우리나라 家族計劃要員과 事業實績에 關한 調査硏究

金允國(Yoon Kook Kim) 서울대학교 보건환경연구소 1971 보건학논집 Vol.8 No.2

흉부 X-Ray 검사시 Low Dose Image Protocol 사용의 유용성에 관한 고찰

채정현(Jeong-hyun Chae),안치복(Chi-bok An),손영목(Yung-mok Son),김윤국(Yoon-kook Kim),박순규(Soon-kyu Park) 대한영상의학기술학회 2018 대한영상의학기술학회 논문지 Vol.2018 No.1

목 적:흉부 X-Ray 검사시, Normal Chest protocol 과 Low Dose Image protocol 영상의 SNR, DAP, 유효선량을 비교함으로써, Low Dose Image protocol의 유용성을 영상의 퀄리티나 환자선량 측면에서 평가하기 위함에 있다. 대상 및 방법: Samsung GC85A를 사용하여 흉부팬 텀을 이용한 Chest PA 검사를 재현하였다. kVp는 110으로 설정하고 mAs는 Auto Exposure Control(AEC) 시스템에 의거하여 총 60장의 영상을 획득한 뒤, 각각 Normal Chest protocol과 Low Dose Image(LDI) protocol을 통하여 Processing을 시행하였다. Image J 프로그램을 통해 각 영상의 SNR을 구하고, GC85A에서 제공하는 DAP를 이용하여 PCXMC 2.0으로 이용하여 유효선량을 계산하였다. 획득한 데이터를 normal protocol과 LDI protocol에 따라 분류한 뒤, 비교 분석하였고, 해당이미지에 대하여 정성적 평가를 시행하였다. 각 그룹의 유의성은 각 그룹의 유의성은 SPSS (version 12.0, SPSS Inc Chicago, IL, USA) 통계 패키지 프로그램을 사용하여 T-test를 시행하여 검증하였으며, 신뢰구간은 95%이다. 결 과:각각의 protocol의 SNR과 DAP, 그리고 유효선 량을 비교 분석한 결과, Normal Chest protocol의 영상들의 SNR이 LDI Chest protocol에서의 영상들 보다 Lung field에서는 10.3%, Rib에서는 11.4%, Heart에 서는 10.9%, Soft skin 에서는 10.9%로 더 높게 측정되었다. 유효선량의 경우, Normal Chest protocol에서의 유효선량 평균은 0.0380mSv, LDI Chest protocol에서의 유효선량 평균은 0.0147로, Normal Chest protocol에서의 유효선량이 LDI Chest protocol의 영상의 유효선량보다 61% 더 높게 측정 되었다. 비록 SNR값이 다소 감소하는 경향이 있었으나, LDI protocol 영상의 정성적 평가 결과가 평균 4.7점인 것으로 볼 때, 진단적 가치가 충분히 있음을 알 수 있었다. 유의성 검증결과 각각의 프로토콜의 부위별 SNR, DAP, mSv 모두 유의한 차이가 있었다(p=0.05). 결 론:Normal protocol과 LDI protocol 영상들의 SNR과 DAP와 유효선량의 비교 분석을 통해, 흉부 X-Ray 검사시 LDI protocol의 사용이 Normal Chest protocol을 사용하는 것보다 영상의 퀄리티적인 측면이나 환자 선량 측면에서 더 유용하다고 사료된다. Purpose:this study has a purpose to evaluate usefulness of Low Dose Image protocol by comparing SNR, DAP and efficient dose of Normal Chest pro-tocol and Low Dose Image protocol in image quality and patient dose. Materials and Methods:We made up Chest PA X-ray exam condition with GC85A of SAMSUNG. kVp is 100, mAs was under the Auto Exposure Control(AEC) system. After acquiring 60 images, we implemented post-processing to each image using Normal protocol and Low Dose image protocol. We measured SNR from Image Jprogram, and DAP from GC86A of SAMSUNG to calculate efficient dose with PCXMC2.0. Acquired data is classified as protocols to compare and analyzed, then we conducted qualitative enaluation. T-test is implemented for significance test with SPSS(version 12.0, SPSS Inc Chicago, IL, USA). Confidence interval is 95%. Result:From result of compare and analysis of SNR, DAP and efficient dose from each protocol, SNR of Normal Chest protocol is higher, 10.3% in lung field, 11.4% in ribs, 10.9% in heart, 10.9% in soft skin, than Low Dose Image protocol. Average efficient dose of Low Dose protocol was 0.0147 mSv, and 0.0380 mSv for Normal. Efficient dose of Normal protocol measured higher than Low Dose protocol as 61%. Although SNR value decreased, images of Low Dose protocol are qualified for diagnosis, cause the result of qualitative evaluation was 4.7 in average. SNR, DAP and mSv of each protocol has significance difference(p=0.05). Conclusion:With comparison and analysis of SNR, DAP and efficient dose of Normal protocol and Low Dose protocol, it is considered that using Low Dose Image protocol is more pertinent in image quality and patient dose than using Normal image protocol.

Evaluation of GSI(Gemstone Spectral Imaging) Mode for Contrast Reduction in Chest CT

소은섭(Eun-Sup So),심지나(Ji-Na Shim),김홍식(Hong-Sik Kim),윤수정(Soo-Jung Yoon),김윤국(Yoon-Kook Kim),박순규(Soon-Kyu Park) 대한CT영상기술학회 2019 대한CT영상기술학회지 Vol.21 No.2

목적: 조영증강 CT 검사는 CT의 발전과 함께 증가하고 있는 추세이다. 그러나 조영증강 CT 검사에서 조영제 사용으로 인한 조영제 부작용이 발생하고 있으며, 부작용을 최소화 하기 위한 다양한 연구도 계속되고 있다. 이에 조영제 사용량을 줄이기 위하여, dual energy CT를 이용한 GSI 모드의 영상을 활용하여 각 에너지 영역대에서 조영제가 영상에서 나타나는 특성에 대해 알아보고, 이를 통해 조영제를 감소시킬 수 있는 방법에 대하여 알아보고자 한다. 대상 및 방법: 이 연구는 phantom study와 patient study로 구분하였다. Phantom study에서는, 조영제와 생리식염수를 1:5로 희석하여 자체 제작한 phantom을 이용하여 dual energy 검사인 GSI(Gemstone spectral imaging) 모드를 이용하여 각 에너지 영역의 monochromatic 영상을 획득하였고, 또한 동일한 CTDIvol 값을 가지는 조건으로 single source를 이용한 polychromatic 영상을 얻은 후 각 영상의 HU, SNR, CNR 값을 비교하였다. Patient study에서는 본원에서 GSI모드로 Chest CT를 검사한 BMI 정상 군에 속해있는 환자 30명을 대상으로 각 에너지 영역의 monochromatic 영상에서 6부위의 HU값을 비교하였다. 결과: Phantom study에서 저에너지 영역으로 갈수록 높은 HU 값을 나타내었고, 50keV monochromatic 영상에서 SNR, CNR이 가장 높았으며 single source 영상의 값보다 각각 1.71배, 1.40배 높았다. 또한 그때 HU값은 1.92배 높았다. Patient study에서 뼈를 제외한 주변 조직이나 장기의 HU 값은 40~140 keV monochromatic 영상에서 에너지의 변화에 따른 HU값의 변화가 나타나지 않았으며, 조영제의 HU값은 40~70 keV monochromatic 영상에서 큰 변화를 보인다. 결론: 조영제를 주입한 Chest CT에서 GSI 모드를 통해 50 keV로 재구성함으로써, 현재 single source 영상과 비슷한 영상의 퀄리티를 가지고 공기를 포함하고 있는 폐 실질이나 기관지, 그리고 근육과 같은 조직은 HU 값을 유지하면서 조영제의 HU 값은 증가한 영상을 얻을 수 있다. 따라서 GSI 모드를 통한 chest CT는 조영제 투여량을 감소시킬 수 있으며 이는 조영제 부작용을 감소하는데 큰 기여를 할 것으로 사료된다. PURPOSE: Contrast-enhanced CT is on the increase with the development of CT. However, the use of contrast has caused side effects, and various studies have been conducted to minimize side effects. In order to reduce the amount of contrasts used in dual energy CT, we investigated the characteristics of the contrast in each energy region using GSI mode image, and the ways to minimize the use of contrast. MATERIAL AND METHODS: We performed both phantom and patient study. In the phantom study, monochromatic images of each energy region were obtained by GSI (gemstone spectral imaging) mode in a dual energy CT using phantom which consist of contrast and normal saline in a ratio of 1:5. In addition, the polychromatic images using a single source under the same CTDIvol were obtained and compared with HU, SNR, and CNR values of images in GSI mode. In the patient study, we compared the HU values at six-ROI in monochromatic images of each energy region. The subject of patient study was 30 patients in normal BMI group who underwent chest CT in GSI mode at Yonsei medical center. RESULT: In phantom study, high HU value was observed in the low energy region. The SNR and CNR of 50 keV monochromatic images were higher than those of single source images by 1.71 times and 1.40 times, respectively. At that time, the HU value of GSI mode was higher than single source by 1.92 times. In the patient study, the HU values of peripheral tissues or organs except for bones were not changed by 40 ~ 140 keV monochromatic images, and the HU values of the contrast showed large changes in 40 ~ 70keV monochromatic images. CONCLUSIONS: The quality of reconstructed image with GSI mode in 50 keV was similar to that of single source image. In addition, HU values of contrast increased while keeping HU values of muscles, bronchi, and lung parenchyma which contain air. Therefore, chest CT using GSI mode can decrease the dose of contrast so it might contribute to the reduction of contrast side effects.

우리나라 家族計劃要員과 事業實績에 關한 調査硏究

金允國 서울大學校 保建大學院 1971 公衆保健雜誌 Vol.8 No.2

During one-month period from August 1 to 30, 1971, surveys were conducted on health centers in the provincial seats and municipalities throughout the country (not including those in Cheju province to shich questionnaire forms were mailed). The surveys included visits to public health sections of municipal and provincial administrations, interviews with their family planning fieldworkers, and studies on data concerning their work performance and statistics provided by the Ministry of Health and Social Affairs regarding the status of the family planning fieldworkers. Through the analysis by year, month and district of the family planning fieldworkers and their work performance, the following conclusion has been reached: 1. As for age distribution of family planning fieldworkers. approximately 50 per cent of health center fieldworkers. belonged to the age group of 25 to 34 years, and 70 per cent of town and township fieldworkers to the age group of 20 to 29 years. Thus, the average age of health center fieldworkers was higher than that of town and township fieldworkers. 2. The health center fieldworkers were broken into 47.6 per cent for licensed nurses or midwives, 34.3 per cent for licensed nurse aides, and 18.1 per cent for unlicensed personnel. The town and township fieldworkers were broken down into 0.4 per cent for licensed nurses or midwives, 56 per cent for licensed nurse aides and 43.6 per cent unlicensed personnel. 3. As for the marital status of family planning fieldworkers, married health center workers (75.6 per cent) were greater in number than unmarried counterprts (24.4 per cent). Contrarily, unmarried personnel (61.5 per cent) were greater in number than married personnel (38.5 per cent) among town and township fieldworkers. 4. The average longitivity of employment of health center family planning fieldworkers was 2.9 years, one year more than that of town and township family planning fieldworkers, 1.9 years/ 5. The average ratio of the actual number of family planning fieldworkers to their authorized strength in 1969 and 1970 was as follows: The ratio for the municipal and provincial supervisors remained at 98.2 per cent for both 1969 and 1970. The ratio for the health center fieldworkers decreased from 84.6 per cent in 1969 to 83.4 per cent in 1970 while that for the town and township fieldworkers increased from 92.5 per cent in 1969 to 94.0 per cent in 1970. 6. The ratio of the actual number of family planning fieldworkers to their authorized strength aecreased in urban areas from 84.2 per cent in 1969 to 78.2 per cent in 1970 while that increased in rural areas from 90.8 per cent in 1969 to 92.9 per cent in 1970. 7. Work performance rate per fieldworker showed an extensive seasonal fluctuation. The setting of IUD(intrauterine device) and vasectomy marked high performance rates in March to May while it dropped during the summer months of June to September. The consumption of oral pills showed sharp yearly increases. The number of condom-users per fieldworker stayed at 50 or more persons without showing any remarkable yearly or monthly fluctuation. 8. The performance rate per fieldworker was more than twofold higher in urban areas than in rural areas for IUD, vasectomy and condom in both 1969 and 1970 while that for the consumption of oral pills showed on great difference between urban areas and rural areas.