• Radiation Oncology Journal
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• v.25 no.2
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• pp.109-117
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• 2007

[ $\underline{Purpose}$ ]: To evaluate the incidences and potential predictive factors for symptomatic radiation pneumonitis (SRP) and radiographic pulmonary toxicity (RPT) following adjuvant radiotherapy (RT) for patients with breast cancer. A particular focus was made to correlate RPT with the dose volume histogram (DVH) parameters based on three-dimensional RT planning (3D-RTP) data. $\underline{Materials\;and\;Methods}$: From September 2003 through February 2006, 171 patients with breast cancer were treated with adjuvant RT following breast surgery. A radiation dose of 50.4 Gy was delivered with tangential photon fields on the whole breast or chest wall. A single anterior oblique photon field for supraclavicular (SCL) nodes was added if indicated. Serial follow-up chest radiographs were reviewed by a chest radiologist. Radiation Therapy Oncology Group (RTOG) toxicity criteria were used for grading SRP and a modified World Health Organization (WHO) grading system was used to evaluate RPT. The overall percentage of the ipsilateral lung volume that received ${\geq}15\;Gy\;(V_{15}),\;20\;Gy\;(V_{20})$, and $30\;Gy\;(V_{30})$ and the mean lung dose (MLD) were calculated. We divided the ipsilateral lung into two territories, and defined separate DVH parameters, i.e., $V_{15\;TNGT},\;V_{20\;TNGT},\;V_{30\;TNGT},\;MLD_{TNGT}$, and $V_{15\;SCL},\;V_{20\;SCL},\;V_{30SCL},\;MLD_{SCL}$ to assess the relationship between these parameters and RPT. $\underline{Results}$: Four patients (2.1%) developed SRP (three with grade 3 and one with grade 2, respectively). There was no significant association of SRP with clinical parameters such as, age, pre-existing lung disease, smoking, chemotherapy, hormonal therapy and regional RT. When 137 patients treated with 3D-RTP were evaluated, 13.9% developed RPT in the tangent (TNGT) territory and 49.2% of 59 patients with regional RT developed RPT in the SCL territory. Regional RT (p<0.001) and age (p=0.039) was significantly correlated with RPT. All DVH parameters except for $V_{15\;TNGT}$ showed a significant correlation with RPT (p<0.05). $MLD_{TNGT}$ was a better predictor for RPT for the TNGT territory than $V_{15\;SCL}$ for the SCL territory. $\underline{Conclusion}$: The incidence of SRP was acceptable with the RT technique that was used. Age and regional RT were significant factors to predict RPT. The DVH parameter was good predictor for RPT for the SCL territory while $MLD_{TNGT}$ was a better predictor for RPT for the TNGT territory.

• Investigative Magnetic Resonance Imaging
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• v.11 no.1
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• pp.39-48
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• 2007

Purpose : To determine the diagnostic accuracy of four different sequences : moderately T2 weighted, two heavily T2-weighted single shot turbo spin-echo sequence and breath-hold axial-2D balanced turbo field-echo sequence(bFFE) for characterization of focal lesions. Materials and Methods : During the 3-month period between June and August 2005, seventy-six patients were proved to have ninety-three focal hepatic lesions on MR imaging. The patients consisted of 49 men and 27 women (age range, 15-75 years; mean age, 56.23 years). All MR images were acquired on a 1.5-T MR using the following sequences: 1. A breath-hold axial T2-weighted single shot turbo spin-echo sequence, 2. a breath-hold axial-2D balanced turbo field-echo sequence. Two radiologists performed quantitative analysis. Another radiologist measured the lesion-to-liver contrast-to-noise ratio at the region-of-interest in the four sequences. Results : There was no significant difference in inter-observer variability between the four sequences. The accuracy for both cyst and malignancy of moderate T2 weighted MRI (echo time: 80 msec) was also highest. There was significant difference for lesion characterization between moderate T2 weighted MRI and balanced steady state procession (p-value: 0.004) in the second reader. For longer echo time, the CNR of cystic lesions were markedly increased in comparison to lesions of other component. Conclusion : The accuracy and inter-observer variability of single shot turbo spin echo T2 weighted sequence was higher than bFFE. Although there was no statically significant difference, moderate T2 weighted MRI (echo time: 80 msec) was more accurate than heavily T2 weighted sequence (echo time: 300 msec). If the results for lesion characterization is equivocal in TE 80, the addition of heavily T2 weighted MRI (echo time: 180 msec) can be helpful.

• Korean Journal of Digital Imaging in Medicine
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• v.12 no.1
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• pp.33-41
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• 2010

National Cancer Screening Project and Korean Society of Breast Imaging recommend that breast cancer screening should be performed on those aged 40 and above. Nevertheless, this recommendation is usually ignored by a number of medical institutions. The purpose of this study is to emphasize the necessity of an age limitation in screening mammography. Ten institutions were randomly selected and telephone inquiries about patients' age limitation and internal guidelines were set up. The 3,214 women, who underwent screening mammography through 'GE Senography 2000D' in each hospital, were classified into five groups according to age(from 20s to 40s, at intervals of 5). And then, collected data was analyzed by a radiologist in accordance with ACR-BIRADS(American College of Radiology Breast Imaging Reporting and Data System), through which breast parenchymal density and the results of analysis were categorized in order to predict the sensitivity of mammography. Information about craniocaudal-view mammograms was automatically produced by use of GE Senography 2000D, and the average glandular dose was retrospectively analyzed through the program 'Excel 2007.' Two institutions did not set the age limitation. Other seven institutions internally allowed those who wanted to receive mammography regardless of age. Approximately 99% of those aged 20 to 29 were judged as having the dense breast. In those aged 35 to 39, breast parenchymal density tended to be lower, but the fatty breast to increase. In the case of 'category-zero' that does not need additional tests, the rate of 'heterogeneously dense' and 'extremely dense' reached to 83.1% and 15.1% respectively. Regarding dense breasts, there was no sufficient information for image reading. The glandular dose, applied to 3,214, was 1.47mGy on the average. In those aged 20 to 24 who are sensitive to radiation, the average glandular dose indicated 1.59mGy. Those aged 35 and above showed the lowest value, 1.43mGy. In those aged 35 to 39, the breast tended to change from denseness to fattiness. The average glandular dose was lowest in those aged 35 and above, which suggests that screening mammography should be periodically performed on those aged 35 and above in order that breast cancer may be early detected. On the other hand, in those aged less than 35, it is difficult to analyze mammograms due to the high density of breast parenchyma, and also retakes become frequent. In particular, subjects may be exposed to excessive doses. Accordingly, it should be substituted by breast self-examination or clinical breast examination. In case of need, it is advisable to perform ultrasonography.

• Korean Journal of Digital Imaging in Medicine
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• v.5 no.1
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• pp.32-44
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• 2002

The role of radiology department has been greatly increased in the past few years as the technology in the medical imaging devices improved and the introduction of PACS (Picture Archiving and Communications System) to the conventional film-based diagnostic structure is a truly remarkable factor to the medical history. In addition, the value of using digital information in medical imaging is highly expected to grow as the technology over the computer and the network improves. However, the current medical practice, using PACS is somewhat limited compared to the film-based conventional one due to a poor image quality. The image quality is the most important and inevitable factor in the PACS environment and it is one of the most necessary steps to more wide practice of digital imaging. The existing image quality control tools are limited in controlling images produced from the medical modalities, because they cannot display the real image changing status. Thus, the image quality is distorted and the ability to diagnosis becomes hindered compared to the one of the film-based practice. In addition, the workflow of the radiologist greatly increases; as every doctor has to perform his or her own image quality control every time they view images produced from the medical modalities. To resolve these kinds of problems and enhance current medical practice under the PACS environment, we have developed a program to display a better image quality by using the ROI optical density of the existing gray level values. When the LUT is used properly, small detailed regions, which cannot be seen by using the existing image quality controls are easily displayed and thus, greatly improves digital medical practice. The purpose of this study is to provide an easier medical practice to physicians, by applying the technology of converting the H-D curves of the analog film screen to the digital imaging technology and to preset image quality control values to each exposed body part, modality and group of physicians for a better and easier medical practice. We have asked to 5 well known professional physicians to compare image quality of the same set of exam by using the two different methods: existing image quality control and the LUT technology. As the result, the LUT technology was enormously favored over the existing image quality control method. All the physicians have pointed out the far more superiority of the LUT over the existing image quality control method and highly praised its ability to display small detailed regions, which cannot be displayed by existing image quality control tools. Two physicians expressed the necessity of presetting the LUT values for each exposed body part. Overall, the LUT technology yielded a great interest among the physicians and highly praised for its ability to overcome currently embedded problems of PACS. We strongly believe that the LUT technology can enhance the current medical practice and open a new beginning in the future medical imaging.

• Journal of radiological science and technology
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• v.21 no.1
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• pp.52-58
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• 1998

We can and must improve the diagnostic images using available knowledge and technology. At the same time we must strive to reduce the patient's integral and entrance radiation dose. Reducing the integral dose to the patient during the radiologic procedure is a primary concern of the patient, especially the pediatric patient, the radiologist and the technologist. A 100cm focal film distance generally is used for most over-table radiography. The early x-ray tubes and screen film combinations required long exposures, which often resulted in motion artifacts. But nowaday, we have the generators and x-ray tubes that can deliver the energy necessary in a very short time and the receptors that can record the information just as rapidly. And, we performed this studies to evaluate the patient exposure dose and the image quality by increasing focal film distance in diagnostic radiography. There are many factors which affected to exposure factor, but we studied to verify of FFD increase, only. Effect of increasing the focal film distance to a 140 cm distance was tested as follows; 1. The focal film distances were set at 100, 120, and 140cm. 2. A 18cm acryl(tissue equivalent) phantom was placed on the table top. 3. An Capintec 192 electrometer with PM 05 ion chamber was placed at the entrance surface of the phantom, and exposure were made at each focal film distances. 4. The procedure was repeated in the same manner as above except the ion chamber was placed beneath the phantom at the film plane. 5. Exit exposure were normalize to 8mR for each portions of the experiment. Based on the success of the empirical measurements, a detailed mathematical analysis of the dose reduction was performed using the percent depth dose data. The results of this study can be summerized as followings ; 1) Increasing FFD from 100 cm to 140 cm, we would create a situation that would have a significant effect on the overall quality of radiograph and achive the 17.42% reduction of entrance dose and the 18.95% reduction of integral dose that the patient receives. 2) Thickness of Al step wedge for equal film density increased with the long distance. 3) Increasing FFD, Magnification of image was lowered. 4) Resolution of image also increased with the FFD. As the results described above, we strongly recommend using the long FFD to provide better information for our patients and profession in abdomen radiographic studies.

• Journal of the Korean Society of Radiology
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• v.84 no.3
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• pp.627-637
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• 2023

Purpose To investigate the effect of patient positioning on tendinosis grade, visible range, and infraspinatus tendon (IST) thickness, and to determine the feasibility of internal rotation (IR) position to assess IST on ultrasound (US). Materials and Methods This study included 52 shoulders of 48 subjects who were evaluated for IST in three different positions: neutral position (N), IR, and position with the ipsilateral hand on the contralateral shoulder (HC). Two radiologists retrospectively graded IST tendinosis from grade 0 to grade 3 and the visible range from grade 1 to grade 4. The thickness of the IST was measured by another radiologist with a short-axis view. A generalized estimating equation was used for statistical analysis. Results The tendinosis grades were higher in the HC position than in the IR position, with a cumulative odds ratio of 2.087 (p = 0.004, 95% confidence interval [CI]: 1.268-3.433). The tendinosis grades in the HC position (p = 0.370) and IR position (p = 0.146) were not significantly different from those in the N position. The overall difference in IST thickness was significant (p < 0.001), but the visible range (p = 0.530) was not significantly different according to position. Conclusion Patient positioning significantly affected the grade of tendinosis and thickness but not the visible range of the IST. The IR position is a feasible position for assessing the IST on US.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.8
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• pp.417-421
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• 2018

Carboxytherapy is very similar to mesotherapy in terms of methods, conditions it treats, and outcomes. An important difference consider, however, is that carboxytherapy administers carbon dioxide gas into the subcutaneous layer, just underneath the skin, whereas mesotherapy administers a cocktail of vitamins, minerals, and drugs and into the mesoderm of the skin. There have been many previous case reports of complications of mesotherapy such as hematoma, granulomatous panniculitis, cellulitis, and abscesses. However, complications of carboxytherapy have rarely been reported because the carbon dioxide gas is absorbed within a week and is infused into the subcutaneous and superficial layers. A 27-year-old woman who had twice undergone carboxytherapy to reduce abdominal fat (3 days and 2 weeks ago) at an oriental medical clinic visited the emergency department due to high fever, myalgia, severe back pain, and subcutaneous emphysema from the buttocks to the lower chest wall area. A computed tomography (CT) scan was performed for diagnosis and treatment. We immediately started broad spectrum antibiotics and consulted with the department of radiology, which could not rule out acute peritonitis due to needle injury. A radiologist confirmed abdominal myositis and needle puncture induced acute pyelonephritis. Pyelonephritis can even lead to septicemia, which can have fatal consequences. Therefore, if the patient has costovertebral or back pain after undergoing needle puncture or acupuncture therapy, the emergency physcians need careful initial evaluation for diagnosis and treatment.

• Journal of the Korean Magnetics Society
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• v.26 no.3
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• pp.105-114
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• 2016

In this study, For assessment of triangular fibrocartilage complex (TFCC) injury, we acquired images by fat suppressed 3D fast spoiled gradient recalled T1 and fat suppressed Isotropic 3D fast spin echo T1 techniques. For quantitative evaluation, measured signal to noise ratio and contrast to noise ratio and verified statistical significance between two imaging techniques by Mann-Whitney U verification. And for qualitative evaluation, marked 4-grade scoring (0: non diagnostic, 1: poor, 2: adequate, 3: good) on shape of TFCC, artifacts by partial volumes, description of the lesions by two radiologist, verified coincidence between 2 observer using Kappa-value verification. We used 3.0 Tesla MR equipment and 8-channel RF coil for imaging acquisition. As quantitative evaluation results, signal to noise ratio and contrast to noise ratio value of Isotropic 3D fast spin echo T1 technique is higher in every image sections, also between two imaging techniques by Mann-Whitney U verification was statistically significant (p < 0.05). As qualitative results, observer 1, 2 marked a higher grade on Isotropic 3D FSE T1 technique, coincidence verification of evaluation results between two observers by Kappa-value verification was statistically significant (p < 0.05). As a result, during MRI examination on TFCC injury, fat suppressed Isotropic 3D fast spin echo T1 technique is considered offering more useful information about abnormal lesion of TFCC.

• Journal of radiological science and technology
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• v.6 no.1
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• pp.117-129
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• 1983

This study, in order to improve clinical and practical trainings in the education of radiologic technologists, applies to 76 medical institutions of 91 ones which are used as the hospitals of clinical and practical training in 9 existing junior colleges except 3 new ones of 12 ones throughout all over the country from November 1, in 1982 to April 30, in 1983. And the purpose of this study is to research the percent conditions of basic practical trainings and clinical ones enforced in each college, and the percent conditions, equipments, contents, and opinions in clinical and practical trainings enforced in each hospital. The results are summarized as follows; 1. In the case of junior colleges in the whole country the curriculum of basic practical trainings averages 336.66 hours and the limits are between 120 and 510 hours. The actual hours in practice average 140 hours and the limits are between 60 and 240 hours, which correspond to 41.58% of the curriculum of basic practical trainings. 2. There were three junior colleges among nine that had a reserved hospital for clinical and practical trainings(only 33.33%). 3. The period of the practice was almost vacation in 4 junior colleges. The practice was conducted only for students to want the practice(44.45%), junior colleges that all students in them conducted the practice was 2 junior colleges and presented 22.22%. 4. In the field of students engaging in the practice, each field of radiation therapy and nuclear medicine presented 16.5%, 20.3% and almost students didin't have experience for the practice. 5. In medical institutions the educational institutions for intern showed 67.11%. Hospital with radiologist showed 26.32%. Radiotechnologist who had experience below 5 years presented 60.17%. 6. In the equipment for radiation diagnosis, each hospital had no difference. The number of hospitals passessing diagnostic equipments above 125 KVP was 56.26%. But radiation therapy equipment and nuclear medicine equipment had extremely low rate. 7. In the diagnosis of patient in the practice hospital, conventional radiography-to Skull, Chest, Abdomen, Skeleton, Urogenital system-reached the criterion. But special radiography was comparatively low. There appeared low rate, 32.89% in the field of nuclear medicine, 15.79% in the field of radiation therapy. 8. Students who carried out the practice were 1-89 students, days in practice were 1-30 days. There were differences in that point among among hospitals. Junior colleges conducting the practice were 2 colleges per hospital. Scope of the object were 1-8 junior colleges. 9. The practice conducted for the request of the colleges presented 72.37%, in addition, The prctices were conducted for growth of the younger generation and the same coperation with the colleges establishment of sisterhood with the colleges, relationship with students. 10. The practice conducted without the establishment of plan presented 59.21% The need for guiding book to the practice and evaluating was recognized over 90%. 11. In the relation between the practice with achievement of credit. There were big differences in opinion between hospitals-Group and the colleges-Group; hospital-Group had opinion that must follow achievement of credit with the practice. The colleges-Group had opinion that must conduct the practice after achieving credit. 12. After conducting the practice, in the practice leaders satisfaction degree dissatisfactory opinion presented the most rate 80.26%. Very much satisfactory opinion, as one hospital, presentd only 1.32%. 13. Both hospitals-Group and the colleges-Group had an opinion that the practice leader must have actual experiences, lectures and achievement, an opinion that actual experiences is over 5 years. 14. In the guide of human relation, cooperation, responsibility, courtesy to patients. Both hospitals-Group and the colleges-Group had an opinion that the guide must be involved in the period of the practice and must be instructed.

• Investigative Magnetic Resonance Imaging
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• v.12 no.2
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• pp.178-187
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• 2008

Purpose : To evaluate and compare the diagnostic accuracy of MRI and ultrasound(US) for estimation of invasion depth of gastric carcinoma by correlation with histopathologic findings in vitro and to find out the best MR pulse sequence for detection and accurate delineation of tumor. Materials and Methods : Resected specimen of total or subtotal gastrectomy from 53 patients with gastric carcinoma were done of imaging studies of MRI and US. And US was examined by using high frequency linear transducer for tumor invasion depth by a radiologist. In each case, both imaging findings of MRI and US were evaluated independently for tumor detection and invasion depth by consensus of two radiologists and were compared the diagnostic accuracy between two imaging modalities according to the histopathologic findings. MR imaging with five MR pulse sequences, spin echo T1 and in- and out-of phase gradient echo T1 weighted images, FSE and SSFSE T2 weighted images, were performed. Five MR pulse sequences were evaluated and compared on the point of detection and accurate distinction of tumor from surrounding normal tissue. Results : In EGC, diagnostic accuracy of US(77%) was superior than that of MRI(59%) but no statistically significant difference was noted between two imaging modalities(p=0.096). In AGC, both imaging modalities of MRI and US showed relatively high diagnostic accuracy as 97% and 84% respectively. Diagnostic accuracy of MRI was statistically better than that of US at the significant level(p<0.001). The best MR pulse sequence among five in each specimen was FSE T2WI(75.5%, 40/53) in both EGC and AGC. In AGC, FSE T2WI showed excellent imaging quality by showing very high ratio (93.5%, 29/31) of accurate delineation of tumor. Conclusion : MRI and US show relatively high diagnostic accuracy in the evaluation of tumor invasion depth of resected specimen in AGC. The most excellent pulse sequence of MRI for the evaluation of tumor invasion depth is FSE T2WI on the point of detection and accurate delineation of tumor in both EGC and AGC.