• Korea Journal of Hospital Management
• /
• v.2 no.1
• /
• pp.1-21
• /
• 1997

In order to analyze the shifts in the volume and profits of Computed Tomography(CT) and Magnetic Resonance Imaging(MRI) utilization for a year before and after the implementation of insurance coverage for CT, this study has been undertaken examining CT and MRI cost data from 'Y' University Hospital situated in Seoul, Korea. Following are the results of this study: 1. The medical insurance payment for CT, implemented on January 1, 1996, increased CT utilization from January 1996 to April 1996 due to low insurance premiums: however, from May 1996 the number of CT cases significantly decreased as a result of strengthened medical cost reviews and the new 'Detailed standards for approval of CT' announced near the end of April 1996 by the insurer. 2. Since the implementation of insurance coverage for CT, CT fee reduction rates for reimbursements by the insurer to the hospital were 50% and 40% for January and February, respectively, and 31% and 15% for March and April. A significant point in the lowering of the reduction rate was reached in May at 11%; furthermore, since June the reduction rate fell below the average reduction rate for reimbursements for all procedures. If the 'Detailed standards for approval of CT' had been announced before the implementation of insurance coverage for CT, CT utilization would not have been so high due to the need to meet those 'standards'. In addition, loss of hospital profits resulting from the reduction for reimbursements would not have occurred. 3. The shifts in MRI utilization showed that there was no particular change with the beginning of insurance coverage for CT, and the introduction of the 'Detailed standards for approval of CT' made MRI utilization increase because MRI is free of restrictions imposed by the insurer. 4. The relationship between CT utilization and MRI utilization showed that they were supplementary to each other before insurance coverage for CT, but that CT was substituted for MRI because of strengthened medical cost reviews after t~e beginning of insurance coverage for CT. 5. The shifts in volume by patient characteristics showed that the number of inappropriate case patients, according to the insurer's "Standards for approval", decreased more than the number of appropriate case patients after the introduction of insurance coverage for CT. Therefore, the health insurance fee schemes for CT have influenced patient care. 6. The shifts in profits from CT utilization showed a net profit decrease of 31.6%. In order to match the pre-coverage profit level, 5,471 more cases would need to be seen and productivity would need to be increased by 32.7%. This profit decrease resulted from a decrease of CT utilization and low reimbursements. With insurance coverage, net profits from CT were 24.4%, and a margin of safety ratio was 39.6%. Because of the net profits and margin of safety ratio, CT utilization fees for insured appropriate cases could not be considered inappropriate. 7. The shifts in profits from MRI utilization before and after the introduction of CT coverage showed that in order to match pre-CT coverage profit levels, 2,011 more cases would need to be seen and productivity would need to be increased by 9.2%. The reasons for needing to increase the number of cases and productivity result from cost burdens created by adding new MRI units. But with CT coverage already begun, MRI utilization increased. Combined with a minor increase in the MRI fee schedule, MRI utilization showed a net profit increase of 18.5%. Net profits of 62.8% and a 'margin of safety ratio' of 43.1% for MRI utilization showed that the hospital relied on this non-covered procedure for profits. 8. The shifts in profits from CT and MRI utilization showed the net profits from CT decreased by 2.33billion Won while the net profits from MRI increased by 815.7million Won. Overall, these two together showed a net profit decrease of 1.51billion Won. The shifts in utilization showed a functional substitutionary relationship, but the shifts in profits did not show a substitutionary relationship. From these results, We can conclude that if insurance is to be expanded to include previously uncovered procedures using expensive medical equipment, detailed standards should be prepared in advance. The decrease in profits from the shifts in coverage and changes in fees is a difficult burden that should be shared, not carried by the hospital alone. Also, a new or improved fee schedule system should include revised standards between items listed and the appropriateness of the fee schedule should constantly be ensured. This study focused on one university hospital in Seoul and is therefore limited in general applicability. But it is valuable for considering current issues and problems, such as the influence of CT coverage on hospital management. Future studies will hopefully expand the scope of the issues considered here.

• Progress in Medical Physics
• /
• v.21 no.4
• /
• pp.323-331
• /
• 2010

The Hi-Art system for TomoTherapy allows only three (1.0 cm, 2.5 cm, 5.0 cm) field widths and this can produce different dose distribution around the end of PTV (Planning target volume) in the direction of jaw movement. In this study, we investigated the effect of field width on the dose difference around the PTV using DQA (Delivery quality assurance) phantom and real clinical patient cases. In the analysis with DQA phantom, the calculated dose and irradiated films showed that the more dose was widely spreaded out in the end region of PTV as increase of field width. The 2.5 cm field width showed a 1.6 cm wider dose profile and the 5.0 cm field width showed a 4.2 cm wider dose profile compared with the 1.0 cm field width in the region of 50% of maximum dose. The analysis with four patient cases also showed the similar results with the DQA phantom which means that more dose was irradiated around the superior and inferior end of PTV as an increase of field width. The 5.0 cm field width produced the remarkable high dose distribution around the end region of PTV and we could evaluate the effect quantitatively with the calculation of DVH (Dose volume histogram) of the virtual PTVs which were delineated around the end of PTV in the direction of jaw variation. From these results, we could verify that the margin for PTV in the direction of table movement should be reduced compared with the conventional margin for PTV when the large field such as 5.0 cm was used in TomoTherapy.

• Radiation Oncology Journal
• /
• v.23 no.4
• /
• pp.236-242
• /
• 2005

Purpose: To evaluate the role of surgical clips and scars in determining electron boost field for early stage breast cancer undergoing conserving surgery and postoperative radiotherapy and to provide an optimal method in drawing the boost field. Materials and Methods: Twenty patients who had $4{\sim}7$ surgical clips in the excision cavity were selected for this study. The depth informations were obtained to determine electron energy by measuring the distance from the skin to chest wall (SCD) and to the clip implanted in the most posterior area of tumor bed. Three different electron fields were outlined on a simulation film. The radiological tumor bed was determined by connecting all the clips implanted during surgery Clinical field (CF) was drawn by adding 3 cm margin around surgical scar. Surgical field (SF) was drawn by adding 2 cm margin around surgical clips and an Ideal field (IF) was outlined by adding 2 cm margin around both scar and clips. These fields were digitized into our planning system to measure the area of each separate field. The areas of the three different electron boost fields were compared. Finally, surgical clips were contoured on axial CT images and dose volume histogram was plotted to investigate 3-dimensional coverage of the clips. Results : The average depth difference between SCD and the maximal clip location was $0.7{\pm}0.55cm$. Greater difference of 5 mm or more was seen in 12 patients. The average shift between the borders of scar and clips were 1.7 1.2, 1.2, and 0.9 cm in superior, inferior, medial, and lateral directions, respectively. The area of the CF was larger than SF and IF in 6y20 patients. In 15/20 patients, the area difference between SF and if was less than 5%. One to three clips were seen outside the CF in 15/20 patients. In addition, dosimetrically inadequate coverage of clips (less than 80% of prescribed dose) were observed in 17/20 patients when CF was used as the boost field. Conclusion: The electron field determined from clinical scar underestimates the tumor bed in superior-inferior direction significantly and thereby underdosing the tissue at risk. The electron field obtained from surgical clips alone dose not cover the entire scar properly As a consequence, our technique, which combines the surgical clips and clinical scars in determining electron boost field, was proved to be effective in minimizing the geographical miss as well as normal tissue complications.

• Journal of Korean Society of Transportation
• /
• v.22 no.6
• /
• pp.17-33
• /
• 2004

Korea's economic development plans instituted in the 1970's, affected by the growth centered policy and rapid industrialization, have prevailed without having aviation safety management system, along with the safety of the other various means of transportation, settled in its place, and subsequently, the aviation accidents occurred until the beginning of year 2000 have incurred an enormous social expense, not to say of a massive loss of human lives. Especially, with regard to the causal factors of accidents, most of recent accidents have been associated with human factor of airmen, thus, only if this can be detected in advance and prevented, the aircraft accident rate will be reduced by a large margin. Therefore, in order to develope improvement methods on the safety system of civil aviation, in this study, safety management system has been divided into three stages: an advance preventive system, a handling system at an accident's occurrence and a post accident handling system, and thereby improvement methods on aviation safety have been suggested for each stage. The threatening factors agatinst aviation safety have been found to be the absence of management standards and regulations, the indifference to or the lack of the law abiding apirit as major factors, and in order to improve on which, it is required that the settlement of the institutional safety management system should precede, and that the Government and the aviation industry should also make a continuous effort to identify the threatening factors against aviation safety, and to provide incentives for the law abiding spirit and the attitude of giving top priority to safety to spread among all the employees.

• Journal of Gastric Cancer
• /
• v.24 no.2
• /
• pp.172-184
• /
• 2024

Purpose: The original eCura system was designed to stratify the risk of lymph node metastasis (LNM) after endoscopic resection (ER) in patients with early gastric cancer (EGC). We assessed the effectiveness of a modified eCura system for reflecting the characteristics of undifferentiated-type (UD)-EGC. Materials and Methods: Six hundred thirty-four patients who underwent non-curative ER for UD-EGC and received either additional surgery (radical surgery group; n=270) or no further treatment (no additional treatment group; n=364) from 18 institutions between 2005 and 2015 were retrospectively included in this study. The eCuraU system assigned 1 point each for tumors >20 mm in size, ulceration, positive vertical margin, and submucosal invasion <500 ㎛; 2 points for submucosal invasion ≥500 ㎛; and 3 points for lymphovascular invasion. Results: LNM rates in the radical surgery group were 1.1%, 5.4%, and 13.3% for the low-(0-1 point), intermediate- (2-3 points), and high-risk (4-8 points), respectively (P-fortrend<0.001). The eCuraU system showed a significantly higher probability of identifying patients with LNM as high-risk than the eCura system (66.7% vs. 22.2%; McNemar P<0.001). In the no additional treatment group, overall survival (93.4%, 87.2%, and 67.6% at 5 years) and cancer-specific survival (99.6%, 98.9%, and 92.9% at 5 years) differed significantly among the low-, intermediate-, and high-risk categories, respectively (both P<0.001). In the high-risk category, surgery outperformed no treatment in terms of overall mortality (hazard ratio, 3.26; P=0.015). Conclusions: The eCuraU system stratified the risk of LNM in patients with UD-EGC after ER. It is strongly recommended that high-risk patients undergo additional surgery.

• The Journal of Korean Society for Radiation Therapy
• /
• v.28 no.1
• /
• pp.65-75
• /
• 2016

Purpose : By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Materials and Methods : Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. Results : The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. Conclusion : As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

• The Journal of the Petrological Society of Korea
• /
• v.19 no.3
• /
• pp.167-180
• /
• 2010

The geochemical studies on the plutonic rocks of the Geochang, the central part of the Ryongnam massif, were carried out in order to constrain the petrogenesis and the paleotectonic environment. The objects of this study are dioritic rocks, biotite granite and hornblende granite. The modal compositions indicate that the dioritic rocks are quartz diorite, quartz monzodiorite, tonalite, biotite granites are granodiorite, granite and hornblende granites are granite, quartz monzonite, quartz syenite. These rocks belong to the calc-alkaline series. Especially, trace elements such as Sr, Nb, Sr, Ti are depleted, suggesting that these rocks are produced in the subduction zone related to calc-alkaline series. Also, the studied granitic rocks correspond to peraluminous and I-type. Chondrite-normalized REE patterns show that LREE are enriched much more than HREE, and have weak Eu(-) anomaly. It is similar to pattern of Jurassic granitoids in the South Korea. Total REE value of the biotite granite and hornblende granite ranges 76.21~137.05 ppm and 73.84~483.21 ppm, respectively, also $(La/Lu)_{CN}$ value ranges 9.61~36.47 and 7.17~21.85. It is suggest that studied rocks suppor their emplacement at active continental margin. Also, these rocks are derived from magma generated by partial melting of lower continental crust materials.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.21 no.11
• /
• pp.870-877
• /
• 2020

A suction bucket foundation, especially useful at depths of more than 20m, is a method of construction. The method first places an empty upturned bucket at the target site. Then, the bucket is installed by sucking water or air into it to create negative pressure. For stability, it is crucial to secure the verticality of the bucket. However, inclination by the bucket may occur due to sea-bottom conditions. In general, a repeated intrusion-pulling method is used for securing verticality. However, it takes a long time to complete the job. In this paper, we propose a real-time suction bucket verticality monitoring system. Specifically, the system consists of a sensor unit that collects raw verticality data, a controller that processes the data and wirelessly transmits the information, and a display unit that shows verticality information of a circular steel pipe. The system is implemented using an inclination sensor and an embedded controller. Experimental results show that the proposed system can efficiently measure roll/pitch information with a 0.028% margin of error. Furthermore, we show that the system properly operates in a suction bucket-based model experiment.

• Journal of the Korean Society of Costume
• /
• v.19
• /
• pp.105-125
• /
• 1992

The research, aiming an automatic pattern design of Korean Costume by utilizing CAD system, tried Grading, Seaming and Marking with a theme of girl's color-strip blouse & skirt. The content & conclusion of the research can be outlined as follows; 1) As we reviewed the current situation of Korean costume which becomes more likely celebrational or festival costume, while the demand of it is getting increase, it's being dealt mostly as ready-made dresses with different qualities & designs. Especially childrens ready-made ones were highly demanded to be picked up as the theme. 2) For the original drawing of children's color-strip blouse & skirt, Kyung-Ja Park's drawing method was used here, and for the substitute of particular body parts absolute size, Joo-Won Lee's standard size chart from a size-study by ages. 3) To work with CAD system we had input master pattern, drawn for age 5 as basic size, then graded six step-sizes for 1-11 years old. For add-subtract of particular body parts size, we graded through computing the standard variation among items to get the pattern developed into ready-made standard size, we can make precise plotting by grading wanted size very rapidly if we correct the rule of changed items different from standard size to make utilization possible enough with easy order method of ready-made Korean Dress. 4) We produced Marker after attaching a margin to seam accordingly by parts for each pattern using P/D/S to mark, In mass gament-cutting, the loss of time and material can minimized. In this research the apparel CAD system which has been utilized and only be western fashion industry was introduced for the design of ready-made Korean costume and utilized it in Grading, Marking which are critical steps to improve productivity and have reported the result in the research. Thus we expect that less cost, improved productivity and better quality with minimized loss of material from marking as well as from prompt and precise size-drawing. Furthermore the utilization of CAD system is considered as an effective one in terms of the research & the development to remove effective one in terms of the research & the development to remove irrational elements in the design and production process of Korean costume as well as in terms of the study of Korean Costume development through creative works of Korean Costume.

• Journal of Korea Multimedia Society
• /
• v.13 no.1
• /
• pp.58-65
• /
• 2010

The final goal of our research is developing not a simple collision a1ann equipment for the blinded walkers, but the apparatus (Audio- Vision System) which can simulate vision based on auditory information so that the blinds can figure the three dimensional space in front of them. On the way to the final goal, in this study, simulation software was developed and verified. Thirty normal volunteers were included in the subject group and the average age Was 25.8 years old. After being accustomed to the system by evaluating 10 blinded virtual spaces, the volunteers performed test using another set of 10 blinded virtual spaces. The results of test were scored by shape, center, margin, and gradient surface of objects in virtual space. The score of each checking point ranged from 1 to 5, and the full score was converted to 100. As results of this study, the total score ranged from 77 to 97 with the average of 88.7. In this study, a simulation software was developed and verified to have acceptable success rale. By combining to visual sensors, the vision-reconstruction system based on auditory signal (Audio-vision System) may be developed.