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Dose Planning of Forward Intensity Modulated Radiation Therapy for Nasopharyngeal Cancer using Compensating Filters (보상여과판을 이용한 비인강암의 전방위 강도변조 방사선치료계획)

  • Chu Sung Sil;Lee Sang-wook;Suh Chang Ok;Kim Gwi Eon
    • Radiation Oncology Journal
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    • v.19 no.1
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    • pp.53-65
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    • 2001
  • Purpose : To improve the local control of patients with nasopharyngeal cancer, we have implemented 3-D conformal radiotherapy and forward intensity modulated radiation therapy (IMRT) to used of compensating filters. Three dimension conformal radiotherapy with intensity modulation is a new modality for cancer treatments. We designed 3-D treatment planning with 3-D RTP (radiation treatment planning system) and evaluation dose distribution with tumor control probability (TCP) and normal tissue complication probability (NTCP). Material and Methods : We have developed a treatment plan consisting four intensity modulated photon fields that are delivered through the compensating tilters and block transmission for critical organs. We get a full size CT imaging including head and neck as 3 mm slices, and delineating PTV (planning target volume) and surrounding critical organs, and reconstructed 3D imaging on the computer windows. In the planning stage, the planner specifies the number of beams and their directions including non-coplanar, and the prescribed doses for the target volume and the permissible dose of normal organs and the overlap regions. We designed compensating filter according to tissue deficit and PTV volume shape also dose weighting for each field to obtain adequate dose distribution, and shielding blocks weighting for transmission. Therapeutic gains were evaluated by numerical equation of tumor control probability and normal tissue complication probability. The TCP and NTCP by DVH (dose volume histogram) were compared with the 3-D conformal radiotherapy and forward intensity modulated conformal radiotherapy by compensator and blocks weighting. Optimization for the weight distribution was peformed iteration with initial guess weight or the even weight distribution. The TCP and NTCP by DVH were compared with the 3-D conformal radiotherapy and intensitiy modulated conformal radiotherapy by compensator and blocks weighting. Results : Using a four field IMRT plan, we have customized dose distribution to conform and deliver sufficient dose to the PTV. In addition, in the overlap regions between the PTV and the normal organs (spinal cord, salivary grand, pituitary, optic nerves), the dose is kept within the tolerance of the respective organs. We evaluated to obtain sufficient TCP value and acceptable NTCP using compensating filters. Quality assurance checks show acceptable agreement between the planned and the implemented MLC(multi-leaf collimator). Conclusion : IMRT provides a powerful and efficient solution for complex planning problems where the surrounding normal tissues place severe constraints on the prescription dose. The intensity modulated fields can be efficaciously and accurately delivered using compensating filters.

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The Effect of Pleural Thickening on the Impairment of Pulmonary Function in Asbestos Exposed Workers (석면취급 근로자에서 늑막비후가 폐기능에 미치는 영향)

  • Kim, Jee-Won;Ahn, Hyeong-Sook;Kim, Kyung-Ah;Lim, Young;Yun, Im-Goung
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.6
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    • pp.923-933
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    • 1995
  • Background: Pleural abnormality is the the most common respiratory change caused by asbestos dust inhalation and also develop other asbestos related disease after cessation of asbestos exposure. So we conducted epidemiologic study to investigate if the pleural abnormality is associated with pulmonary function change and what factors are influenced on pulmonary function impairment. Methods: Two hundred and twenty two asbestos workers from 9 industries using asbestos in Korea were selected to measure the concentration of sectional asbestos fiber. Ouestionnaire, chest X-ray, PFT were also performed. All the data were analyzed by student t-test and chi-square test using SAS. Regressional analysis was performed to evaluate important factors, for example smoking, exposure concentration, period and the existence of pleural thickening, affecting to the change of pulmonary function. Results: 1) All nine industries except two, airborn asbestos fiber concentration was less than an average permissible concentration. PFT was performed on 222 workers and the percentage of male was 88.3%, their mean age was $41{\pm}9$ years old, and the duration of asbestos exposure was $10.6{\pm}7.8$ yrs. 2) The chest X-ray showed normal(89.19%), pulmonary Tb(inactive)(2.7%), pleral thickening (7.66%), suspected reticulonodular shadow(0.9%). 3) The mean values of height, smoking status, concentration of asbestos fiberwere not different between the subjects with pleural thickening and others, but age, cumulative pack-years, the duration of asbestos exposure were higher in subjects with pleural thickening. 4) All the PFT indices were lower in the subjects with pleural thickening than in the subjects without pleural thickening. 5) Simple regression analysis showed there was a significant correlation between $FEF_{75}$ which is sensitive in small airway obstruction and cumulative smoking pack-years, the duration of asbestos exposure and the concentration of asbestos fiber. 6) Multiple regression analysis showed all the pulmonary function indices were decreased as the increase of cumulative smoking pack-years and especially in the indices those are sensitive in small airway obstruction. Pleural thickening was associated with reduction in FVC, $FEV_1$, PEFR and $FEF_{25}$. Conclusion: The more concentration of asbestos fiber and the more duration of asbestos exposure, the greater reduction in $FEF_{50}$, $FEF_{75}$. Therefore PFT was important in the evaluation of early detection for small airway obstruction. Furthermore pleural thickening without asbesto-related parenchymal lung disease is associated with reduction in pulmonary function.

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A Study on the Forest Yield Regulation by Systems Analysis (시스템분석(分析)에 의(依)한 삼림수확조절(森林收穫調節)에 관(關)한 연구(硏究))

  • Cho, Eung-hyouk
    • Korean Journal of Agricultural Science
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    • v.4 no.2
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    • pp.344-390
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    • 1977
  • The purpose of this paper was to schedule optimum cutting strategy which could maximize the total yield under certain restrictions on periodic timber removals and harvest areas from an industrial forest, based on a linear programming technique. Sensitivity of the regulation model to variations in restrictions has also been analyzed to get information on the changes of total yield in the planning period. The regulation procedure has been made on the experimental forest of the Agricultural College of Seoul National University. The forest is composed of 219 cutting units, and characterized by younger age group which is very common in Korea. The planning period is devided into 10 cutting periods of five years each, and cutting is permissible only on the stands of age groups 5-9. It is also assumed in the study that the subsequent forests are established immediately after cutting existing forests, non-stocked forest lands are planted in first cutting period, and established forests are fully stocked until next harvest. All feasible cutting regimes have been defined to each unit depending on their age groups. Total yield (Vi, k) of each regime expected in the planning period has been projected using stand yield tables and forest inventory data, and the regime which gives highest Vi, k has been selected as a optimum cutting regime. After calculating periodic yields and cutting areas, and total yield from the optimum regimes selected without any restrictions, the upper and lower limits of periodic yields(Vj-max, Vj-min) and those of periodic cutting areas (Aj-max, Aj-min) have been decided. The optimum regimes under such restrictions have been selected by linear programming. The results of the study may be summarized as follows:- 1. The fluctuations of periodic harvest yields and areas under cutting regimes selected without restrictions were very great, because of irregular composition of age classes and growing stocks of existing stands. About 68.8 percent of total yield is expected in period 10, while none of yield in periods 6 and 7. 2. After inspection of the above solution, restricted optimum cutting regimes were obtained under the restrictions of Amin=150 ha, Amax=400ha, $Vmin=5,000m^3$ and $Vmax=50,000m^3$, using LP regulation model. As a result, about $50,000m^3$ of stable harvest yield per period and a relatively balanced age group distribution is expected from period 5. In this case, the loss in total yield was about 29 percent of that of unrestricted regimes. 3. Thinning schedule could be easily treated by the model presented in the study, and the thinnings made it possible to select optimum regimes which might be effective for smoothing the wood flows, not to speak of increasing total yield in the planning period. 4. It was known that the stronger the restrictions becomes in the optimum solution the earlier the period comes in which balanced harvest yields and age group distribution can be formed. There was also a tendency in this particular case that the periodic yields were strongly affected by constraints, and the fluctuations of harvest areas depended upon the amount of periodic yields. 5. Because the total yield was decreased at the increasing rate with imposing stronger restrictions, the Joss would be very great where strict sustained yield and normal age group distribution are required in the earlier periods. 6. Total yield under the same restrictions in a period was increased by lowering the felling age and extending the range of cutting age groups. Therefore, it seemed to be advantageous for producing maximum timber yield to adopt wider range of cutting age groups with the lower limit at which the smallest utilization size of timber could be produced. 7. The LP regulation model presented in the study seemed to be useful in the Korean situation from the following point of view: (1) The model can provide forest managers with the solution of where, when, and how much to cut in order to best fulfill the owners objective. (2) Planning is visualized as a continuous process where new strateges are automatically evolved as changes in the forest environment are recognized. (3) The cost (measured as decrease in total yield) of imposing restrictions can be easily evaluated. (4) Thinning schedule can be treated without difficulty. (5) The model can be applied to irregular forests. (6) Traditional regulation methods can be rainforced by the model.

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