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研究生:余宗銘
研究生(外文):Tsung-Ming Yu
論文名稱:心導管數位化透視攝影之皮膚劑量研究
論文名稱(外文):The Study of Entrance Skin Dose Using Digital Fluoroscopy in the Cardiac Catheterization Laboratory
指導教授:林招膨林招膨引用關係
指導教授(外文):Jao-Perng Lin
學位類別:碩士
校院名稱:元培科學技術學院
系所名稱:影像醫學研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:65
中文關鍵詞:介入性心血管透視攝影檢查熱發光劑量計入射皮膚劑量
外文關鍵詞:Cardiac catheterization fluoroscopythermoluminescent dosimeterentrance skin dose
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據行政院衛生署2004年所公佈的台灣十大死因中,心臟血管疾病的死亡人數達一萬兩千多人。隨著臨床介入性心血管透視攝影檢查和心導管診療手術的使用頻率大幅增加,已將大部分心臟疾病獲得有效的控制。然而接受心導管透視攝影檢查的病人,會有某種程度的輻射暴露,其中皮膚劑量是一值得探討的議題。
本研究採用熱發光劑量計(TLD-100)作為數位化心血管透視攝影皮膚劑量量測工具,在不同手術形式下透視攝影X光機對病人的累積皮膚劑量。依照所做的手術性質進行統計及數據分析研究,做一深入的探討。
實驗共收集到51位病患,按照手術形式區分為:診斷性心血管疾病(CAD)、治療性經皮冠狀動脈成形術(PTCA,1條血管)、PTCA(2條血管)及PTCA(3條血管)等四類。病患於心導管手術中所累積的平均劑量在CAD為5.83 cGy、PTCA(1):12.10 cGy、PTCA(2):20.40 cGy、PTCA(3):21.69 cGy。平均一分鐘所接受的劑量率為1.065 cGy。另外,在平均透視及照相時間上,CAD、PTCA(1)、PTCA(2)及PTCA(3)分別為5.4分鐘/29.73秒、10.9分鐘/42.44秒、29.3分鐘/66.65秒、26.73分鐘/70.62秒。胸廓厚度方面,小於20公分時,其接受到的劑量率為0.811 cGy/min;反之,若大於20公分,則平均的劑量率為1.13 cGy/min。結果顯示,影響皮膚劑量的多寡與透影時間、照相時間、照相次數、影像擷取速率及病人胸廓厚度皆有關係。
藉由本研究期望能給予國內各大醫療院所做一參考。建議未來各醫療機構能對於病人之輻射曝露作一紀錄及統計,建立出一套標準程序來管制相關部門的病人劑量水平,並根據此結果,進一步做有效之預防及日後研究的根據,使得介入性心導管檢查之皮膚劑量能夠獲得有效的規範及控制。

關鍵詞: 介入性心血管透視攝影檢查、熱發光劑量計、入射皮膚劑量
Ranking among the ten major causes of death in Taiwan, the annual death toll from cardiovascular disease already exceeds 12,000 according to figures for 2004 from the Department of Health Executive Yuan, R.O.C.(Taiwan). Significantly increasing the utilization frequency of clinical interventional cardiovascular fluoroscopy procedures can enable effective control of most heart diseases. However, patients who undergo cardiovascular procedures will had a certain level of radiation exposure, and the Entrance Skin Dose(ESD)is a key topic that requires further study. This investigation uses thermoluminescent dosimeter(TLD-100)as a measure for patient skin dose monitoring in a cardiac catheterization fluoroscopy procedure. To measure patient accumulated skin dose under different surgical procedures, the research statistics and data are analyzed using different procedures, and an in depth discussion is conducted.

The study obtains data from 51 patients and classifies it according to the procedures form: CAD(Coronary Artery Disease)、PTCA(Percutaneous Transluminal Coronary Angioplasty-one blood vessel)、PTCA(two blood vessel)and PTCA(three blood vessel). In CAD, patient accumulated skin dose during cardiac catheterization procedures is 5.83 cGy、PTCA(1)is 12.10 cGy、PTCA(2)is 20.40 cGy、and PTCA(3)is 21.69 cGy. Following analysis, patient average skin dose is 1.065 cGy/min during cardiac catheterization procedures. Regarding thorax thickness, if patient thorax thickness is less than 20 centimeters, its average dose is 0.811 cGy/min. Meanwhile, the average dose is 1.13 cGy/min if the thorax thickness exceeds 20 cm. Additionally, influences on skin dose include the fluoroscope time、exposure time、number of exposures、frame rate and patient thorax thickness.

This investigation expects to be able to a reference documents in all large domestic medical institutes or hospitals. This study proposes that all medical institutes or hospitals should record statistics regarding patient exposure, and establishes the patient dose limit controlled by a standardization program in the relevant department. Based on the results, enabling further control of patients skin dose in cardiac catheterization procedures.

Keywords: Cardiac catheterization fluoroscopy,
thermoluminescent dosimeter, entrance skin dose
摘要..............................................................i
Abstract......................................................... ii
誌謝..............................................................iv
目錄...............................................................v
圖目錄.......................................................... vii
表目錄........................................................... ix
頁次
第一章 緒論........................................................1
1.1 前言.......................................................1
1.2 皮膚劑量之定義..............................................3
1.2.1 皮膚免除效應..............................................3
1.2.2 皮膚破壞效應..............................................4
1.3 文獻探討....................................................5
1.3.1 相關研究回顧..............................................5
1.3.2 輻射防護之概念............................................6
1.3.3 輻射生物效應..............................................7
1.4 研究目的...................................................12
1.5 實驗架構...................................................12
第二章 實驗儀器與設備...............................................14
2.1 數位化透視主機..............................................14
2.1.1 傳統心導管透視攝影與數位化透視攝影之不同處....................16
2.2 熱發光劑量計................................................17
2.2.1 熱發光原理................................................20
2.2.2 輝光曲線..................................................21
2.2.3 熱發光劑量計計讀儀.........................................23
第三章 研究步驟與方法...............................................25
3.1 熱發光劑量計TLD-100型晶片之處理與使用.........................25
3.1.1 TLD-100之迴火............................................25
3.1.2 TLD-100之篩選............................................26
3.1.3 TLD-100之校正............................................27
3.2病人之入射皮膚劑量............................................29
3.3病人的基本資料統計............................................31
3.4皮膚劑量之評估方式............................................37
第四章 結果與討論...................................................39
4.1 熱發光劑量計TLD-100型晶片之篩選與校正..........................39
4.2 入射皮膚劑量.................................................40
4.3 其他輻射敏感器官之入射皮膚劑量.................................41
4.4 透視時間、照相時間及照相次數統計...............................42
4.5 攝影角度統計................................................47
4.6 討論.......................................................56
4.6.1 其他相關研究比較...........................................56
4.6.2 手術形式對劑量之影響.......................................57
4.6.3 透視時間、照相時間對劑量之影響..............................57
4.6.4 胸廓厚度對劑量之影響.......................................57
4.6.5 攝影角度對劑量之影響.......................................58
4.6.6 誤差之探討................................................58
第五章 結論及展望...................................................59
參考文獻...........................................................61
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