Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.
Proceedings of the Korean Society of Medical Physics Conference
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2002.09a
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pp.86-89
/
2002
The purpose is to develop a system to reduce the organ movement from the respiration during the 3DCRT or IMRT. This research reports the experience of utilizing personally developed system for mobile tumors. The patients clinical database was structured for 10 mobile tumors and patient setup error measurement and immobilization device effects were investigated. The RMRD system is composed of the respiratory motion reduction device utilized in prone position and abdominal strip device(ASD) utilized in the supine position, and the analysis program, which enables the analysis on patients setup reproducibility. Dose to normal tissue between patients with RMRDs and without RMRDs was analyzed by comparing the normal tissue volume, field margins and dose volume histogram(DVH) using fluoroscopy and CT images. And, reproducibility of patients setup verify by utilization of digital images. When patients breathed freely, average movement of diaphragm was 1.2 cm in prone position in contrast to 1.6 cm in supine position. In prone position, difference in diaphragm movement with and without RMRDs was 0.5 cm and 1.2 cm, respectively, showing that PTV margins could be reduced to as much as 0.7 cm. With RMRDs, volume of the irradiated normal tissue (lung, liver) reduced up to 20 % in DVH analysis. Also by obtaining the digital image, reproducibility of patients setup verify by visualization using the real-time image acquisition, leading to practical utilization of our software. Internal organ motion due to breathing can be reduced using RMRDs, which is simple and easy to use in clinical setting. It can reduce the organ motion-related PTV margin, thereby decrease volume of the irradiated normal tissue.
The Journal of Korean Society for Radiation Therapy
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v.17
no.1
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pp.33-40
/
2005
Purpose : We recently perform the latest radiotheraphy (3D conformal, IMRT,etc.) with the development of 3D CT planning technology. However, in case patients with breast cancer, it is difficult to acquire the CT image with the limitation of CT hole size and tilting of breast immobilization device. The Ewha Breast Device(EBD) was constructed to improve the problem in the treatment of patients with breast cancer and we are intend to introduce the procedure of the EBD construction in this study and compare the EBD with conventional breast device in the view point of usefulness. Materials and Methods : We have constructed the EBD with acryl, analyze the skull size with CT data, consider the skin folder in SCL field and evaluated the EBD usefulness from the view point of set-up reproducibility, dose distribution, skin reaction in comparison with conventional breast device. Results : In the case of patients set-up error analysis, the EBD is superior to conventional device in portal film repetition($\%$) check (80pt.), equal to that in simulation & CT image coincidence check(5pt.). There is no difference between the two systems in dose distribution and skin reaction in SCL field is better the EBD than conventional device. Conclusions : The construction of the EBD enable us to perform the latest radiotheraphy in breast treatments, relieve the pains in simulation, and reduce, the skin reaction. In the future, we expect that modification of the EBD is useful in treating for patients with breast cancer.
Journal of the Korean Institute of Electrical and Electronic Material Engineers
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v.18
no.6
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pp.560-570
/
2005
In this paper, a microelectrode away DNA chip was fabricated on glass slide using photolithography technology. Several probe DNAs consisting of mercaptohexyl moiety at their 5' end were immobilized on the gold electrodes by DNA arrayer utilizing the affinity between gold and sulfu. Then target DNAs were hybridized and reacted with Hoechst 33258, which is a DNA minor groove binder and electrochemically active dye. Cyclic voltammetry in 5mA ferricyanide/ferrocyanide solution at 100 mV/s confirmed the immobilization of probe DNA on the gold electrodes. Linear sweep voltammetry or cyclic voltammetry showed a difference between target DNA and control DNA in the anodic peak current values. It was derived from Hoechst 33258 concentrated at the electrode surface through association with formed hybrid. It suggested that this DNA chip could recognize the sequence specific genes. It suggested that multichannel electrochemical DNA microarray is useful to develop a portable device for clinical gene diagnostic system.
Park, Jimin;Park, Dae Keun;Lee, Cho Yeon;Kang, Aeyeon;Oh, Jihye;Kim, Gyuhee;Lee, Sangho;Yun, Wan Soo
Proceedings of the Korean Vacuum Society Conference
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2013.08a
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pp.268.2-268.2
/
2013
Nanogap interdigitated electrodes (NIDEs) can serve as an alternative platform for the biomolecular detection [1]. In this work, the NIDEs were adopted in a simple and sensitive detection of Pneumococcal surface protein A (PspA). The NIDEs were fabricated by the combination of photo and chemical lithography. Photolithographically-defined initial gap of about 200 nm was narrowed down to a few tens of nanometers by surface-initiated growth of the initial electrodes (chemical lithography) [2]. Bare silicon oxide surface between the electrodes was chemically modified to immobilize capturing antibodies and, after exposure to the samples, the device was immersed in a solution containing the probe-antibody-conjugated Au nanoparticles (Au NPs). The conductance change accompanied with the Au NP immobilization was interpreted as the existence of PspA. Detection limit of the measurements and further improvement of the detection efficiency were discussed with the results from I-V analysis, scanning electron microscopy, and atomic force microscopy.
False smut caused by Ustilaginoidea virens is an important rice fungal disease that significantly decreases its production. In the recent past, conventional methods have been developed for its detection that is time-consuming and need high-cost equipments. The research and development in nanotechnology have made it possible to assemble efficient recognition interfaces in biosensors. In this study, we present a simple, sensitive, and selective oxidized graphene-based geno-biosensor for the detection of rice false smut. The biosensor has been developed using a probe DNA as a biological recognition element on paper electrodes, and oxidized graphene to enhance the limit of detection and sensitivity of the sensor. Probe single-stranded DNA (ssDNA) and target ssDNA hybridization on the interface surface has been quantitatively measured with the electrochemical analysis tools namely, cyclic voltammetry, and linear sweep voltammetry. To confirm the selectivity of the device, probe hybridization with non-complementary ssDNA target has been studied. In our study, the developed sensor was able to detect up to 10 fM of target ssDNA. The paper electrodes were employed to produce an effective and cost-effective platform for the immobilization of the DNA and can be extended to design low-cost biosensors for the detection of the other plant pathogens.
Lim Do Hoon;Huh Seung Jae;Ahn Yong Chan;Kim Dae Yong;Wu Hong Gyun;Kim Moon Kyung;Choi Dong Rak;Shin Kyung Hwan
Radiation Oncology Journal
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v.15
no.3
/
pp.263-268
/
1997
Purpose : Authors designed a customized Small Bowel Displacement System (SBDS) to displace the small bowel from the Pelvic radiation fields and minimize treatment-related bowel morbidities. Materials and Methods : From August 1995 to Mar 1996. 55 consecutive patients who received pelvic radiation therapy with the SBDS were included in this study. The SBDS consists of a customized styrofoam compression device which can displace the small bowel from the radiation fields and an individualized immobilization abdominal board for easy daily setup in prone position After opacifying the small bowel with Barium3, the patients were laid Prone and posterior-anterior (PA) and lateral (LAT) simulation films were taken with and without the SBDS. The areas of the small bowel included in the radiation fields with and without the SBDS were compared. Results : Using the SBDS, the mean small bowel area was reduced by $59\%;on\;PA\;and\;51\%$ on LAT films (P=0.0001). In six Patients (6/55. $11\%$), it was Possible that no small bowel was included within the treatment fields. The mean upward displacement of the most caudal small bowel was 4.8 cm using the SBDS. Only $15\%$ (8/55) of patients treated with the SBDS manifested diarrhea requiring medication. Conclusion : The SBDS is a novel method that can be used to displace the small bowel away from the treatment portal effectively and reduce the radiation therapy morbidities. Compliance with setup is excellent when the SBDS is used.
Kim, Woo-Cheol;Chung, Eun-Ji;Lee, Chang-Geol;Chu, Sung-Sil;Kim, Gwi-Eon
Radiation Oncology Journal
/
v.14
no.1
/
pp.69-76
/
1996
Purpose : The aim of this study is to investigate the random and systematic errors and tumor movement using electronic portal imaging device in lung cancer patients for the adequate margin in the treatment planning of 3-dimensional conformal therapy. Material and Methods : The electronic portal imaging device is matrix ion chamber type(Portal Vision, Varian). Ten patients of lung cancer treated with chest irradiation were selected for this study. Patients were treated in the supine position without immobilization device. All treatments were delivered by an 10 MV linear accelerator that had the portal imaging system mounted to its ganrty. AP or PA field Portal images were only analyzed. Radiation therapy field included the tumor, mediastinum and supraclavicular lymph nodes. A total of 103 portal images were analyzed for set-up deviation and 10 multiple images were analyzed for tumor movement because of respiration and cardiac motion. Result : The average values of setup displacements in the x, y direction was 1.41 mm, 1 78 mm, respectively. The standard deviation of systematic component was 4.63 mm, 4.11 mm along the x, y axis, respectively while the random component was 4.17 mm in the x direction and 3.31 mm in the y direction. The average displacement from respiratory movement was 12.2 mm with a standard deviation of 4.03 mm. Conclusion : The overall set-up displacement includes both random and systematic component and respiratory movement. About 10 mm, 25 mm margins along x, y axis which considered the set-up displacement and tumor movement were required for initial 3-dimensional conformal treatment planning in the lung cancer patients and portal images should be made and analyzed during first week of treatment, individually.
Purpose : In order to perform craniospinal irradiation (CSI) in the supine position on patients who are unable to lie in the prone position, a new simulation technique using a CT simulator was developed and its availability was evaluated. Materials and Method : A CT simulator and a 3-D conformal treatment planning system were used to develop CSI in the supine position. The head and neck were immobilized with a thermoplastic mask in the supine position and the entire body was immobilized with a Vac-Loc. A volumetrie image was then obtained using the CT simulator. In order to improve the reproducibility of the patients' setup, datum lines and points were marked on the head and the body. Virtual fluoroscopy was peformed with the removal of visual obstacles such as the treatment table or the immobilization devices. After the virtual simulation, the treatment isocenters of each field were marked on the body and the immobilization devices at the conventional simulation room. Each treatment field was confirmed by comparing the fluoroscopy images with the digitally reconstructed radiography (DRR)/digitally composite radiography (DCR) images from the virtual simulation. The port verification films from the first treatment were also compared with the DRR/DCR images for a geometrical verification. Results : CSI in the supine position was successfully peformed in 9 patients. It required less than 20 minutes to construct the immobilization device and to obtain the whole body volumetric images. This made it possible to not only reduce the patients' inconvenience, but also to eliminate the position change variables during the long conventional simulation process. In addition, by obtaining the CT volumetric image, critical organs, such as the eyeballs and spinal cord, were better defined, and the accuracy of the port designs and shielding was improved. The differences between the DRRs and the portal films were less than 3 mm in the vertebral contour. Conclusion : CSI in the supine position is feasible in patients who cannot lie on prone position, such as pediatric patienta under the age of 4 years, patients with a poor general condition, or patients with a tracheostomy.
Park, Jong-Min;Park, Yang-Kyun;Cho, Woong;Park, Charn-Il;Ha, Sung-Whan
Radiation Oncology Journal
/
v.25
no.2
/
pp.134-144
/
2007
[ $\underline{Purpose}$ ]: Immobilization devices that improve the setup reproducibility of pelvic cancer patients and that provide comfort to patients during radiotherapy were designed and the feasibility of the devices was evaluated. $\underline{Materials\;and\;Methods}$: A customized device was designed to immobilize a knee, thigh, and foot of a patient. Sixty-one patients with prostate cancer were selected and were divided into two groups-with or without devices. The setup errors were measured with respect to bony landmarks. The difference between digitally reconstructed radiographs (DRR) and simulation films, and the differences between DRR and portal films were measured. $\underline{Results}$: The left-right (LR), anterior-posterior (AP) and craniocaudal (CC) errors between the DRR and simulation films were $1.5{\pm}0.9\;mm$, $3.0{\pm}3.6\;mm$, and $1.6{\pm}0.9\;mm$, respectively without devices. The errors were reduced to $1.3{\pm}1.9\;mm$, $1.8{\pm}1.5\;mm$ and $1.1{\pm}1.1\;mm$, respectively with the devices. The errors between DRR and portal films were $1.6{\pm}1.2\;mm$, $4.0{\pm}4.1\;mm$, and $4.2{\pm}5.5\;mm$, respectively without the devices and were reduced to $1.0{\pm}1.8\;mm$, $1.2{\pm}0.9\;mm$, and $1.2{\pm}0.8\;mm$, respectively, with the devices. The standard deviations among the portal films were 1.1 mm, 2.1 mm, and 1.0 mm at each axis without the devices and 0.9 mm, 1.6 mm and 0.8 mm with the devices. The percentage of setup errors larger than 3 mm and 5 mm were significantly reduced by use of the immobilization devices. $\underline{Conclusion}$: The designed devices improved the setup reproducibility for all three directions and significantly reduced critical setup errors.
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