Stereotactic radiosurgery (SRS) is a technique to deliver a high dose to a target region and a low dose to a critical organ through only one or a few irradiation. The SRS must be planned exactly. Currently the surgery plan is performed by trial and error method. There are many questions about the reliability and reproducibility of the plan result. This study improve each step of the Oh's method based on heuristic target shaping to obtain the better result. The target was reconstructed using cylinders with same height and the neighbored cylinders were combined according to the difference of each center and diameter. Then, spheres were packed within each cylinders by the packing rules. Two virtual targets were used to compare this method with Oh's method. As a result, the numbers of isocenter were successfully reduced - more than 36% and 26% - without serious differences of prescription isodose to tumour volume ratio (PITV) and maximum dose to prescription dose ratio (MDPD). This technique using cylinder piling and sphere packing will be a helpful tool to planner in stereotactic radiosurgery.
Planning Techniques* ; Prescriptions ; Radiosurgery*

Outcome mapping (OM) is a participant-oriented new method for project planning,monitoring and evaluation.It is based on continuous learning and focuses on changes in behavior,relationship and activities of persons,groups and organizations.The use of OM can help to clarify the roles and assignments of the government,managers,health workers,and other relevant personnel,making full use of the limited social resources and improving the efficiency and quality of health services.We introduce the principle and operation steps of OM with case simulation in health resource integration,to show its application in decision-making.
Decision Making ; Outcome and Process Assessment (Health Care) ; methods ; Planning Techniques

As medical computer-aided design (CAD) has improved, virtual 3-dimensional medical images have been gaining more easily without any special practice. These images can be applied to various clinical fields. This article illustrates virtual preoperative simulation for excision of spinal tumors using medical CAD software. The software was used directly by the surgeon. The process of virtual preoperative simulation for spinal tumor surgery was found to be not inordinately complicated. And, virtual simulation was helpful in determining surgical steps as well as understanding the surgical anatomy.
Computer-Aided Design* ; Imaging, Three-Dimensional ; Planning Techniques ; Spinal Cord Neoplasms

BACKGROUND: This anthropometric planning is devised for surgeons who assess the esthetic perspectives in Asian rhinoplasty and to provide an easy clinical method using two dimensional photograph. And specific planning in Asian secondary rhinoplasty are also depicted accordingly. METHOD AND DISCUSSION: In order to use a 2-dimensional digital photograph as a tool for the soft tissue cephalometric analysis (STCA) the surgeon can subjectively rotate the photograph to decide the ideal landmarks. Once this is done, consultation and planning begins. Complicated concepts can be simplified and adaptive ideal points needed in rhinoplasty can be determined according to the Asian concepts of beauty so that it will be used under a clinical setting. Initiation of planning starts by identifying the ideal Sellion and Subnasale, thus, determining the length of the nose. Determination of these two points is the foremost important step in planning. Thereafter, an ideal Tip forms naturally from the nasofrontal angle and the columellar-labial angle. Even with the well performed preoperative planning, the shortcomings in secondary Asian rhinoplasty, such as unexpected scar, may be totally different pitfalls to overcome. CONCLUSIONS: With two-dimensional digital photograph and simplified planning in STCA, planning ideal points will bring clarity to a relatively different planning process from western rhinoplasty for surgeons undertaking primary or secondary Asian rhinoplasty.
Asian Continental Ancestry Group* ; Beauty ; Cicatrix ; Humans ; Mortuary Practice ; Nose ; Planning Techniques ; Rhinoplasty*

PURPOSE: This study was designed to determine the optimum radiotherapy technique for internal mammary node (IMN) irradiation after breast-conserving surgery. MATERIALS AND METHODS: We selected ten cases of early stage partial mastectomy for plan comparison. Five of the patients were treated to the right-side breast and the rest of the patients were treated to the left-side breast. For each case, four different treatment plans were made to irradiate the entire breast, IMNs and supraclavicular lymph nodes (SCLs). The four planning techniques include a standard tangential field (STF), wide tangential field (WTF), partially wide tangential field (PWT) and a photon-electron mixed field (PEM). We prescribed a dose of 50.4 Gy to the SCL field at a 3 cm depth and isocenter of the breast field. RESULTS: The dose distribution showed clear characteristics depending on the technique used. All of the techniques covered the breast tissue well. IMN coverage was also good, except for the STF, which was not intended to cover IMNs. For the cases of the left-side breasts, the volume of the heart that received more than 30 Gy was larger (in order) for the WTF, PWT, PEM and STF. For radiation pneumonitis normal tissue complication probability (NTCP), the PWT showed the best results followed by the STF. CONCLUSION: Despite the variety of patient body shapes, the PWT technique showed the best results for coverage of IMNs and for reducing the lung and heart dose.
Breast ; Breast Neoplasms ; Heart ; Humans ; Lung ; Lymph Nodes ; Mastectomy, Segmental ; Planning Techniques ; Radiation Pneumonitis

OBJECTIVE: It is to find the optimum beam angle by comparing the proper directional beam angle with various methods at time of treatment plan of stereotactic spinal radiation therapy. Also, it is to increase the therapy efficiency of spinal stereotactic body radiation therapy (SBRT) by providing the optimal target coverage through the therapy plan establishing various kinds of direction of beams and by decreasing the integral dose. METHODS: The object patients of treatment plan in this study have targeted 10 persons of thoracic spine bone metastasis patients. The treatment plan of prescription dose with 3 fraction of each 8 Gy has been established, it has been normalized so that it may be D95=2,400 cGy. Total 4 groups of treatment plan: the physical factor has been compared for the part for the target and the critical organ by establishing the treatment plan respectively in intensity-modulated radiation therapy (IMRT) and RapidArc therapy in (1) 1 group of IMRT (9 pieces of beam at 40 degrees equispaced angle intervals), (2) 2 groups of IMRT (9 pieces of half beam of non-equispaced angle), (3) arc 1 group (full arc), (4) arc 2 groups (half 2 arc) and eclipse planning (ver. 8.9). The physical factor for the target has been analyzed for the target coverage, maximum dose, minimum dose, maximum dose/prescribed dose (MD/PD). The maximum dose, mean dose, dose by each volume, and therapy time have been compared and analyzed for the spinal cord and esophagus adjacent to the target. RESULTS: The maximum dose of patients group of IMRT 1 group has appeared lower by 15% compared with the full arc and half arc plan as the analysis result of therapy plan for the object patients of thoracic spine. There has been no big difference in maximum dose of IMRT 1 group and 2 group. The full arc plan of conformity index showed the best result with the average 1.06, half arc plan of conformity index showed the highest result value with the average 1.15. Half arc plan of MD/PD showed the best value with the average 1.12. The half IMRT in D1 of planning target volumes showed the lowest value with the average 2,605 cGy; it showed the difference from the average from as small as 1% to as big as 11% as the comparison result with other groups. The plan of IMRT group of non-equispaced angle in D99 (cGy) showed the best value with the average 2,287.56 cGy. The IMRT of non-equispaced angle in Dmax of spinal cord showed the lowest with the average 1,779.9 cGy, D0.1cc and D1cc as well showed the lowest value with the average 1,605.19 cGy and 1,272.63 cGy. The IMRT plan of non-equispaced angle in throat showed the lowest value. The full arc (2 arc) of equispaced angle in therapy time was the shortest with 3.54 minutes, full IMRT of equispaced angle showed the longest time with the average 8.08 minutes. CONCLUSION: The treatment plan for IMRT of non-equispaced angle showed all good value in the target and critical organ as the analysis result of proper beam angle according to the respective therapy technique at time of treatment plan of spinal SBRT. It could find that the good therapy plan satisfactory to all target and critical organ at time of using the beam between 80 degrees and 280 degrees.
Esophagus ; Humans ; Neoplasm Metastasis ; Pharynx ; Planning Techniques* ; Prescriptions ; Spinal Cord ; Spine

PURPOSE: The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO). MATERIALS AND METHODS: This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border. RESULTS: The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group. CONCLUSIONS: In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.
Congenital Abnormalities ; Electrocoagulation ; Fluoroscopy ; Humans ; Knee ; Lower Extremity ; Methods ; Osteoarthritis ; Osteotomy ; Planning Techniques ; Weight-Bearing

OBJECTIVE: The purpose of this study are to evaluate the effectiveness of Gamma Knife radiosurgery(GKS) as a treatment of craniopharyngioma and to investigate the proper dose planning technique in GKS for craniopharyngioma. METHOD: Between May 1992 and March 1999, seven Gamma Knife radiosurgical procedures were done for residual tumor mass of 6 patients with craniopharyngioma after microsurgical resection. Conventional radiation therapy was not performed. In this study, their clinical, radiological and radiosurgical data were analyzed and the radiation dosage to the optic pathway, hypothalamus, pituitary stalk, and cavernous sinus were calculated and correlation with clinical outcome was evaluated. The mean follow-up period was 33.5 months(12.3-55.2 months). RESULT: The mean tumor volume was 4.4cc(0.4-18.0cc) and the maximum radiation dose ranged from 14 to 32 Gy(mean 20.9Gy). The radiation was given with isodose curve, 50-90% and the marginal dose varied within 8-22.4Gy(mean 12.7Gy). The mean number of isocenter was 4.3(1-12). The tumor was well controlled in all cases. In 5 of 7 cases, the size of tumor decreased to 10-50% of pre-GKS volume and remaining two showed no volume change. The mean dose to optic pathway was 5.7Gy(5.1-11.2Gy) and there were no complications. CONCLUSION: GKS seems to be effective for control of craniopharyngioma as an adjuvant treatment after microsurgical resection and even suboptimal dose for tumor margin is considered to be enough for tumor control. It is safe with careful dose planning to protect surrounding important structures, especially optic pathway. We believe conventional radiation therapy should be avoided because it has limitation for dose planning of additional treatments such as radiosurgery or intracystic instillation of radioisotope in case of recurrence.
Cavernous Sinus ; Craniopharyngioma* ; Follow-Up Studies ; Humans ; Hypothalamus ; Neoplasm, Residual ; Pituitary Gland ; Planning Techniques ; Radiation Dosage ; Radiosurgery* ; Recurrence ; Tumor Burden

OBJECTIVES: This study presents a scientific basis for the establishment of an environmental health contingency plan for dealing with accidental coastal oil spills and suggests some strategies for use in an environmental health emergency. METHODS: We reviewed the existing literature, and analyzed the various fundamental factors involved in response strategies for oil spill. Our analysis included data derived from Hebei Spirit oil spill and used air dispersion modeling. RESULTS: Spill amounts of more than 1,000 kl can affect the health of residents along the coast, especially those who belong to vulnerable groups. Almost 30% of South Korean population lives in the vicinity of the coast. The area that is at the highest risk for a spill and that has the greatest number of people at risk is the stretch of coastline from Busan to Tongyeong. The most prevalent types of oil spilt in Korean waters have been crude oil and bunker-C oil, both of which have relatively high specific gravity and contain volatile organic compounds, polycyclic aromatic hydrocarbons, and metals. In the case of a spill of more than 1,000 kl, it may be necessary to evacuate vulnerable and sensitive groups. CONCLUSIONS: The government should establish environmental health planning that considers the spill amount, the types of oil, and the distance between the spot of the accident and the coast, and should assemble a response team that includes environmental health specialists to prepare for the future oil spill.
*Accidents ; Decision Support Techniques ; *Disaster Planning ; *Environmental Health ; Environmental Monitoring ; Environmental Pollution/*prevention & control ; *Petroleum ; Population Dynamics ; Risk Assessment

In order to analyze the image noise effect on the results of Gamma knife dosimetry parameter test, we tested the dosimetry parameters of the Gamma knives according to GBZ 168-2005. Radiological protection standards of X (gamma)-ray stereotactic radiosurgery for head treatment. Dose analysis software was applied to examine the testing film before and after image denoising, and SPSS 11.0 software was used for statistical analysis. The results showed that there was a significant difference in the results of the maximum deviation between radiation field size and its nominal value (t = 7.600, P < 0.01) and the radiation field's penumbra region width of collimators also had significantly different sizes (t = 5.334, P < 0.01) before and after image denoising. This study indicated that the image noise could influence the results of testing Gamma knife dosimetry parameters, so as to cause deviations.
Algorithms ; Artifacts ; Gamma Rays ; Head ; surgery ; Humans ; Radiometry ; instrumentation ; Radiosurgery ; instrumentation ; Radiotherapy Planning, Computer-Assisted ; methods ; Stereotaxic Techniques