• Progress in Medical Physics
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• v.23 no.4
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• pp.269-278
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• 2012

Aquaplast Thermoplastic (AT) is a tissue-equivalent oral compensator that has been developed to improve dose uniformity at the common boundary and around the treated area during radiotherapy in patients with head and neck cancer. In order to assess the usefulness of AT, the degree of improvement in dose distribution and physical properties were compared to those of oral compensators made using paraffin, alginate, and putty, which are materials conventionally used in dental imprinting. To assess the physical properties, strength evaluations (compression and drop evaluations) and natural deformation evaluations (volume change over time) were performed; a Gafchromic EBT2 film and a glass dosimeter inserted into a developed phantom for dose verification were used to measure the common boundary dose and the beam profile to assess the dose delivery. When the natural deformation of the oral compensators was assessed over a two-month period, alginate exhibited a maximum of 80% change in volume from moisture evaporation, while the remaining tissue-equivalent properties, including those of AT, showed a change in volume that was less than 3%. In a free-fall test at a height of 1.5 m (repeated 5 times as a strength evaluation), paraffin was easily damaged by the impact, but AT exhibited no damage from the fall. In compressive strength testing, AT was not destroyed even at 8 times the force needed for paraffin. In dose verification using a glass dosimeter, the results showed that in a single test, the tissue-equivalent (about 80 Hounsfield Units [HU]) AT delivered about 4.9% lower surface dose in terms of delivery of an output coefficient (monitor unit), which was 4% lower than putty and exhibited a value of about 1,000 HU or higher during a dose delivery of the same formulation. In addition, when the incident direction of the beam was used as a reference, the uniformity of the dose, as assessed from the beam profile at the boundary after passing through the oral compensators, was 11.41, 3.98, and 4.30 for air, AT, and putty, respectively. The AT oral compensator had a higher strength and lower probability of material transformation than the oral compensators conventionally used as a tissue-equivalent material, and a uniform dose distribution was successfully formed at the boundary and surrounding area including the mouth. It was also possible to deliver a uniformly formulated dose and reduce the skin dose delivery.

• Progress in Medical Physics
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• v.23 no.4
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• pp.309-316
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• 2012

Multimodal-imaging technique has been rapidly developed for improvement of diagnosis and evaluation of therapeutic effects. In despite of integrated hardware, registration accuracy was decreased due to a discrepancy between multimodal image and insufficiency of count in accordance with different acquisition method of each modality. The purpose of this study was to improve the PET image by event data resampling through analysis of data format, noise and statistical properties of small animal PET list data. Inveon PET listmode data was acquired as static data for 10 min after 60 min of 37 MBq/0.1 ml $^{18}F$-FDG injection via tail vein. Listmode data format was consist of packet containing 48 bit in which divided 8 bit header and 40 bit payload space. Realigned sinogram was generated from resampled event data of original listmode by using adjustment of LOR location, simple event magnification and nonparametric bootstrap. Sinogram was reconstructed for imaging using OSEM 2D algorithm with 16 subset and 4 iterations. Prompt coincidence was 13,940,707 count measured from PET data header and 13,936,687 count measured from analysis of list-event data. In simple event magnification of PET data, maximum was improved from 1.336 to 1.743, but noise was also increased. Resampling efficiency of PET data was assessed from de-noised and improved image by shift operation of payload value of sequential packet. Bootstrap resampling technique provides the PET image which noise and statistical properties was improved. List-event data resampling method would be aid to improve registration accuracy and early diagnosis efficiency.

• Progress in Medical Physics
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• v.23 no.2
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• pp.81-90
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• 2012

The effect of setup uncertainties on CTV dose and the correlation between setup uncertainties and setup margin were evaluated by Monte Carlo based numerical simulation. Patient specific information of IMRT treatment plan for rectal cancer designed on the VARIAN Eclipse planning system was utilized for the Monte Carlo simulation program including the planned dose distribution and tumor volume information of a rectal cancer patient. The simulation program was developed for the purpose of the study on Linux environment using open source packages, GNU C++ and ROOT data analysis framework. All misalignments of patient setup were assumed to follow the central limit theorem. Thus systematic and random errors were generated according to the gaussian statistics with a given standard deviation as simulation input parameter. After the setup error simulations, the change of dose in CTV volume was analyzed with the simulation result. In order to verify the conventional margin recipe, the correlation between setup error and setup margin was compared with the margin formula developed on three dimensional conformal radiation therapy. The simulation was performed total 2,000 times for each simulation input of systematic and random errors independently. The size of standard deviation for generating patient setup errors was changed from 1 mm to 10 mm with 1 mm step. In case for the systematic error the minimum dose on CTV $D_{min}^{stat{\cdot}}$ was decreased from 100.4 to 72.50% and the mean dose $\bar{D}_{syst{\cdot}}$ was decreased from 100.45% to 97.88%. However the standard deviation of dose distribution in CTV volume was increased from 0.02% to 3.33%. The effect of random error gave the same result of a reduction of mean and minimum dose to CTV volume. It was found that the minimum dose on CTV volume $D_{min}^{rand{\cdot}}$ was reduced from 100.45% to 94.80% and the mean dose to CTV $\bar{D}_{rand{\cdot}}$ was decreased from 100.46% to 97.87%. Like systematic error, the standard deviation of CTV dose ${\Delta}D_{rand}$ was increased from 0.01% to 0.63%. After calculating a size of margin for each systematic and random error the "population ratio" was introduced and applied to verify margin recipe. It was found that the conventional margin formula satisfy margin object on IMRT treatment for rectal cancer. It is considered that the developed Monte-carlo based simulation program might be useful to study for patient setup error and dose coverage in CTV volume due to variations of margin size and setup error.

• Progress in Medical Physics
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• v.25 no.4
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• pp.264-270
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• 2014

This study developed a portable respiratory training device to improve breathing stability, which is an important element in using the CyberKnife Synchrony respiratory tracking device, one of the typical Stereotactic Radiation Therapy (SRT) devices. It produced an interface for users to be able to select one of two displays, a graph type and a bar type, supported an auditory system that helps them expect next respiration by improving a sense of rhythm of their respiratory period, and provided comfortable respiratory inducement. By targeting 5 applicants and applying individual respiratory period detected through a self-developed program, it acquired signal data of 'guide respiration' that induces breathing through signal data gained from 'free respiration' and an auditory system, and evaluated the usability by comparing deviation average values of respiratory period and respiratory amplitude. It could be identified that respiratory period decreased $55.74{\pm}0.14%$ compared to free respiration, and respiratory amplitude decreased $28.12{\pm}0.10%$ compared to free respiration, which confirmed the consistency and stability of respiratory. SBRT, developed based on these results, using the portable respiratory training device, for liver cancer or lung cancer, is evaluated to be able to help reduce delayed treatment time due to respiratory instability and improve treatment accuracy, and if it could be applied to developing respiratory training applications targeting an android-based portable device in the future, even use convenience and economic efficiency are expected.

• Progress in Medical Physics
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• v.25 no.4
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• pp.233-241
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• 2014

The aim of this study is to develop a new software tool for 3D dose verification using $PRESAGE^{REU}$ Gel dosimeter. The tool included following functions: importing 3D doses from treatment planning systems (TPS), importing 3D optical density (OD), converting ODs to doses, 3D registration between two volumetric data by translational and rotational transformations, and evaluation with 3D gamma index. To acquire correlation between ODs and doses, CT images of a $PRESAGE^{REU}$ Gel with cylindrical shape was acquired, and a volumetric modulated arc therapy (VMAT) plan was designed to give radiation doses from 1 Gy to 6 Gy to six disk-shaped virtual targets along z-axis. After the VMAT plan was delivered to the targets, 3D OD data were reconstructed from 512 projection data from $Vista^{TM}$ optical CT scanner (Modus Medical Devices Inc, Canada) per every 2 hours after irradiation. A curve for converting ODs to doses was derived by comparing TPS dose profile to OD profile along z-axis, and the 3D OD data were converted to the absorbed doses using the curve. Supra-linearity was observed between doses and ODs, and the ODs were decayed about 60% per 24 hours depending on their magnitudes. Measured doses from the $PRESAGE^{REU}$ Gel were well agreed with the TPS doses at central region, but large under-doses were observed at peripheral region at the cylindrical geometry. Gamma passing rate for 3D doses was 70.36% under the gamma criteria of 3% of dose difference and 3 mm of distance to agreement. The low passing rate was resulted from the mismatching of the refractive index between the PRESAGE gel and oil bath in the optical CT scanner. In conclusion, the developed software was useful for 3D dose verification from PRESAGE gel dosimetry, but further improvement of the Gel dosimetry system were required.

• Investigative Magnetic Resonance Imaging
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• v.7 no.2
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• pp.100-107
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• 2003

Purpose : To assess the usefulness of cardiac MR imaging (MRI) in the diagnosis of acute myocardial infarction and in the assessment of myocardial viability in comparision with T1-201 SPECT. Materials and Methods : We retrospectively studied 17 patients who complained of chest pain and dyspnea with cardiac MRI . The patients were evaluated for the presence or absence of high signal intensity on T2-weighted image (T2wI), abnormal wall motion on 2D-FIESTA, perfusion defect on Gd-DTPA enhanced T1WI, and delayed myocardial enhancement on 15-minutes delay Gd-DTPA enhanced T1WI. The results were correlated with the images on T1-201 SPECT, taken at rest and stress, through which reversibility of perfusion defect was assessed. Results : Both cardiac MRI and T1-201 SPECT proved to be useful methods for diagnosing acute myocardial infarction. In order of decreasing correspondence, T2WI, T1-201 SPECT, delayed enhancement study, and wall motion images all showed significant statistical correlation with the clinical diagnosis of myocardial infarction. Perfusion MRI, on the other hand, showed no significant statistical difference was found between T1-201 SPECT and cardiac MRI. The results on T2WI showed high accordance with those on Tl-201 SPECT, while delayed myocardial enhancement and wall motion studies showed no agreement with Tl-201 SPECT. Conclusion : Cardiac MRI is useful method for diagnosis of acute myocardiac infarction. With respect to the assessment of myocardial viability, the results obtained on cardiac MRI showed high agreement with those on Tl-201 SPECT. However, further study is necessary at this point for standardization and establishment of the methods for assessing myocardial viability on cardiac MRI.

• Investigative Magnetic Resonance Imaging
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• v.2 no.1
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• pp.14-30
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• 1998

Manganese is an essential element in the body. It is mainly deposited in the liver and to a lesser degree in the basal ganglia of the brain and eliminated through the bile duct. Rapid turnover of managanese in the body makes it difficult to evaluate the manganese exposure in workers, esecially in those with irregular or intermittent exposure, like welders. Therefore, conventional biomarkers, including blood and urine manganese can provide only a limited information about the long-tern or cumulative exposure to manganese. Introduction of magnetic resonance imaging (MRI) made a progress in the assessment of manganese exposure in the medical conditions related to manganese accumulation, e. g. hepatic failure and long-term total parenteral nutrition. Manganese shortens spin-lattice(T1) relaxation time on MRI due to its paramagnetic property, resulting in high signal intensity (HSI) on T1-weighted image(T1W1) of MRI. Manganese deposition in the brain, therefore, can be visualizedas an HSI in the globus pallidus, the substantia nigra, the putamen and the pituitary. clinical and epidemiologic studies regarding the MRI findings in the cases of occupational and non-occupational manganese exposure were reviewed. relationships between HSI on T1W1 of MRI and age, gender, occupational manganese exposure, and neurological dysfunction were analysed. Relationships betwen biological exposure indices and HSI on MRE werealso reviewed. Literatures were reviewed to establish the relationships between HSI, Manganese deposition in the brain, pathologic findings, and neurological dysfunction. HSI on T1W1 of MRI reflects regional manganese deposition in the brain. This relationship enables an estimation of regional manganese deposition in the brain by analysing MR signal intensity. Manganese deposition in the brain can induce a neuronal loss in the basal ganglia but functional abnormality is supposed to be related to the cumulative exposure of manganese in the brain, use of brain MRI for the assessment of exposure in a group of workers seems to be hardly rationalized, while ti can be a useful adjunct for the evaluation of manganese exposure int he cases with suspected manganese-related health problems.

• Investigative Magnetic Resonance Imaging
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• v.17 no.3
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• pp.232-238
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• 2013

Purpose : We investigated the possible added value of magnetic resonance imaging (MR) in staging of malignant pleural mesothelioma (MPM) compared to computed tomography (CT). Materials and Methods: We retrospectively enrolled 20 patients (M;F = 14:6; mean age, 53.5 yrs) who diagnosed as MPM by histology and underwent CT and MR at initial evaluation from Jan 1997 to Dec 2012. Two radiologists performed clinical staging by using CT alone or MR alone in consensus. In patients underwent surgery (n = 13), we evaluated the diagnostic accuracy of CT and MR in terms of staging compared to surgical staging. In all patients, we compared clinical staging of CT only and CT with MR. Results: The diagnostic accuracy for T staging of CT only was 23.1% (3/13) and that of combined CT and MR was 38.5% (5/13), respectively. Among 13 patients underwent surgery, surgical stage was higher than combined CT and MR stage in 5 patients, but lower in 3 patients. CT only and combined CT and MR agreed in 85.0% (17/ 20). In cases of disagree (15.0%, 3/20), combined CT and MR showed higher stage than CT only. Conclusion: Combined CT and MR increases the diagnostic accuracy in staging of MPM compared to CT only and is important in determining the appropriate treatment in patients being considered for surgery.

• Clinical and Experimental Reproductive Medicine
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• v.35 no.2
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• pp.155-162
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• 2008

Objectives: The aim of this study was to assess the change of ovarian reserve after removal of ovarian tumor using basal FSH, $E_2$, clomiphene citrate challenge test and ovarian volume. Methods: Twenty two patients with unilateral ovarian tumor, ${\leq}35$ years old, regular menstrual cycle were collected prospectively and divided into endometrioma or non-endometrioma group. We measured the ovarian volume with transvaginal ultrasonography on the day 3 of menstrual cycle within one month before and 3 months after surgery. Basal (cycle day 3) FSH, $E_2$ and CCCT were checked before surgery and repeated at least 2 spontaneous cycles later after surgery. Three patients that had been pregnant within 3 months after surgery were excluded in analysis. Results: The ovarian volume was reduced significantly after surgery in endometrioma and non-endometrioma ${\geq}10\;cm$ group ($4.79{\pm}2.57\;cm^3$ and $5.21{\pm}1.33\;cm^3$, respectively), but not in the non-endometrioma <10 cm group ($6.18{\pm}2.85\;cm^3$). After surgery, basal FSH and cycle day 10 FSH on CCCT in endometrioma and non-endometrioma were $4.25{\pm}0.20\;mIU/ml$ and $3.79{\pm}0.80\;mIU/ml$, $4.24{\pm}0.85\;mIU/ml$ and $4.28{\pm}0.92\;mIU/ml$, respectively. There were neither significant difference in comparison with the preoperative results nor between two groups. Conclusions: Enucleation of ovarian mass was associated with a significant reduction in ovarian volume in endometrioma and non-endometrioma larger than 10cm in diameter. Hormonal markers for evaluation of ovarian reserve, such as basal and cycle day 10 FSH on CCCT, were not changed significantly in each group. In reproductive age women, conservative enucleation or cystectomy rather than oophorectomy should be considered even in a large benign tumor and ovarian function could be reserved by meticulous operative technique.

• International Commerce and Information Review
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• v.15 no.1
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• pp.3-34
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• 2013

This research, which was experimented by dividing tangible and intangible products, established the influence that affects recovery for consumers' complaint behavior and behavioral intention as per each different compensation program. In Experiment 1, the consumers, who experienced complaint behavior owing to company's mistake, have preferably recovered through the compensation program offered by the company. However, there was a significant difference in preference recovery between products that caused complaint behavior. According to the study result, the more clear preference recovery was shown in the case of purchasing laptop than the case of dining in family restaurant. Additionally, the consumers' emotion recovery was possible through compensation.; There was a emotion recovery disparity depending on product type between purchasing laptop case and dining in family restaurant case. The consumers, who experienced complaints, were only able to recover their preference, emotion, and behavioral intention through compensation of which recovery was greater in tangible product case than ordinary service. Meanwhile, there was no distinct difference between recovery compensation types even though the products were identical-type ones whereas it appeared that such tangible product which showed greater purchasing effort as laptop computer was more effective in stimulating emotion response. In Experiment 2, the purpose was to find out the difference between complaint behavior and its recovery process shown after purchase by Korean and Japanese college students, who have different consumer purchasing habits. The both consumers of the two countries, who experienced complaint behavior, demonstrated precise difference in preference recovery while the emotion and behavioral intention exhibited no disparity between the two consumer groups. In this experiment, it was learned that Korean college students were show-off purchase type consumers while on the other hand, the Japanese college students were famous product purchase type consumers. Thus, there was a clear difference in laptop computer purchase process and post-purchase evaluation between these two groups. In particular, the Korean college students had quicker preference recovery through compensation than the Japanese college students on account of their tendency to be consciousness of others. Nevertheless, there was no difference between the emotion recovery and re-purchase recovery and therefore, the compensation program for complaints was proven to affect the emotion and behavioral intention.