선형가속기의 다엽콜리메이터 형태에 따른 치료계획 비교 평가

임지혜,장남준,석진용,정윤주,원희수,정해윤,최병돈,Lim, Ji Hye,Chang, Nam Joon,Seok, Jin Yong,Jung, Yun Ju,Won, Hui Su,Jung, Hae Youn,Choi, Byeong Don 대한방사선치료학회 2018 대한방사선치료학회지 Vol.30 No.1

목 적 : 임상적으로 많이 시행하는 치료부위에 고차원 치료기법 적용 시 선형가속기에 장착된 다엽콜리메이터(Multi leaf collimator, MLC)의 형태가 치료계획에 미치는 영향을 연구해 보고자 한다. 대상 및 방법 : 본원에서 척추암, 폐암 정위적체부방사선치료(Stereotactic body radiation therapy, SBRT)를 받은 환자와 전립선암, 폐암, 두경부암, 전골반암, 유방암의 용적변조회전치료(Volumetric modulated arc therapy, VMAT)를 시행한 환자들을 부위별로 10명씩 총 70명 선정하였다. Truebeam STx(Varian Medical system, Palo Alto, CA)의 high definition MLC(HD MLC)와 Vitalbeam(Varian Medical system, Palo Alto, CA)에 장착된 millenium MLC(M MLC)를 사용하였고, 치료계획은 Eclipse(Version 13.7, Varian Palo Alto USA, CA)를 이용하여 동일한 조건으로 환자마다 각각 2개씩 수립하였다. MLC의 형태에 따른 치료계획을 평가하기 위해 PTV coverage, conformity index(CI), homogeneity index(HI)를 비교하였고, 정상조직은 각 부위별로 임상에서 사용하는 평가 지표를 분석하였으며, 정상조직에서 저 선량 영역을 비교하기 위하여 $V_{30%}$을 평가하였다. 추가적으로 각 부위별로 치료표적의 길이 및 체적을 조사하였다. 결 과 : PTV coverage는 HD MLC를 적용한 폐암 SBRT에서 평균선량이 0.52 %, 척추암 SBRT에서 평균 선량과 최대선량이 각각 0.68 %, 1.13 %로 M MLC에 비해 감소하였다. CI와 HI는 척추암 SBRT 치료계획에서 HD MLC가 1.144, 1.079로 M MLC의 1.160, 1.092 보다 낮은 수치를 나타냈다(p<0.05). 결정장기의 선량 평가는 폐암 SBRT 치료계획에서 치료받는 쪽 폐의 평균선량이 HD MLC에서 1.48 %로 낮아졌다. 전립선암 VMAT은 HD MLC를 적용한 치료계획에서 방광의 $V_{30}$과 평균선량이 0.53 %, 1.42 %, 직장의 $V_{25}$와 평균선량이 0.97 %, 0.69 %로 감소하였다(p<0.05). 유방암 VMAT은 오히려 HD MLC를 사용한 치료계획에서 심장의 평균선량이 0.83 %로 높아졌다. 다른 치료부위 평가지표들은 두 MLC를 적용한 치료계획 사이에 큰 차이를 보이지 않았다(p>0.05). 결 론 : 본 연구 결과 SBRT나 전립선암 VMAT과 같이 치료표적의 길이가 짧고 크기가 작은 경우 HD MLC를 사용하는 것이 PTV coverage 및 정상조직 보호 효과 면에서 다소 이점이 있는 것으로 나타났으나, 그 외 상대적으로 길고, 큰 폐암, 두경부암, 전골반암, 유방암 VMAT에서는 MLC의 형태가 치료계획에 미치는 영향은 크지 않았다. Purpose : An aim of this study was to compare the effect of multi leaf collimator(MLC) types for high dimension radiotherapy in treatment sites used clinically. Material and Method : 70 patients with lung cancer, spine cancer, prostate cancer, whole pelvis, head and neck, breast cancer were included in this study. High definition(HD) MLC of TrueBeam STx (Varian Medical system, Palo Alto, CA) and millenium(M) MLC of VitalBeam (Varian Medical system, Palo Alto, CA) were used. Radiotherapy plans were performed for each patient under same treatment goals with Eclipse (Version 13.7, Varian Palo Alto USA, CA). To compare the indicators of the radiotherapy plans, planning target volume(PTV) coverage, conformity index(CI), homogeneity index(HI), and clinical indicators for each treatment sites in normal tissues were evaluated. To evaluate low dose distribution, $V_{30%}$ values were compared according to MLC types. Additionally, length and volume of targets for each treatment sites were investigated. Result : In stereotatictic body radiotherapy(SBRT) plan for lung, the average value of PTV coverage was reduced by 0.52 % with HD MLC. With SBRT plan using HD MLC for spine, the average value of PTV coverage decreased by 0.63 % and maximum dose decreased by 1.13 %. In the test of CI and HI, the values in SBRT plan with HD MLC for spine were 1.144, 1.079 and the values using M MLC were 1.160, 1.092 in SBRT plan for lung, The dose evaluation of critical organ was reduced by 1.48 % in the ipsilateral lung mean dose with HD MLC. In prostate cancer volumetric modulated arc therapy(VMAT) with HD MLC, the mean dose and the $V_{30}$ of bladder and the mean dose and the $V_{25}$ of rectum were reduced by 0.53 %, 1.42 %, 0.97 %, and 0.69 %, respectively (p<0.05). The average value of heart mean dose was reduced by 0.83 % in breast cancer VMAT with M MLC. Other assessment indices for treatment sites showed no significant difference between treatment plans with two types of MLC. Conclusion : Using HD MLC had a positive impact on the PTV coverage and normal tissue sparing in usually short or small targets such as lung and spine SBRT and prostate VMAT. But, there was no significant difference in targets with long and large such as lung, head and neck, and whole pelvis for VMAT.

어머니의 결혼만족도가 유아의 자기조절능력에 미치는 영향

임지혜,문혜련,Lim. Ji-Hae,Moon. Hae-Lyun 순천향대학교 인문학연구소 2015 순천향 인문과학논총 Vol.34 No.2

본 연구는 어머니의 결혼만족도가 유아의 자기조절능력에 미치는 영향을 알아보고자 하였다. 이를 통해 유아교육 현장이나 부모교육 등 상담현장에서 어머니 지원을 위해 활용할 수 있는 기초자료를 제공하고자 한다. 연구대상은 용인시에 위치한 민간어린이집 8곳에 재원하고 있는 5세 유아 131명과 유아의 어머니 131명이었다. 연구결과는 다음과 같다. 첫째, 어머니의 결혼만족도의 경향성은 중간 이상으로 나타났으며, 직업의 유무와 가정의 월소득에 따른 결혼만족도의 차이는 나타나지 않았으나, 자녀수가 적은 어머니일수록 결혼생활의 갈등이 높게 나타났다. 유아의 자기조절능력의 경향성은 중간 이상으로 나타났으며, 자기조절능력의 하위 요인 중 정서조절능력이 인지조절능력보다 높게 나타났다. 둘째, 어머니의 결혼만족도는 유아의 자기조절능력의 모든 영역과 통계적으로 유의미한 정적 상관관계를 보였다. 셋째, 결혼만족도의 하위요인 중 결혼생활에 대한 인식이 유아의 자기조절능력에 유의미한 정적 영향을 미쳤다. 본 연구는 어머니의 결혼만족도를 결정하는 요인 중 특히 결혼생활에 대한 인식이 유아의 자기조절능력 향상에 영향을 미칠 수 있음을 나타내고 있다. 이는 부부가 서로의 결혼생활에 대해 바르게 이해하고 결혼생활에 대한 자신감을 갖는 것이 자녀의 자기조절능력 향상에 무엇보다 중요함을 시사한다. The purpose of this study was to investigate how mother’s marital satisfaction effect on development of children’s self-regulation ability. Also this study attempts to provide basic materials for use of helping mothers in early childhood education field or consultation field. The subjects of this study were 131 children in 5 years old, who are in 8 daycare center located in Yongin City, Kyeong-gi Province and 131 their mother. The collected data were analyzed by correlation analysis and regression analysis by using the program, SPSS WIN 18.0. The results of this study were as follows: First, the mothers’ marital satisfaction was rated above average, and differences in their marital satisfaction were not observed according to the existence of occupation or monthly household income. However, the mothers with a smaller number of children showed a corresponding higher level of marital conflict. The children’s self-regulation ability was also rated above average. Among the lower-level factors of self-regulation ability, the children exhibited a higher level of emotional self-regulation ability than cognitive self-regulation ability. Second, a statistically significant positive relationship was found between the mothers’ marital satisfaction and every field of the children’s self-regulation ability. Third, among the lower-level factors of marital satisfaction, the mothers’ perception of marital life had statistically significant positive effects on their children’s self-regulation ability. This study indicated that among the factors that determine mothers’ marital satisfaction, in particular, their perception of marital life can affect improvement in their children’s self-regulation ability. This suggests that couples’ correct understanding of mutual marital life and self-confidence in their marital life are the most important elements in improving their children’s self-regulation ability.

Human Paraoxonase 1(PON1)의 유전자 다형성에 따른 중풍환자의 습담 변증과의 상관성 연구

임지혜,고미미,이정섭,방옥선,차민호,Lim, Ji-Hye,Ko, Mi-Mi,Lee, Jung-Sup,Bang, Ok-Sun,Cha, Min-Ho 대한한방내과학회 2010 大韓韓方內科學會誌 Vol.31 No.4

Objective : In the present study, we investigated genetic distribution of eight single nucleotide polymorphisms of PON1 between Dampness and Phlegm and non Dampness and Phlegm pattern identification(PI) among Korean stroke patients. Materials and Methods : One hundred forty stroke subject without Dampness and Phlegm and fifty eight stroke subjects with Dampness and Phlegm were participated in this study. After informed consents, eight single nucleotide polymorphisms(SNPs) in PON1 of each subjects were identified by DNA sequencing and primer extension method and statistical analysis was performed to determine the significant difference between Dampness and Phlegm and non Dampness and Phlegm groups. Results : Among anthropometric characteristics and blood parameters, waist circumference and total cholesterol were significantly higher in Dampness and Phlegm. Among 8 SNPs of PON1, frequency of M allele and subjects with M allele in L55M SNP were significantly higher in Dampness and Phlegm group (p=0.0032 and p=0.0053, respectively) but subjects with T allele in C-2033T SNP were lower in Dampness and Phlegm group(p=0.0302). Effect of L55M and C-2033T on Dampness and Phlegm were 3.07% and 1.75%, respectively. Conclusion : Our results suggest that L55M SNP in exon and C-2033T in promoter region of PON1 maybe affect to Dampness and Phlegm pattern identification. However, further study should be carried out to find out the detailed mechanism how L55M and C-2033T can affect Dampness and Phlegm stroke patients.

모체 혈액 내 세포 유리 태아 핵산을 이용한 비침습적 산전 진단

임지혜 ( Ji Hyae Lim ),박소연 ( So Yeon Park ),류현미 ( Hyun Mee Ryu ) 대한주산의학회 2012 Perinatology Vol.23 No.3

Cell-free fetal nucleic acids in the maternal circulation can be broadly divided into fetal DNA and RNA that originate from apoptotic placenta cells. Cell-free fetal nucleic acids can be detected from 4-5 weeks gestation and are undetectable in the maternal circulation after delivery. Therefore, cell-free fetal nucleic acids have been proposed as a potential material for non-invasive prenatal diagnosis (NIPD), which poses no risk to mother and child. The clinical applications of this technology fall into three categories: first, early sex determination in cases at high risk of X-linked disorders or congenital adrenal hyperplasia requiring follow-up testing or antenatal treatment; second, detection of specific paternally inherited monogenic diseases in families with high genetic risk; and third, routine antenatal care offered to all pregnant women, including prenatal screening/ diagnosis of aneuploidy, particularly Down syndrome. Fetal sex determination is already performed in routine clinical care for high-risk individuals in some countries. Many researchers have explored the possibility of cellfree fetal nucleic acids on NIPD of monogenic diseases and aneuploidy. Promising results have been reported from studies using the combination of markers and the application of various experimental methods. Although these technologies can raise ethical, social, and legal concerns, a reliable noninvasive test using cell-free fetal nucleic acids may in future form a part of national antenatal programs for detection of Down syndrome and other common genetic disorders.

도시와 생태공간의 어울림: 인천 논현지구의 퍼스기호학적 해석

임지혜 ( Ji Hye Lim ),김영순 ( Young Soon Kim ) 한국기호학회 2009 기호학연구 Vol.25 No.-

The aim of this study is to propose some conditions for `Eco-space` in the city. For that reason, we interpreted the hidden meaning of `Eco-space` of Nonhyun area in Incheon metropolitan city with semiotic method; how to be represented ecological meaning on that space by `Eco-concept`. The `Eco-space` is one of conditions for improving the quality of life in the city. It is constructed by the `Eco-concept`. The definition is an idea or abstract principle for the reification of meaning of `the coexistence of people with Nature`. In the macro point of view, the `Eco-space` is the `environment to which people adapt oneself`. In the micro point of view, the `Eco-space` is the `environment with which people cooperate`. This is almost filled of symbolic signs(artificial things), but they change symbolic to iconic ones. The `Eco-space` of the connection is balanced Nature of original ecosystem and the benefit of people. The consequence of the semiotic interpretation is following. There is the kind of role between `the meaning of Eco-space from the relation between people and Nature` and `the nature of signs on Eco-space`. It is caused by balancing the benefit of Nature and people. And it explains both of `natural eco-space` and `artificial eco-space`, `Natural eco-space` is filled of ecological icons and remains original Nature. So it is `environment to which people adapt oneself`, `the space of cultural Nature` and symbolization. `Artificial eco-space` is filled of ecological symbols and made up through the aim for `Eco-space`. So it is `environment with which people cooperate`, `the space of natural culture` and iconization.

보문 : 러닝웨어 재킷의 슬릿 위치가 통기성과 착용감에 미치는 영향

임지혜 ( Ji Hye Lim ),노의경 ( Eui Kyung Roh ),유화숙 ( Hwa Sook Yoo ),김은애 ( Eun Ae Kim ) 韓國衣類學會 2009 한국의류학회지 Vol.33 No.11

팬을 부착한 이중외피의 이론적 검토 및 적용성에 대한 실험 연구

임지혜(Ji Hye Lim),손장열(Jang Yeul Sohn) 대한설비공학회 2010 설비공학 논문집 Vol.22 No.9

Double skin facade(DSF) ventilated by fans consists of a normal external and an internal envelope. In this glass layer, the installed fan replaces an air inlet for the control of air flow through the cavity. The purpose of this paper is to investigate physical theory and to analyze the applicability of fans installed in a DSF. The experiment was conducted in 2 rooms. One room has a DSF with installed fans and the other one has a typical window. The room ventilated through a DSF which fans are installed was always kept warmer than the other room, ventilated directly from the outdoors. The average increase of the supplied air temperature through the DSF ventilated by fans was 6.54℃ at 78CMH, 6.2℃ at 95CMH, and 3.7℃ at 120CMH. As a result, the DSF with installed fans was appropriate for installation in rooms. It supplies outdoor fresh air heated through a cavity and ventilates a constant air volume.

소형견에서 섬유연골 색전성 척수증 2례

임지혜 ( Ji Hey Lim ),정창수 ( Chang Su Jung ),변예은 ( Ye Eun Byeon ),김완희 ( Wan Hee Kim ),이영원 ( Young Won Lee ),권오경 ( Oh Kyeong Kweon ) 한국임상수의학회 2006 한국임상수의학회지 Vol.23 No.2

의료기기 안전에 관한 대학병원 의료인들의 인식과 행동에 관한 연구

임지혜(J. H. Lim),김규성(K. S. Kim),김새롬(S. L. Kim),김영순(Y. S. Kim),이훈재(H. J. Lee) 한국재활복지공학회 2017 재활복지공학회논문지 Vol.11 No.4

본 연구는 의료기기 안전성에 관한 의료인들의 인식(지식, 태도)과 행동에 관한 기초현황을 파악하여 보고, 직종 간 차이를 평가해보기 위한 탐색적 조사연구이다. 인천광역시에 소재한 900병상 규모의 상급종합병원을 대상으로 설문지를 배포하여 220명의 응답 자료를 분석에 사용하였다. 연구결과, 연구대상 의료인들은 대체적으로 의료기기 종류에 따른 잠재적 위험성에 대한 인식이 갖춰져 있고, 의료기기 안전성 교육의 필요성을 느끼고 있었다. 또한 의료진들의 직종 간 의료기기 안전성에 관한 인식의 차이를 살펴봤을 때, 등급 높은 의료기기를 주로 사용하지만 의료기기 안전에 관한 인식이 가장 낮은 전공의를 대상으로 하는 의료기기 안전교육의 필요성이 크다는 것을 알 수 있었다. 향후 전국규모의 연구를 통하여 자료의 질을 향상하고 결과의 수준을 높이며, 이를 바탕으로 의료기기 안전성 관리에 있어 정책적, 교육적 기반으로 활용할 필요가 있다. This exploratory study aimed to explore the perception (knowledge and attitude) and behaviors of medical personnel regarding medical device safety and to identify the differences in results linked with the type of their task. A questionnaire was administered to medical personnel working at a tertiary care hospital with 900 beds in Incheon, Korea, and 220 completed questionnaires were used for analysis. The results revealed that the majority of the medical personnel perceived the potential risk involved in different types of medical devices they use and stated that they need training programs for safe use of medical devices. Concerning the perception regarding medical devices across different positions within the hospital, it was found that the residents had a low awareness about safety issues, although the medical services they handled involve high risks, thereby calling for safety training. Further nationwide studies are needed to improve the quality and validity of data and eventually to provide important information required by policy makers and academicians to manage medical device safety.

사회복지전담공무원의 직무특성이 직무만족에 미치는 영향에 관한 연구: `삶의 양식`의 통제 효과를 중심으로

임지혜 ( Ji-hye Lim ),주재현 ( Jaehyun Joo ) 서울대학교 한국행정연구소 2017 行政論叢 Vol.55 No.1

본 연구는 사회복지전담공무원의 직무특성이 직무만족에 미치는 영향을 조사하고, 사회복지전담공무원의 `삶의 양식`이 직무특성과 직무만족의 영향관계에서 통제효과를 지니는지를 분석하는 데 목적을 두었다. 이 연구목적을 달성하기 위해 서울과 경기지역의 사회복지전담공무원을 대상으로 설문조사를 실시하였고, 계량적 분석을 통해서 다음과 같은 결과를 얻었다. 첫째, 직무특성의 하위요인 중 기술다양성과 과업정체성이 높을수록 직무만족에 부정적인 영향을 미치며, 과업중요성과 자율성이 높을수록 직무만족에 긍정적인 영향을 미치는 것으로 나타났다. 둘째, 같은 업무를 수행하는 사회복지전담공무원이라 하더라도 개인별로 서로 다른 삶의 양식을 지니는 것으로 나타났는데, 다수 사회복지전담공무원의 삶의 양식은 평등주의였고, 다음으로 개인주의가 일정 부분을 구성하고 있었으며, 소수의 계층주의와 운명주의가 존재하였다. 셋째, 삶의 양식 중에서 평등주의가 직무만족에 가장 긍정적인 영향을 미치는 것으로 나타났다. 넷째, 삶의 양식별로 직무특성이 직무만족에 미치는 영향관계에 차이가 있었다. 평등주의자들의 경우 과업중요성이 직무만족에 유의미한 영향을 미쳤으며, 개인주의자들의 경우 자율성이 직무만족에 유의미한 영향을 미쳤다. 이러한 연구결과는 사회복지전담공무원에 대한 이해의 수준을 높여주며, 그들의 직무만족 제고방안을 모색함에 있어 시사하는 바가 큰 것으로 판단된다. This study aimed to examine to what extent the job characteristics of social welfare officials would influence their job satisfaction, and to analyze whether their way of life would have a controlling effects on the relationship between job characteristics and job satisfaction. In order to achieve these purposes, this study conducted a survey of social welfare officials in Seoul and Gyeonggi Province. The results of the quantitative analysis are as follows. First, among the job characteristics of social welfare officials, `skill variety` and `task identity` showed negative effects while `task significance` and `autonomy` showed positive effects on job satisfaction. Second, the main way of life of social welfare officials was egalitarianism. Individualism appeared as the second most common type of way of life among the officials. However, hierarchy and fatalism were only minor ways of life. Third, egalitarianism most positively affected the job satisfaction of social welfare officials. Fourth, the type of way of life made a difference in the pattern of influence of job characteristics on job satisfaction. In the case of egalitarians, `task significance` showed a meaningful causal relationship with job satisfaction. However, `autonomy` showed a meaningful causal relationship with job satisfaction for individualists. These findings could contribute to the understanding of social welfare officials, and to the development of measures for enhancing their job satisfaction.