• 대한방사선기술학회지:방사선기술과학
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• 제38권3호
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• pp.213-220
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• 2015

본 연구는 3차원 입체정위 유방생검술의 정확도를 알아보고, 심부침생검을 이용하여 Stereotactic biopsy과 Sonoguided biopsy의 정확도와 정밀도를 평가하고자 한다. Stereotactic QC phantom을 이용하여 실제 5개의 target 위치로 3D sterotactic machine의 정확도를 측정하고, CT장비로 Scan하여 실측을 구해 X, Y, Z의 길이의 정밀도를 비교한다. 유방조직과 유사하게 제작한 Agar power phantom을 이용하여 5개의 각기 다른 needle tip Target을 통해 3D sterotactic machine과 2D ultrasound machine의 정확도를 비교하고, Z축을 장비별로 실측하여 정밀도와 신뢰도를 비교하며, 6개의 모조병소 Target을 심어놓은 Medical application phantom으로 표적하여 육안검사와 Specimen검사를 통해 정확도를 확인하였다. Stereotactic QC phantom으로 측정한 3D sterotactic machine의 정확도는 100%였으며, CT와 비교한 정밀도는 X, Y, Z축이 모두 p>0.05로 나타났다. Agar powder phantom으로 측정한 두 장비의 정확도는 100%의 정확도를 보였으며, CT와 두 장비 사이에는 p > 0.05로 차이가 없었다. 그러나 2명의 방사선사가 측정한 신뢰도분석에서 3D sterotactic machine은 ICC가 0.954였고, 2D ultrasound machine은 0.785로 2D ultrasound machine이 술자에 따라 차이가 있었다. Medical application phantom의 실험에서 3D sterotactic machine은 Sliced boneless ham을, 2D ultrasound machine은 small chalk powder group를 찾을 수 없었다. Phantom을 이용한 3차원 입체정위 유방생검술의 정확성은 우수하게 나타났고, 인체조직과 비슷한 Agar powder phantom과 유방 조직과 비슷한 Medical application phantom을 이용하여 Stereotactic biopsy과 Sonoguided biopsy의 정확도와 정밀도 모두 우수하게 나타났다. 또한 Medical application phantom의 심부침생검의 정확성 평가에서 각 검사에 따라 생검 표본이 병소의 형태에 따라 상이하게 채취되었고, 3차원 입체정위 유방생검술의 재현성이 유방 초음파검사보다 술자의 영향없이 우수하였다.

• Korean Journal of Radiology
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• 제23권6호
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• pp.625-637
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• 2022

With regard to the indolent clinical characteristics of prostate cancer (PCa), the more selective detection of clinically significant PCa (CSC) has been emphasized in its diagnosis and management. Magnetic resonance imaging (MRI) has advanced technically, and recent international cooperation has provided a standardized imaging and reporting system for prostate MRI. Accordingly, prostate MRI has recently been investigated and utilized as a triage tool before biopsy to guide tissue sampling to increase the detection rate of CSC beyond the staging tool for patients in whom PCa was already confirmed on conventional systematic biopsy. Radiologists must understand the current paradigm shift for better PCa diagnosis and management. This article reviewed the recent literature, demonstrating the diagnostic value of pre-biopsy prostate MRI with targeted biopsy and discussed unsolved issues regarding the paradigm shift in the diagnosis of PCa.

• 한국의학물리학회지:의학물리
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• 제15권4호
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• pp.197-201
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• 2004

뇌 신경계에 발생한 비정상조직 등 병소들을 수술적 방법으로 생체 조직검사 시 방사선 영상 공간과 실제 물리적 공간을 3 차원적으로 일치시키고 국재(localization)하는 영상지원 뇌 정위 수술은 혹시 발생할지도 모르는 후유증을 최소화할 수 있다. 본 연구는 대부분 고가의 대형 정위 수술 프로그램에 포함되어 있는 뇌수술을 영상 지원하는 정위적 국재 프로그램들 중 임상에서 수술 빈도가 높은 생체조직 검사 시술 시에 최소한의 기능으로 수술을 지원할 수 있는 프로그램을 개발하고 팬텀을 이용해 국재 정확도를 측정한 후 임상에서 사용 가능성을 평가하였다. 프로그램은 영상자료 입력, fiducial marker 등록, 목표점 좌표 지정 및 좌표 값 표시 등 3 부분으로 구성하였고 팬텀을 이용한 프로그램의 정확도를 측정결과 임상에서 요구되는 일반적인 국재 정확도 한계인 2 mm 이내였다. 이 프로그램은 고난도의 뇌 정위 생검 수술시 정확한 시술이 가능하도록 지원하여 수술의 위험도를 줄이고 수술 성공률 향상에 기여할 수 있으리라 생각된다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2003년도 제27회 추계학술대회
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• pp.72-72
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• 2003

Purpose: To prove feasibility of proton chemical shift imaging (lH CSI) during stereotactic procedure, authors performed IH CSI in combination with a stereotactic headframe and selected targets according to local metabolic information, evaluated the pathologic results. Methods: The 1H CSI directed stereotactic biopsy was performed in five patients. 1H CSI was performed before conventional stereotactic MRI with gadolinium enhancement for stereotactic coordinates. The metabolite images expressed as integral ratios, Cho/Cr and Lac/Cr, were displayed in different colors. The stereotactic target coordinates were correlated with the coordinates from the 1H CSI images. Results: The final pathologic results obtained were concordant with the local metabolic information from 1H CSI. We believe that 1H CSI-directed stereotatic biopsy has the potential to significantly improve the accuracy of stereotactic biopsy targeting. Conclusions : Metabolic signals derived from 1H CSI could give us more direct clues for stereotactic target selection during the subsequent conventional stereotactic MR imaging. 1H CSI was feasible with the stereotatic headframe in place. The final pathologic results obtained were concordant with the local metabolic information from 1H CSI. Acknowledgement: This study was supported by a grant of the Center for Functional and Metabolic Imaging Technology, Ministry of Health & Welfare, Republic of Korea (02-PJ3-PG6-EV07-0002).

• 대한의사협회지
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• 제61권11호
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• pp.662-669
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• 2018

The cutaneous melanoma has been regarded as rare disease entity in Korea for long time but it shows a silent growth recently. Furthermore the management of cutaneous melanoma including staging system, surgical principle, sentinel lymph node biopsy and subsequent complete node dissection and, most importantly, immunotherapy and target therapy against cutaneous melanoma recently. The incidence of cutaneous melanoma is steadily increasing in Korea but its increase is rapid recent 2 decades to 4.3 times and should be greater soon according to the steeper increase of life expectancy. New staging system proposed by American Joint Committee on Cancer (2017) includes changes in individual TNM category and stage groups, particularly from a prognostic viewpoint. Dermoscopy has been successfully introduced in the differential diagnosis of pigmented skin lesion focusing on cutaneous melanoma by non-invasive simple diagnostic tool. Sentinel lymph node biopsy was a issue of long debate whether survival benefit is real or not. Temporary conclusion about this question is reached after two large scale studies and immediate complete node dissection should be performed in a certain situations. Most important change is drug therapy focusing on immunotherapy and target therapy. Braf- and MEK-inhibitor, immune checkpoint inhibitor and PD-1 blocker has been proved to be effective as a sole or combination regimen against advanced and/or high-risk adjuvant setting of cutaneous melanoma. In conclusion, these remarkable changes will be reviewed shortly here.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.15-22
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• 2000

Objective : This study was undertaken to evaluate the benefits and risks of the stereotactic biopsy in brain lesions. We assessed the diagnostic accuracy and morbidity rate associated with the stereotactic biopsy. Methods : The authors present a review of 47 patients, who underwent stereotactic biopsy using Cosman-Roberts-Wells(CRW) stereotactic apparatus during last six years. Results : Target locations were supratentorial in 36 cases, infratentorial in 9 and multiple in 2. According to pathological diagnosis, the largest group was neoplasm(29) followed by infection(9), infarction(2), cyst(2), and non-specific(5). Definitive diagnosis could be made in 42 of 47 cases(89.4%). When the mass lesion had been suspected as neoplastic condition, the diagnostic rate was 96.7%(29/30). It was being much higher than that of non-neoplastic lesion, 76.5%(13/17). The treatment modality was changed in 15 cases(32%) because the result of stereotactic biopsy was different from clinical diagnosis. Subsequent craniotomy after stereotactic biopsy was then performed in 6 cases, and the pathological diagnoses were precisely coincident in all of these cases. There were two complications(4.3%) : One intratumoral hemorrhage in glioblastoma and a transient hemiparesis in benign astrocytoma. There was no mortality in this series. Conclusion : The precise histological verification is crucial to determine the adequate treatment modality in intracranial lesions. Stereotactic biopsy is a safe and accurate diagnostic procedure for intracranial lesions with a low complication rate.

• Korean Journal of Radiology
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• 제22권7호
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• pp.1203-1212
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• 2021

Objective: To investigate the diagnostic accuracy and complications of cone-beam CT-guided percutaneous transthoracic needle biopsy (PTNB) of juxtaphrenic lesions and identify the risk factors for diagnostic failure and complications. Materials and Methods: In total, 336 PTNB procedures for lung lesions (mean size ± standard deviation [SD], 4.3 ± 2.3 cm) abutting the diaphragm in 326 patients (189 male and 137 female; mean age ± SD, 65.2 ± 11.4 years) performed between January 2010 and December 2014 were included. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PTNB procedures for the diagnosis of malignancy were measured based on the intention-to-diagnose principle. The risk factors for diagnostic failures and complications were evaluated using logistic regression analysis. Results: The accuracy, sensitivity, specificity, PPV, and NPV were 92.7% (293/316), 91.3% (219/240), 91.4% (74/81), 96.9% (219/226), and 77.9% (74/95), respectively. There were 23 diagnostic failures (7.3%), and lesion sizes ≤ 2 cm (p = 0.045) were the only significant risk factors for diagnostic failure. Complications occurred in 98 cases (29.2%), including 89 cases of pneumothorax (26.5%) and 7 cases of hemoptysis (2.1%). The multivariable analysis showed that old age (> 65 years) (p = 0.002), lesion size of ≤ 2 cm (p = 0.003), emphysema (p = 0.006), and distance from the pleura to the target lesion (> 2 cm) (p = 0.010) were significant risk factors for complications. Conclusion: The diagnostic accuracy of cone-beam CT-guided PTNB of juxtaphrenic lesions for malignancy was fairly high, and the target lesion size was the only significant predictor of diagnostic failure. Complications of cone-beam CT-guided PTNB of juxtaphrenic lesions occurred at a reasonable rate.

• Investigative and Clinical Urology
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• 제59권6호
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• pp.363-370
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• 2018

Purpose: The aim of this study is to describe the technique and to report early results of transperineal magnetic resonance imaging and ultrasonography (MRI-US) fusion biopsy. Materials and Methods: A total of 75 patients underwent MRI-US fusion transperineal biopsy. Targeted biopsy via MRI-US fusion imaging was carried out for cancer-suspicious lesions with additional systematic biopsy. Detection rates for overall and clinically significant prostate cancer (csPCa) were evaluated and compared between systematic and targeted biopsy. In addition, further investigation into the detection rate according to prostate imaging reporting and data system (PI-RADS) score was done. Results of repeat biopsies were also evaluated. Results: Overall cancer detection rate was 61.3% (46 patients) and the detection rate for csPCa was 42.7% (32 patients). Overall detection rates for systematic and targeted biopsy were 41.3% and 57.3% (p<0.05), respectively. Detection rates for csPCa were 26.7% and 41.3%, respectively (p<0.05). The cancer detection rates via MRI fusion target biopsy were 30.8% in PI-RADS 3, 62.1% in PI-RADS 4 and 89.4% in PI-RADS 5. Rates of csPCa missed by targeted biopsy and systematic biopsy were 0.0% and 25.0%, respectively. The cancer detection rate in repeat biopsies was 61.1% (11 among 18 patients) in which 55.5% of cancer suspected lesions were located in the anterior portion. Conclusions: Transperineal MRI-US fusion biopsy is useful for improving overall cancer detection rate and especially detection of csPCa. Transperineal MRI-US targeted biopsy show potential benefits to improve cancer detection rate in patients with high PIRADS score, tumor located at the anterior portion and in repeat biopsies.

• 제어로봇시스템학회:학술대회논문집
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• 제어로봇시스템학회 2000년도 제15차 학술회의논문집
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• pp.539-539
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• 2000

This paper shows how to implement force reflection for a needle insertion problem. The target is a needle spine biopsy simulator for tumor inspection by needle insertion. Simulated force is calculated from the relationship of volume graphic data and the orientation and Position of the needle, and it is generated using PHANTOM$^{TM}$. To generate realistic force reflection, the directional force of the needle has been generated by tissue model. The other rotational force is generated using a pivot to keep the needle in the initial inserted direction after puncturing the skin. Since the used haptic device has limitation for generating high stiffness and large damping, scale downed model and digital filter are used to stabilize the system.m.

• 대한방사선기술학회지:방사선기술과학
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• 제26권3호
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• pp.19-24
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• 2003

한국 여성의 유방암 발생은 전체 암 발생의 16.1%로 가장 많으며, 1995년 12.5%에서 2001년 16.1%로 증가하였고, 발생 연령군이 낮아지고 있다. 한국중앙 암 등록사업 연례 보고서, 2001(ICD_ $O_2$분류)에 따르면 유방암 등록분율은 7.1%, 사망분율은 2.1%(사망원인 통계연보, 2001)(ICD 10분류))로 나타나 조기발견의 중요성을 알 수 있다. 따라서 유방 초음파 팬텀을 이용해 주사와 생검 훈련을 하여 정밀한 유방초음파검사를 시행한다는 측면에서, 생검용 유방 초음파 팬텀을 제작하여 다음과 같은 결론을 얻었다. (1) PU를 주제로 하고 C와 $TiO_2$ 첨가제의 농도와 경도를 조정하여 인체 유방과 유사한 에코 양상을 나타내는 TMM을 합성하였으며, (2) 합성한 C와 $TiO_2$ TMM은 첨가량의 농도 변화에 따라 휘도와 대조도의 변화를 보였으며, (3) C형 TMM의 경도 증가에 따라 투과심도가 감소하는 것으로 나타났으며, (4) $TiO_2$ 형 TMM은 C형 TMM에 비해 낮은 휘도와 높은 투과도를 보였으며, (5) $TiO_2$형 TMM과 C형 TMM의 전파속도와 감쇠는 연부조직의 그것과 유사하게 나타났다. 따라서 생검용 유방초음파 팬텀은 $TiO_2$ 4.10 %w/v TMM으로, 표적물질은 C 2.09 %w/v로 제작하여 에코 양상을 평가하였다. 본 팬텀의 개발은 유방초음파검사의 주사 능력 향상은 물론 표재성장기의 TM 팬텀을 개발하는데 기여할 것이다.