• Radiation Oncology Journal
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• 제37권1호
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• pp.13-21
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• 2019

Purpose: Glioblastoma (GBM) carries a high propensity for in-field failure despite trimodality management. Past studies have failed to show outcome improvements with dose-escalation. Herein, we examined trends and outcomes associated with dose-escalation for GBM. Materials and Methods: The National Cancer Database was queried for GBM patients who underwent surgical resection and external-beam radiation with chemotherapy. Patients were excluded if doses were less than 59.4 Gy; dose-escalation referred to doses ≥66 Gy. Odds ratios identified predictors of dose-escalation. Univariable and multivariable Cox regressions determined potential predictors of overall survival (OS). Propensity-adjusted multivariable analysis better accounted for indication biases. Results: Of 33,991 patients, 1,223 patients received dose-escalation. Median dose in the escalation group was 70 Gy (range, 66 to 89.4 Gy). The use of dose-escalation decreased from 8% in 2004 to 2% in 2014. Predictors of escalated dose were African American race, lower comorbidity score, treatment at community centers, decreased income, and more remote treatment year. Median OS was 16.2 months and 15.8 months for the standard and dose-escalated cohorts, respectively (p = 0.35). On multivariable analysis, age >60 years, higher comorbidity score, treatment at community centers, decreased education, lower income, government insurance, Caucasian race, male gender, and more remote year of treatment predicted for worse OS. On propensity-adjusted multivariable analysis, age >60 years, distance from center >12 miles, decreased education, government insurance, and male gender predicted for worse outcome. Conclusion: Dose-escalated radiotherapy for GBM has decreased over time across the United States, in concordance with guidelines and the available evidence. Similarly, this large study did not discern survival improvements with dose-escalation.

• Environmental Analysis Health and Toxicology
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• 제31권
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• pp.7.1-7.6
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• 2016

Objectives The aim of this study is to evaluate radiation exposure resulting from the comprehensive health examinations of selected university hospital programs and to present basic data for research and management strategies on the health effects of medical radiation exposure. Methods Radiation-based diagnostic studies of the comprehensive health examination programs of ten university hospitals in Seoul, Korea, as introduced in their websites, were analyzed. The medical radiation studies of the programs were reviewed by radiologists. Only the effective doses of the basic studies were included in the analysis. The optional studies of the programs were excluded. Results Among the 190 comprehensive health examination programs, 132 programs (69.5%) included computed tomography studies, with an average of 1.4 scans. The average effective dose of radiation by program was 3.62 mSv for an intensive program for specific diseases; 11.12 mSv for an intensive program for cancer; 18.14 mSv for a premium program; and 24.08 mSv for an overnight program. A higher cost of a programs was linked to a higher effective dose (r=0.812). The effective doses of the examination programs for the same purposes differed by as much as 2.1 times by hospital. Inclusion of positron emission tomography-computed tomography was the most critical factor in determining the level of effective dose. Conclusions It was found that radiation exposure dose from comprehensive health exam programs targeted for an asymptomatic, healthy public reached between 3.6 and 24 times the annual dose limit for the general public. Relevant management policies at the national level should be provided to minimize medical radiation exposure.

• Archives of Plastic Surgery
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• 제41권1호
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• pp.40-44
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• 2014

Background Chloral hydrate (CH) is the primary agent most commonly used for pediatric sedation prior to diagnostic, therapeutic procedures. In the management of pediatric facial laceration, the initial dose of CH has to balance the need for adequate sedation against the need to minimize sedative complications. Methods A retrospective review of medical records of 834 children who visited our emergency room for facial lacerations from August 2010 to September 2012 was conducted. They were divided into six groups on the basis of the initial dose of CH administered. Further, each group was compared with the standard group (70 to ${\leq}80mg/kg$) with respect to sedation success, augmentation dose, failed sedation, time to procedure, and time of stay. Results With respect to the complication rate, only group 1 (range, 40 to ${\leq}50mg/kg$) showed a significantly lower complication rate. In the case of all the other variables considered, there were no significant differences among any of the groups. Conclusions An initial CH dose of $48{\pm}2mg/kg$ does not negatively affect the success rate of sedation or the need for additional sedative during the primary closure of facial lacerations in pediatric patients. Further, lower doses reduce the incidences of adverse effects and do not delay procedure readiness. Therefore, $48{\pm}2mg/kg$ of CH can be considered the optimal initial dose for pediatric sedation.

• Journal of Radiation Protection and Research
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• 제44권1호
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• pp.8-14
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• 2019

Background: Management of an agricultural food product system following a nuclear accident is indispensable for reducing radiation exposure due to ingestion of contaminated food. The present study analyzes the effect of agricultural countermeasures on ingestion dose following a nuclear accident. Materials and Methods: Agricultural countermeasures suitable for domestic farming environments were selected by referring to the countermeasures applied after the Fukushima accident in Japan. The avertable ingestion doses that could be obtained by implementing the selected countermeasures were calculated using the Korean Agricultural Countermeasure Analysis Program (K-ACAP) to investigate the efficiency of each countermeasure. Results and Discussion: Of the selected countermeasures, the management of crops was effective when radionuclide deposition occurred during the growing season of plants. Treatment by soil additive and topsoil removal was effective when deposition occurred during the nongrowing season of plants. The disposal of milk was not effective owing to the small contribution of milk to the overall ingestion dose. Clean feeding of livestock was effective when deposition occurred during the growing season of fodder plants such as pasture and rice-straw. Finally, the effect of food restriction increased with the soil deposition density of radionuclide. The practical effect of countermeasures was very small when the avertable ingestion dose was absolutely low. Conclusion: The agricultural countermeasures selected to reduce the radionuclide ingestion dose after a nuclear accident must be made appropriate by considering the accident situation, such as the soil deposition density of the radionuclide and the deposition date in relation to farming cycles.

• 대한방사선기술학회지:방사선기술과학
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• 제45권2호
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• pp.159-164
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• 2022

The study developed a radiation dose measurement program in the radiology laboratory to measure how much exposure the students are exposed to during the radiology class, to request for the improvement and the revision of the current Nuclear Safety Act. The experimental program is shown in the following figure, and experiments were conducted to determine the degree of radiation exposure in the control room with a lead gown at a distance of 1 m, 2 m, and 1 m, and in a control room with a radiographic lead glass wall. The duration of the experiment was 3 months from April to June, when radiation imaging practice classes were conducted, and 128 hours of imaging practice per month were conducted. In order to find out the dose of radiation dose during radiology imaging practice class, the experiment was carried out from April to June for 3 months, and according to the program, the results of exposure dose were 0.34 mSv at 1 m distance, 0.01 mSv at shielding of lead gown at 1 m distance, 0.16 mSv at 2 m distance, and 0.01 mSv at control room with radiation lead glass wall. The exposure dose from the test results was much below the annual general public limit dose of 1 mSv. The restriction on the operation of the radiation equipment in the practice of the students is a regulation that infringes the right of students to learn, and amendments or exemptions of Nuclear Safety Act should be enacted to ensure that it does not violate the fundamental right to learn for students in radiology.

• 대한방사선기술학회지:방사선기술과학
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• 제45권4호
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• pp.331-339
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• 2022

The purpose of this study was to evaluate maternal organ and fetal doses by week of pregnancy for pregnant women nuclear medicine practitioners in the nuclear medicine field. In addition, we intend to present basic data for the management of exposure doses of female nuclear medicine practitioners. In this study, phantoms of childbearing women, 3, 6, 9 months pregnant women were simulated using MCNPX(Monte Carlo N-Particle Extended) among the Monte Carlo methods. First, volume source was constructed based on 10 cm of the anterior part of the lower abdomen of the phantom, and the organ and fetal doses were evaluated for each week of the pregnant woman according to the type of radioactive isotope. Second, the organ and fetal dose of pregnant women were evaluated by increasing the distance between the source and the abdominal surface by 50 and 100 cm. As a result, ¹⁸F sources showed high organ and fetal doses in pregnant women 0 to 3 months, and the dose distribution gradually decreased in 6 to 9 months pregnant women. The distribution of organ and fetal doses for ⁹⁹mTc and ¹²³I sources showed the same tendency as that of ¹⁸F, and the overall absorbed dose distribution was relatively lower than that of ¹⁸F. Through this study, it is considered that workers in the early stages of pregnancy within 3 months will need appropriate management to minimize occupational exposure dose.

• 한국방사선학회논문지
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• 제7권2호
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• pp.145-149
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• 2013

의료용 선형가속기 (linear accelerator)와 나선형 컴퓨터 단층 촬영 장치 (helical computed tomography scanner)의 결합 장치인 토모테라피는 세기 변조 방사선 치료 (intensity modulated radiation therapy(IMRT))의 큰 혁신을 이끌었다. 토모테라피 치료 과정에서, Megavoltage computed tomography (MVCT) 영상획득은 치료 환자의 정확한 자세 정렬을 위해 치료 전 또는 후에 이용된다. 그러나 이는 환자의 총 선량을 증가시키는 결과를 만들며, 본 연구는 이처럼 MVCT 영상 획득 시 증가되는 선량을 Cylindrical "Cheese" Phantom을 이용하여 측정, 비교하였다. 각각의 pitch 별로 (1, 2, 3 mm) 동일한 개수의 slice (10 slice), 그리고 동일한 length (약 9 cm)를 scanning하여, 이때의 선량 (MVCT Scanning Dose)을 A1SL ion chamber를 이용하여 측정하였다. 측정 결과 동일한 Slice 개수 (각각의 pitch 당 10개)일 때, MVCT scanning dose의 평균값은 각각 (pitch 1, 2, 3mm) 2.24 cGy, 1.02 cGy, 0.81 cGy가 측정되었다. 동일한 length에서 MVCT scanning dose의 평균값은 각각 (pitch 1, 2, 3mm) 2.47 cGy, 1.28 cGy, 0.88 cGy가 측정되었다. 이는 할당된 pitch와 scanning length가 MVCT scanning dose에 큰 영향을 미치는 가장 중요한 매개 변수임을 말하며, pitch는 MVCT scanning dose와 역비례 관계를 나타냈다. 때문에 적절한 pitch와 scanning length의 선택으로 치료 선량 외의 추가 선량을 최소로 줄여야 하겠다.

• 한국방사선학회논문지
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• 제17권2호
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• pp.249-255
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• 2023

본 연구는 방사선작업종사자, 방사선관계종사자 그룹의 방사선사들과 수시출입자로 분류된 예비 방사선사인 재학생의 임상실습 과정에서의 피폭선량을 측정하였다. 2021년 1월부터 1년 동안 인천소재의 C 대학병원의 방사선구역에서 근무하였던 방사선사들과 동 의료기관에서 7월 1일부터 8월 31일까지 임상실습을 이수한 121명의 학생들을 연구대상으로 하였다. 방사선 피폭선량으로 인하여 손상위험장기인 폐의 피폭선량으로 인한 부작용 발생확률을 평가하기 위하여 ICRP 103^[12]에 의거한 명목위험계수(Nominal Risk Factor)를 사용하였다. 임상실습기간 중 수시출입자로 분류된 방사선(학)과 학생들의 표층선량은 0.98 ± 0.14 mSv, 심부선량은 0.93 ± 0.14 mSv였다. 즉, 표층선량은 1,000,000당 6.7명, 심부선량은 6.4명이 폐의 피폭선량으로 인한 부작용 발생률이 있음이 나타났다. 이는 1년 피폭선량의 환산 값으로 방사선(학)과 교육과정이 3년 혹은 4년임을 고려하였을 때, 임상실습을 나가는 예비 방사선종사자들에 대한 체계적인 관리와 관심이 필요하며, 방사선의 확률적 영향과 관련하여 방사선 안전관리를 위한 기초자료로 활용될 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3465-3468
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• 2016

Background: Fluorodeoxyglucose ($^{18}FDG$) PET/CT imaging has become an important component of the management paradigm in oncology. However, the significant imparted radiation exposure is a matter of growing concern especially in younger populations who have better odds of survival. The aim of this study was to estimate the effective dose received by patients having whole body $^{18}F$-FDG PET/CT scanning as per recent dose reducing guidelines at a tertiary care hospital. Materials and Methods: This prospective study covered 63 patients with different cancers who were referred for PET/CT study for various indications. Patients were prepared as per departmental protocol and 18FDG was injected at 3 MBq/Kg and a low dose, non-enhanced CT protocol (LD-NECT) was used. Diagnostic CT studies of specific regions were subsequently performed if required. Effective dose imparted by 18FDG (internal exposure) was calculated by using multiplying injected dose in MBq with coefficient $1.9{\times}10^{-2}mSv/MBq$ according to ICRP publication 106. Effective dose imparted by CT was calculated by multiplying DLP (mGy.cm) with ICRP conversion coefficient "k" 0.015 [mSv / (mG. cm)]. Results: Mean age of patients was $49{\pm}18$ years with a male to female ratio of 35:28 (56%:44%). Median dose of 18FDG given was 194 MBq (range: 139-293). Median CTDIvol was 3.25 (2.4-6.2) and median DLP was 334.95 (246.70 - 576.70). Estimated median effective dose imparted by $^{18}FDG$ was 3.69 mSv (range: 2.85-5.57). Similarly the estimated median effective dose by low dose (non-diagnostic) CT examination was 4.93 mSv (range: 2.14 -10.49). Median total effective dose by whole body 18FDG PET plus low dose non-diagnostic CT study was 8.85 mSv (range: 5.56-13.00). Conclusions: We conclude that the median effective dose from a whole body 18FDG PET/CT in our patients was significantly low. We suggest adhering to recently published dose reducing strategies, use of ToF scanner with CT dose reducing option to achieve the lower if not the lowest effective dose. This would certainly reduce the risk of second primary malignancy in younger patients with higher odds of cure from first primary cancer.

• 방사성폐기물학회지
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• 제21권4호
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• pp.531-541
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• 2023

The Wolsong Nuclear Power Plant (NPP) operates an on-site spent fuel dry storage facility using concrete silo and vertical module systems. This facility must be safely maintained until the spent nuclear fuel (SNF) is transferred to an external interim or final disposal facility, aligning with national policies on spent nuclear fuel management. The concrete silo system, operational since 1992, requires an aging management review for its long-term operation and potential license renewal. This involves comparing aging management programs of different dry storage systems against the U.S. NRC's guidelines for license renewal of spent nuclear fuel dry storage facilities and the U.S. DOE's program for long-term storage. Based on this comparison, a specific aging management program for the silo system was developed. Furthermore, the facility's current practices-periodic checks of surface dose rate, contamination, weld integrity, leakage, surface and groundwater, cumulative dose, and concrete structure-were evaluated for their suitability in managing the silo system's aging. Based on this review, several improvements were proposed.