本文選題：CT掃描　切入點：顱腦　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的對比研究常規(guī)顱腦CT掃描和低劑量顱腦CT掃描的有效輻射劑量和圖像質(zhì)量差異,以確定優(yōu)化后的顱腦CT掃描方案(低劑量)在臨床的應(yīng)用價值,使“顱腦病變低度可能”患者,接受最優(yōu)化的低輻射劑量CT掃描,在不影響圖像診斷的前提下,降低這一特殊群體患者所接受的有效輻射劑量。方法放射技師與神經(jīng)科醫(yī)師共同依據(jù)患者自訴體征及臨床查體情況,賦分、篩選出“顱腦病變低度可能”患者183例。其中,男性患者98例、女性患者85例;年齡最小的患者16歲,年齡最大的患者75歲,平均年齡為(58±11.3)歲。按就診順序,隨機分成三組,分別為常規(guī)顱腦CT掃描方案(120k V,280effm As)對照組和優(yōu)化后低劑量顱腦CT掃描方案(100k V,200effm As)研究組(1)及優(yōu)化后低劑量顱腦CT掃描方案(100k V,150effm As)研究組(2),使用SIEMENS 64層雙源螺旋CT分別進行掃描。掃描完成后,設(shè)備自動計算生成出掃描容積CT劑量指數(shù)CTDIvol(volume CT dose index)和劑量長度乘積DLP(dose length product)值,計算每次掃描的有效輻射劑量ED(effective dose)。ED等于DLP值×轉(zhuǎn)換系數(shù),單位是m Sv,根據(jù)相關(guān)文獻資料,CT顱腦成像的有效輻射劑量計算轉(zhuǎn)換系數(shù)設(shè)置為0.0023。分別由兩位高年資影像診斷醫(yī)師和神經(jīng)科臨床醫(yī)師,共同采用盲法評價三組掃描方案獲得的圖像質(zhì)量,統(tǒng)計與比較、分析影像診斷醫(yī)師和臨床主治醫(yī)師對CT圖像的滿意度、影像診斷與最終臨床的診斷符合率。結(jié)果常規(guī)掃描方案對照組顱腦CT掃描患者接受的平均有效劑量為(1.43±0.35)m Sv,優(yōu)化后低劑量掃描方案研究組(1)患者接受的平均有效劑量為(0.68±0.17)m Sv,優(yōu)化后低劑量掃描方案研究組(2)患者接受的平均有效劑量為(0.53±0.12)m Sv,前者明顯高于后兩者,差異具有明顯統(tǒng)計學(xué)意義(t=18.75,P0.05);低劑量掃描方案研究組(1)圖像的診斷滿意度、偽影水平、圖像噪聲及空間分辨力評分與常規(guī)掃描方案組掃描獲取的顱腦CT圖像評分均小于標(biāo)準(zhǔn)值1.972,差異無統(tǒng)計學(xué)意義(t=1.64,t=0.439,t=0.490,t=0.481;P0.05),能夠滿足放射診斷醫(yī)師的診斷要求,能夠?qū)Α帮B腦病變低度可能”患者做出正確的診斷,為臨床醫(yī)師的精準(zhǔn)治療提供影像學(xué)依據(jù)。低劑量掃描方案研究組(2)圖像的診斷滿意度、偽影水平、圖像噪聲及空間分辨力評分與常規(guī)掃描方案組掃描獲取的顱腦CT圖像評分均大于標(biāo)準(zhǔn)值1.972,差異有統(tǒng)計學(xué)意義。結(jié)論顱腦低劑量CT掃描方案(2)(100k V,150effm As),所接受的有效輻射劑量比常規(guī)掃描方案(120k V,280effm As)大幅下降,但是圖像質(zhì)量下降明顯,診斷信心受到較大影響,臨床醫(yī)生滿意度降低,不適于應(yīng)用推廣。優(yōu)化后的顱腦CT掃描方案(1)(100 k V,200effm As)有效降低了“顱腦病變低度可能”患者CT檢查的有效輻射劑量,同時圖像質(zhì)量能夠達到診斷要求,并且方案通俗易懂,技師操作簡單易行,具備可行的臨床應(yīng)用價值,值得臨床推廣應(yīng)用。
[Abstract]:Objective to compare the difference of effective radiation dose and image quality between conventional and low-dose craniocerebral CT scans in order to determine the clinical application value of optimized low-dose craniocerebral CT scans. Make the patients with "low degree of craniocerebral lesion possible" receive optimal low radiation dose CT scan without affecting the image diagnosis, Methods Radiographers and neurologists were assigned a score according to the patients' private complaint signs and clinical physical examination, and selected 183 cases of patients with "low possibility of craniocerebral lesions". There were 98 males and 85 females, the youngest patients were 16 years old, the oldest patients were 75 years old, the average age was 58 鹵11.3 years. The study group was divided into two groups: the routine brain CT scan regimen (120kV) 280effm As) control group, the optimized low-dose craniocerebral CT scan scheme (100kV / 200effm As)) and the optimized low-dose brain CT scan regimen (100kV 150effm As). The study group was treated with SIEMENS 64-slice dual-source spiral CT. Scan separately. After the scan is complete, The scanning volume CT dose index (CTDIvol(volume CT dose index) and the dose length product (DLP(dose length product) were automatically calculated by the device. The effective radiation dose ED(effective dose).ED for each scan was calculated to be equal to DLP value 脳 conversion coefficient. The conversion coefficient was set to 0.0023 according to the effective radiation dose of CT craniocerebral imaging. The blind method was used to evaluate the image quality, statistics and comparison of the three groups of scanning schemes, and the satisfaction of imaging diagnostics and clinical attending physicians to CT images was analyzed. Results the average effective dose of craniocerebral CT scan patients in the control group was 1.43 鹵0.35mSv.After the optimization of the low-dose scanning regimen, the average effective dose of the patients was 1.43 鹵0.35mSv. The average effective dose was 0.53 鹵0.12mSv. the former was significantly higher than that of the latter, and the average effective dose was 0.53 鹵0.12mSv. The difference was statistically significant (P 0.05). The diagnostic satisfaction and artifact level of the low dose scan group were significantly higher than that of the control group (P < 0. 05). The scores of image noise and spatial resolution were less than the standard value of 1.972, and the difference was not statistically significant. The difference was not statistically significant. It could meet the diagnostic requirements of radiologists. Can make the correct diagnosis for the patients with "low degree of craniocerebral lesions", and provide the imaging basis for the accurate treatment of clinicians. The scores of image noise and spatial resolution were higher than that of the standard value of 1.972in the conventional scan group, and the difference was statistically significant. Conclusion the low dose CT scan scheme is 100k V + 150effm Asn, and the effective radiation is obtained. The radiation dose was significantly lower than that of the conventional scanning scheme (120kV / 280effm / s). However, the image quality has declined significantly, the confidence in diagnosis has been greatly affected, and the clinicians' satisfaction has been reduced. It is not suitable for application popularization. The optimized CT scan scheme of 100kV / 200effm As) can effectively reduce the effective radiation dose of the patients with "low degree of craniocerebral lesions", and the image quality can meet the diagnostic requirements, and the scheme is easy to understand. The technician is simple and easy to operate, has the feasible clinical application value, is worth the clinical popularizing application.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R816.1

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