흉골 자기공명영상 검사 시 호흡 등 환자 움직임에 의한 인공물 발생을 최소화하는 것은 어렵다. 하지만 자기공명영 상 검사는 타 영상 검사와 비교해 흉골 병변을 발견하는 데 있어 진단적 가치가 높은 장점이 있다. 따라서 본 연구에 서는 환자의 검사 자세 및 딥러닝 기법을 통해 최적의 검사 방법을 도출하고자 한다. 자세 별 영상 변화를 확인하기 위해 바로 누운 자세, 엎드린 자세, 유방 코일을 사용한 엎드린 자세로 진행하였으며, 고식적 기법의 영상과 Deep Resolve Boost(DRB) 기법을 적용한 영상을 비교 관찰하였다. 모든 대상에게 같은 조건으로 각 영상을 2회씩 획득 한 후 전반적인 영상 품질을 기준으로 정성적으로 평가하였고, DRB의 적용 여부에 따른 신호 대 잡음비의 변화 정도를 정량적으로 평가하여 개선 정도를 산출하였다. 정성적 평가에서 DRB 적용 여부와 무관하게 엎드린 자세, 유방 코일을 사용한 엎드린 자세, 바로 누운 자세 순으로 높은 점수를 얻었으며, DRB를 적용한 영상이 고식적 기법 의 영상보다 높은 점수를 얻었다. 또한 정량적 평가를 통해 유방 코일을 사용한 엎드린 자세, 엎드린 자세, 바로 누운 자세 순으로 높은 개선 정도를 확인하였다. 본 연구를 통해 흉골 검사 시 DRB 기법을 적용하는 것은 영상의 질을 높이는 방법임을 확인하였다. DRB를 적용하지 못하는 환경에서는 될 수 있으면 엎드린 자세를 적용하는 것을 권고하며, DRB를 적용할 수 있는 환경에서는 환자 측 인자를 고려하여 엎드린 자세와 유방 코일을 사용한 엎드린 자세를 모두 적용할 수 있다.

During the past 40 years a huge number of studies investigated destination positioning and images from the tourists’ perspective, but by far fewer studies have been conducted from the destination managers’ perspective. In addition, few articles benchmark image positions between multiple destinations and their projections on marketing material. In order to generalize the results to larger geo-scopes, it is important to include a substantial number of destinations for analysis and take the influences of geography into consideration. The current study focuses on exploring positions of intended (planned) destination images. The primary aim is to compare the intended tourism image that is originally developed by destination managers of the sub-provincial districts in China and identify patterns of similarity and uniqueness behind. The research findings are expected to: (1) inform local destination managers in China about the current status of their destination tourism image positions compared with other destinations; and (2) give suggestions to the tourism administrations of both sub-provincial level and higher levels on how to better understand and coordinate the districts under their authorities and how to develop effective image positioning and projection strategies. In China, substitutability among tourism destinations like cities is growing, which is more obvious among those having same regional contexts, source markets and similar tourism products (Han & Tao, 2005). One remedy against this tendency is the development of strong image positions that are distinctive from other competing destinations. However, Chinese destination managers are facing several problems regarding positioning and marketing their destination images. First, the existing image positions of many destinations are unclear (Chen, 2008). Han and Tao (2005) point out that tourism images of many city destinations − in particular the mid-sized and small cities − are still on the organic stage and lack of systematic planning. What is more important is that many destination managers have not recognized the importance of image positioning and the benefits of induced image (Chen, 2008; Han & Tao, 2005). Second, some destinations have unrealistic image positions because they neglected market research opportunities and carried out positioning in a blind way (Chen, 2008). For instance, many destination managers think that destination image is the same as creative initiatives or slogans rather than the rational result from a systematic positioning process (Han & Tao, 2005). In China, DMOs are government departments traditionally. In other words, China National Tourism Administration (CNTA) is the DMO for whole China; Provincial Tourism Administrations (PTAs) manage provincial-level destinations and Municipal or County Tourism Administrations (RTAs) are the DMOs for sub-provincial districts (Feng, Morrison & Ismail, 2003; Li & Wang, 2010). In this study, when talking about China, “DMO” is exchangeable with “tourism administration”; and “destination manager” refers to the “senior officer working in the tourism administration”. District, province and region are three spatial levels frequently and consistently used in this study. In terms of the size, region is the largest whereas district is the smallest. A region contains one or several provinces. A province has several districts under its authority. In this research, the unit of analysis is sub-provincial districts that belong to provinces. The provinces are sorted into different geographical regions that are characterized by different categories of endowed tourism resources. This study adopts the most recent scheme developed by Song (1994). He classifies the tourism destinations in China into 10 TRG Regions and 77 sub-TRG Regions. TRG Regions consist of complete provinces. While the sub-TRG Regions focusing on market appeal may contain districts across provinces. Table 1 summarizes the features of the 10 TRG Regions and their included provinces; the regions names are the abbreviations of their included provinces. This research investigates intended image positions from the destination managers’ perspectives for sub-provincial districts in China. There are 27 provinces1 and 365 sub-provincial districts (SP Districts) in China. The 365 SP Districts are classified into 9 groups according to the scheme of tourism resources geographical regions (TRG Regions) reviewed before. Due to the different administration systems, the 10th region including Hong Kong, Taiwan and Macau is excluded from this research. 122 out of 365 SP Districts are selected. The sampling method combines multistage sampling, stratified sampling and simple random sampling. For only 83 districts (68%) relevant documents could be retrieved online. 48 documents represent the “Tourism Development Master Plans” and 35 documents the “12th Twelve-Five Year Tourism Development Plans”. Six districts did not mention any type of intended image positions in their development plans. The content about intended destination image position(s) – i.e. the most essential image position(s) for a district as a whole destination to differentiate itself from others – are identified from the tourism plans. The extracted content about image positions often appears in the formats of short sentences or phrases that contain more than one concept. Thus, the original extracted content is processed to identify all included image concepts that are distinct from each other. The content analysis yielded a spread of 164 different image items with only 189 occurrences for a total of 77 districts. So, on average, there are not more than about 2.5 image positions that can be identified in the tourism master plans or development plans of the sub-provincial districts. 20% of these plans use only one image concept; 38% two items, 26% three different items, 12% four and only 5% are using five items. To make this list more comprehensible the items were aggregated in two steps to 48 image factors. In almost each tourism master or development plan which discusses positioning of the district through promoting destination images cognitive or functional terms are used. About one third of these documents uses affective or psychological features. Yet, two thirds of the intended district images are completely lacking any affective element that could help identifying appealing spots on the touristic map among the functionally loaded clutter. Reviewing the coverage of intended image items through the conceptual lenses proposed by Tapachai and Waryszak (2000) it becomes evident that only functional, emotional and epistemic aspects can be found as targeted image elements. Travellers, though, are also using social and conditional criteria when it comes to destination choice (Zins, 2010; Zins & Prompitak, 2010). Despite the relatively scarce usage of intended image positions for each Chinese sub-provincial district it is worthwhile to condense the image profiles of these 77 districts further. The 2-way profile data of 48 image factors for 77 sub-provincial districts were subject to a non-hierarchical cluster procedure to identify similarities among the districts. Considering both, the homogeneity gain of additional clusters and the relative simplicity of interpretation (expressed by the wSSI) a solution with ten different groups of districts was accepted. A sketch of the main characteristics is depicted in Table 2. The largest image profile group pools 24 different districts (31%) from 7 different TRG regions. The other larger groups (number 10, 4, 5 and 2 in descending order of similarity to number 7) do not exhibit one single lead region which means that the TRG regions share a multitude of targeted image positions. The larger TRG regions with quite a number of districts (BTHS, GFH, SJZAJ and YGG; together 49 out of 77 districts) show some gravity into the profiles 7, 4 and 5 (cf. Table 2). However, the frequency is not large enough to claim that a particular region is uniquely represented by one of the identified condensed image profiles. The majority of districts within one TRG region shows targeted image positions that are more common with districts of other TRG regions. Overall, the geographic spread of relatively similar district images is larger across provinces than across regions, which appears plausible. Destination managers may perceive threats from their neighbouring districts that share similar context images and source markets. This drives them to develop differentiated positions in order to prevent direct competition. Officially, higher-level DMOs like provincial tourism administrations have to coordinate the tourism planning of the lower-level districts (Tourism Law 2013; GSTP, 2003).

Purpose – The purpose of this study is to examine the image similarity and attribute recognition of the top 10 rated spa destinations (Chungnam Deoksan, Chungnam Dogo, Busan Dongrae, Daejeon Yuseong, Chungnam Asan, Gyeongbuk Bomun, Chungbuk Suanbo, Gyeongnam Jangyu, Chungnam Onyang, & Gyeongbol Bugok) in Korea based on the visits to these spa places by the customers. Research design, data, and methodology – The survey of this study was conducted on the visitors to the top 10 spa destinations in Korea from April 8 ∼ April 21, 2017, and a total of 300 questionnaires were distributed. Of them, effective questionnaires used in the final study were a total of 241. In this study, empirical analysis was made through frequency analysis, factor analysis, and multidimensional scaling ALSCAL(spinning symmetry for image similarity and rectangle for attributes recognition) by using the Statistics Package SPSS 24.0. Results – According to the analysis result of spa destination image similarity, the stress level was 0.16453 and the level of the stress was good. Moreover, the coefficient of determination (RSQ) was, which had a description of each aspect of the spa destination, 0.79908. According to the results of attribute recognition, the stress value of 0.11805 represents a degree of conformity, and the coefficient of determination(RSQ) appeared at 0.98665. Therefore, the results of this analysis are that the similarities between spa destinations and the attribute recognition of the spa destinations is a suitable model that is properly expressed in two dimensions. Conclusions – First, according to the analysis result of image similarity, Deoksan & Dogo spa revealed similar images, as well as the Dongrae and Yuseong spa, while on the contrary Asan, Bomun, Suanbo spa has different images from the rest. Second, according to the results of attribute recognition, Asan and Onyang spa has competitiveness in terms of accessibility to spa destination; Yuseong, Dongrae, Jangyu spa in terms of spa facilities, spa tourism conditions, and service & shopping conditions. while spa water quality and spa costs showed low attribute reflection for all 10 spas. Therefore, the spa visitors cannot recognize the differentiation of spa water quality and spa costs.

흉부 CT와 같이 조직 대조도 차이가 큰 부위의 CT 검사도 환자의 팔의 위치에 따른 아티팩트 발생과 화질저하, 과다피폭 등을 방지하기 위하여 환자의 손을 머리 위로 올리고 검사를 시행하고 있다. 흉부 CT와 같이 조직 대조도 차이가 큰 부위의 검사에서 환자 팔의 위치에 따라 화질저하, 과다피폭 등이 발생한다. 2012년 서울의 K 대학병원 흉부 CT 검사는 1,642건이었다. 이중 118건이 팔을 올리지 않고 흉부 CT검사를 시행하였다. 정상적으로 팔을 올리고 검사한 그룹은 총 DLP 값의 평균이 275 mGy․cm로 나타났으며 팔을 올리지 않고 검사한 그룹의 총 DLP값 평균은 312.46 mGy․cm로 나타났다. 동일 환자의 경우 후향적 조사에서 적극적으로 팔을 올리고 검사한 경우 총 DLP 값이 267.5 mGy․cm로 조사되었고 팔을 올리지 않고 검사한 경우 총 DLP 값이 307.5 mGy․cm로 나타났다. 흉부 CT 검사에서 검사자가 적극적으로 팔을 올리지 않고 검사하면 인체의 가장 두꺼운 부위인 어깨부위를 통과한 X-ray 광자의 부족으로 인해 선형 아티팩트가 발생하였다. 흉부 CT 검사시 적극적으로 팔을 올려서 검사하는 노력으로 적은 피폭선량과 양질의 의료영상을 환자에게 제공할 수 있는 선량 최적화의 방법이 될 것이다.