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The Benefit of Individualized Custom Bolus in the Postmastectomy Radiation Therapy : Numerical Analysis with 3-D Treatment Planning (유방전절제술 후 방사선치료를 위한 조직보상체 개발 및 3차원 치료계획을 통한 유용성 분석)

  • Cho Jae Ho;Cho Kwang Hwan;Keum Kichang;Han Yongyih;Kim Yong Bae;Chu Sung Sil;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.21 no.1
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    • pp.82-93
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    • 2003
  • Purpose : To reduce the Irradiation dose to the lungs and heart in the case of chest wail irradiation using an oppositional electron beam, we used an Individualized custom bolus, which was precisely designed to compensate for the differences In chest wall thickness. The benefits were evaluated by comparing the normal tissue complication probablilties (NTCPS) and dose statistics both with and without boluses. Materials and Methods : Boluses were made, and their effects evaluated in ten patients treated using the reverse hockey-stick technique. The electron beam energy was determined so as to administer 80% of the irradiation prescription dose to the deepest lung-chest wall border, which was usually located at the internal mammary lymph node chain. An individualized custom bolus was prepared to compensate for a chest wall thinner than the prescription depth by meticulously measuring the chest wall thickness at 1 emf intervals on the planning CT Images. A second planning CT was obtained overlying the individuailzed custom bolus for each patient's chest wall. 3-D treatment planning was peformed using ADAC-Pinnacle$^{3}$ for all patients with and without bolus. NTCPS based on 'the Lyman-Kutcher' model were analyzed and the mean, maximum, minimum doses, V$_{50}$ and V$_{95}$ for 4he heari and lungs were computed. Results .The average NTCPS in the ipsliateral lung showed a statistically significant reduction (p<0.01), from 80.2${\pm}$3.43% to 47.7${\pm}$4.61%, with the use of the individualized custom boluses. The mean lung irradiation dose to the ipsilateral iung was also significantly reduced by about 430 cGy, Trom 2757 cGy to 2,327 cGy (p<0.01). The V$_{50}$ and V$_{95}$ in the ipsilateral lung markedly decreased from the averages of 54.5 and 17.4% to 45.3 and 11.0%, respectively. The V$_{50}$ and V$_{95}$ In the heart also decreased from the averages of 16.8 and 6.1% to 9.8% and 2.2%, respectively. The NTCP In the contralateral lung and the heart were 0%, even for the cases with no bolus because of the small effective mean radiation volume values of 4.4 and 7.1%, respectively Conclusion : The use of an Individualized custom bolus in the radiotherapy of postrnastectorny chest wall reduced the NTCP of the ipsilateral lung by about 24.5 to 40.5%, which can improve the complication free cure probability of breast cancer patients.

Bone mineral density and nutritional state according to milk consumption in Korean postmenopausal women who drink coffee: Using the 2008~2009 Korea National Health and Nutrition Examination Survey (한국 폐경 후 여성 커피소비자에서 우유섭취여부에 따른 골밀도와 영양상태 비교 : 2008~2009년 국민건강영양조사 자료 이용)

  • Ryu, Sun-Hyoung;Suh, Yoon Suk
    • Journal of Nutrition and Health
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    • v.49 no.5
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    • pp.347-357
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    • 2016
  • Purpose: This study investigated bone mineral density and nutritional state according to consumption of milk in Korean postmenopausal women who drink coffee. Methods: Using the 2008~2009 Korean National Health & Nutrition Examination Survey data, a total of 1,373 postmenopausal females aged 50 yrs and over were analyzed after excluding those with diseases related to bone health. According to coffee and/or milk consumption, subjects were divided into four groups: coffee only, both coffee & milk, milk only, and none of the above. All data were processed after application of weighted values and adjustment of age, body mass index, physical activity, drinking, and smoking using a general linear model. For analysis of nutrient intake and bone density, data were additionally adjusted by total energy and calcium intake. Results: The coffee & milk group had more subjects younger than 65 yrs and higher education, urban residents, and higher income than any other group. The coffee only group showed somewhat similar characteristics as the none of the above group, which showed the highest percentage of subjects older than 65 and in a lower education and socio-economic state. Body weight, height, body mass index, and lean mass were the highest in coffee & milk group and lowest in the none of the above group. On the other hand, the milk only group showed the lowest values for body mass index and waist circumference, whereas percent body fat did not show any difference among the groups. The coffee and milk group showed the highest bone mineral density in the total femur and lumbar spine as well as the highest nutritional state and most food group intakes, followed by the milk only group, coffee only group, and none of the above group. In the assessment of osteoporosis based on T-score of bone mineral density, although not significant, the coffee and milk group and milk only group, which showed a better nutritional state, included more subjects with a normal bone density, whereas the none of the above group included more subjects with osteoporosis than any other group. Conclusion: Bone mineral density in postmenopausal women might not be affected by coffee drinking if their diets are accompanied by balanced food and nutrient intake including milk.

A Study on the Daesoon Cosmology of the Correlative Relation between Mugeuk and Taegeuk (무극과 태극 상관연동의 대순우주론 연구)

  • Kim, Yong-hwan
    • Journal of the Daesoon Academy of Sciences
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    • v.33
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    • pp.31-62
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    • 2019
  • The purpose of this article is to study on the Daesoon Cosmology of the Correlative Relation between Mugeuk and Taegeuk. Daesoon cosmology is a cosmology based on the juxtaposition between the Gucheon Sangje and the world. In this article, I would like to say that this theory in Daesoon Thought was developed in three stages: the phase of the Mugeuk Transcendence of Gucheon Sangje, the stage of the Taegeuk Immanence, and the phase of the Grand Opening of the Later World between Mugeuk and Taegeuk as a correlative gentle reign. First of all, the phase of the Mugeuk Transcendence of Gucheon Sangje has been revealed as a yin-yang relationship. The stage of the Taegeuk Immanence represents the togetherness of harmony and co-prosperity between yin and yang, and the phase of the Grand Opening of the Later World between Mukeuk and Taegeuk refers to the unshakable accomplishment of its character and energy. It will be said that this is due to the practical mechanism in the correct balance of yin-yang making a four stage cycle of birth, growth, harvest, and storage. In addition, the Daesoon stage of the settlement of yin and yang is revealed as a change in the growth of all things and the formation of the inner circle. The mental growth reveals the characteristics of everything in the world, each trying to shine at the height of their own respective life as they grow up energetically. The dominant culture of cerebral communion renders a soft and elegant mood and combines yin and yang to elevate the heavenly and earthly period through transcendental change into sympathetic understanding. The stage of the Grand Opening of the Later World between Mugeuk and Taegeuk is one of the earliest days of the lunar month and also the inner circle of Taegeuk. It is in line with Ken Wilbur's integrated model as a step to the true degrees to develop into a world with brightened degrees. It is a beautiful and peaceful scene where celestial maidens play music, the firewood burns, and the scholars command thunder and lightning playfully. Human beings achieve a state of happiness as a free beings who lives as gods upon the earth. This is the world of theGrand Opening of the Later World between Mugeuk and Taegeuk. Daesoon Thought was succeeded by Dojeon in 1958, when Dojeon emerged as the successor in the lineage of religious orthodoxy and was assigned the task of handling Dao in its entirety. In addition, Daesoon is a circle and represents freedom and commonly shared happiness among the populous. Cosmology in the Daesoon Thought will enable us to understand deep dimensions and the identity of members as individuals within an inner circle of correlation between transcendence and immanence. This present study tries to analyze the public effects philologically and also the mutual correlation by utilizing the truthfulness of literature and rational interpretation. The outlook for the future in Daesoon Thought also leads to the one-way communication of Daesoon as a circle.