本文選題：醫(yī)療照射 + X射線攝影��； 參考：《復(fù)旦大學(xué)》2013年碩士論文

【摘要】：[研究目的]醫(yī)療照射是人工電離輻射的最大來源,人類在對(duì)X射線積極開發(fā)利用時(shí),發(fā)現(xiàn)它是一把雙刃劍,我們要注意其輻射防護(hù)問題。適時(shí)掌握醫(yī)用X射線診斷所致受檢者劑量水平現(xiàn)狀和變化情況,可以為制訂醫(yī)用X射線診斷的劑量參考(指導(dǎo))水平(DRL)及其相應(yīng)輻射防護(hù)措施提供依據(jù)。常規(guī)方法的劑量水平普查準(zhǔn)確但耗時(shí)費(fèi)力,而利用劑量估算模式開展劑量水平調(diào)查存在有一定的不確定度但相對(duì)便捷。我國(guó)十年來未更新指導(dǎo)水平,且各地區(qū)未根據(jù)本地實(shí)際制訂本地參考水平。本研究旨在通過實(shí)際調(diào)查和模式估算兩種方式得到劑量指導(dǎo)水平,借鑒國(guó)外經(jīng)驗(yàn),制訂出上海市常見三種類型醫(yī)用X射線攝影的劑量指導(dǎo)水平,并為相關(guān)研究提供方法和依據(jù)。 [研究方法]為實(shí)現(xiàn)上述主要目的,本論文從以下三個(gè)方面開展研究：1)通過分析上海市的醫(yī)療照射應(yīng)用頻率及其發(fā)展趨勢(shì),獲取當(dāng)前醫(yī)用X射線攝影診斷的主要類型；在嚴(yán)格控制數(shù)據(jù)質(zhì)量的基礎(chǔ)上,用熱釋光劑量計(jì)(TLD)開展三種攝影(胸部正位、胸部側(cè)位和腰椎側(cè)位)共1726名成年受檢者的入射體表劑量(ESD)測(cè)量；2)基于課題組已經(jīng)開發(fā)的劑量估算模式,先通過實(shí)驗(yàn)調(diào)查驗(yàn)證,比較實(shí)測(cè)ESD值和估算ESD值間的差異；再將估算模式應(yīng)用于本研究的調(diào)查中計(jì)算得到劑量,并對(duì)估算結(jié)果進(jìn)行分析；評(píng)定估算模式的不確定度；3)基于劑量指導(dǎo)水平建立方法,結(jié)合國(guó)內(nèi)外指導(dǎo)水平的建立現(xiàn)狀和發(fā)展趨勢(shì),將實(shí)際調(diào)查和模式估算兩種方法獲取的劑量進(jìn)一步推導(dǎo)得到劑量指導(dǎo)水平,進(jìn)行結(jié)果分析和比較：根據(jù)本地實(shí)際,嘗試建立上海市三種常見類型醫(yī)用X射線攝影的劑量指導(dǎo)水平。 [研究結(jié)果]上海市醫(yī)用X射線攝影的應(yīng)用頻率和單次劑量調(diào)查結(jié)果表明,胸部正位、胸部側(cè)位、腰椎側(cè)位為三個(gè)常見或主要類型。本次調(diào)查結(jié)果顯示,上海市這三種類型X射線攝影所致1726名成年受檢者的ESD差別較大,三者的ESD均值分別為0.23mGy,0.57mGy,4.48mGy；入射體表劑量值和主要曝光參數(shù)(kVp和mAs)的變化趨勢(shì)與國(guó)外同類調(diào)查的結(jié)果相似。驗(yàn)證實(shí)驗(yàn)結(jié)果表明,利用劑量估算模式求得這三種類型攝影的ESD與實(shí)測(cè)結(jié)果的相對(duì)誤差分別為1.9%,5.1%和1.7%,說明了可用該估算模式開展劑量水平的評(píng)估。對(duì)于全市而言,三種類型攝影所致受檢者的入射體表劑量估算值與實(shí)測(cè)值的均值相差分別為13.0%,12.3%,3.3%,配對(duì)t檢驗(yàn)顯示差異無統(tǒng)計(jì)學(xué)意義。不同國(guó)家或地區(qū)DRL的制訂時(shí)間和類別有一定的差異,但DRL的變化均呈現(xiàn)出下降的趨勢(shì)。上海市這三種類型X射線診斷在各個(gè)設(shè)備間所致受檢者入射體表劑量均值的75%分位值分別為0.32mGy,0.75mGy和6.84mGy與0.28mGy,0.81mGy,6.92mGy,均小于我國(guó)當(dāng)前推薦的劑量指導(dǎo)水平。 [研究結(jié)論]本課題組建立的劑量估算模式可用于醫(yī)用X射線診斷所致受檢者入射體表劑量水平的評(píng)估。醫(yī)用X射線診斷所致受檢者劑量在不斷降低,建議可將胸部正位、胸部側(cè)位、腰椎側(cè)位攝影診斷劑量指導(dǎo)水平分別設(shè)定為0.30mGy,1.0mGy和8.0mGy。
[Abstract]:[Objective] medical irradiation is the largest source of artificial ionizing radiation. When human beings are actively developing and utilizing X rays, it is found that it is a double-edged sword. We should pay attention to the problem of radiation protection. Timely grasp the current situation and changes of the dose level of the examiner caused by medical X ray diagnosis can be a reference for the formulation of the dose of medical X ray diagnosis ( Guidance) level (DRL) and corresponding radiation protection measures provide the basis. The general survey of the dose level of the conventional methods is accurate but time-consuming, but it has some uncertainty but relatively convenient to use the dose estimation model to carry out the dose level survey. In China, the water leveling has not been updated in ten years, and the local reference has not been formulated in various regions according to the local reality. The purpose of this study is to obtain dose guidance level by two ways of actual investigation and model estimation, and draw lessons from foreign experience to draw up the dose guidance level of three types of medical X ray photography common in Shanghai, and provide methods and basis for related research.
[research methods] in order to achieve the above main purpose, this paper carries out the following three aspects: 1) to obtain the main types of medical X ray photography diagnosis by analyzing the frequency of medical irradiation application and its development trend in Shanghai. On the basis of strictly controlling the quality of data, three kinds of photography (chest radiography) are carried out with the thermoluminescence dosimeter (TLD). The incident body surface dose (ESD) measurements of 1726 adult subjects were measured in the Department, the chest side and the lumbar side. 2) based on the dose estimation model developed by the project group, the difference between the measured ESD value and the estimated ESD value was compared with the experimental investigation, and the estimated model formula was used to calculate the dose in the study. The estimation results are analyzed; the uncertainty of evaluation model; 3) based on the method of setting up the dose guidance level, combined with the present situation and development trend of the guidance level at home and abroad, the dose obtained by the actual survey and model estimation is further derived to obtain the level of the dose finger guide, and the results are analyzed and compared. In fact, we try to establish the dose guidance level of three common types of medical X - ray radiography in Shanghai.
[results] the application frequency and single dose survey of medical X ray photography in Shanghai showed that the chest position, the chest lateral position and the lumbar lateral position were three common or main types. The results of this survey showed that the 1726 adult subjects of the three types of X ray photography in the city of Shanghai were different in ESD, and the mean of the three was 0.2, respectively. 3mGy, 0.57mGy, 4.48mGy; the variation trend of the incident body surface dose value and the main exposure parameters (kVp and mAs) is similar to the result of the similar survey in foreign countries. The experimental results show that the relative error between the ESD and the measured results of these three types of photography by using the dose estimation model is 1.9%, 5.1% and 1.7%, indicating that the model can be opened. The assessment of the level of spread dose. For the whole city, the difference between the estimated value of the incident body surface dose and the measured value of the three types of photographers was 13%, 12.3%, 3.3% respectively. The paired t test showed that there was no statistical difference. The time and category of DRL in different countries and regions were different, but the changes of DRL were all present. The downward trend. The three types of X - ray diagnosis in Shanghai were 0.32mGy, 0.75mGy and 6.84mGy with 0.28mGy, 0.81mGy, 6.92mGy, respectively, which were less than the recommended dose level in our country.
[Conclusion] the dose estimation model established by our group can be used to evaluate the level of incidence of incident body surface in the patients with medical X ray diagnosis. The dose of the subjects who are diagnosed with medical X ray is decreasing continuously. It is suggested that the dose guidance of chest position, chest lateral position and lumbar lateral position can be set to 0.30mGy, 1.0mGy and 8 respectively. .0mGy.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R814.2

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本文編號(hào)：2115820