臺灣博碩士論文加值系統

將電腦斷層的七個掃描參數因子(kVp、mAs、螺距、FOV、切片厚度、旋轉時間和矩陣大小)組成田口方法獨特的L18直交表，對周邊動脈阻塞性疾病（PAOD）症候群的電腦斷層掃描進行最佳化的參數設定分析，在最佳化過程中，採用自製線群塊規假體來量化最小可偵測差異(minimum detectable difference, MDD）。首先將L18直交表產生之電腦斷層影像，經由三位訓練有素的資深放射師各別進行了三次排序專家審視，得到最佳化電腦斷層掃描設定參數組合，PAOD的最佳CT掃描參數為100kvp、 240 mAs、0.513掃描螺距、320 FOV、4.0 mm切片厚度、旋轉時間0.75s與768×768矩陣大小。最後經由最小可偵測差異（MDD）經修正後的學生t檢定和變異數分析證實為1.43 mm，深度為0.35 mm。在最佳化過程中，由於可以擴大和加強群組之間的影像相關性，所以採用的排序方法優於算分方法。對不同醫療儀器設備和文獻來源的MDD進行了比較分析，結果顯示根據量化的MDD，心臟X光儀器具有最佳的空間解析率。同時，由於相對使用較低的kVp或者和mAs，本研究採用PAOD之電腦斷層掃描參數所得到MDD數據是優於先前腹部實驗的結果。

Seven factors of CT (kVp, mAs, pitch, FOV, slice thickness, rotation time, and matrix size) were organized into Taguchi unique L18 orthogonal array to optimize the CT scan protocol for peripheral arterial occlusive disease (PAOD) syndrome. An indigenous line group gauge was adopted to quantify the minimum detectable difference (MDD) in the optimizing process. The optimal combination of CT scan protocols was obtained from three well-trained radiologists who ranked the scanned images of the gauge three times. The optimal setting of CT scan protocol for PAOD was 100 kVp, 240 mAs, 0.513 pitch, 320 FOV, 4.0 slice thickness, rotation time of 0.75s, and 768×768 matrix size. The smallest MDD was verified as 1.43 mm at a 0.35 mm depth of the gauge by the revised Student's t-test and ANOVA. The ranking process was found to be preferable than grading in the optimizing process because the imaging correlation among groups could be magnified and emphasized. The comparative analysis of various MDDs obtained from different medical facilities and literary sources was performed, which revealed that the cardiac X-ray provided the finest spatial resolution according to the quantified MDD. Meanwhile, the CT scan protocol for PAOD adopted in this study had finer MDD than that for the abdomen due to comparatively low kVp or/and mAs.

目錄
摘要 I
Abstract II
目錄 III
圖目錄 VII
表目錄 IX
第一章前言 1
1.1 研究背景 1
1.2 研究動機 6
1.3 研究目的 6
1.4 文章架構 7
第二章 背景回顧與文獻分析 9
2.1 周圍動脈阻塞性疾病（Peripheral Arterial Occlusive Disease , PAOD）概論 9
2.1.1 周圍動脈阻塞性疾病其病理機轉 9
2.1.2 周圍動脈阻塞性疾病的診斷 10
2.1.3 周圍動脈阻塞性疾病的治療 12
2.2 研究相關文獻探討 13
2.2.1 電腦斷層(CT)與相關儀器的影像品質分析 13
2.2.2 Minimum Detectable Difference (MDD)之實際運用 16
第三章 材料與方法 19
3.1 田口實驗方法簡述 19
3.1.1 田口實驗方法 19
3.1.2 田口直交表(Orthogonal Array, OA) 20
3.1.3 田口分析法 22
3.1.4 變異係數分析 22
3.2 實驗設備與假體 24
3.2.1 電腦斷層(Computed Tomography)與顯影劑 24
3.2.2 壓克力線群塊規假體 26
3.2.3 擬人下肢壓克力假體 28
3.3 研究實驗設計 31
3.3.1 電腦斷層掃描因子的選用 31
3.3.1.1 管球旋轉時間(Rotation time) 31
3.3.1.2 照野(Field of view, FOV) 31
3.3.1.3 切面厚度(Slice thickness) 32
3.3.1.4 管電流與時間乘積(mAs) 32
3.3.1.5 管電壓峰值(kVp) 32
3.3.1.6 螺距比(Pitch) 33
3.3.1.7 矩陣大小(Matrix size) 33
3.4 直交表實驗因子的設定 34
3.5 CT影像鑑別和評量理論 37
3.5.1 CT影像專家檢定法之Ranking評分方式 37
3.5.2 CT影像品質量化程序 37
3.5.3半高全寬(Full width at half maximum, FWHM)之檢驗方法 39
3.5.4 Minimum Detectable Difference (MDD)之檢驗與計算方法 41
3.6 實驗步驟及流程 43
第四章 結果 45
4.1 CT影像的原始數據資料分析 45
4.1.1 Ranking評分方式的影像數據分析 45
4.1.2 因子反應分析 48
4.2 Ranking評分方式之變異數分析 51
4.3 量化MDD在現實中提供豐富的資訊信息 52
第五章 討論 54
5.1 CT影像實驗因子的交互作用 54
5.2 驗證田口之建議 56
5.3 控制操作運用訊號雜訊比 59
5.4 排序方式優於算分方式 61
5.4.1 電腦斷層影像資料分析之Grading評分方式 61
5.4.2 Grading評分方式的數據分析 62
5.4.3 因子反應分析 64
5.4.4 影像排序方法優於算分方法原因分析 67
5.5 MDD與先前研究結果的比較 69
5.6 CT影像最佳化參數之臨床病例驗證 73
第六章 結論 84
第七章 未來展望 85
參考文獻 86

圖目錄
圖一、血管硬化機轉導致血管形成粥狀樣斑塊 2
圖二、細微之膕動脈和下肢動脈血管網絡 4
圖三、微細的膕動脈與小腿末梢動脈網絡 5
圖四、飛利浦電腦斷層掃描系統 25
圖五、壓克力線群塊規假體(PMMA line group phantom)設計示意圖 27
圖六、擬人小腿壓克力假體和線群塊規假體圖 29
圖七、實際CT掃描影像及猪前臂骨放入壓克力容器圖 29
圖八、壓克力假體與塊規假體放置在CT檯上預備圖 30
圖九、小腿壓克力假體與塊規組裝假體之真實CT側面影像 30
圖十、使用MATLAB將原始CT影像轉換為灰階數值矩陣圖 38
圖十一、兩波峰的平均數與幅高半寬之示意圖 40
圖十二、利用相似三角形定理即可得MDD 之絕對距離 42
圖十三、實驗步驟與流程簡化圖 44
圖十四、線群塊規假體經電腦斷層掃瞄後取得之十八組影像 46
圖十五、Ranking評分方式之因子反應圖 49
圖十六、因子之強與弱交互作用圖 54
圖十七、重要因子與各項設定因子之強烈交互作用圖 55
圖十八、根據MATLAB函數的CT掃描系統之常規預設掃描 58
圖十九、SN 0、SN I 和SNⅡ因不同公式致不同結果之因子反應圖 60
圖二十、Grading評分方式的因子反應圖 65
圖二十一、醫療用商業壓克力假體型號是2144715 Rev 8 71
圖二十二、常規預設參數的商業壓克力假體軸切面CT影像 72
圖二十三、最佳化後參數的商業壓克力假體軸切面CT影像 72
圖二十四、臨床病例驗證案例一之參數最佳化前與後矢狀切面影像 75
圖二十五、臨床病例驗證案例二之參數最佳化前與後矢狀切面影像 76
圖二十六、臨床病例驗證案例三之參數最佳化前與後矢狀切面影像 77
圖二十七、臨床病例驗證案例四之參數最佳化前與後矢狀切面影像 78
圖二十八、臨床病例驗證案例五之參數最佳化前與後冠狀切面影像 79
圖二十九、臨床病例驗證案例六之參數最佳化前與後冠狀切面影像 80
圖三十、 臨床病例驗證案例七之參數最佳化前與後冠狀切面影像 81
圖三十一、臨床病例驗證案例八之參數最佳化前與後冠狀切面影像 82

表目錄
表一、田口方法之L18直交表 21
表二、本研究使用七項CT掃描參數因子與分配之水準 35
表三、參照田口方法所設計之L18 (37)直交表 36
表四、Ranking評分方式，塊規假體之CT影像評分 47
表五、Ranking評分方式之因子反應分析表 50
表六、Ranking評分方式之變異數分析 52
表七、常規預設、第九標和最佳化後參數之MDD精確計算值 57
表八、Grading評分方式，塊規假體之CT影像評分 63
表九、Grading評分方式之因子反應分析表 66
表十、常規預設、第九標、排序及算分數最佳化參數之MDD值 68
表十一、來自各種不同醫療儀器之量化MDD值 70

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