의료인문학 교육과정 개편에 대한 Kern의 교육과정개발 모델에 근거한 비판적 성찰

이이레,안신기 연세대학교 의과대학 2020 의학교육논단 Vol.22 No.3

Medical humanities education (MHE) is as essential as basic medical sciences and clinical medicine education. Despite the importance of MHE, MHE curriculum development (CD) has proven to be challenging. This critical review examines the MHE CD at one medical school. The critical review methodology was developed based on Kern’s six step CD model to systematically examine the CD of “Doctoring and Medical Humanities (DMH)” at the Yonsei University College of Medicine. Five review questions were developed related to (1) necessity, (2) direction and purpose, (3) design, (4) operation, and (5) evaluation of CD based on Kern’s model. The review showed that the process of DMH CD mapped to components of Kern's model. The DMH curriculum content selected was closely related to medical practice and aimed to combine the acquisition of understanding and skills by designing a student-participatory curriculum based on clinical cases. Assessment methods that emphasized students’ reflections were actively introduced in the evaluation section. Since the regular committee for DMH continued the work of the special ad hoc committees for DMH CD, the CD was effectively completed. However, the planning and evaluation functions and responsibilities of the DMH committee need to be strengthened. Despite the apparent limitations, the fact that students showed a high satisfaction rate and preferred small group discussions based on clinical cases has significant implications in the instructional design of MHE, where changes in self-awareness and attitude are more important than the acquisition of information. It is necessary to systematically review and study students’ reflection results produced by the changed assessment methods and to develop assessment indicators for MHE that reflect the achievements of the MHE competencies of students.

[장려상(평론)] 경계 위에서 연결을 말하다 - 조해진의 『환한 숨』(2021)을 읽고

이이레 숙명문학인회 2021 숙명문학 Vol.- No.9

딥메디슨: 인공지능, 의료의 인간화를 꿈꾸다

이이레,Lee, I Re 연세대학교 의과대학 2021 의학교육논단 Vol.23 No.1

의과대학생에서 스트레스 대처방식과 사회적 지지가 스트레스의 지각에 미치는 영향

이이레,김민경,김혜원 대한불안의학회 2021 대한불안의학회지 Vol.17 No.1

Objective : We aimed to examine the demographic factors and personal resources that affect medical students’ perceived stress. In particular, the extent to which coping strategies and social support influenced perceived stress was investigated. Methods : A total of 321 medical students, which consisted of 116 first-year students, 100 second-year students, and 105 third-year students, participated in the present study. The levels of perceived stress, coping style, and perceived social support were measured by the perceived stress scale, the ways of coping scale, and the multi-dimensional scale of perceived social support, respectively. The influence of coping style and social support on perceived stress was examined by multiple linear regression, after controlling for age, sex, grade, and medical school entrance type. Results : The perceived stress level was significantly different between undergraduate-entry and graduate- entry medical students (18.39 vs. 16.38, t=2.625, p=0.009). Other sociodemographic factors did not affect the extent to which medical students experienced stress. The multiple regression model was significant (p<0.001), and active problem-focused coping (p<0.001) and social support from friends (p=0.003) were associated with a lower level of perceived stress. Conclusion : Our results suggest that problem-focused strategies and supportive relationships with friends may play a role in reducing medical students’ stress levels. These findings have implications for teaching students how to approach stressful situations and encouraging students to build communities among themselves may help students manage stress during medical school effectively. (Anxiety and Mood 2021;17(1):12-18)

유방암 환자의 모의치료, CT 스캔 및 치료 과정에서 발생되는 준비 오차 분석

이레나 대한방사선종양학회 2005 Radiation Oncology Journal Vol.23 No.3

유럽, 미국, 일본의 선형가속기 정도관리 비교

이레나,이수진,최진호 한국의학물리학회 2003 의학물리 Vol.14 No.1

컴퓨터에 의해 작동되는 선형가속기의 경우 모든 기기가 적절히 작동되는가를 확인하는 정도관리가 오작동으로 인한 환자 피해를 방지하기 위해 절대적으로 필요하다. 따라서 컴퓨터로직 및 마이크로 프로세서에 의해 작동되는 시스템의 안전을 고려하는 많은 보고서들이 발표되었다. 그 보고서에는 소프트웨어 및 하드웨어 고장으로 인해 발생하는 문제점들을 개선하기 위한 방법들이 제시하고 있다. 이와 관련하여 국내의 경우도 컴퓨터에 의해 작동되는 선형가속기의 수가 점차 적으로 증가하고 있는데 비해 체계적이고 일원화된 정도관리서가 없는 실정이다. 따라서 본 논문에서는 국내의 실정에 맞는 선형가속기 정도관리 기술을 개발하기 위한 기반으로 사용하기 위해 미국, 일본, 및 유럽에서 가장 일반적으로 사용되고 있는 정도관리서를 수집 및 요약하였다. 또한 각 나라간의 공통점 및 차이점이 비교분석 하였다. 국가별 정도관리를 비교한 결과 유럽의 경우 미국의 AAPM TG40을 참고자료로 주로 사용하였으며 중요한 정도관리의 항목은 점검주기에는 약간의 차이가 있으나 점검항목들은 거의 동일하다. For the treatment of cancer using computer controlled linear accelerator, it is important to ensure that all equipments are operated properly. Therefore, many studies were performed and published on the safe use of radiotherapy machine controlled by computer logic and microprocessor These studies provided methods of preventing accident from software and hardware failure. In Korea, the use of computer controlled linear accelerator has increased over the past 10 years. However, there are no standard protocols for quality assurance (QA) of linear accelerator. In this study, three QA protocols from America, Japan, and Europe were collected and summarized. In addition, agreement and disagreement among the protocols were analyzed. In conclusion, the QA items included in the protocols were similar among the various QA protocols although there were differences in performance frequencies.

Statistical Process Control Analysis for Patient Quality Assurance of Intensity Modulated Radiation Therapy

이레나,김규보,조삼주,임상욱,이석,심장보,허현도,이상훈,안소현 한국물리학회 2017 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.71 No.10

This study applied statistical process control to set and verify the quality assurances (QA) tolerance standard for our hospital’s characteristics with the criteria standards that are applied to all the treatment sites with this analysis. Gamma test factor of delivery quality assurances (DQA) was based on 3%/3 mm. Head and neck, breast, prostate cases of intensity modulated radiation therapy (IMRT) or volumetric arc radiation therapy (VMAT) were selected for the analysis of the QA treatment sites. The numbers of data used in the analysis were 73 and 68 for head and neck patients. Prostate and breast were 49 and 152 by MapCHECK and ArcCHECK respectively. Cp value of head and neck and prostate QA were above 1.0, Cpml is 1.53 and 1.71 respectively, which is close to the target value of 100%. Cpml value of breast (IMRT) was 1.67, data values are close to the target value of 95%. But value of was 0.90, which means that the data values are widely distributed. Cp and Cpml of breast VMAT QA were respectively 1.07 and 2.10. This suggests that the VMAT QA has better process capability than the IMRT QA. Consequently, we should pay more attention to planning and QA before treatment for breast Radiotherapy.

국내 의료기관들의 광자 빔 데이터의 비교 분석 및 치료계획 시스템 정도관리자료

이레나,조병철,강세권,Lee, Re-Na,Cho, Byung-Chul,Kang, Sei-Kwon 한국의학물리학회 2006 의학물리 Vol.17 No.3

목적: 방사선 종양학과에서 사용되고 있는 선형가속기의 광자선 빔 데이터를 수집하여 비교 분석하였으며 치료계획용 시스템에 대한 간단한 정도관리 방법을 제시하였다. 대상 및 방법: 국내 26개 방사선 치료기관을 대상으로 출력교정 조건, 출력인자, 쐐기인자, 깊이 선량분포, 측방선량분포 및 선질에 대한 데이터를 수집하였다. 치료계획용 시스템의 선량계산의 정확성을 확인하기 위하여 10가지 광자선 치료 조건(정방형/직사각형/부정형 조사면, 쐐기필터 조사면, 축이탈 선량계산, SSD 변화)에 대한 선량계산을 치료계획용 시스템을 이용하여 시행하였으며 치료계획용 시스템을 이용하여 계산된 모니터 값과 수 계산에 의한 결과를 비교 분석하였다. 결과: 광자선 선질은 6 MV, 10 MV 및 15 MV에 대해 각각 $0.576{\pm}0.005,\;0.632{\pm}0.004$ 및 $0.647{\pm}0.006$이다. 최대선량 깊이에서 조사면의 크기에 따른 출력상수의 평균값은 6 MV 광자선의 경우 $5{\times}5cm,\;15{\times}15cm,\;20{\times}20cm$에 대해 $0.944{\pm}0.006,\;1.031{\pm}0.006,\;1.055{\pm}0.007$이다. 10 MV 광자의 경우는 조사면의 크기가 $5{\times}5cm,\;15{\times}15cm,\;20{\times}20cm$에 대해 각각 $0.935{\pm}0.006,\;1.031{\pm}0.007,\;1.054{\pm}0.0005$이다. 15 MV의 경우는 수집된 데이터의 수가 많지 않지만 $5{\times}5cm,\;15{\times}15cm,\;20{\times}20cm$에 대해 $0.941{\pm}0.008,\;1.032{\pm}0.004,\;1.049{\pm}0.014$이다. 치료 계획용 시스템과 수 계산에 의한 MU값의 계산 비교결과 7개 기관의 값이 허용오차 범위를 벗어났다. 쐐기를 제외한 8가지 조건에서 계산된 평균 MU값들은 SAD 조건으로 출력 교정된 장비가 SSD 조건으로 교정된 장비에 비해 6 MV 광자선은 3 MU, 10 MV 광자선은 5 MU 정도 더 높았다. 쐐기를 사용할 경우 MU값은 Varian사 장비와 Siemens사의 장비에 따라 다르고 동일 각의 쐐기를 사용할 경우 Siemens사의 쐐기를 사용할 때 MU값이 크다. 결론: 수집된 광자선 빔 데이터를 분석하여 빔데이터의 정확성과 치료계획용 시스템의 계산 정확성을 대략적으로 점검 할 수 있는 기준 값을 제시하였다. Purpose: Photon beam data of linear accelerators in Korea are collected, analyzed, and a simple method for checking and verifying the dose calculations in a TPS are suggested. Materials and Methods: Photon beam data such as output calibration condition, output factor, wedge factor, percent depth dose, beam profile, and beam quality were collected from 26 institutions in Korea. In order to verify the accuracy of dose calculation, ten sample planning tests were peformed. These Include square, elongated, and blocked fields, wedge fields, off-axis dose calculation, SSD variation. The planned data were compared to that of manual calculations. Results: The average and standard deviation of photon beam quality for 6, 10, and 15 MV were $0.576{\pm}0.005,\;0.632{\pm}0.004,\;and\;0.647{\pm}0.006$, respectively. The output factors of 6 MV photon beam measured at depth of dose maximum for $5{\times}5cm,\;15{\times}15cm,\;20{\times}20cm\;were\;0.944{\pm}0.006,\;1.031{\pm}0.006,\;and\;1.055{\pm}0.007$. For 10 MV photon beam, the values were $0.935{\pm}0.006,\;1.031{\pm}0.007,\;1.054{\pm}0.0005$. The collected data were not enough to calculate average, the output factors for 15MV photon beam with field size of $5{\times}5cm,\;15{\times}15cm,\;20{\times}20cm\;were\;0.941{\pm}0.008,\;1.032{\pm}0.004,\;1.049{\pm}0.014$. There was seven institutions $e{\times}ceeding$ tolerance when monitor unit values calculated from treatment planning system and manually were compared. The measured average MU values for the machines calibrated at SAD setup were 3 MU and 5 MU higher than the machines calibrated at SSD for 6 MV and 10 MV, respectively except the wedge case. When the wedges were inserted, the MU values to deliver 100 cGy to 5 cm depends on manufactures. When the same wedge angle was used, Siemens machine requires more MUs then Varian machine. Conclusion: In this study, photon beam data are collected and analyzed to provide a baseline value for chocking beam data and the accuracy of dose calculation for a treatment planning system.

거짓 지식의 폭로와 반박(3)

이레네오 광주가톨릭대학교 신학연구소 1977 神學展望 Vol.- No.37

Effectiveness of Bellyboard Device for Displacement of Small Bowel in Pelvic Irradiation

이레나,이경자,서현숙,Lee, Rena,Lee, Kyung-Ja,Suh, Hyunsuk Korean Society of Medical Physics 2007 의학물리 Vol.18 No.4

골반 방사선치료 시 방사선조사부위에서 소장을 제외하여 방사선에 의한 소장의 독성 감소에 가장 효율적인 방법을 알아보기 위하여 본 연구가 시행되었다. 연구대상은 자궁경부암, 자궁내막암, 직장암, S-결장암과 난소암으로 수술 후 골반에 방사선치료를 받은 환자 14명이다. 환자는 모의치료를 시행하기 1시간 30분 전에 150 ml의 바륨과 방광을 채우기 위해 물 500 ml를 마시고 환자의 자세변화와 벨리보드 사용 유무에 따라 5종류의 조영촬영을 하였다. 첫 번째는 방광을 채운 후 누운 자세로 전 후면과 측면을 촬영한다. 두 번째는 방광을 채운 상태에서 엎드린 자세로, 세 번째는 방광을 비운 후 누운 자세로, 네 번째는 방광을 비운 후 엎드린 자세로, 다섯 번째는 방광을 비운 후 벨리보드를 사용하여 엎드린 자세로 각각의 전 후면과 측면을 촬영한다. 모든 조영촬영 사진에서 방사선조사부위에 포함되는 소장의 용적을 측정하였다. 결과는 방광을 채우거나 비운상태 모두 엎드린 자세가 누운 자세보다 소장의 용적이 감소되었으며 특히 측면사진에서 더욱 감소되었다. 엎드린 자세에서는 방광을 채운 상태의 소장 용적이 방광을 비운상태에 비해 전후면 사진에서 13%, 측면 사진에서 26%가 감소되었다. 방광을 비운 후 벨리보드를 사용한 상태의 소장 용적이 벨리보드를 사용하지 않고 엎드린 자세에 비해 전 후면에서 $62.8{\pm}27.1%$, 측면에서 $63{\pm}32.9%$가 감소되었다. 결론적으로 골반에 방사선치료를 시행할 경우 방광을 비운 후 벨리보드를 사용함으로써 소장의 용적을 최소화시킬 수 있었다. Various techniques were evaluated to determine the best method for reducing small bowel involvement in pelvic irradiation. Fourteen patients receiving radiation in pelvic area were enrolled for this study. Five sets of small bowel images were obtained. Patients were positioned on a simulation couch with full bladder in prone and supine positions and 2 sets of images were taken. Then they were asked to empty their bladder and 2 sets of images were taken in prone and supine positions. A belly board device (BBD) was placed and one set of images was obtained. Using a software, the area of small bowel inside treatment field was contoured, measured, and analyzed. In both full and empty bladder cases, small bowel area reduction was observed in prone position as compared to supine position. Especially statistically significant reduction is noted in lateral film. An average decreases of 13% in PA and 26% in lateral direction were noted with bladder distention as compared to empty bladder. With the use of BBD for empty bladder, a significant reduction of $62.8{\pm}27.1%$ and $63.1{\pm}32.9%$ in PA and lateral directions were observed as compared to without BBD in prone position, respectively. In conclusion, the best sparing of small bowel concerning the area included in the treatment fields was achieved with BBD in prone position with empty bladder. However, further reduction is expected if the bladder was filled fully because the analysed data with empty vs full bladder study shows increased sparing of small bowel with distended bladder.