Purpose: Conventional CBCT(Cone-beam Computed-tomography) caused an error in the target volume due to organ movement in the area affected by respiratory movement. The purpose of this paper is to evaluate the usefulness of accuracy and time spent using the Gated CBCT function, which reduces errors when performing RGRT(respiratory gated radiation therapy), and to examine the appropriateness of phase. Materials and methods: To evaluate the usefulness of Gated CBCT, the QUASARTM respiratory motion phantom was used in the Truebeam STxTM. Using lead marker inserts, Gated CBCT was scaned 5 times for every 20~80% phase, 30~70% phase, and 40~60% phase to measure the blurring length of the lead marker, and the distance the lead marker moves from the top phase to the end of the phase was measured 5 times. Using Cedar Solid Tumor Inserts, 4DCT was scanned for every phase, 20-80%, 30-70%, and 40-60%, and the target volume was contoured and the length was measured five times in the axial direction (S-I direction). Result: In Gated CBCT scaned using lead marker inserts, the axial moving distance of the lead marker on average was measured to be 4.46cm in the full phase, 3.11cm in the 20-80% phase, 1.94cm in the 30-70% phase, 0.90cm in the 40-60% phase. In Fluoroscopy, the axial moving distance of the lead marker on average was 4.38cm and the distance on average from the top phase to the beam off phase was 3.342cm in the 20-80% phase, 3.342cm in the 30-70% phase, and 0.84cm in the 40-60% phase. Comparing the results, the difference in the full phase was 0.08cm, the 20~80% phase was 0.23cm, the 30~70% phase was 0.10cm, and the 40~60% phase was 0.07cm. The axial lengths of ITV(Internal Target Volume) and PTV(Planning Target Volume) contoured by 4DCT taken using cedar solid tumor inserts were measured to be 6.40cm and 7.40cm in the full phase, 4.96cm and 5.96cm in the 20~80% phase, 4.42cm and 5.42cm in the 30~70% phase, and 2.95cm and 3.95cm in the 40~60% phase. In the Gated CBCT, the axial lengths on average was measured to be 6.35 cm in the full phase, 5.25 cm in the 20-80% phase, 4.04 cm in the 30-70% phase, and 3.08 cm in the 40-60% phase. Comparing the results, it was confirmed that the error was within ±8.5% of ITV Conclusion: Conventional CBCT had a problem that errors occurred due to organ movement in areas affected by respiratory movement, but through this study, obtained an image similar to the target volume of the setting phase using Gated CBCT and verified its usefulness. However, as the setting phase decreases, the scan time was increases. Therefore, considering the scan time and the error in setting phase, It is recommended to apply it to patients with respiratory coordinated stereotactic radiation therapy using a wide phase of 30-70% or more.
Purpose:
Background : The management of thoracic empyema and complicated parapneumonic effusion requires adequate antibiotics use and prompt drainage of infected pleural space. Tube thoracostomy for loculated empyema has low success rate and is also an invasive procedure with potential morbidity. Complications include hemothorax, perforation of intra-abdominal or intra-thoracic organs, diaphragmatic laceration, empyema, pulmonary edema, and Horner's syndrome. Given the potential morbidity of traditional chest tube insertion, use of the image-guided pigtail catheter drainage(PCD) of empyema has been employed. We retrospectively analyzed the medical records of patients with empyema or complicated parapneumonic effusion to determine the efficacy of percutaneous pigtail catheter drainage. Materials and Methods : 45 patients with complicated parapneumonic effusions or empyema were treated at Gil medical center from January 1998 to June, 1999. All were initially given PCD procedure and the following data were collected: clinical symptoms at the time of diagnosis, alcohol and smoking history, the characteristics of pleural effusion, radiologic findings (at the time of catheter insertion, removal and 1 month after catheter removal), the amount of effusion drained for initial 24 hours, the time from catheter insertion to removal and the use of surgical approach. Results : Male gender was more frequent (42 men vs. 3 women), the mean age of the study population was 52(range: 21~74) years. Empyema was found in 23 patients, complicated parapneumonic effusion in 22 patients. Four patients(three, parapneumonic effusion and one, with empyema) with PCD only treated, were cast off. Among the available patients, 36(80%) patients were treated with PCD only or PCD with urokinase. Among the 23 patients with empyema, surgical approach was required in five patients(27.1%, one required decortication, four open thoracostomy), one patient, treated with surgical procedure, died of sepsis. There was no significant difference of the duration of catheter insertion, the duration of hospital admission after catheter insertion and the mean amount of effusion drained for initial 24 hours between the patients with only PCD treated and the patients treated with PCD and urokinase. The duration of catheter insertion(
Ancestral Burial Ground on the Inwangsan Mountain is a ten-panel folding screen with images and postscripts. Commissioned by Bak Gyeong-bin (dates unknown), this screen was painted by Jo Jung-muk (1820-after 1894) in 1868. The postscripts were written by Hong Seon-ju (dates unknown). The National Museum of Korea restored this painting, which had been housed in the museum on separate sheets, to its original folding screen format. The museum also opened the screen to the public for the first time at the special exhibition Through the Eyes of Joseon Painters: Real Scenery Landscapes of Korea held from July 23 to September 22, 2019. Ancestral Burial Ground on the Inwangsan Mountain depicts real scenery on the western slopes of Inwangsan Mountain spanning present-day Hongje-dong and Hongeun-dong in Seodaemun-gu, Seoul. In the distance, the Bukhansan Mountain ridges are illustrated. The painting also bears place names, including Inwangsan Mountain, Chumohyeon Hill, Hongjewon Inn, Samgaksan Mountain, Daenammun Gate, and Mireukdang Hall. The names and depictions of these places show similarities to those found on late Joseon maps. Jo Jung-muk is thought to have studied the geographical information marked on maps so as to illustrate a broad landscape in this painting. Field trips to the real scenery depicted in the painting have revealed that Jo exaggerated or omitted natural features and blended and arranged them into a row for the purposes of the horizontal picture plane. Jo Jung-muk was a painter proficient at drawing conventional landscapes in the style of the Southern School of Chinese painting. Details in Ancestral Burial Ground on the Inwangsan Mountain reflect the painting style of the School of Four Wangs. Jo also applied a more decorative style to some areas. The nineteenth-century court painters of the Dohwaseo(Royal Bureau of Painting), including Jo, employed such decorative painting styles by drawing houses based on painting manuals, applying dots formed like sprinkled black pepper to depict mounds of earth and illustrating flowers by dotted thick pigment. Moreover, Ancestral Burial Ground on the Inwangsan Mountain shows the individualistic style of Jeong Seon(1676~1759) in the rocks drawn with sweeping brushstrokes in dark ink, the massiveness of the mountain terrain, and the pine trees simply depicted using horizontal brushstrokes. Jo Jung-muk is presumed to have borrowed the authority and styles of Jeong Seon, who was well-known for his real scenery landscapes of Inwangsan Mountain. Nonetheless, the painting lacks an spontaneous sense of space and fails in conveying an impression of actual sites. Additionally, the excessively grand screen does not allow Jo Jung-muk to fully express his own style. In Ancestral Burial Ground on the Inwangsan Mountain, the texts of the postscripts nicely correspond to the images depicted. Their contents can be divided into six parts: (1) the occupant of the tomb and the reason for its relocation; (2) the location and geomancy of the tomb; (3) memorial services held at the tomb and mysterious responses received during the memorial services; (4) cooperation among villagers to manage the tomb; (5) the filial piety of Bak Gyeong-bin, who commissioned the painting and guarded the tomb; and (6) significance of the postscripts. The second part in particular is faithfully depicted in the painting since it can easily be visualized. According to the fifth part revealing the motive for the production of the painting, the commissioner Bak Gyeongbin was satisfied with the painting, stating that "it appears impeccable and is just as if the tomb were newly built." The composition of the natural features in a row as if explaining each one lacks painterly beauty, but it does succeed in providing information on the geomantic topography of the gravesite. A fair number of the existing depictions of gravesites are woodblock prints of family gravesites produced after the eighteenth century. Most of these are included in genealogical records and anthologies. According to sixteenth- and seventeenth-century historical records, hanging scrolls of family gravesites served as objects of worship. Bowing in front of these paintings was considered a substitute ritual when descendants could not physically be present to maintain their parents' or other ancestors' tombs. Han Hyo-won (1468-1534) and Jo Sil-gul (1591-1658) commissioned the production of family burial ground paintings and asked distinguished figures of the time to write a preface for the paintings, thus showing off their filial piety. Such examples are considered precedents for Ancestral Burial Ground on the Inwangsan Mountain. Hermitage of the Recluse Seokjeong in a private collection and Old Villa in Hwagae County at the National Museum of Korea are not paintings of family gravesites. However, they serve as references for seventeenth-century paintings depicting family gravesites in that they are hanging scrolls in the style of the paintings of literary gatherings and they illustrate geomancy. As an object of worship, Ancestral Burial Ground on the Inwangsan Mountain recalls a portrait. As indicated in the postscripts, the painting made Bak Gyeong-bin "feel like hearing his father's cough and seeing his attitudes and behaviors with my eyes." The fable of Xu Xiaosu, who gazed at the portrait of his father day and night, is reflected in this gravesite painting evoking a deceased parent. It is still unclear why Bak Gyeong-bin commissioned Ancestral Burial Ground on the Inwangsan Mountain to be produced as a real scenery landscape in the folding screen format rather than a hanging scroll or woodblock print, the conventional formats for a family gravesite paintings. In the nineteenth century, commoners came to produce numerous folding screens for use during the four rites of coming of age, marriage, burial, and ancestral rituals. However, they did not always use the screens in accordance with the nature of these rites. In the Ancestral Burial Ground on the Inwangsan Mountain, the real scenery landscape appears to have been emphasized more than the image of the gravesite in order to allow the screen to be applied during different rituals or for use to decorate space. The burial mound, which should be the essence of Ancestral Burial Ground on the Inwangsan Mountain, might have been obscured in order to hide its violation of the prohibition on the construction of tombs on the four mountains around the capital. At the western foot of Inwangsan Mountain, which was illustrated in this painting, the construction of tombs was forbidden. In 1832, a tomb discovered illegally built on the forbidden area was immediately dug up and the related people were severely punished. This indicates that the prohibition was effective until the mid-nineteenth century. The postscripts on the Ancestral Burial Ground on the Inwangsan Mountain document in detail Bak Gyeong-bin's efforts to obtain the land as a burial site. The help and connivance of villagers were necessary to use the burial site, probably because constructing tombs within the prohibited area was a burden on the family and villagers. Seokpajeong Pavilion by Yi Han-cheol (1808~1880), currently housed at the Los Angeles County Museum of Art, is another real scenery landscape in the format of a folding screen that is contemporaneous and comparable with Ancestral Burial Ground on the Inwangsan Mountain. In 1861 when Seokpajeong Pavilion was created, both Yi Han-cheol and Jo Jung-muk participated in the production of a portrait of King Cheoljong. Thus, it is highly probable that Jo Jung-muk may have observed the painting process of Yi's Seokpajeong Pavilion. A few years later, when Jo Jungmuk was commissioned to produce Ancestral Burial Ground on the Inwangsan Mountain, his experience with the impressive real scenery landscape of the Seokpajeong Pavilion screen could have been reflected in his work. The difference in the painting style between these two paintings is presumed to be a result of the tastes and purposes of the commissioners. Since Ancestral Burial Ground on the Inwangsan Mountain contains the multilayered structure of a real scenery landscape and family gravesite, it seems to have been perceived in myriad different ways depending on the viewer's level of knowledge, closeness to the commissioner, or viewing time. In the postscripts to the painting, the name and nickname of the tomb occupant as well as the place of his surname are not recorded. He is simply referred to as "Mister Bak." Biographical information about the commissioner Bak Gyeong-bin is also unavailable. However, given that his family did not enter government service, he is thought to have been a person of low standing who could not become a member of the ruling elite despite financial wherewithal. Moreover, it is hard to perceive Hong Seon-ju, who wrote the postscripts, as a member of the nobility. He might have been a low-level administrative official who belonged to the Gyeongajeon, as documented in the Seungjeongwon ilgi (Daily Records of Royal Secretariat of the Joseon Dynasty). Bak Gyeong-bin is presumed to have moved the tomb of his father to a propitious site and commissioned Ancestral Burial Ground on the Inwangsan Mountain to stress his filial piety, a conservative value, out of his desire to enter the upper class. However, Ancestral Burial Ground on the Inwangsan Mountain failed to live up to its original purpose and ended up as a contradictory image due to its multiple applications and the concern over the exposure of the violation of the prohibition on the construction of tombs on the prohibited area. Forty-seven years after its production, this screen became a part of the collection at the Royal Yi Household Museum with each panel being separated. This suggests that Bak Gyeong-bin's dream of bringing fortune and raising his family's social status by selecting a propitious gravesite did not come true.