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The Usefulness of Mammography and Scintimammography in Differential Diagnosis of Breast Tumor (유방 종괴에서 악성 감별을 위한 유방촬영술과 유방스캔의 유용성 연구)

  • Kang, Bong-Joo;Chung, Young-An;Jung, Hyun-Seok;Jung, Jung-Im;Yoo, Ie-Ryung;Kim, Sung-Hoon;Sohn, Hyung-Sun;Chung, Soo-Kyo;Hahn, Seong-Tai;Lee, Jae-Mun
    • The Korean Journal of Nuclear Medicine
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    • v.38 no.6
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    • pp.492-497
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    • 2004
  • Purpose: it is very important to differentiate breast cancer from benign mass. There are many reports to evaluate the differential diagnosis under the several diagnostic tools. We evaluated the usefulness of mammography and Tc-99m MIBI scintimammography in the differential diagnosis of breast mass and correlated with pathologic findings. Materials and Methods: This study included 80 patients (a8e: 24-72, mean: 48.4) who underwent mammography and Tc-99m MIBI scintimammography for breast masses. Scintimammographies (anterior-posterior and lateral projections) were acquired in 10 minutes and 2 hours after intravenous injection of Tc-99m MIBI. four specialists in diagnostic radioloay and nuclear medicine evaluated the findings of breast masses under the mammography and Tc-99m MIBI scintimammography, and calculated the tumor to background (T/B) ratio. The pathologic results were obtained and we statistically analyzed the correlations between pathologic results and imaging findings under the mammography and Tc-99m MIBI scintimammography by chi-square and correlation test. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of mammography for detection of breast cancer were 87.5%, 56.3%, 75.0%), and 75.0% respectively. 45 cases of 80 patients were suspicious for breast cancer under the Tc-99m MIBI scintimammography. 41 cases of 45 patients were confirmed as breast cancer and the remaining 4 cases were confirmed as benign masses. The sensitivity, specificity, positive predictive value and negative predictive value of Tc-99m MIBI scintimammography for detection of breast cancer were 85.4%, 87.5%, 91.1%, and 80.8% respectively. The sensitivity of scintimammography was lower than that of mammography for detection of breast cancer, however the specificity, positive predictive value, and negative predictive value were higher. In the benign mass, the mean T/B ratio in 10 minutes was $1.409{\pm}0.30$, and that in 2 hours was $1.267{\pm}0.42$. The maximal T/B ratio of benign mass in 10 minutes was $1.604{\pm}0.42$, and that in 2 hours was $1.476{\pm}0.50$. In the malignant mass, the mean T/B ratio in 10 minutes was $2.220{\pm}1.07$, and that in 2 hours was $1.842{\pm}0.75$. The maximal T/B ratio of malignant mass was $2.993{\pm}1.94$, and that in 2 hours was $2.480{\pm}1.34$. And the T/B ratio under the early and delayed images were meaningful. Conclusion: The scintimammography is useful diagnostic tool to differentiate breast cancer from benign mass, although the sensitivity of mammography for detection of breast mass is high. Especially, the use of the T/B ratio is helpful to diagnose breast cancer.

A Study on the Clustering Method of Row and Multiplex Housing in Seoul Using K-Means Clustering Algorithm and Hedonic Model (K-Means Clustering 알고리즘과 헤도닉 모형을 활용한 서울시 연립·다세대 군집분류 방법에 관한 연구)

  • Kwon, Soonjae;Kim, Seonghyeon;Tak, Onsik;Jeong, Hyeonhee
    • Journal of Intelligence and Information Systems
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    • v.23 no.3
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    • pp.95-118
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    • 2017
  • Recent centrally the downtown area, the transaction between the row housing and multiplex housing is activated and platform services such as Zigbang and Dabang are growing. The row housing and multiplex housing is a blind spot for real estate information. Because there is a social problem, due to the change in market size and information asymmetry due to changes in demand. Also, the 5 or 25 districts used by the Seoul Metropolitan Government or the Korean Appraisal Board(hereafter, KAB) were established within the administrative boundaries and used in existing real estate studies. This is not a district classification for real estate researches because it is zoned urban planning. Based on the existing study, this study found that the city needs to reset the Seoul Metropolitan Government's spatial structure in estimating future housing prices. So, This study attempted to classify the area without spatial heterogeneity by the reflected the property price characteristics of row housing and Multiplex housing. In other words, There has been a problem that an inefficient side has arisen due to the simple division by the existing administrative district. Therefore, this study aims to cluster Seoul as a new area for more efficient real estate analysis. This study was applied to the hedonic model based on the real transactions price data of row housing and multiplex housing. And the K-Means Clustering algorithm was used to cluster the spatial structure of Seoul. In this study, data onto real transactions price of the Seoul Row housing and Multiplex Housing from January 2014 to December 2016, and the official land value of 2016 was used and it provided by Ministry of Land, Infrastructure and Transport(hereafter, MOLIT). Data preprocessing was followed by the following processing procedures: Removal of underground transaction, Price standardization per area, Removal of Real transaction case(above 5 and below -5). In this study, we analyzed data from 132,707 cases to 126,759 data through data preprocessing. The data analysis tool used the R program. After data preprocessing, data model was constructed. Priority, the K-means Clustering was performed. In addition, a regression analysis was conducted using Hedonic model and it was conducted a cosine similarity analysis. Based on the constructed data model, we clustered on the basis of the longitude and latitude of Seoul and conducted comparative analysis of existing area. The results of this study indicated that the goodness of fit of the model was above 75 % and the variables used for the Hedonic model were significant. In other words, 5 or 25 districts that is the area of the existing administrative area are divided into 16 districts. So, this study derived a clustering method of row housing and multiplex housing in Seoul using K-Means Clustering algorithm and hedonic model by the reflected the property price characteristics. Moreover, they presented academic and practical implications and presented the limitations of this study and the direction of future research. Academic implication has clustered by reflecting the property price characteristics in order to improve the problems of the areas used in the Seoul Metropolitan Government, KAB, and Existing Real Estate Research. Another academic implications are that apartments were the main study of existing real estate research, and has proposed a method of classifying area in Seoul using public information(i.e., real-data of MOLIT) of government 3.0. Practical implication is that it can be used as a basic data for real estate related research on row housing and multiplex housing. Another practical implications are that is expected the activation of row housing and multiplex housing research and, that is expected to increase the accuracy of the model of the actual transaction. The future research direction of this study involves conducting various analyses to overcome the limitations of the threshold and indicates the need for deeper research.

Postoperstive Chemoradiotherapy in Locally Advanced Rectal Cancer (국소 진행된 직장암에서 수술 후 화학방사선요법)

  • Chai, Gyu-Young;Kang, Ki-Mun;Choi, Sang-Gyeong
    • Radiation Oncology Journal
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    • v.20 no.3
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    • pp.221-227
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    • 2002
  • Purpose : To evaluate the role of postoperative chemoradiotherapy in locally advanced rectal cancer, we retrospectively analyzed the treatment results of patients treated by curative surgical resection and postoperative chemoradiotherapy. Materials and Methods : From April 1989 through December 1998, 119 patients were treated with curative surgery and postoperative chemoradiotherapy for rectal carcinoma in Gyeongsang National University Hospital. Patient age ranged from 32 to 73 years, with a median age of 56 years. Low anterior resection was peformed in 59 patients, and abdominoperineal resection in 60. Forty-three patients were AJCC stage II and 76 were stage III. Radiation was delivered with 6 MV X rays using either AP-PA two fields, AP-PA both lateral four fields, or PA both lateral three fields. Total radiation dose ranged from 40 Gy to 56 Gy. In 73 patients, bolus infusions of 5-FU $(400\;mg/m^2)$ were given during the first and fourth weeks of radiotherapy. After completion of radiotherapy, an additional four to six cycles of 5-FU were given. Oral 5-FU (Furtulone) was given for nine months in 46 patients. Results : Forty $(33.7\%)$ of the 119 patients showed treatment failure. Local failure occurred in 16 $(13.5\%)$ patients, 1 $(2.3\%)$ of 43 stage II patients and 15 $(19.7\%)$ of 76 stage III patients. Distant failure occurred in 31 $(26.1\%)$ patients, among whom 5 $(11.6\%)$ were stage II and 26 $(34.2\%)$ were stage III. Five-year actuarial survival was $56.2\%$ overall, $71.1\%$ in stage II patients and $49.1\%$ in stage III patients (p=0.0008). Five-year disease free survival was $53.3\%$ overall, $68.1\%$ in stage II and $45.8\%$ in stage III (p=0.0006). Multivariate analysis showed that T stage and N stage were significant prognostic factors for five year survival, and that T stage, N stage, and preoperative CEA value were significant prognostic factors for five year disease free survival. Bowel complication occurred in 22 patients, and was treated surgically in 15 $(12.6\%)$, and conservatively in 7 $(5.9\%)$. Conclusion : Postoperative chemoradiotherapy was confirmed to be an effective modality for local control of rectal cancer, but the distant failure rate remained high. More effective modalities should be investigated to lower the distant failure rate.

Interlaboratory Comparison of Blood Lead Determination in Some Occupational Health Laboratories in Korea (일부 산업보건기관들의 혈중연 분석치 비교)

  • Ahn, Kyu Dong;Lee, Byung Kook
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.5 no.1
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    • pp.8-15
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    • 1995
  • The reliable measurement of metal in biological media in human body is one of critical indicators for the proper evaluation of its toxic effect on human health. Recently in Korea the necessity of quality assurance of measurement in occupational health and occupational hygiene fields brought out regulatory quality control program. Lead is often used as a standard metal for the program in both fields of occupational health and hygiene. During last 20 years lead poisoning was prevalent in Korea and still is one of main heavy metal poisoning and the capability of the measurement of blood lead is one of prerequisites for institute of specialized occupational health in Korea. Furthermore blood lead is most important indicator to evaluate lead burden of human exposure to lead and the reliable and accurate analysis is most needed whenever possible. To evaluate the extent of the interlaboratory differences of blood lead measurement in several well-known institute specialized in occupational health in Korea, authors prepared 68 blood samples from two storage battery industries and all samples were divided into samples with 2 ml. One set of 68 samples were analyzed by authors's laboratory(Soonchunhyang University Institute of Industrial Medicine: SIIM) and 40 samples of other set were analyzed by C University Institute of Industrial Medicine(CIIM) and the rest 28 samples of other set were analyzed by Japanese institute(K Occupational Health Center:KOHC). Authors also prepared test bovine samples which were obtained from Japanese Federation of Occupational Health Organization (JFOHO) for quality control. Authors selected 2 other well-known occupational health laboratories and one laboratory specialized for instrumental analysis. A total of 6 laboratories joined the interlaboratory comparison of blood lead measurement and the results obtained were as follows: 1. There was no significant difference in average blood lead between SIIM and CIIM in different group of blood lead concentration, and the relative standard deviation of two laboratories was less than 3.0%. On the other hand, there was also no significant difference of average blood lead between SIIM and KOHC with relative standard deviation of 6.84% as maximum. 2. Taking less than 15% difference of mean or less than 6 ug/dl difference in below 40 ug/dl in whole blood as a criteria of agreement of measurement between two laboratories, agreement rates were 87.5%(35/40) and 78.6%(22/28) between SIIM and CIIM, SIIM and KOHC respectively. 3. The correlation of blood lead between SIIM and CIIM was 0.975 (p=0.0001) and the regression equation was SIIM = 2.19 + 0.9243 ClIM, whereas the correlation between SUM and KOHC was O.965(p=0.0001) with the equation of SIIM = 1.91 + 0.9794 KOHC. 4. Taking the reference value as a dependent variable and each of 6 laboratories's measurement value as a independent variable, the determination coefficient($R^2$) of simple regression equations of blood lead measurement for bovine test samples were very high($R^2>0.99$), and the regression coefficient(${\beta}$) was between 0.972 and 1.15 which indicated fairly good agreement of measurement results.

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The Significance of 24-Hour Esophageal pH Monitoring in Children with Recurrent Vomiting or Regurgitation (반복성 구토 또는 역류증 환아에서 24시간식도 산도 측정의 의의)

  • Lee, So-Hyun;Lee, Chang-Han;Chung, Ki-Sup
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.2 no.2
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    • pp.139-146
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    • 1999
  • Purpose: The aim of this study was to evaluate the clinical significance of 24 hour pH monitoring in the pediatric patients with recurrent vomiting or regurgitation. Methods: We performed 24 hour pH monitoring on 87 pediatric patients with recurrent vomiting or regurgitation using GastrograpH with glass electrode. The pathologic GER was determined by the reflux index (RI). RIs>10% were considered positive in patients <1 year of age, whereas RIs of >5% were positive in other age groups. We evaluated the mean and standard deviation of the reflux parameters between physiologic and pathologic GER groups, and also compared the reflux indices of each group with respect to time zones of the day. Results: Pathologic GER was found in 32 of 87 patients (36.8%), and the age incidence included 32.5% in infants <6 months old, 13.3% in infants aged 6 months-1 year old, 61.5% in children aged 1~2 years old, 14.3% in children aged 2~3 years old and 66.7% in children >3 years old. In physiologic GER patients, the RI was $3.7{\pm}2.9%$ for the patients <1 year old (group A), and $1.8{\pm}1.5%$ for those ${\geq}1$ year old (group B) which was statistically significant between the 2 age groups (p=0.02). The number of long refluxes more than 5 minutes was significantly increased (p=0.03) in group A ($1.7{\pm}1.9$) than in group B ($0.8{\pm}1.0$). The duration of the longest reflux was significantly longer (p=0.007) in group A ($604{\pm}551$ sec) than in group B ($275{\pm}296$ sec). In pathologic GER patients, the RI was $17.7{\pm}11.6%$ for the patients <1 year old and $7.8{\pm}2.9$ for those ${\geq}1$ year old. The number of long refluxes of more than 5 minutes were $8.9{\pm}4.6$ and $3.2{\pm}1.8$, and the duration of the longest reflux were $1955{\pm}2190$ sec and $1093{\pm}706$ sec for each age group. In both physiologic and pathologic GER patients, there was no significant difference of RI among the time zones of the day. Conclusion: Pathologic GER was found in 36.8% of patients. There was significant difference of RI between those <1 year old and those ${\geq}1$ year old in physiologic GER patients. There was no significant difference of RI among the time zones of the day in both pathologic and physiologic groups. In our study, the frequency of pathplogic GER was too much higher in age group of 1~2 years old (61.5%) than in group of 6 months-1 year old (13.3%), which means that further study is needed to determine the pathologic criteria of RI (Vandenplas criteria is >5%) in the age group of 1~2 years old.

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Field Survey on Pig Slurry Utilization for Crop Cultivation in the Agricultural Farm (양돈분뇨 액비를 이용한 경종농가의 작물재배 실태조사)

  • Choi, D.Y.;Noh, J.S.;Lee, S.C.;Kim, H.N.;Ahn, K.J.;Cho, I.K.
    • Journal of Animal Environmental Science
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    • v.12 no.3
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    • pp.141-150
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    • 2006
  • To optimise the efficient use of nutrients in pig slurry is to cultivate friendly environmental crops. This field survey is to investigate the actual conditions of pig slurry utilization for cultivation of crops in the agricultural farm, based on the survey for 407 selected farms in 9 provinces included 78 counties in Korea. The results obtained in this survey were summarized as follow ; The motive which came to use pig slurry in the agricultural farm were production of friendly environmental crops (29.7%), economy of chemical fertilizer (25.1%), spontaneously (19.2%), inducement of neighboring farmhouse (16.0%), increase of soil fertility (9.3%), and the others (0.7%), respectively. The proportions of pig slurry application land were 56.5% for.ice paddy, 22.6% for dry field, 13.3% for orchard, 4.4% for controlled agriculture and 3.2% for other, respectively. The number of times of pig slurry utilization per year were once (48.9%), twice (31.9%), thrice (14.0%), and the others (5.2%), respectively. The controversial points of pig slurry utilization were malodor (54.1%), insufficiency of spread equipment (22.1%), inconvenience (14.5%), over application (3.4%), over cost (2.9%), heavy metal (1.7%), sanitation (1.0%) and the other (0.2%), respectively. The results indicated that pig slurry could be used as fertilizer source of friendly environmental crops, but further studies are needed to determine the application method and value of the pig slurry for crop cultivation.

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The Content and Risk Assessment of Heavy Metals in Herbal Pills (유통 환제의 유해 중금속 함량 및 위해도 평가)

  • Lee, Sung-Deuk;Lee, Young-Ki;Kim, Moo-Sang;Park, Seok-Ki;Kim, Yeon-Sun;Chae, Young-Zoo
    • Journal of Food Hygiene and Safety
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    • v.27 no.4
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    • pp.375-387
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    • 2012
  • The objective of this study is investigation of contamination levels and assessment of health risk effects of heavy metals in herbal pills. 31 Items and 93 samples were obtained for this investigation from major herbal medicine producing areas, herbal markets and on-line supermarkets from Jan to Jun in 2010. Inductively coupled plasma mass spectrometer method was conducted for the quantitative analysis of Pb, Cd and As. In addition, the mercury analyzer system was conducted for that of Hg without sample digestion. The average contents of heavy metals in samples were as follows : 0.87 mg/kg for Pb, 0.08 mg/kg for Cd, 2.87 mg/kg for As and 0.16 mg/kg for Hg, respectively. In addition, the average contents of heavy metals in different parts of plants, including cortex, fructus, herba, radix, seed, algae and others were 0.63 mg/kg, 3.94 mg/kg, 1.42 mg/kg, 1.05 mg/kg, 0.16 mg/kg, 22.31 mg/kg and 10.17 mg/kg, respectively. After the estimations of dietary exposure, the acceptable daily intake (ADI), the average daily dose (ADD), the provisional tolerable weekly intake (PTWI) and the relative hazard of heavy metals were evaluated. As the results, the relative hazards compared to PTWI in samples were below the recommended standard of JECFA as Pb 3.1%, Cd 0.9%, Hg 0.5%. Cancer risks through slope factor (SF) by Ministry of Environment Republic Korea and Environmental Protection Agency was $4.24{\times}10^{-7}$ for Pb and $3.38{\times}10^{-4}$ for As (assuming that the total arsenic content was equal to the inorganic arsenic). Based on our results, possible Pb-induced cancer risks in herbal pills according to parts used including cortex, fructus, herba, radix, seed, algae and others were $1.95{\times}10^{-7}$, $1.45{\times}10^{-6}$, $2.14{\times}10^{-7}$, $6.27{\times}10^{-7}$, $1.99{\times}10^{-8}$, $3.61{\times}10^{-7}$ and $9.64{\times}10^{-8}$, respectively. Possible As-induced cancer risks in herbal pills by parts used including cortex, fructus, herba, radix, seed, algae and others were $1.54{\times}10^{-5}$, $7.24{\times}10^{-5}$, $1.23{\times}10^{-4}$, $2.02{\times}10^{-5}$, $3.25{\times}10^{-6}$, $2.18{\times}10^{-3}$ and $5.67{\times}10^{-6}$ respectively. Taken together, these results indicate that the majority of samples except for some samples with relative high contents of heavy metals were safe.

Risk Analysis of Arsenic in Rice Using by HPLC-ICP-MS (HPLC-ICP-MS를 이용한 쌀의 비소 위해도 평가)

  • An, Jae-Min;Park, Dae-Han;Hwang, Hyang-Ran;Chang, Soon-Young;Kwon, Mi-Jung;Kim, In-Sook;Kim, Ik-Ro;Lee, Hye-Min;Lim, Hyun-Ji;Park, Jae-Ok;Lee, Gwang-Hee
    • Korean Journal of Environmental Agriculture
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    • v.37 no.4
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    • pp.291-301
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    • 2018
  • BACKGROUND: Rice is one of the main sources for inorganic arsenic among the consumed crops in the world population's diet. Arsenic is classified into Group 1 as it is carcinogenic for humans, according to the IARC. This study was carried out to assess dietary exposure risk of inorganic arsenic in husked rice and polished rice to the Korean population health. METHODS AND RESULTS: Total arsenic was determined using microwave device and ICP-MS. Inorganic arsenic was determined by ICP-MS coupled with HPLC system. The HPLC-ICP-MS analysis was optimized based on the limit of detection, limit of quantitation, and recovery ratio to be $0.73-1.24{\mu}g/kg$, $2.41-4.09{\mu}g/kg$, and 96.5-98.9%, respectively. The inorganic arsenic concentrations of daily exposure (included in body weight) were $4.97{\times}10^{-3}$ (${\geq}20$ years old) $-1.36{\times}10^{-2}$ (${\leq}2$ years old) ${\mu}g/kg\;b.w./day$ (PTWI 0.23-0.63%) by the husked rice, and $1.39{\times}10^{-1}$ (${\geq}20$ years old) $-3.21{\times}10^{-1}$ (${\leq}2$ years old) ${\mu}g/kg\;b.w./day$ (PTWI 6.47-15.00%) by the polished rice. CONCLUSION: The levels of overall exposure to total and inorganic arsenic by the husked and polished rice were far lower than the recommended levels of The Joint FAO/WHO Expert Committee on Food Additives (JECFA), indicating of little possibility of risk.

Radiation Therapy Using M3 Wax Bolus in Patients with Malignant Scalp Tumors (악성 두피 종양(Scalp) 환자의 M3 Wax Bolus를 이용한 방사선치료)

  • Kwon, Da Eun;Hwang, Ji Hye;Park, In Seo;Yang, Jun Cheol;Kim, Su Jin;You, Ah Young;Won, Young Jinn;Kwon, Kyung Tae
    • The Journal of Korean Society for Radiation Therapy
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    • v.31 no.1
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    • pp.75-81
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    • 2019
  • Purpose: Helmet type bolus for 3D printer is being manufactured because of the disadvantages of Bolus materials when photon beam is used for the treatment of scalp malignancy. However, PLA, which is a used material, has a higher density than a tissue equivalent material and inconveniences occur when the patient wears PLA. In this study, we try to treat malignant scalp tumors by using M3 wax helmet with 3D printer. Methods and materials: For the modeling of the helmet type M3 wax, the head phantom was photographed by CT, which was acquired with a DICOM file. The part for helmet on the scalp was made with Helmet contour. The M3 Wax helmet was made by dissolving paraffin wax, mixing magnesium oxide and calcium carbonate, solidifying it in a PLA 3D helmet, and then eliminated PLA 3D Helmet of the surface. The treatment plan was based on Intensity-Modulated Radiation Therapy (IMRT) of 10 Portals, and the therapeutic dose was 200 cGy, using Analytical Anisotropic Algorithm (AAA) of Eclipse. Then, the dose was verified by using EBT3 film and Mosfet (Metal Oxide Semiconductor Field Effect Transistor: USA), and the IMRT plan was measured 3 times in 3 parts by reproducing the phantom of the head human model under the same condition with the CT simulation room. Results: The Hounsfield unit (HU) of the bolus measured by CT was $52{\pm}37.1$. The dose of TPS was 186.6 cGy, 193.2 cGy and 190.6 cGy at the M3 Wax bolus measurement points of A, B and C, and the dose measured three times at Mostet was $179.66{\pm}2.62cGy$, $184.33{\pm}1.24cGy$ and $195.33{\pm}1.69cGy$. And the error rates were -3.71 %, -4.59 %, and 2.48 %. The dose measured with EBT3 film was $182.00{\pm}1.63cGy$, $193.66{\pm}2.05cGy$ and $196{\pm}2.16cGy$. The error rates were -2.46 %, 0.23 % and 2.83 %. Conclusions: The thickness of the M3 wax bolus was 2 cm, which could help the treatment plan to be established by easily lowering the dose of the brain part. The maximum error rate of the scalp surface dose was measured within 5 % and generally within 3 %, even in the A, B, C measurements of dosimeters of EBT3 film and Mosfet in the treatment dose verification. The making period of M3 wax bolus is shorter, cheaper than that of 3D printer, can be reused and is very useful for the treatment of scalp malignancies as human tissue equivalent material. Therefore, we think that the use of casting type M3 wax bolus, which will complement the making period and cost of high capacity Bolus and Compensator in 3D printer, will increase later.

Usefulness of Abdominal Compressor Using Stereotactic Body Radiotherapy with Hepatocellular Carcinoma Patients (토모테라피를 이용한 간암환자의 정위적 방사선치료시 복부압박장치의 유용성 평가)

  • Woo, Joong-Yeol;Kim, Joo-Ho;Kim, Joon-Won;Baek, Jong-Geal;Park, Kwang-Soon;Lee, Jong-Min;Son, Dong-Min;Lee, Sang-Kyoo;Jeon, Byeong-Chul;Cho, Jeong-Hee
    • The Journal of Korean Society for Radiation Therapy
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    • v.24 no.2
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    • pp.157-165
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    • 2012
  • Purpose: We evaluated usefulness of abdominal compressor for stereotactic body radiotherapy (SBRT) with unresectable hepatocellular carcinoma (HCC) patients and hepato-biliary cancer and metastatic liver cancer patients. Materials and Methods: From November 2011 to March 2012, we selected HCC patients who gained reduction of diaphragm movement >1 cm through abdominal compressor (diaphragm control, elekta, sweden) for HT (Hi-Art Tomotherapy, USA). We got planning computed tomography (CT) images and 4 dimensional (4D) images through 4D CT (somatom sensation, siemens, germany). The gross tumor volume (GTV) included a gross tumor and margins considering tumor movement. The planning target volume (PTV) included a 5 to 7 mm safety margin around GTV. We classified patients into two groups according to distance between tumor and organs at risk (OAR, stomach, duodenum, bowel). Patients with the distance more than 1 cm are classified as the 1st group and they received SBRT of 4 or 5 fractions. Patients with the distance less than 1 cm are classified as the 2nd group and they received tomotherapy of 20 fractions. Megavoltage computed tomography (MVCT) were performed 4 or 10 fractions. When we verify a MVCT fusion considering priority to liver than bone-technique. We sent MVCT images to Mim_vista (Mimsoftware, ver .5.4. USA) and we re-delineated stomach, duodenum and bowel to bowel_organ and delineated liver. First, we analyzed MVCT images to check the setup variation. Second we compared dose difference between tumor and OAR based on adaptive dose through adaptive planning station and Mim_vista. Results: Average setup variation from MVCT was $-0.66{\pm}1.53$ mm (left-right) $0.39{\pm}4.17$ mm (superior-inferior), $0.71{\pm}1.74$ mm (anterior-posterior), $-0.18{\pm}0.30$ degrees (roll). 1st group ($d{\geq}1$) and 2nd group (d<1) were similar to setup variation. 1st group ($d{\geq}1$) of $V_{diff3%}$ (volume of 3% difference of dose) of GTV through adaptive planing station was $0.78{\pm}0.05%$, PTV was $9.97{\pm}3.62%$, $V_{diff5%}$ was GTV 0.0%, PTV was $2.9{\pm}0.95%$, maximum dose difference rate of bowel_organ was $-6.85{\pm}1.11%$. 2nd Group (d<1) GTV of $V_{diff3%}$ was $1.62{\pm}0.55%$, PTV was $8.61{\pm}2.01%$, $V_{diff5%}$ of GTV was 0.0%, PTV was $5.33{\pm}2.32%$, maximum dose difference rate of bowel_organ was $28.33{\pm}24.41%$. Conclusion: Despite we saw diaphragm movement more than 5 mm with flouroscopy after use an abdominal compressor, average setup_variation from MVCT was less than 5 mm. Therefore, we could estimate the range of setup_error within a 5 mm. Target's dose difference rate of 1st group ($d{\geq}1$) and 2nd group (d<1) were similar, while 1st group ($d{\geq}1$) and 2nd group (d<1)'s bowel_organ's maximum dose difference rate's maximum difference was more than 35%, 1st group ($d{\geq}1$)'s bowel_organ's maximum dose difference rate was smaller than 2nd group (d<1). When applicating SBRT to HCC, abdominal compressor is useful to control diaphragm movement in selected patients with more than 1 cm bowel_organ distance.

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