• 의료법학
• /
• 제16권2호
• /
• pp.131-157
• /
• 2015

국민건강보험공단은 의사가 요양급여기준을 위반하여 처방을 함으로써 국민건강보험공단이 약국에 약제비를 지급하게 된 것은 의사가 국민건강보험공단에 대해 민사상 불법행위를 한 것이라고 주장하며 손해배상청구를 하였다. 대법원이 이를 인정하는 판결이 잇따르자, 국민건강보험공단은 의사들이 의료법을 위반하여 진료를 하여 약국에 지급하게 된 약제비나 해당 의료기관에 지급하게 된 요양급여비용에 대해서도 모두 국민건강보험공단에 대한 민법상 불법행위라고 주장하며 손해배상을 청구하였으며, 대법원은 이를 모두 인정하였다. 그러나 우리나라 국민건강보험제도에서 보험급여의 주체는 국민건강보험공단이며, 환자가 의료기관에 진료를 요청하여 의료기관이 행하는 요양급여 역시 보험급여이므로 이러한 요양급여를 행하는 주체 역시 국민건강보험공단이다. 그리고 국민건강보험법은 의사의 의료법위반행위를 규제하기 위해 만든 법이 아니므로 의사의 의료법 위반행위를 국민건강보험공단에 대한 민법상 불법행위책임에서의 위법성으로 포섭할 수 없다. 그렇다면 환자가 보건복지부장관으로부터 부여 받은 면허를 가진 의사에 의해 요양급여기준에 맞는 진료를 받은 경우에는 국민건강보험공단은 민법상 환자에게 요양급여를 해 줄 의무를 면하는 이득을 얻었으므로 설사 해당 의사가 진료를 하는 과정에 의료법을 위반한 행위를 하였더라도 국민건강보험공단으로서는 손해가 없다. 대법원이 의료법위반으로 진료를 한 행위를 모두 국민건강보험공단에 대한 민법상 불법행위책임으로 인정하는 것은 국민건강보험공단이 보험급여의 주체로서 보험급여를 해 줄 의무를 면하였다는 이득은 고려하지 않고, 오로지 의사에게 요양급여비용을 지급하였다는 측면만을 고려한 것으로서 민법 제750조의 법리에 어긋난다. 의사가 의료법을 위반하였다면 의료법에 따라 제재를 받을 일이지, 국민건강보험법으로 규율할 일이 아니며, 대법원이 위와 같이 판결한 것은 국민건강보험법의 법리와 민법의 법리를 혼동한 탓으로 생각된다.

• Journal of Radiation Protection and Research
• /
• 제30권4호
• /
• pp.185-196
• /
• 2005

의료 목적으로 X선 촬영이나 CT, PET과 같은 진단방사선 피폭은 불가피하지만 선진국에서 의료 방사선이 최대의 인공 피폭원을 구성하고 있고 또 빠르게 증가하는 경향에 있음을 고려하면 의료상 피폭의 특성이나 그 결과로 인한 환자 선량 크기를 이해하는 것은 매우 중요하다. 이에 2002년도를 기준으로 단위 진료행위별 선량과 국내 의료보험 통계자료를 결합하여 방사선 진료절차별 집단선량과 1인당 유효선량 평가하였다. 절차의 유효선량 값은 NRPB 보고서, ICRP 80, MIRDOSE3.1 및 우리가 독립적으로 산출한 자료들로부터 편집하였다. 평가 결과 연간 집단선량은 진단방사선 22880man-Sv, 핵의학 4560man-Sv로서 총 27440 man-Sv로 나타났으며 따라서 인구 4770만 명을 나눈 1인당 연평균 의료상 피폭선량은 0.58mSv였다. 이 집단선량은 2002년 16기의 원전을 가동한 우리나라의 직업상피폭 70man-Sv보다 크게 많다. 특히 CT 촬영만의 집단선량도 9960man-Sv에 이름은 주목할 일이다. 이 결과는 국가의 방사선방호 정책이 의료에서 환자선량 최적화에 보다 주목해야 함을 시사한다.

• 한국의사학회지
• /
• 제36권1호
• /
• pp.1-9
• /
• 2023

To be an adjunct professor(gyeomgyosu) literally means to act as an instructor while also holding a different position. Adjunct professors were initially introduced under Confucianism. Gradually, technical offices also appointed adjunct professors using Confucian-educated bureaucrats for the purpose of educating lower-level technical officials and cadets. This paper examines the history of the civil service system related to adjunct professors through the Code of Laws, and examines those who have been appointed to the public office described in various documents. This paper argues that changes in the medical office's adjunct professor system reflect changes in the national medical talent training policy. The main basis of specific recognizing medical personnel is to decouple the appointment of Confucian scholars from that of full-time doctors. The replacement of the role of medical educators from Confucian scholars to full-time doctors was largely accomplished during the reign of King Jungjong(中宗) and was completed during the period of King Injo(仁祖). The time when Euiyakdongcham was created and the Office of Euiyakdongcham was established coincided with the period when the adjunct professor was disrupted in the medical office. However, this change in the adjunct professor system of medical authorities is in contrast to interpretation, which is a representative technical field. In the case of interpretation, Moonshin's sayeogwon position as adjunct professor was maintained even in the late Joseon Dynasty, and apart from this, there was a hanhagmunsin in Seungmunwon. Interpreter families had institutional arrangements that prevented them from making interpretation their own monopoly. Therefore, families of medical bureaucrats had more room for institutional growth than those of bureaucratic interpreters. Of course, these institutional devices did not prevent the growth of interpreting bureaucratic families in the late Joseon Dynasty. However, the situation in which medicine was accepted only as a kind of knowledge, not as an object of full-time work for sadaebue, would have been an opportunity to rise for those in technical jobs who were full-time medicine. As medicine became more differentiated and developed in the late Joseon Dynasty, medical knowledge and the knowledge about the medical profession became more important. The politicians could not avoid the use of a philosophically oriented system in which a confucian-educated bureaucrat equipped with only Confucian knowledge might replace a full-time doctor. Thus, the contradiction between the reality and the ideal of ignoring or denying reality was reproduced like other Confucian-centered societies. These contradictions have implications for us living in the modern age. Establishing the relationship between philosophy (or belief) and technology should not end with the superiority of one side or the other.

• 동국한의학연구소논문집
• /
• 제10권
• /
• pp.119-145
• /
• 2008

Through a simple study of the medical classics in the '$\bar{A}yurveda$', we have summarized them as follows. 1) Traditional Indian medicine started in the Ganges river area at about 1500 B. C. E. and traces of medical science can be found in the "Rigveda" and "Atharvaveda". 2) The "Charaka(閣羅迦集)" and "$Su\acute{s}hruta$(妙聞集)", ancient texts from India, are not the work of one person, but the result of the work and errors of different doctors and philosophers. Due to the lack of historical records, the time of Charaka(閣羅迦) or $Su\acute{s}hruta$(妙聞)s' lives are not exactly known. So the completion of the "Charaka" is estimated at 1st$\sim$2nd century C. E. in northwestern India, and the "$Su\acute{s}hruta$" is estimated to have been completed in 3rd$\sim$4th century C. E. in central India. Also, the "Charaka" contains details on internal medicine, while the "$Su\acute{s}hruta$" contains more details on surgery by comparison. 3) '$V\bar{a}gbhata$', one of the revered Vriddha Trayi(triad of the ancients, 三醫聖) of the '$\bar{A}yurveda$', lived and worked in about the 7th century and wrote the "$Ast\bar{a}nga$ $Ast\bar{a}nga$ hrdaya $samhit\bar{a}$ $samhit\bar{a}$(八支集) and "$Ast\bar{a}nga$ Sangraha $samhit\bar{a}$(八心集)", where he tried to compromise and unify the "Charaka" and "$Su\acute{s}hruta$". The "$Ast\bar{a}nga$ Sangraha $samhit\bar{a}$" was translated into Tibetan and Arabic at about the 8th$\sim$9th century, and if we generalize the medicinal plants recorded in each the "Charaka", "$Su\acute{s}hruta$" and the "$Ast\bar{a}nga$ Sangraha $samhit\bar{a}$", there are 240, 370, 240 types each. 4) The 'Madhava' focused on one of the subjects of Indian medicine, '$Nid\bar{a}na$' ie meaning "the cause of diseases(病因論)", and in one of the copies found by Bower in 4th century C. E. we can see that it uses prescriptions from the "BuHaLaJi(布唅拉集)", "Charaka", "$Su\acute{s}hruta$". 5) According to the "Charaka", there were 8 branches of ancient medicine in India : treatment of the body(kayacikitsa), special surgery(salakya), removal of alien substances(salyapahartka), treatment of poison or mis-combined medicines(visagaravairodhikaprasamana), the study of ghosts(bhutavidya), pediatrics(kaumarabhrtya), perennial youth and long life(rasayana), and the strengthening of the essence of the body(vajikarana). 6) The '$\bar{A}yurveda$', which originated from ancient experience, was recorded in Sanskrit, which was a theorization of knowledge, and also was written in verses to make memorizing easy, and made medicine the exclusive possession of the Brahmin. The first annotations were 1060 for the "Charaka", 1200 for the "$Su\acute{s}hruta$", 1150 for the "$Ast\bar{a}nga$ Sangraha $samhit\bar{a}$", and 1100 for the "$Nid\bar{a}na$". The use of various mineral medicines in the "Charaka" or the use of mercury as internal medicine in the "$Ast\bar{a}nga$ Sangraha $samhit\bar{a}$", and the palpation of the pulse for diagnosing in the '$\bar{A}yurveda$' and 'XiZhang(西藏)' medicine are similar to TCM's pulse diagnostics. The coexistence with Arabian 'Unani' medicine, compromise with western medicine and the reactionism trend restored the '$\bar{A}yurveda$' today. 7) The "Charaka" is a book inclined to internal medicine that investigates the origin of human disease which used the dualism of the 'Samkhya', the natural philosophy of the 'Vaisesika' and the logic of the 'Nyaya' in medical theories, and its structure has 16 syllables per line, 2 lines per poem and is recorded in poetry and prose. Also, the "Charaka" can be summarized into the introduction, cause, judgement, body, sensory organs, treatment, pharmaceuticals, and end, and can be seen as a work that strongly reflects the moral code of Brahmin and Aryans. 8) In extracting bloody pus, the "Charaka" introduces a 'sharp tool' bloodletting treatment, while the "$Su\acute{s}hruta$" introduces many surgical methods such as the use of gourd dippers, horns, sucking the blood with leeches. Also the "$Su\acute{s}hruta$" has 19 chapters specializing in ophthalmology, and shows 76 types of eye diseases and their treatments. 9) Since anatomy did not develop in Indian medicine, the inner structure of the human body was not well known. The only exception is 'GuXiangXue(骨相學)' which developed from 'Atharvaveda' times and the "$Ast\bar{a}nga$ Sangraha $samhit\bar{a}$". In the "$Ast\bar{a}nga$ Sangraha $samhit\bar{a}$"'s 'ShenTiLun(身體論)' there is a thorough listing of the development of a child from pregnancy to birth. The '$\bar{A}yurveda$' is not just an ancient traditional medical system but is being called alternative medicine in the west because of its ability to supplement western medicine and, as its effects are being proved scientifically it is gaining attention worldwide. We would like to say that what we have researched is just a small fragment and a limited view, and would like to correct and supplement any insufficient parts through more research of new records.

• 대한한의학원전학회지
• /
• 제20권4호
• /
• pp.91-117
• /
• 2007

Through a simple study of the medical classics in the '$\bar{A}yurveda$', we have summarized them as follows. 1) Traditional Indian medicine started in the Ganges river area at about 1500 B. C. E. and traces of medical science can be found in the "Rigveda" and "Atharvaveda". 2) The "Charaka" and "$Su\acute{s}hruta$(妙聞集)", ancient texts from India, are not the work of one person, but the result of the work and errors of different doctors and philosophers. Due to the lack of historical records, the time of Charaka or $Su\acute{s}hruta$(妙聞)s' lives are not exactly known. So the completion of the "Charaka" is estimated at 1st${\sim}$2nd century C. E. in northwestern India, and the "$Su\acute{s}hruta$" is estimated to have been completed in 3rd${\sim}$4th century C. E. in central India. Also, the "Charaka" contains details on internal medicine, while the "$Su\acute{s}hruta$" contains more details on surgery by comparison. 3) '$V\bar{a}gbhata$', one of the revered Vriddha Trayi(triad of the ancients, 三醫聖) of the '$\bar{A}yurveda$', lived and worked in about the 7th century and wrote the "$A\d{s}\d{t}\bar{a}nga$ $A\d{s}\d{t}\bar{a}nga$ $h\d{r}daya$ $sa\d{m}hit\bar{a}$ $samhit\bar{a}$(八支集)" and "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$(八心集)", where he tried to compromise and unify the "Charaka" and "$Su\acute{s}hruta$". The "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$" was translated into Tibetan and Arabic at about the 8th${\sim}$9th century, and if we generalize the medicinal plants recorded in each the "Charaka", "$Su\acute{s}hruta$" and the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$", there are 240, 370, 240 types each. 4) The 'Madhava' focused on one of the subjects of Indian medicine, '$Nid\bar{a}na$' ie meaning "the cause of diseases(病因論)", and in one of the copies found by Bower in 4th century C. E. we can see that it uses prescriptions from the "BuHaLaJi(布哈拉集)", "Charaka", "$Su\acute{s}hruta$". 5) According to the "Charaka", there were 8 branches of ancient medicine in India : treatment of the body(kayacikitsa), special surgery(salakya), removal of alien substances(salyapahartka), treatment of poison or mis-combined medicines(visagaravairodhikaprasamana), the study of ghosts(bhutavidya), pediatrics(kaumarabhrtya), perennial youth and long life(rasayana), and the strengthening of the essence of the body(vajikarana). 6) The '$\bar{A}yurveda$', which originated from ancient experience, was recorded in Sanskrit, which was a theorization of knowledge, and also was written in verses to make memorizing easy, and made medicine the exclusive possession of the Brahmin. The first annotations were 1060 for the "Charaka", 1200 for the "$Su\acute{s}hruta$", 1150 for the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$", and 1100 for the "$Nid\bar{a}na$", The use of various mineral medicines in the "Charaka" or the use of mercury as internal medicine in the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$", and the palpation of the pulse for diagnosing in the '$\bar{A}yurveda$' and 'XiZhang(西藏)' medicine are similar to TCM's pulse diagnostics. The coexistence with Arabian 'Unani' medicine, compromise with western medicine and the reactionism trend restored the '$\bar{A}yurveda$' today. 7) The "Charaka" is a book inclined to internal medicine that investigates the origin of human disease which used the dualism of the 'Samkhya', the natural philosophy of the 'Vaisesika' and the logic of the 'Nyaya' in medical theories, and its structure has 16 syllables per line, 2 lines per poem and is recorded in poetry and prose. Also, the "Charaka" can be summarized into the introduction, cause, judgement, body, sensory organs, treatment, pharmaceuticals, and end, and can be seen as a work that strongly reflects the moral code of Brahmin and Aryans. 8) In extracting bloody pus, the "Charaka" introduces a 'sharp tool' bloodletting treatment, while the "$Su\scute{s}hruta$" introduces many surgical methods such as the use of gourd dippers, horns, sucking the blood with leeches. Also the "$Su\acute{s}hruta$" has 19 chapters specializing in ophthalmology, and shows 76 types of eye diseases and their treatments. 9) Since anatomy did not develop in Indian medicine, the inner structure of the human body was not well known. The only exception is 'GuXiangXue(骨相學)' which developed from 'Atharvaveda' times and the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$". In the "$A\d{s}\d{t}\bar{a}nga$ Sangraha $samhit\bar{a}$"'s 'ShenTiLun(身體論)' there is a thorough listing of the development of a child from pregnancy to birth. The '$\bar{A}yurveda$' is not just an ancient traditional medical system but is being called alternative medicine in the west because of its ability to supplement western medicine and, as its effects are being proved scientifically it is gaining attention worldwide. We would like to say that what we have researched is just a small fragment and a limited view, and would like to correct and supplement any insufficient parts through more research of new records.

• 한국의학물리학회지:의학물리
• /
• 제21권3호
• /
• pp.253-260
• /
• 2010

대다수의 근접치료용 방사선치료계획장치는 AAPM TG-43의 계산식에 기반을 둔 선량계산 알고리듬을 적용하고 있으나 이는 조직의 비균질성을 적절히 고려하지 못한다. 본 연구에서는 몬테칼로 방법을 이용하여 강내고선량근접치료계획을 검증하는 체계를 구축하고자 하였으며, 특히 환자의 CT 영상을 이용하여 물질정보로 변환한 후 직접 몬테칼로 계산을 수행하는 방법의 타당성에 초점을 맞추었다. 판형 팬텀 및 자궁경부암 환자의 CT 영상을 Plato (Nucletron, Netherlands) 치료계획장치를 이용하여 근접치료계획을 수행한 후 여기서 얻어진 인자들을 이용하여 EGSnrc 기반의 DOSXYZnrc 코드로 몬테칼로 계산을 수행하였으며, EBT 필름측정 결과와 비교하였다. DOSXYZnrc 코드의 선원 모델링 특성 상 후장전 장치의 $^{192}Ir$ 선원들을 직육면체 형태로 근사화하여 모델링하였으며 계산 시 체적소의 크기는 $2{\times}2{\times}2\;mm^3$로 하였다. 균질 매질 내에서는 TG-43 기반의 선량계산 결과와 몬테칼로 선량계산 결과가 잘 일치함을 확인할 수 있었으나 고밀도 물질이 포함된 비균질 매질 내에서는 오차가 커졌다. 환자의 경우 A점 및 B점의 오차는 3% 이내, 평균선량 오차는 5% 정도였다. 그러나 기존 선량계산 알고리듬의 경우 고밀도 물질의 영향을 적절히 고려하지 못하여 표적의 선량을 과대평가하여 실제로는 더 적은 선량이 들어갈 우려가 있다. 본 연구에서 제안된 선량계산 검증체계는 타당하며 선량 계산 결과도 실제와 잘 일치함을 확인할 수 있었다. 또한 기존의 선량계산 알고리듬으로 계산된 치료계획결과를 확인할 경우에는 주의가 필요하며, 몬테칼로 방법과 같은 독립적인 검증 시스템이 유용할 것이다.

• 농촌의학ㆍ지역보건
• /
• 제28권1호
• /
• pp.15-27
• /
• 2003

Objectives: This study was conducted to compare the medical care patterns of hypertensive patients between rural and urban areas. Methods: We selected one rural county(Region A where there were 19 public health centers; one health center, 8 health sub-centers and 10 community health posts) and two urban districts(Region B and C where there was no health sub-center and community health post) in Daegu city. Region B had similar socioeconomic characteristics with rural county A while region C had different characteristics. The medical insurance records of 14,422 incident patients (2,501 in region A, 4,873 in region B and 7,048 in region C) with diagnostic code of hypertension from September 1998 to August 1999 were reviewed. Incident patient was defined as a patient who had no record of medical fee claim for hypertension to the national health insurance corporation in past 6 months and visited a medical facility for hypertension for the first time. The data for annual visit days, annual prescription days and annual total medical expenses were abstracted. The medical care pattern was categorized by the number of annual visit days and prescription days. The most proper care group was defined as the patient who visited 6-15 days with 240 prescription days or more in a year. Results: The type of medical facilities for the most visit was clinics, 373.% and it was followed by general hospitals, 28.2%; public health centers, 24.7%; and hospitals, 9.8% in region A(p<0.05). In region B, it was clinics, 63.1% and followed by general hospitals, 27.6%; health center, 5.2%; and hospitals, 4.1%(p<0.05). In region C, it was clinics, 53.8% and followed by general hospitals, 35.0%; health center, 6.3%; and hospitals, 4.9%(p<0.05). Annual mean total medical expenses per patient was highest in region C(won195,993) and followed by region A(won191,683) and region B(won178,713). The proportion of the most proper care group was 7.7% in region A, 5.2% in region B and 6.7% in region C(p<0.05). According to the type of medical facilities for the first visit, the proportion of the most proper care group was highest(14.7%) in the patients of public health centers, and it was followed by general hospitals, 8.8%; clinics, 3.6%; and hospitals, 2.0% in region A(p<0.05). In region B, it was highest in general hospitals, 9.7% and followed by hospitals, 4.0%; health center, 3.6%; and clinics, 3.4%(p<0.05). In region C, it was highest in general hospitals, 10.1% and followed by clinics, 5.2%; hospitals, 4.1%; and health center, 3.1%(p<0.05). Conclusions: The proportion of proper care for hypertension was higher in rural area and it was attributed to the care of health center, sub-centers and community health posts which appeared to follow patients better than hospitals and clinics.

• 한국임상수의학회지
• /
• 제27권6호
• /
• pp.718-722
• /
• 2010

전북지역에서 야생 멧돼지 사냥 시 발생한 응급 외상성 질환을 치료하기 위하여 내원한 사냥견 100마리를 외상의 정도에 따라 분류 하였다. 분류는 응급 외상성 질환의 경향과 정도를 부상의 원인, 부상 부위의 숫자와 위치, 부상의 중등도, 치사율과 같은 의료 기록들을 통하여 정보를 수집하였고 이를 토대로 후향성 조사를 실시 하였다. 사냥견 100마리의 환자에서 136개 (71마리의 단일 응급 외상성 질환과 29마리에서 복합 응급 외상성 질환)의 응급 외상성 질환이 발견되었다. 응급 외상성 질환의 원인으로는 야생 멧돼지 공격에 의한 응급 외상이 92마리, 오발로 인한 응급 외상이 7마리 그리고 덫에 의한 응급 외상이 1마리로 조사 되었다. 흉부는 응급 외상 질환이 가장 잘 발생하는 부위이며, 부상심각점수(ISS)는 2단계로 판단되었다. 치사율은 9% 였으며 사망에 이르게 된 증례는 모두 흉강에 외상을 입고 있었다. 야생 멧돼지 사냥 시에 발생하는 응급 외상성 질환은 사냥물을 공격할 때 대부분 발생하는 것으로 특히 가장 흔한 부위는 흉부였으며 이것은 임상 수의사가 흔히 접하는 일반적인 응급 질환들과는 매우 다른 특징을 나타내고 있었다. 본 연구를 통하여 야생 멧돼지 사냥견에서 응급 외상성 질환의 치료 경과, 발생 형태, 예후, 치사율 등 임상 응급 진료에 필요한 정보들을 알 수 있었다.

• 대한핵의학회지
• /
• 제31권4호
• /
• pp.433-439
• /
• 1997

낭성뇌종양은 낭 내부에 베타선을 방출하는 방사성동위원소를 주입하여 낭 내부 및 낭벽에 존재하는 암세포에 일정량의 방사선 에너지를 전달함으로써 그 치료 효과를 기대할 수 있다. 본 연구에서는 $^{166}Ho$-chitosan 복합체를 낭성뇌종양 치료에 이용하고자 할 때 낭의 크기와 주입되는 방사능의 변화에 따라 낭벽에 전달되는 방사선 흡수선량이 어떻게 변화하는가를 평가하고자 한다. 구형의 종양성 낭 모델에 대하여 Monte Carlo code인 EGS4를 이용하여 $^{166}Ho$ 베타선의 에너지 전달 현상에 대한 모사계산을 수행한다. 종양성 낭 내부에 주입된 $^{166}Ho$-chitosan 복합체의 낭내 분포는 낭 내부액과 섞여있거나 낭벽 표면에 부착되는 두 가지 경우를 고려한다. 방사선 조사의 표적 영역으로서, 낭벽의 표면으로부터 매 1mm 깊이의 체적을 설정하여 4mm 깊이까지 고려한다. 직경이 각 1cm, 2cm, 그리고 3cm 인 종양성낭을 평가 대상으로 설정한다. 직경이 3cm인 종양성 낭에 10mCi의 $^{166}Ho$-chitosan 복합체가 주입되어 낭 내부에 균일하게 분포하였다고 가정하였을 경우에 1mm 두께의 낭벽에 전달되는 방사선 흡수선량은 매 1mm 깊이의 낭벽 체적에서 각각 40.06Gy, 14.96Gy, 5.315Gy, 1.660Gy으로 계산되었다. 한편, 낭 내부에 주입된 10mCi의 $^{166}Ho$-chitosan 복합체가 낭벽에 균일하게 분포하였다고 가정하였을 경우에는 매 1mm 두께의 낭벽 체적에 전달되는 방사선 흡수선량이 601.7Gy, 188.7Gy, 73.87Gy, 27.80Gy로 평가되었다. 낭 내부에 주입된 $^{166}Ho$-chitosan 복합체가 낭벽에 부착될 가능성이 있음이 한 임상 적용 예에서 시사된 바, 정확한 $^{166}Ho$-chitosan 복합체의 낭 내부벽 부착률을 확인함으로써 낭벽에 대한 흡수선량을 예시하고 이를 근거로 주입할 $^{166}Ho$-chitosan 복합체의 양을 결정해야 할 것이다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권1호
• /
• pp.259-263
• /
• 2015

Background: In the field of cancer, the ICD-10 coding convention is based on the site of a neoplasm in the body and usually ignores the morphology, thus the same code may be assigned to tumors of different morphologic types in an organ. Nowadays, all general (provincial) and center hospitals in Thailand are equipped with the hospital information system (HIS) database. Objective: This study aimed to find the characteristics and magnitude of agreement represented by the positive predictive value (PPV) of provisional cancer diagnoses in the HIS database in Pattani Hospital in Thailand in comparison with the final cancer diagnosis of the ICD-10 codes generated from a well established cancer registry in Songklanagarind Hospital, the medical school hospital of Prince of Songkla University. Materials and Methods: Data on cancer patients residing in Pattani province who visited Pattani Hospital from January 2007 to May 2011 were obtained from the HIS database. The ICD-10 codes of the HIS computer database of Pattani Hospital were compared against the ICD-10 codes of the same person recorded in the hospital-based cancer registry of Songklanagarind Hospital. The degree of agreement or positive predictive value (PPV) was calculated for each sex and for both sexes combined. Results: A total of 313 cases (15.9%) could be matched in the two databases. Some 222 cases, 109 males and 113 females, fulfilled the criteria of referral from Pattani to Songklanagarind Hospitals. Of 109 male cancer cases, 76 had the same ICD-10 codes in both hospitals, thus, the PPV was 69.7% (95%CI: 60.2-78.2%). Agreement in 76 out of 113 females gave a PPV of 67.3% (95%CI: 57.8-75.8%). The two percentages were found non-significant with Fisher's exact p-value of 0.773. The PPV for combined cases of both sexes was 68.5% (95%CI: 61.9-74.5%). Conclusions: Changes in final diagnosis in the referral system are common, thus the summary statistics of a hospital without full investigation facilities must be used with care, as the statistics are biased towards simple diseases able to be investigated by available facilities. A systematic feedback of patient information from a tertiary to a referring hospital should be considered to increase the accuracy of statistics and to improve the comprehensive care of cancer patients.