• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.53-60
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• 2002

Motion of lung tumors from respiration has been reported in the literature to be as large as of 1-2 cm. This motion requires an additional margin between the Clinical Target Volume (CTV) and the Planning Target Volume (PTV). While such a margin is necessary, it may not be sufficient to ensure proper delivery of Intensity Modulated Radiotherapy (IMRT) to the CTV during the simultaneous movement of the DMLC. Gated treatment has been proposed to improve normal tissues sparing as well as to ensure accurate dose coverage of the tumor volume. The following questions have not been addressed in the literature: a) what is the dose error to a target volume without gated IMRT treatment\ulcorner b) what is an acceptable gating window for such treatment. In this study, we address these questions by proposing a novel technique for calculating the 3D dose error that would result if a lung IMRT plan were delivered without gating. The method is also generalized for gated treatment with an arbitrary triggering window. IMRT plans for three patients with lung tumor were studied. The treatment plans were generated with HELIOS for delivery with 6 MV on a CL2100 Varian linear accelerator with a 26 pair MLC. A CTV to PTV margin of 1 cm was used. An IMRT planning system searches for an optimized fluence map ${\Phi}$ (x,y) for each port, which is then converted into a dynamic MLC file (DMLC). The DMLC file contains information about MLC subfield shapes and the fractional Monitor Units (MUs) to be delivered for each subfield. With a lung tumor, a CTV that executes a quasi periodic motion z(t) does not receive ${\Phi}$ (x,y), but rather an Effective Incident Fluence EIF(x,y). We numerically evaluate the EIF(x,y) from a given DMLC file by a coordinate transformation to the Target's Eye View (TEV). In the TEV coordinate system, the CTV itself is stationary, and the MLC is seen to execute a motion -z(t) that is superimposed on the DMLC motion. The resulting EIF(x,y)is inputted back into the dose calculation engine to estimate the 3D dose to a moving CTV. In this study, we model respiratory motion as a sinusoidal function with an amplitude of 10 mm in the superior-inferior direction, a period of 5 seconds, and an initial phase of zero.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.49-56
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• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.121-125
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• 2005

Anemia can be defined as a reduction in blood hemoglobin concentration or red cell mass relative to age matched normal values. Clinical presentation may range from obviously pale and lethargy to an incidental finding during screening of an otherwise well appearing child. The differential diagnosis of anemia in each instance is broad with numerous possible etiologies. A careful history and physical examination as well as complete blood count, peripheral blood smear and additional laboratory tests are necessary in defining underlying cause of the anemia and guide in further treatment plans. In addition, Iron deficiency anemia and anemia of inflammation are common causes of mild to moderate anemia in children, but most pediatricians have some confusions to differentiate these two entities.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.21 no.2
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• pp.198-204
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• 1999

The treatment of cleft lip and palate patients requires multidisciplinary coorperation, and the involved clinicians rely on the completeness and accuracy of the patient's medical records in developing comprehensive treatment plans. There are so many classifications in cleft lip and palate but each classification has advantages and disadvantages. Furthermore there are few classification or assessment in secondary cleft lip and palate deformities. A modification of Kenahan's Y classification in primary cleft lip and palate and new classification in secondary cleft lip and palate deformities are proposed as a simple and reproducible method. These reproducible classification may be used to facilitate not only storing and analyzing of medical informations in computer but also the planning of secondary repairs

• Journal of the Korean Society of Environmental Restoration Technology
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• v.20 no.5
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• pp.59-66
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• 2017

Preeminent water treatment plans are essential to preserve the water quality of aquatic biotopes. Previous studies have not been sufficient to provide cost-effective maintenance method since they focused only on the purification of deteriorated water that requires a continuous supply of clean water. This study proposes an economical method of water quality maintenance using water treatment media block constructed vertically using porous ceramics, zeolite, and river pebble. The water treatment media block does not require a separate purification area because it functions as a purifier within the ecological pond which can maximize the biotope area. To evaluate the performance of the water treatment media block, we longitudinally tracked the change of water quality indicators (pH, TDS, COND, DO, T-P, T-N, COD) suggested by Water Environment Standards, Ministry of Environment, Republic of Korea. We compared the water quality of one control (A: general ecological pond composition method of the laminated structure) and two experimental groups (B: a combination of aquatic plants and a water treatment media block, C: a water treatment media block only). As a result, we confirmed that the water treatment media block is an efficient and economical method to maintaining the water quality of the ecological pond for a long time. The water treatment media block will be a great help in providing a better aquatic biotope space for aquatic insects and fishes living in clear water.

• Restorative Dentistry and Endodontics
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• v.49 no.1
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• pp.8.1-8.12
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• 2024

Objectives: The purpose of this study was to evaluate the effect of Dental Practicality Index (DPI) training using an online video on the treatment planning decisions and confidence level of dental undergraduates (DUs). Materials and Methods: Ninety-four DUs were shown 15 clinical case scenarios and asked to decide on treatment plans based on 4 treatment options. The most appropriate treatment plan had been decided by a consensus panel of experienced dentists. DUs then underwent DPI training using an online video. In a post-DPI-training test, DUs were shown the same clinical case scenarios and asked to assign the best treatment option. After 6 weeks, DUs were retested to assess their knowledge retention. In all 3 tests, DUs completed the confidence level scale questionnaire. Data were analyzed using the related-samples Wilcoxon signed rank test and the independent-samples Mann-Whitney U test with the level of significance set at p < 0.05. Results: DPI training significantly improved the mean scores of the DUs from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. Conclusions: Training DUs using DPI with an online video improved their decision-making and confidence level in treatment planning.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2004.11a
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• pp.126-129
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• 2004

We compared intensity-modulated radiotherapy (IMRT) treatment plans with commercially available multileaf collimators (MLCs) of different leaf width for intracranial lesions. Twelve cases previously treated with micro-MLCs(mMLCs) were replanned using the Varian 120 and 80 MLCs. These collimators have minimum leaf width of 3mm, 5 mm and 10 mm at isocenter, respectively. These three plans were compared with respect to the uniformity and the conformity indices, doses to normal tissue. For the uniformity index of planning target volume (PTV),there was no statistically significant difference between mMLCs with 120 MLCs (p = 0.06). However, there was a little difference between mMLCs with 80 MLCs (p = 0.001). Maximum target dose to the PTV showedno dependency with respect to the leaf width. On the contrary, there were statistically significant differences in the conformity indices between mMLCs and 120 MLCs (p = 0.003) and between mMLCs and 80 MLCs (p = 0.003).The volumetric increments for MLCs with leaf widths of 5 mm and 10 mm were 6.3% and 23.2% for the normal tissue Irradiated to = 50% dose, and 8.7% and 32.7% for the normal tissue Irradiated to = 70% dose, respectively, compared to the volume for MLCs with leaf width of 3 mm. This shows that for the sparing of normal tissue, MLCs with leaf width of 3 mm are more effective, compared to MLCs with leaf widths of 5 mm and 10 mm.

• Progress in Medical Physics
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• v.17 no.2
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• pp.114-122
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• 2006

The two commonly used methods in delivering intensity modulated radiation therapy (IMRT) plan are the dynamic (sliding window) and static (stop and shoot) mode. In this study, the two IMRI delivery techniques are compared by measuring point dose and dose distributions. Using treatment planning system, clinical target volume (CTV) was created as a sphere with various diameter (3 cm, 7 cm, 12 cm). Two IMRT plans were peformed to deliver 200 cGy to the CTV in dynamic and static mode. The two plans were delivered on a phantom and central point dose and dose distributions were measured. The central point dose differences between static and dynamic IMRT delivery were 0.2%, 0.2% and 0.4% when the diameter of CTV was 3 cm, 7 cm, and 12 cm, respectively. The differences In volume receiving 90% of the proscribed dose were 2.7%, 2.2%, and 2.9% for the diameter of CTV was 3 cm, 7 cm, and 12 cm, respectively. For lung cancer patients, the differences in central point dose were 0.2%, 0.2%, and 0.4% when the volume of CTV was 35.5 cc, 296.8 cc, and 903.5 cc, respectively. The differences in volume receiving 90% of the prescribed dose were 2.7%, 4.8%, and 9.1% when the volume of CTV was 35.5 cc, 296.8 cc, and 903.5 cc, respectively. In conclusion, it was possible to deliver IMRT plans using dynamic mode of MLC operation although the loaves are In motion during radiation delivery.

• Journal of radiological science and technology
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• v.39 no.2
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• pp.163-170
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• 2016

To evaluate whether the difference in geometrical characteristics between high-dose-rate (HDR) $^{192}Ir$ sources would influence the dose distributions of intracavitary brachytherapy. Two types of microSelectron HDR $^{192}Ir$ sources (classic and new models) were selected in this study. Two-dimensional (2D) treatment plans for classic and new sources were generated by using PLATO treatment planning system. We compared the point A, point B, and bladder and rectum reference points based on ICRU 38 recommendation. The radial dose function of the new source agrees with that of the classic source except difference of up to 2.6% at the nearest radial distance. The differences of anisotropy functions agree within 2% for r=1, 3, and 5 cm and $20^{\circ}$ < ${\theta}$ < $165^{\circ}$. The largest discrepancies of anisotropy functions reached up to 27% for ${\theta}$ < $20^{\circ}$ at r=0.25 cm and were up to 13%, 10%, and 7% at r=1, 3, and 5 cm for ${\theta}$ > $170^{\circ}$, respectively. There were no significant differences in doses of point A, point B, and bladder point for the treatment plans between the new and classic sources. For the ICRU rectum point, the percent dose difference was on average 0.65% and up to 1.0%. The dose discrepancies between two treatment plans are mainly affected due to the geometrical difference of the source and the sealed capsule.

• Progress in Medical Physics
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• v.24 no.3
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• pp.154-161
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• 2013

This study assessed compared photon and proton treatment techniques, such as intensity modulated radiation therapy (IMRT), uniform scanning proton therapy (USPT), and intensity modulated proton therapy (IMPT), for a total of 10 prostate cancers. All treatment plans delivered 70 Gy to 95% of the planned target volume in 28 fractions. IMRT plans had 7 fields for the step and shoot technique, while USPT and IMPT plans employed two equally weighted, parallel-opposed lateral fields to deliver the prescribed dose to the planned target. Inverse planning was then incorporated to optimize IMPT. The homogeneity index (HI) and conformity index (CI) for the target and the normal tissue complication probability (NTCP) for organ at risk (OAR) were calculated. Although the mean HI and CI for target were not significantly different for each treatment techniques, the NTCP of the rectum was 2.233, 3.326, and 1.707 for IMRT, USPT, and IMPT, respectively. The NTCP of the bladder was 0.008, 0.003, and 0.002 respectively. The NTCP values at the rectum and bladder were significantly lower using IMPT. Our study shows that using proton therapy, particularly IMPT, to treat prostate cancer could be beneficial compared to 7-field IMRT with similar target coverage. Given these results, radiotherapy using protons, particularly optimized IMPT, is a worthwhile treatment option for prostate cancer.