sterilization methods seems acceptable because the result was resulted to lost its magnetism in higher temperature than $150^{\circ}C$/10minute.

Development of New Device for the Rapid Measurement of the freshness of Wet Fish by Using Micro Computer (마이크로 컴퓨터를 이용한 어육의 신선도 측정장치의 개발)

  • CHO Young-Je;LEE Nam-Geoul;KIM Sang-Bong;CHOI Young-Joon;LEE Keun-Woo;KIM Geon-Bae
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.28 no.3
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    • pp.253-262
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    • 1995
  • To develop a device for measuring fish freshness which could be move accurate and reliable than used freshness measuring systems. A new device based on digital circuit was designed using a microcomputer. The device was composed of a sensor part, 8096 microprocessor and a segment display. The effectiveness of device has been evaluated by the coefficient of correlation among the measured freshness stores such as electrical Q-value, K-value and amount of volatile basic nitrogen (VBN) of plaice, Paralichthys Olivaceus, during storage at $-3^{\circ}C,\;0^{\circ}C,\;5^{\circ}C,\;10^{\circ}C,\;and\;25^{\circ}C$. Q-values measured by a new device were more closely correlated with K-value (r=-0.978-\;-0.962,\;p<0.05) and VBN (r=-0.888-\;-0.988,\;p<0.05) in case of plaice meat. If more data would achieve using various fishes, this new designed device could be a valuable kit in fish market by its compact portability.

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An Analysis of Morphological Variation in Abies koreana Wilson and A. nephrolepis (Traut.) Maxim. of Korea (Pinaceae) and Their Phylogenetic Problems (한국산(韓國産) 분비나무와 구상나무의 형질분석(形質分析)과 종간유연관계(種間類緣關係))

  • Chang, Chin-Sung;Jeon, Jeong Ill;Hyun, Jung Oh
    • Journal of Korean Society of Forest Science
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    • v.86 no.3
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    • pp.378-390
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    • 1997
  • Ten total populations of Korean fir (Abies koreana Wilson) and Manshurian fir [A. nephrolepis (Traut.) Maxim.] were sampled from south Korea to investigate patterns of intraspecific variation in these species and to evaluate a recognition of the two species. Principal components analysis and cluster analysis were performed both on seed-cone data and on needle morphology data. The characters that contributed most to the separation between A. koreana and A. nephrolepis along three principal components axis were leaf width, length of seed, width of seed wing, length of seed wing, cone width, width of scale, and length of bract tip, but these characters were not diagnostic because of overlap in reality. Therefore, all these characters were not reliable in distinguishing these two taxa including bract position (exerted and recurved vs. exerted and straight). The individuals of A. koreana from Mt. Chi-ri appeared quite unique probably on account of its larger cone size and longer scale tip, while those from Mt. Hal-la of A. koreana were generally distinct from others in terms of their larger seed and seed wing and longer scale width. The Mt. Duk-yu specimens of A. korecana appeared somewhat smaller but more data were needed due to the small sampling size. Generally, the gradual clinal geographic trends made evident by the position of resin ducts in leaves of A. koreana can be detected. The southern populations, Mt. Hal-la (an insular population) were generally distinct from the northern populations (Mt. Chi-ri, Mt. Ga-ya and Mt. Duk-yu) in terms of their position of resin duct (medial, within mesophyll vs marginal, close to epidermis : 100% vs 75 or 50%). Although no sharp boundary separating these two species could be detected based on cone and needle morphology, the observed clinal pattern was distinct in northern populations of A. koreana and southern population of A. nephrnlepis. In a preceding study of the flavonoids variation of 20 species in eastern Asia, flavanone (5-deoxyflavanone) was found to be characteristic of A. faxoniana Rehder et Wilson, A. georgei Orr of China and A. koreana of Korea. A. faxoniana, which is assumed to be primitive species, has position of resin duct relative to both the medial and the marginal, while A. georgei and A. koreana are identified by marginal position of resin duct. With respect of foliar flavonoids chemistry, A. koreana was distinct from A. nephrolepis : the southmost samples (Mt. Hal-la and Mt. Chi-ri) contained additional flavonoids derivatives (mainly flavanone) that were not found in the northmost samples of A. nephrolepis except a few individuals from Mts. Seo-rak and Tae-bak populations of Kwang-won province. The presence of A. koreana type flavonoids in two Chinese species suggested that position of resin duct may be a phyletic character. Abies koreana including two Chinese taxa, exhibited the most elaborate and specialized flavonoids profile within the Abies in eastern Asia. Contrary to our initial expectations, the apparent intermediates between A. nephrolepis and A. koreana in Duk-yu and Ga-ya mountains were found. The pattern of variation on position of resin duct and flavonoids chemistry in these populations of A. kareana suggested that genetic interchange or natural hybridization had occurred between these two species. The evidence needed to resolve the status of this taxon is still inconclusive in our opinion until intermediate individuals from Mts. Duk-yu and Ga-ya show indication of hybridization between the two species.

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The Determination of Trust in Franchisor-Franchisee Relationships in China (중국 프랜차이즈 시스템에서의 본부와 가맹점간 신뢰의 영향요인)

  • Shin, Geon-Cheol;Ma, Yaokun
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.2
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    • pp.65-88
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    • 2008
  • Since the implementation of economic reforms in 1978, the Chinese economy grows rapidly at an average annul growth rate of 9% over the post two decades. Franchising has been widely recognized as an important source of entrepreneurial activity. Trust is important in that it facilitates relational exchanges by permits partners to transcend short-run inequities or risks to concentrate on long-term profits or gains. In the relationship between the franchisors and franchisees, trust has been described as an important source of competitive advantage. However, little research has been done on the factors affecting trust in Chinese franchisor-franchisee relationships. The purpose of this study is to investigate what factors affect the trust in the franchise system in China, and to provide guidelines and insights to franchisors which enter Chinese market. In this study, according to Morgan and Hunt (1994), trust is defined as the extending when one party has confidence in an exchange partner's reliability and integrity. We offered a conceptual model of the empirical study. The model shows that the factors affecting the trust include franchisor's supports, communication, satisfaction with previous outcome and conflict. We also suggested the franchisor's supports and communication like to enhance the franchisee's satisfaction with previous outcome, and the franchisor's supports, communication and he franchisee's satisfaction with previous outcome tend to decrease conflict. Before the formal study, a pretest involving exploratory interviews with owners from three franchisees was conducted to make sure the questionnaire was relevant and clear to the respondents. The data were collected using trained interviewers to carry out personal interviews with the aid of an unidentified, muti-page, structured questionnaire. The respondents comprised of owners, managers, and owner managers of franchisee-owned food service franchises located in Beijing, China. Even though a total of 256 potential franchises were initially contacted, the finally usable sample consisted of 125 respondents. As expected, the sampling method was successful in soliciting respondents with waried personal and firm characteristics. Self-administrated questionnaires were used for all measures. And established scales were used to measure the latent constructs in this study. The measures tapped the franchisees' perceptions of the relationship with the referent franchisor. Five-point Likert-type scales ranging from "strongly disagree" (=1) to "strongly agree" (=7) were used throughout the constructs (trust, eight items; support, five items; communication, four items; satisfaction, six items; conflict, three items). The reliability measurements traditionally employed, such as the Cronbach's alpha, were used. All the reliabilities were greater than.80. The proposed measurement model was estimated using SPSS 12.0 and AMOS 5.0 analysis package. We conducted A series of exploratory factor analyses and confirmatory factor analyses to assess the convergent validity, discriminant validity, and reliability. The results indicate reasonable overall fits between the model and the observed data. The overall fit of measurement model were $X^2$= 159.699, p=0.004, d.f. = 116, GFI =.879, NFI =.898, CFI =.969, IFI =.970, TLI =.959, RMR =.058. The results demonstrated that the data reasonably fitted the model. We also examined construct reliability and reliability and average variance extracted (AVE). The construct reliability of each construct was greater than.80 and the AVE of each construct was greater than.50. According to the analysis of Structure Equation Modeling (SEM), the results of path model indicated an adequate fit of the model: $X^2$= 142.126, p = 0.044, d.f. = 115, GFI =.892, NFI =.909, CFI =.981, IFI =.981, TLI =.974, RMR =.057. As hypothesized, the results showed that it is strategically important to establish trust in a franchise system, and the franchisor's supports, communication and satisfaction with previous outcome tend to reinforce franchisee's trust. The results also showed trust seems to decrease as the experience of conflict episodes increases. And we also noticed that franchisor's supports and communication tend to enhance the franchisee's satisfaction with previous outcome, and communication tend to decrease conflict. If the trust between the franchisor and franchisee can be established in a franchise system, franchising offers many benefits and reduces many costs. To manage a mutual trust of relationship with their franchisees, franchisor's should provide support effectively to their franchisees. Effective assistant services have direct effect on franchisees' satisfaction with previous outcome and trust in franchisor. Especially, franchise sales process, orientation, and training in the start-up period are key elements for success of the franchise system. Franchisor's support is an accumulated separate satisfaction evaluation with different kind of service provided by the franchisor. And providing support definitely can improve the trustworthy image of the franchisor. In the franchise system, conflicts of interests and exertions of different power sources are very common. The experience of conflict episodes seems to negatively relate to trust. Therefore, it is important to reduce the negative side of the relationship conflicts. Communication actually plays a broader role in reducing conflict and establish mutual trust in franchisor-franchisee relationship. And effective communication between franchisors and franchisees can improve franchisees' satisfaction toward the franchise system. As the diversification of Chinese markets, both franchisors and franchisees must keep the relevant, timely, and reliable communication. And it is very important to improve the quality of communication. Satisfaction with precious outcomes seems to positively relate to trust. Franchisors and franchisees that are highly satisfied with the previous outcomes that flow from their relationship will perceive their partner as advancing their goal achievement. Therefore, it is necessary for both franchisor and their franchisees to make the welfare of partner with effort. Little literature has focused on what factors affect the trust between franchisors and their franchisees in China. This study developed the hypotheses regarding the factors affecting trust in the transaction relationship. The results of data analysis supported the hypotheses strongly. There are certain limitations in this study. First, we may point out that some other factors missed in this study could be significantly important. Second, the context of this study, food service industry, limits its potential generalizability for all franchise systems. More studies in different categories of franchise system are needed to broaden its generalizability. Third, the model was tested empirically in a sample in Beijing, more empirical tests of the proposed model in other Chinese areas are needed. Finally, the analysis in this study was solely based on the perception of franchisees and the opinions of franchisors were not included.

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Comparison of Nutrient Intakes of Korean Elderly People Living in Rural Area Between 24-hour Recall and Food Frequency Method (24시간회상법과 식품섭취빈도조사법을 이용한 농촌지역 노인의 영양소 섭취수준 비교)

  • Cho, Young-Eun;Lee, Soo-Lim;Cho, Eun-Hyun;Lomeda, Ria-Ann L;Kwak, Eun-Hee;Kim, Yang-Ha;Kwun, In-Sook
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.35 no.6
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    • pp.698-707
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    • 2006
  • Precise and correct assessment of nutrient intake using appropriate dietary intake method is necessary to improve the nutritional status of the target people group. It is more likely so in elderly people since their dietary habits and inadequate nutrient intakes are of special concern even worse in rural areas. Two popular methods of gathering dietary intake are 24-hour recall and food frequency method (or food frequency questionnaire). In the present study, we conducted both 24-hour recall and food frequency method on 120 rural elderly people $(aged\;65{\sim}74\;years)$, 62 male and 58 female. The dietary intakes were analyzed and the correlation of the dietary intake between 24-hour recall and food frequency method to determine the reliability between two methods. Also each nutrient intake was compared to recommended dietary allowance (RDA) or nutrient reference value (NRV) as appropriate. Even correlation did not show significance between the two methods except for dietary fiber intake (0.65 at p<0.01) and energy-yielding nutrients which mostly showed similar results with nutrient intake level. These support the possible reliability between 24-hours record and food frequency method that is also shown on the cases of most mineral and vitamin intakes. Thus, the food frequency method used in this study for the assessment of nutrient intakes of the elderly people would be reliable for the assessment of the nutrient intake along with the 24-hour recall. Also, the present study results suggested that rural female elderly people would be under optimal nutriture status due to the lower food intake measured by 24-hour recall. The optimal food frequency method would be considered to be developed for the precise nutrient assessment.

Element Dispersion and Wallrock Alteration from Samgwang Deposit (삼광광상의 모암변질과 원소분산)

  • Yoo, Bong-Chul;Lee, Gil-Jae;Lee, Jong-Kil;Ji, Eun-Kyung;Lee, Hyun-Koo
    • Economic and Environmental Geology
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    • v.42 no.3
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    • pp.177-193
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    • 2009
  • The Samgwang deposit consists of eight massive mesothermal quartz veins that filled NE and NW-striking fractures along fault zones in Precambrian granitic gneiss of the Gyeonggi massif. The mineralogy and paragenesis of the veins allow two separate discrete mineralization episodes(stage I=quartz and calcite stage, stage II-calcite stage) to be recognized, temporally separated by a major faulting event. The ore minerals are contained within quartz and calcite associated with fracturing and healing of veins that occurred during both mineralization episodes. The hydrothermal alteration of stage I is sericitization, chloritization, carbonitization, pyritization, silicification and argillization. Sericitic zone occurs near and at quartz vein and include mainly sericite, quartz, and minor illite, carbonates and chlorite. Chloritic zone occurs far from quartz vein and is composed of mainly chlorite, quartz and minor sericite, carbonates and epidote. Fe/(Fe+Mg) ratios of sericite and chlorite range 0.45 to 0.50(0.48$\pm$0.02) and 0.74 to 0.81(0.77$\pm$0.03), and belong to muscovite-petzite series and brunsvigite, respectiveIy. Calculated $Al_{IV}$-FE/(FE+Mg) diagrams of sericite and chlorite suggest that this can be a reliable indicator of alteration temperature in Au-Ag deposits. Calculated activities of chlorite end member are $a3(Fe_5Al_2Si_3O_{10}(OH)_6$=0.0275${\sim}$0.0413, $a2(Mg_5Al_2Si_3O_{10}(OH)_6$=1.18E-10${\sim}$7.79E-7, $a1(Mg_6Si_4O_{10}(OH)_6$=4.92E-10${\sim}$9.29E-7. It suggest that chlorite from the Samgwang deposit is iron-rich chlorite formed due to decreasing temperature from high temperature(T>450$^{\circ}C$). Calculated ${\alpha}Na^+$, ${\alpha}K^+$, ${\alpha}Ca^{2+}$, ${\alpha}Mg^{2+}$ and pH values during wallrock alteration are 0.0476($400^{\circ}C$), 0.0863($350^{\circ}C$), 0.0154($400^{\circ}C$), 0.0231($350^{\circ}C$), 2.42E-11($400^{\circ}C$), 7.07E-10($350^{\circ}C$), 1.59E-12($400^{\circ}C$), 1.77E-11($350^{\circ}C$), 5.4${\sim}$6.4($400^{\circ}C$), 5.3${\sim}$5.7($350^{\circ}C$)respectively. Gain elements(enrichment elements) during wallrock alteration are $TiO_2$, $Fe_2O_3(T)$,CaO, MnO, MgO, As, Ag, Cu, Zn, Ni, Co, W, V, Br, Cs, Rb, Sc, Bi, Nb, Sb, Se, Sn and Lu. Elements(Ag, As, Zn, Sc, Sb, Rb, S, $CO_2$) represents a potential tools for exploration in mesothermal and epithermal gold-silver deposits.

A Study on the Availability of the On-Board Imager(OBI) and Cone-Beam CT(CBCT) in the Verification of Patient Set-up (온보드 영상장치(On-Board Imager) 및 콘빔CT(CBCT)를 이용한 환자 자세 검증의 유용성에 대한 연구)

  • Bak, Jino;Park, Sung-Ho;Park, Suk-Won
    • Radiation Oncology Journal
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    • v.26 no.2
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    • pp.118-125
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    • 2008
  • Purpose: On-line image guided radiation therapy(on-line IGRT) and(kV X-ray images or cone beam CT images) were obtained by an on-board imager(OBI) and cone beam CT(CBCT), respectively. The images were then compared with simulated images to evaluate the patient's setup and correct for deviations. The setup deviations between the simulated images(kV or CBCT images), were computed from 2D/2D match or 3D/3D match programs, respectively. We then investigated the correctness of the calculated deviations. Materials and Methods: After the simulation and treatment planning for the RANDO phantom, the phantom was positioned on the treatment table. The phantom setup process was performed with side wall lasers which standardized treatment setup of the phantom with the simulated images, after the establishment of tolerance limits for laser line thickness. After a known translation or rotation angle was applied to the phantom, the kV X-ray images and CBCT images were obtained. Next, 2D/2D match and 3D/3D match with simulation CT images were taken. Lastly, the results were analyzed for accuracy of positional correction. Results: In the case of the 2D/2D match using kV X-ray and simulation images, a setup correction within $0.06^{\circ}$ for rotation only, 1.8 mm for translation only, and 2.1 mm and $0.3^{\circ}$ for both rotation and translation, respectively, was possible. As for the 3D/3D match using CBCT images, a correction within $0.03^{\circ}$ for rotation only, 0.16 mm for translation only, and 1.5 mm for translation and $0.0^{\circ}$ for rotation, respectively, was possible. Conclusion: The use of OBI or CBCT for the on-line IGRT provides the ability to exactly reproduce the simulated images in the setup of a patient in the treatment room. The fast detection and correction of a patient's positional error is possible in two dimensions via kV X-ray images from OBI and in three dimensions via CBCT with a higher accuracy. Consequently, the on-line IGRT represents a promising and reliable treatment procedure.

A Clinical Evaluation of Splanchnic Nerve Block (내장신경차단에 관한 임상적 연구)

  • Kim, Soo-Yeoun;Oh, Hung-Kun;Yoon, Duek-Mi;Shin, Yang-Sik;Lee, Youn-Woo;Kim, Jong-Rae
    • The Korean Journal of Pain
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    • v.1 no.1
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    • pp.34-46
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    • 1988
  • Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hematoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the Period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designate4i as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57.7% who had surgery. and 3.7% of whom had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze loom long needle was inserted at the lower border of the 12th rib on each aide about 7\;cm from the midline. The average distance from the midline was $6.60{\pm}0.61\;cm$ on the left side and $6.60{\pm}0.83\;cm$ on the right side in group 2, and $5.46{\pm}0.76\;cm$ on the left side and $5.49{\pm}0.69\;cm$ on the right side in group 3. The average depth to which the needle was inserted was $8.60{\pm}0.52\;cm$ on the left side and $8.74{\pm}0.60\;cm$ on the right side in group 2, and $8.96{\pm}0.63\;cm$ on the left side and $9.18{\pm}0.57\;cm$ on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% n the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6won the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior mal gin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, $39.17{\pm}6.69\;ml$ of 0.5% -l% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block $40.00{\pm}4.26\;ml$ of 50% alcohol was injected for the semipermanent block. In group 2, $13.75{\pm}4.88\;ml$ of 1% lidocaine were used as the test block and followed by $46.17{\pm}4.37\;ml$ of 50% alcohol was injected as the semipermanent block. In group 3, $15.63{\pm}1.19\;ml$ of 1% lidocaine for test block followed by $15.62{\pm}1.20\;ml$ of pure alcohol and $16.05{\pm}2.58\;ml$ of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to i months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

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