Evaluation of optimal treatment planning for radiotherapy of synchronous bilateral breast cancer including regional lymph node irradiation

BACKGROUND: We evaluated the optimal radiotherapy (RT) plan for synchronous bilateral breast cancer (SBBC), especially treatment plans including the regional lymph node (LN) area. METHODS: This study was conducted using 15 patients with SBBC (5 with small breasts, 5 with large breasts, and 5 who underwent a left total mastectomy). The clinical target volume (CTV) was defined as the volume enveloping the bilateral whole breasts/chest wall and left regional LN area. We established the following plans: 1) volumetric-modulated arc therapy (VMAT)-the only plan using two pairs of partial arcs for the whole target volume, 2) VMAT using one partial arc for the left CTV followed by a 3D tangential technique for the right breast (primary hybrid plan), and 3) VMAT for the left CTV followed by a tangential technique using an automatically calculated prescription dose for the right breast, considering the background dose from the left breast VMAT plan (modified hybrid plan). The Tukey test and one-way analysis of variance were used to compare the target coverage and doses to organs at risk (OARs) of the three techniques. RESULTS: For target coverage, the VMAT-only and modified hybrid plans showed comparable target coverage in terms of Dmean (50.33 Gy vs. 50.53 Gy, p = 0.106). The primary hybrid plan showed the largest distribution of the high-dose volume, with V105% of 25.69% and V110% of 6.37% for the planning target volume (PTV) (p < 0.001). For OARs including the lungs, heart, and left anterior descending artery, the percentages of volume at various doses (V5Gy, V10Gy, V20Gy, V30Gy) and Dmean were significantly lower in both the primary and modified hybrid plans compared to those of the VMAT-only plan. These results were consistent in subgroup analyses of breast size and morphological variation. CONCLUSIONS: The modified hybrid plan, using an automatically calculated prescription dose for the right breast and taking into consideration the background dose from the left breast VMAT plan, showed comparable target coverage to that of the VMAT-only plan, and was superior for saving OARs. However, considering that VMAT can be adjusted according to the physician's intention, further evaluation is needed for developing a better plan.ope

Clinical application of 3D-printed-step-bolus in post-total-mastectomy electron conformal therapy

The 3D-printed boluses were used during the radiation therapy of the chest wall in six patients with breast cancer after modified radical mastectomy (MRM). We measured the in-vivo skin doses while both conventional and 3D-printed boluses were placed on the chest wall and compared the mean doses delivered to the ipsilateral lung and the heart. The homogeneity and conformity of the dose distribution in the chest wall for both types of boluses were also evaluated. The uniformity index on the chest skin was improved when the 3D-printed boluses were used, with the overall average skin dose being closer to the prescribed one in the former case (-0.47% versus -4.43%). On comparing the dose-volume histogram (DVH), it was found that the 3D-printed boluses resulted in a reduction in the mean dose to the ipsilateral lung by up to 20%. The precision of dose delivery was improved by 3% with the 3D-printed boluses; in contrast, the conventional step bolus resulted in a precision level of 5%. In conclusion, the use of the 3D-printed boluses resulted in better dose homogeneity and conformity to the chest wall as well as the sparing of the normal organs, especially the lung. This suggested that their routine use on the chest wall as a therapeutic approach during post-mastectomy radiation therapy offers numerous advantages over conventional step boluses.ope

Foreign visitors attitude toward fashion cultural products

학위논문(박사)--서울대학교 대학원 :의류학과,2007.Docto

황해도 만구대택굿 무복(巫服)의 상징에 관한 고찰

학위논문(석사)--서울대학교 대학원 :의류학과,2000.Maste

A Qualitative Study on Attitude and Career Planning for Work-family Balance of Korean University Student

The purpose of this study w to investigate the attitude and plan toward work-family balance of male and female university students and to explore what experiences and environments developed these attitudes. To gain a subjective understanding from the perspective of university students, 6 focus groups were conducted with 27 students currently attending a university in Seoul. Common findings were obtained from the interviews by using the Consensual Qualitative Research method. In detail, both male and female students expect that family life could be a barrier to their carrier after marriage, they perceive work and family separately when considering on their future careers. When considering their careers only, they did not consider family at all. While both male and female students show strong career seeking directivity, both did not show serious consideration of how they would deal with work-family balance concretely. Furthermore, parental influence was significant in constructing their attitudes and plans towards work-family balance. Based on the results of this study, the implications, limitations and suggestions for future studies are presented in terms of career counseling and educational approaches for university students.본 연구의 목적은 자신의 진로를 탐색하고 준비하는 시기에 있는 남녀 대학생들의 일-가족 양립에 대한 태도 및 계획을 살펴보고, 이러한 태도가 어떠한 경험과 환경을 통해 형성되고 있는지를 탐색적으로 확인하는 것이다. 대학생의 주관적인 관점에서 이를 이해하고자, 서울시내 소재 대학에 재학 중인 남녀 대학생 27명을 6개 집단으로 나누어 포커스 그룹 인터뷰를 실시하였다. 인터뷰를 통해 얻어진 자료는 합의적 질적 연구방법(Consensual Qualitative Research)에 근거하여 분석하였다. 분석 결과 일-가족 양립에 대한 태도, 일-가족 양립에 대한 계획, 계획 및 태도에 영향을 미친 요인, 부모님으로부터의 영향이라는 4개의 영역과 그에 따른 17개의 하위범주가 발견되었다. 구체적인 내용을 살펴보면, 남녀 대학생들은 결혼 이후 일과 가정을 병행하는 과정에서 가정생활이 일에 방해가 될 것이라고 예상하면서도 진로 선택 및 결정의 과정에서는 일과 가정을 분리된 것으로 인식하거나, 일-가족을 양립하게 되는 상황에 대한 고려 없이 현재의 진로 계획과 목표를 세우고 있는 것으로 나타났다. 남녀 대학생 모두 강한 진로지향성을 가지고 있었지만 일과 가정을 양립하는 것과 관련된 구체적인 대안을 고려하고 있지 않았으며, 일-가족 양립과 관련된 태도 및 계획은 부모님으로부터의 영향을 크게 받고 있는 것으로 확인되었다. 이 연구의 결과를 바탕으로 대학생들의 진로 상담 및 교육적 접근에서 가지는 시사점과 제한점, 추후 연구를 위한 제언이 제시되었다