ノート Flat Panel Detector搭載型心血管撮影装置における 冠状動脈
Contents
1. D D2. 00 33 40 49 2kv0 0000000000000000 000000000000 ILU lI 933 17 00
3. 0000 flat panel 1 0000000000 20001 000000000000000 meanc S D T 0 0 0 0 0 0 41 7keV 2 7keV 0000 38 9keV lt 1 00000000000 0000 1050 10610 000000 131000600 60 5 Flat Panel Detector 00 00 00000 00 00 0 00000 00000 00 00 00 00 00 00 0000 00 0000 0000 00000 p 733 ugBgapnraygbDnnunaupapnaunapBapu 0 0
4. 60 5 Flat Panel Detector 0 0 00000 0000 00 0 0000 0000 0000 0000 00 00 00 00000 0 00 0000 00000 000 727 5 Tables of X Ray Mass Attenuati on Coefficients and Mass En ergy Absorption Coefficients H 0000000 30keV 40keV 50kev 60keV AIL 000000 1 3 1 5 0 00000000000 0000600 0000000000 00000 600 120kVv rn skvo 0o 0000000000000000 0 0 0 OrmrrCu 0 2mnrrCu 000000000 00000000 100mA0 0 0 0 O 0000 30f 3 FS 1 2m0 00000 1 3 2 Q00000000000000 00000000000000000 0000 0000000 10 2m9 trm 0000000 0000 7 2mAD 0 B D B D 7 578 SF 0 2mmCui FS 0 6mm 0 0 0 0 0 120KVT LI J 00 7 5f d SF OmmCu FS O 6mni 0 0000 00 00 0 120000000000 0 0000 U 1 00000000 2 0000 1 3 3 p BESIDE BE
5. 5 EE BI E E 0 000000 INNOov A2000 0000000000 00000000 2000 0000000 20000 0 000000000000000
6. eemrir UU 00000000 12OkV 0 dB Fsr eemri 00000 normal modd low modd 000000 uU uuu uuu 0000000 00000000 000 10 0000000000000 000 routing 1 000 15 91 0000000000000000000 00000 68 0 740 0000 00000000000 16 0 FSO 12 70 0 0 unnuggguupnangesxvnuunauna naunmnn 120 0 000 2 Routine angulation for right coronary artery em ploys four directions and that for left coronary artery employs eight directions in our center 1 45 Right coronary artery LAOIS LAO20 CRA30 RAO30 RAO30 RAO10 CAU30 RAO30 CAU30 Left coronary artery RAO30 CRA30 LAO10 CRA30 LAO30 CRA30 LAO45 CRA30 LAO45 CAU30 Parumsebers far Image Teni Fen Low 11s E
7. 2 22 Fig 40 00000000000 18 00000000600 10 25m0 0 000 70kV 0 120 000 2 2 3 0 50 00000000600 50 00000000000 50 0 00000000 1 000000000000000 10 17540 00 0 00000 2000 0000000000 5 0000000000000 0000 SFO O0mrrCu 0000 Y 0 15X 23 4 Ya 0d Burm X 0 kv SFO 0 1mrrCu 000 O Y20 15X 27 5 XI 0 SFO 0 2mrrCu 0000 Y 0 18X 27 6 XI 0 0 LI kv 6 1 0D00000000 00 Fig 66000 0 000000000 II meen S D TI 00000 Relationship Tube Voltage SF and Effective Energy a cC x y DrEx 216 MM ml Ld NR quer irm E l bs 1 mrr 225 mms F ge inibi r ieir inberpolrten 0 irma 14 7 Frera R 50 10 ru pn 100 120 Tihe Vitage kY Fig 3 Relationship between tube voltage
8. GEYMSO l 0 0 00000000000000060600 1 PG Percutaneous Coro 57 50 550 556 20011 Intervention No 7 National Institute of Standards and Technology NISTI R 5632 2002 Tables of X Ray Mass Attenuati on Coefficients and Mass 2 Center for Devices and Radiological Health F D A Fluoro Energy A bsorption Coefficients http physi cs nist gov scopically guided procedures have potential skin injury PhysRefData X rayM assCoef cover htrri 19961 Radiological Health Bulletin 19941 8 2654 3 IVR 5A 1200 1556 1561 57 12 1444 1450 20011 20011 9 4 l nternational Electrotechnical Commision Report 60601 56 50 Medical electrical equipment Part 2 43 Particular require 367 368 1995 T ments for the safety of X ray equipment for interventional 10 10 procedures Genova 60601 2 43 20001 20011 5 11 JFletcher DW Miller DL Balter S et al Comparison of Four Techniques to Estimate Radiation dose to Skin During 58 423 426 20030 Angiographic and Interventional Radiology Procedures J VIR 9 x 18 40 391 397 2002 00000 Fig 1 Fig 2 TII ji Fig 3 SF Fig 4 Fig 5 Fig 6 all 7 Fig 8 Table1 INNOVA 2000 Table 2 20040 5
9. Image size 17cm X Tera Loy mode 30455 un Ingens nmn m 125 123 liz f io E aaea 7 2 15375 10 ri as EF WOUNE 36 UM narsasi vem 5 5 20 30 3 3 om Lie eA PA FED rwrreanemerenerea 10 G Parameters far Digital Cinegraphy bna size T em x Normal mde Taps ul 525 3442 L 10 421 18 T lis wi E M TA fil m I 15 Hos na gt ju tee rd rreMM Hi H 35 i B 20 25 y Em Tam Tuma Dorijan Paano FE Parameters for Digital Cinegraphy lage size Teri X 7em Ninna ende 150s nunc l by F inn 125 HHREERLALpRR risp parua EET E LM DDD po A 6 s z P eree 35 14 M 5 5 ax Ne 1 Ta Fri TE 52 t sp 45 2 i f 3 amp 43 gt z 25 123 i ii REPE unl a d ln 5 15 20 25 3 Acryl terke cn Taba Volta Wa Toi m FE Parameters Digital Cmegraphliy Image sine Tcm X Tem Normal mode is ur Tik mus 12s Mal 11 110 g 423
10. 5 i i T d Aras Saray Fig 1 Geometry on the left is used to investigate clinical parameters such as tube voltage tube current pulse width additional filter and focal spot size as a func tion of patient body size Source image receptor distance is 100 cm Geometry on the right is used to measure effective energy Distance from the flat panel detector to the AI filter is 80 cm and that to the X ray tube is 110 cm 12 source image receptor distanca 0 0 SIDO 10n oDo000 00000000000Fioo 0 00000 000000000 0c 0 00 40cn O 0 0000000000000000600 000 17 17 1 5 FSE focal spotsizdT 000000000 13 000000000000000000 Fig 12 0000000 0000 0000000000000 00 00
11. Flat Panel Detector 00 00000 0000 00 00000 0000 0000 00 00 00 00 00 00000 0 00000 00000 0000 725 Uu Flat Panel Detector 000000 ugmumbpugugugmmiulillll GOU G ETEO TAO HUHH HHH SE 20030 120 5 20040 3D 8 1l Code Nos 621 20 622 732 4m u 0 00000000000 D T percuteneous coronary 0 ugagagnggugagamagnpagmugauuu eu INNOVA2000 GEH 1H B B BB O 7B B DE UO 7T Hl 0 00 international Electrotechnical Commissioni 0 Method of Estimating Patient Skin Dose from Dose Displayed on Medical
12. SF and effec tive energy Linear interpolation shows a good cor relation E 41 7k 2 7keV 1 0 0 0 0 0 38 9k 1 9kev 00000000 0 0 25cmi 00 220 27 00 0 34kev0 33 37kv 000 2 3 00 33 4kv0 0000000000000 49 2keV 0 tssueSOFT ICRU 440 dry near sea leva O0 0000000000000 00000000000 33 4kev 34 1keV E 1 050 0 0 0 O Sokev 0 0 1 0610 0000000 00000000000 C0 00 5 6 0 0 492kev 0 1 60 33 4keV 0 0 40 9 960 0O 1 060 0 U 24 0000000000 Fig 70 30 000000000000000 LAO45 CAUS3O 0 16 10000 0 RAO10 CAUS3OT 0 110cmr 0000000000 1300000000000000 300 0 000000000 00 1994 interventional ra diolody 1 O IVRE DL EL EEL BL E B BEBE BE EE 7E 7E 000 pnmumgugpumganuaunugmumuaguuumuutt 60 5 Flat Panel Detector 0 0 000000000000000000000000000000000000000000000000000000200000 73 Relationship Pulse Width and Effective Energy 110 110 i ao 170 DiD u n
13. rim isi 15 115 i3 EMI i3 i i l 41 aa amt j a 5 4 ima afans LESTI j jik 9 P T E 3123 x aem nen ii li n B 5 2 gt m i Tula a p js Parameters far Image size Tom X 17cm Law mide Miis Dn Tas Ere Eu ja La RE DAMM LEUR i23 j ck H EA hA 112 J li L ri QUU Ue ee IEEE RE EE RUE nn 4133 ocean d a frasi da H ii 3 43 15425 lar 1 li ras i 1 ii L I H t li k i aba capa a ce c Parameters far Fluaragraphiy mage alze Mornmnl mede 3186 Dar est Eimin gt I rupem iN F a 15 a 1 E pue 3 ER 7 173 L i niic ernie sssr s ILI r i ij i 3 I m Li w bi xml Tabu Caras M en ema Parameters far Flucrograplis Image size Tom 7em Normal mide Wis kv Tre E rg gs mal I lia iie 10 41 pasadas i A ii il x IS assai ree 5 123 11 il PTT nd TE i ii Hi Acryl om Taka Molti E
14. 500000 IB imaging 000 100000000000 0 000000000000 0 routing 0 00 0 Teble2 0000000 taosg 00000000000 sed 00000 0 51 200 0 21 000000000 2000 00000 0000 0000000 moeg 00000000 00000 Fig 410 00000 90 4 D 0 cui mAITI J D H H SH mrCu l FB 0000000000000 0 reuind III 000 0000000000 000 D 0 3090 68 8 9 000 0000000 124 5 728 0000 00000 2 0000 29 32c 0000 D 0 1mrCu 0 000
15. n 0 3 15 au m Pube Wish mki 1208 Fig 4 Relationship between pulse width and effective This graph shows no relationship between pulse width and effective energy Relaticushig Tube Current and Effective Energy 1 20 1 E E a agg 2 80 2 70 2 60 2 80 35 50 75 100 105 155 175 Tahe m Fig 5 Relationship between tube current and effective energy This graph shows no relationship between tube current and effective energy Effective Energy fur Fluorigraptiy z Image ize Tem Tem d uiii preeen a1 eri m j ll F 5 Y B H a EF r erm zia ir YE Lm asia Fi Energy for Dghall Cinscgruptes 1 mape size Tem X 17cm aa nea ann prn Aj RE a r erar T TEE k k kia uc x 355 ano 10 15 10 5 Es as Airi heia eral TSF z Lew mnia T sF s Himal mods 15F g Lo raraja ISF a Herma moda ag moda HF m Horna moda Fig 6 a Effective energy for fluorography with image size 17 cmx17 cm as a function of acryl thickness Low energy area is allowed between 26 cm and 28 cm of acryl thickness b Effective energy for digital cinegraphy with image size 17 cmx17 cm as a function of acryl thick ness Low energy area is allowed between 22 cm and 27 cm of acryl thicknes
16. I 00000 10 175mA 0 O0 10mA 00 2 5 0000000 25m0p0000000000000 000 1 0 00 00 0000 0000 00 000 0000000000 0 7okv 0000 10m4 0 0 000 SF 0 22mrrCu FSO 1 75 U 00000 12m0 0000000 0000012000000000 0 0 2000 14 00000000000 0 lI 5 ICRU 44 00000 nersestevar 0 BD BD 0000 11 000000000 30kev 40kev 50keV 60kev 15 2004 5 Table 1 INNOVA2000 has ten X ray modes in image size 17 cm x 17 cm Fluorography at low mode 30 f s and Digital Cinegraphy at low mode 15 f s are routine in our center Low mode 15f s Normal mode 15f s Low mode 301 5 Normal mode 301 5 Fluorography Low mode 7 5f s Normal mode 7 5f s Low mode 15f s Normal mode 15f s Low mode 30 5 Normal mode 301 5 Digital Cinegraphy
17. X ray Equipment with Flat Panel Detector ATSUSHI FUKUDA KICHIRO KOSHIDA U ICHIRO YAMAGUCHIU ATSUHIKO 20 and KOUSUKE 1 Department of Radiology Shiga Medical Center for Adults Department of Radiological Technology School of Health Sciences Faculty of Medicine anazawa University Department of Environmental Health National Institute of Public Health Department of Radiological Technology School of Health Sciences Faculty of Medicine iigata University Department of Radiology Kanazawa University Hospital BZUNAH Received Dec 5 2003 Revision accepted March 8 2004 Code Nos 621 622 732 Summary Thelntermationa Electrotechnical Commission has sti pul ated that medical X ray equi pment for interventi onal procedures must display radiation doses such as air in free air at the interventional reference poi nt and dose area product to establish radiation safety for patients 60601 2 43 However itis necessary to es timate entrance skin dose for the pati ent from air kerma for an accurate risk assessment of radiation skin in jury To estimate entrance skin dose from displayed air in free air at the interventional reference point itis necessary to consider effective energy the ratio of the mass energy absorption coefficient for skin and air and the backscatter factor In addition since autorratic exposure control is installed in medical X ray equi p ment with fla
18. exposure control 0 0 AECI EH E 0100 00 100 1 1 0000 ugmumamusubuuiuu 000000000 20001 GE Medical Sys tems flat panel deectar 0 FPD I EH E 000 radiation monitor 000 model 9015 Radcal Corporation 000 10x5 3CTH 3cc Radcal Corporation 0cm 3Oocm 1cm 400 00000000 PBU SS 2 0000000000000 00 10cm lt 10cm lt 1rm 10000 0000 99 50 0D00000000000 00 0 20000 0 00000000000 14 3000000 05mmAl 0 0056mrCur 0 5mmAI E E 0000000000000 0 O 00 0 2mrrCu SE spectral filte T 1 000000000 UUUDUDUSUUDUUUUUDUUUDUHUU 0 3mm 00000 0 DIAMENTER MA4 KDKT TI LH E B E E E E D D EI HUDUIIDDDDUDUDUDUUUUDUUDUDUDUUDUUDUDDUDUDUuun 00000 Crecimetry far iisirmetry I V pe hka f ain Tun L I4 L kasa Juba
19. inn n 30 123 u J ol n z ioo Hi sich pasa cin kA ma Panra Ree Fig 2 e TT jLP arameters for digital cinegraphy with image size 17 cmx17 cm as a function of acryl thickness Parameters include tube voltage tube current pulse width P W spectral filter SFD and focal spot 5126 FS Routine mode of digital cinegraphy in our center is low mode 15 f s 2004 5 730 0000 FSI 12 00000000000000 000000000000000 00 85 00 0 5 000 000 00 0 2mrCu UUDUDUUDUUUUUDUDUDDDUUDDUUGuuUDUDUDUDnBpU 50 00000 16 0 0 0 0 6m 0 1 2m0 00000000 DUDUDUUDUUUUGUDUDUDDUDUUDUUUUGuUDUDUDUDnn9 DUUDUDUUDUUUDUUDUDUDDUDUUDUUUGuuDUDUunu9 00000000 120 0000000000 norma moda low moddi 0 5 22 000000000000000 2 2 1 5 5 3 5 0 99010
20. laba mA j l ami Fig 2 d P arameters for fluorography with image size 17 cmx17 cm as a function of acryl thickness Parameters include tube voltage tube current pulse width PWO spectral SFO and focal spot 5128 FS Routine mode of fluorography in our center is low mode 30 f s cd Heon 050 Flat Panel Detector 00000 0000 000 0000 00000 00000 000 00 0000 00000 00000 00000 0005 0000 0 29 Parameters for Digstal Ciregrapiiy Image size 17cm X Tom Low mide 7 518 ud vum Premiere rn Fd 128 PNN SE 15 113 5 113 F E HEF bii a 7 5i ntt An 48 2 23 123 ET a J waasrazsaszsaawa i p ii 4 Hi 19 ri ul bu A kitij Piscis Dogs a laka sa a a FL Parameters for Digstal Cinegraplisy Image size 17cm x Low 150 V i Er MA bride nd Rating ie 127 LE TILS khu a HEF T E a Hn N m F 15 15 REUS e prm j il i MI 13 25 45 4384 jus E E lit ui r k J da 53 i xh M ui is Aii 1 Parameters for Digital
21. s Skim arci or Digital Cinesraphisy 5 i E 17 T 1 eirapis Skin area for Digital Cinegraphy size 17em X 17 SAE EI AN Image sire x em 180 100 140 120 imi z Rus Rie EADE LAUICLADI LOME LAIT UAE ranw TEE PE TELU K rars Pina Fig 7 Fig 8 Skin irradiation area for digital cinegraphy with image size 17 cmx17 cm The widest area is an angula tion of LAO 45 CAU 30 Skin irradiation area for digital cinegraphy with image size 17 cmx17 cm 2004 5 732 0 20000 0 000000000000000 000000000 1 051 1061000000000 13 1
22. t panel detectors it is necessary to know the characteristics of control to estimate exposure dose In order to calculate entrance skin dose under various conditi ons we investi gated clinical parameters such as tube voltage tube current pulse width additional filter and focal spot size as functions of pati ent body size We also measured the effective energy of X ray exposure for the patient as a function of clinical parameter settings We found that the conversion factor from air in free air to entrance skin dose is about 1 4 protecti on Key words Entrance sin dose Effective energy Equipment displayed dose Factor for conversion to entrance skin dose 5 4 30 524 8524 00000000 0000 0000 H 2004 5 726 0Do0 000000 00000000000000 00000000 0D0000000Ffio 10 00000c0000000 000 isocenter 0 15cmx0 O00 000000000 auto
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