COVID-19와 관련한 영상검사 사용에 대한 대한영상의학회/대한흉부영상의학회 권고안

진광남,윤순호,박철환,백경민,도경현,용환석 대한영상의학회 2020 대한영상의학회지 Vol.81 No.3

The Korean Society of Radiology and the Korean Society of Thoracic Radiology have prepared recommendations for the use of diagnostic imaging for COVID-19 in various clinical scenarios. We have tried to grasp the situation in the real world, aggregated opinions from the chest radiologists, and reviewed available references, in order to suggest the most reasonable recommendations possible at this moment. As circumstances change and new evidences emerge, the recommendations should immediately be modified accordingly. 대한영상의학회와 대한흉부영상의학회는 COVID-19 에서의 영상검사의 사용에 대하여 다양한 상황에서의 권고안을 마련하였다. 실제 현장의 상황을 파악하고, 흉부영상의학 전문의들의 의견을 수렴하였으며, 국외 학회의 권고안과 수집 가능한 문헌을 바탕으로 현 상황에서의가장 합리적인 안을 제시하는 것이며 상황과 근거의 변화에 따라 유연하게 즉시 수정되어야한다.

영상의학과 전공의에 의한 응급실 컴퓨터단층촬영, 자기공명영상의 야간 예비 판독:얼마나 정확한가?

진광남,제환준,신청일,채지원,전수령,신상도,강영준,나동규 대한응급의학회 2008 대한응급의학회지 Vol.19 No.2

Purpose: At many institutes in Korea, preliminary interpretations of after-hours CT and MR images are performed by radiology residents, with the attending radiologist’s reviewing the interpretations the next day. The purpose of this study was to assess the rate of discrepancy between residents’ interpretations and the final interpretations performed by attending radiologists. Methods: We reviewed the interpretations of 1381 CT and 404 MRI scans that were obtained at the emergency department of our institute over three months. Any discrepancies between the preliminary and final interpretations were categorized as either major or minor discrepancies with a major discrepancy defined as one resulting in a change in diagnosis and treatment plans. We conducted patient follow-up via a retrospective review of the medical records to evaluate the clinical outcomes of the discrepancies. Results: The rate of major discrepancies was 2.5%, and the rate of minor discrepancies was 11.4%. Major discrepancies led to a change in diagnosis or patient treatment plans, but did not lead to any increase in patient morbidity. Conclusion: The discrepancy rate at our institution was relatively insignificant, and patient care at the emergency department was not adversely affected by having radiology residents interpret CT and MRI scans after-hours and the attending radiologist review the interpretations the next morning. Still, further efforts are needed in order to reduce the frequency of major discrepancies.

Computed Tomography Guided Percutaneous Injection of a Mixture of Lipiodol and Methylene Blue in Rabbit Lungs: Evaluation of Localization Ability for Video-Assisted Thoracoscopic Surgery

진광남,이경원,김태정,송용섭,김동일 대한의학회 2014 Journal of Korean medical science Vol.29 No.1

Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue.

Prediction of dysphagia by thoracic muscle mass estimated by chest computed tomography in elderly pneumonia patients

송진화,진광남,이정규,김덕겸,허은영 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Background: Dysphagia is one of the main mechanism of developing pneumonia and it is related to atrophy of the swallowing muscles. The purpose of this study was to predict dysphagia in elderly pneumonia patients by measuring thoracic muscle mass on chest CT. Methods: We retrospectively reviewed 109 patients who were over 65 years and admitted as pneumonia, underwent both chest CT and videofluoroscopy (VFSS) between March 2012 and July 2018. Thoracic muscle mass was calculated using the cross-sectional area at the 4th thoracic vertebra (T4) level and adjusted by dividing the square of height. Dysphagia was defined when the result of VFSS was being unable to oral feeding and changing to nasogastic (NG) tube feeding. We evaluated the relationship between T4 level muscle mass measured by CT scan and the degree of dysphagia using VFSS. Results: Of the 109 elderly pneumonia patients, 37 (33.9%) patients diagnosed as clinically significant dysphagia. In male patients with dysphagia, the mean value of muscle mass index was lower than patients without dysphagia, but no statistically significant difference was found (199.1±132.0 vs. 175.1±65.8, p=0.333). When we divided enrolled patients into quartile group according to the muscle mass, the highest quartile group showed decreased the risk of dysphagia than the lowest quartile group.(odds ratio (95% confidence interval) 0.47 (0.12-1.95), p value=0.300, p-for trend 0.579). Conclusion: The thoracic muscle mass measured by chest CT could not predict dysphagia in elderly pneumonia patients.

TP-81 : 흉부단층촬영에서 발견된 Rasmussen Aneurysm의 임상 양상에 대한 고찰

최한솔,진광남,박성수,허은영,정희순,김덕겸 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

목적: Rasmussen aneurysm은 결핵성 공동이 폐동맥 말단부를 침범하여 발생하는 가성 동맥류로 대량객혈이 동반되어 임상적으로 중요하지만 소수의 증례보고 외에 임상양상에 대한 고찰연구는 없는 실정이다. 방법: 서울특별시보라매병원에서 2000년 12월부터 2012년 11월까지 객혈로 내원한 환자 중에 흉부단층촬영상 Rasmussen aneurysm으로 확인되었고 결핵 과거력이 있거나 활동성 결핵이 진단된 환자를 후향적으로 분석하였다. 성적: 전체 11명의 환자 중 남자는 10명(91%)였으며 연령의 중앙값은 53세였다. 객혈의 양은 평균 175 ml였으나 2예에서 500 ml 이상의 대량객혈이 발생하였다. 진단 당시 활동성 결핵이 확인된 경우는 3명(27.3%)이었고, 나머지 8명(72.7%)은 과거 결핵력이 있는 비활동성 병변으로 최초 결핵 진단시기와 객혈발생 시기 간격은 중앙값으로 23.5개월[3개월-20년] 이었다. 9명(81.8%)의 동맥류가 상엽에 존재하였고, 다발성 병변은 없었으며, 아스페르길루스종은 6명(54.5%)에서 동반되었다. 흉부단층 촬영상 영양동맥은 폐동맥이 4례, 폐동맥과 체동맥의 이중공급이 2례, 체동맥이 1례에서 확인되었고, 4례에서는 뚜렷하지 않았다. 2명은 보존적 치료 후 호전되었으나 9명은 혈관색전술을 시행하였고, 최대 4회까지 색전술을 시도하였다. 그 중 2명은 객혈 재발하여 수술적폐엽절제술을 시행하였다. 9명 중 5명에서 폐동맥혈관조영술을 시행하였고 3명에서 동맥류가 조영되어 색전술 시행하였다. 2명은 기관지동맥조영술에서 단락을 통해 동맥류가 조영되어 색전술을 시행하였다. 사망례는 없었다. 결론: Rasmussen aneurysm은 활동성 결핵여부에 상관 없이 발생하였고, 혈관색전술이나 수술적 처치로 효과적으로 치료되었으나, 폐동맥 기원 뿐만 아니라 단락을 통한 체동맥기원의 동맥류 발생이 있어, 폐동맥 및 체동맥 조영술을 통한 색전술을 모두 고려할 필요가 있다.

Prediction of Anthracofibrosis Based on Clinico-Radiographic Findings

박태윤,김덕겸,허은영,정희순,진광남 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.2

Purpose: Because anthracofibrosis (AF) is associated with tuberculosis (TB), detection of AF is clinically relevant in Korea, a TB endemic region. We thus sought to develop and validate a predictive model for AF using clinical radiographic data. Materials and Methods: Between January 1, 2008 and March 31, 2014, 3849 adult patients who underwent bronchoscopies were retrospectively included from an observational registry. We dichotomized patients based on the presence (n=167) or absence (n=242) of AF. After analyzing their clinico-radiographic characteristics, a logistic prediction model was developed. An area under the curve (AUC) was drawn using the weighted score in logistic regression model. To evaluate the degree of overfitting of the predictivemodel, a 5-fold cross-validation procedure was performed. Results: In multivariate logistic regression, clinical findings such as age >70 years, female gender, active TB, and computed tomographyfindings including atelectasis, stenosis, bronchial wall thickening, enlarged and calcified lymph nodes were significant diagnostic predictors for AF. The weighed score had an AUC of 0.939 [95% confidence interval (CI)=0.911–0.960], similar to the AUC obtained from internal validation (AUC=0.926, 95% CI=0.896–0.949). Conclusion: The prediction model may be helpful for predicting AF based only on clinical and radiographic findings. However, further external validation is necessary.

복부 MDCT 영상에서 국소 위장 병변의 위치 판정: 좌우 위동맥과 위대망막동맥의 중요성

송치성,최영호,윤병재,이상민,진광남,김종성 대한영상의학회 2008 대한영상의학회지 Vol.58 No.4

목적: 복부 MDCT의 축상면 영상으로 국소 위장 병변의 위치를 진단할 때 좌우 위동맥과 위대망막동맥의 중요성을 알아보고자 하였다. 대상과 방법: 72명 환자에서 국소 위장 병변의 위치를 진단하기 위한 복부 MDCT 축상면 영상 판독을 내시경검사와 수술 결과를 모르는 두 명의 영상의학과 의사가 시간 간격을 두고 두 번에 걸쳐 합의 진단 방식으로 후향적으로 시행하였다. 1차 판독에서는 관찰자들에게 어떠한 정보도 제공하지 않았고, 국소 위장 병변의 정확한 위치를 판정하도록 하였다. 1차 판독 후, 관찰자들에게 좌우 위동맥과 위대망막동맥은 각각 소만과 대만 상에 있고 위각도 좌우 위동맥의 경로 상에 있다는 정보를 주었다. 1주일 후 2차 판독을 1차와 같은 증례와 방식으로 시행하였다. 각 판독 과정의 진단 정확도를 비교 평가하였다. 결과: 1차 판독과 2차 판독의 진단 정확도는 각각 52.8%(38/72)와 98.6%(71/72)이었다(p < .05). 결론: 좌우 위동맥과 위대망막동맥은 복부 MDCT 축상면 영상으로 국소 위장 병변의 위치 진단할 때 확고한 위치 표지라고 생각한다.

Association Between Airway Parameters and Abdominal Fat Measured via Computed Tomography in Asthmatic Patients

양민석,최상헌,최예라,진광남 대한천식알레르기학회 2018 Allergy, Asthma & Immunology Research Vol.10 No.5

Purpose: We aimed to investigate whether airway parameters, assessed via computed tomography (CT), are associated with abdominal fat areas and to compare the clinical characteristics of asthmatic patients with and without elevated visceral to subcutaneous fat area ratio (EV). Methods: Asthmatic patients (aged ≥40 years) were prospectively recruited. Chest (airway) and fat areas were assessed via CT. Airway parameters, including bronchial wall thickness (WT), lumen diameter (LD), lumen area (LA), wall area (WA), total area (TA), as well as WA/TA percentage (wall area %) were measured at the apical segmental bronchus in the right upper lobe. Visceral (VFA), subcutaneous (SFA) and total (TFA) fat areas (cm2) were also measured. The correlations between abdominal fat areas and airway parameters were assessed. EV was defined as VFA/SFA ≥ 0.4. Results: Fifty asthmatic patients were included (mean age 62.9 years; 52% female); 38% had severe asthma. Significant correlations were found between VFA and both LD and LA (r = −0.35, P = 0.01; r = −0.34, P = 0.02, respectively), and SFA and both WA and TA (r = 0.38, P = 0.007; r = 0.34, P = 0.02, respectively). Exacerbations, requiring corticosteroid therapy or ER visitation, were significantly more frequent in subjects without EV (83% vs. 34%, P = 0.05). Conclusions: Abdominal fat is associated with asthma, according to the location of fat accumulation. In asthmatic subjects, visceral fat seems to be attributable to the bronchial luminal narrowing, while subcutaneous fat may be related to thickening of bronchial wall.

Computer-Aided Detection of Malignant Lung Nodules on Chest Radiographs: Effect on Observers’ Performance

이경희,구진모,박창민,이현주,진광남 대한영상의학회 2012 Korean Journal of Radiology Vol.13 No.5

Objective: To evaluate the effect of computer-aided detection (CAD) system on observer performance in the detection of malignant lung nodules on chest radiograph. Materials and Methods: Two hundred chest radiographs (100 normal and 100 abnormal with malignant solitary lung nodules) were evaluated. With CT and histological confirmation serving as a reference, the mean nodule size was 15.4 mm (range, 7-20 mm). Five chest radiologists and five radiology residents independently interpreted both the original radiographs and CAD output images using the sequential testing method. The performances of the observers for the detection of malignant nodules with and without CAD were compared using the jackknife free-response receiver operating characteristic analysis. Results: Fifty-nine nodules were detected by the CAD system with a false positive rate of 1.9 nodules per case. The detection of malignant lung nodules significantly increased from 0.90 to 0.92 for a group of observers, excluding one first-year resident (p = 0.04). When lowering the confidence score was not allowed, the average figure of merit also increased from 0.90 to 0.91 (p = 0.04) for all observers after a CAD review. On average, the sensitivities with and without CAD were 87% and 84%, respectively; the false positive rates per case with and without CAD were 0.19 and 0.17, respectively. The number of additional malignancies detected following true positive CAD marks ranged from zero to seven for the various observers. Conclusion: The CAD system may help improve observer performance in detecting malignant lung nodules on chest radiographs and contribute to a decrease in missed lung cancer. Objective: To evaluate the effect of computer-aided detection (CAD) system on observer performance in the detection of malignant lung nodules on chest radiograph. Materials and Methods: Two hundred chest radiographs (100 normal and 100 abnormal with malignant solitary lung nodules) were evaluated. With CT and histological confirmation serving as a reference, the mean nodule size was 15.4 mm (range, 7-20 mm). Five chest radiologists and five radiology residents independently interpreted both the original radiographs and CAD output images using the sequential testing method. The performances of the observers for the detection of malignant nodules with and without CAD were compared using the jackknife free-response receiver operating characteristic analysis. Results: Fifty-nine nodules were detected by the CAD system with a false positive rate of 1.9 nodules per case. The detection of malignant lung nodules significantly increased from 0.90 to 0.92 for a group of observers, excluding one first-year resident (p = 0.04). When lowering the confidence score was not allowed, the average figure of merit also increased from 0.90 to 0.91 (p = 0.04) for all observers after a CAD review. On average, the sensitivities with and without CAD were 87% and 84%, respectively; the false positive rates per case with and without CAD were 0.19 and 0.17, respectively. The number of additional malignancies detected following true positive CAD marks ranged from zero to seven for the various observers. Conclusion: The CAD system may help improve observer performance in detecting malignant lung nodules on chest radiographs and contribute to a decrease in missed lung cancer.

효율적 의료영상정보교류를 위한 프로토콜 제안: 유방자기공명영상

박지희,최선형,김성준,용환석,우현식,진광남,정우경,신나영,최문형,정승은 대한영상의학회 2018 대한영상의학회지 Vol.79 No.5

Purpose: Establishment of an appropriate protocol for breast magnetic resonance imaging (MRI) in the study of image quality standards to enhance the effectiveness of medical image information exchange, which is part of the construction and activation of clinical information exchange for healthcare informatization. Materials and Methods: The recommended protocols of breast and MRI scans were reviewed and the questionnaire was prepared by a responsible researcher. Then, a panel of 9 breast dedicated radiologists was set up in Korea. The expert panel conducted a total of three Delphi agreements to draw up a consensus on the breast MRI protocol. Results: The agreed breast MRI recommendation protocol is a 1.5 Tesla or higher device that acquires images with prone position using a breast dedicated coil and includes T2-weighted and pre-contrast T1-weighted images. Contrast enhancement images are acquired at least two times, and include 60–120 seconds between images and after 4 minutes. The contrast enhancement T1-weighted image should be less than 3 mm in thickness, less than 120 seconds in temporal resolution, and less than 1.5 mm2 in-plane pixel resolution. Conclusion: The Delphi agreement of the domestic breast imaging specialist group has established the recommendation protocol of the effective breast MRI. 목적: 보건의료정보화를 위한 진료정보교류 기반 구축 및 활성화 과제의 일부인 의료영상정보교류의 효용성을 높이기 위한 영상 품질 기준 연구에서 유방 자기공명영상검사의 적절한 프로토콜을 정립한다. 대상과 방법: 문헌 및 참고자료를 통한 국내외 유방 자기공명영상검사의 권고 프로토콜과 판독문 형식을 조사하고, 책임연구자가 설문지를 작성한 후, 국내 9명의 유방영상의학 전문가를 섭외하여 패널을 구성하였다. 전문가 패널은 총 3차례의 델파이 합의를 진행하여 유방자기공명영상 프로토콜의 합의안을 도출하였다. 결과: 합의된 유방자기공명영상 권고 프로토콜은 1.5 테슬라 이상의 기기로 유방 전용 코일을 사용하여 복와위 자세에서 영상을 획득하며, T2 강조영상과 조영 전 T1 강조영상을 포함한다. 조영증강영상은 적어도 2차례 이상 획득하며, 60~120초 사이 영상과 4분 이후 영상을 포함한다. 또한 조영증강 T1 강조영상의 절편 두께는 3 mm 이하, 측면 해상력은 120초 이하, 공간 내 평면 해상도는 1.5 mm2 이하여야 한다. 결론: 국내 유방영상전문가 집단의 3차례에 걸친 델파이 합의를 통하여 효율적인 유방 자기공명영상검사의 검사 프로토콜 권고안을 정립하였다.