【摘要】：核素全身骨顯像是臨床核醫(yī)學(xué)常規(guī)檢查的最重要項(xiàng)目，約占核醫(yī)學(xué)單光子顯像的一半以上，但骨顯像的質(zhì)量參差不齊，多數(shù)醫(yī)院以固定的掃描速度完成所有全身骨顯像檢查，致使注射劑量較低或體型較重的患者難以獲得滿意的顯像效果，直接影響了臨床診斷質(zhì)量，如何保證全身骨顯像質(zhì)量？美國核醫(yī)學(xué)協(xié)會的骨顯像指南建議全身骨顯像總計(jì)數(shù)應(yīng)大于1.5M，但已完成顯像，，對于獲得高質(zhì)量骨顯像無檢查前的指導(dǎo)作用。臨床已有人提出在受檢者胸部獲得預(yù)置計(jì)數(shù)并計(jì)算相應(yīng)的掃描速度，但二者的關(guān)系及最終獲得的滿意顯像效果的研究至今未見報(bào)道，使這一常規(guī)工作似難以科學(xué)規(guī)范地保證質(zhì)量。為此，本文通過一系列全身骨顯像研究，提出由預(yù)置計(jì)數(shù)確定骨顯像的掃描速度，以期獲得穩(wěn)定的高質(zhì)量全身骨顯像結(jié)果。 本文的第一章為緒論，主要介紹了全身骨顯像及其應(yīng)用，調(diào)整掃描速度確保核素骨顯像質(zhì)量研究背景以及本文的主要內(nèi)容。 本文的第二章主要分析比較了骨顯像圖像質(zhì)量與總計(jì)數(shù)之間的關(guān)系，通過5名醫(yī)師對263張骨顯像圖像的綜合評定，并使用統(tǒng)計(jì)學(xué)非參數(shù)檢驗(yàn)(Kruskal-Wallis Test)和秩轉(zhuǎn)換的多重比較法(Dunnett’s t Tests)比較不同質(zhì)量圖片的總計(jì)數(shù)差異，以及確定臨床上能保證骨顯像質(zhì)量的總計(jì)數(shù)值。 第三章主要研究了同一患者，在預(yù)置計(jì)數(shù)確定的情況下，總計(jì)數(shù)與掃描速度之間的關(guān)系，即確定患者以不同掃描速度采集時(shí)，其總計(jì)數(shù)的變化規(guī)律。 第四章則研究了在掃描速度確定的情況下，預(yù)置計(jì)數(shù)與總計(jì)數(shù)之間的關(guān)系。其中我們根據(jù)臨床常用值采取200mm/min為固定采集速度，研究在200mm/min的采集速度下，患者的預(yù)置計(jì)數(shù)與總計(jì)數(shù)之間的關(guān)系。 第五章通過第三、第四章的研究確定如何利用預(yù)置計(jì)數(shù)來計(jì)算不同的掃描速度。 第六章對第五章確定的方法進(jìn)行臨床上的驗(yàn)證，以確定該方法是否適用于臨床，這種用預(yù)置計(jì)數(shù)確定掃描速度的方法是否真正有臨床上的指導(dǎo)意義。 通過以上一系列實(shí)驗(yàn)，我們對臨床上如何實(shí)現(xiàn)通過調(diào)整掃描速度確保核素骨顯像質(zhì)量的方法有了一定程度的了解，作者相信，通過這一骨顯像方法的改進(jìn)，我們在臨床工作中能獲得更高質(zhì)量的圖像，使全身骨顯像的檢查質(zhì)量更加穩(wěn)定。
[Abstract]:The radionuclide whole body bone imaging is the most important item in the routine examination of clinical nuclear medicine. It accounts for more than half of the single photon imaging of nuclear medicine, but the quality of the bone imaging is not uniform. Most hospitals complete all the whole body bone imaging at a fixed scanning rate. It is difficult for patients with lower injection dose or heavier body size to obtain satisfactory imaging effect, which directly affects the quality of clinical diagnosis. How to ensure the quality of whole body bone imaging? The bone imaging guidelines of the American Association of Nuclear Medicine recommend that the total number of bone scintigraphy should be greater than 1.5 m, but that the imaging has been completed and has no preemptive guidance for obtaining high quality bone scintigraphy. It has been proposed to get a preset count in the chest of the patient and calculate the scanning speed. However, the relationship between the two and the final satisfactory imaging effect has not been reported. It seems difficult to ensure the quality of this routine work in a scientific and normative way. Therefore, through a series of bone imaging studies, the authors put forward that the scanning speed of bone imaging can be determined by preset counting, in order to obtain stable results of high quality whole body bone imaging. The first chapter is the introduction, which mainly introduces the whole body bone imaging and its application, adjusts the scanning speed to ensure the quality of the radionuclide bone imaging and the main content of this paper. In the second chapter, the relationship between the image quality and the total number of bone images was analyzed and compared. 263 bone imaging images were evaluated by 5 physicians. Statistical nonparametric test (Kruskal-Wallis Test) and rank conversion (Dunnett's t Tests) were used to compare the total count difference of different mass images and to determine the total value of bone imaging quality. The third chapter mainly studies the relationship between the total number and the scanning speed of the same patient when the preset count is determined, that is to say, determine the law of the change of the total count when the patient collects with different scanning speed. In chapter 4, we study the relationship between the preset count and the total number when the scanning speed is determined. According to the common clinical values, we take 200mm/min as the fixed acquisition speed, and study the relationship between the patient's preset count and the total number under the 200mm/min acquisition speed. Chapter 5 studies how to use preset count to calculate different scanning speed. In chapter 6, the method determined in chapter 5 is validated in clinic to determine whether the method is suitable for clinical use, and whether the method of determining scanning speed by preset count is of clinical significance. Through the above series of experiments, we have a certain degree of understanding of how to ensure the quality of radionuclide bone imaging by adjusting the scanning speed. The authors believe that through the improvement of this bone imaging method, We can obtain higher quality images in clinical work and make the quality of whole body bone scintigraphy more stable.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R817.4

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