회원제 골프장의 대중제 전환시 중요요인에 관한 실증연구

구본승(Goo, Bon Seong),최민섭(Choi, Min Seub) 한국주거환경학회 2017 주거환경(한국주거환경학회논문집) Vol.15 No.2

The purpose of this study is to explore important factors of changing membership golf courses to public golf courses. This study attempted to deduct and analyze important factors among golf course characteristic, golf course management characteristic, golf course operation characteristic. Moreover, this study attempted to conduct the analysis using the general statistical processing method based on the demographical data obtained from the questionnaire research on the basis of the understanding that the identity of the specialist is ambiguous when AHP is used under the changing membership golf courses to public golf courses. And it attempted to analyze the cross-tabs of demographical characteristics by professional group to make an in-depth understanding of the specific contents. Finally, This study was made to find out the degree of importance through the case revealed that changing membership golf courses to public golf courses. The results of the study are as follows, First, it was found that funding capability is the most important factor for the changing membership golf courses to public golf courses. Second, it was found that golf course lawn care is more important factors for the changing membership golf courses to public golf courses. Finally, it was found that green fee competitiveness is important factors for the changing membership golf courses to public golf courses.

Cardiac Functional Analysis를 위한 ECG-gated MDCT의 유용성과 MRI, SPECT, Echocardiography와의 비교분석

정한별(Han Byul Jeong),김영옥(Young Ok Kim),구본승(Bon Seung Goo),대창민(Chang Min Dae),민관홍(Gwan Hong Min),김성룡(Seong Ryong Kim) 대한전산화단층기술학회 2006 대한CT영상기술학회지 Vol.8 No.1

Purpose In the evaluation of ischemic heart disease, accurate measurement of cardiac function is very important as well as the evaluation of vessel status of coronary artery. therefore we evaluate the accuracy of cardiac functional analysis using ECG-gated MDCT compare with other imaging modality such as MRI, single photon emission computed tomography and echocardiography. Materials and Methods We recruited 21 patients(age range:51~78, mean age:62.8±10.69, sex: male-13 female-8) with ischemic heart disease that underwent 4 exam(CT, MRI, single photon emission computed tomography and Echo) all within 1 month. We used 16 slice MDCT(Mx8000 IDT, Philips Medical Systems, Netherland) and dual injector(Medrad, USA). We measured 4 cardiac functional data(ejection- fraction %, end-diastolic volume, end-systolic volume and mass) of left ventricle. To measure data, we used end-systolic & end-diastolic reconstruction phase during cardiac cycle in ECG-gated cardiac CT. 4 cardiac functional data(EF, EDV, ESV and mass) were measured at short axis view using semiautomated contour technique in Extended Brilliance workstation(Brilliance version 2.0, Philips Medical Systems). This cardiac functional data obtained from CT was compared with MRI, ECG-gated single photon emission computed tomography, echocadiography. MRI is known to reference standard of cardiac function. therefore we analyzed the accuracy of cardiac functional data each modality(CT, single photon emission computed tomography, echocadiography) compared with MRIcardiac functional data as reference of standard. Results We analyze difference MRI with other modality(CT, single photon emission computed tomography, echocardiography). First, mean difference for the measurement of EF(%) is CT ±2.7, SPECT ±6.7, echocardiography: ±7.01. Second, end-diastolic volume(EDV) value(ml), mean of difference is CT: ±18.3, SPECT ±44.1 except echocardiography(because echocardiography is not volume but two dimentional diameter). Third, end-systolic volume(ESV) value(ml), mean of difference is CT: ±8.57, SPECT ±15.9 also except echocardiography. At last, left ventricle mass score is only compare MRI with CT and not include papillary muscle. Mean of difference is CT: ±8.09. Conclusion From thisstudy, we concluded that ECG-gated MDCT is more accurate than SPECT or echocardiography for the assessment of cardiac function. According to MDCT is rapidly developed like as 64 MDCT, improvement of temporal resolution bring to reduce artifact that is influenced heart rate. Therefore MDCT will play an important role in the near future for the evaluation of cardiac functional analysis.

북부 Scan시 Scan Projection Radiography의 Exposure condition의 변화에 따른 선량의 영향

정용환(Yong Hwan Chung),남태현(Tae Hyun Nam),구본승(Bone Seung Goo),대창민(Chang Min Dae),민관홍(Kwan Hong Min) 대한CT영상기술학회 2012 대한CT영상기술학회지 Vol.14 No.2

목적 이전에는 Scan 범위와 계획을 세우는 것이 목적이었던 Scan Projection Radiography(이하 SPR)가 Auto Exposure Control(이하 AEC)의 발달로 환자의 크기와 감약정보 등을 얻어 관전류(mA)를 결정하는 중요한 역할을 하게 되었다. 하지만 아직 환자에 따라 SPR획득 시 관전압(kVp)과 관전류(mA)의 설정을 변경할 경우 실제 scan에서 선량에 어떤 영향이 생길지 여부는 객관적으로 증명되지 않았다. 따라서 본 연구가 SPR 획득 시 적정한 관전압과 관전류를 설정하여 선량의 최적화(optimization)를 달성하는 Guide line이 되길 바란다. 대상 및 방법 사용된 CT는 4사장비로 Brilliance iCT(Philips healthcare, 이하 P사), Light Speed VCT(General Electric Medical System, 이하 G사), Somatom Definition Flash(Siemens Healthcare, 이하 S사), Aquilion64(Toshiba Medical System, Auklet Japan, 이하 T사)를 사용하였다. 첫번째 실험은 Phantom을 대상으로 복부 scan시 병원에서 사용하는 Protocol 그대로 적용하였고 SPR촬영은 length를 500mm로 고정하고 관전압을 80~120kVp, 관전류를 10~50mA로 변경하면서 적용하였고 장비에서 제공하는 CTDIvol와 DLP의 평균값을 계산하여 각 노출조건 간의 증감률을 알아보았다, 두번째 실험은 복부 scan을 위해 본원에 내원한 환자 602명을 대상으로 P사의 장비로 각 노출조건을 신체질량지수(Body Mass Index, 이하 BMI)로 분류하고 선량에 영향이 있는지 알아보았다. 세번째 실험은 두번째 실험 대상자 중 Planned mAs가 250 이상인 환자 123명을 대상으로 Auto current selection(Patient size AEC, 이하 ACS)의 적용을 중지하고 longitudinal AEC만 적용한 채로 선량의 증감률을 알아보았다. 결과 첫번째, Phantom을 대상으로 복부 scan후 선량의 증감률이 P사와 G사의 경우에는 SPR의 노출조건이 120kVp, 30mA일 때 CTDI가 최대 7.04%, DLP는 6.28%까지 감소했고 S사와 T사의 경우에는 120kVp, 50mA일 때 CTDI가 최대8.24%. DLP는 1.38% 감소했다. 두번째, 실제 환자를 복부 scan시 BMI에 따라 분류한 결과 SPR의 노출조건이 120 kVp, 30mA일 때 CTDI가 저체중군 15.36%, 정상군 5.09%, 과체중군 7.25%, 비만군 10.48%까지 감소했다. 세번째, longitudinal AEC만을 적용한 환자를 분류한 결과 역시 SPR 노출조건에 따라 CTDI 최대 2.85%까지 차이가 나는 것을 알 수 있었다. 결론 본 실험을 통해서 환자의 체형이나 나이에 따라 SPR의 노출 조건을 검사자가 임의로 조절해서 시행할 경우 오히려 전체적인 선량을 증가시킬 수 있는 오류를 범하게 될 수도 있다. AEC의 발달로 환자에게 적용되는 선량이 감소하는 것은 사실이지만 그에 따라 AEC에 영향을 주는 SPR의 역할이 커진 만큼 환자에 따라 노출 조건의 가이드라인을 확립하여 환자에게 최소의 선량으로 최적의 영상을 만들 수 있는 연구가 필요하다고 사료된다. I. Purpose Due to the development of AEC, Scan Projection Radiography which used to plan scan area only, now performs its important role of control tube current. However, there is no studies and guide line of effective dose depending on SPR scan parameters such as tube voltage and current so far. Therefore, on this study we set a valid tube voltage and tube current when getting SPR and analyze the result We want to set a guide line of suitable SPR parameter in order to achieve the dose optimization. II. Meterial and Methods Used CT scanners are 4 machines, Brilliance iCT(Philips healthcare), Light Speed VCT 64 MDCT(General Electric Medical System), Somatom Definition Flash(Siemens Healthcare), and Aquilion64 (Toshiba Medical System, Auklet Japan). In first study, the routine abdomen CT parameters which is using to patient are applied to this study. SPR scan length was fixed to 500mm. Tube voltage and current are changed from 80 to 120 kVp and 10 to 50 mA. We investigate changing rate between each exposure conditions to calculate the average value. CTDIvol and DLP which come from the machine are used. Second study, I assorted each exposure conditions with Philips machine into Body Mass Index, and studied the effect on liner value targeting 602 patients. Third study, we stop applying Auto current selection(Patient size AEC) and using longitudinal AEC to 123 patients who have over 250 planned mAs. Then we analyze changing rate. III. Result In first study, using P and G with 120 kVp and 30 mA exposure condition, dose was reduced 7.04% in CTDI and 6.28% in DLP. In the case of S and T with 120kVp, 50mA, was 8.24% in CTDI, 1.38% in DLP. In second study, depending on BMI, it was dropped that CTDI’s underweight to 15.35%, normal to 5.09%, overweight to 7.25%, obesity to 10.48% in the case that exposure conditions were 120kVp, and 30mA. In third study, maximum difference was 2.85% in CTDI when only longitudinal AEC is adapted. IV. Conclusions In this study, Depending on the patient’s body type or age of the SPR adjust the exposure conditions controlled by a random Rather, that can increase the overall dose may be commit errors. AEC is applied to the patient to the development of dose reduction is true that the AEC accordingly, affecting as many tients with enlarged role of the SPR, depending on exposure conditions, by establishing guidelines for patients with a dose of at least create the best image research that will be need.

보조기구를 이용한 shoulder supero-inferior axial 검사에 대한 유용성 평가

최진혁(Jin-Hyuk Choi),김동진(Dong-Jin Kim),구본승(Bon-Seung Goo),박신호(Sinho Park),대창민(Chang-Min Dae),민관홍(Kwan-Hong Min) 대한영상의학기술학회 2017 대한영상의학기술학회 논문지 Vol.2017 No.1

목 적:회전근개 질환과 오십견, 외상환자의 경우 어깨 관절 외전이 통증으로 인해 어려워 shoulder axial 검사에 한계가 있다. 따라서 본 연구에서는 새로 개발한 보조기구를 이용한 shoulder supero-inferior axial 검사 시 유용성에 대해서 알아보고자 한다. 대상 및 방법:2016년 11월부터 2017년 1월까지 본원에 내원하여 외상, 오십견, 회전근개 파열을 진단 받은 환자 중 어깨 관절의 외전(abduction)이 90도 이하인 32명을 대상으로 보조기구를 이용하여 shoulder supero-inferior axial 검사를 시행하였다. 보조기구를 사용하기 전 영상과 보조기구를 사용하여 검사한 영상을 정량적으로 평가하기 위해서, 관절와(glenoid fossa)의 관절면이 상완골두에 겹치는 정도와 오훼돌기가 쇄골에 겹치는 정도 그리고 오훼돌기와 상완골두의 간격 등을 경력 5년차 이상의 방사선사 3명이 각각 측정하였다. 정성적 평가는 영상의학과 전임의 1명과 전공의 1명이 5점 척도를 이용하여 평가하였다. 통계학적 검정은 Medcalc version 14를 이용하였고, 정량적 평가는 Paired Student t-test, 정성적 평가는 Wilcoxon signed rank test를 이용하여 비교 분석하였다. p-value<0.001일 때 통계적으로 유의한 차이가 있는 것으로 평가하였다. 결 과:보조기구 사용 전과 후의 영상을 분석한 결과 1) 관절와의 관절면의 길이는 보조기구 사용 전 평균값이 12.9 mm, 사용 후 9.9mm로 2.9 mm 감소하여 어깨관절이 더 열려져 보였다. 2) 오훼돌기가 쇄골 위로 보이는 길이는 보조기구 사용 전 평균값이 13.9 mm, 사용 후 16.3 mm로 2.3 mm 증가하여, 오훼돌기가 쇄골 위로 잘 보였다. 3) 상완골두와 오훼돌기의 간격은 보조기구 사용 전 평균값이 6.3 mm, 사용 후 평균값이 7.9 mm로 1.6mm 증가하였고, 오훼돌기가 상완골두와 겹침 없이 잘 나타났다. 보조기구 사용 전과 후의 정량적 평가와 정성적 평가에서 모두 통계적으로 유의한 차이를 보였다(p<0.0001). 결 론:Shoulder supero-inferior axial 검사에서 보조기구를 사용함으로써, 어깨관절과 오훼돌기 그리고 상완골두를 통해 봉우리빗장관절이 뚜렷하게 보여 보조기구를 사용하기 전영상보다 진단적 가치와 영상의 질이 높게 평가 되었다. 뿐만 아니라, 환자에게 쉽게 적용가능하고, 편의성을 제공하여 환자의 만족도를 향상시킬 수 있을 것으로 사료된다. Purpose:Rotatorcuff tear, Frozen shoulder, trauma patients are in trouble with shoulder abduction, there is certain limitation examining Shoulder axial x-ray. In this study, newly- developed assist device is adapted to examine shoulder supero-inferior axial to evaluate utility of it. Materials and Methods:From November 2016 to January 2017, 32 patients with rotatorcuff tear, frozen shoulder, trauma are thesis objects. The patients who barely reached 90° below in abduction position had been examined for shoulder supero- inferior axial using assist device(below AD). To evaluate images using AD or not, three radiation technicians who have five or more years of experience measure glenoid fossa joint overlapped with humerus head, overlapped space of coracoid and clavicle and distance between coracoid and humerus head. Radiology specialist and radiology resident evaluate those images by 1-5 point criterion in quantitative evaluation way. Statistical test was done by Medcalc version 14, Student t-test had been used for quantitative evaluation and Wilcoxon signed rank test had been used for qualitative evaluation for statistical significance. When p-value is 0.001 under (p<0.001), statistical significance is confirmed. Result:The results of experiment images of AD and non-AD 1) The length of glenoid fossa joint space is average 12.9 mm in non-AD and 9.9 mm in AD. 2.8 mm gap is opened. 2) Coracoid length between the edge of it and clavicle is average 13.9 mm in non-AD and 16.3 mm in AD. 2.3 mm longer length makes coracoid process appeared more clear. 3) Distance between coracoid and humerus head is 6.3 mm in non-AD and 7.9 mm in AD. 1.6 mm increased. Coracoid process looks better without overlap with humerus head. All evaluation items represent statistical significance after using AD. Conclusion:Using AD on shoulder supero-inferior axial makes shoulder joints, coracoid process and acromioclavicle joint more visible and upgrades image quality. Also, it is easier to adapt to patients and meet patients satisfaction.