투시시야와 방사선조사야의 크기 변화에 따른 DAP와 영상의 화질변화에 관한 고찰

황민호(Min Ho Hwang),김민정(Min Jeong Kim),박은성(Eun Seong Park),성민숙(Min Sook Seong) 대한영상의학기술학회 2012 대한영상의학기술학회 논문지 Vol.2012 No.-

목적: 투시조영검사 시 투시시야의 변화에 따른 선량의 변화와 이때 영상의 화질을 평가하여 환자들이 받는 의료피폭을 조금이라도 경감시키기 위한 검사 조건을 알아보고자 실험을 하게 되었다. 대상 및 방법: 실험에는 투시조영장비 SHIMADZU사의 Sonalvision (Overtube unit), 7 ㎝ 아크릴팬텀 2개, CDRH (Center for Devices and Radiological Health, model 07-649) 팬텀, TORECK사의 면적선량계(Dose Area Product;이하 DAP, 모델명: QUALIFIER PD-8100)을 사용하였다. 선량을 측정하기 위해 아크릴팬텀 2개를 사용하여 인체의 복부부위 높이와 유사한 14 ㎝ 높이가 되게 하였고, 화질의 평가를 위하여 CDRH 팬텀을 아크릴 팬텀 위쪽, 정중앙에 위치시켰다. 촬영 조건은 FFD 120 ㎝, 자동조사장치(Auto Exposure Control; AEC) 모드로 10회 저격(spot)촬영한 선량을 다음의 두 가지 방법으로 측정하였 다. ① FOV를 9인치, 12인치, 16인치에서 시준기(collimator)를 모두 개방한 상태에서 평균DAP를 측정하였다. ② FOV를 12인치로 고정한 후 시준기(collimator)를 조절하여 방사 선조사야(exposure area)의 크기를 9인치로 하였을 때 평균 DAP, FOV를 16인치로 고정한 후 방사선조사야의 크기를 9인치, 12인치로 하였을 때의 평균 DAP를 측정하였다. 화질의 평가를 위하여 모든 조건에서 촬영된 CDRH 팬텀의 영상을 투시 임상경력 5년 이상의 방사선사 5인이 판독용 모니터(모델명: EIZO Radiforce GS520)를 사용하여 본원 PACS 프로그램인 Patavision을 통해 분석하였다. 결과: 방사선조사야를 모두 개방한 상태에서 DAP는 FOV 9인치에서 89.1 m㏉㎠, 12인치에서 82.4 m㏉㎠, 16인치에서 79.5 m㏉㎠로 측정되었다. 방사선조사야의 크기를 9인치로 조절하였을 FOV 12인치에서 측정된 DAP는 61.8 m㏉㎠, FOV 16인치에서 측정된 DAP는 41.7 m㏉㎠이었다. 방사선조사야의 크기를 12인치로 조절하였을때 FOV 16인치에서 측정된 DAP는 68.5 m㏉㎠이었다. 모든 조건에서 촬영된 CDRH 팬텀의 고대조도, 저대조도의 해상력을 확인한 결과 방사선조사야를 모두 개방하고 촬영하였을 때 FOV 9인치에서 고대 조도 7, 저대조도 6, FOV 12인치에서 고대조도 6, 저대조도 5, FOV 16인치에서 고대조도 6, 저대조도 5로 평가되었다. 방사선조사야의 크기를 9인치로 조절한 후 촬영하였을 때 FOV 12인치에서 고대조조 7, 저대조도 6, FOV 16인치에서 고대조도 6, 저대조도 5로 조사되었다. 방사선조사야의 크기를 12인치로 조절하여 촬영하였을 때 FOV 16인치에서 고대 조도 5, 저대조도 5로 조사되었다. 결론: 투시조영검사 시 FOV의 크기는 환자의 방사선피폭과 밀접한 관계가 있으며, 환자의 피폭선량을 감소시킴과 동시에 최적의 영상의 질을 위해서는 불필요하게 확대 촬영을 하지 말아야 하고, 방사선 조사야의 크기를 적절하게 조절하여 검사에 임해야 할 것으로 사료된 다. Purpose: We studied on patients does and image quality according to changing Field of View and Collimation. Materials and Methods: We used a Fluoroscopy system (SHIMADZU: Sonalvision, SID:120cm), two 7cm acrylic phantom, CDRH phantom (model 07-649) and DAP meter (Toreck, model: QUALIFIER PD-8100). A CDRH phantom was put on the two 7cm acrylic phantom. We exposured 10 times in AEC mode and recorded average DAP of open collimation, changing FOV and collimation. All DAP data compared each other. We used a Dignostic monitor (modek: EIZO Radiforce GS520) to evaluate CDRH phantom images. Five radiologist evaluated the quality of phanton image. Results: We measured each other DAP such as 89.1 m㏉㎠ (FOV 9 inch), 82.4 m㏉㎠ (FOV 12), 79.5 m㏉㎠ (16 inch) in open collimation. And it was measured as 61.8 m ㏉㎠ (12 inch), 41.7 m㏉㎠ (16 inch) in operationg collimation 9 inch and 68.5 m㏉㎠ (16 inch) in operation collimation 12 inch. The CDRH phantom images evaluated high contrast 7, low contrast 6 in FOV 9 inch, high contrast 6, low contrast 5 in FOV 12 inch, high contrast 6, low contrast 5 in FOV 16 inch, high contrast 7, low contrast 6 in FOV 12 inch (collimation size 9 inch), high contrast 6, low contrast 5 in FOV 16 inch (collimation size 9 inch) and high contrast 8, low contrast 5 in FOV 16 inch (collimation size 12 inch). Conclution: Using the large FOV has an effect on patients dose. So operator shouldn t unnecessarily magnify and do proper collimation in fluoroscopy.

복부투시조영 검사 시 Added filter와 Grid 변화에 따른 선량 및 화질에 관한 연구

홍선숙,강경미,성민숙,이종웅,Hong, Seon Sook,Kang, Kyeong Mi,Seong, Min Suk,Lee, Jong Woong 대한디지털의료영상학회 2012 대한디지털의료영상학회논문지 Vol.14 No.2

Amount of radiation exposure by seeing through fluoroscopy examination while is many patient exposure administration and unprepared misgovernment be. In this study, abdominal fluoroscopy during the scan, the dose and image quality change according to the use of grid and added filter optimized by measuring the test condition is proposed. Uses seeing through fluoroscopy examination equipment of Image Intensifier of Easy Diagnost Eleva (Philips), under tube type and uses Human phantom and measures average area dose according to grid insertion existence and nonexistence and added filter kind change. Measure sum of 29 organ dose and effective dose through PCXMC imagination simulation program and image J program through noise, SNR, image distortion was measured. Resolution, sharpness, and analyzed using the MTF curves. Fluorography the grid to insert the filter thickness and thickening and increased the average area dose and organ doses and effective dose. In the case of spot examination, when inserted grid, average area dose and organ dose and effective dose increased. Filter thickens the average area dose decreased, but the organ doses and effective dose were increased when use 0.2mmCu+1mmAl filter, decreased slightly. Noise and SNR measurements without inserting the gird, if you do not use the added filter was the lowest and when measure the distortion, 0.1mmCu+1mmAl filter was no difference of image quality in case insert grid was judged that when did not use occasion added filter that do not use grid, difference of image quality does not exist. Did not show a big difference, according to the grid and uses of the added filter sharpness, and resolution. Patient dose increases with factors that reduce the quality of the image so reckless grid and the use of the added filter when abdominal fluoroscopy examination should be cautious in using.

투시 검사 시 장비에 따른 환자와 시술자의 입사표면선량 연구

양해두,홍선숙,성민숙,하동윤,Yang, Hae-Doo,Hong, Seon-Sook,Seong, Min-Sook,Ha, Dong-Yoon 대한디지털의료영상학회 2013 대한디지털의료영상학회논문지 Vol.15 No.2

Purpose : Fluoroscopy equipment, depending on the type of changes that occur in the patient's position ESD and study the patient's scatter ray of ESD Practitioners considered a comparative analysis was to evaluate the correct dose. Materials and Methods : HITACHI four overtube type TU-8000 Flat Detector and Under tube C-Arm Philips' Multi Diagnost Eleva with Flat Detector type were measured by. Each devices is a measure of the patient's esd randophantom position in tabel unfors Xi multi funtion then fixed to the abdomen fluoroscopy and 10 seconds, spot was measured three times, practitioners of the incident surface dose by considering the patient's scatter ray of the table for each device in the average human stomach 21cm thickness acrylic phantom ($25cm{\times}25cm$) Place the practitioner position after position randophantom unfors Xi multi funtion in the thyroid and stomach 1 minute by a fixed one-time fluoroscopy and measured. Results : 10 seconds and the patient perspective of the c-arm ESD 1.2 times smaller on the AP and oblique measurements were measured in the 6-13 times smaller. spot positions to changes in the measured three times on the AP of the abdomen, ESD is 18 times smaller c-arm measurements and the oblique measurement was 19-30 times smaller. And 1 minute at practitioners fluoroscopy esd in the thyroid 2.12 times the c-arm, chest 1.75 times less the dose was measured. On the AP, depending on the device, but the lack of dose difference oblique positions of the two devices depending on changes in the area due to changes in both the AP than on the dose increased, the difference in dose between the two devices, the maximum difference was approximately 27 times. Conclusion : Fluoroscopic equipment at the time of inspection in accordance with changes in dose according to the patient and the patient's positions changes, because the area of the scatter ray considering the change of dose measurements be made, and study of the equipment according to the characteristics of the efficiency and the exposure of the patient and practitioner is considered smooth study equipment manufacturers that can be done is to build the system and think that is also important. Various fluoroscopy when you check future changes in many factors of change in dose for the equipment in the laboratory system by considering the scatter ray radiation shielding for the management to take advantage of reckless undertube have been utilized as more exposure Reduction activities can help is considered as the direction.

투시 조영 검사 시 확대율에 따른 피폭선량에 관한 고찰

강경미,홍선숙,성민숙,손운흥,Kang, Kyeong-Mi,Hong, Seon-Sook,Seong, Min-Sook,Song, Woon Heung 대한디지털의료영상학회 2013 대한디지털의료영상학회논문지 Vol.15 No.2

Purpose : The purpose of this study is the magnification rates depending on the area of patient dose (DAP) and glass dosimeter see the change of the dose according to the dose characteristics of low-magnification aims to raise standards. Materials and Method : Direct DR equipment Sonialvision DAR-8000f, Shimadzu was used, the patient entrance dose measurements to the surface of the Rando Phantom of the neck and the abdomen was placed on the Xi unfors. glass dosimeter for measuring organ doses at the same time the Rando Phantom of the major organs in place by inserting a 9 ", 12", 15 ", 17" and 30 seconds for each magnification were measured according in fluoroscopy. DAP meter area of the patient dose was measured. Result : Esophagography at 17" 143% than 9"magnification the average area dose was increased. Organ dose of Esophagography at 17" was decreased 25.32% than 9" magnification. UGI at 17" was increased 129.73% DAP than 9" magnification. Organ dose of UGI at 17" was decreased 23.32% than 9" magnification. Where the major organs of magnification at 17" were decreased(lung -25.96%, stomach -33.09%, spleen -27.81%, liver -4.92%) than 9" magnification. Conclusion : Expected to get better quality image While using the proper magnification, and have recognition that difference Organ doses and DAP meter in fluoroscopy.

투시 검사 시 체위 변화에 따른 입사표면선량의 평가 연구

양해두,홍선숙,박은성,성민숙,하동윤,Yang, Hae-Doo,Hong, Seon-Sook,Park, Eun-Seong,Seong, Min-Sook,Ha, Dong-Yoon 대한디지털의료영상학회 2011 대한디지털의료영상학회논문지 Vol.13 No.4

This study intends to investigate patients' exact exposure doses by comparatively measuring ESD (Entrance Surface Dose) with the DAP meter, which excludes scattered rays, and ESD with the Xi multifunction meter, which includes scattered rays, by posture changes for Esophagography test and UGI test. The materialwere examined through Sonialvision-SafireII SPEC overtube system. ESD was measured by using the DAP meter, and as a tool to measure ESD including scattered rays on the plane of incidence of human phantom, the Xi multifunction meter was used. The average fluoroscopic time of Esophagography test was 4.192 minutes and the average number of images was 47.7, while the average fluoroscopic time of UGI test was 6.881 minutes and the average number of images was 37.8. The ratios of the incident dose of DAP meter and the ESD of Xi meter were calculated bydividing the fluoroscopic time and the number of images by each posture change. As for Esophagography test, the dose increased by 21.6~55.5% in the fluoroscopic test and by 4.8~24.7% in the spot test. In the front spot test, however, the does increased by as little as 5.3%. As for UGI test, the dose increased by 21.1~49.5% in the fluoroscopic test and by 10.1~34.9% in the spot test. It is expected that measuring doses in consideration of scattered rays by posture changes will be an important index in evaluating and managing patients' exact exposure doses for each test above. Furthermore, it is judged that this sort of study is inevitable and desirable to reduce patients' exposure doses after all.

투시 조영 검사 시 압박 강도에 대한 검사자들의 인식도 조사

강경미(Kyeong-Mi Kang),노현아(Hyun-A Nho),김선화(Seon-Hwa Kim),성민숙(Min-Sook Seong),하동윤(Dong-Yoon Ha) 대한영상의학기술학회 2012 대한영상의학기술학회 논문지 Vol.2012 No.-

행하는 압박paddle에 대한 정기적인 점검이나 관리는 거의 이루어지고 있지 않은 실정이 다. 본 연구는 진단적 가치가 높은 영상을 획득하기 위하여 임상에서 투시 조영 검사를 시행하고 있는 검사자들의 압박에 대한 인지도와 압박paddle에 대한 정도관리 실태를 알아보 고자 하였다. 대상 및 방법: 서울 소재의 종합병원 7곳, 의원 5곳의 투시조영 장비를 보유하고 투시조영 검사를 주 업무로 시행한 경험이 있는 방사선사 28명을 대상으로 설문지를 이용하여 설문 조사를 실시하였다. 설문 문항은 총 8개의 문항으로 검사자들의 경력과 투시 내의 주 업무, 압박검사 시행 여부, 압박paddle 점검 유무 및 압박paddle의 적정 압박 강도 등에 대해 사용자들의 인식도에 관한 문항으로 설문을 실시하였다. 설문 결과를 바탕으로 조사 대상의 병원 분포도와 투시 조영 검사자의 숙련 정도, 압박 검사를 이용한 주 업무 분포도, 압박 paddle의 정기적인 점검 현황도 그리고 장비의 압박강도의 인지 실태를 분석하였다. 본원의 Over tube 타입의 투시조영 장비 7대를 이용, 압박 강도를 10회씩 측정하여 임상에서 사용 되고 있는 압박 강도를 측정·비교해 보았다. 결과: 응답자 28명 모두 압박paddle을 이용하여 압박을 시행하고 있다고 응답하였으나, 정기적인 점검은 85.7%가 시행하지 않는 것으로 조사되었고, 14.3%은 정기적인 점검이 아닌 고장 시나 외형의 변형으로 인한 간헐적인 점검을 하는 것으로 나타났다. 압박paddle의 최대 압박 강도는 응답자 전원이 모르고 있는 것으로 조사되었다. 본원의 투시조영 장비 7대를 이용한 각 장비의 최대 압박 강도를 측정 한 결과 13.08kgf부터 12.77kgf까지 평균 8.93kgf로 나타나 다양한 압박 강도로 압박이 이루어지고 있었으며, 단 2대만이 최고 압박 강도인 약 8kgf를 초과하지 않는 것으로 나타났다. 결론: 투시조영 검사를 시행하고 있는 검사자들이 압박 강도에 대한 정확한 인식이 바탕이 되고 압박paddle의 주기적인 점검을 통하여 장비의 성능이 최적화될 때 환자의 고통을 경감시키면서도 진단적 가치가 높은 영상을 획득할 수 있으리라 생각된다. Purpose: In fluroscopy, the compression method is very important thing for defecting lesion, but the compression cone hasn t be done any of check or quality assurance regularly. So this study is for acquiring high quality images and checking the examiner s knowledge of the pressure level and Quality Assurance[Q.A] about the compression cone Materials and Methods: Make a survey to 28 radiologic technologists who have worked in fluoroscopy at the 7 general hospitals and 5 private hospitals having machines for fluoroscopy and located in seoul. Based on the results of this survey, we studied where located the surveyed hospitals, in fluoroscopy examiners skill, main work range using compression methods, status of regular Q.A of compression paddle and knowledge of compression force. We measured and compared figures of clinical compression force by measuring 10 times using 7 in fluoroscopy machines Using 7 Over tube-type fluoroscopic imaging equipment, we measured and compared the intensity of pressure that is being used in clinical measurement by measuring the compression strength 10 times. Results: Even though All 28 respondents answered that they make it using compression cone, 85.7% out of them hasn t done regular examine, and 14.3% has done some tests only if they are out of order or there is some abnormal changes in shape. By this survey, we found out that All have no idea about the maximum intensity of compression. After measuring the maximum intensity of compression by using 7 in fluoroscopy machines of AMC, we found out that average of degrees of compression was 8.93kgf ranging from minimum 12.77kgf to maximum 13.08kgf which means there has been the diversity of doing compressions. Plus, we figured out as well that only 2 machines do not exceed approximately 8kgf, the highest degrees of compression. Conclusion: In short, we conclude that only if the examiners know very well of the accurate pressure level with optimized machines from Q.A, they will acquire high Quality images for diagnosis and less pain.