실험적 신동맥폐색에 의한 신경색의 출력 도플러 초음파소견 : 나선식 CT소견과의 비교

정승은,신경섭,김학희,문석환,이영준,이배영,최병길,이재문,이희정,Jung, Seung Eun,Shinn, Kyung Sub,Kim, Hak Hee,Mun, Seok Hwan,Lee, Young Joon,Lee, Bae Young,Choi, Byung Gil,Lee, Jae Mun,Lee, Hee Jeong 대한영상의학회 1999 대한영상의학회지 Vol.40 No.2

Purpose : To evaluate the efficacy of power Doppler ultrasonography (PDUS) in depicting renal infarction inrabbits during experimental renal segmental arterial occlusion, and to compare the results with those of CTscanning. Materials and Methods : In 28 rabbits weighing 2.5-4kg, the segmental renal artery was occluded throughthe left main renal artery by embolization with Ivalon (Nycomed, Paris, France). Power Doppler ultrasonography andspiral CT scanning were performed before and at 2, 5, 8, 15, and 24 hours, and 3 and 7 days after occlusion of thesegmental renal artery. The location of infarcted areas and collaterals, as seen on PDUS and CT scans, wasevaluated by two radiologists. Results : In all cases, as seen on power Doppler ultrasonography, infaretedareas-when compared with normal parenchyma, clearly demonstrated wedge-shaped perfusion defects in the kidney. Thelocation of the lesion closely corresponded to the location seen during CT scanning. After renal arterialocclusion, transiently congested capsular arteries, which were named ‘capsular sign’, were seen in 63% ofrabbits in the two and five-hour groups. No significant cortical rim sign was demonstrated on power Dopplerultrasonography, though it was noted on spiral CT at 15 and 24 hours, and 3 and 7 days after renal arterialocclusion. Conclusion : Power Doppler ultrasonography was useful for the diagnosis of renal infarction. Congestedcapsular artery seen in the early stage of renal infarction might be a characteristic finding of this condition,as seen on power Doppler ultrasonography.

단일검출기 단일광자발출 전산화단층촬영술에서 원형 ( Circular ) 과 비원형 ( Non - circular ) 회전방식 자료획득 ( Data Acquisition ) 의 비교

손형선,신경섭 ( Hyung Sun Sohn,Kyung Sub Shinn ) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.1

Role of Radiation Therapy for Locally Advanced Gastric Carcinoma Management

윤세철,오윤경,신경섭,박용휘,김인철,이경식,Yoon Sei Chul,Oho Yoon Kyeoung,Shinn Kyeong Sub,Bahk Yong Whee,Kim In Chul,Lee Kyung Sik The Korean Society for Radiation Oncology 1988 Radiation Oncology Journal Vol.6 No.1

가톨릭의대 강남성모병원 방사선치료실에서는 1983년 5월부터 1987년 5월 사이 수술 후 재발되거나 국소적으로 진행되어 절제 불가능한 위암환자 35예에 대하여 외부방사선치료를 실시하였다. 방사선치료는 6MV선형가속기를 사용하여 매일 $160\~180cGy$씩, 주 5회 분할 조사하여 총 $4500\~5500cGy$를 시도하였으며, 전예에서 Box Technique을 이용하였다. 방사선치료만을 실시하였다. 3예를 제외한 전예에서 5-FU 또는 FAM 화학요법을 병행하였다. 1. 총 35예는 남자 25명 여자 10명이었으며 연령은 38세에서 80세사이에(평균 56세)분포하였다. 조직학적으로는 전 예가 선세포암이었다. 2. 수술후 재발되어 방사선치료하기까지의 기간은 수술후 1년이내에 $18(51\%)$명, $1\~2$년내 $8(23\%)$명, 그리고 $2\~3$년내에 $5(14\%)$명이었다. 3. 방사선치료를 하게된 주된 증상으로는 통증 30명$(86\%)$, 종괴 29명$(85\%)$, 위장관폐쇄 11$(31\%)$명 및 폐쇄성 황달이 9$(26\%)$명이었다. 4. 이증상들의 방사선치료 후 반응은 총 치료선량에 따라 $40\~50Gy$에서 14/16$(88\%)$, 50Gy이상에서 8/10$(80\%)$, $30\~40 Gy$에서 6/8$(75\%)$, 및 $20\~30Gy$에서 8/15$(53\%)$의 호전율을 관찰할 수 있었다. 5. 국소 진행된 위암환자의 방사선치료 후 평균 생존율은 3.6개월이었으며 방사선치료에 의한 부작용으로서는 오심, 구토$(46\%)$, 설사$(20\%)$, 백혈구 감소증$(27\%)$, 그리고 빈철 및 폐염$(9\%)$등의 순을 보였다. Thirty-five patients with locally advanced gastric carcinoma were treated with combined modalities of external radiation therapy (RT) and 5-FU based chemotherapy at the Division of Radiation Therapy, Department of Radiology, Kangnam 51. Mary's Hospital, Catholic University Medical College from May 1983 to May 1987. The purpose of this retrospective study is for the evaluation of the palliative response to RT. There were 25 men and 10 women. The age ranged from 38 to 80 years (median: 56 years). The pathologic classification showed $14(40\%)$ poorly differentiated, $12 (34\%)$ moderately differentiated, $3(9\%)$ well differentiated adenocarcinomas, 2 mucinous cystadenocarcinomas, 1 signet ring cell and 3 not specified ones. The time intervals from the initial surgicopathologic diagnosis to the starting day of RT was within 1 year for $18 (51\%)$, 1 to 2 years for $8 (23\%)$ and 2 to 3 years for $5 (14\%)$, respectively. The major symptoms to be treated were pain in $30 (80\%)$, mass for $29 (83\%)$, obstruction for $11 (31\%)$ and jaundice for $9 (20\%)$ patients. The response rate (patient number of positive response/total patient number) according to treated radiation doses were observed as follows; $14/16(88\%)$ for $40\~50Gy,\;8/10(80\%)$ for over $50Gy,6/8 (75\%)\;for\;30\~40Gy\;and\;8/10(53\%)\;for\;20\~30 Gy$ in decreasing order. The over ail survival was 3.0 months and that of 5FU+RT, FAM+RT and RT alone groups were 4.6 months, 3.7 months and 2.5 months respectively. Complications induced by RT were nausea and vomiting in $16(46\%)$, diarrhea in $7(20\%)$, leukopenia in $6(17\%)$ and anemia and intercurrent pneumonia in each $3(9\%)$ patients in decreasing order.

Results in the Treatment of Nasopharyngeal Carcinoma Using Combined Radiotherapy

정수미,윤세철,신경섭,박용휘,김훈교,이경식,조승호,Chung Su Mi,Yoon Sei Chul,Shinn Kyung Sub,Bahk Yong Whee,Kim Hoon Kyo,Lee Kyung Shik,Cho Seung Ho The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

Thirty-one patients with previously untreated and locally advanced nasopharyngeal cancer were retrospectively reviewed for comparing the effects of radical radiotherapy alone with that of combining chemotherapy and radiotherapy from 1983 to 1989 at Kangnam 51. Mavy's hospital.23/31 were evaluable for recurrence and suwival. There were 8 patients for stage III, and 15 patients for stage IV. Eleven patients were treated with radical radiation therapy done (arm I). Twelve patients were given 1~3 courses of cisplatin-5FU or cisplatin-bleomycin-vincristine prior to radiation therapy (arm II). The two arms were comparable in patient characteristics Of 11 radiotherapy Patients, complete response was 55%(6/11) and Partial response 45%(5/11). Among 12 patients after induction chemotherapy, complete response was 25%(3/12) and partial response 75%(9/12). After subsequent radiotherapy, complete response was increased to 83%(10/12) and partial response was 17%(2/12). Treatment failure was 30%(local recurrence; 3/11, and regional recurrence; 1/11) in arm 1 and 33% (local recurrence; 1/12, regional recurrence; 2/12 and distant metastasis; 1/12) in arm ll . There was no significant difference in survival between arm I and arm II (p> 0.05). The toxicities of treatment were acceptable. More controlled clinical trials must be completed before acceptance of chemotherapy as part of a standard radical treatment for locally advanced nasopharyngeal cancer. 1983년에서 1989년까지 가톨릭의대 부속 성모병원 방사선치료실에서 비인강종양으로 확진되어 치료를 시행한 환자 31명중 치료가 불완전했던 환자 8명을 제외한 23명의 치료성적으로 후향조사 하였다. 이들 중 11명의 환자에 있어서는 방사선 단독요법을 시행하였으며, 12명의 환자에소는 cispiatin+5-fluorouracil 혹은 cisplatin-bleomycin-vincristine을 이용하여 1회 내지 3회에 걸친 유도 화학요법후 방사선치료를 시행하였다. 방사선 단독요법으로 치료된 11명의 환자에서 완전 관해율은 55%(6/11), 부분관해율은 45%(5/11)였다. 유도화학요법을 시행한 12명의 환자중 약물 치료후 완전관해율은 25%(3/12)였으며, 부분관해율은 75%(9/12)였고, 연속적으로 시행된 방사선 치료후에는 완전 관해율이 83%(10/12)로 증가되었으며, 부분 관해율은 17%(2/12)였다. 유도 항암요법에 부분관해를 보였던 환자중 stage 111 환자 1명과 stage IV 환자 6명이 추가 방사선 치료후 완전 관해를 보였다. 방사선 단독요법군에서는 4명에 국소재발이 발생했으며,-약물요법과 방사선치료를 병행했던 군에서는 국소재발 3명과 폐로의 원격전이가 1명에서 발생되었다. 방사선단독으로 치료한 환자군과 유도화학요법과 방사선 치료를 병행한 환자군에서의 생존율의 차이가 통계적으로 유의하지 않았다. $28.55{\pm}15$ and $M{\pm}SD=28.588{\pm}25.39$, p>0.05) 치료환자군의 수가 적은 이유로 통계분석 결과 큰 의의를 발견할 수 없었다.

Measurement of Dose Distribution in Small Beams of Philips 6 and 8 MVX Linear Accelerator

서태석,윤세철,신경섭,박용휘,Suh Tae-suk,Yoon Sei Chul,Shinn Kyung Sub,Park Yong Whee The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

본 논문에서는 소조사면에 대한 X-선의 선량분포를 일반실험식으로 계산될 수 있도록 beam 측정 데이타를 종합 처리하는 방법에 대하여 기술하고 있다. Beam 데이타는 philips LINAC 6 MV, 8 MV X-ray에 대하여 측정 되었으며, 측정된 요소는 tissue maximum ratio (TMR), off-axis-ratio (OAH), 그리고 relative output factor (ROF)를 포함한다. 소조사면에 의한 방사선 치료를 위하여 isocenter에서 지름이 1 내지 3cm되도록 실린더 형태의 특수 collimator가 2 mm 간격으로 제작되었다. 본 측정을 위하여 다이오드 detector가 이용되었으며 Film 및 TLO 측정기로 측정된 값과 비교검토 되었다. 제한된 조사면으로 측정된 TMR, OAR data로부터 beam 데이타를 나타내는 실험식을 유도하였으며 이 실험식은 임의의 Set-UP조건에 따른 측정값을 예상할 수 있는 일반 실험식으로 확장되었고 측정된 TMR과 OAR 값들은 잘 일치되었다. The work suggested in this paper addresses a method for collecting beam data for small circular fields. Beam data were obtained from philips 6 and 8 MV LINAC at Dept. Radiation Therapy at Gainesville Incorporated and Shands Teaching Hospital. Specific quantities measured include tissue maximum ratio (TMR), off-axis ratio (OAR) and relative output factor (ROF) In small field irradiation, special collimators were used to produce circular fields of 1 cm to 3 cm diameter in 2 mm steps, measured at SAO (soura axis distance) of 100 cm. Diode detector was chosen for primary beam measurement and compared with measurements made with photographic film and TLD dosimeters. The measured TMRs and OARs were formulated from limited measurements to generate basic beam data for reference set-up. The empirical formula were later, extended and generalized for any possible set-up using the trends of fitting parameters. The measured TMRs and OARs were well represented by the fitting formula developed.

A Verification for Multiple Arc Stereotaxic Radiotherapy

윤세철,장홍석,김인아,신경섭,박용휘,Yoon, Sei-Chul,Jang, Hong-Seok,Kim, In-Ah,Shinn, Kyung-Sub,Bahk, Yong-Whee The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.1

정위다방향 단일 고선량 방사선치료는 최근 치료방사선과 및 신경외과 영역에서 관심의 초점이 되고 있는 분야이다. 이 방법은 병소 부위를 중심축으로하여 여러 방향으로 다양한 각도의 회전조사를 하여, 주위 정상 뇌조직에는 최소한의 방사선을 주면서, 뇌병소 부위에는 집중적으로 1회 고선량을 조사할 수 있어서, 방사선 치료효과를 최대로 높아고자 시도되고 있다. 저자들은 6 MV 선형가속기와 치료 계획용 컴퓨터를 이용한 정위 다방향 단일고선량 방사선치료를 실시 함에 있어, 방사선 선량분포를 증명하고자, 등선량곡선 분포 및 뇌 CT상에 방사선 통로의 증명을 위한 사진을 각각 시도해 보았기에 보고하는 바이다. External stereotaxic irradiation of intracranial lesions has recently gained its interest in the fields of not only radiation oncolgy but also neurosurgery. Its main goal is to deliver large doses to a relatively small target volume. Authors present methods of the stereotaxic radiosurgical irradiation using 6 MV linear accelerator (Nelac-6) and isodose distribution by therapeutic computer (Therac 2000). We attempt to demonstrate the dose distribution on verification films.

Residual, Unresectable and Recurrent Rectal Cancer : Role of External Radiation Therapy in 46 Patients

길학준,오윤경,윤세철,신경섭,박용휘,Gil, Hack-Joon,Oh, Yoon-Kyeong,Yoon, Sei-Chul,Shinn, Kyung-Sub,Bahk, Yong-Whee The Korean Society for Radiation Oncology 1988 Radiation Oncology Journal Vol.6 No.1

가톨릭 의과대학 강남성모병원 방사선치료실에서는 1983년 4월부터 1987년 12월까지 4년 8개월 동안에 국소 재발성 또는 진행된 직장암환자 46예의 외부 방사선 치료를 실시하였다. 방사선 치료는 6MV선형가속기를 사용하였으며 전후 2대문조사 및 4문조사를 혼합 사용하였고, 매일 $160\~180cGy$색 주 5회 분할조사하여 총 $4,500\~6,000rad/5\~7$주를 시도하였다. 필요시는 수술창 및 회음부에 격일로 Bolus를 사용하여 다음과 같은 결과를 얻었기에 보고하는 바이다. 1. 총 46명중 남자 25명, 여자는 21명이었고, 연령 분포는 22세부터 79세까지였다(중앙연령 : 54세). 2. 수술 후 재발된 직장암이 28예였고, 수술 불가능한 경우가 18예였다. 3. 재발된 예 28명에서 Astler-Coiler's Modification of Duke's Method 분류상 C2가 20명이었는데 그중 12명이 수술 후 12개월 내에 재발하였다. Bl 명기에서는 24개월 내 재발한 예는 전혀 없었다. 4. 방사선 치료에 대한 반응으로 통증을 주소로 했던 30명중 22명$(73\%)$에서, 종괴를 주소로 한 14명중 12명$(86\%)$에서, 출혈을 주소로 한 22명 중 17명$(77\%)$에서 각각 반응을 보였다. 5. 합병증은 건성 쪼는 습성 피부탈락과 홍반성 색소침착, 요도-방광염이 $61\%,\;35\%,\;17\%$에서 각각 관찰되었고, 2예에서는 수술을 요하는 장유착이 있었다. 6. 수술 후 2년과 3년 생존율은 각각 $43\%,\;22\%$였고, 방사선 치료 후 2년 생존율은 $13\%$였다. Fifty patients with residual, unresectable or recurrent rectal cancer were treated with external irradiation using a 6-MV linear accelerator at the Division of Therapeutic Radiology, Department of Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College during the period of April 1983 to December 1987. This paper describes the results of a retrospective analysis of the results of external irradiation for the residual, unresectable and recurrent rectal cancer in 46 patients. Four patients were lost to follow-up. Of the 46 patients, $18 (39\%)$ presented with unresectable primary lesions and $28 (61\%)$ with residual or recurrent rectal cancer. In $93\%$, the pathologic diagnosis was adenocarcinoma. Resonse to irradiation was observed in $22 (73\%)$ out of 30 patients who were treated for pain, $12 (86\%)$ out of 14 patients who were treated for mass, and $17 (77\%)$ out of 22 patients who were treated for bloody discharge. The actuarial postoperative 2-year and 3-year survival rates in recurrent and unresectable patients were $43\%$ and $22\%$, respectively. However, the post-RT 2-year survival rate was $13\% (6/46)$.

The Effect of Radiation Therapy on Oligodendrogliomas

윤세철,김성환,정수미,길학준,신경섭,박용휘,강준기,송진언,Yoon Sei Chul,Kim Sung Whan,Chung Soo Mi,Gil Hok Jun,Shinn Kyung Sub,Bahk Yong Whee,Kang Joon Ki,Song Jin Un The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

가톨릭의대 방사선치료실에서는 1983년 4월부터 1989년 4월 사이 6년 동안에 회돌기교종환자 21예를 외부방사선 치료하였다. 전예에 대하여, 연령 및 발병부위별 빈도와 임상증상과 CT소견 그리고 추적 가능하였던 20예의 생존율에 관한 후향적 분석을 하여 다음과 같은 성적을 얻었다. 1. 전예는 원발성 뇌종양으로 방사선치료 하였던 환자(246예)의 약 8%의 빈도를 보였으며, 연령 분포는 5~62세 (중앙값 38세)이고, 남녀의 비는 13:8이었다. 2. 임상주 증상은두통 18예(86%), 뇌운동신경마비 12예(57%), 오심구토 7예(33%), 경련 5예 (24%)등 순을 보였다. 3. 발병부위는 전두엽 10예(48%), 두정엽 10예(48%), 측두엽 7예(33%), 후두엽 2예(10%)그리고 뇌간 및 소뇌가 각각 1예 (5%)씩 이었다. 4. 조직학적 진단은 정위다방향 조직생검이 3예(14%), 종양의 수술적 제거 (부분 전체제거)에 의함이 18예(86%)이었다. 전예에서 전뇌 및 소부위에 3960~6480cGy15~8주 외부방사선 치료를 하였고, 6예 (29%)에서는 항암약물 치료도 병행하였다. 5. CT음영은 저, 고, 혼합 및 등가음영이 각각 13(62%), 3(14%), 3(14%), 2(10%), 예씩 이었고, 낭성종괴 7예(33%), 괴사 및 출혈성 종괴가 각각 1예(5%)씩 이었다. 석회와 음영은 14예 (67%)에서 관찰되었으며, 조영증강 유무는 9 : 12로 나타났다. 6. 평균생존기간은 38개월이었다. From April,1983 through April,1989, we have treated histologically proven 21 patients with oligodendroglioma using 6 MV linear accelerator at the Division of Radiation Therapy, Kangnam 51. Mary's Hospital Catholic University Medical College. These are 8% of the irradiated 246 primary brain tumors during the same period. To investigate influencing factors on the survival of irradiated U patients with oligodendroglioma, we analyzed the cerebral location of the involvements, initial symptoms, CT findings and survival rates, retrospectively. One case was lost to follow up and excluded from survival data. Of the 28 patients, thirteen were male and 8 female. Ages ranged from 5 to 68 years with a median age of 38 years. Radiation doses varied from 3900 cGy to 0480 cGy and were given for 5 to 8 weeks. All but one were supratentorial. The involvement of the frontal and parietal lobes were 10 (48%) patients in each and temporal lobe in 8 (38.1%). Histological diagnosis was made by stereotactic biopsy in 3 and postoperatively in 18. The type of surgery was divided into partial, subtotal and total resection in 7,9 and 2 cases respectively. In 6 cases, chemotherapy was also tried during or after radiation therapy. Major presenting symptoms were headache, cerebral motor, nausea & vomiting and epilepsy in 18,12, 7 and 5 respectively in decreasing order. In CT analysis, low density (02%), cystic mass (33%), calcifiestion (66%) and positive contrast enhancement (42.8%) were observed as the highest frequency. Mean survival duration after radiation therapy was 38 months (K-M methods). We could not achieve statistically significant factors influencing on the survival rate after radiation therapy for oligodendrogliomas by one or two tail test.

악관절 동통 환자에서 Bone SPECT의 유용성

정수교(Soo Kyo Chung),신경섭(Kyung Sub Shinn),양동헌(Dong Hunn Yang),성미숙(Mi Sook Sung),이정휘(Jung Whee Lee) 대한핵의학회 1997 핵의학 분자영상 Vol.31 No.3

N/A Temporomandibular (TM) joint pain results from many etiologic factors. The aim of this study was to evaluate the utility of Bone SPECT in patients with TM joint pain. The subjects were 34 patients with TM joint pain. All patients underwent plain radiography, planar bone scan, and Bone SPECT. The intensity of radioisotope uptake at TM joint was graded into three; no increased uptake above three background activity as grade 0, uptake similar to occipital bone as grade I, and uptake similar to maxillary sinus as grade II. Clinical findings and therapeutic methods were reviewed. Twenty-seven patients (80%) out of 34 patients with TM joint pain had increased uptake in bone SPECT. Twenty-one (78%) out of 27 patients had increased uptake in the mandibular condyle and remaining six patients (22%) had uptake in the mandibular and maxillary arch, which proved to be dental problem. Seven patients out of 34 were grade as 0, four (12%) were grade I, 23 (68%) were grade II. Four patients with grade I had clicking sound and symptoms which were subsided with medication in all cases. Among 23 patients with grade II, 7 patients had clicking sound and 14 patients underwent medication and decompression therapy. With Planar bone scan, 11 cases (32%) had increased uptake in TM joint area. Plain radiography revealed narrowing, distension, erosion and limitation of TM joint in 16 cases (47%). Bone SPECT can be valuable for screening and managing the patients with TM joint pain. Patients with grade II needed intensive treatment such as joint aspiration. However degree of the radioisotope uptake did not well correlated with clinical symptoms.

유골골종의 바늘구멍 조준기 골스캔

김지영,정수교,박영하,김성훈,신경섭,박용휘 ( Jee Young Kim,Soo Kyo Chung,Young Ha Park,Sung Hun Kim,Kyung Sub Shinn,Yong Whee Bahk ) 대한핵의학회 1992 핵의학 분자영상 Vol.26 No.1