87년도 춘계 연수강좌 강의록 : 수술중 방사선 치료 ( IORT )

노준규 대한외과학회 1987 대한외과학회 학술대회자료집 Vol.- No.-

암 환자에 있어 통증의 고식적 방사선 치료요법

노준규 최신의학사 1986 最新醫學 Vol.29 No.10

광자선 소조사면에 대한 다이아몬드 검출기의 선량특성에 관한 연구

노준규,박성용,신동오,권수일,이길동,김우철,조영갑,Loh, John-K.,Park, Sung-Y.,Shin, Dong-O.,Kwon, Soo-I.,Lee, Kil-D.,Kim, Woo-C.,Cho, Young-K. 대한방사선방어학회 1999 방사선방어학회지 Vol.24 No.4

고 에너지 광자선 소조사면에 대한 선량 특성은 조사면내의 급격한 선량 변화와 측면 전자 평형상태하의 측정이 어려우므로 정확하게 파악하기 어렵다. 다이아몬드 검출기를 이용하여 광자선 에너지 4, 6, 그리고 10 MeV에 대한 소조사면의 선량특성을 측정하였고 그 값들을 작은 용적의 원통형과 평행평판형 이온함의 선량특성과 비교하였다. 다이아몬드 검출기와 원통형 이온함을 이용하여 의료용 선형가속기에서 방출되는 광자선 에너지 6 MeV X-선, 10 MeV X-선에 대한 소조사면($1{\times}1,\;1.5{\times}1.5,\;2{\times}2,\;3{\times}3,\;4{\times}4\;cm^2$)에 대하여 심부선량백분율, 측면 선량분포를 측정하였다. 또한 다이아몬드 검출기, 원통형 이온함 및 평행평판형 이온함을 이용하여 광자선 에너지 4 MeV X-선, 6 MeV X-선 및 10 MeV X-선으로 소조사면의 크기를 $1{\times}1\;cm^2$에서 $0.5\;cm^2$간격으로 $4{\times}4\;cm^2$까지 변화하면서 출력계수를 측정하였다. 세 가지 측정기에 대한 출력계수를 비교한 결과 광자선 에너지 4 MeV X-선은 조사면의 크기 $2{\times}2\;cm^2$, 6 MeV X-선은 $2.5{\times}2.5\;cm^2$ 그리고 10 MeV X-선은 $3{\times}3\;cm^2$이상에서 출력계수가 $\pm$1.2% 내외로 잘 일치하였으나 원통형과 평행평판형 이온함에 대한 출력계수는 조사면의 크기가 작아질수록 다이아몬드의 검출기와 비교하여 낮게 평가되었는데 이는 원통형과 평행평판형 이온함의 측면전자평형상태가 이루어지지 않아 낮게 평가되었다. 광자선 에너지 6 MeV X-선과 10 MeV X-선에 대한 심부선량백분율은 다이아몬드 검출기와 원통형 이온함이 조사면의 크기 $3{\times}3\;cm^2$까지 $\pm$1.5% 내외로 잘 일치하였으나 조사면의 크기가 작고 깊이가 깊어짐에 따라 다이아몬드의 심부선량백분율이 크게 평가되었다. 측면 선량분포는 원통형 이온함의 반음영의 크기가 측정된 소조사면에 대하여 다이아몬드 검출기보다 크게 나타났다. 측면 선량분포는 다이아몬드 검출기가 상대적으로 이온함에 비해 민감 용적이 작고 높은 분해능을 가지므로 반음영이 작은 것으로 사료된다. 따라서 고 에너지 광자선 소조사면에 대한 선량 측정시 검출기의 민감 용적이 작고 분해능이 우수하며 물과 등가인 다이아몬드 검출기는 이온함에 비해 상대적으로 우수한 것으로 생각된다. It is difficult to determine dosimetric characteristics for small field photon beams since such small fields do not achieve complete lateral electronic equilibrium and have steep dose gradients. Dosimetric characteristics of small field 4, 6, and 10 MeV photon beams have been measured in water with a diamond detector and compared to measurements using small volume cylindrical and plane parallel ionization chambers. Percent depth dose (PDD) and beam profiles for 6 and 10 MeV photon beams were measured with diamond detector and cylindrical ion chamber for small fields ranging from $1{\times}1\;to\;4{\times}4cm^2$. Total scatter factors($S_{c,p}$) for 4, 6, and 10 MeV photon beams were measured with diamond detector, cylindrical and plane parallel ion chambers for small fields ranging from $1{\times}1\;to\;4{\times}4cm^2$. The $S_{c,p}$ factors obtained with three detectors for 4, 6, and 10 MeV photon beams agreed well ($\pm1.2%$) for field sizes greater than $2{\times}2,\;2.5{\times}2.5,\;and\;3{\times}3\;cm^2$, respectively. For smaller field sizes, the cylindrical and plane parallel ionization chambers measure a smaller $S_{c,p}$ factor, as a result of the steep dose gradients across their sensitive volumes. The PDD values obtained with diamond detector and cylindrical ionization chamber for 6 and 10MeV photon beams agreed well ($\pm1.5%$) for field sizes greater than $4{\times}4\;cm^2$. For smaller field sizes, diamond detector produced a depth-dose curve which had a significantly shallower falloff than that obtained from the measurements of relative depth-dose with a cylindrical ionization chamber. For the measurements of beam profiles, a distortion in terms of broadened penumbra was observed with a cylindrical ionization chamber since diamond detector exhibited higher spatial resolution. The diamond detector with small sensitive volume, near water equivalent, and high spatial resolution is suitable detector compared to ionization chambers for the measurements of small field photon beams.

직장암 치료에 있어 방사선 치료의 역할

노준규,이창걸,성진실,김수곤,박경란,서창옥,김귀언,Loh Juhn Kyu,Lee Chang Geol,Seong Jin Sil,Kim Soo Kon,Park Kyung Ran,Suh Chang Ok,Kim Gwi Eon 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.2

A total of 93 patients with rectal cancer treated with radiotherapy at department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center between January 1974 and December 1983 are retrospectively analysed. The patients are divided into three groups as follows: I. Postoperative radiotherapy, II. Postoperative recurrent, III. Unresectable or Inoperable group. In postoperative radiotherapy group, overall 5 year survival rate is $34.8\%$ and prognostic factors are presence of obstruction and degree of differentiation. In postoperative recurrent group, overall 2 year survival rate is $7.4\%$ with median survival of 13 months and prognostic factors are RT responsiveness and sex, and the local failure rate is $22.7\%$. In unresectable or inoperable group, overall 2 year survival rate is $19.8\%$ with median survival of 12.6 months and prognostic factors are RT responsiveness and RT dose. The complications for RT are not significant and are acceptable in all patients.

하지 외골격 로봇을 위한 Disturbance Observer Control 기반의 HRI 제어기 설계 및 성능 검증

노준규(J.K. No),황순근(S.G. Hwang),임동환(D.H. Lim),정진현(J.H. Jeong),한창수(C.S. Han) 한국정밀공학회 2018 한국정밀공학회 학술발표대회 논문집 Vol.2018 No.5월

비인강암의 방사선 치료 성적

이종영(Jong Young Lee)·노준규(John J.K. Loh)·서창옥(Chang Ok Suh)·이연구(Yonu Goo Lee)·홍원표(Won Pyo Hong) 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

This study is the retrospective evaluation of ninety-six patients with biopsy-proven carcinoma of nasopharynx treated with radiotherapy at Yonsei University, College of Medicine Radiation Oncology from January 1971 to December 1985. Patient's age ranged from 15 to 71 years with a median age of 49 years. Fifty-two point five percent of local control and 47.5% of actuarial 5 year survival were achieved with radical radiotherapy. Five year survival rate for Stage I & II, III and IV were 75.0%, 74.6% and 41.4%, respectively. Distant metastasis rate was related with N stage (N1 12.5%, N1 0%, N2 23.5%, N3 32.1%) and histologic type (lymphoepithelioma 41.7% squamous cell carcinoma 6.5%) but not with T stage. Thirty-one of sixty-seven patient covered adequate radiation field received induction chemotherapy. However induction chemotherapy does not appear to improve over all survival.

Effect of Radiofrequency Induced Local Hyperthermia on Normal Canine Liver

Chang Ok Suh(서창옥) , John J.K.Loh(노준규) , Jin Sil Seong(성진실) , Sun Rock Moon(문성록) Hyung Sik Lee(이형식) , Hyun Soo Shin(신현수) , Sung Sil Chu(추성실) , Gwi Eon Kim(김귀언) , Chan Il Park(박찬일) ,Eun Kyung Han(한은경) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

간조직에 온열치효를 시행시 출현하는 조직병리학적 소견 및 혈액의 생화학적 소견을 관찰하고자 13마리의 정상 간에 8MHz 라디오파를 이용한 온열치료를 시행하였다. 42.5±0.5°C로 30분간 온열치료를 받은 군 (제1군, n=5), 45±0.5°C로 30분간 온열치료를 받은 군 (제2군, n=5) 및 온열치료를 받지않은 대조군(n=3)으로 나누어 분석하였을때, 혈액의 SGOT의 SGPT는 온열치료를 시행한 두군 공히 증가된 소견을 보였고 제 1군에서는 간세포의 부종소견의 특이한 조직병리학적소견이 관찰되지않아 가역성 변화로 생각되었지만 제2군에서는 간 세포의 심한 괴사소견이 관찰되어 있는 불가역성의 가조직 손상으로 생각되었다. 이상의 결론으로 유추할 때 임상에서 행하여지는 간암의 온열치료시에 정상 가조직의 손상을 가능한 방지하기위하여는 정확한 종괴의 구역에 치료온도의 주의깊은 관찰이 요구된다. In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthermia in canine liver were studied. Hyperthemia was externally adminsitered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. Group I (N=5) was heated with 42.5±0.5°C for 30 minutes, and Group Ⅱ (N=5) was heated with 45±0.5°C for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately after hyperthermia and 7, 14, and 28 days after treatment. Blood samples were obtained before treatment and 1, 3, 5, 7, 14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in Group Ⅰ. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with 45°C for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liver damage dy heat of 42.5±0.5°C for 30 minutes is reversible, and liver damage by heat of 45±0.5°C for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in order to apply hyperthermic treatment on human liver tumor safely, close observation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.

The Study of Shielding Effect on Ovoids of Three Different Gynecological Applicator Sets in microSelectron-HDR System

Loh,John J.K.,Kim,Woo C.,Cho,Young K.,Kim,Hung J.,Choi,Jin H.,Park,Sung Y.,Kim,Joo Y. 대한방사선 방어학회 1998 방사선방어학회지 Vol.23 No.4

Nucletron사의 microSelectron-High Dose-Rate(HDR) System에서 부인암의 강내 근접치료에 사용되는 standard shielded applicator set(SSAS)와 Fletcher-Williamson applicator set(FWAS)는 standard applicator set(SAS) 와 비교해서 다른 점이 ovoids 위와 아래 부분에 방광과 직장으로 가는 선량을 줄이기 위해 각각 스테인레스 강철(밀도 (밀도 ρ=8,000 ㎏/㎥)과 텅스텐 합금(밀도 ρ=14,000 ㎏/㎥)으로 차폐가 되어 있다. 이에 본 연구에서는 특별히 고안한 지지장치를 사용해서 국제방사선단위위원회(ICRU) 보고서 38에서 권고한 직장과 방광의 위치에 대하여 두 shielded ovoids의 차례효과가 어느 정도인가를 알아보고자 하였다. 지지장치를 PTW사의 전산화된 3차원 물팬톰에 부착하고 SAS의 ovoids를 지지장치에 고정하였다. Ovoids의 끝 부분을 전리함(PTW 0.125cc)의 측정점 높이와 일치시키고 전리함을 좌우로 이동시키면서 선량을 측정하여 두 ovoids의 중간 위치를 확인하였다. 직장에 미치는 선량은 ovoids의 중간에 위치한 선원 M5로부터 posterior방향으로 수직으로 위치한 점들인 20(R1), 25(R2), 30(R3), 40(R4), 50(R5), 60(R6) mm 에서 측정하였다. 방광에 미치는 선량은 M5로 부터 anterior방향으로 수직으로 위치한 점들인 20(B1), 30(B2), 40(B3), 50(B4), 60(B5) mm에서 측정하였다. 위와 같은 방법으로 SSAS와 FWAS의 ovoids에서도 각각의 점들에 대한 선량을 측정하였다. SAS와 SSAS의 직장에 미치는 선량차이는 실제 임상에서의 관심 점들과 가장 가까운 25 mm(R2) 30 mm(R3)거리에서 각각 8.0%, 6.0%였고 SAS와 FWAS의 직장에 미치는 선량차이는 25 mm(R2)와 30 mm(R3)거리에서 각각 25.0%, 23.0%로 나타났다. SAS와 SSAS의 방광에 미치는 선량차이는 20 mm(B1)와 30 mm(B2)거리에서 각각 8.0%, 3.0%였고 SAS와 FWAS의 방광에 미치는 선량차이는 20 mm(B1)와 30 mm(B2)거리에서 각각 23.0%, 17.0%로 나타났다. SAS를 SSAS나 FWAS가 SSAS보다 차폐효과가 더 좋은 것으로 나타났으며 이 두 종류의 shielded applicator set는 부인암의 근접치료시 직장과 방광으로 가는 선량을 감소시켜 환자치료의 최적화를 이룰 수 있을 것으로 생각된다. There are three different types of gynecological applicator sets available in microSelectron-high dose-rate(HDR) System by Nucletron; standard applicator set(SAS), standard shielded applicator set(SSAS), and Fletcher-Williamson applicator set(FWAS). Shielding effect of a SAS without shielding material was compared with that of a SSAS with shielding material made of stainless steel(density ρ=8,000 ㎏/㎥) at the top and bottom of each ovoid, and of a FWAS with shielding material made of tungsten alloy(density ρ=14,000 ㎏/㎥) at the top and bottom of each ovoid. The shielding effects to the rectum and bladder of these two shielded applicator sets were to be measured at reference points with an ion chamber and specially designed supporting system for applicator ovoids inside of the computerized 3-dimensional water phantom. To determine the middle point of two ovoids the measurement was performed with the reference tip of ion chamber placed at the same level and at the middle point from the two ovoids, while scanning the dose with the ion chamber on each side of ovoids. The doses to the reference points of rectum were measured at 20(R1), 25(R2), 30(R3), 40(R4), 50(R5), and 60(R6) mm located posteriorly on the vertical line drawn from M5(the middle dwell position of ovoid), and the doses to the bladder were measured at 20(B1), 30(B2), 40(B3), 50(B4), and 60(B5) mm located anteriorly on the vertical line drawn from M5. The same technique was employed to measure the doses on each reference point of both SSAS and FWAS. The differences of measured rectal doses at 25 mm(R2) and 30 mm(R3) between SAS and SSAS were 8.0 % and 6.0 %: 25.0% and 23.0% between SAS and FWAS. The differences of measured bladder doses at 20 mm(B1) and 30 mm(B2) between SAS and SSAS were 8.0% and 3.0%: 23.0% and 17.0% between SAS and FWAS. The maximum shielding effects to the rectum and bladder of SSAS were 8.0% and 8.0%, whereas those of FWAS were 26.0% and 23.0%, respectively. These results led to the conclusion that FWAS has much better shielding effect than SSAS does, nd when SSAS and FWAS were used for gynecological intracavitary brachytherapy in microSelectron-HDR system, the dose to the rectum and bladder was significantly reduced to optimize the treatment outcome and to lower the complication rates in the rectum and bladder.

Effects of Radiofrequency Induced Local Hyperthermia on Normal Canine Liver

서창옥,노준규,신현수,이형식,문성록,성진실,추성실,김귀언,한은경,박찬일,Suh Chang Ok,Loh. John J.K.,Shin Hyun Soo,Lee Hyung Sik,Moon Sun Rock,Seong Jin Sil,Chu Sung Sil,Kim Gwi Eon,Han Eun Kyung,Park Chan Il The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

간조직에 온열치효를 시행시 출현하는 조직병리학적 소견 및 혈액의 생화학적 소견을 관찰하고자 13마리의 정상 간에 8 MHz 라디오파를 이용한 온열치료를 시 행하였다. $42\pm0.5^{\circ}C$로 30분간 온열치료를 받은 군(제 1 군, n=5), $45\pm0.5^{\circ}C$로 30분간 온열치료를 받은 군(제 2군, n=5) 및 온열치료를 받지않은 대조군(n=3)으로 나누어 분석하였을때, 혈액의 SGOT의 SGPT는 온열치료를 시행한 두군 공히 증가된 소견을 보였고 제 1군에서는 간세포의 부종소견외 특이한 조직병 리학적소견이 관찰되지않아 가역성 변화로 생각되었지만 제 2군에서는 간세포의 심한 괴사소견이 관찰되어 있는 불가역성의 가조직 손상으로 생각되었다. 이상의 결론으로 유추할때 임상에서 행하여지는 간암의 온열치료시에 정상 가조직의 손상을 가능한 방지하기위하여는 정확한 종괴의 구역에 치료온도의 주의깊은 관찰이 요구된다. In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthermia in canine liver were studied. Hyperthermia was externally adminsitered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. Group I (N=5) was heated with $42.5\pm0.5^{\circ}C$ 30 minutes, and Group II (N=5) was heated with $45\pm0.5^{\circ}C$ for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately after hyperthermia and T,14, and 28 days after treatment. Blood samples were obtained before treatment and W, 3,5, 7,14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in Group 1. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with $45^{\circ}C$ for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liverdamage dy heat of $42.5\pm0.5^{\circ}C$ for 30 minutes is reversible, and liver damage by heat of $45\pm0.5^{\circ}C$ for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in erder to apply hyperthermic treatment on human liver tumor safely, close obsewation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.

비인강암의 방사선 치료 성적

이종영,노준규,서창옥,이연구,홍원표,Lee Jong Young,Loh John J.K.,Suh Chang Ok,Lee Youn Goo,Hong Won Pyo 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

This study is the retrospective evaluation of ninety-six patients with biopsy-proven carcinoma of nasopharynx treated with radiotherapy at Yonsei University, College of Medicine, Radiation Oncology from January 1971 to December 1985. Patient's age ranged from 15 to 71 years with a median age of 49 years. Fifty-two point five percent of local control and $47.5\%$ of actuarial 5 year survival were achieved with radical radiotherapy. Five year survival rate for Stage I&II, III and IV were $75.0\%,\;74.6\%\;and\;41.4\%$, respectively. Distant metastasis rate was related with N stage $(N1\;12.5\%,\;N1\;0\%,\;N2\;23.5\%,\;N3\;32.1\%$and histologic type (lymphoepithelioma $41.7\%$, squamous cell carcinoma $6.5\%$) but not with T stage. Thirty-one of sixty-seven patient covered adequate radiation field received induction chemotherapy. However induction chemotherapy does not appear to improve over all survival.