• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.74-83
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• 2022

Objective : Oblique lumbar interbody fusion (OLIF) is a surgical technique that utilizes a large interbody cage to indirectly decompress neural elements. The position of the cage relative to the vertebral body could affect the degree of foraminal decompression. Previous studies determined the position of the cage using plain radiographs, with conflicting results regarding the influence of the position of the cage to the degree of neural foramen decompression. Because of the cage obliquity, computed tomography (CT) has better accuracy than plain radiograph for the measurement of the obliquely inserted cage. The objective of this study is to find the correlation between the position of the OLIF cage with the degree of indirect decompression of foraminal stenosis using CT and magnetic resonance imaging (MRI). Methods : We review imaging of 46 patients who underwent OLIF from L2-L5 for 68 levels. Segmental lordosis (SL) was measured in a plain radiograph. The positions of the cage were measured in CT. Spinal canal cross-sectional area (SCSA), and foraminal crosssectional area (FSCA) measurements using MRI were taken into consideration. Results : Patients' mean age was 69.7 years. SL increases 3.0±5.1 degrees. Significant increases in SCSA (33.3%), FCSA (43.7% on the left and 45.0% on the right foramen) were found (p<0.001). Multiple linear regression analysis shows putting the cage in the more posterior position correlated with more increase of FSCA and decreases SL correction. The position of the cage does not affect the degree of the central spinal canal decompression. Obliquity of the cage does not result in different degrees of foraminal decompression between right and left side neural foramen. Conclusion : Cage position near the posterior part of the vertebral body increases the decompression effect of the neural foramen while putting the cage in the more anterior position correlated with increases SL.

• Progress in Medical Physics
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• v.32 no.4
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• pp.99-106
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• 2021

Purpose: In this study, we aimed to manufacture a patient-specific gel phantom combining three-dimensional (3D) printing and polymer gel and evaluate the radiation dose and dose profile using gel dosimetry. Methods: The patient-specific head phantom was manufactured based on the patient's computed tomography (CT) scan data to create an anatomically replicated phantom; this was then produced using a ColorJet 3D printer. A 3D polymer gel dosimeter called RTgel-100 is contained inside the 3D printing head phantom, and irradiation was performed using a 6 MV LINAC (Varian Clinac) X-ray beam, a linear accelerator for treatment. The irradiated phantom was scanned using magnetic resonance imaging (Siemens) with a magnetic field of 3 Tesla (3T) of the Korea Institute of Nuclear Medicine, and then compared the irradiated head phantom with the dose calculated by the patient's treatment planning system (TPS). Results: The comparison between the Hounsfield unit (HU) values of the CT image of the patient and those of the phantom revealed that they were almost similar. The electron density value of the patient's bone and brain was 996±167 HU and 58±15 HU, respectively, and that of the head phantom bone and brain material was 986±25 HU and 45±17 HU, respectively. The comparison of the data of TPS and 3D gel revealed that the difference in gamma index was 2%/2 mm and the passing rate was within 95%. Conclusions: 3D printing allows us to manufacture variable density phantoms for patient-specific dosimetric quality assurance (DQA), develop a customized body phantom of the patient in the future, and perform a patient-specific dosimetry with film, ion chamber, gel, and so on.

• Korean Journal of Radiology
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• v.22 no.2
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• pp.168-178
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• 2021

Objective: To provide an automatic method for segmentation and diameter measurement of type B aortic dissection (TBAD). Materials and Methods: Aortic computed tomography angiographic images from 139 patients with TBAD were consecutively collected. We implemented a deep learning method based on a three-dimensional (3D) deep convolutional neural (CNN) network, which realizes automatic segmentation and measurement of the entire aorta (EA), true lumen (TL), and false lumen (FL). The accuracy, stability, and measurement time were compared between deep learning and manual methods. The intra- and inter-observer reproducibility of the manual method was also evaluated. Results: The mean dice coefficient scores were 0.958, 0.961, and 0.932 for EA, TL, and FL, respectively. There was a linear relationship between the reference standard and measurement by the manual and deep learning method (r = 0.964 and 0.991, respectively). The average measurement error of the deep learning method was less than that of the manual method (EA, 1.64% vs. 4.13%; TL, 2.46% vs. 11.67%; FL, 2.50% vs. 8.02%). Bland-Altman plots revealed that the deviations of the diameters between the deep learning method and the reference standard were -0.042 mm (-3.412 to 3.330 mm), -0.376 mm (-3.328 to 2.577 mm), and 0.026 mm (-3.040 to 3.092 mm) for EA, TL, and FL, respectively. For the manual method, the corresponding deviations were -0.166 mm (-1.419 to 1.086 mm), -0.050 mm (-0.970 to 1.070 mm), and -0.085 mm (-1.010 to 0.084 mm). Intra- and inter-observer differences were found in measurements with the manual method, but not with the deep learning method. The measurement time with the deep learning method was markedly shorter than with the manual method (21.7 ± 1.1 vs. 82.5 ± 16.1 minutes, p < 0.001). Conclusion: The performance of efficient segmentation and diameter measurement of TBADs based on the 3D deep CNN was both accurate and stable. This method is promising for evaluating aortic morphology automatically and alleviating the workload of radiologists in the near future.

• Journal of the Korean Society of Radiology
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• v.81 no.3
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• pp.591-603
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• 2020

Purpose The purpose of this study was to describe the clinical features and chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods An Institutional Review Board-approved retrospective review was performed for 51 laboratory-confirmed COVID-19 pneumonia patients. Patients were divided into two groups depending on their clinical status: mild and severe. Clinical characteristics and chest CT findings were compared between the two groups. Results Among the 51 patients (22 men, 29 women; mean age, 56.5 ± 16 years; range, 22-88 years), 37 (72.5%) were in the mild group and 14 (27.5%) were in the severe group. The patients in the severe group (68.7 ± 12.5 years) were older than the patients in the mild group (51.8 ± 14.9 years, p < 0.001). Premorbid conditions and decreased lymphocyte counts were more often observed in the severe group than in the mild group (71% vs. 41%, p = 0.049 and 86% vs. 32%, p = 0.001, respectively). On chest CT, most patients exhibited a mixed ground-glass opacification (GGO) with consolidation (76%) or a GGO (22%) pattern. The majority of lesions were predominantly bilateral in the lower lung with a posterior, peripheral distribution. The patients in the severe group had higher severity scores than those in the mild group. Conclusion Patients with laboratory-confirmed COVID-19 pneumonia have typical chest CT findings that provide important information regarding expected disease severity.

• Journal of the Korean Society of Radiology
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• v.83 no.5
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• pp.1168-1174
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• 2022

Immunoglobulin G4 (IgG4)-related disease is a rare systemic fibroinflammatory condition characterized by elevated serum IgG4 levels and infiltration of IgG4-positive plasma cells in various organs. IgG4-related lung disease shows varied radiologic features on chest CT. Patients usually present with a solid nodule or mass mimicking lung cancer; therefore, distinguishing between IgG4-related disease and other conditions is often challenging. Additionally, co-existing radiologic findings of IgG4-related lung disease may mimic metastasis or lymphangitic carcinomatosis of the lung. We report two cases of histopathologically confirmed IgG4-related lung disease mimicking lung cancer. Chest CT revealed a solid nodule or mass with ancillary radiologic findings, which suggested lung cancer; therefore, IgG4-related lung disease was radiologically indistinguishable from lung cancer in both cases. Measurement of serum IgG4 levels and clinical evaluation to confirm involvement of various organs may be useful to establish the differential diagnosis. However, surgical biopsy evaluation is needed for confirmation.

• Journal of the Korean Society of Radiology
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• v.81 no.2
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• pp.272-289
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• 2020

Current advances in CT techniques allow thorough evaluation of the beating heart. The strengths of cardiac CT relative to echocardiography and magnetic resonance imaging are its high availability in most institutions, rapid production of high-quality images, and outstanding delineation of the anatomy. For many normal variants and pathologic conditions, such as thrombi, masses, and congenital abnormalities of the left atrium, CT findings are sufficient to make a presumptive diagnosis. Assessments of the left atrium and left atrial appendage are particularly important for the management of atrial fibrillation, as various catheter-based procedures are aimed at the mechanical and electrical isolation of these structures. CT offers information crucial to a successful catheter-based procedure or surgery. Therefore, a comprehensive review of the geometry (shape, size, and relative position), along with various CT imaging features of pathologic states, should be provided in radiology reports to be of clinical value.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.1
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• pp.1-11
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• 2012

Purpose: The purpose of this study was to evaluate the bone regeneration capacity of silk fibroin (SF) when combined with beta tricalcium phosphate (${\beta}$-tricalcium phosphate [TCP]) and rh-bone morphogenetic protein (BMP) in vivo by micro-computed tomography (CT), soft x-ray, and histological analysis. Methods: A total of 56 critical size defects formed by a trephine bur made on 28 adult female Spague-Dawley rats were used for this study and the defect size was 5.0 mm in diameter. The defects were transplanted with (1) no graft material (raw defect), (2) autogenous bone, (3) SF ($10{\mu}g$), (4) SF-BMP ($10{\mu}g$, $0.8{\mu}g$ each), and (5) SF+${\beta}$-TCP ($10{\mu}g$). At 4 and 8 weeks after operation, the experimental animals were sacrificed. Samples were evaluated with soft x-ray, histological examinations and 3-dimensional micro-CT analysis. Results: In the 3-dimensional micro-CT evaluation, bone volume and bone surface data were higher in the SF-BMP ($12.8{\pm}1.5$, $138.6{\pm}45.0$ each) (P<0.05) and SF-TCP ($12.3{\pm}1.5$, $144.9{\pm}30.9$ each) group than in the SF group ($6.1{\pm}3.3$, $77.2{\pm}37.3$ each) (P<0.05), except for the autogenous group ($15.0{\pm}3.0$, $190.7{\pm}41.4$ each) at 4 weeks. At 8 weeks, SF-BMP ($16.8{\pm}3.5$, $173.9{\pm}34.2$ each) still revealed higher (P<0.05) bone volum and surface, but SF-TCP ($11.3{\pm}1.5$, $1132.9{\pm}52.1$ each) (P=0.5, P=0.2) revealed the same or lower amount compared with the SF group ($13.8{\pm}2.7$, $127.5{\pm}44.8$ each). The % of bone area determined by radiodensity was higher in the SF-TCP ($31.4{\pm}9.1%$) and SF-BMP ($36.2{\pm}16.2%$) groups than in the SF ($19.0{\pm}10.4$) group at the period of 4 weeks. Also, in the histological evaluation, the SF-BMP group revealed lower inflammation reaction, lower foreign body reaction and higher bone healing than the SF group at postoperative 4 weeks and 8 weeks. The SF-TCP group revealed lower inflammation at 4 weeks, but accordingly, as the TCP membrane was absorbed, inflammatory and foreign body reaction are increased at 8 weeks. Conclusion: The current study provides evidence that the silk fibrin can be used as an effective grafted material for tissue engineering bone generation through a combination of growth factor or surface treatment.

• Journal of the Korean Society of Radiology
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• v.7 no.1
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• pp.37-44
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• 2013

In study suggested clinical availability to shoulder forced traction method in term of quality of image, the patient's convenience and stability, according to whether to use of shoulder forced traction bend using computed tomography(CT) that X-ray calibration and various mathematic calibration algorithm application can be applied by AEC. To achieve this, 79 patients is complaining of cervical pain oriented that shoulder forced traction bend use the before and after acquires lateral projection scout image and transverse image. transverse image of a fixed size in concern field of pixel and figure the average HU value compare that quantitative analysis. Artifact and pixel and resolution to qualitative clinical estimation image analysis. the patient feel inconvenience degree that self-diagnosis survey that estimate. As a result, lateral projection scout image if you used shoulder forced traction bend for the depicted has been an increase in the number of a cervical vertebrae. transverse image concern field shoulder forced traction bend use the before and after for pixel and the average HU-value changes was judged to be almost irrelevant. Artifact and resolution and contrast, in qualitative analysis of the results relating the observer to the unusual result. So, the patients of 82.27% complained discomfort that use of shoulder forced traction bend in self-diagnosis survey. No merit of medical image by using of bend from result was analyzed quality of image to quantitative and qualitative method judged. Nowadays, CT is supplied possible revision of quality of radiation by reduction of slice and automatic exposure controller, etc and application of preconditioning filter process due to various mathematic revision algorithm. So, image noise by beam hardening artifact should not be a problem. shoulder forced traction bend of use no longer judged clinically availability because have not influence of image quality and give discomfort, have extra dangerousness.

• 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.

• Radiation Oncology Journal
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• v.24 no.4
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• pp.285-293
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• 2006

$\underline{Purpose}$: This study was to search the optimal slice thickness of computed tomography (CT) in an intensity modulated radiation therapy plan through changing the slice thickness and comparing the change of the calculated absorbed dose with measured absorbed dose. $\underline{Materials\;and\;Methods}$: An intensity modulated radiation therapy plan for a head and neck cancer patient was done, first of all. Then CT with various ranges of slice thickness ($0.125{\sim}1.0\;cm$) for a head and neck anthropomorphic phantom was done and the images were reconstructed. The plan parameters obtained from the plan of the head and neck cancer patient was applied into the reconstructed images of the phantom and then absorbed doses were calculated. Films were inserted into the phantom, and irradiated with 6 MV X-ray with the same beam data obtained from the head and neck cancer patient. Films were then scanned and isodoses were measured with the use of film measurement software and were compared with the calculated isodeses. $\underline{Results}$: As the slice thickness of CT decreased, the volume of the phantom and the maximum absorbed dose increased. As the slice thickness of CT changed from 0.125 to 1.0 cm, the maximum absorbed dose changed ${\sim}5%$. The difference between the measured and calculated volume of the phantom was small ($3.7{\sim}3.8%$) when the slice thickness of CT was 0.25 cm or less. The difference between the measured and calculated dose was small ($0.35{\sim}1.40%$) when the slice thickness of CT was 0.25 cm or less. $\underline{Conclusion}$: Because the difference between the measured and calculated dose in a head and neck phantom was small and the difference between the measured and calculated volume was small when the slice thickness of CT was 0.25 cm or less, we suggest that the slice thickness of CT should be 0.25 cm or less for an optimal intensity modulated radiation therapy plan.