Jung-Min Kim

Dose area product measurement for diagnostic reference levels and analysis of patient dose in dental radiography

In this study, diagnostic reference levels (DRLs) were suggested and patient doses were analysed through the dose-area product value in dental radiography. In intraoral radiography, at three sites, i.e. molar, premolar and incisor on the maxilla and acquired third quartile values: 55.5, 46 and 36.5 mGy cm(2), respectively, were measured. In panoramic, cephalometric and cone beam computed tomography, the values were 120.3, 146 and 3203 mGy cm(2) (16 × 18 cm), respectively. It has been shown that, in intraoral radiography, the patient dose changes proportionally to the value of mA s, but the change in extraoral radiography in response to mA s could not be confirmed. The authors could confirm, however, the difference in dose according to the manufacturer in all dental radiography examinations, except for panoramic radiography. Depending on the size of hospital, there were some differences in patient dose in intraoral radiography, but no difference in patient dose in extraoral radiography.

Combination therapy of testosterone enanthate and tadalafil on PDE5 inhibitor non-reponders with severe and intermediate testosterone deficiency

Several studies have suggested combination therapy with testosterone supplementation in patients not responding to PDE5 inhibitors. Considering the pathophysiological basis for testosterone supplementation, the present study aims to identify whether combination therapy allows persistence of treatment effect after testosterone discontinuation. Furthermore, we evaluated whether the degree of testosterone depletion affects treatment outcome from combination therapy. Hypogonadal patients (<350u2009ngu2009dl−1) with erectile dysfunction who previously did not respond to PDE5 inhibitors were treated with testosterone enanthate injections and daily tadalafil. Patients were stratified into two groups depending on the level of testosterone deficiency, with 250u2009ngu2009dl−1 as a reference point. Following testosterone supplementation (12 weeks) and combination therapy (12 weeks), patients with severe testosterone deficiency showed higher IIEF (International Index of Erectile Function) erectile function (EF) domain score (16.47±4.019 vs 12.36±4.051, P=0.001) and more patients responding satisfactorily to treatment by general assessment (57.9 vs 16.0%, P=0.009), despite reaching similar levels of serum total testosterone (602±169u2009ngu2009dl−1 vs 698±165u2009ngu2009dl−1, P=0.057). Testosterone supplementation was then discontinued and patients were maintained only on daily tadalafil (12 weeks). The severe depletion group maintained higher EF domain scores than baseline (13.06±3.38 vs 7.20±2.24, P=0.0004), despite testosterone levels returning to baseline. The results suggest that combination therapy was more beneficial to patients with severe testosterone depletion, possibly by improving underlying pathophysiology.

Evaluation of radiation doses in patient and medical staff during endoscopic retrograde cholangiopancreatography procedures

The radiation exposure dose must be optimised because the hazard resulting from an interventional radiology procedure is long term depending on the patient. The aim of this study was to measure the radiation doses received by the patients and medical staff during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Data were collected during 126 ERCP procedures, including the dose-area product (DAP), entrance dose (ED), effective dose (E), fluoroscopy time (T) and number of digital radiographs (F). The medical staff members each wore a personal thermoluminescence dosemeter to monitor exposure during ERCP procedures. The mean DAP, ED, E and T were 47.06 Gy cm(2), 196.06 mGy, 8.93 mSv, 7.65 min and 9.21 images, respectively. The mean dose to the staff was 0.175 mSv and that to the assistant was 0.069 mSv. The dose to the medical staff was minimal when appropriate protective measures were used. The large variation in the patient doses must be further investigated.

Radiobiological model-based bio-anatomical quality assurance in intensity-modulated radiation therapy for prostate cancer

A bio-anatomical quality assurance (QA) method employing tumor control probability (TCP) and normal tissue complication probability (NTCP) is described that can integrate radiobiological effects into intensity-modulated radiation therapy (IMRT). We evaluated the variations in the radiobiological effects caused by random errors (r-errors) and systematic errors (s-errors) by evaluating TCP and NTCP in two groups: patients with an intact prostate (Gintact) and those who have undergone prostatectomy (Gtectomy). The r-errors were generated using an isocenter shift of ±1 mm to simulate a misaligned patient set-up. The s-errors were generated using individual leaves that were displaced inwardly and outwardly by 1 mm on multileaf collimator field files. Subvolume-based TCP and NTCP were visualized on computed tomography (CT) images to determine the radiobiological effects on the principal structures. The bio-anatomical QA using the TCP and NTCP maps differentiated the critical radiobiological effects on specific volumes, particularly at the anterior rectal walls and planning target volumes. The s-errors showed a TCP variation of –40–25% in Gtectomy and –30–10% in Gintact, while the r-errors were less than 1.5% in both groups. The r-errors for the rectum and bladder showed higher NTCP variations at ±20% and ±10%, respectively, and the s-errors were greater than ±65% for both. This bio-anatomical method, as a patient-specific IMRT QA, can provide distinct indications of clinically significant radiobiological effects beyond the minimization of probable physical dose errors in phantoms.

Sex differences in interactions between nucleus accumbens and visual cortex by explicit visual erotic stimuli: an fMRI study.

Men tend to have greater positive responses than women to explicit visual erotic stimuli (EVES). However, it remains unclear, which brain network makes men more sensitive to EVES and which factors contribute to the brain network activity. In this study, we aimed to assess the effect of sex difference on brain connectivity patterns by EVES. We also investigated the association of testosterone with brain connection that showed the effects of sex difference. During functional magnetic resonance imaging scans, 14 males and 14 females were asked to see alternating blocks of pictures that were either erotic or non-erotic. Psychophysiological interaction analysis was performed to investigate the functional connectivity of the nucleus accumbens (NA) as it related to EVES. Men showed significantly greater EVES-specific functional connection between the right NA and the right lateral occipital cortex (LOC). In addition, the right NA and the right LOC network activity was positively correlated with the plasma testosterone level in men. Our results suggest that the reason men are sensitive to EVES is the increased interaction in the visual reward networks, which is modulated by their plasma testosterone level.

A comparative assessment of entrance surface doses in analogue and digital radiography during common radiographic examinations

Digital radiography is often performed at a higher dose rate than analogue radiography for image acquisition. The authors measured the Entrance Surface Dose (ESD) of analogue and digital radiography techniques for 14 radiographic examinations from randomly selected medical centres in the central district of Korea. It was that the mean ESD of the digital examinations was 2.84 mGy (range, 0.37-6.38 mGy) and that of the analogue examinations was 1.83 mGy (range, 0.38-4.74 mGy), resulting in a 55.25 % higher ESD for digital technique. Although this survey is not completely representative of Korea, findings of this study indicate a need for closer exposure management in digital radiography to minimise patient dose.

Estimation of absorbed organ doses and effective dose based on body mass index in digital radiography

With the introduction of digital radiography, patients undergoing radiographic procedures are subject to being overexposed to radiation. Therefore, it is necessary to estimate the absorbed organ dose and the effective dose, which are significant for patient health, along with body type. During chest radiographic examinations conducted in 899 patients for screening, the absorbed dose of the 13 major organs, the average whole-body dose, and two effective doses weighted by factors published in ICRP 60 and ICRP 103 were calculated on the basis of patient information such as height, weight and examination condition, including kilovolt potential, focus-skin distance and entrance surface dose (ESD), using a PC-based Monte Carlo program simulation. It was found that dose per unit ESD had a tendency to decrease with body mass index (BMI). In particular, the absorbed dose for most organs was larger at high voltages (140 kVp) than at low voltages (120 kVp, 100 kVp). In addition, the effective dose which was based on ICRP 60 and ICRP 103 also represented the same tendency in respect of BMI and tube voltage.

New organ-based tube current modulation method to reduce the radiation dose during computed tomography of the head: evaluation of image quality and radiation dose to the eyes in the phantom study

A new organ-based tube current modulation (NOB-TCM) method was designed with the intent to decrease tube current by 30% over a prescribed 90° radial arc across the anterior aspect of the radiosensitive organ, without increasing tube current in the remaining radial arc. We compared a reference scan and five other dose-reducing methods with regard to effects on dose, practicality, and image quality to determine the most effective method for the reduction of the radiation dose to the eyes during CT examinations of the head. We compared the radiation doses to the eyes and physical image quality in different regions of interest for TCM and shielding scans. Three types of TCM scans were performed: longitudinal TCM, angular TCM, and NOB-TCM. A bismuth sheet and lead goggles were each applied for the shielding scan. Relative to the reference scan, the dose to the eye was reduced to 25.88% with NOB-TCM, 44.53% with lead goggles, and 36.91% with a bismuth shield. Relative to the reference scan, the mean signal-to-noise ratio (SNR) was decreased to 8.02% with NOB-TCM, 28.36% with lead goggles, and 32.95% with the bismuth shield. The SNR of the anterior region of interest was decreased to 11.89% with NOB-TCM and 87.89% with the bismuth shield. The average figure of merit was increased by 11.7% with longitudinal TCM and 13.39% with NOB-TCM, compared with the reference scan. NOB-TCM is a superior solution for head CT, including the orbital area, due to the reduction in radiation exposure without significant loss in image quality.

Novel positioning method using Gaussian mixture model for a monolithic scintillator-based detector in positron emission tomography

We developed a high precision position decoding method for a positron emission tomography (PET) detector that consists of a thick slab scintillator coupled with a multichannel photomultiplier tube (PMT). The DETECT2000 simulation package was used to validate light response characteristics for a 48.8 mm×48.8 mm×10 mm slab of lutetium oxy- orthosilicate coupled to a 64 channel PMT. The data are then combined to produce light collection histograms. We employed a Gaussian mixture model (GMM) to parameterize the composite light response with multiple Gaussian mixtures. In the training step, light photons acquired by N PMT channels was used as an N-dimensional feature vector and were fed into a GMM training model to generate optimal parameters for M mixtures. In the positioning step, we decoded the spatial locations of incident photons by evaluating a sample feature vector with respect to the trained mixture parameters. The average spatial resolutions after positioning with four mixtures were 1.1 mm full width at half maximum (FWHM) at the corner and 1.0 mm FWHM at the center section. This indicates that the proposed algorithm achieved high performance in both spatial resolution and posi- tioning bias, especially at the corner section of the detector. C � 2011 Society

AnyHeart: A single-piece heart-saving implantable artificial heart (BVAD): Monitoring and estimation

AnyHeart is a single-piece, implantable biventricular assist device. This electromechanical BVAD has a moving-actuator mechanism. To monitor the status of AnyHeart from anywhere at any time, a portable personal digital assistant (PDA) monitor and web-based remote monitoring system were developed. The PDA local monitoring system has replaced bulky personal computer monitoring systems. The web-based remote monitoring system has several functions such as data collecting, storing, and posting through the internet. Basically, interventricular pressure (IVP) is a parameter indicating the filling level of the blood chambers of AnyHeart. The pump output can be estimated using IVP, which is acquired noninvasively from AnyHeart. With the proposed method, we can estimate the pump output with a small margin of error.