Rib Cage View검사 시 촬영조건 변화에 따른 적정선량 및 영상 평가

김선재(Sun-Jae Kim),이호일(Ho-Il Lee),안치복(Chi-Bock An),손영목( Yung-Mok Son),김윤국(Youn-Kook Kim),박순규(Soon-Kyu Park) 대한영상의학기술학회 2018 대한영상의학기술학회 논문지 Vol.2018 No.1

목 적:디지털 방사선 X-ray장비에서 Rib Cage검사 시 Deviation Index (DI)를 활용하여 적정선량을 평가하고 의학적 목적에 맞는 최적의 노출조건을 표준촬영조건과 비교하여 평가하고자 한다. 대상 및 방법: 실험에 사용된 장비는 디지털 방사선 장치(Samsung GC85A)와 다목적 흉부팬텀(Lungman)을 사용하였다. 관전압을 50kVp부터 80kVp까지 5단계로, 관전류를 10mAs부터 50 mAs까지 10단계로 나누어 총 35개의 영상을 획득하였으며, 촬영 조건에 따라 획득한 영상들의 Deviation Index (DI)를 활용하여 적정 에너지 값을 갖는 촬영 조건을 획득하였다. 획득된 영상들을 정량적 평가를 위해 Image J 프로그램을 이용하여 갈비뼈(Rib)와 폐(Lung)에 동일한 관심영역(ROI)을 설정하여 신호 대 잡음 비(SNR)를 산출하였으며, 영상의 학과 전공의 1명과, 방사선사 3명이 정성적 평가를 실시하였고, Dose Area Product (DAP)를 획득 후 PCXMC (Dose Calculation)프로그램을 이용하여 유효선량을 산출하였다. 모든 값들은 식약청에서 정해선 표준촬영조건 과 비교하였으며, 모든 통계학적 검정은 SPSS (Ver.18)를 이용하여 분석하였다. 결 과:조건에 따른 DI는 80 kVp 10mAs에서 -0.07, 60 kVp 40mAs에서 -0.28로 이 두 조건이 유효범위 안에 가장 가깝게 평가되었고, 평가된 두 조건을 표준 촬영조건인 75kVp 30 mAs와 비교하였다. SNR은 각각 9.1%, 17.4%로 감소하였고, 유효선량은 각각 61%, 45.3%로 감소되었으며, 정성적 평가 결과 각각 3.6점, 4.6점으로 나타났다. 결 론:60 kVp 40 mAs조건이 80 kVp 10 mAs조건 보 다 약간의 낮은 수치를 보였지만 정성적 평가에서 높은 점수를 받았고, 임상적 목적에 따라 요구되는 영상의 품질 수준이 높기 때문에, 60 kVp 40mAs조건이 진단적 가치가 좋은 영상일 뿐만 아니라 환자의 피폭선량을 줄일 수 있는 적정선량이 조사되었다고 사료된다. Purpose:When examining Rib Cage, Digital equipment is to be found to assess the appropriate dose by using a Deviation Index (DI) and compare the optimal exposure conditions for medical purposes with standard imaging conditions. Materials and Methods:The equipment used for the experiment used a digital radiation device (Samsung GC85A) and a multipurpose chest phantom (Lung-man). Tube voltage was divided into 5 units from 50 kVp to 80 kVp and Tube current was divided into 10 units from 10 mAs to 50 mAs to obtain a total of 35 images. Using the Deviation Index (DI) of the images acquired according to the exposure conditions, the exposure conditions with appropriate energy values were selected. The selected ROI was set in the Rib and Lung using ImageJ, and SNR and CNR were calculated. One person in the Radiology resident and three from the Radiological technologist conducted onducted a qualitative evaluation. After obtaining Dose Area Product (DAP), effective dose was calculated using PCXMC (Dose Calculation) program. All values were compared from the Ministry of Food and Drug Safety to the decision line standard photographing condition, and all statistical tests were analyzed using SPSS (Ver.18). Result:According to the condition, DI was –0.07 at 80 kVp 10 mAs, -0.28 at 60 kVp 40 mAs, it was found that these two conditions were the most appropriate dose. Therefore, the two conditions selected were compared with 75 kVp 30 mAs which is the standard exposure condition. Although the SNR decreased to 9.1% and 17.4% respectively, there was no significant difference as a result of the SPSS statistical test (P<0.191). Effective amounts are 61%, 45.3%, reduced, Qualitative evaluation resulted in 3.6 and 4.6 points, respectively. Conclusion:The condition of 60 kVp 40 mAs was slightly lower than the condition of 80 kVp 10 mAs. However, because the qualitative evaluation received a very high score and the quality level of the image required is clinically high according to the purpose, the condition of 60 kVp 40 mAs can be used not only for images with high diagnostic value, Appropriate dose that can reduce exposure dose This is considered to have been investigated.

후하방 흉추간판탈출증에서 전측방 도달법으로 Carbon Cage를 이용한 골융합술

신문수,정봉섭,최훈규,김용인 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

The authors report a case of thoracic disc herniation at T11/12 level which was downward migrated, presenting with signs of progressive spinal cord compression. The lesion was diagnosed by MRI. The operation was done by transthoracic transpleural approach using surgical microscope and the rib was not resected due to floating ribs of T11, 12. A Carbon cage with cancellous bones were used for the graft at the partial corpectomy site. The result of operation was good.

Effects of Rib Cage Joint Mobilization Combined with Diaphragmatic Breathing Exercise on the Pulmonary Function and Chest Circumference in Patients with Stroke

Ayeon Kim,Youngwha Song,Geurin Hong,Dajeong Kim,Soonhee Kim 국제물리치료연구학회 2020 Journal of International Academy of Physical Ther Vol.11 No.3

Background: Patients with stroke have core muscle weakness and limited rib cage movement, resulting in restrictive lung disease. Objectives: To examine the comparison of effects of rib cage joint mobilization combined with diaphragmatic breathing exercise and diaphragmatic breathing exercise on the pulmonary function and chest circumference in patients with stroke. Design: A cluster randomized controlled trial. Methods: Twenty-four patients were randomly assigned to an experimental group (rib cage joint mobilization combined with diaphragmatic breathing exercise group) and control group (diaphragmatic breathing exercise group). Patients in the experimental group underwent rib cage joint mobilization for 15 min and diaphragmatic breathing exercise for 15 min. The control group underwent diaphragmatic breathing exercise for 30 min. Both groups underwent exercise thrice a week for 4 weeks. The pulmonary function and chest circumference were measured using the MicroLab spirometer and a tape measure, respectively. Results: After the intervention, the pulmonary function and chest circumference significantly improved in both groups. These improvements were significantly higher in the experimental group than those in the control group. Conclusion: Rib cage joint mobilization combined with diaphragmatic breathing exercise improves pulmonary function and chest circumference in patients with stroke.

태권도 응용 흉곽확장운동이 폐기능에 미치는 영향

이가현(Ga-Hyeon Lee),정재영(Jae-Young Lim),한동욱(Dong-Wook Han),변성학(Sung-Hak Byun) 대한심장호흡물리치료학회 2013 대한심장호흡물리치료학회지 Vol.1 No.1

Purpose: The purpose of this study is to determine the effects of exercise of expanding rib cage which applied Taekwondo on pulmonary function. Subjects: Twenty female college students at the age of 19~23 without any functional disability of nervous system, muscular system and cardiopulmonary system were participated. Methods: Pulmonary functions were assessed through the use of a pulmonary function measurement device(Pony FX, COSMED Inc, Italy). The Taekwondo group preformed the seven kinds of movements of expanding rib cage which applied Taekwondo. Every movement was repeated three times and each movement was proceeded for 15 seconds. The control group didn’t perform any other exercise. Afterwards, pulmonary functions were assessed again by the same measuring instruments. The Mann-Whitney test and Wilcoxon sign rank test were used to compare pulmonary functions between Taekwondo group and control group. The statistical program was the SPSSWIN (ver 21.0) package program. Results After the exercise of expanding rib cage, fIC of FVC factors and ERV, Rf and Vt, of SVC factors improved significantly. In comparing the difference of changes of pulmonary functions between Taekwondo group and control group, FVC, FEV1 and fIC, of FVC factors in Taekwondo group increased significantly more than control group. Conclusion: This study revealed that the exercise of expanding rib cage which applied Taekwondo can improve the pulmonary functions.

Altered Thoracic Cage Dimensions in Patients with Chronic Obstructive Pulmonary Disease

Lim, Su Jin,Kim, Ju-Young,Lee, Seung Jun,Lee, Gi Dong,Cho, Yu Ji,Jeong, Yi Yeong,Jeon, Kyung Nyeo,Lee, Jong Deog,Kim, Jang Rak,Kim, Ho Cheol The Korean Academy of Tuberculosis and Respiratory 2018 Tuberculosis and Respiratory Diseases Vol.81 No.2

Background: Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage by increasing lung volume and hyperinflation. This study investigated changes in thoracic cage dimensions and related factors in patients with COPD. Methods: We enrolled 85 patients with COPD (76 males, 9 females; mean age, $70.6{\pm}7.1years$) and 30 normal controls. Thoracic cage dimensions were measured using chest computed tomography at levels 3, 6, and 9 of the thoracic spine. We measured the maximal transverse diameter, mid-sagittal anteroposterior (AP) diameter, and maximal AP diameter of the right and left hemithorax. Results: The average AP diameter was significantly greater in patients with COPD compared with normal controls ($13.1{\pm}2.8cm$ vs. $12.2{\pm}1.13cm$, respectively; p=0.001). The ratio of AP/transverse diameter of the thoracic cage was also significantly greater in patients with COPD compared with normal controls ($0.66{\pm}0.061$ vs. $0.61{\pm}0.86$; p=0.002). In COPD patients, the AP diameter of the thoracic cage was positively correlated with body mass index (BMI) and 6-minute walk test distance (r=0.395, p<0.001 and r=0.238, p=0.028) and negatively correlated with increasing age (r=-0.231, p=0.034). Multiple regression analysis revealed independent correlation only between BMI and increased ratio of AP/transverse diameter of the thoracic cage (p<0.001). Conclusion: Patients with COPD exhibited an increased AP diameter of the thoracic cage compared with normal controls. BMI was associated with increased AP diameter in these patients.

태권도 막기동작 응용 가슴우리 확장운동이 폐 기능에 미치는 영향

변성학(Sung-Hak Byun),하미숙(Mi-Sook Ha),한동욱(Dong-Wook Han) 대한심장호흡물리치료학회 2021 대한심장호흡물리치료학회지 Vol.9 No.1

Purpose : In this study, we aimed to investigate the effects of rib cage expansion exercise applying Taekwondo Makki motion on pulmonary functions. Methods : We examined 30 female university students without any dysfunctions of the nervous, muscular, and cardiopulmonary systems. Pulmonary functions were tested using a digital pulmonary function measuring device (Pony FX, COSMED Inc, Italy). The experimental group performed three movements of expanding their rib cage applying Taekwondo Makki motion. The participants performed exercises twice a day, once in the morning and again in the afternoon, for 4 weeks. The control group did not perform any other exercise. Pulmonary functions were measured again after 4weeks. SPSSWIN (ver 25.0) package program was used for statistical analysis. Results : In the experimental group, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), inspiratory reserve volume (IRV), inspiratory capacity (IC), expiratory reserve volume, vital capacity (VC), and maximal voluntary ventilation (MVV) improved significantly after 4 weeks of exercise; the control group showed no change. The changes in FVC, FEV1, IRV, IC, VC, and MVV in the experimental group were higher than those in the control group. Conclusion : The rib cage expansion exercise applying Taekwondo Makki motion can improve pulmonary functions.

Altered Thoracic Cage Dimensions in Patients with Chronic Obstructive Pulmonary Disease

( Su Jin Lim ),( Ju-young Kim ),( Seung Jun Lee ),( Gi Dong Lee ),( Yu Ji Cho ),( Yi Yeong Jeong ),( Kyung Nyeo Jeon ),( Jong Deog Lee ),( Jang Rak Kim ),( Ho Cheol Kim ) 대한결핵 및 호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.2

Background: Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage by increasing lung volume and hyperinflation. This study investigated changes in thoracic cage dimensions and related factors in patients with COPD. Methods: We enrolled 85 patients with COPD (76 males, 9 females; mean age, 70.6±7.1 years) and 30 normal controls. Thoracic cage dimensions were measured using chest computed tomography at levels 3, 6, and 9 of the thoracic spine. We measured the maximal transverse diameter, mid-sagittal anteroposterior (AP) diameter, and maximal AP diameter of the right and left hemithorax. Results: The average AP diameter was significantly greater in patients with COPD compared with normal controls (13.1±2.8 cm vs. 12.2±1.13 cm, respectively; p=0.001). The ratio of AP/transverse diameter of the thoracic cage was also significantly greater in patients with COPD compared with normal controls (0.66±0.061 vs. 0.61±0.86; p=0.002). In COPD patients, the AP diameter of the thoracic cage was positively correlated with body mass index (BMI) and 6-minute walk test distance (r=0.395, p<0.001 and r=0.238, p=0.028) and negatively correlated with increasing age (r=-0.231, p=0.034). Multiple regression analysis revealed independent correlation only between BMI and increased ratio of AP/transverse diameter of the thoracic cage (p<0.001). Conclusion: Patients with COPD exhibited an increased AP diameter of the thoracic cage compared with normal controls. BMI was associated with increased AP diameter in these patients.

Altered Thoracic Cage Dimensions in Patients with Chronic Obstructive Pulmonary Disease

임수진,김주영,이승준,이기동,조유지,정이영,전경녀,이종덕,김장락,김호철 대한결핵및호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.2

Background: Chronic obstructive pulmonary disease (COPD) may cause changes in the shape of the thoracic cage by increasing lung volume and hyperinflation. This study investigated changes in thoracic cage dimensions and related factors in patients with COPD. Methods: We enrolled 85 patients with COPD (76 males, 9 females; mean age, 70.6±7.1 years) and 30 normal controls. Thoracic cage dimensions were measured using chest computed tomography at levels 3, 6, and 9 of the thoracic spine. We measured the maximal transverse diameter, mid-sagittal anteroposterior (AP) diameter, and maximal AP diameter of the right and left hemithorax. Results: The average AP diameter was significantly greater in patients with COPD compared with normal controls (13.1±2.8 cm vs. 12.2±1.13 cm, respectively; p=0.001). The ratio of AP/transverse diameter of the thoracic cage was also significantly greater in patients with COPD compared with normal controls (0.66±0.061 vs. 0.61±0.86; p=0.002). In COPD patients, the AP diameter of the thoracic cage was positively correlated with body mass index (BMI) and 6-minute walk test distance (r=0.395, p<0.001 and r=0.238, p=0.028) and negatively correlated with increasing age (r=–0.231, p=0.034). Multiple regression analysis revealed independent correlation only between BMI and increased ratio of AP/transverse diameter of the thoracic cage (p<0.001). Conclusion: Patients with COPD exhibited an increased AP diameter of the thoracic cage compared with normal controls. BMI was associated with increased AP diameter in these patients.

뇌졸중 환자에게 가슴우리 확장 저항 운동의 적용 위치가 호흡근력에 미치는 영향

이지원,조용호 대한물리의학회 2022 대한물리의학회지 Vol.17 No.2

PURPOSE: The purpose of this study was to compare the effect of depending on the location of applying chest expansion resistance exercise on the respiratory muscle strength stroke patients, and to suggest more effective interventions to improve respiratory function in stroke patients in clinical practice. METHODS: A total of 30 subjects were selected and divided into two groups, and chest cage extension resistance exercise was applied to the sternum and rib cage, respectively, and performed for 4 weeks, 3 times a week, for 20 minutes. In order to compare the general characteristics of the study subjects and the homogeneity of the group, the pre-experimental values were analyzed using the independent sample t-test. Paired-sample t-test was used for pre-post value comparison of maximum inspiratory pressure and maximum expiratory pressure in each group. Statistical significance was set to .05. RESULTS: Both the sternum application group and the rib cage application group showed a significant difference in the maximum inspiratory pressure according to the intervention. Also, there was a statistically significant difference in the maximum expiratory pressure in the sternum application group. CONCLUSION: As breathing exercise is important for stroke patients, based on the results of this study, if therapists perform sternal extension resistance exercise or rib extension resistance exercise according to the patient's condition and environment, it can help the breathing function of stroke patients.

Effects of Thorax Mobility Exercise on the Thorax Mobility, Breathing Pattern and Respiratory Capacity in Subject With Restricted Thorax Mobility: A Case Series

하성민(Sungmin Ha) 대한신경계작업치료학회 2023 재활치료과학 Vol.12 No.2

목적 : 본 연구는 가슴 가동성 제한을 가지고 있는 대상자에게 가슴 가동성 운동이 가슴 가동성, 호흡패턴 및 호흡 용량에 미치는 영향을 알아보고자 하였다. 연구방법 : 13명의 가슴 가동성 제한을 가진 남/녀 대상자를 대상으로 가슴 가동성 운동(갈비뼈 가동성운동)을 시행하여 가슴 가동성, 호흡 패턴 및 호흡량에 어떠한 변화가 있는지를 알아보았다. 가슴가동성 운동 전/후에 연구 참여 대상자의 가슴 가동성(들숨-날숨 간 가슴 확장 길이 측정), 호흡 패턴형태(가슴 움직임 수직 이동거리 측정) 및 호흡량(forced vital capacity, forced expiratory volume in 1 second)을 측정하였다. 가슴 가동성, 호흡 패턴 및 호흡 용량을 비교하기 위하여 짝-검정을 사용하였다. 통계적 유의성 검정을 위한 유의수준은 .05였다. 결과 : 가슴 가동성과 호흡 패턴은 통계적으로 유의한 차이가 있지만, 호흡 용량은 유의한 차이가 없었다(p < .05). 결론 : 본 연구의 결과를 토대로 갈비뼈 가동화 기법을 이용한 가슴 가동성 운동은 가슴 가동성 개선과가슴 올림이 유발되는 비정상적인 호흡 패턴을 정상화시킬 수 있는 방법이라고 여겨진다. Objective : To investigate the effects of thorax mobility exercises on thorax mobility, breathing pattern, and respiratory capacity in subjects with restricted thorax mobility. Methods : Thirteen subjects with restricted thorax mobility participated in this study. Measurement of thorax circumference using a tape measure (difference between inhalation and exhalation), breathing pattern (distance of rib cage elevation during breathing), and respiratory capacity was performed. Paired t -test was used to compare the thorax mobility, breathing pattern, and respiratory capacity between before and after thorax mobility excercise. Statiscal significance was set at .05. Results : There were significant differences in thorax mobility and breathing pattern, but no significant difference in respiratory capacity (p < .05). Conclusion : Based on the results of this study, thorax mobility exercise using the rib mobilization technique is considered to be a method that can improve thorax mobility and normalize abnormal breathing patterns that cause rib cage elevation.