1381 総説 ディジタル画像の画質と被ばくを考慮した適正線量の研究 岸本健治 1) 有賀英司 2) 石垣陸太 3) 今井方丈 4) 川本清澄 5) 6) 小林謙一澤田道人 7) 能登公也 8) 中前光弘 9) 10) 東出了 論文受付 2011 年 8 月 9 日 論文受理 2011 年 10 月
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1 1381 総説 ディジタル画像の画質と被ばくを考慮した適正線量の研究 岸本健治 1) 有賀英司 2) 石垣陸太 3) 今井方丈 4) 川本清澄 5) 6) 小林謙一澤田道人 7) 能登公也 8) 中前光弘 9) 10) 東出了 論文受付 2011 年 8 月 9 日 論文受理 2011 年 10 月 7 日 Code Nos ) 大阪市立大学医学部附属病院中央放射線部 2) 名古屋第 2 赤十字病院 3) 京都医療科学大学 4) 滋賀医科大学医学部附属病院 5) 大阪大学医学部附属病院 6) 藤田保健衛生大学病院 7) 有限会社ムツダ商会 8) 金沢大学附属病院 9) 奈良県立医科大学附属病院 10) 名古屋市立大学病院 はじめに F/S 1983 CR 1998 FPD , 2 Study of Appropriate Dosing in Consideration of Image Quality and Patient Dose on the Digital Radiography Kenji Kishimoto, 1) Eiji Ariga, 2) Rikuta Ishigaki, 3) Masatake Imai, 4) Kiyosumi Kawamoto, 5) Kenichi Kobayashi, 6) Michito Sawada, 7) Kimiya Noto, 8) Mitsuhiro Nakamae, 9) and Ryo Higashide 10) 1) Department of Radiology, Osaka City University Hospital 2) Depertment of Radiological Technology, Nagoya Daini Red Cross Hospital 3) Kyoto College of Medical Science, Faculty of Medical Science 4) Department of Radiology, Shiga University of Medical Science Hospital 5) Department of Radiology, Osaka University Hospital 6) Department of Radiology, Fujita Health University Hospital 7) MUTSUDA SHOUKAI CORPORATION, LTD. 8) Department of Radiology, Kanazawa University Hospital 9) Central Division of Radiology, Nara Medical University Hospital 10) Central Department of Radiology, Nagoya City University Hospital Received August 9, 2011; Revision accepted October 7, 2011; Code Nos. 253, 522, 621 Summary Recently about 90% of radiographs have been taken by the digital radiographic system in Japan, but the exposure dose of the patients are about ten-times different among the systems. We understood it by a surveytaken in We studied the visual evaluation with varying exposure doses using the image phantom of the lumber AP, lumber lateral and hip AP. Additionally we measured quantum efficiency (DQE) of the digital systems. We also studied the exposure index (EI) of IEC standard to see whether it is able to be the sensitivity index among the digital systems. DQE in 1.0 cycle/mm of CR, FPD (GOS), FPD (CsI, a-se) became , 0.3, 0.5, respectively. Our results display that the dose reduction is relative to DQE. The visual evaluation results also show that dose reduction is possible among the systems. From these results, we are able to reduce the exposure dose of the patients at the clinical site. We also suggest that we manage the exposure dose using the E.I of the IEC standard. Key words: digital radiography, patient dose, image quality, detective quantum efficiency (DQE)
2 1382 Fig. 1 Results of a survey on the image receptor system exposure index 第 1 章一般撮影における患者が受ける線量の現状 - 平成 19 年度全国調査から- はじめに 19 X X 1, 2 22 Fig. 2 Transition of the image receptor system , computed radiography CR 69.4 flat panel detector FPD 2.2 CR FPD 17.3 film-screen F/S 11.1 Fig. 1 3 F/S Fig X 100 X entrance surface dose; ESD ESD 3/4 75 Table coefficient of variation; CV 2007 CV 10 Fig Fig. 4 F/S FCR
3 1383 Table 1 Results of a survey on ESD Examination n Mean SD 75%dose Max Min Skull AP/PA Skull LAT Cervical spine AP Thoracic spine AP Thoracic spine LAT Lumbar spine AP Lumbar spine LAT Pelvis AP Femur Forearm Ankle joint Chest low voltage Chest medium voltage Chest high voltage Abdomen Guthmann Martius Infant hip joint Infant chest Pediatric chest Breast unit: mgy Fig. 3 Comparison of the CV value on A.D 2007 and A.D Fig. 4 Transition of the ESD and sale time of the image receptor system.
4 1384 Fig. 5 Comparison of the ESD in FPD, CR and F/S. Fig. 6 Cumulative curve in the lumbar spine AP, the lumbar spine LAT and the pelvis AP examination. (a) X-ray tube voltage in the lumbar spine AP examination (b) X-ray tube voltage in the lumbar spine LAT examination (c) X-ray tube voltage in the pelvis AP examination (d) Value of mas in the lumbar spine AP examination (e) Value of mas in the lumbar spine LAT examination (f) Value of mas in the pelvis AP examination 3 Fig. 5 F/S CR FPD mas Fig. 6 CR F/S mas FPD Fig. 7 FPD CR FPD cesium iodide 67 11
5 1385 Fig. 7 The image receptor system of low dose and high dose at the lumbar spine LAT examination in 20 facilities. CsI gadolinium-oxide sulfide GOS CsI Fig CR PMT 3 dose index 4 F/S CR FPD CsI GOS FPD 5 ICRP Publ.93 9 guest editorial 6 Fig. 8 Comparison of the ESD of the lumbar spine LAT examination in indirect FPD systems. Dose (%) Table 2 modality worklist management MWM Table Results of ESD below 75% dose ESD (mgy) Lumbar spine Lumbar spine Pelvis AP LAT AP
6 1386 Fig. 9 Geometry for calibration of IEC 第 2 章ディジタル装置の感度指標としての exposure index はじめに X 1 exposure index 2-1 Exposure index IEC X exposure index; EI 10 IEC EI Fig. 9 EI EI=c 0 g(v) 1 c μgy 1 g(v) V: value of interest K EI EI=c 0 K cal 2 K cal K cal=g(v cal) 3 EI EI g(v) 11 Fig CR Fig Philips FPD S K EI Fig μgy 1 Fig. 10 CR A B 9 C 50 S S 67 11
7 1387 Fig. 10 Relationship between S number and K. Fig. 11 Relationship between value of interest. Fig. 11 FPD 3 μgy ±15 CR FPD CR FPD 2-3 EI EI IEC EI target exposure index EI T deviation index DI EI T DI EI T EI 9 DI = log EI 4 EI T 2 DI EI T 1 EI T 2 EI T EI T 2 EI T 2-4 EI T EI DI EI DI 90 kv X 12 EI
8 1388 Table 3 Specification of digital radiography systems evaluated in the study System Manufacturer Technology Pixel size (mm) FUJIFILM DR BENEO Fujifilm medical Direct FPD Difinium 8000 GE Healthcare Indirect FPD CsI Digital Diagnost Philips Indirect FPD CsI FUJIFILM DR CALNEO U Fujifilm medical Indirect FPD GOS REGIUS MODEL 170 [RP-3S] Konica Minolta CR FCR PROFECT CS [ST-VI] Fujifilm medical CR FCR 5000 [ST-V N] Fujifilm medical CR IEC62494 EI EI T 第 3 章物理評価による検出器の検出量子効率評価 3-1 X CR FPD X X X CR CR CR FPD 1, 13 2 detective quantum efficiency DQE DQE Table 3 FPD FUJIFILM DR BENEO BENEO 1 FPD 3 CsI Difinium 8000 Difinium Digital Diagnost DiDi 2 Gd 2O 2S GOS FUJIFILM DR CALNEO U CALNEO 1 CR REGIUS MODEL 170 REGIUS FCR PROFECT CS PROFECT FCR DiDi 6 DiDi DiDi 4 presampled modulation transfer function presampled MTF Wiener spectrum WS DQE X IEC RQA5 presampled MTF WS IEC , 20 presampled MTF 2 CR WS 2 DQE X q presampled MTF WS q IEC MTF (f) DQE(f) = 5 q WS(f) 67 11
9 1389 Fig. 12 Determination of presampled MTF in respective systems. Fig. 13 Determination of WS in respective systems. Fig. 14 Relation between air Kerma and WS values at 1.0 cycles/mm. Fig. 15 Determination of DQE in respective systems. 3-3 Fig presampled MTF WS DQE 2 DiDi Presampled MTF Fig. 12 presampled MTF DiDi FPD BENEO MTF FPD CsI GOS CR
10 1390 CR 3 FPD CsI GOS MTF FPD Difinium CALNEO MTF WS X 2.19 μgy 0.25 mr WS Fig μgy WS X 2.19 μgy WS WS 2.19 μgy WS DiDi FPD FPD GOS CR FPD CsI Difinium WS FPD CR WS FPD BENEO MTF WS FPD GOS CALNEO FPD CsI Difinium WS CR PROFECT WS 3 WS Fig cycle/mm WS 1.0 cycle/mm WS FPD CsI Difinium DiDi FPD GOS FPD CR3 WS DQE Fig μgy 0.25 mr DQE DiDi DQE 1.3 cycles/mm FPD CsI Difinium 1.3 cycles/mm FPD BENEO FPD GOS CALNEO CR 3 DQE Difinium BENEO DQE CR REGIUS DQE PROFECT FCR 5000 Table cycle/mm DQE FPD BENEO FPD CsI Difinium 0.5 FPD GOS CALNEO 0.31 CR Table 4 DQE value at 1.0 cycles/mm System DQE value at 1.0 cycle/mm BENEO Difinium CALNEO REGIUS PROFECT FCR DiDi DiDi FPD BENEO FPD CsI Difinium DQE BENEO Difinium FPD GOS CALNEO CR cycle/mm DQE FPD BENEO FPD CsI Difinium 0.5 FPD GOS CALNEO 0.31 CR FPD FPD CsI DQE FPD FPD GOS FPD FPD CsI 60 DQE CR FPD FPD CsI DQE 2 FPD GOS DQE CR 2 DQE FPD FPD CsI CR 1/2 DQE 21 DQE
11 1391 Table 5 The relationship between exposure and skin dose with lumber spine (A-P view), lumber spine (Lateral view) and hip joint (A-P view) The current time product of lumber spine (A-P view), x-ray tube voltage is at 75 kv Grid ratio Grid density CR (FCR5000) FPD CsI (DiDi) Exposure dose FPD The current time product of lumber spine (lateral view), x-ray tube voltage is at 85 kv Grid ratio Grid density CR (FCR5000) FPD CsI (DiDi) Exposure dose The current time product of hip joint (A-P view), x-ray tube voltage is at 75 kv Grid ratio Grid density CR (FCR5000) FPD CsI (DiDi) Exposure dose unit: mgy DQE 第 4 章 視覚評価による適正線量 はじめに CR 1 FPD 1 CR FCR5000 Imaging Plate; ST type FPD CsI Gd 2O 2S Tb GOS FPD CsI Philips Digital Diagnost CR CR FCR5000 Fig. 16 The filing form of observation scores and examples. FPD FPD CsI DiDi Table 5 1 X SDEC Fig
12 1392 Fig. 17 Observer s score and average score. (a) CR (FCR5000) on lumber spine (A-P view) (b) FPD CsI (DiDi) on lumber spine (A-P view) (c) CR (FCR5000) on lumber spine (lateral view) (d) FPD CsI (DiDi) on lumber spine (lateral view) (e) CR (FCR5000) on hip joint (A-P view) (f) FPD CsI (DiDi) on hip joint (A-P view) Fig cm Fig. 17a CR FCR5000 mgy 0.77 mgy Fig. 17b FPD CsI DiDi 67 11
13 1393 Fig. 18 Comparison of the average scores between CR (FCR5000) and FPD CsI (DiDi) on lumber spine (A-P view), lumber spine (lateral view) and hip joint (A-P view). (a) Lumber spine (A-P view) (b) Lumber spine (lateral view) (c) Hip joint (A-P view) 1.08 mgy 0.54 mgy Fig. 17c d Fig. 17e f Fig. 18a CR FCR5000 FPD CsI DiDi 50 Tukey-Kramer CR FCR mgy 0.28 mgy 5.42 mgy FPD CsI DiDi 0.54 mgy 0.22 mgy 5.42 mgy Fig. 18b CR FCR5000 FPD CsI DiDi 50 Tukey-Kramer Fig. 18c CR FCR5000 FPD CsI DiDi 50 Tukey-Kramer CR FCR5000 FPD CsI DiDi Table 6 X 1 Table 2
14 1394 Table 6 Relation between image quality of diagnostic confidence level and minimum required values of exposure dose in this study CR (FCR5000) FPD CsI (DiDi) Lumber spine A-P view ( ) ( ) Lumber spine Lateral view (>3.81) (>2.38) Hip joint A-P view (<1.39) ( ) unit: mgy CR CR FCR5000 FPD FPD CsI DiDi FPD CsI DiDi 3 DQE Table 4 X DQE X exposure index 4-4 CR FCR5000 FPD CsI DiDi 第 5 章まとめと今後の課題
15 Table FPD CsI CR DQE 25 CR FPD GOS CR DQE CR 26 2 IEC 2006 EI EI 3 DQE DQE DQE 1 CR FPD CsI FPD GOS CsI GOS CsI DQE DQE 1.0 cycle/mm CR FPD GOS FPD CsI FPD a-se FPD CsI FPD a-se 1 CR FPD GOS FPD CsI FPD a-se Table 5 1 Table 2 3 CR FCR5000 FPD CsI DiDi 2 CR FCR5000 FPD CsI DiDi CR FCR5000 flexible noise control FNC 27 DR FPD CsI DiDi Low-pass filter Wiener filter detail contrast enhancement DCE noise compensation NC Table 6 1 Table /5 Table 2 1/3 CR FPD CsI DiDi DQE 3 Table 4 3 CR FPD CsI DiDi DQE EI 5-2 謝辞 X
16 参考文献 1 X 2009; 65(5): X ; 65(11): X 2005; 75(2): ; 32(1): X 1973 M 1980; 12(6): X M 1990; 22(6): X ; 46(4): CR 2005; 61(11): ICRP Publication 93. Managing patient dose in digital radiology, IEC Medical electrical equipment Exposure index of digital X-ray imaging systems, Part 1: Definition and requirements for general radiography, Ed. 1, Exposure Index 2011; 67(11): Ariga E, Ito S, Deji S, et al. Development of dosimetry using detectors of diagnostic digital radiography systems. Med Phys 2007; 34(1): X 2009; 65(3): Dainty JC, Shaw R. Image science. Academic Press, London, DQE NEQ 2010; 66(8): Detective Quantum Efficiency DQE 2010; 66(1): IEC Medical diagnostic X-ray equipment-radiation conditions for use in the determination of characteristics, Ed. 2.0, IEC Medical electrical equipment Characteristics of digital X-ray imaging devices, Part1: Determination of the detective quantum efficiency, Ed. 1.0, presampled MTF 2008; 64(4): IEC Medical electrical equipment Characteristics of digital X-ray imaging devices, Part 1-2: Determination of the detective quantum efficiency, Detectors used in mammography, Ed. 1.0, DQE 2009; 32(2): X SDEC 2009; 65(10): ; 52(9): ; 58(4): ; 57(5): FCR II 2007: Digital Diagnost Innervision 2007; 22(2):
17 1397 図表の説明 Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17 Fig CV mas a b c d mas e mas f mas FPD IEC62494 S K air kerma K air kerma presampled MTF WS Air kerma 1.0 cycles/mm WS DQE a CR FCR5000 b FPD CsI DiDi c CR FCR5000 d FPD CsI DiDi e CR FCR5000 f FPD CsI DiDi CR FCR5000 FPD CsI DiDi a b c Table 1 Table 2 75 Table 3 X Table cycle/mm DQE Table 5 mas Table 6
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