臺灣博碩士論文加值系統

骨質疏鬆症為人體之系統性疾病，除了骨質異常減少外，骨內微小結構亦異常惡化，病人不論有無明顯的外傷，骨折的發生率明顯提高，因此如何早期預防以及治療就顯得相當重要。一般診斷骨質疏鬆症的方法主要是測量骨中礦物質密度(BMD)，雖然雙能量X射線吸收測量(DEXA)為方便且精確的量測方式，但是往往伴隨著游離輻射的危險。
超音波具有無游離輻射、價錢便宜、容易攜帶及移動等優點。此方法應用於骨質評估上主要量測波衰減(BUA)、波速(SOS)和堅硬度(stiffness)等參數。目前超音波儀器往往會因為量測的位置受到限制，其評估的參數一般為單點的量測值，且無法確定實際量測的部位是否位於腳跟骨。利用超音波量化參數影像可以進一步分出不同區域，選出同質區的選取區作為不同人的選取量測的標準。
本實驗分為兩部分：假體驗證和人體量測。在假體驗證的部分，可以發現利用改良式輪廓變形模型所偵測的邊界與實際假體邊界相差在1個像素以內；將假體依四種不同選取區的結果做比較，可以發現利用輪廓選取與骨礦物質密度相關性可高達0.99。在人體量測的部分，探討在不同選取直徑(12-18mm)和不同方式(固定選取(ROIfix)、自動圓形選取(ROIcir)和跟骨輪廓選取(ROIanat))的定位誤差及精確度誤差。當選取直徑越大，尤其在固定選取區時定位誤差的比例越高(10-45%)，而利用改良式輪廓變形模型選取跟骨輪廓的定位誤差發生比例較低(3%)。腳跟骨輪廓的精確度誤差(BUA為1.02，SOS為0.07，STI為0.46)優於利用固定選取區的精確度誤差(BUA為3.75-4.23，SOS為0.42-0.54，STI為1.79-2.71)和利用自動圓形選取區的精確度誤差(BUA為1.78-2.85，SOS為0.19-0.36，STI為1.60-1.91)。所以我們可以利用腳跟骨輪廓選取區做為選取的依據，做為提供臨床上診斷的新標準。

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue leading to bone fragility. Therefore, early diagnosis and prevention of the osteoporosis are very important. Commonly used methods of diagnosing osteoporosis, such as dual-energy X-ray absoroptiometry (DEXA), measure the quantitative aspect of bone mineral density (BMD). Although DEXA is a convenient and precise method, which, however, is associated with ionizing radiation and is endangered the patient with more X-ray exposure.
Ultrasound is a technique that has many advantages, including no exposure to ionizing radiation, low cost and portability. It has been applied for the measurement of ultrasonic parameters including broadband ultrasound attenuation (BUA, dB/MHz), speed of sound (SOS, m/s), and stiffness that is the linear combination of the previous two parameters. To date, the ultrasonic devices measure a value of the ultrasonic parameters at a single location without accurate control of transducer’s position with respect to subject’s heel anatomy. To overcome the above problem, we proposed a method that scans the heel and generates parametric images. It was shown that the images could enhance the performance of the technique by assessing the heterogeneity of the bone and by allowing the selection of similar measurement site (or region of interest (ROI)) for each subject.
This study was divided into two parts, including phantom validation and subject measurements. In the former, we have found that the difference between the contour detected by the modified contour deformable model and the true boundary of the phantom was less than one pixel. We also compared four different ROIs of the phantom, significant relationship was found between contour mean and BMD (r=0.99). For subject test, the influence of different ROI diameters (12-18 mm) and different technique, including fixed region (ROIfix), automatic circular region (ROIcir) and calcaneal contour region (ROIanat), was studied. Measurement with large ROI diameters, especially with fixed region, resulted in a high percentage of position errors (10-45%). In contrast, the calcaneal contour detected by modified contour deformable model resulted in a lower percentage of position errors (3%). Precision errors of the ultrasonic parameters were better at ROIanat (PE=1.02 for BUA, PE=0.07 for SOS, PE=0.46 for STI) than at ROIfix (PE=3.75-4.23 for BUA, PE=0.42-0.54 for SOS, PE=1.79-2.71 for STI) and ROIcir (PE=1.78-2.85 for BUA, PE=0.19-0.36 for SOS, PE=1.60-1.91 for STI). The results indicate that ROIanat provide more accurate measurement of the ultrasonic parameters.

中文摘要..........................................I
英文摘要.........................................Ⅱ
誌謝.............................................Ⅳ
目錄.............................................Ⅴ
表目錄...........................................Ⅷ
圖目錄...........................................Ⅸ
第一章 緒論.......................................1
第1-1節 骨骼的解剖生理........................2
第1-2節 骨質疏鬆症............................3
第1-2-1節 骨質疏鬆的成因.................3
第1-2-2節 骨質疏鬆的分類.................6
第1-3節 目前臨床上主要診斷骨質疏鬆症的儀器....6
第1-4節 文獻回顧..............................9
第1-5節 研究動機.............................11
第二章 超音波的腳跟骨量化參數影像與影像處理技術..13
第2-1節 超音波量化參數之量測.................13
第2-1-1節 雙探頭超音波參數的量測原理....13
第2-1-2節 單探頭超音波參數的量測原理....19
第2-1-3節 堅硬度(STI, Stiffness Index)..21
第2-2節 超音波量化參數影像...................21
第2-2-1節 二維超音波....................22
第2-2-2節 超音波骨密度儀的量化參數影像..23
第2-3節 影像處理技術.........................24
第2-3-1節 傳統的主動輪廓模型............24
第2-3-2節 離散動態輪廓模型..............25
第2-3-3節 腳跟骨的內在能量..............30
第2-3-4節 改良式輪廓變形模型............32
第三章 實驗材料與方法............................45
第3-1節 實驗架構.............................45
第3-2節 待測物之選擇.........................46
第3-2-1節 假體之選擇....................46
第3-2-2節 人體實驗的受測者...................46
第3-3節 超音波骨密度儀(UBIS 5000)的量測......47
第3-3-1節 UBIS 5000的量測流程...........47
第3-3-2節 UBIS 5000量化參數影像的轉換...51
第3-4節 UBIS 5000影像選取之處理流程..........54
第3-4-1節 假體之影像選取處理流程........54
第3-4-2節 人體實驗之影像選取處理流程....54
第3-5節 人體實驗結果的分析比較...............58
第四章 結果與討論................................60
第4-1節 超音波量化參數的轉換.................60
第4-2節 假體實驗.............................61
第4-2-1節 假體之訓練模型................61
第4-2-2節 假體之量測結果................62
第4-2-3節 假體輪廓之比較................65
第4-3節 人體實驗.............................67
第4-3-1節 人體腳跟骨之訓練模型..........67
第4-3-2節 超音波量化參數影像的外部能量..68
第4-4節 人體實驗的結果比較...................70
第4-4-1節 人體腳跟骨實驗量測結果........70
第4-4-2節 不同選取區的定位誤差..........79
第4-4-3節 不同選取區的精確度比較結果.........81
第五章 結論與未來展望............................83
第5-1節 結論.................................83
第5-2節 未來展望.............................84
參考文獻.........................................85
附錄一 Canny濾波器...............................90
附錄二 三次方樣條函數............................92

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