• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.222-231
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• 2005

Purpose: This article describes a double-bundle ACL reconstruction technique using a five-strand hamstring tendon autograft with conventional anteromedial bundle reconstruction and additional posterolateral bundle reconstruction. Operative technique: For the tibial tunnel, the conventional single tunnel technique is performed and for the femoral tunnel, the double tunnel technique is performed with the anteromedial and posterolateral bundle. After minimal notchplasty, the anteromedial femoral tunnel is prepared with leaving one milimeter of posterior femoral cortex within the over-the-top, which if positioned at the 11-o'clock orientation for the right knee or at the 1-o'clock position for the left knee. The posterolateral femoral tunnel that is located 5 to 7 mm superior to the inner margin of the lateral meniscus anterior horn at $90^{\circ}$ of flexion is prepared with tile outside-in technique using a 4.5 cannulated reamer. The graft material for the double bundle reconstruction is made of the conventional four-strand hamstring autograft in the anteromedial bundle and of a single-strand semitendinosus tendon in the posterolateral bundle. The anteromedial bundle is fixed with using a rigid fix system on the femoral side and the posterolateral bundle is fixed to tie with the miniplate from the outside femur. Then, with the knee in $10^{\circ}\;to\;20^{\circ}$ of flexion, a bioabsorbable screw is simultaneously applied to achieve tibial fixation with tensioning of both bundles. Conclusion: A double bundle reconstruction with five-strand hamstring autograft, which is designed with a favorable conventional anteromedial bundle and an additional posterolateral bundle to restore rotation stability, seems to be a very effective method for the treatment for ACL instabilities.

• Journal of radiological science and technology
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• v.37 no.3
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• pp.211-221
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• 2014

The clinical practices provide the students with a good opportunity to study the practical experiences in their field through the clinical training education in hospital. Now, in this study, comparing the perceptions of the clinic teachers with those of students at the clinical site. The study was conducted to the students attending universities located in Seoul and who finished the clinical practices in 2013. The questionnaires were distributed to the student and collected from them. The study were conducted to 275 questionnaires with frequency analysis, crosstabs, chi-square test and McNemar test. The major motivation was of the select radiography course was high employment rate(44.0%) and the satisfaction of radiography course was general(53.1%). 51.3% of the study answered 8 weeks current duration of clinical practices is proper. The 3-year course students answered that the period of clinical practices would be proper if it is performed in the winter vacation in their second year in college(47.3%). The 4-year course students answered that the first semester in their third years is proper for clinical practices( 27.7%). The students answered that they felt the lack in their knowledge on the professional field(32.4%) during the clinical practices and some of the practical training is different from the education performed at school(68.4%). Most of answered that they were satisfied with the clinical practices and among them they recognized the importance of the clinical practices ($3.94{\pm}0.89$). After the clinical practices, their desire for getting job as a radiography has changed from 84.1% to 82.9%. The reason why they want the job related to the radiation is because the job is stable (changed from 49.0% to 46.0% after the clinical practice) while the reason why they don't want be a radigrapher because that job is not proper for them (changed from 37.0% to 40.7% after the clinical practice) The effort should be made to enhance the position of radiation professionals through the improved education system to the students, rather giving them education for just employment.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.434-440
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• 2009

Background: Surgical closure of a patent ductus arteriosus (PDA) can be considered when conservative medical treatment is ineffective or contraindicated. Low weight and earlier gestational age neonates who are treated with conservative medical therapy generally showed a higher failure rate. The morbidity of surgical PDA closure in such extremely low birth weight (ELBW) neonates is also high. Here we present the early results of a new technique for approaching the PDA through a dorsal minithoracotomy. Material and Method: From March 2006 to November 2008, 24 premature neonates underwent surgical PDA closure. The procedures were performed in the newborn intensive care unit via a 2 cm long dorsal minithoracotomy with the baby in the prone position with the left hemithorax elevated 30$^{\circ}$. Bimanual cotton swab blunt dissection completed the extrapleural accesstothe PDA and then two clips were applied. Tube thoracostomy was avoided if there was no meaningful pleural laceration. Result: The infants mean gestational age was 26.5$\pm$2.1 weeks (range: 23 to 30 weeks) and the average age at operation was 11$\pm$11 days. The mean body weight at operation was 933$\pm$271 grams (range: 570 to 1,700 grams). Eight patients expired, but there was no procedure-related death. Postoperative echocardiography revealed two cases of residual shunt but none of these shunts were detected on the follow up echocardiogram that was performed on the post operative 5 and 59 days. Conclusion: We concluded that the technique described here is an effective procedure in view of the satisfactory operative exposure and the low rate of complications.

• Tuberculosis and Respiratory Diseases
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• v.42 no.2
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• pp.165-174
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• 1995

Background: Exercise is one of the most common precipitants of acute asthma encountered in clinical practice. The development of airflow limitation that occurs several minutes after vigorous exercise, i. g. exercise-induced bronchoconstriction(EIB), has been shown to be closely correlated with the nonspecific bronchial hyperresponsiveness, which is the hallmark of bronchial asthma. All previous reports that assessed the correlation of EIB to nonspecific bronchial hyperresponsiveness have focused on airway sensitivity($PC_{20}$) to inhaled bronchoconstrictor such as methacholine or histamine. However, maximal airway narrowing(MAN), reflecting the extent to which the airways can narrow, when being exposed to high dose of inhaled stimuli, has not been studied in relation to the degree of EIB. Methods: Fifty-six children with mild asthma(41 boys and 15 girls), aged 6 to 15 years(mean${\pm}$SD, $9.9{\pm}2.5$ years) completed this study. Subjects attended the laboratory on two consecutive days. Each subject performed the high-dose methacholine inhalation test at 4 p.m. on the first day. The dose-response curves were characterized by their position($PC_{20}$) and MAN, which was defined as maximal response plateau(MRP: when two or three data points of the highest concentrations fell within a 5% response range) or the last of the data points(when a plateau could not be measured). On the next day, exercise challenge, free running outdoors for ten minutes, was performed at 9 a.m.. $FEV_1$ was measured at graduated intervals, 3 to 10 minutes apart, until 60 minutes after exercise. Response(the maximal ${\triangle}FEV_1$ from the pre-exercise value) was classified arbitrarily into three groups; no response((-) EIB: ${\triangle}FEV_1$<10%), equivocal response ($({\pm})$EIB:10%<${\triangle}FEV_1$<20%) and definite response($({\pm})$EIB:${\triangle}FEV_1$>20%). Results: 1) When geometric mean $PC_{20}$ of the three groups were compared, $PC_{20}$ of (+) EIB group was significantly lower than that of (-)EIB group. 2) There was a close correlation between $PC_{20}$ and the severity of EIB in the whole group(r=-0.568, p<0.01). 3) Of the total 56 subjects, MRP could be measured in 36 subjects, and the MRP of these subjects correlated fairly with the severity of EIB(r=0.355, p<0.05) 4) The MAN of (+) EIB group was significantly higher than that of (-)EIB group(p<0.01). 5) The MAN correlated well with the severity of EIB in the whole group(r=0.546, p<0.01). Conclusion: The degree of MAN as well as bronchial sensitivity($PC_{20}$) to methacholine is correlated well with the severity of EIB. The results suggest that the two main components of airway hyperresponsiveness may be equally important determinants of exercise reactivity, although the mechanism may be different from each other. The present study also provides further evidence that EIB is a manifestation of the increased airway reactivity characteristic of bronchial asthma.

• Nuclear Medicine and Molecular Imaging
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• v.43 no.1
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• pp.55-59
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• 2009

Purpose: Lymphoscintigraphy and sentinel node biopsy are used in detection of axillary lymph node metastasis in breast cancer patients, but standardized technique is not established. We compared the results of the injection the morning of surgery (1 day protocol) with the subareolar injection the day before surgery (2 day protocol) with the subareolar injection in patients with breast cancer having lymphoscintigraphy and sentinel node biopsy. Materials and Methods: This study included 349 patients who underwent the breast cancer operation during 2001-2004. One hundred seventy one patients (1 day protocol, 1 hour) was injected 0.8ml of Tc-99m Tin-Colloid (37 MBq) by subareolar injection on the morning of surgery. One hundred seventy eight patients (2 day protocol, 16 hour) was injected 0.8 ml of T c-99m Tin-Colloid (185 MBq) on the afternoon before surgery. Lymphoscintigraphy was performed in sitting position and sentinel node localization was performed by hand-held gamma probe during operation. Result: In the 1 day protocol, 153 cases (89.5%) of the sentinel node were localized by lymphoscintigraphy and 150 cases (87.7%) were localized by gamma probe. In the 2 day protocol, 159 cases (89.3%) were localized by lymphoscintigraphy and 154 cases (86.5%) were localized by gamma probe. There was no significant difference in localization of sentinel node between the 1 day and the 2 day protocol by lymphoscintigraphy and gamma probe (p>0.05, p>0.05). Conclusion: There was no difference the result of localization of sentinel node with subareolar injection between the 1 day and the 2 day protocol in breast cancer patients. Because the 2 day protocol allows the enough time of performing lymphoscintigraphy, it is more useful in localization of sentinel node in breast cancer patients.

• Science of Emotion and Sensibility
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• v.7 no.1
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• pp.65-81
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• 2004

With the arrival of the 21th century, the management environments such as the knowledge system, information system, and technology system surrounding small and medium enterprises are being rapidly changed. These rapidly changing the environment of enterprises like the above can be thought rather profitable for the elastic and resiling medium enterprises than large enterprises. Additionally, these environments are recognized as the management circumstances which provide with the change by which medium enterprises equipped with the trustworthy creativity in the 21th century are able to become the main player of the industrial development. The position and role of medium enterprises in the national economical system are very important. The execution of the local autonomy system and the policy to activate the local economy will generally enlarge the power of medium enterprises which are based on the concerned local society more ant more. But, by the standpoint of designer, it is pointed out that there is the problem that the effective application means or the availability of the industrial design was not sufficiently recognized or understood by the manager in enterprises. Notwithstanding the above problem, a lot of domestic small and medium enterprises became to apply the industrial design as the means for improving the competitiveness of their own products in the relatively short time powered by the governmental policy, and moreover both of the concerned partners(the manager and industrial designer) had the opportunity to newly recognize the industrial design and evaluate the availability or problem of the industrial design in the actual aspect. This event means very important change. With the understanding on the above situation, the purpose of this study is to recognize whether the design is strategically applied in the management level of domestic small and medium enterprises, whether the strategical establishment of the design management is performed without any problem, whether the field designer and CEO are well recognizing the design management and what their recognition level is in order to seek the new solution for plenty of problems. Therefore, the actual proof analysis was performed for the field designer and management CEO of small and medium enterprises with the questionnaire survey and direct interview method to understand the actuality of small and medium enterprises.

• Journal of radiological science and technology
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• v.32 no.4
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• pp.453-460
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• 2009

The purpose of this study was to determine the dose distribution and image quality according to slice thickness and BC(beam collimation) in the gantry aperture. CT scans were performed with a 64-slice MDCT(Brilliance 64, Philips, Cleveland, USA) scanner. To determine the dose distribution according to BC, a ionization chamber was placed at isocenter and 5, 10, 15, 20, 25 and 30 cm positions from the isocenter in the 12, 3, 6 and 9 o'clock directions. The dose distribution for phantom scan was also measured using CT head and body dose phantom with five holes at the center of the phantom and the positions of the 12, 3, 6 and 9 o'clock directions. The image noise measurement for different BCs was performed using an AAPM CT phantom. Water-filled block of the phantom was moved by 5 cm or 10 cm to the 12 o'clock direction, and the image noise was measured at the center of the phantom, and the points of 12, 3, 6 and 9 o'clock direction respectively. Some points were placed beyond the scan field of view (SFOV), so that measurement was not possible at that points. The results are as follows: The CTDIw showed a larger decrease as the source goes farther from the iso-center or the BC became wider. The CTDIw depends on the BC width more than the number of the channel of a detector array. The value of CTDIW decreased with increasing BC, but the value decreased 16.6~31.9% in the head phantom scan in air scan and 51.0~64.5% in the body phantom scan. The value of the noise was 3.9~5.9 in the head and 5.3~7.4 in the body except for BC of $2{\times}0.5\;mm$, regardless of the degree of deviation from the iso-center. When a subject was located within the SFOV, the position did not significantly affect image quality even if the subject was out of the center.

• Radiation Oncology Journal
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• v.14 no.1
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• pp.77-85
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• 1996

Purpose : Multileaf collimator(MLC) is very suitable tool for conformal radio-therapy and commissioning measurements for a multileaf collimator installed on a dual energy accelerator with 6 and 10MV photons are required, For modeling the collimator with treament planning software, detailed dosimetric characterization of the multileaf collimator including the penumbra width, leaf transmission between leaf leakage and localization of the leaf ends and sides is an essential requirement. materials and Methods : Measurement of characteristic data of the MLC with 26 pair block leaves installed on CLINAC 2100C linear accelerator was performed. Low sensitive radiographic film(X-omatV) was used for the penumbra measurement and separate experiments using radiographic film and thermoluminescent dosimeters were performed to verify the dose distribution, Measured films were analized with a photodensitometer of WP700i scanner. Results : For 6 & 10 MV x-ray energies, approximately $2.0\%$ of photons incident on the multileaf collimator were transmitted and an additional $0.5\%$ leakage occurs between the leaves. Localizing the physical end of the leaves showed less than 1mm deviation from the $50\%$ decrement line and this difference is attributed to the curved shaped end on the leaves One side of a sin히e leaf corresponded to the $50\%$ decrement line, but the opposite face was aligned with a lower value. This difference is due to the tongue and groove used to decrease between leaf leakage. Alignment of the leaves to form a straight edge resulted larger penumbra at far position from isocenter as compare with divergent alloy blocks. When the MLC edge is stepped by sloping field, the isodose lines follow the leaf pattern and Produce scalloping isodose curves in tissue. The effective penumbra by 45 degree stepped MLC is about 10mm at 10cm depth for 6MV x-ray. The difference of effective penumbra in deep tissue between MLC and divergent alloy blocks is small (5mm). Conclusion : Using the characteristic data of MLC, the MLC has the clinlical acceptability and suitability for 3-D conformal radiotherapy except small field size.

• Proceedings of the Korean Radioactive Waste Society Conference
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• 2005.06a
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• pp.110-120
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• 2005

For utilizing vitrification to treat low and intermediate level waste, industrial pilot plant was designed and constructed in October 1999 at Daejon, Korea through the joint research program among NETEC, MOBIS and SGN. More than 70 tests were performed on simulated IER, DAW etc. including key nuclide surrogate(Cs, Co); this plant has been shown to vitrify the target waste effectively and safely, however, some dust are generated from the HTF(High Temperature Filter) as a secondary waste. In case of long term operation, it is also concerned that pipe plugging can be occurred due to deposited dust in cooling pipe namely, connecting pipe between CCM(Cold Crucible Melter) and HTF. In this regard, we have developed the special complementary system of the off-gas treatment system to recycle the dust from HTF to CCM and to remove the interior dust of cooling pipe. Main concept of the dust recycling is to feed the dust to the CCM as a slurry state; this system is regarded as of an important position in the viewpoint of volume reduction, waste disposal cost and glass melt control in CCM. The role of DRS(Dust Recycling System) is to recycle the major glass components and key nuclides; this system is served to lower glass viscosity and increase waste solubility by recycling B, Na, Li components into glass melt and also to re-entrain and incorporate into glass melt like Cs, Co. Therefore dust recycling is helpful to control the molten glass; it is unnecessary to consider a separate dust treatment system like a cementation equipment. The effects of Dust Cleaner are to prevent the pipe plugging due to dust and to treat the deposited dust by raking the dust into CCM. During the pilot vitrification test, overall performance assessment was successfully performed; DRS and Dust Cleaner are found to be useful and effective for recycling the dust from HTF and also removing the dust in cooling pipe. The obtained operational data and operational experiences will be used as a basis of the commercial facility.

• Progress in Medical Physics
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• v.14 no.2
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• pp.90-98
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• 2003

Purpose : A new virtual simulation technique for craniospinal irradiation (CSI) that uses a CT-simulator was developed to improve the accuracy of field and shielding placement as well as patient positioning. Materials and Methods : A CT simulator (CT-SIM) and a 3-D conformal radiation treatment planning system (3D-CRT) were used to develop CSI. The head and neck were immobilized with a thermoplastic mask while the rest of the body was immobilized with a Vac-Loc. A volumetric image was then obtained with the CT simulator. In order to improve the reproducibility of the setup, datum lines and points were marked on the head and body. Virtual fluoroscopy was performed with the removal of visual obstacles, such as the treatment table or immobilization devices. After virtual simulation, the treatment isocenters of each field were marked on the body and on the immobilization devices at the conventional simulation room. Each treatment fields was confirmed by comparing the fluoroscopy images with the digitally reconstructed radiography (DRR) and digitally composited radiography (DCR) images from virtual simulation. Port verification films from the first treatment were also compared with the DRR/DCR images for geometric verification. Results : We successfully performed virtual simulations on 11 CSI patients by CT-SIM. It took less than 20 minutes to affix the immobilization devices and to obtain the volumetric images of the entire body. In the absence of the patient, virtual simulation of all fields took 20 min. The DRRs were in agreement with simulation films to within 5 mm. This not only reducee inconveniences to the patients, but also eliminated position-shift variables attendant during the long conventional simulation process. In addition, by obtaining CT volumetric image, critical organs, such as the eyes and the spinal cord, were better defined, and the accuracy of the port designs and shielding was improved. Differences between the DRRs and the portal films were less than 3 m in the vertebral contour. Conclusion : Our analysis showed that CT simulation of craniospinal fields was accurate. In addition, CT simulation reduced the duration of the patient's immobility. During the planning process. This technique can improve accuracy in field placement and shielding by using three-dimensional CT-aided localization of critical and target structures. Overall, it has improved staff efficiency and resource utilization by standard protocol for craniospinal irradiation.