• Journal of International Society for Simulation Surgery
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• 제1권1호
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• pp.13-15
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• 2014

Nowadays, with advanced 3D printing techniques, the custom-made implant can be manufactured for the patient. Especially in skull reconstruction, it is difficult to design the implant due to complicated geometry. In large defect, an autograft is inappropriate to cover the defect due to donor morbidity. We present the process of manufacturing the 3D custom-made implant for skull reconstruction. There was one patient with skull defect repaired using custom-made 3D titanium implant in the plastic and reconstructive surgery department. The patient had defect of the left parieto-temporal area after craniectomy due to traumatic subdural hematoma. Custom-made 3D titanium implants were manufactured by Medyssey Co., Ltd. using 3D CT data, Mimics software and an EBM (Electron Beam Melting) machine. The engineer and surgeon reviewed several different designs and simulated a mock surgery on 3D skull model. During the operation, the custom-made implant was fit to the defect properly without dead space. The operative site healed without any specific complications. In skull reconstruction, autograft has been the treatment of choice. However, it is not always available and depends on the size of defect and donor morbidity. As 3D printing technique has been advanced, it is useful to manufacture custom-made implant for skull reconstruction.

• Biomaterials and Biomechanics in Bioengineering
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• 제3권1호
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• pp.47-57
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• 2016

Results from multiple high profile experiments on the parameters influencing the impacts that cause skull fractures to the frontal, temporal, and parietal bones were gathered and analyzed. The location of the impact as a binary function of frontal or lateral strike, the velocity, the striking area of the impactor, and the force needed to cause skull fracture in each experiment were subjected to statistical analysis using the JMP statistical software pack. A novel neural network model predicting skull fracture threshold was developed with a high statistical correlation ($R^2=0.978$) and presented in this text. Despite variation within individual studies, the equation herein proposes a 3 kN greater resistance to fracture for the frontal bone when compared to the temporoparietal bones. Additionally, impacts with low velocities (<4.1 m/s) were more prone to cause fracture in the lateral regions of the skull when compared to similar velocity frontal impacts. Conversely, higher velocity impacts (>4.1 m/s) showed a greater frontal sensitivity.

• 한국정보처리학회:학술대회논문집
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• 한국정보처리학회 2010년도 추계학술발표대회
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• pp.668-671
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• 2010

In this paper, we present a novel automatic algorithm for scalp and skull segmentation in T1-weighted head MR images. First, the scalp and skull part are constructed by using intensity threshold. Second, the scalp outer surface is extracted based on an active level set method. Third, the skull inner surface is extracted using a canny edge detection algorithm. Finally, the fast sweeping, tagging and level set methods are applied to reconstruct surfaces from the detected points in three-dimensional space. The results of the new segmentation algorithm on MRI data acquired from eight persons were compared with manual segmented data. The average similarity indices for the scalp and skull segmented regions were equal to 84.42% for the test data.

• Imaging Science in Dentistry
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• 제34권1호
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• pp.13-18
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• 2004

Purpose : This study was to evaluate the influence of slice thickness of computed tomography (CT) and rapid protyping (RP) type on the accuracy of 3-dimensional medical model. Materials and Methods: Transaxial CT data of human dry skull were taken from multi-detector spiral CT. Slice thickness were 1, 2, 3 and 4 mm respectively. Three-dimensional image model reconstruction using 3-D visualization medical software (V-works /sup TM/ 3.0) and RP model fabrications were followed. 2-RP models were 3D printing (Z402, Z Corp., Burlington, USA) and Stereolithographic Apparatus model. Linear measurements of anatomical landmarks on dry skull, 3-D image model, and 2-RP models were done and compared according to slice thickness and RP model type. Results: There were relative error percentage in absolute value of 0.97, 1.98,3.83 between linear measurements of dry skull and image models of 1, 2, 3 mm slice thickness respectively. There was relative error percentage in absolute value of 0.79 between linear measurements of dry skull and SLA model. There was relative error difference in absolute value of 2.52 between linear measurements of dry skull and 3D printing model. Conclusion: These results indicated that 3-dimensional image model of thin slice thickness and stereolithographic RP model showed relative high accuracy.

• Journal of Korean Neurosurgical Society
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• 제48권1호
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• pp.85-87
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• 2010

We experienced a rare case of solitary syphilitic osteomyelitis of the skull without any other clinical signs or symptoms of syphilis. A 20-year-old man was referred due to intermittent headache and mild tenderness at the right parietal area of the skull with a palpable coin-sized lesion of softened cortical bone. On radiological studies, the lesion was a radiolucent well enhanced mass (17 mm in diameter). The erythrocyte sedimentation rate (52 mm/h) and C-reactive protein (2.24 mg/dL) were elevated on admission. Serum venereal disease research laboratory (VDRL) and Treponema pallidum haemagglutination assay (TPHA) tests were positive. There were no clinical signs or symptoms of syphilis. After treatment with benzathine penicillin, we removed the lesion and performed cranioplasty. The pathologic finding of the skull lesion was fibrous proliferation with lymphoplasmocytic infiltration forming an osteolytic lesion. In addition, a spirochete was identified using the Warthin-starry stain. The polymerase chain reaction study showed a positive band for Treponema pallidum. Solitary osteomyelitis of the skull can be the initial presenting pathological lesion of syphilis.

• 대한수의학회지
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• 제34권4호
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• pp.705-714
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• 1994

This study was carried out to identify the craniometric characteristics of the skull of Korean native goat. The results were as follows; The skull index, cranial index, facial index, right orbital index and left orbital index were $55.86{\pm}2.14$, $59.97{\pm}3.68$, $107.03{\pm}5.71$, $92.22{\pm}4.54$and $90.47{\pm}5.48$, respectively. The ratio of facial length to cranial length was 1:1.15 and the ratio of length of cranial base to palatal length was 1:1.35. The skull length was more correlated to the facial length than to the cranial length(p<0.01). The skull width was more correlated to the width between foramina supraorbitales than to the width between foramina infraorbitales. It also showed negative correlation to the medial width between bases of processus cornualis but positive correlation to the lateral width between bases of processus cornualis(p<0.01). The width between tips of both horns showed high positive correlation to the medial width between processus cornualis, but negative correlation to the lateral width(p<0.01).

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.39.1-39.6
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• 2015

Skull-base osteomyelitis is a rare disease affecting the medulla of the temporal, sphenoid, and occipital bones. In general, it occurs due to external ear canal infections caused by malignant external otitis. Skull-base osteomyelitis usually affects elderly diabetic patients. The patient, a 58-year-old man, was referred for evaluation and management of the left jaw. Clinical examination of the patient revealed pain in the left jaw and mouth-opening deflection to the left. The maximum active mouth opening was measured to about 27 mm. Panoramic, CT, and CBCT revealed bone resorption patterns in the left condyle. Through control of diabetes, continued pharmacological treatment, arthrocentesis, and occlusal stabilization appliance therapy were carried out. The extent of active mouth opening was increased to 45 mm, and pain in the left jaw joint was alleviated. This was a case wherein complications caused by failure to control diabetes induced skull-base osteomyelitis. There is a need for continued discussion about the advantages and disadvantages of arthrocentesis with lavage for patients with skull-base osteomyelitis and other treatment options.

• 한국방사선학회논문지
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• 제11권5호
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• pp.387-392
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• 2017

영 유아는 사건, 사고 및 교통사고 또는 질병으로 인해 머리에 골절 및 혈관파열, 피부에 상처를 받아 병원에 내원하여 영상의학과에서 머리 검사인 전 후(Skull AP) 및 측면(Skull LAT) 촬영을 받게 된다. 머리검사에서 성인 머리(Skull) 촬영은 격자를 이용하여 촬영에 적용하면 방사선 2차선을 제거하여 영상의 대조도를 높인다. 그러나 방사선 노출조건 중 관전압을 8~10 kVp 높게 주어야 하며 환자피폭이 증가한다. 본 연구는 영 유아 머리촬영시 격자(grid)를 이용하지 않고 동등한 영상을 얻을 수 있다면 피폭선량 감소 및 Grid Cut off에 의한 아티팩트를 방지할 수 있어 연구해 보았다. 연구자는 방사선계측기 이용 방사선선량을 측정 하고 의료영상평가 방법 중에서 주관적 평가(ROC,receiver operationg characteristic)을 해 보았다. 결과에서 격자를 이용하지 않고 촬영하면 환자 피폭선량 감소와 영상 평가에서도 영 유아의 머리 촬영시 격자를 이용하지 않고 촬영을 하게 되면 머리 전 후촬영에서 0.019 mGy 와 측면촬영 0.02 mGy 피폭선량 감소가 있었고 영상평가에서도 4점을 높게 받았다. 결론으로 병원에 내원한 영 유아 머리촬영은 격자를 이용하지 않고 촬영하면 피폭 선량 감소 및 영상 아티팩트인 Grid Cut off을 방지 할 수 있고 엑스선관 수명이 연장되리라 사료된다.

• Archives of Plastic Surgery
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• 제39권2호
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• pp.118-123
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• 2012

Background : An area of the skull exposed by burn injury has been covered by various methods including local flap, skin graft, or free flap surgery. Each method has disadvantages, such as postoperative alopecia or donor site morbidities. Due to the risk of osteomyelitis in the injured skull during the expansion period, tissue expansion was excluded from primary reconstruction. However, successful primary reconstruction was possible in burned skull by tissue expansion. Methods : From January 2000 to 2011, tissue expansion surgery was performed on 10 patients who had sustained electrical burn injuries. In the 3 initial cases, removal of the injured part of the skull and a bone graft was performed. In the latter 7 cases, the injured skull tissue was preserved and covered with a scalp flap directly to obtain natural bone healing and bone remodeling. Results : The mean age of patients was $49.9{\pm}12.2$ years, with 8 male and 2 female. The size of the burn wound was an average of $119.6{\pm}36.7cm^2$. The mean expansion duration was $65.5{\pm}5.6$ days, and the inflation volume was an average of $615{\pm}197.6mL$. Mean defect size was $122.2{\pm}34.9cm^2$. The complications including infection, hematoma, and the exposure of the expander were observed in 4 cases. Nonetheless, only 1 case required revision. Conclusions : Successful coverage was performed by tissue expansion surgery in burned skull primarily and no secondary reconstruction was needed. Although the risks of osteomyelitis during the expansion period were present, constant coverage of the injured skull and active wound treatment helped successful primary reconstruction of burned skull by tissue expansion.

• 한국산학기술학회논문지
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• 제12권7호
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• pp.3117-3122
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• 2011

머리부 전후방향촬영은 종래의 증감지-필름 방사선촬영보다 디지털방사선촬영 시 입사표면선량(ESD)이 훨씬 높다. 따라서 본 연구의 목적은 부가필터를 사용하여 환자의 피폭선량을 줄이기 위한 것이다. 본 연구에서는 머리부 팬톰을 이용하여 머리부 전후방향촬영 시 부가여과판의 두께에 따른 선량 감소효과를 알아보았고, 동시에 부가여과판 사용에 따른 영상의 질적 저하의 평가를 위한 실험을 진행하였다. 선량측정은 머리부 팬톰을 머리부 전후방향촬영자 세로 위치시켜 입사표면선량과 투과선량을 0.1 mmAl으로부터 0.5 mmCu+2.0 mmAl까지 16종류의 부가여과판을 바꾸어 가며 측정하였다. 영상의 화질 평가를 위해서 총 17매의 영상을 촬영하였고 촬영된 영상은 영상의학과 전문의에게 평가를 의뢰하였다. 그 결과 부가여과판 중 0.2 mmCu+1.0 mmAl의 복합여과판을 사용한 부가여과판까지 진단적 가치가 있는 영상을 얻었고, 이 때 머리부 팬톰에 입사표면선량은 약 0.6 mGy이었다. 이 값은 국제원자력기구(IAEA)에서 권고하고 있는 머리부 후전방향촬영 시 입사표면선량 5 mGy의 12%에 불과하였다. 따라서 검사부위에 따라 적정한 부가여과판의 사용으로 환자의 피폭선량을 상당히 감소시키는 효과를 얻을 수 있다.