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방사선 수술시 Isocenter, 콜리메이터 변수에 따른 선량 분포 비교연구
오승종,박정훈,곽철은,이형구,최보영,이태규,김문찬,서태석 한국의학물리학회 2002 의학물리 Vol.13 No.3
The radiosurgery is planned that prescribed dose was irradiated to tumor for obtaining expected remedial value in stereotactic radiosurgery. The planning for many irregular tumor shape requires long computation time and skilled planners. Due to the rapid development in computer power recently, many optimization methods using computer has been proposed, although the practical method is still trial and error type of plan. In this study, many beam variables were considered and many tumor shapes were assumed cylinderical ideal models. Then, beam variables that covered the target within 50% isodose curve were searched, the result was compared and analysed. The beam variables considered were isocenter separation distance, number of isocenters and collimator size. Dose distributions obtained with these variables were analysed by dose volume histogram(DVH) and dose profile at orthogonal plane. According to the results compared, the use of more isocenters than specified isocenter dosen't improve DVH and dose profile but only increases complexity of plan. The best result of DVH and dose profile are obtainedwhen isocenter separation was 1.0-1.2 in using same number of isocenter.
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kV Cone-beam CT를 사용한 치료준비에서 재구성 영상의 품질이 표적 위치 결정에 미치는 영향
오승종,김시용,서태석,Oh, Seung-Jong,Kim, Si-Yong,Suh, Tae-Suk 한국의학물리학회 2006 의학물리 Vol.17 No.4
kV cone-beam CT (CBCT)가 결합된 선형가속기의 등장으로 더욱 정확한 영상유도 방사선치료(Image-guided radiation therapy, IGRT)가 가능해졌다. IGRT는 영상장비를 이용해 표적의 이동을 보정할 수 있는 방사선치료기술로, CBCT를 이용한 IGRT의 경우 내부 장기의 정보를 바탕으로 병변의 이동을 정확히 알 수 있다. 내부 장기의 정보를 얻기 위해서는 방사선이 조사되기 바로 전에 환자의 CBCT 영상을 획득하여 치료계획 시 사용한 모의치료 CT영상과 정합을 수행하게 된다. 본 연구에서는 CBCT 영상의 재구성 품질에 따른 정합결과를 비교해 보았다. 6명의 환자로부터 총 56개의 CBCT 투과 정보를 획득하여 분석한 결과, 평행이동벡터의 차가 1 mm를 초과하는 경우는 단 3개에 불과하였다. 회전이동의 경우, x, y, z, 세 축을 모두 고려하였으며, 그 결과 총 168 ($56{\times}3$)개에서 단 3개만이 $1^{\circ}$ 이상의 차이를 나타냈다.
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정위적 방사선 수술에서의 이상표적모델과 경험적 지식을 활용한 수술계획 최적화 방법 개발
오승종,송주영,최경식,김문찬,이태규,서태석 한국의학물리학회 2004 의학물리 Vol.15 No.2
Stereotactic radiosurgery (SRS) is a technique that delivers a high dose to a target legion and a low dose to a critical organ through only one or a few irradiations. For this purpose, many mathematical methods for optimization have been proposed. There are some limitations to using these methods: the long calculation time and difficulty in finding a unique solution due to different tumor shapes. In this study, many clinical target shapes were examined to find a typical pattern of tumor shapes from which some possible ideal geometrical shapes, such as spheres, cylinders, cones or a combination, are assumed to approximate real tumor shapes. Using the arrangement of multiple isocenters, optimum variables, such as isocenter positions or collimator size, were determined. A database was formed from these results. The optimization procedure consisted of the following steps: Any shape of tumor was first assumed to an ideal model through a geometry comparison algorithm, then optimum variables for ideal geometry chosen from the predetermined database, followed by a final adjustment of the optimum parameters using the real tumor shape. Although the result of applying the database to other patients was not superior to the result of optimization in each case, it can be acceptable as a plan starling point.
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오승종,백용해,홍성권,최민규,허진석,노재형,손태성,김용일,김성,Oh, Seung-Jong,Baik, Yong-Hae,Hong, Seong-Kweon,Choi, Min-Gew,Heo, Jin-Seok,Noh, Jae-Hyung,Sohn, Tae-Sung,Kim, Yong-Il,Kim, Sung 대한위암학회 2005 대한위암학회지 Vol.5 No.4
Purpose: Benign anastomotic stricture after an esophagojejunostomy using EEA stapler following a radical total gastrectomy is one of the most serious complications. The purpose of this study is to evaluate the incidence risk factors, and treatment associated with benign stricture. Materials and Methods: From March 1998 to February 2001, 436 patients underwent an esophagojejunostomy with Roux-en-Y anastomosis using an EEA stapler followed by an endoscopy. Thirty three of the 436 patients(5.5%) developed an anastomotic stricture; included 24 of the 33 patients had a benign stricture. Nine patients with a malignant stricture were excluded. Results: The median age of the 436 patients was 57 years $(23{\sim}85\;years)$. Two hundred ninety two patients were male, and 144 patients were female. The median time to diagnosing the stricture was 1.5 months $(0.5{\sim}6months)$. There was no statistical significance in any of the risk factors, including the diameter of the stapling device, the status of adjuvant treatment, the status of reflux esophagitis, and a clinical history of diabetes and hypertension. The strictured patients were treated with balloon dilatation, one to three times, with symptom relief. Conclusion: There were no statistically significant risk factors. However, further study of the vascularity of anastomoses and benign strictures needs to be considered. In the anastomotic strictured patients endoscopic balloon dilatation appeared to be the first line of treatment.
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오승종,정은주 대한의사협회 2020 대한의사협회지 Vol.63 No.5
To meet the increasing social demand for improved patient safety and quality medical care in Korea, a pilot project of the hospitalist system in the field of internal medicine and surgery was initiated in 2016. Since the hospitalist system in the field of surgery in Korea should be based on the specific Korean medical environment, it is difficult to adopt a precedent model from other countries, and therefore a uniquely Korean operational model is necessary. Surgical hospitalists (surgeons working only within wards) in Korea are in charge of advanced primary care, perioperative care, and medical system care. Surgical hospitalists are able to care for older adult patients who have undergone a major operation to treat a highly severe condition. For inpatient care, the axis will need to shift from a trainee-centered structure to a surgical hospitalist-centered structure. This change will make possible the improvement of patient safety and quality medical care. The role of surgical hospitalists will extend not only to medical care, but also to education, academic activities, research, and related administrative aspects. To build a more stable and sustainable system, it is necessary to create a systemic operational foundation for proceeding with this new surgical hospitalist system.
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