6 - Sigma 경영혁신기법 시행에 따른 방사선과 내부고객만족도의 변화

이근옥,박재성,강충환,김미영,김승식,Lee, Keun-Ohk,Park, Jai-Soung,Kang, Chung-Hwan,Kim, Mi-Young,Kim, Seung-Sick 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.1

Background : The concept of 'service' in a hospital is based on the quality of medical staffs who serve as customer-satisfying media, and this is what distinguishes general hospitals from other business corporations in which customer satisfaction is achieved through commercial products. Thus, the internal employee satisfaction is essential in the improvement of the 'service' and subsequent 'competitiveness' of a hospital. The purpose of this study is to establish internal marketing strategies for a general hospital through regular surveys on employee satisfaction. Method : Surveys on employee satisfaction in radiology department were conducted regularly twice a year in a university hospital with 800 beds 2001 in 2004. The subjects of this study were 35 employees who work in radiology department. The authors developed the questionnaires and the surveys were conducted initially during the first 6 months of the year. After necessary improvements were made by applying 6 Sigma techniques, subsequent surveys were conducted during the latter 6 months of the year and the degree of employee satisfaction was compared. Results : Overall satisfaction increased with a constant rate and the authors were able to assess that the hospital is being gradually stabilized. The degree of satisfaction assessed by multiple choices showed only minor changes. However, as a result of focusing on the demands put forth by the employees through the open questions, the degree of satisfaction increased gradually year after year. Conclusions : It is important to heighten the internal employee satisfaction systematically and harmoniously through the assessment on the demands of the internal customers and feedback-based communications between the management officers and the staffs. Continuous surveys on the internal employee satisfaction will serve to be valuable materials in the establishment of internal marketing strategies for a general hospital.

Effects of Gadolinium Contrast agent on Bone Mineral Density Measurement using Dual Energy X-ray Absorptiometry

이근옥(Keun-Ohk Lee),이민수(Min-Su Lee) 한국방사선학회 2021 한국방사선학회 논문지 Vol.15 No.1

골밀도검사에서 측정값에 영향을 주는 요인 중 하나인 방사선 조영제는 진단 목적으로 사용되어 조직 등에 흡수되어 골밀도 측정값을 높이는 효과가 있어, 골밀도검사 시행 전에는 될 수 있으면 피하고 있다. 이러한 방사선 조영제와는 다른 물리적 특성과 작용기전을 갖는 MRI 조영제는 금속원소인 가돌리늄 기반으로 방사선 불투과성 특징을 가지고 있어 일반적으로 방사선을 이용한 검사 전에 MRI 검사를 선 시행하고 있다. 본 연구에서는 MRI 조영제가 이중에너지 X-선 흡수법을 이용한 골밀도검사에 미치는 영향을 알아보고자 하였다. 가돌리늄 기반의 MRI 조영제 2종을 아크릴 수조에 용량별로 주입하여 인체모형 척추 팬텀을 넣고, 각 주입량 종류별로 5회씩 총 30회 scan 하여 L1-L4 번까지의 골밀도와 T-score를 분석하였다. 측정된 2종의 조영제별 Total(L1-L4) 골밀도의 평균값은 가도테레이트 메글루민성분 0mL, 7.5mL, 15mL일때, 각각 0.952±0.052, 0.957±0.050, 0.956±0.05 g/㎠로 나타났으며, 가도부트롤성분 0mL, 5mL, 10mL일 때, 각각 0.953±0.001, 0.954±0.001, 0.945±0.001g/㎠로 모든 부위에서 통계적으로 유의한 차이는 없었다(p>0.05). T otal (L1-L4) T-score의 평균값은 가도테레이트 메글루민성분은 0mL, 7.5mL, 15mL일 때, 각각 –0.46±0.05, -0.4±0, -0.42±0.04로 나타났으며, 가도부트롤성분 0mL, 5mL, 10mL일 때, 각각 –0.46±0.05, -0.46±0.05, 0.5±0.00으로 모든 부위에서 통계적으로 유의한 차이는 없었다(p>0.05). 본 실험에서는 MRI 조영제는 이중에너지 X-선 흡수법을 이용한 골밀도검사에 영향이 없는 것으로 나타났으나, 임상 대상이 아닌 제한적 조건의 인체모형 팬텀을 사용하여 조영제의 배출시간에 영향을 주는 신장 기능, 신체 상태 등이 고려되지 못한 제한점이 있어 추후 추가적인 임상연구 진행이 필요할 것으로 사료된다. Radiographic contrast agents are used for diagnostic purposes and are one of the factors affecting measured values in bone density tests. They are absorbed into tissues and have an effect of increasing the measured values of bone density, so they are avoided as much as possible before performing a bone density test. MRI contrast agents, which have different physical properties and mechanisms of action than radiographic contrast agents, are based on gadolinium, a metal element. They have radiopacity characteristics, so MRI are generally performed prior to examination using radiation. The purpose of this study was to investigate the effects of MRI contrast agents on bone mineral density examination using dual energy X-ray absorption. Two types of gadolinium based MRI contrast agents were injected into an acrylic water tank for each volume, and the humanoid spine phantom was inserted and the BMD and T-score from (L1-L4) were analyzed by scanning a total of 30 times, 5 times for each injection type. The average value of the measured total (L1-L4) bone density for each of the two contrast agents was 0.952±0.052, 0.957±0.050, and 0.956±0.05g/㎠, respectively, for the Gadoterate Meglumine component 0mL, 7.5mL and 15mL, when the gadobutrol components were 0mL, 5mL, and 10mL, there was no statistically significant difference at all sites at 0.953±0.001, 0.954±0.001, and 0.945±0.001g/cm2, respectively(p>0.05). The average value of total T-score was -0.46±0.05, -0.4±0, -0.42±0.04 when the Gadoterate Meglumine component was 0mL, 7.5mL and 15mL, respectively. When the Gadobutrol ingredients were 0mL, 5mL and 10mL, there was no statistically significant difference in all areas, with -0.46±0.05, -0.46±0.05, and 0.5±0.00, respectively. In this experiment, the MRI contrast agent was found to have no effect on bone density tests, using the dual-energy X-ray absorption method. There is a limitation in that physical conditions such as kidney and health conditions etc. were not taken into consideration, so further clinical research is expected to be conducted in the future.

Determination of Appropriate Exposure Angles for the Reverse Water’s View using a Head Phantom

이민수(Min Su Lee),이근옥(Keun Ohk Lee),최재호(Jae Ho Choi),정재홍(Jae Hong Jung) 대한방사선과학회(구 대한방사선기술학회) 2017 방사선기술과학 Vol.40 No.2

상안면부 외상(upper facial trauma)의 초기진단에서 standard Water s view (S-Water s)는 여러 구조물의 중첩과 얇은 뼈의 해부학적 특성 때문에 검사 시 적절한 노출조건, 정확한 환자위치잡이, 환자의 도움, 촬영자의 전문성과 숙련도가 필요하다. 본 연구는 엎드린 자세가 불가능한 경우 안와 골절에 대한 진단적 가치를 높이고 자 reverse Water s view (R-Water s)의 적절한 각도를 찾고자 하였다. 인체모형 팬텀를 사용하였고, 촬영조건은 75 kVp, 400 mA, 45 ms, 1 mAs, SID 100 cm였다. 검사방법은 팬텀을 테이블에 똑바로 누운 자세에서 orbito-meatal line (OML)의 각도를 0°에서 50° 범위에서 촬영 각도를 조절하여 영상을 얻었다. R-Water s 영상 평가는 자체 개발한 평가항목을 토대로 분석하였다. 세부항목으로는 상악동(maxillary sinus), 관골궁(zygomatic arch), 추체부(petrous ridge)와 영상왜곡(image distortion)이었다. 통계분석은 Kippendorff s alpha와 kappa를 확장한 Fleiss kappa를 적용하였다. 각 항목별 총 세 명의 평가자에 대한 일치도는 상악동, 0.957 (0.903, 0.995); 관골궁, 0.939 (0.866, 0.987); 추체부, 0.972 (0.897, 1.000); 영상 왜곡, 0.949 (0.830, 1.000)로 모두 높았다. 측정별 각도 구간을 분석에 대한 high-quality (HI)와 perfect agreement (PA)로 정의하여 각 항목별로 점수화한 결과, 상악동 (36° - 44°), 관골궁 (33° - 40°), 추체능선 (32° - 50°), 영상왜곡 (44° - 50°)구간에서 높았다. 본 연구결과 상안면부 외상환자에 있어 똑바로 누운 자세에서의 R-Water s의 적정 각도는 36° - 40°로 판단된다. 본 연구결과는 단순촬영을 통한 안면부 골절의 신속한 진단에 도움을 줄 것으로 사료된다. Early diagnosis for upper facial trauma is difficult by using the standard Water s view (S-Water s) in general radiograph due to overlapping of anatomical structures, the uncertainty of patient positioning, and specific patients with obese, pediatric, old, or high-risk. The purpose of this study was to analyze appropriate exposure angles through a comparison of two different protocols (S-Water s vs. reverse Water s view (R-Water s)) by using a head phantom. A head phantom and general radiograph with 75 kVp, 400 mA, 45 ms 18 mAs, and SID 100 cm. Images of R-Water s were obtained by different angles in the range of 0° to 50°, which adjusted an angle at 1 degree interval in supine position. Survey elements were developed and three observers were evaluated with four elements including the maxillary sinus, zygomatic arch, petrous ridge, and image distortion. Statistical significant analysis were used the Krippendorff s alpha and Fleiss kappa. The intra-class correlation (ICC) coefficient for three observers were high with maxillary, 0.957 (0.903, 0.995); zygomatic arch, 0.939 (0.866, 0.987); petrous ridge, 0.972 (0.897, 1.000); and image distortion, 0.949 (0.830, 1.000). The high-quality image (HI) and perfect agreement (PA) for acquired exposure angles were high in range of the maxillary sinus (36° - 44°), zygomatic arch (33° - 40°), petrous ridge (32° - 50°), and image distortion (44° - 50°). Consequently, an appropriate exposure angles for the R-Water s view in the supine position for patients with facial trauma are in the from 36° to 40° in this phantom study. The results of this study will be helpful for the rapid diagnosis of facial fractures by simple radiography.

6-Sigma경영혁신기법 시행에 따른 방사선과 내부고객만족도의 변화

이근옥,박재성,강충환,김미영,김승식 한국의료QA학회 2005 한국의료질향상학회지 Vol.12 No.1

Background : The concept of 'service' in a hospital is based on the quality of medical staffs who serve as customer-satisfying media, and this is what distinguishes general hospitals from other business corporations in which customer satisfaction is achieved through commercial products. Thus, the internal employee satisfaction is essential in the improvement of the 'service' and subsequent 'competitiveness' of a hospital. The purpose of this study is to establish internal marketing strategies for a general hospital through regular surveys on employee satisfaction. Method : Surveys on employee satisfaction in radiology department were conducted regularly twice a year in a university hospital with 800 beds 2001 in 2004. The subjects of this study were 35 employees who work in radiology department. The authors developed the questionnaires and the surveys were conducted initially during the first 6 months of the year. After necessary improvements were made by applying 6 Sigma techniques, subsequent surveys were conducted during the latter 6 months of the year and the degree of employee satisfaction was compared. Results : Overall satisfaction increased with a constant rate and the authors were able to assess that the hospital is being gradually stabilized. The degree of satisfaction assessed by multiple choices showed only minor changes. However, as a result of focusing on the demands put forth by the employees through the open questions, the degree of satisfaction increased gradually year after year. Conclusions : It is important to heighten the internal employee satisfaction systematically and harmoniously through the assessment on the demands of the internal customers and feedback-based communications between the management officers and the staffs. Continuous surveys on the internal employee satisfaction will serve to be valuable materials in the establishment of internal marketing strategies for a general hospital.