CT조영제 부작용 고위험군에 대한 전처치의 유용성

장양선(Yang seon Jang),이광원(Gwang won Lee),구양수(Yang su Ku),김대현(Dae hyeon Kim) 대한CT영상기술학회 2013 대한CT영상기술학회지 Vol.15 No.1

목적 : 조영제를 사용하는 CT검사에서 조영제 투여 전 병원 내 약물이상 반응 모니터링 팀에서 만든 조영제 부작용 관련 상병코드에 따라 조영제 부작용 고위험군에게 전처치를 시행할 경우 조영제 부작용을 감소시키고 예방할 수 있는 방안을 제공하고자 한다. 대상 및 방법 : 연구대상은 2012년 1월 1일부터 2012년 12월 31일까지 일개 대학병원에 내원한 외래환자 중 정맥내로 조영제를 투여받은 23,317명에서 조영제 부작용 고위험군에게 전처치를 시행한 남녀 118명을 대상으로 하였다. 전처치 방법으로는 스테로이드제인 Prednisolone tab 5mg 10T를 조영제 주입 13시간, 7시간, 1시간 전에 경구 투여하였으며 항히스타민제인 Cetizal tab 5mg 1T를 조영제 주입 1시간 전에 경구 투여 하였다. 또한 검사 당일 전처치가 되지 않은 환자는 마찬가지로 항히스타민제와 스테로이드제인 Chlorpeniramine 4mg/2ml, solu-cortef 250mg/2ml를 조영제 주입 30분 전에 정맥 주입하였다. 결과 : 일반적 특성에서 남자 61명(51.7%) 중 6명(5.09%), 여자 57명(48.3%) 중 3명(2.54%)으로 검사 후 부작용이 나타났으며(p=0.350), 연령에 따라서는 60세 이상에서 60명(50.8%) 중 6명(5.09%)으로 가장 많이 발생하였다(p=0.914). 촬영부위별 부작용 발생 역시 검사 후 증상과는 유의한 차이가 없었고(p=0.830) 전처치 방법으로 정맥 주입을 한 환자는 65명(55.1%) 중 6명(5.09%), 경구 투여를 한 환자는 53명(44.0%) 중 3명(2.54%)으로 유의한 차이가 없었다(p=0.467). 조영제 종류(p=0.670), 조영제 주입량(p=0.695), 주입속도(p=0.468)의 경우 검사후 증상과 유의한 차이를 보이지 않았고 조영제 부작용 기왕력의 경우 36명(30.5%) 중 6명(5.09%)이 검사후 부작용이 다시 발생되어 검사 후 증상과 유의한 차이를 보였다(p=0.001). 결론 : CT검사 후 조영제 부작용은 기왕력에 대해서 높은 관계가 있는 것으로 분석되어 과거의 기왕력을 철저히 파악하고 고위험군에게 전처치를 시행하여 검사 종료 후 세심하게 관찰하고 이를 예방할수 있는 표준화된 지침이 필요하다고 사료된다. Purpose : It is to provide the method to reduce and prevent adverse reactions to contrast media by performing pretreatment to contrast media anaphylaxis high-risk group according to contrast media anaphylaxis related illness code by drug side effect response monitoring team in hospital before the administration of contrast media. Materials and Methods : The subjects were 118 male and female patients who received pretreatment for contrast media anaphylaxis high-risk group out of 23,317 patients who came to the subject hospital and had contrast media in veins. For conditioning, Prednisolone (corticosteroid agent) tab 5 mg 10T were given 13 hours, 7 hours and 1 hour before the administration of contrast media, and Cetizal (anti-histamine) tab 5mg 1T was given orally an hour before the administration contrast media. The patients who did not get pretreatment got injection of anti-histamine agent (Chlorpeniramine 4mg/2ml) and corticosteroid agent (solu-cortef 250mg/2ml) in veins 30 minutes before the administration of contrast media. Results : In general characteristics, 6(5.09%) out of 61 males(51.7%) and 3(2.54%) out of 57 females(48.3%) showed anaphylaxis after the examination(p=0.350). According to age, the group over 60 showed the highest number of anaphylaxis as 6(5.09%) out of 60 (50.8%)(p=0.914). There was no significant difference between anaphylaxis occurrence according to examination part and symptoms after the examination(p=0.830), and there was no significant difference according to pretreatment method. Six(5.09%) out of 65(55.1%) who got intravenous injection showed anaphylaxis, while 3(2.54%) out of 53(44.0%) who got oral administration showed anaphylaxis(p=0.467). There was no significant difference according to contrast media type(p=0.670), contrast media injection volume(p=0.695), and injection speed(p=0.468), while contrast media anaphylaxis history showed significant difference as 6(5.09%) out of 36(30.5%) showed the recurrence of anaphylaxis after the examination(p=0.001). Conclusion : As adverse reactions to contrast media are analyzed to have high correlation with previous history of adverse reactions, it is very important to identify the previous history and a standardized guideline should be in place to administer pretreatment to the high-risk group and to perform close follow-up after the examination.

16 MDCT를 이용한 CT Urography의 유용성

김동수(Dong Soo Kim),강화원(Hwa Won Kang),임상묵(Sang Muk Im),구양수(Yang Su Ku),이강우(Kang Woo Lee),최창한(Chang Han Choi) 대한CT영상기술학회 2005 대한CT영상기술학회지 Vol.7 No.1

Purpose To evaluate the usefulness of computed tomography urography with 16-channel multidetecter computed tomography in patients with urinary track disease. Materials and Methods IN 28 patients who underwent CT urography from May 2004 to December 2004. The clinical symptoms of these patients include; renal donors or hematuria, which were clinically suggestive of urinary system disorders. All studies were performed on a siemens sensation 16 scanner with 16mm detectors. CT scans were obtained on a unenhanced, arterial phase, 1,3,5 minites with the following technique : a collimator of 5mm a pitch of 1, and 3d reconstrutions at a thickness of 2mm with intervals of l.5mm. Intravenous administered of the normal saline 50 ml immediately after injecting contrast medium(at a rate of 3 ml/sec). Results Of these 28 patients,(9men and 19 women, age ranged from 20 to 79 years old, mean age 44.8 years)l4 patients(46.7%) were proven to have no 뮤normal disease, 4 patients(13.4%) were with renal stones or hydronephrosis, and there were 10 patients(40.9%) of other urinary system disorders. Conclusion CT urography is a very useful modality to evaluate kidny-transeplatation donors, hematuria and flank pain in the patients with urinary track disease

관상동맥 CT혈관조영술에서의 운동 인공물에 대한 심전도 보정에 의한 영상재구성 기법

윤재혁(Jae Hyeok Yun),김홍석(Hong Seok Kim),구양수(Yang Su Ku),조영기(Young Ki Cho) 대한전산화단층기술학회 2009 대한CT영상기술학회지 Vol.11 No.1

Purpose This study was purposed to report cases to whom an image reconstruction technique based on ECG-pulsing editing was applied for artifacts in images caused by instable breathing when the cycle of heart rate is irregular or very fast. Materials and methods An image reconstruction technique based on ECG-pulsing editing was applied to 5 patients who were sampled from those who had ECG-synchronized CT angiography since September 2007 and in whose images artifacts occurred. Results Artifacts in the images could be removed through the movement, deletion and insertion of specific intervals of heart rate by the image reconstruction technique based on ECG-pulsing editing. Conclusion The image reconstruction technique based on ECG-pulsing editing is considered greatly helpful in reconstructing optimal 3D images from images with distortion, loss or stair-step artifacts in patients showing fast or irregular heart rate.

Dosimeter를 이용한 CT 검사실의 공간선량 분포에 대한 비교 분석

정재연(Jae yeon Jeong),김영빈(Yeong bin Kim),구양수(Yang su Ku),이광원(Gwang won Lee),조영기(Yeong gi Cho) 대한CT영상기술학회 2011 대한CT영상기술학회지 Vol.13 No.1

목 적 공간선량은 방사선의 이용과 관리에 중요한 사항이며 더욱이 방사선 관계종사자들은 상대적으로 방사선 구역에 오래 머물기 때문에 각별한 주의가 필요하다. CT검사실 조정실 내ㆍ외부의 공간선량을 측정하여 이에 대한 중요ㆍ위험성 인식 및 작업종사자가 받는 방사선피폭 을 감소시킬 수 있는 방안을 마련하고자 한다. 대상 및 방법 2010년 3월 1일부터 6월 30일까지이며 본관 CT실 조정실 내. 외부의 4개월 동안 발생한 공간선량을 비교분석하였다. 대상 장비로는 16 MDCT(Somatom Sensation16 Siemens, Germany)와 Dual Source CT(Somatom Definition Siemens, Germany)장비를 사용 하였으며, 또한 같은 공간에서의 조정실 실내 구조를 갖춘 상태에서 공간선량을 측정하였다. 측정기로는 Thermo ESM FH40G-L10 2EA를 사용하여 공간선량을 측정 하였으며 차폐기구는 Lead Glass 2EA(TRCT-500-140)를 이용하였다. 결 과 측정 기간동안 조정실 실내의 Max값은 18.3 uSv이었으며 실외의 Max값은 52.8 uSv 이었다. 조정실 실내의 Dose값은 20.22 uSv/week이었고, 실외 Dose 값은 72.64 uSv/week의 공간선량율을 보였다. 공간선량을 줄여 보고자 Lead Glass TRCT-500-140을 사용하였으며 사용전 조정실 실내의 평균 Max값은 4.61 uSv/week이었으며, 사용 후의 조정실 실내의 평균 Max값은 2.09 uSv/week이었다. 사용 전과 후의 2배의 공간선량율 차이를 보였다. 사용 전 조정실 내ㆍ외부의 평균 Dose값은 20.22 uSv/week, 72.64 uSv/week이었으며 사용 후 조정실 내ㆍ외부의 평균 Dose값은 12.8 uSv/week, 32.36 uSv/week의 공간선량율 차이를 보였다. 결 론 공간선량은 식약청 기준치인 0.1 mSv/week 보다 낮은 72.64 uSv/week로 비교적 안전한 것으로 보이지만 방사선방호의 최적화라는 관점에서 볼 때 저선량의 방사선이라도 장기적으로 피폭을 받게 되면 확률적영향이 발생될 수 있으므로 개인별 피폭 선량 데이터를 철저히 관리 분석하여 저감화조치 ALARA와 같은 체계적인 개인별 피폭선량 데이터의 철저한 관리로 개인 피폭관리에 만전을 기울어야 할 것이다. Ⅰ. Objective Spatial dose is a crucial factor in the use and management of radiation, and radiation- related workers should be managed more carefully because they stay in the radiation area relatively longer. Thus, this study purposed to measure spatial dose inside and outside of the control room of the CT Room, to emphasize the importance and risk of radiation exposure, and to make a plan to reduce radiation- related workers’ exposure to radiation. Ⅱ. Subjects and methods This study was conducted from March 1 to June 30, 2010, and made comparative analysis of spatial dose inside and outside the control room of the CT room in the main building for the four months. Machines used in this study were 16 MDCT (Somatom Sensation16 Siemens, Germany) and Dual Source CT (Somatom Definition Siemens, Germany), and spatial dose was measured in the environment where a control room was installed inside the same space. Spatial dose was measured using Thermo ESM FH40G-L10 2EA, and lead glass 1EA (TRCT-500-140) was used as a shielding tool. Ⅲ. Results During the measuring period, the maximum does inside the control room was 18.3 uSv, and that outside the room was 52.8 uSv. The spatial dose rate inside the control room was 20.22 uSv/week, and that outside the room was 72.64 uSv/week. In order to reduce spatial dose, we used lead glass TRCT- 500-140. Then, the mean maximum dose inside the control room decreased from 4.61 uSv/week before the use of the lead glass to 2.09 uSv/week after, showing a decrease by half with the use of the shielding tool. The mean spatial dose rates inside and outside the control room before the use of lead glass were 20.22 uSv/week and 72.64 uSv/week, respectively, and those after the use of lead glass were 12.8 uSv/week and 32.36 uSv/week, respectively, showing significant differences. Ⅳ. Conclusions Spatial dose looks relatively safe as 72.64 uSv/week, which is lower than 0.1 mSv/week, the upper limit required by KFDA, but from the viewpoint of the optimization of radiation protection, even to low-dose radiation, long-term exposure may increase the probability of damage. Therefore, individuals’ exposure should be controlled thoroughly through systematic analysis and management of data on individuals’ exposure dose such as ALARA.

나선형 CT와 16 Slice MDCT의 Brain과 Abdome 검사 시 산란선에 관한 연구

윤재혁(Jae hyeok Yun),류병규(Byeong gyu Ryu),이관원(Gwang won Lee),김동수(Dong su Kim),장양선(Yang seon Jang),구양수(Yang su Ku) 대한CT영상기술학회 2008 대한CT영상기술학회지 Vol.10 No.1

Purpose The present study purposed to measure the degree of scattered ray of radiation in spiral CT and 16-Slice MDCT of brain and abdomen using Rando phantom and to examine the change in non-patients’ exposure to scattered ray according to distance between the central beam and the patient and the reduction of exposure according to the thickness of a protection outfit for shielding from radiation. Materials and methods We measured the change of scattered ray on non-patients according to distance between the brain beam of CT and the patient and the change of scattered ray according to the thickness of an apron for shielding from scattered ray, assuming a critically ill patient and an infant on Somatom Plus 4 and MDCT table at the present hospital using Rando phantom under the same setting of cerebral and abdominal CT scan parameters. In order to reduce errors in measurements, each factor was measured three times and the mean value was obtained. The height of the survey meter probe was 111.5cm, which is ordinary adults’ iliac crest level. Results A. In the result of brain test with Plus 4, the reduction rate of scattered ray at a distance of 50cm according to distance from the central beam without an apron (15.5mR) and with an apron on: 1. When Pb equivalent was 2.5mm, the reduction rate of scattered ray was 91.55% at 50cm, 94.82% at 100cm, 98.64% at 150cm, and 99.38% at 200cm. 2. When Pb equivalent was 5.0mm, the reduction rate of scattered ray was 98.50% at 50cm, 99.26% at 100cm, 99.58% at 150cm, and 99.70% at 200cm. 3. When Pb equivalent was 7.5mm, the reduction rate of scattered ray was 98.87% at 50cm, 99.37% at 100cm, 99.79% at 150cm, and 99.80% at 200cm. B. In the result of brain test with 16-Slice MDCT, the reduction rate of scattered ray at a distance of 50cm according to distance from the central beam without an apron (16.47mR) and with an apron on: 1. When Pb equivalent was 2.5mm, the reduction rate of scattered ray was 95.40% at 50cm, 97.69% at 100cm, 98.84% at 150cm, and 99.33% at 200cm. 2. When Pb equivalent was 5.0mm, the reduction rate of scattered ray was 98.54% at 50cm, 99.18% at 100cm, 98.54% at 150cm, and 99.66% at 200cm. 3. When Pb equivalent was 7.5mm, the reduction rate of scattered ray was 98.10% at 50cm, 99.55% at 100cm, 99.86% at 150cm, and 99.78% at 200cm. C. In the result of abdomen test with Plus 4, the reduction rate of scattered ray at a distance of 50cm according to distance from the central beam without an apron (61.47mR) and with an apron on: 1. When Pb equivalent was 2.5mm, the reduction rate of scattered ray was 91.52% at 50cm, 97.15% at 100cm, 98.74% at 150cm, and 99.40% at 200cm. 2. When Pb equivalent was 5.0mm, the reduction rate of scattered ray was 98.48% at 50cm, 99.19% at 100cm, 99.60% at 150cm, and 99.72% at 200cm. 3. When Pb equivalent was 7.5mm, the reduction rate of scattered ray was 98.81% at 50cm, 99.49% at 100cm, 99.71% at 150cm, and 99.82% at 200cm. D. In the result of abdomen test with 16-Slice MDCT, the reduction rate of scattered ray at a distance of 50cm according to distance from the central beam without an apron (79.47mR) and with an apron on: 1. When Pb equivalent was 2.5mm, the reduction rate of scattered ray was 96.56% at 50cm, 98.64% at 100cm, 99.34% at 150cm, and 99.69% at 200cm. 2. When Pb equivalent was 5.0mm, the reduction rate of scattered ray was 98.96% at 50cm, 99.45% at 100cm, 99.72% at 150cm, and 99.85% at 200cm. 3. When Pb equivalent was 7.5mm, the reduction rate of scattered ray was 99.56% at 50cm, 99.75% at 100cm, 99.86% at 150cm, and 99.94% at 200cm. Conclusion According to the results of this study, scattered ray decreased with the increase of distance. The scattered ray shielding effect was highest when the Pb equivalent of the radiation shielding outfit was 7.5mm. However, the reduction rate of scattered ray with a radiation shielding outfit at thickness of 5.0mm was higher (+4% on the average) than that with an outfit a