• Journal of Korean Neurosurgical Society
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• v.45 no.6
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• pp.329-335
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• 2009

Objective : Determining language lateralization is important for the presurgical evaluation of patients with medically intractable epilepsy. The Wada test has been the gold standard for lateralization of language dominance before epilepsy surgery. However, it is an invasive test with risk, and have some limitations. Methods : We compared the volumetric analysis with Wada test, and studied the clinical potential of volumetric analysis to assess language laterality in large surgical candidates with temporal lobe epilepsy (TLE). To examine the efficacy of volumetric analysis to determine language lateralization during presurgical evaluation, we compared the volumetric analysis of the bilateral planum temporale with the results of Wada test in 59 patients with chronic intractable TLE (rTLE, n=32; lTLE, n=27) who underwent epilepsy surgery. We measured the gray matter volumes of planum temporale (PT) of each patients using the VoxelPlus2 program (Mevisys, Daejeon, Korea). Results : Overall congruence of the volumetric analysis with the Wada test was 97.75% in rTLE patients and 81.5% in lTLE patients. There were more significant leftward asymmetry of the PT in rTLE patients than lTLE patients. In lTLE patients, relatively high proportion (37%) of the patients showed bilateral or right hemispheric language dominance. Conclusion : These results provide evidence that the volumetric analysis of the PT could be used as an alternatives in language lateralization. Also, the results of the Wada test suggested that there was considerable plasticity of language representation in the brains of patients with intractable TLE and it was associated with an earlier age of brain injury.

• Progress in Medical Physics
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• v.9 no.3
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• pp.127-136
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• 1998

On-line geometrical quality assurance system has been developed using electronic portal imaging system(OQuE). EPID system is networked into Pentium PC in order to transmit the acquisited images to analysis PC. Geometrical QA parameters, including light-radiation field congruence, collimator rotation axis, and gantry rotation axis can be easily analyzed with the help of graphic user interface(GUI) software. Equipped with the EPID (Portal Vision, Varian, USA), geometrical quality assurance of a linear accelerator (CL/2100/CD, Varian, USA), which is networked into OQuE, was performed to evaluate this system. Light-radiation field congruence tests by center of gravity analysis shows 0.2～0.3mm differences for various field sizes. Collimator (or Gantry) rotation axis for various angles could be obtained by superposing 4 shots of angles. The radius of collimator rotation axis is measured to 0.2mm for upper jaw collimator, and 0.1mm for lower jaw. Acquisited images for various gantry angles were rotated according to the gantry angle and actual center of image point obtained from collimator axis test. The rotated images are superpositioned and analyzed as the same method as collimator rotation axis. The radius of gantry rotation axis is calculated 0.3mm for anterior/posterior direction (gantry 0$^{\circ}$ and 170$^{\circ}$) and 0.7mm for right/left direction(gantry 90$^{\circ}$ and 260$^{\circ}$). Image acquisition for data analysis is faster than conventional method and the results turn out to be excellent for the development goal and accurate within a milimeter range. The OQuE system is proven to be a good tool for the geometrical quality assurance of linear accelerator using EPID.