• Title/Summary/Keyword: Regional Image

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The Discriminating Nature of Dopamine Transporter Image in Parkinsonism: The Competency of Dopaminergic Transporter Imaging in Differential Diagnosis of Parkinsonism: $^{123}I-FP-CIT$ SPECT Study (도파민운반체 영상의 파킨슨증 감별진단 성능: $^{123}I-FP-CIT$ SPECT 연구)

  • Kim, Bom-Sahn;Jang, Sung-June;Eo, Jae-Seon;Park, Eun-Kyung;Kim, Yu-Kyeong;Kim, Jong-Min;Lee, Won-Woo;Kim, Sang-Eun
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.4
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    • pp.272-279
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    • 2007
  • Purpose: The aim of this study was to evaluate the discriminating nature of $^{123}I-FP-CIT$ SPECT in patients with parkinsonism. Methods: $^{123}I-FP-CIT$ SPECT images acquired from the 18 normal controls; NC ($60.4{\pm}10.0$ yr) and 237 patients with parkinsonism ($65.9{\pm}9.2$ yr) were analyzed. From spatialIy normalized images, regional counts of the caudate, putamen, and occipital lobe were obtained using region of interest method. Binding potential (BP) was calculated with the ratio of specific to nonspecific binding activity at equilibrium. Additionally, the BP ratio of putamen to caudate (PCR) and asymmetric Index (ASI) were measured. Results: BPs of NC $3.37{\pm}0.57,\; 3.10{\pm}0.41,\; 3.23{\pm}0.48$ for caudate, putamen, whole striatum, respectively) had no significant difference with those of essential tremor; ET ($3.31{\pm}0.64,\; 3.06{\pm}0.61,\; 3.14{\pm}0.63$) and Alzheimer's disease; AD (3.33 $\pm$0.60, 3.29$\pm$0.79, 3.31$\pm$0.70), but were higher than those of Parkinson's disease; PD (1.92$\pm$0.74, 1.39$\pm$0.68, 1.64$\pm$0.68), multiple system atrophy; MSA (2.36$\pm$1.07, 2.16$\pm$0.91, 2.26$\pm$0.96), and dementia with Lewy body; DLB (1.95$\pm$0.72, 1.64$\pm$0.65, 1.79$\pm$0.66)(p<0.005). PD had statisticalIy lower values of PER and higher values of ASI than those of NC (p<0.005). And PD had significantIy lower value of PCR, higher ASI and lower BP in the putamen and whole striatum than MSA (p<0.05). Conclusion: Dopamine transporter image of $^{123}I-FP-CIT$ SPECT was a good value in differential diagnosis of parkinsonism.

National brand development research strategy using traditional Korean patterns (한국 전통 문양을 활용한 국가 브랜드 연구 개발 전략 - 금문(錦紋)을 중심으로 -)

  • KIM, Mihye
    • Korean Journal of Heritage: History & Science
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    • v.54 no.4
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    • pp.232-245
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    • 2021
  • The present study is about a brand development strategy that utilizes Korean traditional patterns. The global culturenomics phenomenon confirms the value of the cultural aspects of design when a national brand is established. People succeed with their unique aesthetic sense and reinterpret it in a modern view, and this design acts as today's national brands. In this way, people used traditional patterns and original designs, along with regional characteristics and formative style, in developing their designs. However, due to recent changes in the global environment, modern people live in an "untact" world, and consumption culture shifted toward online marketing. In this environment, where one is isolated from social activities, there needs to be a strong image that can dramatically change the mood of one's home. I would like to re-examine the Dan-Chung pattern, whose painting depends on the aesthetic characteristics of architecture to protect the wooden members of the framework in traditional architecture. The pattern and color of Dan-Chung, coated in traditional architecture, differs by the type of construction used, which includes a palace, a Buddhist temple, and a Confucianism Dan Chung. The Geummoon pattern contains aesthetic factors to add solemnity to the Main Buddhist Halls, which contain Buddha. This is a new medium that continues the current traditions instead of remaining in the past. Among different Dan Chung patterns, Geummoon has magnificent decoration consisting of the highest grade materials and unique composition; therefore, it is suitable to be reinterpreted in modern terms. The same pattern can be interpreted in different ways with different colors, so there is a great aesthetic impression in the Geummoon pattern. The value of preservation for exploration and theoretical study of the traditional pattern is important, but recreating the pattern into modern formative art can present a new angle of view and national brand, bearing pride in our cultural assets. The study used multidimensional molding methods for realistic presentation after going through the two-dimensional design process. The significant value of Korean molding beauty which hangs onto the past will play a crucial role in establishing our national brand.

Effects of Motion Correction for Dynamic $[^{11}C]Raclopride$ Brain PET Data on the Evaluation of Endogenous Dopamine Release in Striatum (동적 $[^{11}C]Raclopride$ 뇌 PET의 움직임 보정이 선조체 내인성 도파민 유리 정량화에 미치는 영향)

  • Lee, Jae-Sung;Kim, Yu-Kyeong;Cho, Sang-Soo;Choe, Yearn-Seong;Kang, Eun-Joo;Lee, Dong-Soo;Chung, June-Key;Lee, Myung-Chul;Kim, Sang-Eun
    • The Korean Journal of Nuclear Medicine
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    • v.39 no.6
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    • pp.413-420
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    • 2005
  • Purpose: Neuroreceptor PET studies require 60-120 minutes to complete and head motion of the subject during the PET scan increases the uncertainty in measured activity. In this study, we investigated the effects of the data-driven head mutton correction on the evaluation of endogenous dopamine release (DAR) in the striatum during the motor task which might have caused significant head motion artifact. Materials and Methods: $[^{11}C]raclopride$ PET scans on 4 normal volunteers acquired with bolus plus constant infusion protocol were retrospectively analyzed. Following the 50 min resting period, the participants played a video game with a monetary reward for 40 min. Dynamic frames acquired during the equilibrium condition (pre-task: 30-50 min, task: 70-90 min, post-task: 110-120 min) were realigned to the first frame in pre-task condition. Intra-condition registrations between the frames were performed, and average image for each condition was created and registered to the pre-task image (inter-condition registration). Pre-task PET image was then co-registered to own MRI of each participant and transformation parameters were reapplied to the others. Volumes of interest (VOI) for dorsal putamen (PU) and caudate (CA), ventral striatum (VS), and cerebellum were defined on the MRI. Binding potential (BP) was measured and DAR was calculated as the percent change of BP during and after the task. SPM analyses on the BP parametric images were also performed to explore the regional difference in the effects of head motion on BP and DAR estimation. Results: Changes in position and orientation of the striatum during the PET scans were observed before the head motion correction. BP values at pre-task condition were not changed significantly after the intra-condition registration. However, the BP values during and after the task and DAR were significantly changed after the correction. SPM analysis also showed that the extent and significance of the BP differences were significantly changed by the head motion correction and such changes were prominent in periphery of the striatum. Conclusion: The results suggest that misalignment of MRI-based VOI and the striatum in PET images and incorrect DAR estimation due to the head motion during the PET activation study were significant, but could be remedied by the data-driven head motion correction.

A Refined Method for Quantification of Myocardial Blood Flow using N-13 Ammonia and Dynamic PET (N-13 암모니아와 양전자방출단층촬영 동적영상을 이용하여 심근혈류량을 정량화하는 새로운 방법 개발에 관한 연구)

  • Kim, Joon-Young;Lee, Kyung-Han;Kim, Sang-Eun;Choe, Yearn-Seong;Ju, Hee-Kyung;Kim, Yong-Jin;Kim, Byung-Tae;Choi, Yong
    • The Korean Journal of Nuclear Medicine
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    • v.31 no.1
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    • pp.73-82
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    • 1997
  • Regional myocardial blood flow (rMBF) can be noninvasively quantified using N-13 ammonia and dynamic positron emission tomography (PET). The quantitative accuracy of the rMBF values, however, is affected by the distortion of myocardial PET images caused by finite PET image resolution and cardiac motion. Although different methods have been developed to correct the distortion typically classified as partial volume effect and spillover, the methods are too complex to employ in a routine clinical environment. We have developed a refined method incorporating a geometric model of the volume representation of a region-of-interest (ROI) into the two-compartment N-13 ammonia model. In the refined model, partial volume effect and spillover are conveniently corrected by an additional parameter in the mathematical model. To examine the accuracy of this approach, studies were performed in 9 coronary artery disease patients. Dynamic transaxial images (16 frames) were acquired with a GE $Advance^{TM}$ PET scanner simultaneous with intravenous injection of 20 mCi N-13 ammonia. rMBF was examined at rest and during pharmacologically (dipyridamole) induced coronary hyperemia. Three sectorial myocardium (septum, anterior wall and lateral wall) and blood pool time-activity curves were generated using dynamic images from manually drawn ROIs. The accuracy of rMBF values estimated by the refined method was examined by comparing to the values estimated using the conventional two-compartment model without partial volume effect correction rMBF values obtained by the refined method linearly correlated with rMBF values obtained by the conventional method (108 myocardial segments, correlation coefficient (r)=0.88). Additionally, underestimated rMBF values by the conventional method due to partial volume effect were corrected by theoretically predicted amount in the refined method (slope(m)=1.57). Spillover fraction estimated by the two methods agreed well (r=1.00, m=0.98). In conclusion, accurate rMBF values can be efficiently quantified by the refined method incorporating myocardium geometric information into the two-compartment model using N-13 ammonia and PET.

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The Establishment of Seongjusa Temple and the Production of Iron Buddhas (성주사 창건과 철불 조성 연구)

  • Kang Kunwoo
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.104
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    • pp.10-39
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    • 2023
  • Seongjusa Temple was founded in Boryeong in Chungcheongnam-do Province by Monk Muyeom (800-888), better known as Nanghye Hwasang. After returning from studying in China, Muyeom stayed in the Silla capital city of Gyeongju for a period. He later settled in a temple that was managed by the descendants of Kim In-mun (629-694). He then restored a burned-out temple and opened it in 847 as a Seon (Zen) temple named Seongjusa. It prospered and grew to become a large-scale temple with several halls within its domains. The influence of Seongjusa in the region can be seen in the Historical Record of Seongjusa Temple on Sungamsan Mountain, which relates that there were seventy-three rooms within the domains of the temple. What is most notable in the record is that the temple is referred to as "栴檀林九間," which means either "a structure with nine rooms built with Chinese juniper wood" or "a place that houses Chinese juniper wood and has nine rooms." Regardless of the interpretation, Seongjusa Temple had a large amount of juniper wood. Around this time, the term "juniper" referred to the olibanum tree (Boswellia sacra) native to the islands of Java and Sumatra in Southeast Asia. It is presumed that at some point after the death of Jang Bogo, the maritime forces that controlled the southwestern coast of Korea may have acquired a large amount of Southeast Asian olibanum wood and offered it to Seongjusa Temple. During the reign of King Munseong, Kim Yang (808-857) patronized Seongjusa Temple and its head monk Muyeom, who enjoyed a lofty reputation in the region. He sought to strengthen his own position as a member of the royal lineage of King Muyeol and create a bridge between the royal family and Seongjusan Buddhist sect. The court of King Wonseong designated Seongjusa Temple as a regional base for the support of royal authority in an area where anti-royal sentiment remained strong. Monk Muyeom is believed to have created an iron Buddha to protect the temple, enlighten the people, and promote regional stability. Given that the Seongjusa community had expanded to include more than 2,000 followers, the iron Buddha at Seongjusa Temple would have been perceived as an image that rallied the local residents. It is assumed that there were two iron Buddhas at Seongjusa Temple. The surviving parts of these Buddhas and the size of their pedestals suggest that they were respectively enshrined in the Geumdang Main Hall and the Samcheonbuljeon Hall of Three Thousand Buddhas. It is presumed that the first iron Buddha in Geumdang was a large statue over two meters in height and the second one was medium-sized with the height over one meter. The Historical Record of Seongjusa Temple on Sungamsan Mountain contains the phrase "改創選法堂五層重閣" which indicates that a multistoried Geumdang was newly built to enshrine a large Buddha sculpture like the first iron Buddha when Seongjusa Temple was founded. Also, according to the Stele of Seongjusa Temple and the surviving finger fragments, the first Buddha was making the fear-not and wish-granting (abhayavarada) mudras. The main Buddha of Seongjusa Temple is possibly Nosana Buddha, just like the main Buddhas at the contemporaneous temples Silsangsa, Borimsa, and Samhwasa. Given that Monk Muyeom studied Hwaeom teachings in his early years and received royal patronage upon his return, it is believed that the retro tendencies of the Hwaeom school, centered on the royal family of the Silla Dynasty, were reflected in Seongjusa temple.

The Serial Change of Cerebral Hemodynamics by Vascular Territory after Extracranial-Intracranial Bypass Surgery in Patients with Atherosclerosis of Cerebral Arteries (죽상 동맥 경화성 뇌혈관 폐색 환자에서의 두개외강-내강 우회로술 후의 혈관 영역별 연속 혈류역학 변화)

  • Hong, Il-Ki;Kim, Jae-Seung;Ahn, Jae-Sung;Kwon, Sun-Uck;Im, Ki-Chun;Lee, Jai-Hyuen;Moon, Dae-Hyuk
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.1
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    • pp.8-16
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    • 2008
  • Purpose: To assess the effect of extracranial-intracranial (EC-IC) bypass surgery on hemodynamic improvement, we evaluated serial regional cerebral hemodynamic change of the middle cerebral artery (MCA) in symptomatic patients with atherosclerotic occlusion of the internal carotid artery (ICA) or MCA using $^{99m}Tc$-ECD acetazolamide stress brain perfusion SPECT (Acetazolamide SPECT). Materials and Methods: The patients who had suffered a recent stroke with atherosclerotic ICA or MCA occlusion underwent EC-IC bypass surgery and Acetazolamide SPECT at 1 week before and three to six months after surgery. For image analysis, attenuation corrected images were spatially normalized to SPECT templates with SPM2. Anatomical automated labeling was applied to calculate mean counts of each Volume-Of-Interest (VOI). Seven VOIs of bilateral frontal, parietal, temporal regions of the MCA territory and the ipsilateral cerebellum were defined. Using mean counts of 7 VOIs, cerebral perfusion index and perfusion reserve index were calculated. Results: Seventeen patients (M:F =12:5, mean age $53{\pm}2yr$) were finally included in the analysis. The cerebral blood flow of the parietal region increased at 1 week (p = 0.003) and decreased to the preoperative level at 3-6 months (p = 0.003). The cerebrovascular reserve of the frontal and parietal regions increased significantly at 1 week after surgery (p<0.01) and improved further at 3-6 months. Conclusion: Cerebrovascular reserve of the MCA territory was significantly improved at early postoperative period after EC-IC bypass and kept improved state during long-term follow-up, although cerebral blood flow did not significantly improved. Therefore, cerebrovascular reserve may be a good indicator of postoperative hemodynamic improvement resulted from bypass effect.

Overview of Research Trends in Estimation of Forest Carbon Stocks Based on Remote Sensing and GIS (원격탐사와 GIS 기반의 산림탄소저장량 추정에 관한 주요국 연구동향 개관)

  • Kim, Kyoung-Min;Lee, Jung-Bin;Kim, Eun-Sook;Park, Hyun-Ju;Roh, Young-Hee;Lee, Seung-Ho;Park, Key-Ho;Shin, Hyu-Seok
    • Journal of the Korean Association of Geographic Information Studies
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    • v.14 no.3
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    • pp.236-256
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    • 2011
  • Forest carbon stocks change due to land use change is an important data required by UNFCCC(United Nations framework convention on climate change). Spatially explicit estimation of forest carbon stocks based on IPCC GPG(intergovernmental panel on climate change good practice guidance) tier 3 gives high reliability. But a current estimation which was aggregated from NFI data doesn't have detail forest carbon stocks by polygon or cell. In order to improve an estimation remote sensing and GIS have been used especially in Europe and North America. We divided research trends in main countries into 4 categories such as remote sensing, GIS, geostatistics and environmental modeling considering spatial heterogeneity. The easiest way to apply is combination NFI data with forest type map based on GIS. Considering especially complicated forest structure of Korea, geostatistics is useful to estimate local variation of forest carbon. In addition, fine scale image is good for verification of forest carbon stocks and determination of CDM site. Related domestic researches are still on initial status and forest carbon stocks are mainly estimated using k-nearest neighbor(k-NN). In order to select suitable method for forest in Korea, an applicability of diverse spatial data and algorithm must be considered. Also the comparison between methods is required.

Imaging Neuroreceptors in the Living Human Brain

  • Wagner Jr Henry N.;Dannals Robert F.;Frost J. James;Wong Dean F.;Ravert Hayden T.;Wilson Alan A.;Links Jonathan M.;Burns H. Donald;Kuhar Michael J.;Snyder Solomon H.
    • The Korean Journal of Nuclear Medicine
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    • v.18 no.2
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    • pp.17-23
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    • 1984
  • For nearly a century it has been known that chemical activity accompanies mental activity, but only recently has it been possible to begin to examine its exact nature. Positron-emitting radioactive tracers have made it possible to study the chemistry of the human mind in health and disease, using chiefly cyclotron-produced radionuclides, carbon-11, fluorine-18 and oxygen-15. It is now well established that measurable increases in regional cerebral blood flow, glucose and oxygen metabolism accompany the mental functions of perception, cognition, emotion and motion. On May 25, 1983 the first imaging of a neuroreceptor in the human brain was accomplished with carbon-11 methyl spiperone, a ligand that binds preferentially to dopamine-2 receptors, 80% of which are located in the caudate nucleus and putamen. Quantitative imaging of serotonin-2, opiate, benzodiazapine and muscarinic cholinergic receptors has subsequently been accomplished. In studies of normal men and women, it has been found that dopamine and serotonin receptor activity decreases dramatically with age, such a decrease being more pronounced in men than in women and greater in the case of dopamine receptors than serotonin-2 receptors. Preliminary studies in patients with neuropsychiatric disorders suggests that dopamine-2 receptor activity is diminished in the caudate nucleus of patients with Huntington's disease. Positron tomography permits quantitative assay of picomolar quantities of neuro-receptors within the living human brain. Studies of patients with Parkinson's disease, Alzheimer's disease, depression, anxiety, schizophrenia, acute and chronic pain states and drug addiction are now in progress. The growth of any scientific field is based on a paradigm or set of ideas that the community of scientists accepts. The unifying principle of nuclear medicine is the tracer principle applied to the study of human disease. Nineteen hundred and sixty-three was a landmark year in which technetium-99m and the Anger camera combined to move the field from its latent stage into a second stage characterized by exponential growth within the framework of the paradigm. The third stage, characterized by gradually declining growth, began in 1973. Faced with competing advances, such as computed tomography and ultrasonography, proponents and participants in the field of nuclear medicine began to search for greener pastures or to pursue narrow sub-specialties. Research became characterized by refinements of existing techniques. In 1983 nuclear medicine experienced what could be a profound change. A new paradigm was born when it was demonstrated that, despite their extremely low chemical concentrations, in the picomolar range, it was possible to image and quantify the distribution of receptors in the human body. Thus, nuclear medicine was able to move beyond physiology into biochemistry and pharmacology. Fundamental to the science of pharmacology is the concept that many drugs and endogenous substances, such as neurotransmitters, react with specific macromolecules that mediate their pharmacologic actions. Such receptors are usually identified in the study of excised tissues, cells or cell membranes, or in autoradiographic studies in animals. The first imaging and quantification of a neuroreceptor in a living human being was performed on May 25, 1983 and reported in the September 23, 1983 issue of SCIENCE. The study involved the development and use of carbon-11 N-methyl spiperone (NMSP), a drug with a high affinity for dopamine receptors. Since then, studies of dopamine and serotonin receptors have been carried out in over 100 normal persons or patients with various neuropsychiatric disorders. Exactly one year later, the first imaging of opitate receptors in a living human being was performed [1].

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Is Skeletonized Internal Mammary Artery Harvesting better than Pedicled Harvesting in Respect of the Sternal Blood Flow\ulcorner: An Estimation Using Bone Scan (내유동맥의 골격화 채취는 흉골로의 혈류 감소 측면에서 과연 유리한가 \ulcorner: 골주사를 이용한 평가)

  • 손국희;김영삼;김정택;윤용한;김광호;최원식;백완기
    • Journal of Chest Surgery
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    • v.37 no.6
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    • pp.511-516
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    • 2004
  • Background: One of the theoretical advantages of skeletonized internal mammary artery harvesting in coronary artery bypass surgery is to minimize the interruption of the sternal blood flow inevitably accompanied by internal mammary harvesting. A study using bone scan is designed to determine the effects of internal mammary artery harvesting technique on the sternal blood flow. Material and Method: From April 2002 to March 2003, 27 patients out of 48 patients who underwent the isolated coronary bypass surgery were enrolled into the study. The enrolled patients underwent bone scan in the preoperative period and postoperative period respectively. Bilateral internal mammary artery was used in 8 patients (BIMA group) and single left internal mammary artery in 19 patients (LIMA group). The patients in LIMA group were divided into two groups: LlMA_skel group, in whom left internal mammary artery was harvested in skeletonized fashion (n=12), and LlMA_ped group, in whom left internal mammary artery was harvested in pedicled fashion (n=7). After the bone scan, the region of interest (ROI) was created on the left of the sternum and the mirror image with the same pixel numbers was placed on the right half of the sternum. The mean counts per pixel on the left side of the sternum was compared with those on the right side and expressed as left to right ratio (L/R ratio). Result: In LIMA group, the L/R ratio decreased from 94.6$\pm$4.1% to 87.9$\pm$6.9% (p=0.003) after the operation as compared to BIMA group, in which no change of the L/R ratio was observed. The changed of the L/R ratio in LlMA_skel group and LlMA_ped group were from 95.3$\pm$4.2% to 88.3$\pm$7.7% and from 93.4$\pm$3.9% to 87.4$\pm$5.8% respectively. The % changes in L/R ratio were -7.44 $\pm$7.08 in LIMA_skel group and -6.17$\pm$9.08 in LiMA_ped group, which did not reach the statistical difference. Conclusion: Ipsilateral sternal blood flow is interrupted by internal mammary artery harvesting as evidenced by the decrease in L/R ratio after left internal mammary artery harvesting irrespective of the harvesting techniques. Skeletonized harvesting did not show superiority in respect to sternal blood flow as compared to pedicled harvesting.

A Study on the Necessary Number of Bolus Treatments in Radiotherapy after Modified Radical Mastectomy (변형 근치적 유방절제술 후 방사선치료에서 볼루스 적용횟수에 대한 고찰)

  • Hong, Chae-Seon;Kim, Jong-Sik;Kim, Young-Kon;Park, Young-Hwan
    • The Journal of Korean Society for Radiation Therapy
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    • v.18 no.2
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    • pp.113-117
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    • 2006
  • Purpose: Post-mastectomy radiotherapy (PMR) is known to decrease loco-regional recurrence. Adequate skin and dermal dose are achieved by adding bolus. The more difficult clinical issue is determining the necessary number of bolus treatment, given the limits of normal skin tolerance. The aim of this study is to evaluate the necessary number of bolus treatment after PMR in patients with breast cancer. Materials and Methods: Four female breast cancer patients were included in the study. The median age was 53 years(range, $38{\sim}74$), tumor were left sided in 2 patients and right sided in 2patients. All patients were treated with postoperative radiotherapy after MRM. Radiotherapy was delivered to the chest wall (C.W) and supraclavicular lymph nodes (SCL) using 4 MV X-ray. The total dose was 50 Gy, in 2 Gy fractions (with 5 times a week). CT was peformed for treatment planning, treatment planning was peformed using $ADAC-Pinnacles^3$ (Phillips, USA) for all patients without and with bolus. Bolus treatment plans were generated using image tool (0.5 cm of thickness and 6 cm of width). Dose distribution was analyzed and the increased skin dose rate in the build-up region was computed and the skin dose using TLD-100 chips (Harshaw, USA) was measured. Results: No significant difference was found in dose distribution without and with bolus; C.W coverage was $95{\sim}100%$ of the prescribed dose in both. But, there was remarkable difference in the skin dose to the scar. The skin dose to the scar without and with bolus were $100{\sim}105%\;and\;50{\sim}75%$. The increased skin dose rates in the build-up region for Pt. 1, Pt. 2. Pt. 3 and Pt. 4 were 23.3%, 35.6%, 34.9%, and 41.7%. The results of measured skin dose using TLD-100 chips in the cases without and with bolus were 209.3 cGy and 161.1 cGy, 200 cGy and 150.2 cGy, 211.4 cGy and 160.5 cGy, 198.6 cGy and 155.5 cGy for Pt. 1, Pt. 2, Pt. 3, and Pt. 4. Conclusion: It was concludes through this analysis that the adequate number of bolus treatments is 50-60% of the treatment program. Further, clinical trial is needed to evaluate the benefit and toxicity associated with the use of bolus in PMR.

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