• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.816-824
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• 2022

Objective : Emergency superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis in patients with large vessel occlusion who fails mechanical thrombectomy or does not become an indication due to over the time window can be done as an alternative for blood flow restoration. The authors planned this study to quantitatively measure the degree of improvement in cerebral perfusion flow using perfusion magnetic resonance imaging (MRI) after bypass surgery and to find out what factors are related to the outcome of the bypass surgery. Methods : For a total of 107 patients who underwent emergent STA-MCA bypass surgery with large vessel occlusion, the National Institute of Health stroke scale (NIHSS), modified Rankin score (mRS), infarction volume, and hypoperfusion area volume was calculated, the duration between symptom onset and reperfusion time, occlusion site and infarction type were analyzed. After emergency STA-MCA bypass, hypoperfusion area volume at post-operative 7 days was calculated and analyzed compared with pre-operative hypoperfusion area volume. The factors affecting the improvement of mRS were analyzed. The clinical status of patients who underwent emergency bypass was investigated by mRS and NIHSS before and after surgery, and changes in infarct volume, extent, degree of collateral circulation, and hypoperfusion area volume were measured using MRI and digital subtraction angiography (DSA). Results : The preoperative infarction volume was median 10 mL and the hypoperfusion area volume was median 101 mL. NIHSS was a median of 8 points, and the last normal to operation time was a median of 60.7 hours. STA patency was fair in 97.1% of patients at 6 months follow-up DSA and recanalization of the occluded vessel was confirmed at 26.5% of patients. Infarction volume significantly influenced the improvement of mRS (p=0.010) but preoperative hypoperfusion volume was not significantly influenced (p=0.192), and the infarction type showed marginal significance (p=0.0508). Preoperative NIHSS, initial mRS, occlusion vessel type, and last normal to operation time did not influence the improvement of mRS (p=0.272, 0.941, 0.354, and 0.391). Conclusion : In a patient who had an acute cerebral infarction due to large vessel occlusion with large ischemic penumbra but was unable to perform mechanical thrombectomy, STA-MCA bypass could be performed. By using time-to-peak images of perfusion MRI, it is possible to quickly and easily confirm that the brain tissue at risk is preserved and that the ischemic penumbra is recovered to a normal blood flow state.

• Journal of the korean academy of Pediatric Dentistry
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• v.50 no.3
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• pp.239-251
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• 2023

The aim of this study is to evaluate the effect of noise-filtering earplugs on the hearing ability of dentists wearing them during noise-induced dental procedures. Pure tone audiometry and distortion product otoacoustic emission (DPOAE) tests were conducted at the initial visit and 1 year later to evaluate the hearing ability of the participants. As a result of the study, the pure tone average of the group wearing earplugs decreased significantly compared to the group not wearing earplugs, indicating an improvement in hearing. However, the signal-to-noise ratio of the DPOAE tests did not show a significant difference. These findings suggest that noise-filtering earplugs may have some effectiveness in preventing hearing loss. However, since the 1-year observation period may not be adequate to identify changes in hearing, a follow-up study with an extended follow-up period is necessary.

• Journal of Korean Neurosurgical Society
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• v.67 no.4
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• pp.442-450
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• 2024

Objective : Cerebral hyperperfusion syndrome (CHS) manifests as a collection of symptoms brought on by heightened focal cerebral blood flow (CBF), afflicting nearly 30% of patients who have undergone superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. The aim of this study was to investigate whether the amalgamation of magnetic resonance imaging (MRI) fluid-attenuated inversion recovery (FLAIR) and apparent diffusion coefficient (ADC) imaging via MRI can discern cerebral hyperemia after STA-MCA anastomosis surgery. Methods : A retrospective study was performed of patients who underwent STA-MCA anastomosis due to Moyamoya disease or atherosclerotic steno-occlusive disease. A protocol aimed at preventing CHS was instituted, leveraging the use of MRI FLAIR. Patients underwent MRI diffusion with FLAIR imaging 24 hours after STA-MCA anastomosis. A high signal on FLAIR images signified the presence of hyperemia at the bypass site, triggering a protocol of hyperemia care. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography, both before and after the surgery. If a high signal intensity is observed on MRI FLAIR within 24 hours of the surgery, a repeat MRI is performed to confirm the presence of hyperemia. Patients with confirmed hyperemia are managed according to a protocol aimed at preventing further progression. Results : Out of a total of 162 patients, 24 individuals (comprising 16 women and 8 men) exhibited hyperemia on their MRI FLAIR scans following the procedure. SPECT was conducted on 23 patients, and 11 of them yielded positive results. All 24 patients underwent perfusion MRI, but nine of them showed no significant findings. Among the patients, 10 displayed elevations in both CBF and cerebral blood volume (CBV), three only showed elevation in CBF, and two only showed elevation in CBV. Follow-up MRI FLAIR scans conducted 6 months later on these patients revealed complete normalization of the previously observed high signal intensity, with no evidence of ischemic injury. Conclusion : The study determined that the use of MRI FLAIR and ADC mapping is a competent means of early detection of hyperemia after STA-MCA anastomosis surgery. The protocol established can be adopted by other neurosurgical institutions to enhance patient outcomes and mitigate the hazard of permanent cerebral injury caused by cerebral hyperemia.

• Journal of the Korean Society of Radiology
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• v.83 no.6
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• pp.1259-1272
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• 2022

Purpose As part of ongoing efforts to improve the current e-learning center, a survey was conducted regarding user experience and satisfaction to identify areas of improvement. Materials and Methods Radiologists (n = 454/617) and radiology residents (n = 163/617) of the Korean Society of Radiology were asked to answer a survey via email. The questionnaire asked for basic user information as well as user experiences relating to the e-learning center, such as workplace, frequency of use, overall satisfaction levels, reasons for satisfaction or dissatisfaction, and other suggestions for improvement. Results Annual members and all members of the e-learning center reported above average satisfaction levels of 67% and 42%, respectively. Approximately 30% of respondents viewed e-learning center lectures more than 5 times a month, with residents having a particularly high usage frequency. There was a high demand for additional lectures covering more diverse specialties (e-learning for annual members only: n = 28/97, e-learning for all members: n = 72/166), a smoother and more convenient searching platform/interface (n = 37/97 and n = 58/166, respectively), and regular content updates. In addition, many of the members suggested the addition of user-friendly functions such as playback speed control, a way to save viewing history, as well as requests for improved system stability. Conclusion Based on survey results, the educational committee plans to continue its efforts to improve the e-learning center by increasing the quality and quantity of available lectures, and increasing technical support to improve the stability and convenience of the e-learning digital system.

• Therapeutic Science for Rehabilitation
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• v.13 no.2
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• pp.53-67
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• 2024

Objective : This study aimed to identify common activities with similar participation levels between community-dwelling individuals in the United States (US) and South Korea (Study 1), and analyze the changes in activity participation patterns across the adult lifespan in South Korea (Study 2). Methods : We administered the online survey-based Activity Card Sort version 3 (ACS-3) to adults living in the US and South Korea. In Study 1, we computed the average participation level and visualized 100 activities of the ACS-3 from both the US and Korean samples. The average participation level across the four age groups in Study 2 was calculated and visualized to understand the changes in patterns of involvement across the four ACS-3 domains in a Korean sample. Results : In Study 1, data from 161 Americans and 163 Koreans were analyzed. Of the 100 activities, 48 (instrumental: 20; leisure: 13; fitness/health: 6; social: 9) demonstrated similar levels of participation between the two samples. In Study 2, data from 420 Koreans were analyzed and a tendency for decreased participation with age was found in all domains, except for the instrumental domain. Conclusion : Common daily activities may be used as a means of intervention across cultures in occupational therapy. Protective approaches and support are recommended to optimize older adults' participation in daily life.

• Anatomy and Cell Biology
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• v.57 no.3
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• pp.384-391
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• 2024

Morphological evaluation of the small intestine mucosa and apoptosis activity (caspase-3) is necessary to assess the severity of damage to the small intestine. At the same time, proliferative index based on Ki-67 can be used to assess the regenerative potential of the small intestine. Fragments of small intestine of Wistar rats (n=60) of three groups: I) control (n=20); II) experimental group (n=20; local single electron irradiation at a dose of 2 Gy), III) experimental group (n=20; local single electron irradiation at a dose of 8 Gy) were studied by light microscopy using hematoxylin and eosin staining and immunohistochemical reactions with antibodies to Ki-67 and caspase-3. In all samples of the experimental groups, a decrease in all morphometric indices was observed on day 1 with a tendency to recover on day 3. Small intestinal electron irradiation led to disturbances in the histoarchitecture of varying severity, and an increase in cell apoptosis was observed (increased expression of caspase-3 and decrease in Ki-67). In addition, modulation of the PI3K/AKT and MAPK/ERK signaling pathways was detected. The most pronounced destructive changes were observed in the group of 8 Gy single electron irradiation. Local irradiation of the small intestine with electrons at a dose of 2 and 8 Gy results in a decrease in the number of enterocytes, mainly stem cells of the intestinal crypts.

• Progress in Medical Physics
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• v.25 no.3
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• pp.143-150
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• 2014

In general radiotherapy, mega-voltage (MV) x-ray images are widely used as the unique method to verify radio-therapeutic fields. But, the image quality of MV images is much lower than that of kilo-voltage x-ray images due to scatter interactions. Since 1990s, studies for the scatter correction have performed with digital-based MV imaging systems. In this study, a novel method for the scatter correction is suggested using scatter to primary ratio (SPR), instead of conventional methods such as digital image processing or scatter kernel calculations. We measured two MV images with and without a solid water phantom describing a patient body with given imaging conditions, and calculated un-attenuated ratios. Then, we obtained SPR distributions for the scatter correction. For experimental validation, a line-pair (LP) phantom using several Al bars and a clinical pelvis MV image was used. As the result, scatter signals of the LP phantom image were successfully reduced so that original density distribution of the phantom was restored. Moreover, image contrast values increased after SPR correction at all ROIs of the clinical image. The mean value of increases was 48%. The SPR correction method suggested in this study has high reliability because it is based on actually measured data. Also, this method can be easily adopted in clinics without additional cost. We expected that the SPR correction can be an effective method to improve the quality of MV image guided radiotherapy.

• Korean Journal of Digital Imaging in Medicine
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• v.9 no.1
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• pp.37-43
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• 2007

1. Purpose : This study is to present effective exposure conditions to acquire the best image of simple abdomen in Film Screen (F.S) system and Computed Radiography (C.R) system. 2. Method : In the F.S system, while an exposure condition was fixed as 70kVp, images of a patients simple abdomen were taken under the different mAs exposure conditions. Among these images, the best one was chosen by radiologists and radiological technologists. In the C.R system, the best image of the same patient was acquired with the same method from the F.S system. Both characteristic curves from F.S system and C.R system were analyzed. 3. Results : In the F.S system, the best exposure condition of simple abdomen was 70kVp and 20mAs. In the CR system, with the fixed condition at 70kVp, the image densities of human organs, such as liver, kidney, spleen, psoas muscle, lumbar spine body and iliac crest, were almost same despite different environments (3.2mAs, 8mAs, 12mAs, 16mAs and 20mAs). However, when the exposure conditions were over or under (below) 12mAs, the images between the abdominal wall and the directly exposed part became blurred because the gap of density was decreased. In the C.R system, while the volume of mAs was decreased, an artifact of quantum mottle was increased. 4. Conclusion : This study shows that the exposure condition in the C.R system can be reduced 40% than in the F.S system. This paper concluded that when the exposure conditions are set in CR environment, after the analysis of equipment character, such as image processing system(EDR : Exposure Data Recognition processing), PACS and so on, the high quality of image with maximum information can be acquired with a minimum exposure dose.

• Journal of the Korean Society of Radiology
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• v.14 no.5
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• pp.603-612
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• 2020

This study has a purpose to look into the effect of the relationship between the Tube current (mA) and SOD(Source to Object Distance), which is a parameter of lower limb angiography examination, and the dilution rate of the contrast medium concentration (300, 320, 350) on the image. To that end, using 3 mm vessel model water phantom, a vessel model custom made in the size of peripheral vessel diameter, this study measured relationships between change of parameters, such as tube current (mA), SOD and varying concentrations (300, 320, 350) of contrast medium dilution into SNR and CNR values while analyzing the coefficients of variance(cv<10). The software used to measure SNR and CNR values was Image J 1.50i from NIH (National Institutes of Health, USA). MPV (mean pixel value) and SD (standard deviation) were used after verifying numerically the image signal for region of interest (ROI) and background on phantom from the DICOM (digital imaging and communications in medicine) 3.0 file transmitted to PACS. As to contrast medium dilution by the change of tube current, when 146 mA and 102 mA were compared, For both SNR and CNR, the coefficient of variation value was less than 10 until the section of CM: N/S dilution (100% ~ 30% : 70%) but CM: N/S dilution rate (20%: 80% ~ 10% : 90%) the coefficient of variation was 10 or more. As to contrast medium dilution by concentration for SOD change, when SOD's (32.5 cm and 22.5 cm) were compared,For both SNR and CNR, the coefficient of variation value was less than 10 until the section of CM: N/S dilution (100% ~ 30% : 70%) but CM: N/S dilution rate (20%: 80% ~ 10% : 90%) the coefficient of variation was 10 or more. As to contrast medium dilution by concentration for SOD change, when SOD's (32.5 cm and 12.5 cm) were compared,For both SNR and CNR, the coefficient of variation value was less than 10 until the section of CM: N/S dilution (100% ~ 30% : 70%) but CM: N/S dilution rate (20%: 80% ~ 10% : 90%) the coefficient of variation was 10 or more. As a result, set a low tube current value in other tests or procedures including peripheral angiography of the lower extremities in the intervention, and make the table as close as possible to the image receiver, and adjust the contrast agent concentration (300) to CM: N/S dilution (30%: 70%). ) Is suggested as the most efficient way to obtain images with an appropriate concentration while simultaneously reducing the burden on the kidney and the burden on exposure.

• Radiation Oncology Journal
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• v.18 no.2
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• pp.101-106
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• 2000

Purpose : This study was peformed to evaluate the effectiveness and tolerance of craniospinal irradiation for patients with modulloblastoma and to define the optimal radiotherapeutic regimen. Materials and Methods : We retrospectively analyzed the records of 43 patients with modulloblastoma who were treated with external beam craniospinal radiotherapy at our institution between May, 1984 and April, 1998. Median follow up period was 47 months with range of 18 to U months. Twenty seven patients were male and sixteen patients were female, a male to female ratio of 1.7:1. Surgery consisted of biopsy alone in 5 patients, subtotal excision in 24 patients, and gross total excision in 14 patients. All of the patients were treated with craniospinal irradiation. All of the patients except four received at least 5,000 cGy to the posterior fossa and forty patients received more than 3,000 cGy to the spinal cord. Results : The overall survival rates at 5 and 7 years for entire group of patients were 57$\%$ and 56$\%$, respectively. Corresponding disease free survival rates were 60$\%$ and 51$\%$, respectively, The rates of disease control in the posterior fossa were 77$\%$ and 67$\%$ at 5 and 7 years. Gross total excision and subtotal excision resulted in 5 year overall survival rates of 76$\%$ and 66$\%$, respectively, In contrast, those patients who had biopsy alone had a 5 year survival rate of only 40$\%$. Posterior fossa was a component of failure in 11 of the 18 recurrences. Seven recurrences were isolated to the posterior fossa. Four patients had neuraxis recurrences, three had distant metastasis alone and four had multiple sites of failure, all involving the primary site. Conclusion : Craniospinal irradiation for patients with moduiloblastoma is an effective adjuvant treatment without significant treatment related toxicitles. There is room for Improvement in terms of posterior fossa control, especially in biopsy alone patients. The advances in radiotherapy including hypefractionation, stereotactic radiosurgery and 3D conformal radiotherapy would be evolved to improve the tumor control rate at primary site.