PET/CT검사에서 Dose Modulation Technic 적용시 BMI에 따른 선량 감소율 분석

김정욱,박세윤,조영준,박종엽,Kim, Jung Wook,Park, Se Yun,Jo, Young Jun,Park, Jong Yeop 대한핵의학기술학회 2012 핵의학 기술 Vol.16 No.2

PET/CT에서의 환자의 피폭선량을 줄이기 위한 많은 연구가 진행되고 있다. 본 연구는 2012년 2월부터 2012년 3월까지 PET/CT검사를 위해 본원 핵의학과에 내원한 환자 149명(평균연령 $58{\pm}12.4$세)을 대상으로 하였고 장비는 Biograph True Point 40 (Siemens, USA)과 Gemini TF 64 (Philips, Cleveland)를 사용하였다. SIEMENS사의 Care Dose 4D를 사용하여 75명의 환자를 BMI 지수에 따라 세 집단으로 나누어 선량 감소율과 CTDI를 측정하였고 PHILIPS사의 D-dom을 이용하여 74명의 환자를 세 집단으로 나누어 선량 감소율과 CTDI를 측정하였다. 각 장비별로 세 집단 간의 측정값들이 유의한 차이를 보이는지 알아보기 위하여 SPSS Ver.18.0 통계분석프로그램을 이용하였다. 각각의 집단별로 평균값을 비교한 결과 Care Dose 4D를 사용했을 때 선량 감소율, CTDI 모두 p-value가 0.000으로서 통계적으로 유의한 차이가 있었다. D-dom을 사용했을 때 집단 간의 p-value는 선량 감소율 0.284, CTDI 0.226으로서 p>0.05이므로 집단 간의 유의한 차이가 없었다. 집단별로 평균 선량 감소율과 CTDI를 분석한 결과 Care Dose 4D를 사용했을 때 각각 정상집단에서 53.4%, 5.3 mGy, 과체중집단에서 49.5%, 5.8 mGy, 비만 집단에서 42.0%, 6.6 mGy로 나타났다. 반면에 D-dom을 사용하였을 때는 각각 정상 집단에서 22.7%, 4.5 mGy, 과체중 집단에서 22.1%, 4.6 mGy, 비만 집단에서 22.9%. 4.5 mGy로 나타났다. D-dom의 원리인 투사각도에 따른 선량조절은 환자의 비만도에 영향이 많지 않음을 알 수 있었다. 그리고 Care Dose 4D의 경우에는 투사각도에 따른 선량조절뿐만 아니라 환자 장축의 감쇠계수에 따른 선량조절, 환자 사이즈에 따른 선량조절 원리를 사용하고 있다. 그러므로 환자 장축의 감쇠계수에 따른 선량조절과 환자 크기에 따른 선량조절 원리가 환자의 비만도에 영향이 있다고 생각된다. 비록 같은 BMI 집단 간에 환자의 체형에 따른 오차가 있다고 여겨지지만, 앞으로 더욱더 많은 연구가 이루어진다면 Dose Modulation Technic이 PET/CT검사에서 환자의 피폭선량을 줄이는데 많은 도움이 될 것으로 생각된다. Purpose : It is important to reduce radiation dose associated with computed tomography (CT) scanning to as low as reasonably achievable (ALARA). With Dose Modulation Technic, user select a desired image quality and the system adapts tube current to obtain the desired image quality with greater radiation dose efficiency. In this paper, we presents a comprehensive description of fundamentals, clinical applications and radiation dose benefits of Dose Modulation Technic depending on Body Mass Index(BMI). Materials and Methods : In this study, 149 patients were examined(The mean age : $58{\pm}12.4$ years old). Biograph True Point 40 (Siemens, USA) and Gemini TF 64 (Philips. Cleveland) were used for equipment. When we used Care Dose 4D (Siemens, USA) and D-dom (Philips, Cleveland), we measured dose reduction and Computed Tomography Dose Index (CTDI) depending on BMI. Then we analyze data using SPSS Ver.18. Results : When we used Care Dose 4D, p-value is considered statistically significant by groups with the result that we compared Care Dose 4D with D-dom. On the other hand, p-value isn't considered statistically significant by groups using D-dom. Conclusion : Dose modulation based on the projection angle didn't affect degree of obesity. And When using Care Dose 4D, dose reduction rate in the normal patients were higher than the obese. In this study, there are errors on somato type. So I think more research have to be done. Then application of Dose Modulation technic can help in maintaining acceptable image quality while reducing radiation dose by 20-60% in most instances.

동결수정란 이식주기에서 수정란 융해 후 생존율과 임신율에 영향을 미치는 요인

김정욱,변혜경,염혜원,전진현,박용석,송인옥,송지홍,최범채,궁미경,전종영,강인수,Kim, Jeong-Wook,Byun, Hye-Kyung,Youm, Hye-Won,Jun, Jin-Hyun,Park, Yong-Seog,Song, In-Ok,Song, Ji-Hong,Choi, Bum-Chae,Koong, Mi-Kyoung,Jun, Jong-Young,Kang, 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.1

Objective: The purpose of this study was to determine the important factors affecting survival and pregnancy rate in frozen-thawed embryo transfer cycles. Methods: we performed retrospective analysis in 738 cycles of frozen-thawed embryo transfers, in relation to the insemination methods, the freezing stage of embryo, patient's age, infertility factors and the origin of injected sperm in ICSI cycles. After conventional IVF or ICSI, the supernumerary PN stage zygotes or multicellular embryos were cryopreserved by slow freezing protocol with 1,2-propanediol (PROH) as a cryoprotectant. Results: The survival rates of thawed embryos were 69.3% (1585/2287) in conventional IVF group and 71.7% (1645/2295) in ICSI group. After frozen-thawed embryo transfers, 27.0% (92/341) and 32.0% (109/341) of pregnancy rates were achieved in conventional IVF and ICSI group, respectively. There were no significant difference in the survival and pregnancy rates according to the insemination methods, the freezing stage and patient's age. However, the pregnancy rate (36.2%) of male factor infertility was significantly higher than the tubal (27.2%) and other female factor infertility (22.9%). In ICSI group, the origin of injected sperm did not affect the outcome of frozen-thawed embryo transfer cycles. Conclusion: The present study demonstrates that acceptable clinical outcomes can be achieved after the transfer of frozen-thawed embryos regardless of the stage of embryos for freezing, the patient's age and the origin of injected sperm.

전신성 홍반성 루프스와 이차성 항인지질 항체 증후군 환자에서 발생한 망상 청피반

김정욱 ( Jung Wook Kim ),오두진 ( Doo Jin Oh ),조경종 ( Kyung Jong Cho ),홍순권 ( Soon Kwon Hong ),이드보라 ( De Bo Rah Lee ),황선욱 ( Seon Wook Hwang ),박성욱 ( Sung Wook Park ) 대한피부과학회 2007 대한피부과학회지 Vol.45 No.6

Antiphospholipid syndrome is defined as the presence of lupus anticoagulant antibodies or anticardiolipin antibodies with vascular thrombosis or specific pregnancy complications. Antiphospholipid syndrome can be associated with autoimmune, malignant or infectious diseases. Cutaneous manifestations of antiphospholipid syndrome are variable and can be a first clue to the syndrome or other associated diseases. We report a case of systemic lupus erythematosus and secondary antiphospholipid syndrome presenting as livedo reticularis on both legs of a patient. We recommend that patients with livedo reticularis should be examined for systemic lupus erythematosus or antiphospholipid syndrome. (Korean J Dermatol 2007;45(6):622∼625)

비알콜성 지방간질환과 대장신생물

김정욱 ( Jong Wook Kim ),변정식 ( Jeong Sik Byeon ) 대한내과학회 2013 대한내과학회지 Vol.84 No.3

The incidence of colorectal neoplasm including adenomas and carcinomas is increasing in Korea. It has been reported that certain components of the metabolic syndrome including abdominal obesity and abnormal glucose metabolism are associated with increased risk for colorectal cancer. The mechanism involved is most likely linked to metabolic stress, which is associated with increased levels of insulin-like growth factor-1 and TNF-α, which promote cell proliferation and survival. Non-alcoholic fatty liver disease (NAFLD) is commonly referred to as the hepatic manifestation of the metabolic syndrome. The study by Lee et al. showed that NAFLD is associated with increased risk for colonic neoplasm. Further studies are needed to decide whether patients with NAFLD require a screening colonoscopy at a younger age than currently recommended. (Korean J Med 2013;84:360-362)

소화기암의 분자 영상

김정욱 ( Jong Wook Kim ),윤순만 ( Soon Man Yoon ),명승재 ( Seung Jae Myung ) 대한장연구학회 2011 Intestinal Research Vol.9 No.2

Endoscopic detection of gastrointestinal cancer currently depends in large part on white light images, which show mucosal surface changes in real time. Molecular imaging is a rapidly growing new field in gastrointestinal endoscopy, which could provide additional information about molecular expression of cells and processes involved in cancer biology. It uses the molecular signature of cells for minimally-invasive, targeted imaging of gastrointestinal pathologies. Exogenous fluorescent agents serve as molecular beacons and include labeled peptides and antibodies, and probes with tumor-specific activation. An advantage of molecular imaging in digestive tract is the opportunity to apply such agents topically, overcoming the hurdles for delivery of these agents to the region of involvement, including immunogenic reaction and potential toxicity. Recently developed molecular targets include proteolytic enzymes, endothelial-specific markers, and apoptosis reporters. Molecular imaging has the potential to greatly impact on future endoscopy in gastroenterology. (Intest Res 2011;9:90-96)

중증 궤양성 대장염 입원환자의 스테로이드 치료실패에 대한 예측 인자 및 모델 검증

김정욱 ( Jung Wook Kim ),김효종 ( Hyo Jong Kim ),이창균 ( Chang Kyun Lee ),김혁 ( Hyuck Kim ),신아리 ( A Ri Shin ),강경환 ( Kyung Hwan Kang ),김민경 ( Min Kyoung Kim ),박현진 ( Hyun Jin Park ),정회훈 ( Hoe Hoon Chung ),황은정 ( E 대한장연구학회 2012 Intestinal Research Vol.10 No.3

Background/Aims: Some clinical and laboratory parameter are predictors to determine steroid treatment failure in patients acute severe ulcerative colitis. We aimed to validate previous models in the Korean patients. Methods: This study was conducted retrospectively with 70 patients who were diagnosed with severe ulcerative colitis (UC) between January 2001 and June 2011. The rate of treatment failure was investigated using predictors or numerical scoring systems from prior studies. Results: Twelve (17.2%) patients failed to respond to steroid therapy. The logistic regression analysis revealed that stool frequency on the fifth day and colonic dilatation were the only independent predictive factors related to treatment failure. Formulated numerical risk scores based on mean stool frequency, colonic dilatation, and hypoalbuminemia were significantly higher in the non-responding group than those in the responding group (P<0.001). Using another scoring system (stool frequency on the third day+1.4×C-reactive protein [CRP]), treatment failure rate was significantly higher in the group in which the score was >8 than in the group with a score <8 (30.8% vs. 8.6%, P=0.042). Lastly, treatment failure rate was higher in the group (stool frequency >8 plus CRP >4.5 mg/dL or bloody stool plus CRP >4.3 mg/dL) than those of the other group at the third day (40% vs. 7.3%, P=0.004; 33.3% vs. 5.2%, P=0.014, respectively). Conclusions: Stool frequency and CRP level were the meaningful parameters among the predictors for steroid treatment response. Furthermore, several predictive models for steroid treatment failure in western countries seem to be of value for use in the Korean population. (Intest Res 2012;10:251-264)

런던 도클랜드 Royal Docks 재개발 사업의 도시유형론적 분석

김정욱(Kim Jung Wook),김종수(Kim Jong su) 한국정책개발학회 2011 정책개발연구 Vol.11 No.2

본 연구는 런던 도클랜드의 Royal Docks 재개발 사업 중 일부 사례의 추진 과정을 도시유형론적 관점에서 분석하였다. H. V. Savitch의 도시유형론의 관점에서 Royal Docks의 사례를 분석하기 위해 Royal Docks 내에서 진행된 일부 사업의 의사결정과정에 참여한 이해관계자를 중심으로 살펴보았다. Royal Docks 재개발 사업은 도클랜드 개발공사와 Newham Borough of London의 협력 또는 의회의 의제 제시 등을 통해 집행되기 시작되었다. 그러나 사업이 진행되면서 공청회와 포럼 등을 통해 지역주민들과 지역 내의 시민 단체가 참여하여 그들의 의견이 수렴 반영되기도 하였으며, 각 사업의 특성에 따라 왕실의 의견을 제시하거나 각종 재단과 기업, 지역 공사, 대학, 민간개발업자 등의 참여가 이루어지기도 하였다. Royal Docks의 재개발 사업은 중앙정부의 위임을 받은 도클랜드 개발공사와 지방정부 그리고 의회의 주도로 진행 되지만, 사업이 진행될수록 다양한 이해관계자들이 참여하고, 그들의 의견이 반영되는 모습을 보이고 있다. Savitch의 도시유형론에 따르면, Royal Docks의 재개발 사업은 조합주의를 따르는 방식으로 진행되었다고 볼 수 있을 것이다. This research analyzed the redevelopment project of the Dockland Royal Docks of London into the view of urban typology. It was focused on the stakeholder who had participated in decision-making process to analyze the case of Royal Docks into H. V. Savitch's Urban typology. At first, the redevelopment project of Royal Docks leaded by London Dockland Development Corporation, the Newham Borough of London and the Council. In the process of the project, however, Newham borough residents and local ngos insisted their situations and opinions in the some forums and public hearings. And some foundations, an university , local public corporations, private developers and private corporations participated in some projects. In other words, it was seemed that LDDC, Newham Borough and Council conducted the redevelopment project in Royal Docks, they cooperated with various stakeholder, such as residents, private developers and corporations etc. Therefore, on the view of Savitch's Urban Typology, Royal Docks redevelopment project could be explained as s type of corporatism.

진단방사선 일반촬영에서의 X-ray Beam Collimator 사용 전국 실태조사

김지혜,성동욱,김정욱,신진호,이순근,정경일,엄종권,이기남,성호진,김윤현,김혁주,Kim, Jee Hye,Sung, Dong-Wook,Kim, Jeong Wook,Shin, Jin Ho,Lee, Soon Keun,Jung, Kyung Il,Uhm, Jong Kwan,Lee, Ki Nam,Seong, Ho Jin,Kim, Youn Hyun,Kim, Hyeog J 한국의학물리학회 2013 의학물리 Vol.24 No.2

방사선 검사에서 CR, DR의 도입으로 인해 X-선속 조사야의 사용이 경시되고 있는 실정이다. 일반방사선 검사에서 검사 부위별 조사야를 적절히 사용하고 있는지에 대해 현장 실태 조사와 설문 조사하고, 조사야의 기준의 필요성을 강조하며 표준 조사야를 제시하고자 한다. 서울, 경기도, 전라도, 충청도, 강원도, 부산 지역 총 333개 의료기관을 대상으로 X-선속 조사야의 사용 실태를 현장 조사하여, 검사부위별, 의료기관종별, 영상종류별로 조사야 조절의 사용 여부를 분석하였다. 또한 조사야 조절이 방사선피폭에 미치는 영향과 인식을 평가하기 위해 종합병원 10곳, 병원 10곳, 의원 10곳의 일반촬영실에 근무하는 168명의 방사선사를 대상으로 X-선속 조사야 조절이 환자피폭선량 저감화에 끼치는 영향에 대한 인식, 조사야 조절 방법과 실제 사용하고 있는 검사부위별 X-선속 조사야 크기를 설문 조사하였다. 검사부위별 적합한 조사야을 사용하고 있는 의료기관은 61.3%이었으나, 주요 장기가 밀집된 요추 검사의 경우에는 적합한 사용이 49.9%에 불과하였다. 의료기관종별에서는 종합병원이 약 69%, 영상종류별로 보면 DR을 사용하는 병원의 65.0%에서 적합한 조사야을 사용하였다. 설문 조사에서는 응답자의 97.6%가 조사야 조절이 환자에게 끼치는 선량을 줄일 수 있다고 인식하고 있었으나, 실제로 부위별 X-선속 조사야의 크기를 조절하여 검사하는 경우는 83.3%이었다. 일반방사선 검사에서 적절한 조사야를 사용하는 경우가 실태조사를 통해 낮게 나타났으며 이는 환자에 대한 방사선 피폭선량을 줄이기 위한 노력이 시급히 필요하며, 조사야에 대한 통일된 표준 규격이 필요하여 철저한 교육이 동반되어야 한다. Due to the introduction of CR and DR, it has been neglected the use of the X-ray beam collimator and field size. This study examines nationwide survey of the proper use of collimator and field size by area in a specific field of plain radiography and the current status. Authors emphasized the need for the field size criteria, and propose a standard reference field size in each specific radiologic examination. Total 333 medical institutions (included in Seoul, Gyeonggi-do, Jeolla, Chungcheong, Gangwon-do, Busan area), were investigated in relation to the status of the X-ray beam collimation field size, type specific inspection areas, medical facilities, and image analyses by type to figure out whether they use the adjustment of image field to the specific examination. To assess the awareness and the impact of radiation exposure to the collimation adjustable, 168 radiographers who was working in 10 general hospitals, 10 hospitals, and 10 clinics, were surveyed how they haver adjusted the actual field size. We examine that 61.3% of medical institutions used the "Proper collimation" and only 49.9% of them employed proper one in lumbar spine densely crowded by major organs. 69% among general hospitals, and 65% among hospitals using DR system were using proper collimation. Radiographers recognized that proper adjustment of collimation could reduce the harmful radiation dose on patients. In the survey, 97.6% of respondents were aware of this fact, but only 83.3% of respondents did the adjustment of the size of the collimation field. The using of proper collimation field was low in the nationwide survey, so the effort to reduce the radiation dose on the patients is urgently needed. A unified standard for the field accompanied by thorough education should be needed.

내시경 역행 췌담관조영술 중 경췌중격절개술 후 발생한 벽내 십이지장 혈종 및 문헌고찰

김정곤 ( Jung Gon Kim ),백우현 ( Woo Hyun Paik ),김재형 ( Jae Hyung Kim ),김정욱 ( Jong Wook Kim ),배원기 ( Won Ki Bae ),김남훈 ( Nam Hoon Kim ),김경아 ( Kyung Ah Kim ),이준성 ( June Sung Lee ) 대한췌장담도학회 2016 대한췌담도학회지 Vol.21 No.1

Transpancreatic septotomy is known to improve the success rate of selective bile duct cannulation in endoscopic retrograde cholangiopancreatography. Recent retrospective study reported that transpancreatic septotomy is more effective and safer than needle knife sphincterotomy. Herein, we report a case of patient with gallstone pancreatitis who suffered from intramural duodenal hematoma after transpancreatic septotomy that caused obstruction of the duodenum and hypovolemic shock. The intramural hematoma improved after conservative management. The rare adverse event such as intramural duodenal hematoma seems to be considered after transpancreatic septotomy, especially when acute pancreatitis is accompanied.

단일 기관에서 경험한 크론병에서 Infliximab의 치료 효과

김연주 ( Yeon Ju Kim ),김정욱 ( Jung Wook Kim ),이창균 ( Chang Kyun Lee ),박현진 ( Hyun Jin Park ),심재준 ( Jae Jun Shim ),장재영 ( Jae Young Jang ),동석호 ( Suk Ho Dong ),김효종 ( Hyo Jong Kim ),김병호 ( Byung Ho Kim ),장영운 ( Y 대한소화기학회 2013 대한소화기학회지 Vol.61 No.5

Background/Aims: Our aim was to assess the long-term data regarding efficacy and safety of infliximab (IFX) treatment for refractory Crohn`s disease (CD) patients in our tertiary teaching hospital. Methods: We have retrospectively analyzed the medical records of 89 CD patients who underwent IFX treatment between March 2003 and February 2011 at Kyung Hee University Hospital (Seoul, Korea). The primary outcome measurements were the rates of initial clinical response (CR) at 10 weeks after the 1st IFX infusion and sustained CR at the end of the follow-up. Overall adverse events related to IFX treatment were also evaluated. Results: The mean (SD) follow-up period of eligible 80 patients was 33.7 (21.9) months. A total of 77 patients (96%) showed initial clinical response, but 8 patients showed loss of response to IFX during the follow-up. Finally, 59 patients (59/77, 76.6%) showed sustained CR at the end of the study. Logistic regression analyses showed that an initial CR at 10 weeks was the independent predictor associated with sustained CR (OR 22.286, 95% CI 2.742-132.717, p=0.001). Overall adverse events reported in 18 patients (18/80, 23.3%), including 3 serious infection (pulmonary tuberculosis and herpes zoster). Conclusions: Treatment with IFX was efficacious and relatively safe for refractory CD patients in Korea. An initial CR at 10 weeks was significantly associated with sustained CR.