Lateral Cephalometric Measurements of Class I Malocclusion Patients with Uncertainty / 대한소아치과학회지

The aim of this study was to obtain the traceability of the software used to analyze lateral cephalometry and to calculate the uncertainty of the measurements. Furthermore, this study aimed to provide a basis for obtaining standard references for measurement values for orthodontic treatment in children.Cephalometric data were collected from 100 children diagnosed with class I malocclusion between the ages 6 to 13 years who visited the pediatric dentist at Seoul National University Dental Hospital. To ensure traceability, a phantom device was created. Correction values were calculated by measuring the length and angle of the phantom device using the software. Type A uncertainty was calculated by obtaining the standard deviation of cephalometric measurements of 100 persons and the standard error of repeated measurements. Determination of the type B uncertainty was induced by minimum resolution and the position of the head. Using these, the combined standard uncertainty was obtained and the expanded uncertainty was calculated.The results of this study confirm that the currently used software has high accuracy and reliability. Furthermore, the uncertainty of orthodontic measurements in Korean children aged 6 to 13 years was calculated, and distribution range for class I malocclusion with 95% confidence interval was suggested.

Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal

OBJECTIVE: To evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test. MATERIALS AND METHODS: Sixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis. RESULTS: Thirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies. CONCLUSION: Greater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.

Control of Mitochondrial Dynamics by Fas-induced Caspase-8 Activation in Hippocampal Neurons

Cells undergo apoptosis mainly via two pathways-the mitochondrial pathway and the cytosolic pathway. It has been well documented that activation of the mitochondrial pathway promotes mitochondrial fragmentation and inhibition of mitochondrial fragmentation partly represses cell death. However, the mitochondrial events following activation of the cytosolic pathway are less understood. In this study, we treated Fas-activating antibody and found mitochondrial fragmentation without cell death in hippocampal primary neurons and HT-22 cell lines. Fas antibody treatment, in fact, promoted rapid activation of caspase-8, while executioner caspase-3 activation was not observed. Furthermore, blockage of caspase-8 efficiently prevented Fas antibody-induced mitochondrial fragmentation. These results suggest that the cytosolic pathway induced by death receptor activation promotes caspase-8-dependent mitochondrial fission.

CDK5-dependent inhibitory phosphorylation of Drp1 during neuronal maturation

Mitochondrial functions are essential for the survival and function of neurons. Recently, it has been demonstrated that mitochondrial functions are highly associated with mitochondrial morphology, which is dynamically changed by the balance between fusion and fission. Mitochondrial morphology is primarily controlled by the activation of dynamin-related proteins including dynamin-related protein 1 (Drp1), which promotes mitochondrial fission. Drp1 activity is regulated by several post-translational modifications, thereby modifying mitochondrial morphology. Here, we found that phosphorylation of Drp1 at serine 616 (S616) is mediated by cyclin-dependent kinase 5 (CDK5) in post-mitotic rat neurons. Perturbation of CDK5 activity modified the level of Drp1S616 phosphorylation and mitochondrial morphology in neurons. In addition, phosphorylated Drp1S616 preferentially localized as a cytosolic monomer compared with total Drp1. Furthermore, roscovitine, a chemical inhibitor of CDKs, increased oligomerization and mitochondrial translocation of Drp1, suggesting that CDK5-dependent phosphorylation of Drp1 serves to reduce Drp1's fission-promoting activity. Taken together, we propose that CDK5 has a significant role in the regulation of mitochondrial morphology via inhibitory phosphorylation of Drp1S616 in post-mitotic neurons.

Physiological and Pathological Significance of Dynamin-Related Protein 1 (Drp1)-Dependent Mitochondrial Fission in the Nervous System

Mitochondria are essential for proper neuronal morphogenesis and functions, as they are the major source of energy for neural development. The dynamic morphology of mitochondria determines the key functions of mitochondria. Several regulatory proteins such as dynamin-related protein 1 (Drp1) are required to maintain mitochondrial morphology via a balance between continuous fusion and fission. Activity of Drp1, a key regulator in mitochondrial fission, is modulated by multiple post-translation modifications and receptor interactions. In addition, numerous researches have revealed that the regulation of Drp1 activity and mitochondrial dynamics is closely associated with several neurodegenerative diseases such as Alzheimer's and Parkinson's diseases. In this article, we concisely review the recent findings about the biological importance of Drp1-mediated mitochondrial fission in neurons under physiological and pathological conditions.

Measurement and Evaluation of Scatter Fractions for Digital Radiography with a Beam-Stop Array / 의학물리

Scatter radiation considerably affects radiographic image quality by reducing image contrast and contributing to a non-uniform background. Images containing a large portion of scatter radiation may result in an incorrect diagnosis. In the past few years, many efforts have been made to reduce the effects of scatter radiation on radiographic images. The purpose of this study is to accurately measure scatter fractions and evaluate the effectiveness of beam-stop arrays. To measure scatter fraction accurately, a beam-stop array and the SFC (Scatter Fraction Calculator) program were developed. Images were obtained using the beam-stop array for both an anti-scatter technique with an anti-scatter grid and an air gap technique. The scatter fractions of the images were measured using the SFC program. Scatter fractions obtained with an anti-scatter grid were evaluated and compared to scatter fractions obtained without an anti-scatter grid. Scatter fractions were also quantitatively measured and evaluated with an air gap technique. The effectiveness of the beam-stop array was demonstrated by quantifying scatter fractions under various conditions. The results showed that a beam-stop array and the SFC program can be used to accurately measure scatter fractions in radiographic images and can be applied for both developing scatter correction methods as well as systems.

Standardization of the Method of Measuring Average Glandular Dose (AGD) and Evaluation of the Breast Composition and Thickness for AGD / 의학물리

Breast cancer is the most common form of cancer among korean woman. Therefore, the early detection activities of breast cancer such as breast self-examinations, clinical breast examinations, mammography are important. A yearly mammography examination has been recommended for women aged 40 and older for the early detection of breast cancer in asymptomatic periods. However, the glandular tissue of breast is the most radiation-sensitive tissue, and the determination of average glandular dose (AGD) forms an important part of the quality control of the mammographic systems. Because of the difficulty of estimating AGD directly, it is often estimated from the measurements of the incident air kerma and by applying the appropriate conversion factors. The primary objective of this study was to standardize the method of measuring AGD. The secondary objective was to evaluate the relationships between AGD per various composition and thickness of the breast using Monte Carlo simulations. As a result, we standardized the method of measuring AGD according to International Atomic Energy Agency (IAEA) guidelines (CoP: an international code of practice). Overall, AGD for mammographic practice in Korea was less than 3.0 mGy recommended by the Korea Food and Drug Adminstration (KFDA) protocol, and Korean Institute for Accreditation of Medical Image (KIAMI). The measured and simulated AGD for a given condition were calculated as 1.7 and 1.6 mGy, respectively. For the AGDs obtained, there was no significant difference between them. The simulated AGD was dependent on the fraction of glandular tissue of the breast. The AGD increases with increasing of the breast glandularity due to increasing absorption of low energy photons. The AGD also increases as a function of breast thickness. In conclusion, the results of this study could be used as a baseline to establish a reference level of radiation dose in mammography.

Investigation of Scatter and Septal Penetration in I-131 Imaging Using GATE Simulation / 의학물리

Scatter correction for I-131 plays a very important role to improve image quality and quantitation. I-131 has multiple and higher energy gamma-ray emissions. Image quality and quantitative accuracy in I-131 imaging are degraded by object scatter as well as scatter and septal penetration in the collimator. The purpose of this study was to estimate scatter and septal penetration and investigate two scatter correction methods using Monte Carlo simulation. The gamma camera system simulated in this study was a FORTE system (Phillips, Nederland) with high energy, general-purpose, parallel hole collimator. We simulated for two types of high energy collimators. One is composed of lead, and the other is composed of artificially high Z number and high density. We simulated energy spectrum using a point source in air. We estimated both full width at half maximum (FWHM) and full width at tenth maximum (FWTM) using line spread function (LSF) in cylindrical water phantom. We applied two scatter correction methods, triple energy window scatter correction (TEW) and extended triple energy window scatter correction (ETEW). The TEW method is a pixel-by pixel based correction which is easy to implement clinically. The ETEW is a modification of the TEW which corrects for scatter by using abutted scatter rejection window, which can overestimate or the underestimate scatter. The both FWHM and FWTM were estimated as 41.2 mm and 206.5 mm for lead collimator, respectively. The FWHM and FWTM were estimated as 27.3 mm and 45.6 mm for artificially high Z and high density collimator, respectively. ETEW showed that the estimation of scatter components was close to the true scatter components. In conclusion, correction for septal penetration and scatter is important to improve image quality and quantitative accuracy in I-131 imaging. The ETEW method in scatter correction appeared to be useful in I-131 imaging.

ROC Analysis of Simulated Chest Lesions for Computed Radiography and Digital Radiography at Various Tube Voltages / 의학물리

Current digital radiographic systems are rapidly growing in clinical applications. The purpose of this study was to evaluate the diagnostic performance of computed radiography (CR) and digital radiography (DR) at different tube voltages in the detection of simulated chest lesions. Patterns of simulated interstitial lung disease, incipient infiltration, and nodules were superimposed over an anthropomorphic chest phantom. A simulated chest phantom radiograph was obtained with CR and DR at different tube voltages (70 kV, 90 kV, and 120 kV). A total of 18,000 observations were analyzed using a receiver operating characteristic (ROC) analysis. The detection of all lesions showed higher Az values at 70 kV than 120 kV with CR. For the DR, mean Az values at 70 kV were higher than other tube voltages not all lesions but for micro-nodule interstitial lung disease, linear interstitial lung disease, and incipient infiltration. Based on these results, a clinical study should be performed to judge the use of suitable tube voltage according to the type of detector system and lesions.

Comparison of Radiation Dose in the Measurement of MDCT Radiation Dose according to Correction of Temperatures and Pressure, and Calibration of Ionization Chamber / 의학물리

This study aims to conduct the comparative analysis of the radiation dose according to before and after the calibration of the ionization chamber used for measuring radiation dose in the MDCT, as well as of CTDIW according to temperature and pressure correction factors in the CT room. A comparative analysis was conducted based on the measured MDCT (GE light speed plus 4 slice, USA) data using head and body CT dosimetric phantom, and Model 2026C electrometer (RADICAL 2026C, USA) calibrated on March 21, 2007. As a result, the CTDIW value which reflected calibration factors, as well as correction factors of temperature and pressure, was found to be the range of 0.479~3.162 mGy in effective radiation dose than the uncorrected values. Also, under the routine abdomen routine CT image acquisition conditions used in reference hospitals, patient effective dose was measured to indicate the difference of the maximum of 0.7 mSv between before and after the application of such factors. These results imply that the calibration of the ion chamber, and the correction of temperature and pressure of the CT room are crucial in measuring and calculating patient effective dose. Thus, to measure patient radiation dose accurately, the detailed information should be made available regarding not only the temperature and pressure of the CT room, but also the humidity and recombination factor, characteristics of X-ray beam quality, exposure conditions, scan region, and so forth.

Imaging Characteristics of Computed Radiography Systems / 의학물리

With recent advancement of the medical imaging systems and picture archiving and communication system (PACS), installation of digital radiography has been accelerated over past few years. Moreover, Computed Radiography (CR) which was well established for the foundation of digital x-ray imaging systems at low cost was widely used for clinical applications. This study analyzes imaging characteristics for two systems with different pixel sizes through the Modulation Transfer Function (MTF), Noise Power Spectrum (NPS) and Detective Quantum Efficiency (DQE). In addition, influence of radiation dose to the imaging characteristics was also measured by quantitative assessment. A standard beam quality RQA5 based on an international electro-technical commission (IEC) standard was used to perform the x-ray imaging studies. For the results, the spatial resolution based on MTF at 10% for Agfa CR system with I.P size of 8x10 inches and 14x17 inches was measured as 3.9 cycles/mm and 2.8 cycles/mm, respectively. The spatial resolution based on MTF at 10% for Fuji CR system with I.P size of 8X10 inches and 14x17 inches was measured as 3.4 cycles/mm and 3.2 cycles/mm, respectively. There was difference in the spatial resolution for 14x17 inches, although radiation dose does not effect to the MTF. The NPS of the Agfa CR system shows similar results for different pixel size between 100 micrometer for 8x10 inch I.P and 150 micrometer for 14x17 inch I.P. For both systems, the results show better NPS for increased radiation dose due to increasing number of photons. DQE of the Agfa CR system for 8X10 inch I.P and 14x17 inch I.P resulted in 11% and 8.8% at 1.5 cycles/mm, respectively. Both systems show that the higher level of radiation dose would lead to the worse DQE efficiency. Measuring DQE for multiple factors of imaging characteristics plays very important role in determining efficiency of equipment and reducing radiation dose for the patients. In conclusion, the results of this study could be used as a baseline to optimize imaging systems and their imaging characteristics by measuring MTF, NPS, and DQE for different level of radiation dose.

The Evaluation for Attenuation Map using Low Dose in PET/CT System / 의학물리

The current PET/CT system with high quality CT images not only increases diagnostic value by providing anatomic localization, but also shortens the acquisition time for attenuation correction than primary PET system. All commercially available PET/CT system uses the CT scan for attenuation correction instead of the transmission scan using radioactive source such as 137Cs, 68Ge. However the CT scan may substantially increase the patient dose. The purpose of this study was to evaluate quality of PET images reconstructed by CT attenuation map using various tube currents. In this study, images were acquired for 3D Hoffman brain phantom and cylindrical phantom using GE DSTe PET/CT system. The emission data were acquired for 10 min using phantoms after injecting 44.03 MBq of 18F-FDG. The CT images for attenuation map were acquired by changing tube current from 10 mA to 95 mA with fixed exposure time of 8 sec and fixed tube voltage of 140 kVp. The PET images were reconstructed using these CT attenuation maps. Image quality of CT images was evaluated by measuring SD (standard deviation) of cylindrical phantom which was filled with water and 18F-FDG solution. The PET images were evaluated by measuring the activity ratio between gray matter and white matter in Hoffman phantom images. SDs of CT images decrease by increasing tube current. When PET images were reconstructed using CT attenuation maps with various tube currents, the activity ratios between gray matter and white matter of PET images were almost same. These results indicated that the quality of the PET images using low dose CT data were comparable to the PET images using general dose CT data. Therefore, the use of low dose CT is recommended than the use of general dose CT, when the diagnostic high quality CT is not required. Further studies may need to be performed for other system, since this study is limited to the GE DSTe system used in this study.

Dose Measurements using Phantoms for Tube Voltage, Tube Current, Slice Thickness in MDCT / 의학물리

The purpose of this study was to measure and evaluate radiation dose for MDCT parameters. Patient dose for various combination of MDCT parameters were experimentally measured, using MDCT (GE light speed plus 4 slice, USA), model 2026C electrometer (RADICAL 2026C, USA), standard Polymethylmethacrylate (PMMA) head and body CT dosimetry phantoms. In clinical situations, for a typical abdominal scan performed with MDCT at 120 kVp, 180 mAs, 20 mm collimation, and a pitch of 0.75, CTDIw, CTDIvol were measured as 20.2 mGy, 26.9 mGy, respectively. When scan length is assumed as 271.3 mm, DLP and measured effective dose of the abdominal would be calculated as 729.1 mGy cm, 10.9 mSv, respectively.

Construction and Performance Evaluation of Digital Radiographic System / 의학물리

Current digital radiography systems are rapidly growing in clinical applications. The purpose of this study was to evaluate the characteristics of a mobile digital radiographic system. The performance of the mobile DR system was evaluated by measuring the modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE). Measurements were made on a LISTEM Mobix-1000 generator and a Teleoptic PRA Alpha-R4000 detector. Imaging characteristics were measured for these two systems using the IEC-61267 defined RQA5 (kVp: 74, additional filtration: 21 mmAl) radiographic condition. The MTF at 10% was measured as 2.4 cycles/mm and the DQE(0) values for radiation exposure 0.19, 0.5, and 1.3 mR were measured as 54%, 55%, and 76%, respectively. The NPS curves gradually decreased at high spatial frequencies. This high DQE at low frequencies, may be useful for low frequency information. The results suggested that mobile DR system could be integrated with emergency ambulance system in teleradiologic imaging applications.