각막 상피를 삽입한 각막 간질에서의 Confocal Microscopy 소견

김재삼 ( Jae Sam Kim ) , 홍종욱 ( Jong Wook Hong ) , 이종수 ( Jong Soo Lee ) 대한안과학회 2002 대한안과학회지 Vol.43 No.11

누소관경유 레이저누낭비강문합술의 수술 성적

이태수 ( Lee Tae Su ) , 김재삼 ( Kim Jae Sam ) , 조상형 ( Jo Sang Hyeong ) , 최준성 ( Choe Jun Seong ) 대한안과학회 2004 대한안과학회지 Vol.45 No.1

변형된 누낭비강문합술의 수술 결과

최준성 ( Jun Sung Choi ) , 김재삼 ( Jae Sam Kim ) , 이태수 ( Tae Soo Lee ) 대한안과학회 2004 대한안과학회지 Vol.45 No.7

양측성 기종성 신우신염이 동반된 기종성 방광염 1 예

김대경(Dae Kyeong Kim),이종민(Jong Min Lee),김지현(Je Hyun Kim),이현숙(Hyun Sook Lee),김재삼(Jae Sam Kim),정문현(Moon Hyun Chung),고경식(Kyung Sik Ko),구자룡(Ja Ryong Koo),김형직(Hyung Jik Kim),김근호(Geun Ho Kim),전노원(Rho Won Chun 대한내과학회 1998 대한내과학회지 Vol.54 No.3

Since the first clinical observation by Kelly and MacCallum, gas-forming infection of the urinary tract has been extensively studied. It is characterized by gas production within the urinary tract. The gas may often pass outside the urinary tract. Patients with this disorder invariably have uncontrolled diabetes mellitus and possibly associated obstructive uropathy. It is usually caused by aerobic bacteria, most commonly Escherichia coli. In the literature, the majority of cases were emphysematous pyelonephritis alone or emphysematous cystitis separately. Bilateral renal involvement associated with emphysematous cystitis is very rarely seen and no case was reported yet in Korea. We report a case of bilateral emphysematous pyelonephritis and emphysematous cystitis which occured in 48-year-old diabetic patient simultaneously. It was caused by E coli The patient was cured by medical management alone.

전신 뼈 검사 환자의 불안감 해소를 위한 가상현실 장비의 유용성 평가

김혜린,김정열,이승재,백송이,김진구,김가윤,남궁혁,강천구,김재삼,Kim, Hae-Rin,Kim, Jung-Yul,Lee, Seung-Jae,Baek, Song-Ee,Kim, Jin-Gu,Kim, Ga-Yoon,Nam-Koong, Hyuk,Kang, Chun-Goo,Kim, Jae-Sam 대한핵의학기술학회 2022 핵의학 기술 Vol.26 No.1

Purpose When performing a whole-body bone scan, many patients are experiencing psychological difficulties due to the close distance to the detector. Recently, in the medical field, there is a report that using virtual reality (VR) equipment can give pain relief to pediatric patients with weak concentration or patients receiving severe treatment through a distraction method. Therefore, in this paper, VR equipment was used to provide psychological stability to patients during nuclear medicine tests, and it is intended to evaluate whether it can be used in clinical practice. Materials and Methods As VR equipment, ALLIP Z6 VR (ALLIP, Korea) was used and the experiment was conducted after connecting to a mobile phone. The subjects were 30 patients who underwent whole-body bone examination from September 1, 2021 to September 30, 2021. After intravenous injection of 99mTc-HDP, 3 to 6 hours later, VR equipment was put on and whole body images were obtained. After the test, a survey was conducted, and a Likert scale of 5 points was used for psychological anxiety and satisfaction with VR equipment. Hypothesis verification and reliability of the survey were analyzed using SPSS Statistics 25 (IBM, Corp., Armonk, NY, USA). Results Anxiety about the existing whole-body bone test was 3.03±1.53, whereas that of anxiety after wearing VR equipment was 2.0±1.21, indicating that anxiety decreased to 34%. When regression analysis of the effect of the patient's concentration on VR equipment on anxiety about the test, the B value was 0.750 (P<0.01) and the t value was 6.181 (P<0.01). decreased and showed an influence of 75%. In addition, overall satisfaction with VR equipment was 3.76±1.28, and the intention to reuse was 66%. The Cronbach α value of the reliability coefficient of the questionnaire was 0.901. Conclusion When using VR equipment, patients' attention was dispersed, anxiety was reduced, and psychological stability was found. In the future, as VR equipment technology develops, it is thought that if the equipment can be miniaturized and the resolution of VR content images is increased, it can be used in various clinical settings if it provides more realistic stability to the patient.

예비전력 정예화 방안

김재삼,Kim, Jae-Sam 대전대학교 군사연구원 2007 군사학연구 Vol.5 No.-

Reserved forces of ROKA are in charge of replacement of TOE in the wartime and mission of rear area operation. But there is institutional inertia in the law and organization oriented to fill human resources rather than take mission. We need to prepare for the investment and arrangement of reserved forces as military power that would be replaced standing forces. In this portion, to reinforce reserve forces elite, First, efficient mobilization regulations and systems are suggested. I covered a maintenance of relevant mobilization ordinances which need to legislated and approved by national assembly for wartime and development of mobilization system which might lose the appropriate time for mobilization due to complicated declaration procedures and measures to overcome the panic at the initial stage of the war and organization and employment of nationwide transportation system and mobilization center. To ensure efficient resource management and mobilization of reserve forces with a number of approximately 3 million, there's a necessity of organization for integration and conciliation. To make it real, I suggested establishing and employing the mobilization center, on first phase, employ the mobilization center focusing on homeland divisions, on second phase, it is advisable to convert to national level mobilization system and develop to central mobilization center focusing on national emergency planning committee. During peacetime, in conjunction with Mobilization Cell, mobilization center can conduct resource survey and integrate and manage mobilization resources and take charge of mobilization training of subordinate units, and during wartime, in conjunction with mobilization coordination team and Cell, can ensure the execution of mobilization. Second, Future oriented reserve forces management system such as service system of reserve forces and support system of homeland defense operations. Current service and trainings of reserve forces by the year have very low connection, as it is very complex to manage the resources and trainings, and service and training lack the equity, re-establishment of service system is required. Also in an aspect of CSS and cultivation support for reserve forces, as the scope and limitation of responsibility between the armed forces and autonomous organization is obscure, conditions to conduct actual-fighting exercises are limited. Concentrated budgetting is extremely difficult because reserve forces training fields are scattered nationwide, and facilities and equipments are rapidly getting older. To improve all these, I suggest the organization of homeland defense battalion with a unit of "City-Gun-District" and supporting the local reserve forces. Conduct unit replacement or personal replacement for those who have finished their 1 or 2 years and homeland defense operation duty for those with 3-5 years for consistency and simplification. Third, I suggest Future oriented Reserved Training(FRT) and Training Center oriented training management to establish a reliable reserve training. Reserves carry out expansion of unit, conventional combat mission, homeland defense and logistics support during wartime, and actual-fighting exercise, and disaster relief, peace keeping activities. Despite diverse activities and roles, their training condition still stays definitely poor. For these reasons, Modernization of weapons and facilities through gradual replacement and procurement is essential to enhance mobilization support system.

RAPD 마커를 이용한 멧누에와 집누에 계통간의 분자적 유연관계 분석

황재삼,이진성,구태원,강현아,손해룡,김호락,Hwang, Jae-Sam,Lee, Jin-Sung,Goo, Tae-Won,Kang, Hyun-Ah,Sohn, Hae-Ryong,Kim, Ho-Rak 한국생명과학회 1998 생명과학회지 Vol.8 No.4

본 연구는 RAPD마커를 이용, 멧누에와 집누에의 분자적 유연관계를 분석하였다. 공시한 35개의 primer에서 166개의 RAPD마커를 얻었으며, 이들 마커를 UPGMA에 의해 분석한 결과, 멧누에와 분자적 유사계수가 가장 낮은 품종은 잠305였고, 가장 높은 품종은 Bibaekjam이었다. 또한, 분자적 유사계수 0.55에서 멧누에와 집누에 계통군으로 분류되고, 0.60에서 3개의 아군 그룹과 2개의 독립개체로 분류되었다. 제1아군에는 J111(일본종계),$pnd^{ps}$(일본종계), Bibaekjam(일본종계)이, 제2아군에는 Galwon(중국종계), C18(중국종계), od yujam JAM306(중국종계), C108(중국종계)이, 제3아군에는 R-hwang(중국종계)이 포함되어 있었고, zebra(유럽종계)와 JAM305(일본종게)는 독립개체로 분류되었다. The molecular relationships have analyzed between the Bombyx mandarina(wild silkworm) and Bombyx mori strains (domesticated silkworm, geographical silkworms). A total of 166 polymorphic RAPD markers amplified from 35 different primers were used to analyze the molecular relationships among thirteen silkworm strains. The genetic similarity coefficient between Bombyx mandarina and Jam305 showed the lowest genetic similarity value with 0.451, Bombyx mandarina and Bibaekjam showed the highest genetic similarity value with 0.958. These strains were classified into Bombyx mandarina(a wild silkworm) and Bombyx mori(twelve domesticated silkworm) groups upon the genetic similary coefficient of 0.55. Further classificient of 0.60; the 1st sub-group (J111, Bibaekjam, $pnd^{ps}$), the 2nd sub-group (Galwon, C18, od yujam, JAM306, C108), the 3rd sub-group(R-hwang, p50), the 4th sub-group(zebra) and the 5th sub-group(JAM305). According to this study, RAPD markers seems to be a valuable tool for molecular relationships and classification among the silkworms.

간담도 스캔 시 담즙 누출(Biliary Leakage)환자에서의 양측와위 자세(Both Decubitus Position)의 유용성

반영각,노동욱,강천구,김재삼,이창호,Bahn, Young-Kag,Roh, Dong-Ook,Kang, Chun-Koo,Kim, Jae-Sam,Lee, Chang-Ho 대한핵의학기술학회 2008 핵의학 기술 Vol.12 No.2

간담도 스캔은 방사성의약품을 정맥주사 후 간세포에 섭취되어 담즙과 함께 담낭과 담도를 통하여 십이지장으로 배출되는 양상을 경시적으로 검사한다. 따라서 간세포와 담낭의 기능 정도 및 담도계의 폐쇄 여부를 알 수 있고 담즙의 누출 유무, 위치 및 정도를 확인하는데 가장 예민한 검사 방법이다. 하지만 담즙 누출을 확인하기 위한 목적의 간담도 스캔은 누출된 담즙과 장으로 배출된 담즙의 구분이 명확하지 않다. 그래서 본 연구는 간담도 스캔 검사 시 양측와위 자세로 검사를 시행하여 누출된 담즙과 장으로 배출 된 방사능을 분리 구분하여 더욱 명확한 담즙 누출의 진단을 하는데 목적을 두고 있다. 총 31명의 환자 중 남자는 14명, 여자는 17명이고, 평균나이는 $51.1{\pm}14.4$세였다. 정상위 자세에서 1분씩 60분간 경시적 영상을 획득하고, 지연검사는 2시간, 4시간, 24시간 간격의 정상위 자세와 좌우 측와위 자세로 각각 5분 동안 영상을 획득하였다. 단, 측와위 자세의 영상 획득 시 약 5분간 측와위 자세를 유지한 후에 영상을 획득 하였다. 간담도 스캔 시 담즙 누출 환자에서의 양측와위 자세의 유용성을 알아보기 위해 정상위 검사에서 누출이 바로 확인되는 환자의 측와위 자세와 관심영역을 비교하여 누출 여부(크기, 위치, 농도)의 감별 편리성의 양상을 비교하였고, 의심되는 질환이 담즙 누출이지만 경시적 영상에서 누출부위를 확실히 구분할 수 없는 환자의 측와위 자세를 통해 누출부위를 우선적으로 식별할 수 있는 환자가 어느 정도인지를 검사대비 감별확률로 비교하였다. 31명의 담즙 누출 환자 중 23명의 환자는 기능영상 혹은 지연영상에서 담즙 누출을 확인하였고, 8명의 환자는 측와위에서 담즙 누출을 확인 할 수 있었다. 영상에서 해부학적으로 누출 위치를 찾는 것은 정상위가 더욱 용이하였으나, 양측와 위 자세 변동으로 인한 장내 담즙의 이동으로 담즙의 누출이 더욱 확실히 구분되었다. 또한 관심영역과 배후방사능의 섭취계수(Counts/Pixel)를 구하여 관심영역/배후방사능비를 평가결과, 평균은 정상위 5.02, 좌측와위 2.08, 우측와위 2.68이었다. 관심영역의 화소 수를 분석하여 크기를 비교할 경우, 좌측와위는 정상위에 비해 평균 1.91배 컸고, 우측와위는 평균 1.05배 컸다. 결과적으로 31명의 환자 중 38.5% 정도만이 측와위가 의미가 있었지만, 위치 변동으로 인해 장내 담즙의 이동으로 누출의 위치는 더욱 명확한 구분이 가능하였다. 또한 그 38.5%의 환자에서 정상위와 양측와위에서의 관심영역/배후방사능비, 관심영역의 크기를 비교하면 측와위에서 관심영역의 넓이는 좌측와위 19%, 우측와위 5% 넓어지고, 농도는 좌측와위 약 60%, 우측와위 약 50% 옅어졌으며, 이는 복강 내로 관심영역의 담즙누출을 의미한다고 할 수 있다. 간담도 검사시 담즙 누출을 의심하는 환자에게 양측와위 자세를 추가하여 검사를 한다면 담즙 누출을 정확하게 진단할 것으로 사료된다. Hepatobiliary scintigraphy is very sensitivity of hepatic cell and gallbladder, biliary track atresia and biliary leakage. however, Hepatobiliary scan of biliary leakage diagnosis was separated determine biliary leakage and bowl drainage bile-juice. The object of this study will determine biliary leakage and bowl drainage bile-juice to hepatobiliary scintigraphy both decubitus position in bile leakage patients. Material & Methode: 31 patients (meal 14, Femeal 17), $51.1{\pm}14.4$ years. dynamic scan acquisition 60 farme for 60 minute on supine position. and delay scan was 2 hrs, 4 hrs, 24 hrs for 5 minute on supine, both decubitus position. Both decubitus position scan was kept for 5 minutes. Efficient of Hepatobiliary Scintigraphy both decubitus position in bile leakage patients was compared leakage size, density, image of supine position and both decubitus position. Results: 23 patients for 31 bile leakage patients was checked up function image or delay image, and 8 patients was checked up bile leakage on both decubitus. anatomical leakage location was supine position very well, but both decubitus position was separated bile leakage and moving bile-juice in bowl. also, uptake (counts/pixel) average of roi and bkg was supine 5.02, left decubitus 2.08, right decubitus 2.68. No. pixels of supine ROI counted 1.91 times than left decubitus, 1.05 times than right decubitus. Conclusion: 31 patient both decubitus position, but decubitus position was separated bile juice movement in bowl leakage location. also, It was compared ROI/BKG ratio and ROI No. pixels of supine, both decubitus in 38.5% patients. And No. pixels of supine position was large 19%, 5% than left decubitus, right decubitus, And density was in low 60%, 50% than left decubitus, right decubitus. It was mean bile leakage of ROI. so, If Hepatobiliary Scintigraphy was additional both decubitus position scan in bile leakage patients, this study will be more valuable in diagnosis of bile leakage.

PET/CT 검사에서 Q.Clear 기법의 유용성에 대한 고찰

최용훈,김정열,최영숙,임한상,김재삼,Choi, Yong Hoon,Kim, Jung Yul,Choi, Young Sook,Lim, Han Sang,Kim, Jae Sam 대한핵의학기술학회 2017 핵의학 기술 Vol.21 No.2

최근 PET/CT 장비의 성능의 발전과 다양한 기법의 개발로 민감도와 해상도등 영상 품질을 개선할 수 있게 되었다. 본 논문에서는 GE사의 Discovery IQ 장비의 Q.Clear (a fully convergent iterative reconstruction) 기법을 이용하여 영상의 질 향상에 유용성이 있는지 알아보고자 한다. 장비는 Discovery IQ (GE Healthcare, MI, USA)를 사용하였다. NEMA IEC Body Phantom의 배후방사능과 열소 체적(10 mm, 13 mm, 17 mm, 22 mm)의 비를 1:4로 하고 3분간 촬영하여 VPHDs (VUE Point High-Definition SharpIR)와 Q.Clear의 대조도를 비교 분석하였다. PET/SPECT Performance Phantom에 $^{18}F-FDG$를 187 MBq을 주입 후 4분간 촬영하여 해상도와 균일도를 비교 분석하였다. 그리고 100명의 임상 환자에서 질환의 종류와 상관없이 2 cm 미만의 작은 병소의 SUVmax를 측정하여 t-test 통계분석하였다. NEMA IEC Body Phantom에서 VPHDs와 Q.Clear의 대조도가 $63.6{\pm}5.7%$, $75{\pm}4.8%$로 나왔고 PET/SPECT Performance Phantom에서 해상도는 VPHDs가 9.2 mm, Q.Clear가 7.3 mm로 나왔다. 균일도는 Q.Clear가 10.8% 더 우수하였다. 임상 환자의 t-test 통계 결과 p-value가 0.021로 유의한 차이가 있었다. 임상환자에서 SUVmax는 Q.Clear에서 높게 측정 되었으며, 신호대 잡음 비도 우수하였다. 이는 부분체적효과의 영향을 줄였기 때문으로 볼 수 있다. Phantom test와 임상 환자의 결과 모두 Q.Clear를 적용 하였을 때 영상품질이 향상된 것을 확인하였다. 이러한 영상 품질 향상은 병소를 더욱 정확하게 발견할 수 있고 나아가 선량저감과 환자평가 그리고 영상 분석 등 다양한 방면에서 활용할 수 있을 것으로 사료된다. Purpose Recently, the performance of PET/CT scanner has been improved and various techniques have been developed to increase the image quality such as Sensitivity and Resolution. The purpose of this study is to evaluate the usefulness of Q.Clear (a fully convergent iterative reconstruction) technique of GE Discovery IQ equipment to enhance the image quality. Materials and Methods All scans were acquired by Discovery IQ (GE Healthcare, MI, USA). In NEMA IEC Body Phantom test, Background to Hot-sphere (10 mm, 13 mm, 17 mm, 22 mm) ratio was 1:4 and scan time was 3 minutes. The images were reconstructed by VPHDs (VUE Point High-Definition + SharpIR) and Q.Clear to evaluate each Contrast. We injected 18F-FDG 187 M㏃ to PET/SPECT Performance Phantom. And then it was scanned for 4 minutes to evaluate Resolution and Uniformity. T-test statistical analysis was performed on SUVmax of small lesions less than 2 cm in 100 clinical patients regardless of disease type. Results In the NEMA IEC Body Phantom, the Contrast was $63.6{\pm}5.7%$ (VPHDs) and $75{\pm}4.8%$ (Q.Clear). In the PET/SPECT Performance Phantom, the Resolution was 9.2 mm (VPHDs) and 7.3 mm (Q.Clear). Uniformity of Q.Clear was 10.8% better than VPHDs. T-test statistic of the clinical patients showed a significant difference of p value of 0.021. Conclusion Both the phantom test and the clinical results showed that the quality of the image was improved in Q.Clear was applied. The SUVmax was highly measured in Q.Clear and the lesions were clearly distinguished visually. Therefore Q.Clear can be useful in various aspects such as dose-reduction, patients evaluation and image analysis.

생성적 적대 신경망(Generative Adversarial Network)을 이용하여 획득한 ¹⁸F-FDG Brain PET/CT 인공지능 영상의 비교평가

김종완,김정열,임한상,김재삼,Kim, Jong-Wan,Kim, Jung-Yul,Lim, Han-sang,Kim, Jae-sam 대한핵의학기술학회 2020 핵의학 기술 Vol.24 No.1

본 연구는 최근에 활발히 연구되고 있는 딥러닝 기술인 생성적 적대 신경망(GAN)을 핵의학 영상에 적용하여 잠재적으로 유용성이 있는지 확인해보고자 하였다. 본원에서 ¹⁸F-FDG Brain PET/CT검사를 진행한 30명의 환자를 대상으로 하였고 List모드로 15분 검사한 후 이를 1, 2, 3, 4, 5분 초기획득시간 이미지로 재구성하였다. 이 중 25명의 환자를 GAN모델의 학습을 위한 트레이닝 이미지로 사용하고 5명의 환자를 학습된 GAN모델의 검증을 위한 테스트 이미지로 사용하였다. 학습된 GAN모델에 입력으로 1, 2, 3, 4, 5분의 초기획득 이미지를 넣고 출력으로 15분 인공지능 표준획득 이미지를 획득한 후 이를 기존의 15분 표준획득시간 검사 이미지와 비교 평가하였다. 평가에는 정량화된 이미지 평가방법인 평균제곱오차, 최대신호 대 잡음비, 구조적 유사도 지수를 이용하였다. 평가 결과 초기획득시간 이미지에서 1에서 5분으로 갈수록 실제 표준획득시간 이미지에 가까운 평균제곱오차, 최대신호 대 잡음비, 구조적 유사도 지수 수치를 나타내었다. 이러한 연구를 통해 앞으로 인공지능 기술이 핵의학 분야에서 의료영상의 획득시간 단축과 관련하여 중요한 영향을 미칠 수 있을 것으로 사료된다. Purpose Generative Adversarial Network(GAN) is one of deep learning technologies. This is a way to create a real fake image after learning the real image. In this study, after acquiring artificial intelligence images through GAN, We were compared and evaluated with real scan time images. We want to see if these technologies are potentially useful. Materials and Methods 30 patients who underwent ¹⁸F-FDG Brain PET/CT scanning at Severance Hospital, were acquired in 15-minute List mode and reconstructed into 1,2,3,4,5 and 15minute images, respectively. 25 out of 30 patients were used as learning images for learning of GAN and 5 patients used as verification images for confirming the learning model. The program was implemented using the Python and Tensorflow frameworks. After learning using the Pix2Pix model of GAN technology, this learning model generated artificial intelligence images. The artificial intelligence image generated in this way were evaluated as Mean Square Error(MSE), Peak Signal to Noise Ratio(PSNR), and Structural Similarity Index(SSIM) with real scan time image. Results The trained model was evaluated with the verification image. As a result, The 15-minute image created by the 5-minute image rather than 1-minute after the start of the scan showed a smaller MSE, and the PSNR and SSIM increased. Conclusion Through this study, it was confirmed that AI imaging technology is applicable. In the future, if these artificial intelligence imaging technologies are applied to nuclear medicine imaging, it will be possible to acquire images even with a short scan time, which can be expected to reduce artifacts caused by patient movement and increase the efficiency of the scanning room.