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Utility of the 16-cm Axial Volume Scan Technique for Coronary Artery Calcium Scoring on Non-Enhanced Chest CT: A Prospective Pilot Study (비 조영증강 흉부 CT에서 관상동맥 칼슘스코어 측정을 위한 16 cm 축상 촬영 기법의 유용성: 전향적 탐색적 연구)

  • So Jung Ki;Chul Hwan Park;Kyunghwa Han;Jae Min Shin;Ji Young Kim;Tae Hoon Kim
    • Journal of the Korean Society of Radiology
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    • v.82 no.6
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    • pp.1493-1504
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    • 2021
  • Purpose This study aimed to evaluate the utility of the 16-cm axial volume scan technique for calculating the coronary artery calcium score (CACS) using non-enhanced chest CT. Materials and Methods This study prospectively enrolled 20 participants who underwent both, non-enhanced chest CT (16-cm-coverage axial volume scan technique) and calcium-score CT, with the same parameters, differing only in slice thickness (in non-enhanced chest CT = 0.625, 1.25, 2.5 mm; in calcium score CT = 2.5 mm). The CACS was calculated using the conventional Agatston method. The difference between the CACS obtained from the two CT scans was compared, and the degree of agreement for the clinical significance of the CACS was confirmed through sectional analysis. Each calcified lesion was classified by location and size, and a one-to-one comparison of non-contrast-enhanced chest CT and calcium score CT was performed. Results The correlation coefficients of the CACS obtained from the two CT scans for slice thickness of 2.5, 1.25, and 0.625 mm were 0.9850, 0.9688, and 0.9834, respectively. The mean differences between the CACS were -21.4% at 0.625 mm, -39.4% at 1.25 mm, and -76.2% at 2.5 mm slice thicknesses. Sectional analysis revealed that 16 (80%), 16 (80%), and 13 (65%) patients showed agreement for the degree of coronary artery disease at each slice interval, respectively. Inter-reader agreement was high for each slice interval. The 0.625 mm CT showed the highest sensitivity for detecting calcified lesions. Conclusion The values in the non-contrast-enhanced chest CT, using the 16-cm axial volume scan technique, were similar to those obtained using the CACS in the calcium score CT, at 0.625 mm slice thickness without electrocardiogram gating. This can ultimately help predict cardiovascular risk without additional radiation exposure.

Effect of Human Implantable Medical Devices on Dose and Image Quality during Chest Radiography using Automatic Exposure Control (자동노출제어를 적용한 흉부 방사선 검사 시 인체 이식형 의료기기가 선량과 화질에 미치는 영향)

  • Kang-Min Lee
    • Journal of the Korean Society of Radiology
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    • v.18 no.3
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    • pp.257-265
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    • 2024
  • In this study, we applied AEC(Auto Exposure Control), which is used in many chest examinations, to evaluate whether medical devices inserted into the body affect the dose and image quality of chest images. After attaching three HIMD(Human implantable medical devices) to the ion chamber, the Monte Carlo methodology-based program PCXMC(PC Program for X-ray Monte Carlo) 2.0 was applied to measure the effective dose by inputting the DAP(Dose Ares Product) value derived from the Pacemaker and CRT and Chemoport Additionally, to evaluate image quality, we set three regions of interest and one noise region on the chest and measured SNR and CNR. The final study results showed significant differences in DAP and Effective dose. There was a significant difference between Pacemaker and CRT when AEC was applied and not applied. (p<0.05) When applied, the dose increased by 37% for Pacemaekr and 52% for CRT. Chemoport showed a 10% increase in effective dose depending on whether AEC was applied, but there was no significant difference. (p>0.05) In the image quality evaluation, there was no significant difference in image quality between all HIMD insertions and AEC applied or not. (p>0.05) Therefore, when the HIMD was inserted into the chest during a chest x ray and overlapped with the ion chamber sensor, the effective dose increased, and there was no difference in image quality even at a low dose without AEC. Therefore, when performing a chest X-ray examination of a patient with a HIMD inserted, it is considered that performing the examination without applying AEC is a method that can be considered to reduce the patient's radiation exposure.

A Study of Myth of King Heokgeose, the Founder of Shilla Dynasty from a Perspective of Analytical Psychology (신라 시조 혁거세왕 신화에 대한 분석심리학적 연구)

  • Sang Ick Han
    • Sim-seong Yeon-gu
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    • v.28 no.1
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    • pp.50-87
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    • 2013
  • C. G. Jung believed that universal and basic condition of human's Unconscious comes out from Märchen or mythology. We can easily experience these universality of human nature in dreams. Therefore, It is very important to interpret mythogens that appear in myths and märchen in analytical psychology to understand these 'big dreams' which could be seen in clinical practice. As I was interested in interpreting myths in analytic psychology, I tried to find universality of archetypes in Korea's traditional folk tales and took note of the birth myth of Hyeokgeose, the founder of Shilla dynasty, while examining the chater of the Unsual in history in the Heritage of the Three Kingdoms. Shilla was founded earlier than two other countries, but it was located in the very south of the Korean Peninsula, and it was behind times in politically, militarily, and culturally compare to Goguryeo and Baekje. However, Shilla achieved unifying the Three Kingdoms and it lasted 1000 years, the longest unified history in Korean history. I tried to examine archetypes in the birth myth if there are any backgrounds that are related to finding a Shilla Kingdom. It is noted that myth of the founder of Korean Peninsula's small Kingdom Shilla has complete story from before the birth to birth, birth of spouse, growth, marriage, accession, governing, death, after death, and succession. Symbols such as numbers 1, 3, 5, 6, 7, 13 and 61, various azimuthes including north, west, south, east, and central, animals like tiger, white horse, hen, dragon, phoenix, and snakes, natures like main symbol egg, rock, gourd, lightening, spring water, stream, tree, forest, mountain, iron and goddess-image like seon-do Holy Mother gradually appears in the myth. These symbols could show a meaning of human experience such as birth of Conscious, growth and development of paternal and maternal love, and story of regeneration and extinction. Moreover, It could be seen as these progress eternally continues in next generation. I have found out that a word, a sentence or stories that looks meaningless in myth revealed its true symbolical meaning. In addition, interaction between Unconscious and Conscious repeats in different forms, and expressed in layered.

Impact of Deep-Learning Based Reconstruction on Single-Breath-Hold, Single-Shot Fast Spin-Echo in MR Enterography for Crohn's Disease (크론병에서 자기공명영상 장운동기록의 단일호흡 단발 고속 스핀 에코기법: 딥러닝 기반 재구성의 영향)

  • Eun Joo Park;Yedaun Lee;Joonsung Lee
    • Journal of the Korean Society of Radiology
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    • v.84 no.6
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    • pp.1309-1323
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    • 2023
  • Purpose To assess the quality of four images obtained using single-breath-hold (SBH), single-shot fast spin-echo (SSFSE) and multiple-breath-hold (MBH) SSFSE with and without deep-learning based reconstruction (DLR) in patients with Crohn's disease. Materials and Methods This study included 61 patients who underwent MR enterography (MRE) for Crohn's disease. The following images were compared: SBH-SSFSE with (SBH-DLR) and without (SBH-conventional reconstruction [CR]) DLR and MBH-SSFSE with (MBH-DLR) and without (MBH-CR) DLR. Two radiologists independently reviewed the overall image quality, artifacts, sharpness, and motion-related signal loss using a 5-point scale. Three inflammatory parameters were evaluated in the ileum, the terminal ileum, and the colon. Moreover, the presence of a spatial misalignment was evaluated. Signal-to-noise ratio (SNR) was calculated at two locations for each sequence. Results DLR significantly improved the image quality, artifacts, and sharpness of the SBH images. No significant differences in scores between MBH-CR and SBH-DLR were detected. SBH-DLR had the highest SNR (p < 0.001). The inter-reader agreement for inflammatory parameters was good to excellent (κ = 0.76-0.95) and the inter-sequence agreement was nearly perfect (κ = 0.92-0.94). Misalignment artifacts were observed more frequently in the MBH images than in the SBH images (p < 0.001). Conclusion SBH-DLR demonstrated equivalent quality and performance compared to MBH-CR. Furthermore, it can be acquired in less than half the time, without multiple BHs and reduce slice misalignments.

Broadening the Understanding of Sixteenth-century Real Scenery Landscape Painting: Gyeongpodae Pavilion and Chongseokjeong Pavilion (16세기(十六世紀) 실경산수화(實景山水畫) 이해의 확장 : <경포대도(鏡浦臺圖)>, <총석정도(叢石亭圖)>를 중심으로)

  • Lee, Soomi
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.96
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    • pp.18-53
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    • 2019
  • The paintings Gyeongpodae Pavilion and Chongseokjeong Pavilion were recently donated to the National Museum of Korea and unveiled to the public for the first time at the 2019 special exhibition "Through the Eyes of Joseon Painters: Real Scenery Landscapes of Korea." These two paintings carry significant implications for understanding Joseon art history. Because the fact that they were components of a folding screen produced after a sightseeing tour of the Gwandong regions in 1557 has led to a broadening of our understanding of sixteenth-century landscape painting. This paper explores the art historical meanings of Gyeongpodae Pavilion and Chongseokjeong Pavilion by examining the contents in the two paintings, dating them, analyzing their stylistic characteristics, and comparing them with other works. The production background of Gyeongpodae Pavilion and Chongseokjeong Pavilion can be found in the colophon of Chongseokjeong Pavilion. According to this writing, Sangsanilro, who is presumed to be Park Chung-gan (?-1601) in this paper, and Hong Yeon(?~?) went sightseeing around Geumgangsan Mountain (or Pungaksan Mountain) and the Gwandong region in the spring of 1557, wrote a travelogue, and after some time produced a folding screen depicting several famous scenic spots that they visited. Hong Yeon, whose courtesy name was Deokwon, passed the special civil examination in 1551 and has a record of being active until 1584. Park Chung-gan, whose pen name was Namae, reported the treason of Jeong Yeo-rip in 1589. In recognition of this meritorious deed, he was promoted to the position of Deputy Minister of the Ministry of Punishments, rewarded with the title of first-grade pyeongnan gongsin(meritorious subject who resolved difficulties), and raised to Lord of Sangsan. Based on the colophon to Chongseokjeong Pavilion, I suggest that the two paintings Gyeongpodae Pavilion and Chongseokjeong Pavilion were painted in the late sixteenth century, more specifically after 1557 when Park Chung-gan and Hong Yeon went on their sightseeing trip and after 1571 when Park, who wrote the colophon, was in his 50s or over. The painting style used in depicting the landscapes corresponds to that of the late sixteenth century. The colophon further states that Gyeongpodae Pavilion and Chongseokjeong Pavilion were two paintings of a folding screen. Chongseokjeong Pavilion with its colophon is thought to have been the final panel of this screen. The composition of Gyeongpodae Pavilion recalls the onesided three-layered composition often used in early Joseon landscape paintings in the style of An Gyeon. However, unlike such landscape paintings in the An Gyeon style, Gyeongpodae Pavilion positions and depicts the scenery in a realistic manner. Moreover, diverse perspectives, including a diagonal bird's-eye perspective and frontal perspective, are employed in Gyeongpodae Pavilion to effectively depict the relations among several natural features and the characteristics of the real scenery around Gyeongpodae Pavilion. The shapes of the mountains and the use of moss dots can be also found in Welcoming an Imperial Edict from China and Chinese Envoys at Uisungwan Lodge painted in 1557 and currently housed in the Kyujanggak Institute for Korean Studies at Seoul National University. Furthermore, the application of "cloud-head" texture strokes as well as the texture strokes with short lines and dots used in paintings in the An Gyeon style are transformed into a sense of realism. Compared to the composition of Gyeongpodae Pavilion, which recalls that of traditional Joseon early landscape painting, the composition of Chongseokjeong Pavilion is remarkably unconventional. Stone pillars lined up in layers with the tallest in the center form a triangle. A sense of space is created by dividing the painting into three planes(foreground, middle-ground, and background) and placing the stone pillars in the foreground, Saseonbong Peaks in the middle-ground, and Saseonjeong Pavilion on the cliff in the background. The Saseonbong Peaks in the center occupy an overwhelming proportion of the picture plane. However, the vertical stone pillars fail to form an organic relation and are segmented and flat. The painter of Chongseokjeong Pavilion had not yet developed a three-dimensional or natural spatial perception. The white lower and dark upper portions of the stone pillars emphasize their loftiness. The textures and cracks of the dense stone pillars were rendered by first applying light ink to the surfaces and then adding fine lines in dark ink. Here, the tip of the brush is pressed at an oblique angle and pulled down vertically, which shows an early stage of the development of axe-cut texture strokes. The contrast of black and white and use of vertical texture strokes signal the forthcoming trend toward the Zhe School painting style. Each and every contour and crack on the stone pillars is unique, which indicates an effort to accentuate their actual characteristics. The birds sitting above the stone pillars, waves, and the foam of breaking waves are all vividly described, not simply in repeated brushstrokes. The configuration of natural features shown in the above-mentioned Gyeongpodae Pavilion and Chongseokjeong Pavilion changes in other later paintings of the two scenic spots. In the Gyeongpodae Pavilion, Jukdo Island is depicted in the foreground, Gyeongpoho Lake in the middle-ground, and Gyeongpodae Pavilion and Odaesan Mountain in the background. This composition differs from the typical configuration of other Gyeongpodae Pavilion paintings from the eighteenth century that place Gyeongpodae Pavilion in the foreground and the sea in the upper section. In Chongseokjeong Pavilion, stone pillars are illustrated using a perspective viewing them from the sea, while other paintings depict them while facing upward toward the sea. These changes resulted from the established patterns of compositions used in Jeong Seon(1676~1759) and Kim Hong-do(1745~ after 1806)'s paintings of Gwandong regions. However, the configuration of the sixteenth-century Gyeongpodae Pavilion, which seemed to have no longer been used, was employed again in late Joseon folk paintings such as Gyeongpodae Pavilion in Gangneung. Famous scenic spots in the Gwandong region were painted from early on. According to historical records, they were created by several painters, including Kim Saeng(711~?) from the Goryeo Dynasty and An Gyeon(act. 15th C.) from the early Joseon period, either on a single scroll or over several panels of a folding screen or several leaves of an album. Although many records mention the production of paintings depicting sites around the Gwandong region, there are no other extant examples from this era beyond the paintings of Gyeongpodae Pavilion and Chongseokjeong Pavilion discussed in this paper. These two paintings are thought to be the earliest works depicting the Gwandong regions thus far. Moreover, they hold art historical significance in that they present information on the tradition of producing folding screens on the Gwandong region. In particular, based on the contents of the colophon written for Chongseokjeong Pavilion, the original folding screen is presumed to have consisted of eight panels. This proves that the convention of painting eight views of Gwangdong had been established by the late sixteenth century. All of the existing works mentioned as examples of sixteenth-century real scenery landscape painting show only partial elements of real scenery landscape painting since they were created as depictions of notable social gatherings or as a documentary painting for practical and/or official purposes. However, a primary objective of the paintings of Gyeongpodae Pavilion and Chongseokjeong Pavilion was to portray the ever-changing and striking nature of this real scenery. Moreover, Park Chung-gan wrote a colophon and added a poem on his admiration of the scenery he witnessed during his trip and ruminated over the true character of nature. Thus, unlike other previously known real-scenery landscape paintings, these two are of great significance as examples of real-scenery landscape paintings produced for the simple appreciation of nature. Gyeongpodae Pavilion and Chongseokjeong Pavilion are noteworthy in that they are the earliest remaining examples of the historical tradition of reflecting a sightseeing trip in painting accompanied by poetry. Furthermore, and most importantly, they broaden the understanding of Korean real-scenery landscape painting by presenting varied forms, compositions, and perspectives from sixteenth-century real-scenery landscape paintings that had formerly been unfound.

The National Survey of Acute Respiratory Distress Syndrome in Korea (급성호흡곤란증후군의 전국 실태조사 보고)

  • Scientific Subcommittee for National Survey of Acute Respiratory Distress Syndrome in Korean Academy of Tuberculosis and Respiratory Disease
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.1
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    • pp.25-43
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    • 1997
  • Introduction : The outcome and incidence of acute respiratory distress syndrome (ARDS) could be variable related to the varied definitions used for ARDS by researchers. The purpose of the national survey was to define the risk factors of ARDS and investigate the prognostic indicies related to mortality of ARDS in Korea according to the definition of ARDS determined by the American-European Concensus Conference on 1992 year. Methods : A Multicenter registry of 48 University or University-affliated hospital and 18 general hospital s equipped with more than 400 patient's beds conducted over 13 months of patients with acute respiratory distress syndrome using the same registry protocol. Results : 1. In the 12 months of the registry, 167 patients were enrolled at the 24 hospitals. 2. The mean age was 56.5 years (${\pm}17.2$ years) and there was a 1.9:1 ratio of males to females. 3. Sepsis was the most common risk factors (78.1%), followed by aspiration (16.6%), trauma (11.6%), and shock (8.5%). 4 The overall mortality rate was 71.9%. The mean duration was 11 days (${\pm}13.1$ days) from the diagnosis of ARDS to the death. Respiratory insufficiency appeared to be a major cause in 43.7% of the deaths followed by sepsis (36.1%), heart failure (7.6%) and hepatic failure (6.7%). 5. There were no significant differences in mortality based on sex or age. No significant difference in mortality in infectious versus noninfectious causes of ARDS was found. 6. There were significant differences in the pulse rate, platelet numbers, serum albumin and glucose levels, the amounts of 24 hour urine, arterial pH, $Pa0_2$, $PaCO_2$, $Sa0_2$, alveolar-arterial oxygen differences, $PaO_2/FIO_2$, and PEEP/$FI0_2$ between the survivors and the deaths on study days 1 through 6 of the first week after enrollment. 7. The survivors had significantly less organ failure and lower APACHE III scores at the time of diagnosis of ARDS (P<0.05). 8. The numbers of organ failure (odd ratio 1.95, 95% confidence intervals:1.05-3.61, P=0.03) and the score of APACHE III (odd ratio 1.59, 95% confidence interval:1.01-2.50, P=0.04) appeared to be independent risk factors of the mortality in the patients with ARDS. Conclusions : The mortality was 71.9% of total 167 patients in this investigation using the definition of American-European Consensus Conference on 1992 year, and the respiratory insufficiency was the leading cause of the death. In addition, the numbers of organ failure and the score of APACHE III at the time of diagnosis of ARDS appeared to be independent risk factors of the mortality in the patients with ARDS.

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A Structural Relationship among Job Requirements, Job Resources and Job Burnout, and Organizational Effectiveness of Private Security Guards (민간경비원의 직무요구 직무자원과 소진, 조직유효성의 구조적 관계)

  • Kim, Sung-Cheol;Kim, Young-Hyun
    • Korean Security Journal
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    • no.48
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    • pp.9-33
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    • 2016
  • The purpose of the present study was to find out cause-and-effect relationship between job requirements and job resources, with job burnout as a mediator variable, and the effects of these variables on organizational effectiveness. The population in the present study was private security guards employed by 13 private security companies in Seoul and Gyeonggi-do areas, and a survey was conducted on 500 security guards selected using purposive sampling technique. Out of 460 questionnaires distributed, 429 responses, excluding 31 outliers or insincere responses, were used for data analysis. For analysis, data were coded and entered into SPSS 18.0 and AMOS 18.0, which were used to analyze the data. Descriptive analyses were performed to find out sociodemographic characteristics of the respondents. The exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test the validity of the measurement tool, and the Cronbach's Alpha coefficients were calculated to test the reliability. To find out the significance of relationships among variables, Pearson's correlation analysis was performed. Covariance Structure Analysis (CSA) was performed to test the relationship among latent factors of a model for job requirements, job resources, job burnout, and organizational effectiveness of the private security guards, and the fitness of the model analyzed with CSA was determined by the goodness-of-fit index ($x^2$, df, p, RMR, GFI, CFI, TLI, RMSEA). The level of significance was set at .05, and the following results were obtained. First, even though the effect of job requirements on job burnout was not statistically significant, it had a positive influence overall, and this result can be considered such that the higher the perception of job requirements by the member of the organization, the higher the perception of job burnout. Second, the influence of job resources on job burnout was negative, which can be considered that the higher the perception of job resources, the lower the perception of job burnout. Third, even though the influence of job requirements on organizational effectiveness was statistically nonsignificant, it had a negative influence overall, and this result can be considered that the higher the perception of job requirements, the lower the perception of organizational effectiveness. Fourth, job resources had a positive influence on organizational effectiveness, and it can be considered that the higher the perception of job resources, the higher the perception of organizational effectiveness. Fifth, the results of the analysis between job burnout and organizational effectiveness revealed that, even though the influence of job burnout on organizational effectiveness was statistically nonsignificant, it had partial negative influences on sublevels of organizational effectiveness, and this may suggest that the higher the perception of job burnout by the organization members, the lower the organizational effectiveness. Sixth, the analysis of mediating role in the relationship between job requirements and organizational effectiveness, job burnout was taking partial mediating role between job requirements and organizational effectiveness. These results suggest that reducing job burnout by managing job requirements, organizational effectiveness that leads to job satisfaction, organizational commitment, and turnover intention can be maximized. Seventh, the analysis of mediating role in the relationship among job requirements, job resources, and organizational effectiveness, job burnout was assuming a partial mediating role in the relationships among job requirements, job resources, and organizational effectiveness. These results suggest that organizational effectiveness can be maximized by either lowering job requirements or burnout management through reorganizing job resources.

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Intestinal Atresia - A Survey by the Korean Association of Pediatric Surgeons - (선천성 장폐쇄증 - 대한소아외과학회 정회원을 대상으로 한 전국조사 -)

  • Kim, I.K.;Kim, S.Y.;Kim, S.K.;Kim, W.K.;Kim, J.E.;Kim, J.C.;Kim, H.H.;Park, K.W.;Park, Y.S.;Park, W.H.;Song, Y.T;Yang, J.W.;Oh, S.M.;Yoo, S.Y.;Lee, D.S.;Lee, M.D.;Lee, S.K.;Lee, S.C.;Chang, S.I.
    • Advances in pediatric surgery
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    • v.5 no.1
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    • pp.75-81
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    • 1999
  • A survey on the intestinal atresias was made among 34 members of Korean Association of Pediatric Surgeons. The response rate was 82.4 %. Two hundred and fifteen patients from the January 1, 1994 to December 31, 1996 were analyzed. The lesions were 73 cases of duodenum(DA), 72 cases of jejunum(JA), 71 cases ileum(IA) and 2 cases cecum and sigmoid colon respectively. There were 2 cases of combined anomalies (DA + JA + IA and DA + JA). Male to female ratio was 1:1 in DA, and 1.8:1 in JA. Seventy four cases(34.3 %) were premature babies(DA 35.2 %, JA:48.6 %, IA:19.2 %), and 62 cases(28.7 %) had low birth weight (DA:39.4 %, JA 33.0 %, IA:13.7 %). Antenatal diagnosis was made in 92 cases(43.6 %). However 22 cases (23.9 %) of them were transferred to pediatric surgeon after delivery. Maternal polyhydramnios was observed in 63 cases(28.9 %). Seventy· five cases(34.4 %) were taken only simple abdominal film for diagnostic studies. The associated malformations were observed in 54 aresia and were observed more frequently in DA(35 cases, 47.9 %). Meconium peritonitis due to intrauterine bowel perforation was more frequently associated with IA compared to DA and JA. The overall mortality rate was 30 %. (Abbreuations: $P_{T}$;p-value in total, $P_{DJ,DI,JI}$;p value between two groups among duodenal, jejunal and ileal groups).

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A Study of Microsatellite Instability in Primary Small Cell Lung Cancers by Microsatellite Analysis (원발성 소세포폐암에서 Microsatellite 분석을 이용한 Microsatellite 불안정화에 대한 연구)

  • Cho, Eun-Song;Chang, Joon;Park, Jae-Min;Shin, Dong-Hwan;Kim, Se-Hoon;Kim, Young-Sam;Chang, Yoon-Soo;Cho, Chul-Ho;Kwak, Seung-Min;Lee, Jun-Gu;Chung, Kyung-Young;Kim, Sung-Kyu;Lee, Won-Young;Kim, Se-Kyu
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.2
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    • pp.180-190
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    • 2000
  • Background: Genomic instability, which is manifested by the replication error(RER) phenotype, has been proposed for the promotion of genetic alterations necessary for carcinogenesis. Merlo et al. reported frequent microsatellite instability in primary small cell lung cancers. However, Kim et al. found that instability occurred in only 1% of the loci tested and did not resemble the replication error-positive phenotype. The significance of microsatellite instability in the tumorigenesis of small cell lung cancer as well as the relationship between microsatellite instability and its clinical prognosis was investigated in our study. Methods: Fifteen primary small cell lung cancers were chosen for this study. The DNAs extracted from paraffin-embedded tissue blocks with primary tumor and corresponding control tissue were investigated. Forty microsatellite markers on chromosome 1p, 2p, 3p, 5q, 6p, 6q, 9p, 9q, 13q, and 17p were used in the microsatellite analysis. Results: Thirteen(86.7%) of 15 tumors exhibited LOH in at least one of the tested microsatellite markers. Three of 13 tumors exhibiting LOH lost a larger area in chromosome 9p. LOH was shown in 72.7% on chromosome 2p, 40% on 3p, 50% on 5q, 46.7% on 9p, 69.2% on 13q, and 66.7% on 17p(Table 1). Nine(60%) of 15 tumors exhibited shifted bands in at least one of the tested microsatellite markers. Nine cases exhibiting shifted bands showed altered loci ranging 2.5~52.5%(mean $9.4%\pm16.19$)(Table 2). Shifted bands occurred in 5.7% (34 of 600) of the loci tested(Table 2). Nine cases with shifted bands exhibited LOH ranging between 0~83.3%, and the median survival duration of those cases was 35 weeks. Six cases without shifted bands exhibited LOH ranging between 0~83.3%, and the median survival duration of those cases was 73 weeks. There was no significant difference between median survival durations of the two groups(p=0.4712). Conclusion: Microsatellite instability as well as the inactivation of several tumor suppressor genes may play important roles in the development and progression process of tumors. However, the relationship between microsatellite instability and its clinical prognosis in primary small cell lung cancer could not be established.

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Usefulness of Non-coplanar Helical Tomotherapy Using Variable Axis Baseplate (Variable Axis Baseplate를 이용한 Non-coplanar 토모테라피의 유용성)

  • Ha, Jin-Sook;Chung, Yoon-Sun;Lee, Ik-Jae;Shin, Dong-Bong;Kim, Jong-Dae;Kim, Sei-Joon;Jeon, Mi-Jin;Cho, Yoon-Jin;Kim, Ki-Kwang;Lee, Seul-Bee
    • The Journal of Korean Society for Radiation Therapy
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    • v.23 no.1
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    • pp.31-39
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    • 2011
  • Purpose: Helical Tomotherapy allows only coplanar beam delivery because it does not allow couch rotation. We investigated a method to introduce non-coplanar beam by tilting a patient's head for Tomotherapy. The aim of this study was to compare intrafractional movement during Tomotherapy between coplanar and non-coplanar patient's setup. Materials and Methods: Helical Tomotherapy was used for treating eight patients with intracranial tumor. The subjects were divided into three groups: one group (coplanar) of 2 patients who lay on S-plate with supine position and wore thermoplastic mask for immobilizing the head, second group (non-coplanar) of 3 patients who lay on S-plate with supine position and whose head was tilted with Variable Axis Baseplate and wore thermoplastic mask, and third group (non-coplanar plus mouthpiece) of 3 patients whose head was tilted and wore a mouthpiece immobilization device and thermoplastic mask. The patients were treated with Tomotherapy after treatment planning with Tomotherapy Planning System. Megavoltage computed tomography (MVCT) was performed before and after treatment, and the intrafractional error was measured with lateral(X), longitudinal(Y), vertical(Z) direction movements and vector ($\sqrt{x^2+y^2+z^2}$) value for assessing overall movement. Results: Intrafractional error was compared among three groups by taking the error of MVCT taken after the treatment. As the correction values (X, Y, Z) between MVCT image taken after treatment and CT-simulation image are close to zero, the patient movement is small. When the mean values of movement of each direction for non-coplanar setup were compared with coplanar setup group, X-axis movement was decreased by 13%, but Y-axis and Z-axis movement were increased by 109% and 88%, respectively. Movements of Y-axis and Z-axis with non-coplanar setup were relatively greater than that of X-axis since a tilted head tended to slip down. The mean of X-axis movement of the group who used a mouthpiece was greater by 9.4% than the group who did not use, but the mean of Y-axis movement was lower by at least 64%, and the mean of Z-axis was lower by at least 67%, and the mean of Z-axis was lower by at least 67%, and the vector was lower by at least 59% with the use of a mouthpiece. Among these 8 patients, one patient whose tumor was located on left frontal lobe and left basal ganglia received reduced radiation dose of 38% in right eye, 23% in left eye, 30% in optic chiasm, 27% in brain stem, and 8% in normal brain with non-coplanar method. Conclusion: Tomotherapy only allows coplanar delivery of IMRT treatment. To complement this shortcoming, Tomotherapy can be used with non-coplanar method by artificially tilting the patient's head and using an oral immobilization instrument to minimize the movement of patient, when intracranial tumor locates near critical organs or has to be treated with high dose radiation.

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