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研究生: 賴佩伶
Lai, Pei-Ling
論文名稱: 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
Establishing Dose Evaluation System for Interventional Angiography : Transcatheter Arterial Embolization
指導教授: 莊克士
Chuang, Keh-Shih
蔡惠予
Tsai, Hui-Yu
口試委員:
學位類別: 碩士
Master
系所名稱: 原子科學院 - 核子工程與科學研究所
Nuclear Engineering and Science
論文出版年: 2010
畢業學年度: 98
語文別: 中文
論文頁數: 78
中文關鍵詞: 經動脈肝腫瘤栓塞術自顯色膠片蒙地卡羅模擬有效劑量
外文關鍵詞: Transcatheter arterial embolization, Gafchromic film, Measurement-based Monte Carlo simulation, Effective dose
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  • 影像導引式手術利用透視導引執行醫療程序,因為容易達到病灶且相對風險小,越來越廣泛使用,成功地治療許多疾病,然而卻存在確定性效應和機率性效應的風險。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。
    本研究利用自顯色膠片和蒙地卡羅程式BEAMnrcMP建立一套評估劑量的方法,對此模型的射束品質、劑量特性進行驗證,並將完成膠片輻射劑量計量測病人表面劑量之結果放入蒙地卡羅模擬,進行決定劑量轉換,進而計算器官組織劑量。
    本系統已成功建立,已可評估經動脈肝腫瘤栓塞手術時,個別病人的器官劑量和有效劑量,未來也可將此系統應用於其他介入性手術,這個系統的建立與運用極具意義,在臨床上的建議及學術上的研究具有相當的價值。


    Minimally invasive imaging-guided vascular interventions with fluoroscopy and digital subtraction angiographic have recently become widespread and have been successfully in the treatment of 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 identification of procedures that may involve patient doses greater than the recommended threshold.
    In this study, we used the gafchromic dosimetric media (self-developing “film”) and Measurement-based Monte Carlo simulation to establish the dose evaluation system for transcatheter arterial embolization of interventional radiology. We investigated the beam quality, characteristics of gafchromic films and further, and successfully inputed dose distribution of the measured films from clinical situation to Monte Carlo simulation. We calculated the organ doses and eventually get the effective doses.
    Establishing the dose evaluation system for transcatheter arterial embolization to investigate the organ and effective doses has provided the good experiences to other applications.

    誌謝 iii 目錄 iv 圖目錄 vi 表目錄 ix 第一章 前言………………………………….………………...………………………... 1 1.1 背景重要性與文獻回顧探討..………………………………………………….1 1.1.1 肝癌 1 1.1.2 介入性放射手術 1 1.1.3 國際組織對於劑量的建議 3 1.1.4 數位平板式血管攝影機組 4 1.1.5 劑量評估方法 5 1.2 研究目的 6 1.3 研究架構 7 第二章 材料與方法 10 2.1 血管攝影機系統特性 12 2.1.1 儀器介紹與校正 12 2.1.2 自動劑量控制系統 14 2.1.3 管電壓輸出線性及再現性 16 2.1.4 射束品質 16 2.1.5 能譜驗證 18 2.2 膠片輻射劑量系統建立 19 2.2.1 輻射劑量計—Gafchromic XR-RV2膠片簡介 19 2.2.2 自顯色膠片Gafchromic XR-RV2膠片之測量—光密度計計讀 20 2.2.3 Gafchromic XR-RV2膠片之測量—數位化掃描 21 2.2.4 劑量反應(Dose response) 22 2.2.5 能量依存性 23 2.2.6 照射後自顯色膠片反應變化的評估(Post exposure growth) 23 2.3 臨床劑量量測 24 2.3.1 經動脈肝腫瘤栓塞手術程序 24 2.3.2 病人資料收集 24 2.3.3 劑量量測與計算 25 2.4 蒙地卡羅方法劑量模擬計算 26 2.4.1 射源定義 29 2.4.2 CT影像數位體素假體建立 30 2.4.3 能譜選擇 35 2.4.4 照野大小的影響 37 2.5 相對劑量與絕對劑量的轉換 37 2.5.1 器官組織劑量分析 38 第三章結果 40 3.1 血管攝影機系統特性 40 3.1.1管電壓輸出線性及再現性 40 3.1.2自動劑量率控制系統 40 3.1.3半值層與有效能量 44 3.2 自顯色膠片劑量系統 46 3.2.1 劑量反應 (dose response) 46 3.2.2 能量依存性 48 3.2.3 照射後自顯色膠片反應變化的評估(Post exposure growth) 49 3.3 臨床劑量量測 50 3.3.1 病人資料收集 50 3.3.2 臨床劑量計算結果 52 3.4 蒙地卡羅方法劑量模擬計算 57 3.4.1 CT影像數位體素假體建立 57 3.4.2 蒙地卡羅方法模擬能譜選擇 58 3.4.3 照野影響 60 3.4.4 相對劑量與絕對劑量的轉換 61 3.5 器官劑量及有效劑量計算 62 第四章 討論 66 4.1 自動劑量控制邏輯 66 4.2 自顯色膠片特性 67 4.3 臨床劑量 67 4.4 蒙地卡羅模擬 71 4.5 限制 73 第五章 結論 74 參考文獻 75

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