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The Role of Radiotherapy in the Treatment of Portal Vein Thrombosis from Advanced Hepatocellular Carcinoma (진행된 간세포암에서의 간문맥 혈전증에 대한 방사선치료 효과)

  • Kim, Jung-Hoon;Choi, Eun-Kyung;Ahn, Seung-Do;Lee, Sang-Wook;Shin, Seong-Soo;Choi, Won-Sik;Lim, Young-Suk;Kim, Kang-Mo;Suh, Dong-Jin;Chung, Young-Wha;Lee, Young-Sang;Won, Hyung-Jin;Kim, Jong-Hoon
    • Radiation Oncology Journal
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    • v.25 no.3
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    • pp.170-176
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    • 2007
  • Purpose: To determine the role of radiotherapy for the treatment of portal vein thrombosis (PVT) from hepatocellular carcinoma (HCC). Material and Methods: A retrospective analysis was performed on 70 patients that had been diagnosed with HCC and were treated with three-dimensional conformal radiotherapy (3D-CRT) for the PVT. The radiation dose ranged from 40 Gy to 60 Gy (median dose: 48 Gy) and the biological effective dose (BED) ranged from 31.3 Gy to 78.0 $Gy_{10}$ (median dose: 61.6 $Gy_{10}$). Response was determined by measuring the extent of the PVT on a CT image at 0, 1 and 3 months after completion of the radiotherapy. The median follow-up period was 9 months. Results: The response rate was 47.1% (33 patients), with two patients (2.9%) showing a complete response, 31 patients (44.3%) showing a partial response, and 35 patients (50%) showing stable disease or no response. The 1-year progression-free survival rate was 60%, and the median progression-free survival time was 17 months. The median overall survival time was 11 months, the median survival time in the responders was 15 months and in the nonresponders was 8 months (p=0.032). Four patients (5.7%) had transient liver function impairment during treatment. Radiation induced liver disease (RILD) was observed in only one patient (1.4%). Conclusion: Three-dimensional conformal radiotherapy for the treatment of PVT from advanced HCC was a relatively effective and safe method.

Lesion Localization in Patients with Hyperparathyroidism Using Double-phase Tc-99m MIBI Parathyroid Scintigraphy (부갑상선기능항진증 환자에서 Tc-99m MIBI 부갑상선 신티그라피를 이용한 병소 국소화)

  • Shin, Jung-Woo;Ryu, Jin-Sook;Kim, Jae-Seung;Moon, Dae-Hyuk;Hong, Seung-Mo;Gong, Gyung-Yub;Hong, Suk-Joon;Lee, Hee-Kyung
    • The Korean Journal of Nuclear Medicine
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    • v.33 no.2
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    • pp.120-130
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    • 1999
  • Purpose: This study was performed to evaluate the diagnostic usefulness of double-phase Tc-99m MIBI parathyroid scintigraphy with single photon emission computed tomography (SPECT) in patients with hyper-parathyroidism. We also evaluated the relationship between Tc-99m MIBI uptake and oxyphil cell contents in parathyroid glands. Materials and Methods: The subjects were 28 parathyroid glands of 10 patients who underwent Tc-99m MIBI parathyroid scintigraphy and parathyroidectomy for clinically suspected hyper-parathyroidism. Early and delayed pinhole images were obtained at 15 minutes and 2 hours after injection of Tc-99m MIBI, and SPECT images were followed. The weight and oxyphil cell contents of parathyroid tissue were obtained from pathologic specimen, and the scintigraphic findings were compared with histopathology. Results: In surgical histopathology, 6 parathyroid adenomas and 9 parathyroid hyperplasias were confirmed. The sensitivity, specificity, and positive predictive value of early and delayed images were 46.7% (7/15), 76.9% (10/13), 70% (7/10) and 66.7% (10/15), 92.3% (12/13), 90.9% (10/11), respectively. SPECT image detected an additional small hyperplasia.. The sensitivity, specificity, and positive predictive value of combined interpretation of early and delayed images with SPECT were 73.3% (11/15), 100% (13/13), 100% (11/11). The sensitivity was 100% (6/6) for adenoma, whereas that was 55.5% (5/9) for hyperplasia. Both adenomas and hyperplasias showed significantly increased oxyphil cell contents compared with normal parathyroid glands (p<0.0001), but the oxyphil cell content and weight were not significantly different between adenomas and hyperplasias. Conclusion: Double-phase Tc-99m MIBI parathyroid scintigraphy with SPECT is useful for lesion localization in patients with hyperparathyroidism. Although both adenoma and hyperplasia have increased oxyphil cell content, the sensitivity is high in adenoma, but low in hyperplasia.

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Evaluation of the usefulness of the method according to changes in patient breathing during chest 4D CT imaging (흉부 4D CT에서 호흡 변화에 대한 일시 중지 및 재개 방법의 유용성 평가)

  • Heo, Sol;Shin, Chung Hun;Jeong, Hyun Sook;Yoo, Soon Mi;Kim, Jeong Mi;Yun, In Ha;Hong, Seung Mo;Back, Geum Mun
    • The Journal of Korean Society for Radiation Therapy
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    • v.33
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    • pp.47-54
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    • 2021
  • Purpose : In order to evaluate the usefulness of clinical application of the Pause & Resume methods by comparing and analyzing the data stability and dose reduction effect when repeat scan assuming irregular breathing and using the Pause & Resume method during chest 4D CT using QuasarTM Phantom. Materials and Methods : Using the QuasarTM Phantom, set the breathing rate per minute to 15 BPM and 7.5 BPM, and set the S15 point as an irregular breathing section, and then placed OSLD to this point and use the Pause & Resume method to measure the dose of S15. CTDIvol, DLP, and ALARA-CT were used for comparative analysis of radiation dose between Pause & Resume method and Repeat-scan. In order to evaluate the stability and usability of the data applying the Pause & Resume method, the captured images were sorted by Advanced Workstation Volume Share7 and then sent to EclipseTM, the diameter and volume were analyzed by forming a contour on the iron ball in the QuasarTM Phantom Results : When using Pause & Resume, the dose of OSLD measurement increased by 1.97 times in the section of S15. As a result of image evaluation, the average value of all volumes measured with and without the Pause & Resume method at 15 BPM and 7.5 BPM was 15.2 cm3±0.5%.Allthemeasuredvaluesfor the radius of iron ball were 3.1 cm regardless of whether Pause & Resume method was used or not. In the case of using Pause & Resume, 33% decreased from the lowest DLP value and 38% decreased from the highest DLP value of repeat scan, and the effective dose also decreased 32.1% from the minimum value and 37.6% from the maximum value. Conclusion: Irradiation dose was increased by Pause & Resume method because of the repeat scan on the S15 site where assuming irregular breathing occurred, However Pause & Resume method led to a significant reduction in dose on overall scan range. It also proved the usefulness of clinical application of the Pause & Resume method as a result of similar diameters and volumes of iron ball measurement.

An Exploratory Study on the Components of Visual Merchandising of Internet Shopping Mall (인터넷쇼핑몰의 VMD 구성요인에 대한 탐색적 연구)

  • Kim, Kwang-Seok;Shin, Jong-Kuk;Koo, Dong-Mo
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.2
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    • pp.19-45
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    • 2008
  • This study is to empirically examine the primary dimensions of visual merchandising (VMD) of internet shopping mall, namely store design, merchandise, and merchandising cues, to be a attractive virtual store to the shoppers. The authors reviewed the literature related to the major components of VMD from the perspective of the AIDA model, which has been mainly applied to the offline store settings. The major purposes of the study are as follows; first, tries to derive the variables related with the components of visual merchandising through reviewing the existing literatures, establish the hypotheses, and test it empirically. Second, examines the relationships between the components of VMD and the attitude toward the VMD, however, putting more emphasis on finding out the component structure of the VMD. VMD needs to be examined with the perspective that an online shopping mall is a virtual self-service or clerkless store, which could reduce the number of employees, help the shoppers search, evaluate and purchase for themselves, and to be explored in terms of the in-store persuasion processes of customers. This study reviewed the literatures related to store design, merchandise, and merchandising cues which might be relevant to the store, product, and promotion respectively. VMD is a total communication tool, and AIDA model could explain the in-store consumer behavior of online shopping. Store design has to do with triggering a consumer attention to the online mall, merchandise with a product related interest, and merchandising cues with promotions such as recommendation and links that induce the desire to pruchase. These three steps might be seen as the processes for purchase actions. The theoretical rationale for the relationship between VMD and AIDA could be found in Tyagi(2005) that the three steps of consumer-oriented merchandising are a store, a product assortment, and placement, in Omar(1999) that three types of interior display are a architectural design display, commodity display, and point-of-sales(POS) display, and in Davies and Ward(2005) that the retail store interior image is related to an atmosphere, merchandise, and in-store promotion. Lee et al(2000) suggested as the web merchandising components a merchandising cues, a shopping metaphor which is an assistant tool for search, a store design, a layout(web design), and a product assortment. The store design which includes differentiation, simplicity and navigation is supposed to be related to the attention to the virtual store. Second, the merchandise dimensions comprising product assortments, visual information and product reputation have to do with the interest in the product offerings. Finally, the merchandising cues that refer to merchandiser(MD)'s recommendation of products and providing the hyperlinks to relevant goods for the shopper is concerned with attempt to induce the desire to purchase. The questionnaire survey was carried out to collect the data about the consumers who would shop at internet shopping malls frequently. To select the subject malls, the mall ranking data announced by a mall rating agency was used to differentiate the most popular and least popular five mall each. The subjects was instructed to answer the questions after navigating the designated mall for five minutes. The 300 questionnaire was distributed to the consumers, 166 samples were used in the final analysis. The empirical testing focused on identifying and confirming the dimensionality of VMD and its subdimensions using a structural equation modeling method. The confirmatory factor analysis for the endogeneous and exogeneous variables was carried out in four parts. The second-order factor analysis was done for a store design, a merchandise, and a merchandising cues, and first-order confirmatory factor analysis for the attitude toward the VMD. The model test results shows that the chi-square value of structural equation is 144.39(d.f 49), significant at 0.01 level which means the proposed model was rejected. But, judging from the ratio of chi-square value vs. degree of freedom, the ratio was 2.94 which smaller than an acceptable level of 3.0, RMR is 0.087 which is higher than a generally acceptable level of 0.08. GFI and AGFI is turned out to be 0.90 and 0.84 respectively. Both NFI and NNFI is 0.94, and CFI 0.95. The major test results are as follows; first, the second-order factor analysis and structural equational modeling reveals that the differentiation, simplicity and ease of identifying current status of the transaction are confirmed to be subdimensions of store design and to be a significant predictors of the dependent variable. This result implies that when designing an online shopping mall, it is necessary to differentiate visually from other malls to improve the effectiveness of the communications of store design. That is, the differentiated store design raise the contrast stimulus to sensory organs to promote the memory of the store and to have a favorable attitude toward the VMD of a store. The results that navigation which means the easiness of identifying current status of shopping affects the attitude to VMD could be interpreted that the navigating processes via the hyperlinks which is characteristics of an internet shopping is a complex and cognitive process and shoppers are likely to lack the sense of overall structure of the store. Consequently, shoppers are likely to be alost amid shopping not knowing where to go. The orientation tool enhance the accessibility of information to raise the perceptive power about the store environment.(Titus & Everett 1995) Second, the primary dimension of merchandise and its subdimensions was confirmed to be unidimensional respectively, have a construct validity, and nomological validity which the VMD dimensions supposed to have a positive correlation with the dependent variable. The subdimensions of product assortment, brand fame and information provision proved to have a positive effect on the attitude toward the VMD. It could be interpreted that the more plentiful the product and brand assortment of the mall is, the more likely the shoppers to favor it. Brand fame and information provision as well affect the VMD attitude, which means that the more famous the brand, the more likely the shoppers would trust and feel familiar with the mall, and the plentifully and visually presented information could have the shopper have a favorable attitude toward the store VMD. Third, it turned out to be that merchandising cue of product recommendation and hyperlinks affect the VMD attitude. This could be interpreted that recommended products could reduce the uncertainty related with the purchase decision, and the hyperlinks to relevant products would help the shopper save the cognitive effort exerted into the information search and gathering, which could lead to a favorable attitude to the VMD. This study tried to sheds some new light on the VMD of online store by reviewing the variables mentioned to be relevant with offline VMD in the existing literatures, and tried to link the VMD components from the perspective of AIDA model. The effect size of the VMD dimensions on the attitude was in the order of the merchandise, the store design and the merchandising cues.It is said that an internet has an unlimited place for display, however, the virtual store is not unlimited since the consumer has a limited amount of cognitive ability to process the external information and internal memory. Particularly, the shoppers are likely to face some difficulties in decision making on account of too many alternative and information overloads. Therefore, the internet shopping mall manager should take into consideration the cost of information search on the part of the consumer, to establish the optimal product placements and search routes. An efficient store composition would be possible by reducing the psychological burdens and cognitive efforts exerted to information search and alternatives evaluation. The store image is in most part determined by the product category and its brand it deals in. The results of this study support this proposition that the merchandise is most important to the VMD attitude than other components, the manager is required to take a strategic approach to VMD. The internet users are getting more accustomed and more knowledgeable about the internet media and more likely to accept the internet as a shopping channel as the period of time during which they use the internet to shop become longer. The web merchandiser should be aware that the product introduction using a moving pictures and a bulletin board become more important in order to present the interactive product information visually and communicate with customers more actively, therefore leading to making the quantity and quality of product information more rich.

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The Impacts of Need for Cognitive Closure, Psychological Wellbeing, and Social Factors on Impulse Purchasing (인지폐합수요(认知闭合需要), 심리건강화사회인소대충동구매적영향(心理健康和社会因素对冲动购买的影响))

  • Lee, Myong-Han;Schellhase, Ralf;Koo, Dong-Mo;Lee, Mi-Jeong
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.4
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    • pp.44-56
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    • 2009
  • Impulse purchasing is defined as an immediate purchase with no pre-shopping intentions. Previous studies of impulse buying have focused primarily on factors linked to marketing mix variables, situational factors, and consumer demographics and traits. In previous studies, marketing mix variables such as product category, product type, and atmospheric factors including advertising, coupons, sales events, promotional stimuli at the point of sale, and media format have been used to evaluate product information. Some authors have also focused on situational factors surrounding the consumer. Factors such as the availability of credit card usage, time available, transportability of the products, and the presence and number of shopping companions were found to have a positive impact on impulse buying and/or impulse tendency. Research has also been conducted to evaluate the effects of individual characteristics such as the age, gender, and educational level of the consumer, as well as perceived crowding, stimulation, and the need for touch, on impulse purchasing. In summary, previous studies have found that all products can be purchased impulsively (Vohs and Faber, 2007), that situational factors affect and/or at least facilitate impulse purchasing behavior, and that various individual traits are closely linked to impulse buying. The recent introduction of new distribution channels such as home shopping channels, discount stores, and Internet stores that are open 24 hours a day increases the probability of impulse purchasing. However, previous literature has focused predominantly on situational and marketing variables and thus studies that consider critical consumer characteristics are still lacking. To fill this gap in the literature, the present study builds on this third tradition of research and focuses on individual trait variables, which have rarely been studied. More specifically, the current study investigates whether impulse buying tendency has a positive impact on impulse buying behavior, and evaluates how consumer characteristics such as the need for cognitive closure (NFCC), psychological wellbeing, and susceptibility to interpersonal influences affect the tendency of consumers towards impulse buying. The survey results reveal that while consumer affective impulsivity has a strong positive impact on impulse buying behavior, cognitive impulsivity has no impact on impulse buying behavior. Furthermore, affective impulse buying tendency is driven by sub-components of NFCC such as decisiveness and discomfort with ambiguity, psychological wellbeing constructs such as environmental control and purpose in life, and by normative and informational influences. In addition, cognitive impulse tendency is driven by sub-components of NFCC such as decisiveness, discomfort with ambiguity, and close-mindedness, and the psychological wellbeing constructs of environmental control, as well as normative and informational influences. The present study has significant theoretical implications. First, affective impulsivity has a strong impact on impulse purchase behavior. Previous studies based on affectivity and flow theories proposed that low to moderate levels of impulsivity are driven by reduced self-control or a failure of self-regulatory mechanisms. The present study confirms the above proposition. Second, the present study also contributes to the literature by confirming that impulse buying tendency can be viewed as a two-dimensional concept with both affective and cognitive dimensions, and illustrates that impulse purchase behavior is explained mainly by affective impulsivity, not by cognitive impulsivity. Third, the current study accommodates new constructs such as psychological wellbeing and NFCC as potential influencing factors in the research model, thereby contributing to the existing literature. Fourth, by incorporating multi-dimensional concepts such as psychological wellbeing and NFCC, more diverse aspects of consumer information processing can be evaluated. Fifth, the current study also extends the existing literature by confirming the two competing routes of normative and informational influences. Normative influence occurs when individuals conform to the expectations of others or to enhance his/her self-image. Whereas informational influence occurs when individuals search for information from knowledgeable others or making inferences based upon observations of the behavior of others. The present study shows that these two competing routes of social influence can be attributed to different sources of influence power. The current study also has many practical implications. First, it suggests that people with affective impulsivity may be primary targets to whom companies should pay closer attention. Cultivating a more amenable and mood-elevating shopping environment will appeal to this segment. Second, the present results demonstrate that NFCC is closely related to the cognitive dimension of impulsivity. These people are driven by careless thoughts, not by feelings or excitement. Rational advertising at the point of purchase will attract these customers. Third, people susceptible to normative influences are another potential target market. Retailers and manufacturers could appeal to this segment by advertising their products and/or services as products that can be used to identify with or conform to the expectations of others in the aspiration group. However, retailers should avoid targeting people susceptible to informational influences as a segment market. These people are engaged in an extensive information search relevant to their purchase, and therefore more elaborate, long-term rational advertising messages, which can be internalized into these consumers' thought processes, will appeal to this segment. The current findings should be interpreted with caution for several reasons. The study used a small convenience sample, and only investigated behavior in two dimensions. Accordingly, future studies should incorporate a sample with more diverse characteristics and measure different aspects of behavior. Future studies should also investigate personality traits closely related to affectivity theories. Trait variables such as sensory curiosity, interpersonal curiosity, and atmospheric responsiveness are interesting areas for future investigation.

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Distortion of the Dose Profile in a Three-dimensional Moving Phantom to Simulate Tumor Motion during Image-guided Radiosurgery (방사선수술에서 종양 움직임을 재현시킨 움직이는 팬텀을 이용하여 선량 분포의 왜곡에 대한 연구)

  • Kim, Mi-Sook;Ha, Seong-Hwan;Lee, Dong-Han;Ji, Young-Hoon;Yoo, Seong-Yul;Cho, Chul-Koo;Yang, Kwang-Mo;Yoo, Hyung-Jun;Seo, Young-Seok;Park, Chan-Il;Kim, Il-Han;Ye, Seong-Jun;Park, Jae-Hong;Kim, Kum-Bae
    • Radiation Oncology Journal
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    • v.25 no.4
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    • pp.268-277
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    • 2007
  • Purpose: Respiratory motion is a considerable inhibiting factor for precise treatment with stereotactic radiosurgery using the CyberKnife (CK). In this study, we developed a moving phantom to simulate three-dimensional breathing movement and investigated the distortion of dose profiles between the use of a moving phantom and a static phantom. Materials and Methods: The phantom consisted of four pieces of polyethylene; two sheets of Gafchromic film were inserted for dosimetry. Treatment was planned to deliver 30 Gy to virtual tumors of 20, 30, 40, and 50 mm diameters using 104 beams and a single center mode. A specially designed robot produced three-dimensional motion in the right-left, anterior-posterior, and craniocaudal directions of 5, 10 and 20 mm, respectively. Using the optical density of the films as a function of dose, the dose profiles of both static and moving phantoms were measured. Results: The prescribed isodose to cover the virtual tumors on the static phantom were 80% for 20 mm, 84% for 30 mm, 83% for 40 mm and 80% for 50 mm tumors. However, to compensate for the respiratory motion, the minimum isodose levels to cover the moving target were 70% for the $30{\sim}50$ mm diameter tumors and 60% for a 20 mm tumor. For the 20 mm tumor, the gaps between the isodose curves for the static and moving phantoms were 3.2, 3.3, 3.5 and 1.1 mm for the cranial, caudal, right, and left direction, respectively. In the case of the 30 mm tumor, the gaps were 3.9, 4.2, 2.8, 0 mm, respectively. In the case of the 40 mm tumor, the gaps were 4.0, 4.8, 1.1, and 0 mm, respectively. In the case of the 50 mm diameter tumor, the gaps were 3.9, 3.9, 0 and 0 mm, respectively. Conclusion: For a tumor of a 20 mm diameter, the 80% isodose curve can be planned to cover the tumor; a 60% isodose curve will have to be chosen due to the tumor motion. The gap between these 80% and 60% curves is 5 mm. In tumors with diameters of 30, 40 and 50 mm, the whole tumor will be covered if an isodose curve of about 70% is selected, equivalent of placing a respiratory margin of below 5 mm. It was confirmed that during CK treatment for a moving tumor, the range of distortion produced by motion was less than the range of motion itself.