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研究生:王暄棉
研究生(外文):WANG,SHUAN-MIEN
論文名稱:放射治療中引起病人不良嗅覺情形之相關研究
論文名稱(外文):A study investigating abnormal olfactory sensation during delivery of radiotherapy
指導教授:郭宗德郭宗德引用關係
指導教授(外文):KUO,TSUNG-TER
口試委員:郭宗德陳一瑋莊奇容
口試委員(外文):KUO,TSUNG-TERCHEN,YI-WEICHUANG,CHI-JUNG
口試日期:2017-06-18
學位類別:碩士
校院名稱:元培醫事科技大學
系所名稱:醫學影像暨放射技術系碩士在職專班
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:2017
畢業學年度:105
語文別:中文
論文頁數:56
中文關鍵詞:放射治療異常感受嗅覺高劑量率嗅球接收劑量
外文關鍵詞:radiotherapyabnormal olfactoryolfactory sensationhigh dose rateolfactory bulb absorbed dose
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在放射治療的臨床中,患者會抱怨在治療當下聞到異味,部分患者甚至因無法忍受異味而嘔吐,險些造成嗆傷甚至翻身跌落治療床。本研究嘗試找出異味與治療過程的關聯性及異味發生的原因,盼能解決臨床上治療過程中可能發生的潛在危險問題。
為釐清異味的來源,選擇60位不限定放射治療部位的患者,及20位治療時須佩戴面具的患者,詢問在治療過程中的感受。結果60位患者中有3位,20位中也有3位聞到異味,都是治療腦部的患者,在某個特定的治療角度聞到異味,用視頻紀錄聞到異味時舉手的時間點,搭配治療計畫系統檢視分析,結果顯示產生異味和治療時嗅球是否位於照野內有顯著相關。進一步將於不同臺加速器治療的患者個別分析。A牌治療機治療的有聞到異味的19位患者共計78門治療角度,其中有聞到異味與沒有聞到異味的治療角度,以SPSS分析患者的年齡、性別、有無吸菸、照射時劑量率、嗅球、梨葉和眶額皮質區的單次治療接收劑量與聞到異味相關性。結果為當嗅球接受劑量超過16.7cGy時即有可能產生異味感。當嗅球分次接收劑量增加1cGy,聞到異味的機率會增加1.067倍。B牌治療機聞到異味的22位患者共計66門治療角度,方法同上,結果當治療時加速器的瞬時劑量率超過446.5MU/min時即有可能產生異味感。並且當劑量率每增加1MU/min,就會多增加3.1倍的機會聞到異味。
本研究嘗試找出異味與治療過程的關聯性及異味發生的原因,盼能解決臨床上治療過程中可能發生的潛在危險。

During delivery of radiotherapy, some patients complained of unpleasant odor sensation like garlic, raw dumpling, pool, raining … etc. Most of patients said that they never experienced an odor like that, but they would just try to describe what it smelled like. A substantial portion of these patients may not be able to tolerate the odor so that they may throw up, choke or even fall down from the couch. This study aims to investigate the cause of the abnormal odor sensation from the factors during radiotherapy, hopefully preventing potential risk in clinical practice.
Multiple experiments were conducted to identify the factors that may correlate to the abnormal odor.
The 1st experiment: 60 patients, including head and neck cancer, lung cancer, breast cancer, intraabdominal cancer, pelvic cancer and total body irradiation (TBI), were queried about whether they sensed the abnormal odor or not.
The 2nd experiment: 20 patients with thermoplastic mask during radiotherapy, including 5 oral cavity cancers, 5 nasopharyngeal cancers, 5 whole brain radiotherapy and 5 focal brain radiotherapy, were queried about whether they sensed the abnormal odor or not.
The 3rd experiment: Two of the patients receiving whole brain radiotherapy sensed the odor at specific treatment angle. By video record, the timing and treatment angle at which the 2 patients reported odor during treatment were correlated with the candidates of anatomical structures in treatment planning system.
Because the condition of machines varies in linear accelerators of different vendors, the patients were analyzed separately in two groups: vendor A and vendor B.
The 4th experiment: 19 patients who were treated with linear accelerator of vendor A sensed the odor. The number of treatment angles of each patient ranged from 2 to 7, totaling 78 angles among the 19 patients. These included odor-positive and odor-negative angles. The correlation between the odor occurrence and factors including age, gender, smoking, dose rate and single fraction doses of olfactory bulb, piriform lobe and orbito-frontal cortex was analyzed using logistic regression model (SPSS software).
The 5th experiment: 22 patients who were treated with linear accelerator of vendor B sensed the odor. The total number of treatment angles was 66 among them. The statistical method was the same as that aforementioned.
In the 1st experiment, 3 patients sensed the odor during radiotherapy, all of whom received radiotherapy to brain. In the 2nd experiment, 3 patients sensed the odor, all of whom received brain radiotherapy including 2 whole brain radiotherapies and 1 focal radiotherapy to pituitary fossa.
In the 3rd experiment, the occurrence of odor was significantly associated with the olfactory bulb within treatment field.
In the 4th experiment (group of vendor A), the threshold dose of the odor occurrence was 16.7cGy to olfactory bulb. The patients tend to sense the odor when their doses to olfactory bulb were more than this threshold. An increment of the doses to olfactory bulb by 1cGy was associated with an odds ratio of 1.067 relevant to the odor occurrence.
In the 5th experiment (group of vendor B), dose rates turned to be main factor related to odor. The patients tend to sense the odor when their instantaneous dose rates were more than 446.5MU/min. An increment of the dose rates by 1MU/min was associated with an odds ratio of 3.1 relevant to the odor occurrence.
The cause of the abnormal odor during radiotherapy may be complicated. Patient factors, irradiation field, doses, and dose rates may be correlated with the odor occurrence. The sensation may differ between different patients receiving similar radiotherapy plan. Dose rates and doses to specific anatomical structure may be important factors associated with the odor occurrence.

口試委員審定書 I
誌謝 II
中文摘要 III
英文摘要 IV
目錄 VII
圖目錄 IX
表目錄 XI
第一章 緒論 1
1.1動機與目的 1
1.2 研究問題 4
1.3 名詞解釋 4
第二章、文獻討論 9
2.1 西元1991年的臨床實驗 9
2.2 紐約城1969年的老鼠實驗 11
2.3 放射線是否能引起神經衝動 15
2.4 當放射線照射到細胞 15
2.5 放射線產生的自由基和粒腺體的交互作用 16
2.6 嗅覺的路徑 17
2.7 嗅功能在接受放射治療後的改變: 19
第三章、材料及研究方法 22
3.1實驗器材 22
3.2實驗設計,釐清異味的來源 22
3.3異味產生與否與嗅覺相關區域是否被照射的相關性 24
3.4嗅覺區域接收劑量與異味感的關連性 31
3.5異味感與放射治療中劑量率的相關性 31
第四章、結果 32
4.1 研究與實驗參予者 32
4.2資料分析 32
第五章、討論 39
5.1依癌症種類討論受試者: 39
5.2 嗅覺的主觀性 40
5.3 嗅覺辨別與大腦資料庫 41
5.4 大腦辨識氣味的極限 41
5.5一種味道如何勾起回憶 42
5.6 異味的來源 43
第六章 結論 47
6.1概述 47
6.1 檢討本實驗的缺失 49
6.2 結果推測與未來展望 50
參考文獻 51
附錄 54
附表一 54
附表二 56

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