本文選題：Pubmed + CNKI��； 參考：《北京協(xié)和醫(yī)學院》2013年碩士論文

【摘要】：目的：探討近十年來國內(nèi)外CT低劑量領(lǐng)域的研究現(xiàn)狀,揭示該領(lǐng)域的發(fā)展特點和規(guī)律,為該領(lǐng)域的進一步研究提供參考。 材料及方法：以PubMed為搜索引擎的Medline數(shù)據(jù)庫,中國知網(wǎng)(CNKI)的中國學術(shù)期刊網(wǎng)絡(luò)出版總庫(China Academic Journal Network Publishing Database,CAJD)以及Web of Science的科學引文數(shù)據(jù)庫(Science Citation Index, SCI)中2002年—2011年間國內(nèi)外發(fā)表的CT低劑量研究論文為研究對象,采用Thomson Data Analyzer (TDA)分析軟件進行數(shù)據(jù)清洗,從作者合作趨勢、機構(gòu)、機構(gòu)合作度、期刊發(fā)文趨勢、國家和國內(nèi)地區(qū)分布、高被引文獻、熱點詞頻等方面進行文獻計量學,并利用SAS8.2編程做聚類分析。 結(jié)果：2002年—2011年間Medline共收錄CT低劑量文獻6433篇；CNKI收錄3148篇；Web of Science收錄6027篇。此領(lǐng)域的高產(chǎn)作家為發(fā)表文獻4篇以上的作家。CT低劑量領(lǐng)域相關(guān)的9種核心期刊在國際放射學領(lǐng)域擁有較高影響因子。其中,Medical Physics、European Journal of Radiology和American Journal of Roentgenology成為該領(lǐng)域發(fā)表高質(zhì)量論文最具代表性的期刊,且發(fā)文量保持逐年快速增長。單篇論文平均作者數(shù)5.93,合作率為89.4%,單篇論文平均機構(gòu)數(shù)2.63,合作率為77.3%,并均呈現(xiàn)逐年遞增趨勢。按國家劃分,美國發(fā)文量3165篇,占總文獻量的49.2%,成為CT低劑量研究的核心力量區(qū)。而我國十年來在該領(lǐng)域發(fā)表SCI論文共計174篇,發(fā)文量較少。我國CT低劑量研究發(fā)文作者來自471個相關(guān)機構(gòu)、33個主要地區(qū),其中北京、上海兩地總發(fā)文量占45.9%。該領(lǐng)域涉及10種核心期刊,其中以中國醫(yī)學影像技術(shù)、中華放射學雜志發(fā)文量最高。該領(lǐng)域十年間獲基金資助發(fā)文量868篇,占國內(nèi)總發(fā)文量的27.57%。CT低劑量的研究熱點主要涉及肺癌篩查、冠狀動脈造影檢查、肺動脈栓塞檢查、CT結(jié)腸仿真內(nèi)窺鏡技術(shù)、CT輻射劑量等。 結(jié)論：十年間CT低劑量研究在國內(nèi)外都得到了大量開展并得到了行業(yè)的廣泛關(guān)注。CT低劑量研究己初具規(guī)模。CT低劑量研究是涉及醫(yī)學、工學、數(shù)理學等多學科的交叉科學,多作者、多學科、多機構(gòu)間的廣泛合作有助于開展更為深入的研究。我國CT低劑量研究與國際同期水平相比尚處于初級階段,科研力量地區(qū)分布極不均衡。相關(guān)研究的發(fā)文數(shù)量、質(zhì)量還有待于進一步提高。加強CT低劑量相關(guān)的基礎(chǔ)研究以及相關(guān)研究的創(chuàng)新性,完善CT低劑量研究所涉及的醫(yī)學倫理、臨床科研方法等不足可加快該領(lǐng)域研究不斷深入的步伐。 目的：探討個體化因素對成人腹部CT圖像質(zhì)量的影響,篩選最具代表性且簡單易行的指標作為調(diào)節(jié)成人腹部CT掃描參數(shù)的分組標準。并確定成人腹部CT圖像質(zhì)量客觀測量的最佳層面區(qū)域。 材料及方法：對2012年3月-10月間有臨床診斷或治療需求的144例患者,以固定管電流模式行腹部CT平掃檢查。記錄患者的身高、體重,并測量定位像上經(jīng)L1椎弓根水平的腹左右徑,測量腹部CT橫斷面圖像經(jīng)第一肝門水平的腹部徑向數(shù)據(jù)。利用3D reformat軟件的X SECTION功能在臍水平測量腹腔內(nèi)脂肪含量百分比及皮下脂肪厚度數(shù)據(jù)�？疾爝@些個體化因素與腹部CT圖像質(zhì)量間的相關(guān)性。選擇腹部常規(guī)CT檢查圖像的肝頂、第一肝門、腎門、腎下極4個層面的腹主動脈區(qū)以及第一肝門層面出現(xiàn)的其他代表性的6個測量區(qū)(門靜脈、肝實質(zhì)周邊、肝實質(zhì)中心、脾、豎脊肌、前腹壁皮下脂肪)進行圖像噪聲測量。比較在相關(guān)性較高的個體化參數(shù)作為基礎(chǔ)水平下所有測量區(qū)的噪聲值與圖像質(zhì)量間的相關(guān)性,從而最終確定成人腹部常規(guī)CT檢查圖像的客觀評價測量的最佳區(qū)域。 結(jié)果：各種個體化因素與客觀圖像質(zhì)量噪聲值間的相關(guān)系數(shù)分別是0.267(身高)、0.702(體重)、0.7(體重身高比)、BMI(0.661)、0.744(定位像L1椎弓根水平腹左右徑測量值)、0.739(最大腹橫徑)、0.712(最大腹前后徑)、0.765(上腹部平均最大徑)、0.613(內(nèi)臟脂肪測量值)、0.431(皮下脂肪測量值)。且定位像上腹左右徑測量值與第一肝門水平最大腹橫徑測量值間比較,有強相關(guān)(R=0.931)。以腹平均徑為基礎(chǔ)水平,4個層面腹主動脈區(qū)測量的噪聲值與圖像質(zhì)量的相關(guān)性系數(shù)R為0.522-0.765,第一肝門層面相關(guān)性最高。以相關(guān)性較高的個體化因素為不同的基礎(chǔ)水平,第一肝門層面的肝實質(zhì)周邊測量區(qū)的噪聲值與圖像質(zhì)量相關(guān)性最高(R0.74-0.802),腹主動脈次之(R0.712-0.765)。前腹壁皮下脂肪與圖像質(zhì)量的相關(guān)性最差(R=0.412,P0.05)。 結(jié)論：本研究涉及的個體化因素與圖像質(zhì)量間有相關(guān)性(0.267-0.765),其中腹部徑向因素的相關(guān)性最高。定位像L1椎弓根水平腹左右徑測量值可作為簡便易行的調(diào)節(jié)成人腹部CT掃描參數(shù)的指標。第一肝門層面的腹主動脈區(qū)是成人腹部常規(guī)CT檢查圖像質(zhì)量客觀評價測量的最佳區(qū)域,其噪聲測量值在一定程度上可指標腹部常規(guī)CT掃描的客觀圖像質(zhì)量。 目的：探討自動管電流調(diào)制技術(shù)對成人腹部CT掃描的圖像質(zhì)量及輻射劑量影響。 材料及方法：(1)模體研究：選用Catphan600性能測試模型為觀察對象,配合成人腹部體環(huán)模擬成人腹部CT低、高對比特點。采用常規(guī)腹部標準電壓120kv,固定管電流450mA及自動毫安技術(shù)NI值設(shè)置為4-14、16、18、20,管電流范圍10-450mA對模型進行掃描。測量catphan600均質(zhì)區(qū)域CT值,驗證模型對X線衰減的等效性。記錄每組掃描方案的輻射劑量指標容積CT劑量指數(shù)(CTDIvol)、個體化劑量估計值(SSDE)、劑量長度積(DLP)、有效劑量(ED)：圖像質(zhì)量客觀評價指標圖像噪聲值(SD)、對比-噪聲比(CNR)。同時由3名來自3家醫(yī)院分別有5年以上工作經(jīng)驗的腹部診斷醫(yī)師對catphan600中的低對比可探測能力(low contrast detectability, LCD)及高對比可探測能力(high contrast detectability, HCD)進行獨立觀察和評分。分析不同NI值與圖像質(zhì)量主、客觀評價指標及輻射劑量指標間的相關(guān)性,并比較不同NI值與腹部標準掃描條件下所得到的SD、CNR及HCD.LCD評分間的差異。(2)選取2012.3至2013.3間需腹部CT平掃患者120例,按比例分層分配隨機抽樣方法以定位像上經(jīng)L1水平測量腹橫徑(D/cm)不同為區(qū)組標準,分為實驗組及對照組共6組,每組20例。實驗組以120kv, ATCM (NI=10),管電流范圍10-450mA;對照組120kv、450mA完成掃描。測量肝頂、肝門、腎下極3個層面的腹主動脈區(qū)圖像噪聲值。由3名醫(yī)師獨立進行腹主動脈、門靜脈、肝臟、脾臟、胰腺、腎臟6個器官的主觀噪聲評價和肝門、胰腺、腎門3個層面的圖像可接受率評價。記錄并計算受檢者所受輻射劑量指標及主要層面的毫安值。圖像質(zhì)量評分比較采用秩和檢驗,各區(qū)組間圖像噪聲值及輻射劑量指標采用方差分析,各區(qū)組內(nèi)兩兩比較采用t檢驗。 結(jié)果：(1)此模型與成人腹部對X線衰減具有較好的等效性。NI值與圖像質(zhì)量主、客觀評價指標及輻射劑量指標間呈較高的線性相關(guān)(r=0.758-0.965,P0.01)；實驗組NI=4-7組與對照組間SD、CNR差異均無統(tǒng)計學意義(t值分別為一0.17-1.63,0.03～1.12,P值均0.05)。實驗組NI=4-10組與對照組間LCD評分差異均無統(tǒng)計學意義(Z值為一0.313～1.637,P值均0.05)。實驗組NI=4～13組與對照組間HCD得分差異均無統(tǒng)計學意義(Z值為一0.147-一1.423,P值均0.05)。(2)實驗組及對照組的主觀圖像質(zhì)量評分比較差異無統(tǒng)計學意義(Z=-1.831--1.000,P值均0.05)：實驗組與對照組在D-≤33.4cm區(qū)組輻射劑量指標比較差異有統(tǒng)計學意義(t=-6.13--3.93,P值均0.05)；實驗組內(nèi)各區(qū)組及各層面間圖像噪聲測量值比較差異無統(tǒng)計學意義(F=0.46-1.37,P值均0.05)；實驗組各區(qū)組間輻射劑量指標比較差異有統(tǒng)計學意義(F=15.88-42.78,P值均0.05)。 結(jié)論：當NI值在8-10時,在保證圖像質(zhì)量LCD評分指標不受影響的前提下,與腹部標準掃描條件相比降低25.33%的輻射劑量。隨NI值的改變HCD的變化不大,當NI≥14時HCD顯著下降。在腹部CT掃描中應(yīng)用ATCM(NI=10)技術(shù)可保證低對比病灶檢出能力不受影響,與此同時使輻射劑量與固定管電流模式相比下降11.2%-78.3%。
[Abstract]:Objective: To explore the research status of CT low dose field at home and abroad in recent ten years, and to reveal the characteristics and laws of the development in this field, and to provide reference for further research in this field.
Materials and methods: the Medline database of PubMed as the search engine, the China Academic Journal Network Publishing Database, CAJD, and the scientific citation database from 2002 to 2011 of the Chinese Academic Journal (CNKI). The quantity research paper is the research object, using the Thomson Data Analyzer (TDA) analysis software to carry on the data cleaning, from the author's cooperation trend, the organization, the organization cooperation degree, the periodical issuing trend, the national and domestic distribution, the high cited literature, the hot word frequency and so on, and using SAS8.2 programming to do cluster analysis.
Results: from 2002 to 2011, Medline included 6433 low doses of CT, 3148 CNKI and 6027 of Science. The high-yield writers in this field have higher influence factors in the field of international Radiology, which have more than 4 writers in the field of low dose.CT. Among them, Medical Physics, Europe An Journal of Radiology and American Journal of Roentgenology have become the most representative periodicals of high quality papers published in this field, and the amount of writing is increasing rapidly year by year. The average author number of single paper is 5.93, the rate of cooperation is 89.4%, the average number of single papers is 2.63, the cooperation rate is 77.3%, and the trend of increasing year by year is increasing. According to the country, the number of papers is increasing year by year. In the United States, 3165 articles, accounting for 49.2% of the total amount of literature, have become the core strength area of CT low dose research. In our country, there are 174 papers published in this field in the past ten years in this field, and the amount of writing is less. The author of low dose research in CT of our country comes from 471 related institutions and 33 main areas, including Beijing and Shanghai, which account for 45.9%. The field involves 10 core periodicals, among which Chinese medical imaging technology, the Chinese Journal of radiology has the highest amount of delivery, and 868 of the funds have been funded in the field in ten years, and the low dose of 27.57%.CT, which accounts for the total amount of domestic service, is mainly involved in lung cancer screening, coronary angiography, pulmonary embolism, and CT colon simulation. Mirror technology, CT radiation dose and so on.
Conclusion: the low dose study of CT in the past ten years has been carried out in a large amount both at home and abroad and received extensive attention from the industry..CT low dose research has begun to take initial scale,.CT low dose research is a cross science involving medicine, engineering, mathematics and other disciplines. Many authors, multidisciplinary and multi agency cooperation will help to carry out more in-depth research. The low dose study of CT in China is still in the primary stage compared with the international level of the same period. The distribution of scientific research forces is very uneven. The quantity and quality of the related research are still to be further improved. The basic research on the low dose of CT and the innovation of related research are strengthened, and the medical ethics involved in the low dose research of CT is perfected, and the clinical department is perfected. Deficiencies in research methods can speed up the pace of research in this field.
Objective: To investigate the influence of individualized factors on the quality of adult abdominal CT images, and to screen the most representative and simple index as a standard for adjusting the CT scan parameters of adult abdomen, and to determine the optimal level area for the objective measurement of the quality of CT images in the abdomen of adults.
Materials and methods: 144 patients with clinical diagnostic or therapeutic needs during the -10 month of March 2012 were performed abdominal CT scan with fixed tube current mode. The height and weight of the patients were recorded and the abdominal diameter of the pedicle of the L1 pedicle on the positioning image was measured, and the abdominal radial data of the abdominal CT cross section like the level of the first hepatic portal was measured. The X SECTION function of the 3D reformat software was used to measure the percentage of intraperitoneal fat content and the thickness of subcutaneous fat at the umbilical level. The correlation between these individualized factors and the mass of the abdominal CT image was examined. The liver top, the first hepatic portal, the renal gate, the 4 layers of the subrenal pole, and the first hepatic hilar layer were selected for the abdominal routine CT examination. Image noise measurement of 6 other representative areas (portal vein, liver parenchyma, liver parenchyma center, spleen, erect ridge muscle, subcutaneous fat in the anterior abdominal wall). The correlation between the noise value of all measured areas and the quality of image in all measured areas was compared, and the adult abdomen was finally determined. The best area of measurement is objective evaluation by routine CT examination.
Results: the correlation coefficients between the individual factors and the objective image quality noise values were 0.267 (height), 0.702 (weight), 0.7 (weight to height ratio), BMI (0.661), 0.744 (the location of the L1 pedicle horizontal abdominal diameter measurement), 0.739 (the largest abdominal transverse diameter), 0.712 (the maximum abdominal diameter), 0.765 (the average maximum diameter of the upper abdomen), 0.613 (visceral fat). The measurement value of the fat), 0.431 (subcutaneous fat measurement). There is a strong correlation between the measured values of the upper abdominal diameter and the maximum abdominal transverse diameter of the first hepatic portal (R=0.931). It is based on the average diameter of the abdomen, and the correlation coefficient of the noise value measured by the abdominal aorta at the 4 levels and the image quality is 0.522-0.765, the first liver gate level. The correlation was the highest. With the higher correlation of individualized factors as the basic level, the correlation between the noise value of the parenchyma surrounding area at the first hepatic portal level and the image quality was the highest (R0.74-0.802), the abdominal aorta was (R0.712-0.765). The correlation between the subcutaneous fat of the anterior abdominal wall and the image quality was the worst (R=0.412, P0.05).
Conclusion: there is a correlation between the individual factors and the image quality involved in this study (0.267-0.765), and the correlation between the abdominal radial factors is the highest. The measurement value of the horizontal abdominal diameter of the pedicle of the pedicle of the L1 can be used as an easy and easy parameter to regulate the CT scanning parameters of the adult abdomen. The abdominal aorta of the first hepatic portal is the routine of the abdominal routine. CT image quality is the objective area to evaluate the best area of measurement, and its noise measurement value can indicate the objective image quality of abdominal routine CT scan to a certain extent.
Objective: To investigate the effect of automatic tube current modulation on image quality and radiation dose of adult abdominal CT scan.
Materials and methods: (1) model body study: using the Catphan600 performance test model as the observation object, combined with adult abdominal body ring to simulate adult abdominal CT low and high contrast characteristics. The conventional abdominal standard voltage 120kv, the fixed tube current 450mA and the automatic Ma technique NI value are set to 4-14,16,18,20, and the tube current range 10-450mA is used to scan the model. The CT value of the catphan600 homogeneous region was measured to verify the equivalence of the model for X-ray attenuation. The dose index volume CT dose index (CTDIvol), individual dose estimate (SSDE), dose length product (DLP), effective dose (ED), image quality objective evaluation index image noise value (SD), contrast noise ratio (CNR), were recorded in each group. 3 abdominal diagnostics with more than 5 years' experience from 3 hospitals were independently observed and graded on the low contrast detectability (low contrast detectability, LCD) and high contrast detectability (high contrast detectability, HCD) in catphan600. The correlation between the dose of radiation dose and the difference between the different NI values and the SD, CNR and HCD.LCD scores under the abdominal standard scan. (2) 120 cases with abdominal CT scan were selected from 2012.3 to 2013.3, and the proportional stratified distribution random sampling method was used to locate the L1 level of the abdominal transverse diameter (D/cm) as the regional group standard. The experimental group and the control group were 6 groups, with 20 cases in each group. The experimental group was 120kv, ATCM (NI=10), the tube current range 10-450mA, the control group 120kv, 450mA completed the scanning. The image noise values of the abdominal aorta in 3 levels of the liver top, the hepatic portal and the lower renal pole were measured. The main 6 organs of the abdominal aorta, the portal vein, the liver, the spleen, the pancreas, and the kidneys were operated by 3 physicians. The evaluation of the image acceptance rate and the evaluation of the image acceptability of the 3 levels of the liver gate, the pancreas and the portal, recorded and calculated the doses of radiation dose and the values of the main level. The image quality score was compared with the rank sum test. The image noise value and the radiation dose index were analyzed by the variance, and the t test was used in the 22 areas in each group.
Results: (1) this model has a good equivalent.NI value with the image quality of the X-ray attenuation in the adult abdomen, and a higher linear correlation between the objective evaluation index and the radiation dose index (r=0.758-0.965, P0.01); the difference of SD and CNR between the NI=4-7 group and the control group in the experimental group is not statistically significant (t value is 0.17-1.63,0.03 to 1.12, P value, respectively. All 0.05). There was no significant difference in LCD score between the experimental group NI=4-10 and the control group (Z value was 0.313 to 1.637, P value was 0.05). There was no statistical difference between the experimental group NI=4 and 13 groups and the control group (Z value was one 0.147- 1.423, P value 0.05). (2) the subjective image quality score of the experimental group and the control group was different. The significance of the study (Z=-1.831--1.000, P value are 0.05): the comparison of the radiation dose indices between the experimental group and the control group in the D- < 33.4cm area group was statistically significant (t=-6.13--3.93, P value was 0.05); there was no statistical significance (F=0.46-1.37, P value 0.05) in the experimental group and the various levels of the experimental group (F=0.46-1.37, P value, 0.05). The difference of radiation dose index was statistically significant (F=15.88-42.78, P = 0.05).
Conclusion: when the NI value is 8-10, the radiation dose is reduced by 25.33% on the premise of ensuring the image quality LCD score is not affected. With the change of NI value, the change of HCD is not significant, and when NI is more than 14, HCD decreases significantly. The application of ATCM (NI=10) technique in the abdominal CT scan can guarantee the low contrast detection ability. At the same time, the radiation dose is reduced by 11.2%-78.3%. compared with the fixed tube current mode.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R816.5

【參考文獻】

相關(guān)期刊論文 前10條

1 趙峰;曾勇明;吳奇華;彭剛;周e，

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