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研究生:沈達亮
研究生(外文):Shen Ta-Liang
論文名稱:台灣執行電腦斷層掃描之醫事放射師與設備現況分析
論文名稱(外文):CT Scanners and Clinical Professionalism Analysis in Taiwan
指導教授:姚學華姚學華引用關係
指導教授(外文):Yao Hsueh-Hua
學位類別:碩士
校院名稱:元培科技大學
系所名稱:醫學影像暨放射技術研究所
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
畢業學年度:102
語文別:中文
論文頁數:82
中文關鍵詞:電腦斷層掃描輻射曝露診斷劑量參考水平醫事放射師
外文關鍵詞:Computed TomographyRadiation ExposureNational Diagnosis Reference Levels (NDRLs)Radiological Technologist
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中文摘要
我國電腦斷層掃描(Computed Tomography, CT),全球逐年有增加使用的趨勢,配合承辦CT品質提升計畫,希望透過全面普查及輔導的方式,建立CT國家診斷劑量參考水平(National Diagnostic Reference Levels, NDRL),合理抑低輻射劑量。
本計畫之執行,期間邀請國內外相關專家學者共同參與,期望進而制定符合我國CT臨床作業規範。整體計畫執行對放射師的人力及素質作檢討,政府相關機關的投入,預期可獲得較理想結果。計畫過程較複雜,預期須二年完成。掌握階段數據與參考參數根據以國人平均身形,符合影像品質與國外數據比對,求取合理數值為後續依循參考。經數次調整分析與驗證,實際數值與歐盟或IAEA的要求也很接近,最後依計畫擇定各區選出標竿醫院,執行第一 年參考水平值雛形於焉完成,並與以確認,將來立法或最後制定診CT斷劑量理想參考值依據基礎。初期各方面問卷回收與後續執行實地驗證,均高達90%以上,對於影像品質或劑量降低也獲極佳成效,其對普遍選擇之國人CT掃描部位以75%位值得參考值意與美國ACR、歐盟甚或IAEA得參考限值相近,其CTDI劑量值亦然,而我國之機器調查及執行之數量完整其效率也相對提升,足資為NDRL之最具體之模式,為我國對兒童之數據與執行CT量較少或未臻完善,但依據既有準則,原能會頒定之數值亦足參酌。
以實證醫學的角度,以病患為中心的立場,對計畫主旨而言,要求服務品質、效率與安全,明顯發現放射專職人力、教育訓練、儀器維護保養咸不足,實質影響CT品保或執行劑量水平,望藉計畫結論中喚起主管機關及各界正視,癥結不在執行計畫的能力,應聚焦檢討人力及教育訓練的落實,提振觀念及理念達成共識。
關鍵詞:電腦斷層掃描,輻射曝露,診斷劑量參考水平,醫事放射師
英文摘要
Computed Tomography (CT) is similar to the well developed countries; the clinical CT application has dramatically increased. Ministry of Health and Welfare draws up positively, to undertake a comprehensive general survey for establish a CT national diagnostic dose reference levels (NDRLs) to formulate a valuable guideline. For the purposes, many experts were invited, to hold a related forum in last two years, for the image quality and the radiation safety on CT.
Throughout the whole process of the project, the similar results has been made, cohered with the ACR, EU even the IAEA advised reference. The investigation for adult’s head abdomen or children‘s reference levels, and regarding the 75% site requested range for CTDI vol and reference levels requests on CT; all about the current outcomes of related digits also ideal. Because of the whole process of questionnaires and feedbacks were satisfied and the returns up to 90%. This represents everything for this stands for the NDRL to be qualified.
But the Radiological Technologists’ forces is an issue on DRLs, the basic requirement is not sufficient, regarding to the education, equipment maintenance and quality assurance, the capabilities for everything but lack of tacit agreement on the matter concern the education and the essential conception of NDRL. The contemporary optimize care and optimize imaging on CT solid components seemly need to be discussed and reviewed.
Keywords: Computed Tomography, Radiation exposure, National Diagnostic Reference Levels (NDRLs), Radiological Technologist

目錄
頁次
中文摘要 .................................................................................................... I
英文摘要 ................................................................................................... II
致謝 .......................................................................................................... III
目錄 ..........................................................................................................IV
表目錄 ......................................................................................................VI
圖目錄 ................................................................................................... VIII
第一章 緒論 .............................................................................................. 1
1.1 研究背景動機 .......................................................................... 1
1.2 歐盟國家劑量參考水平制訂方式 ......................................... 13
1.3 研究目的................................................................................ 19
第二章 資料文獻檢視 ............................................................................. 21
2.1 籌備與規劃內容 .................................................................... 21
2.2 作業之程序及項目 ................................................................ 22
2.2.1 召開會議 ........................................................................... 22
2.2.2 程序及項目 ....................................................................... 22
2.2.3 2.2.3執行問卷及調查表格 ................................................ 22
第三章 材料與方法 ................................................................................ 27
3.1 背景資訊文獻 ........................................................................ 27
3.2 電腦斷層檢查參數資料之填寫方法指導 ............................. 31
第四章 結果與討論 ................................................................................ 39
4.1 全國醫療院所電腦斷層掃描儀資料收集成效 ..................... 39
4.2 主管機關提供全國設置電腦斷層設備分析 ......................... 43
4.2.1 全國目前設有電腦斷層掃描儀之醫院區域分布 ............. 43
V
4.2.2 全國各層級醫院設置電腦斷層機型一覽表 .................... 44
4.2.3 全國各醫院設置CT機型之醫療區域分布 ..................... 45
4.2.4 全國醫療機構電腦斷層檢查參數資料之分析 ................. 45
4.2.5 實地驗證程序請參考「實地驗證成效報告」 ................. 48
4.3 醫療機構CT儀器/操作人員資料分析 ................................. 50
4.3.1 全國各醫院層級執行電腦斷層人員及作業方式 ............. 50
4.4 電腦斷層診斷劑量參考水平 ................................................ 62
4.5 台灣人的標準體型定義之共識............................................. 65
4.6 台灣民眾的電腦斷層診斷劑量參考水平 ............................. 66
第五章 討論 ............................................................................................ 73
5.1 討論 ....................................................................................... 73
5.1.1 國外品保放射師 ............................................................... 74
5.1.2 貫徹實施的思維 ............................................................... 74
5.1.3 老舊機器的思維 ............................................................... 75
5.1.4 CT自費檢查的思維 .......................................................... 75
5.2 結果 ....................................................................................... 75
5.2.1 舉辦國際論壇 ................................................................... 76
5.2.2 我國目前CT掃描劑量增加的理由檢討 ......................... 76
第六章 結論 ............................................................................................ 78
6.1 對於人力與品質與安全訴求 ................................................ 78
6.2 對於CT臨床(醫師)的相關教育訓練 ................................... 78
6.3 對於自費檢查的思維 ............................................................ 78
6.4 最後建議................................................................................ 78
參考文獻 .................................................................................................. 80
參考文獻
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4. AAPM Report No.204. Size-specific dose estimates (SSDE) in pediatric and adult body CT examinations. American Association of Physicists in Medicine: 2011. 5. Foley SJ, McEntee MF, Rainford LA. Establishment of CT diagnostic reference levels in Ireland. The British Journal of Radiology. 2012;85:1390-7.
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10. IAEA Safety Series No. 115; International basic safety standards for protection against ionizing radiation and for the safety of radiation sources. 1996.
11. ICRP Publication 73. Radiological protection and safety in medicine. 1996.
12. Shrimpton PC, Jones DG, Hillier MC et al. Survey of CT practice in the UK. Part 2: dosimetric aspects. NRPB Report R249 (Chilton, UK: NRPB). 1991.
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13. European guidelines on quality criteria for computed tomography. EUR 16262 EN. Luxembourg, Office for Official Publications of the European Communities. 1999.
14. ICRP Publication 102. Managing patient dose in multi- detector computed tomography (MDCT). 2007.
15. ICRP Committee 3, Diagnostic reference levels in medical imaging, Annals of the ICRP 2001;31(4):33-52.
16. American College of Radiology. ACR practice guideline for diagnostic reference levels in medical X-ray imaging. 2002 (revised 2008).
17. Swedish Radiation Protection Authority. Regulations and general advice on diagnostic standard doses and reference levels within medical X-ray diagnostics. Swedish Radiation Protection Authority. 2002.
18. Brix G. Notice of diagnostic reference values for radiology and nuclear medicine studies. Federal Office for Radiation Protection, Germany. 2003.
19. Stirling G, Cotterill A. Computed tomography in diagnostic radiology: a survey of use and patient doses for New Zealand. 2007.
20. Aroua A, Besancon A, Buchillier- Decka I, et al. Adult reference levels in diagnostic and interventional radiology for temporary use in Switzerland, Radiation Protection Dosimetry 2004;111(3):289- 95.
21. Tung CJ, Tsai HY, Lo SH, Guan CN, Chen YB. Determination of guidance levels of dose for diagnostic radiography in Taiwan, Med. Phys. 2001;28:850-7.
22. Regulations for the administration and enforcement of the radiation control for health and safety act of 1968. USDHHS, 2006.
23. Title 10 NY Code of Rules and Regulations, Chapter I, Part 16. Ionizing radiation. 2004.
24. The American College of Radiology Accreditation Program for Computed Tomography. ACR. 2008.
25. 董傳中、蔡惠予、李振弘、朱健豪,電腦斷層掃描X射線劑量評估研究,行政院原子能委員會委託研究計畫,計畫編號:962001INER011, 2007.
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26. 蔡維達、杜俊元、楊邦宏、魏聰文、李文星、洪世凱、邱文彥、林宏益電腦斷層診斷參考水平簡介,台灣醫事放射期刊2012;1:1-9.
27. 衛生福利部,醫療機構現況及醫院服務量統計年報,101年度醫療服務量,二、例年醫院概況,表16歷年特定醫療技術件查檢驗醫療儀器使用人次,http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2758.
28. 黃怡璇、陳健全、廖彥朋、關婉君、蔡惠予、劉鶴齡,醫療曝露診斷參考水平的建立與使用:中華民國醫學物理學會診斷參考水平工作群建議, Formosan J. Med. 2012;16. 29. 蔡惠予、陳建全、黃怡璇、劉鶴齡,X光電腦斷層系統之物理測試彙整建議:中華民國醫學物理學會電腦斷層工作群報告,中華放射醫誌2009;34:173-84.
30. 董傳中、蔡惠予、林怡君,台灣分齡小兒電腦斷層檢查的劑量與風險評估,行政院國家科學委員會專題研究計畫,計畫編號:NSC93-2314-B-007-004, 2005。 31. 中華民國醫事放射師公會:2012國際論壇大會手冊,台北,2012。 32. 中華民國醫事放射師公會:2013國際論壇大會手冊,台北,2013。
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