Objective: In Korea, radiology has been positioned towards the early adoption of artificial intelligence-based software as medical devices (AI-SaMDs); however, little is known about the current usage, implementation, and future needs of AI-SaMDs.We surveyed the current trends and expectations for AI-SaMDs among members of the Korean Society of Radiology (KSR). Materials and Methods: An anonymous and voluntary online survey was open to all KSR members between April 17 and May 15, 2023. The survey was focused on the experiences of using AI-SaMDs, patterns of usage, levels of satisfaction, and expectations regarding the use of AI-SaMDs, including the roles of the industry, government, and KSR regarding the clinical use of AI-SaMDs. Results: Among the 370 respondents (response rate: 7.7% [370/4792]; 340 board-certified radiologists; 210 from academic institutions), 60.3% (223/370) had experience using AI-SaMDs. The two most common use-case of AI-SaMDs among the respondents were lesion detection (82.1%, 183/223), lesion diagnosis/classification (55.2%, 123/223), with the target imaging modalities being plain radiography (62.3%, 139/223), CT (42.6%, 95/223), mammography (29.1%, 65/223), and MRI (28.7%, 64/223). Most users were satisfied with AI-SaMDs (67.6% [115/170, for improvement of patient management] to 85.1% [189/222, for performance]). Regarding the expansion of clinical applications, most respondents expressed a preference for AI-SaMDs to assist in detection/diagnosis (77.0%, 285/370) and to perform automated measurement/quantification (63.5%, 235/370). Most respondents indicated that future development of AI-SaMDs should focus on improving practice efficiency (81.9%, 303/370) and quality (71.4%, 264/370). Overall, 91.9% of the respondents (340/370) agreed that there is a need for education or guidelines driven by the KSR regarding the use of AI-SaMDs. Conclusion The penetration rate of AI-SaMDs in clinical practice and the corresponding satisfaction levels were high among members of the KSR. Most AI-SaMDs have been used for lesion detection, diagnosis, and classification. Most respondents requested KSR-driven education or guidelines on the use of AI-SaMDs.

Purpose: The report of adverse events following immunization (AEFI) in Korea has continued since 1994, and the most frequently reported cases of AEFI of Korea Centers for Disease Control and Prevention (KCDC) is bacille Calmette-Guérin (BCG). Meanwhile, various inoculation methods and strains have been used in the past 6 years in Korea. Therefore, we investigated AEFI of BCG by strain types and inoculation methods using immunization safety surveillance of KCDC. Materials and Methods: We reviewed BCG AEFIs registered in the KCDC from January 2013 to June 2018. Results: There were 336 AEFI cases during the period, and average time interval from vaccination to symptom onset was within 2 months. AEFI proportion was 6.4 cases per 100,000 doses for BCG percutaneous Tokyo strain, 41.6 cases per 100,000 doses of BCG intradermal Danish strain, and 25.9 cases per 100,000 doses of BCG intradermal Tokyo strain. Intradermal type was more reported AEFI than percutaneous type in the same strain. The most common adverse events were local reaction like BCG lymphadenitis and severe adverse reactions such as osteomyelitis or disseminated BCG disease were 0.1 to 0.2 cases per 100,000 doses which are correlated with the range of World Health Organization published AEFI rates. Conclusion The AEFI reporting rate does not equal the actual proportion of AEFI occurrence. Because AEFI monitoring is a passive surveillance system, various factors might influence the number of events reported. Nevertheless, it is important to analyze BCG AEFI by vaccine strains and inoculation method using surveillance data of KCDC.

Purpose: The report of adverse events following immunization (AEFI) in Korea has continued since 1994, and the most frequently reported cases of AEFI of Korea Centers for Disease Control and Prevention (KCDC) is bacille Calmette-Guérin (BCG). Meanwhile, various inoculation methods and strains have been used in the past 6 years in Korea. Therefore, we investigated AEFI of BCG by strain types and inoculation methods using immunization safety surveillance of KCDC. Materials and Methods: We reviewed BCG AEFIs registered in the KCDC from January 2013 to June 2018. Results: There were 336 AEFI cases during the period, and average time interval from vaccination to symptom onset was within 2 months. AEFI proportion was 6.4 cases per 100,000 doses for BCG percutaneous Tokyo strain, 41.6 cases per 100,000 doses of BCG intradermal Danish strain, and 25.9 cases per 100,000 doses of BCG intradermal Tokyo strain. Intradermal type was more reported AEFI than percutaneous type in the same strain. The most common adverse events were local reaction like BCG lymphadenitis and severe adverse reactions such as osteomyelitis or disseminated BCG disease were 0.1 to 0.2 cases per 100,000 doses which are correlated with the range of World Health Organization published AEFI rates. Conclusion The AEFI reporting rate does not equal the actual proportion of AEFI occurrence. Because AEFI monitoring is a passive surveillance system, various factors might influence the number of events reported. Nevertheless, it is important to analyze BCG AEFI by vaccine strains and inoculation method using surveillance data of KCDC.

BACKGROUND: Because conventional echocardiographic parameters have several limitations, strain echocardiography has often been introduced in clinical practice. However, there are also obstacles in using it in clinical practice. Therefore, we wanted to find the current status of awareness on using strain echocardiography in Korea. METHODS: We conducted a nationwide survey to evaluate current use and awareness of strain echocardiography from the members of the Korean Society of Echocardiography. RESULTS: We gathered total 321 questionnaires from 25 cardiology centers in Korea. All participants were able to perform or interpret echocardiographic examinations. All participating institutions performed strain echocardiography. Most of our study participants (97%) were aware of speckle tracking echocardiography and 185 (58%) performed it for clinical and research purposes. Two-dimensional strain echocardiography was the most commonly used modality and left ventricle (LV) was the most commonly used cardiac chamber (99%) for clinical purposes. Most of the participants (89%) did not think LV strain can replace LV ejection fraction (LVEF) in their clinical practice. The common reasons for not performing routine use of strain echocardiography was diversity of strain measurements and lack of normal reference value. Many participants had a favorable view of the future of strain echocardiography. CONCLUSION: Most of our study participants were aware of strain echocardiography, and all institutions performed strain echocardiography for clinical and research purposes. However, they did not think the LV strain values could replace LVEF. The diversity of strain measurements and lack of normal reference values were common reasons for not using strain echocardiography in clinical practice.
Cardiology ; Echocardiography* ; Heart Ventricles ; Korea* ; Reference Values

PURPOSE: Single-port laparoscopic splenectomy has been performed sporadically. The aim of this study is to assess our experience with single-port laparoscopic splenectomy compared to conventional multiport laparoscopic surgery for the usual treatment modality for various kinds of splenic disease. METHODS: Between October 2008 to February 2014, 29 patients underwent single-port laparoscopic splenectomy and 32 patients received multiport laparoscopic splenectomy. We retrospectively analyzed the clinical outcomes of single-port group and multiport group. RESULTS: The body mass index and disease profiles of the both groups were similar. The operative times of single-port and multiport group were 113.6 +/- 39.9 and 95.9 +/- 38.9 minutes, respectively (P = 0.946). The operative blood loss of the two groups were 295.8 +/- 301.3 and 322.5 +/- 254.5 mL (P = 0.582). Postoperative retrieved splenic weight of the single-port and multiport groups were 283.9 +/- 300.7 and 362.3 +/- 471.8 g, respectively (P = 0.261). One single-port partial splenectomy and 6 multiport partial splenectomies were performed in this study. There was one intraoperative gastric wall injury. It occurred in single-port group, which was successfully managed during the operation. Each case was converted to laparotomy in both groups due to bleeding. There was one mortality case in the multiport laparoscopic splenectomy group, which was not related to the splenectomy. Mean hospital stay of the single-port and multiport group was 5.8 +/- 2.5 and 7.3 +/- 5.2 days respectively (P = 0.140). CONCLUSION: Single-port laparoscopic splenectomy seems to be a feasible approach for various kinds of splenic disease compared to multiport laparoscopic surgery.
Body Mass Index ; Hemorrhage ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Mortality ; Operative Time ; Retrospective Studies ; Splenectomy* ; Splenic Diseases

We encountered a case of a rupture of an endotracheal tube cuff during robot-assisted thyroid surgery in a 35-year-old male patient. Two hours after commencing surgery, the bellows of the ventilator were not filled and a rupture of the endotracheal tube cuff was suspected. Once the robot-manipulator is engaged, the position of the operating table cannot be altered without removing it from the patient. Reintubation with direct laryngoscopy was performed with difficulty in the narrow space between the patient's head and robot-manipulator without moving the robot away from the patient. The rupture of the endotracheal tube cuff was confirmed by observing air bubbles exiting from the balloon in water. The patient was discharged 3 days after surgery without complications. In robot-assisted thyroid surgery, a preoperative arrangement of the robot away from the patient's head to obtain easy access to the patient is essential for safe anesthetic care.
Adult ; Anesthesia ; Head ; Humans ; Laryngoscopy ; Male ; Operating Tables ; Rupture ; Thyroid Gland ; Ventilators, Mechanical ; Water

BACKGROUND: This clinical study was designed to evaluate the effect of midazolam as a premedication on the onset of propofol and rocuronium during propofol target-controlled infusion (TCI). METHODS: Seventy four patients (ASA class I or II) were randomly allocated to receive either no premedication (control group) or premedication with 0.04 mg/kg intravenous midazolam (midazolam group). Anesthesia was induced and maintained with propofol TCI. Time from propofol injection to loss of consciousness (LOC) and estimated effect concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was injected. We monitored the degree of neuromuscular blockade by acceleromyography. The following parameters were measured and compared between groups: Time from rocuronium injection to depression of twitch height below 25%, time to maximal depression of twitch height (defined as rocuronium onset time). RESULTS: Systolic blood pressure before induction was lower in midazolam group (125 +/- 15 vs 135 +/- 20 mmHg), however, there was no difference in blood pressure at LOC between groups (111 +/- 16 vs 106 +/- 21 mmHg). In midazolam group, time to LOC in propofol TCI was shorter (63 +/- 22 vs. 203 +/- 118 sec) and estimated effect site concentration of propofol was significantly lower than control group (0.9 +/- 0.3 vs. 2.2 +/- 0.4 microl/ml). The onset time of rocuronium was not different between groups (120 +/- 39 vs. 137 +/- 42 sec). CONCLUSIONS: Midazolam pretreatment fastens the onset time of propofol and decreases the propofol requirement for LOC. However, it does not influence the onset of rocuronium.
Androstanols ; Anesthesia ; Blood Pressure ; Depression ; Humans ; Midazolam ; Neuromuscular Blockade ; Premedication ; Propofol ; Unconsciousness

BACKGROUND:Rocuronium is a commonly used muscle relaxant, however, it has severe injection pain.We supposed that injection pain of rocuronium was due to acidity of solution.We studied whether pH elevation of rocuronium with bicarbonate relieves injection pain. METHODS:We included 140 adult patients with 18 G intravenous catheter in arm for general anesthesia and they were randomly allocated to two groups.All patients received 0.6 mg/kg of rocuronium, one group (Group C) received rocuronium only (pH = 4.04) and the other group (Group B) received bicarbonate mixed rocuronium (rocuronium:bicarbonate = 5 ml :1 ml, pH of mixture = 7.14).The severity (none, mild, severe) of injection pain was assessed.Just after assessment, 5 mg/kg of thiopental was injected for loss of conciousness. Twitch of supramaximal stimuli was monitored and intubation time was considered the interval from injection to 75% depression and onset time the interval from injection to maximal depression. RESULTS:The incidence of injection pain of group C was 96.9% and 18.8% in group B (P< 0.01). Intubation time and onset time were 79.5 +/- 24.4 sec and 114.3 +/- 43.6 sec in group C and 80.6 +/- 27.0 sec and 115.2 +/- 46.2 sec in group B.There was no significant difference between groups. CONCLUSIONS:Our result shows that adding bicarbonate to rocuronium is effective to relieve injection pain of rocuronium without change of onset of rocuronium.
Adult ; Androstanols ; Anesthesia, General ; Arm ; Catheters ; Depression ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Intubation ; Muscles ; Sodium Bicarbonate ; Thiopental

BACKGROUND:Rocuronium is a commonly used muscle relaxant, however, it has severe injection pain.We supposed that injection pain of rocuronium was due to acidity of solution.We studied whether pH elevation of rocuronium with bicarbonate relieves injection pain. METHODS:We included 140 adult patients with 18 G intravenous catheter in arm for general anesthesia and they were randomly allocated to two groups.All patients received 0.6 mg/kg of rocuronium, one group (Group C) received rocuronium only (pH = 4.04) and the other group (Group B) received bicarbonate mixed rocuronium (rocuronium:bicarbonate = 5 ml :1 ml, pH of mixture = 7.14).The severity (none, mild, severe) of injection pain was assessed.Just after assessment, 5 mg/kg of thiopental was injected for loss of conciousness. Twitch of supramaximal stimuli was monitored and intubation time was considered the interval from injection to 75% depression and onset time the interval from injection to maximal depression. RESULTS:The incidence of injection pain of group C was 96.9% and 18.8% in group B (P< 0.01). Intubation time and onset time were 79.5 +/- 24.4 sec and 114.3 +/- 43.6 sec in group C and 80.6 +/- 27.0 sec and 115.2 +/- 46.2 sec in group B.There was no significant difference between groups. CONCLUSIONS:Our result shows that adding bicarbonate to rocuronium is effective to relieve injection pain of rocuronium without change of onset of rocuronium.
Adult ; Androstanols ; Anesthesia, General ; Arm ; Catheters ; Depression ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Intubation ; Muscles ; Sodium Bicarbonate ; Thiopental

BACKGROUND: Postopertative nausea and vomiting (PONV) are frequent and distressing side effects of surgery. Even though many drugs has been developed, PONV still remains unsolved problem. Ondansetron is a commonly used 5-HT3 receptor antagonist. It acts through specific binding to the 5-HT3A, 5-HT3B receptor complex. We hypothesized that patients with genetic variation in 5-HT3A receptor might have variable incidence of PONV and respond differently to ondansetron. METHODS: We included 204 patients undergoing gynecologic laparoscopic surgery. PONV were documented during 24 hours after operation. Ondansetron was injected to every patient who had PONV at PACU and PONV reassessed after 15 minutes. DNA was extracted from blood and 5-HT3A Pro16Ser missense mutation was analyzed by using real-time PCR. RESULTS: The incidence of PONV were 50% for wild type, 53% for heterozygote and 0% for homozygote. There were no significant differences between wild type and heterozygote in VAS of nausea and VAS change after ondansetron. CONCLUSIONS: 5-HT3A receptor Pro16Ser polymorphism is not associated with the incidence of PONV and the response to ondansetron in Korean patients.
DNA ; Genetic Variation ; Heterozygote ; Homozygote ; Humans ; Incidence ; Laparoscopy ; Mutation, Missense ; Nausea ; Ondansetron ; Postoperative Nausea and Vomiting ; Real-Time Polymerase Chain Reaction ; Receptors, Serotonin, 5-HT3 ; Vomiting