• 제목/요약/키워드: Clinical standards

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Deep-learning performance in identifying and classifying dental implant systems from dental imaging: a systematic review and meta-analysis

  • Akhilanand Chaurasia;Arunkumar Namachivayam;Revan Birke Koca-Unsal;Jae-Hong Lee
    • Journal of Periodontal and Implant Science
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    • 제54권1호
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    • pp.3-12
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    • 2024
  • Deep learning (DL) offers promising performance in computer vision tasks and is highly suitable for dental image recognition and analysis. We evaluated the accuracy of DL algorithms in identifying and classifying dental implant systems (DISs) using dental imaging. In this systematic review and meta-analysis, we explored the MEDLINE/PubMed, Scopus, Embase, and Google Scholar databases and identified studies published between January 2011 and March 2022. Studies conducted on DL approaches for DIS identification or classification were included, and the accuracy of the DL models was evaluated using panoramic and periapical radiographic images. The quality of the selected studies was assessed using QUADAS-2. This review was registered with PROSPERO (CRDCRD42022309624). From 1,293 identified records, 9 studies were included in this systematic review and meta-analysis. The DL-based implant classification accuracy was no less than 70.75% (95% confidence interval [CI], 65.6%-75.9%) and no higher than 98.19 (95% CI, 97.8%-98.5%). The weighted accuracy was calculated, and the pooled sample size was 46,645, with an overall accuracy of 92.16% (95% CI, 90.8%-93.5%). The risk of bias and applicability concerns were judged as high for most studies, mainly regarding data selection and reference standards. DL models showed high accuracy in identifying and classifying DISs using panoramic and periapical radiographic images. Therefore, DL models are promising prospects for use as decision aids and decision-making tools; however, there are limitations with respect to their application in actual clinical practice.

항정신병약물 복용 환자의 대사증후군에 대한 한약치료의 체계적 문헌고찰 (A Systematic Review of Traditional Herbal Medicine Treatments for Metabolic Syndrome in Patients Receiving Antipsychotic Drugs)

  • 임선우;박오른;박소현;최성열;김보경;임정화
    • 동의신경정신과학회지
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    • 제35권1호
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    • pp.69-99
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    • 2024
  • Objectives: This study aimed to systematically review the effectiveness and safety of traditional herbal medicine treatments for metabolic syndrome (MS) in patients receiving antipsychotic drugs (APs). Methods: We searched 11 domestic and foreign databases for randomized controlled trials (RCTs) using traditional herbal medicines for MS in patients receiving APs. Results: Twenty RCTs conducted in China were included in the analysis. The most common disease among the participants was schizophrenia. Most studies used the 2004 Chinese Diabetes Society (CDS) standards as the diagnostic criteria for MS. The most used prescription was Yukultang (Liuyu-tang). The most used herbal material was Pinelliae Rhizoma, followed by Poria, Citri Reticulatae Pericarpium, and Glycyrrhizae Radix et Rhizoma. Traditional herbal medicines were mostly reported to improve the symptoms of MS. Conclusions: Traditional herbal medicines may be effective in improving the symptoms of MS in patients receiving APs. However, the quality of the included studies was low, and the studies were heterogeneous. Methodologically rigorous clinical studies on traditional herbal medicine treatments for MS in patients receiving APs are needed.

Additional Value of Integrated 18F-FDG PET/MRI for Evaluating Biliary Tract Cancer: Comparison with Contrast-Enhanced CT

  • Jeongin Yoo;Jeong Min Lee;Jeong Hee Yoon;Ijin Joo;Dong Ho Lee
    • Korean Journal of Radiology
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    • 제22권5호
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    • pp.714-724
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    • 2021
  • Objective: To evaluate the value of 18F-fluorodeoxyglucose PET/MRI added to contrast-enhanced CT (CECT) in initial staging, assessment of resectability, and postoperative follow-up of biliary tract cancer. Materials and Methods: This retrospective study included 100 patients (initial workup [n = 65] and postoperative follow-up [n = 35]) who had undergone PET/MRI and CECT for bile duct or gallbladder lesions between January 2013 and March 2020. Two radiologists independently reviewed the CECT imaging set and CECT plus PET/MRI set to determine the likelihood of malignancy, local and overall resectability, and distant metastasis in the initial workup group, and local recurrence and distant metastasis in the follow-up group. Diagnostic performances of the two imaging sets were compared using clinical-surgical-pathologic findings as standards of reference. Results: The diagnostic performance of CECT significantly improved after the addition of PET/MRI for liver metastasis (area under the receiver operating characteristic curve [Az]: 0.77 vs. 0.91 [p = 0.027] for reviewer 1; 0.76 vs. 0.92 [p = 0.021] for reviewer 2), lymph node metastasis (0.73 vs. 0.92 [p = 0.004]; 0.81 vs. 0.92 [p = 0.023]), and overall resectability (0.79 vs. 0.92 [p = 0.007]; 0.82 vs. 0.94 [p = 0.021]) in the initial workup group. In the follow-up group, the diagnostic performance of CECT plus PET/MRI was significantly higher than that of CECT imaging for local recurrence (0.81 vs. 1.00 [p = 0.029]; 0.82 vs. 0.94 [p = 0.045]). Conclusion: PET/MRI may add value to CECT in patients with biliary tract cancer both in the initial workup for staging and determination of overall resectability and in follow-up for local recurrence.

Hybrid argon plasma coagulation in Barrett's esophagus: a systematic review and meta-analysis

  • Sagar N. Shah;Nabil El Hage Chehade;Amirali Tavangar;Alyssa Choi;Marc Monachese;Kenneth J. Chang;Jason B. Samarasena
    • Clinical Endoscopy
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    • 제56권1호
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    • pp.38-49
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    • 2023
  • Background/Aims: Patients with Barrett's esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC. Methods: We conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett's esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM. Results: Overall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%). Conclusions: Results of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

물질투과율 측정정보 기반 의료용 선형가속기의 에너지스펙트럼 유도기술 개발 (Development of Unfolding Energy Spectrum with Clinical Linear Accelerator based on Transmission Data)

  • 최현준;박효준;유도현;김병철;이철영;민철희
    • Journal of Radiation Protection and Research
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    • 제41권1호
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    • pp.41-47
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    • 2016
  • 연구배경: 세기조절방사선치료와 같이 고선량을 암조직에 정밀하게 전달할 수 있는 방사선 치료기술이 개발됨에 따라, 보다 정확한 선량평가 기술의 개발이 요구되고 있다. 본 연구에서는 선형가속기에서 발생된 광자선의 물질투과율 정보를 통해 간접유도방식으로 에너지스펙트럼을 예측할 수 있는 기술의 개발을 목적으로 한다. 재료 및 방법: 의료용 선형가속기를 사용한 측정과 몬테칼로 전산모사를 통해 감쇠물질의 두께에 따른 X-선의 투과율이 평가되었으며, 이와 더불어 단일에너지에 의한 이온함의 반응함수가 결정되었다. 최종적으로 Unfolding 방법을 사용하는 HEOROW 프로그램을 통해 고선량률의 치료용 선형가속기에서 발생된 광자선의 에너지스펙트럼이 유도되었다. 본 연구에서 실험을 위해 Elekta Synergy Flatform 선형가속기가 사용되었으며, 몬테칼로 방법을 사용하는 Geant4 전산모사 프로그램이 사용되었다. 결과 및 논의: 감쇠물질의 두께에 따른 X-선 투과율과 몬테칼로 전산모사를 통해 계산된 X-선 투과율의 비교 결과 0.43%의 평균제곱근오차가 확인된다. 물질투과정보를 통해 간접적으로 유도된 에너지스펙트럼은 몬테칼로 전산모사를 통해 직접적으로 계산된 에너지스펙트럼과 비교분석 되었으며, 피크위치 및 평균에너지의 오차가 각각 0.066 MeV와 0.03 MeV로 평가되었다. 하지만 보다 정확한 에너지스펙트럼을 예측하기 위해서는 다양한 감쇠물질의 사용과 에너지스펙트럼 유도프로그램의 정밀도 향상을 위한 추가적인 연구가 필요할 것으로 판단된다. 결론: 본 연구를 통해 확인된 물질투과율 기반의 에너지스펙트럼 측정 기술은 에너지가 높고 선량률이 높기 때문에 광자선을 직접적으로 측정하는 것이 제한적인 의료용 선형가속기에 적용될 수 있을 것으로 판단된다.

교정정수 변화에 의한 원통형이온함의 안정성 평가 (Evaluation of the Long-Term Stability for the Cylindrical Ionization Chambers)

  • 라정은;홍주영;김귀야;임천일;정희교;신동오;서태석
    • Radiation Oncology Journal
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    • 제24권2호
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    • pp.138-143
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    • 2006
  • 목적: 식품의약품안전청(Korea Food Drug Administration, KFDA)의 도움을 받아 1998년부터 2004년까지 장기간에 걸친 교정정수의 분석을 통해 원통형이온함의 모델별 안정성을 확인하고자 한다. 대상 및 방법: 치료방사선기관에서 교정을 의뢰한 이온함 중 Farmer형의 원통형이온함만을 대상으로 하였으며 모델은 PTW사의 30001 (30006), 30013, 30002, 30004, 23333과 Capintec사의 PR06C, NE사의 2571, Exradin사의 A12 그리고 Wellhofer사의 FC65G (IC70) 등 총 9개 종류의 이온함에 대해 에어커마 교정정수 및 물흡수선량 교정정수를 분석하였으며 에어커마 교정정수를 이용하여 계산한 물흡수선량 교정정수(cal. $N_{D,W}$)와 실제측정에 의해 결정된 물흡수선량 교정정수(mea. $N_{D,W}$)를 상호 비교하였다. 결과: 교정정수 변화를 분석해 본 결과, PTW사의 30013 (30006), Wellhofer사의 FC65G (IC70) 그리고 NE사의 2571 이온함의 경우 측정 표준편차 0.2% 이내에서 잘 일치하여 다른 모델의 이온함에 비해 안정된 값을 가지는 것으로 나타났으며 계산에 의한 물흡수선량 교정정수와 실제 측정에 의해 결정된 물흡수선량 교정정수를 비교 분석한 결과는 모든 이온함에서 측정에 의한 물흡수선량 교정정수가 약 1.0% 큰 것으로 나타났다. 결론: 본 연구에서는 원통형이온함의 교정정수 값들에 대하여 장기간의 안정성 평가를 토대로 임상에서 요구되는 이온함의 선택 기준을 제시함으로써 표준체계에 따른 이온함의 선택 뫼 선량측정의 정확성을 향상시킬 것으로 기대한다.

대한소아청소년정신의학회 의료윤리규정: 왜 필요한가? (The Code of Medical Ethics for the Korean Academy of Child and Adolescent Psychiatry: Why Is It Important?)

  • 구영진;황준원;이문수;양영희;방수영;강제욱;이대환;이주현;곽영숙;김승태;노경선;박성숙;반건호;송동호;안동현;이영식;이정섭;조수철;홍강의
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제27권1호
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    • pp.2-30
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    • 2016
  • This article provides an overview of the developmental history and rationale of medical ethics to establish the code of ethics and professional conduct of the Korean Academy of Child and Adolescent Psychiatry (KACAP). Most medical professional organizations have their own codes of ethics and conduct because they have continuous responsibility to regulate professional activities and conducts for their members. The Ethics and Award Committee of the KACAP appointed a Task-Force to establish the code of ethics and conduct in 2012. Because bioethics has become global, the Ethics Task Force examined global standards. Global standards in medical ethics and professional conduct adopted by the World Medical Association and the World Psychiatric Association have provided the basic framework for our KACAP's code of ethics and professional conduct. The Code of Ethics of the Americal Academy of Child and Adolescent Psychiatry has provided us additional specific clarifications required for child and adolescent patients. The code of ethics and professional conduct of the KACAP will be helpful to us in ethical clinical practice and will ensure our competence in recognizing ethical violations.

임산부의 산전관리와 산욕기 영양실태에 관한 연구 (Clinical Study on Prenatal care, and Dietary Intakes for Pregnant Women and new Mothers)

  • 차순향;박재순
    • Journal of Nutrition and Health
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    • 제9권4호
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    • pp.36-46
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    • 1976
  • This study was projected to provide basic data on prenatal care for future direction in maternity and child care, and also to investigate the diet of women during pregnancy and the period directly afterwards in order to offer to mothers appropriate advice for the improvement of nutritional standards. A clinical study on prenatal care was based on 1054 delivery cases. A nutritional survey was performed on 174 mothers admitted to the department of obstetrics at St. Mary's Hospital during the period of March, 1975 to February, 1976. The results obtained are summarized as follows; I. Clinical study on prenatal care 1) The age distribution showed 59.4% of the mothers were between the ages of 25 to 29 years old. 2) The gestational period was highest between the 37th and 40th gestational weeks. 33.7% of the mothers were primigravidae and 31.8% of them primiparae. 3) 41.3% of the mothers had not received prenatal care or had only received it once before. 4) Induced deliveries were 61.8% and spontantaneous deliveries 38.2%. 61.9% of the mothers had received prenatal care, while those without prenatal care accounted for 61.6% of the total induced deliveries. 5) Low birth weights were 7.7% and 5.0% of the mothers had received prenatal care, while 11.5% had no prenatal care. 6) There were 1.13% of still births, 0.32% of the mothers had prenatal care and the remainder did not have prenatal care. 7) Of those receiving prenatal care, 2.1% showed in the $0{\sim}3$ Apgar score group, 6.3% in the $4{\sim}6$ Apgar score group, and 91.6% in the $7{\sim}10$ Apgar score group. Among the non-prenatally cared for group 5.0% of the newborns were in the $0{\sim}3$ Apgar score group, 9.7% were in $4{\sim}6$ Apgar score group and 85.3% were in the $7{\sim}10$ Apgar score group. 8) Obstetrical complications were developed in 11.86% of the pregnant women when they were hospitalized. Among the group receiving the prenatal care 8.1% of the mothers had obstetrical complications. In the group without prenatal care 17.16% of the mothers had obstetrical complications. The most common obstetrical complication was malpresentation. 9) The first prenatal care was received between the 37th and 40th gestationl weeks. II. Food intake during pregnancy The following are the results from the questionnaires of the mothers concerning diets during pregnancy; 1) Main meals and snacks In 32.2% of the cases, their main meals during the diet amounted to more than was usually eaten at other times. In 67.8% of the cases, their main meals during the diet were the same as that usually eaten. In 22.4% of the cases, snacks during the diet amounted to more than usually eaten at other times. In 77.6% of the cases, snacks during the diet were the same as usually eaten. 2) Itemized list The mothers made a special effort to include certain items in their diets, the following is a breakdown of those items; a. egg, meat, fish 33.3% b. fruit, vegetables 32.2%. c. milk, fruit juice 18.4% d. cake, bread 2.9% e. nothing special 13.2% 3) Milk 44.8% of the mothers had at least one cup of milk everyday. 33.4% of the mothers had at least one cup of milk on occasion. 15.5% of the mothers did not have any milk. 4) Vitamins 39.7% of the mothers had vitamins everyday. 24.7% of the mothers had vitamins occasionally. 35.6% of the mothers did not have any vitamins. 5) Anemic symptoms 9.2% of the mothers very often had anemic symptoms during pregnancy. 39.1% of the mothers often had anemic symptoms during pregnancy. 51.7% of the mothers did not have anemic symptoms at all. 6) Taboos on food 23% of the mothers recognized 'taboos' on food during pregnancy 27% of the mothers displayed on uncertainty about the 'taboos' on food during pregnancy 50% of the mothers displayed indifference toward the taboos. III. Nutritional survey on the new mothers diet. 1) The diets for new mothers can be divided into four categories, such as general diet, low sodium diet, soft diet and liquid diet. 2) Cooked rice and seaweed soup were the main foods for the new mothers as has been the traditional diet for Korean mothers. 3) The average diet contained 1,783g. And the average consumption of the basic food groups per capita per day was 1,265g for cereals and grains, 456g for meats and legumes, 58g for fruits and vegetables, 0g for milk and fish and 4g for fats and oils. 4) In addition to the 1,783g of food in the main diet there was also 142.8g of food taken as snacks. 5) The average daily consumption of calories and nutrients was 2,697 Kcal and 123.4g for proteins, 44.9g for fats, 718.2mg for calcium, 14mg for iron, 2,101.4 I.U. for vitamin A, 0.43mg for thiamine, 1.02mg for riboflavin, 15.88mg for niacin, 5.26mg for ascorbic acid. When these figures are compared with the recommended allowances for new mothers in Korea, the calories and nutrients taken in were satisfactory. But the intake of minerals and vitamins was below the recommended allowance.

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68Ga-PSMA-11 합성 시간 단축을 위한 자동합성장치의 최적화 및 안정성 연구 (Optimization and Stabilization of Automated Synthesis Systems for Reduced 68Ga-PSMA-11 Synthesis Time)

  • 강지훈;신상민;박영시;김혜지;장화연
    • 대한임상검사과학회지
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    • 제56권2호
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    • pp.147-155
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    • 2024
  • 68Ga-PSMA-11은 전립선특이막항원(PSMA)에 결합하는 Glu-urea-Lys 기반 리간드에 68Ga 방사성동위원소를 표지한 PET 제제로, 재발성 전립선암 및 전이의 진단과 치료를 위한 영상화에 널리 사용한다. 그러나 의료기관에서 68Ga-PSMA-11을 제조하고 품질검사 시험 결과가 나올 때까지의 시간은 평균 60분 이상 소요되어, 하루에 사용할 수 있는 68Ge/68Ga 제너레이터 용량이 제한된다. 또한 제너레이터의 1,110 MBq (30 mCi)의 명목상 활성을 제공하지만 시간이 지남에 따라 감소하고, 표지 수율이 불규칙적으로 저하된다. 이로 인해 의료기관에서는 추가 조제를 통해 동일한 용출을 유지해야 하며, 이 과정에서 작업자의 피폭 위험이 증가하고, 환자의 대기 시간이 길어지며, 제조 스케줄 조정이 불가피한 임상적 문제가 발생한다. 본 연구는 이러한 문제를 해결하기 위해 68Ga-PSMA-11의 조제 시간을 단축하고 자동합성장치를 최적화하는 것을 목표로 하였다. 자동합성장치를 이용한 합성 절차에서 68Ga과 PSMA-11 전구체의 반응 시간을 단축하고 불순물 제거 세척 단계의 횟수를 조절하여 동일한 품질을 유지하면서도 더 신속하고 경제적인 방법을 시험했다. 그 결과, 최종 합성 시간을 30분에서 20분으로 단축하였고, HEPES 함량, 잔류용매 EtOH 함량, 방사화학적 순도 등의 품질 기준을 만족시켰다. 이는 추가 조제로 인한 작업자의 피폭 문제와 환자의 대기 시간을 줄이고, 제조 스케줄 조정에도 문제가 없는 최적의 절차로 임상에서 적용할 수 있음을 시사한다.

방사선치료계획시스템의 독립적 검증을 위한 선량 계산 및 빔데이터 관리 프로그램 (A Comprehensive Computer Program for Monitor Unit Calculation and Beam Data Management: Independent Verification of Radiation Treatment Planning Systems)

  • 김희정;박양균;박종민;최창헌;김정인;이상원;오헌진;임천일;김일한;예성준
    • 한국의학물리학회지:의학물리
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    • 제19권4호
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    • pp.231-240
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    • 2008
  • 방사선치료계획시스템의 MU계산 결과를 포괄적이고 독립적으로 검증할 수 있고 빔데이터 관리를 위한 사용자 친화적인 프로그램을 개발하였다. 선량계산의 정확성을 향상시키기 위해서 축이탈 인자, 빔 경화효과, 비균질성 보정 등의 요소를 계산 알고리듬에 포함하였고 상시적 정도관리 결과로 측정된 빔데이터로의 경신이 용이하도록 하였다. 기준깊이, SSD 등의 측정조건이 다를 때에 보정하는 알고리듬을 구현하였다. 상용 스프레드시트의 워크시트 함수를 빔데이터베이스 접근에 사용하였고, Visual Basic for Application (VBA) 개발환경을 사용하여 graphic user interface (GUI)를 구현하였다. 프로그램의 정확도를 평가하기 위하여 동일한 빔 데이터를 가진 치료계획 시스템을 이용하여 213개의 경우에 대한 팬톰의 선량을 계산하고 비교하였다. 또한 3차원 입체조형방사선 치료를 받은 17명의 환자데이터로부터 108개의 MU계산 기록을 추출하여 본 프로그램에서 계산된 MU와 비교하였다. 가상의 팬톰을 대상으로 계산을 수행한 결과, 과도한 비균질 영역계산을 제외하면 계산된 MU가 치료계획시스템과 3% 이내에서 잘 일치하였고, 환자 데이터를 이용한 계산에서도 과도한 비균질 영역 계산을 제외한 모든 계산에서 최대오차가 5% 이하로 나타났다. VBA 및 Microsoft Excel 워크시트 인터페이스를 이용하여 임상에 이용될 빔데이터 자료의 자동 생성 및 빔데이터 비교 템플릿 등의 용이성이 판명되었다. 본 프로그램을 이용하여 치료계획시스템의 정확성을 포괄적으로 검증할 수 있으므로 치료계획시스템의 정도관리 및 환자의 독립적 선량검증을 효과적으로 수행할 수 있다. 빔데이터베이스 생성 기능을 이용하여 빔데이터의 주기적 관리 경신 및 대단위 빔데이터베이스의 모니터링을 효율적으로 수행할 수 있다.

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