使用透視攝影及數位減贅攝影進行影像導引介入性血管攝影檢查，因為容易達到病灶且相對風險小，可治療許多疾病，在醫療輻射暴露越來越廣泛使用，然而卻存在確定性效應並潛在誘發癌症機率效應的風險。國際組織也對於介入性的放射手術有閾值劑量上的建議，和皮膚劑量的限值，並希望記錄追蹤個別病人的醫療輻射暴露量。
本研究利用自顯色膠片和量測為基礎的蒙地卡羅程式BEAMnrcMP，建立一套個別病人於介入性血管攝影，進行肝動脈血管栓篩治療的劑量評估系統。我們研究自顯色膠片特性，並將量測病人劑量分布結果輸入蒙地卡羅，得到三維劑量分布對應於電腦斷層影像。分叢技術可透過歸類屬性相近的資料點，進行資料區分，我們進而使用K-means分叢法於電腦斷層影像，區分不同器官，計算器官組織劑量。
成功建立個別病人於肝動脈栓塞器官組織劑量評估系統，未來可將此系統運用在不同的介入性手術或心導管造成的劑量評估及追蹤。

Less invasive imaging-guided vascular interventions with fluoroscopy and digital subtraction angiography have recently become widespread and have been successfully used for treating various diseases. However, interventional fluoroscopy procedures may present deterministic and stochastic radiation risks. The International Commission on Radiological Protection (ICRP) and the Food and Drug Administration have requested identifying procedures that may involve patient doses greater than the recommended thresholds. The International Atomic Energy Agency (IAEA) announced a new project to track radiation exposure from medical diagnostic procedures.
In this study, radiochromic dosimetric media, known as self-developing films, and measurement-based Monte Carlo simulations were used to establish an interventional radiology dosing system for individual patients undergoing interventional transcatheter arterial embolization. We investigated the characteristics of gafchromic films, and successfully inputed dose distribution of the measured films from clinical situation to Monte Carlo simulation. A 3D dose map incorporated into CT images was established. Then k-mean clustering method played the role based on the cluster analysis with the nearest mean for the local segmentation. We furthermore utilized the K-mean clustering to achieve the organ segmentation, and calculated the organ doses.
The organ doses for individual patients were evaluated using this dosing system. This system could be applied very well to other fluoroscopic or interventional procedures for patient dose management.

Bacher, K., P. Smeets, et al. (2006). "Image Quality and Radiation Dose on Digital Chest Imaging: Comparison of Amorphous Silicon and Amorphous Selenium Flat-Panel Systems." Am. J. Roentgenol. 187(3): 630-637.
Balter, S. (2006). "Methods for measuring fluoroscopic skin dose " Pediatric Radiology 36: 136-140.
Beasley, R. P. (1988). "Hepatitis B virus. The major etiology of hepatocellular carcinoma." Cancer 61(10): 1942-1956
Betsou, S., E. P. Efstathopoulos, et al. (1998). "Patient radiation doses during cardiac catheterization procedures." Br J Radiol 71(846): 634-639.
Blair, A. and J. Meyer (2009). "Characteristics of Gafchromic XR-RV2 radiochromic film." Med Phys 36(7): 3050-3058.
Bor, D., T. Olg˘ar, et al. (2009). "Patient doses and dosimetric evaluations in interventional cardiology." Physica Medica 25(1): 31-42.
Bozkurt, A. and D. Bor (2007 ). "Simultaneous determination of equivalent dose to organs and tissues of the patient and of the physician in interventional radiology using the Monte Carlo method." Phys. Med. Biol. 52( 2): 317-330
Chen, C. W., J. Luo, et al. (1998). "Image segmentation via adaptive K-mean clustering and knowledge-based morphological operations with biomedical applications." IEEE Trans Image Process 7(12): 1673-1683.
D'Ercole, L., L. Mantovani, et al. (2007). "A Study on Maximum Skin Dose in Cerebral Embolization Procedures." AJNR Am J Neuroradiol 28(3): 503-507.
Dragusin, O., K. Smans, et al. (2008). Evaluation of the contrast-detail response of a cardiovascular angiography system and the influence of equipment variables on image quality, SPIE.
El–Serag, H. B., J. A. Marrero, et al. (2008). "Diagnosis and Treatment of Hepatocellular Carcinoma." GASTROENTEROLOGY 134: 1752–1763.
Hartigan, J. A. and M. A. Wong (1979). "Algorithm AS 136: A k-means clustering algorithm." Journal of the Royal Statistical Society. Series C (Applied Statistics) 28(0bbd941f-926b-520e-f4f4-c3e37f0e57f0): 100-208.
IAEA (2010). Patinet Dose Optimiation in Flurosopically Guide Interventional Procedures Radiation Safety and Monitoring Section. Vienna International Atomic Energy Agency
ICRP (2000). Avoidance of radiation injuries from medical interventional procedures, International Commission on Radiological Protection.
ICRP (2004). Low-dose Extrapolation of Radiation-related
Cancer Risk, International Commission on Radiological Protection.
ISP. (2007). "GAFCHROMIC® XR-RV2: An ideal tool to measure surface peak skin dose in Interventional radiation, guided by fluoroscop." Retrieved Dec. 30, 2011, from http://online1.ispcorp.com/_layouts/Gafchromic/content/products/xrr/pdf/prodpresent.pdf.
ISP. (2011). "GAFCHROMIC XR: XR-QA2, XR-CT2, XR-M2, XR-RV3." Retrieved 12/20, 2011, from http://www.filmqaxr.com/documents/GAFCHROMIC_XR_Series_201105.pdf.
Johns, H. E. and J. B. Cunningham (1983). The physics of radiology, Charles C. Thomas.
Kosunen, A., T. Komppa, et al. (2005). "Evaluation of methods to estimate the patient dose in interventional radiology." Radiat Prot Dosimetry 117(1-3): 178-184.
Kotter, E. and M. Langer (2002). "Digital radiography with large-area flat-panel detectors." Eur Radiol 12: 2562-2570.
Kyriakou, Y., G. Richter, et al. (2008). "Neuroradiologic Applications with Routine C-arm Flat Panel Detector CT: Evaluation of Patient Dose Measurements." AJNR Am J Neuroradiol 29(10): 1930-1936.
Lin, M.-H., T.-C. Chao, et al. (2009). "Measurement-based Monte Carlo dose calculation system for IMRT pretreatment and on-line transit dose verifications." Medical Physics 36(4): 1167-1175.
Lin, P.-J. P. (2007). "The operation logic of automatic dose control of fluoroscopy system in conjunction with spectral shaping filters." Med Phys 34(8): 3169-3172.
Lin, P. J. (2008). "Technical advances of interventional fluoroscopy and flat panel image receptor." Health Phys 95(5): 650-657.
Livingstone, R. S. and T. Mammen (2005). "Evaluation of radiation dose to patients during abdominal embolizations." Indian Journal of Medical Sciences 59(12): 528-534.
LK Wagner, P. (2007). "Radiation injury is a potentially serious complication to fluoroscopically-guided complex interventions." Biomedical Imaging and Intervention Journal 3(2): e22.
Mahesh, M. (2001). "Fluoroscopy: Patient Radiation Exposure Issues." Radiographics 21(4): 1033-1045.
Mantovani, L., L. D'Ercole, et al. (2006). "Radiochromic Films for Improved Evaluation of Patient Dose in Liver Interventions." J Vasc and Interv Radiol 17(5): 855-862.
McCabe, B. P., M. A. Speidel, et al. (2011). "Calibration of GafChromic XR-RV3 radiochromic film for skin dose measurement using standardized x-ray spectra and a commercial flatbed scanner." Med Phys 38(4): 1919-1930.
Miller, D. L. (2008). "Radiation injury is potentially a severe consequence of fluoroscopically guided complex interventions." Health phys 95(5): 645-649.
Nickoloff, E. L., Z. F. Lu, et al. (2007). "Influence of flat-panel fluoroscopic equipment variables on cardiac radiation doses." Cardiovascular and Interventional Radiology 30(2): 169-176.
Omrane, L. B., F. Verhaegen, et al. (2003). "An investigation of entrance surface dose calculations for diagnostic radiology using Monte Carlo simulations and radiotherapy dosimetry formalisms." Phys. Med. Biol. 48: 1809–1824.
Perz, J. F., G. L. Armstrong, et al. (2006). "The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide." Journal of Hepatology 45(4): 529-538.
Peterson, J. H., P. Tian, et al. "Secretion of a bacterial virulence factor is driven by the folding of a C-terminal segment." Proc Natl Acad Sci U S A.
Purcell, R. H. (1993). "The discovery of the hepatitis viruses." Gastroenterology 104: :955-963.
Rassow, S. (1998). "From the Entrance Dose to the Calculation of Organ Doses." Radiat Prot Dosimetry 80(1-3): 327-329.
Robar, J. and B. Clark (2000). "A practical technique for verification of three-dimensional conformal dose distributions in stereotactic radiosurgery." Medical Physics 27(d1c99522-52c8-e65c-2cb5-c3b3fb397ac0): 978-1065.
Ryder, S. D. (2003). "Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults." Gut 52.
Shope, T. B. (1996). "Radiation-induced skin injuries from fluoroscopy." Radiographics 16(5): 1195-1199.
Singh, P. K. (2004). Segmentation of regions in JPEG compressed medical images. Image Processing, 2004. ICIP '04. 2004 International Conference on.
Smans, K., L. Struelens, et al. (2008). "A study of the correlation between dose area product and effective dose in vascular radiology." Radiat Prot Dosimetry 130(3): 300-308.
Stratakis, J., J. Damilakis, et al. (2007). "Radiation dose and risk from fluoroscopically guided percutaneous transluminal angioplasty and stenting in the abdominal region " Eur Radiol 17: 2359-2367.
Strotzer, M., M. Volk, et al. (2000). "Simulated Bone Erosions in a Hand Phantom: Detection with Conventional Screen-Film Technology versus Cesium Iodide-Amorphous Silicon Flat-Panel Detector." Radiology 215(2): 512-515.
Suzuki, S., S. Furui, et al. (2005). "Radiation Dose to Patients and Radiologists During Transcatheter Arterial Embolization: Comparison of a Digital Flat-Panel System and Conventional Unit." Am. J. Roentgenol. 185(4): 855-859.
Suzuki, S., S. Furui, et al. (2008). "Entrance Surface Dose during Three-dimensional Imaging with a Flat-panel Detector Angiography System." Journal of Vascular and Interventional Radiology 19(9): 1361-1365.
Suzuki, S., S. Furui, et al. (2009). "Effective Dose during Abdominal Three-dimensional Imaging with a Flat-Panel Detector Angiography System." Radiology 250(2): 545-550.
Suzuki, S., I. Yamaguchi, et al. (2011). "Evaluation of effective dose during abdominal three-dimensional imaging for three flat-panel-detector angiography systems." Cardiovasc Intervent Radiol 34(2): 376-382.
Tsapaki, V., N. A. Ahmed, et al. (2009). "Radiation Exposure to Patients During Interventional Procedures in 20 Countries: Initial IAEA Project Results." Am. J. Roentgenol. 193(2): 559-569.
Vano, E., H. Jarvinen, et al. (2008). "Patient dose in interventional radiology: a European survey." Radiat Prot Dosimetry 129(1-3): 39-45.
Vel´azquez, R. F., M. Rodrı´guez, et al. (2003). "Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis." Hepatology 37(3): 520-527.
Walters, B., I. Kawrakow, et al. (2009). "DOSXYZnrc Users Manual." Ionizing Radiation Standards National Research Council of Canada.
Wielandts, J.-Y. and et al. "Effective dose analysis of three-dimensional rotational angiography during catheter ablation procedures." Physics in Medicine and Biology 55(3): 563.
Wielandts, J. Y., K. Smans, et al. (2010). "Effective dose analysis of three-dimensional rotational angiography during catheter ablation procedures." Phys Med Biol 55(3): 563-579.
江謝鎮至 (2008). 使用蒙地卡羅方法評估多切面電腦斷層掃描劑量:假體研究, 國立清華大學. 碩士.
賴佩伶 (2010). 介入性血管攝影劑量評估系統之建立：應用於經動脈肝腫瘤栓塞, 國立清華大學. 碩士.