The Change of Lacrimal Gland Volume in Korean Patients with Thyroid-associated Ophthalmopathy

허현도,김지혜,김성재,유지명,서성욱 대한안과학회 2016 Korean Journal of Ophthalmology Vol.30 No.5

Purpose: To describe the change of lacrimal gland volumes in Korean patients with thyroid-associated ophthalmopathy(TAO) via computed tomography (CT). Methods: A retrospective review of CT images from 217 TAO patients and 135 control subjects was performed. The TAO patients were diagnosed between May 2005 and May 2014 and had a CT performed on initial presentation(330 orbital CT scans). These images were compared with 270 orbital CT scans from the controlgroup, obtained between May 2013 and May 2014. An open source DICOM viewer was used to calculate thevolume of the lacrimal gland. Results: The mean volume of the lacrimal gland in TAO patients was 0.816 cm3 in the right orbit (standard deviation[SD], 0.048) and 0.811 cm3 in the left orbit (SD, 0.051), with no significant difference between right and left(p = 0.192). However, significant differences were observed between TAO patients and healthy individuals (p< 0.001). There was no significant difference between mean lacrimal gland volumes of males (0.812 cm3; SD,0.037) and females (0.816 cm3; SD, 0.029) (p = 0.513). There was a negative correlation between gland volumeand age in TAO patients (Pearson r = -0.479, p = 0.00). The subjective tearing (right: r = 0.244, p = 0.018;left: r = 0.226, p = 0.024), corneal superficial punctate keratopathy (right: r = 0.192, p = 0.040; left: r = 0.206, p= 0.036), and exophthalmometry (right: r = 0.182, p = 0.032; left: r = 0.180, p = 0.046) correlated with lacrimalgland volume. Conclusions: This study is the first to use CT images to calculate the lacrimal gland volume of Korean TAOpatients. In TAO patients, the lacrimal gland volume was notably increased compared to control subjects. Thelacrimal gland volume decreased with age, but there was no difference between gender and no difference betweenleft and right. The lacrimal gland volume correlated with subjective tearing, corneal superficial punctatekeratopathy and exophthalmometry.

사이버나이프에서 폐종양 추적 시스템의 정확도 분석

허현도,최상현,김우철,김헌정,김성훈,조삼주,민철기,조광환,이상훈,최진호,임상욱,신동오,Huh, Hyun-Do,Choi, Sang-Hyoun,Kim, Woo-Chul,Kim, Hun-Jeong,Kim, Seong-Hoon,Cho, Sam-Ju,Min, Chul-Ki,Cho, Kwang-Hwan,Lee, Sang-Hoon,Choi, Jin-Ho,Lim, San 한국의학물리학회 2009 의학물리 Vol.20 No.3

사이버나이프 로봇 방사선 수술 시스템은 환자를 치료하는 동안 환자의 내부 기준 마커를 이용하여 종양의 위치를 실시간으로 추적 할 수 있는 시스템이다. 최근 폐종양 치료의 경우 기준 마커의 삽입 없이 폐종양의 밀도 차이를 이용하여 실시간 종양 추적을 할 수 있는 폐종양추적시스템이 개발되어 치료에 적용되고 있다. 최근 개발되어 국내 최초 도입된 폐종양 추적치료시스템의 위치 추적 정확도의 분석은 동적흉부 팬톰과 GafChromic film을 이용하였다. 폐종양추적시스템을 이용하여 종양의 위치 추적 정확도는 평균 오차 $0.85{\pm}0.22$ mm로 분석되었다. 기준마커 삽입 없이 폐종양추적시스템을 이용하여 폐종양 치료에 매우 유용한 것으로 판단되었다. To track moving tumor in real time, CyberKnife system imports a technique of the synchrony respiratory tracking system. The fiducial marker which are detectable in X-ray images were demand in CyberKnife Robotic radiosurgery system. It issued as reference markers to locate and track tumor location during patient alignment and treatment delivery. Fiducial marker implantation is an invasive surgical operation that carries a relatively high risk of pneumothorax. Most recently, it was developed a direct lung tumor registration method that does not require the use of fiducials. The purpose of this study is to measure the accuracy of target applying X-sight lung tracking using the Gafchromic film in dynamic moving thorax phantom. The X-sight Lung Tracking quality assurance motion phantom simulates simple respiratory motion of a lung tumor and provides Gafchromic dosimetry film-based test capability at locations inside the phantom corresponding to a typical lung tumor. The total average error for the X-sight Lung Tracking System with a moving target was $0.85{\pm}0.22$ mm. The results were considered reliable and applicable for lung tumor treatment in CyberKnife radiosurgery system. Clinically, breathing patterns of patients may vary during radiation therapy. Therefore, additional studies with a set real patient data are necessary to evaluate the target accuracy for the X-sight Lung Tracking system.

의료용 붕소중성자포획치료(BNCT) 조사장치 개발현황 조사 분석

허현도,이창열,김우철,김헌정,이정심,임영경,이세병,신동오,최상현,박승우,김금배,지영훈 대한방사선방어학회 2017 대한방사선방어학회 학술발표회 논문요약집 Vol.2017 No.11

체적변조회전치료에서 Hybrid Optimized VMAT Phantom (HOVP)을 이용한 실시간 환자 맞춤형 정도관리를 위한 예비연구

허현도,최상현,김우철,김헌정,김금배,김성훈,조삼주,민철기,조광환,이상훈,이석,심장보,신동오,지영훈,Huh, Hyun-Do,Choi, Sang-Hyoun,Kim, Woo-Chul,Kim, Hun-Jeong,Kim, Kum-Bae,Kim, Seong-Hoon,Cho, Sam-Ju,Min, Chul-Kee,Cho, Kwang-Hwan,Lee, Sang-Hoon 한국의학물리학회 2011 의학물리 Vol.22 No.4

다엽콜리메이터, 겐트리회전, 선량율 등에서 형성되는 플루언스 맵을 이용하여 환자 맞춤형 치료 선량검증이 가능한지 알아보았다. 플루언스 맵은 2D 배열 검출기로 측정하였고, 동일 치료계획을 팬톰 내에서 이온전리함, 필름, 유리선량계 등을 이용하여 측정 비교하였다. 목표점에서 체적감마인자(volume gamma index, 3%, 3 mm)기준에 통과율은 $85.22%{\pm}1.7$(RT_target), $89.96%{\pm}2.15$였고, G4는 $95.14%{\pm}1.18$이었다. 선량 전달 오차는 선량이 급격히 변화는 영역(G1, G2, G3)과 주요장기(G4)에서 각각 $11.72%{\pm}0.531$, $-11.47%{\pm}0.991$, $7.81%{\pm}0.857$, $-4.14%{\pm}0.761$이었다. 이온전리함 측정값의 상대오차는 각각 평균 $-1.02%{\pm}0.222$ (Rt_target), $0.96%{\pm}0.294$ (Lt_target)이었다. 필름의 감마인자(3%, 3 mm) 기준 평균 통과율은 $92.59%{\pm}3.312$이었다. 유리선량계 상대 오차는 8.3% (G1), -5.4% (G2), 7.2% (G3), 6.1% (G4)이었다. 체적변조회전방사선 치료(VMAT)시 실시간 플루언스 맵 측정을 통한 실시간 환자 맞춤형 선량 검증이 가능할 것으로 사료되었다. The purpose of this was to investigate the measurement of fluence dose map for the specific patient quality assurance. The measurement of fluence map was performed using 2D matrixx detector. The absorbed dose was measured by a glass detector, Gafchromic film and ion chamber in Hybrid Optimized VMAT Phantom (HOVP). For 2D Matrixx, the results of comparison were average passing rate $85.22%{\pm}1.7$ (RT_Target), $89.96%{\pm}2.15$ (LT_Target) and $95.14%{\pm}1.18$ (G4). The dose difference was $11.72%{\pm}0.531$, $-11.47%{\pm}0.991$, $7.81%{\pm}0.857$, $-4.14%{\pm}0.761$ at the G1, G2, G3, G4. In HOVP, the results of comparison for film were average passing rate (3%, 3 mm) $93.64%{\pm}3.87$, $90.82%{\pm}0.99$. We were measured an absolute dose in steep gradient area G1, G2, G3, G4 using the glass detector. The difference between the measurement and calculation are 8.3% (G1), -5.4% (G2), 6.1% (G3), 7.2% (G4). The using an Ion-chamber were an average relative dose error $-1.02%{\pm}0.222$ (Rt_target), $0.96%{\pm}0.294$ (Lt_target). Though we need a more study using a transmission detector. However, a measurement of real-time fluence map will be predicting a dose for real-time specific patient quality assurance in volume modulated arc therapy.

아크릴 팬톰에서 GafChromic 필름을 이용한 고선량률 근접치료용 Ir-192 선원의 근접 거리에서 비등방성 측정

허현도,김성훈,최진호,조병철,신동오,권수일,전하정,노준규,김우철 한국의학물리학회 2004 의학물리 Vol.15 No.2

GafChromic 필름은 높은 분해능과 낮은 민감도 그리고 조직 등가 물질에 유사하게 구성되어 있다. 본 연구의 목적은 GafChromic 필름을 이용하여 고선량률 근접치료에 사용하는 Ir-192선원 근접 거리에서의 비등방성을 측정하는 것이다. GafChromic 필름은 0 Gy 105 Gy까지 4 MV 선형가속기를 이용하여 흑화도를 구하였다. 비등방성 값은 아크릴 팬톰에서 GafChromic 필름을 이용하여 측정하였고, 측정된 값은 J. F. Williamson이 몬테칼로 계산한 값과 비교하였다. 비교 결과 거리(r) 2.5 mm, 각도 50~130도까지 영역에서 4.4% 이내로 일치하였고 반면 140도 부근에서 17.6% 차이가 나는 것을 알 수 있었고, 한편 거리(r) 5 mm, 각도 35~160도까지 3.7% 이내로 일치하였고, 30도 부근에서는 7.6% 정도 차이가 나는 것을 알 수 있었다. GafChromic 필름은 고선량률 근접치료 Ir-192선원의 근접 거리에서 비등방성 측정 시 기존에 사용되고 있는 측정 장비보다 매우 유용한 것으로 생각된다. Radiochromic film has several advantages; high spatial resolution, relatively low spectral sensitivity, near tissue equivalence and requires no special development procedure. The object of this study was to measure the anisotropy of an Ir-192 source (microSelectron manufactured by Nucletron) in a few mm regions from the source, using the GafChromic film. The GafChromic film was calibrated in the range of 0~105 Gy, using a 4 MV photon beam, and the anisotropy function measured in an acrylic phantom using the GafChroimic film. The data obtained gave agreement to within 4.4% of the Monte Calro calculation, by J. F. Williamson, at a radial distance of 2.5 mm with polar angles of 50 to 130o, while a maximum deviation of 17.6% was observed at angles near 140o and agreement within 3.7% at a radial distance of 5 mm at polar angles between 35 to 160o and a maximum deviation of 7.6% was observed at angles near 30o. A GafChromic film can be used as a more efficient detector for measuring the anisotropy of an HDR 192Ir source at close distances than any other detector.

Analysis of Dose Distribution on Critical Organs for Radiosurgery with CyberKnife Real-Time Tumor Tracking System

허현도,최상현,김우철,김헌정,김성훈,지영훈,김금배,이상훈,최진호,이레나,신동오,Huh, Hyun-Do,Choi, Sang-Hyoun,Kim, Woo-Chul,Kim, Hun-Jeong,Kim, Seong-Hoon,Ji, Young-Hoon,Kim, Kum-Bae,Lee, Sang-Hoon,Choi, Jin-Ho,Lee, Re-Na,Shin, Dong-Oh Korean Society of Medical Physics 2009 의학물리 Vol.20 No.1

본 연구에서는 복부 전용 팬톰을 이용하여 폐 종양을 모델로 실시간 종양 추적 치료 시 종양에 대한 선량 분포와 종양 부근에 인접하여 상대적으로 움직임이 작은 주요장기인 척추의 선량 분포를 3차원과 4차원 전산화 치료계획을 통하여 나타난 선량분포에 대하여 Gafchromic 필름을 이용하여 선량을 비교평가 하였다. 비교 결과 종양의 선량 분포는 감마 지표 3%, 1 mm를 기준으로 일치도가 3차원 및 4차원에서 각각 90.6%, 97.64%이었고, 척추에서는 감마 지표 3%, 2 mm를 기준으로 3차원 및 4차원에서 각각 57.13%, 90.4%로 나타났다. 종양 및 척추에서 4차원 전산화치료계획 계산값은 측정값과 비교할 경우 근소한 차이를 보였으나 3차원 전산화 치료계획 시 종양에 근접하여 움직임이 작은 척추에서는 계산값과 측정값의 차이가 크게 나타났다. 따라서 사이버나이프와 같은 장비를 이용하여 호흡에 따라 움직이는 종양을 대상으로 실시간 종양추적 치료 시 4차원 전산화 치료계획이 반드시 필요하다고 사료된다. We measured the dose distribution for spinal cord and tumor using Gafchromic film, applying 3D and 4D-Treatment Planning for lung tumor within the phantom. A measured dose distribution was compared with a calculated dose distribution generated from 3D radiation treatment planning and 4D radiation treatment planning system. The agreement of the dose distribution in tumor for 3D and 4D treatment planning was 90.6%, 97.64% using gamma index computed for a distance to agreement of 1 mm and a dose difference of 3%. However, a gamma agreement index of 3% dose difference tolerence of and 2 mm distance to agreement, the accordance of the dose distribution around cord for 3D and 4D radiation treatment planning was 57.13%, 90.4%. There are significant differences between a calculated dose and a measured dose for 3D radiation treatment planning, no significant differences for 4D treatment planning. The results provide the effectiveness of the 4D treatment planning as compared to 3D. We suggest that the 4-dimensional treatment planning should be considered in the case where such equipments as Cyberknife with the real time tracking system are used to treat the tumors in the moving organ.

신생혈관녹내장에서 베바시주맙의 전방과 유리체내 동시 주입과 유리체내 단독 주입의 치료 효과

허현도,한용섭,정인영,서성욱,박종문,유지명,김성재,Hyoun Do Huh,Yong Seop Han,In Young Chung,Seong Wook Seo,Jong Moon Park,Ji Myong Yoo,Seong Jae Kim 대한안과학회 2014 대한안과학회지 Vol.55 No.7

<b>Purpose:</b> To compare the clinical efficacy of simultaneous intracameral and intravitreal injection and intravitreal single injection of bevacizumab in patients with neovascular glaucoma (NVG). <b>Methods:</b> The medical records of 43 eyes of 43 patients, who had treated with simultaneous intracameral and intravitreal injection (Group I) or intravitreal single injection (Group II) of bevacizumab 1.25 mg from January 2010 to December 2012, were retrospectively reviewed. The best corrected visual acuity (BCVA), intraocular pressure (IOP), regression time of new vessel in the iris (NVI) and anterior chamber angle (NVA), progression of peripheral anterior synechiae (PAS), and corneal parameters were measured preoperatively and one day, three days, 1 week, 1 month, and 3 months postoperatively. <b>Results:</b> There was significant changes of IOP between the two groups at 1, 3 days postoperatively (<em>p</em> = 0.001, <em>p</em> < 0.001). The regression time of NVI and NVA in Group I was significantly faster than Group II (<em>p</em> = 0.026, <em>p</em> = 0.033). In the phakic eyes, regression time of NVI and NVA was significantly longer than aphakic and pseudophakic eyes in group II (<em>p</em> = 0.006, <em>p </em>= 0.005). Also, in the phakic NVG patients, the formation of PAS in Group I was significantly less than in Group II for the postoperative three months (<em>p </em>= 0.020). <b>Conclusions:</b> Simultaneous intravitreal and intracameral injection of bevacizumab seem to be more effective for the early lowering of IOP and regression of NVI and NVA, and inhibiting further PAS formation in NVG patients, especially in the phakic eyes. Therefore, simultaneous intracameral and intravitreal injection of bevacizumab may be considered as an adjunct to management of NVG in the phakic eyes. J Korean Ophthalmol Soc 2014;55(7):1039-1048

한국의학물리학회 선형가속기 외부 품질관리 실시 현황보고

허현도,조광환,조삼주,최상현,김동욱,황의중,김기환,민철기,최태진,오영기,이승준,박달,박성광,지영훈,Huh, Hyun Do,Cho, Kwang Hwan,Cho, Sam Ju,Choi, Sang Hyoun,Kim, Dong Wook,Hwang, Ui-Jung,Kim, Ki Hwan,Min, Chul Kee,Choi, Tae Jin,Oh, Young Kee,Le 한국의학물리학회 2013 의학물리 Vol.24 No.4

전문가 그룹의 외부검사를 통하여 의료기관 자체적으로 시행되고 있는 품질관리를 평가하고 구조적 문제점에 대한 상호보완을 하고자 하였다. 외부 검사의 정당성 확보를 위해 전국 80여 개의 의료기관 중 지역 분포를 고려하여 30여 개를 선정하였고, 최종 25개의 의료기관이 자발적 참여의사를 신청하였다. 참여의료기관은 비공개를 원칙으로 하였고, 사전에 상호 비교하여 검증된 측정 장비를 가지고 직접 방문하여 측정하는 것을 원칙으로 하였다. 두 개 이상의 광자선을 대상으로 출력선량을 측정하였고, 갠트리회전 정확도, 콜리메이터 회전 정확도, 다엽콜리메이터 이동 위치 정확도 등을 측정하였다. 출력선량 측정에서 6 MV의 경우 -0.8%~4.5%까지 절대오차를 보였고, 10 MV의 경우 -0.79%~3.01%이었고, 15 MV에서 -0.7%~0.07% 절대오차를 나타내었다. 25개 의료 기관을 대상으로 한 50개의 광자선 중에서 절대 흡수선량이 2% 이상 되는 에너지가 8개(16%)로 나타났다. 조사면과 갠트리, 콜리메이터 회전축 일치도는 2개 의료기관을 제외하고 모두 ${\pm}2$ mm 이내의 결과를 보였다. 다엽콜리메이터 이동 위치 정확도는 모두 ${\pm}1$ mm 이내의 정확도를 보였다. 에너지 선질 조사에서 광자선 6 MV의 경우 KQ 값의 최고값과 최저값의 차이는 0.4%로 나타났다. 물 흡수선량 기반 측정 기준서 사용기관은 21개(84%), 공기 흡수선량 기반 측정 기준서 사용기관은 4개(16%)로 조사되었고, SSD 측정법을 사용하는 기관은 22개, SAD 측정법을 사용하는 기관은 3개 기관으로 조사되었다. 외부검사는 자체적으로 시행되고 있는 품질관리의 구조적인 문제점을 찾아 상호 보완하는 것임으로 매우 중요하다. 따라서 전문가 그룹 및 국가가 함께 주기적이고, 지속적인 외부검사가 시행 될 수 있도록 국제 수준의 전문가의 양성 및 국가지원 제도가 필요하다고 사료된다. The aim of this work is to verify the self-quality assurances in medical institutions in Korea through the external audits by the group of experts and have a mutual discussion of the systematic problems. In order to validate the external audits 30 of 80 medical institutions across the nation were picked out considering the regional distribution and the final 25 institutions applied voluntarily to take part in this work. The basic rules were setup that any information of the participants be kept secrete and the measurements be performed with the dosimetry system already verified through intercomparision. The outputs for 2 or more photon beams, the accuracy of gantry rotation and collimator rotation and the poistional accuracy of MLC movement were measured. The findings for the output measurement showed the differences of -0.8%~4.5%, -0.79%~3.01%, and -0.7%~0.07% with respect to that of the verified dosimetry system for the 6MV, 10MV, and 15MV, respectively. For the reference absorbed dose 8 (16%) of 50 photon beams in 25 medical institutions differed 2.0% or greater from the reference value. The coincidences of Field size with x-ray beam and radiation isocenters of Gantry roration and collimator rotation gave the results of within ${\pm}2$ mm for every institute except 2 institutions. The positional accuracy of MLC movement agreed to within ${\pm}1$ mm for every institute. For the beam qualities of 6 MV photon beams kQ values showed the distribution within 0.4% between maximum and minimum. For the protocols 21 institutions (84%) used absorbed dose to water based protocol while 4 insitutions (16%) used air kerma based one. 22 institutions employed the SSD technique while 3 institutions did the SAD one. External audit plays an important role in discovering the systematic problems of self-performing Quality Assurances and having in depth discussion for mutual complementation. Training experts of international level as well as national support system are required so that both the group of experts of medical physicists and government laboratory could perform together periodical and constant external audits.

치과용 아말감의 파절에 관한 연구

허현도,엄정문 大韓齒科保存學會 1983 Restorative Dentistry & Endodontics Vol.9 No.1

고선량률 근접조사치료용 이리듐-192 방사성동위원소의 교정방법 비교연구

허현도,박성용,이레나,신동오,권수일,노준규,최진호,Huh Hyun Do,Park Sung Yong,Lee Rena J,Shin Dong Oh,Kwon Soo Il,Loh John J K,Choi Jinho 한국의학물리학회 2004 의학물리 Vol.15 No.4

본 연구는 국내에서 이용되고 있는 고선량률 근접치료기에 사용되는 Ir-192 선원에 대하여 Farmer type전리함과 우물형 전리함을 이용하여 선원의 세기를 측정하여 제조사에서 제공된 값과의 오차를 확인하고 두 증기간의 오차를 비교하였다. 동일한 Ir-192가 장착되어 가동 중인 6개의 병원의 고선량률 근접치료기(microSelctron, Nucletron, Netherlands)를 대상으로 선원의 모델별로 구분하여 상품화된 교정 Jig와 우물형 전리함 시스템을 이용, 선원의 세기를 측정하고 제조사에서 제공된 값과 비교하여 오차를 구하였다. 교정용 Jig를 이용한 선원 세기의 오차범위는 -2.40~+3.12%이고 우물형 전리함의 경우 오차범위는 -3.31~0.00%를 나타내었다. 측정 결과 두 장비 모두 제조사에서 제공된 값과 비교하였을 때 ${\pm}5%$의 오차를 넘지 않았으므로 임상 적용에는 문제가 없다. 외국의 사고 사례 보고에 따르면 계산 값에 의존하지 말고 새로운 선원이 교체될때 반드시 치료에 사용되기 전에 측정 도구를 이용하여 방사능의 세기를 측정하고 계산된 값과 비교하여 오차범위 내에서 일치하는지에 대한 확인 절차과정을 거치는 것이 필요하다. The activity of Ir-192 sources for high dose rate (HDR) Brachytherapy in Korea were measured by using the well-type chamber and using the calibration Jig with the Farmer-type ionization chamber to compare the manufacturer certificated source strength which is supplied with each new Ir-192 source. The activity of two different source models used in six hospitals were measured. The range of measured activities to the manufacturer's suggested ones was -2.40% to +3.31% for the calibration Jig and -3.12% to 0.00% for the well-type chamber system. The source strength values given by the manufacturer for the 6 sources were within ${\pm}5%$ for the two different measuring equipment. Our results demonstrate that well-type chamber as wall as Farmer-type chamber system are appropriate system for the routine source calibration procedures in HDR brachytherapy. Whenever a new source is installed to use in clinics, a source calibration should be carried out.