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세기변조방사선치료에서 Pitch와 Roll 변화에 따른 선량전달 정확성 평가
정창영,배선명,이동형,민순기,강태영,백금문,Jeong, Chang Young,Bae, Sun Myung,Lee, Dong Hyung,Min, Soon Ki,Kang, Tae Young,Baek, Geum Mun 대한방사선치료학회 2014 대한방사선치료학회지 Vol.26 No.2
목 적 : 세기변조방사선치료에서(Intensity modulated radiation therapy,IMRT) 6D robotic couch의 pitch 와 roll 변화에 따른 선량전달의 정확성을 평가하고자 한다. 대상 및 방법 : Trilogy(Varian Medical Systems, USA)와 6D robotic couch(ProturaTM 1.4, CIVCO, USA)를 사용하여 골반부위의 세기변조방사선치료를 진행한 14명의 환자를 대상으로 영상유도 시 발생한 pitch 와 roll 방향의 오차 값과 발생빈도를 분석하였다. 오차의 변화에 따른 선량전달 정확성의 차이를 평가하기 위해 pitch 와 roll의 변화가 $0^{\circ}$인 상태의 측정치를 기준으로 각각 $1.0^{\circ}$, $1.5^{\circ}$, $2.0^{\circ}$, $2.5^{\circ}$로 변화시킨 경우에 대하여 2차원 이온전리함 배열 검출기(I'mRT Matrixx, IBA Dosimetry,Germany)와 MultiCube Phantom(IBA Dosimetry, Germany)를 이용하여 측정 후 감마지수(3 mm, 3%)의 비교평가를 실시하였다. 실험에는 Dynamic Multi-Leaf Collimator의 sliding window기법을 사용한 3명의 자궁경부암 치료계획을 적용하였다. 결 과 : 대상 환자의 영상(3D/3D Match 78건, 2D/2D match 79건)을 분석한 결과 pitch 와 roll의 평균 오차값은 $0.9^{\circ}{\pm}0.7$, $0.5^{\circ}{\pm}0.6$, 최대 값은 $2.8^{\circ}$, $2.0^{\circ}$로 분석되었고, 최소값은 pitch 와 roll 모두 $0^{\circ}$으로 나타났다. 각각의 조건에서 측정된 선량전달에 대하여 감마지수를 이용하여 비교한 결과, pitch가 $1.0^{\circ}$, $1.5^{\circ}$, $2.0^{\circ}$, $2.5^{\circ}$일 때 gamma pass rate의 평균은 각각 97.75%, 96.65%, 94.38%, 90.91%, roll의 경우 $1.0^{\circ}$, $1.5^{\circ}$, $2.0^{\circ}$, $2.5^{\circ}$에서 평균 93.68%, 93.05%, 87.77%, 84.96%로 나타났고, pitch 와 roll을 동시에 변화시킨 경우 $1.0^{\circ}$, $1.5^{\circ}$, $2.0^{\circ}$에서 평균 94.90%, 92.37%, 87.88%의 결과 값을 얻었다. 결 론 : 대상 환자의 영상 유도 시 pitch 와 roll의 오차 발생률은 전체 치료 횟수에서 각각 82.20%, 72.20%로 분석되었고, 감마지수를 통해 오차 값이 커질수록 선량전달의 정확성이 낮아진다는 것을 확인할 수 있었다. 세기변조방사선치료 시 선량전달의 정확성을 높이기 위해서는 정확한 자세잡이와 더블어 적절한 영상유도를 통해서 pitch 와 roll 방향으로 발생할 수 있는 오차를 줄이도록 노력해야 할 것으로 사료된다. Purpose : The purpose of this study is to verify the accuracy of dose delivery according to the pitch and roll rotational setup error with 6D robotic couch in Intensity Modulated Radiation Therapy (IMRT) for pelvic region in patients. Materials and Methods : Trilogy(Varian, USA) and 6D robotic couch(ProturaTM 1.4, CIVCO, USA) were used to measure and analyze the rotational setup error of 14 patients (157 setup cases) for pelvic region. The total 157 Images(CBCT 78, Radiography 79) were used to calculate the mean value and the incidence of pitch and roll rotational setup error with Microsoft Office Excel 2007. The measured data (3 mm, 3%) at the reference angle ($0^{\circ}$) without couch rotation of pitch and roll direction was compared to the others at different pitch and roll angles ($1^{\circ}$, $1.5^{\circ}$, $2^{\circ}$, $2.5^{\circ}$) to verify the accuracy of dose delivery by using 2D array ionization chamber (I'mRT Matrixx, IBA Dosimetry, Germany) and MultiCube Phantom(IBA Dosimetry, Germany). Result from the data, gamma index was evaluated. Results : The mean values of pitch and roll rotational setup error were $0.9^{\circ}{\pm}0.7$, $0.5^{\circ}{\pm}0.6$. The maximum values of them were $2.8^{\circ}$, $2.0^{\circ}$. All of the minimum values were zero. The mean values of gamma pass rate at four different pitch angles ($1^{\circ}$, $1.5^{\circ}$, $2^{\circ}$, $2.5^{\circ}$) were 97.75%, 96.65%, 94.38% and 90.91%. The mean values of gamma pass rate at four different roll angles ($1^{\circ}$, $1.5^{\circ}$, $2^{\circ}$, $2.5^{\circ}$) were 93.68%, 93.05%, 87.77% and 84.96%. when the same angles ($1^{\circ}$, $1.5^{\circ}$, $2^{\circ}$) of pitch and roll were applied simultaneously, The mean values of each angle were 94.90%, 92.37% and 87.88%, respectively. Conclusion : As a result of this study, it was able to recognize that the accuracy of dose delivered is lowered gradually as pitch and roll increases. In order to increase the accuracy of delivered dose, therefore, it is recommended to perform IGRT or correct patient's position in the pitch and roll direction, to improve the quality of treatment.
정창영(Chang Young Jeong),윤명하(Myung Ha Yeon),임 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1
Piriformis syndrome is a syndrome of low back and leg radiating pain thought to be due to a chronic contracture of the piriformis muscle that causes irritation of the sciatic nerve. The piriformis muscle is a flat pyramidal muscle, an external rotator and abductor of the hip, originating from the front of the sacrum and inner aspect of the sacroiliac joint, then passes laterally out of the sciatic notch to attach posteriorly to the greater trochan- ter of the femur, the sciatic nerve passes between the two bellies of the muscle. Mechanical irritation of the sciatic nerve by an inflammatory reaction of the piriformis muscle and its fascia at this pelvic level causes pain to radiate in the dermatomal regions of the nerve roots similar to that disk entrapment. Diagnosis of piriformis syndrome is made primary on the basis of history and clinical exami- nation. The incidence is considerably higher in women, with the reported ratio of women to men of 6: 1. These patients frequently present with associated symptoms of pelvic pain and/or dyspareunia. Symptoms are usually unilateral but occasionally be bilateral. We had a 42 year-old woman patient with low back and left leg radiating pain and dyspareu- nia treated by caudal steroid and local anesthetic.
정창영(Chang-Young Jeong),김하진(Ha-Jine Kimn) 한국정보과학회 1995 한국정보과학회 학술발표논문집 Vol.22 No.2A
시각화(Visualization)란 통계적인 정보, 또는 과학적인 현상의 개념화를 편리하게 해주는 과학적 정보를 이미지로 표현하는 방법이다. 즉 시각화는 복잡한 현상에 대한 직관적 통찰을 얻기 위하여 컴퓨터 이미지를 사용하는 것이다. 시각화의 목적은 가상 현실의 구현이나, 단순한 그림을 얻기 위한 것이 아니라 복잡한 현상에 대한 직관적 통찰을 얻는 것이다. 본 논문에서는 해수 유동을 시각화 하는 방법에 대하여 기술하고 이를 X-Window를 이용하여 구현하였다.
임상연구 : 후두 현미경하 미세수술에서 완전정맥마취 시 Remifentanil의 효과처 농도에 따른 혈역학적 변화
박수현 ( Su Hyeon Park ),정성욱 ( Seong Wook Jeong ),김창모 ( Chang Mo Kim ),김석재 ( Seok Jae Kim ),곽상현 ( Sang Hyun Kwak ),윤명하 ( Myung Ha Yoon ),정창영 ( Chang Young Jeong ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: Laryngeal microscopic surgery directly stimulates an airway via endotracheal intubation and insertion of a suspension laryngoscope, and this can result in acute elevation of the blood pressure and heart rate. Therefore, an anesthesia that can maintain a sufficient depth of anesthesia and simultaneously makes awakening and recovery possible in a short period is required. We wanted to present the effect site concentration of remifentanil for achieving the best anesthesia by observing the hemodynamic changes according to the effect site concentration of remifentanil. Methods: 36 patients, who corresponded with the ASA physical status classification 1 and 2 and who were from 20 to 70 years old, were the subjects of this study. They were randomly classified into three groups according to the effect site concentration of remifentanil. Propofol 4μg/ml was infused continuously, and remifentanil was continuously infused for each group to achieve an effect site concentration of 4 ng/ml, 6 ng/ml, and 8 ng/ml, respectively. Rocuronium 0.5 mg/kg was used. The arterial blood pressures and heart rates were measured before induction of anesthesia, before endotracheal intubation, after endotracheal intubation and after insertion of a suspension laryngoscope. Results: In comparison with the other groups, the 4 ng/ml remifentanil group was able to prevent acute elevation of blood pressure and heart rate. Conclusions: For total intravenous anesthesia using propofol and remifentanil, 4 ng/ml of remifentanil is proposed to be the effect site concentration that is able to stably maintain blood pressure and heart rate during laryngeal microscopic surgery. (Korean J Anesthesiol 2007; 52: 9~15)
임상연구 : Doxapram Hydrochloride가 후두마스크기도를 이용한 전 정맥마취 시 환기반응에 미치는 영향
윤영철 ( Young Chul Yoon ),곽상현 ( Sang Hyun Kwak ),정성태 ( Sung Tae Jeong ),김석재 ( Seok Jai Kim ),배홍범 ( Hong Beom Bae ),정성수 ( Sung Su Chung ),정창영 ( Chang Young Jeong ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: Intravenous anesthetics causes depression of ventilatory response to hypercapnea. Doxapram stimulates ventilation via peripheral and central chemoreceptors. This study was aimed to evaluate the effect of doxapram on ventilation during total intravenous anesthesia (TIVA). Methods: 60 patients undergoing operation under spontaneous ventilation via laryngeal mask airwaywere randomly divided into 3 groups: Control group received 5% dextrous infusion, D-2 group received doxapram injection of 1 mg/kg followed by continuous infusion of 2 mg/kg/hr, and D-4 group received doxapram injection of 2 mg/kg followed by continuous infusion of 4 mg/kg/hr. Anesthesia was induced and maintained with propofol and remifentanil. Respiratory rate, tidal volume (VT) and arterial carbon dioxide tension (PaCO2) were measured before and 15 min after induction of anesthesia, 0(15 min after start of operation), 1, 2, 3, 5, 15, 30, 45, and 60 min after start of doxapram infusion during TIVA. Results: VT was significantly increased 1 min after start of doxapram infusion and returned to the value of pre-doxapram infusion immediately. In D-4 group, VT was significantly (P<0.05) increased again 5 min after doxapram infusion compared with the value of pre-doxapram infusion and control group. PaCO2 was decreased 1 min after start of doxapram infusion and then increased again 2 min after doxapram infusion. In D-4 group, the degree of increase of PaCO2 was significantly (P<0.05) less than those of D-2 group. Conclusions: Doxapram injection of 2 mg/kg followed by continuous infusion of 4 mg/kg/hr improved the depression of ventilatory response during TIVA. (Korean J Anesthesiol 2007; 53: 470∼6)
백서의 척수강 내로 투여한 Metabotropic Glutamate 수용체 약물의 항침해효과 및 Morphine과의 상호작용
최정일 ( Jeong Il Choi ),이형곤 ( Hyung Kon Lee ),정성태 ( Sung Tae Chung ),김창모 ( Chang Mo Kim ),배홍범 ( Hong Beom Bae ),김석재 ( Seok Jai Kim ),윤명하 ( Myung Ha Yoon ),정성수 ( Sung Su Chung ),정창영 ( Chang Young Jeong ) 대한통증학회 2005 The Korean Journal of Pain Vol.18 No.1
임상연구 : Remifentanil과 Lidocaine이 Sevoflurane 마취유도 시 기관내삽관에 필요한 흡입시간에 미치는 영향
이재담 ( Jae Dam Lee ),정창영 ( Chang Young Jeong ),최정일 ( Jeong Il Choi ),이형곤 ( Hyung Gon Lee ),정성태 ( Sung Tae Chung ),김웅모 ( Woong Mo Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5
Background: This study was conducted to investigate the optimal time interval for tracheal intubation and the effect of adjuvant drugs such as remifentanil and lidocaine during induction and tracheal intubation using sevoflurane inhalation without muscle relaxant. Methods: This study enrolled patients with the age of 20-60 years old and ASA 1 or 2. Patients were randomly assigned into one of 4 groups (S, SR, SRL, SL), in which they were given remifentanil (R) i.v. at a rate of 0.25 μg/kg/min, or lidocaine (L) i.v. bolus of 1.5 mg/kg during sevoflurane inhalation (S). Anesthesia was performed as inhalation induction 2 minutes after pre-filling with sevoflurane 8 vol%. The time interval between induction and tracheal intubation was determined using up-and-down method. When satisfied all of the categories of response to tracheal intubation, the case was assigned to `success`, otherwise `fail`. In each groups, effective time for successful intubation in 50% (ET50) and 95% (ET95) were calculated by probit analysis. Results: ET50 was 3.90 minutes (95% confidence interval 3.32-4.38) in group S, 3.18 minutes (2.92-3.48) in group SL, 2.83 minutes (2.47-3.07) in group SR, and 2.68 minutes (2.37-2.95) in group SRL. In group S, SL, SR, and SRL, ET95 was 4.52 minutes (4.17-7.95), 3.63 minutes (3.37-4.97), 3.30 minutes (3.06-4.64), and 3.12 minutes (2.89-4.42), respectively. Conclusions: The optimal time to intubate successfully using sevoflurane without muscle relaxant in 95% patients was 4.5 minutes. The optimal time is reduced to 3.1 minutes by coadministration of remifentanil and lidocaine. (Korean J Anesthesiol 2008;55:565~9)