• Radiation Oncology Journal
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• v.35 no.4
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• pp.380-384
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• 2017

Massive chylous leakage is a rare postoperative complication that can prolong hospital stay and cause secondary morbidities. Conservative management strategies are the treatment of choice; however, radiation therapy (RT) can be used as an alternative for cases that are refractory to conservative treatment. Herein, we report a 69-year-old female patient who suffered from massive chylous leakage after subtotal gastrectomy. Due to persistent massive chylous leakage, she was scheduled to undergo low-dose RT. Radiation was delivered with a daily dose of 1 Gy, using an anterior-posterior and posterior-anterior beam arrangement. The clinical target volume encompassed the entire lymph node area of the D2 dissection. RT was completed at the total dose of 8 Gy because the amount of chylous leakage declined rapidly. Percutaneous drainage tube was removed after 3 days of RT. The patient did not complain of any symptoms related to massive chylous leakage 2 years after the completion of RT.

• Asian Spine Journal
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• v.12 no.6
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• pp.1010-1016
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• 2018

Study Design: Retrospective cohort study. Purpose: To report on spinal fusion assessment using computed tomography (CT) after adult spinal deformity (ASD) surgery using ultra-low dose recombinant human bone morphogenetic protein 2 (RhBMP-2). Overview of Literature: The reported dose of RhBMP-2 needed for successful spinal posterolateral fusion in ASD ranges from 10 to 20 mg per spinal level. This study reports the use of ultra-low dose of RhBMP-2 (0.07 mg per facet) to achieve spinal fusion in multilevel ASD surgery. Methods: Consecutive patients who underwent ASD surgery using ultra-low dose RhBMP-2 were recruited. Routine postoperative CT analysis for spinal fusion was performed by two spine surgeons. Inter-observer agreement was calculated for facet fusion (FF) and interbody fusion (IBF) at 6 and 12 months after the procedure. Results: Six consecutive ASD patients with a mean age of 62 years (28-72 years) were examined. Each patient received a total dose of 12 mg with an average dose of $0.69{\pm}0.2mg$ (0.42-1 mg) per single FF and $1.38{\pm}0.44mg$ (0.85-2 mg) for IBF. Total 131 FF and 15 IBF were examined in the study, with 88 FFs and nine IBFs being analyzed specifically at 6 months after the surgery. FF and IBF reported by surgeons A and B at 6 months were 97.7% vs. 91.9% FF, respectively (${\kappa}=0.95$) and 100% vs. 100% IBF, respectively (${\kappa}=1$). Two patients underwent longitudinal follow-up CT at 12 months, and the FF rates reported by surgeons A and B were 100% vs. 95.8%, respectively (${\kappa}=0.96$). Five out of nine facet (56%) non-unions were identified at the cross-links. The remaining four facet pseudarthrosis were noted at 1-2 spinal levels caudal to the cross-links. At the final clinical follow-up, there was no rod breakage, deformity progression, neurological deficit, or symptom recurrence. The Oswestry Disability Index improved by an average of $32.8{\pm}6.3$, while the mental component summary of the 36-item Short-Form Health Survey improved by an average of $4.7{\pm}2.1$, and physical component summary improved by an average of $10.5{\pm}2.1$. Conclusions: To our knowledge, this is the first study to report a CT that defined 92%-98% FF and 100% IBF using the lowest reported dose of RhBMP-2 in multilevel ASD surgery. The use of ultra-low dose RhBMP-2 reduces the RhBMP-2 related complications and healthcare costs.

• Korean Journal of Clinical Pharmacy
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• v.22 no.2
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• pp.181-186
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• 2012

Objective: To report a fatal case of Multidrug-resistant Acinetobacter baumannii (MDR-AB) in a patient with interstitial lung disease (ILD) on high-dose glucocorticoids. Case Summary: A 66-year-old man with a history of coniosis was transferred to the hospital with progressive cough and sputum production. This patient has been diagnosed with pneumonia and ILD on admission, requires antimicrobial therapy and systemic immunosuppressants. He received high dose of methylprednisolone and cyclophosphamide for ILD as well as ceftriaxone and azithromycin for pneumonia. On day 7 in the intensive care units (ICUs), patient had fever and leukocytosis, thus antimicrobials were switched to piperacillin. After 13 days in the ICU, Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) were isolated on transtracheal aspirate (TTA) and meropenem was initiated. However, it was revealed a multidrug-resistant Acinetobacter baumannii (MDR-AB) species, resistant to carbapenem. Patient was administered colistin but expired due to septic shock on day 84. Discussion: Systemic immunosuppressive therapy can result in infections that may compromise patient's survival. MDR-AB has emerged as a serious cause of nosocomial infections in immunocompromised patients. MDR-AB is resistant to most standard antimicrobials and therapeutic options are limited. Conclusion: We report our recent experience with a fatal MDR-AB pneumonia in a patient with ILD, who had to be treated with high dose glucocorticoids and immunosuppressnts.

• Imaging Science in Dentistry
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• v.42 no.2
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• pp.65-70
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• 2012

Purpose : The aim of this study was to compare the effective dose for imaging of mandible between multi-detector computed tomography (MDCT) and cone-beam computed tomography (CBCT). An MDCT with low dose technique was also compared with them. Materials and Methods : Thermoluminescent dosimeter (TLD) chips were placed at 25 organ sites of an anthropomorphic phantom. The mandible of the phantom was exposed using 2 different types of MDCT units (Somatom Sensation 10 for standard-dose MDCT, Somatom Emotion 6 for low-dose MDCT) and 3 different CBCT units (AZ3000CT, Implagraphy, and Kavo 3D eXaM). The radiation absorbed dose was measured and the effective dose was calculated according to the ICRP 2007 report. Results : The effective dose was the highest for Somatom Sensation 10 (425.84 ${\mu}Sv$), followed by AZ3000CT (332.4 ${\mu}Sv$), Somatom Emotion 6 (199.38 ${\mu}Sv$), and 3D eXaM (111.6 ${\mu}Sv$); it was the lowest for Implagraphy (83.09 ${\mu}Sv$). The CBCT showed significant variation in dose level with different device. Conclusion : The effective doses of MDCTs were not significantly different from those of CBCTs for imaging of mandible. The effective dose of MDCT could be markedly decreased by using the low-dose technique.

• Progress in Medical Physics
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• v.34 no.3
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• pp.33-39
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• 2023

Purpose: FLASH radiotherapy (RT) using ultra-high dose rate (>40 Gy/s) radiation is being studied worldwide. However, experimental studies such as preclinical studies using small animals are difficult to perform due to the limited availability of irradiation devices and methods for generating a FLASH beam. In this paper, we report the initial dosimetry results of a prototype electron linear accelerator (LINAC)-based irradiation system to perform ultra-high dose rate (UHDR) preclinical experiments. Methods: The present study used the prototype electron LINAC developed by the Research Center of Dongnam Institute of Radiological and Medical Sciences (DIRAMS) in Korea. We investigated the beam current dependence of the depth dose to determine the optimal beam current for preclinical experiments. The dose rate in the UHDR region was measured by film dosimetry. Results: Depth dose measurements showed that the optimal beam current for preclinical experiments was approximately 33 mA, corresponding to a mean energy of 4.4 MeV. Additionally, the average dose rates of 80.4 Gy/s and 162.0 Gy/s at a source-to-phantom surface distance of 30 cm were obtained at pulse repetition frequencies of 100 Hz and 200 Hz, respectively. The dose per pulse and instantaneous dose rate were estimated to be approximately 0.80 Gy and 3.8×10⁵ Gy/s, respectively. Conclusions: Film dosimetry verified the appropriate dose rates to perform FLASH RT preclinical studies using the developed electron-beam irradiator. However, further research on the development of innovative beam monitoring systems and stabilization of the accelerator beam is required.

• Journal of the Korean Society of Radiology
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• v.17 no.6
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• pp.801-808
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• 2023

In order to minimize radiation exposure and secure diagnostic value images during CT examination of the head of children, the usefulness of volume axial mode is evaluated through comparison and analysis of exposure dose and images of volume axial mode, high pitch mode, and helical mode. Image evaluation and dose evaluation were performed in CT high pitch mode, helical mode, and volume axial mode for infants under the age of 1 according to the voltages of 70, 80, and 100 kVp tubes. The image evaluation was conducted by comparing image quality by setting ROI for each image, calculating SNR and CNR, using ONE-WAY (ANOVA) to evaluated statistical significance, and cross-examining the dose evaluation using DLP values displayed in the Dose Report. When inspected using volume axial mode, DLP values were generally low, and SNR and CNR values differed by ROI and kVp. When volume axial mode evaluated the quality of the image compared to other scan modes, the difference is not uniform. For the reason, certain modes are not considered excellent, but the exposure dose was reduced the most in terms of dose. In addition, the point that the volume axial mode can be examined at its original location, short scanning time and needless of table movement is useful for CT tests for children under 1 year of age with high radiation sensitivity.

• Journal of Radiation Protection and Research
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• v.40 no.3
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• pp.187-193
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• 2015

Deleterious effects of high dose radiation exposure with high-dose-rate are unarguable, but they are still controversial in low-dose-rate. The regulator of G-protein signaling (RGS) is a negative regulator of G protein-coupled receptor (GPCR) signaling. In addition, it is reported that irradiation stress led to GPCR-mediated mitogen-activated protein kinase (MAPK) and phosphotidylinositol 3-kinase (PI3-k) signaling. The RGS mRNA expression profiles by whole body radiation with low-dose-rate has not yet been explored. In the present study, we, therefore, examined which RGS was modulated by the whole body radiation with low-dose-rate ($3.49mGy{\cdot}h^{-1}$). Among 16 RGS expression tested, RGS6, RGS13 and RGS16 mRNA were down-regulated by low-dose-rate irradiation. This is the first report that whole body radiation with low-dose-rate can modulate the different RGS expression levels. These results are expected to reveal the potential target and/or the biomarker proteins associated with male testis toxicity induced by low-dose-rate irradiation, which might contribute to understanding the mechanism beyond the testis toxicity.

• Journal of Radiation Protection and Research
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• v.45 no.2
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• pp.81-87
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• 2020

Background: Kori unit #1 is permanently shut down after a 40-year lifetime. The Nuclear Safety and Security Commission recommends establishing initial decommissioning plans for all nuclear and radwaste treatment facilities. Therefore, the Korea Atomic Energy Research Institute (KAERI) must establish an initial and final decommissioning plan for radwaste-treatment facilities. Radiation safety assessment, which constitutes one chapter of the decommissioning plan, is important for establishing a decommissioning schedule, a strategy, and cost. It is also a critical issue for the government and public to understand. Materials and Methods: This study provides a method for assessing external radiation dose to workers during decommissioning. An external dose is calculated following each exposure scenario, decommissioning strategy, and working schedule. In this study, exposure dose is evaluated using the deterministic method. Physical characterization of the facility is obtained by both direct measurement and analysis of the drawings, and radiological characterization is analyzed using the annual report of KAERI, which measures the ambient dose every month. Results and Discussion: External doses are calculated at each stage of a decommissioning strategy and found to increase with each successive stage. The maximum external dose was evaluated to be 397.06 man-mSv when working in liquid-waste storage. To satisfy the regulations, working period and manpower must be managed. In this study, average and cumulative exposure doses were calculated for three cases, and the average exposure dose was found to be about 17 mSv/yr in all the cases. Conclusion: For the three cases presented, the average exposure dose is well below the annual maximum effective dose restriction imposed by the international and domestic regulations. Working period and manpower greatly affect the cost and entire decommissioning plan; hence, the chosen option must take account of these factors with due consideration of worker safety.

• Journal of Radiation Protection and Research
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• v.41 no.4
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• pp.424-435
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• 2016

Background: The International Commission on Radiological Protection (ICRP) recommendations and the Federal Guidance Report (FGR) published by the U.S. Environmental Protection Agency (EPA) have been widely applied worldwide in the fields of radiation protection and dose assessment. The dose conversion coefficients of the ICRP and FGR are widely used for assessing exposure doses. However, before the coefficients are used, the user must thoroughly understand the derivation process of the coefficients to ensure that they are used appropriately in the evaluation. Materials and Methods: The ICRP provides recommendations to regulatory and advisory agencies, mainly in the form of guidance on the fundamental principles on which appropriate radiological protection can be based. The FGR provides federal and state agencies with technical information to assist their implementation of radiation protection programs for the U.S. population. The system of radiation dose assessment and dose conversion coefficients in the ICRP and FGR is reviewed in this study. Results and Discussion: A thorough understanding of their background is essential for the proper use of dose conversion coefficients. The FGR dose assessment system was strongly influenced by the ICRP and the U.S. National Council on Radiation Protection and Measurements (NCRP), and is hence consistent with those recommendations. Moreover, the ICRP and FGR both used the scientific data reported by Biological Effects of Ionizing Radiation (BEIR) and United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) as their primary source of information. The difference between the ICRP and FGR lies in the fact that the ICRP utilized information regarding a population of diverse races, whereas the FGR utilized data on the American population, as its goal was to provide guidelines for radiological protection in the US. Conclusion: The contents of this study are expected to be utilized as basic research material in the areas of radiation protection and dose assessment.

• Journal of Radiation Protection and Research
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• v.10 no.1
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• pp.74-85
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• 1985

The four new operational quantities for the practical determination of dose equivalents from external radiation sources, defined in the ICRU report 39, are reviewed from the viewpoint of the underlying concept, the relationship to the existing quantities, and the expected role in the radiation protection practice and in the radiation measurements.