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Report on the External Audits Conducted by Korean Society of Medical Physics (한국의학물리학회 선형가속기 외부 품질관리 실시 현황보고)

  • Huh, Hyun Do;Cho, Kwang Hwan;Cho, Sam Ju;Choi, Sang Hyoun;Kim, Dong Wook;Hwang, Ui-Jung;Kim, Ki Hwan;Min, Chul Kee;Choi, Tae Jin;Oh, Young Kee;Lee, Seoung Jun;Park, Dahl;Park, Sung-Kwang;Ji, Young Hoon
    • Progress in Medical Physics
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    • v.24 no.4
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    • pp.315-322
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    • 2013
  • The aim of this work is to verify the self-quality assurances in medical institutions in Korea through the external audits by the group of experts and have a mutual discussion of the systematic problems. In order to validate the external audits 30 of 80 medical institutions across the nation were picked out considering the regional distribution and the final 25 institutions applied voluntarily to take part in this work. The basic rules were setup that any information of the participants be kept secrete and the measurements be performed with the dosimetry system already verified through intercomparision. The outputs for 2 or more photon beams, the accuracy of gantry rotation and collimator rotation and the poistional accuracy of MLC movement were measured. The findings for the output measurement showed the differences of -0.8%~4.5%, -0.79%~3.01%, and -0.7%~0.07% with respect to that of the verified dosimetry system for the 6MV, 10MV, and 15MV, respectively. For the reference absorbed dose 8 (16%) of 50 photon beams in 25 medical institutions differed 2.0% or greater from the reference value. The coincidences of Field size with x-ray beam and radiation isocenters of Gantry roration and collimator rotation gave the results of within ${\pm}2$ mm for every institute except 2 institutions. The positional accuracy of MLC movement agreed to within ${\pm}1$ mm for every institute. For the beam qualities of 6 MV photon beams kQ values showed the distribution within 0.4% between maximum and minimum. For the protocols 21 institutions (84%) used absorbed dose to water based protocol while 4 insitutions (16%) used air kerma based one. 22 institutions employed the SSD technique while 3 institutions did the SAD one. External audit plays an important role in discovering the systematic problems of self-performing Quality Assurances and having in depth discussion for mutual complementation. Training experts of international level as well as national support system are required so that both the group of experts of medical physicists and government laboratory could perform together periodical and constant external audits.

A Study on the Main Issue and Its Solution Explored through Mediation Cases - Focused on the Cases of Busan National Labor Relations Commission - (조정사건을 통해 살펴본 주요 쟁점사항과 해결방안에 대한 연구 - 부산지방노동위원회의 사례를 중심으로 -)

  • Song, Kyung-Soo;Kim, Yong-Ho
    • Management & Information Systems Review
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    • v.30 no.4
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    • pp.253-292
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    • 2011
  • This study is significant of groping for the autonomous perspective of a medication system for the establishment of harmonious regional labor-management relationship and investigating a plan to minimize previously labor disputes through both analyzing mediation cases and finding out any core issue from the labor-management relationship, with matters experienced in the mediation field when I had served as a mediator. Specially, this study has also objectives to prevent previously any labor dispute through analyzing and minimizing the issue of the labor dispute by case and to establish harmonious labor-management relationship thereby. Further since it is necessary to understand the organization and roles of the regional labor relations commission in order to understand the concrete matters in respect of the labor dispute mediation, this study shall be to explore in detail the matters relating hereto and to acquire general knowledge of mediation through case analysis. Additionally, there is little studies exploring alternative research for the establishment of reasonable labor-management relationship with core issues referred a mediation to the labor relations commission through both the position heightening of the labor relations commission and the analysis of core issues until now. Thus, this study may provide a theoretical base for raising a technique to enhance negotiation skill through acquiring the previous training or full knowledge on the approaching manner to be taken by the labor and management in the collective bargaining or wage bargaining on the basis of items analyzed by core issue. The heightening perspectives to be acquired through the analysis of 50 or more mediation cases are as follows. First, it deems to be important what position each mediation party takes. Second, the information acquired by an investigator in the preliminary investigation before holding the mediation is very importantly utilized in the mediation. Third, the gumption of mediators in charge of the mediation is very helpful for the resolution of a case. Fourth, it shall be preceding to understand dispute issues. After reviewing fully the investigation report of an investigator, if separate review is required, it is tried to hold a separate meeting and then reduce the number of issues asserted by the labor & management and, if the number of such issues is reduced, the mediation may approach to be concluded. Fifth, it shall be kept in mind that any matter other than the scope of the law be based on not the judgement of mediator but the legal interpretation. Sixth, it is necessary for both labor and management parties to take a positive approach so as to make the healthy labor & management relationship anchored. Seventh, notwithstanding the mediators are part-time and take a service attitude, it shall be encouraged to abstain from slandering or inveighing against the mediators because the mediation is taken against oneself. Eighth, it is necessary to convert the management's recognition about a labor union. Ninth, it is necessary to not raise any issue on the matters, such as time-off system and multiple labor union, etc., which are legally enforced. Tenth, it is confirmed that the regional labor relations commission plays a bridge role of narrowing down the issue difference between the labor and management.

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Species-specific Expression of Rpia Transcript in Cumulus-oocyte-complex (난자-난구세포 복합체에서 발현하는 Rpia 유전자의 종 특이적 발현)

  • Kim, Yun-Sun;Yoon, Se-Jin;Kim, Eun-Young;Lee, Kyung-Ah
    • Clinical and Experimental Reproductive Medicine
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    • v.34 no.2
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    • pp.95-106
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    • 2007
  • Objective: We previously identified differentially expressed genes (DEGs) between germinal vesicle (GV) and metaphase II (MII) mouse oocyte. The present study was accomplished as a preliminary study to elucidate the role of ribose 5-phosphate isomerase A (Rpia), the essential enzyme of the pentose phosphate pathway (PPP), in oocyte maturation. We observed expression of Rpia in the mouse and porcine oocytes. Methods: Expression pattern of the 11 MII-selective DEGs in various tissues was evaluated using RT-PCR and selected 4 genes highly expressed in the ovary. According to the oocyte-selective expression profile, we selected Rpia as a target for this study. We identified the porcine Rpia sequence using EST clustering technique, since it is not yet registered in public databases. Results: The extended porcine Rpia nucleotide sequence was submitted and registered to GenBank (accession number EF213106). We prepared primers for porcine Rpia according to this sequence. In contrast to the oocyte-specific expression in the mouse, Rpia was expressed in porcine cumulus and granulosa cells as well as in oocytes. Conclusion: This is the first report on the characterization of the Rpia gene in the mouse and porcine ovarian cells. Results of the present study suggest that the mouse and porcine COCs employ different mechanism of glucose metabolism. Therefore, the different metabolic pathways during in vitro oocyte maturation (IVM) in different species may lead different maturation rates. It is required to study further regarding the role of Rpia in glucose metabolism of oocytes and follicular cell fore exploring the regulatory mechanism of oocyte maturation as well as for finding the finest culture conditions for in vitro maturation.

A Study on the Aesthetic Art Marketing Communication of Luxury Brand Using Storytelling (스토리텔링을 이용한 명품 브랜드의 미학적 아트마케팅 커뮤니케이션에 관한 연구)

  • Cho, Hye-Duk;Hwang, Jae-Kwang;Lee, Sang-Youn
    • Journal of Distribution Science
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    • v.9 no.3
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    • pp.73-82
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    • 2011
  • This study presents an effective and distinctive marketing strategy through the implementation of the aesthetic art marketing communication technique of storytelling. The reason applying art to marketing is effective is that it gives "class" and aesthetic beauty to the brand's image, which will lead to an increase in revenue and loyalty of consumers. The story stands in for the brand's subject of "desire." Luxury brand customers not only consume high-quality products, require the utmost in service, and value of the brand, they also appreciate the story the brand is telling. The story, combined with art, is called art marketing communication; it makes the brand more unique through its enhanced visual elements. The study discusses art collaboration, art exhibition, a transforming architecture project, art advertisement, a flagship store, and a human resource training center. Based on the "desire," I adopted the element and principle of storytelling. By visualizing the brand with a symbol, the company is able to relate to consumers' sentimentality. Through storytelling art marketing communication, and the strategy using relevance of brand and artist's popularity, the research shows efficient art marketing influences to the brand's image. The results of the research indicate that by using adequate art marketing communication that best reflects the identity and story of the luxury brand, it produces great results; the research also demonstrated, in various ways, that art marketing will succeed. The case showed the following outcomes. First, consumers have a tendency to choose a brand that is associated with an empathizing story. World renowned brands see through the market's "desires" for unique stories, and they also provide the ability to amuse consumers. The story in a product will become an important competitive element in future markets. Second, the art marketing communication applying a story rendered a brand with distinction. The most effective art marketing communications are art collaboration, art exhibition, locomotive architecture project, and others that are adopted as various means. Third, the brand's products were considered as an art piece, which led to not only strengthening the loyalty of consumers but also an increase in sales. In addition, the company could sustain a premium price for the goods sold. By adapting art to a brand's tradition, an innovative and creative new product provides consumer satisfaction, and producing goods in limited editions creates enthusiastic collectors. Fourth, this study suggests an abridged report, implication, limitation of the study, and directions for further research. Referring to the case for the adaptation of luxury brands, efficient art marketing strategies considering Korean company brand and efficiently study preceding Korean company brand art marketing strategy could be proposed.

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Arthroscopic Posterior Cruciate Ligament Reconstruction with Preservation of the Remnant Posterior Cruciate Ligament (남아 있는 후방 십자 인대 다발을 보존한 관절경하 후방 십자 인대 재건술)

  • Ahn Jin Hwan;Ha Kwon Ik;Chung Yoon Sung;Yang Il Soon
    • Journal of the Korean Arthroscopy Society
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    • v.4 no.2
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    • pp.97-104
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    • 2000
  • Purpose : The majority of PCL deficient knees have some intact remnant PCL bundles. In these cases, the remnant PCL bundles were removed fur easy passage of graft(especially in bone-patellar tendon-bone graft). The purpose of study is to report the results of PCL reconstruction by posterior transseptal portal technique and by preserving the remnant posterior cruciate ligament bundles. Materials & Methods : From November 1993 to June 1999, 44 arthroscopic posterior cruciate ligament reconstructions have been performed by one surgeon. We studied 37 knees those were followed up over 1 year among them. The mean age($14\~56$ years) was 31.8 years. The average follow-up period was 17.8 months($12\~61$ months). The graft materials were 29 double-loop hamstring autografts, 4 double-loop hamstring allografts and 4 Achilles tendon-bone allograft. Results : There are significant improvement of the preoperative subjective symptoms. The last follow-up shows that the average Lysholm knee score was markedly improved from 59.8 pre-operation to 89.2 post-operation and the average KT 2000 side difference was decreased from 11.1mm pre-operation to 2.3 mm post-operation. Follow-up MRI showed that the graft was healed with remnant posterior cruciate ligament bundles as one ligament. Conclusion : The posterior trans-septal portal makes it possible to locate the exact tibial tunnel. The arthroscopic PCL reconstruction preserving the remnant of original PCL bundles seems to provide the good result.

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Arthroscopic Subscapularis Tendon Repair - Preliminary Report of 8 cases study - (관절경하 견갑하건 봉합술 - 8 례에 대한 예비보고 -)

  • Yun, Ho-Hyun;Moon, Gi-Hyuk;Jang, Jong-Hoon;Yoo, Yon-Sik
    • Journal of the Korean Arthroscopy Society
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    • v.8 no.2
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    • pp.124-131
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    • 2004
  • Purpose: To validate and introduce the technique of the arthroscopic repair for the treatment of the Subscapulris tendon tear. Materials and Methods: From April 2003 to April 2004, Arthroscopic repairs were performed in 8 patient with subscapularis tendon tear. The mean follow-up period was 11months. two cases involved only subscaplaris tendon tear. Four cases were associated small sized posterosuperir. rotator cuff tear and two cases were in large size. The type of subscapularis tendon showed upper portion full-thickness tear in 6 cases, partial-thickness tear localized at articular surface in 1 case, complete tear in 1 case. The results were analyzed by using subjective satisfaction, inferior movenent of superior displaced humeral head, Constant-Murley functional scoring Results: Constant-Murley scoring was improved from 55 point preoperatively to 75 point postoperatively following 11 months. Mean score was 71 point except 2 cases of large superoposterior rotator cuff tear, Most humeral heads were distaracted postoperatively. The subjective result for the 8 shoulders were very satisfying in 5 cases, satisfying in 1 case and dissatisfying in 2 cases. Therefore satisfactory results were noted in 6 cases (75%) of this overall treatment group. Conclusion: The arthroscopic repair for the subscapularis tendon tear is thought to be available method, which could reduce severe complications following the weakness of deltoid muscle and postoperative pain. Especially Partial Subscapularis tear not associated with superoposterior rotator cuff tear including PASTA lesion was the sutable indication of the Arthroscopic repair.

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The Dynamics of CO2 Budget in Gwangneung Deciduous Old-growth Forest: Lessons from the 15 years of Monitoring (광릉 낙엽활엽수 노령림의 CO2 수지 역학: 15년 관측으로부터의 교훈)

  • Yang, Hyunyoung;Kang, Minseok;Kim, Joon;Ryu, Daun;Kim, Su-Jin;Chun, Jung-Hwa;Lim, Jong-Hwan;Park, Chan Woo;Yun, Soon Jin
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.23 no.4
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    • pp.198-221
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    • 2021
  • After large-scale reforestation in the 1960s and 1970s, forests in Korea have gradually been aging. Net ecosystem CO2 exchange of old-growth forests is theoretically near zero; however, it can be a CO2 sink or source depending on the intervention of disturbance or management. In this study, we report the CO2 budget dynamics of the Gwangneung deciduous old-growth forest (GDK) in Korea and examined the following two questions: (1) is the preserved GDK indeed CO2 neutral as theoretically known? and (2) can we explain the dynamics of CO2 budget by the common mechanisms reported in the literature? To answer, we analyzed the 15-year long CO2 flux data measured by eddy covariance technique along with other biometeorological data at the KoFlux GDK site from 2006 to 2020. The results showed that (1) GDK switched back-and-forth between sink and source of CO2 but averaged to be a week CO2 source (and turning to a moderate CO2 source for the recent five years) and (2) the interannual variability of solar radiation, growing season length, and leaf area index showed a positive correlation with that of gross primary production (GPP) (R2=0.32~0.45); whereas the interannual variability of both air and surface temperature was not significantly correlated with that of ecosystem respiration (RE). Furthermore, the machine learning-based model trained using the dataset of early monitoring period (first 10 years) failed to reproduce the observed interannual variations of GPP and RE for the recent five years. Biomass data analysis suggests that carbon emissions from coarse woody debris may have contributed partly to the conversion to a moderate CO2 source. To properly understand and interpret the long-term CO2 budget dynamics of GDK, new framework of analysis and modeling based on complex systems science is needed. Also, it is important to maintain the flux monitoring and data quality along with the monitoring of coarse woody debris and disturbances.

Current Status and Transition of the Prevalence of Intestinal Parasitic Infections in Korea (한국(韓國)에 있어서의 장내기생충감염(腸內寄生虫感染)의 현황(現況)과 추이(推移))

  • Kim, Dong-Chan
    • Journal of agricultural medicine and community health
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    • v.9 no.1
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    • pp.83-108
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    • 1984
  • Out of a total of 58 species of helminthic and protozoan parasitic infections in Korea, so far 38 species were reported as intestinal parasites of man. Quite a few species of the intestinal parasitic infections have long been prevalent throughout the country and this has been a significant public health problem. In this paper, current status and transition of the intestinal parasitic infections in the past years were presented. Chronological reviewing of data show background and prospects of change in the prevalence of infections. In the national prevalence survey on parasitic infections conducted once every five years since 1971, stool examinations were done by both cellophane thick smear and brine flotation techniques. Every egg positive case of Ascaris lumbricoides and Clonorchis sinensis was further examined by Stoll's dilution egg counting technique. In 1981, perianal swab using adhesive cellulose tape was added for Enterobius infection. For protozoan cyst examination conducted by province and city in '81, fecal specimens were fixed in SAF solution and examined by the formalin-ether concentration technique. High prevalence of parasitic infection in ana before the 1960s can be easily understood from the data given by the Ministry of Health and Social Affairs in 1967. From a parasite control point of view, the 1960s was the preparatory period particularly for control of soil-transmitted helminthiasis. Several organizations which have contributed to parasite control were founded in this period and the prevention law of parasitic infections was passed in '66. In the '70s, overall prevalence rates of the common intestinal parasitic infections, which were highly prevalent in the past were turned into reduction phase for the first time. The '80s can be said to be an active control period of parasitic infections. Intestinal helminths According to the reports of the national prevalence survey on parasitic infections, the prevalence of helminthic infections was 84.3%(number of person examined:24,887) in '71, 63.2%(27,178) in '76, and 41.1%(35,018) in '81. By area, the prevalence rate in '81 was 35.1%(20,569) in urban areas and 49.6%(14,447) in rural areas. Intestinal nematodes Ascaris lumbricoides The prevalence of Ascaris infection has decreased significantly in recent years. Among students, the prevalence was 55.4%, in '69 and decreased to 4.7% in '83. In the national prevalence surveys, the prevalence decreased to 13.0% in '81 from 54.9% in '71. By area, the prevalence decreased to 8.5% in '81 from 46.4% in '71 in urban area and 19.4% in '81 from 59.6% in '71 in rural area. By age, the prevalence has become in recent years relatively even in all age groups, although higher prevalence used to be seen in young age groups of around 10 years old, particulary in the highly prevalent rural areas. By sex, the prevalence was higher in the female than in the male. Unfertilized egg positive rates among the ascariasis cases increased gradually up to 55.4% on the average in '81. The intensity of the infection was also significantly decreased. Trichuris trichiura Trichuris infection had also decreased to 23.4% in '81 from 65.4% in '71. By area, the decreasing tendency of the prevalence became faster in urban areas than in the rural areas. The prevalence in urban and rural areas in '71 was 69.7%, and 63.1% respectively and decreased to 19.5% and 29.0% respectively in '81. By age, the prevalence reached a peak at the 10-14 age group and showed relatively even distribution throughout all age groups. By sex, the prevalence was close in young age groups, but in the 30s or over age group, especially in rural area, the prevalence was significantly higher in the female than in the male. The prevalence has much fluctuated depending in the area. The prevalence in rural areas surveyed in the '80s shows a range between 20.9% and 73.7% by locality. It is anticipated that the prevalence of Trichuris infection will drop more rapidly, when mass treatment is conducted. Hookworms Hookworm infection by mostly Ancylostoma duodenale and a few by Necator americanus has decreased to a negligible levels in recent years. In the national prevalence surveys, the prevalence was 10.7% in '71, 2.2% in '76, and 0.5% in '81. The prevalence was higher in rural areas than in urban areas. Wide application of multi-specific anthelminthics in the ascariasis control programmes conducted in the past decade appear to have been effective against hookworm infection. Trichostrongylus orientalis As in the case with hookworm infection, the prevalence of Trichostrongylus infection has reached a negligible levels. In the national prevalence surveys, the prevalence was 7.7% in '71, 1.0% in '76 and 0.2% in '81. Enterobius vermicularis In the national prevalence survey in '81, the egg positive rate was 12.0%. Higher prevalence is expected when examined repeatedly. The prevalence rate was 10.3% in urban area and 14.6% in rural area. In recent surveys conducted in rural areas among schoolchildren, the prevalence was 32.4% in Gimhae Gun in '82 and 64.1% in Yeongyang Gun in '83. By age, the egg positive rate was higher in young age groups of around 10 and sharply decreased in age groups of around 20 and then somewhat increased again in middle age groups. By sex, the prevalence was higher in the female than in the male. Strongyloides stercoralis Strongyloides stercoralis infection has rarely been found in Korea. Three cases were reported in 1914. And 0.1-0.5% were found infected out of 2,642 persons examined at the prisoner-of-war camp on Geojedo in 1956. One case was reported in '54 and '82, respectively. Anisakis spp. No systematic survey has been conducted for anisakiasis In Korea. So far, only several cases have been found 1 case in Seoul in '71, 5 cases in Busan in '81 and 1 case in Busan in '84. Intestinal trematodes Metagonimus yokogawai In the national prevalence survey conducted in 1981, the egg positive rate was 1.24% on the average. High endemic areas are located in the southwestern part of Korea. The prevalence in Hadong Gun was 29.1% on the average in '79. In a survey conducted in 76, the prevalence was 44.0% in Gwangyang, 55.0% in Gogseung and 29.0% in Gurye. The infection is closely correlated with raw sweetfish consumption in these areas. Other intestinal trematodes A human case of Heterophyes heterophyes was reported in 1914. Several species were reported in the '80s : 17 cases of Fibricola seoulensis, 9 cases of Pygidiopsis summa, 8 cases of Heterophyes heterophyes nocens, 1case of Heterophyopsis continua, 2 cases of Stellantchasmus falcatus, 1 case of Stictodora sp., 1 case of Echinostoma hortense, and 4 cases of Echinochasmus japonicus. As the intermediate hosts, snakes and frogs play a role for F.seoulensis and fish for the rest of the species. Intestinal cestodes Taenia saginata and T. solium Egg positive rates in the national prevalence survey were 0.7% in '76 and 1.1% in '81. The prevalence in '81 was 0.6% in urban area and 1.8% in rural area. The proglottid positive rate in Jeju Do was 19.2% on the average. On Udo, Jeju Do in 1983, the egg positive rate among the inhabitants was 2.9%. Hymenolepis nana In the national prevalence survey, egg positive rates were 0.6% in '76 and 0.4% in '81. No difference was seen in the prevalence by area and sex. Hymenolepis diminuta Infected cases were reported : 3 in '64 and I in '66. Egg positive rate in '81 was 0.01% in the national prevalence survey. Diphylobothrium latum So far, about 30 cases have been reported. The cases have been reported more frequently in recent surveys. Mesocestoides sp. A case was reported from a hospitalized patient in Seoul in '67. Spirometra erinacei Two cases were reported in '84 following reidentification of the adult worms collected in '74. Intestinal protozoa Out of a total of 23 species of human protozoan infections in Korea, 13 species were reported as intestinal protozoa : Entamoeba histolytica, E coli, Endolimax nana, Iodamoeba b$\ddot{u}$tschlii, Dientamoeba fragilis, Giardia lamblia, Chilomastix mesnilii, Embadomonas sp., Enteromonas hominis, Trichomonas hominis, Isospora belli, I. Hominis(Sarcocystis hominis), and Balantidium coli. Since the first report on intestinal protozoan infections in 1925, there have been quite a few survey data on the prevalence of the infection. It was found reviewing the data chronologically that up to the early '70s the infection was prevalent around a 30-50%. After that, the protozoan cyst positive rate has shown the tendency of gradual decrease throughout the country. Protozoan cyst survey conducted in Seoul and several provinces in 1981 revealed infection rates of 8.9%(1,310) in Gangweondo, 10.7%(1,703) in Gyenggi Do, 11.7%(1,032) in Jeonra Buk Do, 9.1%(4,116) in Jeonra Nam Do, and 1.4%(5,275) in Seoul. Entamoeba histolytica In the survey conducted by province in '81, the cyst positive rate was 0.8% in Gangweon-do, 0.3% in Gyeonggi Do, 1.4% in both Jeonra Buk Do and Jeonra Nam Do, and 0.2% in Seoul. Giardia lamblia In the survey by province in '81, cyst positive rates were 2.2% in both Gyeonggi Do and Jeonra Buk Do, 1.9% in Jeonra Nam Do, 0.5% in Gangweon Do, and 0.9% in Seoul. Balantidium coli Two cases were reported. One in 1930 and the other in '74. Isospora belli and I. Hominis(Sarcocystis hominis) Isospora belli was reported : 1 case in '56 and 3 cases in '66. I. Hominis, recently identified to be synonymous with Sarcocystis hominis, was reported : 3 cases in '66. Other intestinal protozoa The protozoan parasites other than the above mentioned are generally treated as commensal, although some of them are considered to be pathogenic. The data of '81 show that about 10% of the inhabitants are still infected with protozoa.

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Assessment for the Utility of Treatment Plan QA System according to Dosimetric Leaf Gap in Multileaf Collimator (다엽콜리메이터의 선량학적엽간격에 따른 치료계획 정도관리시스템의 효용성 평가)

  • Lee, Soon Sung;Choi, Sang Hyoun;Min, Chul Kee;Kim, Woo Chul;Ji, Young Hoon;Park, Seungwoo;Jung, Haijo;Kim, Mi-Sook;Yoo, Hyung Jun;Kim, Kum Bae
    • Progress in Medical Physics
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    • v.26 no.3
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    • pp.168-177
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    • 2015
  • For evaluating the treatment planning accurately, the quality assurance for treatment planning is recommended when patients were treated with IMRT which is complex and delicate. To realize this purpose, treatment plan quality assurance software can be used to verify the delivered dose accurately before and after of treatment. The purpose of this study is to evaluate the accuracy of treatment plan quality assurance software for each IMRT plan according to MLC DLG (dosimetric leaf gap). Novalis Tx with a built-in HD120 MLC was used in this study to acquire the MLC dynalog file be imported in MobiusFx. To establish IMRT plan, Eclipse RTP system was used and target and organ structures (multi-target, mock prostate, mock head/neck, C-shape case) were contoured in I'mRT phantom. To verify the difference of dose distribution according to DLG, MLC dynalog files were imported to MobiusFx software and changed the DLG (0.5, 0.7, 1.0, 1.3, 1.6 mm) values in MobiusFx. For evaluation dose, dose distribution was evaluated by using 3D gamma index for the gamma criteria 3% and distance to agreement 3 mm, and the point dose was acquired by using the CC13 ionization chamber in isocenter of I'mRT phantom. In the result for point dose, the mock head/neck and multi-target had difference about 4% and 3% in DLG 0.5 and 0.7 mm respectively, and the other DLGs had difference less than 3%. The gamma index passing-rate of mock head/neck were below 81% for PTV and cord, and multi-target were below 30% for center and superior target in DLGs 0.5, 0.7 mm, however, inferior target of multi-target case and parotid of mock head/neck case had 100.0% passing rate in all DLGs. The point dose of mock prostate showed difference below 3.0% in all DLGs, however, the passing rate of PTV were below 95% in 0.5, 0.7 mm DLGs, and the other DLGs were above 98%. The rectum and bladder had 100.0% passing rate in all DLGs. As the difference of point dose in C-shape were 3~9% except for 1.3 mm DLG, the passing rate of PTV in 1.0 1.3 mm were 96.7, 93.0% respectively. However, passing rate of the other DLGs were below 86% and core was 100.0% passing rate in all DLGs. In this study, we verified that the accuracy of treatment planning QA system can be affected by DLG values. For precise quality assurance for treatment technique using the MLC motion like IMRT and VMAT, we should use appropriate DLG value in linear accelerator and RTP system.

The Effect of Structured Information on the Sleep Amount of Patients Undergoing Open Heart Surgery (계획된 간호 정보가 수면량에 미치는 영향에 관한 연구 -개심술 환자를 중심으로-)

  • 이소우
    • Journal of Korean Academy of Nursing
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    • v.12 no.2
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    • pp.1-26
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    • 1982
  • The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

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