과신전 방지를 위한 슬관절 기능 보조기

한영길,이호승,김기용,박수성,최진,조우신 대한슬관절학회 1997 대한슬관절학회지 Vol.9 No.2

The functional knee brace has been used to provide or to assist knee stability in the anterior cruciate ligament(ACL) deficient knee, Nowadays, it is more indicated in the postoperative care of ACL injury to protect the reconstructed or repaired ligament, but controversies still exist regarding the effectiveness and the selection of an appropriate model. For successful application, it must restrict the knee motion within the range of certain arc, especially hyperextension, during weight bearing together with convenience and comfort. The six commercial functional knee braces, which were introduced in Korea, were checked to detect the angle discrepancy between angle of brace and knee joint motion. The purpose of this study was to guide correct application of the functional knee brace in preventing hyperextension of the knee joint. Each brace was grouped into small, medium and large by size, and fixed with the arc of motion 30˚ to 90˚. The brace was applied to 3 healthy volunteers whose size was just fit with the brace size small, medium and large, respectively. True lateral X-ray of the knee joint was taken in active flexion and extension state under the fluoroscopic control and measured the lateral intershaft angle of femur and tibia. Average angle discrepancy between the brace and the intershaft angle of femur and tibia in active extension was 22˚ and 3˚ in active flexion. In active extension at 30˚, angle discrepancy of Denzo brace was the largest recording 26˚, that of Sentry brace was the smallest recording 17˚. In active flexion at 90˚, angle discrcyancy of Sentry brace was the largest recording 13˚, that of ACL brace (custom made modified Sentry brace) was the smallest recording 2˚. There was no statistically significant difference of the angle discrepancy among each size of brace. This study suggests that, at least 20˚ of angle discrepancy must be considered in appling the knee brace for prevention of hyperextension of the knee joint and careful selection of the brace, which may be affected by the design of brace and the soft tissue compliance, is mandatory.

배관해석 관련 주요 해외 사업주의 요구사항

한영길 대한설비공학회 2002 대한설비공학회 강연회 및 기타간행물 Vol.- No.-

양성자 치료계획에서 Iterative Metal Artifact Reduction(IMAR) Algorithm 적용의 유용성 평가

한영길,장요종,강동혁,김선영,이두현,Han, Young Gil,Jang, Yo Jong,Kang, Dong Heok,Kim, Sun Young,Lee, Du Hyeon 대한방사선치료학회 2017 대한방사선치료학회지 Vol.29 No.1

목 적: CT(computed tomography) 영상에서 Metal Artifact로 인해 왜곡된 영상을 보정하는 Iterative Metal Artifact Reduction(IMAR) Algorithm의 정확성을 평가하고 양성자 치료계획에서 IMAR Algorithm 적용의 유용성을 평가하고자 한다. 대상 및 방법: CT simulator를 이용하여 CIRS Phantom 내에 금속을 삽입한 것과 삽입하지 않은 영상을 각각 촬영하였다. Phantom 내의 동일한 위치에 ROI1, ROI2를 설정하여 금속이 없는 경우의 영상과 금속으로 인한 Artifact가 발생한 영상, IMAR Algorithm을 적용한 영상에서 CT Number값의 차이를 비교하였다. 또, 금속 주변에 위치한 조직등가물질의 CT Number값을 비교하였다. 척추에 임플란트 시술을 시행한 환자를 가정하여 Rando 팬텀의 척추 부위에 Titanium 봉을 삽입하여 CT 촬영을 하였다. IMAR Algorithm 적용 전과 후의 영상에서 같은 부위에 ROI 1, ROI 2를 설정하여 CT Number값을 측정하고, 각각의 영상에 동일한 양성자 치료계획을 세워 세 지점에서 양성자선의 비정(Range)의 차이를 비교하였다. 결 과: CIRS Phantom 평가에서 금속이 없는 경우의 평균 CT number값은 ROI 1에서 -6.5 HU, ROI 2에서 -10.5 HU였다. 금속이 있는 경우 Fe, Ti, W 순으로 ROI 1에서 -148.1, -45.1, -151.7 HU였으며 IMAR Algorithm을 적용 하였을 때는 -0.9, -2.0, -1.9 HU로 증가하였다. ROI 2에서는 금속이 있는 경우 171.8, 63.9, 177.0 HU였으며 IMAR Algorithm 적용 후에는 10.0, 6.7, 8.1 HU로 감소하였다. 조직등가물질의 CT Number값은 가장 멀리 위치한 폐를 제외하고 모두 원래의 CT Number값에 가깝게 보정이 되었다. Rando Phantom 평가는 금속이 없는 경우와 금속이 있는 경우, IMAR Algorithm을 적용하였을 때 평균 CT Number값은 각각 ROI 1에서 9.9, -202.8, 35.1 HU였으며 ROI 2에서 9.0, 107.1, 29 HU였다. 치료계획에서 금속이 없을 때와 양성자선의 Range의 차이는 IMAR Algorithm을 적용하였을 때 1번 지점에서 평균 0.26 cm 감소하였으며 2번 지점에서 평균 0.20 cm 감소하였다. 3번 지점에서는 평균 0.12 cm 감소하였다. 결 론: IMAR Algorithm을 적용함으로써 CT Number값은 금속이 없을 때의 원래의 값에 가깝게 보정되었다. 또, 양성자 치료계획의 Beam Profile에서 IMAR Algorithm 적용 후 비정의 차이가 0.01에서 최대 3.6 mm 줄어들었다. Artifact가 존재하지 않는 영상과 비교하여 약간의 차이는 존재하지만 양성자의 비정에 따른 선량의 급격한 변화를 고려한다면 금속이 있는 환자에게 IMAR Algorithm의 적용은 유용할 것으로 사료된다. Purpose: To evaluate the accuracy of the Iterative Metal Artifact Reduction (IMAR) algorithm in correcting CT (computed tomography) images distorted due to a metal artifact and to evaluate the usefulness when proton therapy plan was plan using the images on which IMAR algorithm was applied. Materials and Methods: We used a CT simulator to capture the images when metal was not inserted in the CIRS model 062 Phantom and when metal was inserted in it and Artifact occurred. We compared the differences in the CT numbers from the images without metal, with a metal artifact, and with IMAR algorithm by setting ROI 1 and ROI 2 at the same position in the phantom. In addition, CT numbers of the tissue equivalents located near the metal were compared. For the evaluation of Rando Phantom, CT was taken by inserting a titanium rod into the spinal region of the Rando phantom modelling a patient who underwent spinal implant surgery. In addition, the same proton therapy plan was established for each image, and the differences in Range at three sites were compared. Results: In the evaluation of CIRS Phantom, the CT numbers were -6.5 HU at ROI 1 and -10.5 HU at ROI 2 in the absence of metal. In the presence of metal, Fe, Ti, and W were -148.1, -45.1 and -151.7 HU at ROI 1, respectively, and when the IMAR algorithm was applied, it increased to -0.9, -2.0, -1.9 HU. In the presence of metal, they were 171.8, 63.9 and 177.0 HU at ROI 2 and after the application of IMAR algorithm they decreased to 10.0 6,7 and 8.1 HU. The CT numbers of the tissue equivalents were corrected close to the original CT numbers except those in the lung located farthest. In the evaluation of the Rando Phantom, the mean CT numbers were 9.9, -202.8, and 35.1 HU at ROI 1, and 9.0, 107.1, and 29 HU at ROI 2 in the absence, presence of metal, and in the application of IMAR algorithm. The difference between the absence of metal and the range of proton beam in the therapy was reduced on the average by 0.26 cm at point 1, 0.20 cm at point 2, and 0.12 cm at point 3 when the IMAR algorithm was applied. Conclusion: By applying the IMAR algorithm, the CT numbers were corrected close to the original ones obtained in the absence of metal. In the beam profile of the proton therapy, the difference in Range after applying the IMAR algorithm was reduced by 0.01 to 3.6 mm. There were slight differences as compared to the images absence of metal but it was thought that the application of the IMAR algorithm could result in less error compared with the conventional therapy.

흰쥐 중격핵의 아미노산 함량에 대한 해마 제거의 영향

한영길,김종규,양훈모 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.2

A study was planned to analyze amino acid in target structure -the septal mucleus-of hippocampectomized rats by high-performance liquid chromatograph (HPLC). 33 female rats were divided into 3 groups, of which 8 rats had their hippocampal tissue on both sides removed through an opening in the parieto-occipital cortex (hippocampal group), 7 rats received damage to the parieto-occipital cortex only (cortical control group), and 8 rats serveed as normal control animals. One week later, the animals were sacrificed by decapitationin the cold room. Two to three mg of tissue was obtained from the septal nucleus in one side of the brain. The tissue three mg of tissue was obtained from the septal nucleus in one side of the brain. The tissue samples were homogenized in 200 of 0.5M perchloric acid in 1mM EDTA with ground-glass homogenizers. After centrifugation at 3.500 rpm for 15 min, an aliquot of 80 supernatant was neutralized with 40㎕ of 2.0M KHCO and then centrifuged again at 3,500 rpm for 10min. An aliquot of 20㎕ was taken and diluted with 350㎕ β-mercaptopropionic acid in 10 ml of 100 mM sodium borate buffer (Ph 9.1) and 350㎕ of OPA solved in ethanol which was diluted with 10ml of 100 mM sodium borate buffer (Ph 9.1) Then 400㎕ of the resulting sample was injected auto injector. Peak areas were automatically integrated and calculated by chromatopac. In the septal nucleus, aspartate increased a little in the hippocampla group and the cortical control group than in the normal control group . while there were no significant difference between the 3 groups. Glutamate decreased significantly in the hippocampla group than in the normal control group (P<0.001) and the cortical control group (P<0.005), while there were no significant difference between the 2 control groups. In the serine, glycine, threonine and alanine, the differences among 3 group values were nonsignificant. It is inferred from the above mentioned results that excitatory transmitter substances employ the glutamate in the septal nucleus, and that the hippocampus was facilitatory to the septal nucleus.

Dual Energy CT를 이용한 통풍 검사의 유용성과 요산결절로 오인될 수 있는 artifact에 대한 고찰

한영길(Young Gil Han),부재철(Jae Cheol Boo),김도윤(Do Yun Kim),임근교(Geun Gyo Im),김순배(Soon Bae Kim) 대한CT영상기술학회 2012 대한CT영상기술학회지 Vol.14 No.1

I. Objective The objective of the study is to examine the usefulness of a dual energy CT which uses two different types of energy to differentiate the soft tissue and bones on the urate crystal of the goat in diagnosing gouts. II. Subjects and Method From April 13th, 2011 to August 16th, 2011, a dual energy foot CT was conducted on 44 of the in-patients who were diagnosed or suspected of the gout. Scan data were reconstructed using 3D-workstation (LEONARDO)’ s gout software and then, two specialists from the diagnostic imaging department assessed whether the artifacts are either the urate crystal or those that may be mistaken for one. The patients included 30 patients whose gout diagnosis were confirmed by other medical opinions her than CT test (male: 27, female 3, average age: 53.3, range: 19~76) and 14 patients who were confirmed negative for gout (male: 11, female: 3, average age: 50.7, range: 28~68) and the diagnostic result on the gout and the presence of urate crystal by a dual energy CT were compared for analysis. III. Results Urate cystal was observed in 27 patients out of 30 whose gout diagnosis were confirmed and it was not observed in three patients. 14 out of 14 patients, who did not have gout, did now show urate crystal in all cases. Based on the confirmed diagnosis, 30 gout patients showed 90% sensitivity to the dual energy CT test and 14 patients who were confirmed negative for gout showed 100% specificity. Furthermore, the false positive rate was found to be 0%, the false negative rate, 10% and the accuracy rate 93%. The evaluation results on the artifact that could be mistaken for urate crystal indicated that the artifacts were observed in the thick skin of 19 patients and toe nail parts of 15 patients among 30 patients with confirmed gout. Among 14 patients who did not have gout, artifacts were observed in the thick skin of seven patients and the toe nail part of four patients. IV. Conclusion The findings from the study indicated that the dual energy CT showed a high accuracy in assessing the urate crystal of the gout. However, because the artifacts which could be mistaken for urate crystal in the thick skin and toil nail area in some patients were found, more thorough observation and consideration on diagnosing the urate cystal would be required. Despite this, a dual energy gout CT has high sensitivity and accuracy and it can even determine the location and the volume of urate crystal which were not accurately determined. Thus, a dual energy gout CT will be helpful in assessing the degree of calcification, location and the progress in the treatment of urate crystal for the gout patients who requires the continuous treatment and follow-ups. 목적 서로 다른 두 게의 에너지를 사용하여 통풍에 대한 요산결절을 연부조직 및 뼈와 구분하여 나타내는 특성을 이용한 dual energy CT의 통풍 검사에 대한 유용성과 진단에 있어서 통풍 결절로 오인될 수 있는 artifact에 대해서 알아보고자 한다. 대상 및 방법 2011년 4월 13일부터 2011년 8월 16일까지 내원 환자 중 통풍을 진단받았거나 통풍이 의심되는 환자 44명을 대상으로 dual energy foot CT검사를 시행하였다. Scan data는 3D-workstation(LEONARDO)의 gout software를 이용하여 재구성한 후 영상의학과 전문의 2명이 요산결절 및 요산결절로 오인될 수 있는 artifact의 여부를 평가하였다. 대상 환자들은 CT검사를 제외한 다른 임상 소견들을 통해 통풍으로 확진된 환자 30명(남자: 27명, 여자 3명, 평균연령: 53.3세, 범위: 19~76세)과 통풍이 아니라고 확진된 환자 14명(남자: 11명, 여자: 3명, 평균연령: 50.7세, 범위: 28~68세)으로 구분하여 통풍에 대한 진단결과와 dual energy CT의 요산결절 여부를 비교 평가하였다. 결과 통풍으로 확진을 받은 환자 30명 중 27명에서 요산결절이 발견되었으며 3명에서는 발견되지 않았고 통풍이 아닌 환자 14명 중 14명 모두에게서 요산결절이 발견되지 않았다. 확진을 근거로 통풍환자 30명에 대한 dual energy CT검사의 민감도는 90%, 통풍이 아닌 환자 14명에 대한 특이도는 100%였다. 그리고 위양성발생률은 0%, 위음성발생률은 10%였고 정확도는 93%로 나타났다. 요산결절로 오인될 수 있는 artifact의 평가 결과는 통풍환자 30명 중 19명 환자의 thick skin과 15명의 toe nail부분에서 artifact가 보였고 통풍이 아닌 환자에서도 14명 중 7명의 thick skin과 4명의 toe nail 부분에서 artifact가 관찰되었다. 결론 본 연구결과 dual energy CT는 통풍에 대한 요산결절의 침착 여부를 평가하는데 높은 정확성을 보였다. 그러나 일부의 환자에게서 발바닥의 굳은살과 발톱부위에 요산결절로 오인될 수 있는 artifact가 발생됨에 따라 요산결절을 진단함에 있어 보다 세심한 관찰과 판단이 요구된다. 그럼에도 불구하고 dual energy gout CT는 높은 민감도와 정확도를 가지며 기존에는 정확하게 알 수 없었던 요산결절의 위치와 부피까지도 파악할 수 있었다. 따라서 지속적인 치료와 follow-up이 요구되는 통풍 환자에게 dual energy gout CT는 요산결절의 침착 정도와 위치, 치료의 경과를 평가하는데 있어서 유용한 도움을 줄 수 있을 것이라 사료된다.

요골신경마비 및 수지신전건손상 환자의 건전이술에 의한 치료

한영길(Young Kil Han),나수균(Soo Kyoon Rah),최창욱(Chang Uk Choi) 대한정형외과학회 1995 대한정형외과학회지 Vol.30 No.5

천추골의 불완전 골절 - 증례 보고 -

장영수,한영길 대한골절학회 2000 대한골절학회지 Vol.13 No.4

Insufficiency fractures of the sacrum are rare but a distinct subgroup of pathologic fractures characterized by reduced osseous elastic resistance due to structural alterations of the bone. Stress fractures occurring in the settings have been defined as insufficiency fractures. Insufficiency fracture of the sacrum are difficult to diagnose, as plain radiographic findings are either unhelpful or misleadining. Bone scan is very sensitive and shows moderate to high uptake but the characteristic of H-shaped pattern of increased uptake of sacroiliac joint, specific for an insufficiency fracture, is only rarely seen. M.R.I is clearly the examination of choice, as it reveals early medullary edema and frequently a fracture line in a typical location. M.R.I helps in distinguishing tumoral disease from an insufficiency fracture. In this report, two cases of insufficiency fracture of the sacrum are discribed and compared with those previous studies.

뇌 해마의 복측 또는 배측 부분이 제거된 흰쥐 중격핵의 신경전달물질

양훈모,김종규,한영길,민영기 순천향의학연구소 1999 Journal of Soonchunhyang Medical Science Vol.5 No.1

This study was planned to analyze amino acids in the septal nucleus of dorsal and ventral hippocampectomized rats by high performance liquid chromatography (HPLC). Male albino rats were used. Under chloral hydrate anesthesia (20%, 2 ml/kg body weight), a hole was made in each parietal bone about 4 mm lateral to the sagittal suture, and 4 mm rostral to the lambda suture. The cortical tissue on each side was removed and, through this opening, the hippocampal tissue anterodorsal and posteroventral to the hippocampal flexures on both sides was removed by aspiration. This preparation served as the dorsal and the ventral hippocampal animals, respectively. The cortical control animal received the same surgery short of hippocampectomy. The normal rats served as normal control animal. One day later, the animals were sacrificed by decapitation in the cold room. Two to three milligrams of tissue was obtained form the septal nucleus in one side of the brain. The tissue samples were homogenized and centrifuged. Then content of each amino acid was measured by HPLC form the brain tissue. The contents of aspartate and glutamate were decreased significantly more in the dorsal and ventral hippocampal groups than in the normal and the cortical control groups. The contents of glutamate were decreased significantly more in the ventral hippocampal group than in the dorsal hippocampal, while there were no significant differences between the two control groups. It is inferred form the above mentioned results that glutamate and aspartate may be used as excitatory transmitters in septal nucleus, and that the dorsal hippocampus may be facilitatory to the septal nucleus, but the ventral hippocampus would be inhibitory/facilitatory to the cortex.

거골하 관절 운동의 측정

이우천,박현수,한영길,조정진,장병춘,라종득 대한스포츠의학회 1998 대한스포츠의학회지 Vol.16 No.1

Subtalar motion occurs in all three planes and it is impossible to measure it accurately by clinical examination. There are many studies with so different normal ranges that we can not believe it represents the motion of the same joint. We presumed that the motion measured when the foot moves freely in all three planes will be different from that measured when the foot movement is restricted in one or two planes. We measured inversion and eversion of 80 feet in 40 young healthy adults. The range of inversion and eversion when the foot moves freely in three planes was 28.9±6.2˚, 9.6±3.3˚, when the sagittal plane movement was restricted, those were 10.4±4.9˚, 8±3.4˚ respectively, when the sagittal and transverse plane movement was restricted, those were 9.7±3.6˚, 7.2±3.2˚ respectively. The above result shows that we can get a far greater range of motion when the foot moves freely in three planes. It seems to be more reasonable to measure the range of motion of the subtalar joint while the foot moves in all planes.

족부 및 족관절 부위에서 비복 신경의 해부학 및 수술시의 의미

이우천,박현수,한영길,장병춘,임장운,라종득,Lee, Woo-Chun,Park, Hyun-Soo,Han, Young-Kil,Chang, Byeong-Chun,Rim, Jang-Woon,Rha, Jong-Deuk 대한족부족관절학회 1998 대한족부족관절학회지 Vol.2 No.2

The course of the sural nerve in the calf has been well documented, but there is a general lack of information concerning the distal course of the nerve. The purpose of this study was to describe the distal course of the sural nerve and its surgical implications. Seven fresh amputated specimens were dissected to show the anatomy of the sural nerve in the foot and ankle. At the level of about 10cm proximal to the plantar surface, the sural nerve coursed anteriorly and inferiorly away from the Achilles tendon. 2 to 4 lateral calcaneal branches arose. The first branch of the lateral calcaneal branches coursed along the lateral border of the Achilles tendon, and it arose at 8cm proximal to the plantar surface in 2 specimens, 12cm proximal to the plantar surface in 4 specimens, and at 12cm proximal to the plantar surface in one specimen. The main nerve trunk continued distally plantar to the peroneal tendons and divided into two terminal branches and crossed peroneus longus tendon at the level of the inferior border of the calcaneo-cuboid joint, at about 3cm(range, $2.5\sim3.0$)cm from the plantar surface. In conclusion, a longitudinal incision lateral to the Achilles tendon would cross the path of the sural nerve at about 10cm proximal to the plantar surface. When the first branch of them arise more than 10cm above the plantar surface, a logitudinal incision lateral to the Achilles tendon may be made without damage. The other lateral calcaneal branches will be cut when we make transverse incision paralled to the plantar surface. The terminal branch also may be in danger by the same transverse incision.