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Patient Specific Quality Assurance of IMRT: Quantitative Approach Using Film Dosimetry and Optimization (강도변조방사선치료의 환자별 정도관리: 필름 선량계 및 최적화법을 이용한 정량적 접근)

  • Shin Kyung Hwan;Park Sung-Yong;Park Dong Hyun;Shin Dongho;Park Dahl;Kim Tae Hyun;Pyo Hongryull;Kim Joo-Young;Kim Dae Yong;Cho Kwan Ho;Huh Sun Nyung;Kim Il Han;Park Charn Il
    • Radiation Oncology Journal
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    • v.23 no.3
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    • pp.176-185
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    • 2005
  • Purpose: Film dosimetry as a part of patient specific intensity modulated radiation therapy quality assurance (IMRT QA) was peformed to develop a new optimization method of film isocenter offset and to then suggest new quantitative criteria for film dosimetry. Materials and Methods: Film dosimetry was peformed on 14 IMRT patients with head and neck cancers. An optimization method for obtaining the local minimum was developed to adjust for the error in the film isocenter offset, which is the largest part of the systemic errors. Results: The adjust value of the film isocenter offset under optimization was 1 mm in 12 patients, while only two patients showed 2 mm translation. The means of absolute average dose difference before and after optimization were 2.36 and $1.56\%$, respectively, and the mean ratios over a $5\%$ tolerance were 9.67 and $2.88\%$. After optimization, the differences in the dose decreased dramatically. A low dose range cutoff (L-Cutoff) has been suggested for clinical application. New quantitative criteria of a ratio of over a $5\%$, but less than $10\%$ tolerance, and for an absolute average dose difference less than $3\%$ have been suggested for the verification of film dosimetry. Conclusion: The new optimization method was effective in adjusting for the film dosimetry error, and the newly quantitative criteria suggested in this research are believed to be sufficiently accurate and clinically useful.

An Analysis of Referrals, Nursing Diagnosis, and Nursing Interventions in Home Care - Wonju Christian Hospital Community Health Nursing Service - (가정간호 기록지 분석 - 원주기독병원 가정간호 보건활동을 중심으로 -)

  • Suh, Mi-Hae;Huh, Hae-Kyung
    • Journal of Home Health Care Nursing
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    • v.3
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    • pp.53-66
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    • 1996
  • Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

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A study on the effect of tunnelling to adjacent single piles and pile groups considering the transverse distance of pile tips from the tunnel (말뚝의 횡방향 이격거리를 고려한 터널굴착이 인접 단독말뚝 및 군말뚝에 미치는 영향에 대한 연구)

  • Jeon, Young-Jin;Kim, Sung-Hee;Lee, Cheol-Ju
    • Journal of Korean Tunnelling and Underground Space Association
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    • v.17 no.6
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    • pp.637-652
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    • 2015
  • In the present work, a number of three-dimensional (3D) parametric numerical analyses have been carried out to study the influence of tunnelling on the behaviour of adjacent piles considering the transverse distance of the pile tip from the tunnel. Single piles and $5{\times}5$ piles inside a group with a spacing of 2.5d were considered, where d is the pile diameter. In the numerical modelling, several key issues, such as the tunnelling-induced pile settlements, the interface shear stresses, the relative shear displacements, the axial pile forces, the apparent factors of safety and zone of influence have been rigorously analysed. It has been found that when the piles are inside the influence zone, the pile head settlements are increased up to about 111% compared to those computed from the Greenfield condition. Larger pile settlements and smaller axial pile forces are induced on the piles inside the pile groups than those computed from the single piles since the piles responded as a block with the surrounding ground. Also tensile pile forces are induced associated with the upward resisting skin friction at the upper part of pile and the downward acting skin friction at the lower part of pile. On the contrary, when the piles were outside the influence zone, tunnelling-induced compressive pile forces developed. Based on computed load and displacement relation of the pile, the apparent factor of safety of the piles was reduced up to about 45%. Therefore the serviceability of the piles may be substantially reduced. The pile behaviour, when considering the single piles and the pile groups with regards to the influence zone, has been analysed by considering the key features in great details.

Morphological and Nutritional Characteristics and Crossability with Brassica Species of Baemoochae, xBrassicoraphanus (배무채의 형태와 영양적 특성 및 교잡 친화성)

  • Lee, Soo-Seong;Kim, Tae Yoon;Yang, Jungmin;Kim, Jongkee;Lim, Sooyeon;Yoon, Moo Kyoung
    • Horticultural Science & Technology
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    • v.30 no.5
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    • pp.543-548
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    • 2012
  • Morphological characters of Baemoochae, xBrassicoraphanus are mostly intermedium of the both parents, Chinese cabbage, Brassica rapa ssp. pekinensis and radish, Raphanus sativus. The upper and lower parts of the leaf resemble the shape of Chinese cabbage and radish, respectively. The midrib of the leaf is round like to that of radish, but very big more than 3 cm in diameter and white in color like that of Chinese cabbage. The root was changed from the swollen type like that of radish to the enlarged taproot like that of the land race of Chinese cabbage after attaining genetical stability. The flower is white. The seed pod is divided into 2 different parts; the upper part is radish and about 4 cm in length and holds 3-4 seeds and the lower part is Chinese cabbage and about 3 cm in length and holds 7-8 seeds. The color of seed is brown, weight per 1.000 seeds is 5.5 g and the number of seeds per mL is 120. The matured plant in the fall season is around 5 kg in weight and outer leaves are very vigorous and stiffly and inner leaves are erect and form a loose head. The leaf and the root contain a high level of sulforaphene which is well known as a functional substance for anti-cancer and anti-super-bacteria. Baemoochae is an amphidiploid and does not have the self incompatibility function. It has a high level of cross compatibility with Chinese cabbage as the female parent, but not the male parent. It is cross incompatible to cabbage, B. oleracea, black mustard, B. nigra and radish. However it is highly compatible to oil seed rape, B. napus, yellow mustard, B. carinata and partial compatible to muatard, B. juncea in the reciprocal cross.

Internal Fixation of Proximal Humerus Fracture with Polyaxial Angular Stable Locking Compression Plate in Patients Older Than 65 Years (65세 이상의 상완골 근위부 골절 환자에서 다축 각안정 잠김 압박 금속판을 이용한 내고정술)

  • Lee, Ki-Won;Choi, Young-Joon;Ahn, Hyung-Sun;Kim, Chung-Hwan;Hwang, Jae-Kwang;Kang, Jeong-Ho;Choo, Han-Ho;Park, Jun-Seok;Kim, Tae-Kyung
    • Clinics in Shoulder and Elbow
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    • v.15 no.1
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    • pp.25-31
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    • 2012
  • Purpose: The clinical and radiographic outcomes of the internal fixation, which were executed on patients over the age of 65 with proximal humerus fracture by using a polyaxial angular stable locking compression plate (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB), were evaluated. Materials and Methods: Thirty two patients over the age of 65 among the proximal humerus fracture treated with NCB plate, between August 2007 and January 2011, were chosen as the subjects. The average age of patients was 71 years, and the average postoperative follow-up period was 11.5 months. The fractures included 14 two-part and 18 three-part fractures. The clinical results were evaluated, using the visual analog scale (VAS) score and the Constant score. The radiological results were evaluated by time to union and Paavolainen method, which measures the neck shaft angle. Results: At the last follow-up examination, the mean VAS score was 3 points and the mean Constant score was 64.5 points, with bone union achieved after the average of 16.2 weeks following the surgery in all the cases. The mean neck shaft angle was 125.9 and 24 cases had good results, while 8 cases had fair results by Paavolainen method, at the last follow-up. There were 1 case of delayed union and cerclage wire failure, and 3 cases of subacromial impingement. There were no complications, such as loss of reduction, nonunion, screw loosening, or avascular necrosis of the humeral head. Conclusion: Internal fixation, using a NCB plate, was considered to be an effective surgical method in treating proximal humerus fracture in the elderly patients, on whom the fixation of the fracture and maintenance of reduction are difficult.

Comparisons between the Two Dose Profiles Extracted from Leksell GammaPlan and Calculated by Variable Ellipsoid Modeling Technique (렉셀 감마플랜(LGP)에서 추출된 선량 분포와 가변 타원체 모형화기술(VEMT)에 의해 계산된 선량 분포 사이의 비교)

  • Hur, Beong Ik
    • Journal of the Korean Society of Radiology
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    • v.11 no.1
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    • pp.9-17
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    • 2017
  • A high degree of precision and accuracy in Gamma Knife Radiosurgery(GKRS) is a fundamental requirement for therapeutical success. Elaborate radiation delivery and dose gradients with the steep fall-off of radiation are clinically applied thus necessitating a dedicated Quality Assurance(QA) program in order to guarantee dosimetric and geometric accuracy and reduce all the risk factors that can occur in GKRS. In this study, as a part of QA we verified the accuracy of single-shot dose profiles used in the algorithm of Gamma Knife Perfexion(PFX) treatment planning system employing Variable Ellipsoid Modeling Technique(VEMT). We evaluated the dose distributions of single-shots in a spherical ABC phantom with diameter 160 mm on Gamma Knife PFX. The single-shots were directed to the center of ABC phantom. Collimating configurations of 4, 8, and 16 mm sizes along x, y, and z axes were studied. Gamma Knife PFX treatment planning system being used in GKRS is called Leksell GammaPlan(LGP) ver 10.1.1. From the verification like this, the accuracy of GKRS will be doubled. Then the clinical application must be finally performed based on precision and accuracy of GKRS. Specifically the width at the 50% isodose level, that is, Full-Width-of-Half-Maximum(FWHM) was verified under such conditions that a patient's head is simulated as a sphere with diameter 160mm. All the data about dose profiles along x, y, and z axes predicted through VEMT were excellently consistent with dose profiles from LGP within specifications(${\leq}1mm$ at 50% isodose level) except for a little difference of FWHM and PENUMBRA(isodose level: 20%~80%) along z axis for 4 mm and 8mm collimating configurations. The maximum discrepancy of FWHM was less than 2.3% at all collimating configurations. The maximum discrepancy of PENUMBRA was given for the 8 mm collimator along z axis. The difference of FWHM and PENUMBRA in the dose distributions obtained with VEMT and LGP is too small to give the clinical significance in GKRS. The results of this study are considered as a reference for medical physicists involved in GKRS in the whole world. Therefore we can work to confirm the validity of dose distributions for all collimating configurations determined through the regular preventative maintenance program using the independent verification method VEMT for the results of LGP and clinically assure the perfect treatment for patients of GKRS. Thus the use of VEMT is expected that it will be a part of QA that can verify and operate the system safely.

The Effects of Chest Injury in the Early Deaths of Trauma Patients (외상에 의한 초기 사망에서 흉부손상에 대한 고찰)

  • Lee Dong Hoon;Cho Dai Yun;Kim Chan Woong;Sohn Dong Suep
    • Journal of Chest Surgery
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    • v.39 no.2 s.259
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    • pp.127-133
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    • 2006
  • Background: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. Material and Method: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. Result: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86$\pm$4.15 for the early deaths and 8.24$\pm$5.02 for the late deaths (p < 0.05). The AIS of thorax were 2.66$\pm$1.87 for the early deaths and 1.55$\pm$1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). Conclusion: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.

A Study on Case for Localization of Korean Enterprise in Indonesia (인도네시아 진출 한국기업의 현지화에 관한 사례 연구)

  • Swo, Min-Kyo;Kim, Hee-Jun
    • International Commerce and Information Review
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    • v.15 no.4
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    • pp.481-508
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    • 2013
  • The purpose of this study is to research the specific ways of successful localization by analyzing the success and failures case for localization through the theoretical background and the strategic models of localization. The strategic models of localization are divided by management aspects such as the localization of production and sourcing, the localization of human resources, the localization of marketing, the localization of R&D, harmonious relationship with the local community and authority transfer between headquarters and local subsidiaries. And the specific measures of the successful localization are proposed within the framework of the strategic models by comparing and analyzing the success and failures case for localization of individual companies operating in Indonesia. The results indicate that there are successful companies which develop a suitable products for the local climate and failed automobile company which is weak for assembly of complete vehicle in terms of localization of production and sourcing. In case of localization of human resources, most companies recognize the importance of this part and endeavor to secure superior human resource through a related education. It is found that most of the companies perform R & D in their native country. In part of a harmonious relationship with the local community, Korean companies should contribute to the community and be friendly with local residents and make a good image of the company focusing on the cultural environment. In aspect of authority transfer between headquarters and local subsidiaries, there is a tendency to be determined by the head office rather than the joint participation. In the future, in order for Korean enterprise to be successful one in Indonesia market, a highly interdependent and complex forms between headquarters and local subsidiaries shall be performed and an active exchange of information and the selection of best talent regardless of nationality shall be promoted.

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Studios on the Metagonimus fluke in the Daecheong Reservoir and the upper stream of Geum River, Borea (대청호 및 그 상류의 Metagonimus 흡충에 관한 연구)

  • 김종환;김남만
    • Parasites, Hosts and Diseases
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    • v.25 no.1
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    • pp.69-82
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    • 1987
  • The prevalences of the cuke belonging to genus Metagonimus hove been reported along the upper stream of inhabitants by several workers since 1980, however the taxonomical problems of the fluke was not yet settled. The larval flukes; cercaria and metacercaria as well as their intermediate hosts, and adult were studied in order to identify the Mepagonimus in the areas. The results obtained are summarized as follows: 1. The snails, Semisulcospira globus were collected (rom the three different localities along the upper stream of the River. The cercariae were found from 125(7.2%) out of 1,730 snails by natural emerging method, and were identified into 5 species including Metagenimus sp. (3.7%), Pseudexorchis major(1.4%), Cercaria nipponensis (0.9%), Cercaria incerpa(0.6%), and Cercaria yoshidae(0.6%). Cercariae of Metagonimus species had four to dye oral spines on its anterior of the first line. 2. The cercariae of Metagonimus were experimentally exposed to goldfish. nfection rate was 22.9% out of 105 goldfish, and the encysted metacercariae were found in fins(86.7%) and on scales (13.7%) of the fishes, but not in their muscle, head or visceral organs. 3. Seven species of ask were caught in the Daecheong Reservoir and the upper stream. Infestations with metacercaria of Metagonimus were found 100% in Opsariichtys widens and the parasitized numbers of the metacercariae were observed from 250 to 2,400 per fish. In the upper stream, Zacco termmincki, Z. platypus and Pseudogobio esocinus were infected 100% with the metacercaria, on the other hand, the fishes caught in the reservoir showed the lower infestation rates, and a few metacercariae found in the fishes Carassius carassius and Cyprinus carpio in the reservoir and the stream. The majority of metacercariae was detected only on the scales of fishes. 4. In order to know the infectivity and the distribution patterns in the intestine of hosts, rats and dogs were infected with the metacercariae obtained from O. bidens and Z. platypus. In addition the metacercariae obtained from Z. temmincki, P. esocinus and goldfish were given to the rats. The recovery rates of the worms in the small intestine of dogs were higher (63.3~65.8%) than those of the rats (3.5~31.6%). The flukes were found mostly in the middle and the lower part of small intestine of the rats and the dogs, but no worm was collected in the upper part of the intestine of rats. 5. The sixte of adult flukes varied by the hosts. In the adult cukes, oral sucker was smaller than ventral sucker, and the right and left testes were located diagonally, the uterine tubules circled around the upper left testis. The average egg sixte was $29.1{\times}1.7{\mu\textrm{m}}$. According to the above results, the cukes belonging to genus Metagonimus distributed along the Geum River was concluded to be identical with Miyata type of M. yokogawai as that Saito had proposed.

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Development of Eggs, Larvae and Juveniles of the Hypomesus nipponensis (Pisces:Osmeridae) from Western Coastal, Daeho-man (서해안 대호만에 서식하는 빙어 Hypomesus nipponensis의 난발생 및 자치어 형태발달)

  • Jae-Min Park;Dong-Jae Yoo;Jeong-Nam Yu;Seong-Ryul Lim;Dal-Young Kim;Kyeong-Ho Han
    • Korean Journal of Ichthyology
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    • v.36 no.2
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    • pp.120-128
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    • 2024
  • In this study, the characteristics of the early life history were investigated for the Hypomesus nipponensis in the west coast Daeho Bay. Egg's were adhesive eggs that had the property of sinking in water in a circular shape. The size of mature eggs was 0.52~0.66 (average of 0.59±0.03, n=30) mm. The hatching time took 140 hours at a water temperature of 22~23℃. Immediately after hatching, the yolk sac larvae was 4.78~5.60 (average of 5.25±0.26, n=30) mm in total length, and the mouth and anus were not completely opened. On the 7 days after hatching, the preflexion larvae was 5.91~6.64 (6.32±0.21) mm in total length, and the mouth and anus were opened, and feeding activities were started. On the 25 days after hatching, the flexion larvae was 9.70~12.3 (10.2±0.63) mm in total length, and the end of the spine at the tail end began to bend upward. On the 42 days after hatching, the postflexion larvae was 14.1~18.8 (16.9±1.44) mm in total length, and the end of the spine at the tail was completely bent at 45°. On the 56 days after hatching, it reached the integer with 10 dorsal fins, 16 anal fins, 7 ventral fins, and 19 caudal fins. According to the study, there were spot-shaped melanophore vesicles under the pectoral fins during the incubation period, the different positions of the egg yolk compared to the battlefield, the deposition of melanophore vesicles on the back and under the body of the caudal part during the postflexion larvae period, and the absence of melanophore vesicles on the torso between the head and the starting point of the dorsal fin. It was distinguished from related species in that melanophore vesicles were deposited in one row from the back of the body to the caudal part during the juvenile period.