• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.199-206
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• 2014

Purpose : According to the rapid increase recently in image-guided radiation therapy, It is necessary to control of the image guidance system completely. In particular for the main subject to the accuracy of image guided radiation therapy device to be done essentially the quality assurance. We made efficient phantom in AMC for the management of the accurate and efficient. Materials and Methods : By setting up of five very important as a quality assurance inventory of the Image guidance system, we made (AMC G-Box) phantom for quality assurance efficient and accurate. Quality assurance list were the Iso-center align, the real measurement, the center align of four direction, the accuracy of table movement and the reproducibility of Hounsfield Unit. The rectangular phantom; acrylic with a thickness of 1 cm to $10cm{\time}10cm{\time}10cm$ was inserted the three materials with different densities respectively for measure the CBCT HU. The phantom was to perform a check of consistency centered by creating a marker that indicates the position of the center fixed. By performing the quality assurance using the phantom of existing, comparing the resulting value to the different resulting value using the AMC G-Box, experiment was analyzed time and problems. Therapy equipment was used Varian device. It was measured twice at 1-week intervals. Results : When implemented quality assurance of an image guidance system using AMC G-Box and a phantom existing has been completed, the quality assurance result is similar in $0.2mm{\pm}0.1$. In the case of the conventional method, it was 45 minutes at 30 minutes. When using AMC G-Box, it takes 20 minutes 15 minutes, and declined to 50% of the time. Conclusion : The consistency and accurate of image guidance system tend to decline using device. Therefore, We need to perform thoroughly on the quality assurance related. It needs to be checked daily to consistency check especially. When using the AMC G-Box, It is possible to enhance the accuracy of the patient care and equipment efficiently performing accurate quality assurance.

• Clinical and Experimental Pediatrics
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• v.46 no.2
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• pp.178-182
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• 2003

Purpose : Brain tumors are the second most common tumor in childhood, and medulloblastomas comprise 15-25% of brain tumors. The well known prognostic factors are age at diagnosis, stage of disease, and extent of surgical excision. In this study, we analysed the prognostic factors in patients who received chemotherapy after excision. Methods : We reviewed the medical records of 61 patients who received chemotherapy among the 94 patients who were diagnosed and treated between Jan 1985 and Sep 2001 in the Department of Pediatrics and Neurosurgery at Severance Hospital. Results : Among the total survival rate of patients who underwent chemotherapy, the 3-yr progression-free survival rate was $66.5{\pm}6.3%$ and the 15-yr progression-free survival rate was $60.3{\pm}6.7%$. The progression-free survival rate for patients with age at diagnosis over 3 yrs old and under 3 yrs old, was $64.5{\pm}7.7%$ and $48.2{\pm}12.9%$ respectively and there was no statistically significant difference. The survival rate of the high vs low risk group by staging was $72.7{\pm}10.5%$ and $54.6{\pm}8.3%$ respectively, and there was no significant difference. The survival rate of patients with total removal vs subtotal removal was $65.8{\pm}11.8%$ and $56.8{\pm}8.2%$ respectively, showing no statistical difference. Conclusion : The reason there is no difference in survival rate according to the traditional prognostic factors is that chemotherapy has improved not only the total survival rate but also the survival rate in patients with poor traditional prognostic factors. So, sufficient removal of tumor followed by proper chemotherapy and radiotherapy is an important factor which influences the survival rate of medulloblastoma patients.

• Progress in Medical Physics
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• v.17 no.3
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• pp.173-178
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• 2006

The purpose of this study was to evaluate the radiation dose for clinical PET/CT protocols in clinical environments using Alderson phantom and TLDs. Radiation doses were evaluated for both Philips GEMINI 16 slice PET/CT system and GE DSTe 16 slice PET/CT system. Specific organ doses with $^{137}Cs$ transmission scan, high quality CT scan and topogram in philips GEMINI PET/CT system were measured. Specific organ doses with CT scan for attenuation map, CT scan for diagnosis and topogram in GE DSTe PET/CT system were also measured. The organs were selected based on ICRP60 recommendation. The TLDs used for measurements were selected for within an accuracy of ${\pm}5%$ and calibrated in 10 MV X-ray radiation field. The effective doses for $^{137}Cs$ transmission scan, high qualify scan, and topogram in Philips GEMINI PET/CT system were $0.14{\pm}0.950,\;29.49{\pm}1.508\;and\;0.72{\pm}0.032mSv$ respectively. The effective doses for CT scan to make attenuation map, CT scan to diagnose and topogram in GE DSTe PET/CT system were $20.06{\pm}1.003,\;24.83{\pm}0.805\;and\;0.27{\pm}0.008mSv$ respectively. We evaluated the total effective dose by adding effective dose for PET Image. The total PET/CT doses for Philips GEMINI PET/CT (Topogram+$^{137}Cs$ transmission scan+PET, Topogram+high qualify CT+PET) and GE DSTe PET/CT (Topogram +CT for attenuation map+ PET, Topogram+diagnostic CT+ PET) are $7.65{\pm}0.951,\;37.00{\pm}1.508,\;27.12{\pm}1.003\;and\;31.89{\pm}0.805mSv$ respectively. Further study may be needed to be peformed to find optimal PET/CT acquisition protocols for reducing the patient exposure with good image qualify.

• Clinical and Experimental Pediatrics
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• v.52 no.6
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• pp.674-679
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• 2009

Purpose : The authors aimed to analyze the long-term effects of treatments, especially external beam radiotherapy (EBRT), in bilateral retinoblastoma patients. Methods : This retrospective study analyzed the medical records of 22 bilateral retinoblastoma patients who were registered between October, 1987 and October, 1998 and followed-up for more than 10 years. They were treated by enucleation, EBRT, and systemic chemotherapy. Age at diagnosis, sex, delay prior to treatment, Reese-Ellsworth (RE) classification, and the local treatment modalities were analyzed in relation to recurrence-free survival (RFS) and complications. Results : Median age at diagnosis was 7.0 months (range 1.7-31.6 months). Leukocoria was the most common presenting feature. Two patients had a familial history. The RE classifications of the 44 eyes were group II in 4, III in 14, IV in 4, and V in 22. At the end of a median follow-up period of 141 months (range 55-218 months), 20 patients were alive. The 10-year ocular survival rate of the 44 eyes was $56.8{\pm}7.5%$. The 10-year RFS and ocular survival rate of the 29 eyes treated by combined EBRT and chemotherapy were 75.9% and 86.2%, respectively. Treatment delay (>3 months) was found to be related to higher risk of recurrence. Complications after EBRT were cataract, retinal detachment, phthisis bulbi, and facial asymmetry. No patient developed a second malignancy during the follow-up period. Conclusion : Early detection and prompt treatment can increase ocular survival rates. In addition, careful attention should be paid to possible long-term sequelae in these patients.

• Progress in Medical Physics
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• v.17 no.2
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• pp.89-95
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• 2006

The purpose of this study was to evaluate the radiation doses during CT transmission scan by changing tube voltage and tube current, and to estimate the radiation dose during our clinical whole body $^{137}Cs$ transmission scan and high quality CT scan. Radiation doses were evaluated for Philips GEMINI 16 slices PET/CT system. Radiation dose was measured with standard CTDI head and body phantoms in a variety of CT tube voltage and tube current. A pencil ionization chamber with an active length of 100 mm and electrometer were used for radiation dose measurement. The measurement is carried out at the free-in-air, at the center, and at the periphery. The averaged absorbed dose was calculated by the weighted CTDI ($CTDI_w=1/3CTDI_{100,c}+2/3CTDI_{100,p}$) and then equivalent dose were calculated with $CTDI_w$. Specific organ dose was measured with our clinical whole body $^{137}Cs$ transmission scan and high quality CT scan using Alderson phantom and TLDs. The TLDs used for measurements were selected for an accuracy of ${\pm}5%$ and calibrated in 10 MeV X-ray radiation field. The organ or tissue was selected by the recommendations of ICRP 60. The radiation dose during CT scan is affected by the tube voltage and the tube current. The effective dose for $^{137}Cs$ transmission scan and high qualify CT scan are 0.14 mSv and 29.49 mSv, respectively. Radiation dose during transmission scan in the PET/CT system can measure using CTDI phantom with ionization chamber and anthropomorphic phantom with TLDs. further study need to be peformed to find optimal PET/CT acquisition protocols for reducing the patient exposure with same image qualify.

• Progress in Medical Physics
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• v.21 no.2
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• pp.201-208
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• 2010

Recently, along with technology development of endoscopic equipment, a stent has been developed for the convenience of operation, shortening of recovery times, and reduction of patient's pain. To this end, optimal factors are simulated for the stent structure and mechanical reaction and verified using finite element analysis. In order to compare to present commercialized product such as Zilver (Cook, Bloomington, Indiana, USA) and S.M.A.R.T (Cordis, Bridgewater Towsnhip, New Jersey, USA), mechanical impact factors were determined through Taguchi factor analysis, and flexibility and expandability of all the products including ours were tested using finite element analysis. Also, important factors were sought that fulfill the optimal condition using central composition method of response surface analysis, and optimal design were carried out based on the important factors. From the centra composition method of Response surface analysis, it is found that importat factors for flexibility is stent thickness (T) and unit area (W) and those for expandability is stent thickness (T). In results, important factors for optimum condition are 0.17 mm for stent thickness (T) and $0.09\;mm^2$ for unit area (W). Determined and verified by finite element analysis in out research institute, a stent was manufactured and tested with the results of better flexibility and expandability in optimal condition compared to other products. Recently, As Finite element analysis stent mechanical property assessment for research much proceed. But time and reduce expenses research rarely stent of optimum coditions. In this research, Important factor as mechanical impact factor stent Taguchi factor analysis arrangement to find flexibility with expansibility as Finite element analysis. Also, Using to Center composition method of Response surface method appropriate optimized condition searching for important factor, these considering had design optimized. Production stent time and reduce expenses was able to do the more coincide with optimum conditions. These kind of things as application plan industry of stent development period of time and reduce expenses etc. be of help to many economic development.

• Journal of Hospice and Palliative Care
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• v.9 no.1
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• pp.1-10
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• 2006

Purpose: Terminal cancer influences on patients as well as their family members. This research was performed to evaluate the quality of lift of primary family caregivers and to investigate the influencing factors. Methods: The results of survey were collected from 81 family caregivers who were taking care of hospitalized terminal cancer patients at an oncology department of university hospital in Daejeon from March 2005 to January 2006 with questionnaires. The questionnaires were consisted of the general characteristics of the subjects, and 36-items short-form Health Survey (SE-36) Korean version to evaluate the quality of life of family caregivers, the characteristics of patients and family caregivers' caring trait. Results: Family caregivers' mean (${\pm}SD$) SF-36 score was 47.9 (${\pm}20.7$). Influential factors on family caregivers' life quality were daily raring hours, economic burden, type of treatment; only supportive care, caring duration, sex, the numbers of ADLs (activity of daily livings) items that patients needed help in order by stepwised multiple logistic regression analysis (overall $R^2=0.639$, P=0.044). Conclusion: Daily raring hours and economic burden were two influential modifiable factors on family caregivers' quality of life. Therefore, social supportive systems are required to reduce family caregivers' daily caring hour and economic burden.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.205-215
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• 2013

Most terminally ill cancer patients experience various physical and psychological symptoms during their illness. In addition to pain, they commonly suffer from fatigue, anorexia-cachexia syndrome, nausea, vomiting and dyspnea. In this paper, I reviewed some of the common non-pain symptoms in terminally ill cancer patients, based on the National Comprehensive Cancer Network (NCCN) guidelines to better understand and treat cancer patients. Cancer-related fatigue (CRF) is a common symptom in terminally ill cancer patients. There are reversible causes of fatigue, which include anemia, sleep disturbance, malnutrition, pain, depression and anxiety, medical comorbidities, hyperthyroidism and hypogonadism. Energy conservation and education are recommended as central management for CRF. Corticosteroid and psychostimulants can be used as well. The anorexia and cachexia syndrome has reversible causes and should be managed. It includes stomatitis, constipation and uncontrolled severe symptoms such as pain or dyspnea, delirium, nausea/vomiting, depression and gastroparesis. To manage the syndrome, it is important to provide emotional support and inform the patient and family of the natural history of the disease. Megesteol acetate, dronabinol and corticosteroid can be helpful. Nausea and vomiting will occur by potentially reversible causes including drug consumption, uremia, infection, anxiety, constipation, gastric irritation and proximal gastrointestinal obstruction. Metoclopramide, haloperidol, olanzapine and ondansetron can be used to manage nausea and vomiting. Dyspnea is common even in terminally ill cancer patients without lung disease. Opioids are effective for symptomatic management of dyspnea. To improve the quality of life for terminally ill cancer patients, we should try to ameliorate these symptoms by paying more attention to patients and understanding of management principles.

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.362-368
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• 2008

Background: LKB1(STK11) is a serine/threonine kinase that functions as a tumor growth suppressor. The functions of LKB1 in lung cancer are not completely understood. This study evaluated the relationship between LKB1 protein expression and the clinicopathological features in lung cancer tissues. Methods: The expression of LKB1 was studied in paraffin-embedded tumor blocks, which were obtained from 77 patients who had undergone surgery at Wonkwang University Hospital. The expression of the LKB1 protein was considered positive if the staining intensity in the tumor tissue adjacent to the normal airway epithelium was >30%. Results: The LKB1 expression was positive in 31 (40%) of samples. Loss of LKB1 expression was significantly associated with being male, smoking history, and squamous cell carcinoma. In the peripheral sites, the loss of LKB1 expression was strongly associated with a smoking history. A loss of LKB1 expression was more frequently associated with progression according to TNM staging, particularly more than T2, N progression. Conclusion: There was a significant relationship between the loss of the LKB1 protein and gender, smoking history, and histological type in primary lung cancer. Although LKB1 expression was not found to be a significant prognostic factor, further studies with a larger cohort of patient's lung cancer tissue samples will be needed to confirm this.

• Tuberculosis and Respiratory Diseases
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• v.63 no.2
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• pp.154-164
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• 2007

Background: Irinotecan hydrochloride, a topoisomerase I inhibitor, is effective against small-cell lung cancer. Irinotecan also can act as a potential radiation sensitizer along with cisplatin. To evaluate efficacy and toxicity of irinotecan plus cisplatin (IP) with concurrent thoracic radiotherapy, we conducted a phase II study of IP followed by concurrent IP plus hyperfractionated thoracic radiotherapy in patients with previously untreated limited-stage small-cell lung cancer. Methods: Twenty-four patients with previously untreated small-cell lung cancer were enrolled onto the study since November 2004. Irinotecan $60mg/m^2$ was administered intravenously on days 1 and 8 in combination with cisplatin $60mg/m^2$ on day1 every 21 days. From the first day of third cycle, twice-daily thoracic irradiation (total 45 Gy) was given. Prophylactic cranial irradiation was given to the patients who showed complete remission after concurrent chemoradiotherapy. Restaging was done after second and sixth cycle with chest CT and/or bronchosocpy. Results: Up to November 2004, 19 patients were assessable. The median follow-up time was 12.5 months. A total of 99 cycles (median 5.2 cycles per patient) were administered. The actual dose intensity values were cisplatin $19.6mg/m^2$/week and irinotecan $38.2mg/m^2$/week. Among the 19 patients, the objective response rate was 95% (19 patients), with 9 patients (47%) having a complete response (CR). The major grade 3/4 hematological toxicities were neutropenia (35% of cycles), anemia (7% of cycles), thrombocytopenia (7% of cycles). Febrile neutropenia was 4% of cycles. The predominant grade 3/4 non-hematological toxicities was diarrhea (5% of cycles). Toxicities was not significantly different with concurrent administration of irinotecan and cisplatin with radiotherapy, except grade 3/4 radiation esophagitis (10% of patients). No treatment-related deaths were observed. The 1-year and 2-year survival rate of eligible patients was 89% (16/18) and 47% (9/18), respectively. Conclusion: Three-week schedule of irinotecan plus cisplatin followed by concurrent IP plus hyperfractionated thoracic radiotherapy is an effective treatment for limited disease small-cell lung cancer, with acceptable toxicity.