교원노조의 단체교섭 구조 개선에 관한 연구 (사용자측 교섭당사자를 중심으로)

이태만(Lee, Tae Man) 노동법이론실무학회 2010 노동법포럼 Vol.- No.4

Since teachers' unions contracted the third collective agreements in December 2002, the fourth collective agreement has not been contracted between Teachers' unions and the Ministry of Education Science and Technology for seven years. The issues raised in this study are follows. First, the effect of collective agreements is limitted or ineffective because bargaining rights of the Ministry of Education Science and Technology is restricted by Teachers' Union Act. Second, the employers in private Schools had not constituted groups to collective bargaining in private Schools, or the employers had delayed constitution of groups to collective bargaining. Third, in case of Teachers' unions organizational unit is unified but bargaining unit is not unified. Teachers' unions must negotiate separately with two employers (the employers in public schools and the employers in private schools). As the conclusion of this study, following tasks of policy are suggested. First, for improvement of teachers' unions on the bargaining structure, an extension of bargaining parties of governments shoud be conducted. Second, the legal integration between Government Employees' Union Act and Teachers' Union Act shoud be conducted. Third, groups to collective bargaining in private Schools will  need to change the employers' groups in private Schools. Fourth, the configuration of employers' groups between parties to collective bargaining of government and parties to collective bargaining of private Schools shoud be conducted.

흉 · 복부 CT검사에서 Care kV 적용할 때 환자 피폭 선량 감소에 대한 연구

김성환(Seong Hwan Kim),김건태(Geon Tae Kim),정진수(Jin Su Jeong),이태만(Tae Man Lee) 대한전산화단층기술학회 2016 대한CT영상기술학회지 Vol.18 No.2

목적 : 혈액 내과에 내원하여 주기적으로 추적 검사하는 환자에 대해서 흉부CT와 복부CT의 중복되는 부위의 피폭 선량을 줄이고자 흉부, 복부 CT 검사를 한번에 진행한다. 또 피폭선량 감소를 위해 AEC를 적용시켜서 검사하며, 2015년도부터 Care kV가 적용된 흉 · 복부 CT 검사 시에서 환자 피폭 선량을 비교하고자 한다. 대상 및 방법 : CT 장비는 Somatom Definition AS+ (Siemens, Erlangen, Germany)을 이용하였으며 2014년 6월~2015년 6월까지 본원 혈액내과에 내원한 환자 중 Care kV를 적용하지 않은 2014년(대조군)과 Care kV를 적용한 2015년(실험군)에 검사 진행한 무작위 30명으로 남자 10명, 여자 20명으로 21세부터 78세까지 평균 52세의 임상환자를 대상으로 연구분석하였다. 영상 평가는 흉부 판독 전문의 1명과 복부 판독 전문의 1명이 2014년과 2015년 CT영상을 각각 평가하여 5단계(Unacceptable, Suboptimal, Adequate, Good, Excellent)로 평가하였다. Female Rando Phantom을 이용해 동일하게 실험하였으며, 피폭선량 분석은 검사 후 Dose report에 표시되는 CTDlvoL, DLP 값을 비교하였다. 결과 : 임상 연구에서 실험군이 대조군에 비해 관전압은 100kVp로 낮아졌고, 관전류 31.11% 증가, CTDIVOL 23.84% 감소, DLP 24.03% 감소하였다. 실험군의 영상 평가는 30명 중 Unacceptable 0명, Suboptimal 0명, Adequate 0명, Good 25명, Excellent 5명으로 평가되었다 팬텀 연구에서 실험군이 대조군에 비해 관전압은 100kVp로 낮아졌고, 관전류 37.64% 증가, CTDIVOL 18.99% 감소, DLP 19.25% 감소하였다. 결론 : 주기적으로 검사를 위해 내원하는 환자를 대상으로 Care kV를 적용하여 흉 · 복부 CT검사를 하였을 때 영상의 질 변화 없이 피폭선량을 감소시킬 수 있었다. Objectives : To investigate the relationship between chest computed tomography (CT) and abdominal computed tomography (CT) in patients with hematologic malignancies. AEC is applied to reduce the amount of radiation exposure, and we compare the radiation doses of patients exposed to chest CT and abdominal CT scans using Care kV from FY2015. Methods : The CT system was developed using Somatom Definition AS + (Siemens, Erlangen, Germany) and was applied to patients who visited t he hematologic department of this specification from June 2014 to June 2015 The average age of 52 patients aged 21 to 78 years with 10 males and 20 females in 30 randomized, 2014 (control group) and 2015 (experimental group) Were analyzed and analyzed. One of the radiologist of chest and one of the radiologist of abdominal evaluated each of the CT images of 2014 and 2015 and evaluated them in five stages (Unacceptable, Suboptimal, Adequate, Good, Excellent). Female Rando Phantom was used in the same way and the CTDlvoL and DLP values displayed in the Dose report were compared when analyzing the exposure dose. Results : In the clinical study, the tube voltage was lower at 100 kVp in the experimental group compared with the control group, the tube current increased by 31.11 %, the CTDlvOL decreased by 23.84%, and the DLP decreased by 24.03%. The video evaluation of the experimental group was evaluated by 30 Unacceptable, 0 Suboptimal, 0 Adequate, 25 Good, and 5 Excellent. In the study of the phantom, the tube voltage was lower at 100 kVp in the experimental group than in the control group. The tube current increased by 37.64%, CTDlvOL decreased by 18.99%, and DLP decreased by 19.25%. Conclusion : Care kV can be applied to my desired patient for periodic screening to reduce the amount of radiation that can be seen without altering the quality of the image when chest CT and abdominal CT scan is performed.

소아검사시 사용하는 Narrow Shaped Bowtie Filter가 선량과 화질에 미치는 영향

박기덕(Ki Deok Park),김성환(Seong Hwan Kim),최선영(Seon Yeong Choi),이태만(Tae Man Lee),조민연(Min Yeon Jo) 대한CT영상기술학회 2015 대한CT영상기술학회지 Vol.17 No.2

목적 : 동일한 목적을 가진 CT검사에서 성인과 다르게 소아 검사에서는 standard shaped filter 뿐만 아니라 선랑감소 목적으로 additional filter(narrow shaped filter)가 추가로 사용된다. 소아 두부와 복부 검사를 시행하였을 때 얼마만큼의 선량 감소효과가 나타나고 그에 따른 영상의 화질을 평가하여 보고하고자 한다 대상 및 방법 : SIEMENS사의 SOMATOM Definition AS+와 SIEMENS사의 SOMATOM Definition 장비를 사용하여 소아의 체중을 고려해서 제작된 평균 body size의 아크릴 팬텀과 소아 weight based protocal에 의한 몸무게별 조건을 적용하여 narrow shaped filter를 사용 시와 미사용 시를 반복하여 검사하고 장비에서 제공하는 dose report 상의 CTDIVol, total DLP값으로 선량번화를 관찰하고 검사한 이미지를 PACS상에서 noise를 측정, 화질을 평가하였다. 단 tube rotation time은 0.5s, slice는 3.0mm, AEC는 사용하지 않은 조건으로 동일하게 검사하였다. 결과 : 아크랄 팬텀에서는 동일한 조건으로 narrow shaped filter를 사용하였을 때 사용하지 않았을 때 보다 abdomen의 경우 실질적인 유효선량을 구할 수 있는 DLP값이 평균 19.16% 감소되었고 brain의 경우 DLP값이 평균 13.5%감소 하였다. noise값은 abdomen은 ±0.27, brain은 ±0.1의 오차율로 오차범위가 크지 않은 것을 확인 할 수 있었고 영상의학과 판독의에 소견으로 판독에는 영향을 끼치지 않는 것을 확인하였다. 결론 : 소아 CT검사에서 narrow shaped filterㆍ를 사용하여 검사하는 경우 화질에는 큰 영향을 끼치지 않으면서 선량을 보다 줄일 수 있다. Purpose : In adults, unlike children in the CT scan examination Standard shaped filter with the same purpose, as well as dose reduction objectives Additional filter (Narrow shaped filter) is used as an additional. When underwent dose reduction in pediatric brain and abdominal examination appears and how much we report evaluates the quality of the resulting image Materials and method : SIEMENS’s SOMATOM Definition AS + with SIEMENS’s SOMATOM Definition equipment used in children’s weight and consideration to making an average Body size of the acrylic phantom and Pediatric Weight based protocol in by weight-specific conditions applying to Narrow shaped filter when used and unused during Repeat dose report examines and on the equipment provided by the CTDlvol, observing the dose value to measure the change in Total DLP Noise a test image on the PACS, image quality was evaluated. However Tube rotation time is O.Ss, Slice is 3.0mm. AEC is examined in the same condition unused. Result : In the case of the acrylic phantom the DLP value can be found than the actual effective dose of the Abdomen If you did not use the Narrow shaped filter when used under the same conditions was reduced an average 19.16% Brain DLP values were reduced by 13.5% on average. Noise values are Abdomen is± 0.27, Brain was able to determine that the error rate is not greater by a margin of error of± 0.1, the findings on the image read by the reading was confirmed that the medicine does not affect. Conclusion : If you check in pediatric CT examinations using the Narrow Shaped Filter video quality than the dose can be reduced without not have a significant impact

소아CT검사의 최적화에 대한 이해

김효진(Kim Hyo Jin),김종인(Kim Jong In),이태만(Lee Tae Man) 대한CT영상기술학회 2016 대한CT영상기술학회지 Vol.18 No.1

목적 : 성인에 비해 방사선에 대한 위험도가 높은 소아 CT검사 시 각 의료기관마다 최적화를 위한 노력 및 실태를 분석하고자 한다. 대상 및 방법 : 종합병원(대학병원) 및 중소병원을 포함한 29개 병원을 대상으로 전화 및 방문하여 소아 CT검사 시 선량감소를 위한 의식차이를 조사하였다. 타 병원에서 전원 온 환자의 PACS영상과 본 병원에서 검사 된 소아 환자의 영상 및 선량 정보를 분석 비교하였다. 또한 각 의료기관의 소아 CT검사 시 최소·최대 선량과 식품의약품안정청 권고선량을 비교 분석하였다. 결과 : 소아 CT검사 시 조사 대상 29개 병원 중 프로토콜은 장비회사에서 제공된 것을 사용하고 있는 병원이 13곳(45%)으로 가장 많이 나타났다. 병원자체 프로토콜을 사용하거나 장비회사에서 제공한 것을 병행하여 사용하고 있는 병원이 각각 4곳(13%)으로 나타났다. 86% 이상의 병원이 최적화에 대한 의식 노력이 없거나 장비회사에 의존하고 있다. 자동선량조절장치(AEC)를 사용하며 선택적으로 선량을 조절하여 검사한 본 병원과 권고량을 비교하였을 경우 평균 3.3배 차이가 났다. 부위별 CT 검사 하였을 경우 각 의료기관마다 7배 이상의 CTDIvol(mGy) 값의 차이가 발생하였다. 결론 : 방사선 민감도가 높은 소아 CT검사 시 체중과 신체 모양에 따른 최적화된 검사가 필요하다. 자동선량조절장치를 사용하면서 적절한 소아선량을 조절하며 검사를 해야 한다. 소아 CT검사는 최상의 image보다 판독 가능한 범위의 영상만을 얻도록 최소한의 선량을 사용해야 한다. 소아 CT검사의 최적화를 위해서는 영상의학과 전문의뿐 만이 아니라 방사선사의 역할이 더욱 중요하며 앞으로도 지속적 노력이 필요하다. Purpose : Analysis and optimization efforts for each medical institution when a high-risk pediatric CT scans to radiation than adults Materials and Method : Consciousness differences were examined for dose reduction in pediatric CT including hospitals and small hospitals by telephone and visits to 29 hospitals. Other hospitals and the hospitals were compared and analyzed the CT image and dose report of pediatric patients. And pediatric CT scans were analyzed for each medical minimum·maximum dose and Food and Drug Administration recommended dose. Result : Pediatric CT examinations surveyed using protocols provided by the companies was observed most frequently represented by 13 places (45%) of 29 hospitals. Using the hospital own Protocol and using it in combination provided by the companies was observed by each 4 places (13%). More than 86% of hospitals have no conscious effort on dose optimization and relying on companies. Adjust the dose of this hospital using the automatic dose control (AEC) and Food and Drug Administration recommended dose difference was 3.3 times. In case CT scan specific areas more than seven times each medical CTDIvol (mGy) differences occurred. Conclusions : The high radiation sensitivity of pediatric CT examinations is needed is an optimized test according to weight and body shape. Pediatric CT scan requires a minimal dose in the readable range than the best image. Using the automatic dose control (AEC) and the appropriate pediatric dose adjustment and should be checked. In order to optimize pediatric CT scan the Radiogical technologists not only as a professional Radiology is even more important and requires a continuous effort.

이중 선원을 이용한 복부대동맥 CT에서 조영제의 적정 양

안주용(Ju Yong Ahn),김근우(Geun Woo Kim),이창미(Chang Mi Lee),이태만(Tae Man Lee),조민연(Min Yeon Jo) 대한CT영상기술학회 2010 대한CT영상기술학회지 Vol.12 No.2

Purpose The abdomen aorta computed tomography(CT) is uncomfortable to examinee, because of quickly injection of contrast media. So purpose is to adjust a present day’s dye amount, result from to decreased scan time for introducing the dual source CT. Materials and methods In the patients were prescribed abdomen aorta CT at this hospital from September 17th 2009 to February 22th 2010, we collected group A of 50 persons were used to dye of 12o±10ml, group B of 50 persons of the fresh amount to calculate and gained a distribution of each range, also the time of range with group A. In succession, we counted average moving time of dye from injection point to starting point of abdomen aorta+breath-hold time and the time required from enhance point to end of scan, so computed the optimum amount of dye & saline for scan and applied the figures targeting group B. Results We compared the group B and the group A, they are little difference in CT numbers. Ultimately, the exam is impossible to decrease dye of 33~45% than former amounts. Conclusion Through the research, we can decrease dye amounts for quickening scan time. It can make a positive influence to radiologist and patients, and anticipate the effect to cost reduction of dye.