In this study we estimated a geometric correlation among digitally reconstructed radiographic image (DRRI), kV x-ray image (kVXI) from the On-Board Imager (OBI) and electric portal image (EPI). To verify geometric correspondence of DRRI, kVXI and EPI, specially designed phantom with indexed 6 ball bearings (BBs) were employed. After accurate setup of the phantom on a treatment couch using orthogonal EPIs, we acquired set of orthogonal kVXIs and EPIs then compared the absolute positions of the center of the BBs calculated at each phantom plane for kVXI and EPI respectively. We also checked matching result for obliquely incident beam (gantry angle of 315 degrees) after 2D-2D matching provided by OBI application. A reference EPI obtained after initial setup of the phantom was compared with 10 series of EPIs acquired after each 2D-2D matching. Imaginary setup errors were generated from -5 mm to 5 mm at each couch motion direction. Calculated positions of all center positions of the BBs at three different images were agreed with the actual points within a millimeter and each other. Calculated center positions of the BBs from the reference and obtained EPIs after 2D-2D matching agreed within a millimeter. We could tentatively conclude that the OBI system was mechanically quite reliable for image guided radiation therapy (IGRT) purpose.
Radiotherapy, Image-Guided

Paramyotonia congenita (PMC), an autosomal dominant non-progressive muscle disorder, is characterised by cold-induced stiffness followed by muscle weakness. The weakness is considered to be caused by a dysfunction of the sodium channel in muscle fiber. We report a 37-year-old male patient with PMC, complaining of episodic myotonia and motor weakness on cold exposure. In this patient, we performed clinical and neurological examination, electrophysiologic examination and muscle biopsy. On electrophysiologic study, needle EMG showed spontaneous myotonic discharges at room temperature but disappeared after cooling. Amplitude of compound action potential in abductor pollicis brevis muscle decreased significantly after cooling the tested extremity. Muscle biopsy showed a minimal variation of muscle fiber diameters, internal nuclei, chained nuclei, occasional atrophic fibers in vastus lateralis muscle. His mother, his son, three of six siblings, and five of eleven nephewes are affected with same symptomes.
Action Potentials ; Adult ; Biopsy ; Extremities ; Humans ; Male ; Mothers ; Muscle Weakness ; Muscular Diseases ; Myotonia ; Myotonic Disorders* ; Needles ; Neurologic Examination ; Quadriceps Muscle ; Siblings ; Sodium Channels

BACKGROUND: Family physicians in their on primary practice frequently encounters patients with fever, welch is one of the common symptoms. Fever is an important symptom and can occur in mild disease, common cold, influenza, acute pharyngotonsillitis or can originate from a particular severe disease, such as bacterial endocarditis, malignant lymphoma and SLE, which need more aggressive management. Therefore, we studied patients who were admitted with short-term fever or long-term fever to find out their causes of febrile disease and to compare the differences with previous other studies. METHODS: 601 patients with fever above 37.2 degree centigrade or those who were transferred from other hospitals due to long-term fever were enrolled from Jan. 1991 to Jun. 1997. Patients' medical records reviewed and were classified according to disease, sex, age. Standardization of Petersdorf's rule for F.U.O. was used. RESULTS: 601 patients were randomly selected among which 301 were males and 300 females. Males were 147 and females 147 young adult patients as compared to 154 males and 153 females were elderly patients. According to disease category, the number of infections, connective tissue diseases, neoplastic diseases and other diseases were 442(73.5%), 14(2.3%), 87(14.5%) and 21(3.5%), respectively. The number of diseases of undetermined case was 37(6.2%). The most frequent disease was pneumonia with 103(31.1%). UTI and tuberculosis were the 2nd and 3rd most common diseases. The total number of F.U.O. patients was 82(13.6%). According to the disease categories there were 29(35.4%) in infections, 2(2.4%) in connective tissue diseases, 12(14.6%) in neoplasms, 2(2.4%) in others and 37(45.2%) in unknown origin. The most common disease was tuberculosis. Infection and tuberculosis were common disease category and disease in the classification of sex and age of F.U.O.. CONCLUSIONS: In the clinical study of febrile patients admitted from Jan. 1991 to Jun.1997 through medical record review, the disease category in the order of frequency was infection, neoplasm, collective tissue disease and the distribution of F.U.0. was same result. In comparison with other study, the order of connective tissue disease and neoplasm was different in other hospital study but same result was taken In comparison with Petersdorf's study.
Aged ; Classification ; Common Cold ; Communicable Diseases ; Connective Tissue Diseases ; Endocarditis, Bacterial ; Female ; Fever of Unknown Origin* ; Fever* ; Humans ; Influenza, Human ; Lymphoma ; Male ; Medical Records ; Physicians, Family ; Pneumonia ; Tuberculosis ; Young Adult

PURPOSE: The purpose of this study is to develop a practical method for determining accurate marker positions for prostate cancer radiotherapy using CT images and kV x-ray images obtained from the use of the on-board imager (OBI). MATERIALS AND METHODS: Three gold seed markers were implanted into the reference position inside a prostate gland by a urologist. Multiple digital image processing techniques were used to determine seed marker position and the center-of-mass (COM) technique was employed to determine a representative reference seed marker position. A setup discrepancy can be estimated by comparing a computed COMOBI with the reference COMCT. A proposed algorithm was applied to a seed phantom and to four prostate cancer patients with seed implants treated in our clinic. RESULTS: In the phantom study, the calculated COMCT and COMOBI agreed with COMactual within a millimeter. The algorithm also could localize each seed marker correctly and calculated COMCT and COMOBI for all CT and kV x-ray image sets, respectively. Discrepancies of setup errors between 2D-2D matching results using the OBI application and results using the proposed algorithm were less than one millimeter for each axis. The setup error of each patient was in the range of 0.1+/-2.7~1.8+/-6.6 mm in the AP direction, 0.8+/-1.6~2.0+/-2.7 mm in the SI direction and -0.9+/-1.5~2.8+/-3.0 mm in the lateral direction, even though the setup error was quite patient dependent. CONCLUSION: As it took less than 10 seconds to evaluate a setup discrepancy, it can be helpful to reduce the setup correction time while minimizing subjective factors that may be user dependent. However, the on-line correction process should be integrated into the treatment machine control system for a more reliable procedure.
Axis, Cervical Vertebra ; Humans ; Prostate ; Prostatic Neoplasms ; Radiotherapy

Twenty-our cases of pituitary adenoma, 13 males and 11 females with the age ranging from 11 to 65 years, received radiation therapy(RT) on the pituitary area with 6MV linear accelerator during past 25 months at the Division of Radiation Therapy, Kangnam St. Mary's Hospital, Catholic Medical College. Of 24 case of RT, 20 were postoperative and 4 primary. To evaluate the effect of RT, we analyzed the alteration of the endocrinologic tests, neurologic abnormalities, major clinical symptoms, endocrinologic changes and improvement in visual problems after RT. The results were as follows ; 1. Major clinical symptoms were headache, visual defects, diabetes insipidus, hypogonadisms and general weakness in decreasing order of frequency. 2. All but the one with Nelson's syndrome showed abnormal neuroradiologic changes in the sella turcica with an invasive tumor mass around supra and para-ellar area. 3. Endocrinological classifications of the patient were 11 prolactinoma, 4 growth hormonesecreting tumors, 3 ACTH-ecreting tumors consisting of one Cushing's disease and two Nelson's syndrome, and 6 nonfunctioning tumors. 4. Eleven of 14 patients, visual problems were improved after treatment but remaining 3 were unchanged. 5. Seven of 11 prolactinomas returned to normal hormonal level after postoperative and primary RT and 3 patients are being treated with bromocriptine (BMCP) but on lost case. 6. Two of 4 growth hormone-ecreting tumor returned to normal level after RT but the remaining 2 are being treated with BMCP, as well.
Bromocriptine ; Classification ; Diabetes Insipidus ; Female ; Growth Hormone* ; Headache ; Humans ; Male ; Particle Accelerators ; Pituitary Neoplasms* ; Plasma* ; Prolactinoma ; Sella Turcica

Radiation treatment techniques using photon beam such as three-dimensional conformal radiation therapy (3D-CRT) as well as intensity modulated radiotherapy treatment (IMRT) demand accurate dose calculation in order to increase target coverage and spare healthy tissue. Both jaw collimator and multi-leaf collimators (MLCs) for photon beams have been used to achieve such goals. In the Pinnacle3 treatment planning system (TPS), which we are using in our clinics, a set of model parameters like jaw collimator transmission factor (JTF) and MLC transmission factor (MLCTF) are determined from the measured data because it is using a model-based photon dose algorithm. However, model parameters obtained by this auto-modeling process can be different from those by direct measurement, which can have a dosimetric effect on the dose distribution. In this paper we estimated JTF and MLCTF obtained by the auto-modeling process in the Pinnacle3 TPS. At first, we obtained JTF and MLCTF by direct measurement, which were the ratio of the output at the reference depth under the closed jaw collimator (MLCs for MLCTF) to that at the same depth with the field size 10x10 cm2 in the water phantom. And then JTF and MLCTF were also obtained by auto-modeling process. And we evaluated the dose difference through phantom and patient study in the 3D-CRT plan. For direct measurement, JTF was 0.001966 for 6 MV and 0.002971 for 10 MV, and MLCTF was 0.01657 for 6 MV and 0.01925 for 10 MV. On the other hand, for auto-modeling process, JTF was 0.001983 for 6 MV and 0.010431 for 10 MV, and MLCTF was 0.00188 for 6 MV and 0.00453 for 10 MV. JTF and MLCTF by direct measurement were very different from those by auto-modeling process and even more reasonable considering each beam quality of 6 MV and 10 MV. These different parameters affect the dose in the low-dose region. Since the wrong estimation of JTF and MLCTF can lead some dosimetric error, comparison of direct measurement and auto-modeling of JTF and MLCTF would be helpful during the beam commissioning.
Hand ; Humans ; Jaw ; Water

PURPOSE: We studied the degree of changes in antibiotic sensitivity toward causative organisms, prevalence and clinical manifestations of extended-spectrum beta-lactamase(ESBL)- producers of urinary tract infection(UTI) for a period of three years. This serves to provide useful information in selecting adequate drugs for the treatment of UTI. METHODS: We recruited 137 patients who grew more than 105 CFU/mL in their urine culture among 250 patients who visited and were admitted to Handong University's Sunlin Hospital for UTI treatment from January 2003 to December 2005. We retrospectively analyzed the data from the medical records. RESULTS: The common pathogenic organisms were Escherichia coli(65.0%), Klepsiella pneumoniae(14.0%), Enterococcus faecalis(5.8%) and Proteus vulgaris(2.9%) in consecutive order. The prevalence of ESBL-producers among isolated E. coli and K. pneumoniae was 4.5%(4 cases) and 14.3%(2 cases), respectively. The antibiotic sensitivity rates of E. coli were relatively high to amikacin(100%), imipenem(100%), ceftriaxone(95.5%) and tobramycin(91.4%) while relatively low to TMP/SMZ(55.4%), ampicillin/sulbactam(29.4%) and ampicillin (24.2%). CONCLUSION: The use of ampicillin, ampicillin/sulbactam and TMP/SMZ, which have been the first choices in the treatment of UTI, should be reconsidered due to the low sensitivity rates towards these antibiotics. Due to the high incidence and antibiotic tolerance of ESBL that might have risen from the development of new antibiotics and increased antibiotic use, it is necessary to consider changing the standard antibiotics that have been used in the treatment of UTI.
Ampicillin ; Anti-Bacterial Agents ; Child* ; Enterococcus ; Escherichia ; Humans ; Incidence ; Medical Records ; Pneumonia ; Prevalence ; Proteus ; Retrospective Studies ; Urinary Tract

Background and objectives: Blepharospasm (BS) is best categorized as focal dystonia, but the biochemical and neuroanatomical mechanisms are poorly understood. We performed this study in order to postulate the pathophysiologic mechanism of essential BS, using blink reflex test and EMG studies. METHODS: We studied 24 patients with essential BS and 51 normal adults. Blink reflex tests and EMG on orbicularis oculi muscle were performed in all patients. We evaluated our electrophysiological data, comparing with those obtained from other studies, in which bulbocavernosus reflex, H-reflex, and T-reflex tests were done. We also compared our EMG data with those of hemifacial spasm and facial myokymia in other studies. Results: 1. Rl response latency of blink reflex test in 24 patients with essential BS was not changed, but R2 latency in the papient group was significantly shortened, comparing with those of normal control group. These results can be explained by overexcitability of the interneuron with polysynaptic pathway. Another supporting evidence is the fact that the latency of polysynaptic bulbocavernous reflex test in upper motor neuron lesion is shorter than normal control, although the latency of monosynaptic H-reflex and T-reflex test are not changed. 2. EMG on orbicularis oculi muscle in patients with essential BS showed spontaneous MUPs at irregular intervals at rest, while those in patients with hemifacial spasm and facial myokymia, known to be caused by overexcitability of facial nucleus, showed spontaneous MUPs at regular intervals. EMG in patients with essential BS, during the period of spasm, showed relatively long brief bursts at irregular intervals from 30 to 100 ms, lasting inconstant duration ranging from 30 to 300 ms. CONCULSIONS: It is suggested that the pathophysiology of essential BS is overexcitability of interneuron due to disinhibition in inhibitory interneuron, and that EMG findings of essential BS are remarkably different from those of hemifacial spasm and facial myokymia.
Adult ; Blepharospasm* ; Blinking* ; Dyskinesias* ; Dystonic Disorders ; Facial Nerve Diseases ; H-Reflex ; Hemifacial Spasm ; Humans ; Interneurons ; Motor Neurons ; Reaction Time ; Reflex ; Spasm

PURPOSE: Standardization quality assurance (QA) program of CyberKnife for suitable circumstances in Korea has not been established. In this research, we investigated the development of QA program for CyberKnife and evaluation of the feasibility under applications. MATERIALS AND METHODS: Considering the feature of constitution for systems and the therapeutic methodology of CyberKnife, the list of quality control (QC) was established and divided dependent on the each period of operations. And then all these developed QC lists were categorized into three groups such as basic QC, delivery specific QC, and patient specific QC based on the each purpose of QA. In order to verify the validity of the established QA program, this QC lists was applied to two CyberKnife centers. The acceptable tolerance was based on the undertaking inspection list from the CyberKnife manufacturer and the QC results during last three years of two CyberKnife centers in Korea. The acquired measurement results were evaluated for the analysis of the current QA status and the verification of the propriety for the developed QA program. RESULTS: The current QA status of two CyberKnife centers was evaluated from the accuracy of all measurements in relation with application of the established QA program. Each measurement result was verified having a good agreement within the acceptable tolerance limit of the developed QA program. CONCLUSION: It is considered that the developed QA program in this research could be established the standardization of QC methods for CyberKnife and confirmed the accuracy and stability for the image-guided stereotactic radiotherapy.
Constitution and Bylaws ; Humans ; Korea ; Mortuary Practice ; Quality Control ; Radiotherapy

To determine the appropriate method out of various available methods to measure build-up doses, the measurements and comparisons of depth doses of build-up region including the surface dose were executed using the Attix parallel-plate ionization chamber, the Markus chamber, a cylindrical ionization chamber, and a diode detector. Based on the measurements using the Attix chamber, discrepancies of the Markus chamber were within 2% for the open field and increased up to 3.9% in the case of photon beam containing the contaminant electrons. The measurements of an cylindrical ionization chamber and a diode detector accord with those of the Attix chamber within 1.5% and 1.0% after those detectors were completely immersed in the water phantom. The results suggest that the parallel-plate chamber is the best choice to measure depth doses in the build-up region containing the surface, however, using cylindrical ionization chamber or diode detector would be a reasonable choice if no special care is necessary for the exact surface dose.
Water