펜디메트라진에 의해 발생한 안 합병증 2예

허현도,김재경,한용섭,박종문,Hyoun Do Huh,Jae Kyong Kim,Yong Seop Han,Jong Moon Park 대한안과학회 2012 대한안과학회지 Vol.53 No.6

Purpose: The authors of the present study report treatment experience of acute myopia and branch retinal vein occlusion associated with phendimetrazine, a drug used for weight reduction. Case summary: Case 1: A 32-year-old woman, previously devoid of ocular problems, visited our hospital with bilateral visual disturbance after taking phendimetrazine for weight reduction. Ciliochoroidal effusion and anterior shifting of the lens-iris diaphragm were observed, which resulted in a shallow anterior chamber, myopic shifting and an increase in intraocular pressure due to angle closure. The symptoms were relieved by discontinuing the use of phendimetrazine and administration of intraocular pressure-lowering agents. Case 2: A 26-year-old woman, previously devoid of ocular problems, visited our hospital with left superior visual field disturbance after taking phendimetrazine for weight reduction. The examinations revealed papilledema, disc hemorrhage and tortuous vascular changes in her left eye. Fluorescein angiography was performed, and retinal vein occlusion was diagnosed. The patient discontinued weight reduction agents and recovered while under observation. Conclusions: Phendimetrazine, used for weight reduction, can cause acute myopia via prostaglandin synthesis and retinal venous occlusion due to vascular constriction. J Korean Ophthalmol Soc 2012;53(6):895-900

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

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.

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.

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.

측정용 전리함에 따른 고 선량율 근접치료용 방사성 선원의 겉보기 활성도의 정확도 비교 분석

허현도,최진호,최상현,김성훈,김우철,김헌정,이레나,김금배,홍성언,신동오,Huh, Hyun-Do,Choi, Jin-Ho,Choi, Sang-Hyoun,Kim, Seong-Hoon,Kim, Woo-Chul,Kim, Hun-Jeong,Lee, Re-Na,Kim, Kum-Bae,Hong, Seong-Eon,Shin, Dong-Oh 한국의학물리학회 2008 의학물리 Vol.19 No.4

The aim of this study is to introduce the accuracy of Ir-192 source's apparent activity using the well-type chamber and the Farmer-type ionization chamber in the high dose rate brachytherapy. We measured the apparent activity of Ir-192 that each medical center in the country has and the apparent activity of calibration certificate provided by manufacturer is compared with that by our experimental measurement. The number of sources used for the activity comparison was 5. The accuracy of the measured activity was in the range of -2.8% to -1.0% and -2.1% to 0.2% for the Farmer-type chamber system (Jig) and for the well-type, respectively. The maximum difference was within 1.0% for comparison with two calibration's tool. Our results demonstrate that well-type chamber as wall as Farmer-type chamber is a appropriate system as the routine source calibration procedures in HDR brachytherapy. Whenever a new source is installed to use in clinics, by periods, a source calibration should be carried out. 본 연구에서는 측정 방법이 다른 두 전리함을 이용하여 고선량율 근접치료용 방사성 선원의 겉보기 활성도를 측정하여 선원의 활성도 정확성 및 두 장비간의 정확도를 비교 분석하였다. 국내 5개 의료기관을 선정하여 공기 중 기준거리에서 겉보기 활성도를 측정하고 동일한 선원에 대하여 측정 방법이 다른 두 팬톰을 동시에 측정하여 측정방법에 따른 상호 오차와 측정용 전리함의 정확도를 평가하였다. 우물형 전리함과 Jig 팬톰의 상대 오차는 각각 -2.1%~0.2%, -2.8%~-1.0%로 나타났다. 동일한 방사성선원에 대하여 두 교정 장비간의 정확도 평가는 최대 상대오차 1%로 나타났다. 선원의 세기 검증 시 측정 방법에 따른 의존도는 없었다. 고 선량율 근접방사선치료에 사용되는 방사성 선원의 세기의 변화는 환자의 종양 및 인접장기에 미치는 영향이 매우 크므로 방사성 선원의 세기 오차는 환자치료의 최적화에 심각한 영향을 미칠 수 있다. 그러므로 새로운 선원 교체 시 뿐만 아니라 주기적인 선원 점검이 요구된다.

실시간 종양 추적 방사선 수술 시스템에서 예측 호흡 모델 오차 감소를 위한 고글 모니터 유용성 평가

허현도,최상현,김우철,김헌정,지영훈,김금배,김성훈,민철기,이상훈,이석,조삼주,조광환,신동오 대한방사선방어학회 2010 대한방사선방어학회 학술발표회 논문요약집 Vol.2010 No.04

치과용 아말감의 파절에 관한 연구

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

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

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.