Miyoung Choi

Endoscopic Dacryocystorhinostomy: Creation of a Large Marsupialized Lacrimal Sac

This retrospective study describes and evaluates the effectiveness of a modified technique of conventional endoscopic dacryocystorhinostomy (DCR) that minimizes the obstruction of a neo-ostium by creating an enlarged marsupialized lacrimal sac using mucosal flaps. Forty-two patients who had undergone 46 endoscopic DCR at a tertiary medical center, from 2002 to 2004, for correction of lacrimal system obstruction were investigated. The surgical technique involves elevation of a nasal mucosal flap, full sac exposure using a power drill, and shaping of the mucosal flap to cover denuded bone and juxtapose exposed sac mucosa. Postoperative symptoms and endoscopic findings of the neo-ostium were evaluated. Mean duration of follow-up was 5.9 months. An eighty-three percent primary success rate was observed, without any serious complications. Obstruction of the neo-ostium with granulation tissue was observed in eight cases, among which six underwent revision with success in all cases. Overall, 44 (96%) of 46 cases experienced surgical successes. Endoscopic DCR, a procedure in which a large marsupialized lacrimal sac is created from mucosal flaps, yields a very satisfactory success rate with straightforward and highly successful revision available for those in whom the primary procedure yields a substandard result.

Methodology for Developing Evidence-Based Clinical Imaging Guidelines: Joint Recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

This paper is a summary of the methodology including protocol used to develop evidence-based clinical imaging guidelines (CIGs) in Korea, led by the Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency. This is the first protocol to reflect the process of developing diagnostic guidelines in Korea. The development protocol is largely divided into the following sections: set-up, process of adaptation, and finalization. The working group is composed of clinical imaging experts, and the developmental committee is composed of multidisciplinary experts to validate the methodology. The Korean CIGs will continue to develop based on this protocol, and these guidelines will act for decision supporting tools for clinicians as well as reduce medical radiation exposure.

Endoscopic dacryocystorhinostomy with canalicular marsupialization in common canalicular obstruction

OBJECTIVE To evaluate the surgical outcomes of endoscopic dacryocystorhinostomy with canalicular marsupialization (EDCR CM) in common canalicular obstruction. DESIGN Retrospective review of medical records. PARTICIPANTS Thirty-six patients (38 eyes) who had undergone EDCR CM for chronic epiphora caused by common canalicular obstruction. METHODS Surgical outcomes were evaluated postoperatively by improvement of subjective symptoms and patency of the neo-ostium of DCR on nasal endoscopy. RESULTS Subjective symptoms improved in 81.6% (31/38) after primary EDCR CM and 94.7% (36/38) after revision surgery. In cases of silicone stent intubation, the surgical results were relatively superior compared with patients without silicon stent insertion (83.3% and 75.0%, respectively; p = 0.624). On postoperative nasal examination after primary surgery, the patency of dacryocystorhinostomy site was lower in patients with silicone stent insertion than those without (86.70% and 100%, respectively; p = 0.560), and the patency rate of the canalicular neo-ostium was higher in patients with silicone stent insertion than those without (90.0% and 75.0%, respectively; p = 0.279). There were no serious intraoperative complications except mild punctual erosion (4 patients, 10.5%). CONCLUSION EDCR CM showed favourable surgical outcomes and few surgical complications. This surgical treatment could be the first-line treatment for patients with distal common canalicular obstruction.

2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology

Thermal ablation using radiofrequency is a new, minimally invasive modality employed as an alternative to surgery in patients with benign thyroid nodules and recurrent thyroid cancers. The Task Force Committee of the Korean Society of Thyroid Radiology (KSThR) developed recommendations for the optimal use of radiofrequency ablation for thyroid tumors in 2012. As new meaningful evidences have accumulated, KSThR decided to revise the guidelines. The revised guideline is based on a comprehensive analysis of the current literature and expert consensus.

Imaging Guidelines for Enhancing Justifications for Radiologic Studies

Justification in the field of radiology refers to the appropriate use of radiologic imaging modalities, and may be achieved by establishing clinical imaging guidelines (CIGs). Recently, CIGs have been shown to be useful in selecting the proper medical imaging modality, resulting in the reduction of inappropriate radiologic examinations, thereby enhancing justifications. However, the development of CIGs is both time-consuming and difficult as the methodology of evidence-based medicine should be adhered to. Thus, although the radiologic societies in developed countries such as the United Kingdom and USA are already developing and implementing CIGs in their clinical practices, CIGs are not yet readily available in many other countries owing to differences in medical circumstances and resources. In this review, we assess the role and limitations of CIGs by examining the current status of CIGs in developed countries, and also describe the specific efforts made to establish CIGs in Korea.

Primary Imaging Test and Appropriate Biopsy Methods for Thyroid Nodules: Guidelines by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed guidelines for primary imaging tests and appropriate biopsy methods for thyroid nodules. These guidelines were developed using an adaptation process by collaboration between the development committee and the working group. The development committee, composed of research methodology experts, established the overall plan and provided support about methodological strategies. The working group, composed of radiologist experts in thyroid imaging, wrote the proposals. The guidelines recommend neck ultrasound (US) as a first-line imaging modality for the diagnosis of thyroid nodules in patients with suspected nodules, and US-guided fine-needle aspiration as a primary method for histologic examination of thyroid nodules.

2018 Korean Clinical Imaging Guideline for Hemoptysis

In 2014, the American College of Radiology (ACR) announced the guideline for the appropriate diagnostic approach and treatment of patients according to the severity of hemoptysis and risk for lung cancer. However, the application of the ACR guideline in Korea may not be appropriate, because many patients in Korea have active tuberculosis or pulmonary fibrosis due to previous tuberculosis. The Korean Society of Radiology and Korean Society of Thoracic Radiology have proposed a new guideline suitable for Korean practice. This new guideline was prepared through the consensus of a development committee, working party, and an advisory committee. The guideline proposal process was based on an evidence-based clinical imaging guideline proposed by the development committee. Clinical imaging guideline for adult patients with hemoptysis is as follows: Chest radiography is an initial imaging modality to evaluate hemoptysis. Contrast-enhanced chest CT is recommended in patients with two risk factors for lung cancer (> 40 years old and > 30 pack-year smoking history), moderate hemoptysis (> 30 mL/24 hours) or recurrent hemoptysis. Contrast-enhanced chest CT is also recommended in patients with massive hemoptysis (> 400 mL/24 hours) without cardiopulmonary compromise.

Relationships of Mental Health and Internet Use in Korean Adolescents

AIM: The purpose of this study was to identify the relationships of mental health and internet use in Korean adolescents. Also, it was intended to provide guidelines for reducing internet overuse based on the influencing factors of internet use. METHODS: Participants in this study were convenient sampling, and selected middle and high school students in Incheon metropolitan city, South Korea. Internet use and mental health of adolescents were measured by self‐reported instruments. This study was carried out from June to July 2014. 1248 participants were collected overall except for insufficient data. The data were analyzed by descriptive statistics, t‐test, ANOVA, Pearsons correlation coefficient, and multiple regression. RESULTS: There were significant correlations between mental health and internet use. The significant influencing factors of internet use were normal internet use group, mental health, middle school, internet using time on weekends (3 h or more), internet using time at a time (3 h or more), and high school record. These six variables accounted for 38.1% of internet use. CONCLUSIONS: The results of this study will be used as guidelines for reducing internet overuse of adolescents. HIGHLIGHTSThere were significant correlations between mental health and internet use.By identifying the influencing factors of internet use, this study provided guidelines for reducing internet overuse.The poorer mental health and school grades, and the middle students, the more heavily relied on internet usage.It is necessary to regularly provide screening test and guidelines for potential risk group of internet overuse.