• The Korean Journal of Nuclear Medicine Technology
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• v.16 no.2
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• pp.57-61
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• 2012

Purpose : The whole body bone scan on nuclear medicine is a widely accepted examination and procedure. However, unusual nonosseous uptake can be observed, which reflects a rare interaction between the radiopharmacceutical and the patient. This study aimed to evaluate the influence of MRI(Magnetic Resonance Imaging) contrast and $^{99m}Tc$-DPD(Dicarboxpropane diphosphonate) on whole body bone scan. Materials and Methods : We analyzed the 982 patients who were examined by $^{99m}Tc$-DPD on whole body bone scan in nuclear medicine department of pusan national university hospital from january to december 2010. All these 982 patients had MRI contrast administration prior to whole body bone scan. We analyzed laboratory test. Results : 46 patients(men 39, women 7) showed diffuse hepatic uptake on whole body bone scan. These uptakes were disappeared on the follow-up whole body bone scan. There were no significant difference of CBC test, liver function tests and renal function tests. Conclusion : The study might be an indirect evidence that diffuse hepatic and splenic uptake of 99mTc-DPD on whole body bone scan after intravenous administration of Gadolinium(Gd) MRI contrast. To perform a precise examination, Gd-contrast agent should be removed from the body before performing a whole body bone scan.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.133-137
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• 2010

Purpose: Breast cancer is known to be more vulnerable to bone metastasis and lymph node metastasis than other types of cancer, and nuclear examinations whole body bone scan and lymphoscintigraphy are performed commonly before and after breast cancer operation. In case whole body bone scan is performed on the day before lymphoscintigraphy, the radiopharmaceutical taken into and remaining in the bones provides anatomical information for tracking and locating sentinel lymph nodes. Thus, this study purposed to examine how much bone density affects in locating sentinel lymph nodes. Materials and Methods: The subjects of this study were 22 patients (average age $52{\pm}7.2$) who had whole body bone scan and lymphoscintigraphy over two days in our hospital during the period from January to December, 2009. In the blind test, 22 patients (average age $57{\pm}6.5$) who had lymphoscintigraphy using $^{57}Co$ flood phantom were used as a control group. In quantitative analysis, the relative ratio of the background to sentinel lymph nodes was measured by drawing ROIs on sentinel lymph nodes and the background, and in gross examination, each of a nuclear physician and a radiological technologist with five years' or longer field experience examined images through blind test in a five-point scale. Results: In the results of quantitative analysis, the relative ratio of the background to sentinel lymph nodes was 14.2:1 maximum and 8.5:1 ($SD{\pm}3.48$) on the average on the front, and 14.7:1 maximum and 8.5:1 ($SD{\pm}3.42$) on the average on the side. In the results of gross examination, when $^{57}Co$ flood phantom images were compared with images containing bones, the score was relative high as 3.86 ($SD{\pm}0.35$) point for $^{57}Co$ flood phantom images and 4.09 ($SD{\pm}0.42$) for bone images. Conclusion: When whole body bone scan was performed on the day before lymphoscintigraphy, the ratio of the background to sentinel lymph nodes was over 10:1, so there was no problem in locating lymph nodes. In addition, we expect to reduce examination procedures and improve the quality of images by indicating the location of sentinel lymph nodes using bone images as body contour without the use of a source.

• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.3
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• pp.208-213
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• 2008

Purpose: Generally a whole body bone scan has been known as one of the most frequently executed exams in the nuclear medicine fields. Asan medical center, usually use various gamma camera systems - manufactured by PHILIPS (PRECEDENCE, BRIGHTVIEW), SIEMENS (ECAM, ECAM signature, ECAM plus, SYMBIA T2), GE (INFINIA) - to execute whole body scan. But, as we know, each camera's sensitivity is not same so it is hard to consistent diagnosis of patients. So our purpose is when we execute whole body bone scans, we exclude uncontrollable factors and try to correct controllable factors such as inherent sensitivity of gamma camera. In this study, we're going to measure each gamma camera's sensitivity and study about reasonable correction factors of whole body bone scan to follow up patient's condition using different gamma cameras. Materials and Methods: We used the $^{99m}Tc$ flood phantom, it recommend by IAEA recommendation based on general counts rate of a whole body scan and measured counts rates by the use of various gamma cameras - PRECEDENCE, BRIGHTVIEW, ECAM, ECAM signature, ECAM plus, IFINIA - in Asan medical center nuclear medicine department. For measuring sensitivity, all gamma camera equipped LEHR collimator (Low Energy High Resolution multi parallel Collimator) and the $^{99m}Tc$ gamma spectrum was adjusted around 15% window level, the photo peak was set to 140-kev and acquirded for 60 sec and 120 sec in all gamma cameras. In order to verify whether can apply calculated correction factors to whole body bone scan or not, we actually conducted the whole body bone scan to 27 patients and we compared it analyzed that results. Results: After experimenting using $^{99m}Tc$ flood phantom, sensitivity of ECAM plus was highest and other sensitivity order of all gamma camera is ECAM signature, SYMBIA T2, ECAM, BRIGHTVIEW, IFINIA, PRECEDENCE. And yield sensitivity correction factor show each gamma camera's relative sensitivity ratio by yielded based on ECAM's sensitivity. (ECAM plus 1.07, ECAM signature 1.05, SYMBIA T2 1.03, ECAM 1.00, BRIGHTVIEW 0.90, INFINIA 0.83, PRECEDENCE 0.72) When analyzing the correction factor yielded by $^{99m}Tc$ experiment and another correction factor yielded by whole body bone scan, it shows statistically insignificant value (p<0.05) in whole body bone scan diagnosis. Conclusion: In diagnosing the bone metastasis of patients undergoing cancer, whole body bone scan has been conducted as follow up tests due to its good points (high sensitivity, non invasive, easily conducted). But as a follow up study, it's hard to perform whole body bone scan continuously using same gamma camera. If we use same gamma camera to patients, we have to consider effectiveness of equipment's change by time elapsed. So we expect that applying sensitivity correction factor to patients who tested whole body bone scan regularly will add consistence in diagnosis of patients.

• Journal of radiological science and technology
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• v.36 no.4
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• pp.299-304
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• 2013

Whole body bone scan has been used to confirm bone metastasis and follow-up study with radio isotope. However, if the factors related to $^{99m}Tc$ uptake and waiting time for study are inappropriate, it would be image of low quality. The purpose of present study was to investigate correlation between the evaluation index of renal function and uptake of radiopharmaceuticals. The population for this retrospective study consisted of 387 patients who underwent whole body bone scan between June 2012 and December 2012. As a result of quantitative and qualitative analysis, we were able to confirm that GFR of less than normal range and creatinine levels in blood of more than average are more likely to be under the mean uptake rate. As a result of analysis on the indicator affecting soft-tissue and bone uptake, the correlation of all elements was somewhat low. Also there are no statistically significances due to the other parameters we did not deal with. Therefore, further research on additional factors is needed for exact study and improvement of the image quality.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.3
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• pp.56-60
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• 2009

Purpose: The various studies and efforts to develop program are in progress in the field of nuclear medicine for the purpose of reducing scan time. The Oncoflash is one of the programs used in whole body bone scan which allows to maintain the image quality while to reduce scan time. When Those applications are used in clinical setting, both the image quality and reduction of scan time should be considered, therefore, the purpose of this study was to determine the criteria for proper scan speed. Materials and Methods: The subjects of this study were the patients who underwent whole body bone scan at the departments of nuclear medicine in the Asan Medical Center located in Seoul from 1st to 10th, July, 2008. The whole body bone images obtained in the scan speed of 30cm/min were classified by the total counts into under 800 K, and over 800 K, 900 K, 1,000 K, 1,500 K, and 2,000 K. The image quality were assessed qualitatively and the percentages of those of 1,000K and under of total counts were calculated. The FWHM before and after applying the Oncoflash were analyzed using images obtained in $^{99m}Tc$ Flood and 4-Quadrant bar phantom in order to compare the resolution according to the amount of total counts by the application of the Oncoflash. Considering the counts of the whole body bone scan, the dosed 2~5 mCi were used. 152 patients underwent the measurement in which the counts of Patient Postioning Monitor (PPM) were measured with including head and the parts of chest which the starting point of whole body bone scan from 7th to 26th, August, 2008. The correlations with total counts obtained in the scan speed of 30cm/min among them were analyzed (The exclusion criteria were after over six hours of applying isotopes or low amount of doses). Results: The percentage of the whole body bone image which has the geometric average of total counts of under 1,000K among them obtained in the scan speed of 30cm/min were 17.6%(n=58) of 329 patients. The qualitative analysis of the image groups according to the whole body counts showed that the images of under 1,000K were assessed to have coarse particles and increased noises. The analysis on the FWHM of the images before and after applying the Oncoflash showed that, in the case of PPM counts of under 3.6 K, FWHM values after applying the Oncoflash were higher than that before applying the Oncoflash, whereas, in the case of that of over 3.6 K, the FWHM after applying the Oncoflash were not higher than that before applying the Oncoflash. The average of total counts at 2.5~3.0 K, 3.1~3.5 K, 3.6~4.0 k, 4.1~4.5 K, 4.6~5.0 K, 5.1~6.0 K, 6.1~7.0 K, and 7.1 K over (in PPM) were $965{\pm}173\;K$, $1084{\pm}154\;K$, $1242{\pm}186\;K$, $1359{\pm}170\;K$, $1405{\pm}184\;K$, $1640{\pm}376\;K$, $1,771{\pm}324\;K$, and $1,972{\pm}385\;K$, respectively and the correlations between the counts in PPM and the total counts of image obtained in the scan speed of 30 cm/min demonstrated strong correlation (r=.775, p<.01). Conclusions: In the case of PPM coefficient over 3.6 K, the image quality obtained in the scan speed of 30cm/min and after applying the Oncoflash was similar to that obtained in the scan speed of 15 cm/min. In the case of total counts over 1,000 K, it is expected to reduce scan time without any damage on the image quality. In the case of total counts under 1,000 K, however, the image quality were decreased even though the Oncoflash is applied, so it is recommended to perform the re-image in the scan speed of 15 cm/min.

• The Korean Journal of Nuclear Medicine Technology
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• v.19 no.1
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• pp.30-36
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• 2015

Purpose Whole body bone scan, which makes up a largest percentage of nuclear medicine tests, has high sensitivity and resolution about bone lesion like osteomyelitis, fracture and the early detection of primary cancer. However, any standard for valuation has not yet been created except minimum factor. Therefore, in this study, we will analysis the method which show a quantitative evaluation index in whole body bone scan. Materials and Methods This study is conducted among 30 call patients, who visited the hospital from April to September 2014 with no special point of view about bone lesion, using GE INFINIA equipment. Enumerated data is measured mainly with patient's whole body count and lumbar vertabrae, and the things which include CNR (Contrast to Noise ratio), SNR (Signal to Noise ratio) are calculated according to the mean value signal and standard deviation of each lumbar vertabrae. In addition, the numerical value with the abdominal thickness is compared to each value by the change of scan speed and tissue equivalent material throughout the phantom examination, and compared with 1hours deleyed value. Completely, on the scale of ten, 2 reading doctors and 5 skilled radiologists with 5-years experience analysis the correlation between visual analysis with blind test and quantitative calculation. Results The whole body count and interest region count of patients have no significant correlation with visual analysis value throughout the blind test(P<0.05). There is definite correlation among CNR and SNR. In phantom examination, Value of the change was caused by the thickness of the abdomen and the scan speed. And The poor value of the image in the subject as a delay test patient could be confirmed that the increase tendency. Conclusion Now, a standard for valuation has not been created in whole body bone scan except minimum factor. In this study, we can verify the significant correlation with blind test using CNR and SNR and also assure that the scan speed is a important factor to influence the imagine quality from the value. It is possible to be some limit depending on the physiology function and fluid intake of patient even if we progress the evaluation in same condition include same injection amount, same scan speed and so on. However, that we prove the significant evaluation index by presenting quantitative calculation objectively could be considered academic value.

• Journal of radiological science and technology
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• v.40 no.3
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• pp.407-413
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• 2017

Medical radiation offers significant benefits in diagnosing and treating patients, but it also generates unnecessary radiation exposure to those nearby. Accordingly, the objective of the present study was to analyze spatial dose rate according to types of radiation source term in multi-bed hospital rooms occupied by patients and general public. MCNPX was used for geometric simulation of multi-bed hospital rooms and radiation source terms, while the radiation source terms were established as whole body bone scan patients and imaging using a portable X-ray generator. The results of simulation on whole body bone scan patients showed $3.46{\mu}Sv/hr$ to another patient position, while experimental results on imaging using a portable X-ray generator showed $1.47{\times}10^{-8}{\mu}Sv/irradiation$ to another patient position in chest imaging and $2.97{\times}10^{-8}{\mu}Sv/irradiation$ to another patient position in abdomen imaging. Multi-bed hospital room, unnecessary radiation generated in the surrounding patients, while legal regulations and systematic measures are needed for radiation exposure in multi-bed hospital rooms that are currently lacking in Korea.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.67-72
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• 2010

Purpose: In Asan Medical Center we perform myocardial perfusion SPECT to evaluate cardiac event risk level for non-cardiac surgery patients. In case of patients with cancer, we check tumor metastasis using whole body bone scan and whole body PET scan and then perform myocardial perfusion SPECT to reduce unnecessary exam. In case of short term in patients, we perform $^{201}Tl$ myocardial perfusion SPECT after whole body bone scan a minimum 16 hours in order to reduce hospitalization period but it is still the actual condition in which the evaluation about the affect of the crosstalk contamination due to the each other dissimilar isotope administration doesn't properly realize. So in our experiments, we try to evaluate crosstalk contamination influence on $^{201}Tl$ myocardial perfusion SPECT using anthropomorphic torso phantom and patient's data. Materials and Methods: From 2009 August to September, we analyzed 87 patients with $^{201}Tl$ myocardial perfusion SPECT. According to $^{201}Tl$ myocardial perfusion SPECT yesterday whole body bone scan possibility of carrying out, a patient was classified. The image data are obtained by using the dual energy window in $^{201}Tl$ myocardial perfusion SPECT. We analyzed $^{201}Tl$ and $^{99m}Tc$ counts ratio in each patients groups obtained image data. We utilized anthropomorphic torso phantom in our experiment and administrated $^{201}Tl$ 14.8 MBq (0.4 mCi) at myocardium and $^{99m}Tc$ 44.4 MBq (1.2 mCi) at extracardiac region. We obtained image by $^{201}Tl$ myocardial perfusion SPECT without gate method application and analyzed spatial resolution using Xeleris ver 2.0551. Results: In case of $^{201}Tl$ window and the counts rate comparison result yesterday whole body bone scan of being counted in $^{99m}Tc$ window, the difference in which a rate to 24 hours exponential-functionally notes in 1:0.114 with Ventri (GE Healthcare, Wisconsin, USA), 1:0.249 after the bone tracer injection in 12 hours in 1:0.411 with 1:0.79 with Infinia (GE healthcare, Wisconsin, USA) according to a reduction a time-out was shown (Ventri p=0.001, Infinia p=0.001). Moreover, the rate of the case in which it doesn't perform the whole body bone scan showed up as the average 1:$0.067{\pm}0.6$ of Ventri, and 1:$0.063{\pm}0.7$ of Infinia. According to the phantom after experiment spatial resolution measurement result, and an addition or no and time-out of $^{99m}Tc$ administrated, it doesn't note any change of FWHM (p=0.134). Conclusion: Through the experiments using anthropomorphic torso phantom and patients data, we found that $^{201}Tl$ myocardium perfusion SPECT image later carried out after the bone tracer injection with 16 hours this confirmed that it doesn't receive notable influence in spatial resolution by $^{99m}Tc$. But this investigation is only aimed to image quality, so it needs more investigation in patient's radiation dose and exam accuracy and precision. The exact guideline presentation about the exam interval should be made of the validation test which is exact and in which it is standardized about the affect of the crosstalk contamination according to the isotope use in which it is different later on.

• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.792-796
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• 2008

Bone pain in a child could be associated with cancer as an initial manifestation of the disease. The childhood malignancies that frequently present bone pain are leukemia, neuroblastoma, and primary bone tumors such as osteosarcoma and Ewing sarcoma. Persistent bone or joint pain associated with swelling, mass, or limitation of motion implies underlying serious causes. Systemic manifestations such as lymphadenopathy, hepatosplenomegaly, fever, fatigue, night sweat, and laboratory abnormalities are also suggestive of malignancy. The index of suspicion tends to be low since less than 1% of children who complain of bone pain are diagnosed as cancer. Nonetheless, pediatricians should be alert to the possibilities of cancer since early detection and prompt treatment might reduce mortality.

• The Korean Journal of Nuclear Medicine Technology
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• v.26 no.1
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• pp.27-32
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• 2022

Purpose When performing a whole-body bone scan, many patients are experiencing psychological difficulties due to the close distance to the detector. Recently, in the medical field, there is a report that using virtual reality (VR) equipment can give pain relief to pediatric patients with weak concentration or patients receiving severe treatment through a distraction method. Therefore, in this paper, VR equipment was used to provide psychological stability to patients during nuclear medicine tests, and it is intended to evaluate whether it can be used in clinical practice. Materials and Methods As VR equipment, ALLIP Z6 VR (ALLIP, Korea) was used and the experiment was conducted after connecting to a mobile phone. The subjects were 30 patients who underwent whole-body bone examination from September 1, 2021 to September 30, 2021. After intravenous injection of 99mTc-HDP, 3 to 6 hours later, VR equipment was put on and whole body images were obtained. After the test, a survey was conducted, and a Likert scale of 5 points was used for psychological anxiety and satisfaction with VR equipment. Hypothesis verification and reliability of the survey were analyzed using SPSS Statistics 25 (IBM, Corp., Armonk, NY, USA). Results Anxiety about the existing whole-body bone test was 3.03±1.53, whereas that of anxiety after wearing VR equipment was 2.0±1.21, indicating that anxiety decreased to 34%. When regression analysis of the effect of the patient's concentration on VR equipment on anxiety about the test, the B value was 0.750 (P<0.01) and the t value was 6.181 (P<0.01). decreased and showed an influence of 75%. In addition, overall satisfaction with VR equipment was 3.76±1.28, and the intention to reuse was 66%. The Cronbach α value of the reliability coefficient of the questionnaire was 0.901. Conclusion When using VR equipment, patients' attention was dispersed, anxiety was reduced, and psychological stability was found. In the future, as VR equipment technology develops, it is thought that if the equipment can be miniaturized and the resolution of VR content images is increased, it can be used in various clinical settings if it provides more realistic stability to the patient.